Life Course Perspective: evidence for the role of nutrition

Quality evaluation of nutrition policies in early childhood education and care services in Nerang, QLD

ISSUE ADDRESSED

Food environments in early childhood, such as early childhood education and care services, influence the development of dietary patterns and behaviours that traverse into adulthood, where they affect health and longevity. Nutrition policies are mandatory in early childhood education and care services in Australia and can positively or negatively shape the food environment. However, the quality of such nutrition policies is unknown. This study aimed to evaluate the comprehensiveness and strength of nutrition policies of early childhood education and care services among services participating in a university-community alliance in South East Queensland.

METHODS

Early childhood education and care services (n = 12) in Nerang, Queensland, Australia, participated in a cross-sectional study evaluating the comprehensiveness and strength of nutrition policies across four domains (Nutrition Education, Nutrition Standards, Promoting Healthy Eating and Communication and Evaluation) of the Wellness in Child Care Assessment Tool.

RESULTS

Nutrition policies evaluated in this study had median total comprehensiveness scores of 55 (out of 100) and median total strength scores of 19 (out of 100). 'Nutrition Education' had the highest median scores for comprehensiveness (67 out of 100) and strength (33 out of 100), while 'Nutrition Standards' had the lowest comprehensiveness score (41 out of 100), and 'Communication and Evaluation' had the lowest strength score (0 out of 100).

CONCLUSIONS

All services have a nutrition policy, but there are opportunities to enhance both the content and linguistic strength of statements within policies related to nutrition domains. SO WHAT?: There is a clear need to improve the comprehensiveness and strength of written statements in nutrition policies across all four domains, particularly 'Nutrition Standards' and 'Communication and Evaluation'.

Diets high in subsidized foods and chronic kidney disease in Hispanic communities in the United States: the Hispanic Community Health Study/Study of Latinos

Prior research shows that diets high in government subsidized foods may be associated with cardiometabolic disease risk factors. Our aim was to evaluate the relationship between diets high in subsidized foods and the development of chronic kidney disease (CKD) and other cardiometabolic risk factors in United States (US) Hispanics/Latinos. Using data from 16,172 Hispanics/Latino's living in the United States, we used the Cochran-Armitage test to assess the relationship between subsidized foods in the diets of participants and baseline characteristics. We used survey-weighted Poisson regression models to examine whether intake of subsidized foods was associated with incident CKD or cardiometabolic risk factors. Several baseline characteristics were associated with higher subsidized food scores. Higher subsidized food scores were not associated with incident CKD or cardiometabolic risk factors. These findings may be useful for future researchers, clinicians, and nutritional policy advocates who are interested in the way Hispanic and Latinos consume foods subsidized by the US government and the structural factors that may shape observed dietary and disease patterns.

Social factors associated with changes in nutrition risk scores measured using SCREEN-8: data from the Canadian Longitudinal Study on Aging

Purpose: To examine the social network factors associated with changes in nutrition risk scores, measured by SCREEN-8, over three years, in community-dwelling Canadians aged 45 years and older, using data from the Canadian Longitudinal Study on Aging (CLSA).Methods: Change in SCREEN-8 scores between the baseline and first follow-up waves of the CLSA was calculated by subtracting SCREEN-8 scores at follow-up from baseline scores. Multivariable linear regression was used to examine the factors associated with change in SCREEN-8 score.Results: The mean SCREEN-8 score at baseline was 38.7 (SD = 6.4), and the mean SCREEN-8 score at follow-up was 37.9 (SD = 6.6). The mean change in SCREEN-8 score was -0.90 (SD = 5.99). Higher levels of social participation (participation in community activities) were associated with increases in SCREEN-8 scores between baseline and follow-up, three years later.Conclusions: Dietitians should be aware that individuals with low levels of social participation may be at risk for having their nutritional status decrease over time and consideration should be given to screening them proactively for nutrition risk. Dietitians can develop and support programs aimed at combining food with social participation.

Association between occlusal supports and nutritional status in older adults: A systematic review

Background/purpose

Impaired masticatory performance results in nutritional deficiencies in older adults. This systematic review aims to investigate the following clinical question (CQ): Do occlusal supports impact nutritional intake or nutritional status in older individuals?

Materials and methods

An extensive systematic literature search was performed to summarize the currently available knowledge to address the CQ. The cohort and intervention studies with participants of ≧60 years old or a mean age of 65 years performed before May 2021 were included. Studies were required to measure the parameters related to occluding tooth pairs/occlusal units and food/nutrient intake and/or nutritional status. Bias risk was assessed using the Risk of Bias Assessment Tool for Nonrandomized Studies.

Results

After an independent screening of 1130 initial records, 24 reports from 22 studies were included. Participants (n = 8684) in the included studies were mainly residents of nursing homes or community-dwelling individuals. Following the assessment of bias risk, it is revealed that all studies had methodological weaknesses. Over half of the studies concluded that there was an association between occlusal support and nutritional intake or status. However, it was also revealed that various confounding factors are involved in the association between occlusal support and nutrition.

Conclusion

This systematic review concludes that occlusal support might be associated with nutritional intake or nutritional status in the older population, although there are methodological limitations of each study. The evidence is still insufficient, and more well-designed studies are required.

Nutritional awareness of pregnant women and the underlying influencing factors

Nutritional awareness is described as having knowledge or understanding of nutrition. It is often related to the ability of an individual to make an accurate estimate of their food intake, which involves comparing their actual nutritional behavior with the recommended food consumption. Nutritional awareness of women during the various phases of pregnancy may vary significantly across countries due to cultural and lifestyle differences. There has been extensive research on nutritional awareness of pregnant women in selected countries or regions; however, relatively few studies have explored it during different stages of pregnancy. To fill this gap, this article reviews the existing literature and draws together insights into the following areas: changes in nutritional awareness during various phases of pregnancy, nutritional awareness of pregnant women and its underlying factors in various nations, and the research methods used to study nutritional awareness of pregnant women.

