Gestational weight gain in overweight and obese women enrolled in a healthy lifestyle and eating habits program

Abstract

Objectives: To determine whether changes in lifestyle in women with BMI?>?25 could decrease gestational weight gain and unfavorable pregnancy outcomes.

Methods: Women with BMI?>?25 were randomized at 1st trimester to no intervention or a Therapeutic Lifestyle Changes (TLC) Program including diet (overweight: 1700?kcal/day, obese: 1800?kcal/day) and mild physical activity (30?min/day, 3 times/week). At baseline and at the 36th week women filled-in a Food Frequency Questionnaire. Outcomes: gestational weight gain, gestational diabetes mellitus, gestational hypertension, preterm delivery. Data stratified by BMI categories.

Results: Socio-demographic features were similar between groups (TLC: 33 cases, Controls: 28 cases). At term, gestational weight gain in obese women randomized to TLC group was lower (6.7?±?4.3?kg) versus controls (10.1?±?5.6?kg, p?=?0.047). Gestational diabetes mellitus, gestational hypertension and preterm delivery were also significantly lower. TLC was an independent factor in preventing gestational weight gain, gestational diabetes mellitus, gestational hypertension. Significant changes in eating habits occurred in the TLC group, which increased the number of snacks, the intake of fruits–vegetables and decreased the consumption of sugar.

Conclusions: A caloric restriction associated to changes in eating behavior and constant physical activity, is able to reduce gestational weight gain and related pregnancy complications in obese women.     

Effect of cumin powder on body composition and lipid profile in overweight and obese women

IntroductionThis study aimed to determine the effect of cumin powder on body composition and lipid profile in overweight and obese women.Materials & methodsIn this randomized clinical trial, 88 overweight/obese women were randomly assigned into two groups. The experimental group was asked to have 3 g/d cumin powder with yogurt at two meals for 3 months. The same amount of yogurt minus cumin powder was prescribed for the control group. All patients received nutrition counseling for weight loss in a similar manner. Anthropometric and biochemical parameters were determined before and after the intervention.ResultsCumin powder reduced serum levels of fasting cholesterol, triglyceride, and LDL and increased HDL. Weight, BMI, waist circumference, fat mass and its percentage significantly reduced. It has no effect on FBS and fat-free mass.ConclusionCumin powder in a weight reduction diet showed improvement in anthropometric and biochemical parameters in overweight/obese women.     

Influences on the food choices and physical activity behaviours of overweight and obese pregnant women: A qualitative study

Objectiveto qualitatively explore influences identified by overweight/obese pregnant women on food choices and physical activity (PA) behaviours; to determine the impact of pregnancy on these factors; and to inform development of future lifestyle interventions during pregnancy.Designcross-sectional interview study.Settingmaternity hospital, Ireland.Participantspregnant women (n=22), early pregnancy Body Mass Index > 25 kg/m²Measuresbarriers to and facilitators of healthy eating and PA in overweight/obese pregnancy. Interviews were transcribed verbatim and analysed using inductive thematic analysis.Findingsoverweight/obese women perceived the following factors to influence their food choices and PA behaviours: personal (e.g. age, enjoyment, health, aesthetic appearance, and response to fatigue); social (e.g. social support, food modelling, social facilitation and weight bias) and environmental (e.g. food salience and the obesogenic environment). These factors affected PA and food choice trajectories differently according to socio-economic and socio-cultural context.Conclusion and Implicationspersonal, social and environmental factors affect food choices and PA behaviours. Pregnancy is a powerful stimulus for positive changes in food choices particularly. This change is driven by desire for healthy pregnancy outcome, and is not intrinsically motivated. Healthy lifestyle interventions should aim to sustain positive changes beyond pregnancy through: empowerment, intrinsic motivation, family-centred approach, and behavioural goals.     

Regular exercise is the most significant lifestyle parameter associated with the severity of climacteric symptoms: a cross sectional study

Objective

To assess the association between demographic and lifestyle parameters and perceived severity of the climacteric syndrome in perimenopausal women.

Study design

A cross-sectional study of 151 healthy women aged 45–55 years who attended the University Medical Center affiliated menopause clinics. The analysis was based on self completion of the Greene climacteric score, consisting of psychological, somatic/physical, sexual and vasomotor subscores. The Greene total score and subscores were the main outcomes of the study.

