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Phelan S, Jelalian E, Coustan D, Caughey AB, Castorino K, Hagobian T, Muñoz-Christian K, Schaffner A, Shields L, Heaney C, McHugh A, Wing RR. Randomized controlled trial of prepregnancy lifestyle intervention to reduce recurrence of gestational diabetes mellitus. Am J Obstet Gynecol 2023; 229:158.e1-158.e14. [PMID: 36758710 DOI: 10.1016/j.ajog.2023.01.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Preconception lifestyle intervention holds potential for reducing gestational diabetes mellitus, but clinical trial data are lacking. OBJECTIVE This study aimed to determine the effects of a prepregnancy weight loss intervention on gestational diabetes mellitus recurrence in women with overweight/obesity and previous gestational diabetes mellitus. STUDY DESIGN A 2-site, randomized controlled trial comparing a prepregnancy lifestyle intervention with educational control was conducted between December 2017 and February 2022. A total of 199 English- and Spanish-speaking adults with overweight/obesity and previous gestational diabetes mellitus were randomized to a 16-week prepregnancy lifestyle intervention with ongoing treatment until conception or educational control. The primary outcome was gestational diabetes mellitus recurrence. Analyses excluded 6 participants who conceived but did not have gestational diabetes mellitus ascertained by standard methods. RESULTS In the 63 (33%) women who conceived and had gestational diabetes mellitus ascertained (Ns=38/102 [37%] intervention vs 25/91 [28.0%] control; P=.17), those in the intervention group had significantly greater weight loss at 16 weeks compared with controls (4.8 [3.4-6.0] vs 0.7 [-0.9 to 2.3] kg; P=.001) and a greater proportion lost ≥5% of body weight (50.0% [17/34] vs 13.6% [3/22]; P=.005). There was no significant difference in the incidence of gestational diabetes mellitus recurrence between the intervention (57.9% [ns=23/38]) and the control group (44.0% [ns=11/25]; odds ratio, 1.8 [0.59-5.8]). Independent of group, greater prepregnancy weight loss predicted 21% lower odds of gestational diabetes mellitus recurrence (odds ratio, 0.79 [0.66-0.94]; P=.008). A ≥5% weight loss before conception reduced the odds of gestational diabetes mellitus recurrence by 82% (odds ratio, 0.18 [0.04-0.88]; P=.03). CONCLUSION Lifestyle intervention produced considerable prepregnancy weight loss but did not affect gestational diabetes mellitus rates. Given that the conception rate was 50% lower than expected, this study was underpowered.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, San Luis Obispo, CA.
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI; Weight Control and Diabetes Research Center, Miriam Hospital, Providence, RI
| | - Donald Coustan
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, RI
| | - Aaron B Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR
| | | | - Todd Hagobian
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, San Luis Obispo, CA
| | - Karen Muñoz-Christian
- Department of World Languages and Cultures, California Polytechnic State University, San Luis Obispo, San Luis Obispo, CA
| | - Andrew Schaffner
- Statistics Department, California Polytechnic State University, San Luis Obispo, San Luis Obispo, CA
| | | | - Casey Heaney
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, San Luis Obispo, CA
| | - Angelica McHugh
- Weight Control and Diabetes Research Center, Miriam Hospital, Providence, RI
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI; Weight Control and Diabetes Research Center, Miriam Hospital, Providence, RI
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Heath H, Rosario R, McMichael LE, Fanter R, Alarcon N, Quintana-Diaz A, Pilolla K, Schaffner A, Jelalian E, Wing RR, Brito A, Phelan S, La Frano MR. Gestational Diabetes Is Characterized by Decreased Medium-Chain Acylcarnitines and Elevated Purine Degradation Metabolites across Pregnancy: A Case-Control Time-Course Analysis. J Proteome Res 2023. [PMID: 37129248 DOI: 10.1021/acs.jproteome.2c00430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Gestational Diabetes Mellitus (GDM) results in complications affecting both mothers and their offspring. Metabolomic analysis across pregnancy provides an opportunity to better understand GDM pathophysiology. The objective was to conduct a metabolomics analysis of first and third trimester plasma samples to identify metabolic differences associated with GDM development. Forty pregnant women with overweight/obesity from a multisite clinical trial of a lifestyle intervention were included. Participants who developed GDM (n = 20; GDM group) were matched with those who did not develop GDM (n = 20; Non-GDM group). Plasma samples collected at the first (10-16 weeks) and third (28-35 weeks) trimesters were analyzed with ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Cardiometabolic risk markers, dietary recalls, and physical activity metrics were also assessed. Four medium-chain acylcarnitines, lauroyl-, octanoyl-, decanoyl-, and decenoylcarnitine, significantly differed over the course of pregnancy in the GDM vs Non-GDM group in a group-by-time interaction (p < 0.05). Hypoxanthine and inosine monophosphate were elevated in the GDM group (p < 0.04). In both groups over time, bile acids and sorbitol increased while numerous acylcarnitines and α-hydroxybutyrate decreased (p < 0.05). Metabolites involved in fatty acid oxidation and purine degradation were altered across the first and third trimesters of GDM-affected pregnancies, providing insight into metabolites and metabolic pathways altered with GDM development.
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Affiliation(s)
- Hannah Heath
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, California 93407, United States
| | - Rodrigo Rosario
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, California 93407, United States
| | - Lauren E McMichael
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, California 93407, United States
| | - Rob Fanter
- College of Agriculture, Food and Environmental Sciences, California Polytechnic State University, San Luis Obispo, California 93407, United States
- Cal Poly Metabolomics Service Center, California Polytechnic State University, San Luis Obispo, California 93407, United States
| | - Noemi Alarcon
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California 93407, United States
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California 93407, United States
| | - Adilene Quintana-Diaz
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California 93407, United States
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California 93407, United States
| | - Kari Pilolla
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, California 93407, United States
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California 93407, United States
| | - Andrew Schaffner
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California 93407, United States
- Department of Statistics, California Polytechnic State University, San Luis Obispo, California 93407, United States
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, Rhode Island 02903, United States
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, Rhode Island 02903, United States
| | - Alex Brito
- Laboratory of Pharmacokinetics and Metabolomic Analysis. Institute of Translational Medicine and Biotechnology. I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", I.M. Sechenov First Moscow State Medical University, 119991 Moscow, Russia
| | - Suzanne Phelan
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California 93407, United States
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California 93407, United States
| | - Michael R La Frano
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, California 93407, United States
- Cal Poly Metabolomics Service Center, California Polytechnic State University, San Luis Obispo, California 93407, United States
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California 93407, United States
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Chimera-Khombe B, Barcus G, Schaffner A, Papathakis P. High prevalence, low identification and screening tools of hospital malnutrition in critically- ill patients in Malawi. Eur J Clin Nutr 2022; 76:1158-1164. [PMID: 35110679 DOI: 10.1038/s41430-022-01087-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/12/2022] [Accepted: 01/21/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/OBJECTIVES In Africa, approximately two-thirds of patients are at risk of malnutrition on admission and the nutritional status of patients deteriorates during hospitalization, with associated increased morbidity, mortality, and hospital-related cost. This cross-sectional study aimed at estimating rates of malnutrition in critical care units and determining the extent to which malnutrition diagnoses are documented in medical records by physicians, at two public tertiary hospitals in Malawi. METHODS A total of 315 adult (n = 112) and paediatric (n = 203) participants from Queen Elizabeth Central Hospital and Kamuzu Central Hospital, were included in the analysis. Nutrition status was measured by Subjective Global Assessment (SGA) and Mid-Upper Arm circumference (MUAC) and medical notes were reviewed, in both adults and paediatrics. RESULTS In adults, more than half were malnourished, with a higher proportion considered moderately-to-severely malnourished using SGA compared to MUAC (84.8%; 57.3%, respectively). Likewise, in paediatrics, a higher proportion was considered moderately-to-severely malnourished using SGA compared to MUAC (84.7%; 23.4%, respectively). Both adult and paediatric patients with cancer had the highest rates of malnutrition. Only 12.9% and 9.6% had documentation of malnutrition diagnosis in the medical record, for paediatrics and adult patients, respectively. CONCLUSION The high rates of hospital malnutrition in critically ill patients in Malawi call for comprehensive screening practices and methods; complemented by documentation of the malnutrition diagnosis and use of nutrition interventions by dietitians. This includes enteral, parenteral and supplemental nutrition as a prerequisite for patient recovery in hospitals.
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Affiliation(s)
| | - Grace Barcus
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, 93407, USA
| | - Andrew Schaffner
- Department of Statistics, California Polytechnic State University, San Luis Obispo, CA, 93407, USA
| | - Peggy Papathakis
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, 93407, USA
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Jensen AJ, Perrine JD, Schaffner A, Brewster R, Giordano AJ, Robertson M, Siepel N. Mammal use of undercrossings is influenced by openness and proximity to riparian corridors. Wildl Res 2022. [DOI: 10.1071/wr21183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Seal A, Schaffner A, Phelan S, Brunner‐Gaydos H, Tseng M, Keadle S, Alber J, Kiteck I, Hagobian T. COVID-19 pandemic and stay-at-home mandates promote weight gain in US adults. Obesity (Silver Spring) 2022; 30:240-248. [PMID: 34467670 PMCID: PMC8662140 DOI: 10.1002/oby.23293] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to prospectively examine the effect of state stay-at-home mandates on weight of US adults by BMI over 3 months during COVID-19. METHODS US adults completed an online questionnaire containing demographics, weight, physical activity, sedentary time, fruit/vegetable intake, depressive symptoms, stress, and sleep at baseline (May 2020) and after 3 months (August 2020). RESULTS Participants gained 0.6 kg (76.7-77.3 kg, p = 0.002). A total of 26% of those with obesity gained > 2 kg compared with 14.8% of those with normal weight (p < 0.001). A total of 53.3% of individuals with obesity maintained weight within 2 kg compared with 72.5% of those with normal weight (p < 0.001). Greater weight gain was related to longer stay-at-home mandates (β = 0.078, p = 0.010), lower baseline minutes of physical activity per day (β = -0.107, p = 0.004), greater declines in minutes of physical activity per day (β = -0.076, p = 0.026), depressive symptoms (β = 0.098, p = 0.034), and greater increases in time preparing food (β = 0.075, p = 0.031). CONCLUSIONS US adults gained weight, and stay-at-home mandates were associated with atypical weight gain and greater reported weight gain in individuals with obesity over 3 months.
