Associations of appetite sensations and metabolic characteristics with weight retention in postpartum women.

Postpartum weight retention (PPWR) is an important risk factor for long-term obesity. Appetite may be a key factor regulating PPWR. The objectives of this study were to determine the associations between (i) PPWR and appetite; and (ii) appetite, lactation, and metabolic characteristics. Data from 49 women at 9 months postpartum contributed to this cross-sectional analysis. Energy expenditure was assessed in a whole-body calorimetry unit for 24 h. Appetite sensations were rated using visual analogue scales. Lactation (min/day) was measured using a 3-day breastfeeding diary. PPWR was negatively associated with fullness (ß ± SE; R2 = -2.97 ± 0.72; 0.661; P < 0.001), and satiety (-2.75 ± 0.81; 0.617; P = 0.002), and was positively associated with hunger (2.19 ± 1.02; 0.548; P = 0.039), prospective food consumption (PFC; 2.19 ± 0.91; 0.562; P = 0.021), and composite appetite score (CAS; 0.34 ± 0.09; 0.632; P = 0.001). Lactation was associated with higher CAS (39.68 ± 15.56; 0.365; P = 0.015), hunger (3.56 ± 1.61; 0.308; P = 0.033), and PFC (4.22 ± 1.78; 0.314; P = 0.023), and with reduced sensations of fullness (-4.18 ± 1.94; 0.358; P = 0.038) and satiety (-3.83 ± 1.87; 0.295; P = 0.048). Lactation was associated with appetite, which in turn was related to PPWR. Appetite control should be explored to support postpartum weight management strategies. Novelty Postpartum weight retention was associated with appetite sensations, which were assessed throughout the day under conditions in which energy intake and expenditure were precisely matched. Lactation and other maternal metabolic factors, including carbohydrate oxidation and physical activity level may play a role in controlling appetite during the postpartum period.

Association of pre-pregnancy BMI and gestational weight gain with fat mass distribution and accretion during pregnancy and early postpartum: a prospective study of Albertan women.

OBJECTIVES: To examine the patterns of fat mass gain in pregnancy and fat loss in the early postpartum period relative to women's pre-pregnancy body mass index (BMI) and by adherence to Institute of Medicine's gestational weight gain (GWG) recommendations. DESIGN: Prospective cohort study with three to four study visits. SETTING: This study is a part of the prospective longitudinal birth cohort, 'The Alberta Pregnancy Outcomes and Nutrition Study' (APrON) that recruited pregnant women from the cities of Edmonton and Calgary in Alberta. PARTICIPANTS: 1820 pregnant women were recruited and followed through their pregnancy and at 3 months postpartum. OUTCOME MEASURES: Body weight and skinfold thicknesses were measured during pregnancy and early postpartum in women. Body density was calculated from sum of skinfold thickness (biceps, triceps, subscapula and suprailiac), and total fat mass accretion during pregnancy was calculated using Van Raaij's equations and at postpartum using Siri's equation. Differences in total fat mass gain, fat mass loss and fat retention according to pre-pregnancy BMI categories and GWG categories were tested using two-way analysis of variance and post hoc comparisons. RESULTS: Most women (64%) had a normal pre-pregnancy BMI, and overall 49% women exceeded the GWG recommendations. Obese women gained significantly less total fat mass, had lower fat mass loss and had lower postpartum fat retention than normal-weight women (p<0.05). Women with excessive GWG gained higher total fat mass and had higher postpartum fat mass retention (p<0.03) than women who met the GWG recommendations. Total GWG was positively correlated with total fat gain (r=0.61, p<0.01) and total fat retention (r=0.31, p<0.05). CONCLUSION: Excessive GWG is the significant risk factor for higher fat mass accretion during pregnancy and higher postpartum fat retention, irrespective of pre-pregnancy BMI.

The influence of energy metabolism on postpartum weight retention.

