Unhealthy Lifestyle Choices Research Articles

Modelling the Impact of Chronic Cigarette Smoke Exposure in Obese Mice: Metabolic, Pulmonary, Intestinal, and Cardiac Issues.

Unhealthy lifestyle choices, such as bad eating behaviors and cigarette smoking, have major detrimental impacts on health. However, the inter-relations between obesity and smoking are still not fully understood. We thus developed an experimental model of high-fat diet-fed obese C57BL/6 male mice chronically exposed to cigarette smoke. Our study evaluated for the first time the resulting effects of the combined exposure to unhealthy diet and cigarette smoke on several metabolic, pulmonary, intestinal, and cardiac parameters. We showed that the chronic exposure to cigarette smoke modified the pattern of body fat distribution in favor of the visceral depots in obese mice, impaired the respiratory function, triggered pulmonary inflammation and emphysema, and was associated with gut microbiota dysbiosis, cardiac hypertrophy and myocardial fibrosis.

Diet and Neurocognition in Mood Disorders - An Overview of the Overlooked.

Bipolar disorder and major depression are associated with significant disability, morbidity, and reduced life expectancy. People with mood disorders have shown higher ratios of unhealthy lifestyle choices, including poor diet quality and suboptimal nutrition. Diet and nutrition impact on brain /mental health, but cognitive outcomes have been less researched in psychiatric disorders. Neurocognitive dysfunction is a major driver of social dysfunction and a therapeutic target in mood disorders, although effective cognitive-enhancers are currently lacking. This narrative review aimed to assess the potential cognitive benefits of dietary and nutritional interventions in subjects diagnosed with mood disorders. Eight clinical trials with nutrients were identified, whereas none involved dietary interventions. Efficacy to improve select cognitive deficits has been reported, but results are either preliminary or inconsistent. Methodological recommendations for future cognition trials in the field are advanced. Current evidence and future views are discussed from the perspectives of precision medicine, clinical staging, nutritional psychiatry, and the brain-gut-microbiota axis.

Risk factors for hepatocellular carcinoma (HCC) in the northeast of the United States: results of a case-control study.

HCC incidence has been continuously rising in the US for the past 30years. To understand the increase in HCC risk, we conducted a case-control study in Connecticut, New Jersey and part of New York City. Through rapid case ascertainment and random digit dialing, we recruited 673 incident HCC patients and 1,166 controls. Information on demographic and anthropometric characteristics, lifestyle factors, medical and family cancer histories, were ascertained through telephone interviews using a structured questionnaire. Saliva specimens were collected for testing hepatitis C virus (HCV) antibodies. Unconditional logistic regression models were utilized to calculate odds ratio (OR) and 95% confidence interval (CI) to determine HCC associations with risk factors. The study confirmed that HCV infection and obesity were important risk factors for HCC, ORs 110 (95% CI 59.2-204) and 2.13 (95% CI 1.52-3.00), respectively. High BMI and HCV infection had synergy in association with elevated HCC risk. Patients both obese and infected with HCV had HCC detected on average nearly 10years earlier than those with neither factor. Diabetes, cigarette smoking and heavy alcohol intake were all associated with increased risk of HCC, whereas aspirin and other NSAID use were associated with reduced risk. HCC cases tended to attain less education, with lower household incomes, unmarried, and to have had more sexual partners than the controls. Individuals at risk of HCC in the US comprise a unique population with low socioeconomic status and unhealthy lifestyle choices. Given the multifactorial nature, a comprehensive approach is needed in HCC prevention.

