Padrões alimentares de mulheres durante o primeiro ano pós-parto em uma área de elevada vulnerabilidade socioeconômica: um estudo de coorte

Abstract

Dietary patterns are understood as a set of foods frequently consumed by individuals and populations, promising for analyzing diets as they characterize the complexity in the act of eating, as well as helping to propose health promotion measures through nutrition. Identifying dietary patterns helps to understand the complexities of the diet, which may be lost during analyzes of the isolated consumption of foods or nutrients, in addition to allowing us to understand how factors determine adherence to dietary patterns. Among the factors, food insecurity stands out for establishing difficulties in physical and financial access to healthy foods and favoring food substitutions, often ultraprocessed foods. Due to the high physiological vulnerability of pregnant and postpartum women, a specialized approach to nutrition is necessary at this stage of the life cycle, as inadequate food intake predisposes to a greater risk of developing nutritional disorders, which can have repercussions until adulthood, resulting in reduced of life expectancy. Aiming to contribute to the discussion of the problem, this dissertation presents two articles: a literature review and an article, whose objective is to identify dietary patterns of women during the first year postpartum and evaluate the effect of food insecurity, age and education on adherence to dietary patterns. This is a longitudinal study with data from a prospective cohort conducted in Brazil between the years 2017-2018. Analysis of the main components was carried out to identify dietary patterns, based on three food frequency questionnaires, applied to women in the third (n= 207), sixth (n= 195) and twelfth (n= 183) month postpartum, through home visits. To evaluate the effect of food insecurity and demographic factors on adherence to the identified dietary patterns, generalized logistic regression models, with mixed, fixed and random effects, were developed. We identified two dietary patterns with different composition: the first dietary pattern identified was composed of predominantly healthy and traditional foods from the study region, named Predominant Healthy (PHDP); the second dietary pattern was composed of mostly ultra-processed foods, being named Predominant Ultra processed (PUPDP). It was observed that PHDP explained the greatest variance in the three stages analyzed: 27.6%, 24.3% and 32.7%, respectively, while for PUPDP, the explained variance was 13.1%, 12. 9% and 12.9%. Dietary patterns did not show temporal variation during the analyzed period. According to the generalized logistic regression models, with mixed effects, the effect on greater adherence to PHDP remained, increasing age (OR=1.08; p= 0.032), greater access to education (OR=1.18; p= 0.026) and lower food insecurity score (OR= 0.85; p= 0.009). Regarding adherence to PUPDP, we observed an inverse association with age (OR=0.92; p=0.033) and access to education (OR=0.84; p= 0.029) and with higher food insecurity scores (OR=1.18; p= 0.010). We observed a negative association between PHDP adherence and the level of food insecurity. This relationship with PUPDP was positive. The higher the age and level of education, the greater the adherence to PAPS. Conversely, the lower the age and level of education, the greater the adherence to PAPUP. We recommend resolute responses, aiming at food security and the human right to adequate food, especially in the most vulnerable populations.