Review: Nutritional requirements and dietary advice targeted for pregnant and breastfeeding women PDF
Preview Review: Nutritional requirements and dietary advice targeted for pregnant and breastfeeding women
Review: Nutritional requirements and dietary advice targeted for pregnant and breastfeeding women 2011 © Commonwealth of Australia 2011 Electronic document This work is copyright. You may download, display, print and reproduce the whole or part of this work in unaltered form for your own personal use or, if you are part of an organisation, for internal use within your organisation, but only if you or your organisation do not use the reproduction for any commercial purpose and retain this copyright notice and all disclaimer notices as part of that reproduction. Apart from rights to use as permitted by the Copyright Act 1968 or allowed by this copyright notice, all other rights are reserved and you are not allowed to reproduce the whole or any part of this work in any way (electronic or otherwise) without first being given the specific written permission from the Commonwealth to do so. Requests and enquiries concerning reproduction and rights are to be sent to Strategic Communications, National Health and Medical Research Council, GPO Box 1421, Canberra ACT 2600 or via email to [email protected]. ISBN Online: 1864965843 Acknowledgements The review of nutritional requirements and dietary advice targeted for pregnant and breastfeeding women was co-funded by the Australian Government Department of Health and Ageing. Relevant contributions were provided by the Nutrition Section of the Population Health Division. The NHMRC commissioned Adelaide Research and Innovation to undertake this review. The Adelaide Research and Innovation team included: Ms Philippa Middleton Professor Maria Makrides Dr Carmel Collins Dr Alice Rumbold Dr Jo Zhou Professor Caroline Crowther Associate Professor Vicki Flenady Suggested citation National Health and Medical Research Council (2012) Review: Nutritional requirements and dietary advice targeted for pregnant and breastfeeding women. Canberra: National Health and Medical Research Council. To obtain information regarding NHMRC publications contact: Email: [email protected] Phone: Toll free 13 000 NHMRC (13 000 64672) or call (02) 6217 9000 Internet: http://www.nhmrc.gov.au NHMRC Publication reference: N55n Published: August 2011 Contents Abbreviations .................................................................................................................................................................................................................................... 7 Review Methods ................................................................................................................................................................................................................................ 9 Pregnancy and breastfeeding dietary patterns .................................................................................................................................................................................. 12 Included Studies .................................................................................................................................................................................................................................... 12 Evidence Summaries .............................................................................................................................................................................................................................. 14 Evidence Tables ..................................................................................................................................................................................................................................... 23 References ............................................................................................................................................................................................................................................. 78 Caffeine ........................................................................................................................................................................................................................................... 81 Included Studies .................................................................................................................................................................................................................................... 81 Evidence Summaries .............................................................................................................................................................................................................................. 82 Evidence Tables ..................................................................................................................................................................................................................................... 85 References ........................................................................................................................................................................................................................................... 106 Cereal ............................................................................................................................................................................................................................................ 107 Included Studies .................................................................................................................................................................................................................................. 107 Evidence Summaries ............................................................................................................................................................................................................................ 108 Evidence Table ..................................................................................................................................................................................................................................... 111 References ........................................................................................................................................................................................................................................... 132 Dairy Foods .................................................................................................................................................................................................................................... 134 Included studies ................................................................................................................................................................................................................................... 134 Evidence Summary .............................................................................................................................................................................................................................. 136 Evidence Tables ................................................................................................................................................................................................................................... 142 References ........................................................................................................................................................................................................................................... 197 Dairy foods and eggs ...................................................................................................................................................................................................................... 200 Included Studies .................................................................................................................................................................................................................................. 200 Evidence summaries ............................................................................................................................................................................................................................ 201 Evidence Tables ................................................................................................................................................................................................................................... 202 References ........................................................................................................................................................................................................................................... 207 Eggs ............................................................................................................................................................................................................................................... 208 Included Studies .................................................................................................................................................................................................................................. 208 Evidence Summaries ............................................................................................................................................................................................................................ 209 Evidence Tables ................................................................................................................................................................................................................................... 211 References ........................................................................................................................................................................................................................................... 225 Fats and Oils .................................................................................................................................................................................................................................. 226 Included Studies .................................................................................................................................................................................................................................. 226 Evidence Summaries ............................................................................................................................................................................................................................ 227 Evidence Tables ................................................................................................................................................................................................................................... 230 References ........................................................................................................................................................................................................................................... 251 Fish ................................................................................................................................................................................................................................................ 253 Included Studies .................................................................................................................................................................................................................................. 253 Evidence Summary .............................................................................................................................................................................................................................. 256 Evidence Tables ................................................................................................................................................................................................................................... 264 References ........................................................................................................................................................................................................................................... 343 Fruit............................................................................................................................................................................................................................................... 348 Included Studies .................................................................................................................................................................................................................................. 348 Evidence Summaries ............................................................................................................................................................................................................................ 