Faculty Bibliography

BACKGROUND:Child appetite traits (ATs) are associated with later child weight and obesity risk. Less research has focused on ATs in low-income Hispanic children or included longitudinal associations with infant weight. OBJECTIVE:To determine stability of ATs during infancy and childhood and their relationship with subsequent weight and obesity risk at age 3 years among low-income Hispanic children. DESIGN/METHODS:A secondary longitudinal analysis of data from the Starting Early Program randomized controlled obesity prevention trial. PARTICIPANTS/SETTING/METHODS:Three hundred twenty-two low-income, Hispanic mother-child pairs enrolled between 2012 and 2014 in a public hospital in New York City. MAIN OUTCOME MEASURES/METHODS:ATs, including Slowness in Eating, Satiety Responsiveness, Food Responsiveness, and Enjoyment of Food were assessed using the Baby and Child Eating Behavior Questionnaires at ages 3 months, 2 years, and 3 years. Main outcome measures were child standardized weight-for-age z score (WFAz) and obesity risk (WFA≥95th percentile) at age 3 years. STATISTICAL ANALYSES PERFORMED/METHODS:AT stability was assessed using correlations and multilevel modeling. Linear and logistic regression analyses examined associations between ATs and child WFAz and obesity risk at age 3 years. RESULTS:There was limited stability for all ATs measured over time. During infancy, Slowness in Eating was associated with lower 3-year WFAz (B = -0.18, 95% CI -0.33 to -0.04; P = 0.01). At age 2 years, Slowness in Eating and Satiety Responsiveness were associated with lower WFAz (B = -0.29, 95% CI -0.47 to -0.12; P < 0.01; B = -0.36, 95% CI -0.55 to -0.17; P < 0.01) and obesity risk (adjusted odds ratio 0.49, 95% CI 0.28 to 0.85; adjusted odds ratio 0.61, 95% CI 0.38 to 0.99) at 3 years. Increased Slowness in Eating and Satiety Responsiveness over time were associated with lower 3-year WFAz (B = -0.74, 95% CI -1.18 to -0.2 [Slowness in Eating]; B = -1.19, 95% CI -1.87 to -0.52 [Satiety Responsiveness], both P values = 0.001). Higher Enjoyment of Food over time was associated with higher 3-year WFAz (B = 0.62, 95% CI 0.24 to 1.01; P = 0.002). CONCLUSIONS:Infants with lower Slowness in Eating and Satiety Responsiveness may have higher levels of obesity risk and need more tailored approaches to nutrition counseling and obesity prevention.

Social determinants of health influence child health behavior, development, and outcomes. This paper frames social capital, or the benefits that a child receives from social relationships, as a positive social determinant of health that helps children exposed to adversity achieve healthy outcomes across the life course. Children are uniquely dependent on their relationships with surrounding adults for material and non-material resources. We identify and define three relevant aspects of social capital: 1) social support, which is embedded in a 2) social network, which is a structure through which 3) social cohesion can be observed. Social support is direct assistance available through social relationships and can be received indirectly through a caregiver or directly by a child. A child's social network describes the people in a child's life and the relationships between them. Social cohesion represents the strength of a group to which a child belongs (e.g. family, community). Pediatric primary care practices play an important role in fostering social relationships between families, the health care system, and the community. Further research is needed to develop definitional and measurement rigor for social capital, to evaluate interventions (e.g. peer health educators) that may improve health outcomes through social capital, and to broaden our understanding of how social relationships influence health outcomes.

OBJECTIVE:To assess relationships between material hardships, shortened sleep duration, and suboptimal sleep practices across infancy and toddlerhood in low-income Hispanic families. METHODS:We analyzed longitudinal data of 451 low-income Hispanic mother-child pairs from a child obesity prevention trial. During infancy and toddlerhood, we used adjusted linear regression to assess associations between material hardship (financial difficulty, food insecurity, housing disrepair, multiple hardships), sleep duration (24-hour, night), and the number of suboptimal sleep practices (e.g., later bedtime, co-sleeping). We used adjusted linear regression to assess the longitudinal association between the number of suboptimal sleep practices in infancy and toddlerhood, and tested whether specific or multiple hardships moderated this association. RESULTS:In infants, financial difficulty and multiple hardships were associated with decreased night sleep (B=-0.59 hours, 95% CI: -1.04, -0.14; and B=-0.54 hours, 95% CI: -1.00, -0.08). Housing disrepair was associated with decreased 24-hour sleep (B=-0.64 hours, 95% CI: -1.29, -0.01). In toddlers, each additional suboptimal sleep practice was associated with a decrease in night sleep (B=-0.19 hours, 95% CI: -0.29, -0.09). Each additional suboptimal sleep practice in infancy was associated with a 0.30 increase in the number of suboptimal sleep practices in toddlerhood (p<0.001), with greater increases for those with food insecurity or multiple hardships. CONCLUSION/CONCLUSIONS:Specific and multiple hardships shortened sleep duration during infancy, and moderated the increase of suboptimal sleep behaviors between infancy and toddlerhood. Future studies should consider these early critically sensitive periods for interventions to mitigate material hardships and establish healthy sleep practices.

