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Kim CN, Messito MJ, Duh-Leong C, Katzow M, Teli R, Gross RS. The effects of parent-child dysfunctional interactions on early childhood weight: A serial mediation model through emotional feeding and child appetite traits. Appetite 2024; 200:107564. [PMID: 38897417 DOI: 10.1016/j.appet.2024.107564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/22/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024]
Abstract
Parent-child dysfunctional interactions (PCDI) are known to contribute to children's weight status. However, the underlying mechanisms in how dysfunctional interactions between parent and child influence child weight are not clear. This study investigates the impact of PCDI on toddlers' weight, focusing on the potential serial mediation by maternal emotional feeding and child appetite traits. We conducted a secondary analysis of longitudinal data from a larger intervention trial to prevent childhood obesity in low-income Hispanic families. A total of 241 mother-child dyads were included in these analyses. Measurements were taken at various stages: PCDI at child age 19 months, maternal emotional feeding at 28 months, and both child appetite traits and weight-for-age z-score (WFAz) at 36 months. Serial mediation analyses revealed a significant indirect effect of early PCDI on later child WFAz through maternal emotional feeding and two child food approach traits (food responsiveness, emotional overeating) out of the eight child appetite traits assessed. PCDI at 19 months was associated with increased use of emotional feeding in mothers at 28 months, which was associated with heightened food responsiveness and emotional overeating in children at 36 months, which in turn was linked to greater child WFAz at 36 months. The findings of this study expand the understanding of the mechanisms underlying PCDI and child weight, emphasizing the interplay between maternal feeding practices and child appetite in the context of adverse parent-child interactions during early childhood.
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Affiliation(s)
| | | | | | | | - Radhika Teli
- New York University Grossman School of Medicine, USA
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Teli R, Messito MJ, Kim CN, Duh-Leong C, Katzow M, Gross R. Prolonged Early Food Insecurity and Child Feeding Practices among a Low-Income Hispanic Population: Role of Parenting Stress. Acad Pediatr 2024:S1876-2859(24)00236-5. [PMID: 38945524 DOI: 10.1016/j.acap.2024.06.013] [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] [Received: 01/16/2024] [Revised: 06/17/2024] [Accepted: 06/23/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE To examine associations between prolonged early household food insecurity (FI) during pregnancy, infancy, and toddlerhood, and child feeding practices, and the mediating role of dysfunctional parent-child interactions. METHODS We conducted secondary longitudinal analyses of data from the Starting Early Program (StEP) randomized controlled trial, which studied a primary care-based child obesity prevention program for low-income Hispanic families. Our independent variable was FI, using the USDA Food Security Module, during the third trimester of pregnancy and at child ages 10- and 19-months. Frequency of reported FI was defined by the number of periods with FI (0, 1, 2, or 3). Our dependent variables were feeding practices at child age 28-months using the Comprehensive Feeding Practices Questionnaire. Our mediating variable was dysfunctional parent-child interactions using the Parenting Stress Index subscale at age 19-months. We used linear regression to determine associations between frequency of reported FI and feeding practices adjusting for covariates, and mediation analyses to determine if dysfunctional parent-child interactions mediate these associations. RESULTS Three hundred and forty four mothers completed assessments at child age 28-months. Of the 12 feeding practices examined, higher frequency of reported FI was positively associated with using food as a reward, restriction of food for weight control, and using food for emotional regulation, and was negatively associated with monitoring of less healthy foods. There was a significant indirect effect of frequency of reported FI on these practices through dysfunctional parent-child interactions. CONCLUSION Higher frequency of reported FI was associated with four feeding practices, through dysfunctional parent-child interactions. Understanding these pathways can inform preventive interventions.
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Affiliation(s)
- Radhika Teli
- Department of Pediatrics (R Teli, MJ Messito, CN Kim, C Duh-Leong and R Gross), New York University Grossman School of Medicine, New York, NY.
| | - Mary Jo Messito
- Department of Pediatrics (R Teli, MJ Messito, CN Kim, C Duh-Leong and R Gross), New York University Grossman School of Medicine, New York, NY
| | - Christina N Kim
- Department of Pediatrics (R Teli, MJ Messito, CN Kim, C Duh-Leong and R Gross), New York University Grossman School of Medicine, New York, NY
| | - Carol Duh-Leong
- Department of Pediatrics (R Teli, MJ Messito, CN Kim, C Duh-Leong and R Gross), New York University Grossman School of Medicine, New York, NY
| | - Michelle Katzow
- Department of Pediatrics (M Katzow), Zucker School of Medicine at Hofstra/Northwell, New York, NY
| | - Rachel Gross
- Department of Pediatrics (R Teli, MJ Messito, CN Kim, C Duh-Leong and R Gross), New York University Grossman School of Medicine, New York, NY
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Duh-Leong C, Au L, Chang LY, Feldman NM, Pierce KA, Mendelsohn AL, Perrin EM, Sanders LM, Velazquez JJ, Lei Y, Xing SX, Shonna Yin H. Infant Feeding Outcomes From a Culturally-Adapted Early Obesity Prevention Program for Immigrant Chinese American Parents. Acad Pediatr 2024:S1876-2859(24)00214-6. [PMID: 38880393 DOI: 10.1016/j.acap.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 06/01/2024] [Accepted: 06/06/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To examine whether a cultural adaptation of an early childhood obesity prevention program promotes healthy infant feeding practices. METHODS Prospective quasi-experimental study of a community-engaged multiphasic cultural adaptation of an obesity prevention program set at a federally qualified health center serving immigrant Chinese American parent-child dyads (N = 298). In a group of historical controls, we assessed early infant feeding practices (breastfeeding, sugar-sweetened beverage intake) in 6-month-olds and then the same practices alongside early solid food feeding practices (bottle weaning, fruit, vegetable, sugary or salty snack consumption) in 12-month-olds. After implementation, we assessed these practices in an intervention cohort group at 6 and 12 months. We used cross-sectional groupwise comparisons and adjusted regression analyses to evaluate group differences. RESULTS At 6 months, the intervention group had increased odds of no sugar-sweetened beverage intake (aOR: 5.69 [95% confidence interval (CI): 1.65, 19.63], P = .006). At 12 months, the intervention group also had increased odds of no sugar-sweetened beverage intake (aOR: 15.22 [95% CI: 6.33, 36.62], P < .001), increased odds of bottle weaning (aOR: 2.34 [95% CI: 1.05, 5.23], P = .03), and decreased odds of sugary snack consumption (aOR: 0.36 [0.18, 0.70], P = .003). We did not detect improvements in breastfeeding, fruit, vegetable, or salty snack consumption. CONCLUSIONS A cultural adaptation of a primary care-based educational obesity prevention program for immigrant Chinese American families with low income is associated with certain healthy infant feeding practices. Future studies should evaluate cultural adaptations of more intensive interventions that better address complex feeding practices, such as breastfeeding, and evaluate long-term weight outcomes.
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Affiliation(s)
- Carol Duh-Leong
- Division of General Pediatrics (C Duh-Leong, LY Chang, KA Pierce, JJ Velazquez, and H Shonna Yin), Department of Pediatrics, NYU Grossman School of Medicine, New York, NY.
| | - Loretta Au
- Department of Pediatrics (L Au), Charles B. Wang Community Health Center, New York, NY
| | - Lucy Y Chang
- Division of General Pediatrics (C Duh-Leong, LY Chang, KA Pierce, JJ Velazquez, and H Shonna Yin), Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Naumi M Feldman
- Department of Population Health (NM Feldman), Charles B. Wang Community Health Center, New York, NY
| | - Kristyn A Pierce
- Division of General Pediatrics (C Duh-Leong, LY Chang, KA Pierce, JJ Velazquez, and H Shonna Yin), Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Alan L Mendelsohn
- Division of Developmental-Behavioral Pediatrics (AL Mendelsohn), Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Eliana M Perrin
- Division of General Pediatrics, Department of Pediatrics (EM Perrin), Schools of Medicine and Nursing, Johns Hopkins University, Baltimore, MD
| | - Lee M Sanders
- Division of General Pediatrics, Department of Pediatrics (LM Sanders), Stanford University School of Medicine, Palo Alto, Calif
| | - Jessica J Velazquez
- Division of General Pediatrics (C Duh-Leong, LY Chang, KA Pierce, JJ Velazquez, and H Shonna Yin), Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
| | - Yuxiao Lei
- Department of Health Policy (Y Lei), The London School of Economics and Political Science, London, United Kingdom
| | - Samantha X Xing
- Columbia Vagelos College of Physicians and Surgeons (SX Xing), New York, NY
| | - H Shonna Yin
- Division of General Pediatrics (C Duh-Leong, LY Chang, KA Pierce, JJ Velazquez, and H Shonna Yin), Department of Pediatrics, NYU Grossman School of Medicine, New York, NY
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Starnberg J, Renström L. Scoping review showed that obesity prevention in Nordic countries had limited effects on children from birth to 7 years of age. Acta Paediatr 2024; 113:912-922. [PMID: 37988200 DOI: 10.1111/apa.17043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 11/23/2023]
Abstract
AIM The aim of this scoping review was to map and summarise clinical trials that attempted to prevent obesity in children from birth to 7 years of age in any of the Nordic countries. METHODS PubMed, CINAHL Plus and clinicaltrials.gov were searched for peer-reviewed papers and registered trials published in English or Swedish. The overall search period was from 1 January 2002 to 13 December 2022. We included randomised and non-randomised trials initiated from birth to 7 years of age that aimed to prevent obesity in Denmark, Finland, Iceland, Norway and Sweden. RESULTS The search resulted in 414 papers and 14 were included. Despite having diverse settings and designs, none of them reported consistently favourable results for anthropometric outcomes, apart from beneficial trends in subgroups with a high body mass index at baseline. Most studies reported temporarily improved dietary patterns. CONCLUSION There is a gap in the current research about how to best prevent obesity in children. We suggest that researchers should focus on risk groups and that interventions that last a number of years are needed.
