Browsing by Subject "Low-income women"
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Item Development of a risk scale for postpartum weight retention(2003-05) Milani, Tracey Joy; Freeland-Graves, Jeanne H.The purpose of this research was to develop and va lidate a Risk Scale for Postpartum Weight Retention in low-income tri-ethnic women. In Study I, the scale was created in 187 subjects given six questionnaires and monitored for weight from 0 - 6 months postpartum. There were a total of 263 items derived from the questionnaires and 39 were related to weight change at 6 months postpartum (r = -0.20 to 0.61, p < 0.005). Expert review and exploratory multivariate analyses were used to reduce the questionnaire to six items that included weights, fat habits, weight control practices and self-esteem. Weight change was calculated as weight in kilograms retained from prepregnancy to 6 months postpartum. An initial method of evaluation, multiple regression, accounted for 45.8% of the variance in weight change (p < 0.001). A simpler method for clinicians, a ROC curve, discriminated between women who retained < 10 kg prepregnancy weight vs >̲ 10 kg. Area under the curve was 0.87; sensitivity was 76% and specificity, 80%. In Study II, validity was determined in a sample of 75 women who visited health clinics at 1.5 and 6 months postpartum. The risk scale and a demographic questionnaire were administered at 1.5 months postpartum; weight and waist circumference were measured at 1.5 and 6 months after delivering a child. When cross-validated in this sample, multiple regression explained 35.7% of the variance in weight. The ROC curve classified 81% of subjects into correct weight categories, with sensitivity of 65% and specificity, 89%, (p < 0.001). To enhance the predictive ability and reliability of the risk scale, weight at 1.5 months was replaced by waist circumference at 1.5 months postpartum. In the revised scale, multiple regression explained 41.5% of the variance in weight retention (p < 0.001). The updated ROC curve had an area under the curve of 0.83; with a sensitivity and specificity of 65 and 92%, respectively (p < 0.01). These results indicate that the risk scale is a valid measure of postpartum weight retention, using either complex multiple regression or simpler ROC methods. Additionally, waist circumference greatly increases its predictive power in Study II.Item Diet and related behaviors of low-income, overweight women in early postpartum(2009-05) Shah, Bijal Sanghani; Freeland-Graves, Jeanne H.The purpose of this study was to determine the influence of diet and physical activity behaviors on weight status and lipid profiles in low-income women in early postpartum. In addition, the relationship of nutrition knowledge with dietary intakes was evaluated. A convenience sample of low-income mothers was recruited from public health clinics, community centers, and doctor's offices. Inclusion criteria was Hispanic, African American, or Caucasian ethnicity; body mass index (BMI) [greater-than or equal to] 25 kg/m², low-income (annual household income <185% federal poverty line); parity<3 and ability to speak and write English. Demographic, dietary (24-hr recalls and 2 day food intake recalls), psychosocial, anthropometric, serum lipids (LDL, HDL and total cholesterol and triglycerides) and physical activity (pedometer steps) data were collected. For study 1, the Healthy Eating Index-2005 (HEI-2005) scores were computed as a measure of diet quality in a sample of 125 women. Analysis of Covariance and linear regression was performed to determine the relationship between HEI-2005 and serum lipids. The mean total index score of the sample was 51.4 and was associated inversely with BMI ([beta]=-0.117), LDL ([beta]=-.659) and total ([beta]=-.690) and positively with HDL ([beta]=.216) (P<0.05). Less than 20% of the sample failed to meet the recommendations for fruits, total vegetables, whole grains and oil and 60% had overconsumption of solid fats, alcohol and added sugars. In study 2, snacking frequency and choices of 134 postpartum women were evaluated. Influence of snacking frequency on HEI-2005 scores and disparities in snack choices by BMI categories was assessed by performing ANCOVA. A majority of the sample (82%) consumed snacks and the most favored snack group was sweets and desserts. Increase in snacking frequency was associated with higher mean total HEI-2005 scores, and total fruit, dark green vegetables and legumes, total grains, and saturated fat (P<0.05) component scores when adjusted for energy intakes. Snacking frequency was also associated with higher intakes of protein, vitamins A and C, and calcium (P<0.05). In study 3, 66 new mothers participated and completed an 8-week weight loss intervention promoting exercise by using pedometers. Paired t test revealed improvement in physical activity after intervention. Linear regression analysis determined the ability of pedometer steps to predict weight loss ([beta]=0.465), % body fat ([beta]=-0.316), triglycerides ([beta]=-0.549), LDL ([beta]=-0.391) and total cholesterol ([beta]=-0.418). In