Determinants of weight loss after an intervention in low-income women in early postpartum.

OBJECTIVE: Postpartum is a critical period for the development of obesity in women, yet there is limited research of factors associated with changes in weight during early postpartum. Therefore, the objective of this study was to identify determinants of weight loss after an intervention. METHODS: A sample of women in early postpartum was recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children clinics, doctors' offices, and neighborhood centers (N = 58). Women participated in an 8-week weight-loss intervention. Subjects were measured for weight and height and completed demographics, the Eating Stimulus Index, a nutrition knowledge test, a food-frequency questionnaire, and a household environment survey. Correlations and linear regression determined associations with the outcome variable weight loss, and hierarchical regression was used to determine the most significant predictors. RESULTS: All subjects improved their nutrition knowledge, skills, convenience-eating resistance, and fruit and vegetable availability after the intervention. Responders had greater changes in dietary restraint, fruit juice servings, and discretionary energy than did nonresponders. Increases in dietary restraint, weight-management skills, and weight-loss self-efficacy and decreases in discretionary energy intake significantly predicted weight loss in individual regression analysis. After hierarchical regression analysis, improvement in dietary restraint was the most significant determinant, followed by decreases in total energy intake. Although weight-loss self-efficacy, weight-management skills, and discretionary energy intake significantly predicted weight loss when analyzed alone, these variables did not contribute to the prediction model revealed by this study. CONCLUSIONS: Positive changes in social cognitive theory constructs are associated with weight loss in low-income postpartum women. Dietary restraint, weight-management skills, weight loss self-efficacy, and reductions in total and discretionary energy are modifiable factors that should be emphasized in interventions designed for this population, but only dietary restraint and total energy intake were predicted in the model.

Motivations to eat are related to diet quality and food intake in overweight and obese, low-income women in early postpartum.

Healthful dietary practices and a return to prepregnancy weight are of significant importance in the prevention of obesity for women. The Eating Stimulus Index (ESI) was used to determine the relationship between motivations to eat and diet quality and food intake in 115 overweight/obese, low-income women in early postpartum. In this cross-sectional design, participants completed the ESI and food frequency questionnaire. Diet quality was assessed using the Dietary Guidelines Adherence Index. Diet quality was related to greater fruit and vegetable availability, convenience eating resistance, and vegetable taste preference. Women with high fruit and vegetable availability consumed more vegetables, as compared to those with low availability. High convenience eating resistance was associated with lower discretionary energy intakes. High taste preference for vegetables was related to greater intakes of these foods. Hierarchical regression analysis indicated that convenience eating resistance was the strongest predictor of diet quality followed by vegetable taste preference, and fruit and vegetable availability. Convenience eating resistance was also the strongest predictor of discretionary energy intake. In conclusion, women who were less vulnerable to environmental eating cues, had greater fruit and vegetable availability, and preferred the taste of vegetables consumed a more healthful diet. Thus, the ESI may be a useful screening tool for the design of personalized weight loss messages in the treatment of obesity.

Diet quality as measured by the healthy eating index and the association with lipid profile in low-income women in early postpartum.

Early postpartum is a critical period that may initiate consumption of an unhealthful diet, which can lead to obesity and adverse lipid profiles. The Healthy Eating Index 2005 (HEI 2005) is a tool that assesses diet quality in terms of adherence to the 2005 Dietary Guidelines for Americans. Previous versions of HEI have shown to be associated with serum lipids. The aim of this research is to evaluate the diet quality of women in early postpartum using the HEI 2005 and to examine the relationship of index scores with serum lipids and anthropometrics. A convenience sample of 125 multiethnic, overweight/obese women in early postpartum was recruited from urban clinics from June 2004 through April 2007. Dietary intake was measured via the average of a 24-hour dietary recall and 2-day food intake records. The HEI 2005 scores were computed to assess diet quality and were compared to anthropometrics and serum lipids. Descriptive statistics, analysis of covariance, and linear regression were utilized. This sample had low mean scores in fruits, total vegetables, whole grains, and oil components. Conversely, participants consumed more than recommended amounts of sodium, saturated fats, and discretionary calories. The HEI 2005 scores inversely predicted body mass index and low-density lipoprotein and total cholesterol, and positively predicted high-density lipoprotein cholesterol. Low-income women in early postpartum exhibited poor diet quality, as indicated by low total index scores. Further studies are warranted to identify appropriate dietary modifications in this population and to confirm the association of diet quality, as assessed by this HEI 2005 index, with lipids and other markers of health.

Development and validation of the eating stimulus index in low-income, minority women in early postpartum.

Dietary modification to achieve weight loss during the postpartum period may be critical for prevention of obesity, particularly in low-income, minority women. The aim of this cross-sectional study was to develop and validate a measure to examine motivations to eat in low-income, minority women during early postpartum. A convenience sample of 179 triethnic women was recruited from the Special Supplemental Program for Women, Infants, and Children clinics from June 2004 to April 2007. Subjects made one visit to a study center where they completed the Eating Stimulus Index and questions regarding individual demographic characteristics including ethnicity, age, income, education, marital status, breastfeeding, and employment status. Weight and height were also measured during this visit and used to calculate body mass index (BMI; calculated as kg/m(2)). An additional sample of 31 women completed the Eating Stimulus Index on two occasions with 2 weeks between to establish test-retest reliability. The factor structure of the scale was examined with principal components analysis. Total scale scores and subscale scores were calculated and Pearson's correlation and multiple regression analysis examined relationships to BMI. Principal component analysis produced an eight-factor structure with loadings >0.40. Cronbach's alpha coefficients for each subscale ranged from .54 to .89. Subscales of Convenience Eating, Emotional Eating, and Dietary Restraint were related to BMI in mothers. African-American, exclusively formula-feeding, and older women were most vulnerable to convenience eating. White women and those with the highest level of education were most vulnerable to emotional eating. The Eating Stimulus Index is a valid and reliable instrument with the ability to discriminate by weight. It can be used to assess motivations to eat in order to facilitate development of tailored weight-loss messages during early postpartum.

Impaired zinc and copper status in children with burn injuries: need to reassess nutritional requirements.

Major burns are associated with impaired Zn and Cu status. These micronutrients are essential for bone matrix formation, linear growth, and wound healing. This study evaluated the status of Zn and Cu in burned children and assessed adequacy of supplementation. Six children, mean total body surface area (TBSA), 54+/-9% (S.D.), were recruited. Nutrient intakes, plasma, wound exudate, and 24h urine samples were collected and analyzed for Zn and Cu. Bone mineral content was assessed by dual energy X-ray absorptiometry. Dietary Zn and Cu were three times the dietary reference, and mean plasma concentrations of Zn and Cu were low at admission and discharge. Urinary Zn was elevated at admission, whereas Cu was elevated at both times. Wound Zn and Cu concentrations exceeded plasma concentrations, suggesting that inflammatory wound exudate was a primary route of loss. We demonstrate that burn injury in children results in low plasma levels of Zn and Cu that are inadequately compensated during hospitalization.