Karen Switkowski
Senior Research Scientist, Pediatrics - Gastroenterology
Contact
https://orcid.org/0000-0001-8212-4354All Publications
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Estimating sex-specific population-level effects of limiting sugar-sweetened beverages or 100% fruit juices during childhood on insulin resistance, central adiposity, and glycemic outcomes in late adolescence.
American journal of epidemiology
2025
Abstract
We estimated sex-specific population effects of hypothetical interventions to limit SSBs and 100% fruit juice throughout childhood on central adiposity, insulin resistance and glycemic outcomes in adolescence in Project Viva pre-birth cohort. Among 481 females and 491 males, mothers reported beverage intake from 3 to 10 years from food frequency questionnaire. Primary outcome was the homeostasis model assessment for insulin resistance (HOMA-IR), and secondary outcomes were waist circumference, truncal fat mass, fasting glucose and glycated hemoglobin in late adolescence. We applied inverse probability weighting of longitudinal marginal structural models to account for baseline and time-varying confounding, and censoring. We estimated that limiting SSBs to one serving weekly across childhood would reduce HOMA-IR by 0.28 units (95%CI: -0.61; 0.02), waist circumference by 1.91 cm (95%CI: -3.79; -0.05), truncal fat mass by 0.64 kg (95%CI: -1.33; 0.05) and fasting glucose by 1.02 mg/dL (95%CI: -2.40; 0.35) in males compared to no intervention. In females, effect estimates were near zero and less precise than males. Effect estimates for 100% fruit juice were small with imprecise CI in both sexes. Overall, limiting SSBs in childhood may have small effects on insulin resistance, central adiposity and glycemia in males in this population of low consumers. Study registry number: NCT02820402.
View details for DOI 10.1093/aje/kwaf225
View details for PubMedID 41108089
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Lifetime history of hypertensive disorders of pregnancy is associated with shorter sleep duration and more sleep disturbance in midlife: results from the Project Viva women's health cohort
BIOLOGY OF SEX DIFFERENCES
2025; 16 (1): 46
Abstract
Hypertensive disorders of pregnancy (HDP) are associated with worse prenatal and perinatal sleep health and higher cardiovascular disease risk beyond the peripartum period. The relationship of HDP with sleep health in midlife, when sleep problems are common, remains unclear.We studied women enrolled in Project Viva during early pregnancy (1999-2002) with sleep outcomes assessed in midlife (2017-2024). We determined lifetime HDP via medical records from the index pregnancy and self-report both at enrollment and during midlife. Outcomes were (i) self-reported sleep duration and sleep quality, using the patient-reported outcomes measurement information system sleep disturbance and sleep-related impairment instruments at mean 52.3yrs; and (ii) objectively measured 5-day sleep duration and efficiency by wrist actigraphy at mean 55.8yrs in a subset. We performed linear and logistic regression models adjusted for enrollment age, education, parity, household income, pre-pregnancy BMI, race, and ethnicity and considered modification by social determinants of health.Of 767 participants, 23% had a lifetime history of HDP, 4% had ≥ 2 episodes, and 7% had HDP during their last pregnancy. Mean (SD) daily sleep duration was 7.1 (1.0) hours by self-report and 6.7 (1.0) hours by actigraphy. Any (vs. no) lifetime HDP was associated with shorter self-reported (-8 min, 95% CI: -19, 2) and actigraphy-measured (-16 min, 95% CI: -31, -1) sleep duration. Estimates were stronger but with wider CIs for those with ≥ 2 (vs. no) HDP episodes (e.g., -23 min, 95% CI: -53, 6 for actigraphy-measured sleep duration). Mean (SD) sleep disturbance T-score was 48.6 (7.4) and sleep-related impairment was 45.8 (8.5). Any lifetime HDP (vs. none) was associated with higher (worse) sleep disturbance T-score (1.85 points, 95% CI: 0.28, 3.42) with stronger associations for ≥ 2 HDP episodes (3.41 points, 95% CI: 0.17, 6.65) and for HDP in the last pregnancy (3.63 points, 95% CI: 0.70, 6.57). HDP was not associated with self-reported sleep-related impairment or sleep efficiency.History of HDP was associated with shorter sleep duration and higher sleep disturbance in midlife. Future work should investigate the contribution of sleep health to associations of HDP exposure with cardiovascular disease risk in later life.
View details for DOI 10.1186/s13293-025-00725-4
View details for Web of Science ID 001521116800004
View details for PubMedID 40597286
View details for PubMedCentralID PMC12219990
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The Interplay of Dietary Choline and Methyl Donors in Modulating Maternal Inflammation: Insights from Project Viva
JOURNAL OF NUTRITION
2025; 155 (6): 1999-2005
Abstract
Inflammation during pregnancy is an important contributor to maternal and offspring morbidity and mortality. Evidence from both nonpregnant human and animal studies suggests that dietary choline can attenuate inflammation, but this has not yet been explored in human pregnancy.This study explored the cross-sectional associations between maternal mid-pregnancy dietary choline intake and inflammation biomarkers, specifically IL-6, tumor necrosis factor- α (TNF-α), and C-reactive protein (CRP), while also examining the modifying effects of other methyl donor nutrients.We analyzed data from 640 pregnant women enrolled in Project Viva, a longitudinal cohort study in Eastern Massachusetts. We assessed mid-pregnancy maternal dietary intake via a semiquantitative food frequency questionnaire, and measured inflammatory markers in maternal blood collected concurrently, namely IL-6, TNF-α, and CRP. We employed censored and linear regression models to assess associations of z-scored choline intake with log-transformed inflammatory markers and assessed potential interactions between choline intake and intakes of other methyl donor nutrients. We assessed unadjusted models and models adjusted for sociodemographic and dietary covariates.We found no main effect of choline intake with IL-6, TNF-α, or CRP levels [for example, for IL-6, β = -0.02 pg/mL, 95% confidence interval (CI): -0.08, 0.05]. However, an interaction term demonstrated that greater combined intake of choline and other methyl donor nutrients was related to lower IL-6 (for example, for betaine, β interaction =-0.08 pg/mL, 95% CI: -0.14, -0.02). We did not observe similar interaction effects or TNF-α or CRP.These findings highlight the interplay between choline and other dietary methyl donors in modulating inflammation status during pregnancy, specifically through IL-6. Higher intake of methyl donor nutrients may be necessary for any anti-inflammatory effects of choline, although further studies in this area are warranted.
View details for DOI 10.1016/j.tjnut.2025.04.032
View details for Web of Science ID 001511708500013
View details for PubMedID 40334784
View details for PubMedCentralID PMC12264560
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Associations of Infant Colic and Excessive Crying With Atopic Outcomes in Childhood and Adolescence
JOURNAL OF PEDIATRICS
2025; 283: 114623
Abstract
To assess the extent to which risks of atopic and respiratory conditions throughout childhood and adolescence differ by history of (1) infant colic, characterized by apparent abdominal discomfort and unsoothable crying, (2) excessive crying without colic, or (3) neither condition.Among 1249 children participating in the prospective, unselected Project Viva cohort, we examined associations of history of infant colic or excessive crying without colic with risks of eczema, allergic rhinitis, asthma, and respiratory infections, measured in toddlerhood, early childhood, mid-childhood, early adolescence, and mid-adolescence using multinomial logistic regression models.The study sample was 50% female and 71% non-Hispanic White; 26% had colic and 9% excessive crying. Children with colic (vs no colic or excessive crying) had higher risk of eczema (relative risk ratio [RRR], 2.1; 95% CI, 1.2-3.8), allergic rhinitis (RRR, 1.6; 95% CI, 1.1-2.4), and asthma (RRR, 1.6; 95% CI,1.1-2.4) in mid-childhood, and a higher risk of respiratory infections in toddlerhood (RRR, 1.6; 95% CI, 1.2-2.2) and mid-adolescence (RRR, 2.1; 95% CI, 1.2, 3.7). The risk of 2-3 concurrent atopic conditions (eczema, allergic rhinitis, and/or asthma) was nearly twice that among the colic group (vs unaffected) at all life stages. The group with excessive crying without colic did not have increased risk of atopic and respiratory outcomes.Colic characterized by unsoothable crying and parent perceptions of abdominal distress may be an early marker of atopic susceptibility.
View details for DOI 10.1016/j.jpeds.2025.114623
View details for Web of Science ID 001492513200001
View details for PubMedID 40280470
View details for PubMedCentralID PMC12277002
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Prenatal Diet and Infant Growth From Birth to Age 24 Months
JAMA NETWORK OPEN
2024; 7 (11): e2445771
Abstract
Being born either small for gestational age (SGA) or large for gestational age (LGA) and experiencing rapid or slow growth after birth are associated with later-life obesity. Understanding the associations of dietary quality during pregnancy with infant growth may inform obesity prevention strategies.To evaluate the associations of prenatal dietary quality according to the Healthy Eating Index (HEI) and the Empirical Dietary Inflammatory Pattern (EDIP) with infant size at birth and infant growth from birth to age 24 months.This cohort study used data from birthing parent-child dyads in 8 cohorts participating in the Environmental influences on Child Health Outcomes program between 2007 and 2021. Data were analyzed from March 2021 to August 2024.The HEI and the EDIP dietary patterns.Outcomes of interest were infant birth weight, categorized as SGA, reference range, or LGA, and infant growth from birth to ages 6, 12, and 24 months, categorized as slow growth (weight-for-length z score [WLZ] score difference <-0.67), within reference range (WLZ score difference -0.67 to 0.67), or rapid (WLZ score difference, >0.67).The study included 2854 birthing parent-child dyads (median [IQR] maternal age, 30 [25-34] years; 1464 [51.3%] male infants). The cohort was racially and ethnically diverse, including 225 Asian or Pacific Islander infants (7.9%), 640 Black infants (22.4%), 1022 Hispanic infants (35.8%), 664 White infants (23.3%), and 224 infants (7.8%) with other race or multiple races. A high HEI score (>80), indicative of a healthier diet, was associated with lower odds of LGA (adjusted odds ratio [aOR], 0.88 [95% CI, 0.79-0.98]), rapid growth from birth to age 6 months (aOR, 0.80 [95% CI, 0.37-0.94]) and age 24 months (aOR 0.82 [95% CI, 0.70- 0.96]), and slow growth from birth to age 6 months (aOR, 0.65 [95% CI, 0.50-0.84]), 12 months (aOR, 0.74 [95% CI, 0.65-0.83]), and 24 months (OR, 0.65 [95% CI, 0.56-0.76]) compared with an HEI score 80 or lower. There was no association between high HEI and SGA (aOR, 1.14 [95% CI, 0.95-1.35]). A low EDIP score (ie, ≤63.6), indicative of a less inflammatory diet, was associated with higher odds of LGA (aOR, 1.24 [95% CI, 1.13-1.36]) and rapid infant growth from birth to age 12 months (aOR, 1.50 [95% CI, 1.18-1.91]) and lower odds of rapid growth to age 6 months (aOR, 0.77 [95% CI, 0.71-0.83]), but there was no association with SGA (aOR, 0.80 [95% CI, 0.51-1.25]) compared with an EDIP score of 63.6 or greater.In this cohort study, a prenatal diet that aligned with the US Dietary Guidelines was associated with reduced patterns of rapid and slow infant growth, known risk factors associated with obesity. Future research should examine whether interventions to improve prenatal diet are also beneficial in improving growth trajectory in children.
