Sociodemographic and dietary predictors of maternal and placental mycoestrogen concentrations in a US pregnancy cohort.

BACKGROUND: Zearalenone (ZEN) is a mycotoxin contaminating grains and processed foods. ZEN alters nuclear estrogen receptor α/ß signaling earning its designation as a mycoestrogen. Experimental evidence demonstrates that mycoestrogen exposure during pregnancy is associated with altered maternal sex steroid hormones, changes in placental size, and decreases in fetal weight and length. While mycoestrogens have been detected in human biospecimens worldwide, exposure assessment of ZEN in US populations, particularly during pregnancy, is lacking. OBJECTIVE: To characterize urinary and placental concentrations of ZEN and its metabolites in healthy US pregnant people and examine demographic, perinatal, and dietary predictors of exposure. METHODS: Urine samples were collected in each trimester from pregnant participants in the UPSIDE study and placenta samples were collected at delivery (Rochester, NY, n = 317). We used high performance liquid chromatography and high-resolution tandem mass spectrometry to measure total urinary (ng/ml) and placental mycoestrogens (ng/g). Using linear regression and linear mixed effect models, we examined associations between mycoestrogen concentrations and demographic, perinatal, and dietary factors (Healthy Eating Index [HEI], ultra-processed food [UPF] consumption). RESULTS: Mycoestrogens were detected in 97% of urines (median 0.323 ng/ml) and 84% of placentas (median 0.012 ng/g). Stability of urinary mycoestrogens across pregnancy was low (ICC: 0.16-0.22) and did not correlate with placental levels. In adjusted models, parity (multiparous) and pre-pregnancy BMI (higher) predicted higher urinary concentrations. Birth season (fall) corresponded with higher placental mycoestrogens. Dietary analyses indicated that higher HEI (healthier diets) predicted lower exposure (e.g., Σmycoestrogens %∆ -2.03; 95%CI -3.23, -0.81) and higher percent calories from UPF predicted higher exposure (e.g., Σmycoestrogens %∆ 1.26; 95%CI 0.29, 2.24). IMPACT: The mycotoxin, zearalenone (ZEN), has been linked to adverse health and reproductive impacts in animal models and livestock. Despite evidence of widespread human exposure, relatively little is known about predictors of exposure. In a pregnant population, we observed that maternal ZEN concentrations varied by maternal pre-pregnancy BMI and parity. Consumption of ultra-processed foods, added sugars, and refined grains were linked to higher ZEN concentrations while healthier diets were associated with lower levels. Our research suggests disparities in exposure that are likely due to diet. Further research is needed to understand the impacts of ZEN on maternal and offspring health.

Cultural Adaptation of Child Discipline Measures for Puerto Rican Mothers: Enhancing the Cultural Sensitivity of Parenting Assessments.

BACKGROUND/OBJECTIVES: Puerto Ricans (PRs) face significant challenges in accessing essential parenting resources and support due to language barriers and lack of culturally appropriate healthcare services, perpetuating health disparities. Cultural adaptation of psychosocial measurement tools is crucial for promoting health equity and improving health outcomes. This study describes the cultural adaptation of two parenting discipline assessment measures for use with Spanish-speaking PR mothers of 2-4-year-old children. METHODS: We used a community-engaged, mixed-methods approach to measurement adaptation that involved independent translations (n = 2), back-translations (n = 2), and an adaptation committee (n = 6, including all translators) who reviewed, appraised, and modified survey versions. We conducted cognitive interviews (n = 20) to pretest the semi-finalized Spanish measures and assess mothers' understanding of survey items. RESULTS: Mothers had a mean age of 28.6 years. Most were married/cohabitating (70%), had a high school diploma or GED (90%), and a household income of less than $40,000 (68%). Indexed children's mean age was 2.9 years, with most identified by mothers as female (60%). Feedback from the adaptation committee and pretesting participants led to specific changes like rephrasing culturally specific terms and adjusting examples to better fit the daily experiences of PR mothers. Most mothers found the Spanish version of the measures to be clear and culturally relevant. This cultural adaptation process addressed translation inconsistencies and design issues, and better captured culturally relevant discipline practices. CONCLUSIONS: Engaging communities in measurement adaptations ensures culturally and linguistically tailored measures that respect participant preferences, strengthen partnerships, and enable interventions to address health disparities, thereby promoting child health.

