ORCID Profile
0000-0003-3547-6634
Current Organisations
Deakin University
,
University of Dublin Trinity College
,
University College Dublin
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Publisher: Elsevier BV
Date: 11-2006
Abstract: There is increasing evidence to suggest that reduced folate status may be a causative factor in carcinogenesis, particularly colorectal carcinogenesis. Folate is essential for the synthesis of S-adenosylmethionine, the methyl donor required for all methylation reactions in the cell, including the methylation of DNA. Global DNA hypomethylation appears to be an early, and consistent, molecular event in carcinogenesis. We have examined the effects of folate depletion on human-derived cultured colon carcinoma cells using 2 novel modifications to the Comet (single cell gel electrophoresis) assay to detect global DNA hypomethylation and gene region-specific DNA hypomethylation. Colon cells cultured in folate-free medium for 14 d showed a significant increase in global DNA hypomethylation compared with cells grown in medium containing 3 micromol/L folic acid. This was also true at a gene level, with folate-deprived cells showing significantly more DNA hypomethylation in the region of the p53 gene. In both cases, the effects of folate depletion were completely reversed by the reintroduction of folic acid to the cells. These results confirm that decreased folate levels are capable of inducing DNA hypomethylation in colon cells and particularly in the region of the p53 gene, suggesting that a more optimal folate status in vivo may normalize any DNA hypomethylation, offering potential protective effects against carcinogenesis. This study also introduces 2 novel functional biomarkers of DNA hypomethylation and demonstrates their suitability to detect folate depletion-induced molecular changes.
Publisher: Wiley
Date: 13-02-2018
Abstract: A health workforce with the ability to practice with Aboriginal communities is crucial to bridge the health gap between Aboriginal and non-Aboriginal Australians. This study aimed to explore the impact of university Aboriginal health placements on preparing dietetic graduates for practice with Aboriginal communities. A mixed methods sequential explanatory design was used. A s le of 594 dietetic graduates was invited to complete a survey that identified Aboriginal health experiences and measured attitudes and self-confidence towards working in Aboriginal health using a five-point Likert scale. Participants were ided into placement versus no-placement groups and compared using chi-squared tests. Sixteen of 33 participants who had completed an Aboriginal health placement were invited to participate in a semi-structured interview to explore how placement influenced practice with Aboriginal communities. Interviews were analysed using content analysis. A final s le of 120 participants showed that placement participants reported significantly higher self-confidence towards working in Aboriginal health compared with no-placement participants (No-placement = 35% agree, 36% neutral, 29% disagree Placement = 74% agree, 11% neutral, 16% disagree χ The results suggest that Aboriginal health placements may be an effective strategy for preparing dietetic graduates for practice with Aboriginal communities. The feasibility of placement or alternative curriculum content needs to be explored.
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.PCD.2018.10.006
Abstract: Gestational diabetes (GDM) and Type 2 diabetes pose tremendous health and economic burdens as worldwide incidence increases. Primary care-based systematic diabetes screening and prevention programs could be effective in women with previous GDM. GooD4Mum aimed to determine whether a Quality Improvement Collaborative (QIC) would improve postpartum diabetes screening and prevention planning in women with previous GDM in general practice. Fifteen general practices within Victoria (Australia) participated in a 12-month QIC, consisting of baseline and four quarterly audits, guideline-led workshops and Plan-Do-Study-Act feedback cycles after each audit. The primary outcome measures were the proportion of women on local GDM registers completing a diabetes screening test and a diabetes prevention planning consultation within the previous 15 months. Diabetes screening increased with rates more than doubled from 26% to 61% and postpartum screening increased from 43%-60%. Diabetes prevention planning consultations did not show the same level of increase (0%-10%). The recording of body mass index improved overall (51%-69%) but the number of women with normal body mass index did not. GooD4Mum supported increased diabetes screening and the monitoring of high risk women with previous GDM in general practice.
Publisher: Wiley
Date: 16-01-2022
DOI: 10.1111/DME.14772
Abstract: Women with prior gestational diabetes have nearly 10 times the risk of developing type 2 diabetes. Postpartum screening for type 2 diabetes is recommended for early diagnosis and management, yet uptake is low. This work updates a previous systematic review and advances it through the application of the Theoretical Domains Framework (TDF) to synthesise personal‐level factors impacting type 2 diabetes screening and the Capability, Opportunity, Motivation‐Behaviour model (COM‐B), to develop messaging recommendations for use in clinical practice and screening promotion interventions. We searched seven academic databases from September 2017 (prior review) to April 2021, reference lists and grey literature. Two reviewers independently screened articles against inclusion criteria (qualitative studies exploring factors impacting postpartum diabetes screening, any language) and extracted data. Using an inductive‐deductive model, we coded determinants to the TDF and mapped onto the COM‐B model. We identified 38 eligible papers from 34 studies ( N = 1291 participants). Most (71%) reported s le sizes of N ≥ 16. The ratio of barriers to enablers was three to one. Eight key TDF domains were identified. Evidence‐based recommendations include addressing knowledge, risk perception, fear of diabetes diagnosis, low prioritisation of personal health and fatalism. The risk of bias was low and confidence in findings was moderate to high. A limitation was conceptual overlap between TDF domains, which we addressed via the study procedure. The theoretical categorisation of determinants enables the development of messaging and interventions at the personal level, to promote women's uptake of postpartum type 2 diabetes screening.
Publisher: BMJ
Date: 17-05-2019
DOI: 10.1136/BMJOPEN-2018-027841
Abstract: India has high prevalence of hypertension but low awareness, treatment and control rate. A cluster randomised trial entitled ‘m-Power Heart Project’ is being implemented to test the effectiveness of a nurse care coordinator (NCC) led complex intervention to address uncontrolled hypertension in the community health centres (CHCs). The trial’s process evaluation will assess the fidelity and quality of implementation, clarify the causal mechanisms and identify the contextual factors associated with variation in the outcomes. The trial will use a theory-based mixed-methods process evaluation, guided by the Consolidated Framework for Implementation Research. The process evaluation will be conducted in the CHCs of Visakhapatnam (southern India). The key stakeholders involved in the intervention development and implementation will be included as participants. In-depth interviews will be conducted with intervention developers, doctors, NCCs and health department officials and focus groups with patients and their caregivers. NCC training will be evaluated using Kirkpatrick’s model for training evaluation. Key process evaluation indicators (number of patients recruited and retained concordance between the treatment plans generated by the electronic decision support system and treatment prescribed by the doctor and so on) will be assessed. Fidelity will be assessed using Borrelli et al ’s framework. Qualitative data will be analysed using the template analysis technique. Quantitative data will be summarised as medians (IQR), means (SD) and proportions as appropriate. Mixed-methods analysis will be conducted to assess if the variation in the mean reduction of systolic blood pressure between the intervention CHCs is influenced by patient satisfaction, training outcome, attitude of doctors, patients and NCCs about the intervention, process indicators etc. Ethical approval for this study was obtained from the ethics committees at Public Health Foundation of India and Deakin University. Findings will be disseminated via peer-reviewed publications, national and international conference presentations. NCT03164317 Pre-results.
Publisher: JMIR Publications Inc.
Date: 31-07-2023
Abstract: omen with overweight and obesity are at higher risk of developing complications in pregnancy such as gestational diabetes and longer-term chronic conditions. Research concerning health behaviour change interventions during pregnancy and postpartum show promising effects, but implementation into routine services is sparsely investigated. Most interventions focus on the antenatal or postpartum life stages, failing to meet the needs of women. IMPACT DIABETES Bump 2 Baby (B2B) is a multi-centre project across four high income countries developed to test the implementation of an antenatal and postpartum evidence-based mobile health (mHealth) coaching intervention called Bump2Baby and Me (B2B& Me) designed to sit alongside usual care in the perinatal period. e aim to explore the feasibility and implementation of the B2B& Me intervention and investigate the effectiveness of the B2B& Me intervention in women at risk of gestational diabetes. DB2B is a hybrid type two effectiveness-implementation study, which integrates an evidence-based mHealth coaching app that includes personalised health coaching provided by healthcare professionals alongside antenatal care to twelve months postpartum. This randomised controlled trial across four clinical sites within Ireland, UK, Spain, and Australia will recruit 800 women in early pregnancy to evaluate effectiveness on postpartum weight. The Exploration, Preparation, Implementation, Sustainment (EPIS) implementation framework is the theoretical underpinning of the study. The implementation evaluation will be assessed at in idual, hospital staff, and broader community levels using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. he study was approved and registered with the Australian New Zealand Clinical Trials Registry on 19th November 2020. Recruitment commenced on 9th February 2021 and data collection is ongoing. Publication of the results are expected in 2024. his is the first hybrid effectiveness-implementation study of an 18-month mHealth coaching intervention in at risk women that we are aware of. As research aims to move towards real-world implementable solutions, it is critical that hybrid studies are conducted. The data from this large multi-centre study will be useful in planning the implementation and scale-up of evidence-based perinatal health behaviour change interventions. ustralian New Zealand Clinical Trials Registry ACTRN12620001240932. Registered on 19th November 2020.
Publisher: BMJ
Date: 2022
DOI: 10.1136/BMJOPEN-2020-048166
Abstract: Behavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the in idual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of in idual and trial-level subgroups. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups. Systematic searches of Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2021 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index z-score at age 24±6 months using WHO Growth Standards, and effect differences will be explored among prespecified in idual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events. Approved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations and media releases. CRD42020177408.
Publisher: BMJ
Date: 2022
DOI: 10.1136/BMJOPEN-2020-048165
Abstract: Little is known about how early (eg, commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to (1) characterise early obesity prevention interventions in terms of target behaviours, delivery features and behaviour change techniques (BCTs), (2) explore similarities and differences in BCTs used to target behaviours and (3) explore effectiveness of intervention components in preventing childhood obesity. Annual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries. Eligible randomised controlled trials of behavioural interventions to prevent childhood obesity commencing antenatally or in the first year after birth will be invited to join the Transforming Obesity in CHILDren Collaboration. Standard ontologies will be used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials provided by trialists. Narrative syntheses will be performed to summarise intervention components and compare applied BCTs by types of target behaviours. Exploratory analyses will be undertaken to assess effectiveness of intervention components. The study has been approved by The University of Sydney Human Research Ethics Committee (project no. 2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). The study’s findings will be disseminated through peer-reviewed publications, conference presentations and targeted communication with key stakeholders. CRD42020177408.
Publisher: Cambridge University Press (CUP)
Date: 2023
Publisher: IGI Global
Date: 2020
Abstract: The purpose of this study was to examine how students received the combination of technology-based tools implemented in a staged manner within a curriculum and if any specific tool was of greater benefit in developing their reflective practice skills. Participants were 45 tertiary students enrolled in a health professional course. Qualitative and quantitative analysis revealed student preference for in idual tools changed over time. Students preferred supportive tools (simulated video recordings, group blogging and teaching approaches) earlier on and independent tools (e-journaling and online reflective summary writing) in their final year. The findings support the use of different reflective practice tools in course design to better support student development and improve student engagement in reflective practices.
Publisher: Springer Science and Business Media LLC
Date: 27-06-2022
DOI: 10.1186/S12887-022-03423-X
Abstract: In idual differences in children eating behaviours have been linked with childhood overweight and obesity. The determinants of childhood eating behaviours are influenced by a complex combination of hereditary and ecological factors. This study examines if key ecological predictors of childhood overweight maternal socio-economic status (SES), children’s screen time, and childcare arrangements, are associated with eating behaviours in children aged 5-years-old . This is secondary, cross-sectional analysis of the ROLO (Randomized COntrol Trial of LOw glycemic diet in pregnancy) study, using data from the 5-year follow-up ( n = 306). Weight, height, and body mass index (BMI) were obtained from mothers and children at the 5-year follow-up. Children’s BMI z-scores were calculated. SES was determined using maternal education level and neighborhood deprivation score. Information on children’s screen time and childcare arrangements were collected using lifestyle questionnaires. Children’s eating behaviours were measured using the Children’s Eating Behaviour Questionnaire (CEBQ). Multiple linear regression, adjusted for potential confounders, assessed associations between maternal SES, screen time and children’s eating behaviours. One-way ANOVA, independent s le t-tests and Spearman’s correlation examined childcare exposure and children’s eating behaviour. Mothers in the lowest SES group had higher BMI and were younger than those in the highest SES group ( p = 0.001, p = 0.03 respectively). In adjusted analysis, the lowest SES group was associated with a 0.463-point higher mean score for ‘Desire to Drink’ (95% CI = 0.054,0.870, p = 0.027) and higher ‘Slowness to Eat’ (B = 0.388, 95% CI = 0.044,0.733, p = 0.027) when compared with the highest SES group. Screen time (hours) was associated with higher ‘Food Fussiness’ (B = 0.032, 95% CI = 0.014,0.051, p = 0.001). Those who attended childcare had higher scores for ‘Desire to Drink’( p = 0.046). No relationship was observed between longer duration (years) spent in childcare and eating behaviours. In this cohort, the ecological factors examined had an influence on children’s eating behaviours aged 5-years-old. Our results illustrate the complexity of the relationship between the child’s environment, eating behaviour and children’s body composition. Being aware of the ecological factors that impact the development of eating behaviours, in the pre-school years is vital to promote optimal childhood appetitive traits, thus reducing the risk of issues with excess adiposity long-term.
