Exploring Australian women's level of nutrition knowledge during pregnancy: a cross-sectional study

Nutrition Education and Nutrition Knowledge Among Obstetrics and Gynecology Residents

Background: Nutrition in pregnancy is a component of the Council on Resident Education in obstetrics and gynecology core curriculum; however, no studies currently examine adherence to this goal. Objectives: Our objective was to assess obstetrics and gynecology (Ob/Gyn) residents' education and knowledge surrounding nutrition in pregnancy, including (1) amount of dedicated didactic time to and attitudes toward, (2) subjective comfort in counseling patients on, and (3) objective knowledge of pregnancy-related nutrition. Materials and Methods: This is a cross-sectional electronic survey-based study. A 28-item questionnaire was distributed to residents enrolled in Ob/Gyn training programs across the United States in 2022. Results: From 247 Ob/Gyn residency programs, 218 residents across postgraduate years and from geographically diverse locations consented to participation and completed all survey questions. Almost half (48%) of participants reported 0 hours per year of dedicated nutrition-related education, 49% reported 1-2 hours, and 3% reported >2 hours. Most residents (92%) strongly agreed or agreed that education regarding pregnancy-related nutrition guidelines would be useful for clinical practice. However, less than one-third (31%) of residents reported feeling comfortable counseling patients on nutrition in pregnancy. On assessment of residents' objective knowledge of pregnancy-related nutrition, mean percentage of correct responses was 74%. Conclusions: This study identifies a gap in graduate medical education, specifically a disconnect between the recognized impact of nutrition on pregnancy outcomes and residents' ability to confidently and effectively counsel patients on nutrition in pregnancy. Results demonstrate a need to develop curriculum and interventions to educate Ob/Gyn residents about pregnancy-related nutrition.

Could commercial meal kits be part of the solution to food insecurity during pregnancy? An Australian exploratory study

AIM

To explore the nutritional content of meal kits from two main Australian companies over a 6-week period against healthy eating guidelines for pregnancy.

METHOD

Across the 6-week period, weekly meal kits from both Provider 1 and Provider 2 were purchased, 36 individual meals were assessed. All data were analysed for the development of a macronutrient and micronutrient profile of meals. Extracted data were macronutrient, vitamin, and mineral composition, which were compared against the healthy eating guidelines for pregnant women in Australia and New Zealand.

RESULTS

Meal kits include higher levels of sodium, and lower levels of dietary fibre, calcium, magnesium, zinc, iron, thiamin, riboflavin, grains, and dairy when compared against the guidelines for healthy eating for pregnant women in Australia and New Zealand.

CONCLUSIONS AND IMPLICATIONS

Meal kits may increase meals prepared and consumed in the home, and thanks to the clear instructions and pre-portioned ingredients, may reduce stress related to food preparation. They have the potential to provide nutritionally adequate meals to pregnant women as a way to mitigate food insecurity or hunger during pregnancy and may provide some nutritional benefits and have the potential to remove some of the challenges with maintaining an adequate diet when pregnant.

Different experiences of weight management and physical activity during pregnancy - a qualitative study of women and healthcare professionals in Australia

OBJECTIVE

Pregnancy is often described as a pivotal life stage for women, where regular contact with health professionals may play an important role in lifestyle awareness. This study explored the knowledge, practices, and beliefs of health professionals and pregnant women regarding physical activity and weight management during the antenatal period.

METHODS

A qualitative study was undertaken in southeastern Australia using individual interviews. Recruitment sought women of gestation >12 weeks, experiencing an uncomplicated pregnancy (n = 6), and antenatal health professionals including midwives (n = 4) and an obstetrician (n = 1). Data were analysed using Interpretive Phenomenological Analysis.

RESULTS

Three major themes emerged: (1) women rely on multiple sources of pregnancy-related healthy lifestyle information; (2) discussions around healthy lifestyle behaviours are low priority and often inconsistent; and (3) lifestyle-related topics perceived as sensitive make some conversations and actions difficult.

CONCLUSIONS

Pregnant women expressed gaps in lifestyle-related knowledge and education being provided by health professionals. In turn, health professionals expressed difficulty discussing sensitive topics such as weight with pregnant women and had limited knowledge of pregnancy-specific physical activity guidelines. The themes generated by this study may form the foundation for further research to inform clinical policy and practice regarding advice in antenatal care.

Caregivers' nutrition-related knowledge, perceptions, practices and barriers regarding the therapeutic diet for classical galactosaemia

BACKGROUND

Classical galactosaemia is a life-threatening disorder of carbohydrate metabolism, and the primary treatment is a lifelong galactose-restricted diet commenced in infancy. Adherence to restrictive diets can be burdensome for patients and their families; however, little is known about the impact on caregivers.

AIM

This study aims to determine the nutrition-related knowledge, perceptions, practices, and barriers of caregivers related to the therapeutic diet for classical galactosaemia.

METHODS

An online survey was conducted among 98 eligible members of the Galactosaemia Support Group using a novel questionnaire. Descriptive and inferential analyses were performed using Microsoft Excel 2021 and Stata/MP (version 17.0), respectively. Forty-three caregivers participated in the study. RESULTS AND CONCLUSION: Of those who participated, 98% had high levels of dietary knowledge. Caregivers' knowledge scores (x ¯ $\bar{{\rm{x}}}$  = 17.9, standard deviation [SD] = 1.7) were positively correlated with educational level (r = 0.383, p = 0.013). High attitudinal scores (x ¯ $\bar{{\rm{x}}}$  = 32.5, SD = 5.5) obtained by most caregivers (65%) revealed an overall positive attitude towards the galactosaemia diet. Negative perceptions of being unable to feed their child breast milk (49%) were apparent, and this perception was positively correlated with caregivers' intention to feed their child breast milk (r = 0.450, p = 0.003). Caregivers' concerns about the safety of their child in social settings (79%) and feeling that their child was excluded in social settings (49%) were clear barriers. A multidisciplinary approach to galactosaemia management is warranted, with healthcare interventions focusing on addressing caregivers' negative perceptions and barriers related to the diet to enable tailored support and facilitate lifelong compliance.

