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O'Reilly SL, McAuliffe FM, Geraghty AA, Burden C, Davies A. Implementing weight management during and after pregnancy to reduce diabetes and CVD risk in maternal and child populations. Proc Nutr Soc 2023:1-12. [PMID: 38037711 DOI: 10.1017/s0029665123004883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Maintaining a healthy weight during pregnancy is critical for both women's and children's health. Excessive gestational weight gain (GWG) can lead to complications such as gestational diabetes, hypertension and caesarean delivery. Insufficient GWG can cause fetal growth restriction and increase infant mortality risk. Additionally, postpartum weight retention raises risk of obesity, type 2 diabetes and other chronic diseases for both mother and child. This review seeks to identify current obstacles in weight management research during and after pregnancy and explore evidence-based strategies to overcome them. Pregnancy offers a window of opportunity for health behaviour changes as women are more receptive to education and have regular contact with health services. Staying within Institute of Medicine's recommended GWG ranges is associated with better maternal and fetal outcomes. Systematic review evidence supports structured diet and physical activity pregnancy interventions, leading to reduced GWG and fewer complications. Health economic evaluation indicates significant returns from implementation, surpassing investment costs due to decreased perinatal morbidity and adverse events. However, the most effective way to implement interventions within routine antenatal care remains unclear. Challenges increase in the postpartum period due to competing demands on women physically, mentally and socially, hindering intervention reach and retention. Flexible, technology-supported interventions are needed, requiring frameworks such as penetration-implementation-participation-effectiveness and template-for-intervention-description-and-replication for successful implementation. Greater research efforts are necessary to inform practice and investigate fidelity aspects through pragmatic implementation trials during the pregnancy and postpartum periods. Understanding the best ways to deliver interventions will empower women to maintain a healthy weight during their reproductive years.
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Affiliation(s)
- Sharleen L O'Reilly
- School of Agriculture and Food Science, University College Dublin College of Health Sciences, Dublin, Ireland
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin School of Medicine, Dublin 2, Ireland
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin School of Medicine, Dublin 2, Ireland
| | - Aisling A Geraghty
- School of Agriculture and Food Science, University College Dublin College of Health Sciences, Dublin, Ireland
- UCD Perinatal Research Centre, National Maternity Hospital, University College Dublin School of Medicine, Dublin 2, Ireland
| | - Christy Burden
- Academic Women's Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anna Davies
- Academic Women's Health Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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O’Hara H, Taylor J, Woodside JV. The Association of Specific Dietary Patterns with Cardiometabolic Outcomes in Women with a History of Gestational Diabetes Mellitus: A Scoping Review. Nutrients 2023; 15:nu15071613. [PMID: 37049454 PMCID: PMC10097232 DOI: 10.3390/nu15071613] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/29/2023] Open
Abstract
Gestational diabetes mellitus is associated with a significantly increased risk of later type 2 diabetes (T2DM) and cardiovascular disease (CVD). Post-natal interventions aim to reduce this risk by addressing diet and lifestyle factors and frequently focus on restricting energy or macronutrient intake. With increased interest in the role of complete dietary patterns in the prevention of cardiometabolic disease, we sought to evaluate what is known about the role of dietary patterns in reducing cardiometabolic risk in women with previous GDM. A systematic search was conducted to identify studies relating to dietary pattern and cardiometabolic parameters in women with a history of GDM. The search criteria returned 6014 individual studies. In total, 71 full texts were reviewed, with 24 studies included in the final review. Eleven individual dietary patterns were identified, with the Alternative Health Eating Index (AHEI), Mediterranean diet (MD), and low glycaemic index (GI) as the most commonly featured dietary patterns. Relevant reported outcomes included incident T2DM and glucose tolerance parameters, as well as several cardiovascular risk factors. Dietary patterns which have previously been extensively demonstrated to reduce the risk of cardiovascular and metabolic disorders in the general population, including AHEI, MD, and DASH, were found to be associated with a reduction in the incidence of T2DM, hypertension, and additional risk factors for cardiometabolic disease in women with a history of GDM. Notable gaps in the literature were identified, including the relationship between dietary patterns and incident CVD, as well as the relationship between a low GI diet and the development of T2DM in this population.
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Lewandowski S, Neale E, D'Arcy E, Hodge AM, Schoenaker DAJM. Quality of low-carbohydrate diets among Australian post-partum women: Cross-sectional analysis of a national population-based cohort study. MATERNAL & CHILD NUTRITION 2023:e13502. [PMID: 36938942 DOI: 10.1111/mcn.13502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023]
Abstract
Low-carbohydrate diets (LCDs) are popular among people attempting weight loss and recommended for pregnant women with gestational diabetes (GDM), but they may increase health risks if nutritionally inadequate. We aimed to describe the dietary intake of post-partum women according to their relative carbohydrate intake, overall, and among women attempting weight loss or diagnosed with GDM in their recent pregnancy. This cross-sectional population-based cohort study included 2093 post-partum women aged 25-36 years who participated in the Australian Longitudinal Study on Women's Health. Dietary intake was assessed using a validated food frequency questionnaire. Relative carbohydrate intake was determined using a previously developed LCD score. Data were weighted to account for oversampling of women from rural/remote areas. More than half of women (n[weighted] = 1362, 66.3%) were trying to lose weight, and 4.6% (n[weighted]=88) had GDM in their recent pregnancy. Women with the lowest relative carbohydrate intake (LCD score quartile 4) consumed 36.8% of total energy intake from carbohydrates, and had a lower intake of refined grains, whole grains, fruit and fruit juice, and a higher intake of red and processed meat, compared with women with the highest relative carbohydrate intake (quartile 1). Different food groups, both healthy and unhealthy, were restricted depending on whether women were attempting weight loss and had recent GDM. These findings may reflect a lack of knowledge among post-partum women on carbohydrates and dietary guidelines. Health professionals may have an important role in providing advice and support for post-partum women who wish to restrict their carbohydrate intake, to ensure optimal diet quality.
