Diet, Weight Change, and Obesity in Pregnancy / Pregnancy Eating Attributes (PEAS)

怀孕期间的饮食、体重变化和肥胖/怀孕饮食属性 (PEAS)

• 批准号: 10691096
• 负责人: Tonja Nansel
• 金额: $ 102.95万
• 依托单位: EUNICE KENNEDY SHRIVER NATIONAL INSTITUTE OF CHILD HEALTH & HUMAN DEVELOPMENT
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10691096
• 关键词: Address; Behavior Control; Behavioral; Body Weight Changes; Cohort Studies; Complementary Feeding; Consumption; Data; Desire for food; Development; Diet; Dietary intake; Eating; Eating Behavior; Emotional; Energy Intake; Enrollment; Ethnic group; Exclusive Breastfeeding; Fatty acid glycerol esters; Focus Groups; Food; Frequencies; Functional Magnetic Resonance Imaging; Gaussian model; General Population; Genetic; Goals; Health behavior; Home; Hyperphagia; Income; Individual; Infant; Inflammation; Informal Social Control; Intake; Intervention; Investigation; Laboratories; Laboratory Finding; Maternal and Child Health; Medical Records; Mental Depression; Modeling; Nutrition management; Outcome; Participant; Patient Self-Report; Pattern; Physical activity; Postpartum Period; Pregnancy; Pregnant Women; Process; Prospective, cohort study; Psychosocial Factor; Public Health; Reporting; Rewards; Risk; Risk Factors; Role; Sampling; Self-control as a personality trait; Sleep; Speed; Standardization; Stress; Weight; Weight maintenance regimen; Woman; Work; craving; critical developmental period; experience; feeding; food craving; food environment; fruits and vegetables; gestational weight gain; hedonic; improved; modifiable risk; mother nutrition; neural; neurobehavioral; obesity in pregnancy; obesogenic; poor sleep; population based; postpartum weight; psychosocial; racial and ethnic; response; sleep health; sleep quality; success; trait

The Pregnancy Eating Attributes Study (PEAS) addresses the public health problem of low maternal diet quality and excessive gestational weight gain and postpartum weight retention, which are prevalent across racial/ethnic groups and income levels, and are modifiable risk factors for numerous adverse maternal and child health outcomes. Nutrition and weight management interventions in pregnant women and the general population have achieved only marginal success, indicating the need to identify more effective modifiable targets. An emerging hypothesis posits that energy homeostatic processes are overridden by "hedonic eating," in which food intake is motivated by the neural reward response to food. The relative strength of this reward response varies between individuals and has been positively associated with body weight and weight change in small samples, supporting the need for further investigation in population-based samples. PEAS is an observational prospective cohort study investigating relations of reward-related eating, self-regulation, and the home food environment with dietary intake and weight change during pregnancy and postpartum. Participants were enrolled before 12 weeks gestation and followed, with their infants, until 1 year postpartum. The study collected data on dietary intake, anthropometrics, biospecimens, medical records, self-reported eating and other health-related behaviors, infant feeding, functional magnetic resonance imaging, focus groups, and a laboratory feeding substudy assessing overeating. The overarching goal is to identify neurobehavioral and environmental determinants of diet quality and weight change, and inform best practices for supporting optimal diet quality and weight management during this critical developmental period, leading to improved maternal and child health trajectories. Primary study findings are that greater reward-related eating was associated with worse diet quality during pregnancy, but not with gestational weight gain or postpartum weight retention (Nansel et al 2020 a & b; PMID: 33228724 & PMID 32958906). Lower availability of fruit and vegetables and greater availability of obesogenic foods in the home food environment were associated with worse diet quality, but the associations of reward-related eating with diet and weight did not vary depending on the home food environment or individual self-control. Findings have advanced our understanding of relations among maternal diet, weight, reward-related eating, sleep health, and psychosocial factors. Findings from the laboratory feeding study showed that overall, pregnant women a consumed a similar proportion of highly processed and minimally processed foods following a standardized meal, but their relative intake of each type of food differed, resulting in substantial differences in energy intake (Lipsky et al. 2021 PMID 33109504). Further, only their intake of highly processed food was associated with worse diet quality (Lipsky et al. 2021 PMID 33158801). Qualitative data from the focus groups indicated that women experience cravings as intense and emotional desires for specific food items, and that their decisions either to resist or satisfy cravings were both triggered by and resulted in salient emotional states (Blau et al. 2020 PMID 31813756). Additionally, while women reported that they experienced stronger food cravings in response to increased stress, stress was not associated with overall diet quality (Mooney et al. 2021 PMID 33737210). Other analyses indicated that depression, stress, and poor sleep quality were associated with greater reward-related eating (Betts et al. 2021 PMID: 33933087), and that worse sleep quality and shorter sleep duration were associated with greater maternal reward-related eating, gestational weight gain, and gestational fat gain (Hill et al. 2021 PMID 32945728). We used gaussian graphical models to examine meal-specific patterns by overall diet quality (Schwedhelm et al. 2021 PMID: 34301273), and identified reciprocal associations of maternal feeding to soothe with infant responsiveness to food (Temmen et al. 2021 PMID 34380499). Work in the current year includes findings that the timing and frequency of eating was associated with diet quality and energy intake, with several differences between pregnancy and postpartum suggesting that efforts to support optimal dietary intake may require specific strategies for each developmental period (Schweldhelm et al. 2022 PMID 35334823). Findings also suggest the potential relevance of targeting ultra-processed food intake. Greater intake of ultra-processed food in pregnancy was associated with greater risk of excess gestational weight gain, greater inflammation, and greater postpartum weight retention, but not with infant weight (Cummings et al. 2022 PMID 35619114). Further, greater maternal dietary intake of ultra-processed food and shorter duration of exclusive breastfeeding was associated with more obesogenic infant appetitive traits (Cummings et al. 2022 PMID 35922793). Additionally, our examination of infant appetitive traits also indicates that lower infant enjoyment of food and greater speed of eating may be associated with suboptimal complementary feeding practices (Sanjeevi et al. 2022 PMID 34481014).

