1
|
Willis EA, Burney R, Hales D, Ilugbusi LO, Tate DF, Nezami B, Clarke EC, Moore RH, Mathews E, Thompson M, Beckelheimer B, Ward DS. "My wellbeing-their wellbeing "- An eHealth intervention for managing obesity in early care and education: Protocol for the Go NAPSACC Cares cluster randomized control trial. PLoS One 2023; 18:e0286912. [PMID: 37418363 PMCID: PMC10328321 DOI: 10.1371/journal.pone.0286912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/23/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND To fully leverage the potential of the early care and education (ECE) setting for childhood obesity prevention, initiatives must not intervene solely at the organizational level, but rather they should also address the health needs of the ECE workers. Workers suffer disproportionately high rates of obesity, and have reported low confidence in modeling and promoting healthy eating and activity behaviors. However, information regarding the effectiveness of improving ECE workers' health behaviors or whether such improvements elicit meaningful change in the ECE environment and/or the children in their care is limited. METHOD The proposed study will integrate a staff wellness intervention into a nationally recognized, ECE obesity prevention initiative (Go NAPSACC). Go NAPSACC+ Staff Wellness program will be assessed using a clustered randomized controlled trial including 84 ECE centers, 168 workers, and 672 2-5-year-old children. Centers will be randomly assigned to 1) standard "Go NAPSACC" or 2) Go NAPSACC+ Staff Wellness. Outcome measures will assess impact on dietary intake and PA behaviors of 2-5-year-old children at 6 months (primary aim) and 12 months. Secondarily, we will compare the impact of the intervention on centers' implementation of healthy weight practices and the effect on ECE workers' diet quality and PA at 6- and 12 months. DISCUSSION This trial expects to increase our understanding of how ECE worker's personal health behaviors impact the health behaviors of the children in their care and the ECE environment. TRIAL REGISTRATION ClinicalTrials.gov: NCT05656807, registered on 19 December 2022. Protocol version 1.0, 22 March 2023.
Collapse
Affiliation(s)
- Erik A. Willis
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Regan Burney
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Derek Hales
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - LeAndra O. Ilugbusi
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Deborah F. Tate
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Brooke Nezami
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Emily C. Clarke
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Renee H. Moore
- Department of Epidemiology and Biostatistics, School of Public Health, Drexel University, Philadelphia, Pennsylvania, United States of America
| | - Emma Mathews
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Meredith Thompson
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Brittany Beckelheimer
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Dianne S. Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
2
|
Valmorbida JL, Sangalli CN, Leffa PS, Baratto PS, Rauber F, Mennella JA, Vitolo MR. Sodium Intake Tracked from Infancy and Salt Taste Preference during Adolescence: Follow-up of a Randomized Controlled Field Trial in Brazil. Curr Dev Nutr 2023; 7:100011. [PMID: 37181123 PMCID: PMC10100944 DOI: 10.1016/j.cdnut.2022.100011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/25/2022] [Accepted: 10/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background Effective interventions to promote healthy sodium intakes require understanding factors driving liking for salt taste. Objectives To examine effects of an early feeding intervention among low-income mothers on their children's energy and sodium intake and salt taste preferences at 12 years; and to identify age-related changes in dietary sodium sources. Methods Secondary analyses were conducted on dietary intake and taste preference data collected from children in a longitudinal trial (NCT00629629). Mothers randomized to the intervention group received counseling on healthy eating practices for 1 year postpartum; the control group received no counseling. Two-day dietary recalls were obtained at 1 year (intervention end) and at 4-, 8-, and 12-year follow-up visits, from which foods were categorized as unprocessed, processed, or ultra-processed. At the 12-year visit, children's most preferred concentration of salt was measured using a validated, forced-choice, paired-comparison tracking method, and pubertal stage was self-assessed. Results The intervention group had reduced energy intake compared with controls in all food categories at 1 year (P = 0.04) but not at the other time points. Sodium intake from processed foods increased from 4 to 12 years and from ultra-processed foods from 1 to 4; intake from unprocessed foods decreased from 1 to 8 year (all P < 0.01). At 12 years, children in early stages of puberty (Tanner stages 1-3; P = 0.04) or in the ≥75th percentile of sodium intake (P < 0.01) preferred significantly higher concentrations of salt than the other children. Conclusions Both dietary intake of sodium and early puberty were associated with preferences for higher salt concentrations. Childhood and adolescence are important periods for understanding how experience and growth shape diet by changing salt taste. Clinical Trial Registration This manuscript reports secondary analysis of data collected in trial NCT00629629 (2001-3) and follow-up [https://clinicaltrials.gov/ct2/show/NCT00629629?term=NCT00629629&draw=2&rank=1].
Collapse
Affiliation(s)
- Julia L. Valmorbida
- Nutrition Research Center, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Pediatrics, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Caroline N. Sangalli
- Nutrition Research Center, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Paula S. Leffa
- Nutrition Research Center, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Paola S. Baratto
- Nutrition Research Center, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Pediatrics, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Rauber
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Marcia R. Vitolo
- Nutrition Research Center, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- Graduate Program in Pediatrics, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
3
|
Gavine A, Shinwell SC, Buchanan P, Farre A, Wade A, Lynn F, Marshall J, Cumming SE, Dare S, McFadden A. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2022; 10:CD001141. [PMID: 36282618 PMCID: PMC9595242 DOI: 10.1002/14651858.cd001141.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES 1. To describe types of breastfeeding support for healthy breastfeeding mothers with healthy term babies. 2. To examine the effectiveness of different types of breastfeeding support interventions in terms of whether they offered only breastfeeding support or breastfeeding support in combination with a wider maternal and child health intervention ('breastfeeding plus' support). 3. To examine the effectiveness of the following intervention characteristics on breastfeeding support: a. type of support (e.g. face-to-face, telephone, digital technologies, group or individual support, proactive or reactive); b. intensity of support (i.e. number of postnatal contacts); c. person delivering the intervention (e.g. healthcare professional, lay person); d. to examine whether the impact of support varied between high- and low-and middle-income countries. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes results of searches of CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP)) (11 May 2021) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Support could be provided face-to-face, over the phone or via digital technologies. All studies had to meet the trustworthiness criteria. DATA COLLECTION AND ANALYSIS: We used standard Cochrane Pregnancy and Childbirth methods. Two review authors independently selected trials, extracted data, and assessed risk of bias and study trustworthiness. The certainty of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 116 trials of which 103 contribute data to the analyses. In total more than 98,816 mother-infant pairs were included. Moderate-certainty evidence indicated that 'breastfeeding only' support probably reduced the number of women stopping breastfeeding for all primary outcomes: stopping any breastfeeding at six months (Risk Ratio (RR) 0.93, 95% Confidence Interval (CI) 0.89 to 0.97); stopping exclusive breastfeeding at six months (RR 0.90, 95% CI 0.88 to 0.93); stopping any breastfeeding at 4-6 weeks (RR 0.88, 95% CI 0.79 to 0.97); and stopping exclusive breastfeeding at 4-6 (RR 0.83 95% CI 0.76 to 0.90). Similar findings were reported for the secondary breastfeeding outcomes except for any breastfeeding at two months and 12 months when the evidence was uncertain if 'breastfeeding only' support helped reduce the number of women stopping breastfeeding. The evidence for 'breastfeeding plus' was less consistent. For primary outcomes there was some evidence that 'breastfeeding plus' support probably reduced the number of women stopping any breastfeeding (RR 0.94, 95% CI 0.91 to 0.97, moderate-certainty evidence) or exclusive breastfeeding at six months (RR 0.79, 95% CI 0.70 to 0.90). 'Breastfeeding plus' interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4-6 weeks, but the evidence is very uncertain (RR 0.73, 95% CI 0.57 to 0.95). The evidence suggests that 'breastfeeding plus' support probably results in little to no difference in the number of women stopping any breastfeeding at 4-6 weeks (RR 0.94, 95% CI 0.82 to 1.08, moderate-certainty evidence). For the secondary outcomes, it was uncertain if 'breastfeeding plus' support helped reduce the number of women stopping any or exclusive breastfeeding at any time points. There were no consistent findings emerging from the narrative synthesis of the non-breastfeeding outcomes (maternal satisfaction with care, maternal satisfaction with feeding method, infant morbidity, and maternal mental health), except for a possible reduction of diarrhoea in intervention infants. We considered the overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions and as studies utilised self-report breastfeeding data, there is also a risk of bias in outcome assessment. We conducted meta-regression to explore substantial heterogeneity for the primary outcomes using the following categories: person providing care; mode of delivery; intensity of support; and income status of country. It is possible that moderate levels (defined as 4-8 visits) of 'breastfeeding only' support may be associated with a more beneficial effect on exclusive breastfeeding at 4-6 weeks and six months. 'Breastfeeding only' support may also be more effective in reducing women in low- and middle-income countries (LMICs) stopping exclusive breastfeeding at six months compared to women in high-income countries (HICs). However, no other differential effects were found and thus heterogeneity remains largely unexplained. The meta-regression suggested that there were no differential effects regarding person providing support or mode of delivery, however, power was limited. AUTHORS' CONCLUSIONS: When 'breastfeeding only' support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For 'breastfeeding plus' interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face-to-face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale.
Collapse
Affiliation(s)
- Anna Gavine
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Shona C Shinwell
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | | | - Albert Farre
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Angela Wade
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | - Fiona Lynn
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Joyce Marshall
- Division of Maternal Health, University of Huddersfield, Huddersfield, UK
| | - Sara E Cumming
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Shadrach Dare
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Alison McFadden
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| |
Collapse
|
4
|
de Castilhos JK, Campagnolo PDB, de Almeida S, Vitolo MR, Mattevi VS. Impact of maternal dietary counseling in the first year of life on DNA methylation in a cohort of children. Genet Mol Biol 2021; 44:e20200330. [PMID: 34874049 PMCID: PMC8670011 DOI: 10.1590/1678-4685-gmb-2020-0330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/28/2021] [Indexed: 01/16/2023] Open
Abstract
Epigenetic modifications established during prenatal and early life, including DNA methylation, have been suggested as potential mediators of the interaction between environmental exposures during the perinatal period and adult metabolic health adverse outcomes, especially cardiometabolic complications and overweight. The effect of a dietary intervention in the first year of life on global methylation levels in leukocyte samples from a cohort of children born between 2001 and 2002 in southern Brazil was examined. Overall methylation measurements were performed using enzyme-linked immunosorbent assays on DNA samples from 237 children at 4 years old. Mean methylation values were higher in the intervention group (mean: 2.20 ± 1.31%) than in the control group (mean: 1.65 ± 1.11%; P = 0.001). It was observed that nutritional counseling in the first year increased breastfeeding duration and stimulated the development of healthier eating habits. Therefore, these factors might have contributed to increase global DNA methylation. The findings of the present study reinforce the notion that performing nutritional interventions in the early stages of life is important and provide further evidence of the interaction between the environment and epigenetic traits.
