Digital Commons Network^™

Blood Pressure Self-Monitoring In Pregnancy: Examining Feasibility In A Prospective Cohort Study, Katherine L. Tucker, Kathryn S. Taylor, Carole Crawford, James A. Hodgkinson, Clare Bankhead, Tricia Carver, Elizabeth Ewers, Margaret Glogowska, Sheila M. Greenfield, Lucy Annang Ingram Phd, Lisa Hinton, Khalid S. Khan, Louise Locock, Lucy Mackillop, Christine Mccourt, Alexander M. Pirie, Richard Stevens, Richard J. Mcmanus

Faculty Publications

BACKGROUND: Raised blood pressure (BP) affects approximately 10% of pregnancies worldwide, and a high proportion of affected women develop pre-eclampsia. This study aimed to evaluate the feasibility of self-monitoring of BP in pregnancy in women at higher risk of pre-eclampsia. METHODS: This prospective cohort study of self-monitoring BP in pregnancy was carried out in two hospital trusts in Birmingham and Oxford and thirteen primary care practices in Oxfordshire. Eligible women were those defined by the UK National Institute for Health and Care Excellence (NICE) guidelines as at higher risk of pre-eclampsia. A total of 201 participants were recruited between 12 …

Evaluation Of A Health Education Intervention To Improve Knowledge, Skills, Behavioral Intentions And Resources Associated With Preventable Determinants Of Infant Mortality, Danielle Fastring, Susan Mayfield-Johnson, Janna Madison

Faculty Publications

Mississippi has the highest rate of infant mortality in the nation (9.3 infant deaths for 1,000 live births). A health disparity exists between white infants (6.2) and black infants (13.0). This project reports on the effectiveness of a pilot educational program, Healthy Moms and Healthy Babies, which sought to improve knowledge, skills, behavioral intentions and resources related to preventable determinants of infant mortality. A curriculum was developed and piloted with women who were currently pregnant, thinking of becoming pregnant or who had an infant

Introduction Of Iodised Salt Benefits Infants’ Mental Development In A Community-Based Cluster-Randomised Effectiveness Trial In Ethiopia, Karim Bougma, Frances E. Aboud, Tizita M. Lemma, Edward A. Frongillo Jr., Grace S. Marquis

Faculty Publications

The effectiveness of salt iodisation in improving the mental development of young children has not been assessed. We implemented a community-based cluster-randomised effectiveness trial in sixty randomly selected districts in the Amhara region of Ethiopia. We randomly allocated each district to treatment and randomly selected one of its villages. In parallel to national salt iodisation efforts, iodised salt was brought early into the markets of the thirty intervention villages before it became widely available in the thirty control villages 4–6 months later. The primary outcome was children’s mental development scores on the Bayley Scales. This was an intention-to-treat analysis using …

Examining The Relationship Between Park Neighborhoods, Features, Cleanliness, And Condition With Observed Weekday Park Usage And Physical Activity: A Case Study, Kerry Hamilton, Andrew T. Kaczynski, Melissa L. Fair, Lucie Levesque

Faculty Publications

Background. Little research has comprehensively explored how park features, quality indicators, and neighborhood environments are associated with observed park usage and physical activity (PA). This case study examined whether weekday park usage and PA differ by neighborhood type, across numerous categories of park features, and according to park feature condition and cleanliness. Methods. Direct observation was used to capture the number of users and PA levels within 143 park features in 6 parks (3 urban, 3 suburban) over the course of six weeks. Audits of park environments assessed the type, condition, and cleanliness of all features and amenities. …

The Association Between Gastro-Oesophageal Reflux Disease And Subsequent Rheumatoid Arthritis Occurrence: A Nested Case–Control Study From Taiwan, Herng-Ching Lin, Sudha Xirasagar, Cha-Ze Lee, Chung-Chien Huang, Chao-Hung Chen

Faculty Publications

Objective Gastro-oesophageal reflux disease (GORD) is a common comorbidity among patients with rheumatoid arthritis (RA). While GORD has been attributed to the antirheumatic medications, no studies of human cohorts have investigated a link between GORD and RA. This study investigates whether GORD is associated with a subsequent RA diagnosis over a 5-year follow-up using a population-based dataset.

