Weight Women Research Articles

Is estrogen plus progestin menopausal hormone therapy safe with respect to endometrial cancer risk?

Given the strong link between use of unopposed estrogens and development of endometrial cancers, estrogens are usually prescribed with a progestin, particularly for women with intact uteri. Some studies suggest that sequential use of progestins may increase risk; however, the moderating effects of usage patterns or patient characteristics, including body mass index (BMI), are unknown. We evaluated menopausal hormone use and incident endometrial cancer (n = 885) in 68,419 postmenopausal women with intact uteri enrolled in the National Institutes of Health-American Association of Retired Persons Diet and Health study. Participants completed a risk factor questionnaire in 1996-1997 and were followed up through 2006. Hazard rate ratios (RRs) and 95% confidence intervals (CIs) were estimated using Cox regression. Among 19,131 women reporting exclusive estrogen plus progestin use, 176 developed endometrial cancer (RR = 0.88; 95% CI = 0.74-1.06). Long-duration (≥ 10 years) sequential (<15 days progestin per month) estrogen plus progestin use was positively associated with risk (RR = 1.88; 95% CI = 1.36-2.60], whereas continuous (>25 days progestin per month) estrogen plus progestin use was associated with a decreased risk (RR = 0.64; 95% CI = 0.49-0.83). Increased risk for sequential estrogen plus progestin was seen only among thin-to-normal weight women (BMI < 25 kg/m(2); RR = 2.53). Our findings support that specific categories of estrogen plus progestin use increases endometrial cancer risk, specifically long durations of sequential progestins, whereas decreased endometrial cancer risk was observed for users of short-duration continuous progestins. Risks were highest among thin-to-normal weight women, presumably reflecting their lower endogenous estrogen levels, suggesting that menopausal hormones and obesity increase endometrial cancer through common etiologic pathways.

Specific role of maternal weight change in the first trimester of pregnancy on birth size

The specific role of weight change in the first weeks of gestation in fetal growth has not been fully explored in humans. Our aims were to investigate: (1) the specific association between weight change in the first trimester of pregnancy (WCT1) and size at birth in term pregnancies; and (2) the role of placental weight in this relationship. From 2002 women included in the French EDEN study, 1744 mother-child pairs reached term, had pre-pregnancy weight available and at least five measures of weight in pregnancy. We extrapolated women's weight at each week of gestation with a three-degree polynomial model and estimated weight change during each trimester of gestation. We used a multivariate linear model to investigate the associations between WCT1 and birth size after taking into account potential confounders (age, parity, BMI, tobacco use, educational level, length of gestation, newborn gender, weight change after the first trimester and centre of study). Then, we performed path analysis to investigate whether the relation between WCT1 and birth size could be mediated by placental weight. After taking into account weight gain in later gestation, WCT1 was positively associated with birthweight. Results of path analysis showed that there was no direct association between WCT1 and birth size, but that this association was mediated by placental weight. Weight change during the first weeks of pregnancy may impact on fetal growth independently of weight change later in pregnancy through its effects on placental growth and function.

Completion surgery after concomitant chemoradiation in obese women with locally advanced cervical cancer: Evaluation of toxicity and outcome measures

