Effectiveness of a paediatric weight management intervention for rural youth (iAmHealthy): Primary outcomes of a cluster randomised control trial

BACKGROUND

Youth in rural areas are disproportionally affected by obesity. Given the unique barriers rural populations face, tailoring and increasing access to obesity interventions is necessary.

OBJECTIVE

This paper evaluates the effectiveness of iAmHealthy, a family-based paediatric obesity intervention delivered to rural children, compared to a Newsletter Control.

METHODS

Participating schools (n = 18) were randomly assigned to iAmHealthy or Newsletter Control. iAmHealthy consists of individual health coaching and group sessions delivered via televideo to a participant's home. The child and parent's body mass index (BMI), child physical activity and child dietary intake were assessed at baseline, post-treatment (8 months) and follow-up (20 months). Multilevel modeling estimated the effect of treatment at both time points.

RESULTS

Parent and child dyads were recruited (n = 148) and randomised to iAmHealthy (n = 64) or the Control group (n = 84). The Control group had significant increases in child BMIz from baseline to follow-up. iAmHealthy youth had no significant changes in BMIz from baseline to post or follow-up. Child dietary intake, physical activity and parent BMI results are also discussed.

CONCLUSIONS

This trial extends previous paediatric obesity work by simultaneously increasing convenience and dose of treatment. Results suggest iAmHealthy resulted in a change in BMIz trajectories and long-term health behaviour for youth.

Anthropometric Changes During Pregnancy and Their Association with Adequacy of Gestational Weight Gain

Background

Gestational weight gain (GWG) is an expected component of a healthy pregnancy. Gaining weight within the recommended range helps support the mother's health by providing energy reserves and nutrients to meet the increased metabolic demands during pregnancy. Too much or too little GWG has been associated with adverse health outcomes for the mother and child.

Objective

The objective of the study was to examine how changes in anthropometric indicators during pregnancy, including fat gain, vary, compare changes among body mass index (BMI) (kg/m2) groups, and examine how the changes were associated with adequacy of GWG defined using the 2009 Institute of Medicine guidelines.

Methods

Data came from a cohort of 360 pregnant women with measured anthropometric indicators (weight, midupper arm circumference, and skin folds of the triceps, thigh, and upper iliac) at <12-, 16 to 22-, and 28 to 32-wks of gestation. Fat gain was calculated using a formula. Analysis of variance was used to test for differences in anthropometric changes by BMI and adequacy of GWG in the third trimester. Multiple logistic regression was used to examine associations between changes in anthropometric indicators and GWG recommendations.

Results

Women with normal weight had greater increases in all anthropometric indicators, which differed from women with obesity, who had negative changes and gained less weight. Women who gained inadequately (21%) had negative changes that were all less, compared with women who gained adequately (46%) (except in upper iliac) or excessively (34%). Women with BMI of >25 who gained adequately also had negative changes. Logistic regression results indicated that changes in midupper arm circumference, triceps, and thigh skin folds, and fat gain were all inversely associated with inadequate GWG, whereas all indicators were positively associated with excessive GWG.

Conclusions

Anthropometric changes during pregnancy differ by BMI and are associated with adequacy of GWG. Women who gained adequately had minimal fat gain, lending support for current GWG guidelines.

'eatNplay' - a rurally-tailored, family-based, telehealth intervention for childhood obesity: Protocol for a mixed-methods randomized newsletter controlled pilot study

BACKGROUND

Childhood obesity disproportionately affects rural communities where access to pediatric weight control services is limited. Telehealth may facilitate access to these services.

OBJECTIVE

This paper describes the rationale, curriculum, and methodology for conducting a randomized controlled pilot trial of a rural, family-based, telehealth intervention that aims to improve weight-related behaviors among children, compared to monthly newsletters.

