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Influence of alternative lifestyles on self-reported body weight and health characteristics in women

Ana Paula Simões-Wüst, Ischa Kummeling, Monique Mommers, Machteld A.S. Huber, Lukas Rist, Lucy P.L. van de Vijver, Pieter C. Dagnelie, Carel Thijs
DOI: http://dx.doi.org/10.1093/eurpub/ckt045 321-327 First published online: 2 May 2013

Abstract

Background: Alternative lifestyles are often associated with distinct practices with respect to nutrition, physical activity, smoking, alcohol use and usage of complementary medicine. Evidence concerning effects of these lifestyle-related practices on health status is still fragmentary. Objective: To describe maternal health characteristics related to alternative lifestyles, with emphasis on body-weight status, during pregnancy and maternity periods. Methods: We compared self-reported health-related features of mothers with alternative lifestyles and conventional lifestyles during pregnancy and maternity period in the KOALA Birth Cohort Study. This cohort comprises two recruitment groups of mother–infant pairs, one with a conventional (no selection based on lifestyle, n = 2333), the other with an alternative lifestyle (selected via organic food shops, anthroposophic clinicians and midwives, anthroposophic under-five clinics, Rudolf Steiner schools and relevant magazines, n = 485). Mothers in the alternative group more frequently chose organic foods, adhered to specific living rules, practised vegetarianism and identified themselves with anthroposophy. Results: Mothers in the alternative group showed lower BMI and lower prevalence of overweight and obesity than the conventional group, before pregnancy as well as 4–5 years after delivery. This difference was partly retained after adjusting for potential confounders. Furthermore, women in the alternative group had a lower prevalence of pregnancy-related hypertension, more often started breastfeeding and gave exclusive and prolonged breastfeeding for a longer period. Finally, they smoked less often, but more often drunk alcohol during pregnancy. Conclusion: The results suggest that an alternative lifestyle is associated with favourable body weight and with several differences in other health features.

Introduction

The western society permits the coexistence of different lifestyles, which are likely to affect health-related outcomes and are characterized by different practical decisions—on nutrition, physical activity, education, smoking, alcohol consumption and selective use of conventional or complementary medicine—and frequently by different underlying ideologies. Throughout this text, the lifestyle of the majority of people living in central Europe is referred to as conventional, whereas lifestyles that are perceived to be distinct from this—because of avoiding main stream diet, schools or medicine—are called alternative.

Although often inspired by a broader ideology (e.g. including environmental sustainability or animal well-being), motives for adherence to alternative lifestyles also may include expected health benefits. One alternative lifestyle that has already been suggested to affect health is the one influenced by anthroposophy, a movement initiated by Rudolf Steiner in the 1920s. A Swedish observational study showed a reduced risk of atopic diseases for children attending Steiner schools compared with those attending neighbouring schools.1 This was corroborated by an international study in five European countries2 and by the PARSIFAL-study.3 Other reports indicated that patients of anthroposophic physicians were less often overweighed than patients of conventional physicians4 and that the stress level in children from anthroposophic families might be lower than in the others.5

Some of the effects of an alternative lifestyle on health are likely to be mediated by diet, either due to dietary composition or to the application of alternative production systems. In hypertensive adults, consumption of fruits and vegetables may moderate lipid cardiovascular risk,6 and vegetarian diets are associated with reduced risks of several chronic diseases as indicated by lower low-density lipoprotein levels, lower blood pressure as well as lower rates of hypertension and type-2 diabetes.7 A direct indication that the adoption of alternative food production might also influence health was reported for eczema, where the consumption of organic dairy products was associated with lower prevalence.8 Moreover, higher levels of the main conjugated linoleic acid (CLA) isomer were found in breast milk of women who consumed organic milk products and ruminant meat during pregnancy,9 and their concentrations in the mother’s milk were inversely associated with the risk of atopic diseases of their children.10

The aim of the present work is to describe the maternal health characteristics during pregnancy and maternity related to alternative lifestyles, with the emphasis on weight status before and during pregnancy and after the maternity period, in an observational cohort study with two distinct recruitment groups: one with conventional, the other with alternative lifestyles.

