Introduction Much is to be learned about humanbreast milk (HBM) Purpose Extend our knowledge of HBM by investigating the role of maternal body mass index (BMI), sex and stage of lactation (month 1 vs. 6) on HBM insulin, glucose, leptin, IL-6 and TNF-α and their associations with infant body composition. Methods Thirty-seven exclusively breastfeeding infants (n=37; 16♀, 21♂) and their mothers (19–47 kg/m2) were studied at 1 and 6 months of lactation. Infants had body composition measured (using dual energy X-ray absorptiometry (DXA)) and HBM collected. Results A significant interaction between maternal BMI and infant sex on insulin levels (p = 0.0322) was observed, such that insulin was 229% higher in obese mothers nursing female infants than in normal weight mothers nursing female infants and 179% higher than obese mothers nursing male infants. For leptin, a significant association with BMI category was observed (p < 0.0001) such that overweight and obese mothers had 96.5% and 315.1% higher leptin levels than normal weight mothers, respectively. Leptin was also found to have a significant (p = 0.0004) 33.7% decrease from month 1 to month 6, controlling for BMI category and sex. A significant inverse relationship between month 1 leptin levels and infant length (p=0.0257), percent fat (p=0.0223), total fat mass (p=0.0226) and trunk fat mass (p=0.0111) at month 6 was also found. No associations or interactions were observed for glucose, TNF-α, or IL-6. Conclusions These data demonstrates that maternal BMI, infant sex and stage of lactation affect the compositional make-up of insulin and leptin.

Evidence suggests that depressive symptoms are associated with poorer dietary intake and inadequate physical activity; however, this association has not been examined in lower income overweight and obese African American women. The objective of this cross-sectional study was to examine the associations between depressive symptoms and diet and physical activity in 196 women (87% African American, ages 25–51). Higher depressive symptoms were hypothesized to predict poorer diet quality, greater emotional eating, lower physical activity levels, and greater sedentary time. Depressive symptoms were measured using the validated short form of the Center for Epidemiological Studies Depression Scale (CESD-10). Dietary intake and quality were assessed using three 24-hour dietary recalls. Emotional eating was evaluated using four items from the emotional eating subscale of the Eating Behavior Patterns Questionnaire. Physical activity and sedentary time were objectively measured using the ActiGraph accelerometer. Linear regression models tested the associations between depressive symptoms and each dietary and physical activity outcome variable. Symptoms of depression were positively associated with total daily caloric intake from saturated fat and total sugars, as well as emotional eating scores (p values < .05). While not statistically significant, depressive symptoms were positively associated with sweetened beverage consumption (p=.06) and added sugars (p=.07). Depressive symptoms were not associated with total fat, sodium, fruit and vegetables, fast food consumption, the Alternate Healthy Eating Index score, moderate-to-vigorous physical activity or sedentary time. Future studies should explore the mechanisms linking the identified associations between depressive symptoms and dietary intake, such as the role of emotional eating.

Objective To investigate patient and provider perceptions of weight gain, physical activity, and nutrition counseling during prenatal care visits. Methods Individual qualitative interviews were conducted with 30 pregnant women between 20–30 weeks gestation (15 African American, 15 White) and 11 prenatal care providers (5 attending physicians, 5 residents, 1 nurse practitioner) in 2014. Results The majority of patients and providers reported receiving or giving advice on weight gain (87% and 100%, respectively), physical activity (87% and 91%), and nutrition (100% and 91%) during a prenatal visit. Discussion of counseling content was largely consistent between patients and providers. However, counseling was limited and not fully consistent with current weight gain, physical activity, or dietary guidelines during pregnancy. Most patients viewed provider advice positively, but some wanted more detailed information. Providers discussed many barriers to lifestyle counseling, including: lack of time, inadequate training, concern about the sensitivity of the topic, lower education or income level of the patient, cultural differences, and lack of patient interest. Conclusions Providers discussed weight gain, physical activity, and nutrition during prenatal care visits and patients accurately recalled this advice. However, counseling was limited and not fully consistent with guidelines. Future studies are needed to develop and evaluate the efficacy of interventions to help providers overcome perceived barriers and more effectively counsel women on weight and healthy lifestyles during pregnancy.