Vascular Endothelial Glycocalyx as a Mechanism of Vascular Endothelial Dysfunction and Atherosclerosis

Atherosclerosis occurs as a result of organized processes that include vascular endothelial dysfunction, lipid accumulation, abnormal inflammatory reaction, excessive reactive oxygen species production, and vascular cell proliferation and migration. In patients with atherosclerosis, vascular endothelial dysfunction is commonly observed with the damage of vascular endothelial glycocalyx, which is an extracellular matrix bound to and encapsulating the endothelial cells that line the blood vessel wall. Unhealthy lifestyle choices such as smoking and physical inactivity also induce glycocalyx degradation. Additionally, vascular endothelial glycocalyx can be damaged by various pathological conditions including dehydration, acute infectious disease, trauma, sepsis, acute respiratory distress syndrome, Kawasaki disease, preeclampsia, gestational diabetes mellitus, hypertension, diabetes mellitus, chronic kidney disease, atherosclerosis, stroke, dementia, microvascular angina, acute coronary syndrome, and heart failure. Vascular endothelial glycocalyx has been shown to be important as a physical cytoprotective barrier for vascular endothelial cells and as a regulatory mechanism for intracellular cell signaling. Therefore, vascular endothelial glycocalyx has immense potential in the exploration of novel strategies for the evaluation of beneficial conditions of healthy vasculature.

Human gastrointestinal (GI) tract microbiome-derived pro-inflammatory neurotoxins from Bacteroides fragilis: Effects of low fiber diets and environmental and lifestyle factors

Over the last decade, our understanding of the immense contribution of GI-tract microbiome to human physiology and host metabolic functions has increased dramatically, yet progress is limited by the sheer complexity and dynamics of these microbial communities [3,81]. Microorganisms of the human GI-tract microbiome are now generally appreciated as playing some critical role in the maintenance of health and the development of disease, however the complexity and diversity of this ‘dispersed organ system’, and commensal and symbiotic relationships with human host cells, particularly with host cells of the central nervous system (CNS) remains incompletely understood. Neurotoxins detrimental to the normal structure, function and signaling properties of brain cells: (i) may be acquired directly via naturally-occurring, plant growth- and plant yield-promoting factors or processed components of ingested foodstuffs; (ii) from the environment; (iii) from the individual lifestyles that we live; and also (iv) from the neurotoxic exudates derived from thousands of species of stressed GI-tract resident microbes. Diet, environment and lifestyle are inextricably linked when considering ‘hologenome’ aspects of a highly networked ‘metaorganism’ and metagenomics factors with the most recent findings that microbiome-derived neurotoxins can strongly contribute to human diseases from intestinal and systemic inflammation, to obesity to schizophrenia and to Alzheimer’s disease (AD) [21,27–33,37–40]. For example, in fiber-deprived diets which can be strongly impacted by environmental and lifestyle choices certain GI-tract abundant Gram negative bacilli such as B. fragilis appear to strongly proliferate, increasing both their potential and abundance for the synthesis and release of neurotoxins by mass action alone. Importantly, especially against a background of unwise and unhealthy environmental and lifestyle choices, some of the most potent neurotoxins known can be a significant and a continuous ‘life-long’ source from the diet, in part through an insufficient supply of dietary fiber and the maintenance, support and proliferation of dysbiotic microbes that maintain their persistent and continual residence in the human GI-tract microbiome.

Detecting Lifestyle Risk Factors for Chronic Kidney Disease With Comorbidities: Association Rule Mining Analysis of Web-Based Survey Data.

