A Mobile Gaming App to Train Teenage Mothers on Appropriate Child Feeding Practices: Development and Validation Study.

BACKGROUND: Undernutrition is an underlying factor in nearly 50% of 1 million estimated annual deaths among Nigerian children aged <5 years. Inappropriate maternal infant and young child feeding (IYCF) practices are basic contributors to child undernutrition. Teenage motherhood exacerbates the problem of inadequate child feeding. One possible intervention method to improve IYCF knowledge and practices of teenage mothers is the use of mobile gaming technologies. Despite extreme poverty in low- and middle-income countries, a ubiquity of mobile phone networks exists. OBJECTIVE: This study aims to develop and validate a mobile gaming app, called BabyThrive, to train Nigerian teenage mothers on appropriate IYCF practices. METHODS: To identify gaps in current IYCF practices in northern Nigeria, we conducted an extensive search of the literature and held 2 focus group interviews with 16 teenage mothers with low-income status. An initial app content design was then created, and content validity was established by 10 nutrition experts. Next, we developed an app prototype, which was assessed for quality by 7 nutrition and mobile gaming experts and evaluated for usability by 90 teenage mothers from rural areas in Abuja, the country's capital. The final app, BabyThrive, is a 2D mobile game that is fully functional offline and available in English as well as Hausa, which is commonly spoken in northern Nigeria. The efficacy of the BabyThrive app was assessed using IYCF knowledge scores obtained from the administration of the validated Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. Construct validity was established via crossover design by comparing the total IYCF knowledge scores of the teenage mothers obtained after a verbal training program and BabyThrive app use. RESULTS: Large proportions of the study participants were married (53/90, 59%) and had no personal income (63/90, 70%). The mean quality rating for the BabyThrive app was 4.3 (SD 0.39) out of 5.0. High levels (>80%) of usability and user satisfaction were documented. Knowledge of exclusive breastfeeding (P<.001) and total knowledge scores (P=.002) were significantly higher in the BabyThrive group than in the verbal training group. The IYCF knowledge scores obtained from both groups showed coherence, with a statistically significant Spearman correlation coefficient of 0.50 (P<.001). CONCLUSIONS: This research developed and validated a novel, offline mobile gaming app. It will be an easy, effective, and acceptable method to disseminate critical knowledge on IYCF practices to teenage mothers in rural Nigeria.

Development and validation of the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa.

BACKGROUND: In Sub-Saharan Africa, the nutritional status of children born to teenage mothers deserves critical attention. Maternal knowledge and attitudes concerning infant and young child feeding (IYCF) may predict actual practices and child nutritional status. This study created and validated the Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa. METHODS: A literature search on IYCF knowledge and attitude gaps in teenage mothers generated scale items. Ten nutrition experts and six teenage mothers assessed content validity and comprehensibility, respectively. Construct validation was conducted by item response theory (IRT) and confirmatory factor analysis (CFA), in 150 teenage mothers in rural communities of Abuja, Nigeria. Model fit parameters were estimated by standardized chi-square tests. Internal consistency reliability was determined by marginal reliability and Cronbach's alpha. In a sub-sample of 40 women who completed the questionnaire two weeks later, test-retest reliability was assessed via intraclass correlations. RESULTS: The IRT analysis retained 23 knowledge items on infant food type, breastfeeding and complementary feeding, with acceptable discrimination and difficulty. CFA produced a six-factor solution (exclusive breastfeeding, breast milk expression, meal frequency, responsive feeding, dietary diversity, and barriers) with 17 attitude items. Confirmatory fit and Tucker Lewis indices > 0.9; Root Mean Square Errors of Approximation and Standardized Root Mean Square Residuals < 0.08, showed good model fit. Overall Cronbach's alpha of the attitude scale (0.843), subscales (≥ 0.6) and high intraclass correlation coefficients (> 0.75) indicated reliability. CONCLUSION: The Teen Moms Child Feeding Questionnaire for Sub-Saharan Africa is a valid assessment tool for IYCF knowledge and attitudes of teenage mothers.

Low diet quality is associated with adverse levels of metabolic health markers and clustering of risk factors in adults with type 2 diabetes.

