Isabelle Giroux

Nutrition and exercise prevent excess weight gain in overweight pregnant women.

PURPOSE To determine the effect of a Nutrition and Exercise Lifestyle Intervention Program (NELIP) for overweight (OW) and obese (OB) pregnant women on pregnancy weight gain, birth weight, and maternal weight retention at 2 months postpartum. METHODS This is a single-arm intervention matched by prepregnant body mass index, age, and parity to a historical cohort (4:1). Women with a prepregnancy body mass index of > or = 25.0 kg x m(-2) (N = 65) participated in a NELIP starting at 16-20 wk of pregnancy, continuing until delivery. NELIP consisted of an individualized nutrition plan with total energy intake of approximately 2000 kcal x d(-1) (8360 kJ x d(-1)) and 40%-55% of total energy intake from carbohydrate. Exercise consisted of a walking program (30% HR reserve), three to four times per week, using a pedometer to count steps. Matched historical cohort (MC; N = 260) was from a large local perinatal database. RESULTS Weight gained by women on the NELIP was 6.8 +/- 4.1 kg (0.38 +/- 0.2 kg x wk(-1)), with a total pregnancy weight gain of 12.0 +/- 5.7 kg. Excessive weight gain occurred before NELIP began at 16 wk of gestation. Eighty percent of the women did not exceed recommended pregnancy weight gain on NELIP. Weight retention at 2 months postpartum was 2.2 +/- 5.6 kg with no difference between the OW and the OB women on NELIP. Mean birth weight was not different between NELIP (3.59 +/- 0.5 kg) and MC (3.56 +/- 0.6 kg, P > 0.05). CONCLUSIONS NELIP reduces the risk of excessive pregnancy weight gain with minimal weight retention at 2 months postpartum in OW and OB women. This intervention may assist OW and OB women in successful weight control after childbirth.

Timing of excessive pregnancy-related weight gain and offspring adiposity at birth.

OBJECTIVE: To evaluate whether the timing of excessive maternal weight gain in a cohort of women following current guidelines for healthy living during pregnancy affects neonatal adiposity at birth. METHODS: One hundred seventy-two healthy women who were at least 18 years old with body mass indexes (BMIs) of at least 18.5 were recruited between 16 weeks and 20 weeks of gestation. The cohort followed healthy living guidelines during pregnancy and were retrospectively grouped according to 2009 Institute of Medicine guidelines for weight gain in the first and second halves of pregnancy: 1) appropriate gestational weight gain (ie, within Institute of Medicine recommendations) in the first and second halves of pregnancy (“overall appropriate”); 2) appropriate gestational weight gain in the first half of pregnancy and excessive gestational weight gain in the second half of pregnancy (“late excessive”); 3) excessive gestational weight gain in the first half of pregnancy and appropriate gestational weight gain in the second half of pregnancy (“early excessive”); and 4) excessive gestational weight gain throughout pregnancy (“overall excessive”). Primary measures included neonatal weight, length, BMI, and body fat at birth measured 6–18 hours after delivery. Neonatal body fat greater than 14% was considered excessive. RESULTS: Neonates of women who gained excessively in the first half of pregnancy exhibited greater heel-crown length, birth weight, and excessive body fat (“early excessive” 17.5±3.1%, “overall excessive” 18.7±3.3%) compared with those born to women who gained appropriately (“overall appropriate” 13.2±4.1%; “late excessive” 14.7±3.3%; P<.01). Neonates of women who gained excessively in the first half of pregnancy had an increased risk (odds ratio [OR] 2.64, 95% confidence interval [CI] 1.35–5.17) of elevated body fat at birth compared with neonates of women with total excessive weight gain (OR 1.49, 95% CI 0.80–2.79). CONCLUSION: Timing of excessive weight gain is an important factor influencing neonatal morphometrics. Prevention of early excessive weight gain should be encouraged in the period before conception and reinforced early in pregnancy. LEVEL OF EVIDENCE: II

Effect of exercise intensity and duration on capillary glucose responses in pregnant women at low and high risk for gestational diabetes

Exercise may influence glucose metabolism during pregnancy. We examined the effect of exercise intensity and duration on capillary glucose responses in pregnant women at low and high risk for gestational diabetes mellitus (GDM) who followed a modified GDM meal plan.

