The occurrence of GWG surpassing the recommended levels in approximately half of pregnancies is often attributed to unhealthy lifestyles and unbalanced diets (19). Excess GWG is linked to increased risk of adverse maternal and neonatal outcomes (20, 21). Data from China indicate that 30–50% of women experience excessive GWG (22). Multiple interventions including diet, physical activity, and combinations have been proposed to address this issue (23). A meta-analysis showed that dietary interventions are associated with reduced GWG and exert a more significant impact than physical activity alone (24). Strategies for dietary interventions in weight management should focus on reducing energy intake and consider dietary patterns related to differences in food accessibility, eating behaviors, taste preferences, and cultural background (25). A comprehensive understanding of regional dietary intake elements is crucial for devising targeted dietary interventions to prevent excessive GWG.
In the current study, we evaluated dietary intake and taste preference among pregnant women in Chongqing and their impacts on GWG. Our results showed that food intake during pregnancy was notably inadequate, except for cereals, meats/poultries, and eggs, with less than 70% of the recommended minimum intake based on the CBDP. This is consistent with the 2018 Chongqing Residents’ Health Status report (17). An unbalanced diet heavily laden with carbohydrates has been reported to be associated with weight gain and obesity in Asia (26). This explains why, despite inadequate dietary intake, there are still quite a few cases of excessive GWG in Chongqing (30.4%). Using the PCA method, we identified three dietary patterns: TD, MD, and QPD. Linear regression analysis revealed that pregnant women adhering to a TD or MD, but not a QPD, experienced greater GWG. Our results are similar to those of Danish study that low-glycemic index and high-protein diet reduced GWG (13). TD and MD are both characterized by high intakes of cereals, often consisting of refined carbohydrate with high-glycemic indexes. Another prospective study in Central China showed that women following a fish-meat-egg, rice-wheat-fruit diet during the second trimester of pregnancy had a significantly higher GWG (14).
Taste influences nutritional status and health. A recent systematic review evaluated the relationship between weight status and the perception of and preference for four common tastes (sweet, salty, fatty, bitter, and sour) by reviewing observational and interventional studies (27). The findings indicate that adults with overweight and obesity exhibit decreased perceptions of the four tastes and that preferences for sweetness and fat increase with weight gain (27). There is no consensus in the literature regarding the effects of spiciness on obesity. One prospective study from China suggests that high intake of spicy food is positively associated with energy intake but is inversely associated with the risk of overweight or obesity (28). A beneficial effect of spicy food consumption on weight management has been demonstrated in intervention studies with small sample sizes from Western countries (29). However, a recent meta-analysis of cross-sectional studies shows that spiciness may adversely affect overweight or obesity (30).
Regarding taste preference during pregnancy, only sugar consumption has been reported to contribute to increased GWG and the development of pregnancy complications (31). In our present study, we investigated four taste preferences of pregnant women, including fatty, salty, spicy, and Mala flavors, and found that pregnant women who preferred the Mala flavor (but not fatty, salty, or spicy flavors) exhibited higher GWG. Among pregnant women with no or light preference for Mala flavor, the rate of excessive GWG was 27.4%, whereas the rate among women with a medium or heavy preference was 38.8%. Further analysis showed that the positive effect of numbing-spicy flavor on GWG was partially mediated by TD and MD. Unlike the simple spicy flavor found in other Chinese cuisines, the Mala evoked by Chinese prickly ash combined with chili peppers constitutes the distinctive feature of Sichuan cuisine (32). This Mala sensation in the mouth further affect the mediation and recognition of tastes, stimulating appetite. Our findings indicate that women who preferred Mala flavors scored higher on all three dietary patterns. It is worth mentioning that a QPD did not significantly increase GWG, indicating that it is a more favorable food choice to provide necessary nutrients and help manage weight gain during pregnancy.
Our study provides an innovative analysis of the impact of the unique Mala taste preference of Sichuan cuisine on GWG. However, this study had some limitations. First, the self-designed FFQ is simple and fail to provide detailed information on specific foods. However, it is effective for collecting the frequency and amount of food category intake and analyzing dietary patterns. Second, the reliability and validity of the FFQ were not evaluated. Nevertheless, the results of our food category intake were consistent with those of the Chongqing Residents’ Health Status Report, which partially reflects the validity of the FFQ. Moreover, the FFQ showed good reproducibility. The Spearman and intra-class correlation coefficients between the two FFQ measurements 3 months apart ranged from 0.22 to 0.66 and from 0.22 to 0.60, respectively (Additional Table 1). The proportion of women classified into the same or adjacent quartiles by both FFQ measurements ranged from 72–85%, whereas the rate of misclassification into opposite quartiles was < 9% (Additional Table 2). Another significant limitation is that we did not adjust for food intake when analyzing the relationship between taste preferences and GWG, which could potentially introduce bias into the results. However, in the subsequent mediation analysis, dietary patterns extracted based on food category intake were included and adjusted in the model.