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Affiliation(s)
- Sophie Lewandowski
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia
| | - Elizabeth Neale
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, New South Wales, Australia
| | - Ellie D'Arcy
- Integrated Care, Western New South Wales Local Health District, New South Wales, Dubbo, Australia
| | - Allison M Hodge
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Danielle A J M Schoenaker
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Wollongong, New South Wales, Australia.,School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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McAuley E, Fleck O, Cassidy L, Kemp BJ, Cupples G, Kelly B, Creighton RM, Graham U, Wallace H, Patterson CC, McCance DR. A pragmatic lifestyle intervention for overweight and obese women with gestational diabetes mellitus (PAIGE2): A parallel arm, multicenter randomized controlled trial study protocol. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1118509. [PMID: 37034478 PMCID: PMC10080069 DOI: 10.3389/fcdhc.2023.1118509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/07/2023] [Indexed: 04/11/2023]
Abstract
Background The global epidemic of type 2 diabetes (T2D) and obesity has been translated into pregnancy, with approximately 18% of women being diagnosed worldwide with Gestational Diabetes Mellitus (GDM). Whilst preventive strategies have proven effective in the non-pregnant context, attrition rates are high and there is an urgent need to develop a customized, pragmatic lifestyle intervention for women both during and after pregnancy. Diet and exercise modification, behavioral support, and Commercial Weight Management Organizations have been strongly recommended to aid postpartum weight reduction for mothers with previous GDM, subsequently reducing their risk of developing obesity and T2D. This study, informed by a previous pilot study, aims to determine the effectiveness of a pragmatic pregnancy and postpartum lifestyle modification program for overweight women with previous GDM (PAIGE2) to reduce body weight at 12 months postpartum. Methods/design This paper summarizes the protocol for the PAIGE2 study, which has been developed based on results from a pilot study (PAIGE). A six center, two parallel arm, 12-month, randomized controlled trial will be conducted across Northern Ireland and the Republic of Ireland (3 centers each), involving 340 women with GDM and body mass index ≥25 kg/m2 recruited during pregnancy. The lifestyle intervention involves a one-hour virtual educational program (to take place at 32-36 weeks gestation). Postpartum, the intervention will include monthly phone calls, weekly motivational text messages, weekly step counts, and referral for three months to a Commercial Weight Management Organization (Slimming World). The control arm will receive usual care as offered by the local maternity hospital. The primary outcome is weight loss at 12 months postpartum. Study visits for anthropometric and clinical measurements, fasting blood samples, questionnaires pertaining to health, wellbeing and physical activity will take place at 6 weeks, 6- and 12-months postpartum. Focus groups will be conducted with intervention mothers' post-intervention to determine the acceptability of the study design including utility of a Commercial Weight Management Organization, feasibility of remote patient contact, family involvement and patient satisfaction. Discussion The PAIGE2 study will address the gaps in previously conducted research and, if positive, has the potential to have major public health implications for the prevention of future GDM and subsequent T2D. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT04579016?term=NCT04579016&draw=2&rank=1, identifier NCT04579016.
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Affiliation(s)
- Emma McAuley
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Olwen Fleck
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Laura Cassidy
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Bridie J. Kemp
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, United Kingdom
| | - Gina Cupples
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Bronagh Kelly
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Rachel M. Creighton
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Una Graham
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Helen Wallace
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Chris C. Patterson
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - David R. McCance
- Regional Centre for Endocrinology and Diabetes, Royal Jubilee Maternity Centre, Belfast Health and Social Care Trust, Belfast, United Kingdom
- *Correspondence: David R. McCance,
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Potzel AL, Gar C, Seissler J, Lechner A. A Smartphone App (TRIANGLE) to Change Cardiometabolic Risk Behaviors in Women Following Gestational Diabetes Mellitus: Intervention Mapping Approach. JMIR Mhealth Uhealth 2021; 9:e26163. [PMID: 33973864 PMCID: PMC8150415 DOI: 10.2196/26163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/11/2021] [Accepted: 03/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is the most common complication during pregnancy and is associated with an increased risk for the development of cardiometabolic diseases. Behavioral interventions can reduce this risk, but current solutions insufficiently address the requirements for such a program. The systematic development of a scalable mobile health (mHealth) promotion program for mothers during the first years post-GDM may contribute to solving this problem. OBJECTIVE The aim of this project was to systematically plan and develop a theory- and evidence-based mHealth intervention to change cardiometabolic risk behaviors in women during the first 5 years post-GDM that meets women's expected standards of commercial health apps. METHODS The intervention mapping steps 1 to 4 structured the systematic planning and development of the mHealth program described in this paper. Steps 1 and 2 led to a theory- and evidence-based logic model of change for cardiometabolic health. Based on this model, the prevention program was designed (step 3) and produced (step 4) in cooperation with industrial partners to ensure a high technological standard of the resulting smartphone app for the iPhone (Apple Inc). Step 4 included a user study with women during the first 5 years post-GDM once a beta version of the app ("TRIANGLE") was available. The user study comprised 2 test rounds of 1 week (n=5) and 4 weeks (n=6), respectively. The tests included validated questionnaires on user acceptance, user logs, and think-alouds with semistructured interviews. RESULTS The novel TRIANGLE app is among the first self-paced smartphone apps for individual habit change in the 3 lifestyle areas of physical activity, nutrition, and psychosocial well-being. The 3 core features-a challenge system, human coaching, and a library-address 11 behavioral determinants with 39 behavior change methods to support lifestyle changes. Participants in the user study showed a high acceptance, high perceived quality, and high perceived impact of the TRIANGLE app on their health behaviors. Participants tested the app regularly, used it intuitively, and suggested improvements. We then adapted the TRIANGLE app according to the insights from the user study before the full TRIANGLE program production. CONCLUSIONS The intervention mapping approach was feasible to plan and develop an innovative and scalable smartphone solution for women during the first 5 years post-GDM. The resulting TRIANGLE intervention has the potential to support behavior change for cardiometabolic disease prevention. However, the app needs further refinement and testing in clinical trials. Intervention mapping steps 5 (implementation plan) and 6 (evaluation plan) may support the integration of the TRIANGLE intervention into routine care. TRIAL REGISTRATION German Clinical Trials Register DRKS00012736; https://www.drks.de/DRKS00012736.
