Publications by authors named "Andrew Schaffner"

20 Publications

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Nutrition Screening, Reported Dietary Intake, Hospital Foods, and Malnutrition in Critical Care Patients in Malawi.

Nutrients 2021 Apr 1;13(4). Epub 2021 Apr 1.

Queen Elizabeth Central Hospital, P.O. Box 95, Blantyre, Malawi.

In low-income countries there are few data on hospital malnutrition. Reduced food intake combined with nutrient-poor foods served in hospitals contribute to nutritional risk. This study investigated whether reported dietary intake and disease state of hospitalized adults in critical care units was related to malnutrition determined by mid-upper arm circumference (MUAC). Adult in-patients ( = 126) in tuberculosis, burn, oncology, and intensive care units in two public tertiary hospitals in Malawi were screened for nutritional status using MUAC and a question on current dietary intake. The hospital menu was reviewed; portion sizes were weighed. The prevalence of moderate and severe malnutrition was 62%. Patients with organ-related diseases and infectious diseases had the highest rates of reduced reported dietary intake, 71.4% and 57.9%, respectively; however, there was no association between reported dietary intake and MUAC. In those unable to eat, however, the rate of severe malnutrition was 50%. The menu consisted of porridge and thickened corn-based starch with fried cabbage; protein foods were provided twice weekly. There was a nutrient gap of 250 calories and 13 gm protein daily. The findings support the need for increasing dietetic/nutrition services to prevent and treat malnutrition in hospitals using simple screening tools.
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http://dx.doi.org/10.3390/nu13041170DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8066941PMC
April 2021

Protocol for a randomized controlled trial of pre-pregnancy lifestyle intervention to reduce recurrence of gestational diabetes: Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional.

Trials 2021 Apr 7;22(1):256. Epub 2021 Apr 7.

Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, USA.

Background: Gestational diabetes mellitus (GDM) is associated with several maternal complications in pregnancy, including preeclampsia, preterm labor, need for induction of labor, and cesarean delivery as well as increased long-term risks of type 2 diabetes, metabolic syndrome, and cardiovascular disease. Intrauterine exposure to GDM raises the risk for complications in offspring as well, including stillbirth, macrosomia, and birth trauma, and long-term risk of metabolic disease. One of the strongest risk factors for GDM is the occurrence of GDM in a prior pregnancy. Preliminary data from epidemiologic and bariatric surgery studies suggest that reducing body weight before pregnancy can prevent the development of GDM, but no adequately powered trial has tested the effects of a maternal lifestyle intervention before pregnancy to reduce body weight and prevent GDM recurrence.

Methods: The principal aim of the Gestational Diabetes Prevention/Prevención de la Diabetes Gestacional is to determine whether a lifestyle intervention to reduce body weight before pregnancy can reduce GDM recurrence. This two-site trial targets recruitment of 252 women with overweight and obesity who have previous histories of GDM and who plan to have another pregnancy in the next 1-3 years. Women are randomized within site to a comprehensive pre-pregnancy lifestyle intervention to promote weight loss with ongoing treatment until conception or an educational control group. Participants are assessed preconceptionally (at study entry, after 4 months, and at brief quarterly visits until conception), during pregnancy (at 26 weeks' gestation), and at 6 weeks postpartum. The primary outcome is GDM recurrence, and secondary outcomes include fasting glucose, biomarkers of cardiometabolic disease, prenatal and perinatal complications, and changes over time in weight, diet, physical activity, and psychosocial measures.

Discussion: The Gestational Diabetes Prevention /Prevención de la Diabetes Gestacional is the first randomized controlled trial to evaluate the effects of a lifestyle intervention delivered before pregnancy to prevent GDM recurrence. If found effective, the proposed lifestyle intervention could lay the groundwork for shifting current treatment practices towards the interconception period and provide evidence-based preconception counseling to optimize reproductive outcomes and prevent GDM and associated health risks.

Trial Registration: ClinicalTrials.gov NCT02763150 . Registered on May 5, 2016.
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http://dx.doi.org/10.1186/s13063-021-05204-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024941PMC
April 2021

Rationale and design of a randomized controlled trial examining oral administration of bisphenol A on hepatic glucose production and skeletal muscle insulin sensitivity in adults.

Contemp Clin Trials Commun 2020 Mar 25;17:100549. Epub 2020 Feb 25.

Center for Health Research, California Polytechnic State University, USA.

