Gustaaf Sevenhuysen

Community-based Exercise and Dietary Intervention During Pregnancy:A Pilot Study

ABSTRACT OBJECTIVE To determine the feasibility of implementing a communitybased exercise/dietary intervention program targeted at socioeconomically deprived pregnant women living in an urban core in an attempt to reduce risks of obesity and diabetes. METHODS Fifty-two participants were enrolled and randomized into additional intervention (AI) and standard care (SC) groups. Participants in the AI group undertook group and homebased exercises during pregnancy and received computerassisted Food Choice Map dietary interviews and counselling. Participants in the SC group received an information package on diet and activity for a healthy pregnancy. RESULTS Forty-five participants completed the study (SC group, n=21, AI group, n=24). No adverse effects of exercise were observed during the study. Physical activity levels in the AI group were greater than those in the SC group (p CONCLUSIONS The results of this pilot study demonstrated the feasibility of the lifestyle intervention during pregnancy and its potential to improve pregnancy outcomes in urban communities.

Folate Status of Young Canadian Women after Folic Acid Fortification of Grain Products

Women of childbearing age are advised to consume folic acid-containing supplements. Whether this remains necessary after folic acid fortification of the food supply in North America has yet to be determined. The objectives of this study were to assess folate intakes and the contribution of folic acid to the diets of women of childbearing age in the post-folic acid fortification era. Using a cross-sectional study design, fasting blood samples were obtained from 95 women (aged 18 to 25 years), and the samples were analyzed for serum and red blood cell folate, as well for total homocysteine. Dietary and supplemental folate intakes were assessed. The biochemical evidence showed that no women were folate deficient, but only 14% reached red blood cell folate concentrations associated with significant reductions in neural tube defect risk. Mean dietary intake of food folic acid was 96+/-64 microg/day, supplemental folic acid was 94+/-189 microg/day, natural folate was 314+/-134 microg/day, and the total intake, as dietary folate equivalents, was 646+/-368 microg dietary folate equivalents/day. Therefore, intakes of folic acid from fortified foods are within the level originally predicted for the fortification efforts; however, only 17% of participants met the special recommendation for women capable of becoming pregnant (400 microg folic acid daily from supplements, fortified foods, or both in addition to consuming food folate from a varied diet). These data suggest that women of childbearing age are achieving positive folate status in the postfortification era, but it may not be sufficient to achieve red blood cell folate concentrations associated with a significant reduction in neural tube defect risk. Even with food fortification, women of childbearing age should be advised to take a folic acid-containing supplement on a daily basis.

Validation of a Food Choice Map with a 3-Day Food Record and Serum Values to Assess Folate and Vitamin B-12 Intake in College-Aged Women

BACKGROUND Estimates of dietary folate and vitamin B-12 intakes are currently of considerable interest, but a valid assessment method that is faster than those currently available would better suit everyday health promotion activities. OBJECTIVE To validate a new assessment technique for estimating folate and vitamin B-12 intakes, known as the Food Choice Map (FCM), using serum folate and vitamin B-12 concentrations in a group of 95 women aged 18 to 25 years. DESIGN The FCM tool was used in a cross-sectional study design to estimate the usual folate and vitamin B-12 intakes of each participant. Immediately thereafter, blood samples were taken to determine serum folate and vitamin B-12 concentrations. Subsequently, 3-day food records were completed during each of three successive weeks and used as the reference method. Using the method of triads, validity coefficients were calculated. RESULTS There was no significant difference between the two methods in the correlations with serum values. FCM-obtained folate intakes (r=0.43, P<0.01) exhibited a similar and moderate association with serum folate as did 3-day food record-obtained folate intakes (r=0.39, P<0.01). Similarly, vitamin B-12 intakes obtained from both techniques showed a modest association with serum vitamin B-12 (FCM r=0.40, P<0.01; 3-day food record r=0.44, P<0.01). However, the validity coefficient for the FCM was higher than that for the 3-day food record for both folate (FCM 0.97, 3-day food record 0.79) and B-12 (FCM 0.95; 3-day food record 0.85). CONCLUSIONS This study provides validation for the use of a new dietary assessment method, the FCM, for estimating folate and vitamin B-12 intakes in women of reproductive age. Larger validation studies that include men and other age groups are needed to further characterize the applicability of the FCM.

The growing Canadian energy gap: more the can than the couch?

OBJECTIVE The present study describes the trajectory of the energy gap (energy imbalance) in the Canadian population from 1976 to 2003, its temporal relationship to adult obesity, and estimates the relative contribution of energy availability and expenditure to the energy gap. It also assesses which foods contributed the most to changes in available energy over the study period. DESIGN Annual estimates of the energy gap were derived by subtracting population-adjusted per capita daily estimated energy requirements (derived from Dietary Reference Intakes) from per capita daily estimated energy available (obtained from food balance sheets). Food balance sheets were used to assess which foods contributed to changes in energy availability. Adult obesity rates were derived from six national surveys. The relationship to the energy gap was assessed through regression analysis. RESULTS Between 1976 and 2003, per capita daily estimated energy availability increased by 18 % (1744 kJ), and increased energy availability was the major driver of the increased energy gap. Salad oils, wheat flour, soft drinks and shortening accounted for the majority of the net increase in energy availability. Adult obesity was significantly correlated with the energy gap over the study period. CONCLUSIONS The widening energy gap is being driven primarily by increased energy availability. The food commodities driving the widening energy gap are major ingredients in many energy-dense convenience foods, which are being consumed with increasing frequency in Canada. Policies to address population obesity must have a strong nutritional focus with the objective of decreasing energy consumption at the population level.

