Vitamin D intakes and health outcomes in infants and preschool children: Summary of an evidence report.

BACKGROUND: A systematic review was commissioned to support an international expert group charged to update the Food and Agriculture Organisation of the United Nations (FAO)/World Health Organisation (WHO)'s vitamin D intake recommendations for children aged 0-4 years. MATERIALS AND METHODS: Multiple electronic databases were searched to capture studies published from database inception to the 2nd week of June 2020 according to key questions formulated by the FAO/WHO. Relevant studies were summarised and synthesised by key questions and by health outcomes using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. RESULTS: The 146 included studies examined the effects of different vitamin D intake levels on a variety of health outcomes (e.g. infectious disease, growth, neurodevelopment, rickets, and bone mineral density), and on outcomes for setting vitamin D upper limits (e.g. hypercalcemia, hypercalciuria, and nephrocalcinosis). For most outcomes, the strength of evidence was low or very low. Evidence was rated moderate for the effect of daily vitamin D supplementation on raising serum 25(OH)D concentrations, and a random-effects meta-regression analysis of 28 randomised controlled trials (mostly in infants 0-12 months) showed that each 100 IU/d increase in vitamin D supplementation was associated with an average of 1.92 (95% CI 0.28, 3.56) nmol/L increase in achieved 25-hydroxy-vitaminn D (25[OH]D) concentration (n = 53 intervention arms; p = .022) with large residual heterogeneity (I2 = 99.39%). Evidence was very low on two of the upper limit outcomes - hypercalcemia and hypercalciuria. CONCLUSIONS: The evidence report provided the expert group with a foundation and core set of data to begin their work to set vitamin D nutrient reference values. To move the field forward, future studies should use standardised 25(OH)D assay measurements and should examine the relationship between long-term vitamin D status and health outcomes.Key MessagesResults of a large complex systematic review suggest the current totality of evidence from trials and prospective observational studies do not reach sufficient certainty level to support a causal relationship between vitamin D intake and asthma, wheeze, eczema, infectious diseases, or rickets (most trials reported no rickets) in generally healthy infants and young children.In this systematic review, the only body of evidence that reached a moderate level of certainty was regarding the effect of daily vitamin D supplementation (vitamin D3 or D2 supplements to infants/children) on increasing serum 25(OH)D concentrations. However, currently there is no consensus on the definitions of vitamin D status, e.g. deficiency, insufficiency, sufficiency and toxicity, based on serum 25(OH)D concentrations.This systematic review provided an international expert group a foundation and core set of data through intake-response modelling to help set vitamin D nutrient reference values for infants and children up to 4 years of age.

Development of a Community Coalition to Influence Nutrition and Physical Activity in Early Childhood Education.

BACKGROUND: Recognizing insufficient support for healthy eating and physical activity in early childhood education centers in Greenville, South Carolina, a group of stakeholders formed a workgroup as an organizing structure. Members developed and implemented a 2-year community-based participatory research initiative aimed at nutrition and physical activity policy, systems and environment change in 10 early childhood education centers. OBJECTIVES: This article 1) describes engagement efforts and partnerships leading to formation of the workgroup and initiative, 2) presents data on Workgroup members' knowledge and engagement, and 3) shares lessons learned. METHODS: Workgroup member knowledge and engagement related to obesity prevention was measured at two time points during the ECE initiative using the "Stakeholder-driven Community Diffusion Survey." LESSONS LEARNED: Knowledge and engagement scores increased over the measurement period. Scores for engagement were higher than scores for knowledge at both time points. There was a substantial increase in perceived leadership and stewardship, knowledge of intervention factors and how to intervene sustainably, and understanding of local resources and roles. An important strength was stakeholder buy-in and ownership of planning and implementation processes.

Food Choice With Economic Scarcity and Time Abundance: A Qualitative Study.

