The longitudinal relationship between diet quality and executive functioning development of Hispanic preschoolers in Houston, Texas.

BACKGROUND: Diet quality has been found to be related to cognitive health in school-aged children. However, this relationship remains understudied among Hispanic preschoolers, who are vulnerable to poor dietary habits and low cognitive development due to socioeconomic, cultural, and structural disparities. OBJECTIVE: This longitudinal study evaluated whether the diet quality of preschoolers would be associated with executive functions (EFs) in later childhood. DESIGN: This is a secondary analysis of a longitudinal study of Hispanic preschoolers (4-5 years) at baseline (T1) and 18 months (T2). PARTICIPANTS/SETTING: This study included 185 mother-child dyads with complete data at T1, recruited through Head Start centers in Houston, TX, beginning in 2011. MAIN OUTCOME MEASURES: Mothers reported on their child's dietary intake via three 24-hour recalls, which was used to calculate Healthy Eating Index (HEI)-2010 component and total scores. Laboratory tasks assessed cold EFs (Tapping and Flexible Item Selection Tasks) and hot EFs (delay of gratification and gift-wrapping tasks). While higher scores on tapping, flexible, and delay of gratification tasks represent a high EF, higher scores in gift-wrapping task represent a low EF. STATISTICAL ANALYSIS: Hierarchical linear regression analyses assessed the relationship between diet quality, as measured by HEI-2010 total and component scores, at T1 (Independent Variables) and EF outcomes (Dependent Variables) at T2, controlling for child sex, age, BMI z-score, and EF at T1. RESULTS: HEI-2010 component score for fatty acids (B=-.13; p=.04) and seafood and plant proteins (B=.09; p=.05), were respectively related to later "cold" and "hot" EFs of Hispanic preschoolers. Other HEI components or the overall score did not predict EFs. CONCLUSIONS: This study shows that specific HEI components support cold and hot EFs development among Hispanic preschoolers, but total HEI-2010 score does not. Experimental research is needed to assess the impact of dietary interventions on cognitive development of Hispanic preschoolers.

Jerks are Useful: Extracting pulse rate from wrist-placed accelerometry jerk during sleep in children.

STUDY OBJECTIVES: Evaluate wrist-placed accelerometry predicted heartrate compared to electrocardiogram (ECG) heartrate in children during sleep. METHODS: Children (n=82, 61% male, 43.9% Black) wore a wrist-placed Apple Watch Series 7 (AWS7) and ActiGraph GT9X during a polysomnogram. 3-Axis accelerometry data was extracted from AWS7 and the GT9X. Accelerometry heartrate estimates were derived from jerk (the rate of acceleration change), computed using the peak magnitude frequency in short time Fourier Transforms of Hilbert transformed jerk computed from acceleration magnitude. Heartrates from ECG traces were estimated from R-R intervals using R-pulse detection. Lin's Concordance Correlation Coefficient (CCC), mean absolute error (MAE) and mean absolute percent error (MAPE) assessed agreement with ECG estimated heartrate. Secondary analyses explored agreement by polysomnography sleep stage and a signal quality metric. RESULTS: The developed scripts are available on Github. For the GT9X, CCC was poor at -0.11 and MAE and MAPE were high at 16.8 (SD=14.2) beats/minute and 20.4% (SD=18.5%). For AWS7, CCC was moderate at 0.61 while MAE and MAPE were lower at 6.4 (SD=9.9) beats/minute and 7.3% (SD=10.3%). Accelerometry estimated heartrate for AWS7 was more closely related to ECG heartrate during N2, N3 and REM sleep than lights on, wake, and N1 and when signal quality was high. These patterns were not evident for the GT9X. CONCLUSIONS: Raw accelerometry data extracted from AWS7, but not the GT9X, can be used to estimate heartrate in children while they sleep. Future work is needed to explore the sources (i.e., hardware, software, etc.) of the GT9X's poor performance.

Exploring Factors Associated With Accelerometer Validity Among Ethnically Diverse Toddlers.

PURPOSE: Studying physical activity in toddlers using accelerometers is challenging due to noncompliance with wear time (WT) and activity log (AL) instructions. The aims of this study are to examine relationships between WT and AL completion and (1) demographic and socioeconomic variables, (2) parenting style, and (3) whether sedentary time differs by AL completion. METHODS: Secondary analysis was performed using baseline data from a community wellness program randomized controlled trial for parents with toddlers (12-35 mo). Parents had toddlers wear ActiGraph wGT3x accelerometers and completed ALs. Valid days included ≥600-minute WT. Analysis of variance and chi-square analyses were used. RESULTS: The sample (n = 50) comprised racial and ethnically diverse toddlers (mean age = 27 mo, 58% male) and parents (mean age = 31.7 y, 84% female). Twenty-eight families (56%) returned valid accelerometer data with ALs. Participants in relationships were more likely to complete ALs (P < .05). Toddler sedentary time did not differ between those with ALs and those without. CONCLUSIONS: We found varied compliance with WT instructions and AL completion. Returned AL quality was poor, presenting challenges in correctly characterizing low-activity counts to improve internal validity of WT and physical activity measures. Support from marital partners may be important for adherence to study protocols.

