Physical activity during pregnancy is associated with a lower prevalence of gestational diabetes mellitus in Vietnam.

AIMS: To assess the association between physical activity (PA) during pregnancy and the prevalence of gestational diabetes mellitus (GDM) accounting for sitting time. METHODS: The study used data from a cohort study of 2030 pregnant women in Vietnam. Women were recruited from six hospitals in Ha Noi, Hai Phong, and Ho Chi Minh City. Baseline measurements including PA and GDM were taken at 24-28 weeks of gestation. PA was assessed during the past 3 months before the interview using the interviewer-administered Pregnancy Physical Activity Questionnaire. GDM was diagnosed at 24-28 weeks of gestation using the 2013 World Health Organization criteria. RESULTS: 1987 out of 2030 pregnant women were included in the final analysis, of which 432 had GDM (21.7%). Women undertaking the highest level (upper tertile) of PA during pregnancy appeared to have a lower risk of GDM [odds ratio (OR) 0.70, 95% confidence interval (CI) 0.53-0.94, Ptrend 0.017] when compared to those at the lowest tertile of PA. Similarly, women with increased levels of moderate-intensive activity and household/caregiving activity during pregnancy were associated with reduced risks of GDM (OR 0.66, 95% CI 0.50-0.86, Ptrend 0.002 and OR 0.72, 95% CI 0.55-0.95, Ptrend 0.020, respectively). These apparent inverse associations were not attenuated by their sitting time. There were no significant associations between sitting time, light-intensity activity, vigorous-intensity activity, occupation, sports/exercise, commuting, or meeting exercise guidelines and GDM risk. CONCLUSIONS: High levels of PA, particularly moderate-intensity and household/caregiving activities during pregnancy were associated with a lower prevalence of GDM independent of sitting time.

Soyfood and isoflavone intake and risk of type 2 diabetes in Vietnamese adults.

BACKGROUND/OBJECTIVES: Animal studies have demonstrated that soy isoflavones exert antidiabetic effects. However, evidence regarding the association between soyfood intake, a unique source of isoflavones, and type 2 diabetes remains inconclusive. This study assessed the relationship between habitual intakes of soyfoods and major isoflavones and risk of type 2 diabetes in Vietnamese adults. SUBJECTS/METHODS: A hospital-based case-control study was conducted in Vietnam during 2013-2015. A total of 599 newly diagnosed diabetic cases (age 40-65 years) and 599 hospital-based controls, frequency matched by age and sex, were recruited in Hanoi, capital city of Vietnam. Information on frequency and quantity of soyfood and isoflavone intake, together with demographics, habitual diet and lifestyle characteristics, was obtained from direct interviews using a validated and reliable questionnaire. Unconditional logistic regression analyses were performed to examine the association between soy variables and type 2 diabetes risk. RESULTS: Higher intake of total soyfoods was significantly associated with a lower risk of type 2 diabetes; the adjusted odds ratio (OR) for the highest versus the lowest intake was 0.31 (95% confidence interval (CI): 0.21-0.46; P<0.001). An inverse dose-response relationship of similar magnitude was also observed for total isoflavone intake (OR: 0.35; 95% CI: 0.24 to 0.49; P<0.001). In addition, inverse associations of specific soyfoods (soy milk, tofu and mung bean sprout) and major isoflavones (daidzein, genistein and glycitein) with the type 2 diabetes risk were evident. CONCLUSIONS: Soyfood and isoflavone intake was associated with a lower type 2 diabetes risk in Vietnamese adults.

Consumption of a whey protein-enriched diet may prevent hepatic steatosis associated with weight gain in elderly women.

