Rationale, design and methods for the RIGHT Track Health Study: pathways from childhood self-regulation to cardiovascular risk in adolescence.

BACKGROUND: Cardiovascular risk factors during adolescence-including obesity, elevated lipids, altered glucose metabolism, hypertension, and elevated low-grade inflammation-is cause for serious concern and potentially impacts subsequent morbidity and mortality. Despite the importance of these cardiovascular risk factors, very little is known about their developmental origins in childhood. In addition, since adolescence is a time when individuals are navigating major life changes and gaining increasing autonomy from their parents or parental figures, it is a period when control over their own health behaviors (e.g. drug use, sleep, nutrition) also increases. The primary aim of this paper is to describe the rationale, design and methods for the RIGHT Track Health Study. This study examines self-regulation as a key factor in the development of cardiovascular risk, and further explores health behaviors as an explanatory mechanism of this association. We also examine potential moderators (e.g. psychosocial adversities such as harsh parenting) of this association. METHOD/DESIGN: RIGHT Track is a longitudinal study that investigates social and emotional development. The RIGHT Track Health Study prospectively follows participants from age 2 through young adulthood in an effort to understand how self-regulatory behavior throughout childhood alters the trajectories of various cardiovascular risk factors during late adolescence via health behaviors. Individuals from RIGHT Track were re-contacted and invited to participate in adolescent data collection (~16.5, 17.5 and 18(+) years old). Individuals completed assessments of body composition, anthropometric indicators, fitness testing (via peak oxygen consumption), heart rate variability during orthostatic challenge, 7-day accelerometry for physical activity and sleep, 24-h dietary recalls, and blood analysis for biomarkers related to metabolic syndrome, inflammatory status and various hormones and cytokines. Individuals also completed extensive self-report measures on diet and eating regulation, physical activity and sedentary behaviors, sleep, substance use, medical history, medication use and a laboratory-day checklist, which chronicled previous day activities and menstrual information for female participants. DISCUSSION: Insights emerging from this analysis can help researchers and public health policy administrators target intervention efforts in early childhood, when preventing chronic disease is most cost-effective and behavior is more malleable.

Satiety responsiveness and the relationship between breastfeeding and weight status of toddlers of overweight and obese women.

Numerous studies indicate an association between breastfeeding and decreased toddler adiposity. The mechanism behind this association is still unknown. One possibility is that children who are breastfed may have increased responsiveness to internal satiety cues. This study assessed the effect of satiety responsiveness on the association between breastfeeding and weight status among toddlers. We conducted a secondary analysis of data from 428 toddlers aged 2 years. Mothers' body mass index (BMI) and children's BMI z score were calculated from measured height and weight. Mothers completed a detailed breastfeeding survey and the satiety responsiveness subscale of the Child Eating Behaviour Questionnaire. Multiple linear regression and logistic regression were used to determine if satiety responsiveness mediated the effect of breastfeeding on BMI z score or overweight/obesity (BMI ≥ 85th percentile). Establishment of breastfeeding was associated with decreased BMI z score (0.40 vs. 0.60; p = 0.04), and increased breastfeeding intensity was associated with lower odds of overweight/obesity (OR 0.97, p = 0.04). Satiety responsiveness was not associated with either breastfeeding measures, suggesting it does not play a meditational role in the relationship between breastfeeding and toddler weight status. Furthermore, a relationship between satiety responsiveness and obesity does not exist after controlling for well-known confounders. This study did not find a mediation effect of satiety responsiveness on the association between breastfeeding and weight status in toddlers. More research is needed to characterize satiety responsiveness and its influence on the relationship between breastfeeding and childhood obesity.

Diet, physical activity, and body composition changes during the first year of treatment for childhood acute leukemia and lymphoma.

BACKGROUND: Children who undergo treatment for childhood acute lymphoblastic leukemia (ALL) and lymphoma are at risk for several long-term health problems. Obesity, for which survivors of ALL and lymphoma are also at risk, may further exacerbate these problems. This pilot study evaluates changes in physical activity and body composition among children being treated for ALL and lymphoma and their parents. PROCEDURES: Recently diagnosed adolescent ALL and lymphoma patients were recruited from 2 pediatric hematology and oncology clinics, and matched on age, race, and sex to healthy individuals in the community. Changes in diet, physical activity, and body composition were collected at baseline, 6, and 12 months. RESULTS: All children (n=15) were, on average, 10.3 years of age at enrollment, and were fairly evenly distributed with regard to sex. Analyses revealed a significant difference between cases and controls with respect to the change in body mass index from baseline to 12 months (P=0.01). In addition, controls demonstrated a significantly greater increase in moderate-vigorous physical activity than the cases [229.8 metabolic equivalent of tasks (METs) vs. 23.5 METs]; indicating cases remained fairly inactive over the course of treatment. CONCLUSIONS: Our data corroborate previous findings that following treatment for ALL and lymphoma, childhood cancer survivors tend to be less active and at greater risk for obesity than their healthy peers. The present study, which assessed cases prospectively over a 12-month period during the early phases of treatment, extends prior reports by demonstrating that these outcomes are evident at an early stage in treatment.