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Affiliation(s)
- Adam Seal
- Center for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Andrew Schaffner
- Statistics DepartmentCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Suzanne Phelan
- Center for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Hannah Brunner‐Gaydos
- Center for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Marilyn Tseng
- Center for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Sarah Keadle
- Center for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Julia Alber
- Center for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Isabelle Kiteck
- Center for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
| | - Todd Hagobian
- Center for Health ResearchCalifornia Polytechnic State UniversitySan Luis ObispoCaliforniaUSA
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McMichael LE, Heath H, Johnson CM, Fanter R, Alarcon N, Quintana-Diaz A, Pilolla K, Schaffner A, Jelalian E, Wing RR, Brito A, Phelan S, La Frano MR. Correction to: Metabolites involved in purine degradation, insulin resistance, and fatty acid oxidation are associated with prediction of Gestational diabetes in plasma. Metabolomics 2021; 18:4. [PMID: 34923607 DOI: 10.1007/s11306-021-01863-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Lauren E McMichael
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Hannah Heath
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Catherine M Johnson
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Rob Fanter
- College of Agriculture, Food and Environmental Sciences, California Polytechnic State University, San Luis Obispo, CA, USA
- Cal Poly Metabolomics Service Center, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Noemi Alarcon
- Department of Kinesiology and Public Health, California Polytechnic State University, 1 Grand Ave, San Luis Obispo, CA, 93407, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Adilene Quintana-Diaz
- Department of Kinesiology and Public Health, California Polytechnic State University, 1 Grand Ave, San Luis Obispo, CA, 93407, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Kari Pilolla
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Andrew Schaffner
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
- Department of Statistics, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Alex Brito
- Laboratory of Pharmacokinetics and Metabolomic Analysis, Institute of Translational Medicine and Biotechnology. I.M. Sechenov First, Moscow Medical University, Moscow, Russia
- World-Class Research Center Digital Biodesign and Personalized Healthcare, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Suzanne Phelan
- Department of Kinesiology and Public Health, California Polytechnic State University, 1 Grand Ave, San Luis Obispo, CA, 93407, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Michael R La Frano
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA.
- Cal Poly Metabolomics Service Center, California Polytechnic State University, San Luis Obispo, CA, USA.
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA.
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McMichael LE, Heath H, Johnson CM, Fanter R, Alarcon N, Quintana-Diaz A, Pilolla K, Schaffner A, Jelalian E, Wing RR, Brito A, Phelan S, La Frano MR. Metabolites involved in purine degradation, insulin resistance, and fatty acid oxidation are associated with prediction of Gestational diabetes in plasma. Metabolomics 2021; 17:105. [PMID: 34837546 PMCID: PMC8741304 DOI: 10.1007/s11306-021-01857-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/20/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) significantly increases maternal and fetal health risks, but factors predictive of GDM are poorly understood. OBJECTIVES Plasma metabolomics analyses were conducted in early pregnancy to identify potential metabolites associated with prediction of GDM. METHODS Sixty-eight pregnant women with overweight/obesity from a clinical trial of a lifestyle intervention were included. Participants who developed GDM (n = 34; GDM group) were matched on treatment group, age, body mass index, and ethnicity with those who did not develop GDM (n = 34; Non-GDM group). Blood draws were completed early in pregnancy (10-16 weeks). Plasma samples were analyzed by UPLC-MS using three metabolomics assays. RESULTS One hundred thirty moieties were identified. Thirteen metabolites including pyrimidine/purine derivatives involved in uric acid metabolism, carboxylic acids, fatty acylcarnitines, and sphingomyelins (SM) were different when comparing the GDM vs. the Non-GDM groups (p < 0.05). The most significant differences were elevations in the metabolites' hypoxanthine, xanthine and alpha-hydroxybutyrate (p < 0.002, adjusted p < 0.02) in GDM patients. A panel consisting of four metabolites: SM 14:0, hypoxanthine, alpha-hydroxybutyrate, and xanthine presented the highest diagnostic accuracy with an AUC = 0.833 (95% CI: 0.572686-0.893946), classifying as a "very good panel". CONCLUSION Plasma metabolites mainly involved in purine degradation, insulin resistance, and fatty acid oxidation, were altered in early pregnancy in connection with subsequent GDM development.
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Affiliation(s)
- Lauren E McMichael
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Hannah Heath
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Catherine M Johnson
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Rob Fanter
- College of Agriculture, Food and Environmental Sciences, California Polytechnic State University, San Luis Obispo, CA, USA
- Cal Poly Metabolomics Service Center, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Noemi Alarcon
- Department of Kinesiology and Public Health, California Polytechnic State University, 1 Grand Ave, San Luis Obispo, CA, 93407, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Adilene Quintana-Diaz
- Department of Kinesiology and Public Health, California Polytechnic State University, 1 Grand Ave, San Luis Obispo, CA, 93407, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Kari Pilolla
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Andrew Schaffner
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
- Department of Statistics, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Alex Brito
- Laboratory of Pharmacokinetics and Metabolomic Analysis, Institute of Translational Medicine and Biotechnology. I.M. Sechenov First, Moscow Medical University, Moscow, Russia
- World-Class Research Center Digital Biodesign and Personalized Healthcare, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Suzanne Phelan
- Department of Kinesiology and Public Health, California Polytechnic State University, 1 Grand Ave, San Luis Obispo, CA, 93407, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Michael R La Frano
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA.
- Cal Poly Metabolomics Service Center, California Polytechnic State University, San Luis Obispo, CA, USA.
- Center for Health Research, California Polytechnic State University, San Luis Obispo, CA, USA.
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Scudero E, Papathakis P, Schaffner A, Phelan S. Home Food Environments of Mothers in South-Eastern Africa and California-An Illustration of Global Extremes. Glob J Health Sci 2021. [DOI: 10.5539/gjhs.v13n11p35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION: The type and availability of food in the home is known to directly shape food intake and weight status, but cross-cultural differences remain poorly documented.
OBJECTIVE: The purpose of this study was to describe and compare the home food environments of low-income, childbearing women living in a low-income country (Malawi) and a high-income country (United States).
METHODS: A home food environment survey was available in 714 mothers in Malawi (mean BMI 19.5, mean age 22.1 years) and 371 in California (mean BMI 31.8, mean age 28.1 years).
RESULTS: Mothers in California vs. Malawi had on average (SD) 22.8 (4.4) vs. 1.2 (1.4) different food items in the home. The women in California had an abundance of fruits and vegetables that were virtually absent in the homes of Malawian women. The most prevalent food in the homes in Californian women was rice (in 97% homes) and in Malawian women was corn flour (in 47% of homes).
CONCLUSIONS: Given the global extremes in food availability, efforts to address over and under food availabilities in the homes of childbearing women need to move beyond country centric approaches. It is time to consider maternal and child health as a global priority.
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Phelan S, Jelalian E, Coustan D, Caughey AB, Castorino K, Hagobian T, Muñoz-Christian K, Schaffner A, Shields L, Heaney C, McHugh A, Wing RR. Protocol for a randomized controlled trial of pre-pregnancy lifestyle intervention to reduce recurrence of gestational diabetes: Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional. Trials 2021; 22:256. [PMID: 33827659 PMCID: PMC8024941 DOI: 10.1186/s13063-021-05204-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is associated with several maternal complications in pregnancy, including preeclampsia, preterm labor, need for induction of labor, and cesarean delivery as well as increased long-term risks of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Intrauterine exposure to GDM raises the risk for complications in offspring as well, including stillbirth, macrosomia, and birth trauma, and long-term risk of metabolic disease. One of the strongest risk factors for GDM is the occurrence of GDM in a prior pregnancy. Preliminary data from epidemiologic and bariatric surgery studies suggest that reducing body weight before pregnancy can prevent the development of GDM, but no adequately powered trial has tested the effects of a maternal lifestyle intervention before pregnancy to reduce body weight and prevent GDM recurrence. METHODS The principal aim of the Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional is to determine whether a lifestyle intervention to reduce body weight before pregnancy can reduce GDM recurrence. This two-site trial targets recruitment of 252 women with overweight and obesity who have previous histories of GDM and who plan to have another pregnancy in the next 1-3 years. Women are randomized within site to a comprehensive pre-pregnancy lifestyle intervention to promote weight loss with ongoing treatment until conception or an educational control group. Participants are assessed preconceptionally (at study entry, after 4 months, and at brief quarterly visits until conception), during pregnancy (at 26 weeks' gestation), and at 6 weeks postpartum. The primary outcome is GDM recurrence, and secondary outcomes include fasting glucose, biomarkers of cardiometabolic disease, prenatal and perinatal complications, and changes over time in weight, diet, physical activity, and psychosocial measures. DISCUSSION The Gestational Diabetes Prevention /Prevención de la Diabetes Gestacional is the first randomized controlled trial to evaluate the effects of a lifestyle intervention delivered before pregnancy to prevent GDM recurrence. If found effective, the proposed lifestyle intervention could lay the groundwork for shifting current treatment practices towards the interconception period and provide evidence-based preconception counseling to optimize reproductive outcomes and prevent GDM and associated health risks. TRIAL REGISTRATION ClinicalTrials.gov NCT02763150 . Registered on May 5, 2016.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI USA
| | - Donald Coustan
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI USA
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR, USA
| | | | - Todd Hagobian
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Karen Muñoz-Christian
- Department of World Languages and Cultures, California Polytechnic State University, San Luis Obispo, CA USA
| | - Andrew Schaffner
- Statistics Department, California Polytechnic State University, San Luis Obispo, CA USA
| | - Laurence Shields
- Dignity Health, Marian Regional Medical Center, Santa Maria, CA USA
| | - Casey Heaney
- Department of Kinesiology & Public Health, Center for Health Research, California Polytechnic State University, San Luis Obispo, CA USA
| | - Angelica McHugh
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
| | - Rena R. Wing
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, USA
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Barcus GC, Papathakis PC, Schaffner A, Chimera B. Nutrition Screening, Reported Dietary Intake, Hospital Foods, and Malnutrition in Critical Care Patients in Malawi. Nutrients 2021; 13:nu13041170. [PMID: 33916149 PMCID: PMC8066941 DOI: 10.3390/nu13041170] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022] Open
Abstract
In low-income countries there are few data on hospital malnutrition. Reduced food intake combined with nutrient-poor foods served in hospitals contribute to nutritional risk. This study investigated whether reported dietary intake and disease state of hospitalized adults in critical care units was related to malnutrition determined by mid-upper arm circumference (MUAC). Adult in-patients (n = 126) in tuberculosis, burn, oncology, and intensive care units in two public tertiary hospitals in Malawi were screened for nutritional status using MUAC and a question on current dietary intake. The hospital menu was reviewed; portion sizes were weighed. The prevalence of moderate and severe malnutrition was 62%. Patients with organ-related diseases and infectious diseases had the highest rates of reduced reported dietary intake, 71.4% and 57.9%, respectively; however, there was no association between reported dietary intake and MUAC. In those unable to eat, however, the rate of severe malnutrition was 50%. The menu consisted of porridge and thickened corn-based starch with fried cabbage; protein foods were provided twice weekly. There was a nutrient gap of 250 calories and 13 gm protein daily. The findings support the need for increasing dietetic/nutrition services to prevent and treat malnutrition in hospitals using simple screening tools.
