Dietary quality and household food insecurity among Mexican children and adolescents

Seventy percent of Mexican households experience some level of food insecurity (FI). Studies have shown positive associations between FI and poor dietary quality. As far as it is known, this is the first time the Healthy Eating Index (HEI‐2010) has been used to assess dietary quality of children and adolescents in Mexico, and to examine if FI is related to it. The objective of this research is to assess dietary quality and its association with FI among Mexican children and adolescents from a nationally representative cross‐sectional sample. We analyzed data from 4635 2–19‐year‐old Mexican children and adolescents participating in the Mexican National Health and Nutrition Survey (Ensanut 2012). FI was measured using the Latin American and Caribbean Household Food Security Scale (ELCSA) and dietary quality with the HEI‐2010. We examined the association between FI and dietary quality using multivariate linear regressions. Dietary quality was worst as FI became more severe among children and adolescents compared with their counterparts living in households with food security. Specifically, FI had a negative association with fruits, vegetables, and protein foods, and a positive association with refined grains consumption. Dairy intake was negatively associated with FI among older children and adolescents. Added sugars were not associated with FI, but intake was excessive across the population at 15% of total daily energy intake. Decreasing FI may help improve dietary quality of Mexican children and adolescents.     

Maternal anxiety and depression,poverty and marital relationship factors during early childhood as predictors of anxiety and depressive symptoms in adolescence

BACKGROUND: This paper examines the degree to which symptoms of anxiety and depression at age 14 years are associated with early childhood experience of maternal anxiety and depression, poverty, and mother's marital relationship distress and break-up. METHODS: In a longitudinal study, 4434 families were followed-up from infancy to adolescence. RESULTS: Maternal anxiety and depression during early childhood were found to have small, but significant, influences upon the development of high anxiety-depression symptoms at age 14, after controlling for the effects of poverty and marital relationship factors. This effect was greater with repeated exposure to high maternal anxiety and depression. Poverty, distressed marital relationship and marital break-up during the child's first five years also produced small, but significant, increases in risk of high anxiety and depression symptoms in adolescence. Stable, single-parent status was not found to be a risk factor. There was no evidence of marked gender differences in risk factors, other than poverty, which had a stronger impact for girls than boys. CONCLUSIONS: Overall, the results suggest that maternal anxiety and depression, poverty, parent relationship conflict and marital break-up during early childhood are associated with small, but significant, increased risk of anxiety-depression symptoms in adolescence.     

Maternal diet during pregnancy and islet autoimmunity in offspring

Background:  Recent studies on the etiology of type 1 diabetes mellitus (T1DM) suggest that the components of the infant diet are associated with islet autoimmunity (IA), a precursor of T1DM. The role of prenatal nutritional exposures has not been thoroughly investigated.
Methods:  The Diabetes Autoimmunity Study in the Young has enrolled newborns from 1993 to 2004 at increased risk for T1DM based on human leukocyte antigen (HLA) genotype and family history of T1DM. The child is tested for islet autoantibodies at 9 and 15 months, 2 yr, and annually thereafter. We conducted a cohort study of 642 subjects for whom a Willett food frequency questionnaire for the mother's third trimester diet was completed. A case is defined as a subject who tests positive for islet autoantibodies at two consecutive blood draws and is still positive (or diabetic) at last follow-up (n = 27).
Maternal consumption frequencies of potatoes, other root vegetables, gluten-containing foods, non-gluten cereal grains, cow's milk and cow's milk products, fruits, vegetables, meat and poultry, and fish were analyzed in a survival analysis.
Results:  Adjusting for breast-feeding duration, age at first cereal introduction, ethnicity, HLA genotype, family history of T1DM, and total caloric intake, higher maternal intake of potatoes (hazard ratio for one standard deviation difference: 0.49, 95% confidence interval: 0.28–0.86) was associated with a delayed time to IA onset. No other food groups ingested during pregnancy were associated with IA in the child.
Conclusions:  The composition of the maternal diet during pregnancy may play a role in the offspring's risk of development of IA and potentially T1DM.     