Nutrition and Exercise Reduce Excessive Weight Gain in Normal-Weight Pregnant Women

PURPOSE This study aimed to evaluate the effect of an exercise program of two different intensities, with nutritional control, on gestational weight gain (GWG), infant birth weight, and maternal weight retention at 2 months postpartum (2 mopp). METHODS Pregnant women (prepregnancy body mass index = 18.5-24.9 kg·m) were randomized at study entry (16-20 wk of gestation) to a low-intensity (LI, 30% HR reserve (HRR), n = 23) or moderate-intensity (MI, 70% HRR, n = 26) exercise program, with nutritional control. The exercise program consisted of walking sessions three to four times per week, gradually increasing exercise time from 25 to 40 min per session. Forty-five normal-weight women who did not participate in any structured exercise program during pregnancy and had singleton births were used as a historical control group. RESULTS Total GWG was higher in the control group (18.3 ± 5.3 kg) compared with the LI (15.3 ± 2.9 kg, P = 0.01) and MI (14.9 ± 3.8 kg, P = 0.003) groups. During the intervention, GWG was similar in both intervention groups, with weekly rates of weight gain of 0.49 ± 0.1 and 0.47 ± 0.1 kg·wk in the LI and MI groups, respectively. Excessive GWG during the intervention was prevented in 70% of the women in the LI group and 77% of those in the MI group. Excessive GWG occurred before the intervention began. At 2 mopp, 18% and 28% of the women in the LI and MI groups, respectively, retained ≤2.0 kg compared with only 7% of those in the control group. Infant birth weight was not different between the groups. CONCLUSIONS Results suggest that a prenatal nutrition and exercise program regardless of exercise intensity, reduced excessive GWG and decreased weight retention at 2 mopp in women of normal weight before pregnancy.

Postpartum Exercise Regardless of Intensity Improves Chronic Disease Risk Factors

PURPOSE Women who are unable to return to a healthy weight by 6 months postpartum increase their risk factors for the development of chronic disease (CD; including metabolic syndrome, obesity, and cardiovascular disease). In a prospective randomized intervention study, we examined the effect of exercise intensity on risk factors for CD in the postpartum. We hypothesized that women receiving an intervention targeting healthy weight loss would have improved CD risk factors compared with women not receiving the intervention. Further, we hypothesized that nutrition control and moderate-intensity exercise would have the greatest improvement in CD risk factors versus low-intensity exercise. METHODS Women were randomly assigned to a nutrition plus low-intensity (30% HR reserve; n = 20) or moderate-intensity (70% HR reserve; n = 20) exercise intervention group. The program consisted of supervised walking for 45 min, three to four times per week for 16 wk. All women were screened for CD at the beginning (7-8 wk postpartum) and at the end (23-25 wk postpartum) of the study. A historical control group of 20 sedentary postpartum women was matched by body mass index, age, and parity. RESULTS The low- and moderate-intensity groups lost more body mass (-4.2 ± 4.0 and -5.0 ± 2.9 kg, respectively) compared with the control group (-0.1 ± 3.3 kg, P < 0.01). Plasma low-density lipoprotein was reduced for the low- and moderate-intensity groups (-0.29 ± 0.21 and -0.28 ± 0.17 mmol · L) compared with the control group (0.03 ± 0.18 mmol · L, P = 0.015). In addition, glucose concentrations were reduced and adiponectin concentrations increased (P = 0.037), regardless of exercise intensity, although the sedentary controls remained unchanged or at increased risk for CD. CONCLUSIONS Women receiving a postpartum intervention targeting healthy weight loss, regardless of exercise intensity, improved CD risk factors compared with women not receiving the intervention.

Walking Program of Low or Vigorous Intensity During Pregnancy Confers an Aerobic Benefit

Walking is the most popular activity during pregnancy and may confer an aerobic benefit. However, the minimum intensity threshold of a maternal walking program for an aerobic conditioning response is unknown. The purpose was to examine the effect of a walking program of a low-intensity (LI, 30% heart rate reserve, HRR) or vigorous-intensity (VI, 70%HRR) on maternal cardiorespiratory responses to a standard submaximal treadmill test. Normal weight pregnant women were randomized at study entry (16-20 weeks of gestation) to the LI (n=23) or VI (n=21) walking program, with nutritional control. Participants performed a steady-state treadmill exercise test at their prescribed intensity pre- and post-intervention (34-36 weeks) to evaluate changes in cardiorespiratory responses. Increasing body mass due to pregnancy was similar between the groups throughout the study. From pre- to post-intervention, relative (mL kg - 1 min - 1) VO2 and VCO2 during steady-state submaximal treadmill exercise did not change in the LI group but decreased in the VI group (- 1.25±2.71, p=0.02 and - 1.50±2.64, p=0.005, respectively). Both groups presented increases in oxygen pulse (p≤0.002). Our results showed that the energy cost of walking was not affected by the increase in maternal body weight in the LI group and was decreased in the VI group, suggesting an aerobic conditioning response in both groups, although the VI group presented a greater response. All women presented similar body mass throughout the intervention and delivered healthy babies, indicating that a prenatal walking program of low or vigorous intensity, combined with healthy eating habits, is safe and beneficial to the mother and fetus.

Nutritional modulation of endogenous glucagon-like peptide-1 secretion: a review.