BACKGROUND: Nutritional recommendations for diabetes management emphasise an overall, healthful diet consistent with the guidelines for the general population. The present study assessed the relationship of diet quality, as measured by Healthy Eating Index-2015 (HEI-2015), with metabolic health markers and risk factor clustering in type 2 diabetes patients using National Health and Nutrition Examination Survey 2011-2016 data. METHODS: HEI-2015 diet quality scores were calculated using 24-h dietary recalls. Adults with type 2 diabetes (n = 2220) were assessed for: (1) hyperglycaemia; (2) overweight/obesity; (3) dyslipidaemia; and (4) hypertension. Logistic regression examined associations of diet quality quartiles with odds of hyperglycaemia, overweight/obesity, dyslipidaemia and hypertension, as well as odds of clustering of these risk factors. RESULTS: Odds of overweight/obesity and hyperglycaemia were significantly greater for participants in the lowest HEI-2015 quartile compared to those in the highest quartile. Furthermore, individuals in the bottom two HEI-2015 quartiles had increased odds of dyslipidaemia. Those in the lowest quartile also had significantly higher odds of having ≥ 2, ≥ 3 and 4 risk factors (vs. having ≤ 1 risk factor). CONCLUSIONS: Low diet quality was related to increased odds of hyperglycaemia, dyslipidaemia, overweight/obesity and risk factor clustering. Findings imply poorer prognosis of diabetes in individuals with low diet quality.

Iron and zinc status of children aged 3 to 5 years attending Early Childhood Development centres in Venda, South Africa.

This study assessed iron and zinc levels of preschoolers. 276 children were randomly chosen from 8 preschools. Weight and height were measured using standard techniques. After blood was obtained, serum zinc, iron, ferritin, transferrin saturation, and transferrin were assessed. Dietary intake was calculated using the Food Frequency Questionnaire. Prevalence of severe underweight, stunted, and acute malnutrition was 4.7%, 12.7% and 2.9%. Using transferrin saturation<5%, one-quarter were iron deficient. Using serum iron<40 µg/dl as indicative of depletion, 8% exhibited low serum iron while 18% were mildly deficient. Based on ferritin<12 µg/L, 99% had iron deficiency.

Twenty-year trends in vegetable consumption by preparation method and eating location for Korean population from 1998 to 2017.

Vegetables are an important source for the essential vitamins and minerals that are necessary for optimal health. This research investigated changes in vegetable intake over time in the Korean population from 1998 to 2017, focusing on preparation methods of vegetables and location of consumption. This cross-sectional study is based on the Korea National Health and Nutrition Examination Survey (KNHANES) that was established in 1998 to assess the health and nutritional status of the South Korean population. This research utilised information from 1998 to 2017 which is the extent of all available KNHANES data. Vegetable consumption was grouped, according to preparation methods and common eating locations. Both crude and age-standardised means of vegetable intake were derived via a 24-h dietary recall. All participants who completed a 24-h dietary recall survey were selected for the analyses. This included 109 220 individuals (49 069 men and 60 151 women) over the course of 20 years of the KNHANES. Total vegetable intake decreased over time (Pfor trends < 0·001), specifically, steamed and salted vegetables (Pfor trends < 0·001). In contrast, Koreans consumed noticeably more raw vegetables from 1998 to 2017 (Pfor trends < 0·001). Vegetable intake at home significantly declined (Pfor trends < 0·001), while that eaten at restaurants or outside the home increased greatly (Pfor trends < 0·001). Over 20 years, Koreans have ingested decreasing amounts of vegetables, but the intake of raw vegetables has escalated. However, the location of vegetable consumption has changed, with an increase at both restaurants and outside the home (approximately 70·0 %).

Nineteen-year trends in fermented food consumption and sodium intake from fermented foods for Korean adults from 1998 to 2016.

