Sibylle Kranz

Examining Breast Cancer Growth and Lifestyle Risk Factors: Early Life, Childhood, and Adolescence

The perinatal period, childhood, and adolescence are important intervals for breast cancer risk development. Endogenous estrogen exposure is thought to be highest in utero, and exposure to estrogens throughout life plays an important role in increasing breast cancer risk. Some evidence suggests that breast tissue is not fully differentiated until after the first full-term pregnancy; thus, breast tissue might be more susceptible to carcinogenic influences during early life and adolescence. Birth characteristics of the daughter, including gestational age, birth weight, and birth length are associated with maternal hormone levels during the index pregnancy, and birth size has been related to daughters timing of puberty and adult breast cancer incidence. Furthermore, early life and adolescence are critical times for maturation of the hypothalamic pituitary ovarian axis, which regulates production of ovarian hormones including estrogen and progesterone. Childhood height, growth, diet, and body mass index (BMI) have also been associated with breast cancer risk later in life. Of the examined characteristics, we conclude that the available evidence is suggestive of a positive relationship of breast cancer risk with birth weight, birth length, and adolescent height, and an inverse relationship with gestational age and childhood BMI, although several inconsistencies exist in the literature. The best evidence for a relationship of adolescent diet and adult breast cancer risk is indirect, and the relationship of diet, weight status, and weight gain in childhood deserves further attention. The interaction of birth characteristics with established risk factors over the life course, such as age at menarche, in addition to gene-environment interactions, require more research. Further study is also needed to clarify the biologic mechanisms influencing the observed associations.

Changes in Diet Quality of American Preschoolers Between 1977 and 1998

OBJECTIVES We determined diet quality trends among nationally representative samples of preschoolers between 1977 and 1998. METHODS Adjusted diet quality index scores, overall intake, and tertiles of total score were compared for combined samples and 2 age groups using t tests with Bonferroni correction; surveys used were the US Department of Agricultures National Food Consumption Survey 1977-1979 (n = 2342), Continuing Survey of Food Intake by Individuals (CSFII) 1989-1991 (n = 858), and CSFII 1994-1996 and 1998 (n = 5355). RESULTS Total scores increased slightly. Consumption of grains, fruits, and vegetables improved while added sugar and juice intake worsened. CONCLUSIONS Diet quality improved marginally since 1977. Consumption of fruits and vegetables needs to be increased and that of total and saturated fat, juice, and added sugar decreased.

A childhood obesity intervention developed by families for families: results from a pilot study

BackgroundIneffective family interventions for the prevention of childhood obesity have, in part, been attributed to the challenges of reaching and engaging parents. With a particular focus on parent engagement, this study utilized community-based participatory research to develop and pilot test a family-centered intervention for low-income families with preschool-aged children enrolled in Head Start.MethodsDuring year 1 (2009–2010), parents played an active and equal role with the research team in planning and conducting a community assessment and using the results to design a family-centered childhood obesity intervention. During year 2 (2010–2011), parents played a leading role in implementing the intervention and worked with the research team to evaluate its results using a pre-post cohort design. Intervention components included: (1) revisions to letters sent home to families reporting child body mass index (BMI); (2) a communication campaign to raise parents’ awareness of their child’s weight status; (3) the integration of nutrition counseling into Head Start family engagement activities; and (4) a 6-week parent-led program to strengthen parents’ communication skills, conflict resolution, resource-related empowerment for healthy lifestyles, social networks, and media literacy. A total of 423 children ages 2–5 years, from five Head Start centers in upstate New York, and their families were exposed to the intervention and 154 families participated in its evaluation. Child outcome measures included BMI z-score, accelerometer-assessed physical activity, and dietary intake assessed using 24-hour recall. Parent outcomes included food-, physical activity- and media-related parenting practices and attitudes.ResultsCompared with pre intervention, children at post intervention exhibited significant improvements in their rate of obesity, light physical activity, daily TV viewing, and dietary intake (energy and macronutrient intake). Trends were observed for BMI z-score, sedentary activity and moderate activity. Parents at post intervention reported significantly greater self-efficacy to promote healthy eating in children and increased support for children’s physical activity. Dose effects were observed for most outcomes.ConclusionsEmpowering parents to play an equal role in intervention design and implementation is a promising approach to family-centered obesity prevention and merits further testing in a larger trial with a rigorous research design.

Use of the Revised Children's Diet Quality Index to assess preschooler's diet quality, its sociodemographic predictors, and its association with body weight status

OBJECTIVE To determine the level of overall diet quality, sociodemographic predictors of diet quality, and the association between diet quality and body weight status in a nationally representative sample of preschoolers. METHODS Cross-sectional study using a sample of 2-5 years old with sociodemographic, dietary, and anthropometric data (n = 1,521) in the National Health and Examination Survey 1999-2002. Overall diet quality was determined using the Revised Childrens Diet Quality Index. Sociodemographic predictors (age, sex, sociodemographic, ethnic group, household income, preschool attendance, federal food program participation) of diet quality were determined using multiple linear regression models in the total sample and stratified by household income for Food Stamp eligible (< 1.3 of the poverty income ratio) or Special Supplemental Program for Women, Infants, and Children eligible (poverty income ratio < 1.85). Association between diet quality and prevalence of childhood obesity was assessed with Pearson chi-square tests. Statistical significance was assumed at p <or= 0.05. All analysis was conducted using complex survey design routines. RESULTS On average, preschooler consumed suboptimal levels of whole grains, fruits, vegetables, and dairy. Overall diet quality decreased with increasing age (beta-coefficient: -2.38, p < 0.001) but improved with increasing family income in the full sample (beta-coefficient: 1.22, p < 0.001) but not in the low-income subpopulations. Mexican American children had significantly better diet quality than non-Hispanic white children (beta-coefficient: 2.18, p < 0.033) especially in the low income group (beta-coefficient: 3.57, p < 0.006). Childhood obesity prevalence decreased significantly with increasing diet quality. CONCLUSIONS Preschoolers diet quality needs to be improved to support the prevention of childhood obesity early in life.