349 Evidence Tables ................................................................................................................................................................................................................................... 353 References ........................................................................................................................................................................................................................................... 386 Fruit & Vegetables ......................................................................................................................................................................................................................... 388 Included Studies .................................................................................................................................................................................................................................. 388 Evidence Summaries ............................................................................................................................................................................................................................ 389 Evidence Tables ................................................................................................................................................................................................................................... 391 References ........................................................................................................................................................................................................................................... 402 Legumes ........................................................................................................................................................................................................................................ 403 Included Studies .................................................................................................................................................................................................................................. 403 Evidence Statements ........................................................................................................................................................................................................................... 404 Evidence Tables ................................................................................................................................................................................................................................... 406 References ........................................................................................................................................................................................................................................... 415 Meat.............................................................................................................................................................................................................................................. 416 Included Studies .................................................................................................................................................................................................................................. 416 Evidence Summaries ............................................................................................................................................................................................................................ 418 Evidence Tables ................................................................................................................................................................................................................................... 422 References ........................................................................................................................................................................................................................................... 461 Nuts and Seeds .............................................................................................................................................................................................................................. 464 Included Studies .................................................................................................................................................................................................................................. 464 Evidence Summaries ............................................................................................................................................................................................................................ 465 Evidence Tables ................................................................................................................................................................................................................................... 466 References ........................................................................................................................................................................................................................................... 476 Salt / Sodium ................................................................................................................................................................................................................................. 477 Included studies ................................................................................................................................................................................................................................... 477 Evidence summaries ............................................................................................................................................................................................................................ 478 Evidence Tables ................................................................................................................................................................................................................................... 479 References ........................................................................................................................................................................................................................................... 483 Sugar ............................................................................................................................................................................................................................................. 484 Included Studies .................................................................................................................................................................................................................................. 484 Evidence Summaries ............................................................................................................................................................................................................................ 485 Evidence Tables ................................................................................................................................................................................................................................... 487 References ........................................................................................................................................................................................................................................... 501 Vegetables ..................................................................................................................................................................................................................................... 502 Included Studies .................................................................................................................................................................................................................................. 502 Evidence Statements ........................................................................................................................................................................................................................... 504 Evidence Tables ................................................................................................................................................................................................................................... 509 References ........................................................................................................................................................................................................................................... 545 Excluded Studies ............................................................................................................................................................................................................................ 547 References ........................................................................................................................................................................................................................................... 548 Abbreviations Abbreviation Meaning AHEI-P Alternate Healthy Eating Index for Pregnancy BaP Benzo(a)pyrene BMC Bone Mineral Content BMI Body Mass Index CI Confidence Interval DQI-P Diet Quality Index - Pregnancy EPA Eicosapentaenoic acid FFQ Food frequency questionnaire GA Gestational age GDM Gestational diabetes mellitus GI Glycaemic index GWG Gestational weight gain IGT Impaired glucose tolerance IQR Interquartile range IUGR Intrauterine growth restriction LA Linoleic acid LC-PUFAs Long-chain polyunsaturated fatty acids LGA Large for gestational age MD Mean Difference PAH Polycyclic aromatic hydrocarbons PCA Principal component factor analysis Pns P value not significant PTB Preterm birth RCTs Randomised controlled trials RRR Reduced risk regression SD Standard deviation SEM Standard error of the mean SES Socio-economic status SGA Small for gestational age SHBG Sex Hormone Binding Globulin SIDs Sudden infant death syndrome 7 Abbreviations Abbreviation Meaning SR Systematic review SSB Sugar sweetened beverages Review Methods Questions The principal question addressed in this systematic review was: What food groups consumed by pregnant and breastfeeding women, are associated with health outcomes for the mother and/or child? The groups included dietary patterns; fruit; vegetables; meat; dairy foods (cheese, milks and yoghurt); cereals/grains; legumes; nuts and seeds; fish; poultry; eggs; fat/oil; salt/sodium; sugars; and beverages. Search strategy We searched the following databases and sources: • Cochrane Library: issue 8, 2010 (published 4 August 2010); • Other databases and sources to 31 July 2010 (including Pubmed, EMBASE, Austhealth, Google Scholar, Google, government and agency sources, other dietary guidelines). These sources were searched from inception, with no date restrictions applied. We made extensive use of pearling and snowballing strategies on retrieved references. We did not apply language or publication status restrictions. Search terms included: • Maternal diet, pregnancy diet, pregnancy intake, breastfeeding diet, breastfeeding intake alone and in combination with the food patterns and food groups specified above. We used Endnote to manage the references. Inclusion and exclusion criteria Studies needed to: • be applicable to an Australian population • be food-based not nutrient-based or assessing food supplements; and • report maternal, fetal, infant, child (or child as an adult) health outcomes. 9 Methods Data extraction We designed a data extraction sheet specifically for this project. For each included study, one person extracted descriptive information, study design, study results, potential risk of bias, and relevance of the study. At least one other person checked the data extraction. We used the NHMRC Hierarchies of Evidence to assign a level of evidence to each study, according to its particular hierarchy. Most included studies fell into the aetiology or intervention hierarchies. Risk of bias We used the Cochrane risk of bias tool to criticially appraise randomised controlled trials and adapted this tool and the set of NICE critical appraisal tools to assess other study designs such as cohort (aetiology) and case control studies. Each included study was assessed as being of low, low-moderate, moderate, moderate-high or high risk of bias. Structure of report For each food group, we provided: • A table of included studies (alphabetical by first author’s surname with list of outcomes included in the study); • An evidence summary arranged chronologically by outcome (e.g. pre-pregnancy, fetal, maternal antenatal, maternal postnatal, infant, child, child as an adult) and giving a quantitative results summary for each included study; • Evidence tables of the detailed data extraction for each study, arranged alphabetically by first author’s surname); and • References for that particular food group.
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