Quality of low-carbohydrate diets among Australian post-partum women: Cross-sectional analysis of a national population-based cohort study.

Low-carbohydrate diets (LCDs) are popular among people attempting weight loss and recommended for pregnant women with gestational diabetes (GDM), but they may increase health risks if nutritionally inadequate. We aimed to describe the dietary intake of post-partum women according to their relative carbohydrate intake, overall, and among women attempting weight loss or diagnosed with GDM in their recent pregnancy. This cross-sectional population-based cohort study included 2093 post-partum women aged 25-36 years who participated in the Australian Longitudinal Study on Women's Health. Dietary intake was assessed using a validated food frequency questionnaire. Relative carbohydrate intake was determined using a previously developed LCD score. Data were weighted to account for oversampling of women from rural/remote areas. More than half of women (n[weighted] = 1362, 66.3%) were trying to lose weight, and 4.6% (n[weighted]=88) had GDM in their recent pregnancy. Women with the lowest relative carbohydrate intake (LCD score quartile 4) consumed 36.8% of total energy intake from carbohydrates, and had a lower intake of refined grains, whole grains, fruit and fruit juice, and a higher intake of red and processed meat, compared with women with the highest relative carbohydrate intake (quartile 1). Different food groups, both healthy and unhealthy, were restricted depending on whether women were attempting weight loss and had recent GDM. These findings may reflect a lack of knowledge among post-partum women on carbohydrates and dietary guidelines. Health professionals may have an important role in providing advice and support for post-partum women who wish to restrict their carbohydrate intake, to ensure optimal diet quality.

The effect of dietary patterns on maternal anaemia in North Shewa, Ethiopia: A case-control study with Propensity Score Analysis.

OBJECTIVE: This study aimed to assess the effect of dietary patterns during pregnancy on anaemia. DESIGN, SETTING AND PARTICIPANTS: A case-control study with propensity score analysis was conducted among pregnant women selected from five health facilities in North Shewa Zone, Ethiopia from November 2018 to March 2019. A multivariable conditional logistic regression model was applied after propensity score matching to assess the effect of dietary patterns on anaemia, and a p < 0.05 was taken as significant. Four hundred and seventeen pregnant women were included (105 cases and 312 controls) with a 1:3 case-to-control ratio. Cases were pregnant women with a haemoglobin level <11 gram/Deci litter (g/dL), and controls were pregnant women with a haemoglobin level ≥11.0 g/dL. RESULTS: A low dietary diversity score (adjusted odd ratio (AOR) = 2.14; 95% confidence interval (CI): 1.24, 3.69), reducing food intake (AOR = 6.89; 95% CI: 3.23, 14.70) and having no formal education (AOR = 3.13; 95% CI: 1.18, 8.32) were associated with higher odds of anaemia among pregnant women. CONCLUSIONS: During pregnancy, intake of a low diversified diet, reduced food intake and low educational status were associated with higher odds of anaemia. Dietary counselling should be emphasised and strengthened in the existing prenatal health service program, with women strongly encouraged to increase their diversified food intake instead of reducing it during pregnancy.

The Impact of Modifying Food Service Practices in Secondary Schools Providing a Routine Meal Service on Student's Food Behaviours, Health and Dining Experience: A Systematic Review and Meta-Analysis.

The education sector is recognised as an ideal platform to promote good nutrition and decision making around food and eating. Examining adolescents in this setting is important because of the unique features of adolescence compared to younger childhood. This systematic review and meta-analysis examine interventions in secondary schools that provide a routine meal service and the impact on adolescents' food behaviours, health and dining experience in this setting. The review was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist and Cochrane Handbook recommendations. Studies published in English searched in four databases and a hand search yielded 42 interventions in 35 studies. Risk of bias was assessed independently by two reviewers. Interventions were classified using the NOURISHING framework, and their impact analysed using meta-analysis, vote-counting synthesis or narrative summary. The meta-analysis showed an improvement in students selecting vegetables (odds ratio (OR): 1.39; 1.12 to 1.23; p = 0.002), fruit serves selected (mean difference (MD): 0.09; 0.09 to 0.09; p < 0.001) and consumed (MD: 0.10; 0.04 to 0.15; p < 0.001), and vegetable serves consumed (MD: 0.06; 0.01 to 0.10; p = 0.024). Vote-counting showed a positive impact for most interventions that measured selection (15 of 25; 41% to 77%; p = 0.002) and consumption (14 of 24; 39% to 76%; p = 0.013) of a meal component. Interventions that integrate improving menu quality, assess palatability, accessibility of healthier options, and student engagement can enhance success. These results should be interpreted with caution as most studies were not methodologically strong and at higher risk of bias. There is a need for higher quality pragmatic trials, strategies to build and measure sustained change, and evaluation of end-user attitudes and perceptions towards intervention components and implementation for greater insight into intervention success and future directions (PROSPERO registration: CRD42020167133).

