Greet Vansant

Effect of lifestyle intervention on dietary habits, physical activity, and gestational weight gain in obese pregnant women: a randomized controlled trial

BACKGROUND Maternal obesity and excessive gestational weight gain (GWG) are major short- and long-term risk factors for maternal and fetal complications. OBJECTIVE The objective was to study whether a lifestyle intervention based on a brochure or on active education can improve dietary habits, increase physical activity (PA), and reduce GWG in obese pregnant women. DESIGN In this randomized controlled trial, 195 white, obese pregnant women [age: 29 + or - 4 y; body mass index (in kg/m(2)); 33.6 + or - 4.2] were randomly assigned into 3 groups: a group that received nutritional advice from a brochure, a group that received the brochure and lifestyle education by a nutritionist, and a control group. Nutritional habits were evaluated every trimester through 7-d food records. PA was evaluated with the Baecke questionnaire. RESULTS Energy intake did not change during pregnancy and was comparable in all groups. Fat intake, specifically saturated fat intake, decreased and protein intake increased from the first to the third trimester in the passive and active groups compared with an opposite change in the control group. Calcium intake and vegetable consumption increased during pregnancy in all groups. PA decreased in all groups, especially in the third trimester. No significant differences in GWG and obstetrical or neonatal outcome could be observed between the groups. CONCLUSIONS Both lifestyle interventions improved the nutritional habits of obese women during pregnancy. Neither PA nor GWG was affected.

Reproductive outcome after bariatric surgery: a critical review

BACKGROUND After many cycles of weight loss and weight gain, more and more morbidly obese patients undergo bariatric surgery, like gastric banding or gastric bypass, as the ultimate treatment for their obesity-problem. Since women of reproductive age are candidates for bariatric surgery, concerns arise regarding the potential impact on future pregnancy. METHODS English-language articles were identified in a PUBMED search from 1982 to January 2008 using the keywords for pregnancy and bariatric surgery or gastric bypass or gastric banding. RESULTS The few reported case-control and cohort studies clearly show improved fertility and a reduced risk in obstetrical complications, including gestational diabetes, macrosomia and hypertensive disorders of pregnancy, in women after operatively induced weight loss when compared with morbidly obesity women. The incidence of intrauterine growth restriction (IUGR) appears to be increased, however. No conclusions can be drawn concerning the risk for preterm labour and miscarriage, although these risks are probably increased compared with controls matched for body mass index. Operative complications are not uncommon with bariatric surgery and several cases have pointed to the increased risk for intestinal hernias and nutritional deficiencies in subsequent pregnancy. Deficiencies in iron, vitamin A, vitamin B(12), vitamin K, folate and calcium can result in both maternal complications, such as severe anaemia, and fetal complications, such as congenital abnormalities, IUGR and failure to thrive. CONCLUSIONS Close supervision before, during and after pregnancy following bariatric surgery and nutrient supplementation adapted to the patients individual requirements can help to prevent nutrition-related complications and improve maternal and fetal health, in this high-risk obstetric population.

Dietary patterns and socioeconomic position

Background/Objectives:To test a socioeconomic hypothesis on three dietary patterns and to describe the relation between three commonly used methods to determine dietary patterns, namely Healthy Eating Index, Mediterranean Diet Score and principal component analysis.Subjects/Methods:Cross-sectional design in 1852 military men. Using mailed questionnaires, the food consumption frequency was recorded.Results:The correlation coefficients between the three dietary patterns varied between 0.43 and 0.62. The highest correlation was found between Healthy Eating Index and Healthy Dietary Pattern (principal components analysis). Cohens kappa coefficient of agreement varied between 0.10 and 0.20. After age-adjustment, education and income remained associated with the most healthy dietary pattern. Even when both socioeconomic indicators were used together in one model, higher income and education were associated with higher scores for Healthy Eating Index, Mediterranean Diet Score and Healthy Dietary Pattern. The least healthy quintiles of dietary pattern as measured by the three methods were associated with a clustering of unhealthy behaviors, that is, smoking, low physical activity, highest intake of total fat and saturated fatty acids, and low intakes of fruits and vegetables.Conclusions:The three dietary patterns used indicated that the most healthy patterns were associated with a higher socioeconomic position, while lower patterns were associated with several unhealthy behaviors.

