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This cluster randomized controlled trial aimed at overweight and obese children compared three treatments. Two psychoeducation interventions for parents and children were conducted: Family Lifestyle (FL) focused on food and physical activity, Family Dynamics (FD) added parenting and healthy emotion management. A third Peer Group (PG) intervention taught social acceptance to children. Crossing interventions yielded four conditions: FL, FL + PG, FL + FD, and FL + FD + PG—compared with the control. Longitudinal BMI data were collected to determine if family- and peer-based psychosocial components enhanced the Family Lifestyle approach. Participants were 1st graders with BMI%ile &gt, 75 (n = 538: 278 boys, 260 girls). Schools were randomly assigned to condition after stratifying for community size and percent American Indian. Anthropometric data were collected pre- and post-intervention in 1st grade and annually through 4th grade. Using a two-level random intercept growth model, intervention status predicted differences in growth in BMI or BMI-M% over three years. Children with obesity who received the FL + FD + PG intervention had lower BMI gains compared to controls for both raw BMI (B = −0.05) and BMI-M% (B = −2.36). Interventions to simultaneously improve parent, child, and peer-group behaviors related to physical and socioemotional health offer promise for long-term positive impact on child obesity.

Background : Children with fetal alcohol spectrum disorders (FASDs), aged 3 to 5 years, have physical, behavioral, and functional problems. Because of alcohol-related deficits, children with FASDs are at risk for malnutrition; yet, little is known about how FASD affects eating behavior and nutrition. Aim : The purpose of this study was to identify atypical eating behavior in children with FASDs, aged 3 to 5 years, and their associations with socio-demographic characteristics. Method : This descriptive cross-sectional study gathered data from a caregiver-reported online survey targeting the eating behavior of preschool-aged children with FASDs. The survey included the Children’s Eating Behavior Questionnaire (CEBQ) and a socio-demographic questionnaire. Participants/Setting : Seventy-four caregivers qualified for the study with nine having two children with FASDs. Responses to survey questions varied since caregivers had permission to omit any question. Results : Significant differences were found between the preschool-aged children with FASDs and Wardle’s published normative sample by gender and age. Compared to reported norms, study children scored higher in Desire to Drink, Food Responsiveness, Emotional Overeating, and Food Fussiness, and lower in Enjoyment of Food. Regarding socio-demographic characteristics, there was greater Enjoyment of Food with larger families and Food Avoidance with college-educated caregivers. Conclusion : Children with FASDs, aged 3 to 5 years, have atypical eating behaviors characteristic of maladaptive appetites, overeating under stress, selective eating, slowness in eating, and an excessive need for drinks, in comparison with a published normative sample.

OBJECTIVES: Phase angle, derived from bioelectrical impedance analysis (BIA), is used to describe both cellular and overall health. Many of the variables measured using BIA vary based on the hydration status of the individual. The ratio between extracellular water/total body water is commonly measured in BIA, and can be used as a measure of individual hydration. This pilot study explores the relationship between individual hydration status and phase angle and other BIA measurements. METHODS: Male college students (n = 57) from Oklahoma State University-Stillwater were recruited through an email messaging campaign. The participants answered an online Qualtrics demographic survey; height (±0.1 cm), blood pressure, and weight were taken. The Seca Medical Body Composition Analyzer mBCA 514 was used to conduct the BIA. Variable mean, standard deviations, and frequencies were calculated using SPSS version 25. Pearson correlation analysis and regression analysis were conducted. Significance was set at

Fetal alcohol spectrum disorders (FASD) occur as a result of prenatal alcohol exposure and are commonly associated with intellectual disability. Maternal alcohol consumption affects fetal development resulting in numerous lifelong physical, mental, and neurobehavioral abnormalities. To promote prevention of prenatal alcohol exposure and intervention to mitigate alcohol’s postnatal effects, the Centers for Disease Control and Prevention (CDC) provides continuing education to healthcare providers through their FASD Regional Training Centers (RTCs). An online survey evaluated healthcare providers’ perceived competency after training. Cover letters with the survey link were electronically mailed to healthcare providers, who received training between 2002 and 2009 from the Midwest and Southeast RTCs. Eighty-two providers who treated women or children responded to the survey (7.5% response rate). Approximately 86% of providers who treated women have identified women ‘at risk’ for alcohol abuse with 90% indicating they would refer to Substance Abuse or Mental Health Services. However, over 25% perceived lack of training and limited time as barriers in treating women of childbearing age for at-risk drinking. Over 90% of providers who treated children reported feeling competent in recognizing FAS and other alcohol-related effects. Yet, only 23% of providers for children reported using FASD diagnostic schema and were more apt to use growth charts (70%) rather than lip philtrum guides (58%) or palpebral fissure length measurements (50%), tools typically used in FAS determination. These results suggest a need for training to focus on methodology that assists providers to easily incorporate screening, diagnostic, and treatment procedures into their daily practice.

