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To construct an evidence-based practice programme for the nutrition management of older adults in nursing homes. The programme will provide a basis for improving or solving the nutrition management problems of older adults in nursing homes.
Design:
The study is based on guideline evidence and Delphi method. The evidence was comprehensively searched, assessed and summarized, and the best evidence and a preliminary programme for nutrition management of older adults in nursing homes were aggregated. Then, the Delphi method was used to assess the applicability of the preliminary programme and the obstacle factors to modify, supplement and improve the nutrition management programme.
Setting:
Baseline survey data were collected from three nursing homes in Ningxia, China, and guideline evidence was obtained through systematic searches of the Cochrane Library, PubMed and other scientific databases, as well as relevant official websites.
Participants:
A total of 350 older adults residing nursing homes and 160 nurses participated in the baseline survey. To ensure the programme’s applicability and identify potential implementation obstacles, fifteen experts from local grade A hospitals, nursing homes and community health centres were consulted for review.
Results:
A fourteen-item, fifty-six-best-evidence nutrition management programme for older adults in nursing homes was developed based on five guideline evidences and baseline survey findings.
Conclusions:
This is a systematic and comprehensive nutritional management programme for older adults in nursing homes based on guideline evidence, which can provide a standardised basis for the implementation of scientific nutritional management in nursing homes in Ningxia. Managers should promote the translation of evidence into practice in accordance with the specific circumstances of individual nursing homes.
Neural tube defects (NTD) are serious, life-threatening birth defects. Staple food fortification with folic acid (vitamin B9) is a proven, effective intervention to reduce NTD birth prevalence. Mandatory food fortification with folic acid was implemented in South Africa (SA) in 2003. This article provides an overview of NTD birth prevalence in SA, pre- and post-fortification, and evaluates current folic acid fortification regulations.
Design:
Fortification effectiveness data in SA were reviewed using published studies and national reports on NTD birth prevalence pre- and post-folic acid fortification. Current folic acid fortification regulations in SA were evaluated by experts.
Setting:
Regulations were assessed using national health guidelines, legislation and regulations. NTD birth prevalence data were sourced from the published literature.
Participants:
None.
Results:
Significant reductions in the birth prevalence of spina bifida and anencephaly and improved maternal folate levels have been achieved following the introduction of folic acid fortification in SA. However, there is poor overall regulatory compliance in some instances and a gap in current regulations that excludes the fortification of cake flour in SA.
Conclusions:
While the SA NTD birth prevalence has decreased by 30% post-fortification, the regulatory exclusion of cake flour fortification is a significant and growing issue. Proposed 2016 regulatory amendments to address this gap urgently require finalisation and enactment by government to prevent negating benefits achieved to date and to ensure continued improvement. Fortification monitoring requires strengthening to ensure widespread compliance with policies, particularly in underserved areas.
Dietitians working at evacuation shelters conduct weighed food records (WFR) for multiple days for dietary assessment. Because the menus in evacuation shelters do not change much from day to day, this study examined whether 1- and 2-d WFR are sufficient for dietary assessment at shelters and identified dietary components that can influence the number of assessment days. Overall, twenty-six WFR were collected from ten shelters in Kumamoto Prefecture, and the amounts of energy; protein; vitamins B1, B2 and C and salt were calculated. Correlation analysis and paired sample tests were conducted to examine significant differences between ‘one- and two-consecutive- or non-consecutive-day WFR’ and ‘three-consecutive-day WFR’, which were set as the standard in this study. Additionally, the (CV for the categories by meal and dish were calculated to examine the variables that affected the large variations. As a result, 1-d WFR had significant positive correlations with the standard; thus, it could be used for the triage of shelters requiring nutrition assistance as a substitute for 3-d WFR. Two-consecutive-day and non-consecutive-day WFR showed a stronger correlation with the standard compared with the 1-d WFR. For energy and nutrients and dish categories, ready-to-eat foods had larger CV than boxed meals or foods from hot meal services. Whenever the meals included ready-to-eat foods, a two-non-consecutive-day WFR is recommended considering large between-day variations. Salty soup or beverages affected the variation of some nutrients. Our result would help municipalities to consider the number of WFR during emergency.
