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Mokhtari P, Holzhausen EA, Chalifour BN, Schmidt KA, Babaei M, Machle CJ, Adise S, Alderete TL, Goran MI. Associations between Dietary Sugar and Fiber with Infant Gut Microbiome Colonization at 6 Mo of Age. J Nutr 2024; 154:152-162. [PMID: 37717629 PMCID: PMC10808822 DOI: 10.1016/j.tjnut.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND The taxonomic composition of the gut microbiome undergoes rapid development during the first 2-3 y of life. Poor diet during complementary feeding has been associated with alterations in infant growth and compromised bone, immune system, and neurodevelopment, but how it may affect gut microbial composition is unknown. OBJECTIVES This cross-sectional study aimed to examine the associations between early-life nutrition and the developing infant gut microbiota at 6 mo of age. METHODS Latino mother-infant pairs from the Mother's Milk Study (n = 105) were included. Infant gut microbiota and dietary intake were analyzed at 6 mo of age using 16S ribosomal RNA amplicon sequencing and 24-h dietary recalls, respectively. Poisson generalized linear regression analysis was performed to examine associations between dietary nutrients and microbial community abundance while adjusting for infants' mode of delivery, antibiotics, infant feeding type, time of introduction of solid foods, energy intake, and body weight. A P value of <0.05 was used to determine the statistical significance in the study. RESULTS Infants with higher consumption of total sugar exhibited a lower relative abundance of the genera Bacteroides (β = -0.01; 95% CI: -0.02, -0.00; P = 0.03) and genus Clostridium belonging to the Lachnospiraceae family (β = -0.02; 95% CI: -0.03, -0.00; P = 0.01). In addition, a higher intake of free sugar (which excludes sugar from milk, dairy, and whole fruit) was associated with several bacteria at the genus level, including Parabacteroides genus (β = 0.03; 95% CI: 0.01, 0.05; P = 0.001). Total insoluble fiber intake was associated with favorable bacteria at the genus level such as Faecalibacterium (β = 0.28; 95% CI: 0.03, 0.52; P = 0.02) and Coprococcus (β = 0.28; 95% CI: 0.02, 0.52; P = 0.03). CONCLUSION These findings demonstrate that early-life dietary intake at 6 mo impacts the developing gut microbiome associated with the presence of both unfavorable gut microbes and dietary fiber-associated commensal microbes.
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Affiliation(s)
- Pari Mokhtari
- Department of Pediatrics, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Elizabeth A Holzhausen
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Bridget N Chalifour
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Kelsey A Schmidt
- Department of Pediatrics, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Mahsa Babaei
- Department of Pediatrics, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Christopher J Machle
- Department of Pediatrics, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Shana Adise
- Department of Pediatrics, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Tanya L Alderete
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, United States
| | - Michael I Goran
- Department of Pediatrics, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States.
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Beck AL, Mora R, Joseph G, Perrin E, Cabana M, Schickedanz A, Fernandez A. A Multimethod Evaluation of the Futuros Fuertes Intervention to Promote Healthy Feeding, Screen Time, and Sleep Practices. Acad Pediatr 2023; 23:1351-1360. [PMID: 37211275 DOI: 10.1016/j.acap.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/26/2023] [Accepted: 05/16/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE 1) To evaluate the impact of the Futuros Fuertes intervention on infant feeding, screen time, and sleep practices and 2) To use qualitative methods to explore mechanisms of action. METHODS Low-income Latino infant-parent dyads were recruited from birth to 1 month and randomized to Futuros Fuertes or a financial coaching control. Parents received health education sessions from a lay health educator at well-child visits in the first year of life. Parents received two text messages per week that reinforced intervention content. We assessed infant feeding, screen time, and sleep practices via surveys. body mass index z-score (BMI-z) was measured at 6 and 12 months. Seventeen parents from the intervention arm participated in a semi-structured interview that explored parental experiences with the intervention. RESULTS There were n = 96 infant-parent dyads randomized. Fruit intake was higher in the intervention group at 15 months (1.1 vs 0.86 cups p = 0.05). Breastfeeding rates were higher in intervention participants at 6 months (84% vs 59% p = 0.02) and 9 months (81% vs 51% p = 0.008). Mean daily screen time was lower among intervention participants at 6 months (7 vs 22 min p = 0.003), 12 months (35 vs 52 min p = 0.03), and 15 months (60 vs 73 min p = 0.03). Major qualitative themes include 1) parental trust in intervention messaging 2) changes in feeding and screen time parenting practices, 3) text messages supported behavior change for parents and family members, and 4) varying effectiveness of intervention on different health behaviors. CONCLUSIONS Low-income Latino infants participating in the Futuros Fuertes intervention had modestly healthier feeding and screen time practices compared to control participants.