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Affiliation(s)
- Grace C. Barcus
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA 93407, USA;
| | - Peggy C. Papathakis
- Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA 93407, USA;
- Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi;
- Correspondence:
| | - Andrew Schaffner
- Department of Statistics, California Polytechnic State University, San Luis Obispo, CA 93407, USA;
| | - Bernadette Chimera
- Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi;
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Chichiri, Blantyre, Malawi
- Kamuzu Central Hospital, Area 33 Mzimba Street, P.O. Box 106, Lilongwe, Malawi
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Hagobian TA, Brunner-Gaydos H, Seal A, Schaffner A, Kitts C, Hubbard R, Malin SK, La Frano MR, Bennion KA, Phelan S. Rationale and design of a randomized controlled trial examining oral administration of bisphenol A on hepatic glucose production and skeletal muscle insulin sensitivity in adults. Contemp Clin Trials Commun 2020; 17:100549. [PMID: 32154432 PMCID: PMC7052501 DOI: 10.1016/j.conctc.2020.100549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 02/10/2020] [Accepted: 02/22/2020] [Indexed: 01/15/2023] Open
Abstract
Previous observational studies have shown that the endocrine disrupting chemical bisphenol A (BPA) is associated with type 2 diabetes, but few studies have examined direct effects of BPA on human health. The purpose of this study is to determine whether orally administered BPA at the US Environmental Protection Agency (EPA) safe dose of 50 μg/kg body weight has an adverse effect on hepatic glucose production and skeletal muscle insulin sensitivity. Forty, non-habitually active, healthy adults of normal weight will be enrolled. Participants will begin with a 2-day baseline energy balance diet low in bisphenols in which urine and blood will be collected, and standard tests performed to assess the primary outcome measures of hepatic glucose production (via [6,6-2H] glucose infusion) and skeletal muscle insulin sensitivity (via euglycemic hyperinsulinemic clamp technique). Secondary outcome measures are fasting hormones/endocrine factors (insulin, glucose, C-peptide, Pro-insulin, adiponectin, 17-beta-estradiol, free fatty acids) related to the pathogenesis of type 2 diabetes. Participants will then be randomly assigned to a 4-day energy balance diet plus oral administration of BPA at 50 μg/kg body weight (Diet + BPA) or 4-day energy balance diet plus oral administration of placebo (Diet + No BPA); all outcome measures will be reassessed after 4 days. Findings from this study will provide a framework for other studies in this area, and provide much needed experimental evidence using gold standard measures as to whether oral BPA administration over several days poses any risk of type 2 diabetes. Bisphenol A is associated with type 2 diabetes. Few studies have examined oral bisphenol A administration on the pathogenesis of type 2 diabetes. This study will examine oral bisphenol A administration on hepatic glucose [6,6-2H] suppression. This study will examine insulin sensitivity (euglycemic hyperinsulinemic clamp technique).
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Affiliation(s)
- Todd A Hagobian
- Center for Health Research, California Polytechnic State University, USA.,Department of Kinesiology and Public Health, California Polytechnic State University, USA
| | - Hannah Brunner-Gaydos
- Center for Health Research, California Polytechnic State University, USA.,Department of Kinesiology and Public Health, California Polytechnic State University, USA
| | - Adam Seal
- Center for Health Research, California Polytechnic State University, USA.,Department of Kinesiology and Public Health, California Polytechnic State University, USA
| | - Andrew Schaffner
- Center for Health Research, California Polytechnic State University, USA.,Department of Statistics, California Polytechnic State University, USA
| | - Chris Kitts
- Department of Biology, California Polytechnic State University, USA
| | - Ryan Hubbard
- Campus Health and Wellbeing, California Polytechnic State University, USA
| | | | - Michael R La Frano
- Center for Health Research, California Polytechnic State University, USA.,Department of Food Science and Nutrition, California Polytechnic State University, USA
| | - Kelly A Bennion
- Center for Health Research, California Polytechnic State University, USA.,Department of Psychology and Child Development, California Polytechnic State University, USA
| | - Suzanne Phelan
- Center for Health Research, California Polytechnic State University, USA.,Department of Kinesiology and Public Health, California Polytechnic State University, USA
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Hagobian T, Phelan S, Schaffner A, Brannen A, McHugh A, Ashby-Thompson M, Gorin A, Pi-Sunyer X, Gallagher D, Wing R. Ripple Effect Of Lifestyle Interventions During Pregnancy On Untreated Partners’ Weight. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000563069.16382.ce] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Hagobian TA, Phelan S, Schaffner A, Brannen A, McHugh A, Ashby-Thompson M, Gorin AA, Pi-Sunyer X, Gallagher D, Wing R. Ripple Effect of Lifestyle Interventions During Pregnancy on Untreated Partners' Weight. Obesity (Silver Spring) 2019; 27:733-739. [PMID: 30957985 PMCID: PMC6478509 DOI: 10.1002/oby.22447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 01/23/2019] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Weight-loss interventions have a positive "ripple effect" on untreated partners' weight, but ripple effects in pregnancy are unknown. The objective of this study was to determine whether prenatal lifestyle interventions that reduce gestational weight gain in pregnant women have a positive ripple effect on untreated partners' weight. METHODS Two clinical trials with the same outcome measures randomly assigned pregnant women to a lifestyle intervention or usual care. Untreated partners were randomly assigned according to their pregnant partner's group allocation and were assessed at study entry (~13 weeks' gestation), 35 weeks' gestation, and 6 and 12 months after delivery. RESULTS A total of 122 partners (100% male, 23% Hispanic, 82% married, and 48% with obesity) were randomly assigned to the intervention (n = 59) or usual care (n = 63). There was no intervention or intervention-by-time interaction effect on partner weight (P = 0.795). Partner weight changes were not statistically significant (P = 0.120) from study entry to 35 weeks' gestation (mean 0.19 kg; 95% CI: -0.73 to 1.24) or to 12 months after delivery (mean 0.82 kg; 95% CI: -0.26 to 1.91). CONCLUSIONS There was no evidence of a ripple effect on partner weight. In a self-selected sample, partners of pregnant women appeared not to experience sympathy weight gain.
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Affiliation(s)
- Todd A Hagobian
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Suzanne Phelan
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Andrew Schaffner
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
- Department of Statistics, California Polytechnic State University, San Luis Obispo, California, USA
| | - Anna Brannen
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California, USA
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California, USA
| | - Angelica McHugh
- Department of Psychiatry, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Maxine Ashby-Thompson
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Amy A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Xavier Pi-Sunyer
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Dympna Gallagher
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Rena Wing
- Department of Psychiatry, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Hagobian TA, Bird A, Stanelle S, Williams D, Schaffner A, Phelan S. Pilot Study on the Effect of Orally Administered Bisphenol A on Glucose and Insulin Response in Nonobese Adults. J Endocr Soc 2019; 3:643-654. [PMID: 30842988 PMCID: PMC6397423 DOI: 10.1210/js.2018-00322] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/01/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine the effects of varying doses of orally administered BPA on indices of glucose metabolism. METHODS Eleven college students (21.0 ± 0.8 years; 24.2 ± 3.9 kg/m2) were randomized in a double-blinded, crossover fashion separated by >1 week to placebo (PL), deuterated BPA at 4 µg/kg body weight (BPA-4), and deuterated BPA at 50 µg/kg body weight (BPA-50). Total BPA, glucose, insulin, and C-peptide were assessed at baseline, minutes 15, 30, 45, 60, and every 30 minutes for 2 hours in response to a glucose tolerance test. RESULTS There was a significant condition × time interaction for total BPA (P < 0.001) such that BPA increased more rapidly in BPA-50 than BPA-4 and PL (P = 0.003) and increased more rapidly in BPA-4 than PL (P < 0.001). There were no significant condition × time interactions on glucose, insulin, and C-peptide. Significant condition main effects were observed for glucose such that BPA-50 was significantly lower than PL (P = 0.036) and nearly lower for BPA-4 vs PL (P = 0.056). Significant condition main effects were observed such that insulin in BPA-50 was lower than BPA-4 (P = 0.021), and C-peptide in BPA-50 was lower than BPA-4 (t18 = 3.95; Tukey-adjusted P = 0.003). Glucose, insulin, and C-peptide areas under the curve for the 3-hour profile were significantly lower in BPA-50 vs PL (P < 0.05). CONCLUSION Orally administered BPA protocol appeared feasible and has immediate effects on glucose, insulin, and C-peptide concentrations.
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Affiliation(s)
- Todd Alan Hagobian
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California
| | - Alyssa Bird
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California
| | - Sean Stanelle
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California
| | - Dana Williams
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California
| | - Andrew Schaffner
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California
- Department of Statistics, California Polytechnic State University, San Luis Obispo, California
| | - Suzanne Phelan
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California
- Center for Health Research, California Polytechnic State University, San Luis Obispo, California
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15
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Phelan S, Wing RR, Brannen A, McHugh A, Hagobian T, Schaffner A, Jelalian E, Hart CN, Scholl TO, Muñoz-Christian K, Yin E, Phipps MG, Keadle S, Abrams B. Does Partial Meal Replacement During Pregnancy Reduce 12-Month Postpartum Weight Retention? Obesity (Silver Spring) 2019; 27:226-236. [PMID: 30421864 PMCID: PMC8142600 DOI: 10.1002/oby.22361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 10/12/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This randomized trial tested whether a behavioral intervention with meal replacements in pregnancy could increase the proportion of women who returned to prepregnancy weight and reduce postpartum weight retention by 12 months after delivery. METHODS Women (N = 264; 13.7 weeks' gestation) with overweight or obesity were randomly assigned to usual care or intervention. The intervention reduced excess gestational weight gain and was discontinued at delivery. At follow-up, 83.7% completed the 12-month assessment. RESULTS Compared with usual care, prenatal intervention had no significant effect on odds of achieving prepregnancy weight (38/128 [29.7%] vs. 41/129 [31.8%]; P = 0.98) or in reducing the magnitude of weight retained (3.3 vs. 3.1 kg; P = 0.82) at 12 months. After delivery, significant (P < 0.0001) declines in meal replacements, practice of weight control behaviors, and dietary restraint were observed in the intervention group. Independent of group, lower gestational weight gain was the strongest predictor of achieving prepregnancy weight at 12 months (P = 0.0008). CONCLUSIONS A prenatal behavioral intervention with meal replacements that reduced pregnancy weight gain had no significant effect on 12-month postpartum weight retention.
