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Objective: To explore the barriers associated with the adoption of the Alberta Nutrition Guidelines for Children and Youth in schools according to characteristics of the innovation (guidelines) and the organization (schools). Design: Cross-sectional telephone survey. Setting and Participants: Schools in Alberta, Canada. Principals from 357 schools. Main Outcome Measure: Barriers to adopting the nutrition guidelines. Analysis: A 19-question telephone survey, including open- and closed-ended questions, was used to obtain information regarding schools' characteristics and barriers to adopting the guidelines. Qualitative data were coded according to common themes a priori, based on constructs from the Diffusion of Innovations framework. Results: Schools reported many barriers related to the relative advantage, compatibility, and complexity of adopting the guidelines. Parents' resistance to change and cost were the key reported barriers. Lack of knowledge, student preferences, the physical location of the school, and barriers related to the provision of healthful food were also reported. Conclusions and Implications: Disseminating guidelines without providing adequate support for their implementation may not promote change within the school setting. School nutrition initiatives need to involve the parents and have access to sufficient financial and human resource support. (Contains 4 tables.)

OBJECTIVE: Unhealthy dietary and physical inactivity patterns inspired many initiatives promoting healthy youth and healthy schools in Alberta between 2005 and 2008. The purpose of this study was to examine differences in the prevalence of lifestyle risk factors for type 2 diabetes (T2D) between two province-wide samples of Alberta adolescents (2005 and 2008). METHODS: The dietary and physical activity (PA) patterns of Alberta youth were assessed in two cross-sectional studies of grade 7-10 students, one in 2005 (n=4936) and one in 2008 (n=5091), using a validated web-survey. For each diabetes risk factor, participants were classified as either at risk or not at risk, depending on their survey results relative to cut-off values. Chi-square tests and logistic regression models were used to determine differences in risk factor prevalence between 2005 and 2008. RESULTS: Compared to 2005, mean BMI, energy intake, fat intake, glycemic index (GI) and glycemic load (GL) were lower in 2008 (p CONCLUSIONS: Improvements were observed between 2005 and 2008 in terms of the proportion of adolescents having specific risk factors for T2D. The cause of these changes could not be determined. Continued monitoring of adolescent lifestyle habits and monitoring of exposure to health promotion programming is recommended. KEY WORDS: Type 2 Diabetes Mellitus; adolescents; prevalence; risk factors; diet; physical activity OBJECTIF: Les habitudes alimentaires malsaines et l'inactivite physique ont inspire de nombreuses initiatives de promotion de la sante des jeunes et des ecoles en Alberta entre 2005 et 2008. Nous avons cherche a examiner les differences dans la prevalence des facteurs de risque lies aux habitudes de vie pour le diabete de type 2 (DT2) entre deux echantillons provinciaux d'adolescents albertains (2005 et 2008). METHODE: Les habitudes d'alimentation et d'activite physique des jeunes de l'Alberta ont ete evaluees a la faveur de deux etudes transversales aupres d'eleves de la 7e a la 10e annee, l'une en 2005 (n=4 936) et l'autre en 2008 (n=5 091), a l'aide d'un sondage en ligne valide. Pour chaque facteur de risque du diabete, les participants ont ete classes comme etant a risque ou non a risque selon leurs reponses au sondage par rapport aux valeurs limites. Des tests du khi-carre et des modeles de regression logistique ont servi a determiner les differences dans la prevalence des facteurs de risque entre 2005 et 2008. RESULTATS: Comparativement a 2005, l'IMC moyen, l'apport energetique, l'apport en matieres grasses, l'indice glycemique (IG) et la charge glycemique (CG) etaient plus faibles en 2008 (p CONCLUSIONS: Des ameliorations ont ete observees entre 2005 et 2008 dans la proportion d'adolescents presentant les facteurs de risque propres au DT2. Nous n'avons pas pu determiner la cause de ces changements. Il est recommande de continuer a surveiller les habitudes de vie des adolescents et leur exposition aux programmes de promotion de la sante. MOTS CLES: diabete de type 2; adolescent; prevalence; facteurs de risque; regime alimentaire; exercice physique La traduction du resume se trouve a la fin de l'article., Unhealthy dietary and physical activity patterns are prevalent among Canadian youth (1,2) and are implicated in increasing rates of early onset type 2 diabetes that have been observed in Canada. [...]

