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Alterman N, Youssim I, Nevo D, Calderon-Margalit R, Yuval, Broday D, Hauzer M, Raz R. Prenatal and postnatal exposure to NO 2 and rapid infant weight gain - A population-based cohort study. Paediatr Perinat Epidemiol 2023; 37:669-678. [PMID: 37565531 DOI: 10.1111/ppe.13000] [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: 04/09/2023] [Revised: 07/07/2023] [Accepted: 07/29/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Childhood overweight and obesity is a global public health problem. Rapid infant weight gain is predictive of childhood overweight. Studies found that exposure to ambient air pollution is associated with childhood overweight, and have linked prenatal exposure to air pollution with rapid infant weight gain. OBJECTIVES To examine the association between prenatal and postnatal ambient NO2 exposure, a traffic-related marker, with rapid weight gain in infants. METHODS We carried out a population-based historical cohort study using data from the Israeli national network of maternal and child health clinics. The study included 474,136 infants born at term with birthweight ≥2500 g in 2011-2019 in central Israel. Weekly averages of NO2 concentration throughout pregnancy (prenatal) and the first 4 weeks of life (postnatal) were assessed using an optimized dispersion model and were linked to geocoded home addresses. We modelled weight gain velocity throughout infancy using the SuperImposition by Translation and Rotation (SITAR) method, a mixed-effects nonlinear model specialized for modelling growth curves, and defined rapid weight gain as the highest velocity tertile. Distributed-lag models were used to assess critical periods of risk and to measure relative risks for rapid weight gain. Adjustments were made for socioeconomic status, population group, subdistrict, month and year of birth, and the alternate exposure period - prenatal or postnatal. RESULTS The cumulative adjusted relative risk for rapid weight gain of NO2 exposure was 1.02 (95% confidence intereval [CI] 1.00, 1.04) for exposure throughout pregnancy and 1.02 (95% CI 1.01, 1.04) for exposure during the first four postnatal weeks per NO2 interquartile range increase (7.3 ppb). An examination of weekly associations revealed that the critical period of risk for the prenatal exposure was from mid-pregnancy to birth. CONCLUSIONS Prenatal and postnatal exposures to higher concentrations of traffic-related air pollution are each independently associated with rapid infant weight gain, a risk factor for childhood overweight and obesity.
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Affiliation(s)
- Neora Alterman
- Braun School of Public Health and Community Medicine, The Hebrew University at Jerusalem - Hadassah, Jerusalem, Israel
| | - Iaroslav Youssim
- Braun School of Public Health and Community Medicine, The Hebrew University at Jerusalem - Hadassah, Jerusalem, Israel
| | - Daniel Nevo
- Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Calderon-Margalit
- Braun School of Public Health and Community Medicine, The Hebrew University at Jerusalem - Hadassah, Jerusalem, Israel
| | - Yuval
- Civil and Environmental Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - David Broday
- Civil and Environmental Engineering, Technion, Israel Institute of Technology, Haifa, Israel
| | - Michael Hauzer
- Bonen Clinic, Haifa and Western Galilee District, Israel
- Clalit Health Services Community Division, Haifa, Israel
| | - Raanan Raz
- Braun School of Public Health and Community Medicine, The Hebrew University at Jerusalem - Hadassah, Jerusalem, Israel
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Gilbert L, Quansah DY, Arhab A, Schenk S, Gross J, Lanzi S, Stuijfzand B, Lacroix A, Horsch A, Puder JJ. Effect of the MySweetheart randomized controlled trial on birth, anthropometric and psychobehavioral outcomes in offspring of women with GDM. Front Endocrinol (Lausanne) 2023; 14:1148426. [PMID: 37351105 PMCID: PMC10284133 DOI: 10.3389/fendo.2023.1148426] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023] Open
Abstract
Introduction Gestational diabetes mellitus (GDM) may negatively affect offspring outcomes. A lifestyle intervention may therefore not only improve maternal, but also offspring outcomes. The effects of lifestyle interventions on birth, anthropometric, and psychobehavioral outcomes in offspring of women with GDM need further evidence. Design The MySweetheart trial is a monocentric single-blind randomized controlled trial in 211 women with GDM. It tested the effect of a pre- and postpartum multidimensional interdisciplinary lifestyle and psychosocial intervention focusing on both the mothers and their infants and its effects on maternal (primary outcomes) and offspring (secondary outcomes) metabolic and psychobehavioral outcomes compared with guidelines-based usual-care. This paper focuses on offspring's birth, anthropometric, and maternal report of psychobehavioral outcomes at singular timepoints. Methods Women with GDM aged ≥18 years, between 24-32 weeks of gestation, speaking French or English were included and randomly allocated to either the intervention or to an active guidelines-based usual-care group using a 1:1 allocation ratio. The intervention lasted from pregnancy until 1 year postpartum and focused on improving diet, physical activity, and mental health in the mother. For the offspring it focused on supporting breastfeeding, delaying the timing of introduction of solid foods, reducing the consumption of sweetened beverages, increasing physical activity of the family, and improving parental responsiveness to infant distress, hunger, satiety and sleeping cues, and difficult behavior. Results Adverse birth and neonatal outcomes rarely occurred overall. There were no differences between groups in offspring birth, neonatal, anthropometric, or psychobehavioral outcomes up to one year. After adjustments for maternal age and the offspring's sex and age, there was a borderline significant between-group difference in birth length (β:-0.64, CI:-1.27; -0.01, p: 0.05), i.e., offspring of mothers in the intervention group were born 0.64 cm shorter compared to those in the usual-care group. Conclusion This is the first pre- and postpartum multidimensional interdisciplinary lifestyle and psychosocial intervention in GDM focusing on both the mother and the offspring. It did not lead to a significant improvement in most birth, anthropometric, and psychobehavioral outcomes in offspring of women with GDM. ClinicalTrials.gov Identifier: NCT02890693.
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Affiliation(s)
- Leah Gilbert
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Obstetric Service, Department Woman-Mother-Child, Interdisciplinary GDM Group Lausanne, Lausanne University Hospital, Lausanne, Switzerland
| | - Dan Yedu Quansah
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Amar Arhab
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sybille Schenk
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Justine Gross
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stefano Lanzi
- Service d’angiologie, Département Cœur-Vaisseaux, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Bobby Stuijfzand
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Alain Lacroix
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
- Neonatology Service, Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Jardena J. Puder
- Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Sarı E, Güngör Satılmış İ. The effect of acupressure on lactation in non-breastfeeding mothers after preterm cesarean delivery. Health Care Women Int 2023; 44:361-373. [PMID: 36219142 DOI: 10.1080/07399332.2022.2132253] [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]
Abstract
This randomized controlled experimental study was conducted to determine the effect of acupressure on lactation in non-breastfeeding mothers. The sample of the study was comprised of 64 mothers, who were randomly selected among the primipara mothers of premature newborns delivered through cesarean section in a hospital. Before the implementation, the Depression-Anxiety-Stress Scale and the Richards? Campbell Sleep Questionnaire were applied. In post-operative three days, 15-minute acupressure was implemented in the morning/evening, for acupressure-group mothers and pump milking was applied; control group mothers were only milked in the mornings and evenings. Mothers' perceptions of lactation symptoms were evaluated with Visual Analog Scale. Acupressure satisfaction was evaluated with a Visual Analog Patient Satisfaction Scale, and pumped milk quantities were recorded. Indications of lactation such as tension, heat, and pain in breasts were found to be higher in acupressure group.The amounts of milk in acupressure group were significantly higher compared to control group.
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Affiliation(s)
- Esra Sarı
- Depertmant of Midwifery, Faculty of Health Science, Van Yüzüncü Yıl University, Van, Turkey
| | - İlkay Güngör Satılmış
- Department of Women Health and Gynecologic Nursing, Florence Nightingale Faculty of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Hale I, Fergus T, Buhler H, Purcell M, Amed S. RAISE (Raising Infants to Be Smart Eaters) Pilot Study. Child Obes 2023; 19:25-33. [PMID: 35325551 DOI: 10.1089/chi.2021.0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background: Many of the complex determinants of obesity originate during infancy when small changes in the environment can permanently influence appetite, behavior, and energy metabolism. Parent feeding style ("how" rather than "what" to feed) has emerged as a potentially important factor in early obesity prevention. Objectives: (1) To assess the feasibility of conducting a brief responsive feeding education intervention by public health nurses during routine well-baby visits. (2) To assess whether this intervention affects parents' attitudes and behavior related to responsive feeding. Methods: Prospective, nonrandomized, comparative pilot study conducted in two communities. Intervention participants were exposed to enhanced responsive feeding education by public health nurses at routine well-baby visits from 0 to 18 months along with wall posters, handouts, automated text messages and tangible takeaways. Parent knowledge and behavior were measured using the Infant Feeding Style Questionnaire and the Toddler Development Index. Feasibility and acceptability were assessed by patients and nurses through open text feedback forms and mid-point and exit interviews. Results: Recruitment (18 intervention; 9 control) and retention fell below targets. Average adherence to protocol by nurses from 0 to 12 months was 89%. Delivery of the intervention was feasible and acceptable, but the additional research-related tasks were challenging in a busy clinical setting. Parents found the different formats and information new and helpful. There was a trend toward less nonresponsive (pressuring, restrictive, laissez-faire) feeding practices in the intervention group. Conclusions: This pilot study demonstrated encouraging results related to overall feasibility and effect on parent feeding style.
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Affiliation(s)
- Ilona Hale
- Department of Family Practice, University of British Columbia, Kimberley, British Columbia, Canada
| | - Terri Fergus
- Interior Health Authority, Cranbrook, British Columbia, Canada
| | - Holly Buhler
- Interior Health Authority, Cranbrook, British Columbia, Canada
| | - Megan Purcell
- East Kootenay Division of Family Practice, Cranbrook, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, British Columbia Children and Women's Hospital, University of British Columbia, Kimberley, British Columbia, Canada
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Abou-Dakn M, Alexy U, Beyer K, Cremer M, Ensenauer R, Flothkötter M, Geene R, Hellmers C, Joisten C, Koletzko B, Mata J, Schiffner U, Somm I, Speck M, Weißenborn A, Wöckel A. Ernährung und Bewegung im Kleinkindalter. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01519-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Jochum F, Abdellatif M, Adel A, Alhammadi A, Alnemri A, Alohali E, AlSarraf K, Al Said K, Elzalabany M, Isa HMA, Kalyanasundaram S, Reheim NA, Saadah O. Burden of Early Life Obesity and Its Relationship with Protein Intake in Infancy: The Middle East Expert Consensus. Pediatr Gastroenterol Hepatol Nutr 2022; 25:93-108. [PMID: 35360379 PMCID: PMC8958054 DOI: 10.5223/pghn.2022.25.2.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 12/13/2021] [Accepted: 02/20/2022] [Indexed: 02/06/2023] Open
Abstract
Adequate nutrition in early life is proposed to shape a child's future health by launching the growth trajectory in the proper direction, which helps to avoid negative metabolic programming effects. Protein intake during infancy and early childhood is of great importance, as it plays a key role in infant metabolic programming and the future risk of obesity. Breastfeeding provides the best nutrition in early life, with many benefits tailored for the baby, including the appropriate quantity and quality of proteins. Considering the high prevalence of childhood, and subsequent adult, obesity in the region, a virtual Middle East expert consensus meeting was held to discuss an effective approach for managing childhood obesity. Leading pediatric experts from Bahrain, Egypt, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates participated in the meeting. The experts discussed, debated, and agreed on certain directions, including the importance of educating parents, endorsing breastfeeding, and ensuring optimum quantity and quality intake of proteins in early life. This expert consensus may serve as the starting point for healthcare professionals in the region who are interested in shaping a healthy future for the generations to come.