View details for DOI 10.1001/jamanetworkopen.2024.45771
View details for Web of Science ID 001361868200008
View details for PubMedID 39570591
View details for PubMedCentralID PMC11582932
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Cohort Profile Update: Project Viva Offspring.
International journal of epidemiology
2024; 53 (6)
View details for DOI 10.1093/ije/dyae162
View details for PubMedID 39657066
View details for PubMedCentralID PMC11630542
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Early-life risk factors for both infant colic and excessive crying without colic
PEDIATRIC RESEARCH
2024: 1537-1545
Abstract
Infantile colic may represent gastrointestinal distress, yet most definitions emphasize excessive crying. Each may have distinct etiologies.In a pre-birth cohort, we used maternal reports of infant crying and apparent abdominal discomfort at 6mos to categorize infants as (1) unaffected (no excessive crying or colic), (2) excessive crying only, and (3) colic (abdominal discomfort +/- excessive crying). We examined associations of potential risk factors in separate models with excessive crying and colic (each vs. unaffected) using unadjusted multinomial logistic regression, and associations between count of risk factors and colic using logistic regression.Of 1403 infants, 140 (10%) had excessive crying, and 346 (25%) colic. Infants that were non-Hispanic white, low birthweight, firstborn, or had a maternal history of atopy, high postpartum depressive symptoms, or persistent prenatal nausea, had a 40-80% higher relative risk of colic. Preterm birth was associated with double the risk. Being firstborn, low birthweight, and preterm birth predicted excessive crying. Infants with ≥four (vs. 0-1) of the seven identified risk factors had 3.9 times (95% CI: 2.6, 6.1) higher odds of colic.Colic characterized by apparent abdominal discomfort can be phenotypically distinguished from excessive crying only. Multiple risk factors may further increase colic risk.Infant colic characterized by apparent gastrointestinal distress may be phenotypically distinct from excessive crying only. Literature that defines colic only based on crying behaviors may miss important predictors. Mother-reported colic and excessive crying appear to have overlapping risk factors, with additional risk factors identified for colic. The presence of multiple risk factors increases the risk of colic, supporting a multifactorial etiology.
View details for DOI 10.1038/s41390-024-03518-4
View details for Web of Science ID 001308086100008
View details for PubMedID 39242932
View details for PubMedCentralID PMC11882934
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Associations of Gestational Exposure to Air Pollution With Maternal Vitamin D Levels: A Meta-Analysis
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
2025; 110 (5): 1410-1418
Abstract
Maternal vitamin D level is an important determinant of pregnancy and child health outcomes. Exposure to air pollution is suspected to increase the risk of vitamin D deficiency, but the evidence is scarce.We investigated the association between air pollution during pregnancy and maternal vitamin D levels.A total of 15 935 pregnant women from 5 birth cohorts in Europe and the United States were included. Averaged concentrations of nitrogen oxides, fine and coarse particles, and composition of fine particles from conception until vitamin D measurement were estimated at participants' residential addresses using land-use regression or other spatiotemporal models. Cohorts measured vitamin D as 25(OH)D or 25(OH)D3 levels in serum or plasma at early or mid-pregnancy. We defined suboptimal vitamin D levels as levels below 20 ng/mL. We performed logistic regression models for each cohort to estimate the association between air pollution exposure and suboptimal vitamin D levels and pooled cohort-specific estimates in a random-effect meta-analysis. Models were adjusted for sociodemographic and lifestyle characteristics and month of conception.We found an association between particulate matter (PM)2.5 and higher odds of suboptimal vitamin D levels (ie, below 20 ng/mL) (odds ratio per 5 μg/m3 increase in PM2.5, 1.43; 95% CI: 1.02, 1.99). There was no association between other air pollutant exposure and vitamin D levels.PM2.5 exposure might contribute to suboptimal levels of vitamin D in pregnancy. Reducing air pollution exposure should be a priority because vitamin D deficiency may adversely influence offspring development.
View details for DOI 10.1210/clinem/dgae395
View details for Web of Science ID 001259990900001
View details for PubMedID 38870315
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Evaluation of the Prime Diet Quality Score from Early Childhood Through Mid-Adolescence
JOURNAL OF NUTRITION
2024; 154 (6): 1890-1906
Abstract
Few diet quality indices have been developed and validated for use among children and adolescents. Additionally, many available indices require completion of burdensome dietary assessments.We aimed to calculate and evaluate the performance of a modified version of the food-based Prime Diet Quality Score (PDQS) derived from different diet assessment methods conducted at 4 time points in a single study population from childhood through adolescence.Among 1460 child participants in the Project Viva cohort, we calculated the PDQS in early and mid-childhood and early and mid-adolescence using dietary data obtained from food frequency questionnaire (early childhood: parent report), PrimeScreen (mid-childhood: parent report; early adolescence: self-report) and 24-h recall (mid-adolescence: self-report). We evaluated construct and relative validity and internal reliability of the score in each life stage.The PDQS showed a range of scores at all life stages and higher scores were associated with intake of many health-promoting macronutrients and micronutrients (e.g., protein, fiber, and vitamins) in early childhood and mid-adolescence. The PDQS performed similarly to the Youth Healthy Eating Index/Healthy Eating Index (Spearman r = 0.63-0.85) in various assessments. Higher PDQS was associated with expected characteristics including more frequent breakfast eating, family dinners, and vigorous physical activity; with less frequent TV viewing and fast food intake; and with more sleep and higher maternal diet scores during pregnancy. Cross-sectional associations of the PDQS with various anthropometric measurements and biomarkers were inconsistent but generally in the expected directions (e.g., higher PDQS associated with lower triglycerides and insulin and higher HDL cholesterol). Internal reliability was consistent with what has been found for other diet quality indices.The PDQS can be calculated from data collected using different and brief dietary assessment methods and appears to be a valid and useful measure of overall diet quality in children and adolescents. Project Viva was registered at clinicaltrials.gov as NCT02820402.
View details for DOI 10.1016/j.tjnut.2024.04.014
View details for Web of Science ID 001289907900001
View details for PubMedID 38614240
View details for PubMedCentralID PMC11217026
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History of Infertility and Midlife Cardiovascular Health in Female Individuals
JAMA NETWORK OPEN
2024; 7 (1): e2350424
Abstract
Fertility status is a marker for future health, and infertility has been associated with risk for later cancer and diabetes, but associations with midlife cardiovascular health (CVH) in female individuals remain understudied.To evaluate the association of infertility history with CVH at midlife (approximately age 50 years) among parous individuals.Project Viva is a prospective cohort study of pregnant participants enrolled between 1999 and 2002 who delivered a singleton live birth in the greater Boston, Massachusetts, area. Infertility history was collected at a midlife visit between 2017 and 2021, approximately 18 years after enrollment. Data analysis was performed from January to June 2023.The primary exposure was any lifetime history of infertility identified by self-report, medical record, diagnosis, or claims for infertility treatment.The American Heart Association's Life's Essential 8 (LE8) is a construct for ranking CVH that includes scores from 0 to 100 (higher scores denote better health status) in 4 behavioral (diet, physical activity, sleep, and smoking status) and 4 biomedical (body mass index, blood pressure, blood lipids, and glycemia) domains to form an overall assessment of CVH. Associations of a history of infertility (yes or no) with mean LE8 total, behavioral, biomedical, and blood biomarker (lipids and glycemia) scores were examined, adjusting for age at outcome (midlife visit), race and ethnicity, education, household income, age at menarche, and perceived body size at age 10 years.Of 468 included participants (mean [SD] age at the midlife visit, 50.6 [5.3] years) with exposure and outcome data, 160 (34.2%) experienced any infertility. Mean (SD) LE8 scores were 76.3 (12.2) overall, 76.5 (13.4) for the behavioral domain, 76.0 (17.5) for the biomedical domain, and 78.9 (19.2) for the blood biomarkers subdomain. In adjusted models, the estimated overall LE8 score at midlife was 2.94 points lower (95% CI, -5.13 to -0.74 points), the biomedical score was 4.07 points lower (95% CI, -7.33 to -0.78 points), and the blood subdomain score was 5.98 points lower (95% CI, -9.71 to -2.26 points) among those with vs without history of infertility. The point estimate also was lower for the behavioral domain score (β = -1.81; 95% CI, -4.28 to 0.66), although the result was not statistically significant.This cohort study of parous individuals found evidence for an association between a history of infertility and lower overall and biomedical CVH scores. Future study of enhanced cardiovascular preventive strategies among those who experience infertility is warranted.
View details for DOI 10.1001/jamanetworkopen.2023.50424
View details for Web of Science ID 001137059100004
View details for PubMedID 38180761
View details for PubMedCentralID PMC10770770
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Associations between prenatal blood metals and vitamins and cord blood peptide hormone concentrations
ENVIRONMENTAL EPIDEMIOLOGY
2023; 7 (6)
View details for DOI 10.1097/EE9.0000000000000275
View details for Web of Science ID 001085560900001
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Associations Between Prenatal Blood Metals and Vitamins and Cord Blood Peptide Hormone Concentrations.
Global reproductive health
2023; 7 (6)
Abstract
Nonessential metals have endocrine disrupting properties, interfere with cellular processes, generate reactive oxygen and deplete antioxidants, while essential metals and vitamins act as antioxidants. The extent to which prenatal metals and vitamins are associated with cord blood hormones involved in maternal and fetal metabolic and growth processes is unknown.We measured six nonessential (arsenic, barium, cadmium, cesium, lead, mercury) and four essential (magnesium, manganese, selenium, zinc) metals and trace elements, and two vitamins (B12 and folate) in first trimester blood from participants in the longitudinal pre-birth Project Viva cohort, who were recruited between 1999-2002 in eastern Massachusetts. We measured adiponectin, C-peptide, IGF-1, IGF-2, IGFBP-3, insulin, and leptin concentrations in cord blood (~n=695). We used covariate-adjusted quantile g-computation for mixtures and linear regression for individual exposures to estimate associations with cord blood peptide hormones.The essential metal mixture (magnesium, manganese, selenium, zinc) was associated with higher IGF-1 (β=3.20 ng/ml per quartile, 95% CI: 0.39, 6.01), IGF-2 (β=10.93 ng/ml, 95% CI: 0.08, 21.79), and leptin (β=1.03 ng/ml, 95% CI: 0.25, 1.80). Magnesium was associated with higher leptin (β=2.90 ng/ml, 95% CI: 0.89, 4.91), while B12 was associated with lower adiponectin, IGF-2, and leptin, but higher C-peptide. Other individual nonessential metals were associated with cord blood hormones.Our findings suggest that some prenatal metals and vitamins are associated with cord blood hormones, which may influence growth and development.