Background. This study aims at comparing the morbidity and oncologic outcomes in normal weight, overweight, and obese women with locally advanced cervical cancers (LACC) submitted to radical surgery after chemoradiation. Methods. A review of LACC patients with body mass index (BMI) ≥18.5 kg/m2 who underwent neoadjuvant chemoradiation followed by radical surgery between January 1996 and December 2010 was performed. BMI categories were created according to the World Health Organization (WHO) classification. Results. Two hundred sixty-eight women met the inclusion criteria: 118 (44.0%) were normal weight, 100 (37.3%) overweight and 50 (18.7%) obese. The median follow-up was 42 months. Higher BMI was associated with older age (p = 0.0041), while there were no differences among the three groups in Charlson comorbidity score, tumor characteristics, radiotherapy dosing, type of surgery, and pathological response. There were no differences among the three groups in the intraoperative and postoperative complications as well as rate of patients requiring adjuvant treatments: 21 (7.8%) patients experienced grade 3–4 toxicity, including six normal weight, 12 overweight and three obese patients (p = 0.14). Only the rate of grade 1–2 skin toxicity was higher in obese (14%) with respect to overweight (1%) and normal women (0%) (p = 0.00001). There were no differences in the five-year DFS (74%, 77%, and 84% for normal weight, overweight, and obese women, respectively, p = n.s.), and five-year OS (76%, 78%, and 78% for normal weight, overweight, and obese women, respectively, p = n.s.). Conclusions. The role of obesity should not be overestimated when evaluating the chance of enrolment of LACC patients into preoperative chemoradiation protocols.

PP156. High prevalence of pre-pregnancy overweight and obesity associated with maternal and perinatal complications

High prevalence of pre-pregnancy weight excess, as well as evidence of increased risk of maternal and perinatal complications associated with nutritional states have been observed lately. Considering the possible ethnic and environmental influences few studies have assessed this risk in pregnant Brazilian women. This study aimed at determining the prevalence of pre-pregnancy weight excess (overweight and obesity) and its association with maternal and perinatal complications in a Brazilian women population. We conducted a prospective cross-sectional study with 3,300 women who had birth care at the Asa Sul Regional Hospital of Brasília - Federal District (FD), from October 2009 to May 2010. Nutritional status was determined by body mass index (BMI), according to WHO criteria (2000): Low weight (BMI<18.5kg/m(2)), Normal weight (BMI between 18.5 and 24.9kg/m(2)), Weight excess (BMI⩾25kg/m(2)), Overweight (BMI between 25 and 29.9kg/m(2)) and obesity (BMI⩾30kg/m(2)). The outcome variables were: pre-clinical complications such as chronic hypertension and diabetes, manifestation of gestational hypertension/preeclampsia, pregnancy duration and resolution as well as perinatal outcomes. The association among these variables was assessed using chi-square (Pearson) and Fisher's exact test. Results were considered significant when p<0.05. In this population, weight excess before pregnancy had a prevalence of 27.2%, being 19.7% and 7.5% of pregnant women presenting, respectively, overweight and obesity. The prevalence of normal weight was 64.6% and low weight was 8.3%. Comparing the weight excess (BMI⩾25kg/m(2)) group with the normal weight group it was observed predominant hypertension (23% vs. 10%) and diabetes (10.1% vs. 3.6%), prolonged pregnancy (14.4% vs. 10.7%) and cesarean section rate (58.1% vs. 47.2%) in the weight excess group. Newborn weight equal to or greater than 4,000 g (9.5% vs. 4.5%) as well as fetal macrosomia (14.6% vs. 7.4%) also predominated in weight excess group. The comparison among the groups normal weight, overweight and obesity showed predominance of hypertension, diabetes cesarean section rate, newborns weight and fetal macrosomia in the obesity group. In the population analyzed, the prevalence of pre-pregnancy weight excess, particularly obesity, was high and associated with maternal and perinatal complications. Weight excess pre-pregnancy should be considered a risk to the pregnancy, demanding different obstetric care. Efforts should be made so that, in the pre-pregnancy period, women's weight can be as close to the normal weight as possible.

Influences on body weight of female Moroccan migrants in the Netherlands: A qualitative study

We aimed to gain insight into the influences on Moroccan migrant women's weight and weight-related behavior by enriching their perspectives with those of their non-migrant compatriots living in Morocco. In focus groups with migrant women in Amsterdam, participants attributed overweight to traditional Moroccan foods and food culture. In contrast, focus group participants in Morocco emphasized that overweight in migrants was largely due to their adoption of the Western diet. Results from women in both locations indicate a general lack of knowledge regarding appropriate physical activity. Migrants attributed their lower levels of physical activity to changes in lifestyle due to migration and reported having problems adjusting to these changes. All participants reported a cultural shift in preference towards slimmer body sizes. However, weight gain still tends to be seen as a sign of success. In designing interventions, universal approaches may be sufficient to address migration-related influences on behavior; however behavior that is driven by migrants' socio-cultural context may require more culturally appropriate strategies.

