Effects of lifestyle intervention on dietary intake, physical activity level, and gestational weight gain in pregnant women with different pre-pregnancy Body Mass Index in a randomized control trial.

BACKGROUND: The objectives of this study were to assess the efficacy of lifestyle intervention on gestational weight gain in pregnant women with normal and above normal body mass index (BMI) in a randomized controlled trial. METHODS: A total of 116 pregnant women (<20 weeks of pregnancy) without diabetes were enrolled and 113 pregnant women completed the program. Participants were randomized into intervention and control groups. Women in the intervention group received weekly trainer-led group exercise sessions, instructed home exercise for 3-5-times/week during 20-36 weeks of gestation, and dietary counseling twice during pregnancy. Participants in the control group did not receive the intervention. All participants completed a physical activity questionnaire and a 3-day food record at enrolment and 2 months after enrolment. RESULTS: The participants in the intervention group with normal pre-pregnancy BMI (≤24.9 kg/M2, n = 30) had lower gestational weight gain (GWG), offspring birth weight and excessive gestational weight gain (EGWG) on pregnancy weight gain compared to the control group (n = 27, p < 0.05). Those weight related-changes were not detected between the intervention (n = 27) and control group (n = 29) in the above normal pre-pregnancy BMI participants. Intervention reduced total calorie, total fat, saturated fat and cholesterol intake were detected in women with normal or above normal pre-pregnancy BMI compared to the control group (p < 0.05 or 0.01). Increased physical activity and reduced carbohydrate intake were detected in women with normal (p < 0.05), but not above normal, pre-pregnancy BMI at 2 months after the onset of the intervention compared to the control group. CONCLUSION: The results of the present study demonstrated that the lifestyle intervention program decreased EGWG, GWG, offspring birth weight in pregnant women with normal, but not above normal, pre-pregnancy BMI, which was associated with increased physical activity and decreased carbohydrate intake. TRIAL REGISTRATION: NCT00486629.

Barriers and coping strategies of women with gestational diabetes to follow dietary advice.

OBJECTIVE: To understand barriers and coping strategies of women with gestational diabetes (GDM) to follow dietary advice. DESIGN: Qualitative study. PARTICIPANTS: Thirty women with GDM from the Winnipeg area participated. Each participant completed a Food Choice Map (FCM) semi-structured interview and a demographic questionnaire. MAJOR OUTCOME MEASURES: Underlying beliefs of women with GDM and factors that hinder following dietary advice. ANALYSIS: Qualitative data analyzed using constant comparative method to identify emergent themes of factors and beliefs that affected following dietary advice. Themes were categorized within the Integrative Model of Behavioral Prediction. RESULTS: GDM women faced challenges and barriers when (1) personal food preference conflicted with dietary advice; (2) eating in different social environments where food choice and portions were out of control and food choice decisions were affected by social norms; (3) lack of knowledge and skills in dietary management and lack of a tailored dietary plan. CONCLUSIONS AND IMPLICATIONS: Quick adaptation to dietary management in a short time period created challenges for women with GDM. Stress and anxiety were reported when women talked about following dietary advice. Tailored educational and mental health consultation with consideration of the barriers may promote dietary compliance and overall better health.

Stress and anxiety in women with gestational diabetes during dietary management.

PURPOSE: To explore the stress and anxiety experiences during dietary management in women with gestational diabetes (GDM). METHODS: Thirty women with GDM from the Winnipeg area participated in the mixed methods study. Each participant completed a Food Choice Map semistructured interview, a Perceived Stress Scale, a Pregnancy Anxiety Scale, a State-Trait Anxiety Inventory-Trait questionnaire, and a demographic questionnaire. Stress and anxiety experiences were identified from interview transcripts and categorized into themes based on the constant comparative method. Questionnaire scores aided in interpreting the stress and anxiety experience in the qualitative data. RESULTS: Three major themes were generated from the interviews: (1) stress related to GDM diagnosis and the perception of a high risk pregnancy; (2) stress over losing control of GDM during the process of dietary management; and (3) anxiety related to the fear of maternal and infant complications. Women on insulin experienced significantly higher levels of perceived stress (P < .01), and the dietary management stress was more prevalent in women using insulin compared to the ones on diet treatment only (Fisher exact test, P < .01). Unhealthy diet coping strategies occurred with the stress and anxiety. CONCLUSIONS: Stress and anxiety were associated with different contexts in this study sample. Women who were on insulin experienced significantly higher levels of perceived stress related to dietary management.

