Development of a dietary screening questionnaire to predict excessive weight gain in pregnancy

Excessive gestational weight gain (GWG) is a risk factor for several adverse pregnancy outcomes, including macrosomia. Diet is one of the few modifiable risk factors identified. However, most dietary assessment methods are impractical for use in maternal care. This study evaluated whether a short dietary screening questionnaire could be used as a predictor of excessive GWG in a cohort of Icelandic women. The dietary data were collected in gestational weeks 11–14, using a 40‐item food frequency screening questionnaire. The dietary data were transformed into 13 predefined dietary risk factors for an inadequate diet. Stepwise backward elimination was used to identify a reduced set of factors that best predicted excessive GWG. This set of variables was then used to calculate a combined dietary risk score (range 0–5). Information regarding outcomes, GWG (n = 1,326) and birth weight (n = 1,651), was extracted from maternal hospital records. In total, 36% had excessive GWG (Icelandic criteria), and 5% of infants were macrosomic (≥4,500 g). A high dietary risk score (characterized by a nonvaried diet, nonadequate frequency of consumption of fruits/vegetables, dairy, and whole grain intake, and excessive intake of sugar/artificially sweetened beverages and dairy) was associated with a higher risk of excessive GWG. Women with a high (≥4) versus low (≤2) risk score had higher risk of excessive GWG (relative risk = 1.23, 95% confidence interval, CI [1.002, 1.50]) and higher odds of delivering a macrosomic offspring (odds ratio = 2.20, 95% CI [1.14, 4.25]). The results indicate that asking simple questions about women's dietary intake early in pregnancy could identify women who should be prioritized for further dietary counselling and support.     

Weight status and disordered sleep in preschool children,parents’ negative mood states and marital status

Short sleep duration has increased in tandem with rising obesity levels in all age groups. Research on parent mental health and its relationship with childhood obesity has been growing in recent years. This cross-sectional study assessed children’s zBMI (Body Mass Index adjusted for age and sex) and parent-reported children’s sleep behaviors, parents’ negative emotional state, and parents’ marital status in a sample of 4- to 5-year-old children. Eight-hundred seventy-seven parents answered the DASS (Depression Anxiety Stress Scales) and CSHQ (Children’s Sleep Habit Questionnaire) and reported children’s height and weight. Children in the ≥ 85th percentile weight category had significantly more sleep behavior problems than children in the < 85th percentile weight category. Mothers of children in the ≥ 85th percentile weight category were more likely to be in the overweight/obese category and had more depressive symptoms than mothers of children in the < 85th percentile weight category. Single fathers had higher levels of anxiety and depression and their children had greater sleep behavior problems than fathers in a relationship/married. The findings indicate a difference between children below and above the 85th BMI percentile in terms of children’s sleep habits and parents’ negative emotional state.     

Lower Intake of Saturated Fatty Acids Is Associated with Improved Lipid Profile in a 6-Year-Old Nationally Representative Population

To strengthen the organization of new national dietary surveys and interventions in childhood, our aim was to study macronutrient intake and blood lipid profile at 6 years of age by comparing results from two earlier population-based cohorts. Subjects were n = 131 and n = 162 in the years 2001–2002 and 2011–2012, respectively. Three-day weighed food records were used to estimate diet and calculate nutrient intake. Total cholesterol, HDL-cholesterol and triacylglycerol were measured in serum and LDL-cholesterol was calculated. The average intake of saturated fatty acids (SFA) and trans FA was lower in 2011–2012 than 2001–2002 (13.3E% vs. 14.7E%, p < 0.001, and 0.8E% vs. 1.4E%, p < 0.001, respectively), replaced by a higher intake of unsaturated fatty acids. Total cholesterol and LDL-cholesterol were significantly lower in 2011–2012 than 2001–2002 (4.6 vs. 4.4 mmol/L, p = 0.003 and 2.8 vs. 2.5 mmol/L, p < 0.001, respectively). In a multiple linear regression model, one E% increase in SFA intake was related to a 0.03 mmol/L increase in LDL cholesterol (p = 0.04). A lower intake of saturated and trans fatty acids, replaced by unsaturated fatty acids, may have contributed to an improved lipid profile in a healthy 6-year-old population. Biological data for analysis of blood lipids are important in national dietary surveys in healthy children to monitor important health outcomes of interventions.     

