Search

Background Vegetarian diets are becoming increasingly popular among Canadians, yet few studies have evaluated the relationship between a vegetarian diet and childhood growth and nutritional status. Since vegetarian diets can be less energy dense and may have lower micronutrient content, we hypothesized that a vegetarian diet may affect childhood growth including lower adiposity and height, as well as lower micronutrient stores. Objectives The primary objective of this study was to evaluate the relationship between vegetarian diet and growth, including adiposity and height among healthy children 6 months to 10 years of age. Secondary objectives included the examination of the relationship between vegetarian diet and iron and vitamin D stores. We also explored whether cow’s milk intake or age modified the associations between vegetarian diet and growth, and micronutrient stores. Design/Methods This was a prospective cohort study of healthy children age 6 months to 10 years. The primary exposure was vegetarian diet measured by parent report. The primary outcome was BMI z-score. Secondary outcomes included height-for-age z-score, serum ferritin, and serum 25-hydroxyvitamin D. Anthropometric measures and venous blood samples were collected at health supervision visits by trained research assistants. Linear mixed effect modelling was used to determine the association between vegetarian diet, growth, and micronutrient stores. Results A total of 8912 children (n = 248 vegetarian) participated. In the adjusted models there was no evidence of an association between vegetarian diet and BMI z-score (p = 0.605, 95% CI: -0.06, 0.10), height-for-age z-score (p 0.057, 95% CI: -0.16, 0.002), serum ferritin (p = 0.768, 95% CI: -3.84, 2.84), or 25-hydroxyvitamin D (p = 0.204, 95% CI: -2.14, 0.46). The relationship between vegetarian diet and serum 25-hydroxyvitamin D was modified by child age. Volume of cow’s milk intake did not modify the relationships between vegetarian diet and BMI z-score, height-for-age z-score, serum ferritin, or 25-hydroxyvitamin D. In a secondary analysis, we examined adiposity through weight status categories and found children with a vegetarian diet had higher odds of being underweight (BMI z-score Conclusion In this prospective cohort study, evidence of an association between vegetarian diet and lower BMI z-score, height-for-age z-score, and micronutrient stores was not found. Our results suggest children with vegetarian diets had higher odds of being underweight. Future research is needed to evaluate dietary factors and patterns of children following vegetarian diets, especially those with an underweight weight status.

Background Income related inequities in child health are well-established, with children from lower income households showing increased risk of obesity, behavior problems, and delayed development. To facilitate clinical diagnosis, outcomes are conventionally measured in dichotomous terms. However, inequities may exist along the entire range of distribution, with implications for population health. Objectives Our primary objective was to examine differences in the distribution of three measures of child health by income: body mass index (BMI), behavior difficulties and development. Design/Methods This was a cross sectional study of children enrolled in a primary care practice-based research cohort. Our study included generally healthy children recruited from age 0-5 years. Dependent variables were 1) BMI z-score (zBMI) at 5 years; 2) behavior: total score on the Strengths and Difficulties Questionnaire (SDQ), measured at 3-5 years; 3) development: total score on the Infant Toddler Checklist (ITC), measured at 18-24 months. Independent variable was parent-reported annual household income (< $100,000 vs ≥ $100000). We then used distributional decomposition, which uses mathematical re-weighting to construct a counterfactual distribution that describes the distribution of the lower income group based on the predictor profile (child age, sex, birthweight, prematurity, breastfeeding duration; maternal age, education, immigration status, ethnicity) of the higher income group. Results Our study samples consisted of 1649 (zBMI), 764 (SDQ) and 761 (ITC) children. Mean BMI z-score was 0.16, median total difficulties score was 7, median ITC score was 48. Comparing distributions graphically (Figure 1), children with low income have a higher risk distribution for all outcomes; for example, children with low income were more likely to have BMI z-scores in the underweight and obese ranges. For each outcome, the counterfactual curve lower income children with the predictor profile of their higher income counterparts reduced inequities somewhat, particularly in the normal or low risk range, but not in the high-risk range. However, there were notable unexplained portions of inequity remaining. Conclusion In a cohort of generally healthy children, we found evidence of meaningful income-related inequities in the distribution of child zBMI, behavior difficulties, and development. Population health interventions aiming to mitigate these inequities by addressing common predictors may improve outcomes in the normal range; however targeted clinical interventions are likely required for those in the high-risk range.

BACKGROUND: Television viewing during mealtime has been associated with elevated BMI in children. Recently, there has been an increase in the use of mobile media devices; however, the association between overall media use during mealtime and markers of cardiometabolic risk (CMR) remains unknown. OBJECTIVES: To examine mealtime media use in children and its association with non-HDL cholesterol levels and other CMR outcomes, including BMI z-score (zBMI), total cholesterol, HDL cholesterol, triglycerides, glucose and insulin. DESIGN/METHODS: A cross-sectional analysis using repeated measures was conducted on n=2,117 (total observations=2,911) healthy children age 1–13 years participating in a practice-based research network from 2013–2018. To account for repeated measures, multivariable linear regression with generalized estimating equations was used to examine the association between weekly mealtime media use and non-HDL cholesterol as well as secondary CMR outcomes. Individual age groups (0.05). CONCLUSION: While mealtime media use was not associated with non-HDL cholesterol, it may be associated with unfavourable lipid profiles through effects on HDL cholesterol in children ≥5y. Motivations for mealtime media use may differ among pre-school and school-aged children, which may therefore contribute to the differing direction of associations observed in our study. Further research examining the context in which mealtime media is used is warranted.

BACKGROUND: Considerable debate exists around what age children should start consuming cow milk. The Canadian Paediatric Society recommends that cow milk be introduced between 9 and 12 months of age while American, Australian and UK guidelines recommend waiting until 12 months. Children who consume cow milk tend to be taller than those who do not, so earlier introduction may positively impact child height. However, later introduction may decrease weight gain and lower the risk of child obesity. OBJECTIVES: The objectives of the study were to evaluate the association between the age of introduction to cow milk and child height (primary objective) and adiposity (secondary objective). DESIGN/METHODS: A prospective cohort study was conducted through a large practice-based research network. The primary exposure was child age at introduction to cow milk measured using a parent-completed standardized questionnaire. The primary outcome was height-for-age z-score and the secondary outcome was body mass index z-score (BMIz) measured between 3 and 5 years of age. Multiple linear regression was used to evaluate the associations. RESULTS: A total of 1864 children were included in the study (54% male). On average, cow milk was introduced at 11.8 months (SD = 2.2) and almost all children (94.2%) had been introduced to cow milk by 2 years of age. Mean age at follow-up was 46.9 months (SD = 7.5). In the primary analysis, earlier introduction to cow milk was associated with taller children (p< 0.001). Each month earlier that cow milk was introduced was associated with 0.04 higher height-for-age z-score (95% CI: 0.02–0.06). For example, the height difference between a 4-year-old child introduced to cow milk at 12 months relative to 18 months was 0.25 height-for-age z-score units (95% CI: 013-0.36) or 1.05 cm (95% CI: 0.55–1.54 cm). Exploration of non-linearity using linear splines revealed the association between earlier introduction to cow milk and child height was statistically significant after 10 months of age but not before. In the secondary analysis, there was no association between age of introduction to cow milk and BMIz (p= 0.27). CONCLUSION: Earlier introduction to cow milk was associated with taller children by 3 to 5 years of age without increasing child adiposity. Canadian Paediatric Society recommendations for cow milk introduction as early as 9 months of age appear to be appropriate for optimizing childhood height. Future research is needed to understand the causal relationship between starting cow milk earlier and taller height.