Weight Loss Barriers and Dietary Quality of Intermittent and Continuous Dieters in Women with a History of Gestational Diabetes

Weight-loss after gestational diabetes (GDM) lowers the risk of type-2 diabetes (T2DM). Intermittent energy restriction (IER) produces comparable weight-loss to continuous energy restriction (CER), but long-term adherence remains difficult in this population. This exploratory secondary analysis of a 12-month trial comparing IER to CER following GDM examined weight-loss and dietary quality associated with barriers to weight-loss or T2DM risk perception as assessed in a Likert scale questionnaire at baseline. The participants had a median (IQR) BMI of 32.6 (9.4) kg/m² and 3 (4) years postpartum (n = 121). Forty-five percent (n = 54) of the participants thought they were at a high risk of developing T2DM. Greater affordability of healthy food was related with greater weight-loss at 3 months (p = 0.044, n = 85). At 12 months, there was no significant relationship between weight-loss and the barriers to weight-loss (p > 0.05). CER had superior improvement in dietary quality at 12 months (CER 11 ± 10, IER 6 ± 5.6, n = 42, p = 0.05). Under the Theoretical Domains Framework, the barriers were predominantly related to behavioral regulation (n = 83, 69%; n = 76, 63%) and environmental context and resources (n = 67, 56%). Interventions for diabetes prevention in this population should include behavioral regulation strategies, consider the family home environment, and ensure that the risk of T2DM is conveyed. Women choosing IER may benefit from education to improve their dietary quality.

The effect of intermittent energy restriction on weight loss and diabetes risk markers in women with a history of gestational diabetes: a 12-month randomized control trial

BACKGROUND

Weight loss after gestational diabetes (GDM) can prevent or delay the onset of type 2 diabetes. Intermittent energy restriction (IER) may offer an alternative to continuous energy restriction (CER) for weight loss.

OBJECTIVES

We compared the effects of IER (2 days per week) to daily CER over 12 mo on weight loss and diabetes risk markers in overweight women with previous GDM.

METHODS

Overweight females (n = 121) ≥18 y were randomized 1:1 to either IER [2-d 500 kcal (2100 kJ); n = 61] or CER [1500 kcal (6000 kJ); n = 60] in this 12-mo noninferiority trial.

RESULTS

The trial was completed by 62 participants with a median age of 39.6 y [Quartile (Q) 1 to Quartile 3, 34.9 to 43.9 y] with a median BMI of 32.6 kg/m2 (Q1 to Q3, 28.5 to 37.9 kg/m2) at a median of 2.9 y after GDM (Q1 to Q3, 2.1 to 6.4 y; 49% attrition; IER n = 29; CER n = 30; P = 0.8). The mean ± SD weight loss was significant over time (P < 0.001) but not by diet group (IER -4.8 ± 5.0 kg; CER -3.2 ± 5.0; P = 0.2). The mean between-group difference was -1.6 kg (95% CI: -4.2 to 1.0 kg; P = 0.2). There were no significant between-group differences in change in HbA1c, fasting plasma glucose, fasting serum insulin, HOMA-IR or 2-h oral glucose tolerance at 12 mo (p>0.05). The trial was registered at https://www.anzctr.org.au/ (ACTRN12617001476325).

CONCLUSIONS

IER produces comparable weight loss to CER over 12 mo in overweight women with previous GDM. The high dropout rate in this study is a limitation in the interpretation of these results. Larger studies are needed to confirm noninferiority of IER compared to CER.

Women's Barriers to Weight Loss, Perception of Future Diabetes Risk and Opinions of Diet Strategies Following Gestational Diabetes: An Online Survey

Weight loss after gestational diabetes (GDM) reduces the risk of type 2 diabetes (T2DM); however, weight loss remains challenging in this population. In order to explore perceptions of T2DM risk, barriers to weight loss, and views of diet strategies in women with previous GDM, a cross-sectional online survey of n = 429 women in Australia aged ≥18 years with previous GDM was conducted. Opinions of intermittent energy restriction (IER) were of interest. Seventy-five percent of responders (n = 322) had overweight or obesity, and 34% (n = 144) believed they had a high risk of developing T2DM. Within the Theoretical Domains Framework, barriers to weight loss were prominently related to Environmental Context and Resources, Beliefs about Capabilities, and Behavioural Regulation. Exercising was the most tried method of weight loss over other diet strategies (71%, n = 234) and weight loss support by a dietician was appealing as individual appointments (65%, n = 242) or an online program (54%, n = 200). Most women (73%, n = 284) had heard of IER (the "5:2 diet"), but only 12% (n = 34) had tried it. Open comments (n = 100) revealed mixed views of IER. Women in Australia with previous GDM were found to lack a self-perceived high risk of developing T2DM and expressed barriers to weight loss related to their family environment, beliefs about their capabilities and behavioural regulation. IER is appealing for some women with previous GDM; however, views vary.