Collapse
Affiliation(s)
| | | | - Silvana de Almeida
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Márcia Regina Vitolo
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Vanessa Suñé Mattevi
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| |
Collapse
|
5
|
Effect of a healthy eating intervention in the first months of life on ultraprocessed food consumption at the age of 4-7 years: a randomised clinical trial with adolescent mothers and their infants. Br J Nutr 2021; 126:1048-1055. [PMID: 33292886 DOI: 10.1017/s0007114520004869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This randomised clinical trial aimed to evaluate the effect of a pro-breast-feeding (BF) and healthy complementary feeding intervention performed during infants' first months of life on ultraprocessed food (UPF) consumption at 4-7 years. We enrolled 323 teenage mothers and their infants from South Brazil, 163 allocated to the intervention group and 160 to the control group. Intervention consisted of sessions on BF and healthy complementary feeding promotion and was carried out in the maternity ward and at home after delivery. Food consumption was assessed using three 24-h food recalls at child's age of 4-7 years. Foods were classified according to NOVA classification. Dietary contribution of UPF was adjusted for intra-individual variability by the SPADE method and categorised into tertiles. We used Poisson regression models with robust variance, adjusted for confounders, to estimate the effect of the intervention and duration of BF on the risk of high consumption of UPF. Our final analysis included 194 children, with mean age of 6·1 (sd 0·5) years. Mean dietary contribution of UPF was 38 % in the intervention group and 42·7 % in the control group, from total daily intakes. Results adjusted for BF duration, propensity score, income and total energy content demonstrated that the intervention reduced the risk of high consumption of UPF by 35 % (relative risk 0·65, 95 % CI 0·43, 0·98). BF duration was not associated with UPF consumption. The intervention was effective in reducing the risk of high UPF consumption at the age of 4-7 years.
Collapse
|
6
|
Vaughn AE, Hennink-Kaminski H, Moore R, Burney R, Chittams JL, Parker P, Luecking CT, Hales D, Ward DS. Evaluating a child care-based social marketing approach for improving children's diet and physical activity: results from the Healthy Me, Healthy We cluster-randomized controlled trial. Transl Behav Med 2021; 11:775-784. [PMID: 33231679 DOI: 10.1093/tbm/ibaa113] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Child care-based interventions offer an opportunity to reach children at a young and impressionable age to support healthy eating and physical activity behaviors. Ideally, these interventions engage caregivers, including both childcare providers and parents, in united effort. This study evaluated the impact of the Healthy Me, Healthy We intervention on children's diet quality and physical activity. A sample of 853 three- to four-year-old children from 92 childcare centers were enrolled in this cluster-randomized control trial. Healthy Me, Healthy We was an 8-month, social marketing intervention delivered through childcare that encouraged caregivers (childcare providers and parents) to use practices that supported children's healthy eating and physical activity behaviors. Outcome measures, collected at baseline and post-intervention, assessed children's diet quality, physical activity, and BMI as well as caregivers' feeding and physical activity practices. Generalized Linear Mixed Models were used to assess change from baseline to post-intervention between intervention and control arms. No significant changes were noted in any of the outcome measures except for small improvements in children's sodium intake and select parent practices. Despite the negative findings, this study offers many lessons about the importance and challenges of effective parent engagement which is critical for meaningful changes in children's health behaviors.
Collapse
Affiliation(s)
- Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Heidi Hennink-Kaminski
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Renee Moore
- Biostats Collaboration Core, Emory University, Atlanta, GA
| | - Regan Burney
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jesse L Chittams
- Biostatistics Consulting Unit, Office of Nursing Research, School of Nursing, University of Pennsylvania, Philadelphia, PA
| | | | - Courtney T Luecking
- Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY
| | - Derek Hales
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dianne S Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
7
|
Luo S, Angelo B, Chow T, Monterosso JR, Xiang AH, Thompson PM, Page KA. The role of maternal BMI on brain food cue reactivity in children: a preliminary study. Brain Imaging Behav 2021; 15:2746-2755. [PMID: 33738669 DOI: 10.1007/s11682-021-00466-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 01/24/2023]
Abstract
Children of overweight and obese parents have an increased risk of obesity. Little is known the neural mechanisms underlying this relationship, specifically the brain systems implicated in self-regulation of food intake. The primary goal here is to examine relationships between maternal body mass index (BMI) and brain responses to food cues in children. Seventy-six children (8.62 ± 1.02 years; 28 M,48F) were included in this study. Height and weight were assessed for children and their biological parents. Maternal height and weight before pregnancy were extracted from the Electronic Medical Records (EMR). BMI (kg/m2) or BMIz (age- and sex-specific BMI) were calculated. Children underwent a magnetic resonance imaging session where they viewed food and non-food images before and after glucose ingestion. The dorsolateral prefrontal cortex (dlPFC) and anterior cingulate cortex (ACC) food cue reactivity was the measurement of interest for region-of-interest (ROI) analyses. Whole-brain exploratory analysis was performed as well. Non-parametric methods were used for data analysis. ROI and whole brain analyses showed that maternal current BMI was inversely associated with child's ACC and dlPFC food cue reactivity after glucose ingestion, adjusting for age and sex. No significant relationships were found between paternal BMI and child's food cue reactivity. Child BMIz was negatively associated with the ACC food cue reactivity after glucose ingestion. Our results supported the role of maternal adiposity on child's responses to appetitive food cues in brain self-regulation circuitry, which may influence eating behavior and obesity risk in children.
Collapse
Affiliation(s)
- Shan Luo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA. .,Diabetes and Obesity Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA. .,Department of Psychology, University of Southern California, Los Angeles, CA, 90089, USA. .,Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.
| | - Brendan Angelo
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.,Diabetes and Obesity Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA
| | - Ting Chow
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - John R Monterosso
- Department of Psychology, University of Southern California, Los Angeles, CA, 90089, USA.,Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, 90089, USA
| | - Anny H Xiang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - Paul M Thompson
- Imaging Genetics Center, Mark & Mary Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.,Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, 90089, USA
| | - Kathleen A Page
- Division of Endocrinology, Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.,Diabetes and Obesity Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90089, USA.,Neuroscience Graduate Program, University of Southern California, Los Angeles, CA, 90089, USA
| |
Collapse
|
8
|
Passanha A, Benício MHD, Venâncio SI. Determinants of fruits, vegetables, and ultra-processed foods consumption among infants. CIENCIA & SAUDE COLETIVA 2021; 26:209-220. [PMID: 33533842 DOI: 10.1590/1413-81232020261.06892019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 04/15/2019] [Indexed: 12/23/2022] Open
Abstract
The objective was to evaluate the influence of individual and contextual determinants on infant's consumption of fruits and vegetables (FV), and ultra-processed foods (UPF). The data was obtained from the Survey of Prevalence of Breastfeeding in Brazilian Municipalities, 2008. A representative sample of 14,326 infants 6-11.9 months old, from seventy-five municipalities of São Paulo state was evaluated. The influence of determinants on FV and UPF consumption was analyzed using Poisson multilevel regression. Mother's educational level and maternal age had positive dose-response effect for the consumption of FV (p trend < 0.001) and negative for UPF (p trend < 0.001). Infants of multiparous women and those who received outpatient care in public medical system showed lower prevalence of FV (p < 0.001 for both) and higher prevalence of UPF (respectively, p < 0.001 and p = 0.001). Moreover, the contextual variable related to population size indicated that the prevalence of consumption of FV decreased (p < 0.001) and UPF increased (p = 0.081) with decreased population size. Therefore, infants born to women with low education levels, who received outpatient care in the public health network, and who reside in small municipalities should be prioritized for educational programs related to feeding practices.
Collapse
Affiliation(s)
- Adriana Passanha
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. Av. Doutor Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
| | - Maria Helena D'Aquino Benício
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo. Av. Doutor Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
| | - Sonia Isovama Venâncio
- Núcleo de Evidências, Instituto de Saúde, Secretaria de Estado da Saúde de São Paulo. São Paulo SP Brasil
| |
Collapse
|
9
|
Fox K, Gans K, McCurdy K, Risica PM, Jennings E, Gorin A, Papandonatos GD, Tovar A. Rationale, design and study protocol of the 'Strong Families Start at Home' feasibility trial to improve the diet quality of low-income, ethnically diverse children by helping parents improve their feeding and food preparation practices. Contemp Clin Trials Commun 2020; 19:100583. [PMID: 32637721 PMCID: PMC7327278 DOI: 10.1016/j.conctc.2020.100583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/18/2020] [Accepted: 06/07/2020] [Indexed: 12/28/2022] Open
Abstract
There is an urgent need to create effective interventions that help parents establish a healthy diet among their children early in life, especially among low-income and ethnically and racially diverse families. U.S. children eat too few fruits, vegetables and whole grains, and too many energy dense foods, dietary behaviors associated with increased morbidity from chronic diseases. Parents play a key role in shaping children's diets. Best practices suggest that parents should involve children in food preparation, and offer, encourage and model eating a variety of healthy foods. In addition, while parents help to shape food preferences, not all children respond in the same way. Certain child appetitive traits, such as satiety responsiveness (sensitivity to internal satiety signals), food responsiveness (sensitivity to external food cues), and food fussiness may help explain some of these differences. Prior interventions to improve the diet of preschool children have not used a holistic approach that targets the home food environment, by focusing on food quality, food preparation, and positive feeding practices while also acknowledging a child's appetitive traits. This manuscript describes the rationale and design for a 6-month pilot randomized controlled trial, Strong Families Start at Home, that randomizes parents and their 2-to 5-year old children to either a home-based environmental dietary intervention or an attention-control group. The primary aim of the study is to explore the feasibility and acceptability of the intervention and evaluation and to determine the intervention's preliminary efficacy on child diet quality, feeding practices, and availability of healthy foods in the home.
Collapse
Affiliation(s)
- Katelyn Fox
- Department of Nutrition and Food Science, University of Rhode Island, 41 Lower College Road, Room 125, Kingston, RI, 02881, USA
| | - Kim Gans
- Department of Human Development and Family Studies, and Institute for Collaboration in Health, Interventions, and Policy, University of Connecticut, Storrs, CT, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Karen McCurdy
- Department of Human Development & Family Studies, University of Rhode Island, Kingston, RI, USA
| | - Patricia Markham Risica
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Ernestine Jennings
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Amy Gorin
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | | | - Alison Tovar
- Department of Nutrition and Food Science, University of Rhode Island, Kingston, RI, USA
| |
Collapse
|
10
|
Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2020; 5:CD008552. [PMID: 32449203 PMCID: PMC7273132 DOI: 10.1002/14651858.cd008552.pub7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Collapse
Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| |
Collapse
|
11
|
Sirasa F, Mitchell LJ, Rigby R, Harris N. Family and community factors shaping the eating behaviour of preschool-aged children in low and middle-income countries: A systematic review of interventions. Prev Med 2019; 129:105827. [PMID: 31476337 DOI: 10.1016/j.ypmed.2019.105827] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 11/23/2022]
Abstract
Low and middle-income countries are experiencing the dual burden of malnutrition which is, at least in part, attributable to changes in eating behaviours of children under age five. Development of food choices is influenced by multiple factors and understanding the interplay of these factors in early childhood in these countries is necessary to promote healthy food choices. We conducted a systematic review to examine the evidence of family and community factors targeted in interventions to influence the eating behaviour of preschool-aged children in low and middle-income countries. A search for peer-reviewed papers was conducted using CINAHL, MEDLINE, PsycINFO, Scopus and ProQuest Health Management published prior to September 2018, in English language including preschool-aged children (PROSPERO registration CRD42018108474). Fourteen studies published between 1994 and 2017 were eligible for inclusion. Factors that were consistently and positively associated with children's healthy food consumption were household food availability, nutritional knowledge of family or caregivers and family income. Unhealthy food consumption in children was inversely associated with family or caregivers' nutritional knowledge. Children's micronutrient intake was positively associated with household food availability, nutritional knowledge of family or caregivers and food availability within the surrounding environment. Findings highlight the importance of targeting nutritional knowledge of family or caregivers to facilitate healthy eating behaviours in children. In addition, creating a supportive family environment via increasing household food availability and family income should be considered when designing interventions to promote healthy eating behaviours in preschool-aged children living in low and middle-income countries.