BACKGROUND: Profiling postpartum energy metabolism may assist in optimizing weight management following childbirth. OBJECTIVES: The aims of this study were to profile total energy expenditure (TEE), resting energy expenditure (REE), exercise energy expenditure, sleep energy expenditure, and respiratory quotient in women at 3 and 9 mo postpartum (3M-PP, 9M-PP, respectively), and to examine the association between energy metabolism and postpartum weight retention (PPWR). METHODS: In this cohort study, 1-h REE (measured in a whole body calorimetry unit, WBCU) and body composition (BC, measured by dual-energy X-ray absorptiometry) were measured at 3M-PP and 9M-PP (n = 49). Cardiorespiratory fitness [measured by the predicted maximal volume of oxygen consumption (p$\dot{V}$O2 max), n = 47] and 24-h TEE (WBCU, n = 43) were assessed only at 9M-PP. Women were stratified as high (>4.8 kg) or low (≤ 4.8 kg) weight retainers. Two-way mixed repeated-measures ANOVA and longitudinal regression models were applied. Linear regression was used to generate an equation at 3M-PP from the BC data, to predict the REE at 9M-PP. RESULTS: The fat mass at 3M-PP was positively associated with PPWR at 3M-PP (mean ± SE ß: 0.09 ± 0.03; P = 0.005) and 9M-PP (ß: 0.11 ± 0.04; P = 0.008), and negatively associated with REE at 3M-PP (ß: -0.16 ± 0.02; P < 0.001) and TEE at 9M-PP (ß: -0.15 ± 0.03; P < 0.001). REE was negatively associated with PPWR (ß: -0.74; 95% CI: -1.29, -0.19; P = 0.0087). REE was 2 kcal/kg higher in low- vs. high-retainers at 3M-PP, and REE and TEE were both 4 kcal/kg higher in low- vs. high-retainers at 9M-PP. Low-retainers demonstrated an increase in REE greater than expected for changes in BC. PPWR was negatively associated with TEE (ß: -0.08 ± 0.02; P = 0.0009) and p$\dot{V}$O2 max (ß: -0.02 ± 0.01; P = 0.047); p$\dot{V}$O2 max was 7 mL · kg-1 · min-1 higher in low- vs. high-retainers (P = 0.047). CONCLUSIONS: Energy metabolism, BC, and cardiorespiratory fitness may be associated with weight regulation and its trajectory during the postpartum period. This provides the foundation for future strategies to promote appropriate postpartum weight management.

The use of whole body calorimetry to compare measured versus predicted energy expenditure in postpartum women.

BACKGROUND: Accurate assessment of energy expenditure may support weight-management recommendations. Measuring energy expenditure for each postpartum woman is unfeasible; therefore, accurate predictive equations are needed. OBJECTIVES: This study compared measured with predicted resting energy expenditure (REE) and total energy expenditure (TEE) in postpartum women. METHODS: This was a longitudinal observational study. REE was measured at 3 mo postpartum (n = 52) and 9 mo postpartum (n = 49), whereas TEE was measured once at 9 mo postpartum (n = 43) by whole body calorimetry (WBC). Measured REE (REEWBC) was compared with 17 predictive equations; measured TEE plus breast milk energy output (ERWBC) was compared with the estimated energy requirements/Dietary Reference Intakes equation (EERDRI). Fat and fat-free mass were measured by dual-energy X-ray absorptiometry. Group-level agreement was assessed by the Pearson correlation, paired t test, and Bland-Altman (bias) analyses. Individual-level accuracy was assessed with the use of Bland-Altman limits of agreement, and by the percentage of women with predicted energy expenditure within 10% of measured values ("accuracy"). RESULTS: The cohort was primarily Caucasian (90%). At a group level, the best equation predicting REEWBC was the DRI at 3 mo postpartum (-7 kcal, -0.1%; absolute and percentage bias, respectively), and the Harris-Benedict at 9 mo postpartum (-17 kcal, -0.5%). At an individual level, the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) height and weight equation was the most accurate at 3 mo postpartum (100% accuracy) and 9 mo postpartum (98% accuracy), with the smallest limits of agreement. Equations including body composition variables were not more accurate. Compared with ERWBC, EERDRI bias was -36 kcal, with inaccurate predictions in 33% of women. CONCLUSIONS: Many REE predictive equations were accurate for group assessment, with the FAO/WHO/UNU height and weight equation having the highest accuracy for individuals. EERDRI performed well at a group level, but inaccurately for 33% of women. A greater understanding of the physiology driving energy expenditure in the postpartum period is needed to better predict TEE and ultimately guide effective weight-management recommendations.