Factors Associated with the Development of High Nutrition Risk: Data from the Canadian Longitudinal Study on Aging

This study aimed to determine which social network, demographic, and health-indicator variables were able to predict the development of high nutrition risk in Canadian adults at midlife and beyond, using data from the Canadian Longitudinal Study on Aging. Multivariable binomial logistic regression was used to examine the predictors of the development of high nutrition risk at follow-up, 3 years after baseline. At baseline, 35.0 per cent of participants were at high nutrition risk and 42.2 per cent were at high risk at follow-up. Lower levels of social support, lower social participation, depression, and poor self-rated healthy aging were associated with the development of high nutrition risk at follow-up. Individuals showing these factors should be screened proactively for nutrition risk.

Nutrition in a lifecourse perspective: From molecular aspects to public health approaches

This Special Issue covers a variety of topics related to nutrition from a lifecourse perspective, addressing diet in sensitive periods (preconception, pregnancy and infancy/toddlerhood), in different contexts, spanning from molecular nutrition to settings and gatekeepers of diet in these sensitive periods. It highlights challenges and research gaps within the field.

Toddler dietary patterns from the INSIGHT randomized clinical trial comparing responsive parenting versus control: A latent class analysis

OBJECTIVE

The aim of this study was to examine the effect of a responsive parenting (RP) intervention on toddler diet and explore associations with mothers' infant feeding practices and child weight status.

METHODS

INSIGHT tested an RP intervention designed for the prevention of obesity against a safety control among primiparous mothers and their infants. Mothers reported on feeding practices, as well as toddler diet with a Food Frequency Questionnaire (n = 229). Trained research staff obtained child anthropometrics at age 2 years.

RESULTS

Latent class analysis identified three dietary patterns: high fruits and vegetables (HFV, 31%); meat, potatoes, and added sugars (MPAS, 24%); and high juice, low fruits and vegetables (JLFV, 45%). Toddler dietary pattern was not related to study group (RP, control) or child weight status at age 2 years. Mothers who reported more structure-based feeding had toddlers that were more likely to have the healthier, HFV dietary pattern than MPAS and JLFV. Findings for control-based feeding practices were mixed; maternal restriction was associated with the HFV dietary pattern, whereas the use of food as a reward was associated with MPAS and JLFV.

CONCLUSIONS

Mothers' structure-based feeding practices in infancy, as well as some control-based feeding practices, were associated with later healthier toddler dietary patterns.

Large-Scale Data Harmonization Across Prospective Studies

The Preconception Period Analysis of Risks and Exposures Influencing Health and Development (PrePARED) Consortium creates a novel resource for addressing preconception health by merging data from numerous cohort studies. In this paper, we describe our data harmonization methods and results. Individual-level data from 12 prospective studies were pooled. The crosswalk-cataloging-harmonization procedure was used. The index pregnancy was defined as the first postbaseline pregnancy lasting more than 20 weeks. We assessed heterogeneity across studies by comparing preconception characteristics in different types of studies. The pooled data set included 114,762 women, and 25,531 (22%) reported at least 1 pregnancy of more than 20 weeks' gestation during the study period. Babies from the index pregnancies were delivered between 1976 and 2021 (median, 2008), at a mean maternal age of 29.7 (standard deviation, 4.6) years. Before the index pregnancy, 60% of women were nulligravid, 58% had a college degree or more, and 37% were overweight or obese. Other harmonized variables included race/ethnicity, household income, substance use, chronic conditions, and perinatal outcomes. Participants from pregnancy-planning studies had more education and were healthier. The prevalence of preexisting medical conditions did not vary substantially based on whether studies relied on self-reported data. Use of harmonized data presents opportunities to study uncommon preconception risk factors and pregnancy-related events. This harmonization effort laid the groundwork for future analyses and additional data harmonization.

Strategies to Improve Physical Activity and Nutrition Behaviours in Children and Adolescents: A Review

Despite widespread acknowledgement of the multifarious health benefits of physical activity (PA), including prevention and control of obesity, an overwhelming majority of children and adolescents are not sufficiently active to realise such benefits. Concurrently, young people are significantly impacted by the rapid global rise of sedentarism, and suboptimal dietary patterns during key phases of development. Regrettably, the cumulative effects of unhealthy behaviours during the growing years predisposes young people to the early stages of several chronic conditions, including obesity. Clear and consistent approaches are urgently needed to improve eating and activity behaviours of children and adolescents. Based on existing evidence of "best bets" to prevent and control obesity and its comorbidities, we present a set of non-negotiable strategies as a 'road map' to achieving prevention and improving the health of children and adolescents.

Childhood and adolescent nutrition outcomes among girls exposed to gender-based violence: A rapid evidence assessment of quantitative research

BACKGROUND

An emerging evidence base has explored the nutritional consequences of gender-based violence (GBV) perpetrated against girls during childhood/adolescence. We conducted a rapid evidence assessment of quantitative studies describing associations between GBV and girls' nutrition.

METHODS

We adapted systematic review methods and included empirical, peer-reviewed studies, published after 2000 (until November, 2022), that were written in Spanish or English and reported quantitative associations between girls' exposure to GBV and nutrition outcomes. A variety of GBV forms were considered: childhood sexual abuse (CSA), child marriage, preferential feeding of boys, sexual IPV and dating violence. Nutrition outcomes included anemia, underweight, overweight, stunting, micronutrient deficiencies, meal frequency, and dietary diversity.

RESULTS

In total, 18 studies were included, 13 of which were conducted in high-income countries. Most sources utilized longitudinal or cross-sectional data to quantify associations between CSA, sexual assault, and intimate partner/dating violence and elevated BMI/overweight/obesity/adiposity. Findings suggest that CSA perpetrated by parents/caregivers is associated with elevated BMI/overweight/obesity/adiposity via cortisol reactivity and depression; this relationship may be compounded by additional intimate partner/dating violence in adolescence. The effects of sexual violence on BMI are likely to emerge during a sensitive period of development between late adolescence and young adulthood. Emerging evidence was found regarding the relationship between child marriage (and the related exposure: age at first pregnancy) and undernutrition. The association between sexual abuse and reduced height and leg length was inconclusive.

