Assessing Diet Quality in a Population of Low-Income Pregnant Women: A Comparison Between Native Americans and Whites
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Objective: To assess diet quality of pregnant women in the WIC program in North Dakota and to compare Native Americans with whites, we used a DQI-P (diet quality index for pregnancy) among low-income pregnant women enrolled in WIC, a special supplemental program for women, infants, and children. Methods: Dietary information was collected for all participants using the Harvard Service Food Frequency Questionnaire (HSFFQ). DQI-P scores were based on 10 components previously used in other diet quality indices: percent recommended intake of grains, vegetables, fruits, folate, calcium, and iron; total fat, saturated fat, and cholesterol; and dietary diversity. Each component contributed 10 points to the total possible DQI-P score of 100. Results: The mean DQI-P score was 53.9. Native Americans (51.8) had significantly lower DQI-P scores (51.8 vs. 54.2; p<0.0001); significantly higher scores for iron and folate; and significantly lower scores for cholesterol, total fat intake, and saturated fat components than did whites. As DQI-P scores increased, diet improved and scores for individual components increased. Conclusion: While there were significant differences between the diet quality of Native American and white pregnant women, the differences were minimal. The DQI-P scores for all women in this population indicate that their diets are not meeting dietary recommendations. Interventions should focus on decreasing fat intake and increasing iron and folate intake to meet national dietary recommendations. More emphasis should be placed on eating whole fruit and vegetables.
KeywordsPregnancy Diet Nutrition Diet assessment Diet quality American Indians
This study was supported by grant # RO1 HD 33763 from the National Institutes of Health. Dr. Colditz is also supported by the American Cancer Society Cissy Hornung Clinical Research Professorship. The authors gratefully acknowledge the North Dakota WIC clients who participated in this study and the dietitians who collected the data. The authors would also like to acknowledge the assistance of Robin EB Flaig, at the Harvard School of Public Health, as well as the contributions of Jill Leppert, of the North Dakota WIC Program, Division of Maternal and Child Health, for her active collaboration in the preparation of this manuscript. Unfortunately, prior to the completion of the manuscript, Jill Leppert passed away.
- 1.Institute of Medicine. Nutrition during pregnancy: weight gain and nutritional supplements. Washington DC: National Academy Press; 1990.Google Scholar
- 2.Mardis AL, Anand R. A look at the diet of pregnant women. 2001;13:55–57. [Online]. Available: http://www.usda.gov/cnpp/FENR/FENRv13n2/ Accessed 24 April 2005.
- 4.Perry GS, Zyrkowski CL, Clark LS, Yu S. Pregnancy-related nutrition. In from data to action: CDC’s public health surveillance for women, infants, and children. In: Wilcox LS, Marks JS editors. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 1994; p. 119–28.Google Scholar
- 8.Phillip W, James T, Nelson M, Ralph A. Leather S. Socioeconomic determinants of health: The contribution of nutrition to inequalities in health. BMJ. 1997;314:1545.Google Scholar
- 9.Wilkins DE. Native American politics and the American political system. Lanham, MD: Rowman & Littlefield Publishers, Inc.; 2002.Google Scholar
- 10.Snipp M. Selected demographic characteristics of Indians. In ER Rhoades (Eds.) American Indian Health: Innovations in Health Care, Promotion, and Policy. Baltimore, MD: The Johns Hopkins University Press; 2000. pp. 41–57.Google Scholar
- 13.Indian Health Service, Office of Public Health, Office of Program Support, Division of Program Statistics. Trends in Indian health 1998–99. [Online]. Available: http://www.ihs.gov/publicinfo/publications/trends98/part3.pdf Accessed 10 March 2005.
- 14.U.S. Department of Health and Human Services, U.S. Department of Agriculture. Dietary Guidelines for Americans. 2005. Available: http://www.health.gov/dietaryguidelines/dga2005/document/pdf/DGA2005.pdf Accessed 10 March 2005.
- 15.Shaw A, Fulton L, Savis C, Hogbin M. Using the Food Guide Pyramid: A Resource for Nutrition Educators [Online] Available at http://www.nal.usda.gov/fnic/Fpyr/guide.pdf Accessed 10 March 2005.
- 24.U.S. Department of Agriculture Nutrient Database for Standard Reference Version Release 10. Washington, DC: U.S. Government Printing Office.Google Scholar
- 25.U.S. Department of Agriculture Nutrient Database for Standard Reference Version Release 11. Washington, DC: U.S. Government Printing Office.Google Scholar
- 26.Holland B, Welch AA, Unwin ID, Buss DH, Paul AA, Southgate DAT, McCance and Widdowson’s The Composition of Foods. 5th edition. Cambridge, UK: Royal Chemical Society and Ministry of Agriculture, Fisheries, and Food; 1991.Google Scholar
- 27.Paul AA, Southgate DAT. McCance and Widdowson’s The Composition of Foods. 4th edition. London, UK:H.M. Stationery Office; 1976.Google Scholar
- 29.National Academies. Dietary Reference Intakes. [Online]. Available: http://www.iom.edu/Object.File/Master/7/294/0.pdf Accessed 10 March 2005.
- 30.U.S. Department of Agriculture, U.S. Department of Health and Human Services. Nutrition and Your Health: Dietary Guidelines for Americans, fourth edition. Home and Garden Bulletin 232. 1995.Google Scholar
- 31.Kennedy E, Bowman SA, Lino M, Gerrior SA, Basiotis PP. Diet Quality of Americans. [Online]. Available: http://www.ers.usda.gov/publications/aib750/aib750e.pdf Accessed 10 March 2005.
- 32.U.S. Department of Health and Human Services, U.S. Department of Agriculture. Dietary Guidelines for Americans. 2005. Available: http://www.health.gov/dietaryguidelines/dga2005/document/pdf/DGA2005.pdf
- 33.Koop-Hoolihan LE, van Loan MD, Wong WW, King JC. Longitudinal assessment of energy balance in well-nourished, pregnant women. Am J Clin Nutr 1999;69(4):697–704.Google Scholar
- 34.Food and Nutrition Board. Diet and Health: Implications for reducing chronic disease risk. Washington, DC: National Academy Press; 1989.Google Scholar