Lisa Pawloski

Maternal obesity, health status during pregnancy, and breastfeeding initiation and duration

Objective. The purpose of this study was to determine whether maternal prepregnancy overweight/obesity has independent effects on breastfeeding initiation and duration and whether these effects are different for women who experience medical problems during pregnancy or labor/delivery complications in comparison with those who have no medical or labor/delivery complications. Methods. We used the early childhood longitudinal study-birth cohort data. Kaplan–Meier survival functions, logistic, and Cox regression modeling were used in the analyses. Results. Findings indicate that overweight/obese women with medical or labor/delivery complications were less likely to initiate breastfeeding in comparison with their counterparts of normal weight. We did not find an independent effect of prepregnancy overweight/obesity on breastfeeding initiation among women with no medical problems. This group of women, however, had an 11% increased risk of stopping breastfeeding with each additional month of breastfeeding duration in comparison to those of normal weight. Conclusions. It is important to evaluate the health history and pregnancy complications among overweight/obese mothers in developing interventions for successful initiation and duration of breastfeeding.

Childhood Obesity Study: A Pilot Study of the Effect of the Nutrition Education Program Color My Pyramid

The need for successful nutrition interventions is critical as the prevalence of childhood obesity increases. Thus, this pilot project examines the effect of a nutrition education program, Color My Pyramid, on children’s nutrition knowledge, self-care practices, activity levels, and nutrition status. Using a pretest–posttest, quasiexperimental design, 126 fourth- and fifth-grade students from experimental and control schools are compared. The intervention program incorporates an online component www.MyPyramid.gov, Orem’s Self-Care Deficit Nursing Theory, and consists of six classes taught over a 3-month period. Results indicated that the program increased nutrition knowledge in the control group. Furthermore, it increased activity time from pretest to posttest and decreased systolic blood pressure for children in both groups; however, there were no significant differences in BMI percentiles. The findings indicate that Color My Pyramid can be successfully employed in school settings and thus support school nursing practice.

Physical activity and body composition analysis of female baccalaureate nursing students

Although nursing students are educated about the importance of healthy diets and the benefits of exercise, many do not engage in health promotion behaviors. This study longitudinally examined specific indicators of obesity among a group of female nursing students who incorporated an exercise program into their normal weekly routine. Indicators for obesity were identified using anthropometric data that included weight, body mass index (BMI), and percentage of body fat. Blood pressure, pulse data, and a physical activity level assessment were performed at the beginning and at the conclusion of the study period. Results indicated improvement in overall body composition, including a reduction in percent body fat and BMI. Students also showed improved physical activity levels. Since nurses need to counsel clients on primary prevention issues such as physical activity and maintaining ideal body weight and lean mass, the importance of positive health behaviors for nursing students and nurses cannot be stressed enough.

Maternal-child overweight/obesity and undernutrition in Kenya: a geographic analysis.

OBJECTIVE The purpose of the study was to examine geographic relationships of nutritional status (BMI), including underweight, overweight and obesity, among Kenyan mothers and children. DESIGN Spatial relationships were examined concerning BMI of the mothers and BMI-for-age percentiles of their children. These included spatial statistical measures of the clustering of segments of the population, in addition to inspection of co-location of significant clusters. SETTING Rural and urban areas of Kenya, including the cities of Nairobi and Mombasa, and the Kisumu region. SUBJECTS Mother-child pairs from Demographic and Health Survey data including 1541 observations in 2003 and 1592 observations in 2009. These mother-child pairs were organized into 399 locational clusters. RESULTS There is extremely strong evidence that high BMI values exhibit strong spatial clustering. There were co-locations of overweight mothers and overweight children only in the Nairobi region, while both underweight mothers and children tended to cluster in rural areas. In Mombasa clusters of overweight mothers were associated with normal-weight children, while in the Kisumu region clusters of overweight children were associated with normal-weight mothers. CONCLUSIONS These findings show there is geographic variability as well as some defined patterns concerning the distribution of malnutrition among mothers and children in Kenya, and suggest the need for further geographic analyses concerning the potential factors which influence nutritional status in this population. In addition, the methods used in this research may be easily applied to other Demographic and Health Survey data in order to begin to understand the geographic determinants of health in low-income countries.

A cross-sectional examination of growth indicators from Nicaraguan adolescent girls: a comparison of anthropometric data from their Guatemalan counterparts

Background: Few studies have examined growth data from adolescent girls in Latin America and almost none have been conducted in Nicaragua. Thus this study examines growth data from Nicaraguan adolescent girls. Aim: This study describes cross-sectional growth data from a sample of Nicaraguan girls. These data are compared with data from Mexican–US and Guatemalan girls. It is hypothesized that (a) Mexican–US and Guatemalan wealthy ladina girls will show better indicators of nutritional status when compared with the Nicaraguan girls, and (b) the Nicaraguan girls will show similar anthropometric indicators when compared with poor Guatemalan girls. Subjects and Methods: Anthropometric and age at menarche data were collected from a sample of 154 adolescent girls ages 10–17 years living in Managua, Nicaragua. Results: The findings revealed that these girls are significantly shorter and lighter than US, Mexican–US and wealthy Guatemalan adolescent girls. These girls are also significantly taller and heavier than their poor Guatemalan counterparts. Conclusion: This study reveals that the Nicaraguan girls are undernourished when compared with other Latin American girls living in an improved overall environment. The data also reveal that the Nicaraguan girls have better indicators of nutritional status when compared with a cohort of poor Guatemalan girls.