Parent-focused change to prevent obesity in preschoolers: results from the KAN-DO study.

OBJECTIVE: The study presents the immediate post-intervention results of Kids and Adults Now - Defeat Obesity!, a randomized controlled trial to enhance healthy lifestyle behaviors in mother-preschooler (2-5 years old) dyads in North Carolina (2007-2011). The outcomes include change from baseline in the child's diet, physical activity and weight, and in the mother's parenting behaviors, diet, physical activity, and weight. METHOD: The intervention targeted parenting through maternal emotion regulation, home environment, feeding practices, and modeling of healthy behaviors. 400 mother-child dyads were randomized. RESULTS: Mothers in the intervention arm, compared to the control arm, reduced instrumental feeding (-0.24 vs. 0.01, p<0.001) and TV snacks (-.069 vs. -0.24, p=0.001). There were also improvements in emotional feeding (p=0.03), mother's sugary beverage (p=0.03) and fruit/vegetable (p=0.04) intake, and dinners eaten in front of TV (p=0.01); these differences were not significant after adjustment for multiple comparisons. CONCLUSION: KAN-DO, designed to maximize the capacity of mothers as agents of change, improved several channels of maternal influence. There were no group differences in the primary outcomes, but differences were observed in the parenting and maternal outcomes and there were trends toward improvement in the preschoolers' diets. Long-term follow-up will address whether these short-term trends ultimately improve weight status.

Predictors of breastfeeding in overweight and obese women: data from Active Mothers Postpartum (AMP).

Excess maternal weight has been negatively associated with breastfeeding. We examined correlates of breastfeeding initiation and intensity in a racially diverse sample of overweight and obese women. This paper presents a secondary analysis of data from 450 women enrolled in a postpartum weight loss intervention (Active Mothers Postpartum [AMP]). Sociodemographic measures and body mass index (BMI), collected at 6 weeks postpartum, were examined for associations with breastfeeding initiation and lactation score (a measure combining duration and exclusivity of breastfeeding until 12 months postpartum). Data were collected September 2004-April 2007. In multivariable analyses, BMI was negatively associated with both initiation of breastfeeding (OR: .96; CI: .92-.99) and lactation score (ß -0.22; P = 0.01). Education and infant gestational age were additional correlates of initiation, while race, working full-time, smoking, parity, and gestational age were additional correlates of lactation score. Some racial differences in these correlates were noted, but were not statistically significant. Belief that breastfeeding could aid postpartum weight loss was initially high, but unrelated to breastfeeding initiation or intensity. Maintenance of this belief over time, however, was associated with lower lactation scores. BMI was negatively correlated with breastfeeding initiation and intensity. Among overweight and obese women, unrealistic expectations regarding the effect of breastfeeding on weight loss may negatively impact breastfeeding duration. In general, overweight and obese women may need additional encouragement to initiate breastfeeding and to continue breastfeeding during the infant's first year.

Gestational weight gain in consecutive pregnancies.

OBJECTIVE: The purpose of this study was to examine the association between gestational weight gain (GWG) in a woman's first and second pregnancies. STUDY DESIGN: We conducted a retrospective observational cohort study of 27,771 women with their first and second births in North Carolina's Pregnancy Nutrition Surveillance System database from 1996-2004. GWG was categorized as inadequate, appropriate, or excessive, according to 2009 Institute of Medicine guidelines. Covariate adjusted polytomous logistic regression was used to test the association between GWG category in the first and second pregnancy. RESULTS: Compared with women with appropriate GWG in their first pregnancy, women with excessive GWG in their first pregnancy had an odds ratio of 2.6 (95% confidence interval, 2.4-2.7) for excessive GWG in their second pregnancy. Women with inadequate GWG in their first pregnancy were similarly likely to repeat this category in their subsequent pregnancy. CONCLUSION: GWG category in a woman's first pregnancy is a significant predictor of GWG category in her subsequent pregnancy.