Longitudinal effects of prenatal substance use and environmental stressors on executive functioning in low-income African American adolescents: A latent growth modeling analysis.

Adverse prenatal substance use and environmental stressors have been linked to prefrontal cortex (PFC) impairments, the brain region that regulates executive functioning. Executive functions (e.g., inhibitory control, working memory, and cognitive flexibility) are crucial for sophisticated cognitive activities throughout child and adolescent development. There is little research on how prenatal substance use and environmental stressors longitudinally program executive functioning in children over time. We investigated the associations between prenatal/environmental stressors (i.e., maternal prenatal substance use, maternal-fetal bonding, and neighborhood disorganization) and executive function performance among low-income African American youth from age 6 until age 18. Analyses were based on four waves of data collected between 1994 and 2014 in the Memphis New Mothers Study, a longitudinal randomized controlled trial that was an intervention during pregnancy and the first two years of the child's life in low-SES women and their first-born children. Mothers and their children were followed longitudinally through 18 years post-childbirth. Prenatal substance use (e.g., prenatal smoke, alcohol, and drug use) and environmental stressor (e.g., food environment, maternal-fetal bonding and neighborhood disorganizations) evaluations were gathered from mothers and children prenatally and postnatally before the age of 4.5 years. Executive function was assessed using the Child Behavior Checklist for impulsivity and inattention, while the coding subscale of the Wechsler Intelligence Scale for Children-Third Edition, the reading recognition subtest of the Peabody Individual Achievement Test, and the digit span subtest of the Wechsler Adult Intelligence Scale were employed to assess working memory at three time periods (6, 12, and 18 years). Covariate-adjusted latent growth models estimated the associations between prenatal substance use and environmental stressors and changes in executive functioning over three time points. Prenatal smoking and alcohol use were associated with changes in impulsivity scores over 12 years. Prenatal alcohol use predicted higher inattention at baseline and a slower rate of change from ages 6 to 18. Neighborhood disorganization at ages 6 and 18 predicted higher inattention and lower working memory in youth at age 18, respectively. Our findings underscore the long-term impact of prenatal substance use exposures and neighborhood environments on cognitive development and highlight the importance of early interventions to mitigate these effects.

Dietary Intake of Nutrients Involved in Serotonin and Melatonin Synthesis and Prenatal Maternal Sleep Quality and Affective Symptoms.

Poor sleep quality and psychological distress in pregnancy are important health concerns. Serotonin and melatonin levels may underlie variation in these adverse outcomes. In this study, we examined dietary nutrients involved in serotonin and melatonin synthesis in relation to maternal sleep quality and affective symptoms during pregnancy. Pregnant women at no greater than normal medical risk at enrollment completed 24-hour dietary recalls in mid-late pregnancy. Usual intakes of vitamin B6, vitamin D, eicosapentaenoic acid (EPA) + docosahexaenoic acid (DHA), and tryptophan were estimated from dietary intake of foods and supplements using the National Cancer Institute (NCI) method. Sleep quality, depression, and anxiety were measured using validated questionnaires. Associations between nutrient intakes, sleep quality, and affective symptoms were estimated using generalized estimating equation models adjusting for potential confounding factors. In minimally adjusted models, EPA + DHA and tryptophan intakes were associated with a lower score indicating better sleep quality (b: -1.07, 95% CI: -2.09, -0.05) and (b: -12.40, 95% CI: -24.60, -0.21), respectively. EPA + DHA and tryptophan intakes were also associated with a lower odds of shorter sleep duration and sleep disturbances. In addition, tryptophan was associated with a lower odds of higher sleep latency. However, associations were attenuated and nonsignificant after adjustment for demographic and lifestyle factors. In conclusion, intakes of EPA + DHA and tryptophan were associated with improved sleep quality, but these associations were confounded by maternal demographic and lifestyle characteristics. This study highlights the need to consider dietary intake and pregnancy health in the context of demographic characteristics and lifestyle behaviors.

Validation of the Weight-Related Eating Questionnaire in pregnancy.

