What does it mean to have a healthy diet? We talk about it with Dr. Miriam Levi, specialist in Hygiene and Preventive Medicine
Maintaining a healthy diet is important at all times in life, but especially during pregnancy. In fact, food choices in this period are reflected not only on women’s health, but also on that of the unborn child, with long-term consequences as well.
We often hear it said that women must “eat for two”, in other words twice as much as usual, but there is nothing more inaccurate. From the third month onwards, in fact, the additional energy requirement is only about 200-300 Kcal per day  .
According to the recommendations of the World Health Organization (WHO), a healthy diet is a diet based mainly on foods of plant origin, therefore vegetables and fruit (possibly in season, and “0 km”, more nutritious and cheaper), bread, pasta, cereals, legumes, potatoes, but which also includes, in smaller quantities, milk, cheese, yogurt, fish and low-fat meat. We Italians have an advantage from this point of view: following the WHO recommendations largely coincides with adopting a Mediterranean diet , whose effectiveness in the prevention of chronic degenerative diseases has been repeatedly highlighted by the results of numerous and authoritative scientific studies (it is no coincidence that the Mediterranean diet has been inscribed, since 2013, in the representative list of the intangible cultural heritage of humanity of UNESCO).
For the first time in Sweden in 1974, some researchers, by dividing foods into specific groups, offered a graphic representation of a correct diet, using the so-called food pyramid . The Pyramid, divided into various levels, shows the proportions of the foods to be consumed in order to stay healthy: at the base of the Pyramid, at the lowest level, the foods to be consumed most often are represented; the higher levels indicate those to be consumed progressively with less frequency. Many countries have since built their own food pyramid, based on specific culinary traditions. Figure 1 shows the pyramid of the Mediterranean diet, according to which:
- Every week you should consume at least 2 portions of fish, 2 portions of white meat, no more than one portion of red meat, 2-4 eggs, 2 or more portions of legumes.
- Every day 2 portions of dairy products, 1-2 portions of nuts / olives / seeds should be consumed.
- Each meal should not be missing bread / pasta / couscous or other cereals, preferably wholemeal, at least 2 portions of vegetables, extra virgin olive oil for dressing and fruit
The Italian food pyramid is available on the website http://www.piramideitaliana.it/ . To help the consumer to make informed choices in the nutritional field, versions adapted to the local context and versions in which, on the contrary, the Mediterranean diet is integrated with other cultures and culinary traditions have also been created. In Tuscany, for example, the Regional Health Agency has developed the Tuscan Food Pyramid : of the approximately 70 foods listed, 65 belong to the Tuscan tradition. The Italian Society of Pediatrics, on the other hand, has developed the Transcultural Food Pyramid , always inspired by the principles of the Mediterranean diet, but which also includes products from the food traditions of other countries, designed to unite cultures and flavors through food.
In each of these food pyramids, fruit and vegetables are always found at the lowest level, the one intended for foods to be consumed more frequently ( at least 5 portions every day); cereals and derivatives and extra virgin olive oil (source of monounsaturated fats) are on the second level; followed by legumes, dried fruit, milk and yogurt in the third; quarter fish and poultry; cheese, eggs and potatoes to the fifth; finally red meats, cold cuts and sweets at the last levels (they should be consumed less than two servings per week ). It is also advisable to moderate the consumption of salt, carry out regular physical activity and obtain adequate hours of rest.
Specific information on the diet to be followed during pregnancy is provided in chapter 9 of the “ Guidelines for healthy eating ” of the National Research Institute for Food (INRAN). In particular, pregnant women are recommended to 1) avoid excessive weight gain and cope with increased needs for protein, calcium, iron, folate and water by habitually consuming a wide variety of vegetables and fruits, fish, lean meats, eggs, milk and derivatives; 2) do not consume raw or undercooked foods of animal origin and 3) do not drink alcoholic beverages. The recommendation for women of childbearing age is to take an adequate amount of folate (400 micrograms per day starting at least one month before conception and for the first three months of pregnancy), in order to reduce the risk of neural tube in the fetus. Foods rich in folate are for example vegetables such as broccoli, spinach, green salad, cereals. A varied diet, rich in water (at least 2 liters per day), fresh vegetables, fish, milk and derivatives is also recommended during breastfeeding , during which it is also good to avoid alcoholic beverages and limit the consumption of products containing substances stimulants, such as coffee.
