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Delgas F, Bitsch L, König LM, Beitze DE, Scherbaum V, Podszun MC. Dietary supplement use among lactating mothers following different dietary patterns - an online survey. Matern Health Neonatol Perinatol 2024; 10:3. [PMID: 38297389 PMCID: PMC10832081 DOI: 10.1186/s40748-023-00171-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/16/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Breastfeeding is important for the healthy growth and development of newborns, and the nutrient composition of human milk can be affected by maternal nutrition and supplementation. In Germany, iodine supplementation is recommended for all lactating mothers, and docosahexaenoic acid (DHA) supplementation is recommended for mothers with inadequate or no fish intake. Vitamin B12 supplementation is required for strict vegans during lactation, and other nutrient supplementation may be necessary depending on the individual's nutritional status. To address the lack of data on dietary supplements used by lactating mothers following a vegetarian or vegan diet, an online survey was conducted in Germany, with a focus on iodine, DHA, and vitamin B12. METHODS Study participants were asked to report whether they followed specific dietary patterns (omnivorous [OM], vegetarian [VT], vegan [VN]) as well as their use of dietary supplements. Relationships between diets and supplement use were analyzed using chi-square tests. RESULTS 2054 lactating women were included (1240 OM, 410 VT, and 404 VN) in this analysis. Within OM, VT and VN, at least one dietary supplement was taken by 67.3%, 84.9% and 98.0% respectively (p < 0.001). Overall, 53.2% OM, 66.8% VT, 88.4% VN reported taking at least one supplement containing iodine (p < 0.001). 54.6% OM, 61.7% VT and 58.2% VN reported supplements containing vitamin B12, while 34.1% OM, 40.2% VT and 38.6% VN mentioned supplements containing DHA (p < 0.05). CONCLUSION More than half of the participants reported the use of supplements during lactation with the highest proportion in vegans. However, over one third of the mothers did not report supplementing with iodine, regardless of their dietary pattern and most participants also did not report DHA supplements. It is worrisome that a high number of vegans did not report vitamin B12 supplementation, but this could be partly due to issues with reporting. It is crucial to provide further education to breastfeeding mothers about the importance of taking micronutrient supplements, especially for those following a vegetarian or vegan diet. This will help ensure that mothers and their breastfed infants receive optimal nutrition for a healthy development.
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Affiliation(s)
- Franziska Delgas
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr.12, 70599, Stuttgart, Germany.
| | - Lisa Bitsch
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr.12, 70599, Stuttgart, Germany
| | - Laura Maria König
- Faculty of Life Sciences: Food, Nutrition and Health, University of Bayreuth, Bayreuth, Germany
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | | | - Veronika Scherbaum
- Institute of Nutritional Sciences, University of Hohenheim, Stuttgart, Germany
| | - Maren C Podszun
- Institute of Nutritional Medicine, University of Hohenheim, Fruwirthstr.12, 70599, Stuttgart, Germany.
