An index measuring adherence to New Zealand Infant Feeding Guidelines has convergent validity with maternal socio-demographic and health behaviours and with children's body size.

Using data from a nationally generalisable birth cohort, we aimed to: (i) describe the cohort's adherence to national evidence-based dietary guidelines using an Infant Feeding Index (IFI) and (ii) assess the IFI's convergent construct validity, by exploring associations with antenatal maternal socio-demographic and health behaviours and with child overweight/obesity and central adiposity at age 54 months. Data were from the Growing Up in New Zealand cohort (n 6343). The IFI scores ranged from zero to twelve points, with twelve representing full adherence to the guidelines. Overweight/obesity was defined by BMI-for-age (based on the WHO Growth Standards). Central adiposity was defined as waist-to-height ratio > 90th percentile. Associations were tested using multiple linear regression and Poisson regression with robust variance (risk ratios, 95 % CI). Mean IFI score was 8·2 (sd 2·1). Maternal characteristics explained 29·1 % of variation in the IFI score. Maternal age, education and smoking had the strongest independent relationships with IFI scores. Compared with children in the highest IFI tertile, girls in the lowest and middle tertiles were more likely to be overweight/obese (1·46, 1·03, 2·06 and 1·56, 1·09, 2·23, respectively) and boys in the lowest tertile were more likely to have central adiposity (1·53, 1·02, 2·30) at age 54 months. Most infants fell short of meeting national Infant Feeding Guidelines. The associations between IFI score and maternal characteristics, and children's overweight/obesity/central adiposity, were in the expected directions and confirm the IFI's convergent construct validity.

Pre-pregnancy dietary pattern is associated with newborn size: results from ProcriAr study.

Babies born small-for-gestational age (SGA) have an increased risk of mortality, morbidity and adverse functional consequences. Studies suggest that pre-pregnancy maternal diet may influence newborns' size. This study aimed to determine whether maternal pre-pregnancy dietary patterns (DP) are associated with delivering SGA newborns in the ProcriAr Cohort Study, Sao Paulo-Brazil. Pre-pregnancy DP of 299 women were investigated using factor analysis with principal component's estimation, based on intake reported on a validated 110-item FFQ. Newborns were classified as SGA if their weight and/or length, adjusted by gestational age and sex, were below the 10th percentile of the INTERGROWTH-21st standards. Multivariate Poisson regression modelling with robust error variance was performed to examine associations between the different DP (in quintiles) and SGA. In a model adjusted by maternal sociodemographic and health behaviours, women who scored in the highest quintile of the DP 'Snacks, sandwiches, sweets and soft drinks' (in relation to the women who scored in the lowest quintile) were significantly more likely to deliver SGA babies (relative risk 1·92; 95 % CI 1·08, 3·39). This study verified that women's pre-pregnancy dietary behaviour characterised by an energy-dense nutrient-poor food intake was a risk factor for delivering SGA newborns. Investments in education and improved access to healthful food and nutritional information before pregnancy should be prioritised due to their potential positive impact on child health. However, further studies are warranted to identify specific metabolic pathways that may be underlying these associations.

Effects of folic acid food fortification scenarios on the folate intake of a multi-ethnic pregnant population.

OBJECTIVE: To simulate effects of different scenarios of folic acid fortification of food on dietary folate equivalents (DFE) intake in an ethnically diverse sample of pregnant women. DESIGN: A forty-four-item FFQ was used to evaluate dietary intake of the population. DFE intakes were estimated for different scenarios of food fortification with folic acid: (i) voluntary fortification; (ii) increased voluntary fortification; (iii) simulated bread mandatory fortification; and (iv) simulated grains-and-rice mandatory fortification. SETTING: Ethnically and socio-economically diverse cohort of pregnant women in New Zealand.ParticipantsPregnant women (n 5664) whose children were born in 2009-2010. RESULTS: Participants identified their ethnicity as European (56·0 %), Asian (14·2 %), Maori (13·2 %), Pacific (12·8 %) or Others (3·8 %). Bread, breakfast cereals and yeast spread were main food sources of DFE in the two voluntary fortification scenarios. However, for Asian women, green leafy vegetables, bread and breakfast cereals were main contributors of DFE in these scenarios. In descending order, proportions of different ethnic groups in the lowest tertile of DFE intake for the four fortification scenarios were: Asian (39-60 %), Others (41-44 %), European (31-37 %), Pacific (23-26 %) and Maori (23-27 %). In comparisons within each ethnic group across scenarios of food fortification with folic acid, differences were observed only with DFE intake higher in the simulated grains-and-rice mandatory fortification v. other scenarios. CONCLUSIONS: If grain and rice fortification with folic acid was mandatory in New Zealand, DFE intakes would be more evenly distributed among pregnant women of different ethnicities, potentially reducing ethnic group differences in risk of lower folate intakes.