Setting Taiwan

Participants We used data from the Taiwan Longitudinal Health Insurance Database. The study group consisted of 13 645 patients with an ambulatory claim showing a GORD diagnosis. We used propensity score matching to select 13 645 comparison patients (one per study …

Are Our Policymakers On Board? A Systematic Review Of U.S. Policymakers’ Views On The Social Determinants Of Health, Health Disparities, Health Equity, & Health In All Policies, M. Lelinneth B. Novilla, Michael C. Goates, Spencer Calder, Laura A. Galvao, Tabetha Ellis, Kraymer Eppich, Noyra Melissa Quintana, David Mateos, Russell Doria

Faculty Publications

BACKGROUND: Policies shape our society and influence our health. Poor social policies and bad politics create a collective social milieu that result in health inequities. Closing the health gap in our communities will require tackling these root causes. But how are U.S. policymakers addressing the social conditions that negatively influence health?

OBJECTIVE: Identify the social determinants of health perceived as legislative priorities by U.S. policymakers and the factors that facilitate/hinder their intent to act on the social determinants of health.

METHODS: A systematic review of 1,832 newspaper, magazine, and journal articles published between January 2000 and July 2016 yielded 202 …

Hospitalization Rates And Predictors Of Rehospitalization Among Individuals With Advanced Cancer In The Year After Diagnosis, Robin Whitney, Janice Bell, Daniel Tancredi, Patrick Romano, Richard Bold, Jill Joseph

Faculty Publications

PurposeAmong individuals with advanced cancer, frequent hospitalization increasingly is viewed as a hallmark of poor-quality care. We examined hospitalization rates and individual- and hospital-level predictors of rehospitalization among individuals with advanced cancer in the year after diagnosis.MethodsIndividuals diagnosed with advanced breast, colorectal, non–small-cell lung, or pancreatic cancer from 2009 to 2012 (N = 25,032) were identified with data from the California Cancer Registry (CCR). After linkage with inpatient discharge data, multistate and log-linear Poisson regression models were used to calculate hospitalization rates and to model rehospitalization in the year after diagnosis, accounting for survival.ResultsIn the year after diagnosis, 71% of …

Pilot Test Results Of A Video-Based Hiv Intervention For Chinese College Students In The United States, Wei-Chen Tung, Minggen Lu, Rudolph Rull, Wei Yang

Faculty Publications

Background: No culturally relevant and appropriate HIV/sexually transmitted infection (STI) programs are available to Chinese college students in the United States. This study evaluated the effectiveness of a translated Center for Disease Control and Prevention (CDC) intervention, Video Opportunities for Innovative Condom Education and Safer Sex (VOICES), to change condom use intention and self-efficacy, perceived benefits and barriers, and HIV/AIDS knowledge among Chinese students in a U.S. university. The VOICES program includes video viewing and a facilitated small-group discussion.

Methods: A quasi-experimental design with single-group pretest-posttest was conducted in Chinese. Chinese students (N=67) from a local university were recruited to …

A Mixed-Method Multiple Case Study Of Three Business Models For Local Healthy Food Delivery Systems In Underprivileged Urban Areas, Gretchen Elizabeth Krivak, Garth B. Woodruff, S. Forrest, Hannah Mbungu, Kechler Orcel, Soraya Fish, Sherine R. Brown-Fraser

Faculty Publications

Define a USDA food desert Analyze the three business models for benefits and deficiencies Identify methods for starting a sustainable mobile farmers market program. Over 40% of Berrien County Michigan land use is agricultural. Many products are fruits and vegetables. Yet, the county has six identified USDA defined Food Deserts. Past research, based on a mobile farmers market, confirmed local trends and deficits. The purpose for this research is to define a sustainable business model that delivers healthy local food options to USDA Food Deserts combating food inequity. A mixed method multiple case study was created to test three business …

Evaluation Of Programs To Improve Complementary Feeding In Infants And Young Children, Edward A. Frongillo Jr.