Collapse
Affiliation(s)
- Fathima Sirasa
- Public Health, School of Medicine, Griffith University, Gold Coast, QLD 4222, Australia.
| | - Lana J Mitchell
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD 4222, Australia; Menzies Health Institute Queensland, Australia.
| | - Roshan Rigby
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD 4222, Australia; Menzies Health Institute Queensland, Australia.
| | - Neil Harris
- Public Health, School of Medicine, Griffith University, Gold Coast, QLD 4222, Australia.
| |
Collapse
|
12
|
Hodder RK, O'Brien KM, Stacey FG, Tzelepis F, Wyse RJ, Bartlem KM, Sutherland R, James EL, Barnes C, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2019; 2019:CD008552. [PMID: 31697869 PMCID: PMC6837849 DOI: 10.1002/14651858.cd008552.pub6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 August 2019. We searched Proquest Dissertations and Theses in May 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 78 trials with 214 trial arms and 13,746 participants. Forty-eight trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 20 of the 78 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is very low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 4.45 g as-desired consumption of vegetables (SMD 0.42, 95% CI 0.23 to 0.60; 18 trials, 2004 participants; mean post-intervention follow-up = 8.2 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.34, 95% CI 0.10 to 0.57; 9 trials, 3022 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.36 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; 11 trials, 3078 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) and unintended adverse consequences of interventions (2 trials), limiting their assessment. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 78 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low-quality evidence that child-feeding practice may lead to, and moderate-quality evidence that multicomponent interventions probably lead to small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Collapse
Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Fiona G Stacey
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
- University of NewcastlePriority Research Centre in Physical Activity and NutritionCallaghanAustralia
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanNew South WalesAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Erica L James
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Luke Wolfenden
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | | |
Collapse
|
13
|
Snuggs S, Houston-Price C, Harvey K. Healthy eating interventions delivered in the family home: A systematic review. Appetite 2019; 140:114-133. [PMID: 31091432 DOI: 10.1016/j.appet.2019.05.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 12/13/2022]
Abstract
Unhealthy eating habits have long term health implications and can begin at a young age when children still consume the majority of their meals at home. As parents are the principal agents of change in children's eating behaviours, the home environment is the logical location for the delivery of interventions targeting healthy family eating. Despite the recent proliferation of published studies of behaviour-change interventions delivered in the home, there has been little attempt to evaluate what makes such interventions successful. This review provides a systematic evaluation of all healthy eating interventions delivered to families in the home environment to date and seeks to identify the successful elements of these interventions and make recommendations for future work. Thirty nine studies are described, evaluated and synthesised. Results show that evidence- and theory-based interventions tended to be more successful than those that did not report detailed formative or evaluative work although details of theory application were often lacking. Careful analysis of the results did not show any further systematic similarities shared by successful interventions. Recommendations include the need for more clearly theoretically driven interventions, consistent approaches to measuring outcomes and clarity regarding target populations and desired outcomes.
Collapse
Affiliation(s)
- Sarah Snuggs
- School of Psychology and Clinical Language Sciences, University of Reading, RG6 7BE, UK
| | - Carmel Houston-Price
- School of Psychology and Clinical Language Sciences, University of Reading, RG6 7BE, UK
| | - Kate Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, RG6 7BE, UK.
| |
Collapse
|
14
|
Exclusive breast-feeding and sociodemographic characteristics are associated with dietary patterns in children aged 4–7 years. Public Health Nutr 2019; 22:1398-1405. [DOI: 10.1017/s1368980018003257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveTo identify the dietary patterns of children aged 4–7 years and verify their association with sociodemographic characteristics, lifestyle habits and exclusive breast-feeding (EBF).DesignA cross-sectional study nested within a cohort, performed with Brazilian children aged 4–7 years. The children were re-evaluated at age 4 to 7 years and food patterns were identified a posteriori through principal component analysis. The predictive variables were related to socio-economic characteristics, lifestyle habits and duration of EBF.SettingViçosa, Minas Gerais, Brazil.ParticipantsRepresentative sample of 403 children followed up by the Lactation Support Program from the Extension Program of the Universidade Federal de Viçosa during the first 6 months of life.ResultsFive dietary patterns were identified: ‘Traditional’, ‘Unhealthy’, ‘Milk and chocolate’, ‘Snack’ and ‘Healthy’. Children who did not receive EBF until they were at least 4 months old had a higher adherence to the ‘Unhealthy’ and ‘Snack’ patterns, and older children also consumed more ‘Unhealthy’ foods. The highest income was associated with the highest consumption of foods of the patterns ‘Unhealthy’, ‘Milk and chocolate’ and ‘Healthy’.ConclusionsIn view of the results, we emphasize the importance of providing support and encouragement towards EBF in the first months of life, as it can positively influence lifelong eating habits.
Collapse
|
15
|
Feistauer V, Vitolo MR, Campagnolo PDB, Mattevi VS, Almeida S. Evaluation of association of DRD2 TaqIA and -141C InsDel polymorphisms with food intake and anthropometric data in children at the first stages of development. Genet Mol Biol 2018; 41:562-569. [PMID: 30044466 PMCID: PMC6136368 DOI: 10.1590/1678-4685-gmb-2017-0202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/09/2018] [Indexed: 01/17/2023] Open
Abstract
The reward sensation after food intake may be different between individuals and variants in genes related to the dopaminergic system may indicate a different response in people exposed to the same environmental factors. This study investigated the association of TaqIA (rs1800497) and -141C InsDel (rs1799732) variants in DRD2/ANKK1 gene with food intake and adiposity parameters in a cohort of children. The sample consisted of 270 children followed until 7 to 8 years old. DNA was extracted from blood and polymorphisms were detected by PCR-RFLP analysis. Food intake and nutritional status were compared among individuals with different SNP genotypes. Children carrying the A1 allele (TaqIA) had higher energy of lipid dense foods (LDF) when compared with A2/A2 homozygous children at 7 to 8 years old (GLM p=0.004; Mann Whitney p=0.005). No association was detected with -141C Ins/Del polymorphism. To our knowledge, this is the first association study of the DRD2 TaqIA and -141C Ins/Del polymorphism with food intake and anthropometric parameters in children. DRD2 TaqIA polymorphism has been associated with a reduction in D2 dopamine receptor availability. Therefore, the differences observed in LDF intake in our sample may occur as an effort to compensate the hypodopaminergic functioning.
Collapse
Affiliation(s)
- Vanessa Feistauer
- Laboratório de Biologia Molecular, Programa de Pós-Graduação em Biociências, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Márcia R Vitolo
- Departamento de Saúde Coletiva, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Paula D B Campagnolo
- Curso de Nutrição, Universidade do Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
| | - Vanessa S Mattevi
- Laboratório de Biologia Molecular, Programa de Pós-Graduação em Biociências, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.,Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Silvana Almeida
- Laboratório de Biologia Molecular, Programa de Pós-Graduação em Biociências, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.,Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| |
Collapse
|
16
|
Arikpo D, Edet ES, Chibuzor MT, Odey F, Caldwell DM. Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under. Cochrane Database Syst Rev 2018; 5:CD011768. [PMID: 29775501 PMCID: PMC6494551 DOI: 10.1002/14651858.cd011768.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although complementary feeding is a universal practice, the methods and manner in which it is practiced vary between cultures, individuals and socioeconomic classes. The period of complementary feeding is a critical time of transition in the life of an infant, and inappropriate complementary feeding practices, with their associated adverse health consequences, remain a significant global public health problem. Educational interventions are widely acknowledged as effective in promoting public health strategy, and those aimed at improving complementary feeding practices provide information about proper complementary feeding practices to caregivers of infants/children. It is therefore important to summarise evidence on the effectiveness of educational interventions to improve the complementary feeding practices of caregivers of infants. OBJECTIVES To assess the effectiveness of educational interventions for improving the complementary feeding (weaning) practices of primary caregivers of children of complementary feeding age, and related health and growth outcomes in infants. SEARCH METHODS In November 2017, we searched CENTRAL, MEDLINE, Embase, 10 other databases and two trials registers. We also searched the reference lists of relevant studies and reviews to identify any additional studies. We did not limit the searches by date, language or publication status. SELECTION CRITERIA Randomised controlled trials (RCTs), comparing educational interventions to no intervention, usual practice, or educational interventions provided in conjunction with another intervention, so long as the educational intervention was only available in the experimental group and the adjunctive intervention was available to the control group. Study participants included caregivers of infants aged 4 to 24 months undergoing complementary feeding. Pregnant women who were expected to give birth and commence complementary feeding during the period of the study were also included. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data on participants, settings, interventions, methodology and outcomes using a specifically-developed and piloted data extraction form. We calculated risk ratios (RR) and 95% confidence intervals (CIs) for dichotomous data, and mean differences (MD) and 95% CIs for continuous data. Where data permitted, we conducted a meta-analysis using a random-effects model. We assessed the included studies for risk of bias and also assessed the quality of evidence using the GRADE approach. MAIN RESULTS We included 23 studies (from 35 reports) with a total of 11,170 caregiver-infant pairs who were randomly assigned to receive an educational intervention delivered to the caregiver or usual care. Nineteen of the included studies were community-based studies while four were facility-based studies. In addition, 13 of the included studies were cluster-randomised while the others were individually randomised. Generally, the interventions were focused on the introduction of complementary feeding at the appropriate time, the types and amount of complementary foods to be fed to infants, and hygiene. Using the GRADE criteria, we assessed the quality of the evidence as moderate, mostly due to inadequate allocation concealment and insufficient blinding.Educational interventions led to improvements in complementary feeding practices for age at introduction of complementary foods (average RR 0.88, 95% CI 0.83 to 0.94; 4 studies, 1738 children; moderate-quality evidence) and hygiene practices (average RR 1.38, 95% CI 1.23 to 1.55; 4 studies, 2029 participants; moderate-quality evidence). For duration of exclusive breastfeeding, pooled results were compatible with both a reduction and an increase in the outcome (average RR 1.58, 95% CI 0.77 to 3.22; 3 studies, 1544 children; very low-quality evidence). There was limited (low to very low-quality) evidence of an effect for all growth outcomes.Quality of evidenceThere is moderate to very low-quality evidence that educational interventions can improve complementary feeding practices but insufficient evidence to conclude that it impacts growth outcomes. AUTHORS' CONCLUSIONS Overall, we found evidence that education improves complementary feeding practices.
