Energy Intake Under-Reporting Increases Over Pregnancy: An Intensive Longitudinal Study of Women with Overweight and Obesity
Open Access
- Author:
- Mc Nitt, Katherine
- Graduate Program:
- Nutritional Sciences
- Degree:
- Master of Science
- Document Type:
- Master Thesis
- Date of Defense:
- April 09, 2020
- Committee Members:
- Jennifer Savage Williams, Thesis Advisor/Co-Advisor
Danielle Symons Downs, Committee Member
Alison Diane Gernand, Committee Member
Laura E Murray-Kolb, Program Head/Chair - Keywords:
- pregnancy
under-reporting obesity - Abstract:
- Background: Energy intake under-reporting is widespread, yet poorly understood during pregnancy. Adequate energy intake and energy balance are essential for optimizing maternal and fetal outcomes, including gestational weight gain. Inaccurate self-reported energy intake may result in erroneous nutrition education from health professionals during pregnancy. Objective: This study aimed to examine the trends (i.e., changes over gestation), magnitude (i.e., degree of severity), and predictors (i.e., gestational age, anthropometrics, demographics, perceived stress, and eating behaviors) of energy intake under-reporting using intensive longitudinal data in a sample of pregnant women with overweight and obesity in the United States. Methods: This is a post hoc analysis using data from the Healthy Mom Zone Study. Pre-pregnancy weight and demographics were reported at study enrollment (at 8-12 weeks gestational age). Validated questionnaires were completed weekly to assess perceived stress and monthly to assess eating behaviors. Mobile health technology was used to measure daily weight (Wi-Fi Scale) and physical activity (activity monitor) and tri-weekly self-reported energy intake (smartphone app). An energy balance model was used to calculate energy intake with the inputs of measured weight, physical activity, and resting metabolic rate. Reporting accuracy was defined as: [(self-reported EI – back-calculated EI) / back-calculated EI)] * 100%. Linear fixed effects modelling was used to test whether each predictor was associated with under-reporting. Results: Women were, on average, 30.7 years old, married, well-educated, pregnant with their first child (64%), and had overweight or obesity (mean BMI=31.5). Women under-reported by 36% of their estimated energy intake, on average. Energy intake under-reporting increased significantly between trimesters from 28% (first) to 33% (second) to 39% (third) (p<0.001). We also found a significant positive association between under-reporting and gestational age (in days) (p<0.001), pre-pregnancy body mass index (p<0.01), perceived stress (p<0.05), and uncontrolled eating (p<0.05). The following variables were not associated with reporting accuracy: age, education, income, parity, gestational weight gain, treatment group, birth weight, cognitive restraint and emotional overeating. Conclusions: This study contributes to the literature by evaluating the accuracy of self-reported energy intake multiple times in each trimester. These findings suggest that under-reporting during pregnancy is complex. Whereas additional research on predictors of under-reporting in pregnancy is needed, this preliminary study could help inform gestational weight gain intervention efforts by identifying individuals who may be more susceptible to under-estimating energy intake during pregnancy.