View details for DOI 10.1097/EE9.0000000000000275
View details for PubMedID 38645676
View details for PubMedCentralID PMC11031200
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Opportunities for Examining Child Health Impacts of Early-Life Nutrition in the ECHO Program: Maternal and Child Dietary Intake Data from Pregnancy to Adolescence
CURRENT DEVELOPMENTS IN NUTRITION
2023; 7 (11): 102019
Abstract
Longitudinal measures of diet spanning pregnancy through adolescence are needed from a large, diverse sample to advance research on the effect of early-life nutrition on child health. The Environmental influences on Child Health Outcomes (ECHO) Program, which includes 69 cohorts, >33,000 pregnancies, and >31,000 children in its first 7-y cycle, provides such data, now publicly available.This study aimed to describe dietary intake data available in the ECHO Program as of 31 August, 2022 (end of year 6 of Cycle 1) from pregnancy through adolescence, including estimated sample sizes, and to highlight the potential for future analyses of nutrition and child health.We identified and categorized ECHO Program dietary intake data, by assessment method, participant (pregnant person or child), and life stage of data collection. We calculated the number of maternal-child dyads with dietary data and the number of participants with repeated measures. We identified diet-related variables derived from raw dietary intake data and nutrient biomarkers measured from biospecimens.Overall, 66 cohorts (26,941 pregnancies, 27,103 children, including 22,712 dyads) across 34 US states/territories provided dietary intake data. Dietary intake assessments included 24-h recalls (1548 pregnancies and 1457 children), food frequency questionnaires (4902 and 4117), dietary screeners (8816 and 23,626), and dietary supplement use questionnaires (24,798 and 26,513). Repeated measures were available for ∼70%, ∼30%, and ∼15% of participants with 24-h recalls, food frequency questionnaires, and dietary screeners, respectively. The available diet-related variables describe nutrient and food intake, diet patterns, and breastfeeding practices. Overall, 17% of participants with dietary intake data had measured nutrient biomarkers.ECHO cohorts have collected longitudinal dietary intake data spanning pregnancy through adolescence from a geographically, socioeconomically, and ethnically diverse US sample. As data collection continues in Cycle 2, these data present an opportunity to advance the field of nutrition and child health.
View details for DOI 10.1016/j.cdnut.2023.102019
View details for Web of Science ID 001113895600001
View details for PubMedID 38035205
View details for PubMedCentralID PMC10681943
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Cohort Profile Update: Project Viva mothers
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
2023; 52 (6): E332-E339
View details for DOI 10.1093/ije/dyad137
View details for Web of Science ID 001090386700001
View details for PubMedID 37875013
View details for PubMedCentralID PMC10749767
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Identifying Foods That Optimize Intake of Key Micronutrients During Pregnancy
JOURNAL OF NUTRITION
2023; 153 (10): 3012-3022
Abstract
Most pregnant women in the United States are at risk of inadequate intake of vitamin A, vitamin D, folic acid, calcium, iron, and omega-3 fatty acids from foods alone. Very few United States dietary supplements provide sufficient doses of all 6 nutrients without inducing excess intake.We aimed to identify energy-efficient foods that provide sufficient doses of these nutrients and could be consumed in lieu of dietary supplements to achieve the recommended intake in pregnancy.In a previous analysis of 2,450 pregnant women, we calculated the range of additional intake needed to shift 90% of participants to intake above the estimated average requirement and keep 90% below the tolerable upper level for these 6 nutrients. Here, we identified foods and beverages from the 2019 to 2020 Food and Nutrient Database for Dietary Studies that provide target levels of these nutrients without exceeding the additional energy intake recommended for pregnancy beginning in the second trimester (340 kilocalories).We identified 2358 candidate foods meeting the target intake range for at least one nutrient. No candidate foods provided target amounts of all 6 nutrients. Seaweed (raw or cooked without fat) provided sufficient vitamin A, folate, calcium, iron, and omega-3s (5 of 6 nutrients) but would require an intake of >5 cups/d. Twenty-one other foods/beverages (mainly fish, vegetables, and beverages) provided target amounts of 4 of the 6 nutrients. Few foods met targets for vitamin D (n = 54) or iron (n = 93).Results highlight the difficulty in meeting nutritional requirements from diet alone and imply that dietary supplements are likely necessary to meet vitamin D and iron targets in pregnancy, as well as omega-3 fatty acid targets for individuals who do not consume fish products. Other foods could be added in limited amounts to help meet intake targets without exceeding caloric recommendations or nutrient safety limits.
View details for DOI 10.1016/j.tjnut.2023.08.012
View details for Web of Science ID 001103077900001
View details for PubMedID 37604382
View details for PubMedCentralID PMC10613721
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Reply to E Ciappio et al
AMERICAN JOURNAL OF CLINICAL NUTRITION
2023; 118 (3): 731-732
View details for DOI 10.1016/j.ajcnut.2023.06.019
View details for Web of Science ID 001078564200001
View details for PubMedID 37661110
View details for PubMedCentralID PMC10624762
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Prenatal Supplements for Pregnant Women Reply
AMERICAN JOURNAL OF CLINICAL NUTRITION
2023; 118 (1): 339-340
View details for DOI 10.1016/j.ajcnut.2023.04.030
View details for Web of Science ID 001033308500001
View details for PubMedID 37407168
View details for PubMedCentralID PMC10550834
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Greater Gestational Vitamin D Status is Associated with Reduced Childhood Behavioral Problems in the Environmental Influences on Child Health Outcomes Program
JOURNAL OF NUTRITION
2023; 153 (5): 1502-1511
Abstract
Vitamin D deficiency is common in pregnancy. Vitamin D plays an important role in the developing brain, and deficiency may impair childhood behavioral development.This study examined the relationship between gestational 25(OH)D concentrations and childhood behavior in the Environmental influences on Child Health Outcomes (ECHO) Program.Mother-child dyads from ECHO cohorts with data available on prenatal (first trimester through delivery) or cord blood 25(OH)D and childhood behavioral outcomes were included. Behavior was assessed using the Strengths and Difficulties Questionnaire or the Child Behavior Checklist, and data were harmonized using a crosswalk conversion. Linear mixed-effects models examined associations of 25(OH)D with total, internalizing, and externalizing problem scores while adjusting for important confounders, including age, sex, and socioeconomic and lifestyle factors. The effect modification by maternal race was also assessed.Early (1.5-5 y) and middle childhood (6-13 y) outcomes were examined in 1688 and 1480 dyads, respectively. Approximately 45% were vitamin D deficient [25(OH)D < 20 ng/mL], with Black women overrepresented in this group. In fully adjusted models, 25(OH)D concentrations in prenatal or cord blood were negatively associated with externalizing behavior T-scores in middle childhood [-0.73 (95% CI: -1.36, -0.10) per 10 ng/mL increase in gestational 25(OH)D]. We found no evidence of effect modification by race. In a sensitivity analysis restricted to those with 25(OH)D assessed in prenatal maternal samples, 25(OH)D was negatively associated with externalizing and total behavioral problems in early childhood.This study confirmed a high prevalence of vitamin D deficiency in pregnancy, particularly among Black women, and revealed evidence of an association between lower gestational 25(OH)D and childhood behavioral problems. Associations were more apparent in analyses restricted to prenatal rather than cord blood samples. Interventions to correct vitamin D deficiency during pregnancy should be explored as a strategy to improve childhood behavioral outcomes.
View details for DOI 10.1016/j.tjnut.2023.03.005
View details for Web of Science ID 001054463100001
View details for PubMedID 37147034
View details for PubMedCentralID PMC10367223
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Selecting a dietary supplement with appropriate dosing for 6 key nutrients in pregnancy
AMERICAN JOURNAL OF CLINICAL NUTRITION
2023; 117 (4): 823-829
Abstract
Most pregnant women in the United States (US) are at risk of inadequate intake of key nutrients during pregnancy from foods alone. Current dietary supplement practices reduce risk of inadequacy for only some nutrients and induce excessive intake of other nutrients.Our study aimed to estimate the doses of supplementation needed to help most pregnant women achieve the recommended intake without exceeding upper limits for key prenatal nutrients and to identify US dietary supplements providing these doses.We conducted 24-h dietary recalls in 2450 pregnant participants aged 14-50 y from 2007 to 2019. We estimated the usual intake of vitamins A and D, folate, calcium, iron, and ω-3 FAs from foods alone. We calculated the target doses of supplementation needed to shift 90% of participants to consume above the estimated average requirement and keep 90% below the tolerable upper limit. We identified products in the Dietary Supplement Label Database providing these target doses of supplementation.The target dose for supplementation was ≥198 mcg retinol activity equivalents of total vitamin A (with ≤2063 mcg preformed retinol); 7-91 mcg vitamin D; 169-720 mcg dietary folate equivalents of folic acid; 383-943 mg calcium; 13-22 mg iron; and ≥59 mg ω-3 FAs. Out of 20,547 dietary supplements (including 421 prenatal products), 69 products (33 prenatal) contained all 6 nutrients; 7 products (2 prenatal) contained target doses for 5 nutrients. Only 1 product (not a prenatal) contained target doses for all 6 nutrients, but it currently costs ∼USD200/mo and requires 7 tablets per daily serving.Almost no US dietary supplements provide key nutrients in the doses needed for pregnant women. Affordable and convenient products that fill the gap between food-based intake and estimated requirements of pregnancy without inducing excess intake are needed to support pregnant women and their offspring. Am J Clin Nutr 20XX;xx:xx-xx.
View details for DOI 10.1016/j.ajcnut.2022.12.018
View details for Web of Science ID 000973189900001
View details for PubMedID 37019542
View details for PubMedCentralID PMC10273074
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Early Childhood Lutein and Zeaxanthin Intake Is Positively Associated with Early Childhood Receptive Vocabulary and Mid-Childhood Executive Function But No Other Cognitive or Behavioral Outcomes in Project Viva.
The Journal of nutrition
2022; 152 (11): 2555-2564
Abstract
Lutein and zeaxanthin are carotenoids associated with better cognition in older adults. Recent evidence suggests that their dietary intake may also have cognitive implications in childhood.The aim was to examine associations of early childhood lutein and zeaxanthin (L/Z) intake with cognition in early and mid-childhood.Among 1378 children in Project Viva, a prospective cohort, mothers reported their child's dietary intake in early childhood (median: 3.2 y) using a food-frequency questionnaire. Child cognition and behavior were assessed at the same time point using the Peabody Picture Vocabulary Test (PPVT-III) and the Wide Range Assessment of Visual Motor Abilities (WRAVMA) and at mid-childhood (median: 7.7 y) using the Kaufman Brief Intelligence Test, the WRAVMA drawing subtest, the Wide Range Assessment of Memory and Learning, the Behavior Rating Inventory of Executive Function (BRIEF), and the Strengths and Difficulties Questionnaire.Children consumed a daily mean (SD) of 1.0 (0.4) mg L/Z in early childhood. Children in the third-quartile category of L/Z intake had a mean PPVT-III score 2.40 (95% CI: 0.27, 4.53) points higher than children in the lowest quartile category in early childhood, suggesting better receptive vocabulary. Children in the highest quartile category of L/Z intake had a parent-reported mean BRIEF Global Executive Composite score 1.65 (95% CI: -3.27, -0.03) points lower than children in the lowest quartile category in mid-childhood, indicating better executive function. We did not observe associations between L/Z intake and any of the other cognitive or behavioral outcomes assessed.The overall findings do not provide strong evidence of an association between child L/Z intake and cognition and behavior. However, the positive associations found between early childhood L/Z intake and early childhood receptive vocabulary and mid-childhood executive function, in addition to previous evidence of neurodevelopmental benefit of L/Z intake, suggest that this relation deserves further investigation.
