The underlying role of food guilt in adolescent food choice: A potential conceptual model for adolescent food choice negotiations under circumstances of conscious internal conflict.

Food choice decisions are challenging to conceptualise, and literature is lacking specific to adolescent food choice decisions. Understanding adolescent nutrition and food choice is becoming increasingly important. This research aims to understand what influences the food choices of Irish adolescents, and the mental negotiations occurring in food-based decisions. Additionally, it aims to develop a holistic conceptual model of food choice, specific to adolescents. A qualitative study was conducted in N = 47 Irish adolescents, via focus group discussions using vignettes to introduce discussion topics around food and eating habits. Data were analysed using reflexive thematic analysis, involving both semantic and latent analysis. Thirteen distinct factors related to adolescent food choices were discussed, forming one main theme and three inter-linking subthemes. The main theme relates to food choice being multi-factorial in nature, needing a balance of priorities through internal negotiations for food choice with the aim of reducing food guilt. This can change depending on the social setting. Social concerns and food guilt appear to play a strong role in adolescent food choice, with adolescents feeling guilty for eating unhealthy food, wasting food, or spending/wasting money on food. A conceptual model for food choice in adolescents was developed, named a "Food Choice Funnel", incorporating a specific "Food Guilt Matrix". While we should encourage healthy eating and a healthy lifestyle, it is important to understand the value placed on the social component to eating among adolescents, since they have increasing social interactions and occasions where choosing health-promoting foods may be more challenging. Healthy eating messages should be designed in a balanced manner to support healthy growth and development, while limiting the potential to induce feelings of guilt among adolescents.

What makes a city 'breastfeeding-friendly'? A scoping review of indicators of a breastfeeding-friendly city.

A breastfeeding-friendly city is one where there is an enabling environment to support breastfeeding throughout the first 2 years or more of a child's life. Indicators of a breastfeeding-friendly city have yet to be identified. What are the indicators or criteria used to define breastfeeding friendliness in a geographic area such as a city and the settings within, which we have classified as community, healthcare and workplace? Three major databases and grey literature were searched. Records were screened to identify publications describing criteria such as indicators or descriptions of a breastfeeding-friendly setting, defined as 'criteria-sets'. These criteria-sets were then categorized and summarized by settings. The search up to 2 September 2021 found 119 criteria-sets from a range of settings: geographic locations (n = 33), community entities (n = 24), healthcare facilities (n = 28), workplaces (n = 28) and others (n = 6). Overall, 15 community, 22 healthcare and 9 workplace related criteria were extracted from the criteria-sets. Criteria that were consistently present in all settings were policy, training & education, skilled breastfeeding support and physical infrastructure. Some criteria-sets of geographic locations contained criteria only from a single setting (e.g., the presence of breastfeeding-friendly cafes). Criteria-sets were present for all settings as defined in this review, but few were actual indicators. Specifically, there were no existing indicators of a breastfeeding-friendly city. Several common components of the criteria-sets were identified, and these could be used in developing indicators of a breastfeeding-friendly city. Future studies should determine which of these are important and how each can be measured.

Parents' experiences of infant and young child feeding during the COVID-19 pandemic in Ireland.

OBJECTIVE: The WHO has urged member states to develop preparedness plans for infant and young child feeding (IYCF) during emergencies. Ireland has no such plan. We aimed to identify the needs of caregivers in Ireland with regards IYCF during the COVID-19 pandemic. DESIGN: Online survey conducted in May-June 2020. SETTING: Ireland, during the first period of severely restricted movement due to COVID-19 (lockdown). PARTICIPANTS: Respondents (n 745) were primary caregivers of a child under 2 years; they were primarily well educated and likely of higher socio-economic status. RESULTS: Among those who breastfed, being unable to access breast-feeding support groups and being unable to access in-person, one-to-one breast-feeding assistance were the biggest challenges reported. Nearly three quarters of those who had their babies during lockdown reported these challenges: 72·8 % and 68·8 %, respectively. For those using formula, the main challenges were structural in nature; approximately two-thirds of those who had their baby prior to lockdown feared there would be formula shortages and a third were unable to purchase formula due to shortages. CONCLUSIONS: Regardless of how their babies were fed, parents in Ireland experienced multiple challenges with infant feeding during the COVID-19 crisis. Breast-feeding should be protected, supported and promoted, particularly during an infectious disease pandemic. Additionally, assurances around supply of infant formula could reduce parental stress during a pandemic or emergency. An IYCF in emergencies plan would clearly set out how we could best support and protect the nutrition of the most vulnerable members of our population.

