1,720,990 research outputs found
The role of childhood adversity in the development of gestational diabetes
No full textIntroduction: The influence of women's childhood psychosocial environment and subsequent preconception mental health on risk of developing gestational diabetes mellitus is unclear. This study examines this relationship. Methods: Data from a population-based cohort study, the Australian Longitudinal Study on Women's Health, were used. A total of 6,317 women with no pre-existing diabetes were followed from 1996 (aged 18–23 years) until 2015. Gestational diabetes mellitus diagnosis was self-reported. Exposures to eight subcategories of adverse childhood experiences were recalled. Individual subcategories and total number of adverse childhood experiences were examined. Log-binomial regression models with generalized estimating equations were used to estimate RRs and 95% CIs. Analyses were adjusted for early life, preconception, and antenatal gestational diabetes mellitus risk factors. Effect modification by preconception mental health was tested using cross-product terms. Analyses were conducted in 2018. Results: Among 11,556 pregnancies, 4.7% were complicated by gestational diabetes mellitus. Compared with women not exposed to adverse childhood experiences, exposure to any three adverse childhood experiences (6% of women, adjusted RR=1.73, 95% CI=1.02, 3.01) or four or more adverse childhood experiences (7%, adjusted RR=1.76, 95% CI=1.04, 2.99) was associated with elevated gestational diabetes mellitus risk in women with preconception depressive symptoms. Among the subcategories of adverse childhood experiences, physical abuse, and household substance abuse were associated with higher gestational diabetes mellitus risk. Adverse childhood experiences were not associated with gestational diabetes mellitus in women without depressive symptoms before pregnancy (p=0.01, for interaction). Conclusions: These findings suggest that, in addition to primary prevention of childhood adversity, strategies to curb poor mental health trajectories among women exposed to adverse childhood experiences may contribute to prevention of gestational diabetes mellitus
Does psychosocial stress explain socioeconomic inequities in 9-year weight gain among young women?
No full textPublished online 28 April 2017Objective: This study investigated the contribution of psychosocial stress to mediating inequities in weight gain by educational status in a large cohort of young Australian women over a 9-year follow-up. Methods: This observational cohort study used survey data drawn from 4,806 women, aged 22 to 27 years at baseline (2000), participating in the Australian Longitudinal Study on Women’s Health, who reported their education level (2000), perceived stress (2003), and weight (2003 and 2012). Using a causal inference framework based on counterfactuals for mediation analysis, we fitted linear or logistic regression models to examine the total effect, decomposed into natural direct and indirect effects via perceived stress, of education level (highest qualification completed: up to year 12/trade or diploma vs. university) on weight change. Results: Women with lower education gained more weight over 9 years (6.1 kg, standard deviation [SD] 9.5) than women with higher education (3.8 kg, SD 7.7; P<0.0001) and were more likely to be very or extremely stressed. The higher weight gain associated with low education was not mediated through perceived stress (per SD increase, percent mediated: 1.0%). Conclusions: Education-based inequities in weight gain over time were not attributable to greater psychosocial stress among women with lower education levels.Kylie Ball, Danielle A.J.M. Schoenaker, and Gita D. Mishr
How do women’s diets compare with the new Australian dietary guidelines?