BackgroundThe rise in the number of patients with chronic kidney disease (CKD) and consequent end-stage renal disease necessitating renal replacement therapy has placed a significant strain on health care. The rate of progression of CKD is influenced by both modifiable and unmodifiable risk factors. Identification of modifiable risk factors, such as lifestyle choices, is vital in informing strategies toward renoprotection. Modification of unhealthy lifestyle choices lessens the risk of CKD progression and associated comorbidities, although the lifestyle risk factors and modification strategies may vary with different comorbidities (eg, diabetes, hypertension). However, there are limited studies on suitable lifestyle interventions for CKD patients with comorbidities.ObjectiveThe objectives of our study are to (1) identify the lifestyle risk factors for CKD with common comorbid chronic conditions using a US nationwide survey in combination with literature mining, and (2) demonstrate the potential effectiveness of association rule mining (ARM) analysis for the aforementioned task, which can be generalized for similar tasks associated with noncommunicable diseases (NCDs).MethodsWe applied ARM to identify lifestyle risk factors for CKD progression with comorbidities (cardiovascular disease, chronic pulmonary disease, rheumatoid arthritis, diabetes, and cancer) using questionnaire data for 450,000 participants collected from the Behavioral Risk Factor Surveillance System (BRFSS) 2017. The BRFSS is a Web-based resource, which includes demographic information, chronic health conditions, fruit and vegetable consumption, and sugar- or salt-related behavior. To enrich the BRFSS questionnaire, the Semantic MEDLINE Database was also mined to identify lifestyle risk factors.ResultsThe results suggest that lifestyle modification for CKD varies among different comorbidities. For example, the lifestyle modification of CKD with cardiovascular disease needs to focus on increasing aerobic capacity by improving muscle strength or functional ability. For CKD patients with chronic pulmonary disease or rheumatoid arthritis, lifestyle modification should be high dietary fiber intake and participation in moderate-intensity exercise. Meanwhile, the management of CKD patients with diabetes focuses on exercise and weight loss predominantly.ConclusionsWe have demonstrated the use of ARM to identify lifestyle risk factors for CKD with common comorbid chronic conditions using data from BRFSS 2017. Our methods can be generalized to advance chronic disease management with more focused and optimized lifestyle modification of NCDs.

Creating a Culture of Wellness: A Call to Action for Higher Education, Igniting Change in Academic Institutions

Background: Due to the continued rise of chronic conditions and unhealthy lifestyle choices, more innovative and evidence-based practices are needed for students, faculty and staff to improve population health outcomes and enhance overall well-being. Aim: The purpose of this paper is to inform academic health promotion professionals of key strategies to consider in order to create cultures of wellness on their college campuses. Methods: A review of the existing literature was conducted.Results: The most current evidence-based practices to create a culture of wellness are discussed. Conclusions:Institutions of higher education have an opportunity to create campus cultures that foster health and well-being. The time is now for enacting change to create, improve, or sustain cultures of wellness within campus communities.

Cardiac Stem Cell Therapy, Resident Progenitor Cells and the role of Cellular Signalling; a Review

Abstract Cardiovascular disease (CVD) remains the most common cause of death worldwide. Unhealthy lifestyle choices promote an upward trend of primary risk factors for CVD. As a result, novel methods of treatment are required. The myocardium itself could serve as a source of treatment, via resident cardiac progenitor cells (CPC). A brief overview of current studies and findings related to the potential of differentiation of CPCs to form mature cardiomyocytes (CM) and thereby heal damaged myocardial tissue, as well as implications of these findings for further research areas and possible treatments, is offered. Also investigated is the possible role of CM cell reprogramming, cardiac fibroblasts and signalling molecules in treatment of CVD. Running title: Cardiac stem cells - review

Superman vs. Nick O\u2019Teen: anti-smoking campaigns and children in 1980s Britain

In December 1980, the Health Education Council launched a campaign designed to discourage children from taking up smoking. Advertisements on TV and in comics and magazines featured a battle between Superman and the evil Nick O’Teen as he attempted to recruit children to his army of smokers. Children were also encouraged to join Superman in his fight by signing a pledge not to smoke, in return for which they received a poster and badges featuring the superhero. This article examines the design, production, delivery and reception of the Superman vs. Nick O’Teen campaign in order to probe the multi-faceted nature of the making of healthy publics in 1980s Britain. Children constituted a particularly problematic public. On the one hand, they were thought to be vulnerable and easily led towards unhealthy lifestyle choices. But on the other, children were also recognised as agents who might convince adults, as well as their peers not to smoke. This ambivalent conceptualisation of the child as a potential victim of malign influences, or potential rational agent and force for good, is typical of the 1980s, a time when the meanings of the child as consumer, agent, and citizen were undergoing increased ideological debate. This campaign also took place as ideas about health education, its place within public health policy and practice, and its relationship with the public, were in flux. The battle between Superman and Nick O’Teen was thus not just about smoking, but about particular ways of seeing and interacting with healthy (and unhealthy) publics.