Previous observational studies have shown that the endocrine disrupting chemical bisphenol A (BPA) is associated with type 2 diabetes, but few studies have examined direct effects of BPA on human health. The purpose of this study is to determine whether orally administered BPA at the US Environmental Protection Agency (EPA) safe dose of 50 μg/kg body weight has an adverse effect on hepatic glucose production and skeletal muscle insulin sensitivity. Forty, non-habitually active, healthy adults of normal weight will be enrolled. Participants will begin with a 2-day baseline energy balance diet low in bisphenols in which urine and blood will be collected, and standard tests performed to assess the primary outcome measures of hepatic glucose production (via [6,6-H] glucose infusion) and skeletal muscle insulin sensitivity (via euglycemic hyperinsulinemic clamp technique). Secondary outcome measures are fasting hormones/endocrine factors (insulin, glucose, C-peptide, Pro-insulin, adiponectin, 17-beta-estradiol, free fatty acids) related to the pathogenesis of type 2 diabetes. Participants will then be randomly assigned to a 4-day energy balance diet plus oral administration of BPA at 50 μg/kg body weight (Diet + BPA) or 4-day energy balance diet plus oral administration of placebo (Diet + No BPA); all outcome measures will be reassessed after 4 days. Findings from this study will provide a framework for other studies in this area, and provide much needed experimental evidence using gold standard measures as to whether oral BPA administration over several days poses any risk of type 2 diabetes.
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http://dx.doi.org/10.1016/j.conctc.2020.100549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7052501PMC
March 2020

Ripple Effect of Lifestyle Interventions During Pregnancy on Untreated Partners' Weight.

Obesity (Silver Spring) 2019 05 8;27(5):733-739. Epub 2019 Apr 8.

Department of Psychiatry, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.

Objective: Weight-loss interventions have a positive "ripple effect" on untreated partners' weight, but ripple effects in pregnancy are unknown. The objective of this study was to determine whether prenatal lifestyle interventions that reduce gestational weight gain in pregnant women have a positive ripple effect on untreated partners' weight.

Methods: Two clinical trials with the same outcome measures randomly assigned pregnant women to a lifestyle intervention or usual care. Untreated partners were randomly assigned according to their pregnant partner's group allocation and were assessed at study entry (~13 weeks' gestation), 35 weeks' gestation, and 6 and 12 months after delivery.

Results: A total of 122 partners (100% male, 23% Hispanic, 82% married, and 48% with obesity) were randomly assigned to the intervention (n = 59) or usual care (n = 63). There was no intervention or intervention-by-time interaction effect on partner weight (P = 0.795). Partner weight changes were not statistically significant (P = 0.120) from study entry to 35 weeks' gestation (mean 0.19 kg; 95% CI: -0.73 to 1.24) or to 12 months after delivery (mean 0.82 kg; 95% CI: -0.26 to 1.91).

Conclusions: There was no evidence of a ripple effect on partner weight. In a self-selected sample, partners of pregnant women appeared not to experience sympathy weight gain.
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http://dx.doi.org/10.1002/oby.22447DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478509PMC
May 2019

Pilot Study on the Effect of Orally Administered Bisphenol A on Glucose and Insulin Response in Nonobese Adults.

J Endocr Soc 2019 Mar 8;3(3):643-654. Epub 2019 Feb 8.

Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, California.

Objective: To determine the effects of varying doses of orally administered BPA on indices of glucose metabolism.

Methods: Eleven college students (21.0 ± 0.8 years; 24.2 ± 3.9 kg/m) were randomized in a double-blinded, crossover fashion separated by >1 week to placebo (PL), deuterated BPA at 4 µg/kg body weight (BPA-4), and deuterated BPA at 50 µg/kg body weight (BPA-50). Total BPA, glucose, insulin, and C-peptide were assessed at baseline, minutes 15, 30, 45, 60, and every 30 minutes for 2 hours in response to a glucose tolerance test.

Results: There was a significant condition × time interaction for total BPA ( < 0.001) such that BPA increased more rapidly in BPA-50 than BPA-4 and PL ( = 0.003) and increased more rapidly in BPA-4 than PL ( < 0.001). There were no significant condition × time interactions on glucose, insulin, and C-peptide. Significant condition main effects were observed for glucose such that BPA-50 was significantly lower than PL ( = 0.036) and nearly lower for BPA-4 vs PL ( = 0.056). Significant condition main effects were observed such that insulin in BPA-50 was lower than BPA-4 ( = 0.021), and C-peptide in BPA-50 was lower than BPA-4 (t = 3.95; Tukey-adjusted = 0.003). Glucose, insulin, and C-peptide areas under the curve for the 3-hour profile were significantly lower in BPA-50 vs PL ( < 0.05).

Conclusion: Orally administered BPA protocol appeared feasible and has immediate effects on glucose, insulin, and C-peptide concentrations.
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http://dx.doi.org/10.1210/js.2018-00322DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6397423PMC
March 2019

Does Partial Meal Replacement During Pregnancy Reduce 12-Month Postpartum Weight Retention?

Obesity (Silver Spring) 2019 02 13;27(2):226-236. Epub 2018 Nov 13.

Division of Epidemiology, School of Public Health, University of California at Berkeley, Berkeley, California, USA.

Objective: This randomized trial tested whether a behavioral intervention with meal replacements in pregnancy could increase the proportion of women who returned to prepregnancy weight and reduce postpartum weight retention by 12 months after delivery.

