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.

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.

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.

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.

Serotonin system genes contribute to the susceptibility to obesity in Black adolescents.

OBJECTIVE: The importance of the central and peripheral serotonin systems in regulating energy balance and obesity development has been highlighted in animal models. Yet, the role of both serotonin systems has not been systematically assessed in humans. The purpose of this study was to investigate the association of genes within both serotonin systems with obesity outcomes in black adolescents. METHODS: African-American adolescents (n = 1052) whose mothers participated the Memphis New Mother's Study were assessed. In total, 110 polymorphisms mapped to 10 serotonin genes were examined for their associations with standardized body mass index (BMI-z) scores and waist circumferences using generalized estimating equation models. RESULTS: Over 39% of adolescents were overweight or had obesity. Three single nucleotide polymorphisms (SNPs) within TPH2, HTR3B, and SLC6A4, were significantly associated with BMI-z scores (p < 1.7 × 10-3). Two SNPs in TPH2 were nominally associated with waist circumferences. One SNP in HTR2C was associated with BMI-z scores (p = 0.001) and waist circumferences (p = 0.005) only in girls. Tissue-specific expression indicates that three identified genes are predominantly expressed in the brain. CONCLUSION: The central serotonin system may play a key role in obesity development in black adolescents. Future studies are warranted to explore additional serotonin system genes and their potential obesogenic mechanisms in humans.

Gut hormones, adipokines, and pro- and anti-inflammatory cytokines/markers in loss of control eating: A scoping review.

Loss of control (LOC) eating is the defining feature of binge-eating disorder, and it has particular relevance for bariatric patients. The biomarkers of LOC eating are unclear; however, gut hormones (i.e., ghrelin, cholecystokinin [CCK], peptide YY [PYY], glucagon-like peptide 1 [GLP-1], and pancreatic polypeptide [PP]), adipokines (i.e., leptin, adiponectin), and pro- and anti-inflammatory cytokines/markers (e.g., high-sensitivity C-reactive protein [hsCRP]) are candidates due to their involvement in the psychophysiological mechanisms of LOC eating. This review aimed to synthesize research that has investigated these biomarkers with LOC eating. Because LOC eating is commonly examined within the context of binge-eating disorder, is sometimes used interchangeably with subclinical binge-eating, and is the latent construct underlying disinhibition, uncontrolled eating, and food addiction, these eating behaviors were included in the search. Only studies among individuals with overweight or obesity were included. Among the identified 31 studies, 2 studies directly examined LOC eating and 4 studies were conducted among bariatric patients. Most studies were case-control in design (n = 16) and comprised female-dominant (n = 13) or female-only (n = 13) samples. Studies generally excluded fasting total ghrelin, fasting CCK, fasting PYY, and fasting PP as correlates of the examined eating behaviors. However, there was evidence that the examined eating behaviors were associated with lower levels of fasting acyl ghrelin (the active form of ghrelin) and adiponectin, higher levels of leptin and hsCRP, and altered responses of postprandial ghrelin, CCK, and PYY. The use of GLP-1 analog was able to decrease binge-eating. In conclusion, this review identified potential biomarkers of LOC eating. Future studies would benefit from a direct focus on LOC eating (especially in the bariatric population), using longitudinal designs, exploring potential mediators and moderators, and increased inclusion of the male population.

Biological changes in the pregnancy-postpartum period and subsequent cardiometabolic risk-UPSIDE MOMS: A research protocol.