Trajectory and determinants of change in lean soft tissue over the postpartum period.

The aim of this study was to characterise changes in lean soft tissue (LST) and examine the contributions of energy intake, physical activity and breast-feeding practices to LST changes at 3 and 9 months postpartum. We examined current weight, LST (via dual-energy X-ray absorptiometry), dietary intake (3-d food diary), physical activity (Baecke questionnaire) and breast-feeding practices (3-d breast-feeding diary) in forty-nine women aged 32·9 (sd 3·8) years. Changes in LST varied from -2·51 to +2·50 kg with twenty-nine women gaining LST (1·1 (sd 0·7) kg, P<0·001) and twenty women losing LST (-0·9 (sd 0·8) kg, P<0·001). Energy intake (133 (SD 42) v. 109 (SD 33) kJ/kg, P=0·019) and % kJ from fat at 3 months postpartum was higher in women who gained LST at 9 months postpartum (gained LST=34 (sd 5) % kJ; lost LST=29 (sd 4) % kJ, P=0·002). Women who gained LST reported breast-feeding their infants more frequently (gained LST=8 (sd 3) feeds/d; lost LST=5 (sd 1) feeds/d, P=0·014) and for more time per d (gained LST=115 (sd 78) min/d; lost LST=59 (sd 34) min/d, P=0·016) at 9 months postpartum. Energy intake and % kJ from fat at 3 months were significant predictors of LST gain (ß=0·08 (se 0·04) and 0·24 (se 0·09), respectively). This suggests that gain in LST may be associated with more frequent and longer episodes of breast-feeding at 9 months postpartum as well as dietary intake early in the postpartum period.

Changes in Energy Metabolism from Prepregnancy to Postpartum: A Case Report.

PURPOSE: Energy metabolism is at the core of maintaining healthy body weights. Likewise, the assessment of energy needs is essential for providing adequate dietary advice. We explored differences in energy metabolism of a primigravid woman (age: 30 years) at 1 month prepregnancy ("baseline"), during pregnancy (33 weeks), and at 3 and 9 months postpartum. Measured versus estimated energy expenditure were compared using equations commonly used in clinical practice. METHODS: Energy metabolism was measured using a state-of-the-art whole body calorimetry unit (WBCU). Body composition (dual-energy X-ray absorptiometry), energy intake (3-day food records), physical activity (Baecke questionnaire), and breastmilk volume/breastfeeding energy expenditure (24-hours of infant test-retest weighing) were assessed. RESULTS: This case report is the first to assess energy expenditure in 3 different stages of a woman's life (prepregnancy, pregnancy, and postpartum) using WBCU. We noticed that weight and energy needs returned to prepregnancy values at 9 months postpartum, although a pattern of altered body composition emerged (higher fat/lean ratio) without changes in physical activity and energy intake. For this woman, current recommendations for energy overestimated actual needs by 350 kcal/day (9 months postpartum). CONCLUSION: It is likely that more accurate approaches are needed to estimate energy needs during and postpregnancy, with targeted interventions to optimize body composition.

Targeting specific interstitial glycemic parameters with high-intensity interval exercise and fasted-state exercise in type 2 diabetes.