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Jühling M, König LM, Gruber H, Wolf V, Ritz-Timme S, Mayer F. Impact of (forensic) expert opinions according to the Istanbul Protocol in Germany-results and insights of the in:Fo-project-reply to commentary of C. Cattaneo and L. Franceschetti. Int J Legal Med 2023; 137:1941. [PMID: 37477749 PMCID: PMC10567797 DOI: 10.1007/s00414-023-03064-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Affiliation(s)
- M Jühling
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - L M König
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - H Gruber
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
- Department of Psychology, University of Cologne, Cologne, Germany
- Psychosocial Center for Refugees Düsseldorf e. V., Düsseldorf, Germany
| | - V Wolf
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
- Psychosocial Center for Refugees Düsseldorf e. V., Düsseldorf, Germany
| | - St Ritz-Timme
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - F Mayer
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
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Jühling M, König LM, Gruber H, Wolf V, Ritz-Timme S, Mayer F. Impact of (forensic) expert opinions according to the Istanbul Protocol in Germany-results and insights of the in:Fo-project. Int J Legal Med 2023; 137:863-873. [PMID: 36781444 PMCID: PMC10085958 DOI: 10.1007/s00414-023-02950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/11/2023] [Indexed: 02/15/2023]
Abstract
As part of a third-party funded project, expert opinions according to the Istanbul Protocol (IP) standards were compiled in Germany on a larger scale for the first time. The assessment process was initiated for 130 project participants. Statistical analysis on numerous variables was performed to test the impact of the expert opinions, foremost of the forensic medical expert opinions, on the individuals' asylum proceedings. The variables were drawn from forensic medical expert opinions and reports of findings, questionnaires for the study participants' counsellors in the project and a query on the asylum status of the study participants. Regression analysis and bivariate analysis on two dependent variables-subjective impact on the asylum procedure from the counsellors' point of view and objective change in the asylum status-were performed to test for an influence on asylum procedures. No statistically significant results were obtained for the objective change of the study participants' asylum status. For the subjective dependent variable, a positive prediction was possible when simultaneously controlling for the independent variables introduction of a forensic medical expert opinion and highest IP grade; a negative prediction was possible when simultaneously controlling for the independent variables introduction of a forensic medical expert opinion and use of IP grading. Apart from the statistical analysis, a positive effect of the assessment on the psychosocial well-being of the study participants could be demonstrated. The results differed from other European studies which demonstrated a correlation between the objective outcome of an asylum procedure (asylum status) and, for example, specific types of violence or the number of documented injuries. Differences also occurred in the use of the plausibility grades proposed by the IP, which questions their use in cases in which the reported torture happened a relevant time ago. Therefore, compiling individually worded evaluations instead of using the IP grading system-if possible, by an experienced forensic physician-is recommended in this scenario. Still, the assessment of alleged torture experiences should follow the IP guidelines, since psychological assessments are of especially high importance in cases with healed physical injuries and since the results also demonstrated a positive effect on the psychosocial well-being of the study participants.
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Affiliation(s)
- M Jühling
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - L M König
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - H Gruber
- Department of Psychology, University of Cologne, Cologne, Germany
- Psychosocial Center for Refugees Düsseldorf e. V., Düsseldorf, Germany
| | - V Wolf
- Psychosocial Center for Refugees Düsseldorf e. V., Düsseldorf, Germany
| | - St Ritz-Timme
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany
| | - F Mayer
- Institute of Legal Medicine, University Hospital Düsseldorf, Düsseldorf, Germany.
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König LM, Attig C, Franke T, Renner B. Barriers to and Facilitators for Using Nutrition Apps: Systematic Review and Conceptual Framework. JMIR Mhealth Uhealth 2021; 9:e20037. [PMID: 34254938 PMCID: PMC8409150 DOI: 10.2196/20037] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 01/11/2021] [Accepted: 04/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Nutrition apps are effective in changing eating behavior and diet-related health risk factors. However, while they may curb growing overweight and obesity rates, widespread adoption is yet to be achieved. Hence, profound knowledge regarding factors motivating and hindering (long-term) nutrition app use is crucial for developing design guidelines aimed at supporting uptake and prolonged use of nutrition apps. OBJECTIVE In this systematic review, we synthesized the literature on barriers to and facilitators for nutrition app use across disciplines including empirical qualitative and quantitative studies with current users, ex-users, and nonusers of nutrition apps. METHODS A systematic literature search including 6 databases (PubMed, Web of Science, PsychINFO, PSYNDEX, PsycArticles, and SPORTDiscus) as well as backward and forward citation search was conducted. Search strategy, inclusion and exclusion criteria, and the planned data extraction process were preregistered. All empirical qualitative and quantitative studies published in German or English were eligible for inclusion if they examined adolescents (aged 13-18) or adults who were either current users, ex-users, and nonusers of nutrition apps. Based on qualitative content analysis, extracted individual barriers and facilitators were grouped into categories. RESULTS A total of 28 publications were identified as eligible. A framework with a 3-level hierarchy was designed which grouped 328 individual barriers and facilitators into 23 subcategories, 12 categories, and 4 clusters that focus on either the individual user (goal setting and goal striving, motivation, routines, lack of awareness of knowledge), different aspects of the app and the smartphone (features, usability of the app or food database, technical issues, data security, accuracy/trustworthiness, costs), positive and negative outcomes of nutrition app use, or interactions between the user and their social environment. CONCLUSIONS The resulting conceptual framework underlines a pronounced diversity of reasons for (not) using nutrition apps, indicating that there is no "one-size-fits-all" approach for uptake and prolonged use of nutrition apps. Hence, tailoring nutrition apps to needs of specific user groups seems promising for increasing engagement.