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Affiliation(s)
- Amy L Beck
- Department of Pediatrics, School of Medicine (AL Beck), University of California San Francisco.
| | - Rosa Mora
- School of Medicine (R Mora), University of California San Francisco
| | - Galen Joseph
- Department of Humanities and Social Medicine, School of Medicine (G Joseph), University of California San Francisco
| | - Eliana Perrin
- Department of Pediatrics, Schools of Medicine and Nursing (E Perrin), Johns Hopkins University, Baltimore, Md
| | - Michael Cabana
- Department of Pediatrics (M Cabana), Albert Einstein College of Medicine, New York, NY
| | - Adam Schickedanz
- Department of Pediatrics (A Schickedanz), University of California Los Angeles
| | - Alicia Fernandez
- Department of Medicine (A Fernandez), University of California San Francisco
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MacMillan Uribe AL, Rudt HG, Leak TM. Cultural influences on infant and toddler feeding among low-income Latinx mothers. MATERNAL & CHILD NUTRITION 2022; 18:e13342. [PMID: 35702987 PMCID: PMC9480920 DOI: 10.1111/mcn.13342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022]
Abstract
Latinx infants and toddlers experience higher obesity rates than their black or white counterparts, increasing chronic disease risk later in life. Infant and toddler feeding (ITF) interventions are shown to improve dietary behaviours, but few studies target Latinx populations. Culturally tailoring such interventions is imperative, but cultural influences on Latinx ITF practices remain unclear. The purpose of this study was to characterize how culture influences ITF practices among Latinx mothers of low income. A brief survey and semistructured interview informed by the theory of planned behaviour (TPB) were conducted on Zoom with New York City-based Latinx mothers of children 4 to 24 months old. A directed content analysis approach was used to identify themes using TPB theoretical codes and inductive codes. Transcripts were coded independently by two researchers using NVivo 12. Survey data were analyzed using descriptive statistics in Excel. Participants (n = 19) were of Dominican, Mexican and Central and South American origin, had low acculturation scores and mean child age was 16.7 months (range: 5-24 months old). The central theme identified was that participants balanced cultural information with evidence-based health information to determine which ITF practices were most beneficial to infant/toddler health. This resulted in the adoption of evidence-based ITF recommendations, adoption of cultural practices that aligned with evidence-based recommendations and dismissal or postponement of cultural ITF practices that contradicted evidence-based recommendations. The present results can be applied to culturally relevant ITF education as follows: emphasizing the benefits of desirable ITF practices on children's health and promoting healthy cultural ITF practices.
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Affiliation(s)
- Alexandra L. MacMillan Uribe
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
- Institute for Advancing Health Through AgricultureTexas A&M AgriLife ResearchDallasTexasUnited States
| | - Hannah G. Rudt
- Division of Nutritional SciencesCornell UniversityIthacaNew YorkUSA
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DeJesus JM. Judgments about appropriate foods for infants: Associations with parents’ own food preferences. Front Nutr 2022; 9:954981. [PMID: 36061904 PMCID: PMC9434009 DOI: 10.3389/fnut.2022.954981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/01/2022] [Indexed: 11/25/2022] Open
Abstract
When infants begin to eat solid foods (recommended at around 6 months of age), parents have a huge variety of choices in terms of what foods to offer. The present studies examine parents’ judgments about foods for infants. Participants included parents recruited from Prolific (n = 99), who were shown descriptions of foods offered to infants (including familiar and unfamiliar foods at 6-, 9-, and 12-months) and a set of control foods eaten by adults. Participants rated each food based on how appropriate they thought it was for an infant and how much they personally wanted to eat the food. Parents rated foods as more appropriate for infants if they were familiar (vs. unfamiliar) and offered to younger infants (6- vs. 12-month-olds, or infant foods vs. adult foods), but demonstrated the opposite pattern when considering whether they wanted to eat each food. Participants’ own food pickiness was related to their judgments about what they would eat, but not whether foods were appropriate for infants. Parents’ judgments of individual foods were inversely related: The more appropriate they rated each food for an infant, the less they were interested in eating that food. These findings are discussed in terms of potential barriers to engaging in social modeling (i.e., parents demonstrating eating and liking the foods they offer to their infants).