AIMS: To compare the acute glycemic responses to a bout of high-intensity interval exercise (HIIE) and energy-matched moderate-intensity continuous exercise (MICE) performed under fasted and postprandial conditions. METHODS: A randomized, controlled, crossover design was used. Ten individuals with type 2 diabetes were each tested in five experimental conditions after an overnight fast: 1) fasted-state HIIE (HIIEfast); 2) post-breakfast HIIE (HIIEfed); 3) fasted-state MICE (MICEfast); 4) post-breakfast MICE (MICEfed); and 5) no exercise (control). MICE was performed at workload corresponding to 55% of V.V̇O2peak, whereas HIIE was composed of repetitions of three minutes at workload corresponding to 40% followed by one minute at workload corresponding to 100% V.V̇̇O2peak. Interstitial glucose was monitored by continuous glucose monitoring over 24h under standardized diet and medication. RESULTS: Fasted-state exercise attenuated postprandial glycemic increments (p<0.05) to a greater extent than post-breakfast exercise did. HIIE reduced nocturnal and fasting glycemia on the day following exercise more than MICE did (main effect: both p<0.05). Compared to the control condition, HIIEfast lowered most interstitial glycemic parameters, i.e., 24-h mean glucose (-1.5mmol·l(-1); p<0.05), fasting glucose (-1.0mmol·l(-1); p<0.05), overall postprandial glycemic increment (-257mmol·360min·l(-1); p<0.05), glycemic variability (-1.79mmol·l(-1); p<0.05), and time spent in hyperglycemia (-283min; p<0.05). CONCLUSION: This study showed that HIIE is more effective than MICE in lowering nocturnal/fasting glycemia. Exercise performed in the fasted state reduces postprandial glycemic increments to a greater extent than post-breakfast exercise does. Performing HIIE under fasted condition may be most advantageous as it lowered most aspects of glycemia.

Assessment of Pre-Pregnancy Dietary Intake with a Food Frequency Questionnaire in Alberta Women.

PURPOSE: Pre-pregnancy is an under-examined and potentially important time to optimize dietary intake to support fetal growth and development as well as maternal health. The purpose of the study was to determine the extent to which dietary intake reported by non-pregnant women is similar to pre-pregnancy dietary intake reported by pregnant women using the same assessment tool. METHODS: The self-administered, semi-quantitative food frequency questionnaire (FFQ) was adapted from the Canadian version of the Diet History Questionnaire, originally developed by the National Cancer Institute in the United States. Pregnant women (n = 98) completed the FFQ which assessed dietary intake for the year prior to pregnancy. Non-pregnant women (n = 103) completed the same FFQ which assessed dietary intake for the previous year. Energy, macronutrients, and key micronutrients: long-chain omega-3 fatty acids, folate, vitamin B6, vitamin B12, calcium, vitamin D and iron were examined. RESULTS: Dietary intake between groups; reported with the FFQ; was similar except for saturated fat; trans fat; calcium; and alcohol. Pregnant women reported significantly higher intakes of saturated fat; trans fat; and calcium and lower intake of alcohol in the year prior to pregnancy compared to non-pregnant women who reported intake in the previous year. CONCLUSIONS: Despite limitations; a FFQ may be used to assist with retrospective assessment of pre-pregnancy dietary intake.

Using traffic light labels to improve food selection in recreation and sport facility eating environments.

Many recreation and sports facilities have unhealthy food environments, however managers are reluctant to offer healthier foods because they perceive patrons will not purchase them. Preliminary evidence indicates that traffic light labeling (TLL) can increase purchase of healthy foods in away-from-home food retail settings. We examined the effectiveness of TLL of menus in promoting healthier food purchases by patrons of a recreation and sport facility concession, and among various sub-groups. TLL of all menu items was implemented for a 1-week period and sales were assessed for 1-week pre- and 1-week post-implementation of TLL (n = 2101 transactions). A subset of consumers completed a survey during the baseline (n = 322) and intervention (n = 313) periods. We assessed change in the proportion of patrons' purchases that were labeled with green, yellow and red lights from baseline to the TLL intervention, and association with demographic characteristics and other survey responses. Change in overall revenues was also assessed. There was an overall increase in sales of green (52.2% to 55.5%; p < 0.05) and a reduction in sales of red (30.4% to 27.2%; p < 0.05) light items from baseline to the TLL period. The effectiveness of TLL did not differ according to any of the demographic or other factors examined in the survey. Average daily revenues did not differ between the baseline and TLL periods. TLL of menus increased purchase of healthy, and reduced purchase of unhealthy foods in a publicly funded recreation and sport facility, with no loss of revenue. Policymakers should consider extending menu labeling laws to public buildings such as recreation and sports facilities to promote selection of healthier items.

