Measuring the rate of weight gain and the influential role of diet in patients undergoing elective laparoscopic cholecystectomy: a 6-month follow-up study

Weight gain after cholecystectomy is one of the major surgical problems consistent with morbidities and long-term mortalities. Here, we aimed to study the impact of palliative cholecystectomy on weight gain and nutritional status of the patients before and in 1, 4 and 6 months after surgery. We performed a prospective survey on a cohort of 48 patients undergoing elective cholecystectomy. The nutritional status of the patients was collected by nutrition nurse and analysed by NutriBase software. There were 13 (16%) females and 35 (84%) males with the mean age of 51.8?±?1.97. In 6 months after surgery, patients had higher values of BMI, daily energy expenditure, carbohydrate and lipid consumption and a decreased level of protein consumption. Weight gain after surgery was caused by an increase in fat consumption which resulted in the weight gain and worsening of lipid profile. Dietary consultation, shortly after surgery, would improve patient outcome after cholecystectomy.     

Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract,non‐small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial

Background: Weight loss in patients with cancer is common and associated with a poorer survival and quality of life. Benefits from nutritional interventions are unclear. The present study assessed the effect of dietary advice and/or oral nutritional supplements on survival, nutritional endpoints and quality of life in patients with weight loss receiving palliative chemotherapy for gastrointestinal and non‐small cell lung cancers or mesothelioma. Methods: Participants were randomly assigned to receive no intervention, dietary advice, a nutritional supplement or dietary advice plus supplement before the start of chemotherapy. Patients were followed for 1 year. Survival, nutritional status and quality of life were assessed. Results: In total, 256 men and 102 women (median age, 66 years; range 24–88 years) with gastrointestinal (n = 277) and lung (n = 81) cancers were recruited. Median (range) follow‐up was 6 (0–49) months. One‐year survival was 38.6% (95% confidence interval 33.3–43.9). No differences in survival, weight or quality of life between groups were seen. Patients surviving beyond 26 weeks experienced significant weight gain from baseline to 12 weeks, although this was independent of nutritional intervention. Conclusions: Simple nutritional interventions did not improve clinical or nutritional outcomes or quality of life. Weight gain predicted a longer survival but occurred independently of nutritional intervention.     

A pilot study to assess the use of megesterol acetate to promote weight gain in frail elderly persons residing in long-term care

OBJECTIVE: The purpose of this pilot study was to determine the effectiveness of megesterol acetate (MA) for increasing body weight of frail older persons residing in long-term care settings. DESIGN: A retrospective study. SETTING: Two long-term care facilities in a large city in the southwestern US. PARTICIPANTS: Six white residents (five female, one male, mean age 87.8 years) of the facilities who had a sustained weight loss of 5% in 1 month or 10% in 6 months or longer. MEASUREMENTS: Weight gain or loss of participants receiving 480 milligrams of megesterol acetate for a minimum of 28 consecutive days. RESULTS: Five of the six subjects gained weight over a 2-month period after taking 480 milligrams of MA for 1 month or more. There was a delayed effect of non-fluid weight gain that was statistically significant 2 months after the end of treatment. One woman with diagnoses of stroke, arthritis, and hypertension lost weight despite taking MA continuously for 84 days. CONCLUSIONS: Results suggest that MA has been underutilized by geriatric health professionals as an intervention to ameliorate or reverse anorexia of aging after other nutritional efforts have failed. Using MA to prevent unintentional weight loss and malnutrition may significantly improve the health status of older patients. A prospective study using a larger sample and based on ideal weight should be carried out to evaluate the benefit of MA, with particular attention to weight gain that persists after 2 months. Future studies should also take into account the high dropout rate of participants and consider earlier intervention with MA.     

The effects of parathyroidectomy on nutritional and biochemical status of hemodialysis patients with severe secondary hyperparathyroidism.

