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Nascimento T, Yang N, Salman D, Jassar H, Kaciroti N, Bellile E, Danciu T, Koeppe R, Stohler C, Zubieta J, Ellingrod V, DaSilva A. µ-Opioid Activity in Chronic TMD Pain Is Associated with COMT Polymorphism. J Dent Res 2019; 98:1324-1331. [PMID: 31490699 PMCID: PMC6806132 DOI: 10.1177/0022034519871938] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Clinicians have the dilemma of prescribing opioid or nonopioid analgesics to chronic pain patients; however, the impact of pain on our endogenous µ-opioid system and how our genetic profile (specifically catechol-O-methyltransferase [COMT] polymorphisms) impacts its activation are currently unknown. Twelve chronic temporomandibular disorder (TMD) patients and 12 healthy controls (HCs) were scanned using positron emission tomography (PET) with [11C]carfentanil, a selective radioligand for µ-opioid receptors (µORs). The first 45 min of each PET measured the µOR nondisplaceable binding potential (BPND) at resting state, and the last 45 min consisted of a 20-min masseteric pain challenge with an injection of 5% hypertonic saline. Participants were also genotyped for different COMT alleles. There were no group differences in µOR BPND at resting state (early phase). However, during the masseteric pain challenge (late phase), TMD patients exhibited significant reductions in µOR BPND (decreased [11C]carfentanil binding) in the contralateral parahippocampus (P = 0.002) compared to HCs. The µOR BPND was also significantly lower in TMD patients with longer pain chronicity (P < 0.001). When considering COMT genotype and chronic pain suffering, TMD patients with the COMT158Met substitution had higher pain sensitivity and longer pain chronicity with a 5-y threshold for µOR BPND changes to occur in the parahippocampus. Together, the TMD diagnosis, COMT158Met substitution, and pain chronicity explained 52% of µOR BPND variance in the parahippocampus (cumulative R2 = 52%, P < 0.003, and HC vs. TMD Cohen's effect size d = 1.33 SD). There is strong evidence of dysregulation of our main analgesic and limbic systems in chronic TMD pain. The data also support precision medicine by helping identify TMD patients who may be more susceptible to chronic pain sensitivity and opioid dysfunction based on their genetic profile.
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Munzer TG, Miller AL, Weeks HM, Kaciroti N, Radesky J. Parent-Toddler Social Reciprocity During Reading From Electronic Tablets vs Print Books. JAMA Pediatr 2019; 173:1076-1083. [PMID: 31566689 PMCID: PMC6777236 DOI: 10.1001/jamapediatrics.2019.3480] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Although the American Academy of Pediatrics recommends parent-child joint engagement with digital media, recent evidence suggests this may be challenging when tablets contain interactive enhancements. OBJECTIVE To examine parent-toddler social reciprocity while reading enhanced (eg, with sound effects, animation) and basic tablet-based books compared with print books. DESIGN, SETTING, AND PARTICIPANTS This within-participants comparison included 37 parent-toddler dyads in a counterbalanced crossover, video-recorded laboratory design at the University of Michigan from May 31 to November 7, 2017. The volunteer sample was recruited from an online research registry and community sites. Dyads included children aged 24 to 36 months with no developmental delay or serious medical condition, parents who were the legal guardians and read English sufficiently for consent, and parents and children without uncorrected hearing or vision impairments. Data were analyzed from October 18, 2017, through April 30, 2018. EXPOSURES Reading an enhanced tablet-based book, a basic tablet-based book, and a print book in counterbalanced order for 5 minutes each. MAIN OUTCOMES AND MEASURES Video recordings were coded continuously for nonverbal aspects of parent-toddler social reciprocity, including body position (child body posture limiting parental book access coded in 10-second intervals), control behaviors (child closing the book, child grabbing the book or tablet, parent or child pivoting their body away from the other), and intrusive behaviors (parent or child pushing the other's hand away). Coding intracorrelation coefficients were greater than 0.75. Poisson regression was used to compare each outcome by book format. RESULTS Among the 37 parent-child dyads, mean (SD) parent age was 33.5 (4.0) years; 30 (81%) were mothers, and 28 (76%) had a 4-year college degree or greater educational attainment. Mean (SD) age of children was 29.2 (4.2) months, 20 (54%) were boys, 21 (57%) were white non-Hispanic, and 6 (16%) were black non-Hispanic. Compared with print books, greater frequency of child body posture limiting parental book access (mean [SD], 7.9 [1.9; P = .01] for enhanced; 8.4 [1.8; P = .006] for basic), child closing the book (mean [SD], 1.2 [0.4; P = .007] for enhanced; 1.2 [0.5; P < .001] for basic), parent pivoting (mean [SD], 0.4 [0.2; P = .05] for enhanced; 0.9 [0.4; P = .004] for basic), child pushing parent's hand (mean [SD], 0.6 [0.2; P < .001] for enhanced; 0.4 [0.2; P = .002] for basic), and parent pushing child's hand (mean [SD], 1.7 [0.3; P < .001] for enhanced; 2.4 [0.5; P < .001] for basic) occurred while reading enhanced and basic tablet-based books. Child pivots occurred more frequently while reading basic tablet-based books than print (mean [SD], 1.0 [0.3] vs 0.3 [0.1]; P = .005). CONCLUSIONS AND RELEVANCE In this study, toddlers and parents engaged in more frequent social control behaviors and less social reciprocity when reading tablet-based vs print books. These findings suggest that toddlers may have difficulty engaging in shared tablet experiences with their parents.