Attitudes and beliefs of health risks associated with sodium intake in diabetes

BACKGROUND

  Despite good evidence that reducing sodium intake can reduce blood pressure (BP), salt intake in people with type 1 diabetes (T1DM) or type 2 diabetes (T2DM) remains high. The purpose of this study was to describe the knowledge and beliefs of health risks associated with a high salt diet in adults with diabetes.

METHODS

Men and women with T1DM (n = 27; age 38 ± 16 years) or T2DM (n = 124; age 60 ± 11 years) were recruited.

RESULTS

Nine (6.0%) respondents knew the correct maximum daily recommended upper limit for salt intake. Thirty-six (23.9%) participants were not concerned with the amount of salt in their diet. Most participants knew that a diet high in salt was related to high BP (88.1%) and stroke (78.1%) and that foods such as pizza (80.8%) and bacon (84.8%) were high in salt. Fewer than 30% of people knew that foods such as white bread, cheese and breakfast cereals are high in salt (white bread 28.5%, cheese 29.1%, breakfast cereals 19.9%) and 51.0% correctly ranked three different nutrition information panels based on the sodium content. Label reading and purchase of low salt products was used by 60-80% of the group. Estimated average 24 hour urinary sodium excretion was 169 ± 32 mmol/24 h in men and 115 ± 27 mmol/24 h in women.

CONCLUSION

Label reading and purchase of low salt products was used by the majority of the group but their salt excretion was still high. Men who used label reading had a lower salt intake. Other strategies to promote a lower sodium intake such as reducing sodium in staple foods such as bread need investigation.

Natural history of disease in a rabbit model for keratoconjunctivitis sicca

We have continued our study of the tear film and ocular surface in our full KCS (keratoconjunctivitis sicca) rabbit model up to 52 weeks post-operatively. Tear film osmolarity remains elevated, conjunctival goblet cell density remains decreased, and the conjunctival epithelium remains abnormal. Corneal epithelial glycogen levels decreased progressively, and at 44 weeks post-operatively rabbits developed abnormal rose Bengal staining of the affected cornea that was shown to be associated with morphologic abnormalities at 52 weeks. Rabbits began rubbing the affected eye after the development of corneal staining. Our full KCS rabbit model demonstrates the features of the human disease.

Age-related alterations in the inflammatory response to dermal injury

Previous studies have documented that the ability to heal wounds declines with age. Although many factors contribute to this age-associated deficit, one variable that has not been carefully examined is leukocyte recruitment and function in wounds. This investigation compares the inflammatory response in excisional wounds of young (age 8 wk) and aged (age 22 mo) mice. In the early inflammatory response, neutrophil content of wounds was similar for both aged and young mice. In contrast, macrophage levels were 56% higher in aged versus young mice (81 +/- 20 vs 52 +/- 13 cells per mm2). In the later inflammatory response, wounds of aged mice exhibited a delay in T cell infiltration, with maximum T cell levels at day 10 in aged mice versus day 7 in young mice. Despite this delay, the eventual peak concentration of T cells was 23% higher in the wounds of aged mice (152 +/- 11 cells per mm2 vs 124 +/- 21cells per mm2). The observed alterations in inflammatory cell content suggested that chemokine production might be altered with age. An elevation of monocyte chemoattractant protein (MCP-1) levels was observed in wounds of aged mice. RNase protection studies, however, revealed that the production of most chemokines, including MIP-2, MIP-1alpha, MIP-1beta, and eotaxin, tended to decline with age. Because optimal wound healing requires both appropriate macrophage infiltration and phagocytic activity, phagocytosis was examined. Compared to young mice, wound macrophages from aged mice exhibited a 37%-43% reduction in phagocytic capacity. Taken together, the data demonstrate age-related shifts in both macrophage and T cell infiltration into wounds, alterations in chemokine content, and a concurrent decline in wound macrophage phagocytic function. These alterations may contribute to the delayed repair response of aging.

Open-label crossover study of vitamin A ointment as a treatment for keratoconjunctivitis sicca

The authors evaluated the efficacy of all-trans retinoic acid (vitamin A) ointment as a treatment for keratoconjunctivitis sicca (KCS) in a group of 11 patients selected on the basis of clinical history, slit-lamp examination results, rose Bengal staining, and tear film osmolarity. In this open-label crossover study, vitamin A ointment was no more effective than placebo in increasing tear secretion, as indicated by Schirmer test with proparacaine or tear film osmolarity, or in decreasing ocular surface disease, as indicated by rose Bengal staining. Seven patients stated some preference for the placebo ointment, two patients for the vitamin A ointment, and two patients had no preference.

