Tracking food consumption frequency of children from age 4 to 6 years: the Pacific Islands Families study

AIM

To report longitudinal food frequency consumption and evaluate tracking of food frequency among a cohort of New Zealand-born Pacific children.

OBJECTIVE

Identify the most commonly consumed foods and estimate tracking among Pacific children aged 4 and 6 years.

METHOD

A qualitative food frequency questionnaire was administered to n>1,000 caregivers of children aged 4 and 6 years. Consumption scores were developed from averaged frequency of daily food. Foods and food groups were examined for tracking.

RESULTS

Caregivers completed questionnaires for 646 children at both ages. Twelve most frequently consumed foods were identified, accounting for up to 25% of all food consumed daily. Across ages 4 and 6, the association for frequency of the most frequently consumed foods was moderate (r(2)=0.53). Food groups: breads and cereals; meat and alternates; and vegetables and fruit constituted approximately 72% of all foods consumed daily. The association of frequency of consumption within food groups across the two measurement periods was strong (r(2)=0.96).

CONCLUSIONS

Pacific children consume similar foods that track from age 4 through age 6 years.

Maternal Cultural Orientation and Child Growth in New Zealand Pacific Families

BACKGROUND

In New Zealand (NZ), children of Pacific heritage are generally born heavier and gain weight more quickly than non-Pacific children. Immigrants' health is commonly expected to converge with the host population through acculturation. The aim of this analysis was to examine whether mothers' acculturation is associated with less-rapid weight gain in NZ Pacific children, and whether this differs by mothers' nativity.

METHODS

In a birth cohort of 1249 children followed 2000-2011, birth weight and weight and standing height, measured at years 2, 4, 6, 9, and 11, were quantified as sex- and age-specific weight (weight-for-age; WFA) and BMI z-scores. Maternal acculturation (range, 11-54) was assessed at baseline and years 4, 6, and 11.

RESULTS

In adjusted models using generalized estimating equations to account for repeated measures, maternal acculturation was not significantly associated with children's WFA or BMI z-scores overall. In stratified analyses, change in maternal acculturation score was inversely associated with WFA z-score change among children of NZ-born, but not immigrant, mothers (beta=-0.021; 95% confidence interval, -0.036 to -0.007; p=0.006; interaction, p=0.005).

CONCLUSIONS

Our study provides the first evidence in a longitudinal sample that changes in maternal acculturation can influence children's growth, suggesting the importance of lifestyle or behavioral factors related to a mother's cultural orientation. Given the high risk of obesity and its related conditions in the NZ Pacific population, critical next steps are to identify mediating factors, as well as to understand the processes influencing growth among children of immigrant mothers.

Blood pressure measurement at two years in offspring of women randomized to a trial of metformin for GDM: follow up data from the MiG trial

Background

Offspring born following maternal gestational diabetes are at risk of excessive childhood weight gain and Type 2 diabetes in childhood, which in turn is associated with an increased rate of hypertension.

We aimed to determine the systolic and diastolic blood pressure at two years of age in a cohort of children exposed to gestational diabetes mellitus using data from the MiG trial of metformin use in gestational diabetes. The secondary aim was to analyze these data by randomization of treatment to insulin or metformin.

Methods

The offspring of women who had gestational diabetes and had been assigned to either open treatment with metformin (with supplemental insulin if required) or insulin in the MiG trial were followed up at 2 years of age. Oscillometric measurement of BP in the right arm was performed by a researcher using an appropriately sized cuff.

Results

A total of 489 measurement blood pressure measurements were obtained in 170 of the 222 children who were seen at a median (range) age of 29 (22–38) months corrected gestational age. At the time of assessment the mean (SD) weight and height was 13.8(2) kg and 90 (4.2) cm respectively. For the whole group the mean (SD) systolic pressure was 90.9 (9.9) mmHg and mean (SD) diastolic pressure was 55.7 (8.1) mmHg. No difference was found between the metformin and insulin treatment arms. In a regression model, height and weight were only two factors associated with the levels of systolic blood pressure. For each additional kg the systolic blood pressure increased by 1.0 mmHg. For each additional cm of height the systolic blood pressure increased by 0.42 mmHg.

Conclusions

Blood pressure data was obtained at approximately two years of age in a substantial cohort of children whose mothers received treatment for GDM. These novel data compare favorably with published norms.

Clinical Trials Registry

This study was registered under the Australian New Zealand Clinical Trials Registry (ACTRN12605000311651).

