Dietary intake and physical activity in severely obese pregnancy in Scotland

Maternal obesity is associated with adverse effects for mothers and offspring. The primary aim of this thesis was to assess food intake and physical activity (PA) using validated self-administered questionnaires, and whether these were associated with gestational weight gain (GWG) and birthweight (BWT), in severely obese (body mass index, BMI≥40kg/m2) compared with lean pregnant women (BMI 20-25kg/m2). The secondary aims were to validate self-reports against food diary (FD) and accelerometry; to assess the prevalence of under or over-reporting of energy intake; and to carry out a pilot study to assess total energy expenditure, as well as self-reporting accuracy, by using doubly-labelled water (DLW) technique, in subgroups of participants. Pregnant women were recruited from an ongoing study of severe obesity in pregnancy at the Royal Infirmary of Edinburgh, UK. Assessments were done in early (12-20 weeks) and late (28-32 weeks) pregnancy. A subgroup of women also completed questionnaires on appetite, general nutrition knowledge, and eating behaviours. All results were adjusted for age, parity, ethnic origin and deprivation category score. Self-reported total energy intake was not significantly different between obese and lean during early (median 2,444 vs 2,312 kcal/day) and late (2,173 vs 2,354 kcal/day) pregnancy. However when validated with FD, the relative validity of the food frequency questionnaire was lower in obese compared to lean. Under-reporting of total energy intake was higher in obese compared to lean (49% vs 15%, P<0.01) through comparison of selfreported energy intake with estimated total energy expenditure, and this was supported by the DLW pilot study results. The DLW also showed possible over-reporting of PA by the obese group. Obese women reported significantly lower appetite than lean throughout pregnancy (P<0.01). They also had lower scores in general nutrition knowledge, but these were no longer significant after controlling for confounders. Obese women had significantly higher scores of restrained and emotional eating behaviours than, and similar scores of external eating behaviours to, lean. Appetite, nutrition knowledge, restraint and emotional eating behaviours scores were not associated with food intake in either obese or lean. On the other hand, increased intakes of total calories and fats were influenced by increasing score of external eating behaviour in both groups. Obese women reported doing similar amounts of total PA but significantly less of vigorous and sports and exercise activities than lean (P<0.05). Accelerometry showed obese women had lower average activity counts/day, although they did have significantly greater energy expenditure in light-intensity activity than lean (P<0.01). Obese women had less GWG than lean (Mean ± SD, 5.3± 52 vs 10.8±3.7kg, P<0.001). Increased GWG was associated with increased self-reported total energy intake in lean, but this was not seen in obese. GWG was not associated with PA in either group. BWT was not significantly different between obese and lean (3,547±549g vs 3,567±516g). In lean, increased BWT was associated with increased energy intake and total PA. BWT in obese was not associated with diet but with increased with PA in early pregnancy. In conclusion, self-reported methods were less reliable in assessment of diet and PA in severely obese compared to lean pregnant women. These exploratory studies found that obese women did not appear to have the same factors as lean women affecting GWG and BWT, though this may be complicated by the poor reliability of self-reports. Therefore, quantitative assessments such as measurement of serum micronutrient levels (to evaluate nutritional status), and accelerometry (to assess physical activity) may be necessary in this poorly understood population

Traditional postpartum dietary practices and maternal nutritional status

Introduction: In Malaysia, new mothers commonly practise traditional postpartum dietary restrictions, which generally involve food proscriptions and prescriptions. These practices may affect the success of breastfeeding as it may impact the ability to meet the increased nutritional requirements during lactation period. Objectives: This review examines the postpartum dietary practices of different cultures in Malaysia. It also intends to assess maternal nutritional status during the confinement period. Methodology: A literature search was conducted through Mendeley software and PubMed (from year 2001 to 2016) by the keywords postpartum, practices, dietary, beliefs, culture, and nutritional status. Search by bibliography was also done. Results: A total of 30 literatures were examined in this review which included quantitative and qualitative studies. Typically, mothers in Eastern cultures avoid intake of particular foods perceived to have properties of “cold”, “gassy”, “itchy”, etc. A study found that women in confinement have 19% lower mean energy intake as compared to Malaysian Recommended Nutrients Intake (RNI) and more than 90% of mothers did not meet nutritional requirements for some micronutrients and minerals. As lactating mother needs higher energy and nutrients intake, food restrictions practiced during this period may impact their ability to meet these nutritional requirements. Consequently, the lactation process may be affected. Conclusion: More investigations are needed to determine the potential effects of dietary postnatal restrictions on maternal nutritional status and lactation practices. This is necessary to optimize the effectiveness of breastfeeding, which would enhance the intermediate as well as the future health of the country’s next generations

