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* AHA Guidelines on Prescription Omega-3


* Pregnancy Outcomes Post-Bariatric Surgery


* Teenage Weight Loss



Pregnancy after bariatric surgery is associated with increases in some adverse perinatal outcomes, according to a new systematic review and meta-analysis. Previous assessments of pregnancy after bariatric surgery have focused on maternal outcomes, and there is limited evidence on perinatal outcomes other than size for gestational age and preterm birth.


The researchers compared adverse perinatal outcomes among women who underwent bariatric surgery prior to pregnancy with those who did not in 33 studies that reported original data on perinatal outcomes.


Overall, the studies included 14 880 pregnancies after bariatric surgery and more than 3.9 million without. The pooled odds of perinatal mortality or stillbirth were 38% higher, and the odds of congenital anomalies were 29% higher with prior bariatric surgery than without, according to results from 10 studies.


The overall odds of preterm birth were 35% higher among women who had bariatric surgery than among those without, whereas the odds of postterm birth were 54% lower among women who had bariatric surgery, the researchers report in PLoS Medicine. Mean gestational age, however, did not differ significantly between the groups.


The odds of a small-for-gestational-age baby with prior bariatric surgery were twice as high than without, but this increase seemed to be limited to women who had undergone Roux-en-Y gastric bypass (RYGB) or biliopancreatic diversion. Mean birth weights were also significantly lower after bariatric surgery, again limited to the RYGB group in subgroup analyses.


Babies born post-bariatric surgery were 41% more likely than those born to other mothers to be admitted to the neonatal intensive care unit.


Based findings when investigators were able to subgroup results by surgery type, it was clear that malabsorptive procedures, particularly RYGB, were more likely to increase the risk of an adverse perinatal outcome than restrictive surgery types, suggesting a link with malnutrition.


The current evidence base could be used to inform risk communication about potential future pregnancies with women of reproductive age prior to surgery. Health professionals involved in the care of these women need to provide additional nutritional support during preconception and pregnancy after bariatric surgery


Source: PLoS Med 2019.



Prescription omega-3 fatty acids-products containing eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) or EPA alone-are an "effective and safe" way to reduce elevated triglyceride levels when used alone or with other lipid-lowering therapy, according to a science advisory from the American Heart Association (AHA).


The 2002 AHA scientific statement on fish and omega-3 fatty acids recommended increased intake of dietary omega-3 plus dietary supplements to achieve a level of 2 to 4 g/d of omega-3 fatty acids (referring to the total amount of EPA and DHA) for triglyceride lowering under the supervision of a physician. At the time of that statement, no prescription omega-3 fatty acid were available. Since then, 2 prescription omega-3 fatty acid medications have become available in the United States. Dietary supplements containing omega-3 fatty acids, which are not regulated as prescription products by the US Food and Drug Administration (FDA), should not be used in place of prescription medication for the long-term management of high triglyceride levels. Prescription omega-3 fatty acids at the FDA-approved dose of 4 g/d are safe and are generally well tolerated, the advisory states. In clinical trials of adults with very high triglyceride levels (VHTG), EPA + DHA at this dose reduced triglycerides by 30% or greater and concurrently increased low-density lipoprotein (LDL) cholesterol levels, whereas EPA alone did not increase LDL cholesterol. For patients with triglyceride levels from 200 to 499 mg/dL, prescription omega-3 fatty acids at a dose of 4 g/d reduced triglyceride levels by 20% to 30% without significantly increasing LDL cholesterol, they note. For these patients, EPA alone and EPA + DHA are roughly comparable for lowering triglyceride levels.


The authors emphasize that medical conditions such as poorly controlled type 2 diabetes, hypothyroidism, and obesity that may contribute to elevations in triglyceride levels should be addressed before use of prescription medications. The AHA advisory does not recommend one prescription omega-3 product over the other because there have been no head-to-head comparisons of the 2 different formulations at prescription doses.