BACKGROUND AND AIMS: Protein consumption has been associated with cardio-metabolic benefits, including weight loss and improved insulin sensitivity, and may have potential benefits for individuals with fatty liver disease (FLD). We investigated the effect of increasing dietary protein intake from whey relative to carbohydrate on hepatic steatosis. METHODS AND RESULTS: A two-year randomized, double-blind, placebo-controlled trial of 30 g/day whey protein-supplemented beverage (protein) or an energy-matched low-protein high-carbohydrate beverage (control) for cardio-metabolic and bone health in 219 healthy elderly women, recruited from the Western Australian general population. Hepatic steatosis was quantified using computed tomographic liver-to-spleen (L/S) ratio. FLD was defined as liver-to-spleen difference <10 Hounsfield units. At baseline, FLD prevalence was 11.4%. Control and protein groups were similar in body mass index (BMI), insulin resistance, L/S ratio and FLD prevalence at baseline. At two-years, dietary protein increased by 20 g in the protein, but not the control, group. Total energy intake and physical activity remained similar between groups. At two-years, BMI and FLD prevalence increased in both groups, with no between group differences. L/S ratio increased in control, but not protein, group at two-years, with no between group differences. In a within group comparison, change in BMI correlated with changes in L/S ratio in control (r = 0.37, P = 0.0007), but not with protein group (r = 0.04, P = 0.73). CONCLUSION: Increasing dietary protein intake from whey relative to carbohydrate does not reduce weight, hepatic steatosis or the prevalence of FLD in elderly women. However, it may prevent worsening of hepatic steatosis associated with weight gain. CLINICAL TRIALS REGISTRATION: Australian New Zealand Clinical Trials Registry (Registration no. ACTRN012607000163404).

RECENT TRENDS IN GENDER RATIO AT BIRTH IN HANGZHOU, CHINA.

INTRODUCTION: Higher than normal sex ratios at birth in China have been reported since the early 1980's. This study aimed to investigate recent trends in sex ratio at birth in Hangzhou, capital of Zhejiang Province in southeast China. METHODS: Information on selected maternal and birth-related characteristics was extracted from the Hangzhou Birth Information Database for all pregnant women who delivered live births during 2005-2014. The sex ratios at birth were calculated after excluding infants with missing data on gender and those born with ambiguous genitalia. RESULTS: A total of 478,192 male births and 430,852 female births were recorded giving an overall ratio of 111.0. The sex ratio at birth was almost constant at around 110.7 during the period 2005-2008, followed by an increase to the peak at 113.1 in 2010 and then declined back to 109.6 in 2014. CONCLUSION: The gender ratio at birth in Hangzhou remained unbalanced for the past decade.

Fruit and vegetable consumption and risk of esophageal cancer: a case-control study in north-west China.

The north-western region of China carries a big burden of esophageal cancer with incidence above the national average. This study ascertained the association between fruit and vegetable consumption and the risk of esophageal cancer in this remote part of China. A case-control study was undertaken in Urumqi and Shihezi, Xinjiang Uyghur Autonomous Region of China, between 2008 and 2009. Participants were 359 incident esophageal cancer patients and 380 hospital-based controls. Information on habitual fruit and vegetable consumption was obtained by face-to-face interview using a validated semiquantitative food frequency questionnaire. Unconditional logistic regression analyses were performed to assess the strength of the associations. The esophageal cancer patients consumed significantly less fruits (mean 364.3, standard deviation [SD] 497.4 g) and vegetables (mean 711.4, SD 727.9 g) daily than their counterparts without the disease (mean 496.5, SD 634.4 g and mean 894.5, SD 746.1 g, respectively). The adjusted odds ratios were 0.48 (95% confidence interval 0.33-0.71) and 0.46 (95% confidence interval 0.32-0.68) for consuming at least 515 g of fruits and 940 g of vegetables per day, respectively, relative to at most 170 g and 520 g. With respect to nutrients contained in fruits and vegetables, intakes of vitamin C, vitamin E, ß-cryptoxanthin, potassium, and magnesium at high levels also reduced the esophageal cancer risk. In conclusion, inverse associations were evident between consumption of fruits and vegetables and the risk of esophageal cancer for adults residing in north-west China.

Under-reporting of energy intake in elderly Australian women is associated with a higher body mass index.