Financial hardship and dietary adherence during COVID-19 pandemic

The COVID-19 pandemic affected the global economy resulting in financial hardship due to declining wages or job losses. A decreased income influences food expenditure and accessibility affecting dietary adherence to healthy recommendations. Thus, this study aimed to investigate the association between financial hardship and dietary adherence among Malaysian working adults during the pandemic. Individuals aged 18 to 59 years (N=163) who experienced financial hardship during the pandemic participated in this cross-sectional study. The data were collected through an online survey. The reported number of servings consumed by the respondents for nine food groups was compared with the recommendations by the Malaysian Dietary Guidelines 2020 and Malaysian Food Pyramid 2020 using one-sample t-test to measure dietary adherence. The association between the financial hardship categories (≤25%, 26-50%, 51-75%, and 76-100% of monthly household income reduction rate during the pandemic) and dietary adherence status was assessed using the chi-squared test. The respondents consumed significantly lower number of servings of vegetables, fruits, cereals, fish, legumes, milk and milk products, and fat/oils, compared to recommendations (all p<0.001) whereas their sugar intake was significantly higher than recommended (p=0.041). These indicate dietary non-adherence. However, no association between financial hardship and dietary adherence was detected among adults who were financially affected during the COVID-19 pandemic in this study. In conclusion, most Malaysian adults who reportedly experienced financial hardship during the COVID-19 pandemic demonstrated non-adherence to healthy dietary recommendations. However, whether this was influenced by financial difficulties faced during the pandemic is inconclusive and warrants further investigation

The gadget generation: body mass index and duration of physical activity and screen-viewing among preschoolers in Kuantan, Pahang

Early childhood caries (ECC) is considered the most common chronic disease in childhood globally. Earlier reports have associated ECC with weights at birth and during early childhood, but these have never been assessed in our local populations. Thus, the aim of this study was to find the associations between birth weight and current body mass index (BMI) and the occurrence of ECC among young children in Kuantan, Pahang. A total of 200 children aged from two to five years were recruited for this research. Visual examination for caries detection was conducted to determine the present of caries. The information on demographic data such as age, parental education levels, socioeconomic status, and anthropometry data such as birth weight, current height and weight of the participants were obtained from the parents through a self-administered questionnaire. The findings indicate that ECC was prevalent among 83% of the study participants. In addition, the children who were diagnosed with ECC had significantly (p=0.008) lower mean BMI (16.0 ± 12.0 kg/m²) compared to caries free children (18.7 ± 9.3 kg/m²). There is no association between ECC and birth weight but children with ECC were significantly more likely to be underweight compared to caries free children

Chromatographic evaluation of gallic acid, catechin and quer-cetin in methanolic extracts of selected formulations of spices and herbs

The main objective of this study was to quantify the probable antioxidants such as gallic acid (phe-nolic acid), catechin and quercetin (flavonoids) in the three different formulations of mixed spices and herbs, that is mixed herbs (F1), mixed spices (F2) and mixed spices & herbs (F3) predominantly formulated for general health and wellbeing. The aforementioned antioxidants could be highly beneficial for the maintenance of good health as they possess the capacity to scavenge the free radicals which sequentially prevents certain non-communicable diseases (NCDs) such as diabetes mellitus, cancer and atherosclerosis for which free radicals are considered one the major causes. The formulation F2 comprising of mixed spices showed highest contents of gallic acid (86.03 μg/ml), catechin (339.40 μg/ml) and quercetin (394.59 μg/ml) thus highlighting its nutritional potential against various NCDs. The findings of this study depict that the daily supplementa-tion of spices and herbs particularly that of mixed spices could be highly beneficial for the maintenance of good health as they are a rich source of phenolic antioxidants

