Determinants of dietary patterns of Ghanaian mother-child dyads: A Demographic and Health Survey.

Having a comprehensive understanding of a population's dietary patterns is a key component of any effective strategy for preventing malnutrition, planning, and putting nutrition interventions and policies into place. It's interesting to note that information on dietary patterns of Ghana's vulnerable subpopulations of women and children is lacking. The purpose of this study is to characterize the dietary patterns of women (15-49 years old) and their young children (0-3 years old), as well as to investigate into the socioeconomic and demographic factors influencing the characterized dietary patterns. The sociodemographic information and food consumption of mother-child dyads (n = 1,548) were collected for this nationally representative cross-sectional study. Principal component analysis and multiple variable logistic regression were used, respectively, to determine the dietary patterns of dyads and the determinants of the identified dietary patterns. For women and children, respectively, four dietary patterns ('Beverage & sugary based', 'Meat based', 'Indigenous- tuber based' and 'Indigenous- grain based') and two ('Indigenous' and 'Milk, Meat, & cereal based') emerged. Ethnicity, wealth quintiles, parity, seasonality, dyad's age, body mass index, education, residency, marital status, and household size were the socioeconomic / demographic determinants of the dietary patterns. To sum up for women and children, meat based and indigenous staple based dietary patterns were identified, with several important socioeconomic and demographic variables acting as predictors of the dietary patterns. The identified dietary patterns and their determinants may serve as a basis for nutrition intervention and policies for women and children in Ghana.

Food-based indicators are related to iron and iodine deficiencies of mother-toddler dyads during the lean season in northern Ghana.

Fe and iodine deficiencies are among the common forms of nutritional deficiencies globally and cause detrimental effects on mother and child. In developing countries, strategies to address these problems rarely use preventative dietary approaches. This cross-sectional study aims to ascertain whether dietary diversity score (DDS) and dietary patterns (DP) can predict the associated risk (AR) of Fe and iodine deficiencies in mother-toddler dyads during the dry/lean season in northern Ghana. Data were collected from women (15-49 years; n 118) and their toddlers (6-23 months, n 121). Dyads DDS and DP were calculated from their food intake recall. Multivariable logistic regression models were used to examine whether DDS, DP and socio-demographic factors predict higher odds of Fe and iodine deficiencies in dyads. DDS and DP predicted Fe and iodine deficiencies AR. Compared with DDS ≥4, women with DDS <4 have higher odds of Fe deficiency (ID) (adjusted OR (AOR) 1·82, 95 % CI 1·03, 3·21) and iodine deficiency (AOR 9·73, 95 % CI 3·19, 29·67). Two DP emerged in principal component analyses, 'rural elites diet' predicted ID risk in mothers (AOR 8·65, 95 % CI 1·76, 42·39), while 'indigenous diet' predicted iodine deficiency risk (AOR 11·41, 95 % CI 1·36, 95·97) in mothers only. The AR of Fe and iodine deficiencies in vulnerable populations may be predicted by diet-based measures in northern Ghana. We recommend further research into DDS and DP to predict Fe and iodine status of mother-toddler dyads in Ghana.

Iodine status of reproductive age women and their toddlers in northern Ghana improved through household supply of iodized salt and weekly indigenous meal consumption.

Iodine deficiency (ID) during pregnancy results in pregnancy losses, intrauterine growth retardation, and lower IQ in the offspring. Even after two decades of universal salt iodization (USI) implementation, the efficacy of USI has not been reported in high risk groups in vulnerable regions in Ghana. We aimed to assess and improve ID status in childbearing age women (all lactating women) and their toddlers in northern Ghana, a geographically and socioeconomically vulnerable region. We provided weekly supply of household iodized salt and community-based feeding of native Hibiscus Sabdariffaa leaves meal (HSM) prepared with iodized salt to women and their toddlers in intervention (n = 60) vs. control group (n = 60). At baseline, ID was prevalent in women (36%) and their toddlers (29%). For women, both median UIC values for intervention (57.4 ug/l) and control group (65.1 ug/l) were below the recommended UIC value of 100 ug/l with no significant differences between the two groups (p = 0.2778). At the endpoint, median UIC for the intervention group (123.6 ug/l) was significantly higher (p = 0.008) than the control group (59.7 ug/l). Our results suggest that weekly supply of iodized salt along with the feeding HSM is an effective channel for improving iodine status of economically disadvantaged groups in communities remote from coastal lands. Furthermore, our results suggest that decreased median UIC among lactating mothers does not necessarily imply lower iodine status for their breastfed toddlers. And finally, the observed median UIC<100 ug/l may point to a non-improvement in iodine status for the past decade for Ghana. There is a need to revisit, assess, and ascertain the challenges in preventing populations from attaining the intended benefits of the USI policy in Ghana.