The nutritional and biochemical parameters of 15 chronic hemodialysis (HD) patients with severe secondary hyperparathyroidism who had undergone total parathyroidectomy (PTX), with a forearm implant, were retrospectively studied at 1, 3, 6, and 12 months pre- and post-PTX. The concentrations of serum calcium and phosphorous significantly decreased in the first 6 months post-PTX. The concentration of blood urea nitrogen significantly increased at 6 and 12 months post-PTX. In contrast with control chronic HD patients who had no weight gain after nonparathyroid surgery, there was a progressive weight gain leading to a significantly higher dry weight at 12 months post-PTX. There was no significant change in serum potassium, albumin, cholesterol, transferrin, bicarbonate, hematocrit, normalized protein catabolic rate (nPCR), or erythropoietin dose at any time point post-PTX. The biochemical parameters of the 8 patients who had more than 5% weight gain, during 12 months post-PTX, were not statistically different from the remaining 7 cases who had weight gain less than 5% (or had lost weight) in the same time period. The same was true for 4 patients with weight gain of more than 10% versus the latter group. In conclusion, HD patients with severe secondary hyperparathyroidism are prone to progressive weight gain post-PTX, which reaches significance by the twelfth month. In 53% of the patients, the weight gain is more than 5% above the baseline. The nutritional and biochemical parameters pre-PTX were not helpful in distinguishing those who developed significant weight gain post-PTX.     

Evaluation of nutritional counselling in HIV-associated malnutrition

In HIV-infected patients, the outcome of counselling as the first step of a nutritional intervention programme was evaluated, in order to identify clinical and nutritional predictors for its efficacy. 75 HIV-infected patients were investigated, most with advanced disease. Nutritional status was determined by body weight, bioelectrical impedance and 7-day food intake record. Prior mean weight loss was 10% (range = +4% to -31%). Counselling facilitated weight gain in 40 75 patients (1-4 months later, overall mean difference +1.4 +/- 6.2%) and in 14 34 patients (8-11 months later, overall mean difference -1.4 +/- 9.0%). Weight changes correlated with changes in body cell mass (r(2) = .69, p < .001) and in body fat (r(2) = .29, p < 0.05), but not extracellular mass. Underlying conditions such as AIDS definition, fever, and diarrhoea correlated to prior weight loss (p < .001) but not to the outcome of counselling. Low energy intake (before counselling, < 31.5 kcal/kg) did not correlate to prior weight loss but it predicted further weight loss (p < 0.05 towards normal intake). High energy intake (> 38.5 kcal/kg) correlated (p < 0.05) with more prior weight loss but not with further weight changes. Nutritional counselling may be an effective first-line intervention for malnourished HIV infected patients. More than half of patients gain weight without other nutritional treatment. Whereas the severity of malnutrition is influenced by the underlying disease, fever, and diarrhoea, the course of weight change after nutritional intervention is not. Counselling may reduce the nutritional impact of these risk factors. In patients with low spontaneous intake, efficacy of counselling alone is limited, but it may help to identify those who require more invasive nutritional treatment.     

What Are the Maternal Factors that Potentially Intervenes in the Nutritional Composition of Human Milk?

Background: To evaluate the potential factors associated with the nutritional composition of human milk of puerperal women. Methods: cross-sectional study, conducted between March 2016 and August 2017, with 107 women, selected in a Tertiary Health Care Tertiary Health Facility of the Unified Health System (SUS) in the Municipality of Rio de Janeiro. Data were collected two months after delivery. The dependent variable of the study was the nutritional composition of human milk. We divided the independent variables into hierarchical levels: distal (age, schooling, parity and pregestational nutritional status), intermediate (number of prenatal visits and gestational weight gain) and proximal (alcohol consumption, smoking, diabetes mellitus and hypertension). For data analysis, we applied the multiple linear regression, centered on the hierarchical model. Only the variables associated with the nutritional composition of breast milk remained in the final model at a 5% level of significance. Results: The nutritional composition of human milk yielded by women with pregestational overweight, smokers and hypertensive had higher amounts of lipids and energy. Conversely, women with gestational weight gain below the recommended had lower amounts of these components. Conclusion: The evaluation of factors associated with the nutritional composition of human milk is extremely important to assist post-partum care practices. In this study, we observed that lipid and energy contents were associated to pregestational nutritional status, gestational weight gain, smoking and hypertension.     

Energy intakes of children with Crohn''s disease treated with enteral nutrition as primary therapy

BACKGROUND: Enteral nutrition (EN) is widely used and is effective in the treatment of children with Crohn's disease given as an exclusive feed for 6-8 weeks. Current dietetic practice during EN is to recommend an energy intake based on estimated average requirement (EAR) for energy for age. AIMS: To examine factors affecting energy intake and weight gain during EN in relation to disease site and nutritional status. METHODS: A retrospective cohort study examining energy intake and weight gain during the exclusive EN feeding period in 40 patients newly diagnosed with Crohn's in relation to EAR, nutritional status, disease site. RESULTS: All patients improved clinically and gained weight during EN with improvement in the CRP as a marker of the systemic inflammatory response. Energy intake was higher than EAR in 82% (33/40 patients), with the median 117.5% of EAR. Weight gain correlated with body mass index standard deviation score (P = 0.001) at start of treatment, but not energy intake or CRP. CONCLUSION: Estimated average requirement underestimates energy intakes in most children with newly diagnosed Crohn's disease. During EN, an energy intake in the range of 100-149% (median 117.5%) EAR for energy for age may be required. Energy balance studies in children with active disease are required.     

