Elizabeth Metallinos-Katsaras

The Association Between an Objective Measure of Physical Activity and Weight Status in Preschoolers

Objective: Our objective was to determine the association between physical activity and BMI among racially diverse low‐income preschoolers.

A Longitudinal Study of Food Insecurity on Obesity in Preschool Children

BACKGROUND Obesity and its co-occurrence with household food insecurity among low-income families is a public health concern, particularly because both are associated with later adverse health consequences. OBJECTIVE Our aim was to examine the relationship between household food insecurity with and without hunger in infancy and later childhood with weight status at 2 to 5 years. DESIGN This longitudinal study uses household food-security status, weight, and height data collected at the first infancy and last child (2 to 5 years) Special Supplemental Nutrition Program for Women, Infants, and Children visits. Household food security was based on parent/caretaker responses to a four-question subscale of the 18-item Core Food Security Module. Obesity was defined as sex-specific body mass index for age ≥ 95th percentile. PARTICIPANTS/SETTING A diverse (58.6% non-white) low-income sample of 28,353 children participating in the Massachusetts Special Supplemental Nutrition Program for Women, Infants, and Children (2001-2006); 24.9% of infants and 23.1% of children lived in food-insecure households and 17.1% were obese at their last child visit. STATISTICAL ANALYSIS Multivariate logistic regression analyses assessed the association between household food-security status during the infant and child visits, and risk of preschool obesity, while controlling for child race/Hispanic ethnicity, sex, child and household size, maternal age, education, and prepregnancy weight. Interactions between these covariates and household food-security status were also examined. In cases of multiple comparisons, a Bonferroni correction was applied. RESULTS Persistent household food insecurity without hunger was associated with 22% greater odds of child obesity (odds ratio=1.22; 95% CI 1.06 to 1.41) compared with those persistently food secure (P<0.05). Maternal prepregnancy weight status modified this association with children of underweight (adjusted odds ratio=3.22; 95% CI 1.70 to 6.11; P=0.003) or overweight/obese (adjusted odds ratio=1.34; 95% CI 1.11 to 1.62; P=0.03) mothers experiencing greater odds of child obesity with persistent household food insecurity without hunger compared with those with persistent household food security. CONCLUSIONS These results suggest that persistent household food insecurity without hunger is prospectively related to child obesity, but that these associations depend on maternal weight status. Vulnerable groups should be targeted for early interventions to prevent overweight and obesity later in life.

Food Insecurity Is Associated with Overweight in Children Younger than 5 Years of Age

Both household food insecurity and childhood overweight are serious public health problems that appear to be paradoxically correlated. This study examines the relationship between overweight and household food insecurity with/without hunger in low-income children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children. Weight, height, and household food insecurity data were collected on 8,493 children ages 1 month to 5 years and analyzed by sex and age groups using logistic regression to model the odds of being overweight (weight for length or body mass index [calculated as kg/m(2)] for age > or =95th percentile) given household food insecurity status, controlling for race/ethnicity and maternal education. Analyses were stratified by age and sex because interaction terms with household food insecurity were significant (P<0.10). In this sample, prevalence of household food insecurity was 30.7% (8.3% with hunger) and 18.4% were overweight. Among girls younger than 2 years of age, household food insecurity was associated with reduced odds of overweight compared with food-secure households (odds ratio=0.65; 95% confidence interval: 0.47 to 0.88); hunger status did not alter this association. Among 2- to 5-year-old girls, there was no overall significant association between household food insecurity and overweight; however, household food insecurity with hunger was positively associated with overweight compared with those from food-secure households (odds ratio=1.49; 95% confidence interval: 1.06 to 2.10). No association between household food insecurity and overweight was found among boys. These findings suggest an association between household food insecurity and overweight prevalence in this low-income population. However, sex and age appear to modify both the magnitude and direction of the association.

Obesity in preschool children is more prevalent and identified at a younger age when WHO growth charts are used compared with CDC charts.

Our objective was to compare the prevalence and determinants of child obesity using the WHO child growth standards compared with the CDC growth reference. We used data from 143,787 2- to 5-y olds who participated in the Massachusetts Special Supplemental Food and Nutrition Program for Women, Infants and Children (WIC) program between 2001 and 2006. The prevalence of obesity (>95th percentile, BMI-for-age) was 23.3% when we used the WHO standards vs. 16.9% using the CDC reference; for obesity plus overweight (>85th percentile), the prevalence was 42.2 vs. 33.8%, respectively. The difference between the prevalence estimates was greatest at 24-36 mo of age. Multivariate logistic regression analysis indicated that child obesity (based on the WHO standards) was more common in boys, Hispanics, children of less educated mothers, and those born to obese mothers. These results confirm that the prevalence of child obesity is higher according to the WHO standards and indicate that the WHO charts allow for a more timely detection of obesity in childhood.

Associations between family food behaviors, maternal depression, and child weight among low-income children☆

Although low-income children are at greater risk for overweight and obesity than their higher income counterparts, the majority of poor children are not overweight. The current study examined why such variation exists among diverse young children in poor families. Cross-sectional data were collected on 164 low-income, preschool aged children and their mothers living in two Rhode Island cities. Over half of the sample was Hispanic (55%). Mothers completed measures of family food behaviors and depression while trained assistants collected anthropometric data from children at seven day care centers and a Supplemental Nutrition Assistance Program outreach project. Multivariate analysis of covariance revealed that higher maternal depression scores were associated with lower scores on maternal presence when child eats (P < .05), maternal control of childs eating routines (P < .03), and food resource management skills (P < .01), and with higher scores on child control of snacking (P < .03) and negative mealtime practices (P < .05). Multiple regression results revealed that greater maternal presence whenever the child ate was significantly associated with lower child BMI z scores (β = .166, P < .05). Logistic regression analyses indicated that higher scores on food resource management skills reduced the odds of child overweight (odds ratios = .72-.95, P < .01). Maternal depression did not modify the relationship between family food behaviors and child weight. Overall, caregiver presence whenever a child eats, not just at meals, and better parental food resource management skills may promote healthier weights in low-income preschoolers. Further research is needed to identify the mechanisms that connect caregiver presence and food resource management skills to healthier weights for this age group.