Nutritional Education in the Midwife's Consultation Room

Evidence of the importance of maternal nutrition during pregnancy is growing, and midwives are the healthcare professionals in charge of monitoring pregnancy. In the present review, the aim is therefore to look at the relevant contributions on midwifery and the role of midwifery in the provision of nutritional education. Searches were conducted on three databases-Medline, PubMed Central, and Web of Science-using two key search terms ("nutrition" and "midwives") and their synonyms, for an extensive set of results. The final selection consisted of 27 original papers, most of which concerned the nutritional knowledge of midwives, their training, and their views, attitudes, and practices within the field of nutrition. According to the findings, although the midwives considered nutritional education to be part of their role and they agreed on the importance of nutrition during pregnancy, their knowledge of this topic was poor, perhaps due to inadequate nutritional education during their midwifery training. Academic programs on midwifery must therefore be reviewed, so as to increase the workload of nutrition-related subjects, in order to reinforce the corresponding knowledge bases of future midwives. In addition, based on the success of the nutritional interventions discussed in the present review, these sorts of initiatives could be of utmost importance to improve the knowledge of practicing midwives. In any case, it must be highlighted that the available evidence discussed in this review was drawn from only a few countries around the world. Further studies involving midwives of varied origins are therefore needed. Such research would be of immense assistance in the design of the corresponding nutritional interventions in the field, so as to improve the health of pregnant women.

Nutritional Health Knowledge and Literacy among Pregnant Women in the Czech Republic: Analytical Cross-Sectional Study

Adequate nutrition and the nutritional status of pregnant women are critical for the health of both the mother and the developing foetus. Research has shown a significant impact of nutrition on the child's health and the future risk of developing chronic noncommunicable diseases (NCDs), such as obesity, diabetes, hypertension, and cardiovascular disease. There is currently no data on the level of nutritional knowledge of Czech pregnant women. This survey aimed to evaluate their level of nutritional knowledge and literacy. An analytical cross-sectional study was conducted in two healthcare facilities in Prague and Pilsen between April and June 2022. An anonymous self-administered paper-form questionnaire for assessing the level of nutritional knowledge (40 items) and the Likert scale for assessing nutrition literacy (5 items) were used. A total number of 401 women completed the questionnaire. An individual's nutritional knowledge score was calculated and compared with demographic and anamnestic characteristics using statistical methods. The results showed that only 5% of women achieved an overall nutritional score of 80% or more. University education (p < 0.001), living in the capital city (p < 0.001), experiencing first pregnancy (p = 0.041), having normal weight and being overweight (p = 0.024), and having NCDs (p = 0.044) were statistically significantly associated with a higher nutritional knowledge score. The lowest knowledge scores were found in the areas of optimal energy intake, optimal weight gain, and the role of micronutrients in diet during pregnancy. In conclusion, the study shows limited nutrition knowledge of Czech pregnant women in some areas of nutrition. Increasing nutritional knowledge and nutrition literacy in Czech pregnant women is crucial for supporting their optimal course of pregnancy and the future health of their offspring.

Carbohydrate Knowledge Observed to be Low in Vietnamese Women With Gestational Diabetes Mellitus

OBJECTIVE

To assess carbohydrate knowledge of Vietnamese women with gestational diabetes mellitus (GDM) and explore factors associated with carbohydrate knowledge.

METHODS

Vietnamese women (n = 100) with GDM completed an online questionnaire about self-efficacy in managing blood glucose, the habit of regularly self-monitoring blood glucose activities at home, and an adapted culturally tailored carbohydrate quiz for the target population.

RESULTS

Participants (30 ± 4 years) answered on average 51% of the carbohydrate knowledge questions correctly, showing most difficulty in identifying honey, milk, and orange juice as carbohydrate sources. Only 46% of participants correctly identified carbohydrate content on nutrition labels, and 58% practice self-monitoring blood glucose activities at home. Carbohydrate knowledge was positively associated with self-efficacy in blood glucose management (r² = 0.101, P = 0.003) and practicing self-monitoring blood glucose (r² = 0.064, P = 0.013).

CONCLUSIONS AND IMPLICATIONS

There is a need to provide nutrition education about carbohydrate knowledge and blood glucose control to Vietnamese women to manage GDM.

Adherence to Dietary Guidelines among Women with and without Gestational Diabetes: Evidence from the Growing up in New Zealand Study

Diet is thought to play a role in the development and management of gestational diabetes mellitus (GDM). Dietary guidelines provide practical recommendations for achieving nutrient requirements and mitigating the risk of chronic disease. The aim of this study was to describe the adherence to dietary guidelines by women with and without GDM and determine whether adherence is associated with the development of GDM. Adherence to Ministry of Health food group recommendations was assessed in 5391 pregnant women participating in the Growing Up in New Zealand study. A food frequency questionnaire (FFQ) administered during pregnancy provided dietary data. The presence of GDM was determined using diagnostic coding in clinical data and blood glucose results. A quarter of women did not meet any food group recommendations. There were no significant differences in the number of food group targets met by women with or those without GDM. Meeting food group recommendations was not associated with odds of having GDM in adjusted analyses. This study found adherence to dietary recommendations is poor in both women with and without GDM and no association between adherence to food group recommendations and the development of GDM. Greater support is required to assist women to achieve food and nutrition recommendations.

