COVID and Gender: A Narrative Review of the Asia-Pacific Region.

The COVID-19 pandemic has been the largest infectious disease epidemic to affect the human race since the great influenza pandemic of 1918-19 and is close to approaching the number of deaths from the earlier epidemic. A review of available data and the numerous currently available studies on COVID-19 shows that the rate of clinical cases is about 10% greater in females than males in Asia. However, the number of deaths is greater in males than in females. Women are more likely to experience the psychological effects of COVID-19 during and after acute infections. A significant proportion of acute COVID-19 infections continue and their prolonged symptoms have been reported. Further studies are needed, including detailed serology, to measure and monitor the incidence of COVID-19. The pandemic has had a widespread impact on broader societies including shortages of food, lockdowns and isolation. The number of orphans in developing countries has increased. Women have had to bear the major impacts of these community effects. More research is required to develop better vaccines acting against new strains of the virus and to develop systems to distribute vaccines to all people.

Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial.

BACKGROUND: Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant's father, has been identified as a crucial element for successful breastfeeding. OBJECTIVE: The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. METHODS: The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. RESULTS: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. CONCLUSIONS: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12884-015-0601-5.

Climate Change, Food Supply, and Dietary Guidelines.

Food production is affected by climate change, and, in turn, food production is responsible for 20-30% of greenhouse gases. The food system must increase output as the population increases and must meet nutrition and health needs while simultaneously assisting in achieving the Sustainable Development Goals. Good nutrition is important for combatting infection, reducing child mortality, and controlling obesity and chronic disease throughout the life course. Dietary guidelines provide advice for a healthy diet, and the main principles are now well established and compatible with sustainable development. Climate change will have a significant effect on food supply; however, with political commitment and substantial investment, projected improvements will be sufficient to provide food for the healthy diets needed to achieve the Sustainable Development Goals. Some changes will need to be made to food production, nutrient content will need monitoring, and more equitable distribution is required to meet the dietary guidelines. Increased breastfeeding rates will improve infant and adult health while helping to reduce greenhouse gases.

Dietary Inflammatory Index and Epithelial Ovarian Cancer in Southern Chinese Women: A Case-Control Study.

The association between inflammatory properties of diet and ovarian cancer risk has been investigated in some Western populations. However, little evidence is available from Asian women whose ovarian cancer incidence rates are low and dietary and lifestyle patterns are very different from their Western counterparts. We aimed to examine whether more pro-inflammatory diets, as indicated by higher dietary inflammatory index (DII®) scores, are associated with increased odds of epithelial ovarian cancer in southern China. A case-control study was conducted during 2006-2008 in Guangzhou, Guangdong Province. Energy-adjusted DII (E-DII) scores were calculated based on dietary intake assessed by a validated food frequency questionnaire administered to 500 incident epithelial ovarian cancer patients and 500 hospital-based controls. Logistic regression models were used to assess the relationship between E-DII scores and odds of ovarian cancer. Positive associations were observed between higher E-DII scores and ovarian cancer odds, using both continuous DII scores (odds ratio (OR) 1.87; 95% confidence interval (CI) 1.65, 2.13) and by DII tertiles (ORtertile3vs1 7.04, 95% CI: 4.70, 10.54, p for trend < 0.001). Likewise, a more pro-inflammatory diet was associated with a higher chance of serous and mucinous ovarian tumors. Our results suggest that a pro-inflammatory diet was associated with increased odds of developing epithelial ovarian cancer in southern Chinese women. The findings add to epidemiological evidence for the role of dietary inflammatory potential in ovarian cancer development.

WeChat-based intervention to support breastfeeding for Chinese mothers: protocol of a randomised controlled trial.

