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Tracking of dietary patterns between pregnancy and 6 years post-pregnancy in a multiethnic Asian cohort: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study

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Abstract

Purpose

Few studies have described adherence to dietary patterns over time in women of childbearing age. This study aims to describe, examine the stability and changes in dietary patterns between pregnancy and 6 years post-pregnancy and the sociodemographic and lifestyle factors influencing the adherence over time.

Methods

During pregnancy and at 6 years post-pregnancy, 24-h recalls and food frequency questionnaires were collected, respectively, from 709 women. Data on sociodemographic and lifestyle factors were collected via questionnaires. Dietary patterns were identified using principal component analysis and stability assessed using Pearson’s correlation coefficients (r) and Cohen’s weighted kappa (κ). Associations with sociodemographic characteristics were assessed by multiple logistic regression.

Results

The ‘Fruits, Vegetables and Legumes’ (FVL) and ‘Seafood, Noodle, Soup’ (SNS) patterns were identified at both time points, with low correlation for the dietary pattern z scores (r 0.2 and 0.3, respectively) and modest agreement in tertile assignment, suggesting poor stability. An ‘unhealthy’ pattern was only observed at 6 years post-pregnancy. Women who showed increased adherence to FVL pattern had higher educational attainment and exhibited healthy lifestyle behaviours. Women who had gestational diabetes during pregnancy were less likely to decrease adherence to FVL pattern over time. Women who adhered more closely to the ‘unhealthy’ pattern at 6 years post-pregnancy tended to be younger, of Malay ethnicity, had lower socioeconomic status, were less physically active and had additional pregnancies.

Conclusions

Dietary habits of women became less healthy during the transition from pregnancy to 6 years post-pregnancy. However, results should be interpreted with caution due to the different dietary assessment tools used at the two time points.

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Abbreviations

T2D:

Type 2 diabetes

GUSTO:

Growing Up in Singapore Toward healthy Outcomes

BMI:

Body mass index

GDM:

Gestational diabetes mellitus

GWG:

Gestational weight gain

PPWR:

Postpartum weight retention

OGTT:

Oral glucose tolerance test

HCS:

Healthy choice symbol

FFQ:

Food Frequency Questionnaire

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Acknowledgements

The authors would like to thank the study participants and the GUSTO study group, which includes Airu Chia, Allan Sheppard, Amutha Chinnadurai, Anna Magdalena Fogel, Anne Eng Neo Goh, Anne Hin Yee Chu, Anne Rifkin-Graboi, Anqi Qiu, Arijit Biswas, Bee Wah Lee, Birit Froukje Philipp Broekman , Bobby Kyungbeom Cheon, Boon Long Quah, Candida Vaz, Chai Kiat Chng, Cheryl Shufen Ngo, Choon Looi Bong, Christiani Jeyakumar Henry, Ciaran Gerard Forde, Claudia Chi, Daniel Yam Thiam Goh, Dawn Xin Ping Koh, Desiree Y. Phua, Doris Ngiuk Lan Loh, E Shyong Tai, Elaine Kwang Hsia Tham, Elaine Phaik Ling Quah, Elizabeth Huiwen Tham, Evelyn Chung Ning Law, Evelyn Xiu Ling Loo, Fabian Kok Peng Yap, Faidon Magkos, Falk Müller-Riemenschneider, George Seow Heong Yeo, Hannah Ee Juen Yong, Helen Yu Chen, Heng Hao Tan, Hong Pan, Hugo P S van Bever, Hui Min Tan, Iliana Magiati, Inez Bik Yun Wong, Ives Yubin Lim, Ivy Yee-Man Lau, Izzuddin Bin Mohd Aris, Jeannie Tay, Jeevesh Kapur, Jenny L. Richmond, Jerry Kok Yen Chan, Jia Xu, Joanna Dawn Holbrook, Joanne Su-Yin Yoong, Joao Nuno Andrade Requicha Ferreira, Johan Gunnar Eriksson, Jonathan Tze Liang Choo, Jonathan Y. Bernard, Jonathan Yinhao Huang, Joshua J. Gooley, Jun Shi Lai, Karen Mei Ling Tan, Keith M. Godfrey, Kenneth Yung Chiang Kwek, Keri McCrickerd, Kok Hian Tan, Kothandaraman Narasimhan, Krishnamoorthy Naiduvaje, Kuan Jin Lee, Leher Singh, Li Chen, Lieng Hsi Ling, Lin Lin Su, Ling-Wei Chen, Lourdes Mary Daniel, Lynette Pei-Chi Shek, Marielle V. Fortier, Mark Hanson, Mary Foong-Fong Chong, Mary Rauff, Mei Chien Chua, Melvin Khee-Shing Leow, Michael J. Meaney, Michelle Zhi Ling Kee, Min Gong, Mya Thway Tint, Navin Michael, Neerja Karnani, Ngee Lek, Oon Hoe Teoh, P. C. Wong, Paulin Tay Straughan, Peter David Gluckman, Pratibha Keshav Agarwal, Priti Mishra, Queenie Ling Jun Li, Rob Martinus van Dam, Salome A. Rebello, Sambasivam Sendhil Velan, Seang Mei Saw, See Ling Loy, Seng Bin Ang, Shang Chee Chong, Sharon Ng, Shiao-Yng Chan, Shirong Cai, Shu-E Soh, Sok Bee Lim, Stella Tsotsi, Stephen Chin-Ying Hsu, Sue-Anne Ee Shiow Toh, Suresh Anand Sadananthan, Swee Chye Quek, Varsha Gupta, Victor Samuel Rajadurai, Walter Stunkel, Wayne Cutfield, Wee Meng Han, Wei Wei Pang, Wen Lun Yuan, Yanan Zhu, Yap Seng Chong, Yin Bun Cheung, Yiong Huak Chan, Yung Seng Lee.