Effects of calcium and resistance exercise on body composition in overweight premenopausal women.

OBJECTIVE: To examine the combined treatment effect of a mild energy restriction, high dairy calcium intake, and resistance exercise on promoting favorable body composition changes in overweight women with a low dairy intake. Combined treatment strategies may produce synergistic effects on increasing fat loss and preserving bone in a population at risk for obesity and osteoporosis. METHODS: Overweight, sedentary women consuming a diet low in dairy calcium (≤1 serving of dairy per day) were randomized either (1) to maintain a low-calcium diet (LOW; ≤ 500 mg; n = 15) or (2) to increase dairy calcium (HIGH; ≥1200 mg; n = 14) for 16 weeks. Both groups began resistance training 3 days per week and received dietary counseling to reduce energy intake by 250 kcal per day. Body composition was measured at the beginning and at the end of the study with dual energy x-ray absorptiometry. Two 24-hour dietary recalls were measured at baseline, midpoint, and end of study with Nutrition Data System for Research software. RESULTS: Participants were 36.8 ± 4.8 years of age, with an average body mass index of 29.1 ± 2.1 kg/m2. Fat mass decreased significantly over time (LOW = 3.8 ± 4.1 kg and HIGH = 1.8 ± 2.1 kg) but was not significantly different by group. Mean energy reduction from baseline was 382 kcal (LOW) and 214 kcal (HIGH; p = 0.14). When change in energy intake was included as a covariate, there was still no significant difference in fat loss between groups. Change in lumbar spine bone mineral density (LOW = -1.5% and HIGH = 0.8%) was significant between groups (p = 0.02). The prescribed mean calcium intake was achieved for each study group (LOW = 454 ± 143 mg and HIGH = 1312 ± 183 mg), with no significant changes in protein intake over time (LOW = 0.9 g/kg and HIGH = 1.0 g/kg, p = 0.08). CONCLUSION: These results suggest that increasing dairy calcium offers no added benefit in reducing body fat when combined with resistance training and energy restriction. However, increasing dairy calcium improves bone mineral density in premenopausal overweight women.

Effect of breastfeeding on weight retention from one pregnancy to the next: results from the North Carolina WIC program.

OBJECTIVES: Pregnancy-related weight retention can contribute to obesity, and breastfeeding may facilitate postpartum weight loss. We investigated the effect of breastfeeding on long-term postpartum weight retention. METHODS: Using data from the North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children (WIC; 1996-2004), weight retention was assessed in women aged 18 years or older who had more than one pregnancy available for analysis (n=32,920). Using multivariable linear regression, the relationship between duration of breastfeeding after the first pregnancy and change in pre-pregnancy weight from the first pregnancy to the second pregnancy was estimated, controlling for demographic and weight-related covariates. RESULTS: Mean time between pregnancies was 2.8 years (standard deviation (SD) 1.5), and mean weight retention from the first to the second pregnancy was 4.9kg (SD 8.7). In covariate-adjusted analyses, breastfeeding for 20 weeks or more resulted in 0.39kg (standard error (SE) 0.18) less weight retention at the beginning of the second pregnancy relative to no breastfeeding (p=0.025). CONCLUSION: In this large, racially diverse sample of low-income women, long-term weight retention was lower among those who breastfed for at least 20 weeks.

Effect of breast-feeding on weight retention at 3 and 6 months postpartum: data from the North Carolina WIC Programme.

OBJECTIVE: Pregnancy-related weight retention can contribute to obesity, and breast-feeding may facilitate postpartum weight loss. We investigated the effect of breast-feeding on postpartum weight retention. DESIGN: A retrospective follow-up study of weight retention, compared in women who were fully breast-feeding, combining breast-feeding with formula-feeding (mixed feeding), or formula-feeding at 3 months (n 14 330) or 6 months (n 4922) postpartum, controlling for demographic and weight-related covariates using multiple linear regression. SETTING: The North Carolina Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). SUBJECTS: Participants in the North Carolina WIC Programme who delivered a baby between 1996 and 2004. RESULTS: In covariate-adjusted analyses, there was no association between breast-feeding and weight retention at 3 months postpartum. At 6 months postpartum, as compared to formula-feeders, mean weight retention was 0·84 kg lower in mixed feeders (95 % CI 0·39, 1·29; P = 0·0002) and 1·38 kg lower in full breast-feeders (95 % CI 0·89, 1·87; P ≤ 0·0001). CONCLUSIONS: Breast-feeding was inversely associated with weight retention at 6 months postpartum in this large, racially diverse sample of low-income women. Further, full breast-feeding had a larger protective effect than did breast-feeding combined with formula-feeding.