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Affiliation(s)
- Suzanne Phelan
- Department of Kinesiology & Public Health, California Polytechnic State University, San Luis Obispo, California, USA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Anna Brannen
- Department of Kinesiology & Public Health, California Polytechnic State University, San Luis Obispo, California, USA
| | - Angelica McHugh
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Todd Hagobian
- Department of Kinesiology & Public Health, California Polytechnic State University, San Luis Obispo, California, USA
| | - Andrew Schaffner
- Statistics Department, California Polytechnic State University, San Luis Obispo, California, USA
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Chantelle N Hart
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA
| | - Theresa O Scholl
- Department of Obstetrics and Gynecology, Rowan University, Glassboro, New Jersey, USA
| | - Karen Muñoz-Christian
- Modern Languages Department, California Polytechnic State University, San Luis Obispo, California, USA
| | - Elaine Yin
- Pacific Central Coast Health Centers, Santa Maria Women's Health, Santa Maria, California, USA
| | - Maureen G Phipps
- Department of Obstetrics and Gynecology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- Department of Obstetrics and Gynecology, Women & Infants Hospital, Providence, Rhode Island, USA
| | - Sarah Keadle
- Department of Kinesiology & Public Health, California Polytechnic State University, San Luis Obispo, California, USA
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California, USA
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16
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Phelan S, Hagobian TA, Ventura A, Brannen A, Erickson-Hatley K, Schaffner A, Muñoz-Christian K, Mercado A, Tate DF. 'Ripple' effect on infant zBMI trajectory of an internet-based weight loss program for low-income postpartum women. Pediatr Obes 2019; 14:10.1111/ijpo.12456. [PMID: 30225981 PMCID: PMC7368392 DOI: 10.1111/ijpo.12456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/18/2018] [Accepted: 06/15/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Weight loss interventions can have positive 'ripple' effects on untreated partners in the home, but ripple effects on infants are unknown. OBJECTIVE To examine whether a 12-month internet-based weight loss intervention for postpartum mothers had a positive ripple effect on participants' infants. METHODS A 12-month cluster randomized, assessor-blind, clinical trial enrolling 371 postpartum women at 12 Women, Infants, Children clinics in CA. Clinics were randomized to standard Women, Infants, Children or an internet-based weight loss intervention for mothers. RESULTS A total of 333 of the 371 (89.8%) mothers assented for infant participation. Infants were 5.3 ± 3.2 months; 75.9% were Hispanic and 64% were breastfeeding. Infant retention was 272/333 (82.7%) at 6 months post enrollment and 251/333 (75.3%) at 12 months post enrollment. In intent-to-treat analysis, a significant interaction between group and time was observed (p = 0.008) with the offspring of intervention mothers exhibiting lower zBMI change from study entry through 6 months (0.23 [CI, 0.03, 0.44] vs. 0.65 [0.50, 0.79] zBMI change, respectively; p = 0.001) but was not significant through 12 months (p = 0.16). Regardless of group, maternal reports at the final assessment indicated that infants (aged =17.2 ± 3.4 months) consumed sweetened beverages (0.93 ± 1.5/week), juice (2.0 ± 1.4/day), 'junk food' (7.8 ± 5.4/week) and fast food (2/month), and 46.7% of the infants had a TV in their bedroom. CONCLUSIONS An internet-based weight loss program for low-income, postpartum mothers had a positive 'ripple' effect on the zBMI of infants in the home during the first 6 months of treatment.
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Affiliation(s)
- S. Phelan
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - T. A. Hagobian
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - A. Ventura
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - A. Brannen
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - K. Erickson-Hatley
- Departments of Health Behavior and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A. Schaffner
- Statistics Department, California Polytechnic State University, San Luis Obispo, CA, USA
| | - K. Muñoz-Christian
- Modern Languages Department, California Polytechnic State University, San Luis Obispo, CA, USA
| | - A. Mercado
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - D. F. Tate
- Departments of Health Behavior and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Phelan S, Wing RR, Brannen A, McHugh A, Hagobian TA, Schaffner A, Jelalian E, Hart CN, Scholl TO, Munoz-Christian K, Yin E, Phipps MG, Keadle S, Abrams B. Randomized controlled clinical trial of behavioral lifestyle intervention with partial meal replacement to reduce excessive gestational weight gain. Am J Clin Nutr 2018; 107:183-194. [PMID: 29529157 PMCID: PMC6455030 DOI: 10.1093/ajcn/nqx043] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/21/2017] [Indexed: 12/24/2022] Open
Abstract
Background Behavioral lifestyle interventions during pregnancy can prevent excessive gestational weight gain (GWG) in women with normal weight; however, effective interventions to reduce GWG in ethnically diverse women with obesity are lacking. Objective A randomized controlled trial was conducted to test whether a behavioral lifestyle intervention with partial meal replacement reduces GWG rate in Hispanic and non-Hispanic women with overweight or obesity relative to enhanced usual care. Design Participants (n = 257) were recruited in San Luis Obispo, California, and Providence, Rhode Island, between November 2012 and May 2016. Participants were pregnant (mean ± SD: 13.6 ± 1.8 wk of gestation) with overweight or obesity and had a mean age of 30.3 y; 41.6% of participants were Hispanic. Women were randomly assigned within site and by ethnicity to enhanced usual care (n = 128) or to a behavioral lifestyle intervention with partial meal replacement (n = 129). The primary outcome was GWG per week of observation. Secondary outcomes were proportions exceeding Institute of Medicine (IOM) guidelines for total GWG, changes in weight-control behaviors and cardiovascular disease risk factors, and incidence of pregnancy complications. Study retention was 99.6% (256 of 257). Results The intervention compared with usual care resulted in less mean ± SD weekly GWG (0.33 ± 0.25 compared with 0.39 ± 0.23 kg/wk; P = 0.02) and total GWG (9.4 ± 6.9 compared with 11.2 ± 7.0 kg; P = 0.03) and reduced the proportion of women who exceeded IOM guidelines for total GWG (41.1% compared with 53.9%; P = 0.03). No significant group × time × demographic subgroup (ethnicity, BMI, age, parity, and income) interactions were observed. Among intervention participants, greater meal replacement intake was related to reduced GWG rate (β = -0.07; 95% CI:-0.12, -0.03; P = 0.002). The intervention compared with usual care increased weight-control strategies (P < 0.0001) and cognitive restraint (P < 0.0001) and reduced triglycerides (P = 0.03). Conclusion Prenatal behavioral intervention with partial meal replacement significantly reduced GWG in Hispanic and non-Hispanic women with overweight or obesity. This trial was registered at www.clinicaltrials.gov as NCT01545934.
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Affiliation(s)
- Suzanne Phelan
- Departments of Kinesiology, Statistics, and Modern Languages, California Polytechnic State University, San Luis Obispo, CA
| | - Rena R Wing
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI
| | - Anna Brannen
- Departments of Kinesiology, Statistics, and Modern Languages, California Polytechnic State University, San Luis Obispo, CA
| | - Angelica McHugh
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI
| | - Todd A Hagobian
- Departments of Kinesiology, Statistics, and Modern Languages, California Polytechnic State University, San Luis Obispo, CA
| | - Andrew Schaffner
- Departments of Statistics, and Modern Languages, California Polytechnic State University, San Luis Obispo, CA
| | - Elissa Jelalian
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, RI
| | - Chantelle N Hart
- Department of Social and Behavioral Sciences, Temple University Center for Obesity Research and Education, Philadelphia, PA
| | - Theresa O Scholl
- Department of Obstetrics and Gynecology, University of Medicine and Dentistry of New Jersey (now Rowan), Glassboro, NJ
| | - Karen Munoz-Christian
- Departments of Modern Languages, California Polytechnic State University, San Luis Obispo, CA
| | - Elaine Yin
- Pacific Central Coast Health Centers, Santa Maria Women's Health, Santa Maria, CA
| | - Maureen G Phipps
- Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
| | - Sarah Keadle
- Departments of Kinesiology, Statistics, and Modern Languages, California Polytechnic State University, San Luis Obispo, CA
| | - Barbara Abrams
- Division of Epidemiology, University of California at Berkeley School of Public Health, Berkeley, CA
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18
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Martin CL, Tate DF, Schaffner A, Brannen A, Hatley KE, Diamond M, Munoz-Christian K, Pomeroy J, Sanchez T, Mercado A, Hagobian T, Phelan S. Acculturation Influences Postpartum Eating, Activity, and Weight Retention in Low-Income Hispanic Women. J Womens Health (Larchmt) 2017; 26:1333-1339. [PMID: 28816589 PMCID: PMC5733667 DOI: 10.1089/jwh.2016.6154] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Low-income Hispanic women experience elevated rates of high postpartum weight retention (PPWR), which is an independent risk factor for lifetime obesity. Sociocultural factors might play an important role among Hispanic women; however, very few studies have examined this association. OBJECTIVE The purpose of our study was to examine the associations between acculturation and maternal diet, physical activity, and PPWR. DESIGN This is a cross-sectional study of baseline data from 282 Hispanic women participating in the FitMoms/Mamás Activas study, a randomized controlled trial examining the impact of primarily an internet-based weight control program, in reducing PPWR among low-income women. We performed multivariable linear regression to examine the association of acculturation with diet quality, physical activity, and PPWR at study entry. RESULTS A total of 213 (76%) women had acculturation scores reflecting Mexican orientation or bicultural orientation, whereas 69 (24%) had scores that represented assimilation to Anglo culture. Women who were more acculturated had lower intakes of fruits and vegetables, lower HEI scores, and lower physical activity levels than women who were less acculturated (p < 0.05). We found an association between acculturation and PPWR in that for every 1-unit increase in acculturation score, PPWR increased, on average, by 0.80 kg. CONCLUSION Higher acculturation was associated with poorer diet and physical activity behaviors and greater PPWR.