View details for DOI 10.1093/jn/nxac188
View details for PubMedID 36774121
View details for PubMedCentralID PMC9644167
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Timing of Cow's Milk Protein Introduction and Childhood Adverse Reactions to Cow's Milk
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
2022; 10 (10): 2713-+
Abstract
Current guidelines emphasize early introduction to potentially allergenic foods, but the optimal timing, amount, and exposure routes for foods other than peanut are not well-established. Cow's milk is often the first allergenic food introduced through infant formulas.To examine timing of cow's milk protein introduction (CMPI), including interaction with formula supplementation after delivery, in relation to reported cow's milk adverse reactions throughout childhood.Among children in the Boston, Mass-area Project Viva cohort, we assessed timing of CMPI (<2 weeks, 2 weeks-<6 months, ≥6 months) with questionnaires administered in infancy. Outcomes were (1) parent-reported cow's milk adverse reactions via annual questionnaires from age 2 to 13 years (n = 1298) and (2) milk sensitization (n = 505) and IgE-mediated milk allergy (n = 491) at age approximately 8 years. We used multivariable logistic regression models adjusted for parental atopy history, delivery mode, gestational age at delivery, child race, and census tract median household income, and investigated effect modification by ever/never breast-fed status and formula supplementation in the delivery hospital.A total of 32% were introduced to cow's milk protein at age less than 2 weeks, 38% at age 2 weeks to less than 6 months, and 30% at age 6 months or more. Compared with children with CMPI at age less than 2 weeks, children with CMPI at age 6 months or more had a higher risk of cow's milk adverse reaction at age 2 to 5 years (odds ratio, 2.4 [1.2-4.7]). Children given formula after delivery + CMPI at age less than 2 weeks had the lowest risk overall. Among children not given formula after delivery, CMPI at age 2 weeks to 6 months appeared most protective. Results were similar among ever-breast-fed children. Timing of CMPI was not associated with milk sensitization or IgE-mediated milk allergy in mid-childhood.Early, consistent cow's milk exposure appears protective against adverse reactions to cow's milk.
View details for DOI 10.1016/j.jaip.2022.06.022
View details for Web of Science ID 000882886300029
View details for PubMedID 35779778
View details for PubMedCentralID PMC10846592
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Early Childhood Lutein and Zeaxanthin Intake is Positively Associated with Early Childhood Receptive Vocabulary and Mid-childhood Executive Function but no Other Cognitive or Behavioral Outcomes in Project Viva.
The Journal of nutrition
2022
Abstract
BACKGROUND: Lutein and zeaxanthin are carotenoids associated with better cognition in older adults. Recent evidence suggest that their dietary intake may also have cognitive implications in childhood.OBJECTIVES: To examine associations of early childhood lutein and zeaxanthin (L/Z) intake with cognition in early and mid-childhood.METHODS: Among 1378 children in Project Viva, a prospective cohort, mothers reported their child's dietary intake in early childhood (median 3.2 years) using a food frequency questionnaire. Child cognition and behavior were assessed at the same timepoint using the Peabody Picture Vocabulary Test (PPVT-III) and the Wide Range Assessment of Visual Motor Abilities (WRAVMA); and at mid-childhood (median 7.7 years) using the Kaufman Brief Intelligence Test, the WRAVMA drawing subtest, the Wide Range Assessment of Memory and Learning, the Behavior Rating Inventory of Executive Function (BRIEF), and the Strengths and Difficulties Questionnaire.RESULTS: Children consumed a daily mean (SD) of 1.0 (0.4) mg of L/Z in early childhood. Children in the third quartile category of L/Z intake had a mean PPVT-III score 2.40 (95%CI: 0.27, 4.53) points higher than children in the lowest quartile category in early childhood, suggesting better receptive vocabulary. Children in the highest quartile category of L/Z intake had a parent-reported mean BRIEF Global Executive Composite score 1.65 (95%CI: -3.27, -0.03) points lower than children in the lowest quartile category in mid-childhood, indicating better executive function. We did not observe associations between L/Z intake and any of the other cognitive or behavioral outcomes assessed.CONCLUSION: The overall findings do not provide strong evidence of an association between child L/Z intake and cognition and behavior. However, the positive associations found between early childhood L/Z intake and early childhood receptive vocabulary and mid-childhood executive function, in addition to previous evidence of neurodevelopmental benefit of L/Z intake, suggest that this relationship deserves further investigation.
View details for DOI 10.1093/jn/nxac188
View details for PubMedID 36002019
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Association of cow's milk intake in early childhood with adiposity and cardiometabolic risk in early adolescence.
The American journal of clinical nutrition
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
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Association of cow's milk intake in early childhood with adiposity and cardiometabolic risk in early adolescence
AMERICAN JOURNAL OF CLINICAL NUTRITION
2022; 116 (2): 561-571
View details for DOI 10.1093/ajcn/nqac103
View details for Web of Science ID 000808212200001
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Estimated causal effects of complementary feeding behaviors on early childhood diet quality in a US cohort
AMERICAN JOURNAL OF CLINICAL NUTRITION
2022; 115 (4): 1105-1114
Abstract
Complementary feeding (CF) provides an opportunity to shape children's future dietary habits, setting the foundation for good nutrition and health.We estimated effects of 3 CF behaviors on early childhood diet quality using inverse probability (IP) weighting of marginal structural models (MSMs).Among 1041 children from the Boston-area Project Viva cohort, we estimated effects on the mean Youth Healthy Eating Index (YHEI) score in early childhood of 1) delayed (≥12 mo) compared with early (<12 mo) introduction of sweets and fruit juice; 2) continued compared with ceased offering of initially refused foods; and 3) early (<12 mo) compared with late (≥12 mo) introduction of flavor/texture variety. Mothers reported CF behaviors at 1 y and completed FFQs for children in early childhood (median age: 3.1 y). We estimated average treatment effects (ATEs) using IP weighting of MSMs to adjust for both confounding and selection bias due to censored outcomes and examined effect modification by child sex and breastfeeding compared with formula feeding at 6 mo.Twelve percent of mothers delayed introducing sweets/fruit juice, 93% continued offering initially refused foods, and 32% introduced flavor/texture variety early. The mean ± SD YHEI score was 52.8 ± 9.2 points. In adjusted models, we estimated a higher mean YHEI score with delayed (compared with early) sweets and fruit juice among breastfeeding children (ATE: 4.5 points; 95% CI: 1.0, 7.4 points), as well as with continued (compared with ceased) offering of refused foods among females (ATE: 5.4 points; 95% CI: 0.8, 9.1 points). The ATE for early (compared with late) flavor/texture variety was 1.7 points (95% CI: 0.3, 3.2 points) overall and stronger (2.8 points; 95% CI: 0.7, 5.1 points) among the formula-fed group.Delayed introduction of sweets/juice, continued offering of refused foods, and early flavor/texture variety may all result in higher childhood diet quality. Effects may depend on child sex and infant breastfeeding status.
View details for DOI 10.1093/ajcn/nqac003
View details for Web of Science ID 000756919300001
View details for PubMedID 35030237
View details for PubMedCentralID PMC8970996
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Maternal Dietary Inflammatory Index in Pregnancy and Offspring Behavioral Problems in Mid-Childhood and Early Adolescence
BIOLOGICAL PSYCHIATRY
2021; 90 (12): E73-E75
View details for DOI 10.1016/j.biopsych.2021.01.018
View details for Web of Science ID 000726757100002
View details for PubMedID 33824005
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Disparities in Risks of Inadequate and Excessive Intake of Micronutrients during Pregnancy
JOURNAL OF NUTRITION
2021; 151 (11): 3555-3569
Abstract
Inadequate or excessive intake of micronutrients in pregnancy has potential to negatively impact maternal/offspring health outcomes.The aim was to compare risks of inadequate or excessive micronutrient intake in diverse females with singleton pregnancies by strata of maternal age, race/ethnicity, education, and prepregnancy BMI.Fifteen observational cohorts in the US Environmental influences on Child Health Outcomes (ECHO) Consortium assessed participant dietary intake with 24-h dietary recalls (n = 1910) or food-frequency questionnaires (n = 7891) from 1999-2019. We compared the distributions of usual intake of 19 micronutrients from food alone (15 cohorts; n = 9801) and food plus dietary supplements (10 cohorts with supplement data; n = 7082) to estimate the proportion with usual daily intakes below their age-specific daily Estimated Average Requirement (EAR), above their Adequate Intake (AI), and above their Tolerable Upper Intake Level (UL), overall and within sociodemographic and anthropometric subgroups.Risk of inadequate intake from food alone ranged from 0% to 87%, depending on the micronutrient and assessment methodology. When dietary supplements were included, some women were below the EAR for vitamin D (20-38%), vitamin E (17-22%), and magnesium (39-41%); some women were above the AI for vitamin K (63-75%), choline (7%), and potassium (37-53%); and some were above the UL for folic acid (32-51%), iron (39-40%), and zinc (19-20%). Highest risks for inadequate intakes were observed among participants with age 14-18 y (6 nutrients), non-White race or Hispanic ethnicity (10 nutrients), less than a high school education (9 nutrients), or obesity (9 nutrients).Improved diet quality is needed for most pregnant females. Even with dietary supplement use, >20% of participants were at risk of inadequate intake of ≥1 micronutrients, especially in some population subgroups. Pregnancy may be a window of opportunity to address disparities in micronutrient intake that could contribute to intergenerational health inequalities.
View details for DOI 10.1093/jn/nxab273
View details for Web of Science ID 000731863600030
View details for PubMedID 34494118
View details for PubMedCentralID PMC8564697
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Maternal diet quality during pregnancy and child cognition and behavior in a US cohort
AMERICAN JOURNAL OF CLINICAL NUTRITION
2022; 115 (1): 128-141
Abstract
Maternal intake of several nutrients during pregnancy is linked to offspring cognition. The relation between maternal dietary patterns and offspring cognition is less established.We aimed to examine associations of maternal diet quality during pregnancy with child cognition and behavior.Among 1580 mother-child pairs in Project Viva, a prospective prebirth cohort, we assessed maternal diet during pregnancy using FFQs and evaluated diet quality using versions modified for pregnancy of the Mediterranean Diet Score (MDS-P) and Alternate Healthy Eating Index (AHEI-P). Child cognitive and behavioral outcomes were assessed using standardized tests and questionnaires at infancy and in early and mid-childhood. We conducted multivariable linear regression analyses.Mothers were predominantly white, college-educated, and nonsmokers. After adjustment for child age and sex and maternal sociodemographic and lifestyle characteristics, maternal high (6-9) compared with low (0-3) MDS-P during pregnancy was associated with higher child Kaufman Brief Intelligence Test (KBIT-II) nonverbal (mean difference for first trimester: 4.54; 95% CI: 1.53, 7.56) and verbal scores (3.78; 95% CI: 1.37, 6.19) and lower Behavioral Rating Inventory of Executive Function (BRIEF) Metacognition Index (-1.76; 95% CI: -3.25, -0.27), indicating better intelligence and fewer metacognition problems in mid-childhood. Maternal Q4 compared with Q1 AHEI-P during pregnancy was associated with higher Wide Range Assessment of Visual Motor Abilities matching scores in early childhood (mean difference for first trimester: 2.79; 95% CI: 0.55, 5.04) and higher KBIT-II verbal scores (2.59; 95% CI: 0.13, 5.04) and lower BRIEF Global Executive Composite scores in mid-childhood (-1.61; 95% CI: -3.20, -0.01), indicating better visual spatial skills, verbal intelligence, and executive function.Maternal intake of a better-quality diet during pregnancy was associated with better visual spatial skills in the offspring at early childhood and with better intelligence and executive function in the offspring at mid-childhood.
