Body mass index and dietary intake among Head Start children and caregivers

Postpartum Obesity Is Associated With Increases in Child Adiposity in Midchildhood in a Cohort of Black and Dominican Youth

Background

Obesity disproportionately affects marginalized and low-income populations. Birth parent obesity from the prenatal period and childhood has been associated with child obesity. It is unknown whether prenatal or postnatal birth parent obesity has differential effects on subsequent changes in adiposity and metabolic health in children.

Objectives

We evaluated how birth parent obesity 7 y after delivery was associated with child body composition changes and cardiometabolic health in midchildhood and further assessed the influence of the perinatal and postpartum period on associations.

Methods

Black and Dominican pregnant individuals were enrolled, and dyads (n = 319) were followed up at child age 7 and 9 y. Measures included, height, weight, waist circumference (WC), and percent body fat (BF%). Multiple linear regression was used to relate postpartum weight status with child outcomes accounting for attrition, and a series of secondary analyses were conducted with additional adjustment for perinatal weight status, gestational weight gain (GWG), and/or long-term weight retention to evaluate how these factors influenced associations.

Results

Almost one-quarter (23%) of birth parents and 24.1% children were classified with obesity at child age 7 y, while at 9 y, 30% of children had obesity. Birth parent obesity at child age 7 y was associated with greater changes, from ages 7 to 9 y, in child BMI z-score (β: 0.13; 95% CI: 0.02, 0.24) and BF% (β: 1.15; 95% CI: 0.22, 2.09) but not obesity at age 9 y. All observed associations crossed the null after additional adjustment for prenatal factors.

Conclusions

Birth parent obesity at 7-y postpartum is associated with greater gains in child BMI z-score and BF% in midchildhood. These associations diminish after accounting for prenatal size, suggesting a lasting impact of the perinatal environment and that interventions supporting families from the prenatal period through childhood are needed.

Predictors of Overweight and Obesity in Early Care and Education Teachers during COVID-19

The purpose of this cross-sectional study was to determine individual, sociocultural, policy, and economic predictors of overweight/obesity in early care and education (ECE) teachers to identify modifiable opportunities to enhance the health of this critical workforce. ECE teachers (n = 1434) in the U.S. completed an online survey in late spring to mid-summer 2020. Teachers self-reported height and weight; body mass index (BMI) and weight status were calculated. Teachers reported micro-environment variables including age, race, gender, obesogenic lifestyle behaviors, well-being, food security, personal health, stress, job stress, type of ECE, COVID-19 teaching modality, and age of children in the classroom. Logistic regression predicting overweight/obesity and linear regression predicting BMI were conducted. Teachers with more years of teaching experience (OR: 1.022: 95% CI 1.005, 1.039) and higher consumption of fast food (2.038: 1.310, 3.169) had higher odds of overweight/obesity. Teachers with higher levels of education (0.58: 0.407, 0.828) and higher physical health (0.836: 0.775, 0.902) had lower odds of overweight/obesity. Other variables were not associated with overweight/obesity. Variables significant in logistic regression were also associated with higher BMI. Additionally, Native American race (β = 2.467 SE = 1.206) and sedentary hours/day (β = 0.152 SE = 0.075) were associated with higher BMI. Implications for enhancing workplace health for these ECE teachers are emerging.

Maternal consumption of ultra-processed foods and subsequent risk of offspring overweight or obesity: results from three prospective cohort studies

OBJECTIVE

To assess whether maternal ultra-processed food intake during peripregnancy and during the child rearing period is associated with offspring risk of overweight or obesity during childhood and adolescence.

DESIGN

Population based prospective cohort study.

SETTING

The Nurses' Health Study II (NHSII) and the Growing Up Today Study (GUTS I and II) in the United States.

PARTICIPANTS

19 958 mother-child (45% boys, aged 7-17 years at study enrollment) pairs with a median follow-up of 4 years (interquartile range 2-5 years) until age 18 or the onset of overweight or obesity, including a subsample of 2925 mother-child pairs with information on peripregnancy diet.

MAIN OUTCOME MEASURES

Multivariable adjusted, log binomial models with generalized estimating equations and an exchangeable correlation structure were used to account for correlations between siblings and to estimate the relative risk of offspring overweight or obesity defined by the International Obesity Task Force.

