Jennifer Woo Baidal

All Publications

• Bias, Prejudice, Discrimination, Racism, and Social Determinants: The Impact on the Health and Well-Being of Latino Children and Youth. Academic pediatrics Mendoza, F. S., Woo Baidal, J. A., Fernández, C. R., Flores, G. 2024; 24 (7S): S196-S203

  Abstract

  This narrative review focuses on the impact of bias, prejudice, discrimination, racism (BPDR), social determinants of health, and structural racism on Latino children's health and well-being. The race/ethnicity, country of origin, immigrant/generational status, limited English proficiency (LEP), acculturation level, and social class of Latino children and their parents can heighten or modify the impact of BPDR. These differences have been shown to affect BPDR among Latino adults and presumably for their children. Surveys of Latino adolescents reveal that 60% have experienced discrimination, with first- and second-generation teens having a higher prevalence. These experiences are magnified by adverse social determinants/structural racism. BPDR can impact Latino children prenatally through adolescence. Bias involving neonatal, primary, and inpatient pediatric services has been reported. In 2021, Latino children were 19% less likely to complete preventive care, and 32% of LEP children had no medical home. School-age Latino children experience system inequities associated with chronic physical and mental health conditions. BPDR is also seen in educational performance but can be buffered by a strong racial/ethnic self-identity. To address BPDR/structural racism for Latino children, we suggest pediatricians: 1) increase the Latino child-health workforce to address BPDR internally and externally, 2) advocate for data collection on and monitoring of Latino children's disparities and racism metrics in pediatric services, to improve quality of care for Latino children and their families, and 3) advocate for child health equity. Together, these steps will help eliminate BPDR for Latino children and ensure they obtain their full potential.

  View details for DOI 10.1016/j.acap.2023.12.013

  View details for PubMedID 39428154

• Applying an Equity Lens to Pediatric Obesity: Clinical, Environmental, and Policy Considerations for Clinicians. Pediatric clinics of North America Orr, C. J., Gorecki, M. C., Woo Baidal, J. A. 2024; 71 (5): 805-818

  Abstract

  The etiology of pediatric obesity is complex and multifactorial. This article encourages pediatric clinicians to consider patient's socioenvironmental context and structural discrimination as drivers of pediatric obesity. Viewing pediatric obesity through an equity lens can inform clinical practice, advocacy, and policy to promote equity.

  View details for DOI 10.1016/j.pcl.2024.07.001

  View details for PubMedID 39343494

• Participant and Stakeholder Perceptions of the Food FARMacy Emergency Food Assistance Program for the Coronavirus Disease 2019 Pandemic: A Qualitative Study. Journal of the Academy of Nutrition and Dietetics Finkel, M. A., Barrios, D., Partida, I., Kelman, E., Hulse, E., Rosenthal, A., Reiss, J., Schwartz, R., Meyer, D., Woo Baidal, J. A. 2024; 124 (9): 1118-1133

  Abstract

  Food FARMacy is a clinical-community emergency food assistance program developed in response to food insecurity during the COVID-19 pandemic. Few qualitative studies have examined participant, and clinical and community stakeholder experiences with these food assistance programs.To examine the motivations, experiences, and perceptions of Food FARMacy participants and program stakeholders.A qualitative study using in-depth interviews between March 2021 and July 2021.Twenty-four Food FARMacy participants and 10 program stakeholders in New York, NY (Manhattan, Brooklyn, and Queens) older than age 18 years were interviewed.Interviews were recorded, transcribed, translated, and analyzed using thematic analysis. Participant and program stakeholder interviews were analyzed separately. Themes that were salient in both groups were combined for reporting.Both program participants and stakeholders perceived: pandemic-related demands combined with reduced resources motivated participation; convenience, safety, and ease of access facilitated program retention; participants valued fresh produce and diversity of foods; the program improved diet and health; minimizing food waste was a priority; and social cohesion was an unexpected program benefit. Two additional themes among only program stakeholders also were identified: aligned values, flexibility, and communication were key to successful partnerships; and trust between community partners and community members drove programmatic success.Results suggest that a multisite clinical-community partnership to provide emergency food assistance in New York City can be leveraged to reduce barriers to healthy food access and address food insecurity during crises.

  View details for DOI 10.1016/j.jand.2023.10.021

  View details for PubMedID 37926236

  View details for PubMedCentralID PMC11068857

• Associations of Infant Sleep Characteristics with Childhood Cognitive Outcomes. Journal of developmental and behavioral pediatrics : JDBP Finkel, M. A., Duong, N., Hernandez, A., Goldsmith, J., Rifas-Shiman, S. L., Dumitriu, D., Oken, E., Shechter, A., Woo Baidal, J. A. 2024

  Abstract

  The objective of this study was to quantify associations of infant 24-hour sleep duration and nighttime sleep consolidation with later child cognition.This study included children from Project Viva, a prospective cohort in Massachusetts with (1) sleep measures in infancy (median age 6.4 months) and (2) child cognition in early childhood (median age 3.2 years) or mid-childhood (median age 7.7 years). Main exposures were parental reports of infant 24-hour sleep duration and nighttime sleep consolidation (% of total daily sleep occurring at nighttime). Cognitive outcomes were (1) early childhood vocabulary and visual-motor abilities and (2) mid-childhood verbal and nonverbal intelligence quotient (IQ), memory, and visual-motor abilities. We examined associations of infant sleep with childhood cognition using linear regression models adjusted for child sex, age, and race or ethnicity; maternal age, education, and parity; and household income.Early and mid-childhood analyses included 1102 and 969 children, respectively. Most mothers reported infant race or ethnicity as White (69%) and were college graduates (71%). The mean infant 24-hour sleep duration was 12.2 ± 2.0 hours, and the mean nighttime sleep consolidation was 76.8% ± 8.8%. Infant 24-hour sleep duration was not associated with any early or mid-childhood outcomes. Higher infant nighttime sleep consolidation was associated with higher mid-childhood verbal intelligence (β: 0.12 points per % nighttime sleep; 95% CI, 0.01-0.22), but not with any early childhood cognitive measures.In this cohort, higher infant nighttime sleep consolidation was associated with higher verbal IQ in mid-childhood. Future studies should investigate causal relationships of infant sleep consolidation with child cognition among diverse populations.

  View details for DOI 10.1097/DBP.0000000000001311

  View details for PubMedID 39140879

• Health Disparities Among Children in Immigrant Households: New York City 2009 and 2017. Journal of immigrant and minority health Woo Baidal, J., Vachon, M. E., Hernandez, A., Brahmbhatt, D., Rosenbaum, J. E., Li, S. 2024; 26 (4): 806-811

  Abstract

  We tested the hypothesis that children in New York City (NYC) with an immigrant parent were more likely to lack health insurance and report poorer parent-rated health compared to those of US-born parents in this serial, cross-sectional study using existing data from 2009 to 2017 among children age < 12 years in two NYC health surveys. Main outcomes were parent-reported responses for (1) child insurance coverage and (2) child general health status. In multivariable logistic regression models, we estimated likelihood of outcomes for children of immigrants compared to those of US-born parents, adjusting for child, parent, and household characteristics. We included 2,637 children in 2009 and 7,042 in 2017 in NYC. In 2017, children of immigrant parents were more likely to experience uninsurance than children of US-born parents [adjusted odds ratio (AOR) 2.36 (95% CI: 1.05-5.31)]. Compared to children of US-born parents, children with an immigrant parent were more likely to have a gap in insurance coverage in both 2009 (AOR 1.88; 95% CI: 1.08-3.27) and 2017 (AOR 1.60; 95% CI: 1.06-2.41). Although more children of immigrants had poor/fair health than those of US-born parents in both years, differences were not statistically significant after adjusting for covariates. Our findings among a sample of children eligible for health insurance suggest policies intended to expand child health care access did not equitably reach children of immigrants despite their eligibility for health insurance. Tailored interventions for children of immigrants are needed to mitigate disparities in health insurance coverage.

  View details for DOI 10.1007/s10903-024-01588-4

  View details for PubMedID 38568393

  View details for PubMedCentralID 9647749

• Longitudinal Associations of Food Security with Health and Dietary Factors among Food FARMacy Participants during COVID-19 in New York City. Nutrients Woo Baidal, J., Finkel, M. A., Kelman, E., Duong, N., Bien-Aime, C., Goldsmith, J., Albrecht, S. S., Hulse, E., Rosenthal, A., Reiss, J., Schwartz, R., Meyer, D. 2024; 16 (3)

  Abstract

  In cross-sectional studies, food insecurity is associated with adverse health and dietary outcomes. Whether self-reported health and dietary outcomes change in response to improvements in food security has not been examined. We sought to examine how increases in food security are related to changes in health and dietary factors. In this longitudinal, observational study, we included adult participants in a clinical-community emergency food assistance program in New York City from July 2020 to November 2021. Program staff measured food security with a validated six-item measure at program enrollment and six-month re-enrollment. Participants self-reported health and dietary factors (vegetable, fruit, juice, and sugar-sweetened beverage (SSB) consumption frequency). We used multivariable regression to examine associations between change in food security with change in health and dietary factors over six months. Among 310 participants, the mean food security score improved by 1.7 ± 2.3 points over six months. In unadjusted models, each point improvement in food security was associated with increased vegetable (β = 0.10 times; 95% CI: 0.05-0.15); fruit (β = 0.08 times; 95% CI: 0.03-0.14); and juice (β = 0.10 times; 95% CI: 0.05-0.15) consumption. In adjusted models, results remained significant for vegetable and fruit consumption, but not juice. Change in food security was not associated with change in health or SSB outcomes. In this cohort during COVID-19, improved food security was associated with improved vegetable and fruit consumption. Randomized trials that examine the effectiveness of clinical-community partnerships focused on improving food security and nutrition are warranted.

  View details for DOI 10.3390/nu16030434

  View details for PubMedID 38337718

  View details for PubMedCentralID PMC10857290

• The potential role of social care in reducing childhood obesity. Current opinion in pediatrics Cruz Herrera, E., Figueroa-Nieves, A. I., Woo Baidal, J. A. 2024; 36 (1): 10-16

  Abstract

  This review evaluates the current evidence for relationships of social factors with childhood obesity and for a role of social care in reduction of childhood obesity.Most literature on the relationship between social factors and childhood obesity has examined food insecurity as a risk factor for obesity. Associations between food insecurity and excess weight in children are most consistent during infancy and among those with food insecurity at more than one time point. A few pilot food security interventions that link patients with produce or groceries show feasibility and potential promise for reducing childhood obesity risk factors. However, full-scale, randomized studies to examine interventions that reduce social needs and their effects on childhood obesity are lacking. Future research is needed to examine holistic social care approaches to effectively reduce childhood obesity risk factors.Food insecurity acts as a barrier to childhood obesity prevention and treatment. Patient-centered, validated measures of social needs and effective interventions to address social needs are needed to equitably prevent and treat childhood obesity.

