Blanca Ribot

Background: Pakistani women are among the most affected groups by obesity and heart failure in Catalonia. Due to cultural and linguistic barriers, their participation in standard health promotion programs is limited. To address this issue, we implemented a culturally and linguistically appropriate food education program called the PakCat Program. Methods: The study employed a community-based participatory research (CBPR) design, utilizing a two-arm, cluster-assignment, non-blinded mixed-method randomized control trial (RCT) implemented in Badalona and Santa Coloma de Gramenet, two neighboring municipalities with a substantial Pakistani population. Participants were randomly assigned to the control group (n = 67) and the intervention group (n = 70). The intervention group received ten weekly culturally and linguistically appropriate food education sessions over ten weeks, while the control group attended three general sessions. The main outcome measures included nutritional status, nutrition knowledge and skills, dietary patterns, and satisfaction with the intervention, which were assessed pre-and post-intervention combining quantitative methods based on a survey and qualitative approaches consisting of conducting focus group discussions (FGDs). Results: The quantitative analysis conducted through a two-factor analysis of variance (ANOVA) for repeated measures indicated a significant improvement in the study variables across the entire sample (p < 0.001 within group), with the intervention group experiencing greater improvements in nutrition knowledge and skills and dietary pattern (p <0.001 for interaction and between groups). These findings were corroborated by thematically analyzed qualitative data confirming a more pronounced improvement in the study outcomes of the intervention group. Furthermore, both groups reported a high level of satisfaction with the intervention. Conclusions: The PakCat Program effectively improved the nutrition knowledge, skills, and dietary patterns of immigrant women of Pakistani origin residing in Catalonia. However, future research involving a larger sample size and combining the behavioral and clinical parameters is needed to enhance the generalizability of the results.

Background: Multidisciplinary lifestyle interventions are being researched to treat fibromyalgia. However, the impact of nutrition as a key treatment component is little studied. This study aimed to evaluate the effectiveness of the SYNCHRONIZE + lifestyle multidisciplinary intervention in improving adherence to the Mediterranean diet, nutrition quality and dietary intake pattern in persons with fibromyalgia and chronic fatigue syndrome. Methods: A pragmatic randomized clinical trial was conducted in primary care. Data were collected using the 17-item energy-restricted Mediterranean Adherence Screener (er-MEDAS), the food frequency questionnaire (sFFQ) and the 24 h recall questionnaire (24 HR), in addition to chrono-nutritional, anthropometric, and body composition data, at baseline and 3-, 6-, and 12- month follow-up visits, and statistically analyzed. Results: A total of 158 participants were evaluated. Results showed the effectiveness of the intervention in improving adherence to the Mediterranean diet. The adherence depended on the group-time interaction being positive and significant at 3 and 6 months post-intervention in the INT group and on the participant age and educational level. Specifically, the intake of legumes, fruits, vegetables, nuts and blue fish was increased, while the intake of sweets and pastries, butter and cream and red and processed meat was reduced. Furthermore, the intake of chips and candies was also reduced, and the consumption of fermented food (yogurts, cheese, kefir) increased. Thus, general diet quality improved. Interestingly, the intake of key nutrients such as protein and iron increased. Furthermore, the number of night eaters was decreased significantly. Muscle mass index was also improved in the intervention group. These results were maintained in the medium to long term. Conclusion: SYNCHRONIZE + is a brief, low-cost, multidisciplinary intervention effective in improving adherence to the Mediterranean diet and improving nutritional and dietary intake patterns in persons with fibromyalgia and chronic fatigue syndrome. Further evaluation of the effect on quality of life and symptoms is needed.

To evaluate whether women with anaemia or high haemoglobin (Hb) in early pregnancy would be at higher risk of miscarriage, this population-based cohort study involved 9453 women whose pregnancies were monitored at primary care centres between 2007 and 2012. The computerised clinical histories were used to collect: Hb measurements (up to 14 weeks of gestation), miscarriage before or by 24 weeks of gestation, and other maternal characteristics. The relation between anaemia (Hb < 110 g/L), normal Hb (110–140 g/L, reference), and high Hb concentrations (≥140 g/L) with miscarriage were expressed as adjusted OR with 95%CI. Restricted cubic spline models were applied to evaluate the dose-response relationships. A total of 520 (5.5%) women were recorded as having a miscarriage. The rate of miscarriage in anaemia, normal Hb, and high Hb concentrations was 8.4%, 5.1%, and 10.2%, respectively. Compared with women with normal Hb at the first trimester, the multivariable-adjusted OR for miscarriage was 2.11 (95%CI, 1.38–3.21) for women with anaemia and 1.83 (95%CI, 1.29–2.58) for women with high Hb. Hb concentrations showed a U-shaped association with miscarriage, with the lowest incidence among women with Hb of 120–130 g/L. These data highlight the importance of considering anaemia and high Hb levels in early pregnancy as harmful indicators for miscarriage.

