Jill L. Kaar

Maternal obesity, gestational weight gain, and offspring adiposity: the exploring perinatal outcomes among children study.

OBJECTIVE To determine whether adequate vs excessive gestational weight gain (GWG) attenuated the association between maternal obesity and offspring outcomes. STUDY DESIGN Data from 313 mother-child pairs participating in the Exploring Perinatal Outcomes among Children study were used to test this hypothesis. Maternal prepregnancy body mass index (BMI) and weight measures throughout pregnancy were abstracted from electronic medical records. GWG was categorized according to the 2009 Institute of Medicine criteria as adequate or excessive. Offspring outcomes were obtained at a research visit (average age 10.4 years) and included BMI, waist circumference (WC), subcutaneous adipose tissue (SAT) and visceral adipose tissue, high-density lipoprotein cholesterol, and triglyceride levels. RESULTS More overweight/obese mothers exceeded the Institute of Medicine GWG recommendations (68%) compared with normal-weight women (50%) (P < .01). Maternal prepregnancy BMI was associated with worse childhood outcomes, particularly among offspring of mothers with excessive GWG (increased BMI [20.34 vs 17.80 kg/m(2)], WC [69.23 vs 62.83 cm], SAT [149.30 vs 90.47 cm(2)], visceral adipose tissue [24.11 vs 17.55 cm(2)], and homeostatic model assessment [52.52 vs 36.69], all P < .001). The effect of maternal prepregnancy BMI on several childhood outcomes was attenuated for offspring of mothers with adequate vs excessive GWG (P < .05 for the interaction between maternal BMI and GWG status on childhood BMI, WC, SAT, and high-density lipoprotein cholesterol). CONCLUSION Our findings lend support for pregnancy interventions aiming at controlling GWG to prevent childhood obesity.

Maternal diet quality in pregnancy and neonatal adiposity: the Healthy Start Study.

Background/Objectives:Poor maternal diet in pregnancy can influence fetal growth and development. We tested the hypothesis that poor maternal diet quality during pregnancy would increase neonatal adiposity (percent fat mass (%FM)) at birth by increasing the fat mass (FM) component of neonatal body composition.Methods:Our analysis was conducted using a prebirth observational cohort of 1079 mother–offspring pairs. Pregnancy diet was assessed via repeated Automated Self-Administered 24-h dietary recalls, from which Healthy Eating Index-2010 (HEI-2010) scores were calculated for each mother. HEI-2010 was dichotomized into scores of ⩽57 and >57, with low scores representing poorer diet quality. Neonatal %FM was assessed within 72 h after birth with air displacement plethysmography. Using univariate and multivariate linear models, we analyzed the relationship between maternal diet quality and neonatal %FM, FM, and fat-free mass (FFM) while adjusting for prepregnancy body mass index (BMI), physical activity, maternal age, smoking, energy intake, preeclampsia, hypertension, infant sex and gestational age.Results:Total HEI-2010 score ranged between 18.2 and 89.5 (mean: 54.2, s.d.: 13.6). An HEI-2010 score of ⩽57 was significantly associated with higher neonatal %FM (β=0.58, 95% confidence interval (CI) 0.07–1.1, P<0.05) and FM (β=20.74; 95% CI 1.49–40.0; P<0.05) but no difference in FFM.Conclusions:Poor diet quality during pregnancy increases neonatal adiposity independent of maternal prepregnancy BMI and total caloric intake. This further implicates maternal diet as a potentially important exposure for fetal adiposity.

Maternal Dietary Patterns during Pregnancy Are Associated with Newborn Body Composition

