Lifestyle modification intervention for overweight and obese Hispanic pregnant women: development, implementation, lessons learned and future applications.

OBJECTIVES: To describe the development, implementation and lessons learned of lifestyle intervention to promote appropriate gestational weight gain among Hispanic pregnant women. DESIGN: The intervention was informed by an empowerment oriented theoretical framework, and targeted women in the Pregnancy and Early Life Improvement Study. METHODS: The nutrition component consisted of recommendations for total calories, food quantity and improving carbohydrate and fat quality. We provided brown rice, omega-3 rich vegetable oil and spread, and water monthly. The physical activity focused on limiting sedentary behavior and promoting regular movement. The intervention was delivered through individual and group sessions and phone calls. Participants set their own goals, which were closely monitored. The intervention was evaluated extracting data from participant's record (attendance, goals, and challenges) and using a questionnaire. RESULTS: Participants were from underserved communities with economic, time, cultural and social barriers for engaging in lifestyle interventions. Modifications were done to facilitate participation, such as coordinating sessions with prenatal appointments and reducing group size and duration of sessions. Weekly text messages were added to reinforce the intervention. The main goal chosen by participants was reduction of sweetened beverages. The greatest challenges were replacing white rice with brown rice and improving physical activity. Participants suggested conducting sessions near their community and using social media as a motivation tool. Main outcomes results will be published elsewhere. CONCLUSION: We identified barriers to delivering the lifestyle intervention, mainly related to group session's participation. Sessions should be conducted in the community, using text messages and social media as reinforcement.

Validation and reproducibility of a semi-quantitative FFQ as a measure of dietary intake in adults from Puerto Rico.

OBJECTIVE: We aimed to assess the relative validity and reproducibility of a semi-quantitative FFQ in Puerto Rican adults. DESIGN: Participants completed an FFQ, followed by a 6 d food record and a second administration of the FFQ, 30 d later. All nutrients were log transformed and adjusted for energy intake. Statistical analyses included correlations, paired t tests, cross-classification and Bland-Altman plots. SETTING: Medical Sciences Campus, University of Puerto Rico. SUBJECTS: Convenience sample of students, employees and faculty members (n 100, ≥21 years). Data were collected in 2010. RESULTS: A total of ninety-two participants completed the study. Most were young overweight females. All nutrients were significantly correlated between the two FFQ, with an average correlation of 0·61 (range 0·43-0·73) and an average difference of 4·8 % between them. Most energy-adjusted nutrients showed significant correlations between the FFQ and food record, which improved with de-attenuation and averaged 0·38 (range 0·11-0·63). The lowest non-significant correlations (≤0·20) were for trans-fat, n 3 fatty acids, thiamin and vitamin E. Intakes assessed by the FFQ were higher than those from the food record by a mean of 19 % (range 4-44 %). Bland-Altman plots showed that there was a systematic trend towards higher estimates with the FFQ, particularly for energy, carbohydrate and Ca. Most participants were correctly classified into the same or adjacent quintile (average 66 %) by both methods with only 3 % gross misclassification. CONCLUSIONS: This semi-quantitative FFQ is a tool that offers relatively valid and reproducible estimates of energy and certain nutrients in this group of mostly female Puerto Ricans.

Reproducibility and validity of a food frequency questionnaire to estimate calcium intake in Puerto Ricans

The objective of the study was to assess the reproducibility and validity of a short semiquantitative calcium specific FFQ in a convenience Puerto Rican sample.Reproducibility was tested by the difference between calcium intakes from the FFQ completed twice, with a one month difference; validity was assessed against 6-day diet records (DR) in a sample of students, employees and faculty of the Medical Sciences Campus of the University of Puerto Rico. The statistical analyses performed were Pearson correlations, paired t-test, Bland-Altman plots, cross-classification analysis, Willett’s surrogate categories, specificity, sensitivity and predictive value. A total of 93 subjects were included in the study (mean age 28.8±10.1 years, BMI 25.7±6.1 kg/m2). Mean estimated calcium intakes were 846.4±356.9 mg/day for the first FFQ, 801.1±423.7 mg/day for the repeated FFQ and 845.4±377.5 mg/day for 6-day DR. No statistical difference was observed between the means by paired t-test (p>0.05), with significant correlations between means (p<0.05). The FFQ was found to have a specificity of 65.2%, a sensitivity of 73.5%, a positive predictive value of 86.2% and a negative predictive value of 45.5%. In conclusion, the short FFQ is a valid tool that could be used in the future to assess calcium intake in epidemiological surveys in this group.

Reproducibilidad y validez de un cuestionario de frecuencia de consumo de alimentos para estimar la ingesta de calcio en puertorriqueños. El objetivo del presente estudio fue medir la reproducibilidad y validez de un cuestionario semi-cuantitativo de frecuencia de consumo de alimentos (CFC) corto para estimar la ingesta de calcio en una muestra puertorriqueña de conveniencia. La reproducibilidad fue medida por la diferencia entre la ingesta de calcio del CFC completada dos veces, con un mes de diferencia; la validez fue medida usando un registro dietario de 6 días como referencia, en una muestra de estudiantes, empleados y profesores del Recinto de Ciencias Medicas de la Universidad de Puerto Rico. Para el análisis estadístico, se utilizó la correlación Pearson, la prueba T pareada, los gráficos de Bland-Altman, el análisis de clasificación cruzada, las categoríassustitutas de Willett, y los valores de especificidad, sensibilidad y de predicción. Un total de 93 sujetos fueron incluidos en el estudio (edad promedio 28.8±10.1 años, IMC 25.7±6.1 kg/m2). La ingesta promedio estimada de calcio fue de 846.4±356.9 mg/día en el primer CFC, 801.1±423.7 mg/día en la repetición del CFC y 845.4±377.5 mg/día en el registro de 6 días. No hubo diferencias estadísticas entre los promedios con la prueba T pareada (p>0.05) y se obtuvieron correlaciones significativas entre los promedios (p<0.05). El CFC tuvo una especificidad de 65.2%, una sensibilidad de 73.5%, un valor de predicción positivo de 86.2% y un valor de predicción negativo de 45.5%. Enconclusión, el CFC es una herramienta válida que puede ser usada en el futuro para estimar el consumo de calcio en estudios epidemiológicos en este grupo.