CONCLUSION

Given that only 18 studies were included, the relationship between girls' direct exposure to GBV and malnutrition has received little empirical attention, especially with respect to studies conducted in LMIC and fragile settings. Most studies focused on CSA and overweight/obesity, where significant associations were found. Future research should test the moderation and mediation effects of intermediary variables (depression, PTSD, cortisol reactivity, impulsivity, emotional eating) and consider sensitive periods of development. Research should also explore the nutritional consequences of child marriage.

Dietary Quality and Diet-Related Factors Among Female Adults of Reproductive Age With and Without Disabilities Participating in the National Health and Nutrition Examination Surveys, 2013-2018

BACKGROUND

Female adults of reproductive age (18 to 44 years) with disabilities have higher rates of health-risk behaviors and chronic conditions compared with their counterparts without disabilities; however, there is limited examination of diet.

OBJECTIVE

Our aim was to examine associations of self-reported disability status with diet quality and diet-related factors.

DESIGN

Cross-sectional data were from the National Health and Nutrition Examination Surveys, 2013-2018.

PARTICIPANTS/SETTING

Female adults aged 18 through 44 years were included. Disability was defined as serious difficulty hearing, seeing, concentrating, walking, dressing, and/or running errands due to physical, mental, or emotional conditions.

MAIN OUTCOME MEASURES

The Healthy Eating Index-2015 assessed diet quality. Diet-related factors included self-rated diet healthfulness, meal characteristics, food security, and food assistance programs.

STATISTICAL ANALYSIS

Multivariable linear regression estimated differences in Healthy Eating Index-2015 scores for a given day and multivariable Poisson regression estimated adjusted prevalence ratios and 95% CI of diet-related factors by disability status.

RESULTS

Of 3,579 female adults, 557 (16%) reported any disabilities, 207 (6%) of whom reported having 2 or more types of disabilities. Differences in mean Healthy Eating Index-2015 scores for a given day were one-third to one-half a point lower for fruits, total protein foods, and seafood and plant proteins among female adults with 2 or more types of disabilities compared with those without disabilities. Female adults with any disabilities were more likely to rate their diet as poor, have low food security, participate in food-assistance programs, and consume frozen foods or pizza, compared with those without disabilities (adjusted prevalence ratio ranged from 1.35 to 1.93); they were less likely to be the main food planner or preparer or shopper for their households.

CONCLUSIONS

Some indicators of diet quality and diet-related factors differed between female adults with and without disabilities. Additional investigation of dietary intakes and behaviors, as well as access to and availability of healthy foods, among female adults with disabilities is necessary.

Ernährungskommunikation in Schwangerschaft und früher Kindheit: Erkenntnisse aus zwei Literaturreviews

Hintergrund

In der Schwangerschaft sowie im Säuglings- und Kleinkindalter werden entscheidende Weichen für die spätere Gesundheit gestellt. Das trifft in besonderem Maße auf die Ernährung zu. Unbestritten ist, dass Kommunikation eine wesentliche Rolle dabei spielt, ob ernährungsbezogene Präventionsprogramme erfolgreich sind bzw. sein können.

Ziel der Arbeit

Ziel dieser Arbeit war es, den internationalen Forschungsstand zu kommunikationsbasierten ernährungsbezogenen Interventionen bei Schwangeren, jungen Familien und Kindern im Alter bis 36 Monate aus einem kommunikationswissenschaftlichen Blickwinkel zu analysieren. Erhoben wurde, welche Kommunikationsstrategien im Kontext der Ernährungskommunikation erfolgreich waren und welche nicht.

Material und Methoden

Zwei Reviews des internationalen Forschungsstands zu kommunikativen Interventionen im Kontext der Ernährung in Schwangerschaft und früher Kindheit wurden durchgeführt: Ein Scoping Review von 187 Übersichtsarbeiten sowie ein systematisches Review von 65 Einzelstudien mit einem mittleren oder hohen Evidenzgrad.

Ergebnisse

Obwohl sich keine Übersichtsarbeit fand, in der verschiedene kommunikative Zugänge im Detail diskutiert wurden, ergab das Scoping Review viele Hinweise auf Erfolgsfaktoren und Barrieren ernährungsbezogener Interventionen. Das systematische Review der Einzelstudien illustrierte u. a. die wichtige Rolle interpersoneller Ansprachen (z. B. durch Kinder- und Jugendärztinnen und -ärzte, Frauenärztinnen und -ärzte, Hebammen), sowohl einzeln als auch ergänzend zu massenmedialen, digitalen (z. B. Apps) oder Social-Media-Interventionszugängen.

Schlussfolgerung

Verschiedene kommunikative Zugänge der Ernährungskommunikation werden bislang unzureichend in der nötigen Differenziertheit diskutiert und sind überwiegend schlecht in der Literatur dokumentiert. Ein gesicherteres und umfangreicheres Wissen über evidenzbasierte Kommunikationsstrategien im Kontext von Schwangerschaft und früher Kindheit ist nötig, wenn ernährungsbezogene Präventionsprogramme erfolgreich sein sollen.

Academy of Nutrition and Dietetics: Revised 2022 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Public Health and Community Nutrition

Awareness of the social determinants of health has been increasing in recent years. These include equitable access to health care and foods that support healthy eating patterns. A wide range of issues related to these determinants influence practice in the public health and community nutrition field. In response to these evolving needs, the Public Health and Community Nutrition Dietetic Practice Group, with guidance from the Academy of Nutrition and Dietetics Quality Management Committee, has developed Standards of Practice and Standards of Professional Performance as a tool for Registered Dietitian Nutritionist (RDNs) currently in practice or interested in working in public health and community nutrition, to assess their current skill levels and to identify areas for professional development. The Standards of Practice address the four steps of the Nutrition Care Process for community and public health RDNs: assessment, diagnosis, intervention, and evaluation/monitoring. The Standards of Professional Performance consists of six domains of professional performance for community and public health RDNs: Quality in Practice, Competence and Accountability, Provision of Services, Application of Research, Communication and Application of Knowledge, and Utilization and Management of Resources. Within each standard, specific indicators provide measurable action statements that illustrate the ways in which RDNs can address population nutrition and health. The indicators describe three skill levels (Competent, Proficient, and Expert) for RDNs. These tools highlight the unique scope of expertise that RDNs provide to the field of public health and community nutrition.