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Oliveira MSDS, Unsain RAF, Sato PDM, Ulian MD, Scagliusi FB. Mulheres Comem, Mães Cozinham: uma aproximação da construção da maternidade e das práticas culinárias domésticas na Amazônia Ocidental Brasileira. SAUDE E SOCIEDADE 2022. [DOI: 10.1590/s0104-12902022211025pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Resumo Este artigo objetiva descrever e discutir as maneiras como a maternidade é praticada e representada nas práticas culinárias domésticas das mulheres na Amazônia ocidental brasileira. Desenvolvemos um estudo qualitativo descritivo, conduzimos entrevistas em profundidade com 16 mulheres que eram mães e que cozinhavam em domicílio. Os dados foram analisados identificando as unidades de significância regulares, expressivas e significativas coletadas por meio das entrevistas. Essas mulheres, quando não tinham filhos, realizavam práticas culinárias atendendo suas demandas pessoais e horários do trabalho extradomiciliar. A partir da gestação, porém mais marcadamente após o parto, as mulheres modificam suas práticas culinárias se apropriando das ideias hegemônicas pré-construídas do que é ser uma mãe, desenvolvendo atividades culinárias mais rotineiras, não discricionárias, focadas no cuidado dos membros da família e com maior investimento de tempo e esforço. Estas mudanças reforçam a concepção de que a relação mãe e criança deve estar orientada para uma maternidade intensiva.
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Ventura AK, Phelan S, Silva Garcia K. Maternal Diet During Pregnancy and Lactation and Child Food Preferences, Dietary Patterns, and Weight Outcomes: a Review of Recent Research. Curr Nutr Rep 2021; 10:413-426. [PMID: 34383279 DOI: 10.1007/s13668-021-00366-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Efforts to promote children's preferences for healthy foods hold much potential for improving diet quality and preventing obesity. The purpose of this review was to summarize recent evidence for associations between maternal diet during pregnancy and lactation and child food preferences, dietary patterns, and weight outcomes. RECENT FINDINGS Recent research illustrates greater maternal vegetable intakes during pregnancy and lactation predict greater child preferences for and intakes of vegetables. Recent randomized clinical trials to improve maternal weight outcomes during the perinatal period via behavioral lifestyle interventions that included dietary components have yielded mixed findings for effects on child weight outcomes. There is strong evidence that maternal diet during pregnancy and lactation shapes flavor preferences during infancy; more research is needed to understand factors that facilitate versus hinder the translation of these preferences to later dietary patterns and weight outcomes.
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Affiliation(s)
- Alison K Ventura
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, One Grand Ave, San Luis Obispo, CA, 93407, USA.