METHODS

A mixed-methods randomized design will randomly assign 44 rural families with one or more children aged 5 to 11 years identified as overweight or obese to an intervention or newsletter control group. The intervention group will attend 'eatNplay' group videoconferencing telehealth sessions, conducted weekly by a registered nurse and a motivational interviewing expert, to discuss diet, exercise, sleep, and peer group influences. The control group will receive newsletters covering these topics. Outcome measures at baseline, 12, and 26 weeks will assess 1) participant engagement and satisfaction with 'eatNplay'; 2) child's BMI, dietary behavior, physical activity, and sleep behavior; and 3) parent/guardians' self-reported beliefs, behaviors, attitudes, perceived stress, and perceived quality of life. Analyses will employ 1) thematic analysis of semi-structured parent/guardian interviews after follow-up to help refine the intervention (e.g., curriculum), and 2) linear mixed models to compare outcomes between groups pre- and post-intervention and reduce bias from unobserved variables. Results of this pilot study could refine methodology for conducting telehealth studies, acceptability of healthcare provider-involved recruitment, interdisciplinary team approach, and addressing childhood obesity in rural communities through telehealth.

Body Weight Perception and Health-Related Behaviors Among U.S. Adolescents: Mediating Effects of Body Weight Control Behaviors

This study examined mediating effects of body weight control behaviors in the relationship between body weight perception and health-related behaviors among 11,458 U.S. adolescents from the 2010 National Youth Physical Activity and Nutrition Survey. Parallel multiple mediation analysis was performed for the secondary data analysis. Nearly one third of adolescents (32.5%) had overweight or obesity; one quarter (25.0%) perceived themselves as slightly overweight and 5.1% thought they were very overweight. More girls (58.6%) had tried to lose weight than boys (32.3%), while boys were more physically active than girls. Healthy and unhealthy weight control behaviors significantly mediated the relationship between adolescents' body weight perception and health-related behaviors (physical activity and screen time). Teachers and parents should help adolescents have accurate weight perception and utilize reliable and healthy weight control strategies. Future studies should consider the intercorrelated relationships among adolescents' perceptions and behaviors regarding weight to provide successful weight control intervention programs.

The accelerator, the brake, and the terrain: associations of reward-related eating, self-regulation, and the home food environment with diet quality during pregnancy and postpartum in the pregnancy eating attributes study (PEAS) cohort

Background

Neurobehavioral factors, including reward-related eating and self-regulation, in conjunction with the food environment, may influence dietary behaviors. However, these constructs have not been examined in pregnancy and postpartum, a time of changing appetite and eating behaviors, and when dietary intake has implications for maternal and child health. This study examined associations of reward-related eating, self-regulation, and the home food environment with pregnancy and postpartum diet quality.

Methods

Participants in the Pregnancy Eating Attributes Study observational cohort were enrolled at ≤12 weeks gestation and followed through one-year postpartum. Pregnancy and postpartum Healthy Eating Index-2015 (HEI-total), and adequacy and moderation scores, respectively, were calculated by pooling 24-h diet recalls administered each trimester and during 2, 6, and 12 months postpartum. Participants completed four measures of reward-related eating – Modified Yale Food Addiction Scale (mYFAS), Power of Food Scale (PFS), Multiple Choice Procedure (MCP), and Reinforcing Value of Food Questionnaire (RVFQ); two measures of self-regulation – Barratt Impulsiveness Scale (BIS) and Delay of Gratification Inventory (DGI); and a Home Food Inventory (HFI), yielding obesogenic (OBES) and fruit/vegetables (FV) scores. Linear regression analyses estimated associations of reward-related eating, self-regulation, and home food environment with diet quality during pregnancy and postpartum, adjusting for sociodemographic characteristics.

Results

Pregnancy HEI-total was inversely associated with PFS (β = − 0.14 ± 0.05, p = 0.009), mYFAS(β = − 0.14 ± 0.06, p = 0.02), 2 of the 5 RVFQ indices, MCP (β = − 0.14 ± 0.05, p = 0.01), and DGI food subscale (β = 0.23 ± 0.05, p < 0.001), but associations of postpartum HEI-total with reward-related eating measures and self-regulation were small and not statistically significant. Pregnancy and postpartum HEI-total were associated inversely with HFI-OBES (β = − 0.17 ± 0.06, p = 0.004 and β = − 0.19 ± 0.07, p = 0.006, respectively), and positively with HFI-FV (β = 0.21 ± 0.05, p < 0.001 and β = 0.17 ± 0.06, p = 0.009, respectively).

