Protein-Energy Supplementation in Early-Life Decreases the Odds of Mental Distress in Later Adulthood in Guatemala

The prevalence of mental health concerns is growing worldwide, along with lack of access to and receipt of needed treatment. Current gaps in treatment provision have led to exploring alternative methods of prevention, with research linking nutrition and mental health, of particular relevance in low- and middle-income countries, with a high prevalence of undernutrition. To examine whether exposure to a protein-energy nutritional supplement during the first 1000 d of life decreased odds of mental distress in adulthood among men and women in Guatemala compared with receiving a low energy-no protein supplement or supplementation outside the 1000-d window. Data from participants (n = 1249) in a longitudinal cohort protein-energy supplementation trial (early-life, supplementation data from 1969 to 1977, ages 0­7 y; life course, outcome data from 2017­2018 follow-up, ages 40­57 y) were analyzed for associations between nutrition in the first 1000 d and mental distress in adulthood (WHO Self- Reporting Questionnaire 20 [SRQ-20]), controlling for early-life variables and current life stress; life course variables (e.g. education) were examined as potential mediators of this relation. Generalized linear mixed models and zero-inflated Poisson generalized linear mixed models were utilized. Both partial and full supplementation with Atole during the first 1000 d were associated with 63% (95% CI: 0.16, 0.87) and 56% (95% CI: 0.19, 1.03) lower odds, respectively, of experiencing mental distress in adulthood. Did not differ by sex. These inverse relations remained relatively unchanged (partial OR = 0.34 [95% CI: 0.14, 0.83]; full OR = 0.38 [95% CI: 0.16, 0.92]) after controlling for early-life and life course variables, including life stress. Protein-energy supplementation during the first 1000 d of life in Guatemala, where undernutrition is prevalent, may reduce the prevalence of later mental distress in adulthood. This effect appears to occur directly, rather than indirectly, through pathways of life course variables such as education, wealth, and marital status. Keywords: early childhood nutrition, protein-energy

Age at childbirth and change in BMI across the life-course: evidence from the INCAP Longitudinal Study

Background: Parity has been associated with both short- and long-term weight gain in women. However, it is not clear if timing of parity across the reproductive age has different associations with BMI. Methods: To prospectively assess the association between age at childbirth and maternal change in BMI, we analyzed data from the ongoing INCAP Longitudinal Study, which started in 1969 in four villages in Guatemala. Cohort women (n=778) provided information on reproductive history and anthropometric measures were measured in 1988-89 (adolescence, 15 to 25y), 2002-04 (early adulthood, 26 to 36y) and 2015-17 (mid adulthood, 37 to 55y). We evaluated the associations of number of live births in the period preceding each study wave (1969-77 to 1988-89, 1988-89 to 2002-04 and 2002-04 to 2015-17) with BMI change in the same period using multivariable linear regression models. Results: Number of live births between 1988 and 89 and 2002-04 was positively associated with increased BMI, while there was not an association between number of live births and BMI in the other intervals. Women who had one, two, or three or more children between 1988 and 89 and 2002-04 had 0.90 (kg/m2, 95% CI: -0.55, 2.35), 2.39 (kg/m2, 95% CI: 1.09, 3.70) and 2.54 (kg/m2, 95% CI: 1.26, 3.82) higher BMI, respectively, than women who did not give birth in the same period. Conclusions: Our findings suggest that women who had three or more children during early adulthood gained more weight compared to women who had no children in the same period. In contrast, women who had children earlier or later in their reproductive lives did not gain additional weight compared to those who did not have children during that period. Childbirth may have different

Maternity care practices: implications for breastfeeding.