OBJECTIVES/OBJECTIVE:To determine impact of a primary care-based child obesity prevention intervention beginning during pregnancy on early childhood weight outcomes in low-income Hispanic families. METHODS:-scores (WFAzs) from clinical anthropometric measures, obesity prevalence (weight for age ≥95th percentile), and excess weight gain (WFAz trajectory) from birth to age 3 years. Secondary outcomes included dose effects. RESULTS:= .02) decreased as attendance increased with low, medium, and high attendance. CONCLUSIONS:Mean WFAz and growth trajectories were lower for the intervention group through age 2 years, but there were no group differences at age 3. Further study is needed to enhance sustainability of effects beyond age 2.

OBJECTIVE:To describe total and trimester-specific gestational weight gain (GWG) among low-income Hispanic women and determine whether these GWG exposures are associated with infant anthropometric outcomes at birth and 6 months. STUDY DESIGN/METHODS:trimester GWG rates (kg/week) and categorized as inadequate, adequate, and excessive according to the 2009 Institute of Medicine recommendations. Multivariable linear and modified Poisson regressions estimated associations of infant anthropometric outcomes (birthweight, small-for-gestational age [SGA], large-for-gestational age [LGA], rapid weight gain, and weight-for-age, length-for-age, and weight-for-length z-scores at 6 months) with GWG categories. RESULTS:trimesters were associated with greater weight outcomes at birth and 6 months (ß range for z-scores = 0.24 to 0.35, p < 0.05). CONCLUSIONS:Counseling women about health behaviors and closely monitoring GWG beginning in early pregnancy is necessary, particularly among populations at high-risk of obesity.

Hispanic women have a higher prevalence of weight associated complications in pregnancy. This ethnic disparity is likely related to behavior patterns, social circumstances, environmental exposures, and access to healthcare, rather than biologic differences. The objective was to determine associations between sociodemographic characteristics, health behaviors, and psychosocial stressors and gestational weight gain (GWG) in low-income Hispanic women. During pregnancy, information on sociodemographic characteristics, health behaviors, and psychosocial stressors were collected. Linear regression estimated mean differences in GWG by selected predictors. Multinomial logistic regression estimated odds of inadequate and excessive GWG by selected predictors. Five-hundred and eight women were included, 38% had inadequate and 28% had excessive GWG; 57% with a normal pre-pregnancy BMI had inadequate GWG. Compared to women with normal BMI, women with overweight or obesity were more likely to have excessive GWG (aRRR = 1.88, 95% CI: 1.04, 3.40 and aRRR = 1.98, 95% CI: 1.08, 3.62, respectively). Mean total GWG was higher among women who were nulliparous (ß = 1.34 kg, 95% CI: 0.38, 2.29) and those who engaged in ≥3 h of screen time daily (ß = 0.98 kg, 95% CI: 0.02, 1.94), and lower among women who were physically active during pregnancy (ß = -1.00 kg, 95% CI: -1.99, -0.03). Eating breakfast daily was associated with lower risk of inadequate GWG (aRRR = 0.47, 95% CI: 0.26, 0.83). Depressive symptoms and poor adherence to dietary recommendations were prevalent, but none of the psychosocial or dietary variables were associated with GWG. In this cohort of primarily immigrant, low-income, Hispanic women, there were high rates of poor adherence to diet and physical activity recommendations, and a majority of women did not meet GWG guidelines. Modifiable health behaviors were associated with GWG, and their promotion should be included in prenatal care.

OBJECTIVE:Feeding concerns are common in the first 2 years of life and typically reflect maternal perceptions occurring within the larger context of the parent-child relationship. We aimed to determine whether (1) maternal depressive systems predicted perceived picky eating, mediated by maternal negative perceptions; (2) receipt of the Video Interaction Project (VIP) parenting intervention impacted perceived picky eating through this pathway; and (3) perceived picky eating was associated with child growth or subsequent dietary patterns. METHODS:We performed a partial longitudinal analysis of 187 low-income, predominantly Hispanic mother-child dyads enrolled in a randomized controlled trial of the VIP. Mother-infant dyads were enrolled postpartum in an urban public hospital. Participants randomized to the VIP met with an interventionist on days of well-child visits; sessions were designed to facilitate interactions in play and shared reading through provision of learning materials and review of videotaped parent-child interaction; the curriculum did not contain feeding-specific elements. We used structural equation modeling to determine direct, indirect, and total effects of maternal depressive symptoms, maternal negative perceptions, and the VIP on perceived picky eating. We then tested associations between perceived picky eating and (1) child growth, using multivariable linear regression and multilevel modeling; and (2) subsequent child dietary consumption, using multivariable multinomial logistic regression. RESULTS:Maternal depressive symptoms had significant total effects on negative maternal perceptions (β = 0.32, p < 0.001) and perceived picky eating (β = 0.21, p < 0.01) after controlling for potential confounders. This effect was partially mediated by maternal negative perceptions (indirect effect: β = 0.06, p = 0.04). When used in the model as the predictor, the VIP had a significant total effect on perceived picky eating (β = -0.16, p = 0.02), which was partially mediated by maternal depressive symptoms and negative perceptions (indirect effect: β = -0.05, p = 0.02). Perceived picky eating was not associated with child diet at age 2 years or adiposity from 6 months to 3 years. CONCLUSION/CONCLUSIONS:Maternal concerns about picky eating may reflect deeper depressive symptoms and negative perceptions of her child's behavior. Interventions designed to facilitate positive parenting in general may lessen feeding-specific concerns, such as picky eating. Although reassurance about growth and nutritional outcomes for children perceived as picky eaters is appropriate, clinicians should also consider probing for underlying symptoms of depression that could lead to eating concerns.