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      A low intensity, community based lifestyle programme to prevent weight gain in women with young children: cluster randomised controlled trial

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          Abstract

          Objective To develop and evaluate the effectiveness of a community behavioural intervention to prevent weight gain and improve health related behaviours in women with young children.

          Design Cluster randomised controlled trial.

          Setting A community setting in urban Australia.

          Participants 250 adult women with a mean age of 40.39 years (SD 4.77, range 25-51) and a mean body mass index of 27.82 kg/m 2 (SD 5.42, range 18-47) were recruited as clusters through 12 primary (elementary) schools.

          Intervention Schools were randomly assigned to the intervention or the control. Mothers whose schools fell in the intervention group (n=127) attended four interactive group sessions that involved simple health messages, behaviour change strategies, and group discussion, and received monthly support using mobile telephone text messages for 12 months. The control group (n=123) attended one non-interactive information session based on population dietary and physical activity guidelines.

          Main outcome measures The main outcome measures were weight change and difference in weight change between the intervention group and the control group at 12 months. Secondary outcomes were changes in serum concentrations of fasting lipids and glucose, and changes in dietary behaviours, physical activity, and self management behaviours.

          Results All analyses were adjusted for baseline values and the possible clustering effect. Women in the control group gained weight over the 12 month study period (0.83 kg, 95% confidence interval (CI) 0.12 to 1.54), whereas those in the intervention group lost weight (−0.20 kg, −0.90 to 0.49). The difference in weight change between the intervention group and the control group at 12 months was −1.13 kg (−2.03 to −0.24 kg; P<0.05) on the basis of observed values and −1.11 kg (−2.17 to −0.04) after multiple imputation to account for possible bias created by missing values. Secondary analyses after multiple imputation showed a difference in the intervention group compared with the control group for total cholesterol concentration (−0.35 mmol/l, −0.70 to −0.001), self management behaviours (diet score 0.18, 0.13 to 0.33; physical activity score 0.24, 0.05 to 0.43), and confidence to control weight (0.40, 0.11 to 0.69). Regular self weighing was associated with weight loss in the intervention group only (−1.98 kg, −3.75 to −0.23).

          Conclusions Weight gain in women with young children could be prevented using a low intensity self management intervention delivered in a community setting. Self management of health behaviours improved with the intervention. The response rate of 12%, although comparable with that in other community studies, might limit the ability to generalise to other populations.

          Trial registration Australian New Zealand Clinical Trials Registry number ACTRN12608000110381.

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          The Anti Cancer Council of Victoria FFQ: relative validity of nutrient intakes compared with weighed food records in young to middle-aged women in a study of iron supplementation.

          To assess the validity of the Anti Cancer Council of Victoria food frequency questionnaire (ACCVFFQ) relative to seven-day weighed food records (WFRs) in 63 women of child-bearing age. 63 women completed WFRs to assess iron intake as part of a study on iron deficiency. These women also completed the ACCVFFQ. Nutrient intakes were computed independently for the WFRs and FFQs. Intakes were compared as group means, by correlation and by quintile classification, adjusting for day-to-day variation in intakes, and for energy intake. Individual differences in results were also examined. The strongest associations between WFR and FFQ results were energy-adjusted, log-transformed and adjusted for day-to-day variability in intake. Correlation coefficients ranged from 0.28 for vitamin A to 0.78 for carbohydrate. Mean intakes from the WFRs and FFQs were within +/- 20% for 21 of 27 nutrients. Poor agreement between FFQs and WFRs for retinol intake was due to the inclusion of liver in two WFRs, an item which is not included in the FFQ. The ACCVFFQ performs as well as other FFQs for which validation data are available. The relatively poor measurement of retinol is consistent with other data, and with the limited number of foods in which this nutrient is abundant. The availability of an optically scannable valid instrument for assessing dietary intake will facilitate epidemiological studies of diet and disease, an area of current research priority.
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            Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial.