Get PDFObjective To compare women's diets with recommended intakes from the new Australian Dietary Guidelines (ADG 2013). Design Cross-sectional study using data from the Australian Longitudinal Study on Women's Health. Diet was assessed using a validated FFQ. Setting Two nationally representative age cohorts of Australian women. Subjects Women in the young cohort (born 1973-1978, aged 31-36 years) and mid-age cohort (born 1946-1951, aged 50-55 years). Women (n 18 226) were categorised into three groups: 'young women' (n 5760), young 'pregnant women' at the time or who had given birth in the 12 months prior to the survey (n 1999) and 'mid-age women' (n 10 467). Results Less than 2 % of women in all three groups attained the ADG 2013 recommendation of five daily servings of vegetables, with the majority needing more than two additional servings. For young women, less than one-third met recommendations for fruit (32%) and meat and alternatives (28 %), while only a small minority did so for dairy (12 %) and cereals (7 %). Fifty per cent of pregnant women met guidelines for fruit, but low percentages reached guidelines for dairy (22 %), meat and alternatives (10 %) and cereals (2·5 %). For mid-age women, adherence was higher for meat and alternatives (41 %) and cereals (45 %), whereas only 1 % had the suggested dairy intake of four daily servings. Conclusions For most women to follow ADG 2013 recommendations would require substantially increased consumption of cereals, vegetables and dairy. Findings have implications for tailoring the dissemination of dietary guidelines for women in different age groups and for pregnant women
Carbohydrate restriction in midlife is associated with higher risk of type 2 diabetes among Australian women: a cohort study
No full textBACKGROUND AND AIMS: Low-carbohydrate diets (LCDs) are increasingly popular but may be nutritionally inadequate. We aimed to examine if carbohydrate restriction in midlife is associated with risk of developing type 2 diabetes (T2DM), and if this association differs by previous gestational diabetes (GDM) diagnosis.METHODS AND RESULTS: Dietary intake was assessed for 9689 women from the Australian Longitudinal Study on Women's Health in 2001 (aged 50-55) and 2013 (aged 62-67) via validated food frequency questionnaires. Average long-term carbohydrate restriction was assessed using a low-carbohydrate diet score (highest quartile (Q4) indicating lowest proportion of energy from carbohydrates). Incidence of T2DM between 2001 and 2016 was self-reported at 3-yearly surveys. Log-binomial regression was used to estimate relative risks (RR) and 95% CIs. During 15 years of follow-up, 959 women (9.9%) developed T2DM. Carbohydrate restriction was associated with T2DM after adjustment for sociodemographic factors, history of GDM diagnosis and physical activity (Q4 vs Q1: RR 1.27 [95% CI 1.10, 1.48]), and this was attenuated when additionally adjusted for BMI (1.10 [0.95, 1.27]). Carbohydrate restriction was associated with lower consumption of fruit, cereals and high-fibre bread, and lower intakes of these food groups were associated with higher T2DM risk. Associations did not differ by history of GDM (P for interaction >0.15).CONCLUSION: Carbohydrate restriction was associated with higher T2DM incidence in middle-aged women, regardless of GDM history. Health professionals should advise women to avoid LCDs that are low in fruit and grains, and to consume a diet in line with current dietary recommendations.</p
Quantifying the mediating effect of body mass index in the relationship between a Mediterranean diet and development of maternal pregnancy complications: Australian Longitudinal Study on Women’s Health
No full textBackground: The contribution of body mass index (BMI) to the observed associations between dietary patterns and risk of gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP) remains unclear. Objective: The objective of this study was to formally quantify the mediating effect of prepregnancy BMI in these associations. Design: Women (aged 25–30 y) participating in the Australian Longitudinal Study on Women’s Health were not pregnant at baseline in 2003 and reported ≥1 pregnancy up to 2012. GDM and HDP diagnoses were self-reported for each pregnancy and validated in a subset. A Mediterranean diet score was created by use of a baseline-validated food-frequency questionnaire and dichotomized to reflect low adherence (<25th percentile) and higher adherence (≥25th percentile). A causal inference framework for mediation analysis was used to estimate total, natural direct, and natural indirect effects of the prepregnancy Mediterranean diet on incident GDM and HDP and proportions mediated through prepregnancy BMI. Results: In 3378 women without a history of diabetes, 240 (7.1%) developed GDM. HDP was reported in 273 (8.6%) of 3167 women with no history of hypertension. Low adherence to the Mediterranean diet was associated with higher risk of GDM (OR: 1.35; 95% CI: 1.02, 1.60) and HDP (OR: 1.41; 95% CI: 1.18, 1.56), after adjustment for education, parity, polycystic ovary syndrome, energy intake, and physical activity. Proportions mediated through prepregnancy BMI (per 1-kg/m2 increase) were 32% and 22% for GDM and HDP, respectively. Conclusion: These findings suggest that prepregnancy BMI as a single mediator contributes substantially to the total effects of the prepregnancy Mediterranean diet on GDM and HDP risk
