Janis Randall Simpson

Parenting stress: a cross-sectional analysis of associations with childhood obesity, physical activity, and TV viewing

BackgroundParents influence their children’s obesity risk through feeding behaviours and modeling of weight-related behaviours. Little is known about how the general home environment, including parental stress, may influence children’s weight. The objective of this study was to explore the association between parenting stress and child body mass index (BMI) as well as obesity risk factors, physical activity and television (TV) viewing.MethodsWe used cross-sectional data from 110 parent–child dyads participating in a community-based parenting intervention. Child heights and weights were measured by trained research assistants. Parents (93% mothers) reported level of parenting stress via the Parenting Stress Index- Short Form (PSI-3-SF) as well as children’s activity behaviours and TV viewing. This was an ethnically diverse (55% Hispanic/Latino, 22% Black), low-income (64% earning < 

Zinc Supplementation Does Not Alter Sensitive Biomarkers of Copper Status in Healthy Boys

45,000/year) sample.ResultsLevel of parenting stress was not associated with children’s risk of being overweight/obese. Children with highly stressed parents were less likely to meet physical activity guidelines on weekdays than children with normally stressed parents (OR = 0.33, 95% CI, 0.12-0.95). Parents experiencing high stress were less likely to set limits on the amount of TV their children watched (OR = 0.32, 95% CI, 0.11, 0.93).ConclusionResults suggest stress specific to parenting may not be associated with increased obesity risk among children. However, future interventions may need to address stress as a possible underlying factor associated with unhealthful behaviours among preschoolers.

Dietary and Total Calcium Intakes Are Associated with Lower Percentage Total Body and Truncal Fat in Young, Healthy Adults

The tolerable upper intake levels (UL) for zinc for children were based on limited data and there is concern that the UL may be set too low. The first effect of excessive zinc intake is a reduction in copper status. The primary objective of this study was to examine the effect of zinc supplementation on copper status in children. Healthy, 6- to 8-y-old boys from Ontario, Canada were assigned to take a placebo (n = 10) or 5 mg (n = 10), 10 mg (n = 9), or 15 mg (n = 8) of zinc supplement daily for 4 mo in a double-blinded, placebo-controlled, randomized trial. Biochemical measures were evaluated at baseline and after 2 and 4 mo of supplementation. Food records were completed near the baseline and 4-mo visits. Age and anthropometric measurements did not differ (P > 0.05) between treatment groups at baseline. Mean zinc intakes from food alone (10.9-14.8 mg zinc/d) approached or exceeded the UL of 12 mg/d. Compared with the placebo group, the zinc groups had a greater change in the urine zinc:creatinine ratio at 4 mo (P = 0.02). Traditional (plasma copper and ceruloplasmin activity) and more sensitive biomarkers of copper status, including erythrocyte SOD1 activity and the erythrocyte CCS:SOD1 protein ratio, were unchanged in zinc-supplemented boys, demonstrating that copper status was not depressed. Serum lipid measures and hemoglobin concentrations were also unaffected and gastrointestinal symptoms were not reported. These data provide evidence in support of the need for reexamining the current UL for zinc for children.

Zinc-Fortified Foods Do Not Improve Intake of Total Dietary Zinc for Ontario Preschoolers

Objective: To investigate the relationship between different sources of calcium intake (dairy [milk products only], dietary [all dietary sources including dairy], nondairy dietary [all dietary sources excluding dairy], and total [dietary + supplemental]) and fat mass in young adults. Methods: One hundred ninety-seven healthy Caucasian men and women aged 18 to 28 years from southwestern Ontario underwent whole-body dual-energy x-ray absorptiometry to determine total body fat mass (%FM) and truncal fat (%TF). Calcium intakes, determined using a food frequency questionnaire, were divided into quartiles for each of dairy, dietary, nondairy dietary, and total sources. Physical activity scores were collected on a subset of subjects (n = 167). Mean %FM and %TF were compared between the lowest (Q1) and highest (Q4) quartiles of calcium consumers for each calcium source. Calcium intakes between subjects with %FM ≥50th and <50th percentile were also compared. Results: Mean calcium intakes were as follows: 568 mg/d dairy calcium, 312 mg/d nondairy dietary calcium, 881 mg/d dietary calcium, 68 mg/d supplemental calcium, and 948 mg/d total calcium. %FM was 3.9%–4.9% lower and %TF was 4.1%–5.0% lower (all P ≤ 0.05) for subjects in Q4 vs Q1, regardless of calcium source (dairy, dietary, and total). When adjusted for physical activity, lower %FM and %TF persisted (P ≤ 0.05) for subjects in Q4 (1113–1595 mg/d mean dietary and total calcium intakes) vs Q1 (116–393 mg/d mean dietary and total calcium intakes). Calcium intakes from dairy, dietary, and total sources for subjects with a %FM ≥50th percentile were significantly lower (all P ≤ 0.05); when adjusted for physical activity, dietary (P = 0.025) and total (P = 0.060) calcium intakes remained lower. Implications and Conclusions: Our findings support a relationship, even after adjusting for physical activity, between higher dietary and total calcium intakes and lower total body and truncal fat in young adults. Results suggest an intake of approximately 1500 mg/d calcium could aid in the management of body and truncal fat. We recommend that young adults be encouraged to increase their total calcium intakes to at least the recommended daily allowance of 1000 mg/d for reasons extending beyond bone health.