            The main 6-month results from the PREMIER trial showed that comprehensive behavioral intervention programs improve lifestyle behaviors and lower blood pressure. To compare the 18-month effects of 2 multicomponent behavioral interventions versus advice only on hypertension status, lifestyle changes, and blood pressure. Multicenter, 3-arm, randomized trial conducted from January 2000 through November 2002. 4 clinical centers and a coordinating center. 810 adult volunteers with prehypertension or stage 1 hypertension (systolic blood pressure, 120 to 159 mm Hg; diastolic blood pressure, 80 to 95 mm Hg). A multicomponent behavioral intervention that implemented long-established recommendations ("established"); a multicomponent behavioral intervention that implemented the established recommendations plus the Dietary Approaches to Stop Hypertension (DASH) diet ("established plus DASH"); and advice only. Lifestyle variables and blood pressure status. Follow-up for blood pressure measurement at 18 months was 94%. Compared with advice only, both behavioral interventions statistically significantly reduced weight, fat intake, and sodium intake. The established plus DASH intervention also statistically significantly increased fruit, vegetable, dairy, fiber, and mineral intakes. Relative to the advice only group, the odds ratios for hypertension at 18 months were 0.83 (95% CI, 0.67 to 1.04) for the established group and 0.77 (CI, 0.62 to 0.97) for the established plus DASH group. Although reductions in absolute blood pressure at 18 months were greater for participants in the established and the established plus DASH groups than for the advice only group, the differences were not statistically significant. The exclusion criteria and the volunteer nature of this cohort may limit generalizability. Although blood pressure is a well-accepted risk factor for cardiovascular disease, the authors were not able to assess intervention effects on clinical cardiovascular events in this limited time and with this sample size. Over 18 months, persons with prehypertension and stage 1 hypertension can sustain multiple lifestyle modifications that improve control of blood pressure and could reduce the risk for chronic disease.
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              Randomized trial of lifestyle modification and pharmacotherapy for obesity.

              Weight-loss medications are recommended as an adjunct to a comprehensive program of diet, exercise, and behavior therapy but are typically prescribed with minimal or no lifestyle modification. This practice is likely to limit therapeutic benefits. In this one-year trial, we randomly assigned 224 obese adults to receive 15 mg of sibutramine per day alone, delivered by a primary care provider in eight visits of 10 to 15 minutes each; lifestyle-modification counseling alone, delivered in 30 group sessions; sibutramine plus 30 group sessions of lifestyle-modification counseling (i.e., combined therapy); or sibutramine plus brief lifestyle-modification counseling delivered by a primary care provider in eight visits of 10 to 15 minutes each. All subjects were prescribed a diet of 1200 to 1500 kcal per day and the same exercise regimen. At one year, subjects who received combined therapy lost a mean (+/-SD) of 12.1+/-9.8 kg, whereas those receiving sibutramine alone lost 5.0+/-7.4 kg, those treated by lifestyle modification alone lost 6.7+/-7.9 kg, and those receiving sibutramine plus brief therapy lost 7.5+/-8.0 kg (P<0.001). Those in the combined-therapy group who frequently recorded their food intake lost more weight than those who did so infrequently (18.1+/-9.8 kg vs. 7.7+/-7.5 kg, P=0.04). The combination of medication and group lifestyle modification resulted in more weight loss than either medication or lifestyle modification alone. The results underscore the importance of prescribing weight-loss medications in combination with, rather than in lieu of, lifestyle modification. Copyright 2005 Massachusetts Medical Society.
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                Author and article information

                Contributors
                Role: senior research fellow
                Role: senior research fellow
                Role: associate professor in biostatistics
                Role: associate professor in behavioural epidemiology
                Role: professor in women’s health
                Journal
                BMJ
                bmj
                BMJ : British Medical Journal
                BMJ Publishing Group Ltd.
                0959-8138
                1468-5833
                2010
                2010
                13 July 2010
                : 341
                : c3215
                Affiliations
                [1 ]The Jean Hailes Research Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
                [2 ]School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
                [3 ]School of Exercise and Nutritional Sciences, Deakin University, Melbourne, Australia
                [4 ]Diabetes Research Unit, Southern Health, Melbourne, Australia
                Author notes
                Correspondence to: H Teede helena.teede@ 123456med.monash.edu.au
                Article
                lomc649558
                10.1136/bmj.c3215
                2903665
                20627974
                9caba05d-23a6-4ace-a5cc-27893c82700c
                © Lombard et al 2010

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.

                History
                : 26 March 2010
                Categories
                Research
                Clinical trials (epidemiology)
                Childhood nutrition
                Diet
                Childhood nutrition (paediatrics)
                Health promotion

                Medicine
                Medicine

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