Determinants of folic acid supplement use outside national recommendations for pregnant women: results from the Growing Up in New Zealand cohort study.

OBJECTIVE: To evaluate the sociodemographic and lifestyle factors associated with insufficient and excessive use of folic acid supplements (FAS) among pregnant women. DESIGN: A pregnancy cohort to which multinomial logistic regression models were applied to identify factors associated with duration and dose of FAS use. SETTING: The Growing Up in New Zealand child study, which enrolled pregnant women whose children were born in 2009-2010. SUBJECTS: Pregnant women (n 6822) enrolled into a nationally generalizable cohort. RESULTS: Ninety-two per cent of pregnant women were not taking FAS according to the national recommendation (4 weeks before until 12 weeks after conception), with 69 % taking insufficient FAS and 57 % extending FAS use past 13 weeks' gestation. The factors associated with extended use differed from those associated with insufficient use. Consistent with published literature, the relative risks of insufficient use were increased for younger women, those with less education, of non-European ethnicities, unemployed, who smoked cigarettes, whose pregnancy was unplanned or who had older children, or were living in more deprived households. In contrast, the relative risks of extended use were increased for women of higher socio-economic status or for whom this was their first pregnancy and decreased for women of Pacific v. European ethnicity. CONCLUSIONS: In New Zealand, current use of FAS during pregnancy potentially exposes pregnant women and their unborn children to too little or too much folic acid. Further policy development is necessary to reduce current socio-economic inequities in the use of FAS.

Excess weight in preschoolers: prevalence and associated factors.

OBJECTIVE: To study the prevalence and factors associated with excess weight in children enrolled in public schools in the states of Rio Grande do Sul (RS) and Santa Catarina (SC). METHODS: This was a cross-sectional study, carried out with children aged 4 to 6 years. The studied outcome was excess weight, defined by z-score > two standard deviations for body mass index (BMI)/age, compared with the World Health Organization (WHO) reference population of 2006/2007. Anthropometric measurements of body mass and height were measured in duplicate using standard techniques, in accordance with the WHO. Data were double entered using EPI-INFO software, release 6.04. Absolute and relative frequencies were calculated, as well as mean values and standard deviations. Associations between excess weight and other variables were assessed by using Poisson model with robust variance. STATA software release 12.0 was used (p < 0.05). RESULTS: A total of 4,914 children were evaluated (2,578 in RS and 2,336 in SC). In RS, the incidence of excess weight was 14.4% (95% CI = 13.1% to 15.8%) and in SC, 7.5% (95% CI = 6.5% to 8.7%). The variables associated with excess weight were number of household members, maternal education, marital status, number of children, mother's age at birth of first child, gestational age, and birth weight. CONCLUSION: Children enrolled in public preschools in RS had a two-fold higher excess weight prevalence than that identified in SC, demonstrating a significant difference in the magnitude of childhood obesity in two Brazilian states located in the same region.

Excesso de peso em crianças de pré-escolas: prevalência e fatores associados / Excess weight in preschoolers: prevalence and associated factors