Fatty acids in serum and diet – a canonical correlation analysis among toddlers

Fatty acid concentrations in blood are potential biomarkers of dietary fat intake, but methodological studies among children are scarce. The large number of fatty acids and their complex interrelationships pose a special challenge in research on fatty acids. Our target was to assess the interrelationships between the total fatty acid profiles in diet and serum of young children. The study subjects were healthy control children from the birth cohort of the Type 1 Diabetes Prediction and Prevention Study. A 3‐day food record and a frozen serum sample were available from 135 children at the age of 1 year, from 133 at 2 years, and from 92 at 3 years. The relationship between dietary and serum fatty acid profiles was analysed using canonical correlation analysis. The consumption of fatty milk correlated positively with serum fatty acids, pentadecanoic acid, palmitic acid and conjugated linoleic acid (CLA) at all ages. Correlations between dietary and serum eicosapentaenoic and/or docosahexaenoic acid were observed at 2 and 3 years of age. Serum linoleic acid was positively associated with the consumption of infant formula at the age of 1 year, and with the consumption of vegetable margarine at 2 and 3 years. The results indicate a high quality of the 3‐day food records kept by parents and other caretakers of the children, and suitability of non‐fasting, un‐fractioned serum samples for total fatty acid analyses. The correlation between intake of milk fat and serum proportion of CLA is a novel finding.     

Dietary patterns and diet quality during pregnancy and low birthweight: The PRINCESA cohort

Although the isolated effects of several specific nutrients have been examined, little is known about the relationship between overall maternal diet during pregnancy and fetal development and growth. This study evaluates the association between maternal diet and low birthweight (LBW) in 660 pregnant women from the Pregnancy Research on Inflammation, Nutrition,& City Environment: Systematic Analyses (PRINCESA) cohort in Mexico City. Using prior day dietary intake reported at multiple prenatal visits, diet was assessed prospectively using a priori (Maternal Diet Quality Score [MDQS]) and a posteriori (dietary patterns extracted by factor analysis) approaches. The association between maternal diet and LBW was investigated by logistic regression, controlling for confounders. Adherence to recommended guidelines (higher MDQS) was associated with a reduced risk of LBW (OR, 0.22; 95% confidence interval [0.06, 0.75], P < .05, N = 49) compared with the lowest adherence category (reference group), controlling for maternal age, education, height, marital status, pre‐pregnancy body mass index, parity, energy intake, gestational weight gain, and preterm versus term birth; a posteriori dietary patterns were not associated with LBW risk. Higher adherence to MDQS was associated with a lower risk of having an LBW baby in this sample. Our results support the role of advocating a healthy overall diet, versus individual foods or nutrients, in preventing LBW.     

Vitamin D deficiency among healthy infants and toddlers: A prospective study from Irbid,Jordan

Background: The aim of this study was to estimate the prevalence of vitamin D deficiency among healthy infants and toddlers, as well as its associated factors, in Irbid, Jordan. Methods: A total of 275 subjects (136 infants and 139 toddlers) aged 6–36 months participated in this study. Information concerning sociodemographic characterastics and early feeding patterns was collected using a self‐guided questionnaire. Plasma vitamin D, calcium, phosphorous, and alkaline phosphatase activity were measured. Results: The prevalence of vitamin D deficiency was 28% (16.7% for severe vitamin D deficiency and 11.3% for vitamin D deficiency) and vitamin D insufficiency was 28.4%. Plasma calcium and alkaline phosphatase levels showed no correlation with the vitamin D status of the study population. For both age groups, a significant association was found between vitamin D status and sun exposure (P < 0.001). A significant association between infant feeding practices and vitamin D status was found (P < 0.001). Infants who were exclusively breast‐fed had higher risk for vitamin D deficiency and vitamin D insufficiency than those who were bottle‐fed. Multivariate logistic regression analyses results showed that female sex, low sun exposure and exclusive breast‐feeding were the main determents of vitamin D levels. Conclusion: The prevalence of vitamin D deficiency is considered to be high among northern Jordanian infants and toddlers. Sun exposure of less than 30 min daily and exclusively breast‐feeding are the main factors for developing vitamin D deficiency.     