BACKGROUND: Many United States mothers never breastfeed their infants or do so for very short periods. The Baby-Friendly Hospital Initiative was developed to help make breastfeeding the norm in birthing environments, and consists of specific recommendations for maternity care practices. The objective of the current study was to assess the impact of the type and number of Baby-Friendly practices experienced on breastfeeding. METHODS: A longitudinal mail survey (1993-1994) was administered to women prenatally through 12 months postpartum. The study focused on the 1085 women with prenatal intentions to breastfeed for more than 2 months who initiated breastfeeding, using data from the prenatal and neonatal periods. Predictor variables included indicators of the absence of specific Baby-Friendly practices (late breastfeeding initiation, introduction of supplements, no rooming-in, not breastfeeding on demand, use of pacifiers), and number of Baby-Friendly practices experienced. The main outcome measure was breastfeeding termination before 6 weeks. RESULTS: Only 7 percent of mothers experienced all five Baby-Friendly practices. The strongest risk factors for early breastfeeding termination were late breastfeeding initiation and supplementing the infant. Compared with mothers experiencing all five Baby-Friendly practices, mothers experiencing none were approximately eight times more likely to stop breastfeeding early. Additional practices decreased the risk for early termination. CONCLUSION: Increased Baby-Friendly Hospital Initiative practices improve the chances of breastfeeding beyond 6 weeks. The need to work with hospitals to increase adoption of these practices is illustrated by the small proportion of mothers who experienced all five practices measured in this study.

Identification and assessment of ongoing stressors in adolescents with a chronic illness: an application of the behavior-analytic model.

Applied Goldfriend and D'Zurilla's (1969) Behavior-Analytic Model to the development of a context-specific measure of stressful situations for adolescents with a serious, chronic illness. In completing the situational analysis phase of the model, 45 adolescents with cystic fibrosis (CF), 20 parents of adolescents with CF, and 8 health care professionals completed structured interviews or daily diaries to obtain the widest range of problematic situations. The adolescent sample was recruited from two different medical centers, and stratified by sex and illness severity. A total of 1,174 problem situations were elicited across all participants and then content-analyzed into 164 nonredundant items in 10 domains (e.g., Medications and Treatment, and School). Few relations were found between demographic variables (e.g., age and illness severity) and the number or difficulty of problematic situations. Both adolescents and parents mentioned the greatest number of problematic situations in the domains of School, Medications and Treatment, and Parent-Teen Relationship. In terms of difficulty, all three respondents (i.e., teens, parents, and health care professionals) rated problems with Clinic and Hospital Visits as very difficult. For the adolescent sample, problems in the Parent-Teen Relationship and Health Concerns were also highly difficult. Significant associations were found between the problematic situations we identified and standardized measures of social and emotional functioning. Adolescents who rated their problems as more difficult also endorsed more symptoms of depression and lower perceptions of social competence. In a future study, the most salient items will be selected to create a role-play measure to elicit adolescents' coping strategies.

Psychological adjustment of pediatric lung transplantation candidates and their parents.

Investigated psychological functioning of 45 children and adolescents (ages 5 to 17 years) and their parents presenting at a major medical center for evaluation for lung transplantation. Patients completed self-reports, and parents completed measures on their children's behavior problems and emotional distress as well as on their own symptoms of distress. In general, children and their parents reported normal functioning on standard psychological measures. Few children fell in the clinically significant range, whereas 21% of mothers and 14% of fathers reported clinically significant levels of distress. Older children reported lower levels of depressive symptoms than younger children, and patients with cystic fibrosis manifested lower levels of internalizing symptoms than those with other pulmonary diseases. Findings demonstrate the resiliency of children and their parents facing a stressful point in the child's medical status and document the usefulness of psychological screening of patients and parents to identify those in need of clinical intervention.

Parental response to cystic fibrosis: a contextual analysis of the diagnosis phase.

A contextual framework guided the measurement of specific stressors encountered by parents of children recently diagnosed with cystic fibrosis (CF). Three variables were assessed within the context of the parenting role: illness-specific tasks, normal parenting tasks, and strains in family roles. These situation-specific stressors were contrasted with global measures of parenting stress in their ability to predict depression. Sixty-four parents (36 mothers, 28 fathers) of infants and toddlers recently diagnosed with CF completed a structured interview and standardized measures in the home. Parents reported elevations in both situation-specific and global parenting stress, and a greater number of depressive symptoms than a norm group. Mothers reported significantly greater strain in managing their caregiving role and higher levels of depression than fathers. Controlling for situation-specific parenting stress and marital satisfaction, regression analyses indicated that role strain related to CF was associated with greater depression in mothers, but not fathers. Furthermore, stressors measured contextually rather than globally accounted for substantially greater proportions of the variance in depression. The findings highlight the need to measure ongoing strains specific to the medical condition, and to assess role-related changes.