Abstract Background Postpartum depression is a serious problem for women and their offspring. Micronutrient supplements are recommended for pregnant women because of their documented protective effects for the offspring, but their potential beneficial effects on maternal mental health are unknown. This study investigated the association between prenatal micronutrient supplementation and the risk for symptoms of postpartum depression in a longitudinal pregnancy cohort from the Alberta Pregnancy Outcomes and Nutrition (APrON) study. Methods Participants came from a cohort of the first 600 APrON women. Supplemental nutrient intake and symptoms of depression (measured with the Edinburgh Postnatal Depression Scale (EPDS)) were collected at each trimester and 12 weeks postpartum. Results Of the 475 participants who completed the EPDS at least twice in pregnancy and at 12 weeks postpartum, 416 (88%) scored Conclusions Multiple factors, including supplementary selenium intake, are associated with the risk of postpartum depressive symptoms. Future research on dietary supplementation in pregnancy with special attention to selenium intake is warranted.

Abstract Background Recreational facilities are an important community resource for health promotion because they provide access to affordable physical activities. However, despite their health mandate, many have unhealthy food environments that may paradoxically increase the risk of childhood obesity. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are government-initiated, voluntary guidelines intended to facilitate children’s access to healthy food and beverage choices in schools, childcare and recreational facilities, however few recreational facilities are using them. Methods We used mixed methods within an exploratory multiple case study to examine factors that influenced adoption and implementation of the ANGCY and the nature of the food environment within three cases: an adopter, a semi-adopter and a non-adopter of the ANGCY. Diffusion of Innovations theory provided the theoretical platform for the study. Qualitative data were generated through interviews, observations, and document reviews, and were analysed using directed content analysis. Set theoretic logic was used to identify factors that differentiated adopters from the non-adopter. Quantitative sales data were also collected, and the quality of the food environment was scored using four complementary tools. Results The keys to adoption and implementation of nutrition guidelines in recreational facilities related to the managers’ nutrition-related knowledge, beliefs and perceptions, as these shaped his decisions and actions. The manager, however, could not accomplish adoption and implementation alone. Intersectoral linkages with schools and formal, health promoting partnerships with industry were also important for adoption and implementation to occur. The food environment in facilities that had adopted the ANGCY did not appear to be superior to the food environment in facilities that had not adopted the ANGCY. Conclusions ANGCY uptake may continue to falter under the current voluntary approach, as the environmental supports for voluntary action are poor. Where ANGCY uptake does occur, changes to the food environment may be relatively minor. Stronger government measures may be needed to require recreational facilities to improve their food environments and to limit availability of unhealthy foods.

Abstract Background Although the mandate of recreational facilities is to enhance well-being, many offer foods inconsistent with recommendations for healthy eating. Little is known regarding recreational facility food environments and how they might be improved, as few studies exist. The Alberta Nutrition Guidelines for Children and Youth (ANGCY) are intended to ensure access to healthy food choices in schools, childcare and recreational facilities. This study investigated awareness, adoption and implementation of the ANGCY among recreational facilities in Alberta, Canada, one year following their release. Methods A cross-sectional telephone survey was conducted from June - December, 2009 (n = 151) with managers of publicly funded recreational facilities that served food. The questionnaire included 10 closed and 7 open ended questions to assess the organizational priority for healthy eating, awareness, adoption and implementation of the ANGCY. Chi-squared tests examined quantitative variables, while qualitative data were analysed using directed content analysis. Greenhalgh's model of diffusion of complex innovations within health service organizations constituted the theoretical framework for the study. Results One half of respondents had heard of the ANGCY, however their knowledge of them was limited. Although 51% of facilities had made changes to improve the nutritional quality of foods offered in the past year, only a small fraction (11%) of these changes were motivated by the ANGCY. At the time of the survey, 14% of facilities had adopted the ANGCY and 6% had implemented them. Barriers to adoption and implementation were primarily related to perceived negative attributes of the ANGCY, the inner (organizational) context, and negative feedback received during the implementation process. Managers strongly perceived that implementing nutrition guidelines would limit their profit-making ability. Conclusions If fully adopted and implemented, the ANGCY have the potential to make a significant and sustained contribution to improving the recreational facility food environment, however one year following their release, awareness, adoption and implementation of the ANGCY remained low. A mandated policy approach could offer an efficacious, cost-effective means of improving the food environment within recreational facilities.

