Vicky Leblanc

Impact of a health-at-every-size intervention on changes in dietary intakes and eating patterns in premenopausal overweight women : results of a randomized trial

BACKGROUND & AIMS Previous studies have shown improvements in eating behaviors following a Health-At-Every-Size approach (HAES). However, to our knowledge, no study has yet investigated how a HAES intervention could influence dietary intakes and eating patterns in overweight women. Therefore, objectives of this study were to determine changes in dietary intakes and eating patterns in premenopausal overweight women in response to a HAES intervention compared to a social support intervention and a control group, and then to determine whether changes in eating behaviors were associated with changes in dietary intakes and eating patterns in response to the HAES intervention. METHODS Women completed a 3-day food record and the Three-Factor Eating Questionnaire was used to assess eating behaviors. RESULTS Energy intake (main effect of time; p = 0.045) and snack frequency (main effect of time; p = 0.0004) decreased similarly over time in the three groups whereas proportion of energy intake from breakfast (main effect of time; p = 0.03) increased over time. Within HAES group, decreases in hunger and external hunger were associated with a decrease in total daily energy intake (r = 0.50, p = 0.0009 and r = 0.50, p = 0.0007, respectively). CONCLUSIONS HAES intervention has no specific impact on eating patterns. However, a decrease in hunger, which characterizes women who respond well to HAES, is associated with a decrease in overall energy intake. Clinical trial registration number (www.clinicaltrials.gov): NCT01240499.

Gender differences in dietary intakes: what is the contribution of motivational variables?

BACKGROUND Differences between men and women with respect to dietary intakes and eating behaviours have been reported and could be explained by gender differences in motivational variables associated with the regulation of food intake. The main objectives of the present study were to identify gender differences in dietary intakes, eating behaviours and motivational variables and to determine how motivational variables were associated with dietary intakes and eating behaviours in men and women. METHODS Sixty-four men and 59 premenopausal women were included in the present study and presented cardiovascular risk factors. The Regulation of Eating Behaviours scale was completed to assess motivational variables. A validated food frequency questionnaire was administered to evaluate dietary intakes and subjects completed the Three-Factor Eating questionnaire to assess eating behaviours. RESULTS Men had higher energy intake, energy density and percentage of energy from lipids and lower percentage of energy from carbohydrates than women (P ≤ 0.04). Men also had a lower emotional susceptibility to disinhibition than women (P = 0.0001). Women reported a higher score for eating-related self-determined motivation [i.e., eating-related self-determination index (SDI)] than men (P = 0.002). The most notable gender difference in the pattern of associations was that eating-related SDI was negatively associated with energy density (r = -0.30; P = 0.02), only in women. CONCLUSIONS Women had a better dietary profile and higher eating-related SDI than men. However, gender differences in dietary variables might be explained by a potential gender-specific pattern of association of eating-related SDI with dietary intakes and eating behaviours.

Gender differences in the long-term effects of a nutritional intervention program promoting the Mediterranean diet: changes in dietary intakes, eating behaviors, anthropometric and metabolic variables

BackgroundLong-term adherence to principles of the Mediterranean diet (MedDiet) following a nutritional intervention promoting the Mediterranean food pattern in Canadian men and women is not known. Moreover, gender differences in dietary and metabolic profile in such an intervention context has never been addressed. Objective was to determine gender differences in long-term effects of a 12-week nutritional intervention program promoting the adoption of the MedDiet and based on the Self-Determination Theory (SDT) on dietary intakes, eating behaviors, anthropometric and metabolic variables, in men and women presenting cardiovascular risk factors.MethodsSixty-four men and 59 premenopausal women were recruited. The 12-week nutritional program used a motivational interviewing approach and included individual and group sessions. A food frequency questionnaire was administered to evaluate dietary intakes from which a Mediterranean score (Medscore) was derived and the Three-Factor Eating Questionnaire allowed assessment of eating behaviors. Measurements were performed at baseline and after the 12-week nutritional intervention, and then at 3 and 6-month post intervention.ResultsNo gender difference was observed in changes in the Medscore during the nutritional intervention and follow-up. However, the Medscore returned towards baseline values during follow-up in men and women (P <0.0001). Men reported larger decreases in red and processed meat and larger increases in whole fruit intakes than women (P = 0.03 and P = 0.04, respectively). Men showed a greater decrease in habitual susceptibility to disinhibition than women (P = 0.03). A gender by time interaction was found for waist circumference, i.e. men had lower waist circumference at the end of the intervention as well as at follow-up than at baseline while women’s waist circumference decreased in response to the intervention only (P = 0.05). As for metabolic variables, changes observed in total-cholesterol (C) to HDL-C ratio, triglyceride levels and triglycerides to HDL-C ratio were more pronounced in men than in women after the intervention as well as at follow-up (P ≤0.03).ConclusionsOur results indicate that the 12-week nutritional intervention based on the SDT leads to more pronounced beneficial changes in long-term dietary intakes in men than in women and to greater improvements in metabolic profile in men.Trial registrationCurrent Controlled Trials NCT01852721.