Food choices made by low‐income households when feeding their pre‐school children: a qualitative study

The growing concern about poor dietary practices among low‐income families has led to a ‘victim blaming’ culture that excludes wider social and environmental factors, which influence household food choices. This small‐scale qualitative study investigated influences on the diets of young children in families on a low income in the West Midlands, UK. Using semi‐structured interview schedule, rich data was gathered through individual interviews with 11 mothers of pre‐school children. Information was collected about the type and range of food given following the introduction of solid foods including factors influencing parent's knowledge and diet, sources of nutrition advice and financial constraints. Food accessibility and storage issues were also explored. Interviews were audio‐recorded, transcribed and analysed using a modified grounded theory approach. Findings highlighted that parents and professionals may have different interpretations about ‘cooking from scratch’. The results indicated that some parents have poor understanding of what constitutes a healthy diet. However, most parents included fruit and vegetables to varying degrees and were motivated to give their children healthy foods, suggesting that, with adequate support and information, the diets of these children could be improved. There was evidence that when striving to improve the diet of their children, many parents' diets also improved. The findings from this small‐scale in‐depth study highlighted a number of issues for local and national policy and practice in the area of nutrition and child health in the early years.     

Maternal childrearing anxiety reflects childrearing burden and quality of life

Background: The government of Japan has recently initiated public programs to allay maternal childrearing anxiety. The aim of the present study was to determine the prevalence of childrearing anxiety and describe its relationships with perceived childrearing burden and maternal quality of life (QOL). Methods: A secondary analysis was done of survey data from 1229 mothers enrolled in the Seiiku Birth Cohort Study at the National Center for Child Health and Development between November 2003 and December 2006. Childrearing anxiety was determined by asking mothers, at infant age 3 months, ‘Regarding childrearing, do you have any anxiety or worry?’. Childrearing burden was assessed in specific categories such as physical fatigue, household expenses, and personal time. The validated Japanese translation of the WHOQOL‐BREF instrument was used to measure Maternal QOL. Results: Sixty‐four percent of mothers reported some and 9% much childrearing anxiety. In total, 73% percent of mothers reported any childrearing anxiety. As childrearing anxiety increased from ‘none’ to ‘some’ and ‘much’, the proportion of mothers who reported any childrearing burden increased from 75% to 99% (P < 0.001). QOL scores in each of four domains (physical, psychological, social relationships, and environment) decreased with increasing level of anxiety (P < 0.001). Primiparity, pregnant with more than a singleton and admission to the neonatal intensive care unit were associated with greater anxiety. Conclusions: The strong associations between childrearing anxiety and childrearing burden, and between childrearing anxiety and maternal QOL, suggest that childrearing anxiety is an empirically credible and measurable phenomenon.     

Maternal psychosocial factors around delivery,and the behavior of 2‐year‐old children

Background: The objectives of the present study were to explore whether maternal psychosocial factors, mental health and work stress around delivery, are related to the behavior of 2‐year‐old children. Methods: In a prospective cohort study design, pregnant women attending the National Taiwan University Hospital for delivery and post‐partum care from April 2004 to January 2005 were recruited and their children were observed at 24 months. A total of 186 mother–term‐born child dyads completed the measurement. The five‐item Mental Health Index (MHI‐5) self‐report data of maternal psychosocial factors were selected from the Taiwanese version of the short form 36 (SF‐36). The Child Behavior Checklist for age 1½–5 (CBCL/1½‐5) was completed by the parents when the child was 2 years old. Results: The mean score of mental health around delivery was 68.11. The proportion of mothers with work stress seldom and always was 61.8% and 24.7%, respectively. The mean of the total CBCL score, and internalizing, externalizing behavior and sleep problems scores was 45.95, 11.89, 15.59 and 4.23, respectively. After adjusting for the potential confounders, maternal work stress around delivery was found to have a significant effect on the total CBCL and externalizing, attention and aggressive, behavioral problems of 2‐year old children. Maternal mental health around delivery, however, did not show significant effects on child behavior. Conclusions: Work stress around delivery seems to aggravate children's externalizing behavior problems at 2 years old. It is therefore important to improve the psychosocial health and reduce the stress of pregnant women.     

