Maternal responsiveness and toddler body mass index z-score: Prospective analysis of maternal and child mealtime interactions.

Responsive feeding, where parents are guided by children's hunger and satiation cues and provide appropriate structure and support for eating, is believed to promote healthier weight status. However, few studies have assessed prospective associations between observed parental feeding and toddler growth. We characterized toddler growth from 18 to 36 months and, in a subset of families, examined whether observed maternal responsiveness to toddler satiation cues and encouraging prompts to eat at 18 and 24 months were associated with toddler body mass index z-score (BMIz) from 18 to 36 months. Participants included 163 toddlers and their mothers with overweight/obesity who had participated in a lifestyle intervention during pregnancy. Anthropometrics were measured at 18, 24, and 36 months. In a subsample, mealtime interactions were recorded in families' homes at 18 (n = 77) and 24 (n = 75) months. On average, toddler BMIz remained stable from 18 to 36 months with 31.3% (n = 51) categorized with a healthy weight, 56.4% (n = 92) with at risk for overweight and 12.3% (n = 20) with overweight. Fewer maternal prompts to eat at 18 months was associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p = .002). Higher child weight status at 12 months was also associated with both higher probability of having at risk for overweight/overweight (p < .05), and higher child 36-month BMIz (p < .001). Neither 24-month maternal prompts nor 18 or 24 month responsiveness to satiation cues were associated with toddler BMIz. In this diverse sample, weight status was relatively stable from 18 to 36 months. Maternal prompts to eat measured earlier in toddlerhood and prior child weight status were associated with toddler BMIz.

Promoting healthy food preferences from the start: a narrative review of food preference learning from the prenatal period through early childhood.

The palatable, energy-dense foods that characterize modern environments can promote unhealthy eating habits, along with humans' predispositions to accept sweet tastes and reject those that are sour or bitter. Yet food preferences are malleable, and examining food preference learning during early life can highlight ways to promote acceptance of healthier foods. This narrative review describes research from the past 10 years focused on food preference learning from the prenatal period through early childhood (ages 2-5 years). Exposure to a variety of healthy foods from the start, including during the prenatal period, early milk-feeding and the introduction to complementary foods and beverages, can support subsequent acceptance of those foods. Yet development is plastic, and healthier food preferences can still be promoted after infancy. In early childhood, research supports starting with the simplest strategies, such as repeated exposure and modelling, reserving other strategies for use when needed to motivate the initial tasting necessary for repeated exposure effects to begin. This review can help caregivers and practitioners to promote the development of healthy food preferences early in life. Specific implementation recommendations, the role of individual differences and next steps for research in this area are also discussed.

Consistency in infants' behavioural signalling of satiation during bottle-feeding.

BACKGROUND: Understanding the dynamics of feeding is essential for preventing accelerated weight gain during infancy, a risk factor for obesity. OBJECTIVES: Because infants satiate on larger volumes of cow milk formula (CMF) than CMF enriched with the free amino acid glutamate (CMF + glu), we used this model system to determine whether infants displayed consistent behaviours despite satiating on lower volumes. METHODS: In this laboratory-based, within-subject experimental study of ≤4-month-old infants (n = 41) and their mothers, infants were videotaped while feeding to satiation CMF on one test day and CMF + glu on the other, in counterbalanced order. Each video-recording was analysed frame-by-frame for frequency and timing of behaviours. RESULTS: Infants' behaviours were consistent in types and frequency but were displayed sooner when feeding CMF + glu compared with CMF. The less responsive the mother's feeding style, the less consistent the infant displayed behaviours across the two formula meals (P = 0.05). Infants who spat up (a possible sign of overfeeding) consumed more formula (P = 0.01) and had less responsive mothers (P = 0.04) compared with the other infants. CONCLUSIONS: Infants are consistent in their behavioural displays during feeding at this developmental age. Regulation of intake and signalling of satiation during bottle-feeding are associated with formula composition and maternal feeding style.

Preventing childhood obesity: what works?