OBJECTIVE: Fermented foods such as kimchi are traditional foods in Korea and could provide beneficial health effects. However, fermented foods also contribute to increased Na intake since salt is added during the fermentation process. The present research aimed to examine trends in the consumption of fermented foods and Na intake over time by Korean adults, using data from the Korea National Health and Nutrition Examination Survey (KNHANES). DESIGN: KNHANES is a cross-sectional survey; data from 1998 to 2016 were divided into seven groups from KNHANES I to VII. SETTING: Demographic information on sex, age, education and income were collected. Assessment of fermented food and Na consumption was conducted via analysis of 24 h dietary recall data. Multivariate linear regressions and logistic regressions were performed to calculate the P for trends by applying strata, cluster and sampling weights by SAS PROC SURVEY. PARTICIPANTS: The target population was Korean adults, aged ≥19 years, who participated in a 24 h dietary recall. The total number was 76 199, with 32 324 men and 43 875 women. RESULTS: A significant decline in fermented food consumption was observed from 1998 to 2016 in both men and women (P < 0·0001). Among fermented foods, kimchi consumption was greatly reduced while pickled vegetables consumption showed a marked increase. Similarly, Na intake from fermented foods declined significantly over time in both men and women (P < 0·0001). CONCLUSIONS: The consumption of fermented foods and Na intake from fermented foods by Korean adults decreased significantly over time from 1998 to 2016.

Zinc deficiency associated with anaemia among young children in rural Guatemala.

One in four children younger than age five in Guatemala experiences anaemia (haemoglobin <11.0 g/dl). This study characterized the factors and micronutrient deficiencies associated with anaemia in a baseline cross-sectional sample of 182 Guatemalan infants/toddlers and 207 preschoolers, using generalized linear mixed models. Associations between anaemia and maternal, child and household variables, and biomarkers (soluble transferrin receptor, ferritin, zinc, folate, vitamin B12, C-reactive protein, and α1-acid glycoprotein) were explored. Rates of anaemia were 56% among infants/toddlers and 12.1% among preschoolers. In children with anaemia, rates of iron deficiency (low ferritin based on inflammation status, and/or high soluble transferrin receptor, ≥1.97 mg/L) and zinc deficiency (serum zinc <65 µg/dl) were 81.1% and 53.7%, respectively. Folate deficiency (either plasma folate <3 ng/ml or erythrocyte folate <100 ng/ml) was 3.3%. Vitamin B12 deficiency (plasma vitamin B12 <148 pmol/L) was 7.5%. For infants and toddlers (<24 months), the odds ratio of anaemia was lower when higher number of adults lived in the household (OR = 0.69; 95% CI [0.53, 0.90]), and higher when children were zinc deficient (OR = 3.40; 95% CI [1.54, 7.47]). For preschoolers (36-60 months), the odds ratio of anaemia was lower for every additional month of age (OR = 0.90; 95% CI [0.81, 1.00]). Findings suggest that micronutrient deficiencies coexist in Guatemalan rural children, and zinc deficiency is associated with anaemia in children <24 months, highlighting the need of continued multidisciplinary interventions with multiple micronutrients. Further research examining how household composition, feeding practices, and accessibility to micronutrient supplements and to animal source foods is needed to incorporate strategies to improve the nutritional status of Guatemalan children.

Food security of food recipients of a food pantry and soup kitchen.

OBJECTIVE: To discern the impact of food donations provided by a food pantry and soup kitchen on food security. DESIGN: In this cross-sectional study, participants completed a demographic questionnaire, core food security module, FFQ and list of food donations. The FFQ was utilized to assess diet quality as estimated via the 2010 Healthy Eating Index. SETTING: Clients were selected randomly from a food pantry and soup kitchen in Central Texas, USA.ParticipantsA total of 222 adults. RESULTS: Approximately 73 % of participants lacked food security. Compared with the food secure, the food insecure consisted of 61 % men, 42 % Caucasians, 56 % single and 67 % homeless. Also, of the food insecure, 60 % were soup kitchen clients and 64 % had an annual income <$US 1000 (P<0·01). The probability of food insecurity was reduced by ≥1·17-fold when the total dietary intake included the food donations, as these were rich in fruits, total vegetables and grains, dairy and protein foods (P<0·05). CONCLUSIONS: Food insecurity was quite prevalent in this sample of individuals who visited food pantries and soup kitchens. The addition of food donations improved the quality of the participants' total diet and had a positive influence on food security. Thus, community organizations should financially support these food assistance agencies and strive to offer a variety of healthy and tasty foods in adequate quantities to provide optimum diet quality.

Prediction of Android and Gynoid Body Adiposity via a Three-dimensional Stereovision Body Imaging System and Dual-Energy X-ray Absorptiometry.

