Dietary habits and supplementation practices of young women during pregnancy: an online cross-sectional survey of young mothers and health care professionals

Background: Nutrition is a modifiable factor affecting birth outcomes, particularly in adolescent pregnancies. This study explores diet and supplementation practices, information and advice before, during and after pregnancy from the perspectives of pregnant or new young mothers and healthcare professionals. Methods: Two cross-sectional surveys used online questionnaires for young women who were currently pregnant or who had recently given birth, and health care professionals providing antenatal care. The surveys utilised a combination of question types including free text and multiple choice. Recruitment was conducted via the Tommy's website, online forums for young mothers and professional networks. Results: A total of 205 young women and 146 health care professionals were included in the study. Most young women reported taking supplements at some stage of pregnancy (93.2%), with 54.6% taking it on a daily basis. Those who reported taking supplements less than 7 days a week stated it was mainly due to forgetting. Health care professionals however reported that some young women had difficulties accessing healthy start supplements. Young women reported positive dietary changes; however a significant proportion of participants indicated that they avoided some foods unnecessarily. Avoiding or reducing foods such as red meat (22.7%), eggs (40.6%), oily fish (60.4%) and soft cheese (36.2%) is of concern. Midwife/family nurse (38.0%) was young women's current favourite information source; smartphone applications (apps) and recipe booklets were suggested by over 50% of participants as a new addition to existing services. Health care professionals reported they included nutritional information and support as part of their role; however they felt there were some gaps in knowledge and confidence. Midwives in particular suggested a lack of sufficient time and resources as a main challenge in providing adequate support

Exploring the views of young women and their healthcare professionals on dietary habits and supplementation practices in adolescent pregnancy: a qualitative study

Background: Nutrition is a modifiable factor affecting foetal growth and pregnancy outcomes. Inadequate nutrition is of particular concern in adolescent pregnancies with poor quality diet and competing demands for nutrients. The aim of this study was to explore knowledge and understanding of nutrition advice during adolescent pregnancy,and identify barriers and facilitators to dietary change and supplementation use in this vulnerable population. Methods: Semi-structured interviews were conducted with young women and key antenatal healthcare providers: midwives, family nurses and obstetricians. Doncaster, Manchester and London were chosen as sites offering different models of midwifery care alongside referral to the Family Nurse Partnership programme. Results: A total of 34 young women (adolescents aged 16–19 years) and 20 health professionals were interviewed. Young women made small changes to their dietary intake despite limited knowledge and social constraints. Supplementation use varied; the tablet format was identified by few participants as a barrier but forgetting to take them was the main reason for poor adherence. Health professionals provided nutrition information but often lack the time and resources to tailor this appropriately. Young women’s prime motivator was a desire to have a healthy baby; they wanted to understand the benefits of supplementation and dietary change in those terms. Conclusion: Pregnancy is a window of opportunity for improving nutrition but often constrained by social circumstances. Health professionals should be supported in their role to access education, training and resources which build their self-efficacy to facilitate change in this vulnerable population group beyond the routine care they provide

Social Inequalities in Height: Persisting Differences Today Depend upon Height of the Parents

BACKGROUND: Substantial increases in height have occurred concurrently with economic development in most populations during the last century. In high-income countries, environmental exposures that can limit genetic growth potential appear to have lessened, and variation in height by socioeconomic position may have diminished. The objective of this study is to investigate inequalities in height in a cohort of children born in the early 1990s in England, and to evaluate which factors might explain any identified inequalities. METHODS AND FINDINGS: 12,830 children from The Avon Longitudinal Study of Parents and Children (ALSPAC), a population based cohort from birth to about 11.5 years of age, were used in this analysis. Gender- and age-specific z-scores of height at different ages were used as outcome variables. Multilevel models were used to take into account the repeated measures of height and to analyze gender- and age-specific relative changes in height from birth to 11.5 years. Maternal education was the main exposure variable used to examine socioeconomic inequalities. The roles of parental and family characteristics in explaining any observed differences between maternal education and child height were investigated. Children whose mothers had the highest education compared to those with none or a basic level of education, were 0.39 cm longer at birth (95% CI: 0.30 to 0.48). These differences persisted and at 11.5 years the height difference was 1.4 cm (95% CI: 1.07 to 1.74). Several other factors were related to offspring height, but few changed the relationship with maternal education. The one exception was mid-parental height, which fully accounted for the maternal educational differences in offspring height. CONCLUSIONS: In a cohort of children born in the 1990s, mothers with higher education gave birth to taller boys and girls. Although height differences were small they persisted throughout childhood. Maternal and paternal height fully explained these differences.Bruna Galobardes, Valerie A. McCormack, Peter McCarron, Laura D. Howe, John Lynch, Debbie A. Lawlor and George Davey Smit

Determinants of the urinary and serum metabolome in children from six European populations

