Lifestyle habits and novel means for dietary screening and health promotion in pregnant women and children

Lifestyle habits, including diet and physical activity, that deviate from the recommendations during pregnancy and early childhood may eventually increase the risk for obesity and other lifestyle-related diseases in both the mother and the child. High prevalence of obesity among pregnant women and children in Finland suggest that novel means to support health-promoting lifestyle habits among these target groups are needed. Thus, the aim was to assess lifestyle habits of pregnant women and children with reference to the national recommendations. Another aim was to study the effects of a health app for improving lifestyle habits during pregnancy and to develop a short method for the assessment of diet quality in children for dietary screening and health promotion purposes. Weight, diet quality and physical activity during early and late pregnancy as well as the efficacy of the health app on improving these lifestyle habits were investigated in 1038 Finnish women (study I). Further, food supplement use during pregnancy was studied in 1804 women from Finland, Italy, Poland and the United Kingdom (study II). Diet quality was assessed with a validated index in 766 preschool-aged children (study III) and diet with food diary and food frequency questionnaire in 266 elementary school-aged children (study IV). Moreover, a tool for assessing diet quality in elementary school-aged children was developed (study IV). The results indicated that the diet quality and physical activity levels were suboptimal in majority of the pregnant women. Most of the women consumed vitamin D and folic acid supplements during pregnancy, but adherence to the recommended doses was low. No benefits on the use of the health app were seen in diet quality and weight gain. However, physical activity level among app users decreased less likely compared with app non-users over the pregnancy course, indicating that the benefits of the app use may arise from maintenance of physical activity. The results also showed that diet quality was suboptimal in most of the preschool and elementary school-aged children; especially the consumption of vegetables, fruits and berries was low. The developed stand-alone index depicted diet quality in elementary school-aged children as defined in the dietary recommendations. Thus, it may be used as a valid tool in e.g. dietary screening.--- Suosituksista poikkeavat elintavat eli ravitsemuslaadultaan heikko ravinto ja riittämätön liikunta raskausaikana ja lapsuudessa voivat ajan myötä kohottaa lihavuuden ja muiden elintapasairauksien riskiä sekä äidillä että lapsella. Lihavuuden suuri esiintyvyys suomalaisilla raskaana olevilla naisilla ja lapsilla osoittaa, että uusia keinoja tarvitaan terveyttä edistävien elintapojen tukemiseen näissä kohderyhmissä. Tämän väitöskirjan tavoitteena oli selvittää raskaana olevien naisten ja lasten elintapoja suhteessa suosituksiin. Lisäksi tavoitteena oli tutkia terveyssovelluksen hyötyjä raskausajan elintapojen parantamiseksi sekä kehittää lyhytmenetelmä lasten ruokavalion laadun selvittämiseksi käytettäväksi seulonnanja terveyden edistämisen tueksi. Tutkimuksessa selvitettiin suomalaisten raskaana olevien naisten (n=1038) paino, ruokavalion laatu ja fyysinen aktiivisuus sekä terveyssovelluksen hyödyt näiden elintapatekijöiden parantamisessa (tutkimus I). Lisäksi kysyttiin ravintolisien käyttö raskaana olevilta naisilta (n=1804), jotka asuivat Suomessa, Italiassa, Puolassa tai Iso-Britanniassa (tutkimus II). Alle kouluikäisten lasten (n=766) ruokavalion laatu selvitettiin validoidulla indeksillä (tutkimus III) ja alakouluikäisten lasten (n=266) ravintotekijät ruokapäiväkirjan ja frekvenssikyselyn avulla (tutkimus IV). Lisäksi kehitettiin työväline alakouluikäisten lasten ruokavalion laadun selvittämiseen (tutkimus IV). Suurella osalla raskaana olevista naisista ruokavalion laatu oli suosituksia heikompaa ja fyysinen aktiivisuus suositeltua vähäisempää. Suurin osa naisista käytti D-vitamiini- ja foolihappolisää raskauden aikana, mutta eivät suositusten mukaisin annoksin. Terveyssovelluksen käyttö ei vaikuttanut ruokavalion laatuun eikä painoon. Sovellus saattaa kuitenkin motivoida raskaana olevia naisia fyysisen aktiivisuuden ylläpitämiseen raskauden edetessä. Tulokset osoittivat myös, että ruokavalion laatu oli heikko tai kohtalainen suurella osalla alle kouluikäisistä ja alakouluikäisistä lapsista; erityisesti kasvisten, hedelmien ja marjojen käyttö oli vähäistä. Tutkimuksessa kehitetty lyhytmenetelmä kuvaa alakouluikäisten lasten ruokavalion laatua suhteessa suosituksiin. Sitä voidaan käyttää esimerkiksi validina seulontatyökaluna