Results

Of all demographic, anthropometric and lifestyle parameters recorded, the correlates with reduced total Greene score were high-order maternity and regular physical exercise. Mothers of 3 or more children reported significantly lower total Greene score (18 ± 12.8 vs. 22.1 ± 8.1) (p = 0.01) as well as lower psychological subscore (8.7 ± 6.8 vs. 11.5 ± 5.4) (p = 0.01). Regular physical activity was also associated with significantly lower total Greene score (17.0 ± 11.0 vs. 22.6 ± 11.3) (p = 0.01) and specifically lower psychological subscore (9.5 ± 6.6 vs. 12.8 ± 7.7) (p = 0.03) and sexual subscore (1.1 ± 0.99 vs. 1.61 ± 1.05) (p = 0.03). Linear regression models showed that regular exercise was the lifestyle parameter most significantly correlated with a lower total Greene score (p = 0.006) independent of menopausal status. Of particular note, regular exercise was significantly correlated with lower psychological (p = 0.006) and physical subscores (p = 0.06). Moreover, the higher the frequency of exercise (both aerobic and non aerobic), the lower the severity of the climacteric symptoms reported, yet the vasomotor and sexual subscores remained unchanged.

Conclusions

Regular exercise of at least 3 times a week was the most significant lifestyle parameter to be associated with the severity of climacteric symptoms.     

Labor length among overweight and obese women undergoing induction of labor

Abstract

Objective: Maternal weight is thought to impact labor. With rising rates of obesity and inductions, we sought to evaluate labor times among induced women by body mass index (BMI) category.

Methods: Retrospective cohort study of term inductions from 2005 to 2010. BMI categories were: normal weight (NW), overweight (OW), and obese (Ob) (18.5–24.9, 25–29.9, ≥30?kg/m²). Kruskal–Wallis tests compared median latent labor (LL) length and active labor (AL) length. Chi-square determined associations. Multivariable logistic regression controlled for confounders. Analyses were stratified by parity.

Results: A total of 448 inductions were analyzed. For nulliparas, there was no difference in LL by BMI category (p?=?0.22). However, OW nulliparas had a longer AL compared to NW and Ob nulliparas (3.2, 1.7, 2.0?h, p?=?0.005). For multiparas, NW had the shortest LL (5.5?h, p?=?0.025) with no difference in AL among BMI categories (p?=?0.42). The overall cesarean rate was 23% with no difference by BMI category (p?=?0.95). However, Ob women had a greater percentage of first stage cesareans (41%) and NW had a greater percentage of second stage cesareans (55%), p?=?0.06.

Conclusion: The association between BMI and labor length among inductions differs by phase of labor and parity. BMI also influences the stage of labor in which a cesarean occurs.     

The histology and management of ovarian cysts found in children and adolescents presenting to a children's hospital from 1991 to 2007: a call for more paediatric gynaecologists

Objective  To determine the nature and surgical management of ovarian cysts.
Design  Retrospective case-note study.
Setting  Large Childrens' Hospital: Alder Hey NHS Foundation Trust.
Sample  Children undergoing surgery for ovarian cysts between 1991 and 2007.
Methods  Cases identified using coding and the pathology database, and analysed using snap  9.
Main outcome measures  Extent of surgery performed. Size and histological features of cysts removed.
Results  A total of 155 cases were identified. There were 62 ovarian cysts in children under nine who were prepubertal. There were 58 neoplastic cysts in total. Most were benign teratomas (36). Ten cysts were malignant, including five granulosa cell tumours, one yolk sac tumour, one endodermal sinus tumour and one dysgerminoma. Tumour markers were performed in only 16 cases (10%). Sixty-one (39%) had an ultrasound scan and 16 (10%) had a computed tomography (CT) or magnetic resonance imaging (MRI) scan. Ninety girls (58%) had an oophorectomy and 40 (25%) had an ovarian cystectomy. Oophorectomies were performed for all cases of malignancy, but 75 were also performed for benign or normal pathology. Only 16% of cases were referred to the paediatric gynaecologist and all were for post-operative management.
Conclusions  We recommend the greater use of imaging of the pelvis and tumour markers preoperatively. There should be greater use of conservative expectant management or ovarian-sparing surgery in view of the low risk of malignancy in this age group. The practice of removing ovaries for benign cysts may be overcome by appointing more gynaecologists with advanced training skills training in paediatric and adolescent gynaecology.     

Self-efficacy,quality of life,and weight loss in overweight/obese endometrial cancer survivors (SUCCEED): A randomized controlled trial

Objective

More patient-centered programming is essential for endometrial cancer (EC) survivors needing to lose weight to reduce cardiovascular disease risk (CVD). The purpose of this study was to improve self-efficacy (SE) and quality of life (QOL) using a lifestyle intervention program designed for weight loss.