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Resting metabolic rate (RMR; kilocalories per minute) decreases with decreased food intake over the short term. This has been shown repeatedly in studies where very-low-calorie diets were implemented as part [...]

We investigated whether body composition, physical activity, physical inactivity, and cardiorespiratory fitness explained the presence of risk factors for cardiovascular disease (CVD) and type 2 diabetes in youth. Eighty-three obese children (6-12 years old) were classified as either low health risk (LHR; n = 30) or high health risk (HHR; n = 53) based on the absence/presence of metabolic risk factors that included measures of dyslipidemia, insulin resistance, and elevated blood pressure. Along with demographic and anthropometric data, body composition, physical activity, physical inactivity, and cardiorespiratory fitness variables were assessed. Risk factor clustering was evident in this sample with 24/83 (29%) possessing at least 2 risk factors. Percent body fat did not differ between the LHR (38.5%) and HHR (39.8%) groups, but total fat mass, total fat-free mass, and central body fat mass were greater in the high health risk group. The strongest predictor for the presence of risk factors was central body fat accumulation. Physical activity, physical inactivity, and cardiorespiratory fitness were unable to predict metabolic risk. Overall, we found that risk factors for CVD and type 2 diabetes were common and that body fat mass and central body fat distribution, in particular, were more important than physical activity, physical inactivity, and cardiorespiratory fitness in predicting metabolic risk in obese children. [ABSTRACT FROM AUTHOR]

Examines the relationship between energy balance, resting energy expenditure and luteal phase progesterone levels in elite adolescent athletes participating in aesthetic sports. Assessment of the stages of sexual development; Derivation of total energy expenditure; Measurement of progesterone in saliva; Components of energy balance.

Objectives To examine the patterns of fat mass gain in pregnancy and fat loss in the early postpartum period relative to women's pre-pregnancy body mass index (BMI) and by adherence to Institute of Medicine's gestational weight gain (GWG) recommendations. Design Prospective cohort study with three to four study visits. Setting This study is a part of the prospective longitudinal birth cohort, 'The Alberta Pregnancy Outcomes and Nutrition Study' (APrON) that recruited pregnant women from the cities of Edmonton and Calgary in Alberta. Participants 1820 pregnant women were recruited and followed through their pregnancy and at 3 months postpartum. Outcome measures Body weight and skinfold thicknesses were measured during pregnancy and early postpartum in women. Body density was calculated from sum of skinfold thickness (biceps, triceps, subscapula and suprailiac), and total fat mass accretion during pregnancy was calculated using Van Raaij's equations and at postpartum using Siri's equation. Differences in total fat mass gain, fat mass loss and fat retention according to pre-pregnancy BMI categories and GWG categories were tested using two-way analysis of variance and post hoc comparisons. Results Most women (64%) had a normal pre-pregnancy BMI, and overall 49% women exceeded the GWG recommendations. Obese women gained significantly less total fat mass, had lower fat mass loss and had lower postpartum fat retention than normal-weight women (p<0.05). Women with excessive GWG gained higher total fat mass and had higher postpartum fat mass retention (p<0.03) than women who met the GWG recommendations. Total GWG was positively correlated with total fat gain (r=0.61, p<0.01) and total fat retention (r=0.31, p<0.05). Conclusion Excessive GWG is the significant risk factor for higher fat mass accretion during pregnancy and higher postpartum fat retention, irrespective of pre-pregnancy BMI. [ABSTRACT FROM AUTHOR]