RESULTS

2471 (12.4%) offspring developed overweight or obesity in the full analytic cohort. After adjusting for established maternal risk factors and offspring's ultra-processed food intake, physical activity, and sedentary time, maternal consumption of ultra-processed foods during the child rearing period was associated with overweight or obesity in offspring, with a 26% higher risk in the group with the highest maternal ultra-processed food consumption (group 5) versus the lowest consumption group (group 1; relative risk 1.26, 95% confidence interval 1.08 to 1.47, P for trend<0.001). In the subsample with information on peripregnancy diet, while rates were higher, peripregnancy ultra-processed food intake was not significantly associated with an increased risk of offspring overweight or obesity (n=845 (28.9%); group 5 v group 1: relative risk 1.17, 95% confidence interval 0.89 to 1.53, P fortrend=0.07). These associations were not modified by age, sex, birth weight, and gestational age of offspring or maternal body weight.

CONCLUSIONS

Maternal consumption of ultra-processed food during the child rearing period was associated with an increased risk of overweight or obesity in offspring, independent of maternal and offspring lifestyle risk factors. Further study is needed to confirm these findings and to understand the underlying biological mechanisms and environmental determinants. These data support the importance of refining dietary recommendations and the development of programs to improve nutrition for women of reproductive age to promote offspring health.

Whole milk compared with reduced-fat milk and childhood overweight: a systematic review and meta-analysis

BACKGROUND

The majority of children in North America consume cow-milk daily. Children aged >2 y are recommended to consume reduced-fat (0.1-2%) cow-milk to lower the risk of obesity.

OBJECTIVES

To evaluate the relation between cow-milk fat consumption and adiposity in children aged 1-18 y.

METHODS

Embase (Excerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), MEDLINE, Scopus, and Cochrane Library databases from inception to August 2019 were used. The search included observational and interventional studies of healthy children aged 1-18 y that described the association between cow-milk fat consumption and adiposity. Two reviewers extracted data, using the Newcastle-Ottawa Scale to assess risk of bias. Meta-analysis was conducted using random effects to evaluate the relation between cow-milk fat and risk of overweight or obesity. Adiposity was assessed using BMI z-score (zBMI).

RESULTS

Of 5862 reports identified by the search, 28 met the inclusion criteria: 20 were cross-sectional and 8 were prospective cohort. No clinical trials were identified. In 18 studies, higher cow-milk fat consumption was associated with lower child adiposity, and 10 studies did not identify an association. Meta-analysis included 14 of the 28 studies (n = 20,897) that measured the proportion of children who consumed whole milk compared with reduced-fat milk and direct measures of overweight or obesity. Among children who consumed whole (3.25% fat) compared with reduced-fat (0.1-2%) milk, the OR of overweight or obesity was 0.61 (95% CI: 0.52, 0.72; P < 0.0001), but heterogeneity between studies was high (I2 = 73.8%).

CONCLUSIONS

Observational research suggests that higher cow-milk fat intake is associated with lower childhood adiposity. International guidelines that recommend reduced-fat milk for children might not lower the risk of childhood obesity. Randomized trials are needed to determine which cow-milk fat minimizes risk of excess adiposity. This systematic review and meta-analysis was registered with PROSPERO (registration number: CRD42018085075).

Urban Preschool Teachers' Nutrition Beliefs, Mealtime Practices, and Associations With Training

OBJECTIVE

To examine preschool teachers' nutrition-related beliefs and practices and explore associations with Eat Well Play Hard in Child Care Settings (EWPHCCS) training.

DESIGN

Causal-comparative study using a post-only, cross-sectional survey exploring teachers' nutrition-related beliefs and mealtime practices.

SETTING

New York City preschools serving low-income children.

PARTICIPANTS

Ethnically diverse preschool teachers (n = 660), 420 (response rate 90.4%) with EWPHCCS training and 240 (response rate 57.1%) without training.

MAIN OUTCOME MEASURES

Teachers' beliefs about their preschool nutrition environments and compliance with recommended mealtime practices.

ANALYSIS

Analysis of variance and hierarchical linear modeling.