Determining the food choice motivations of Irish teens and their association with dietary intakes, using the Food Choice Questionnaire.

During adolescence, teens start making their own food choices. While health and nutrition are important, practical and social concerns are also influential. This study aims to determine factors that motivate the food choices of Irish teens (using Food Choice Questionnaire), using data from the National Teens' Food Survey II (N = 428, 50% male, 13-18 years), and to identify how these motivations relate to dietary intakes (4-day semi-weighed food diaries). Data analysis used PCA to determine the food choice motivation subscales, and correlation and comparative statistical tests (t-test, ANOVA). Eight motivating factors were identified for Irish teens: Sensory Appeal, Price & Availability, Health & Natural Content, Familiarity, Ease of Preparation, Mood, Weight Control, and Ethical Concerns. Health and practical aspects to food choice (Price, Availability, Ease of Preparation) are important for teens, but taste (Sensory Appeal) remains a key influence. Food choice motivations vary by sex and by age, BMI status and weight perception, where girls were more motivated by health, weight control, mood and ethical concerns, and older teens were more influenced by mood and ease of preparation. Both those classified as overweight and those who perceived they were overweight were motivated more by weight control and mood for their food choices, whereas those who perceived their weight to be correct placed more importance on health and natural content. Those motivated by weight control had lower energy and higher protein intakes, and those motivated by health and natural content had more health promoting behaviours, with higher physical activity, lower screen time, and higher protein intakes. Understanding the motivations of teens' food choice can help understand why they struggle to meet dietary recommendations, and help to develop more effective health promotion messages by capitalising on the key motivations in the population.

Eating behaviour styles in Irish teens: a cross-sectional study.

OBJECTIVES: To describe the eating behaviour styles of Irish teens and to explore the relationships between demographic factors, BMI and dietary intake and these eating behaviour styles. DESIGN: Cross-sectional data from the Irish National Teens' Food Survey (2005-2006). The Dutch Eating Behaviour Questionnaire assessed three eating behaviour styles in teens: restrained, emotional and external eating. Data were stratified by sex and age groups. SETTING: The Republic of Ireland. PARTICIPANTS: Nationally representative sample of teens aged 13-17 years (n 441). RESULTS: The highest scoring eating behaviour style was external eating (2·83 external v. 1·79 restraint and 1·84 emotional). Girls scored higher than boys on all three scales (Restraint: 2·04 v. 1·56, P < 0·001, Emotional: 2·15 v. 1·55, P < 0·001 and External: 2·91 v. 2·76, P = 0·03), and older teens scored higher than younger teens on the Emotional (1·97 v. 1·67, P < 0·001) and External scales (2·91 v. 2·72, P = 0·01). Teens classified as overweight/obese scored higher than those classified as normal weight on the Restraint scale (2·15 v. 1·71, P < 0·001) and lower on the External scale (2·67 v. 2·87, P < 0·03). Daily energy intake was negatively correlated with the Restraint (r -0·343, P < 0·001) and Emotional scales (r -0·137, P = 0·004) and positively correlated with the External scale (r 0·110, P = 0·02). CONCLUSIONS: External eating is the predominant eating behaviour style among Irish teens, but sex, age, BMI and dietary differences exist for each eating behaviour style. Including measures of eating behaviour styles into future dietary research could help understand both how and why as well as what people eat.

Cost-effectiveness of a mobile health-supported lifestyle intervention for pregnant women with an elevated body mass index.

