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Background. Mothers with a history of gestational diabetes mellitus (GDM) have a high risk of progressing to type 2 diabetes mellitus (T2DM) in the future. This progression can be attenuated by appropriate lifestyle interventions. We aimed to understand the perceptions of mothers with GDM and their healthcare workers regarding postpartum physical activity with a view to design a lifestyle intervention programme. Methods. We did this qualitative study in three selected districts of Sri Lanka. We also conducted six focus group discussions with 30 antenatal mothers with a history of GDM in a previous pregnancy, and six in-depth interviews with 3 postnatal nurses and 3 field midwives caring for postpartum mothers to explore their perceptions on postpartum physical exercises. Framework analysis was used to analyse the data. The transcripts were analysed using a Microsoft matrix and themes were generated. Results. Eight themes related to physical exercises emerged from both groups of participants. Two themes, 'Myths regarding postpartum physical activity' and 'Lack of awareness of the importance of postpartum physical activity' emerged from both groups of participants. Three themes, 'Time pressure', 'Stigma' and 'Child demands' emerged only from mothers while three themes, 'Traditional and cultural beliefs', 'Lack of influence from healthcare workers' and 'Lack of motivation' emerged solely from healthcare workers. Conclusions. The findings, especially the facilitators and barriers deserve the attention of health policy-makers when designing appropriate interventions to enhance postpartum physical exercises to attenuate the development of T2DM in women with GDM. [ABSTRACT FROM AUTHOR]

Background: Regular physical activity (PA) attenuates the development of type 2 diabetes mellitus in postpartum women with prior gestational diabetes mellitus (GDM). PA is assessed by calculating the energy expenditure (EE), thus accurate estimation of EE is crucial. International PA Questionnaire (IPAQ) and activity diary are widely used subjective methods while pedometer provides objective evidence of PA and EE. Aims and Objectives: This study aims to compare subjective and objective methods of assessing EE as a measure of PA in postpartum women with a history of GDM. Materials and Methods: Fifty postpartum women who had a history of GDM were advised to maintain activity diaries and pedometer readings for 1 week each month up to 1 year and IPAQ was administered at the end of 6 and 12 months. EE was calculated by all three methods separately and Bland-Altman plots were used to assess the level of agreement between IPAQ and the other tools at 6 and 12 months. Friedman test was performed to compare estimated EE between the three methods. Results: There was a poor agreement between the subjective and objective methods. According to Bland-Altman plot results, the highest mean difference was observed between IPAQ and pedometer at 12 months (mean difference was 75.9). This observation indicated an underestimation of pedometer values at 12 months. EE assessed by two subjective methods were statistically comparable at both time points whereas, EE assessed by pedometer was significantly lower (P<0.017) compared to self-reported tools. Conclusion: Assessment of EE by subjective methods which are based on personal judgment may cause overestimation of PA. In contrast, pedometer readings are likely to underestimate the PA as it only reports kinetics activities. Therefore, a combination of subjective and objective methods is recommended to ameliorate the reliability and validity. [ABSTRACT FROM AUTHOR]

Background: The link between sweet taste perception and carbohydrate intake in diabetics who perform regular combined exercises has not been explored. Aims and Objectives: This study aimed at determining the impact of combined exercises on taste perception for sucrose and carbohydrate intake in patients with type 2 diabetes mellitus. Materials and Methods: A clinical trial was conducted with 225 patients with T2DM, aged 35-60 years assigned randomly into three groups; aerobic, combined, and a control group. Outcomes of the aerobic group were not reported. Combined group performed brisk walking 4-5 days/week and resistance exercises 2-3 days/week for 6 months. Supra-threshold intensity ratings, preference for sucrose, and carbohydrate intake assessed at baseline, at 3 and 6 months were measured using "general Labeled Magnitude Scale," "Monell 2-series-forced choice method," and a 3-day diet diary, respectively. Results: Ratings for the highest (combined vs. control: +3.15±0.57 vs. -7.96±0.40 mol/L, P=0.022) and the second-highest sucrose concentrations (combined vs. control: +7.79±4.49 vs. -8.98±0.99 mol/L, P=0.003) in the combined group were significantly higher with significant time × group interaction (2.02M: P=0.002, 0.64M: P=0.003). Preference for sucrose was lower in the combined group (combined vs. control: -0.08±0.14 vs. +0.01±0.03 mol/L, P=0.002), and the time × group interaction was not significant. Carbohydrate intake (combined vs. control: -46.97±21.60 vs. -6.30±9.36 g, P=0.001) and HbA1c level (combined vs. control: -0.66±1.81 vs. +0.33±1.84%, P=0.008) were reduced in the combined group, and taste sensitivity significantly predicted the carbohydrate intake with combined exercises (R2=0.64, P=0.01). Conclusion: Regular combined exercises increase sweet taste sensitivity for higher concentrations of sucrose. Taste sensitivity, not the preference determines the carbohydrate intake in exercising diabetics. [ABSTRACT FROM AUTHOR]