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Doom JR, Lumeng JC, Sturza J, Kaciroti N, Vazquez DM, Miller AL. Longitudinal associations between overweight/obesity and stress biology in low-income children. Int J Obes (Lond) 2019; 44:646-655. [PMID: 31477784 PMCID: PMC7050333 DOI: 10.1038/s41366-019-0447-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/01/2019] [Accepted: 07/22/2019] [Indexed: 01/22/2023]
Abstract
Background/Objectives Associations between overweight and altered stress biology have been reported cross-sectionally during childhood, but it is unclear whether overweight precedes altered stress biology or if altered stress biology predicts greater likelihood of overweight over time. The current longitudinal study investigates associations between overweight/obesity, salivary alpha amylase and cortisol morning intercept, diurnal slope, and reactivity to social stress in a cohort of low-income children during preschool and middle childhood. Subjects/Methods Children were recruited through Head Start and were observed and followed into middle childhood (N = 257; M = 8.0 years). Height and weight were measured at both time points. Saliva samples were collected across the day and in response to a social challenge at both ages for alpha amylase and cortisol determination. Results Cross-lagged panel analyses indicated that overweight/obesity at preschool predicted lower morning alpha amylase (β = −0.18, 95% CI: −0.34, −0.03; p = .023), lower morning cortisol (β = −0.22, 95% CI: −0.38, −0.06; p = .006), lower sAA diurnal slope (β = −0.18, 95% CI: −0.34, −0.03; p = .021), and lower cortisol stress reactivity (β = −0.19, 95% CI: −0.35, −0.02; p = .031) in middle childhood. Lower alpha amylase reactivity at preschool was the only biological factor that predicted higher likelihood of overweight/obesity at middle childhood (β = −0.20, 95% CI: −0.38, −0.01; p = .035). Conclusions These findings suggest that overweight/obesity may be driving changes in stress biology across early to middle childhood, particularly in down-regulation of morning levels of stress hormones, diurnal sAA slope, and cortisol reactivity to stress, rather than stress biology driving overweight/obesity.
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Hu XS, Nascimento TD, Bender MC, Hall T, Petty S, O'Malley S, Ellwood RP, Kaciroti N, Maslowski E, DaSilva AF. Feasibility of a Real-Time Clinical Augmented Reality and Artificial Intelligence Framework for Pain Detection and Localization From the Brain. J Med Internet Res 2019; 21:e13594. [PMID: 31254336 PMCID: PMC6625219 DOI: 10.2196/13594] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/26/2019] [Accepted: 05/12/2019] [Indexed: 12/25/2022] Open
Abstract
Background For many years, clinicians have been seeking for objective pain assessment solutions via neuroimaging techniques, focusing on the brain to detect human pain. Unfortunately, most of those techniques are not applicable in the clinical environment or lack accuracy. Objective This study aimed to test the feasibility of a mobile neuroimaging-based clinical augmented reality (AR) and artificial intelligence (AI) framework, CLARAi, for objective pain detection and also localization direct from the patient’s brain in real time. Methods Clinical dental pain was triggered in 21 patients by hypersensitive tooth stimulation with 20 consecutive descending cold stimulations (32°C-0°C). We used a portable optical neuroimaging technology, functional near-infrared spectroscopy, to gauge their cortical activity during evoked acute clinical pain. The data were decoded using a neural network (NN)–based AI algorithm to classify hemodynamic response data into pain and no-pain brain states in real time. We tested the performance of several networks (NN with 7 layers, 6 layers, 5 layers, 3 layers, recurrent NN, and long short-term memory network) upon reorganized data features on pain diction and localization in a simulated real-time environment. In addition, we also tested the feasibility of transmitting the neuroimaging data to an AR device, HoloLens, in the same simulated environment, allowing visualization of the ongoing cortical activity on a 3-dimensional brain template virtually plotted on the patients’ head during clinical consult. Results The artificial neutral network (3-layer NN) achieved an optimal classification accuracy at 80.37% (126,000/156,680) for pain and no pain discrimination, with positive likelihood ratio (PLR) at 2.35. We further explored a 3-class localization task of left/right side pain and no-pain states, and convolutional NN-6 (6-layer NN) achieved highest classification accuracy at 74.23% (1040/1401) with PLR at 2.02. Conclusions Additional studies are needed to optimize and validate our prototype CLARAi framework for other pains and neurologic disorders. However, we presented an innovative and feasible neuroimaging-based AR/AI concept that can potentially transform the human brain into an objective target to visualize and precisely measure and localize pain in real time where it is most needed: in the doctor’s office. International Registered Report Identifier (IRRID) RR1-10.2196/13594
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Jassar H, Nascimento TD, Kaciroti N, DosSantos MF, Danciu T, Koeppe RA, Smith YR, Bigal ME, Porreca F, Casey KL, Zubieta JK, DaSilva AF. Impact of chronic migraine attacks and their severity on the endogenous μ-opioid neurotransmission in the limbic system. NEUROIMAGE-CLINICAL 2019; 23:101905. [PMID: 31279240 PMCID: PMC6612052 DOI: 10.1016/j.nicl.2019.101905] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 06/17/2019] [Indexed: 12/21/2022]
Abstract
Objective To evaluate, in vivo, the impact of ongoing chronic migraine (CM) attacks on the endogenous μ-opioid neurotransmission. Background CM is associated with cognitive-emotional dysfunction. CM is commonly associated with frequent acute medication use, including opioids. Methods We scanned 15 migraine patients during the spontaneous headache attack (ictal phase): 7 individuals with CM and 8 with episodic migraine (EM), as well as 7 healthy controls (HC), using positron emission tomography (PET) with the selective μ-opioid receptor (μOR) radiotracer [11C]carfentanil. Migraineurs were scanned in two paradigms, one with thermal pain threshold challenge applied to the site of the headache, and one without thermal challenge. Multivariable analysis was performed between the μ-opioid receptor availability and the clinical data. Results μOR availability, measured with [11C]carfentanil nondisplaceable binding potential (BPND), in the left thalamus (P-value = 0.005) and left caudate (P-value = 0.003) were decreased in CM patients with thermal pain threshold during the ictal phase relative to HC. Lower μOR BPND in the right parahippocampal region (P-value = 0.001) and right amygdala (P-value = 0.002) were seen in CM relative to EM patients. Lower μOR BPND values indicate either a decrease in μOR concentration or an increase in endogenous μ-opioid release in CM patients. In the right amygdala, 71% of the overall variance in μOR BPND levels was explained by the type of migraine (CM vs. EM: partial-R2 = 0.47, P-value<0.001, Cohen's effect size d = 2.6SD), the severity of the attack (pain area and intensity number summation [P.A.I.N.S.]: partial-R2 = 0.16, P-value = 0.031), and the thermal pain threshold (allodynia: partial-R2 = 0.08). Conclusions Increased endogenous μ-opioid receptor-mediated neurotransmission is seen in the limbic system of CM patients, especially in right amygdala, which is highly modulated by the attack frequency, pain severity, and sensitivity. This study demonstrates for the first time the negative impact of chronification and exacerbation of headache attacks on the endogenous μ-opioid mechanisms of migraine patients. ClinicalTrials.gov identifier: NCT03004313 Increased endogenous μ-opioid neurotransmission in limbic system of chronic migraineurs Right amygdala opioid dysfunction is 71% explained by attack frequency, severity and sensitivity. Amygdala dysfunction links cognitive-emotional brain mechanisms to migraine suffering.