OBJECTIVE: To assess the cost-effectiveness of a mobile health-supported lifestyle intervention compared with usual care. METHODS: We conducted a cost-effectiveness analysis from the perspective of the publicly-funded health care system. We estimated costs associated with the intervention and health care utilisation from first antenatal care appointment through delivery. We used bootstrap methods to quantify the uncertainty around cost-effectiveness estimates. Health outcomes assessed in this analysis were gestational weight gain (GWG; kg), incidence of excessive GWG, quality-adjusted life years (QALYs), and incidence of large-for-gestational-age (LGA). Incremental cost-effectiveness ratios (ICERs) were calculated as cost per QALY gained, cost per kg of GWG avoided, cost per case of excessive GWG averted, and cost per case of LGA averted. RESULTS: Total mean cost including intervention and health care utilisation was €3745 in the intervention group and €3471 in the control group (mean difference €274, P = 0.08). The ICER was €2914 per QALY gained. Assuming a ceiling ratio of €45,000, the probability that the intervention was cost-effective based on QALYs was 79%. Cost per kg of GWG avoided was €209. The cost-effectiveness acceptability curve (CEAC) for kg of GWG avoided reached a confidence level of 95% at €905, indicating that if one is willing to pay a maximum of an additional €905 per kg of GWG avoided, there is a 95% probability that the intervention is cost-effective. Costs per case of excessive GWG averted and case of LGA averted were €2117 and €5911, respectively. The CEAC for case of excessive GWG averted and for case of LGA averted reached a confidence level of 95% at €7090 and €25,737, respectively. CONCLUSIONS: Results suggest that a mobile-health lifestyle intervention could be cost-effective; however, a better understanding of the short- and long-term costs of LGA and excessive GWG is necessary to confirm the results.

Awareness and prevalence of human milk sharing and selling in the United States.

There are limited data available about the prevalence of human milk (HM) sharing and selling in the general population. We aimed to describe attitudes toward HM selling among participants in a qualitative-interview study and prevalence of HM sharing and selling among a national sample of U.S. mothers. Mothers (n = 41) in our qualitative-interview study felt that sharing or donating HM was more common than selling; none had ever purchased or sold HM. Three themes related to HM selling emerged from this work: questioning the motives of those selling HM, HM selling limits access to HM to those with money, and HM selling is a legitimate way to make money. Some mothers had reservations about treating HM as a commodity and the intentions of those who profit from the sale of HM. Nearly all participants in our national survey of U.S. mothers (94%, n = 429) had heard of infants consuming another mother's HM. Approximately 12% had provided their milk to another; half provided it to someone they knew. Fewer mothers (6.8%) reported that their infant had consumed another mother's HM; most received this HM from someone they knew. A smaller proportion of respondents (1.3%) had ever purchased or sold HM. Among a national sample of U.S. mothers, purchasing and selling HM was less common than freely sharing HM. Together, these data highlight that HM sharing is not uncommon in the United States. Research is required to create guidelines for families considering HM sharing.

Maternal and fetal blood lipid concentrations during pregnancy differ by maternal body mass index: findings from the ROLO study.

BACKGROUND: Pregnancy is a time of altered metabolic functioning and maternal blood lipid profiles change to accommodate the developing fetus. While these changes are physiologically necessary, blood lipids concentrations have been associated with adverse pregnancy outcomes such as gestational diabetes, pregnancy-induced hypertension and high birth weight. As blood lipids are not routinely measured during pregnancy, there is limited information on what is considered normal during pregnancy and in fetal blood. METHODS: Data from 327 mother-child pairs from the ROLO longitudinal birth cohort study were analysed. Fasting total cholesterol and triglycerides were measured in early and late pregnancy and fetal cord blood. Intervals were calculated using the 2.5th, 50th and 97.5th centile. Data was stratified based on maternal body mass index (BMI) measured during early pregnancy. Differences in blood lipids between BMI categories were explored using ANOVA and infant outcomes of macrosomia and large-for-gestational-age (LGA) were explored using independent student T-tests and binary logistic regression. RESULTS: All maternal blood lipid concentrations increased significantly from early to late pregnancy. In early pregnancy, women with a BMI < 25 kg/m2 had lower concentrations of total cholesterol compared to women with a BMI of 25-29.9 kg/m2 (P = 0.02). With triglycerides, women in the obese category (BMI > 30 kg/m2) had higher concentrations than both women in the normal-weight and overweight category in early and late pregnancy (P < 0.001 and P = 0.03, respectively). In late pregnancy, triglyceride concentrations remained elevated in women in the obese category compared to women in the normal-weight category (P = 0.01). Triglyceride concentrations were also elevated in late pregnancy in mothers that then gave birth to infants with macrosomia and LGA (P = 0.01 and P = 0.03, respectively). CONCLUSION: Blood lipid concentrations increase during pregnancy and differ by maternal BMI. These intervals could help to inform the development of references for blood lipid concentrations during pregnancy. TRIAL REGISTRATION: ROLO Study - ISRCTN54392969 . Date of registration: 22/04/2009.