Collapse
Affiliation(s)
- Dachi Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching HospitalCalabarCross River StateNigeria540261
| | - Ededet Sewanu Edet
- University of Calabar Teaching HospitalDepartment of Community MedicineCalabarCross RiverNigeria540261
| | - Moriam T Chibuzor
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching HospitalCalabarCross River StateNigeria540261
| | - Friday Odey
- University of Calabar Teaching HospitalDepartment of PaediatricsPMB 1115CalabarCross River StateNigeria540261
| | - Deborah M Caldwell
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolAvonUKBS8 2PS
| | | |
Collapse
|
17
|
Hodder RK, O'Brien KM, Stacey FG, Wyse RJ, Clinton‐McHarg T, Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2018; 5:CD008552. [PMID: 29770960 PMCID: PMC6373580 DOI: 10.1002/14651858.cd008552.pub5] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2018. We searched Proquest Dissertations and Theses in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 63 trials with 178 trial arms and 11,698 participants. Thirty-nine trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fourteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Nine studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 63 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.There is very low quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 3.50 g as-desired consumption of vegetables (SMD 0.33, 95% CI 0.13 to 0.54; participants = 1741; studies = 13). Multicomponent interventions versus no intervention may have a very small effect on child consumption of fruit and vegetables (SMD 0.35, 95% CI 0.04 to 0.66; participants = 2009; studies = 5; low-quality evidence), equivalent to an increase of 0.37 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; participants = 3078; studies = 11; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for four studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 63 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low- and low-quality evidence respectively that child-feeding practice and multicomponent interventions may lead to very small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up is required and future research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Collapse
Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority
Research Centre in Health Behaviour, and Priority Research Centre in
Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| |
Collapse
|
18
|
Hodder RK, Stacey FG, O'Brien KM, Wyse RJ, Clinton‐McHarg T, Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2018; 1:CD008552. [PMID: 29365346 PMCID: PMC6491117 DOI: 10.1002/14651858.cd008552.pub4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Embase to identify eligible trials on 25 September 2017. We searched Proquest Dissertations and Theses and two clinical trial registers in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 55 trials with 154 trial arms and 11,108 participants. Thirty-three trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Thirteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 55 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% confidence interval (CI) 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 g of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for three studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 55 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains sparse. There was very low-quality evidence that child-feeding practice interventions are effective in increasing vegetable consumption in children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption in children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Collapse
Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre in Health Behaviour, and Priority Research Centre in Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| |
Collapse
|
19
|
Passanha A, Benício MHD, Venâncio SI. INFLUENCE OF BREASTFEEDING ON CONSUMPTION OF SWEETENED BEVERAGES OR FOODS. ACTA ACUST UNITED AC 2018; 36:148-154. [PMID: 29412434 PMCID: PMC6038789 DOI: 10.1590/1984-0462/;2018;36;2;00008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/12/2017] [Indexed: 11/22/2022]
Abstract
Objective: To verify whether breastfeeding is associated with lower prevalence of
consumption of sweetened beverages or foods in infants. Methods: This is a cross-sectional study with data collected from the Survey on
Prevalence of Breastfeeding conducted in Brazilian municipalities in 2008. A
representative sample of 14,326 infants aged 6 to 11.9 months of age,
residents of 75 municipalities in the State of São Paulo, Southeastern
Brazil, was studied. The influence of breastfeeding on the consumption of
sweetened beverages or food products was analyzed by multilevel Poisson
regression. Variables with p<0.20 in the crude analysis
were included in the multilevel analysis. Results: Most infants were on breastfeeding (56.1%). The prevalence of sweetened
drinks or foods consumption was 53.3%. The consumption of sweetened products
was shown to be less prevalent among breastfed infants after adjustment for
confounding factors (PR 0.87; 95%CI 0.83-0.91). Conclusions: Breastfeeding was associated with lower consumption of sweetened beverages
or foods. As an additional effect of actions aimed at promoting
breastfeeding, a decrease in intake of sweetened products is expected among
infants.
Collapse
|
20
|
Hennink-Kaminski H, Vaughn AE, Hales D, Moore RH, Luecking CT, Ward DS. Parent and child care provider partnerships: Protocol for the Healthy Me, Healthy We (HMHW) cluster randomized control trial. Contemp Clin Trials 2017; 64:49-57. [PMID: 29128650 DOI: 10.1016/j.cct.2017.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Formation of diet and physical activity habits begins during early childhood. However, many preschool-aged children in the United States do not achieve recommendations for a nutritious diet or active lifestyle. Two important spheres of influence, home and child care, could ensure that children receive consistent health messages. Innovative approaches that engage both parents and child care providers in a substantial way are needed. Social marketing, a promising approach for health promotion targeting children, uses principles that recognize the need to engage multiple stakeholders and to emphasize benefits and overcome barriers associated with behavior change. Yet, application of social marketing principles in interventions for preschool-age children is limited. METHODS Healthy Me, Healthy We (HMHW) is 2-arm, cluster randomized controlled trial to evaluate the effect of a 8-month social marketing campaign on the diet and physical activity behaviors of preschool children (3-4years old), their parents, and child care providers. The campaign is delivered by the child care center and includes branded classroom and at-home activities and materials. Primary outcomes are children's diet quality (assessed with Healthy Eating Index scores) and minutes of non-sedentary activity (measured via accelerometers). Secondary outcomes assess children's body mass index, nutrition and physical activity practices at the child care center and at home, and health behaviors of child care providers and parents. CONCLUSION HMHW is an innovative approach to promoting healthy eating and physical activity in preschool children. The campaign targets children during a key developmental period and leverages a partnership between providers and parents to affect behavior change.
Collapse
Affiliation(s)
| | - Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, USA
| | - Derek Hales
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Reneé H Moore
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, USA
| | - Courtney T Luecking
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Dianne S Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| |
Collapse
|
21
|
Hodder RK, Stacey FG, Wyse RJ, O'Brien KM, Clinton‐McHarg T, Tzelepis F, Nathan NK, James EL, Bartlem KM, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2017; 9:CD008552. [PMID: 28945919 PMCID: PMC6483688 DOI: 10.1002/14651858.cd008552.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE, Embase Classic and Embase to identify eligible trials on 30 September 2016. We searched CINAHL and PsycINFO in July 2016, Proquest Dissertations and Theses in November 2016 and three clinical trial registers in November 2016 and June 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures.We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 50 trials with 137 trial arms and 10,267 participants. Thirty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Eleven trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake.Thirteen of the 50 included trials were judged as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias of remaining studies.Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% CI 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 grams of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions.Studies reported receiving governmental or charitable funds, except for two studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 50 eligible trials of various intervention approaches, the evidence for how to increase fruit and vegetable consumption of children remains sparse. There was very low-quality evidence child-feeding practice interventions are effective in increasing vegetable consumption of children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption of children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Collapse
Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority Research Centre in Health Behaviour, and Priority Research Centre in Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | | | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter Population HealthLocked Bag 10WallsendAustralia
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| |
Collapse
|
22
|
Moreira PRS, Rocha NP, Milagres LC, de Novaes JF. [Critical analysis of the diet quality of the Brazilian population according to the Healthy Eating Index: a systematic review]. CIENCIA & SAUDE COLETIVA 2017; 20:3907-23. [PMID: 26691814 DOI: 10.1590/1413-812320152012.18352015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/30/2015] [Indexed: 12/17/2022] Open
Abstract
In light of the importance of studying instruments that assess the food quality of the population, this study sought to conduct a systematic review of the quality of the diet of the Brazilian population using the Healthy Eating Index (HEI) and duly analyzing its methodology and results. The major electronic databases were used for the selection of studies. After the searches with the key words, 32 articles were included in this review. The growing interest of the scientific community in addressing this issue was observed, with recent studies using this instrument in Brazil. Methodological issues of articles were evaluated and discussed taking into consideration the revised versions and adaptations of the HEI. Some common results were highlighted among the studies such as low consumption of fruit, vegetables and/or dairy products, and the wider consumption of meat and eggs, cholesterol, total fat and saturated fat. Among the articles that address the HEI and socioeconomic aspects it was seen that quality of diet improves both in accordance with the increasing level of education of parents and with the family income in the population studied. The HEI can be used to monitor changes in dietary patterns and also as a nutrition education and health promotion tool.
Collapse
Affiliation(s)
| | - Naruna Pereira Rocha
- Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, MG, Brasil,
| | | | | |
Collapse
|
23
|
Morais DDC, Moraes LFDS, Silva DCGD, Pinto CA, Novaes JFD. Aspectos metodológicos da avaliação da qualidade da dieta no Brasil: revisão sistemática. CIENCIA & SAUDE COLETIVA 2017; 22:2671-2680. [DOI: 10.1590/1413-81232017228.23502015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/23/2016] [Indexed: 12/30/2022] Open
Abstract
Resumo Esta revisão sistemática objetivou analisar metodologias de estudos brasileiros que utilizam índices para avaliação da qualidade da dieta. Realizou-se busca sistemática em bases eletrônicas de dados (Lilacs, Medline, SciELO e Scopus), sem fazer restrição ao ano de publicação dos estudos. Foram selecionados artigos originais, nacionais, que avaliassem a qualidade da dieta pelo Healthy Eating Index (HEI) ou suas versões revisadas. Utilizou-se os descritores: qualidade da dieta, índice de alimentação saudável, índice de qualidade da dieta e respectivos termos em inglês. Foram selecionados 45 artigos, dos quais, 60% analisaram a qualidade da dieta por instrumento denominado índice de alimentação saudável e o restante por índice de qualidade da dieta. Dos estudos analisados, 68,9% classificaram a qualidade da dieta. A maioria dos estudos utilizou 10 itens para avaliação da qualidade da dieta e não apresentaram padronização quanto às metodologias. Dos estudos, 33,3% relacionaram o índice com fatores socioeconômicos e demográficos, itens alimentares e condições de saúde. Diferenças de nomeação e metodologias dificultam comparações entre os estudos de avaliação da qualidade da dieta.