Iodine deficiency is one of the major causes of brain damage in childhood. However, iodine supplementation during early pregnancy and lactation can prevent the ill effects of iodine deficiency. This study evaluated maternal and infant thyroid function and infant visual information processing (VIP) in the context of maternal iodine supplementation. A community-based, randomized, supplementation trial was conducted. Mother infant dyads (n = 106) were enrolled within the first 10 days after delivery to participate in this study. Mothers were randomly assigned either to receive a potassium iodide capsule (225 μg iodine) daily for 26 weeks or iodized salt weekly for 26 weeks. Maternal thyroxine (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH), thyroglobulin (Tg), urinary iodine concentration (UIC), breast milk iodine concentration (BMIC) and infant T4, TSH, UIC and VIP were measured as outcome variables. At baseline, neither mothers nor infants in the two groups were significantly different in any of the biomarkers or anthropometric measurements. Maternal TSH and goiter prevalence significantly decreased following iodine supplementation. The percentage of infants who preferentially remembered the familiar face was 26% in the capsule and 51% in the I-salt groups. Infant sex, length for age Z score, BMIC, maternal education and household food security were strong predictors of novelty quotient. In conclusion supplementation daily for six months with an iodine capsule or the use of appropriately iodized salt for an equivalent time was sufficient to reduce goiter and TSH in lactating women. Higher BMIC and LAZ as well as better household food security, maternal education, and male sex predicted higher novelty quotient scores in the VIP paradigm.

Several recent studies have supported relations between infant behaviour (alertness and responsiveness) and nutrition in addition to investigating infant behaviour within the context of changes in iron status over time. Existing research is typically limited to the investigation of the effects of a single vitamin or mineral, and no studies have been found that examined the influence that early alertness and responsiveness have on growth in early infancy, despite the fact that relations between behaviour and nutritional status may be bidirectional. The current study used a sample of Ethiopian infants and investigated anthropometrics, haemoglobin, the frequency of alertness and the frequency of responsiveness at 6 and 9 months of age. Six-month weight-for-age predicted 9-month frequency of alertness, while 6-month haemoglobin predicted 9-month frequency of responsiveness. Compared with responsive infants, non-responsive infants at 6 months remained more non-responsive at 9 months, although weight-for-age for both groups converged at 9 months. Results support relations between nutrition and behaviour (alertness and responsiveness) and provide evidence of a potentially useful tool (the Laboratory Temperament Assessment Battery) that was adapted to evaluate these relations in Ethiopia.

The purpose of this study was to assess the nutritional status and cognitive performance of women and their 5-year-old children using a cross-sectional design. Cognitive performance of mothers and children was assessed with Raven's Colored Progressive Matrices (CPM) and Kaufman Assessment Battery for Children-II (KABC-II). Demographic characteristics, food consumption patterns and anthropometry were also measured. Four rural districts in Sidama, southern Ethiopia served as the setting for this study. Subjects were one hundred women and their 5-year-old children. Mean ± standard deviation age of the mothers was 29 ± 6 years and family size was 7.0 ± 2.6. Maternal body mass index (BMI) ranged from 15.3 to 29.0 with 14% of the mothers having BMI < 18.5. Anthropometric assessment of children revealed 29% to be stunted (height-for-age z-score < -2) and 12% to be underweight (weight-for-age z-score < -2). Mothers' education significantly contributed to prediction of both mothers' and children's cognitive test scores. There were significant differences in mean cognitive test scores between stunted and non-stunted, and between underweight and normal-weight children. Height-for-age z-scores were correlated with scores for short-term memory (r = 0.42, P < 0.001), and visual processing (r = 0.42, P < 0.001) indices and weight-for-age z-scores were also correlated with scores of short-term memory (r = 0.41, P < 0.001) and visual processing (r = 0.43, P < 0.001) indices. Malnutrition in the community likely contributed to the cognitive performance of the subjects. Performance on memory and visual processing tasks was significantly lower in children with growth deficits suggesting that efficient and cost effective methods to alleviate malnutrition and food insecurity would impact not only child health but also cognitive function.