Behaviour change in overweight and obese pregnancy: a decision tree to support the development of antenatal lifestyle interventions.

OBJECTIVE: Antenatal healthy lifestyle interventions are frequently implemented in overweight and obese pregnancy, yet there is inconsistent reporting of the behaviour-change methods and behavioural outcomes. This limits our understanding of how and why such interventions were successful or not. DESIGN: The current paper discusses the application of behaviour-change theories and techniques within complex lifestyle interventions in overweight and obese pregnancy. The authors propose a decision tree to help guide researchers through intervention design, implementation and evaluation. The implications for adopting behaviour-change theories and techniques, and using appropriate guidance when constructing and evaluating interventions in research and clinical practice are also discussed. CONCLUSIONS: To enhance the evidence base for successful behaviour-change interventions during pregnancy, adoption of behaviour-change theories and techniques, and use of published guidelines when designing lifestyle interventions are necessary. The proposed decision tree may be a useful guide for researchers working to develop effective behaviour-change interventions in clinical settings. This guide directs researchers towards key literature sources that will be important in each stage of study development.

Human milk expression as a sole or ancillary strategy for infant feeding: a qualitative study.

In the United States, a significant proportion of human milk (HM) is now fed to infants from bottles. This mode of infant feeding is rarely measured or described in research studies or monitored by national surveillance systems. Consequently, little is known about expressed-HM feeding as an infant feeding strategy. Our objective was to understand how mothers use HM expression and expressed-HM feeding as a sole strategy or in combination with at-the-breast feeding to feed HM to their infants. We conducted semi-structured interviews with 41 mothers with experience of HM expression and infants under three years of age. Data were analysed using a grounded theory approach for sub-themes related to the pre-selected major themes of maternal HM production and infant HM consumption. Within the major theme of maternal HM production, sub-themes related to maternal over-production of HM. Many mothers produced more HM than their infant was consuming and stored it in the freezer. This enabled some infants to consume HM weeks or months after it was expressed. Within the major theme of infant HM consumption, the most salient sub-theme related to HM-feeding strategies. Four basic HM-feeding strategies emerged, ranging from predominant at-the-breast feeding to exclusive expressed-HM feeding. The HM-feeding strategies and trajectories highlighted by this study are complex, and most mothers fed HM both at-the-breast and from a bottle-information that is not collected by the current national breastfeeding survey questions. To understand health outcomes associated with expressed-HM feeding, new terminology may be needed.

Interventions for promoting the initiation of breastfeeding.