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Affiliation(s)
- Chantel L. Martin
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, North Carolina
| | - Deborah F. Tate
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, North Carolina
- Department of Nutrition, UNC Chapel Hill, Chapel Hill, North Carolina
| | - Andrew Schaffner
- Statistics Department, California Polytechnic State University, San Luis Obispo, California
| | - Anna Brannen
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, California
| | | | - Molly Diamond
- Department of Health Behavior, UNC Chapel Hill, Chapel Hill, North Carolina
| | - Karen Munoz-Christian
- Department of Modern Languages, California Polytechnic State University, San Luis Obispo, California
| | - Jeremy Pomeroy
- Marshfield Clinic Research Foundation, Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Teresa Sanchez
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, California
| | - Adrian Mercado
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, California
| | - Todd Hagobian
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, California
| | - Suzanne Phelan
- Kinesiology Department, California Polytechnic State University, San Luis Obispo, California
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Phelan S, Hagobian T, Brannen A, Hatley KE, Schaffner A, Muñoz-Christian K, Tate DF. Effect of an Internet-Based Program on Weight Loss for Low-Income Postpartum Women: A Randomized Clinical Trial. JAMA 2017; 317. [PMID: 28632867 PMCID: PMC5815021 DOI: 10.1001/jama.2017.7119] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
IMPORTANCE Postpartum weight retention increases lifetime risk of obesity and related morbidity. Few effective interventions exist for multicultural, low-income women. OBJECTIVE To test whether an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) for low-income postpartum women could produce greater weight loss than the WIC program alone over 12 months. DESIGN, SETTING, AND PARTICIPANTS A 12-month, cluster randomized, assessor-blind, clinical trial enrolling 371 adult postpartum women at 12 clinics in WIC programs from the California central coast between July 2011 and May 2015 with data collection completed in May 2016. INTERVENTIONS Clinics were randomized to the WIC program (standard care group) or the WIC program plus a 12-month primarily internet-based weight loss program (intervention group), including a website with weekly lessons, web diary, instructional videos, computerized feedback, text messages, and monthly face-to-face groups at the WIC clinics. MAIN OUTCOMES AND MEASURES The primary outcome was weight change over 12 months, based on measurements at baseline, 6 months, and 12 months. Secondary outcomes included proportion returning to preconception weight and changes in physical activity and diet. RESULTS Participants included 371 women (mean age, 28.1 years; Hispanic, 81.6%; mean weight above prepregnancy weight, 7.8 kg; mean months post partum, 5.2 months) randomized to the intervention group (n = 174) or standard care group (n = 197); 89.2% of participants completed the study. The intervention group produced greater mean 12-month weight loss compared with the standard care group (3.2 kg in the intervention group vs 0.9 kg in standard care group, P < .001; difference, 2.3 kg (95% CI, 1.1 to 3.5). More participants in the intervention group than the standard care group returned to preconception weight by 12 months (32.8% in the intervention group vs 18.6% in the standard care group, P < .001; difference, 14.2 percentage points [95% CI, 4.7 to 23.5]). The intervention group and standard care group did not significantly differ in 12-month changes in physical activity (mean [95% CI]: -7.8 min/d [-16.1 to 0.4] in the intervention group vs -7.2 min/d [-14.6 to 0.3] in the standard care group; difference, -0.7 min/d [95% CI, -42.0 to 10.6], P = .76), calorie intake (mean [95% CI]: -298 kcal/d [-423 to -174] in the intervention group vs -144 kcal/d [-257 to -32] in the standard care group; difference, -154 kcal/d [-325 to 17], P = .06), or incidences of injury (16 in the intervention group vs 16 in the standard care group) or low breastmilk supply from baseline to month 6 (21 of 61 participants in the intervention group vs 23 of 72 participants in the standard care group) and from month 6 to 12 (13 of 32 participants in the intervention group vs 14 of 37 participants in the standard care group). CONCLUSIONS AND RELEVANCE Among low-income postpartum women, an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) compared with the WIC program alone resulted in a statistically significant greater weight loss over 12 months. Further research is needed to determine program and cost-effectiveness as part of the WIC program. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01408147.
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Affiliation(s)
- Suzanne Phelan
- Kinesiology Department, California Polytechnic State University, San Luis Obispo
| | - Todd Hagobian
- Kinesiology Department, California Polytechnic State University, San Luis Obispo
| | - Anna Brannen
- Kinesiology Department, California Polytechnic State University, San Luis Obispo
| | - Karen E. Hatley
- Departments of Health Behavior and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Andrew Schaffner
- Kinesiology Department, California Polytechnic State University, San Luis Obispo
| | | | - Deborah F. Tate
- Departments of Health Behavior and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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Papathakis P, Schaffner A, Garcia P, Eckert R, Fry J, Malek S, Trehan I, Thakwalakwa C, Maleta K, Manary M. Provision of Supplementary Food to Pregnant Malawian Women with Moderate Acute Malnutrition Improves Gestational Weight Gain and Reduces Low Birth Weight. FASEB J 2017. [DOI: 10.1096/fasebj.31.1_supplement.639.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Peggy Papathakis
- Dept of Food Science and NutritionCalifornia Polytechnic State UniversitySan Luis ObispoCA
| | - Andrew Schaffner
- Dept of StatisticsCalifornia Polytechnic State UniversitySan Luis ObispoCA
| | - Patsy Garcia
- Dept of StatisticsCalifornia Polytechnic State UniversitySan Luis ObispoCA
| | - Rachael Eckert
- Dept of Food Science and NutritionCalifornia Polytechnic State UniversitySan Luis ObispoCA
| | - Jocelyn Fry
- Dept of Food Science and NutritionCalifornia Polytechnic State UniversitySan Luis ObispoCA
| | - Shirin Malek
- Dept of Food Science and NutritionCalifornia Polytechnic State UniversitySan Luis ObispoCA
| | - Indi Trehan
- Washington University School of MedicineSt. LouisMO
- University of MalawiBlantyreMalawi
| | | | | | - Mark Manary
- Washington University School of MedicineSt. LouisMO
- University of MalawiBlantyreMalawi
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Quon S, Papathakis P, Schaffner A, Finfer E, Bell L, Peace B, Varni M, Gates E, Tolleshaug C, Manary M. Low Birth Weight is More Common in Food Insecure Pregnant Malawian Women with Moderate Malnutrition. FASEB J 2017. [DOI: 10.1096/fasebj.31.1_supplement.639.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sarah Quon
- California Polytechnic State UniversitySan Luis ObispoCA
| | | | | | - Erica Finfer
- California Polytechnic State UniversitySan Luis ObispoCA
| | - Lauren Bell
- California Polytechnic State UniversitySan Luis ObispoCA
| | - Bryanna Peace
- California Polytechnic State UniversitySan Luis ObispoCA
| | - Marissa Varni
- California Polytechnic State UniversitySan Luis ObispoCA
| | - Elaina Gates
- California Polytechnic State UniversitySan Luis ObispoCA
| | | | - Mark Manary
- Washington University School of MedicineSt. LouisMO
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Hagobian T, Smouse A, Streeter M, Wurst C, Schaffner A, Phelan S. Randomized Intervention Trial to Decrease Bisphenol A Urine Concentrations in Women: Pilot Study. J Womens Health (Larchmt) 2016; 26:128-132. [PMID: 27726525 DOI: 10.1089/jwh.2016.5746] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous studies have shown that women have higher concentrations of the endocrine disruptor bisphenol A (BPA), but an intervention to reduce BPA is lacking in women. To test the hypothesis that an intervention to reduce BPA would decrease urinary BPA concentrations over 3 weeks, 24 women (mean ± standard deviation [SD]; 22.1 ± 2.8 kg/m2 body mass index, 20.9 ± 1.5 years) were randomly assigned to an intervention or control. MATERIALS AND METHODS The intervention included weekly face-to-face meetings to reduce BPA exposures from food, cosmetics, and other packaged products. Women were provided with BPA-free cosmetics, hygiene, glass food/water containers, and daily self-monitored major sources of BPA. Fasting urine BPA and creatinine concentrations, and weight were assessed at study entry and after 3 weeks. RESULTS A significant (p = 0.04) treatment × time interaction effect was observed on creatinine-adjusted BPA concentrations. From study entry to 3 weeks, women in the intervention significantly decreased geometric mean creatinine-adjusted urinary BPA by -0.71 ng/m, whereas women in the control significantly increased urinary BPA by 0.32 ng/mL (p = 0.04). Additionally, from study entry to 3 weeks, women in the intervention significantly lost weight -0.28 ± 0.44 kg, whereas women in the control significantly gained weight +1.65 ± 0.74 kg (p = 0.03). Changes in creatinine-adjusted BPA concentrations and weight were not significantly related (p = 0.67). CONCLUSION In this pilot study, a 3-week intervention decreased urinary BPA concentrations in women. Future clinical trials are needed to confirm these results and to examine whether a similar BPA intervention positively impacts risk markers in the pathogenesis of cardiovascular disease and diabetes.
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Affiliation(s)
- Todd Hagobian
- 1 Department of Kinesiology, California Polytechnic State University , San Luis Obispo, California
| | - Allison Smouse
- 1 Department of Kinesiology, California Polytechnic State University , San Luis Obispo, California
| | - Mikaela Streeter
- 1 Department of Kinesiology, California Polytechnic State University , San Luis Obispo, California
| | - Chloe Wurst
- 1 Department of Kinesiology, California Polytechnic State University , San Luis Obispo, California
| | - Andrew Schaffner
- 2 Department of Statistics, California Polytechnic State University , San Luis Obispo, California
| | - Suzanne Phelan
- 1 Department of Kinesiology, California Polytechnic State University , San Luis Obispo, California
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Schneemann M, Schaffner A. Deactivation of the respiratory burst of human and murine macrophages by lipopolysaccharide is a receptor mediated effect independent from autocrine mechanisms. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/096805199400100403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endotoxin blunts secretion of reactive oxygen intermediates by macrophages. Because transforming growth factor β (TGFβ) or interleukin 10 (IL-10) were shown to deactivate macrophages, and are secreted by macrophages in response to LPS, we sought for autocrine mechanisms of macrophage deactivation by endotoxin. TGFβ did not deactivate the respiratory burst of human blood-derived and resident or thioglycollate-induced murine peritoneal macrophages. According to previous reports, suppression of H202 secretion by TGFβ was restricted to periodate-elicited murine peritoneal macrophages. In contrast to TGFβ, IL-10 deactivated systems producing reactive oxygen intermediates in human blood-derived human macrophages, but neither anti-TGFβ1 nor anti-IL-10 antibodies restored LPS-mediated deactivation of macrophages. Supernatants from LPS-treated human blood-derived macrophages could not confer deactivation to homologous macrophages. Deactivation by LPS required the presence of serum proteins and appeared to be mediated by the CD14 antigen-related LPS receptor, because anti-CD14 antibody and IL-4, which downregulates CD14, antagonized the LPS effect. Taken together, these observations indicate that the suppressive effect of LPS on the respiratory burst of macrophages is lipid A receptor-dependent, and results in a direct deactivation response of the cell without mediation by autocrine mechanisms.