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Julian MM, Leung CYY, Rosenblum KL, LeBourgeois MK, Lumeng JC, Kaciroti N, Miller AL. Parenting and toddler self-regulation in low-income families: What does sleep have to do with it? Infant Ment Health J 2019; 40:479-495. [PMID: 31066463 DOI: 10.1002/imhj.21783] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Toddlerhood is a sensitive period in the development of self-regulation, a set of adaptive skills that are fundamental to mental health and partly shaped by parenting. Healthy sleep is known to be critical for self-regulation; yet, the degree to which child sleep alters interactive child-parent processes remains understudied. This study examines associations between observed parenting and toddler self-regulation, with toddler sleep as a moderator of this association. Toddlers in low-income families (N = 171) and their mothers were videotaped during free play and a self-regulation challenge task; videos were coded for mothers' behavior and affect (free play) and toddlers' self-regulation (challenge task). Mothers reported their child's nighttime sleep duration via questionnaire. Results revealed significant Sleep × Maternal Negative Affect and Sleep × Maternal Negative Control interactions. Children who did not experience negative parenting had good self-regulation regardless of their nighttime sleep duration. For children who did experience negative parenting, self-regulation was intact among those who obtained more nighttime sleep, but significantly poorer among children who were getting less nighttime sleep. Thus, among children who were reported to obtain less nighttime sleep, there were more robust associations between negative parenting and poorer self-regulation than among toddlers who were reported to obtain more sleep.
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Munzer TG, Miller AL, Weeks HM, Kaciroti N, Radesky J. Differences in Parent-Toddler Interactions With Electronic Versus Print Books. Pediatrics 2019; 143:e20182012. [PMID: 30910918 PMCID: PMC6564071 DOI: 10.1542/peds.2018-2012] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Previous research has documented less dialogic interaction between parents and preschoolers during electronic-book reading versus print. Parent-toddler interactions around commercially available tablet-based books have not been described. We examined parent-toddler verbal and nonverbal interactions when reading electronic versus print books. METHODS We conducted a videotaped, laboratory-based, counterbalanced study of 37 parent-toddler dyads reading on 3 book formats (enhanced electronic [sound effects and/or animation], basic electronic, and print). We coded verbalizations in 10-second intervals for parents (dialogic, nondialogic, text reading, format related, negative format-related directives, and off task) and children (book related, negative, and off task). Shared positive affect and collaborative book reading were coded on a scale of 1 to 5 (5 = high). Proc Genmod and Proc Mixed analyzed within-subjects variance by book format. RESULTS Parents showed significantly more dialogic (print 11.9; enhanced 6.2 [P < .001]; basic 8.3 [P < .001]), text-reading (print 14.3; enhanced 10.6 [P = .003]; basic 14.4 [P < .001]), off-task (print 2.3; enhanced 1.3 [P = .007]), and total (29.5; enhanced 28.1 [P = .003]; basic 29.3 [P = .005]) verbalizations with print books and fewer format-related verbalizations (print 1.9; enhanced 10.0 [P < .001]; basic 8.3 [P < .001]). Toddlers showed more book-related verbalizations (print 15.0; enhanced 11.5 [P < .001]; basic 12.5 [P = .005]), total verbalizations (print 18.8; enhanced 13.8 [P < .001]; basic 15.3 [P < .001]), and higher collaboration scores (print 3.1; enhanced 2.7 [P = .004]; basic 2.8 [P = .02]) with print-book reading. CONCLUSIONS Parents and toddlers verbalized less with electronic books, and collaboration was lower. Future studies should examine specific aspects of tablet-book design that support parent-child interaction. Pediatricians may wish to continue promoting shared reading of print books, particularly for toddlers and younger children.
