Experiences with nutrition-related information during antenatal care of pregnant women of different ethnic backgrounds residing in the area of Oslo, Norway.

Objective: to explore experiences with nutrition-related information during routine antenatal care among women of different ethnical backgrounds. Design: individual interviews with seventeen participants were conducted twice during pregnancy. Data collection and analysis were inspired by an interpretative phenomenological approach. Setting: participants were purposively recruited at eight Mother and Child Health Centres in the area of Oslo, Norway, where they received antenatal care. Participants: participants had either immigrant backgrounds from African and Asian countries (n¼12) or were ethnic Norwegian (n¼5). Participants were pregnant with their first child and had a pre-pregnancy Body Mass Index above 25 kg/m2. Findings: participants experienced that they were provided with little nutrition-related information in antenatal care. The information was perceived as presented in very general terms and focused on food safety. Weight management and the long-term prevention of diet-related chronic diseases had hardly been discussed. Participants with immigrant backgrounds appeared to be confused about information given by the midwife which was incongruent with their original food culture. The participants were actively seeking for nutrition-related information and had to navigate between various sources of information. Conclusions: the midwife is considered a trustworthy source of nutrition-related information. Therefore, antenatal care may have considerable potential to promote a healthy diet to pregnant women. Findings suggest that nutrition communication in antenatal care should be more tailored towards women’s dietary habits and cultural background, nutritional knowledge as well as level of nutrition literacy

Perceptions of the Host Country’s food culture among female immigrants from Africa and Asia: Aspects relevant for culture sensitivity in nutrition communication

Objective: To explore how female immigrants from Africa and Asia perceive the host country’s food culture, to identify aspects of their original food culture they considered important to preserve, and to describe how they go about preserving them. Design: Qualitative in-depth interviews. Setting: Oslo, Norway. Participants: Twenty one female immigrants from 11 African and Asian countries, residing in areas of Oslo with a population having a low-to-middle socioeconomic status and a high proportion of immigrants. Participants varied in years of residence, employment status, and marital status. Analysis: Analysis of the interviews was guided by a phenomenological approach. Results: Participants emphasized the importance of preserving aspects of their original food cultures and related these aspects to taste, preparation effort and method, and adherence to religious dietary rules. They often perceived the food of the host country as ‘‘tasteless and boring.’’ The authors observed strict, flexible, or limited continuity with the original food culture. Some elements that possibly influenced participants’ degree of continuity are indicated. Conclusions and Implications: Immigrants may strive to preserve aspects of their original food culture after immigration. Nutrition communication becomes more culturally sensitive when it takes such aspects into accoun

Adiposity and hyperglycaemia in pregnancy and related health outcomes in European ethnic minorities of Asian and African origin: a review.

Background: Ethnic minorities in Europe have high susceptibility to type 2 diabetes (T2DM) and, in some groups, also cardiovascular disease (CVD). Pregnancy can be considered a stress test that predicts future morbidity patterns in women and that affects future health of the child. Objective: To review ethnic differences in: 1) adiposity, hyperglycaemia, and pre-eclampsia during pregnancy; 2) future risk in the mother of obesity, T2DM and CVD; and 3) prenatal development and possible influences of maternal obesity, hyperglycaemia, and pre-eclampsia on offspring’s future disease risk, as relevant for ethnic minorities in Europe of Asian and African origin. Design: Literature review. Results: Maternal health among ethnic minorities is still sparsely documented. Higher pre-pregnant body mass index (BMI) is found in women of African and Middle Eastern descent, and lower BMI in women from East and South Asia compared with women from the majority population. Within study populations, risk of gestational diabetes mellitus (GDM) is considerably higher in many minority groups, particularly South Asians, than in the majority population. This increased risk is apparent at lower BMI and younger ages. Women of African origin have higher risk of pre-eclampsia. A GDM pregnancy implies approximately seven-fold higher risk of T2DM than normal pregnancies, and both GDM and pre-eclampsia increase later risk of CVD. Asian neonates have lower birth weights, and mostly also African neonates. This may translate into increased risks of later obesity, T2DM, and CVD. Foetal overgrowth can promote the same conditions. Breastfeeding represents a possible strategy to reduce risk of T2DM in both the mother and the child. Conclusions: Ethnic minority women in Europe with Asian and African origin and their offspring seem to be at increased risk of T2DM and CVD, both currently and in the future. Pregnancy is an important window of opportunity for short and long-term disease prevention

Ethnic differences in maternal dietary patterns are largely explained by socioeconomic score and integration score: a population-based study