OBJECTIVE: Current methods for measuring regional body fat are expensive and inconvenient compared to the relative cost-effectiveness and ease of use of a stereovision body imaging (SBI) system. The primary goal of this research is to develop prediction models for android and gynoid fat by body measurements assessed via SBI and dual-energy x-ray absorptiometry (DXA). Subsequently, mathematical equations for prediction of total and regional (trunk, leg) body adiposity were established via parameters measured by SBI and DXA. METHODS: A total of 121 participants were randomly assigned into primary and cross-validation groups. Body measurements were obtained via traditional anthropometrics, SBI, and DXA. Multiple regression analysis was conducted to develop mathematical equations by demographics and SBI assessed body measurements as independent variables and body adiposity (fat mass and percentage fat) as dependent variables. The validity of the prediction models was evaluated by a split sample method and Bland-Altman analysis. RESULTS: The R(2) of the prediction equations for fat mass and percentage body fat were 93.2% and 76.4% for android and 91.4% and 66.5% for gynoid, respectively. The limits of agreement for the fat mass and percentage fat were -0.06 ± 0.87 kg and -0.11% ± 1.97% for android and -0.04 ± 1.58 kg and -0.19% ± 4.27% for gynoid. Prediction values for fat mass and percentage fat were 94.6% and 88.9% for total body, 93.9% and 71.0% for trunk, and 92.4% and 64.1% for leg, respectively. CONCLUSIONS: The three-dimensional (3D) SBI produces reliable parameters that can predict android and gynoid as well as total and regional (trunk, leg) fat mass.

Efficacy of thigh volume ratios assessed via stereovision body imaging as a predictor of visceral adipose tissue measured by magnetic resonance imaging.

OBJECTIVES: The research examined the efficacy of regional volumes of thigh ratios assessed by stereovision body imaging (SBI) as a predictor of visceral adipose tissue measured by magnetic resonance imaging (MRI). Body measurements obtained via SBI also were utilized to explore disparities of body size and shape in men and women. METHOD: One hundred twenty-one participants were measured for total/regional body volumes and ratios via SBI and abdominal subcutaneous and visceral adipose tissue areas by MRI. RESULTS: Thigh to torso and thigh to abdomen-hip volume ratios were the most reliable parameters to predict the accumulation of visceral adipose tissue depots compared to other body measurements. Thigh volume in relation to torso [odds ratios (OR) 0.44] and abdomen-hip (OR 0.41) volumes were negatively associated with increased risks of greater visceral adipose tissue depots, even after controlling for age, gender, and body mass index (BMI). Irrespective of BMI classification, men exhibited greater total body (80.95L vs. 72.41L), torso (39.26L vs. 34.13L), and abdomen-hip (29.01L vs. 25.85L) volumes than women. Women had higher thigh volumes (4.93L vs. 3.99L) and lower-body volume ratios [thigh to total body (0.07 vs. 0.05), thigh to torso (0.15 vs. 0.11), and thigh to abdomen-hip (0.20 vs. 0.15); P < 0.05]. CONCLUSIONS: The unique parameters of the volumes of thigh in relation to torso and abdomen-hip, by SBI were highly effective in predicting visceral adipose tissue deposition. The SBI provided an efficient method for determining body size and shape in men and women via total and regional body volumes and ratios. Am. J. Hum. Biol. 27:445-457, 2015. © 2015 Wiley Periodicals, Inc.

Why Acute Undernutrition? A Qualitative Exploration of Food Preferences, Perceptions and Factors Underlying Diet in Adolescent Girls in Rural Communities in Nigeria.