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Affiliation(s)
- Anne Lotte Potzel
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Christina Gar
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Jochen Seissler
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- German Center for Diabetes Research, Neuherberg, Germany
| | - Andreas Lechner
- Diabetes Research Group, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, Munich, Germany
- CCG Type 2 Diabetes, Helmholtz Zentrum München, Munich, Germany
- German Center for Diabetes Research, Neuherberg, Germany
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Makama M, Awoke MA, Skouteris H, Moran LJ, Lim S. Barriers and facilitators to a healthy lifestyle in postpartum women: A systematic review of qualitative and quantitative studies in postpartum women and healthcare providers. Obes Rev 2021; 22:e13167. [PMID: 33403746 DOI: 10.1111/obr.13167] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 12/26/2022]
Abstract
A healthy postpartum lifestyle is vital for the promotion of optimal maternal health, return to pre-pregnancy weight and prevention of postpartum weight retention, but barriers exist. We performed a systematic review that aimed to describe the barriers and facilitators to a healthy lifestyle in the first 2 years postpartum from the perspectives of women and healthcare providers. Databases were searched for eligible studies published up to 26 August 2019. Following thematic analysis, identified themes were mapped to the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behaviour model. We included 28 qualitative and quantitative studies after screening 15,643 citations and 246 full texts. We identified barriers and facilitators relating to capability (e.g., lack of knowledge regarding benefits of lifestyle behaviours; limitations in healthcare providers' skills in providing lifestyle support), opportunity (e.g., social support from partners, family, friends and healthcare providers; childcare needs) and motivation (e.g., identifying benefits of exercise and perception of personal health; enjoyment of the activity or food). We suggest intervention components to include in lifestyle interventions for postpartum women based on the identified themes. Our findings provide evidence to inform the development of interventions to support postpartum women in adopting and maintaining a healthy lifestyle.
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Affiliation(s)
- Maureen Makama
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Mamaru Ayenew Awoke
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Lisa J Moran
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
| | - Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
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Siritharan SS, Henry A, Gow ML, Roberts LM, Yao A, Ojurovic M, O'Sullivan AJ. Maternal macro- and micronutrient intake six months after hypertensive versus normotensive pregnancy: is poor diet quality contributing to future cardiometabolic disease risk? Pregnancy Hypertens 2021; 23:196-204. [PMID: 33515976 DOI: 10.1016/j.preghy.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertensive pregnancy is associated with increased long-term cardiometabolic disease risk. Assessing dietary intake patterns after hypertensive (HP) versus normotensive pregnancy (NP) may provide insights into the mechanism of this risk. METHODS This study was a prospective sub-study of the P4 (Postpartum, Physiology, Psychology and Paediatrics) cohort. Women were studied six months after NP versus HP (preeclampsia or gestational hypertension). Dietary energy, macronutrient and micronutrient intake were measured using a three-day food diary (FoodWorks™) and assessed against Australian and New Zealand Nutrient Reference Values to determine nutritional adequacy. Comparisons between breastfeeding and non-breastfeeding women were assessed, and linear regression modelling (using hypertensive status, breastfeeding status, and demographic/pregnancy variables) performed to assess predictors of energy intake. RESULTS Seventy-four women (60 NP, 14 HP) were included. HP women had higher mean body mass index (p = 0.02) and lower breastfeeding rates (29% HP versus 83% NP, p < 0.001) compared to NP women. Twenty-four-hour energy intake and total fat intake were 17% and 20% lower after HP respectively. Nutrient deficiencies were prevalent across all participants, however more HP women had inadequate magnesium, calcium and phosphorus intake. Breastfeeding women had significantly increased energy (17%), carbohydrate (15%) and total fat intake (21%), and increased vitamin A, vitamin E, riboflavin, magnesium and iron intake compared to non-breastfeeding women. HP and breastfeeding status were independent predictors of energy intake. CONCLUSIONS HP women had lower micronutrient intake and greater prevalence of nutritional inadequacy compared to NP women, reflecting poorer diet quality and potentially contributing to future increased cardiometabolic disease risk.
