Age of Juice Introduction and Child Anthropometry at 2-3 and 7-9 Years

Projected Impact of Replacing Juice With Whole Fruit in Early Care and Education

INTRODUCTION

The purpose of this study was to simulate potential changes in dietary intake and food costs by replacing juice with whole fruit among children ages 1-5 years attending U.S. early care and education settings between 2008 and 2020.

METHODS

Estimated mean changes in daily intake of calories, sugar, fiber, calcium, vitamin C and overall food costs under plausible scenarios of replacing juice with whole fruit. Researchers fit hierarchical regression with children nested within early care and education nested within studies, adjusting for potential confounders.

RESULTS

The sample consisted of 6,304 days of direct observation (90% aged 2 years or older, 51% female, 38% Black/African American) in 846 early care and education facilities (73% centers, 75% Child and Adult Care Food Program participants). Replacing juice with whole fruit would reduce energy intake by 8.2-27.3 kcal/day, reduce sugar by 3.4-5.6 g/d, increase fiber by 0.5-1.3 g/d, and have negligible impact on vitamin C and calcium. Replacing juice with whole fruit in early care and education would increase per-child daily food costs between $0.44 and 0.49, representing an increase from 3.8% for juice to approximately 9.8%-10.7% for whole fruit as a percent of total food costs.

CONCLUSIONS

Replacing juice with whole fruit in early care and education would result in increased fiber intake and decreased sugar and calories. A policy to replace juice with whole fruit in early care and education would likely cause an increased daily food cost and given the potential broad benefit of this dietary intervention, there may be reason to expand funding within nutrition assistance programs in early care and education.

Socioeconomic Characteristics and the Home Food Environment Are Associated With Feeding Healthful and Discretionary Foods During the First Year of Life in the Pregnancy Eating Attributes Study

BACKGROUND

Feeding of nutrient-poor foods begins in infancy and may adversely influence long-term food preferences.

OBJECTIVE

To examine associations of socioeconomic characteristics, childbearing parent eating behaviors, and home food environment with infant feeding characteristics.

DESIGN

Secondary analysis of a prospective cohort study from first trimester of pregnancy through 12 months postpartum.

PARTICIPANTS/SETTING

Participants with uncomplicated singleton pregnancies and no major chronic illness were enrolled from November 2014 through October 2016 from 2 university-based obstetrics clinics in Chapel Hill, NC. Of 458 enrolled, 321 were retained through 12 months postpartum.

MAIN OUTCOME MEASURES

Participants completed infant food frequency questionnaires indicating age at introduction and frequency of consuming multiple food groups. Exposures included childbearing parent socioeconomic characteristics, hedonic hunger, addictive-like eating, Healthy Eating Index 2015 calculated from three 24-hour diet recalls, and home food environment fruit/vegetable and obesogenic scores.

STATISTICAL ANALYSES PERFORMED

Multiple imputation using Heckman selection model; linear and logistic regressions examining associations with infant feeding characteristics.

RESULTS

Lower education and income were associated with later infant age at introduction to, and lower frequency of consuming fruits and vegetables at age 12 months. Socioeconomic characteristics were not associated with age at introduction to discretionary solid foods; however, lower education and income were associated with greater infant frequency of intake of discretionary foods and greater odds of introducing fruit juice and sweetened beverages by age 12 months. Childbearing parent Healthy Eating Index 2015, hedonic hunger, and addictive-like eating were not consistently associated with infant feeding characteristics. A more obesogenic food environment was associated with greater frequency of intake of discretionary foods, lower frequency of intake of fruit, and greater odds of fruit juice introduction by age 12 months.

CONCLUSIONS

Infant feeding characteristics may be important intervention targets for addressing socioeconomic disparities in child diet quality. Efforts to reduce routine feeding of discretionary foods across socioeconomic groups are needed; modifying the home food environment may promote healthful infant feeding.

A study of parental knowledge and intended behaviour regarding introduction of juices and sugar-sweetened beverages in early childhood

Background

Parents and families have a role to play in helping children develop healthy behaviours that will carry over into adulthood. The sugary drink and fruit juice consumption is significantly related to unhealthy weight gain in childhood. Hence, this study was planned to assess parental knowledge, attitudes, and practices about juice and sugar-sweetened beverages (SSBs) among parents of children (2-24 months) and identify factors that contribute to their early introduction.

Methods and Material

A cross-sectional study was conducted on 400 children-parent dyads (2-24 months). A questionnaire regarding the knowledge and attitudes about initiating fruit juice and SSB among children was prepared with 6 statements that were validated for contents by two subject experts. Each of the questions was designed to be answered on a Five-point Likert-type scale. STATA 14.2 version was used to analyse data.

Results

Out of 400, 14 (26.9%) and 125 (68%) parents planned to introduce SSBs and juices respectively in the first year life of their child. None of the parents had an excellent knowledge score. There was no significant difference reported between parents with less than high school and those with high school/graduation educated in their intention to introduce juice and SSBs (P = 0.68) to their babies in the first year of life and about its knowledge (P = 0.82). Most parents with lower socio-economic status (58.6%) showed less likeliness to introduce juices and SSBs to their child's diet as reflected by a statistically significant (P = 0.01) knowledge score.

