High-calorie low-protein dietary pattern among overweight and obese pregnant women in Tanzania

Abstract

Traditionally, addressing underweight during pregnancy has been a priority in low-middle-income countries, including Tanzania. However, due to ongoing lifestyle and socioeconomic transitions, increasing rates of overweight and obesity have created a double burden of malnutrition (undernutrition and overnutrition). As a result of this transition, pregnancy-related weight gain tends to be excessive among women who are overweight or obese and does not adequately reverse after childbirth. This study aimed to explore the dietary patterns and macronutrient intakes of pregnant women with pre-pregnancy overweight or obesity and compare them with their normal-weight counterparts. We consecutively recruited 242 pregnant women attending antenatal clinics in Dodoma, Tanzania. Dietary intake and patterns were assessed using 179-item food frequency questionnaires (FFQ). The Tanzanian food composition tables were then used to calculate nutrient and energy intake. We used principal component analysis (PCA) to identify dietary patterns. Energy and nutrient intake comparisons were made using the Mann–Whitney U test for independent analysis of medians and the Wilcoxon matched-pairs signed-rank test. Proportions were used to categorise protein, carbohydrate, and fat intakes below, within, or beyond recommendations. We identified six dietary patterns that accounted for 63% of the total variance in descending order of contribution as follows: nuts-cereals-legumes (24%); roots–plantains–fruits (10%); poultry–milky–meat (9%); fats-alcohol-eggs (8%); soda–sweets–meat (7%); vegetables–fish–legumes (6%). Energy intake was higher than recommended (z = 6, P < 0.001), with % carbohydrate contribution higher than recommended among most participants (81%, n = 197). Although patterns rich in poultry, dairy, and meat were relatively more common among overweight and obese than normal–weight women, about 28% of them had a protein intake below the recommended. Overweight and obese participants had a higher caloric intake with a greater % of carbohydrate contribution than recommended, and others consumed alcohol during pregnancy. A substantial proportion had a protein intake below the recommended.