The Weight-Related Eating Questionnaire (WREQ), designed for assessing distinct constructs of dietary restraint and disinhibition-related eating behaviors, has not been validated in pregnancy. This secondary data analysis aimed to evaluate the WREQ's psychometrics in a diverse sample of pregnant women from the eMoms randomized controlled trial (N = 1399), randomly split for exploratory (EFA, n = 691) and confirmatory factor analysis (CFA, n = 708). Cronbach's alpha and corrected item-total correlation was used to examine internal consistency reliability. Sequential multiple regression analyses were used to assess criterion validity. EFA revealed three factors - dietary restraint, susceptibility to external cues, and emotional eating - accounting for 65.6 % of total variances. Parallel analysis confirmed a combination of two restraint subtypes (routine restraint and compensatory restraint). CFA showed that item 3 for assessing routine restraint had the lowest squared multiple correlation (0.22). The overall Cronbach's alpha of 0.87 demonstrated good internal consistency. Dietary restraint was negatively associated with the intake of energy (p = .03) and carbohydrates (p = .02), whereas susceptibility to external cues was positively associated with the intake of energy (p < .001), carbohydrates (p < .001), and total fat (p = .003). Additionally, emotional eating was positively associated with early-pregnancy body mass index (BMI) after adjustment for covariates (p < .001). These findings confirmed the reliability of the WREQ, the construct validity for susceptibility to external cues and emotional eating, and demonstrated its criterion validity regarding nutritional intake in pregnant women.

Prepregnancy dieting and obstetrical and neonatal outcomes: Findings from a national surveillance project in the United States.

PROBLEM AND BACKGROUND: Women with overweight or obesity are recommended to lose weight before pregnancy. Dieting is one of the most used weight control strategies. However, the health implications of dieting before pregnancy remain unclear. AIM: To evaluate the associations of dieting during the year before pregnancy with obstetrical and neonatal outcomes, including gestational weight gain (GWG), gestational diabetes, low birthweight, macrosomia, small-for-gestational-age infants (SGA), large-for-gestational-age infants (LGA), and preterm birth. METHODS: This study analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS), which is a surveillance project in the United States that collects data on maternal health before, during, and after pregnancy. Women who participated in PRAMS phase 7 with a prepregnancy body mass index ≥25 kg/m2 and a singleton birth were eligible. Statistical analyses included logistic regressions and post-hoc mediation analysis (Sobel Test). FINDINGS: A total number of 51,399 women were included in the analysis. Women who self-reported prepregnancy dieting (42.8 %) had lower odds of SGA (adjusted odds ratio [aOR]: 0.87; 95 % CI: 0.79-0.97), and higher odds of excessive GWG vs adequate GWG (aOR: 1.42; 95 % CI: 1.32-1.52), gestational diabetes (aOR: 1.12; 95 % CI: 1.02-1.22), and LGA (aOR: 1.18; 95 % CI: 1.08-1.28). Furthermore, the association between prepregnancy dieting and LGA was mediated by excessive GWG (Sobel Test z-value = 5.72, p < 0.01). DISCUSSION AND CONCLUSION: This analysis revealed that prepregnancy dieting was associated with several adverse consequences, including excessive GWG, gestational diabetes, and LGA infants. Findings contribute to an improved understanding of the perinatal implications of prepregnancy dieting.

Association between sex steroid hormones and subsequent hyperglycemia during pregnancy.