BACKGROUND: Adolescent girls are nutritionally vulnerable due to their rapid growth and increased nutrient requirements. Nigeria has the sixth-largest population in the world. This study qualitatively explored the food preferences, perceptions of nutritive value and factors underlying food consumption of adolescent girls in rural communities in Nigeria. METHODS: The data were collected via the free listing of foods and focus group sessions conducted in the Hausa language with 48 unmarried adolescent girls. The discussions were audio-recorded, transcribed, translated into English, and analyzed using a deductive thematic framework. RESULTS: The mean age of the respondents was 13.0 ± 2.7, and almost half (48%) had a primary school education. A total of 19 and 23 foods were identified as preferred, and perceived as nourishing, respectively. The top 10 foods present on both free lists overlapped considerably in terms of cognitive salience. The focus group themes included nutrition knowledge, food preferences, autonomy, household food allocation, courtship practices, and agricultural landscapes and economic access. The participants had minimal knowledge of nutrients and food groups, and their preferred foods were limited in diversity. The key factors in food preferences were desirable health effects, sensory attributes, and the contribution of foods to a desirable body image for marriage. Household food choices depended on parents. Thus, a desire for independence was an incentive for early marriage, mostly at 13 to 17 years. Gender inequities in household food distribution (quantity) and animal protein intake were reported. The participants believed that boys need more food for strength to impregnate girls. As part of a courtship practice, the girls received gifts of animal source foods from potential suitors. The food options were limited by financial challenges and low agricultural diversity. CONCLUSION: To interrupt the cycle of inadequate food consumption and undernutrition in these adolescent girls, policy makers need to promote nutrition education and address the underlying determinants of inequitable access to nutritious foods.

Effects of Cucurbita Moschata squash (Butternut) seed paste in improving zinc and iron status in children attending Early Childhood Development centres in Limpopo province, South Africa.

Cucurbita moschata (Butternut squash) seeds are a rich source of nutrition containing nutrients including iron, zinc, copper, calcium, potassium, and phosphorus. The aim of this study was to determine if Cucurbita Moschata squash seed paste improves zinc and iron status, anthropometric status, and dietary intake in preschool children. A pretest-posttest control group trial using cluster randomisation was conducted over 6 months. Four preschools were randomly assigned to receive 100 g of intervention or 100 g of a placebo as the control to enhance iron and zinc status. A total of 276 preschool children were recruited from eight government registered Early Childhood Development centres in Limpopo province, South Africa. The control group consumed Cucurbita moschata flesh twice-weekly, while the intervention group consumed Cucurbita moschata seed paste twice-weekly during a six-month period. Iron (serum iron, transferrin, transferrin saturation, ferritin) and zinc (serum zinc) status and anthropometric indices such as weight, height and mid upper arm circumference for children were evaluated at baseline and the endpoint. Iron and zinc-rich food consumption was measured using a 24-hour dietary recall and food record during the study, and dietary intake was estimated using a food frequency questionnaire which was conducted at the beginning and endpoint. The intervention group significantly improved in the mean serum iron 0.23 µg/dL (95% CI: 0.11;0.33); ferritin 0.21µg/dL (95% CI: 0.13;0.39), transferrin saturation 0.33% (0.23;0.74) and zinc 0.16 µmol/dl (95% CI: 0.13;0.25) at the end of the study. In addition, the intervention group exhibited greater mean weight for age of 0.13 z-score (95% CI: 0.28; 0.34) and weight for height of 0.04 z-score (95% CI: 0.12,0.05), as well as the consumption of iron (p < 0,001), zinc (p < 0,001), and vitamin C (p < 0.001). At the end of the trial, fiber (p < 0.001), riboflavin (p = 0.001), vitamin B6 (p < 0.001), and vitamin B12 (p < 0.001) were significantly higher in the control group. Thus, the inclusion of intervention in the diet of children in an impoverished area of South Africa improved the iron and zinc status of these children. This supplement could be a cost effective and sustainable approach to improve nutrient status in rural South Africa. Trial registration: Pan African Clinical Trial Registry (PACTR202308740458863).

Food Security Status, WIC Participation, and Early Childhood Caries in a Nationally Representative Sample of Children.

BACKGROUND: Despite the potential role of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in mitigating the adverse effects of food insecurity on oral health, to our knowledge, no study has examined whether WIC participation could modify the association between food insecurity with caries in young children. OBJECTIVE: Our aim was to investigate the impact of WIC participation in modifying the association between food insecurity and early childhood caries. DESIGN: This was a cross-sectional study. PARTICIPANTS/SETTING: Using 2011-2018 National Health and Nutrition Examination Survey data, children aged 2 through 5 years; with household income ≤185% of the Federal Poverty Level; and with data on WIC participation, food security, and dental examinations were included (n = 1,921). STUDY EXPOSURES: Food-security status and WIC participation were the study exposures. MAIN OUTCOME MEASURES: Total and untreated dental caries were the main outcome measures. STATISTICAL ANALYSES: Logistic regression examined associations of food security (household-level and child-level) and WIC participation with odds of caries. Interactions between food security and WIC participation were examined using multiplicative interaction terms. RESULTS: Marginal child food security was significantly related to higher odds of total caries in income-eligible WIC nonparticipants (odds ratio 1.92; 95% CI 1.07 to 3.46); however, this relationship was not observed in WIC participants. Furthermore, food insecurity was significantly associated with greater odds of untreated caries only among income-eligible WIC nonparticipants (odds ratio 1.79; 95% CI 1.12 to 2.85). CONCLUSIONS: In this sample of preschool-aged children, the relationship of food insecurity with caries differed by WIC participation status. Findings suggest that WIC participation could improve the oral health of income-eligible children with lower levels of food security.