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Affiliation(s)
- Frank Jochum
- Department of Pediatrics, Evangelisches Waldkrankenhaus Spandau, Berlin, Germany.,Pediatric Medicine, Brandenburg Medical School (MHB) Theodor Fontane, Neuruppin, Germany
| | | | - Ashraf Adel
- Department of General Pediatrics, Sidra Medicine, Doha, Qatar
| | - Ahmed Alhammadi
- Department of General Pediatrics, Sidra Medicine, Doha, Qatar
| | | | - Eman Alohali
- Dietetics Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Khaled AlSarraf
- Department of Pediatrics-Pediatric Gastroenterology, Amiri Hospital, Sharq, Kuwait
| | - Khoula Al Said
- Department of Child Health, Royal Hospital, Muscat, Oman
| | - Mahmoud Elzalabany
- Pediatrics Department, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Hasan M A Isa
- Pediatric Department, Salmaniya Medical Complex/Arabian Gulf University, Manama, Bahrain
| | | | | | - Omar Saadah
- Pediatrics Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Hupp MK, Papathakis PC, Phelan S, Ventura AK. Associations between mothers' use of food to soothe, feeding mode, and infant weight during early infancy. Appetite 2022; 168:105736. [PMID: 34627981 PMCID: PMC8671361 DOI: 10.1016/j.appet.2021.105736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 12/18/2022]
Abstract
Weight status and rate of weight gain in the first six months postpartum are strong predictors of later obesity; thus, infant feeding practices are an important target for obesity prevention efforts. The use of food to soothe (FTS) is associated with less-favorable eating habits and weight outcomes for older infants and children. However, few studies have examined correlates of use of FTS during early infancy. The primary aim of this cross-sectional study was to explore associations between use of FTS and infant weight status in the first 6 months postpartum. A secondary aim was to identify the combination of maternal and infant characteristics that predicted use of FTS. Mothers of infants aged 6 months or younger (N = 134) completed questionnaires assessing use of FTS, bottle-feeding intensity (i.e., percentage of daily feedings from bottles versus directly from the breast), levels of responsive and pressuring feeding styles, dimensions of infant temperament and eating behaviors, and family demographics. Dyads were observed during feeding to assess maternal sensitivity to infant cues and responsiveness to infant distress and infant clarity of cues and responsiveness to the mother. Infant weight and length at study entry were assessed by a trained research assistant. Use of FTS was not associated with infant weight for age z-score (WAZ), even when bottle-feeding intensity was considered as a moderator. More frequent use of FTS was predicted by the combination of greater levels of pressuring feeding style (p = .005) and infant temperamental negative affectivity (p = .001), and lower levels of infant temperamental surgency/extraversion (p = .018). In conclusion, use of FTS was associated with dimensions of infant temperament and maternal feeding style, but not with WAZ during early infancy.
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Affiliation(s)
- Megan K Hupp
- Center for Health Research, Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA; Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Peggy C Papathakis
- Center for Health Research, Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA; Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Suzanne Phelan
- Center for Health Research, Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Alison K Ventura
- Center for Health Research, Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA.
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Rybak TM, Goetz AR, Stark LJ. Examining patterns of postnatal feeding in relation to infant's weight during the first year. Appetite 2021; 166:105473. [PMID: 34153422 PMCID: PMC9280867 DOI: 10.1016/j.appet.2021.105473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/06/2021] [Accepted: 06/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is mixed evidence regarding specific infant feeding behaviors and later risk for overweight and obesity. We sought to detect underlying patterns in duration of breastfeeding, introduction of solid foods and sweetened beverages, in order to understand the relation to later weight. METHODS Patterns of postnatal feeding were examined among infants enrolled in the Infant Feeding Practices Study II (N = 3033). At monthly intervals, mothers reported on the duration of any and exclusive breastfeeding, age of solid food and sweetened beverage introduction, and reported infant weight at ages 9- and 12-months. Latent profile analysis was used to empirically derive patterns of postnatal feeding and examine associations with weight z-scores at 9 and 12 months. RESULTS Two profiles emerged: (1) Short breastfeeding duration and early introduction to solid foods and sweetened beverages (Short BF/Early Introduction; 53%) and (2) longer breastfeeding duration and later introduction to solid foods and sweetened beverages (Longer BF/Later Introduction; 43%). Infants in the Shorter BF/Early Introduction profile had significantly greater weight z-scores at 9 (M = 0.18) and 12 months (M = 0.26), compared to those in the Longer BF/Later Introduction profile (M = -0.21; M = -0.17, respectively). CONCLUSIONS Overall, shorter BF duration and earlier food and sweetened beverage introduction is associated with higher weight z-scores at 9 and 12 months. Early intervention should aim to promote breastfeeding and later introduction of solids and discourage consumption of sweetened beverages. These postnatal patterns of feeding behaviors provides important context to inform targeted interventions aimed at reducing risk for later obesity.
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Affiliation(s)
- Tiffany M Rybak
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Amy R Goetz
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Lori J Stark
- Department of Pediatrics, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Karssen LT, Vink JM, de Weerth C, Hermans RCJ, de Kort CPM, Kremers SP, Ruiter ELM, Larsen JK. An App-Based Parenting Program to Promote Healthy Energy Balance-Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework. JMIR Form Res 2021; 5:e24802. [PMID: 33988510 PMCID: PMC8164123 DOI: 10.2196/24802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/02/2021] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The family environment plays an important role in the development of children's energy balance-related behaviors. As a result, parents' energy balance-related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP. OBJECTIVE This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance-related parenting practices among parents of children (aged 0-4 years) with a lower SEP. METHODS The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program. RESULTS In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance-related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2). CONCLUSIONS The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance-related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP. TRIAL REGISTRATION Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371.
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Affiliation(s)
- Levie T Karssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Jacqueline M Vink
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
| | - Roel C J Hermans
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
- Netherlands Nutrition Centre, The Hague, Netherlands
| | - Carina P M de Kort
- Institute of Health Studies, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Stef Pj Kremers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Emilie L M Ruiter
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Junilla K Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
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Body composition during the first 4 months in infants affected by neonatal abstinence syndrome: a pilot study. J Dev Orig Health Dis 2021; 13:120-127. [PMID: 33650484 DOI: 10.1017/s2040174421000052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Newborns with neonatal abstinence syndrome (NAS) display symptoms related to neurologic excitability and autonomic dysfunction that result in increased metabolic demands. These infants also exhibit feeding difficulties and/or hyperphagia. Because the effects of these symptoms and behaviors on growth are unknown, we sought to measure serial body composition measurements over the first 4 months in infants with NAS requiring pharmacologic treatment using air displacement plethysmography. Fourteen infants of singleton birth with appropriate-for-gestational-age (AGA) weight and a gestational age of ≥35 weeks and <42 weeks were evaluated. In mixed-effects models, per week, infants increased in mean fat percent by 1.1% (95% confidence interval [CI]: 0.85-1.43), fat mass by 90 g (CI: 70-100), and fat-free mass by 140 g (CI: 130-150). The subgroup of infants (N = 5) requiring multidrug therapy for symptom control had lower mean fat percent (-1.2%, CI: -5.2-2.1), fat mass (-60 g, CI: -25-13), and fat-free mass (-270 g, CI: -610-80) across time compared to infants requiring monotherapy. We are the first to report how body composition measures change over time in a small group of patients with NAS. Infants with NAS were smaller and leaner in the first several weeks compared to previously reported body composition measurements in term infants, but grew similarly to their healthy counterparts by 16 weeks. Infants with more severe NAS may be at risk for abnormalities in longer term growth.
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Erzse A, Christofides N, Stacey N, Lebard K, Foley L, Hofman K. Availability and advertising of sugar sweetened beverages in South African public primary schools following a voluntary pledge by a major beverage company: a mixed methods study. Glob Health Action 2021; 14:1898130. [PMID: 33910480 PMCID: PMC8288764 DOI: 10.1080/16549716.2021.1898130] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/28/2021] [Indexed: 10/31/2022] Open
Abstract
Background: Towards the end of the 2017 school year, a prominent beverage company in South Africa pledged to remove their sugar-sweetened beverages (SSBs) and advertisements from primary schools in order to contribute to the realization of a healthy school environment.Objectives: To assess the availability and advertising of the company's beverages in public primary schools in Gauteng province following their voluntary pledge to remove the products, and to explore perceptions of school staff regarding SSB availability in schools and processes related to the implementation of the pledge.Methods: In 2019, we conducted a representative survey of public sector primary (elementary) schools in Gauteng province, South Africa. A random sample of schools was drawn, with schools stratified by whether or not they charge fees. This was a proxy for the socioeconomic status of the locale and student body. At each school, the availability of beverages and presence of advertising or not was assessed by an observational audit tool and differences across fee status assessed by Pearson χ 2 test. Semi-structured interviews were conducted with a purposive sample of school officials. Data from the interviews were coded and thematic analysis conducted.Results: Two years following a voluntary pledge, the company's carbonated SSBs were available for sale in 54% (CI: 45-63%) of schools with tuck shops and advertised in 31% (CI: 25-39%). Qualitative interviews revealed a complex landscape of actors within schools, which, combined with indifference or resistance to the pledge, may have contributed to the continued availability of SSBs.Conclusions: Though we were unable to examine SSB availability before and after the pledge, our findings provide some preliminary evidence that voluntary pledges by commercial entities are not sufficient to remove SSBs and advertisements from schools. Mandatory regulations coupled with in-depth engagement with schools may be an avenue to pursue in the future.
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Affiliation(s)
- Agnes Erzse
- SAMRC/Centre for Health Economics and Decision Science, PRICELESS, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Nicola Christofides
- Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Nicholas Stacey
- SAMRC/Centre for Health Economics and Decision Science, PRICELESS, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Kelsey Lebard
- SAMRC/Centre for Health Economics and Decision Science, PRICELESS, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
| | - Louise Foley
- MRC Epidemiology Unit, University of Cambridge, UK
| | - Karen Hofman
- SAMRC/Centre for Health Economics and Decision Science, PRICELESS, Faculty of Health Sciences, University of Witwatersrand School of Public Health, Johannesburg, South Africa
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Armstrong B, Hepworth AD, Black MM. Hunger in the household: Food insecurity and associations with maternal eating and toddler feeding. Pediatr Obes 2020; 15:e12637. [PMID: 32294800 PMCID: PMC9132245 DOI: 10.1111/ijpo.12637] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/09/2020] [Accepted: 03/15/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Research is needed to identify how food insecurity affects maternal eating behavior and child feeding practices, factors that may pose intergenerational risks for obesity. OBJECTIVES This longitudinal study investigated whether maternal restrained eating mediated the association between household food insecurity and feeding practices. METHODS Participants included 277 WIC-eligible mothers (69% below the poverty line, 70% African American) and their toddlers (Mage = 20.11 months, SD = 5.50) participating in a childhood obesity prevention trial. Maternal reports of household food insecurity, restrained eating, and child feeding practices (restrictive and responsive) were collected at baseline, 6 and 12 months and analyzed using multilevel mediation. RESULTS Forty percent of mothers reported some degree of household food insecurity over 12 months. Within-person analyses showed that relative increases in household food insecurity were indirectly related to increases in restrictive and decreases in responsive child feeding practices, mediated through increases in mothers' own restrained eating. CONCLUSIONS Relative change in household food insecurity (rather than overall severity) appears to have indirect effects on toddler feeding practices, through mothers' own eating. Stable household food security without transient food insecurity may improve health and wellbeing for both mothers and children.
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Affiliation(s)
- Bridget Armstrong
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, US
| | - Allison D. Hepworth
- Department of Social Work, University of Maryland School of Social Work, Baltimore, Maryland, US
| | - Maureen M. Black
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, US,RTI International, Research Triangle Park, North Carolina, US
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Dressler A, Trimmel-Schwahofer P. The ketogenic diet for infants: How long can you go? Epilepsy Res 2020; 164:106339. [PMID: 32422496 DOI: 10.1016/j.eplepsyres.2020.106339] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE Ketogenic diets (KD) are high-fat, low-carbohydrate therapies, established in the treatment for drug-resistant epilepsy in childhood since the 1920ies. This review focuses on the use of ketogenic diet therapies in young childhood with an emphasis on the most recent advances. FINDINGS The KD has been used effectively and safely in childhood, and has increasingly been offered in infancy during the last decade. The introduction of a KD is recommended with a fixed fat/ non-fat ratio of 3:1, modified if necessary. In infants the KD is initiated without fasting and fluid restriction and with a shorter treatment duration than in older children. Twenty studies that also included infants below 1 year of age are available. When the KD is used early and in an approach based on syndromes and etiology, seizure freedom is achieved and maintained more often than when used as last ressort. In infants with genetic causes already recognized in early infancy, the KD has shown to be even more effective. Most frequent adverse effects in infancy include emesis, hypoglycemia, food/ liquid refusal and constipation which are mostly transient and resolvable by dietary adjustments. Promising data on the inclusion of expressed breast milk to the KD and maintaining actual breastfeeding while on the KD have shown that complete weaning from breast-feeding is not necessary and inclusion of breast milk as well as breastfeeding should be encouraged. SUMMARY The ketogenic diet is a versatile therapy, and effective and safe in its use in infancy. There is growing evidence and guidelines that specify indications where the KD should be used early.
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Affiliation(s)
- Anastasia Dressler
- Department of Pediatrics and Adolescent Health, Medical University Vienna, Austria.