OBJECTIVES: Identify the extent of under-reporting of energy intake and the characteristics associated with implausible intakes in elderly women. DESIGN: Dietary intake was assessed using a 3-day weighed food record. Protein intake was validated by 24-hour urinary nitrogen. To examine under-reporting, participants were grouped according to their energy intake and compared to the Goldberg cut-off equation. Logistic regression was performed to assess the influence of body mass index (BMI) and social-demographic factors on under-reporting. SETTING: Community dwelling elderly women from Perth, Western Australia. PARTICIPANTS: 217 elderly women aged 70-80 years. RESULTS: Under-reporters had a higher physical activity level (p<0.001) compared with acceptable-reporters. The under-reporters also had a higher body weight (p=0.006), body mass index (BMI) (p=0.001), waist (p=0.011), hip circumference (p<0.001), whole body fat mass (p<0.001) and percentage body fat (p<0.001) than acceptable-reporters. Under-reporters had a significantly lower intakes of protein, fat, carbohydrate and alcohol (p<0.001) and fewer reported food items, compared with acceptable reporters. However, 24-hour urinary nitrogen was only marginally different between the two groups (p=0.053). Participants with a higher BMI were more likely to under-report their energy intake (BMI=25-29.9: odds ratio=2.98[95% CI=1.46-6.09]; BMI≥30: 5.84[2.41-14.14]). CONCLUSION: Under-reporting energy intake in elderly women was associated with a higher BMI, body fat and higher self-reported physical activity levels. A higher BMI (≥25) appears to be most significant factor in determining if elderly women will underreport their food intake and may be related to body image. These results have implications for undertaking surveys of food intake in elderly women.

GROWTH AND NUTRITIONAL STATUS OF THE FIRST SIX MONTHS OF LIFE AMONG SELECTED HOSPITALS--NAIROBI PROVINCE.

BACKGROUND: Exclusive breastfeeding for infants is recommended for the first six months for optimal health, development and growth. However, there is limited data on infant feeding practices and nutrition status of infants in Nairobi. OBJECTIVE: To assess infant growth and nutritional status and compare with feeding practices in the first six months of life in selected hospitals, Nairobi Province. DESIGN: Prospective cohort design SETTING: Five major hospitals in Nairobi namely; The Aga Khan, Pumwani Maternity, Mater Misercordiae, St Mary's Langata and Jamaa Hospitals. SUBJECTS: A sample of 692 mother-infant pairs were recruited at birth and followed up until six months. INTERVENTION: There was no direct experimental intervention, but there was observation of infant feeding practices, weight and height measurement was recorded every four weeks and determination of nutrition status of the infants for a period of six months. MAIN OUTCOME MEASURES: Nutritional status and infant feeding practices in the first six months. RESULTS: Slightly more than half (58.8%) of the mothers were formally employed and the rest were self employed. The mean age of the mothers was 28.3 ± 4.9 years. The mean income was KES 26,360 ± 34,696. The mean birth weight of infants was 3.24 ± 0.43 kg and 53.3% of all infants were male. Above 80% of infants were within normal weight based on weight for age Z-scores (WAZ) at 6, 10, 14 and 23 weeks. The prevalence of overweight based on WAZ was 9.5%, 11.6%, 11.9% and 11% at 6, 14, 19 and 23 weeks, respectively. There were no significant (P > 0.05) differences in WAZ between infants on different feeding methods. CONCLUSIONS: There was no significant difference in weight or length gain among children that were fully breastfed in comparison to those who were given infant formula or had mixed feeding. However, there was concern over the proportion of overweight infants, as the condition may lead to long term health problems.

Mortality rate of alcoholic liver disease and risk of hospitalization for alcoholic liver cirrhosis, alcoholic hepatitis and alcoholic liver failure in Australia between 1993 and 2005.