Barriers and enablers to make lifestyle changes among type 2 diabetes patients: a review

Type 2 diabetes is a non-communicable disease that affects most people around the world and is generally the result of excessive food intake and physical inactivity. Therefore, the purpose of this review was to identify facilitators and barriers for lifestyle modifications among type 2 diabetes patients. We combined quantitative and qualitative studies for this systematic narrative review. A literary search was carried out using EBSCO, HighWire Press, Medline, PsycInfo, PubMed and Scopus. Narrative review was used to extract results from quantitative studies, while thematic synthesis was used to extract results from qualitative studies. Twenty-three studies were included in this review, with a total of 2287 participants from Western, Arab and Asian populations. The two main themes generated from this review are intrinsic factors and extrinsic factors that can either be facilitators or barriers to implementing lifestyle change. Among the barriers faced by the participants are established food habits, lack of self-efficacy, lack of motivation, lack of social support, inadequate knowledge, low socio-economic status, food culture and poor time management. In contrast, the facilitating factors generated are strong self-efficacy, high motivation, good habits, and sufficient knowledge. In general, patients with diabetes observed more barriers than facilitators to implementing healthy lifestyle changes

Adhering to lifestyle change recommendations via the transtheoretical model: a mixed methods study among type 2 diabetes patients

Abstract Purpose – This paper aims to identify and explore the factors affecting type 2 diabetes mellitus (T2DM) patients’ adherence to lifestyle change recommendations, with the guidance of the trans-theoretical model (stages of change). Design/methodology/approach – This study was conducted in two parts. In Part A, 163 randomly selected participants were asked to complete a cross-sectional survey. Data regarding demographics, stages of change and levels of confidence to engage in lifestyle changes were collected. In Part B, in-depth interviews were conducted among 30 individuals, aged between 30 and 65 years, had been diagnosed with T2DM and had seen dietitian at least once. Purposive sampling was used to recruit participants with different sociodemographic characteristics. Findings – Part A showed that most of the participants were in the pre-action group (60%), with a higher mean HbA1c (8.9%) as compared to the action group (40%) which had a mean HbA1c of 6.9%. Part B further revealed the pre-action group and action group identified four key themes concerning lifestyle changes adherence: stumbling block; self-care belief; knowledge implementation; and selfempowerment. Practical implications – Health-care providers should identify patients’ stages of change before lifestyle changes implementation. Originality/value – This study highlighted that many factors might influence a T2DM patient’s adherence to lifestyle change recommendations. Determining the stages of change and self-confidence of T2DM patients is needed to ascertain long-term adherence

The association of maternal diet and polyamines in human milk: a study among Malay ethnic mothers in Kuantan, Malaysia

Human milk contains a lot of nutrient and it offers advantages to infant age less than six months. Polyamines in milk accelerate the in-fants’ gut maturation and protect babies from the harsh environment. Maternal diet is a factor which can affect the polyamines variability in milk. To date, no research on local diet and the composition of human milk has been investigated. This study aimed to identify an association between Malaysian maternal diet and composition of polyamines in human milk. Seventy nursing mothers were recruited in Pahang and each mother recorded their 24-hours food consumption within a week. Maternal diets were recorded in Nutritionist Pro-software and the macronutrients were calculated. Milk samples were collected from each mother after24 h of food diary. Polyamines in milk were extracted using 0.4 M Perchloric acid, dansylated and quantified using HPLC. The mean age of the respondent was 30.13 years [SD= 3.145].Nursing mothers consumed high carbohydrate [41.4%] compared to fat [23.1%] and protein [13.7%].Spermidine [49.1%] was the highest polyamines in the breast milk samples. A significant correlation were shown between putrescine and dietary carbohydrate [p=0.027] and putrescine and dietary protein [p=0.031].The maternal education levels has no association with maternal diet pattern and breastfeeding practice in this study [p=0.657]. It is suggested that polyamines composition in human milk may be modulated by carbohydrate and protein intake among maternal mothe