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Jansen EC, Peterson KE, Lumeng JC, Kaciroti N, LeBourgeois MK, Chen K, Miller AL. Associations between Sleep and Dietary Patterns among Low-Income Children Attending Preschool. J Acad Nutr Diet 2019; 119:1176-1187. [PMID: 30878402 DOI: 10.1016/j.jand.2019.01.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/09/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sleep disturbances and low-quality diets are prevalent among children in low-income settings, yet the nature of their relationship remains unclear. In particular, whether aspects other than sleep duration, including timing and quality, are associated with dietary patterns has rarely been examined, especially among preschool-aged children. OBJECTIVE To evaluate whether nightly and total sleep duration, sleep timing, differences in timing and duration from weekdays to weekends, and sleep quality were related to dietary patterns. DESIGN A cross-sectional analysis of children attending preschool. Parents completed questionnaires about children's sleep habits as well as a semiquantitative food frequency questionnaire. PARTICIPANTS/SETTING Three hundred fifty-four English-speaking children (49.9% boys) with no serious medical conditions aged 3 to 5 years who were enrolled in Head Start in Michigan (2009-2011) with complete information on sleep and diet. MAIN OUTCOME MEASURES Dietary pattern scores derived from food frequency questionnaire. STATISTICAL ANALYSES PERFORMED Principal component analysis was used to identify dietary patterns. Separate linear regression models with dietary pattern scores as the dependent variable and continuous sleep measures as independent variables were used to evaluate associations between sleep and diet, adjusting for sex, age, parent education level, and sleep hygiene. RESULTS Three dietary patterns were identified: Vegetables, Healthy Proteins, and Sides; Breads and Spreads; and Processed and Fried. Longer average weekend sleep duration and a greater difference in weekend-to-weekday sleep duration was related to lower Vegetables, Healthy Proteins, and Sides pattern scores. Later sleep midpoint during weekdays was related to lower Vegetables, Healthy Proteins, and Sides pattern scores, whereas later sleep midpoint on the weekend was associated with higher Processed and Fried pattern scores. Similarly, a larger weekend-weekday midpoint difference was associated with higher Processed and Fried pattern scores. CONCLUSIONS Later sleep timing and differences in sleep duration and timing from weekends to weekdays were related to less-optimal dietary pattern scores in young children.
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Pesch MH, Viechnicki GB, Appugliese DP, Kaciroti N, Rosenblum KL, Miller AL, Lumeng JC. A mixed methods analysis of maternal response to children's consumption of a palatable food: differences by child weight status. Pediatr Obes 2019; 14:e12474. [PMID: 30350348 PMCID: PMC6495602 DOI: 10.1111/ijpo.12474] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 07/11/2018] [Accepted: 08/21/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about how mothers respond to their child eating palatable foods. OBJECTIVES The objectives of the study are to examine maternal behaviours when children are presented with a large portion of energy-dense palatable food in an experimental setting and to examine differences by child weight status. METHODS Mother-child dyads (N = 37) (mean child age 70.8 months) participated in a videotaped eating protocol with cupcakes. Anthropometrics were measured. Videos were analysed using discourse analysis and were reliably coded for the presence or absence of the most salient theme. Analysis of variance examined theme presence by child and mother weight status. RESULTS Mothers disavowed responsibility for their child's eating. Mothers were observed to roll their eyes at the child, throw their hands up in exasperation and distance themselves both physically and emotionally when the child ate the cupcakes voraciously or with high enjoyment. Mothers of children with obesity (vs recommended weight) engaged in more counts of disavowal (p = 0.01). CONCLUSIONS Mothers of children with obesity distanced themselves from their child, seeming to disavow responsibility for the child's eating of 'junk food'. Mothers may respond to their child's seemingly gluttonous eating by disavowing responsibility due to the stigma of being a parent of a child with obesity.
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Miller AL, Riley H, Domoff SE, Gearhardt AN, Sturza J, Kaciroti N, Lumeng JC. Weight status moderates stress-eating in the absence of hunger associations in children. Appetite 2019; 136:184-192. [PMID: 30771403 DOI: 10.1016/j.appet.2019.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/16/2019] [Accepted: 02/10/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The association between stress and eating remains unclear in children potentially due to factors that may moderate the association. We examined whether weight status or sex moderated associations between response to a stress induction and eating in the absence of hunger (EAH), among low-income children. METHOD Children (n = 223; M age = 7.8 years, SD = 0.7 years) participated in a stress induction protocol (modified Trier Social Stress Test for Children [TSST-C]) during which behavioral coding of observed anxiety and change in self-reported distress were measured. Afterwards, participants completed a standardized EAH protocol where they were offered palatable foods. Total kilocalories consumed during the EAH protocol was calculated. Weight and height were measured and weight status calculated as overweight (BMI ≥ 85th percentile for age and sex) vs. not overweight. Multivariate linear regression models adjusting for covariates were conducted to test whether child weight status or sex moderated the stress response-EAH association, for both stress response variables. RESULTS Weight status moderated the association between observed stress response and EAH such that children with overweight engaged in more EAH as observed anxiety increased, whereas children without overweight engaged in less EAH as observed anxiety increased (βinteraction = 0.48; p = .010). Weight status did not moderate associations between self-reported distress and EAH. Child sex was not a significant moderator. CONCLUSIONS After exposure to stress, children with overweight in middle childhood may eat more palatable food compared to children without overweight, possibly due to hypersensitization to food cues or weight stigma experienced by youth with overweight. It may be helpful to encourage youth with overweight to engage in stress-management techniques that do not involve eating as a response to stress.
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Silver MK, Shao J, Ji C, Zhu B, Xu L, Li M, Chen M, Xia Y, Kaciroti N, Lozoff B, Meeker JD. Prenatal organophosphate insecticide exposure and infant sensory function. Int J Hyg Environ Health 2019; 221:469-478. [PMID: 29402694 DOI: 10.1016/j.ijheh.2018.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/29/2017] [Accepted: 01/18/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Occupational studies suggest that exposure to organophosphate insecticides (OPs) can lead to vision or hearing loss. Yet the effects of early-life exposure on visual and auditory function are unknown. Here we examined associations between prenatal OP exposure and grating visual acuity (VA) and auditory brainstem response (ABR) during infancy. METHODS 30 OPs were measured in umbilical cord blood using gas chromatography tandem mass spectrometry in a cohort of Chinese infants. Grating visual acuity (VA) (n = 179-200) and auditory brainstem response (ABR) (n = 139-183) were assessed at 6 weeks, 9 months, and 18 months. Outcomes included VA score, ABR wave V latency and central conduction time, and head circumference (HC). Associations between sensory outcomes during infancy and cord OPs were examined using linear mixed models. RESULTS Prenatal chlorpyrifos exposure was associated with lower 9-month grating VA scores; scores were 0.64 (95% CI: -1.22, -0.06) points lower for exposed versus unexposed infants (p = 0.03). The OPs examined were not associated with infant ABR latencies, but chlorpyrifos and phorate were both significantly inversely associated with HC at 9 months; HCs were 0.41 (95% CI: 0.75, 0.6) cm and 0.44 (95% CI: 0.88, 0.1) cm smaller for chlorpyrifos (p = 0.02) and phorate (p = 0.04), respectively. CONCLUSIONS We found deficits in grating VA and HC in 9-month-old infants with prenatal exposure to chlorpyrifos. The clinical significance of these small but statistically significant deficits is unclear. However, the disruption of visual or auditory pathway maturation in infancy could potentially negatively affect downstream cognitive development.
