Abstract
Objective
This study aimed to develop a k-means clustering algorithm to identify distinct food
intake patterns through cluster analysis.
Study Design
This was a secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring
Mothers-to-Be (nuMoM2b), including nulliparous individuals with singleton pregnancies.
Dietary intake data from the 3 months preceding pregnancy were collected using a validated
questionnaire. The primary outcome was a composite measure including preterm birth,
stillbirth, preeclampsia, eclampsia, gestational diabetes, and small for gestational
age. Clusters were formed using a k-means clustering algorithm with Euclidean distance,
based on 335 dietary variables. The association between dietary clusters and adverse
pregnancy outcomes (APOs) was assessed. Relative risks with 95% confidence intervals
(95% CIs) were calculated using modified Poisson regression, adjusting for predefined
confounders. A random forest model was also employed to identify features predictive
of cluster allocation.
Results
The analysis included 7,599 participants, distributed across three clusters: Cluster
1 (n = 4,243, 55.8%), Cluster 2 (n = 2,768, 36.4%), and Cluster 3 (n = 588, 7.7%). Cluster 2, which serves as the referent cluster, is characterized by
a higher intake of vitamin E as α-tocopherol, vitamin A retinol activity equivalents,
vegetables, and fruits, aligning most closely with a healthy diet pattern. Compared
with Cluster 2, Cluster 1, characterized by a lower intake of the same nutrients,
did not show a significant association with increased odds of APOs (22.7 vs. 25.4%;
adjusted relative risk [aRR], 1.07 [95% CI: 0.98–1.18]). In contrast, Cluster 3, characterized
by higher intake of trans fats, dietary polyunsaturated fatty acids 20:4, red meat,
and sugary beverages, was significantly associated with APOs compared with Cluster
2 (31.0 vs. 22.7%; aRR, 1.19 [95% CI: 1.01–1.39]).
Conclusion
A dietary pattern characterized by a high intake of trans fats, polyunsaturated fatty
acids, red meat, and sugary beverages is significantly associated with an increased
risk of APOs.
Key Points
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Diets high in trans fats, polyunsaturated fatty acids, red meat, and sugary beverages
are associated with increased APOs.
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Diets rich in vitamin E, vitamin A, vegetables, and green salads are linked to a lower
risk of these outcomes.
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This study underscores the significant role of nutrition in influencing APOs.
Keywords
nutrition - nulliparous women - adverse pregnancy outcomes - diet