Publisher: Wiley
Date: 28-07-2015
Publisher: JMIR Publications Inc.
Date: 20-12-2022
DOI: 10.2196/40058
Abstract: Lifestyle-related diseases are among the leading causes of death and disability. Their rapid increase worldwide has called for low-cost, scalable solutions to promote health behavior changes. Digital health coaching has proved to be effective in delivering affordable, scalable programs to support lifestyle change. This approach increasingly relies on asynchronous text-based interventions to motivate and support behavior change. Although we know that empathy is a core element for a successful coach-user relationship and positive patient outcomes, we lack research on how this is realized in text-based interactions. Systemic functional linguistics (SFL) is a linguistic theory that may support the identification of empathy opportunities (EOs) in text-based interactions, as well as the reasoning behind patients' linguistic choices in their formulation. This study aims to determine whether empathy and SFL approaches correspond and complement each other satisfactorily to study text-based communication in a health coaching context. We sought to explore whether combining empathic assessment with SFL categories can provide a means to understand client-coach interactions in asynchronous text-based coaching interactions. We retrieved 148 text messages sent by 29 women who participated in a randomized trial of telecoaching for the prevention of gestational diabetes mellitus (GDM) and postnatal weight loss. We conducted a pilot study to identify users' explicit and implicit EOs and further investigated these statements using the SFL approach, focusing on the analysis of transitivity and thematic analysis. We identified 164 EOs present in 42.37% (3478/8209) of the word count in the corpus. These were mainly negative (n=90, 54.88%) and implicit (n=55, 60.00%). We distinguished opening, content and closing messages structures. Most of the wording was found in the content (n=7077, 86.21%) with a declarative structure (n=7084, 86.30%). Processes represented 22.4% (n=1839) of the corpus, with half being material (n=876, 10.67%) and mostly related to food and diet (n=196, 54.92%), physical activity (n=96, 26.89%), and lifestyle goals (n=40, 11.20%). Our findings show that empathy and SFL approaches are compatible. The results from our transitivity analysis reveal novel insights into the meanings of the users’ EOs, such as their seek for help or praise, often missed by health care professionals (HCPs), and on the coach-user relationship. The absence of explicit EOs and direct questions could be attributed to low trust on or information about the coach’s abilities. In the future, we will conduct further research to explore additional linguistic features and code coach messages. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001240932 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020
Publisher: BMJ
Date: 11-2020
DOI: 10.1136/BMJDRC-2020-001594
Abstract: Mothers with gestational diabetes mellitus (GDM) are at high risk of future diabetes. An active area of research examines health behavior change strategies in women within 5 years of a GDM pregnancy to prevent diabetes after pregnancy. We aimed to develop a core outcome set (COS) to facilitate synthesis and comparison across trials. Candidate outcomes were identified through systematic review and scored for importance (1–9) by healthcare professionals, researchers, and women with prior GDM through an international two-round electronic-Delphi survey. Outcomes retained required round two scores above prespecified thresholds (≥70% scoring 7–9) or expert panel endorsement when scores were indeterminate. The panel organized the COS by domain. 115 stakeholders participated in the survey and 56 completed both rounds. SD of scores decreased by 0.24 (95%CI 0.21 to 0.27) by round 2, signaling convergence. The final COS includes 19 domains (50 outcomes): diabetes (n=3 outcomes), other related diseases (n=3), complications in subsequent pregnancy (n=2), offspring outcomes (n=3), adiposity (n=4), cardiometabolic measures (n=5), glycemia (n=3), physical activity (n=2), diet (n=4), breast feeding (n=2), behavior change theory (n=5), diabetes-related knowledge (n=2), health literacy (n=1), social support (n=1), sleep (n=1), quality of life (n=1), program delivery (n=4), health economic evaluation (n=2), and diabetes risk screening (n=2). The seven outcomes endorsed by ≥90% were diabetes development and GDM recurrence, attending the postpartum diabetes screening and completing oral glucose tolerance testing and/or other glycemia measures, weight and total energy intake, and health behaviors in general. Among the 15 at the 80%–90% endorsement level, approximately half were specific elements related to the top 7, while the remainder related to diabetes knowledge, personal risk perception, motivation for change, program element completion, and health service use and cost. Researchers should collect and report outcomes from the breadth of domains in the COS.
Publisher: Elsevier BV
Date: 04-2017
DOI: 10.1016/J.DIABRES.2017.02.026
Abstract: To explore the acceptability of a telephone- or a group-delivered diabetes prevention program for women with previous gestational diabetes and to compare the characteristics associated with program engagement. Postpartum women participated in a lifestyle modification program delivered by telephone (n=33) or group format (n=284). Semi-structured interviews on barriers and enablers to program engagement (defined as completing≥80% sessions) were conducted before (Group) and after (Group and Telephone) interventions. The Health Action Process Approach theory was used as the framework for inquiry. Psychological measures were compared between engagement subgroups before and after group-delivered intervention. In the telephone-delivered program 82% participants met the engagement criteria compared with 38% for the group-delivered program. Engaged participants (Group) had significantly higher risk perception, outcome expectancy, and activity self-efficacy at baseline (P<0.05). There was a greater decrease in body weight (-1.45±3.9 vs -0.26±3.5, P=0.024) and waist circumference (-3.56±5.1 vs -1.24±5.3, P=0.002) for engaged vs non-engaged participants following group program completion. Telephone delivery was associated with greater engagement in postpartum women. Engagement was associated with greater reduction in weight and waist circumference. Further studies are required to confirm the effectiveness of telephone-delivered program for diabetes prevention in postpartum women.
Publisher: Cambridge University Press (CUP)
Date: 27-10-2021
DOI: 10.1017/S0029665121003724
Abstract: The present paper outlines current issues in the nutritional care of women during pregnancy and potential resources to address them. Globally, overnutrition, undernutrition and nutritional imbalances are widespread among women of reproductive age increasing the risk of pregnancy complications and non-communicable diseases in both mothers and their children. Most women do not meet dietary guidelines for pregnancy. The World Health Organisation (WHO) recommends nutrition and weight counselling during pregnancy for all women. However, clinical practices focusing on nutrition vary and there is no consensus on which outcomes are most important for pregnancy nutrition interventions, with little consideration for the ‘patient voice’. The International Federation of Gynaecology and Obstetrics (FIGO) nutrition checklist is a clinical practice tool that is available for healthcare professionals that will address this issue. The pregnancy nutrition core outcome set will also support advancement of antenatal nutrition by identifying the most critical nutrition-related outcomes from the perspective of healthcare professionals, researchers and women with experience of pregnancy. While poor nutrition can result in adverse outcomes across women of all weight categories, those with obesity may require specialist care to reduce their risk. Obesity is a chronic, progressive, relapsing disease that has high in idual variability in its prognosis. The use of obesity staging systems, which consider mental, physical and functional health, can stratify in iduals into risk categories and aid in treatment prioritisation in pregnancy. As the prevalence of obesity continues to rise, an obesity staging approach may support clinicians, especially those in limited resource settings.
Publisher: Springer Science and Business Media LLC
Date: 03-2003
Publisher: Elsevier BV
Date: 11-2018
DOI: 10.1016/J.DIABRES.2018.04.016
Abstract: Health behaviour change interventions have potential to reduce diabetes after pregnancy (DAP) rates following gestational diabetes mellitus (GDM). Recruitment success is arguably as important as intervention effectiveness, but receives less attention. We examined penetration into target populations and participation in DAP prevention interventions in women with a GDM history. Five databases were searched for studies published up to December 2017. Studies were reviewed by at least three reviewers and data were qualitatively synthesized. Penetration (invited/target population) and participation (enrolled/invited) rates were calculated after data extraction. Among 2859 records, 33 intervention studies were identified, among which 16 had sufficient information to calculate penetration or participation. Penetration proportion (n = 9 studies) was between 85 and 100% for two-thirds of studies included. Participation proportion (n = 16 studies) varied substantially when recruitment occurred during pregnancy or early postpartum, participation was 40% or more, especially if face-to-face contact was used within the GDM care setting, compared to under 15% in mid/late postpartum with mailed invitation and/or telephone contact. Although penetration and participation reporting is sub-optimal, penetration is generally high while participation is variable. Leveraging and structuring recruitment within standard GDM care and settings appears to be important to engage women in DAP prevention activities.
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.APPET.2022.106291
Abstract: Maternal diet during pregnancy is an important determinant of birth outcomes and offspring health. The relationship between maternal diet quality during pregnancy and the development of appetitive traits in early childhood has not been extensively researched. We examined associations of maternal diet quality during pregnancy with child appetitive traits at 5 years old. This is a secondary analysis of the ROLO longitudinal birth cohort study. We assessed maternal diet during pregnancy using 3-day food diaries and evaluated diet quality using the Alternative Healthy Eating Index, modified for pregnancy (AHEI-P). Children's appetitive traits at 5-years-old were assessed using the Child Eating Behaviour Questionnaire (CEBQ) (n = 306). Average AHEI-P score over trimesters was calculated and stratified into tertiles. Maternal and child characteristics were examined across AHEI-P tertiles. Multiple linear regression was conducted to explore associations between maternal AHEI-P scores in each trimester and child appetitive traits at 5-years-old. Women with low AHEI-P scores were younger at childbirth and had higher BMI. In adjusted linear regression maternal AHEI-P was negatively associated with child 'Desire to Drink' (Trimester 1: B = -0.014, 95% CI = -0.025, -0.002, p = 0.017 Trimester 2: B = -0.013, 95% CI = -0.025, -0.001, p = 0.035). Trimester 3 AHEI-P was not associated with any child appetitive traits. Maternal diet quality in pregnancy may provide an early opportunity to positively influence the development of offspring's appetitive traits.
Publisher: Public Library of Science (PLoS)
Date: 25-08-2022
DOI: 10.1371/JOURNAL.PONE.0273339
Abstract: The COVID-19 pandemic has had a negative impact on the mental health of people globally. Significant concerns about health and access to services among women of reproductive age considering pregnancy may cause psychological distress, and in turn increase health risks during and after pregnancy for mothers and offspring. To examine the association between pregnancy intention and psychological distress during the COVID-19 pandemic in Australia, and explore if this association differed based on local viral transmission rates and corresponding levels of pandemic restrictions. A nationwide online survey was completed by 849 non-pregnant women aged 18–50 years between 15 October and 7 November 2020. Women were asked about their intention to become pregnant, and psychological distress was assessed using the Kessler Psychological Distress Scale (K10). Multivariable regression analysis examined associations between pregnancy intention and psychological distress. An interaction term was added to the model to examine differences in associations by level of viral transmission rates and lockdown restrictions which was determined based on postcode. Pregnancy intention was not associated with experiencing (very) high psychological distress in the overall study population (odds ratio (OR) 1.42, 95% CI 0.94, 2.11). The interaction term (p = 0.09) suggested potential differences by level of restrictions and viral transmission rates. In stratified analysis among women living in a location with strict lockdown restrictions and high viral transmission rates leading up to and during the study, those planning to become pregnant were more likely to experience (very) high psychological distress (OR 3.39, 2.04, 5.65) compared with women not planning to become pregnant. Pregnancy intention was not associated with psychological distress among women exposed to lower levels of pandemic restrictions and viral transmission rates (OR 1.17, 0.74, 1.85). Our findings highlight the need to identify and support women planning pregnancy during a public health crisis to mitigate potential short- and long-term intergenerational negative health outcomes associated with psychological distress.