  View details for DOI 10.1097/MOP.0000000000001309

  View details for PubMedID 37972976

• The Creation of a Multidomain Neighborhood Environmental Vulnerability Index Across New York City. Journal of urban health : bulletin of the New York Academy of Medicine Uong, S. P., Zhou, J., Lovinsky-Desir, S., Albrecht, S. S., Azan, A., Chambers, E. C., Sheffield, P. E., Thompson, A., Wilson, J., Woo Baidal, J., Stingone, J. A. 2023; 100 (5): 1007-1023

  Abstract

  Compared to previous studies commonly using a single summary score, we aimed to construct a multidomain neighborhood environmental vulnerability index (NEVI) to characterize the magnitude and variability of area-level factors with the potential to modify the association between environmental pollutants and health effects. Using the Toxicological Prioritization Index framework and data from the 2015-2019 U.S. Census American Community Survey and the 2020 CDC PLACES Project, we quantified census tract-level vulnerability overall and in 4 primary domains (demographic, economic, residential, and health status), 24 subdomains, and 54 distinct area-level features for New York City (NYC). Overall and domain-specific indices were calculated by summing standardized feature values within the subdomains and then aggregating and weighting based on the number of features within each subdomain within equally-weighted primary domains. In citywide comparisons, NEVI was correlated with multiple existing indices, including the Neighborhood Deprivation Index (r = 0.91) and Social Vulnerability Index (r = 0.87) but provided additional information on features contributing to vulnerability. Vulnerability varied spatially across NYC, and hierarchical cluster analysis using subdomain scores revealed six patterns of vulnerability across domains: 1) low in all, 2) primarily low except residential, 3) medium in all, 4) high demographic, economic, and residential 5) high economic, residential, and health status, and 6) high demographic, economic and health status. Created using methods that offer flexibility for theory-based construction, NEVI provided detailed vulnerability metrics across domains that can inform targeted research and public health interventions aimed at reducing the health impacts from environmental exposures across urban centers.

  View details for DOI 10.1007/s11524-023-00766-3

  View details for PubMedID 37594675

  View details for PubMedCentralID PMC10618140

• Weight Loss After Laparoscopic Sleeve Gastrectomy in Children and Adolescents. Obesity surgery Griggs, C. L., Kochis, M., Perez, N. P., Fennoy, I., Woo Baidal, J., Parkinson, K., Lynch, L., Bank, E., DeFazio, J., Zitsman, J. L. 2023; 33 (10): 3186-3192

  Abstract

  For children and adolescents with severe obesity, metabolic and bariatric surgery including laparoscopic sleeve gastrectomy (LSG) is increasingly used to facilitate weight loss and reduce associated medical problems. Outcomes of LSG are understudied among patients under age 15 years. We sought to examine surgical complications and weight loss outcomes among children and adolescents who underwent LSG.This is a single-center retrospective cohort analysis at a high-volume metropolitan children's hospital in the northeast USA between 2011 and 2021. Weight loss was assessed at routine follow-up appointments for up to 36 months postoperatively.There were 12 patients under 13 years of age (< 13), 45 from 13 up to 15 years of age (13-14), and 57 patients aged 15 years or over (≥ 15). Among all patients, 70% were female, 41% were Hispanic, and 18% were non-Hispanic Black. There were no operative mortalities. Two patients had surgical complications requiring reoperation. Follow-up beyond 6 months occurred for 62% of patients. Weight loss was evident for each group at all time points, and there was no statistically significant difference among groups at any time point. BMI Z-score reduction at 6 months was 1.53 for the < 13 group, 0.89 for the 13-14 group, and 0.86 for the ≥ 15 group and at 36 months was 1.79, 1.50, and 1.16, respectively.These results support that LSG is a safe and effective method of achieving weight loss for young adolescents with severe obesity. Strategies to promote postoperative follow-up are needed.

  View details for DOI 10.1007/s11695-023-06789-8

  View details for PubMedID 37626262

  View details for PubMedCentralID 6097871

• Cost-Effectiveness of Pharmacotherapy for the Treatment of Obesity in Adolescents. JAMA network open Lim, F., Bellows, B. K., Tan, S. X., Aziz, Z., Woo Baidal, J. A., Kelly, A. S., Hur, C. 2023; 6 (8): e2329178

  Abstract

  Antiobesity pharmacotherapy is recommended for adolescents ages 12 years and older with obesity. Several medications have been approved by the US Food and Drug Administration for adolescent use, but the most cost-effective medication remains unclear.To estimate the cost-effectiveness of lifestyle counseling alone and as adjunct to liraglutide, mid-dose phentermine and topiramate (7.5 mg phentermine and 46 mg topiramate), top-dose phentermine and topiramate (15 mg phentermine and 92 mg topiramate), or semaglutide among adolescent patients with obesity.This economic evaluation used a microsimulation model to project health and cost outcomes of lifestyle counseling alone and adjunct to liraglutide, mid-dose phentermine and topiramate, top-dose phentermine and topiramate, or semaglutide over 13 months, 2 years, and 5 years among a hypothetical cohort of 100 000 adolescents with obesity, defined as an initial body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 37. Model inputs were derived from clinical trials, published literature, and national sources. Data were analyzed from April 2022 to July 2023.Lifestyle counseling alone and as adjunct to liraglutide, mid-dose phentermine and topiramate, top-dose phentermine and topiramate, or semaglutide.The main outcome was quality-adjusted life years (QALYs), costs (2022 US dollars), and incremental cost-effectiveness ratios (ICERs), with future costs and QALYs discounted 3.0% annually. A strategy was considered cost-effective if the ICER was less than $100 000 per QALY gained. The preferred strategy was determined as the strategy with the greatest increase in QALYs while being cost-effective. One-way and probabilistic sensitivity analyses were used to assess parameter uncertainty.The model simulated 100 000 adolescents at age 15 with an initial BMI of 37, of whom 58 000 (58%) were female. At 13 months and 2 years, lifestyle counseling was estimated to be the preferred strategy. At 5 years, top-dose phentermine and topiramate was projected to be the preferred strategy with an ICER of $56 876 per QALY gained vs lifestyle counseling. Semaglutide was projected to yield the most QALYs, but with an unfavorable ICER of $1.1 million per QALY gained compared with top-dose phentermine and topiramate. Model results were most sensitive to utility of weight reduction and weight loss of lifestyle counseling and top-dose phentermine and topiramate.In this economic evaluation of pharmacotherapy for adolescents with obesity, top-dose phentermine and topiramate as adjunct to lifestyle counseling was estimated to be cost-effective after 5 years. Long-term clinical trials in adolescents are needed to fully evaluate the outcomes of pharmacotherapy, especially into adulthood.

  View details for DOI 10.1001/jamanetworkopen.2023.29178

  View details for PubMedID 37651143

  View details for PubMedCentralID PMC10472196

• Neighborhood environmental vulnerability and pediatric asthma morbidity in US metropolitan areas. The Journal of allergy and clinical immunology Kannoth, S., Chung, S. E., Tamakloe, K. D., Albrecht, S. S., Azan, A., Chambers, E. C., Sheffield, P. E., Thompson, A., Woo Baidal, J. A., Lovinsky-Desir, S., Stingone, J. A. 2023; 152 (2): 378-385.e2

  Abstract

  Research suggests demographic, economic, residential, and health-related factors influence vulnerability to environmental exposures. Greater environmental vulnerability may exacerbate environmentally related health outcomes. We developed a neighborhood environmental vulnerability index (NEVI) to operationalize environmental vulnerability on a neighborhood level.We explored the relationship between NEVI and pediatric asthma emergency department (ED) visits (2014-19) in 3 US metropolitan areas: Los Angeles County, Calif; Fulton County, Ga; and New York City, NY.We performed separate linear regression analyses examining the association between overall NEVI score and domain-specific NEVI scores (demographic, economic, residential, health status) with pediatric asthma ED visits (per 10,000) across each area.Linear regression analyses suggest that higher overall and domain-specific NEVI scores were associated with higher annual pediatric asthma ED visits. Adjusted R2 values suggest that overall NEVI scores explained at least 40% of the variance in pediatric asthma ED visits. Overall NEVI scores explained more of the variance in pediatric asthma ED visits in Fulton County. NEVI scores for the demographic, economic, and health status domains explained more of the variance in pediatric asthma ED visits in each area compared to the NEVI score for the residential domain.Greater neighborhood environmental vulnerability was associated with greater pediatric asthma ED visits in each area. The relationship differed in effect size and variance explained across the areas. Future studies can use NEVI to identify populations in need of greater resources to mitigate the severity of environmentally related outcomes, such as pediatric asthma.

  View details for DOI 10.1016/j.jaci.2023.03.018

  View details for PubMedID 36990323

  View details for PubMedCentralID PMC10524145

• Association of a primary care-based mobile food pantry with child body mass index: A propensity score matched cohort study. Pediatric obesity Woo Baidal, J. A., Duong, N., Goldsmith, J., Hur, C., Lauren, B. N., Partida, I., Rosenthal, A., Hulse, E., Shea, S., Cheung, K., Meyer, D. 2023; 18 (6): e13023

  Abstract

  To test the hypothesis that children in Food FARMacia-a six-month food insecurity intervention from May 2019 to January 2020-would have smaller age-adjusted, sex-specific body mass index (BMIz) gains than matched counterparts.In this proof-of-concept study, we performed a difference-in-differences (DiD) analysis of a propensity-score matched cohort among paediatric primary care patients aged <6 years with household food insecurity. Children with anthropometric measures prior to and after intervention started were included. The main outcome was child BMIz from standardized clinical anthropometric measurements. We examined differences in child BMIz change between Food FARMacia participants and matched non-participants.Among 454 children with household food insecurity, 265 were included, 44 of whom were in Food FARMacia. Mean child age was 1.48 (SD 1.46) years and most reported Hispanic/Latino ethnicity (84.5%). After propensity score matching, children in Food FARMacia had smaller increases in BMIz (unadjusted DiD -0.28 [-0.52, -0.04]) compared to non-participants in the follow-up period. After adjusting for potential confounders, findings remained statistically significant [adjusted DiD, -0.31 units (95% CI: -0.54, -0.08)].In this proof-of-concept cohort study of children in households with food insecurity, a paediatric primary care-based mobile food pantry program was associated with improvement in child BMIz over 6 months.

  View details for DOI 10.1111/ijpo.13023

  View details for PubMedID 36939408

  View details for PubMedCentralID PMC10159907

• The Healthy, Hunger-Free Kids Act and Children's Body Mass Index Outcomes. JAMA pediatrics Fiechtner, L., Woo Baidal, J., Cheng, E. R. 2023; 177 (4): 335-336

  View details for DOI 10.1001/jamapediatrics.2022.5834

  View details for PubMedID 36780154

• Longitudinal trends in parent-reported child sleep, physical activity, and screen use during the COVID-19 pandemic in New York City. SAGE open medicine Finkel, M. A., Bryan, A., Partida, I., Raaen, L., Duong, N., Goldsmith, J., Woo Baidal, J. A. 2023; 11: 20503121221147851

  Abstract

  To examine trends in child sleep, physical activity, and screen use during the COVID-19 pandemic in New York City with a prospective, longitudinal online survey of parents recruited from a large medical center.Data was collected Spring 2020 ("Complete Shutdown") and Fall 2020 ("Partial Shutdown"). Outcomes were parental perceptions about changes in child sleep, physical activity, and screen time compared to before COVID-19; and contemporaneous measures of these child behaviors. We report contemporaneous responses and paired analyses to describe longitudinal changes.Two hundred seventy-seven participants were surveyed during Complete Shutdown and 227 (81.9%) filled out a follow-up survey during Partial Shutdown. The largest percentage of parents at both time points perceived no change in child sleep, decreases in child exercise, and increases in child screen time. In paired analyses, perceptions shifted toward less sleep, more physical activity and less screen time from Complete Shutdown to Partial Shutdown.COVID-19 had negative impacts on child health behaviors that did not resolve over a 6-month period despite partial reopenings.