The "Cinderella sector": The challenges of promoting food and nutrition for young children in early years' settings in England

The quality of food that children eat in early childhood has profound impacts on their future wellbeing. In England, many children eat the majority of meals in early years' settings including nurseries and childminders. We conducted 16 interviews with 18 stakeholders exploring food provision, the use of voluntary nutrition guidelines, and the effects of government support on the early years' sector. Key themes emerging from our thematic analysis included feeling insufficiently consulted, undervalued, support being unequally distributed, needing to fill multiple support roles for families, disagreement about the role and effect of voluntary nutrition standards, and being chronically underfunded.

Association of Serum Retinol Concentrations With Metabolic Syndrome Components in Iranian Children and Adolescents: The CASPIAN-V Study

Background

As a fat-soluble vitamin, vitamin A plays a crucial role in adipogenesis, lipolysis, insulin resistance, and obesity. However, it is still unclear whether they are associated with cardiometabolic risk factors in children and adolescents. The current study aimed to determine the association between serum retinol concentration and the cluster of metabolic syndrome components among children and adolescents.

Methods

This nationwide cross-sectional study was performed on 2,518 students aged 7–18 years from the Childhood and Adolescence Surveillance and Prevention of Adult Non- communicable disease (CASPIAN-V) study. Students were selected via multistage cluster sampling method from 30 provinces of Iran in 2015. Multivariable logistic regression was used to assess the association of serum retinol concentration with metabolic syndrome (MetS) components.

Results

Overall, the mean (SD) age of study participants was 12.16 (3.04) years, and 44.9% (n = 1,166) of them were girls. The mean serum retinol concentration was 1.48 ± 1.55 μmol/L and vitamin A deficiency was observed among 19.7% (95% CI: 18.2–21.3) of study subjects. The results of the logistic regression analysis showed that increasing serum retinol concentrations were associated with an increased likelihood of developing obesity (OR: 1.12, 95% CI: 1.04, 1.20), abdominal obesity (OR: 1.07, 95% CI: 1.01, 1.14), low high-density lipoprotein cholesterol (HDL-C) (OR: 1.10, 95% CI: 1.04, 1.16) and high fasting blood glucose (FBG) (OR: 1.21, 95% CI: 1.10, 1.35), whereas it was associated with a decreased odds of developing high blood pressure (OR: 0.82, 95% CI: 0.73, 0.93). Nevertheless, there was no statistically significant association between metabolic syndrome itself and retinol concentration (OR: 1.02, 95% CI: 0.88, 1.18).

Conclusion

We found that serum retinol concentration was positively associated with metabolic syndrome components such as obesity, low HDL-C, and high FBG, but not with metabolic syndrome itself.

Food Insecurity and Vision Impairment Among Adults Age 50 and Older in the United States

PURPOSE

To test the hypothesis that food insecurity is associated with greater prevalence of vision impairment (VI).

DESIGN

Cross-sectional, nationally representative survey of US adults.

METHODS

Adults 50 years and older were included. Food security category (ie, full, marginal, low, or very low) was assessed by the US Household Food Security Survey Module. Objective presenting VI (PVI) and self-reported VI (SRVI) were assessed by examination and survey, respectively. Separate logistic regression models were constructed with food insecurity category as a predictor of PVI or SRVI. Models were adjusted for age, gender, race, education, income, cigarette use, alcohol use, body mass index, and physical activity. Age-stratified analyses (age 50 through 64 years vs 65 years and older) were also conducted.

RESULTS

Mean age of participants (n = 10,078) was 63.4 years; 8,518 (89.9%) were fully food secure, 1,033 (7.2%) had PVI, and 2,633 (20.1%) had SRVI. Compared with full food security, adjusting for sociodemographic confounders, those with marginal (adjusted odds ratio [aOR], 1.31; 95% CI, 0.97-1.76), low (aOR, 1.61; 95% CI, 1.17-2.23), and very low (aOR, 2.71; 95% CI, 1.75-4.20) food security had higher odds of PVI. Compared with full food security, those with marginal (aOR, 1.58; 95% CI, 1.23-2.02), low (aOR, 1.46; 95% CI, 1.11-1.92), and very low (aOR, 1.85; 95% CI, 1.41-2.41) food security had higher odds of SRVI. The associations between food insecurity and PVI were greater in magnitude in those 65 years and older compared with those age 50 through 64 years.

CONCLUSIONS

In this nationally representative sample of US adults 50 years and older, severe food insecurity was increasingly associated with greater prevalence of VI in a dose-response manner.

Holding no-one back: The Nutrition Equity Framework in theory and practice

Equity remains poorly conceptualised in current nutrition frameworks and policy approaches. We draw on existing literatures to present a novel Nutrition Equity Framework (NEF) that can be used to identify priorities for nutrition research and action. The framework illustrates how social and political processes structure the food, health and care environments most important to nutrition. Central to the framework are processes of unfairness, injustice and exclusion as the engine of nutrition inequity across place, time and generations, ultimately influencing both nutritional status and people's space to act. The NEF illustrates conceptually how action on the socio-political determinants of nutrition is the most fundamental and sustainable way of improving nutrition equity for everyone everywhere, through 'equity-sensitive nutrition'. Efforts must ensure, in the words of the Sustainable Development Goals, that not only is "no one left behind" but also that the inequities and injustices we describe do not hold anyone back from realising their right to healthy diets and good nutrition.

Breast-feeding, rapid growth in the first year of life and excess weight at the age of 2 years: the 3D Cohort Study

OBJECTIVE

To assess relationships between breast-feeding, rapid growth in the first year of life and overweight/obesity status at the age of 2 years.

DESIGN

As part of an observational, longitudinal study beginning in early pregnancy, multivariable logistic regressions were used to assess associations between breast-feeding duration (total and exclusive) and rapid weight gain (RWG) between birth and 1 year of age, and to determine predictors of overweight/obesity status at the age of 2 years.

SETTING

Nine hospitals located in the province of Quebec, Canada.