Relations between transport choices and active behaviour

Unhealthy lifestyle choices and passive behaviour are a significant problem for many developed countries. They lead to a decrease in public health in the form of diseases related to contemporary civilization, such as: cardiovascular diseases, type II diabetes and obesity. This increases the costs generated in the healthcare system. The share of costs resulting from combating these diseases increases every year.The choice of a transport mode used when commuting is often perceived as one of the factors leading to more proactive behaviour and thus decreasing the externalities not only connected directly with transport such as pollution, noise, congestion and accidents, but also those connected with public health.The paper shows the results of a study performed in Poland, which was meant to identify and measure the relations between the transport choices and other proactive choices of commuters. A logistic regression model was estimated to identify the occurrence and intensity of these relations.
 The goal of the article is, therefore, to assess whether the choice of a transport mode used when commuting is connected with other types of proactive behaviour of citizens. In particular, the authorwishes to determine if people choosing a car as their mode of transport tend to be generally less active than people choosing public transport or those who commute actively.

Recent advances in novel therapies for lipid disorders.

The prevalence of lipid disorders is alarmingly increasing in the Western world. They are the result of either primary causes, such as unhealthy lifestyle choices or inherited risk factors, or secondary causes like other diseases or medication. Atypical changes in the synthesis, processing and catabolism of lipoprotein particles may lead to severe hypercholesterolemia, hypertriglyceridemia or elevated Lp(a). Although cholesterol-lowering drugs are the most prescribed medications, not all patients achieve guideline recommended cholesterol levels with the current treatment options, emphasising the need for new therapies. Also, some lipid disorders do not have any treatment options but rely only on stringent dietary restriction. Patients with untreated lipid disorders carry a severe risk of cardiovascular disease, diabetes, non-alcoholic fatty liver disease and pancreatitis among others. To achieve better treatment outcome, novel selective gene expression and epigenetic targeting therapies are constantly being developed. Therapeutic innovations employing targeted RNA technology utilise small interfering RNAs, antisense oligonucleotides, long non-coding RNAs and microRNAs to regulate target protein production whereas viral gene therapy provides functional therapeutic genes and CRISPR/Cas technology relies on gene editing and transcriptional regulation. In this review, we will discuss the latest advances in clinical trials for novel lipid-lowering therapies and potential new targets in pre-clinical phase.

Polygenic Prediction of Weight and Obesity Trajectories from Birth to Adulthood

Severe obesity is a rapidly growing global health threat. Although often attributed to unhealthy lifestyle choices or environmental factors, obesity is known to be heritable and highly polygenic; the majority of inherited susceptibility is related to the cumulative effect of many common DNA variants. Here we derive and validate a new polygenic predictor comprised of 2.1 million common variants to quantify this susceptibility and test this predictor in more than 300,000 individuals ranging from middle age to birth. Among middle-aged adults, we observe a 13-kg gradient in weight and a 25-fold gradient in risk of severe obesity across polygenic score deciles. In a longitudinal birth cohort, we note minimal differences in birthweight across score deciles, but a significant gradient emerged in early childhood and reached 12kg by 18 years of age. This new approach to quantify inherited susceptibility to obesity affords new opportunities for clinical prevention and mechanistic assessment.

