Dipti Dev

Risk Factors for Overweight/Obesity in Preschool Children: An Ecological Approach

BACKGROUND Identification of risk factors is critical to preventing the childhood obesity epidemic. Risk factors that contribute to obesity are multifactorial. However, limited research has focused on identifying obesity risk factors using an ecological approach. METHODS Baseline self-report survey data from the STRONG Kids program were used. The sample consisted of 329 parent-child dyads recruited from childcare programs in east-central Illinois. Child height and weight were measured and converted to age- and sex-specific z-scores using standard growth charts. An ecological model provided the theoretical framework for the selection of 22 previously reported childhood obesity risk factors. Multiple logistic regression analyses were used to identify risk factors. RESULTS Of 22 potential risk factors, three were found to be significantly associated with child overweight/obesity. These included child nighttime sleep duration (χ(2)=8.56; p=0.003), parent BMI (χ(2)=5.62; p=0.01), and parental restrictive feeding for weight control (χ(2)=4.77; p=0.02). Children who slept for 8 hours and less were 2.2 times more likely to be overweight/obese [95% confidence interval (CI): 1.3-3.7), whereas children with an overweight/obese parent were 1.9 times more likely to be overweight/obese (95% CI: 1.12-3.2). Finally, children whose parents used restrictive feeding practices were 1.75 times more likely to be overweight/obese (95% CI: 1.06-2.9). CONCLUSIONS Using an ecological approach, we conclude that childhood obesity prevention efforts may benefit from targeting the key risk factors of child sleep duration, parent BMI, and parental restrictive feeding practices as focus areas for obesity prevention.

The relationship between physical activity and diet and young children's cognitive development: A systematic review

Objective Given the high prevalence of suboptimal nutrition and low activity levels in children, we systematically reviewed the literature on the relationship between physical activity and dietary patterns and cognitive development in early childhood (six months to five years). Methods In February 2016, we conducted two different searches of MEDLINE, PsycINFO, and ERIC. Each search included either physical activity (including gross motor skills) or diet terms, and neurocognitive development outcome terms. Included studies were in English, published since 2005, and of any study design in which the physical activity or diet measure occurred prior to age five. Results For physical activity, twelve studies (5 cross-sectional, 3 longitudinal and 4 experimental) were included. Eleven studies reported evidence suggesting that physical activity or gross motor skills are related to cognition or learning. Both acute bouts and longer term exposures showed benefit. For diet, eight studies were included consisting of secondary analyses from longitudinal cohort studies. A healthier dietary pattern was associated with better cognitive outcomes in all studies, although some of the reported associations were weak and the measures used varied across the studies. Conclusions Physical activity and healthy diets in early childhood are associated with better cognitive outcomes in young children. The paucity of literature and the variability in the type and quality of measures used highlight the need for more rigorous research. Given that the early childhood years are critical for both obesity prevention and neurocognitive development, evidence that the same healthy behaviors could promote both should inform future interventions.

Engaging Parents to Promote Children’s Nutrition and Health: Providers’ Barriers and Strategies in Head Start and Child Care Centers

Purpose: Using the Academy of Nutrition and Dietetics benchmarks as a framework, this study examined childcare providers’ (Head Start [HS], Child and Adult Care Food Program [CACFP] funded, and non-CACFP) perspectives regarding communicating with parents about nutrition to promote children’s health. Design: Qualitative. Setting: State-licensed center-based childcare programs. Participants: Full-time childcare providers (n = 18) caring for children 2 to 5 years old from varying childcare contexts (HS, CACFP funded, and non-CACFP), race, education, and years of experience. Methods: In-person interviews using semi-structured interview protocol until saturation were achieved. Thematic analysis was conducted. Results: Two overarching themes were barriers and strategies to communicate with parents about children’s nutrition. Barriers to communication included—(a) parents are too busy to talk with providers, (b) parents offer unhealthy foods, (c) parents prioritize talking about child food issues over nutrition, (d) providers are unsure of how to communicate about nutrition without offending parents, and (e) providers are concerned if parents are receptive to nutrition education materials. Strategies for communication included—(a) recognize the benefits of communicating with parents about nutrition to support child health, (b) build a partnership with parents through education, (c) leverage policy (federal and state) to communicate positively and avoid conflict, (d) implement center-level practices to reinforce policy, and (e) foster a respectful relationship between providers and parents. Conclusion: Policy and environmental changes were recommended for fostering a respectful relationship and building a bridge between providers and parents to improve communication about children’s nutrition and health.

Improving the Physical Activity and Outdoor Play Environment of Family Child Care Homes in Nebraska Through Go Nutrition and Physical Activity Self-Assessment for Child Care

BACKGROUND The purpose of this study was to determine if the Go Nutrition and Physical Activity Self-Assessment in Child Care (Go NAP SACC) intervention was effective in improving best practices in the areas of infant and child physical activity and outdoor play and learning in family child care homes (FCCHs) in Nebraska. METHODS FCCHs (n = 201) participated in a pre-post evaluation using the Infant and Child Physical Activity and Outdoor Play and Learning assessments from the Go NAP SACC validated measure to assess compliance with best practices. RESULTS At post, FCCHs demonstrated significant differences in 85% of the Infant and Child Physical Activity items (17 of 20) and 80% of the Outdoor Play and Learning items (12 of 15). Significant differences in best practices between urban and rural FCCH providers were also found. CONCLUSION Go NAP SACC appears to be an effective intervention in Nebraska as, after participation in the initiative, providers were improving child care physical activity best practices. Additional research is needed to objectively determine if these changes resulted in objective improvements in childrens physical activity levels. Further, efforts are needed to develop and/or identify geographic-specific resources for continued improvement.

