ASSOCIATION BETWEEN BREASTFEEDING AND OVERWEIGHT/OBESITY IN SCHOOLCHILDREN AGED 7-14 YEARS.

OBJECTIVE: To evaluate the prevalence of breastfeeding (BF) and the association between occurrence/duration of BF and overweight/obesity in schoolchildren aged 7-14 years. METHODS: This is a cross-sectional study, conducted in 2012-2013, on schoolchildren aged 7-14 years from Florianópolis, Santa Catarina, Southern Brazil. Weight and height were measured according to procedures of the World Health Organization. Breastfeeding and sociodemographic data were obtained from a questionnaire responded by parents/guardians. BF was categorized as a dichotomous variable (yes/no) and according to duration (months). Nutritional status was evaluated according to the Z score of the body mass index per age for sex and it was categorized into two groups: normal weight (

Association between breastfeeding and overweight/obesity in schoolchildren aged 7-14 years / Associação entre aleitamento materno e sobrepeso/obesidade em escolares de 7-14 anos

ABSTRACT Objective: To evaluate the prevalence of breastfeeding (BF) and the association between occurrence/duration of BF and overweight/obesity in schoolchildren aged 7-14 years. Methods: This is a cross-sectional study, conducted in 2012-2013, on schoolchildren aged 7-14 years from Florianópolis, Santa Catarina, Southern Brazil. Weight and height were measured according to procedures of the World Health Organization. Breastfeeding and sociodemographic data were obtained from a questionnaire responded by parents/guardians. BF was categorized as a dichotomous variable (yes/no) and according to duration (months). Nutritional status was evaluated according to the Z score of the body mass index per age for sex and it was categorized into two groups: normal weight (<Z score+1) and overweight/obesity (≥Z score+1). The adjusted analysis was performed by logistic regression in two age strata (age groups of 7-10 and 11-14 years). Results: 6.6% of schoolchildren had never breastfed; 16.8% had been breastfed for ≤3 months; 16.7%, for 4-6 months; and 59.9%, for ≥7 months. No statistically significant differences were found in the occurrence and duration of BF between the age groups. The prevalence of overweight/obesity was 34.2%. For age groups (7-10 and 11-14 years), the prevalence of overweight/obesity was 36.7% and 29.8%, respectively. Chance of overweight/obesity for the age group of 7-10 years was lower among schoolchildren who were breastfed (OR=0.54; 95%CI 0.33-0.88), when compared with those who never breastfed. When categorized, the chance of overweight/obesity in the age group of 7-10 years was lower for duration of BF ≤3 months (OR=0.41; 95%CI 0.20-0.83), and 4-6 months (OR=0.48; 95%CI 0.28-0.82) when compared with children who never breastfed. Conclusions: BF for at least six months was associated with a lower chance of overweight/obesity for schoolchildren aged 7-10 years. No association was found for schoolchildren aged 11-14 years.

RESUMO Objetivo: Investigar prevalência e duração de aleitamento materno (AM) e sua associação com sobrepeso/obesidade em escolares de 7-14 anos. Métodos: Estudo transversal, realizado em 2012-2013, com escolares de 7-14 anos de Florianópolis, Santa Catarina. Peso e altura foram mensurados segundo preconizado pela Organização Mundial da Saúde (OMS). Dados sociodemográficos e sobre AM foram obtidos por questionários enviados aos responsáveis/cuidadores. A variável amamentação foi analisada como dicotômica (sim/não) e por duração (em meses). O perfil antropométrico foi avaliado por escore Z do índice de massa corporal (IMC) para a idade, segundo sexo, categorizado em: normal (<escore Z+1) e sobrepreso/obesidade (≥escore Z+1). Análises ajustadas foram realizadas (regressão logística) em dois estratos etários (7-10 e 11-14 anos). Resultados: 6,6% dos escolares nunca tinham sido amamentados, 16,8% foram amamentados por ≤3 meses, 16,7% por 4-6 meses e 59,9% por ≥7 meses. Não houve diferença estatística de ocorrência/duração de AM entre os grupos etários. A prevalência de sobrepeso/obesidade foi 34,2%. Nos grupos etários (7-10 e 11-14 anos), a prevalência foi 36,7% e 29,8%, respectivamente. A chance de sobrepeso/obesidade nos escolares de 7-10 anos foi menor entre aqueles que tinham sido amamentados (OR=0,54; IC95% 0,33-0,88), comparando com os nunca amamentados. Quando categorizada, a chance de ter sobrepeso/obesidade nos escolares de 7-10 anos foi menor quando a duração do AM foi ≤3 meses (OR=0,41; IC95% 0,20-0,83) e 4-6 meses (OR=0,48; IC95% 0,28-0,82), em comparação à ausência de AM. Conclusões: AM por pelo menos seis meses foi associado com menor chance de sobrepeso/obesidade para escolares de 7-10 anos. Não foi observada associação para o grupo 11-14 anos.