  View details for DOI 10.1177/20503121221147851

  View details for PubMedID 36660110

  View details for PubMedCentralID PMC9845847

• Magnetic Resonance Imaging to Assess Body Composition Change in Adolescents With Obesity After Sleeve Gastrectomy. Journal of pediatric gastroenterology and nutrition Berg, E. A., Huang, Z., Wang, Y., Woo Baidal, J., Fennoy, I., Lavine, J. E., Zitsman, J., Shen, W. 2022; 75 (6): 761-767

  Abstract

  Metabolic and bariatric surgery is the most effective weight loss treatment for severe obesity. The number of adolescents undergoing sleeve gastrectomy is increasing. We investigated changes in body composition in adolescents undergoing sleeve gastrectomy 12-26 weeks post-operatively using whole-body magnetic resonance imaging (WB-MRI).This prospective cohort study assessed changes in adipose tissue compartments (ie, visceral, subcutaneous, and intermuscular) and muscle in 18 obese adolescents, ages 14-19, 89% female, with body mass index z -score of 2.6 ± 0.25 (range 2.16-3.2). All underwent WB-MRI 1.5-17 weeks pre-operatively and 12-26 weeks post-operatively.Pre- and post-operative WB-MRI showed decreases in all adipose tissue compartments, as well as decreased skeletal muscle and liver fat fraction ( P < 0.0001). The post-operative percentage loss of adipose tissue in subcutaneous, visceral, and intermuscular compartments (89.0%, 5.8%, 5.2%, respectively) was similar to the pre-operative percentages of corresponding adipose tissue compartments (90.5%, 5.0%, 4.5%, respectively). Of note, participants with obstructive sleep apnea had significantly higher pre-operative volume of subcutaneous and intermuscular adipose tissue than participants without obstructive sleep apnea ( P = 0.003).We found, contrary to what is reported to occur in adults, that pre-operative percentage loss of adipose tissue in subcutaneous, visceral, and intermuscular compartments was similar to the post-operative percentage loss of corresponding adipose tissue compartments in adolescents 12-26 weeks after sleeve gastrectomy.

  View details for DOI 10.1097/MPG.0000000000003607

  View details for PubMedID 36070531

  View details for PubMedCentralID PMC9675718

• Association of cow's milk intake in early childhood with adiposity and cardiometabolic risk in early adolescence. The American journal of clinical nutrition McGovern, C., Rifas-Shiman, S. L., Switkowski, K. M., Woo Baidal, J. A., Lightdale, J. R., Hivert, M. F., Oken, E., Aris, I. M. 2022; 116 (2): 561-571

  Abstract

  Prior studies have provided conflicting evidence regarding associations of pediatric milk consumption with subsequent adiposity.We aimed to estimate associations of the consumption frequency and fat content of early childhood milk intake with early adolescent adiposity and cardiometabolic risk.We analyzed data collected prospectively from 796 children in Project Viva, a Boston-area prebirth cohort. Parents reported the frequency (times/day) and fat content [higher-fat: whole (3.25%) or 2% milk; lower-fat: 1% or skim milk] of cow's milk consumed in early childhood (mean, 3.2 years) via food-frequency questionnaires. We measured adiposity and cardiometabolic markers in early adolescence (mean, 13.2 years) and conducted multivariable regressions to assess associations adjusted for baseline parental and child sociodemographic, anthropometric, and dietary factors.In early childhood, mean milk intake was 2.3 times/day (SD, 1.2 times/day), and 63% of children drank primarily higher-fat milk. The early childhood BMI z-score (BMIz) was inversely associated with the fat content of milk consumed in early childhood. After adjustment for baseline parent and child factors, early childhood intake of higher-fat compared with lower-fat milk was associated with lower adiposity; however, the 95% CIs for most adiposity outcomes-except for the odds of overweight or obesity (OR, 0.60; 95% CI, 0.38-0.93)-crossed the null after adjustment for the baseline child BMIz and BMIz change between ages 2 and 3 years. Early childhood consumption of higher-fat milk (compared with lower-fat milk) was not associated with adverse cardiometabolic outcomes. The frequency of cow's milk consumption in early childhood was not associated with adiposity or cardiometabolic risk in early adolescence.Consumption of higher-fat cow's milk in early childhood was not associated with increased adiposity or adverse cardiometabolic health over a decade later. Our findings do not support current recommendations to consume lower-fat milk to reduce the risk of later obesity and adverse cardiometabolic outcomes. This trial was registered at clinicaltrials.gov as NCT02820402.

  View details for DOI 10.1093/ajcn/nqac103

  View details for PubMedID 35441227

  View details for PubMedCentralID PMC9348987

• Association of cow's milk intake in early childhood with adiposity and cardiometabolic risk in early adolescence AMERICAN JOURNAL OF CLINICAL NUTRITION McGovern, C., Rifas-Shiman, S. L., Switkowski, K. M., Baidal, J., Lightdale, J. R., Hivert, M., Oken, E., Aris, I. M. 2022; 116 (2): 561-571

  View details for DOI 10.1093/ajcn/nqac103

  View details for Web of Science ID 000808212200001

• Feasibility of Food FARMacia: Mobile Food Pantry to Reduce Household Food Insecurity in Pediatric Primary Care. Nutrients Woo Baidal, J. A., Meyer, D., Partida, I., Duong, N., Rosenthal, A., Hulse, E., Nieto, A. 2022; 14 (5)

  Abstract

  Despite recommendations for systematic food insecurity screening in pediatric primary care, feasible interventions in clinical settings are lacking. The goal of this study was to examine reach, feasibility, and retention in Food FARMacia, a pilot clinically based food insecurity intervention among children aged <6 years. We examined electronic health record data to assess reach and performed a prospective, longitudinal study of families in Food FARMacia (May 2019 to January 2020) to examine attendance and retention. We used descriptive statistics and bivariate analyses to assess outcomes. Among 650 pediatric patients, 172 reported household food insecurity and 50 registered for Food FARMacia (child mean age 22 ± 18 months; 88% Hispanic/Latino). Demographic characteristics of Food FARMacia participants were similar to those of the target group. Median attendance rate was 75% (10 sessions) and retention in both the study and program was 68%. Older child age (retention: age 26.7 ± 18.7 months vs. attrition: age 12.1 ± 13.8 months, p = 0.01), Hispanic/Latino ethnicity (retention: 97% vs. attrition: 69%, p < 0.01), and larger household size (retention: 4.5 ± 1.1 vs. attrition: 3.7 ± 1.4, p = 0.04) correlated with retention. A clinically based mobile food pantry pilot program and study reached the target population and were feasible.

  View details for DOI 10.3390/nu14051059

  View details for PubMedID 35268034

  View details for PubMedCentralID PMC8912842

• Estimated Cost-effectiveness of Medical Therapy, Sleeve Gastrectomy, and Gastric Bypass in Patients With Severe Obesity and Type 2 Diabetes. JAMA network open Lauren, B. N., Lim, F., Krikhely, A., Taveras, E. M., Woo Baidal, J. A., Bellows, B. K., Hur, C. 2022; 5 (2): e2148317

  Abstract

  Bariatric surgery is recommended for patients with severe obesity (body mass index ≥40) and type 2 diabetes (T2D). However, the most cost-effective treatment remains unclear and may depend on the patient's T2D severity.To estimate the cost-effectiveness of medical therapy, sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) among patients with severe obesity and T2D, stratified by T2D severity.This economic evaluation used a microsimulation model to project health and cost outcomes of medical therapy, SG, and RYGB over 5 years. Time horizons varied between 10 and 30 years in sensitivity analyses. Model inputs were derived from clinical trials, large cohort studies, national databases, and published literature. Probabilistic sampling of model inputs accounted for parameter uncertainty. Estimates of US adults with severe obesity and T2D were derived from the National Health and Nutrition Examination Survey. Data analysis was performed from January 2020 to August 2021.Medical therapy, SG, and RYGB.Quality-adjusted life-years (QALYs), costs (in 2020 US dollars), and incremental cost-effectiveness ratios (ICERs) were projected, with future cost and QALYs discounted 3.0% annually. A strategy was deemed cost-effective if the ICER was less than $100 000 per QALY. The preferred strategy resulted in the greatest number of QALYs gained while being cost-effective.The model simulated 1000 cohorts of 10 000 patients, of whom 16% had mild T2D, 56% had moderate T2D, and 28% had severe T2D at baseline. The mean age of simulated patients was 54.6 years (95% CI, 54.2-55.0 years), 61.6% (95% CI, 60.1%-63.4%) were female, and 65.1% (95% CI, 63.6%-66.7%) were non-Hispanic White. Compared with medical therapy over 5 years, RYGB was associated with the most QALYs gained in the overall population (mean, 0.44 QALY; 95% CI, 0.21-0.86 QALY) and when stratified by baseline T2D severity: mild (mean, 0.59 QALY; 95% CI, 0.35-0.98 QALY), moderate (mean, 0.50 QALY; 95% CI, 0.25-0.88 QALY), and severe (mean, 0.30 QALY; 95% CI, 0.07-0.79 QALY). RYGB was the preferred strategy in the overall population (ICER, $46 877 per QALY; 83.0% probability preferred) and when stratified by baseline T2D severity: mild (ICER, $36 479 per QALY; 73.7% probability preferred), moderate (ICER, $37 056 per QALY; 85.6% probability preferred), and severe (ICER, $98 940 per QALY; 40.2% probability preferred). The cost-effectiveness of RYGB improved over a longer time horizon.These findings suggest that the effectiveness and cost-effectiveness of bariatric surgery vary by baseline severity of T2D. Over a 5-year time horizon, RYGB is projected to be the preferred treatment strategy for patients with severe obesity regardless of baseline T2D severity.