Background: The impact of socio-economic position and integration level on the observed ethnic differences in dietary habits has received little attention. Objectives: To identify and describe dietary patterns in a multi-ethnic population of pregnant women, to explore ethnic differences in odds ratio (OR) for belonging to a dietary pattern, when adjusted for socioeconomic status and integration level and to examine whether the dietary patterns were reflected in levels of biomarkers related to obesity and hyperglycaemia. Design: This cross-sectional study was a part of the STORK Groruddalen study. In total, 757 pregnant women, of whom 59% were of a non-Western origin, completed a food frequency questionnaire in gestational week 28 ± 2. Dietary patterns were extracted through cluster analysis using Ward’s method. Results: Four robust clusters were identified where cluster 4 was considered the healthier dietary pattern and cluster 1 the least healthy. All non-European women as compared to Europeans had higher OR for belonging to the unhealthier dietary patterns 1-3 vs. cluster 4. Women from the Middle East and Africa had the highest OR, 21.5 (95% CI 10.6-43.7), of falling into cluster 1 vs. 4 as compared to Europeans. The ORs decreased substantially after adjusting for socio-economic score and integration score. A non-European ethnic origin, low socio-economic and integration scores, conduced higher OR for belonging to clusters 1, 2, and 3 as compared to cluster 4. Significant differences in fasting and 2-h glucose, fasting insulin, glycosylated haemoglobin (HbA1c), insulin resistance (HOMA-IR), and total cholesterol were observed across the dietary patterns. After adjusting for ethnicity, differences in fasting insulin (p=0.015) and HOMA-IR (p=0.040) across clusters remained significant, despite low power. Conclusion: The results indicate that socio-economic and integration level may explain a large proportion of the ethnic differences in dietary patterns.Norges forskningsråd SPH 19454

Substitution of TAG oil with diacylglycerol oil in food items improves the predicted 10 years cardiovascular risk score in healthy, overweight subjects

Dietary fat is normally in TAG form, but diacylglycerol (DAG) is a natural component of edible oils. Studies have shown that consumption of DAG results in metabolic characteristics that are distinct from those of TAG, which may be beneficial in preventing and managing obesity. The objective of the present study was to investigate if food items in which part of the TAG oil is replaced with DAG oil combined with high α-linolenic acid (ALA) content would influence metabolic markers. A 12-week double-blinded randomised controlled parallel-design study was conducted. The participants (n 23) were healthy, overweight men and women, aged 37–67 years, BMI 27–35 kg/m2, with waist circumference >94 cm (men) and >88 cm (women). The two groups received 20 g margarine, 11 g mayonnaise and 12 g oil per d, containing either high ALA and sn-1,3-DAG or high ALA and TAG. Substitution of TAG oil with DAG oil in food items for 12 weeks led to an improvement of the predicted 10 years cardiovascular risk score in overweight subjects by non-significantly improving markers of health such as total body fat percentage, trunk fat mass, alanine aminotransferase, systolic blood pressure, γ-glutamyl transferase, alkaline phosphatase and total fat-free mass. This may suggest that replacing TAG oil with DAG oil in healthy, overweight individuals may have beneficial metabolic effects

GRADE equity guidelines 3: considering health equity in GRADE guideline development: rating the certainty of synthesized evidence

Objectives: The aim of this paper is to describe a conceptual framework for how to consider health equity in the Grading Recommendations Assessment and Development Evidence (GRADE) guideline development process. Study Design and Setting: Consensus-based guidance developed by the GRADE working group members and other methodologists. Results: We developed consensus-based guidance to help address health equity when rating the certainty of synthesized evidence (i.e., quality of evidence). When health inequity is determined to be a concern by stakeholders, we propose five methods for explicitly assessing health equity: (1) include health equity as an outcome; (2) consider patient-important outcomes relevant to health equity; (3) assess differences in the relative effect size of the treatment; (4) assess differences in baseline risk and the differing impacts on absolute effects; and (5) assess indirectness of evidence to disadvantaged populations and/or settings. Conclusion: The most important priority for research on health inequity and guidelines is to identify and document examples where health equity has been considered explicitly in guidelines. Although there is a weak scientific evidence base for assessing health equity, this should not discourage the explicit consideration of how guidelines and recommendations affect the most vulnerable members of society

Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study

Objective The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recently proposed new criteria for diagnosing gestational diabetes mellitus (GDM). We compared prevalence rates, risk factors, and the effect of ethnicity using the World Health Organization (WHO) and modified IADPSG criteria. Methods This was a population-based cohort study of 823 (74% of eligible) healthy pregnant women, of whom 59% were from ethnic minorities. Universal screening was performed at 28±2 weeks of gestation with the 75 g oral glucose tolerance test (OGTT). Venous plasma glucose (PG) was measured on site. GDM was diagnosed as per the definition of WHO criteria as fasting PG (FPG) ≥7.0 or 2-h PG ≥7.8 mmol/l; and as per the modified IADPSG criteria as FPG ≥5.1 or 2-h PG ≥8.5 mmol/l. Results OGTT was performed in 759 women. Crude GDM prevalence was 13.0% with WHO (Western Europeans 11%, ethnic minorities 15%, P=0.14) and 31.5% with modified IADPSG criteria (Western Europeans 24%, ethnic minorities 37%, P< 0.001). Using the WHO criteria, ethnic minority origin was an independent predictor (South Asians, odds ratio (OR) 2.24 (95% confidence interval (CI) 1.26–3.97); Middle Easterners, OR 2.13 (1.12–4.08)) after adjustments for age, parity, and prepregnant body mass index (BMI). This increased OR was unapparent after further adjustments for body height (proxy for early life socioeconomic status), education and family history of diabetes. Using the modified IADPSG criteria, prepregnant BMI (1.09 (1.05–1.13)) and ethnic minority origin (South Asians, 2.54 (1.56–4.13)) were independent predictors, while education, body height and family history had little impact. Conclusion GDM prevalence was overall 2.4-times higher with the modified IADPSG criteria compared with the WHO criteria. The new criteria identified many subjects with a relatively mild increase in FPG, strongly associated with South Asian origin and prepregnant overweigh

The effects of concurrent prescription of benzodiazepines for people undergoing opioid maintenance treatment. Systematic review

Background In Opioid Maintenance Treatment patients receive long acting opioids as a substitute for heroin and other common illegally used opioids. People with opioid dependence are likely to experience elevated levels of anxiety and sleep disturbance. Therefore, benzodiazepines are often prescribed for these patients to alleviate such problems. Meanwhile, benzodiazepines are readily available on the illicit street market and are in high risk to be misused. Several studies find that concurrent prescription of benzodiazepines during opioid maintenance treatment is associated with more drug abuse and dependence. Prolonged use of benzodiazepines may result in anxiety and mental health problems, and increased risk of personal injury. However, the evidence is mostly descriptive and does not distinguish between prescribed versus illicitly procured benzodiazepines. Objective The purpose of this systematic review is to assess the effects of concurrent benzodiazepines prescription among people who receive opioid maintenance treatment (i.e. methadone, buprenorphine or buprenorphine combined with naloxone). Method We first searched for systematic reviews that could answer our research question in the following databases: Epistemonikos, Cochrane Library (CDSR, DARE, HTA), MEDLINE (Ovid), PubMed [sb] and Embase (Ovid). Thereafter, we searched for primary studies to conduct a systematic review to summarize the available evidence. Randomised and non-randomised controlled trials, controlled before-and-after studies and interrupted time series were included as relevant study designs. The target population was people 18 years or older who received substitution treatment with methadone, buprenorphine or buprenorphine combined with naloxone for opioid dependence. Relevant intervention was prescription of benzodiazepines as compared with no prescription of benzodiazepines. The outcomes of interest were retention in treatment, patients’ satisfaction, opioid use (self report or biological test), other substance use (self report or biological test), extent of anxiety and depression, sleep disorders, mortality, side effects (overdose, injury and use of hospital emergency) and criminal offences. We carried out a systematic search for literature, with no limit of publication time or language, in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), PubMed [sb], Embase (Ovid), CINAHL (EBSCO) and PsycINFO. Three authors evaluated the references based on the title and abstract, in pairs independently of each other (Kristoffer Yunpeng Ding evaluated all, Annhild Mosdøl and Laila Hov half each). Potentially relevant references were read in full-text (Kristoffer Yunpeng Ding evaluated all, Annhild Mosdøl and Laila Hov half each). We planned to assess the risk of bias, synthesise the data if possible and use the GRADE method (Grading of Recommendation Assessment, Development and Evaluation) to assess our confidence in the estimated effects. Results The literature search for systematic reviews identified 998 titles and abstracts. No systematic reviews were relevant for this topic after screening. The search for primary studies identified 3696 references. We considered eight references as potentially relevant and read them in full text. However, none of these references met our inclusion criteria. Discussion We did not find any relevant systematic reviews, clinical trials or controlled studies meeting our inclusion criteria. Experimental studies with controlled use of benzodiazepines are needed to evaluate the effects and consequences of benzodiazepines prescription during opioid maintenance treatment. We suggest the following outcomes: drug retention rates and abuse; patient satisfaction; mental health; sleep disorders; side effects and criminal behaviours. Conclusion We found no controlled studies focusing on the effects and consequences of concurrent benzodiazepines prescription during opioid maintenance treatment