Maternal nutrition and duration of breastfeeding in a birth cohort in Pelotas, Brazil

OBJECTIVE: The effects of maternal nutritional status on the duration of breastfeeding are inconsistent in the literature. A population-based cohort study was set to investigate this relationship. METHODS: Nine hundred and seventy seven mothers giving birth in 1993 (20% of that year's births) were studied. Studied maternal characteristics included nutritional status, social, economic, and demographic variables. The effects of these variables on the prevalence of breastfeeding at six months were analyzed through logistic regression. Cox regression was applied to analyze the effects on the duration of breastfeeding. RESULTS: Multivariate logistic regression analysis showed a higher prevalence of breastfeeding among women with a pre-pregnancy weight of 49 kg or more (odds ratio = 1.31; CI(95%) 1.04 - 1.64). The association with maternal height was not significant (p=0.06). Cox regression also showed a non-significant protective effect of having a higher pre-pregnancy weight (hazard ratio = 0.91; CI(95%) 0.82 - 1.01). The duration of breastfeeding duration was not associated with maternal height. Weight gain during pregnancy was not associated with breastfeeding in either analyses. Other variables associated with the duration of breastfeeding in both analyses were maternal age, parity, smoking, and gestational age. Family income was associated with the prevalence of breastfeeding at six months, and birthweight was associated with the duration of breastfeeding. CONCLUSIONS: Pre-pregnancy nutritional status is a stronger predictor of breastfeeding than weight gain during pregnancy.     

Effect of a fish oil-enriched nutritional supplement on metabolic mediators in patients with pancreatic cancer cachexia

Weight loss in advanced cancer patients is refractory to conventional nutritional support. This may be due to metabolic changes mediated by proinflammatory cytokines, hormones, and tumor-derived products. We previously showed that a nutritional supplement enriched with fish oil will reverse weight loss in patients with pancreatic cancer cachexia. The present study examines the effect of this supplement on a number of mediators thought to play a role in cancer cachexia. Twenty weight-losing patients with pancreatic cancer were asked to consume a nutritional supplement providing 600 kcal and 2 g of eicosapentaenoic acid per day. At baseline and after 3 wk, patients were weighed and samples were collected to measure serum concentrations of interleukin (IL)-6 and its soluble receptor tumor necrosis factor receptors I and II, cortisol, insulin, and leptin, peripheral blood mononuclear cell production of IL-1 beta, IL-6, and tumor necrosis factor, and urinary excretion of proteolysis inducing factor. After 3 wk of consumption of the fish oil-enriched nutritional supplement, there was a significant fall in production of IL-6 (from median 16.5 to 13.7 ng/ml, P = 0.015), a rise in serum insulin concentration (from 3.3 to 5.0 mU/l, P = 0.0064), a fall in the cortisol-to-insulin ratio (P = 0.0084), and a fall in the proportion of patients excreting proteolysis inducing factor (from 88% to 40%, P = 0.008). These changes occurred in association with weight gain (median 1 kg, P = 0.024). Various mediators of catabolism in cachexia are modulated by administration of a fish oil-enriched nutritional supplement in pancreatic cancer patients. This may account for the reversal of weight loss in patients consuming this supplement.     

Nutritional status and clinical outcome in elderly female surgical orthopaedic patients

The possible relationship between nutritional status and clinical outcome following orthopaedic hip surgery was investigated. The nutritional status of 60 elderly female patients admitted for elective total hip replacement (THR) and emergency fractured neck of femur surgery (FNF) was measured over time. Specific measures of clinical outcome, including well-being and functional status, were monitored during hospital stay and at 4, 8 and 26 weeks following discharge. Patients were allocated to a high nutritional risk group where any three of the following were less than the 5th percentile value: serum albumin, haemoglobin, triceps skinfold thickness, mid-upper arm muscle circumference and body weight. Using this definition, malnutrition was present in 4% of THR patients and 41% of FNF patients. It was found that the high risk patients had significantly longer convalescence periods, (median stay 27.5 days compared with 0 days, P < 0.0009), and a greater proportion were dependent upon walking frames at 6 months (46% compared with 11%, P < 0.01). Fifty percent of the high risk patients had been living independently prior to admission, in contrast only 29% had returned to their homes at 6 months after discharge. The results indicate an apparent link between clinical outcome and nutritional status based upon the allocation procedure employed, which has the potential for ensuring cost-effective nutritional intervention.     