Faculty Publications

Evaluation of complementary feeding programs is needed to enhance knowledge on what works,to document responsible use of resources, and for advocacy. Evaluation is done during program conceptualization and design, implementation, and determination of effectiveness. This paper explains the role of evaluation in the advancement of complementary feeding programs,presenting concepts and methods and illustrating them through examples. Planning and investments for eval-uations should occur from the beginning of the project life cycle. Essential to evaluation is articu-lation of a program theory on how change would occur and what program actions are required for change. Analysis of program impact pathways makes explicit …

College Freshmen Students’ Perspectives On Weight Gain Prevention In The Digital Age: Web-Based Survey, Courtney M. Monroe, Gabrielle Turner-Mcgrievy, Chelsea A. Larsen, Karen Magradey, Heather M. Brandt, Sara Wilcox, Beth Sundstrom, Delia Smith West

Faculty Publications

BACKGROUND: College freshmen are highly vulnerable to experiencing weight gain, and this phenomenon is associated with an increased risk of chronic diseases and mortality in older adulthood. Technology offers an attractive and scalable way to deliver behavioral weight gain prevention interventions for this population. Weight gain prevention programs that harness the appeal and widespread reach of Web-based technologies (electronic health or eHealth) are increasingly being evaluated in college students. Yet, few of these interventions are informed by college students' perspectives on weight gain prevention and related lifestyle behaviors. OBJECTIVE: The objective of this study was to assess college freshmen students' …

Integrating Nutrition Interventions Into An Existing Maternal, Neonatal, And Child Health Program Increased Maternal Dietary Diversity, Micronutrient Intake, And Exclusive Breastfeeding Practices In Bangladesh: Results Of A Cluster-Randomized Program Evaluation, Phuong Hong Nguyen, Sunny S. Kim, Tina Sanghvi, Zeba Mahmud, Lan Mai Tran, Sadia Shabnam, Bachera Aktar, Raisul Haque, Kaosar Afsana, Edward A. Frongillo Jr., Marie T. Ruel, Purnima Menon

Faculty Publications

Maternal undernutrition is a major concern globally, contributing to poor birth outcomes. Limited evidence exists on delivering multiple interventions for maternal nutrition simultaneously. Alive & Thrive addressed this gap by integrating nutrition-focused interpersonal counseling, community mobilization, distribution of free micronutrient supplements, and weight-gain monitoring through an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh. We evaluated the effect of providing nutrition-focused MNCH compared with standard MNCH (antenatal care with standard nutrition counseling) on coverage of nutrition interventions, maternal dietary diversity, micronutrient supplement intake, and early breastfeeding practices. We used a cluster-randomized design with cross-sectional surveys at baseline (2015) …

Proactive Protection For Adolescents, The Innocent Victim: Risk And Protective Factors For Pornography, Julie Varner, Kellie Hoch, Michael C. Goates, Carl L. Hanson

Faculty Publications

Several states, including Utah, have declared pornography a public health hazard as use has been equated with sexual violence, normalizing rape, and promoting risky sexual behaviors. Growing access to the internet has led many researchers to explore the effects of internet pornography use on adolescents; however, less has been done to summarize the antecedents. The purpose of this study was to explore the root causes of adolescent pornography use in the context of a well-established prevention framework - the social development model. Findings have implications for creating prevention programming related to adolescent digital pornography use.

