Five meals a day prevents youth obesity | Yle Uutiset | yle.fi


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A new 5-a-day rule seems to be in the offing.

Image: Arja Lento / Yle

Master of Health Sciences Anne Jääskeläinen’s doctoral research shows that a regular five meal rhythm on weekdays protects against overweight and obesity in young people – as well as in infants who might be prone to overly padded waistlines.

According to the study, even those who are genetically more susceptible to weight gain will not pack on more kilos than their more genetically fortunate peers if they stick to the five a day rule.

The results also show that if a father was overweight before the mother’s pregnancy, the risk factors are almost the same as if the mother was overweight before the pregnancy began – for both girls and boys. In addition, mothers who packed on the pounds at the start of their pregnancy increased the risk of continuing the trend in their offspring.

The study brings new information on early risk factors associated with young Finns at risk of overweight and obesity.

USPSTF Favors Gestational Diabetes Testing

All asymptomatic pregnant women should be screened for gestational diabetes after 24 weeks’ gestation, according to draft guidelines from the U.S. Preventive Services Task Force (USPSTF).

The common practice of screening before 24 weeks based on risk factors didn’t get either a thumbs up or down, as the group cited insufficient evidence from its literature reviews appearing online in the Annals of Internal Medicine. The same was true for which test and threshold to use for screening.

The task force had previously suggested insufficient evidence for any gestational diabetes screening.

The update aligns most closely with guidelines from the American Diabetes Association, which recommends screening all women without a preexisting diabetes diagnosis at 24- to 28-weeks’ gestation using a 75-g, 2-hour oral glucose tolerance test (OGTT).

The American College of Obstetricians and Gynecologists recommends screening all but low-risk women, although that organization is also in the process of a guideline revision.

The shift for the USPSTF appeared to have hinged on more evidence for a benefit of treating gestational diabetes since the last revision in 2008.

The literature review by Lois Donovan, MD, of the University of Calgary, Alberta, and colleagues indicated that diet modification, glucose monitoring, and insulin when needed resulted in less preeclampsia, shoulder dystocia, and macrosomia.

“When these outcomes are considered collectively, there is a moderate net benefit for both mother and infant,” the draft guideline noted.

Evidence for long-term metabolic benefits for the mother and baby weren’t certain.

But there was little evidence for harm aside from more prenatal visits. Small-for-gestational age and neonatal hypoglycemia weren’t more common with treatment, although the trials may have been underpowered to detect meaningful differences, Donovan’s group cautioned.

The treatment literature review included five randomized, controlled trials and six cohort studies. The group’s review of the literature on screening turned up 51 studies, but that evidence didn’t show a clear winner among the various strategies.

The characteristics of an oral glucose challenge test with a threshold of 7.8 mmol/L (140 mg/dL) to indicate a positive screen were sensitivity of 70% to 88%, specificity of 69% to 89%, a positive likelihood ratio of 2.6 to 6.5, and a negative likelihood ratio of 0.16 to 0.33, the review found.

A lower threshold of 7.2 mmol/L (130 mg/dL) had higher sensitivity of 88% to 99% but lower specificity of 66% to 77%, which yielded a positive likelihood ratio of 2.7 to 4.2 and negative likelihood ratio of 0.02 to 0.14.

Fasting plasma glucose has been suggested as an alternative initial measurement that is easier and less time-consuming to obtain.

A threshold of 4.7 mmol/L (85 mg/dL) on that test had similar sensitivity of 87% but low specificity of 52% and low positive likelihood ratio of 1.8, which “suggests that it is not as good at predicting an abnormal OGTT result,” the authors noted.

Glycated hemoglobin level has also been suggested as an alternative but had poorer test characteristics than the other tests.

The limited evidence on these alternative screening approaches was inadequate, according to the draft guidelines. It didn’t recommend one screening test or threshold as the best for clinical practice.

There were few data on screening tests before 24 weeks’ gestation.

The period for public comment on the draft guidelines ends June 24, after which the final recommendations will be released.

The reviews were funded by the Agency for Healthcare Research and Quality.

