Effective strategies for weight loss in post‐partum women: a systematic review and meta‐analysis

Post‐partum weight loss is critical to preventing and managing obesity in women, but the results from lifestyle interventions are variable and the components associated with successful outcomes are not yet clearly identified. This study aimed to identify lifestyle intervention strategies associated with weight loss in post‐partum women. MEDLINE, EMBASE, PubMed, CINAHL and four other databases were searched for lifestyle intervention studies (diet or exercise or both) in post‐partum women (within 12 months of delivery) published up to July 2014. The primary outcome was weight loss. Subgroup analyses were conducted for self‐monitoring, individual or group setting, intervention duration, intervention types, the use of technology as a support, and home‐ or centre‐based interventions. From 12,673 studies, 46 studies were included in systematic review and 32 randomized controlled trials were eligible for meta‐analysis (1,892 women, age 24–36 years). Studies with self‐monitoring had significantly greater weight lost than those without (?4.61 kg [?7.08, ?2.15] vs. ?1.34 kg [?1.66, ?1.02], P = 0.01 for subgroup differences). Diet and physical activity when combined were significantly more effective on weight loss compared with physical activity alone (?3.24 kg [?4.59, ?1.90] vs. ?1.63 kg [?2.16, ?1.10], P < 0.001 for subgroup differences). Lifestyle interventions that use self‐monitoring and take a combined diet‐and‐exercise approach have significantly greater weight loss in post‐partum women.     

Post‐partum weight retention in women in Asia: a systematic review

Obesity is a health issue for people in Asia, and many studies support that childbearing may contribute to women's obesity. However, most studies of post‐partum weight retention (PWR) focus on Western countries. This paper aimed to review recent data on PWR and discuss the related factors of PWR for women in Asia. Three electronic databases – MEDLINE, CINAHL and PsycINFO – were searched for data from January 1990 to August 2010. Twelve studies were identified as containing information related to PWR. Chinese, Taiwanese and Korean women tend to have higher gestational weight gain and PWR than women in other Asian countries in this review. The average reported gestational weight gain in these studies ranged from 8.3 kg to 18.0 kg, and the average weight retention at 6 months post partum in various countries ranged from 1.56 kg to 4.1 kg. Gestational weight gain had a positive effect on PWR, but there were no consistent conclusions for other factors. Only a few psychosocial and behavioural factors have been studied. Moreover, no one has assessed changes in waist circumference and waist‐to‐hip ratio for measuring central obesity and ensuring risk of chronic disease. Focusing on changes in maternal weight and body composition, and considering the impact of psychological and behavioural factors are suggested for future studies in Asia.     

Impaired intrathyroidal iodine organification and iodine-induced hypothyroidism in euthyroid women with a previous episode of postpartum thyroiditis.

Postpartum thyroiditis (PPT) is common and occurs in 1.7 to 16.7% of pregnant women, depending upon the study population. Most of these women develop transient hypothyroidism and thyroid function usually returns to normal. We have studied 11 euthyroid women with a previous history of PPT to determine the incidence of subtle defects in thyroid function measured by iodide-perchlorate (I-ClO4) discharge tests and TRH tests and to determine whether these women would develop iodide-induced hypothyroidism. Seven (64%) had positive I-ClO4 discharge tests and 5 (46%) had an abnormally high TSH response to TRH. Thyroid antimicrosomal and antithyroid peroxidase were positive in 8 women (73%) with a previous episode of PPT. The administration of pharmacological amounts of iodide (10 drops of saturated solution of potassium iodide daily) for 90 days to these 11 women resulted in elevated basal and TRH stimulated serum TSH concentrations in 8 (72.7%) compared to TSH values during iodide administration to women who had never been pregnant. Antimicrosomal and antithyroid peroxidase concentrations did not change during iodide administration. These findings strongly suggest that euthyroid women with a previous episode of PPT have permanent subtle defects in thyroid hormone synthesis and are inordinately prone to develop iodide-induced hypothyroidism, similar to findings previously reported in euthyroid subjects with Hashimoto's thyroiditis, with a previous episode of painful subacute thyroiditis, or previously treated with radioactive iodine or surgery for Graves' disease.     

Survey of vitamin D levels among post‐menopausal Filipino women with osteoporosis

Objective: To determine the prevalence of vitamin D inadequacy in a group of Filipino post‐menopausal women with osteoporosis. Methods: Seventy otherwise healthy post‐menopausal Filipino women seen at the University of Santo Tomas Hospital, Section of Rheumatology, were diagnosed with osteoporosis by central dual‐energy X‐ray absorptiometry (DXA) technique. Levels of serum 25‐hydroxyvitamin D were measured using enzyme‐linked immunosorbent assay. Results: The mean age of this population was 70 ± 8 years, with an average of 22 ± 10 years since menopause, and mean body mass index (BMI) of 22 ± 1 kg/m². Only 30% (21/70) were on calcium plus vitamin D supplementation. Overall serum 25‐hydroxyvitamin D levels ranged from 48–128 nmol/L, with a mean of 87 ± 20.48 nmol/L. Serum 25‐hydroxyvitamin D levels were divided as follows: 80–140 nmol/L (adequate), 25–79 nmol/L (inadequate/insufficient), and < 25 nmol/L (deficient). Sixty‐four percent (45/70) of subjects had adequate levels while 36% (25/70) had inadequate levels of 25‐hydroxyvitamin D. There were no subjects with deficient levels of 25‐hydroxyvitamin D. Fischer’s exact test did not show a significant association between BMD and 25‐hydroxyvitamin D (P = 0.4804). Conclusion: Among this group of women with post‐menopausal osteoporosis, only 36% had insufficient levels of 25‐hydroxyvitamin D, with none of the subjects having deficient 25‐hydroxyvitamin D levels. The majority (64%) had normal serum 25‐hydroxyvitamin D levels – comparatively higher than that reported in the literature. These results suggest the possible contribution of factors other than vitamin D deficiency in post‐menopausal Filipino women with osteoporosis.     

Umbilical cord blood transplantation in adults with advanced hodgkin's disease: high incidence of post‐transplant lymphoproliferative disease

We report the outcome of 30 consecutive patients with Hodgkin disease (HD) who underwent single‐unit UCBT. Most (90%) patients had failed previous autologous hematopoietic stem cell transplantation. The conditioning regimens were based on combinations of thiotepa, busulfan, cyclophosphamide or fludarabine, and antithymocyte globulin. The cumulative incidence (CI) of myeloid engraftment was 90% [95% confidence interval (C.I.), 74–98%] with a median of 18 d (range, 10–48). CI of acute graft‐versus‐host disease (GvHD) grades II–IV was 30% (95% C.I., 17–44%), while the incidence of chronic GVHD was 42% (95% C.I., 23–77%). The non‐relapse mortality (NRM) at 100 d and 4 yr was 30% (95% C.I., 13–46%) and 47% (95% C.I., 29–65%), respectively. EBV‐related post‐transplant lymphoproliferative disease (EBV‐PTLD) accounted for more than one‐third of transplant‐related death, with an estimate incidence of 26% (95% C.I., 9–44). The incidence of relapse at 4 yr was 25% (95% C.I., 9–42%). Four‐year event‐free survival (EFS) and overall survival (OS) were 28% and 30%, respectively. Despite a high NRM and an unexpected high incidence of EBV‐PTLD, UCBT in heavily pretreated HD patients is an option for patients lacking a suitable adult donor, provided the disease is not in refractory relapse.