Maternal mindful eating as a target for improving metabolic outcomes in pregnant women with obesity

Karen L Lindsay, Jasper Most, Kerrie Buehler, Maryam Kebbe, Abby D Altazan, Leanne M Redman, Karen L Lindsay, Jasper Most, Kerrie Buehler, Maryam Kebbe, Abby D Altazan, Leanne M Redman

Abstract

Background: Maternal diet and eating behaviors have the potential to influence the metabolic milieu in pregnancies complicated by obesity, with implications for the developmental programming of offspring obesity. Emerging evidence suggests that mindfulness during eating may influence metabolic health in non-pregnant populations, but its effects in the context of pregnancy is less well understood. This study explored the individual and combined effects of mindful eating and diet quality on metabolic outcomes among pregnant women with obesity.

Methods: In 46 pregnant women (body mas index >30 kg/m2) enrolled in the MomEE observational study, mindful eating (Mindful Eating Questionnaire, MEQ) and energy-adjusted dietary inflammatory index (DII, from 7 days of food photography) was assessed at two time points and the mean pregnancy values computed. Rate of gestational weight gain (GWG) and fat mass gain per week were determined from measured weight and body composition using a three-compartment method, respectively, at each assessment. Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and ghrelin concentrations were determined from fasting blood samples in late gestation (35-37 weeks). Linear regression was used to examine the association of the MEQ and its subscales (where higher values indicate more mindful eating) with metabolic outcomes, adjusting for covariates: maternal age, pregravid body mass index, race, parity, DII. The effects of the MEQ*DII interaction was also tested.

Results: Total MEQ scores were not associated with rate of weight or fat mass gain, although greater distracted eating behavior was associated with greater adiposity gain (weight and fat mass). Mindful eating was inversely associated with insulin resistance, although this was attenuated to non-significance after additional adjustment for GWG. Total MEQ and the external eating subscale was significantly inversely associated with fasted ghrelin, such that less tendency to eat under the influence of external cues was associated with lower ghrelin concentrations. After false discovery rate adjustment for multiple testing, only the association of the total MEQ and external eating subscale with ghrelin levels trended towards significance. The DII was not associated with MEQ scores or outcome variables, nor did it moderate the effect of MEQ on any of the outcomes.

Conclusion: This study generates early evidence to suggest that mindful eating holds potential as a tool to improve metabolic health outcomes in pregnant women with obesity, although further research is required on this topic. Prenatal lifestyle interventions should consider including mindfulness during eating to determine its efficacy for reducing adverse pregnancy and offspring health outcomes associated with maternal obesity.

Trial registration: ClinicalTrials.gov NCT01954342.

Keywords: Adiposity; Dietary inflammatory index; Gestational weight gain; Insulin resistance; Ghrelin; Maternal obesity; Mindful eating; Pregnancy.

Conflict of interest statement

Conflict of interest

The authors declare no conflict of interest.

© 2021 The Author(s). Published by BRI.

Figures

Fig. 1.. Association of mindful eating with…
Fig. 1.. Association of mindful eating with metabolic outcomes in pregnant women with obesity, identified by race category.
Linear association of the mindful eating distraction subscale with (A) rate of gestational weight gain and (B) rate of fat mass gain, and linear association of the total mindful eating score with (C) insulin resistance and (D) fasting ghrelin concentration. Independent variables (x-axes) are adjusted for maternal age, early pregnancy BMI, parity, and race. Red markers represent participants of Black or African-American race and blue markers represent participants of non-Black or African-American race.
Fig. 2.. Association of mindful eating with…
Fig. 2.. Association of mindful eating with the dietary inflammatory index in pregnant women with obesity, identified by race category.
Linear association of the mindful eating awareness subscale with the dietary inflammatory index, stratified by race category. Red markers represent participants of Black or African-American race and blue markers represent participants of non-Black or African-American race. Fit lines represent the direction of association for each race category.