Background: Maternal dietary intake during pregnancy may influence offspring growth and adiposity. Specific dietary patterns associated with newborn adiposity have not been identified.Objective: We aimed to identify patterns of maternal dietary intake associated with gestational weight gain (GWG) and fasting glucose during pregnancy and to evaluate whether adherence to these patterns is associated with newborn adiposity.Methods: In the Healthy Start prospective cohort, dietary intake during pregnancy was assessed via 24-h recalls. Reduced-rank regression identified dietary patterns predictive of GWG and fasting glucose. Associations between dietary patterns and newborn fat mass, fat-free mass, and adiposity were estimated by using linear regression models among 764 ethnically diverse mother-infant pairs.Results: Two dietary patterns were identified. Pattern 1, correlated with greater GWG (r = 0.22, P < 0.01), was characterized by a higher consumption of poultry, nuts, cheese, fruits, whole grains, added sugars, and solid fats. Greater adherence to pattern 1 (upper compared with lower tertile) predicted a greater newborn fat-free mass (61 g; 95% CI: 12, 110 g) but no difference in fat mass or adiposity. Pattern 2, correlated with greater maternal fasting glucose (r = 0.16, P < 0.01), was characterized by a higher consumption of eggs, starchy vegetables, solid fats, fruits, and nonwhole grains and a lower consumption of dairy foods, dark-green vegetables, and whole grains. Greater adherence to pattern 2 was associated with a greater newborn birth weight (80 g; 95% CI: 15, 145 g), fat mass (33 g; 95% CI: 8, 59 g), and adiposity (0.9%; 95% CI: 0.3%, 1.6%).Conclusions: Among pregnant women, adherence to a dietary pattern characterized by an intake of poultry, nuts, cheese, and whole grains was associated with greater GWG but not maternal fasting glucose or newborn adiposity. Adherence to a pattern characterized by an intake of eggs, starchy vegetables, and nonwhole grains was associated with higher maternal fasting glucose and greater newborn adiposity. Maternal dietary patterns during pregnancy may influence newborn body composition.

Predictors of Infant Body Composition at 5 Months of Age: The Healthy Start Study

Objective To examine associations of demographic, perinatal, and infant feeding characteristics with offspring body composition at approximately 5 months of age. Study design We collected data on 640 mother/offspring pairs from early pregnancy through approximately 5 months of age. We assessed offspring body composition with air displacement plethysmography at birth and approximately 5 months of age. Linear regression analyses examined associations between predictors and fat‐free mass, fat mass, and percent fat mass (adiposity) at approximately 5 months. Secondary models further adjusted for body composition at birth and rapid infant growth. Results Greater prepregnant body mass index and gestational weight gain were associated with greater fat‐free mass at approximately 5 months of age, but not after adjustment for fat‐free mass at birth. Greater gestational weight gain was also associated with greater fat mass at approximately 5 months of age, independent of fat mass at birth and rapid infant growth, although this did not translate into increased adiposity. Greater percent time of exclusive breastfeeding was associated with lower fat‐free mass (‐311 g; P < .001), greater fat mass (+224 g; P < .001), and greater adiposity (+3.51%; P < .001). Compared with offspring of non‐Hispanic white mothers, offspring of Hispanic mothers had greater adiposity (+2.72%; P < .001) and offspring of non‐Hispanic black mothers had lower adiposity (‐1.93%; P < .001). Greater adiposity at birth predicted greater adiposity at approximately 5 months of age, independent of infant feeding and rapid infant growth. Conclusions There are clear differences in infant body composition by demographic, perinatal, and infant feeding characteristics, although our data also show that increased adiposity at birth persists through approximately 5 months of age. Our findings warrant further research into implications of differences in infant body composition.

Longitudinal association between television watching and computer use and risk markers in diabetes in the SEARCH for Diabetes in Youth Study.

The study provides evidence of the longitudinal association between screen time with hemoglobin A1c (HbA1c) and cardiovascular risk markers among youth with type 1 diabetes (T1D) and type 2 diabetes (T2D).

The National Children's Study: An introduction and historical overview

The National Children’s Study (NCS) was an ambitious attempt to map children’s health and development in a large representative group of children in the United States. In this introduction, we briefly review the background of the NCS and the history of the multiple strategies that were tested to recruit women and children. Subsequent articles then detail the protocols and outcomes of 4 of the recruitment strategies. It is hoped that lessons learned from these attempts to define a study protocol that could achieve the initial aims of the NCS will inform future efforts to conceptualize and execute strategies to provide generalizable insights on the longitudinal health of our nation’s children.