Background Profiling postpartum energy metabolism may assist in optimizing weight management following childbirth. Objectives The aims of this study were to profile total energy expenditure (TEE), resting energy expenditure (REE), exercise energy expenditure, sleep energy expenditure, and respiratory quotient in women at 3 and 9 mo postpartum (3M-PP, 9M-PP, respectively), and to examine the association between energy metabolism and postpartum weight retention (PPWR). Methods In this cohort study, 1-h REE (measured in a whole body calorimetry unit, WBCU) and body composition (BC, measured by dual-energy X-ray absorptiometry) were measured at 3M-PP and 9M-PP (n  = 49). Cardiorespiratory fitness [measured by the predicted maximal volume of oxygen consumption (p |$\dot{V}$| O2 max), n  = 47] and 24-h TEE (WBCU, n  = 43) were assessed only at 9M-PP. Women were stratified as high (>4.8 kg) or low (≤ 4.8 kg) weight retainers. Two-way mixed repeated-measures ANOVA and longitudinal regression models were applied. Linear regression was used to generate an equation at 3M-PP from the BC data, to predict the REE at 9M-PP. Results The fat mass at 3M-PP was positively associated with PPWR at 3M-PP (mean ± SE β: 0.09 ± 0.03; P  = 0.005) and 9M-PP (β: 0.11 ± 0.04; P  = 0.008), and negatively associated with REE at 3M-PP (β: −0.16 ± 0.02; P  < 0.001) and TEE at 9M-PP (β: −0.15 ± 0.03; P  < 0.001). REE was negatively associated with PPWR (β: −0.74; 95% CI: −1.29, −0.19; P  = 0.0087). REE was 2 kcal/kg higher in low- vs. high-retainers at 3M-PP, and REE and TEE were both 4 kcal/kg higher in low- vs. high-retainers at 9M-PP. Low-retainers demonstrated an increase in REE greater than expected for changes in BC. PPWR was negatively associated with TEE (β: −0.08 ± 0.02; P  = 0.0009) and p |$\dot{V}$| O2 max (β: −0.02 ± 0.01; P  = 0.047); p |$\dot{V}$| O2 max was 7 mL · kg–1 · min–1 higher in low- vs. high-retainers (P  = 0.047). Conclusions Energy metabolism, BC, and cardiorespiratory fitness may be associated with weight regulation and its trajectory during the postpartum period. This provides the foundation for future strategies to promote appropriate postpartum weight management. [ABSTRACT FROM AUTHOR]

The aim of this study was to characterise changes in lean soft tissue (LST) and examine the contributions of energy intake, physical activity and breast-feeding practices to LST changes at 3 and 9 months postpartum. We examined current weight, LST (via dual-energy X-ray absorptiometry), dietary intake (3-d food diary), physical activity (Baecke questionnaire) and breast-feeding practices (3-d breast-feeding diary) in forty-nine women aged 32·9 (sd 3·8) years. Changes in LST varied from −2·51 to +2·50 kg with twenty-nine women gaining LST (1·1 (sd 0·7) kg, P <0·001) and twenty women losing LST (−0·9 (sd 0·8) kg, P <0·001). Energy intake (133 (SD 42) v. 109 (SD 33) kJ/kg, P =0·019) and % kJ from fat at 3 months postpartum was higher in women who gained LST at 9 months postpartum (gained LST=34 (sd 5) % kJ; lost LST=29 (sd 4) % kJ, P =0·002). Women who gained LST reported breast-feeding their infants more frequently (gained LST=8 (sd 3) feeds/d; lost LST=5 (sd 1) feeds/d, P =0·014) and for more time per d (gained LST=115 (sd 78) min/d; lost LST=59 (sd 34) min/d, P =0·016) at 9 months postpartum. Energy intake and % kJ from fat at 3 months were significant predictors of LST gain (β =0·08 (se 0·04) and 0·24 (se 0·09), respectively). This suggests that gain in LST may be associated with more frequent and longer episodes of breast-feeding at 9 months postpartum as well as dietary intake early in the postpartum period. [ABSTRACT FROM AUTHOR]

