Gestational diabetes and progression to type two diabetes mellitus: missed opportunities of follow up and prevention?

Abstract Background: The incidence of type 2 diabetes (T2DM) is increasing. Having a pregnancy complicated by gestational diabetes mellitus (GDM) is a potent risk factor for the later development of T2DM. Aims: To explore the characteristics of women diagnosed with GDM in a single centre and their follow up for progression to T2DM. Methods: A retrospective cohort study using anonymised data of one hundred and fifty four (154) women with GDM receiving maternity care at the Oxford University Hospitals NHS Foundation Trust (OUHFT) in 2010 and their follow up until 2018. Results: The prevalence of GDM in women delivering in Oxfordshire in 2010 was 3.4%. 70% of pregnant women were overweight or obese (with 51% being obese) at booking. Gestational weight gain (GWG) was excessive in 29% of women, when compared to Institute of Medicine (IOM) guidelines. Almost a quarter of women (23.4%) had no follow up after delivery. Over a median follow up of 3.5 years (range 0-8 years) nearly one in six (16.9%) of the total cohort (22% of those tested) went on to develop T2DM. 74% of women with GDM were multiparous, and 65% of nulliparous women were tested compared to 81% of multiparous women. There was a significant difference between multiparous women (53.8%) compared to nulliparous women (46.2%) developing T2DM (p=0.01). There was no significant difference in BMI (p=0.866) or GWG (p=0.83) in women who progressed to T2DM versus those who did not. Conclusion: The risk of T2DM after GDM is substantial however, follow up rates of this population is poor. Subsequent screening of women with GDM and their management crosses secondary and primary care with scope for improvement in counselling of women of the importance of annual reviews, in data collection and follow up in both obstetrics and general practice. The implementation of a recall system, an education programme for general practitioners and/or a registry of women diagnosed with GDM could be useful to identify those at high risk of developing T2DM as well as providing a platform for the potential development of interventions to prevent progression to T2DM after GDM

Association between adherence to the Mediterranean Diet and the Eatwell Guide and changes in weight and waist circumference in post-menopausal women in the UK Women's Cohort Study

Objective This study investigated the associations between adherence to the Mediterranean Diet and the Eatwell Guide (EWG) and changes in weight and waist circumference in post-menopausal women. Study Design Post-hoc analysis of post-menopausal women from the UK Women’s Cohort Study. Main outcome measures Changes in weight, waist circumference and the risk of abdominal and general obesity. Results 4162 post-menopausal women were selected. Higher adherence to both the EWG and the Mediterranean Diet was associated with smaller increases in waist circumference over 4 years (EWG: β −0.47, CI −0.75, −0.20 per 1 tertile increase in score), (Mediterranean Diet: β −0.29, CI −0.58, −0.01 per 1 tertile increase in score); and lower risk of abdominal obesity (EWG: OR 0.55, CI 0.43, 0.70 third versus the first tertile), (Mediterranean Diet: OR 0.60, CI 0.46, 0.76 third versus the first tertile), but was not associated with weight changes (EWG: β 0.14, CI −0.07, 0.36 per 1 tertile increase in score), (Mediterranean Diet: β 0.03, CI −0.19, 0.25 per 1 tertile increase in score) or risk of becoming overweight or obese (EWG: OR 1.09, CI 0.77, 1.52 third versus the first tertile), (Mediterranean Diet: OR 0.91, CI 0.65, 1.27 third versus the first tertile). Conclusions The results suggest that adherence to either the Mediterranean Diet or the EWG can help to prevent abdominal obesity in post-menopausal women

Office cake culture: an exploration of its characteristics, associated behaviours and attitudes among UK office workers; implications for workplace health.