Methods: Women (N = 264; 13.7 weeks' gestation) with overweight or obesity were randomly assigned to usual care or intervention. The intervention reduced excess gestational weight gain and was discontinued at delivery. At follow-up, 83.7% completed the 12-month assessment.

Results: Compared with usual care, prenatal intervention had no significant effect on odds of achieving prepregnancy weight (38/128 [29.7%] vs. 41/129 [31.8%]; P = 0.98) or in reducing the magnitude of weight retained (3.3 vs. 3.1 kg; P = 0.82) at 12 months. After delivery, significant (P < 0.0001) declines in meal replacements, practice of weight control behaviors, and dietary restraint were observed in the intervention group. Independent of group, lower gestational weight gain was the strongest predictor of achieving prepregnancy weight at 12 months (P = 0.0008).

Conclusions: A prenatal behavioral intervention with meal replacements that reduced pregnancy weight gain had no significant effect on 12-month postpartum weight retention.
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http://dx.doi.org/10.1002/oby.22361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8142600PMC
February 2019

Effect of Nutritional Interventions on Micronutrient Status in Pregnant Malawian Women with Moderate Malnutrition: A Randomized, Controlled Trial.

Nutrients 2018 Jul 7;10(7). Epub 2018 Jul 7.

Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA 93407, USA.

Micronutrient deficiencies during pregnancy are common in Africa and can cause adverse outcomes. The objective was to measure micronutrient status and change in moderately malnourished pregnant Malawian women randomized to one of three nutritional interventions. Serum vitamin B, 25-hydroxyvitamin D, folate, retinol, ferritin, zinc, albumin and C-reactive protein were measured in pregnant women with MUAC ≥20.6 cm and ≤23.0 cm at enrollment ( = 343) and after 10 weeks ( = 229) of receiving: (1) ready-to-use supplementary food (RUSF); (2) fortified corn-soy blend (CSB+) with multiple-micronutrient supplement (CSB+UNIMMAP); or (3) CSB+ with iron and folic acid (CSB+IFA). Each provided 100⁻300% Recommended Dietary Allowance of most micronutrients and 900 kcal/day. Birth length was measured in 272 infants. Enrollment measurements indicated deficiencies in vitamin B (20.9%) and zinc (22.3%), low values of ferritin (25.1%) and albumin (33.7%), and elevated CRP (46.0%). Vitamin B is known to decrease in the third trimester; the RUSF group had the smallest decrease from enrollment to week 10 (3%), compared to 20% decrease in the CSB+IFA group and 8% decrease in the CSB+UNIMMAP group ( = 0.001). Mean serum 25-hydroxyvitamin D increased most in the RUSF group (+6.4 ng/mL), compared to CSB+IFA (+1.7 ng/mL) and CSB+UNIMMAP (+2.7 ng/mL) ( < 0.001). Micronutrient deficiencies and inflammation are common among moderately malnourished pregnant women and had little improvement despite supplementation above the RDA, with the exception of vitamins B and D.
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http://dx.doi.org/10.3390/nu10070879DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6073606PMC
July 2018

Randomized controlled clinical trial of behavioral lifestyle intervention with partial meal replacement to reduce excessive gestational weight gain.

Am J Clin Nutr 2018 02;107(2):183-194

Division of Epidemiology, University of California at Berkeley School of Public Health, Berkeley, CA.

Background: Behavioral lifestyle interventions during pregnancy can prevent excessive gestational weight gain (GWG) in women with normal weight; however, effective interventions to reduce GWG in ethnically diverse women with obesity are lacking.

Objective: A randomized controlled trial was conducted to test whether a behavioral lifestyle intervention with partial meal replacement reduces GWG rate in Hispanic and non-Hispanic women with overweight or obesity relative to enhanced usual care.

Design: Participants (n = 257) were recruited in San Luis Obispo, California, and Providence, Rhode Island, between November 2012 and May 2016. Participants were pregnant (mean ± SD: 13.6 ± 1.8 wk of gestation) with overweight or obesity and had a mean age of 30.3 y; 41.6% of participants were Hispanic. Women were randomly assigned within site and by ethnicity to enhanced usual care (n = 128) or to a behavioral lifestyle intervention with partial meal replacement (n = 129). The primary outcome was GWG per week of observation. Secondary outcomes were proportions exceeding Institute of Medicine (IOM) guidelines for total GWG, changes in weight-control behaviors and cardiovascular disease risk factors, and incidence of pregnancy complications. Study retention was 99.6% (256 of 257).

Results: The intervention compared with usual care resulted in less mean ± SD weekly GWG (0.33 ± 0.25 compared with 0.39 ± 0.23 kg/wk; P = 0.02) and total GWG (9.4 ± 6.9 compared with 11.2 ± 7.0 kg; P = 0.03) and reduced the proportion of women who exceeded IOM guidelines for total GWG (41.1% compared with 53.9%; P = 0.03). No significant group × time × demographic subgroup (ethnicity, BMI, age, parity, and income) interactions were observed. Among intervention participants, greater meal replacement intake was related to reduced GWG rate (β = -0.07; 95% CI:-0.12, -0.03; P = 0.002). The intervention compared with usual care increased weight-control strategies (P < 0.0001) and cognitive restraint (P < 0.0001) and reduced triglycerides (P = 0.03).