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Affiliation(s)
- M. Schneemann
- Department of Medicine, University of Zürich Medical School, Zürich, Switzerland
| | - A. Schaffner
- Department of Medicine, University of Zürich Medical School, Zürich, Switzerland
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Phelan S, Brannen A, Erickson K, Diamond M, Schaffner A, Muñoz-Christian K, Stewart A, Sanchez T, Rodriguez VC, Ramos DI, McClure L, Stinson C, Tate DF. 'Fit Moms/Mamás Activas' internet-based weight control program with group support to reduce postpartum weight retention in low-income women: study protocol for a randomized controlled trial. Trials 2015; 16:59. [PMID: 25887964 PMCID: PMC4347547 DOI: 10.1186/s13063-015-0573-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 01/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High postpartum weight retention is a strong independent risk factor for lifetime obesity, cardiovascular disease, and type 2 diabetes in women. Interventions to promote postpartum weight loss have met with some success but have been limited by high attrition. Internet-based treatment has the potential to overcome this barrier and reduce postpartum weight retention, but no study has evaluated the effects of an internet-based program to prevent high postpartum weight retention in women. METHODS/DESIGN Fit Moms/Mamás Activas targets recruitment of 12 Women, Infants and Children (WIC) Supplemental Nutrition Program clinics with a total of 408 adult (>18 years), postpartum (<1 year) women with 14.5 kg or more weight retention or a body mass index of 25.0 kg/m(2) or higher. Clinics are matched on size and randomly assigned within county to either a 12-month standard WIC intervention or to a 12-month WIC enhanced plus internet-based weight loss intervention. The intervention includes: monthly face-to-face group sessions; access to a website with weekly lessons, a web diary, instructional videos, and computer-tailored feedback; four weekly text messages; and brief reinforcement from WIC counselors. Participants are assessed at baseline, six months, and 12 months. The primary outcome is weight loss over six and 12 months; secondary outcomes include diet and physical activity behaviors, and psychosocial measures. DISCUSSION Fit Moms/Mamás Activas is the first study to empirically examine the effects of an internet-based treatment program, coupled with monthly group contact at the WIC program, designed to prevent sustained postpartum weight retention in low-income women at high risk for weight gain, obesity, and related comorbidities. TRIAL REGISTRATION This trial was registered with Clinicaltrials.gov (identifier: NCT01408147 ) on 29 July 2011.
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Affiliation(s)
- Suzanne Phelan
- Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Anna Brannen
- Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Karen Erickson
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, 318 Rosenau Hall, Campus Box 7400, Chapel Hill, NC, 27599-7440, USA.
| | - Molly Diamond
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, 318 Rosenau Hall, Campus Box 7400, Chapel Hill, NC, 27599-7440, USA.
| | - Andrew Schaffner
- Statistics Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Karen Muñoz-Christian
- Department of Modern Languages, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Ana Stewart
- Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Teresa Sanchez
- Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Vanessa C Rodriguez
- Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Dalila I Ramos
- Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA, 93407, USA.
| | - Linda McClure
- San Luis Obispo County Women, Infants, and Children Supplemental Nutrition Program, 2191 Johnson Ave, San Luis Obispo, CA, 93401, USA.
| | - Caro Stinson
- Santa Barbara County Women, Infants, and Children Supplemental Nutrition Program, 315 Camino del Remedio, Santa Barbara, CA, 93110, USA.
| | - Deborah F Tate
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, 318 Rosenau Hall, Campus Box 7400, Chapel Hill, NC, 27599-7440, USA.
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Phelan S, Phipps MG, Abrams B, Darroch F, Grantham K, Schaffner A, Wing RR. Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial. Am J Clin Nutr 2014; 99:302-11. [PMID: 24284438 PMCID: PMC3893723 DOI: 10.3945/ajcn.113.070151] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Excessive weight gain during pregnancy is a risk factor for postpartum weight retention and future weight gain and obesity. Whether a behavioral intervention in pregnancy can reduce long-term weight retention is unknown. OBJECTIVE This randomized trial tested whether a low-intensity behavioral intervention to prevent excessive gestational weight gain could increase the proportion of women who returned to prepregnancy weight by 12 mo postpartum. DESIGN Women (n = 401, 13.5 wk of gestation, 50% normal weight, 50% overweight/obese) were randomly assigned into an intervention or control group; 79% completed the 12-mo assessment. The telephone-based intervention targeted gestational weight gain, healthy eating, and exercise and was discontinued at delivery. RESULTS In modified intent-to-treat analyses that excluded women with miscarriages (n = 6), gestational diabetes (n = 32), or subsequent pregnancies (n = 32), the intervention had no significant effect on the odds of achieving prepregnancy weight at 12 mo postpartum (n = 331; 35.4% compared with 28.1%; P = 0.18). Completer analyses suggested that the intervention tended to increase the percentages of women who reached prepregnancy weight (n = 261; 45.3% compared with 35.3%; P = 0.09) and significantly reduced the magnitude of mean ± SD postpartum weight retained (1.4 ± 6.3 compared with 3.0 ± 5.7 kg; P = 0.046) at 12 mo. Women in the intervention group reported higher dietary restraint through 6 mo postpartum (P = 0.023) and more frequent self-monitoring of body weight (P < 0.02 for all) throughout the study. CONCLUSIONS A low-intensity behavioral intervention in pregnancy can reduce 12-mo postpartum weight retention and improve dietary restraint and self-weighing in study completers. Future research is needed to test the long-term effects of more intensive behavioral interventions in pregnancy. This trial was registered at clinicaltrials.gov as NCT01117961.
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Affiliation(s)
- Suzanne Phelan
- Kinesiology Department (SP) and Statistics Department (AS and KG), California Polytechnic State University, San Luis Obispo, CA; the Warren Alpert Medical School, Department of Psychiatry and Human Behavior, and The Miriam Hospital, Weight Control and Diabetes Research Center, Brown University, Providence, RI (SP, RRW, and FD); the Department of Obstetrics and Gynecology and Women & Infants Hospital of Rhode Island, Division of Research, Warren Alpert Medical School, Brown University, Providence, RI (MGP); and the University of California, Berkeley, School of Public Health, Berkeley, CA (BA)
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Jimenez-Flores R, Heick J, Davis SC, Hall KG, Schaffner A. A comparison of the effects of a high carbohydrate vs. a higher protein milk supplement following simulated mountain skirmishes. Mil Med 2012; 177:723-31. [PMID: 22730850 DOI: 10.7205/milmed-d-11-00396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
This study compared the effects of a higher protein supplement manufactured from milk vs. a commercially available higher carbohydrate supplement on serum markers of muscle damage, anaerobic exercise, choice reaction time, and body composition during 2 weekends of vigorous hikes with simulated mountain skirmishes. Thirty-five university students, including Reserve Officers Training Corps cadets and athletes, carried 25% of their body weight (up to 26.4 kg) on Friday, Saturday, and Sunday hikes. Supplementation and Wingate tests followed each hike, and choice reaction testing preceded and followed each hike. Blood samples were obtained and body compositions were measured pre- and postweekend. Increased cortisol, highly sensitive C-reactive protein, creatine phosphokinase, and aldolase suggested the exercise regimen induced muscle damage and inflammation, which was attenuated during the second weekend of hikes. Absolute anaerobic capacity was somewhat greater following consumption of the milk supplement (p = 0.082). Body compositions did not change significantly during this study. Choice reaction times decreased following hikes and were significantly faster following consumption of the carbohydrate supplement (p < 0.04). Supplements including milk proteins and carbohydrates may improve endurance exercise and decision-making abilities of military personnel and endurance athletes.
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Affiliation(s)
- Rafael Jimenez-Flores
- Dairy Products Technology Center, Department of Dairy Science, California Polytechnic State University, San Luis Obispo, CA 93407-0257, USA
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Phelan S, Phipps MG, Abrams B, Darroch F, Schaffner A, Wing RR. Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study. Am J Clin Nutr 2011; 93:772-9. [PMID: 21310836 PMCID: PMC3057546 DOI: 10.3945/ajcn.110.005306] [Citation(s) in RCA: 264] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Excessive weight gain during pregnancy is a major risk factor for postpartum weight retention and future weight gain and obesity in women, but few adequately powered randomized controlled trials have examined the efficacy of a behavioral weight-control intervention during pregnancy. OBJECTIVE This study examined whether a behavioral intervention during pregnancy could decrease the proportion of women who exceeded the 1990 Institute of Medicine (IOM) recommendations for gestational weight gains and increase the proportion of women who returned to pregravid weights by 6 mo postpartum. DESIGN This study was a randomized, assessor-blind, controlled trial. Participants were pregnant (13.5 wk gestation), normal-weight (NW; n = 201) and overweight or obese (OW/OB; n = 200) women whose average age was 28.8 y. Participants were randomly assigned within the 1990 IOM weight category (NW compared with OW/OB) to standard care (n = 200) or to a behavioral intervention to prevent excessive gestational weight gain (n = 201). The intervention included one face-to-face visit; weekly mailed materials that promoted an appropriate weight gain, healthy eating, and exercise; individual graphs of weight gain; and telephone-based feedback. The retention at the 6-mo postpartum assessment was 82%. RESULTS Intent-to-treat analyses showed that the intervention, compared with standard care, decreased the percentage of NW women who exceeded IOM recommendations (40.2% compared with 52.1%; P = 0.003) and increased the percentages of NW and OW/OB women who returned to their pregravid weights or below by 6 mo postpartum (30.7% compared with 18.7%; P = 0.005). CONCLUSION A low-intensity behavioral intervention during pregnancy reduced excessive gestational weight gains in NW women and prevented postpartum weight retention in NW and OW/OB women. This trial was registered at clinicaltrials.gov as NCT01117961.
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Affiliation(s)
- Suzanne Phelan
- Departments of Kinesiology, California Polytechnic State University, San Luis Obispo, 93407-0386, USA.
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Abstract
BACKGROUND The purpose of this study was to investigate receipt of gestational weight gain advice in prenatal care and ideal and expected gestational weight gain outcomes for normal weight and overweight/obese women. METHODS This was a cross-sectional study of normal weight (n = 203) and overweight/obese (n = 198) women in early (<16 weeks) pregnancy. RESULTS Less than half of participants (41.7%) reported receiving weight gain advice from a practitioner. In multivariate models, pregravid weight status was not significantly related to receiving advice. However, women with lower income (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.13-0.77, p = 0.01), younger age (OR 0.93, 95% CI 0.87-0.99, p = 0.02), and multiparity (OR 0.49, 95% CI 0.28-0.87, p = 0.02) were least likely to report receiving advice. Among those receiving advice, most (85%) received accurate advice; however, overweight/obese women were more likely to be advised to overgain compared with normal weight women (22.2% vs. 2.3%, p = 0.0001). Overweight/obese women were also more likely than normal weight women to report ideal (OR 7.2, 95% CI 2.3-22.7, p = 0.001) and expected (OR 4.7, 95% CI 2.6-8.4, p = 0.0001) pregnancy weight gains above Institute of Medicine guidelines. Further, a consistent relationship was observed between higher ideal and expected weight gains and greater first trimester weight gain (p < 0.03). CONCLUSIONS Clinicians should be encouraged to provide timely and accurate advice to women about gestational weight gain. Interventions to promote healthy gestational weight gain may benefit from targeting women's beliefs about ideal and expected gestational weight gain.