Donovan reported a contract with the University of Alberta Evidence Practice Centre for an evidence report on screening and diagnosis of gestational diabetes, and grant funds from International Diabetes Federation and Eli Lilly.

Primary source: Annals of Internal Medicine
Source reference:
Donovan L, et al “Screening tests for gestational diabetes: A systematic review for the U.S. Preventive Services Task Force” Ann Intern Med 2013; 159.

Additional source: Annals of Internal Medicine
Source reference:
Hartling L, et al “Benefits and harms of treating gestational diabetes mellitus: A systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research” Ann Intern Med 2013;159.


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Crystal Phend

Staff Writer

Crystal Phend joined MedPage Today in 2006 after roaming conference halls for publications including The Medical Post, Oncology Times, Doctor’s Guide, and the journal IDrugs. When not covering medical meetings, she writes from Silicon Valley, just south of the San Francisco fog.

Alan Alda’s childhood plagued by polio and mother’s schizophrenia

Alan Alda is an acclaimed actor, screenwriter and director. Perhaps best known for his role as Hawkeye Pierce in the TV series M*A*S*H, he boasts a total of six Golden Globe Awards and five Emmy’s for his outstanding achievements within the TV and film industry.

In 2005, the now 74-year-old published his first autobiography, titled “Never Have Your Dog Stuffed: and Other Things I’ve Learned”, giving readers an intimate insight into his life as a child: suffering from polio, travelling with his actor father and trying to deal with his beauty-queen mother’s mental illness.

Alda contracted polio at the age of 7. “There was an epidemic in those days, and that was before the vaccine,” he told Tavis Smiley in an interview following the release of the book. “And there really wasn’t any treatment except Sister Elizabeth Kenny,” he added.

This treatment, developed by the eponymous Australian nurse, involved wrapping burning hot woollen blankets around the limbs and administering extremely firm massage in order to stretch the muscles and prevent them from going lame.

The actor described his therapy as “extremely painful” and remembers having to endure it “every 2 hours, for months”. He said: “Everybody who went through those treatments knows what I mean. They were just awful. And my parents, who had no money, had to–they didn’t have anybody to administer these treatments. They had to do it themselves. So here your parents are torturing you against their own will. You know, they don’t want you to hurt.”

Yet, polio is not the only pain Alda associates with his childhood. In his autobiography, he talks frankly about his mother, a former Miss New York, and her serious mental health problems.

“As a boy, I didn’t understand how ill she was. … It’s hard to understand what it was like in those days — no one spoke about mental illness. It was a thing to be ashamed of,” CNN cites the author.

Alda goes on to admit to his own anger at and shame of his mother, whose manic episodes were sometimes so severe she tried to stab his father and attempted to escape from a moving plane.

“I couldn’t have written [this book] 20 years ago. I couldn’t even talk about it 25 years ago. I not only wouldn’t talk about it in public, I had friends I wouldn’t talk about it to,” he writes.

Despite this, the star claims to have drawn a lot of strength from Joan Alda, who he says was tireless in treating his polio and “tried really hard to be as good a mother as she could…despite the fact that she was so incapacitated”.

Images: Wikimedia Commons

Newborn’s full diaper can reveal mother’s exposure to tobacco smoke during pregnancy

A new born baby’s diaper can reveal the amount of tobacco smoke exposure that the mother has had during pregnancy, says a new health report published on www.sciencedaily.com.

The stools, also known as meconium, passed by a baby in his or her first few days, can show whether or not the mother was exposed to smoke while she was pregnant. The research was carried out by scientists at the University of North Carolina and its findings were published in the journal Environmental Health.

Researchers collected meconium samples from 337 babies to find out the amount of smoke metabolites present. They concluded that due to the active and secondhand tobacco smoke, the infants have to suffer these adverse effects, says the report in www.physorg.com.

Measurement of tobacco and smoke exposure can be taken with the help of biomarkers. The researchers have found that the metabolites in the stool reflect the amount and duration of the smoke exposure in the baby’s mother. In babies born to active smokers, the concentration of the metabolites was found to be too high as compared to the women who were exposed to only second hand smoke or were not exposed to any smoke at all.

Images: Wikipedia France and viZZZual on Flikr