Conclusion: Prenatal behavioral intervention with partial meal replacement significantly reduced GWG in Hispanic and non-Hispanic women with overweight or obesity. This trial was registered at www.clinicaltrials.gov as NCT01545934.
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http://dx.doi.org/10.1093/ajcn/nqx043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6455030PMC
February 2018

Food consumption increases cell proliferation in the python brain.

J Exp Biol 2018 04 6;221(Pt 7). Epub 2018 Apr 6.

Biological Sciences Department, California Polytechnic State University, San Luis Obispo, CA 93407-0401, USA

Pythons are model organisms for investigating physiological responses to food intake. While systemic growth in response to food consumption is well documented, what occurs in the brain is currently unexplored. In this study, male ball pythons () were used to test the hypothesis that food consumption stimulates cell proliferation in the brain. We used 5-bromo-12'-deoxyuridine (BrdU) as a cell-birth marker to quantify and compare cell proliferation in the brain of fasted snakes and those at 2 and 6 days after a meal. Throughout the telencephalon, cell proliferation was significantly increased in the 6 day group, with no difference between the 2 day group and controls. Systemic postprandial plasticity occurs quickly after a meal is ingested, during the period of active digestion; however, the brain displays a surge of cell proliferation after most digestion and absorption is complete.
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http://dx.doi.org/10.1242/jeb.173377DOI Listing
April 2018

Associations between bottle-feeding intensity and maternal encouragement of bottle-emptying.

Public Health Nutr 2017 Dec 12;20(17):3090-3098. Epub 2017 Sep 12.

2Department of Statistics,California Polytechnic State University,San Luis Obispo,San Luis Obispo,CA,USA.

Objective: To explore longitudinal associations between bottle-feeding and maternal encouragement of infant bottle-emptying during the first 6 months of infancy.

Design: Mothers completed questionnaires during the third trimester of pregnancy, then monthly during the first 6 months postpartum. Questionnaires assessed family demographics, maternal and infant weight status, infant feeding patterns and maternal encouragement of infant bottle-emptying.

Setting: The Infant Feeding Practices Study 2, conducted by the US Centers for Disease Control and Prevention and the Food and Drug Administration.

Subjects: Mothers (n 1776).

Results: Repeated-measures regression was used to explore associations between bottle-feeding intensity (BFI; defined as the percentage of daily feedings that were from a bottle) and encouragement of bottle-emptying. Mothers who reported consistently high or consistently low BFI also exhibited consistently higher or lower frequency of encouraging their infants to empty the bottle (respectively) across the first 6 months of infancy, whereas mothers who reported increases in their BFI also exhibited concomitant increases in the frequency to which they encouraged their infants to finish the bottle. More frequent encouragement of bottle-emptying was also associated with feeding expressed breast milk (P<0·001), and lower parity (P=0·01), pre-pregnancy BMI (P=0·002) and infant birth weight (P=0·001).

Conclusions: More frequent use of bottles for infant feeding was significantly associated with more frequent encouragement of bottle-emptying. Further research using causal designs is needed to better understand whether the use of bottles promotes this controlling feeding practice or whether mothers with more controlling feeding practices opt to bottle-feed.
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http://dx.doi.org/10.1017/S1368980017002166DOI Listing
December 2017

Acculturation Influences Postpartum Eating, Activity, and Weight Retention in Low-Income Hispanic Women.

J Womens Health (Larchmt) 2017 12 17;26(12):1333-1339. Epub 2017 Aug 17.

4 Kinesiology Department, California Polytechnic State University , San Luis Obispo, California.

Background: Low-income Hispanic women experience elevated rates of high postpartum weight retention (PPWR), which is an independent risk factor for lifetime obesity. Sociocultural factors might play an important role among Hispanic women; however, very few studies have examined this association.

Objective: The purpose of our study was to examine the associations between acculturation and maternal diet, physical activity, and PPWR.

Design: This is a cross-sectional study of baseline data from 282 Hispanic women participating in the FitMoms/Mamás Activas study, a randomized controlled trial examining the impact of primarily an internet-based weight control program, in reducing PPWR among low-income women. We performed multivariable linear regression to examine the association of acculturation with diet quality, physical activity, and PPWR at study entry.

Results: A total of 213 (76%) women had acculturation scores reflecting Mexican orientation or bicultural orientation, whereas 69 (24%) had scores that represented assimilation to Anglo culture. Women who were more acculturated had lower intakes of fruits and vegetables, lower HEI scores, and lower physical activity levels than women who were less acculturated (p < 0.05). We found an association between acculturation and PPWR in that for every 1-unit increase in acculturation score, PPWR increased, on average, by 0.80 kg.

