Sugar, stress, and the Supplemental Nutrition Assistance Program: early childhood obesity risks among a clinic-based sample of low-income Hispanics

Contributions of subjective status to eating behaviors, obesity, and metabolic health across development

Subjective status is the evaluation of one's social or socioeconomic status relative to others. Lower subjective status has been associated with risk of overweight/obesity, poorer metabolic health, and obesogenic food preferences and eating behaviors. However, these findings are predominantly based on studies of adolescents and young adults. This indicates major gaps in knowledge and application of this social determinant of obesity and metabolic health, given that perceived status develops throughout the life course along with food environments and eating habits. Here, we review the relationships that subjective status shares with the outcomes of eating behaviors, obesity, and metabolic health across milestones and periods of development: during the prenatal period, as caregivers who feed children, during childhood (prior to age 10) and from adolescence into emerging adulthood (until mid-20's). For each developmental period, we explore why the period critically contributes to these outcomes and how subjective status may affect eating behaviors and metabolic health. We propose that subjective status contributes to eating/feeding behaviors and metabolic health both within and across developmental periods, such that the effect of low subjective status at an earlier period may contribute to obesogenic eating behaviors and metabolic health in later developmental periods and intergenerationally. The influence of low subjective status on higher body weight may also threaten subjective status later in development through heightened vulnerability to social stressors, such as weight-based stigma. Overall, subjective status may be a broadly influential factor to consider when examining social determinants of obesity and metabolic health across development.

Lessons on food security from the COVID-19 pandemic in Bermuda

Compared with other OECD countries, Bermuda ranks third globally in terms of income inequality globally. During the COVID-19 pandemic, anecdotal evidence suggested, significant fluctuations in the food demand and supply. We aimed to examine the impact of the COVID-19 pandemic on food insecurity, with a focus on the availability and affordability of various foods in Bermuda. We utilized a cross-sectional study design to investigate potential drivers of food insecurity within the local population. To gauge the level of household food insecurity we relied on the Bermuda Omnibus survey (N = 400) undertaken by Total Research Associates Ltd via telephone. To assess changes in food availability and affordability we conducted semi-structured interviews with key stakeholders who played pivotal roles in shaping food accessibility availability and affordability of food in Bermuda. These interviews were systematically analysed using the framework method. We performed analyses of food retail and import data to evaluate fluctuations in food prices and their impact on food availability and affordability. We found statistically significant associations between changes in food consumption, household income, and government aid. Food aid beneficiaries ate fewer fruits and vegetables by 50% [95% CI:17%-83%] and less fresh meat and fish by 39% [95 CI:3%-75%] compared with residents who did not receive any aid during the COVID-19 period from March 2020 to March 2021. Although we did not identify statistically significant food price increases feeding programmes played a pivotal role in preventing food insecurity during the pandemic in Bermuda. However, a lack of monitoring regarding the nutritional quality within the programmes, allowed a wide availability of foods high in sugar, salts, and fats, disproportionately affected low-income populations. In conclusion, food availability in Bermuda remained largely unaffected during the pandemic. Nevertheless, the surge in demand for feeding programs underscores underlying food security challenges in Bermuda and warrants further attention.

Associations of Maternal Consumption of Sugary Beverages in Pregnancy With Infant Weight Status

OBJECTIVES

To examine associations of maternal consumption of 100% juice and sugar-sweetened beverages (SSBs) in the third trimester of pregnancy with infant weight status at 6 and 12 months.

METHODS

We studied 379 mother-infant dyads from Rise & SHINE, a prospective cohort study. Exposures were maternal consumption of 100% juice and SSBs in the third trimester. Outcome measures were infant weight-for-length (WFL) z-scores at 6 and 12 months and rapid infant weight gain (RIWG; change in weight-for-age z-score ≥0.67) from birth to 6 and 12 months.

RESULTS

Mean (SD) maternal age was 32.8 (5.1) years; 71.7% reported household income ≥$50,000. In the third trimester, nearly daily or daily consumption of 100% juice and SSBs was 25.9% and 16.6%, respectively. Mean (SD) WFL z-scores at 6 and 12 months were 0.35 (0.96) and 0.50 (0.98). RIWG was present in 30.2% and 36.6% of infants from birth to 6 months and birth to 12 months, respectively. In multivariable models, 100% juice consumption was associated with higher WFL z-score at 6 months (β = 0.26; 95% confidence interval [CI]: 0.03, 0.49) and higher odds of RIWG from birth to 6 months (adjusted odds ratio [aOR] = 2.09; 95%CI: 1.23, 3.56) and birth to 12 months (aOR = 1.85; 95%CI: 1.04, 3.28). 100% juice consumption was not associated with WFL z-score at 12 months and SSB consumption was not associated with any of the outcomes.

CONCLUSIONS

Consumption of 100% juice, but not SSBs, in the third trimester of pregnancy is associated with infant weight status at 6 months and RIWG.