RESULTS

Overall, teachers reported generally favorable beliefs about their preschool nutrition environments and compliance with recommended mealtime practices. EWPHCCS teachers reported more favorable scores on beliefs and practices than nontrained teachers. Teachers who were not parents reported significantly lower scores on beliefs and practices than teachers who were parents. White teachers and the least experienced teachers reported the lowest scores on compliance with mealtime practices.

CONCLUSIONS AND IMPLICATIONS

EWPHCCS training was associated with higher scores on both beliefs and practices. However, school-level policy and leadership may also be important. Providing specific training for preschool directors and addressing food quality may further improve teachers' nutrition-related attitudes, beliefs, and practices.

A qualitative study to understand parent and physician perspectives about cow's milk fat for children

OBJECTIVE

Consensus guidelines recommend that children consume reduced-fat (0·1-2 %) cow's milk at age 2 years to reduce the risk of obesity. Behaviours and perspectives of parents and physicians about cow's milk fat for children are unknown. Objectives were to: (i) understand what cow's milk fat recommendations physicians provide to 2-year-old children; (ii) assess the acceptability of reduced-fat v. whole cow's milk in children's diets by parents and physicians; and (iii) explore attitudes and perceptions about cow's milk fat for children.

DESIGN

Online questionnaires and individual interviews were conducted. Questionnaire data were analysed using descriptive statistics. Interview transcripts were analysed using a general inductive approach and thematic analysis.

SETTING

The TARGet Kids! practice-based research network in Toronto, Canada.

PARTICIPANTS

Questionnaire respondents included fifty parents and fifteen physicians; individual interviews were conducted with with fourteen parents and twelve physicians.

RESULTS

Physicians provided various milk fat recommendations for 2-year-old children. Parents also provided different cow's milks: eighteen (36 %) provided whole milk and twenty-nine (58 %) provided reduced-fat milk. Analysis of qualitative interviews revealed three themes: (i) healthy eating behaviours, (ii) trustworthy nutrition information and (iii) importance of dietary fat for children.

CONCLUSIONS

Parents provide, and physicians recommend, a variety of cow's milks for children and hold mixed interpretations of the role of cow's milk fat in children's diets. Clarity about its effect on child adiposity is needed to help make informed decisions about cow's milk fat for children.

Dietary Intake Among Head Start Preschooler-caregiver Dyads

PURPOSE

The purpose of this study was to examine the relationship between Head Start preschooler-caregiver dyad's dietary intake and factors influencing dietary intake.

DESIGN AND METHODS

A cross-sectional, correlational design was used. Height and weight were measured. Caregivers completed an online survey assessing demographics, dietary intake, feeding practices, and psychosocial factors.

RESULTS

Seventy dyads, recruited from two urban Head Start centers in the Midwestern U.S., participated. The mean age for preschoolers and caregivers was 3.90 (63% female) and 28.97 years (94% female), respectively. About 43% of preschoolers and 81% of caregivers were overweight/obese. Sixty-seven percent of caregivers, but only 9% of preschoolers, met the fruit/vegetable (F/V) recommendation. Preschoolers' F/V intake was not significantly correlated with their caregivers' F/V intake after adjusting for demographics and psychosocial factors (B = 0.05, p = .607). Caregiver race (B = -0.71, p = .05), nutrition knowledge (B = -0.35, p = .017), perceived caregiver weight (B = -0.85, p = .035), perceived child weight (B = 1.09, p = .029), and concerns of preschoolers' weight (B = 0.79, p = .004) were significantly correlated with preschoolers' F/V intake, after adjusting for demographics, caregiver F/V intake, and other psychosocial factors.

CONCLUSIONS

The study findings indicate the critical need to improve preschoolers' dietary intake and the important influence of caregivers on their preschoolers' dietary intake. Given the few limitations of the study (e.g., small sample size, food frequency questionnaire), interpretation and application of the study's findings warrant caution.

PRACTICE IMPLICATIONS

Pediatric practitioners and researchers need to design effective programs to improve low-income Head Start preschoolers' dietary intake, thereby helping to curb the current childhood obesity epidemic.