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Affiliation(s)
- S S Siritharan
- School of Women's and Children's Health, UNSW Medicine, Level 1 Royal Hospital for Women, Barker Street, NSW 2031, Australia.
| | - A Henry
- School of Women's and Children's Health, UNSW Medicine, Level 1 Royal Hospital for Women, Barker Street, NSW 2031, Australia; Department of Women's and Children's Health, St George Hospital - Prichard Wing Level 1, Gray Street, Kogarah, NSW 2217, Australia; Global Women's Health Program, The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW 2042, Australia
| | - M L Gow
- The University of Sydney Children's Hospital Westmead Clinical School, Corner Hawkesbury Road and Hainsworth Street, Westmead, NSW 2145, Australia
| | - L M Roberts
- Department of Women's and Children's Health, St George Hospital - Prichard Wing Level 1, Gray Street, Kogarah, NSW 2217, Australia; St George and Sutherland Clinical School, Short Street, St George Hospital, Kogarah, NSW 2217, Australia; Faculty of Health - University of Technology Sydney, 235 Jones Street, Ultimo, NSW 2007, Australia
| | - A Yao
- School of Women's and Children's Health, UNSW Medicine, Level 1 Royal Hospital for Women, Barker Street, NSW 2031, Australia; Department of Endocrinology, St George Hospital, Kogarah, NSW 2217, Australia
| | - M Ojurovic
- School of Women's and Children's Health, UNSW Medicine, Level 1 Royal Hospital for Women, Barker Street, NSW 2031, Australia
| | - A J O'Sullivan
- St George and Sutherland Clinical School, Short Street, St George Hospital, Kogarah, NSW 2217, Australia; Department of Endocrinology, St George Hospital, Kogarah, NSW 2217, Australia
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Diet Quality Indices Used in Australian and New Zealand Adults: A Systematic Review and Critical Appraisal. Nutrients 2020; 12:nu12123777. [PMID: 33317123 PMCID: PMC7763901 DOI: 10.3390/nu12123777] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/07/2020] [Accepted: 12/07/2020] [Indexed: 12/24/2022] Open
Abstract
Distilling the complexity of overall diet into a simple measure or summative score by data reduction methods has become a common practice in nutritional epidemiology. Recent reviews on diet quality indices (DQI) have highlighted the importance of sound construction criteria and validation. The aim of this current review was to identify and critically appraise all DQI used within Australian and New Zealand adult populations. Twenty-five existing DQI were identified by electronic searching in Medline and hand searching of reference lists. DQI were constructed based on the respective national dietary guidelines and condition-specific recommendations. For preferable features of DQI, six captured the dimensions of adequacy, moderation and balance; five had a nested structure; 12 consisted of foods, food groups and nutrients; 11 used metric scoring systems and most of those with metric scales used normative cutoff points. Food frequency questionnaires, either alone or with other methods, were the most common dietary assessment method used in 20 DQI. For evaluation of DQI, construct validity and relative validity are reported. Based on our critical appraisal, Dietary Guideline Index (DGI), Dietary Guideline Index-2013 (DGI-2013), Total Diet Score (TDS), Healthy Eating Index for Australian Adults-2013 (HEIFA-2013), and Aussie-Diet Quality Index (Aussie-DQI) were the preferred DQI used in Australian adults according to dimension, indicator selection, scoring criteria and evaluation. Further work is needed to enhance the construction of all Australian and New Zealand DQI, especially in terms of dimension and structure, for alignment with recommended construction criteria.
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D'Arcy E, Rayner J, Hodge A, Ross LJ, Schoenaker DAJM. The Role of Diet in the Prevention of Diabetes among Women with Prior Gestational Diabetes: A Systematic Review of Intervention and Observational Studies. J Acad Nutr Diet 2019; 120:69-85.e7. [PMID: 31636052 DOI: 10.1016/j.jand.2019.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/26/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND Women with prior gestational diabetes (GDM) have an increased lifetime risk of developing type 2 diabetes mellitus (T2DM). There are no up-to-date systematic reviews analyzing the relationship of diet with risk of developing T2DM following GDM. OBJECTIVE To systematically review the evidence from intervention and observational studies on effects of dietary interventions and associations of dietary intake with T2DM outcomes in women with a GDM history. METHODS Six electronic databases were searched (Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, Cochrane Central, Proquest, and Scopus) for articles published until May 2019. This review includes intervention and observational studies among women of any age with a history of GDM that reported on the effects of dietary interventions or association of dietary intake (energy, nutrients, foods, dietary patterns) with T2DM, impaired glucose tolerance, impaired fasting glucose, or prediabetes. RESULTS The systematic review identified five articles reporting results from four intervention studies, and seven articles reporting results from four observational studies. Findings from intervention studies indicated trends toward beneficial effects of a low-glycemic index diet, a low-carbohydrate diet, and a diet in line with general population dietary guidelines, but studies had unclear or high risk of bias. Findings from two cross-sectional and one prospective study indicated poorer diabetes outcomes for women with higher intakes of branched-chain amino acids, total and heme iron, and a diet relatively low in carbohydrates and high in animal fat and protein, and better outcomes among those consuming diets rich in fruit, vegetables, nuts, fish, and legumes, and low in red and processed meats and sugar-sweetened beverages, after adjustment for confounders, including body mass index. CONCLUSIONS Findings from observational studies support current dietary guidelines for the prevention of T2DM. Further dietary intervention studies are needed to confirm whether or not dietary modification following a GDM pregnancy reduces women's risk of developing T2DM.