Understanding Determinants of Pregnant Women's Knowledge of Lifestyle-Related Risk Factors: A Cross-Sectional Study

Research indicates that a woman’s lifestyle during pregnancy influences her child’s health and development. Therefore, women need to possess sufficient knowledge regarding the elements of a healthy lifestyle during pregnancy. To date, there has been little research on the assessment of lifestyle knowledge of pregnant women in the perinatal healthcare setting. This study describes the development and application of a knowledge-based questionnaire for pregnancy to be used in a lifestyle intervention trial conducted in Germany. Within the trial, pregnant women receive counselling on lifestyle topics. These topics are based on the German initiative ‘Healthy Start—Young Family Network’ (GiL), which provides evidence-based recommendations regarding diet and lifestyle before and during pregnancy. These serve as a basis for health professionals who provide counselling on healthy lifestyle choices during the antenatal period. The questionnaire consists of eight items, each of which can be answered using ‘Yes’, ‘No’ or ‘Don’t know’. The pregnant women who completed the questionnaire at baseline around the twelfth week of gestation were recruited within the host trial from gynaecological practices in Germany. Demographic variables and the respondents’ answers to the questionnaire were analysed using descriptive statistics and regression analyses. Descriptive statistics show that more than 85% of participants answered the majority of questions (n = 5) correctly. Questions on whether tap water is safe and the normal range for gestational weight gain (GWG) were answered correctly by about 62% and 74% of the women, respectively, and the question on whether it is beneficial to obtain information on breastfeeding at an early stage was answered correctly by about 29%. The results of the regression analyses indicate that age, gestational week, education and income are positive predictors for answering the questionnaire correctly. Nullipara and migration background are predictors for answering the questions incorrectly. This study indicates that there are gaps in women’s knowledge regarding lifestyle during pregnancy. Particular focus on certain topics, such as breastfeeding and normal GWG ranges, is still required during counselling. Our analysis shows that migration background is a predictor of insufficient knowledge and incorrect answers to the questions. Women with such backgrounds require special attention during antenatal counselling in order to cater to their needs and the gaps in their knowledge.

Effectiveness of national multicentric school-based health lifestyles intervention among chinese children and adolescents on knowledge, belief, and practice toward obesity at individual, family and schools' levels

BACKGROUND

This study aims to evaluate the effectiveness of the trial of national multicentric school-based health lifestyles intervention toward childhood obesity on the KBP at individual, family and schools' levels.

METHODS

The national trial was a multi-centered, cluster-controlled trial, which was conducted in seven provinces from September 2013 to February 2014, aiming at preventing childhood overweight and obesity. Integrated intervention strategies focused on changing specific practice related to energy intake and expenditure, such as decreasing the consumption of sweetened fizzy drinks, increasing the consumption of vegetables, ensuring proper protein intake, reducing sedentary practice including screen time, and maintaining at least 1 h of moderate to vigorous physical activity. A total of 27,477 children and adolescents in the control group and 30,997 in the intervention group were recruited with a mean follow-up period of 6.7 months. The binomial response mixed-effects model was used for assessing the effects of the national school-based health lifestyles intervention on obesity-related KBP at students individual, parents' and schools' levels.

RESULTS

Children and adolescents in the intervention group mastered better obesity-related knowledge, and they had higher correct response rates to all questions about obesity-related knowledge compared to the control group (P < 0.05). In terms of obesity-related belief, individuals in the intervention group was more motivated than the control group, participants in the intervention group had higher correctness of 71.18, 52.94, and 56.60% than the control group of 68.61, 49.86, and 54.43%, (P < 0.05). In addition, healthier habits of eating breakfast and drinking milk every day were observed in the intervention group. For the beliefs toward obesity, parents of the intervention group had higher correctness than the control group. At the same time except for the fruit consumption, other obesity-related practice in the intervention group were healthier than the control group (P < 0.05). Except for some beliefs and practice, the intervention effect at the parent level was not significant in other aspects.

CONCLUSION

The obesity-related knowledge and beliefs of children and adolescents got improved significantly. However, the effects on the knowledge, beliefs and certain practices of their parents and school administrators failed to reach significance.

Information seeking behaviors, attitudes, and beliefs about pregnancy-related nutrition and supplementation: A qualitative study among US women

Background: Maternal behavior during pregnancy is crucial to her own and her infant's health, and as such, it is important to understand the nutrition and supplement habits of women during pregnancy and what informs those behaviors. Aim: We aimed to assess the information seeking habits, attitudes, and beliefs about pregnancy-related nutrition and supplementation among pregnant women in the United States. Methods: Qualitative study using key informant interviews with pregnant and recently pregnant (n = 21) US women. Themes related to concerns, attitudes, behaviors, and information seeking habits were extracted. Results: The mean age was 31.9 years and all had at least a university degree. Two major themes that emerged: (1) nutrition information-related attitudes and beliefs and (2) food and supplement-related attitudes and beliefs. Pregnant women in the US were underwhelmed with their health care provider experience when receiving information about pregnancy-related nutrition and supplementation. Nutrition was most often addressed in a reactive manner while women desired a more proactive approach. As a result, they conducted their own research using the internet as their primary tool, and ultimately made nutrition and supplement decisions based largely on their own instincts. Conclusion: Women interviewed for this study encountered barriers to pregnancy related nutrition information from a lack of clear communication from their health care provider and ambiguity and inconsistencies in information within and between sources. Women relied on themselves for information seeking and nutrition related decision making throughout their pregnancy.