Food choice decision-making by women with gestational diabetes.

OBJECTIVE: To enhance the dietary education presented to women with gestational diabetes (GDM) by exploring the reasons and experiences that women with GDM reported in making their food-choice decisions after receipt of dietary education from a healthcare professional. METHODS: Food Choice Map (FCM) semi-structured in-depth interviews were conducted with 30 women with GDM living in the Winnipeg area during their pregnancies. Verbatim transcripts were generated from the interviews. A constant comparative method was used to generate common themes to answer research inquiries. RESULTS: Personal food preferences, hunger and cravings were the main factors affecting food choice decision-making in women with GDM. Although the information from healthcare professionals was 1 factor that affected food choice decision-making for most of the participants, more than half of the women, including all the women who were on insulin, reported difficulties in quick adaptation to dietary management in a limited time period. Information from other sources such as family members, friends, and internet were used to cope with the adaptation. These difficulties led to a sense of decreased control of GDM and were accompanied by frustration, especially for women taking insulin. CONCLUSIONS: Food choice decision-making varied for this group of women with GDM. Knowledge and information aided in making healthy food choices and in portion control. However, balancing individual needs and blood glucose control in a short time period was felt to be difficult and created frustration. The findings suggested that dietary consultation needs to be personalized and to be time sensitive to promote confidence in self-control.

Low vegetable intake is associated with allergic asthma and moderate-to-severe airway hyperresponsiveness.

BACKGROUND: In recent decades, children's diet quality has changed and asthma prevalence has increased, although it remains unclear if these events are associated. OBJECTIVE: To examine children's total and component diet quality and asthma and airway hyperresponsiveness (AHR), a proxy for asthma severity. METHODS: Food frequency questionnaires adapted from the Nurses' Health Study and supplemented with foods whose nutrients which have garnered interest of late in relation to asthma were administered. From these data, diet quality scores (total and component), based on the Youth Healthy Eating Index (YHEI adapted) were developed. Asthma assessments were performed by pediatric allergists and classified by atopic status: Allergic asthma (≥1 positive skin prick test to common allergens >3 mm compared to negative control) versus non-allergic asthma (negative skin prick test). AHR was assessed via the Cockcroft technique. Participants included 270 boys (30% with asthma) and 206 girls (33% with asthma) involved in the 1995 Manitoba Prospective Cohort Study nested case-control study. Logistic regression was used to examine associations between diet quality and asthma, and multinomial logistic regression was used to examine associations between diet quality and AHR. RESULTS: Four hundred seventy six children (56.7% boys) were seen at 12.6 ± 0.5 years. Asthma and AHR prevalence were 26.2 and 53.8%, respectively. In fully adjusted models, high vegetable intake was protective against allergic asthma (OR 0.49; 95% CI 0.29-0.84; P < 0.009) and moderate/severe AHR (OR 0.58; 0.37-0.91; P < 0.019). CONCLUSIONS: Vegetable intake is inversely associated with allergic asthma and moderate/severe AHR.

"Asthma isn't an excuse, it's just a condition": youths' perceptions of physical activity and screen time.