Methods

Overweight and obese early-stage EC survivors, n = 75, were randomized into two groups: 1) Survivors of Uterine Cancer Empowered by Exercise and Healthy Diet (SUCCEED), a six-month lifestyle intervention or 2) a usual care group (UC). Participants completed the Weight Efficacy Lifestyle Questionnaire (WEL) to assess SE and the Functional Assessment of Cancer Therapy—General (FACT-G) to measure QOL, and their body mass index (BMI) was calculated at baseline, 3, 6, and 12 months. Mixed, repeated-measures ANCOVA models with baseline covariates were employed using SPSS 20.0.

Results

Positive effects in every WEL domain, including the total score, were statistically significant in the SUCCEED group versus the UC group. A linear regression model demonstrated that, if BMI decreased by 1 unit, the total WEL score increased by 4.49 points. Significant negative correlations were found in the total WEL score and a change in BMI of R = − 0.356 (p = 0.006). Between-group differences in the FACT-G were significant from baseline in the fatigue domain at three months (p = .008) and in the physical domain at six months (p = .048). No other significant differences were found.

Conclusion

Overall, this study shows promise for targeted interventions to help improve SE, thus improving BMI.     

Motivational interviewing: a part of the weight loss program for overweight and obese women prior to fertility treatment

Abstract

This is a retrospective study to investigate whether motivational interviewing increases weight loss among obese or overweight women prior to fertility treatment. Women with body mass index (BMI)?>?30?kg/m² approaching the Fertility Clinic, Regional Hospital Skive, were given advice about diet and physical activity with the purpose of weight loss. In addition, they were asked if they wanted to receive motivational interviewing. Among other data, age, height and weight were obtained. Main outcomes were weight loss measured in kg and decrease in BMI. We studied 187 women: 110 received sessions of motivational interviewing (intervention group, n?=?110), 64 received motivational support by phone or e-mail only and 13 women did not wish any motivational support (control group, n?=?77). The mean weight loss and decrease in BMI was greater in the intervention group compared with the control group (9.3?kg versus 7.3?kg, difference p?=?0.01, 3.3?kg/m² versus 2.6?kg/m², difference p?=?0.02). The mean period of intervention was comparable in the two groups, 7.9 month and 7.3 month, respectively, (difference non significant: NS). The study indicates that motivational interviewing may be a valuable tool in weight loss programs for obese and overweight women prior to fertility treatment.     

Influence of habitual physical activity on body composition,fat distribution and metabolic variables in early postmenopausal women receiving hormonal therapy

Objective

To determine whether there is an association between the level of habitual physical activity, body composition and anthropometric and metabolic variables in postmenopausal patients before and after hormone replacement therapy (HRT).

Study design

Thirty-four healthy, recent postmenopausal women (50 ± 2.7 years; 23.8 ± 10 months since menopause) consulting for symptoms of estrogen deficiency were included in the study. Anthropometric assessment, percent of body fat (BF) estimated by skinfold measures, and metabolic evaluation were performed before and 4 months after the start of HRT, which included non-oral or low-dose oral preparations. The status of physical activity was defined by counting steps with a pedometer. Patients were stratified as active (6000 steps ore more per day) or inactive (fewer than 6000 steps per day). Results are expressed as mean ± SD or median and interquartile range. log 10 transformation was used to normalize the distribution of non-Gaussian variables. ANOVA for repeated measures was performed for the active and inactive groups, before and after HT. Pearson correlation coefficient was used to investigate the relationship between anthropometric and metabolic variables and habitual physical activity.

Results

BMI and BF did not change with HRT in comparison with baseline. In contrast, a decline was observed in waist circumference (WC) and waist to hip ratio (WHR) after HRT in both active and inactive women (P < 0.01). While triglycerides and glucose did not change after HRT, total and LDL-cholesterol decreased from baseline. In contrast, after HRT, active patients were found to have lower BF than inactive women (active: 25.4 ± 2.5; inactive: 26.6 ± 2, P = 0.01). There was a significant negative correlation between habitual physical activity (number of steps per day) and BF (r = −0.36, P = 0.04). After HRT, when only active patients were considered, a significant negative correlation was found between the number of steps and WC (r = −0.42, P = 0.04) and WHR (r= −0.58, P = 0.03).

Conclusion

Habitual physical activity plays a major role in preserving a favorable cardiovascular profile in postmenopausal patients using HRT.     