Conclusions

Associations of poorer diet quality with greater reward-related eating during pregnancy but not postpartum suggests the need to better understand differences in the determinants of eating behaviors and approaches to circumvent or moderate reward-related eating to facilitate more optimal diet quality across this critical period.

Trial registration

Clinicaltrials.gov. URL – Registration ID – NCT02217462. Date of registration – August 13, 2014.

Reward-related eating, self-regulation, and weight change in pregnancy and postpartum: the Pregnancy Eating Attributes Study (PEAS)

Background/Objectives.

Reward-related eating is hypothesized to underlie risk for weight gain in obesogenic environments, but its role is unknown during pregnancy and postpartum when weight change is normative, but excess weight gain and weight retention are common. This study examined associations of self-reported reward-related eating, self-regulation, and the home food environment with excessive gestational weight gain (GWG) and postpartum weight change.

Subjects/Methods.

Participants in the Pregnancy Eating Attributes Study observational cohort were enrolled at ≤12 weeks pregnancy and followed through one-year postpartum (458 recruited; 367 retained through delivery). Participants completed four measures of reward-related eating – Modified Yale Food Addiction Scale, Power of Food Scale, Multiple Choice Procedure, and a Reinforcing Value of Food Questionnaire; two measures of self-regulation – Barratt Impulsiveness Scale and Delay of Gratification Inventory; and a Home Food Inventory. Measured weight and skinfolds were obtained. Multinomial logistic and multiple linear regression analyses estimated associations of reward-related eating, self-regulation, and home food environment with excessive GWG, gestational fat gain, postpartum weight change, and percent of GWG retained.

Results.

Excessive GWG was associated with food reinforcement intensity, but not with any other measure of reward-related eating, self-regulation, or home food environment. Greater gestational fat gain was associated only with higher Multiple Choice Procedure. Postpartum weight change and percent of GWG retained were associated with greater Delay of Gratification and obesogenic home food environment, but not with any measure of reward-related eating or with impulsivity.

Conclusions.

Findings do not support the hypothesis that self-reported reward-related eating is associated with weight outcomes in pregnancy and postpartum but indicate a relation of Delay of Gratification with postpartum weight retention. Further research using both surveys and objective measures of reward-related eating is needed to advance our understanding of the relation of reward-related eating with weight changes during this critical period of a woman’s life.

Effects of COVID-19 Lockdown on Lifestyle Behaviors in Children with Obesity Living in Verona, Italy: A Longitudinal Study

OBJECTIVE

The aim of this study was to test the hypothesis that youths with obesity, when removed from structured school activities and confined to their homes during the coronavirus disease 2019 pandemic, will display unfavorable trends in lifestyle behaviors.

METHODS

The sample included 41 children and adolescents with obesity participating in a longitudinal observational study located in Verona, Italy. Lifestyle information including diet, activity, and sleep behaviors was collected at baseline and 3 weeks into the national lockdown during which home confinement was mandatory. Changes in outcomes over the two study time points were evaluated for significance using paired t tests.

RESULTS

There were no changes in reported vegetable intake; fruit intake increased (P = 0.055) during the lockdown. By contrast, potato chip, red meat, and sugary drink intakes increased significantly during the lockdown (P value range, 0.005 to < 0.001). Time spent in sports activities decreased by 2.30 (SD 4.60) h/wk (P = 0.003), and sleep time increased by 0.65 (SD 1.29) h/d (P = 0.003). Screen time increased by 4.85 (SD 2.40) h/d (P < 0.001).

CONCLUSIONS

Recognizing these adverse collateral effects of the coronavirus disease 2019 pandemic lockdown is critical in avoiding depreciation of weight control efforts among youths afflicted with excess adiposity. Depending on duration, these untoward lockdown effects may have a lasting impact on a child's or adolescent's adult adiposity level.

A Prospective Study of Relations Among Infant, Maternal, and Paternal Adiposity Indicators

Objectives

This study examines relations of infant birth size and growth with maternal early pregnancy BMI, gestational weight gain (GWG), postpartum weight change and paternal body size.