OBJECTIVE: During puberty, physical activity patterns begin to decline, while sedentary time increases. These changes may be confounded by asthma. The purpose of this study was to gain insight into youths' perceptions of screen time and physical activity by asthma status. METHODS: Four interviews and seven focus groups with boys only or girls only were conducted with 15- to 16-year-old youth enrolled in either of two asthma-focused cohorts in Manitoba, Canada. Using a semi-structured interview guide, youth were asked about their perceptions of physical activity and screen time such as texting, watching television, electronic games, and Internet chatting and about their perceptions of the influence that asthma has on these behaviors. Data were analyzed using thematic coding. RESULTS: Two themes were common to youth with asthma and without asthma: (1) sports are an integral part of youths' lives and (2) screen time is important to youth. Two themes were identified among youth with asthma only: (1) physical activity used to be more difficult and (2) being active and living with asthma. Youth with asthma described physical activity as neither a hindrance to activity nor an excuse for inactivity, although asthma may still present some challenges. They also acknowledged their reliance on screen time for communication and for entertainment. CONCLUSIONS: Youth with asthma believe that physical activity has become increasingly easier as they become older and that being active with asthma, despite its challenges, is a key part of their lives.

'Trying to make it all come together': structuration and employed mothers' experience of family food provisioning in Canada.

This research examined the aetiology of employed mothers' food choice and food provisioning decisions using a qualitative, grounded theory methodology. Semi-structured interviews using the Food Choice Map were conducted with eleven middle-income employed mothers of elementary school-age children. Results demonstrated that the women exhibited conflicting identities with respect to food choice and provisioning. As 'good mothers' they were the primary food and nutrition caregivers for the family, desiring to provide healthy, homemade foods their families preferred at shared family meals. They also sought to be independent selves, working outside the home, within the context of a busy modern family. Increased food autonomy of children, and lack of time due to working outside the home and children's involvement in extracurricular activities, were significant influences on their food choice and provisioning. This resulted in frequently being unable to live up to their expectations of consistently providing healthy homemade foods and having shared family meals. To cope, the women frequently relied on processed convenience and fast foods despite their acknowledged inferior nutritional status. Using Giddens' structuration theory, the dynamic relationships between the women's food choice and provisioning actions, their identities and larger structures including socio-cultural norms, conditions of work and the industrial food system were explored. The ensuing dietary pattern of the women and their families increases the risk of poor health outcomes, including obesity. These results have implications for public health responses to improve population health by shifting the focus from individual-level maternal influences to structural influences on diet.

The growing Canadian energy gap: more the can than the couch?

OBJECTIVE: The present study describes the trajectory of the energy gap (energy imbalance) in the Canadian population from 1976 to 2003, its temporal relationship to adult obesity, and estimates the relative contribution of energy availability and expenditure to the energy gap. It also assesses which foods contributed the most to changes in available energy over the study period. DESIGN: Annual estimates of the energy gap were derived by subtracting population-adjusted per capita daily estimated energy requirements (derived from Dietary Reference Intakes) from per capita daily estimated energy available (obtained from food balance sheets). Food balance sheets were used to assess which foods contributed to changes in energy availability. Adult obesity rates were derived from six national surveys. The relationship to the energy gap was assessed through regression analysis. RESULTS: Between 1976 and 2003, per capita daily estimated energy availability increased by 18 % (1744 kJ), and increased energy availability was the major driver of the increased energy gap. Salad oils, wheat flour, soft drinks and shortening accounted for the majority of the net increase in energy availability. Adult obesity was significantly correlated with the energy gap over the study period. CONCLUSIONS: The widening energy gap is being driven primarily by increased energy availability. The food commodities driving the widening energy gap are major ingredients in many energy-dense convenience foods, which are being consumed with increasing frequency in Canada. Policies to address population obesity must have a strong nutritional focus with the objective of decreasing energy consumption at the population level.

Validation of a food choice map with a 3-day food record and serum values to assess folate and vitamin B-12 intake in college-aged women.