Objective: Sex steroid hormones may play a role in insulin resistance and glucose dysregulation. However, evidence regarding associations between early-pregnancy sex steroid hormones and hyperglycemia during pregnancy is limited. The primary objective of this study was to assess the relationships between first trimester sex steroid hormones and the subsequent development of hyperglycemia during pregnancy; with secondary evaluation of sex steroid hormones levels in mid-late pregnancy, concurrent with and subsequent to diagnosis of gestational diabetes. Methods: Retrospective analysis of a prospective pregnancy cohort study was conducted. Medically low-risk participants with no known major endocrine disorders were recruited in the first trimester of pregnancy (n=319). Sex steroid hormones in each trimester, including total testosterone, free testosterone, estrone, estradiol, and estriol, were assessed using high-performance liquid chromatography and tandem mass spectrometry. Glucose levels of the 1-hour oral glucose tolerance test and gestational diabetes diagnosis were abstracted from medical records. Multivariable linear regression models were fitted to assess the associations of individual first trimester sex steroids and glucose levels. Results: In adjusted models, first trimester total testosterone (ß=5.24, 95% CI: 0.01, 10.46, p=0.05) and free testosterone (ß=5.98, 95% CI: 0.97, 10.98, p=0.02) were positively associated with subsequent glucose concentrations and gestational diabetes diagnosis (total testosterone: OR=3.63, 95% CI: 1.50, 8.78; free testosterone: OR=3.69; 95% CI: 1.56, 8.73). First trimester estrone was also positively associated with gestational diabetes (OR=3.66, 95% CI: 1.56, 8.55). In mid-late pregnancy, pregnant people with gestational diabetes had lower total testosterone levels (ß=-0.19, 95% CI: -0.36, -0.02) after adjustment for first trimester total testosterone. Conclusion: Early-pregnancy sex steroid hormones, including total testosterone, free testosterone, and estrone, were positively associated with glucose levels and gestational diabetes in mid-late pregnancy. These hormones may serve as early predictors of gestational diabetes in combination with other risk factors.

Use of Continuous Glucose Monitoring in Patients Following Bariatric Surgery: A Scoping Review.

The objective of this scoping review was to summarize the emerging literature on the use of continuous glucose monitoring (CGM) in post-bariatric surgery patients, with a focus on its features (e.g., device, mode, and accuracy), as well as purposes and outcomes of utilization. Three databases (PubMed, EMBASE, and Web of Science) were searched to obtain relevant studies. Results suggested that most studies used CGM for 3-7 days under blinded mode. Accuracy data were available in only one study, which reported a mean absolute relative difference of 21.7% for Freestyle Libre. The primary applications of CGM were for elucidating glucose patterns and assessing glycemic treatment outcomes. No study has tested the effect of CGM as an intervention strategy to enhance glucose control.

The impact of maternal bariatric surgery on long-term health of offspring: a scoping review.

While pregnancy post-bariatric surgery has become increasingly common, little is known about whether and how maternal bariatric surgery affects the next generation. This scoping review aimed to collate available evidence about the long-term health of offspring following maternal bariatric surgery. A literature search was conducted using three databases (PubMed, PsycINFO, EMBASE) to obtain relevant human and animal studies. A total of 26 studies were included: 17 were ancillary reports from five "primary" studies (three human, two animal studies) and the remaining nine were "independent" studies (eight human, one animal studies). The human studies adopted sibling-comparison, case-control, and single-group descriptive designs. Despite limited data and inconsistent results across studies, findings suggested that maternal bariatric surgery appeared to (1) modify epigenetics (especially genes involved in immune, glucose, and obesity regulation); (2) alter weight status (unclear direction of alteration); (3) impair cardiometabolic, immune, inflammatory, and appetite regulation markers (primarily based on animal studies); and (4) not affect the neurodevelopment in offspring. In conclusion, this review supports that maternal bariatric surgery has an effect on the health of offspring. However, the scarcity of studies and heterogenous findings highlight that more research is required to determine the scope and degree of such effects. IMPACT: There is evidence that bariatric surgery modifies epigenetics in offspring, especially genes involved in immune, glucose, and obesity regulation. Bariatric surgery appears to alter weight status in offspring, although the direction of alteration is unclear. There is preliminary evidence that bariatric surgery impairs offspring's cardiometabolic, immune, inflammatory, and appetite regulation markers. Therefore, extra care may be needed to ensure optimal growth in children born to mothers with previous bariatric surgery.

Risk factors of lower birth weight, small-for-gestational-age infants, and preterm birth in pregnancies following bariatric surgery: a scoping review.