BACKGROUND: Despite the widely documented risks of not breastfeeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower-income groups. In low- and middle-income countries, many women do not follow World Health Organization (WHO) recommendations to initiate breastfeeding within the first hour after birth. This is an update of a Cochrane Review, first published in 2005. OBJECTIVES: To identify and describe health promotion activities intended to increase the initiation rate of breastfeeding.To evaluate the effectiveness of different types of breastfeeding promotion activities, in terms of changing the number of women who initiate breastfeeding.To evaluate the effectiveness of different types of breastfeeding promotion activities, in terms of changing the number of women who initiate breastfeeding early (within one hour after birth). SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register (29 February 2016) and scanned reference lists of all articles obtained. SELECTION CRITERIA: Randomised controlled trials (RCTs), with or without blinding, of any breastfeeding promotion intervention in any population group, except women and infants with a specific health problem. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial reports for inclusion, extracted data and assessed trial quality. Discrepancies were resolved through discussion and a third review author was involved when necessary. We contacted investigators to obtain missing information. MAIN RESULTS: Twenty-eight trials involving 107,362 women in seven countries are included in this updated review. Five studies involving 3,124 women did not contribute outcome data and we excluded them from the analyses. The methodological quality of the included trials was mixed, with significant numbers of studies at high or unclear risk of bias due to: inadequate allocation concealment (N = 20); lack of blinding of outcome assessment (N = 20); incomplete outcome data (N = 19); selective reporting (N = 22) and bias from other potential sources (N = 17). Healthcare professional-led breastfeeding education and support versus standard care The studies pooled here compare professional health workers delivering breastfeeding education and support during the prenatal and postpartum periods with standard care. Interventions included promotion campaigns and counselling, and all took place in a formal setting. There was evidence from five trials involving 564 women for improved rates ofbreastfeeding initiation among women who received healthcare professional-led breastfeeding education and support (average risk ratio (RR) 1.43, 95% confidence interval (CI) 1.07 to 1.92; Tau² = 0.07, I² = 62%, low-quality evidence) compared to those women who received standard care. We downgraded evidence due to design limitations and heterogeneity. The outcome of early initiation of breastfeeding was not reported in the studies under this comparison. Non-healthcare professional-led breastfeeding education and support versus standard care There was evidence from eight trials of 5712 women for improved rates of breastfeeding initiation among women who received interventions from non-healthcare professional counsellors and support groups (average RR 1.22, 95% CI 1.06 to 1.40; Tau² = 0.02, I² = 86%, low-quality evidence) compared to women who received standard care. In three trials of 76,373 women, there was no clear difference between groups in terms of the number of women practicing early initiation of breastfeeding (average RR 1.70, 95% CI 0.98 to 2.95; Tau² = 0.18, I² = 78%, very low-quality evidence). We downgraded the evidence for a combination of design limitations, heterogeneity and imprecision (wide confidence intervals crossing the line of no effect). Other comparisonsOther comparisons in this review also looked at the rates of initiation of breastfeeding and there were no clear differences between groups for the following comparisons of combined healthcare professional-led education with peer support or community educator versus standard care (2 studies, 1371 women) or attention control (1 study, 237 women), breastfeeding education using multimedia (a self-help manual or a video) versus routine care (2 studies, 497 women); early mother-infant contact versus standard care (2 studies, 309 women); and community-based breastfeeding groups versus no breastfeeding groups (1 study, 18,603 women). None of these comparisons reported data on early initiation of breastfeeding. AUTHORS' CONCLUSIONS: This review found low-quality evidence that healthcare professional-led breastfeeding education and non-healthcare professional-led counselling and peer support interventions can result in some improvements in the number of women beginning to breastfeed. The majority of the trials were conducted in the USA, among women on low incomes and who varied in ethnicity and feeding intention, thus limiting the generalisability of these results to other settings.Future studies would ideally be conducted in a range of low- and high-income settings, with data on breastfeeding rates over various timeframes, and explore the effectiveness of interventions that are initiated prior to conception or during pregnancy. These might include well-described interventions, including health education, early and continuing mother-infant contact, and initiatives to help mothers overcome societal barriers to breastfeeding, all with clearly defined outcome measures.

Early Breastfeeding Problems Mediate the Negative Association between Maternal Obesity and Exclusive Breastfeeding at 1 and 2 Months Postpartum.

BACKGROUND: Compared with normal-weight women, women with obesity experience poorer breastfeeding outcomes. Successful breastfeeding among women with obesity is important for achieving national breastfeeding goals. OBJECTIVES: The objectives were to determine whether the negative association between obesity and any or exclusive breastfeeding at 1 and 2 mo postpartum is mediated through breastfeeding problems that occur in the first 2 wk postpartum and if this association differs by parity. METHODS: Mothers (1151 normal-weight and 580 obese) in the Infant Feeding Practices Study II provided information on sociodemographic and psychosocial characteristics, body mass index, and breastfeeding outcomes. At 1 mo postpartum, participants reported the breastfeeding problems they experienced in the first 2 wk postpartum from a predefined list of 17 options. We used factor analysis to condense these problems into 4 explanatory variables; continuous factor scores were computed for use in further analyses. We used maximum likelihood logistic regression to assess mediation of the association between obesity and breastfeeding outcomes through early breastfeeding problems. RESULTS: No significant effect of obesity was found on any breastfeeding at 1 or 2 mo. At 1 mo postpartum, for both primiparous and multiparous women, there was a significant direct effect of obesity on exclusive breastfeeding and a significant indirect effect of obesity through early breastfeeding problems related to the explanatory mediating variable "Insufficient Milk" (throughout the remainder of the Abstract, this factor will be denoted by upper case notation). At 2 mo postpartum both the direct effect of obesity and the indirect effect through Insufficient Milk were significant in primiparous women but only the indirect effect remained significant in multiparous women. CONCLUSIONS: Early problems related to Insufficient Milk may partially explain the association between obesity and poor exclusive breastfeeding outcomes. Women who are obese, particularly those reporting breastfeeding problems that grouped in the Insufficient Milk factor in the early postpartum period, may benefit from additional breastfeeding support.