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Dressler A, Häfele C, Giordano V, Benninger F, Trimmel-Schwahofer P, Gröppel G, Samueli S, Feucht M, Male C, Repa A. The Ketogenic Diet Including Breast Milk for Treatment of Infants with Severe Childhood Epilepsy: Feasibility, Safety, and Effectiveness. Breastfeed Med 2020; 15:72-78. [PMID: 31770024 DOI: 10.1089/bfm.2019.0190] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: The ketogenic diet (KD) is a high-fat and restricted carbohydrate diet for treating severe childhood epilepsy. In infants, breast milk is usually fully replaced by a ketogenic formula. At our center, mothers are encouraged to include breastfeeding into the KD if still breastfeeding. This retrospective study describes achievement and maintenance of ketosis with or without inclusion of breast milk. Methods: Data were retrieved from a prospective longitudinal database of children treated with KD for epilepsy analyzing infants <1 year of age. The time to achieve clinically relevant ketosis (≥2 mmol/L beta-hydroxybutyrate) was compared with and without inclusion of breast milk into standard KD. Ketosis, nutritional intakes, effectiveness, adverse effects, and successful continuation of breastfeeding were evaluated. Results: A total of 79 infants were eligible for analysis. In 20% (16), breast milk was included. Infants with breast milk included into the KD achieved relevant ketosis in 47 hours (interquartile range [IQR] 24-95) compared with 41 hours (IQR 22-70; p = 0.779) in infants with standard KD. Beta-hydroxybutyrate at day 2 was 3.1 mmol/L (IQR 0.5-4.9) and 3.8 mmol/L (IQR 2.2-4.9). Infants with breast milk included received higher amounts of carbohydrates at baseline and calories at 3 months. Seizure freedom and adverse effects showed no relevant differences. No infections occurred in infants receiving breast milk. In two infants, KD was initiated with breast-feds after bottle-feeding KD formula. In 31%, breastfeeding was continued after the KD, and in 25%, inclusion of breast milk and breastfeeding was maintained until complete weaning. Before discharge from hospital, the amount of breast milk included was median 90 mL/day (IQR 53-203) equivalent to median 9% (IQR 6-15). Conclusions: Appropriate ketosis was achieved in most infants and maintained within 48 hours. Incorporation of breast milk into KD is feasible, safe, and effective.
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Affiliation(s)
- Anastasia Dressler
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Chiara Häfele
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Franz Benninger
- Department of Child and Adolescent Neuropsychiatry, Medical University Vienna, Vienna, Austria
| | | | - Gudrun Gröppel
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Sharon Samueli
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Martha Feucht
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Christoph Male
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Andreas Repa
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
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Standard v. baby-led complementary feeding: a comparison of food and nutrient intakes in 6–12-month-old infants in the UK. Public Health Nutr 2019; 22:2813-2822. [DOI: 10.1017/s136898001900082x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:To compare food and nutrient intakes of infants aged 6–12 months following a baby-led complementary feeding (BLCF) approach and a standard weaning (SW) approach.Design:Participants completed an online questionnaire consisting of sociodemographic questions, a 28 d FFQ and a 24 h dietary recall.Setting:UK.Participants:Infants (n 134) aged 6–12 months (n 88, BLCF; n 46, SW).Results:There was no difference between weaning methods for the food groups ‘fruits’, ‘vegetables’, ‘all fish’, ‘meat and fish’, ‘sugary’ or ‘starchy’ foods. The SW group was offered ‘fortified infant cereals’ (P < 0·001), ‘salty snacks’ at 6–8 months (P = 0·03), ‘dairy and dairy-based desserts’ at 9–12 months (P = 0·04) and ‘pre-prepared baby foods’ at all ages (P < 0·001) more often than the BLCF group. The SW group was offered ‘oily fish’ at all ages (P < 0·001) and 6–8 months (P = 0·01) and ‘processed meats’ at all ages (P < 0·001), 6–8 months (P = 0·003) and 9–12 months (P < 0·001) less often than the BLCF group. The BLCF group had significantly greater intakes of Na (P = 0·028) and fat from food (P = 0·035), and significantly lower intakes of Fe from milk (P = 0·012) and free sugar in the 6–8 months subgroup (P = 0·03) v. the SW group. Fe intake was below the Reference Nutrient Intake (RNI) for both groups and Na was above the RNI in the BLCF group.Conclusion:Compared with the SW group, the BLCF group was offered foods higher in Na and lower in Fe; however, the foods offered contained less free sugar.
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Rito AI, Buoncristiano M, Spinelli A, Salanave B, Kunešová M, Hejgaard T, García Solano M, Fijałkowska A, Sturua L, Hyska J, Kelleher C, Duleva V, Musić Milanović S, Farrugia Sant'Angelo V, Abdrakhmanova S, Kujundzic E, Peterkova V, Gualtieri A, Pudule I, Petrauskienė A, Tanrygulyyeva M, Sherali R, Huidumac-Petrescu C, Williams J, Ahrens W, Breda J. Association between Characteristics at Birth, Breastfeeding and Obesity in 22 Countries: The WHO European Childhood Obesity Surveillance Initiative - COSI 2015/2017. Obes Facts 2019; 12:226-243. [PMID: 31030194 PMCID: PMC6547266 DOI: 10.1159/000500425] [Citation(s) in RCA: 159] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/16/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In Europe, although the prevalence of childhood obesity seems to be plateauing in some countries, progress on tackling this important public health issue remains slow and inconsistent. Breastfeeding has been described as a protective factor, and the more exclusively and the longer children are breastfed, the greater their protection from obesity. Birth weight has been shown to have a positive association with later risk for obesity. OBJECTIVES It was the aim of this paper to investigate the association of early-life factors, namely breastfeeding, exclusive breastfeeding and birth weight, with obesity among children. METHOD Data from 22 participating countries in the WHO European COSI study (round 4: 2015/2017) were collected using cross-sectional, nationally representative samples of 6- to 9-year-olds (n = 100,583). The children's standardized weight and height measurements followed a common WHO protocol. Information on the children's birth weight and breastfeeding practice and duration was collected through a family record form. A multivariate multilevel logistic regression analysis regarding breastfeeding practice (both general and exclusive) and characteristics at birth was performed. RESULTS The highest prevalence rates of obesity were observed in Spain (17.7%), Malta (17.2%) and Italy (16.8%). A wide between-country disparity in breastfeeding prevalence was found. Tajikistan had the highest percentage of children that were breastfed for ≥6 months (94.4%) and exclusively breastfed for ≥6 months (73.3%). In France, Ireland and Malta, only around 1 in 4 children was breastfed for ≥6 months. Italy and Malta showed the highest prevalence of obesity among children who have never been breastfed (21.2%), followed by Spain (21.0%). The pooled analysis showed that, compared to children who were breastfed for at least 6 months, the odds of being obese were higher among children never breastfed or breastfed for a shorter period, both in case of general (adjusted odds ratio [adjOR] [95% CI] 1.22 [1.16-1.28] and 1.12 [1.07-1.16], respectively) and exclusive breastfeeding (adjOR [95% CI] 1.25 [1.17-1.36] and 1.05 [0.99-1.12], respectively). Higher birth weight was associated with a higher risk of being overweight, which was reported in 11 out of the 22 countries. Bulgaria, Croatia, France, Italy, Poland and Romania showed that children who were preterm at birth had higher odds of being obese, compared to children who were full-term babies. CONCLUSION The present work confirms the beneficial effect of breastfeeding against obesity, which was highly increased if children had never been breastfed or had been breastfed for a shorter period. Nevertheless, adoption of exclusive breastfeeding is below global recommendations and far from the target endorsed by the WHO Member States at the World Health Assembly Global Targets for Nutrition of increasing the prevalence of exclusive breastfeeding in the first 6 months up to at least 50% by 2025.
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Affiliation(s)
- Ana Isabel Rito
- Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal,
| | - Marta Buoncristiano
- NCD Office, WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Angela Spinelli
- National Centre for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| | | | - Marie Kunešová
- Institute of Endocrinology, Obesity Management Centre, Prague, Czechia
| | | | | | - Anna Fijałkowska
- Department of Cardiology, Institute of Mother and Child, Warsaw, Poland
| | - Lela Sturua
- NCD Department, National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Jolanda Hyska
- Nutrition and Food Safety Sector, Institute of Public Health, Tirana, Albania
| | - Cecily Kelleher
- National Nutrition Surveillance Centre, School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Vesselka Duleva
- Department of Food and Nutrition, National Centre of Public Health and Analyses, Sofia, Bulgaria
| | | | | | | | - Enisa Kujundzic
- Institute of Public Health of Montenegro, Podgorica, Montenegro
| | | | | | - Iveta Pudule
- Department of Research and Health Statistics, Centre for Disease Prevention and Control, Riga, Latvia
| | - Aušra Petrauskienė
- Department of Preventive Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Maya Tanrygulyyeva
- Scientific Research Institute of Maternal and Child Health, Ashgabat, Turkmenistan
| | - Rakhmatulloev Sherali
- Department for Organization and Provision of the Medical Care to Mother, Child and Family Planning, Ministry of Health and Social Protection of Population, Dushanbe, Tajikistan
| | - Constanta Huidumac-Petrescu
- National Health Assessment and Promotion Center, National Institute of Public Health Bucharest, Bucharest, Romania
| | - Julianne Williams
- NCD Office, WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
| | - Wolfgang Ahrens
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany
| | - João Breda
- NCD Office, WHO European Office for Prevention and Control of Noncommunicable Diseases, Moscow, Russian Federation
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Graulau RE, Banna J, Campos M, Gibby CLK, Palacios C. Amount, Preparation and Type of Formula Consumed and Its Association with Weight Gain in Infants Participating in the WIC Program in Hawaii and Puerto Rico. Nutrients 2019; 11:E695. [PMID: 30909642 PMCID: PMC6471683 DOI: 10.3390/nu11030695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/18/2019] [Accepted: 03/19/2019] [Indexed: 12/18/2022] Open
Abstract
The aim of this study was to assess the association between amount (below or above recommendations), preparation (liquid vs. powder), and type (regular vs. hydrolysate) of infant formula consumed and weight in infants participating in the Women, Infant and Children (WIC) Program in Hawaii (HI) and Puerto Rico (PR). This was a secondary analysis of 162 caregivers with healthy term 0⁻2-month-old infants. Socio-demographics, infant food frequency questionnaires, and weight and length were assessed at baseline and after four months. Infant feeding practices were associated with weight-for-length z-scores using multivariable logistic regression. In total, 37.7% were exclusively breastfed and 27.2% were exclusively formula-fed. Among formula users, regular (63.6%) and powder (87.0%) formula were the most common; 43.2% consumed formula above recommendations. Most infants had rapid weight gain (61.1%). Infants fed regular formula had higher odds of overweight after four months (adjusted OR = 8.77, 95% CI: 1.81⁻42.6) and higher odds of rapid weight gain (adjusted OR = 3.10, 95% CI: 1.12, 8.61). Those exclusively formula fed had higher odds of slow weight gain (adjusted OR = 4.07, 95% CI: 1.17⁻14.2). Formula preparation and amount of formula were not associated with weight. These results could inform the WIC program's nutrition education messages on infant feeding. Studies with longer follow-up are needed to confirm these results.
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Affiliation(s)
- Rafael E Graulau
- Nutrition Program, Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, P.O. Box 365067, San Juan, PR 00936-5067, Puerto Rico.
| | - Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Agricultural Sciences 216, 1955 East-West Rd, Honolulu, HI 96822, USA.
| | - Maribel Campos
- Dental and Craniofacial Genomics Core, Endocrinology Section School of Medicine, University of Puerto Rico, P.O. Box 365067, San Juan, PR 00936-5067, Puerto Rico.
| | - Cheryl L K Gibby
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Agricultural Sciences 216, 1955 East-West Rd, Honolulu, HI 96822, USA.
| | - Cristina Palacios
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street, AHC 5-313, Miami, FL 33199, USA.
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López-Sobaler AM, Aparicio A, Rubio J, Marcos V, Sanchidrián R, Santos S, Pérez-Farinós N, Dal-Re MÁ, Villar-Villalba C, Yusta-Boyo MJ, Robledo T, Castrodeza-Sanz JJ, Ortega RM. Adequacy of usual macronutrient intake and macronutrient distribution in children and adolescents in Spain: A National Dietary Survey on the Child and Adolescent Population, ENALIA 2013-2014. Eur J Nutr 2019; 58:705-719. [PMID: 29789933 PMCID: PMC6437129 DOI: 10.1007/s00394-018-1676-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 03/23/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To describe the nutritional profile and assess the National Dietary Survey on the Child and Adolescent Population project in Spain (ENALIA) regarding usual total energy and macronutrient intake. METHODS A cross-sectional nationally representative sample of 1862 children and adolescents (age 6 months to 17) was surveyed between 2013 and 2014 following European methodology recommendations. Dietary information was collected using two methods, dietary records (for children from age 6 months to 9 years) and 24-h dietary recall (participants age 10 and older). Usual intake was estimated by correcting for within-person intake variance using the Iowa State University (ISU) method. A probability analysis was used to assess compliance with dietary reference intakes in the target population. RESULTS Protein consumption in the age 1-3 group as a percentage of total energy exceeded the upper limit of the Acceptable Macronutrient Distribution Range (AMDR) by 4.7% for boys and 12.1% for girls. 42.9% of girls age 4-8 were under the lower limit of the AMDR for carbohydrates. 43.4% of boys and 46.9% of girls between 4 and 17 exceeded the AMDR in total fat intake, saturated fatty acids (SFAs) accounting for 12.3% of total energy. CONCLUSIONS The results suggest that Spanish children and adolescents could improve macronutrient distribution by reducing fat and increasing carbohydrate intake across all age groups, and decreasing protein intake, especially in young children.