All guidelines also advise to limit the consumption of simple carbohydrates (i.e. sugars) , which include monosaccharides (glucose and fructose) and disaccharides, such as sucrose (commonly called sugar, composed of one glucose molecule and one fructose molecule), maltose (composed of two glucose molecules) and lactose (one molecule of glucose and one of galactose). Sugars are found in sweets, ice cream, drinks, jams, fruit juices, yogurt, honey. But they are also used in “unsuspected” foods, for example in balsamic vinegar, in ready-made sauces, and sometimes in sausages, to increase their pleasantness. From an energy point of view, 100 grams of sugar provide 392 kcal, which is a significant caloric intake, but characterized by a low nutritional value. The total energy load is equal to the sum of the calories derived from food and drinks. Energy comes from macronutrients: lipids (9 Kcal per gram), carbohydrates (4 Kcal per gram), proteins (4 Kcal per gram) and ethanol (7 Kcal per gram). WHO recommendations on sugar intake , addressed to the general population, both in adulthood and in childhood, are to reduce the consumption of sugars to less than 10% of the total daily energy load, even if the results of some studies would suggest a further reduction to levels below 5%. In pregnancy , in particular, simple sugars must be banned, and complex carbohydrates (pasta and bread, possibly wholemeal) should be preferred. In fact, the glycemic changes that are created when sweets are consumed predispose the mother to gestational diabetes and can alter fetal growth, the amount of amniotic fluid, and favor the development of type 2 diabetes, both of the mother and of the unborn child. the prenatal environment influences the health of the unborn child in later times. On the other hand, the results of many studies highlight how the foundations for many chronic diseases of adulthood (for example: type 2 diabetes mellitus, cardiovascular diseases, tumors) are already laid in fetal life  . So it is very important to read food labels carefully, keeping in mind the rules drawn up a few years ago by journalist and essayist Michael Pollan, published in part in the New York Times  and Time Magazine  :
- Don’t eat things your great grandmother wouldn’t recognize as food
- Avoid foods that contain sugars (avoid nutritionally empty calories)
- Stay away from products with health claims on their labels. Ѐ probable they are highly processed foods and the hypothesized beneficial effects are mostly doubtful (e.g. margarine in the past passed as a healthier food than butter, we know today instead to be more harmful than butter)
- Do not eat anything that is made up of more than five ingredients, or that contains ingredients with an unpronounceable name (they indicate highly processed foods)
- Stay away from supermarkets as much as possible and shop at the market – where you won’t find highly processed foods, but fresh foods with the highest nutritional value, exactly the kind of foods your great-grandmother would have recognized as food.
- Pay more and eat less (the higher the quality of the food, the higher the nutritional value: you will feel satiety sooner)
- Cut back on meat, and eat mostly vegetables *
- Do not prepare excessive portions, do not make an encore and eat with taste, possibly in good company, letting yourself be guided by culture and not by science
- Cook the dishes you eat yourself, it will help you eat well
- Eat like an omnivore and pay attention to biodiversity
- Stop eating when you are 80% full, to allow your brain, which “travels” 20 minutes later than the stomach, to understand that you are full.
- How you eat is just as important as what you eat. When you eat, relax, and enjoy the food.
Figure 1 The food pyramid based on the Mediterranean diet  .
About the author. Miriam Levi – specialist in Hygiene and Preventive Medicine
Born in Florence in 1978, after graduating in Medicine and Surgery in 2005, she obtained the specialization in Hygiene and Preventive Medicine in 2009. During his specialization he carries out a three-month internship at the European Regional Office of the World Health Organization, in Copenhagen.
Since 2010 he has been part of the research group coordinated by Prof. Paolo Bonanni at the Department of Public Health of the University of Florence and deals with epidemiology and the prevention of diseases preventable by vaccination. At the same time she was a project collaborator at the Regional Reference Center for Accidents and Occupational Diseases (CeRIMP).
He is currently finishing his PhD in Biomedical Sciences of the Evolutionary Age at the University of Florence, where he also has a research grant for a project on the importance of communication on vaccinations, and collaborates on a project with Genomedics srl to run of researches of clinical epidemiology.
She is the author of over 30 national and international scientific publications and has collaborated in the drafting of some chapters of Public Health manuals.
 World Health Organization – Regional Office for Europe Nutrition and Food Security. Healthy Eating during Pregnancy and Breastfeeding http://www.euro.who.int/__data/assets/pdf_file/0020/120296/E73182.pdf
 Skogen JC, Overland S. The fetal origins of adult disease: a narrative review of the epidemiological literature. JRSM Short Rep. 2012 Aug; 3 (8): 59 ( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3434434/ ).
* This point is all the more important considering that the excessive consumption of meat does not only damage the health of human beings, but also the environment and the economy. Almost 80% of agricultural resources are used for
feed farm animals, according to FAO
 Bach-Faig A1, Berry EM, Lairon D, Reguant J, Trichopoulou A, Dernini S, Medina FX, Battino M, Belahsen R, Miranda G, Serra-Majem L; Mediterranean Diet Foundation Expert Group. Mediterranean diet pyramid today. Science and cultural updates. Public Health Nutr. 2011 Dec; 14 (12A): 2274-84. http://www.ciiscam.org/files/download/pubblicazioni/phn %20new% 20md% 20pyramid.pdf