View details for DOI 10.1093/ajcn/nqab325
View details for Web of Science ID 000743115600014
View details for PubMedID 34562095
View details for PubMedCentralID PMC8755080
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Early-Life Factors Are Associated with Vitamin D Status in Early and Mid-Childhood and May Differ between White and Black Children.
The Journal of nutrition
2021; 151 (5): 1256-1268
Abstract
BACKGROUND: Suboptimal vitamin D (VitD) status has been associated with poor bone health and other adverse health outcomes and is common among children. Various early-life factors are associated with child VitD, yet few studies have examined multiple factors simultaneously in a single study population.OBJECTIVES: We aimed to characterize relations of early-life factors with plasma 25-hydroxyvitamin D [25(OH)D] concentrations in early and mid-childhood, and to explore potential differences in these associations between white and black children.METHODS: We identified associations of various early-life factors with 25(OH)D concentrations in early and mid-childhood among 961 children in Project Viva using linear regression models. All variables associated with 25(OH)D were included together in final multivariable models at each outcome time point: 1 in the overall sample and additional models for children whose mothers identified them as being white or black.RESULTS: Overall mean±SD 25(OH)D concentrations were 86±29nmol/L in early childhood and 68±21nmol/L in mid-childhood. After accounting for other predictors, children who took VitD supplements (compared with those who did not) had 25(OH)D concentrations 5.6 nmol/L (95% CI: 2.0, 9.2 nmol/L) higher in early childhood and 8.2 nmol/L (95% CI: 4.8, 11.6 nmol/L) higher in mid-childhood. Other factors consistently associated with higher 25(OH)D were blood collection in summer or fall, white race, nonfall birth season, prenatal exposure to higher 25(OH)D, and higher dietary intake of VitD. Greater waist circumference was associated with lower 25(OH)D in early childhood (beta: -3.8; 95% CI: -7.4, -0.2 per 1-SD increase) among black children only.CONCLUSIONS: Our findings may help clinicians better target children at risk of lower 25(OH)D for screening and/or intervention and may inform research focused on associations of 25(OH)D with different exposures and outcomes or causal effects of early-life factors on later VitD status.This trial was registered at clinicaltrials.gov as NCT02820402.
View details for DOI 10.1093/jn/nxaa456
View details for PubMedID 33693813
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Maternal Intake of Lutein and Zeaxanthin during Pregnancy Is Positively Associated with Offspring Verbal Intelligence and Behavior Regulation in Mid-Childhood in the Project Viva Cohort
JOURNAL OF NUTRITION
2021; 151 (3): 615-627
Abstract
Lutein and zeaxanthin are carotenoids associated with better cognition at older age. To our knowledge, no previous study has evaluated their cognitive implications in the prenatal period, when the brain undergoes its most rapid development.The objective of this study was to examine associations of maternal lutein and zeaxanthin (L/Z) intake during pregnancy with child cognition.Among 1580 mother-child pairs in Project Viva, a prospective cohort, we assessed maternal intake of L/Z during pregnancy using food frequency questionnaires and offspring cognition by the Visual Recognition Memory paradigm in infancy, the Peabody Picture Vocabulary Test and the Wide Range Assessment of Visual Motor Abilities (WRAVMA) in early childhood, and the Kaufman Brief Intelligence Test (KBIT-II), the WRAVMA drawing subtest, and the Wide Range Assessment of Memory and Learning in mid-childhood. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and Strengths and Difficulties Questionnaire.Mothers consumed a daily mean (SD) of 2.6 (2.0) mg L/Z in the first and second trimesters of pregnancy. Mean mid-childhood KBIT-II verbal scores were higher with greater maternal L/Z intake [difference of Q4-Q1 means for first trimester: 2.67 (95% CI: 0.13, 5.20) and for second trimester: 3.55 (95% CI: 0.81, 6.28)], indicating better verbal intelligence. Secondary analyses on cognitive subtests showed that mean mid-childhood BRIEF Behavioral Regulation Index scores were lower with greater maternal L/Z intake [difference of Q4-Q1 means for first trimester: -1.63 (95% CI: -3.22, -0.04) and for second trimester: -1.89 (95% CI: -3.58, -0.21)], indicating better behavior regulation ability.Higher maternal L/Z intake during pregnancy was associated with better offspring verbal intelligence and behavior regulation ability in mid-childhood, suggesting a potential benefit during prenatal development. We did not find a benefit of higher maternal L/Z intake on other child cognitive or behavioral outcomes. Project Viva is registered at clinicaltrials.gov as NCT02820402.
View details for DOI 10.1093/jn/nxaa348
View details for Web of Science ID 000649736900023
View details for PubMedID 33484136
View details for PubMedCentralID PMC7948203
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Associations of Early Parental Concerns and Feeding Behaviors with Child's Diet Quality through Mid-Childhood
NUTRIENTS
2020; 12 (11)
Abstract
Parental feeding practices have been associated with children's dietary intakes, yet the directionality of these associations remains unclear. Among 1172 mother-child pairs from Project Viva, we aimed to examine associations of parental concerns and feeding behaviors at 2 years (behaviors dichotomized as yes vs. no), with diet quality (Youth Healthy Eating Index; YHEI) in early (mean 3.2, SD 0.3 years; n = 1076) and mid-childhood (mean 7.8, SD 0.7 years; n = 993). We used multivariable linear regression models adjusted for sociodemographic characteristics, parental body mass index (BMI), maternal diet quality in pregnancy, and child's BMI z-score and diet quality at 2 years. Early parental concerns about their child becoming overweight (15%) was associated with lower YHEI (β -1.54 points; 95%CI -2.75, -0.33; fully adjusted model) in early childhood. Early parental concerns about their child becoming underweight (7%) was associated with lower YHEI (-2.19 points; -4.31, -0.07) in early childhood, but the association was attenuated after adjustment for child's BMI z-score and diet quality at 2 years. We did not find associations of parental restrictive feeding (8%) and parental pressure to eat (47%) with child's YHEI through mid-childhood. In conclusion, we found no evidence that early parental concerns and feeding behaviors independently contribute to child's diet quality through childhood.
View details for DOI 10.3390/nu12113231
View details for Web of Science ID 000593750400001
View details for PubMedID 33105682
View details for PubMedCentralID PMC7690442
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Weight Trajectories After Delivery are Associated with Adiposity and Cardiometabolic Markers at 3 Years Postpartum Among Women in Project Viva
JOURNAL OF NUTRITION
2020; 150 (7): 1889-1898
Abstract
Postpartum weight trajectories and its implications on later cardiometabolic health are not entirely understood.Our objectives were: 1) to characterize maternal weight trajectories from 1 to 24 mo postpartum, 2) to determine the association of prepregnancy BMI, gestational weight gain (GWG), and pregnancy behaviors with the trajectories, and 3) to evaluate the association of weight trajectories with BMI, waist circumference (WC), lipid profile, glucose, insulin resistance, blood pressure, and inflammatory markers at 3 y postpartum.We studied 1359 mothers from the prospective cohort Project Viva. Using weights at 1, 6, 12, and 24 mo postpartum, we characterized weight trajectories using a latent class growth model. For objectives 2 and 3, we used multinomial logistic regression and multiple linear regression models, respectively.Around 85% of women fell into a trajectory of sustained weight loss (1-12 mo) + maintenance (12-24 mo) (reference), 5.7% followed a trajectory characterized by fast weight loss + slight gain, and 9.7% fell into a trajectory of little weight loss + slight gain. Prepregnancy overweight and obesity increased the odds of falling into the fast weight loss + slight gain trajectory, compared with the reference. Prepregnancy overweight [OR 1.57 (95% CI: 1.01, 2.46)] and a higher total GWG rate [3.69 (2.90, 4.68)] increased the odds of falling into the little weight loss + slight gain trajectory, whereas a higher Prudent dietary pattern score was protective [0.73 (0.54, 0.98)]. Women in this trajectory had higher BMI, WC, weight gain from prepregnancy, low-density lipoprotein cholesterol, and inflammatory markers at 3 y postpartum.Women following a trajectory of little weight loss + slight gain during the first 2 y postpartum had an adverse cardiometabolic profile 3 y after delivery. Targeting diet and GWG during pregnancy and facilitating postpartum weight loss could improve women's long-term health.
View details for DOI 10.1093/jn/nxaa104
View details for Web of Science ID 000568433300027
View details for PubMedID 32321175
View details for PubMedCentralID PMC7330455
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Patterns of Complementary Feeding Behaviors Predict Diet Quality in Early Childhood
NUTRIENTS
2020; 12 (3)
Abstract
Infancy is a time of plasticity in development of taste preference. Complementary feeding (CF) may be a "sensitive period" for learning new taste preferences and establishing healthy dietary behaviors that may track later in life. Among 1162 children in the U.S. prospective cohort study Project Viva, we aimed to identify patterns of CF behaviors around 1 year and examine associations with diet quality in early childhood (median age 3.1y). We identified patterns of CF using latent class analysis (LCA) and examined later diet quality based on scores on the Youth Healthy Eating Index (YHEI). We identified four distinct CF patterns (latent classes). Later YHEI scores were highest in the class characterized by "breast milk and delayed sweets and fruit juice" and lowest in the "picky eaters" class. The classes defined as "late flavor introduction and delayed sweets" and "early flavor introduction and more fruit juice" had similar, moderate scores. Our results suggest that CF patterns that increase food acceptance and discourage the innate preference for sweetness may have persistent influences on diet quality.
View details for DOI 10.3390/nu12030810
View details for Web of Science ID 000531831000219
View details for PubMedID 32204442
View details for PubMedCentralID PMC7146403
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Prenatal oxidative balance and risk of asthma and allergic disease in adolescence
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
2019; 144 (6): 1534-+
Abstract
Fetal oxidative balance (achieved when protective prenatal factors counteract sources of oxidative stress) might be critical for preventing asthma and allergic disease.We examined prenatal intakes of hypothesized protective nutrients (including antioxidants) in conjunction with potential sources of oxidative stress in models of adolescent asthma and allergic disease.We used data from 996 mother-child pairs in Project Viva. Exposures of interest were maternal prepregnancy body mass index and prenatal nutrients (energy-adjusted intakes of vitamins D, C, and E; β-carotene; folate; choline; and n-3 and n-6 polyunsaturated fatty acids [PUFAs]), air pollutant exposures (residence-specific third-trimester black carbon or particulate matter with a diameter of less than 2.5 μm [PM2.5]), acetaminophen, and smoking. Outcomes were offspring's current asthma, allergic rhinitis, and allergen sensitization at a median age of 12.9 years. We performed logistic regression. Continuous exposures were log-transformed and modeled as z scores.We observed protective associations for vitamin D (odds ratio [OR], 0.69 [95% CI, 0.53-0.89] for allergic rhinitis), the sum of the n-3 PUFAs eicosapentaenoic acid and docosahexaenoic acid (OR, 0.81 [95% CI, 0.66-0.99] for current asthma), and the n-3 PUFA α-linolenic acid (OR, 0.78 [95% CI, 0.64-0.95] for allergen sensitization and OR, 0.80 [95% CI 0.65-0.99] for current asthma). Black carbon and PM2.5 were associated with an approximately 30% increased risk for allergen sensitization. No multiplicative interactions were observed for protective nutrient intakes with sources of oxidative stress.We identified potential protective prenatal nutrients (vitamin D and n-3 PUFAs), as well as adverse prenatal pro-oxidant exposures that might alter the risk of asthma and allergic disease into adolescence.