Association between maternal adherence to healthy lifestyle practices and risk of obesity in offspring: results from two prospective cohort studies of mother-child pairs in the United States

OBJECTIVE

To examine the association between an overall maternal healthy lifestyle (characterized by a healthy body mass index, high quality diet, regular exercise, no smoking, and light to moderate alcohol intake) and the risk of developing obesity in offspring.

DESIGN

Prospective cohort studies of mother-child pairs.

SETTING

Nurses' Health Study II (NHSII) and Growing Up Today Study (GUTS) in the United States.

PARTICIPANTS

24 289 GUTS participants aged 9-14 years at baseline who were free of obesity and born to 16 945 NHSII women.

MAIN OUTCOME MEASURE

Obesity in childhood and adolescence, defined by age and sex specific cutoff points from the International Obesity Task Force. Risk of offspring obesity was evaluated by multivariable log-binomial regression models with generalized estimating equations and an exchangeable correlation structure.

RESULTS

1282 (5.3%) offspring became obese during a median of five years of follow-up. Risk of incident obesity was lower among offspring whose mothers maintained a healthy body mass index of 18.5-24.9 (relative risk 0.44, 95% confidence interval 0.39 to 0.50), engaged in at least 150 min/week of moderate/vigorous physical activities (0.79, 0.69 to 0.91), did not smoke (0.69, 0.56 to 0.86), and consumed alcohol in moderation (1.0-14.9 g/day; 0.88, 0.79 to 0.99), compared with the rest. Maternal high quality diet (top 40% of the Alternate Healthy Eating Index 2010 diet score) was not significantly associated with the risk of obesity in offspring (0.97, 0.83 to 1.12). When all healthy lifestyle factors were considered simultaneously, offspring of women who adhered to all five low risk lifestyle factors had a 75% lower risk of obesity than offspring of mothers who did not adhere to any low risk factor (0.25, 0.14 to 0.47). This association was similar across sex and age groups and persisted in subgroups of children with various risk profiles defined by factors such as pregnancy complications, birth weight, gestational age, and gestational weight gain. Children's lifestyle did not significantly account for the association between maternal lifestyle and offspring obesity risk, but when both mothers and offspring adhered to a healthy lifestyle, the risk of developing obesity fell further (0.18, 0.09 to 0.37).

CONCLUSION

Our study indicates that adherence to a healthy lifestyle in mothers during their offspring's childhood and adolescence is associated with a substantially reduced risk of obesity in the children. These findings highlight the potential benefits of implementing family or parental based multifactorial interventions to curb the risk of childhood obesity.

Chemical and non-chemical stressors affecting childhood obesity: a systematic scoping review

Childhood obesity in the United States has doubled over the last three decades and currently affects 17% of children and adolescents. While much research has focused on individual behaviors impacting obesity, little research has emphasized the complex interactions of numerous chemical and non-chemical stressors found in a child's environment and how these interactions affect a child's health and well-being. The objectives of this systematic scoping review were to (1) identify potential chemical stressors in the context of non-chemical stressors that impact childhood obesity; and, (2) summarize our observations for chemical and non-chemical stressors in regards to child-specific environments within a community setting. A review was conducted to identify chemical and non-chemical stressors related to childhood obesity for the childhood life stages ranging from prenatal to adolescence. Stressors were identified and grouped into domains: individual behaviors, family/household behaviors, community stressors, and chemical exposures. Stressors were related to the child and the child's everyday environments and used to characterize child health and well-being. This review suggests that the interactions of chemical and non-chemical stressors are important for understanding a child's overall health and well-being. By considering these relationships, the exposure science research community can better design and implement strategies to reduce childhood obesity.

Beliefs and practices regarding solid food introduction among Latino parents in Northern California

Latino children are more likely to be obese than non-Hispanic white children, and feeding patterns that begin in infancy may contribute to this disparity. The objective of this study was to elucidate beliefs and practices related to the introduction of solids and solid food feeding in the first year of life among low-income Latino parents residing in Northern California. We conducted 26 semi-structured interviews that explored the timing of introduction of solids, selection of foods to serve to infants, feeding strategies, sources of information on solid food feeding and concerns about infant weight. We found that most parents relied on traditional practices in selecting first foods for infants and had a strong preference for homemade food, which was often chicken soup with vegetables. Parents generally described responsive feeding practices; however a minority used pressuring practices to encourage infants to eat more. Very few parents practiced repeated gentle introduction of unfamiliar food to increase acceptance. High calorie low nutrient foods were typically introduced at around 12 months of age and parents struggled to limit such foods once children were old enough to ask for them. Parents were concerned about the possibility of infants becoming overweight and considered health care providers to be an important source of information on infant weight status. The results of this study can be used to inform the development of interventions to prevent obesity in Latino children with similar demographics to our study population.