Prospective associations of breastfeeding and smoking cessation among low‐income pregnant women

Although low‐income pregnant women have high rates of smoking and low rates of breastfeeding, few studies have examined prospective associations between these risk factors in community samples. Doing so may help improve breast‐feeding support programs in this population. We used a secondary analysis of 247 low‐income pregnant smokers in Memphis, Tennessee, who were interviewed up to 4 times (twice during pregnancy and twice through 6 months postpartum). Smoking cessation during prepartum and postpartum was defined as a self‐report of not smoking for ≥1 week and an expired carbon monoxide level of <10 ppm. Multivariable logistic regression analyses were used to determine whether intent to breastfeed was associated with smoking cessation and whether smoking cessation was associated with actual breastfeeding. Models were adjusted for sociodemographic, pregnancy‐related, and smoking‐related confounders. Thirty‐nine percent of participants intended to breastfeed, and 38% did so. Women who intended to breastfeed were 2 times more likely to quit smoking prepartum (adjusted OR = 1.99, 95% CI [1.06, 3.74]), but not postpartum (adjusted OR = 1.27, 95% CI [0.57, 2.84]). Quitting smoking at baseline and during pregnancy was associated with subsequent breastfeeding (adjusted OR 2.27, 95% CI [1.05, 4.94] and adjusted OR = 2.49, 95% CI [1.21, 5.11]). Low‐income women who intended to breastfeed were more likely to quit smoking during pregnancy and those who quit smoking at baseline and prepartum were more likely to breastfeed. Simultaneously supporting breastfeeding and smoking cessation may be very useful to change these important health behaviours among this high‐risk population.     

Acculturative type is associated with breastfeeding duration among low‐income Latinas

We sought to assess the relationship between acculturative type and breastfeeding outcomes among low‐income Latinas, utilising a multidimensional assessment of acculturation. We analysed data derived from a breastfeeding peer counselling randomised trial. Acculturation was assessed during pregnancy using a modified Acculturation Rating Scale for Mexican Americans scale. Analyses were restricted to Latinas who completed the acculturation scale and had post‐partum breastfeeding data (n = 114). Cox survival analyses were conducted to evaluate differences in breastfeeding continuation and exclusivity by acculturative type. Participants were classified as integrated‐high (23.7%, n = 27), traditional Hispanic (36.8%, n = 42), integrated‐low (12.3%, n = 14) and assimilated (27.2%, n = 31). The integrated‐low group was significantly more likely to continue breastfeeding than the traditional Hispanic, assimilated, and integrated‐high groups (P < 0.05, P < 0.05, and P < 0.01, respectively). The traditional Hispanic group was marginally more likely to continue breastfeeding than the integrated‐high group (P = 0.06). Breastfeeding continuation rates vary significantly between acculturative types in this multinational, low‐income Latina sample. Multidimensional assessments of acculturation may prove useful in better tailoring future breastfeeding promotion interventions.     

Maternal folic acid supplementation and infant birthweight in low‐ and middle‐income countries: A systematic review

The relationship between maternal folic acid supplementation in pregnancy and infant birthweight has not been well described in low‐ and middle‐income countries. We conducted a systematic review and meta‐analysis of the current evidence of the association between folic acid supplementation in pregnancy on three primary outcomes: the incidence of low birthweight, small for gestational age, and mean birthweight. Seventeen studies were identified, which satisfied the inclusion criteria, covering a total of 275,421 women from 13 cohort studies and four randomized controlled trials. For the primary outcome of mean birthweight (n = 9), the pooled mean difference between folic acid and control groups was 0.37 kg (95% confidence interval [CI]: 0.24 to 0.50), and this effect was larger in the randomized controlled trials (0.56, 95% CI: 0.15 to 0.97, n = 3). The pooled odds ratio was 0.59 for low birthweight (95% CI: 0.47 to 0.74, n = 10) among folic acid supplementation versus control. The pooled odds ratio for the association with small for gestational age was 0.63 (95% CI: 0.39 to 1.01, n = 5). Maternal folic acid supplementation in low‐ and middle‐income countries was associated with an increased mean birthweight of infants and decreases in the incidence of low birthweight and small for gestational age.     

Impact of extremely low‐birth‐weight status on risk and resilience for depression and anxiety in adulthood

Background

Preterm birth is associated with an increased risk of depression and anxiety, but it is not known if this is due to greater exposure to risk, or if perinatal adversity amplifies the impact of traditional risk factors. This study sought to determine if exposure to perinatal adversity modifies associations between traditional risk and resilience factors and depression and anxiety in adulthood.

Methods

A sample of 142 extremely low‐birth‐weight (ELBW < 1,000 g) survivors and 133 sociodemographically matched normal birth weight (NBW) control participants was followed longitudinally to 22–26 years of age. Separate postnatal risk and resilience scales were created using eight risk and seven resilience factors, respectively. Depression and anxiety were assessed using the internalizing scale of the Young Adult Self‐Report (YASR). This scale was also dichotomized at the 90th percentile to define clinically significant psychopathology.