ObjectiveThe purpose of the study was to test the moderating influence of two risk factors, maternal depression and socio-economic status (SES), on the association between authoritarian and permissive parenting styles and child obesity.DesignCorrelational, cross-sectional study. Parenting style was measured with the Parenting Styles and Dimensions Questionnaire (PSDQ). Maternal depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D). BMI-for-age percentile was used to categorize children by weight status (children with BMI-for-age ≥95th percentile were classified as obese). SES was computed from parent education and occupational status using the four-factor Hollingshead index.SettingRural public schools in a mid-western state in the USA.SubjectsOne hundred and seventy-six mothers of first-grade children (ninety-one boys, eighty-five girls) enrolled in rural public schools.ResultsBoth maternal depression and SES were found to moderate the permissive parenting style/child obesity association, but not the authoritarian/child obesity association. For depressed mothers, but not for non-depressed mothers, more permissive parenting was predictive of child obesity. Similarly more permissive parenting was predictive of child obesity among higher SES mothers, but not for lower SES mothers.ConclusionsMaternal depression and SES interact with permissive parenting style to predict child obesity. Future research should examine the relationship among these variables using a longitudinal design.

In response to the increased incidence of child overweight, a school-based program, It's All About Kids, was designed by the Tulsa Health Department, Tulsa Public Schools, and community partners to improve food choices and increase physical activity of students in first through fifth grade. The nutrition component consisted of six weekly 30-minute experiential, age-appropriate classroom lessons, including healthful-eating food games, taste-testing foods, whole-grain bread baking, information on portion sizes, and food demonstrations. Documenting and evaluating school-based intervention programs is critical for setting evidence-based health policy, justifying funding, and achieving broader implementation of successful interventions. To evaluate the effectiveness of the It's All About Kids nutrition component in fourth-grade children, we conducted a controlled trial from 20 fourth-grade classes in five intervention and five comparison Title I public schools. Evaluation included 140 fourth-grade students, including 69 in the comparison group and 71 in the intervention group. Outcomes were measured by pre-, post-, and follow-up tests using a modified version of the Pathways Knowledge, Attitudes, and Behaviors questionnaire and the Child and Adolescent Trial of Cardiovascular Health (CATCH) Food Checklist. Data were analyzed using repeated measures analysis of variance over time controlling for sex, paired samples t tests, and independent samples t tests. Intervention students had significant improvements in knowledge of which food had more fat (P

Background As breastfeeding duration increases, it is important to understand diets of breastfeeding women and other factors salient to maternal/offspring health, including stress. It is important to further consider sociodemographic factors, given their associations with nutritional deficiencies and perceived stress. Objective We cross-sectionally compared breastfeeding women's dietary intakes from a food frequency questionnaire (assessing from pregnancy through 3 months postpartum) with Estimated Average Requirements (EARs). We hypothesized that dietary intake was related to sociodemographic variables and parenting stress. Design We examined a cohort of predominately breastfeeding women. Food frequency questionnaire results were compared with EARs, the Parenting Stress Index: Short Form, and a demographic questionnaire. Participants/setting Participants included 101 women (of 289 recruited) who breastfed singleton, full-term infants for the first 3 months while using Statistical analyses Mean and standard deviation or frequencies were reported. One-sample t tests compared EARs with mean dietary intakes over the past 12 months. Pearson correlations and one-way analyses of variance explored relationships among dietary, sociodemographic, and stress variables. Results Twenty-two percent of women did not meet EAR minimum energy recommendations and >40% did not meet protein recommendations. Despite widespread supplement use, some consumed less than the EAR for vitamin E (35%), calcium (22%), and vitamin C (19%). Carbohydrate consumption was positively related to the difficult child scale ( r =0.19; P =0.05). Dietary riboflavin ( r =–0.19; P =0.05) and vitamin D intake ( r =–0.19; P =0.05) were negatively related to the parent–child dysfunction scale. Conclusions Despite efforts to enhance education and counseling regarding adequate perinatal nutrition-related practices, even well-educated women may not meet EARs. This poor dietary intake may be associated with parenting stress and have potential long-term implications for child health.