Abstract P118: Serious Financial Difficulties Impact Subclinical Cardiovascular Disease Among Mexican Women

Introduction: Sudden loss of income has been previously associated to all-cause mortality. Diminished financial resources may result in reduced access to healthcare. On the other hand, the psychological stress associated with economic loss may also affect cardiovascular health through a combination of negative physiological changes and unhealthy lifestyle choices. Hypothesis: We hypothesize that serious financial difficulties will increase cardiovascular risk in Mexican women. Methods: We categorized 1,764 employed and insured disease-free women from the Mexican Teachers’ Cohort according to their response to ‘Have you ever had serious financial difficulties (for example, not enough money for food or place to live)?’ included in a self-reported instrument on life stressors conducted 2013 and 2016. On the same visit, carotid artery intima-media thickness (IMT) was measured by standardized neurologists on both carotid arteries through ultrasound following international guidelines and log transformed. We defined carotid atherosclerosis as an intima media thickness of ≥0.8mm in either of the carotid arteries or the presence of plaque. We collected data on cofounders (age, site, and socio-economic status calculated based on score of household assets), perceived stress (Perceived Stress Scale-10), and other potential intermediates (body mass index, smoking, hypercholesterolemia, hypertension, and diabetes). We used multivariable linear and logistic regression models to assess the association of serious financial difficulties, IMT, and carotid atherosclerosis. Results: The average age of the study population was 49.4 (SD±5.0) years and 312 (17.8%) women reported exposure to serious financial difficulties as adults. High levels of perceived stress (62.2% vs. 42.5%), obesity (42.0% vs. 36.2%), smoking (9.3% vs. 6.7%), hypercholesterolemia (33.3% vs. 31.7%), and diabetes (10.3% vs. 7.5%) were more common among women with serious financial difficulties relative to women without. Women with serious financial difficulties had 1.7% (95% CI 0.2, 3.3) higher mean IMT than women without after adjusting for potential confounders. The prevalence of carotid atherosclerosis was 26.6% in women who experienced serious financial difficulties and 20.9% in women without such exposure. The multivariable-adjusted odds ratio for carotid atherosclerosis among women with serious financial difficulties was 1.40 (95% CI 1.03, 1.90) relative to women without. Adjusting for potential intermediates did not alter the interpretation of our results. Conclusion: Serious financial difficulties were associated to subclinical cardiovascular disease among employed and insured Mexican women.

Homeobox Genes and Homeodomain Proteins: New Insights into Cardiac Development, Degeneration and Regeneration.

Cardiovascular diseases are the most common cause of human death in the developing world. Extensive evidence indicates that various toxic environmental factors and unhealthy lifestyle choices contribute to the risk, incidence and severity of cardiovascular diseases. Alterations in the genetic level of myocardium affects normal heart development and initiates pathological processes leading to various types of cardiac diseases. Homeobox genes are a large and highly specialized family of closely related genes that direct the formation of body structure, including cardiac development. Homeobox genes encode homeodomain proteins that function as transcription factors with characteristic structures that allow them to bind to DNA, regulate gene expression and subsequently control the proper physiological function of cells, tissues and organs. Mutations in homeobox genes are rare and usually lethal with evident alterations in cardiac function at or soon after the birth. Our understanding of homeobox gene family expression and function has expanded significantly during the recent years. However, the involvement of homeobox genes in the development of human and animal cardiac tissue requires further investigation. The phenotype of human congenital heart defects unveils only some aspects of human heart development. Therefore, mouse models are often used to gain a better understanding of human heart function, pathology and regeneration. In this review, we have focused on the role of homeobox genes in the development and pathology of human heart as potential tools for the future development of targeted regenerative strategies for various heart malfunctions.

Comprehensive cancer control: promoting survivor health and wellness.

As of 2016, an estimated 15.5million cancer survivors were living in the United States and the number of cancer survivors is expected to increase to 20.3million by 2026. Numerous clinical studies have shown that comorbidities, such as obesity and diabetes, and unhealthy lifestyle choices, such as physical inactivity and heavy smoking, negatively influence overall quality of life and long-term survival of cancer survivors. Accordingly, survivorship programs seek to focus on overall wellness, including symptom management, monitoring for late effects of treatment, monitoring for recurrence, helping patients adapt healthy behaviors, and quality of life. This paper provides a broad overview of public health efforts to address the needs of cancer survivors. To describe a range of examples of survivorship initiatives in comprehensive cancer control, we analyzed documents from comprehensive cancer control programs and coalitions and solicited detailed examples from several national partners. Comprehensive cancer control programs, coalitions, and partners are undertaking myriad initiatives to address cancer survivorship and building upon evidence-based interventions to promote healthy behaviors for cancer survivors across the country. A coordinated public health approach to caring for the growing population of cancer survivors can help address the long-term physical, psychosocial, and economic effects of cancer treatment on cancer survivors and their families.