A mixed-method systematic review and meta-analysis of the influences of food environments and food insecurity on obesity in high-income countries

Obesity remains a serious public health concern in rich countries and the current obesogenic food environments and food insecurity are predictors of this disease. The impact of these variables on rising obesity trends is, however, mixed and inconsistent, due to measurement issues and cross-sectional study designs. To further the work in this area, this review aimed to summarize quantitative and qualitative data on the relationship between these variables, among adults and children across high-income countries. A mixed-method systematic review was conducted using 13 electronic databases, up to August 2021. Two authors independently extracted data and evaluated quality of publications. Random-effects meta-analysis was used to estimate the odds ratio (OR) for the association between food insecurity and obesity. Where statistical pooling for extracted statistics related to food environments was not possible due to heterogeneity, a narrative synthesis was performed. Meta-analysis of 36,113 adults and children showed statistically significant associations between food insecurity and obesity (OR: 1.503, 95% confidence interval: 1.432-1.577, p < .05). Narrative synthesis showed association between different types of food environments and obesity. Findings from qualitative studies regarding a reliance on energy-dense, nutrient-poor foods owing to their affordability and accessibility aligned with findings from quantitative studies. Results from both qualitative and quantitative studies regarding the potential links between increased body weight and participation in food assistance programs such as food banks were supportive of weight gain. To address obesity among individuals experiencing food insecurity, wide-reaching approaches are required, especially among those surrounded by unhealthy food environments which could potentially influence food choice.

The relation between prenatal stress, overweight and obesity in children diagnosed according to BMI and percentage fat tissue

BACKGROUND

One of the environmental factors contributing to abnormal weight changes in children may be maternal exposure to adverse environmental factors during pregnancy, which in previous studies led to inconclusive results showing both overweight or obesity and underweight in children. The aim of the study was to assess the influence of prenatal stress on the BMI status and cut-off points for the percentage of fat content.

METHODS

The cohort study included 254 girls and 276 boys. Information on prenatal stress was collected retrospectively with a questionnaire on objective adverse events completed by a parent/guardian of a 6-12-year-old child. We examined the body weight of children and performed an electrical bioimpedance analysis of their body composition. We assessed the BMI status according to the International Obesity Task Force (IOTF) criterion and on the basis of body fat according to McCarthy criterion.

RESULTS

The results of our study show that the prenatal stress was related to increased risk of overweight (OR 2.14, 95% CI: 1.25-3.65) diagnosed on the basis of body fat cut-off points, but not when the BMI was a diagnostic criterion (OR 1.03, 95% CI: 0.58-1.83).

CONCLUSION

The method of diagnosis based on the fat content appears to be an indicator of the occurrence of abnormalities in body composition due to prenatal stress more sensitive than that based on the BMI.

LEVEL OF EVIDENCE

Level III evidence obtained from well-designed cohort or case-control analytic studies.

Contributing Factors of Sugar-Sweetened Beverage Intake in the Latinx Population: A Narrative Review Using the Social-Ecological Model

Sugar-sweetened beverage (SSB) consumption in the Latinx population has been a topic of increasing interest due to higher rates of consumption in this population, as well as higher prevalence of chronic health conditions, such as diabetes and obesity. SSB behaviors are influenced by multiple factors across the socio-ecological model. Understanding these factors can inform future intervention development and improve SSB consumption and overall health. Therefore, this narrative review identifies factors contributing to SSB consumption, as well as interventions conducted to address SSB consumption in the Latinx population residing in the United States. Contributing factors that are not currently addressed in published interventions are highlighted with the intent to inform the development of future comprehensive interventions.

High sugar content and body mass index: modelling pathways around the first 1000 d of life, BRISA cohort

OBJECTIVE

Few studies are focused on sugar consumption around the first 1000 d of life. Thus, this work modelled the pathways linking the consumption of sugary drinks in pregnancy and maternal pre-gestational BMI to early child’s exposure to products with high sugar content and to BMI z-score in the second year of life.

DESIGN

BRISA cohort, São Luís, Brazil was used from the baseline to the follow-up at the second year of life.

SETTING

A theoretical model was constructed to analyse associations between variables from prenatal period (socio-economic status, age, frequency of sugary drinks consumption during pregnancy and pre-gestational BMI), birth weight, exclusive breast-feeding and two outcomes: higher calories from products with added sugar as a percentage of the total daily energy intake and BMI z-score at follow-up at the first 2 years of life, using structural equation modelling.

PARTICIPANTS

Data of pregnant women (n 1136) and their offspring.

RESULTS

Higher pre-gestational BMI (standardised coefficient (SC) = 0·100; P = 0·008) and higher frequency of sugary drinks consumption during pregnancy (SC = 0·134; P < 0·001) resulted in high percentage of daily calories from products with added sugar in the second year of child, although no yet effect was observed on offspring weight at that time.

CONCLUSIONS

Maternal obesity and sugary drinks consumption in pregnancy increased the risk of early exposure (before to 2 years) and high exposure of child to added sugar, showing perpetuation of the unhealthy dietary behaviours in the first 1000 d of life.

