Using food network analysis to understand meal patterns in pregnant women with high and low diet quality

Abstract Background Little is known about how meal-specific food intake contributes to overall diet quality during pregnancy, which is related to numerous maternal and child health outcomes. Food networks are probabilistic graphs using partial correlations to identify relationships among food groups in dietary intake data, and can be analyzed at the meal level. This study investigated food networks across meals in pregnant women and explored differences by overall diet quality classification. Methods Women were asked to complete three 24-h dietary recalls throughout pregnancy (n = 365) within a prospective cohort study in the US. Pregnancy diet quality was evaluated using the Healthy Eating Index-2015 (HEI, range 0-100), calculated across pregnancy. Networks from 40 food groups were derived for women in the highest and lowest HEI tertiles at each participant-labeled meal (i.e., breakfast, lunch, dinner, snacks) using Gaussian graphical models. Network composition was qualitatively compared across meals and between HEI tertiles. Results In both HEI tertiles, breakfast food combinations comprised ready-to-eat cereals with milk, quick breads with sweets (e.g., pancakes with syrup), and bread with cheese and meat. Vegetables were consumed at breakfast among women in the high HEI tertile only. Combinations at lunch and dinner were more varied, including vegetables with oils (e.g., salads) in the high tertile and sugary foods with nuts, fruits, and milk in the low tertile at lunch; and cooked grains with fats (e.g., pasta with oil) in the high tertile and potatoes with vegetables and meat in the low tertile at dinner. Fried potatoes, sugar-sweetened beverages, and sandwiches were consumed together at all main meals in the low tertile only. Foods were consumed individually at snacks in both tertiles; the most commonly consumed food were fruits in the high HEI tertile and cakes & cookies in the low tertile. Conclusions In this cohort of pregnant women, food network analysis indicated that food combinations differed by meal and between HEI tertiles. Meal-specific patterns that differed between diet quality tertiles suggest potential targets to improve food choices at meals; the impact of meal-based dietary modifications on intake of correlated foods and on overall diet quality should be investigated in simulations and intervention studies. Trial registration PEAS was registered with number NCT02217462 in Clinicaltrials.gov on August 13, 2014.

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Using Food Network Analysis to Understand Meal Patterns in Pregnant Women with High and Low Diet Quality

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_145 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1073-1073

Author(s):

Carolina Schwedhelm ◽

Leah Lipsky ◽

Grace Shearrer ◽

Grace Betts ◽

Aiyi Liu ◽

...

Keyword(s):

Network Analysis ◽

Pregnant Women ◽

Diet Quality ◽

Sparse Matrix ◽

Healthy Eating Index ◽

Gaussian Copula ◽

Food Groups ◽

High Group ◽

Food Network ◽

Fried Potatoes

Abstract Objectives Our aim was to qualitatively assess networks describing interrelations among foods consumed at meals in pregnant women with high and low overall diet quality as defined by the Healthy Eating Index-2015 (HEI). Methods Multiple 24-hour dietary recalls (mean = 3.4) from 365 women in the Pregnancy Eating Attributes Study (PEAS) were collected across pregnancy. Food networks using intakes of 40 food groups were derived for each meal (breakfast, lunch, dinner) for women in the highest (n = 122) and lowest (n = 121) HEI tertiles using semiparametric gaussian copula graphical models (SGCGM). Networks are based on the resulting sparse matrix of partial correlations (edges) between food groups (nodes); communities within the networks were detected using the Louvain method (LM). Results In breakfast networks, 3 communities were detected in the low and 4 communities in the high group. In both groups, breakfast community (BC) 1 included white bread, eggs, cured meat and cheese; whole grain bread was also part of BC1 only in the high group. BC2 included milk and breakfast cereals in both groups; fried potatoes and sugar-sweetened beverages (SSB) were part of BC2 in the low group only. BC3, composed of cooked cereals and legumes/nuts/seeds in the high group, replaces a community composed of pancakes/other breads and sugars/sweets in the low group. In lunch networks, 5 communities were detected in both the low and high groups. Fried potatoes and SSBs were consumed with sandwiches in the low group but not in the high group. Vegetables were consumed more often (green P < .0001, red/orange P < .0001, other p 0.004) and in combinations with other foods in the high group. In dinner networks, 6 communities were detected in both groups. Sandwiches, fried potatoes and SSBs were consumed together and more often in the low group (5%, 12%, 23% of dinners, respectively) but separately in the high group (2%, 6%, 10% of dinners, respectively). Conclusions Food network analysis may provide a better understanding of the interrelationships of food intake at meals than traditional methods of meal pattern analysis. Differences observed in networks among pregnant women with low and with high diet quality may serve as a guide for meal-specific recommendations and interventions aimed at improving diet quality during pregnancy. Funding Sources This research was supported by the NICHD Intramural Research Program.