View details for DOI 10.1016/j.jaci.2019.07.044
View details for Web of Science ID 000500694900012
View details for PubMedID 31437488
View details for PubMedCentralID PMC6900442
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Timing of Complementary Feeding Introduction and Adiposity Throughout Childhood
PEDIATRICS
2019; 144 (6)
Abstract
To examine associations of the timing of complementary feeding (CF) introduction with adiposity throughout childhood.We studied 1013 children from Project Viva. Our exposure was CF introduction, categorized as <4 months (19%), 4 to <6 months (68%; reference group), and ≥6 months of age (14%). Our outcomes included adiposity measures in midchildhood (mean: 7.9 years; SD 0.8; n = 896) and early adolescence (mean: 13.2 years; SD 0.9; n = 850). We used linear regression models adjusted for potential confounders and ran separate models for infants who were breastfed at least partly for ≥4 months (categorized as breastfed; 69%) and infants who were never breastfed or stopped breastfeeding at <4 months (categorized as formula fed; 31%).CF initiated at <4 months was associated with higher adiposity in midchildhood in breastfed children; associations persisted into adolescence for waist circumference, truncal fat mass, and the sum of subscapular and triceps skinfolds (eg, waist circumference: confounder-adjusted β 2.97 [95% confidence interval (CI) 0.47 to 5.47] cm). The effect estimates were larger in formula-fed children, with more associations persisting into adolescence (eg, waist circumference: adjusted β 3.42 [95% CI 0.12 to 6.71] cm). CF initiated at ≥6 months was associated with a higher subscapular/triceps skinfold ratio in midchildhood and adolescence (adjusted β 0.13 [95% CI 0.02 to 0.25]) in formula-fed children.We found associations of early CF introduction with higher adiposity measurements in breastfed and formula-fed children and associations of late introduction of CF with higher adiposity in formula-fed children.
View details for DOI 10.1542/peds.2019-1320
View details for Web of Science ID 000503171700020
View details for PubMedID 31757860
View details for PubMedCentralID PMC6889977
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Is a high workload an unaccounted confounding factor in the relation between heavy coffee consumption and cardiovascular disease risk? Reply
AMERICAN JOURNAL OF CLINICAL NUTRITION
2019; 110 (5): 1261-+
View details for DOI 10.1093/ajcn/nqz194
View details for Web of Science ID 000504093300030
View details for PubMedID 31667516
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Association of BMI with Linear Growth and Pubertal Development
OBESITY
2019; 27 (10): 1661-1670
Abstract
The aim of this study was to investigate the relationship of BMI with subsequent statural growth among children born in the era of the obesity epidemic.Among 18,271 children from Belarus (n = 16,781, born 1996 to 1997) and the United States (n = 1,490, born 1999 to 2002), multivariable linear and ordinal logistic regression was used to analyze associations of BMI z score from infancy to adolescence with subsequent standardized length and height velocity, standing height and its components (trunk and leg lengths), and pubertal timing.The prevalence of early adolescent obesity was 6.2% in Belarus and 12.8% in the United States. In both Belarusian and US children, higher BMI z scores in infancy and childhood were associated with faster length and height velocity in early life, while higher BMI z scores during middle childhood were associated with slower length and height velocity during adolescence. Associations with greater standing height and trunk length and earlier pubertal development in adolescence were stronger for BMI z scores at middle childhood than BMI z scores at birth or infancy.These findings in both Belarus and the United States support the role of higher BMI in accelerating linear growth in early life (taller stature and longer trunk length) but earlier pubertal development and slower linear growth during adolescence.
View details for DOI 10.1002/oby.22592
View details for Web of Science ID 000485072900001
View details for PubMedID 31479205
View details for PubMedCentralID PMC6756952
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Cord Blood Vitamin D Status Is Associated With Cord Blood Insulin and C-Peptide in Two Cohorts of Mother-Newborn Pairs
JOURNAL OF CLINICAL ENDOCRINOLOGY & METABOLISM
2019; 104 (9): 3785-3794
Abstract
Vitamin D may be important for prenatal programming of insulin and glucose regulation, but maternal vitamin D deficiency during pregnancy is common.We examined associations of early vitamin D status with markers of fetal insulin secretion: cord blood insulin and c-peptide. We hypothesized that maternal 25-hydroxyvitamin D (25(OH)D) during pregnancy and cord blood 25(OH)D would both be positively associated with cord blood insulin and c-peptide.We studied mother-newborn pairs from two cohorts: Project Viva (n = 862 pairs included) and Genetics of Glucose Regulation in Gestation and Growth (Gen3G; n = 660 pairs included). We analyzed associations of the cord blood hormones with maternal 25(OH)D using generalized additive models with nonlinear spline terms, and with cord blood 25(OH)D using multivariable linear regression models.The 25(OH)D levels were <75 nmol/L in >70% of mothers and 85% of newborns. Maternal and cord blood 25(OH)D levels were correlated (Project Viva, r = 0.58; Gen3G, r = 0.37). Maternal 25(OH)D had an inverted-U-shaped relationship with cord blood insulin and c-peptide in both cohorts. Cord blood 25(OH)D had a linear relationship with the cord blood hormones. In fully adjusted models, each 10-nmol/L increase in cord blood 25(OH)D was associated with higher cord blood insulin and c-peptide concentrations: 3.7% (95% CI, 0.09 to 7.5) and 3.2% (95% CI, 0.8 to 5.6), respectively, in Project Viva; 2.2% (95% CI, -0.1 to 4.6) and 3.6% (95% CI, 1.0 to 6.3), respectively, in Gen3G.Vitamin D may play a role in regulating fetal insulin secretion, potentially affecting glucose regulation and growth.
View details for DOI 10.1210/jc.2018-02550
View details for Web of Science ID 000484208900026
View details for PubMedID 31127822
View details for PubMedCentralID PMC6656419
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Body composition and bone mineral density in childhood
BONE
2019; 121: 9-15
Abstract
Body mass compartments may have different directions of influence on bone accrual. Studies of children are limited by relatively small sample sizes and typically make strong assumptions of linear regression.To evaluate associations of overall body mass, components of overall body mass (fat-free and total fat), and components of total fat mass (truncal and non-truncal fat), measured via dual-energy X-ray absorptiometry (DXA) and anthropometry, with total body less head areal bone mineral density (aBMD) Z-score in mid-childhood.We performed a cross-sectional study among 876 Boston-area children who had DXA measures. We evaluated linearity of associations using generalized additive models.Children were median 7.7 (range 6-10) years of age, and 61% were white. After adjustment for sociodemographics and other compartments of body mass, overall body mass, particularly the fat-free mass component, appeared to have a positive relationship with aBMD Z-score [e.g., 0.25 (95% CI: 0.23, 0.28) per 1-kg fat-free mass]. The relationship between truncal fat and aBMD Z-score appeared non-linear, with a negative association only in children with levels of fat mass in the upper 15th percentile [-0.17 (95% CI: -0.26, -0.07) aBMD Z-score per 1-kg truncal fat mass], while non-truncal fat mass was not associated with aBMD Z-score.Our analyses suggest that central adiposity is associated with lower aBMD Z-score only in children with the highest levels of abdominal fat. This finding raises the possibility of a threshold above which central adipose tissue becomes more metabolically active and thereby adversely impacts bone.
View details for DOI 10.1016/j.bone.2018.12.009
View details for Web of Science ID 000460495000002
View details for PubMedID 30557635
View details for PubMedCentralID PMC6391186
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Associations of protein intake in early childhood with body composition, height, and insulin-like growth factor I in mid-childhood and early adolescence
AMERICAN JOURNAL OF CLINICAL NUTRITION
2019; 109 (4): 1154-1163
Abstract
Early protein intake may program later body composition and height growth, perhaps mediated by insulin-like growth factor I (IGF-I). In infancy, higher protein intake is consistently associated with higher IGF-I concentrations and more rapid growth, but associations of protein intake after infancy with later growth and IGF-I are less clear.Our objective was to examine associations of protein intake in early childhood (median 3.2 y) with height, IGF-I, and measures of adiposity and lean mass in mid-childhood (median 7.7 y) and early adolescence (median 13.0 y), and with changes in these outcomes over time. We hypothesized that early childhood protein intake programs later growth.We studied 1165 children in the Boston-area Project Viva cohort. Mothers reported children's diet using food-frequency questionnaires. We stratified by child sex and examined associations of early childhood protein intake with mid-childhood and early adolescent BMI z score, skinfold thicknesses, dual-energy X-ray absorptiometry (DXA) fat mass, DXA lean mass, height z score, and IGF-I concentration. We adjusted linear regression models for race/ethnicity, family sociodemographics, parental and birth anthropometrics, breastfeeding status, physical activity, and fast food intake.Mean protein intake in early childhood was 58.3 g/d. There were no associations of protein intake in early childhood with any of the mid-childhood outcomes. Among boys, however, each 10-g increase in early childhood total protein intake was associated with several markers of early adolescent size, namely BMI z score (0.12 higher; 95% CI: 0.01, 0.23), DXA lean mass index (1.34% higher; 95% CI: -0.07%, 2.78%), and circulating IGF-I (5.67% higher; 95% CI: 0.30%, 11.3%). There were no associations with fat mass and no associations with any adolescent outcomes among girls.Early childhood protein intake may contribute to programming lean mass and IGF-I around the time of puberty in boys, but not to adiposity development. This study was registered at clinicaltrials.gov as NCT02820402.
View details for DOI 10.1093/ajcn/nqy354
View details for Web of Science ID 000478064700014
View details for PubMedID 30869114
View details for PubMedCentralID PMC6462426
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Oxidative Balance in Fetal Life and Allergic Disease Risk in Adolescence: Investigating the role of Prenatal Nutrient Intakes and Potential Sources of Oxidative Stress in Utero
MOSBY-ELSEVIER. 2019: AB107
View details for DOI 10.1016/j.jaci.2018.12.324
View details for Web of Science ID 000457771200317
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Mid-Pregnancy Fructosamine MeasurementPredictive Value for Gestational Diabetes and Association with Postpartum Glycemic Indices
NUTRIENTS
2018; 10 (12)
Abstract
Screening for gestational diabetes mellitus (GDM) during pregnancy is cumbersome. Measurement of plasma fructosamine may help simplify the first step of detecting GDM. We aimed to assess the predictive value of mid-pregnancy fructosamine for GDM, and its association with postpartum glycemic indices. Among 1488 women from Project Viva (mean ± SD: 32.1 ± 5.0 years old; pre-pregnancy body mass index 24.7 ± 5.3 kg/m²), we measured second trimester fructosamine and assessed gestational glucose tolerance with a 50 g glucose challenge test (GCT) followed, if abnormal, by a 100 g oral glucose tolerance test (OGTT). Approximately 3 years postpartum (median 3.2 years; SD 0.4 years), we measured maternal glycated hemoglobin (n = 450) and estimated insulin resistance (HOMA-IR; n = 132) from fasting blood samples. Higher glucose levels 1 h post 50 g GCT were associated with higher fructosamine levels (Pearson's r = 0.06; p = 0.02). However, fructosamine ≥222 µmol/L (median) had a sensitivity of 54.8% and specificity of 48.6% to detect GDM (area under the receiver operating characteristic curve = 0.52); other fructosamine thresholds did not show better predictive characteristics. Fructosamine was also weakly associated with 3-year postpartum glycated hemoglobin (per 1 SD increment: adjusted β = 0.03 95% CI [0.00, 0.05] %) and HOMA-IR (per 1 SD increment: adjusted % difference 15.7, 95% CI [3.7, 29.0] %). Second trimester fructosamine is a poor predictor of gestational glucose tolerance and postpartum glycemic indices.