The Rationale and Logistics for Incorporating Community Health Workers Into the Multidisciplinary Team.

Community Health Workers (CHWs) have shown value in diabetes care. CHWs are often the individuals who provide behavioral lifestyle intervention to underserved communities and are often the first to assist patients in gaining appropriate access to care. As trusted members of their communities, they have the ability to significantly impact psychosocial and biomedical outcomes, making them important members of the behavioral medicine team. However, lack of recognition of CHWs within multidisciplinary teams (MDTs) gives rise to the issue of the underutilization of their services. Therefore, barriers to including CHWs in MDTs including standardized training and strategies to overcome these are discussed.

Response to school-based interventions for overweight and obesity: A systematic scoping review.

Heterogeneity of response to paediatric obesity interventions is one of the greatest challenges to obesity care. While evaluating school-based interventions by mean changes compared to control is important, it does not provide an understanding of the individual variability in response to intervention. The objective of this study was to comprehensively review school-based interventions that reported study results in terms of response and identify definitions of response used. A scoping review was conducted using a systematic search of five scientific databases from 2009 to 2021. Inclusion criteria included randomized controlled trial design, school-based setting, weight-based outcomes (e.g., BMI, BMI z-score), weight-based outcomes analysed among youth with overweight/obesity, a study conducted in a developed country and publication in English. A total of 26 reports representing 25 unique studies were included. Overall, 19% (5/26) of articles reported response. Response was defined in three ways: maintenance/decrease in BMI z-score, decrease in BMI z-score ≥0.10, and decrease in BMI z-score ≥0.20. Few school-based interventions identified an a priori intervention goal or identified the proportion of participants who responded to the intervention. Without such evaluation participants who do not benefit are likely to be overlooked.

Incorporating Nutrition Counseling into Lifestyle Medicine.

Despite considerable evidence that plant-based diets can significantly improve health, medical professionals seldom discuss this with their patients. This issue might occur due to minimal training received in medical education, lack of time, and low self-efficacy for counseling patients about diet. Nutrition and lifestyle change should be considered a core competency for all physicians and health professionals looking for cost-effective ways to improve patient health outcomes and reduce nutrition-related chronic diseases. Strategies for health professionals to acquire nutrition counseling skills in medical training and clinical practices are discussed.

Feasibility and Efficacy of the "FUNPALs Playgroup" Intervention to Improve Toddler Dietary and Activity Behaviors: A Pilot Randomized Controlled Trial.

This study evaluated the feasibility and effects of the Families Understanding Nutrition and Physically Active Lifestyles (FUNPALs) Playgroup on toddler (12-36-month-old) diet and activity behaviors. Parent-toddler dyads were recruited from disadvantaged communities and randomly assigned to receive 10-weekly sessions of the FUNPALs Playgroup (n = 24) or dose-matched health education control group (n = 26). FUNPALs Playgroups involved physical and snack activities, delivery of health information, and positive parenting coaching. The control group involved group health education for parents only. Process outcomes (e.g., retention rate, fidelity) and focus groups determined feasibility and perceived effects. To evaluate preliminary effects, validated measures of toddler diet (food frequency questionnaire and a carotenoid biomarker), physical activity (PA; accelerometers), general and feeding parenting (self-report surveys), and home environment (phone interview) were collected pre and post. The sample comprised parents (84% female) who self-identified as Hispanic/Latino (38%) and/or African American (32%). Retention was high (78%). Parents from both groups enjoyed the program and perceived improvements in their children's health behaviors. Objective measures demonstrated improvement with large effects (η2 = 0.29) in toddler diet (p < 0.001) but not PA (p = 0.099). In conclusion, the FUNPALs Playgroup is feasible and may improve toddler eating behaviors.

Exploring qualities of ethnically diverse parents related to the healthy home environment of toddlers.

Parents serve as role models and household policy makers for their children's home social environment. Also, parents may influence the home physical environment through the provision of resources to support their children's dietary, activity, and sleep behaviors. Understanding the parental characteristics related to children's home environment may allow for tailoring obesity interventions to families' needs. This study aimed to explore parental qualities (general parenting styles, parent feeding practices, and parental BMI) related to healthy home food, physical activity, media and sleep environment of toddlers. A total of 50 multi-ethnic parents with toddler age children who were enrolled in a randomized pilot study of a wellness program completed the Structure and Control in Parent Feeding (SCPF) questionnaire and Comprehensive General Parenting Questionnaire (CGPQ). Parental BMI was calculated using self-reported weight and height data. The Healthy Home Survey, the Home Food Inventory, the Sleep Environment Questionnaire, and items developed for this study were standardized and summed to create home food, physical activity, screen media, and sleep environment scores; high scores reflected healthier environments. To examine the relationships between parental qualities and the home environment, Pearson's correlation test was performed. Parental BMI and overall healthy home environment were inversely associated (r = -0.306; p = 0.032). Structure in general parenting and parental feeding practice were positively correlated with the overall healthy home environment (r = 0.336; p = 0.026) and healthy home food environment (r = 0.415; p = 0.003), respectively. The coercive control general parenting was inversely related to overall healthy home environment score (r = -0.333; p = 0.022). Based on the findings from this study, parents who provide clear communication, set consistent rules, avoid pressure to control their child's behavior, and have lower BMI tend to live in a home environment that support children's health behaviors.

