Sara E. Benjamin-Neelon

Erythrocyte folate concentrations, CpG methylation at genomically imprinted domains, and birth weight in a multiethnic newborn cohort

Epigenetic mechanisms are proposed to link maternal concentrations of methyl group donor nutrients with the risk of low birth weight. However, empirical data are lacking. We have examined the association between maternal folate and birth weight and assessed the mediating role of DNA methylation at nine differentially methylated regions (DMRs) of genomically imprinted genes in these associations. Compared with newborns of women with folate levels in the lowest quartile, birth weight was higher in newborns of mothers in the second (β = 143.2, se = 63.2, P = 0.02), third (β = 117.3, se = 64.0, P = 0.07), and fourth (β = 133.9, se = 65.2, P = 0.04) quartiles, consistent with a threshold effect. This pattern of association did not vary by race/ethnicity but was more apparent in newborns of non-obese women. DNA methylation at the PLAGL1, SGCE, DLK1/MEG3 and IGF2/H19 DMRs was associated with maternal folate levels and also birth weight, suggestive of threshold effects. MEG3 DMR methylation mediated the association between maternal folate levels and birth weight (P =0.06). While the small sample size and partial scope of examined DMRs limit our conclusions, our data suggest that, with respect to birth weight, no additional benefits may be derived from increased maternal folate concentrations, especially in non-obese women. These data also support epigenetic plasticity as a key mechanistic response to folate availability during early fetal development.

DNA methylation of imprinted genes at birth is associated with child weight status at birth, 1 year, and 3 years

BackgroundThis study assessed the associations between nine differentially methylated regions (DMRs) of imprinted genes in DNA derived from umbilical cord blood leukocytes in males and females and (1) birth weight for gestational age z score, (2) weight-for-length (WFL) z score at 1xa0year, and (3) body mass index (BMI) z score at 3xa0years.MethodsWe conducted multiple linear regression in nu2009=u2009567 infants at birth, nu2009=u2009288 children at 1xa0year, and nu2009=u2009294 children at 3xa0years from the Newborn Epigenetics Study (NEST). We stratified by sex and adjusted for race/ethnicity, maternal education, maternal pre-pregnancy BMI, prenatal smoking, maternal age, gestational age, and paternal race. We also conducted analysis restricting to infants not born small for gestational age.ResultsWe found an association between higher methylation of the sequences regulating paternally expressed gene 10 (PEG10) and anthropometric z scores at 1xa0year (βu2009=u20090.84; 95% CIu2009=u20090.34, 1.33; pu2009=u20090.001) and 3xa0years (βu2009=u20091.03; 95% CIu2009=u20090.37, 1.69; p valueu2009=u20090.003) in males only. Higher methylation of the DMR regulating mesoderm-specific transcript (MEST) was associated with lower anthropometric z scores in females at 1xa0year (βu2009=u2009−u20091.03; 95% CI −u20091.60, −u20090.45; p valueu2009=u20090.001) and 3xa0years (βu2009=u2009−u20091.11; 95% CI −u20091.98, −u20090.24; p valueu2009=u20090.01). These associations persisted when we restricted to infants not born small for gestational age.ConclusionOur data support a sex-specific association between altered methylation and weight status in early life. These methylation marks can contribute to the compendium of epigenetically regulated regions detectable at birth, influencing obesity in childhood. Larger studies are required to confirm these findings.

