Comparing Diet Quality Indices for Low-Income 24-Month-Old Toddlers: Exploring Changes Driven by 2020-2025 Dietary Guidelines for Americans.

BACKGROUND: Accurate assessment of toddler diet quality is essential for understanding current intakes and evaluating the effect of interventions and programs to promote healthy eating and prevent chronic disease. OBJECTIVES: The goal of this article was to assess the diet quality among toddlers using two different indices appropriate for 24-mo-old toddlers and compare differences in scoring between the measures by race and Hispanic origin. METHODS: We used cross-sectional data from 24-mo-old toddlers participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study-2 (ITFPS-2), a national study that includes 24-hour dietary recall information from children enrolled in WIC at birth. The main outcome measure was diet quality using both the toddler diet quality index (TDQI) and the healthy eating index (HEI)-2015. We derived mean scores for overall diet quality and for each component. We examined associations between the distribution of diet quality scores across terciles and by race and Hispanic origin using Rao-Scott chi-square tests of association. RESULTS: Nearly half of the mothers and caregivers self-identified as Hispanic (49%). Diet quality scores were higher when using the HEI-2015 compared with the TDQI (56.4 vs. 49.9, respectively). The difference in component scores was largest for refined grains, followed by sodium, added sugars, and dairy. Toddlers from Hispanic mothers and caregivers had significantly higher component scores for greens and beans and dairy but had lower scores for whole grains (P < 0.05) than those for the other racial and ethnic subgroups assessed. CONCLUSIONS: We found noteworthy differences in toddler diet quality depending on whether the HEI-2015 or TDQI is used, and children of different racial and ethnic subgroups may be differentially classified as having high or low diet quality depending on which index is used. This may have important implications for understanding which populations are at risk of future diet-related diseases.

Duration of WIC Participation and Early Feeding Practices Are Associated With Meeting the Added Sugars Recommendation at Age 3 Years.

OBJECTIVE: To examine whether duration of participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and early feeding practices are associated with the likelihood of meeting the Dietary Guidelines for Americans (DGA) recommendation for added sugars (AS) at age 3 years. METHODS: Using data from the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2), logistic regression assessed associations between WIC participation patterns, early feeding practices, and whether 3-year-olds met the AS recommendation. RESULTS: Children introduced to sugar-sweetened beverages (SSBs) in their first year were about half (adjusted odds ratio, 0.65; P < 0.01) as likely to meet the recommendation as those not exposed in their first 2 years. First-year-only WIC participation (adjusted odds ratio, 0.61; P < 0.04) also increased the risk of excessive consumption compared with children who participated in their third year. CONCLUSIONS AND IMPLICATIONS: Duration of WIC participation is inversely associated with young children's AS intakes. Public health efforts to reduce WIC attrition and enhance education efforts focused on delaying sugar-sweetened beverage introduction are supported.

Duration of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participation is Associated With Children's Diet Quality at Age 3 Years.

INTRODUCTION: Adequate childhood nutrition contributes to prevention of chronic diseases. The supplemental foods and nutrition education provided by the Special Supplemental Nutrition Program for Women, Infants, and Children, a federal program serving women, infants, and children up to age 5 years in low-income families and at nutritional risk, intend to optimize dietary intakes. This study assesses associations between duration of the Special Supplemental Nutrition Program for Women, Infants, and Children participation, early feeding practices, and children's diet quality at age 3 years. METHODS: Using data collected between 2013 and 2017 from the Special Supplemental Nutrition Program for Women, Infants, and Children Infant and Toddler Feeding Practices Study-2, investigators derived 4 mutually exclusive patterns of the Special Supplemental Nutrition Program for Women, Infants, and Children participation: participation in the child's first year only, participation into the second year, participation into the third year, and intermittent participation across 3 years. In 2021, multivariable regression assessed associations between these patterns, early feeding practices, and 2015 Health Eating Index total score at age 3 years. RESULTS: When compared with children who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children into their third year, children who participated in their first year only (p<0.01) had 2015 Healthy Eating Index total scores that were 3.6 points lower on a given day. Children introduced to sugar-sweetened beverages in their first year had scores that were 2.4 points lower than children not introduced to them in their first 2 years (p=0.03), whereas those breastfed longer exhibited a small increase in scores (p<0.01). CONCLUSIONS: Longer participation in the Special Supplemental Nutrition Program for Women, Infants, and Children improves children's diets, potentially mitigating chronic disease risk. Clinician efforts to refer at-risk families to the Special Supplemental Nutrition Program for Women, Infants, and Children during the early childhood years are supported.