Validity of predictive equations for resting energy expenditure in Belgian normal weight to morbid obese women

BACKGROUND & AIMS Individual energy requirements of overweight and obese adults can often not be measured by indirect calorimetry, mainly due to the time-consuming procedure and the high costs. To analyze which resting energy expenditure (REE) predictive equation is the best alternative for indirect calorimetry in Belgian normal weight to morbid obese women. METHODS Predictive equations were included when based on weight, height, gender, age, fat free mass and fat mass. REE was measured with indirect calorimetry. Accuracy of equations was evaluated by the percentage of subjects predicted within 10% of REE measured, the root mean squared prediction error (RMSE) and the mean percentage difference (bias) between predicted and measured REE. RESULTS Twenty-seven predictive equations (of which 9 based on FFM) were included. Validation was based on 536 F (18-71 year). Most accurate and precise for the Belgian women were the Huang, Siervo, Muller (FFM), Harris-Benedict (HB), and the Mifflin equation with 71%, 71%, 70%, 69%, and 68% accurate predictions, respectively; bias -1.7, -0.5, +1.1, +2.2, and -1.8%, RMSE 168, 170, 163, 167, and 173kcal/d. The equations of HB and Mifflin are most widely used in clinical practice and both provide accurate predictions across a wide range of BMI groups. In an already overweight group the underpredicting Mifflin equation might be preferred. Above BMI 45kg/m(2), the Siervo equation performed best, while the FAO/WHO/UNU or Schofield equation should not be used in this extremely obese group. CONCLUSIONS In Belgian women, the original Harris-Benedict or the Mifflin equation is a reliable tool to predict REE across a wide variety of body weight (BMI 18.5-50). Estimations for the BMI range between 30 and 40kg/m(2), however, should be improved.

Lifestyle changes and breast cancer prognosis: a review

Objective Because of its high incidence and improving survival, breast cancer is currently the most prevalent cancer in the world. We reviewed the published literature in our search for modifiable factors valuable as an adjuvant health measure to surgery, radio and systemic therapy for breast cancer. Methods We included material which was identified from computerised searches of PubMed (1966 to May, 2007). Published material was restricted to prospective cohort studies and randomised clinical trials. We reviewed the literature concerning the association between physical activity, smoking, weight gain after the diagnosis, diet and prognosis. Results and conclusion We conclude that life style changes following standard breast cancer therapy are highly recommended (although scientific evidence is still lacking for some of inconsistency regarding available data). They include physical activity, weight control, high consumption of fruit and vegetables, and a reduction of dietary fat intake.

The effect of pre-pregnancy BMI on intention, initiation and duration of breast-feeding

OBJECTIVE To determine whether pre-pregnancy BMI influences breast-feeding practice. DESIGN Retrospective epidemiological study. SETTING University Hospital Leuven, Catholic University Leuven, Belgium. SUBJECTS Two hundred women (median age 29 years, interquartile range (IQR) 4; 52 % nulliparae) were grouped into four categories according to pre-pregnancy BMI using WHO cut-offs. RESULTS The incidence of intention and initiation of breast-feeding was significantly lower in underweight (64 %) and obese women (68 %) compared with normal weight (92 %) and overweight women (80 %). Initiation was also related to parity (OR = 0.582; 95 % CI 0.400, 0.846), but not to gestational weight gain, method of delivery or hypertensive disorders. Fifty-two per cent of underweight, 70 % of normal weight and 56 % of overweight women were exclusively breast-feeding their infant during the first month of life. This incidence was significantly lower in the obese group (34 %; P = 0.030). Only 40 % of all infants were exclusively breast-fed at 3 months of age, with the lowest prevalence among women with obesity (P = 0.0 0 1). The median duration of any breast-feeding in the obese group (1.8 months, IQR 3.4) was significantly shorter than in the underweight (3.0 months, IQR 3.1), normal weight (3.0 months, IQR 2.4) and overweight group (3.0 months, IQR 3.5; P = 0.024). Reasons given for ceasing breast-feeding in the obese group were maternal complications (29 %), insufficient milk supply (23 %), sucking problems (21 %) and work resumption (21 %). CONCLUSIONS Breast-feeding practice in the total population, but especially among women with obesity, fell short of global WHO recommended standards. Policy initiatives and local interventions should continue to support breast-feeding, but also prevent maternal obesity.

Socio-economic determinants of micronutrient intake and status in Europe: a systematic review

OBJECTIVE To provide the evidence base for targeted nutrition policies to reduce the risk of micronutrient/diet-related diseases among disadvantaged populations in Europe, by focusing on: folate, vitamin B12, Fe, Zn and iodine for intake and status; and vitamin C, vitamin D, Ca, Se and Cu for intake. DESIGN MEDLINE and Embase databases were searched to collect original studies that: (i) were published from 1990 to 2011; (ii) involved >100 subjects; (iii) had assessed dietary intake at the individual level; and/or (iv) included best practice biomarkers reflecting micronutrient status. We estimated relative differences in mean micronutrient intake and/or status between the lowest and highest socio-economic groups to: (i) evaluate variation in intake and status between socio-economic groups; and (ii) report on data availability. SETTING Europe. SUBJECTS Children, adults and elderly. RESULTS Data from eighteen publications originating primarily from Western Europe showed that there is a positive association between indicators of socio-economic status and micronutrient intake and/or status. The largest differences were observed for intake of vitamin C in eleven out of twelve studies (5-47 %) and for vitamin D in total of four studies (4-31 %). CONCLUSIONS The positive association observed between micronutrient intake and socio-economic status should complement existing evidence on socio-economic inequalities in diet-related diseases among disadvantaged populations in Europe. These findings could provide clues for further research and have implications for public health policy aimed at improving the intake of micronutrients and diet-related diseases.