The family child care home environment and children's diet quality

BACKGROUNDnDeveloping healthy eating behaviors and food preferences in early childhood may help establish future healthy diets. Large numbers of children spend time in child care, but little research has assessed the nutritional quality of meals and snacks in family child care homes. Therefore, it is important to assess foods and beverages provided, policies related to nutrition and feeding children, and interactions between providers and children during mealtimes. We examined associations between the nutrition environments of family child care homes and childrens diet quality.nnnMETHODSnWe assessed the nutrition environments of 166 family child care homes using the Environment and Policy Assessment and Observation (EPAO) (scores range: 0-21). We also recorded foods and beverages consumed by 496 children in care and calculated healthy eating index (HEI) (scores range: 0-100). We used a mixed effects linear regression model to examine the association between the EPAO nutrition environment (and EPAO sub-scales) and child HEI, controlling for potential confounders.nnnRESULTSnFamily child care homes had a mean (standard deviation, SD) of 7.2 (3.6) children in care, 74.1% of providers were black or African American, and children had a mean (SD) age of 35.7 (11.4) months. In adjusted multivariable models, higher EPAO nutrition score was associated with increased child HEI score (1.16; 95% CI: 0.34, 1.98; pu202f=u202f0.006). Higher scores on EPAO sub-scales for foods provided (8.98; 95% CI: 3.94, 14.01; pu202f=u202f0.0006), nutrition education (5.37; 95% CI: 0.80, 9.94; pu202f=u202f0.02), and nutrition policy (2.36; 95% CI: 0.23, 4.49; pu202f=u202f0.03) were all associated with greater child HEI score.nnnCONCLUSIONSnFoods and beverages served, in addition to nutrition education and nutrition policies in family child care homes, may be promising intervention targets for improving child diet quality.

Physical activity and sedentary behavior during pregnancy and postpartum, measured using hip and wrist-worn accelerometers

Background Physical activity in pregnancy and postpartum is beneficial to mothers and infants. To advance knowledge of objective physical activity measurement during these periods, this study compares hip to wrist accelerometer compliance; assesses convergent validity (correlation) between hip- and wrist-worn accelerometry; and assesses change in physical activity from pregnancy to postpartum. Methods We recruited women during pregnancy (nu202f=u202f100; 2014–2015), asking them to wear hip and wrist accelerometers for 7u202fdays during Trimester 2 (T2), Trimester 3 (T3), and 3-, 6-, 9- and 12-months postpartum. We assessed average wear-time and correlations (axis-specific counts/minute, vector magnitude counts/day and step counts/day) at T2, T3, and postpartum. Results Compliance was higher for wrist-worn accelerometers. Hip and wrist accelerometers showed moderate to high correlations (Pearsons r 0.59 to 0.84). Hip-measured sedentary and active time differed little between T2 and T3. Moderate-to-vigorous physical activity decreased at T3 and remained low postpartum. Light physical activity increased and sedentary time decreased throughout the postpartum period. Conclusions Wrist accelerometers may be preferable during pregnancy and appear comparable to hip accelerometers. As physical activity declines during later pregnancy and may not rebound post birth, support for re-engaging in physical activity earlier in the postpartum period may benefit women.

Media and Young Minds: Comparing State Screen Media Use Regulations for Children Under 24 Months of Age in Early Care and Education to a National Standard

Introduction Excessive screen media use has been associated with a number of negative health outcomes in young children, including increased risk for obesity and comparatively lagging cognitive development. The purpose of this study was to assess state licensing regulations restricting screen media use for children under 24 months old in early care and education (ECE) and to compare regulations to a national standard. Methods We reviewed screen media use regulations for all US states for child care centers (“centers”) and family child care homes (“homes”) and compared these regulations to a national standard discouraging screen media use in children under 24xa0months of age. We assessed associations between state geographic region and year of last update with the presence of regulations consistent with the standard. In centers, 24 states had regulations limiting screen media use for children under 24xa0months of age and 19 states had regulations limiting screen media use in homes. Results More states in the South and fewer states in the Midwest had regulations limiting screen media use. The association between geographic region and regulations was not significant for centers (pu2009=u20090.06), but was for homes (pu2009=u20090.04). The year of last update (within the past 5xa0years versus older than 5xa0years) was not associated with regulations for centers (pu2009=u20090.18) or homes (pu2009=u20090.90). Discussionxa0Many states lacked screen media use regulations for ECE. States should consider adding screen media use restrictions for children under 24 months based on current research data and current recommendations in future regulations updates.

