Exploration of the dietary habits,lifestyle patterns and barriers to healthy eating in UK post‐partum women

Maternal nutrition during the post‐partum period (PPP) is important for optimal health. The aim of this study was to explore dietary habits, lifestyle patterns and barriers to healthy eating in post‐partum women. An online survey exploring eating habits, weight status, sleep duration, breastfeeding, nutrition knowledge, physical activity, provision of advice and barriers to healthy eating was completed by 228 women (56.1% were 25–34 years, mean PPP of 5.73 ± 3.31 months). A sub‐sample of 34 women (50% were 35–44 years) completed an optional online multiple‐pass 24‐hour recall. At 6 months post‐partum (n = 60), 72.3% of participants weighed more than their pre‐pregnancy weight (mean 5.56 ± 4.61 kg). In addition, while 60.8% (n = 107) of women had a healthy body mass index (BMI) pre‐pregnancy, this dropped to 46.7% (n = 77) in the PPP. Only 2.2% of women were meeting current UK physical activity guidelines and 73.7% were not meeting the 5 A DAY fruit and vegetable recommendations. Consumption of high calorie snacks and meal skipping were significantly higher during the PPP compared to pre‐pregnancy (P < 0.01). Meal skipping was significantly associated with poor nutrition knowledge (P < 0.05). Women who were breastfeeding had significantly lower BMI than those who were bottle‐feeding after adjusting for age of baby, education, socio‐economic status and BMI pre‐pregnancy (P < 0.05). Fatigue, lack of time and feeling stressed were the most common self‐reported barriers to healthy eating, and these were greater for women with low combined household income and those having ≥3 children (P < 0.05). Dietary analysis showed that women were not meeting the national recommendations for energy, fibre, iron and vitamin D. Diet and lifestyle advice given to post‐partum women needs to be tailored to different sociodemographic characteristics, pre‐pregnancy health status and baseline nutrition knowledge, with a greater focus on those experiencing more barriers to healthy eating.     

Folklore,food, female reproductive cycle

It is common knowledge that food is equated with health in many cultures and that dietary patterns may change in response to illness. Food habits may also change in response to normal physiological states associated with the female reproductive cycle, and may result in impaired nutritional status. The data presented here are drawn from a study designed to gain information on the concerns, attitudes, beliefs and knowledge that women have about reproductive life. Patients in a clinic setting were questioned about the advisability of dietary changes during menstruation, pregnancy and the post‐partum period, and about their attitudes concerning clay and starch‐eating practices. Results show that a majority of respondents held one or more dietary folk beliefs linked to the various phases of the reproductive cycle and that many of these are nutritionally unsound. Some of these beliefs are culturally‐patterned and it is suggested that clinicians and nutritionists be aware that they exist in modern health care settings, and that they may affect patients’ willingness to follow prescribed dietary regimens.     

Good food in family day care: Improving nutrition and food safety in family day care

Aim:  To determine the effectiveness of a nutrition and food safety intervention in family day care schemes.
Methods:  Staff and carers from seven Sydney family day care schemes completed a nutrition and food safety knowledge questionnaire and diet history about food and drinks offered to children in care before and after attending workshops and receiving advice and resources. Participating schemes' nutrition and food safety policies were assessed before and after intervention. At baseline, 18 staff members and 104 carers were interviewed. Diet histories were collected for 20 infants and 103 one-to-five-year olds. Post intervention, 21 staff and 102 carers were interviewed and diet histories collected for 22 infants and 102 one-to-five-year olds. Baseline and post-intervention data were compared using the χ²-test for categorical data (or the Fisher's exact test when expected values were below five), and t -tests for independent samples for normally distributed means.
Results:  Nutrition and food safety knowledge and the number (from one to seven) and quality of appropriate policies improved post intervention. Changes in mean per cent nutrition scores for infants (78.2% to 83.4%) and for one-to-five-year olds (68.8% to 75.2%; P  < 0.01) indicated improvements in nutritional quality of food and drinks offered during care.
Conclusion:  Health promotion strategies can improve food and drinks offered in family day care and make a sustainable contribution to children's access to safe and nutritious food.     