Methods

Infant birth size (small for gestational age- SGA, &lt;10th percentile and large for gestational age- LGA, &gt;90th percentile) and weight-for-length z-scores (WFLz) were calculated from anthropometrics obtained at birth (n = 331), 6 weeks, 6 months and 12 months of age. Maternal early pregnancy BMI, GWG, % of GWG lost (%GWGL), and return to early pregnancy weight (EPW) were derived from height and weight measured from early pregnancy (mean ± SD = 9.9 ± 1.7 weeks gestation) through 12 months postpartum. Mothers reported father's baseline body size via Stunkard figure ratings. Logistic regressions and linear mixed models estimated relations of SGA, LGA and WFLz with parent weight indicators. Multiplicative interaction terms tested interactions of maternal BMI with pregnancy and postpartum weight change, and of paternal with maternal weight indicators. Analyses controlled for maternal height, demographics, child sex, gestational age at delivery, and delivery mode.

Results

LGA was positively associated with maternal BMI (OR = 1.10, 95%CI:1.05–1.16, P &lt; 0.001) but not GWG. SGA was associated with lower odds of excessive GWG (OR = 0.24, 95%CI:0.07–0.79, P = 0.02) but was not associated with maternal BMI. Paternal body size was not associated with LGA or SGA. WFLz was positively associated with maternal BMI (β ± SE = 0.03 ± 0.09 P = 0.001), but not GWG, %GWGL, EPW, or paternal body size. However, WFLz was positively associated with GWG in mothers with low (&lt;25) but not high (≥25) early pregnancy BMI (β ± SE interaction term = −0.004 ± 0.002, P = 0.04). Paternal body size did not modify associations of maternal with infant weight indicators.

Conclusions

Maternal BMI was consistently associated with birth size and infant adiposity development, and associations were not modified by paternal body size. Whether pre-pregnancy interventions are more effective than pregnancy interventions for reducing offspring overweight in women with high BMI is an important area of future investigation.

Funding Sources

This research was supported by the NICHD Intramural Research Program.

Associations of Maternal Sociodemographic Characteristics and Eating Behaviors with Infant Feeding Behaviors

Objectives

This study examines associations of maternal characteristics with infant feeding of discretionary and health-promoting foods.

Methods

Mothers in PEAS, a prospective cohort study, reported maternal and child dietary intake, demographics, and eating competence (EC). Maternal diet quality (Healthy Eating Index-2015, HEI) was calculated combining 24-hour diet recalls at 6 weeks, 6, and 12 months postpartum (n = 209). Infant food frequency questionnaires were completed at 6, 9, and 12 months, assessing age of introduction and intake frequency of food groups. T-tests examined bivariate associations of demographics with feeding of discretionary sweets, discretionary savory foods, fruit, and vegetables. Linear regressions examined associations of maternal EC and HEI with infant feeding controlling for demographics.

Results

Fruit, vegetables, discretionary sweet, and discretionary savory foods were introduced at 5.8 ± 1.7, 5.9 ± 1.7, 8.0 ± 2.0, and 8.8 ± 1.8 months, respectively. Earlier introduction of fruit and vegetables was associated with higher maternal education, white race, and nulliparity; earlier introduction of vegetables was also associated with higher income. Age of introduction of discretionary sweet and savory foods was not associated with maternal demographics, HEI, or EC. At age 12 months, greater infant intake frequency of fruit and vegetables was associated with higher education and income, white race, and breastfeeding, while greater intake frequency of discretionary sweet and savory foods was associated with lower maternal education and minority race. Greater intake frequency of sweets was also associated with multiparity and greater intake frequency of discretionary savory foods was associated with lower income. Maternal HEI was positively associated with infant intake frequency of fruit, vegetables, and discretionary sweet and savory foods. Maternal EC was positively associated with infant intake frequency of fruit and vegetables.

Conclusions

Demographic differences in infant feeding behaviors indicates these behaviors as critical intervention targets to address disparities in child diet quality. Associations of maternal HEI and EC with infant feeding behaviors suggest potential pathways of maternal influence on infant diet.