Preconception health and care policies, strategies and guidelines in the UK and Ireland: a scoping review
No full textBackground: preconception health has the potential to improve parental, pregnancy and infant outcomes. This scoping review aims to (1) provide an overview of the strategies, policies, guidelines, frameworks, and recommendations available in the UK and Ireland that address preconception health and care, identifying common approaches and health-influencing factors that are targeted; and (2) conduct an audit to explore the awareness and use of resources found in the scoping review amongst healthcare professionals, to validate and contextualise findings relevant to Northern Ireland.Methods: grey literature resources were identified through Google Advanced Search, NICE, OpenAire, ProQuest and relevant public health and government websites. Resources were included if published, reviewed, or updated between January 2011 and May 2022. Data were extracted into Excel and coded using NVivo. The review design included the involvement of the "Healthy Reproductive Years" Patient and Public Involvement and Engagement advisory panel.Results: the searches identified 273 resources, and a subsequent audit with healthcare professionals in Northern Ireland revealed five additional preconception health-related resources. A wide range of resource types were identified, and preconception health was often not the only focus of the resources reviewed. Resources proposed approaches to improve preconception health and care, such as the need for improved awareness and access to care, preconceptual counselling, multidisciplinary collaborations, and the adoption of a life-course approach. Many behavioural (e.g., folic acid intake, smoking), biomedical (e.g., mental and physical health conditions), and environmental and social (e.g., deprivation) factors were identified and addressed in the resources reviewed. In particular, pre-existing physical health conditions were frequently mentioned, with fewer resources addressing psychological factors and mental health. Overall, there was a greater focus on women's, rather than men's, behaviours.Conclusions: this scoping review synthesised existing resources available in the UK and Ireland to identify a wide range of common approaches and factors that influence preconception health and care. Efforts are needed to implement the identified resources (e.g., strategies, guidelines) to support people of childbearing age to access preconception care and optimise their preconception health.</p
Association between inflammatory potential of diet and risk of depression in middle-aged women: the Australian longitudinal study on women's health
Full text linkDietary factors and inflammation markers have been shown to play a role in the development of depression. However, there are very few studies that have explored the association between inflammatory potential of diet and risk of depression. In this study, we examined the association between the dietary inflammatory index (DII), which was developed specifically to measure the inflammatory potential of diet, and risk of depression in the middle-aged cohort of the Australian Longitudinal Study on Women's Health. A total of 6438 women with a mean age of 52·0 (sd 1·4) years at baseline were followed-up at five surveys over 12 years (2001-2013). Depression was defined as a score of ≥10 on the Center for Epidemiologic Studies Depression-10 scale. The DII score, a literature-derived, population-based dietary index that has been validated against several inflammatory markers, was computed on the basis of dietary intake assessed using a validated FFQ. Generalised estimating equations were used to estimate relative risk (RR) of depression according to DII score. Models were adjusted for energy intake, highest education completed, marital status, menopause status and symptoms, personal illness or injury, smoking status, physical activity, BMI and depression diagnosis or treatment. In total, 1156 women (18 %) had scores≥10 on the CESD scale over the course of 9 years. Women with the most anti-inflammatory diet had an approximately 20 % lower risk of developing depression compared with women with the most pro-inflammatory diet (RRDII quartile 1 v. 4: 0·81; 95 % CI 0·69, 0·96; P trend=0·03). These results suggest that an anti-inflammatory diet is associated with lower risk of depression in middle-aged Australian women
Quality of low-carbohydrate diets among Australian post-partum women: Cross-sectional analysis of a national population-based cohort study