BACKGROUND: Estimates of dietary folate and vitamin B-12 intakes are currently of considerable interest, but a valid assessment method that is faster than those currently available would better suit everyday health promotion activities. OBJECTIVE: To validate a new assessment technique for estimating folate and vitamin B-12 intakes, known as the Food Choice Map (FCM), using serum folate and vitamin B-12 concentrations in a group of 95 women aged 18 to 25 years. DESIGN: The FCM tool was used in a cross-sectional study design to estimate the usual folate and vitamin B-12 intakes of each participant. Immediately thereafter, blood samples were taken to determine serum folate and vitamin B-12 concentrations. Subsequently, 3-day food records were completed during each of three successive weeks and used as the reference method. Using the method of triads, validity coefficients were calculated. RESULTS: There was no significant difference between the two methods in the correlations with serum values. FCM-obtained folate intakes (r=0.43, P<0.01) exhibited a similar and moderate association with serum folate as did 3-day food record-obtained folate intakes (r=0.39, P<0.01). Similarly, vitamin B-12 intakes obtained from both techniques showed a modest association with serum vitamin B-12 (FCM r=0.40, P<0.01; 3-day food record r=0.44, P<0.01). However, the validity coefficient for the FCM was higher than that for the 3-day food record for both folate (FCM 0.97, 3-day food record 0.79) and B-12 (FCM 0.95; 3-day food record 0.85). CONCLUSIONS: This study provides validation for the use of a new dietary assessment method, the FCM, for estimating folate and vitamin B-12 intakes in women of reproductive age. Larger validation studies that include men and other age groups are needed to further characterize the applicability of the FCM.

Folate status of young Canadian women after folic acid fortification of grain products.

Women of childbearing age are advised to consume folic acid-containing supplements. Whether this remains necessary after folic acid fortification of the food supply in North America has yet to be determined. The objectives of this study were to assess folate intakes and the contribution of folic acid to the diets of women of childbearing age in the post-folic acid fortification era. Using a cross-sectional study design, fasting blood samples were obtained from 95 women (aged 18 to 25 years), and the samples were analyzed for serum and red blood cell folate, as well for total homocysteine. Dietary and supplemental folate intakes were assessed. The biochemical evidence showed that no women were folate deficient, but only 14% reached red blood cell folate concentrations associated with significant reductions in neural tube defect risk. Mean dietary intake of food folic acid was 96+/-64 microg/day, supplemental folic acid was 94+/-189 microg/day, natural folate was 314+/-134 microg/day, and the total intake, as dietary folate equivalents, was 646+/-368 microg dietary folate equivalents/day. Therefore, intakes of folic acid from fortified foods are within the level originally predicted for the fortification efforts; however, only 17% of participants met the special recommendation for women capable of becoming pregnant (400 microg folic acid daily from supplements, fortified foods, or both in addition to consuming food folate from a varied diet). These data suggest that women of childbearing age are achieving positive folate status in the postfortification era, but it may not be sufficient to achieve red blood cell folate concentrations associated with a significant reduction in neural tube defect risk. Even with food fortification, women of childbearing age should be advised to take a folic acid-containing supplement on a daily basis.

Documenting the reasons people have for choosing their food.

Understanding the reasons that people have for choosing their food, and why these choices vary, may affect the dietary advice and assumptions about the nutrient adequacy of future food intake. One group of respondents living in Jakarta, Indonesia completed two interviews with the same combined food frequency and qualitative technique, called Food Choice Map (FCM) over a one-month period. Another group of Indonesian respondents from a town in Java completed an FCM interview and a 24-hour recall interview. The Food Choice Map identified the same major foods as contributing to individual intakes as are identified by a 24-hr recall interview. The FCM also identified reasons for changes in food choice. The reasons for food choices varied less than the different food items chosen. The FCM links data on dietary behaviours with perceptions that respondents use to explain of those behaviours. Such data can be used to develop communication strategies for health promotion.

Complementary feeding patterns in Pondok Labu, South Jakarta, Indonesia.

This paper explores the sociocultural aspects in the reasons mothers gave for terminating exclusive breastfeeding. These sociocultural aspects were anticipated to influence the variance between actual breastfeeding practice and the current recommendations for exclusive breastfeeding. The complementary feeding patterns and the reasons for introducing complementary foods were assessed using a dietary recall called the Food Choice Map, in a sample of 40 mothers living in a sub-district of South Jakarta. The results showed that the most common reason for introducing first foods in this study was 'insufficient breastmilk'. The influential social factors, including parents, friends and medical professionals were identified. The feeding pattern of the infants in the first six months was highly variable, and commercial baby food was frequently used. We suggest that, even though current exclusive breastfeeding recommendations are beneficial, their promotion should be more sensitive to the social reality of the mothers.