BACKGROUND: Exclusive breastfeeding for the first 6 months of life is the optimal way to feed infants. However, recent studies suggest that exclusive breastfeeding rates in China remain low and are well below the recommended target. There has been evidence that a lack of awareness of, or exposure to, breastfeeding information is associated with poor breastfeeding practices. WeChat, the most widely used social networking platform in China, has shown some potential to promote health behaviours. We thus hypothesised that a breastfeeding intervention program delivered via WeChat would achieve at least a 10% increase in exclusive breastfeeding prevalence at 6 months compared to the control group. METHODS: A two-arm, parallel, multicentre randomised controlled trial of 1000 pregnant women will be conducted at four maternity hospitals of Chengdu, China. Eligible women who consent to participate in the trial will be recruited at 28-30 weeks of gestation, and randomly allocated to either the intervention group (participants receive breastfeeding-related information from WeChat) or the control group (participants receive non-breastfeeding information from WeChat) using a central randomisation system on a 1:1 ratio at each participating site. The primary outcomes are exclusive breastfeeding rate and full breastfeeding rate at 6 months postpartum. All randomised participants will be included in the outcome analyses with missing data being imputed based on the best-case and worst-case scenarios. Multilevel mixed regression models will be used in the primary analyses to assess the effectiveness of intervention program on the breastfeeding rates. DISCUSSION: This trial uses the most widely used social media program as a means of delivering messages to mothers to increase exclusive breastfeeding in China. Increasing exclusive breastfeeding will contribute to meeting the health and environmental goals of the Sustainable Development Guidelines. Trial registration ClinicalTrials.gov, NCT04499404. Registered 5 August 2020-Retrospectively registered, https://clinicaltrials.gov/show/NCT04499404.

Incidence and Determinants of Caesarean Section in Shiraz, Iran.

The rate of Caesarean section (CS) without medical indication has increased markedly worldwide in the past decades. This study reports the incidence of CS and identifies the determinants of elective and emergency CS as separate pregnancy outcomes in a cohort of Iranian women. Mothers (n = 700) of healthy, full-term infants were recruited from five maternity hospitals in Shiraz. The association between maternal socio-demographic and biomedical factors with mode of delivery was explored using multivariable, multinomial logistic regression. Most mothers underwent either an elective (35.4%) or emergency (34.7%) CS. After adjustment, women were more likely to deliver by elective CS than vaginally if they were older (≥30 year) compared to younger mothers (<25 year) (Relative Risk Ratio (RRR) 2.22; 95% Confidence Interval (CI) 1.28, 3.84), and had given birth at a private hospital (RRR 3.64; 95% CI 1.79, 7.38). Compared to those educated to primary or lower secondary level, university educated women were more likely to have undergone an elective (RRR 2.65; 95% CI 1.54, 4.58) or an emergency CS (RRR 3.92; 95% CI 2.27, 6.78) than a vaginal delivery. Similarly, overweight or obese women were more likely than healthy weight women to have undergone an elective (RRR 1.91; 95% CI 1.27, 2.87) or an emergency CS (RRR 2.02; 95% CI 1.35, 3.02) than a vaginal delivery. Specialist education of obstetricians and midwives along with financial incentives paid to private hospitals to encourage natural delivery may help in the reduction of unnecessary CS in Iran. In addition, to increase their childbirth knowledge and self-efficacy, pregnant women need to have the opportunity to attend purposefully designed antenatal childbirth preparation classes where they receive evidence-based information on natural childbirth and alternative methods of pain control, as well as the risks and indications for CS.

Physical activity and sedentary behaviour during pregnancy are associated with gestational weight gain in Vietnamese women.

BACKGROUND AND OBJECTIVES: Gestational weight gain is known to impact maternal and child health outcomes. Energy intake and energy expenditure are major components of clinical nutrition in relation to weight gain during pregnancy. The study was to determine the association of physical activity and sitting time during pregnancy with gestational weight gain in Vietnamese women. METHODS AND STUDY DESIGN: A multicentre prospective cohort study was conducted in Vietnam from 2015 to 2017. A total of 1873 women with a singleton pregnancy were included. Physical activity and sitting exposures during pregnancy were determined using an interviewer-administered validated questionnaire. Multiple regression analysis was performed to assess physical activity and sitting time in relation to gestational weight gain, adjusting for the confounding effects of maternal characteristics and total energy intake during pregnancy. RESULTS: The mean weight gain was 12.9 (Standard deviation 4.1) kg throughout pregnancy. Pregnant women with prolonged sitting time gained an average of 0.6 kg more weight (p=0.016 for highest versus lowest tertiles). Conversely, women who were physically active, in terms of having higher tertiles of total physical activity, moderate-to-vigorous-intensity, household/ caregiving activities, and occupational physical activity, experienced significantly less gestational weight gain (p<0.05 for highest versus lowest tertiles). CONCLUSIONS: Inverse associations were found between gestational weight gain and physical activity (i.e. intensities and several domains), whereas gestational weight gain tended to increase with longer sitting time. Therefore, being physically active and less sedentary is important to regulate weight gain during pregnancy.