Publisher: Wiley
Date: 10-2019
DOI: 10.1002/IJGO.12953
Abstract: To develop a Core Outcome Set (COS) for pregnancy nutrition research that is relevant to varied stakeholders and resource settings. This study has three distinct phases. The first phase involves generating a list of outcomes for consideration for the COS. This includes a systematic review of studies evaluating nutrition during pregnancy where all outcomes reported in relevant literature will be extracted. Qualitative interviews with currently or previously pregnant women will also be conducted. This step will supplement the findings of the systematic review by identifying additional outcomes of importance to this stakeholder group. In the second phase of the study, healthcare professionals, researchers, and mothers from various international resource settings will be invited to participate in a two-round modified Delphi survey. The aim of the survey is to gain consensus on which outcomes are most important to include in the COS. Finally, a face-face consensus meeting will be held with a select group of participants to finalize the COS. This COS will support standardization of outcome reporting in pregnancy nutrition research and ensure that selected outcomes are considered important by a variety of stakeholders. This will enhance the evidence behind nutrition interventions in pregnancy to improve outcomes for pregnant women.
Publisher: Academy of Management
Date: 08-2020
Publisher: MDPI AG
Date: 24-10-2022
Abstract: Engaging women with obesity in health-related studies during preconception is challenging. Limited data exists relating to their participation. The aim of this study is to explore the experiences and opinions of women participating in a weight-related, preconception trial. This is an explanatory sequential (quan-QUAL) mixed-methods Study Within A Trial, embedded in the GetGutsy randomized controlled trial (ISRCTN11295995). Screened participants completed an online survey of eight questions (single or multiple choice and Likert scale) on recruitment, motivations and opinions on study activities. Participants with abdominal obesity (waist circumference ≥ 80 cm) were invited to a subsequent semi-structured, online focus group (n = 2, 9 participants) that was transcribed and analyzed using inductive thematic analysis, with a pragmatic epistemological approach. The survey (n = 102) showed the main research participation motivations were supporting health research (n = 38, 37.3%) and wanting health screening (n = 30, 29.4%). Most participants were recruited via email (n = 35, 34.7%) or social media (n = 15, 14.7%). In the FGs, participants valued flexibility, convenience and. research methods that aligned with their lifestyles. Participants had an expanded view of health that considered emotional well-being and balance alongside more traditional medical assessments. Clinical trialists should consider well-being, addressing the interconnectedness of health and incorporate a variety of research activities to engage women of reproductive age with obesity.
Publisher: Wiley
Date: 04-2023
DOI: 10.1111/DME.15047
Publisher: MDPI AG
Date: 08-01-2021
Abstract: Our objective was to describe the development and validation of a survey investigating barriers to weight loss, perception of diabetes risk, and views of diet strategies following gestational diabetes (GDM). The survey underwent three stages of development: generation of items, expert evaluation, and pilot testing. A content validation index (CVI) was calculated from expert responses regarding item relevance, coherence, clarity, and response options. Experts also responded to the domain fit of questions linked to the Theoretical Domains Framework (TDF). Pilot responders answered the survey and responded to review questions. Six experts in the field of nutrition, midwifery, psychology, or other health or medical research completed the expert review stage of the survey. In the pilot test, there were 20 responders who were women with previous GDM and who were living in Australia. The overall CVI from the expert review was 0.91. All questions except one received an I-CVI of .78 for relevance (n = 35). Fourteen of the 27 items linked to the TDF received an agreement ratio of .0. Twenty-seven of the 31 pilot questions were completed by ≥90% of responders. Pilot review questions revealed an agreement percentage of ≥86% (n = 12) regarding the survey’s ease to complete, understand, importance, length, and interest level. The final survey tool consists of 30 items and achieved content validation through expert evaluation and pilot testing.
Publisher: Springer Science and Business Media LLC
Date: 15-10-2015
Publisher: Elsevier BV
Date: 06-2019
Publisher: Springer Science and Business Media LLC
Date: 28-08-2012
Abstract: The successful Greater Green Triangle Diabetes Prevention Program (GGT DPP), a small implementation trial, has been scaled-up to the Victorian state-wide ‘Life!’ programme with over 10,000 in iduals enrolled. The Melbourne Diabetes Prevention Study (MDPS) is an evaluation of the translation from the GGT DPP to the Life! programme. We report results from the preliminary phase (pMDPS) of this evaluation. The pMDPS is a randomised controlled trial with 92 in iduals aged 50 to 75 at high risk of developing type 2 diabetes randomised to Life! or usual care. Intervention consisted of six structured 90-minute group sessions: five fortnightly sessions and the final session at 8 months. Participants underwent anthropometric and laboratory tests at baseline and 12 months, and provided self-reported psychosocial, dietary, and physical activity measures. Intervention group participants additionally underwent these tests at 3 months. Paired t tests were used to analyse within-group changes over time. Chi-square tests were used to analyse differences between groups in goals met at 12 months. Differences between groups for changes over time were tested with generalised estimating equations and analysis of covariance. Intervention participants significantly improved at 12 months in mean body mass index (−0.98 kg/m 2 , standard error (SE)%20=%200.26), weight (−2.65 kg, SE%20=%200.72), waist circumference (−7.45 cm, SE%20=%201.15), and systolic blood pressure (−3.18 mmHg, SE%20=%201.26), increased high-density lipoprotein-cholesterol (0.07 mmol/l, SE%20=%200.03), reduced energy from total (−2.00%, SE%20=%200.78) and saturated fat (−1.54%, SE%20=%200.41), and increased fibre intake (1.98 g/1,000 kcal energy, SE%20=%200.47). In controls, oral glucose at 2 hours deteriorated (0.59 mmol/l, SE%20=%200.27). Only waist circumference reduced significantly (−4.02 cm, SE%20=%200.95). Intervention participants significantly outperformed controls over 12 months for body mass index and fibre intake. After baseline adjustment, they also showed greater weight loss and reduced saturated fat versus total energy intake. At least 5% weight loss was achieved by 32% of intervention participants versus 0% controls. pMDPS results indicate that scaling-up from implementation trial to state-wide programme is possible. The system design for Life! was fit for purpose of scaling-up from efficacy to effectiveness. Australian and New Zealand Clinical Trials Registry ACTRN12609000507280
Publisher: MDPI AG
Date: 21-11-2014
Publisher: MDPI AG
Date: 08-12-2020
Abstract: Weight loss after gestational diabetes (GDM) reduces the risk of type 2 diabetes (T2DM) however, weight loss remains challenging in this population. In order to explore perceptions of T2DM risk, barriers to weight loss, and views of diet strategies in women with previous GDM, a cross-sectional online survey of n = 429 women in Australia aged ≥18 years with previous GDM was conducted. Opinions of intermittent energy restriction (IER) were of interest. Seventy-five percent of responders (n = 322) had overweight or obesity, and 34% (n = 144) believed they had a high risk of developing T2DM. Within the Theoretical Domains Framework, barriers to weight loss were prominently related to Environmental Context and Resources, Beliefs about Capabilities, and Behavioural Regulation. Exercising was the most tried method of weight loss over other diet strategies (71%, n = 234) and weight loss support by a dietician was appealing as in idual appointments (65%, n = 242) or an online program (54%, n = 200). Most women (73%, n = 284) had heard of IER (the “5:2 diet”), but only 12% (n = 34) had tried it. Open comments (n = 100) revealed mixed views of IER. Women in Australia with previous GDM were found to lack a self-perceived high risk of developing T2DM and expressed barriers to weight loss related to their family environment, beliefs about their capabilities and behavioural regulation. IER is appealing for some women with previous GDM however, views vary.
Publisher: Wiley
Date: 24-07-2023
DOI: 10.1002/IJGO.15029
Publisher: Wiley
Date: 05-04-2023
Abstract: To develop a core outcome set for pregnancy nutrition. Mixed‐methods core outcome set development study. Online. Healthcare professionals, researchers and women with experience of pregnancy. Candidate outcomes were identified from a systematic review of intervention and observational studies. One‐to‐one semi‐structured interviews with women with experience of pregnancy ( n = 26) were transcribed and analysed using inductive thematic analysis. Outcomes were consolidated, organised into domains and categorised using the Core Outcome Measures in Effectiveness Trials taxonomy. A two‐round, modified Delphi survey (May–August 2021) was conducted. Participants voted on how critical each outcome was to include using a nine‐point Likert scale. All outcomes that did not reach consensus were discussed at a consensus meeting. Critical outcomes to include in the core outcome set. A total of 53 091 articles were identified. Outcomes were extracted from 427 articles. The qualitative data yielded 45 outcomes. An additional 24 outcomes came from the literature. In round one, 82 participants ranked 30 outcomes. One new outcome was included in round two, during which participants ( n = 60) voted 12/31 outcomes as critical to include. The remaining 20 outcomes were discussed at the consensus meeting and two outcomes were included. Maternal outcomes included: pregnancy complications delivery complications maternal wellbeing gestational weight change maternal vitamin and mineral status mental health diet quality nutritional intakes need for treatments, interventions, medications and supplements pregnancy loss or perinatal death birth defects or congenital anomalies neonatal complications and newborn anthropometry and body composition. The use of the Pregnancy Nutrition Core Outcome Set (PRENCOS) will ensure researchers measure what matters most from the perspective of key stakeholders.
Publisher: Springer Science and Business Media LLC
Date: 07-09-2010
Publisher: Wiley
Date: 14-01-2020
DOI: 10.1111/MCN.12947
Publisher: Springer Science and Business Media LLC
Date: 31-01-2013
Abstract: Worldwide, type 2 diabetes (T2DM) prevalence has more than doubled over two decades. In Australia, diabetes is the second highest contributor to the burden of disease. Lifestyle modification programs comprising diet changes, weight loss and moderate physical activity, have been proven to reduce the incidence of T2DM in high risk in iduals. As part of the Council of Australia Governments, the State of Victoria committed to develop and support the diabetes prevention program ‘Life! Taking action on diabetes’ (Life!) which has direct lineage from effective clinical and implementation trials from Finland and Australia. The Melbourne Diabetes Prevention Study (MDPS) has been set up to evaluate the effectiveness and cost-effectiveness of a specific version of the Life! program. We intend to recruit 796 participants for this open randomized clinical trial 398 will be allocated to the intervention arm and 398 to the usual care arm. Several methods of recruitment will be used in order to maximize the number of participants. In iduals aged 50 to 75 years will be screened with a risk tool (AUSDRISK) to detect those at high risk of developing T2DM. Those with existing diabetes will be excluded. Intervention participants will undergo anthropometric and laboratory tests, and comprehensive surveys at baseline, following the fourth group session (approximately three months after the commencement of the intervention) and 12 months after commencement of the intervention, while control participants will undergo testing at baseline and 12 months only. The intervention consists of an initial in idual session followed by a series of five structured-group sessions. The first four group sessions will be carried out at two week intervals and the fifth session will occur eight months after the first group session. The intervention is based on the Health Action Process Approach (HAPA) model and sessions will empower and enable the participants to follow the five goals of the Life! program. This study will determine whether the effect of this intervention is larger than the effect of usual care in reducing central obesity and cardiovascular risk factors and thus the risk of developing diabetes and cardiovascular disease. Also it will evaluate how these two options compare economically. Australian New Zealand Clinical Trials Registry ACTRN12609000507280
Publisher: Wiley
Date: 08-01-2020
DOI: 10.1111/OBR.12990
Abstract: The established efficacy in postpartum lifestyle interventions has not been translated into better outcomes. This systematic review and meta-analysis assess the penetration (the proportion of women invited within the target population), implementation (fidelity), participation (the proportion of those invited who enrolled), and effect (weight loss compared to controls) (PIPE) of randomized controlled trials of lifestyle interventions in postpartum women (within two years after birth). MEDLINE, EMBASE, Pubmed, and other databases and clinical trial registries were searched up to the 3rd of May 2019. Data was extracted from published reports and missing data was obtained from study authors. The quality of the studies was appraised using the Cochrane Risk of Bias tool (2·0). Main outcomes were the PIPE impact metrics and changes in body weight. Thirty-six trials (49 publications) were included (n=5,315 women). One study provided sufficient information to calculate the population penetration rate (2·5%). All studies provided implementation (fidelity) information, but over half had low program fidelity. The participation rate was calculated for nine studies (0·94% to 86%). There was significant change in body weight (mean difference (MD) (95% confidence interval, CI) of -2·33 (-3·10 to -1·56). This highlights the inadequacy of conventional RCTs to inform implementation. Future research should broaden methods to pragmatic trials.