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Affiliation(s)
- Laura Maria König
- Department of Psychology, University of Konstanz, Universitätsstraße 10, Konstanz, DE
- Faculty of Life Sciences, University of Bayreuth, Kulmbach, DE
| | - Christiane Attig
- Department of Psychology, Chemnitz University of Technology, Chemnitz, DE
| | - Thomas Franke
- Institute for Multimedia and Interactive Systems, University of Lübeck, Lübeck, DE
| | - Britta Renner
- Department of Psychology, University of Konstanz, Universitätsstraße 10, Konstanz, DE
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Ziesemer K, König LM, Boushey CJ, Villinger K, Wahl DR, Butscher S, Müller J, Reiterer H, Schupp HT, Renner B. Occurrence of and Reasons for "Missing Events" in Mobile Dietary Assessments: Results From Three Event-Based Ecological Momentary Assessment Studies. JMIR Mhealth Uhealth 2020; 8:e15430. [PMID: 33052123 PMCID: PMC7593856 DOI: 10.2196/15430] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 03/16/2020] [Accepted: 08/03/2020] [Indexed: 01/24/2023] Open
Abstract
Background Establishing a methodology for assessing nutritional behavior comprehensively and accurately poses a great challenge. Mobile technologies such as mobile image-based food recording apps enable eating events to be assessed in the moment in real time, thereby reducing memory biases inherent in retrospective food records. However, users might find it challenging to take images of the food they consume at every eating event over an extended period, which might lead to incomplete records of eating events (missing events). Objective Analyzing data from 3 studies that used mobile image-based food recording apps and varied in their technical enrichment, this study aims to assess how often eating events (meals and snacks) were missed over a period of 8 days in a naturalistic setting by comparing the number of recorded events with the number of normative expected events, over time, and with recollections of missing events. Methods Participants in 3 event-based Ecological Momentary Assessment (EMA) studies using mobile image-based dietary assessments were asked to record all eating events (study 1, N=38, 1070 eating events; study 2, N=35, 934 eating events; study 3, N=110, 3469 eating events). Study 1 used a basic app; study 2 included 1 fixed reminder and the possibility to add meals after the actual eating events occurred instead of in the moment (addendum); and study 3 included 2 fixed reminders, an addendum feature, and the option to record skipped meals. The number of recalled missed events and their reasons were assessed by semistructured interviews after the EMA period (studies 1 and 2) and daily questionnaires (study 3). Results Overall, 183 participants reported 5473 eating events. Although the momentary adherence rate as indexed by a comparison with normative expected events was generally high across all 3 studies, a differential pattern of results emerged with a higher rate of logged meals in the more technically intensive study 3. Multilevel models for the logging trajectories of reported meals in all 3 studies showed a significant, albeit small, decline over time (b=−.11 to −.14, Ps<.001, pseudo-R²=0.04-0.06), mainly because of a drop in reported snacks between days 1 and 2. Intraclass coefficients indicated that 38% or less of the observed variance was because of individual differences. The most common reasons for missing events were competing activities and technical issues, whereas situational barriers were less important. Conclusions Three different indicators (normative, time stability, and recalled missing events) consistently indicated missing events. However, given the intensive nature of diet EMA protocols, the effect sizes were rather small and the logging trajectories over time were remarkably stable. Moreover, the individual’s actual state and context seemed to exert a greater influence on adherence rates than stable individual differences, which emphasizes the need for a more nuanced understanding of the factors that affect momentary adherence.