Position of the Academy of Nutrition and Dietetics: Benchmarks for Nutrition in Child Care

It is the position of the Academy of Nutrition and Dietetics that early care and education (ECE) programs should achieve recommended benchmarks to meet childrens nutrition needs and promote childrens optimal growth in safe and healthy environments. Childrens dietary intake is influenced by a number of factors within ECE, including the nutritional quality of the foods and beverages served, the mealtime environments, and the interactions that take place between children and their care providers. Other important and related health behaviors that may influence the development of obesity include childrens physical activity, sleep, and stress within child care. Recent efforts to promote healthy eating and improve other health behaviors in ECE include national, state, and local policy changes. In addition, a number of interventions have been developed in recent years to encourage healthy eating and help prevent obesity in young children in ECE. Members of the dietetics profession, including registered dietitian nutritionists and nutrition and dietetics technicians, registered, can work in partnership with ECE providers and parents to help promote healthy eating, increase physical activity, and address other important health behaviors of children in care. Providers and parents can serve as role models to support these healthy behaviors. This Position Paper presents current evidence and recommendations for nutrition in ECE and provides guidance for registered dietitian nutritionists; nutrition and dietetics technicians, registered; and other food and nutrition practitioners working with parents and child-care providers. This Position Paper targets children ages 2 to 5 years attending ECE programs and highlights opportunities to improve and enhance childrens healthy eating while in care.

Does cesarean delivery impact infant weight gain and adiposity over the first year of life

BackgroundPotentially driven by the lack of mother-to-infant transmission of microbiota at birth, cesarean delivery has been associated with higherxa0risk of offspring obesity. Yet, no studies have examined when delivery-mode differences in adiposity begin to emerge. In this study, we examine differences in infant weight and adiposity trajectories from birth to 12 months by delivery mode.MethodsFrom 2013 to 2015, we recruited pregnant women into the Nurture Study and followed up their 666 infants. We ascertained maternal delivery method and infant birth weight from medical records. We measured weight, length, and skinfoldxa0thicknesses (subscapular, triceps, abdominal) when infants were 3, 6, 9, and 12 months of age. The main outcome, infant weight-for-length z score, was derived based on the WHO Child Growth Standards. We used linear regressionxa0models to assess the difference at each time point and used linear mixed models to examine the growth rate for infant weight and adiposity trajectories. We controlled for maternal age, race, marital status, education level, household income, smoking status, maternal pre-pregnancy body mass index, and infant birth weight.ResultsOf the 563 infants in our final sample, 179 (31.8%) were cesarean delivered. From birth to 12 months, the rate of increase in weight-for-length z score was 0.02/month (pu2009=u20090.03) greater for cesarean-delivered than vaginally-delivered infants. As a result of more rapid growth, cesarean-delivered infants had higher weight-for-length z score (0.26, 95% CI: 0.05,xa00.47) and sum of subscapular and triceps (SSu2009+u2009TR) skinfoldxa0thickness (0.95u2009mm, 95% CI: 0.30,xa01.60)—an indicatorxa0for overall adiposity—at 12 months, compared to vaginally-delivered infants.ConclusionsCompared to vaginal delivery, cesarean delivery was associated with greater offspring rate of weight gain over the first year and differences in adiposity that appear as early as 3 months of age. Monitoring cesarean-delivered infants closely for excess weight gain may help guide primordial prevention of obesity later in life.

Child care centre adherence to infant physical activity and screen time recommendations in Australia, Canada and the United States: An observational study