Purpose: This paper explores the characteristics of office cake (OC) consumption and the associated attitudes and behaviours among UK office workers to gain insight into the implications for workplace health. Design: A cross-sectional online questionnaire was completed by 940 respondents. Data were analysed using descriptive statistics and cross-tabulation with Chi-square tests for between-group difference. Findings: Respondents reported both positive social and negative health-related consequences of OC. OC influenced eating behaviour through increased salience and availability, and the effects of social influencing. Almost all (94.8%) reported ideal OC frequency to be once/week or less. Gender and age significantly affected attitudes and behaviour. Research limitations/implications: The questionnaire was not validated so data accuracy could have been diminished or biased. Portion size was not examined and consumption data was self-reported which could have resulted in under-reporting. Only office workers were investigated therefore results may not be applicable to other workplaces. Practical implications: OC appears to influence both the workplace eating environment and employee eating behaviour. It could therefore affect employee health and workplace health promotion programme efficacy. However the findings suggest that nudge-based initiatives could reduce OC consumption to make workplaces healthier while retaining social benefits. Originality/value: The present study provides the first data on OC culture and insights on how to address it sensitively. It also highlights that sweet treats used for celebration and employee recognition should be considered a relevant part of workplace food provision alongside canteens and vending

Eco-score labels on meat products: consumer perceptions and attitudes towards sustainable choices

Non-profit organisations have developed labelling strategies to communicate the environmental impact of food products, helping consumers make more informed purchase decisions. The evidence on whether environmental food labelling can change behaviours toward environmental meat choices is unclear, due to context factors within shopping environments and differences in attitudes towards meat and the environment. This study investigates attitudes towards an eco-score label on meat products by measuring the influence of meat and environmental attitudes and identifying drivers and barriers through a mixed-methods design. An online questionnaire (N = 255) posed questions concerning meat consumption, label perceptions, and use intentions. Recruitment was via convenience sampling under the criteria of UK dweller, omnivorous diet and over 18 years of age. Nine semi-structured interviews explored the drivers and barriers for intended use through thematic analysis. Perceptions Scores (PS) and Purchase Intention (PI) scores of the label were positive. Results showed an individual's Meat attachment (affinity) score (MAAS) negligibly influenced PS but provided a moderately negative relationship with PI. Environmental label use and attitudes positively influenced PS and PI. The qualitative data identified label design and concept perceptions as drivers for use, whereas habitual shopping behaviours and perceived price were barriers. The research contributes to the transtheoretical model of behavioural change, identifying that 58% of participants contemplate label use but require more information. Explanations found for the gap between positive perceptions and low behavioural intentions support this, as poor label awareness and knowledge of the environmental impact of meat production were highlighted

Factors affecting consumer attitudes to fungi-based protein: a pilot study

Meat substitutes using alternative proteins can facilitate sustainable diets without compromising animal welfare. The fungal protein, also called mycoprotein is the biomass that results from the fermentation of a filamentous fungus. This paper reports the results of a consumer acceptance study of fungal protein-based meat substitutes using a mixed-method design with a web-based survey and a series of semi-structured interviews amongst European participants. Based on the description provided in the survey, 56% of participants were not directly familiar with fungal proteins but they understood its potential societal benefits. The overall Food Technology Neophobia Score (FTNS) of the sample was moderate (M = 40.0, range = 19–62), with more neophilic participants (52.9%) than neophobic (47.1%). FTN was a significant but weak predictor of Perceived Benefits (PB) and Purchase Intentions (PI). Younger participants perceived fungal proteins more positively, and city-dwellers had higher PI than rural dwellers. Reducetarians were more likely to purchase fungal proteins, compared to unrestricted omnivores. Participants with lower acceptance of fungal proteins’ association with mould had significantly lower PI than those who were comfortable with it. In turn, familiarity with fungal protein was positively associated with mould acceptance. The qualitative data suggested that the sensory attributes were the most important factor in the acceptance of meat substitutes. The participants also valued clean label products which were perceived as healthier. Familiarity with other products containing mould seemed to assuage concerns and drive acceptance of fungal protein. The findings suggest that the overall acceptance of fungal protein is still rather low. This may be attributed to the perceived low appeal and tastiness of available fungal protein products

An Exploration into the Impact of Social Networking Site (SNS) Use on Body Image and Eating Behavior of Physically Active Men