The present study investigated whether dietary n-3 very-long-chain PUFA (n-3 VLC-PUFA) could increase skin and bone mineralisation in Atlantic salmon (Salmo salar) in vivo and examined their potential effects on human osteoblast proliferation and differentiation in vitro. Atlantic salmon were fed different dietary levels of n-3 VLC-PUFA, and changes in tissue n-3 VLC-PUFA composition, skeletal morphology, skin and bone mineral content, bone mineral density (BMD) and gene expression patterns were examined. Additionally, in vitro experiments using human foetal osteoblast cells were conducted to investigate the potential influence of n-3 VLC-PUFA supplementation on cell proliferation, osteogenic differentiation and cytokine expression. The results demonstrated that increasing the dietary levels of n-3 VLC-PUFA increased the mineral content of vertebrae and BMD in salmon, with subtle yet significant impacts on the expression of genes involved in bone-related processes. Furthermore, in vitro experiments showed a potential contextual influence of n-3 VLC-PUFA supplementation on gene expression of osteogenic markers and cytokine expression. Our findings indicate for the first time that n-3 VLC-PUFA may influence processes related to bone mineralisation.
Propolis, as a by-product of honey production, has shown several beneficial effects on cardiovascular risks in past randomised controlled trials, although the findings are not conclusive. In this review, we intend to evaluate the effects of propolis consumption on cardiovascular risk factors by conducting a meta-analysis. The Web of Science, Medline and Scopus databases were comprehensively searched until September 2023. Eligible studies were identified by screening, and their data were extracted. Weighted mean differences with a 95 % CI for each outcome were estimated using the random-effects model. This meta-analysis revealed that propolis consumption led to a significant decrease in the levels of TAG (weighted mean differences (WMD): –10·44 mg/dl 95 % CI: –16·58, –4·31; P = 0·001), LDL-cholesterol (WMD: –9·31 mg/dl; 95 % CI: –13·50, –5·12 mg; P < 0·001), fasting blood glucose (WMD: –7·30 mg/dl; 95 % CI: –11·58, –3·02; P = 0·001), HbA1c (WMD: –0·32 %; 95 % CI: –0·60, –0·05; P = 0·01), insulin (WMD: –1·36 μU/ml; 95 % CI: –2·36, –0·36; P = 0·007), homeostatic model assessment for insulin resistance (WMD: –0·39; 95 % CI: –0·74, –0·03; P = 0·020) and systolic blood pressure (WMD: –2·24 mmHg 95 % CI: –4·08, –0·39; P = 0·010), compared with the control groups. Furthermore, propolis consumption had a significant increasing effect on HDL-cholesterol levels (WMD: 2·03 mg/dl; 95 % CI: 0·24, 3·83; P = 0·020). In contrast, the consumption of propolis had no significant effect on total cholesterol and diastolic blood pressure levels. This systematic review and dose–response meta-analysis suggested that propolis intake may be effective in cardiometabolic improvement in adults. Further, well-designed studies are required to confirm and elucidate all aspects of these findings.
The objective of this study was to explore barriers and facilitators to utilising a range of food assistance resources as reported by parents living with or at risk for food insecurity (FI), as well as parents’ recommendations for improving utilisation of these resources. Qualitative data from semi-structured interviews about parents’ perspectives on interventions to address FI were analysed using a hybrid deductive/inductive thematic approach. Parents were drawn from the larger Family Matters longitudinal cohort study (N = 1,307), which was recruited from primary care clinics in Minnesota. Forty racially and ethnically diverse parents (Mage = 38.5 years; 97.5% mothers; 85% parents of colour) were recruited by food security level, with ten parents representing each level (i.e. high, marginal, low, very low). Six overarching qualitative themes were identified, which indicated the importance of (1) comfort level seeking assistance; (2) routine screening to assess need; (3) advertising, referrals, and outreach; (4) adequacy of policies and programmes to address need; (5) resource proximity and delivery; and (6) acceptability of foods/benefits provided. With some exceptions, these themes were generally represented from more than one angle (i.e. as barriers, facilitators, recommendations) and raised as relevant across different types of assistance (e.g. federal food assistance programmes, food pantries) and different settings (e.g. schools, healthcare). This study identified key factors influencing food assistance utilisation across multiple dimensions of access. These factors—which range from psychosocial to logistical in nature—should be considered in efforts to expand the reach of food assistance programmes and, in turn, improve food security among families.
To examine underlying political economy factors that enable or impede the integration of nutrition considerations into food system governance.