Conclusion: Higher acculturation was associated with poorer diet and physical activity behaviors and greater PPWR.
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http://dx.doi.org/10.1089/jwh.2016.6154DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5733667PMC
December 2017

Trial of ready-to-use supplemental food and corn-soy blend in pregnant Malawian women with moderate malnutrition: a randomized controlled clinical trial.

Am J Clin Nutr 2017 10;106(4):1062-1069

Department of Nutrition and Food Science, California Polytechnic State University, San Luis Obispo, CA.

Background: Malnutrition during pregnancy in sub-Saharan Africa is associated with poor birth outcomes.

Objective: This study compared maternal and offspring anthropometry for moderately malnourished pregnant women receiving ready-to-use supplemental food (RUSF), a fortified corn-soy blend (CSB+) with a daily multiple micronutrient antenatal supplement [United Nations International Multiple Micronutrient Preparation (UNIMMAP)], or standard of care comprising CSB+ and iron and folic acid (IFA).

Design: A single-blind randomized controlled clinical trial was conducted in southern Malawi among 1828 pregnant women with moderate malnutrition, defined as a midupper arm circumference (MUAC) ≥20.6 and ≤23.0 cm. Women received 1 of 3 dietary treatment regimens that provided ∼900 kcal/d and 33-36 g protein/d. Maternal and infant anthropometry were followed until the child was 3 mo old.

Results: Newborns had a mean length-for-age z score of -1.3 ± 1.2 and 22% were stunted at birth. Mothers receiving RUSF had the highest weight gain during supplementation (3.4 ± 2.6, 3.0 ± 2.2, and 3.2 ± 2.4 kg for the RUSF, CSB+ with UNIMMAP, and CSB+ with IFA groups, respectively; P = 0.03). Newborn birth weights and lengths were similar across intervention groups, but the incidence of newborns with a birth weight <2.4 kg (weight-for-age z score <-2) was higher in the CSB+ with UNIMMAP group than the other groups (17%, 18%, and 24% for the CSB+ with IFA, RUSF, and CSB+ with UNIMMAP groups, respectively; P = 0.02). At birth, HIV-exposed newborns had a similar length and weight as newborns without HIV exposure, but their head circumference was smaller (34.0 ± 1.5 and 34.3 ± 1.6 cm, respectively; P = 0.02). At 3 mo of age, HIV-exposed infants had smaller weights, lengths, and head and arm circumferences than infants without HIV exposure.

Conclusions: RUSF improved maternal weight gain compared with CSB+ with UNIMMAP. The large amount of food given and the modest effect on linear growth in newborns suggests that stunting in utero is unlikely to be reduced by supplemental food alone. This trial was registered at clinicaltrials.gov as NCT02120599.
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http://dx.doi.org/10.3945/ajcn.117.157198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483045PMC
October 2017

Effect of an Internet-Based Program on Weight Loss for Low-Income Postpartum Women: A Randomized Clinical Trial.

JAMA 2017 06;317(23):2381-2391

Departments of Health Behavior and Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.

Importance: Postpartum weight retention increases lifetime risk of obesity and related morbidity. Few effective interventions exist for multicultural, low-income women.

Objective: To test whether an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) for low-income postpartum women could produce greater weight loss than the WIC program alone over 12 months.

Design, Setting, And Participants: A 12-month, cluster randomized, assessor-blind, clinical trial enrolling 371 adult postpartum women at 12 clinics in WIC programs from the California central coast between July 2011 and May 2015 with data collection completed in May 2016.

Interventions: Clinics were randomized to the WIC program (standard care group) or the WIC program plus a 12-month primarily internet-based weight loss program (intervention group), including a website with weekly lessons, web diary, instructional videos, computerized feedback, text messages, and monthly face-to-face groups at the WIC clinics.

Main Outcomes And Measures: The primary outcome was weight change over 12 months, based on measurements at baseline, 6 months, and 12 months. Secondary outcomes included proportion returning to preconception weight and changes in physical activity and diet.

Results: Participants included 371 women (mean age, 28.1 years; Hispanic, 81.6%; mean weight above prepregnancy weight, 7.8 kg; mean months post partum, 5.2 months) randomized to the intervention group (n = 174) or standard care group (n = 197); 89.2% of participants completed the study. The intervention group produced greater mean 12-month weight loss compared with the standard care group (3.2 kg in the intervention group vs 0.9 kg in standard care group, P < .001; difference, 2.3 kg (95% CI, 1.1 to 3.5). More participants in the intervention group than the standard care group returned to preconception weight by 12 months (32.8% in the intervention group vs 18.6% in the standard care group, P < .001; difference, 14.2 percentage points [95% CI, 4.7 to 23.5]). The intervention group and standard care group did not significantly differ in 12-month changes in physical activity (mean [95% CI]: -7.8 min/d [-16.1 to 0.4] in the intervention group vs -7.2 min/d [-14.6 to 0.3] in the standard care group; difference, -0.7 min/d [95% CI, -42.0 to 10.6], P = .76), calorie intake (mean [95% CI]: -298 kcal/d [-423 to -174] in the intervention group vs -144 kcal/d [-257 to -32] in the standard care group; difference, -154 kcal/d [-325 to 17], P = .06), or incidences of injury (16 in the intervention group vs 16 in the standard care group) or low breastmilk supply from baseline to month 6 (21 of 61 participants in the intervention group vs 23 of 72 participants in the standard care group) and from month 6 to 12 (13 of 32 participants in the intervention group vs 14 of 37 participants in the standard care group).

