Assessing the Preconception Dietary Intake of Canadian Adults using a new, short dietary assessment tool: The PREP’D Study

• Author / Creator

  Dragana Misita

• Background: A self-administered, 24-question dietary tool, called the Diet Screening for Adults in Canada (D-SAC), was chosen for use by the Canadian, Healthy Life Trajectories Initiative (HeLTI-Canada). Assessment of the reproducibility and comparability (to another dietary assessment tool) of the D-SAC questionnaire was required, so that HeLTI researchers could interpret dietary intake information and support participants in making optimal dietary changes. Study 1 compared dietary intake and diet quality collected using the D-SAC to 24-hour food recalls; reproducibility of the D-SAC was also determined. Study 2 was a pilot study that applied the D-SAC in a group of Canadian adults of child-bearing age to assess their preconception dietary intake. This study was conducted because very little is known about women’s and men’s diet during this phase of the life-course, despite it being critical for a healthy life trajectory. Study 2 also assessed dietary intake of Canadian women and men and compared intake between those who are planning a pregnancy and those who are not. Methods: English-speaking women and men, between the ages of 18-45, living in Canada, who had reliable access to the internet were recruited for both studies. Those who were currently pregnant were excluded. All participants were recruited online. Study 1: Participants completed the D-SAC questionnaire, followed by five, 24-hour recalls, and then a final D-SAC questionnaire. All assessments took place over approximately one month. Reproducibility was assessed using Pearson and Intraclass correlation analyse and paired t-tests. Differences in the frequency of weekly food and beverage intake and dietary quality between the D-SAC and 24-hour recalls was compared using weighted kappa and Bland-Altman analysis. Study 2: The D-SAC was included as part of a cross-sectional survey that examined Canadian women’s and men’s knowledge, attitudes, beliefs, and self-reported behaviours related to preconception health. Frequency of weekly food and beverage intake, dietary patterns and diet quality scores were compared between women and men and between those who were planning a pregnancy and those who were not. Multivariable regression analysis was used to assess participant characteristics associated with different dietary patterns and different levels of diet quality. Results: Study 1: Dietary quality determined by the D-SAC was reproducible over a one-month period. The D-SAC was moderately comparable to repeated 24-hour recalls in estimating weekly intake of many foods and beverages. The D-SAC performed best when estimating intake of moderate-quality foods, but overestimated intake of high-quality foods and underestimated intake of low-quality foods. Study 2: Overall, women’s and men’s food and beverage intake did not align with Canada’s Food Guide recommendations; superficially their intake of higher quality foods was below inadequate. Women (β=2.1, 95% CI: 0.9, 3.3), participants who had completed post-secondary education (β=3.4, 95% CI: 1.6 5.2), met weekly physical activity requirements (β=3.5, 95% CI: 2.7, 4.3), and were older (β=0.1, 95% CI: 0.05, 0.2) tended to have a higher total quality score. However, participants who had children (β=-4.1, 95% CI: -6.80, -1.5), those who smoked (β=-2.4*, 95% CI: -4.5, -0.3), and those who had a BMI >30 kg/m2 had a significantly lower total quality score (β=-1.8, 95% CI: -2.9, -0.6) compared to those with a BMI between 18.5 and 24.9 kg/m2. Pregnancy intention was generally not associated with differences in dietary intake or quality although a greater proportion of women actively planning a pregnancy consumed less alcohol and more water on a weekly basis as compared to those who were not planning a pregnancy, and a greater proportion of men who were actively planning a pregnancy with their partners consumed more low-fat dairy products and less calorie-containing beverages than those who were not planning a pregnancy with their partners. Conclusions: Intake assessed using the D-SAC is reproducible. Overall, the ability of the D-SAC to assess individuals’ dietary intake of food and beverage groups and diet quality compares well to 24-hour recalls but should be interpreted cautiously when determining absolute intake of high and low-quality foods and beverages. There is room for improvement in the preconception dietary intake of Canadians regardless of their intention to become pregnant.

• Subjects / Keywords

  • Dietary Assessment
  • Preconception
  • Dietary Assessment
  • Before Pregnancy
  • Pregnancy Planning
  • Diet
  • Nutrition
  • Adults
  • Canada

• Graduation date

  Fall 2021

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-p3q0-jp12

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.