BACKGROUND: Alcoholic liver disease (ALD) is an important contributor to the total burden of alcohol-related harm; however, the morbidity of different types of ALD in Australia has not been described. The aim of this study was to investigate recent trends in hospital admission rates among alcoholic liver cirrhosis, alcoholic hepatic failure and alcoholic hepatitis in Australia, as well as the mortality of ALD. METHOD: This is a population-based cohort study including the total 15+ years Australian population. Data were obtained from the Australian Bureau of Statistics and the Australian Institute of Health and Welfare. MAIN OUTCOME MEASURES: (i) trend of standardized mortality rates and trend of standardized hospital admission rates for males and females for 1993/1994-2004/2005 (fiscal year), (ii) relative risk of alcoholic liver cirrhosis, alcoholic hepatic failure and alcoholic hepatitis hospital admissions for 1999/2000-2004/2005. RESULTS: The mortality rate of ALD decreased significantly. Significant increases in hospital admissions for alcoholic hepatic failure among older adults and alcoholic hepatitis among younger age groups were observed. There is a significant 10-fold increase in the risk of hospital admissions of alcoholic cirrhosis in 2002/2003 for the 20-29 years population. CONCLUSION: Reductions in overall ALD mortality observed are likely the result of advances in disease management. Significant increase in hospital admissions suggests an increase in the prevalence of ALD among the Australian population. Dramatic increases in hospital admissions for alcoholic cirrhosis in 2002/2003 for the 20-29 years population may have been due to an increase in screening of alcohol-related harms in primary care settings.

The effectiveness of health promotion materials and activities on breastfeeding outcomes.

AIM: To determine the effect of mothers receiving health promotion material and education antenatally and/or postnatally on breastfeeding outcomes in Perth, Western Australia. METHODS: A 12-month longitudinal study was conducted in two public maternity hospitals in Perth, Western Australia, between 2002 and 2003. Data were collected on a consecutive sample 587 mothers. RESULTS: The results showed that mothers who received an individual consultation or were involved in a discussion on breastfeeding antenatally with hospital staff were approximately 55% less likely to cease fully breastfeeding (HR 0.44; 95% CI 0.24-0.88) before 6 months, and 50% less likely to cease any breastfeeding before 12 months postnatally (HR 0.51; 95% CI 0.28-0.92). In the postnatal period, mothers who received instruction on positioning and attachment of the infant to the breast while in hospital were approximately 30% less likely to cease fully breastfeeding before 6 months (HR 0.66; 95% CI 0.45-0.99). CONCLUSION: The results of this study suggest a positive association between receiving individualized breastfeeding information in both the antenatal and postnatal period, and breastfeeding outcomes.

Hepatitis B and breastfeeding in Hangzhou, Zhejiang Province, People's Republic of China.

OBJECTIVE: This study examined infant feeding methods in hepatitis B-positive mothers in Zhejiang Province, People's Republic of China. METHODS: A cohort study was undertaken in Hangzhou in Zhejiang Province. A sample of 638 mothers was recruited at birth from the city of Hangzhou and was followed up until their infants were 6 months of age. RESULTS: Chronic hepatitis B is a continuing public health issue in pregnant women. Breastfeeding is the foundation of infant nutrition, sets the scene for lifetime health, and is important for all mothers. In the Hangzhou cohort of 638 mothers, 38 were identified as hepatitis B positive, a rate of 6.0%. All of the infants of the hepatitis B-positive mothers were fed on formula immediately after birth while their breastmilk was tested for virus transmission and their infants were vaccinated. At 1 month of age 61.8% of the hepatitis B-positive mothers were breastfeeding compared to 92% of the remainder of the cohort. The rates at 3 months were 60.6% and 89% and at 6 months were 45.5% and 64%, respectively. The hazard ratio for hepatitis B-positive mothers discontinuing breastfeeding before 6 months was 3.69 (95% confidence interval, 2.28, 5.98). CONCLUSIONS: The World Health Organization recommends that all mothers who are hepatitis B positive breastfeed their infants and that their infants be immunized at birth. In this study breastfeeding rates of hepatitis B-positive mothers were substantially less than those of the other mothers.

The effect of pre-lacteal feeding on full breastfeeding in Nairobi, Kenya.