The Relationship between Written District Policies and School Practices among High-Need Districts in New York State.

BACKGROUND: This study tested the hypothesis that written district wellness policies are associated with higher rates of implementation of nutrition and physical activity practices. METHODS: Written wellness policies and building level practices were assessed for schools (N = 295) within high-need districts (N = 70) in New York State. The relationship between policies and practices was measured using multi-level mixed-effects logistic regressions. RESULTS: Overall, stronger written district policies significantly increase the likelihood of practice implementation in schools. This relationship is strongest for physical education and physical activity items, followed by nutrition standards for competitive foods in middle and high schools. Most elementary schools implemented nutrition practices with or without a policy and there were differences in implementation rates between elementary and middle/high schools. When examined separately, policies were for the most part not significantly associated with implementation of corresponding practices. CONCLUSIONS: Strong and comprehensive written policies are associated with higher rates of practice implementation overall, but the consistency of this relationship varies by policy-practice domain. The newer policy topics areas of school wellness promotion and marketing were less frequently included in written policies. Future research should examine whether districts that strengthen their written policies achieve greater implementation over time.

School Wellness Programs: Magnitude and Distribution in New York City Public Schools.

BACKGROUND: Public schools provide students with opportunities to participate in many discretionary, unmandated wellness programs. Little is known about the number of these programs, their distribution across schools, and the kinds of students served. We provide evidence on these questions for New York City (NYC) public schools. METHODS: Data on wellness programs were collected from program websites, NYC's Office of School Food and Wellness, and direct contact with program sponsors for 2013. Programs were grouped into categories, nutrition, fitness, and comprehensive, and were combined with data on school characteristics available from NYC's Department of Education. Numbers of programs and provision of programs were analyzed for relationships with demographic and school structural characteristics, using descriptive statistics and multiple regression. RESULTS: Discretionary wellness programs are numerous, at 18 programs. Little evidence supports inequity according to student race/ethnicity, income, or nativity, but high schools, new schools, co-located schools, small schools, and schools with larger proportions of inexperienced teachers are less likely to provide wellness programs. CONCLUSIONS: Opportunities exist to further the reach of wellness programs in public schools by modifying them for high school adoption and building capacity in schools less likely to have the administrative support to house them.

Elite Distance Runners and Breastfeeding.

BACKGROUND: Elite female distance runners lack guidelines regarding breastfeeding while training at a high intensity. OBJECTIVES: The purpose of this research was to understand how elite female distance runners manage breastfeeding. METHODS: Semistructured interviews were conducted with 14 women who had had at least one pregnancy within the past 5 years and had achieved a minimum of the USA Track and Field 2012 Olympic Trials "B" entry standard for running for the marathon or equivalent performance for 1,500 m or longer. RESULTS: Using thematic analysis, we identified the following themes: breastfeeding as a barrier to training and competition, limited access to relevant breastfeeding information, and concerns for the baby's health. Our findings show that despite the considerable barriers with which these women contend, they breastfed at higher rates and for longer duration than members of the general public. CONCLUSION: Based on our findings, we argue that elite female distance runners' experiences of breastfeeding would be enhanced if more research were conducted on breastfeeding practices while training and competing at an elite level.

An index measuring adherence to complementary feeding guidelines has convergent validity as a measure of infant diet quality.

The complementary feeding period is an important stage of child development. The study aim was to develop an index reflecting the degree of adherence to complementary feeding guidelines, evaluate its convergent validity, and explore associations with socio-demographic factors and dietary pattern scores in childhood. Data were analyzed from the Avon Longitudinal Study of Parents and Children (n = 6065) using parent-completed dietary questionnaires at 6 mo of age, socio-demographic information, and dietary patterns derived by principal component analysis at age 3 y. The Complementary Feeding Utility Index (CFUI) consists of 14 components: breastfeeding duration, feeding to appetite, timing of introduction to solids, exposure to iron-rich cereals, fruit and vegetable intake, exposure to high-fat/-salt/-sugar foods including sugary drinks, food texture, and meal/snack frequency. Regression analyses were undertaken to investigate associations between index scores, socio-demographic factors, food and nutrient intakes, and dietary pattern scores at age 3 y. Milk and food intake at 6 mo and nutrient intake at 8 mo of age varied across quintiles of index score in largely the expected directions. Associations were found among index score, maternal age, education, social class, maternal smoking history, and prepregnancy BMI. After adjustment for socio-demographic factors, the index score was associated with "processed" [ß = -0.234 (95% CI = -0.260, -0.209)] and "healthy" [ß = 0.185 (95% CI = 0.155, 0.215)] dietary pattern scores at age 3 y. The CFUI is able to discriminate across food intake, nutrient intake, and socio-demographic factors and is associated with later dietary patterns.