PURPOSE: Bariatric surgery increases the risk of lower birth weight, small-for-gestational-age (SGA) infants, and preterm birth in a subsequent pregnancy. However, the factors that contribute to these adverse birth outcomes are unclear. This review aimed to collate available information about risk factors of lower birth weight, SGA, and preterm birth following bariatric surgery. METHODS: A literature search was conducted using five databases (PubMed, PsycINFO, EMBASE, Web of Science, and Cochrane Library) to obtain relevant studies. RESULTS: A total number of 85 studies were included. Studies generally excluded surgery-to-conception interval, pregnancy complications, cigarette use, and maternal age as influencing factors of birth weight, SGA, or preterm birth. In contrast, most studies found that malabsorptive procedures, lower gestational weight gain, lower glucose levels, abdominal pain, and insufficient prenatal care were associated with an elevated risk of adverse birth outcomes. Findings were mixed regarding the effects of surgery-to-conception weight loss, pre-pregnancy body mass index, micronutrient deficiency, and lipid levels on birth outcomes. The examination of maternal microbiome profiles, placental function, alcohol use, and exercise was limited to one study; therefore, no conclusions could be made. CONCLUSION: This review identified factors that appear to be associated (e.g., surgery type) or not associated (e.g., surgery-to-conception interval) with birth outcomes following bariatric surgery. The mixed findings and the limited number of studies on several variables (e.g., micronutrients, exercise) highlight the need for further investigation. Additionally, future studies may benefit from exploring interactions among risk factors and expanding to assess additional exposures such as maternal mental health.

Risk factors for preterm birth in pregnancies following bariatric surgery: an analysis of the Longitudinal Assessment of Bariatric Surgery-2.

BACKGROUND: Bariatric surgery has been shown to increase the risk for preterm birth in a subsequent pregnancy. Determining factors that contribute to this heightened risk will inform the development of targeted interventions to improve birth outcomes postbariatric surgery. OBJECTIVES: This study aimed to identify risk factors of preterm birth in pregnancies following bariatric surgery. Factors being considered were preoperative medical conditions and behaviors (e.g., obesity-associated co-morbidities, gastrointestinal symptoms, substance use), antenatal factors (e.g., prepregnancy body mass index, gestational weight gain), and surgery-specific factors (e.g., surgery type, surgery-to-conception interval). SETTING: Bariatric surgery centers in the United States. METHODS: This is a retrospective analysis of the Longitudinal Assessment of Bariatric Surgery-2. Participants were women who reported at least 1 singleton live birth during the 7-year postoperative period. Logistic regressions were used to identify risk factors of preterm birth, adjusting for covariates such as maternal age, race, and ethnicity. RESULTS: Participants (n = 97) were mostly White (84.5%) and non-Hispanic (88.7%). At the time of surgery, the mean age was 29.4 ± 4.6 years, and the mean body mass index was 47.6 ± 6.3 kg/m2. The prevalence of preterm birth was 13.4%. Preoperative gastrointestinal symptoms significantly increased (odds ratio: 1.12; 95% confidence interval: 1.00-1.26), while unexpectedly, excessive versus adequate gestational weight gain (odds ratio: .12; 95% confidence interval: .02-1.00) decreased the odds of preterm birth following bariatric surgery. CONCLUSIONS: This analysis identified potential risk and protective factors of preterm birth among pregnancies postbariatric surgery. However, given the small sample size, findings should be regarded as hypothesis-generating and merit further study.

Prenatal diurnal cortisol: Normative patterns and associations with affective symptoms and stress.

The hypothalamic-pituitary-adrenal (HPA) axis in pregnancy has attracted considerable research attention, in part, because it may be a mechanism by which diverse prenatal exposures alter perinatal and child health outcomes. Symptoms of affective disturbance and stress are among the most-studied prenatal factors associated with HPA axis alterations, but there remains uncertainty about the nature of the association because of the limitations to, and variability in, data collection and analytic approaches. The current study capitalized on a prospective, longitudinal pregnancy cohort that examined salivary diurnal cortisol, collected at 5 time points across the day, at each trimester in a diverse sample of women. Detailed data on affective symptoms and major life events were collected at each trimester, as were data on health behaviors, medication, and socio-demographics. Results indicated modest stability of individual differences in diurnal cortisol across pregnancy, which was evident for diurnal slope (ICC = .20) and measures of total output (area under the curve, ICC = .25); substantial gestation-related increases in total cortisol output across pregnancy was also observed (p < .001). Adjusting for health behaviors, medication, and socio-demographic covariates, elevated levels of depressive symptoms and major life events were significantly (p < .05) associated with a higher morning awakening value and flatter diurnal slope, which was evident across all trimesters. In addition to the normative gestation-related changes in cortisol production, our results demonstrate selective but robust associations between psychological symptoms, stressors, and the HPA axis across gestation, and suggest both methodological and mechanistic strategies for future study.