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Affiliation(s)
- Josefine Starnberg
- Centre for Research and Development, Region Gävleborg, Gävle, Sweden
- Centre for Clinical Research, Region Gävleborg and Uppsala University, Gävle, Sweden
| | - Lina Renström
- Centre for Research and Development, Region Gävleborg, Gävle, Sweden
- Centre for Clinical Research, Region Gävleborg and Uppsala University, Gävle, Sweden
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Mann K, Miller DiGiacomo R, Mirza N, Vaidya S. Virtual Nutrition Counseling in Pediatric Primary Care: An Integrated Approach to the Prevention and Management of Pediatric Obesity. Clin Pediatr (Phila) 2024:99228241242174. [PMID: 38563419 DOI: 10.1177/00099228241242174] [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: 04/04/2024]
Abstract
Given the rising prevalence of pediatric obesity, new approaches to the delivery of targeted nutrition counseling to not only prevent but also treat pediatric obesity are needed. The integration of a dietitian virtually was a successful quality improvement measure in this academic pediatric primary care clinic. The virtual dietitian provided age-appropriate nutrition counseling at well-child visits from 9 months to 6 years of age. Dietary counseling was also provided for children with overweight and obesity regardless of age. Vegetable, fruit, snack, and dairy intake was assessed in children who received counseling versus those who had traditional well childcare. Improved dairy habits were noted in the counseling cohort. A decrease in body mass index was not demonstrated in the patients with obesity or overweight; however, patient and provider satisfaction was quite high with this novel quality improvement measure. Virtual nutrition counseling can be easily integrated to facilitate a comprehensive pediatric medical home.
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Affiliation(s)
- Katherine Mann
- School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
| | | | - Nazrat Mirza
- School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
- IDEAL Pediatric Weight Management Clinic, Department of General Pediatrics & Adolescent Medicine, Children's National Health System, Washington, DC, USA
| | - Susma Vaidya
- School of Medicine & Health Sciences, George Washington University, Washington, DC, USA
- IDEAL Pediatric Weight Management Clinic, Department of General Pediatrics & Adolescent Medicine, Children's National Health System, Washington, DC, USA
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Duh-Leong C, Ortiz R, Messito MJ, Katzow MW, Kim CN, Teli R, Gross RS. Household Food Insecurity and Maternal-Toddler Fruit and Vegetable Dietary Concordance. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024; 56:100-109. [PMID: 38142387 PMCID: PMC10922249 DOI: 10.1016/j.jneb.2023.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 10/28/2023] [Accepted: 10/31/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To examine whether prenatal or concurrent household food insecurity influences associations between maternal and toddler fruit and vegetable (FV) intake. DESIGN Application of a life-course framework to an analysis of a longitudinal dataset. SETTING Early childhood obesity prevention program at a New York City public hospital. PARTICIPANTS One-hundred and fifty-six maternal-toddler dyads self-identifying as Hispanic or Latino. VARIABLES MEASURED Maternal and toddler FV intake was measured using Centers for Disease Control and Prevention dietary measures when toddlers were aged 19 months. Household food insecurity (measured prenatally and concurrently at 19 months) was measured using the US Department of Agriculture Food Security Module. ANALYSIS Regression analyses assessed associations between adequate maternal FV intake and toddler FV intake. Interaction terms tested whether prenatal or concurrent household food insecurity moderated this association. RESULTS Adequate maternal FV intake was associated with increased toddler FV intake (B = 6.2 times/wk, 95% confidence interval, 2.0-10.5, P = 0.004). Prenatal household food insecurity was associated with decreased toddler FV intake (B = -6.3 times/wk, 95% confidence interval, -11.67 to -0.9, P = 0.02). There was a significant interaction between the level of maternal-toddler FV association (concordance or similarity in FV intake between mothers and toddlers) and the presence of food insecurity such that maternal-toddler FV association was greater when prenatal household food insecurity was not present (B = -11.6, P = 0.04). CONCLUSIONS AND IMPLICATIONS Strategies to increase FV intake across the life course could examine how the timing of household food insecurity may affect intergenerational maternal-child transmission of dietary practices.
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Affiliation(s)
- Carol Duh-Leong
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY.
| | - Robin Ortiz
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY; Institute for Excellence in Health Equity, New York University Langone Health, New York, NY
| | - Mary Jo Messito
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY
| | - Michelle W Katzow
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Christina N Kim
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Radhika Teli
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
| | - Rachel S Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY; Department of Population Health, New York University Grossman School of Medicine, New York, NY
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Duh-Leong C, Messito MJ, Katzow MW, Kim CN, Mendelsohn AL, Scott MA, Gross RS. Prenatal and Pediatric Primary Care-Based Child Obesity Prevention: Effects of Adverse Social Determinants of Health on Intervention Attendance and Impact. Child Obes 2024. [PMID: 38301173 DOI: 10.1089/chi.2023.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Background: Adverse social determinants of health (SDoHs), specifically psychosocial stressors and material hardships, are associated with early childhood obesity. Less is known about whether adverse SDoHs modify the efficacy of early childhood obesity prevention programs. Methods: We conducted a secondary analysis of publicly insured birthing parent-child dyads with Latino backgrounds participating in a randomized controlled trial of the Starting Early Program (StEP), a child obesity prevention program beginning in pregnancy. We measured baseline adverse SDoHs categorized as psychosocial stressors (low social support, single marital status, and maternal depressive symptoms) and material hardships (food insecurity, housing disrepair, and financial difficulties) individually and cumulatively in the third trimester. Logistic regression models tested effects of adverse SDoHs on StEP attendance. We then tested whether adverse SDoHs moderated intervention impacts on weight at age 2 years. Results: We observed heterogeneous effects of adverse SDoHs on outcomes in 358 parent-child dyads. While housing disrepair decreased odds of higher attendance [adjusted odds ratio (aOR) 0.52, 95% confidence interval (CI): 0.29-0.94], high levels of psychosocial stressors doubled odds of higher attendance (aOR 2.36, 95% CI: 1.04-5.34). Similarly, while certain adverse SDoHs diminished StEP impact on weight (e.g., housing disrepair), others (e.g., high psychosocial stress) enhanced StEP impact on weight. Conclusions: Effects of adverse SDoHs on intervention outcomes depend on the specific adverse SDoH. Highest engagement and benefit occurred in those with high psychosocial stress at baseline, suggesting that StEP components may mitigate aspects of psychosocial stressors. Findings also support integration of adverse SDoH assessment into strategies to enhance obesity prevention impacts on families with material hardships. Trial Registration: This study is registered on clinicaltrials.gov: Starting Early Obesity Prevention Program (NCT01541761); https://clinicaltrials.gov/ct2/show/NCT01541761.