Shifts in Sources of Food but Stable Nutritional Outcomes among Children in the Early Months of the COVID-19 Pandemic.

Early in the COVID-19 pandemic, the U.S. Department of Agriculture (USDA), State governments, and school districts took unprecedented steps to mitigate the pandemic's impact on students' nutrition. To examine the effect of emergency responses on 6-year-old children's nutritional outcomes, this study analyzed longitudinal data from a national study of children's feeding practices, the Special Supplemental Nutrition Program for Women, Infants, and Children-Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2). Findings include no differences in food insecurity prevalence; however, there were shifts in sources of food, with children in the post-COVID-emergency-declaration (post-ED) group consuming more dietary energy from stores and community food programs and less from restaurants and schools than children in the pre-COVID-emergency-declaration (pre-ED) group (p < 0.01 for all comparisons). Examination of within-person mean differences in 2015 Healthy Eating Index scores and nutrient intakes between ages 5 and 6 years revealed few statistically significant differences between the two groups: children in the post-ED group consumed slightly fewer vegetables (p = 0.02) and less sodium (p = 0.01) than their pre-ED peers. Findings suggest emergency efforts to maintain children's nutrition were largely successful in the early months of the pandemic. Research is needed to understand the mechanisms by which emergency efforts contributed to these findings.

Prenatal and Postnatal Experiences Predict Breastfeeding Patterns in the WIC Infant and Toddler Feeding Practices Study-2.

Objective: To examine pre- and postnatal experiential factors associated with desirable breastfeeding patterns in a nationally representative population of low-income women who prenatally enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and initiated breastfeeding. Materials and Methods: Using data from the longitudinal WIC Infant and Toddler Feeding Practices Study-2, multivariable, hierarchical logistic regression analyses identified prenatal and postnatal experiential factors associated with three breastfeeding patterns: (1) breastfeeding at 6 months, (2) breastfeeding at 1 year, and (3) breastfeeding at 1 year without introducing formula through age 6 months. Results: After controlling for covariates, one prenatal factor, breastfeeding intentions, and one postnatal factor, receipt of a doctor's recommendation to breastfeed, raised the odds of exhibiting the patterns analyzed. Another postnatal factor, returning to full-time employment before infant age 3 months, lowered the odds of exhibiting the patterns. Prior WIC participation significantly increased the odds of breastfeeding at 1 year, while postnatal employment before infant age 3 months significantly decreased the odds of exhibiting this pattern. Conclusions: Health care providers and those working in public health programs, including WIC, play an important role in helping low-income women mitigate shorter breastfeeding durations. Their efforts should continue focusing on bolstering women's prenatal breastfeeding intentions, reducing structural barriers to breastfeeding in the early postnatal period, particularly among those women returning to work, and connecting low-income families with WIC if they are not already enrolled in the program. This study is registered at clinicaltrials.gov as Feeding My Baby-A National WIC Study, NCT02031978.

Distribution of Epstein-Barr viral load in serum of individuals from nasopharyngeal carcinoma high-risk families in Taiwan.

