Zhixian Sui

The effects of antenatal dietary and lifestyle advice for women who are overweight or obese on maternal diet and physical activity: the LIMIT randomised trial

BackgroundOverweight and obesity is a significant health concern during pregnancy. Our aim was to investigate the effect of providing antenatal dietary and lifestyle advice to women who are overweight or obese on components of maternal diet and physical activity.MethodsWe conducted a randomised controlled trial, in which pregnant women with a body mass index ≥25 kg/m2, and singleton gestation between 10+0 to 20+0 weeks were recruited and randomised to Lifestyle Advice (involving a comprehensive dietary and lifestyle intervention over their pregnancy) or Standard Care. Within the intervention group, we conducted a nested randomised trial in which a subgroup of women were further randomised to receive access to supervised group walking sessions in addition to the standard information presented during the intervention contacts (the Walking group) or standard information only.The outcome measures were maternal dietary intake, (including food groups, macronutrient and micronutrient intake, diet quality (using the Healthy Eating Index; HEI), dietary glycaemic load, and glycaemic index) and maternal physical activity. Women completed the Harvard Semi-Structured Food Frequency Questionnaire, and the Short Questionnaire to Assess Health-enhancing Physical Activity (SQUASH), at trial entry, 28 and 36 weeks’ gestational age, and 4 months postpartum.Analyses were performed on an intention-to-treat basis, using linear mixed effects models with adjustment for the stratification variables.ResultsWomen randomised to Lifestyle Advice demonstrated a statistically significant increase in the number of servings of fruit and vegetables consumed per day, as well as increased consumption of fibre, and reduced percentage energy intake from saturated fats (P < 0.05 for all). Maternal HEI was significantly improved at both 28 (73.35 ± 6.62 versus 71.86 ± 7.01; adjusted difference in means 1.58; 95% CI 0.89 to 2.27; P < 0.0001) and 36 (72.95 ± 6.82 versus 71.17 ± 7.69; adjusted difference in means 1.77; 95% CI 1.01 to 2.53; P < 0.0001) weeks. There were no differences in dietary glycaemic index or glycaemic load. Women randomised to Lifestyle Advice also demonstrated greater total physical activity (adjusted difference in means 359.76 metabolic equivalent task units (MET) minutes/week; 95% CI 74.87 to 644.65; P = 0.01) compared with women receiving Standard Care. The supervised walking group was poorly utilised.ConclusionsFor women who are overweight or obese, antenatal lifestyle advice improves maternal diet and physical activity during pregnancy.Please see related articles: http://www.biomedcentral.com/1741-7015/12/163 and http://www.biomedcentral.com/1741-7015/12/201.Trial registrationAustralian and New Zealand Clinical Trials Registry (http://ACTRN12607000161426)

Antenatal exercise to improve outcomes in overweight or obese women: A systematic review

Background. Women who are overweight or obese during pregnancy are at increased risk of a number of adverse pregnancy outcomes. Objective. To review the literature systematically to assess the benefits and harms of an exercise intervention for pregnant women who are overweight or obese. Search strategy. A literature search of PUBMED, SCOPUS, the Cochrane Controlled Trials Register (CENTRAL) and the Australian and International Clinical Trials Registers was performed, as well as an additional hand search through bibliographies of various publications. There were no date or language restrictions. Selection criteria. Studies included were randomized controlled trials comparing supervised antenatal exercise intervention with routine standard antenatal care in women who were overweight or obese during pregnancy. The primary outcome was maternal gestational weight gain. The quality of each study was assessed utilizing standard Cochrane systematic review methodology. Data collection and analysis. Six randomized controlled trials and one quasi‐randomized trial were identified and included, involving a total of 276 women who were overweight or obese during pregnancy. Results. Provision of a supervised antenatal exercise intervention was associated with lower gestational weight gain (five trials, 216 participants, mean difference of −0.36 kg, 95% confidence interval −0.64 to −0.09 kg) when compared with standard antenatal care. Conclusions. A monitored physical activity intervention appears to be successful in limiting gestational weight gain; however, the effect on maternal and infant health is less certain.