Seasonal variations in the nutritional status of urban Gambian children

1. Children aged 6-35 months in an urban community in The Gambia, West Africa, were weighed and their lengths measured at four surveys over an 18-month period, twice towards the end of the rains, and twice during the dry season. 2. Relative to international standards, height-for-age deteriorated steadily with age, while weight-for-age fell sharply in the second-half of infancy but showed no further deterioration from 12 to 35 months of age. 3. Height-for-age showed little seasonal variation, but weight-for-age and weight-for-height were lower at the end of the rains than during the dry season. Weight and height velocities were much lower during the rains than in the dry season, with more than 20% of the children losing weight during the rains. Possible reasons for these seasonal variations are discussed. Compensatory weight gain in the dry season exceeded the velocity expected from the standards in children aged 12 months or more, but height velocity fell below the standards all year. 4. The results are compared with previous findings from Keneba, a rural Gambian village. Weight velocity during the dry season was similar in the two communities, but the village children experienced a sharper decline in weight gain during the rains. 5. These results suggest that seasonal ecological factors may seriously influence the nutritional status of children living in an urban environment with adequate availability of food.     

Energy balance in depleted ambulatory patients with chronic obstructive pulmonary disease: the effect of physical activity and oral nutritional supplementation

Patients with chronic obstructive pulmonary disease (COPD) often suffer from weight loss. The aim of the present study was to gain insight into the energy balance of depleted ambulatory COPD patients, in relation to their habitual level of physical activity and consumption of oral nutritional supplements. Clinically stable and weight-stable patients (n 20; BMI 19.8+/- SD 2.0 kg/m2) were studied 1 and 3 months after rehabilitation or recovery in the clinic and were at random assigned to a control or intervention group with regard to nutritional supplementation. Energy intake was measured with a 7 d food record. Energy expenditure was estimated from a simultaneous 7 d assessment of physical activity with a tri-axial accelerometer for movement registration in combination with measured BMR. Body mass was measured at several time points. The body mass remained stable in both groups after 1 or 3 months and mean energy balances were comparable for both groups. The mean body-mass change between month 1 and 3 was negatively related to the mean physical activity level (r -0.49; P=0.03). Weight change over the 3 months was negatively associated with the physical activity level. These results suggest that knowledge about the individual physical activity level is necessary for the estimation of the energy need of the COPD patient.     

Incidence and recognition of malnutrition in hospital J. P. McWhirter and C. R. Pennington BMJ 1994; 308: 945-948

This paper describes a prospective study to determine the incidence of malnutrition among patients on admission to an acute teaching hospital, to monitor their changes in nutritional status during stay and to determine awareness of nutrition in different clinical units. Nutritional status was assessed in 500 patients admitted to hospital: 100 each from general surgery, general medicine, respiratory medicine, orthopaedic surgery and medicine for the elderly. The main outcome measures were weight, height, triceps skinfold thickness, mid arm circumference, mid arm muscle circumference and grip strength. Patients were studied on admission and discharge and case notes reviewed for information about nutritional status. On admission 200 out of 500 patients were considered undernourished (BMI < 20). Of these only 96 had any nutritional information documented in the notes. 34% of patients were overweight (BMI > 25). The 112 patients reassessed on discharge had a mean weight loss of 5.4% with the greatest weight loss in those initially most malnourished. The 10 patients who were referred for nutritional support (3 for parenteral nutrition, 7 for enteral nutrition) showed a mean weight gain of 7.9%.     

Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ)

OBJECTIVE: For the early detection and treatment of malnourished hospital patients no valid screening instrument for the Dutch language exists. Calculation of percentage weight loss and body mass index (BMI) by the nurse at admission to the hospital appeared to be not feasible. Therefore, the short, nutritional assessment questionnaire (SNAQ), was developed. RESEARCH, DESIGN AND METHODS: Two hundred and ninety one patients on the mixed internal and surgery/oncology wards of the VU University medical center were screened on nutritional status and classified as well nourished (<5% weight loss in the last 6 months and BMI>18.5), moderately malnourished (5-10% weight loss in the last 6 months and BMI>18.5) or severely malnourished (>10% weight loss in the last 6 months or >5% in the last month or BMI<18.5). All patients were asked 26 questions related to eating and drinking difficulties, defecation, condition and pain. Odds ratio, binary and multinomial logistic regression were used to determine the set of questions that best predicts the nutritional status. Based on the regression coefficient a score was composed to detect moderately (2 points) and severely (3 points) malnourished patients. The validity, the nurse-nurse reproducibility and nurse-dietitian reproducibility was tested in another but similar population of 297 patients. RESULTS: The questions 'Did you lose weight unintentionally?'. 'Did you experience a decreased appetite over the last month?' and 'Did you use supplemental drinks or tube feeding over the last month?' were most predictive of malnutrition. The instrument proved to be valid and reproducible. CONCLUSION: SNAQ is an easy, short, valid and reproducible questionnaire for early detection of hospital malnutrition.     

Smoking cessation in women concerned about weight.

BACKGROUND. Weight gain after smoking cessation is often cited by women smokers as a primary reason for not attempting to quit smoking or for relapsing after a cessation attempt. METHODS. A randomized trial of 417 women smokers was conducted to test the addition of two weight control strategies to a smoking cessation program. Participants received the standard smoking cessation program, the program plus nicotine gum, the program plus behavioral weight control, or the program plus both nicotine gum and behavioral weight control. Weight and smoking status were measured at the end of treatment and at 6 and 12 months posttreatment. RESULTS. Smoking cessation rates were highest in the group receiving the smoking cessation program plus nicotine gum. Weight gain did not vary by treatment condition, so its effect on relapse could not be examined by group. There was no significant relationship between weight gained and relapse in individuals. CONCLUSIONS. The added behavioral weight control program was attractive to the participants and did not reduce smoking cessation rates. However, it did not produce the expected effect on weight, thereby restricting our ability to examine the effect of weight control on smoking cessation and relapse.     

Food quality, physical activity, and nutritional follow-up as determinant of weight regain after Roux-en-Y gastric bypass

Objective

Assess the lifestyle habits, including food patterns, of patients who underwent Roux-en-Y gastric bypass (RYGB) and to identify predictive factors in weight loss and regain.

Methods

Obese patients (100) who underwent RYGB from 1998 to 2008 were included. Dietary habits were assessed by using 24 h dietary recall and the Food Frequency Questionnaire. Rates of weight regain and the percentage of excess weight loss (EWL) were calculated. Patients were also asked whether they attended nutritional follow-up visits after the operation and about the type and regularity of physical activities.

Results

The mean age was 45.1 ± 9.9 y, and the majority of the patients were women (84%). Mean EWL was 59.1 ± 20.3%. Weight regain was seen in 56% of the patients with 29% of the patients having regained over 10.1% of the minimum weight reached after RYGB. Weight regain increased significantly with time after surgery (up to 2 y: 14.7%; from 2 to 5 y: 69.7%; over 5 y: 84.8%). Poor diet quality characterized by excessive intake of calories, snacks, sweets, and fatty foods was statistically higher among those who regained weight. Sedentary lifestyle and lack of nutritional counseling follow-up were also significantly associated with regaining weight.

Conclusion

Despite satisfactory results of EWL, the patients did not properly maintain the lost weight, mainly after 5 y postsurgery. Major factors that influenced this weight gain were poor diet quality, sedentary lifestyle, and lack of nutritional counseling follow-up.     

Optimizing oral nutritional drink supplementation in patients with chronic obstructive pulmonary disease