Background: Obesity and its' comorbidities in young adults are emerging health concerns. Obesity is a well-known risk factor for developing cardiovascular diseases, type -2 diabetes, carcinomas, gallbladder disease, sleep apnea, osteoarthritis, and gynecological complications. Young adulthood is considered the best time period to introduce weight control interventions as the established lifestyle behaviors may persist throughout life. Aims and Objectives: The present study assessed self-perception of body weight, knowledge and practices on obesity and weight reduction and their associated factors in a sample of treatment seeking obese young adults. Materials and Methods: Two-hundred and sixty-one obese (BMI ≥ 25 kg m-2) young (18-35 years) adults attending an out-patient nutrition clinic of a teaching hospital in Sri Lanka were studied. An interviewer administered questionnaire was used to collect demographic data and information on body weight perception and, knowledge and practices on obesity and weight reduction. Weight, height and waist circumference were measured. Results: The mean (±SD) BMI of the participants was 29.0 (±3.6) kg m-2. Only 16.1% precisely perceived themselves as 'obese' and increased BMI was only significant predictor of accurate body weight perception (OR=1.23; 95% CI = 1.07-1.47; p = 0.003). Only 49.0% reported obesity as a disease and 46.0 % and 27.2% that it predisposes to stroke and carcinoma respectively. Although 86.2% have attempted weight reduction, only 33.8% sought professional advice. Diet control was the most common weight reduction strategy (73.1%) and among them 33.3% combined with exercises. One fourth (n = 56) relied on green tea for weight reduction and meal skipping was reported in 52.9%. Conclusion: Significant body weight misperception was reported in lower BMI categories. The overall knowledge regarding obesity and weight reduction was satisfactory though not optimum. Diet control with or without physical exercises was the most popular method of weight reduction. [ABSTRACT FROM AUTHOR]

Objectives: Gestational diabetes mellitus (GDM) is a world health concern. Women with a history of GDM have a high prevalence of developing type two diabetes mellitus, recurrence of GDM, and impaired glucose intolerance in their future life. Physical activity (PA) is a key component to attenuate the development of these complications. Therefore, the aim of this study was to evaluate the PA patterns of GDM women at 6 weeks postpartum. Material and Methods: This descriptive cross-sectional component of a large quasi-experimental study was conducted in three selected districts of Sri Lanka in 100 postpartum mothers. Anthropometric and glycemic parameters were assessed at 6 weeks postpartum. Pre-tested International PA Questionnaire (short-version) was used to assess PA. The PA level and intensity were calculated in metabolic equivalent task minutes per week (METminutes/week). Data were analyzed by SPSS 21 version. Both continuous and categorical data were analyzed. Ethical clearance was obtained from the University of Sri Jayewardenepura. Results: Mean HbA1c value was 6.64 ± 1.95. Median truncated PA was 3250 MET-minutes/week. The main contributors to energy expenditure in the study sample were moderate intensity household activities and walking with 58% of mothers walking more than 150 min/week. Although in the categorical analysis, 52% of mothers reported high level of PA, only 10% participated in at least one vigorous intensity activity continuously for more than 10 min to achieve reduced metabolic risks. Average sitting time of mothers was about 3 h/day which is in par with the breast-feeding recommendation. None of the PA MET values significantly correlated with the glycemic parameter, HbA1c. Conclusion: Although it appears that majority of mothers are physically active, these activities are not optimum in terms of reducing the metabolic risk. We suggest designing exercise protocols incorporating day-to-day moderate intensity activities and walking in a structured and scientific manner to achieve maximum benefits for this special group of women. [ABSTRACT FROM AUTHOR]

Background. Gestational diabetes mellitus (GDM) is a global concern. GDM mothers have a 7-fold relative risk of developing type 2 diabetes mellitus (T2DM) in their later life. User-friendly and culturally acceptable dietary interventions can minimize this risk. Therefore, this study aims at exploring the perceptions of GDM mothers and health care workers regarding factors that influence postpartum dietary practices aimed at attenuating the trajectory from GDM to DM. Methods. The study was conducted in selected MOH areas in three districts of Sri Lanka. Six focus group discussions were conducted with thirty mothers with a history of GDM and six in-depth interviews with six health care workers. The phenomenon of interest was to obtain inputs of two stakeholder groups on healthy food habits of GDM mothers during the postpartum period. Framework analysis was used to analyse the data. Data were coded using the analytical framework, abstracted from transcripts, and summarized verbatim in Microsoft Excel in a matrix comprised of one row per participant and one column per code. Finally, the matrix was reviewed intensely and themes were generated. Results. Overall, seven themes emerged from both cases: (1) myths and traditions specific to the postpartum period, (2) lack of motivation, (3) time pressure, (4) financial barriers, (5) negligence of mothers and families, (6) lack of awareness regarding GDM and its postpartum dietary recommendations, and (7) cultural barriers. Conclusions. This study provides an insight into the existing knowledge, common practices, and attitudes regarding food habits among postpartum mothers with a history of GDM. Since the postpartum period is unique, identifying barriers is crucial when introducing dietary modification protocols in order to prevent or attenuate the progression of GDM to T2DM in these mothers. The knowledge gained will be used to introduce feasible, scientifically sound, and culturally acceptable postpartum dietary recommendations for GDM mothers. [ABSTRACT FROM AUTHOR]

Objective: To assess appetite and gut hormone levels in patients following partial (PR) or total resection (TR) of the large bowel.Methods: A comparative cross sectional study was carried out with healthy controls (n = 99) and patients who had undergone PR (n = 64) or TR (n = 12) of the large bowel. Participants consumed a standard (720 kcal) breakfast meal at 0830 (t = 0) h followed by lactulose (15 g) and a buffet lunch (t = 210 min). Participants rated the subjective feelings of hunger at t = -30, 0, 30, 60, 120, and 180 min. Breath hydrogen (BH) concentrations were also evaluated. In a matched subset (11 controls, 11 PR and 9 TR patients) PYY and GLP-1 concentrations were measured following breakfast. The primary outcome measure was appetite, as measured using visual analogue scales and the buffet lunch. The secondary outcome was BH concentrations following a test meal.Results: PR and TR participants had lower hunger and energy intake at the buffet lunch meal compared to controls. PR subjects had higher BH concentrations compared to controls and TR subjects. BH levels correlated with circulating GLP-1 levels at specific time points.Conclusions: PR or TR of the large bowel reduced feelings of hunger and energy intake, and PR increased gastrointestinal fermentation. [ABSTRACT FROM AUTHOR]