IMPORTANCESteps per day is a meaningful metric for physical activity promotion in clinical and population settings. To guide promotion strategies of step goals, it is important to understand the association of steps with clinical end points, including mortality. OBJECTIVETo estimate the association of steps per day with premature (age 41-65 years) all-cause mortality among Black and White men and women. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was part of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants were aged 38 to 50 years and wore an accelerometer from 2005 to 2006. Participants were followed for a mean (SD) of 10.8 (0.9) years. Data were analyzed in 2020 and 2021. EXPOSURE Daily steps volume, classified as low (<7000 steps/d), moderate (7000-9999 steps/d), and high (Ն10 000 steps/d) and stepping intensity, classified as peak 30-minute stepping rate and time spent at 100 steps/min or more. MAIN OUTCOMES AND MEASURES All-cause mortality. RESULTS A total of 2110 participants from the CARDIA study were included, with a mean (SD) age of 45.2 (3.6) years, 1205 (57.1%) women, 888 (42.1%) Black participants, and a median (interquartile range [IQR]) of 9146 (7307-11 162) steps/d. During 22 845 person years of follow-up, 72 participants (3.4%) died. Using multivariable adjusted Cox proportional hazards models, compared with participants in the low step group, there was significantly lower risk of mortality in the moderate (hazard ratio [HR], 0.28 [95% CI, 0.15-0.54]; risk difference [RD], 53 [95% CI, 27-78] events per 1000 people) and high (HR, 0.45 [95% CI, 0.25-0.81]; RD, 41 [95% CI, 15-68] events per 1000 people) step groups. Compared with the low step group, moderate/high step rate was associated with reduced risk of mortality in Black participants (HR, 0.30 [95% CI, 0.14-0.63]) and in White participants (HR, 0.37 [95% CI, 0.17-0.81]). Similarly, compared with the low step group, moderate/ high step rate was associated with reduce risk of mortality in women (HR, 0.28 [95% CI, 0.12-0.63]) and men (HR, 0.42 [95% CI, 0.20-0.88]). There was no significant association between peak 30-minute intensity (lowest vs highest tertile: HR, 0.98 [95% CI, 0.54-1.77]) or time at 100 steps/min or more (lowest vs highest tertile: HR, 1.38 [95% CI, 0.73-2.61]) with risk of mortality.CONCLUSIONS AND RELEVANCE This cohort study found that among Black and White men and women in middle adulthood, participants who took approximately 7000 steps/d or more experienced lower mortality rates compared with participants taking fewer than 7000 steps/d.There was no association of step intensity with mortality.

A better understanding of women’s perceptions of weight gain and related behaviors during pregnancy is necessary to inform behavioral interventions. We used the Theory of Planned Behavior (TPB) to examine pregnant women’s perceptions and intentions toward weight gain, physical activity (PA), and nutrition using a mixed methods study design. Women between 20 and 30 weeks gestation (n = 189) were recruited to complete an Internet-based survey. Salient beliefs toward weight gain, PA, and nutrition were captured through open-ended responses and content analyzed into themes. TPB constructs (attitude, subjective norm, perceived behavioral control, intentions) were examined using Pearson correlations and hierarchical linear regression models. Salient beliefs were consistent with the existing literature in non-pregnant populations, with the addition of many pregnancy-specific beliefs. TPB constructs accounted for 23–39 % of the variance in weight gain, PA, and nutrition intentions, and made varying contributions across outcomes. The TPB is a useful framework for examining women’s weight-related intentions during pregnancy. Study implications for intervention development are discussed.