PARTICIPANTS

A sample of 1599 term infants who participated in the 3D Cohort Study.

RESULTS

Children having RWG in the first year and those having excess weight at the age of 2 years accounted for 28 % and < 10 %, respectively. In multivariable models, children breastfed < 6 months and from 6 months to < 1 year were, respectively, 2·5 times (OR 2·45; 95 % CI 1·76, 3·41) and 1·8 times (OR 1·78; 95 % CI 1·29, 2·45) more likely to show RWG up to 1 year of age compared to children breastfed ≥ 1 year. Children exclusively breastfed < 3 months had significantly greater odds of RWG in the first year (OR 1·94; 95 % CI 1·25, 3·04) compared to children exclusively breastfed for ≥ 6 months. Associations between breast-feeding duration (total or exclusive) and excess weight at the age of 2 years were not detected. RWG in the first year was found to be the main predictor of excess weight at the age of 2 years (OR 6·98; 95 % CI 4·35, 11·47).

CONCLUSIONS

The potential beneficial effects of breast-feeding on rate of growth in the first year of life suggest that interventions promoting breast-feeding are relevant for obesity prevention early in life.

Perceptions of Tailored Dietary Advice to Improve the Nutrient Adequacy of the Diet in French Pregnant Women

Tailored dietary counseling could be specifically efficient during pregnancy, a period accompanied by a rise in nutrition awareness, but little is known about the expectations of pregnant women in this regard. We studied these expectations regarding tailored dietary advice in French women during their pregnancy, as well as their motivations and the perceived barriers and enablers. In French pregnant women, we evaluated the perceptions of tailored dietary advice provided by stepwise dietary counseling based on three types of dietary changes, consisting of: (1) a modification of the amounts consumed, (2) substitutions within the food subgroups, and (3) substitutions between food subgroups. A sequential explanatory mixed-method approach was designed. Using qualitative data from a focus group study (n = 40), we intended to explore in depth the women’s expectations regarding dietary advice and adherence to a tailored approach. These were combined with quantitative and qualitative data from a 6-week online longitudinal study (n = 115), using questionnaires designed to assess the modifications of dietary habits during pregnancy and to evaluate each type of dietary change. Both studies confirmed that most women in our samples did indeed intend to institute changes regarding healthier dietary practices during pregnancy. The principal motivation behind changes to their habits was to ensure the health and well-being of both their babies and themselves. The proposal of dietary advice that is tailored to both the current diet and the specific needs of pregnant women, but that is also positive and credible, was perceived as enabling implementing healthier dietary practices during pregnancy. Regarding the implementation of the dietary changes proposed, the enablers and barriers identified differed between modifications of the amounts consumed and substitutions. The women displayed interest in all types of dietary changes. This gave relevance to combining different types of changes in order to propose dietary counseling during pregnancy. Tailored dietary counseling was identified by French pregnant women in our samples as enabling them to adopt a healthier diet. However, perceived barriers might limit the implementation of dietary changes, especially when they involved marked modifications to their usual diet.

Information seeking behaviors, attitudes, and beliefs about pregnancy-related nutrition and supplementation: A qualitative study among US women

Background: Maternal behavior during pregnancy is crucial to her own and her infant's health, and as such, it is important to understand the nutrition and supplement habits of women during pregnancy and what informs those behaviors. Aim: We aimed to assess the information seeking habits, attitudes, and beliefs about pregnancy-related nutrition and supplementation among pregnant women in the United States. Methods: Qualitative study using key informant interviews with pregnant and recently pregnant (n = 21) US women. Themes related to concerns, attitudes, behaviors, and information seeking habits were extracted. Results: The mean age was 31.9 years and all had at least a university degree. Two major themes that emerged: (1) nutrition information-related attitudes and beliefs and (2) food and supplement-related attitudes and beliefs. Pregnant women in the US were underwhelmed with their health care provider experience when receiving information about pregnancy-related nutrition and supplementation. Nutrition was most often addressed in a reactive manner while women desired a more proactive approach. As a result, they conducted their own research using the internet as their primary tool, and ultimately made nutrition and supplement decisions based largely on their own instincts. Conclusion: Women interviewed for this study encountered barriers to pregnancy related nutrition information from a lack of clear communication from their health care provider and ambiguity and inconsistencies in information within and between sources. Women relied on themselves for information seeking and nutrition related decision making throughout their pregnancy.

Drivers of food choice among women living in informal settlements in Nairobi, Kenya

Suboptimal diets drive the multiple burdens of malnutrition among women living in informal settlements. Women's food choices have important implications for their health, as well as that of their families. The purpose of this study was to examine how food choice decisions might differ across different age groups of women living in informal settlements in Nairobi, Kenya. Using in-depth interviews which incorporated a free-listing task, we determined the factors influencing food choice decisions in women in two informal settlements, Kibera and Mukuru. Among women in all age groups, we found income and food price to be the most salient factors influencing food choice decisions. Differences across age groups regarding food choice considerations included individual preference and quality being more salient factors amongst younger women while household preferences were more salient among older women. Women also reported making trade-offs between food affordability and other factors including time and nutrition, which led to sub-optimal diets. Our findings suggest that interventions in these settings may need to be tailored to specific age groups. Additionally, interventions may need to target both individual factors and the external food environment to help women overcome the trade-offs they often find themselves making in food choice decisions.

Percentile values for serum levels of vitamins A and D in Iranian children and adolescents: The CASPIAN-V study

OBJECTIVES

The reference values to determine vitamin A and D deficiency may vary based on ethnicity, age, and region of residence. The aim of this study was to determine the reference interval of circulating vitamin A and D levels among Iranian children and adolescents based on sex, age, and region of residence.

METHODS

This nationwide cross-sectional study was performed with 2596 students 7 to 18 y of age from the CASPIAN-V (Childhood and Adolescence Surveillance and Prevention of Adult Non- communicable disease) study. A parametric method was used to define the age-specific reference values by obtaining smooth centile curves and explicit formulae for the centile estimates and SD scores for both sexes and regions of residence.