Collaborative, individualised lifestyle interventions are acceptable to people with first episode psychosis; a qualitative study

BackgroundThe adverse impact of unhealthy lifestyle choices and the prescription of antipsychotic medications contribute to weight gain, poor cardiovascular health and reduced life expectancy for people with psychosis. The present study aimed to explore the acceptability and perceived outcomes of a lifestyle intervention designed to prevent or reduce weight gain in people with first-episode psychosis.MethodsThis was a qualitative study using a data-driven approach. People recovering from first-episode psychosis recruited from UK early intervention services and taking part in the active arm of a randomised controlled trial of a lifestyle intervention (the InterACT trial), were interviewed using a semi-structured interview schedule. Interviews were transcribed verbatim and analysed using Framework Analysis.ResultsParticipants valued the collaborative and individualised approach taken by the intervention deliverers, and formed high quality relationships with them. Aspects of the intervention that were positively appraised included goal setting, social opportunities, and progress monitoring. Benefits of the intervention, including increased levels of exercise; improved diet and physical health; increased psychological wellbeing (e.g. confidence, self-esteem); and improved social relationships, were identified by participants, independent of actual weight loss.ConclusionsFuture interventions should ensure that workers have the skills to form high quality relationships with users, and to individualise the intervention according to users’ needs and preferences. Future trials that test healthy living interventions should consider supplementing physical outcome measures with wider psychosocial outcome assessments, in particular social relationship quality, psychological wellbeing, self-esteem and self-efficacy.Trial registrationCurrent Controlled Trials: ISRCTN22581937. Date of registration: 27 October 2010 (retrospectively registered).

Depression and anxiety in axial spondyloarthritis

Abstract Axial spondyloarthritis (SpA) is a spectrum of chronic inflammatory rheumatologic diseases commonly presenting with symptoms of inflammatory back pain, peripheral joint pain, and fatigue. When compared to the general population, patients with SpA have higher prevalence of depression and anxiety symptoms. Poor psychological status is associated with worse disease activity, poorer functional status, poor treatment adherence, and unhealthy lifestyle choices such as cigarette smoking. The Chinese-bilingual Hospital Anxiety and Depression Scale (HADS) is a validated tool to screen depression and anxiety in patients with axial SpA. The cytokine theory of depression may explain emerging evidence on the mutually beneficial effects of antidepressants on disease outcomes and anti-tumor necrosis factor α (TNFα) therapy on psychological status.

O5.2. PREDICTORS OF CARDIOMETABOLIC RISK IN THE YEAR AFTER ONSET OF PSYCHOSIS: A PROSPECTIVE COHORT STUDY

BackgroundThe first episode of psychosis (FEP) is a critical time to prevent the onset of weight gain, cardiovascular and metabolic disease. However, little is known about the influence of patient characteristics and lifestyle on these outcomesMethodsWe conducted a prospective cohort study over 12 months of 294 people with FEP investigating the influence of lifestyle factors and medication on cardiometabolic outcomes over 12 months. Information on sociodemographics, lifestyle (physical activity (PA), sedentary behaviour (SB) nutrition, smoking), medication and service use and mental health symptoms was collected at baseline and after twelve months.ResultsThere were high rates of cardiometabolic abnormalities and unhealthy lifestyle choices on first presentation with psychosis, increasing over the subsequent 12 months. Obesity rates rose from 17.8% to 23.7% while the proportion with Hba1c levels >/= 39mmol/mol rose from 12% to 23.7%. White participants were more at risk of developing central obesity while there were highly clinically relevant increases in mean Hba1c in those of non-white ethnicity from 36.4 to 39.7mmol/mol. We found no association between lifestyle or medication with either baseline or 12-month cardiometabolic outcomes.DiscussionCardiometabolic risk factors and unhealthy lifestyle behavior are already prevalent in those with early psychosis and worsen in the year following first presentation, making this an important time for preventative strategies. We found no evidence however that such strategies should be preferentially directed towards those reporting less healthy lifestyle habits. Patterns of emergence of cardiometabolic risk over the first year of psychosis varied by ethnicity.