Are variations in gender equality evident in pornography? A cross-cultural study

In 1960, feminist groups and scholars published critiques of common “male-centric” views of sexuality. They analyzed pornography, traditions as to who initiates sexual encounters, the (non)existence of foreplay, and common (male dominant) sexual positions. Some even said such activities should be abolished (see Dworkin, 1985; Firestone, 1970; Solanas, 1971). Today, the appropriate role of sexuality, specifically the role of pornography in women's lives, probably sparks the biggest debate among feminists. The majority of research on pornography focuses on its misogynistic biases and maladaptive effects, while the minority of literature contends that pornography can be egalitarian and thus be empowering for women. There is little research to test these competing hypotheses as to the value of pornography for women.This paper was designed to investigate whether or not in societies where men and women are relatively equal in status versus unequal, different kinds of pornography flourishes. Three countries that differed markedly in the status of women (based on their United Nation's Gender Empowerment Measure (GEM) ranking published in the 2007/2008 Human Development Report) were selected for comparison: Norway (1), the United States (15), and Japan (54). We then compared the nature of their most popular pornography.An analysis of variance (ANOVA) was used to test the hypothesis that – consistent with their GEM ranking – popular Norwegian pornography would depict women in more empowered positions than pornography from the United States and Japan. Results supported this hypothesis. This finding could be attributed to the wider variety in Norwegian pornography, e.g. greater variation in the women's age, weight, and body positioning. There were no significant differences in the extent models in the three countries appeared in demeaning positions.

Stages of Change in the Trajectory of Postpartum Weight Self‐Management

To identify women's patterns of readiness to engage in weight self-management behaviors during the postpartum period. Prospective, longitudinal design with repeated measures, guided by the transtheoretical model of behavior change (TTM). A tertiary perinatal center in an urban setting in the midwestern United States with approximately 3,000 births annually. One hundred ninety-one (191) adult postpartum women. Participants were surveyed in person during their postpartum hospitalizations, and by telephone at 4 and 8 weeks postpartum using the Stages of Change for Weight Management (SOCWM) and the Decisional Balance for Weight Management (DBWM) tools. There was a significant effect of time on stage of change for women in the postpartum period, with women in a higher stage of change at 8 weeks than during the postpartum hospitalization. There were no significant differences in stage of change at any of the three time points by prepregnant weight category or by race. Nearly one half of the sample was in the contemplation stage during the postpartum hospitalization, and more than 80% were in action or maintenance stages by 8 weeks postpartum. The early postpartum period is an opportune time to influence stage of change in women's weight management behaviors. Assessment of readiness to engage in or continue weight management behaviors will allow providers to use stage-matched interventions guided by the TTM to facilitate women's self-management of weight.

A clinical decision rule to enhance targeted bone mineral density testing in healthy mid-life women