Background Accurate assessment of energy expenditure may support weight-management recommendations. Measuring energy expenditure for each postpartum woman is unfeasible; therefore, accurate predictive equations are needed. Objectives This study compared measured with predicted resting energy expenditure (REE) and total energy expenditure (TEE) in postpartum women. Methods This was a longitudinal observational study. REE was measured at 3 mo postpartum (n  = 52) and 9 mo postpartum (n  = 49), whereas TEE was measured once at 9 mo postpartum (n  = 43) by whole body calorimetry (WBC). Measured REE (REEWBC) was compared with 17 predictive equations; measured TEE plus breast milk energy output (ERWBC) was compared with the estimated energy requirements/Dietary Reference Intakes equation (EERDRI). Fat and fat-free mass were measured by dual-energy X-ray absorptiometry. Group-level agreement was assessed by the Pearson correlation, paired t test, and Bland-Altman (bias) analyses. Individual-level accuracy was assessed with the use of Bland-Altman limits of agreement, and by the percentage of women with predicted energy expenditure within 10% of measured values ("accuracy"). Results The cohort was primarily Caucasian (90%). At a group level, the best equation predicting REEWBC was the DRI at 3 mo postpartum (–7 kcal, –0.1%; absolute and percentage bias, respectively), and the Harris-Benedict at 9 mo postpartum (–17 kcal, –0.5%). At an individual level, the Food and Agriculture Organization/World Health Organization/United Nations University (FAO/WHO/UNU) height and weight equation was the most accurate at 3 mo postpartum (100% accuracy) and 9 mo postpartum (98% accuracy), with the smallest limits of agreement. Equations including body composition variables were not more accurate. Compared with ERWBC, EERDRI bias was –36 kcal, with inaccurate predictions in 33% of women. Conclusions Many REE predictive equations were accurate for group assessment, with the FAO/WHO/UNU height and weight equation having the highest accuracy for individuals. EERDRI performed well at a group level, but inaccurately for 33% of women. A greater understanding of the physiology driving energy expenditure in the postpartum period is needed to better predict TEE and ultimately guide effective weight-management recommendations. [ABSTRACT FROM AUTHOR]

Despite recommendations for higher choline intakes during pregnancy and lactation, there is limited research regarding maternal intake during these important periods. In the present study, we estimated dietary choline intake during pregnancy and lactation in a population of Albertan women and the contribution of egg and milk consumption to intake. Dietary intake data were collected from the first 600 women enrolled in a prospective cohort study carried out in Alberta, Canada. During the first and/or second trimester, the third trimester and 3 months postpartum, 24 h dietary intake recall data were collected. A database was constructed including foods consumed by the cohort and used to estimate dietary choline intake. The mean total choline intake value during pregnancy was 347 (sd 149) mg/d, with 23 % of the participants meeting the adequate intake (AI) recommendation. During lactation, the mean total choline intake value was 346 (sd 151) mg/d, with 10 % of the participants meeting the AI recommendation. Phosphatidylcholine was the form of choline consumed in the highest proportion and the main dietary sources of choline were dairy products, eggs and meat. Women who consumed at least one egg in a 24 h period had higher (P< 0·001) total choline intake and were eight times more likely (95 % CI 5·2, 12·6) to meet choline intake recommendations compared with those who did not consume eggs during pregnancy. Women who reported consuming ≥ 500 ml of milk in a 24 h period were 2·8 times more likely (95 % CI 1·7, 4·8) to meet daily choline intake recommendations compared with those consuming < 250 ml of milk/d during pregnancy. Choline intake is below the recommendation levels in this population and the promotion of both egg and milk consumption may assist in meeting the daily choline intake recommendations. [ABSTRACT FROM PUBLISHER]