Postpartum weight retention (PPWR) is a significant contributor to the development of overweight and obesity in women of childbearing age. Stress may be a key mechanism making it more difficult for mothers to lose weight in the year following delivery. The aim of this study was to assess whether specific aspects of parenting stress and life stress influence postpartum weight retention in new mothers. Women in late pregnancy or up to 2 months postpartum (n = 123) were enrolled in the study and followed through the first year postpartum. Linear regression models evaluated the associations of parenting stress (isolation, attachment and depressive symptoms) as well as overall life stress at 2, 6, and 12 months postpartum with PPWR at 6 and 12 months. During the first year postpartum, higher depression and life stress were significantly associated with greater PPWR. As the effect of depression diminished, the effect of life stress became significant. Contrary to hypothesized relationships, fewer problems with attachment and less social isolation were significantly associated with greater PPWR. Higher gestational weight gain and African American race were also significantly associated with greater PPWR at both 6 and 12 months. Different types of stress predict weight retention in first time mothers during the first year postpartum. Understanding the relationships between parenting stress, concurrent life stress and PPWR can enhance the development of future interventions that specifically target self-identified stressors, leading to improved weight related outcomes.

Experiences of discrimination are associated with increased risk of adverse health outcomes; however, it is unknown whether discrimination is related to incident type 2 diabetes mellitus (diabetes). We investigated the associations of major experiences of discrimination (unfair treatment in 6 situations) and everyday discrimination (frequency of day-to-day experiences of unfair treatment) with incident diabetes among 5,310 participants from the Multi-Ethnic Study of Atherosclerosis, enrolled in 2000-2002. Using Cox proportional hazards models, we estimated hazard ratios and confidence intervals, adjusting for demographic factors, depressive symptoms, stress, smoking, alcohol, physical activity, diet, waist circumference, and body mass index. Over a median follow-up of 9.4 years, 654 diabetes cases were accrued. Major experiences of discrimination were associated with greater risk of incident diabetes when modeled continuously (for each additional experience of discrimination, hazard ratio = 1.09, 95% confidence interval: 1.01, 1.17) or categorically (for ≥2 experiences vs. 0, hazard ratio = 1.34, 95% confidence interval: 1.08, 1.66). Similar patterns were observed when evaluating discrimination attributed to race/ethnicity or to a combination of other sources. Everyday discrimination was not associated with incident diabetes. In conclusion, major experiences of discrimination were associated with increased risk of incident diabetes, independent of obesity or behavioral and psychosocial factors. Future research is needed to explore the mechanisms of the discrimination-diabetes relationship.

Objectives To determine the prevalence and accuracy of patient-reported provider advice on weight gain, physical activity, and nutrition during prenatal visits and to examine the associations of provider advice with women’s behavioral intentions toward weight gain, physical activity, and nutrition. Methods A mixed-methods study design was used to assess patient-report of provider advice and health intentions in women between 20-30 weeks gestation (n=188). Bivariate analyses examined patient-reported provider advice on weight gain, physical activity, and nutrition with women’s behavioral intentions. Linear and logistic regression models examined associations of provider weight gain recommendations with women’s intended weight gain. Results Approximately 52% of women reported provider advice on weight gain, 63% on physical activity, and 56% on nutrition. Of those who reported weight gain advice, 79% cited provider recommendations within the Institute of Medicine guidelines, 9% below, and 11% above. Patient-report of provider advice on physical activity and nutrition were consistent with guidelines, but limited in scope. Provider advice (yes/no) was significantly associated with women’s intentions to meet physical activity (p=0.01) and nutrition (p=0.02), but not weight gain guidelines (p=0.86). Provider recommended weight gain (pounds) was significantly associated with women’s intended weight gain in linear and logistic regression models. Conclusions for Practice A large percentage of women report receiving no advice from providers on weight gain, physical activity or nutrition during pregnancy. Of those who receive advice, most report recommendations consistent with current guidelines. Provider advice was associated with women’s weight gain, physical activity, and nutrition intentions in pregnancy.