OBJECTIVE: To assess the effect of pre-lacteal feeding on full breastfeeding in the first six months of life in selected hospitals, Nairobi Province. Pre-lacteal feeding has been internationally discouraged because of its negative effect on the duration of breastfeeding. METHODS: A prospective cohort design was used with a sample of 692 mother-infant pairs recruited at birth and followed up until 6 months of age. The sample was drawn from five major hospitals in Nairobi. Data was analyzed using the SPSS computer software. Descriptive analysis was used on all variables. Chi-test was used for univariate analysis. Logistic regression analysis was used to determine the effect of pre-lacteal feeding on full breastfeeding. RESULTS: Slightly more than half (58.8%) of the mothers were formally employed and their mean age was 28.3 +/- 4.9 years. The mean income was KES 26,360 +/- 34,696. The mean birth weight of the infants was 3.24 +/- 0.43 kg and 53.3% were males. The prevalence of pre-lacteal feeding was 26.8% (95% CI 23.5%-30.1%). The most common pre-lacteal feeds used at all hospitals were infant formula and glucose solution. There were significant (P < 0.05) differences across the five study hospitals in this practice. In one hospital nearly all (93%) infants received a pre-lacteal feed. The use of pre-lacteal feeding was significant predictor for early cessation of full breastfeeding at 6, 10, 14 and 19 weeks. CONCLUSIONS: The practice of giving pre-lacteal feeds is a key determinant of early cessation of full breastfeeding. Some hospitals do not appear to be adhering to international recommendations on infant feeding. Polices to promote exclusive and full breastfeeding are necessary to enable infants to attain optimal health and lead to achievement of the Millennium Development Goals in our settings.

High incidence of respiratory infections in 'nil by mouth' tube-fed acute ischemic stroke patients.

BACKGROUND: Respiratory infections are common in acute stroke. Previous studies have found dysphagia is associated with respiratory infections. Of interest is whether patients who are 'Nil by Mouth' (NBM) and tube fed have higher risk of developing infections due to aspiration of bacteria-laden saliva or refluxed material than stroke patients who are fed orally. METHODS: Prospective cohort of 330 ischemic stroke survivors were followed for 30 days and infections recorded. RESULTS: 115 infections were treated with antibiotics; these included 51 respiratory infections. Incidence of infection in NBM tube-fed stroke patients (n = 74) was 69%, with 30 respiratory infections occurring in 74 patients who received enteral feeding after stroke. Logistic regression analysis showed tube feeding during admission was a significant risk for respiratory infection. We also saw a significant time-to-event effect with 73% (22/30) respiratory infections in tube-fed survivors diagnosed on days 2-4 after stroke, and 76% (39/51) of infections in all tube-fed survivors occurring by day 7 after stroke. Relevance to a theory of critical period of susceptibility to infection in acute stroke is discussed. CONCLUSIONS: NBM tube-fed survivors were unlikely to have aspirated anything other than saliva/secretions or reflux, yet experienced significantly higher rates of respiratory infections than survivors fed orally. Stringent oral care and measures to prevent reflux are potentially modifiable aspects of stroke management.

Prenatal iron supplementation in rural Vietnam.

OBJECTIVE: To assess the potential impact of a national iron supplementation programme in rural Vietnam. METHODS: The study included questionnaires, focus group discussions of pregnant women and key informant interviews, together with measurements of haemoglobin (Hb) and a stool examination for soil-transmitted helminths. RESULTS: Iron supplementation significantly increased Hb concentration among participants in the second and third trimesters by 0.4 and 0.7 g/dl, respectively (P=0.017 and P<0.001). The risk of anaemia (Hb <10.0 g/dl) was increased significantly by hookworm infestation (P=0.041) and in summer season (P=0.001) and was decreased significantly by taking iron tablets (P=0.041). CONCLUSIONS: The results of this study show that an iron supplementation programme is beneficial as a part of a comprehensive anaemia programme for pregnant women in these communities. These results will be useful for developing improved iron-deficiency anaemia control programs for pregnant women.

The acute effects of psyllium on postprandial lipaemia and thermogenesis in overweight and obese men.