Population attributable fraction estimates for factors associated with different types of anaemia among women in Ethiopia: multilevel multinomial analysis.

OBJECTIVE: This study aimed to identify factors for different levels of anaemia among Ethiopian women and to estimate the population attributable fraction (PAF). DESIGN: This study was a detailed analysis of data of the 2016 Ethiopian Demographic and Health Survey data. Adjusted OR (AOR) with 95 % CI was computed using multilevel multinomial regression models, and the PAF were estimated using these AOR. SETTING: This study was conducted in Ethiopia. PARTICIPANTS: Women of reproductive age. RESULTS: The PAF showed that the proportion of mild anaemia cases attributable to having no formal education was 14·6 % (95 % CI 3·4, 24·5), high gravidity (≥4) was 11·2 % (95 % CI 1·2, 19·9) and currently breast-feeding was 5·2 % (95 % CI 0·0, 10·7). Similarly, the proportion of moderate-severe anaemia cases attributable to being in a rural residence was 38·1 % (95 % CI 15·9, 54·8); poorest wealth quantile, 12·6 % (95 % CI 2·9, 24·6); giving birth in the last 5 years, 10·5 % (95 % CI 2·9, 18·2) and unimproved latrine facilities, 17 % (95 % CI 0, 32·5). CONCLUSIONS: The PAF suggest that rural residency, low education, low wealth status, high parity, pregnancy and breast-feeding contribute substantially to the occurrence of anaemia among women in Ethiopia. Mild anaemia could be reduced by setting intervention strategies targeting women with low education, multigravida women and breast-feeding women, while preventing moderate-severe anaemia may require increasing income and improving living environments through the accessibility of hygienic latrines.

Managing Complex Healthcare Change: A Qualitative Exploration of Current Practice in New South Wales, Australia.

PURPOSE: As the cost of healthcare continues to rise, healthcare organizations internationally are seeking long-term solutions to eradicate inefficiency, achieve value-based healthcare, and minimize hospital inpatient services. This requires transformational change in healthcare organizations, and associated change management and leadership capability at multiple levels. Despite the critical need for effective change leadership and management in healthcare, limited evidence exists that this currently occurs in addition to the capability and capacity for managing change in health systems. METHODS: Semi-structured interviews were undertaken with 16 healthcare managers and leaders at a range of levels in nine healthcare organizations across the public health system of one Australian state (New South Wales), including metropolitan, regional and rural geographical areas. Thematic content analysis was undertaken with the emergent data. RESULTS: Four key themes emerged from the data: 1) lack of adoption of frameworks and methods for change management for any scope or scale of change, 2) inadequate resources for delivering, managing and leading change, 3) insufficient leadership, capacity and capability in managing change, and 4) the need for support and culture that supports change at all levels of the system. CONCLUSION: Ensuring dedicated resources for change and sufficient capacity and capability amongst health professionals and managers at every level in a health system are required for effective management of change. An enabling culture for change, supported by adequate education and training in change leadership and management are critical in order for the benefits of health service and system changes to be realised.

The effect of dietary patterns on hypertensive disorders of pregnancy in North Shewa, Ethiopia: A propensity score matched case-control study.

OBJECTIVE: This study aimed to assess the effect of dietary patterns during pregnancy on HDP. A propensity score matched case-control study was conducted with 340 pregnant women (71 cases and 269 controls) in North Shewa Zone, Ethiopia. Data were collected through an interviewer-administered questionnaire and maternal anthropometry measurements. After propensity score matching, a conditional logistic regression model was used to identify the independent predictors of HDP by adjusting for the confounders. A p-value of < 0.05 was taken as statistically significant. RESULTS: A high dietary diversity score (Adjusted Odd Ratio (AOR) = 0.45; 95% CI: 0.21, 0.93) was associated with a lower odds of HDP. Being merchant (AOR = 3.71 (95% CI: 1.16, 11.89), having previous history of HDP (AOR = 27.58; 95% CI: 4.53, 168.06) and high hemoglobin level (AOR = 2.26; 95% CI: 1.66, 3.09) were associated with an increased odds of HDP. Diet is an amendable factor, and the promotion of diversified diet is an important approach for preventing the occurrence of HDP. Women should be counselled to diversify their dietary intake to include a high amount of vegetables, legumes, and fruit.

Carbohydrate restriction in midlife is associated with higher risk of type 2 diabetes among Australian women: A cohort study.

