Anna S. Olafsdottir

Maternal diet in early and late pregnancy in relation to weight gain

Objective:To identify dietary factors related to the risk of gaining weight outside recommendations for pregnancy weight gain and birth outcome.Design:An observational study with free-living conditions.Subjects:Four hundred and ninety five healthy pregnant Icelandic women.Methods:The dietary intake of the women was estimated with a semiquantitative food frequency questionnaire covering food intake together with lifestyle factors for the previous 3 months. Questionnaires were filled out at between 11 and 15 weeks and between 34 and 37 weeks gestation. Comparison of birth outcome between the three weight gain groups was made with ANOVA and Bonferroni post hoc tests. Dietary factors related to at least optimal and excessive weight gain during pregnancy were represented with logistic regression controlling for potential confounding.Results:Of the women, 26% gained suboptimal and 34% excessive weight during pregnancy. Women in late pregnancy with at least optimal, compared with women with suboptimal, weight gain were eating more (OR=3.32, confidence interval (CI)=1.81–6.09, P<0.001) and drinking more milk (OR=3.10, CI=1.57–6.13, P=0.001). The same dietary factors were related to excessive, compared with optimal, weight gain. Furthermore, eating more sweets early in pregnancy increased the risk of gaining excessive weight (OR=2.52, CI=1.10–5.77, P=0.029). Women with a body mass index of 25.0–29.9 kg/m2 before pregnancy were most likely to gain excessive weight (OR=7.37, CI 4.13–13.14, P<0.001). Women gaining suboptimal weight gave birth to lighter children (P<0.001) and had shorter gestation (P=0.008) than women gaining optimal or excessive weight.Conclusion:Women who are overweight before pregnancy should get special attention regarding lifestyle modifications affecting consequent weight gain during pregnancy. They are most likely to gain excessive weight and therefore most likely to suffer pregnancy and delivery complications and struggle with increasing overweight and obesity after giving birth.

Comparison of Women’s Diet Assessed by FFQs and 24-Hour Recalls with and without Underreporters: Associations with Biomarkers

Background/Aims: Women’s diet can be especially difficult to assess, as women tend to underreport their intakes more often than men and are more likely to do so if they think they are overweight or obese. The aim was to compare two methods to assess women’s diet and how well they associate with biomarkers. The influence and frequency of underreporting was also investigated. Methods: Diet of 53 women was assessed by two 24-hour recalls and a food frequency questionnaire (FFQ). Blood was analyzed for retinol, β-carotene, vitamin C and serum ferritin, and 24-hour urine for nitrogen, potassium and sodium. Underreporting was evaluated with nitrogen excretion vs. intake, and energy intake vs. basal metabolic rate. Results: Energy percent (E%) from macronutrients was similar from FFQ and 24-hour recalls, but total intake was higher from 24-hour recalls (9,516 ± 2,080 vs. 8,183 ± 2,893 kJ, p < 0.01). Intakes of vitamin C and potassium from both methods correlated with their respective biomarkers (r = 0.316–0.393). Underreporters had higher body mass index (BMI) than others (27.7 ± 5.5 vs. 23.8 ± 3.7 kg/m2, p < 0.05). They reported lower E% total fat (32 ± 5 vs. 38 ± 6 E%, p < 0.01) and higher E% carbohydrate (49 ± 4 vs. 45 ± 7 E%, p < 0.05). Correlation between intake and biomarkers increased after exclusion of underreporters. Conclusion: For women, FFQ and 24-hour recalls give similar E% and most nutrients correlate, but FFQ gives lower intake. Underreporters have higher BMI and diminish the correlation between calculated intake and biomarkers. This has to be considered when intake data are associated with weight management, disease and lifestyle factors.

Relationship between high consumption of marine fatty acids in early pregnancy and hypertensive disorders in pregnancy

Objective  To investigate whether there is a relationship between maternal intake of cod‐liver oil in early and late pregnancy and hypertensive disorders in pregnancy.

The role of parental motivation in family-based treatment for childhood obesity.