Publisher: MDPI AG
Date: 26-11-2021
DOI: 10.3390/NU13124262
Abstract: This study aimed to describe the prevalence, severity and socio-demographic predictors of food insecurity in Australian households during the COVID-19 pandemic in 2020, from the perspective of women. A cross-sectional online survey of Australian (18–50 years) women was conducted. The survey collected demographic information and utilised the 18-item US Department of Agriculture Household Food Security Survey Module and the Kessler Psychological Distress Scale (K10). A multivariable regression was used to identify predictors of food security status. In this cohort (n = 1005), 19.6% were living in households experiencing food insecurity with 11.8% experiencing low food-security and 7.8% very low food-security. A further 13.7% of households reported marginal food-security. Poor mental health status (K10 score ≥ 20) predicted household food insecurity at all levels. The presence of more than three children in the household was associated with low food-security (OR 6.24, 95% CI: 2.59–15.03). Those who were renting were 2.10 (95% CI: 1.09–4.05) times likely to experience very low food-security than those owning their own home. The COVID-19 pandemic may have contributed to an increased prevalence of household food insecurity. This study supports the need for a range of responses that address mental health, financial, employment and housing support to food security in Australia.
Publisher: BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
Date: 06-2019
Publisher: Elsevier BV
Date: 10-2016
Publisher: Cambridge University Press (CUP)
Date: 2023
Publisher: Elsevier BV
Date: 2013
Abstract: Low folate status is a risk factor for colon carcinogenesis mechanisms proposed to account for this relationship include uracil misincorporation into DNA and global DNA hypomethylation. We investigated whether such biomarkers are related to folate status in isolated colonocytes from colonoscopy patients. In cases with adenomatous polyps (n = 40) or hyperplastic polyps (n = 16), colonocytes were isolated from biopsies from the polyp, from a site adjacent to the polyp, and from normal mucosa 10-15 cm distal to the polyp. In polyp-free controls (n = 53), biopsies were taken from ascending, transverse, and descending areas of colon. Within adenoma cases, there was a trend (P-trend < 0.001) of decreasing colonocyte folate (pg/10⁵ cells, mean ± CI) from the site distal to the polyp (16.9 ± 2.4), to the site adjacent to the polyp (14.7 ± 2.3), to the polyp (12.8 ± 2.0). Correspondingly, there were increases in uracil misincorporation (P-trend < 0.001) and global DNA hypomethylation (P-trend = 0.012) across the 3 sites. Colonocyte folate concentrations were significantly correlated with RBC folate concentrations, but only in in iduals with generally lower (≤484 μg/L) RBC folate status (r = 0.54 P = 0.006 n = 24), and were also significantly lower in normal mucosa of cases with adenomatous polyps than in controls matched for colonic segment. In conclusion, localized folate deficiency in specific areas of colon might create carcinogenic fields and affect the development of colorectal polyps through uracil misincorporation and DNA hypomethylation alternatively, the polyp itself might deplete folate in the surrounding tissue. Folate supplementation trials aimed at colon cancer prevention should target in iduals with suboptimal folate status.
Publisher: Wiley
Date: 03-04-2019
DOI: 10.1111/OBR.12846
Abstract: Postpartum weight retention is a significant contributor to obesity in reproductive-aged women, but the key implementation characteristics of postpartum weight management interventions have not been systematically identified to inform policy and practice. This study aimed to evaluate the intervention characteristics associated with weight loss in postpartum women using the Template for Intervention Description and Replication (TIDieR) framework. We searched MEDLINE, CINAHL, EMBASE, PSYCINFO, and EBM databases to identify lifestyle intervention RCTs in postpartum women (within 2 years after birth) published up to January 2018. From 4512 studies, 33 studies were included in the systematic review and meta-analysis (n = 4960 women). Health professional-delivered interventions had significantly greater weight loss than those delivered by nonhealth professionals (mean difference, 95% confidence interval: (-3.22 kg [-4.83, -1.61] vs -0.99 kg [-1.53, -0.45], P = 0.01 for subgroup differences)). Diet and physical activity combined had significantly greater weight loss compared with physical activity-only interventions (-3.15 kg [-4.34, -1.96] vs -0.78 kg [-1.73, 0.16], P = 0.009 for subgroup differences). The extent of weight loss was not influenced by intervention intensity (duration, number of sessions) and setting (in idual or group).
Publisher: F1000 Research Ltd
Date: 24-01-2023
DOI: 10.12688/OPENRESEUROPE.14938.3
Abstract: Objective : To synthesise the evidence on prenatal breastfeeding self-efficacy, including identifying concepts and theoretical frameworks that underpin its development, the evidence on its measurement, interventions used to improve it, and association with breastfeeding outcomes. Background : Breastfeeding self-efficacy is described as a woman’s self-belief and confidence in her perceived ability to breastfeed. It is a modifiable measure that is strongly associated with breastfeeding outcomes such as initiation, exclusivity, and duration. Interventions aimed at increasing self-efficacy are often in the postnatal period and have been shown to be effective at improving breastfeeding outcomes. The prenatal period appears to be underexplored in the literature and yet focusing on enhancing it may have the potential for further improvements in self-efficacy and on subsequent breastfeeding outcomes. A comprehensive knowledge synthesis on prenatal breastfeeding self-efficacy is lacking. Methods : The search will include databases across health, psychology, sociology, and the grey literature on breastfeeding guidance. Once the PCC framework (Problem: breastfeeding, Concept: self-efficacy, Context: prenatal period) is met, sources of evidence from any contextual setting will be eligible for inclusion. Limits will not be applied on geographic location or year of publication. The PRISMA-ScR flow diagram of search and study selection will be used to report final figures. Two independent reviewers will perform title and abstract screening and full text review. Data will be charted to provide a logical and descriptive summary of the results that align with the objectives. Conclusion : The results will provide an understanding of what has been done in the space and what gaps exist, informing recommendations for the timing of measurement and the design of prenatal interventions.
Publisher: AMPCo
Date: 08-2011
DOI: 10.5694/J.1326-5377.2011.TB03239.X
Abstract: To assess the relationship between dietary sodium intake, as measured by urinary electrolyte excretion, and blood pressure within a population of older Australian adults. A cross-sectional study of adults enrolled in the Melbourne Collaborative Cohort Study, stratified by sex, country of birth (Italy, Greece, Australia/New Zealand) and age (50-59 and 60-75 years). Blood pressure measurements were taken in 2003-2007 and 24-hour urine collections in 2007-2008. 24-hour urinary excretion of sodium and potassium, urinary sodium-to-potassium ratio, and clinic blood pressure measurement. The mean ± SD age of 783 participants was 64.0 ± 6.3 years. Mean ± SD urinary sodium was 155.1 ± 63.1 mmol/day (8.9 ± 3.6 g salt/day), urinary potassium was 82.3 ± 27.9 mmol/day, and urinary sodium-to-potassium ratio was 1.99 ± 0.83. In the 587 participants with blood pressure measurements, urinary sodium and the sodium-to-potassium ratio were both associated with systolic blood pressure in all adjusted and unadjusted models (mmHg change per 100 mmol/day increase in sodium: regression coefficient, 2.3, 95% CI, 0.1-4.6 P = 0.049, adjusted for age, sex, body mass index, country of birth and antihypertensive medication use). This study has demonstrated, for the first time within an Australian population s le of older adults, that sodium intake is positively associated with blood pressure. These results suggest that a population-wide reduction in sodium intake could be effective in reducing blood pressure in adults in Australia.
Publisher: MDPI AG
Date: 08-2020
DOI: 10.3390/JCM9082463
Abstract: Background: Postpartum weight retention is a significant contributor to obesity in women, adverse perinatal events in subsequent pregnancies, and chronic disease risk. Health literacy is known to impact health behaviors. The study aimed to identify the health literacy domains utilized in postpartum weight management interventions and to determine their impact on weight, diet and physical activity in postpartum women. Methods: We searched MEDLINE, CINAHL, EMBASE, PSYCINFO, and EBM databases. We included random control trials of lifestyle intervention in postpartum women (within two years post-delivery) published up to 3 May 2019. Subgroup analyses were performed to determine the effect of health literacy domains on outcomes. Results: Out of 5000 studies, 33 studies (n = 3905) were included in the systematic review and meta-analysis. The health literacy domain self-care (skills and knowledge) was associated with a significant reduction in body weight (mean difference (MD) −2.46 kg 95% confidence interval (CI) from −3.65 to −1.27) and increase in physical activity (standardized mean difference (SMD) 0.61 95% CI 0.20 to 1.02). No other health literacy domain was associated with significant outcomes in weight, energy intake, or physical activity. Conclusions: Health literacy skills such as knowledge of self-care are effective in improving weight and in increasing physical activity in postpartum women. The efficacy of other health domains was not supported.
Publisher: S. Karger AG
Date: 21-04-2023
DOI: 10.1159/000530091
Publisher: F1000 Research Ltd
Date: 17-10-2022
DOI: 10.12688/OPENRESEUROPE.14938.2
Abstract: Objective : To synthesise the evidence on prenatal breastfeeding self-efficacy, including identifying concepts and theoretical frameworks that underpin its development, the evidence on its measurement, interventions used to improve it, and association with breastfeeding outcomes. Background : Breastfeeding self-efficacy is described as a woman’s self-belief and confidence in her perceived ability to breastfeed. It is a modifiable measure that is strongly associated with breastfeeding outcomes such as initiation, exclusivity, and duration. Interventions aimed at increasing self-efficacy are often in the postnatal period and have been shown to be effective at improving breastfeeding outcomes. The prenatal period appears to be underexplored in the literature and yet focusing on enhancing it may have the potential for further improvements in self-efficacy and on subsequent breastfeeding outcomes. A comprehensive knowledge synthesis on prenatal breastfeeding self-efficacy is lacking. Methods : The search will include databases across health, psychology, sociology, and the grey literature on breastfeeding guidance. Once the PCC framework (Problem: breastfeeding, Concept: self-efficacy, Context: prenatal period) is met, sources of evidence from any contextual setting will be eligible for inclusion. Limits will not be applied on geographic location or year of publication. The PRISMA-ScR flow diagram of search and study selection will be used to report final figures. Two independent reviewers will perform title and abstract screening, full-text review, and data extraction. Data will be charted to provide a logical and descriptive summary of the results that align with the objectives. Conclusion : The results will provide an understanding of what has been done in the space and what gaps exist, informing recommendations for the timing of measurement and the design of prenatal interventions.
Publisher: SAGE Publications
Date: 02-2012
DOI: 10.1345/APH.1Q572
Publisher: Cold Spring Harbor Laboratory
Date: 19-12-2020
DOI: 10.1101/2020.12.17.20248441
Abstract: Behavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the in idual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of intervention-covariate interactions. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and to explore whether there are differential effects among key subgroups. Systematic searches of Medline, Embase, CENTRAL, CINAHL, PsycInfo, and trial registries for all ongoing and completed randomised controlled trials evaluating behavioural interventions for the prevention of early childhood obesity have been completed up to March 2020 and will be updated annually to include additional trials. Eligible trialists will be asked to share their IPD if unavailable, aggregate data will be used where possible. An IPD meta-analysis and a nested prospective meta-analysis (PMA) will be performed using methodologies recommended by the Cochrane Collaboration. The primary outcome will be body mass index (BMI) z-score at age 24 +/- 6 months using World Health Organisation Growth Standards, and effect differences will be explored among pre-specified in idual and trial-level subgroups. Secondary outcomes include other child weight-related measures, infant feeding, dietary intake, physical activity, sedentary behaviours, sleep, parenting measures and adverse events. Approved by The University of Sydney Human Research Ethics Committee (2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). Results will be relevant to clinicians, child health services, researchers, policy-makers and families, and will be disseminated via publications, presentations, and media releases. Prospectively registered on PROSPERO: CRD42020177408 This will be the largest in idual participant data (IPD) meta-analysis evaluating behavioural interventions for the prevention of early childhood obesity to date, and will provide the most reliable and precise estimates of early intervention effects to inform future decision-making. IPD meta-analysis methodology will enable unprecedented exploration of important in idual and trial-level characteristics that may be associated with childhood obesity or that may be effect modifiers. The proposed innovative methodologies are feasible and have been successfully piloted by members of our group. It may not be possible to obtain IPD from all eligible trials in this instance, aggregate data will be used where available, and sensitivity analyses will be conducted to assess inclusion bias. Outcome measures may be collected and reported differently across included trials, potentially increasing imprecision however, we will harmonise available data where possible, and encourage those planning or conducting ongoing trials to collect common core outcomes following prospective meta-analysis methodology.