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Affiliation(s)
- Suzanne Phelan
- California Polytechnic State University, Kinesiology Department, San Luis Obispo, CA 93407-0386, USA.
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Plummer W, Beckett D, Schaffner A, Layport B, Norman J, Grimbleby C, Wessinger P, Pace E, Kirscher L, Matthews K, Dorshorst T. 227 THE EFFECTS OF SEXED SEMEN ON EMBRYONIC DEVELOPMENT TO THE BLASTOCYST STAGE. Reprod Fertil Dev 2011. [DOI: 10.1071/rdv23n1ab227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sexed semen (SS) exhibits approximately 80% of the fertilizing ability of conventional semen (CS), and studies have shown that this continues through the 8-cell stage of bovine embryo development. At the time of this study, no information could be found that, when used for IVF and intracytoplasmic sperm injection (ICSI) development, had been carried to the blastocyst stage. In addition, questions have arisen regarding which of the measured sperm parameters are responsible for the difference between the SS and CS and contribute to this decline in fertility. The goals of this project were to evaluate the effects of using sexed sperm as it relates to embryonic development and to determine if any of the differences in sperm parameters affect embryonic development. A preliminary project evaluated SS and CS from 5 bulls for IVF and ICSI. One bull was selected to provide the sperm (both SS and CS) for the trial, and 1752 oocytes were assigned to either IVF or ICSI. The SS and CS were divided among the available oocytes used for IVF and ICSI. Straws were thawed for 30 s at 37°C, and sperm were then evaluated for motility (provided by CASA, SpermVision, MiniTube of America, Verona, WI), morphology, acrosomal integrity (Coomassie and Pope stains), viability, and nuclear decondensation (SYBR Green and HALO). Results for SS v. CS were as follows: motility, 8 v. 26%; viability, 40.6 v. 30%; nuclear decondensation, 40 v. 30%; normal morphology and acrosomal integrity, no differences. Oocytes were obtained from Applied Reproductive Technologies, LLC (Madison, WI). The fertilization rate was consistently lower (Table 1) for both IVF and ICSI when SS were used (Z = 3.65; P = 0.0003), and there was no evidence that this decline in fertilization rate differed for the 2 methods (Z = 0.18; P = 0.86). Nor was there any evidence that the method affected the fertilization rate in general (Z = 0.75; P = 0.45). Thus, the difference was specific for fertilization rate and had no effect on Day 3 cells or Day 7 blastocysts. A higher fertility rate using ICSI would have indicated that a surface membrane factor may have been decreasing the fertility rate with SS because of the elimination of binding factors associated with ICSI. Thus, it may not be the sperm surface membrane that is distorted in the sexing procedure, but likely the integrity of the spermal DNA, as indicated by the increased nuclear decondensation of SS.
Table 1.Comparison of sexed sperm with conventional sperm when used for IVF and intracytoplasmic sperm injection (ICSI)
Partial funding for this project was made available by the California State University Agricultural Research Institute (ARI). Appreciation is extended to Sexing Technologies, Inc. (Navasota, TX) for donating the semen.
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Plummer B, Schaffner A, Grimbleby C, Einstein J, Wessinger P, Pace E, Kirscher L. Comparison of Sperm Counts Between a Relocated Computer System and Human Technicians. Biol Reprod 2010. [DOI: 10.1093/biolreprod/83.s1.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Schaffner A. Journal impact factors depend on more than just publication language. Swiss Med Wkly 2006; 136:411-2. [PMID: 16862460 DOI: 10.4414/smw.2006.11650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Schaffner A. Journal impact factors depend on more than just publication language. Swiss Med Wkly 2006; 136:411-2. [PMID: 16862460 DOI: 2006/27/smw-11650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
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Abstract
Fever is a phylogenetically ancient host reaction to invading microorganisms and other noxious stimuli. Poikylothermic organisms can reach febrile temperatures by seeking a hot environment in response to a higher set point in their thermoregulatory center. Endothermic organisms produce febrile temperatures through endogenous heat production at the expenditure of a higher metabolic rate. Nevertheless, fever has been conserved during evolution through millennia, obviously because of its advantage for host defense. Despite of these arguments most doctors, nurses and patients treat fever with antipyretics. The role of fever for the recovery from low risk infections is marginal at best. A large study of ibuprofen in patients with severe sepsis could not establish a positive or negative role on the course or final outcome of the infection in an intensive care setting. These clinical observations seemingly contradict findings in severe experimental bacterial infections in rodents but it has to be taken into consideration that these animals, in contrast to patients, received no antibiotic treatment. In patients with influenza-like illnesses non-steroidal antirhumatics (NSAR) improve fever and wellbeing with little or no evidence for undesired side-effects. It therefore appears appropriate to treat patients with these and similar infections with NSAR. Antipyretic therapy in special patient groups such as brain injury victims, patients with cardiac or respiratory failure or dementia has not been established to be indicated to overcome a worsening of these organs to fail during infections. In children with a history of fever convulsions prevention or lowering of fever does not reduce recurrence. In patients with strokes it appears advisable however to use antipyretics in case of fever despite of a present lack of a proven beneficial effect. In conclusion symptomatic antipyretic therapy should be considered for low risk infections if patient suffering from fever. For more severe infections antipyretic therapy can be applied on an individual basis without too much hope to improve outcome or cause a severe worsening of prognosis.
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Affiliation(s)
- A Schaffner
- Universitätsspital Zürich, Labor für Makrophagenbiologie
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34
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Himmelmann B, Brandner S, Jung HH, Schoedon G, Schuknecht B, Schaffner A. Severe Hypothermia in a Patient with Cerebral Relapse of Whipple?s Disease. Infection 2004; 32:119-21. [PMID: 15057578 DOI: 10.1007/s15010-004-3024-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2003] [Accepted: 07/28/2003] [Indexed: 10/26/2022]
Abstract
The diagnosis of cerebral relapse of Whipple's disease in a 67-year-old patient was made after he presented with somnolence and severe hypothermia 4 months after discontinuing treatment with cotrimoxazole. Hypothermia is a rare hypothalamic manifestation of cerebral Whipple's disease.
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Affiliation(s)
- B Himmelmann
- Department of Internal Medicine, University Hospital of Zurich, CH-8091, Zurich, Switzerland.
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35
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Imhof A, Schaer C, Schoedon G, Schaer DJ, Walter RB, Schaffner A, Schneemann M. Rapid detection of pathogenic fungi from clinical specimens using LightCycler real-time fluorescence PCR. Eur J Clin Microbiol Infect Dis 2003; 22:558-60. [PMID: 12938011 DOI: 10.1007/s10096-003-0989-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the study presented here a LightCycler real-time PCR system was used for the diagnosis of fungal infections from clinical tissue samples. Nine specimens were investigated from six patients with suspected or proven invasive fungal infections. Seven of nine samples were positive in a broad-range fungal PCR assay. In four samples, Aspergillus fumigatus was detected both by a species-specific hybridization assay as well as by sequencing of amplification products. In addition, the broad-range fungal PCR assay and PCR sequencing detected and identified, respectively, the following organisms in the specimens noted: Candida albicans in a culture-negative liver biopsy, Histoplasma capsulatum in a bone marrow sample, and Conidiobolus coronatus in a facial soft tissue specimen. Real-time PCR is a promising tool for the diagnosis of invasive fungal infections in human tissue samples and offers some advantages over culture methods, such as rapid analysis and increased sensitivity.
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Affiliation(s)
- A Imhof
- Program in Infectious Disease, Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N, D3-100, WA 98109-1024, Seattle, USA
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36
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Schaer DJ, Schoedon G, Schaffner A. Assignment of the CD163 antigen (CD163) to mouse chromosome 6 band F2 by radiation hybrid mapping. Cytogenet Genome Res 2003; 98:231B. [PMID: 12698011 DOI: 10.1159/000069812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2002] [Accepted: 01/13/2003] [Indexed: 11/19/2022] Open
Affiliation(s)
- D J Schaer
- Department of Internal Medicine, University Hospital, Zurich, Switzerland.
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37
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Farkye NY, Considine T, Schaffner A, Drake MA. Effects of standardization of whole milk with dry milk protein concentrate on the yield and ripening of reduced-fat cheddar cheese. J Dairy Sci 2003; 86:1608-15. [PMID: 12778571 DOI: 10.3168/jds.s0022-0302(03)73746-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Commercial milk protein concentrate (MPC) was used to standardize whole milk for reduced-fat Cheddar cheesemaking. Four replicate cheesemaking trials of three treatments (control, MPC1, and MPC2) were conducted. The control cheese (CC) was made from standardized milk (casein-to-fat ratio, C/F approximately 1.7) obtained by mixing skim milk and whole milk (WM); MPC1 and MPC2 cheeses were made from standardized milk (C/F approximately 1.8) obtained from mixing WM and MPC, except that commercial mesophilic starter was added at the rate of 1% to the CC and MPC1 and 2% to MPC2 vats. The addition of MPC doubled cheese yields and had insignificant effects on fat recoveries (approximately 94% in MPC1 and MPC2 vs. approximately 92% in CC) but increased significantly total solids recoveries (approximately 63% in CC vs. 63% in MPC1 and MPC2). Although minor differences were noted in the gross composition of the cheeses, both MPC1 and MPC2 cheeses had lower lactose contents (0.25 or 0.32%, respectively) than in CC (0.60%) 7 d post manufacture. Cheeses from all three treatments had approximately 10(9) cfu/g initial starter bacteria count. The nonstarter lactic acid bacteria (NSLAB) grew slowly in MPC1 and MPC2 cheeses during ripening compared to CC, and at the end of 6 mo of ripening, numbers of NSLAB in the CC were 1 to 2 log cycles higher than in MPC1 and MPC2 cheeses. Primary proteolysis, as noted by water-soluble N contents, was markedly slower in MPC1 and MPC2 cheeses compared to CC. The concentrations of total free amino acids were in decreasing order CC > MPC2 > MPC1 cheeses, suggesting slower secondary proteolysis in the MPC cheeses than in CC. Sensory analysis showed that MPC cheeses had lower brothy and bitter scores than CC. Increasing the amount of starter bacteria improved maturity in MPC cheese.