Collapse
|
24
|
Nunes LM, Vigo Á, Oliveira LDD, Giugliani ERJ. [Effect of a healthy eating intervention on compliance with dietary recommendations in the first year of life: a randomized clinical trial with adolescent mothers and maternal grandmothers]. CAD SAUDE PUBLICA 2017; 33:e00205615. [PMID: 28678940 DOI: 10.1590/0102-311x00205615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/28/2016] [Indexed: 11/22/2022] Open
Abstract
The objective was to evaluate the effect of a healthy eating intervention targeting adolescent mothers and maternal grandmothers on compliance with dietary recommendations in the first year of life. This was a randomized clinical trial involving 320 adolescent mothers, their infants, and 169 maternal grandmothers (when the three generations were living together), randomly assigned to the intervention versus control group. The intervention consisted of six counseling sessions on healthy feeding during the child's first year of life, the first of which held at the maternity ward and the others at 7, 15, 30, 60, and 120 days, at the homes. Information on the infant's diet was obtained monthly during the first 6 months and then every 2 months until the child reached 12 months of age, using a Food Frequency Questionnaire, in addition to questions on mealtimes, consistency of the foods, hygiene, preparation of meals, conservation of foods, and the mother's or grandmother's approach to the child's diet in the presence of illness. The outcome was defined as meeting the Ten Steps to a Healthy Diet: A Food Guide for Children Under Two Years Old, assessed by a score. The mean sum of the scores for each step obtained in the intervention group was higher than in the control group; the intervention doubled the odds of the total score being greater than or equal to the median. Living with grandmother did not influence the score either in the intervention group or the control group. The proposed intervention had a positive effect on meeting the Ten Steps, independently of participation by the maternal grandmother, showing that educational interventions can improve quality of diet for children in the first year of life.
Collapse
Affiliation(s)
- Leandro Meirelles Nunes
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil.,Universidade Feevale, Novo Hamburgo, Brasil
| | - Álvaro Vigo
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil
| | | | | |
Collapse
|
25
|
Dumas AA, Lemieux S, Lapointe A, Provencher V, Robitaille J, Desroches S. Development of an Evidence-Informed Blog to Promote Healthy Eating Among Mothers: Use of the Intervention Mapping Protocol. JMIR Res Protoc 2017; 6:e92. [PMID: 28526669 PMCID: PMC5457529 DOI: 10.2196/resprot.7147] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 02/15/2017] [Accepted: 04/14/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Low adherence to dietary guidelines and a concurrent rise of obesity-related chronic diseases emphasize the need for effective interventions to promote healthy eating. There is growing recognition that behavior change interventions should draw on theories of behavior change. Online interventions grounded in theory lead to increased effectiveness for health behavior change; however, few theory-driven social media-based health promotion interventions have been described in the literature. OBJECTIVE The objective of this study was to describe the application of the Intervention Mapping (IM) protocol to develop an evidence-informed blog to promote healthy eating among French-Canadian mothers of preschool and school-aged children. METHODS The following six steps of the IM protocol were performed. In Step 1, a preliminary needs assessment included a literature search on theoretical domains predicting Vegetables and Fruits intakes and Milk and Alternatives intakes in adults (ie, knowledge, beliefs about capabilities, beliefs about consequences, intention/goals) and a qualitative study including focus groups to identify female Internet users' perceptions of their use of healthy eating blogs. In Step 2, two behavioral outcomes were selected (ie, increase daily intakes of Vegetables and Fruits and Milk and Alternatives of mothers to reach Canadian dietary recommendations) and subsequently divided into six performance objectives inspired by national and international dietary recommendations such as planning for healthy meals. A matrix of change objectives was then created by crossing performance objectives with theoretical domains predicting Vegetables and Fruits intakes and Milk and Alternatives intakes in adults. Step 3 consisted of selecting theory-based intervention methods (eg, modeling and goal setting) and translating them into practical applications for the context of a dietary intervention delivered through a blog. A 6-month intervention was developed in Step 4 in which we aimed to address one performance objective per month in weekly blog publications written by a registered dietitian. For Step 5, we sought to include engagement-promoting methods (eg, peer and counselor support) to promote mothers' use of the blog and adherence to the intervention. Finally in Step 6, a randomized controlled trial has been launched to evaluate the effects of the blog on dietary behaviors of French-Canadian mothers. RESULTS The intervention study is expected to be completed in March 2018. CONCLUSIONS An intervention mapping protocol allowed for effective decision making in the development of a novel knowledge translation tool to increase adherence to dietary recommendations among mothers of preschool and school-aged children.
Collapse
Affiliation(s)
- Audrée-Anne Dumas
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada
| | - Simone Lemieux
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada
| | - Annie Lapointe
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada
| | - Véronique Provencher
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada
| | - Julie Robitaille
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada
| | - Sophie Desroches
- Institute of Nutrition and Functional Foods, Laval University, Quebec City, QC, Canada
| |
Collapse
|
26
|
Melo SV, Agnes G, Vitolo MR, Mattevi VS, Campagnolo PDB, Almeida S. Evaluation of the association between the TAS1R2 and TAS1R3 variants and food intake and nutritional status in children. Genet Mol Biol 2017; 40:415-420. [PMID: 28497839 PMCID: PMC5488460 DOI: 10.1590/1678-4685-gmb-2016-0205] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/23/2016] [Indexed: 11/26/2022] Open
Abstract
Taste perception plays a key role in determining individual food preferences and
dietary habits and may influence nutritional status. This study aimed to investigate
the association of TAS1R2 (Ile191Val - rs35874116)
and TAS1R3 (-1266 C/T - rs35744813) variants with
food intake and nutritional status in children followed from birth until 7.7 years
old. The nutritional status and food intake data of 312 children were collected at
three developmental stages (1, 3.9 and 7.7 years old). DNA was extracted from blood
samples and the polymorphisms were analyzed by real-time polymerase chain reactions
(qPCR) using hydrolysis probes as the detection method. Food intake and nutritional
status were compared among individuals with different single nucleotide polymorphism
(SNP) genotypes. At 3.9 years old, children homozygous (Val/Val) for
the TAS1R2 Ile191Val polymorphism ingested less sugar and
sugar-dense foods than children who were *Ile carriers. This finding
demonstrated that a genetic variant of the T1R2 taste receptor is associated with the
intake of different amounts of high sugar-content foods in childhood. This
association may provide new perspectives for studying dietary patterns and
nutritional status in childhood.
Collapse
Affiliation(s)
- Silvia V Melo
- Laboratório de Biologia Molecular, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Grasiela Agnes
- Laboratório de Biologia Molecular, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Márcia R Vitolo
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Vanessa S Mattevi
- Laboratório de Biologia Molecular, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Paula D B Campagnolo
- Centro de Ciências da Saúde, Universidade do Vale dos Sinos (UNISINOS), Porto Alegre, RS, Brazil
| | - Silvana Almeida
- Laboratório de Biologia Molecular, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil.,Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| |
Collapse
|
27
|
McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, Veitch E, Rennie AM, Crowther SA, Neiman S, MacGillivray S. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2017; 2:CD001141. [PMID: 28244064 PMCID: PMC6464485 DOI: 10.1002/14651858.cd001141.pub5] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES To describe forms of breastfeeding support which have been evaluated in controlled studies, the timing of the interventions and the settings in which they have been used.To examine the effectiveness of different modes of offering similar supportive interventions (for example, whether the support offered was proactive or reactive, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone.To examine the effectiveness of different care providers and (where information was available) training.To explore the interaction between background breastfeeding rates and effectiveness of support. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (29 February 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 100 trials involving more than 83,246 mother-infant pairs of which 73 studies contribute data (58 individually-randomised trials and 15 cluster-randomised trials). We considered that the overall risk of bias of trials included in the review was mixed. Of the 31 new studies included in this update, 21 provided data for one or more of the primary outcomes. The total number of mother-infant pairs in the 73 studies that contributed data to this review is 74,656 (this total was 56,451 in the previous version of this review). The 73 studies were conducted in 29 countries. Results of the analyses continue to confirm that all forms of extra support analyzed together showed a decrease in cessation of 'any breastfeeding', which includes partial and exclusive breastfeeding (average risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.95; moderate-quality evidence, 51 studies) and for stopping breastfeeding before four to six weeks (average RR 0.87, 95% CI 0.80 to 0.95; moderate-quality evidence, 33 studies). All forms of extra support together also showed a decrease in cessation of exclusive breastfeeding at six months (average RR 0.88, 95% CI 0.85 to 0.92; moderate-quality evidence, 46 studies) and at four to six weeks (average RR 0.79, 95% CI 0.71 to 0.89; moderate quality, 32 studies). We downgraded evidence to moderate-quality due to very high heterogeneity.We investigated substantial heterogeneity for all four outcomes with subgroup analyses for the following covariates: who delivered care, type of support, timing of support, background breastfeeding rate and number of postnatal contacts. Covariates were not able to explain heterogeneity in general. Though the interaction tests were significant for some analyses, we advise caution in the interpretation of results for subgroups due to the heterogeneity. Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Several factors may have also improved results for women practising exclusive breastfeeding, such as interventions delivered with a face-to-face component, high background initiation rates of breastfeeding, lay support, and a specific schedule of four to eight contacts. However, because within-group heterogeneity remained high for all of these analyses, we advise caution when making specific conclusions based on subgroup results. We noted no evidence for subgroup differences for the any breastfeeding outcomes. AUTHORS' CONCLUSIONS When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. Support is likely to be more effective in settings with high initiation rates. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding.
Collapse
Affiliation(s)
- Alison McFadden
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Anna Gavine
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
| | - Mary J Renfrew
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Angela Wade
- Institute of Child HealthCentre for Paediatric Epidemiology and Biostatistics30 Guilford StLondonUKWC1N 1 EH
| | | | | | - Emma Veitch
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Anne Marie Rennie
- NHS Grampian, Aberdeen Maternity HospitalCornhill RoadAberdeenUKAB25 2ZL
| | - Susan A Crowther
- Robert Gordon UniversityFaculty of Health and Social Care, School of Nursing and MidwiferyGarthdee RoadAberdeenUKAB10 7AQ
| | - Sara Neiman
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Stephen MacGillivray
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
| | | |
Collapse
|
28
|
Miranda RCK, Genro JP, Campagnolo PDB, Mattevi VS, Vitolo MR, Almeida S. Biallelic and triallelic approaches of 5-HTTLPR polymorphism are associated with food intake and nutritional status in childhood. J Nutr Biochem 2017; 43:47-52. [PMID: 28242565 DOI: 10.1016/j.jnutbio.2017.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 12/30/2016] [Accepted: 01/25/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The 5-HTT gene contains polymorphisms in its promoter region, the insertion/deletion (5-HTTLPR) that creates long (L) or short (S) alleles (biallelic approach) and SNP (rs25531) in L allele (triallelic approach). OBJECTIVES The aim of this study is to investigate the association of the 5-HTTLPR and rs25531 polymorphisms, using bi- and triallelic approach, with dietary intake and anthropometric parameters in children followed until 8 years old. METHODS The sample were 303 children who were recruited at birth and examined at 1, 3 to 4 and 7 to 8 years old. The polymorphisms were analyzed by polymerase-chain-reaction-based methods. RESULTS In the biallelic approach, children with the S/S genotype presented a higher body mass index Z-score in the three developmental stages and higher sum of skinfolds at 3 to 4 and 7 to 8 years old than carriers of the L allele. In the triallelic approach, S/S, Lg/S plus Lg/Lg genotypes were associated with higher energy intake daily at 1 year old and with waist circumference at 3 to 4 years old. CONCLUSIONS In the biallelic approach, the 5-HTTLPR polymorphism is associated with food intake, body mass index Z-score and sum of skinfolds in children, reinforcing the role of the serotonin transporter in childhood obesity. Our data indicate that the biallelic approach is more sensible than the triallelic approach for detected associations with food intake and nutritional status in childhood. Identifying susceptibility genes in early life could provide the foundations for interventions in lifestyle to prevent children to become obese adults.