Determinants of Breastfeeding Duration in Shiraz, Southwest Iran.

A prospective cohort study was conducted in Shiraz in the south west of Iran to investigate breastfeeding from birth to six months of age. Mothers were recruited in a face-to-face interview within 48 h of giving birth in three public and two private hospitals (n = 700). They were then followed-up at 4, 12, 16, and 26 weeks postpartum in local Maternal and Child Health Clinics. Upon being discharge from hospital, 98.7% of mothers were breastfeeding and 74.3% were 'fully' breastfeeding, but only 29.9% of mothers had breastfed 'exclusively' since birth. The median duration of 'full' breastfeeding was 13 weeks and less than 1 week for exclusive breastfeeding. In a multivariable Cox proportional hazard regression, after adjustment, shorter durations of 'exclusive', 'full', and 'any' breastfeeding were associated with the introduction of a pacifier. The in-hospital use of formula and prelacteal feeds were also associated with a shorter duration of full and any breastfeeding. Breastfeeding on demand at 3 months and beyond was associated with a longer duration of breastfeeding. The risk factors associated with the premature discontinuation of breastfeeding identified in this study are all related to the "Ten steps to successful breastfeeding" and the Baby Friendly Hospital Initiative (BFHI). The principles that the BFHI provide are reaffirmed in this study as the basis for future breastfeeding promotion programs.

Postpartum Physical Activity and Weight Retention within One Year: A Prospective Cohort Study in Vietnam.

After delivery, mothers are encouraged to increase physical activity (PA) gradually to regulate body weight; however, data on PA in relation to postpartum weight retention remains scarce, particularly among Asian women. In a cohort of 1617 Vietnamese mothers, we investigated the prospective association between habitual PA exposures at 3-month postpartum and weight retention at 6-month and 12-month postpartum. Detailed information on PA intensity and domains was collected from participants using a validated instrument specifically for Vietnamese women. Linear regression analyses and a general linear model for the repeated weight retention measures were used to ascertain the apparent relationships. On average, the participants reported 3.6 (SD 3.9) and 2.6 (SD 3.8) kg weight loss at 6- and 12-month postpartum, respectively. Total and light-intensity PA were inversely associated with the postpartum weight retention (p for trend <0.05). Our findings highlight the importance of resuming PA in the early postpartum period as an appropriate weight management strategy.

Prelacteal and early formula feeding increase risk of infant hospitalisation: a prospective cohort study.

OBJECTIVE: To ascertain the relationship between prelacteal feeding, early formula feeding and adverse health outcomes, especially hospitalisation during the first year of life. DESIGN: Multicentre prospective cohort study. SETTING: Six hospitals across three cities in Vietnam. PATIENTS: A total of 2030 pregnant women were recruited at 24-28 weeks of gestation and followed up at hospital discharge, 1, 3, 6 and 12 months post partum. MAIN OUTCOME MEASURES: Rates of infant hospitalisation, diarrhoea and lower respiratory tract infection during the first 12 months. RESULTS: For the final complete sample (n=1709, 84%), about one-quarter of the infants experienced diarrhoea (25.5%) or were admitted to hospital with at least one episode (24.8%), and almost half (47.6%) the cohort contracted lower respiratory tract infection by 12 months. The prevalence of prelacteal feeding was high (56.5%) while formula feeding was common (79.5%) before hospital discharge, both of which increased the risks of adverse health outcomes particularly hospitalisation by approximately 1.5-fold, with adjusted OR (95% CI) 1.43 (1.09 to 1.88) and 1.48 (1.07 to 2.05), respectively for these infants by 12 months, when compared with others who were exclusively breast fed. CONCLUSIONS: Prelacteal feeding and early formula feeding before hospital discharge are associated with higher risks of infection and hospital admission in Vietnamese infants. Support for exclusive breast feeding should be provided to mothers to avoid the adverse consequences of giving formula milk and prelateal foods.

Caesarean delivery associated with adverse breastfeeding practices: a prospective cohort study.