  View details for DOI 10.1001/jamanetworkopen.2021.48317

  View details for PubMedID 35157054

  View details for PubMedCentralID PMC8845022

• Persistent effects of the COVID-19 pandemic on diet, exercise, risk for food insecurity, and quality of life: A longitudinal study among U.S. adults (vol 167, 105639, 2021) APPETITE Rogers, A. M., Lauren, B. N., Baidal, J., Ozanne, E. M., Hur, C. 2022; 168: 105701

  View details for DOI 10.1016/j.appet.2021.105701

  View details for Web of Science ID 000729655100019

  View details for PubMedID 34607699

  View details for PubMedCentralID PMC9025975

• Text Messages to Curb Sugar-Sweetened Beverage Consumption among Pregnant Women and Mothers: A Mobile Health Randomized Controlled Trial. Nutrients Woo Baidal, J. A., Nichols, K., Charles, N., Chernick, L., Duong, N., Finkel, M. A., Falbe, J., Valeri, L. 2021; 13 (12)

  Abstract

  Racial, ethnic, and socioeconomic disparities in childhood obesity in the United States (U.S.) originate in early life. Maternal sugar-sweetened beverage (SSB) consumption is an early life risk factor for later offspring obesity. The goal of this study was to test the effects of policy-relevant messages delivered by text messages mobile devices (mHealth) on maternal SSB consumption. In this three-arm 1-month randomized controlled trial (RCT), pregnant women or mothers of infants in predominantly Hispanic/Latino New York City neighborhoods were randomized to receive one of three text message sets: graphic beverage health warning labels, beverage sugar content information, or attention control. The main outcome was change in maternal self-reporting of average daily SSB consumption from baseline to one month. Among 262 participants, maternal SSB consumption declined over the 1-month period in all three arms. No intervention effect was detected in primary analyses. In sensitivity analyses accounting for outliers, graphic health warning labels reduced maternal SSB consumption by 28 kcal daily (95% CI: -56, -1). In this mHealth RCT among pregnant women and mothers of infants, graphic health warning labels and beverage sugar content information did not reduce maternal SSB consumption.

  View details for DOI 10.3390/nu13124367

  View details for PubMedID 34959919

  View details for PubMedCentralID PMC8703966

• Persistent effects of the COVID-19 pandemic on diet, exercise, risk for food insecurity, and quality of life: A longitudinal study among U.S. adults. Appetite Rogers, A. M., Lauren, B. N., Woo Baidal, J. A., Ozanne, E. M., Hur, C. 2021; 167: 105639

  Abstract

  COVID-19 has affected the health and well-being of almost every American. The aim of this study was to examine the sustained impacts of COVID-19 prevention measures on the diet and exercise habits, risk for food insecurity, and quality of life among adults in the U.S. We conducted a longitudinal study using a convenience sample of participants recruited via Amazon's Mechanical Turk (MTurk) platform between March 30 and April 7, 2020, and 8 months into the outbreak, from November 2 to November 21, 2020. We compared self-reported diet and exercise habits and risk for food insecurity shortly after the pandemic began, in April, to those reported in November. We also measured changes in quality-of-life using the PROMIS-29 + 2 (PROPr) scale. A total of 636 respondents completed both surveys. Compared to reports in April, respondents ate lunch and dinner out more frequently in November and consumed more take-out and fast food. Weekly frequencies of consuming frozen food and the number of daily meals were slightly lower in November than they were in April. 54% of respondents screened positively for being at risk for food insecurity in April, reducing to 41% by November. In April, survey respondents were found to have lower quality-of-life relative to U.S. population norms, but by November levels of depression and cognitive function had improved. Our findings underscore how the initial effects of the pandemic on diet, exercise, risk for food insecurity, and quality of life have evolved. As U.S. states re-open, continued efforts to encourage healthy eating and support mental health, especially to reduce feelings of anxiety and social isolation, remain important to mitigate the potential long-term effects of the pandemic.

  View details for DOI 10.1016/j.appet.2021.105639

  View details for PubMedID 34384807

  View details for PubMedCentralID PMC8990782

• Community Perceptions in New York City: Sugar-Sweetened Beverage Policies and Programs in the First 1000 Days MATERNAL AND CHILD HEALTH JOURNAL Braid, L., Oliva, R., Nichols, K., Reyes, A., Guzman, J., Goldman, R. E., Baidal, J. 2022; 26 (1): 193-204

  Abstract

  To examine perceptions of Sugar-sweetened beverage (SSB) policies and programs focused on the first 1000 days-gestation through age 2 years-among community stakeholders in Washington Heights and the South Bronx, two neighborhoods in New York City with disproportionately high prevalence of childhood obesity.A multilevel framework informed interview guide development. Using purposeful sampling, we recruited study participants who were (1) able to speak English or Spanish and (2) resided or employed in Washington Heights or the South Bronx. Participants included community leaders (local government officials, community board members, and employees from community- and faith-based organizations) as well as community members. Trained research staff conducted semi-structured in-depth interviews. Using immersion/crystallization and template style coding, the study team performed thematic analysis until no new relevant themes emerged.Among the 19 female study participants, perceived facilitators to SSB policy and program implementation included sustained partnerships with broad coalitions; continual education and clear messaging; and increased accessibility to healthier beverages. Perceived barriers included systems-level challenges accessing programs that support healthy beverage options, and individual-level lack of access to affordable healthy beverages. Acceptable potential intervention strategies included messaging that emphasizes health in pregnancy and infancy; policies that require healthy beverages as the default option in restaurants; and policies that remove SSBs from childcare settings. Some strongly favored SSB excise taxes while others opposed them, but all participants supported reinvestment of SSB tax revenue into health resources among marginalized communities.A multi-pronged approach that incorporates engagement, access, equitable reinvestment of revenue, and continual clear messaging may facilitate implementation of policies and programs to reduce SSB consumption in the first 1000 days.

  View details for DOI 10.1007/s10995-021-03255-8

  View details for Web of Science ID 000704938100005

  View details for PubMedID 34618312

  View details for PubMedCentralID PMC8495667

• Predictors of households at risk for food insecurity in the United States during the COVID-19 pandemic. Public health nutrition Lauren, B. N., Silver, E. R., Faye, A. S., Rogers, A. M., Woo-Baidal, J. A., Ozanne, E. M., Hur, C. 2021; 24 (12): 3929-3936

  Abstract

  To examine associations between sociodemographic and mental health characteristics with household risk for food insecurity during the COVID-19 outbreak.Cross-sectional online survey analysed using univariable tests and a multivariable logistic regression model.The United States during the week of 30 March 2020.A convenience sample of 1965 American adults using Amazon's Mechanical Turk platform. Participants reporting household food insecurity prior to the pandemic were excluded from analyses.One thousand two hundred and fifty participants reported household food security before the COVID-19 outbreak. Among this subset, 41 % were identified as at risk for food insecurity after COVID-19, 55 % were women and 73 % were white. On a multivariable analysis, race, income, relationship status, living situation, anxiety and depression were significantly associated with an incident risk for food insecurity. Black, Asian and Hispanic/Latino respondents, respondents with an annual income <$100 000 and those living with children or others were significantly more likely to be newly at risk for food insecurity. Individuals at risk for food insecurity were 2·60 (95 % CI 1·91, 3·55) times more likely to screen positively for anxiety and 1·71 (95 % CI 1·21, 2·42) times more likely to screen positively for depression.An increased risk for food insecurity during the COVID-19 pandemic is common, and certain populations are particularly vulnerable. There are strong associations between being at risk for food insecurity and anxiety/depression. Interventions to increase access to healthful foods, especially among minority and low-income individuals, and ease the socioemotional effects of the outbreak are crucial to relieving the economic stress of this pandemic.

  View details for DOI 10.1017/S1368980021000355

  View details for PubMedID 33500018

  View details for PubMedCentralID PMC8207551

• Correlates of sugar-sweetened beverage intake among low-income women during the first 1000 days. Public health nutrition Cheng, E. R., Batista, E., Chen, L., Nichols, K., Park, S., Charles, N., Woo Baidal, J. 2021; 24 (9): 2496-2501

  Abstract

  To describe prenatal and postpartum consumption of water, cows' milk, 100 % juice and sugar-sweetened beverages (SSB) among women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) programme in New York City (NYC) and to identify correlates of SSB intake in this population.Cross-sectional data were collected from structured questionnaires that included validated beverage frequency questionnaires with the assistance of container samples. The association of maternal and household factors and non-SSB consumption with habitual daily energetic (kJ (kcal)) intake from SSB was assessed by using multivariable median regression.WIC programme in NYC, NY. Data were collected in 2017.388 pregnant or postpartum women (infant aged <2 years) from the NYC First 1000 Days Study.Median age was 28 years (interquartile range (IQR) 24-34); 94·1 % were Hispanic/Latina, and 31·4 % were pregnant. Overall, 87·7 % of pregnant and 89·1% of postpartum women consumed SSB ≥ once weekly, contributing to a median daily energetic intake of 410 kJ (98 kcal) (IQR (113-904 kJ) 27-216) and 464 kJ (111 kcal) (IQR (163-1013 kJ) 39-242), respectively. In adjusted analyses, only consumption of 100 % juice was associated with greater median energetic intake from SSB (adjusted β for each additional ounce = 13; 95% CI 8, 31 (3·2; 95 % CI 2·0, 7·3).Among pregnant and postpartum women in WIC-enrolled families, interventions to reduce SSB consumption should include reduction of 100 % juice consumption as a co-target of the intervention.

  View details for DOI 10.1017/S1368980020003390

  View details for PubMedID 33087210

  View details for PubMedCentralID PMC8063590

• Longitudinal associations of modifiable risk factors in the first 1000 days with weight status and metabolic risk in early adolescence. The American journal of clinical nutrition Hu, J., Aris, I. M., Lin, P. D., Rifas-Shiman, S. L., Perng, W., Woo Baidal, J. A., Wen, D., Oken, E. 2021; 113 (1): 113-122

  Abstract

  Many studies have identified early-life risk factors for childhood overweight/obesity (OwOb), but few have evaluated how they combine to influence later cardiometabolic health.We aimed to examine the association of risk factors in the first 1000 d with adiposity and cardiometabolic risk in early adolescence.We studied 1038 mother-child pairs in Project Viva. We chose 6 modifiable early-life risk factors previously associated with child adiposity or metabolic health in the cohort: smoking during pregnancy (yes compared with no); gestational weight gain (excessive compared with nonexcessive); sugar-sweetened beverage consumption during pregnancy (≥0.5 compared with <0.5 servings/d); breastfeeding duration (<12 compared with ≥12 mo); timing of complementary food introduction (<4 compared with ≥4 mo); and infant sleep duration (<12 compared with ≥12 h/d). We computed risk factor scores by calculating the cumulative number of risk factors for each child. In early adolescence (median: 13.1 y) we measured indicators of adiposity [BMI, fat mass index (FMI), trunk fat mass index (TFMI)]. We also calculated OwOb prevalence and metabolic syndrome (MetS) risk z score of adolescents.Among 1038 adolescents, 71% had >1 early-life risk factor. In covariate-adjusted models, we observed positive monotonic increases in BMI, FMI, TFMI, and MetS z scores with increasing risk factor score. Children with 5‒6 risk factors (compared with 0-1 risk factors) had the highest risk of OwOb [risk ratio (RR): 2.53; 95% CI: 1.63, 3.91] and being in the highest MetS quartile (RR: 2.46; 95% CI: 1.43, 4.21). The predicted probability of OwOb in adolescence varied from 9.4% (favorable levels for all factors) to 63.6% (adverse levels for all factors), and for being in the highest MetS quartile from 9.6% to 56.6%.Early-life risk factors in the first 1000 d cumulatively predicted higher adiposity and cardiometabolic risk in early adolescence. Intervention strategies to prevent later obesity and cardiometabolic risk may be more effective if they concurrently target multiple modifiable factors.