Consumers’ knowledge of healthy diets and its correlation with dietary behaviour

Background: Procedural nutrition knowledge is knowledge of how to eat a healthy diet. This type of knowledge potentially plays an important role in dietary behaviour. Previous studies of consumers' nutrition knowledge did not systematically assess procedural nutrition knowledge. Thus, we administered a survey of procedural nutrition knowledge to Swiss consumers to assess the prevalence of misconceptions about healthy eating. Methods: We developed 13 procedural nutrition knowledge items. Nine items were based on qualitative consumer interviews and four items were derived from expert guidelines. The items had a true/false format. We administered the items to a random population sample in a written postal survey (n = 1,043). The survey also assessed the consumers' self‐reported food consumption. For each respondent, we computed the number of correctly answered knowledge items and we correlated this number with food consumption frequencies. Results: The procedural nutrition knowledge items received between 3% and 38% incorrect answers. Individuals with a higher number of correctly answered items consumed more vegetables (r = 0.29). Higher knowledge was associated with the female gender, younger age, higher education, nutrition‐related qualifications and not being on a diet (P < 0.001). Conclusions: Our findings indicate that misconceptions exist in the general population about healthy eating. These misconceptions are associated with a decreased consumption of foods usually defined as healthy. Some population sub‐groups seem particularly susceptible to holding such misconceptions. The implications for nutrition education, particularly concerning the role of fruit and vegetable consumption as well as the food pyramid are discussed.     

成都市孕妇营养知识、态度及行为调查与分析

目的：了解成都市孕妇营养知识及饮食行为及其影响因素，为今后孕妇营养教育工作提供科学依据。方法：采用问卷调查法对成都329名孕妇进行调查。结果：成都市孕妇营养KAP水平较差，总合格率27．1％；营养态度普遍较好；营养行为中的主要问题是：孕妇特殊需要食物如奶类（74．5％）、蛋类（57．4％）、豆类（17．0％）、海产品（7．0％）、动物内脏（0．9％）和血（0．3％）、坚果类（15．2％）等摄入不足，主食（93．9％）、蔬菜（88．1％）水果类（80．2％）食物的摄人频率较合理；营养KAP之间有明显正相关性，孕妇的营养KAP水平与其文化程度和丈夫职业呈正相关关系；孕妇希望获得营养信息的来源主要是医护人员（79．9％）和营养师指导（43．2％）、专业书籍。结论：目前孕妇人群的营养知识和饮食行为有待改善，建议利用孕妇营养态度普遍较好的有利条件，提高医护人员的营养知识技能水平，加强孕妇及家人的营养教育，以促进母子健康。     

广州市孕妇营养知识、态度及饮食行为调查

[目的]了解广州市孕妇的营养知识、态度与饮食行为现况及其影响因素,为今后孕妇营养教育工作提供科学依据。[方法]采用问卷调查方法对广州市两所医院的169名孕妇进行调查。[结果]广州市孕妇对营养知识缺乏全面深入的了解,营养态度普遍较好。90%以上的孕妇每天都摄入粮谷类、蔬菜、水果;一半以上的孕妇每天都摄入奶及制品、蛋类、禽畜肉类;对豆及制品、鱼贝类的摄取一个月大于20d的孕妇亦超过一半;对菌藻、坚果类食物的摄取频率则较低,一个月超过20d的仅占19.1%和18.0%,几乎不吃的人数分别占17.9%和18.6%。营养KAP之间有明显正相关性,孕妇的营养KAP水平与其文化程度和丈夫职业呈正相关关系,孕妇希望获得营养信息的来源主要是医护人员和营养师指导（53.6%）。[结论]目前孕妇人群的营养知识和饮食行为有待改善,建议利用孕妇营养态度普遍较好的有利条件,提高医护人员的营养知识技能水平,在利用公共传媒的基础上加强有医务人员参与的咨询和讲座的力度,营养教育的内容重点在大力宣讲食物的营养价值及推荐合理的膳食结构,通过加强孕妇及家人的营养教育促进母子健康。     