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Affiliation(s)
- Carol Duh-Leong
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Michelle W Katzow
- Division of General Pediatrics, Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Christina N Kim
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Alan L Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Marc A Scott
- Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY, USA
| | - Rachel S Gross
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
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Zhang L, Li P, Ge Q, Sun Z, Cai J, Xiao C, Yu C, Nosarti C, Liao J, Liu Z. Maternal Prenatal Depressive Symptoms and Fetal Growth During the Critical Rapid Growth Stage. JAMA Netw Open 2023; 6:e2346018. [PMID: 38048129 PMCID: PMC10696489 DOI: 10.1001/jamanetworkopen.2023.46018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
Importance Fetal growth in the critical rapid growth stage (CRGS) before delivery, approximately between 30 to 37 gestational weeks, carries significant implications for subsequent overweight, obesity, and arterial health. Previous evidence has demonstrated the association between maternal depressive symptoms and fetal growth trajectories from early to late pregnancy, but there remains limited understanding of the association of these symptoms with the longitudinal fetal growth change within the CRGS. Objective To investigate the association between maternal depressive symptoms and fetal growth during the CRGS before delivery. Design, Setting, and Participants This prospective birth cohort study was conducted from January 2018 to December 2020. Volunteer pregnant women were enrolled in their first trimester of prenatal visits. Women with severe disease before pregnancy and multiple births, fetuses with congenital anomalies, and preterm or postterm births were excluded. This multicenter study was based in 13 hospitals covering 81 counties across 12 cities in Sichuan Province, China. Follow-up visits were performed at the second trimester, the third trimester, and 24 hours after delivery. The analysis was conducted from January to May 2023. Exposures Maternal depressive symptoms, as a continuous variable, measured by the Edinburgh Postpartum Depression Scale (EPDS) at a median gestational week of 24 (range, 14 to 27) weeks of gestation. A higher score on the EPDS indicates worse depressive symptoms. Main Outcomes and Measures The main outcomes included ultrasonography-measured biparietal diameter (BPD), femur length (FL), and abdominal circumference (AC), along with calculated estimated fetal weight (EFW). These parameters were evaluated longitudinally at a median gestational week of 30 (range, 28 to 32) and 37 (range, 35 to 39) weeks. Linear mixed models were used to estimate the associations between maternal depressive symptoms and fetal growth parameters. Results A total of 2676 mother-offspring dyads were included, in which the mean (SD) age of mothers was 28.0 (4.4) years, and 1294 (48.4%) of the offspring were female. The median (IQR) maternal EPDS score was 5.0 (4.0 to 9.0). After adjustment for confounders, a significant correlation was found between a higher score of depressive symptoms in mothers and a slower rate of fetal growth across FL (β = -0.40; 95% CI, -0.58 to -0.22), AC (β = -1.97; 95% CI, -2.90 to -1.03), and EFW (β = -50.11; 95% CI, -68.46 to -31.75). These associations were stronger in female fetuses or those with better family socioeconomic conditions. Conclusions and Relevance In this prospective cohort study, maternal depressive symptoms were associated with slower fetal growth rate in the CRGS before delivery. Early screening for depressive disorders in pregnant women appears to be essential for fetal growth and later health.
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Affiliation(s)
- Lu Zhang
- Department of Maternal and Child Health, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ping Li
- Department of Maternal and Child Health, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qiaoyue Ge
- Department of Maternal and Child Health, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zeyuan Sun
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, United Kingdom
| | - Jiarui Cai
- Department of Maternal and Child Health, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chenghan Xiao
- Department of Maternal and Child Health, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chuan Yu
- Department of Maternal and Child Health, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Chiara Nosarti
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering & Imaging Sciences, King’s College London, United Kingdom
| | - Jiaqiang Liao
- Department of Maternal and Child Health, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhenmi Liu
- Department of Maternal and Child Health, Child and Adolescent Health, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
- Institute of Systems Epidemiology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
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Vandyousefi S, Messito MJ, Scott MA, Gross RS. Do Appetite Traits Mediate the Link Between Birth Weight and Later Child Weight in Low-Income Hispanic Families? Child Obes 2023; 19:489-497. [PMID: 36255444 PMCID: PMC10541931 DOI: 10.1089/chi.2022.0124] [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] [Indexed: 11/12/2022]
Abstract
Background: Birth weight and appetite traits (ATs) are important early life determinants of child weight and obesity. Objectives: The aim of this study is to examine whether (1) birth weight-for-gestational age z-scores (BWGAzs) were associated with ATs at child age 2 years and (2) ATs mediated the link between BWGAzs and weight-for-age z-scores (WFAzs) at child ages 3 and 4 years among Hispanic children. Methods: We conducted a secondary longitudinal analysis of data from the Starting Early Program of low-income, Hispanic mother-child pairs. ATs were assessed using the Child Eating Behavior Questionnaire at age 2 years. Child birth weight was obtained from medical records. Birth weight, sex, and gestational age were used to generate BWGAzs with Fenton growth curves. WFAz was calculated based on the CDC 2000 growth charts. Regression and mediation analyses were used to explore associations between BWGAzs, ATs, and WFAzs. Results: Infants with higher BWGAzs had significantly lower Satiety Responsiveness (B = -0.10) and Food Fussiness (B = -0.13) scores at age 2 years and higher WFAzs at ages 3 (B = 0.44) and 4 (B = 0.34) years. Lower Satiety Responsiveness at age 2 years was associated with higher WFAzs at ages 3 (B = -0.11) and 4 (B = -0.34; all p < 0.01) years. Lower Satiety Responsiveness partially mediated the positive relationship between birth weight and child WFAzs at ages 3 and 4 years. Conclusions: Children with higher birth weight and lower Satiety Responsiveness scores may be at higher risk of developing obesity in childhood. Further research is needed to understand the mechanisms through which birth weight influences child appetite. Clinical Trial Registration: ClinicalTrials.gov: NCT01541761.
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Affiliation(s)
- Sarvenaz Vandyousefi
- Department of Medicine and New York University Grossman School of Medicine, New York, NY, USA
| | - Mary Jo Messito
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Marc A Scott
- Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY, USA
| | - Rachel S Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
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Beck AL, Mora R, Joseph G, Perrin E, Cabana M, Schickedanz A, Fernandez A. A Multimethod Evaluation of the Futuros Fuertes Intervention to Promote Healthy Feeding, Screen Time, and Sleep Practices. Acad Pediatr 2023; 23:1351-1360. [PMID: 37211275 DOI: 10.1016/j.acap.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/26/2023] [Accepted: 05/16/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE 1) To evaluate the impact of the Futuros Fuertes intervention on infant feeding, screen time, and sleep practices and 2) To use qualitative methods to explore mechanisms of action. METHODS Low-income Latino infant-parent dyads were recruited from birth to 1 month and randomized to Futuros Fuertes or a financial coaching control. Parents received health education sessions from a lay health educator at well-child visits in the first year of life. Parents received two text messages per week that reinforced intervention content. We assessed infant feeding, screen time, and sleep practices via surveys. body mass index z-score (BMI-z) was measured at 6 and 12 months. Seventeen parents from the intervention arm participated in a semi-structured interview that explored parental experiences with the intervention. RESULTS There were n = 96 infant-parent dyads randomized. Fruit intake was higher in the intervention group at 15 months (1.1 vs 0.86 cups p = 0.05). Breastfeeding rates were higher in intervention participants at 6 months (84% vs 59% p = 0.02) and 9 months (81% vs 51% p = 0.008). Mean daily screen time was lower among intervention participants at 6 months (7 vs 22 min p = 0.003), 12 months (35 vs 52 min p = 0.03), and 15 months (60 vs 73 min p = 0.03). Major qualitative themes include 1) parental trust in intervention messaging 2) changes in feeding and screen time parenting practices, 3) text messages supported behavior change for parents and family members, and 4) varying effectiveness of intervention on different health behaviors. CONCLUSIONS Low-income Latino infants participating in the Futuros Fuertes intervention had modestly healthier feeding and screen time practices compared to control participants.