孕期进食属性研究(PEAS)涉及孕妇饮食质量低、孕期体重增加过多和产后体重滞留等公共卫生问题，这些问题在种族/民族群体和收入水平中普遍存在，是造成许多不利孕产妇和儿童健康结果的可改变的风险因素。在孕妇和一般人群中的营养和体重管理干预措施仅取得了微乎其微的成功，这表明需要确定更有效的可修改目标。一种新的假说认为，能量平衡过程被“享乐进食”所取代，在“享乐进食”中，食物的摄入量是由对食物的神经回报反应所激发的。这种奖励反应的相对强度因个体而异，在小样本中与体重和体重变化呈正相关，支持在基于总体的样本中进行进一步研究的必要性。 PEAS是一项观察性前瞻性队列研究，调查与奖励相关的进食、自我调节和家庭食物环境与怀孕和产后饮食摄入量和体重变化的关系。参与者在怀孕12周之前登记，并与他们的婴儿一起跟踪调查，直到产后一年。这项研究收集了饮食摄入量、人体测量学、生物样本、医疗记录、自我报告的饮食和其他与健康相关的行为、婴儿喂养、功能磁共振成像、焦点小组以及评估暴饮暴食的实验室喂养子研究的数据。总体目标是确定饮食质量和体重变化的神经行为和环境决定因素，并为在这一关键发展时期支持最佳饮食质量和体重管理的最佳做法提供信息，从而改善孕产妇和儿童的健康轨迹。 初步研究发现，更多与奖励相关的饮食与怀孕期间较差的饮食质量有关，但与孕期体重增加或产后体重保留无关(Nansel等人，2020a&b；PMID：33228724&PMID 32958906)。家庭食物环境中水果和蔬菜的可获得性较低以及肥胖食物的可获得性较高与饮食质量较差有关，但与饮食和体重相关的奖励进食与饮食和体重的相关性并不因家庭食物环境或个人自我控制而异。 这些发现加深了我们对母亲饮食、体重、与奖励相关的饮食、睡眠健康和心理社会因素之间关系的理解。实验室喂养研究的结果表明，总的来说，孕妇在标准化膳食后摄入了类似比例的深加工和低加工食品，但她们对每种食物的相对摄入量不同，导致能量摄入量有很大差异(Lipsky等人)。2021年PMID 33109504)。此外，只有他们摄入的深加工食品与较差的饮食质量有关(Lipsky等人。2021年PMID 33158801)。来自焦点小组的定性数据表明，女性对特定食物的渴望是强烈的和情绪化的，她们抵制或满足渴望的决定既是由突出的情绪状态触发的，也是导致这种渴望的(Blau等人)。2020年PMID为31813756)。此外，尽管女性报告称，她们在压力增加时会经历更强烈的食物渴望，但压力与总体饮食质量无关(Mooney等人。2021年PMID 33737210)。其他分析表明，抑郁、压力和睡眠质量差与更多的与奖励有关的进食有关(Betts等人。2021年PMID：33933087)，睡眠质量较差和睡眠时间较短与母亲与奖励相关的进食、妊娠体重增加和妊娠脂肪增加相关(Hill等人。2021年PMID 32945728)。我们使用高斯图形模型来检查总体饮食质量的特定膳食模式(Schwehelm等人。2021年PMID：34301273)，并确定了母亲喂养抚慰婴儿对食物的反应的相互关联(Temmen等人。2021年PMID 34380499)。 本年度的工作发现，进食的时间和频率与饮食质量和能量摄入量有关，孕期和产后之间的几个差异表明，支持最佳饮食摄入量的努力可能需要针对每个发育时期的具体战略(SchWeldhelm等人)。2022年PMID 35334823)。研究结果还表明，以超加工食品摄入量为目标具有潜在的相关性。怀孕期间摄入更多的超加工食品与妊娠体重超标、炎症和产后体重滞留的风险更大有关，但与婴儿体重无关(Cummings等人。2022年PMID 35619114)。此外，母亲摄入更多的超加工食品和较短的纯母乳喂养时间与更多的肥胖婴儿食欲特征有关(Cummings等人。2022年PMID 35922793)。此外，我们对婴儿食欲特征的研究也表明，婴儿对食物的幸福感较低，进食速度较快，可能与次优的补充喂养做法有关(Sanjeevi等人。2022年PMID 34481014)。