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Affiliation(s)
- Ana M. López-Sobaler
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Aránzazu Aparicio
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain
| | - Josefa Rubio
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition, Ministry of Health, Social Services and Equality, Alcalá 56, 28071 Madrid, Spain
| | - Victoria Marcos
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition, Ministry of Health, Social Services and Equality, Alcalá 56, 28071 Madrid, Spain
| | - Rosa Sanchidrián
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition, Ministry of Health, Social Services and Equality, Alcalá 56, 28071 Madrid, Spain
| | - Sara Santos
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition, Ministry of Health, Social Services and Equality, Alcalá 56, 28071 Madrid, Spain
| | - Napoleón Pérez-Farinós
- Department of Public Health and Psychiatry, Faculty of Medicine, University of Málaga, Boulevard Louis Pasteur, 32, 28071 Málaga, Spain
| | - M. Ángeles Dal-Re
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition, Ministry of Health, Social Services and Equality, Alcalá 56, 28071 Madrid, Spain
| | - Carmen Villar-Villalba
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition, Ministry of Health, Social Services and Equality, Alcalá 56, 28071 Madrid, Spain
| | - Maria José Yusta-Boyo
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition, Ministry of Health, Social Services and Equality, Alcalá 56, 28071 Madrid, Spain
| | - Teresa Robledo
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition, Ministry of Health, Social Services and Equality, Alcalá 56, 28071 Madrid, Spain
| | - José Javier Castrodeza-Sanz
- Spanish Agency for Consumer Affairs, Food Safety and Nutrition, Ministry of Health, Social Services and Equality, Alcalá 56, 28071 Madrid, Spain
| | - Rosa M. Ortega
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain
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Lora KR, Branscum PW, Chen S, Wakefield D. Home Food Environment Factors Associated With Hispanic Preschoolers' Intake of Fruits and Vegetables. FAMILY & COMMUNITY HEALTH 2019; 42:261-270. [PMID: 31403987 PMCID: PMC6693638 DOI: 10.1097/fch.0000000000000235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to evaluate the relationship of home fruit and vegetable (F&V) availability and maternal feeding practices with Hispanic preschoolers' F&V intake (N = 238). "Availability' of total fruit" (P < .0001) and "modeling" (P < .020) increased the odds of consuming 1 or more cups of fruit. "Pressure" (P < .009) and the child being female (P < .028) increased the odds of consuming 1 or more cups of vegetables, while having a greater number of children in the home (P < .037) reduced the odds of consuming 1 or more cups of vegetables. To increase preschoolers' intake of F&V, interventions should target specific environmental factors in the home and maternal monitoring practices.
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Affiliation(s)
- Karina R Lora
- Department of Exercise and Nutrition Science, The George Washington University, Washington, District of Columbia (Dr Lora); Department of Kinesiology and Health, Miami University, Oxford, Ohio (Dr Branscum); Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City (Dr Chen); and Center of Aging, University of Connecticut Health, Farmington (Ms Wakefield)
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20
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Corr TE, Schaefer EW, Paul IM. Growth during the first year in infants affected by neonatal abstinence syndrome. BMC Pediatr 2018; 18:343. [PMID: 30396334 PMCID: PMC6217785 DOI: 10.1186/s12887-018-1327-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 10/25/2018] [Indexed: 01/17/2023] Open
Abstract
Background Infants with neonatal abstinence syndrome (NAS) initially experience neurologic excitability, poor feeding, and/or hyperphagia in the setting of increased metabolic demand. Because the longitudinal effects of these early symptoms and behaviors on weight trends are unknown, we sought to contrast weight gain patterns through age 1 year for infants diagnosed with NAS with matched controls. Methods Retrospective cohort of 70 singletons with a gestational age of ≥37 weeks and an ICD-9 or ICD-10 diagnosis of NAS made ≤7 days after birth with institutional follow-up matched to patients without NAS. Infants were matched on gestational age (±2 weeks), birth weight (±20 g), sex (exact), and insurance type (exact). Quantile regression methods were used to estimate 10th, 25th, 50th, 75th and 90th percentiles of weight over time. Results The mean gestational age for an infant with NAS was 38.8 weeks (standard deviation [SD], 1.3). The mean birth weight was 3.141 kg (SD, 0.510). NAS patients had a median of 24 weights recorded between birth and 400 days (inter-quartile range [IQR], 16–32 weights). Patients without NAS had a median of 12 weights recorded (IQR, 10–16). Growth curves were similar over the first 400 days of life. Patients with NAS had non-significantly higher and lower estimated weights for the 90th and 10th percentiles, respectively. Conclusion Infants with a diagnosis of NAS grew similarly to controls during their first year. Given the frequently-encountered NAS symptoms of hyperphagia and irritability, future studies may evaluate whether early differences in caregiver feeding exist and whether they have longer-term impacts on growth.
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Affiliation(s)
- Tammy E Corr
- Penn State College of Medicine, Department of Pediatrics, P.O. Box 850, 500 University Drive, Hershey, PA, 17033-0850, USA.
| | - Eric W Schaefer
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, USA
| | - Ian M Paul
- Penn State College of Medicine, Department of Pediatrics, P.O. Box 850, 500 University Drive, Hershey, PA, 17033-0850, USA.,Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, USA
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Wright CM, Marryat L, McColl J, Harjunmaa U, Cole TJ. Pathways into and out of overweight and obesity from infancy to mid-childhood. Pediatr Obes 2018; 13:621-627. [PMID: 29998577 PMCID: PMC6220864 DOI: 10.1111/ijpo.12427] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/13/2018] [Accepted: 04/24/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To investigate whether high weight in infancy predicts obesity in childhood. METHOD Data from two UK cohorts (Newcastle Growth and Development N = 795, Gateshead Millennium N = 393) and one Finnish (Tampere N = 1262) were combined. Z scores of weight at 3 and 12 months and body mass index (BMI) at 5 and 8 years were categorized as raised/overweight (1 to <2 SD) or high/obese (≥2 SD). RESULTS The majority of infants with raised or high weight at birth tended to revert to normal by 3 months and to track in the same category from 3 to 12 months. Although infants with high weight were five times more likely to have BMI ≥ 2 SD at 8 years (p < 0.001), only 22% went on to have BMI ≥ 2 SD, while 64% of infants with raised weight had normal BMI at 8 years. Of children with BMI ≥ 2 SD aged 8 years, only 22% had raised weight in infancy and half had BMI ≥ 2 SD for the first time at that age. CONCLUSIONS Infants with raised weight in infancy tend to remain so, but most children who go on to have BMI ≥ 2 SD were not unusually heavy infants and the majority of infants with high weight reverted to overweight or normal weight in childhood.
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Affiliation(s)
- C. M. Wright
- School of Medicine, College of MVLSUniversity of GlasgowGlasgowUK
| | - L. Marryat
- School of Mathematics and StatisticsUniversity of GlasgowGlasgowUK
- Farr Institute @ Scotland/Scottish Collaboration for Public Health Research and PolicyUniversity of EdinburghEdinburghUK
| | - J. McColl
- School of Mathematics and StatisticsUniversity of GlasgowGlasgowUK
| | - U. Harjunmaa
- Center for Child Health ResearchUniversity of Tampere Faculty of Medicine and Life Sciences, and Tampere University HospitalTampereFinland
| | - T. J. Cole
- Population, Policy and Practice ProgrammeUCL Great Ormond Street Institute of Child HealthLondonUK
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Honaker SM, Schwichtenberg AJ, Kreps TA, Mindell JA. Real-World Implementation of Infant Behavioral Sleep Interventions: Results of a Parental Survey. J Pediatr 2018; 199:106-111.e2. [PMID: 29753539 DOI: 10.1016/j.jpeds.2018.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/15/2018] [Accepted: 04/05/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe parental practices implementing behavioral sleep intervention (BSI) outside a clinical setting. STUDY DESIGN Parents (n = 652), recruited through a Facebook group designed as a peer support group for parents using BSI, completed an online survey about their experience using BSI with their infant or toddler. RESULTS On average, parents implemented BSI when their infant was 5.6 (±2.77) months. Parents most often used modified (49.5%) or unmodified extinction (34.9%), with fewer using a parental presence approach (15.6%). Regardless of BSI type, more parents endorsed "a great deal of stress" during the first night (42.2%) than 1 week later (5.2%). The duration of infant crying was typically greatest the first night (reported by 45%; M = 43 minutes) and was significantly reduced after 1 week (M = 8.54 minutes). Successful implementation of BSI on the first attempt was reported by 83%, with a median and mode of 7 days until completion (79% by 2 weeks). Regardless of BSI type, after intervention parents reported their infant had less difficulty falling asleep, fewer night awakenings, and were more likely to sleep in their room and/or in their own crib/bed. CONCLUSIONS The majority of parents report successfully implementing BSI, with significantly reduced infant crying by the end of 1 week and success within 2 weeks. Few differences were found between behavioral approaches.
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Affiliation(s)
- Sarah M Honaker
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
| | - Amy J Schwichtenberg
- Department of Human Development and Family Studies, Purdue University, Lafayette, IN
| | - Tamar A Kreps
- David Eccles School of Business, University of Utah, Salt Lake City, UT
| | - Jodi A Mindell
- Department of Psychology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Saint Joseph's University, Philadelphia, PA
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Savage JS, Hohman EE, Marini ME, Shelly A, Paul IM, Birch LL. INSIGHT responsive parenting intervention and infant feeding practices: randomized clinical trial. Int J Behav Nutr Phys Act 2018; 15:64. [PMID: 29986721 PMCID: PMC6038199 DOI: 10.1186/s12966-018-0700-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 06/28/2018] [Indexed: 01/08/2023] Open
Abstract
Background What, when, how, how much, and how often infants are fed have been associated with childhood obesity risk. The objective of this secondary analysis was to examine the effect of a responsive parenting (RP) intervention designed for obesity prevention on parents’ infant feeding practices in the first year after birth. Methods Primiparous mother-newborn dyads were randomized to the Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) Study RP intervention or child safety control. Research nurses delivered intervention content at home at infant age 3–4, 16, 28, and 40 weeks, and at a research center at 1 year. RP feeding guidance advised feeding that was contingent (i.e., feed in response to hunger and satiety signs, alternatives to using food to soothe), and developmentally appropriate (i.e., delaying introduction of solids, age-appropriate portion sizes). Infant feeding practices (i.e., bottle use, introduction of solids, food to soothe) were assessed by phone interviews and online surveys and dietary intake was assessed using a food frequency questionnaire. Results RP mothers were more likely to use of structure-based feeding practices including limit-setting (p < 0.05) and consistent feeding routines (p < 0.01) at age 1 year. RP group mothers were less likely to use non-responsive feeding practices such as pressuring their infant to finish the bottle/food (p < 0.001), and using food to soothe (p < 0.01), propping the bottle (p < 0.05) assessed between 4 and 8 months, and putting baby to bed with a bottle at age 1 year (p < 0.05). Few differences were seen between groups in what specific foods or food groups infants were fed. Conclusions Anticipatory guidance on RP in feeding can prevent the use of food to soothe and promote use of more sensitive, structure-based feeding which could reduce obesity risk by affecting how and when infants are fed during the first year. Trial registration The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) Study. www.clinicaltrials.gov . NCT01167270. Registered 21 July 2010. Electronic supplementary material The online version of this article (10.1186/s12966-018-0700-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jennifer S Savage
- Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA. .,Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.
| | - Emily E Hohman
- Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Michele E Marini
- Center for Childhood Obesity Research, 129 Noll Laboratory, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Amy Shelly
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Ian M Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Leann L Birch
- Department of Foods and Nutrition, University of Georgia, Athens, GA, USA
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Bell KA, Wagner CL, Perng W, Feldman HA, Shypailo RJ, Belfort MB. Validity of Body Mass Index as a Measure of Adiposity in Infancy. J Pediatr 2018; 196:168-174.e1. [PMID: 29551311 PMCID: PMC5924641 DOI: 10.1016/j.jpeds.2018.01.028] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/11/2017] [Accepted: 01/10/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To assess the validity of body mass index (BMI) and age- and sex-standardized BMI z-score (BMIZ) as surrogates for adiposity (body fat percentage [BF%], fat mass, and fat mass index [kg/m2]) at 3 time points in infancy (1, 4, and 7 months) and to assess the extent to which the change in BMIZ represents change in adiposity. STUDY DESIGN We performed a secondary analysis of 447 full-term infants in a previous trial of maternal vitamin D supplementation during lactation. Study staff measured infant anthropometrics and assessed body composition with dual-energy x-ray absorptiometry at 1, 4, and 7 months of age. We calculated Spearman correlations (rs) among BMI, BMIZ, and adiposity at each time point, and between change in BMIZ and change in adiposity between time points. RESULTS Infants (N = 447) were 52% male, 38% white, 31% black, and 29% Hispanic. The BMIZ was moderately correlated with BF% (rs = 0.43, 0.55, 0.48 at 1, 4, and 7 months of age, respectively). BMIZ correlated more strongly with fat mass and fat mass index, particularly at 4 and 7 months of age (fat mass rs = 0.72-0.76; fat mass index rs = 0.75-0.79). Changes in BMIZ were moderately correlated with adiposity changes from 1 to 4 months of age (rs = 0.44 with BF% change; rs = 0.53 with fat mass change), but only weakly correlated from 4 to 7 months of age (rs = 0.21 with BF% change; rs = 0.27 with fat mass change). CONCLUSIONS BMIZ is moderately correlated with adiposity in infancy. Changes in BMIZ are a poor indicator of adiposity changes in later infancy. BMI and BMIZ are limited as surrogates for adiposity and especially adiposity changes in infancy. TRIAL REGISTRATION ClinicalTrials.gov: NCT00412074.