Publisher: Public Library of Science (PLoS)
Date: 08-08-2018
Publisher: Cambridge University Press (CUP)
Date: 2021
Publisher: Public Library of Science (PLoS)
Date: 26-07-2016
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/PY15177
Abstract: This paper investigates factors influencing women’s engagement with diabetes preventative care after a pregnancy with gestational diabetes (GDM) from the perspectives of GPs and women and explores the role of the GP in that care. Qualitative research using semi-structured interviews with women who had experienced GDM (n=16) and GPs (n=18) were conducted and a thematic content analysis conducted. Women’s interviews explored their experience of GDM, factors influencing, and engagement with, follow-up care for diabetes prevention and role of the GP in that care. GP interviews explored postnatal care provided to women with GDM, the role of the GP in that care and perceived factors influencing a mother’s engagement in her self-care. Three themes were identified: (1) advice and testing (2) role of the GP and (3) barriers and enablers to care. Significant consensus about the role of the GP and barriers and enablers to care existed. Both groups believed post GDM follow-up is best done by GPs and suggested recall and reminders would improve care. GPs gave consistent exercise advice, but lacked consensus on follow-up testing, dietary and weight-loss advice. Women’s health literacy influenced how they viewed their GPs role. Consensus guidelines on follow-up testing and diabetes prevention advice, tailored advice according to health literacy and addressing barriers to care would likely improve the capacity of GPs to prevent unnecessary conversion to type 2 diabetes in these at-risk women.
Publisher: Springer Science and Business Media LLC
Date: 26-01-2012
DOI: 10.1007/S10903-011-9442-0
Abstract: To examine the extent of nutritional vulnerability seen in a cohort of asylum seekers in Australia. Twenty-one asylum seekers (15 males, 6 females) that used a food bank were interviewed over a 6 week period at the Melbourne based Asylum Seeker Resource Centre about foods consumed in the previous 24-h and any non food bank foods obtained. A basket audit was conducted after participants accessed the food bank on the day of interview, Participants obtained significantly less than the minimum requirements for the Australian Guide to Healthy Eating in the vegetables and legumes (P < .001, 95% CI -3.5, -1.7) fruits (P < .001, 95% CI -1.7, -.1.2), dairy (P < .001, 95% CI -1.8, -1.5) and meat and meat alternatives core food groups (P = .001, 95% CI -0.8, -0.3) using foods accessed from the food bank, their primary or sole food source. A high level of nutritional vulnerability was seen in this cohort due to their inability to meet minimum nutritional requirements from their primary food access point. Health professionals working with asylum seeker populations need to be aware of this issue and the resulting potential for longer term ill health as a consequence.
Publisher: CSIRO Publishing
Date: 2012
DOI: 10.1071/PY11005
Abstract: The aim of this study was to develop and evaluate a dietary screening tool for use in a secondary cardiovascular disease (CVD) prevention setting to identify an in idual’s overall dietary quality. The Diet Quality Tool (DQT) was validated against a 4-day food diary for 37 in iduals with established CVD attending cardiac rehabilitation. Construct validity was demonstrated for % energy from saturated fat (P = 0.002, r = –0.500), dietary fibre (P 0.001, r = 0.559) and omega-3 fatty acids (P = 0.048, r = 0.327). Criterion validity was established with a significant difference found between mean (95% CI) dietary intakes of fibre (28.2 g, 4.4 to 17.3) and % total energy from saturated fat (10.6%, –4.8 to –0.8) for those with better DQT scores ( %) versus those with poorer scores (≤60%) when compared with 4-day food diary nutrient values. The usefulness of the DQT was confirmed by both patients (n = 25) and cardiac rehabilitation health professionals (n = 8). The DQT was found to be a valid and useful dietary assessment tool with potential for use in a secondary CVD prevention setting. The tool has the capacity to be used in a wider variety of settings and further refinement of the tool would enable a greater amount of nutrients to be reliably screened.
Publisher: Wiley
Date: 22-12-2019
DOI: 10.1111/DME.14208
Publisher: Cambridge University Press (CUP)
Date: 21-07-2021
DOI: 10.1017/S0007114521002725
Abstract: Inadequate sleep and poor eating behaviours are associated with higher risk of childhood overweight and obesity. Less is known about the influence sleep has on eating behaviours and consequently body composition. Furthermore, whether associations differ in boys and girls has not been investigated extensively. We investigate associations between sleep, eating behaviours and body composition in cross-sectional analysis of 5-year-old children. Weight, height, BMI, mid upper arm circumference (MUAC), abdominal circumference (AC) and skinfold measurements were obtained. Maternal reported information on child’s eating behaviour and sleep habits were collected using validated questionnaires. Multiple linear regression examined associations between sleep, eating behaviours and body composition. Sleep duration was negatively associated with BMI, with 1-h greater sleep duration associated with 0·24 kg/m 2 ( B = 0·24, CI −0·42, −0·03, P = 0·026) lower BMI and 0·21 cm lower ( B = –0·21, CI −0·41, −0·02, P = 0·035) MUAC. When stratified by sex, girls showed stronger inverse associations between sleep duration (h) and BMI (kg/m 2 ) ( B = –0·32 CI −0·60, −0·04, P = 0·024), MUAC (cm) ( B = –0·29 CI −0·58, 0·000, P = 0·05) and AC (cm) ( B = –1·10 CI −1·85, −0·21, P = 0·014) than boys. Positive associations for ‘Enjoys Food’ and ‘Food Responsiveness’ with BMI, MUAC and AC were observed in girls only. Inverse associations between sleep duration and ‘Emotional Undereating’ and ‘Food Fussiness’ were observed in both sexes, although stronger in boys. Sleep duration did not mediate the relationship between eating behaviours and BMI. Further exploration is required to understand how sleep impacts eating behaviours and consequently body composition and how sex influences this relationship.
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Publisher: Springer Science and Business Media LLC
Date: 03-07-2019
Publisher: Springer Science and Business Media LLC
Date: 30-06-0026
Publisher: Elsevier BV
Date: 11-2022
Publisher: JMIR Publications Inc.
Date: 18-09-2023
DOI: 10.2196/51431
Publisher: MDPI AG
Date: 31-05-2023
DOI: 10.3390/NU15112579
Abstract: Background: People with polycystic ovary syndrome (PCOS) have higher weight gain and psychological distress compared to those without PCOS. While COVID-19 restrictions led to population level adverse changes in lifestyle, weight gain and psychological distress, their impact on people with PCOS is unclear. The aim of this study was to investigate the impact the 2020 COVID-19 restrictions had on weight, physical activity, diet and psychological distress for Australians with PCOS. Methods: Australian reproductive-aged women participated in an online survey with assessment of weight, physical activity, diet and psychological distress. Multivariable logistic and linear regression were used to examine associations between PCOS and residential location with health outcomes. Results: On adjusted analysis, those with PCOS gained more weight (2.9% 95% CI 0.027–3.020 p = 0.046), were less likely to meet physical activity recommendations (OR 0.50 95% CI 0.32–0.79 p = 0.003) and had higher sugar-sweetened beverage intake (OR 1.74 95% CI 1.10–2.75 p = 0.019) but no differences in psychological distress compared to women without PCOS. Conclusions: People with PCOS were more adversely affected by COVID-19 restrictions, which may worsen their clinical features and disease burden. Additional health care support may be necessary to assist people with PCOS to meet dietary and physical activity recommendations.
Publisher: S. Karger AG
Date: 31-07-2019
Publisher: Georg Thieme Verlag KG
Date: 11-2021
Abstract: Gestational diabetes mellitus (GDM) places a woman at high risk of developing subsequent type 2 diabetes mellitus (T2DM), particularly in the first 5 years postpartum. Engaging women in health behavior change during this period is challenging and current diabetes prevention programs were developed for middle-aged adults, all of which have limited the evidence on successful implementation for this high-risk population. In this review, we will first summarize the effects of existing diabetes prevention programs in women with a history of GDM. Second, we suggest that the programs need to be modified according to the facilitators and barriers faced by this population. Third, we propose that improving program penetration, fidelity, and participation is critical for population-level success. Finally, we outline the research priorities to improve the implementation of diabetes prevention programs for postpartum women with a history of GDM.
Publisher: S. Karger AG
Date: 2022
DOI: 10.1159/000527131
Abstract: b i Background: /i /b This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity. b i Summary: /i /b It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management validate patients’ lived experiences move beyond simplistic approaches of “eat less, move more” and address the root drivers of obesity. b i Key Messages: /i /b People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Education is needed for all healthcare professionals in Ireland to address the gap in skills, increase knowledge of evidence-based practice, and eliminate bias and stigma in healthcare settings. We call for people living with obesity in Ireland to have access to evidence-informed care, including medical, medical nutrition therapy, physical activity and physical rehabilitation interventions, psychological interventions, pharmacotherapy, and bariatric surgery. This can be best achieved by resourcing and fully implementing the Model of Care for the Management of Adult Overweight and Obesity. To address health inequalities, we also call for the inclusion of obesity in the Structured Chronic Disease Management Programme and for pharmacotherapy reimbursement, to ensure equal access to treatment based on health-need rather than ability to pay.
Publisher: Cold Spring Harbor Laboratory
Date: 19-12-2020
DOI: 10.1101/2020.12.17.20248435
Abstract: Little is known about how early (e.g., commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to 1) characterise early obesity prevention interventions in terms of target behaviours, delivery features, and behaviour change techniques (BCTs), 2) explore similarities and differences in BCTs used to target behaviours, and 3) explore effectiveness of intervention components in preventing childhood obesity. Annual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as clinical trial registries. Eligible randomised controlled trials of behavioural interventions to prevent childhood obesity commencing antenatally or in the first year after birth will be invited to join the TOPCHILD Collaboration. Standard ontologies will be used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials provided by trialists. Narrative syntheses will be performed to summarise intervention components and compare applied BCTs by types of target behaviours. Exploratory analyses will be undertaken to assess effectiveness of intervention components. The study has been approved by The University of Sydney Human Research Ethics Committee (project no. 2020/273) and Flinders University Social and Behavioural Research Ethics Committee (project no. HREC CIA2133-1). The study’s findings will be disseminated through peer-reviewed publications, conference presentations, and targeted communication with key stakeholders. Our study will provide an in depth understanding of behavioural components and delivery features used in obesity prevention interventions starting antenatally or in the first 12 months after birth. Understanding common intervention approaches in a systematic way will provide much needed insight to advance the design of early obesity prevention interventions and provide the opportunity to undertake future quantitative predictive modelling. PROSPERO registration no. CRD42020177408 This study provides an understanding of behaviours targeted, behaviour change techniques and delivery features used in early childhood obesity prevention trials identified in a systematic review as being eligible for inclusion in the Transforming Obesity Prevention in CHILDren (TOPCHILD) Collaboration. Extends previous methods by coding behaviour change techniques in published and unpublished intervention materials and performing cross validation with trialists through the TOPCHILD Collaboration. Using standardised coding taxonomies will allow for comparisons across studies, and we will pilot test new ontologies from the Human Behaviour Change Project. Explores the complex area of targeting parent and caregivers’ behaviours to impact child outcomes across four key obesity prevention behavioural domains (relating to infant feeding practices, food provision and parent feeding practices, movement practices, sleep health practices). This study will provide preliminary results regarding the examination of intervention components’ effectiveness based on exploratory analysis. Yet, the internationally unique database this project creates will further our understanding of effective intervention components in future research. To date we already have 38 out of 65 eligible trials agreeing to share data, since not all trials may provide unpublished material we may perform sensitivity analyses comparing trials that have shared data to trials that have not shared materials.