RESULTS

Significant differences were found between the residents of rural and urban regions in terms of serum 25-hydroxyvitamin D [25(OH)D] and retinol concentration (P < 0.05). Boys (27 ± 8 versus 26.04 ± 10, P = 0.009). Children ages 7 to 12 y had higher serum 25(OH)D concentration than 13- to 18-y-old adolescents (26.96 ± 8 versus 26.04 ± 10, P = 0.007). The estimated reference interval for circulating 25(OH)D levels corresponding to the range between the 5th and 95th percentiles were 11.45 to 48.40 ng/mL in boys and 9.51 to 47.69 ng/mL in girls. Estimated reference intervals for serum retinol concentration among boys and girls corresponding to the 5th and 95th percentiles were 0.58 to 3.38 and 0.58 to 4.52, respectively. There were significant variations in both retinol and 25(OH)D concentrations across different age groups.

CONCLUSION

This study established the reference intervals for circulating 25(OH)D and retinol levels in Iranian adolescents and children in different age groups based on sex and region.

Relationship between parents' dietary care and food diversity among preschool children in Japan

Objective:

To identify the relationship between preschool children’s dietary diversity and parents’ care behaviours related to their diet including contents of foods and snacks, mealtime practice and parent–child communication.

Design:

Cross-sectional study. Data were extracted from the National Nutrition Survey on Preschool Children in 2015 by Japan’s Ministry of Health, Labour and Welfare.

Setting:

The distribution of food diversity score (FDS) (maximum of eight points) was confirmed. The participants were divided into higher (≥4 points) and lower (≤3 points) food diversity groups. A comparison between the two groups examined parents’ socio-economic status, children’s health and living conditions, and parental care concerning children’s diets (thirteen items). A multiple regression analysis was performed relating FDS to the factors of parental socio-economic status and child health, and a logistic regression analysis was conducted to identify factors of parental care related to the higher food diversity group.

Participants:

2143 persons from households with children aged 2–6 years.

Results:

Parental care concerning children’s diets was the factor most strongly associated with children’s FDS. Those factors most strongly associated with higher food diversity were nutritional balance of foods (OR: 1·76; 95 % CI 1·44, 2·16; P < 0 0001), snack contents (OR: 1·41; 95 % CI 1·07, 1·86; P = 0·014) and regular mealtimes (OR: 1·30; 95 % CI 1·08, 1·55; P = 0·005).

Conclusions:

The findings indicate the importance of parents paying attention to the contents of children’s foods and snacks, ensuring that children eat regularly, and increasing the diversity of their diets.

Association of Periodontal Status, Number of Teeth, and Obesity: A Cross-Sectional Study in Japan

Recent reports have shown an association between obesity and periodontitis, but the precise relationship between these conditions has yet to be clarified. The purpose of this study was to compare the status of periodontitis, tooth loss, and obesity. Participants comprised 235 patients at the Center for Medical and Dental Collaboration in Kanagawa Dental University Hospital between 2018 and 2020. Clinical examinations such as blood testing, body composition analysis, periodontal measurement, assessment of chewing ability, salivary testing, and oral malodor analysis were performed. Periodontal inflamed surface area (PISA) was significantly associated with the number of teeth and body mass index (BMI). The number of teeth was negatively associated with age, but positively with chewing ability. Chewing ability was associated negatively with age, and positively with high-sensitivity C-reactive protein (hsCRP). The level of methyl-mercaptan in breath and protein and leukocyte scores from salivary testing were positively associated with PISA. The rate of insufficient chewing ability was increased in subjects with hemoglobin (Hb)A1c ≥ 7%. The high PISA group showed increased hsCRP. BMI as an obesity marker was positively associated with PISA, indicating periodontal inflammation. Chewing ability was related to serum markers such as HbA1c and hsCRP.

Critical and Sensitive Periods in Development and Nutrition

Critical or sensitive periods in the life of an organism during which certain experiences or conditions may exert disproportionate influence (either for harm or benefit) on long-term developmental outcomes have been the subject of investigation for over a century. This chapter reviews research in the context of the development of social preferences and sensory systems, with a summary of the criteria for defining such a period and the evidence necessary to establish its existence. The notion of nutritional programming, central to the Barker/Developmental Origins hypotheses of health and disease, represents a variant of the critical/sensitive period concept. It is implicit in these hypotheses that the fetal period is a time during which metabolic and physiological systems are malleable and thus susceptible to either insult or enhancement by nutrient intake. Evidence for critical/sensitive periods or nutritional programming requires a systematic manipulation of the age at which nutritional conditions or supplements are implemented. While common in research using animal models, the approach is difficult to establish in epidemiological studies and virtually nonexistent in human clinical trials. Future work seeking to establish definitive evidence for critical/sensitive periods or programming may be advanced by harmonized outcome measures in experimental trials across which the timing, duration, and dose of nutrients is varied.

Parent-child cooking meal together may relate to parental concerns about the diets of their toddlers and preschoolers: a cross-sectional analysis in Japan

BACKGROUND

Parents often have concerns about the food habits of their young children. Cooking is a frequent behavior related to dietary activities at home. We hypothesized that "a parent cooking meals together with young children might alleviate dietary concerns." The aim of this study was to identify the relationship between parental cooking practices (e.g., cooking meals together with the child) and diet-related concerns.

METHODS

Data were extracted from the "National nutrition survey on preschool children" conducted among nation-wide households with toddlers and preschoolers in 2015 by the Ministry of Health, Labour and Welfare of Japan. Parents were classified into two groups comprising those who cooked meals together with their children and those who did not. The following variables were compared: taking too much time to eat (slow eaters), "picky" eating (eating only certain foods), inconsistent food intake (eating too much or too little), playing with food/utensils while eating, preferring sweetened beverages and snacks over meals, eating too fast to chew well, not swallowing food, disinterested in eating, and spitting out food. The associations between parent-child cooking meals together and the concerns pertaining to the child's dietary habits and food intake were analyzed and compared between the two groups.

RESULTS

The concerns of "picky eating" and "playing with food/utensils while eating" were lower, while "eating too much" was higher in the parent-cooking together group. The intake frequency of fish, soybeans/soy products, vegetables, and milk among children were higher in the "cooking together" group than among those in the "not cooking together" group. Children in the "cooking together" group consumed a significantly greater variety of foods than those in the "not cooking together" group.