The Stroke Riskometer(TM) App: validation of a data collection tool and stroke risk predictor

Background

The greatest potential to reduce the burden of stroke is by primary prevention of first-ever stroke, which constitutes three quarters of all stroke. In addition to population-wide prevention strategies (the ‘mass’ approach), the ‘high risk’ approach aims to identify individuals at risk of stroke and to modify their risk factors, and risk, accordingly. Current methods of assessing and modifying stroke risk are difficult to access and implement by the general population, amongst whom most future strokes will arise. To help reduce the burden of stroke on individuals and the population a new app, the Stroke Riskometer™, has been developed. We aim to explore the validity of the app for predicting the risk of stroke compared with current best methods.

Methods

752 stroke outcomes from a sample of 9501 individuals across three countries (New Zealand, Russia and the Netherlands) were utilized to investigate the performance of a novel stroke risk prediction tool algorithm (Stroke Riskometer™) compared with two established stroke risk score prediction algorithms (Framingham Stroke Risk Score [FSRS] and QStroke). We calculated the receiver operating characteristics (ROC) curves and area under the ROC curve (AUROC) with 95% confidence intervals, Harrels C-statistic and D-statistics for measure of discrimination, R² statistics to indicate level of variability accounted for by each prediction algorithm, the Hosmer-Lemeshow statistic for calibration, and the sensitivity and specificity of each algorithm.

Results

The Stroke Riskometer™ performed well against the FSRS five-year AUROC for both males (FSRS = 75·0% (95% CI 72·3%–77·6%), Stroke Riskometer™ = 74·0(95% CI 71·3%–76·7%) and females [FSRS = 70·3% (95% CI 67·9%–72·8%, Stroke Riskometer™ = 71·5% (95% CI 69·0%–73·9%)], and better than QStroke [males – 59·7% (95% CI 57·3%–62·0%) and comparable to females = 71·1% (95% CI 69·0%–73·1%)]. Discriminative ability of all algorithms was low (C-statistic ranging from 0·51–0·56, D-statistic ranging from 0·01–0·12). Hosmer-Lemeshow illustrated that all of the predicted risk scores were not well calibrated with the observed event data (P < 0·006).

Conclusions

The Stroke Riskometer™ is comparable in performance for stroke prediction with FSRS and QStroke. All three algorithms performed equally poorly in predicting stroke events. The Stroke Riskometer™ will be continually developed and validated to address the need to improve the current stroke risk scoring systems to more accurately predict stroke, particularly by identifying robust ethnic/race ethnicity group and country specific risk factors.

Pathways to health and wellbeing for Pacific children--how are we tracking?

The government's 5-year strategy for improving Pacific people's health and wellbeing, 'Ala Mo'ui Pathways to Pacific Health and Wellbeing 2010-2014, emphasised disease prevention and improvements in health systems as priority outcomes. Actions that would contribute to disease prevention included reducing barriers to health in structural mechanisms (such as better access to healthy housing) and improving health service systems. However, after 4 years since its release, not only have important structural barriers remained but so have the poor health outcomes of Pacific peoples in New Zealand.

Physical activity in children: prevention of obesity and type 2 diabetes

There is strong evidence that increased physical activity is beneficial for blood glucose homeostasis and the prevention of obesity and type 2 diabetes mellitus. This chapter takes a life course approach with an emphasis on the intrauterine and childhood stages of life. Firstly, growth and development at critical periods with a focus on skeletal muscle and adipose tissue; then, obesity and type 2 diabetes mellitus are considered in relation to physical activity and sedentary behaviour. The importance of the development of fundamental movement skills in early childhood for both physical fitness and also growth and development is emphasised. Physical activity guidelines in westernised countries are examined for commonalities. Finally, the effective translation of the evidence base for the benefits of physical activity into randomised controlled trials and then into real-world public health services that are sustainable is addressed with a case study from New Zealand of Project Energize--a through-school physical activity and nutrition intervention. Physical activity, alongside a 'healthy diet' is arguably the best preventive measure and treatment for both obesity and type 2 diabetes. It is an essential and normal activity of daily life, and all aspects of the life course and the environment should support physical activity.

Improvement of fundamental movement skills through support and mentorship of class room teachers

Project Energize, a multicomponent through-school programme aims to improve the overall health and reducing weight gain of Waikato primary school children by increasing their physical activity and encouraging healthy eating. The aim of this report is to describe the efficacy of one intervention that provided classroom teachers with tools for improving fundamental movement skill (FMS) proficiency in years 0-8 school children. In 2008 the Test of Gross Motor Development (TGMD) was used to measure the FMS proficiency of children from 11 schools and 41 classes; before (n = 701) and after (n = 598) the teacher support was provided. Children were identified only by class years. At baseline less than half of the children exhibited proficiency in kicking (21%), throwing (31%) and striking (40%) while most children were able to run (84.6%) and slide (78.0%). All skills were substantially improved (P < 0.001) after the intervention with the biggest changes in kicking, throwing and striking; 49.8%, 63.5% and 76.3% proficient. At baseline children in years 0-3 from higher decile schools performed better than lower decile schools and after intervention this gap was reduced or removed. After receiving tailored FMS physical education classes led by the teacher, younger children were more competent than the older children were at baseline. The large, positive effects of the intervention have implications for long term physical activity participation and fitness with subsequent health benefits. The school-based FMS teacher support intervention by Team Energize is an effective way to improve outcomes for children.