Conclusion

There was a knowledge gap among parent's of children irrespective of their education level and socio-economic status.

Age of Juice Introduction and Cardiometabolic Outcomes in Middle Childhood

BACKGROUND

The American Academy of Pediatrics recommends juice introduction after 12 months of age. Juice consumption has been linked to childhood obesity and cardiometabolic risk.

OBJECTIVES

To examine the prospective relationship between the age of juice introduction and primary and secondary cardiometabolic outcomes in middle childhood.

METHODS

Parents reported the age of juice introduction on Upstate KIDS questionnaires completed between 4 and 18 months. The quantity and type of juice introduced were not measured. Anthropometry, blood pressure (BP), and arterial stiffness by pulse wave velocity (PWV) were measured for 524 children (age, 8-10 y) at study visits (2017-2019). Age- and gender-adjusted z-scores were calculated using the Centers for Disease Control and Prevention reference for anthropometrics. Plasma lipids, hemoglobin A1c (HbA1c), and C-reactive protein (CRP) in a subset of children were also measured (n = 248). Associations between age at juice introduction (categorized as <6, 6 to <12, ≥12 months), and outcomes were estimated using mean differences and odds ratios, applying generalized estimating equations to account for correlations between twins.

RESULTS

Approximately 18% of children were introduced to juice at <6 months, 52% between 6 and <12 months, and 30% ≥ 12 months of age. Children who were introduced to juice before 6 months had higher systolic BP (3.13 mmHg; 95% confidence interval [CI]: 0.52, 5.74), heart rate (4.46 bpm; 95% CI: 1.05, 7.87), and mean arterial pressure (2.08 mmHg; 95% CI: 0.15, 4.00) compared with those introduced ≥12 months after covariate adjustment including sociodemographic factors and maternal prepregnancy body mass index. No adjusted differences in anthropometry, lipids, HbA1c, and CRP levels were found.

CONCLUSIONS

Early juice introduction during infancy was associated with higher systolic BP, heart rate, and mean arterial pressure in middle childhood. This trial was registered at clinicaltrials.gov as NCT03106493 (https://clinicaltrials.gov/study/NCT03106493?term=upstate%20KIDS&rank=1).

Association between adherence to a lifestyle behavior and the risk of asthma in overweight and obese adolescents

With the increasing prevalence of overweight and obesity in children and adolescents, to actively prevent the occurrence of asthma in this population is important for reducing the burden of the disease. Lifestyle factors, including diet and exercise, are importance for overweight and obese adolescents, as well as an important modifiable factor affecting airway inflammation and asthma, whether healthy lifestyle was correlated with the risk of asthma in adolescents ≥ 12 years has not been reported. We suspected that there might be correlation between healthy lifestyle behaviors and the risk of asthma in overweight and obese adolescents. This cross-sectional study aimed to explore the association between the adherence to a healthy lifestyle behaviors and the risk of asthma in overweight and obese adolescents based on the data of 945 participants aged between 12-18 years from the National Health and Nutrition Examination Surveys (NHANES). Univariable and multivariable weighted Logistic regression models were applied to evaluate the association between healthy lifestyle behaviors with asthma risk in overweight and obese adolescents. Odds ratio (OR) and 95% confidence interval (CI) were applied as estimates. We found that the risk of asthma was reduced in overweight and obese adolescents with intermediate (OR = 0.40, 95%CI: 0.17-0.94) or good lifestyle behaviors (OR = 0.33, 95%CI: 0.13-0.86) in comparison to those with poor lifestyle behaviors. In summary, intermediate or good lifestyle behaviors was correlated with decreased risk of asthma in overweight and obese adolescents, which might provide a reference for making further prevention strategies for asthma in adolescents.

Early Infant Feeding Practices and Associations with Growth in Childhood

Early infant growth trajectories have been linked to obesity risk. The aim of this study was to examine early infant feeding practices in association with anthropometric measures and risk of overweight/obesity in childhood. A total of 2492 children from Upstate KIDS, a population-based longitudinal cohort, were included for the analysis. Parents reported breastfeeding and complementary food introduction from 4 to 12 months on questionnaires. Weight and height were reported at 2-3 years of age and during later follow-up at 7-9 years of age. Age and sex z-scores were calculated. Linear mixed models were conducted, adjusting for maternal and child sociodemographic factors. Approximately 54% of infants were formula-fed at <5 months of age. Compared to those formula-fed, BMI- (adjusted B, -0.23; 95% CI: -0.42, -0.05) and weight-for-age z-scores (adjusted B, -0.16; -0.28, -0.03) were lower for those exclusively breastfed. Infants breastfed for ≥12 months had a lower risk of being overweight (aRR, 0.33; 0.18, 0.59) at 2-3 years, relative to formula-fed infants. Compared to introduction at <5 months, the introduction of fruits and vegetables between 5 and 8 months was associated with lower risk of obesity at 7-9 years (aRR, 0.45; 0.22, 0.93). The type and duration of breastfeeding and delayed introduction of certain complementary foods was associated with lower childhood BMI.