Living with Overweight, Rather than a History of Gestational Diabetes, Influences Dietary Quality and Physical Activity during Pregnancy

(1) Background: Clinical practice guidelines recommend dietary and physical activity counselling for pregnant women with gestational diabetes (GDM). The aim of this study was to evaluate the extent to which a history of GDM and living with overweight before pregnancy modify dietary quality and physical activity during pregnancy. (2) Methods: The study is a cross-sectional study of 1034 pregnant women from different parts of Finland. The data were collected through electronic questionnaires. Dietary quality and physical activity were measured with stand-alone indices and compared according to the history of GDM and overweight status based on body mass index (BMI) category. (3) Results: Overall, 53% of the women had a poor dietary quality (Index of Diet Quality (IDQ) score p < 0.001). (4) Conclusions: Pregnant women, particularly if living with overweight, commonly have a poor dietary quality and a light level of physical activity. A history of GDM is not reflected in the lifestyle habits, despite the assumption that they have received lifestyle counselling during a previous pregnancy. Pregnant women would benefit from new means to promote healthy lifestyle changes.</p

Ravintolisien käyttö on yleistä ja poikkeaa suosituksista raskaana olevilla

LÄHTÖKOHDAT Tavoitteena oli tutkia suomalaisten raskaana olevien naisten ravintolisien käyttöä ja verrata saantia raskausajan suosituksiin.MENETELMÄT Aineisto (n = 542) kerättiin sähköisellä lomakkeella. Raportoidun ravintolisien käytön perusteella laskettiin vitamiinien, kivennäisaineiden ja kalaöljyn rasvahappojen päivittäinen saanti. Probiooteista selvitettiin käytetyimmät lajit.TULOKSET Tutkimukseen osallistuneista naisista 98 % (532/542) oli käyttänyt jotain ravintolisää raskauden aikana, ja käytettyjen valmisteiden määrä oli 1–9. Yleisimmin käytettiin (82 % vastanneista) raskaana oleville suunnattua monivitamiini- ja kivennäisainevalmistetta. Naisista 70 %:n mukaan monivitamiini- ja kivennäis­aine­valmistetta suositellaan käytettäväksi raskauden aikana. D-vitamiinilisän suosituksesta tiesi 61 % vastanneista sekä foolihapon suosituksesta raskautta edeltävälle ajalle 85 % ja raskauden ajalle 82 %. Ravintolisien käyttäjistä 5 %:lla ylittyi vähintään yhden ravintoaineen turvallisen saannin yläraja.PÄÄTELMÄT Raskaana olevat naiset käyttävät yleisesti ravintolisiä, jopa huomattavan suurina annoksina. Terveydenhuollossa on siten oleellista selvittää ravintolisien käyttöä raskaana olevilta sekä ohjata valmisteiden asianmukaisessa valinnassa ja annostelussa.</p

Elementary School-Aged Children’s and Parents’ Report of Health-Related Quality of Life and Relationships with Lifestyle Measures : A Cross-Sectional Study

Supporting a child’s health-promoting lifestyle is an investment in their future health and health-related quality of life (HRQoL). Particularly children with overweight and obesity may be at an increased risk of a poor HRQoL. Currently, a comprehensive evaluation of lifestyle factors and age in relation to HRQoL in healthy children and, further, separate child and parental proxy-reports of HRQoL are lacking. The aims of this cross-sectional study in Finland are to compare healthy elementary school-aged children’s and parents’ reports of the child‘s HRQoL, and to view them in relation to lifestyle markers. The HRQoL was measured with Pediatric Quality of Life InventoryTM 4.0, and the following lifestyle markers: leisure-time physical activity as MET, diet quality via a validated index (ES-CIDQ), sleeping time and screen time by questionnaires. Furthermore, age and BMI were recorded. Data were obtained from 270 primary school-aged children (6–13 years). Female gender, the child’s older age (8–13 years), high physical activity level and less screen time were strong predictors of a higher HRQoL in both the child’s and parental proxy-reports. Means to promote healthy lifestyles should be particularly targeted to young children, especially boys, and new ways to promote physical activity and other forms of free-time activities should be sought.Peer reviewe

