Introduction Much is to be learned about humanbreast milk (HBM) Purpose Extend our knowledge of HBM by investigating the role of maternal body mass index (BMI), sex and stage of lactation (month 1 vs. 6) on HBM insulin, glucose, leptin, IL-6 and TNF-α and their associations with infant body composition. Methods Thirty-seven exclusively breastfeeding infants (n=37; 16♀, 21♂) and their mothers (19–47 kg/m2) were studied at 1 and 6 months of lactation. Infants had body composition measured (using dual energy X-ray absorptiometry (DXA)) and HBM collected. Results A significant interaction between maternal BMI and infant sex on insulin levels (p = 0.0322) was observed, such that insulin was 229% higher in obese mothers nursing female infants than in normal weight mothers nursing female infants and 179% higher than obese mothers nursing male infants. For leptin, a significant association with BMI category was observed (p < 0.0001) such that overweight and obese mothers had 96.5% and 315.1% higher leptin levels than normal weight mothers, respectively. Leptin was also found to have a significant (p = 0.0004) 33.7% decrease from month 1 to month 6, controlling for BMI category and sex. A significant inverse relationship between month 1 leptin levels and infant length (p=0.0257), percent fat (p=0.0223), total fat mass (p=0.0226) and trunk fat mass (p=0.0111) at month 6 was also found. No associations or interactions were observed for glucose, TNF-α, or IL-6. Conclusions These data demonstrates that maternal BMI, infant sex and stage of lactation affect the compositional make-up of insulin and leptin.

Evidence suggests that depressive symptoms are associated with poorer dietary intake and inadequate physical activity; however, this association has not been examined in lower income overweight and obese African American women. The objective of this cross-sectional study was to examine the associations between depressive symptoms and diet and physical activity in 196 women (87% African American, ages 25–51). Higher depressive symptoms were hypothesized to predict poorer diet quality, greater emotional eating, lower physical activity levels, and greater sedentary time. Depressive symptoms were measured using the validated short form of the Center for Epidemiological Studies Depression Scale (CESD-10). Dietary intake and quality were assessed using three 24-hour dietary recalls. Emotional eating was evaluated using four items from the emotional eating subscale of the Eating Behavior Patterns Questionnaire. Physical activity and sedentary time were objectively measured using the ActiGraph accelerometer. Linear regression models tested the associations between depressive symptoms and each dietary and physical activity outcome variable. Symptoms of depression were positively associated with total daily caloric intake from saturated fat and total sugars, as well as emotional eating scores (p values < .05). While not statistically significant, depressive symptoms were positively associated with sweetened beverage consumption (p=.06) and added sugars (p=.07). Depressive symptoms were not associated with total fat, sodium, fruit and vegetables, fast food consumption, the Alternate Healthy Eating Index score, moderate-to-vigorous physical activity or sedentary time. Future studies should explore the mechanisms linking the identified associations between depressive symptoms and dietary intake, such as the role of emotional eating.

Objective To investigate patient and provider perceptions of weight gain, physical activity, and nutrition counseling during prenatal care visits. Methods Individual qualitative interviews were conducted with 30 pregnant women between 20–30 weeks gestation (15 African American, 15 White) and 11 prenatal care providers (5 attending physicians, 5 residents, 1 nurse practitioner) in 2014. Results The majority of patients and providers reported receiving or giving advice on weight gain (87% and 100%, respectively), physical activity (87% and 91%), and nutrition (100% and 91%) during a prenatal visit. Discussion of counseling content was largely consistent between patients and providers. However, counseling was limited and not fully consistent with current weight gain, physical activity, or dietary guidelines during pregnancy. Most patients viewed provider advice positively, but some wanted more detailed information. Providers discussed many barriers to lifestyle counseling, including: lack of time, inadequate training, concern about the sensitivity of the topic, lower education or income level of the patient, cultural differences, and lack of patient interest. Conclusions Providers discussed weight gain, physical activity, and nutrition during prenatal care visits and patients accurately recalled this advice. However, counseling was limited and not fully consistent with guidelines. Future studies are needed to develop and evaluate the efficacy of interventions to help providers overcome perceived barriers and more effectively counsel women on weight and healthy lifestyles during pregnancy.

IMPORTANCESteps per day is a meaningful metric for physical activity promotion in clinical and population settings. To guide promotion strategies of step goals, it is important to understand the association of steps with clinical end points, including mortality. OBJECTIVETo estimate the association of steps per day with premature (age 41-65 years) all-cause mortality among Black and White men and women. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was part of the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants were aged 38 to 50 years and wore an accelerometer from 2005 to 2006. Participants were followed for a mean (SD) of 10.8 (0.9) years. Data were analyzed in 2020 and 2021. EXPOSURE Daily steps volume, classified as low (<7000 steps/d), moderate (7000-9999 steps/d), and high (Ն10 000 steps/d) and stepping intensity, classified as peak 30-minute stepping rate and time spent at 100 steps/min or more. MAIN OUTCOMES AND MEASURES All-cause mortality. RESULTS A total of 2110 participants from the CARDIA study were included, with a mean (SD) age of 45.2 (3.6) years, 1205 (57.1%) women, 888 (42.1%) Black participants, and a median (interquartile range [IQR]) of 9146 (7307-11 162) steps/d. During 22 845 person years of follow-up, 72 participants (3.4%) died. Using multivariable adjusted Cox proportional hazards models, compared with participants in the low step group, there was significantly lower risk of mortality in the moderate (hazard ratio [HR], 0.28 [95% CI, 0.15-0.54]; risk difference [RD], 53 [95% CI, 27-78] events per 1000 people) and high (HR, 0.45 [95% CI, 0.25-0.81]; RD, 41 [95% CI, 15-68] events per 1000 people) step groups. Compared with the low step group, moderate/high step rate was associated with reduced risk of mortality in Black participants (HR, 0.30 [95% CI, 0.14-0.63]) and in White participants (HR, 0.37 [95% CI, 0.17-0.81]). Similarly, compared with the low step group, moderate/ high step rate was associated with reduce risk of mortality in women (HR, 0.28 [95% CI, 0.12-0.63]) and men (HR, 0.42 [95% CI, 0.20-0.88]). There was no significant association between peak 30-minute intensity (lowest vs highest tertile: HR, 0.98 [95% CI, 0.54-1.77]) or time at 100 steps/min or more (lowest vs highest tertile: HR, 1.38 [95% CI, 0.73-2.61]) with risk of mortality.CONCLUSIONS AND RELEVANCE This cohort study found that among Black and White men and women in middle adulthood, participants who took approximately 7000 steps/d or more experienced lower mortality rates compared with participants taking fewer than 7000 steps/d.There was no association of step intensity with mortality.