Background Nudging is an approach to environmental change that alters social and physical environments to shift behaviors in positive, self-interested directions. Evidence indicates that eating is largely an automatic behavior governed by environmental cues, suggesting that it might be possible to nudge healthier dietary behaviors. This study assessed the comparative and additive efficacy of two nudges and an economic incentive in supporting healthy food purchases by patrons at a recreational swimming pool. Methods An initial pre-intervention period was followed by three successive and additive interventions that promoted sales of healthy items through: signage, taste testing, and 30% price reductions; concluding with a return to baseline conditions. Each period was 8 days in length. The primary outcome was the change in the proportion of healthy items sold in the intervention periods relative to pre- and post-intervention in the full sample, and in a subsample of patrons whose purchases were directly observed. Secondary outcomes included change in the caloric value of purchases, change in revenues and gross profits, and qualitative process observations. Data were analyzed using analysis of covariance, chi-square tests and thematic content analysis. Results Healthy items represented 41% of sales and were significantly lower than sales of unhealthy items (p < 0.0001). In the full sample, sales of healthy items did not differ across periods, whereas in the subsample, sales of healthy items increased by 30% when a signage + taste testing intervention was implemented (p < 0.01). This increase was maintained when prices of healthy items were reduced by 30%, and when all interventions were removed. When adults were alone they purchased more healthy items compared to when children were present during food purchases (p < 0.001), however parental choices were not substantially better than choices made by children alone. Conclusions This study found mixed evidence for the efficacy of nudging in cueing healthier dietary behaviors. Moreover, price reductions appeared ineffectual in this setting. Our findings point to complex, context-specific patterns of effectiveness and suggest that nudging should not supplant the use of other strategies that have proven to promote healthier dietary behaviors. [ABSTRACT FROM AUTHOR]

ObjectiveLittle is known about how public entities can partner with industry to achieve public health goals. We investigated industry's perspective of factors that influenced their adoption and implementation of voluntary, government-issued nutrition guidelines (Alberta Nutrition Guidelines for Children and Youth, ANGCY) in recreational facilities.DesignIn-depth semi-structured interviews were conducted. Data were analysed using directed content analysis.SettingFood services in recreational facilities.SubjectsSeven managers from industry participated; five from companies that had adopted and implemented the ANGCY (adopters) in recreational facilities and two from companies that had not (non-adopters).ResultsIndustry views nutrition guidelines through the lens of profitability. Non-adopters were unwilling to implement the ANGCY for fear of sacrificing short-term profitability, whereas adopters adhered to them in an attempt to position themselves for long-term profitability. Adopters faced barriers including few resources, no training, complex guidelines, low availability of and demand for ANGCY-compliant products, competitive pressures and substantial declines in revenue. Managers believed widespread voluntary adoption of the ANGCY was unlikely without government incentives and/or a mandate, as the environmental context for voluntary action was poor. All managers supported government-mandated implementation of the ANGCY to level the playing field upon which companies compete.ConclusionsPublic–private partnerships in recreational facilities can embrace public health goals in the short term, provided industry perceives potential for long-term financial gain. Widespread uptake of voluntary nutrition guidelines in this setting is unlikely, however, as market mechanisms do not encourage industry to sell and promote healthier options. Government legislation may therefore be warranted. [ABSTRACT FROM AUTHOR]

Aim. To explore the factors associated with exercise-induced acute capillary glucose (CapBG) changes in individuals with type 2 diabetes (T2D). Methods. Fifteen individuals with T2D were randomly assigned to energy-matched high intensity interval exercise (HI-IE) and moderate intensity continuous exercise (MI-CE) interventions and performed a designated exercise protocol 5 days per week for 12 weeks. The duration of exercise progressed from 30 to 60 minutes. CapBG was measured immediately before and after each exercise session. Timing of food and antihyperglycemic medication intake prior to exercise was recorded. Results. Overall, the mean CapBG was lowered by 1.9 mmol/L (p < 0.001) with the change ranging from-8.9 to +2.7mmol/L. Preexercise CapBG(44%; p < 0.001), medication (5%; p < 0.001), food intake (4%; p = 0.043), exercise duration (5%; p < 0.001), and exercise intensity (1%; p = 0.007) were all associated with CapBG changes, explaining 59% of the variability. Conclusion. The greater reduction in CapBG seen in individuals with higher preexercise CapBG may suggest the importance of exercise in the population with elevated glycemia. Lower blood glucose can be achieved with moderate intensity exercise, but prolonging exercise duration and/or including brief bouts of intense exercise accentuate the reduction, which can further be magnified by performing exercise after meals and anti hyperglycemic medication. [ABSTRACT FROM AUTHOR]