View details for DOI 10.3390/nu10122003
View details for Web of Science ID 000455073200184
View details for PubMedID 30567328
View details for PubMedCentralID PMC6315870
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Relation of Prenatal Air Pollutant and Nutritional Exposures with Biomarkers of Allergic Disease in Adolescence
SCIENTIFIC REPORTS
2018; 8: 10578
Abstract
Prenatal exposures may be critical for immune system development, with consequences for allergic disease susceptibility. We examined associations of prenatal exposures (nutrient intakes and air pollutants) with allergic disease biomarkers in adolescence. We used data from 857 mother-child pairs in Project Viva, a Massachusetts-based pre-birth cohort. Outcomes of interest at follow-up (median age 12.9 years) were fractional exhaled nitric oxide (FeNO) and total serum IgE. We applied Bayesian Kernel Machine Regression analyses to estimate multivariate exposure-response functions, allowing for exposure interactions. Exposures were expressed as z-scores of log-transformed data and we report effects in % change in FeNO or IgE z-score per increase in exposure from the 25th to 75th percentile. FeNO levels were lower with higher intakes of prenatal vitamin D (-16.15%, 95% CI: -20.38 to -2.88%), folate from foods (-3.86%, 95% CI: -8.33 to 0.83%) and n-3 PUFAs (-9.21%, 95% CI -16.81 to -0.92%). Prenatal air pollutants were associated with higher FeNO and IgE, with the strongest associations detected for PM2.5 with IgE (25.6% increase, 95% CI 9.34% to 44.29%). We identified a potential synergistic interaction (p = 0.02) between vitamin E (food + supplements) and PM2.5; this exposure combination was associated with further increases in FeNO levels.
View details for DOI 10.1038/s41598-018-28216-0
View details for Web of Science ID 000438343600088
View details for PubMedID 30002468
View details for PubMedCentralID PMC6043562
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Higher Maternal Protein Intake during Pregnancy Is Associated with Lower Cord Blood Concentrations of Insulin-like Growth Factor (IGF)-II, IGF Binding Protein 3, and Insulin, but Not IGF-I, in a Cohort of Women with High Protein Intake
JOURNAL OF NUTRITION
2017; 147 (7): 1392-1400
Abstract
Background: Prenatal exposure to dietary protein may program growth-regulating hormones, consequently influencing early-life growth patterns and later risk of associated chronic diseases. The insulin-like growth factor (IGF) axis is of particular interest in this context given its influence on pre- and postnatal growth and its sensitivity to the early nutritional environment.Objective: Our objective was to examine associations of maternal protein intake during pregnancy with cord blood concentrations of IGF-I, IGF-II, IGF binding protein-3 (IGFBP-3), and insulin.Methods: We studied 938 mother-child pairs from early pregnancy through delivery in the Project Viva cohort. Using multivariable linear regression models adjusted for maternal race/ethnicity, education, income, smoking, parity, height, and gestational weight gain and for child sex, we examined associations of second-trimester maternal protein intake [grams per kilogram (weight before pregnancy) per day], as reported on a food frequency questionnaire, with IGF-I, IGF-II, IGFBP-3, and insulin concentrations in cord blood. We also examined how these associations may differ by child sex and parity.Results: Mothers were predominantly white (71%), college-educated (64%), and nonsmokers (67%). Mean ± SD protein intake was 1.35 ± 0.35 g ⋅ kg-1 ⋅ d-1 Each 1-SD increment in second-trimester protein intake corresponded to a change of -0.50 ng/mL (95% CI: -2.26, 1.26 ng/mL) in IGF-I and -0.91 μU/mL (95% CI: -1.45, -0.37 μU/mL) in insulin. Child sex and parity modified associations of maternal protein intake with IGF-II and IGFBP-3: protein intake was inversely associated with IGF-II in girls (P-interaction = 0.04) and multiparous mothers (P-interaction = 0.05), and with IGFBP-3 in multiparous mothers (P-interaction = 0.04).Conclusions: In a cohort of pregnant women with relatively high mean protein intakes, higher intake was associated with lower concentrations of growth-promoting hormones in cord blood, suggesting a pathway that may link higher protein intake to lower fetal growth. This trial was registered at clinicaltrials.gov as NCT02820402.
View details for DOI 10.3945/jn.117.250589
View details for Web of Science ID 000406533100021
View details for PubMedID 28592512
View details for PubMedCentralID PMC5483967
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Assessment of Child Anthropometry in a Large Epidemiologic Study
JOVE-JOURNAL OF VISUALIZED EXPERIMENTS
2017
Abstract
A high proportion of children have overweight and obesity in the United States and other countries. Accurate assessment of anthropometry is essential to understand health effects of child growth and adiposity. Gold standard methods of measuring adiposity, such as dual X-ray absorptiometry (DXA), may not be feasible in large field studies. Research staff can, however, complete anthropometric measurements, such as body circumferences and skinfold measurements, using inexpensive portable equipment. In this protocol we detail how to obtain manual anthropometric measurements from children, including standing and sitting height, weight, waist circumference, hip circumference, mid-upper arm circumference, triceps skinfold thickness, and subscapular skinfold thickness, and procedures to assess the quality of these measurements. To demonstrate accuracy of these measurements, among 1,110 school-aged children in the pre-birth cohort Project Viva we calculated Spearman correlation coefficients comparing manual anthropometric measurements with a gold standard measure of body fat, DXA fat mass1. To address reliability, we evaluate intra-rater technical error of measurement at a quality control session conducted on adult female volunteers.
View details for DOI 10.3791/54895
View details for Web of Science ID 000397847700020
View details for PubMedID 28191881
View details for PubMedCentralID PMC5344680
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Sex-Specific Associations of Maternal Gestational Glycemia with Hormones in Umbilical Cord Blood at Delivery
AMERICAN JOURNAL OF PERINATOLOGY
2016; 33 (13): 1273-1281
Abstract
Background Few studies have examined sex-specific associations of maternal gestational glycemia with cord blood hormones, which might predict later health. Methods In 976 women without pre-existing diabetes in the Project Viva cohort, we used linear regression to examine associations of maternal gestational glycemia with cord hormone concentrations, adjusted for maternal characteristics and stratified by infant sex. Results A total of 6.1% of women had gestational diabetes mellitus (GDM), 8.8% isolated hyperglycemia, 3.2% gestational impaired glucose tolerance, and 81.9% were normoglycemic. In boys, compared with infants of normoglycemic mothers, infants of GDM mothers had higher cord levels of IGF-2 (β 35.55 ng/mL; 95% CI: 2.60, 68.50), IGFBP-3 (111.2 ng/mL; 5.53, 216.8), insulin (4.66 uU/mL; 2.38, 6.95), C-peptide (0.46 ng/mL; 0.25, 0.67), and leptin (3.51 ng/mL; 1.37, 5.64), but lower IGF-1 (-6.71 ng/mL; -12.7, - 0.76, adjusted for IGFBP-3). In girls, GDM offspring had higher cord blood levels of IGF-1 adjusted for IGFBP-3 (12.45 ng/mL; 4.85, 20.04). Boys, but not girls, of mothers with abnormal glucose tolerance but not GDM also had higher levels of some hormones. Conclusion GDM was associated with growth factors and adipokines in cord blood from boys, but only IGF-1 in girls. These findings suggest sex differences in responses to fetal overnutrition.
View details for DOI 10.1055/s-0036-1586509
View details for Web of Science ID 000386403900009
View details for PubMedID 27490771
View details for PubMedCentralID PMC5080532
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Maternal protein intake during pregnancy and linear growth in the offspring
AMERICAN JOURNAL OF CLINICAL NUTRITION
2016; 104 (4): 1128-1136
Abstract
Observational and experimental evidence demonstrates that protein intake in infancy programs linear growth. To our knowledge, few studies have examined prenatal maternal protein intake.Our objective was to examine associations of maternal protein intake during pregnancy with offspring linear growth.We analyzed data from 1961 mother-child pairs in Project Viva. We assessed first- and second-trimester diet with the use of food-frequency questionnaires and analyzed protein intake as grams per kilogram prepregnancy weight per day. We used research measures of offspring length at birth and in infancy (∼6 mo), early childhood (∼3 y), and midchildhood (∼7 y), as well as clinical growth measures obtained from after birth through midchildhood. We calculated sex-specific birth length z scores for gestational age with the use of international reference data. We used mixed models with repeated length measures to predict individual length gain velocities for birth to <6 mo and 6 mo to 7 y of age, then used these velocities as outcomes in adjusted linear regression models with maternal protein intake as the main predictor.Mean (range) second-trimester protein intake was 1.4 g · kg-1 · d-1 (0.3-3.1 g · kg-1 · d-1). After adjusting for maternal sociodemographics, gestational weight gain, maternal and paternal height, and (for postdelivery outcomes) child sex, gestational age, and breastfeeding duration, each 1-SD (0.36 g · kg-1 · d-1) increment in second-trimester protein intake corresponded to a -0.10 (95% CI: -0.18, -0.03) change in birth length z score, a -0.03 cm/mo (95% CI: -0.05, -0.01 cm/mo) change in slope of length growth from birth to <6mo, and a -0.09 cm/y (95% CI: -0.14, -0.05 cm/y) change in slope of length growth from 6 mo to midchildhood. Results were similar for first-trimester intake.In a population with relatively high protein intake during pregnancy, higher protein intake was associated with shorter offspring birth length and slower linear growth into midchildhood. Results suggest that higher protein intake during pregnancy does not increase fetal and child growth and may even reduce early length growth. Project Viva was registered at clinicaltrials.gov as NCT02820402.
View details for DOI 10.3945/ajcn.115.128421
View details for Web of Science ID 000384874900024
View details for PubMedID 27581477
View details for PubMedCentralID PMC5039807
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Growth in Total Height and Its Components and Cardiometabolic Health in Childhood
PLOS ONE
2016; 11 (9): e0163564
Abstract
Short stature or short legs is associated with cardiometabolic disease. Few studies have addressed this issue in children, incorporated repeated measures, or studied modern cohorts.We examined if change in total height, leg length and trunk length between two time points from early (median: 3.2 years) to mid-childhood (median: 7.7 years), with and without adjustment for concurrent change in adiposity (subscapular plus triceps skinfold thickness), was associated with mid-childhood cardiometabolic risk in 315 boys and 295 girls from Project Viva. The main outcome was a cardiometabolic risk score based on sex-specific internal z-scores for systolic blood pressure, waist circumference, homeostatic model assessment of insulin resistance, triglycerides and high-density lipoprotein-cholesterol.Mean (SD) total height was 97.9 (4.5) cm in boys and 97.1 (4.7) cm in girls in early childhood and 129.1 (7.2) cm in boys and 128.3 (7.9) cm in girls in mid-childhood. Trunk length constituted about half of total height. In linear regression models adjusted for parental anthropometry and socio-demographics, faster growth in total height, leg length and particularly trunk length, were associated with higher cardiometabolic risk in mid-childhood. Per 1 cm annual increase in trunk length, the cardiometabolic risk score was 0.23 z-score (95% confidence interval [CI] 0.08, 0.39) higher among boys and 0.47 z-score (95% CI 0.33, 0.60) higher among girls. Estimates were attenuated after adjusting for adiposity (boys: 0.03 z-score, 95% CI -0.11, 0.18; girls: 0.32 z-score, 95% CI 0.19, 0.45).Rapid linear growth, particularly in trunk length, was associated with higher cardiometabolic risk in childhood, which was explained by relationships of linear growth with adiposity in boys, but only partly in girls.