| | - Suzanne Phelan
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, One Grand Ave, San Luis Obispo, CA, 93407, USA
| | - Karina Silva Garcia
- Department of Kinesiology and Public Health, Center for Health Research, California Polytechnic State University, One Grand Ave, San Luis Obispo, CA, 93407, USA
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Parental considerations during complementary feeding in higher income countries: a systematic review of qualitative evidence. Public Health Nutr 2021; 24:2834-2847. [PMID: 33877043 PMCID: PMC9884778 DOI: 10.1017/s1368980021001749] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Worldwide data suggest a clash between parental complementary feeding practices and recommendations. Understanding the circumstances under which parents form their feeding practices is a crucial step to improve such practices. This paper aimed to systematically review the existing qualitative literature and synthesise the factors that parents take into consideration in relation to complementary feeding. DESIGN A systematic review was undertaken. Four electronic databases were searched for qualitative studies published after 2001 exploring parental experiences during complementary feeding. A framework that included authors' outcomes of interest was used to extract and synthesise study findings. The Standards for Reporting Qualitative Research were used to critically assess the included studies. SETTING Upper-middle- and high-income countries. PARTICIPANTS Parents with a child below the age of 3 years. RESULTS A total of forty-seven studies met the eligibility criteria and were included in this systematic review. The themes were organised into three main categories: (1) factors related to introduction of complementary foods; (2) factors related to the type of complementary foods and (3) factors related to both timing and type. The selected literature highlights: prevalent baby cues that prompt parents to introduce solid foods; parents' views on the recommended timing of complementary feeding; factors that drive the choice of complementary foods and perceived value in advice received from health professionals and grandmothers. CONCLUSIONS This systematic review indicates factors that can be barriers to complying with the complementary feeding guidelines, and therefore, its findings are pertinent to improving parental feeding practices through intervention studies and through infant feeding education in a primary care setting.
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Samady W, Campbell E, Aktas ON, Jiang J, Bozen A, Fierstein JL, Joyce AH, Gupta RS. Recommendations on Complementary Food Introduction Among Pediatric Practitioners. JAMA Netw Open 2020; 3:e2013070. [PMID: 32804213 PMCID: PMC7431991 DOI: 10.1001/jamanetworkopen.2020.13070] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022] Open
Abstract
Importance The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend waiting 3 to 5 days between the introduction of new complementary foods (solid foods introduced to infants <12 months of age), yet with advances in the understanding of infant food diversity, the guidance that pediatric practitioners are providing to parents is unclear. Objective To characterize pediatric practitioner recommendations regarding complementary food introduction and waiting periods between introducing new foods. Design, Setting, and Participants In this survey study, a 23-item electronic survey on complementary food introduction among infants was administered to pediatric health care professionals from February 1 to April 30, 2019. Responses were described among the total sample and compared among subgroups. Survey invitations were emailed to 2215 members of the Illinois Chapter of the American Academy of Pediatrics and the national American Academy of Pediatrics' Council on Early Childhood. Participants were required to be primary medical practitioners, such as physicians, resident physicians, or nurse practitioners, providing pediatric care to infants 12 months or younger. Main Outcomes and Measures The main outcome measures were recommendations on age of complementary food introduction and waiting periods between the introduction of new foods. Categorical survey items were reported as numbers (percentages) and 95% CIs. Means (SDs) were used to describe continuous survey items. Results The survey was sent to 2215 practitioners and completed by 604 (response rate, 27.3%). Of these respondents, 41 were excluded because they did not provide care for infants or pediatric patients. The final analyses included responses from 563 surveys. Of these, 454 pediatricians (80.6%), 85 resident physicians (15.1%), and 20 nurse practitioners (3.6%) completed the survey. Only 217 practitioners (38.6%; 95% CI, 34.1%-44.6%) recommended waiting 3 days or longer between food introduction; 259 practitioners (66.3%; 95% CI, 61.4%-70.8%) recommended waiting that amount of time for infants at risk for food allergy development (P = .02). A total of 264 practitioners (46.9%; 95% CI, 42.8%-51.0%) recommended infant cereal as the first food, and 226 practitioners (40.1%; 95% CI, 36.1%-44.2%) did not recommend a specific order. A total of 268 practitioners (47.6%; 95% CI, 43.5%-51.7%) recommended food introduction at 6 months for exclusively breastfed (EBF) infants, and 193 (34.3%; 95% CI, 30.5%-38.3%) recommended food introduction at 6 months for non-EBF infants (P < .001); 179 practitioners (31.8%; 95% CI, 28.1%-35.8%) recommended food introduction at 4 months for EBF infants, and 239 practitioners (42.5%; 95% CI, 38.4%-46.6%) recommended food introduction at 4 months for non-EBF infants (P < .001). A need for additional training on complementary food introduction was reported by 310 practitioners (55.1%; 95% CI, 50.9%-59.1%). Conclusions and Relevance In this survey study, most pediatric practitioners did not counsel families to wait 3 days or longer between introducing foods unless infants were at risk for food allergy development. The findings suggest that the current recommendation limits infant food diversity and may delay early peanut introduction. Because the approach to food allergy prevention has changed, a reevaluation of published feeding guidelines may be necessary.