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Griauzde DH, Lumeng JC, Shah PE, Kaciroti N. Lower Body Mass Index Z-Score Trajectory During Early Childhood After the Birth of a Younger Sibling. Acad Pediatr 2019; 19:51-57. [PMID: 29920332 DOI: 10.1016/j.acap.2018.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/06/2018] [Accepted: 06/09/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objectives of this study were to examine differences in body mass index z-score (BMIZ) trajectory during early childhood among children with a younger sibling compared with those without and to test potential mediators. METHODS This longitudinal cohort study included 6050 participants of the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B). Focal children's weight, height, sibship status, screen time, active play time, family dinner frequency, and diet quality were assessed at 9 months, 24 months, preschool, and kindergarten when available. A piecewise linear regression model was used to examine the association between sibling birth and focal child's subsequent BMIZ trajectory to kindergarten. Mediation by screen time, active play time, family dinner frequency, and diet quality was tested. RESULTS BMIZ trajectory was lower among children who had a new sibling join the family before kindergarten compared to children who did not have a new sibling join the family by kindergarten. The association was strongest when new sibship occurred when the focal child was 48 to 66 months (b = -0.026, P = .044). The association was not mediated by screen time, active play time, family dinner frequency, or diet quality. CONCLUSION Among a nationally representative cohort of US children, new sibship before kindergarten was associated with a lower BMIZ trajectory. Several common obesogenic risk factors did not explain the association.
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Quist M, Kaciroti N, Poehlmann-Tynan J, Weeks HM, Asta K, Singh P, Shah PE. Interactive Effects of Infant Gestational Age and Infant Fussiness on the Risk of Maternal Depressive Symptoms in a Nationally Representative Sample. Acad Pediatr 2019; 19:917-924. [PMID: 30867136 PMCID: PMC6736763 DOI: 10.1016/j.acap.2019.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 12/22/2018] [Accepted: 02/08/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the interactive effects of gestational age and infant fussiness on the risk of maternal depressive symptoms in a nationally representative sample. METHODS Our sample included 8200 children from the Early Childhood Longitudinal Study, Birth Cohort. Gestational age categories were very preterm (VPT, 24-31 weeks), moderate/late preterm (MLPT, 32-36 weeks) and full term (FT, 37-41 weeks). Maternal depressive symptoms (categorized as nondepressed/mild/moderate-severe), from the modified Center for Epidemiological Studies Depression Questionnaire, and infant fussiness (categorized as fussy/not fussy) were assessed at 9 months from parent-report questionnaires. We examined the interactive effects of infant fussiness and gestational age categories and estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) of maternal depressive symptoms using multinomial logistic regression. RESULTS Infant fussiness interacted with gestational age categories in predicting maternal depressive symptoms (P = .04), with severity varying by gestational age and infant fussiness. Compared with mothers of VPT infants without fussiness, mothers of VPT infants with fussiness had greater odds of mild depressive symptoms (aOR, 2.32; 95% CI, 1.19-4.53). Similarly, compared with mothers of MLPT and FT infants without fussiness, mothers of fussy MLPT and FT infants had greater odds of moderate-severe symptoms (aOR, 2.30; 95% CI, 1.40-3.80, and aOR, 1.74; 95% CI, 1.40-2.16, respectively). CONCLUSIONS Mothers of MLPT and FT infants with fussiness had increased odds of moderate-severe depressive symptoms, and mothers of VPT infants with fussiness had increased risk of mild symptoms. Early screening for infant fussiness in preterm and FT may help identify mothers with depressive symptoms in need of support.
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Shah PE, Weeks HM, Richards B, Kaciroti N. Early childhood curiosity and kindergarten reading and math academic achievement. Pediatr Res 2018; 84:380-386. [PMID: 29884846 PMCID: PMC6203666 DOI: 10.1038/s41390-018-0039-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 01/05/2018] [Accepted: 02/06/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although children's curiosity is thought to be important for early learning, the association of curiosity with early academic achievement has not been tested. We hypothesized that greater curiosity would be associated with greater kindergarten academic achievement in reading and math. METHODS Sample included 6200 children in the Early Childhood Longitudinal Study, Birth Cohort. Measures at kindergarten included direct assessments of reading and math, and a parent-report behavioral questionnaire from which we derived measures of curiosity and effortful control. Multivariate linear regression examined associations of curiosity with kindergarten reading and math academic achievement, adjusting for effortful control and confounders. We also tested for moderation by effortful control, sex, and socioeconomic status (SES). RESULTS In adjusted models, greater curiosity was associated with greater kindergarten reading and math academic achievement: breading = 0.11, p < 0.001; bmath = 0.12, p < 0.001. This association was not moderated by effortful control or sex, but was moderated by SES (preading = 0.01; pmath = 0.005). The association of curiosity with academic achievement was greater for children with low SES (breading = 0.18, p < 0.001; bmath = 0.20, p < 0.001), versus high SES (breading = 0.08, p = 0.004; bmath = 0.07, p < 0.001). CONCLUSIONS Curiosity may be an important, yet under-recognized contributor to academic achievement. Fostering curiosity may optimize academic achievement at kindergarten, especially for children with low SES.