A tool for assessing healthy food knowledge in 5-6-year-old Australian children.

OBJECTIVE: In the early years of life, influential attributes are formed and may be difficult to change later in life. Early childhood is now recognised as a key target in the prevention of overweight and obesity, and the knowledge that children gain at this time about food and its health benefits may have an important influence on their dietary choices and preferences in later life. Therefore, an activity was designed using age-appropriate methods to assess nutrition knowledge of young children. DESIGN: The Healthy Food Knowledge Activity was developed using a list of thirty healthy and unhealthy foods and drinks generated from the Australian Guide to Healthy Eating. SETTING: The activity was conducted with individual children from reception classes of South Australian schools. SUBJECTS: Children aged 5-6 years undertook the activity in a pilot study (n 13) and in the main study (n 192). RESULTS: Pilot data indicated good test-retest reliability of the activity (r = 0·84, P < 0·01). In the main study, there was a good distribution of scores with acceptable skewness and kurtosis statistics. A breakdown of responses indicated good face validity, with more obvious foods being more correctly classified. CONCLUSIONS: Children as young as 5-6 years of age can correctly identify healthy foods, and this can be measured objectively. This activity also provides interesting insights regarding misconceptions about foods that could be attributed to influences such as media advertising and that can be addressed by educators of this age group.

Mother-child agreement on the child's past food exposure.

OBJECTIVE: To assess mother-child agreement on the child's past food exposure, and factors affecting response discrepancy. METHODS: Twelve- to 14-year-old children and their mothers (n = 78) in an urban community, a rural community, and 2 orthodontic clinics completed a 69-item food questionnaire to determine mother-child level of agreement on the child's past consumption frequency; response discrepancies; the frequencies that the mother cooked for and ate together with her child; food types; mother-child pair effect; and food item effect. RESULTS: Sixty-eight percent of food items had moderate to good agreement (Kqw > or = 0.41). Rural pairs had lower odds of producing response discrepancy (odds ratio = 0.55). Variances of the mother-child pair and food item random effects were 0.87 and 0.08, respectively. CONCLUSIONS AND IMPLICATIONS: The child's past food exposure recall by the mother and the child had moderate to good agreement, especially among rural mother-child pairs. Mother-child disagreement was not affected by the food items.

Deficiencias nutritivas en niños vegetarianos / Nutritional deficiencies in vegetarian children

Presentamos a cuatro niños vegetarianos, de edades comprendidas entre 1 y 3 años, con múltiples deficiencias nutritivas. En sus dietas se incluían pequeñas cantidades de leche y de huevos (lacto-ovo-vegetarianos) pero no tomaban carne, pescado ni suplementos vitamínicos. En la encuesta nutricional encontramos una ingesta insuficiente de energía, calcio, hierro y vitamina B12. Todos los niños tenían una talla normal, pero con puntuaciones Z bajas (entre -0,77 y -1,28) y un peso muy disminuido (puntuación Z entre - 1,92 y -2,38). Un niño tenía raquitismo clínico con hipocalcemia y déficit de vitamina D. Otro niño tenía raquitismo clínico con niveles normales de vitamina D, sugiriendo que la causa del raquitismo era la deficiencia en calcio. Los datos de laboratorio mostraron en todos lo niños una anemia por déficit de vitamina B12 entre 102 y 130 pg/ml, niveles normales, 180-900 pg/mL ) con VCM elevado, homocisteína sérica elevada y ferritina sérica muy baja, indicando el déficit de hierro. Todos los niños tuvieron una buena respuesta al tratamiento con suplementos nutricionales de vitaminas, calcio, hierro y una modificación parcial de sus dietas, de acuerdo con los padres (AU)

We report four vegetarian children aged between 1 and 3 years old with multiple nutritional deficiencies. Their diets included milk eggs in small amount (lacto-ovo-vegetarian) but not received meat, fish or supplementary vitamins. In the dietary recall we found an inadequate intake of energy, calcium, iron and vitamin B12. All children had normal height but in lower Z-score (between -0.77 an -1.28) and greatly decreased weight (Z-score between -1.92 and -2.38). One children had clinical rickets with hypocalcemia and vitamin D deficiency. Another children had clinical rickets with normal vitamin D levels. This suggests that the calcium deficiency was the cause of rickets. Laboratory data revealed in all children a vitamin B12 deficiency anemia (vitamin b 12 levels between 102 and 130 pg/ml, normal range 180-900 pg/ml) with high MCV, high homocysteine serum levels and low ferritin serum levels. All children responded well to nutritional supplementation with vitamins, calcium, iron and moderate adjustment of diets by mutual agreement with the parents (AU)