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Associations of Maternal Sociodemographic Characteristics and Eating Behaviors with Infant Feeding Behaviors

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_118 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1046-1046

Author(s):

Tonja Nansel ◽

Leah Lipsky ◽

Carolina Schwedhelm ◽

Breanne Wright ◽

Chelsie Temmen ◽

...

Keyword(s):

Infant Feeding ◽

Diet Quality ◽

Maternal Education ◽

Healthy Eating Index ◽

Fruit And Vegetables ◽

Infant Food ◽

Food Groups ◽

Feeding Behaviors ◽

White Race ◽

Maternal Characteristics

Abstract Objectives This study examines associations of maternal characteristics with infant feeding of discretionary and health-promoting foods. Methods Mothers in PEAS, a prospective cohort study, reported maternal and child dietary intake, demographics, and eating competence (EC). Maternal diet quality (Healthy Eating Index-2015, HEI) was calculated combining 24-hour diet recalls at 6 weeks, 6, and 12 months postpartum (n = 209). Infant food frequency questionnaires were completed at 6, 9, and 12 months, assessing age of introduction and intake frequency of food groups. T-tests examined bivariate associations of demographics with feeding of discretionary sweets, discretionary savory foods, fruit, and vegetables. Linear regressions examined associations of maternal EC and HEI with infant feeding controlling for demographics. Results Fruit, vegetables, discretionary sweet, and discretionary savory foods were introduced at 5.8 ± 1.7, 5.9 ± 1.7, 8.0 ± 2.0, and 8.8 ± 1.8 months, respectively. Earlier introduction of fruit and vegetables was associated with higher maternal education, white race, and nulliparity; earlier introduction of vegetables was also associated with higher income. Age of introduction of discretionary sweet and savory foods was not associated with maternal demographics, HEI, or EC. At age 12 months, greater infant intake frequency of fruit and vegetables was associated with higher education and income, white race, and breastfeeding, while greater intake frequency of discretionary sweet and savory foods was associated with lower maternal education and minority race. Greater intake frequency of sweets was also associated with multiparity and greater intake frequency of discretionary savory foods was associated with lower income. Maternal HEI was positively associated with infant intake frequency of fruit, vegetables, and discretionary sweet and savory foods. Maternal EC was positively associated with infant intake frequency of fruit and vegetables. Conclusions Demographic differences in infant feeding behaviors indicates these behaviors as critical intervention targets to address disparities in child diet quality. Associations of maternal HEI and EC with infant feeding behaviors suggest potential pathways of maternal influence on infant diet. Funding Sources This research was supported by the NICHD Intramural Research Program.

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Association between Ready-to-Eat Cereal Consumption and Nutrient Intake, Nutritional Adequacy, and Diet Quality in Adults in the National Health and Nutrition Examination Survey 2015–2016

Nutrients ◽

10.3390/nu11122952 ◽

2019 ◽

Vol 11 (12) ◽

pp. 2952

Author(s):

Yong Zhu ◽

Neha Jain ◽

Vipra Vanage ◽

Norton Holschuh ◽

Anne Hermetet Agler ◽

...