Prevalence of food insecurity among caregivers of young children during the COVID-19 pandemic in Ireland.

Our objectives were to explore the prevalence of food insecurity in primary caregivers of young children in Ireland and to compare two tools for measuring food insecurity during the COVID-19 crisis. A cross-sectional online survey was conducted among caregivers of children aged <2 years in Ireland in May/June 2020. Relevant survey questions were closed-ended using two established tools for measuring food poverty/insecurity; the Irish Food Poverty Indicator and the Food Insecurity Experience Scale, developed by the Food and Agriculture Organization. Descriptive statistics were used to calculate the prevalence of food poverty/insecurity. To explore agreement in the classification of food insecurity by the Food Poverty Indicator and the Food Insecurity Experience Scale, Cohen's κ was used. Analyses are based on 716 participants; most had a 3rd-level education and were married or in a partnership. Per the food poverty index, Ireland's national measure of food poverty, 3.9% (n = 28) of our sample were experiencing food poverty. This rose to 10.5% (n = 75) experiencing food insecurity when using the Food Insecurity Experience Scale, which also measures worry/anxiety around access to food. There was low agreement between the tools, with 11.3% of the sample classified as food secure by one tool and food insecure by the other. Our current measure of food poverty in Ireland may not be sufficient to describe the food-access struggles or worry/anxiety about food access, experienced by the population, particularly during an emergency like COVID-19.

A qualitative analysis of women's postnatal experiences of breastfeeding supports during the perinatal period in Ireland.

Ireland has among the lowest rates of breastfeeding worldwide. Despite policies to support breastfeeding, breastfeeding initiation and exclusivity remain low in Ireland. Greater knowledge about support received in the maternity unit may-in part-shed light on why this is so. Our aim was to analyse women's experiences of the breastfeeding supports available in the early postnatal period in Ireland. We conducted an analysis of an open-ended question on a cross-sectional survey about breastfeeding support conducted in the Republic of Ireland in 2022. Participants were asked to provide comments about the breastfeeding support they received in the maternity unit or during your home birth. Data were analysed using Braun and Clarke's six-step Thematic Analysis Framework. There were 5,412 unique responses to the survey and 2,264 responses to the question of interest. Two themes were generated from the data: (i) 'Breastfeeding support in theory but not in practice.' Although breastfeeding was promoted by healthcare professionals antenatally, breastfeeding challenges were rarely mentioned. Participants then felt unsupported in overcoming challenges postnatally. (ii) 'Support was either inaccessible due to lack of staff/time, inadequate; i.e., unhelpful or non-specific, and/or physically inappropriate.' Most participants described receiving supports that were less than optimal in aiding them to establish breastfeeding. While many described difficulties in accessing supports, others found support to be 'non-specific,' 'rushed' and sometimes 'rough.' A lack of knowledge, time and support from healthcare professionals was frequently described, which was often recognised as a failing of the healthcare system. Women require practical, informative, and specific breastfeeding support. Barriers such as lack of time and trained staff in the maternity unit need to be addressed.

Considerations for health and food choice in adolescents.

The aim of this review is to summarise the common barriers and motivations for healthy food choice among adolescents, with a specific focus on the Irish context where available. It will also discuss other concerns adolescents have, which may influence their food choices and eating habits. Adolescence represents a period of rapid physical, mental and social development, and many health-related habits developed during adolescence tend to persist into adulthood, making the teenage years an optimal time to encourage healthy eating and health-promoting behaviours. Adolescents are concerned about the health impact of their diet, but their understanding of health is often seen in the context of their physical appearance or body image. Body image concerns are prevalent in adolescents, and this can affect their food choices. Taste, price and convenience are commonly noted factors influencing adolescents' food choices, and as they grow, their level of independence increases and spending more time with their peers means that social desirability and social norms about food become increasingly important factors in adolescent food choice. However, their limited autonomy means their supporting food environment also plays an important role. When developing more targeted interventions in adolescent populations, information on adolescent nutrition needs, their concerns for health and body image, and the barriers and motivations for healthy eating and food choice should be considered. Such a holistic approach should help support healthy eating and the prevention of overweight and obesity in the population, whilst also supporting a healthy relationship with food and their bodies.