To determine red blood cell (RBC) folate and serum vitamin B12 levels in children with sickle cell disease, SS-type, and to evaluate the associations of these nutrient levels with growth and hematologic parameters.Subjects enrolled in this prospective, cross-sectional study were recruited from one tertiary care setting. Complete blood counts, measurement of red blood cell (RBC) folate and serum vitamin B12, anthropometric measures (height, weight, skinfold measurements), pubertal status, and 24-hour dietary recalls were obtained from 70 patients ages 1 to 19 years.Low RBC folate levels were found in 15% of the children. Fifty-seven percent of the sample had inadequate dietary folate intake. Three percent of the children had low serum vitamin B12 levels. All children and adolescents sampled had adequate dietary intake of vitamin B12. Both RBC folate (P = 0.01) and serum vitamin B12 levels (P0.01) decreased with increasing age.More than half of the subjects had inadequate intake of folate from food, and despite daily folate supplementation, 15% had low RBC folate levels. Low serum vitamin B12 levels were rare, and dietary vitamin B12 intake was adequate. Additional research is needed to explore the effects of improved folate status, the need for folate supplementation, and the relationship of folate, vitamin B12, and homocysteine levels and the risk for vascular damage and stroke in children with sickle cell disease.

A randomized, prospective, family-centered study investigated the outcome of a telephone-based, nutrition intervention that provided monthly nutritional guidance and support to families of infants (N = 25) born at < 1750 g and evaluated the effects of the intervention on the stress level of the infants' mothers. Growth in length normalized at 1-year adjusted age (p = .08) after using regression modeling to control for the effects of broncho-pulmonary dysplasia. Maternal stress related to parental expectations was negatively correlated with the intervention (p = .027). Infants' 24-hour recall at 4 months was pooled, and the mean, which was 117 kcal/kg, was significantly above the Recommended Daily Allowance (RDA) for age (p = .008). Results suggest that interventions focusing on early catch-up growth and ensuring that preterm infants have an intake higher than the RDA for age in the first few months of life may normalize growth and developmental outcomes and decrease maternal stress.

The relation between zinc status and cognitive function was examined in a cross-sectional study in the Sidama area of Southern Ethiopia. Pregnant women >24 weeks of gestation from three adjacent rural villages volunteered to participate. Mean (s.d.) plasma zinc of 99 women was 6.97 (1.07) μmol/l (below the cutoff of 7.6 μmol/l indicative of zinc deficiency at this stage of gestation). The Raven’s Coloured Progressive Matrices (CPM) test was administered individually. Scores for the Raven’s scale A, which is the simplest scale, ranged from 4 to 10 of a possible 12. Women with plasma zinc 7.6 μmol/l. Plasma zinc and maternal age and education predicted 17% of the variation in Raven’s CPM scale A scores. We conclude that zinc deficiency is a major factor affecting cognition in these pregnant women.

More complex models than those currently available are needed to guide research about childhood obesity. This article presents an interpersonal and intra- personal risk model of child obesity, a transdisciplinary model of psychosocial risk factors that is based on work in developmental, family, and nutritional sciences. Two interpersonal realms of child development identified as being potentially significant for understanding the devel- opment and maintenance of overweight include the child's family and peer contexts. Child intrapersonal variables proposed as mediators between these contexts and weight outcomes include poor self-regulation and self-awareness, negative affect, and emotional or external eating. The article encourages developmental scientists to add their expertise to the study of childhood obesity by using models such as the one outlined here for the generation and testing of hypotheses so that future intervention efforts may be improved.

Purpose was to identify correlates of amount of formula fed to 9 mo infants who had been predominantly breastfed at 3 mo. Participants were 117 mothers and infants (68 female, 49 male) weighed and ...