The AHA currently recommends that adults consume two 3.5-oz servings of nonfried fish (or about three-fourths of a cup of flaked fish) per week, preferably oily fish, such as salmon, mackerel, herring, lake trout, sardines, or albacore tuna, which are all high in omega-3 fatty acids.


Source:Circulation. Published online August 19, 2019.



More US teens, especially girls, have been attempting to lose weight, according to newly analyzed federal survey data. Results from the 2013-2016 National Health and Nutrition Examination Survey (NHANES) indicated that nearly 38% of adolescents said they had attempted to lose weight within the last year, with more girls attempting weight loss than boys from 2013 to 2016 (45.2% vs 30.1%). Notably, 50.8% of Hispanic teens tried to lose weight, whereas only 31.8% of non-Hispanic black, 33.1% of non-Hispanic white, and 28.4% of non-Hispanic Asian teens attempted to lose weight, the group reported in an NCHS Data Brief. The NHANES data covered 602 boys and 619 girls, aged 16 to 19 years, surveyed in the program's 2013-2014 and 2015-2016 cycles. NHANES includes standardized physical examinations done in mobile examination centers as well as in-home interviews.


In an effort to lose weight, more than 50% of teens reported drinking a lot of water, 83.5% exercised, 44.7% tried to eat less junk food or fast food, and 44.6% ate more salads, vegetables and fruits, and following recommended lifestyle modification strategies for healthy eating and exercise. However, the data also showed 16.5% of teens saying they skipped meals in order to lose weight. The American Academy of Pediatrics guidelines discourage such approaches as they are unhealthy. Prior studies have shown that approximately 24% of US teens tried to lose weight from 2009 to 2010 and that girls are more likely than boys to try to lose weight, the authors noted.


This report should encourage clinicians to continue discussing the importance of healthy habits. It is also important for the clinician to understand the motivation behind intended weight loss. Some teens may attempt to lose weight to change their appearance rather than for health reasons. This motivation may lead to more extreme practices to achieve a desired weight. Understanding the techniques that teens employ to lose weight may help clinicians better support and counsel their efforts with appropriate referrals to support such as dietitians when possible, and provision of healthy lifestyle advice.


More frequent follow-up in the office would also support this effort. Providing this type of support will increase the likelihood of success and reduce the chance of unhealthy dietary practices and behaviors.


Source: McDow KB, et al. Attempts to lose weight among adolescents aged 16-19 in the United States, 2013-2016. NCHS Data Brief No. 340.



A new study has found that offering children a wide variety and large quantities of snack food encourages them to eat more. The research also found that how snacks are presented (in a large or small container) influences how much children snack. The study found children were not greatly affected by container size, with food consumption mainly driven by the quantity/variety of snacks on offer.


The researchers gave snack boxes filled with crackers, cheese, a granola bar, cookies, a container of peaches, and chocolate to 1800 Australian 11- and 12-year-old children and their parents. The size of the boxes and the number of snacks inside of them varied by child and parent, and the children and parents were separated while they ate.


The total number of grams and calories of food eaten by the parents and children were measured, along with their physical activity and sleeping habits. The findings showed the size of the package had a great impact on how much the children ate. The eating habits of the parents, however, were unchanged. While the presentation of the packaging had no effect on how much the children ate, the amount of food available did.


Past research has shown people make food options based on how it is displayed. Nearly 19% of children in the United States are obese, according to the Centers for Disease Control and Prevention. The researchers recommend that "more attention and resources should be directed toward offering children smaller amounts of food and, specifically, fewer and less variety of energy-dense foods and prepackaged items." "Interventions should not solely invest in reducing dishware size in the expectation that this will lead to reduced intake of snack foods." Further research with both parents and community leaders may help better understand the use and purpose of snack food items in the face of time pressures, marketing, and child preferences.


Source: Kerr J et al. International Journal of Obesity. 2019. DOI 10.1038/s41366-019-0407-z.