Dietary Inflammatory Index And Colorectal Cancer Risk – A Meta-Analysis, Nitin Shivappa, Justyna Godos, James R. Hébert, Michael David Wirth, Gabriele Piuri, Attilio Speciani, Giuseppe Grosso

Faculty Publications

Diet and chronic inflammation of the colon have been suggested to be risk factors in the development of colorectal cancer (CRC). The possible link between inflammatory potential of diet, measured through the Dietary Inflammatory Index (DII®), and CRC has been investigated in several populations across the world. The aim of this study was to conduct a meta-analysis on studies exploring this association. Data from nine studies were eligible, of which five were case-control and four were cohort studies. Results from meta-analysis showed a positive association between increasing DII scores, indicating a pro-inflammatory diet, and CRC. Individuals in the highest versus …

Gulf States Health Policy Center Community Research Fellows Birmingham, Al Evaluation Report, Candace Bright, Braden Bagley

Faculty Publications

The Gulf States Community Research Program (GSCRP) program took place in Birmingham between January 10th, 2017 and May 16th, 2017. This report reflects the implementation and evaluation of a community based participatory training (CBPR) program for this cohort of community members. The report provides data on the assessment of the program’s effectiveness in promoting the role of underserved populations in research by enhancing the capacity for CBPR. In assessing the social network development of the cohort, we seek to understand effectiveness in bridging many community roles to serve the purpose of addressing health disparities. Specifically, the report assesses if the …

Gulf States Health Policy Center Community Research Fellows Mobile, Al Evaluation Report, Candace Bright, Braden Bagley

Faculty Publications

The Gulf States Community Research Program (GSCRP) program took place in Mobile between January 10th, 2017 and May 9, 2017. This report reflects the implementation and evaluation of a community based participatory training (CBPR) program for this cohort of community members. The report provides data on the assessment of the program’s effectiveness in promoting the role of underserved populations in research by enhancing the capacity for CBPR. In assessing the social network development of the cohort, we seek to understand effectiveness in bridging many community roles to serve the purpose of addressing health disparities. Specifically, the report assesses if the …

Alternative Healthy Eating Index 2010, Dietary Inflammatory Index And Risk Of Mortality: Results From The Whitehall Ii Cohort Study And Meta-Analysis Of Previous Dietary Inflammatory Index And Mortality Studies, Nitin Shivappa, James R. Hébert, Mika Kivimaki, Tasnime Akbaraly

Faculty Publications

We aimed to examine the association between the Alternative Healthy Eating Index updated in 2010 (AHEI-2010), the Dietary Inflammatory Index (DIITM) and risk of mortality in the Whitehall II study. We also conducted a meta-analysis on the DII-based results from previous studies to summarise the overall evidence. Data on dietary behaviour assessed by self-administered repeated FFQ and on mortality status were available for 7627 participants from the Whitehall II cohort. Cox proportional hazards regression models were performed to assess the association between cumulative average of AHEI-2010 and DII scores and mortality risk. During 22 years of follow-up, 1001 participants died …

The Relationship Of Plasma Trans Fatty Acids With Dietary Inflammatory Index Among Us Adults, Mohsen Mazidi, Hong-Kai Gao, Nitin Shivappa, Michael David Wirth, James R. Hébert, Andre Pascal Kengne

Faculty Publications

Background: It has been suggested that trans fatty acids (TFAs) play an important role in cardiovascular diseases. We investigated the association between plasma TFAs and the dietary inflammatory index (DII) ™ in US adults.

Methods: National Health and Nutrition Examination Survey (NHANES) participants with data on plasma TFAs measured from 1999 to 2010 were included. Energy-adjusted-DII ™ (E-DII ™) expressed per 1000 kcal was calculated from 24-h dietary recalls. All statistical analyses accounted for the survey design and sample weights.

