Maternal responsiveness and toddler body mass index z-score: Prospective analysis of maternal and child mealtime interactions.

Responsive feeding, where parents are guided by children's hunger and satiation cues and provide appropriate structure and support for eating, is believed to promote healthier weight status. However, few studies have assessed prospective associations between observed parental feeding and toddler growth. We characterized toddler growth from 18 to 36 months and, in a subset of families, examined whether observed maternal responsiveness to toddler satiation cues and encouraging prompts to eat at 18 and 24 months were associated with toddler body mass index z-score (BMIz) from 18 to 36 months. Participants included 163 toddlers and their mothers with overweight/obesity who had participated in a lifestyle intervention during pregnancy. Anthropometrics were measured at 18, 24, and 36 months. In a subsample, mealtime interactions were recorded in families' homes at 18 (n = 77) and 24 (n = 75) months. On average, toddler BMIz remained stable from 18 to 36 months with 31.3% (n = 51) categorized with a healthy weight, 56.4% (n = 92) with at risk for overweight and 12.3% (n = 20) with overweight. Fewer maternal prompts to eat at 18 months was associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p = .002). Higher child weight status at 12 months was also associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p < .001). Neither 24-month maternal prompts nor 18 or 24 month responsiveness to satiation cues were associated with toddler BMIz. In this diverse sample, weight status was relatively stable from 18 to 36 months. Maternal prompts to eat measured earlier in toddlerhood and prior child weight status were associated with toddler BMIz.

Effect of experimental change in children's sleep duration on television viewing and physical activity.

BACKGROUND: Paediatric observational studies demonstrate associations between sleep, television viewing and potential changes in daytime activity levels. OBJECTIVE(S): To determine whether experimental changes in sleep lead to changes in children's sedentary and physical activities. METHODS: Using a within-subject counterbalanced design, 37 children 8-11 years old completed a 3-week study. Children slept their typical amount during a baseline week and were then randomized to increase or decrease mean time in bed by 1.5 h/night for 1 week; the alternate schedule was completed the final week. Children wore actigraphs on their non-dominant wrist and completed 3-d physical activity recalls each week. RESULTS: Children reported watching more television (p < 0.001) and demonstrated lower daytime actigraph-measured activity counts per epoch (p = 0.03) when sleep was decreased (compared with increased). However, total actigraph-measured activity counts accrued throughout the entire waking period were higher when sleep was decreased (and children were awake for longer) than when it was increased (p < 0.001). CONCLUSION(S): Short sleep during childhood may lead to increased television viewing and decreased mean activity levels. Although additional time awake may help to counteract negative effects of short sleep, increases in reported sedentary activities could contribute to weight gain over time.

Partial sleep deprivation impacts impulsive action but not impulsive decision-making.

Sleep deprivation may lead to increased impulsivity, however, previous literature has focused on examining effects of total sleep deprivation (TSD) rather than the more common condition, partial sleep deprivation (PSD) or 'short sleep'. Moreover, it has been unclear whether PSD impacts impulse-related cognitive processes, and specifically if it differentially affects impulsive action versus impulsive decision-making. We sought to determine if short compared to long sleep (6 vs. 9h/night) impacts impulsive action via behavioral inhibition (Go/No-Go), and/or impulsive decision-making processes of risk taking (Balloon Analogue Risk Task [BART]) and preferences for immediate over delayed rewards (Delay Discounting). In a within-subject design, 34 participants (71% female, mean age=37.0years, SD=10.54) were assigned to four consecutive nights of 6h/night (short sleep) and 9h/night (long sleep) in their own home in random counterbalanced order. Sleep was measured via wrist-worn actigraphs to confirm adherence to the sleep schedules (mean short sleep=5.9h, SD=0.3; mean long sleep=8.6h, SD=0.3, p<0.001). The Go/No-Go, BART, and Delay Discounting tasks were completed following both sleep conditions. Participants had more inhibition errors on the Go/No-Go task after short (mean false alarms=19.79%, SD=14.51) versus long sleep (mean=15.97%, SD=9.51, p=0.039). This effect was strongest in participants reporting longer habitual time in bed (p=0.04). There were no differences in performance following long- versus short-sleep for either delay discounting or the BART (p's>0.4). Overall, these results indicate that four days of PSD diminishes behavioral inhibition abilities, but may not alter impulsive decision-making. These findings contribute to the emerging understanding of how partial sleep deprivation, currently an epidemic, impacts cognitive ability. Future research should continue to explore the connection between PSD and cognitive functions, and ways to minimize the occurrence and negative consequences of short sleep.