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O'Reilly S, Versace V, Mohebbi M, Lim S, Janus E, Dunbar J. The effect of a diabetes prevention program on dietary quality in women with previous gestational diabetes. BMC WOMENS HEALTH 2019; 19:88. [PMID: 31269928 PMCID: PMC6610772 DOI: 10.1186/s12905-019-0788-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/24/2019] [Indexed: 12/12/2022]
Abstract
Background Women with gestational diabetes have low diet quality. We evaluated the effectiveness of a group-based lifestyle modification program for improvement of dietary quality in women with previous gestational diabetes predominantly within their first postnatal year. Methods Women were randomised to intervention (n = 284) or usual care (n = 289). Dietary data was collected at baseline and twelve months using a food frequency questionnaire and recoded into the Australian Recommended Food Score (ARFS). Mixed model analyses investigated the intervention effect on ARFS (per-protocol-set (PPS) excluded women without the minimum intervention exposure). Results Baseline mean total ARFS was low (31.8 ± 8.9, maximum score = 74) and no significant changes were seen in total ARFS (Cohen’s D = − 0.06). 2% reduction in alcohol for intervention (0.05, 0.26) compared with − 1% for usual care (Odds ratio: 0.68; 95%CI 0.46, 0.99). Dairy ARFS sub-category significantly improved (low fat/saturated fat foods) in the intervention group over time compared with usual care for the PPS analysis (dairy + 0.28 in intervention (95%CI 0.08, 0.48) compared with + 0.02 in usual care (95%CI -0.14, 0.18) (group-by-treatment interaction p = 0.05, Cohen’s D = 0.14)). Conclusions Engaging with the intervention improved aspects of diet quality that aligned with minimum intervention exposure, but the total diet quality remains low. Further research is needed to improve diabetes prevention program engagement. Trial registration Australian New Zealand Clinical Trials Registry ANZCTRN12610000338066, April 2010.
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Affiliation(s)
- Sharleen O'Reilly
- UCD Institute of Food and Health, University College Dublin, Dublin, Ireland.
| | - Vincent Versace
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Australia
| | | | - Siew Lim
- Monash Centre for Health Research and Implementation, Monash University, Clayton, Australia
| | - Edward Janus
- General Internal Medicine Unit, Western Health and Department of Medicine, Melbourne Medical School - Western Precinct, University of Melbourne, Melbourne, Australia
| | - James Dunbar
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Australia
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Misra S, Wai Yew Y, Seok Shin T. Maternal dietary patterns, diet quality and micronutrient status in gestational diabetes mellitus across different economies: A review. AIMS MEDICAL SCIENCE 2019. [DOI: 10.3934/medsci.2019.1.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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12
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Improved dietary quality in women with previous gestational diabetes: secondary analysis of a randomised trial. Proc Nutr Soc 2018. [DOI: 10.1017/s0029665118000575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pedersen ALW, Terkildsen Maindal H, Juul L. How to prevent type 2 diabetes in women with previous gestational diabetes? A systematic review of behavioural interventions. Prim Care Diabetes 2017; 11:403-413. [PMID: 28601549 DOI: 10.1016/j.pcd.2017.05.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 01/22/2017] [Accepted: 05/09/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Women with previous gestational diabetes (GDM) have a seven times higher risk of developing type 2 diabetes (T2DM) than women without. We aimed to review the evidence of effective behavioural interventions seeking to prevent T2DM in this high-risk group. METHODS A systematic review of RCTs in several databases in March 2016. RESULTS No specific intervention or intervention components were found superior. The pooled effect on diabetes incidence (four trials) was estimated to: -5.02 per 100 (95% CI: -9.24; -0.80). CONCLUSIONS This study indicates that intervention is superior to no intervention in prevention of T2DM among women with previous GDM.
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MESH Headings
- Counseling
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/epidemiology
- Diabetes Mellitus, Type 2/prevention & control
- Diabetes Mellitus, Type 2/psychology
- Diabetes, Gestational/blood
- Diabetes, Gestational/epidemiology
- Diabetes, Gestational/psychology
- Diabetes, Gestational/therapy
- Female
- Health Behavior
- Health Knowledge, Attitudes, Practice
- Healthy Lifestyle
- Humans
- Incidence
- Patient Education as Topic
- Pregnancy
- Protective Factors
- Risk Factors
- Risk Reduction Behavior
- Treatment Outcome
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Affiliation(s)
- Anne Louise Winkler Pedersen
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Bartholins Alle 2, DK 8000 Aarhus C, Denmark.