Stress and Anxiety in Women With Gestational Diabetes During Dietary Management

Purpose To explore the stress and anxiety experiences during dietary management in women with gestational diabetes (GDM). Methods Thirty women with GDM from the Winnipeg area participated in the mixed methods study. Each participant completed a Food Choice Map semistructured interview, a Perceived Stress Scale, a Pregnancy Anxiety Scale, a State-Trait Anxiety Inventory–Trait questionnaire, and a demographic questionnaire. Stress and anxiety experiences were identified from interview transcripts and categorized into themes based on the constant comparative method. Questionnaire scores aided in interpreting the stress and anxiety experience in the qualitative data. Results Three major themes were generated from the interviews: (1) stress related to GDM diagnosis and the perception of a high risk pregnancy; (2) stress over losing control of GDM during the process of dietary management; and (3) anxiety related to the fear of maternal and infant complications. Women on insulin experienced significantly higher levels of perceived stress (P < .01), and the dietary management stress was more prevalent in women using insulin compared to the ones on diet treatment only (Fisher exact test, P < .01). Unhealthy diet coping strategies occurred with the stress and anxiety. Conclusions Stress and anxiety were associated with different contexts in this study sample. Women who were on insulin experienced significantly higher levels of perceived stress related to dietary management.

Food Choice Decision-Making by Women with Gestational Diabetes

OBJECTIVE To enhance the dietary education presented to women with gestational diabetes (GDM) by exploring the reasons and experiences that women with GDM reported in making their food-choice decisions after receipt of dietary education from a healthcare professional. METHODS Food Choice Map (FCM) semi-structured in-depth interviews were conducted with 30 women with GDM living in the Winnipeg area during their pregnancies. Verbatim transcripts were generated from the interviews. A constant comparative method was used to generate common themes to answer research inquiries. RESULTS Personal food preferences, hunger and cravings were the main factors affecting food choice decision-making in women with GDM. Although the information from healthcare professionals was 1 factor that affected food choice decision-making for most of the participants, more than half of the women, including all the women who were on insulin, reported difficulties in quick adaptation to dietary management in a limited time period. Information from other sources such as family members, friends, and internet were used to cope with the adaptation. These difficulties led to a sense of decreased control of GDM and were accompanied by frustration, especially for women taking insulin. CONCLUSIONS Food choice decision-making varied for this group of women with GDM. Knowledge and information aided in making healthy food choices and in portion control. However, balancing individual needs and blood glucose control in a short time period was felt to be difficult and created frustration. The findings suggested that dietary consultation needs to be personalized and to be time sensitive to promote confidence in self-control.

Low vegetable intake is associated with allergic asthma and moderate‐to‐severe airway hyperresponsiveness

In recent decades, childrens diet quality has changed and asthma prevalence has increased, although it remains unclear if these events are associated.

Barriers and coping strategies of women with gestational diabetes to follow dietary advice.

OBJECTIVE To understand barriers and coping strategies of women with gestational diabetes (GDM) to follow dietary advice. DESIGN Qualitative study. PARTICIPANTS Thirty women with GDM from the Winnipeg area participated. Each participant completed a Food Choice Map (FCM) semi-structured interview and a demographic questionnaire. MAJOR OUTCOME MEASURES Underlying beliefs of women with GDM and factors that hinder following dietary advice. ANALYSIS Qualitative data analyzed using constant comparative method to identify emergent themes of factors and beliefs that affected following dietary advice. Themes were categorized within the Integrative Model of Behavioral Prediction. RESULTS GDM women faced challenges and barriers when (1) personal food preference conflicted with dietary advice; (2) eating in different social environments where food choice and portions were out of control and food choice decisions were affected by social norms; (3) lack of knowledge and skills in dietary management and lack of a tailored dietary plan. CONCLUSIONS AND IMPLICATIONS Quick adaptation to dietary management in a short time period created challenges for women with GDM. Stress and anxiety were reported when women talked about following dietary advice. Tailored educational and mental health consultation with consideration of the barriers may promote dietary compliance and overall better health.

“Asthma Isn’t an Excuse, It’s Just a Condition”: Youths’ Perceptions of Physical Activity and Screen Time

Objective. During puberty, physical activity patterns begin to decline, while sedentary time increases. These changes may be confounded by asthma. The purpose of this study was to gain insight into youths’ perceptions of screen time and physical activity by asthma status. Methods. Four interviews and seven focus groups with boys only or girls only were conducted with 15- to 16-year-old youth enrolled in either of two asthma-focused cohorts in Manitoba, Canada. Using a semi-structured interview guide, youth were asked about their perceptions of physical activity and screen time such as texting, watching television, electronic games, and Internet chatting and about their perceptions of the influence that asthma has on these behaviors. Data were analyzed using thematic coding. Results. Two themes were common to youth with asthma and without asthma: (1) sports are an integral part of youths’ lives and (2) screen time is important to youth. Two themes were identified among youth with asthma only: (1) physical activity used to be more difficult and (2) being active and living with asthma. Youth with asthma described physical activity as neither a hindrance to activity nor an excuse for inactivity, although asthma may still present some challenges. They also acknowledged their reliance on screen time for communication and for entertainment. Conclusions. Youth with asthma believe that physical activity has become increasingly easier as they become older and that being active with asthma, despite its challenges, is a key part of their lives.

Pregnancy outcome and maternal weight in an Ethiopian famine relief camp

During the food emergency of 1984/85 in Northern Ethiopia records were kept on births in one relief camp. In retrospective analysis of these records birthweight and neonatal mortality were related to selected maternal characteristics. Mean birthweights were significantly lower than those previously reported in other Ethiopian populations. Birthweights were related to maternal weights recorded immediately after delivery. Neonatal mortality increased as the maternal Body Mass Index decreased. However birthweight only showed a significant reduction when maternal BMI was below 18 kg/m2.