Multiple physiological changes occur in pregnancy as a woman's body adapts to support the growing fetus. These pregnancy-induced changes are essential for fetal growth, but the extent to which they reverse after pregnancy remains in question. For some women, physiological changes persist after pregnancy and may increase long-term cardiometabolic disease risk. The National Institutes of Health-funded study described in this protocol addresses a scientific gap by characterizing weight and biological changes during pregnancy and an extended postpartum period in relation to cardiometabolic risk. We use a longitudinal repeated measures design to prospectively examine maternal health from early pregnancy until 3 years postpartum. The aims are: (1) identify maternal weight profiles in the pregnancy-postpartum period that predict adverse cardiometabolic risk profiles three years postpartum; (2) describe immune, endocrine, and metabolic biomarker profiles in the pregnancy-postpartum period, and determine their associations with cardiometabolic risk; and (3) determine how modifiable postpartum health behaviors (diet, physical activity, breastfeeding, sleep, stress) (a) predict weight and cardiometabolic risk in the postpartum period; and (b) moderate associations between postpartum weight retention and downstream cardiometabolic risk. The proposed sample is 250 women. This study of mothers is conducted in conjunction with the Understanding Pregnancy Signals and Infant Development study, which examines child health outcomes. Biological and behavioral data are collected in each trimester and at 6, 12, 24, and 36 months postpartum. Findings will inform targeted health strategies that promote health and reduce cardiometabolic risk in childbearing women.

Associations between Dietary Patterns and Inflammatory Markers during Pregnancy: A Systematic Review.

Elevated inflammation in pregnancy has been associated with multiple adverse pregnancy outcomes and potentially an increased susceptibility to future chronic disease. How maternal dietary patterns influence systemic inflammation during pregnancy requires further investigation. The purpose of this review was to comprehensively evaluate studies that assessed dietary patterns and inflammatory markers during pregnancy. This review was guided by the Preferred Reporting Items for Systematic Review and Meta-Analyses. Included studies were sourced from EMBASE, PubMed, Web of Science, and Scopus and evaluated using The Quality Assessment Tool for Quantitative Studies. Inclusion criteria consisted of human studies published in English between January 2007 and May 2020 that addressed associations between dietary patterns and inflammatory markers during pregnancy. Studies focused on a single nutrient, supplementation, or combined interventions were excluded. A total of 17 studies were included. Despite some inconsistent findings, maternal diets characterized by a higher intake of animal protein and cholesterol and/or a lower intake of fiber were shown to be associated with certain pro-inflammatory markers (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF- α), IL-8, serum amyloid A (SAA), and glycoprotein acetylation (GlycA)). Future studies that explore a broader range of inflammatory markers in the pregnant population, reduce measurement errors, and ensure adequate statistical adjustment are warranted.

Eating patterns and unhealthy weight control behaviors are associated with loss-of-control eating following bariatric surgery.

BACKGROUND: Loss-of-control (LOC) eating is associated with poor weight-loss outcomes following bariatric surgery. It is not clear whether eating patterns (e.g., total number of daily meals/snacks, eating after suppertime, eating when not hungry) and unhealthy weight control behaviors (e.g., smoking, using laxatives) are associated with or predictive of LOC eating. OBJECTIVES: To examine whether eating patterns and unhealthy weight-control behaviors are associated with LOC eating and, if so, whether they predict LOC eating in bariatric patients. SETTING: Multicenter study, United States. METHODS: This is a secondary analysis of the Longitudinal Assessment of Bariatric Surgery-2 study. Assessments were conducted before surgery and at 12, 24, 36, 48, 60, and 84 months after surgery. Logistic mixed models were used to examine the longitudinal associations between eating patterns, unhealthy weight-control behaviors, and LOC eating. Time-lag techniques were applied to examine whether the associated patterns and behaviors predict LOC eating. RESULTS: The participants (n = 1477) were mostly women (80%), white (86.9%), and married (62.5%). At the time of surgery, the mean age was 45.4 ± 11.0 years and the mean body mass index was 47.8 ± 7.5 kg/m2. The total number of daily meals/snacks, food intake after suppertime, eating when not hungry, eating when feeling full, and use of any unhealthy weight-control behaviors were positively associated with LOC eating (P < .05). Food intake after suppertime, eating when not hungry, and eating when feeling full predicted LOC eating (P < .05). CONCLUSION: Meal patterns and unhealthy weight control behaviors may be important intervention targets for addressing LOC eating after bariatric surgery.