Development and validation of the 'Knowledge of Gestational Diabetes (GDM)' questionnaire among a sample of women with GDM in Australia

OBJECTIVE

At present, there are few validated tools that measure women's knowledge of GDM and no tool was located, that measured effective self-management of GDM. To address this gap, this study aimed to assess the validity and reliability of the 'Knowledge of GDM' questionnaire, for use by pregnant women.

METHODS

A total of 116 pregnant women, with recently diagnosed GDM, were recruited from a public hospital in Australia. Content validity, construct validity, internal consistency reliability and test-retest reliability of the questionnaire were undertaken as part of the validation process.

RESULTS

The questionnaire performed well in terms of content validity and internal consistency. Test-retest reliability indicated that the instrument was effective at measuring knowledge of GDM over time.

CONCLUSION

we concluded that the Knowledge of GDM questionnaire is a reliable and valid measure of GDM knowledge, nutrition values and self-management principles.

PRACTICE IMPLICATIONS

The questionnaire can be used to effectively determine knowledge gaps and the information needs of pregnant women with GDM. This information can then be used to improve health literacy and provide targeted support for women to better self-manage GDM.

Culinary nutrition course equips future physicians to educate patients on a healthy diet: an interventional pilot study

BACKGROUND

Poor-quality diet is associated with one in five deaths globally. In the United States, it is the leading cause of death, representing a bigger risk factor than even smoking. For many, education on a healthy diet comes from their physician. However, as few as 25% of medical schools currently offer a dedicated nutrition course. We hypothesized that an active learning, culinary nutrition experience for medical students would improve the quality of their diets and better equip them to counsel future patients on food and nutrition.

METHODS

This was a prospective, interventional, uncontrolled, non-randomized, pilot study. Ten first-year medical students at the Wayne State University School of Medicine completed a 4-part, 8-h course in culinary-nutritional instruction and hands-on cooking. Online assessment surveys were completed immediately prior to, immediately following, and 2 months after the intervention. There was a 100% retention rate and 98.8% item-completion rate on the questionnaires. The primary outcome was changes in attitudes regarding counselling patients on a healthy diet. Secondary outcomes included changes in dietary habits and acquisition of culinary knowledge. Average within-person change between timepoints was determined using ordinary least squares fixed-effect models. Statistical significance was defined as P ≤ .05.

RESULTS

Participants felt better prepared to counsel patients on a healthy diet immediately post-intervention (coefficient = 2.8; 95% confidence interval: 1.6 to 4.0 points; P < .001) and 2 months later (2.2 [1.0, 3.4]; P = .002). Scores on the objective test of culinary knowledge increased immediately after (3.6 [2.4, 4.9]; P < .001) and 2 months after (1.6 [0.4, 2.9]; P = .01) the intervention. Two months post-intervention, participants reported that a higher percentage of their meals were homemade compared to pre-intervention (13.7 [2.1, 25.3]; P = .02).

CONCLUSIONS

An experiential culinary nutrition course may improve medical students' readiness to provide dietary counselling. Further research will be necessary to determine what effects such interventions may have on the quality of participants' own diets.

Pregnant Women Have Poor Carbohydrate Knowledge and Do Not Receive Adequate Nutrition Education

OBJECTIVES

In order to manage blood glucose levels in pregnancy, women need to know what and how much to eat, particularly for foods containing carbohydrate. The aim was to assess pregnant women's carbohydrate and standard serve size knowledge and examine whether health professionals provided nutrition education.

METHODS

Between July 2017 and April 2018 Australian pregnant women were recruited to complete an online survey, including a modified PedCarbQuiz carbohydrate knowledge questionnaire and an online buffet, where they selected images equivalent to one Australian Guide to Healthy Eating (AGHE) standard serve size.

RESULTS

186 pregnant women (mean age 30.9 years, SD = 4.7 years) 12-22 weeks gestation completed the survey. Participants achieved a median score of 27/36 for identification of carbohydrate-containing foods and a median score of 1/12 (range 0-11) for identification of grams of carbohydrate in specific portions. Participants achieved a median score of 14/22 (range 4-19) for identification of one AGHE standard serve of 11 carbohydrate-containing foods. Less than half (n = 92, 49.5%) received nutrition education from health professionals.

CONCLUSIONS FOR PRACTICE

Pregnant women had sub-optimal carbohydrate knowledge. This could contribute to impaired blood glucose concentrations and risk of adverse health outcomes in pregnancy. Opportunities for pregnant women to access nutrition advice from health professionals should be explored.

Maternal Diet Influences Fetal Growth but Not Fetal Kidney Volume in an Australian Indigenous Pregnancy Cohort

