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OBJECTIVES: Maternal weight and anthropometric trajectories may affect both fetal programming and maternal pregnancy health outcomes. We developed a statistical model that categorized concomitant changes in weight and body composition across gestation. METHODS: We conducted a secondary analysis of a prospective cohort of singletons (n = 2,353) enrolled from 11 US perinatal centers, 2009–2013. Weight, mid-upper arm circumference (MUAC), plus triceps and subscapular skinfold thickness (TSF, SSF) were measured up to 5 times across gestation. Prenatal weights were also abstracted from medical records. Gestational weight change (GWG) trajectories and time-varying, region-specific body composition (MUAC, TSF, SSF) were modeled jointly with a flexible latent class trajectory model, adjusting for prepregnancy BMI. RESULTS: Most women had prepregnancy normal weight (56.4%), while fewer were classified as overweight (27.2%) or obese (16.4%). Five trajectory patterns for weight and body composition were identified. (1) InitalHighSteadyGain (12.5%) had the highest 1(st) trimester weight gain and steady gain thereafter, with high model estimated total GWG (36.1 lbs). (2) InitialModerateSlowGain (19.8%) had moderate 1(st) trimester gain, then slow steady gain with the lowest total GWG (28.7 lbs). InitalHighSteadyGain and InitialModerateSlowGain showed relatively stable MUAC, while SSF and TSF increased in 1(st) and 2(nd) trimesters and decreased in 3(rd) trimester. Other GWG trajectory groups showed (3) 1(st) trimester weight loss (LossSteadyGain, 8.2%), (4) stability (StableSteadyGain, 21.5%), or (5) low gain (LowSteadyGain, 38.2%), then steady GWG in the 2(nd) and 3(rd) trimesters with estimated total GWG of 35.7, 36.8 and 32.8 lb, respectively. Small increases in MUAC and SSF were observed in LowSteadyGain across pregnancy, while TSF increased up to 30 wk and then decreased. LossSteadyGain and StableSteadyGain groups showed similarities in initial MUAC, TSF and SSF measurements with small increases in MUAC and TSF, and moderate increases in SSF over time. CONCLUSIONS: Joint modeling of prenatal weight and regional body composition changes identified five trajectory patterns, which offers a more advanced understanding of how these trajectories concomitantly change during pregnancy. FUNDING SOURCES: NICHD; HHS.

Background Native American (NA) children have a high prevalence of obesity contributing to lifespan health disparities. Dietary intake is important to promote healthy weight gain, growth, and development. In 2017, the USDA enforced changes to the Child and Adult Care Food Program (CACFP). The CACFP provides reimbursement to qualifying Early Care and Education (ECE) programs that serve foods that uphold the program's nutrition requirements. Objective This study had the following 2 objectives: 1) Describe a novel index to evaluate ECE menus based on revised CACFP requirements (accounting for food substitutions) and best practices for 3- to-5-y-old children, and 2) analyze CACFP requirement and best practice compliance and nutrient changes in 9 NA ECE programs before and after enforcement of the revised CACFP requirements. Methods This longitudinal study is within a larger community-based participatory research study. Menus and meals served were evaluated for 1 wk at each of 9 programs before and after enforcement of the revised meal patterns. Nutrient analysis, CACFP requirement and best practice compliance, and substitution quality were evaluated. Differences were determined using a paired t-test or Wilcoxon matched test. This trial was registered at clinicaltrials.gov as NCT03251950. Results Total grams of fiber consumed increased (5.0 ± 1.2 compared with 5.9 ± 0.8 g, P = 0.04) and total grams of sugar consumed decreased (53.8 ± 12.6 compared with 48.4 ± 7.9 g, P = 0.024), although room for further improvement exists. Although total grams of fat remained unchanged, grams of saturated fat significantly increased (7.8 ± 1.4 compared with 10.5 ± 3.4, P = 0.041). Other nutrients remained unchanged. Overall CACFP requirement and best practice compliance scores improved, although this finding was not statistically significant. No significant changes in food quality associated with substitutions occurred. Conclusions This study provides early evidence to support the beneficial impact of the revised CACFP requirements. Understanding barriers to compliance within rural NA communities would be an important next step in enhancing the health of vulnerable children.

OBJECTIVES: New Child and Adult Care Food Program (CACFP) meal patterns and best-practices were implemented nationally in 2017 to address the need to prevent chronic diseases. Young Native American children have disproportionately higher risk of chronic disease. Some Native American tribes operate early care and education (ECE) programs and have the opportunity to participate in the CACFP. The purpose of this paper is to describe a CACFP best-practice menu and training developed and implemented as part of the Food Resource Equity and Sustainability for Health (FRESH) study. METHODS: FRESH is a community-based participatory research (CBPR) intervention implemented within ECE programs in the Osage Nation of Oklahoma. Site managers and cooks from each of the nine ECE programs attended meetings and provided feedback to investigators which shaped the best-practice menu and training. Each site participated in a three-hour training in January 2018 to discuss the best-practice menu and ways to overcome implementation barriers. Goals of the menu aimed to increase intake of fruit and vegetables and whole grains and reduce pre-fried and processed foods without increasing cook burden. Training included application activities individually and in small and large groups. RESULTS: Though the project is still underway, lessons learned have emerged including the need for technical assistance, improved communication between ECE program staff and food supply vendors, and infrastructure barriers (e.g., limited space, lack of supplies) that challenge work-flow. CONCLUSIONS: Efforts to improve menus in rural and low-income ECE programs must consider these issues in developing feasible intervention strategies. Collaboration with the site manager and cook is essential to fully understand perceived and actual barriers to provide training that can provide necessary background rationale for nutrition recommendations as well as beneficial and productive activities and hands-on training to effect change outside the training. FUNDING SOURCES: This study was funded by the National Institute on Minority Health and Health Disparities (R01MD011266). The funding agency did not participate in the study design, data collection, analysis, decision to publish, or preparation of the manuscript.