References

    1. Driscoll AK, Gregory ECW. Increases in Prepregnancy Obesity: United States, 2016–2019. NCHS Data Brief. 2020: 1–8.
    1. Chen C, Xu X, Yan Y. Estimated global overweight and obesity burden in pregnant women based on panel data model. PLoS ONE. 2018. ; 13: e0202183.
    1. Parrettini S, Caroli A, Torlone E. Nutrition and Metabolic Adaptations in Physiological and Complicated Pregnancy: Focus on Obesity and Gestational Diabetes. Frontiers in Endocrinology. 2020. ; 11: 611929.
    1. Barbour LA, Hernandez TL. Maternal Lipids and Fetal Over-growth: Making Fat from Fat. Clinical Therapeutics. 2018. ; 40: 1638–1647.
    1. Heerman WJ, Bian A, Shintani A, Barkin SL. Interaction between Maternal Prepregnancy Body Mass Index and Gestational Weight Gain Shapes Infant Growth. Academic Pediatrics. 2014. ; 14: 463–470.
    1. Tomedi LE, Simhan HN, Chang CH, McTigue KM, Bodnar LM. Gestational Weight Gain, Early Pregnancy Maternal Adiposity Distribution, and Maternal Hyperglycemia. Maternal and Child Health Journal. 2014. ; 18: 1265–1270.
    1. Toro-Ramos T, Sichieri R, Hoffman DJ. Maternal fat mass at mid-pregnancy and birth weight in Brazilian women. Annals of Human Biology. 2016. ; 43: 212–218.
    1. Villar J, Cogswell M, Kestler E, Castillo P, Menendez R, Repke JT. Effect of fat and fat-free mass deposition during pregnancy on birth weight. American Journal of Obstetrics and Gynecology. 1992. ; 167: 1344–1352.
    1. Murray S, Tulloch A, Gold MS, Avena NM. Hormonal and neural mechanisms of food reward, eating behaviour and obesity. Nature Reviews Endocrinology. 2014. ; 10: 540–552.
    1. Muktabhant B, Lawrie TA, Lumbiganon P, Laopaiboon M. Diet or exercise, or both, for preventing excessive weight gain in pregnancy. Cochrane Database of Systematic Reviews. 2015. ; CD007145.
    1. Rogozińska E, Chamillard M, Hitman GA, Khan KS, Thangaratinam S. Nutritional manipulation for the primary prevention of gestational diabetes mellitus: a meta-analysis of randomised studies. PLoS ONE. 2015. ; 10: e0115526.
    1. Fair F, Soltani H. A metareview of systematic reviews of lifestyle interventions for reducing gestational weight gain in women with overweight or obesity. Obesity Reviews. 2021. ; 22: e13199.
    1. Raab R, Michel S, Günther J, Hoffmann J, Stecher L, Hauner H. Associations between lifestyle interventions during pregnancy and childhood weight and growth: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity. 2021. ; 18: 8.
    1. Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, et al. Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement. Journal of the American Medical Association. 2021. ; 325: 2087.
    1. Shivappa N, Steck SE, Hurley TG, Hussey JR, Hébert JR. Designing and developing a literature-derived, population-based dietary inflammatory index. Public Health Nutrition. 2014. ; 17: 1689–1696.
    1. Shin D, Hur J, Cho E, Chung H, Shivappa N, Wirth MD, et al. Pre-Pregnancy Body Mass Index is Associated with Dietary Inflammatory Index and C-Reactive Protein Concentrations during Pregnancy. Nutrients. 2017. ; 9: 351.
    1. Zhang Z, Wu Y, Zhong C, Zhou X, Liu C, Li Q, et al. Association between dietary inflammatory index and gestational diabetes mellitus risk in a prospective birth cohort study. Nutrition. 2021. ; 87–88: 111193.
    1. Moore BF, Sauder KA, Starling AP, Hébert JR, Shivappa N, Ringham BM, et al. Proinflammatory Diets during Pregnancy and Neonatal Adiposity in the Healthy Start Study. The Journal of Pediatrics. 2018. ; 195: 121–127.e122.