Results: Of the 5446 eligible participants, 46.8% (n = 2550) were men. The mean age of the population was 47.1 …

Future Orientation, Social Support, And Psychological Adjustment Among Left-Behind Children In Rural China: A Longitudinal Study, Shaobing Su, Xiaoming Li, Danhua Lin, Maoling Zhu

Faculty Publications

Existing research has found that parental migration may negatively impact the psychological adjustment of left-behind children. However, limited longitudinal research has examined if and how future orientation (individual protective factor) and social support (contextual protective factor) are associated with the indicators of psychological adjustment (i.e., life satisfaction, school satisfaction, happiness, and loneliness) of left-behind children. In the current longitudinal study, we examined the differences in psychological adjustment between left-behind children and non-left behind children (comparison children) in rural areas, and explored the protective roles of future orientation and social support on the immediate (cross-sectional effects) and subsequent (lagged effects) status …

Breastfeeding Practices, Beliefs, And Social Norms In Low-Resource Communities In Mexico: Insights For How To Improve Future Promotion Strategies, Tessa M. Swigart, Anabelle Bonvecchio, Florence L. The´Odore, Sophia Zamudio-Hass, Maria Angeles Villanueva-Borbolla, Jim Thrasher

Faculty Publications

INTRODUCTION:

Breastfeeding is recommended exclusively for the first 6 months after birth, with continued breastfeeding for at least 2 years. Yet prevalence of these recommendations is low globally, although it is an effective and cost-effective way to prevent serious infections and chronic illness. Previous studies have reported that social support greatly influences breastfeeding, but there is little evidence on perceived social norms in Mexico and how they affect actual behavior.

OBJECTIVE:

Our objective was to investigate breastfeeding intention, practices, attitudes, and beliefs, particularly normative, among low-resource communities in central and southern Mexico.

METHODS:

We performed a secondary analysis using the …

Individual And Structural Environmental Influences On Utilization Of Iron And Folic Acid Supplementation Among Pregnant Women In Harare, Zimbabwe, Chiwoneso B. Tinago, Lucy Annang Ingram, Christine E. Blake, Edward A. Frongillo Jr.

Faculty Publications

Micronutrient deficiencies are prevalent among Zimbabweans with serious health and social implications. Due to alack of a national micronutrient food fortification policy, the Zimbabwe Ministry of Health and Child Careestablished a policy for the prevention of maternal micronutrient deficiencies, which centres on pregnant womenreceiving daily iron and folic acid (IFA) at theirfirst antenatal care visit and throughout pregnancy. Despite theseefforts, utilization of IFA supplementation in pregnancy in Zimbabwe is low. This study aimed to understand theexperiences and knowledge of IFA supplementation among pregnant women and healthcare workers in Harare,Zimbabwe, and the influence of health-service and social environments on utilization. Semi-structured …

Association Of Alzhemier's Disease With Hepatitis C Among Patients With Bipolar Disorder, Herng-Ching Lin, Sudha Xirasagar, Hsin-Chien Lee, Chung-Chien Huang, Chao-Hung Chen

Faculty Publications

Associations of hepatitis C virus infection with Alzheimer’s disease have not been studied among higher risk, bipolar disorder patients. This population-based case-control study investigated the risks of hepatitis C virus infection among Alzheimer’s disease patients with bipolar disorder in the years preceding their Alzheimer’s disease diagnosis. We used 2000–2013 data from the Longitudinal Health Insurance Database in Taiwan. Among patients with bipolar disorder, 73 were diagnosed with Alzheimer’s disease (cases), who were compared with 365 individuals with bipolar disorder but without Alzheimer’s disease (randomly selected controls matched on sex, age, and index year with cases). Prior claims (before the diagnosis …

Dietary Inflammatory Index In Relation To Sub-Clinical Atherosclerosis And Atherosclerotic Vascular Disease Mortality In Older Women, Nicola P. Bondonno, Joshua R. Lewis, Lauren C. Blekkenhorst, Nitin Shivappa, Richard J. Woodman, Catherine P. Bondonno, Natalie C. Ward, James R. Hébert, Peter L. Thompson, Richard L. Prince, Jonathan M. Hodgson