Collapse
Affiliation(s)
- Raquel C K Miranda
- Laboratório de Biologia Molecular, Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245/Anexo 3 sala 303; CEP 90050-170, Porto Alegre, RS, Brazil
| | - Júlia P Genro
- Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245-sala 309; CEP 90050-170, Porto Alegre, RS, Brazil
| | - Paula D B Campagnolo
- Departamento de Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245/Anexo 2-sala 03; CEP 90050-170, Porto Alegre, RS, Brazil
| | - Vanessa S Mattevi
- Laboratório de Biologia Molecular, Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245/Anexo 3 sala 303; CEP 90050-170, Porto Alegre, RS, Brazil; Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245-sala 309; CEP 90050-170, Porto Alegre, RS, Brazil
| | - Márcia R Vitolo
- Departamento de Nutrição, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245/Anexo 2-sala 03; CEP 90050-170, Porto Alegre, RS, Brazil
| | - Silvana Almeida
- Laboratório de Biologia Molecular, Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245/Anexo 3 sala 303; CEP 90050-170, Porto Alegre, RS, Brazil; Departamento de Ciências Básicas da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre, Rua Sarmento Leite, 245-sala 309; CEP 90050-170, Porto Alegre, RS, Brazil.
| |
Collapse
|
29
|
Zandoná MR, Sangalli CN, Campagnolo PDB, Vitolo MR, Almeida S, Mattevi VS. Validation of obesity susceptibility loci identified by genome-wide association studies in early childhood in South Brazilian children. Pediatr Obes 2017; 12:85-92. [PMID: 27005443 DOI: 10.1111/ijpo.12113] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 12/11/2015] [Accepted: 01/04/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND The prevalence of childhood obesity has been dramatically increasing in developing countries as it has been reported for developed nations. Identifying susceptibility genes in early life could provide the foundations for interventions in lifestyle to prevent obese children to become obese adults. OBJECTIVES The objective of this study was to evaluate the influence of genetic variants related to obesity identified by genome-wide association studies (MC4R, TMEM18, KCTD15, SH2B1, SEC16B, BDNF, NEGR1, OLFM4 and HOXB5 genes) on anthropometric and dietary phenotypes in two Brazilian cohorts followed-up since birth. METHODS There were 745 children examined at birth, after 1 year and after 3.5 years of follow-up. Ten single nucleotide polymorphisms were genotyped. Anthropometric and dietary parameters were compared among genotypes. Children were classified as overweight when body mass index Z-score was >+1. RESULTS Overweight prevalence was 30.7% at 3.5 years old. Significant associations were identified at 3.5 years old for TMEM18 rs6548238, NEGR1 rs2815752, BDNF rs10767664 and rs6265 (1 year old and 3.5 years old) with anthropometric phenotypes and at 3.5 years old for SEC16B rs10913469 with dietary parameters. CONCLUSIONS Our results indicate that genetic variants in/near these genes contribute to obesity susceptibility in childhood and highlight the age at which they begin to affect obesity-related phenotypes.
Collapse
Affiliation(s)
- M R Zandoná
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - C N Sangalli
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.,Nutrition Research Group (NUPEN), Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - P D B Campagnolo
- Department of Nutrition, Vale do Rio do Sinos University, São Leopoldo, RS, Brazil
| | - M R Vitolo
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.,Nutrition Research Group (NUPEN), Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - S Almeida
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - V S Mattevi
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| |
Collapse
|
30
|
Effect of maternal dietary counselling during the 1st year of life on glucose profile and insulin resistance at the age of 8 years: a randomised field trial. Br J Nutr 2017; 117:134-141. [DOI: 10.1017/s0007114516004578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractEducation interventions that stimulate complementary feeding practices can improve the nutritional status of children and may protect against future chronic diseases. We assessed the long-term effectiveness of dietary intervention during the 1st year of life on insulin resistance levels, and investigated the relationship between insulin resistance and weight changes over time. A randomised field trial was conducted among 500 mothers who gave birth to full-term infants between October 2001 and June 2002 in a low-income area in São Leopoldo, Brazil. Mother–child pairs were randomly assigned to intervention (n 200) and control groups (n 300), and the mothers in the intervention group received dietary counselling on breast-feeding and complementary feeding of their children during the 1st year of life. Fieldworkers blinded to assignment assessed socio-demographic, dietary and anthropometric data during follow-up at ages 1, 4 and 8 years. Blood tests were performed in 305 children aged 8 years to measure fasting serum glucose and insulin concentrations and the homoeostasis model assessment index of insulin resistance (HOMA-IR). At the age of 8 years, the intervention group showed no changes in glucose and insulin concentrations or HOMA-IR values (change 0·07; 95 % CI −0·06, 0·21 for girls; and change −0·07; 95 % CI −0·19, 0·04 for boys) compared with study controls. Insulin resistance was highly correlated, however, with increases in BMI between birth and 8 years of age. Although this dietary intervention had no impact on glucose profile at age 8 years, our findings suggest that BMI changes in early childhood can serve as an effective marker of insulin resistance.
Collapse
|
31
|
Soldateli B, Vigo A, Giugliani ERJ. Adherence to dietary recommendations for preschoolers: clinical trial with teenage mothers. Rev Saude Publica 2016; 50:83. [PMID: 28099665 PMCID: PMC5167099 DOI: 10.1590/s1518-8787.2016050006622] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/17/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the effect of educational dietary intervention offered in the child’s first year of life, as well as teenage mothers and grandmothers in carrying out the dietary recommendations at four to seven years. METHODS Randomized clinical trial initiated in 2006, in Porto Alegre, RS, involving 323 teenage mothers and grandmothers who cohabited. The intervention consisted of six counseling sessions on breastfeeding and healthy complementary feeding. The first session occurred in the maternity ward and the other ones in the households of mothers at seven, 15, 30, 60, and 120 days of the child’s life. The information about the child’s diet were obtained on a monthly basis in the first six months, every two months in the second half-year, and at four to seven years, using a food frequency questionnaire. To assess the adequacy of food consumption to the recommendations from the Ministry of Health, we elaborated a score system that would reflect the compliance with the Ten Steps for Healthy Toddlers from 2 to 10 Years. The average scores of intervention and control groups were compared using the t-test. RESULTS Low adherence to recommendations on child nutrition was found in the study population, with no difference in implementation the steps between the groups. The score on the compliance with the steps was similar in both groups (9.6 [SD = 1.63] and 9.3 [SD = 1.60] in the intervention and control groups, respectively) and no influence of the cohabitation with the grandmother was found. CONCLUSIONS Educational dietary intervention in the first four months of the child’s life for teenage mothers and grandmothers had no effect on the compliance with the recommendations at four to seven years of the child’s life.
Collapse
Affiliation(s)
- Betina Soldateli
- Departamento de Nutrição. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Alvaro Vigo
- Departamento de Estatística. Instituto de Matemática e Estatística. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| | - Elsa Regina Justo Giugliani
- Departamento de Pediatria. Faculdade de Medicina. Universidade Federal do Rio Grande do Sul. Porto Alegre, RS, Brasil
| |
Collapse
|
32
|
Baldissera R, Issler RMS, Giugliani ERJ. [Effectiveness of the National Strategy for Healthy Complementary Feeding to improve complemantary feeding of infants in a municipality in Southern Brazil]. CAD SAUDE PUBLICA 2016; 32:e00101315. [PMID: 27653194 DOI: 10.1590/0102-311x00101315] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 02/12/2016] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to assess the effectiveness of the National Strategy for Healthy Complementary Feeding (ENPACS) in improving complementary feeding in the first year of life in a Brazilian municipality (county). This was an impact evaluation study that enrolled 340 infants from 6 to 12 months of age, followed at primary healthcare units. The target outcomes were prevalence rates for the consumption of vegetables, legumes, fruits, and unhealthy foods, and the prevalence of foods with adequate consistency for age. Poisson regression showed that the strategy was associated with reductions of 32% in the consumption of sodas and/or industrialized juices, 35% of industrialized foods, and 5% of unhealthy foods. There was no increase in the consumption of fruits, legumes, vegetables, or foods with adequate consistency for age. In conclusion, the strategy's positive effect was partial, but it has the potential to help improve infant nutrition, based on its effectiveness in reducing the consumption of unhealthy foods.
Collapse
|
33
|
Brazilian infant and preschool children feeding: literature review. J Pediatr (Rio J) 2016; 92:451-63. [PMID: 27320201 DOI: 10.1016/j.jped.2016.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/14/2016] [Accepted: 02/23/2016] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To assess the feeding profile of Brazilian infants and preschool children aged 6 months to 6 years, based on the qualitative and quantitative analysis of food and nutrient intake. DATA SOURCE This review analyzed studies carried out in Brazil that had food survey data on infants and preschool children. The search was limited to publications from the last 10 years included in the LILACS and MEDLINE electronic databases. DATA SUMMARY The initial search identified 1480 articles, of which 1411 were excluded after the analysis of abstracts, as they were repeated or did not meet the inclusion criteria. Of the 69 articles assessed in full, 31 articles contained data on food survey and were selected. Only three studies concurrently assessed children from different Brazilian geographical regions. Of the assessed articles, eight had qualitative data, with descriptive analysis of food consumption frequency, and 23 had predominantly quantitative data, with information on energy and nutrient consumption. CONCLUSIONS The articles assessed in this review showed very heterogeneous results, making it difficult to compare findings. Overall, the feeding of infants and preschool children is characterized by low consumption of meat, fruits, and vegetables; high consumption of cow's milk and inadequate preparation of bottles; as well as early and high intake of fried foods, candies/sweets, soft drinks, and salt. These results provide aid for the development of strategies that aim to achieve better quality feeding of Brazilian infants and preschoolers.
Collapse
|
34
|
Mello CS, Barros KV, de Morais MB. Brazilian infant and preschool children feeding: literature review. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2016. [DOI: 10.1016/j.jpedp.2016.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
35
|
Soldateli B, Vigo A, Giugliani ERJ. Effect of Pattern and Duration of Breastfeeding on the Consumption of Fruits and Vegetables among Preschool Children. PLoS One 2016; 11:e0148357. [PMID: 26844543 PMCID: PMC4741390 DOI: 10.1371/journal.pone.0148357] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/19/2016] [Indexed: 01/10/2023] Open
Abstract
Background The duration and pattern of breastfeeding can influence the consumption of fruits and vegetables in later childhood. Objective To investigate the association between pattern and duration of breastfeeding and consumption of fruits and vegetables in children aged between 4 and 7 years. Methods We conducted a secondary analysis using data from a former randomized clinical trial with 323 adolescent mothers, their children, and maternal grandmothers, when they cohabited. Information on infant feeding was collected monthly during the first 6 months of life, every two months until the child was 1 year old over and when children were between 4 and 7 years old. The associations between duration of breastfeeding and exclusive breastfeeding and consumption of fruits and vegetables were tested by a logistic regression model. Results Approximately 60% and 45% of children consumed fruits and vegetables, respectively, five or more times a week. Consumption of vegetables among 4-7-year-old children was higher in children who were breastfed for 12 months or longer (OR 2.7; 95%CI 1.49–4.93); however, exclusive breastfeeding duration did not have a significant association with consumption of vegetables (OR 1.5; 95%CI 0.70–3.04). There was no association between weekly consumption of fruits and duration of breastfeeding (OR 1.3; 95%CI 0.71–2.30) or exclusive breastfeeding (OR 0.7; 95%CI 0.34–1.44). Conclusions Longer duration of breastfeeding was positively associated with consumption of vegetables in children aged 4–7 years; however, there was no association with consumption of fruits. Exclusive breastfeeding duration did not have influence on consumption of fruits or vegetables.