The objective of this study was to conduct a preliminary investigation of lead, zinc, and iron levels in relation to child cognition and behavior in a small sample of Head Start children. The design was cross-sectional and correlational. Participants were 42 3- to 5-year-old children attending rural Head Start centers. Nonfasting blood samples of whole blood lead, plasma zinc, and ferritin were collected. Teachers rated children's behavior on the California Preschool Social Competency Scale, Howes' Sociability subscale, and the Preschool Behavior Questionnaire. Children were tested individually with the McCarthy Scales of Children's Abilities. Hierarchical regression analyses revealed that zinc and ferritin jointly explained 25% of the variance in McCarthy Scales of Children's Abilities verbal scores. Lead levels explained 25% of the variance in teacher ratings of girls' sociability and 20% of the variance in teacher ratings of girls' classroom competence. Zinc levels explained 39% of the variance in teacher ratings of boys' anxiety. Univariate analysis of variance revealed that the four children low in zinc and iron had significantly higher blood lead (median=0.23 micromol/L [4.73 microg/dL]) than the 31 children sufficient in zinc or iron (median=0.07 micromol/L [1.54 microg/dL]) or the 7 children sufficient in both (median=0.12 micromol/L [2.52 microg/dL]), suggesting an interaction among the three minerals. Within this small low-income sample, the results imply both separate and interacting effects of iron, zinc, and lead. They underscore the importance of studying these three minerals in larger samples of low-income preschool children to make more definitive conclusions.

To evaluate relations among measures of iron and zinc status, C-reactive protein (CRP), and leukocytes in low-income children participating in the Head Start program.Cross-sectional correlational study with samples collected at Head Start centers in May 2003.Forty-seven children (aged 3 to 5 years) attending Head Start centers in three rural communities.Zinc, ferritin, CRP, and complete blood count were analyzed in nonfasting blood samples.Correlations were computed among leukocyte levels, CRP levels, and measures of micronutrient status. Children having two abnormal measures (ie, leukocytes and CRP) were compared by univariate analysis of variance with children having zero or one abnormal measure.Most (72%) of the children had elevated CRP levels. Four percent were anemic (hemoglobin11.0 g/dL [110 g/L]); 11% had low iron stores (serum ferritinor=15 ng/mL [or=33.7 pmol/L]); and 77% had low iron stores when a reference value that accounts for the presence of infection was used (serum ferritinor=30 ng/mL [or=67.4 pmol/L]). Twenty-one percent had low plasma zinc levels. Children with two measures that indicated infection had higher serum ferritin and lower plasma zinc levels than children with zero or one indicator of infection.The link between measures of infection and serum ferritin levels suggests low-income preschool children with low iron stores are not identified by theor=15 ng/mL (or=33.7 pmol/L) criterion. The link between zinc and infection suggests possible overestimations of zinc deficiency in low-income children. Thus, in this population, the presence of infection (as indicated by CRP levels and leukocyte counts) should be determined to assess micronutrient status.

Objective To identify patterns of growth, nutrition practices, and feeding behaviors associated with normal Denver II developmental screening results at 18 months of age. Design A retrospective review of hospital medical charts was conducted to collect discharge diagnosis and dietary data. Developmental clinic charts were reviewed to collect growth and diet data, Denver II results, and medical data from 4-, 9-, and 18-month visits. Subjects/setting Twenty-eight children were identified from a review of developmental clinic records in a mid-western children's hospital. Criteria were single or twin birth, birth weight of 2,000g or less, follow up at the hospital developmental clinic, and completion of 3 screening visits. Statistical analyses performed National standards were used to calculate z scores. Patterns of growth were analyzed using analysis of variance. Stepwise forward linear regression analysis was done to construct a model predicting head circumference at 18 months of age. Results Significant catch-up growth ( P =.0006) occurred as length z score increased from −0.87 at 4 months of age to −0.45 at 18 months. A regression model predicting head circumference at age 18 months was developed that included nutrition and growth variables such as head circumference at 9 months, type of parenteral amino acids administered in the hospital, z score of weight at 4 months' adjusted age, and time of first enteral feeding. Applications Interventions designed to support breastfeeding in the hospital and at home are indicated as is increased emphasis on monitoring growth. Delays in growth need to be treated aggressively; for example, nutrition interventions should begin by the age of 4 months if weight gain is not appropriate. J Am Diet Assoc. 1999;99:1522–1526 .