The rates of bone mineral density testing for osteoporosis among healthy mid-life women are high, although their osteoporosis or fracture risk is low. To reduce unnecessary testing, we created and evaluated a tool to guide bone density testing based on the woman's age, weight, fracture history, and menopausal status. This study aims to improve case finding of mid-life women with low bone mass on bone mineral density (BMD) assessment. Among healthy women aged 40-60 years having their first BMD test, osteoporosis risk factors were assessed by questionnaire and BMD by dual-energy X-ray absorptiometry. The combination of risk factors that best discriminated women with/without low bone mass (T-score ≤ -2.0) was determined from the logistic regression model area under the curve (AUC) and internally validated using bootstrapping. Using the model odds ratios, a clinical prediction rule was created and its discriminative properties assessed and compared with that of the osteoporosis self-assessment tool (OST). Sensitivity analyses examined results for pre-/peri- and post-menopausal women, separately. Of 1,664 women referred for baseline BMD testing, 433 with conditions known to be associated with bone loss were excluded. Of 1,231 eligible women, 944 (77%) participated and 87 (9.2%) had low bone mass (35 pre-/peri- and 52 post-menopausal). Four risk factors for low bone mass were identified and incorporated into a clinical prediction rule. Selecting women for BMD testing with weight of ≤70 kg or any two of age >51, years' post-menopause of ≥1, and history of fragility fracture after age 40 was associated with 93% sensitivity to identify women with low bone mass, compared with 47% sensitivity for an OST score of ≤1 (AUC 0.75 versus OST AUC 0.69, p = 0.04). Results restricted to post-menopausal women were similar. Among healthy mid-life women receiving a baseline BMD test, few had low bone mass, supporting the need for guidance about testing. A prediction rule with four risk factors had improved sensitivity over the OST. Further validation is warranted.

Impaired Fetal Growth and Low Plasma Volume in Adult Life

To estimate whether normotensive women who were born small for gestational age have low plasma volume in adult life, which is associated with later chronic hypertension. In 280 normotensive women with a history of hypertension in pregnancy, we recorded recalled gestational age and weight at birth and measured plasma volume (I-human serum albumin indicator dilution method). To correct for possible confounders, we recorded recent obstetric history and measured in each individual all constituents of the metabolic syndrome (World Health Organization criteria), sex hormones (progesterone and estradiol), renal function, and cardiac performance at rest (echocardiography). We estimated daily activity level with a validated questionnaire (Short Questionnaire to Assess Health-enhancing physical activity). We studied the relation between women's own birth weight centile and her adult plasma volume (mL) and adjusted for the effects of confounding variables using multiple linear regression analysis. Birth weight correlated positively with adult plasma volume (P<.001). Linear regression analysis demonstrated that each 10 centile change in birth weight is associated with an average change of 46.6 mL (95% confidence interval [CI] 30.8-62.3) in adult plasma volume. This association persisted after adjustment for confounding factors (current body surface area, mean arterial pressure, total vascular resistance, glomerular filtration rate, and a total 24 hours of sodium output). After adjustment, each 10 centile change in birth weight was associated with an average change of 32.1 mL (95% CI 19.6-44.6) in adult plasma volume. Birth centile contributes 14% to the variation in total adult plasma volume. Impaired fetal growth is associated with low plasma volume in adult life. II.

Preconception mental health predicts pregnancy complications and adverse birth outcomes: a national population-based study.

Pregnancy complications and poor birth outcomes can affect the survival and long-term health of children. The preconception period represents an opportunity to intervene and improve outcomes; however little is known about women's mental health prior to pregnancy as a predictor of such outcomes. We sought to determine if and to what extent women's preconception mental health status impacted subsequent pregnancy complications, non-live birth, and birth weight using a nationally representative, population-based sample. We used pooled 1996-2006 data from the nationally-representative Medical Expenditure Panel Survey (MEPS). Poor preconception mental health was defined as women's global mental health rating of "fair" or "poor" before conception. Logistic regression was used to assess the association between preconception mental health and pregnancy complications, non-live birth, and having a low birth weight baby within the follow up period. Poor preconception mental health was associated with increased odds of experiencing any pregnancy complication (AOR 1.40, 95% CI: 1.02-1.92), having a non-live birth (AOR 1.48, 95% CI: 0.96-2.27), and having a low birth weight baby (AOR 1.99, 95% CI: 1.00-3.98), all controlling for maternal age, race/ethnicity, marital status, education, health insurance status, income, and number of children in the household. Significant racial and ethnic disparities exist for pregnancy complications and non-live births, but not for low birth weight. Women's preconception mental health is a modifiable risk factor that stands to reduce the incidence of adverse pregnancy complications and birth outcomes.