  View details for DOI 10.1093/ajcn/nqaa297

  View details for PubMedID 33184628

  View details for PubMedCentralID PMC7779210

• The Prevalence of Co-morbidities in Adult and Adolescent Bariatric Surgery Candidates OBESITY SURGERY Liu, J., Woo Baidal, J., Fennoy, I., Parkinson, K. L., Lynch, L., Zitsman, J. L. 2021; 31 (3): 1369-1371

  Abstract

  Severe obesity is often associated with co-morbid conditions such as diabetes mellitus, hypertension, and obstructive sleep apnea. Successful weight loss can result in remission of these conditions. The authors retrospectively examined the co-morbidity profiles of pre-operative gastric sleeve adult patients from the MBSAQIP database with subjects from our adolescent bariatric program. Five conditions were compared: hypertension (HTN), type 2 diabetes mellitus (T2DM), dyslipidemia (DL), obstructive sleep apnea (OSA), and gastroesophageal reflux disease (GERD). Patients were matched by gender and body mass index (BMI). The prevalence of each condition was statistically more significant in the adult cohort. Successful weight loss at an earlier age may reduce the prevalence of these co-morbid conditions.

  View details for DOI 10.1007/s11695-020-05024-y

  View details for Web of Science ID 000577038700006

  View details for PubMedID 33047286

• Food Insecurity and Sugar-Sweetened Beverage Consumption Among WIC-Enrolled Families in the First 1,000 Days. Journal of nutrition education and behavior Fernández, C. R., Chen, L., Cheng, E. R., Charles, N., Meyer, D., Monk, C., Woo Baidal, J. 2020; 52 (8): 796-800

  Abstract

  Determine the association between household food insecurity and habitual sugar-sweetened beverage (SSB) consumption among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-enrolled families during the first 1,000 days.Cross-sectional analysis of pregnant women and mothers of infants aged under 2 years in the WIC was performed. Families recruited sequentially at consecutive visits completed food insecurity and beverage intake questionnaires; estimated logistic regression models controlled for sociodemographic characteristics.Of 394 Hispanic/Latino mothers and 281 infants, 63% had household food insecurity. Food insecurity significantly increased odds of habitual maternal (unadjusted odds ratio (OR), 2.39; 95% CI, 1.27-4.47; P = .01) and infant SSB consumption (OR, 2.05; 95% CI, 1.15-3.65; P = .02), and the relationship was not attenuated by maternal age, education, or foreign-born status.Food insecurity increased odds of habitual SSB consumption in WIC families. Interventions to curb SSB consumption among WIC-enrolled families in the first 1,000 days in the context of household food insecurity are needed.

  View details for DOI 10.1016/j.jneb.2020.03.006

  View details for PubMedID 32444189

  View details for PubMedCentralID PMC7423699

• Zooming Toward a Telehealth Solution for Vulnerable Children with Obesity During Coronavirus Disease 2019. Obesity (Silver Spring, Md.) Woo Baidal, J. A., Chang, J., Hulse, E., Turetsky, R., Parkinson, K., Rausch, J. C. 2020; 28 (7): 1184-1186

  Abstract

  Health inequities exist throughout the life course, resulting in racial/ethnic and socioeconomic disparities in obesity and obesity-related health complications. Obesity and its comorbidities appear to be linked to coronavirus disease 2019 (COVID-19) mortality. Approaches to reduce obesity in the time of COVID-19 closures are urgently needed and should start early in life. In New York City, a telehealth pediatric weight-management collaborative spanning NewYork-Presbyterian, Columbia University Vagelos College of Physicians and Surgeons, and Weill Cornell Medicine was developed during COVID-19 with show rates from 76% to 89%. To stave off the impending exacerbation of health disparities related to obesity risk factors in the aftermath of the COVID-19 pandemic, effective interventions that can be delivered remotely are urgently needed among vulnerable children with obesity. Challenges in digital technology access, social and linguistic differences, privacy security, and reimbursement must be overcome to realize the full potential of telehealth for pediatric weight management among low-income and racial/ethnic-minority children.

  View details for DOI 10.1002/oby.22860

  View details for PubMedID 32352650

  View details for PubMedCentralID PMC7267304

• Sugar-Sweetened Beverage Intake Among Pregnant and Non-pregnant Women of Reproductive Age. Maternal and child health journal Lundeen, E. A., Park, S., Woo Baidal, J. A., Sharma, A. J., Blanck, H. M. 2020; 24 (6): 709-717

  Abstract

  Frequent sugar-sweetened beverage (SSB) intake is associated with weight gain in women, and pre-pregnancy overweight and excessive gestational weight gain are linked to adverse pregnancy outcomes. SSB intake information for women of reproductive age (WRA) is limited. We described SSB intake among non-pregnant and pregnant WRA and identified correlates of daily intake.Using 2017 Behavioral Risk Factor Surveillance System data, we analyzed SSB intake (regular soda, fruit drinks, sweet tea, sports/energy drinks) for 11,321 non-pregnant and 392 pregnant WRA (18-49 years) in 12 states and D.C. Adjusted odds ratios (aOR) for daily (≥ 1 time/day) SSB intake (reference: < 1 time/day) by characteristics were estimated using multivariable logistic regression.Overall, 27.3% of non-pregnant and 21.9% of pregnant women reported consuming SSBs ≥ 1 time/day; 12.6% and 9.7%, respectively, consumed SSBs ≥ 2 times/day. Among non-pregnant women, odds of daily SSB intake were higher for women who were non-Hispanic black (aOR 2.04, 95% CI 1.55-2.69) vs. non-Hispanic white; had ≤ high school education (aOR 2.79, CI 2.26-3.44) or some college (aOR 1.85, CI 1.50-2.27) vs. college graduates; lived in nonmetropolitan counties (aOR 1.35, CI 1.11-1.63) vs. metropolitan; had no physical activity (aOR 1.72, CI 1.43-2.07) vs. some; were former (aOR 1.51, CI 1.17-1.94) or current (aOR 3.48, CI 2.82-4.28) smokers vs. nonsmokers. Among pregnant women, those not married had higher odds (aOR 2.81, CI 1.05-7.51) for daily SSB intake than married women.One in five pregnant women and one in four non-pregnant women of reproductive age consumed SSBs at least once per day. Sociodemographic and behavioral correlates of daily SSB intake were identified.

  View details for DOI 10.1007/s10995-020-02918-2

  View details for PubMedID 32303941

  View details for PubMedCentralID PMC10949990

• Consumption of sugar-sweetened beverages and obesity in SNAP-eligible children and adolescents. Primary care diabetes Twarog, J. P., Peraj, E., Vaknin, O. S., Russo, A. T., Woo Baidal, J. A., Sonneville, K. R. 2020; 14 (2): 181-185

  Abstract

  Low-income individuals who are eligible for nutrition assistance have been shown to consume a larger portion of their daily calories from beverages with added sugar. We examined the association between Supplemental Nutrition Assistance Program (SNAP) participation and self-reported sugar sweetened beverage (SSB) consumption as well as the association between self-reported consumption of SSBs and overweight/obesity in low-income children.Cross-sectional analysis of 1455 SNAP-eligible U.S. children, ages 2-17, who completed a questionnaire and physical examination during the 2009-2010 National Health and Nutrition Examination Survey (NHANES).SNAP-eligible children who received SNAP in the last month were more likely to drink soda in the last month [76.0% (2.2)] than those who did not receive benefits [70.5% (2.8)]. These children were also more likely to drink fruit drinks [74.8% (1.6) vs. 69.3% (3.1)]. Among youth in households receiving SNAP benefits, soda consumption in the past month was associated with a greater risk of obesity, particularly Hispanic youth [OR=1.93 (1.07, 3.50), p=0.0314] aged 2-5 [OR=2.71 (1.29, 5.69), p=0.0114]. Additionally, among youth in households receiving SNAP benefits, male children who consumed sugar-sweetened fruit drinks in the past month were significantly more likely to be overweight [3.13 (1.12, 8.73), p=0.0315] as compared to male peers who did not consume any sugar sweetened fruit drinks.Among youth, SNAP recipients drink more SSBs than their eligible non-recipient peers. Our results indicate that certain populations of children receiving SNAP benefits and consuming SSBs are more likely to be overweight or obese when compared to their peers who receive SNAP benefits but do not consume SSBs.

  View details for DOI 10.1016/j.pcd.2019.07.003

  View details for PubMedID 31439469

• Upper Gastrointestinal Endoscopy in Adolescents With Severe Obesity Before Vertical Sleeve Gastrectomy JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION Colman, R. J., Baidal, J., Zitsman, J. L., Mencin, A. A. 2019; 69 (3): 287-291

  Abstract

  Esophagogastroduodenoscopy (EGD) is often performed to evaluate for mucosal and anatomical abnormalities before vertical sleeve gastrectomy (SG). Little is known, however, about how prebariatric EGD in adolescents influences clinical management or outcome. Our aim was to assess if an abnormal prebariatric EGD resulted in interventions or modification of bariatric surgery.We performed a retrospective cohort study of adolescents undergoing evaluation for bariatric surgery. We obtained demographic and anthropometric data in addition to EGD findings, biopsy pathology, gastrointestinal symptoms, and surgical outcomes. An EGD was considered abnormal if either abnormal gross findings or abnormal pathology was reported. Patients were followed until a 6-week postop visit.Of 134 patients presenting for evaluation, 94 (70%) underwent preoperative EGD. Fifty-one (54%) had a normal EGD and 43 (46%) had EGD abnormalities including 7 with an anatomical abnormality and 36 with mild mucosal abnormalities. Among patients with EGD abnormalities, 22% received medical intervention including proton pump inhibitor (PPI) administration (n = 10) and Helicobacter pylori eradication (n = 11). GI symptoms were the only predictor of EGD abnormalities (odds ratio [OR] 4.9: 95% confidence interval [CI] 1.6-15.0; P < 0.001). No factors predicted likelihood of a post-EGD intervention. An abnormal EGD did not correlate with any postoperative complications.In this cohort of adolescents undergoing evaluation for SG, 46% had an abnormal EGD, of which 22% received a medical intervention. Symptoms were the only predictor of EGD abnormalities. Abnormal EGD findings were not associated with modification of the surgery or any adverse outcome.

  View details for DOI 10.1097/MPG.0000000000002371

  View details for Web of Science ID 000502025700011

  View details for PubMedID 31436669

• Nutrition provider confidence in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study. Preventive medicine reports Cheng, E. R., Nelson, C. C., Leung-Strle, P., Colchamiro, R., Taveras, E. M., Woo Baidal, J. A. 2019; 13: 289-292

  Abstract

  The multi-sector, multi-level Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study resulted in improvements in obesity risk factors among children age 2-4 years enrolled in the Special Supplemental Nutrition program for Women, Infants, and Children (WIC). The goal of this study was to examine whether the MA-CORD intervention increased WIC provider confidence in their ability to identify childhood obesity and obesity-related behaviors.As part of the MA-CORD intervention conducted from 2012 to 2015, we implemented WIC practice changes focused on childhood obesity prevention within two Massachusetts communities. We examined changes in provider confidence to assess childhood obesity risk factors and practice frequency among WIC practices located in MA-CORD intervention communities over a 3-year period, compared to non-intervention sites. We measured provider confidence on a continuous scale using questions previously developed to assess provider and parent confidence to make weight-related behavior change (range 0 to 24).There were 205 providers at baseline and 165 at follow-up. WIC providers at intervention sites reported greater confidence in their ability to identify childhood obesity and obesity-related behaviors compared to the usual care sites (β = 1.01, standard error = 0.13). These findings persisted after adjusting for provider gender, years in practice, highest education level, and WIC position.The MA-CORD intervention was associated with increased WIC provider confidence to assess children's obesity risk. Interventions that increase confidence in assessing obesity-related behaviors may have salutary effects within WIC programs that serve low-income families.