Classification tree analysis of stunting in Malian adolescent girls

This study examines relationships between growth data and energy expenditure, economic status, and family structure among Malian adolescent girls, aged 10–17 years living in the Segou Region of Mali. Classification and regression trees (CART) were used as the primary methodology to identify high‐risk subgroups for stunting (measured as height‐for‐age) in a sample of 1,103 Malian adolescents. Because CART has been used rarely to examine growth and development, this study provides a new way to better understand how economic status, family structure, and energy expenditure related factors influence stunting in Mali. The findings indicate that the greater the number of sisters and women in a household, the poorer the nutritional status of adolescent girls. The data also show that the presence of servants within the household may predict better nutritional success of young girls. Energy expenditure was an important predictor in the context of family structure regarding the number of sisters and the presence of servants. Wealth indicators did not appear in the final tree, suggesting that wealth may not play as great a role in predicting poor growth and nutritional status as family size and structure. In conclusion, classification trees may assist in understanding the interactive nature of predictive factors of stunting in this population, and further provide evidence for intervention programs aimed at improving the health and nutritional status of Malian adolescent girls. Am. J. Hum. Biol., 2008.

Role of Exercise in Optimizing the Functional Status of Patients with Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is frequently concomitant with obesity. This article discusses factors that influence health and functional outcomes of people who develop NAFLD, including increased burden of illness, whole body function, performance, and perception of self-efficacy. Changes in macronutrients, amount of calories consumed, and decreased physical activity all negatively influence patient outcome. The benefits of exercise in this population are also discussed. To be effective, exercise must be performed, regularly and in conjunction with dietary and other behavioral change. Therefore, a lifelong commitment to exercise, activity, and diet are needed if NAFLD is to be successfully treated.

Concepts of anemia among low income Nicaraguan women

La anemia es un problema de salud comun entre las mujeres alrededor del mundo, sin embargo, se hanrealizado pocas investigaciones sobre los conceptos de anemia entre las mujeres. El proposito de este estudiofue examinar los conceptos de anemia en mujeres Nicaraguenses de bajos ingresos economicos. La investigacionfue de orden cualitativa. Para la recoleccion de datos, se realizaron entrevistas semiestructuradas, grabadasen castellano, con 14 mujeres. Las cintas grabadas fueron transcritas y se realizo un analisis de contenido. Losresultados indican que pocas mujeres poseen conocimientos biomedicos sobre anemia, por ejemplo, la ingestionde alimentos pobres en hierro. Otras expresaron creencias populares, como remedios caseros, ingestion deleche de yegua o jugo de remolacha y ciertos alimentos como sopa de judias. La mayoria de las mujeres noconocia ningun sintoma de anemia y pocas relataron que creian que esta enfermedad podria transformarse enleucemia. Estos conceptos de anemia son instructivos para las enfermeras que trabajan con pacientes enNicaragua y sera de mucha utilidad para desarrollar intervenciones de enfermeria para aliviar este problemade salud publica.DESCRIPTORES: anemia, Nicaragua, America LatinaAnemia is a common health problem among women throughout the world, however, there has been minimal research on womens concepts of anemia. The purpose of this study was to examine concepts of anemia in low income Nicaraguan women. A qualitative design was used. Audio-taped open-ended interviews in Spanish with 14 women were used to obtain data. Tapes were transcribed and content analyzed. The findings indicate that few of the women had biomedically accurate concepts of anemia, such as that it was due to lack of iron from poor eating. Others held folk medical beliefs including home remedies, for example drinking the milk of a mare or beet juice and eating certain foods such as bean soup. Most of the women did not know any symptoms of anemia and a few reported that it can develop into leukemia. These concepts of anemia are instructive for nurses working with patients from Nicaragua and will be useful in developing nursing interventions to alleviate this public health problem.

Geographic distribution and socio-economic determinants of women's nutritional status in Mali households.

OBJECTIVE Mali is one of the poorest countries in Africa, with 72% of its population surviving on less than

A cross-sectional examination of growth indicators from Thai adolescent girls: Evidence of obesity among Thai youth?

US 1.00 per day. Health and demographic indicators are bleak. With few exceptions, studies related to the health of women in Mali have largely been under-represented. In addition, in recent years a new type of malnutrition stemming from weight gain and obesity has been observed throughout Africa. The present study aimed to (i) describe geographic and health variations of women of reproductive age, (ii) describe geographic variations of household salt iodine levels and (iii) investigate potential factors associated with women’s anthropometric status and use of adequately iodized salt among households in Mali. DESIGN Demographic and Health Survey data, multistage-stratified cluster sampling methodology. SETTING Rural and urban areas of Mali. SUBJECTS Non-pregnant women (n 6015) between the ages of 19 and 44 years. RESULTS Nineteen per cent of the women were overweight or obese while 11% were underweight. Seventy-eight per cent of the households utilized adequately iodized salt. Underweight women were more prevalent in southern Mali, while obesity was more frequent in the north-east and within the major urban areas. Households located within the southern parts of Mali were more likely to utilize adequately iodized salt. Education, age, modern contraceptive use, breast-feeding status at time of the survey and household wealth index were significantly associated with the women’s BMI or households’ use of adequately iodized salt. CONCLUSIONS The combined use of statistical and geographic system analysis contributes to improve targeting of interventions among vulnerable populations.