Funding

This research was supported by the Singapore National Research Foundation under its Translational and Clinical Research (TCR) Flagship Programme and administered by the Singapore Ministry of Health’s National Medical Research Council (NMRC), Singapore- NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014. Additional funding was provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. KMG is supported by the UK Medical Research Council (MC_UU_12011/4), the National Institute for Health Research (NIHR Senior Investigator (NF-SI-0515-10042), NIHR Southampton 1000DaysPlus Global Nutrition Research Group (17/63/154) and NIHR Southampton Biomedical Research Centre (IS-BRC-1215-20004)), the European Union (Erasmus + Programme Early Nutrition eAcademy Southeast Asia-573651-EPP-1-2016-1-DE-EPPKA2-CBHE-JP and ImpENSA 598488-EPP-1-2018-1-DE-EPPKA2-CBHE-JP) and the British Heart Foundation (RG/15/17/3174). None of the funding bodies identified had any role in the design of the study, in data collection, or in analysis, interpretation or writing the manuscript.

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  1. Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore

    Yu Qi Lee, Ray Sugianto, Falk Müller‑Riemenschneider, Natarajan Padmapriya, Bee Choo Tai & Mary Foong-Fong Chong

  2. Singapore Institute for Clinical Sciences (SICS), Brenner Centre for Molecular Medicine, Agency for Science, Technology, and Research (A*STAR), Singapore, 117609, Singapore

    Marjorelee Colega, Jun Shi Lai, Lynette Pei-Chi Shek, Yap Seng Chong, Johan Gunnar Eriksson, Shiao-Yng Chan & Mary Foong-Fong Chong

  3. Medical Research Council Lifecourse Epidemiology Unit and National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, SO16 6YD, UK

    Keith M. Godfrey

  4. Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore, 229899, Singapore

    Kok Hian Tan

  5. Graduate Medical School, Duke-National University of Singapore, Singapore, 169857, Singapore

    Kok Hian Tan, See Ling Loy & Jerry Kok Yen Chan

  6. Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 119228, Singapore

    Lynette Pei-Chi Shek

  7. Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, 229899, Singapore

    See Ling Loy & Jerry Kok Yen Chan

  8. Digital Health Center, Berlin Institute of Health, Charite University Medical Centre, Berlin, Germany

    Falk Müller‑Riemenschneider

  9. Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 117597, Singapore

    Natarajan Padmapriya, Yap Seng Chong, Johan Gunnar Eriksson & Shiao-Yng Chan

  10. Folkhälsan Research Center, 00250, Helsinki, Finland

    Johan Gunnar Eriksson

  11. Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, 00014, Helsinki, Finland

    Johan Gunnar Eriksson

Authors
  1. Yu Qi Lee
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  2. Marjorelee Colega
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  3. Ray Sugianto
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  4. Jun Shi Lai
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  5. Keith M. Godfrey
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  6. Kok Hian Tan
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  7. Lynette Pei-Chi Shek
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  8. See Ling Loy
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  9. Falk Müller‑Riemenschneider
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  10. Natarajan Padmapriya
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  11. Yap Seng Chong
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  12. Johan Gunnar Eriksson
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  13. Jerry Kok Yen Chan
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  14. Shiao-Yng Chan
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  15. Bee Choo Tai
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  16. Mary Foong-Fong Chong
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Contributions

KMG, KHT, LPCS, YSC and SYC: designed and led the GUSTO study; YQL and MF-FC designed the present study; MC, SLL and NP: collected and cleaned the data; YQL: performed the statistical analysis; RS, BCT, JSL and MF-FC: provided statistical input; YQL and MF-FC: wrote the manuscript and had primary responsibility for the final content; KMG, KHT, LPCS, FMR, YSC, JGE, SYC, MF-FC, BCT, RS, JSL, NP: reviewed the manuscript for intellectual content; and all authors: read and approved the final manuscript.

Corresponding author

Correspondence to Yu Qi Lee.

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Conflict of interest

KMG and Y-SC have received reimbursements for speaking at conferences sponsored by companies selling nutritional products and are part of an academic consortium that has received research funding from Abbott Nutrition, Nestle, and Danone. All other authors declare no competing interest.

Ethical standards

The GUSTO study has received ethical approval from the Institutional Review Board of KKH and NUH, and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from all study participants prior to their inclusion in the study.

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Lee, Y.Q., Colega, M., Sugianto, R. et al. Tracking of dietary patterns between pregnancy and 6 years post-pregnancy in a multiethnic Asian cohort: the Growing Up in Singapore Towards healthy Outcomes (GUSTO) study. Eur J Nutr 61, 985–1001 (2022). https://doi.org/10.1007/s00394-021-02703-z

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  • DOI: https://doi.org/10.1007/s00394-021-02703-z

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