OBJECTIVEnThe aim of this study was to compare adherence to physical activity and sedentary behaviour recommendations within the 2011 Institute of Medicine Early Childhood Obesity Prevention Policies as well as screen time recommendations from the 2013 American Academy of Pediatrics for samples of infants in child care centres in Australia, Canada, and the United States (US).nnnMETHODSnThis cross-sectional study used data from: the Australian 2013 Standing Preschools (N=9) and the 2014-2017 Early Start Baseline (N=22) studies; the 2011 Canadian Healthy Living Habits in Pre-School Children study (N=14); and the American 2008 (N=31) and 2013-2017 (N=31) Baby Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) trials. Data were compared on the above infant recommendations. Percentages were used to describe compliance to the recommendations and chi-square tests to determine whether compliance differed by country.nnnRESULTSnChild care centres were most compliant (74%-95%) with recommendations to: provide daily indoor opportunities for infants to move freely under adult supervision, daily tummy time for infants less than 6 months of age, indoor and outdoor recreation areas that encourage infants to be physically active, and discourage screen time. Centres were least compliant (38%-41%) with adhering to recommendations to: limit the use of equipment that restricts an infants movement and provide education about physical activity to families. Compared with Canadian and US centres, Australian centres were less compliant (46%) with the recommendation to engage with infants on the ground each day, to optimize adult-infant interactions and to limit the use of equipment that restricts the infants movement. Canadian centres were less compliant (39%) with the recommendation to provide training to staff and education to parents about childrens physical activity. US centres were less compliant (25%-41%) with the recommendations to provide daily opportunities for infants to explore their outdoor environment, limit the use of equipment that restricts the infants movement and provide education to families about childrens physical activity.nnnCONCLUSIONSnAssisting child care centres on limiting the use of equipment that restricts an infants movement, and providing education about childrens physical activity to families may be important targets for future interventions.

State Regulations Promoting Infant Physical Activity in Early Care and Education

BACKGROUNDnState policies have the potential to improve early care and education (ECE) settings, but little is known about the extent to which states are updating their licensing and administrative regulations, especially in response to national calls to action. In 2013, we assessed state regulations promoting infant physical activity in ECE and compared them with national recommendations. To assess change over time, we conducted this review again in 2018.nnnMETHODSnWe reviewed regulations for all US states for child care centers (centers) and family child care homes (homes) and compared them with three national recommendations: (1) provide daily tummy time; (2) use cribs, car seats, and high chairs for their primary purpose; and (3) limit the use of restrictive equipment (e.g., strollers). We performed exact McNemars tests to compare the number of states meeting recommendations from 2013 to 2018 to evaluate whether states had made changes over this period.nnnRESULTSnFrom 2013 to 2018, we observed significant improvement in one recommendation for homes-to use cribs, car seats, and high chairs for their primary purpose (odds ratio 11.0; 95% CI 1.6-47.3; pu2009=u20090.006). We did not observe any other significant difference between 2013 and 2018 regulations.nnnCONCLUSIONSnDespite increased awareness of the importance of early-life physical activity, we observed only modest improvement in the number of states meeting infant physical activity recommendations over the past 5 years. In practice, ECE programs may be promoting infant physical activity, but may not be required to do so through state regulations.

Barriers and Facilitators to Compliance with a State Healthy Eating Policy in Early Care and Education Centers

BACKGROUNDnEarly care and education (ECE) policies can improve childhood obesity risk factors. We evaluated barriers and facilitators to implementing mandatory nutrition standards for foods provided in South Carolina ECE centers serving low-income children, comparing centers participating in the Child and Adult Care Food Program (CACFP) with non-CACFP centers.nnnMETHODSnWe mailed 261 surveys (demographics, policies and practices, barriers and facilitators) to center directors after new state nutrition standards were implemented in South Carolina. We conducted univariate and bivariate analyses to explore relationships between barriers, facilitators, and center-level characteristics, by CACFP status.nnnRESULTSnWe received 163 surveys (62% response rate). Centers had a median [interquartile range (IQR)] of 5 (4-7) classrooms and 59 (37.5-89) total children enrolled. More than half (60.1%) of directors reported they were moderately or fully informed about the standards. The most common barriers were food costs (17.8%) and childrens food preferences (17.8%). More non-CACFP directors reported food costs as a barrier (28.6% vs. 6.5%, pu2009<u20090.001), having to spend additional money on healthier foods (48.8% vs. 28.6%, pu2009=u20090.01), and having to provide additional nutrition education to parents (28.6% vs. 11.7%, pu2009=u20090.01), compared with CACFP directors.nnnCONCLUSIONSnCenter directors were generally well informed about the nutrition standards. The most common barriers to implementing the standards were food costs and childrens food preferences. Centers participating in CACFP may be in a better position to adhere to new state nutrition standards, as they receive some federal reimbursement for serving healthy foods and may be more accustomed to regulation.