A systematic review examining the relationship between food insecurity and early childhood physiological health outcomes

Food insecurity, or limited access to nutritious foods, is a significant public health concern especially among vulnerable populations including infants and young children in low-income households. While literature to date has thoroughly examined the psychological and behavioral impacts of food insecurity on children, no known study to date has specifically synthesized the literature exploring the relationship between food insecurity and physiological health outcomes during early childhood. The purpose of this study was to review the literature on physiological health outcomes associated with food insecurity during early childhood among children aged 0-5 years in developed countries. Our literature search sources included PubMed, PsycInfo, CINAHL, and Embase databases. A total of 657 articles published up to September 2019 were reviewed for eligibility by two coders, with a third reviewer in cases of disagreement. Eighty-three articles remained after screening by abstract, with a final 27 studies ultimately included in the final synthesis. This review is registered with PROSPERO and adhered to PRISMA guidelines. In total, 20 articles (74%) noted significant relationships between food insecurity and physiological health outcomes in young children. Findings included an association with overweight or obesity (n = 9), anemia (n = 3), poor child health (n = 3), low birth weight (n = 3), chronic illness (n = 1), special health care needs (n = 1), and increased cortisol (n = 1), in young children who experience food insecurity. Identifying relationships between food insecurity and health outcomes during early childhood has the potential to inform future prevention interventions to reduce health disparities in these vulnerable populations.

Climate change is a major stressor causing poor pregnancy outcomes and child development

The climate crisis is the existential threat of our times and for generations to come. This is no longer a threat but a reality affecting us, our children, and the generations that follow. Pregnant mothers, their fetuses, and their children are among those at greatest risk in every population and every jurisdiction. A timely consideration is the health of racialized groups who are particularly vulnerable owing to the confluence of several risk factors that are compounded by climate change. Included among these are Indigenous communities that are the most directly threatened by climate change. This review discusses the main health challenges faced by mothers, fathers, and their children during the climate crisis, focusing on mental health as a causal factor. Exploration of this topic includes the role of prenatal maternal and paternal stresses, allostatic load, and the effect of degradation of the environment and ecosystems on individuals. These will be examined in relation to adverse pregnancy outcomes and altered developmental trajectories of children. The climate crisis is a health threat multiplier that amplifies the health inequities of the most at-risk populations and individuals. It accelerates the increase in allostatic load of those at risk. The path of tragedy begins with an accumulating allostatic load that overwhelms both individual and socio-ecological resilience. This can lead to worse mental health including depression and anxiety and, in the case of pregnant women and their children, more adverse pregnancy outcomes and impaired developmental trajectories for their newborn children. We argue that there is an urgent need to develop new (or re-discover or re-purpose existing) tools that will predict communities and individuals who are experiencing the highest levels of climate-related hazards and intervene to reduce stress and increase resilience in pre-conceptual women and men, pregnant and post-partum women, and their young children.

An Ecological Approach to Obesity in Mexican American Children

INTRODUCTION

The objective of this study was to explore the risk factors that contribute to obesity in Mexican American children compared with Mexican American normal weight children. No hypotheses were tested in the study. When risk factors are known, nurses can use evidence to reduce risky behavior.

METHOD

A cross-sectional descriptive design was used, comparing two groups of children to discern the risk factors for obesity. The setting is a county in South Texas along the border with Mexico. The sample consisted of 55 Mexican American dyads (mother-child). The following measures, based on the Ecological Model of Growth, were used to collect data: anthropometrics, dietary data of children, home environment, perceived stress of mother, and maternal acculturation. Independent sample t tests, chi-square tests, Fisher exact tests, and a hierarchical logistic regression analysis were used to analyze the data.

RESULTS

The findings show children's age and maternal body mass index (BMI) are positively correlated with childhood obesity, as measured by BMI percentile by age/sex. There were significant differences in the host and agent factors of prolonged bottle feeding, amount of outdoor play, and fruit drinks between normal weight and obese children.

DISCUSSION

Engagement and involvement of other family members in outdoor activities, nutrition/feeding, and child care may mitigate the negative effects of host and agent factors on child body size.

Maternal stress in the first 1000 days and risk of childhood obesity: a systematic review

Objective: Maternal stress is associated with adverse child outcomes. Conception to 2-years postpartum (the first 1000 days) is a developmentally sensitive period for stress exposure. The role of maternal stress in the first 1000 days on child obesity risk is unclear. This review systematically examines the relationship between maternal stress across the first 1000 days and child obesity risk. Methods: The Cochrane Library, MEDLINE, PsycINFO, EMBASE, CINAHL, and Maternity and Infant Care were searched from inception to June 2018. Eligible studies included women who experienced maternal stress in the first 1000 days; an included a measure of maternal stress and of child anthropometrics. Results: Sixteen studies met inclusion criteria, the majority of these examined prenatal stress exposure. Inconsistent effects were observed for psychological and physiological stress responses, on child weight outcomes. Environmental stress exposures, including natural disaster and bereavement, were more consistently associated with increased obesity risk. Conclusion: This review does not provide support for the effects of psychological or physiological maternal stress on child weight outcomes; there is some evidence of associations between environmental stress exposures and greater childhood adiposity. Variation in conceptualisation and measurement of stress, timing of stress exposure, and limited examination of stress-related behaviours were noted.

Sugar sweetened beverage consumption during pregnancy is associated with lower diet quality and greater total energy intake

OBJECTIVE

Identify the socio-economic correlates of sugar sweetened beverage (SSB) consumption among pregnant women and analyze to what extent SSB consumption is associated with diet quality and total energy intake. Additionally, we aim to predict how diet quality scores and totally energy intakes would change if SSB consumption was artificially set to 0.

DESIGN

Repeated Cross Sectional Study.