Overweight and obesity is one of the risk factors for developing CVD. At present, very little is known about the acute effects of dietary fibre on lipids, glucose and insulin, resting energy expenditure and diet-induced thermogenesis in overweight and obese individuals. This study examined the postprandial metabolic effects of dietary fibre in overweight and obese men. Ten overweight and obese men consumed a mixed meal accompanied by either a high-fibre or low-fibre supplement on two separate visits, in a random order, 1 week apart. Two isoenergetic breakfast meals with similar composition were consumed by ten overweight/obese men. The meals contained either a low (3 g) or high (15 g) amount of fibre, low-fibre meal (LFM) and high-fibre meal (HFM) respectively. Analysis was carried out using paired t test and ANOVA. Serum TAG incremental area under the curve during 6 h of the postprandial period was significantly lower after the consumption of HFM compared with LFM. At the first hour of the postprandial period, plasma apo B48 concentration after consumption of HFM was significantly lower compared with LFM. The resting energy expenditure and diet-induced thermogenesis after both meals was similar during 6 h of the postprandial period. Collectively, these findings suggest that a single acute dose of dietary fibre in the form of psyllium supplement can decrease arterial exposure to TAG and modify chylomicron responses in the postprandial period.

A comparison of body perceptions in relation to measured body composition in young Japanese males and females.

The body composition of 139 Japanese females and 84 Japanese males (aged 18-30 years) was measured using anthropometry to assess gender differences in body perceptions in relation to their measured values. Participants were asked to rate perceptions of their own "heaviness" and "fatness" and these were compared to their BMI and percent body fat (%BF). Japanese females showed a significantly greater desire to lose body weight (-4.20+/-0.6 kg) compared to males (0.27+/-1.4 kg). Females also showed poor understanding of their "heaviness" and "fatness" in relation to actual body composition compared to males. The results confirmed distinct gender differences in body perception in relation to actual body composition and attitudes to weight management. Further promotion of "healthy" body image is recommended for the Japanese population.

The CUPDAY Study: prebiotic-probiotic milk product in 1-3-year-old children attending childcare centres.

AIM: The aim of the study was to evaluate the efficacy of a milk product containing probiotics and prebiotics (CUPDAY Milk) on the incidence of diarrhoea in children attending daycare centres. METHODS: The study was undertaken in a randomized controlled trial with 496 children aged 1-3 years attending 29 childcare centres in Perth, Australia. The endpoint for the study was the number of days in which children were recorded as having four or more stools. The diarrhoeal rates were analyzed by Poisson regression using 'intention to treat' (all children) and 'reduced' (children enrolled for more than 10 days) data sets. RESULTS: There was no difference in demographic characteristics between the case and control groups. In the 'intention to treat' analysis, a total of 41 745 child-days were included in the study. The adjusted risk ratio for those consuming the 'Cupday' milk drink was 0.82 (95% CI 0.73-0.94) for the intention to treat sample (n = 496) and 0.80 (95% CI 0.70-0.91) for the reduced sample (n = 315). The children consuming the 'Cupday' drink had a 20% reduction in the number of days experiencing four or more stools per day. CONCLUSION: A milk containing probiotics and prebiotics reduced the number of days children attending child care who had four or more stools by 20%.

Patterns of alcohol intake of pregnant and lactating women in Perth, Australia.

INTRODUCTION AND AIMS: Australian alcohol consumption data for women during the period of pregnancy and lactation is limited. The purpose of this paper is to provide current alcohol consumption data for pregnant and lactating women in Perth, Western Australia (WA). Data were collected from 587 women between mid-September 2002 and mid-July 2003. DESIGN AND METHODS: Women from two public hospitals with maternity wards in the Perth metropolitan area completed a self-administered baseline questionnaire while in hospital or shortly after discharge. All women, regardless of their chosen infant feeding method, were followed-up by telephone interview at 4, 10, 16, 22, 32, 40 and 52 weeks postpartum. Data were analysed to determine alcohol use patterns of the women during the period of pregnancy and lactation and results were compared to national guidelines for alcohol consumption. RESULTS: Approximately 32% of women stopped drinking alcohol during pregnancy. A remaining 35% of pregnant women consumed alcohol during pregnancy, with 82.2% of these women consuming up to two standard drinks per week. At 4, 6 and 12 months postpartum, 46.7%, 47.4% and 42.3% of breastfeeding women were consuming alcohol, respectively. DISCUSSION AND CONCLUSIONS: The majority of breastfeeding women consumed up to two standard drinks per week, which is within levels recommended by national authorities. There is, however, a small proportion of women consuming alcohol at levels above national recommendations for pregnancy and lactation. The development of 'safe' alcohol intake practices, within national recommendations, during the postnatal period would remove any potential health risks to the infant from alcohol exposure at this vulnerable growth stage.