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Robbins LB, Ling J, Clevenger K, Voskuil VR, Wasilevich E, Kerver JM, Kaciroti N, Pfeiffer KA. A School- and Home-Based Intervention to Improve Adolescents' Physical Activity and Healthy Eating: A Pilot Study. J Sch Nurs 2018; 36:121-134. [PMID: 30068245 DOI: 10.1177/1059840518791290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study evaluated feasibility, acceptability, and preliminary efficacy of a 12-week Guys/Girls Opt for Activities for Life (GOAL) intervention on 10- to 13-year-old adolescents' body mass index (BMI), percent body fat, physical activity (PA), diet quality, and psychosocial perceptions related to PA and healthy eating. Parent-adolescent dyads from two schools were enrolled. Schools were assigned to either GOAL (38 dyads) or control (43 dyads) condition. The intervention included an after-school club for adolescents 2 days/week, parent-adolescent dyad meeting, and parent Facebook group. Intervention adolescents had greater autonomous motivation for PA and self-efficacy for healthy eating than control adolescents (both p < .05). Although between-group differences were not significant, close-to-moderate effect sizes resulted for accelerometer-measured moderate-to-vigorous PA and diet quality measured via 24-hr dietary recall (d = .46 and .44, respectively). A trivial effect size occurred for percent body fat (d = -.10). No differences emerged for BMI. Efficacy testing with a larger sample may be warranted.
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Miller AL, Gearhardt AN, Retzloff L, Sturza J, Kaciroti N, Lumeng JC. Early Childhood Stress and Child Age Predict Longitudinal Increases in Obesogenic Eating Among Low-Income Children. Acad Pediatr 2018; 18:685-691. [PMID: 29357310 PMCID: PMC6067997 DOI: 10.1016/j.acap.2018.01.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/09/2018] [Accepted: 01/13/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To identify whether psychosocial stress exposure during early childhood predicts subsequent increased eating in the absence of hunger (EAH), emotional overeating, food responsiveness, and enjoyment of food. METHODS This was an observational longitudinal study. Among 207 low-income children (54.6% non-Hispanic white, 46.9% girls), early childhood stress exposure was measured by parent report and a stress exposure index calculated, with higher scores indicating more stress exposure. Eating behaviors were measured in early (mean, 4.3; standard deviation, 0.5 years) and middle (mean, 7.9; standard deviation, 0.7 years) childhood. Observed EAH was assessed by measuring kilocalories of palatable food the child consumed after a meal. Parents reported on child eating behaviors on the Child Eating Behavior Questionnaire. Child weight and height were measured and body mass index z score (BMIz) calculated. Multivariable linear regression, adjusting for child sex, race/ethnicity, and BMIz, was used to examine the association of stress exposure with rate of change per year in each child eating behavior. RESULTS Early childhood stress exposure predicted yearly increases in EAH (β = 0.14; 95% confidence interval, 0.002, 0.27) and Emotional Overeating (β = 0.14; 95% confidence interval, 0.008, 0.27). Stress exposure was not associated with Food Responsiveness (trend for decreased Enjoyment of Food; β = -0.13; 95% confidence interval, 0.002, -0.26). All child obesogenic eating behaviors increased with age (P < .05). CONCLUSIONS Early stress exposure predicted increases in child eating behaviors known to associate with overweight/obesity. Psychosocial stress may confer overweight/obesity risk through eating behavior pathways. Targeting eating behaviors may be an important prevention strategy for children exposed to stress.
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Doom JR, Cook SH, Sturza J, Kaciroti N, Gearhardt AN, Vazquez DM, Lumeng JC, Miller AL. Family conflict, chaos, and negative life events predict cortisol activity in low-income children. Dev Psychobiol 2018; 60:364-379. [PMID: 29388194 DOI: 10.1002/dev.21602] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/08/2017] [Indexed: 12/20/2022]
Abstract
Childhood poverty is hypothesized to increase risk for mental and physical health problems at least in part through dysregulation of the hypothalamic-pituitary-adrenal axis. However, less is known about the specific psychosocial stressors associated with cortisol reactivity and regulation for children living in poverty. The current study investigates negative life events, household chaos, and family conflict in preschool and middle childhood as potential predictors of cortisol regulation in low-income 7-10 year olds (N = 242; M age = 7.9 years). Participants were assessed in preschool and participated in a follow-up assessment in middle childhood, during which diurnal free cortisol and free cortisol reactivity to the Trier Social Stress Test for Children (TSST-C) were assessed. Household chaos during preschool predicted a more blunted diurnal cortisol slope in middle childhood. Greater negative life events during preschool and greater concurrent family conflict were associated with increased free cortisol reactivity in middle childhood.
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Shakkottai A, Kaciroti N, Kasmikha L, Nasr SZ. Impact of home spirometry on medication adherence among adolescents with cystic fibrosis. Pediatr Pulmonol 2018; 53:431-436. [PMID: 29457700 DOI: 10.1002/ppul.23950] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 12/21/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Medication adherence among adolescents with cystic fibrosis (CF) is often suboptimal and this has significant impact on their health and quality of life. The purpose of the study was to evaluate the impact of frequent home pulmonary function (PFT) monitoring on medication adherence among adolescents with CF. HYPOTHESIS We hypothesized that weekly home PFT monitoring will improve adherence while not significantly adding to the treatment burden. METHODS Individuals aged 12-21 years with CF were provided a spirometer to measure PFTs weekly for 1 year. Results were reviewed weekly via telephone. PFT data were downloaded from the device during quarterly clinic visits. Adherence was calculated from prescription refill data and compared to the previous year. Perceptions of treatment burden were assessed using the CF questionnaire-revised (CFQ-R) quality of life measure. Health outcome measures including nutritional status and PFTs from clinic were collected for the study period and the year prior. RESULTS Thirty-nine subjects participated in the study. Mean age was 15.89 ± 2.18 years and 54% were female. Mean adherence to weekly spirometry monitoring was 59.47 ± 24.60%. Values generated on the device showed good correlation with those obtained in clinic. Mean medication possession ratio (MPR) was 60% in the previous year and 65% during the study (P = 0.04). Mean treatment burden scaled score on the CFQ-R was 68 at enrollment and 66 at study completion (P = 0.14). CONCLUSIONS Frequent home PFT monitoring is feasible in CF adolescents and could successfully improve medication adherence without significantly impacting treatment burden.