Iodine status of breastfed infants and their mothers' breast milk iodine concentration

Iodine is an essential nutrient for growth and development during infancy. Data on iodine status of exclusively (EBF) and partially breastfed (PBF) infants as well as breast milk iodine concentration (BMIC) are scarce. We aimed to assess (a) infant iodine nutrition at the age of 5.5 months by measuring urinary iodine concentration (UIC) in EBF (n = 32) and PBF (n = 28) infants and (b) mothers' breast milk iodine concentration (n = 57). Sixty mother–infant pairs from three primary health care centres in Reykjavik and vicinities provided urine and breast milk samples for iodine analysis and information on mothers' habitual diet. The mother–infant pairs were participants of the IceAge2 study, which focuses on factors contributing to infant growth and development, including body composition and breast‐milk energy content. The median (25th–75th percentiles) UIC was 152 (79–239) μg/L, with no significant difference between EBF and PBF infants. The estimated median iodine intake ranged from 52 to 86 μg/day, based on urinary data (assuming an average urine volume of 300–500 ml/day and UIC from the present study). The median (25th–75th percentiles) BMIC was 84 (48–114) μg/L. It is difficult to conclude whether iodine status is adequate in the present study, as no ranges for median UIC reflecting optimal iodine nutrition exist for infants. However, the results add important information to the relatively sparse literature on UIC, BMIC, and iodine intake of breastfed infants.     

Birth weight, growth and feeding in infancy: relation to serum lipid concentration in 12-month-old infants

OBJECTIVE: To assess the effects of birth size, growth and feeding in infancy on serum lipids in 12-month-old infants. DESIGN: A longitudinal observation study on infants' consumption and growth. Food and growth records were made every month. At 6, 9 and 12 months, food records were weighed to calculate intake. Serum total cholesterol (TC), high-density lipoprotein-cholesterol (HDL), low-density lipoprotein (LDL) -cholesterol and triglyceride concentrations were analysed at 12 months. SETTINGS: Birth and growth information was gathered from maternity wards and healthcare centres in Iceland and food consumption data at home. SUBJECTS: Randomly selected newborns (n=180) according to the mother's domicile and 77% (n=138) participated, of them 75% (n=103), came in for blood sampling. RESULTS: Among boys, a 1 kg higher birth weight resulted in a 0.79 mmol/l higher TC (P=0.005), but nonsignificant after adjustment for growth. Duration of breastfeeding was related to LDL-cholesterol (B=0.06 +/-0.02, P=0.020, adj. R(2)=0.039), adjusting for gender. Independent of size at birth and breastfeeding, increase in length from 6 to 12 months and in weight from birth to 12 months were negatively related to TC (B=-0.455+/-0.156, P=0.008 and B=-1.086+/-0.474, P=0.032, respecitvely) in boys. PUFA was the strongest nutrient variable predicting TC (B=0.332, adj. R(2)=0.24, P>0.001). Cod liver oil consumption increased both TC and LDL-cholesterol in girls (B=0.141+/-0.051, P=0.008 and B=0.112+/-0.047, P=0.021, respectively). CONCLUSION: Slower growth of high birth weight infants and breastfeeding contributes to higher TC concentration at the age of 12 months. Nutrient intake in infancy also affects lipid profile. The effect of birth weight, growth and nutrient intake in infancy on lipid profile is different for boys and girls.     

Interventions to overcome clinician- and patient-related barriers to pain management

Barriers to optimal cancer pain management exist among clinicians and patients, and within the healthcare system. This article focuses on clinician- and patient-related barriers and the interventions that have been tested to overcome them. Although individual studies have shown promise in improving patient outcomes, overall the studies do not provide clear answers to guide practice. Further research is required to determine what components of educational interventions are necessary to facilitate optimal cancer pain management.     

Multifocality as a prognostic factor in breast cancer patients registered in Danish Breast Cancer Cooperative Group (DBCG) 1996-2001

The purpose of this study was to investigate the prognostic influence of multifocality in breast cancer patients. In a cohort of 7196 patients there were 945 patients with multifocality. We found no prognostic influence of multifocality on overall survival when controlling for known prognostic factors. We found a small but significant influence on disease-free survival (HR = 1.16 [1.03–1.31]) and a strong correlation between multifocality and known prognostic factors. This was in accordance with an earlier study done on a smaller population and in a different period of time [Pedersen L, Gunnarsdottir KA, Rasmussen BB, Moeller S, Lanng C. The prognostic influence of multifocality in breast cancer patients. Breast 2004;13:188–193].