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Affiliation(s)
- Katherine A Bell
- Department of Pediatric Newborn Medicine, Brigham & Women's Hospital, Boston, MA.
| | - Carol L Wagner
- Medical University of South Carolina, Department of Pediatrics
| | - Wei Perng
- University of Michigan School of Public Health, Departments of Nutritional Sciences and Epidemiology
| | | | - Roman J Shypailo
- Baylor College of Medicine, USDA/ARS Children's Nutrition Research Center
| | - Mandy B Belfort
- Brigham & Women’s Hospital, Department of Pediatric Newborn Medicine
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Roberts A, Nip A, Verma A, LaRoche A. Meeting Report: 2017 International Joint Meeting of Pediatric Endocrinology Washington DC (September 14-17, 2017) Selected Highlights. PEDIATRIC ENDOCRINOLOGY REVIEWS : PER 2018; 15:255-266. [PMID: 29493130 PMCID: PMC6478025 DOI: 10.17458/per.vol15.2018.rnvl.intjointwashington] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Alissa Roberts
- Seattle Children's Hospital, OC.7.820 - Endocrinology, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Angel Nip
- Seattle Children's Hospital, Seattle, WA 98105, USA
| | - Arushi Verma
- Seattle Children's Hospital, Seattle, WA 98105, USA
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Horsch A, Gilbert L, Lanzi S, Gross J, Kayser B, Vial Y, Simeoni U, Hans D, Berney A, Scholz U, Barakat R, Puder JJ. Improving cardiometabolic and mental health in women with gestational diabetes mellitus and their offspring: study protocol for MySweetHeart Trial, a randomised controlled trial. BMJ Open 2018; 8:e020462. [PMID: 29487077 PMCID: PMC5855393 DOI: 10.1136/bmjopen-2017-020462] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 11/10/2017] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) carries prenatal and perinatal risk for the mother and her offspring as well as longer-term risks for both the mother (obesity, diabetes, cardiovascular disease) and her child (obesity, type 2 diabetes). Compared with women without GDM, women with GDM are twice as likely to develop perinatal or postpartum depression. Lifestyle interventions for GDM are generally limited to physical activity and/or nutrition, often focus separately on the mother or the child and take place either during or after pregnancy, while their results are inconsistent. To increase efficacy of intervention, the multifactorial origins of GDM and the tight link between mental and metabolic as well as maternal and child health need to be heeded. This calls for an interdisciplinary transgenerational approach starting in, but continuing beyond pregnancy. METHODS AND ANALYSIS This randomised controlled trial will assess the effect of a multidimensional interdisciplinary lifestyle and psychosocial intervention aimed at improving the metabolic and mental health of 200 women with GDM and their offspring. Women with GDM at 24-32 weeks gestational age who understand French or English, and their offspring and partners can participate. The intervention components will be delivered on top of usual care during pregnancy and the first year postpartum. Metabolic and mental health outcomes will be measured at 24-32 weeks of pregnancy, shortly after birth and at 6-8 weeks and 1 year after childbirth. Data will be analysed using intention-to-treat analyses. The MySweetHeart Trial is linked to the MySweetHeart Cohort (clinicaltrials.gov/ct2/show/NCT02872974). ETHICS AND DISSEMINATION We will disseminate the findings through regional, national and international conferences and through peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02890693; Pre-results.
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Affiliation(s)
- Antje Horsch
- Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
| | - Leah Gilbert
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefano Lanzi
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Service of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Justine Gross
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Bengt Kayser
- Institute of Sport Sciences, University of Lausanne, Lausanne, Switzerland
| | - Yvan Vial
- Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Umberto Simeoni
- DOHad Laboratory, Pediatrics Division, Woman-Mother-Child Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Didier Hans
- Center of Bone Diseases, Rheumatology Service, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Alexandre Berney
- Consultation Liaison Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Urte Scholz
- Applied Social and Health Psychology, Department of Psychology, University Research Priority Program Dynamics of Healthy Aging, University of Zurich, Lausanne, Switzerland
| | - Ruben Barakat
- Facultad de Ciencias de la Actividad Física y del Deporte-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | - Jardena J Puder
- Institute of Higher Education and Research in Healthcare (IUFRS), University of Lausanne, Lausanne, Switzerland
- Service of Pediatric Endocrinology, Diabetology and Obesity, Lausanne University Hospital, Lausanne, Switzerland
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Byrne R, Zhou Y, Perry R, Mauch C, Magarey A. Beverage intake of Australian children and relationship with intake of fruit, vegetables, milk and body weight at 2, 3.7 and 5 years of age. Nutr Diet 2018; 75:159-166. [PMID: 29424057 DOI: 10.1111/1747-0080.12409] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/21/2017] [Accepted: 12/19/2017] [Indexed: 02/03/2023]
Abstract
AIM Describe the type and amount of beverages consumed by Australian children at age 2, 3.7 and 5; investigate the longitudinal relationship between intake of sweet beverages with fruits and vegetables or milk/alternatives, and body mass index (BMI) z-score. METHODS Mothers in the NOURISH trial completed a single 24-hour recall of their child's intake, at age 2 (n = 515), 3.7 (n = 426) and 5 (n = 405). Anthropometry was measured by study staff. At each time point, proportion of children consuming at least one beverage on 24-hour recall from the following groups was determined; essential-cow's milk/alternatives, breast milk; non-essential-formula, sweet beverages. For consumers, intake (grams) of each beverage and proportion total estimated energy intake was calculated. The longitudinal relationship between intake of sweet beverages, and fruit and vegetable intake (g/kg body weight), with BMI z-score at 2, 3.7 and 5 years was examined using structural equation modelling. A second model investigated relationship with intake of milk/alternatives. RESULTS Sweet beverages were consumed by 38, 55 and 47% of children at each time point. Intake of sweet beverages strongly correlated between two and five years; however, intake was not associated with BMIz and did not appear to displace fruit and vegetable intake. Intake of cow's milk declined over time and was negatively associated with intake of sweet beverages at two and five years. CONCLUSIONS Tracking of intake over time supports the notion that children's early experience of sweet tastes is a strong predictor of future intake. Limiting exposure to sweet beverages in early childhood remains an important strategy in the development of healthy food preferences and promotion of dietary quality.
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Affiliation(s)
- Rebecca Byrne
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Yi Zhou
- Nutrition and Dietetics, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Rebecca Perry
- Nutrition and Dietetics, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Chelsea Mauch
- Nutrition and Dietetics, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Anthea Magarey
- Nutrition and Dietetics, School of Medicine, Flinders University, Adelaide, South Australia, Australia
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Infant feeding practices and dietary consumption of US infants and toddlers: National Health and Nutrition Examination Survey (NHANES) 2003–2012. Public Health Nutr 2017; 21:711-720. [DOI: 10.1017/s1368980017003184] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractObjectiveTo compare infant and toddler anthropometric measurements, feeding practices and mean nutrient intakes by race/ethnicity and income.DesignCross-sectional analysis using general linear modelling. Ten years of survey data (2003–2012) were combined to compare anthropometric measurements, feeding practices and mean nutrient intakes from a nationally representative US sample.SettingThe 2003–2012 National Health and Nutrition Examination Survey (NHANES).SubjectsInfants and toddlers (n 3669) aged 0–24 months.ResultsRates of overweight were higher among Mexican-American infants and toddlers (P=0·002). There were also several differences in feeding practices among groups based on race/ethnicity. Cessation of breast-feeding occurred earlier for non-Hispanic black and Mexican-American v. non-Hispanic white infants (3·6 and 4·2 v. 5·3 months; P<0·0001; P=0·001). Age at first feeding of solids was earlier for white than Mexican-American infants (5·3 v. 5·7 months; P=0·02). There were differences in almost all feeding practices based on income, including the lowest-income infants stopped breast-feeding earlier than the highest-income infants (3·2 v. 5·8 months, P<0·0001). Several differences in mean nutrient intakes by both race/ethnicity and income were also identified.ConclusionsOur study indicates that disparities in overweight, feeding practices and mean nutrient intakes exist among infants and toddlers according to race/ethnicity, which cannot be disentangled from income.
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Fiks AG, Gruver RS, Bishop-Gilyard CT, Shults J, Virudachalam S, Suh AW, Gerdes M, Kalra GK, DeRusso PA, Lieberman A, Weng D, Elovitz MA, Berkowitz RI, Power TJ. A Social Media Peer Group for Mothers To Prevent Obesity from Infancy: The Grow2Gether Randomized Trial. Child Obes 2017; 13:356-368. [PMID: 28557558 PMCID: PMC5647509 DOI: 10.1089/chi.2017.0042] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few studies have addressed obesity prevention among low-income families whose infants are at increased obesity risk. We tested a Facebook peer-group intervention for low-income mothers to foster behaviors promoting healthy infant growth. METHODS In this randomized controlled trial, 87 pregnant women (Medicaid insured, BMI ≥25 kg/m2) were randomized to the Grow2Gether intervention or text message appointment reminders. Grow2Gether participants joined a private Facebook group of 9-13 women from 2 months before delivery until infant age 9 months. A psychologist facilitated groups featuring a curriculum of weekly videos addressing feeding, sleep, parenting, and maternal well-being. Feasibility was assessed using the frequency and content of participation, and acceptability using surveys. Maternal beliefs and behaviors and infant growth were assessed at birth, 2, 4, 6, and 9 months. Differences in infant growth between study arms were explored. We conducted intention-to-treat analyses using quasi-least-squares regression. RESULTS Eighty-eight percent (75/85) of intervention participants (42% (36/85) food insecure, 88% (75/85) black) reported the group was helpful. Participants posted 30 times/group/week on average. At 9 months, the intervention group had significant improvement in feeding behaviors (Infant Feeding Style Questionnaire) compared to the control group (p = 0.01, effect size = 0.45). Intervention group mothers were significantly less likely to pressure infants to finish food and, at age 6 months, give cereal in the bottle. Differences were not observed for other outcomes, including maternal feeding beliefs or infant weight-for-length. CONCLUSIONS A social media peer-group intervention was engaging and significantly impacted certain feeding behaviors in families with infants at high risk of obesity.
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Affiliation(s)
- Alexander G. Fiks
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rachel S. Gruver
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Chanelle T. Bishop-Gilyard
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Justine Shults
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Senbagam Virudachalam
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew W. Suh
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Marsha Gerdes
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Gurpreet K. Kalra
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Patricia A. DeRusso
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alexandra Lieberman
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Daniel Weng
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michal A. Elovitz
- Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Robert I. Berkowitz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thomas J. Power
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
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Ash T, Taveras EM. Associations of short sleep duration with childhood obesity and weight gain: summary of a presentation to the National Academy of Science's Roundtable on Obesity Solutions. Sleep Health 2017; 3:389-392. [DOI: 10.1016/j.sleh.2017.07.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 07/18/2017] [Indexed: 01/25/2023]
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Abstract
People who are overweight or have obesity are estimated to comprise 30% of the global population and up to 59% of companion dogs and cats are estimated to be above their optimal body weight. The prevalence of human and companion obesity is increasing. The direct and indirect costs of obesity and associated comorbidities are significant for human and veterinary healthcare. There are numerous similarities between obesity in people and companion animals, likely related to the shared environmental and lifestyle elements of this multifactorial disease. While the study of human obesity is relatively robust, research conducted in pets is generally limited to small studies, studies with cross-sectional designs or reports that have yet to be replicated. Greater understanding of human obesity may elucidate some of the factors driving the more recent rise in pet obesity. In particular, there are overlapping features of obesity in children and pets that are, in part, related to dependency on their 'parents' for care and feeding. When feeding is used in a coercive and controlling fashion, it may lead to undesirable feeding behaviour and increase the risk for obesity. A 'responsive parenting' intervention teaches parents to respond appropriately to hunger-satiety cues and to recognize and respond to others' distress. Such interventions may impact on childhood overweight and obesity and have the potential to be adapted for use with companion animals. Social behaviour towards people with obesity or owners of pets with obesity is often driven by beliefs about the cause of the obesity. Educating healthcare professionals and the public about the multifactorial nature of this complex disease process is a fundamental step in reducing the bias and stigma associated with obesity. Children living in low-income households have particularly high rates of obesity and as household income falls, rates of obesity also rise in pets and their owners. There are risk regulators (i.e. dynamic components of interconnected systems that influence obesity-related behaviours) and internal factors (i.e. biological determinants of obesity) that may influence the development of both childhood and pet obesity, and poverty may intersect with these variables to exacerbate obesity in low-income environments. This review discusses the costs, behaviours and psychology related to obesity in people and pets, and also proposes potential techniques that can be considered for prevention and treatment of this disease in pets. A 'One Health' approach to obesity suggests that an understanding of human obesity may elucidate some of the factors driving the more recent rise in pet obesity.