No full textLow-carbohydrate diets (LCDs) are popular among people attempting weight loss and recommended for pregnant women with gestational diabetes (GDM), but they may increase health risks if nutritionally inadequate. We aimed to describe the dietary intake of post-partum women according to their relative carbohydrate intake, overall, and among women attempting weight loss or diagnosed with GDM in their recent pregnancy. This cross-sectional population-based cohort study included 2093 post-partum women aged 25-36 years who participated in the Australian Longitudinal Study on Women's Health. Dietary intake was assessed using a validated food frequency questionnaire. Relative carbohydrate intake was determined using a previously developed LCD score. Data were weighted to account for oversampling of women from rural/remote areas. More than half of women (n[weighted] = 1362, 66.3%) were trying to lose weight, and 4.6% (n[weighted]=88) had GDM in their recent pregnancy. Women with the lowest relative carbohydrate intake (LCD score quartile 4) consumed 36.8% of total energy intake from carbohydrates, and had a lower intake of refined grains, whole grains, fruit and fruit juice, and a higher intake of red and processed meat, compared with women with the highest relative carbohydrate intake (quartile 1). Different food groups, both healthy and unhealthy, were restricted depending on whether women were attempting weight loss and had recent GDM. These findings may reflect a lack of knowledge among post-partum women on carbohydrates and dietary guidelines. Health professionals may have an important role in providing advice and support for post-partum women who wish to restrict their carbohydrate intake, to ensure optimal diet quality.</p
Socioeconomic position, lifestyle factors and age at natural menopause: a systematic review and meta-analyses of studies across six continents
Full text linkAge at natural menopause (ANM) is considered a marker of biological ageing and is increasingly recognized as a sentinel for chronic disease risk in later life. Socioeconomic position (SEP) and lifestyle factors are thought to be associated with ANM.We performed a systematic review and meta-analyses to determine the overall mean ANM, and the effect of SEP and lifestyle factors on ANM by calculating the weighted mean difference (WMD) and pooling adjusted hazard ratios. We explored heterogeneity using meta-regression and also included unpublished findings from the Australian Longitudinal Study on Women's Health.We identified 46 studies across 24 countries. Mean ANM was 48.8 years [95% confidence interval (CI): 48.3, 49.2], with between-study heterogeneity partly explained by geographical region. ANM was lowest among African, Latin American, Asian and Middle Eastern countries and highest in Europe and Australia, followed by the USA. Education was associated with later ANM (WMD middle vs low education 0.30, 95% CI: 0.10, 0.51; high vs low education 0.64, 95% CI 0.26, 1.02). A similar dose-response relationship was also observed for occupation. Smoking was associated with a 1-year reduction of ANM (WMD: -0.91, 95% CI: -1.34, -0.48). Being overweight and moderate/high physical activity were modestly associated with later ANM, but findings were less conclusive.ANM varies across populations, partly due to differences across geographical regions. SEP and some lifestyle factors are associated with ANM, but further research is needed to examine the impact of the associations between risk factors and ANM on future health outcomes
Glycemic control and all-cause mortality risk in type 1 diabetes patients: the EURODIAB prospective complications study
No full textContext: Glycemic targets and the benefit of intensive glucose control are currently under debate because intensive glycemic control has been suggested to have negative effects on mortality risk in type 2 diabetes patients. Objective: We examined the association between glycated hemoglobin (HbA1c) and all-cause mortality in patients with type 1 diabetes mellitus. Design, Setting, and Patients: A clinic-based prospective cohort study was performed in 2764 European patients with type 1 diabetes aged 15–60 years enrolled in the EURODIAB Prospective Complications Study. Outcome Measure: Possible nonlinearity of the association between HbA1c and all-cause mortality was examined using multivariable restricted cubic spline regression using three (at HbA1c 5.6%, 8.1%, and 11.8%) and five knots (additionally at HbA1c 7.1% and 9.5%). Mortality data were collected approximately 7 years after baseline examination. Results: HbA1c was related to all-cause mortality in a nonlinear manner after adjustment for age and sex. All-cause mortality risk was increased at both low (5.6%) and high (11.8%) HbA1c compared with the reference (median HbA1c: 8.1%) following a U-shaped association [P overall effect = .008 and .04, P nonlinearity = .03 and .11 (three and five knots, respectively)]. Conclusions: Results from our study in type 1 diabetes patients suggest that target HbA1c below a certain threshold may not be appropriate in this population. We recognize that these low HbA1c levels may be related to anemia, renal insufficiency, infection, or other factors not available in our database. If our data are confirmed, the potential mechanisms underlying this increased mortality risk among those with low HbA1c will need further study
- …