| | - Helle Terkildsen Maindal
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Bartholins Alle 2, DK 8000 Aarhus C, Denmark; Steno Diabetes Center Copenhagen, Health Promotion Research, Denmark
| | - Lise Juul
- Department of Public Health, Section for Health Promotion and Health Services, Aarhus University, Bartholins Alle 2, DK 8000 Aarhus C, Denmark; Department of Clinical Medicine, Danish Centre for Mindfulness, Aarhus University, Denmark
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Zulfiqar T, Lithander FE, Banwell C, Young R, Boisseau L, Ingle M, Nolan CJ. Barriers to a healthy lifestyle post gestational-diabetes: An Australian qualitative study. Women Birth 2017; 30:319-324. [PMID: 28169159 DOI: 10.1016/j.wombi.2016.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/25/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overseas-born-women from certain ethnicities are at high risk of type-2 diabetes and related metabolic disorders. This study explored the barriers and facilitators to long-term healthy lifestyle recommendations among Australian-born and overseas-born-women who attended health promotion sessions at a tertiary Australian Hospital for gestational diabetes 3-4 years previously. METHOD Face-to-face semi-structured interviews were conducted. Data were analyzed to identify major themes and the differing experiences of both groups of women. FINDINGS Women in both groups faced many barriers to improve post-gestational-diabetes lifestyle. Women from both groups recalled healthy lifestyle recommendations for during pregnancy they received at the service, but had difficulty recalling the long-term lifestyle recommendations. Timing of the health information, non-reiteration of lifestyle recommendations, uncoordinated and fragmented health system support after childbirth were barriers faced by all women. Additional barriers for overseas-born women included the cultural competence of the health education material, their cultural preferences for food and physical activities and unsupportive family and partner. Both groups had excellent compliance with the first annual postnatal oral-glucose-tolerance-test. This was attributed to the personal motivation and health professional reminder. Women only reverted to the healthy lifestyles postnatally for weight loss. CONCLUSION A better understanding of the barriers to healthy lifestyle by women in their everyday lives will assist in the development of culturally appropriate health promotion guidelines and strategies. Constant un-fragmented postnatal engagement by the specialised diabetes clinics and primary health care services is crucial to sustain the healthy lifestyle in the long-term for women with previous gestational-diabetes.
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Affiliation(s)
- Tehzeeb Zulfiqar
- National Centre of Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia; ANU College of Medicine, Biology and Environment, Australian National University, Canberra, ACT, Australia.
| | - Fiona E Lithander
- NIHR Biomedical Research Unit in Nutrition, Diet and Lifestyle at University Hospitals Bristol NHS Foundation Trust and the University of Bristol, UK.
| | - Cathy Banwell
- National Centre of Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia.
| | - Rosemary Young
- ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, ACT, Australia.
| | - Lynelle Boisseau
- ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, ACT, Australia.
| | - Martha Ingle
- ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, ACT, Australia.
| | - Christopher J Nolan
- ANU College of Medicine, Biology and Environment, Australian National University, Canberra, ACT, Australia; ACT Health Diabetes Service, Canberra Hospital and Health Services, Canberra, ACT, Australia.
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Diet quality before or during pregnancy and the relationship with pregnancy and birth outcomes: the Australian Longitudinal Study on Women's Health. Public Health Nutr 2016; 19:2975-2983. [PMID: 27238757 DOI: 10.1017/s1368980016001245] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To assess whether diet quality before or during pregnancy predicts adverse pregnancy and birth outcomes in a sample of Australian women. DESIGN The Dietary Questionnaire for Epidemiological Studies was used to calculate diet quality using the Australian Recommended Food Score (ARFS) methodology modified for pregnancy. SETTING A population-based cohort participating in the Australian Longitudinal Study on Women's Health (ALSWH). SUBJECTS A national sample of Australian women, aged 20-25 and 31-36 years, who were classified as preconception or pregnant when completing Survey 3 or Survey 5 of the ALSWH, respectively. The 1907 women with biologically plausible energy intake estimates were included in regression analyses of associations between preconception and pregnancy ARFS and subsequent pregnancy outcomes. RESULTS Preconception and pregnancy groups were combined as no significant differences were detected for total and component ARFS. Women with gestational hypertension, compared with those without, had lower scores for total ARFS, vegetable, fruit, grain and nuts/bean/soya components. Women with gestational diabetes had a higher score for the vegetable component only, and women who had a low-birth-weight infant had lower scores for total ARFS and the grain component, compared with those who did not report these outcomes. Women with the highest ARFS had the lowest odds of developing gestational hypertension (OR=0·4; 95 % CI 0·2, 0·7) or delivering a child of low birth weight (OR=0·4; 95 % CI 0·2, 0·9), which remained significant for gestational hypertension after adjustment for potential confounders. CONCLUSIONS A high-quality diet before and during pregnancy may reduce the risk of gestational hypertension for the mother.