From SAGE Publishing via Jisc Publications RouterHistory: epub 2020-04-02Publication status: PublishedThe rapid proliferation of social networking sites (SNSs) has transformed the way people now socialize and communicate. SNSs have been recognized to contribute to body image (BI) dissatisfaction and disordered eating behavior (EB). Few qualitative studies have explored this issue in men. The aim of the current study was to investigate male SNS use and possible impacts on BI and EB. One-to-one semi-structured interviews were conducted with eight men in the United Kingdom. Interviews aimed to examine men’s views on the potential impact of SNSs on BI and EB. Data were thematically analyzed. Findings suggested that SNSs may be a useful nutrition idea tool and motivational platform for men to improve their diet and exercise uptake. However, results also indicated that SNS use may contribute to BI dissatisfaction and increased risk of disorder. Future research may identify risk factors of SNS use, male BI concerns, and eating pathology across the lifespan

Metagenomic insights of the infant microbiome community structure and function across multiple sites in the United States

The gut microbiome plays an important role in early life, protecting newborns from enteric pathogens, promoting immune system development and providing key functions to the infant host. Currently, there are limited data to broadly assess the status of the US healthy infant gut microbiome. To address this gap, we performed a multi-state metagenomic survey and found high levels of bacteria associated with enteric inflammation (e.g. Escherichia, Klebsiella), antibiotic resistance genes, and signatures of dysbiosis, independent of location, age, and diet. Bifidobacterium were less abundant than generally expected and the species identified, including B. breve, B. longum and B. bifidum, had limited genetic capacity to metabolize human milk oligosaccharides (HMOs), while B. infantis strains with a complete capacity for HMOs utilization were found to be exceptionally rare. Considering microbiome composition and functional capacity, this survey revealed a previously unappreciated dysbiosis that is widespread in the contemporary US infant gut microbiome

The Efficacy of Energy-Restricted Diets in Achieving Preoperative Weight Loss for bariatric Pateints: A Systematic Review

The final publication is available at Springer via https://doi.org/10.1007/s11695-018-3451-1In bariatric practice, a preoperative weight loss of at least 5% is recommended. However, the hypocaloric diets prescribed vary and no consensus exists. This study examined the efficacy of preoperative diets in achieving 5% weight loss. From a systematic literature search, eight randomised controlled trials (n = 862) were identified. Half of the trials used a Bvery-low-calorie diet^ whilst the rest employed a Blow-calorie diet^. Only five diets achieved ≥ 5% weight loss over varying durations and energy intakes. By inference, compliance with a 700–1050 kcal (2929–4393 kJ) diet, consisting of moderate carbohydrate, high protein and low/moderate fat, for 3 weeks is likely to achieve 5% weight loss. A low-carbohydrate diet (< 20 g/day) may achieve this target within a shorter duration. Additional research is required to validate these conclusions

Childhood obesity : understanding the user perspective to inform prevention and treatment strategies

As a result of increasing prevalence in childhood obesity, it is now at the forefront of policy agendas. To date, however, there is a paucity of evidence in the UK, relating to the behavioural and environmental factors which influence diet and physical activity from the user perspective. Using the social-ecological framework, the principle aim of this thesis was to obtain the user perspective to identify priorities for action to inform prevention and treatment strategies for childhood obesity. A series of qualitative studies were carried out to determine the views of professionals, parents and children. In addition, a family based intervention for childhood obesity was evaluated. There was congruence in the findings across all studies. Poor diet and physical inactivity were identified as the main causes of obesity. Cost, availability, a lack of knowledge on portion sizes and food labels, a lack of appropriate facilities for activity and an unsupportive environment emerged as the main barriers. Across the studies, parents were consistently purported to be a contributor and a potential solution to childhood obesity. In terms of interventions, cookery courses which provide parents with practical information were deemed crucial. In addition, the development of a training programme for health care professionals on childhood obesity was identified as a priority. Children identified the use of the media and the internet as mechanisms with which to engage with children. With regard to the family based intervention, there was a significant decrease (p<0.05) in BMI and a significant increase in self-esteem (/?<0.05) post intervention. Although it is likely that the intervention had an effect, these findings warrant further investigation. In summary, this thesis provides a comprehensive insight to childhood obesity from the user perspective. Whilst change needs to occur to reduce the wider environmental barriers, equally parents are responsible for childhood obesity. However, there needs to be a concerted effort from health care professionals to ensure that parents have the necessary skills and knowledge to change behaviour.EThOS - Electronic Theses Online ServiceGBUnited Kingdo