The Effect of an Exercise Intervention During Early Lactation on Bone Mineral Density During the First Year Postpartum.

BACKGROUND: During lactation, women may lose up to 10% of bone mineral density (BMD) at trabecular-rich sites. Previous studies show that resistance exercise may slow BMD; however, the long-term effects of exercise on BMD during lactation have not been reported. OBJECTIVE: To evaluate the effect of two 16-week exercise interventions (4- to 20-wk postpartum) in lactating women at 1-year postpartum on lumbar spine, total body, and hip BMD. METHODS: To increase sample size at 1-year postpartum, two 16-week exercise interventions were combined for analysis. At 4-week postpartum, 55 women were randomized to intervention group (weight bearing aerobic exercise and resistance exercise) or control group (no exercise) for 16-week, with a 1-year postpartum follow-up. BMD was measured by dual-energy X-ray absorptiometry. Repeated-measures analysis of covariance was used to test for time and group differences for BMD controlling for prolactin concentration and dietary calcium at 1-year postpartum. RESULTS: Change in lumbar spine BMD was significantly different over time and between groups from 4-week to 1-year postpartum, when controlling for prolactin concentration and dietary calcium. There were no significant differences between groups in total body and hip BMD. CONCLUSION: These results suggest that resistance exercise may slow bone loss during lactation, resulting in higher BMD levels at 1-year postpartum.

Diets Rich in Fruits and Vegetables Are Associated with Lower Cardiovascular Disease Risk in Adolescents.

Obesity and cardiovascular disease (CVD) risk are public health concerns in adolescents, yet few studies have examined the association of their diet to CVD risk factors. This study investigated associations between diet, body mass index (BMI), waist circumference (WC), blood pressure (BP), and blood lipids in 163 16-17 year olds. Diet recall data were converted into Healthy Eating Index-2010 (HEI) to assess diet quality. Differences in diet between groups with normal or obese BMI, normal or hypertensive BP, and normal or altered lipids were determined. Associations between diet and BMI, WC, BP, and lipids, controlling for race, gender, and socioeconomic status, were examined. Mean HEI was 49.2 (±12.0), with no differences observed between groups. HEI was not associated with any CVD risk. Sweetened beverage consumption was higher in obese adolescents, and positively related to total cholesterol (TC). Fruit intake was negatively related to BMI and diastolic BP. Total vegetable intake was negatively related to systolic BP. Greens and beans were negatively related to TC and LDL. Whole grains were negatively related to HDL. This research suggests a cardioprotective effect of diets rich in fruits and vegetables, as well as low in sweetened beverages in adolescents.

The effects of dieting on food and nutrient intake of lactating women.

The purpose of this report was to identify and evaluate dietary changes in women who were participating in a study on the effects of weight loss in overweight lactating women on the growth of their infants. Women were randomly assigned at 4 weeks postpartum to either restrict energy intake by 500 kcal/day (diet and exercise group) or to maintain usual dietary intake (control group) for 10 weeks. The diet and exercise group significantly decreased fats, sweetened drinks, sweets and desserts, snack foods, and energy intake. Micronutrient intake decreased in the diet and exercise group; however, mean intakes were not significantly different from those of the control group except for calcium and vitamin D. Both groups consumed less than 76% of the Recommended Dietary Allowance for vitamins E and C at the end of the study. Mean intake of all other nutrients was adequate in both groups. These results suggest that overweight lactating women can restrict their energy intake by 500 kcal per day by decreasing consumption of foods high in fat and simple sugars. However, they must be advised to increase their intakes of foods high in calcium and vitamin D. Increased intake of fruits and vegetables should also be recommended to all lactating women, as well as multivitamin and calcium supplements to those who do not consume adequate amounts of these foods.

Is maternal obesity a cause of poor lactation performance.

Several investigators have reported a relationship between maternal obesity and low rates of initiation and duration of breast-feeding. Recent research findings suggest that poor infant feeding behavior and reduced hormonal responses in the early postpartum period result in delayed lactogenesis and early cessation of breast-feeding among overweight/obese women.

Maternal diet and exercise: effects on long-chain polyunsaturated fatty acid concentrations in breast milk.