Collapse
Affiliation(s)
- Betina Soldateli
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail:
| | - Alvaro Vigo
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Elsa Regina Justo Giugliani
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
36
|
Spence AC, Campbell KJ, Crawford DA, McNaughton SA, Hesketh KD. Mediators of improved child diet quality following a health promotion intervention: the Melbourne InFANT Program. Int J Behav Nutr Phys Act 2014; 11:137. [PMID: 25366542 PMCID: PMC4230360 DOI: 10.1186/s12966-014-0137-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 10/20/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Young children's diets are currently suboptimal. Given that mothers have a critical influence on children' diets, they are typically a target of interventions to improve early childhood nutrition. Understanding the maternal factors which mediate an intervention's effect on young children's diets is important, but has not been well investigated. This research aimed to test whether maternal feeding knowledge, maternal feeding practices, maternal self-efficacy, and maternal dietary intakes acted as mediators of the effect of an intervention to improve child diet quality. METHODS The Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program was a cluster-randomized controlled trial, conducted from 2008-2010. This novel, low-dose, health promotion intervention was delivered quarterly over 15 months and involved educational activities, promotion of peer discussion, a DVD and written materials. Post-intervention, when children were approximately 18 months of age, child diets were assessed using multiple 24-hour recalls and a purpose-developed index of diet quality, the Obesity Protective Dietary Index. Maternal mediators were assessed using a combination of previously validated and purpose-deigned tools. Mediation analysis was conducted using the test of joint significance and difference of coefficients methods. RESULTS Across 62 parents' groups in Melbourne, Australia, 542 parents were recruited. Post- intervention, higher maternal feeding knowledge and lower use of foods as rewards was found to mediate the direct intervention effect on child diet quality. While other aspects of maternal feeding practices, self-efficacy and dietary intakes did not act as mediators, they were associated with child diet quality. CONCLUSIONS Mediation analysis of this novel health promotion intervention showed the importance of maternal feeding knowledge and use of foods as rewards in impacting child diet quality. The other maternal factors assessed were appropriate targets but further research on how to impact these in an intervention is important. This evidence of intervention efficacy and mediation provides important insights for planning future interventions. TRIAL REGISTRATION Current Controlled Trials ISRCTN81847050, registered 23 November 2007.
Collapse
Affiliation(s)
- Alison C Spence
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - Karen J Campbell
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - David A Crawford
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - Sarah A McNaughton
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - Kylie D Hesketh
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| |
Collapse
|
37
|
Factors associated with low consumption of fruits and vegetables by preschoolers of low socio‐economic level. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2014. [DOI: 10.1016/j.jpedp.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
38
|
Valmórbida JL, Vitolo MR. Factors associated with low consumption of fruits and vegetables by preschoolers of low socio-economic level. J Pediatr (Rio J) 2014; 90:464-71. [PMID: 24656872 DOI: 10.1016/j.jped.2014.02.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 02/07/2014] [Accepted: 02/19/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate factors associated with low consumption of fruits and vegetables among preschoolers from families treated at basic health centers in Porto Alegre, RS, Brazil. METHODS This was a cohort study nested in a randomized field trial. Data collection was performed through structured questionnaires to obtain demographic and dietary data, combined with two 24-hour recalls in the age groups 12-16 months and again at 2-3 years of age. Data on the consumption of one daily serving of fruits (80 g) and vegetables (60 g) were evaluated, as well as consumption of non-recommended foods such as candy, chocolate, and soft drinks. Statistical analyses were performed using Poisson regression with robust estimation. RESULTS A total of 388 children aged 2-3 years were evaluated; of these, 58% and 87.4% did not consume one daily serving of fruits and vegetables, respectively. The following factors were negatively associated with fruit consumption: family income higher than four minimum wages, (p=0.024), lower paternal educational level (p=0.03), and lower fruit consumption at 12-16 months (p=0.002). Factors negatively associated with the consumption of vegetables were low paternal educational level (p=0.033) and consumption of high-sugar content beverages at 12-16 months (p=0.014). CONCLUSION This study demonstrated a high prevalence of children who consumed less than one daily serving of fruit and vegetables; early feeding practices, parental education, and family income were associated with this process.
Collapse
Affiliation(s)
- Julia L Valmórbida
- Center for Research in Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
| | - Márcia R Vitolo
- Department of Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| |
Collapse
|
39
|
Laws R, Campbell KJ, van der Pligt P, Russell G, Ball K, Lynch J, Crawford D, Taylor R, Askew D, Denney-Wilson E. The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review. BMC Public Health 2014; 14:779. [PMID: 25084804 PMCID: PMC4137086 DOI: 10.1186/1471-2458-14-779] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/17/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families. METHODS Searches of major electronic databases identified articles published from 1993-2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity. RESULTS Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m(2) to -0.54 kg/m(2) for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3-5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery. CONCLUSION There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required. TRIAL REGISTRATION PROSPERO Registration no: CRD42013006536.
Collapse
Affiliation(s)
- Rachel Laws
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Karen J Campbell
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Paige van der Pligt
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Georgina Russell
- />Faculty of Health, University of Technology, Sydney, NSW Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Kylie Ball
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - John Lynch
- />School of Population Health, University of Adelaide, Adelaide, SA Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - David Crawford
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Rachael Taylor
- />University of Otago, Dunedin, New Zealand
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Deborah Askew
- />Inala Indigenous Health Service, Inala, QLD, Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Elizabeth Denney-Wilson
- />Faculty of Health, University of Technology, Sydney, NSW Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| |
Collapse
|
40
|
Sunguya BF, Poudel KC, Mlunde LB, Urassa DP, Yasuoka J, Jimba M. Poor nutrition status and associated feeding practices among HIV-positive children in a food secure region in Tanzania: a call for tailored nutrition training. PLoS One 2014; 9:e98308. [PMID: 24846016 PMCID: PMC4028312 DOI: 10.1371/journal.pone.0098308] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 05/01/2014] [Indexed: 11/18/2022] Open
Abstract
Undernutrition among HIV-positive children can be ameliorated if they are given adequate foods in the right frequency and diversity. Food insecurity is known to undermine such efforts, but even in food rich areas, people have undernutrition. As yet no study has examined feeding practices and their associations with nutrition status among as HIV-positive children in regions with high food production. We therefore examined the magnitude of undernutrition and its association with feeding practices among HIV-positive children in a high food production region in Tanzania.
Collapse
Affiliation(s)
- Bruno F. Sunguya
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Krishna C. Poudel
- Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Linda B. Mlunde
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - David P. Urassa
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
41
|
Marshall S, Burrows T, Collins CE. Systematic review of diet quality indices and their associations with health-related outcomes in children and adolescents. J Hum Nutr Diet 2014; 27:577-98. [PMID: 24524271 DOI: 10.1111/jhn.12208] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Diet quality indices add an important dimension to dietary assessment. The aim of this systematic review was to: (i) identify and describe the attributes and applications of diet quality indices developed for use or used in paediatric populations; (ii) describe associations between these diet quality indices and health-related variables in paediatric populations; and (iii) identify factors that are associated with diet quality in paediatric populations worldwide. METHODS Studies were identified by searching electronic databases for relevant papers from 1980 to October 2013 using keywords. Inclusion criteria were original studies that utilised a quantitative measure of diet quality in children and adolescents aged 0-18 years. RESULTS One hundred and nineteen studies met the inclusion criteria, from which 80 different diet quality indices were identified. The majority of studies had >1000 participants and were of acceptable quality. Of the 56 studies that investigated health-related outcomes, weight status was the most researched. Europe produced the most number of diet quality indices (n = 27 indices). Of the 119 studies, seven intervention studies were identified. Paediatric diet quality indices were found to be associated with environmental, behavioural and maternal factors. CONCLUSIONS The use of diet quality indices in paediatric populations is a rapidly expanding area of research in diverse populations internationally. In economically disadvantaged countries, diet quality indices may be predictive of child growth. However, prospective cohort, intervention and validation studies are required to draw stronger conclusions concerning risk of future disease in paediatric populations in general.
Collapse
Affiliation(s)
- S Marshall
- Nutrition and Dietetics, Faculty of Health, School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia
| | | | | |
Collapse
|
42
|
Zandoná MR, Rodrigues RO, Albiero G, Campagnolo PDB, Vitolo MR, Almeida S, Mattevi VS. Polymorphisms in LEPR, PPARG and APM1 genes: associations with energy intake and metabolic traits in young children. ACTA ACUST UNITED AC 2013; 57:603-11. [DOI: 10.1590/s0004-27302013000800004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 04/14/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVE: To assess the association of single nucleotide polymorphisms (SNPs) in five genes - leptin, leptin receptor (LEPR), adiponectin (APM1), peroxisome proliferator-activated receptor gamma (PPARG) and uncoupling protein 1 - with anthropometric, metabolic, and dietary parameters in a Southern Brazilian cohort of 325 children followed up from birth to 4 years old. MATERIALS AND METHODS: SNPs were analyzed using polymerase chain reaction-based procedures, and their association with phenotypes was evaluated by t-test, analysis of variance, and general linear models. RESULTS: LEPR223Arg allele (rs1137101) was associated with higher daily energy intake at 4 years of age (P = 0.002; Pcorrected = 0.024). PPARG 12Ala-carriers (rs1801282) presented higher glucose levels than Pro/Pro homozygotes (P = 0.007; Pcorrected = 0.042). CONCLUSIONS: Two of the six studied SNPs presented consistent associations, showing that it is already possible to detect the influences of genetic variants on susceptibility to overweight in 4-year-old children.
Collapse
Affiliation(s)
- Marília Remuzzi Zandoná
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | | | - Gabriela Albiero
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | | | | | - Silvana Almeida
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Vanessa Suñé Mattevi
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil; Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| |
Collapse
|
43
|
Spence AC, McNaughton SA, Lioret S, Hesketh KD, Crawford DA, Campbell KJ. A health promotion intervention can affect diet quality in early childhood. J Nutr 2013; 143:1672-8. [PMID: 23966329 DOI: 10.3945/jn.113.177931] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Initiatives to promote children's nutrition and prevent childhood obesity are vital. Dietary patterns are a useful way to characterize whole diets, though no previous early childhood health promotion trial to our knowledge has assessed intervention impact using this approach. This research aimed to assess the effect of a healthy eating and physical activity intervention on young children's dietary patterns. The Melbourne Infant Feeding Activity and Nutrition Trial Program was a health promotion, cluster-randomized controlled trial involving 542 families. Child diets were assessed by multiple 24-h recalls postintervention at ~18 mo of age. An Obesity Protective Dietary Index (OPDI) was created and dietary patterns were also assessed by principal components analysis (PCA). These outcomes were used to compare intervention and control participants to test the effectiveness of the intervention. Children in the intervention arm scored higher (15.6 ± 5.9) than those in the control arm (14.5 ± 6.7) for the OPDI (scores out of 30, P = 0.01). Three dietary patterns were identified by PCA; however, the scores did not substantially differ between the intervention and control arms. In conclusion, this paper presents novel results in both the evaluation of an early childhood health promotion intervention and the assessment of child dietary patterns. The results highlight the capacity for such an initiative to improve child diets and the need for further research in this area.