Association between maternal psychological factors and offspring executive function: analysis of African-American mother-child dyads.

BACKGROUND: Executive function (EF) develops throughout childhood and adolescence; however, little is known about whether and how early life factors are associated with EF during these two stages. This secondary analysis examined the associations between maternal psychological characteristics at 2 years after childbirth and offspring EF at 6 and 18 years. METHODS: Data were from the 18-year New Mothers' Study in Memphis, TN. Women who self-identified as African-American were included (mother-child dyads: N = 414). Maternal psychological characteristics (e.g., depressive symptoms, self-esteem) were assessed using standardized questionnaires; offspring EF at 6 (i.e., working memory, response inhibition) and 18 years (e.g., working memory, sustained attention) were assessed using age-appropriate cognitive tasks. Statistical analyses included principal component analysis (PCA) and regression models. RESULTS: PCA reduced the correlated psychological characteristics to two factors: emotionality (depressive symptoms, emotional instability) and psychological resources (self-esteem, mastery, active coping). After controlling for maternal IQ, maternal emotionality was associated with worse working memory and response inhibition (marginally significant) at 6 years. Maternal psychological resources were marginally associated with better working memory at 6 years. CONCLUSIONS: Maternal psychological characteristics may be associated with later EF in offspring. Future studies are needed to replicate these findings and to explore potential mediators. IMPACT: African-American mothers' depressive symptoms and emotional instability at 2 years after childbirth were associated with offspring executive function at 6 and 18 years. African-American mothers' psychological resources at 2 years after childbirth were marginally associated with offspring working memory at 6 years. Maternal IQ attenuated all of the associations observed between maternal psychological status and offspring executive function.

Desire to lose weight was associated with the adoption of weight control strategies but not healthier lifestyle behaviours among post-bariatric surgery patients: NHANES 2013-2018.

The desire to lose weight is presumably high among patients with severe obesity who have undergone bariatric surgery. The purpose of this study is to examine the associations of desire to lose weight with weight control strategies, depressive symptoms and lifestyle behaviours among post-bariatric surgery patients. Participants were adults who participated in the National Health and Nutrition Examination Survey (2013-2018) and self-identified a history of bariatric surgery. The desire to lose weight, weight control strategies, depressive symptoms, physical activity and sitting time were measured by self-report questionnaires. Dietary information was derived from 24-h dietary recalls. The correlates of the desire to lose weight were examined by logistic or linear regressions with appropriate weighting and variance estimation techniques, adjusting for covariates such as length of time post-surgery. Results showed that at a mean of 7.8 (standard deviation [SD] = 0.5) years post-surgery (N = 142), 88.6% of participants wanted to weigh less. The average total energy intake was 1747 (SD = 72) kcal/day with 36.2% (SD = 0.7%) of the energy from total fat; the median total moderate-intensity physical activity was 88.5 min/week; and the mean sitting time was 796.0 (SD = 47.0) min/day. The desire to lose weight was positively associated with the adoption of healthy weight control strategies (odds ratio 17.4, 95% confidence interval 3.5-87.0, p < .01). No other significant associations were observed. Findings highlight the need for studies to improve patients' lifestyle behaviours post-surgery (e.g., reduce fat intake, increase physical activity) and examine the correlates of desire to lose weight in larger samples.

Predictors of 30-day follow-up visit completion after primary bariatric surgery: an analysis of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program data registry.