Funding Sources

This research was supported by the NICHD Intramural Research Program.

Using Food Network Analysis to Understand Meal Patterns in Pregnant Women with High and Low Diet Quality

Objectives

Our aim was to qualitatively assess networks describing interrelations among foods consumed at meals in pregnant women with high and low overall diet quality as defined by the Healthy Eating Index-2015 (HEI).

Methods

Multiple 24-hour dietary recalls (mean = 3.4) from 365 women in the Pregnancy Eating Attributes Study (PEAS) were collected across pregnancy. Food networks using intakes of 40 food groups were derived for each meal (breakfast, lunch, dinner) for women in the highest (n = 122) and lowest (n = 121) HEI tertiles using semiparametric gaussian copula graphical models (SGCGM). Networks are based on the resulting sparse matrix of partial correlations (edges) between food groups (nodes); communities within the networks were detected using the Louvain method (LM).

Results

In breakfast networks, 3 communities were detected in the low and 4 communities in the high group. In both groups, breakfast community (BC) 1 included white bread, eggs, cured meat and cheese; whole grain bread was also part of BC1 only in the high group. BC2 included milk and breakfast cereals in both groups; fried potatoes and sugar-sweetened beverages (SSB) were part of BC2 in the low group only. BC3, composed of cooked cereals and legumes/nuts/seeds in the high group, replaces a community composed of pancakes/other breads and sugars/sweets in the low group. In lunch networks, 5 communities were detected in both the low and high groups. Fried potatoes and SSBs were consumed with sandwiches in the low group but not in the high group. Vegetables were consumed more often (green P &lt; .0001, red/orange P &lt; .0001, other p 0.004) and in combinations with other foods in the high group. In dinner networks, 6 communities were detected in both groups. Sandwiches, fried potatoes and SSBs were consumed together and more often in the low group (5%, 12%, 23% of dinners, respectively) but separately in the high group (2%, 6%, 10% of dinners, respectively).

Conclusions

Food network analysis may provide a better understanding of the interrelationships of food intake at meals than traditional methods of meal pattern analysis. Differences observed in networks among pregnant women with low and with high diet quality may serve as a guide for meal-specific recommendations and interventions aimed at improving diet quality during pregnancy.

Funding Sources

This research was supported by the NICHD Intramural Research Program.

A Prospective Study of the Relationship of Infant Adiposity with Maternal Prenatal and Postnatal Diet Quality

Objectives

This study examines relationships of maternal prenatal and postnatal diet quality with infant birth size and growth, which are known risk factors for child obesity.

Methods

Women completed six 24-hour diet recalls (1 per pregnancy trimester and at 6 weeks, 6 months, and 12 months postpartum); infant anthropometrics were obtained at birth (n = 331 mother-child dyads), 6 weeks, 6 months and 12 months of age. Prenatal and postnatal Healthy Eating Index 2015 total (HEI), adequacy (HEI-adq) and moderation (HEI-mod) scores were calculated by combining recalls across pregnancy and across postpartum. Linear mixed models estimated associations of infant weight-for-length z-scores (WFLz) with prenatal and postnatal diet quality. Logistic regressions estimated odds of small-for-gestational age (SGA, &lt;10th percentile) and large-for-gestational age (LGA, &gt;90th percentile) associated with maternal prenatal diet quality. Covariates included maternal height, demographics, delivery mode, child sex, and gestational age at delivery. Sensitivity analyses examined whether associations were robust to inclusion of maternal total energy intake or early pregnancy BMI.

Results

WFLz was inversely associated with prenatal HEI (β±SE = −0.02 ± 0.005, P = 0.004) and HEI-mod (β ± SE = −0.04 ± 0.01, P &lt; 0.001), and with postnatal HEI (β ± SE = −0.01 ± 0.005, P = 0.01) and HEI-adq (β ± SE = −0.02 ± 0.007, P = 0.005). SGA and LGA occurred for 92 (7%) and 172 (12%) babies, respectively. LGA was inversely associated with prenatal HEI (OR = 0.94, 95% CI: 0.90–0.98), HEI-mod (OR = 0.83, 95% CI: 0.74–0.83) and HEI-adq (OR = 0.95, 95% CI: 0.90–1.01). SGA was not associated with prenatal diet quality. Associations were not changed when adjusted for energy intake but were modestly attenuated when adjusted for BMI.