    1. Lindsay KL, Buss C, Wadhwa PD, Entringer S. Maternal Stress Potentiates the Effect of an Inflammatory Diet in Pregnancy on Maternal Concentrations of Tumor Necrosis Factor Alpha. Nutrients. 2018. ; 10: 1252.
    1. Lindsay KL, Buss C, Wadhwa PD, Entringer S. The Effect of a Maternal Mediterranean Diet in Pregnancy on Insulin Resistance is Moderated by Maternal Negative Affect. Nutrients. 2020. ; 12: 420.
    1. Lindsay KL, Buss C, Wadhwa PD, Entringer S. The Interplay between Maternal Nutrition and Stress during Pregnancy: Issues and Considerations. Annals of Nutrition & Metabolism. 2018. ; 70: 191–200.
    1. Warren JM, Smith N, Ashwell M. A structured literature review on the role of mindfulness, mindful eating and intuitive eating in changing eating behaviours: effectiveness and associated potential mechanisms. Nutrition Research Reviews. 2017. ; 30: 272–283.
    1. Miller CK, Kristeller JL, Headings A, Nagaraja H, Miser WF. Comparative effectiveness of a mindful eating intervention to a diabetes self-management intervention among adults with type 2 diabetes: a pilot study. Journal of the Academy of Nutrition and Dietetics. 2012. ; 112: 1835–1842.
    1. Most J, Vallo PM, Gilmore LA, St Amant M, Hsia DS, Altazan AD, et al. Energy Expenditure in Pregnant Women with Obesity does not Support Energy Intake Recommendations. Obesity. 2018. ; 26: 992–999.
    1. Most J, Amant MS, Hsia DS, Altazan AD, Thomas DM, Gilmore LA, et al. Evidence-based recommendations for energy intake in pregnant women with obesity. Journal of Clinical Investigation. 2019. ; 129: 4682–4690.
    1. Most J, Marlatt KL, Altazan AD, Redman LM. Advances in assessing body composition during pregnancy. European Journal of Clinical Nutrition. 2018. ; 72: 645–656.
    1. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985. ; 28: 412–419.
    1. Apolzan JW, Myers CA, Cowley AD, Brady H, Hsia DS, Stewart TM, et al. Examination of the reliability and validity of the Mindful Eating Questionnaire in pregnant women. Appetite. 2016. ; 100: 142–151.
    1. Framson C, Kristal AR, Schenk JM, Littman AJ, Zeliadt S, Benitez D. Development and Validation of the Mindful Eating Questionnaire. Journal of the American Dietetic Association. 2009. ; 109: 1439–1444.
    1. Thomas DM, Navarro-Barrientos JE, Rivera DE, Heymsfield SB, Bredlau C, Redman LM, et al. Dynamic energy-balance model predicting gestational weight gain. The American Journal of Clinical Nutrition. 2012. ; 95: 115–122.
    1. Martin CK, Nicklas T, Gunturk B, Correa JB, Allen HR, Champagne C. Measuring food intake with digital photography. Journal of Human Nutrition and Dietetics. 2014. ; 27: 72–81.
    1. van Woudenbergh GJ, Theofylaktopoulou D, Kuijsten A, Ferreira I, van Greevenbroek MM, van der Kallen CJ, et al. Adapted dietary inflammatory index and its association with a summary score for low-grade inflammation and markers of glucose metabolism: the Cohort study on Diabetes and Atherosclerosis Maastricht (CODAM) and the Hoorn study. The American Journal of Clinical Nutrition. 2013. ; 98: 1533–1542.
    1. Benjamini Y, Yekutieli D. The control of the false discovery rate in multiple testing under dependency. Annals of Statistics. 2001. ; 1165–1188.
    1. National Center for Health Statistics, final natality data, 2017–2019. Available at: (Accessed: 12 July 2021).
    1. Benjamini Y, Hochberg Y. Controlling the False Discovery Rate: a Practical and Powerful Approach to Multiple Testing. Journal of the Royal Statistical Society: Series B. 1995. ; 57: 289–300.
    1. Daubenmier J, Moran PJ, Kristeller J, Acree M, Bacchetti P, Kemeny ME, et al. Effects of a mindfulness-based weight loss intervention in adults with obesity: a randomized clinical trial. Obesity. 2016. ; 24: 794–804.