Caesarean delivery rates are increasing in many Asian countries. This study investigated the effects of caesarean section on breastfeeding practices from delivery to twelve months postpartum. A prospective cohort study was conducted on 2030 pregnant women recruited from three cities in Vietnam during 2015-2017. The overall caesarean rate was 38.1%. Mothers who underwent caesarean section were more likely to give prelacteal feeds to their infants (adjusted odds ratio (OR) 13.91, 95% confidence interval (CI) 10.52-18.39) and as a result have lower rates of early initiation of breastfeeding (adjusted OR 0.04, 95%CI 0.02-0.05). Having a caesarean section reduced the likelihood of (any, predominant and exclusive) breastfeeding from discharge to 6 months postpartum. After 1 year, the any breastfeeding rate was still lower in the caesarean delivery (70.2%) compared with the vaginal delivery group (72.9%), p = .232. Vietnamese women who give birth by caesarean section need extra support to initiate and maintain breastfeeding.IMPACT STATEMENTWhat is already known on this subject? Early initiation of breastfeeding, and 'exclusive' or 'predominant' breastfeeding rates at discharge are lower in mothers delivering by caesarean section compared to vaginal delivery. Prelacteal feeding rates are higher following caesarean section. However, the association between 'any' breastfeeding duration and caesarean delivery has not been established.What the results of this study add? This study showed that caesarean delivery reduced all breastfeeding rates from discharge to six months and any breastfeeding rate at 12 months postpartum in Vietnamese women.What the implications are of these findings for clinical practice and/or further research? Further breastfeeding interventions are needed during the postpartum period for mothers who deliver by caesarean section.

Prevalence and pregnancy outcomes of gestational diabetes mellitus by different international diagnostic criteria: a prospective cohort study in Vietnam.

Background: Several diagnostic criteria for gestational diabetes mellitus (GDM) have been developed and used internationally. This study estimated the prevalence of GDM and pregnancy outcomes among Vietnamese women.Methods: A prospective cohort study of 2030 women was undertaken in Vietnam between 2015 and 2016. Baseline interview and a single-step 75-g oral glucose tolerance test (OGTT) were conducted at 24-28 weeks of gestation. GDM was defined by five international diagnostic criteria: America Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), International Association of the Diabetes and Pregnancy study groups (IADPSG), National Institute of Health and Clinical Excellence (NICE), and World Health Organization (WHO). Maternal and neonatal outcomes were assessed using medical records. Besides descriptive statistics and univariate analyses, logistic regressions were performed to ascertain the associations between GDM and maternal and neonatal outcomes.Results: The prevalence of GDM varied considerably by the diagnostic criteria: 6.4% (ADA), 7.9% (EASD), 22.8% (IADPSG/WHO), and 24.2% (NICE). Women with GDM according to EASD were more likely to have macrosomic infants (adjusted odds ratio (OR) 4.35, 95% confidence interval [CI]: 1.49-12.72), despite no apparent increase in risk under other criteria. Babies born to mothers with GDM appeared to be large-for-gestational age (LGA) by ADA criteria (adjusted OR 2.10, 95% CI: 1.10-4.02) or EASD criteria (adjusted OR 2.15, 95% CI: 1.16-3.98), when compared to their counterparts in the normal group. No significant differences in maternal and other neonatal outcomes were found between the normal and GDM groups.Conclusions: A global guideline is needed for the diagnosis, prevention and management of GDM.

A two-part mixed-effects model for analyzing clustered time-to-event data with clumping at zero.

BACKGROUND AND OBJECTIVE: In longitudinal epidemiological studies consisting of a baseline stage and a follow-up stage, observations at the baseline stage may contain a countable proportion of negative responses. The time-to-event outcomes of those observations corresponding to negative responses at baseline can be denoted as zeros, which are excluded from standard survival analysis. Consequently, some important information on these subjects is therefore lost in the analysis. Furthermore, subjects are often clustered within hospitals, communities or health service centers, resulting in correlated observations. The framework of the two-part model has been developed and utilized widely to analyze semi-continuous data or count data with excess zeros, but its application to clustered time-to-event data with clumping at zero remains sparse. METHODS: A two-part mixed-effects modeling approach was proposed. A logistic mixed-effects regression model was used in the first part to determine factors associated with the prevalence of the baseline event of interest. Parametric frailty models (including Weibull, exponential, log-logistic and log-normal) were used in the second part to assess associations between exposures and time-to-event outcomes. Correlated random effects were incorporated within the two regression models to accommodate the inherent correlation within each clustering unit and the correlation between the two parts. As an illustrative example, the method was applied to exclusive breastfeeding data from a community-based prospective cohort study in Nepal. RESULTS: A significantly positive correlation between the baseline prevalence of exclusive breastfeeding and exclusive breastfeeding duration was confirmed (ρ = 0.67, P < 0.001). The correlated two-part model outperformed the independent two-part model (likelihood ratio test statistic = 8.6, df = 1, P = 0.003). CONCLUSIONS: The proposed approach makes full use of all available information at baseline and during the follow-up, compared to the conventional survival analysis. In addition to breastfeeding studies, the method can be applied to other research areas where clustered time-to-event data with clumping at zero arise.