Participants and methods

The KOALA Birth Cohort Study is a prospective cohort study of 2834 mother–infant pairs in the Netherlands. KOALA is an acronym (in Dutch) for ‘Kind, Ouders en gezondheid: Aandacht voor Leefstijl en Aanleg’ (Child, parents and health: addressing lifestyle and constitution). Starting in October 2000,11 healthy pregnant women (n = 2343) were recruited at midwives practices in the southern part of the Netherlands from an ongoing prospective cohort study on Pregnancy-Related Pelvic Girdle.12 To enrich the study with women with alternative lifestyles, pregnant women were recruited through several specific channels, such as organic food shops, anthroposophic general practitioners and midwives, anthroposophic under-five clinics, Rudolf Steiner schools and relevant magazines. All women were enrolled between 14 and 18 weeks of gestation and were sent detailed questionnaires on socio-demographic and health characteristics at recruitment and at 30 weeks of pregnancy. At 34 weeks of pregnancy, the women were sent an additional questionnaire on personal habits and their diet. Finally, when their children were 4–5 years old, the women received a questionnaire that comprised items on their weight. In the present analysis, only the mothers having singleton pregnancies and who answered both the questionnaires at week 30 and at week 34 were considered (N = 2834). To exclude women likely to be in a stressful situation, mothers of children with stillbirth or neonatal death (N = 9) or that had Down’s syndrome (N = 7) were excluded from the analysis, which was therefore performed with data corresponding to 2818 children, 2333 out of 2343 in the conventional recruitment group, 485 out of 491 in the alternative recruitment group. Main determinant (exposure) was the alternative lifestyle adopted by the alternative recruitment group, which was compared with the conventional lifestyle of the conventional recruitment group.

At 14 and 30 weeks of pregnancy, maternal perceived stress was ascertained by using the 10-item version of Cohen’s Perceived Stress Scale.13,14 In addition, at 30 weeks pregnancy, mothers filled in the 12-items General Health Questionnaire15,16 (GHQ-12), which aims at evaluating general well-being and psychological problems and was scored using the Likert-type scale.15 Whether participants were living according to lifestyle rules was asked at 34 weeks pregnancy with the question ‘Did you adhere to certain living rules derived from a religious or a philosophical background over the last month?’, which included the possibility to answer yes or no, and to tick one or more of 10 items, namely vegetarianism, veganism, macrobiotics, anthroposophy, life reform (Lebensreform) movement, Islam, Buddhism, Judaism, Hinduism and/or others.

All maternal data were self-reported, and specific items were checked in the obstetric reports (hypertension in pregnancy, diabetes gravidarum, mode and place of delivery, duration of gestation, birth weight).

The KOALA Birth Cohort Study was approved by the Medical Ethical Committee of Maastricht University/Academic Hospital Maastricht. All children’s parents (and therefore also their mothers) signed for written informed consent.

Statistical analysis and data presentation

Differences between both recruitment groups were evaluated by analysis of variance and χ2 test for continuous and categorical variables, respectively. Statistical significance was set at P ≤ 0.05), whereas a tendency for a difference was defined as 0.05 < P < 0.10. Linear regression analysis were fitted with BMI (before pregnancy and 4–5 years after delivery) as continuous outcome variable with recruitment group as the independent variable. Possible confounding by baseline characteristics of the recruitment groups was assessed by adding mother’s age at delivery, number of previous children and geographic region to the regression models. Likewise, logistic regression was used to estimate the odds ratio for overweight and obesity comparing the alternative and conventional group, without and with adjustment for the possible confounders. All data were analyzed with IBM® SPSS® Statistics 19. For sake of clarity, while listing the various characteristics in the tables, variables are written in bold, possible answers in plain text.

Results

Mothers of the alternative group had more often a higher education (72.7 vs. 42.5%), were on average 2 years older at delivery (33.7 vs. 31.7 years) and had more often delivered at least one child previously (65.3 vs. 53.9%). The large majority of both groups were of Dutch ancestry (94.2 and 97.0%), but the region of residence differed between the two recruitment groups (P < 0.001): most women with an alternative lifestyle lived in the Mid-Northern provinces (67.8%), whereas most women with a conventional lifestyle lived in southern provinces (Limburg 50.1%, Brabant 41.1%). For more information on demographic characteristics, see Supplementary information.

As expected from the ways of recruitment, more women in the alternative recruitment group adhered to certain living rules, most often to those concerning vegetarianism and anthroposophy, and chose organic and biodynamic products (table 1).