An evaluation of a community dietetics intervention on the management of malnutrition for healthcare professionals

Background: Healthcare professionals working in the community setting have limited knowledge of the evidence‐based management of malnutrition. The present study aimed to evaluate a community dietetics intervention, which included an education programme for healthcare professionals in conjunction with the introduction of a community dietetics service for patients ‘at risk’ of malnutrition. Changes in nutritional knowledge and the reported management of malnourished patients were investigated and the acceptability of the intervention was explored. Methods: An education programme, incorporating ‘Malnutrition Universal Screening Tool (MUST)’ training, was implemented in eight of 10 eligible primary care practices (14 general practitioners and nine practice nurses attended), in seven private nursing homes (20 staff nurses attended) and two health centres (53 community nurses attended) in conjunction with a community dietetics service for patients at risk of malnutrition. Nutritional knowledge was assessed before, immediately after, and 6 months after the intervention using self‐administered, multiple‐choice questionnaires. Reported changes in practice and the acceptability of the education programme were considered using self‐administered questionnaires 6 months after the intervention. Results: A significant increase in nutritional knowledge 6 months after the intervention was observed (P < 0.001). The management of malnutrition was reported to be improved, with 69% (38/55) of healthcare professionals reporting to weigh patients ‘more frequently’, whereas 80% (43/54) reported giving dietary advice to prevent or treat malnutrition. Eighty‐percent (44/55) of healthcare professionals stated that ‘MUST’ was an acceptable nutrition screening tool. Conclusion: An education programme supported by a community dietetics service for patients ‘at risk’ of malnutrition increased the nutritional knowledge and improved the reported management of malnourished patients in the community by healthcare professionals.     

Weight gain and nutritional intake in obese pregnant women: Some clues for intervention

Aim: Maternal obesity is associated with increased risk of adverse outcomes for mothers and offspring. Strategies to better manage maternal obesity are urgently needed; however, there is little evidence to assist the development of nutrition interventions during antenatal care. The present study aimed to assess maternal weight gain and dietary intakes of overweight and obese women participating in an exercise trial. Results will assist the development of interventions for the management of maternal overweight and obesity. Methods: Fifty overweight and obese pregnant women receiving antenatal care were recruited and provided dietary and weight data at baseline (12 weeks), 28 weeks, 36 weeks gestation and 6 weeks post‐partum. Data collected were compared with current nutritional and weight gain recommendations. Associations used Pearson's correlation coefficient, and ANOVA assessed dietary changes over time, P < 0.05. Results: Mean prepregnancy body mass index was 34.4 ± 6.6 kg/m². Gestational weight gain was 10.6 ± 6 kg with a wide range (?4.1 to 23.0 kg). 52% of women gained excessive weight (>11.5 kg for overweight and >9 kg for obese women). Gestational weight gain correlated with post‐partum weight retention (P < 0.001). Dietary intakes did not change significantly during pregnancy. No women achieved dietary fat or dietary iron recommendations, only 11% achieved adequate dietary folate, and 38% achieved adequate dietary calcium. Very few women achieved recommended food group servings for pregnancy, with 83% consuming excess servings of non‐core foods. Conclusion: Results provide evidence that early intervention and personalised support for obese pregnant women may help achieve individualised goals for maternal weight gain and dietary adequacy, but this needs to be tested in a clinical setting.     

未婚女青年流产及接受流产后服务的现况调查

目的:了解未婚女青年流产原因以及避孕知识、行为和在医院接受的流产后服务现况。方法:采用分层整群随机抽样的方法,选取在郑州市8家医院自愿要求流产、年龄≤25岁的女青年进行横断面现场问卷调查,获得合格调查问卷992名,本文仅分析其中的705名未婚妇女数据。结果:调查对象年龄在16.4～25岁之间,62.1%未婚同居,33.3%有流产史。本次流产原因未避孕66.7%,避孕失败33.3%。58.2%曾使用过避孕措施,既往使用的避孕方法构成为:避孕套47.2%、紧急避孕药18.3%、安全期16.0%、体外射精13.8%、口服避孕药4.6%、宫内节育器0.1%。避孕和生殖健康知识得分无1人满分,13个问题中能正确回答7个问题的占44.7%。术后接受宣教内容最多的是流产后注意事项(95.6%),最少的是避孕药具的优缺点(26%)。没有接受过医生提供的咨询服务有83.0%;医生没有提供免费的避孕药具和转诊服务。93.9%的愿意接受流产后宣教服务。结论:未婚女青年流产原因多为未避孕,她们缺乏避孕知识,避孕措施使用率低,现医院提供的流产后服务不能满足育龄妇女的需求。     

