The association between hydration status and total fluid intake in healthy children and adolescents.

BACKGROUND: Children 10-20 years old in the US have suboptimal hydration status. Hydration is best assessed using an objective marker, such as urine specific gravity (USG) from a 24-h urine collection. There are limited studies associating hydration from an objective marker with intake assessed from 24-h recalls in children. The objective of the study was to evaluate which foods or beverages are significantly associated with an objective marker of hydration (USG) in a sample of children and adolescents. METHODS: Intake was assessed from three 24-h dietary recalls and analyzed using the Nutrition Data System for Research (NDSR). Hydration status was objectively measured using USG via 24-h urine collection. Associations were assessed with logistic regressions. RESULTS: A total of 68 children and adolescents were recruited (50% females). Average overall USG score was 1.020 ± 0.011 uG with 39.7% categorized as dehydrated. After adjusting for age and sex, fruit juice (1.009, 95% CI: 1.001, 1.018) and all beverages (1.001, 95% CI: 1.000, 1.002) were significantly associated with higher odds of being euhydrated. CONCLUSIONS: The main predictors of hydration were fruit juice and all beverages intake. Future research should be conducted to explore differences in dietary patterns in a larger, more generalizable sample. IMPACT: Findings showed that the main predictors of hydration were water and fruit juice intake in children and water intake in adolescents in southern Florida. This is the first study to examine which type of beverages and foods are associated with USG, an objective marker of hydration status, in US children and adolescents. Provides further insight into the use of objective markers to assess hydration status, while providing data to assist epidemiological studies that may have limited resources to examine beverages and foods that contribute to hydration.

The association between hydration status and body composition in healthy children and adolescents.

OBJECTIVES: Children 10-20 years old in the US are currently obese, showing suboptimal hydration as 60% fail to meet the US Dietary Reference Intakes for water. Studies have shown a significant inverse association between hydration status and body composition in children, although most failed to use the Dual-X-Ray Absorptiometry Scan (DEXA), the gold standard for body composition. Limited studies used an objective marker to measure hydration, such as urine specific gravity (USG) from a 24-h urine collection. Therefore, this study aimed to examine the association between hydration status (measured from USG in a 24-h urine sample and assessed from three 24-h dietary recalls) and body fat % and lean mass (assessed from a DEXA scan) in children (10-13 years, n=34) and adolescents (18-20 years, n=34). METHODS: Body composition was measured using DEXA, total water intake (mL/d) was assessed from three 24-h dietary recalls and analyzed using the Nutrition Data System for Research (NDSR). Hydration status was objectively measured using USG via 24-h urine collection. RESULTS: Overall body fat % was 31.7 ± 7.31, total water intake was 1746 ± 762.0 mL/d, and USG score was 1.020 ± 0.011 uG. Linear regressions showed significance between total water intake and lean mass (B=12.2, p<0.05). Logistic regressions showed no significant association between body composition and USG and total water intake. CONCLUSIONS: Findings showed total water intake was significantly associated with lean mass. Future research should be conducted to explore other objective markers of hydration and with a larger sample.

Effect of a Short Messaging Service (SMS) intervention delivered to caregivers on energy, nutrients, and food groups intake in infant participants of the WIC program.

Objectives: To test the effect of a weekly test message (SMS) intervention for improving feeding practices on infant intake of energy, nutrients, and specific food groups. Methods: This study was a multi-site, randomized clinical trial, in 202 caregivers of healthy term infants participating in either the Puerto Rico or Hawaii WIC program. Participants were randomized to receive weekly SMS about either infant's general health issues (control) or SMS for improving feeding practices (intervention) to complement WIC messages for 4 months. Anthropometrics and demographics were assessed at baseline. A validated infant food frequency questionnaire was assessed at the four-month visit to assess intake of general food groups. Data was summarized as median (25th and 75th percentiles) or percentage and differences between study arms was compared using Mann Whitney or chi-square. Results: A total of 163 participants completed the study (n = 84 control and n = 79 intervention). Baseline characteristics were similar between both groups. At 4-6 months of age, compared to the control group, the intervention group had a significantly higher intake of total grains (0.28 oz; 0.00, 0.60; P = 0.033), protein (13.5 g, 10.5, 18.3; P = 0.022), calcium (472 mg; 418, 667; P = 0.012), and zinc (4.39 mg; 2.61, 6.51; P = 0.028). No differences were seen in the other food groups, including breastmilk. Conclusions for practice: Feeding SMS to complement WIC messages led to higher intakes of some key nutrients but did not have an overall improvement in the intake of food groups. Messaging also did not delay the introduction of complimentary foods or improve breastfeeding rates. Future studies should evaluate the use of more intensive SMS interventions for continued care between WIC visits.