Relationship between dietary energy density and dietary quality in overweight young children: a cross-sectional analysis.

BACKGROUND: Observational research has found that lower energy density (ED) diets are related to reduced intake of fat and greater intake of fruits and vegetables. No study has examined the relationship between dietary ED and dietary quality, as determined by the Healthy Eating Index-2005 (HEI), in children who are overweight and obese. OBJECTIVE: Examine the relationship between dietary ED and HEI, determined from 3-d food records, in 156 children, aged 4-9 years, who had ≥85th percentile body mass index presenting for family-based obesity treatment. METHOD: Dietary ED, in kcal/g, was calculated using two methods: food and all beverages consumed (food+bev) and food only consumed (food). For calculation of HEI, all components of the HEI were included except oils. RESULTS: Participants were classified as consuming a low-ED, medium-ED or high-ED diet using tertile cut-off points with ED calculated using food and beverages(food+bev) or food only(food) . After controlling for group difference in child sex and race and parent sex, LOW(food+bev) and LOWfood had significantly (P < 0.05) higher total HEI scores, and total fruit, total vegetable and saturated fat HEI scores than HIGH(food+bev) and HIGHfood , with higher scores indicating greater quality. CONCLUSIONS: Lower dietary ED is associated with higher dietary quality in children presenting for obesity treatment. Additional research investigating an ED prescription on dietary quality in children who are overweight or obese is needed to better understand this relationship.

A pilot randomized controlled trial testing the effects of a routine-based intervention on outcomes in a behavioural weight loss programme.

BACKGROUND: Structured routines aimed at eating and sleep have been successfully employed in weight loss interventions for children. Although such routines are discussed in lifestyle modification programmes for adults, they are not a primary focus. PURPOSE: The purpose of this study is to determine if establishing healthy eating and sleep routines may improve outcomes in a behavioural weight loss (BWL) intervention. METHODS: Twenty-five overweight/obese participants (age = 52.4 ± 9.8; body mass index = 33.5 ± 4.1) were randomly assigned to either a 4-week routine-based intervention (ROU) targeting regular eating and sleep or an education control before beginning an 18-week BWL intervention. RESULTS: Routine-based intervention participants reported adhering to eating routines, with increased 'on-schedule' eating (p = 0.007) and decreased 'off-schedule' eating (p = 0.002) but showed no change in 'on-schedule' sleep (p = 0.74). However, contrary to our hypothesis, ROU participants lost less weight than controls after 6 weeks of BWL (2.3 ± 2.5 vs. 4.6 ± 2.6 kg, p = 0.04) and achieved only modest weight loss over the full 18 weeks (ROU: 3.2 ± 4.6 vs. education control: 5.8 ± 5.7 kg, p = 0.23). CONCLUSIONS: Focusing initially on establishing healthy sleep and eating routines led to poorer, rather than better, subsequent weight loss outcomes. Further studies using a longer initial intervention period or focusing on only sleep or eating behaviour are needed to determine whether establishing routines for eating and sleep behaviours can enhance weight loss in adults.

Efficacy of U.S. paediatric obesity primary care guidelines: two randomized trials.