BACKGROUND: Adherence to follow-up visits is often unsatisfactory after bariatric surgery. OBJECTIVES: To identify predictors, including surgery type and preoperative demographics, body mass index (BMI), medical conditions, and smoking status, of 30-day follow-up visit completion. SETTING: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program participating centers (2015-2018). METHODS: Patients who underwent primary Roux-en-Y gastric bypass or sleeve gastrectomy were included in this analysis. Data were analyzed using weighted logistic regression. Subanalyses included stratification of the sample by sex and age (<45, 45-60, and >60 years). RESULTS: Patients (n = 566,774) were predominantly female (79.6%), White (72.4%), non-Hispanic (77.9%), and middle-aged (44.5 ± 11.9 years), with a mean BMI of 45.3 ± 7.8 kg/m2. More than 95% of patients completed the 30-day visits. In the whole-sample analysis, older age (odds ratio [OR], 1.02) and the presence of non-insulin-dependent diabetes (OR, 1.04), hypertension (OR, 1.03), hyperlipidemia (OR, 1.10), obstructive sleep apnea (OR, 1.15), and gastroesophageal reflux disease (OR, 1.16) were positive predictors of the 30-day visit completion (Ps < .01). Conversely, sleeve gastrectomy procedure (OR, .86), Black race (OR, .87), Hispanic ethnicity (OR, .94), and the presence of insulin-dependent diabetes (OR, .96) and smoking (OR, .83) were negative predictors (Ps < .01). Several differences emerged in subanalyses. For example, in sex stratification, Hispanic ethnicity lost its significance in men. In age stratification, BMI and male sex emerged as positive predictors in the age groups of <45 and 45-60 years, respectively. CONCLUSION: Although challenged by small effect sizes, this analysis identified subgroups at a higher risk of being lost to follow-up after bariatric surgery.

A literature review of dopamine in binge eating.

OBJECTIVE: Binge eating, a core diagnostic symptom in binge eating disorder and bulimia nervosa, increases the risk of multiple physiological and psychiatric disorders. The neurotransmitter dopamine is involved in food craving, decision making, executive functioning, and impulsivity personality trait; all of which contribute to the development and maintenance of binge eating. The objective of this paper is to review the associations of dopamine levels/activities, dopamine regulator (e.g., dopamine transporter, degrading enzymes) levels/activities, and dopamine receptor availability/affinity with binge eating. METHODS: A literature search was conducted in PubMed and PsycINFO to obtain human and animal studies published since 2010. RESULTS: A total of 31 studies (25 human, six animal) were included. Among the human studies, there were 12 case-control studies, eight randomized controlled trials, and five cross-sectional studies. Studies used neuroimaging (e.g., positron emission tomography), genetic, and pharmacological (e.g., dopamine transporter inhibitor) techniques to describe or compare dopamine levels/activities, dopamine transporter levels/activities, dopamine degrading enzyme (e.g., catechol-O-methyltransferase) levels/activities, and dopamine receptor (e.g., D1, D2) availability/affinity among participants with and without binge eating. Most human and animal studies supported an altered dopaminergic state in binge eating (26/31, 83.9%); however, results were divergent regarding whether the altered state was hyperdopaminergic (9/26, 34.6%) or hypodopaminergic (17/26, 65.4%). The mixed findings may be partially explained by the variability in sample characteristics, study design, diagnosis criteria, and neuroimaging/genetic/pharmacological techniques used. However, it is possible that instead of being mutually exclusive, the hyperdopaminergic and hypodopaminergic state may co-exist, but in different stages of binge eating or in different individual genotypes. CONCLUSIONS: For future studies to clarify the inconsistent findings, a homogenous sample that controls for confounders that may influence dopamine levels (e.g., psychiatric diseases) is preferable. Longitudinal studies are needed to evaluate whether the hyper- and hypo-dopaminergic states co-exist in different stages of binge eating or co-exist in individual phenotypes. Binge eating is characterized by eating a large amount of food in a short time and a feeling of difficulty to stop while eating. Binge eating is the defining symptom of binge eating disorder and bulimia nervosa, both of which are associated with serious health consequences. Studies have identified several psychological risk factors of binge eating, including a strong desire for food, impaired cognitive skills, and distinct personality traits (e.g., quick action without careful thinking). However, the physiological markers of binge eating remain unclear. Dopamine is a neurotransmitter that is heavily involved in feeding behavior, human motivation, cognitive ability, and personality. Therefore, dopamine is believed to play a critical role in binge eating. This review synthesized study findings related to the levels and activities of dopamine, dopamine regulators, and dopamine receptors in the context of binge eating. The primary finding is that most studies that used neuroimaging, genetic, or drug techniques found an altered dopaminergic state related to binge eating. However, the literature is inconsistent concerning the direction of the alteration. Considering the mixed findings and the limitations in study design, future studies, especially those that include repeated measurements, are needed to clarify the role of dopamine in binge eating.