study 4, a nutrition knowledge scale was developed and validated in new mothers. Knowledge was associated with greater consumption of grains, low fat meats and dairy (P<0.01), fiber (p<0.01), calcium (p<0.001), and iron (p<0.05). Participants appeared to be more cognizant of information about vitamins and minerals and weight management and less of energy nutrients and calorie counting. Hierarchical regression model identified age, education, ethnicity and income as determinants of knowledge.Item Dietary behavior in low income postpartum women : psychosocial and body weight correlates(2004-05) George, Goldy Chacko, 1973-; Freeland-Graves, Jeanne H.The purpose of this research was to examine psychosocial and body weight correlates of dietary behavior in low-income tri-ethnic women. In Study 1, a semi-quantitative food frequency questionnaire (FFQ) was developed and validated against diet records in 95 college women and 50 low-income postpartum women. Pearson's correlations were 0.42 among college women and 0.45 among low-income women. Cross-classification of participants into quartiles resulted in 76% of college women and 79% of low-income women being classified correctly. These results suggested that the FFQ was valid for dietary assessment among young women in the southwestern United States. In Study 2, approximately 160 mothers were recruited in the hospital 0-1 days following childbirth, and prepregnancy weight and demographic information were obtained. Weight was measured at 6 months and 1 year postpartum; psychosocial factors were assessed at 1 year. Diet during pregnancy and postpartum was assessed via food frequency questionnaires administered at 1.5 months, and at 6 and 12 months postpartum, respectively. From pregnancy to postpartum, % calories from fat (delta = +1.1%, p<0.05) and added sugar (delta = +2.0%, p<0.05) increased. A greater percentage of lactating than non-lactating women (64% vs. 38%, p<0.05) met recommendations for fruits during pregnancy. Mean intakes of calcium, vitamin A and dairy foods were higher in women who had retained <10% of their prepregnancy weight at 1 year postpartum than in those who had gained [greater-than or equal to] 10%. During late postpartum, women in the highest tertile of compliance with dietary recommendations had a more positive body image (p<0.041) than those in the lowest tertile, and less neglect of self-care (p<0.001), weight-related distress (p<0.006), stress (p<0.009), depressive symptoms (p<0.020), and perceived barriers to weight loss (p<0.039). These findings suggest that the transition from pregnancy to postpartum is associated with a negative impact on dietary behavior in low-income women. Intakes of calcium, vitamin A and dairy foods may be associated with lower weight retention in postpartum. Furthermore, psychosocial variables may influence adherence to dietary guidelines during this time.Item Nutrition knowledge, attitudes, and diet associated with postpartum weight retention in low-income and minority women(2006-05) Nuss, Henry Joseph; Freeland-Graves, Jeanne H.The purpose of this research was to discern associations of nutrition knowledge, attitudes, and diet with postpartum weight retention 1 year following childbirth. Subjects for this research were low-income, Hispanic, non-Hispanic black, and non-Hispanic white women recruited in a hospital 0 -- 1 day postpartum. In study 1, a nutrition attitudes scale was developed and validated in 134 low-income women at 1.5 months post-delivery. The final scale was administered to a second group of 206 women at 1.5, 6 and 12 months postpartum. Attitudes at each time were compared to demographics and weight status. Obese women at 1 year had higher barriers to healthful eating subscale averages than normal and overweight subjects at 1.5 and 6 months, and overweight participants at 12 months. Obese individuals also had greater emotional eating subscale scores than both normal and overweight subjects at 12 months. In study 2, a test of general nutrition knowledge was developed and validated in a sample of 151 women at 1 day post-delivery. The validated instrument was then administered to a test sample of 140 women at 0 and 12 months postpartum. Body weights were measured at 1.5, 6, and 12 months and height 1.5 months. Women with < 5% weight retention at 1 year had greater knowledge at 0 (53% vs.49%, p<0.05) and 12 months (55% vs. 51%, p <0.05) than those with >̲5%. Women who lactated >̲ 6 months had more knowledge than those who lactated < 6 months. In study 3, 182 women visited the research site at 1.5, 3, 6, and 12 months postpartum where dietary data were collected via one 24-hour recall and 2 days of diet records. Weight status was measured during each clinic visit; height was measured at 1.5 months. At 1 year postpartum, obese women had a greater percentage of energy from carbohydrates than their normal weight counterparts (52.5 % vs. 49.6%, p<0.05). Less than half of the population met the recommendations for folate, calcium, magnesium, and vitamins B6, D, E and C at all time points, regardless of ethnicity, BMI and lactation status.