BMJ Nutrition, Prevention and Health最新文献

Background and aim: Sustained lifestyle changes are crucial for the remission of type 2 diabetes (T2D) but remain challenging. Citizen initiatives using peer coaching and self-management may offer a promising alternative to professional medical care. This study evaluated Your Lifestyle As Medicine (YLAM), a Dutch citizen initiative for people with T2D. We aimed to assess its impact on metabolic parameters and to examine participants' engagement.

Methods: This observational study analysed self-reported data on weight, waist circumference, fasting glucose and glycated haemoglobin (HbA₁c) from participants in YLAM's online community. Participants could report their self-measured data on a weekly basis. Linear mixed-model analyses, stratified by sex, were used to assess changes in metabolic parameters over time. Additionally, we evaluated participants' engagement through reporting duration and weekly reporting rates.

Results: We assessed all 232 people with T2D who reported multiple measurements for at least 3 months. The median reporting duration was 11.2 months (IQR 4.6-26.5). Weekly reporting rates were 59% for weight, 55% for waist circumference and 52% for fasting glucose, and 12-weekly reporting rates were 49% for HbA₁c. Overall, mean weight, waist circumference, fasting glucose and HbA₁c improved in the first year in both women and men. More specifically, weight decreased by 7.2 kg in women (95% CI -7.6 to -6.8) and by 7.4 kg in men (95% CI -8.0 to -6.8). This represented a mean relative weight loss of 9.0% (SD 7.7) and 8.6% (SD 6.5), respectively. Waist circumference decreased by 8.9 cm in women (95% CI -9.4 to -8.5) and by 8.5 cm in men (95% CI -9.1 to -7.8). Fasting glucose decreased by 1.15 mmol/L in women (95% CI -1.32 to -0.98) and by 0.49 mmol/L in men (95% CI -0.75 to -0.23). HbA₁c decreased by 14.5 mmol/mol in women (95% CI -17.4 to -11.6) and by 9.1 mmol/mol in men (95% CI -13.2 to -5.0). Of all participants, 44% reported data for longer than a year and demonstrated sustained improvements in weight and waist circumference in the long term.

Conclusion: This study provides evidence for substantial and sustained improvements in self-reported metabolic parameters in people with T2D engaged in a citizen initiative without medical supervision. Initiatives like YLAM offer a promising, accessible and scalable strategy to address the growing burden of lifestyle-related diseases.

Introduction: Lactating mothers in low-income countries frequently experience low dietary diversity and inadequate vitamin A-rich food consumption. This can lead to micronutrient deficiencies, which increase the risk of intergenerational malnutrition and mortality. Regardless of this, there is limited research on dietary diversity and vitamin A-rich food consumption among lactating mothers in the study area.

Objective: To assess the prevalence of dietary diversity, adequate vitamin A-rich food consumption and associated factors among lactating mothers in Arba Minch Zuria district, Southern Ethiopia.

Study design: A community-based cross-sectional study design was employed.

Setting and participants: This study was conducted among 410 randomly selected lactating mothers from the Arba Minch Zuria district, Southern Ethiopia.

Primary and secondary outcomes: The data were collected by trained data collectors through a structured interviewer-administered questionnaire. Bivariate logistic regression was conducted to select candidate variables, and a multivariable logistic regression model was used to assess the association. A p value<0.05 with corresponding 95% CI was used to test statistical significance.

Results: The prevalence of minimum dietary diversity was 44.1% (95% CI 39.3% to 48.9%); family size (adjusted OR (AOR)=1.92; 95% CI 1.09 to 3.397), meal frequency (AOR 3.43, 95% CI 1.69 to 6.95), home gardening (AOR=3.56; 95% CI 1.99 to 6.37), postnatal care follow-up (AOR=2.73, 95% CI 1.54-4.837) and food security (AOR=2.067; 95% CI 1.237 to 3.45) were significantly associated with dietary diversity among lactating mothers. Adequate consumption of vitamin A-rich food was 24.6% (95% CI 20.5% to 28.9%); educational status (AOR=3.604; 95% CI 1.635 to 7.94), antenatal care follow-up (AOR=2.73; 95% CI 1.03 to 7.28) and home gardening (AOR=2.21; 95% CI 1.11 to 4.34) were significantly associated with it.