Keyword(s):

United States ◽

Dietary Intake ◽

National Health ◽

Diet Quality ◽

The United States ◽

Healthy Eating Index ◽

Nutrition Examination Survey ◽

Food Groups ◽

Dietary Recall ◽

Health And Nutrition

This study examined differences in dietary intake between ready-to-eat cereal eaters and non-eaters in adults from the United States. Participants (n = 5163) from the National Health and Nutrition Examination Survey 2015–2016 were included. One-day dietary recall was used to define ready-to-eat cereal consumption status and estimate dietary intake in eaters and non-eaters. Data from Food Patterns Equivalent Database 2015–2016 were used to compare intakes of food groups by consumption status. Diet quality was assessed by Healthy Eating Index 2015. Nineteen percent of US adults were ready-to-eat cereal eaters; they had a similar level of energy intake as non-eaters, but they had significantly higher intake of dietary fiber, and several vitamins and minerals, such as calcium, iron, magnesium, potassium, zinc, vitamin A, thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, and vitamin D. They were also more likely to meet nutrient recommendations. Compared to non-eaters, ready-to-eat cereal eaters had the same level of added sugar intake but they had significantly higher intake of whole grains, total fruits, and dairy products. The diet quality of ready-to-eat cereal eaters was significantly higher than that of non-eaters. The study supports that ready-to-eat cereal eaters have better dietary intake with a healthier dietary pattern than non-eaters in the United States.

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A cohort study on diet and the risk of Parkinson's disease: the role of food groups and diet quality

British Journal Of Nutrition ◽

10.1017/s0007114512000955 ◽

2012 ◽

Vol 109 (2) ◽

pp. 329-337 ◽

Cited By ~ 33

Author(s):

K. Sääksjärvi ◽

P. Knekt ◽

A. Lundqvist ◽

S. Männistö ◽

M. Heliövaara ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Diet Quality ◽

Healthy Eating Index ◽

Adjusted Relative Risk ◽

Inverse Association ◽

Food Groups ◽

Incident Cases

Previous studies on individual foods and nutrients and Parkinson's disease (PD) risk have been inconsistent. Furthermore, only one study has examined the association between the quality of diet and PD. We investigated the prediction of food groups and diet quality on PD in the Finnish Mobile Clinic Survey (1966–72). The population comprised 4524 individuals, aged 40–79 years and free from PD at baseline. Data collection included health examinations, a questionnaire and a 1-year dietary history interview. A modified Alternate Healthy Eating Index was formed to assess diet quality. Statistical analyses were based on Cox's model. During a 41-year follow-up, eighty-five incident cases of PD occurred. No statistically significant associations were found between PD incidence and most of the food groups examined. A few exceptions were fruits and berries in men and milk in women, which showed positive associations. An inverse association between the intake of meat products and PD was found in women. The diet quality index did not predict PD, the adjusted relative risk between the highest and lowest quartiles being 1·83 (95 % CI 0·65, 5·18) in men and 0·97 (95 % CI 0·38, 2·48) in women. The present study suggests that since most of the single food groups or the quality of diet did not predict PD occurrence, the role of diet is apparently rather modest.

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Role of alternate healthy eating index (AHEI) in communicating the quality of diet

FOOD SCIENCE RESEARCH JOURNAL ◽

10.15740/has/fsrj/11.2/96-102 ◽

2020 ◽

Vol 11 (2) ◽

pp. 96-102

Author(s):

Krishna Mohandas ◽

L. Prema

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Dietary Habits ◽

Mean Value ◽

Healthy Eating Index ◽

Overweight And Obesity ◽

Food Groups ◽

Good Tool ◽

The Difference

The food habits of global population has been evolving in such a way that makes unhealthy foods cheaper and widely available and healthy foods costly and less available. Being surrounded by such foods and living in an environment with lesser requirement for physical activity is the primary reason for the pandemic explosion in overweight and obesity. This study is an attempt to analyze the quality of diet with an aim to study the significance of Alternate Healthy Eating Index (AHEI) in predicting the quality of dietary intake. Methodology: The study was conducted in 66 respondents (44 females and 22 males) aged 18-65 years with BMI between 23 kg/m2 to 50 kg/m2. The respondent’s data were collected using a pretested standard questionnaire. The nutrient consumption was calculated from the 24 hour recall and the AHEI scores were derived from recall and food use frequency data. The data were analysed using SAS software. Results: The intake of Energy, protein, fat and carbohydrates were more than their requirement while intake of fibre was not meeting the requirement. The AHEI scores obtained ranged from 36 to 76 with a mean value of 55.6 ± 9.54. A positive linear association for AHEI with BMI (0.0362) and energy intake (0.13) was established through Pearson’s correlation while the association was negative with BMR (-0.14). Paired t test comparing AHEI against the difference between intake and requirement of macronutrients revealed that when the diet quality was good (as indicated by AHEI>51), the difference in intake exhibited a significant linear relationship with p values <0.001 while no relation was established when the diet quality was poor. Conclusion: AHEI encompasses all nutrients and food groups relevant to metabolic health and it can be used as a good tool to assess the quality of dietary habits of overweight and obese subjects.