How much and what: Using a buffet to determine self-regulation of food intake among young school-age children.

Energy compensation indices are commonly used to examine self-regulation of food intake in children. However, previous studies failed to consider children's ability to self-regulate under complete autonomy. This study examined self-regulation of food intake among young children and the effect of calorie manipulation on food/nutrient intake using an unlimited lunch buffet paradigm. Participants were 66 children (Mage = 6.14, SD = 1.15 years; 68.2% male; 89.4% Latinx; 59.1% overweight/obese [OV/OB]). Children participated in a crossover research trial, one week apart. Participants consumed 2 different types of preloads followed by an ad-libitum lunch during each trial. A compensation index (COMPX) was calculated to identify the level of self-regulation in food intake. Food/nutrient intake was compared between both sessions. Results indicated OV/OB children showed poorer self-regulation compared to healthy weight children (t = 2.19, p = 0.032; Hedges' g = 0.55). There were significant differences in food intake/selection between OV/OB and healthy weight groups. OV/OB children consumed a higher amount of calorie, fat, and cholesterol after the high energy preload compared to healthy weight children (d's range: 0.31-0.48). Our findings support differences between the amount of self-regulation between normal and OV/OB children as well as the items they select in order to compensate.

Osteopenia en una adolescente blanca hispana: reporte de caso / Osteopenia in a white, hispanic, adolescent female: a case report

Introducción. Un estilo de vida poco saludable (malos hábitos alimentarios y sedentarismo), deficiencia de vitamina D, y la ingesta inadecuada de calcio, pueden contribuir a desarrollar osteopenia grave en la infancia, condicionando el riesgo futuro a sufrir fracturas y osteoporosis. Materiales y métodos. Presentamos un caso de osteopenia en una niña blanca, hispana y premenárquica de 13 años quien completó la visita basal del estudio de MetA-Bone. Evaluamos el contenido de masa ósea, la densidad de masa ósea corporal total y de la columna y la composición corporal mediante densitometría ósea (DXA). Abarcamos el historial de salud, antecedentes familiares, desarrollo puberal, actividad física, sueño, ingesta de nutrientes, antropometría, biomarcadores óseos y metabólicos. Resultados. La niña tiene antecedentes familiares de osteoporosis y no reporta fracturas previas. Muestra una actividad moderada al aire libre <1 hora/día 3 veces/semana con 8 horas/día de sueño. El consumo de productos lácteos y vegetales fue <1 ración/día. Presenta deficiencia de vitamina D (25(OH)D: 9 ng/mL) e hiperfosfatemia (5,2 mg/dL). El Z-score del DXA fue -2,1 DE (indicativo de osteopenia por edad y sexo). La niña fue referida a un pediatra, quien confirmó los hallazgos e indicó un suplemento diario con 2000 UI de vitamina D y 1000 mg de calcio. Conclusiones. El aislamiento durante la pandemia de COVID pudo haber contribuido a la gravedad de los hallazgos. Por lo tanto, recomendamos realizar pruebas de detección de vitamina D, calcio y hábitos de vida a los niños que experimentaron crecimiento acelerado durante y después de la pandemia(AU)

Introduction. Poor lifestyle habits, vitamin D deficiency, and inadequate calcium intake, particularly during the COVID-19 pandemic, may contribute to severe osteopenia in childhood, increasing future fractures and osteoporosis risk. Materials and methodology. We here present a case of osteopenia in a 13-year-old white, Hispanic, premenarchal girl who completed the baseline visit of the MetA-Bone Trial during the COVID-19 pandemic. Using a dual-energy X-ray absorptiometry, we assessed bone mass content (BMC), total body and spine bone mass density (BMD), and body composition. We cover the girl's health history and family history, pubertal development, intensity, duration, and frequency of physical activity and sleep, and nutrient intake (calcium and vitamin D), as well as anthropometric parameters, and bone and metabolic biomarkers. Results. The girl has a family history of osteoporosis (maternal grandfather) but no previous fractures; moderate outdoor activity was <1 hour/day 3 times/week with 8 hours/day of sleep. Consumption of dairy products and vegetables was <1 serving/day. Lab blood tests confirmed vitamin D deficiency (serum 25(OH) D: 9 ng/ml) and hyperphosphatemia (5.2 mg/dL); other tests were normal. DXA scan Z-score was -2.1 SD (indicative of osteopenia by age and sex). The girl was referred to a pediatrician, who confirmed the results, and prescribed a daily supplement with 2000 IU of vitamin D and 1000 mg of calcium. Conclusions. Seclusion during the COVID pandemic may have contributed to the severity of the findings. Therefore, we recommend screening children undergoing growth spurts for vitamin D, calcium, and poor lifestyle habits during and after the pandemic(AU)