If we offer it, will children buy it? Sales of healthy foods mirrored their availability in a community sport, commercial setting in Alberta, Canada.

BACKGROUND: Community sports settings are often sources of unhealthy foods for children. Many managers in these settings are reluctant to increase availability of healthy food options because they perceive that healthy foods are not profitable. This study assessed the independent contribution of increased availability of healthy foods to their sales in a community sport, commercial context. Change in revenues per patron was also examined. METHODS: The availability of healthy items was increased from 9.1% at baseline (35 days) to 25.0% during the intervention period (40 days), returning to 9.1% postintervention (6 days). Purchases of all patrons who bought foods/beverages (n=17,262 items sold) from two concessions at an outdoor community pool were assessed from baseline to postintervention. Chi-square analyses assessed differences in the proportion of healthy and unhealthy items sold, as well as in the proportion of total revenues per patron across periods. A trained observer also recorded qualitative observations pertaining to a subset of patrons' (n=221) dietary behaviors and activities. RESULTS: Healthy items represented 7.7%, 22.7%, and 9.8% of sales during the preintervention, intervention, and postintervention periods, respectively (p<0.01). Sales of healthy beverages exceeded sales of all other product types. The proportion of total revenues per patron did not differ by period. CONCLUSIONS: Food availability was an important environmental determinant of food purchasing behaviors in this community commercial context, given that sales of healthy foods closely mirrored their availability. Increased availability of healthy foods in community and commercial settings is important because concurrent changes within multiple environments will be required to improve children's dietary behaviors.

Perceptions of the characteristics of the Alberta Nutrition Guidelines for Children and Youth by child care providers may influence early adoption of nutrition guidelines in child care centres.

In 2008, the Alberta government released the Alberta Nutrition Guidelines for Children and Youth (ANGCY) as a resource for child care facilities to translate nutrition recommendations into practical food choices. Using a multiple case study method, early adoption of the guidelines was examined in two child care centres in Alberta, Canada. Key constructs from the Diffusion of Innovations framework were used to develop an interview protocol based on the perceived characteristics of the guidelines (relative advantage, compatibility, complexity, trialability and observability) by child care providers. Analysis of the ANGCY was conducted by a trained qualitative researcher and validated by an external qualitative researcher. This entailed reviewing guideline content, layout, organisation, presentation, format, comprehensiveness and dissemination to understand whether characteristics of the guidelines affect the adoption process. Data were collected through direct observation, key informant interviews and documentation of field notes. Qualitative data were analysed using content analysis. Overall, the guidelines were perceived positively by child care providers. Child care providers found the guidelines to have a high relative advantage, be compatible with current practice, have a low level of complexity, easy to try and easy to observe changes. It is valuable to understand how child care providers perceive characteristics of guidelines as this is the first step in identifying the needs of child care providers with respect to early adoption and identifying potential educational strategies important for dissemination.

Use of micronutrient supplements among pregnant women in Alberta: results from the Alberta Pregnancy Outcomes and Nutrition (APrON) cohort.

Maternal nutrient intake in the prenatal period is an important determinant of fetal growth and development and supports maternal health. Many women, however, fail to meet their prenatal nutrient requirements through diet alone and are therefore advised to consume nutrient supplements. The purpose of this study was to describe the use of natural health products (NHP) by pregnant women in each trimester of pregnancy. Women (n = 599) participating in the first cohort of the Alberta Pregnancy Outcomes and Nutrition (APrON) study completed an interviewer-administered supplement intake questionnaire during each trimester of pregnancy. NHP use was high, with >90% taking multivitamin/mineral supplements, and nearly half taking at least one additional single-nutrient supplement. Compliance with supplementation guidelines was high for folic acid (>90%), vitamin D (∼70%) and calcium (∼80%), but low for iron (<30%) and for all four nutrients together (≤11%). On average, women met or exceeded the recommended dietary allowance for folic acid, vitamin D and iron from NHPs alone, with median daily intakes of 1000 µg, 400 IU and 27 mg, respectively. The median calcium intake was 250 mg d(-1) . Up to 26% of women exceeded the tolerable upper intake level for folic acid and up to 19% did so for iron at some point of their pregnancy. Findings highlight the need to consider both dietary and supplemental sources of micronutrients when assessing the nutrient intakes of pregnant women.