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Lumeng JC, Miller AL, Appugliese D, Rosenblum K, Kaciroti N. Picky eating, pressuring feeding, and growth in toddlers. Appetite 2018; 123:299-305. [PMID: 29331364 PMCID: PMC5817026 DOI: 10.1016/j.appet.2017.12.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 12/16/2017] [Accepted: 12/17/2017] [Indexed: 10/18/2022]
Abstract
Several common theoretical frameworks have posited causal pathways between picky eating, pressuring feeding, and growth in early childhood. The evidence to support these pathways is limited. This observational cohort study sought to examine the cross-lagged associations between mother-reported pressuring feeding, mother-reported child picky eating, and measured weight-for-length z-score (WLZ) across child ages 21, 27, and 33 months (n = 244). Cross-lagged analysis was used to evaluate longitudinal associations between these three constructs. The sample was 50.5% white, 52.3% male and 37.8% of mothers had a high school education or less. Mean WLZ was 0.52, 0.41, and 0.38 at each age, respectively. Pressuring feeding, picky eating, and WLZ each tracked strongly from 21 to 33 months. There were concurrent associations between pressuring feeding and picky eating. However, there were no prospective associations between pressuring feeding and future WLZ; WLZ and future pressuring feeding; pressuring feeding and future picky eating; picky eating and future pressuring feeding; or picky eating and future WLZ. Our results do not support causal relationships between picky eating, pressuring feeding, and growth in toddlerhood. Future work that examines alternative mechanisms shaping growth in early childhood is needed.
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Shellhaas RA, Kenia PV, Hassan F, Barks JD, Kaciroti N, Chervin RD. Sleep-Disordered Breathing among Newborns with Myelomeningocele. J Pediatr 2018; 194:244-247.e1. [PMID: 29221695 PMCID: PMC5826838 DOI: 10.1016/j.jpeds.2017.10.070] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/13/2017] [Accepted: 10/30/2017] [Indexed: 01/11/2023]
Abstract
In a matched cohort study, we report that the apnea-hypopnea index is significantly higher in neonates with myelomeningocele (34 ± 22) compared with age-matched controls (19 ± 11; P = .021). Assessment of newborns with myelomeningocele for sleep-disordered breathing may facilitate early treatment; the impact on long-term neurodevelopment is unknown.
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Miller AL, Gearhardt AN, Fredericks EM, Katz B, Shapiro LF, Holden K, Kaciroti N, Gonzalez R, Hunter C, Lumeng JC. Targeting self-regulation to promote health behaviors in children. Behav Res Ther 2018; 101:71-81. [PMID: 29050636 PMCID: PMC5801044 DOI: 10.1016/j.brat.2017.09.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 09/15/2017] [Accepted: 09/25/2017] [Indexed: 01/10/2023]
Abstract
Poor self-regulation (i.e., inability to harness cognitive, emotional, motivational resources to achieve goals) is hypothesized to contribute to unhealthy behaviors across the lifespan. Enhancing early self-regulation may increase positive health outcomes. Obesity is a major public health concern with early-emerging precursors related to self-regulation; it is therefore a good model for understanding self-regulation and health behavior. Preadolescence is a transition when children increase autonomy in health behaviors (e.g., eating, exercise habits), many of which involve self-regulation. This paper presents the scientific rationale for examining self-regulation mechanisms that are hypothesized to relate to health behaviors, specifically obesogenic eating, that have not been examined in children. We describe novel intervention protocols designed to enhance self-regulation skills, specifically executive functioning, emotion regulation, future-oriented thinking, and approach bias. Interventions are delivered via home visits. Assays of self-regulation and obesogenic eating behaviors using behavioral tasks and self-reports are implemented and evaluated to determine feasibility and psychometrics and to test intervention effects. Participants are low-income 9-12 year-old children who have been phenotyped for self-regulation, stress, eating behavior and adiposity through early childhood. Study goals are to examine intervention effects on self-regulation and whether change in self-regulation improves obesogenic eating.
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Park BKD, Reed MP, Kaciroti N, Love M, Miller AL, Appugliese DP, Lumeng JC. shapecoder: a new method for visual quantification of body mass index in young children. Pediatr Obes 2018; 13:88-93. [PMID: 27900848 PMCID: PMC5447493 DOI: 10.1111/ijpo.12202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 08/19/2016] [Accepted: 10/17/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Few tools exist to quantify body mass index visually. OBJECTIVE To examine the inter-rater reliability and validity (sensitivity and specificity for overweight/obesity and obesity) of a three-dimensional visual rating system to quantify body mass index (BMI) in young children. METHODS Children (n = 242, mean age 5.9 years, 50.0% male; 40.5% overweight/ obese) participated in a videotaped protocol and weight and height were measured. Research staff applied a novel three-dimensional computer-based figure rating system (shapecoder) to the child's videotaped image. Inter-rater reliability was calculated, as well as correlation with measured body mass index (BMI) and sensitivity, specificity, positive predictive value and negative predictive value for overweight/obesity and obesity. RESULTS Inter-rater reliability was excellent (intraclass correlation coefficient = 0.98). The correlation of shapecoder-generated BMI with measured BMI was 0.89. For overweight/obesity, the sensitivity, specificity, positive predictive value and negative predictive value were 62%, 97%, 94% and 79% respectively. For obesity, these values were 65%, 99%, 97% and 92% respectively. CONCLUSION shapecoder provides a method to quantify child BMI from video images with high inter-rater reliability, fair sensitivity and good specificity for overweight/obesity and obesity. The approach offers an improvement over existing two-dimensional rating scales for BMI.