  View details for DOI 10.1016/j.pmedr.2019.01.010

  View details for PubMedID 30740295

  View details for PubMedCentralID PMC6357843

• Parental and Provider Perceptions of Sugar-Sweetened Beverage Interventions in the First 1000 Days: A Qualitative Study. Academic pediatrics Morel, K., Nichols, K., Nong, Y., Charles, N., Price, S., Taveras, E., Goldman, R., Woo Baidal, J. A. 2019; 19 (7): 748-755

  Abstract

  Novel approaches to reduce sugar-sweetened beverage (SSB) consumption during the first 1000 days-pregnancy through age 2 years-are urgently needed.To examine perceptions of SSB consumption and acceptability of potential intervention strategies to promote SSB avoidance in low-income families in the first 1000 days.In this qualitative research, we performed semistructured, in-depth interviews of 25 women and 7 nutrition/health care providers. Eligible women were Women, Infants, and Children program-enrolled and pregnant or had an infant younger than age 2 years. Eligible providers cared for families during the first 1000 days. Using immersion-crystallization techniques, we examined perceptions, barriers, and facilitators related to avoidance of SSB consumption; acceptability of messages framed as positive gains or negative losses; and perceived influence on SSB consumption of various intervention modalities.Themes related to SSB consumption included parental confusion about healthy beverage recommendations and maternal feelings of lack of control over beverage choices due to pregnancy cravings and infant tastes. Themes surrounding message frames included negative health consequences of sugary drink consumption are strong motivators for behavior change; and savings and cost count, but are not top priority. Highly acceptable intervention strategies included use of images showing health consequences of SSB consumption, illustrations of sugar content at the point of purchase, and multimodal delivery of messages.Messages focused on infant health consequences and parental empowerment to evaluate and select healthier beverages based on sugar content should be tested in interventions to reduce SSB consumption in the first 1000 days.

  View details for DOI 10.1016/j.acap.2019.01.004

  View details for PubMedID 30677540

  View details for PubMedCentralID PMC6642844

• Sugar-Sweetened Beverage Attitudes and Consumption During the First 1000 Days of Life. American journal of public health Woo Baidal, J. A., Morel, K., Nichols, K., Elbel, E., Charles, N., Goldsmith, J., Chen, L., Taveras, E. 2018; 108 (12): 1659-1665

  Abstract

  To examine the relationship of parental sugar-sweetened beverage (SSB) attitudes with SSB consumption during the first 1000 days of life-gestation to age 2 years.We studied 394 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-enrolled families during the first 1000 days of life in northern Manhattan, New York, in 2017. In regression models, we assessed cross-sectional relationships of parental SSB attitude scores with habitual daily parent SSB calories and infant SSB consumption, adjusting for demographic and socioeconomic characteristics.Each point higher parental SSB attitude score was associated with lower parental SSB consumption (-14.5 median kcals; 95% confidence interval [CI] = -22.6, -6.4). For infants, higher parental SSB attitude score was linked with lower odds of infant SSB consumption (adjusted odds ratio [AOR] = 0.84; 95% CI = 0.71, 0.99), and adjustment for socioeconomic factors slightly attenuated results (AOR = 0.85; 95% CI = 0.71, 1.02).During the first 1000 days of life, greater negativity in parental attitudes toward SSB consumption was associated with fewer parental calories consumed from SSBs and lower likelihood of infant SSB consumption. Public Health Implications. Parental attitudes toward SSBs should be targeted in future childhood obesity interventions during pregnancy and infancy.

  View details for DOI 10.2105/AJPH.2018.304691

  View details for PubMedID 30359102

  View details for PubMedCentralID PMC6236748

• Racial/Ethnic Differences in the Effectiveness of a Multisector Childhood Obesity Prevention Intervention. American journal of public health Nelson, C. C., Colchamiro, R., Perkins, M., Taveras, E. M., Leung-Strle, P., Kwass, J., Woo Baidal, J. A. 2018; 108 (9): 1200-1206

  Abstract

  To investigate racial/ethnic and language differences in the effectiveness of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study among children aged 2 to 4 years enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).We performed a multisector quasiexperimental study in 2 MA-CORD intervention communities and 1 comparison community. Using WIC data from 2010 to 2015, we examined intervention effect on child weight and behavior outcomes by child race/ethnicity and parental primary language using multilevel linear regression models with an interaction term.Non-Hispanic Black children exposed to the intervention demonstrated a greater decrease in body mass index (BMI) than did other children (P < .05). Racial/ethnic minority children in the comparison site had greater increases in BMI than did their White counterparts (P < .05). There were no differences in intervention effectiveness by race/ethnicity or language for health behaviors.White children demonstrated decreased BMI in both the intervention and control groups. However, intervention minority children demonstrated greater improvements in BMI than did control minority children. Public Health Implications. To reduce racial/ethnic disparities, we need to disseminate effective obesity prevention interventions during early childhood in low-income settings.

  View details for DOI 10.2105/AJPH.2018.304511

  View details for PubMedID 30024810

  View details for PubMedCentralID PMC6085047

• Associations of Early to Mid-Childhood Adiposity with Elevated Mid-Childhood Alanine Aminotransferase Levels in the Project Viva Cohort. The Journal of pediatrics Woo Baidal, J. A., Elbel, E. E., Lavine, J. E., Rifas-Shiman, S. L., Gillman, M. W., Oken, E., Taveras, E. M. 2018; 197: 121-127.e1

  Abstract

  To examine the longitudinal relationship of early to mid-childhood adiposity measures with mid-childhood alanine aminotransferase (ALT) levels.We studied 635 children in the Project Viva cohort. Research staff measured weight, height, skinfolds thicknesses, and waist and hip circumferences at early (median 3.2 years) and mid-childhood (median 7.7 years) visits. At mid-childhood, we collected blood for ALT analysis. We used established sex-specific ALT cut-offs to define elevated ALT. In multivariable linear and logistic regression models, we assessed the association of adiposity measures from early to mid-childhood with mid-childhood ALT level, adjusting for confounders.Children were 48% female, 59% white, 21% black, 6% Hispanic/Latino, and 3% Asian. At early childhood, 29% had overweight/obesity and mean waist circumference was 51.5 (SD 3.8) cm. At mid-childhood, mean ALT was 20.3 (SD 7.3) units/L, and 23% had an elevated ALT. In multivariable-adjusted regression models, each additional 10-cm greater waist circumference at early childhood was associated with 1.99 (95% CI 1.19-3.33) greater odds of elevated ALT at mid-childhood. Greater increases from early to mid-childhood in body mass index z score, sum of subscapular and triceps skinfold thicknesses, waist circumference, and hip circumference were associated with greater ALT at mid-childhood.In this prospective cohort, greater waist circumference at early childhood and greater increases in adiposity measures from early to mid-childhood were associated with greater ALT levels at mid-childhood.

  View details for DOI 10.1016/j.jpeds.2018.01.069

  View details for PubMedID 29627190

  View details for PubMedCentralID PMC5970959

• Association of vitamin E intake at early childhood with alanine aminotransferase levels at mid-childhood HEPATOLOGY Baidal, J., Cheng, E. R., Rifas-Shiman, S. L., Oken, E., Gillman, M. W., Taveras, E. M. 2018; 67 (4): 1339-1347

  Abstract

  The extent to which vitamin E (alpha-tocopherol) intake early in childhood is associated with alanine aminotransferase (ALT) level later in childhood is unknown. The objective of this research is to test the hypothesis that higher alpha-tocopherol intake during early childhood is associated with lower odds of elevated ALT levels during mid-childhood and to examine how body mass index (BMI) influences these relationships. We studied 528 children in Project Viva. Mothers reported child dietary intake at early childhood visits (median 3.1 years) using a validated food frequency questionnaire. At mid-childhood (median 7.6 years), we collected child blood and anthropometric data. The main outcome was elevated sex-specific mid-childhood ALT level (≥22.1 U/L for female children and ≥25.8 U/L for male children). In multivariable logistic regression models, we assessed the association of energy-adjusted alpha-tocopherol intake with ALT levels, adjusting for child age, sex, race/ethnicity, diet, and age-adjusted sex-specific BMI z-score at mid-childhood. Among children in this study, 48% were female, 63% were non-Hispanic white, 19% were non-Hispanic black, and 4% were Hispanic/Latino. Mean alpha-tocopherol intake was 3.7 ± 1.0 mg/day (range, 1.4-9.2) at early childhood. At mid-childhood, mean BMI z-score was 0.41 ± 1.0 units and 22% had an elevated ALT level. In multivariable-adjusted logistic regression models, children with higher early childhood vitamin E intake had lower odds of elevated mid-childhood ALT (adjusted odds ratio [AOR], 0.62; 95% confidence interval [CI], 0.39, 0.99) for quartiles 2-4 compared with the lowest quartile of intake. Findings persisted after accounting for early childhood diet (AOR, 0.62; 95% CI, 0.36, 1.08) and were strengthened after additionally accounting for mid-childhood BMI z-score (AOR, 0.56; 95% CI, 0.32, 0.99).In this cohort, higher early childhood intake of alpha-tocopherol was associated with lower odds of elevated mid-childhood ALT level. (Hepatology 2018;67:1339-1347).

  View details for DOI 10.1002/hep.29629

  View details for Web of Science ID 000428332600018

  View details for PubMedID 29119610

  View details for PubMedCentralID PMC5867213

• Early life exposure to per- and polyfluoroalkyl substances and mid-childhood lipid and alanine aminotransferase levels. Environment international Mora, A. M., Fleisch, A. F., Rifas-Shiman, S. L., Woo Baidal, J. A., Pardo, L., Webster, T. F., Calafat, A. M., Ye, X., Oken, E., Sagiv, S. K. 2018; 111: 1-13

  Abstract

  Growing evidence suggests that exposure to per- and polyfluoroalkyl substances (PFASs) may disrupt lipid homeostasis and liver function, but data in children are limited.We examined the association of prenatal and mid-childhood PFAS exposure with lipids and alanine aminotransferase (ALT) levels in children.We studied 682 mother-child pairs from a Boston-area pre-birth cohort. We quantified PFASs in maternal plasma collected in pregnancy (median 9.7weeks gestation, 1999-2002) and in child plasma collected in mid-childhood (median age 7.7years, 2007-2010). In mid-childhood we also measured fasting total (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), and ALT. We then derived low-density lipoprotein cholesterol (LDL-C) from TC, HDL-C, and TG using the Friedewald formula.Median (interquartile range, IQR) perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), and perfluorodecanoate (PFDeA) concentrations in child plasma were 6.2 (5.5), 4.3 (3.0), and 0.3 (0.3) ng/mL, respectively. Among girls, higher child PFOS, PFOA, and PFDeA concentrations were associated with detrimental changes in the lipid profile, including higher TC and/or LDL-C [e.g., β per IQR increment in PFOS=4.0mg/dL (95% CI: 0.3, 7.8) for TC and 2.6mg/dL (-0.5, 5.8) for LDL-C]. However, among both boys and girls, higher plasma concentrations of these child PFASs were also associated with higher HDL-C, which predicts better cardiovascular health, and slightly lower ALT, which may indicate better liver function. Prenatal PFAS concentrations were also modestly associated with improved childhood lipid and ALT levels.Our data suggest that prenatal and mid-childhood PFAS exposure may be associated with modest, but somewhat conflicting changes in the lipid profile and ALT levels in children.