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Reyes I, Higgins M. Parental perception of child's body mass index and health within primary care. J Am Assoc Nurse Pract 2017; 29:375-383. [PMID: 28440560 DOI: 10.1002/2327-6924.12463] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 03/03/2017] [Accepted: 03/10/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE Overweight and obesity are sensitive issues to address with pediatric patients during any visit. Patients and families may not recognize that their child is overweight or obese and may not be ready to make change. The goals for this study were to collect overall statistics on the clinic in regards to weight status of children presenting for well child visits and to capture parental perception of the child's weight status in relation to child's age. METHODS A consecutive sample of parents and caregivers with a child aged 2-18 completed the survey and consented for the study on the day of the survey during a well child visit. CONCLUSIONS Parents, regardless of culture and age tended to underestimate the weight of their child. These findings further support the literature in that the younger the child, the more likely it is that the parent underestimates their weight status. IMPLICATIONS FOR PRACTICE Interventions should include early education with parents on what a healthy weight is and how it can predict future health. Addressing and recognizing early concerns and assessing parental perception can be important if educational messages are delivered throughout the span of the early years.
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Affiliation(s)
- Imelda Reyes
- Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
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Kugler KC, Balantekin KN, Birch LL, Savage JS. Application of the multiphase optimization strategy to a pilot study: an empirical example targeting obesity among children of low-income mothers. BMC Public Health 2016; 16:1181. [PMID: 27876027 PMCID: PMC5120514 DOI: 10.1186/s12889-016-3850-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/16/2016] [Indexed: 11/18/2022] Open
Abstract
Background Emerging approaches to building more efficient and effective behavioral interventions are becoming more widely available. The current paper provides an empirical example of the use of the engineering-inspired multiphase optimization strategy (MOST) to build a remotely delivered responsive parenting intervention to prevent obesity among children of low-income mothers with and without depressive symptoms. Methods Participants were 107 mothers with (n = 45) and without (n = 62) depressive symptoms who had a child aged 12 to 42 months participating in the Women, Infants and Children program. Participants were randomized to one of sixteen experimental conditions using a factorial design that included a combination of the following eight remotely delivered intervention components: responsive feeding curriculum (given to all participants), parenting curriculum, portion size guidance, obesogenic risk assessment, personalized feedback on mealtime routines, feeding curriculum counseling, goal setting, mobile messaging, and social support. This design enabled efficient identification of components with low feasibility and acceptability. Results Completion rates were high (85%) and did not statistically differ by depressive symptoms. However, mothers with depressive symptoms who received obesogenic risk assessment and personalized feedback on mealtime routines components had lower completion rates than mothers without depressive symptoms. All intervention components were feasible to implement except the social support component. Regardless of experimental condition, most participants reported that the program increased their awareness of what, when, and how to feed their children. Conclusions MOST provided an efficient way to assess the feasibility of components prior to testing them with a fully powered experiment. This framework helped identify potentially challenging combinations of remotely delivered intervention components. Consideration of how these results can inform future studies focused on the optimization phase of MOST is discussed.
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Affiliation(s)
- Kari C Kugler
- The Methodology Center, The Pennsylvania State University, 404 Health & Human Development Building, University Park, PA, 16802, USA.
| | - Katherine N Balantekin
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.,Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
| | - Leann L Birch
- Department of Foods and Nutrition, The University of Georgia, Athens, GA, USA
| | - Jennifer S Savage
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.,Center for Childhood Obesity Research, The Pennsylvania State University, University Park, PA, USA
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Gruver RS, Bishop-Gilyard CT, Lieberman A, Gerdes M, Virudachalam S, Suh AW, Kalra GK, Magge SN, Shults J, Schreiner MS, Power TJ, Berkowitz RI, Fiks AG. A Social Media Peer Group Intervention for Mothers to Prevent Obesity and Promote Healthy Growth from Infancy: Development and Pilot Trial. JMIR Res Protoc 2016; 5:e159. [PMID: 27485934 PMCID: PMC4987492 DOI: 10.2196/resprot.5276] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/22/2016] [Accepted: 03/18/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Evidence increasingly indicates that childhood obesity prevention efforts should begin as early as infancy. However, few interventions meet the needs of families whose infants are at increased obesity risk due to factors including income and maternal body mass index (BMI). Social media peer groups may offer a promising new way to provide these families with the knowledge, strategies, and support they need to adopt obesity prevention behaviors. OBJECTIVE The aim of this study is to develop and pilot test a Facebook-based peer group intervention for mothers, designed to prevent pediatric obesity and promote health beginning in infancy. METHODS We conducted in-depth semi-structured interviews with 29 mothers of infants and focus groups with 30 pediatric clinicians, to inform the development of a theory-based intervention. We then conducted a single-group pilot trial with 8 mothers to assess its feasibility and acceptability. All participants were recruited offline at pediatric primary care practices. Participants in the pilot trial joined a private Facebook group, moderated by a psychologist, with a weekly video-based curriculum, and also had the option to meet at a face-to-face event. Within the Facebook group, mothers were encouraged to chat, ask questions, and share photos and videos of themselves and babies practicing healthy behaviors. Consistent with the literature on obesity prevention, the curriculum addressed infant feeding, sleep, activity, and maternal well-being. Feasibility was assessed using the frequency and content of group participation by mothers, and acceptability was measured using online surveys and phone interviews. RESULTS Based on preferences of mothers interviewed (mean BMI 35 kg/m(2), all Medicaid-insured, mean age 27, all Black), we designed the intervention to include frequent posts with new information, videos showing parents of infants demonstrating healthy behaviors, and an optional face-to-face meeting. We developed a privacy and safety plan that met the needs of participants as well as the requirements of the local institutional review board (IRB), which included use of a "secret" group and frequent screening of participant posts. Clinicians, 97% (29/30) women and 87% (26/30) pediatricians, preferred no direct involvement in the intervention, but were supportive of their patients' participation. In our 8-week, single group pilot trial, all participants (mean BMI 35 kg/m(2), all Medicaid-insured, mean age 28, all Black) viewed every weekly video post, and interacted frequently, with a weekly average of 4.4 posts/comments from each participant. All participant posts were related to parenting topics. Participants initiated conversations about behaviors related to healthy infant growth including solid food introduction, feeding volume, and managing stress. All 8 pilot group participants reported that they found the group helpful and would recommend it to others. CONCLUSIONS Our methodology was feasible and acceptable to low-income mothers of infants at high risk of obesity, and could be adapted to implement peer groups through social media for underserved populations in varied settings. CLINICALTRIAL ClinicalTrials.gov NCT01977105; https://clinicaltrials.gov/ct2/show/NCT01977105 (Archived by WebCite at http://www.webcitation.org/6iMFfOBat).
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Affiliation(s)
- Rachel S Gruver
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Savage JS, Birch LL, Marini M, Anzman-Frasca S, Paul IM. Effect of the INSIGHT Responsive Parenting Intervention on Rapid Infant Weight Gain and Overweight Status at Age 1 Year: A Randomized Clinical Trial. JAMA Pediatr 2016; 170:742-9. [PMID: 27271455 PMCID: PMC4969142 DOI: 10.1001/jamapediatrics.2016.0445] [Citation(s) in RCA: 165] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Rapid infant weight gain is associated with later obesity, but interventions to prevent rapid infant growth and reduce risk for overweight status in infancy are lacking. OBJECTIVE To examine the effect of a responsive parenting (RP) intervention on infant weight gain between birth and 28 weeks and overweight status at age 1 year. DESIGN, SETTING, AND PARTICIPANTS The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study is an ongoing randomized clinical trial comparing an RP intervention designed to prevent childhood obesity with a safety control. The study includes primiparous mother-newborn dyads (n = 291) and was conducted at the Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, in addition to home visits. Enrollment was initiated in January 2012, and evaluable population analyses for this study were conducted between April 2015 and November 2015. INTERVENTIONS At 2 weeks post partum, initial intervention materials appropriate to the assigned treatment group were mailed to the participant's home. Research nurses conducted home visits at 3 weeks, 16 weeks, 28 weeks, and 40 weeks, and a research center visit occurred at 1 year. The Intervention Nurses Start Infants Growing on Healthy Trajectories curriculum included messages about infant feeding, sleep hygiene, active social play, emotion regulation, and growth record education. The control group received a developmentally appropriate home safety intervention also delivered by nurse home visitors. MAIN OUTCOMES AND MEASURES Conditional weight gain from birth to 28 weeks was calculated. General linear models examined intervention effect on conditional weight gain. The intervention's effect on infant weight-for-length percentiles was tested using analysis of variance. Logistic regression compared the odds of overweight status (weight for length ≥95th percentile) at 1 year as a function of conditional weight gain. RESULTS Of the mothers included in the study, 246 were white (88%), 260 were non-Hispanic (93%), 210 were married (75%), and 201 were working full time (72%) at time of enrollment. The mean conditional weight gain score was lower among infants in the RP group compared with the control group (-0.18; 95% CI, -0.36 to -0.001), reflecting that the RP infants gained weight more slowly than control group infants (0.18; 95% CI, 0.02-0.34); this effect did not differ by feeding mode (predominantly fed breast milk or not). Infants in the RP group also had lower mean weight-for-length percentiles at 1 year than infants in the control group (57.5%; 95% CI, 52.56%-62.37% vs 64.4%; 95% CI, 59.94%-69.26%; P = .04) and were less likely to be overweight at age 1 year (5.5% vs 12.7%; P = .05). CONCLUSIONS AND RELEVANCE An RP intervention is associated with reduced rapid weight gain during the first 6 months after birth and overweight status at age 1 year. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01167270.
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Affiliation(s)
- Jennifer S Savage
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park2Nutritional Sciences, The Pennsylvania State University, University Park
| | - Leann L Birch
- Department of Foods and Nutrition, University of Georgia, Athens
| | - Michele Marini
- Center for Childhood Obesity Research, The Pennsylvania State University, University Park
| | | | - Ian M Paul
- Pediatrics and Public Health Sciences, Pennsylvania State College of Medicine, University Park
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Yeung S, Chan R, Li L, Leung S, Woo J. Bottle milk feeding and its association with food group consumption, growth and socio-demographic characteristics in Chinese young children. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 27456355 DOI: 10.1111/mcn.12341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 12/31/2022]
Abstract
It is recommended that infants from the age of 12 months should be weaned from bottles. However, an overwhelming proportion of young children were still using bottle after the recommended age of bottle-weaning. This cross-sectional study examined the association between utensils for milk drinking and food group consumption, growth and socio-demographic characteristics among young children. Data from the Survey of Infant and Young Child Feeding in Hong Kong were analyzed for 649 children aged 18-48 months old. Dietary outcomes were obtained via 3-day dietary records, while utensils for milk drinking and socio-demographic characteristics were collected from a self-developed questionnaire. Length/height and weight of the children were measured by the nurses. Results showed that daily consumption of formula milk was significantly greater among bottle users or bottle plus cup users than non-bottle users (p < 0.05). Exclusive bottle users had significantly lower intakes of meat and meat alternatives than bottle plus cup users for the 18 to 24-month group (p = 0.001) and lower intakes of fruits than non-bottle users in the 48-month group (p = 0.015). BMI z-score was significantly higher for exclusive bottle users than non-bottle users, even after adjusting for socio-economic factors and child's age (p = 0.006). The results showed that the milk drinking utensil was associated with the amount of formula milk and food group consumption as well as BMI z-score. There is a need to actively discourage prolonged bottle use in order to help young children develop good dietary habits. © 2016 John Wiley & Sons Ltd.
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Affiliation(s)
- Suey Yeung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Ruth Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Centre for Nutritional Studies, The Chinese University of Hong Kong, Hong Kong
| | - Liz Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Shirley Leung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.,Centre for Nutritional Studies, The Chinese University of Hong Kong, Hong Kong
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Virudachalam S, Gruver RS, Gerdes M, Power TJ, Magge SN, Shults J, Faerber JA, Kalra GK, Bishop-Gilyard CT, Suh AW, Berkowitz RI, Fiks AG. Mothers' and Clinicians' Priorities for Obesity Prevention Among Black, High-Risk Infants. Am J Prev Med 2016; 51:46-53. [PMID: 26947214 DOI: 10.1016/j.amepre.2015.12.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 12/01/2015] [Accepted: 12/18/2015] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Despite many recommended strategies for obesity prevention during infancy, effectively delivering recommendations to parents in clinical settings is challenging, especially among high-risk populations. This study describes and compares mothers' and clinicians' priorities for obesity prevention during infancy, to facilitate more-effective obesity prevention messaging. METHODS A discrete choice experiment using maximum difference scaling was administered in 2013 and analyzed in 2013-2014. Twenty-nine low-income, obese mothers of infants and 30 pediatric clinicians from three urban primary care practices rated the relative importance of 16 items relevant to obesity prevention during infancy, in response to this question: Which topic would be most helpful [for new mothers] to learn about to prevent your [their] child from becoming overweight? Response options encompassed the domains of feeding, sleep, parenting (including physical activity and screen time), and maternal self-care. RESULTS Mothers (all Medicaid-enrolled and black; mean age, 27 years; mean BMI, 35 kg/m(2)) and clinicians (97% female, 87% pediatricians, 13% nurse practitioners) both highly prioritized recognizing infant satiety and hunger cues, and appropriate feeding volume. Mothers rated infant physical activity and maintaining regular routines as 3.5 times more important than clinicians did (p<0.001). Clinicians rated breastfeeding as 3.4 times more important than mothers did (p<0.001). Neither group prioritized learning about screen time or maternal self-care. CONCLUSIONS Low-income, obese, black mothers of infants highly prioritized learning about many effective obesity prevention strategies, including recognizing hunger and satiety cues, promoting infant activity, and maintaining regular routines. Clinicians may frame preventive guidance to be responsive to these priorities.