Conclusions And Relevance: Among low-income postpartum women, an internet-based weight loss program in addition to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) compared with the WIC program alone resulted in a statistically significant greater weight loss over 12 months. Further research is needed to determine program and cost-effectiveness as part of the WIC program.

Trial Registration: clinicaltrials.gov Identifier: NCT01408147.
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http://dx.doi.org/10.1001/jama.2017.7119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5815021PMC
June 2017

Randomized Intervention Trial to Decrease Bisphenol A Urine Concentrations in Women: Pilot Study.

J Womens Health (Larchmt) 2017 02 11;26(2):128-132. Epub 2016 Oct 11.

1 Department of Kinesiology, California Polytechnic State University , San Luis Obispo, California.

Background: Previous studies have shown that women have higher concentrations of the endocrine disruptor bisphenol A (BPA), but an intervention to reduce BPA is lacking in women. To test the hypothesis that an intervention to reduce BPA would decrease urinary BPA concentrations over 3 weeks, 24 women (mean ± standard deviation [SD]; 22.1 ± 2.8 kg/m body mass index, 20.9 ± 1.5 years) were randomly assigned to an intervention or control.

Materials And Methods: The intervention included weekly face-to-face meetings to reduce BPA exposures from food, cosmetics, and other packaged products. Women were provided with BPA-free cosmetics, hygiene, glass food/water containers, and daily self-monitored major sources of BPA. Fasting urine BPA and creatinine concentrations, and weight were assessed at study entry and after 3 weeks.

Results: A significant (p = 0.04) treatment × time interaction effect was observed on creatinine-adjusted BPA concentrations. From study entry to 3 weeks, women in the intervention significantly decreased geometric mean creatinine-adjusted urinary BPA by -0.71 ng/m, whereas women in the control significantly increased urinary BPA by 0.32 ng/mL (p = 0.04). Additionally, from study entry to 3 weeks, women in the intervention significantly lost weight -0.28 ± 0.44 kg, whereas women in the control significantly gained weight +1.65 ± 0.74 kg (p = 0.03). Changes in creatinine-adjusted BPA concentrations and weight were not significantly related (p = 0.67).

Conclusion: In this pilot study, a 3-week intervention decreased urinary BPA concentrations in women. Future clinical trials are needed to confirm these results and to examine whether a similar BPA intervention positively impacts risk markers in the pathogenesis of cardiovascular disease and diabetes.
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http://dx.doi.org/10.1089/jwh.2016.5746DOI Listing
February 2017

'Fit Moms/Mamás Activas' internet-based weight control program with group support to reduce postpartum weight retention in low-income women: study protocol for a randomized controlled trial.

Trials 2015 Feb 25;16:59. Epub 2015 Feb 25.

Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, 318 Rosenau Hall, Campus Box 7400, Chapel Hill, NC, 27599-7440, USA.

Background: High postpartum weight retention is a strong independent risk factor for lifetime obesity, cardiovascular disease, and type 2 diabetes in women. Interventions to promote postpartum weight loss have met with some success but have been limited by high attrition. Internet-based treatment has the potential to overcome this barrier and reduce postpartum weight retention, but no study has evaluated the effects of an internet-based program to prevent high postpartum weight retention in women.

Methods/design: Fit Moms/Mamás Activas targets recruitment of 12 Women, Infants and Children (WIC) Supplemental Nutrition Program clinics with a total of 408 adult (>18 years), postpartum (<1 year) women with 14.5 kg or more weight retention or a body mass index of 25.0 kg/m(2) or higher. Clinics are matched on size and randomly assigned within county to either a 12-month standard WIC intervention or to a 12-month WIC enhanced plus internet-based weight loss intervention. The intervention includes: monthly face-to-face group sessions; access to a website with weekly lessons, a web diary, instructional videos, and computer-tailored feedback; four weekly text messages; and brief reinforcement from WIC counselors. Participants are assessed at baseline, six months, and 12 months. The primary outcome is weight loss over six and 12 months; secondary outcomes include diet and physical activity behaviors, and psychosocial measures.

Discussion: Fit Moms/Mamás Activas is the first study to empirically examine the effects of an internet-based treatment program, coupled with monthly group contact at the WIC program, designed to prevent sustained postpartum weight retention in low-income women at high risk for weight gain, obesity, and related comorbidities.