  View details for DOI 10.1016/j.envint.2017.11.008

  View details for PubMedID 29156323

  View details for PubMedCentralID PMC5801004

• Perceived not actual overweight is associated with excessive school absenteeism among U.S. adolescents. Obesity research & clinical practice Duncan, D. T., Hansen, A. R., Woo Baidal, J., Lyn, R., Hill, A., Zhang, J. 2017; 11 (4): 398-405

  Abstract

  Excess body weight has been reported to be associated with excessive school absenteeism (ESA), but less is known about the association with perceived body weight. The study objective was to weigh the relative influence of perceived and measured weight status on school attendance.We used the data from 3113 adolescents age 12-19 years who were interviewed as a part of the National Health and Nutrition Examination Surveys (NHANES), 2003-2008. Body weight and height were measured during the physical examination, while self-perceived body weight and the number of school days missed was assessed using questionnaires. Missing one or more days per school month (nine days per school year) was defined as, and indicative of, experiencing ESA.ESA was reported from 12.31 (SE=0.89) % of adolescents. The highest prevalence occurred among healthy weight adolescents who erroneously self-perceived as overweight [21.6 (4.77) %], two times higher than adolescents with obesity who self-perceived as "just right weight" [10.3 (2.87) %]. The adjusted prevalence ratio (PR) of ESA for healthy weight adolescents who erroneously self-perceived as "overweight" was 1.91 (95%CI=1.10-3.32) compared to healthy weight peers who correctly self-perceived as "just right" (reference group). The PRs were 0.99 (0.48-2.06) and 1.41 (0.86-2.32) respectively for adolescents with obesity who believed that their body weight was "just right" or "overweight". No significant differences were observed between boys and girls, young (12-15 years) and older adolescents (16-19 years).Perceived overweight rather than actual overweight is significantly associated ESA among adolescents.

  View details for DOI 10.1016/j.orcp.2016.10.286

  View details for PubMedID 27839673

• Clinical effectiveness of the massachusetts childhood obesity research demonstration initiative among low-income children. Obesity (Silver Spring, Md.) Taveras, E. M., Perkins, M., Anand, S., Woo Baidal, J. A., Nelson, C. C., Kamdar, N., Kwass, J. A., Gortmaker, S. L., Barrett, J. L., Davison, K. K., Land, T. 2017; 25 (7): 1159-1166

  Abstract

  To examine the extent to which a clinical intervention resulted in reduced BMI z scores among 2- to 12-year-old children compared to routine practice (treatment as usual [TAU]).The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project is a multifaceted initiative to prevent childhood obesity among low-income children. At the federally qualified community health centers (FQHCs) of two communities (Intervention Site #1 and #2), the following were implemented: (1) pediatric weight management training, (2) electronic decision supports for clinicians, (3) on-site Healthy Weight Clinics, (4) community health worker integration, and (5) healthful clinical environment changes. One FQHC in a demographically matched community served as the TAU site. Using electronic health records, we assessed BMI z scores and used linear mixed models to examine BMI z score change over 2 years in each intervention site compared to a TAU site.Compared to children in the TAU site (n = 2,286), children in Intervention Site #2 (n = 1,368) had a significant decline in BMI z scores following the start of the intervention (-0.16 units/y; 95% confidence interval: -0.21 to -0.12). No evidence of an effect was found in Intervention Site #1 (n = 111).The MA-CORD clinical interventions were associated with modest improvement in BMI z scores in one of two intervention communities compared to a TAU community.

  View details for DOI 10.1002/oby.21866

  View details for PubMedID 28653504

  View details for PubMedCentralID PMC5506684

• Childhood obesity prevention in the women, infants, and children program: Outcomes of the MA-CORD study. Obesity (Silver Spring, Md.) Woo Baidal, J. A., Nelson, C. C., Perkins, M., Colchamiro, R., Leung-Strle, P., Kwass, J. A., Gortmaker, S. L., Davison, K. K., Taveras, E. M. 2017; 25 (7): 1167-1174

  Abstract

  To examine the extent to which a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) intervention improved BMI z scores and obesity-related behaviors among children age 2 to 4 years.In two Massachusetts communities, practice changes in WIC were implemented as part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) initiative to prevent obesity among low-income children. One WIC program was the comparison. Changes in BMI z scores pre and post intervention and prevalence of obesity-related behaviors of WIC participants were assessed. Linear mixed models were used to examine BMI z score change, and logistic regression models were used to examine changes in obesity-related behaviors in each intervention site versus comparison over 2 years.WIC-enrolled children in both intervention sites (vs. comparison) had improved sugar-sweetened beverage consumption and sleep duration. Compared to the comparison WIC program (n = 626), no differences were observed in BMI z score among children in Intervention Site #1 (n = 198) or #2 (n = 637). In sensitivity analyses excluding Asian children, a small decline was observed in BMI z score (-0.08 units/y [95% confidence interval: -0.14 to -0.02], P = 0.01) in Intervention Site #2 versus comparison.Among children enrolled in WIC, the MA-CORD intervention was associated with reduced prevalence of obesity risk factors in both intervention communities and a small improvement in BMI z scores in one of two intervention communities in non-Asian children.

  View details for DOI 10.1002/oby.21865

  View details for PubMedID 28653498

  View details for PubMedCentralID PMC5600510

• Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review. American journal of preventive medicine Woo Baidal, J. A., Locks, L. M., Cheng, E. R., Blake-Lamb, T. L., Perkins, M. E., Taveras, E. M. 2016; 50 (6): 761-779

  Abstract

  Mounting evidence suggests that the origins of childhood obesity and related disparities can be found as early as the "first 1,000 days"-the period from conception to age 2 years. The main goal of this study is to systematically review existing evidence for modifiable childhood obesity risk factors present from conception to age 2 years.PubMed, Embase, and Web of Science were searched for studies published between January 1, 1980, and December 12, 2014, of childhood obesity risk factors present during the first 1,000 days. Prospective, original human subject, English-language research with exposure occurrence during the first 1,000 days and with the outcome of childhood overweight or obesity (BMI ≥85th percentile for age and sex) collected between age 6 months and 18 years were analyzed between December 13, 2014, and March 15, 2015.Of 5,952 identified citations, 282 studies met inclusion criteria. Several risk factors during the first 1,000 days were consistently associated with later childhood obesity. These included higher maternal pre-pregnancy BMI, prenatal tobacco exposure, maternal excess gestational weight gain, high infant birth weight, and accelerated infant weight gain. Fewer studies also supported gestational diabetes, child care attendance, low strength of maternal-infant relationship, low SES, curtailed infant sleep, inappropriate bottle use, introduction of solid food intake before age 4 months, and infant antibiotic exposure as risk factors for childhood obesity.Modifiable risk factors in the first 1,000 days can inform future research and policy priorities and intervention efforts to prevent childhood obesity.

  View details for DOI 10.1016/j.amepre.2015.11.012

  View details for PubMedID 26916261

• Interventions for Childhood Obesity in the First 1,000 Days A Systematic Review. American journal of preventive medicine Blake-Lamb, T. L., Locks, L. M., Perkins, M. E., Woo Baidal, J. A., Cheng, E. R., Taveras, E. M. 2016; 50 (6): 780-789

  Abstract

  The "first 1,000 days"-conception through age 24 months-are critical for the development and prevention of childhood obesity. This study systematically reviews existing and ongoing interventions during this period, identifies gaps in current research, and discusses conceptual frameworks and opportunities for future interventions.PubMed, Embase, Web of Science, and ClinicalTrials.gov were searched to identify completed and ongoing interventions implemented during pregnancy through age 24 months that aimed to prevent overweight/obesity between ages 6 months and 18 years. English-language, controlled interventions published between January 1, 1980 and December 12, 2014, were analyzed between December 13, 2014 and March 15, 2015.Of 34 completed studies from 26 unique identified interventions, nine were effective. Effective interventions focused on individual- or family-level behavior changes through home visits, individual counseling or group sessions in clinical settings, a combination of home and group visits in a community setting, and using hydrolyzed protein formula. Protein-enriched formula increased childhood obesity risk. Forty-seven ongoing interventions were identified. Across completed and ongoing interventions, the majority target individual- or family-level changes, many are conducted in clinical settings, and few target early-life systems and policies that may impact childhood obesity.Obesity interventions may have the greatest preventive effect if begun early in life. Yet, few effective interventions in the first 1,000 days exist, and many target individual-level behaviors of parents and infants. Interventions that operate at systems levels and are grounded in salient conceptual frameworks hold promise for improving future models of early-life obesity prevention.

  View details for DOI 10.1016/j.amepre.2015.11.010

  View details for PubMedID 26916260

  View details for PubMedCentralID PMC5207495

• The intersection of nonalcoholic fatty liver disease and obesity. Science translational medicine Woo Baidal, J. A., Lavine, J. E. 2016; 8 (323): 323rv1

  Abstract

  Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide and recently emerged as the most rapidly increasing indication for liver transplant. Although obesity is a risk factor for NAFLD, overlap between these two entities is incompletely understood. We highlight recent insights into the pathogenesis of human NAFLD in relation to obesity and discuss advances in the diagnosis and treatment of NAFLD.

  View details for DOI 10.1126/scitranslmed.aad8390

  View details for PubMedID 26819197

• The Role of Health Information Sources in Decision-Making Among Hispanic Mothers During Their Children's First 1000 Days of Life. Maternal and child health journal Criss, S., Woo Baidal, J. A., Goldman, R. E., Perkins, M., Cunningham, C., Taveras, E. M. 2015; 19 (11): 2536-43

  Abstract

  This qualitative research aimed to explore how health information sources inform decision-making among Hispanic mothers during their children's first 1000 days of life (conception-age 24 months), and to generate appropriate health information sources and communication strategies for future interventions.We conducted seven focus groups with 49 Hispanic women who were pregnant or had children <2 years old. Domains included interpersonal and media sources, source trustworthiness, dealing with contradictory information, and how information affects decision-making. We used immersion/crystallization process for analysis.Trusted health information sources included health care providers, female and male family members, BabyCenter.com and other Internet sources, selected social media, and television. Some immigrant women reported preferring the Internet citing less established local support networks. Women highlighted the importance of validating health information through checking multiple sources for consistency and resolving contradictory information. Mothers expressed interest in receiving reliable website links from healthcare professionals and outreach to extended family.Cultural factors, including immigration status, are important in understanding the use of health information sources and their role in decision-making about pregnancy and child health among Hispanic mothers. Healthcare providers and public health professionals should consider Hispanic mothers health information environment and provide culturally-relevant communication strategies and interventions during this high information-seeking time period.