The effects of being overweight and obese on female reproduction: a review

Obesity is a major international problem related to many reproductive health problems including polycystic ovary syndrome (PCOS). This article reviews the evidence of being overweight and its effect on female reproduction. The fecundity of obese women is lower than normal weight women, but there is no absolute consensus about the effect of obesity on infertility treatment. The obese patient might have oocyte, hormone, metabolic and endometrial dysfunction affecting reproduction. Insulin and leptin may be some of the answers explaining anovulation during obesity leading to infertility. Moreover, the follicular glucose and lipids which are important for oocyte development also increase in the obese patient and these might have an effect on oocyte quality because studies in mice have revealed that the obesity affects follicular cell stress and oocyte lipids. Overall, obesity affects female reproduction by disturbing the general body metabolism, hormone metabolism and the follicular environment.     

肥胖儿童骨密度变化及其影响因素分析

分析肥胖儿童骨密度（BMD）及其影响因素,为早期预防骨质疏松提供科学依据。方法　2007年1—12月从长沙市开福区5所小学7～12岁学龄儿童中 ,按照体质指数（BMI）法诊断单纯性肥胖,随机抽取119例单纯性肥胖儿童及103名正常儿童。采用双能X线骨密度仪（DEXA）全身扫描,测量BMD和身体成分。结 果　单纯性肥胖儿童的身高、体重、BMI、腰围和腰臀比均显著高于正常儿童。单纯性肥胖儿童的各部位瘦组织含量（LM）、脂肪组织含量（FM）、体脂百分比（ PBF）及躯干脂肪组织百分比均显著高于正常儿童,但四肢FM百分比却显著低于正常儿童。肥胖儿童各部位BMD和骨矿物质含量（BMC）均大于正常儿童。控制FM后 ,BMD（或BMC）与LM呈显著正相关：控制LM后,BMC与FM亦呈正相关。多元逐步回归分析显示,影响儿童BMD的主要因素是LM。 结论　肥胖儿童BMD高于正常儿童 ,LM对儿童成长中骨的BMD起重要作用。     

Subclinical hypothyroidism is not a risk factor for polycystic ovary syndrome in obese women of reproductive age

Obese women are at high risk for polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SCH) has been associated with weight gain, insulin resistance and impaired fertility, which are also factors involved in PCOS. However, there is limited information regarding the influence of SCH on the presence of PCOS. In order to determine whether SCH increases the prevalence of PCOS, we performed a cross-sectional study in a cohort of reproductive-aged obese women. All subjects underwent anthropometric evaluation, laboratory tests and ultrasound examination. Diagnosis of PCOS was based on the Rotterdam criteria. A total of 534 obese women were included and 108 (20.2%) of them were diagnosed with SCH. Patients with SCH showed similar insulin resistance, comparable androgen levels, and higher triglycerides levels (1.7 vs. 1.5?mmol/L, p?=?.002) compared to those with normal thyroid status. The frequency of PCOS did not differ between the two groups (56.1% for normal thyroid function vs. 60.2% for subclinical hypothyroidism, p?=?.514). In logistic regression analysis, SCH was not an independent risk factor for PCOS after adjusting for confounding factors (OR =?0.984, 95% CI 0.581–1.667). For the first time, our results suggest that SCH does not increase the risk of PCOS in obese women of reproductive age.     

Measuring physical activity in pregnancy: a comparison of accelerometry and self-completion questionnaires in overweight and obese women

Objectives

Increased physical activity in pregnancy may reduce the risk of gestational diabetes and pre-eclampsia, which occur more commonly in overweight and obese women. There is limited assessment of physical activity questionnaires in pregnancy. This study compares self-reported physical activity using two questionnaire methods with objectively recorded physical activity using accelerometry in overweight and obese pregnant women.

Study design

59 women with booking BMI ≥ 25 kg/m² completed the Recent Physical Activity Questionnaire (RPAQ) and Australian Women's Activity Survey (AWAS) or recorded at least 3 days of accelerometry at median 12 weeks’ gestation. Accelerometer thresholds of 100 counts/min and 1952 counts/min were used to define light and moderate or vigorous physical activity (MVPA) respectively.

Results

48% of women were in their first pregnancy and 41% were obese. Median daily self-reported MVPA was significantly higher for both AWAS (127 min, p < 0.001) and RPAQ (81 min, p < 0.001) than that recorded by accelerometer (35 min). There was low or moderate correlation between questionnaire and accelerometer estimates of total active time (AWAS ρ = 0.36, p = 0.008; RPAQ ρ = 0.53, p < 0.001) but no significant correlation between estimates of time spent in MVPA.