Differences between men and women in dietary intakes and metabolic profile in response to a 12-week nutritional intervention promoting the Mediterranean diet

Few studies have compared men and women in response to nutritional interventions but none has assessed differences between men and women in the response to a nutritional intervention programme based on the self-determination theory (SDT) and using the Mediterranean diet (MedDiet) as a model of healthy eating, in a context of CVD prevention and within a non-Mediterranean population. The present study aimed to document differences between men and women in changes in dietary, anthropometric and metabolic variables, in response to a nutritional intervention programme promoting the adoption of the MedDiet and based on the SDT. A total of sixty-four men and fifty-nine premenopausal women presenting risk factors for CVD were recruited through different media advertisements in the Québec City Metropolitan area (Canada). The 12-week nutritional programme used a motivational interviewing approach and included individual and group sessions. A validated FFQ was administered to evaluate dietary intakes from which a Mediterranean score (Medscore) was derived. Both men and women significantly increased their Medscore in response to the intervention (P < 0·0001). Men showed a significantly greater decrease in red and processed meat (−0·4 (95 % CI −0·7, −0·1) portions per d) and a greater increase in fruit (0·9 (95 % CI 0·2, 1·6) portions per d) intakes than women. Significant decreases were observed for BMI and waist circumference in both men and women (P ≤ 0·04). Significant greater decreases were found for total cholesterol (total-C):HDL-cholesterol (HDL-C) (−0·2; 95 % CI −0·4, −0·03) and TAG:HDL-C (−0·2; 95 % CI −0·4, −0·04) ratios in men than in women. When adjusting for the baseline value of the response variable, differences between men and women became non-significant for red and processed meat and fruit intakes whereas significant differences between men and women (i.e. larger increases in men than women) were observed for legumes, nuts and seeds (0·6 (95 % CI 0·2, 1·0) portions per d) and whole-grain products (0·5 (95 % CI 0·01, 1·0) portions per d) intakes. For metabolic variables, differences between men and women became non-significant for total-C:HDL-C and TAG:HDL-C ratios when adjusted for the baseline value of the response variable. The present results suggest that the nutritional intervention promoting the adoption of the Mediterranean diet and based on the SDT led to greater improvements in dietary intakes in men than in women, which appear to have contributed to beneficial anthropometric and metabolic changes, more particularly in men. However, the more deteriorated metabolic profile found in men at baseline seems to contribute to a large extent to the more beneficial changes in CVD risk factors observed in men as compared with women.

Associations between eating patterns, dietary intakes and eating behaviors in premenopausal overweight women ☆

The regulation of energy intake is complex and many biological, psychosocial and environmental influences have been identified. To our knowledge, no study has yet investigated how eating patterns could mediate associations between eating behaviors and self-reported energy intake in premenopausal overweight women. Therefore, objectives of this study were to examine associations between eating behaviors and eating patterns in premenopausal overweight women and to test if eating patterns could mediate the associations between eating behaviors and self-reported energy intake. Women completed a 3-day food record and the Three-Factor Eating Questionnaire was used to assess eating behaviors (dietary restraint, disinhibition, hunger). In the total sample of women, flexible restraint was negatively (r=-0.18; p=0.03) and binge eating severity was positively (r=0.24; p=0.004) associated with self-reported energy intake. Moreover, flexible restraint was positively associated with the proportion of energy intake at breakfast (r=0.24; p=0.004), whereas disinhibition and binge eating severity were positively associated with the proportion of energy intake from snacks consumed after 5:00 pm (r=0.22, p=0.007 and r=0.22, p=0.01, respectively). In addition, mediational analyses showed that proportion of energy intake from snacks consumed after 5:00 pm explained 24.1% of the association between binge eating severity and self-reported energy intake. In conclusion, these results suggest that eating patterns are important factors to consider in order to explain the associations between eating behaviors and self-reported energy intake.