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Defining Diet Quality: A Review of Diet Metrics as Applied to the Double Burden of Malnutrition (OR17-01-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz039.or17-01-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Cited By ~ 1

Author(s):

Victoria Miller ◽

Patrick Webb ◽

Renata Micha ◽

Dariush Mozaffarian

Keyword(s):

Healthy Eating ◽

Diet Quality ◽

Fruits And Vegetables ◽

Healthy Eating Index ◽

Dietary Guidelines ◽

Healthy Diet ◽

Food Groups ◽

Policy Action ◽

Double Burden ◽

Meta Analyses

Abstract Objectives Meeting most of the UN Sustainable Development Goals (SGDs) will require a strong focus on tackling all forms of malnutrition─ addressing maternal and child health (MCH) as well as diet-related non-communicable diseases (NCDs). Yet, the optimal metrics to define a healthy diet remain unclear. Our aim was to comprehensively review diet metrics and assess the evidence on each metric's association with MCH and NCDs. Methods Using comprehensive searches and expert discussions, we identified metrics that i) are used in ≥3 countries to link diet to health, ii) quantify the number of foods/food groups consumed and/or iii) quantify recommended nutrient intakes. We reviewed and summarized each metric's development, components and scoring. For each identified metric, we systematically searched PubMed to identify meta-analyses or narrative reviews evaluating these metrics with nutrient adequacy and health outcomes. We assessed validity by grading the number of studies included and the consistency of the diet metric-disease relationship. Results We identified 6 MCH, 13 NCD and 0 MCH/NCD metrics. Most were developed for describing adherence to dietary guidelines or patterns, and others were developed for predicting micronutrient adequacy. On average, the metrics included 14 food groups/nutrients (range 4–45), with 10 food-group only metrics and 0 nutrient-only metrics. The most frequent metric components were grains/roots/tubers, fruits and vegetables. We identified 16 meta-analyses and 14 narrative reviews representing 102 metric-disease relationships (98 metric-NCD and 4 metric-MCH relationships, respectively). We found 5 metrics that have been consistently validated in meta-analyses and narrative reviews for NCDs, 1 metric with limited evidence for MCH, but 0 metrics for both. Of the metrics, the Alternative Healthy Eating Index (aHEI), Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index (HEI), and Mediterranean Diet Score (MED) were most commonly validated, especially for all-cause mortality and cardiovascular disease (Figure 1). Conclusions Few diet metrics have been used in multiple countries to define a healthy diet. This suggests a serious gap in global analyses of diet quality relating to malnutrition in all its forms, which hinders effective policy action. Funding Sources Gates Foundation. Supporting Tables, Images and/or Graphs

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Racial/Ethnic Differences in Diet Quality and Eating Habits Among WIC Pregnant Women: Implications for Policy and Practice

American Journal of Health Promotion ◽

10.1177/0890117119883584 ◽

2019 ◽

Vol 34 (2) ◽

pp. 169-176 ◽

Cited By ~ 2

Author(s):

Alla M. Hill ◽

Danielle L. Nunnery ◽

Alice Ammerman ◽

Jigna M. Dharod

Keyword(s):