A decrease in diet quality occurs during pregnancy in overweight and obese women which is maintained post-partum

Background:Ensuring adequate dietary intake during pregnancy has important implications for optimising maternal and fetal health. It is not known whether diet quality is altered over pregnancy and the post-partum period.Objective:The aim of this study was to perform a comprehensive assessment of diet quality in overweight and obese women during pregnancy and early post-partum.Design:In a prospective cohort study, n=301 overweight or obese pregnant women completed a food frequency questionnaire at study entry (10–20 weeks gestation), 28 weeks gestation, 36 weeks gestation and 4 months post-partum for assessment of macronutrient and micronutrient intake and diet quality by the Healthy Eating Index (HEI).Results:Energy, macronutrient and dietary sources of micronutrients did not alter across pregnancy or post-partum. The HEI was of below average quality in 31.0% of women at baseline. This decreased from week 28 (P<0.001) and was maintained at a lower level post-partum such that HEI levels were lower compared with study entry (53.3±12.7 versus 56.7±10.1, P<0.001). The HEI decrease occurred in association with decreases in the milk, meat and unsaturated oil components, and increases in the proportion of energy from solid fats, alcohol and added sugars (P<0.001), and was independently predicted by the socioeconomic index for areas score (β=−0.011, s.e.=0.011, P=0.031).Conclusion:We report for the first time that dietary quality decreases across pregnancy and is maintained at this reduced level in the early post-partum period in overweight and obese women. Dietary interventions aimed at improving diet quality should be targeted to early pregnancy and post-partum.

Effect of body image on gestational weight gain in overweight and obese women.

PROBLEM OR BACKGROUND There is little information available describing how women who are overweight or obese in pregnancy perceive their bodies, and in particular the effect of body image dissatisfaction on gestational weight gain. QUESTION To describe how women who are overweight or obese in pregnancy perceive their body, and the effect of body image on gestational weight gain. METHODS This prospective nested cohort study evaluated self estimation of body weight, preferred body shape, dieting behavior, satisfaction with body weight and shape, and gestational weight gain in pregnant women who were overweight or obese, through self-completed questionnaire in early pregnancy in South Australia from October 2010 to February 2012. FINDINGS Of the 442 women who completed the questionnaire, 25.8% correctly identified their BMI, with 70.1% under-estimating and 4.1% over-estimating their BMI. Women who were obese were significantly less likely to correctly identify their BMI, as were younger women. Women who incorrectly identified their BMI were significantly more likely to have higher gestational weight gain (P<0.001). Approximately 45% of women indicated dissatisfaction with their weight or body shape, with this being more common in women of higher parity and higher BMI. Dissatisfaction was significantly related to gestational weight gain. CONCLUSION Women who report increasing dissatisfaction with their body size and shape are more likely to gain excessive weight during pregnancy. Further research should explore insights about maternal body image and diet related behaviors.

Exercise in obese pregnant women: positive impacts and current perceptions

Overweight and obesity have significant implications during pregnancy and childbirth. The objective of this review was to provide a comprehensive overview of the effect of physical activity on pregnancy outcomes, the change of physical activity during pregnancy, and women’s perception of being physically active during pregnancy, with a particular focus on women who are overweight or obese. Many studies have investigated the beneficial effect of exercise during pregnancy, including reduced risk of gestational diabetes, preeclampsia, and operative birth, in addition to improved cardiovascular function, overall fitness, psychological well-being, and mood stability. Benefits for the infant include reduced risks of prematurity and improved fetal growth, although there is more limited information about longer-term health benefits for both women and infants. The existing literature examining physical activity patterns during pregnancy has generally focused on women of all body mass index categories, consistently indicating a reduction in activity over the course of pregnancy. However, the available literature evaluating physical activity during pregnancy among women who are overweight or obese is more limited and contradictory. A number of studies identified barriers preventing women from being active during pregnancy, including pregnancy symptoms, lack of time, access to child care, and concerns about their safety and that of their unborn baby. Conversely, significant enablers included positive psychological feelings, family influence, and receiving advice from health professionals. Very few studies have provided insights about perceptions of being active during pregnancy in the overweight and obese population. There is a need for a detailed description of physical activity patterns during pregnancy in women who are overweight or obese, and more randomized trials evaluating exercise interventions for women who are overweight or obese, with a focus on clinical outcomes.