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Affiliation(s)
- Amy L Beck
- Department of Pediatrics, School of Medicine (AL Beck), University of California San Francisco.
| | - Rosa Mora
- School of Medicine (R Mora), University of California San Francisco
| | - Galen Joseph
- Department of Humanities and Social Medicine, School of Medicine (G Joseph), University of California San Francisco
| | - Eliana Perrin
- Department of Pediatrics, Schools of Medicine and Nursing (E Perrin), Johns Hopkins University, Baltimore, Md
| | - Michael Cabana
- Department of Pediatrics (M Cabana), Albert Einstein College of Medicine, New York, NY
| | - Adam Schickedanz
- Department of Pediatrics (A Schickedanz), University of California Los Angeles
| | - Alicia Fernandez
- Department of Medicine (A Fernandez), University of California San Francisco
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11
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Katzow MW, Messito MJ, Mendelsohn AL, Scott MA, Gross RS. Protective Effect of Prenatal Social Support on the Intergenerational Transmission of Obesity in Low-Income Hispanic Families. Child Obes 2023; 19:382-390. [PMID: 36112108 PMCID: PMC10468550 DOI: 10.1089/chi.2021.0306] [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] [Indexed: 11/12/2022]
Abstract
Background: Prepregnancy overweight/obesity (OW/OB) is a strong risk factor for child obesity. Few studies have identified modifiable factors that mitigate this risk. Objective: The objective of this study was to determine if prenatal social support buffers the effect of prepregnancy OW/OB on child birth weight z-score (BWz) and weight-for-age z-score (WFAz) trajectory. Methods: We performed a longitudinal secondary analysis of 524 mother-infant pairs enrolled in a randomized controlled trial of the Starting Early Program, a child obesity prevention program for Hispanic families with low income. Social support was assessed in the third trimester of pregnancy; maternal prepregnancy OW/OB and child WFAz from birth to age 3 years were obtained from medical records. Linear regression and multilevel modeling tested the effects of maternal prepregnancy OW/OB on child weight outcomes, and whether prenatal social support moderated these effects. Results: Prepregnancy OW/OB was associated with significantly higher child BWz (B = 0.23, p = 0.01) and WFAz trajectories (B = 0.19, 0.01). The interaction between social support and prepregnancy OW/OB was negatively related to child BWz (B = -0.26, p = 0.02) and WFAz trajectory (B = -0.40, p = 0.047). Conclusions: Prenatal social support may be protective against the intergenerational transmission of obesity risk. Interventions for the prevention of child obesity should consider incorporating social support into their design. Clinical Trial Registration Number: NCT01541761.
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Affiliation(s)
- Michelle W. Katzow
- Division of General Pediatrics, Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Alan L. Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
| | - Marc A. Scott
- Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY, USA
| | - Rachel S. Gross
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA
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12
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McCormick DP, Niebuhr B, Reyna L, Reifsnider E. Influences of Parenting Education on Development of Obesity Among Young Children. Acad Pediatr 2023; 23:963-970. [PMID: 36972784 DOI: 10.1016/j.acap.2023.03.010] [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: 09/23/2022] [Revised: 03/20/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE This project aimed to prevent obesity in high-risk infants using community health workers.ßto provide mothers with culturally appropriate nutrition and health education. METHODS This randomized controlled trial enrolled mothers prenatally and infants at birth. Mothers were Spanish-speaking WIC participants with obesity. Trained, Spanish-fluent, community health workers visited homes of intervention mothers to encourage breastfeeding, and promote delayed introduction of solid foods, adequate sleep, limited screen time, and active play. A blinded research assistant collected data at the home. Outcomes were weight-for-length and BMI-z scores, obesity at age 3.ßyears and percent time obese during follow-up. Data were analyzed using multiple variable regression. RESULTS Of 177 children enrolled at birth, 108 were followed to age 30...36.ßmonths. At the final visit, 24% of children were obese. Obese status at age 3.ßdid not differ between intervention and control (P.ß=.ß.32). Using BMI-z at the final visit, we observed a significant interaction between education and breastfeeding (P.ß=.ß.01). Time spent while obese from birth until age 30...36.ßmonths, by multiple variable analysis, did not show significant differences between intervention and control, but breastfed children experienced significantly less time obese than formula fed (P.ß=.ß.03). Formula-fed children in the control group, spent 29.8% of time obese, while breastfed infants in the intervention group spent 11.9% of time obese. CONCLUSIONS The educational intervention did not prevent obesity at age 3.ßyears. However, time spent obese from birth to age 3.ßyears was best in breastfed children living in homes regularly visited by community health workers.
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Affiliation(s)
- David P McCormick
- University of Texas Medical Branch (DP.ßMcCormick and B.ßNiebuhr), Galveston.
| | - Bruce Niebuhr
- University of Texas Medical Branch (DP.ßMcCormick and B.ßNiebuhr), Galveston
| | - Lucia Reyna
- College of Nursing and Health Innovation (Elizabeth.ßReifsnider), Arizona State University, Phoenix
| | - Elizabeth Reifsnider
- College of Nursing and Health Innovation (Elizabeth.ßReifsnider), Arizona State University, Phoenix
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13
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Duh-Leong C, Ghassabian A, Kannan K, Gross RS, Ortiz R, Gaylord A, Afanasyeva Y, Lakuleswaran M, Spadacini L, Trasande L. Prenatal oxidative stress and rapid infant weight gain. Int J Obes (Lond) 2023; 47:583-589. [PMID: 37012425 PMCID: PMC11251034 DOI: 10.1038/s41366-023-01302-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Infant weight patterns predict subsequent weight outcomes. Rapid infant weight gain, defined as a >0.67 increase in weight-for-age z-score (WAZ) between two time points in infancy, increases obesity risk. Higher oxidative stress, an imbalance between antioxidants and reactive oxygen species, has been associated with low birthweight and paradoxically also with later obesity. We hypothesized that prenatal oxidative stress may also be associated with rapid infant weight gain, an early weight pattern associated with future obesity. METHODS Within the NYU Children's Health and Environment Study prospective pregnancy cohort, we analyzed associations between prenatal lipid, protein, and DNA urinary oxidative stress biomarkers and infant weight data. Primary outcome was rapid infant weight gain (>0.67 increase in WAZ) between birth and later infancy at the 8 or 12 month visit. Secondary outcomes included: very rapid weight gain (>1.34 increase in WAZ), low (<2500 g) or high (≥4000 g) birthweight, and low (< -1 WAZ) or high (>1 WAZ) 12 month weight. RESULTS Pregnant participants consented to the postnatal study (n = 541); 425 participants had weight data both at birth and in later infancy. In an adjusted binary model, prenatal 8-iso-PGF2α, a lipid oxidative stress biomarker, was associated with rapid infant weight gain (aOR 1.44; 95% CI: 1.16, 1.78, p = 0.001). In a multinomial model using ≤0.67 change in WAZ as a reference group, 8-iso-PGF2α was associated with rapid infant weight gain (defined as >0.67 but ≤1.34 WAZ; aOR 1.57, 95% CI: 1.19, 2.05, p = 0.001) and very rapid infant weight gain (defined as >1.34 WAZ; aOR 1.33; 95% CI: 1.02, 1.72, p < 0.05) Secondary analyses detected associations between 8-iso-PGF2α and low birthweight outcomes. CONCLUSIONS We found an association between 8-iso-PGF2α, a lipid prenatal oxidative stress biomarker, and rapid infant weight gain, expanding our understanding of the developmental origins of obesity and cardiometabolic disease.
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Affiliation(s)
- Carol Duh-Leong
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA.
| | - Akhgar Ghassabian
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Kurunthachalam Kannan
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Rachel S Gross
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Robin Ortiz
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
| | - Abigail Gaylord
- Department of Environmental Health Sciences, Columbia Mailman School of Public Health, New York, NY, USA
| | - Yelena Afanasyeva
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Larry Spadacini
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Leonardo Trasande
- Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York, NY, USA
- NYU Wagner Graduate School of Public Service, New York, NY, USA
- NYU School of Global Public Health, New York, NY, USA
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14
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Feldman K, Asta K, Gearhardt AN, Sturza JM, Appugliese D, Miller AL, Rosenblum K, Kong KL, Crandall AK, Lumeng JC. Characterization of a Vigorous sucking style in early infancy and its predictive value for weight gain and eating behaviors at 12 months. Appetite 2023; 185:106525. [PMID: 36898582 PMCID: PMC10281081 DOI: 10.1016/j.appet.2023.106525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/13/2023] [Accepted: 03/04/2023] [Indexed: 03/12/2023]
Abstract
This study sought to identify sucking profiles among healthy, full-term infants and assess their predictive value for future weight gain and eating behaviors. Pressure waves of infant sucking were captured during a typical feeding at age 4 months and quantified via 14 metrics. Anthropometry was measured at 4 and 12 months, and eating behaviors were measured by parent report via the Children's Eating Behavior Questionnaire-Toddler (CEBQ-T) at 12 months. Sucking profiles were created using a clustering approach on the pressure wave metrics, and utility of these profiles was assessed for predicting which infants will have weight-for-age (WFA) percentile changes from ages 4-12 months that exceed thresholds of 5, 10, and 15 percentiles, and for estimating each CEBQ-T subscale score. Among 114 infants, three sucking profiles were identified: Vigorous (51%), Capable (28%), and Leisurely (21%). Sucking profiles were found to improve estimation of change in WFA from 4 to 12 months and 12-month maternal-reported eating behaviors above infant sex, race/ethnicity, birthweight, gestational age, and pre-pregnancy body mass index alone. Infants with a Vigorous sucking profile gained significantly more weight during the study period than infants with a Leisurely profile. Infant sucking characteristics may aid in predicting which infants may be at greater risk of obesity, and therefore sucking profiles deserve more investigation.