Publisher: Springer Science and Business Media LLC
Date: 17-10-2013
Abstract: Gestational diabetes mellitus (GDM) is defined as glucose intolerance with its onset or first recognition during pregnancy. Post-GDM women have a life-time risk exceeding 70% of developing type 2 diabetes mellitus (T2DM). Lifestyle modifications reduce the incidence of T2DM by up to 58% for high-risk in iduals. The Mothers After Gestational Diabetes in Australia Diabetes Prevention Program (MAGDA-DPP) is a randomized controlled trial aiming to assess the effectiveness of a structured diabetes prevention intervention for post-GDM women. This trial has an intervention group participating in a diabetes prevention program (DPP), and a control group receiving usual care from their general practitioners during the same time period. The 12-month intervention comprises an in idual session followed by five group sessions at two-week intervals, and two follow-up telephone calls. A total of 574 women will be recruited, with 287 in each arm. The women will undergo blood tests, anthropometric measurements, and self-reported health status, diet, physical activity, quality of life, depression, risk perception and healthcare service usage, at baseline and 12 months. At completion, primary outcome (changes in diabetes risk) and secondary outcome (changes in psychosocial and quality of life measurements and in cardiovascular disease risk factors) will be assessed in both groups. This study aims to show whether MAGDA-DPP leads to a reduction in diabetes risk for post-GDM women. The characteristics that predict intervention completion and improvement in clinical and behavioral measures will be useful for further development of DPPs for this population. Australian New Zealand Clinical Trials Registry ANZCTRN 12610000338066
Publisher: Wiley
Date: 14-08-2019
Abstract: Women with prior gestational diabetes have increased risk for developing type 2 diabetes postpartum. While diabetes prevention programs are effective in reducing a woman's risk, the reach of traditional face-to-face programs is poor in this population and using a mHealth approach appears to be promising. We aimed to evaluate a pilot smartphone app developed from an evidence-based diabetes prevention program specifically for women with previous gestational diabetes mellitus using a series of focus groups to explore the app functionality and messaging. The Health-e Mums app underwent an iterative, three-phase development: initial development, wireframe development and pilot testing. Twenty-six women participated in four focus groups during the pilot-testing phase. The focus group transcripts were analysed thematically to evaluate the app functionality and user-experience. Focus group participants identified diabetes screening confusion and a need for personalisation as sub-themes within the app functionality theme. The user-experience exploration found generally positive findings but participants had mixed responses to the utility of video segments and applying milestones relating to diabetes prevention guidelines. A user-centred approach was taken to develop a diabetes prevention program app for women with prior gestational diabetes. Women were predominantly satisfied with the overall app design, how it functioned and what the user experience would be like when fully developed.
Publisher: Elsevier BV
Date: 10-2016
Publisher: Cambridge University Press (CUP)
Date: 2020
DOI: 10.1017/S0029665120005728
Abstract: Breastfeeding provides optimal nutrition for infants yet breastfeeding rates worldwide do not meet WHO targets for 50% exclusive breastfeeding at 6 months. Ireland's breastfeeding rate is one of the lowest in the world (only 58% initiation) and maternal obesity and overweight is prevalent ( 50% pregnancies). Women with obesity and overweight are particularly at risk of having lower breastfeeding rates but little is known about the factors that supported this sub-group to successfully breastfeed. Our aim was to explore barriers and enablers present in: women with high body mass index (BMI) who successfully breastfed for 6 months, partners of women with 6 months breastfeeding, and healthcare professionals (HPs) who support women to breastfeed. Women with high BMIs (n = 20) were recruited via an extended breastfeeding Facebook group and snowballing. Partners (n = 20) were recruited via social media and word of mouth. HPs (n = 19) were recruited via posters and direct invitation. Semi-structured interviews were conducted either in-person or on telephone and digitally recorded. Interviews were verbatim transcribed and thematically analysed. Two research students independently coded each interview and consensus decided any discrepancies. Barriers to breastfeeding identified aligned with previous research but the challenges appear to be increased for either the frequency or intensity of occurrence in women with high BMIs. Common barriers are: a lack of breastfeeding culture limited access within health services to high quality and consistent breastfeeding advice large breast size and issues with breastfeeding in public. Enablers for successful extended breastfeeding are: strong self-efficacy supportive partner and family social networks for creating breastfeeding-friendly settings seeking support from a lactation consultant and breastfeeding aides (clothing, pillows, lanolin, etc.). Women with high BMIs are able to successfully breastfeed for extended periods of time when they are provided with the right support at the right time and in a way that is acceptable to them and their families. Reorientation of maternity health services to ensure greater and more consistent support for women with high BMIs to initiate breastfeeding is needed. HPs engaging with women with high BMIs should seek to support them through the use of the enablers identified and make a conscious decision to include appropriate advice for women with high BMIs in their antenatal education and any postpartum services provided.
Publisher: Springer Science and Business Media LLC
Date: 03-11-2022
DOI: 10.1038/S41430-021-01032-Y
Abstract: To determine the impact of diet quality interventions on neurocognitive decline in older adults. Four databases were searched (Medline, EMBASE, CENTRAL and PsycINFO) for randomised controlled trials involving diet quality interventions and cognitive outcomes in older adults. Study quality was assessed using the Cochrane Risk of Bias tool. Outcomes selected for meta-analysis were memory and executive function, for which standardised mean differences (SMD) were calculated. Subgroup and sensitivity analyses were undertaken to explore causes of heterogeneity. Additional outcomes of global cognitive function, incident dementia, attention, language/verbal fluency, and processing speed were narratively synthesised. Twelve studies were included, investigating the Mediterranean, Dietary Approaches to Stop Hypertension and Nordic diets. Risk of bias varied across studies. Dietary intervention had a significant effect on memory (SMD: 0.98 95% CI: 0.39, 1.57 p = 0.001) and executive function (SMD: 2.02 95% CI: 1.04, 3.01 p < 0.00001), although neither outcome was significant in sensitivity analyses. Heterogeneity was high (I The current body of evidence would suggest the effect of dietary intervention on neurocognitive decline in older adults is unclear given the considerable heterogeneity and bias present across studies. These findings should be interpreted with consideration to the limited number of studies that could be included and the large variation in study designs. Further randomised controlled trials with harmonised cognitive outcomes and assessments are needed to clarify direction of effect.
Publisher: MDPI
Date: 14-03-2022
Publisher: Springer Science and Business Media LLC
Date: 12-2021
DOI: 10.1186/S13063-021-05892-4
Abstract: Gestational diabetes (GDM) impacts 8–18% of pregnancies and greatly increases both maternal and child risk of developing non-communicable diseases such as type 2 diabetes and obesity. Whilst lifestyle interventions in pregnancy and postpartum reduce this risk, a research translation gap remains around delivering implementable interventions with adequate population penetration and participation. Impact Diabetes Bump2Baby is an implementation project of an evidence-based system of care for the prevention of overweight and obesity. Bump2Baby and Me is the multicentre randomised controlled trial investigating the effectiveness of a mHealth coaching programme in pregnancy and postpartum for women at high risk of developing GDM. Eight hundred women will be recruited in early pregnancy from 4 clinical sites within Ireland, the UK, Spain, and Australia. Women will be screened for eligibility using the validated Monash GDM screening tool. Participants will be enrolled from 12 to 24 weeks’ gestation and randomised on a 1:1 basis into the intervention or control arm. Alongside usual care, the intervention involves mHealth coaching via a smartphone application, which uses a combination of synchronous and asynchronous video and text messaging, and allows for personalised support and goal setting with a trained health coach. The control arm receives usual care. All women and their children will be followed from early pregnancy until 12 months postpartum. The primary outcome will be a difference in maternal body mass index (BMI) of 0.8 kg/m 2 at 12 months postpartum. Secondary maternal and infant outcomes include the development of GDM, gestational weight gain, pregnancy outcomes, improvements in diet, physical activity, sleep, and neonatal weight and infant growth patterns. The 5-year project is funded by the EU Commission Horizon 2020 and the Australian National Health and Medical Research Council. Ethical approval has been received. Previous interventions have not moved beyond tightly controlled efficacy trials into routine service delivery. This project aims to provide evidence-based, sustainable support that could be incorporated into usual care for women during pregnancy and postpartum. This study will contribute evidence to inform the early prevention of non-communicable diseases like obesity and diabetes in mothers and the next generation. Australian New Zealand Clinical Trials Registry ACTRN12620001240932 . Registered on 19 November 2020
Publisher: F1000 Research Ltd
Date: 22-07-2022
DOI: 10.12688/OPENRESEUROPE.14938.1
Abstract: Objective : To synthesise the evidence on prenatal breastfeeding self-efficacy, including identifying concepts and theoretical frameworks that underpin its development, the evidence on its measurement, interventions used to improve it, and association with breastfeeding outcomes. Background : Breastfeeding self-efficacy is described as a woman’s self-belief and confidence in her perceived ability to breastfeed. It is a modifiable measure that is strongly associated with breastfeeding outcomes such as initiation, exclusivity, and duration. Interventions aimed at increasing self-efficacy are often in the postnatal period and have been shown to be effective at improving breastfeeding outcomes. The prenatal period appears to be underexplored in the literature and yet focusing on enhancing it may have the potential for further improvements in self-efficacy and on subsequent breastfeeding outcomes. A comprehensive knowledge synthesis on prenatal breastfeeding self-efficacy is lacking. Methods : The search will include databases across health, psychology, sociology, and the grey literature on breastfeeding guidance. Once the PCC framework (Problem: breastfeeding, Concept: self-efficacy, Context: prenatal period) is met, sources of evidence from any contextual setting will be eligible for inclusion. Limits will not be applied on geographic location or year of publication. The PRISMA-ScR flow diagram of search and study selection will be used to report final figures. Two independent reviewers will perform title and abstract screening, full-text review, and data extraction. Data will be charted to provide a logical and descriptive summary of the results that align with the objectives. Conclusion : The results will provide an understanding of what has been done in the space and what gaps exist, informing recommendations for the timing of measurement and the design of prenatal interventions.
Publisher: Elsevier BV
Date: 12-2014
Publisher: Cambridge University Press (CUP)
Date: 13-01-2021
DOI: 10.1017/S1368980021000136
Abstract: The current study sought to describe and compare study type, research design and translation phase of published research in nutrition and dietetic journals in 1998 and 2018. This was a repeat cross-sectional bibliographic analysis of Nutrition and Dietetics research. All eligible studies in the top eight Nutrition and Dietetics indexed journals in 1998 and 2018 were included. Two independent reviewers coded each study for research design (study type and study design) and translation phase (T0-T4) of the research using seminal texts in the field. Not relevant. Not relevant. The number of publications (1998, n 1030 2018, n 1016) has not changed over time, but the research type, design and translation phases have. The proportion of intervention studies in 1998 (43·8 %) was significantly higher than 2018 (19·4 %). In 2018, more reviews (46·9 % v . 15·6 % in 1998) and less randomised trials (14·3 % v . 37·8 % in 1998) were published. In regard to translation phase, there was a higher proportion of T2–T4 research in 2018 (18·3 % v . 3·8 % in 1998) however, the proportion of T3/T4 (dissemination, implementation and population-level research) research was still low ( %). Our sensitivity analysis with the four journals that remained in the top eight journal across the two time periods found no differences in the research type, design and translation phases across time. There was a reduction in intervention and T0 publications, alongside higher publication of clinical study designs over time however, published T3/T4 research in Nutrition and Dietetics is low. A greater focus on publishing interventions and dissemination and implementation may be needed.
Publisher: Wiley
Date: 2023
DOI: 10.1002/IJGO.14537
Abstract: Gestational diabetes (GDM) impacts approximately 17 million pregnancies worldwide. Women with a history of GDM have an 8–10‐fold higher risk of developing type 2 diabetes and a 2‐fold higher risk of developing cardiovascular disease (CVD) compared with women without prior GDM. Although it is possible to prevent and/or delay progression of GDM to type 2 diabetes, this is not widely undertaken. Considering the increasing global rates of type 2 diabetes and CVD in women, it is essential to utilize pregnancy as an opportunity to identify women at risk and initiate preventive intervention. This article reviews existing clinical guidelines for postpartum identification and management of women with previous GDM and identifies key recommendations for the prevention and/or delayed progression to type 2 diabetes for global clinical practice.
Publisher: MDPI AG
Date: 24-04-2019
DOI: 10.3390/NU11040922
Abstract: Weight gain after childbirth is a significant risk factor for type 2 diabetes (T2DM) development after gestational diabetes mellitus (GDM). The level of weight loss achieved in diabetes prevention programs for women after GDM is often low but its effects on the cardiometabolic risk are not known. In a secondary analysis of a diabetes prevention program in postpartum women with history of gestational diabetes, we evaluated the effect of weight change on the cardiometabolic outcomes at 1-year follow-up. Of the 284 women randomized to the intervention arm, 206 with the final outcome measurements were included in the analyses. Participants were categorized into weight loss ( kg, n = 74), weight stable (±2 kg, n = 74) or weight gain ( kg, n = 58) groups. The weight loss group had significantly greater decrease in glycated hemoglobin (HbA1c) than the weight gain group (−0.1 + 0.4% vs. 0 + 0.4%, p = 0.049). The weight loss group had significantly greater decrease in total cholesterol and low-density lipoprotein cholesterol cholesterol than the other two groups (p 0.05). The weight gain group had significantly greater increase in triglyceride and triglyceride:high-density lipoprotein cholesterol ratio compare with the other groups (p 0.01). Overall, a small amount of weight loss and prevention of further weight gain was beneficial to the cardiometabolic outcomes of postpartum women after GDM.