Influence of the Adequacy of the Prenatal Care Utilization Index on Small-For-Gestational-Age Infants and Preterm Births in the United States.

Little is known about the associations of Adequacy of Prenatal Care Utilization (APNCU) index with small-for-gestational-age (SGA) infants and preterm births. This study investigated the association between the Adequacy of Prenatal Care Utilization (APNCU) index in relation to small-for-gestational-age (SGA) infants and preterm births. We used data from 212,050 pregnant women from the Pregnancy Risk Assessment Monitoring System (PRAMS) between 2004 and 2011. Multivariable logistic regression analyses were performed to examine the effect of the APNCU index on SGA infants and preterm births after controlling for maternal sociodemographic factors. Women who received adequate-plus prenatal care in reference to adequate prenatal care had increased odds for delivering SGA infants (adjusted odds ratio (AOR) = 1.08, 95% confidence interval (CI) = 1.03-1.15). Women with 9-11 prenatal care visits had increased odds of delivering SGA infants (AOR = 1.07, 95% CI = 1.02-1.14) compared to those with more than 12 visits. Among the four APNCU index categories, the highest rate of preterm births was observed in the adequate-plus group. Compared to those with adequate prenatal care, women who received adequate-plus prenatal care had increased odds of preterm birth (AOR = 1.69, 95% CI = 1.55-1.84). Compared to those with more than 12 visits, women with fewer than eight prenatal care visits had increased odds of preterm birth (AOR = 1.29, 95% CI = 1.13-1.48). In conclusion, women in the adequate-plus APNCU index category were more likely to deliver SGA infants and to have preterm births compared to those in the adequate APNCU index category. Women in the U.S. with high-risk pregnancies were prone to receiving adequate-plus prenatal care. Future prospective studies are warranted to investigate the influence of APNCU index in relation to pregnancy and birth outcomes.

Trends in total fat and fatty acid intakes and chronic health conditions in Korean adults over 2007-2015.

OBJECTIVE: To investigate trends in total fat and fatty acid intakes and chronic health conditions among Korean adults over nine years between 2007 and 2015. DESIGN: Cross-sectional, observational study using a stratified, multistage probability sampling design at a national level. Intakes of total fat and fatty acids were estimated from 24 h dietary recalls by sex and age groups. Trends of total fat and fatty acid intakes were determined by multiple linear regression after adjusting for covariates. Trends in age-standardized prevalence of obesity, hypercholesterolaemia and hypertriacylglycerolaemia were examined by sex. SETTING: Korea.ParticipantsPopulation data of 47749 healthy adults (aged ≥19 years) derived from the Korea National Health and Nutrition Examination Survey between 2007 and 2015. RESULTS: Over the survey period, daily intakes of energy and total, saturated, monounsaturated, polyunsaturated, n-3 and n-6 fats (grams and percentage of energy (%E)) increased steadily. In all sex and age groups, significant increases were seen in SFA intake from 9·9 g (4·7 %E) to 12·0 g (5·3 %E) and in MUFA intake from 9·9 g (4·6 %E) to 13·3 g (5·8 %E). The prevalence of hypercholesterolaemia increased from 10·7 to 17·9 % over the same period. CONCLUSIONS: In Korean adults, total fat, SFA and other fatty acids have been increasing along with the prevalence of hypercholesterolaemia. This information can help set adequate macronutrient and fatty acid distribution ranges in developing population-specific preventive strategies against diet-related illness.

Hibiscus sabdariffa Meal Improves Iron Status of Childbearing Age Women and Prevents Stunting in Their Toddlers in Northern Ghana.

Globally, iron deficiency (ID) is the most common form of nutritional deficiency, particularly in young children and childbearing age women. ID can lead to stunting and impaired cognitive development in children, as well as adverse maternal health and birth outcomes. In this study, the efficacy of an alternative food-to-food fortification utilizing indigenous iron-rich food sources was investigated in a quasi-experimental study. Childbearing age women (15⁻49 years, intervention-Kassena Nankana West district: n = 60; control-Builsa North district: n = 60) and their toddlers (6⁻24 months) consumed Hibiscus sabdariffa leaf meals (HSM, 1.71 mg Fe/100 g meal) three times a week for 12 weeks during the dry/lean season in Northern Ghana. We found that feeding the HSM (1.9 kg/day) improved iron status of women of childbearing age with time (p = 0.011), and protected stunting among toddlers during the dry/lean season (p = 0.024), which is the period with the worst food and nutrition insecurity. Compared with the control group, the number of stunted toddlers declined in the intervention group.