Reducing recurrent stroke: methodology of the motivational interviewing in stroke (MIST) randomized clinical trial

RATIONALE

Recurrent stroke is prevalent in both developed and developing countries, contributing significantly to disability and death. Recurrent stroke rates can be reduced by adequate risk factor management. However, adherence to prescribed medications and lifestyle changes recommended by physicians at discharge after stroke is poor, leading to a large number of preventable recurrent strokes. Using behavior change methods such as Motivational Interviewing early after stroke occurrence has the potential to prevent recurrent stroke.

AIMS AND/OR HYPOTHESIS

The overall aim of the study is to determine the effectiveness of motivational interviewing in improving adherence to medication and lifestyle changes recommended by treating physicians at and after hospital discharge in stroke patients 12 months poststroke to reduce risk factors for recurrent stroke.

DESIGN

Recruitment of 430 first-ever stroke participants will occur in the Auckland and Waikato regions. Randomization will be to intervention or usual care groups. Participants randomized to intervention will receive four motivational interviews and five follow-up assessments over 12 months. Nonintervention participants will be assessed at the same time points.

STUDY OUTCOMES

Primary outcome measures are changes in systolic blood pressure and low-density lipoprotein levels 12 months poststroke. Secondary outcomes include self-reported adherence and barriers to prescribed medications, new cardiovascular events (including stroke), changes in quality of life, and mood.

DISCUSSION

The results of the motivational interviewing in stroke trial will add to our understanding of whether motivational interviewing may be potentially beneficial in the management of stroke and other diseases where similar lifestyle factors or medication adherence are relevant.

Methodology of a population-based stroke and TIA incidence and outcomes study: the Auckland Regional Community Stroke Study (ARCOS IV) 2011-2012

BACKGROUND

Stroke is a leading cause of death and disability worldwide. Stroke burden is immense as it leads to premature deaths, leaves survivors with ongoing disabilities, and has a major financial impact on the individual, their families, and the community. Reliable, high-quality evidence is needed on stroke risk factors, incidence, and outcomes to provide information on how best to reduce this burden. Population-based studies are regarded as the 'gold-standard' of measuring disease burden but are not common due to the logistical and financial challenges they present. The Auckland Regional Community Stroke Studies are among a few in the world that have been carried out at a population level and at regular intervals.

AIM

The aim of the fourth Auckland Regional Community Stroke Studies IV is to examine the current measures of stroke incidence, prevalence, and outcomes as well the trends over four decades. This article describes the methodology of the Auckland Regional Community Stroke Studies IV with stroke and transient ischemic attacks cases registered over a 12-month period from March 1, 2011 to February 29, 2012.

CONCLUSIONS

The methodology described may be used as a guide in order to design similar population-based stroke incidence and outcome studies in other countries and populations, thus facilitating the collection of most consistent and accurate stroke epidemiological data.

Growth centiles of Pacific children living in Auckland, New Zealand

BACKGROUND

Since 2000, the longitudinal Pacific Island Families study has measured the weight, height and body mass index (BMI) of 582 girls and 643 boys at 2, 4, 6 and 9 year data collection phases.

AIM

To extend and record the age-related distribution of weight, height and BMI measures in Pacific children aged 2-10 years and to compare the distribution to population and clinical growth charts.

METHODS

Gender-specific age-related centile curves were derived using the LMS method for weight, height and BMI. The 50th centiles from the World Health Organisation growth reference for 2-5 year olds and the Centres for Disease Control (CDC) for 5-10 year olds were compared. Overweight and obesity were defined by the CDC BMI 85th and 95th centiles.

RESULTS

The proportion of children whose weight and height were above the reference 50th centile increased with age. At age 10, using CDC criteria, more than 50% of the children were classified as obese and 70% were overweight.

CONCLUSIONS

These charts support the need to prioritize interventions for Pacific families to address childhood obesity. These centile curves could help assess the relative growth of Pacific children and identify children for further assessment and treatment.

Baseline measures for a school-based obesity control programme: Project Energize: differences by ethnicity, rurality, age and school socio-economic status

AIM

School-based interventions to tackle the rise in childhood overweight and obesity remain inconclusive and are often limited in their application to diverse populations. To inform and measure the effect of the implementation of a primary school-based longitudinal randomised controlled nutrition and activity intervention, Project Energize, baseline measures of body size and blood pressure were required.