Changes in household food insecurity are related to changes in BMI and diet quality among Michigan Head Start preschoolers in a sex-specific manner

Children living in households that have recently become food insecure may be particularly vulnerable to adverse weight and dietary changes, but longitudinal studies examining these associations are lacking. Using data from 501 Head Start preschoolers from Michigan (48% male) who were followed during one school year as a part of a randomized obesity prevention trial, we examined changes in children's adiposity indices and dietary quality according to changes in household food insecurity. Household food insecurity change status was categorized as persistently food secure, became food secure, persistently food insecure, or became food insecure. Linear mixed effects models were used to estimate relative changes in BMI-for-age z scores (BAZ), triceps skinfolds-for-age z scores (TAZ), or diet quality (assessed with the 2010 Healthy Eating Index) over the school year according to food insecurity category. We found that girls from households that became food insecure over the year had a 0.21 unit higher gain in BAZ than girls from households that were persistently food secure, after adjustment for potential confounders (95% CI 0.02 to 0.39, P = 0.03). Girls from households that became food secure had improvements in dietary quality over the year compared to girls from persistently food insecure households (adjusted difference in Healthy Eating Index score change = 9.1 points; 95% CI 3.0 to 15.0; p = 0.003). There were no statistically significant associations with changes in TAZ. Among boys, there were no associations between changes in household food insecurity and changes in BAZ, TAZ, or dietary quality. In summary, we found that BMI and diet quality changes of Head Start preschool girls were correlated with short-term changes in household food insecurity. Continued research efforts should focus on identifying the most effective ways to promote the health of children in food insecure households, especially those who may have recently transitioned or are transitioning into food insecurity.

Effectiveness of the Lunch is in the Bag program on communication between the parent, child and child-care provider around fruits, vegetables and whole grain foods: A group-randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of the parent- and early care education (ECE) center-based Lunch is in the Bag program on communication between parent, child, and their ECE center providers around fruits, vegetables and whole grain foods (FVWG).

METHOD

A total of n=30 ECE center; 577 parent-child dyads participated in this group-randomized controlled trial conducted from 2011 to 2013 in Texas (n=15 ECE center, 327 dyads intervention group; n=15 ECE center, 250 dyads comparison group). Parent-child and parent-ECE center provider communication was measured using a parent-reported survey administered at baseline and end of the five-week intervention period. Multilevel linear regression analysis was used to compare the pre-to-post intervention changes in the parent-child and parent-ECE center provider communication scales. Significance was set at p<0.05.

RESULTS

At baseline, parent-child and parent-ECE center provider communication scores were low. There was a significant increase post-intervention in the parent-ECE center provider communication around vegetables (Adjusted β=0.78, 95%CI: 0.13, 1.43, p=0.002), and around fruit (Adjusted β=0.62, 95%CI: 0.04, 0.20, p=0.04) among the parents in the intervention group as compared to those in the comparison group. There were no significant intervention effects on parent-child communication.

CONCLUSION

Lunch is in the Bag had significant positive effects on improving communication between the parents and ECE center providers around FVWG.

Food security, maternal feeding practices and child weight-for-length

BACKGROUND

Over consumption of energy-dense nutrient-poor foods may contribute to childhood obesity. We hypothesized that greater than recommended servings of sugar sweetened beverages and foods, indicators of food security, and a high maternal recumbent weight-for-length are positively associated with high percentages of child overweight/obesity.