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Affiliation(s)
- Senbagam Virudachalam
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Rachel S Gruver
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marsha Gerdes
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Thomas J Power
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sheela N Magge
- Division of Endocrinology and Diabetes, Center for Translational Science, Children's National Health Systems, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Justine Shults
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jennifer A Faerber
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gurpreet K Kalra
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Chanelle T Bishop-Gilyard
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrew W Suh
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Robert I Berkowitz
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Russell CG, Taki S, Azadi L, Campbell KJ, Laws R, Elliott R, Denney-Wilson E. A qualitative study of the infant feeding beliefs and behaviours of mothers with low educational attainment. BMC Pediatr 2016; 16:69. [PMID: 27209010 PMCID: PMC4875628 DOI: 10.1186/s12887-016-0601-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 05/10/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Infancy is an important period for the promotion of healthy eating, diet and weight. However little is known about how best to engage caregivers of infants in healthy eating programs. This is particularly true for caregivers, infants and children from socioeconomically disadvantaged backgrounds who experience greater rates of overweight and obesity yet are more challenging to reach in health programs. Behaviour change interventions targeting parent-infant feeding interactions are more likely to be effective if assumptions about what needs to change for the target behaviours to occur are identified. As such we explored the precursors of key obesity promoting infant feeding practices in mothers with low educational attainment. METHODS One-on-one semi-structured telephone interviews were developed around the Capability Opportunity Motivation Behaviour (COM-B) framework and applied to parental feeding practices associated with infant excess or healthy weight gain. The target behaviours and their competing alternatives were (a) initiating breastfeeding/formula feeding, (b) prolonging breastfeeding/replacing breast milk with formula, (c) best practice formula preparation/sub-optimal formula preparation, (d) delaying the introduction of solid foods until around six months of age/introducing solids earlier than four months of age, and (e) introducing healthy first foods/introducing unhealthy first foods, and (f) feeding to appetite/use of non-nutritive (i.e., feeding for reasons other than hunger) feeding. The participants' education level was used as the indicator of socioeconomic disadvantage. Two researchers independently undertook thematic analysis. RESULTS Participants were 29 mothers of infants aged 2-11 months. The COM-B elements of Social and Environmental Opportunity, Psychological Capability, and Reflective Motivation were the key elements identified as determinants of a mother's likelihood to adopt the healthy target behaviours although the relative importance of each of the COM-B factors varied with each of the target feeding behaviours. CONCLUSIONS Interventions targeting healthy infant feeding practices should be tailored to the unique factors that may influence mothers' various feeding practices, taking into account motivational and social influences.
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Affiliation(s)
| | - Sarah Taki
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Leva Azadi
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Rachel Laws
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, Australia
| | - Rosalind Elliott
- Faculty of Health, University of Technology Sydney, Sydney, Australia
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Wood CT, Perreira KM, Perrin EM, Yin HS, Rothman RL, Sanders LM, Delamater AM, Bentley ME, Bronaugh AB, Thompson AL. Confirmatory factor analysis of the Infant Feeding Styles Questionnaire in Latino families. Appetite 2016; 100:118-25. [PMID: 26876910 PMCID: PMC4799737 DOI: 10.1016/j.appet.2016.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/25/2016] [Accepted: 02/09/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Parent feeding practices affect risk of obesity in children. Latino children are at higher risk of obesity than the general population, yet valid measure of feeding practices, one of which is the Infant Feeding Styles Questionnaire (IFSQ), have not been formally validated in Spanish. OBJECTIVE To validate the IFSQ among Latino families, we conducted confirmatory factor analysis of pressuring, restrictive, and responsive feeding constructs from the IFSQ. DESIGN/METHODS The IFSQ was administered at the 12-month visit in the Greenlight study, a multi-center cluster randomized trial to prevent obesity. Parents were included if they were of Latino origin (n = 303) and completed an English or Spanish language modified IFSQ (without the indulgence construct). Scores from nine sub-constructs of the IFSQ were compared between English and Spanish language versions. We tested reliability with Cronbach's alpha coefficients and performed confirmatory factor analysis to examine factor loadings and goodness of fit characteristics, modifying constructs to achieve best fit. RESULTS Of 303 parents completing the IFSQ, 84% were born outside the US, and 74% completed the IFSQ in Spanish. Reliability coefficients ranged from 0.28 to 0.61 for the laissez-faire sub-constructs and from 0.58 to 0.83 for the pressuring, restrictive, and responsive sub-constructs. Results for all coefficients were similar between participants responding to an English and Spanish version of the IFSQ. Goodness of fit indices ranged from CFI 0.82-1 and RMSEA 0.00-0.31, and the model performed best in pressuring-soothing (CFI 1.0, RMSEA 0.00) and restrictive-amount (CFI 0.98, RMSEA 0.1) sub-constructs. CONCLUSIONS In a sample of Latino families, pressuring, restrictive, and responsive constructs performed well. The modified IFSQ in both English and Spanish-speaking Latino families may be used to assess parenting behaviors related to early obesity risk in this at-risk population.
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Affiliation(s)
- Charles T Wood
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Krista M Perreira
- Carolina Population Center, University of North Carolina at Chapel Hill School of Public Health, Chapel Hill, NC, USA
| | - Eliana M Perrin
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - H Shonna Yin
- Department of Pediatrics, School of Medicine/Bellevue Hospital Center, New York University, New York, NY, USA
| | - Russell L Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lee M Sanders
- Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, CA, USA
| | - Alan M Delamater
- Department of Pediatrics, University of Miami School of Medicine, Miami, FL, USA
| | - Margaret E Bentley
- Carolina Population Center, University of North Carolina at Chapel Hill School of Public Health, Chapel Hill, NC, USA
| | - Andrea B Bronaugh
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda L Thompson
- Carolina Population Center, University of North Carolina at Chapel Hill School of Public Health, Chapel Hill, NC, USA
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Hittner JB, Johnson C, Tripicchio G, Faith MS. Infant emotional distress, maternal restriction at a home meal, and child BMI gain through age 6years in the Colorado Adoption Project. Eat Behav 2016; 21:135-41. [PMID: 26872074 DOI: 10.1016/j.eatbeh.2016.01.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 12/30/2015] [Accepted: 01/19/2016] [Indexed: 11/26/2022]
Abstract
Infant temperament and parental feeding practices may be risk factors for childhood obesity, however most studies have relied upon parent-report assessments. We tested whether infant emotional distress and maternal restrictive feeding at 12-months of age, assessed observationally at a home feeding interaction, predicted child BMI through age 6years. We conducted a prospective observational study of 86 children (34 girls and 52 boys, from 55 adoptive and 31 non-adoptive families) enrolled in the Colorado Adoption Project. Mother-infant feeding interactions were video-recorded during a home snack or meal at year 1, and child anthropometrics (length or height, and weight) were assessed at years 1 through 6. The main outcome measures were child weight-for-length at year 1 and body mass index (BMI: kg/m(2)) at years 2-6. Results of generalized linear models indicated that greater infant emotional distress at 12-months predicted greater increases in child weight status through age 6years, B=0.62 and odds ratio (OR)=1.87. In separate analyses, restrictive feeding interacted with child sex in predicting weight status trajectories (p=.012). Male infants whose mothers displayed any compared to no restriction at year 1 showed a downward BMI trajectory from 2 to 6years; for female infants, exposure to any compared to no restriction prompts predicted increasing BMI from 4 to 6years. In sum, early obesity prevention strategies should pay greater attention to infant temperament, especially distress and negative affect, and how parents respond to such cues. Additionally, 'responsive feeding' strategies that provide an alternative to restriction warrant greater research during infancy.
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Affiliation(s)
- James B Hittner
- Department of Psychology, College of Charleston, United States
| | - Cassandra Johnson
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, United States
| | - Gina Tripicchio
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina - Chapel Hill, United States
| | - Myles S Faith
- Department of Counseling, School, and Educational Psychology (CSEP), Graduate School of Education, University of Buffalo - SUNY, United States.
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Bagci Bosi AT, Eriksen KG, Sobko T, Wijnhoven TMA, Breda J. Breastfeeding practices and policies in WHO European Region Member States. Public Health Nutr 2016; 19:753-64. [PMID: 26096540 PMCID: PMC4754616 DOI: 10.1017/s1368980015001767] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 03/03/2015] [Accepted: 04/15/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To provide an update on current practices and policy development status concerning breastfeeding in the WHO European Region. DESIGN National surveys and studies conducted by national health institutions were prioritized. Sub-national data were included where no national data or studies existed. Information on national breastfeeding policies was collected mainly from the WHO Seventh Meeting of Baby-Friendly Hospital Initiative Coordinators and European Union projects. Owing to the different data sources and methods, any comparisons between countries must be made with caution. SETTING WHO European Member States. RESULTS Data from fifty-three WHO European Member States were investigated; however, a large proportion had not reported any data. Rates of early initiation of breastfeeding, exclusive breastfeeding and continued breastfeeding to 1 year all varied considerably within the WHO European Region. Exclusive breastfeeding rates declined considerably after 4 months, and were low in infants under 6 months and at 6 months of age. The majority of the countries with existing data reported having a national infant and young child feeding policy and the establishment of a national committee on breastfeeding or infant and young child feeding. The majority of the countries with existing data reported having baby-friendly hospitals, although the proportion of baby-friendly hospitals to the total number of national hospitals with maternity units was low in most countries. CONCLUSIONS Breastfeeding practices within the WHO European Region, especially exclusive breastfeeding rates, are far from complying with the WHO recommendations. There are marked differences between countries in breastfeeding practices, infant and young child feeding policy adoption and proportion of baby-friendly hospitals.
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Affiliation(s)
- Ayse Tulay Bagci Bosi
- Department of Public Health, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Kamilla Gehrt Eriksen
- MRC Human Nutrition Research, Darwin College, Cambridge, Silver Street, Cambridge CB3 9EU, UK
| | - Tanja Sobko
- Department of Human Performance, Hong Kong University, Pokfulam, Hong Kong SAR, People’s Republic of China
| | - Trudy MA Wijnhoven
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark
| | - João Breda
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, WHO Regional Office for Europe, Copenhagen, Denmark
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Doub AE, Small M, Birch LL. A call for research exploring social media influences on mothers' child feeding practices and childhood obesity risk. Appetite 2016; 99:298-305. [PMID: 26767614 DOI: 10.1016/j.appet.2016.01.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/30/2015] [Accepted: 01/04/2016] [Indexed: 10/22/2022]
Abstract
There is increasing interest in leveraging social media to prevent childhood obesity, however, the evidence base for how social media currently influences related behaviors and how interventions could be developed for these platforms is lacking. This commentary calls for research on the extent to which mothers use social media to learn about child feeding practices and the mechanisms through which social media influences their child feeding practices. Such formative research could be applied to the development and dissemination of evidence-based childhood obesity prevention programs that utilize social media. Mothers are identified as a uniquely important target audience for social media-based interventions because of their proximal influence on children's eating behavior and their high engagement with social media platforms. Understanding mothers' current behaviors, interests, and needs as they relate to their social media use and child feeding practices is an integral first step in the development of interventions that aim to engage mothers for obesity prevention. This commentary highlights the importance of mothers for childhood obesity prevention; discusses theoretical and analytic frameworks that can inform research on social media and mothers' child feeding practices; provides evidence that social media is an emerging context for social influences on mothers' attitudes and behaviors in which food is a salient topic; and suggests directions for future research.