View this table:
Table 1

Alternative lifestyle characteristics of the women participating in the study at 34 weeks pregnancy (N = 2818)

CharacteristicsAlternative lifestyle (N = 485)Conventional lifestyle (N = 2333)P
n/N%n/N%
Adhered to living rules during the last month153/47232.450/23212.2<0.001
Adhered to…
Vegetarianism83/48517.136/23331.5<0.001
Veganism2/4850.41/23330.00.079
Macrobiotics5/4851.00/23330.0<0.001
Anthroposophy69/48514.23/23330.1<0.001
Life reform movement18/4853.74/23330.2<0.001
Islam0/4850.010/23330.40.149
Buddhism3/4850.60/23330.0<0.001
Judaism3/4850.60/23330.0<0.001
Hinduism0/4850.00/23330.00.648
Other31/4856.46/23330.3<0.001
Intentional choice of some organic productsa<0.001
    Consumed organic products422/48487.2484/232320.8
    Did not consume organic biological products52/48410.71464/232363.0
    Did not know/did not care10/4842.1375/232316.1
Intentional choice of biodynamic productsb352/48273.0166/23177.2<0.001
  • N, number of participants either total or that answered a particular item.

  • n, number of participants that chose a certain pre-defined answer in a categorical question.

  • aQuestion was ‘Do you buy intentionally products of biological production, recognisable by the EKO-label?’

  • bQuestion was ‘Do you buy intentionally products of biologic-dynamic production, recognisable by a Demeter-label?’

Health behaviours during pregnancy

The percentage of women who actively smoked at 34 weeks pregnancy was clearly lower in the alternative group (0.8 vs. 8.7%), and exposure to passive smoking was also lower (9.9 vs. 40.1% with exposure >1 h/week) (see Supplementary information for details). In contrast, the alternative group consumed more alcohol during pregnancy than the conventional group (21.2 vs. 15.4% drinking one glass or more per day).

Health during pregnancy

In the alternative group, fewer women reported high blood pressure during pregnancy than in the conventional group (2.5 vs. 5.0%, P = 0.015) (see Supplementary information for details). After the first pregnancy trimester, fewer women of the alternative group tended to have diarrhoea (19.8 vs. 23.6%, P = 0.075) and urinary tract infections (5.8 vs. 8.0%, P = 0.093). In contrast, from the beginning of the pregnancy until week 34, a markedly higher percentage of women in the alternative group reported genital Candida infections (23.0 vs. 14.2%, P < 0.001) and oral aphtae (13.0 vs. 8.0%, P < 0.001) than the conventional group, while there was also a tendency for more oral Candida infections (1.2 vs. 0.6%, P = 0.096). No significant differences between the two recruitment groups were found concerning the frequency of hyperemesis, pregnancy diabetes, flu, fever, nasal allergies or asthma during pregnancy (Supplementary table). The stress levels perceived by the mothers were similar between the groups (mean score on a 0–40 point scale in the first and third trimester: 12.0 and 12.0 in the alternative group, and 12.3 and 11.7 in the conventional group, P = 0.311 and P = 0.331, respectively). Self-reported life satisfaction was generally high, but nevertheless the percentage satisfied was lower in the alternative group than the conventional group (93.1 vs. 97.0%, P < 0.001). Also the score for the GHQ-12 was slightly but significantly lower in the alternative group (20.1 vs. 20.6 points on a 0–36 scale, P < 0.001).

Pregnancy outcomes, mode and place of delivery and breast feeding duration

Children in the alternative group were in average approximately 100 g heavier at birth than those of the conventional group, in spite of similar pregnancy duration (table 2). The mode and place of delivery was significantly different in the two recruitment groups (P = 0.007). Relatively to the women of the conventional group, more women in the alternative group had vaginal way, at home (51.3 vs. 43.0%). Moreover, fewer alternative women underwent a caesarean section (8.8 vs. 12.2%). Duration of breastfeeding was considerably longer in the alternative group (median 9 months) compared with the conventional group (median 2.5 months), and in the alternative group, 26% still gave any breastfeeding after the child's first birthday. Fewer mothers in the alternative group started artificial formula from birth, and in the majority, they gave exclusive breastfeeding in the first 3 months or breastfeeding as the sole type of milk feeding until 6 months, whereas in the conventional group, breastfeeding was most often combined or followed by artificial formula in that period.