SETTING

United States.

SUBJECTS

SSB consumption was estimated from 1-2 24-hour dietary recalls from 1,154 pregnant women who participated in the 1999-2006 National Health and Nutrition Examination Survey.

METHODS

Linear regression models were used to identify socioeconomic and demographic factors associated with SSB consumption and to assess the associations between SSB consumption and diet quality and total energy intake. Diet quality was measured with the Alternate Healthy Eating Index modified for Pregnancy (AHEI-P).

RESULTS

The mean SSB intake was 1.3 servings per day (sd 1.5). Having a household income ≤100% of the Federal Poverty Level, being born in the United States, and not being married or living with a partner were positively associated with SSB consumption. Every 12 oz. of SSBs consumed was associated with a 2.3 lower AHEI-P score (95% CI: 1.6, 2.9) and the consumption of 124 more calories (95% CI: 85, 163), after adjusting for age, country of birth, race/ethnicity, educational attainment, marital status, household income, survey year and day/s of the week the recall/s were collected. Our predictive models indicated that average AHEI-P would be 6.4 (5.4, 7.6) higher and average total energy intakes would be 203.5 calories (122.2, 284.8) lower if SSB intake was set to 0.

CONCLUSIONS

SSB consumption is associated with poorer diet quality and higher total energy intake among pregnant women.

Increases in Sugary Drink Marketing During Supplemental Nutrition Assistance Program Benefit Issuance in New York

INTRODUCTION

The Supplemental Nutrition Assistance Program (SNAP) is the largest federal food assistance program, providing $67 billion in benefits to 44 million Americans. Some states distribute SNAP benefits over one or a few days each month, which may create an incentive for retailers to heavily promote top-selling products, like sugar-sweetened beverages, when benefits are disbursed.

METHODS

A beverage environment scan assessing presence of displays, advertisements, and price promotions for sugar-sweetened, low-calorie, and unsweetened beverages was administered in a census of SNAP-authorized beverage retailers (n=630) in three cities in New York from September to November 2011. Multilevel regression models controlling for store type; county; and percentage SNAP enrollment, poverty, and non-Hispanic white population in the store's census tract were used to estimate the odds of in-store beverage marketing during the SNAP benefit issuance period compared to other days of the month. Data were analyzed in 2016.

RESULTS

There were higher odds of in-store sugar-sweetened beverage marketing during SNAP benefit issuance days (first to ninth days of the month) compared with other days of the month, particularly for sugar-sweetened beverage advertisements (OR=1.66, 95% CI=1.01, 2.72) and displays (OR=1.88, 95% CI=1.16, 3.03). In census tracts with high SNAP enrollment (>28%), the odds of a retailer having sugar-sweetened beverage displays were 4.35 times higher (95% CI=1.93, 9.98) during issuance compared with non-issuance days. There were no differences in marketing for low-calorie or unsweetened beverages.

CONCLUSIONS

Increases in sugar-sweetened beverage marketing during issuance may exacerbate disparities in diet quality of households participating in SNAP. Policy changes, like extending SNAP benefit issuance, may mitigate these effects.

Beverage Intake During Pregnancy and Childhood Adiposity

OBJECTIVES

To examine associations of sugar sweetened beverages (SSBs) and other beverage intake during pregnancy with adiposity in midchildhood (median age of 7.7 years).

METHODS

We studied 1078 mother-child pairs in Project Viva, a prospective prebirth cohort study. Exposures were sugary and nonsugary beverage intake assessed in the first and second trimesters of pregnancy by using a food frequency questionnaire. Main outcome measures were offspring overall adiposity (BMI z score, fat mass index [FMI, kg/m²] from dual-energy radiograph absorptiometry, and sum of subscapular [SS] and triceps [TR] skinfold thicknesses) and central adiposity (SS:TR ratio and waist circumference).

RESULTS

In the second trimester, mean (SD) SSB intake was 0.6 (0.9) servings per day. Thirty-two percent of mothers were multiracial or people of color, 68% were college graduates, and 10% smoked during pregnancy. In midchildhood, mean (SD) BMI z score was 0.38 (1.00), and the FMI was 4.4 (1.9) kg/m². In multivariable models adjusted for multiple maternal and child covariates, each additional serving per day of SSB was associated with higher BMI z scores (0.07 U; 95% confidence interval [CI]: -0.01 to 0.15), FMI (0.15 kg/m²; 95% CI: -0.01 to 0.30), SS + TR (0.85 mm; 95% CI: 0.06 to 1.64), and waist circumference (0.65 cm; 95% CI: 0.01 to 1.28). Stratified models suggested that the associations were due primarily to maternal, not child, SSB intake and to sugary soda rather than fruit drinks or juice. We did not find differences between boys and girls, nor did we observe the effects of sugar-free soda or of first-trimester beverage intake.

CONCLUSIONS

Higher SSB intake during the second trimester of pregnancy was associated with greater adiposity in midchildhood.

A scoping review of epidemiologic risk factors for pediatric obesity: Implications for future childhood obesity and dental caries prevention research

RESEARCH QUESTIONS

What are the non-modifiable (socioeconomic, genetic) and modifiable factors (physical activity, dietary behaviors) related to childhood (under age 12) obesity? How can this knowledge be applied to oral health professionals' efforts to prevent or manage dental caries in children?

