See Me, Hear Me, Know Me: Perspectives on Diet and Physical Activity Influences among Teens Living in Rural Texas Communities.

Teens in rural communities are at greater risk of obesity than teens in urban areas. Diet and physical activity influence obesity risk. Understanding their perspectives is an important step in intervention design. This qualitative investigation explored teen perspectives on how living in a rural community influenced their diet and physical activity choices. Forty parent-teen pairs were recruited. Data collection included surveys and telephone interviews. This paper reports teen perspectives identified in the first interview. Thematic analysis was used to code and analyze the data. Findings revealed that the primary factor driving teens' diet and physical activity behaviors was the teens themselves. They clearly understood their role in the choices they made, although they acknowledged not always making the healthiest choice. This belief was driven by their motivation to engage in healthy behaviors, which was influenced by the perceived benefits derived from making healthy choices and from the synergistic relationship between diet and physical activity. Diet and physical activity, in turn, were influenced by the environment, particularly the home, social, and community environments. Family and friends were particularly influential, as well as resource availability. These findings can serve as a foundation for designing interventions tailored to this population.

Diet Quality among Pre-Adolescent African American Girls in a Randomized Controlled Obesity Prevention Intervention Trial.

Consuming an unhealthy diet increases health risks. This study assessed the impact of a culturally adapted behaviorally innovative obesity prevention intervention (The Butterfly Girls and the Quest for Founder's Rock) on diet quality in pre-adolescent non-Hispanic Black/African American girls. The RCT consisted of three groups (experimental, comparison, and waitlist control); block randomization allocated participants to each group. The two treatment groups varied in terms of whether or not they set goals. Data were collected at baseline (prior to receiving the intervention), post 1 (3 months post-baseline), and post 2 (6 months post-baseline). Two dietitian-assisted 24 h dietary recalls were collected at each timepoint. Healthy Eating Index 2015 (HEI-2015) was used to determine diet quality. A total of 361 families were recruited; 342 completed baseline data collection. No significant differences in overall HEI score or component scores were observed. To attain more equitable health outcomes, future efforts to promote dietary intake change among at-risk children should explore other behavior change procedures and employ more child-friendly dietary assessment methods.

Associations of prenatal phthalate exposure with neurobehavioral outcomes in 4.5- and 7.5-month-old infants.

Phthalates are ubiquitous endocrine-disrupting chemicals, and research indicates that prenatal exposure to some phthalates may affect neurodevelopment. In a prospective birth cohort study, five first-morning urine samples collected across pregnancy were pooled and the following phthalate biomarkers assessed: sum of di-(2-ethylhexyl) phthalate metabolites (ΣDEHP), sum of diisononyl phthalate metabolites (ΣDINP), sum of dibutyl phthalate metabolites (ΣDBP), sum of anti-androgenic metabolites (ΣAA), monoethyl phthalate (MEP), and sum of all phthalate metabolites (ΣAll). The Ages & Stages Questionnaires® (ASQ), a standardized parent-reported, age-adapted screening tool, measured communication, personal-social, problem solving, and motor domains in infants at 4.5 and 7.5 months (n = 123). Adjusting for maternal age, annual household income, gestational age at birth, infant age at assessment, and sex, repeated-measures generalized linear regression models were used to examine associations between prenatal phthalate urine biomarker concentrations and domain scores (assuming a Poisson distribution). Beta estimates were exponentiated back to the domain scale for ease of interpretation. Mothers were mostly white and college-educated, and most reported an annual household income of ≥$60,000. Associations of phthalate concentrations with ASQ outcomes are presented as follows: (1) anti-androgenic phthalate metabolites (ΣDEHP, ΣDINP, ΣDBP, and ΣAA), (2) MEP, which is not anti-androgenic, and (3) ΣAll. Overall, anti-androgenic phthalates were associated with higher (i.e., better) scores. However, there were exceptions, including the finding that a one-unit increase in ΣDBP was associated with a 12% increase in problem solving scores in 4.5-month-old females (ß = 1.12; 95% CI: 0.99, 1.28; p = 0.067) but a 85% decrease for 7.5-month-old females (ß = 0.54; 95% CI: 0.3, 0.99; p = 0.047). In contrast, MEP was associated with poorer scores on several outcomes. Sex- and timepoint-specific estimates demonstrated a one-unit increase in MEP was associated with: a 52% decrease in personal-social scores in 7.5-month-old males (ß = 0.66; 95% CI: 0.46, 0.95; p = 0.02), a 39% decrease in fine motor scores in 7.5-month-old males (ß = 0.72; 95% CI: 0.52, 0.98; p = 0.035), and a 6% decrease in fine motor scores in 4.5-month-old females (ß = 0.94; 95% CI: 0.88, 0.99; p = 0.03). A one-unit increase in ΣAll was associated with a 4% increase in personal-social scores in 4.5-month-old males (ß = 1.04; 95% CI: 0.99, 1.1; p = 0.08) but a 17% decrease in 7.5-month-old males (ß = 0.85; 95% CI: 0.73, 0.99; p = 0.03). These data suggest age- and sex-specific associations of prenatal phthalates with infant neurobehavior. The current findings should be confirmed by longitudinal studies with larger sample sizes.