Dietitians supporting breastfeeding: a survey of education, skills, knowledge and attitudes.

BACKGROUND: Breastfeeding rates in Ireland are among the lowest in the world; thus, it is important to understand what knowledge and skills exist and what are the education needs of dietitians. There has been no Irish research on dietitians' perception of their role in promoting, protecting and supporting breastfeeding. AIMS: The aim of this study was to explore the breastfeeding-related education that dietitians participated in, their breastfeeding-related skills, knowledge and attitudes towards breastfeeding. METHODS: An e-survey was conducted among members of the Irish Nutrition and Dietetic Institute. RESULTS: Fifty-nine percent of the 181 respondents received education or training on breastfeeding since qualifying with a trend of more training time on general breastfeeding knowledge and less time on clinical issues. There were lower confidence in skills, and role expectations related to clinical practice and clinical skills were perceived as required by only a few dietitians in specific roles. Personal breastfeeding experience was associated with greater confidence in their breastfeeding-related skills and a greater likiehood of reporting positive attitudes. The main source of information about breastfeeding was own reading or experience. Most respondents (64%) felt that their practice would benefit from additional training. The most frequently reported barriers to providing breastfeeding-related care were "I lack the skill", "I lack the confidence", and "I lack the knowledge to provide assistance with breastfeeding". CONCLUSIONS: Further examination of the role of the dietitian and the establishment of expected competencies would provide a clear framework for future training and education of dietitians towards increasing breastfeeding prevalence in Ireland.

A Qualitative Exploration of the Attitudes and Experiences of Polish Breastfeeding Mothers in Ireland.

BACKGROUND: Breastfeeding rates in Ireland are among the lowest in the world. Improving the prevalence of breastfeeding is an objective of the Irish Health Service Executive, with the recognition that this would improve public health. Polish people represent the largest immigrant group in Ireland, and Polish women are more likely to initiate breastfeeding than Irish women. RESEARCH AIMS: This study had two aims: (1) to describe the breastfeeding experiences and attitudes among Polish mothers living in Ireland, and (2) to explore similarities and differences in infant feeding experiences, attitudes, and beliefs among Polish and Irish women, as perceived by Polish women. METHODS: Semi-structured interviews were conducted in Polish with Polish mothers (N = 16) who had lived in Ireland for 10 years or less. Interviews were audio recorded, transcribed, and translated into English. Data were analyzed using qualitative thematic analysis. Coding was a cyclical process; codes were amended and refined through iterative reading of the transcripts. Themes were developed through categorization of codes and via in-depth discussion between two analysts. RESULTS: Three major themes were developed after analyzing the data. First, there is no universal correct way to provide support for infant feeding; women would like individualized support based on their infant-feeding decisions. Second, breastfeeding is an inherent part of Polish culture and formula feeding is part of Irish culture. Finally, the Irish social environment is supportive of breastfeeding and breastfeeding in public is acceptable in Ireland. CONCLUSIONS: Although the Irish social environment is supportive of breastfeeding, the infant-formula culture is a barrier to breastfeeding. Future research should explore ways to change societal attitudes towards breastfeeding in Ireland.

An observational analysis of meal patterns in overweight and obese pregnancy: exploring meal pattern behaviours and the association with maternal and fetal health measures.