OBJECTIVES

Studies have identified risk factors for childhood obesity. The purpose of this scoping review was to develop a conceptual model to identify non-modifiable and modifiable risk factors for childhood obesity and to illustrate how these findings are relevant in developing interventions aimed at preventing obesity and dental caries in children.

METHODS

The authors searched PubMed and Embase and limited the study to English-language publications. A total of 2,572 studies were identified. After de-duplication, 2,479 studies remained and were downloaded into a citation-management tool. Two authors screened the titles and abstracts for relevance. Two hundred and sixty studies remained and were retrieved for a full-text review, and 80 studies were excluded, resulting in 180 studies included in the scoping review. An inductive content analytic methods was used to organize all statistically significant obesity risk factors into seven domains, which were classified as non-modifiable or modifiable; then a conceptual model of common risk factors associated with childhood obesity and dental caries was developed.

RESULTS

Non-modifiable obesity risk factors include biological and developmental (e.g., genes, developmental conditions, puberty), sociodemographic and household (e.g., race/ethnicity, socioeconomic status, parent education, unemployment), cultural (e.g., degree of acculturation), and community (e.g., neighborhood composition). Modifiable risk factors included behavioral (e.g., diet, physical activity, weight), psychosocial (e.g., maternal stress, family functioning, parenting practices, child temperament), and medical (e.g., parent smoking, maternal health, child health).

CONCLUSIONS

Identifying common risk factors has important implications for future oral health research aimed at preventing childhood obesity and dental caries. Epidemiologic knowledge gleaned from the literature can be used to develop rigorous interventions and programs aimed at preventing these highly prevalent diseases and improving health outcomes for children.

Home Environmental Influences on Childhood Obesity in the Latino Population: A Decade Review of Literature

Latinos are the largest and fastest-growing ethnically diverse group in the United States. Latino children are also among the most overweight and obese ethnic groups of children in the United States. Research over the last decade has identified the home environment as a key influence on the diet and physical activity of children. To summarize cross-sectional and longitudinal research that has identified factors within the home environment of Latino families that are associated with childhood obesity and to provide recommendations for future research and intervention development with Latino families. A decade review from 2005 to 2015 was conducted. Studies identifying factors within the home environments of Latino families that were associated with childhood obesity were examined. Five main factors were identified across the literature as home environment factors that are associated with childhood obesity in Latino children. These factors included: parental influences (e.g., parent feeding practices, modeling), screen time, physical activity/sedentary behavior, socioeconomic status/food security and sleep duration. The current review identified several home environment factors that may contribute to the disparities in childhood obesity for Latino children. Results from this review such as, focusing on decreasing controlling parent feeding practices, and increasing parent modeling of healthy behaviors and child sleep duration, can be used in developing culturally-specific interventions for Latino children.

Pregnant women's cognitive appraisal of a natural disaster affects their children's BMI and central adiposity via DNA methylation: Project Ice Storm

We determined the extent to which DNA methylation mediates the effects of maternal cognitive appraisal of a natural disaster during pregnancy on offspring growth at age 13. Negative maternal cognitive appraisal predicted both lower BMI and central adiposity via DNA methylation of diabetes-related genes, suggesting a protective role of epigenetics.

Primary Care Interventions to Reduce Childhood Obesity in Latino Families

INTRODUCTION

Increasing rates of obesity in Latino children call for culturally sensitive primary care interventions. Despite recent efforts to address this growing disparity, little is known about cultural variables that influence obesity management programs in Latino children.

METHODS

A literature search was conducted using CINHAL, Scopus, PubMed, and PsycINFO to review the state of the science regarding primary care interventions to decrease obesity in Latino children. The author analyzed the effects of several cultural practices on obesity and made recommendations based on their clinical implications for weight reduction management programs.

RESULTS

Obesity in Latino children is a multifactorial problem influenced by family behaviors, cultural perceptions of weight and health, traditional dietary norms, and socioeconomic status. Current practice lags behind national obesity management recommendations and is further hindered by a lack of consideration of the roles of key cultural differences in Latino families.

DISCUSSION

It is imperative to recognize the importance of family preferences and culture when developing weight reduction programs so as to foster long-term behavior changes. More research assessing the efficacy of culturally competent interventions is necessary to guide national efforts to address this increasing disparity.

Impact of Food Assistance Programs on Obesity in Mothers and Children: A Prospective Cohort Study in Peru

OBJECTIVES

To assess obesity risk among mothers participating in Community Kitchens and children participating in Glass of Milk (Peru food assistance programs).

METHODS

We analyzed prospective data from the Young Lives study. The exposure consisted in varying degrees of benefit from any of the programs (no participation in any of the programs, program participation for some months, or program participation nearly every month) at baseline (2006-2007). The outcome was overweight and obesity in mothers and children at follow-up (2009-2010).

RESULTS

Prevalence of childhood overweight and obesity was 15.5% and 5.1%, respectively; the corresponding figures for mothers were 40.5% and 14.6%. Children exposed nearly every month to the Glass of Milk program had a 65% lower risk of becoming obese compared with children not participating in the program (relative risk [RR] = 0.35; 95% confidence interval [CI] = 0.18, 0.66). Mothers participating frequently in the Community Kitchens program had almost twice the risk of becoming obese compared with those who did not participate (RR = 1.93; 95% CI = 1.18, 3.15).