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16
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Yuen L, Wong VW. Gestational diabetes mellitus: Challenges for different ethnic groups. World J Diabetes 2015; 6:1024-1032. [PMID: 26240699 PMCID: PMC4515442 DOI: 10.4239/wjd.v6.i8.1024] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 04/09/2015] [Accepted: 05/06/2015] [Indexed: 02/05/2023] Open
Abstract
Ethnicity is defined as “belonging to a social group that has a common national or cultural tradition”. Membership of certain ethnic groups has long been associated with increased risk of gestational diabetes mellitus (GDM). Studies that examined ethnic differences amongst women with GDM were often conducted in western countries where women from various ethnic backgrounds were represented. The prevalence of GDM appears to be particularly high among women from South Asia and South East Asia, compared to Caucasian, African-American and Hispanic communities. For some, but not all ethnic groups, the body mass index is a risk factor for the development of GDM. Even within a particular ethnic group, those who were born in their native countries have a different risk profile for GDM compared to those born in western countries. In terms of treatment, medical nutrition therapy (MNT) plays a key role in the management of GDM and the prescription of MNT should be culturally sensitive. Limited studies have shown that women who live in an English-speaking country but predominantly speak a language other than English, have lower rates of dietary understanding compared with their English speaking counterparts, and this may affect compliance to therapy. Insulin therapy also plays an important role and there appears to be variation as to the progression of women who progress to requiring insulin among different ethnicities. As for peri-natal outcomes, women from Pacific Islander countries have higher rates of macrosomia, while women from Chinese backgrounds had lower adverse pregnancy outcomes. From a maternal outcome point of view, pregnant women from Asia with GDM have a higher incidence of abnormal glucose tolerance test results post-partum and hence a higher risk of future development of type 2 diabetes mellitus. On the other hand, women from Hispanic or African-American backgrounds with GDM are more likely to develop hypertension post-partum. This review highlights the fact that management needs to be individualised and the clinician should be mindful of the impact that differences in ethnicity may have on the clinical characteristics and pregnancy outcomes in women affected by GDM, particularly those living in Western countries. Understanding these differences is critical in the delivery of optimal antenatal care for women from diverse ethnic backgrounds.
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Xiao RS, Simas TAM, Person SD, Goldberg RJ, Waring ME. Diet quality and history of gestational diabetes mellitus among childbearing women, United States, 2007-2010. Prev Chronic Dis 2015; 12:E25. [PMID: 25719215 PMCID: PMC4344352 DOI: 10.5888/pcd12.140360] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Women with a history of gestational diabetes mellitus (GDM) have elevated risk of developing type 2 diabetes. Diet quality plays an important role in the prevention of type 2 diabetes. We compared diet quality among childbearing women with a history of GDM with the diet quality of childbearing women without a history of GDM. Methods We used data from the National Health and Nutrition Examination Survey for 2007 through 2010. We included women without diabetes aged 20 to 44 years whose most recent live infant was born within the previous 10 years and who completed two 24-hour dietary recalls. The Healthy Eating Index (HEI)-2010 estimated overall and component diet quality. Multivariable linear regression models estimated the association between a history of GDM and current diet quality, adjusting for age, education, smoking status, and health risk for diabetes. Results A history of GDM was reported by 7.7% of women. Compared with women without a history of GDM, women with a history of GDM had, on average, 3.4 points lower overall diet quality (95% confidence interval [CI], −6.6 to −0.2) and 0.9 points lower score for consumption of green vegetables and beans (95% CI, −1.4 to −0.4). Other dietary component scores did not differ by history of GDM. Conclusion In the United States, women with a history of GDM have lower diet quality compared with women who bore a child and do not have a history of GDM. Improving diet quality may be a strategy for preventing type 2 diabetes among childbearing women.
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Affiliation(s)
- Rui S Xiao
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, The Albert Sherman Center, ASC7-1063, Worcester, MA 01605.
| | - Tiffany A Moore Simas
- University of Massachusetts Medical School and University of Massachusetts Memorial Health Care, Worcester, Massachusetts
| | - Sharina D Person
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert J Goldberg
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Molly E Waring
- University of Massachusetts Medical School, Worcester, Massachusetts
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Ferranti EP, Narayan KMV, Reilly CM, Foster J, McCullough M, Ziegler TR, Guo Y, Dunbar SB. Dietary self-efficacy predicts AHEI diet quality in women with previous gestational diabetes. DIABETES EDUCATOR 2014; 40:688-99. [PMID: 24942530 DOI: 10.1177/0145721714539735] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE The purpose of this study was to examine the association of intrapersonal influences of diet quality as defined by the Health Belief Model constructs in women with recent histories of gestational diabetes. METHODS A descriptive, correlational, cross-sectional design was used to analyze relationships between diet quality and intrapersonal variables, including perceptions of threat of type 2 diabetes mellitus development, benefits and barriers of healthy eating, and dietary self-efficacy, in a convenience sample of 75 community-dwelling women (55% minority; mean age, 35.5 years; SD, 5.5 years) with previous gestational diabetes mellitus. Diet quality was defined by the Alternative Healthy Eating Index (AHEI). Multiple regression was used to identify predictors of AHEI diet quality. RESULTS Women had moderate AHEI diet quality (mean score, 47.6; SD, 14.3). Only higher levels of education and self-efficacy significantly predicted better AHEI diet quality, controlling for other contributing variables. CONCLUSIONS There is a significant opportunity to improve diet quality in women with previous gestational diabetes mellitus. Improving self-efficacy may be an important component to include in nutrition interventions. In addition to identifying other important individual components, future studies of diet quality in women with previous gestational diabetes mellitus are needed to investigate the scope of influence beyond the individual to potential family, social, and environmental factors.