Faculty Publications

Arterial wall thickening, stimulated by low-grade systemic inflammation, underlies many cardiovascular events. As diet is a significant moderator of systemic inflammation, the dietary inflammatory index (DIITM) has recently been devised to assess the overall inflammatory potential of an individual’s diet. The primary objective of this study was to assess the association of the DII with common carotid artery–intima-media thickness (CCA–IMT) and carotid plaques. To substantiate the clinical importance of these findings we assessed the relationship of DII score with atherosclerotic vascular disease (ASVD)-related mortality, ischaemic cerebrovascular disease (CVA)-related mortality and ischaemic heart disease (IHD)-related mortality more. The study was conducted …

Changes In The Policy Environment For Infant And Young Child Feeding In Vietnam, Bangladesh, And Ethiopia, And The Role Of Targeted Advocacy, Jody Harris, Edward A. Frongillo Jr., Phuong H. Nguyen, Sunny S. Kim, Purnima Menon

Faculty Publications

Background

There is limited literature examining shifts in policy environments for nutrition and infant and young child feeding (IYCF) over time, and on the potential contribution of targeted advocacy to improved policy environments in low- and middle-income countries. This study tracked changes in the policy environment over a four-year period in three countries, and examined the role of targeted nutrition and IYCF advocacy strategies by a global initiative.

Methods

Qualitative methods, including key informant interviews, social network mapping, document and literature review, and event tracking, were used to gather data on nutrition and IYCF policies and programs, actor networks, and …

A Higher Dietary Inflammatory Index Score Is Associated With A Higher Risk Of Breast Cancer Among Chinese Women: A Case–Control Study, Nitin Shivappa, James R. Hébert, Lesley A. Anderson, Martha J. Shrubsole, Liam J. Murray, Lauren B. Getty, Helen G. Coleman, On Behalf Of The Finbar Study Group

Faculty Publications

The dietary inflammatory index (DIITM) is a novel composite score based on a range of nutrients and foods known to be associated with inflammation. DII scores have been linked to the risk of a number of cancers, including oesophageal squamous cell cancer and oesophageal adenocarcinoma (OAC). Given that OAC stems from acid reflux and that the oesophageal epithelium undergoes a metaplasia-dysplasia transition from the resulting inflammation, it is plausible that a high DII score (indicating a pro-inflammatory diet) may exacerbate risk of OAC and its precursor conditions. The aim of this analytical study was to explore the association between energy-adjusted …

A Higher Dietary Inflammatory Index Score Is Associated With A Higher Risk Of Breast Cancer Among Chinese Women: A Case–Control Study, Wu-Qing Huang, Xiong-Fei Mo, Yan-Bing Ye, Nitin Shivappa, Fang-Yu Lin, Jing Huang, James R. Hébert, Bo Yan, Cai-Xia Zhang

Faculty Publications

Previous studies have investigated the association between dietary inflammatory potential and the development of cancer. For breast cancer the results have been equivocal. The present study aimed to investigate whether higher Dietary Inflammatory IndexTM (DII) scores were associated with increased risk of breast cancer among Chinese women. A total of 867 cases and 824 controls were recruited into the present case–control study from September 2011 to February 2016. DII scores were computed based on baseline dietary intake assessed by a validated 81-item FFQ. The OR and 95 % CI were assessed by multivariable logistic regression after adjusting for various potential …

Microbial Extracellular Polymeric Substances (Epss) In Ocean Systems, Alan W. Decho, Tony Gutierrez

Faculty Publications

Microbial cells (i.e., bacteria, archaea, microeukaryotes) in oceans secrete a diverse array of large molecules, collectively called extracellular polymeric substances (EPSs) or simply exopolymers. These secretions facilitate attachment to surfaces that lead to the formation of structured ‘biofilm’ communities. In open-water environments, they also lead to formation of organic colloids, and larger aggregations of cells, called ‘marine snow.’ Secretion of EPS is now recognized as a fundamental microbial adaptation, occurring under many environmental conditions, and one that influences many ocean processes. This relatively recent realization has revolutionized our understanding of microbial impacts on ocean systems. EPS …

Trading Pounds For Points: Engagement And Weight Loss In A Mobile Health Intervention, Sarah Hales, Gabrielle Turner-Mcgrievy, Sarah Wilcox, Rachel Davis, Arjang Fahim, Michael N. Huhns, Homayoun Valafar

Faculty Publications

Abstract Objective The objective of this study was to describe participant engagement and examine predictors of weight loss and points earned through the point-based incentive system of the Social Pounds Off Digitally (POD) app.