Nutrition knowledge and food intake of seven-year-old children in an atherosclerosis prevention project with onset in infancy: the impact of child-targeted nutrition counselling given to the parents

OBJECTIVE: To compare nutrition knowledge and food intake in 7-y-old intervention and control children in an atherosclerosis risk factor intervention trial after 6.5 y of nutrition counselling given to the parents. DESIGN, SUBJECTS AND METHODS: Intervention families in the Special Turku Coronary Risk Factor Intervention Project received child-oriented nutritional counselling one to three times a year since child's age of 7 months, aimed at reduced saturated fat and cholesterol intake. Children's nutrition knowledge was analysed in a time-restricted cohort of 70 seven-y-old (34 boys) intervention children and 70 control children (40 boys) with a picture identification test. For comparison, children's food intake was evaluated using scores developed for the project that reflected quality and quantity of fat and quantity of salt in children's two or three 4-day food diaries recorded between 5.5 and 7 y of age. RESULTS: Child-targeted nutrition counselling of the intervention families only slightly increased intervention children's knowledge of heart-healthy foods (42.6% vs 34.9% correct answers by the intervention and control children, P = 0.057). Only < or = 20% of the children were able to adequately justify their answers in the test. The food diaries of the intervention children comprised more foods low in saturated fat and high in unsaturated fat than those of the control children (57.1% vs 41.7% of the maximum score for low fat foods, P = 0.0001; 48.9% vs 37.7% for high unsaturated fat foods, P = 0.0009, respectively), but the intervention and control children consumed similar amounts of low-salt foods (P = 0.23). Nutrition knowledge and food use scores correlated poorly (r = -0.20-0.35). CONCLUSIONS: Child-targeted nutrition counselling repeatedly given to the parents during and after child's infancy strongly influenced food choice scores of the 5.5-7-y-old children but failed to influence children's salt intake or scores in a nutrition knowledge picture test.     

A method for implementation of nutritional therapy in hospitals

BACKGROUND AND AIMS: Many barriers make implementation of nutritional therapy difficult in hospitals. In this study we investigated whether, a targeted plan made by the staff in different departments could improve nutritional treatment within selected quality goals based on the ESPEN screening guidelines. METHODS: The project was carried out as a continuous quality improvement project. Four different specialities participated in the study with a nutrition team of both doctors, nurses, and a dietician, and included the following methods: (1) Pre-measurement: assessment of quality goals prior to study including the use of screening of nutritional risk (NRS-2002), whether a nutrition plan was made, and monitoring was documented in the records. (2) Intervention: multidisciplinary meeting for the ward staff using a PC-based meeting system for detecting barriers in the department concerning nutrition, elaboration of an action plan and implementation of the plan. (3) Re-measurement: as in (1) based on information from records and patient interviews, and an evaluation based on focus group interview with the staff. Patients who gave informed consent to participate in the study (>14 years) were included consecutively. Mann-Whitney and Kruskal-Wallis test was used for ordinal data, and Pearson chi(2) test for nominative data. P values <0.05 were considered significant. The study was performed in accordance with the Research Ethics Committee. RESULTS: In this study 141/122 patients were included before/after the implementation period with a mean weight loss within the last 3 months of 6.2 and 5.2 kg, respectively. Before the study we found that BMI was not measured. More than half of the patients had a weight loss within the last 3 months, and 40% had a weight loss during hospitalization, and this was not documented in the records. About 75% had a food intake less than normal within the last week, and nearly one-third were at a severe nutritional risk, and only 33% of these had a nutrition plan, and 18% a plan for monitoring. Barriers concerning nutrition included low priority, no focus, no routine or established procedures, and insufficient knowledge, lack of quality and choice of menus, and lack of support from general manager of the hospital. The staff introduced individually targeted procedures including assigning of responsibility, a nutrition record, electronic calculator of energy intake, upgrading of the dieticians and special diets, communication, and educational programs. A great consistency existed between barriers for targeted nutrition effort and ideas for improvement of the quality goals between the different departments. Quality assessment after study showed an overall significant improvement of the selected quality goals. CONCLUSION: The introduction of a new method for implementation of nutritional therapy according to ESPEN screening guidelines seems to improve nutritional therapy in hospitals. The method included assessment of quality goals, identification of barriers and individual targeted plans for each department followed by an evaluation process. The model has to be refined further with relevant clinical endpoints.     