Feasibility and efficacy of menu planning combined with individual counselling to improve health outcomes and dietary adherence in people with type 2 diabetes: a pilot study.

OBJECTIVE: The purpose of this study was to test the feasibility and efficacy of implementing a 4-week menu plan combined with individual counselling among people with type 2 diabetes. METHODS: A 12-week pilot study with a pretest and post-test design was conducted among 15 participants with type 2 diabetes. The menu plan incorporated the overall recommendations of the Canadian Diabetes Association nutrition therapy guidelines and considered factors such as the accessibility, availability and acceptability of foods. Change in glycated hemoglobin (A1C) was the primary outcome, and secondary outcomes were changes in serum lipid, anthropometric and dietary measures. RESULTS: Mean (±SD) age of the participants was 59.3±9.9 years, and duration of diabetes was 8.1±8.3 years. After the program, A1C decreased by 1.0%±0.86% (p<0.05). There were significant reductions (p<0.05) in weight, body mass index, waist circumference and fat mass and increased high-density lipoprotein cholesterol. No significant changes were observed in dietary measures except for perceived dietary adherence score, which increased significantly (p<0.05). Participants reported using the menu plan an average of 5.0±1.9 days a week and attended, on average, 4 of 6 counselling sessions. CONCLUSIONS: Menu planning and individual counselling were demonstrated to be feasible and effective for diabetes management, and they represent a simple and practical approach to implement the nutritional recommendations for diabetes in Canada.

Test-retest reliability of a continuous glucose monitoring system in individuals with type 2 diabetes.

AIMS: This study determined the test-retest reliability of a continuous glucose monitoring system (CGMS) (iPro™2; Medtronic, Northridge, CA) under standardized conditions in individuals with type 2 diabetes (T2D). SUBJECTS AND METHODS: Fourteen individuals with T2D spent two nonconsecutive days in a calorimetry unit. On both days, meals, medication, and exercise were standardized. Glucose concentrations were measured continuously by CGMS, from which daily mean glucose concentration (GLU(mean)), time spent in hyperglycemia (t(>10.0 mmol/L)), and meal, exercise, and nocturnal mean glucose concentrations, as well as glycemic variability (SD(w), percentage coefficient of variation [%cv(w)], mean amplitude of glycemic excursions [MAGEc, MAGE(ave), and MAGE(abs.gos)], and continuous overlapping net glycemic action [CONGA(n)]) were estimated. Absolute and relative reliabilities were investigated using coefficient of variation (CV) and intraclass correlation, respectively. RESULTS: Relative reliability ranged from 0.77 to 0.95 (P<0.05) for GLU(mean) and meal, exercise, and nocturnal glycemia with CV ranging from 3.9% to 11.7%. Despite significant relative reliability (R=0.93; P<0.01), t(>10.0 mmol/L) showed larger CV (54.7%). Among the different glycemic variability measures, a significant between-day difference was observed in MAGEc, MAGE(ave), CONGA6, and CONGA12. The remaining measures (i.e., SD(w), %cv(w), MAGE(abs.gos), and CONGA1-4) indicated no between-day differences and significant relative reliability. CONCLUSIONS: In individuals with T2D, CGMS-estimated glycemic profiles were characterized by high relative and absolute reliability for both daily and shorter-term measurements as represented by GLUmean and meal, exercise, and nocturnal glycemia. Among the different methods to calculate glycemic variability, our results showed SD(w), %cv(w), MAGE(abs.gos), and CONGAn with n ≤ 4 were reliable measures. These results suggest the usefulness of CGMS in clinical trials utilizing repeated measured.

Estimation of choline intake from 24 h dietary intake recalls and contribution of egg and milk consumption to intake among pregnant and lactating women in Alberta.

