Objective: To identify dietary factors related to the risk of gaining weight outside recommendations for pregnancy weight gain and birth outcome. Design: An observational study with free-living conditions. Subjects: Four hundred and ninety five healthy pregnant Icelandic women. Methods: The dietary intake of the women was estimated with a semiquantitative food frequency questionnaire covering food intake together with lifestyle factors for the previous 3 months. Questionnaires were filled out at between 11 and 15 weeks and between 34 and 37 weeks gestation. Comparison of birth outcome between the three weight gain groups was made with ANOVA and Bonferroni post hoc tests. Dietary factors related to at least optimal and excessive weight gain during pregnancy were represented with logistic regression controlling for potential confounding. Results: Of the women, 26% gained suboptimal and 34% excessive weight during pregnancy. Women in late pregnancy with at least optimal, compared with women with suboptimal, weight gain were eating more (OR ¼ 3.32, confidence interval (CI) ¼ 1.81-6.09, Po0.001) and drinking more milk (OR ¼ 3.10, CI ¼ 1.57-6.13, P ¼ 0.001). The same dietary factors were related to excessive, compared with optimal, weight gain. Furthermore, eating more sweets early in pregnancy increased the risk of gaining excessive weight (OR ¼ 2.52, CI ¼ 1.10-5.77, P ¼ 0.029). Women with a body mass index of 25.0-29.9 kg/m 2 before pregnancy were most likely to gain excessive weight (OR ¼ 7.37, CI 4.13-13.14, Po0.001). Women gaining suboptimal weight gave birth to lighter children (Po0.001) and had shorter gestation (P ¼ 0.008) than women gaining optimal or excessive weight. Conclusion: Women who are overweight before pregnancy should get special attention regarding lifestyle modifications affecting consequent weight gain during pregnancy. They are most likely to gain excessive weight and therefore most likely to suffer pregnancy and delivery complications and struggle with increasing overweight and obesity after giving birth.

This study investigated the role of parental motivation (importance, confidence and readiness) for predicting dropout and outcome from family‐based behavioral treatment for childhood obesity. Parent and child demographics, adherence to treatment, and weight loss parameters were also explored as potential predictors. Eighty‐four obese children (BMI‐standard deviation scores (SDS) >2.14) and a participating parent with each child started treatment consisting of 12 weeks of group and individual treatment sessions (24 sessions total) delivered over a period of 18 weeks. Sixty‐one families (73%) completed treatment and attended follow‐up at 1 year after treatment. Child session attendance and completion of self‐monitoring records served as measures of adherence. In regression analyses, parent reports (pretreatment) of confidence for doing well in treatment was the strongest predictor of treatment completion (P = 0.003) as well as early treatment response (weight loss at week 5) (P = 0.003). This variable remained a significant predictor of child weight loss at post‐treatment (P = 0.014), but was not associated with child outcome at 1‐year follow‐up (P > 0.05). The only significant predictor of child weight loss at that point was child baseline weight (P = 0.001). However, pretreatment parent ratings of importance of and readiness for treatment did not predict dropout or weight loss at any point. The results underscore the importance of addressing parental motivation, specifically parental confidence for changing lifestyle related behaviors, early in the treatment process. Doing so may reduce treatment dropout and enhance treatment outcome.

Background/Aims: Women’s diet can be especially difficult to assess, as women tend to underreport their intakes more often than men and are more likely to do so if they think they are overweight or obese. The aim was to compare two methods to assess women’s diet and how well they associate with biomarkers. The influence and frequency of underreporting was also investigated. Methods: Diet of 53 women was assessed by two 24-hour recalls and a food frequency questionnaire (FFQ). Blood was analyzed for retinol, β-carotene, vitamin C and serum ferritin, and 24-hour urine for nitrogen, potassium and sodium. Underreporting was evaluated with nitrogen excretion vs. intake, and energy intake vs. basal metabolic rate. Results: Energy percent (E%) from macronutrients was similar from FFQ and 24-hour recalls, but total intake was higher from 24-hour recalls (9,516 ± 2,080 vs. 8,183 ± 2,893 kJ, p < 0.01). Intakes of vitamin C and potassium from both methods correlated with their respective biomarkers (r = 0.316–0.393). Underreporters had higher body mass index (BMI) than others (27.7 ± 5.5 vs. 23.8 ± 3.7 kg/m², p < 0.05). They reported lower E% total fat (32 ± 5 vs. 38 ± 6 E%, p < 0.01) and higher E% carbohydrate (49 ± 4 vs. 45 ± 7 E%, p < 0.05). Correlation between intake and biomarkers increased after exclusion of underreporters. Conclusion: For women, FFQ and 24-hour recalls give similar E% and most nutrients correlate, but FFQ gives lower intake. Underreporters have higher BMI and diminish the correlation between calculated intake and biomarkers. This has to be considered when intake data are associated with weight management, disease and lifestyle factors.