Trial Registration: This trial was registered with Clinicaltrials.gov (identifier: NCT01408147 ) on 29 July 2011.
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http://dx.doi.org/10.1186/s13063-015-0573-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347547PMC
February 2015

Does behavioral intervention in pregnancy reduce postpartum weight retention? Twelve-month outcomes of the Fit for Delivery randomized trial.

Am J Clin Nutr 2014 Feb 27;99(2):302-11. Epub 2013 Nov 27.

Kinesiology Department (SP) and Statistics Department (AS and KG), California Polytechnic State University, San Luis Obispo, CA; the Warren Alpert Medical School, Department of Psychiatry and Human Behavior, and The Miriam Hospital, Weight Control and Diabetes Research Center, Brown University, Providence, RI (SP, RRW, and FD); the Department of Obstetrics and Gynecology and Women & Infants Hospital of Rhode Island, Division of Research, Warren Alpert Medical School, Brown University, Providence, RI (MGP); and the University of California, Berkeley, School of Public Health, Berkeley, CA (BA).

Background: Excessive weight gain during pregnancy is a risk factor for postpartum weight retention and future weight gain and obesity. Whether a behavioral intervention in pregnancy can reduce long-term weight retention is unknown.

Objective: This randomized trial tested whether a low-intensity behavioral intervention to prevent excessive gestational weight gain could increase the proportion of women who returned to prepregnancy weight by 12 mo postpartum.

Design: Women (n = 401, 13.5 wk of gestation, 50% normal weight, 50% overweight/obese) were randomly assigned into an intervention or control group; 79% completed the 12-mo assessment. The telephone-based intervention targeted gestational weight gain, healthy eating, and exercise and was discontinued at delivery.

Results: In modified intent-to-treat analyses that excluded women with miscarriages (n = 6), gestational diabetes (n = 32), or subsequent pregnancies (n = 32), the intervention had no significant effect on the odds of achieving prepregnancy weight at 12 mo postpartum (n = 331; 35.4% compared with 28.1%; P = 0.18). Completer analyses suggested that the intervention tended to increase the percentages of women who reached prepregnancy weight (n = 261; 45.3% compared with 35.3%; P = 0.09) and significantly reduced the magnitude of mean ± SD postpartum weight retained (1.4 ± 6.3 compared with 3.0 ± 5.7 kg; P = 0.046) at 12 mo. Women in the intervention group reported higher dietary restraint through 6 mo postpartum (P = 0.023) and more frequent self-monitoring of body weight (P < 0.02 for all) throughout the study.

Conclusions: A low-intensity behavioral intervention in pregnancy can reduce 12-mo postpartum weight retention and improve dietary restraint and self-weighing in study completers. Future research is needed to test the long-term effects of more intensive behavioral interventions in pregnancy. This trial was registered at clinicaltrials.gov as NCT01117961.
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http://dx.doi.org/10.3945/ajcn.113.070151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3893723PMC
February 2014

A comparison of the effects of a high carbohydrate vs. a higher protein milk supplement following simulated mountain skirmishes.

Mil Med 2012 Jun;177(6):723-31

Dairy Products Technology Center, Department of Dairy Science, California Polytechnic State University, San Luis Obispo, CA 93407-0257, USA.

This study compared the effects of a higher protein supplement manufactured from milk vs. a commercially available higher carbohydrate supplement on serum markers of muscle damage, anaerobic exercise, choice reaction time, and body composition during 2 weekends of vigorous hikes with simulated mountain skirmishes. Thirty-five university students, including Reserve Officers Training Corps cadets and athletes, carried 25% of their body weight (up to 26.4 kg) on Friday, Saturday, and Sunday hikes. Supplementation and Wingate tests followed each hike, and choice reaction testing preceded and followed each hike. Blood samples were obtained and body compositions were measured pre- and postweekend. Increased cortisol, highly sensitive C-reactive protein, creatine phosphokinase, and aldolase suggested the exercise regimen induced muscle damage and inflammation, which was attenuated during the second weekend of hikes. Absolute anaerobic capacity was somewhat greater following consumption of the milk supplement (p = 0.082). Body compositions did not change significantly during this study. Choice reaction times decreased following hikes and were significantly faster following consumption of the carbohydrate supplement (p < 0.04). Supplements including milk proteins and carbohydrates may improve endurance exercise and decision-making abilities of military personnel and endurance athletes.
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http://dx.doi.org/10.7205/milmed-d-11-00396DOI Listing
June 2012

Maternal behaviors during pregnancy impact offspring obesity risk.

Exp Diabetes Res 2011 26;2011:985139. Epub 2011 Oct 26.

Kinesiology Department, California Polytechnic State University, 1 Grand Avenue, San Luis Obispo, CA 93407-0386, USA.