Consumers with low income in the United States have higher vulnerability to unhealthy diets compared with the general population. Although some literature speculates that scarcity is an explanation for this disparity, empirical evidence is lacking. We conducted a qualitative study of food choice to explore whether scarcity-related phenomena, such as tunneling and bandwidth tax, may contribute to unhealthy dietary choices. We used participant-driven photo elicitation (n = 18) to investigate the food choice behaviors of individuals living in the greater Boston area who met the federal guidelines for poverty. Participants took photos at the point of food acquisition for 1 month, after which we interviewed them using a semistructured interview guide with the photos as prompts. Thematic coding was used for analysis. Respondents had relative time abundance. Two major themes emerged: participants used a set of strategies to stretch their budgets, and they highly prioritized cost and preference when making food choices. The extreme focus on obtaining food at low cost, which required time and effort, was suggestive of tunneling. We found no evidence of the bandwidth tax. Our findings raise the hypothesis of scarcity as a continuum: when individuals experience multiple resource constraints, they experience scarcity; whereas people with very limited finances and relative time abundance may instead be in a prescarcity condition, with a hyperfocus on a scarce resource that could lead to tunneling as constraints increase. Additional studies are needed to understand whether and how tunneling and bandwidth tax emerge, independently or together, as people face different levels and types of scarcity.

Effectiveness of multimodal nutrition interventions during pregnancy to achieve 2009 Institute of Medicine gestational weight gain guidelines: a systematic review and meta-analysis.

BACKGROUND: In 2009, the Institute of Medicine (IOM) published a revision to its 1990 recommendations on gestational weight gain (GWG). The objective of this review is to update a previous systematic review and meta-analysis to evaluate the effectiveness of nutrition interventions in achieving recommended GWG. METHODS: We conducted updated literature searches in MEDLINE® (2012 through 2019), Web of Science (2012 to 6 February 2017), Embase (2016 through 2019), and Cochrane Central Register of Controlled Trials (2012 through 2019). Literature published before January 2012 was identified from a published systematic review. We included controlled trials conducted in the U.S. or Canada among generally healthy pregnant women that compared nutrition interventions with or without exercise to controls (e.g., usual care) and reported total GWG or rate of GWG based on the 2009 IOM GWG guidelines. Two independent investigators conducted screening, data extraction, and risk-of-bias (ROB) assessment. Random-effects meta-analyses were conducted when data were sufficient. RESULTS: Eighteen unique studies were included, of which 11 were conducted in women with overweight or obesity. Nutrition interventions, compared to controls, had a similar effect on total GWG (mean difference = -1.24 kg; 95% CI [-2.65, 0.18]; I2=67.6%) but significantly decreased second and third trimester rate of GWG (-0.07 kg/week; 95% CI [-0.12, -0.03]; I2=54.7%). Nutrition interventions also reduced the risk of exceeding IOM's rate of GWG targets (pooled RR = 0.71; 95% CI [0.55, 0.92]; I2=86.3%). Meta-analyses showed no significant differences in achieving IOM's total GWG or any secondary outcome (e.g., preterm birth or small/large for gestational age) between groups. Most studies were assessed as having some or high ROB in at least two domains. CONCLUSION: Multimodal nutrition interventions designed to meet the 2009 IOM's GWG targets may decrease the rate of GWG over the second and third trimesters but may not decrease total GWG.Key messagesExcessive gestational weight gain is associated with higher risk of many adverse maternal and fetal outcomes and represents a public health concern in the United States and Canada.Nutrition interventions designed to meet the 2009 IOM GWG guidelines may decrease the rates of GWG over the second and third trimesters but may not be effective at reducing total GWG.

Vitamin D and Calcium in Children 0-36 Months: A Scoping Review of Health Outcomes.

METHODS: Updated literature searches were conducted across 5 electronic databases to identify all randomized controlled trials, cohort studies, nested case-control or case-cohort studies, and systematic reviews published after the 2009 U.S. Agency for Healthcare Research and Quality's (AHRQ) evidence report, Vitamin D and Calcium: a Systematic Review of Health Outcomes. In total, 65 studies were summarized and analyzed in the present review. RESULTS: There was a steady increasing trend in the number of publications reporting outcomes related to skeletal health, growth, and infectious disease from 2008 to 2019, although the number of published vitamin D studies was much larger than calcium studies. CONCLUSIONS: The data presented in this review can facilitate assessment of the variety of outcomes and the amount of potentially useful literature available for each outcome. The results of this scoping review can be used to guide the undertaking of the subsequent systematic reviews.