Conclusion: Nearly half of the lactating mothers in the study area achieved the minimum dietary diversity; family size, meal frequency, home gardening, postnatal care and food security were factors significantly associated. Almost one-fourth of the mothers consumed adequate vitamin A-rich food; educational status, antenatal care follow-up and home gardening were significantly associated with it.

Background: Pre-eclampsia remains a major global public health challenge, contributing significantly to maternal mortality and adverse birth outcomes. Despite progress in reducing maternal deaths in Ghana, pre-eclampsia continues to disproportionately impact maternal health. The diverse and poorly understood predictors of pre-eclampsia highlight the need for further research. This study aimed to assess the incidence and predictors of pre-eclampsia among pregnant women attending antenatal clinics at the 37 Military Hospital in Ghana.

Methods: A prospective cohort study was conducted with 288 pregnant women enrolled before their 12th week of gestation, selected through simple random sampling. Participants were interviewed once per trimester to collect data on dietary diversity, protein intake and fruit and vegetable consumption during pregnancy. Multiple logistic regression was used to identify associations between pre-eclampsia and maternal dietary intake, along with other factors, with statistical significance set at p<0.05.

Results: The incidence of pre-eclampsia was 19.5% (n=56), with most cases (95.8%, n=46) resolved before the third trimester. Higher intake of fruits and vegetables was associated with a modest increase in odds (adjusted ORs (aORs) 1.00; 95% CI 1.00 to 1.01). Adequate gestational weight gain was linked to higher odds (aOR 29.26; 95% CI 7.48 to 114.51). Maternal stress was a significant predictor of pre-eclampsia (aOR 10.95; 95% CI 1.10 to 109.37), while increased maternal education correlated with decreased odds (aOR 0.83; 95% CI 0.68 to 0.96). Younger maternal age, under 24 years (aOR 0.04; 95% CI 0.00 to 0.26) and between 25 and 34 years (aOR 0.23; 95% CI 0.05 to 0.98), was a protective factor compared with women aged 35 and older. No significant associations were found for dietary diversity (aOR 0.82; 95% CI 0.33 to 2.02), protein intake (aOR 1.00; 95% CI 0.99 to 1.01) or modified salt consumption (aOR 0.44; 95% CI 0.11 to 1.79).

Conclusion: This study reported a higher incidence of pre-eclampsia than previous research and identified maternal age, education, gestational weight gain, stress and fruit and vegetable intake as key risk factors. These findings highlight the need for targeted interventions to enhance maternal awareness, optimise prenatal care and reduce the risk of pre-eclampsia, ultimately improving pregnancy outcomes.

[This retracts the article DOI: 10.1136/bmjnph-2023-000823.].

Background: Vegetarianism is widely recognised for its health and environmental benefits. However, its broader impacts on physical, mental and social well-being remain underexplored. This study investigates the health and behavioural outcomes associated with vegetarianism across diverse populations.

Methods: We analysed polygenic scores for vegetarianism (VegPGS) in 495 971 UK Biobank participants and performed phenome-wide association studies (PheWAS) on 443 health and behavioural traits. Cross-validation analyses were conducted using data from 9009 vegetarians to 486 962 non-vegetarians. One-sample and two-sample Mendelian randomisation (MR) analyses explored causal relationships. Findings were further validated in 11 642 participants from the China Health and Nutrition Survey (CHNS). Additionally, machine-learning classification models were developed to predict vegetarian status using behavioural, physiological and genetic factors.

Findings: PheWAS identified 65 health-related and 2 behaviour-related factors significantly associated with VegPGS, with cross-validation confirming these links. MR analyses supported causal effects of vegetarianism on lower basal metabolic rate, reduced body mass index (BMI), decreased fat mass and lower risk of type 2 diabetes. CHNS data confirmed associations with lower BMI and diabetes risk in East Asian populations. Machine-learning models achieved high accuracy in predicting vegetarian status (area under the receiver operating characteristic curve=0.913±0.018, area under the precision-recall curve (PR-AUC)=0.40).