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Affiliation(s)
- Keith Feldman
- Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, USA.
| | - Katharine Asta
- Department of Pediatrics, University of Michigan Medical School, 2800 Plymouth Road Building 520, Ann Arbor, MI, 48109, USA
| | - Ashley N Gearhardt
- Department of Psychology, University of Michigan, 530 Church St, Ann Arbor, MI, 48109, USA.
| | - Julie M Sturza
- Department of Pediatrics, University of Michigan Medical School, 2800 Plymouth Road Building 520, Ann Arbor, MI, 48109, USA
| | | | - Alison L Miller
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Katherine Rosenblum
- Department of Psychiatry, University of Michigan Medical School, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Kai Ling Kong
- Department of Pediatrics, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA; Department of Pediatrics, University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO, USA.
| | - Amanda K Crandall
- Department of Pediatrics, University of Michigan Medical School, 2800 Plymouth Road Building 520, Ann Arbor, MI, 48109, USA
| | - Julie C Lumeng
- Department of Pediatrics, University of Michigan Medical School, 2800 Plymouth Road Building 520, Ann Arbor, MI, 48109, USA; Department of Nutritional Sciences, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
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15
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Obita G, Alkhatib A. Effectiveness of Lifestyle Nutrition and Physical Activity Interventions for Childhood Obesity and Associated Comorbidities among Children from Minority Ethnic Groups: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15112524. [PMID: 37299488 DOI: 10.3390/nu15112524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Lifestyle physical activity (PA) and nutrition are known to be effective interventions in preventing and managing obesity-related comorbidities among adult populations but less so among children and adolescents. We examined the effectiveness of lifestyle interventions in children from minority ethnic populations in Western high-income countries (HICs). Our systematic review included 53 studies, involving 26,045 children from minority ethnic populations who followed lifestyle intervention programmes lasting between 8 weeks and 5 years with the aim of preventing and/or managing childhood obesity and associated comorbidities, including adiposity and cardiometabolic risks. The studies were heterogenous in terms of lifestyle intervention components (nutrition, PA, behavioural counselling) and settings (community vs. schools and after-school settings). Our meta-analysis included 31 eligible studies and showed no significant effects of lifestyle interventions when they focused on body mass index (BMI) outcomes (pooled BMI mean change = -0.09 (95% CI = -0.19, 0.01); p = 0.09). This was irrespective of the intervention programme duration (<6 months vs. ≥6 months), type (PA vs. nutrition/combined intervention) and weight status (overweight or obese vs. normal weight) as all showed nonsignificant effects in the sensitivity analysis. Nonetheless, 19 of the 53 studies reported reductions in BMI, BMI z-score and body fat percentage. However, the majority of lifestyle interventions adopting a quasi-design with combined primary and secondary obesity measures (11 out of 15 studies) were effective in reducing the obesity comorbidities of cardiometabolic risks, including metabolic syndrome, insulin sensitivity and blood pressure, in overweight and obese children. Preventing childhood obesity in high-risk ethnic minority groups is best achieved using combined PA and nutrition intervention approaches, which jointly target preventing obesity and its comorbidities, especially the outcomes of diabetes, hypertension and cardiovascular disease. Therefore, public health stakeholders should integrate cultural and lifestyle factors and contextualise obesity prevention strategies among minority ethnic groups in Western HICs.
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Affiliation(s)
- George Obita
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough TS1 3BX, UK
| | - Ahmad Alkhatib
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough TS1 3BX, UK
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16
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Kim L, Duh-Leong C, Nagpal N, Ortiz R, Katzow MW, Russ S, Halfon N. Supporting early childhood routines to promote cardiovascular health across the life course. Curr Probl Pediatr Adolesc Health Care 2023; 53:101434. [PMID: 37821292 PMCID: PMC10842608 DOI: 10.1016/j.cppeds.2023.101434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Optimal cardiovascular health is an essential component of human health and well-being across the life course. Heart healthy practices around diet, physical activity, and sleep early in childhood have the potential to greatly improve lifespan and quality (Mehta et al., 2020). Early childhood routines, defined as functional practices that are predictable and repeatable, predict positive growth and development across the lifecourse (Fiese et al., 2002; Ferretti and Bub, 2017; Spagnola and Fiese, 2007). The American Heart Association has identified key heart healthy routines, such as daily regular activities including diet, physical activity, and sleep that promote cardiovascular health (Lloyd-Jones et al., 2022). Integrating the strength-based relational aspects of routines with the acquisition of cardiovascular health development capabilities allows children to establish their own optimal cardiovascular health trajectory early on. A systematic life course approach to supporting heart healthy routines in early childhood would inform clinical, research, and policy strategies to promote long-term cardiovascular health, and contribute to reducing inequalities in cardiovascular outcomes.
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Affiliation(s)
- Leah Kim
- NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA.
| | - Carol Duh-Leong
- Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Nikita Nagpal
- Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA
| | - Robin Ortiz
- Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, NY, USA; Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA; Institute for Excellence in Health Equity, NYU Langone Health, New York, NY, USA
| | - Michelle W Katzow
- Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA; Health Systems Science, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Shirley Russ
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, CA, USA; Department of Pediatrics, Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Neal Halfon
- Center for Healthier Children, Families, and Communities, University of California, Los Angeles, CA, USA; Department of Pediatrics, Geffen School of Medicine, University of California, Los Angeles, CA, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA; Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
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17
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Piccolo LR, Batista Araujo Oliveira J, Hirata G, Duarte Neto W, Mendelsohn AL. Supporting Reading Aloud Beginning Prenatally and in Early Infancy: A Randomized Trial in Brazil. J Dev Behav Pediatr 2022; 43:e590-e597. [PMID: 36103251 DOI: 10.1097/dbp.0000000000001118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A previous study of a reading aloud intervention in Brazil, called Universidade do Bebê (UBB), demonstrated impacts on parenting and child outcomes for families with toddlers and preschoolers, even for parents with low literacy, and cognitive stimulation mediated effects on child outcomes. In a new study, we sought to determine whether similar results would be found when UBB was provided beginning in pregnancy through early toddlerhood, including (1) impacts on parenting and child development, (2) variation in impact on parenting and child outcomes by parent literacy level, and (3) indirect impacts on child outcomes through cognitive stimulation. METHOD Women with low income who were either pregnant or with children aged 0 to 24 months were randomized to UBB or control groups. UBB consisted of monthly workshops focused on reading aloud complemented by a book-lending library. Participants were evaluated at baseline and approximately 11 months later (M = 11.0, SD = 0.4; range 9.9-12.2 months) on parenting (cognitive stimulation, beliefs about early reading, screen time, and discipline) and child development. RESULTS Four hundred families (n = 200 UBB) were randomized; 286 (71.5%; n = 150 UBB) received 11-month follow-up. UBB families showed increased cognitive stimulation (Cohen's d = 0.92) and awareness about the importance of early reading ( d = 0.90) than controls, with no differences by parent literacy level. UBB was associated with reduced screen time and increased vocabulary, but only for families with low parent literacy. UBB effects on child outcomes were mediated by cognitive stimulation. CONCLUSION The findings support implementation of reading aloud programs beginning in pregnancy and early childhood.
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Affiliation(s)
- Luciane R Piccolo
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, NYU Grossman School of Medicine, New York, NY
| | | | | | | | - Alan L Mendelsohn
- Department of Pediatrics, Division of Developmental-Behavioral Pediatrics, NYU Grossman School of Medicine, New York, NY
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18
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Nagpal N, Messito MJ, Katzow M, Gross RS. Obesity in Children. Pediatr Rev 2022; 43:601-617. [PMID: 36316265 DOI: 10.1542/pir.2021-005095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Child obesity is widely prevalent, and general pediatricians play an important role in identifying and caring for patients with obesity. Appropriate evaluation and treatment require an understanding of the complex etiology of child obesity, its intergenerational transmission, and its epidemiologic trends, including racial/ethnic and socioeconomic disparities. The American Academy of Pediatrics has published screening, evaluation, and treatment guidelines based on the best available evidence. However, gaps in evidence remain, and implementation of evidence-based recommendations can be challenging. It is important to review optimal care in both the primary care and multidisciplinary weight management settings. This allows for timely evaluation and appropriate referrals, with the pediatrician playing a key role in advocating for patients at higher risk. There is also a role for larger-scale prevention and policy measures that would not only aid pediatricians in managing obesity but greatly benefit child health on a population scale.