Design:
Comparative political economy analysis of data collected through (1) value chain analyses of selected healthy and unhealthy commodities and (2) food system policy analyses, using a theoretical framework focused on power, politics, interests and ideas.
Setting:
Ghana and South Africa.
Participants:
Value chain actors relevant to healthy and unhealthy foods (Ghana n 121; South Africa n 72) and policy stakeholders from government (Health, Agriculture, Trade and Industry, Finance), academia, civil society, development partners, Civil Society Organization (CSO) and private sector (Ghana n 28; South Africa n 48).
Results:
Nutrition was a stated policy priority in both countries; however, policy responsibility was located within the health sector, with limited integration of nutrition into food system sectors (including Agriculture, Trade and Industry). Contributing factors included a conceptions of policy responsibilities for nutrition and food systems, dominant ideas and narratives regarding the economic role of the food industry and the purpose of food system policy, the influence of large food industry actors, and limited institutional structures for cross-sectoral engagement and coordination.
Conclusions:
Integrating nutrition into multi-sectoral food policy to achieve multiple food system policy goals will require strategic action across jurisdictions and regional levels. Opportunities included increasing investment in healthy traditional foods, strengthening urban/rural linkages and informal food systems, and strengthening institutional structures for policy coherence and coordination related to nutrition.
Polymorphisms in the vitamin D receptor (VDR) gene (BsmI (rs1544410), FokI (rs2228570), ApaI (rs7975232), TaqI (rs731236)) and low vitamin D concentrations have previously been associated with type 1 diabetes (T1D). Vitamin D is thought to mediate the switch from a pro-inflammatory Th1 response to an anti-inflammatory Th2 response which is protective against the development of T1D. These associations are inconsistent across studies and population groups. These associations have not been investigated in the South African black population. Thus, this observational, case-control study aims to address this knowledge gap. South African black participants with T1D (cases; n = 182) and healthy controls (n = 151) were genotyped for the four VDR polymorphisms using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Vitamin D levels were measured using high performance liquid chromatography (HPLC). Vitamin D levels were not significantly different between cases and controls (62.8 ± 20.7 vs. 59.5 ± 17.0 nmol/l, respectively; P = 0.122). Higher vitamin D levels were associated with the TaqI TT (P = 0.045) and FokI TT/TC (P = 0.014) genotypes in multivariate analyses. Furthermore, the TaqI TT genotype was associated with T1D status in multivariate analysis (P = 0.040). The FokI CC genotype increases the transcription of CYP24A1, resulting in vitamin D catabolism and thus decreased vitamin D concentration through the action of 24-hydroxlase. The TaqI TT genotype results in increased vitamin D potentially through calcium metabolism feedback pathways. In addition, the TaqI TT genotype is associated with T1D through a vitamin D-independent mechanism and may be in linkage disequilibrium with a true causative variant.
Combating the double burden of malnutrition (DBM) in adolescents is a critical public health challenge in low-income countries like Ethiopia. However, past efforts have lacked focus and exhibited diverse governance strategies. Therefore, this study assesses the effect of selected double-duty interventions (DDIs) on DBM among adolescents in Central Ethiopia. The DBM status (thinness, normal, overweight/obesity) was determined using WHO AnthroPlus software. A two-arm parallel cluster randomised controlled trial was used among 708 adolescents (356 for the intervention group [IG] and 352 for the control group [CG]) from 13 October 2022 to 30 June 2023. The intervention’s effect was analysed through difference-in-difference (DID) analysis and a multivariable multinomial generalised estimating equation (GEE) model with significance set at P < 0.05. The overall DBM prevalence decreased by nearly 7% (4.7% for thinness, 2.2% for overweight/obesity) in the DID analysis. After adjusting for possible confounders, the GEE model indicated that adolescents in the IG were 34% less likely to have higher DBM than those in the CG (AOR = 0.66, 95% CI [0.46, 0.94]). Additionally, the probability of DBM decreased by 59% at the end line compared to baseline measurements (AOR = 0.41, 95% CI [0.03, 0.92]). Adolescents in the category of time and IG interaction were 44% less likely to have increased DBM (AOR = 0.56, 95% [CI 0.02, 0.38]). Thus, this study underscores the effectiveness of selected DDIs in addressing DBM among adolescents using a health belief model. These results advocate for the integration of DDI strategies into existing nutrition guidelines, programmes, and policies.