Feasibility of Visual Estimation Using Digital Template Photos to Assess Children's Dietary Intake in Childcare Settings

intervention and noted its potential for designing precision interventions. For this purpose, psychosocial phenotyping must be scalable and identify mediators that can serve as intervention targets along with related moderators and behaviors. Mixed membership models, including Latent Dirichlet Allocation (LDA) and UPhenome, are machine-learning methods used for clinical phenotyping. Whereas LDA treats mediators, moderators, and behaviors as a single data type, UPhenome handles them separately, learning phenotypes that represent each equally. These data-driven models have not yet been applied in behavioral nutrition. Objective: We assessed the utility of LDA and UPhenome for automatic learning of psychosocial phenotypes from survey data. Study Design, Setting, Participants, Intervention: We extracted individual’s (n = 5,883) psychosocial characteristics from surveys collected during a cohort study of a predominantly Latino New York City community affected by high levels of chronic disease and health disparity. We conducted a secondary analysis of these data using UPhenome and LDA. Outcome Measures and Analysis: Participant responses were tokenized (n = 4,604) and used as input to LDA and UPhenome to identify phenotypes (k = 10). Domain experts (n = 4) assessed internal consistency among phenotypes resulting from LDA; a heatmap (n = 3,233) depicted dietary patterns for each phenotype. Results: Experts found within-phenotype consistency and between-phenotype discrimination. Differences in dietary patterns were visually detected. UPhenome identified more specific intervention targets than LDA. Conclusions and Implications: LDA and UPhenome can identify psychosocial phenotypes in a large cohort of Latino New Yorkers and could advance Precision Behavioral Nutrition. Future research will assess generalizability of psychosocial phenotypes and integrate psychosocial phenotyping into behavioral nutrition interventions. Funding: NIH Sackler Institute for Nutrition Science at the New York Academy of Sciences.

Predictors of Parent Engagement Based on Child Care Providers’ Perspectives

Objective: Determine the predictors of child care providers’ parent engagement regarding child nutrition in child care centers (CCCs) and family child care homes (FCCHs). Design: Cross‐sectional. Setting: Child care centers and FCCHs. Participants: Child care center directors (n = 337) and FCCH providers (n = 1,153) completed a self‐administered survey. Main Outcome Measures: Fifteen variables were examined as predictors for parent engagement: providers’ perceived barriers to communication, participation in Go Nutrition and Physical Self‐ Assessment in Child Care, National Association for the Education of Young Children accreditation, participation in Quality Ratings and Improvement Systems, feeding practices, and professional development. Analysis: Structural equation modeling examined the relation between variables for CCCs and for FCCHs. Results: For CCCs, NAEYC accreditation, providers’ perceived barriers regarding parents’ cultural beliefs about food, parents not liking the taste of healthy foods, and parents prioritizing other food‐related topics over healthy eating significantly predicted parent engagement. For FCCHs, participation in Go Nutrition and Physical Self‐ Assessment in Child Care, perceiving parents to be busy, not wanting to offend parents, and practicing family‐style dining were significantly related to parent engagement. For both CCCs and FCCHs, professional development regarding child nutrition was related to parent engagement. Conclusions and Implications: Focusing professional development on child care contexts and addressing providers’ perceived barriers may improve parent engagement.

Assessment of Nutrition Knowledge of Childcare Providers Regarding the Implementation of the 2017 CACFP Meal Pattern Update

ABSTRACT Background: With the release of 2017 Child and Adult Care Food Program (CACFP) meal pattern, states need to determine knowledge gaps in order to develop targeted training materials and resources to aid childcare providers in achieving new regulations. Purpose: To assess the nutrition knowledge of childcare providers in regards to the implementation of the 2017 CACFP meal pattern. Methods: Convenience sampling, where CACFP participants (n = 398) completed a self-reported survey at the annual mandatory trainings across the state of Nebraska, was employed in this study. Descriptive statistics including frequencies, means, standard deviations, independent sample t tests, and chi-square tests were used to determine differences in nutrition knowledge by geographical location, for-profit and nonprofit, and program settings. Results: Data obtained from this study indicate that CACFP participants scored low on questions regarding yogurt (30%), juice (35%), breakfast cereal (37%), and whole grain (43%) questions. Data also show that there was no significant difference in levels of knowledge among characteristics and demographics of programs, types of facilities, and geographic locations. Translation to Health Education Practice: The present study results underscore the importance for continued professional development for CACFP participating childcare providers to implement the new CACFP meal pattern for child nutrition standards.