View this table:
Table 2

Main pregnancy outcomes and breastfeeding duration (N = 2818)

CharacteristicsAlternative lifestyle (N = 485)Conventional lifestyle (N = 2333)P
n/N or N% or Mean ± SDn/N or N% or Mean ± SD
Duration of pregnancy (weeks)47640.0 ± 1.39232339.9 ± 1.490.086
Mode and place of delivery0.007
    Natural vaginal, at home245/47851.3991/230543.0
    Natural vaginal, hospital160/47833.5820/230535.6
    Natural vaginal, elsewhere1/4780.25/23050.2
    Artificial vaginala, hospital30/4786.3207/23059.0
    Caesarean section, hospital42/4788.8282/230512.2
Birth weight (kg)4783.586 ± 0.50423223.489 ± 0.511<0.001
Small (weight) for gestational age34/4787.1219/23229.40.114
Duration of any breastfeedingb<0.001
    None10/4792.1436/231918.8
    0–3 months55/47911.5875/231937.7
    4–6 months79/47916.5423/231918.2
    7–9 months94/47919.6246/231910.6
    10–12 months117/47924.4179/23197.7
    ≥13 months124/47925.9160/23196.9
Exclusivity of breastfeeding/type of milk feeding<0.001
    No breastfeeding10/4792.1436/231918.8
    Any combinationc (first 3 months)91/47919.01089/231947.0
    Exclusive breastfeeding (first 3 months)149/47931.1463/231920.0
    Exclusive breastfeeding (first 6 months)229/47947.8331/231914.3
  • N, number of participants either total or that answered a particular item.

  • n, number of participants that chose a certain pre-defined answer in a categorical question.

  • aForceps or vacuum extraction.

  • bExclusive or combined with other milk feedings and supplemental or solid feedings.

  • cof breastfeeding and artificial formula feeding.

Maternal weight status

As the women of the alternative lifestyle group were ca. 1 cm taller than those of the conventional group, their BMIs, rather then their weight, were compared (table 3). Mean BMI at the beginning of pregnancy was slightly but significantly lower in the alternative than in the conventional group (22.6 vs. 23.9 kg/m2, P < 0.001). A comparable difference was observed 4–5 years after delivery (23.0 vs. 24.2 kg/m2, P < 0.001). While no difference was observed concerning weight gain during pregnancy, the overall weight gain from pre-pregnancy to 4–5 years after delivery was slightly higher in the alternative group, in spite of lower BMI values not only at the first but also at the later time point. Although the majority of the women in both recruitment groups showed a BMI within the normal range (18.5–24.9 kg/m2), the distribution of the participants among the various BMI categories, differed significantly between the two groups both at the beginning of pregnancy as well as 4–5 years after delivery (table 3, P < 0.001). The prevalence of a normal BMI was higher in the alternative than the conventional group at the beginning of pregnancy (78.6 vs. 68.3%) as well as 4–5 years after delivery (74.7 vs. 65.3%). In the conventional group, underweight was less prevalent at both occasions, whereas overweight and obesity were considerably more prevalent (table 3).

View this table:
Table 3

Weight status during and after the pregnancy based on self-reported height and weight (N = 2818)

CharacteristicsAlternative lifestyle (N = 485)Conventional lifestyle (N = 2333)P
n/N or N% or Mean ± SDn/N or N% or Mean ± SD
Height (cm)483170.8 ± 6.582327169.6 ± 6.19< 0.001
BMI before pregnancy48222.6 ± 3.36231923.9 ± 4.04<0.001
Weight gain during the pregnancy (kg)43114.1 ± 4.79219414.2 ± 5.20
BMI at 4–5 years38023.0 ± 3.37160824.2 ± 3.74<0.001
Weight gain (kg) to 4–5 yearsa3791.3 ± 4.4416050.7 ± 5.490.038
BMI before pregnancy<0.001
    Underweight (<18.5)18/4823.759/23192.5
    Normal (18.5–24.9)379/48278.61584/231968.3
    Overweight (25–29.9)64/48213.3469/231920.2
    Obese (≥30)21/4824.4207/23198.9
BMI at 4–5 years<0.001
    Underweight (<18.5)13/3803.419/16081.2
    Normal (18.5–24.9)282/38074.71050/160865.3
    Overweight (25–29.9)66/38017.4408/160825.4
    Obese (≥30)19/3805.1131/16088.1
  • aFrom before pregnancy until 4–5 years after delivery.

Since mother’s age, number of previous children and living area differed between the two recruitment groups and we expected these factors to affect BMI; a multivariable linear regression analysis was performed with BMI (before pregnancy and 4–5 years after delivery) as the dependent variable, the recruitment group (alternative vs. conventional) as the main independent variable and the other mentioned factors were added to the model to correct for potential confounding. Before adding the possible confounders, the regression coefficient for BMI before pregnancy was −1.307 (95% confidence interval −1.693 to −0.921, P < 0.001, N = 2081), indicating a 1.3 kg/m2 lower pre-pregnant BMI in the alternative group. After correcting for potential confounders, the regression coefficient was attenuated to −0.662 (−1.236 to −0.089), but remained statistically significant (P = 0.024). Similarly, the risk of being overweight or obese before pregnancy (BMI ≥ 25.0 kg/m2) was lower in the alternative vs. the conventional group (17.6 vs. 29.2%, odds ratio 0.52, 95% confidence interval 0.41–0.67, P < 0.001) and attenuated after controlling for potential confounders (odds ratio 0.70, 0.49–0.99), but remained statistically significant (P = 0.046, logistic regression analysis).