Sleep duration mediates the relationship between health behavior patterns and obesity

Objective: To examine associations between health behavior patterns and childhood obesity, and the mediating effect of sleep duration. Design: Population‐based survey. Participants: Secondary analysis of data from the Infant Feeding Practices Study (age 6 years, n = 1073). Measurements: Mothers self‐reported their childs health behaviors including physical activity (PA), screen time, sleep duration, and diet. Latent class analysis determined the childs patterns based on health behaviors. Sleep was examined as a mediator between the class membership variable and %BMIp95. Results: A 3‐class model fit the data best, with classes labeled as “Poorest eaters” (low fruit/vegetable consumption, high fast food), “Healthy” (low screen time, highest fruit/vegetable consumption) and “Active, super‐eaters, highest screen time” (highest PA and screen time, ate the most). “Poorest eaters” had an increased %BMIp95 (&bgr; = 4.11, P = .006) relative to the “Healthy” class. The “Poorest eaters” and “Active, super‐eaters, highest screen time” classes had shorter sleep duration (&bgr; = −0.51, P < .001; &bgr; = −0.38, P < .001; respectively) relative to the “Healthy” class. Independent of class membership, each additional hour of sleep was associated with a %BMIp95 that was 2.93 U lower (P < .001). Conclusions: Our results indicate that health behavior patterns mediated by sleep duration may influence a childs %BMIp95. The bi‐directionality of the relationship between health behaviors and sleep remains unclear. Our findings suggest the importance of a constellation of health behaviors on childhood obesity. Interventions should include a multitude of health behaviors and consider the possibility that improving diet and activity behaviors may facilitate improved sleep and lowered obesity risk among children.

Use of the Delphi Technique to Obtain Community Input on Leading Contributors to Early Childhood Obesity in Latino Communities

Introduction: In the United States, Latino children are disproportionately affected by childhood obesity and related comorbidities. Stakeholder engagement has the potential to heighten the efficacy of interventions, thereby reducing the disparate prevalence of obesity among Latino children. The objective of this study was to identify stakeholders’ opinions on factors influencing early childhood obesity in Latino children aged 0 to 5 years. Method: This study used the Delphi technique to gather and prioritize stakeholders’ opinions about the factors and barriers considered most influential in early (age 0-5 years) childhood obesity intervention or prevention within the Latino community. Three sequential phases were used. Participants included Latina women as well as staff from community organizations serving Denver metropolitan’s Latino population. Results: Study results revealed that stakeholders value the role of the child’s primary care provider in the identification of overweight children and desire more educational support to reduce intake of nonnutritious foods. Participants further determined that obesity-related knowledge gaps and affordability of healthy foods and activities were the largest barriers to helping Latino children maintain healthy weights. Conclusion: Use of this stakeholder-informed data could assist in the development of future culturally tailored interventions aimed at reducing the rates of early childhood obesity in the Latino population.

Adolescent’s Health Behaviors and Risk for Insulin Resistance: A Review of the Literature

Purpose of ReviewOne-third of US adolescents are obese, and related comorbidities exist in this population. Preventing early indicators of these diseases, such as insulin resistance (IR), may impact future morbidity and mortality. Interventions to date have only focused on diet or exercise. Additional targets to prevent disease are needed. This paper reviews the evidence in adolescents examining multiple health behaviors that have been associated with IR.Recent FindingsHealth behaviors (i.e., diet, activity, sleep) have been individually examined as possible contributors to disease, but an understanding of the complex interplay between these behaviors is lacking.SummaryA better understanding of how multiple health behaviors contribute to IR in adolescents is needed. Future studies using both advanced statistical methodology and robust measures of each health behavior may facilitate better understanding of the impact of lifestyle factors on IR and guide intervention strategies to reduce the risk of disease.

The Association between Change in Physical Activity and Weight duringAdolescence

Objective: To investigate the association between annual change in physical activity and subsequent annual change in weight status in adolescents over a 4 year period. Design: Longitudinalstudy design with annualdata collection over 4 years. Setting: Suburban school district in Pittsburgh, PA. Participants: 1245 adolescents aged 11-16 years. Main outcome measures: Physical activity and body mass index (BMI) percentile. Analysis: Generalized estimating equation (GEE). Results: 994 participants (53% male) were included in the analyses. The longitudinal associations between changes in physical activity and BMI% were mostly small and non-significant. However, compared with those who did not change their physical activity, a large annual increase in physical activity (>10 hr/wk) was associated with a significant increase in BMI%. Results were broadly similar for total and vigorous physical activity, boys and girls and for healthy and unhealthy (>85th percentile) BMI%. Conclusions and Implications: The role of physical activity in the development of obesity during adolescence therefore remains unclear. Further work is needed to elucidate the role of physical activity in the preventionof obesity.