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Affiliation(s)
- Katrin Ziesemer
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Laura Maria König
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Carol Jo Boushey
- University of Hawaii Cancer Center, University of Hawaii, Honolulu, HI, United States
| | - Karoline Villinger
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Deborah Ronja Wahl
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Simon Butscher
- Human-Computer Interaction Group, Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Jens Müller
- Human-Computer Interaction Group, Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Harald Reiterer
- Human-Computer Interaction Group, Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Harald Thomas Schupp
- General Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Britta Renner
- Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
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Wahl DR, Villinger K, Blumenschein M, König LM, Ziesemer K, Sproesser G, Schupp HT, Renner B. Why We Eat What We Eat: Assessing Dispositional and In-the-Moment Eating Motives by Using Ecological Momentary Assessment. JMIR Mhealth Uhealth 2020; 8:e13191. [PMID: 31909719 PMCID: PMC6996745 DOI: 10.2196/13191] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 08/15/2019] [Accepted: 09/26/2019] [Indexed: 01/08/2023] Open
Abstract
Background Why do we eat? Our motives for eating are diverse, ranging from hunger and liking to social norms and affect regulation. Although eating motives can vary from eating event to eating event, which implies substantial moment-to-moment differences, current ways of measuring eating motives rely on single timepoint questionnaires that assess eating motives as situation-stable dispositions (traits). However, mobile technologies including smartphones allow eating events and motives to be captured in real time and real life, thus capturing experienced eating motives in-the-moment (states). Objective This study aimed to examine differences between why people think they eat (trait motives) and why they eat in the moment of consumption (state motives) by comparing a dispositional (trait) and an in-the-moment (state) assessment of eating motives. Methods A total of 15 basic eating motives included in The Eating Motivation Survey (ie, liking, habit, need and hunger, health, convenience, pleasure, traditional eating, natural concerns, sociability, price, visual appeal, weight control, affect regulation, social norms, and social image) were assessed in 35 participants using 2 methodological approaches: (1) a single timepoint dispositional assessment and (2) a smartphone-based ecological momentary assessment (EMA) across 8 days (N=888 meals) capturing eating motives in the moment of eating. Similarities between dispositional and in-the-moment eating motive profiles were assessed according to 4 different indices of profile similarity, that is, overall fit, shape, scatter, and elevation. Moreover, a visualized person × motive data matrix was created to visualize and analyze between- and within-person differences in trait and state eating motives. Results Similarity analyses yielded a good overall fit between the trait and state eating motive profiles across participants, indicated by a double-entry intraclass correlation of 0.52 (P<.001). However, although trait and state motives revealed a comparable rank order (r=0.65; P<.001), trait motives overestimated 12 of 15 state motives (P<.001; d=1.97). Specifically, the participants assumed that 6 motives (need and hunger, price, habit, sociability, traditional eating, and natural concerns) are more essential for eating than they actually were in the moment (d>0.8). Furthermore, the visualized person × motive data matrix revealed substantial interindividual differences in intraindividual motive profiles. Conclusions For a comprehensive understanding of why we eat what we eat, dispositional assessments need to be extended by in-the-moment assessments of eating motives. Smartphone-based EMAs reveal considerable intra- and interindividual differences in eating motives, which are not captured by single timepoint dispositional assessments. Targeting these differences between why people think they eat what they eat and why they actually eat in the moment may hold great promise for tailored mobile health interventions facilitating behavior changes.
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Affiliation(s)
- Deborah Ronja Wahl
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Karoline Villinger
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Michael Blumenschein
- Data Analysis and Visualization, Department of Computer and Information Science, University of Konstanz, Konstanz, Germany
| | - Laura Maria König
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Katrin Ziesemer
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Gudrun Sproesser
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Harald Thomas Schupp
- General and Biological Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Britta Renner
- Psychological Assessment and Health Psychology, Department of Psychology, University of Konstanz, Konstanz, Germany
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