Physical Activity During Pregnancy and Postpartum Low Back Pain: A Prospective Cohort Study in Vietnam.

Low back pain (LBP) is a universal public health problem for all age groups, related to the upright stance of humans. Postpartum LBP is more common and can lead to limitations to women's daily activity. Knowledge about preventing postpartum LBP is limited, and the relationship between prenatal physical activity (PA) and LBP remains inconclusive. We conducted a prospective cohort study of 1807 singleton pregnant Vietnamese women to investigate the association between prenatal PA and postpartum LBP using logistic regression analyses. The prevalence of postpartum LBP was 12.3% (n = 222). Women reporting LBP spent more hours sitting per week. Relative to the lowest level of total PA, the highest level was associated with reduced odds of postpartum LBP (odds ratio = 0.55; 95% confidence interval = 0.38-0.80). Inverse associations with LBP were also observed for light intensity, moderate-to-vigorous intensity, household/caregiving, occupational, and transportation activities. Overall, prenatal PA was inversely associated with postpartum LBP in Vietnamese women.

Low Prevalence of Folic Acid Supplementation during Pregnancy: A Multicenter Study in Vietnam.

Periconceptional folic acid (FA) supplementation is recommended to prevent neural tube defects (NTDs), but little information is known about its use in Vietnam. It is important that FA supplements start to be taken when planning a pregnancy and continued through the first trimester to prevent NTDs, as the neural tube closes in the first month of pregnancy. However, FA supplementation in Vietnam is usually recommended to commence from the first antenatal visit, which is usually at 16 weeks, and very few women take FA before their first visit. This multicenter study aimed to determine the prevalence of FA supplement use and associated maternal characteristics in Vietnam. FA supplementation was assessed in 2030 singleton pregnant women between 2015 and 2016. In total, 654 (32.2%) women reported taking either supplements containing FA alone or multivitamins containing FA, and 505 (24.9%) reported correctly taking supplements containing FA alone. Women who were aged 30 years or over, had low education levels, had formal employment, and whose current pregnancy was first or unplanned were less likely to supplement with FA. Education programs are needed to encourage FA supplementation when contemplating pregnancy.

Physical Activity During Pregnancy is Associated with Improved Breastfeeding Outcomes: A Prospective Cohort Study.

Physical activity is important for health, but little is known about associations between physical activity during pregnancy and breastfeeding. The aim of this study was to investigate any association between antenatal physical activity and breastfeeding duration. A prospective cohort of 2030 Vietnamese women, recruited between 24 and 28 week-gestation was followed up to twelve months postpartum. Physical activity was determined using the pregnancy physical activity questionnaire at baseline interview. Data was available for 1715 participants at 12 months, a 15.5% attrition rate. At 12 months 71.8% of mothers were still breastfeeding. A total of 20.9% women met physical activity targets and those mothers undertaking higher levels of physical activity had a lower risk of breastfeeding cessation by twelve months [hazard ratios HR = 0.59 (95% CI 0.47-0.74), p < 0.001, and HR = 0.74 (0.60-0.92), p = 0.006; respectively] when compared to the lowest tertile. Similarly, women with increased levels of physical activity have higher rates of breastfeeding at twelve months, compared to the lowest level [odds ratio OR = 1.71 (95% CI 1.29-2.25) and 1.38 (1.06-1.79)]. Higher levels of physical activity by pregnant women are associated with improved breastfeeding outcomes.

The Early Introduction of Complementary (Solid) Foods: A Prospective Cohort Study of Infants in Chengdu, China.