Background Environment and diet in early life can affect development and health throughout the life course. Metabolic phenotyping of urine and serum represents a complementary systems-wide approach to elucidate environment–health interactions. However, large-scale metabolome studies in children combining analyses of these biological fluids are lacking. Here, we sought to characterise the major determinants of the child metabolome and to define metabolite associations with age, sex, BMI and dietary habits in European children, by exploiting a unique biobank established as part of the Human Early-Life Exposome project (http://www.projecthelix.eu). Methods Metabolic phenotypes of matched urine and serum samples from 1192 children (aged 6–11) recruited from birth cohorts in six European countries were measured using high-throughput 1H nuclear magnetic resonance (NMR) spectroscopy and a targeted LC-MS/MS metabolomic assay (Biocrates AbsoluteIDQ p180 kit). Results We identified both urinary and serum creatinine to be positively associated with age. Metabolic associations to BMI z-score included a novel association with urinary 4-deoxyerythronic acid in addition to valine, serum carnitine, short-chain acylcarnitines (C3, C5), glutamate, BCAAs, lysophosphatidylcholines (lysoPC a C14:0, lysoPC a C16:1, lysoPC a C18:1, lysoPC a C18:2) and sphingolipids (SM C16:0, SM C16:1, SM C18:1). Dietary-metabolite associations included urinary creatine and serum phosphatidylcholines (4) with meat intake, serum phosphatidylcholines (12) with fish, urinary hippurate with vegetables, and urinary proline betaine and hippurate with fruit intake. Population-specific variance (age, sex, BMI, ethnicity, dietary and country of origin) was better captured in the serum than in the urine profile; these factors explained a median of 9.0% variance amongst serum metabolites versus a median of 5.1% amongst urinary metabolites. Metabolic pathway correlations were identified, and concentrations of corresponding metabolites were significantly correlated (r > 0.18) between urine and serum. Conclusions We have established a pan-European reference metabolome for urine and serum of healthy children and gathered critical resources not previously available for future investigations into the influence of the metabolome on child health. The six European cohort populations studied share common metabolic associations with age, sex, BMI z-score and main dietary habits. Furthermore, we have identified a novel metabolic association between threonine catabolism and BMI of children

O potencial diagnóstico dos indicadores da obesidade centralizada The potential of central obesity antropometric indicators as diagnostic tools

OBJETIVO: Tem sido sugerido que os indicadores da obesidade centralizada, representados pela relação entre as medidas das circunferências da cintura e do quadril e pela medida da circunferência da cintura, expressam distúrbios metabólicos diferentes. Assim, realizou-se estudo para verificar o potencial diagnóstico da relação circunferência cintura/circunferência do quadril com fatores sociais, comportamentais e biológicos, determinantes da obesidade centralizada. MÉTODOS: Em uma amostra da população do Município de São Paulo, SP, composta por 1.042 pessoas, foram utilizados dois modelos de análise hierárquica de regressão múltipla para se avaliar as relações entre os indicadores e os fatores determinantes da obesidade centralizada. Foram realizados três inquéritos (clínico, bioquímico e laboratorial e comportamental), utilizando questionário padronizado. Para avaliação, foram utilizados os instrumentos: pressão arterial, medidas antropométricas, medida de cintura e medida do quadril. RESULTADOS: A medida de circunferência da cintura e do quadril (RCQ) mostrou associação significativa com a baixa estatura e foi fortemente relacionada ao nível socioeconômico, não ocorrendo o mesmo com a CC. A RCQ e a medida de circunferência da cintura (CC) foram fortemente associadas à idade, sexo e sedentarismo. As mulheres têm maior risco de apresentaram obesidade centralizada: OR=5,04 e 7,27, para a RCQ e CC, respectivamente. No que se refere aos distúrbios metabólicos, a RCQ associou-se significativamente com as alterações indicativas da síndrome metabólica: hipertensão e baixos níveis de HDL-colesterol. A CC associou-se significativamente com a hipertensão isolada. Ambos os indicadores associaram-se intensamente com a presença concomitante de duas ou mais alterações ligadas à síndrome metabólica. A CC associou-se à hipercolesterolemia, o que não ocorreu com a RCQ. CONCLUSÕES: A RCQ relacionou-se melhor com os fatores socioeconômicos, risco de desnutrição pregressa e com as alterações indicativas da síndrome metabólica do que a CC, mais associada aos fatores de risco para doenças cardiovasculares ateroscleróticas.<br>OBJECTIVE: It has been suggested that the indicators of centralized obesity, namely by waist-to-hip circumference ratio (WHR) and waistline measure (WM), express different metabolic disorders. Thus, a study was conducted in order to verify the diagnostic potential of the relationship between these two measures and social, behavioral, and biological determinants of centralized obesity. METHODS: Two hierarchical multiple regression models were applied to a 1,042 subject sample from the city of São Paulo, southeastern Brazil, in order to evaluate relationships between indicators and determinants for centralized obesity. Clinical, biochemical/laboratory, and behavioral surveys were carried out using standardized questionnaires. Evaluation included blood pressure, anthropometric measurements, and waistline and hip measures. RESULTS: WHR was significantly associated with low stature and strongly related to socioeconomic level; this was not the case with WM. Both WHR and WM were strongly associated with age, sex, and sedentary lifestyle. Women were at greater risk of centralized obesity then men: OR=5.04 and 7.27 for WHR and WM, respectively. WHR was significantly associated with alterations indicative of metabolic syndrome: hypertension and low levels of HDL-cholesterol. WM was significantly associated with hypertension alone. Both indicators were strongly associated with the concomitant presence of two or more alterations related to metabolic syndrome. Unlike WHR, WC was associated with hypercholesterolemia. CONCLUSIONS: WHR was more closely associated with socioeconomic factors, former risk of malnutrition, and alterations indicative of metabolic syndrome than WM, which was more closely associated with risk factors for cardiovascular and arteriosclerotic diseases