An examination of dieting behaviors among adults: Links with depression

In the current study, we examined predictors of healthy and unhealthy dieting behaviors with the aim of examining whether or not weight control strategies are associated with depression. Men and women (N=198; M=24.80years; 51% women) were recruited from a university campus and its surrounding community in the northeastern US. Participants' height and weight were measured, and they completed a survey on health behaviors and attitudes. Results indicated that women and men with high BMIs were more likely to engage in both healthy and unhealthy dieting behaviors than those with low BMIs. Additionally, women with higher levels of depressive symptoms utilized fewer healthy dieting behaviors and more unhealthy dieting behaviors. Depression was not linked to healthy or unhealthy dieting behaviors in men. These findings are discussed in terms of the potential reciprocal relationship between women's unhealthy weight control strategies and depression.

Abstract P46: Misperception of Body Size and Barriers to Weight Loss among Families

Background: Misperception of body size and barriers to weight loss are prevalent in families at risk for cardiovascular disease. Methods: Women (n=111) and their pre-adolescent children (n=111) at an academic medical clinic were surveyed regarding socio-demographics, anthropometrics, weight loss attitudes, and body size perception. Results: The majority of women self-identified as Hispanic (79.3%), age 40±7 yrs. Children's age ranged from 7-13 yrs (10.5±1.3 yrs) with 51.4% girls. Among mothers, 65.8% were overweight (OW) or obese (OB), avg BMI 27.7 ± 5.1. Children's avg BMI percentile was 72.3%; 38.9% were OW or OB. OB women (81.8%) underestimated weight more than OW (42.5%) and normal weight (NW) women (13.2%) (p &lt; .0001). Analogous to mothers, 85.7% of OW or OB children underestimated weight vs 15.2% of NW children (p &lt; 0.0001). OB (97.0%) and OW (77.5%) women had more body dissatisfaction, the difference between self-perceived and ideal size, than NW women (42.1%) (p &lt; 0.0001); similarly, 77.8% of OB and 50.0% of OW children were dissatisfied vs 26.7% of NW children (p &lt; 0.0001). Overall, 55.7% of all women were attempting weight loss by improving eating habits (67.2%), exercising (40.3%), dieting (13.5%), medications (12.6%), and surgery (4.5%). Weight loss barriers included family responsibilities (27.0%), time (25.2%), money (11.7%), and employment (11.7%). OW and OB women were more likely to cite family responsibilities (34.3% vs 13.2%, p=0.018) and employment (16.4% vs 2.6%, p=0.03) then NW women. Almost half (46.3%) used nutrition labels “always” or “most of the time,” however 37.0% did not know daily caloric consumption. Women with ≤ 8 years education (73.3%) were less likely to know their caloric consumption compared to those with 9-12 years (42.9%) and &gt; 12 years (16.7%) (p=0.003). Conclusion: Misperception of body size is common among OW/OB women and children in this urban population. However, these women and children are also highly dissatisfied with their current body size, indicating some awareness and prompting more then half to attempt weight loss. Strategies to overcome the obesity epidemic should emphasize healthy body size goals and address barriers including family responsibilities, time, and lack of proper nutritional knowledge.

Abstract A79: Body shape throughout life, long-term weight cycling, and risk of multiple myeloma in the Nurses' Health Study