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Affiliation(s)
- Nikita Nagpal
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
| | - Mary Jo Messito
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
| | - Michelle Katzow
- Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | - Rachel S Gross
- New York University Grossman School of Medicine, New York, NY.,Bellevue Hospital Center, New York, NY
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19
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Vandyousefi S, Messito MJ, Katzow MW, Scott MA, Gross RS. Infant appetite traits, feeding practices and child obesity in low-income Hispanic families. Pediatr Obes 2022; 17:e12913. [PMID: 35274484 PMCID: PMC9283219 DOI: 10.1111/ijpo.12913] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 02/11/2022] [Accepted: 02/28/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Appetite traits and feeding practices are important determinants of child weight and obesity. OBJECTIVES This study examined whether: (1) infant appetite traits were associated with feeding practices and (2) feeding practices mediated the link between appetite traits and weight-for-age z-scores at age 3 years. METHODS We conducted a secondary data analysis from the 'Starting Early Program' of low-income, Hispanic mother-child pairs. Appetite traits were assessed using the Baby Eating Behaviour Questionnaire. Infant feeding practices were collected using 24-h dietary recalls and surveys: (1) breastfeeding exclusivity, intensity and duration; (2) early introduction to complementary foods/liquids and (3) any 100% fruit juice consumption at age 10 months. Regression and mediation analyses were used to explore associations between appetite, feeding and weight. RESULTS Higher infant Slowness in Eating scores were associated with greater breastfeeding exclusivity, intensity and duration, compared to lower Slowness in Eating. Infants with higher Slowness in Eating and Satiety Responsiveness had lower odds of early introduction to complementary foods/liquids. Infants with higher Enjoyment of Food had greater odds of 100% juice consumption. Breastfeeding duration mediated the relationship between higher infant Slowness in Eating and lower weight-for-age z-scores. CONCLUSIONS Appetite traits represent potential targets for early life infant feeding interventions.
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Affiliation(s)
- Sarvenaz Vandyousefi
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016, United States
| | - Mary Jo Messito
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016, United States
| | - Michelle W. Katzow
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Cohen Children’s Medical Center, Hempstead, NY 11040
| | - Marc A. Scott
- Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development, New York, NY
| | - Rachel S. Gross
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY 10016, United States
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20
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Brown V, Moodie M, Sultana M, Hunter KE, Byrne R, Zarnowiecki D, Seidler AL, Golley R, Taylor RW, Hesketh KD, Matvienko-Sikar K. A scoping review of outcomes commonly reported in obesity prevention interventions aiming to improve obesity-related health behaviors in children to age 5 years. Obes Rev 2022; 23:e13427. [PMID: 35122457 DOI: 10.1111/obr.13427] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/17/2021] [Accepted: 12/17/2021] [Indexed: 12/18/2022]
Abstract
This scoping review was undertaken as the first stage of development of the Core Outcome Sets for Early Prevention of Obesity in CHildhood (COS-EPOCH). The aim of this review is to identify the outcomes collected and reported in randomized controlled trials of early childhood obesity prevention interventions. A systematic scoping review was undertaken following published guidelines. Trial registries and Medline were searched, and records retrieved were screened by two reviewers. Included trials aimed to prevent childhood obesity in the first 5 years of life and were randomized. Data were extracted using a standardized form. Outcomes were assigned to outcome domains, and similar definitions within each domain were merged, based on key literature and expert consensus. Outcome and domain frequencies were estimated and presented in outcome matrices. Eighteen outcome domains were identified from 161 included studies: "anthropometry," "dietary intake," "physical activity," "sedentary behaviour," "emotional functioning/wellbeing," "feeding," "cognitive/executive functioning," "sleep," "other," "study-related," "parenting practices," "motor skill development," "environmental," "blood and lymphatic system," "perceptions and preferences," "quality of life," and "economic," "oral health." The most frequently reported outcome domain was anthropometry (92% of studies), followed by dietary intake (77%) and physical activity (60%). 221 unique outcomes were identified, indicating a high degree of heterogeneity. Body mass index was the only outcome reported in >50% of studies. The considerable heterogeneity in outcomes supports the need for the development of COS-EPOCH.
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Affiliation(s)
- Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Deakin University, Geelong, Australia.,Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Deakin University, Geelong, Australia.,Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia
| | - Marufa Sultana
- Deakin Health Economics, Institute for Health Transformation, Global Obesity Centre (GLOBE), School of Health and Social Development, Deakin University, Geelong, Australia
| | - Kylie E Hunter
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Rebecca Byrne
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Australia
| | - Dorota Zarnowiecki
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Anna Lene Seidler
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - Rebecca Golley
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, Australia
| | - Rachael W Taylor
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Kylie D Hesketh
- Centre for Research Excellence in the Early Prevention of Obesity in Childhood, University of Sydney, Sydney, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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21
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Gomahr J, Julian V, Thivel D, Maruszczak K, Schneider AM, Weghuber D. Childhood obesity prevention: what can be achieved? Curr Opin Clin Nutr Metab Care 2022; 25:223-231. [PMID: 35256565 DOI: 10.1097/mco.0000000000000831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Childhood obesity is a pandemic generating an enormous individual and socioeconomic burden worldwide. This narrative review summarizes recent evidence on successful and recommended prevention strategies according to age groups and different levels of interventions. RECENT FINDINGS Effective prevention of childhood obesity is feasible and most successful early in life up to preschool age, and it should include a multicomponent approach, integrating individuals, family and society. Trials that improve nutrition and/or enhance physical activity are the cornerstones of childhood obesity prevention on an individual level. However, their efficacy is determined by the combination of interventions for the target age group. Further, improving family support and sleep, as well as reducing screen time, lead to favourable results. Many research gaps remain, including a lack of effective interventions for high-risk groups. SUMMARY As a multifactorial condition, childhood obesity requires a multicomponent approach. Interventions should be developmental stage-specific and adjusted to the setting. Current research gaps need to be targeted by future trials, with a special focus on the benefit of the most vulnerable groups. From a systems response perspective, a paradigm shift from interventions focusing on the individual to approaches that target society as a whole is warranted.
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Affiliation(s)
- Julian Gomahr
- Department of Pediatrics, Obesity Research Unit and Division of Pediatric Gastroenterology, Hepatology and Nutrition, Paracelsus Medical University, Salzburg, Austria
| | - Valérie Julian
- Department of Sport Medicine and Functional Explorations, University Teaching Hospital of Clermont-Ferrand, Diet and Musculoskeletal Health Team, CRNH, INRA, University of Clermont Auvergne, Clermont-Ferrand
| | - David Thivel
- Laboratory AME2P, University of Clermont Auvergne, Aubiere, Franoe
| | - Katharina Maruszczak
- Department of Pediatrics, Obesity Research Unit and Division of Pediatric Gastroenterology, Hepatology and Nutrition, Paracelsus Medical University, Salzburg, Austria
| | - Anna-Maria Schneider
- Department of Pediatrics, Obesity Research Unit and Division of Pediatric Gastroenterology, Hepatology and Nutrition, Paracelsus Medical University, Salzburg, Austria
| | - Daniel Weghuber
- Department of Pediatrics, Obesity Research Unit and Division of Pediatric Gastroenterology, Hepatology and Nutrition, Paracelsus Medical University, Salzburg, Austria
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22
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Derwig M, Tiberg I, Björk J, Welander Tärneberg A, Hallström IK. A child-centered health dialogue for the prevention of obesity in child health services in Sweden - A randomized controlled trial including an economic evaluation. Obes Sci Pract 2022; 8:77-90. [PMID: 35127124 PMCID: PMC8804939 DOI: 10.1002/osp4.547] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/16/2021] [Accepted: 07/26/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Prevention of child obesity is an international public health priority and believed to be effective when started in early childhood. Caregivers often ask for an early and structured response from health professionals when their child is identified with overweight, yet cost-effective interventions for children aged 2-6 years and their caregivers in Child Health Services are lacking. OBJECTIVES To evaluate the effects and cost-effectiveness of a child-centered health dialogue in the Child Health Services in Sweden on 4-year-old children with normal weight and overweight. METHODS Thirty-seven Child Health Centers were randomly assigned to deliver intervention or usual care. The primary outcome was zBMI-change. RESULTS A total of 4598 children with normal weight (zBMI: 0.1 [SD = 0.6] and 490 children with overweight (zBMI: 1.6 [SD = 0.3]) (mean age: 4.1 years [SD = 0.1]; 49% females) were included. At follow-up, at a mean age of 5.1 years [SD = 0.1], there was no intervention effect on zBMI-change for children with normal weight. Children with overweight in the control group increased zBMI by 0.01 ± 0.50, while children in the intervention group decreased zBMI by 0.08 ± 0.52. The intervention effect on zBMI-change for children with overweight was -0.11, with a 95% confidence interval of -0.24 to 0.01 (p = 0.07). The estimated additional costs of the Child-Centered Health Dialogue for children with overweight were 167 euros per child with overweight and the incremental cost-effectiveness ratio was 183 euros per 0.1 zBMI unit prevented. CONCLUSIONS This low-intensive multicomponent child-centered intervention for the primary prevention of child obesity did not show statistical significant effects on zBMI, but is suggested to be cost-effective with the potential to be implemented universally in the Child Health Services. Future studies should investigate the impact of socio-economic factors in universally implemented obesity prevention programs.