Sportsmen’s Attitude towards Dietary Supplements and Nutrition Knowledge: An Investigation in Selected Roman Area Gyms

The non-professional sport environment is a grey zone not as widely assessed as that of elite athletes. The purpose of this research was to investigate the dietary supplementation habits and the nutrition knowledge on sport (NKS) in a sample of gym users. The level of adequacy of NKS was set at ≥60% of correct answers. Almost half (46.4%) of respondents stated they used food supplements, in particular multivitamins (31.0%), amino acid pills (29.5%), minerals (29.1%), and protein powders (28.7%). Supplements were used to increase muscle mass (36.9%) and to repair muscle (35.1%). Gym trainers were the preferred source of information on the use of supplements, especially in males (84%). The NKS correct response rate was 57.1% and the proportion of respondents with a sufficient level of NKS was 47.3%. The prevalence of correct answers was highest in males (61.5%) and for respondents with the highest educational attainment levels (44.5% and 53%). This study demonstrated that non-professional sportsmen do not have sufficient knowledge of nutrition and that the gym environment does not facilitate the circulation of the correct information on the role of supplementation. Considering the importance of nutrition for sportsmen, it is necessary to put in place actions aimed at increasing the knowledge of nutrition of gym users and their trainers.     

Post Partum Discharge Against Medical Advice: Who Leaves and Does it Matter?

Objective: To examine risk factors and sequela for post partum discharge against medical advice. Methods: We conducted cross-sectional analyses of hospital discharge data linked to American Hospital Association data for women discharged following a live birth for California, Florida, and New York in the years 1998–2000. We examined rates, risk factors, hospital readmission rate and mortality (California only), associated with discharge against medical advice after controlling for patient and hospital characteristics. Results: Post partum discharge against medical advice averaged 0.10%. Rates were lowest among women following uncomplicated cesarean and vaginal births (0.07%), intermediate following complicated vaginal birth (0.21%) and highest following complicated cesarean birth (0.29%). African American race, lower income, public health insurance, no health insurance, or greater comorbidity, particularly drug abuse or psychotic illness, discharge from a hospital in California or New York (compared to Florida), and location in medium or large metropolitan areas, were associated with significantly higher rates of discharge against advice. Asian or Hispanic race or ethnicity and delivery at an obstetrical specialized hospital were associated with lower risk. Patients discharged against medical advice in California were significantly more likely to be re-admitted within 30 days (adjusted odds ratio 2.7; 95% confidence interval [CI] 1.8–3.9), though none died during the period. Conclusions: Discharge against medical advice among post partum patients is uncommon, but occurs primarily among vulnerable women with psychosocial and medical risk factors. Thus, discharge against medical advice may help identify women who may benefit from additional maternal and/or child services.     