METHODS

This secondary data analysis consisted of a sample of 240 mother-child dyads. The original studies were designed to examine the effect of a public health nursing intervention on optimal childhood growth for low-income, minority children. Eligibility to participate included: 1) mothers self-identified as Hispanic; 2) children were 12-24 months old; and 3) children were enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC); and 4) children were free of any major disease. Multivariate logistic regression examined the association between child weight, weight-for-length, maternal recumbent weight-for-length, child's eating schedule, maternal attitudes on feeding, food security, and consumption of sugar-sweetened beverages, desserts and fatty meats.

RESULTS

Receiving SNAP was positively associated with child weight-for-length (WL). Children whose mothers reported ever having received SNAP were 2.01 times more likely to be overweight compared to children whose mothers did not report ever having received SNAP (95% CI=1.04-3.90). Children who consumed desserts were 2.87 times more likely to be overweight compared to children who did not consume desserts (95% CI=1.19-6.88). Also, child's caloric intake was significantly associated with child WL. Children who consumed more calories were 1.00 times more likely to be overweight compared to children who consumed fewer calories (95% CI=1.00-1.00).

DISCUSSION

Research on food security and children's weight has reported mixed findings. Methodological issues have been identified as contributory to the inconsistent findings. Of paramount importance to these studies is the measurement of low food security.

CONCLUSION

Children in this sample who were food insecure, as indicated by SNAP recipients, were more likely to have a higher WL measurement. Future studies should focus on the correlation between food security and hunger/satiety cues.

Home food availability, parental dietary intake, and familial eating habits influence the diet quality of urban Hispanic children

BACKGROUND

The home food environment influences children's eating behaviors and potentially affects overall diet quality. The aim of the present study was to evaluate the relationship between the home food environment and Hispanic children's diet quality.

METHODS

Hispanic children, 10-14 years of age (n=187), and their parents participated in this cross-sectional study. The Healthy Eating Index (HEI) was used to determine diet quality based on reported dietary intake obtained through a food frequency questionnaire administered to the children. Parents self-reported home food availability, familial eating habits, and their own habitual diet through a home environment survey.

RESULTS

The children's HEI total score was 59.4±8.8. Reported diets did not adhere to the dietary recommendations for total vegetables, greens and beans, whole grains, seafood and plant proteins, fatty acids, refined grains, sodium, solid fats, and added sugars. None of the participants had "good" scores (HEI, >80), 86% had scores that "need improvement" (HEI, 51-80), and 14% had "poor" scores (HEI, <50). Children with lower HEI scores had sugar-sweetened beverages available at home and participated in family meals while watching television more frequently, when compared with children with higher HEI scores.

CONCLUSIONS

Home food availability, parental diet, and familial eating habits seem to play an important role in the diet quality of children. Interventions targeting family education on healthful dietary habits at home could have a positive impact on children's diet quality and overall health.

Determinants of fruit and vegetable intake in low-income children and adolescents

Although low-income youth are likely to have low or less frequent fruit and vegetable intake, current understanding of the influences on intake in youth is limited. A systematic review of quantitative research on determinants of fruit and vegetable intake among low-income youth (i.e., persons aged <20 years) was conducted. The aims were to identify which determinants have been studied and which are consistently associated with intake. Fifty-eight papers published between 2003 and August 2013 were included. Across studies, 85 unique determinants were identified. Those best supported by evidence were race/ethnicity (with intake consistently higher among Hispanic as compared with African American and white youth), fruit and vegetable preferences, and maternal fruit and vegetable intake. For many potential determinants, the consistency of evidence could not be examined because of a lack of studies. Findings highlight racial/ethnic differences in fruit and vegetable intake and influences on intake that should be considered when designing dietary interventions for low-income youth. Further research on intake determinants in this at-risk population is needed to establish an evidence base to guide interventions.

Cardiovascular disease risk factors are elevated in urban minority children enrolled in head start

BACKGROUND

The prevalence of obesity and overweight persists in the preschool population, despite some prevention and treatment advances, particularly in minorities. Investigating the prevalence of dyslipidemia and the effect of family health may also guide the focus of intervention efforts.

METHODS

Anthropometric data were collected from urban minority preschool children (n=161; 42% female) enrolled in USDA Head Start. Blood was collected by finger prick and analyzed with the Cholestech LDX Analyzer (Cholestech Corporation, Hayward, CA). Caregivers provided a self-reported family health history for cardiovascular diseases (CVDs).