The trial was registered prospectively in ClinicalTrials.gov with registration number NCT05574842.
This commentary highlights the release of findings now available in the report International Food Policy Study Youth Surveys: Summary of Findings 2019–2021.
Design:
The survey data described in this commentary consist of repeated cross-sectional surveys conducted annually beginning in 2019.
Setting:
Online surveys were conducted in 2019 to 2021 among respondents living in Australia, Canada, Chile, Mexico, the United Kingdom and the USA.
Participants:
Survey respondents were youth aged 10–17 years in 2019 (n 12 031), 2020 (n 11 108) and 2021 (n 10 459).
Results:
The report described in this commentary summarises findings on food and nutrition behaviours, attitudes and knowledge among youth, including their diet sources and patterns, school nutrition environments, food security, diet intentions, weight perceptions and weight loss behaviours, sugary drink perceptions, awareness of public education and mass media campaigns, perceptions of food labels and exposure to food and beverage marketing.
Conclusion:
Results from the IFPS Youth surveys provide important insights into key policies of global interest, including front-of-package nutrition labelling, levies on sugary beverages and restrictions on marketing unhealthy food and beverages to children. As policymakers continue to seek effective strategies to improve adolescent health outcomes, ongoing cross-country monitoring of food and nutrition-related indicators, such as the data from the International Food Policy Study, will be critical in assessing dietary trends and evaluating upcoming policies.
Spontaneous abortion (SA) is considered one of the most prevalent adverse outcomes of pregnancy. SA may occur due to genetic susceptibility and various maternal factors such as nutritional status. The aim of this study was to assess how dietary carotenoids and the FTO gene are related to SA. This case–control study included 192 women with a history of SA as the case group and 347 healthy women without history of SA as the control group. To evaluate carotenoid intake, a valid 168-item food frequency questionnaire (FFQ) was used. The FTO gene was genotyped for the presence of the rs9939609 polymorphism using the tetra-primer amplification refractory mutation system-polymerase chain (ARMS-PCR). The results indicated a significant negative association between dietary intake of β-cryptoxanthin and SA in carriers of the TT genotype of the FTO rs9939609 polymorphism after adjustment for age, BMI, physical activity, smoking, alcohol drinking, and calorie intake (β = −0.28, P = 0.02). No association was found between SA with dietary intake of beta-carotene, alpha-carotene, lutein, and lycopene among carriers of different FTO genotypes. The FTO genotype may have an effect on the association between SA and carotenoid intake. Dietary intake of β-cryptoxanthin may act as a protective factor against SA only in carriers of the TT genotype of the FTO rs9939609 polymorphism.
To understand the dietary patterns of adults and explore their association with iodine nutritional levels and thyroid function in adults.
Design:
We randomly collected 5 ml of adult urine samples and measured urinary iodine concentration (UIC) by cerium arsenate-catalysed spectrophotometry. A serum sample of 5 ml was collected for the determination of free triiodothyronine, free thyroxine and thyrotropin, and diet-related information was collected through a FFQ. Dietary patterns were extracted by principal component analysis, and the relationship between dietary patterns and iodine nutrition levels and thyroid function was explored.
Settings:
A cross-sectional study involving adults in Xinjiang, China, was conducted.
Participants:
A total of 435 adults were enrolled in the study.
Results:
The overall median urinary iodine of the 435 respondents was 219·73 μg/l. The dietary patterns were PCA1 (staple food pattern), PCA2 (fruit, vegetable and meat pattern), PCA3 (fish, shrimp and legume pattern) and PCA4 (dairy-based protein pattern). The correlation analyses showed that PCA1 and PCA3 were positively correlated with the UIC. The results of the multivariable analysis showed that PCA1, Q1, Q2 and Q3 were associated with an increased risk of iodine deficiency compared with Q4 ((OR): 260·41 (95 % CI: 20·16, 663·70)), 59·89 (5·64, 335·81), and 2·01 (0·15, 26·16), respectively). In PCA2, Q3 was associated with an increased risk of iodine deficiency compared with Q4 (OR: 0·16 (0·05, 0·53)). In PCA3, Q3 was associated with an increased risk of iodine deficiency compared with Q4 (OR: 0·23 (0·06, 0·90)). In PCA4, Q1 was associated with an increased risk of iodine deficiency compared with Q4 (OR: 31·30 (4·88, 200·64)).