Suboptimal nutrition during pregnancy is recognised as a significant modifiable determinant in the development of chronic disease in offspring in later life. The current study aimed: (i) to assess the dietary intakes of pregnant Indigenous Australian women against national recommendations and (ii) to investigate the associations between maternal nutrition during pregnancy and the growth of the offspring, including kidney development in late gestation in the Gomeroi gaaynggal cohort (n = 103). Maternal dietary intake in the third trimester was assessed using the Australian Eating Survey Food Frequency Questionnaire. Estimated fetal weight (EFW) and kidney size were obtained by ultrasound. Birth weight was retrieved from hospital birth records. Of the five key nutrients for optimal reproductive health (folate, iron, calcium, zinc and fibre), the nutrients with the highest percentage of pregnant women achieving the nutrient reference values (NRVs) were zinc (75.7%) and folate (57.3%), whereas iron was the lowest. Only four people achieved all NRVs (folate, iron, calcium, zinc and fibre) important in pregnancy. Sodium and saturated fat intake exceeded recommended levels and diet quality was low, with a median score of 28 out of 73 points. After adjusting for smoking and pre-pregnancy body mass index, only maternal intake of retinol equivalents and the proportion of energy from nutrient-dense or energy-dense, nutrient-poor (EDNP) foods were associated with fetal growth. EFW decreased by 0.13 g and birth weight decreased by 0.24 g for every µg increase in maternal dietary retinol intake. Interestingly, EFW, but not actual birth weight, was positively associated with percentage energy from nutrient dense foods and negatively associated with percentage energy from EDNP foods. Dietary supplement usage was associated with increased birthweight, most significantly iron and folate supplementation. Current dietary intakes of pregnant Australian women from this cohort do not align with national guidelines. Furthermore, current findings show that maternal retinol intake and diet composition during pregnancy can influence fetal growth, but not fetal kidney growth in late gestation. Strategies that aim to support and optimise nutrient intakes of Indigenous pregnant women are urgently needed. Future studies with long-term follow-up of the children in the current cohort to assess renal damage and blood pressure are imperative.

First 1000 days: New Zealand Mothers' perceptions of early life nutrition resources

Research into associations between early life nutritional exposures and vulnerability to adult non-communicable disease (NCD) highlights the importance of maternal diet. A booklet outlining evidence-based dietary guidelines for the first 1000 days of life was first published in 2016 by early life nutrition experts for distribution to pregnant women in Australia and New Zealand. First-time New Zealand mothers' (n=9) perceptions of the booklet and its relevance for the future health of their child were explored via semi-structured focus groups and interviews. Recruitment took place via social media channels and antenatal classes around Auckland. Three major themes were identified using thematic analysis: 1. A difference in the ways mothers related to the booklet depending on their apparent level of health literacy and communication preferences; 2. A tendency for women to outsource decision-making to nutrition 'rules', rather than interpreting information to suit personal circumstances; 3. Intense pressure to comply, resulting in feelings of shame or guilt when the 'rules' were not followed. In this study, first-time mums expressed feeling under pressure to 'get it right' and identified a desire for more support from healthcare providers and society. Nutrition education is essential; however, a booklet should provide a starting point for conversation rather than a stand-alone list of recommendations. Further exploration is needed to develop a resource that can be used by health professionals working alongside women and their partners to support healthy child development.

Impact of Physical Activity on Challenging Obesity in Pakistan: A Knowledge, Attitude, and Practice (KAP) Study

Physical activity (PA) refers to any action produced by skeletal muscle that consumes energy. According to the World Health Organization (WHO), PA is the primary element that can improve health at the community level. Obviously, PA plays an important role in the social, physical, and mental development of men and women, as well as in balancing weight. However, the large-scale negative impacts of physical inactivity on health-related issues are also recognized globally, such as obesity, which is the source of many non-communication diseases (NCDs). In Pakistan alone, 46% of deaths occur due to NCD. The majority of NCD deaths are linked to obesity, and Pakistan is the ninth most obese country in the world. Research on obesity caused by sedentary work in Pakistan is lacking, especially among university employees. To fill this gap, the current study mainly focuses on the rising non-communicable disease (NCD) rates among university employees in Pakistan due to a lack of exercise (obesity, in this case), with the help of a self-designed knowledge, attitude, and practice (KAP) questionnaire. Five universities in the Sindh province of Pakistan were surveyed (n = 276), following the concept of Yin-Yang as a theoretical lens. The results of the current study show that the knowledge, behaviors, and attitudes of university employees have a great influence on their body mass index (BMI). The study shows that Pakistani residents' (especially teaching staff) perceptions and attitudes towards obesity and PA have been instructive, but their practices need to be improved.

Food and Nutrition-Related Knowledge, Attitudes, and Practices among Reproductive-Age Women in Marginalized Areas in Sri Lanka

Nutrient deficiencies are a public health problem in Sri Lanka. Achieving food security is a major challenge due to unhealthy eating patterns. The nutritional status of a woman and her knowledge is a powerful indicator of the nutritional security of her children and household food security. Nutrition-related knowledge and attitude are necessary for dietary changes towards a healthier dietary pattern. For that reason, food and nutrition-related Knowledge, Attitude and Practice (KAP) is one of the key factors to achieving household food and nutritional security. The main objective of this study is to assess the food and nutrition-related KAP among reproductive-age women and understanding of household food and nutritional security in Sri Lanka as an example for marginalized societies. Thus, a cross-sectional survey was conducted using the KAP model questionnaire administered on 400 reproductive age women (18–49 Years) in marginalized areas in Sri Lanka. Data were collected using a random sampling method. The research results clearly showed that the reproductive age women have a low level of nutritional knowledge in the areas being investigated. Most women have a positive attitude towards receiving nutritional knowledge but have low-level practice about a healthy diet. Furthermore, knowledge, practices, and attitudes of women largely affect their BMI status, as well as household food security. Multiple linear regression analysis was used to analyze the influential factors. There was a highly significant positive correlation between nutritional knowledge, attitude score, and BMI level and a significant difference was found in the area, age, family size, monthly income, educational level, attitudes towards nutrition, food and nutrition practices across the reproductive women (R²: 467, p < 0.01). The research results showed that KAP largely determines women’s nutrition and household food security. Based on the results of this research, there is a need to enhance nutritional education in reproductive-age women in marginalized areas in Sri Lanka.