Interpretation: This study provides robust evidence supporting the metabolic health benefits of vegetarianism. The integration of multimodal genetic, behavioural and physiological data enhances understanding and prediction of dietary choices, offering valuable insights for policymakers and individuals considering a transition to plant-based diets to achieve sustainability.

Hypertension affects 10%-15% of pregnancies worldwide and can lead to serious adverse fetal and maternal outcomes. In addition, women with hypertension in pregnancy are at greater risk of developing stroke and renal disease later in life, while hypertensive pregnancy complications can also affect the long-term health of the child. The identification of strategies to maintain healthy blood pressure in women before and during pregnancy should therefore be prioritised. Emerging research points to an important role for folate, one-carbon metabolism and the related B vitamin, riboflavin, in blood pressure. In particular, evidence from clinical and genome-wide association studies links the C677T polymorphism in the gene encoding the folate-metabolising enzyme methylenetetrahydrofolate reductase (MTHFR) with blood pressure and an increased risk of hypertension and hypertensive disorders of pregnancy. Riboflavin (in the form of flavin adenine dinucleotide) is required as a cofactor for MTHFR, and notably, randomised trials show that supplemental riboflavin can effectively lower blood pressure specifically in individuals with the variant MTHFR 677TT genotype, independently of antihypertensive medications. The evidence that better riboflavin status modifies the blood pressure phenotype in these genetically at-risk individuals has important public health implications, especially for populations worldwide with the highest frequencies of the variant TT genotype in MTHFR, including Guatemala (up to 66%), Mexico (32%) and Northern China (20%). This novel gene-nutrient interaction warrants particular attention in the context of blood pressure before and during pregnancy. Furthermore, the biological mechanisms require investigation, whereby one-carbon metabolism is linked with blood pressure and how riboflavin, a much-overlooked nutrient in health and research settings, can modulate the excess genetic risk of hypertension in affected individuals. Here, we review the generally unrecognised role of riboflavin as a novel personalised solution to prevent hypertension and hypertensive disorders of pregnancy in genetically at-risk women. This article should stimulate current thinking, with potentially important impacts for public health nutrition strategies to promote better pregnancy outcomes in women.

Background: The serum uric acid to high-density lipoprotein cholesterol ratio (UHR) is a marker reflecting systemic inflammation and metabolic dysregulation. This study aimed to explore the association of UHR with all-cause and cause-specific mortality in a community-based Chinese cohort.

Methods: This study included 9448 participants from the community-based prospective cohort study conducted in Pudong New Area, Shanghai, China. We employed Cox proportional hazards regression to assess the associations between UHR quartiles and mortality risks. Nonlinear trends were examined through restricted cubic spline Cox regression, while bivariate exposure-response surface plots showed the joint effects of UHR and age. Model performance improvements were evaluated using C-index changes, integrated discrimination improvement and net reclassification improvement.

Results: During a median follow-up of 10.77 years, 987 deaths occurred. Compared with the lowest quartile (Q1), the highest UHR quartile (Q4) exhibited a 37% increased risk for all-cause mortality (HR=1.37, 95% CI: 1.14 to 1.65, p=0.001) and a 49% increased risk for cardiovascular mortality (HR=1.49, 95% CI: 1.10 to 2.00, p<0.01). The correlation between UHR and all-cause mortality risk exhibited an inverted L-shaped curve, whereas no significant nonlinear pattern was observed for cardiovascular mortality. Bivariate response analysis revealed a significant synergistic effect between UHR and age on all-cause mortality (p<0.05). The addition of UHR significantly improved the prediction performance of conventional models for all-cause and cardiovascular mortality.

Conclusions: Our findings establish UHR as an independent risk factor for all-cause and cardiovascular mortality, and the impact of UHR on all-cause mortality varies with age.