BACKGROUND AND AIMS: Low-carbohydrate diets (LCDs) are increasingly popular but may be nutritionally inadequate. We aimed to examine if carbohydrate restriction in midlife is associated with risk of developing type 2 diabetes (T2DM), and if this association differs by previous gestational diabetes (GDM) diagnosis. METHODS AND RESULTS: Dietary intake was assessed for 9689 women from the Australian Longitudinal Study on Women's Health in 2001 (aged 50-55) and 2013 (aged 62-67) via validated food frequency questionnaires. Average long-term carbohydrate restriction was assessed using a low-carbohydrate diet score (highest quartile (Q4) indicating lowest proportion of energy from carbohydrates). Incidence of T2DM between 2001 and 2016 was self-reported at 3-yearly surveys. Log-binomial regression was used to estimate relative risks (RR) and 95% CIs. During 15 years of follow-up, 959 women (9.9%) developed T2DM. Carbohydrate restriction was associated with T2DM after adjustment for sociodemographic factors, history of GDM diagnosis and physical activity (Q4 vs Q1: RR 1.27 [95% CI 1.10, 1.48]), and this was attenuated when additionally adjusted for BMI (1.10 [0.95, 1.27]). Carbohydrate restriction was associated with lower consumption of fruit, cereals and high-fibre bread, and lower intakes of these food groups were associated with higher T2DM risk. Associations did not differ by history of GDM (P for interaction >0.15). CONCLUSION: Carbohydrate restriction was associated with higher T2DM incidence in middle-aged women, regardless of GDM history. Health professionals should advise women to avoid LCDs that are low in fruit and grains, and to consume a diet in line with current dietary recommendations.

The Role of Diet in the Prevention of Diabetes among Women with Prior Gestational Diabetes: A Systematic Review of Intervention and Observational Studies.

BACKGROUND: Women with prior gestational diabetes (GDM) have an increased lifetime risk of developing type 2 diabetes mellitus (T2DM). There are no up-to-date systematic reviews analyzing the relationship of diet with risk of developing T2DM following GDM. OBJECTIVE: To systematically review the evidence from intervention and observational studies on effects of dietary interventions and associations of dietary intake with T2DM outcomes in women with a GDM history. METHODS: Six electronic databases were searched (Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, Cochrane Central, Proquest, and Scopus) for articles published until May 2019. This review includes intervention and observational studies among women of any age with a history of GDM that reported on the effects of dietary interventions or association of dietary intake (energy, nutrients, foods, dietary patterns) with T2DM, impaired glucose tolerance, impaired fasting glucose, or prediabetes. RESULTS: The systematic review identified five articles reporting results from four intervention studies, and seven articles reporting results from four observational studies. Findings from intervention studies indicated trends toward beneficial effects of a low-glycemic index diet, a low-carbohydrate diet, and a diet in line with general population dietary guidelines, but studies had unclear or high risk of bias. Findings from two cross-sectional and one prospective study indicated poorer diabetes outcomes for women with higher intakes of branched-chain amino acids, total and heme iron, and a diet relatively low in carbohydrates and high in animal fat and protein, and better outcomes among those consuming diets rich in fruit, vegetables, nuts, fish, and legumes, and low in red and processed meats and sugar-sweetened beverages, after adjustment for confounders, including body mass index. CONCLUSIONS: Findings from observational studies support current dietary guidelines for the prevention of T2DM. Further dietary intervention studies are needed to confirm whether or not dietary modification following a GDM pregnancy reduces women's risk of developing T2DM.

Spatial distribution and determinant factors of anaemia among women of reproductive age in Ethiopia: a multilevel and spatial analysis.

OBJECTIVE: The aim of this study was to assess the spatial distribution and determinant factors of anaemia among reproductive age women in Ethiopia. METHODS: An in-depth analysis of the 2016 Ethiopian Demographic and Health Survey data was undertaken. Getis-Ord Gi* statistics were used to identify the hot and cold spot areas for anaemia among women of reproductive age. A multilevel logistic regression model was used to identify independent predictors of anaemia among women of reproductive age. RESULTS: Older age (adjusted OR [AOR]=0.75; 95% CI 0.64 to 0.96), no education (AOR=1.37; 95% CI 1.102 to 1.72), lowest wealth quantile (AOR=1.29; 95% CI 1.014 to 1.60), currently pregnant (AOR=1.28; 95% CI 1.10 to 1.51, currently breast feeding (AOR=1.09; 95% CI 1.025 to 1.28), high gravidity (AOR=1.39; 95% CI 1.13 to 1.69) and HIV positive (AOR=2.11; 95% CI 1.59 to 2.79) are individual factors associated with the occurrence of anaemia. Likewise, living in a rural area (AOR=1.29; 95% CI 1.02 to 1.63) and availability of unimproved latrine facilities (AOR=1.18; 95% CI 1.01 to 1.39) are community-level factors associated with higher odds of anaemia. The spatial analysis indicated that statistically high hotspots of anaemia were observed in the eastern (Somali, Dire Dawa and Harari regions) and north-eastern (Afar) parts of the country. CONCLUSION: The prevalence rate of anaemia among women of reproductive age varied across the country. Significant hotspots/high prevalence of anaemia was observed in the eastern and north-eastern parts of Ethiopia. Anaemia prevention strategies need to be targeted on rural residents, women with limited to no education, women who are breast feeding, areas with poor latrine facilities and women who are HIV positive.