OBJECTIVE: The objective of this study was to examine the efficacy of U.S. primary care paediatric obesity treatment recommendations, within two randomized trials. METHODS: Between November 2005 to September 2007, 182 families (children aged 4-9 years, body mass index [BMI] ≥85th percentile) were recruited for two separate trials and randomized within trial to a 6-month intervention. Each trial had one intervention that increased child growth-monitoring frequency and feedback to families (GROWTH MONITORING). Each trial also had two interventions, combining GROWTH MONITORING with an eight-session, behavioural, parent-only intervention targeting two energy-balance behaviours (Trial 1: reducing snack foods and sugar-sweetened beverages [DECREASE], and increasing fruits, vegetables and low-fat dairy [INCREASE]; Trial 2: decreasing sugar-sweetened beverages and increasing physical activity [TRADITIONAL] and increasing low-fat milk consumption and reducing television watching [SUBSTITUTES]). Child standardized BMI (ZBMI) and energy intake were assessed at 0, 6 and 12 months. RESULTS: In both trials, main effects of time were found for ZBMI, which decreased at 6 and 12 months (P < 0.01). In Trial 1, ZBMI reduced from 0 to 6 months, which was maintained from 6 to 12 months (ΔZBMI 0 to 12 months = -0.12 ± 0.22). In Trial 2, ZBMI reduced from 0 to 6 and from 6 to 12 months (ΔZBMI 0-12 months = -0.16 ± 0.31). For energy intake, main effects of time were found in both trials and intake reduced from 0 to 6 months (P < 0.05), with Trial 1 reducing intake from 0 to 12 months (P < 0.05). CONCLUSIONS: All interventions improved weight status. Future research should examine effectiveness and translatability of these approaches into primary care settings.

Sleep duration and weight loss among overweight/obese women enrolled in a behavioral weight loss program.

OBJECTIVE: The purpose of this study was to examine whether baseline sleep duration predicts weight loss outcomes in a randomized controlled trial examining a behavioral weight loss (BWL) intervention among overweight and obese (OW/OB) women with urinary incontinence; and whether participation in the BWL intervention is associated with changes in sleep duration. DESIGN: Longitudinal, clinical intervention study of a 6-month BWL program. SUBJECTS: Three hundred sixteen OW/OB women, with urinary incontinence (age: 30-81 years, body mass index (BMI; 25-50 kg m(-2)) enrolled from July 2004-April 2006. MEASUREMENTS: Measured height and weight, self-report measures of demographics, sleep and physical activity. RESULTS: Neither self-reported total sleep time (TST) nor time in bed (TIB) at baseline significantly predicted weight loss outcomes among OW/OB women in a BWL treatment. BWL treatment was successful regardless of how much subjects reported sleeping at baseline, with an average weight loss of 8.19 kg for OW/OB women receiving BWL treatment, versus a weight loss of 1.44 kg in the control condition. Similarly, changes in weight, BMI and incontinence episodes did not significantly predict changes in sleep duration or TIB across the treatment period. CONCLUSION: Although epidemiological and cross-sectional studies support a relationship between short sleep and increased BMI, the present study found no significant relationship between TST or TIB and weight loss for OW/OB women participating in a BWL treatment.

The association of maternal food intake and infants' and toddlers' food intake.

BACKGROUND: Young children's first experiences with food may influence development of food preferences and lifelong eating habits. However, little is known about what factors are associated with the development of eating behaviours in infants and toddlers. Studies with older children and adolescents suggest that parental food intake is associated with children's food intake. The purpose of the present paper is to determine whether this association starts even earlier during infancy and toddlerhood. METHODS: A convenience sample of n= 98 primarily African American mothers of children 6-18 months old completed questionnaires, including questions on their own and their young child's food intake. Mothers completed questions while waiting to be seen by their child's primary care provider. RESULTS: Per maternal report, children consumed fruit 2.45 (1.79) times, vegetables 1.63 (1.51) times and snack foods 2.22 (2.49) times each day. Infants' and toddlers' fruit (r= 0.54, P < 0.001), vegetable (r= 0.42, P < 0.001) and snack food (r= 0.37, P < 0.001) intake were significantly associated with maternal intake of each of these foods, respectively. These significant associations remained even after controlling for additional study variables. CONCLUSION: Even at very young ages, maternal food intake is an important correlate of children's food intake. Taken together with findings documenting significant snack food consumption in this age group, findings suggest that development of prevention and intervention programmes to enhance healthy eating behaviours need to start very early, perhaps just prior to children being introduced to complementary foods.

Clinical nurse specialists: an institutional process for determining priorities.

This article describes a four-step process designed by a midwest teaching hospital to identify priorities for the appointment and use of clinical nurse specialists. In an era of cost containment where the outcomes and effectiveness of staff positions are continually questioned, such a process enhances the objectivity and quality of administrative decision making.