African American ◽

Pregnant Women ◽

African American Women ◽

Healthy Eating ◽

Diet Quality ◽

Low Income ◽

Eating Behaviors ◽

Dietary Habits ◽

Healthy Eating Index ◽

American Women

Purpose: One of the major federal food assistance programs, the Special Supplemental Program for Women, Infants, and Children (WIC), serves approximately 1.5 million low-income pregnant women per year; however, limited information is available on their dietary habits. This is critical because low-income women are at higher risk of gaining excess weight during pregnancy. Thus, the study objectives were to (1) determine the overall diet quality of WIC pregnant women and (2) examine diet quality and eating behaviors by race/ethnicity and other sociodemographics. Design: This was a cross-sectional study. Setting: One of the 3 WIC offices in a north-central county in North Carolina, USA. Sample: Pregnant women (n = 198) in the second trimester. Measures: Interviews included sociodemographics, food security, diet, and eating behaviors. Diet quality was assessed by the Healthy Eating Index (HEI) 2010 scores. Analysis: Descriptives, bivariate analysis, and multivariate analysis. Results: Average participant age was 26 years, and the mean HEI-2010 score was 56 of maximum score of 100. Specifically, African American women consumed significantly lower servings of whole grains (β = −1.71; 95% CI: −3.10 to −0.32; P < .05) and dairy (β = −1.42; 95% CI: −2.51 to −0.33; P < .05) compared with non-Hispanic white women. Hispanic women scored higher in daily intake of fruits (β = 0.98; 95% CI: 0.17-1.79; P < .05) and for consuming empty calories in moderation (β = 1.57; 95% CI: 0.06-3.09; P < .05). Frequency of intake of fast foods/outside meals was higher among African American women (57%, P = .025). Conclusion: Efforts are warranted to promote optimal nutrition among WIC pregnant women. Specifically, African American women are highly vulnerable to poor dietary habits during pregnancy. Further investigation of barriers/facilitators for healthy eating is necessary to address nutrition disparities among WIC pregnant women.

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The accelerator, the brake, and the terrain: associations of reward-related eating, self-regulation, and the home food environment with diet quality during pregnancy and postpartum in the pregnancy eating attributes study (PEAS) cohort

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-020-01047-x ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Tonja R. Nansel ◽

Leah M. Lipsky ◽

Myles Faith ◽

Aiyi Liu ◽

Anna Maria Siega-Riz

Keyword(s):

Diet Quality ◽

Food Environment ◽

Eating Behaviors ◽

Self Regulation ◽

Delay Of Gratification ◽

Healthy Eating Index ◽

Home Food Environment ◽

Link Type ◽

Pregnancy And Postpartum ◽

Home Food

Abstract Background Neurobehavioral factors, including reward-related eating and self-regulation, in conjunction with the food environment, may influence dietary behaviors. However, these constructs have not been examined in pregnancy and postpartum, a time of changing appetite and eating behaviors, and when dietary intake has implications for maternal and child health. This study examined associations of reward-related eating, self-regulation, and the home food environment with pregnancy and postpartum diet quality. Methods Participants in the Pregnancy Eating Attributes Study observational cohort were enrolled at ≤12 weeks gestation and followed through one-year postpartum. Pregnancy and postpartum Healthy Eating Index-2015 (HEI-total), and adequacy and moderation scores, respectively, were calculated by pooling 24-h diet recalls administered each trimester and during 2, 6, and 12 months postpartum. Participants completed four measures of reward-related eating – Modified Yale Food Addiction Scale (mYFAS), Power of Food Scale (PFS), Multiple Choice Procedure (MCP), and Reinforcing Value of Food Questionnaire (RVFQ); two measures of self-regulation – Barratt Impulsiveness Scale (BIS) and Delay of Gratification Inventory (DGI); and a Home Food Inventory (HFI), yielding obesogenic (OBES) and fruit/vegetables (FV) scores. Linear regression analyses estimated associations of reward-related eating, self-regulation, and home food environment with diet quality during pregnancy and postpartum, adjusting for sociodemographic characteristics. Results Pregnancy HEI-total was inversely associated with PFS (β = − 0.14 ± 0.05, p = 0.009), mYFAS(β = − 0.14 ± 0.06, p = 0.02), 2 of the 5 RVFQ indices, MCP (β = − 0.14 ± 0.05, p = 0.01), and DGI food subscale (β = 0.23 ± 0.05, p < 0.001), but associations of postpartum HEI-total with reward-related eating measures and self-regulation were small and not statistically significant. Pregnancy and postpartum HEI-total were associated inversely with HFI-OBES (β = − 0.17 ± 0.06, p = 0.004 and β = − 0.19 ± 0.07, p = 0.006, respectively), and positively with HFI-FV (β = 0.21 ± 0.05, p < 0.001 and β = 0.17 ± 0.06, p = 0.009, respectively). Conclusions Associations of poorer diet quality with greater reward-related eating during pregnancy but not postpartum suggests the need to better understand differences in the determinants of eating behaviors and approaches to circumvent or moderate reward-related eating to facilitate more optimal diet quality across this critical period. Trial registration Clinicaltrials.gov. URL – Registration ID – NCT02217462. Date of registration – August 13, 2014.