CONCLUSIONS

Participating in food assistance programs in Peru was associated with a lower risk of obesity in children and greater risk of obesity in mothers.

Rebound Body Mass Index Growth in Year-Round Elementary Education Students of Largely Hispanic Descent Undergoing Obesity Interventions

BACKGROUND

Body mass index (BMI) increases when students are away on summer vacation. Evaluation of serial BMI measurements on year-round students allows new insight into the reasons children gain weight seasonally.

METHODS

The 206 first and second graders of 2-year-round elementary schools with obesity intervention programs were weighed and measured every 6 months from April 2011 until April 2013. BMI and BMI percentiles were recorded.

RESULTS

Children <50th, 50th to 85th, and 85th to 95th BMI percentiles showed significant accelerated winter gains in BMI (p = 2.6 × 10(-7), p = 6.8 × 10(-10), and p = .0007, respectively) compared with the previous summers. Accelerated BMI growth of the second summer was absent when compared with the previous winter BMI changes in children <95th percentile (p = .48, p = .81, and p = .93). For children >95th percentile, BMI gain continued without significant changes year-round.

CONCLUSIONS

School-wide interventions to induce BMI growth limitations are associated with significant rebound BMI gain with possible wintertime augmentation in nonobese children of year-round education programs. Obese children do not display rebound BMI gain, BMI seasonal change, or BMI limitations in response to school-based interventions. School weight control programs should consider off-campus sources of weight gain and be vigilant for rebound and delayed seasonal BMI gains.

Effects of parent and child behaviours on overweight and obesity in infants and young children from disadvantaged backgrounds: systematic review with narrative synthesis

Background

Despite the crucial need to develop targeted and effective approaches for obesity prevention in children most at risk, the pathways explaining socioeconomic disparity in children’s obesity prevalence remain poorly understood.

Methods

We conducted a systematic review of the literature that investigated causes of weight gain in children aged 0–5 years from socioeconomically disadvantaged or Indigenous backgrounds residing in OECD countries. Major electronic databases were searched from inception until December 2015. Key words identified studies addressing relationships between parenting, child eating, child physical activity or sedentary behaviour and child weight in disadvantaged samples.

Results

A total of 32 articles met the inclusion criteria. The Mixed Methods Appraisal Tool quality rating for the studies ranged from 25 % (weak) to 100 % (strong). Studies predominantly reported on relationships between parenting and child weight (n = 21), or parenting and child eating (n = 12), with fewer (n = 8) investigating child eating and weight. Most evidence was from socio-economically disadvantaged ethnic minority groups in the USA. Clustering of diet, weight and feeding behaviours by socioeconomic indicators and ethnicity precluded identification of independent effects of each of these risk factors.

Conclusions

This review has highlighted significant gaps in our mechanistic understanding of the relative importance of different aspects of parent and child behaviours in disadvantaged population groups.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2801-y) contains supplementary material, which is available to authorized users.

Low-Income Immigrant Hispanic Mothers' Concerns and Perceptions of Their Young Child's Weight

OBJECTIVES

To describe how low-income Hispanic immigrant mothers' concerns and perceptions of her child's health, along with her concerns for herself becoming overweight, relate to her (a) concerns that her child will become overweight and (b) underestimation of her child's weight status.

DESIGN AND SAMPLE

Cross-sectional survey and direct body composition assessments were collected among 96 low-income Hispanic mothers and their young children from Houston-area community centers.

MEASURES

Data were collected on maternal concerns and perceptions of child's weight and health, concerns about her own weight, demographic characteristics, and measured child's height and weight.

RESULTS

Fifty-four percent of mothers with an overweight/obese child perceived their child was "about the right weight." Mothers concerned with becoming overweight themselves had 3 times higher odds of being concerned that her child would become overweight (OR = 3.01, p < .01). Mothers who perceived their child as less healthy had approximately 2 times higher odds of underestimating their child's weight (OR = 1.86, p < .01).

CONCLUSIONS

Short screeners that focus on maternal concerns about herself and her child becoming overweight, along with perceptions of her child's health and weight status, may assist nurses in effectively tailoring their health message at point of care.

Dietary Quality of Americans by Supplemental Nutrition Assistance Program Participation Status: A Systematic Review

CONTEXT

The Supplemental Nutrition Assistance Program (SNAP) is an effective component in reducing food insecurity in the U.S. In the discussion of strategies to also help SNAP participants maximize diet quality, it is important to know their current dietary patterns and food choices. This paper provides a systematic review of recent U.S. studies on dietary quality, food consumption, and spending among SNAP participants as compared to income-eligible and higher-income nonparticipants.

EVIDENCE ACQUISITION

The review, completed in 2014, summarized studies that were peer-reviewed, published between January 2003 and August 2014, and provided data on dietary quality and intake of SNAP participants and nonparticipants.