Associations among diet, the gastrointestinal microbiota, and negative emotional states in adults.

Objective: Habitual diet impacts mood and the human gastrointestinal (GI) microbiota. Yet, studies infrequently control for diet when evaluating associations between mood and GI microbiota. Accordingly, we aimed to investigate relationships among diet, GI microbiota, and mood in adults without mood disorders by conducting a cross-sectional examination of dietary intake, subjective emotional state, and fecal microbial taxa abundances. Methods: Adults (N = 133; 25-45 years of age) without physician-diagnosed mood disorders were studied. Fecal DNA was extracted, and the V4 region of the 16S rRNA gene was sequenced. Sequences were analyzed using QIIME2. Subjective mood state was assessed using the 42-item Depression, Anxiety, and Stress Scale (DASS-42). Habitual dietary intake was measured with the National Cancer Institute's Diet History Questionnaire II, and diet quality was evaluated with the 2010 Healthy Eating Index (HEI). Results: Relationships were observed between 28 bacterial taxa and DASS-42 scores. Sex-dependent associations were observed among 21 bacterial taxa and DASS-42 scores, including an inverse relationship between Anxiety scale scores and Bifidobacterium in females and an inverse relationship between Depression scale scores and Lactobacillus in males. HEI total fruit and dairy components were inversely associated with Depression and Stress scales, respectively. Conclusions: These results suggest GI microbes are related to mood in adults without diagnosed mood disorders and that these relationships differ by sex and are influenced by dietary fiber intake. Incorporating dietary intake data in gut-microbiota-brain studies may help clarify the roles of specific microbes and dietary components in mental health symptoms.

Implementation and Evaluation of the Abriendo Caminos Program: A Randomized Control Trial Intervention for Hispanic Children and Families.

OBJECTIVE: To describe the methodology of a family-focused, culturally tailored program, Abriendo Caminos, for the prevention of excess weight gain in children. DESIGN: Randomized control trial with outcome assessment at pretest, posttest, and 6 months after intervention or abbreviated-attention control group. SETTING: Community setting across 5 sites (Illinois, California, Iowa, Texas, and Puerto Rico). PARTICIPANTS: Mexican American and Puerto Rican families (parent and 1 child aged 6-18 years). A sample size of 100 families (50 intervention and 50 control) per site (n = 500) will provide adequate power to detect intervention effects. INTERVENTION: Families will participate in 6 weekly, 2-hour group workshops on nutrition education through combined presentations and activities, family wellness, and physical activity. MAIN OUTCOME MEASURES: The primary outcome is prevention of excess weight gain in children; secondary outcomes include changes in child diet, specifically fruit, vegetable, and sugar-sweetened beverage consumption, and changes in parents' diets and improvement of family routines. Measures will be collected at baseline, postintervention, and 6 months after. ANALYSIS: Modeling to assess changes within and between experimental groups will be checked using standard methods including assessment of model fit, influence diagnostics, adjusted R2, and multicollinearity. Significance of effects will be examined using Type III tests.

Predictors and Outcomes of Mealtime Emotional Climate in Families With Preschoolers.

Objective: Mealtime emotional climate (MEC) is related to parent feeding and mental health, and possibly to child food consumption. However, MEC has been inconsistently assessed with a variety of coding schemes and self-report instruments, and has not been examined longitudinally. This study aims to characterize MEC systematically using an observational, count-based coding scheme; identify whether parent feeding or mental health predict MEC; and examine whether MEC predicts child food consumption and weight. Methods: A subsample of parents (n = 74) recruited from a larger study completed questionnaires when children were about 37 months, participated in a home visit to videotape a mealtime when children were about 41 months, and completed questionnaires again when children were about 51 months old. Maternal and child positive and negative emotions were coded from videotaped mealtimes. Observational data were submitted to cluster analyses, to identify dyads with similar emotion expression patterns, or MEC. Logistic regression was used to identify predictors of MEC, and Analysis of Covariance was used to examine differences between MEC groups. Results: Dyads were characterized as either Positive Expressers (high positive, low negative emotion) or All Expressers (similar positive and negative emotion). Increased food involvement feeding practices were related to decreased likelihood of being an All Expresser. Positive Expressers reported that their children ate more healthy food, compared with All Expressers. Conclusions: Observed MEC is driven by maternal emotion, and may predict child food consumption. Food involvement may promote positive MEC. Improving MEC may increase child consumption of healthy foods.

