Diet Quality and Evening Snacking in Relation to Sleep Duration and Quality among Women with Young Children: A Dissertation

Background: Mothers’ diets impact their health and the health of their children, but diet quality is suboptimal among women with young children. Evening snacking among women with young children, especially consumption of high-calorie, high-carbohydrate snacks, may impact overall diet quality and glucose metabolism. Short sleep duration and poor sleep quality may be potential risk factors. We examined whether sleep duration and poor sleep quality were associated with diet quality and evening snacking among women with young children. Methods: Data were from the National Health and Nutrition Examination Survey (NHANES) 2005-2012, nationally representative cross-sectional surveys of noninstitutionalized U.S. population. Eligible participants were non-pregnant women aged 20-44 years within 5 years of childbirth who completed two 24-hour dietary recalls and completed questions on sleep duration and quality. Results: Among US women with young children, sleep duration was not associated with diet quality. However, overall sleep quality was associated with poorer diet quality. Short sleep duration was not associated with the consumption of neither evening snacks, nor energy intake from or nutrient consumption of evening snacks. Conclusion: The findings of this dissertation provide information useful for informing the direction of future research of dietary quality and eating behaviors of U.S. women with young children. Studies are needed to explore whether improvement in sleep quality may improve diet quality among women with young children, which has the potential to improve both maternal and children’s health. Research may be better focused on identifying other psychosocial and behavioral risk factors for unhealthy dietary behaviors among US women with young children

Diet quality and history of gestational diabetes mellitus among childbearing women, United States, 2007-2010

INTRODUCTION: Women with a history of gestational diabetes mellitus (GDM) have elevated risk of developing type 2 diabetes. Diet quality plays an important role in the prevention of type 2 diabetes. We compared diet quality among childbearing women with a history of GDM with the diet quality of childbearing women without a history of GDM. METHODS: We used data from the National Health and Nutrition Examination Survey for 2007 through 2010. We included women without diabetes aged 20 to 44 years whose most recent live infant was born within the previous 10 years and who completed two 24-hour dietary recalls. The Healthy Eating Index (HEI)-2010 estimated overall and component diet quality. Multivariable linear regression models estimated the association between a history of GDM and current diet quality, adjusting for age, education, smoking status, and health risk for diabetes. RESULTS: A history of GDM was reported by 7.7% of women. Compared with women without a history of GDM, women with a history of GDM had, on average, 3.4 points lower overall diet quality (95% confidence interval [CI], -6.6 to -0.2) and 0.9 points lower score for consumption of green vegetables and beans (95% CI, -1.4 to -0.4). Other dietary component scores did not differ by history of GDM. CONCLUSION: In the United States, women with a history of GDM have lower diet quality compared with women who bore a child and do not have a history of GDM. Improving diet quality may be a strategy for preventing type 2 diabetes among childbearing women

Evening Snacking in Relation to Self-reported Declines in Sleep Quality during Pregnancy: Preliminary Results from the Decision-Making, Eating, and Weight Gain During Pregnancy (DEW) Study

Background: Poor sleep in non-pregnant adults has been associated with increased evening snacking, which may contribute to weight gain. Sleep disturbances are common during pregnancy. Objective: To examine the association between changes in sleep quality from pre-pregnancy and evening snacking. Methods: In an ongoing prospective cohort study, pregnant women were recruited from UMMHC obstetric practices and the community. Participants are 18+ years, with singleton gestationweeks, pre-pregnancy BMI 18.5-40 kg/m2, English-speaking, and with plans to deliver at UMMHC. Participants were asked “compared to the three months before you became pregnant, how is your sleep quality now?”; we combined responses of “about the same”/“a little better”/“a lot better” versus “a little worse”/“much worse”. Participants completed three 24-hour dietary recalls (2 weekdays, 1 weekend day). Evening snacks were defined as eating occasions after dinner but before bedtime during which food items other than water was consumed. Fisher’s Exact tests and t-tests provided comparisons for evening snacking (yes/no), number of snacks, and energy intake. Results: Women with complete data (n=55) were 58% non-Hispanic White and aged 30.0 (SD:4.3) years; gestational age at study visit was 23.0 (SD:5.9) weeks. Of 866 meals reported, 94 were evening snacks. 71% (n=39) reported that their current sleep quality was worse than before pregnancy. Evening snacks were reported by 90% of women reporting worse sleep and 69% same/better (p=0.1028). While the number of snacks among snackers did not differ by change in sleep quality (M[SD]: 2.2[1.2] versus 1.6[0.8], p=0.2372), energy intake from these snacks was higher among women whose sleep quality had declined (M[SD]: 630[488] versus 309[331] kcal, p=0.0480). Conclusions: Declines in sleep quality during pregnancy may be linked to evening snacking. More research is needed to understand the role of sleep quality, eating behavior, and weight gain during pregnancy

Availability of Food Preparation Supplies among Pregnant Women: Preliminary Results from the Decision Making, Eating, and Weight Gain during Pregnancy (DEW) Study