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Affiliation(s)
- Mariette Derwig
- Department of Health SciencesFaculty of MedicineLund UniversityLundSweden
| | - Irén Tiberg
- Department of Health SciencesFaculty of MedicineLund UniversityLundSweden
| | - Jonas Björk
- Department of Laboratory MedicineLund UniversityLundSweden
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23
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Katzow MW, Messito MJ, Mendelsohn AL, Scott MA, Gross RS. Grandparent Coresidence and Risk of Early Child Overweight and Obesity in Low-Income, Hispanic Families in New York City. Acad Pediatr 2022; 22:90-97. [PMID: 34058403 PMCID: PMC8627526 DOI: 10.1016/j.acap.2021.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Children in low-income Hispanic families are at high risk of obesity and are more likely to live with grandparents than their non-Hispanic white counterparts. We aimed to determine if grandparent coresidence (prenatal through age 2 years) was associated with: 1) obesogenic feeding practices; and 2) child weight outcomes from birth to three years. METHODS We analyzed data from 267 low-income, Hispanic mother-infant pairs in the control group of an obesity prevention trial in New York City. Linear and logistic regression tested differences in obesogenic feeding practices and weight outcomes at 2 and 3 years, dependent upon grandparent coresidence. Multilevel modeling tested associations between grandparent coresidence and WFAz over time. RESULTS Persistent grandparent coresidence (vs none) was associated with putting cereal in the bottle (adjusted odds ratio [aOR] 3.46; 95% confidence interval [CI] 1.43, 8.40). Persistent grandparent coresidence (vs none) was associated with higher mean WFAz (2 years: B 0.83; 95% CI 0.41, 1.25; 3 years: B 0.79; 95% CI 0.32, 1.25) and higher odds of child overweight/obesity risk (2 years: aOR 4.38; 95% CI 1.64, 11.69; 3 years: aOR 3.15; 95% CI 1.19, 8.36). In multilevel models, more occasions of grandparent coresidence were associated with higher WFAz. CONCLUSIONS Grandparent coresidence may be associated with higher risk of child overweight/obesity in low-income, Hispanic families. Further research is needed to elucidate mechanisms of these associations and to inform obesity prevention strategies in the context of multigenerational families.
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Affiliation(s)
- Michelle W Katzow
- Division of General Pediatrics, Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell (MW Katzow), Hempstead, NY; The Feinstein Institutes for Medical Research, Northwell Health (MW Katzow), Manhasset, NY.
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine (MJ Messito and RS Gross), New York, NY
| | - Alan L Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine (AL Mendelsohn), New York, NY
| | - Marc A Scott
- Department of Applied Statistics, Social Science, and Humanities, New York University Steinhardt School of Culture, Education, and Human Development (MA Scott), New York, NY
| | - Rachel S Gross
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine (MJ Messito and RS Gross), New York, NY
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24
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Gross RS, Brown NM, Mendelsohn AL, Katzow MW, Arana MM, Messito MJ. Maternal Stress and Infant Feeding in Hispanic Families Experiencing Poverty. Acad Pediatr 2022; 22:71-79. [PMID: 33940204 PMCID: PMC8556387 DOI: 10.1016/j.acap.2021.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 04/10/2021] [Accepted: 04/23/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Maternal stress has been associated with early child obesity through pathways related to decreased exclusive breastfeeding and increased nonresponsive maternal-infant feeding styles. We sought to gain an in-depth understanding of how maternal stress, sadness, and isolation are perceived to affect feeding, in order to inform modifiable targets of intervention. METHODS We conducted semi-structured qualitative interviews with Hispanic mothers living in poverty with young infants between 3 and 7 months old (n = 32) from the intervention group of a randomized controlled trial of an early child obesity prevention intervention (Starting Early Program). Bilingual English-Spanish interviewers conducted the interviews, which were audio recorded, transcribed, and translated. Building on an existing theoretical framework developed by the National Scientific Council on the Developing Child, we used an iterative process of textual analysis to code the transcripts, until thematic saturation was reached. RESULTS Three key themes were described: 1) maternal stress responses were varied and included positive (brief and mild), tolerable (sustained but limited long-term impacts), or toxic stress (sustained and severe); 2) buffers included support from family, infants, health care providers, social service programs, and community organizations; 3) perceived effects on infant feeding included decreased breastfeeding due to concerns about stress passing directly through breast milk and indirectly through physical closeness, and increased nonresponsive feeding styles. CONCLUSIONS Maternal stress, particularly toxic stress, was perceived to negatively affect infant feeding. Mothers reported disrupting healthy feeding to avoid infant exposure to stress. Interventions to enhance buffering may help to mitigate toxic stress and promote healthy feeding interactions.
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Affiliation(s)
- Rachel S. Gross
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, 462 First Avenue, New York, NY, 10016
| | - Nicole M. Brown
- Strong Children Wellness Medical Group, 163-18 Jamaica Avenue, Jamaica, NY, 11432
| | - Alan L. Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, 462 First Avenue, New York, NY, 10016
| | - Michelle W. Katzow
- Division of General Pediatrics, Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, 269-01 76th Ave, New Hyde Park, NY, 11040
| | - Mayela M. Arana
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, 462 First Avenue, New York, NY, 10016
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, New York University Grossman School of Medicine, 462 First Avenue, New York, NY, 10016
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25
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Hails KA, Whipps MDM, Gross RS, Bogen DL, Morris PA, Mendelsohn AL, Shaw DS. Breastfeeding and Responsive Parenting as Predictors of Infant Weight Change in the First Year. J Pediatr Psychol 2021; 46:768-778. [PMID: 34270767 PMCID: PMC8502476 DOI: 10.1093/jpepsy/jsab049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/31/2021] [Accepted: 04/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To test breastfeeding duration and responsive parenting as independent predictors of infant weight change from birth to 12 months, and to test the moderating effect of a tiered parenting intervention on relations between breastfeeding and responsive parenting in relation to infant weight change. METHODS Mother-infant dyads (N = 403) were participants in the ongoing Smart Beginnings (SB) randomized controlled trial testing the impact of the tiered SB parenting model that incorporates two evidence-based interventions: Video Interaction Project (VIP) and Family Check-Up (FCU). The sample was low income and predominantly Black and Latinx. Responsive parenting variables (maternal sensitivity and intrusiveness) came from coded observations of mother-infant interactions when infants were 6 months. Continuous weight-for-age (WFA) z-score change and infant rapid weight gain (RWG) from 0 to 12 months were both assessed. RESULTS Longer breastfeeding duration was significantly associated with less WFA z-score change. The relationship between breastfeeding duration and WFA z-score change was significant only for infants in the intervention group. Intrusive parenting behaviors were also associated with greater WFA z-score change after accounting for breastfeeding duration. CONCLUSIONS This study is one of the first to test both breastfeeding and parenting in relation to infant weight gain in the first year. Findings may have implications for family-focused child obesity prevention programs.