OBJETIVO: Estudar a prevalência e os fatores associados ao excesso de peso em crianças matriculadas em escolas públicas dos estados do Rio Grande do Sul (RS) e Santa Catarina (SC). MÉTODOS: Realizou-se estudo transversal com crianças de idade entre quatro e seis anos. O desfecho estudado foi o excesso de peso, definido através do escore Z > 2DP para o Índice de Massa Corporal (IMC)/idade, em comparação com a população de referência da OMS 2006/2007. As medidas antropométricas de massa corporal e altura foram aferidas em duplicata, utilizando-se técnicas padronizadas conforme a Organização Mundial de Saúde (OMS). Os dados foram duplamente digitados utilizando o software EPI-INFO, versão 6.04. Foram calculadas frequências absolutas e relativas e médias (DP). Associações entre excesso de peso e demais variáveis foram avaliadas em modelo de Poisson de variância robusta. Foi utilizado o programa STATA versão 12.0 (p < 0,05). RESULTADOS: Foram avaliadas 4.914 crianças (RS 2.578 e SC 2.336). No RS, o excesso de peso foi de 14,4% (IC 95% = 13,1-15,8%) e, em SC, de 7,5% (IC 95% = 6,5-8,7%). As variáveis que apresentaram associação com o excesso de peso foram: número de moradores no domicílio; escolaridade materna; situação conjugal; número de filhos; idade materna ao nascimento do primeiro filho; idade gestacional; e o peso ao nascer. CONCLUSÃO: As crianças matriculadas nas pré-escolas públicas do RS apresentaram uma prevalência de excesso de peso duas vezes maior do que a identificada em SC, demonstrando uma diferença significativa na magnitude da obesidade infantil em dois estados brasileiros situados em uma mesma região.

OBJECTIVE: To study the prevalence and factors associated with excess weight in children enrolled in public schools in the states of Rio Grande do Sul (RS) and Santa Catarina (SC). METHODS: This was a cross-sectional study, carried out with children aged 4 to 6 years. The studied outcome was excess weight, defined by z-score > two standard deviations for body mass index (BMI)/age, compared with the World Health Organization (WHO) reference population of 2006/2007. Anthropometric measurements of body mass and height were measured in duplicate using standard techniques, in accordance with the WHO. Data were double entered using EPI-INFO software, release 6.04. Absolute and relative frequencies were calculated, as well as mean values and standard deviations. Associations between excess weight and other variables were assessed by using Poisson model with robust variance. STATA software release 12.0 was used (p < 0.05). RESULTS: A total of 4,914 children were evaluated (2,578 in RS and 2,336 in SC). In RS, the incidence of excess weight was 14.4% (95% CI = 13.1% to 15.8%) and in SC, 7.5% (95% CI = 6.5% to 8.7%). The variables associated with excess weight were number of household members, maternal education, marital status, number of children, mother's age at birth of first child, gestational age, and birth weight. CONCLUSIONS: Children enrolled in public preschools in RS had a two-fold higher excess weight prevalence than that identified in SC, demonstrating a significant difference in the magnitude of childhood obesity in two Brazilian states located in the same region.

Dietary intakes associated with metabolic syndrome in a cohort of Japanese ancestry.

The present study examined the association between dietary factors and metabolic syndrome in a 7-year follow-up of Japanese-Brazilians. In 1993, a survey estimated the prevalence of diabetes in a Japanese-Brazilian population aged 40-79 years. From 647 subjects studied at baseline, 394 (60.9 %) participated in a second survey (2000); after exclusion of subjects with self-reported diseases, 23.4 % (n 151) were included in the present analysis. Metabolic syndrome diagnosis was based on the National Cholesterol Education Program criteria modified for Asians. Food intake was assessed by a validated food-frequency questionnaire. At baseline, mean ages were 56.1 (sd 9.7) and 54.7 (sd 10.6) years for men and women, respectively. Similar cumulative incidence rates of the metabolic syndrome were found in both sexes (36.9 (95 % CI 26.6, 48.1)% for men and 38.8 (95 % CI 27.1, 51.4) % for women). In 1993, mean values of blood pressure, waist circumference for men and 2 h plasma glucose for both sexes were higher among subjects who developed metabolic syndrome when compared with those who did not. Comparisons of nutrient intakes between subsets of subjects who developed or did not develop metabolic syndrome showed an association of protein intake with the syndrome only in men (96.4 (sd 56.8) v. 74.3 (sd 26.0) g/d; P<0.05). Odds ratios of the metabolic syndrome across tertiles of food groups intake showed that among men the highest tertile of red meat consumption was associated with a 4.7-fold increase in risk of developing the syndrome, after adjustments for confounders. However, the statistical significance of this model disappeared when saturated fatty acids were added. The data raised the possibility of a role of red meat consumption for the occurrence of metabolic syndrome in Japanese-Brazilian men. The present findings may have implications for the prevention of metabolic syndrome in this high-risk population.