Similar results were obtained for BMI 4–5 years after delivery: before multivariate adjustment, the regression coefficient was −1.156 (95% confidence interval −1.567 to −0.745, P < 0.001, linear regression), and after multivariate adjustment −0.592 (−1.209 to 0.025, P = 0.060). The risk of overweight/obesity was lower in the alternative compared with the conventional group (odds ratio 0.57, 0.44–0.74, P < 0.001, N = 1987) and attenuated somewhat after correcting for confounders (odds ratio 0.72 (0.49–1.06), P = 0.092, logistic regression).

Discussion

In the present study, women were recruited in two different ways (see Participants and Methods) to obtain a group of women representative of the population with a normal conventional lifestyle and another group likely to represent alternative lifestyles. The comparison between the two groups—showing for instance, differences in the consumption of organic food or in the frequency of living according to rules—corroborates that they differed indeed from each other. Further confirmed differences between the two recruitment groups concerned the mode and place of delivery, with the women of the alternative group giving more often birth in a natural way at home and less frequently undergoing caesarean sections, and breastfeeding, which was more often, longer and more frequently exclusive in the alternative group.

Our analysis shows that women of the alternative recruitment group were less often overweight and obese, both at the beginning of pregnancy and 4–5 years after delivery. Overweight and obesity are well-known risk factors for an adverse pregnancy outcome17,18 and cardiovascular disease (CVD) in women.19 At baseline, some distinctions between the two recruitment groups were observed, which could have influenced the corresponding prevalence of overweight and obesity. Women of the alternative lifestyle group were in average 2 years older than those of the conventional group, had more often given birth previously, were ca. 1 cm taller and lived less often in the south of the Netherlands. To correct for the observed difference in height, we compared BMI instead of women’s weight. Furthermore, we adjusted in multivariate analyses for maternal age at delivery, parity and region. Differences between pre-pregnancy BMI and BMI at 4–5 years after delivery were attenuated by these adjustments, but were partly retained and remained statistically significant, confirming the lower BMI in the alternative lifestyle recruitment group relatively to the conventional lifestyle group. The women of the alternative group had less often pregnancy-related hypertension; because previous work has shown that high BMI is an independent risk factor for this pathology, our data suggest that the higher number of overweight and obese women in the conventional group is likely to be associated with the corresponding higher prevalence of pregnancy-related hypertension.20

Women of the alternative group smoked less—both actively and passively—but drank more alcohol than the women of the conventional group. While it is conceivable that the women of the alternative group were more interested in health issues, and therefore invested more on having a natural delivery and breastfeeding and were more aware of the negative impact of smoking on health, this attitude seemed not to apply in the case of alcohol consumption during pregnancy. Finally, the prevalence of several diseases as well as the perceived general health quality and life satisfaction differed between the two groups. At the moment, the reasons for these differences are not clear, and further more defined studies are required to address these issues. It would be interesting to find out what are the causes for the lower life satisfaction among the women of the alternative group, which was not associated with higher stress levels. The same applies to the significantly higher prevalence of Candida infections and aphtae in the alternative group and their possible association with various factors, e.g. different diets. For aphthous stomatitis, a risk factor related to alternative lifestyles may be vitamin B12 deficiency due to a vegan diet,21 but the low number of vegans in our study (only 2) is too low to explain the high prevalence of reported aphtae. For vulvovaginal candidosis, none of the established risk factors from an earlier review22 are known to be more present among women in the alternative group, and on the contrary, antibiotic use (one of the best-studied risk factors for candidosis) was less prevalent in our alternative group.23 The review authors conclude that ‘women with vulvovaginal candidosis are often misdiagnosed, mistreated and misunderstood by the medical community’.22 Therefore, an alternative explanation of our findings may be that women with certain difficulty to diagnose and manage recurrent conditions labelled as candidosis and aphtae seek support from complementary medicine and seek relief from alternative lifestyle changes, and are thus overrepresented among women with alternative lifestyles. That users of complementary medicine have a higher incidence of self-reported overall illness than non-users has been previously shown.24,25

A limitation of the present work is the fact that outcomes were self-reported. In particular, weight reporting could be critical for the present work. However, accuracy and reliability of weight and height reporting have been shown to be reasonable, with women with normal-range BMI (as the majority of women participating in the KOALA -study) reporting most accurately, obese women being more vulnerable to under-report weight and underweight women to over-report weight.26 In the present study, such tendencies for miss reporting would, however, have led to an underestimation of the differences between the recruitment groups, not to an overestimation, thus supporting the validity of our findings.