Interventions for prevention of childhood obesity in primary care: a qualitative study

Objective: To examine if zinc food fortification makes a significant contribution to dietary zinc intake and to describe zinc-fortified food usage, amongst Canadian preschoolers. Methods: Cross-sectional data were used from the NutriSTEP™ validation project for which preschoolers (3–5 years) from across Ontario were recruited using convenience sampling. Three-day food records were used to estimate mean daily zinc intake and children were stratified by age group for analysis. Comparisons were then made to the Dietary Reference Intakes, whilst accounting for zinc from zinc-fortified foods and supplements and also whilst excluding zinc from zinc-fortified foods, to determine the prevalence of inadequate (< Estimated AverageRequirement (EAR)) and excessive (> Tolerable Upper Intake Level (TUL)) zinc intakes. The contributions (%) made to total zinc intake by zinc-fortified foods, unfortified foods and zinc-containing supplements were determined as were contributions made to zinc intake by zinc-fortified foods, categorized by fortified-food type. Results: Fewer than a third (30%, n = 76) of participants ate zinc-fortified foods and only 3% (n = 7) used a zinc-containing supplement. Including the contribution from zinc-fortified foods, 25% (n = 32) of 3-year-olds (n = 128) had mean zinc intake (range 7.0–7.6 mg/day) marginally above the TUL (7 mg/day). Zinc-fortified foods contributed only 2.3 ± 5.8% (mean% ± SD) to total zinc intake. The mean intake of the 25% of 3-year-olds above the TUL is attributed to their higher mean energy and protein intakes (p < 0.001) as compared to 3-year-olds not consuming zinc at levels above the TUL. Even excluding zinc-fortified foods, the prevalence of inadequate zinc intakes (<EAR) (n = 254) was zero. Fortified breakfast cereals contributed most (77 ± 41%) (mean% ± SD) to zinc intake derived from zinc-fortified foods. Conclusions: Overall, zinc-fortified foods and supplements contributed minimally to the total dietary zinc intake amongst these preschoolers. These children did not have inadequate intakes of zinc and intakes in excess of the TUL were only evident in the youngest age group. Food fortification and parental choice to use a multivitamin-mineral supplement did not appear to play a role in either preventing inadequate or causing excessive zinc intake.

Vitamin D Intake Among Young Canadian Adults: Validation of a Mobile Vitamin D Calculator App

BACKGROUND Preventing childhood obesity is a public health priority, and primary care is an important setting for early intervention. Authors of a recent national guideline have identified a need for effective primary care interventions for obesity prevention and that parent perspectives on interventions are notably absent from the literature. Our objective was to determine the perspectives of primary care clinicians and parents of children 2-5 years of age on the implementation of an obesity prevention intervention within team-based primary care to inform intervention implementation. METHODS We conducted focus groups with interprofessional primary care clinicians (n = 40) and interviews with parents (n = 26). Participants were asked about facilitators and barriers to, and recommendations for implementing a prevention program in primary care. Data were recorded and transcribed, and we used directed content analysis to identify major themes. RESULTS Barriers existed to addressing obesity-related behaviours in this age group and included a gap in well-child primary care between ages 18 months and 4-5 years, lack of time and sensitivity of the topic. Trust and existing relationships with primary care clinicians were facilitators to program implementation. Offering separate programs for parents and children, and addressing both general parenting topics and obesity-related behaviours were identified as desirable. INTERPRETATION Despite barriers to addressing obesity-related behaviours within well-child primary care, both clinicians and parents expressed interest in interventions in primary care settings. Next steps should include pilot studies to identify feasible strategies for intervention implementation.

Folic acid food fortification prevents inadequate folate intake among preschoolers from Ontario

OBJECTIVE To establish the validity and reproducibility of the dietary component of a mobile vitamin D calculator app. METHODS Participants entered their dietary intake into the Vitamin D Calculator app on 3 recording days over 1 month and underwent subsequent 24-hour dietary recalls. RESULTS There were 50 adults (25 female), aged 18-25 years (mean, 22 ± 2 years). Paired-samples t tests tested for significant differences (P < .05) in mean vitamin D and calcium intake between the app and dietary recalls; Bland-Altman plots assessed agreement between the 2 measures. Intra-class correlations and Wilcoxon signed-rank tests assessed reproducibility of intakes estimated by the app. Mean vitamin D (n = 50) and calcium (n = 48) intakes and risk classifications did not differ significantly between the 2 measures (P > .05). CONCLUSIONS AND IMPLICATIONS The Vitamin D Calculator app is a valid classification measure for dietary vitamin D and calcium intake. This tool could be used by the general public to increase awareness and intake of these nutrients.