    1. Ruffault A, Czernichow S, Hagger MS, Ferrand M, Erichot N, Carette C, et al. The effects of mindfulness training on weight-loss and health-related behaviours in adults with overweight and obesity: a systematic review and meta-analysis. Obesity Research & Clinical Practice. 2017. ; 11: 90–111.
    1. Skibicka KP, Hansson C, Alvarez-Crespo M, Friberg PA, Dickson SL. Ghrelin directly targets the ventral tegmental area to increase food motivation. Neuroscience. 2011. ; 180: 129–137.
    1. Disse E, Bussier A, Veyrat-Durebex C, Deblon N, Pfluger PT, Tschöp MH, et al. Peripheral ghrelin enhances sweet taste food consumption and preference, regardless of its caloric content. Physiology & Behavior. 2010. ; 101: 277–281.
    1. Khani S, Tayek JA. Cortisol increases gluconeogenesis in humans: its role in the metabolic syndrome. Clinical Science. 2001. ; 101: 739–747.
    1. Goldstein RE, Wasserman DH, McGuinness OP, Lacy DB, Cherrington AD, Abumrad NN. Effects of chronic elevation in plasma cortisol on hepatic carbohydrate metabolism. American Journal of Physiology-Endocrinology and Metabolism. 1993. ; 264: E119–E127.
    1. Ulrich-Lai YM. Self-medication with sucrose. Current Opinion in Behavioral Sciences. 2016. ; 9: 78–83.
    1. van Loenen MR, Geenen B, Arnoldussen IAC, Kiliaan AJ. Ghrelin as a prominent endocrine factor in stress-induced obesity. Nutritional Neuroscience. 2020. ; 1–12.
    1. Azzam I, Gilad S, Limor R, Stern N, Greenman Y. Ghrelin stimulation by hypothalamic-pituitary-adrenal axis activation depends on increasing cortisol levels. Endocrine Connections. 2017. ; 6: 847–855.
    1. Dallman MF. Stress-induced obesity and the emotional nervous system. Trends in Endocrinology and Metabolism. 2010. ; 21: 159–165.
    1. McCullough LE, Miller EE, Calderwood LE, Shivappa N, Steck SE, Forman MR, et al. Maternal inflammatory diet and adverse pregnancy outcomes: Circulating cytokines and genomic imprinting as potential regulators? Epigenetics. 2017. ; 12: 688–697.
    1. Hutchinson AD, Charters M, Prichard I, Fletcher C, Wilson C. Understanding maternal dietary choices during pregnancy: the role of social norms and mindful eating. Appetite. 2017. ; 112: 227–234.
    1. Grider HS, Douglas SM, Raynor HA. The Influence of Mindful Eating and/or Intuitive Eating Approaches on Dietary Intake: a Systematic Review. Journal of the Academy of Nutrition and Dietetics. 2021. ; 121: 709–727.e1.
    1. Epel E, Laraia B, Coleman-Phox K, Leung C, Vieten C, Mellin L, et al. Effects of a Mindfulness-Based Intervention on Distress, Weight Gain, and Glucose Control for Pregnant Low-Income Women: a Quasi-Experimental Trial Using the ORBIT Model. International Journal of Behavioral Medicine. 2019. ; 26: 461–473.
    1. Fuentes Artiles R, Staub K, Aldakak L, Eppenberger P, Rühli F, Bender N. Mindful eating and common diet programs lower body weight similarly: Systematic review and meta analysis. Obesity Reviews. 2019. ; 20: 1619–1627.
    1. Dunn C, Haubenreiser M, Johnson M, Nordby K, Aggarwal S, Myer S, et al. Mindfulness Approaches and Weight Loss, Weight Maintenance, and Weight Regain. Current Obesity Reports. 2018. ; 7: 37–49.
    1. Robinson E, Aveyard P, Daley A, Jolly K, Lewis A, Lycett D, et al. Eating attentively: a systematic review and meta-analysis of the effect of food intake memory and awareness on eating. the American Journal of Clinical Nutrition. 2013. ; 97: 728–742.

Source: PubMed

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