BackgroundThe positive influences of glucagon-like peptide-1 (GLP-1) on blood glucose homeostasis, appetite sensations, and food intake provide a strong rationale for its therapeutic potential in the nutritional management of obesity and type 2 diabetes.AimTo summarize GLP-1 physiology and the nutritional modulation of its secretion in the context of obesity and type 2 diabetes management.FindingsGLP-1 is mainly synthesized and secreted by enteroendocrine L-cells of the gastrointestinal tract. Its secretion is partly mediated by the direct nutrient sensing by G-protein coupled receptors which specifically bind to monosaccharides, peptides and amino-acids, monounsaturated and polyunsaturated fatty acids as well as to short chain fatty acids. Foods rich in these nutrients, such as high-fiber grain products, nuts, avocados and eggs also seem to influence GLP-1 secretion and may thus promote associated beneficial outcomes in healthy individuals as well as individuals with type 2 diabetes or with other metabolic disturbances.ConclusionThe stimulation of endogenous GLP-1 secretion by manipulating the composition of the diet may be a relevant strategy for obesity and type 2 diabetes management. A better understanding of the dose-dependent effects as well as the synergistic effects of nutrients and whole foods is needed in order to develop recommendations to appropriately modify the diet to enhance GLP-1 beneficial effects.

Weight history of overweight pregnant women.

PURPOSE Pre-conception weight gain and postpartum weight retention may contribute to womens increased risk of developing overweight/obesity; however, weight history data that would permit an examination of this hypothesis have been lacking. Our objective was to describe the weight history of pregnant overweight women and their families. METHODS Between 16 and 20 weeks of gestation, 107 overweight pregnant women (21 Aboriginal, including 20 First Nations and one Métis, and 86 non-Aboriginal) completed a weight history questionnaire. RESULTS Average adult usual body weight (UBW) corresponded to a body mass index (BMI) of 29.2 +/- 5.5 kg/m2 (overweight). Average pre-pregnancy BMI (33.0 +/- 6.6 kg/m2) increased into the obesity category. Over two-thirds of subjects reported an unstable UBW. A large proportion of multiparous subjects had retained weight after pregnancy. The average weight retained was 12.7 +/- 9.4 kg, and it accounted for almost all of the weight change from UBW. CONCLUSIONS Weight history questionnaire results showed that pre-conception weight fluctuations and postpartum weight retention are significant problems for many overweight/obese women. Health care professionals can use this information for early prenatal through postpartum interventions designed to help overweight/obese women achieve an appropriate pregnancy weight and prevent sustained postpartum weight retention.

Screening and assessment of nutritional status following stroke: results from a national survey of registered dietitians in Canada

Abstract Purpose: The objective of this study was to survey registered dietitians (RDs) at acute care hospitals across Canada to determine whether valid screening and assessment methods (i.e. those with formal evaluation of the psychometric and/or clinimetric properties of the tool) are used to identify protein-energy malnutrition following stroke. Methods: One hundred and twenty-five Canadian healthcare institutions admitting high volumes (≥100/year) of acute stroke patients were identified. RDs at these sites who provided services to patients recovering from acute stroke were contacted and invited to participate in an online survey. Results: Ninety-five RDs completed the survey. Sixty dietitians (63%) indicated that patients were screened routinely at their institution, which was conducted primarily by dietitians (n = 64, 67.3%). Ten respondents (10.5%) stated they used a screening tool with previously-established validity, while 32 (33.7%) indicated they used a validated assessment tool. Among dietitians using validated tools, 40% and 64% indicated that they used modified versions of the original screening and assessment tools. The most frequently cited tools used for both screening and assessment purposes were Subjective Global Assessment and Mini Nutritional Assessment. Conclusions: The results of this national survey suggest that screening and assessment of nutritional status following acute stroke is conducted using tools that have not been validated previously. Implications for Rehabilitation Although the use of valid screening and assessment tools is considered part of evidence-based practice, and recommendations for their adoption are included in several national stroke-specific clinical practice guidelines, the results from an online survey suggest that they are not used in clinical practice by RDs in Canada caring for patients following stroke. There are associated risks with the use of screening and assessment tools, which have not been formally validated. The true nutritional status of patients may not be initially identified correctly, and the response to subsequent nutritional interventions may not be assessed accurately or reliably. While the results of this survey were stroke-specific, we suggest that the results are likely generalizable to dietitians working in other patient areas.

Strategies and Challenges in Recruiting Black Immigrant Mothers for a Community-Based Study on Child Nutritional Health in Ottawa, Canada

There is a need to identify barriers to participation as well as recruitment strategies to engage minority parents of young children in health-oriented research. This paper offers insights on strategies and challenges in recruiting black immigrant mothers living in Ottawa (Canada) for a community-based health-oriented research project among 6-to-12-year-old children. We recruited 259 mother–child dyads. Most participants were recruited by team members during community events, fairs, religious gatherings, etc. Other successful strategies included referral from participants, community partners, and through research team members’ networks. Mass media strategies were mostly ineffective. Instant and meaningful incentives, developing community partnerships, building and ensuring study legitimacy and trust, placing convenience of participants ahead of that of research team members, doing community outreach, and taking contact information on the spot, as well as using word-of-mouth were essential to recruiting. This study clearly indicates the importance of adopting multiple recruitment strategies.