Dietary diversity and nutritional status of children attending early childhood development centres in Vhembe District, Limpopo province, South Africa.

The present study assessed dietary diversity and anthropometric status of children attending early development centres in South Africa. In the Vhembe District of Limpopo province, South Africa, 273 children were conveniently chosen from 8 randomly selected early childhood development centres for a cross-sectional study. Data were gathered via a questionnaire administered by the interviewer in June 2021. Height, body weight and mid-upper arm circumference were measured to assess anthropometric status. A 24-h dietary recall was obtained to provide information on dietary diversity. The prevalence of underweight, wasting and stunting was 9, 4 and 26 %, respectively. More than half of the children had a low dietary diversity score, according to the Food and Agriculture Organization scoring system for children. Grains, roots, tubers, dairy products, other fruits and vegetables, and flesh-based foods were the highest consumed food groups. The lowest consumption was for eggs, vitamin A-rich fruits and vegetables, legumes and nuts. Height for age and weight for age were significantly associated with dietary diversity score, but not weight for height. Children who did not meet the reference value of greater than 4 for dietary diversity had a significant risk of being underweight (AOR 0⋅25, 95 % CI 0⋅08, 0⋅75) and stunted (AOR 0⋅32, 95 % CI 0⋅14, 0⋅74). The nutritional status of the children was impacted by a lack of adequate dietary diversity. Young children in rural areas need to receive a wide range of food to promote greater diversification of diets in order to diminish the risk of undernutrition.

Determinants of weight loss after an intervention in low-income women in early postpartum.

OBJECTIVE: Postpartum is a critical period for the development of obesity in women, yet there is limited research of factors associated with changes in weight during early postpartum. Therefore, the objective of this study was to identify determinants of weight loss after an intervention. METHODS: A sample of women in early postpartum was recruited from the Special Supplemental Nutrition Program for Women, Infants, and Children clinics, doctors' offices, and neighborhood centers (N = 58). Women participated in an 8-week weight-loss intervention. Subjects were measured for weight and height and completed demographics, the Eating Stimulus Index, a nutrition knowledge test, a food-frequency questionnaire, and a household environment survey. Correlations and linear regression determined associations with the outcome variable weight loss, and hierarchical regression was used to determine the most significant predictors. RESULTS: All subjects improved their nutrition knowledge, skills, convenience-eating resistance, and fruit and vegetable availability after the intervention. Responders had greater changes in dietary restraint, fruit juice servings, and discretionary energy than did nonresponders. Increases in dietary restraint, weight-management skills, and weight-loss self-efficacy and decreases in discretionary energy intake significantly predicted weight loss in individual regression analysis. After hierarchical regression analysis, improvement in dietary restraint was the most significant determinant, followed by decreases in total energy intake. Although weight-loss self-efficacy, weight-management skills, and discretionary energy intake significantly predicted weight loss when analyzed alone, these variables did not contribute to the prediction model revealed by this study. CONCLUSIONS: Positive changes in social cognitive theory constructs are associated with weight loss in low-income postpartum women. Dietary restraint, weight-management skills, weight loss self-efficacy, and reductions in total and discretionary energy are modifiable factors that should be emphasized in interventions designed for this population, but only dietary restraint and total energy intake were predicted in the model.

The Special Supplemental Nutrition Program for Women, Infants, and Children food package revisions and anemia in children aged 2-5 years.