Conclusions

Higher maternal prenatal and postnatal diet quality were associated with more favorable indicators of infant adiposity from birth through 12 months of age. Interventions are needed to determine whether targeting both prenatal and postnatal diet may lead to improved infant adiposity development.

Funding Sources

This research was supported by the NICHD Intramural Research Program.

Influence of Maternal Diet on Flavor Transfer to Amniotic Fluid and Breast Milk and Children's Responses: A Systematic Review (P11-029-19)

Objectives

Systematic reviews were completed to examine the relationships between maternal diet during pregnancy and lactation; amniotic fluid flavor; breast milk flavor, and children's food acceptability and overall dietary intake into adulthood.

Methods

A literature search was conducted in 10 databases (e.g., Pubmed, Embase, Cochrane, and CINAHL) to identify articles published from January 1980 to June 2017. Data from each included study were extracted, risk of bias assessed, evidence synthesized qualitatively, conclusion statements developed, and strength of the evidence graded.

Results

Twenty-five articles met a priori criteria; 11 articles were relevant for the relationship between maternal diet, amniotic fluid flavor, and infant flavor acceptance and dietary intake; 15 articles were relevant for the relationship between maternal diet, breast milk flavor, and infant flavor acceptance and dietary intake. One article was included in both reviews. Limited but consistent evidence indicates that flavors (alcohol, anise carrot, garlic) originating from the maternal diet during pregnancy can transfer to and flavor amniotic fluid, and fetal flavor exposure increases acceptance of the exposed flavor during infancy and potentially childhood. Moderate evidence indicates that flavors originating from the maternal diet during lactation (alcohol, anise, caraway, carrot, eucalyptus, garlic, mint) transmit to and flavor breast milk in a time-dependent manner. Moderate evidence indicates that infants can detect flavors from the maternal diet through breast milk. This occurs within hours (alcohol, garlic, vanilla), within days (garlic, carrot juice), and within months (cereal flavored with a variety of vegetables including carrot) following maternal ingestion of those flavors during lactation. Findings may not generalize to all foods and beverages. Conclusions cannot be drawn regarding the relationship between mothers' diet during either pregnancy or lactation and overall dietary intake of infants or children.

Conclusions

Maternal diet during pregnancy and lactation may provide the earliest opportunity to influence child food acceptance.

Funding Sources

USDA Food and Nutrition Service, Alexandria, VA.

iAmHealthy: Rationale, design and application of a family-based mHealth pediatric obesity intervention for rural children

Children in rural areas are disproportionately affected by pediatric obesity. Poor access to healthcare providers, lack of nutrition education, lower socioeconomic status, and fewer opportunities to be physically active are all unique barriers that contribute to this growing health concern. There are very few pediatric obesity interventions that have been developed that target this unique population. iAmHealthy is a family-based behavioral, nutrition and physical activity intervention developed with input from rural children and families that capitalizes on the innovative use of mobile health applications (mHealth). iAmHealthy is a 25-contact hour multicomponent intervention delivered over an 8-month period targeting 2nd-4th grade school children and their families. This paper describes the rationale, design, participant/school enrollment, and planned implementation of a randomized controlled trial of the iAmHealthy intervention in comparison to a monthly newsletter delivered through rural elementary schools. Child Body Mass Index z-score (BMIz) is the primary outcome, along with child 24-hour dietary recall, and child accelerometer-determined physical activity and sedentary behavior as secondary outcomes. The study will include 18 schools (with 8 children each) resulting in a final planned sample size of 144 children. This project also has a strong focus on dissemination and implementation science, and thus includes many measures related to the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, and Maintenance). Data collection is completed at baseline, end of intervention (8 months), and follow-up (20 months). This study is the first randomized controlled trial to deliver a rurally tailored, empirically supported, family-based behavioral intervention for pediatric obesity solely over mHealth. Registered with ClinicalTrials.gov NCT ID 03304249.