BACKGROUND: Long-chain polyunsaturated fatty acids (LC-PUFA) are essential for infant growth and development. The amount of long-chain PUFA in breast milk depends on maternal diet and body stores. Because exercise increases mobilization and utilization of fatty acids, maternal activity may also influence the amount of LC-PUFA in breast milk. OBJECTIVE: To investigate the effects of exercise on alpha-linolenic acid (LNA), linoleic acid (LA), docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and arachidonic acid (AA) concentrations in maternal plasma and breast milk and to determine if lactating women consume adequate amounts of LC-PUFA to compensate for those used for energy during exercise. DESIGN: LC-PUFA in plasma and breast milk were measured at 12 weeks postpartum in exercising and sedentary women. Dietary intake was recorded for 3 days. A subsample of women participated in exercise and rest sessions to examine the acute effects of exercise on breast milk LC-PUFA. RESULTS: There were no differences in dietary intake between the two groups. Mean intake (+/-standard error of the mean) of LA was 11.05+/-1.39 and 9.34+/-0.97 and LNA was 0.96+/-0.12 and 0.82+/-0.09 g/day by the sedentary and exercise groups, respectively. These amounts are close to the Adequate Intakes of LA and LNA for lactation (13 and 1.3 g/day, respectively). No differences were found in LC-PUFA in plasma and breast milk between groups. After 30 minutes of exercise, there was a trend for an increase in LA and LNA concentrations in breast milk, with no change in DHA, EPA, and AA concentrations. CONCLUSIONS: These results suggest that women consuming adequate amounts of LC-PUFA can exercise moderately without decreasing the LC-PUFA in their breast milk.

Immune status of physically active women during lactation.

PURPOSE: The purpose of this study was to provide baseline data on immune status of exercising and sedentary exclusively lactating women. Dietary intake and body composition were also investigated to determine whether they related to immune function. METHODS: Healthy, exclusively breastfeeding women with a body mass index between 20 and 30 kg x m were studied at 3 months postpartum. Participants in the exercise group (EG; N = 27) exercised aerobically at least 30 min x d, 3x wk, and women in the sedentary group (SG; N = 23) exercised once a week or less during the previous 6 wk. Immune status while at rest was determined by measuring: 1) a complete blood cell count and differential leukocyte count; 2) percentages and absolute counts of peripheral blood T cells (CD3+), cytotoxic T cells (CD3+CD8+), helper T cells (CD3+CD4+), B cells (CD19+), and natural killer cells (CD56+); 3) neutrophil bacterial killing and oxidative burst activity; and 4) in vitro mitogenic responsiveness of lymphocytes. Cardiorespiratory fitness, body composition, and dietary intake were also measured. RESULTS: Participants in the EG had a significantly higher level of mean predicted cardiorespiratory fitness than women in the SG (39.5 +/- 1.1 vs 32.5 +/- 1.0 mL O2 x min x kg; P < 0.05); however, there were no significant differences in body composition or dietary intake. There were no significant differences in any of the indicators of immune status between groups. In addition, there were no significant relationships between body composition or dietary intake and immune status. CONCLUSIONS: The results of this study suggest that women may exercise moderately during lactation and increase their fitness level without impairing their immune function.

Guidelines for collection of human milk samples for monitoring and research of environmental chemicals.

This article addresses sample collection protocols for monitoring and research of environmental chemicals in human milk. The process of milk synthesis and secretion and variations in contents of constituents that may impact measurement of environmental chemicals are presented. Possible sources of variation include parity, stage of lactation, method of sampling, maternal nutritional status, and dietary intake. General principles regarding how and when to collect milk samples are provided. For any previously unstudied environmental chemical in milk, all sources of variance must be assessed before a meaningful sampling protocol can be devised.

The impact of energy restriction and exercise in lactating women.

Exercise improves cardiovascular fitness, plasma lipids, and insulin response in lactating women. However, exercise alone, without caloric restriction, does not promote weight loss. Once lactation is established, over-weight women may restrict their energy intake by 500 kcal/day to promote a weight loss of 0.5 kg/week without affecting the growth of their infants. Moderate exercise does not affect maternal immune status or levels of sIgA, lactoferrin, and lysozyme in human milk. Further research is needed to determine the effect of exercise and energy restriction on maternal bone health and immune status and composition of human milk.

Psychosocial predictors of primiparous breastfeeding initiation and duration.