RESULTS

By BMI percentile, 8% of the children were underweight (UW), 54% healthy weight (HW), 10% overweight (OW), and 28% obese (OB). One of every 5 children had borderline or high-risk levels for total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides based on the National Cholesterol Education Program categories. In OW/OB children only, BMI was positively correlated with TC (r(61)=0.428; p=0.001) and LDL (r(58)=0.395; p=0.005). Child BMI was also associated with family comorbid diseases (r(159)=0.177; p=0.025). UW/HW children with a family history of CVD had significantly higher LDL than UW/HW children without a family history of CVD (p=0.001). Step-wise regression analysis revealed that BMI (p=0.005) plus family history of heart attack (p=0.018) were significant predictors of blood TC levels.

CONCLUSION

Continued efforts to treat and prevent elevated weight are urgently needed for minority preschoolers. Attention to CVD screening may be an important target in school, community, and healthcare arenas for minority populations regardless of weight status.

Nutrition-related knowledge, attitudes, and dietary behaviors among head start teachers in Texas: a cross-sectional study

Head Start teachers are responsible for providing nutrition education to over 1 million low-income children annually, yet little is known about their nutrition-related knowledge, attitudes, and behaviors. The purpose of this study is to assess the self-reported nutrition knowledge, attitudes, and behaviors among Head Start teachers from one urban Head Start organization in Harris County, TX. A cross-sectional, descriptive analysis was conducted using baseline surveys in the 2008-2009 school year. One hundred eighty-one Head Start teachers completed self-reported surveys of their nutrition knowledge, attitudes, behaviors, weight status, and other weight-related behaviors. The sample was predominantly female (97%) and minority (93%); 24% were overweight and 55% were obese. One fourth of the sample did not consume fruit (26%) or vegetables (23%) the previous day. Half of the teachers reported consuming french fries (52%) and soda (44%), and one fourth consumed fried meat (28%) at least once on the previous day. Only four teachers (3%) answered at least four of the five nutrition knowledge questions correctly. Half of the teachers (54%) agreed that it was hard to know which nutrition information to believe, and only 9% reported that their nutrition habits were healthy. A majority of teachers were trying to lose weight (71%) and said they would like to weigh less (81%). This study underscores the importance of providing nutrition education and wellness opportunities to Head Start teachers to better enable them to teach nutrition education to their students and to improve their own health.

Evaluation of a childhood obesity awareness campaign targeting head start families: designed by parents for parents

The Communities for Healthy Living program used a community-based participatory research (CBPR) approach to empower Head Start parents in designing and pilot testing a multi-component family-centered obesity prevention program. One program component was a childhood obesity awareness campaign addressing common parental misconceptions about obesity. The campaign was designed by a community advisory board of parents to target specific issues identified within their own community. Results from pre-post intervention surveys (N=108) showed that campaign exposure was high; 92% of responding parents reported noticing the campaign. Parents also demonstrated significant increases in awareness of childhood obesity, along with decreases in obesity-related misconceptions. Findings, supported by growing literature on CBPR, suggest a CBPR approach to campaign development is an effective strategy to promote parent awareness of childhood obesity.

Need for early interventions in the prevention of pediatric overweight: a review and upcoming directions

Childhood obesity is currently one of the most prevailing and challenging public health issues among industrialized countries and of international priority. The global prevalence of obesity poses such a serious concern that the World Health Organization (WHO) has described it as a "global epidemic." Recent literature suggests that the genesis of the problem occurs in the first years of life as feeding patterns, dietary habits, and parental feeding practices are established. Obesity prevention evidence points to specific dietary factors, such as the promotion of breastfeeding and appropriate introduction of nutritious complementary foods, but also calls for attention to parental feeding practices, awareness of appropriate responses to infant hunger and satiety cues, physical activity/inactivity behaviors, infant sleep duration, and family meals. Interventions that begin at birth, targeting multiple factors related to healthy growth, have not been adequately studied. Due to the overwhelming importance and global significance of excess weight within pediatric populations, this narrative review was undertaken to summarize factors associated with overweight and obesity among infants and toddlers, with focus on potentially modifiable risk factors beginning at birth, and to address the need for early intervention prevention.