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Mediterranean Diet or Mindfulness-Based Stress Reduction and Prevention of Small-for-Gestational-Age Birth Weights in Newborns—Reply
In Reply In response to the comments by Dr Liu and colleagues about the IMPACT BCN trial, we would like to point out that evaluation of potential cross-effects was part of our study design, since any lifestyle change is likely to have general beneficial effects on behavior beyond the specific intervention. As reported in the trial, the biological effects in each study group suggested that strong cross-effects were unlikely. Women in the Mediterranean diet intervention group showed statistically significant increases in Mediterranean diet scores (eTable 9 in Supplement 3 of the article) and in olive oil and nuts biological biomarkers at the end of the intervention, while these scores remained unchanged in the stress reduction and control groups (eTable 14). In addition, intake of specific nutrients (ie, polyunsaturated fatty acid and α-linolenic acid) were significantly increased in the Mediterranean diet group but not in the stress reduction group (eTable 10). On the other hand, women in the stress reduction group had significant score reductions in anxiety and increased well-being scores per validated questionnaires (eTable 13), accompanied by a significant reduction in their cortisone/cortisol ratio (eTable 14). These changes were not observed in the Mediterranean diet and control groups.
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