Background: Lack of cooking supplies may be a potential barrier to preparing healthy meals at home. We examined the availability of food preparation supplies among pregnant women in relation to sociodemographic characteristics. Methods: We used preliminary data (N=59) from an ongoing study which enrolled English-speaking women aged 18+ years, pregnant with singleton gestation \u3c36\u3eweeks, pre-pregnancy BMI 18.5-40 kg/m2, and planning to deliver at UMMHC. Women completed the Food Preparation Checklist (FPC) at home. The FPC asks women if 41 specific food preparation items; scores reflect number of items present in the home. Other variables were self-reported. Pearson’s correlation, t-tests, and ANOVAs provided comparisons. We constructed an adjusted linear regression model to explore FPC by sociodemographic characteristics. Results: Women were aged 30.3 (SD=4.1) years, 64.4% were non-Hispanic White, 84.8% were married or living with a partner, and 30.5% reported difficulty paying for basic expenses. Women were enrolled at 22.7 (SD=5.6) weeks gestation; 30.5% were primigravid. Mean pre-pregnancy BMI was 25.0 (SD=4.6) kg/m2; 25.4% were overweight and 17.0% obese. Average FPC score was 32.3 (SD=6.1; range:14-39). FPC scores were higher among Non-Hispanic White women (34.6±3.5 vs. 28.1±7.5, p\u3c0.0001), those with higher education (28.3±7.0 high school/GED or less, 31.0±6.2 some/college degree, vs. 34.7±4.6 some/degree graduate, p\u3c0.01), those married or living with a partner (33.3±5.7 vs. 26.9±5.7, p\u3c0.01), with lower pre-pregnancy BMI (r=-0.38, p\u3c0.01), and who had no difficulty paying for basic expenses (34.0±5.0 vs. 28.4±6.6, p\u3c0.001). In a model that additionally adjusted for pre-pregnancy BMI, non-Hispanic White women had on average 5.7 more food preparation items (95% CI: 3.2, 8.3) and those reporting difficulty paying for basic expenses 3.8 fewer items (95% CI: -6.8, -0.9). Conclusions: Understanding the food preparation supplies available to pregnant women may be useful when designing interventions to improve diet quality and promote healthy weight gain during pregnancy

31st Annual Meeting and Associated Programs of the Society for Immunotherapy of Cancer (SITC 2016) : part two

Background The immunological escape of tumors represents one of the main ob- stacles to the treatment of malignancies. The blockade of PD-1 or CTLA-4 receptors represented a milestone in the history of immunotherapy. However, immune checkpoint inhibitors seem to be effective in specific cohorts of patients. It has been proposed that their efficacy relies on the presence of an immunological response. Thus, we hypothesized that disruption of the PD-L1/PD-1 axis would synergize with our oncolytic vaccine platform PeptiCRAd. Methods We used murine B16OVA in vivo tumor models and flow cytometry analysis to investigate the immunological background. Results First, we found that high-burden B16OVA tumors were refractory to combination immunotherapy. However, with a more aggressive schedule, tumors with a lower burden were more susceptible to the combination of PeptiCRAd and PD-L1 blockade. The therapy signifi- cantly increased the median survival of mice (Fig. 7). Interestingly, the reduced growth of contralaterally injected B16F10 cells sug- gested the presence of a long lasting immunological memory also against non-targeted antigens. Concerning the functional state of tumor infiltrating lymphocytes (TILs), we found that all the immune therapies would enhance the percentage of activated (PD-1pos TIM- 3neg) T lymphocytes and reduce the amount of exhausted (PD-1pos TIM-3pos) cells compared to placebo. As expected, we found that PeptiCRAd monotherapy could increase the number of antigen spe- cific CD8+ T cells compared to other treatments. However, only the combination with PD-L1 blockade could significantly increase the ra- tio between activated and exhausted pentamer positive cells (p= 0.0058), suggesting that by disrupting the PD-1/PD-L1 axis we could decrease the amount of dysfunctional antigen specific T cells. We ob- served that the anatomical location deeply influenced the state of CD4+ and CD8+ T lymphocytes. In fact, TIM-3 expression was in- creased by 2 fold on TILs compared to splenic and lymphoid T cells. In the CD8+ compartment, the expression of PD-1 on the surface seemed to be restricted to the tumor micro-environment, while CD4 + T cells had a high expression of PD-1 also in lymphoid organs. Interestingly, we found that the levels of PD-1 were significantly higher on CD8+ T cells than on CD4+ T cells into the tumor micro- environment (p < 0.0001). Conclusions In conclusion, we demonstrated that the efficacy of immune check- point inhibitors might be strongly enhanced by their combination with cancer vaccines. PeptiCRAd was able to increase the number of antigen-specific T cells and PD-L1 blockade prevented their exhaus- tion, resulting in long-lasting immunological memory and increased median survival

Mental health care use in relation to depressive symptoms among pregnant women in the USA