Physical activity levels during pregnancy and gestational weight gain among women who are overweight or obese

ISSUE ADDRESSED There is contradictory research assessing physical activity patterns during pregnancy and postpartum among women who are overweight or obese. The aim of this study was to evaluate physical activity among overweight and obese women over the course of pregnancy and the initial postpartum period. METHODS Three hundred and five overweight or obese pregnant women completed physical-activity questionnaires at three time points during pregnancy and at 4-months postpartum. RESULTS Physical activity declined between early pregnancy and 28-weeks gestation (P<0.001) and declined further at 36-weeks gestation (P<0.001) before increasing significantly at 4-months postpartum (P<0.001). However, reported activity at 4-months postpartum remained significantly lower than that reported in early pregnancy (P<0.001). There was no significant difference either cross-sectionally or for changes over pregnancy and postpartum for total levels or categories of physical activity for women with different body mass index (BMI) or gestational weight gain (GWG). BMI was the only independent predictor of the change in total physical activity over the study and GWG, with women with higher BMI having larger decline of physical activity (β=0.114, s.e.=0.750, P=0.032) and less GWG (β=-0.253, s.e.=0.063, P<0.001). CONCLUSIONS Physical activity declined significantly between early pregnancy and 28-weeks gestation, with a further decline to 36-weeks gestation. At 4-months postpartum, physical activity significantly increased but not to the level of that reported at early pregnancy. SO WHAT?: The promotion of appropriate physical activity should be implemented early in pregnancy and postpartum to prevent the decline in activity we have observed in overweight and obese women. Future research should also explore the barriers and enablers to women engaging in exercise during pregnancy and the postpartum period.

Discretionary food and beverage consumption and its association with demographic characteristics, weight status, and fruit and vegetable intakes in Australian adults.

OBJECTIVE Excessive consumption of discretionary foods/beverages in the Australian population has been identified, increasing the risk of obesity and chronic disease. The present study aimed to examine the associations between demographic, anthropometric and dietary factors and the consumption of discretionary foods, discretionary beverages and discretionary foods/beverages combined. DESIGN Discretionary food/beverage consumption reported in two 24 h recalls was analysed, stratified by gender, age, socio-economic status, country of birth, BMI, waist circumference, and fruit and vegetable intakes. SETTING 2011-12 National Nutrition and Physical Activity Survey. SUBJECTS Australian adults (n 7873) aged 19 years or above. RESULTS Mean discretionary food and beverage consumption was 631 g (28 % by weight from foods; 72 % from beverages), providing 2721 kJ of energy intake (72 % from foods; 28 % from beverages). Total discretionary food/beverage consumption was higher in younger age groups (P<0·001), those in lower socio-economic categories (P<0·001), those born in Australia (P<0·001), those with higher BMI (P<0·001) and those with lower fruit (P<0·001) or vegetable intake (P<0·001). Discretionary beverage consumption (β=6·6, P<0·001) was more strongly associated with BMI than discretionary food consumption (β=0·5, P=0·01). CONCLUSIONS Total discretionary food/beverage consumption as well as discretionary foods alone and discretionary beverages alone were associated with BMI in Australian adults. In addition, high intakes were associated with younger age, lower socio-economic status, and lower consumption of fruit and vegetables.

Socio-Demographic Determinants of Diet Quality in Australian Adults Using the Validated Healthy Eating Index for Australian Adults (HEIFA-2013)