Publisher: Wiley
Date: 09-2016
Publisher: Wiley
Date: 2023
DOI: 10.1002/IJGO.14539
Abstract: The period before and during pregnancy is increasingly recognized as an important stage for addressing malnutrition. This can help to reduce the risk of noncommunicable diseases in mothers and passage of risk to their infants. The FIGO Nutrition Checklist is a tool designed to address these issues. The checklist contains questions on specific dietary requirements, body mass index, diet quality, and micronutrients. Through answering these questions, awareness is generated, potential risks are identified, and information is collected that can inform health‐promoting conversations between women and their healthcare professionals. The tool can be used across a range of health settings, regions, and life stages. The aim of this review is to summarize nutritional recommendations related to the FIGO Nutrition Checklist to support healthcare providers using it in practice. Included is a selection of global dietary recommendations for each of the components of the checklist and practical insights from countries that have used it. Implementation of the FIGO Nutrition Checklist will help identify potential nutritional deficiencies in women so that they can be addressed by healthcare providers. This has potential longstanding benefits for mothers and their children, across generations.
Publisher: Springer Science and Business Media LLC
Date: 08-09-2023
Publisher: Oxford University Press (OUP)
Date: 12-04-2022
Abstract: The implementation of diabetes prevention for women with previous gestational diabetes (GDM) has been stymied by many barriers that are located within routine general practice (GP). We aimed to unpack the GP factors and understand the mechanisms that explain why a diabetes prevention intervention for this population succeeds or fails. We performed a mixed-methods study with a Normalization Process Theory framework that included clinical audits, semistructured interviews, and focus groups within mixed urban and rural primary care practices in Victoria, Australia. Staff of primary care practices and external support staff who provide services to women with previous GDM participated in a 12-month quality improvement collaborative intervention. We compared diabetes screening and prevention activity planning with the strategies and factors identified through a process evaluation of full-, moderate-, and low-active participating practices. The intervention doubled screening rates (26%–61%) and 1-in-10 women received a diabetes prevention planning consultation. Critical improvement factors were: mothers being seen as participants in the quality improvement work staff collectively building care strategies staff taking a long-term care of a community perspective rather than episodic service delivery and feedback processes being provided and acted on across the practice. The observable factors from the external perspective were: leadership by identified practice staff, reminder systems in action and practice staff driving the process collectively. Successful engagement in diabetes prevention for women with previous GDM requires proactive building of the critical improvement factors and audit feedback into routine GP.
Publisher: Research Square Platform LLC
Date: 25-09-2023
Publisher: Springer Science and Business Media LLC
Date: 19-09-2012
Publisher: Wiley
Date: 08-09-2022
DOI: 10.1111/DME.14945
Abstract: Racial and ethnic disparities exist in gestational diabetes prevalence and risk of subsequent type 2 diabetes mellitus (T2DM). Postpartum engagement in healthy behaviours is recommended for prevention and early detection of T2DM, yet uptake is low among women from erse cultural backgrounds. Greater understanding of factors impacting postpartum health behaviours is needed. Applying the Theoretical Domains Framework (TDF) and Capability , Opportunity , Motivation‐Behaviour (COM‐B) model, our aim was to synthesise barriers to and enablers of postpartum health behaviours among women from erse cultural backgrounds with prior GDM and identify relevant intervention components. Databases, reference lists and grey literature were searched from September 2017 to April 2021. Two reviewers screened articles independently against inclusion criteria and extracted data. Using an inductive–deductive model, themes were mapped to the TDF and COM‐B model. After screening 5148 citations and 139 full texts, we included 35 studies ( N = 787 participants). The main ethnicities included Asian (43%), Indigenous (15%) and African (11%). Barriers and enablers focused on Capability (e.g. knowledge), Opportunity (e.g. competing demands, social support from family, friends and healthcare professionals, culturally appropriate education and resources) and Motivation (e.g. negative emotions, perceived consequences and necessity of health behaviours, social/cultural identity). Five relevant intervention functions are identified to link the barriers and enablers to evidence‐based recommendations for communications to support behaviour change. We provide a conceptual model to inform recommendations regarding the development of messaging and interventions to support women from erse cultural backgrounds in engaging in healthy behaviours to reduce risk of T2DM.
Publisher: Wiley
Date: 04-2023
Publisher: Elsevier BV
Date: 10-2019
Publisher: Elsevier BV
Date: 06-2021
Publisher: MDPI AG
Date: 16-01-2020
DOI: 10.3390/JCM9010237
Abstract: Successful implementation of postpartum lifestyle interventions first requires the identification of effective core components, such as strategies for behavioural change. This systematic review and meta-analysis aimed to describe the associations between behavioural strategies and changes in weight, diet, and physical activity in postpartum women. Databases MEDLINE, CINAHL, EMBASE, and PsycINFO were searched for randomised controlled trials of lifestyle interventions in postpartum women (within 2 years post-delivery). Strategies were categorised according to the Behaviour Change Technique Taxonomy (v1). Forty-six articles were included (n = 3905 women, age 23–36 years). Meta-analysis showed that postpartum lifestyle interventions significantly improved weight (mean difference −2.46 kg, 95%CI −3.65 to −1.27) and physical activity (standardised mean difference 0.61, 95%CI 0.20 to 1.02) but not in energy intake. No in idual strategy was significantly associated with weight or physical activity outcomes. On meta-regression, strategies such as problem solving (β = −1.74, P = 0.045), goal setting of outcome (β = −1.91, P = 0.046), reviewing outcome goal (β = −3.94, P = 0.007), feedback on behaviour (β = −2.81, P = 0.002), self-monitoring of behaviour (β = −3.20, P = 0.003), behavioural substitution (β = −3.20, P = 0.003), and credible source (β = −1.72, P = 0.033) were associated with greater reduction in energy intake. Behavioural strategies relating to self-regulation are associated with greater reduction in energy intake.
Publisher: Elsevier BV
Date: 10-2019
Publisher: Elsevier BV
Date: 05-2019
Publisher: American Medical Association (AMA)
Date: 05-10-2022
DOI: 10.1001/JAMANETWORKOPEN.2022.34870
Abstract: Lifestyle interventions in pregnancy optimize gestational weight gain and improve pregnancy outcomes, with implementation recommended by the US Preventive Services Task Force. Yet, implementation research taking these efficacy trials into pragmatic translation remains limited. To evaluate success factors for implementing pregnancy lifestyle interventions into antenatal care settings in a meta-analysis, using the penetration, implementation, participation, and effectiveness (PIPE) impact metric. Data from a previous systematic review that searched across 9 databases, including MEDLINE, Embase, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Health Technology Assessment Database, were obtained, in 2 stages, up to May 6, 2020. Randomized clinical trials reporting gestational weight gain in singleton pregnancies. The association of penetration, implementation, and participation with effectiveness of antenatal lifestyle interventions in optimizing gestational weight gain was estimated using random-effects meta-analyses. The Cochrane risk of bias tool, version 1.0, was used to assess risk of bias. Penetration (reach), implementation (fidelity), participation, and effectiveness of randomized clinical trials of lifestyle interventions in pregnancy. Ninety-nine studies with 34 546 participants were included. Only 14 studies reported penetration of target populations. Overall, 38 studies (38.4%) had moderate fidelity, 25 (25.2%) had high fidelity, and 36 (36.4%) had unclear fidelity. Participation was reported in 84 studies (84.8%). Lifestyle interventions were associated with reducing gestational weight gain by 1.15 kg (95% CI, –1.40 to –0.91 kg). The findings of this systematic review and meta-analysis suggest that, despite the large body of evidence on efficacy of lifestyle interventions during pregnancy in optimizing gestational weight gain, little guidance is available to inform implementation of this evidence into practice. There is a need to better elucidate implementation outcomes in trial design alongside pragmatic implementation research to improve the health of women who are pregnant and the next generation.
Publisher: Cambridge University Press (CUP)
Date: 2022
Publisher: Georg Thieme Verlag KG
Date: 19-04-2005
Publisher: Cambridge University Press (CUP)
Date: 2018
Publisher: Frontiers Media SA
Date: 24-02-2023
DOI: 10.3389/FCDHC.2023.1086186
Abstract: Women with previous gestational diabetes mellitus (GDM) are at increased risk of type 2 diabetes (T2D). Guidelines recommend postnatal diabetes screening (oral glucose tolerance test or HbA1c) typically 6-12 weeks after birth, with screening maintained at regular intervals thereafter. Despite this, around half of women are not screened, representing a critical missed opportunity for early identification of prediabetes or type 2 diabetes. While policy and practice-level recommendations are comprehensive, those at the personal-level primarily focus on increasing screening knowledge and risk perception, potentially missing other influential behavioral determinants. We aimed to identify modifiable, personal-level factors impacting postpartum type 2 diabetes screening among Australian women with prior gestational diabetes and recommend intervention functions and behavior change techniques to underpin intervention content. Semi-structured interviews with participants recruited via Australia’s National Gestational Diabetes Register, using a guide based on the Theoretical Domains Framework (TDF). Using an inductive-deductive approach, we coded data to TDF domains. We used established criteria to identify ‘important’ domains which we then mapped to the Capability, Opportunity, Motivation–Behavior (COM-B) model. Nineteen women participated: 34 ± 4 years, 19 ± 4 months postpartum, 63% Australian-born, 90% metropolitan, 58% screened for T2D according to guidelines. Eight TDF domains were identified: ‘knowledge’, ‘memory, attention, and decision-making processes’, ‘environmental context and resources’, ‘social influences’, ‘emotion’, ‘beliefs about consequences’, ‘social role and identity’, and ‘beliefs about capabilities’. Study strengths include a methodologically rigorous design limitations include low recruitment and homogenous s le. This study identified numerous modifiable barriers and enablers to postpartum T2D screening for women with prior GDM. By mapping to the COM-B, we identified intervention functions and behavior change techniques to underpin intervention content. These findings provide a valuable evidence base for developing messaging and interventions that target the behavioral determinants most likely to optimize T2D screening uptake among women with prior GDM.
Publisher: Wiley
Date: 2023
DOI: 10.1002/IJGO.14549
Abstract: Obesity is a chronic, progressive, relapsing, and treatable multifactorial, neurobehavioral disease. According to the World Health Organization, obesity affects 15% of women and has long‐term effects on women's health. The focus of care in patients with obesity should be on optimizing health outcomes rather than on weight loss. Appropriate and common language, considering cultural sensitivity and trauma‐informed care, is needed to discuss obesity. Pregnancy is a time of significant physiological change. Pre‐, ante‐, and postpartum clinical encounters provide opportunities for health optimization for parents with obesity in terms of, but not limited to, fertility and breastfeeding. Pre‐existing conditions may also be identified and managed. Beyond pregnancy, women with obesity are at an increased risk for gastrointestinal and liver diseases, impaired kidney function, obstructive sleep apnea, and venous thromboembolism. Gynecological and reproductive health of women living with obesity cannot be dismissed, with accommodations needed for preventive health screenings and consideration of increased risk for gynecologic malignancies. Mental wellness, specifically depression, should be screened and managed appropriately. Obesity is a complex condition and is increasing in prevalence with failure of public health interventions to achieve significant decrease. Future research efforts should focus on interprofessional care and discovering effective interventions for health optimization.
Publisher: Wiley
Date: 27-08-2015
DOI: 10.1111/OBR.12312
Abstract: Post-partum weight loss is critical to preventing and managing obesity in women, but the results from lifestyle interventions are variable and the components associated with successful outcomes are not yet clearly identified. This study aimed to identify lifestyle intervention strategies associated with weight loss in post-partum women. MEDLINE, EMBASE, PubMed, CINAHL and four other databases were searched for lifestyle intervention studies (diet or exercise or both) in post-partum women (within 12 months of delivery) published up to July 2014. The primary outcome was weight loss. Subgroup analyses were conducted for self-monitoring, in idual or group setting, intervention duration, intervention types, the use of technology as a support, and home- or centre-based interventions. From 12,673 studies, 46 studies were included in systematic review and 32 randomized controlled trials were eligible for meta-analysis (1,892 women, age 24-36 years). Studies with self-monitoring had significantly greater weight lost than those without (-4.61 kg [-7.08, -2.15] vs. -1.34 kg [-1.66, -1.02], P = 0.01 for subgroup differences). Diet and physical activity when combined were significantly more effective on weight loss compared with physical activity alone (-3.24 kg [-4.59, -1.90] vs. -1.63 kg [-2.16, -1.10], P < 0.001 for subgroup differences). Lifestyle interventions that use self-monitoring and take a combined diet-and-exercise approach have significantly greater weight loss in post-partum women.
