Relationship among chrononutrition, sleep, and glycemic control in women with gestational diabetes mellitus: a randomized controlled trial.

BACKGROUND: Gestational diabetes mellitus is associated with an increased risk of maternal, fetal, and neonatal morbidities. Chronobiological disorders have recently been identified as risk factors for those morbidities. The disorders include chrononutritional disorders related to meal frequency and content according to the sleep-wake cycle, sleep disorders related to sleep quality, and chrono-obesity disorders, such as abnormal weight gain because of sleep deprivation and time of eating. OBJECTIVE: This study aimed to assess whether a chrononutritional and sleep hygiene intervention can improve maternal glycemic control and reduce the proportion of large-for-gestational-age newborns among women with gestational diabetes mellitus. STUDY DESIGN: This randomized controlled trial included 103 women with gestational diabetes mellitus who were carrying a singleton fetus and assigned to either the intervention group (n=33) or the control group (n=70). The intervention group was assigned to a chrononutrition and sleep hygiene program, in addition to the usual care for gestational diabetes mellitus, from the time of diabetes mellitus diagnosis to birth, whereas the control group received the usual gestational diabetes mellitus care. RESULTS: The chrononutritional and sleep hygiene intervention significantly reduced the proportion of women with suboptimal glycemic control (<80% of the plasma glucose values at target), after adjustment for maternal age, prepregnancy body mass index, gravidity, history of gestational diabetes mellitus, and large for gestational age (relative risk, 0.28; 95% confidence interval, 0.18-0.81). The effect of the intervention on balancing maternal glycemic control was mainly because of the decreased carbohydrate intake in the evening interval of the day (relative risk, 0.8; 95% confidence interval, 0.64-0.99). However, the intervention had no effect on the proportion of large-for-gestational-age newborns. CONCLUSION: The chrononutritional and sleep hygiene intervention can improve maternal glycemic control.

Nutrigenetic impact of daily folate intake on plasma homocysteine and folate levels in patients with different methylenetetrahydrofolate reductase genotypes.

BACKGROUND: Elevated plasma homocysteine level is associated with coronary artery disease (CAD). Homozygosity for the C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene is typically but inconsistently associated with hyperhomocysteinemia. We examined the impact of daily intake of folate, a co-factor in homocysteine metabolism, on plasma homocysteine and folate levels in CAD patients in relation with MTHFR genotypes. METHODS: Daily folate intake was assessed from 3-day food records in 99 patients with CAD: 35 with the T/T (homozygous mutant) genotype and 64 with the C/C or C/T (non-T/T) genotypes. RESULTS: Patients with the T/T genotype had higher fasting plasma homocysteine levels (18.4±1.9 vs. 12.6±0.6 µmol/l, P=0.01) and lower plasma folate levels (17.8±1.7 vs. 20.8±1.0 nmol/l, P=0.02). There were no differences between the genotype groups in energy-adjusted folate intake. In patients with the non-T/T genotypes, higher folate intake was associated with higher plasma folate levels and lower plasma homocysteine levels. In T/T homozygotes this association was weaker. Linear regression analysis showed that folate intake, the MTHFR genotype, plasma vitamin B12 levels, and the interaction between plasma folate level and MTHFR genotype, predicted homocysteine elevation. (folate intake, P=0.04, MTHFR genotype, P=0.03, plasma folate, P=0.02, and plasma B12 level, P=0.004). The model explained only 29% of the variance in log-transformed plasma homocysteine levels. CONCLUSION: T/T homozygotes are more sensitive to the combination of low folate intake, low plasma folate and vitamin B12 level, than patients with non-T/T genotypes. The variability in plasma homocysteine in T/T homozygotes is only partly explained by these variables.

Self-reported health as a cultural health determinant in Arab and Jewish Israelis MABAT--National Health and Nutrition Survey 1999-2001.