BACKGROUND: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides nutritional assistance to low-income women and children in the United States. The WIC food package was revised to align more closely to dietary recommendations in October 2009. The revised package included more fruits, vegetables, whole grains, and low-fat milk. OBJECTIVES: The objective of this study was to examine the association of the revised WIC package with anemia indicators and iron intake in children. METHODS: A quasi-experimental difference-in-difference design compared anemia and iron intake variables between WIC (n = 1497 and n = 1626 for anemia and iron intake variables, respectively) and WIC-eligible nonparticipating children (n = 1183 and n = 1322 for anemia and iron intake variables, respectively), aged 2-5 y, before and after the 2009 revisions. The NHANES 2003-2008 and 2011-2018 data represented the period pre- and post-2009 revisions, respectively. RESULTS: The 2009 package revisions were significantly associated with reduced probability of anemia (-4.3% points; 95% CI: -7.5, -1.1% points) and nonthalassemic microcytic anemia (-1.7% points; 95% CI: -3.3, -0.1% points) in children from WIC-participating households. The revised WIC package also was significantly related to higher nutrient adequacy ratio (0.04; 95% CI: 0.02, 0.07) and greater probability of meeting the RDA (12.1% points; 95% CI: 3.2, 21.0% points) for iron among WIC participants. CONCLUSIONS: This study found that the WIC 2009 revisions were associated with lower probability of nonthalassemic microcytic anemia and better adequacy of dietary iron intake, thereby suggesting the beneficial impact of WIC revisions on iron deficiency anemia in children. The current study findings suggest that nutritional policies could play a crucial role in supporting the health of vulnerable children in the United States.

Birth weight and prediabetes in a nationally representative sample of US adolescents.

Prediabetes affects about 20% of adolescents in the United States. Previous studies have shown that low and high birth weight impairs glucose homeostasis in adults; however, limited research has examined this relationship in adolescents. To investigate association of birthweight with prediabetes in US adolescents using data from NHANES 2005-2016 and examine whether sex and obesity moderate this relationship. Adolescents, aged 12-15 years without diagnosed/undiagnosed diabetes and extreme birthweight (n = 1396), were classified as low birth weight (LBW), normal birthweight (NBW) and high birth weight (HBW). Logistic regression examined relationship of birthweight with odds of prediabetes. Likelihood ratio test tested interactions of birthweight with sex and obesity measures. In this nationally representative cross-sectional study, LBW adolescents had significantly higher odds of prediabetes compared to NBW counterparts (Odds ratio [95% confidence interval] = 1.93 (1.10, 3.38); p < .05). Sex and obesity moderated the association, such that the strength of the relationship of LBW with increased prediabetes odds was greater among male adolescents (Odds ratio [95% confidence interval] = 2.40 (1.02, 5.67); p < .05) and those with overweight/obesity (Odds ratio [95% confidence interval] = 2.13 (1.01, 4.49); p < .05). Findings imply that the adverse effects of LBW on glucose homeostasis could be manifested early in life. Further, the higher odds of prediabetes among LBW adolescents who are male or have overweight/obesity underscore the heightened need for prediabetes screening of these subgroups.

Alcohol consumption according to socioeconomic and hypertensive status among Korean adults.

This research investigated variations in alcohol consumption by socioeconomic factors and hypertensive status in South Korean adults, aged ≥19 years. This is a secondary data analysis using the Korea National Health and Nutrition Examination Survey (KNHANES). Alcohol intake by socioeconomic and hypertensive status was examined using data from the 2013 to 2016 KNHANES. Total participants were 19,641 adults, with 8,123 men and 11,518 women. Consumption of alcohol in the Korean population was estimated from a single 24-hour dietary recall. Alcohol intake differed, according to socioeconomic status, and, particularly, by occupation among Korean adults. Women with lower education consumed more alcohol daily than those with a higher education (p = 0.018). Furthermore, adult men with hypertension consumed a greater amount of alcohol daily, 30.9 g, than those with pre-hypertension, 23.7 g, followed by those without hypertension, 15.9 g (p < 0.001). In women, adults with pre-hypertension and hypertension consumed more alcohol daily, 9.4 g and 9.0 g, respectively, than those without, 6.6 g (p < 0.001). In addition, men with hypertension who were unaware of their disease and those who were cognizant consumed a higher amount of alcohol daily, 32.4 g and 28.6 g, respectively, than individuals without hypertension, 19.7 g (p < 0.001). Moreover, men with hypertension who had not been treated for hypertension and those in treatment consumed a greater amount of alcohol daily, 32.6 g and 28.0 g, respectively, than those without hypertension, 19.7 g (p < 0.001). In conclusion, Korean adults consume alcohol differently by socioeconomic status, and alcohol intake was more prevalent among people with hypertension.