High-flavanol and high-theobromine versus low-flavanol and low-theobromine chocolate to improve uterine artery pulsatility index: a double blind randomized clinical trial

Abstract Objective: To evaluate the impact of high-flavanol and high-theobromine (HFHT) chocolate in women at risk of preeclampsia (PE). Study design: We conducted a single-center randomized controlled trial including women with singleton pregnancy between 11 and 14 weeks gestation who had bilateral abnormal uterine artery (UtA) waveforms (notching) and elevated pulsatility index (PI). Participants were randomized to either HFHT or low-flavanol and low-theobromine (LFLT) chocolate (30 grams daily for a total of 12 weeks). UtA PI, reported as multiple of medians (MoM) adjusted for gestational age, was assessed at baseline and 12 weeks after randomization. Results: One hundred thirty-one women were randomized with mean gestational age of 12.4 ± 0.6 weeks and a mean UtA PI of 1.39 ± 0.31 MoM. UtA PI adjusted for gestational age significantly decreased from baseline to the second visit (12 weeks later) in the two groups (p < 0.0001) but no significant difference was observed between the groups (p = 0.16). Conclusions: Compared with LFLT chocolate, daily intake of HFHT chocolate was not associated with significant changes of UtA PI. Nevertheless, the improvement observed in both groups suggests that chocolate could improve placental function independently of flavanol and/or theobromine content.

Changes in endothelial function, arterial stiffness and blood pressure in pregnant women after consumption of high-flavanol and high-theobromine chocolate: a double blind randomized clinical trial

ABSTRACT Objectives: The aim of this 2-group, parallel, double blind single-centre RCT was to evaluate the acute and chronic impacts of high flavanol high theobromine (HFHT) chocolate consumption on endothelial function, arterial stiffness and blood pressure (BP) in women at risk of preeclampsia. Methods: 131 pregnant women considered at risk of preeclampsia based on uterine artery Doppler ultrasound were divided into two groups (HFHT or low flavanol and theobromine chocolate (LFLT). Acute changes in plasma flavanol and theobromine, peripheral arterial tonometry and BP were evaluated at randomization (0, 60 and 120 min after a single 40-g dose of chocolate) and again 6 and 12 weeks after daily 30-g chocolate intake. The EndoPAT 2000 provided reactive hyperemia index (RHI) and adjusted augmentation index (AIx) as markers for endothelial function and arterial stiffness, respectively. Results: Compared with LFLT, acute HFHT intake significantly increased plasma epicatechin and theobromine (p < 0.0001), decreased AIx (p < 0.0001) and increased diastolic BP (3.49 ± 3.40 mmHg increase in HFHT group vs 1.55 ± 2.59 mmHg increase in LFLT group, p = 0.0008). Chronic HFHT compared with LFLT intake significantly increased plasma theobromine (p < 0.0001). No other significant within group or between group changes were observed. Conclusions: Acute consumption of HFHT, compared to LFLT, increased plasma epicatechin and theobromine concentrations and decreased arterial stiffness, with no effect on endothelial function and a marginal increase in diastolic BP. Chronic HFHT intake increased plasma theobromine, though it did not have positive impacts on endothelial function, arterial stiffness or BP when compared to LFLT in pregnant women at risk of PE.

Effects of a nutritional intervention program based on the self-determination theory and promoting the Mediterranean diet

Our objective was to determine gender differences in the impact of a nutritional intervention based on the self-determination theory and promoting the Mediterranean diet on changes in eating-related self-determined motivation and adherence to the Mediterranean diet. Changes in eating-related self-determined motivation were larger in men than in women in response to the intervention and at follow-up, but the magnitude of change decreased with time in both genders. Changes in eating-related self-determined motivation were positively associated with changes in the Mediterranean diet adherence in response to the intervention and at follow-up in men only, suggesting that the nutritional program seems to fit better men than women.