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Food Security and Diet Quality in Native Hawaiian, Pacific Islander, and Filipino Infants 3 to 12 Months of Age

Nutrients ◽

10.3390/nu12072120 ◽

2020 ◽

Vol 12 (7) ◽

pp. 2120

Author(s):

Sally Campbell ◽

John J. Chen ◽

Carol J. Boushey ◽

Heather Eicher-Miller ◽

Fengqing Zhu ◽

...

Keyword(s):

Food Security ◽

Diet Quality ◽

Native Hawaiian ◽

Multinomial Logistic Regression ◽

Pacific Islander ◽

Infant Food ◽

Food Groups ◽

Linear Regression Models ◽

Cross Sectional ◽

The Impact

Food insecurity and other nutritional risks in infancy pose a lifelong risk to wellbeing; however, their effect on diet quality in Native Hawaiian, Pacific Islander, and Filipino (NHPIF) infants in Hawai‘i is unknown. In this cross-sectional analysis, the association between various indicators of food security and NHPIF infant diet quality were investigated in 70 NHPIF infants aged 3–12 months residing on O‘ahu, Hawai‘i. The dietary assessments of the infants were collected using a mobile food recordTM. Foods consumed across four days were categorized into seven food groups. Indicators for food security were examined through an adapted infant food security index and other indicators. Data were analyzed using chi-square tests, independent sample t-tests, multinomial logistic regression, and linear regression models. In models adjusting for age and sex, infants defined as food insecure by the adapted index were found to consume foods from more food groups and consume flesh foods on a greater proportion of days. Of the indicators examined, the adapted index was shown to be the best indicator for food group consumption. Further work is needed on a more representative sample of NHPIF infants to determine the impact that food security has on nutritional status and other indicators of health.

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Examination of Prenatal Dietary Choline Intake, and Maternal and Infant Outcomes

Current Developments in Nutrition ◽

10.1093/cdn/nzaa054_065 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 993-993

Author(s):

Rosemary Gatliff ◽

Joshua Phelps ◽

Christi Arthur ◽

Aline Andres

Keyword(s):

Birth Weight ◽

Pregnant Women ◽

Diet Quality ◽

Healthy Eating Index ◽

Maternal Body Mass Index ◽

Food Records ◽

Choline Intake ◽

Infant Birth ◽

Dietary Choline ◽

Maternal Bmi

Abstract Objectives The objectives of this study were to explore associations between maternal dietary choline intake and diet quality, maternal body mass index (BMI), and infant birth weight. Methods De-identified secondary data from 251 participants in a study involving pregnant women were analyzed to investigate associations between maternal dietary choline intake and infant birth weight; maternal dietary choline intake and 2015 Healthy Eating Index (HEI) scores; as well as 2015 HEI scores and maternal BMI. HEI scores were calculated from 3-day food records obtained during gestation (<10, 12, 18, 24, 30, 36 weeks). Overall dietary choline intake during pregnancy was computed from all food records. Spearman's rank-order correlations, a one-sample Wilcoxon signed rank test, and a mixed linear model were used to test the hypotheses. Results There was a statistically significant correlation between maternal choline intake and the 1st trimester and 3rd trimester 2015-HEI scores (rs(207) = 0.204, P = 0.003 and rs(207) = 0.249, P = 0.00028, respectively). Median intake of dietary choline, 267 milligrams, was significantly lower (P < 0.0005) than the adequate Intake for pregnant women (450 milligrams). There were trends (0.05 < P < 0.1) pointing to a pattern of negative association between maternal BMI and 1st, 2nd, and 3rd trimester 2015-HEI scores. Mixed model analysis revealed a statistically significant negative correlation (β = −0.001, P = 0.010) between maternal choline intake and infant birth weight. Conclusions As dietary choline increased, there was an associative decrease in birthweight; however, overall diet quality was poor and dietary choline intake was significantly lower than the recommended intake for pregnant women. These findings reflect the current body of evidence that pregnant women are at risk for choline inadequacy and that overall diet quality may help in preventing low choline intake during pregnancy. Funding Sources USDA-ARS Project.

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