ObjectiveTo explore health behaviors and metabolic risk factors in normal weight obese (NWO) adolescents compared with normal weight lean (NWL) peers.Design and MethodsA cross-sectional study of 18-year-old students (n = 182, 47% female) in the capital area of Iceland, with body mass index within normal range (BMI, 18.5–24.9 kg/m2). Body composition was estimated via dual energy X-ray absorptiometry, fitness was assessed with maximal oxygen uptake (VO2max) during treadmill test, dietary intake through 24-hour recall, questionnaires explained health behavior and fasting blood samples were taken. NWO was defined as normal BMI and body fat >17.6% in males and >31.6% in females.ResultsAmong normal weight adolescents, 42% (n = 76) were defined as NWO, thereof 61% (n = 46) male participants. Fewer participants with NWO were physically active, ate breakfast on a regular basis, and consumed vegetables frequently compared with NWL. No difference was detected between the two groups in energy- and nutrient intake. The mean difference in aerobic fitness was 5.1 ml/kg/min between the groups in favor of the NWL group (p<0.001). NWO was positively associated with having one or more risk factors for metabolic syndrome (Odds Ratio OR = 2.2; 95% confidence interval CI: 1.2, 3.9) when adjusted for sex. High waist circumference was more prevalent among NWO than NWL, but only among girls (13% vs 4%, p = 0.019).ConclusionsHigh prevalence of NWO was observed in the study group. Promoting healthy lifestyle with regard to nutrition and physical activity in early life should be emphasized regardless of BMI.

Epstein's family-based behavioural treatment produced promising effects in both the short and the longer term in a clinical sample of Icelandic children with substantial rates of co-morbid concerns. Co-morbid problems affect outcome and tailoring treatment to address co-morbid concerns might improve outcomes for certain subgroups.

BackgroundOlder adults have the highest rates of disability, functional dependence and use of healthcare resources. Training interventions for older individuals are of special interest where regular physical activity (PA) has many health benefits. The main purpose of this study was to assess the immediate and long-term effects of a 6-month multimodal training intervention (MTI) on functional fitness in old adults.MethodsFor this study, 117 participants, 71 to 90 years old, were randomized in immediate intervention group and a control group (delayed intervention group). The intervention consisted of daily endurance and twice-a-week strength training. The method was based on a randomized-controlled cross-over design. Short Physical Performance Battery (SPPB), 8 foot up-and-go test, strength performance, six min walking test (6 MW), physical activity, BMI and quality of life were obtained at baseline, after a 6-month intervention- and control phase, again after 6-month crossover- and delayed intervention phase, and after anadditional 6-month follow-up.ResultsAfter 6 months of MTI, the intervention group improved in physical performance compared with the control group via Short Physical Performance Battery (SPPB) score (mean diff = 0.6, 95 % CI: 0.1, 1.0) and 8-foot up-and-go test (mean diff = −1.0 s, 95 % CI: -1.5, -0.6), and in endurance performance via 6-minute walking test (6 MW) (mean diff = 44.2 meters, 95 % CI: 17.1, 71.2). In strength performance via knee extension the intervention group improved while control group declined (mean diff = 55.0 Newton, 95 % CI: 28.4, 81.7), and also in PA (mean diff = 125.9 cpm, 95 % CI: 96.0, 155.8). Long-term effects of MTI on the particpants was assesed by estimating the mean difference in the variables measured between time-point 1 and 4: SPPB (1.1 points, 95 % CI: 0.8, 1.4); 8-foot up-and-go (−0.9 s, 95 % CI: -1.2, -0.6); 6 MW (18.7 m, 95 % CI: 6.5, 31.0); knee extension (4.2 Newton, 95 % CI: -10.0, 18.3); hand grip (6.7 Newton, 95 % CI: -4.4, 17.8); PA (−4.0 cpm, 95 % CI: -33.9, 26.0); BMI (−0.6 kg/m2, 95 % CI: -0.9, -0.3) and Icelandic quality of life (0.3 points, 95 % CI: -0.7, 1.4).ConclusionsOur results suggest that regular MTI can improve and prevent decline in functional fitness in older individuals, influence their lifestyle and positively affect their ability to stay independent, thus reducing the need for institutional care.Trial registrationThis study was approved by the National Bioethics Committee in Iceland, VSNb20080300114/03-1