Since iron plays an important role in several physiological processes, its deficiency but also overload may harm the development of children. The aim was to assess the effect of iron–fortified milk on the iron biochemical status and the neurodevelopment of children at 12 months of age. Randomized controlled trial conducted in 133 Spanish children, allocated in two groups to receive formula milk fortified with 1.2 or 0.4 mg/100 mL of iron between 6 and 12 months of age. Psychomotor (PDI) and Mental (MDI) Development Index were assessed by the Bayley Scales before and after the intervention. Maternal obstetrical and psychosocial variables were recorded. The biochemical iron status of children was measured and data about breastfeeding, anthropometry and infections during the first year of life were registered. Children fortified with 1.2 mg/100 mL of iron, compared with 0.4 mg/100 mL, showed higher serum ferritin (21.5 vs 19.1 μg/L) and lower percentage of both iron deficiency (1.1 to 5.9% vs 3.8 to 16.7%, respectively, from 6 to 12 months) and iron deficiency anemia (4.3 to 1.1% vs 0 to 4.2%, respectively, from 6 to 12 months) at the end of the intervention. No significant differences were found on neurodevelopment from 6 to 12 months between children who received high dose of Fe compared with those who received low dose. Despite differences on the iron status were observed, there were no effects on neurodevelopment of well–nourished children in a developed country after iron supplementation with doses within dietary recommendations. Follow–up studies are needed to test for long–term neurodevelopmental improvement. Retrospectively registered in ClinicalTrials.gov with the ID: NCT02690675.

Objective: To determine the associations between haemoconcentration at the end of pregnancy (third trimester and delivery) and neonatal behaviour in healthy pregnant women supplemented with moderate doses of Fe.Design: A prospective longitudinal study in which obstetric and clinical history, maternal toxic habits, maternal anxiety and Hb levels were recorded at the third trimester and delivery. Neonatal behaviour was assessed at 48–72 h of age using the Neonatal Behavioral Assessment Scale.Setting: Unit of Obstetrics and Gynaecology of the Sant Joan University Hospital in Reus, Tarragona (Spain).Subjects: A total of 210 healthy and well-nourished pregnant women and their full-term, normal-weight newborns.Results: The results showed that, after adjusting for confounders, in the third trimester the risk of haemoconcentration (6·2 % of pregnant women) was related to decreased neonatal state regulation (B=−1·273,P=0·006) and alertness (B=−1·848,P=0·006) scores. In addition, the risk of haemoconcentration at delivery (12·0 % of pregnant women) was also related to decreased neonatal state regulation (B=−0·796,P=0·021) and poor robustness and endurance (B=−0·921,P=0·005) scores.Conclusions: Our results show that the risk of haemoconcentration at the end of pregnancy is related to the neonate’s neurodevelopment (and self-regulation capabilities), suggesting that Fe supplementation patterns and maternal Fe status during pregnancy are important factors for neurodevelopment which may be carefully controlled.

The aim of this systematic review and meta‐analysis of observational studies was to assess the relationship between elevated iron status, measured as hemoglobin and ferritin levels, and the risk of gestational diabetes mellitus (GDM). The present study was recorded in PROSPERO (2013:CRD42013005717). The selected studies were identified through a systematic review of scientific literature published in The Cochrane Library and PubMed/MEDLINE databases from their inception until March 10, 2016, in addition to citation tracking and hand‐searches. The search strategy of original articles combined several terms for hemoglobin, ferritin, pregnancy, and GDM. OR and 95% CI of the selected studies were used to identify associations between hemoglobin and/or ferritin levels with the risk of GDM. Summary estimates were calculated by combining inverse‐variance using fixed‐effects model. 2468 abstracts were initially found during the search. Of these, 11 with hemoglobin and/or ferritin data were selected for the meta‐analyses. We observed that high hemoglobin (OR = 1.52; 95% CI: 1.23–1.88), as well as ferritin (OR = 2.09; 95% CI: 1.48–2.96) levels were linked to an increased risk of GDM. Low heterogeneity was observed in hemoglobin (I² = 33.3%, P = 0.151) and ferritin (I² = 0.7%, P = 0.418) meta‐analyses, respectively. Publication bias was not appreciated. High hemoglobin or ferritin levels increase the risk of GDM by more than 50% and more than double, respectively, in the first and third trimester. Therefore, determining of hemoglobin or ferritin concentration in early pregnancy might be a useful tool for recognizing pregnant women at risk of GDM.

Objectives To study the longitudinal effects of prenatal nicotine exposure on cognitive development, taking into consideration prenatal and postnatal second-hand smoke exposure. Methods A cohort follow up study was carried out. One hundred and fifty-eight pregnant women and their infants were followed during pregnancy and infant development (at 6, 12, 30 months). In each trimester of pregnancy and during postnatal follow-up, a survey was administered to obtain sociodemographic data and the details of maternal and close familial toxic habits. Obstetric and neonatal data were obtained from hospital medical records. To assess cognitive development, the Bayley Scales of Infant Development were applied at 6, 12 and 30 months; to assess language development, the MacArthur-Bates Communicative Development Inventories were applied at 12 months and the Peabody Picture Vocabulary Test at 30 months. Results After adjustment for confounding variables, the results showed that infants prenatally exposed to cigarette smoke recorded poor cognitive development scores. Language development was most consistently affected, specifically those aspects related to auditory function (vocalizations, sound discrimination, word imitation, prelinguistic vocalizations, and word and sentence comprehension). Conclusions for Practice Irrespective of prenatal, perinatal and sociodemographic data (including infant postnatal nicotine exposure), prenatal exposure to cigarette smoke and second-hand smoke affect infant cognitive development, especially language abilities.