Subjective health (SH) status serves as a measure of health in many studies of health-related issues as it is a good predictor of mortality, morbidity, and use of health services. The measure is used in many population groups. However, the degree to which it measures the same condition in different ethnic groups is not clear. Within Israel's first National Health and Nutrition Survey (MABAT) conducted during 1999-2001, face-to-face interviews were held with 3222 Israeli interviewees, 2379 Jews and 843 Arabs, aged between 25-64 years. Respondents reported their SH, co-morbidity, and other socioeconomic characteristics. Arabs reported higher levels of SH than Jews. In logistic regression analysis, co-morbidity was a much stronger correlate of poorer SH in the Arab than in the Jewish population. The association between socioeconomic variables depended on ethnic group and sex. The findings indicate that SH in Jews and Arabs does not necessarily have the same meaning in relation to objective measures of health, and caution should be exercised in the use of this measure in different population groups with different cultures. Arabs tend to evaluate health better than Jews even though life expectancy is lower and morbidity and mortality are higher in the former population group. Yet diagnosis of a disease increases the frequency of reporting lower SH, more in Arabs than in Jews.

Multiethnic differences in smoking in Israel: pooled analysis from three national surveys.

BACKGROUND: Smoking is a major public health risk and information regarding high-risk groups is needed to plan, implement and evaluate interventions aimed at lowering the number of smokers. METHODS: During the years 1999-2001 data was collected regarding the smoking behaviour of the Israeli population in three national surveys. All three surveys included ages 25-64 and two included also ages 21-25 and over 64. RESULTS: Smoking was associated with age, sex, ethnicity, education and religiosity after adjusting for the various demographic characteristics of the survey population. The prevalence of smoking among Arab and immigrant men from the former Soviet Union is higher than among Jewish men. Among women the opposite association exists. The older, religious and more educated reported smoking less frequently. In the Jewish population respondents, defining themselves as secular, reported higher rates of smoking. Only in women was marital status associated with smoking. A few specific high-risk groups for smoking can be identified such as young, less educated men, Arab men, single Jewish women and young immigrant men and women. CONCLUSIONS: The three ethnic groups residing in Israel differ in the prevalence of smoking; each has a distinct pattern of smoking, positioning them at different stages within the conceptual framework of the larger smoking pandemic. Ethnicity, religiosity, age and education are associated with smoking in both sexes. This calls for specific tailored interventions aimed at younger men with less education, Arab men, and young immigrants.

Ethnic differences in reported smoking behaviors in face-to-face and telephone interviews.

Different modes of gathering data on self-reported health measures and self-reported risk factors are used frequently in research. However, data on the influence of the mode of collection of data on self-reporting are limited. The aim of the study was to identify associations between the mode of data collection and self-reported smoking in two distinct ethnic groups, Jews and Arabs in Israel. During the last 2 years, data were collected in two national surveys regarding the smoking behaviors of Jews and Arabs in Israel. In the telephone surveys 4713 Israeli residents were interviewed and in the face-to-face interviewees 3239 people were interviewed. The interviewees were between the ages 25 and 64. There was no significant difference in smoking rates between face-to-face interviews and telephone interviews among Jewish men or women after adjusting for other variables associated with smoking. However, there was a difference between the two methods of data collection in the Arab population also after the adjustment. In this group, respondents tended to report more often being a smoker in the face-to-face interviews. This was especially apparent in Arab women. There was no significant difference in the reported number of cigarettes smoked in the two modes of data collection. In Arabs compared to Jews there is a significant difference between reporting smoking during a telephone interview and a face-to-face interview. The mode of data collection can affect comparisons between different groups.

Factors associated with age of smoking initiation in adult populations from different ethnic backgrounds.

BACKGROUND: The age at which the individual begins smoking may influence the health of smokers at an older age. Cultural and social factors effect the age of smoking initiation. METHODS: A cross-sectional national survey of a random sample of 6,021 Israeli residents over the age of 21 were interviewed by telephone. The sample consisted of 4248 Jews, 858 Arabs and 915 immigrants, 856 of them were from the former Soviet Union. RESULTS: Compared to the Jewish population the Jews who immigrated from the former Soviet Union began smoking at an earlier age and the Arabs started smoking at an older age. The young respondents in all ethnic groups reported starting to smoke at a younger age compared to the older respondents, and there was a decrease in smoking initiation at an older age. Father smoking during childhood predicted earlier age of smoking initiation but not mother or sibling smoking, significantly among Jews and immigrants and non-significantly among Arabs. CONCLUSIONS: Age of smoking initiation is dependent on the ethnic background in which the smokers grow up, however, the influence of the father smoking seems to be similar in all population groups. It seems that a higher percentage of young adults started smoking at an early age and there is a decrease in smoking initiation at older ages in all ethnic groups.