The Importance of Health Values Among Health Care Providers.

Medical professionals' healthy eating and physical activity behaviors are likely to wane as other life events and everyday pressures increase. This is vital because as health behaviors decrease, the likelihood that this topic is addressed with patients also decreases. Increased training to improve health care providers' knowledge about lifestyle behaviors may be inadequate to actually bring about a healthier lifestyle. The area of personal identity and value formation may shed light on a significant barrier in this area. Developing health care professionals who have values consistent with a healthy diet and physical activity, instead of just being informed about it, would increase the likelihood that healthy behavior changes are discussed with patients. Strategies to encourage value formation around healthy lifestyles among medical professionals are discussed.

Disentangling food insecurity and maternal depression: which comes first?

OBJECTIVE: To determine the temporal directionality of the association between food insecurity and maternal depression. DESIGN: Food insecurity was measured at two time points using the eighteen-item USDA Food Security Scale. Maternal depression was measured at two time points using the fifteen-item Composite International Diagnostic Interview-Short Form. Two structural equation models were utilised to evaluate the impact of food insecurity on maternal depression (model 1) and the impact of maternal depression on food insecurity (model 2). Both models controlled for socio-demographic and parenting characteristics and child behaviour problems, along with prior measures of the dependent variable and concurrent measures of the independent variable. SETTING: Fragile Families and Child Wellbeing (FFCW) study, twenty cities across the USA. PARTICIPANTS: 4897 mothers who participated in two waves of the FFCW study. RESULTS: On average, 17 % (time 1) and 15 % (time 2) of mothers experienced food insecurity and 21 % (time 1) and 17 % (time 2) of mothers experienced depression over time. Maternal depression at time 1 was associated with 53 % increased odds (OR = 1·53; B = 0·43; P < 0·001) of food insecurity at time 2, controlling for time 1 food insecurity, concurrent depression and covariates. Food insecurity at time 1 was associated with 36 % increased odds (OR = 1·36; B = 0·31; P < 0·001) of maternal depression at time 2, controlling for time 1 depression, concurrent food insecurity and covariates. CONCLUSIONS: We found a bidirectional relationship between food insecurity and maternal depression. A holistic approach that combines food assistance and mental health services may be an efficacious approach to reducing both depressive symptoms and food insecurity among low-income mothers.

Bidirectional Relationship Between Food Insecurity and Housing Instability.

BACKGROUND: Due to the commonality of material hardship, food insecurity and housing instability are highly correlated. There is a need to assess the bidirectional relationship between food insecurity and housing instability over time. OBJECTIVES: To examine the potential bidirectional associations between food insecurity and housing instability over a 2-year period. DESIGN: Two time points from the Fragile Families and Child Wellbeing Study were used to conduct an analysis on 2368 families. PARTICIPANTS/SETTING: At baseline (1998-2000), researchers recruited primarily unmarried mothers after giving birth from 75 hospitals in 20 cities across the United States. Participants were followed up when the child was 3 years old (2001-2003) and 5 years old (2003-2005). MAIN OUTCOMES MEASURED: Food insecurity was assessed using the 18-item US Department of Agriculture's Food Security Survey. Housing instability was assessed using 6 items that describe housing related hardship. STATISTICAL ANALYSES PERFORMED: Cross-lagged path analyses using structural equation modeling were conducted to test bidirectional relationship of food insecurity and housing instability over time, controlling for sociodemographic characteristics. RESULTS: Families who experienced food insecurity at time 1 were 62% higher odds of experiencing housing instability at time 2 (odds ratio: 1.624, B = 0.485, 95% confidence interval: 0.199, 0.778), controlling for time 1 housing instability, concurrent food insecurity, and covariates. Families who experienced housing instability at time 1 were 40% increased odds of experiencing food insecurity at time 2 (odds ratio: 1.404, B = 0.339, 95% confidence interval: 0.071, 0.619), controlling for food insecurity at time 1, concurrent housing instability, and covariates. CONCLUSIONS: The relationships between food insecurity and housing instability were highly correlated over time, controlling for covariates that are associated with socioeconomic status. Currently, programs designed to reduce food insecurity and housing instability function in isolation. Consolidating antipoverty programs or increasing referrals to various programs may help to reduce these 2 types of economic hardships.

Screen Media: A Powerful Reinforcement.

The use of screen media has significantly increased and several lifestyle consequences have occurred following this change. Screen media exposure is more common among younger age children. Multiple factors may be the reason for this; however, their use is likely reinforced. Parents seek support from screen media devices, which can help calm and occupy their children in a matter of minutes. However, resorting to electronic devices for instant relief is likely to persist due to both negative and positive reinforcement. Reinforcing screen media in this way will make the use of screen devices inextricable for parents and their children. Explaining the issue clearly and coming up with feasible solutions will help minimize the negative health effects of prolonged screen use, the general desirability of screen media devices, and also improve (and increase) healthy screen time habits in children.