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Brook RD, Kaciroti N, Bakris G, Dahlöf B, Pitt B, Velazquez E, Weber M, Zappe DH, Hau T, Jamerson KA. Prior Medications and the Cardiovascular Benefits From Combination Angiotensin-Converting Enzyme Inhibition Plus Calcium Channel Blockade Among High-Risk Hypertensive Patients. J Am Heart Assoc 2018; 7:JAHA.117.006940. [PMID: 29301757 PMCID: PMC5778960 DOI: 10.1161/jaha.117.006940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background The ACCOMPLISH (Avoiding Cardiovascular Events Through Combination Therapy in Patients Living with Systolic Hypertension) trial demonstrated that combination therapy using amlodipine, rather than hydrochlorothiazide, in conjunction with benazepril provided greater cardiovascular risk reduction among high‐risk hypertensive patients. Few trials have evaluated the effect of prior antihypertensive therapy used among participants on the study outcomes. Methods and Results In a post hoc observational analysis, we examined the characteristics of the drug regimens taken before trial enrollment in the context of the primary composite outcome (death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, hospitalization for angina, resuscitation after sudden cardiac death, and coronary revascularization). In the “primary subgroup” (n=4475), patients previously taking any renin‐angiotensin system blockade plus either a diuretic or a calcium channel blocker alone or as part of their antihypertensive regimen, there were 206 of 2193 (9.4%) versus 281 of 2282 (12.3%) primary composite events among those randomized to combination therapy involving amlodipine versus hydrochlorothiazide, respectively (adjusted Cox proportional hazard ratio, 0.74; 95% confidence interval, 0.62–0.89; P=0.0015). All other participants (n=6975) previously taking any antihypertensive regimen not included in the primary subgroup also benefited from randomization to amlodipine plus benazepril (adjusted hazard ratio, 0.84; 95% confidence interval, 0.72–0.98; P=0.024). Outcomes among most other subgroups, including patients previously taking lipid‐lowering medications or dichotomized by prior blood pressure control status, showed similar results. Conclusions When combined with an angiotensin‐converting enzyme inhibitor, amlodipine provides cardiovascular risk reduction superior to hydrochlorothiazide, largely regardless of prior medication use. These findings add further support for the initial use of this combination regimen among high‐risk hypertensive patients.
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Horodynski MA, Brophy-Herb HE, Martoccio TL, Contreras D, Peterson K, Shattuck M, Senehi N, Favreau Z, Miller AL, Sturza J, Kaciroti N, Lumeng JC. Familial psychosocial risk classes and preschooler body mass index: The moderating effect of caregiver feeding style. Appetite 2017; 123:216-224. [PMID: 29287633 DOI: 10.1016/j.appet.2017.12.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 12/15/2017] [Accepted: 12/21/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Early child weight gain predicts adolescent and adult obesity, underscoring the need to determine early risk factors affecting weight status and how risk factors might be mitigated. Socioeconomic status, food insecurity, caregiver depressive symptomology, single parenthood, and dysfunctional parenting each have been linked to early childhood weight status. However, the associations between these risk factors and children's weight status may be moderated by caregiver feeding styles (CFS). Examining modifiable factors buffering risk could provide key information to guide early obesity intervention efforts. METHODS This analysis used baseline data from the Growing Healthy project that recruited caregivers/child dyads (N = 626) from Michigan Head Start programs. Caregivers were primarily non-Hispanic white (62%) and African American (30%). After using latent class analysis to identify classes of familial psychosocial risk, CFS was tested as a moderator of the association between familial psychosocial risk class and child body mass index (BMI) z-score. RESULTS Latent class analysis identified three familial psychosocial risk classes: (1) poor, food insecure and depressed families; (2) poor, single parent families; and (3) low risk families. Interactive effects for uninvolved feeding styles and risk group indicated that children in poor, food insecure, and depressed families had higher BMI z-scores compared to children in the low risk group. Authoritative feeding styles in low risk and poor, food insecure, and depressed families showed lower child BMI z-scores relative to poor, single parent families with authoritative feeding styles. CONCLUSIONS Uninvolved feeding styles intensified the risk and an authoritative feeding style muted the risk conferred by living in a poor, food-insecure, and depressed family. Interventions that promote responsive feeding practices could help decrease the associations of familial psychosocial risks with early child weight outcomes.
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Gearhardt AN, Miller AL, Sturza J, Epstein LH, Kaciroti N, Lumeng JC. Behavioral Associations with Overweight in Low-Income Children. Obesity (Silver Spring) 2017; 25:2123-2127. [PMID: 29071792 PMCID: PMC5743329 DOI: 10.1002/oby.22033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 08/28/2017] [Accepted: 09/06/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Food reinforcement (relative reinforcement value [RRV]), self-control (the ability to delay gratification [ATDG]), and eating outside of homeostatic need (eating in the absence of hunger [EAH]) are associated with overweight/obesity. These constructs have typically been studied in isolation in children, and little is known about how they interrelate and whether these associations differ by sex. The objective of this study is to investigate these associations by sex. METHODS In a low-income sample of 230 7- to 10-year-old children, RRV, ATDG, and EAH were assessed. The model showing that elevated RRV, lower ATDG, and greater EAH are each independent, direct predictors of overweight in middle childhood was separately tested by sex. It was predicted that greater RRV and less ATDG would also have indirect effects on overweight through EAH. The association between RRV and ATDG was investigated. RESULTS For girls, higher RRV was indirectly associated with overweight through EAH. For boys, no associations of RRV, ATDG, or EAH with overweight were significant. Finally, for girls, RRV and ATDG were significantly positively associated. CONCLUSIONS In girls, higher food reinforcement appears to be an important contributor to overweight. During middle childhood, ATDG may be assessing food reinforcement rather than self-control. Future studies are needed to identify the mechanisms underlying childhood overweight in boys.
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