  View details for DOI 10.1007/s10995-015-1774-2

  View details for PubMedID 26122256

  View details for PubMedCentralID PMC4596758

• Reducing Hispanic children's obesity risk factors in the first 1000 days of life: a qualitative analysis. Journal of obesity Woo Baidal, J. A., Criss, S., Goldman, R. E., Perkins, M., Cunningham, C., Taveras, E. M. 2015; 2015: 945918

  Abstract

  Modifiable behaviors during the first 1000 days (conception age 24 months) mediate Hispanic children's obesity disparities. We aimed to examine underlying reasons for early life obesity risk factors and identify potential early life intervention strategies.We conducted 7 focus groups with 49 Hispanic women who were pregnant or had children < age 24 months. Domains included influences on childhood obesity risk factors and future intervention ideas. We analyzed data with immersion-crystallization methods until no new themes emerged.Themes included coping with pregnancy may trump healthy eating and physical activity; early life weight gain is unrelated to later life obesity; fear of infant hunger drives bottle and early solids introduction; beliefs about infant taste promote early solids and sugary beverage introduction; and belief that screen time promotes infant development. Mothers identified physicians, nutritionists, and relatives as important health information sources and expressed interest in mobile technology and group or home visits for interventions.Opportunities exist in the first 1000 days to improve Hispanic mothers' understanding of the role of early life weight gain in childhood obesity and other obesity risk factors. Interventions that link health care and public health systems and include extended family may prevent obesity among Hispanic children.

  View details for DOI 10.1155/2015/945918

  View details for PubMedID 25874127

  View details for PubMedCentralID PMC4385595

• Evaluation overview for the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project. Childhood obesity (Print) Davison, K. K., Falbe, J., Taveras, E. M., Gortmaker, S., Kulldorff, M., Perkins, M., Blaine, R. E., Franckle, R. L., Ganter, C., Woo Baidal, J., Kwass, J. A., Buszkiewicz, J., Smith, L., Land, T. 2015; 11 (1): 23-36

  Abstract

  The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project is a 2-year, multilevel, multisector community intervention to prevent and control obesity among children 2-12 years of age from two predominantly low-income communities in Massachusetts. MA-CORD includes evidence-based interventions in multiple sectors, including community health centers, early care and education centers, schools, afterschool programs, the Special Supplemental Nutrition Program for Women, Infants and Children, and the broader community. Currently, implementation of MA-CORD is complete and the final year of data collection is in progress. Here, the MA-CORD evaluation plan is described and baseline data are presented.The impact of MA-CORD on children's BMI, lifestyle behaviors, obesity-related care, and quality of life will be assessed using sector-specific, pre/post, time-series, and quasi-experimental designs. Change in the primary outcomes will be compared for intervention and comparison communities. Additionally, change in mean BMI and obesity prevalence in intervention school districts will be compared to similar districts throughout the state.At baseline in 2012, approximately 16% of preschool-aged and 25% of school-aged children were obese. Moreover, 15-40% of children consumed no vegetables on the previous day, 25-75% drank a sugar-sweetened beverage on the previous day, up to 87% had insufficient physical activity, 50-75% had a television in the room where they slept, and 50-80% obtained insufficient sleep.There is ample room for improvement in BMI and health behaviors in children in MA-CORD communities. If successful, MA-CORD may serve as a model for multilevel, multisector approaches to childhood obesity prevention and control.

  View details for DOI 10.1089/chi.2014.0059

  View details for PubMedID 25575095

  View details for PubMedCentralID PMC5915219

• Design of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study. Childhood obesity (Print) Taveras, E. M., Blaine, R. E., Davison, K. K., Gortmaker, S., Anand, S., Falbe, J., Kwass, J. A., Perkins, M., Giles, C., Criss, S., Colchamiro, R., Woo Baidal, J., Land, T., Smith, L. 2015; 11 (1): 11-22

  Abstract

  Childhood obesity is highly prevalent, is associated with both short- and long-term adverse outcomes, disproportionately affects racial/ethnic minority and economically deprived children, and represents a major threat to public health. Among the most promising approaches for its prevention and management are multilevel, multisector strategies.The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Study was a comprehensive, systematic intervention to prevent and reduce childhood obesity among low-income children ages 2-12 years in two selected cities in Massachusetts. Building on the Obesity Chronic Care Model, MA-CORD expanded a state public health department community-level obesity prevention initiative that incorporated evidence-based interventions in primary healthcare, the Women, Infants, and Children program, early care and education, schools/afterschool programs, as well as community-wide programs to improve food, beverage, physical activity (PA), and messaging environments. The study used a combination of pre- and post-time series and quasi-experimental designs to examine the extent to which the intervention resulted in changes in BMI, individual-level lifestyle behaviors, satisfaction with healthcare services, and quality of life among children, as well as changes in health policies, programs, and environments in the two intervention cities, compared to a comparison city. The intervention period was 2 years.MA-CORD will determine the extent to which a multisetting, multilevel intervention that integrates activities in primary care with broader public health interventions in schools, early care and education, and the community at large can improve children's dietary and PA behaviors and ultimately reduce obesity in low-income children.

  View details for DOI 10.1089/chi.2014.0031

  View details for PubMedID 25469676

  View details for PubMedCentralID PMC4322791

• Protecting progress against childhood obesity--the National School Lunch Program. The New England journal of medicine Woo Baidal, J. A., Taveras, E. M. 2014; 371 (20): 1862-5

  Abstract

  Two years after their implementation, new school-nutrition standards are at risk. In response to complaints about food waste and difficulties in meeting certain goals, among other issues, lawmakers have proposed granting schools waivers if they are losing revenue.

  View details for DOI 10.1056/NEJMp1409353

  View details for PubMedID 25353967

• Parental perceptions of a motivational interviewing-based pediatric obesity prevention intervention. Clinical pediatrics Woo Baidal, J. A., Price, S. N., Gonzalez-Suarez, E., Gillman, M. W., Mitchell, K., Rifas-Shiman, S. L., Horan, C. M., Gortmaker, S. L., Taveras, E. M. 2013; 52 (6): 540-8

  Abstract

  Motivational interviewing (MI) shows promise for pediatric obesity prevention, but few studies address parental perceptions of MI. The aim of this study was to identify correlates of parental perceptions of helpfulness of and satisfaction with a MI-based pediatric obesity prevention intervention. We studied 253 children 2 to 6 years of age in the intervention arm of High Five for Kids, a primary care-based randomized controlled trial. In multivariable models, parents born outside the United States (odds ratio [OR] = 8.81; 95% confidence interval [CI] = 2.44, 31.8), with lower household income (OR = 3.60; 95% CI = 1.03, 12.55), and with higher BMI (OR = 2.86; 95% CI = 1.07, 7.65) were more likely to perceive MI-based visits as helpful in improving children's obesity-related behaviors after the first year of the intervention. Parents of female (vs male), black (vs white), and Latino (vs white) children had lower intervention satisfaction. Our findings underscore the importance of tailoring pediatric obesity prevention efforts to target populations.

  View details for DOI 10.1177/0009922813483170

  View details for PubMedID 23564304

  View details for PubMedCentralID PMC3800680

• Childhood obesity: shifting the focus to early prevention. Archives of pediatrics & adolescent medicine Woo Baidal, J. A., Taveras, E. M. 2012; 166 (12): 1179-81

  View details for DOI 10.1001/2013.jamapediatrics.358

  View details for PubMedID 23108905

• Beta-2-adrenergic receptor polymorphisms in cystic fibrosis. Pharmacogenetics and genomics Steagall, W. K., Barrow, B. J., Glasgow, C. G., Mendoza, J. W., Ehrmantraut, M., Lin, J. P., Insel, P. A., Moss, J. 2007; 17 (6): 425-30

  Abstract

  Cystic fibrosis (CF), an autosomal recessive disease affecting the lung, pancreas, gut, liver, and reproductive tract, is caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene, which encodes a cyclic adenosine 3', 5' monophosphate-regulated chloride channel. The variability of disease progression among patients with CF suggests effects of genetic modifiers of disease. Beta-2 adrenergic receptors (beta2AR), which are abundant in airway epithelial cells, accelerate the formation of cyclic adenosine 3', 5' monophosphate, which can modulate CFTR activity and affect smooth muscle contractility. We tested the hypothesis that genetic variants of the beta2AR gene, which have been shown to influence receptor desensitization, are more frequent in patients than in controls.We genotyped 130 adult CF patients and 1 : 1 age-matched, sex-matched, and ethnicity-matched normal volunteers for GlyArg and GlnGlu beta2AR.We found that CF patients were more likely than controls to be Gly homozygotes (48 and 32%, respectively) (P<0.01) and Glu homozygotes (29 and 10%, respectively) (P<0.01).Our results, showing a higher frequency of Gly and Glu beta2AR alleles in adult CF patients than in the control population, contrast with data from children with CF, who are reported to have lower frequency of Gly and similar frequency of G1u, and with data from young adults with CF, who showed no differences in frequencies of beta2AR variants. The GlyGlu variant of beta2AR may have properties that lead to enhanced beta2AR function, resulting in the upregulation of CFTR activity and the improvement of CF disease.

  View details for DOI 10.1097/FPC.0b013e3280119349

  View details for PubMedID 17502834

  View details for PubMedCentralID PMC3021988

• Elucidation of the c-Jun N-terminal kinase pathway mediated by Estein-Barr virus-encoded latent membrane protein 1. Molecular and cellular biology Wan, J., Sun, L., Mendoza, J. W., Chui, Y. L., Huang, D. P., Chen, Z. J., Suzuki, N., Suzuki, S., Yeh, W. C., Akira, S., Matsumoto, K., Liu, Z. G., Wu, Z. 2004; 24 (1): 192-9

  Abstract

  Epstein-Barr virus (EBV) is associated with several human diseases including infectious mononucleosis and nasopharyngeal carcinoma. EBV-encoded latent membrane protein 1 (LMP1) is oncogenic and indispensable for cellular transformation caused by EBV. Expression of LMP1 in host cells constitutively activates both the c-Jun N-terminal kinase (JNK) and NF-kappaB pathways, which contributes to the oncogenic effect of LMP1. However, the underlying signaling mechanisms are not very well understood. Based mainly on overexpression studies with various dominant-negative constructs, LMP1 was generally thought to functionally mimic members of the tumor necrosis factor (TNF) receptor superfamily in signaling. In contrast to the prevailing paradigm, using embryonic fibroblasts from different knockout mice and the small interfering RNA technique, we find that the LMP1-mediated JNK pathway is distinct from those mediated by either TNF-alpha or interleukin-1. Moreover, we have further elucidated the LMP1-mediated JNK pathway by demonstrating that LMP1 selectively utilizes TNF receptor-associated factor 6, TAK1/TAB1, and c-Jun N-terminal kinase kinases 1 and 2 to activate JNK.

  View details for DOI 10.1128/MCB.24.1.192-199.2004

  View details for PubMedID 14673155

  View details for PubMedCentralID PMC303354