Abstract Background: Multiple myeloma (MM) is a lethal malignancy with a poorly understood etiology. Adult body mass index (BMI) is a recently identified risk factor for MM, but the etiologic roles of body fatness at different ages and adult weight cycling have not been assessed. We prospectively examined body shape during childhood, adolescence, and adulthood, as well as weight cycling over a 20-year period, in relation to MM risk in the Nurses' Health Study (NHS) cohort. Methods: The NHS was formed in 1976 among 121,700 female registered nurses ages 30–55 years from the United States who returned the enrollment questionnaire on lifestyle and medical history. Biennial follow-up questionnaires have subsequently updated lifestyle and medical information. A validated somatogram-depicted body shape (current and at ages 5, 10, 20, 30, and 40 years) was queried in 1988. The 1992 questionnaire characterized weight change over the prior 20 years (when most NHS participants were middle-aged adults). The present analyses included women who completed the 1988 (somatogram) or 1992 (weight cycling) questionnaires and had no cancer history at that time. Women were followed through the earliest among a cancer diagnosis, death, or June 2008. We classified body shapes as relatively lean, medium, and heavier at the specified ages and for the average shape at ages 5 and 10 (“childhood”) and ages 10 and 20 years (“adolescent”). We classified women's 20-year weight cycling patterns as weight loser/maintainer, gainer (i.e., only weight gain), light cycler (i.e., net loss or gain of ≥5 lbs. with ≥1 episode of voluntary 5–9 lb. change), or heavy cycler (i.e., net loss or gain of ≥5 lbs. with ≥1 episode of voluntary ≥20 lb. change). We computed hazard ratios (HR) and 95% confidence intervals (CI) in Cox proportional hazard models to assess the association of body shape and weight cycling with MM risk. Models included only one body shape or weight cycling variable and controlled for potential confounding by age and baseline BMI. Results: We confirmed 126 incident diagnoses of MM over 1,049,600 person-years for the somatogram analyses and 96 incident diagnoses of MM over 749,578 person-years for the weight cycling analyses. We observed suggestive increases in MM risk among women who reported heavier average body shapes in childhood (v. those with a relatively lean childhood shape; HR=1.8; 95% CI=0. 8–4.2) and adolescence (HR=1.6; CI=0.6–4.1). Body shape at specific ages and at baseline did not appear to predict MM risk. In the 20-year weight cycling analysis, we observed a suggested modest increase in MM risk among women who were weight gainers (HR=1.2; 95% CI=0.5–3.0) or light (HR=1.2; 95% CI=0.5–2.8) or heavy cyclers (HR=1.4; 95% CI=0.6–3.2) compared to those who lost weight or maintained stable weight. Discussion: These first prospective studies of body shape at various ages and long-term adult weight cycling are consistent with existing evidence that obesity is positively associated with risk of MM. Obesity in adulthood has consistently predicted an increased risk of MM in published studies and is thus a potentially modifiable risk factor for MM. Obesity at younger ages or an inability to maintain stable adult weight may be predictors of adult obesity, or may indicate an etiologic role for earlier life exposures in MM. Confirmation of the present findings in men and in other large populations is warranted, as are studies to explore potential biologic correlates of these lifestyle factors. If confirmed, these data would suggest that maintenance of a healthy weight from an early age, in addition to conferring other health benefits, may help to diminish risk of MM. Citation Information: Cancer Prev Res 2011;4(10 Suppl):A79.

Effect of Body Mass Index on Affect at Intensities Spanning the Ventilatory Threshold

The aim of this study was to compare acute affective responses at exercise intensities based on the ventilatory threshold between normal weight, overweight, and obese women. 66 sedentary women (22 in each Body Mass Index group) performed a maximal graded treadmill test to measure their maximal oxygen uptake and ventilatory thresholds. Affective valence was compared at intensities spanning the ventilatory threshold (below, at, and above threshold). Affective valence below ventilatory threshold did not differ among the Body Mass Index groups. The obese group had a lower affective response at ventilatory threshold and above ventilatory threshold than the normal weight and overweight groups; the latter two groups did not differ. The obese group had a lower affective response than the normal and overweight groups, which corresponds to a less pleasant experience. Exercise prescriptions for obese subjects targeting intensities below ventilatory threshold can provide a more pleasant experience and may facilitate exercise adherence.