BACKGROUND: Many US women fall short of meeting the recommendations on breastfeeding. Whereas prenatal demographic factors have been well researched in relation to breastfeeding, psychosocial maternal characteristics are less understood but could be important predictors of breastfeeding initiation and duration. OBJECTIVE: This study examined primiparous maternal psychosocial characteristics and temperamentally based negative infant affect as predictors of breastfeeding initiation and duration while accounting for depression and sociodemographic covariates. METHODS: Prenatally, 237 primiparous women were administered the Adult Attachment Interview and completed a measure of beliefs related to infant crying. At 6 months postpartum, negative infant affect was assessed via mother report. Breastfeeding was assessed at 6 months and 1 year postpartum via mother report. RESULTS: Results indicated that younger, low income, less educated, single, ethnic minority mothers and mothers with elevated depressive symptoms were less likely to initiate breastfeeding and breastfed for a shorter period than other women. Women who initiated breastfeeding tended to have higher adult attachment coherence scores (more secure attachment) than those who did not initiate breastfeeding (median score of 6.00 vs 4.00). An interaction was observed between negative infant affect and beliefs about crying related to spoiling, such that earlier cessation of breastfeeding was observed among mothers who reported high levels of negative infant affect and strongly endorsed the belief that responding to cries spoils infants (hazard ratio = 1.71, P < .01). CONCLUSION: Although these psychosocial variables predicted relatively little variation in breastfeeding over and above covariates, the results suggest some novel approaches to promote breastfeeding.

Parental obesity moderates the relationship between childhood appetitive traits and weight.

OBJECTIVE: In this study, the independent and combined associations between childhood appetitive traits and parental obesity on weight gain from 0 to 24 months and body mass index (BMI) z-score at 24 months in a diverse community-based sample of dual parent families (n = 213) were examined. DESIGN AND METHODS: Participants were mothers who had recently completed a randomized trial of weight loss for overweight/obese postpartum women. As measures of childhood appetitive traits, mothers completed subscales of the Children's Eating Behavior Questionnaire, including Desire to Drink (DD), Enjoyment of Food (EF), and Satiety Responsiveness (SR), and a 24-h dietary recall for their child. Heights and weights were measured for all children and mothers and self-reported for mothers' partners. The relationship between children's appetitive traits and parental obesity on toddler weight gain and BMI z-score were evaluated using multivariate linear regression models, controlling for a number of potential confounders. RESULTS: Having two obese parents was related to greater weight gain from birth to 24 months independent of childhood appetitive traits, and although significant associations were found between appetitive traits (DD and SR) and child BMI z-score at 24 months, these associations were observed only among children who had two obese parents. When both parents were obese, increasing DD and decreasing SR were associated with a higher BMI z-score. CONCLUSIONS: The results highlight the importance of considering familial risk factors when examining the relationship between childhood appetitive traits on childhood obesity.

Diet quality of overweight and obese mothers and their preschool children.

BACKGROUND: Children of obese parents are more likely to become obese than children of normal-weight parents. However, there is little information regarding the diet intakes of children of obese parents. OBJECTIVE: Our objective was to determine the diet quality of preschoolers and their overweight/obese mothers, whether maternal and child diet quality were correlated, and predictors of child's diet quality. DESIGN: Results are from baseline measurements from a randomized controlled behavioral intervention. PARTICIPANTS: Participants were English-literate, postpartum mothers and their preschoolers (n=177 mother-child dyads) in North Carolina. Visits took place in the Triangle and Triad regions of North Carolina between September 2007 and November 2009. MAIN OUTCOME MEASURES: We measured diet quality of mothers and preschoolers using the Healthy Eating Index-2005. STATISTICAL ANALYSES PERFORMED: Descriptive statistics, χ(2), analysis of variance, Pearson correlations, and stepwise regression models were used. RESULTS: Only 11% of children and 7% of mothers had Healthy Eating Index-2005 scores ≥80. Most children did not meet recommendations for fruits, vegetables, whole grains, meat and beans, sodium, saturated fat, and energy from solid fat and added sugars. Child diet quality was correlated with maternal diet quality (r=0.44; P<0.001). However, children and mothers differed in the proportion that met food-group recommendations: children vs mothers: total fruit (50% vs 14%), whole fruit (46% vs 28%), total vegetables (6% vs 18%), dark green and orange vegetables and legumes (7% vs 19%), total grains (57% vs 71%), milk (63% vs 22%), and meat and beans (33% vs 60%). Maternal diet quality and household income were positively correlated with child diet quality. CONCLUSIONS: The diets of children of overweight/obese mothers need improvement in several areas. Mother's diet quality and household income are important contributors to child's diet quality and should be considered in efforts to improve the diets of these children.