Publisher: Cambridge University Press (CUP)
Date: 2010
Publisher: Elsevier BV
Date: 12-2022
DOI: 10.1016/J.EJOGRB.2022.10.010
Abstract: Neural tube defects are disabling birth defects developing during the very early stages of conception. Children born with spina bifida face significant physical, psychological and social consequences. They may have bowel and urinary dysfunction, and no lower limb muscle control, resulting in lifelong wheelchair use. There is robust evidence that periconceptual folic acid supplementation prevents neural tube defects, when compared with no intervention. However, approximately 40% pregnancies in Europe are unplanned, and women may therefore not be taking prophylactic folic acid at the time of conception. There is evidence that low dose folic acid consumption via flour fortification provides further benefits in prevention of neural tube defects.
Publisher: AMPCo
Date: 21-07-2014
DOI: 10.5694/MJA14.00251
Abstract: Despite its increasing incidence and high conferred risk to women and their children, gestational diabetes mellitus (GDM) is managed inconsistently during and after pregnancy due to an absence of a systemic approach to managing these women. New guidelines for GDM testing and diagnosis are based on stronger evidence, but raise concerns about increased workloads and confusion in a landscape of multiple, conflicting guidelines. Postnatal care and long-term preventive measures are particularly fragmented, with no professional group taking responsibility for this crucial role. Clearer guidelines and assistance from existing frameworks, such as the National Gestational Diabetes Register, could enable general practitioners to take ownership of the management of women at risk of type 2 diabetes following GDM, applying the principles of chronic disease management long term.
Publisher: Wiley
Date: 05-2021
DOI: 10.1002/PDI.2336
Abstract: Gestational diabetes increases a woman's risk of developing type 2 diabetes. In 2011, Australia started the first National Gestational Diabetes Register (NGDR). The register aims to improve risk awareness, promote diabetes prevention, and encourage regular diabetes screening. This study aimed to identify postnatal diabetes prevention activity and the association of NGDR awareness with that activity in a nationally representative s le of Australian women after a pregnancy with gestational diabetes. An anonymous, cross‐sectional, online survey of women previously diagnosed with gestational diabetes and aged 18 years or over was run from June to November 2014. Of 8860 women invited from a stratified NGDR s le, 966 participated (response rate 13%). Postnatal screening rate was 73%. Only 47% of respondents reported receiving NGDR information postnatally. Log‐binomial regression demonstrated an association with women reporting receiving NGDR information and being at intermediate risk of developing type 2 diabetes (relative ratio [RR] 1.307, 95% CI 1.030, 1.660) and at higher disadvantage (RR 1.501, 95% CI 1.080, 2.080). Postnatal screening rates, total diabetes risk perception and lifestyle risk factors were not significantly different between those recalling or not recalling receiving NGDR information. The reach and impact of NGDR information alone are limited. Women's engagement with the NGDR was not associated with better lifestyle, greater postnatal screening or higher risk perception. System‐level integration is needed for improved NGDR functioning and further improvements should yield enhanced diabetes prevention efforts when primary care ties are strengthened. Copyright © 2021 John Wiley & Sons.
Publisher: SAGE Publications
Date: 16-06-2022
DOI: 10.1177/08903344221102839
Abstract: Women with high body mass indices are at risk of lower breastfeeding rates but the drivers of successful breastfeeding in this population are unclear. We aimed to (a) explore the barriers and enablers to breastfeeding among women with high body mass indices and (b) map specific behaviors suitable for intervention across the antenatal to postpartum periods. This was a prospective, cross-sectional qualitative study. We conducted semi-structured interviews with women with high body mass indices who successfully breastfed for 6 months or more ( n =20), partners ( n = 22), and healthcare professionals ( n =19) in Ireland during 2018. Interviews were audio recorded, and transcribed verbatim. Data were inductively coded using reflexive thematic analysis and deductively mapped within the Capability, Opportunity, Motivation–Behavior model. The three themes developed were knowledge, support, and self-efficacy. Knowledge supported a participant’s psychological and physical capability to engage in breastfeeding. Support was related to the social and physical opportunity to enable performance of breastfeeding behaviors. Self-efficacy influenced reflective and automatic motivation to perform breastfeeding behaviors. A multifactorial intervention design is needed to support successful breastfeeding. The barriers and enablers identified for participants with high body mass indices were similar to those for the broader population however, the physicality and associated social bias of high body mass indices mean that additional support is warranted. Antenatal and postpartum breastfeeding services need a multifaceted, inclusive, and high-quality program to provide the necessary support to women with higher body mass indices.
Publisher: Oxford University Press (OUP)
Date: 14-10-2015
DOI: 10.1093/HER/CYV050
Abstract: Delivery of cardiovascular disease (CVD) prevention programs by community pharmacists appears effective and enhances health service access. However, their capacity to implement complex behavioural change processes during patient counselling remains largely unexplored. This study aims to determine intervention fidelity by pharmacists for behavioural components of a complex educational intervention for CVD prevention. After receiving training to improve lifestyle and medicines adherence, pharmacists recruited 70 patients aged 50-74 years without established CVD, and taking antihypertensive or lipid lowering therapy. Patients received five counselling sessions, each at monthly intervals. Researchers assessed biomedical and behavioural risk factors at baseline and six months. Pharmacists documented key outcomes from counselling after each session. Most patients (86%) reported suboptimal cardiovascular diets, 41% reported suboptimal medicines adherence, and 39% were physically inactive. Of those advised to complete the intervention, 85% attended all five sessions. Pharmacists achieved patient agreement with most recommended goals for behaviour change, and overwhelmingly translated goals into practical behavioural strategies. Barriers to changing behaviours were regularly documented, and pharmacists reported most behavioural strategies as having had some success. Meaningful improvements to health behaviours were observed post-intervention. Findings support further exploration of pharmacists' potential roles for delivering interventions with complex behaviour change requirements.
Publisher: BMJ
Date: 10-2015
Publisher: Wiley
Date: 06-10-2022
DOI: 10.1111/OBR.13371
Abstract: Exclusive breastfeeding is recommended for the first 6 months of life and benefits both mother and child. Women with overweight/obesity or gestational diabetes are at risk for poor breastfeeding outcomes. This review evaluates the efficacy of breastfeeding interventions in these at‐risk populations. The review followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. Five databases were searched for interventions from inception to May 2020. Nineteen trials including 2,740 participants, 226 of which were dyads, were included. Intervention increased any breastfeeding at ≥6 months (OR 1.43, 95% CI [1.05–1.95]), and women in the intervention group were 90% more likely to exclusively breastfeed at 1–2 weeks (OR 1.9, 95% CI [1.17–3.09]) and more than twice as likely to exclusively breastfeed at 4–6 weeks (OR 2.23, 95% CI [1.27–3.90]) within the sensitivity analysis. These findings support breastfeeding interventions improving exclusive early postpartum breastfeeding and any breastfeeding from 6 months in women with gestational diabetes or obesity/overweight. Further randomized controlled trials with harmonized breastfeeding outcome reporting are needed to confirm efficacy.
Publisher: S. Karger AG
Date: 11-12-2020
DOI: 10.1159/000513442
Publisher: Wiley
Date: 2023
DOI: 10.1002/IJGO.14540
Abstract: Hypertensive disorders of pregnancy (HDP) are the most common causes of maternal and perinatal morbidity and mortality. They are responsible for 16% of maternal deaths in high‐income countries and approximately 25% in low‐ and middle‐income countries. The impact of HDP can be lifelong as they are a recognized risk factor for future cardiovascular disease. During pregnancy, the cardiovascular system undergoes significant adaptive changes that ensure adequate uteroplacental blood flow and exchange of oxygen and nutrients to nurture and accommodate the developing fetus. Failure to achieve normal cardiovascular adaptation is associated with the development of HDP. Hemodynamic alterations in women with a history of HDP can persist for years and predispose to long‐term cardiovascular morbidity and mortality. Therefore, pregnancy and the postpartum period are an opportunity to identify women with underlying, often unrecognized, cardiovascular risk factors. It is important to develop strategies with lifestyle and therapeutic interventions to reduce the risk of future cardiovascular disease in those who have a history of HDP.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Elsevier BV
Date: 05-2016
Abstract: Low folate status is associated with an increased risk of colorectal carcinogenesis. Optimal folate status may be genoprotective by preventing uracil misincorporation into DNA and DNA hypomethylation. Adenomatous polyps have low folate status compared with normal colonic mucosa, and they are surrounded by histologically normal mucosa that also is of low folate status. In a randomized controlled trial conducted at a single Dublin hospital between April 2002 and March 2004, we assessed the effect of folic acid supplementation on tissue folate, uracil misincorporation into DNA, and global DNA hypomethylation in colonocytes isolated from sites of adenomatous polyps and from histologically normal tissue adjacent and 10-15 cm distal to them. Twenty patients with adenomatous polyps on initial colonoscopy and polypectomy were randomly assigned to receive either 600 μg folic acid/d [n = 12, 38% men, mean age 64.3 y, and body mass index (BMI, in kg/m(2)) 26.6] or placebo (n = 8, 50% men, mean age 68.4 y, and BMI 27.2) for 6 mo, and then repeat the colonoscopy. Blood and colonocyte tissue folate concentrations were measured with the use of a microbiological assay. Uracil misincorporation and global DNA hypomethylation were measured in colonocytes with the use of modified comet assays. Over time, folic acid supplementation, compared with placebo, increased tissue folate (mean ± SEM) from 15.6 ± 2.62 pg/10(5) cells to 18.1 ± 2.12 pg/10(5) cells (P < 0.001) and decreased the global DNA hypomethylation ratio from 1.7 ± 0.1 to 1.0 ± 0.1 (P < 0.001). The uracil misincorporation ratio decreased by 0.5 ± 0.1 for the site adjacent to the polyp over time (P = 0.05). A response to folic acid supplementation, which increased colonocyte folate and improved folate-related DNA biomarkers of cancer risk, was seen in the participants studied. Exploratory analysis points toward the area formerly adjacent to polyps as possibly driving the response. That these areas persist after polypectomy in the absence of folate supplementation is consistent with a potentially carcinogenic field's causing the appearance of the polyp.
Publisher: Oxford University Press (OUP)
Date: 10-2022
DOI: 10.1093/EURPUB/CKAC131.290
Abstract: Gestational diabetes mellitus (GDM) is a significant, global public health problem. Subsequent strain on healthcare systems is widespread and multidisciplinary care may be inadequate. We assessed current nutrition management of GDM in a large, metropolitan maternity hospital in Melbourne, Australia and associations between the model of dietetic care and maternal and neonatal health outcomes. Hospital medical record data from The Women’s Hospital, Melbourne for women with GDM (n = 1,185) (July 2105-May 2017) was retrospectively analysed. Adjusted linear and logistic regression were used to assess associations between the number of dietitian consultations and maternal and neonatal health outcomes. Half of all women received two consultations with a dietitian. Nineteen percent of women received three or more consultations and of these women, almost twice as many were managed by medical nutrition therapy (MNT) and pharmacotherapy (66%) compared with MNT alone (34%). Odds of maternal complications increased with number of consultations (p = 0.008). Lower odds of infant admission to the Neonatal Intensive Care Unit were observed among women receiving one (OR = 0.38 [95% CI: 0.18, 0.78], p = 0.008), two (OR = 0.37 [95% CI: 15 0.19, 0.71], p = 0.003), or three+ dietitian consultations (OR = 0.43 [95% CI: 0.21, 0.88], p = 0.020), compared to no consultations. The optimal schedule of dietitian consultations for women with GDM in Australia is unclear. Alternative delivery of nutrition education for women with GDM such as telehealth and utilisation of technology may assist in relieving public health and healthcare system pressures and ensure optimal pregnancy outcomes. • Delivering medical nutrition therapy through in idual consultations does not deliver a linear benefit to women with GDM and their offspring. • Alternative delivery modes are needed to optimise outcomes for healthcare services and their patients.
No related grants have been discovered for Sharleen O'Reilly.