Although it is not possible to say at present which exact factors of the alternative lifestyle are responsible for the observed differences in risk factors for CVD, it is likely that decisions affecting nutrition play a major role. For instance, women with an alternative lifestyle consumed markedly more often organic food. Interestingly, cow’s milk from animals kept under the guidelines of organic production27,28 or grass-fed29—as often happens in the organic animal husbandry—contains higher contents of CLA than conventional milk. Similarly, the meat from ruminants contains higher amounts of CLA if they are grass-fed.30 A recent review of randomized controlled trials in humans of the effect of dietary CLA supplementation showed, however, inconsistent effects on metabolism and weight that may depend on dosage, type of CLA and synthetic vs. natural source.31 In the sub-group of mothers participating in KOALA study that donated a milk probe (n = 312), it could be shown that the higher consumption of meat and dairy products from organic origin in the alternative group was associated with higher ratio vaccenic acid to elaidic acid in breast milk. Because this ratio is a marker of lower intake of partially hydrogenated (hardened) fats and oils of industrially processed foods,32 this suggests that the women of the alternative group had eaten fewer of those products. A recent meta-analysis of cohort studies compared the effect on coronary heart disease of industrial vs. ruminant trans fatty acids, and indicated that the evidence in favour of ruminant trans fatty acids was suggestive though not conclusive.33 A higher absolute intake of dairy products by itself may lower the risk for overweight and obesity,34 metabolic syndrome35 and hypertension,36 but all systematic reviews here cited noticed that experimental studies are lacking, so that firm conclusions cannot be drawn. The option for organic food might also affect product choice: a recent consumers’ survey in the Netherlands shows that consumption of organic food is often accompanied by the use of more freshly prepared foods and fewer ready-to-eat meals.36 The higher prevalence of vegetarianism in the alternative group could as well have contributed to the corresponding lower weight.37,38 Finally, a previous report showed that patients attending anthroposophic physicians suffer more seldom from overweight than those going to a conventional physician,4 whereas vegetarian Buddhist nuns have been shown to exhibit a higher BMI than omnivore Catholic.39

Alternative lifestyles differ per definition from the one adopted by the majority of the citizens of a given society and are thereby associated with a critical attitude towards the conventional lifestyle. Given the high prevalence of overweight and high blood pressure in the western world, it seems reasonable that this attitude might offer some protection towards these major health problems. The present analysis is restricted to women in the pregnancy and maternity period; therefore, it is unknown whether our observations are applicable to other life periods. The influence of families and environment on children’s health is, however, in the case of CVD particularly well documented.40 Hope is frequently put on behavioural changes, as a non-pharmacological possibility to manage some of the risk factors for CVD in youth. Through a lifestyle change it should be possible to stop the epidemic of overweight and obesity in youth and concomitant hypertension increase in children and adolescents.41

Our work emphasizes the need to become aware of the numerous, practical, daily decisions that together constitute lifestyle. This awareness is likely to have beneficial effects on health. Especially for women who have a longer life expectancy than men, die more frequently from diseases (instead of from external causes) and spend more time with childcare and household,42 lifestyle changes might constitute a possibility to improve their health-related outcomes and those of their offspring.

Supplementary Data

Supplementary data are available at EURPUB online.

Funding

The clinical study was supported by a grant from the Netherlands Organization for Health Research and Development (ZonMw Prevention Program 1, grant no. 2001-1-1260), the present analysis and publication by Weleda AG (Arlesheim, Switzerland). The sponsors had no influence on the analysis and reporting of the results.

Conflicts of interest: None declared.

Key points

  • Self-reported health behaviours and prevalence of several diseases differed between the alternative and conventional recruitment groups.

  • An alternative lifestyle was associated with lower prevalence of overweight and obesity, before and during pregnancy and after the maternity period, as well as of high blood pressure during pregnancy.

  • Some aspects of an alternative lifestyle might have potential to attenuate the present tendency for increasing prevalence of overweight and high blood pressure.

References

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