Predictors of bone mineral density in a convenience sample of young Caucasian adults living in southern Ontario

OBJECTIVE Folic acid food fortification has successfully reduced neural tube defect-affected pregnancies across Canada. The effect of this uncontrolled public health intervention on folate intake among Canadian children is, however, unknown. Our objectives were to determine folic acid intake from food fortification and whether fortification promoted adequate folate intakes, and to describe folic acid-fortified food usage among Ontario preschoolers. DESIGN Cross-sectional data were used from the NutriSTEP validation project with preschoolers recruited using convenience sampling. Mean daily total folate and folic acid intakes were estimated from 3 d food records, which included multivitamin supplement use. Comparisons were made to Dietary Reference Intakes, accounting for and excluding fortificant folic acid, to determine the prevalence of inadequate and excessive intakes. SETTING Canada. SUBJECTS Two hundred and fifty-four preschoolers (aged 3-5 years). RESULTS All participants (130 girls, 124 boys) ate folic acid-fortified foods and 30% (n 76) used folic acid-containing supplements. Mean (SE) fortificant folic acid intake was 83 (2) microg/d, which contributed 30% and 50% to total folate intake for supplement users and non-users, respectively. The prevalence of total folate intakes below the Estimated Average Requirement was <1%; however, excluding fortificant folic acid, the prevalence was 32%, 54% and 47% for 3-, 4- and 5-year-olds, respectively. The overall prevalence of folic acid (fortificant and supplemental) intakes above the Tolerable Upper Intake Level was 2% (7% among supplement users). CONCLUSIONS Folic acid food fortification promotes dietary folate adequacy and did not appear to result in excessive folic acid intake unless folic acid-containing supplements were consumed.

The impact of an integrated community-based micronutrient and health programme on stunting in Malawian preschool children

Osteoporosis is a major public health concern in Canada and worldwide. Although much is known about bone health in older adults, little is known about bone health in young, healthy Canadian men and women. The objectives of this research were to describe bone mineral density (BMD) of young, healthy adults living in southern Ontario, Canada, and to identify predictors of BMD in this population. Two-hundred and fifty-eight Caucasian men and women aged 18-33 years completed health and physical activity questionnaires along with a calcium and vitamin D specific food frequency questionnaire. Height and mass were measured. BMD of the total hip, femoral neck, spine, and total body was measured using dual energy X-ray absorptiometry. Among men, body mass, weight-bearing physical activity, and calcium intake were significant predictors of BMD. Among women, body mass, calcium intake, and family history of osteoporosis significantly predicted log BMD. The predictors of BMD in young Canadian men and women identified in this study may inform the development of longitudinal studies designed to examine the influence of lifestyle factors on BMD in young adults.

Hair, serum, and urine chromium concentrations in former employees of the leather tanning industry

OBJECTIVE To assess the impact of the 1996-2005 integrated community-based micronutrient and health (MICAH) programme on linear growth retardation (stunting) in Malawian preschool children living in rural areas. DESIGN Prospective study of three large-scale cross-sectional surveys conducted in 1996, 2000 and 2004 in MICAH and Comparison populations. SETTING Rural areas in Malawi. SUBJECTS Preschool children (6.0-59.9 months) from randomly selected households (474 from the 1996 baseline survey; 1264 from 2000 MICAH areas; 1500 from 2000 Comparison areas; 1959 from 2004 MICAH areas; and 1008 from 2004 Comparison areas), who responded to a household questionnaire, were weighed and measured using standard protocols. RESULTS At the baseline in 1996, the prevalence of stunting (60.2 %) was very high. By 2000, the prevalence of stunting had declined to 50.6 % and 56.0 % (chi2 = 7.8, P = 0.005) in MICAH and Comparison areas, respectively. In 2004, the prevalence of stunting did not differ significantly between MICAH and Comparison areas (43.0 % v. 45.1 %; chi2 = 1.11, P = 0.3). Severe stunting affected 34.7 % of children at baseline, which declined to 15.8 % and 17.1 % (chi2 = 0.86, P = 0.4) in MICAH and Comparison areas, respectively, by 2004. Regional variations existed, with proportionately fewer children from the Northern region being stunted compared to their Central and Southern region counterparts. CONCLUSION Given the length of implementation, wide-scale coverage and positive impact on child growth in Phase I (1996-2000), the MICAH programme is a potential model for combating linear growth retardation in rural areas in Malawi, although the catch-up improvement in Comparison areas during Phase II (2000-2004) cannot be adequately explained.