The impact of environmental, parental and child factors on health-related behaviors among low-income children.

Multi-level factors act in concert to influence child weight-related behaviors. This study examined the simultaneous impact of variables obtained at the level of the home environment (e.g., mealtime ritualization), parent (e.g., modeling) and child (e.g., satiety responsiveness) with the outcomes of practicing healthy and limiting unhealthy child behaviors (PHCB and LUCB, respectively) in a low-income U.S. SAMPLE: This was a cross sectional study of caregivers of preschool children (n = 432). Caregivers were interviewed using validated scales. Structural equation modeling was used to examine associations with the outcomes. Adjusting for study region, demographics and caregiver's body mass index, we found significant associations between PHCB and higher mealtime ritualizations (ß: 0.21, 95% confidence interval [CI]: 0.11; 0.32, more parental modeling (ß: 0.39, 95% CI: 0.27; 0.49) and less parental restrictive behavior (ß: -0.19, 95% CI: -0.29; -0.10). More parental covert control (ß: 0.44, 95% CI: 0.35; 0.54), more parental overt control (ß: 0.14, 95% CI: 0.03; 0.25) and less parental permissive behavior (ß: -0.25, 95% CI: -0.34; -0.09) were significantly associated with LUCB. Findings suggest the synergistic effects of mealtime ritualizations and covert control at the environmental-level and parental modeling, overt control, restrictive and permissive behavior at the parent-level on the outcomes. Most factors are modifiable and support multidisciplinary interventions that promote healthy child weight-related behaviors.

Lipoprotein Biomarkers and Risk of Cardiovascular Disease: A Laboratory Medicine Best Practices (LMBP) Systematic Review.

BACKGROUND: Controversy exists about the incremental utility of nontraditional lipid biomarkers [e.g., apolipoprotein (apo) B, apo A-I, and non-HDL-C] in improving cardiovascular disease (CVD) risk prediction when added to a conventional model of traditional risk factors (e.g., total cholesterol, LDL cholesterol, HDL cholesterol, sex, age, smoking status, and blood pressure). Here we present a systematic review that was conducted to assess the use of nontraditional lipid biomarkers including apo B, apo A-I, apo B/A-I ratio, and non-HDL-C in improving CVD risk prediction after controlling for the traditional risk factors in populations at risk for cardiovascular events. CONTENT: This systematic review used the Laboratory Medicine Best Practices (LMBP™) A-6 methods. A total of 9 relevant studies published before and including July 2015 comprised the evidence base for this review. Results from this systematic review indicated that after the adjustment for standard nonlipid and lipid CVD risk factors, nontraditional apolipoprotein biomarkers apo B (overall effect = relative risk: 1.31; 95% CI, 1.22-1.40; 4 studies) and apo B/apo A-I ratio (overall effect = relative risk: 1.31; 95% CI, 1.11-1.38; 7 studies) resulted in significant improvement in long-term CVD risk assessment. SUMMARY: Available evidence showed that nontraditional lipid biomarkers apo B and apo B/apo I ratio can improve the risk prediction for cardiovascular events after controlling for the traditional risk factors for the populations at risk. However, because of insufficient evidence, no conclusions could be made for the effectiveness of apo A-I and non-HDL-C lipid markers to predict the CVD events, indicating a need for more research in this field.

The Independent and Cumulative Effect of Early Life Risk Factors on Child Growth: A Preliminary Report.

BACKGROUND: Early life risk factors may promote faster infant growth leading to childhood obesity. We examined growth patterns (birth to 12 months) and their association with early life risk factors. METHODS: Participants were drawn from an ongoing birth cohort of 351 mothers. Child weight and length were obtained at birth, 6 weeks, and 3, 6, 9, and 12 months. Independent variables and demographics were tested as risk factors for inclusion in the cumulative risk score if they were significantly associated with change in weight-for-length z-scores (WFLZ; month 12 minus birth) or based on established evidence for an association with child growth. Multiple regression was used to determine the association of change in WFLZ with low maternal education, low month 3 postpartum maternal weight loss, and nonexclusive breastfeeding by month 3 (use of formula) or their cumulative risk. Trajectory groups were identified using semiparametric mixture models and their association with the risk factors and cumulative risk score was tested using logistic regression. RESULTS: Nonexclusive breastfeeding by month 3 was associated with greater WFLZ increase. We identified three trajectory groups: low-rising (14.5%), mid-stable (59.4%), and high-rising (26.1%). Low-rising versus mid-stable group membership doubled with nonexclusive breastfeeding by month 3 (odds ratio [OR] = 2.24; 95% confidence interval [CI] = 1.05-4.80), but increased the most among children who had three risk factors compared to none (OR = 4.82; 95% CI = 1.14-20.32). No relationships were observed with high-rising growth. CONCLUSIONS: Early life risk factors influence the development of growth trajectories during the first year in a cumulative fashion.