The utility of EBV load as a tumor marker in nasopharyngeal carcinoma (NPC) patients suggests that it might also serve as a screening test for individuals who are at high risk for developing NPC. We previously demonstrated that unaffected individuals from high-risk families had elevated anti-EBV antibody levels compared to community controls. In this study, we measured EBV load using 2 different real-time PCR assays (targeting BamH1W and polymerase gene sequences, respectively) carried out in 2 independent research labs in serum samples from 19 untreated NPC cases, 11 healthy community controls and 100 unaffected individuals from families in which 2 or more individuals were affected with NPC. EBV genomes were detectable in 68% of NPC cases by the EBV BamH1W assay and in 74% by the EBV polymerase assay (kappa = 0.64). Patients with stage III or IV disease had significantly higher EBV load compared to those with stage I or II disease (p = 0.008). EBV DNA was detected in a single community control sample by the EBV BamH1W assay and in none of the samples by the EBV polymerase assay. Only one of 100 unaffected family members tested positive by both assays. An additional 14 were positive by only one of the 2 EBV load assays used and usually in only one of the duplicate wells tested, all with very low viral loads (3-50 copies/ml). In addition, EBV load did not correlate with EBV serology results (anti-VCA, anti-DNase, anti-EBNA-1) among these unaffected family members. In conclusion, our study suggests limited clinical utility of the EBV load test, in its current configuration, to screen individuals from high-risk families. Should a more sensitive or specific molecular assay be developed that is capable of detecting and distinguishing tumor-derived EBV genomes or gene products from true negatives, it could be evaluated as a possible screening tool for asymptomatic and early-stage NPC.

Evaluation of risk factors for nasopharyngeal carcinoma in high-risk nasopharyngeal carcinoma families in Taiwan.

A study of nasopharyngeal carcinoma (NPC) families with two or more affected members was conducted in Taiwan (265 families with 2,444 individuals, 502 affected and 1,942 unaffected) to determine the association between NPC and potential etiologic factors in NPC high-risk families. Similar to results from a previous case-control study in Taiwan, Guangdong salted fish consumption during childhood, exposure to wood, and betel nut consumption were all associated with elevated NPC risk using conditional logistic regression, although these associations were not as strong as in the case-control study possibly due to shared environment among family members. Risk associated with cumulative wood exposure and salted fish consumption before age 10 was stronger in families with early NPC age-onset [odds ratio (OR(wood)), 5.10; 95% confidence interval (95% CI), 1.50-17.34; OR(fish), 3.94; 95% CI, 1.47-10.55] or three or more affected members (OR(wood), 4.41; 95% CI, 1.58-12.30; OR(fish), 4.27; 95% CI, 1.10-16.47). In contrast, a tendency for elevated risk was noted for betel nut use in late age-onset families (OR, 2.44; 95% CI, 1.16-5.13) and the CYP2E1 c2 allele in families with less than three affected members (OR, 2.06; 95% CI, 1.04-3.35). Risk estimates associated with these exposures were similar when the analyses were restricted to EBV-seropositive subjects. To better adjust for degree of relationship among family members and residual genetic correlations, we also calculated ORs using a variance components model. The results from the two methods were similar indicating that the risk estimates from conditional logistic regression were unbiased.

Epstein-Barr virus seroreactivity among unaffected individuals within high-risk nasopharyngeal carcinoma families in Taiwan.

Most adults have been infected with EBV. Many studies have indicated that antibodies against specific EBV antigens, particularly IgA antibodies, can be predictive or prognostic of EBV-associated malignancies, such as NPC. We hypothesized that healthy individuals from families with a history of multiple members affected with NPC (who therefore might be genetically susceptible to NPC themselves) might have an EBV antibody profile that is distinct from that seen in healthy individuals from the community at large. To explore this possibility and examine determinants of anti-EBV antibody levels in healthy, high-risk individuals, we evaluated data from 2 parallel studies of NPC in Taiwan, which included 1,229 healthy members of families in which 2 or more individuals were affected with NPC and 320 controls from the community at large. Blood collected from participants was tested for IgA antibodies against EBV VCA and EBNA-1 and for neutralizing antibodies against EBV DNase using standard assays. We observed evidence of familial aggregation of EBV seroreactivity among individuals from high-risk, multiplex NPC families. Anti-VCA IgA and anti-EBNA-1 IgA antibody seroprevalence in unaffected family members of NPC cases was 5-6 times higher than in members of the community (p < 0.01). This elevated seroprevalence among unaffected individuals from high-risk families was observed regardless of the relationship of the unaffected individual to the closest affected relative (siblings, parents, children or spouses). No sociodemographic or environmental factors examined were found to strongly and consistently correlate with elevated seroprevalence, but patterns emerged of increasing seroprevalence among older individuals and among females. Unaffected individuals from high-risk NPC families have elevated anti-EBV IgA antibody titers. The etiologic and clinical implications of this finding remain to be established.