Tear film osmolarity and ocular surface disease in two rabbit models for keratoconjunctivitis sicca

We report the natural history of keratoconjunctivitis sicca (KCS) in two rabbit models. The first one (full KCS model) was created by closing the lacrimal gland excretory duct, and removing the nictitating membrane and harderian gland. We created the second one (lacrimal gland duct only [LGDO]-KCS model) by closing the lacrimal gland excretory duct. Although tear film osmolarity was abnormally high in both models, it was higher in the full KCS model. Decreases in corneal epithelial glycogen and in conjunctival goblet cell density, and morphological abnormalities of the conjunctiva correlated with increases in tear film osmolarity and duration of disease.

Stimulation of rabbit lacrimal gland secretion with biologically active peptides

To determine whether biologically active peptides can stimulate lacrimal gland secretion, we measured fluid and protein secretion from the cannulated lacrimal gland excretory duct of anesthetized rabbits after arterial injection of various peptides. Vasoactive intestinal peptide (VIP, 0.003-3 nmol) and porcine histidine isoleucine-containing peptide (PHI, 0.01-3 nmol) stimulated fluid and protein secretion in a dose-dependent manner. Cholecystokinin octapeptide (CCK-8, 0.01-3 nmol) stimulated fluid but not protein secretion. Neither bombesin nor eledoisin in doses as high as 3 nmol stimulated fluid or protein secretion. When combinations of high or low doses of VIP and the cholinergic agonist acetylcholine (ACh) were injected simultaneously, fluid and protein secretion was additive. We concluded that VIP and PHI stimulated secretion of lacrimal gland fluid and protein, CCK-8 stimulated secretion of fluid, and bombesin and eledoisin did not stimulate either fluid or protein secretion. VIP and ACh, both found in lacrimal gland nerve endings, stimulate lacrimal gland fluid and protein secretion by separate pathways.

A new rabbit model for keratoconjunctivitis sicca

The authors created a new rabbit model for keratoconjunctivitis sicca by cauterizing the lacrimal gland excretory duct and surgically removing the nictitating membrane and harderian gland. Although the slit-lamp examination findings remained normal for the first 8 wk postoperatively, tear-film osmolarity was elevated by postoperative day 1. Corneal epithelial glycogen levels declined progressively, and conjunctival goblet cell density remained decreased. Multiple controls indicated that closure of the lacrimal gland excretory duct was required for elevation of tear film osmolarity, which, in turn, was required for persistent ocular surface disease.

Improved technique for storage of tear microvolumes

The authors have developed an improved technique for storage of fluid microvolumes prior to osmolality measurement. To date, tear samples have been stored in a column of Cargilles B immersion oil contained within a capillary tube, sealed at one end with Critoseal. Covering the open end of this tube with Parafilm now provides reliable storage of 0.5-microliter samples for up to 24 hr; using water-saturated Cargilles B immersion oil within the capillary tube, and covering the open end of the tube with Parafilm now provides reliable storage of 0.1-microliter samples for up to 18 hr.

A proposed mechanism for increased tear-film osmolarity in contact lens wearers

Contact lenses decrease corneal sensitivity and increase tear-film osmolarity. To determine whether the decrease in corneal sensitivity is responsible for the increase in tear-film osmolarity, we studied tear-film osmolarity in normal rabbits and rabbits with surgically induced keratoconjunctivitis sicca before and after the instillation of 0.5% proparacaine. Instillation of proparacaine resulted in a significant increase in tear-film osmolarity. Decreased corneal sensitivity, with a resultant decrease in tear secretory rates, is the most likely cause for increased tear-film osmolarity in wearers of hard contact and extended-wear soft contact lenses.

Prenatal exposure to the fungicide dinocap causes behavioral torticollis, ballooning and cleft palate in mice, but not rats or hamsters

The present study is an evaluation of the developmental toxicity of dinocap in three rodent species using an in vivo teratology screen. Our protocol uses postnatal viability, weight gain, and morphological and behavioral development through weaning to assess the developmental toxicity of compounds. Dinocap administered orally on days 7 to 16 of gestation to the CD-1 mouse resulted in increased postnatal mortality at 25 mg/kg/d (80% in block 1 and 40% in block 2). Many of the treated pups that died during the neonatal period were "ballooned" and had cleft palates. Although there was no treatment related mortality in the 12 mg/kg/d dosage group, 6% (14/226) of these mice and 24% (23/96) of the survivors from the 25 mg/kg/d dosage group displayed torticollis (a twisting of the neck resulting in an abnormal tilting of the head). These tilted-head mice held the head and forepart of the body tilted constantly to one side, both when resting and walking. The tilt was in either direction but was always constant for a given animal; in different mice, the angle varied considerably from almost 0 to 30 degrees. Some mice circled repeatedly in one direction in the home cage, others bobbed their heads and did back-flips, while others rolled over, always rolling in the same direction. In the hamster, developmental toxicity was seen at (100 and 200 mg/kg/d) or near (50 mg/kg/d) maternally toxic doses but no behavioral alterations were noted and none of the pups were ballooned.