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Affiliation(s)
- Allison E Doub
- Pennsylvania State University, Department of Human Development and Family Studies, College of Health and Human Development, USA.
| | - Meg Small
- Pennsylvania State University, Bennett Pierce Prevention Research Center for the Promotion of Human Development, USA
| | - Leann L Birch
- University of Georgia, Department of Foods and Nutrition, College of Family and Consumer Sciences, USA
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Doub AE, Moding KJ, Stifter CA. Infant and maternal predictors of early life feeding decisions. The timing of solid food introduction. Appetite 2015; 92:261-8. [PMID: 26025089 PMCID: PMC4499500 DOI: 10.1016/j.appet.2015.05.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 04/26/2015] [Accepted: 05/22/2015] [Indexed: 11/22/2022]
Abstract
There is limited research on the maternal and infant characteristics associated with the timing of solid food introduction. The current study examined how maternal feeding style and infant temperament independently and interactively predicted the age at which infants were introduced to solid food. Data from 115 predominately white, middle-class mothers were collected when infants were 4 and 6 months of age. The timing of solid food introduction was positively correlated with mothers' age, education, breastfeeding at 4 months, self-reported responsiveness to infants' hunger and satiety cues, and negatively correlated with mothers' pre-pregnancy body mass index (BMI), beliefs about feeding infants solid food prior to 6 months of age, and infants' temperamental motor reactivity. When controlling for maternal age, education, pre-pregnancy BMI, and milk feeding method at 4 months, the timing of solid food introduction was negatively predicted by mothers' beliefs about feeding solid food prior to 6 months of age. Exploratory interaction analyses suggested that infant temperament marginally moderated maternal feeding style in predicting the timing of solid food introduction.
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Affiliation(s)
- Allison E. Doub
- 315 Health and Human Development-East Building, The Pennsylvania State University, University Park, PA 16802, United States
| | - Kameron J. Moding
- 315 Health and Human Development-East Building, The Pennsylvania State University, University Park, PA 16802, United States
| | - Cynthia A. Stifter
- 308 Health & Human Development-East Building, The Pennsylvania State University, University Park PA 16802, United States
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Macpherson-Sánchez AE. Integrating fundamental concepts of obesity and eating disorders: implications for the obesity epidemic. Am J Public Health 2015; 105:e71-85. [PMID: 25713933 PMCID: PMC4358173 DOI: 10.2105/ajph.2014.302507] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2014] [Indexed: 12/12/2022]
Abstract
Physiological mechanisms promote weight gain after famine. Because eating disorders, obesity, and dieting limit food intake, they are famine-like experiences. The development of the concept of meeting an ideal weight was the beginning of increasing obesity. Weight stigma, the perception of being fat, lack of understanding of normal growth and development, and increased concern about obesity on the part of health providers, parents, and caregivers have reinforced each other to promote dieting. Because weight suppression and disinhibition provoke long-term weight increase, dieting is a major factor producing the obesity epidemic. The integrated eating disorder-obesity theory included in this article emphasizes that, contrary to dieters, lifetime weight maintainers depend on physiological processes to control weight and experience minimal weight change.
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Affiliation(s)
- Ann E Macpherson-Sánchez
- Ann E. Macpherson-Sánchez is with the Department of Agricultural Education, University of Puerto Rico, Mayagüez
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Horodynski MA, Silk K, Hsieh G, Hoffman A, Robson M. Tools for teen moms to reduce infant obesity: a randomized clinical trial. BMC Public Health 2015; 15:22. [PMID: 25604090 PMCID: PMC4308927 DOI: 10.1186/s12889-015-1345-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 01/02/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Unhealthy infant feeding practices, such as a combination of formula feeding and early introduction of solids may lead to rapid or excessive weight gain in early infancy. Adolescent mothers' feeding behaviors are most directly related to infant weight gain in the first year of life. Compared to adult mothers, adolescent mothers are less knowledgeable, less responsive, more controlling, and less skilled in infant feeding, which interferes with infants' healthy growth. The Tools for Teen Moms trial aims to compare the effect of a social media intervention for low-income adolescent, first-time mothers of infants 2 months of age or younger, versus standard care on infant weight, maternal responsiveness, and feeding style and practices. The intervention is conducted during the infant's first four months of life to promote healthy transition to solids during their first year. Tools for Teen Moms is an intervention delivered via a social media platform that actively engages and coaches low-income adolescent mothers in infant-centered feeding to reduce rapid/excessive infant weight gain in the first six months of life. METHODS/DESIGN We describe our study protocol for a randomized control trial with an anticipated sample of 100 low-income African- American and Caucasian adolescent, first-time mothers of infants. Participants are recruited through Maternal-Infant Health Programs in four counties in Michigan, USA. Participants are randomly assigned to the intervention or the control group. The intervention provides infant feeding information to mothers via a web-based application, and includes daily behavioral challenges, text message reminders, discussion forums, and website information as a comprehensive social media strategy over 6 weeks. Participants continue to receive usual care during the intervention. Main maternal outcomes include: (a) maternal responsiveness, (b) feeding style, and (c) feeding practices. The primary infant outcome is infant weight. Data collection occurs at baseline, and when the baby is 3 and 6 months old. DISCUSSION Expected outcomes will address the effectiveness of the social media intervention in helping teen mothers develop healthy infant feeding practices that contribute to reducing the risk of early onset childhood obesity. TRIAL REGISTRATION Clinical Trials.Gov NCT02244424, June 24, 2014.
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Affiliation(s)
- Mildred A Horodynski
- College of Nursing, Michigan State University, 1355 Bogue Street, Bott Nursing Building, East Lansing, MI, 48824, USA.
| | - Kami Silk
- Department of Communication, Michigan State University, 404 Wilson Road, East Lansing, MI, 48824, USA.
| | - Gary Hsieh
- Department of Human Centered Design and Engineering, University of Washington, 414 Sieg Hall, Seattle, WA, 98195, USA.
| | - Alice Hoffman
- College of Nursing, Michigan State University, 1355 Bogue Street, Bott Nursing Building, East Lansing, MI, 48824, USA.
| | - Mackenzie Robson
- College of Nursing, Michigan State University, 1355 Bogue Street, Bott Nursing Building, East Lansing, MI, 48824, USA.
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Kronborg H, Foverskov E, Væth M. Predictors for early introduction of solid food among Danish mothers and infants: an observational study. BMC Pediatr 2014; 14:243. [PMID: 25270266 PMCID: PMC4263048 DOI: 10.1186/1471-2431-14-243] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 09/25/2014] [Indexed: 11/12/2022] Open
Abstract
Background Early introduction of complementary feeding may interfere with breastfeeding and the infant’s self-controlled appetite resulting in increased growth. The aim of the present study was to investigate predictors for early introduction of solid food. Methods In an observational study Danish mothers filled in a self-administered questionnaire approximately six months after birth. The questionnaire included questions about factors related to the infant, the mother, attachment and feeding known to influence time for introduction of solid food. The study population consisted of 4503 infants. Data were analysed using ordered logistic regression models. Outcome variable was time for introduction to solid food. Results Almost all of the included infants 4386 (97%) initiated breastfeeding. At weeks 16, 17–25, 25+, 330 infants (7%); 2923 (65%); and 1250 (28%), respectively had been introduced to solid food. Full breastfeeding at five weeks was the most influential predictor for later introduction of solid food (OR = 2.52 CI: 1.93-3.28). Among infant factors male gender, increased gestational age at birth, and higher birth weight were found to be statistically significant predictors. Among maternal factors, lower maternal age, higher BMI, and being primipara were significant predictors, and among attachment factors mother’s reported perception of the infant as being temperamental, and not recognising early infant cues of hunger were significant predictors for earlier introduction of solid food. Supplementary analyses of interactions between the predictors showed that the association of maternal perceived infant temperament on early introduction was restricted to primiparae, that the mother’s pre-pregnancy BMI had no impact if the infant was fully breastfed at week five, and that birth weight was only associated if the mother had reported early uncertainty in recognising infant’s cues of hunger. Conclusions Breastfeeding was the single most powerful indicator for preventing early introduction to solid food. Modifiable predictors pointed to the importance of supporting breastfeeding and educating primipara and mothers with low birth weight infants to be able to read and respond to their infants’ cues to prevent early introduction to solid food.
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Affiliation(s)
- Hanne Kronborg
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
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Paul IM, Williams JS, Anzman-Frasca S, Beiler JS, Makova KD, Marini ME, Hess LB, Rzucidlo SE, Verdiglione N, Mindell JA, Birch LL. The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study. BMC Pediatr 2014; 14:184. [PMID: 25037579 PMCID: PMC4105401 DOI: 10.1186/1471-2431-14-184] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/09/2014] [Indexed: 12/15/2022] Open
Abstract
Background Because early life growth has long-lasting metabolic and behavioral consequences, intervention during this period of developmental plasticity may alter long-term obesity risk. While modifiable factors during infancy have been identified, until recently, preventive interventions had not been tested. The Intervention Nurses Starting Infants Growing on Healthy Trajectories (INSIGHT). Study is a longitudinal, randomized, controlled trial evaluating a responsive parenting intervention designed for the primary prevention of obesity. This “parenting” intervention is being compared with a home safety control among first-born infants and their parents. INSIGHT’s central hypothesis is that responsive parenting and specifically responsive feeding promotes self-regulation and shared parent–child responsibility for feeding, reducing subsequent risk for overeating and overweight. Methods/Design 316 first-time mothers and their full-term newborns were enrolled from one maternity ward. Two weeks following delivery, dyads were randomly assigned to the “parenting” or “safety” groups. Subsequently, research nurses conduct study visits for both groups consisting of home visits at infant age 3–4, 16, 28, and 40 weeks, followed by annual clinic-based visits at 1, 2, and 3 years. Both groups receive intervention components framed around four behavior states: Sleeping, Fussy, Alert and Calm, and Drowsy. The main study outcome is BMI z-score at age 3 years; additional outcomes include those related to patterns of infant weight gain, infant sleep hygiene and duration, maternal responsiveness and soothing strategies for infant/toddler distress and fussiness, maternal feeding style and infant dietary content and physical activity. Maternal outcomes related to weight status, diet, mental health, and parenting sense of competence are being collected. Infant temperament will be explored as a moderator of parenting effects, and blood is collected to obtain genetic predictors of weight status. Finally, second-born siblings of INSIGHT participants will be enrolled in an observation-only study to explore parenting differences between siblings, their effect on weight outcomes, and carryover effects of INSIGHT interventions to subsequent siblings. Discussion With increasing evidence suggesting the importance of early life experiences on long-term health trajectories, the INSIGHT trial has the ability to inform future obesity prevention efforts in clinical settings. Trial registration NCT01167270. Registered 21 July 2010.
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Affiliation(s)
- Ian M Paul
- Department of Pediatrics, HS83, Penn State College of Medicine, 500 University Dr,, Hershey 17033, PA, USA.
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Abstract
During the first 2 y of life, development is rapid and includes dramatic changes in eating behavior. Individual patterns of food preferences and eating behaviors emerge and differ depending on the foods offered and on the contexts of feeding during this early period of dietary transition. In this review, we discuss evidence on ways in which early learning influences food preferences and eating behavior, which, in turn, shape differences in dietary patterns, growth, and health. Although the evidence reviewed indicates that this early period of transition provides opportunities to influence children's developing intake patterns, there is no consistent, evidence-based guidance for caregivers who are feeding infants and toddlers; the current Dietary Guidelines are intended to apply to Americans over the age of 2 y. At present, the evidence base with regard to how and what children learn about food and eating behavior during these first years is limited. Before developing guidance for parents and caregivers, more scholarship and research is necessary to understand how infants and toddlers develop the food preferences and self-regulatory processes necessary to promote healthy growth, particularly in today's environment. By the time they reach 2 y of age, children have essentially completed the transition to "table foods" and are consuming diets similar to those of other family members. This article discusses parenting and feeding approaches that may facilitate or impede the development of self-regulation of intake and the acceptance of a variety of foods and flavors necessary for a healthy diet. We review the limited evidence on how traditional feeding practices, familiarization, associative learning, and observational learning affect the development of eating behavior in the context of the current food environment. Areas for future research that could inform the development of anticipatory guidance for parents and caregivers responsible for the care and feeding of young children are identified.
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Affiliation(s)
- Leann L Birch
- Departments of Human Development and Family Studies (LLB and AED) and Nutritional Sciences (LLB), The Pennsylvania State University, University Park, PA
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Abstract
Pregnancy is a time when women are at increased risk to gain substantial weight. It is also a time when women are more health conscious and may be more likely to engage in healthier behaviors. Because of these factors, women are primed to engage in lifestyle strategies to promote healthy weight gain during pregnancy. Similarly, mothers of newborns also have an increased readiness for change, making infancy an ideal time to begin obesity prevention efforts in families. Health care providers are encouraged to take advantage of the increased health awareness and the behavioral momentum that is present surrounding pregnancy in order to promote healthy lifestyle changes for both pregnant women and new mothers.
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Affiliation(s)
- Craig A. Johnston
- Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, Texas
| | - Jennette P. Moreno
- Department of Pediatrics-Nutrition, Baylor College of Medicine, Houston, Texas
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Koletzko B, Armbruster M, Bauer CP, Bös K, Cierpka M, Cremer M, Dieminger B, Flothkötter M, Graf C, Heindl I, Hellmers C, Kersting M, Krawinkel M, Plöger A, Przyrembel H, Reichert-Garschhammer E, Schäfer T, Wahn U, Vetter K, Wabitsch M, Weißenborn A, Wiegand S. Ernährung und Bewegung im Kleinkindalter. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-013-3031-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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