The Impacts of Fish Oil and/or Probiotic Intervention on Low-Grade Inflammation, IGFBP-1 and MMP-8 in Pregnancy: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Background: We investigated the impact of fish oil and/or probiotics on serum and vaginal inflammatory and metabolic proteins and their relation to the onset of gestational diabetes mellitus (GDM). Methods: Overweight/obese pregnant women received fish oil + placebo, probiotics + placebo, fish oil + probiotics or placebo + placebo from early pregnancy until six months postpartum (fish oil: 1.9 g docosahexaenoic acid and 0.22 g eicosapentaenoic acid; probiotics: Lactobacillus rhamnosus HN001 and Bifidobacterium animalis ssp. lactis 420, 1010 colony-forming units each). Serum high sensitivity C-reactive protein (hsCRP) and serum/vaginal (s/v) phosphorylated insulin-like growth factor binding-protein-1 (phIGFBP-1), IGFBP-1 and matrix metalloproteinase 8 (MMP-8) were analyzed. GDM was diagnosed according to 2 h 75 g OGTT. Results: The intervention had no impact on the change in proteins during pregnancy. Nevertheless, s-MMP-8 decreased and s-IGFBP-1 increased more in obese than in overweight women in the fish oil + probiotics group, while a decrease in s-MMP-8 was seen in obese women and an increase was seen in overweight women in the probiotics + placebo group. The late pregnancy s-phIGFBP-1 was higher in women who developed GDM in fish oil + probiotics-group compared to fish oil + placebo-group. The concentrations of s-phIGFBP-1 (635.9 ± 315.3 ng/mL vs. 753.2 ± 335.1 ng/mL, p = 0.005) and s-IGFBP-1 (3.78 ± 0.72 ng/mL vs. 3.96 ± 0.69 ng/mL, p = 0.042) were lower in early pregnancy in women who developed GDM than in women remaining healthy. Conclusions: The intervention per se had no impact on the proteins, but obesity and GDM may modify the effect. IGFBPs may affect the development of GDM

Development of a stand-alone index for the assessment of diet quality in elementary school-aged children

Objective: To develop and evaluate a stand-alone Elementary School-aged Children's Index of Diet Quality (ES-CIDQ).Design: In this cross-sectional study, children filled in a food frequency questionnaire (FFQ) with twenty-nine multiple-item questions on the consumption of foods, portion sizes and eating frequency and a 5-d food diary. Nutrient intakes were calculated with nutrient analysis software. FFQ questions best reflecting a health-promoting diet with reference to dietary recommendations were identified by correlations, logistic regression modelling and receiver-operating characteristics curve analysis.Setting: Southwest and Eastern Finland.Participants: Healthy elementary school-aged volunteers [n 266, mean (sd) age 9·7 (1·7) years] were recruited between March 2017 and February 2018.Results: A set of questions was identified from the FFQ that best depicted the children's diet quality as defined in the dietary recommendations. These fifteen questions were scored and formulated into a stand-alone index as a continuous index score (range 0-16·5 points) and a two-category score: good and poor diet quality. The cut-off score of six points for a good diet quality had a sensitivity of 0·60 and a specificity of 0·78. Children with a good diet quality (49·8 % of the children) had higher intakes of protein, dietary fibre, and several vitamins and minerals, and lower intakes of sucrose, total fat, SFA and cholesterol compared to children with a poor diet quality.Conclusions: The developed short stand-alone index depicted diet quality as defined in the dietary recommendations. Thus, ES-CIDQ may be used for assessing diet quality in Finnish elementary school-aged children in school health care and nutrition research.</p

Impact of combined consumption of fish oil and probiotics on the serum metabolome in pregnant women with overweight or obesity

Background: If a pregnant woman is overweight, this can evoke metabolic alterations that may have health consequences for both mother and child.Methods: Pregnant women with overweight/obesity (n = 358) received fish oil+placebo, probiotics+placebo, fish oil+probiotics or placebo+placebo from early pregnancy onwards. The serum metabolome was analysed from fasting samples with a targeted NMR-approach in early and late pregnancy. GDM was diagnosed by OGTT.Findings: The intervention changed the metabolic profile of the women, but the effect was influenced by their GDM status. In women without GDM, the changes in nine lipids (FDRInterpretation: Fish oil and particularly the combination of fish oil and probiotics modified serum lipids in pregnant women with overweight or obesity, while no such effects were seen with probiotics alone. The effects were most evident in the lipid contents of VLDL and LDL only in women without GDM.</p

GlycA, a novel marker for low grade inflammation, reflects gut microbiome diversity and is more accurate than high sensitive CRP in reflecting metabolomic profile

Introduction Gut microbiota is, along with adipose tissue, recognized as a source for many metabolic and inflammatory disturbances that may contribute to the individual's state of health. Objectives We investigated in cross-sectional setting the feasibility of utilizing GlycA, a novel low grade inflammatory marker, and traditional low grade inflammatory marker, high sensitivity CRP (hsCRP), in reflecting serum metabolomics status and gut microbiome diversity. Methods Fasting serum samples of overweight/obese pregnant women (n = 335, gestational weeks: mean 13.8) were analysed for hsCRP by immunoassay, GlycA and metabolomics status by NMR metabolomics and faecal samples for gut microbiome diversity by metagenomics. The benefits of GlycA as a metabolic marker were investigated against hsCRP. Results The GlycA concentration correlated with more of the metabolomics markers (144 out of 157), than hsCRP (55 out of 157) (FDR Conclusion GlycA is a superior marker than hsCRP in assessing the metabolomic profile and gut microbiome diversity. It is proposed that GlycA may act as a novel marker that reflects both the gut microbiome and adipose tissue originated metabolic aberrations; this proposal will need to be verified with regard to clinical outcomes.</div