This study investigated the role of parental motivation (importance, confidence and readiness) for predicting dropout and outcome from family‐based behavioral treatment for childhood obesity. Parent and child demographics, adherence to treatment, and weight loss parameters were also explored as potential predictors. Eighty‐four obese children (BMI‐standard deviation scores (SDS) >2.14) and a participating parent with each child started treatment consisting of 12 weeks of group and individual treatment sessions (24 sessions total) delivered over a period of 18 weeks. Sixty‐one families (73%) completed treatment and attended follow‐up at 1 year after treatment. Child session attendance and completion of self‐monitoring records served as measures of adherence. In regression analyses, parent reports (pretreatment) of confidence for doing well in treatment was the strongest predictor of treatment completion (P = 0.003) as well as early treatment response (weight loss at week 5) (P = 0.003). This variable remained a significant predictor of child weight loss at post‐treatment (P = 0.014), but was not associated with child outcome at 1‐year follow‐up (P > 0.05). The only significant predictor of child weight loss at that point was child baseline weight (P = 0.001). However, pretreatment parent ratings of importance of and readiness for treatment did not predict dropout or weight loss at any point. The results underscore the importance of addressing parental motivation, specifically parental confidence for changing lifestyle related behaviors, early in the treatment process. Doing so may reduce treatment dropout and enhance treatment outcome.

Fat-soluble vitamins in the maternal diet, influence of cod liver oil supplementation and impact of the maternal diet on human milk composition.

Background/Aims: To investigate lactating mothers’ intake of fat-soluble vitamins in free-living subjects and to what extent cod liver oil supplementation influences the maternal intake in a population with common intake of cod liver oil. The impact of maternal diet on the concentration of fat-soluble vitamins in human milk was studied. Methods: Dietary intake of 77 lactating women was investigated by 24-hour diet recalls and breast-milk samples were taken at the same occasions. Breast milk samples were analyzed for fat-soluble vitamins. Results: The median intakes were 927 µg/day for vitamin A, 5.5 mg/day for vitamin E and 3.3 µg/day for vitamin D. Maternal vitamin A, E and D intakes were higher when the diet was supplemented with cod liver oil. Icelandic breast milk was found to have high contents of vitamin A and E. Only vitamin D was too low in breast milk to meet the recommended intake for infants. Retinylpalmitate in relation to lipids correlated with maternal vitamin A intake (r = 0.23, p < 0.05). The group with cod liver oil supplementation had significantly lower levels of γ-tocopherol in breast milk (p < 0.01), whereas the supplementation did not affect other fat-soluble vitamins. Conclusion: The recommended intake of fat-soluble vitamins for lactating women can more easily be met with a cod liver oil supplementation than diet alone. Only vitamin D in human milk cannot meet the recommended intakes for infants, with normal breastfeeding. There is a relationship between the content of vitamins A and E in human milk and the maternal diet.

Relationship between dietary intake of cod liver oil in early pregnancy and birthweight

Objective  To investigate the possible association between birth outcome and marine food and cod liver oil intake of healthy women in early (prior to 15 weeks of gestation) pregnancy.

Teasing and social rejection among obese children enrolling in family-based behavioural treatment: effects on psychological adjustment and academic competencies

Objectives:The first objective was to determine the prevalence of psychological maladjustment (emotional and behavioural problems), low academic competencies and teasing/social rejection among obese Icelandic children enrolling in a family-based behavioural treatment. A second objective was to explore the degree to which teasing/social rejection specifically contributes to childrens psychological adjustment and academic competencies when controlling for other variables, including demographics, childrens physical activity, parental depression and life-stress.Methods:Participants were 84 obese children (mean body mass index-standard deviation score=3.11, age range=7.52–13.61 years). Height and weight, demographics and measures of childrens psychological adjustment, academic competencies, teasing/social rejection and physical activity were collected from children, parents and teachers. Parental depression and life-stress was self-reported.Results:Over half the children exceeded cutoffs indicating concern on at least one measure of behavioural or emotional difficulties. Children endorsed significant levels of teasing/social rejection, with almost half acknowledging they were not popular with same-gender peers. Parent reports of peer problems were even higher, with over 90% of both boys and girls being rated by their parents as having significant peer difficulties. However, rates of low academic competencies as reported by teachers were not different from those of the general population. In regression analyses controlling for other variables, self-reported teasing/social rejection emerged as a significant contributor to explaining both child psychological adjustment and academic competencies.Conclusions:The results indicate that among obese children enrolled in family-based treatment, self-reported teasing/social rejection is quite high and it is associated with poorer psychological adjustment as well as lower academic competencies. Parent reports corroborate the presence of substantial peer difficulties, supporting the need to address peer relations with overweight children both in clinical practice and in public health interventions.