Results

While the average number of risk exposures did not differ between groups, ELBW survivors were more susceptible to risk than NBW control participants. For the ELBW group, each additional risk factor resulted in a 2‐point increase in internalizing scores, and two and a half times the odds of clinically significant internalizing symptoms (OR = 2.47, 95% CI = 1.63, 3.76). The protective effect of resiliency factors was also blunted among ELBW survivors.

Conclusions

Extremely low‐birth‐weight survivors may be more sensitive to traditional risk factors for psychopathology and less protected by resiliency factors. Intervention strategies aimed at preventing or reducing exposure to traditional childhood risk factors for psychopathology may reduce the burden of mental illness in adult survivors of prematurity.     

Maternal folate,one‐carbon metabolism and pregnancy outcomes

Single nucleotide polymorphisms and pre‐ and peri‐conception folic acid (FA) supplementation and dietary data were used to identify one‐carbon metabolic factors associated with pregnancy outcomes in 3196 nulliparous women. In 325 participants, we also measured circulating folate, vitamin B12 and homocysteine. Pregnancy outcomes included preeclampsia (PE), gestational hypertension (GHT), small for gestational age (SGA), spontaneous preterm birth (sPTB) and gestational diabetes mellitus (GDM). Study findings show that maternal genotype MTHFR A1298C(CC) was associated with increased risk for PE, whereas TCN2 C766G(GG) had a reduced risk for sPTB. Paternal MTHFR A1298C(CC) and MTHFD1 G1958A(AA) genotypes were associated with reduced risk for sPTB, whereas MTHFR C677T(CT) genotype had an increased risk for GHT. FA supplementation was associated with higher serum folate and vitamin B12 concentrations, reduced uterine artery resistance index and increased birth weight. Women who supplemented with <800 μg daily FA at 15‐week gestation had a higher incidence of PE (10.3%) compared with women who did not supplement (6.1%) or who supplemented with ≥800 μg (5.4%) (P < .0001). Higher serum folate levels were found in women who later developed GDM compared with women with uncomplicated pregnancies (Mean ± SD: 37.6 ± 8 nmol L⁻¹ vs. 31.9 ± 11.2, P = .007). Fast food consumption was associated with increased risk for developing GDM, whereas low consumption of green leafy vegetables and fruit were independent risk factors for SGA and GDM and sPTB and SGA, respectively. In conclusion, maternal and paternal genotypes, together with maternal circulating folate and homocysteine concentrations, and pre‐ and early‐pregnancy dietary factors, are independent risk factors for pregnancy complications.     

Cluster‐randomized trial on complementary and responsive feeding education to caregivers found improved dietary intake,growth and development among rural Indian toddlers

Inadequate feeding and care may contribute to high rates of stunting and underweight among children in rural families in India. This cluster‐randomized trial tested the hypothesis that teaching caregivers appropriate complementary feeding and strategies for how to feed and play responsively through home‐visits would increase children's dietary intake, growth and development compared with home‐visit‐complementary feeding education alone or routine care. Sixty villages in Andhra Pradesh were randomized into three groups of 20 villages with 200 mother–infant dyads in each group. The control group (CG) received routine Integrated Child Development Services (ICDS); the complementary feeding group (CFG) received the ICDS plus the World Health Organization recommendations on breastfeeding and complementary foods; and the responsive complementary feeding and play group (RCF&PG) received the same intervention as the CFG plus skills for responsive feeding and psychosocial stimulation. Both intervention groups received bi‐weekly visits by trained village women. The groups did not differ at 3 months on socioeconomic status, maternal and child nutritional indices, and maternal depression. After controlling for potential confounding factors using the mixed models approach, the 12‐month intervention to the CFG and RCF&PG significantly (P < 0.05) increased median intakes of energy, protein, Vitamin A, calcium (CFG), iron and zinc, reduced stunting [0.19, confidence interval (CI): 0.0–0.4] in the CFG (but not RCF&PG) and increased (P < 0.01) Bayley Mental Development scores (mean = 3.1, CI: 0.8–5.3) in the RCF&PG (but not CFG) compared with CG. Community‐based educational interventions can improve dietary intake, length (CFG) and mental development (RCF&PG) for children under 2 years in food‐secure rural Indian families.