CONCLUSIONS

Cooking a meal together with a child may be related to the parent's lower concerns about the dietary habits of the child, including "picky eating" and "playing with food/utensils while eating," but may also be related to the higher concerns of "eating too much."

Examining Relationships between Food Procurement Characteristics and Nutritional Quality in Washington State Child Care Settings

BACKGROUND

Sixty percent of US children 5 years old and under receive up to two-thirds of their daily nutrition in early care and education (ECE) settings. Although participation in the federal Child and Adult Care Food Program (CACFP) is shown to improve nutrition, little is known about the relationship between procurement practices (where and how child care programs purchase food) and nutrition in ECE settings or whether these practices differ depending on participation in CACFP.

METHODS

We assessed self-reported nutrition practices and procurement practices by CACFP participation using a 2013 cross-sectional survey of 690 Washington ECE centers ("Centers") and 1260 family homes (family home child care [FHCCs]) serving children aged 2-5 years old using validated survey tools. We examined the relationship between procurement variables (i.e., main store and main mode) and nutrition scores using multinomial logistic regression models that adjusted for sociodemographic and program characteristics.

RESULTS

In-person shopping was the primary mode of shopping for all programs, regardless of CACFP participation. Some Centers but very few FHCCs reported online shopping as their primary mode. Centers and non-CACFP FHCCs shopped primarily at megastores (Costco, Target, etc.). CACFP FHCCs used both megastores and grocery stores (Albertsons, QFC, etc.) at similar rates. Adjusted multinomial models found that shopping online or at two or more stores was associated with higher nutritional quality of foods served by programs.

CONCLUSIONS

Understanding the procurement behaviors of ECE programs helps to illuminate and prioritize potential interventions that would support healthy food purchases.

Physical Activity Practices, Policies and Environments in Washington State Child Care Settings: Results of a Statewide Survey

Objectives Child care is an important setting for the promotion of physical activity (PA) in early childhood. The purpose of this study was to examine the associations between specific PA environments and recommended practices in child care settings as well as the degree to which child care settings met recommended standards for total PA time. Methods In 2013, all programs licensed to care for children ages 2-5 in WA state were surveyed about their PA related practices. Logistic regression was used to determine odds of meeting best-practice standards for outdoor time and PA. Results The response rate was 45.8 % from centers (692/1511) and 32.1 % from homes (1281/3991). Few programs reported meeting best-practice standards for the amount of time children spend being physically active (centers: 12.1 %, homes: 20.1 %) and outdoor time (centers: 21.8 %, homes: 21.7 %). Programs where children go outside regardless of weather and those reporting more adult-led PA had higher odds of meeting best-practice standards for both PA and outdoor time. Meeting best-practice standards for outdoor time was the strongest predictor of meeting best-practice standards for total PA time [centers: OR 15.9 (9.3-27.2), homes: OR 5.2 (3.8-7.1)]. Conclusions for Practice There is considerable room for improvement in licensed child care settings in WA to meet best-practice standards for young children's outdoor and PA time. Initiatives that create policies and environments encouraging outdoor play and adult-led PA in child care have the potential to increase physical activity in substantial numbers of young children.

Timing, intensity, and duration of household food insecurity are associated with early childhood development in Kenya

This study examines the association between 3 dimensions of food insecurity (timing, intensity, and duration) and 3 domains of child development (gross motor, communication, and personal social). Longitudinal data from 303 households (n = 309 children) visited 9 times over 2 years were collected. Children in households experiencing severe food insecurity 3 months prior (timing) had significantly lower gross motor (β -0.14; 95% CI [0.27, -0.0033]; p = .045), communication (β -0.16; 95% CI [-0.30, -0.023]; p = .023), and personal social (β -0.20; 95% CI [-0.33, -0.073]; p = .002) Z-scores, using lagged longitudinal linear models controlling for current food insecurity; these results were attenuated in full models, which included maternal education, household asset index, and child anthropometry. Children in households that experienced greater aggregate food insecurity over the past 2 years (intensity) had significantly lower gross motor (β -0.047; 95% CI [-0.077, -0.018]; p = .002), communication (β -0.042; 95% CI [-0.076, -0.0073]; p = .018), and personal social (β -0.042; 95% CI [-0.074, -0.010]; p = .010) Z-scores; these results were also attenuated in full models. Children with more time exposed to food insecurity (duration) had significantly lower gross motor (β -0.050; 95% CI [-0.087, -0.012]; p = .010), communication (β -0.042; 95% CI [-0.086, 0.0013]; p = .057), and personal social (β -0.037; 95% CI [-0.077, 0.0039]; p = .076) Z-scores; these results were no longer significant in full models. Our findings suggest that acute and chronic food insecurity and child development are related, but that many associations are attenuated with the inclusion of relevant covariates.

Concerns, attitudes, beliefs and information seeking practices with respect to nutrition-related issues: a qualitative study in French pregnant women

BACKGROUND

From a life course perspective, pregnancy leads to a rise in nutrition awareness and an increase in information flow in favour of adopting healthier eating behaviours. This qualitative study was designed to better understand the determinants of eating behaviours in French pregnant women by focusing on their concerns, attitudes and beliefs and their nutrition-related information seeking practices.

METHODS

Seven focus groups were conducted, involving a total of 40 French pregnant women. An inductive thematic approach, adapted from the grounded theory, was adopted to analyse the data. Two major themes were identified: eating behaviour and nutrition-related information behaviour.

RESULTS

The eating behaviour theme was divided into four sub-themes using the attribution theory. Three external causes affected the eating behaviour of pregnant women (food restrictions, physiological changes and weight gain), and led to frustration and a perceived loss of control. By contrast the adoption of a healthier diet was perceived as internal by pregnant women, and resulted in self-fulfilment and empowerment regarding the health and the well-being of their baby and themselves, and their weight gain management. Greater attention was paid to nutrition-related information obtained from healthcare providers, the social environment and the mass media. Information was passively absorbed or actively sought by pregnant women, but most was perceived as contradictory, which led to confusion.