Dietary quality influences body composition in overweight and obese pregnant women

BACKGROUND & AIMS: Excessive adiposity and gestational weight gain (GWG) have been linked with maternal and offspring morbidity. We investigated the relation of maternal diet, physical activity and GWG on body composition in overweight and obese pregnant women.METHODS: Fat mass (FM) and fat free mass (FFM) of 110 overweight and obese pregnant women were measured by air displacement plethysmography in early and late pregnancy (mean 13.5 and 35.3 gestational weeks). At the same time points, the quality of overall diet was assessed by validated index of diet quality (IDQ) questionnaire (score < 10/15 denotes poor dietary quality and score ≥ 10/15 denotes good dietary quality), nutrient intakes by 3-day food diaries, and physical activity by questionnaire. Weight gain between early and late pregnancy was compared to the gestational weight gain guidelines issued by Institute of Medicine.RESULTS: Of the women, 77% gained more weight than recommended; this was related to greater dietary fat consumption (80 ± 21 g/day vs. 67 ± 11 g/day, p = 0.010) and greater increase in FM (2.7 ± 3.0 kg vs. -1.0 ± 2.4 kg, p < 0.001) compared to women with ideal GWG. Dietary protein intake (g) correlated positively with FFM at both time points (early pregnancy: r = 0.31, p < 0.002, late pregnancy: r = 0.39, p < 0.001). Women with higher dietary quality index score had more FFM, compared to women with lower dietary quality (early pregnancy FFM: 48.8 ± 5.8 kg vs. 45.8 ± 4.7 kg, p = 0.004, late pregnancy FFM: 56.1 ± 6.4 kg vs. 53.4 ± 5.6 kg, p = 0.025). No correlations were detected between total energy intake or physical activity and FM or FFM at early or late pregnancy.CONCLUSIONS: Body composition changes from early to late pregnancy were related to the amount of weight gained and overall dietary quality during pregnancy. Higher dietary quality and protein intake were associated with greater FFM, while dietary fat intake was related to excess weight gain. Identification of these dietary determinants of body composition and weight offers new targets for dietary counseling of pregnant women and thus potential for ensuing health benefits through reduced adiposity.</p

The Impacts of Fish Oil and/or Probiotic Intervention on Low-Grade Inflammation, IGFBP-1 and MMP-8 in Pregnancy: A Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Background: We investigated the impact of fish oil and/or probiotics on serum and vaginal inflammatory and metabolic proteins and their relation to the onset of gestational diabetes mellitus (GDM). Methods: Overweight/obese pregnant women received fish oil + placebo, probiotics + placebo, fish oil + probiotics or placebo + placebo from early pregnancy until six months postpartum (fish oil: 1.9 g docosahexaenoic acid and 0.22 g eicosapentaenoic acid; probiotics: Lactobacillus rhamnosus HN001 and Bifidobacterium animalis ssp. lactis 420, 1010 colony-forming units each). Serum high sensitivity C-reactive protein (hsCRP) and serum/vaginal (s/v) phosphorylated insulin-like growth factor binding-protein-1 (phIGFBP-1), IGFBP-1 and matrix metalloproteinase 8 (MMP-8) were analyzed. GDM was diagnosed according to 2 h 75 g OGTT. Results: The intervention had no impact on the change in proteins during pregnancy. Nevertheless, s-MMP-8 decreased and s-IGFBP-1 increased more in obese than in overweight women in the fish oil + probiotics group, while a decrease in s-MMP-8 was seen in obese women and an increase was seen in overweight women in the probiotics + placebo group. The late pregnancy s-phIGFBP-1 was higher in women who developed GDM in fish oil + probiotics-group compared to fish oil + placebo-group. The concentrations of s-phIGFBP-1 (635.9 ± 315.3 ng/mL vs. 753.2 ± 335.1 ng/mL, p = 0.005) and s-IGFBP-1 (3.78 ± 0.72 ng/mL vs. 3.96 ± 0.69 ng/mL, p = 0.042) were lower in early pregnancy in women who developed GDM than in women remaining healthy. Conclusions: The intervention per se had no impact on the proteins, but obesity and GDM may modify the effect. IGFBPs may affect the development of GDM