Despite recommendations for higher choline intakes during pregnancy and lactation, there is limited research regarding maternal intake during these important periods. In the present study, we estimated dietary choline intake during pregnancy and lactation in a population of Albertan women and the contribution of egg and milk consumption to intake. Dietary intake data were collected from the first 600 women enrolled in a prospective cohort study carried out in Alberta, Canada. During the first and/or second trimester, the third trimester and 3 months postpartum, 24 h dietary intake recall data were collected. A database was constructed including foods consumed by the cohort and used to estimate dietary choline intake. The mean total choline intake value during pregnancy was 347 (SD 149) mg/d, with 23% of the participants meeting the adequate intake (AI) recommendation. During lactation, the mean total choline intake value was 346 (SD 151) mg/d, with 10% of the participants meeting the AI recommendation. Phosphatidylcholine was the form of choline consumed in the highest proportion and the main dietary sources of choline were dairy products, eggs and meat. Women who consumed at least one egg in a 24 h period had higher (P< 0·001) total choline intake and were eight times more likely (95% CI 5·2, 12·6) to meet choline intake recommendations compared with those who did not consume eggs during pregnancy. Women who reported consuming ≥ 500 ml of milk in a 24 h period were 2·8 times more likely (95 % CI 1·7, 4·8) to meet daily choline intake recommendations compared with those consuming < 250 ml of milk/d during pregnancy. Choline intake is below the recommendation levels in this population and the promotion of both egg and milk consumption may assist in meeting the daily choline intake recommendations.

Choosing healthier foods in recreational sports settings: a mixed methods investigation of the impact of nudging and an economic incentive.

BACKGROUND: Nudging is an approach to environmental change that alters social and physical environments to shift behaviors in positive, self-interested directions. Evidence indicates that eating is largely an automatic behavior governed by environmental cues, suggesting that it might be possible to nudge healthier dietary behaviors. This study assessed the comparative and additive efficacy of two nudges and an economic incentive in supporting healthy food purchases by patrons at a recreational swimming pool. METHODS: An initial pre-intervention period was followed by three successive and additive interventions that promoted sales of healthy items through: signage, taste testing, and 30% price reductions; concluding with a return to baseline conditions. Each period was 8 days in length. The primary outcome was the change in the proportion of healthy items sold in the intervention periods relative to pre- and post-intervention in the full sample, and in a subsample of patrons whose purchases were directly observed. Secondary outcomes included change in the caloric value of purchases, change in revenues and gross profits, and qualitative process observations. Data were analyzed using analysis of covariance, chi-square tests and thematic content analysis. RESULTS: Healthy items represented 41% of sales and were significantly lower than sales of unhealthy items (p < 0.0001). In the full sample, sales of healthy items did not differ across periods, whereas in the subsample, sales of healthy items increased by 30% when a signage + taste testing intervention was implemented (p < 0.01). This increase was maintained when prices of healthy items were reduced by 30%, and when all interventions were removed. When adults were alone they purchased more healthy items compared to when children were present during food purchases (p < 0.001), however parental choices were not substantially better than choices made by children alone. CONCLUSIONS: This study found mixed evidence for the efficacy of nudging in cueing healthier dietary behaviors. Moreover, price reductions appeared ineffectual in this setting. Our findings point to complex, context-specific patterns of effectiveness and suggest that nudging should not supplant the use of other strategies that have proven to promote healthier dietary behaviors.

The Alberta Pregnancy Outcomes and Nutrition (APrON) cohort study: rationale and methods.

The Alberta Pregnancy Outcomes and Nutrition (APrON) study is an ongoing prospective cohort study that recruits pregnant women early in pregnancy and, as of 2012, is following up their infants to 3 years of age. It has currently enrolled approximately 5000 Canadians (2000 pregnant women, their offspring and many of their partners). The primary aims of the APrON study were to determine the relationships between maternal nutrient intake and status, before, during and after gestation, and (1) maternal mood; (2) birth and obstetric outcomes; and (3) infant neurodevelopment. We have collected comprehensive maternal nutrition, anthropometric, biological and mental health data at multiple points in the pregnancy and the post-partum period, as well as obstetrical, birth, health and neurodevelopmental outcomes of these pregnancies. The study continues to follow the infants through to 36 months of age. The current report describes the study design and methods, and findings of some pilot work. The APrON study is a significant resource with opportunities for collaboration.