Rates of overweight in North American children and adolescents have increased dramatically since the 1970s. Childhood obesity has reached epidemic proportions and calls for prevention and treatment programs to reverse this trend have been made. However, the evidence base needed for effective action is still incomplete, especially for childhood obesity prevention programs. This paper focuses on primary prevention of childhood obesity and has three aims: (1) to briefly describe current primary prevention approaches for childhood obesity and the evidence for their impact; (2) to elucidate promising, but untested intervention strategies using an ecological framework and evidence from experimental and epidemiological research on factors influencing children's eating and weight status; and (3) to introduce a multiphase strategy for screening intervention components and building and evaluating potent interventions for childhood obesity. Most childhood obesity prevention programs have focused on school-aged children and have had little success. We suggest that, given these findings, prevention efforts should be expanded to explore other contexts in which children live as possible settings for intervention efforts, including the family and childcare settings. Given that 25% of preschool children are already overweight, intervening with children before school entry should be a priority. A review of experimental research on the developing controls of food intake in infancy and childhood suggests possible intervention strategies, focusing on parenting and aspects of the feeding environment. Epidemiological findings point to even earlier modifiable risk factors, including gestational weight gain, maternal prepregnancy weight, and formula feeding. However, the potential impact of altering these risk factors remains to be evaluated. In response to this problem, we suggest a new, multiphase method for accomplishing this, including screening intervention components, refining intervention designs and confirming component efficacy to build and evaluate potent, optimized interventions.

Influenza vaccination in renal transplant recipients.

Renal transplant recipients receiving immunosuppressive therapy are prone to major pulmonary infections. Development of influenza virus infection may lead to renal allograft damage or rejection. These patients should therefore be protected against influenza viruses by vaccination. A satisfactory antibody response was found in 12 (60%) of 20 renal transplant recipients vaccinated. Among 15 control subjects, the antibody response was satisfactory in all participants (100%). Factors that might play a role in suppression of antibody response include use of immunosuppressive drugs and renal allograft function. Immunization is safe and does not appear to affect renal allograft function.

Endemic dengue virus infection in Hispaniola. I. Haiti.

Antibodies to group B arbovirus were common among coastal populations in the Haitian part of the Caribbean island of Hispaniola. Antibodies were present in 43% of children one to five years old; prevalence in older persons increased with age. In nine asymptomatic persons serodiagnostic changes indicative of group B arbovirus were detected during six of twelve consecutive months. In port cities where antibodies were common in children, Aedes aegypti indices of 50%-70% were observed; in contrast, no A. aegypti mosquitoes were found in an inland village in which children lacked denjue hemagglutination-inhibiting antibodes. Between 1969 and 1971, dengue 2 virus was isolated from 11 persons with episodic febrile illnesses, although no epidemic was apparent. These findings indicate that dengue virus infection was endemic in Haiti during the period of the study.

Detection of Venezuelan equine encephalitis virus in rural communities of Southern Florida by exposure of sentinel hamsters.

Venezuelan equine encephalitis (VEE) virus strains were recovered from sentinel hamsters exposed in close proximity to homes in rural South Florida. Sentinel hamster surveillance methods over extended periods offer one effective way of uncovering VEE virus activity in relation to human habitation.

Placental passage of antibodies to Dengue virus in persons living in a region of hyperendemic Dengue virus infection.

Maternal and umbilical cord levels of antibodies to dengue 2 and 3 viruses were compared in 54 matched pairs of specimens from subjects in the Dominican Republic. Dengue infection appeared to be hyperendemic; pregnant women experienced a 6% weekly infection rate. Titers of antibody to dengue 2 and 3 viruses were considerably higher in cord sera than in maternal sera (P smaller than 0.001 and P smaller 0.01, respectively), especially when maternal levels were low. When maternal and cord sera were compared at equal titers of dengue 2 virus, heterotypic antibodies to dengue 1 and St. Louis encephalitis viruses were higher in the cord. These findings could not be directly related to the higher levels of IgG found in cord sera or to the presence of elevated concentrations of IgM. It is concluded that antibody with increased cross-reactivity preferentially crosses the placenta. The presence of such cross-reactive antibody does not appear to sensitize infants to dengue hemorrhagic fever/shock syndrome.

Clinical evaluation of a new measles-mumps-rubella combined live virus vaccine in the Dominican Republic.

Over 900 children were enrolled in a double-blind placebo-controlled clinical study of measles (Schwarz strain), mumps (Jeryl Lynn strain), and rubella (Cendehill strain) trivalent vaccine. The trivalent vaccine caused about the same degree of reactivity as is generally associated with the Schwarz strain measles vaccine. Paired sera from triplesusceptible vaccinees had seroconversion rates of 99% for measles, 94% for mumps, and 93% for rubella. The results of this study show that this trivalent vaccine is as well tolerated and as effective as its component vaccines.