EVIDENCE SYNTHESIS

Twenty-five studies were included in this review. Daily caloric, macronutrient, and micronutrient intake of SNAP participants did not differ systematically from those of income-eligible nonparticipants; however, differences in dietary quality emerged. Adult SNAP participants scored lower on the Healthy Eating Index than either group of nonparticipants. Children's diets were similar among SNAP participants and low-income nonparticipants, but were less nutritious than diets of higher-income children. The evidence regarding sugar-sweetened beverage consumption was mixed, with most studies indicating significantly higher beverage intake among SNAP participants compared with higher-income nonparticipants, but no difference compared to income-eligible nonparticipants.

CONCLUSIONS

SNAP effectively alleviates food insecurity in terms of caloric, macronutrient, and micronutrient intake. Still, SNAP participants are struggling more than income-eligible and higher-income nonparticipants to meet key dietary guidelines. Future policies should ensure that this vital food assistance program addresses diet quality while reducing food insecurity.

Farmers' market shopping and dietary behaviours among Supplemental Nutrition Assistance Program participants

OBJECTIVE

Because farmers' markets include a variety of fruits and vegetables, shopping at farmers' markets would likely improve diet quality among low-income consumers, as well as promote sustainable direct farm-to-consumer business models. However, not much is known about how to promote farmers' market shopping among low-income consumers. Therefore, the purpose of the present paper was to examine barriers to and facilitators of shopping at farmers' markets and associations between shopping at farmers' markets and self-reported dietary behaviours (fruit and vegetable, sugar-sweetened beverage and fast-food consumption) and BMI.

DESIGN

Cross-sectional analyses of associations between farmers' market shopping frequency, awareness of markets, access to markets, dietary behaviours and BMI.

SETTING

Department of Social Services, Pitt County, eastern North Carolina, USA.

SUBJECTS

Between April and July 2013, Supplemental Nutrition Assistance Program (SNAP) participants (n 205) completed a quantitative survey.

RESULTS

Barriers to shopping at farmers' markets included does not accept SNAP/electronic benefit transfer, out of the way and lack of transportation. Farmers' market shopping was associated with awareness of farmers' markets (estimate =0·18 (se 0·04), P<0·001). Fruit and vegetable consumption was positively associated with farmers' market shopping (estimate =1·06 (se 0·32), P=0·001).

CONCLUSIONS

Our study is one of the first to examine SNAP participants' farmers' market shopping, distance to farmers' markets and dietary behaviours. Barriers to shopping at farmers' markets and increasing awareness of existing markets should be addressed in future interventions to increase SNAP participants' use of farmers' markets, ultimately improving diet quality in this high-risk group.

A Primary Care-Based Early Childhood Nutrition Intervention: Evaluation of a Pilot Program Serving Low-Income Hispanic Women

Nutrition in early childhood can significantly impact physical and mental health outcomes for children. However, research on broadly defined pre/postnatal nutrition interventions is sparse. The present study is a process and outcome evaluation of a primary care-based nutrition intervention targeting low-income Hispanic women. Pregnant women enrolled in the program were in their first trimester and received services through their 6-month well child check. The program provided vouchers for fruits and vegetables from the local farmers' market, nutrition classes, cooking classes, and lactation counseling. We conducted a prospective study of program participants (n = 32) and a comparable group of women for whom the program was not available (n = 29). Panel survey data measured maternal diet, exercise, stress, depression, social support, infant feeding practices, and demographics. Outcome measures obtained from medical records included pregnancy weight gain, infant weight at 6 and 12 months, and infant development at 9 months. Findings reveal that the program was not associated with infant weights. However, despite similar profiles at baseline, women in the intervention group were more likely than women in the comparison group to have significant improvements in diet, exercise, and depression (p ≤ .05). In addition, participants were more likely to breastfeed (p = .07) and their infants were more likely to pass the ages and stages developmental screen (p = .06) than women in the comparison group. The study was limited by a lack of random assignment and small samples. However, the breadth and size of the effects suggest pre/postnatal nutrition interventions integrated into primary care warrant additional investigation.

Prenatal parental separation and body weight, including development of overweight and obesity later in childhood

Background

Early parental separation may be a stress factor causing a long-term alteration in the hypothalamic-pituitary-adrenal-axis activity possibly impacting on the susceptibility to develop overweight and obesity in offspring. We aimed to examine the body mass index (BMI) and the risk of overweight and obesity in children whose parents lived separately before the child was born.

Methods

A follow-up study was conducted using data from the Aarhus Birth Cohort in Denmark and included 2876 children with measurements of height and weight at 9-11-years-of-age, and self-reported information on parental cohabitation status at child birth and at 9-11-years-of-age. Quantile regression was used to estimate the difference in median BMI between children whose parents lived separately (n = 124) or together (n = 2752) before the birth. We used multiple logistic regression to calculate odds ratio (OR) for overweight and obesity, adjusted for gender, parity, breast feeding status, and maternal pre-pregnancy BMI, weight gain during pregnancy, age and educational level at child birth; with and without possible intermediate factors birth weight and maternal smoking during pregnancy. Due to a limited number of obese children, OR for obesity was adjusted for the a priori confounder maternal pre-pregnancy BMI only.

Results

The difference in median BMI was 0.54 kg/m² (95% confidence intervals (CI): 0.10; 0.98) between children whose parents lived separately before birth and children whose parents lived together. The risk of overweight and obesity was statistically significantly increased in children whose parents lived separately before the birth of the child; OR 2.29 (95% CI: 1.18; 4.45) and OR 2.81 (95% CI: 1.05; 7.51), respectively. Additional, adjustment for possible intermediate factors did not substantially change the estimates.