Association of loss of Supplemental Nutrition Assistance Program benefits with food insecurity and dietary intake of adults and children.

BACKGROUND: Supplemental Nutrition Assistance Program (SNAP) disenrollment among income-eligible households could limit their ability to access food. OBJECTIVES: To assess the association of loss of SNAP benefits on food security status and dietary intake of household members, using 2011-2016 NHANES data. METHODS: SNAP participation status among those with a household income ≤130% of the federal poverty level was categorized as 1) current participants, 2) former participants with benefits cut off in the past year, and 3) former participants with benefits cut off for more than a year. Logistic regression examined associations of SNAP participation status with odds of household (n = 7387), adult (n = 7387), and child (n = 5898) food security. Linear regression examined associations of participation status with Healthy Eating Index-2015 (HEI-2015) total and component scores in adults (n = 2784) and children/adolescents (n = 2553). RESULTS: Former SNAP participants with benefits cut off in the past year had greater odds of severe household (OR: 2.18; 95% CI: 1.25, 3.78) and adult (OR: 2.09; 95% CI: 1.24, 3.54) food insecurity compared with current participants. Benefit cutoff in the past year was significantly related to low child food security (OR: 1.80; 95% CI: 1.04, 3.11) and lower child/adolescent greens and beans score (estimate: -0.40; SE: 0.18). Loss of benefits for more than a year was significantly associated with increased marginal child food security odds (OR: 2.07; 95% CI: 1.23, 3.47), lower adult dairy score (estimate: -0.63; SE: 0.24), and lower child/adolescent greens and beans (estimate: -0.34; SE: 0.16), whole grains (estimate: -0.50; SE: 0.21), and dairy scores (estimate: -0.93; SE: 0.29). CONCLUSIONS: This study suggests that loss of benefits may increase household food insecurity. Although child/adolescent intakes of certain HEI-2015 adequacy components were lower among former SNAP participants, overall diet quality score did not differ. Findings collectively imply the need for policies that protect households from the adverse effects of benefits loss.

Differences in factors associated with anemia in Haitian children from urban and rural areas.

BACKGROUND: In Haiti, differences in the prevalence of anemia between urban and rural areas have been observed. OBJECTIVE: To identify moderating factors that may help explain the difference in the prevalence of anemia in children from poor urban vs. rural areas of Haiti. METHODS: This cross-sectional study used secondary data from urban and rural school-based trials that assessed the effectiveness of a nutrition intervention. The study was registered at ClinicalTrials.gov as NCT02747524. A total of 300 rural- and 981 urban- children between 2.5-13 years of age were included in this analysis. Effect modification in a binary logistic generalized linear mixed model was conducted using sample weights in SPSS® version 26. Models were adjusted for age and income. School cluster was included as random effect. RESULTS: In rural areas, stunting was more prevalent in children with anemia vs. no anemia, (16.6%, and 6.3%, P = 0.008), respectively. Also, rural children with anemia lived with fewer adults vs. rural children with no anemia, ([Formula: see text] = 2.83±1.29, and 3.30±1.54, P = 0.005), respectively. In poor urban areas, helminth morbidities were more frequent in children with anemia vs. no anemia, (21.9% vs. 13.9, P = 0.011), respectively. In the combined sample, stunting, [AOR = 2.05; 95%CI (1.32-3.18)], age [AOR = 0.89; 95%CI (0.85-0.93)], and households with more adults [AOR = 0.77; 95%CI (0.67-0.87)] were associated with anemia. Effect modification by place of residence was observed in households with more adults (t = 3.83, P<0.001). No other nutritional, dietary, sanitation or morbidity factors or effect modifiers were observed. CONCLUSIONS: In this sample, factors associated with anemia differed in poor urban and rural children from Haiti including family structure and helminth morbidities. Stunting and lower age increased the odds of anemia in the combined sample. Family structure appears to have an important role in anemia, and further research understanding the influence of family structures in anemia is needed.