中小学饮食服务人员营养知识现状及需求调查

目的 了解中小学饮食服务人员的营养知识水平和需求。方法 对6省、市12个市、县22所中小学校的135名饮食服务人员进行问卷调查。结果 学校饮食服务人同的基础营养知识水平较低，对营养缺乏病知识的回顾正确率较低，对营养与疾病知识有一定的了解，具有一定的烹调知识。71.9%的人通过多种途径获得过健康和营养方面的知识。94.1%的人表示愿意多学习一些有关健康和营养的知识。结论 学校饮食服务人员的营养知识水平较低，不全面，建议通过多种途径对他们进行营养知识的培训。     

中学生营养知识、态度及饮食行为的现状调查

目的:了解中学生营养知识的掌握情况及其对合理营养的态度和饮食行为情况,以便指导学生正确的饮食行为,改正不良饮食习惯,提高学生营养知识水平。方法:采用自行设计的问卷调查表,随机抽取样本进行中学生营养知识、态度和饮食行为的调查。结果:93.3%的中学生对了解营养知识的态度积极,营养知识测试最高分为50分(满分),最低分为5分,平均分为42.06分,比较理想;有50%以上的中学生选择食物时最关心的是个人口味和爱好,其次是价格。把既有营养又卫生,有利于健康作为第一考虑的仅有19.1%。结论:本次调查中学生常识性营养知识得分较高,饮食行为较合理,但选择食物的标准欠合理。     

豫粤两省孕产妇家庭暴力现况比较

目的:在不同地域的较大范围内初步了解我国孕期及产后妇女家庭暴力的发生现况,分析产生家庭暴力的原因及其影响因素。方法:采用整体抽样的方法,于2004年3月~2004年9月在河南省和广东省的部分城镇医院产科门诊和住院部对待产及产后复查的2 835名妇女进行问卷调查。结果:2 835人中孕期曾发生家庭暴力的327人,发生率为11.5%;河南省孕期家庭暴力发生率为16.8%,广东省发生率为6.4%。1 776名产后妇女调查对象中464人遭受家庭暴力,发生率26.1%;河南省发生率为33.7%,广东省发生率为17.4%,两地发生率明显不同(P<0.001,OR=3.0)。孕妇家庭暴力发生的影响因素主要包括:文化程度和职业、家庭收入、家庭生活状况、社会文化背景等。在与非暴力组相比,暴力组孕妇的各种身心健康问题发生率明显增高(P<0.001)。结论;家庭暴力在我国城镇妇女孕期及产后有一定发生,且产后发生率较高,家庭暴力严重影响孕产妇身心健康,应该从多方面进行干预。     

Lactation and pregnancy in Iran. I. Social and economic aspects

Adequacy of lactation was assessed in Teheran women of low (LSE) and lower-middle (MSE) socioeconomic status in the third month postpartum, as part of a study linking nutrition, hormonal status, and lactation. Methods of assessment of nutritional adequacy are discussed. Characteristics of the socioeconomic groups, infant mortality, food beliefs related to lactation, and supplemental feeding practices are described. Of the LSE mothers 15 to 30% and of the MSE mothers 40 to 55% had a fully adequate milk supply in the third month. Substitutes used and affordable by the LSE were nutritionally inadequate. LSE mothers were traditional in their food beliefs. MSE mothers demonstrate the influence of scientific nutrition knowledge. The low percentage of lactation adequacy even in the MSE indicates that other social or health factors associated with urban living conditions may be just as important as economic and nutritional factors in lactation failure.     

医护人员营养KAP调查分析

目的:了解医护人员的营养“知识、态度、行为”(KAP)现状,为今后对医护人员进行营养教育提供基础资料。方法:采用问卷调查方法,对成都市某医院医护人员2 6 4人进行营养KAP的现况调查。结果:医护人员营养知识(K)、态度(A)、行为(P)之间存在明显的正相关关系(相关系数r分别为0 . 2 33、0 . 12 7、0 . 4 85 ,P <0 . 0 5 )。营养知识受年龄(r=0 . 2 4 5 ,P =0 . 0 0 0 )、专业(r=0 . 36 5 ,P <0 . 0 1)、学历(r=0 . 315 ,P =0 . 0 0 0 )影响较大,而态度、行为与年龄、职业等因素无关(P >0 .0 5 )。调查对象的营养知识不足,但具有良好的接受营养知识和改变自身行为的态度。结论:非常有必要对医护人员进行营养教育。