Overweight Women Are More Susceptible to Hunger than Normal Weight Women

Overweight Women Are More Susceptible to Hunger than Normal Weight Women

Food-Related Environmental, Behavioral, and Personal Factors Associated with Body Mass Index among Urban, Low-Income African-American, American Indian, and Caucasian Women

To examine racial/ethnic differences in relationships between food-related environmental, behavioral and personal factors and low-income women's weight status using Social Cognitive Theory (SCT) as a framework. Cross-sectional survey. Community sites and low-income housing developments in the Twin Cities metropolitan area. Low-income African-American, American Indian, and Caucasian women ≥18 years old (n = 367). Participants completed a survey including demographic, food security, and theoretically based questions. Heights and weights were measured to determine body mass index (BMI). Data were split by race/ethnicity and reduced by examining Pearson coefficients for SCT survey questions significantly correlated with BMI (p < .05). Separate environmental, behavioral, and personal multiple linear regression models for each racial/ethnic group were run to explore the proportion of variance in BMI explained by each SCT construct and which questions were significant predictors. All regression models were statistically significant, although the personal regression models predicted the greatest proportion of the variance in BMI for African-American (15% of the variance), American Indian (22% of the variance), and Caucasian women (37% of the variance). Effective nutrition education and intervention efforts to control the obesity epidemic among urban, low-income women may call for a tailored approach with noted consideration of their racial/ethnic identity. Although broader changes to the food environment are necessary, the importance of addressing personal factors such as nutrition knowledge, self-efficacy, and emotional coping responses to stress, in the context of income constraints, food insecurity, and health beliefs, is also implicated.

Testing the integrated theory of health behaviour change for postpartum weight management.

This is a report of a correlational study to test the Integrated Theory of Health Behaviour Change within the context of postpartum weight self-management including the impact of race/ethnicity and weight classification. Women experiencing childbirth face increasing challenges to manage their weight postpartum. Little is known about women's weight self-management during the complex physiological and psychosocial transition of the postpartum period. Data were collected during the birth hospitalization and 4 months postbirth during 2005 and 2006. A quota sample of 250 postpartum women using two strata, race/ethnicity and prepregnant weight classification, were enrolled; 179 women completed the follow-up survey. A survey questionnaire measured concepts from the Integrated Theory of Health Behaviour Change concepts, including knowledge and beliefs (self-efficacy, outcome expectancy and goal congruence), self-regulation skills and abilities, and social facilitation (social support and social influence) and the proximal outcome of weight retention. Factor analysis identified 5 factors consistent with the theoretical concepts that accounted for 47·1% of total survey variance. Model testing using path analysis explored the relationship among factors. The final model explained 25·7% of the variance in self regulation at 4 months, but did not explain weight retention. The contribution of select concepts to total variance was different for Caucasian and African American women, but not by weight classification. Findings support use of theoretical concepts and relationships to understand postpartum weight self-management. The different relationships among concepts in Caucasian and African American women should be considered in planning targeted postpartum weight self-management interventions.

20-Year Trends in Filipino Women's Weight Reflect Substantial Secular and Age Effects

Increasing obesity in low- and middle-income countries is well documented in cross-sectional studies. However, few longitudinal studies identify factors that influence individual weight gain patterns over time in relation to the major social and economic changes that now characterize these settings. This study uses data from adult Filipino women participating in the Cebu Longitudinal Health and Nutrition Survey from 1983 to 2005. A sample of 3005 women contributed 1–8 observations each. Longitudinal mixed effects models identified how age and secular weight trends related to underlying effects of urbanization and changing household socioeconomic status (SES) and to proximate individual effects of reproductive history, diet, and occupational physical activity. The 23-y secular trend in weight amounted to nearly 10 kg. Younger women gained more weight than older women (12.4 kg in those < 20 y old in 1983 vs. 4.9 kg in those > 35 y). Periods of more rapid weight gain corresponded to periods of rapid increase in SES and urbanization. Weight was positively related to energy intake, percentage of calories from protein, and more sedentary occupations, but negatively related to months pregnant and lactating and postmenopausal status. These effects all varied with age and over time. The trends contributed to a 6-fold increase in prevalence of overweight and an increasing number of women who have or are likely to develop obesity-related metabolic diseases. The trends are highly relevant for health policy and preventive health measures in the Philippines and other countries now facing the dual burden of over- and undernutrition.