Nutritional support is indicated in some patients with chronic obstructive pulmonary disease to restore nutritional status and improve functional capacity. However, the efficacy of nutritional supplements is sometimes disappointing, partly owing to a compensatory drop in habitual food intake. We retrospectively studied the effect of nutritional drink supplements, differing in portion size and energy content, on weight gain and body composition. Thirty-nine patients with stable chronic obstructive pulmonary disease, participating in an 8-week pulmonary rehabilitation programme and eligible for nutritional support, were studied. Group A (n 19) received three portions of 125 ml (2380 kJ), whereas group B (n 20) received three portions of 200 ml (3350 kJ) daily. The macronutrient composition of the regimens was similar (20 % protein, 60 % carbohydrates and 20 % fat). Lung function, body weight, body composition (by bio-electrical impedance analysis), habitual dietary intake (by dietary history) and resting energy expenditure (by ventilated hood) were determined. Weight gain was compared with expected weight as predicted by a computer simulation model. Although patients in both groups significantly increased in weight, this increase was higher in group A (A, 3.3 (sd 1.9) kg; B, 2.0 (sd 1.2) kg; P=0.019), while receiving less energy. The observed weight gain in group A was similar to that expected, but in group B it was lower than expected (P<0.001). In both groups, fat-free mass and fat mass were gained in a ratio of 2:1, fat-free mass increasing primarily during the first 4 weeks. This study illustrates that there might be an optimum for the portion size of nutritional drink supplements in chronic obstructive pulmonary disease and that more is not always better.     

Maternal weight and lean body mass may influence the lactation-related bone changes in young undernourished Indian women

Lactation is known to be associated with a transient loss of bone mineral density (BMD) during 3-6 months post-partum. Bone changes during lactation in women consuming low dietary calcium are not sufficiently studied. The present longitudinal study examined the BMD changes during lactation in undernourished women and the relationship of bone changes to the nutritional status. Whole-body bone mineral content and BMD at hip, lumbar spine and forearm were assessed using dual-energy X-ray absorptiometry in thirty-six lactating women from the low socio-economic group at four time points -- within 1 month after delivery (baseline), and at 6, 12 and 18 months after delivery. Maternal body composition and biochemical parameters of bone metabolism were estimated at the same time. It was observed that femoral neck BMD reduced by 4.6 % at 6 months, but recovery to the baseline was incomplete at 18 months with a deficit of 2 %. Hip BMD reduction at 6 months was transient. Lumbar spine BMD did not show significant loss at 6 months and BMD increased by 3.6 and 6.3 % at 12 and 18 months, respectively. Regression analyses indicated that baseline lean mass was the most important determinant of bone preservation at femoral neck, hip as well as whole body, whereas baseline body weight was the most important determinant of per cent gain in lumbar spine. Maternal nutritional status as indicated by body weight and lean mass appears to influence the lactation-related BMD changes in undernourished women from the low socio-economic group in India.     

Effects of nutritional support long time after total gastrectomy

BACKGROUND & AIMS: Long-term effects of total gastrectomy on nutritional status are not well known, neither is the role of nutritional support. Dietary counselling is usually individualized, but generally not well defined. We aimed to evaluate effects of individualized oral nutritional support long time after total gastrectomy. METHODS: Dietary advice was given, aiming for an energy and protein rich diet, using ordinary food and liquid supplements tailored to individual needs and preferences. Counselling was repeated monthly. Body weight and a 4-day food record were obtained at baseline, and thereafter-at month 1, 3, 6 and 12. Body composition, resting and total energy expenditure were measured at baseline and at 12 months. RESULTS: Thirteen of 15 included patients completed the study. Though a trend of weight gain was seen after 1 month, there was no significant weight change at 12 months as weight development was quite heterogeneous. Six patients who remained healthy during the study (all with BMI<25) gained weight (p<0.05), while five patients with intercurrent co-morbidity and two with initial BMI>25 lost weight or remained stable. CONCLUSIONS: Nutritional intervention long time after total gastrectomy did not change body weight, body composition or energy metabolism. Intercurrent co-morbidity appeared to have a major impact on outcome, as the nutritional support was more effective in patients who remained healthy and had a BMI<25.     

The association of pregnancy weight gain with the mother's postpartum weight

The association between pregnancy weight gain and the mother's weight at intervals following delivery was studied using the records of two clinics serving low-income populations. All the prenatal patients on whom complete data were available for a 2-year period were used. The 158 pregnant women gained a mean of 12.9 kg during their pregnancies; 44% gained more than 13.6 kg and 25% gained less than 9.1 kg. Three months after delivery the women showed gains significantly greater than those experienced by a nonpregnant comparison group during a comparable period. Maternal weight gain was determined by subtracting the infant's birth weight from the mother's total gain during pregnancy. Weight changes at three periods postpartum were compared among maternal weight gain tertiles. Sustained weight gains resulted in 39% of the women in the upper tertile being newly classified as overfat 1 to 3 months postpartum. Women in the high tertile had retained significantly more weight up through the sixth postpartum month. We conclude that a significant portion of maternal weight gain is likely to be retained, putting some women at risk of obesity.