Influence of dietary intake and decision-making during pregnancy on birth outcomes

AIM

This study aimed to examine dietary intake and decision-making in a cohort of pregnant South-East Queensland women to determine compliance with dietary guidelines and the relationships between dietary intake, decision-making and birth outcomes.

METHODS

Pregnant women attending maternity services at participating hospitals reported food frequency and motivations using the Maternal Outcomes and Nutrition Tool, a novel digital instrument. Birth outcomes were sourced from hospital records. A cross-sectional cohort design was used to examine the data.

RESULTS

Analysis demonstrated suboptimal intake of core food groups; meat and alternatives (median [IQR]) (2.6 [2.0-3.4] serves/day) and grains (3.1 [2.1-4.1]) fell below recommendations; fruit (3.8 [2.5-5.3]) and discretionary foods (3.1 [2.1-4.4]) exceeded them. Hypertensive disorders demonstrated a negative linear relationship with vegetable intake (P = .017). Cultural diversity was significantly associated with decreased birthweight (P = .022) but increased intake of meat and alternatives (3.1 vs 2.6, P < .001) compared to Caucasian women; median intake of meat and alternatives was lower in women who reported smoking in the examined time frame. Smokers were less likely to declare health motives for food selection than non-smokers; smoking and health were inversely associated with increasing maternal age. Food choice was primarily sensory-driven.

CONCLUSIONS

This cohort demonstrated poor adherence to dietary guidelines. Culturally and linguistically diverse women and smokers exhibit dietary behaviours which may contribute to suboptimal birth outcomes; targeted nutrition counselling may improve outcomes in these women. These findings highlight the need for transdisciplinary maternity care and provide a foundation for further research aimed at optimising nutrition-related birth outcomes in at-risk groups.

Evaluation of questionnaire as an instrument to measure the level of nutritional and weight gain knowledge in pregnant women in Poland. A pilot study

Pregnancy is a period in life in which women are willing to improve their lifestyle. Providing proper information for these women is crucial for their health and the health of their offspring. Clear information about weak points in their nutritional and weight gain knowledge is the first step for proper health care assistance. There are a few previous studies evaluating the nutritional and weight gain knowledge of pregnant women. In the few studies available, different approaches were taken and there was no wider discussion on the content of the questionnaires attempting to measure level of knowledge. The aim of this study, designed in a pilot fashion, was to test the adequacy of the questionnaire as a research instrument in a group of 139 pregnant Polish women. The developed instrument is a 33-item questionnaire comprising four domains: weight gain, importance of nutrients, quality and quantity of food intake. The results of this study indicate that the questionnaire is stable and internal consistency is acceptable (Cronbach’s alpha > 0.7) for dimensions with more than four items. For dimensions with less than four items, internal consistency was poor (Cronbach’s alpha < 0.7). The cumulative explained variance for domains weight gain, importance of nutrients, quantity and quality of food intake was 54.74%, 42.74%, 54.42% and 48.99% respectively. Results from validity, reliability and factor analysis indicate that the questionnaire is adequate for its purpose.

A comparative study on nutritional knowledge and dietary behavior between Korean and Chinese postpartum women

BACKGROUND/OBJECTIVES

Proper nutrition intake during pregnancy and lactation is very important to both mothers and babies. Pregnant women should maintain proper nutritional status to restore decreased physical strength due to pregnancy and childbirth and produce breastmilk for the growth and development of the baby. Recently, the number of Chinese people living in Korea has increased as the exchange between Korea and China becomes active. It is important to provide proper nutrition education for pregnant women of both countries considering cultural differences.

SUBJECTS/METHODS

The subjects of this study were postpartum women in Gyeonggi, South Korea and Jinhua, China. The subjects were 20-45 years old less than six months after childbirth. A survey, using self-administered questionnaires, was conducted from October 2018 to January 2019. For data analysis, 221 Korean postpartum women (KPW) and 221 Chinese postpartum women (CPW) questionnaires were used.

RESULTS

KPW had significantly higher nutritional knowledge score and dietary attitude score than CPW (P < 0.001). However, overall score for dietary habits was significantly higher in CPW compared to KPW (P < 0.001). In KPW, nutritional knowledge (P < 0.01) and dietary attitude (P < 0.001) had significantly positive correlations with dietary habits. The proportions of KPW and CPW who answered that they had experience of nutrition education were 28.5% and 80.1% (P < 0.001). The score for dietary habits was lower as the hours for watching TV and using mobile phone became longer in postpartum women of both countries, with significant differences in KPW (P < 0.001) and CPW (P < 0.05). In KPW, the score for dietary habits in postpartum women with exercise experience was significantly higher than that in postpartum women without exercise experience (P < 0.001).

CONCLUSIONS

More pregnancy-related nutrition education should be provided and various and effective nutrition education programs, which not only transfer information but can be practiced in the actual life, should be developed.

The Nutritional Behaviour of Pregnant Women in Poland

A woman's diet during pregnancy can significantly affect her health, as well as her child's future development and well-being. Unfortunately, many pregnant women do not follow the recommended nutritional guidelines. The reason could be that they have insufficient knowledge about nutritional best practice. Accordingly, the purpose of this study is to investigate the nutritional behaviour of pregnant women in Poland. The research was conducted using a questionnaire to survey a sample of N = 815 pregnant women in first pregnancy. Among the findings were that the subjects ate an excessive amount of sweets, and white bread, and consumed insufficient quantities of fish, milk and fermented milk drinks. Subjects chose white bread more often than wholemeal bread, and fruit rather than vegetables. The study showed that the nutritional behaviour of pregnant women was characterised by many bad practices.