High energy expenditure is not protective against increased adiposity in children

BACKGROUND

Low levels of energy expenditure (TEE) may contribute to excess weight during childhood, but limited longitudinal data exist.

OBJECTIVES

This is to test whether low TEE during the first 6 years of life could predict excess weight status at 8 years.

METHODS

Total energy expenditure from doubly labelled water, weight, stature, waist circumference and fat mass and fat-free mass (FFM) in children at 0.25, 2, 4 and 6 years of age. This cohort includes individuals at high (n = 27) and low risk (n = 26) for childhood obesity, based upon whether pre-pregnant maternal obesity. A linear mixed effects model was fit to TEE. Individual variation was accounted for as a random effect. Residual TEE was calculated for age and individually averaged across time.

RESULTS

Fat-free mass (kg) was highly correlated (R²  = 0.91) with TEE (kcal/day), and waist circumference and sex were also significant predictors of TEE. TEE residual tracked within individuals. TEE residuals did not correlate with either BMI or %fat at age 8 years.

CONCLUSION

Using the residual TEE approach to identify high and low TEE during the first 6 years of life did not explain excess weight at 8 years of life in this cohort of children at high and low risk of obesity based upon maternal obesity status.

Pregnancy eating attributes study (PEAS): a cohort study examining behavioral and environmental influences on diet and weight change in pregnancy and postpartum

BACKGROUND

The rising prevalence of maternal overweight/obesity and excessive gestational weight gain poses a serious public health concern due to the contribution of these factors to increased risk of negative health outcomes for both mother and child. Scant intervention research has indicated moderate short-term improvement in maternal diet and gestational weight gain, with little evidence of long-term behavior change, in parallel with findings from interventions outside of pregnancy. Recent laboratory-based findings from neuroscience implicate aberrant reward processing of food at the brain level ("food reward sensitivity," the between-individual variation in the response to food stimuli) as a contributor to eating beyond energy needs. However, scant research has examined the influence of these processes on weight change in population-based settings, and the relevance of these processes to pregnancy-related weight change has not been explored. The purpose of the Pregnancy Eating Attributes Study (PEAS) is to examine the role of food reward sensitivity in maternal diet and weight change during pregnancy and postpartum. The study examines the interplay of food reward sensitivity with behavioral control, home food environment, and related aspects of eating behavior in the context of weight-related biomedical, psychosocial, genetic and behavioral factors including physical activity, stress, sleep and depression.

METHODS

Women of varying baseline weight status (n = 450) are enrolled early in pregnancy and followed, along with their infants, until 1 year postpartum. Assessments occur during each trimester of pregnancy, and postpartum at approximately 2 months, 6 months, 9 months and 12 months. Maternal food reward, self-control, home food environment, eating behaviors, dietary intake, health behaviors, and anthropometrics are assessed along with maternal and infant clinical and biological data, infant anthropometrics, and feeding practices. Primary exposures of interest include food reward sensitivity, behavioral control, and home food environment. Primary outcomes include gestational weight gain, postpartum weight retention and maternal diet quality.

DISCUSSION

With increasing evidence suggesting the relevance of food reward sensitivity for understanding eating behavior, PEAS aims to advance understanding of the determinants of eating behavior during pregnancy, informing future interventions for improving maternal diet and weight change, and leading to improved maternal and child health and weight trajectories.

TRIAL REGISTRATION

Clinicaltrials.gov, NCT02217462. Date of registration: August 13, 2014.

Nicotine abstinence-induced cerebral blood flow changes by genotype

This study explored whether functional genetic variants previously associated with nicotine dependence are associated with regional cerebral blood flow (rCBF) changes during nicotine abstinence (compared to satiety; smoking as usual). Thirteen smokers participating in a prior arterial spin labeled (ASL) perfusion MRI study were scanned on two occasions (after >12h abstinence vs. satiety), and were genotyped for variants in the dopamine D2 receptor (DRD2-141 Ins/DelC; DRD2 C957T); a dopamine metabolizing enzyme (COMT val(158) met), and the mu opioid receptor (OPRM1 A118G). Significantly greater CBF increases were found in regions previously linked with cigarette cravings among carriers of the DelC variant of DRD2-141 and among the COMT val/val group. Smokers with TT genotypes for the DRD2 C957T exhibited less change in rCBF in abstinence relative to satiety, compared to those with CC or CT genotypes. Finally, smokers with OPRM1 AA genotypes showed significant increases in CBF in regions associated previously with cigarette cravings. While preliminary, these results suggest a neural mechanism through which these genetic variants may be linked with nicotine dependence, and provide further support for increased biological vulnerability in these subgroups of smokers.