Which mothers smoke before, during and after pregnancy?

OBJECTIVE: To investigate the sociodemographic factors associated with cigarette smoking in women before, during and after pregnancy. STUDY DESIGN: A 12-month longitudinal study. METHOD: All eligible mothers at two public maternity hospitals in Perth, Australia were asked to participate in a study of infant feeding. While in hospital, participating mothers completed a self-administered baseline questionnaire. Follow-up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks. Data collected included sociodemographic, biomedical, hospital-related and psychosocial factors associated with the initiation and duration of breastfeeding. RESULTS: A total of 587 (55%) mothers participated in the study. Thirty-nine percent of mothers reported smoking pre-pregnancy. Mothers who smoked were more likely to have a partner who smoked and to have consumed alcohol prior to pregnancy, and less likely to have attended antenatal classes. They were also less likely to have known how they were going to feed their baby before conception and likely to be more inclined to consider stopping breastfeeding before four months postpartum. CONCLUSIONS: Having a partner (father of the newborn infant) who smoked and maternal alcohol consumption prenatally were factors associated with pre-pregnancy smoking. In addition, if a woman decided how she would feed her infant before the pregnancy occurred and intended to breastfeed for longer than four months she was less likely to smoke in the prenatal period. Having a father (of the newborn infant) who smoked during pregnancy continued to be a factor significantly associated with maternal smoking in the antenatal and postnatal period. Not attending antenatal classes and not intending to breastfeed for longer than four months were also factors associated with maternal smoking. At ten weeks postpartum being of Caucasian origin and having a low Iowa Infant Feeding Attitude Score were factors significantly associated with smoking postnatally.

The infant feeding practices of mothers in the Maldives.

OBJECTIVE: To document the infant feeding practices of Maldivian mothers. METHODS: A cross-sectional survey of 251 Maldivian mothers recruited in 2004 from the 'well baby' or 'well child' clinics on the island of Male' and including 75 mothers from three other islands, Hura, Himmafushi and Thulusdhoo. RESULTS: The full breast-feeding rate at hospital discharge was 93% but declined to 41% at 4 months. Any breast-feeding rates were high among Maldivian mothers: 100% at 1 month and 85% were still breast-feeding at 6 months. The median duration of breast-feeding was 24 months. CONCLUSION: Breast-feeding rates are high and the average duration of breast-feeding is more than 2 years in the Maldives. Health promotion activities should be directed towards maintaining the already high 'any breast-feeding' rates and increasing the proportion of infants exclusively breast-fed to 6 months.

Trends in the expression of breastmilk 1993-2003.

The expression of breastmilk is an important strategy to enable mothers to continue exclusive breastfeeding. In some situations, for health or convenience, expressed breastmilk is required and infants fed this way still fall within the definition of exclusive breastfeeding. The aim of this study was to document the changes in rates of breastmilk expression between the first Perth Infant Feeding Study (PIFS I) in 1992-03 and PIFS II in 2002-03. The proportion of mothers expressing breastmilk peaked in the first six weeks, at 38% for PIFS I and 69% for PIFS II. The proportion of mothers who had expressed breastmilk had almost doubled in the decade between studies. The proportion of mothers expressing declined to about 28% of mothers at 22 weeks for PIFS II and slightly less in PIFS I. Breastmilk expression is a very useful skill to allow mothers to exclusively breastfeed until six months and should be taught to all mothers.