We examined mental health care use in relation to depressive symptoms (Patient Health Questionnaire (PHQ-9) \u3e/=10) among a nationally representative sample of pregnant women using data from the National Health and Nutrition Examination Survey 2005-2012. Logistic regression models estimated crude and adjusted odds ratios for mental health care use in the past year in relation to depressive symptoms. While 8.2 % (95 % CI 4.6-11.8) of pregnant women were depressed, only 12 % (95 % CI 1.8-22.1) of these women reported mental health care use in the past year

The impact of sleep, stress, and depression on postpartum weight retention: A systematic review

OBJECTIVE: To review the impact of sleep, stress, and/or depression on postpartum weight retention. METHODS: We searched three electronic databases, PubMed, ISI Web of Science, and PsycInfo. Studies were included if they were published between January 1990 and September 2013 in English, measured sleep, stress, and/or depression in the postpartum period, and assessed the association of these factors with postpartum weight retention. Two reviewers reviewed included articles and rated study quality using a modified version of the Downs and Black scale. RESULTS: Thirteen studies met our pre-defined eligibility criteria, reporting on 9 study samples. Two were cross-sectional studies and eleven were longitudinal studies. The study sample size ranged from 74 to 37,127. All four studies examining short sleep duration and postpartum weight retention reported a positive association. The four studies examining postpartum stress and weight retention reported non-significant associations only. Of 7 studies examining postpartum depression and weight retention, 3 reported non-significant associations, and 4 reported positive associations. CONCLUSION: Research investigating the impact of postpartum sleep, stress, depression on weight retention is limited. Future longitudinal studies are needed

Sleep Duration and Diet Quality Among Women Within 5 Years of Childbirth in the United States: A Cross-Sectional Study

Objective: Only 9 % of women with young children consume a high quality diet. The association between sleep duration and health may be U-shaped. We examined diet quality in relation to sleep duration among US women within 5 years of childbirth. Methods: Data were from non-pregnant women aged 20-44 years within 5 years of childbirth who completed two 24-h dietary recalls (N = 896) in the National Health and Nutrition Examination Survey 2005-2012. Self-reported weekday/workday sleep duration was categorized as short ( \u3c /=6 h), adequate (7-8 h), or long ( \u3e /=9 h). The Healthy Eating Index (HEI-2010, range 0-100) estimated overall and components of diet quality. Multivariable-adjusted linear regression models estimated the association between sleep duration and diet quality, adjusting for age, race/ethnicity, and education. Results: Thirty-four percent of women reported short, 57.1 % adequate, and 8.6 % long sleep duration. The average diet quality total score was 47.4 out of 100. Short sleep duration was not associated with diet quality. Long sleep duration was associated with lower quality diet (beta = -4.3; 95 % CI -8.1 to -0.4), lower consumption of total fruit (beta = -0.7; 95 % CI -1.3 to -0.1), whole fruit (beta = -0.9; 95 % CI -1.6 to -0.2), and total protein (beta = -0.7; 95 % CI -1.3 to -0.03), and higher consumption of empty calories (beta = 2.2; 95 % CI -4.3 to -0.1). Conclusions: for practice Future studies should examine the longitudinal association between sleep duration and diet quality among women following childbirth and whether interventions to improve sleep can enhance diet quality

Pregnant women\u27s interest in a website or mobile application for healthy gestational weight gain

We examined pregnant women\u27s interest in using a website or mobile application to help them gain a healthy amount of weight during pregnancy. Pregnant women (N = 64) completed a short questionnaire during routine prenatal care at hospital-based obstetric clinics in central Massachusetts during April-August 2012. Eighty-six percent reported interest in using a website or mobile application to help them gain a healthy amount of weight; interest ranged from 67% to 100% across demographics, clinical characteristics, and technology use. The Internet is a promising modality for delivering interventions to prevent excessive gestational weight gain and associated maternal and child health consequences

Feasibility and Acceptability of Delivering a Postpartum Weight Loss Intervention via Facebook: A Pilot Study

OBJECTIVE: To evaluate the feasibility and acceptability of a Facebook-delivered postpartum weight loss intervention. METHODS: Overweight and obese postpartum women received a 12-week weight loss intervention via Facebook. Feasibility outcomes were recruitment, retention, engagement, and acceptability. Weight loss was an exploratory outcome. RESULTS: Participants (n = 19) were 3.5 (SD 2.2) months postpartum with a baseline body mass index of 30.1 (SD 4.2) kg/m(2). Retention was 95%. Forty-two percent of participants visibly engaged on the last day of the intervention, and 100% in the last 4 weeks; 88% were likely or very likely to participate again and 82% were likely or very likely to recommend the program to a postpartum friend. Average 12-week weight loss was 4.8% (SD 4.2%); 58% lost \u3e /=5%. CONCLUSIONS AND IMPLICATIONS: Findings suggested that this Facebook-delivered intervention is feasible and acceptable and supports research to test efficacy for weight loss. Research is needed to determine how best to engage participants in social network-delivered weight loss interventions