Conclusion:
This study demonstrated that of the four dietary patterns, the least dependent staple food pattern (Q1) had a higher risk of iodine deficiency compared with the most dependent staple food pattern (Q4). However, the current evidence on the effect of dietary patterns on thyroid function needs to be validated by further longitudinal studies that include long-term follow-up, larger sample sizes and repeated measures.
Modifying the food environment holds promise for instilling healthier behaviours in children and may be an effective public health strategy for preventing childhood obesity and adverse health outcomes. The school food environment is a valuable setting to influence most children’s dietary behaviours from an early age, yet evidence suggests that the New Zealand and Australian school food environment is not conducive to healthy food and drink consumption. The present study aimed to investigate the level of compliance in New Zealand and Australia with government guidelines for food and drink availability within schools and the subsequent effect on food consumption and purchasing behaviours of children. A systematic review utilising three databases, PubMed, Scopus and the Cochrane Library, was conducted. The research covered peer-reviewed studies from both New Zealand and Australia that met predefined inclusion criteria. Fifteen studies focused on assessing food availability within schools on the basis of government guidelines, and ten studies explored food purchasing and consumption by students influenced by changes to the school food environment. Results showed low compliance with government healthy food guidelines for schools, and significant socioeconomic disparities. Western Australia’s clear targets as well as the mandatory monitoring systems in place stand out as being a significant enabler of greater compliance with government food policies. Interventions aimed at improving healthy food availability and promoting healthy options in the canteen may positively influence student purchasing and consumption habits. Strategies such as feedback models and incentivisation hold promise for promoting healthier school environments and influencing children’s food choices.
This study aimed to assess nutritional status and associated factors among adult tuberculosis patients in public health centres in Horro Guduru Wollega Zone, Western Ethiopia, 2021. An institutional-based cross-sectional study was conducted among 334 randomly selected adult TB patients at public health centres from May 7, 2021, to June 21, 2021. Data were collected using structured questionnaires and anthropometric measurements. The nutritional status was measured by using body mass index (BMI). Data was entered into EpiData version 4.6 and exported to SPSS version 25 for analysis. A bivariate and multivariable multinomial logistic regression analysis was done to identify factors associated with nutritional status. The prevalence of under and overnutrition was found to be 48.2% and 8.7%, respectively. Female TB patients (AOR = 3.48, 95% CI: (1.918–6.314)), patients who didn’t receive dietary counselling (AOR = 2.51, 95% CI: (1.335–4.720)), TB patients on the initiation phase of treatment (AOR = 3.76, 95% CI: (2.072–6.852)), and meal frequency less than three times per day (AOR = 3.6, 95% CI: (1.942–6.676)) were significantly associated with under nutrition. The prevalence of undernutrition was high in the study area. Being a female, being in the initiation phase of treatment, lack of dietary counselling, and having meal less than three per day were independently associated with undernutrition. Hence, regular nutritional assessments, dietary counselling, and nutritional support should be encouraged at the facility and community level.
The scientific literature indicates that chokeberry is widely used as a supplement to support the maintenance of the body’s homeostasis by reducing inflammation and oxidative stress. In recent years, positive effects of chokeberry on intestinal parameters have also been observed. Oxidative stress, inflammation and, according to recent reports, also the gut microbiome are closely related to the overall well-being and health of the population. This study, therefore, attempts to summarise all the health benefits of black chokeberry supplementation. This study was registered in PROSPERO (International Prospective Register of Systematic Reviews) under registration number CRD42023395969. Additionally, the systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Electronic databases were searched in Web of Science, PubMed, Scopus and EBSCO using the following combination of the words ‘chokeberry or aronia’ and ‘inflammation or oxidative stress or microbiota or microbiome or permeability or gut’. Ultimately, fifty-seven studies were summarised in the review. Data analysis showed that black chokeberry has a positive effect on the reduction of inflammation, oxidative stress and intestinal microflora, but the size of the changes varies and depends on many variables. Therefore, the researchers concluded that the compounds found in black chokeberry play a pivotal role in maintaining the overall balance within the system. This is a crucial consideration given the tendency for disturbances in organismal homeostasis to accompany disease processes and various disorders. However, further research is necessary to elucidate the mechanisms and optimise its use fully.