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Affiliation(s)
- Waheeda Samady
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily Campbell
- Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ozge Nur Aktas
- Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Jialing Jiang
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alexandria Bozen
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jamie L. Fierstein
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alanna Higgins Joyce
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ruchi S. Gupta
- Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Dattilo AM, Carvalho RS, Feferbaum R, Forsyth S, Zhao A. Hidden Realities of Infant Feeding: Systematic Review of Qualitative Findings from Parents. Behav Sci (Basel) 2020; 10:E83. [PMID: 32349324 PMCID: PMC7287829 DOI: 10.3390/bs10050083] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 01/22/2023] Open
Abstract
A growing, global conversation, regarding realities and challenges that parents experience today is ever-present. To understand recent parent's attitudes, beliefs, and perceptions regarding infant feeding, we sought to systematically identify and synthesize original qualitative research findings. Following the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) framework, electronic databases were searched with a priori terms applied to title/abstract fields and limited to studies published in English from 2015 to 2019, inclusive. Study quality assessment was conducted using the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed. Of 73 studies meeting inclusion criteria, four major themes emerged. (1) Breastfeeding is best for an infant; (2) Distinct attitudes, beliefs, and perceptions of mothers that breastfeed, and those that could not or chose not to breastfeed, are evident; (3) Infant feeding behaviors are influenced by the socio-cultural environment of the family, and (4) Parent's expectations of education and support addressing personal infant feeding choices from health care providers are not always met. This systematic review, guided by constructs within behavioral models and theories, provides updated findings to help inform the development of nutrition education curricula and public policy programs. Results can be applied within scale-up nutrition and behavioral education interventions that support parents during infant feeding.
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Affiliation(s)
- Anne M. Dattilo
- Nestlé Nutrition, Avenue Nestle, 55 CH-1800 Vevey, Switzerland;
| | | | - Rubens Feferbaum
- Children’s Institute University of São Paulo, Rua Tremembé, São Paulo-SP 01256-010, Brazil;
| | - Stewart Forsyth
- School of Medicine, University of Dundee, Dundee DD5 1JG, UK;
| | - Ai Zhao
- School of Public Health, Peking University Health Science Center, Xueyuan Road No. 38., Beijing 100191, China;
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Hepworth AD, Berlin LJ, Martoccio TL, Jones Harden B. Maternal attachment style, sensitivity, and infant obesity risk in low-income, Latino families. Attach Hum Dev 2020; 23:75-89. [PMID: 32126901 DOI: 10.1080/14616734.2020.1729214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Disparities in childhood obesity highlight the need for research to identify its early predictors in high-risk populations, such as low-income, Latino families. In the current study, the first of its kind in a low-income Latino sample (N = 55; M child age = 12.74 months, SD = 3.96), we investigated whether mothers' self-reported attachment style predicted their infants' weight-for-length (WFL; an early indicator of childhood obesity). We also explored whether observed maternal sensitivity, coded from a video-recorded semi-structured play assessment, mediated this association. We found a significant direct effect of maternal attachment style on infants' WFL z-scores (c' = -0.68, SE = 0.22, p = .004). Infants of mothers who classified themselves as secure had lower WFL z-scores than infants of insecure mothers (avoidant or anxious). Maternal sensitivity did not mediate this association, but was positively associated with infant WFL z-scores. We discuss implications of these findings for future research.
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Affiliation(s)
- Allison D Hepworth
- Department of Social Work, University of Maryland School of Social Work , Baltimore, MD, USA
| | - Lisa J Berlin
- Department of Social Work, University of Maryland School of Social Work , Baltimore, MD, USA
| | - Tiffany L Martoccio
- Department of Human Development and Quantitative Methodology, University of Maryland , College Park, MD, USA
| | - Brenda Jones Harden
- Department of Social Work, University of Maryland School of Social Work , Baltimore, MD, USA.,Department of Human Development and Quantitative Methodology, University of Maryland , College Park, MD, USA
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