Materials and methods Overweight and obese adults with Android smartphones/tablets (body mass index 25–49.9 kg/m2; N = 24) were recruited for a 3-month weight loss intervention. Participants completed a survey assessing demographics and personality and had their weight measured. Participants received the content of the intervention via podcasts and used the Social POD app to self-monitor diet, physical activity, and weight. The Social POD app contained: …

Social Franchising And A Nationwide Mass Media Campaign Increased The Prevalence Of Adequate Complementary Feeding In Vietnam: A Cluster-Randomized Program Evaluation, Rahul Rawat, Phuong Hong Nguyen, Lan Mai Tran, Nemat Hajeebhoy, Huan Van Nguyen, Jean Baker, Edward A. Frongillo Jr., Marie T. Ruel, Purnima Menon

Faculty Publications

Rigorous evaluations of health system-based interventions in large-scale programs to improve complementary feeding (CF) practices are limited. Alive & Thrive applied principles of social franchising within the government health system in Vietnam to improve the quality of interpersonal counseling (IPC) for infant and young child feeding combined with a national mass media (MM) campaign and community mobilization (CM). We evaluated the impact of enhanced IPC + MM + CM (intensive) compared with standard IPC + less-intensive MM and CM (nonintensive) on CF practices and anthropometric indicators. A cluster-randomized, nonblinded evaluation design with cross-sectional surveys ( = ∼500 children aged 6-23.9 …

Pre-Pregnancy Body Mass Index Is Associated With Dietary Inflammatory Index And C-Reactive Protein Concentrations During Pregnancy, Dayeon Shin, Junguk Hur, Eun-Hee Cho, Hae-Kyung Chung, Nitin Shivappa, Michael D. Wirth, James R. Hébert, Kyung Won Lee

Faculty Publications

There have been a limited number of studies examining the association between pre-pregnancy body mass index (BMI) and dietary inflammation during pregnancy. Our aim is to examine the association between pre-pregnancy BMI and the Dietary Inflammatory Index (DII)™ and C-reactive protein (CRP) concentrations during pregnancy. The study included 631 pregnant American women from the National Health and Nutrition Examination Survey (NHANES) cross-sectional examinations from 2003 to 2012. Pre-pregnancy BMI was calculated based on self-reported pre-pregnancy weight and measured height. The cut-offs of <18.5 (underweight), 18.5–24.9 (normal), 25.0–29.9 (overweight), and ≥30 kg/m2 (obese) were used to categorize the weight status of pregnant women prior to pregnancy. The DII, a literature-based dietary index to assess the inflammatory properties of diet, was estimated based on a one-day 24-h recall. Multivariable linear and logistic regressions were performed to estimate beta coefficients and the adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) on the association of pre-pregnancy BMI categories with the DII and CRP concentrations during pregnancy. After controlling for variables including: race/ethnicity, family poverty income ratio, education, marital status, month in pregnancy, and smoking status during pregnancy; women who were obese before pregnancy (n = 136) had increased odds for being in the highest tertile of the DII and CRP concentrations compared to women with normal weight (AORs 2.40, 95% CIs 1.01–5.71; AORs 24.84, 95% CIs 6.19–99.67, respectively). These findings suggest that women with pre-pregnancy obesity had greater odds of reporting higher DII and having elevated CRP. In conclusion, high pre-pregnancy BMI was associated with increased odds of pro-inflammatory diet and elevated CRP levels during pregnancy in the USA.