The aim of this randomised controlled trial was to investigate the effects of breakfast high or low in protein on body composition and cardiometabolic markers in young women with overweight. In total, fifty-six women aged 18–30 years consumed a breakfast containing either high protein (34 g protein, n 26) or low protein (6 g protein, n 30) for 12 weeks. Measurements of body composition by dual-energy X-ray absorptiometry, waist circumference, glucose tolerance, fasting glucose, insulin and lipid profile were performed before and after this period. The primary outcome was fat mass. Satiety and hunger were evaluated by self-reported Visual Analogue Scale (VAS) scores. Dietary intake was estimated by 4-d dietary records, and calcium intake was estimated by FFQ. At baseline, relative daily protein intake was 15·2 ± 2·8 E%, which increased to 19·3 ± 3·4 E% in high protein but was unchanged in low protein (P < 0·001 between groups). High protein reported higher satiety compared with low protein (P = 0·02). Yet, no group differences were observed in changes in energy intake, body composition, blood lipid profile or measures of glucose tolerance (all P > 0·10). However, bone mineral content tended to increase in high protein (P = 0·05) and decrease in low protein (P = 0·07, interaction effect: P = 0·01). Conclusively, a high v. low content of protein in breakfast increased satiety but did not affect body composition or cardiometabolic markers in young women with overweight. This study adds to the sparse evidence on the effects of breakfast with different macronutrient compositions on health parameters in women with overweight. Registered at clinicaltrials.gov: NCT04518605.
To understand the characteristics of food environments in the Pacific region, and the broader economic, policy and sociocultural surroundings that influence food choices and interventions to improve food environments for Pacific communities.
Design:
Systematic searches were conducted for articles related to food environments or factors influencing food choices from 1993 to 2024 in five academic databases, Google, Google Scholar and relevant organisations’ websites. Studies were included if they meet the eligibility criteria. Two authors independently reviewed the title and abstract of identified articles. Full-text screening was conducted before data were extracted from eligible studies. A narrative analysis was informed by an existing food environments framework.
Setting:
Pacific Island countries or territories that are a member of the Pacific Community (SPC).
Participants:
Not applicable.
Results:
From the sixty-six included studies (of 2520 records screened), it was clear that food environments in the Pacific region are characterised by high availability and promotion of ultra-processed unhealthy foods. These foods were reported to be cheaper than healthier alternatives and have poor nutritional labelling. Food trade and investment, together with sociocultural and political factors, were found to contribute to unhealthy food choices. Policy interventions have been implemented to address food environments; however, the development and implementation of food environment policies could be strengthened through stronger leadership, effective multisectoral collaboration and clear lines of responsibility.
Conclusions:
Interventions focused on improving physical, economic, policy and sociocultural influences on food choices should be prioritised in the Pacific region to improve the food environment and mitigate barriers to healthy eating.
To investigate the relationship between violence and the nutritional status of pregnant women, and whether mental health could be a mediator in this relationship.
Design:
Cross-sectional study. Violence and mental health status were investigated using the following questionnaires: WHO-Violence Against Women (WHO-VAW), Abuse Assessment Screen (AAS), Patient Health Questionnaire (PHQ-9) and General Health Questionnaire (GHQ). Demographic, socio-economic, obstetric and lifestyle factors (smoking/alcohol consumption) were also investigated. The nutritional status of the women was assessed by the BMI.
Setting:
Data were collected from February 2021 to August 2022 in Araraquara city, Brazil.
Participants:
Four hundred pregnant women recruited at thirty-four health units and the municipal maternity hospital.
Results:
Experience of violence was reported by 52·2 % of the women, and psychological violence in the last 12 months was the most prevalent type of domestic violence (19·5 %). Approximately 43 % of the women showed mental health changes and 59·7 % had a risk of major depression. Women with mental health changes had an increased risk (OR = 2·34) of obesity. Psychological violence in the last 12 months was associated with obesity (P = 0·01) when mediated by mental health changes. The mediation effect was significant (β = 0·708; 95 % bias-corrected and accelerated (BCa) CI = 0·004, 1·460), with mental health changes mediating 46·1 % of the relationship between psychological violence and obesity.
Conclusions:
The relationship between psychological violence and obesity during pregnancy was mediated by changes in mental health. This original study shows that nutritional status is not limited to biological factors and highlights the importance of social, mental and psychological factors.