Collapse
Affiliation(s)
- Alison C Spence
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood Victoria, Australia
| | | | | | | | | | | |
Collapse
|
44
|
Diet quality from pre-school to school age in Brazilian children: a 4-year follow-up in a randomised control study. Br J Nutr 2013; 111:499-505. [DOI: 10.1017/s0007114513002857] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A previous study demonstrated that dietary counselling for mothers during the first year of life improved overall diet quality of children at pre-school age in a low-income population. Thus, the objective of the present study was to assess the long-term effect of this intervention on diet quality of children at school age and examine the tracking of dietary intake throughout childhood. The present study was a follow-up of a randomised controlled trial with children who were assessed at 3–4 years (n 345) and 7–8 years (n 307) of age. We collected two 24 h dietary recalls and assessed diet quality using the Healthy Eating Index (HEI). Analyses were performed by group using a paired t test and a Student's t test for independent samples. Diet quality did not differ between the intervention and control groups at 7–8 years of age (HEI score 65·2 (sd 9·5) v. 64·9 (sd 8·5)). Regarding changes in diet quality from pre-school to school age, we observed the tracking of diet quality in the control group and the loss of the intervention effect in the intervention group. In both groups, the score for fruit and milk intake decreased, while that for saturated fat and dietary variety intake increased. The score for the intakes of grains, meat and legumes, and total fat remained constant for all children. The present data provide evidence that diet quality tracks during childhood since the total HEI score did not differ over time in the control group. The decrease in score for some HEI components did not affect the overall diet quality due to the increase in score for other HEI components.
Collapse
|
45
|
Sunguya BF, Poudel KC, Mlunde LB, Shakya P, Urassa DP, Jimba M, Yasuoka J. Effectiveness of nutrition training of health workers toward improving caregivers' feeding practices for children aged six months to two years: a systematic review. Nutr J 2013; 12:66. [PMID: 23688174 PMCID: PMC3668136 DOI: 10.1186/1475-2891-12-66] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 05/10/2013] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Nutrition training of health workers can help to reduce child undernutrition. Specifically, trained health workers might contribute to this end through frequent nutrition counseling of caregivers. This may improve child-feeding practices and thus reduce the risk of undernutrition among children of counseled caregivers. Although studies have shown varied impacts of health workers' nutrition training on child feeding practices, no systematic review of the effectiveness of such intervention has yet been reported. Therefore, we conducted this study to examine the effectiveness of nutrition training for health workers on child feeding practices including feeding frequency, energy intake, and dietary diversity among children aged six months to two years. METHODS We searched the literature for published randomized controlled trials (RCTs) and cluster RCTs using medical databases including PubMed/MEDLINE, CINAHL, EMBASE, and ISI Web of Knowledge, and through WHO regional databases. Our intervention of interest was nutrition training of health workers. We pooled the results of the selected trials, evaluated them using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria, and calculated the overall effect size of the intervention in meta-analyses. RESULTS Ten RCTs and cluster RCTs out of 4757 retrieved articles were eligible for final analyses. Overall, health workers' nutrition training improved daily energy intake of children between six months and two years of age. The pooled evidence from the three studies reporting mean energy intake per day revealed a standardized mean difference (SMD) of 0.76, 95% CI (0.63-0.88). For the two studies with median energy intake SMD was 1.06 (95% CI 0.87-1.24). Health workers' nutrition training also improved feeding frequency among children aged six months to two years. The pooled evidence from the three studies reporting mean feeding frequency showed an SMD of 0.48 (95% CI 0.38-0.58). Regarding dietary diversity, children in intervention groups were more likely to consume more diverse diets compared to their counterparts. CONCLUSION AND RECOMMENDATIONS Nutrition training for health workers can improve feeding frequency, energy intake, and dietary diversity of children aged six months to two years. Scaling up of nutrition training for health workers presents a potential entry point to improve nutrition status among children.
Collapse
Affiliation(s)
- Bruno F Sunguya
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Krishna C Poudel
- Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts Amherst, Arnold House, 715 North Pleasant St, Amherst, MA 01003-9304, USA
- School of Community and Global Health, Claremont Graduate University, 18 East Via Verde Ste. 100, Claremont, CA 91773, USA
| | - Linda B Mlunde
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Prakash Shakya
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - David P Urassa
- School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65489, Dar es Salaam, Tanzania
| | - Masamine Jimba
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Junko Yasuoka
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| |
Collapse
|
46
|
da Silva CF, Zandoná MR, Vitolo MR, Campagnolo PDB, Rotta LN, Almeida S, Mattevi VS. Association between a frequent variant of the FTO gene and anthropometric phenotypes in Brazilian children. BMC MEDICAL GENETICS 2013; 14:34. [PMID: 23497514 PMCID: PMC3662589 DOI: 10.1186/1471-2350-14-34] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 03/07/2013] [Indexed: 12/20/2022]
Abstract
Background Our goal was to analyze the association of the fat mass and obesity- associated (FTO) gene rs9939609 variant (T/A) with the anthropometric and dietary intake phenotypes related to obesity in Brazilian children. Methods We analyzed the association of this single nucleotide polymorphism (SNP) with phenotypes related to the accumulation of body mass in a cohort of 348 children followed from the time of birth until 8 years old and then replicated the main findings in an independent schoolchildren sample (n = 615). Results At the age of 4, we observed a significant association between the A/A genotype and a higher mean BMI Z-score (P = 0.036). At the age of 8, the A/A individuals still presented with a higher BMI Z-score (P = 0.011) and with marginal differences in the volume of subcutaneous fat (P = 0.048). We replicated these findings in the schoolchildren sample, which showed that those with at least one copy of the A allele presented with a higher BMI Z-score (P = 0.029) and volume of subcutaneous fat (P = 0.016). Conclusion Our results indicate that this FTO variant is associated with increased body mass and subcutaneous fat in Brazilian children beginning at the age of 4.
Collapse
|
47
|
Rauber F, da Costa Louzada ML, Feldens CA, Vitolo MR. Maternal and family characteristics associated with the Healthy Eating Index among low socioeconomic status Brazilian children. J Hum Nutr Diet 2012. [DOI: 10.1111/jhn.12005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- F. Rauber
- Federal University of Health Sciences of Porto Alegre (UFCSPA); Porto Alegre RS Brazil
| | | | - C. A. Feldens
- Lutheran University of Brazil (ULBRA); Bairro São José Canoas RS Brazil
| | - M. R. Vitolo
- Federal University of Health Sciences of Porto Alegre (UFCSPA); Porto Alegre RS Brazil
| |
Collapse
|
48
|
Bortolini GA, Gubert MB, Santos LMP. Consumo alimentar entre crianças brasileiras com idade de 6 a 59 meses. CAD SAUDE PUBLICA 2012; 28:1759-71. [DOI: 10.1590/s0102-311x2012000900014] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 06/11/2012] [Indexed: 11/22/2022] Open
Abstract
O objetivo foi avaliar o consumo alimentar em crianças brasileiras de 6-59 meses de idade, por região e zona de residência. Trata-se de estudo descritivo transversal com 4.322 crianças investigadas na Pesquisa Nacional de Demografia e Saúde (2006/2007). Observou-se baixo consumo diário de verduras (12,7%), legumes (21,8%), carnes (24,6%) e elevado consumo de refrigerantes (40,5%), alimentos fritos (39,4%), salgadinhos (39,4%), doces (37,8%), na frequência de uma a três vezes na semana. Comparando-se as regiões, as crianças residentes no Sul, Sudeste e Centro-oeste consumiram com mais frequência arroz, pão, batata, feijão, verdura de folha, legumes e carne, mas também consumiram, mais frequentemente, alimentos não recomendados para a idade, como doces e refrigerantes. Crianças da zona rural apresentaram menor consumo dos alimentos recomendados para a idade e, também, dos não recomendados, quando comparadas às crianças da zona urbana. O consumo alimentar evidenciado neste estudo não está de acordo com recomendações de alimentação saudável para crianças.
Collapse
|
49
|
Renfrew MJ, McCormick FM, Wade A, Quinn B, Dowswell T. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2012; 5:CD001141. [PMID: 22592675 PMCID: PMC3966266 DOI: 10.1002/14651858.cd001141.pub4] [Citation(s) in RCA: 201] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended infants be exclusively breastfed until six months of age, with breastfeeding continuing as an important part of the infant's diet till at least two years of age. However, breastfeeding rates in many countries currently do not reflect this recommendation. OBJECTIVES To assess the effectiveness of support for breastfeeding mothers. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (3 October 2011). SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. MAIN RESULTS Of the 67 studies that we assessed as eligible for inclusion, 52 contributed outcome data to the review (56,451 mother-infant pairs) from 21 countries. All forms of extra support analysed together showed an increase in duration of 'any breastfeeding' (includes partial and exclusive breastfeeding) (risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.96). All forms of extra support together also had a positive effect on duration of exclusive breastfeeding (RR at six months 0.86, 95% CI 0.82 to 0.91; RR at four to six weeks 0.74, 95% CI 0.61 to 0.89). Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Maternal satisfaction was poorly reported. AUTHORS' CONCLUSIONS All women should be offered support to breastfeed their babies to increase the duration and exclusivity of breastfeeding. Support is likely to be more effective in settings with high initiation rates, so efforts to increase the uptake of breastfeeding should be in place. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed. Support that is only offered reactively, in which women are expected to initiate the contact, is unlikely to be effective; women should be offered ongoing visits on a scheduled basis so they can predict that support will be available. Support should be tailored to the needs of the setting and the population group.
Collapse
Affiliation(s)
- Mary J Renfrew
- Mother and Infant Research Unit, Department of Health Sciences, University of York, York, UK
| | - Felicia M McCormick
- Mother and Infant Research Unit, Department of Health Sciences, University of York, York, UK
| | - Angela Wade
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | - Beverley Quinn
- Health and Community Care Research Unit (HaCCRU), The University of Liverpool, Liverpool, UK
| | - Therese Dowswell
- Cochrane Pregnancy and Childbirth Group, Department of Women’s and Children’s Health, The University of Liverpool, Liverpool, UK
| |
Collapse
|
50
|
Effect of a nutritional intervention on childhood caries: reply to Seow. J Evid Based Dent Pract 2011; 11:164-5; author reply 165-6. [PMID: 21855823 DOI: 10.1016/j.jebdp.2011.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|