Mental Health, Behavior Change Skills, and Eating Behaviors in Postpartum Women.

Excessive postpartum weight retention conveys risks for future metabolic diseases. Eating behaviors influence postpartum weight retention; however, the modifiable predictors of eating behaviors remain unclear. Using data from a three-arm, randomized controlled trial, the purpose of this study was to examine the longitudinal associations of mental health (e.g., depressive symptoms) and behavior change skills (e.g., self-efficacy) with eating behaviors (i.e., compensatory restraint, routine restraint, emotional eating, and external eating) among women (N = 424) over 18-months postpartum. Results revealed that depressive symptoms, perceived stress, healthy eating self-efficacy, overeating self-efficacy, self-weighing, and problem-solving confidence were associated with one or more of the examined eating behaviors. Furthermore, depressive symptoms moderated the association between healthy eating self-efficacy and routine restraint. Perceived stress moderated the associations between healthy eating/overeating self-efficacy and emotional eating. The findings suggest that mental health and behavior change skills may serve as targets for interventions designed to improve postpartum women's eating behaviors.Clinical trials registry:ClinicalTrials.gov #NCT01331564.

Influence of Appetite and Perceived Ability to Control Cravings on Excessive Gestational Weight Gain.

OBJECTIVE: To explore whether appetite is associated with gestational weight gain (GWG) and to assess the effect of perceived ability to control cravings on excessive GWG. DESIGN: Secondary data analysis. SETTING: Rochester, New York, United States. PARTICIPANTS: Women who were pregnant (N = 1,005) and participated in a randomized controlled trial to test the effect of electronically mediated interventions to prevent excessive GWG and postpartum weight retention. METHODS: We used two questions to assess appetite and perceived ability to control cravings before 28 weeks gestation: "How would you describe your appetite now compared to times when you are not pregnant?" and "How sure are you that you will be able to avoid overeating when you have cravings?" We conducted logistic regression to assess the relationships between appetite, perceived ability to control cravings, and excessive GWG. RESULTS: More than 47% of participants gained excessive weight during pregnancy. Approximately 62% of participants reported being hungrier, and more than 42% indicated that they were unsure they could avoid overeating with cravings. Participants who reported similar/less appetite than before pregnancy were less likely to gain excessive weight (p < .05). Participants who were sure they could control cravings were less likely to gain excessive weight (p = .02). CONCLUSION: Our results show that appetite and perceived ability to control cravings may affect GWG. Additional research is needed to assess if interventions targeting appetite and craving control could limit GWG.

Participation in genetic research among Latinx populations by Latin America birth-residency concordance: a global study.

Latinx populations are underrepresented in DNA-based research, and risk not benefiting from research if underrepresentation continues. Latinx populations are heterogenous; reflect complex social, migration, and colonial histories; and form strong global diasporas. We conducted a global study using a survey tool (Amazon's Mechanical Turk portal) to ascertain willingness to participate in genetic research by Latin America birth-residency concordance. Participants in the global study identified as Latinx (n=250) were classified as the following: (1) born/live outside of Latin America and the Caribbean (LAC), (2) born within/live outside LAC, and (3) born/live within LAC. Latinx were similarly likely to indicated they would participate DNA-based research as their non-Latinx counterparts (52.8% vs. 56.2%, respectively). Latinx born and living in LAC were significantly more willing to participate in DNA-based research than Latinx born and living outside of LAC (OR: 2.5; 95% CI: 1.3, 4.9, p<.01). Latinx indicating they would participate in genetic research were more likely to trust researchers (<.05), believe genetic research could lead to better understanding of disease (<.05), and that genetic research could lead to new treatments (p<.05) when compared with Latinx not interested in participating in genetic research. In summary, significant variation exists in genetic research interest among Latinx based on where they were born and live, suggesting that this context itself independently influences decisions about participation. Cultivating and investing in a research ecosystem that addresses, values, and respects Latinx priorities, circumstances, and researchers would likely increase research participation and, even more importantly, potentially impact the inequitable health disparities disproportionately represented in Latinx communities.