Cultural, socioeconomic and nutritional determinants of functional food consumption patterns.

Objectives:The aim of our research was to describe cultural, socioeconomic and nutritional determinants associated with functional food consumption.Methods:Cross-sectional design in 5000 military men. Using mailed questionnaires, the functional food consumption frequency was recorded.Results:Margarines fortified with phytosterols or phytostanols were used on a daily basis by 26.3% of the responders. Only 4.7% took a daily portion of probiotics, whereas 14.0% consumed one or more portions of nuts a week. One man out of three consumed one cup of tea daily, whereas 10.2% consumed one glass of red wine daily. Three or more portions of fruit a day were consumed by 19.1%, and two or more portions of vegetables a day by 26.6%. Only 12.3% consumed a portion of fatty fish weekly. After adjustment for age, body mass index, physical activity, use of vitamin supplements, smoking, marital status, cultural background, educational and income level, the daily consumption of fortified margarines increased with age. The consumption of fermented dairy products increased with physical activity and with the use of vitamin supplements. The consumption of fortified margarines, nuts, tea and fatty fish was strongly influenced by cultural background, with higher consumptions for Flemish-speaking men compared with French-speaking persons. Daily consumption of red wine was higher in French-speaking men and in higher educated men. Finally, functional food consumption was associated with a healthy dietary pattern.Conclusion:Age, physical activity, level of education, use of vitamin supplements and cultural background are predictors of functional food consumption patterns.

The assessment of dietary habits in obese women: influence of eating behavior patterns.

The objective of this cross-sectional, observational study was to compare the dietary history and the 7-day record method to assess dietary habits in obese women. The second goal was to investigate whether eating behavior characteristics influence self-reported dietary intake. The study took place at the Obesity Outpatient Clinic, University Hospital Gasthuisberg, Leuven, Belgium. Subjects were 137 obese women with a mean age of 40 ± 12 years and a mean body mass index of 38.2 ± 6.0 kg/m2. Dietary intake was assessed both by the dietary history and by the 7-day record method. Resting energy expenditure was measured by continuous indirect calorimetry. Physical activity level was estimated using the Baecke questionnaire. To study different aspects of eating behaviour, the “Dutch Eating Behaviour Questionnaire” was used. Absolute energy intake, as assessed by the 7-day record, was consistently lower than with the dietary history method. Sixteen percent of the obese women were overreporters while 66% clearly underreported energy intake, using dietary history as standard method. Restrained eating was associated with underreporting, while all aspects of emotional and external eating behavior were significantly higher in the group of overreporters. No relationship could be observed between the degree of underreporting and age, body weight or body mass index. Energy intake, as assessed by the dietary history method, correlated better with measured energy expenditure in obese subjects than the 7-day record. Eating behavior characteristics influence the accuracy of self-reported dietary intake in obese women. This study was supported in part by the Fonds voor Wetenschappelijk Onderzoek – Vlaanderen (Project G.0178.96 and ‘Krediet aan Navorsers’ 1.5.006.95).

Evaluation of Body Fat Estimated from Body Mass Index and Impedance in Belgian Male Military Candidates: Comparing Two Methods for Estimating Body Composition

OBJECTIVE The study objective was to evaluate whether a classification based on body mass index (BMI) agrees with a classification based on body fat mass, estimated by bioelectrical impedance. METHODS A random sample of 448 male candidates between 18 and 20 years was selected during their medical visit in a military recruitment center. BMI was determined as weight/height2 and was considered normal between 20.0 and 25.0 kg/m2 (cfr. WHO classification). Percentage of body fat was estimated with bioelectrical impedance, using the Omron Body Fat Analyzer HBF-306. Subjects with a body fat percentage measured by bipolar bioelectrical impedance analysis (BF%(IMP)) < or = 20.9% were considered normal weight, while subjects with a BF%(IMP) > or = 21.0% were considered overweight. We used the following classification: true positives were normal scores for BMI and impedance; false positives were normal scores for BMI but not for impedance; true negatives were overweight scores for BMI and for impedance; and false negatives were overweight scores for BMI but not for impedance. Data were analyzed using the SPSS statistical program. RESULTS BMI ranged from 17.0 to 29.4 kg/m2; percentage of fat mass varied between 5.3 and 31.4% of body weight. Of the total sample, 328 (73.2%) candidates were classified as true positive, 29 (6.5%) as false negative, 47 (10.5%) as false positive, and finally 44 (9.8%) as true negative. The difference in classification in normal weight versus overweight between the BMI method and the bipolar bioelectrical impedance method was statistically significant (chi2 with one df = 86.04; p < 0.001). CONCLUSIONS To limit false-negative classifications, additional impedance measurements in the BMI category between 25.0 and 27.0 kg/m2 is mandatory to determine whether there is really an excess fat mass.