Parental perception of child weight in the first two years-of-life: a potential link between infant feeding and preschoolers' diet.

Approximately 23% of preschoolers are overweight or obese. Establishing a healthy dietary lifestyle at an early age can improve later child diet and body weight. This study examined the determinants of past infant feeding practices that do not follow standard feeding recommendations (breastfeeding for less than 6 months duration, cow's milk prior to the first year of age and solid foods at or before 4 months of age). It also examined the role of parental perception of child weight in the first 2 years-of-life on past infant feeding practices as well as current child diet and body weight. Families of 497 preschoolers aged 22-63 months (39.0 ± 8.2) were recruited from 30 child care centers in East-Central Illinois. Main findings indicate that past infant feeding practices were common and varied by socio-demographic factors including race/ethnicity, parental education and child gender. Children perceived as overweight in the first 2 years-of-life tended to breastfeed for lesser duration. Additionally, the majority (79.8%) of preschoolers who were classified as overweight using BMI percentile were perceived as non-overweight by the parent in the first 2 years-of-life. Mean daily total fatty/sugary food intake was higher among those perceived to be non-overweight in the first 2 years-of-life. These findings have identified parental perception of child weight in the first 2 years-of-life as a modifiable risk factor for unhealthy child diet and obesity among preschoolers.

Childhood overweight/obesity and pediatric asthma: the role of parental perception of child weight status.

Childhood obesity and asthma are on the rise in the U.S. Clinical and epidemiological data suggest a link between the two, in which overweight and obese children are at higher risk for asthma. Prevention of childhood obesity is preferred over treatment, however, in order to be receptive to messages, parents must perceive that their child is overweight. Many parents do not accurately assess their child's weight status. Herein, the relation between parental perceptions of child weight status, observed body mass index (BMI) percentiles, and a measure of child feeding practices were explored in the context of asthma, food allergy, or both. Out of the children with asthma or food allergy that were classified as overweight/obese by BMI percentiles, 93% were not perceived as overweight/obese by the parent. Mean scores for concern about child weight were higher in children with both asthma and food allergy than either condition alone, yet there were no significant differences among the groups in terms of pressure to eat and restrictive feeding practices. In summary, parents of children with asthma or food allergy were less likely to recognize their child's overweight/obese status and their feeding practices did not differ from those without asthma and food allergy.

Pancreatic cancer in Saudi patients treated at tertiary institution. Ten years retrospective study.

OBJECTIVES: To describe presentation, management, and outcome, and determine prognostic factors for pancreatic cancer patients. METHODS: A retrospective review of patients diagnosed with pancreatic cancer at King Abdulaziz Medical City, Riyadh, Saudi Arabia during the period from January 2000 to December 2010. Descriptive statistics were conducted on the collected data and survival was estimated using the Kaplan Meier estimate. Univariate and multiple regression analyses were carried out. RESULTS: The medical records of 179 patients were reviewed. The patients' median age was 63 years ranging from 15-96 years, and 116 (64.8%) of them were male. The one-year survival rate was 39% and the 5-year survival was 10%. The median overall survival (OS) was 6.9 months. Age at diagnosis, grade, T stage, N stage, M stage, TNM stage group, and the combined stage group (stage III/IV versus others), site of distant metastasis, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9, surgery and chemotherapy were significant predictors for OS on an univariate Cox proportional hazards regression analysis. A multiple regression model including all the significant predictors was conducted. Age at the time of diagnosis and M stage were significant variables. CONCLUSION: Our patients present at a younger age and have better 5-year survival compared with the United States Surveillance Epidemiology and End Results data, which deserves further evaluation. Age and disease stage were identified as independent prognostic factors for survival in this patient population.

Comparison of anthropometric measures of obesity in childhood allergic asthma: central obesity is most relevant.

BACKGROUND: Established indicators of central obesity include waist circumference, waist/height ratio, and the conicity index. Studies using such measures (as opposed to body mass index [BMI] percentiles) to characterize the association between obesity and asthma are lacking, despite the fact that these measures have been shown to be most relevant for many other chronic diseases. OBJECTIVES: We sought to examine measures assessing the distribution of obesity in the context of childhood allergic rhinitis and asthma and to elucidate the association of obesity, including central obesity, with allergic asthma in children. METHODS: Children with allergic rhinitis with (cases) or without (control subjects) asthma were recruited. BMI percentiles were derived by using national growth charts. Waist circumference, waist/height ratio, and conicity index values were obtained. RESULTS: Central obesity was associated with asthma, asthma severity, lower lung function, and reduced atopy in asthmatic subjects. CONCLUSION: Measures of central obesity are more associated with the presence of asthma and asthma severity in children with allergic rhinitis when compared with standard BMI measures.