The effect of a health literacy approach to counselling on the lifestyle of women with gestational diabetes: A clinical trial

Background: Gestational diabetes is a common pregnancy disorder that affects the mother’s and neonate’s health. The present study was conducted to investigate the effect of a health literacy approach to counselling on the lifestyle of women with gestational diabetes. The present randomized controlled clinical trial was conducted in 2017 using a parallel design. The subjects included 84 eligible women presenting to Alborz and Kamali Hospitals, Karaj, Iran. Methods: Convenience sampling was first used to select the subjects. They were then assigned to an intervention or control group based on randomized blocks of four. Both groups attended counselling sessions. The mothers in the intervention group attended six sessions of counselling with a health literacy approach in addition to counselling on routine pregnancy care. The control group attended counselling sessions on safe pregnancy care and received a training package containing all the subjects discussed in the intervention group. The Lifestyle Questionnaire and the Iranian Health Literacy Questionnaire were completed by the mothers at the beginning and at the end of the sessions as well as three weeks after the sessions. The data obtained were analyzed in SPSS-19. Results: According to the study findings, the scores of lifestyle (P=0.8) and health literacy (P=0.423) showed no significant differences between the intervention and control groups before the intervention. Significant differences were, however, observed in the mean scores of lifestyle and health literacy between the two groups immediately and three weeks after the intervention. Comparing the means showed a higher increase in the mean scores in the intervention group (P<0.001). Conclusions: Providing counselling services by midwives can significantly help modify mothers’ unhealthy lifestyle choices and increase their health literacy; therefore, reducing maternal and neonatal consequences, especially in high-risk pregnancies. Trial registration number: IRCT2017021427728N3 Trial registry: Iranian Registry of Clinical Trials Trial registration date: 5th April 2017

The effect of a health literacy approach to counselling on the lifestyle of women with gestational diabetes: A clinical trial.

Background: Gestational diabetes is a common pregnancy disorder that affects the mother's and neonate's health. The present study was conducted to investigate the effect of a health literacy approach to counselling on the lifestyle of women with gestational diabetes. The present randomized controlled clinical trial was conducted in 2017 using a parallel design. The subjects included 84 eligible women presenting to Alborz and Kamali Hospitals, Karaj, Iran. Methods: Convenience sampling was first used to select the subjects. They were then assigned to an intervention or control group based on randomized blocks of four. Both groups attended counselling sessions. The mothers in the intervention group attended six sessions of counselling with a health literacy approach in addition to counselling on routine pregnancy care. The control group attended counselling sessions on safe pregnancy care and received a training package containing all the subjects discussed in the intervention group. The Lifestyle Questionnaire and the Iranian Health Literacy Questionnaire were completed by the mothers at the beginning and at the end of the sessions as well as three weeks after the sessions. The data obtained were analyzed in SPSS-19. Results: According to the study findings, the scores of lifestyle (P=0.8) and health literacy (P=0.423) showed no significant differences between the intervention and control groups before the intervention. Significant differences were, however, observed in the mean scores of lifestyle and health literacy between the two groups immediately and three weeks after the intervention. Comparing the means showed a higher increase in the mean scores in the intervention group (P<0.001). Conclusions: Providing counselling services by midwives can significantly help modify mothers' unhealthy lifestyle choices and increase their health literacy; therefore, reducing maternal and neonatal consequences, especially in high-risk pregnancies. Trial registration number: IRCT2017021427728N3 Trial registry: Iranian Registry of Clinical Trials Trial registration date: 5th April 2017.