Long-Term Developmental Consequences of Intrauterine and Postnatal Growth Retardation in Rural Guatemala

Knowledge on the developmental consequences of low birth weight (LBW) infants is derived primarily from research in developed countries such as the United States and Great Britain (Friedman & Sigman, 1981; Vietze & Vaughan, 1988). In that context it is now recognized that except for extreme cases, LBW is not a sufficient cause for developmental deviation. In fact, the final developmental outcome of LBW infants is often determined by the nature of the social environment to which the LBW child is exposed after birth rather than by the child’s intrauterine history (Hack & Breslau, 1988; Sameroff & Chandler, 1975; Werner & Smith, 1977). The social environment acts as either a buffer against the potential effects of the prenatal trauma or as a remedial agent that corrects a deviation that may be apparent in early life (Ricciuti, 1989).

Food- and Health-Related Correlates of Self-Reported Body Mass Index Among Low-Income Mothers of Young Children

OBJECTIVE To examine how income-related challenges regarding food and health are associated with variation in self-reported maternal body weight among low-income mothers. DESIGN Cross-sectional design. SETTING Two Northeastern cities. Seven day care centers and a Supplemental Nutrition Assistance Program outreach project. PARTICIPANTS Sample of 166 mothers; 67% were overweight or obese, 55% were Hispanic, and 42% reported household food insecurity (HFI). MAIN OUTCOME MEASURES Maternal self-reported height and weight to calculate body mass index (BMI). Independent variables were food program participation, supermarket use, 8-item food shopping practices scale, HFI, maternal depressive symptoms, and self-rated health. ANALYSIS Hierarchical multiple regression analysis tested relationships between maternal BMI with the independent variables of interest, adjusting for demographic confounds. RESULTS Shopping practices to stretch food dollars (P = .04), using community food assistance programs (P < .05), and HFI (P < .04) correlated with heavier maternal BMIs; higher self-rated health corresponded to lower BMIs (P = .004). CONCLUSIONS AND IMPLICATIONS Some strategies low-income mothers use to manage food resources are associated with heavier BMIs. Nutrition educators, public health practitioners, and researchers need to collaboratively address the associations between these strategies, food insecurity, poor health, and unhealthy weight.

Maternal Strategies to Access Food Differ by Food Security Status

BACKGROUND Household food insecurity is associated with health and behavior risk. Much less is known about how food insecurity is related to strategies that adults use in accessing food: how and where they shop, use of alternative food sources, and their ability to manage resources. OBJECTIVE To examine how maternal behaviors, including shopping, accessing alternative sources of food, and managing resources, are related to household food security status (HHFSS). DESIGN Cross-sectional study collecting survey data on HHFSS, shopping behaviors, use of alternative food sources, and managing resources obtained from low-income mothers of preschool-aged children. PARTICIPANTS One hundred sixty-four low-income mothers of young children (55% Hispanic) from two communities in Rhode Island. MEASURES HHFSS was measured using 10 items from the 18-item Core Food Security Module to assess adult food security. Mothers were surveyed about where, when, and how often they shopped; the strategies they use when shopping; their use of alternative sources of food, including federal, state, and local assistance; and their ability to manage their resources. STATISTICAL ANALYSIS Analysis of variance and χ2 analyses assessed the associations between demographic variables, shopping, accessing alternative food sources, and managing resources, and HHFSS. Multivariate logistic regression assessed the associations between HHFSS and maternal demographic variables, food shopping, strategies, alternative sources of food, and ability to manage resources. RESULTS Maternal age and language spoken at home were significantly associated with HHFSS; food insecurity was 10% more likely among older mothers (adjusted odds ratio [aOR] 1.10, 95% CI 1.03 to 1.17) and 2.5 times more likely among Spanish-speaking households (compared with non-Spanish speaking [aOR 3.57, 95% CI 1.25 to 10.18]). Food insecurity was more likely among mothers reporting more informal strategies (aOR 1.98, 95% CI 1.28 to 3.01; P<0.05) and perceiving greater inability to manage resources (aOR 1.60, 95% CI 1.30 to 1.98; P<0.05). CONCLUSIONS The results suggest that low-income mothers use a variety of strategies to feed their families and that the strategies they use vary by HHFSS. Community nutrition programs and providers will need to consider these strategies when counseling families at risk for food insecurity and provide guidance to minimize the influence on healthy food choices.

Members' Attitudes Toward Corporate Sponsorship of the Academy of Nutrition and Dietetics

Corporate sponsorship of the Academy of Nutrition and Dietetics has become commonplace; however, published reports on membership approval of sponsorship appear nonexistent. This study investigates attitudes of Academy members regarding corporate sponsorship. Participants included 2968 members of the Academy aged 18 and older. Thirty-two states and districts from 3 additional states sent the link to an anonymous, self-administered online survey to their members. The survey consisted of 33 items and was administered between January and March 2011. Results suggest that Academy members have strong opinions about corporate sponsorship and the Academy should be more selective as to which corporations should be allowed to sponsor the association.