Polyunsaturated Fatty Acids in the Diet and Breast Milk of Lactating Icelandic Women with Traditional Fish and Cod Liver Oil Consumption

Background/Aims: The proportion of polyunsaturated fatty acids (PUFA) in the diet and breast milk of lactating women with traditional fish and cod liver oil consumption was investigated under free-living conditions. Methods: Dietary intake of 77 lactating women was investigated by 24-hour recalls and breast milk samples were taken at the same occasions. Maternal intake data was calculated and fatty acid pattern from breast milk samples analyzed with gas chromatography. Results: Women using cod liver oil (n = 18) had a significantly higher total PUFA intake (14 ± 10 vs. 9 ± 7 g/day; 5.0 ± 3.4 vs. 3.9 ± 3.0 Energy%; p < 0.05) than women who did not use it (n = 59). In particular, mothers consuming cod liver oil had higher breast milk proportion of docosahexaenoic acid (DHA, 0.54 vs. 0.30%, p < 0.05). They also had higher breast milk proportions of eicosapentaenoic acid (EPA; 0.16 vs.0.07%; p < 0.05) and docosapentaenoic acid (DPA; 0.22 vs. 0.17%; p < 0.05). Conclusion: The proportion of PUFA in the diet is significantly higher among women consuming cod liver oil. Its use also gives higher proportion of EPA,DPA and DHA in breast milk without decreasing other important fatty acids. As this may have an impact on the health and development of breast-fed infants in later life, regular maternal cod liver oil intake could be relevant for the infant as well as for the nutritional adequacy of the maternal diet.

Combined effects of maternal smoking status and dietary intake related to weight gain and birth size parameters

Objective  To investigate the interaction of smoking status and dietary intake during pregnancy and its relationship to maternal weight gain and birth size parameters.

Effects of a 6-month multimodal training intervention on retention of functional fitness in older adults: A randomized-controlled cross-over design

BackgroundOlder adults have the highest rates of disability, functional dependence and use of healthcare resources. Training interventions for older individuals are of special interest where regular physical activity (PA) has many health benefits. The main purpose of this study was to assess the immediate and long-term effects of a 6-month multimodal training intervention (MTI) on functional fitness in old adults.MethodsFor this study, 117 participants, 71 to 90 years old, were randomized in immediate intervention group and a control group (delayed intervention group). The intervention consisted of daily endurance and twice-a-week strength training. The method was based on a randomized-controlled cross-over design. Short Physical Performance Battery (SPPB), 8 foot up-and-go test, strength performance, six min walking test (6 MW), physical activity, BMI and quality of life were obtained at baseline, after a 6-month intervention- and control phase, again after 6-month crossover- and delayed intervention phase, and after anadditional 6-month follow-up.ResultsAfter 6 months of MTI, the intervention group improved in physical performance compared with the control group via Short Physical Performance Battery (SPPB) score (mean diff = 0.6, 95 % CI: 0.1, 1.0) and 8-foot up-and-go test (mean diff = −1.0 s, 95 % CI: -1.5, -0.6), and in endurance performance via 6-minute walking test (6 MW) (mean diff = 44.2 meters, 95 % CI: 17.1, 71.2). In strength performance via knee extension the intervention group improved while control group declined (mean diff = 55.0 Newton, 95 % CI: 28.4, 81.7), and also in PA (mean diff = 125.9 cpm, 95 % CI: 96.0, 155.8). Long-term effects of MTI on the particpants was assesed by estimating the mean difference in the variables measured between time-point 1 and 4: SPPB (1.1 points, 95 % CI: 0.8, 1.4); 8-foot up-and-go (−0.9 s, 95 % CI: -1.2, -0.6); 6 MW (18.7 m, 95 % CI: 6.5, 31.0); knee extension (4.2 Newton, 95 % CI: -10.0, 18.3); hand grip (6.7 Newton, 95 % CI: -4.4, 17.8); PA (−4.0 cpm, 95 % CI: -33.9, 26.0); BMI (−0.6 kg/m2, 95 % CI: -0.9, -0.3) and Icelandic quality of life (0.3 points, 95 % CI: -0.7, 1.4).ConclusionsOur results suggest that regular MTI can improve and prevent decline in functional fitness in older individuals, influence their lifestyle and positively affect their ability to stay independent, thus reducing the need for institutional care.Trial registrationThis study was approved by the National Bioethics Committee in Iceland, VSNb20080300114/03-1