JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION

1. Comparison of Dietary Intake of Overweight Postpartum Mothers Practicing Breastfeeding or Formula Feeding Holiday A. Durham PhD, RD: Louisiana State University Cheryl A. Lovelady PhD, MPH, RD, FADA: University North Carolina at Greensboro Rebecca J. N. Brouwer MS: Duke University Medical Center (DUMC) Katrina M. Krause MS: DUMC Truls Østbye PhD, MD: DUMC JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Durham HA, et al, J Am Diet Assoc. 2011; 111 (January).

2. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding Rates of overweight & obesity in childbearing years The postpartum period is a critical time for weight-management interventions because weight retention and weight gain in this period are significant predictors of long-term obesity 2,3. In 2007-2008, percentage of women ages 20-39 years who were overweight or obese 1 1. National Center for Health Statistics. Health, United States, 2008. With Chartbook. Hyattsville, Maryland: 2009. Web site. http://www.cdc.gov/nchs/data/hus/hus08.pdf. Published March 2009. Updated August 2009. Accessed September 1, 2009. 2. Gunderson EP, Abrams B. Epidemiology of gestational weight gain and body weight changes after pregnancy. Epidemiol Rev. 2000;22:261-74. 3. Rooney BL, Schauberger CW. Excess pregnancy weight gain and long-term obesity: one decade later. Obstet Gynecol. 2002;100:245-52. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Durham HA, et al.J Am Diet Assoc. 2011; 111 (January).

3. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding Objectives • Compare nutrient, meal and snack intakes, food group servings and prevalence of dieting among fully breastfeeding, mixed breast and formula feeding, and formula feeding, overweight and obese women. • Compare nutrient intakes and food group servings to the Dietary Reference Intake and MyPyramid recommendations, respectively. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Durham HA, et al. J Am Diet Assoc. 2011; 111 (January).

4. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding Serum Vitamin C (mg/dl) by Salad Intake Study Design • Infant feeding practices, demographic information, and dietary information were collected on 450 women between six and nine weeks postpartum. • Two 24-hour dietary recalls were completed by phone, using Nutrition Data Systems for Research1,2. 1. Nutrition Coordinating Center, University of Minnesota. Nutrition Data System (NDS). NDS-R[5.0]. 2004. Minneapolis, MN, University of Minnesota. 2. Nutrition Coordinating Center, University of Minnesota. Nutrition Data System (NDS). NDS-R[2005]. 2005. Minneapolis, MN, University of Minnesota. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Durham HA, et al.J Am Diet Assoc. 2011; 111 (January).

5. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding Serum Vitamin C (mg/dl) by Salad Intake Comparison of energy intake and supplement use of women fully breastfeeding (FB), mixed feeding (MF) or formula feeding (FF) a, b, c Groups with different letters are significantly different, P ≤ 0.001 * Significantly different between groups, Chi-square, P ≤ 0.05. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Durham HA, et al.J Am Diet Assoc. 2011; 111 (January).

6. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding Serum Vitamin C (mg/dl) by Salad Intake Percentage of women consuming less than the Estimated Average Requirement (EAR) Total Vitamin A Vitamin C group group percentage percentage Vitamin E Total Folate group group percentage percentage % < EAR is the percentage of group whose intake was below the Estimated Average Requirements. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Durham HA, et al.J Am Diet Assoc. 2011; 111 (January).

7. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding Serum Vitamin C (mg/dl) by Salad Intake Percentage of women consuming less than the Adequate Intakes (AI) Calcium group percentage % < AI is the percentage of group whose intake was below the Adequate Intake recommendation. Durham HA, et al.J Am Diet Assoc. 2011; 111 (January). JOURNAL OFTHE AMERICAN DIETETICASSOCIATION

8. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding Percentage of fully breastfeeding, mixed feeding or formula feeding women consuming meals and snacks on both days *p= 0.06 * p < 0.01 * p < 0.01 percentage The majority of women (n=399) reported consuming dinner on both days, with no differences between groups. * Significantly different between groups, Chi-square, P ≤ 0.05. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Durham HA, et al.J Am Diet Assoc. 2011; 111 (January).

9. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding Serum Vitamin C (mg/dl) by Salad Intake Breastfeeding (BF), mixed feeding (MF) and formula feeding (FF) women did not meet MyPyramid1 recommendations for any food group Recommended food group servings based on MyPyramid1 guidelines for reference participants who represents the average Active Mother’s Postpartum participant (sedentary, 165 cm, 89 kg, 31 years old, with a 2 month old baby, who was either FB, MF, or FF). a a, b serving b a a b Food Groups food groups Groups with different letters are significantly different, P ≤ 0.001 (when adjusted for group differences in participant characteristics: pre-pregnancy BMI, race, age, education, income, marital status). 1U.S. Department of Agriculture. MyPyramid. 2007. Web site. http://www.MyPyramid.com. Published October 2007. Updated March 2009. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Durham HA, et al.J Am Diet Assoc. 2011; 111 (January).

10. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding Comparison of beverage and dessert intake among fully breastfeeding, mixed feeding or formula feeding women serving a a b Groups with different letters are significantly different, P ≤ 0.001 (when adjusted for group differences in participant characteristics: pre-pregnancy BMI, race, age, education, income, marital status). food groups JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Durham HA, et al. J Am Diet Assoc. 2011; 111 (January).

11. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding Summary Serum Vitamin C (mg/dl) by Salad Intake Formula feeding women: • Consumed less energy, servings of grains, and desserts • More likely to diet • Less likely to consume a multivitamin supplement Breastfeeding women: • Consumed more energy and more refined grains and desserts • Snacked more frequently All groups were at risk for inadequate intake of vitamins A, C, E, and folate. In addition, the intakes of vitamin D and calcium were low in all groups. All groups did not consume the recommended servings of any of the MyPyramid food groups. JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Durham HA, et al.J Am Diet Assoc. 2011; 111 (January).

12. Comparison of dietary intake of overweight postpartum mothers practicing breastfeeding or formula feeding Serum Vitamin C (mg/dl) by Salad Intake Conclusion To help increase intakes of nutrients that are lacking in the diet and promote postpartum weight loss, dietitians should encourage women to: Increase • Fruits • Vegetables • Low-fat dairy • Whole grains • Legumes • Healthy types of fat Decrease • Refined grains • Regular soda • Sweetened beverages • Desserts JOURNAL OFTHE AMERICAN DIETETICASSOCIATION Durham HA, et al.J Am Diet Assoc. 2011; 111 (January).