Predictors and Health Consequences of Epigenetic Changes Associated with Excess Body Weight in Women of Child-bearing Age

Abstract Background: Epigenetic alterations occurring during pregnancy have recently emerged as important factors for developmental programming of the fetus leading to obesity-related diseases in children. However, the role of excess body weight (EBW) in the modification of epigenetic patterns or its health consequences during child-bearing age is largely unknown. Because a lower degree of DNA methylation of long interspersed nucleotide element-1 (LINE-1) in PBMCs was shown to be associated with a higher risk of developing obesity-related diseases, for example cancer, the purpose of this study was to (1) evaluate the influence of indicators of obesity (BMI, WC, and % body fat) on PBMC LINE-1 methylation, (2) determine the predictors of PBMC LINE-1 methylation, and (3) determine the influence of PBMC LINE-1 methylation on biomarkers of obesity-related diseases. Methods: The study population consisted of 470 child-bearing age women. We quantified the degree of PBMC LINE-1 methylation by pyrosequencing. Folate concentrations were measured using a microbiological assay. The degree of LINE-1 methylation (&amp;gt; median vs. ≤ median) was the dependent variable in logistic models that specified BMI (&amp;gt;25 vs. ≤ 25), WC (&amp;gt;88 cm vs. ≤ 88 cm), or % body fat (&amp;gt;33% vs. ≤ 33%) separately as the independent predictors of primary interest, adjusting for other relevant variables. The predictors and determinants of lower LINE-1 methylation were evaluated among women with EBW. Results: Women with higher BMI, WC, or % body fat were 2.0, 1.9, and 1.8 times more likely to have lower LINE-1 methylation, respectively (P = 0.003, 0.005, and 0.01). The predictors and determinants of lower LINE-1 methylation yielded similar patterns with all three indicators of obesity. The following results are based on models run with BMI as the indicator for EBW. Women with higher plasma folate concentrations were less likely to have lower LINE-1 methylation (OR = 0.54, P = 0.0009). Higher LINE-1 methylation was associated with lower insulin resistance as indicated by HOMA (OR = 0.50, P = 0.02). Conclusions: EBW-associated lower LINE-1 methylation in women of child-bearing age appears to have significant, and potentially transgenerational, health consequences. Higher folate status may exert beneficial effects on obesity-related health outcomes.

Influence of Psychosocial Factors on Postpartum Weight Retention

For some women, pregnancy may increase the risk of future obesity with consequences for health and well-being. Psychosocial factors may be partly responsible for this. The aim of this study was to examine the association between psychosocial factors during pregnancy and postpartum weight retention (PPWR) at 6 and 18 months. A total of 37,127 women in The Danish National Birth Cohort (DNBC; 1996-2002) participated in four telephone interviews before and after delivery. They gave information about their experience of distress, depression and anxiety, social support, and psychosocial burdens during pregnancy. PPWR was defined as retention ≥ 5 kg at 6 and 18 months postpartum according to a woman's prepregnancy weight. The associations were examined by use of logistic regression and presented as odds radios with 95% confidence intervals. Women who were more likely to feel depressed/anxious or distressed during pregnancy had a higher risk of PPWR at 6 months (1.35 (1.27; 1.44) and 1.30 (1.22; 1.38)) and 18 months (1.34 (1.24; 1.45) and 1.32 (1.23; 1.42)). Likewise, women who felt burdened by their economy or working situation had a higher risk of PPWR as did women with the lowest incomes or less education. Women who reported a high level of distress or depression/anxiety both during pregnancy and in the first 6 months of motherhood had the highest risk of PPWR 18 months postpartum (1.54 (1.39; 1.71) and 1.49 (1.32; 1.69), respectively). Feeling distressed, depressed, or anxious during pregnancy was associated with higher PPWR as was personal and economical burdens. Adverse psychosocial characteristics may be a common determinant of weight retention after childbirth.