What do we know about dietary fiber intake in children and health? The effects of fiber intake on constipation, obesity, and diabetes in children

The effect of dietary fiber intake on chronic diseases has been explored in adults but is largely unknown in children. This paper summarizes the currently existing evidence on the implications of dietary fiber intake on constipation, obesity, and diabetes in children. Current intake studies suggest that all efforts to increase childrens dietary fiber consumption should be encouraged. Available data, predominantly from adult studies, indicate significantly lower risks for obesity, diabetes, and constipation could be expected with higher dietary fiber consumption. However, there is a lack of data from clinical studies in children of various ages consuming different levels of dietary fiber to support such assumptions. The existing fiber recommendations for children are conflicting, a surprising situation, because the health benefits associated with higher dietary fiber intake are well established in adults. Data providing conclusive evidence to either support or refute some, if not all, of the current pediatric fiber intake recommendations are lacking. The opportunity to improve childrens health should be a priority, because it also relates to their health later in life. The known health benefits of dietary fiber intake, as summarized in this paper, call for increased awareness of the need to examine the potential benefits to childrens health through increased dietary fiber.

Elder Insecurities: Poverty, Hunger, and Malnutrition

Between 8% and 16% (2.5 to 4.9 million) of the elder population have experienced food insecurity within a 6-month period. Federal programs to combat food insecurity reach only one-third of needy elders. While hunger and poverty are linked directly to malnutrition, the multifaceted nature of elderly malnutrition cuts across all economic, racial, and ethnic groups. Malnourished patients experience 2 to 20 times more complications, have up to 100% longer hospital stays, and compile hospital costs

Sources of Dietary Fiber and the Association of Fiber Intake with Childhood Obesity Risk (in 2–18 Year Olds) and Diabetes Risk of Adolescents 12–18 Year Olds: NHANES 2003–2006

2,000 to

Diet Quality in Childhood Is Prospectively Associated with the Timing of Puberty but Not with Body Composition at Puberty Onset

10,000 higher per stay. Dietitians can advocate routine nutrition screening to target elders at highest risk and lobby for expansion of appropriate nutrition services in home, community, and institutional settings.

Diagnostic criteria patterns of U.S. children with Metabolic Syndrome: NHANES 1999–2002

Increased fiber intake has been linked with lower risk of overweight and obesity in adults, but data are sparse for children. To address this issue, NHANES 2003–2006 data was used to evaluate (1) the food sources of fiber in children, (2) the dietary fiber density levels and risk of being classified as overweight/obese, and (3) the association between fiber intake level and impaired glucose metabolism in children. Analyses were restricted to the subsample of children with biological plausible diet reports (N = 4,667) and stratified by 2–11 year olds (n = 2072) and 12–18 year olds (n = 2595). Results showed that the food sources are predominantly foods that are low in dietary fiber, but are consumed at high levels. In 2–18 year old plausible reporters, the risk for overweight/obesity decreased by 17% from children in the medium tertile of fiber density intake compared to the lowest tertile (OR = 0.83, P value = 0.043) and by 21% between the highest compared to the lowest tertile (OR = 0.79, P value = 0.031). There was a protective effect of being in the medium tertile of dietary fiber density (OR = 0.68, P value <0.001) on impaired glucose metabolism. These results indicate a beneficial effect of higher fiber density in childrens diets.

Intake of seafood in the US varies by age, income, and education level but not by race-ethnicity.

We examined whether the diet quality of healthy children prior to the pubertal growth spurt was associated with age and body composition at puberty onset. Multivariate regression analyses were performed using data from 222 Dortmund Nutritional and Anthropometric Longitudinally Designed Study participants (mean age +/- SD at baseline: 7.4 +/- 1.3 y) with 3-d weighed dietary records and anthropometric data at baseline, i.e. the visits 2 and 3 y before the onset of pubertal growth spurt [defined as age at take-off (ATO)]. Diet quality at baseline was determined using the nutrient density-based Nutritional Quality Index (NQI) and the food group and nutrient-based Revised Childrens Diet Quality Index (RC-DQI). Based on their distribution, 3 NQI or RC-DQI categories were created to indicate lower, moderate, and higher diet quality. Parameters describing body composition at ATO were age- and gender-specific Z-scores of BMI, fat mass/height(2), and fat-free mass/height(2). Children with lower diet quality indicated by lower NQI scores entered puberty approximately 0.4 y earlier than children with higher NQI scores {ATO in lower and higher NQI categories were [mean (95% CI)] 9.2 y (9.0-9.4), and 9.6 y (9.4-9.9), adjusted for sex, maternal overweight, baseline energy intake, and baseline BMI Z-score} (P-value = 0.02). A similar association of the RC-DQI with ATO was largely explained by baseline energy intakes. Our data suggest that diet quality was not independently associated with body composition at ATO. Children with lower diet quality according to a nutrient density-based index appear to enter puberty at an earlier age, independently of prepubertal body composition.