Evaluation of the effectiveness and usability of an educational portion size tool, ServARpreg, for pregnant women

BACKGROUND

Elevated blood glucose levels in pregnancy increases the risk of adverse pregnancy outcomes. Modifying consumption of carbohydrate-rich foods is important for blood glucose regulation; however, the tools commonly used to assist in guiding portion control are impractical. The present study aimed to evaluate usability of ServARpreg, a mobile phone-based nutrition tool, and its effectiveness with respect to improving carbohydrate and standard serve size knowledge in pregnant women.

METHODS

A baseline survey assessed knowledge of carbohydrates and standard serve sizes of pregnant women. A subset of women living in Newcastle were invited to use ServARpreg, containing pregnancy nutrition information and augmented reality guidance on portion control. A follow-up survey was sent to all women 4 weeks after baseline and women who received ServARpreg also received a process evaluation survey after 10 weeks.

RESULTS

Responses were received from 186 pregnant women for the baseline survey, with 97 completing the follow-up (52.2%). Of the 56 women eligible to receive ServARpreg in the sub-study, 47 accepted (83.9%) and, of these, 40 completed the process evaluation survey (85.1%). At follow-up, there was a significant group × time interaction in favour of the ServARpreg group for carbohydrate quantification knowledge (F_1,279  = 9.705, P = 0.002). Standard serve size knowledge did not change between groups. In the process evaluation survey, 80% strongly agreed/agreed that ServARpreg made them more aware of how much they ate and 72.5% found ServARpreg easy to use.

CONCLUSIONS

ServARpreg has shown potential to educate pregnant women about carbohydrate quantification and increase portion size awareness. Further refinement of the tool and evaluation is needed to improve standard serve size knowledge.

What do pregnant women eat, and are they meeting the recommended dietary requirements for pregnancy?

OBJECTIVE

To compare the dietary intake of pregnant women to the 2013 Australian Dietary Guidelines and explore factors associated with inadequate intake.

DESIGN

Dietary intake data were collected between July 2011 and July 2012 (n = 1570) using a 74-item food frequency questionnaire.

SETTING

Metropolitan public health hospitals in Melbourne, Australia.

PARTICIPANTS

Pregnant women, at least 16 years of age, with a singleton pregnancy, and literate in English.

MEASUREMENTS AND FINDINGS

The highest proportion of women met the recommended daily servings for fruit (65.7%), followed by dairy products (55.2%), meat/meat alternatives (31.1%), vegetables (10.3%), and then grain foods (1.8%). A majority of women (83.8%) regularly consumed up to 2.5 serves of discretionary foods per day. Only one woman met the minimum recommended daily servings for all five food groups. Women who were obese were more likely to consume an inadequate diet (Adj. OR 2.13, 95% CI 1.53, 2.95); and having a university degree was associated with a lower odds of consuming an inadequate diet (Adj. OR 0.63, 95% CI 0.50, 0.78).

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Pregnancy care providers need to be aware of women's low compliance with the national dietary guidelines, particularly regarding the poor intake of vegetables and grain foods; targeted as well as population-based approaches may be required.

Nutrition-Related Knowledge, Attitudes, and Practices (KAP) among Kindergarten Teachers in Chongqing, China: A Cross-Sectional Survey

Kindergarten teachers play an important role in providing kindergarten children with education on nutrition. However, few studies have been published on nutrition-related knowledge, attitudes, and practices (KAP) of Chinese kindergarten teachers. This study aimed to assess the nutrition-related knowledge, attitudes, and practices (KAP) of kindergarten teachers in Chongqing, China. Thus, a cross-sectional survey was conducted using a structured KAP model questionnaire administered to 222 kindergarten teachers, who were senior teachers from 80 kindergartens in 19 districts and 20 counties in Chongqing. Multiple regression analysis was used to analyze the influential factors. Among the participants, 54.2% were familiar with simple nutrition-related knowledge; only 9.9% of them were satisfied with their knowledge of childhood nutrition; and 97.7% of them had a positive attitude to learn nutrition-related knowledge. Only 38.7% of the participants had attended pediatric nutrition knowledge courses or training. Multiple regression analysis confirmed significant independent effects on the nutrition knowledge score (p < 0.0001) of respondents on age, type of residence, type of kindergarten, body mass index(BMI), professional training of kindergarten teachers, behavior of having ever participated in childhood nutrition education knowledge courses or training, and behavior of having ever paid attention to children’s nutrition knowledge. The model indicated that independent variables explained 45.4% (adjusted R²) of the variance found in the knowledge scores of respondents. While there were low levels of nutrition knowledge and training, it was still encouraging to note that there were positive attitudes towards acquiring nutrition-related knowledge among kindergarten teachers in Chongqing, China. These findings provide some implications that necessary training measures need to be carried out to improve the nutrition-related knowledge level among kindergarten teachers in China.

Effects of dietary advice on insulin-like growth factors among healthy newborns

OBJECTIVES

In fetal life, insulin, insulin-like growth factor (IGF) 1, IGF 2 and IGF-binding protein (IGFBP) 3 are essential growth factors. The purpose of this study is to investigate the effects of dietary intervention on insulin-like growth factors in the cord blood of neonates.

METHODS

The study involved 52 pregnant women who were followed up in Gazi University Medical School Hospital at Ankara, Turkey. They were randomly divided into two groups: The experimental group was involved in nutrition education. We measured IGF 1, IGF 2 and IGFBP 3 concentrations in cord blood from 52 neonates.