Psychometric properties of a new questionnaire to assess eating in the absence of hunger in children and adolescents

BACKGROUND

Eating in the absence of hunger (EAH), studied in the context of laboratory paradigms, has been associated with obesity and is predictive of excess weight gain in children. However, no easily administered questionnaire exists to assess for EAH in children.

OBJECTIVE

We developed an Eating in the Absence of Hunger Questionnaire to be administered to children and adolescents (EAH-C) and examined psychometric properties of the measure.

DESIGN

Two-hundred and twenty-six obese (BMI > or = 95th percentile for age and sex, n=73) and non-obese (BMI<95th percentile, n=153) youth (mean age+/-S.D., 14.4+/-2.5 y) completed the EAH-C and measures of loss of control and emotional eating, and general psychopathology. Temporal stability was assessed in a subset of participants.

RESULTS

Factor analysis generated three subscales for the EAH-C: Negative Affect, External Eating, and Fatigue/Boredom. Internal consistency for all subscales was established (Cronbach's alphas: 0.80-0.88). The EAH-C subscales had good convergent validity with emotional eating and loss of control episodes (p's<0.01). Obese children reported higher Negative Affect subscale scores than non-obese children (p</=0.05). All three subscales were positively correlated with measures of general psychopathology. Intra-class correlation coefficients revealed temporal stability for all subscales (ranging from 0.65 to 0.70, p's<0.01). We conclude that the EAH-C had internally consistent subscales with good convergent validity and temporal stability, but may have limited discriminant validity. Further investigations examining the EAH-C in relation to laboratory feeding studies are required to determine whether reported EAH is related to actual energy intake or to the development of excess weight gain.

An effective integrated learning programme in the first year of the medical course

BACKGROUND

An integrated approach to teaching medical subjects is an effective educational strategy. Yet, this has not become popular in medical colleges in India. We describe an integrated learning programme to teach the gastrointestinal system in the first year of the medical course.

METHODS

The integrated learning programme was conducted for 3 years (2003-2005). It incorporated elements of problem-based learning, early clinical exposure, lectures and small group laboratory work. Student assessment was formative (for problem-based learning sessions) and summative (using problem-based learning and knowledge tests). Evaluation of the programme was based on feedback from the students and faculty members.

RESULTS

Ninety-six per cent of the students obtained more than 60% marks in the problem-based learning test. The mean (SD) score in the knowledge test was 62 (0.89)%. The majority of students received satisfactory and more than satisfactory grades for their performance in the problem-based learning sessions. The feedback from faculty members and students was positive, which highlighted benefits such as integrated learning of the basic sciences, their application to clinical cases and active student learning. The challenges encountered included the higher input required from faculty members. Most of the faculty members and students recommended that the integrated programme should be continued and extended to other parts of the curriculum.

CONCLUSION

An integrated learning programme is feasible within a conventional medical curriculum of an Indian medical college.

A dynamical systems interpretation of a dimensional model of emotion

The dimensional structure of emotion was investigated using self reports of induced mood and idiographic and nomothetic analyses. Subjects attended four experimental sessions during which an array of affective states was induced via auditory, visual, and imaginal channels. For each of 118 stimulus events, subjects self-rated their response. Factor analysis yielded the predicted bipolar factors of valence and arousal: these were obtained in group-aggregated analysis and subsequently confirmed as change dimensions at the intraindividual level. Controversy over the fundamental dimensions of affective space was considered with respect to methodological issues such as factor rotation and sampling of data space. Valence and arousal are discussed as motivational, driving parameters of affective experience and a dynamical systems conceptualization of emotion is proposed.