View details for DOI 10.1371/journal.pone.0163564
View details for Web of Science ID 000383893200146
View details for PubMedID 27658308
View details for PubMedCentralID PMC5033234
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Where is the leak in the pipeline? Investigating gender differences in academic promotion at an academic medical centre
PERSPECTIVES ON MEDICAL EDUCATION
2016; 5 (2): 125-128
Abstract
Women are still under-represented in the senior ranks of academic medicine. As local surveys represent a critical initial step in addressing the challenges of gender disparities in academic promotion within institutions, we surveyed faculty at an academic medical centre to identify factors to improve the academic advancement of women.We conducted an electronic survey of all full-time faculty members in a Department of Medicine assessing academic rank and factors important in consideration for promotion.106 faculty members (46 %) responded to the survey; 40 % of the respondents were women. There was a statistically significant gender gap in faculty rank (p = 0.002), with only 2 of 17 full professor positions occupied by women. Among faculty who had not yet requested promotion, women were more likely to report that they did not think an academic promotion would benefit them (69 vs. 32 % in men, p = 0.01), and to report a lack of encouragement for requesting promotion (50 vs. 29 %, p = 0.08).Targeting the perceived value of academic promotion among women faculty, increasing junior faculty mentorship and modifying annual review processes could address gender disparities in academic medicine ranks.
View details for DOI 10.1007/s40037-016-0263-7
View details for Web of Science ID 000443152400012
View details for PubMedID 27001528
View details for PubMedCentralID PMC4839010
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A national survey of infectious disease practitioners on their use of outpatient parenteral antimicrobial therapy (OPAT)
INFECTIOUS DISEASES
2015; 47 (1): 39-45
Abstract
The use of outpatient parenteral antimicrobial therapy (OPAT) is standard medical practice; however, significant heterogeneity in practice exists. We hypothesized that formal OPAT programs are associated with increased physician participation in patient safety activities.United States Infectious Disease (ID) physicians were contacted and asked to participate in an electronic survey from April through June 2012. Data were analyzed using SPSS version 20.In all, 3718 physicians were contacted and 316 (8.5%) responded. Respondents practice in 47 states; the majority (79%) practice adult ID, 11% pediatric ID, 10% a combination of the two. Sixty percent reported that ID consultation was not mandatory before OPAT, and 75% of these respondents thought it should be compulsory. The most common indications were osteomyelitis, prosthetic joint infections, and endocarditis, and the most common antibiotics were vancomycin, ceftriaxone, and ertapenem. Most respondents (59%) discharge patients with OPAT weekly, and have a median number of 11 OPAT patients (95% confidence interval (CI) 8.5-13.4). Half of respondents have a formal OPAT program. Fifty-two percent report no systematic method of communication between inpatient and outpatient physicians when patients are discharged with OPAT, 49% have no systematic method of lab tracking, and 34% have no method of ensuring patient adherence to clinic visits. All of these patient safety measures were more likely to be present in practice sites with formal OPAT programs (p < 0.001).Opportunities exist for improving OPAT monitoring and patient safety. Formal OPAT programs provide the framework for safe and effective care and are to be encouraged.
View details for DOI 10.3109/00365548.2014.967290
View details for Web of Science ID 000350052400007
View details for PubMedID 25415655
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Case Misclassification in Studies of Spinal Manipulation and Arterial Dissection
JOURNAL OF STROKE & CEREBROVASCULAR DISEASES
2014; 23 (8): 2031-2035
Abstract
Spinal manipulation has been associated with cervical arterial dissection and stroke but a causal relationship has been questioned by population-based studies. Earlier studies identified cases using International Classification of Diseases Ninth Revision (ICD-9) codes specific to anatomic stroke location rather than stroke etiology. We hypothesize that case misclassification occurred in these previous studies and an underestimation of the strength of the association. We also predicted that case misclassification would differ by patient age.We identified cases in the Veterans Health Administration database using the same strategy as the prior studies. The electronic medical record was then screened for the word "dissection." The presence of atraumatic dissection was determined by medical record review by a neurologist.Of 3690 patients found by ICD-9 codes over a 30-month period, 414 (11.2%) had confirmed cervical artery dissection with a positive predictive value of 10.5% (95% confidence interval [CI] 9.6%-11.5%). The positive predictive value was higher in patients less than 45 years of age vs 45 years of age or older (41% vs 9%, P < .001). We reanalyzed a previous study, which reported no association between spinal manipulation and cervical artery dissection (odds ratio [OR] = 1.12, 95% CI .77-1.63) and recalculated an odds ratio of 2.15 (95% CI .98-4.69). For patients less than 45 years of age, the OR was 6.91 (95% CI 2.59-13.74).Prior studies grossly misclassified cases of cervical dissection and mistakenly dismissed a causal association with manipulation. Our study indicates that the OR for spinal manipulation exposure in cervical artery dissection is higher than previously reported.
View details for DOI 10.1016/j.jstrokecerebrovasdis.2014.03.007
View details for Web of Science ID 000341484900016
View details for PubMedID 25085345
View details for PubMedCentralID PMC4157954
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A Qualitative Study of Gestational Weight Gain Counseling and Tracking
MATERNAL AND CHILD HEALTH JOURNAL
2013; 17 (8): 1508-1517
Abstract
Excessive gestational weight gain (GWG) predicts adverse pregnancy outcomes and later obesity risk for both mother and child. Women who receive GWG advice from their obstetric clinicians are more likely to gain the recommended amount, but many clinicians do not counsel their patients on GWG, pointing to the need for new strategies. Electronic medical records (EMRs) are a useful tool for tracking weight and supporting guideline-concordant care, but their use for care related to GWG has not been evaluated. We performed in-depth interviews with 16 obstetric clinicians from a multi-site group practice in Massachusetts that uses an EMR. We recorded, transcribed, coded, and analyzed the interviews using immersion-crystallization. Many respondents believed that GWG had "a lot" of influence on pregnancy and child health outcomes but that their patients did not consider it important. Most indicated that excessive GWG was a big or moderate problem in their practice, and that inadequate GWG was rarely a problem. All used an EMR feature that calculates total GWG at each visit. Many were enthusiastic about additional EMR-based supports, such as a reference for recommended GWG for each patient based on pre-pregnancy body mass index, a "growth chart" to plot actual and recommended GWG, and an alert to identify out-of-range gains, features which many felt would remind them to counsel patients about excessive weight gain. Additional decision support tools within EMRs would be well received by many clinicians and may help improve the frequency and accuracy of GWG tracking and counseling.
View details for DOI 10.1007/s10995-012-1158-9
View details for Web of Science ID 000325024100021
View details for PubMedID 23065312
View details for PubMedCentralID PMC3574181
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SINGLE-OPERATOR ULTRASOUND-GUIDED INTRAVENOUS LINE PLACEMENT BY EMERGENCY NURSES REDUCES THE NEED FOR PHYSICIAN INTERVENTION IN PATIENTS WITH DIFFICULT-TO-ESTABLISH INTRAVENOUS ACCESS
JOURNAL OF EMERGENCY MEDICINE
2013; 44 (3): 653-660
Abstract
Emergency physicians (EPs) have become facile with ultrasound-guided intravenous line (USIV) placement in patients for whom access is difficult to achieve, though the procedure can distract the EP from other patient care activities.We hypothesize that adequately trained Emergency Nurses (ENs) can effectively perform single-operator USIV placement with less physician intervention than is required with blind techniques.This was a prospective multicenter pilot study. Interested ENs received a 2-h tutorial from an experienced EP. Patients were eligible for inclusion if they had either two failed blind peripheral intravenous (i.v.) attempts, or if they reported or had a known history of difficult i.v. placement. Consenting patients were assigned to have either EN USIV placement or standard of care (SOC).Fifty patients were enrolled, of which 29 were assigned to USIV and 21 to SOC. There were no significant differences in age, race, gender, or reason for inclusion. Physicians were called to assist in 11/21 (52.4%) of SOC cases and 7/29 (24.1%) of USIV cases (p = 0.04). Mean time to i.v. placement (USIV 27.6 vs. SOC 26.4 minutes, p = 0.88) and the number of skin punctures (USIV 2.0 vs. SOC 2.1, p = 0.70) were not significantly different. Patient satisfaction was higher in the USIV group, though the difference did not reach statistical significance (USIV 86.2% vs. SOC 63.2%, p = 0.06). Patient perception of pain on a 10-point scale was also similar (USIV 4.9 vs. SOC 5.5, p = 0.50).ENs performing single-operator USIV placement in patients with difficult-to-establish i.v. access reduces the need for EP intervention.
View details for DOI 10.1016/j.jemermed.2012.08.021
View details for Web of Science ID 000315946900021
View details for PubMedID 23103067
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The Volume and pH-of-residual pharyngeal fluid aspirated from the TaperGuard Evac™ Endotracheal Tube following elective surgery: a prospective pilot study
MINERVA ANESTESIOLOGICA
2013; 79 (3): 240-247
Abstract
Oropharyngeal suctioning prior to extubation aims to minimize postextubation tracheal soiling from remaining fluid. We investigated the amount and nature of any fluid remaining after such suctioning and contributing factors.ASA I - III patients undergoing elective surgery under general anesthesia with endotracheal intubation participated in this prospective observational pilot study. Following oropharyngeal suctioning immediately prior to extubation, a dedicated port of the endotracheal tube (TaperGuard Evac™ Endotracheal Tube) was aspirated. The amount and pH of residual fluid was recorded. Data collection included age, sex, body mass index, comorbidities, ASA status, procedure type and duration. The Chi-Square, Wilcoxon Rank-Sum, t-tests, and univariate regression analysis were used as appropriate.Ninety-eight patients completed the study. The mean aspirated volume in 38 (38.8%) patients was 0.9 ± 1.3 mL and sixty patients (61.2%) had no aspirate. A body mass index of ≥ 30 kg/m2 was associated with the presence of fluid (P=0.03), and a higher volume (P=0.03). The fluid pH was 7 ± 0.81 (mean ± SD). A duration of surgery ≥ 120 minutes predicted a lower pH.The prevalence and amount of residual fluid after oropharyngeal suctioning was low and likely clinically insignificant. A higher body mass index was associated with a higher incidence and volume of residual fluid. Longer procedure duration determined a slightly lower pH, with a mildly acidic pH range. The possibility of a lower fluid pH after prolonged surgery contributing to postoperative sore throat via mucosal irritation warrants investigation.
View details for Web of Science ID 000319102300006
View details for PubMedID 23254167