RESULTS

In the experimental group, cord serum levels of IGF 1, IGF 2 were observed to be higher than that of control group.

CONCLUSION

Dietary advice had positive effects on the cord serum IGF 1 and IGF 2 concentrations. Dietary advice during pregnancy proved to be effective in fetal development.

What Should Be Taught in Secondary Schools' Nutrition and Food Systems Education? Views from Prominent Food-Related Professionals in Australia

Education can help young people to attain the knowledge and the skills that they need to make proper food choices and develop lifelong healthy eating patterns. This study explored the perspectives of prominent food-related professionals in Australia regarding essential nutrition and food systems (N&FS) education programs for adolescents during formal education. Semi-structured interviews were conducted with 21 prominent food-related professionals in Australia. Interview transcripts were analysed thematically. Four essential areas for N&FS education programs were identified. (1) Key nutrition messages to a healthy lifestyle; (2) Skill development programs to enhance health and wellbeing; (3) Ethical food-related lessons to support environmental sustainability, farm animal welfare, local producers, and food security; and, (4) Introductory lessons about foods from farm to plate to facilitate more informed food choices. Findings of this study may provide new insights for curriculum developers in Australia for further assessment of the current gaps in N&FS components of secondary school curriculum. Integration of these four areas into secondary school curricula has the potential to enhance adolescents’ knowledge of important scientific and ethical issues in a range of N&FS fields, and enable them to develop fundamental food-related life skills that are supportive of health and wellbeing.

Informing Nutrition Care in the Antenatal Period: Pregnant Women's Experiences and Need for Support

This study aimed to provide insights into Australian women's experiences in gaining nutrition information during pregnancy. Individual semistructured telephone interviews were conducted with 17 pregnant (across all trimesters) and 9 postpartum women in five Australian states. Data were transcribed and analysed using inductive thematic analysis. Women valued nutrition information, actively sought it, and passively received it mainly from three sources: healthcare providers (HCPs), media, and their social networks. Women reported HCPs as highest for reliability but they had limited time and indifferent approaches. Various media were easily and most frequently accessed but were less reliable. Social networks were considered to be the least reliable and least accessed. Women reported becoming overwhelmed and confused. This in turn influenced their decisions (pragmatic/rational) and their eating behaviours (“overdo it,” “loosen it,” “ignore it,” and “positive response”). Individual and environmental barriers impacted their application of knowledge to dietary practice. Women wanted more constructive and interactive engagement with their HCPs. This study identified the need to establish and maintain mutually respectful environments where women feel able to raise issues with their HCPs throughout their pregnancies and where they are confident that the information they receive will be accurate and meet their needs.

A Brief Tool to Assess Image-Based Dietary Records and Guide Nutrition Counselling Among Pregnant Women: An Evaluation

Background

Dietitians ideally should provide personally tailored nutrition advice to pregnant women. Provision is hampered by a lack of appropriate tools for nutrition assessment and counselling in practice settings. Smartphone technology, through the use of image-based dietary records, can address limitations of traditional methods of recording dietary intake. Feedback on these records can then be provided by the dietitian via smartphone. Efficacy and validity of these methods requires examination.

Objective

The aims of the Australian Diet Bytes and Baby Bumps study, which used image-based dietary records and a purpose-built brief Selected Nutrient and Diet Quality (SNaQ) tool to provide tailored nutrition advice to pregnant women, were to assess relative validity of the SNaQ tool for analyzing dietary intake compared with nutrient analysis software, to describe the nutritional intake adequacy of pregnant participants, and to assess acceptability of dietary feedback via smartphone.

Methods

Eligible women used a smartphone app to record everything they consumed over 3 nonconsecutive days. Records consisted of an image of the food or drink item placed next to a fiducial marker, with a voice or text description, or both, providing additional detail. We used the SNaQ tool to analyze participants’ intake of daily food group servings and selected key micronutrients for pregnancy relative to Australian guideline recommendations. A visual reference guide consisting of images of foods and drinks in standard serving sizes assisted the dietitian with quantification. Feedback on participants’ diets was provided via 2 methods: (1) a short video summary sent to participants’ smartphones, and (2) a follow-up telephone consultation with a dietitian. Agreement between dietary intake assessment using the SNaQ tool and nutrient analysis software was evaluated using Spearman rank correlation and Cohen kappa.

Results

We enrolled 27 women (median age 28.8 years, 8 Indigenous Australians, 15 primiparas), of whom 25 completed the image-based dietary record. Median intakes of grains, vegetables, fruit, meat, and dairy were below recommendations. Median (interquartile range) intake of energy-dense, nutrient-poor foods was 3.5 (2.4-3.9) servings/day and exceeded recommendations (0-2.5 servings/day). Positive correlations between the SNaQ tool and nutrient analysis software were observed for energy (ρ=.898, P<.001) and all selected micronutrients (iron, calcium, zinc, folate, and iodine, ρ range .510-.955, all P<.05), both with and without vitamin and mineral supplements included in the analysis. Cohen kappa showed moderate to substantial agreement for selected micronutrients when supplements were included (kappa range .488-.803, all P ≤.001) and for calcium, iodine, and zinc when excluded (kappa range .554-.632, all P<.001). A total of 17 women reported changing their diet as a result of the personalized nutrition advice.

Conclusions

The SNaQ tool demonstrated acceptable validity for assessing adequacy of key pregnancy nutrient intakes and preliminary evidence of utility to support dietitians in providing women with personalized advice to optimize nutrition during pregnancy.