BACKGROUND: Nutrient intakes are known to be poorer among pregnant women with raised body mass index (BMI) than those with a healthy BMI. While meal patterns have the potential to influence obstetric, metabolic and anthropometric measures for mother and infant, limited data exists regarding meal patterns among pregnant women with raised BMI. AIM: To identify categories of meal patterns among pregnant women with overweight and obesity and determine whether patterns change with advancing gestation. To determine if maternal meal patterns are associated with dietary intakes and pregnancy outcomes. METHODS: Prospective, observational analysis of pregnant women (n = 143) (BMI 25-39.9 kg/m2). Meal pattern data were analysed from 3-day food diaries at 16 and 28 weeks' gestation. Outcomes include maternal blood glucose, insulin resistance, gestational diabetes, gestational weight gain and infant anthropometry. RESULTS: Three meal pattern categories were identified: 'main meal dominant' (3 main eating occasions + 0-3 snacks), 'large meal dominant' (≤ 2 main eating occasions + < 2 snacks), and 'snack dominant' (3 main eating occasions + > 3 snacks and ≤ 2 main + ≥ 2 snacks). A main meal-dominant pattern prevailed at 16 weeks' (85.3%) and a snack-dominant pattern at 28 weeks' (68.5%). Dietary glycaemic index was lower among the main meal versus large meal-dominant pattern at 28 weeks (P = 0.018). Infant birth weight (kg) and macrosomia were highest among participants with a large meal-dominant pattern at 28 weeks (P = 0.030 and P = 0.008, respectively). CONCLUSION: Women with raised BMI changed eating patterns as pregnancy progressed, moving from main meal-dominant to snack-dominant patterns. Large meal-dominant meal patterns in later pregnancy were associated with higher glycaemic index and greater prevalence of macrosomia.

Comparing Alternative Breast Milk Feeding Questions to U.S. Breastfeeding Surveillance Questions.

Background: Most mothers in the United States express their milk, which is then bottle fed to their infants. The National Immunization Survey (NIS), used to report national breastfeeding prevalence, asks about infant breast milk consumption, regardless of whether it is consumed at the mother's breast or from a bottle. The NIS data are often erroneously interpreted, however, to mean prevalence of at-the-breast feeding. We hypothesized that over half of infants classified as breastfed at 3, 6, and 12 months by the NIS questions would also be consuming expressed breast milk. Materials and Methods: A convenience sample of 456 mothers of infants 19-35 months of age recruited through ResearchMatch.org completed an online infant-feeding questionnaire. The questionnaire included both the NIS questions and more-detailed questions about feeding mode, distinguishing between at-the-breast and bottle. Results: Based on responses of our sample to the NIS questions, it could be interpreted that 74%, 64%, and 39% of mother-infant dyads were at-the-breast feeding at 3, 6, and 12 months, respectively. However, at each time point, most infants consumed at least some breast milk from a bottle. As infants got older, the proportion of breast milk consumed from a bottle increased. Conclusions: In this U.S. sample, the predominant breast milk feeding style involves both at-the-breast and expressed breast milk feeding. Future research and national surveillance should consider including separate measures of maternal breast milk expression and infant consumption of expressed breast milk to enable meaningful exploration of maternal and infant outcomes associated with these asynchronous behaviors.

Nutrition, Behavior Change and Physical Activity Outcomes From the PEARS RCT-An mHealth-Supported, Lifestyle Intervention Among Pregnant Women With Overweight and Obesity.

Background: Diet quality and physical activity positively impact pregnancy outcomes among women with obesity, but successful lifestyle interventions require intense clinician time. We aimed to investigate the impact of a behavioral-lifestyle intervention (PEARS) supported by a smartphone app among pregnant women with overweight and obesity, on nutrient intake, behavioral stage-of-change and physical activity. Methods: Pregnant women (BMI 25-39.9 kg/m2, measured, n = 565) were randomized at 15.6 weeks' gestation to the intervention (n = 278), or a control group (n = 287) (ISRCTN29316280). The intervention was grounded in behavior-change theory. Participants received nutrition (low glycaemic index and healthy eating) and exercise advice, a smartphone app and fortnightly emails. The control group received usual care which does not include dietary advice. At baseline and 28 weeks' gestation, dietary data were obtained through 3-day food diaries (n = 290 matched), and stage-of-change and physical activity data were self-reported. App usage data were collected. Results: There were no differences between the groups at baseline. Compared with the control group, the intervention group had improved dietary intakes post-intervention with; lower glycaemic index (MD -1.75); free sugars (%TE) (MD -0.98); fat (%TE) (MD -1.80); and sodium (mg) (MD -183.49). Physical activity (MET-minutes/week) was higher in the intervention group post-intervention (MD 141.4; 95% CI 62.9, 219.9). The proportion of participants at "maintenance" stage-of-change for physical activity was higher in the intervention group (56.3 vs. 31.2%). App use was associated with lower glycaemic index and less energy from free sugars, but not with physical activity. Conclusion: A behavioral-lifestyle intervention in pregnancy supported by a smartphone app improved dietary intakes, physical activity, and motivation to engage in exercise.