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Abstract
BACKGROUND DNA of Tropheryma whipplei, the etiologic agent of Whipple's disease, has recently been detected in the saliva of healthy subjects. In this pilot study we searched for the habitat of T. whipplei within the oral cavity. MATERIALS AND METHODS Samples from different oral sites were obtained from periodontically healthy volunteers, patients with progressive periodontitis and Chinese subjects with necrotizing ulcerative gingivitis or gingivitis. Quantitative real-time PCR was performed using T. whippleispecific primers, human beta-globin-specific primers to control for tissue DNA extraction and PCR reaction and broad-range eubacterial primers to control for bacterial DNA extraction. T. whipplei specificity of multiple amplicons was confirmed by sequencing. The detection limit of the method was 10 ag of T. whipplei DNA, corresponding to one to five bacteria under reference assay conditions. RESULTS T. whipplei was found in the oral cavity of four out of ten healthy individuals from hospital staff and in three out of nine periodontitis patients, but in none of the individuals from China. All positive samples derived from subgingival and gingival sulcus plaque containing between 10(3) and 5 x 10(5) cells ml(-1) of plaque suspension, whereas saliva, smooth surface plaque and samples from the tongue or cheeks were negative. CONCLUSION Our results suggest that T. whipplei colonizes the human body via the oral cavity and that bacterial plaques of the gingival crevice and the gingival sulcus/pocket may serve as a natural primary habitat.
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Affiliation(s)
- A S Zinkernagel
- Department of Medicine, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland
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Affiliation(s)
- S R Vavricka
- Department of Internal Medicine, University Hospital 8091, Zurich, Switzerland
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40
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Schaffner A. Nursing Care of the General Pediatric Surgical Patient. J Wound Ostomy Continence Nurs 2002. [DOI: 10.1067/mjw.2002.127483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Fehr T, Cathomas G, Weber C, Fontana A, Schaffner A. Foetal loss, liver necrosis and acute lupus erythematosus in a patient with antiphospholipid antibody syndrome. Lupus 2002; 10:576-9. [PMID: 11531001 DOI: 10.1191/096120301701549606] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The antiphospholipid antibody syndrome (APS) is characterized by arterial or venous thromboses and recurrent foetal loss. It occurs as primary disease, but also in the context of systemic lupus erythematosus (SLE). Whereas primary APS induces a thrombotic microangiopathy without significant inflammatory reaction, secondary APS in SLE is usually associated with vasculitis. Here we report a patient with APS who presented with acute diarrhoea and then developed a HELLP-like syndrome characterized by a spontaneous abortion, multifocal hepatic necroses and thrombocytopenia. Thereafter an acute flare of SLE with arthralgias, pleuritis, skin rash and glomerulitis occurred. Clinical amelioration was only achieved by combining curettage, anticoagulation and immunosuppression, a treatment taking into account the pathogenesis of HELLP-like disease, APS and SLE. To our knowledge this is the first reported case of APS associated with combined acute manifestations of these three syndromes triggered by a presumable intestinal infection.
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Affiliation(s)
- T Fehr
- Medical Clinic B, University Hospital, Zurich, Switzerland.
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42
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Kaim AH, Burger C, Ganter CC, Goerres GW, Kamel E, Weishaupt D, Dizendorf E, Schaffner A, von Schulthess GK. PET-CT-guided percutaneous puncture of an infected cyst in autosomal dominant polycystic kidney disease: case report. Radiology 2001; 221:818-21. [PMID: 11719684 DOI: 10.1148/radiol.2213010445] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An infected cyst in autosomal dominant polycystic kidney disease was identified with a combined positron emission tomographic (PET) and computed tomographic (CT) system, an experimental setup mimicking an integrated CT-PET scanner. Image fusion of fluorine 18 fluorodeoxyglucose PET and CT images allowed exact localization of the infected cyst among many cysts identified on previous CT and magnetic resonance images. Confirmation was obtained instantly, followed by CT-guided percutaneous puncture. Integrated imaging systems hold promise for direct PET-guided puncture of areas of increased fluorodeoxyglucose uptake by using the anatomic accuracy of CT.
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Affiliation(s)
- A H Kaim
- Department of Nuclear Medicine, University Hospital of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
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Minkowski P, Staege H, Groscurth P, Schaffner A. Effects of trimethoprim and co-trimoxazole on the morphology of Listeria monocytogenes in culture medium and after phagocytosis. J Antimicrob Chemother 2001; 48:185-93. [PMID: 11481287 DOI: 10.1093/jac/48.2.185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The purpose of this study was to compare the extra- and intracellular activity of antifolates on Listeria monocytogenes. The fortuitous discovery of elongated bacteria in response to trimethoprim revealed a novel effect on the morphology of Listeria in cell culture medium and after phagocytosis. This phenomenon permitted the quantification of trimethoprim activity, revealing comparable activity intra- and extracellularly. Subinhibitory concentrations of trimethoprim resulted in bacterial elongation, which was reversed after removal of trimethoprim. We attribute this effect of trimethoprim to an inhibition of cell wall synthesis and/or cell separation of Listeria.
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Affiliation(s)
- P Minkowski
- Research Unit, Medical Clinic B, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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44
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Rubin RH, Schaffner A, Speich R. Introduction to the Immunocompromised Host Society consensus conference on epidemiology, prevention, diagnosis, and management of infections in solid-organ transplant patients. Clin Infect Dis 2001; 33 Suppl 1:S1-4. [PMID: 11389514 DOI: 10.1086/320896] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Infectious complications are still a significant cause of morbidity and death in solid-organ transplant patients, with significant infection being found in up to two-thirds of these individuals. The risk of infection in the organ transplant patient, particularly of opportunistic infection, is largely determined by 3 factors: the net state of immunosuppression, the epidemiologic exposures the patient encounters, and the consequences of the invasive procedures to which the patient is subjected. The most important principles of patient treatment are prevention, early diagnosis, and specific therapy. This issue is designed as a position paper by a group of experts on epidemiology, prevention, diagnosis, and management of infections in solid-organ transplant patients. We feel that our efforts may serve as an important first step in the development of guidelines in this area.
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Affiliation(s)
- R H Rubin
- Center for Experimental Pharmacology and Therapeutics, Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA 02142-1308, USA.
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45
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Abstract
The risk of infectious disease reactivation in recipients of and transmission by solid-organ transplants remains, and thorough screening and testing of recipient and donor is especially important. In conceiving screening strategies, it is crucial to consider the sensitivity and specificity of individual diagnostic tests in the context of their use. Furthermore, recognition of special risks for infectious complications of transplantation will help to guide preventive, diagnostic, and therapeutic steps in the control of infectious complications in individual patients. The acceptability of risks for infectious complications after transplantation depends also on the urgency of transplantation of a vital organ as well as the availability of organs. Although these principals are well accepted, standards for the extent of screening and criteria for inappropriate donors and exclusion of unfit recipients remain controversial to some extent.
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Affiliation(s)
- A Schaffner
- Department of Internal Medicine, University Hospital, Zurich, Switzerland.
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46
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Affiliation(s)
- A S Zinkernagel
- Department of Internal Medicine, University Hospital Zurich, Switzerland
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47
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48
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Eriksson U, Seifert B, Schaffner A. Comparison of effects of amphotericin B deoxycholate infused over 4 or 24 hours: randomised controlled trial. BMJ 2001; 322:579-82. [PMID: 11238151 PMCID: PMC26549 DOI: 10.1136/bmj.322.7286.579] [Citation(s) in RCA: 181] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To test the hypothesis that amphotericin B deoxycholate is less toxic when given by continuous infusion than by conventional rapid infusion. DESIGN Randomised, controlled, non-blinded, single centre study. SETTING University hospital providing tertiary clinical care. PATIENTS 80 mostly neutropenic patients with refractory fever and suspected or proved invasive fungal infections. INTERVENTION Patients were randomised to receive 0.97 mg/kg amphotericin B by continuous infusion over 24 hours or 0.95 mg/kg by rapid infusion over four hours. MAIN OUTCOME MEASURES Patients were evaluated for side effects related to infusion, nephrotoxicity, and mortality up to three months after treatment. Analysis was on an intention to treat basis. RESULTS Patients in the continuous infusion group had fewer side effects and significantly reduced nephrotoxicity than those in the rapid infusion group. Overall mortality was higher during treatment and after three months' follow up in the rapid infusion than in the continuous infusion group. CONCLUSION Continuous infusions of amphotericin B reduce nephrotoxicity and side effects related to infusion without increasing mortality.
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Affiliation(s)
- U Eriksson
- Medicine B, University Hospital, University of Zurich, CH-8091 Zurich, Switzerland.
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49
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Schaer DJ, Boretti FS, Hongegger A, Poehler D, Linnscheid P, Staege H, Müller C, Schoedon G, Schaffner A. Molecular cloning and characterization of the mouse CD163 homologue, a highly glucocorticoid-inducible member of the scavenger receptor cysteine-rich family. Immunogenetics 2001; 53:170-7. [PMID: 11345593 DOI: 10.1007/s002510100304] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
MESH Headings
- Amino Acid Sequence
- Animals
- Antigens, CD
- Antigens, Differentiation, Myelomonocytic/chemistry
- Antigens, Differentiation, Myelomonocytic/genetics
- Base Sequence
- Cloning, Molecular
- DNA Primers/genetics
- DNA, Complementary/genetics
- Dexamethasone/pharmacology
- Glucocorticoids/pharmacology
- Humans
- Macrophages, Peritoneal/drug effects
- Macrophages, Peritoneal/immunology
- Mice
- Models, Molecular
- Molecular Sequence Data
- Protein Structure, Tertiary
- Receptors, Cell Surface/chemistry
- Receptors, Cell Surface/genetics
- Sequence Homology, Nucleic Acid
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Affiliation(s)
- D J Schaer
- Medizinische Klinik B, B Lab 93, Department of Internal Medicine, University Hospital, Rämistrasse 100, 8091 Zurich, Switzerland.
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50
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Abstract
Infection with Tropheryma whippelii, the causative agent of Whipple's disease, involves nearly every organ. Involvement of bone marrow may be an overlooked area of Whipple's disease. We report a case of lymphoma-like Whipple's disease with bone marrow involvement together with a brief review of the literature on this topic. Despite minimal documentation, bone marrow may be commonly involved in Whipple's disease and, although not specific, diastase-resistant periodic acid-Schiff (PAS)-positive macrophages in bone marrow may offer an important clue to diagnosis using PAS histology of upper endoscopic biopsies, polymerase chain reaction or electron microscopy.
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Affiliation(s)
- R Walter
- Department of Medicine, Medical Clinic B, University Hospital, Rämistrasse 100, CH-8091 Zurich, Switzerland.
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