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Affiliation(s)
| | - Mackenzie D M Whipps
- Department of Applied Psychology, New York University Steinhardt School of Culture, Education and Human Development
| | | | - Debra L Bogen
- Department of Pediatrics, UPMC Children’s Hospital of Pittsburgh
| | - Pamela A Morris
- Department of Applied Psychology, New York University Steinhardt School of Culture, Education and Human Development
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26
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Taveras EM, Perkins ME, Boudreau AA, Blake-Lamb T, Matathia S, Kotelchuck M, Luo M, Price SN, Roche B, Cheng ER. Twelve-Month Outcomes of the First 1000 Days Program on Infant Weight Status. Pediatrics 2021; 148:peds.2020-046706. [PMID: 34326179 PMCID: PMC8579422 DOI: 10.1542/peds.2020-046706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine the effects of the First 1000 Days intervention on the prevalence of infant overweight and maternal postpartum weight retention and care. METHODS Using a quasi-experimental design, we evaluated the effects of the First 1000 Days program among 995 term, low-income infants and their mothers receiving care in 2 intervention community health centers and 650 dyads in 2 comparison health centers. The program includes staff training, growth tracking, health and behavioral screening, patient navigation, text messaging, educational materials, and health coaching. Comparison centers implemented usual care. Infant outcomes were assessed at 6 and 12 months, including weight-for-length z score and overweight (weight for length ≥97.7th percentile). We also examined maternal weight retention and receipt of care 6 weeks' post partum. RESULTS The mean birth weight was 3.34 kg (SD 0.45); 57% of infants were Hispanic; 66% were publicly insured. At 6 months, infants had lower weight-for-length z scores (β: -.27; 95% confidence interval [CI]: -.39 to -.15) and lower odds of overweight (adjusted odds ratio [OR]: 0.46; 95% CI: 0.28 to 0.76) than infants in comparison sites; differences persisted at 12 months (z score β: -.18; 95% CI: -.30 to -.07; adjusted OR for overweight: 0.60; 95% CI: 0.39 to 0.92). Mothers in the intervention sites had modestly lower, but nonsignificant, weight retention at 6 weeks' post partum (β: -.51 kg; 95% CI: -1.15 to .13) and had higher odds (adjusted OR: 1.50; 95% CI: 1.16 to 1.94) of completing their postpartum visit compared with mothers in the comparison sites. CONCLUSIONS An early-life systems-change intervention combined with coaching was associated with improved infant weight status and maternal postpartum care.
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Affiliation(s)
- Elsie M. Taveras
- The Kraft Center for Community Health,Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children,Department of Nutrition, Harvard T.H. Chan School of Public
Health, Harvard University, Boston, Massachusetts
| | - Meghan E. Perkins
- Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children
| | - Alexy Arauz Boudreau
- Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children
| | - Tiffany Blake-Lamb
- The Kraft Center for Community Health,Department of Obstetrics and Gynecology, Massachusetts General
Hospital, Boston, Massachusetts
| | - Sarah Matathia
- The Kraft Center for Community Health,Massachusetts General Hospital Everett Family Care Community
Health Center, Everett, Massachusetts
| | - Milton Kotelchuck
- Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children
| | - Mandy Luo
- Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children
| | - Sarah N. Price
- Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children
| | - Brianna Roche
- Division of General Academic Pediatrics, Department of
Pediatrics, Massachusetts General Hospital for Children
| | - Erika R. Cheng
- Division of Children’s Health Services Research,
Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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27
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Vandyousefi S, Gross RS, Katzow MW, Scott MA, Messito MJ. Infant and Early Child Appetite Traits and Child Weight and Obesity Risk in Low-Income Hispanic Families. J Acad Nutr Diet 2021; 121:2210-2220. [PMID: 33994142 DOI: 10.1016/j.jand.2021.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/03/2021] [Accepted: 04/01/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Child appetite traits (ATs) are associated with later child weight and obesity risk. Less research has focused on ATs in low-income Hispanic children or included longitudinal associations with infant weight. OBJECTIVE To determine stability of ATs during infancy and childhood and their relationship with subsequent weight and obesity risk at age 3 years among low-income Hispanic children. DESIGN A secondary longitudinal analysis of data from the Starting Early Program randomized controlled obesity prevention trial. PARTICIPANTS/SETTING Three hundred twenty-two low-income, Hispanic mother-child pairs enrolled between 2012 and 2014 in a public hospital in New York City. MAIN OUTCOME MEASURES ATs, including Slowness in Eating, Satiety Responsiveness, Food Responsiveness, and Enjoyment of Food were assessed using the Baby and Child Eating Behavior Questionnaires at ages 3 months, 2 years, and 3 years. Main outcome measures were child standardized weight-for-age z score (WFAz) and obesity risk (WFA≥95th percentile) at age 3 years. STATISTICAL ANALYSES PERFORMED AT stability was assessed using correlations and multilevel modeling. Linear and logistic regression analyses examined associations between ATs and child WFAz and obesity risk at age 3 years. RESULTS There was limited stability for all ATs measured over time. During infancy, Slowness in Eating was associated with lower 3-year WFAz (B = -0.18, 95% CI -0.33 to -0.04; P = 0.01). At age 2 years, Slowness in Eating and Satiety Responsiveness were associated with lower WFAz (B = -0.29, 95% CI -0.47 to -0.12; P < 0.01; B = -0.36, 95% CI -0.55 to -0.17; P < 0.01) and obesity risk (adjusted odds ratio 0.49, 95% CI 0.28 to 0.85; adjusted odds ratio 0.61, 95% CI 0.38 to 0.99) at 3 years. Increased Slowness in Eating and Satiety Responsiveness over time were associated with lower 3-year WFAz (B = -0.74, 95% CI -1.18 to -0.2 [Slowness in Eating]; B = -1.19, 95% CI -1.87 to -0.52 [Satiety Responsiveness], both P values = 0.001). Higher Enjoyment of Food over time was associated with higher 3-year WFAz (B = 0.62, 95% CI 0.24 to 1.01; P = 0.002). CONCLUSIONS Infants with lower Slowness in Eating and Satiety Responsiveness may have higher levels of obesity risk and need more tailored approaches to nutrition counseling and obesity prevention.
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28
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Gross RS, Messito MJ, Klass P, Canfield CF, Yin HS, Morris PA, Shaw DS, Dreyer BP, Mendelsohn AL. Integrating Health Care Strategies to Prevent Poverty-Related Disparities in Development and Growth: Addressing Core Outcomes of Early Childhood. Acad Pediatr 2021; 21:S161-S168. [PMID: 34740424 PMCID: PMC8574213 DOI: 10.1016/j.acap.2021.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 11/18/2022]
Abstract
Poverty-related disparities appear early in life in cognitive, language, and social-emotional development, and in growth, especially obesity, and have long-term consequences across the life course. It is essential to develop effective strategies to promote healthy behaviors in pregnancy and the early years of parenthood that can mitigate disparities. Primary preventive interventions within the pediatric primary care setting offer universal access, high engagement, and population-level impact at low cost. While many families in poverty or with low income would benefit from preventive services related to both development and growth, most successful interventions have tended to focus on only one of these domains. In this manuscript, we suggest that it may be possible to address both development and growth simultaneously and effectively. In particular, current theoretical models suggest alignment in mechanisms by which poverty can create barriers to parent-child early relational health (i.e., parenting practices, creating structure, and parent-child relationship quality), constituting a final common pathway for both domains. Based on these models and related empirical data, we propose a strength-based, whole child approach to target common antecedents through positive parenting and prevent disparities in both development and growth; we believe this approach has the potential to transform policy and practice. Achieving these goals will require new payment systems that make scaling of primary prevention in health care feasible, research funding to assess efficacy/effectiveness and inform implementation, and collaboration among early childhood stakeholders, including clinicians across specialties, scientists across academic disciplines, and policy makers.
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Affiliation(s)
- Rachel S Gross
- Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine (RS Gross, MJ Messito, and HS Yin), New York, NY.
| | - Mary Jo Messito
- Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine (RS Gross, MJ Messito, and HS Yin), New York, NY
| | - Perri Klass
- Departments of Pediatrics and Journalism, NYU Grossman School of Medicine and NYU College of Arts and Sciences (P Klass), New York, NY
| | - Caitlin F Canfield
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine (CF Canfield, BP Dreyer, and AL Mendelsohn), New York, NY
| | - H Shonna Yin
- Division of General Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine (RS Gross, MJ Messito, and HS Yin), New York, NY
| | - Pamela A Morris
- Department of Applied Psychology, NYU Steinhardt School of Culture, Education, and Human Development (PA Morris), New York, NY
| | - Daniel S Shaw
- Department of Psychology, University of Pittsburgh (DS Shaw), Pittsburgh, Pa
| | - Benard P Dreyer
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine (CF Canfield, BP Dreyer, and AL Mendelsohn), New York, NY
| | - Alan L Mendelsohn
- Division of Developmental-Behavioral Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine (CF Canfield, BP Dreyer, and AL Mendelsohn), New York, NY
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29
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da Rosa Piccolo L, Weisleder A, Mendelsohn AL. Promoting Global Early Child Development Through Play: Two Sustainable, Effective Models. Pediatrics 2020; 146:peds.2020-032433. [PMID: 33148770 DOI: 10.1542/peds.2020-032433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Luciane da Rosa Piccolo
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York; and
| | - Adriana Weisleder
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
| | - Alan L Mendelsohn
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, NYU Grossman School of Medicine, New York, New York; and
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