This study investigated the effects of maternal changes during pregnancy in diet, exercise, and psychosocial factors on offspring weight parameters at birth and 6 months. In overweight/obese (OW/OB; n = 132) mothers, greater % kcal from sweets early in pregnancy was the strongest, independent predictor of higher weight for age (WFA) (beta = 0.19; P = 0.004), higher odds of macrosomia (OR = 1.1 (1.0-1.2); P = 0.004) and WFA >90th percentile at birth (OR = 1.2 (1.1-1.3); P = 0.002) and higher WFA at 6 months (beta = 0.30; P = 0.002). In normal weight (n = 153) mothers, higher intake of soft drinks was the strongest predictor of higher offspring WFA at birth (beta = 0.16; P = 0.04) but not at 6 months. Prenatal physical activity, depressive symptoms, and sleep-related variables did not significantly predict offspring weight outcomes. Mothers' eating behaviors during pregnancy, especially intake of sweets in OW/OB mothers, may have a lasting effect on child weight.
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http://dx.doi.org/10.1155/2011/985139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3205727PMC
March 2012

Practitioner advice and gestational weight gain.

J Womens Health (Larchmt) 2011 Apr 17;20(4):585-91. Epub 2011 Mar 17.

California Polytechnic State University, Kinesiology Department, San Luis Obispo, CA 93407-0386, USA.

Background: The purpose of this study was to investigate receipt of gestational weight gain advice in prenatal care and ideal and expected gestational weight gain outcomes for normal weight and overweight/obese women.

Methods: This was a cross-sectional study of normal weight (n = 203) and overweight/obese (n = 198) women in early (<16 weeks) pregnancy.

Results: Less than half of participants (41.7%) reported receiving weight gain advice from a practitioner. In multivariate models, pregravid weight status was not significantly related to receiving advice. However, women with lower income (odds ratio [OR] 0.31, 95% confidence interval [CI] 0.13-0.77, p = 0.01), younger age (OR 0.93, 95% CI 0.87-0.99, p = 0.02), and multiparity (OR 0.49, 95% CI 0.28-0.87, p = 0.02) were least likely to report receiving advice. Among those receiving advice, most (85%) received accurate advice; however, overweight/obese women were more likely to be advised to overgain compared with normal weight women (22.2% vs. 2.3%, p = 0.0001). Overweight/obese women were also more likely than normal weight women to report ideal (OR 7.2, 95% CI 2.3-22.7, p = 0.001) and expected (OR 4.7, 95% CI 2.6-8.4, p = 0.0001) pregnancy weight gains above Institute of Medicine guidelines. Further, a consistent relationship was observed between higher ideal and expected weight gains and greater first trimester weight gain (p < 0.03).

Conclusions: Clinicians should be encouraged to provide timely and accurate advice to women about gestational weight gain. Interventions to promote healthy gestational weight gain may benefit from targeting women's beliefs about ideal and expected gestational weight gain.
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http://dx.doi.org/10.1089/jwh.2010.2316DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075048PMC
April 2011

Randomized trial of a behavioral intervention to prevent excessive gestational weight gain: the Fit for Delivery Study.

Am J Clin Nutr 2011 Apr 10;93(4):772-9. Epub 2011 Feb 10.

Departments of Kinesiology, California Polytechnic State University, San Luis Obispo, 93407-0386, USA.

Background: Excessive weight gain during pregnancy is a major risk factor for postpartum weight retention and future weight gain and obesity in women, but few adequately powered randomized controlled trials have examined the efficacy of a behavioral weight-control intervention during pregnancy.

Objective: This study examined whether a behavioral intervention during pregnancy could decrease the proportion of women who exceeded the 1990 Institute of Medicine (IOM) recommendations for gestational weight gains and increase the proportion of women who returned to pregravid weights by 6 mo postpartum.

Design: This study was a randomized, assessor-blind, controlled trial. Participants were pregnant (13.5 wk gestation), normal-weight (NW; n = 201) and overweight or obese (OW/OB; n = 200) women whose average age was 28.8 y. Participants were randomly assigned within the 1990 IOM weight category (NW compared with OW/OB) to standard care (n = 200) or to a behavioral intervention to prevent excessive gestational weight gain (n = 201). The intervention included one face-to-face visit; weekly mailed materials that promoted an appropriate weight gain, healthy eating, and exercise; individual graphs of weight gain; and telephone-based feedback. The retention at the 6-mo postpartum assessment was 82%.

Results: Intent-to-treat analyses showed that the intervention, compared with standard care, decreased the percentage of NW women who exceeded IOM recommendations (40.2% compared with 52.1%; P = 0.003) and increased the percentages of NW and OW/OB women who returned to their pregravid weights or below by 6 mo postpartum (30.7% compared with 18.7%; P = 0.005).

Conclusion: A low-intensity behavioral intervention during pregnancy reduced excessive gestational weight gains in NW women and prevented postpartum weight retention in NW and OW/OB women. This trial was registered at clinicaltrials.gov as NCT01117961.
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http://dx.doi.org/10.3945/ajcn.110.005306DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057546PMC
April 2011