The objective of this study was to document the types of foods introduced to infants before six months of age and identify factors associated with their early introduction. A prospective cohort study of infant feeding for the first six months after birth was undertaken in the city of Chengdu, PR China. The participants were 845 mothers who delivered their infants in hospitals in Chengdu. Mothers were interviewed within 15 days of giving birth and were followed up with for six months. The outcome measures were the introduction of complementary foods to infants within four and six months postpartum. Complementary foods are defined as any food, whether manufactured or locally prepared, used as a complement to breast milk or infant formula. In this study the emphasis was on solids and not liquid foods. More than 94% of the infants were given complementary foods (semi-solid or solid foods) before the age of six months and 10% by four months. The most commonly introduced food was infant cereal, which was given to three quarters of the infants by six months. Multivariate analysis showed that maternal education level was a significant factor affecting the introduction of complementary foods before four months, adjusted odds ratio 2.983 (1.232⁻7.219), with the more educated mothers introducing complementary foods earlier. More antenatal and postnatal health promotion efforts are required to highlight the benefits of introducing solid foods later than is the current practice in Chengdu, at or close to six months of age. Further education is also required for training health professionals including pediatricians, midwives, and community health staff.

Dietary inflammatory index is associated with increased risk for prostate cancer among Vietnamese men.

OBJECTIVE: Inflammatory potential of diet, as measured by the dietary inflammatory index (DII), has consistently been associated with an increased risk for prostate cancer (PCa). However, data has largely been reported in populations with more proinflammatory dietary patterns, whereas there is high diversity in dietary pattern worldwide. The aim of this study was to assess the association between DII scores and the risk for PCa in Vietnam. METHODS: A case-control study of 652 participants (244 incident PCa patients, 64-75 y of age, and 408 controls, frequency matched for age) was conducted in Ho Chi Minh City, Vietnam, from 2013 to 2015. Habitual diet was ascertained using a validated food frequency questionnaire (FFQ), whereas other factors, including demographic and lifestyle characteristics, were assessed via face-to-face interviews. The daily intake of pro- and anti-inflammatory nutrients for each participant was calculated from the FFQ and used to estimate individuals' energy-adjusted DII (E-DII) scores. Multivariate-adjusted odds ratios (OR) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression models. RESULTS: Comparing the middle and highest versus lowest tertile of DII scores, there was an increased risk for overall PCa. The OR and associated 95% CI was 2.63 (1.61-4.37) and 3.35 (2.06-5.53), respectively (Ptrend < 0.01). Similar results were found for low-moderate and high-grade PCa. The respective ORs (95% CI) were 3.34 (1.66-7.13) and 5.29 (2.69-11.18), Ptrend < 0.001, and 2.51 (1.40-4.63) and 2.57 (1.43-4.73), Ptrend 0.006. CONCLUSION: A proinflammatory diet was associated with increased risk for PCa among Vietnamese men.

Postpartum weight retention in relation to gestational weight gain and pre-pregnancy body mass index: A prospective cohort study in Vietnam.

BACKGROUND: The prevalence of maternal overweight and obesity is increasing in Asia. This study prospectively investigated the association between pre-pregnancy body mass index (BMI), gestational weight gain (GWG) and 12-month postpartum weight retention (PPWR) in a large cohort of Vietnamese mothers. METHODS: Of the 2030 pregnant women recruited from three cities in Vietnam at 24-28 weeks of gestation, a total of 1666 mothers were followed up for 12 months after delivery and available for analysis. The outcome variable PPWR was determined by subtracting the pre-pregnancy weight from the 12-month postpartum measured weight, while GWG and pre-pregnancy BMI were classified according to the Institute of Medicine and WHO criteria for adults, respectively. Linear regression models were used to ascertain the association between pre-pregnancy BMI, GWG and PPWR accounting for the effects of plausible confounding factors. RESULTS: Both pre-pregnancy BMI and GWG were significantly associated with PPWR (P<0.001). The adjusted mean weight retention in underweight women before pregnancy (3.71kg, 95% confidence interval (CI) 3.37-4.05) was significantly higher than that in those with normal pre-pregnancy weight (2.34kg, 95% CI 2.13-2.54). Women with excessive GWG retained significantly more weight (5.07kg, 95% CI 4.63-5.50) on average at 12 months, when compared to mothers with adequate GWG (2.92kg, 95% CI 2.67-3.17). CONCLUSIONS: Being underweight before pregnancy and excessive GWG contribute to greater weight retention twelve months after giving birth. Interventions to prevent postpartum maternal obesity should target at risk women at the first antenatal visit and control their weight gain during the course of pregnancy.