Conclusions

These self-report questionnaires over-estimated MVPA and showed poor ability to discriminate women on the basis of MVPA. Accelerometry measurement was feasible and acceptable. Objective methods should be used where possible in studies measuring physical activity in pregnancy. Questionnaires remain valuable to define types of activity.     

新疆哈萨克族儿童超重 肥胖与血清超敏C-反应蛋白及胰岛素抵抗指数的相关研究

摘要：目的　探讨新疆哈萨克族超重、肥胖学龄儿童血清超敏C-反应蛋白（hsCRP）、胰岛素抵抗指数（HOMA-IR）变化及临床意义。方法　2009年5月至2009年7月采用随机分层整群抽样的方法调查新疆伊犁哈萨克族自治州2475名6～14岁哈萨克族在校学生,对其中122例超重或肥胖儿童（超重、肥胖组）及119例年龄、性别相匹配的非肥胖儿童（对照组）分别测体重指数（BMI）、hsCRP、空腹血糖（FPG）、空腹胰岛素（ FINS）,计算HOMA-IR,比较两组差异及各指标的相关性。结果　超重、肥胖组hsCRP、FINS、HMOA-IR明显高于对照组;FPG、低密度脂蛋白（LDL）、总胆固醇（CHO）、高密度脂蛋白（HDL）两组间差异无统计学意义。Pearson相关分析示,BMI与hsCRP、HMOA-IR、FINS有显著正相关趋势,与FPG有负相关趋势,但相关性无统计学意义（P > 0.05）。与CHO、HDL、LDL有正相关趋势,但相关性无统计学意义（P > 0.05）。多重线性回归显示,FINS、HMOA-IR、hsCRP、FPG、LDL均与BMI相关。结论　新疆哈萨克族超重、肥胖儿童存在胰岛素抵抗,同时炎症因子CRP与新疆哈萨克族儿童超重、肥胖的发生及发展有密切关系。     

The interrelationships between age, physical measurements and body composition at menarche in schoolgirls at Ilorin, Nigeria

A cross-sectional study of age, physical size and body composition at menarche was made at Ilorin, Nigeria among 162 secondary school girls who reached menarche between March and June, 1983. The findings show that the mean age, height and weight are 13.7 +/- 1.0 years, 156.2 +/- 6.3 cm and 47.4 +/- 6.7 kg, respectively. The estimated body composition is: total body water (TBW), 25.7 +/- 2.3 l; lean body mass (LBM), 35.7 +/- 3.3 kg; and fat content, 11.8 +/- 3.8 kg. Whereas the coefficient of variation was highest for fat content (32.2), it was least for height (4.0). Menarcheal age has a weak correlation to all the variables, but strong correlation existed between weight and the parameters of body composition. The findings of body composition at menarche in Nigerian and North American schoolgirls are similar.     

Differences in Anthropometric and Ultrasonographic Parameters between Adolescent Girls with Regular and Irregular Menstrual Cycles: A Case-Study of 835 Cases

Study ObjectiveExploring the relation between the age, time since menarche, anthropometric parameters and the growth of the uterus and ovaries in postmenarcheal girls.DesignCross sectional.SettingDepartment of Human reproduction at a tertiary pediatric referral center.ParticipantsEight hundred thirty-five adolescent girls.InterventionsPostmenarcheal girls were classified according to the regularity of their menstrual cycles in 2 groups (regular and irregular cycles) and compared. Anthropometric measurements and ultrasonographic examination of the pelvis was conducted with all participants.Main Outcome MeasuresAnthropometric and ultrasonographic parameters were evaluated.ResultsResults of our study showed that girls with regular and irregular cycles differed in height, weight, body mass index, percentage of body fat and ovarian volumes. The size of the ovaries decreases in the group of girls with regular cycles (r = 0.14; P < .005), while it increases in girls with irregular cycles (r = 0.15; P < .001) with advancing age. Uterine volume in all patients increases gradually with age reaching consistent values at 16 years (r = 0.5; P < .001). Age at menarche, the time elapsed since menarche, the height, weight, body mass index and percentage of body fat in patients correlated with uterine volume. Ovarian volume correlated with patients' weight, BMI and percentage of fat.ConclusionUterus continues to grow in postmenarcheal years, with increasing height and weight of girls, regardless of the regularity of cycles. Postmenarcheal girls with irregular cycles were found to have heavier figures and larger ovaries.