CONCLUSION

Pregnancy is accompanied by a rise in nutrition awareness, substantiated by eating behaviour modifications due to external and internal causes. However, conflicts between and within information sources result in confusion that can limit the adoption of healthier eating behaviour.

Household food insecurity and child health

Food insecurity, the lack of consistent access to sufficient quality and quantity of food, affects an estimated 800 million people around the world. Although household food insecurity is generally associated with poor child nutrition and health in the USA, we know less about household food insecurity and child health in developing countries. Particularly lacking is research assessing how associations between household food insecurity and children's health outcomes may differ by child age and among children beyond age 5 years in low-income settings. We use data from a population-based sample of households with children ages 3-11 years (N = 431) in León, Nicaragua to consider how household food insecurity is associated with three measures of child health: illness, anaemia and low height-for-age. Our results provide new evidence that even mild household food insecurity is detrimental to children's health; and that child age conditions the associations between household food insecurity and child health. We find that food insecurity is especially harmful to health during early childhood, but continues to have significant associations with health into middle childhood (up to ages 7-8 years). We discuss the potential implications of these results for future child health research and policies in low-income countries. © 2016 John Wiley & Sons Ltd.

More than metabolic: Considering the broader paleoepidemiological impact of vitamin D deficiency in bioarchaeology

Vitamin D deficiency has traditionally been viewed as a metabolic bone disease by bioarchaeologists and considered primarily in terms of the development of specific musculoskeletal changes used for diagnosis in paleopathological research. These skeletal manifestations are usually interpreted as representing general ill-health. Clinical research shows that vitamin D is also integral to a number of extra-skeletal physiological processes including immunoregulation, blood pressure homeostasis, cell division, and programmed cell death. Vitamin D deficiency and sub-clinical insufficiency are thought to be risk factors for infectious and autoimmune diseases, as well as certain cancers and cardiovascular diseases. Epidemiological work indicates that the skeletal manifestations of vitamin D deficiency represent the extreme end of a spectrum of morbidity associated with negative health outcomes, including increased risk for secondary tuberculosis. This article provides a review of clinical research on the extra-skeletal roles of vitamin D and the pathological consequences of poor vitamin D status. Additionally, it presents an interpretive model for bioarchaeological analyses of rickets and osteomalacia for consideration of the whole-body impact of poor vitamin D nutriture and possible comorbidities that may have affected the wider population. Am J Phys Anthropol 160:183-196, 2016. © 2016 Wiley Periodicals, Inc.

Consumo alimentar de crianças de 12 a 30 meses que frequentam Centros Municipais de Educação Infantil no município de Colombo, Sul do Brasil

Objetivo:Analisar o consumo alimentar de crianças de 12 a 30 meses que frequentam Centros Municipais de Educação Infantil.Métodos:Estudo transversal realizado com 86 crianças dos Centros Municipais de Educação Infantil do município de Colombo, Paraná. O consumo alimentar nas creches foi avaliado pelo método da pesagem direta individual dos alimentos em dois dias não consecutivos e, no domicílio, utilizando-se o recordatório alimentar de 24 horas. Foram analisadas as medianas e o risco de inadequação de energia e de nutrientes de acordo com as Ingestões Dietéticas de Referência e as recomendações do Programa Nacional de Alimentação Escolar.Resultados:A maioria dos nutrientes apresentou ingestão mediana diária acima dos valores recomendados pelas Ingestões Dietéticas de Referência; o cálcio apresentou o maior risco de inadequação entre os nutrientes; 43% das crianças mostraram elevada ingestão energética e o lipídeo apresentou valor abaixo do aceitável. O consumo nas creches foi inferior às recomendações do Programa Nacional de Alimentação Escolar para energia, carboidrato, lipídeo, cálcio, ferro e fibras. A contribuição da ingestão de energia e lipídeo no domicílio foi superior a 50% em relação à ingestão diária.Conclusão:Os valores medianos dos nutrientes, geralmente acima das recomendações, associados aos riscos de inadequação de alguns micronutrientes e ao elevado consumo energético, evidenciam a importância de adequar o consumo alimentar e promover hábitos alimentares saudáveis nas crianças.

Maternal pregravid body mass index and child hospital admissions in the first 5 years of life: results from an Australian birth cohort

OBJECTIVES

To examine the association of maternal pregravid body mass index (BMI) and child offspring, all-cause hospitalisations in the first 5 years of life.

METHODS

Prospective birth cohort study. From 2006 to 2011, 2779 pregnant women (2807 children) were enrolled in the Environments for Healthy Living: Griffith birth cohort study in South-East Queensland, Australia. Hospital delivery record and self-report baseline survey of maternal, household and demographic factors during pregnancy were linked to the Queensland Hospital Admitted Patients Data Collection from 1 November 2006 to 30 June 2012, for child admissions. Maternal pregravid BMI was classified as underweight (<18.5 kg m(-)(2)), normal weight (18.5-24.9 kg m(-)(2)), overweight (25.0-29.9 kg m(-)(2)) or obese (⩾30 kg m(-)(2)). Main outcomes were the total number of child hospital admissions and ICD-10-AM diagnostic groupings in the first 5 years of life. Negative binomial regression models were calculated, adjusting for follow-up duration, demographic and health factors. The cohort comprised 8397.9 person years (PYs) follow-up.

RESULTS

Children of mothers who were classified as obese had an increased risk of all-cause hospital admissions in the first 5 years of life than the children of mothers with a normal BMI (adjusted rate ratio (RR) =1.48, 95% confidence interval 1.10-1.98). Conditions of the nervous system, infections, metabolic conditions, perinatal conditions, injuries and respiratory conditions were excessive, in both absolute and relative terms, for children of obese mothers, with RRs ranging from 1.3-4.0 (PYs adjusted). Children of mothers who were underweight were 1.8 times more likely to sustain an injury or poisoning than children of normal-weight mothers (PYs adjusted).

CONCLUSION

RESULTS suggest that if the intergenerational impact of maternal obesity (and similarly issues related to underweight) could be addressed, a significant reduction in child health care use, costs and public health burden would be likely.