Objective To investigate whether there is a relationship between maternal intake of cod-liver oil in early and late pregnancy and hypertensive disorders in pregnancy.Design An observational prospective study.Setting Free-living conditions in a community with traditional fish and cod-liver oil consumption.Population Four hundred and eighty-eight low-risk pregnant Icelandic women.Methods Maternal use of cod-liver oil, foods and other supplements was estimated with a semiquantitative food frequency questionnaire covering food intake together with lifestyle factors for the previous 3 months. Questionnaires were filled out twice, between 11 and 15 weeks of gestation and between 34 and 37 weeks of gestation. Supplements related to hypertensive disorders in pregnancy, i.e. gestational hypertension and pre-eclampsia, were presented, with logistic regression controlling for potential confounding.Main outcome measures Gestational hypertension, pre-eclampsia, cod-liver oil and multivitamins.Results The odds ratio for developing hypertensive disorders in pregnancy for women consuming liquid cod-liver oil was 4.7 (95% CI 1.8-12.6, P = 0.002), after adjusting for confounding factors. By dividing the amount of n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) into centiles, the odds ratio for hypertensive disorders across groups for n-3 LCPUFA suggested a u-shaped curve (P = 0.008). Similar results were found for gestational hypertension alone. Further, the use of multivitamin supplements without vitamins A and D in late pregnancy doubled the odds of hypertensive disorders (OR 2.4, 95% CI 1.0-5.4, P = 0.044).Conclusions Consumption of high doses of n-3 LCPUFA in early pregnancy, or other nutrients found in liquid cod-liver oil, may increase the risk of developing hypertensive disorders in pregnancy.

Background/Aims: The proportion of polyunsaturated fatty acids (PUFA) in the diet and breast milk of lactating women with traditional fish and cod liver oil consumption was investigated under free-living conditions. Methods: Dietary intake of 77 lactating women was investigated by 24-hour recalls and breast milk samples were taken at the same occasions. Maternal intake data was calculated and fatty acid pattern from breast milk samples analyzed with gas chromatography. Results: Women using cod liver oil (n = 18) had a significantly higher total PUFA intake (14 ± 10 vs. 9 ± 7 g/day; 5.0 ± 3.4 vs. 3.9 ± 3.0 Energy%; p < 0.05) than women who did not use it (n = 59). In particular, mothers consuming cod liver oil had higher breast milk proportion of docosahexaenoic acid (DHA, 0.54 vs. 0.30%, p < 0.05). They also had higher breast milk proportions of eicosapentaenoic acid (EPA; 0.16 vs.0.07%; p < 0.05) and docosapentaenoic acid (DPA; 0.22 vs. 0.17%; p < 0.05). Conclusion: The proportion of PUFA in the diet is significantly higher among women consuming cod liver oil. Its use also gives higher proportion of EPA,DPA and DHA in breast milk without decreasing other important fatty acids. As this may have an impact on the health and development of breast-fed infants in later life, regular maternal cod liver oil intake could be relevant for the infant as well as for the nutritional adequacy of the maternal diet.