METHODS

This cross-sectional study stratified by age, sex, ethnicity, rurality and school socio-economic-status (school-SES) measured body mass index (BMI), percentage body fat (%BF), waist and resting blood pressure from 2752 5- and 10-year-old children (62% European, 31% Māori) representative of the Waikato region of New Zealand.

RESULT

Waikato children have a high prevalence of overweight and obesity that is linked with hypertension. Cardiovascular risk factors including raised blood pressure and hypertension, waist and arm circumference and percentage body fat (%BF) were more prevalent in 10-year-olds, lower school-SES and to some extent, urban living. In European children, BMI and waist circumference were similarly predictive of %BF, but for Māori children, waist circumference predicted %BF better than BMI.

CONCLUSIONS

A variety of stratified, baseline measurements is important when designing school-based interventions. In particular, waist circumference measures may be a more accurate predictor of %BF than BMI when determining measurement protocols that consider different ethnic groups and environments among children. The effect of targeted improvements of the school physical activity and nutrition environment on the rate of increase of weight, fatness and blood pressure in children should be examined.

Enzogenol for cognitive functioning in traumatic brain injury: a pilot placebo-controlled RCT

BACKGROUND AND PURPOSE

Enzogenol, a flavonoid-rich extract from Pinus radiata bark with antioxidant and anti-inflammatory properties has been shown to improve working memory in healthy adults. In traumatic brain injury (TBI), oxidation and inflammation have been linked to poorer cognitive outcomes. Hence, this phase II, randomized controlled trial investigated safety, compliance and efficacy of Enzogenol for improving cognitive functioning in people following mild TBI.

METHODS

Sixty adults, who sustained a mild TBI, 3-12 months prior to recruitment, and who were experiencing persistent cognitive difficulties [Cognitive Failures Questionnaire (CFQ) score > 38], were randomized to receive Enzogenol (1000 mg/day) or matching placebo for 6 weeks. Subsequently, all participants received Enzogenol for a further 6 weeks, followed by placebo for 4 weeks. Compliance, side-effects, cognitive failures, working and episodic memory, post-concussive symptoms and mood were assessed at baseline, 6, 12 and 16 weeks. Simultaneous estimation of treatment effect and breakpoint was effected, with confidence intervals (CIs) obtained through a treatment-placebo balance-preserving bootstrap procedure.

RESULTS

Enzogenol was found to be safe and well tolerated. Trend and breakpoint analyses showed a significant reduction in cognitive failures after 6 weeks [mean CFQ score, 95% CI, Enzogenol versus placebo -6.9 (-10.8 to -4.1)]. Improvements in the frequency of self-reported cognitive failures were estimated to continue until week 11 before stabilizing. Other outcome measures showed some positive trends but no significant treatment effects.

CONCLUSIONS

Enzogenol supplementation is safe and well tolerated in people after mild TBI, and may improve cognitive functioning in this patient population. This study provides Class IIB evidence that Enzogenol is well tolerated and may reduce self-perceived cognitive failures in patients 3-12 months post-mild TBI.

Doubly labeled water validation of a computerized use-of-time recall in active young people

OBJECTIVE

Low levels of daily energy expenditure (insufficient physical activity and increased sedentary time) have been associated with adverse health outcomes in young people. The Multimedia Activity Recall for Children and Adolescents (MARCA) is a computerized, self-report, use-of-time tool that can assess daily energy expenditure. The study aim was to validate the MARCA for the estimation of energy expenditure in young people, using the criterion standard doubly labeled water.

MATERIALS/METHODS

Over a 15 day assessment period, 32 participants (10-18 years) completed the MARCA and underwent a doubly labeled water protocol. Indirect calorimetry was used to assess resting metabolic rate. Total daily energy expenditure (TEE) and activity-related energy expenditure (AEE) were estimated from both the MARCA and doubly labeled water. Association and agreement between methods for TEE and AEE were assessed using Spearman correlations and Bland-Altman plots, respectively.

RESULTS

Compared to doubly labeled water, the MARCA over-estimated TEE by an average of 50 kcal/day (limits of agreement -1 589 to 1 490 kcal/day) and under-estimated AEE 105 kcal/day (limits of agreement -1 404 to 1 614 kcal/day). The MARCA showed strong correlation with doubly labeled water for TEE (rho=0.70, p<0.0001) and moderate correlation for AEE (rho=0.56, p=0.0009).

CONCLUSIONS

Overall, the MARCA indicated moderate validity for the assessment of daily TEE and AEE. The wide limits of agreement indicate the MARCA has greater utility for group-level rather than individual-level estimates.