Exploring the variability in acute glycemic responses to exercise in type 2 diabetes.

AIM: To explore the factors associated with exercise-induced acute capillary glucose (CapBG) changes in individuals with type 2 diabetes (T2D). METHODS: Fifteen individuals with T2D were randomly assigned to energy-matched high intensity interval exercise (HI-IE) and moderate intensity continuous exercise (MI-CE) interventions and performed a designated exercise protocol 5 days per week for 12 weeks. The duration of exercise progressed from 30 to 60 minutes. CapBG was measured immediately before and after each exercise session. Timing of food and antihyperglycemic medication intake prior to exercise was recorded. RESULTS: Overall, the mean CapBG was lowered by 1.9 mmol/L (P < 0.001) with the change ranging from -8.9 to +2.7 mmol/L. Preexercise CapBG (44%; P < 0.001), medication (5%; P < 0.001), food intake (4%; P = 0.043), exercise duration (5%; P < 0.001), and exercise intensity (1%; P = 0.007) were all associated with CapBG changes, explaining 59% of the variability. CONCLUSION: The greater reduction in CapBG seen in individuals with higher preexercise CapBG may suggest the importance of exercise in the population with elevated glycemia. Lower blood glucose can be achieved with moderate intensity exercise, but prolonging exercise duration and/or including brief bouts of intense exercise accentuate the reduction, which can further be magnified by performing exercise after meals and antihyperglycemic medication. This trial is registered with ClinicalTrial.gov NCT01144078.

Making compromises: a qualitative study of sugar consumption behaviors during pregnancy.

OBJECTIVE: To explore influences on women's sugar consumption behaviors during pregnancy. DESIGN: Focused ethnography guided this qualitative study. Contrasting experiences between women with varying sugar intakes were investigated using semi-structured interviews. SETTING: Metropolitan area, Canada. PARTICIPANTS: Fifteen women with varying intakes of added sugar, who were in the third trimester of their first pregnancy, participated in this study. PHENOMENON OF INTEREST: Sugar consumption behaviors during pregnancy. ANALYSIS: Interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis to inductively derive themes. RESULTS: Pregnant women increased their intake of sugars in an effort to achieve a compromise between meeting nutrition recommendations, lifestyle adjustments, physical symptoms, and cultural norms. Physical symptoms, lack of nutritional guidance, and social pressures were identified as barriers to achieving a diet low in sugars, whereas implementing dietary strategies guided by nutritional knowledge was a facilitator. CONCLUSIONS AND IMPLICATIONS: This research provides insights that may be used to design effective interventions to improve maternal health. Strategies to help pregnant women achieve a healthy diet and limit sugar intake should be guided by nutritional knowledge, dietary awareness, and internal motivations to engage in healthy dietary changes.

Factors and barriers associated with early adoption of nutrition guidelines in Alberta, Canada.

OBJECTIVE: To identify factors that influenced early adoption and implementation of the Alberta Nutrition Guidelines for Children and Youth (ANGCY) in schools in Alberta, Canada; and to identify healthy eating strategies that were implemented as a result of the guidelines. Barriers and facilitators were also investigated. DESIGN: Multiple case study design (n = 3). Semi-structured interviews and direct observations were used to collect data. SETTING AND PARTICIPANTS: Three schools in Alberta were selected for individual case studies. Eighteen key informants were interviewed from the 3 cases. PHENOMENON OF INTEREST: To investigate how the motivation shown by school administration and stakeholders for the ANGCY influenced the early adoption and implementation of the guidelines. ANALYSIS: Content analysis was used to analyze data. RESULTS: Various healthy eating strategies were implemented within the 3 cases after uptake of the guidelines. Support from the school superintendent and the work of a health champion facilitated the adoption and implementation of the guidelines, whereas parents posed some barriers to the adoption and implementation of the ANGCY. CONCLUSIONS AND IMPLICATIONS: This study reinforces the importance of identifying a health champion to oversee healthy eating strategies in schools, and of involving parents in the promotion of children's healthy lifestyles.