Diet quality indices have been shown to predict cardiovascular disease, cancer, Type 2 Diabetes, obesity and all-cause mortality. This study aimed to determine the socio-demographics of Australian adults with poor diet quality. Diet quality was assessed for participants of the 2011–2012 National Nutrition and Physical Activity Survey aged 18 years or above (n = 9435), with the validated 11-component Healthy Eating Index for Australians (HEIFA-2013), based on the 2013 Australian Dietary Guidelines. Differences in scores by demographics (ANOVA) and regression models for associations between the HEIFA-2013 score and demographic characteristics were conducted. The mean (SD) HEIFA-2013 score was 45.5 (14.7) out of 100 due to poor intakes of vegetables, fruit, grains, dairy and fat and high intakes of added sugar, sodium and discretionary foods. Lower mean HEIFA-2013 scores (SD) were found for males 43.3 (14.7), young-adults 41.6 (14.2) obese 44.1 (14.3), smokers 40.0 (14.2), low socio-economic status 43.7 (14.9) and Australian country-of-birth 44.2 (14.6) (p < 0.05). The overall diet quality of the Australian population is poor and targeted interventions for young-adults, males, obese and those with lower socio-economic status are recommended.

Water and Beverage Consumption: Analysis of the Australian 2011-2012 National Nutrition and Physical Activity Survey.

Background: Water consumption as a vital component of the human diet is under-researched in dietary surveys and nutrition studies. Aim: To assess total water and fluid intakes and examine demographic, anthropometric, and dietary factors associated with water consumption in the Australian population. Methods: Dietary intake data from the 2011 to 2012 National Nutrition and Physical Activity Survey were used. Usual water, fluid and food and nutrient intakes were estimated from two days of dietary recalls. Total water includes plain drinking water and moisture from all food and beverage sources; total fluids include plain drinking water and other beverages, but not food moisture. Results: The mean (SD) daily total water intakes for children and adolescents aged 2–18 years were 1.7 (0.6) L for males and 1.5 (0.4) L for females, and for adults aged 19 years and over were 2.6 (0.9) L for males and 2.3 (0.7) L for females. The majority of the population failed to meet the Adequate Intake (AI) values for total water intake (82%) and total fluids intake (78%) with the elderly at highest risk (90%–95%). The contributions of plain drinking water, other beverages and food moisture to total water intake were 44%, 27%, and 29%, respectively, among children and adolescents, and 37%, 37% and 25% among adults. The main sources of other beverages were full-fat plain milk and regular soft drinks for children and adolescents, and tea, coffee, and alcoholic drinks for adults. For adults, higher total water intake was associated with lower percent energy from fat, saturated fat, and free sugars, lower sodium and energy-dense nutrient poor food intakes but higher dietary fibre, fruit, vegetable, caffeine, and alcohol intakes. No associations were found between total water consumption and body mass index (BMI) for adults and BMI z-score for children and adolescents. Conclusion: Reported water consumption was below recommendations. Higher water intakes were suggestive of better diet quality.

The fruit and vegetable intake of young Australian adults: a population perspective

OBJECTIVE To examine intakes and variety of fruit and vegetables consumed by Australian young adults, also assessing differences by meal occasion and sociodemographic characteristics. DESIGN Secondary analysis of cross-sectional 24 h recall data collected through the 2011-12 National Nutrition and Physical Activity Survey. Crude means and proportions consuming fruits and vegetables were calculated. Pearson χ 2 tests, Kruskal-Wallis analyses and linear regression models were used to assess differences in mean intakes by age, BMI and sociodemographic variables. The variety eaten was determined based on the number of fruit and vegetable subgroups consumed. SETTING Representative sample of metropolitan and rural areas across Australia. SUBJECTS Respondents aged 18-34 years were included (n 2397). RESULTS Mean daily intake of fruit (128 g/0·9 servings) and vegetables (205 g/2·7 servings) was lower than the minimum recommended intake set at 2 and 5 servings, respectively. Age was positively associated with fruit and vegetable intake (P=0·002, P<0·001), with 18-24-year-olds reporting the poorest vegetable variety compared with 25-29- and 30-34-year-olds (P=0·002). When controlling for total energy, males consumed less vegetables than females (P=0·002). A large proportion of the 15 % of respondents who consumed adequate amounts of fruits and vegetables on the day prior to the survey reported intake across all meal occasions (P<0·001). CONCLUSIONS Fruit and vegetable intake is suboptimal among Australian young adults. An age-appropriate campaign is recommended to target increased consumption, particularly for those aged 18-24 years, with opportunity to promote increased variety and consumption across the day.