Conclusion

Parental separation before child birth was associated with higher BMI, and increased risk of overweight and obesity in 9-11-year-old children; this may suggest a fetal programming effect or unmeasured difference in psychosocial factors between separated and non-separated parents.

Hispanic Americans living in the United States and their risk for obesity, diabetes and kidney disease: Genetic and environmental considerations

The Hispanic American, the largest minority population in the United States, is at increased risk for obesity, diabetes and end-stage renal disease. Here we review genetic and environmental factors that might account for their increased risk for these conditions. Whereas many environmental and genetic factors have important roles in driving the increased risk for obesity and kidney disease in this population, a case is made that excessive intake of sugary beverages is a contributory cause. Studies focusing on decreasing intake of sugary beverages among the Hispanic American could potentially reduce renal and cardiovascular complications in this population.

DNA methylation mediates the impact of exposure to prenatal maternal stress on BMI and central adiposity in children at age 13½ years: Project Ice Storm

Prenatal maternal stress (PNMS) in animals and humans predicts obesity and metabolic dysfunction in the offspring. Epigenetic modification of gene function is considered one possible mechanism by which PNMS results in poor outcomes in offspring. Our goal was to determine the role of maternal objective exposure and subjective distress on child BMI and central adiposity at 13½ years of age, and to test the hypothesis that DNA methylation mediates the effect of PNMS on growth. Mothers were pregnant during the January 1998 Quebec ice storm. We assessed their objective exposure and subjective distress in June 1998. At age 13½ their children were weighed and measured (n = 66); a subsample provided blood samples for epigenetic studies (n = 31). Objective and subjective PNMS correlated with central adiposity (waist-to-height ratio); only objective PNMS predicted body mass index (BMI). Bootstrapping analyses showed that the methylation level of genes from established Type-1 and -2 diabetes mellitus pathways showed significant mediation of the effect of objective PNMS on both central adiposity and BMI. However, the negative mediating effects indicate that, although greater objective PNMS predicts greater BMI and adiposity, this effect is dampened by the effects of objective PNMS on DNA methylation, suggesting a protective role of the selected genes from Type-1 and -2 diabetes mellitus pathways. We provide data supporting that DNA methylation is a potential mechanism involved in the long-term adaptation and programming of the genome in response to early adverse environmental factors.

Early-Life Stress, HPA Axis Adaptation, and Mechanisms Contributing to Later Health Outcomes

Stress activates the hypothalamic-pituitary-adrenal (HPA) axis, which then modulates the degree of adaptation and response to a later stressor. It is known that early-life stress can impact on later health but less is known about how early-life stress impairs HPA axis activity, contributing to maladaptation of the stress-response system. Early-life stress exposure (either prenatally or in the early postnatal period) can impact developmental pathways resulting in lasting structural and regulatory changes that predispose to adulthood disease. Epidemiological, clinical, and experimental studies have demonstrated that early-life stress produces long term hyper-responsiveness to stress with exaggerated circulating glucocorticoids, and enhanced anxiety and depression-like behaviors. Recently, evidence has emerged on early-life stress-induced metabolic derangements, for example hyperinsulinemia and altered insulin sensitivity on exposure to a high energy diet later in life. This draws our attention to the contribution of later environment to disease vulnerability. Early-life stress can alter the expression of genes in peripheral tissues, such as the glucocorticoid receptor and 11-beta hydroxysteroid dehydrogenase (11β-HSD1). We propose that interactions between altered HPA axis activity and liver 11β-HSD1 modulates both tissue and circulating glucocorticoid availability, with adverse metabolic consequences. This review discusses the potential mechanisms underlying early-life stress-induced maladaptation of the HPA axis, and its subsequent effects on energy utilization and expenditure. The effects of positive later environments as a means of ameliorating early-life stress-induced health deficits, and proposed mechanisms underpinning the interaction between early-life stress and subsequent detrimental environmental exposures on metabolic risk will be outlined. Limitations in current methodology linking early-life stress and later health outcomes will also be addressed.

Impact of stress and stress physiology during pregnancy on child metabolic function and obesity risk

PURPOSE OF REVIEW

To summarize recent conceptual frameworks and empirical findings addressing the role of prenatal stress and stress biology in the context of fetal programming of metabolic function and obesity risk.

RECENT FINDINGS

The link between stress exposure and adverse health outcomes is well established. Growing evidence from animal and human studies now suggests that the experience of severe stress or perturbations in stress-related immune and endocrine processes during pregnancy may also impact the developing fetus to produce increased susceptibility for childhood and adult obesity, and dysregulated glycemic control.

SUMMARY

Because endocrine and immune ligands commonly associated with stress play an essential role during intrauterine development in cellular growth and differentiation perturbations in these systems during pregnancy are likely to produce alterations of structure and function of the brain and peripheral physiological systems in the offspring. To systematically study the effects of intrauterine stress exposure on child metabolic function and obesity risk, a multilevel approach is required that includes molecular and cellular studies, the use of animal models, and human observational and interventional studies. Such studies will set the stage for translational research to inform the subsequent development of diagnostic and primary or secondary intervention strategies in at-risk individuals.