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Omand JA, Janus M, Maguire JL, Parkin PC, Aglipay M, Randall Simpson J, Keown-Stoneman CDG, Duku E, Reid-Westoby C, Birken CS. Nutritional Risk in Early Childhood and School Readiness. J Nutr 2021; 151:3811-3819. [PMID: 34587245 DOI: 10.1093/jn/nxab307] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/19/2021] [Accepted: 08/17/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Nutrition in early childhood is important for healthy growth and development. Achieving school readiness is considered one of the most important developmental milestones for young children. OBJECTIVES The purpose of this study is to determine if nutritional risk in early childhood is associated with school readiness in kindergarten. METHODS A prospective cohort study was conducted through The Applied Research Group for Kids (TARGet Kids!) primary care research network in Toronto, Canada, 2015-2020. Nutritional risk was measured (18 mo to 5 y) using validated parent-completed questionnaires called Nutrition Screening for Toddlers and Preschoolers (NutriSTEP). High nutritional risk was categorized as scores ≥21. School readiness was measured using the validated teacher-completed Early Developmental Instrument (EDI), which measures 5 developmental domains in kindergarten (2 y of schooling, ages 4-6 y, before they enter grade 1). Vulnerability indicates scores lower than a population-based cutoff at the 10th percentile on at least 1 domain. Multiple logistic and linear regression models were conducted adjusting for relevant confounders. RESULTS The study included 896 children: 53% were male, 9% had high nutritional risk, and 17% were vulnerable on the EDI. A 1-SD increase in NutriSTEP total score was associated with 1.54 times increased odds of being vulnerable on the EDI among children in year 2 of kindergarten (P = 0.001). High nutritional risk cutoff was associated with 4.28 times increased odds of being vulnerable on the EDI among children in year 2 of kindergarten (P < 0.001). NutriSTEP total score and high nutritional risk were associated with lower scores on all 5 EDI domains, with the strongest association observed for the domains of language and cognitive development and communication skills and general knowledge. CONCLUSIONS Higher nutritional risk in early childhood is associated with lower school readiness in year 2 of kindergarten. Nutritional interventions early in life may offer opportunities to enhance school readiness. This trial was registered www.clinicaltrials.gov as NCT01869530.
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Affiliation(s)
- Jessica A Omand
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
| | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jonathon L Maguire
- The Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mary Aglipay
- Department of Pediatrics, St. Michael's Hospital, Pediatric Research, Toronto, Ontario, Canada
| | | | - Charles D G Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Eric Duku
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Caroline Reid-Westoby
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Catherine S Birken
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.,Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.,Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Omand JA, Janus M, Maguire JL, Parkin PC, Randall Simpson J, Keown-Stoneman CD, Aglipay M, Birken CS. Nutritional risk in early childhood and parent-reported school concerns. Public Health Nutr 2021; 24:6169-6177. [PMID: 33993902 PMCID: PMC11148608 DOI: 10.1017/s1368980021001725] [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] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine if nutritional risk in early childhood is associated with parent-reported school concerns. DESIGN A prospective cohort study conducted through the TARGet Kids! primary care research network (2011-2018). Nutritional risk was measured between 18 months and 5 years of age using validated parent-completed NutriSTEP® questionnaires with eating behaviour and dietary intake subscores (0 = lowest and 68 = highest total nutritional risk score). Parent-reported school concerns were measured at school age (4-10 years of age) and included: speech and language; learning; attention; behaviour; social relationships; physical coordination; fine motor coordination and self-help skills and independence. The primary outcome was any parent-reported school concerns, and individual school concerns were used as secondary outcomes. Multiple logistic regression models were conducted adjusting for clinically relevant confounders to assess the relationship between nutritional risk and school concerns. SETTING Toronto, Canada. PARTICIPANTS Children aged 18 months to 10 years. RESULTS The study included 3655 children, 52 % were male, mean NutriSTEP® score was 14·4 (sd 6·4). Each 1 sd increase in NutriSTEP® total score was associated with a 1·18 times increased odds of school concerns (adj OR: 1·18, 95 % CI 1·07, 1·28, P = 0·0004), and high nutritional risk was associated with a 1·42 times increased odds of school concerns (adj OR: 1·42, 95 % CI 1·13, 1·78, P = 0·002). CONCLUSIONS Nutritional risk in early childhood was associated with school concerns. Nutritional interventions in early childhood may reveal opportunities to enhance school outcomes.
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Affiliation(s)
- Jessica A Omand
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 555 University Ave, Toronto, ON M5G 1X8, Canada
| | - Magdalena Janus
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neuroscience, Faculty of Health Sciences, Hamilton, ON, Canada
| | - Jonathon L Maguire
- The Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
- Division of Pediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
- Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, St. Michael's Hospital, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Patricia C Parkin
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 555 University Ave, Toronto, ON M5G 1X8, Canada
- Division of Pediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
- Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Charles Dg Keown-Stoneman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Mary Aglipay
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Catherine S Birken
- Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, 555 University Ave, Toronto, ON M5G 1X8, Canada
- Division of Pediatric Medicine, Hospital for Sick Children, Toronto, ON, Canada
- Joannah & Brian Lawson Centre for Child Nutrition, Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Greater Nutritional Risk Scores in 2-Year-Old Children Exposed to Gestational Diabetes Mellitus In Utero and Their Relationship to Homeostasis Model Assessment for Insulin Resistance at Age 5 Years. Can J Diabetes 2020; 45:390-394. [PMID: 33046396 DOI: 10.1016/j.jcjd.2020.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/26/2020] [Accepted: 07/29/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Exposure to gestational diabetes mellitus (GDM) in utero may impact nutritional intake and lifestyle habits in early childhood. However, it is unclear whether nutritional status predicts greater risk for metabolic disturbances, such as insulin resistance (IR). The primary objectives were: 1) to determine parent-reported nutritional risk scores in 2-year-old children born to women with and without GDM and 2) to assess whether these scores predict IR in 5-year-old children. METHODS Children exposed (n=34) and unexposed (n=46) to GDM were screened at 2 years of age using the Toddler version of the Nutrition Screening Tool for Every Preschooler (NutriSTEP). At a 5-year follow up, IR was assessed using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). RESULTS Total NutriSTEP scores ranged from 6 to 33, with higher scores indicating greater risk. After controlling for infant birthweight, sex of the child, child ethnicity, maternal age at time of pregnancy, breastfeeding status and maternal prepregnancy body mass index, average NutriSTEP scores were higher in children exposed to GDM compared with those unexposed (13.8±1.1 vs 11.2±1.1, p=0.03). NutriSTEP scores at 2 years emerged as a positive independent predictor of HOMA-IR at 5 years. For each unit increase in NutriSTEP score, suggesting greater nutritional risk, we saw a 0.48 (95% confidence interval, 0.17 to 0.80; p=0.003) increase in score on the HOMA-IR. CONCLUSIONS Parent-reported nutritional risk is greater in GDM-exposed children, and these nutritional behaviours developed during the first years of life may predispose to metabolic disturbance in early childhood.
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