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Affiliation(s)
- Erin Poe Ferranti
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Ferranti, Dr Reilly, Dr Foster, Dr Dunbar)
| | - K M Venkat Narayan
- Rollins School of Public Health and School of Medicine, Emory University, Atlanta, Georgia (Dr Narayan, Dr Guo)
| | - Carolyn M Reilly
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Ferranti, Dr Reilly, Dr Foster, Dr Dunbar)
| | - Jennifer Foster
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Ferranti, Dr Reilly, Dr Foster, Dr Dunbar)
| | | | - Thomas R Ziegler
- School of Medicine, Emory University, Atlanta, Georgia (Dr Ziegler)
| | - Ying Guo
- Rollins School of Public Health and School of Medicine, Emory University, Atlanta, Georgia (Dr Narayan, Dr Guo)
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia (Dr Ferranti, Dr Reilly, Dr Foster, Dr Dunbar)
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Morrison MK, Lowe JM, Collins CE. Response to Letter to the Editor regarding "Australian women's experiences of living with gestational diabetes". Women Birth 2014; 27:72. [PMID: 24480014 DOI: 10.1016/j.wombi.2014.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Melinda K Morrison
- Education & Prevention Division, Australian Diabetes Council, Sydney, NSW, Australia.
| | - Julia M Lowe
- University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
| | - Clare E Collins
- School of Health Sciences, Faculty of Health & Medicine, University of Newcastle, Australia.
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Cumulative poor psychosocial and behavioral health among low-income women at 6 weeks postpartum. Nurs Res 2013; 62:233-42. [PMID: 23817281 DOI: 10.1097/nnr.0b013e31829499ac] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND During the postpartum period, women may experience unfavorable psychosocial and behavioral health in multiple domains with adverse effects on parenting and maternal and infant health. Yet, little is known about the accumulation of poor health across the domains of depressive symptoms; body image; diet and physical activity; substance use including smoking and alcohol; and general self-care at 6 weeks postpartum, the usual end of maternity care. OBJECTIVES The aims of this study were to evaluate relationships among the domains comprising psychosocial and behavioral health and to examine the distribution and risk factors associated with cumulative poor psychosocial and behavioral health at 6 weeks postpartum. METHODS This study was a secondary analysis of cumulative poor health assessed by self-report scales for depressive symptoms, body image dissatisfaction, diet and exercise, substance use, and general self-care among 419 low-income White, African American, and Hispanic women at 6 weeks postpartum. Multivariable Poisson and logistic regression were used in key analyses. RESULTS The correlation among psychosocial and behavioral domains had a range of r = .50-.00. In this sample of women, 45% had two or more domains in which they had poor health. The model testing risk factors for cumulative poor health was significant (likelihood ratio chi-square = 39.26, df = 11, p < 0.05), with two significant factors: not exclusively breastfeeding (odds ratio [OR] = 1.459, 95% confidence interval [CI] [1.119, 1.901]) and Hispanic ethnicity (OR = 0.707, 95% CI [0.582, 0.858], psuedo-R = .029). Within individual domains, significant risk factors (body mass index, not exclusively breastfeeding, ethnicity, education level, and parity) varied by domain. DISCUSSION Many low-income women postpartum have poor psychosocial and behavioral health in multiple domains, which constitute areas for health promotion and early disease prevention.
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Aljadani HM, Patterson A, Sibbritt D, Hutchesson MJ, Jensen ME, Collins CE. Diet quality, measured by fruit and vegetable intake, predicts weight change in young women. J Obes 2013; 2013:525161. [PMID: 24062946 PMCID: PMC3770048 DOI: 10.1155/2013/525161] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 06/18/2013] [Accepted: 07/11/2013] [Indexed: 01/31/2023] Open
Abstract
This study investigates the relationship between diet quality and weight gain in young women. Young women (n = 4,287, with 1,356 women identified as plausible subsample aged 27.6 ± 1.5 years at baseline) sampled from the Australian Longitudinal Study on Women's Health study completed food frequency questionnaires in 2003, which were used to evaluate diet quality using three indices: Australian Recommended Food Score (ARFS), Australian Diet Quality Index (Aus-DQI), and Fruit and Vegetable Index (FAVI). Weight was self-reported in 2003 and 2009. Multivariate linear regression was used to examine the association between tertiles of each diet quality index and weight change from 2003 to 2009. The ARFS and FAVI were significant predictors of 6-year weight change in this group of young women, while Aus-DQI did not predict weight change (P > 0.05). In the fully adjusted model, those who were in the top tertile of the ARFS significantly gained lower weight gain compared with the lower tertile for the plausible TEI sub-sample (β = -1.6 kg (95% CI: -2.67 to -0.56), P = 0.003). In the fully adjustment model, young women were classified in the highest FAVI tertile and gained significantly less weight than those in the lowest tertile for the plausible TEI (β = -1.6 kg (95% CI: -2.4 to -0.3) P = 0.01). In conclusion, overall diet quality measured by the ARFS and the frequency and variety of fruit and vegetable consumption may predict long-term weight gain in young women. Therefore, health promotion programs encouraging frequent consumption of a wide variety of fruits and vegetables are warranted.
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Affiliation(s)
- Haya M. Aljadani
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308, Australia
- School of Health Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
- Faculty of Nutrition and Health Science, King Abdul-Aziz University, Jeddah, MK 80200, Saudi Arabia
| | - Amanda Patterson
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308, Australia
- School of Health Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
| | - David Sibbritt
- Faculty of Health, University of Technology Sydney, Sydney, NSW 2007, Australia
| | - Melinda J. Hutchesson
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308, Australia
- School of Health Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Megan E. Jensen
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308, Australia
- School of Health Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
| | - Clare E. Collins
- Priority Research Centre in Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW 2308, Australia
- School of Health Sciences, University of Newcastle, Newcastle, NSW 2308, Australia
- *Clare E. Collins:
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