Gestational weight gain across continents and ethnicity: systematic review and meta-analysis of maternal and infant outcomes in more than one million women.

BACKGROUND: The association between Institute of Medicine (IOM) guidelines and pregnancy outcomes across ethnicities is uncertain. We evaluated the associations of gestational weight gain (GWG) outside 2009 IOM guidelines, with maternal and infant outcomes across the USA, western Europe and east Asia, with subgroup analyses in Asia. The aim was to explore ethnic differences in maternal prepregnancy body mass index (BMI), GWG and health outcomes across these regions. METHODS: Systematic review, meta-analysis and meta-regression of observational studies were used for the study. MEDLINE, MEDLINE In-Process, Embase and all Evidence-Based Medicine (EBM) Reviews were searched from 1999 to 2017. Studies were stratified by prepregnancy BMI category and total pregnancy GWG. Odds ratio (ORs) 95% confidence intervals (CI) applied recommended GWG within each BMI category as the reference. Primary outcomes were small for gestational age (SGA), preterm birth and large for gestational age (LGA). Secondary outcomes were macrosomia, caesarean section and gestational diabetes. RESULTS: Overall, 5874 studies were identified and 23 were included (n = 1,309,136). Prepregnancy overweight/obesity in the USA, Europe and Asia was measured at 42%, 30% and 10% respectively, with underweight 5%, 3% and 17%. GWG below guidelines in the USA, Europe and Asia was 21%, 18% and 31%, and above was 51%, 51% and 37% respectively. Applying regional BMI categories in Asia showed GWG above guidelines (51%) was similar to that in the USA and Europe. GWG below guidelines was associated with a higher risk of SGA (USA/Europe [OR 1.51; CI 1.39, 1.63]; Asia [1.63; 1.45, 1.82]) and preterm birth (USA/Europe [1.35; 1.17, 1.56]; Asia [1.06; 0.78, 1.44]) than GWG within guidelines. GWG above guidelines was associated with a higher risk of LGA (USA/Europe [1.93; 1.81, 2.06]; Asia [1.68; 1.51 , 1.87]), macrosomia (USA/Europe [1.87; 1.70, 2.06]; Asia [2.18; 1.91, 2.49]) and caesarean (USA/Europe [1.26; 1.21, 1.33]; Asia [1.37; 1.30, 1.45]). Risks remained elevated when regional BMI categories were applied for GWG recommendations. More women in Asia were categorised as having GWG below guidelines using World Health Organization (WHO) (60%) compared to regional BMI categories (16%), yet WHO BMI was not accompanied by increased risks of adverse outcomes. CONCLUSIONS: Women in the USA and western Europe have higher prepregnancy BMI and higher rates of GWG above guidelines than women in east Asia. However, when using regional BMI categories in east Asia, rates of GWG above guidelines are similar across the three continents. GWG outside guidelines is associated with adverse outcomes across all regions. If regional BMI categories are used in east Asia, IOM guidelines are applicable in the USA, western Europe and east Asia.

Compliance to Prenatal Iron and Folic Acid Supplement Use in Relation to Low Birth Weight in Lilongwe, Malawi.

Prenatal iron and folic acid (IFA) supplements are offered free to all pregnant women in Malawi to reduce maternal anemia and improve birth outcomes. We investigated the association between self-reported compliance to IFA intake and risk of low birth weight (LBW). Pregnant women who attended Bwaila Maternity Wing of Lilongwe District Hospital for delivery were recruited (n = 220). We used a questionnaire to collect self-reported information on IFA use and maternal sociodemographic data. Before delivery, blood samples for maternal hemoglobin (Hb) and folate status, and upon delivery, birth weight, and other newborn anthropometrics were measured. We used multivariable logistic regression to determine risk of LBW by prenatal IFA intake. The self-reported number of IFA pills taken during pregnancy was positively associated with Hb, but not serum and RBC folate concentration: <45, 45⁻89 and ≥90 pills taken corresponded with mean (SD) Hb 10.7 (1.6), 11.3 (1.8), and 11.7 (1.6) g/dL, respectively (p = 0.006). The prevalence of LBW was 20.1%, 13.5% and 5.6% for those who reported taking IFA pills <45, 45⁻89, and ≥90 pills, respectively (p = 0.027). Taking >60 IFA pills reduced risk of LBW delivery (OR (95% CI) = 0.15 (0.03⁻0.70), p = 0.033) than taking ≤30 pills. Self-reported compliance to IFA use is valid for assessing prenatal supplement program in Malawi, especially Hb status, and can reduce the rate of LBW.

Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis.

IMPORTANCE: Body mass index (BMI) and gestational weight gain are increasing globally. In 2009, the Institute of Medicine (IOM) provided specific recommendations regarding the ideal gestational weight gain. However, the association between gestational weight gain consistent with theIOM guidelines and pregnancy outcomes is unclear. OBJECTIVE: To perform a systematic review, meta-analysis, and metaregression to evaluate associations between gestational weight gain above or below the IOM guidelines (gain of 12.5-18 kg for underweight women [BMI <18.5]; 11.5-16 kg for normal-weight women [BMI 18.5-24.9]; 7-11 kg for overweight women [BMI 25-29.9]; and 5-9 kg for obese women [BMI ≥30]) and maternal and infant outcomes. DATA SOURCES AND STUDY SELECTION: Search of EMBASE, Evidence-Based Medicine Reviews, MEDLINE, and MEDLINE In-Process between January 1, 1999, and February 7, 2017, for observational studies stratified by prepregnancy BMI category and total gestational weight gain. DATA EXTRACTION AND SYNTHESIS: Data were extracted by 2 independent reviewers. Odds ratios (ORs) and absolute risk differences (ARDs) per live birth were calculated using a random-effects model based on a subset of studies with available data. MAIN OUTCOMES AND MEASURES: Primary outcomes were small for gestational age (SGA), preterm birth, and large for gestational age (LGA). Secondary outcomes were macrosomia, cesarean delivery, and gestational diabetes mellitus. RESULTS: Of 5354 identified studies, 23 (n = 1 309 136 women) met inclusion criteria. Gestational weight gain was below or above guidelines in 23% and 47% of pregnancies, respectively. Gestational weight gain below the recommendations was associated with higher risk of SGA (OR, 1.53 [95% CI, 1.44-1.64]; ARD, 5% [95% CI, 4%-6%]) and preterm birth (OR, 1.70 [1.32-2.20]; ARD, 5% [3%-8%]) and lower risk of LGA (OR, 0.59 [0.55-0.64]; ARD, -2% [-10% to -6%]) and macrosomia (OR, 0.60 [0.52-0.68]; ARD, -2% [-3% to -1%]); cesarean delivery showed no significant difference (OR, 0.98 [0.96-1.02]; ARD, 0% [-2% to 1%]). Gestational weight gain above the recommendations was associated with lower risk of SGA (OR, 0.66 [0.63-0.69]; ARD, -3%; [-4% to -2%]) and preterm birth (OR, 0.77 [0.69-0.86]; ARD, -2% [-2% to -1%]) and higher risk of LGA (OR, 1.85 [1.76-1.95]; ARD, 4% [2%-5%]), macrosomia (OR, 1.95 [1.79-2.11]; ARD, 6% [4%-9%]), and cesarean delivery (OR, 1.30 [1.25-1.35]; ARD, 4% [3%-6%]). Gestational diabetes mellitus could not be evaluated because of the nature of available data. CONCLUSIONS AND RELEVANCE: In this systematic review and meta-analysis of more than 1 million pregnant women, 47% had gestational weight gain greater than IOM recommendations and 23% had gestational weight gain less than IOM recommendations. Gestational weight gain greater than or less than guideline recommendations, compared with weight gain within recommended levels, was associated with higher risk of adverse maternal and infant outcomes.

Dietary carbohydrate and fat intakes are differentially associated with lipid abnormalities in Korean adults.

BACKGROUND: A high prevalence of metabolic syndrome along with increasing rates of low high-density lipoprotein cholesterol (HDL-C) and elevated triglycerides (TGs) is shown in Korean adults. Little is known about the associations between macronutrient intake and lipid abnormalities in the Asian population, whose major energy source is carbohydrates. OBJECTIVE: We examined the associations of dietary carbohydrate and fat intakes with lipid abnormalities in Korean adults. METHODS: A total of 14,301 adults (5715 men and 8586 women) aged ≥30 years with no diagnosis and treatment for diabetes, hypertension, or dyslipidemia were selected from the 2008 to 2012 Korea National Health and Nutrition Examination Survey data. From the 24-hour recall data, dietary carbohydrate and fat intakes were estimated. Multivariate logistic regression was used to estimate odds ratios for lipid abnormalities, that is, elevated total cholesterol (TC), low HDL-C, high TC to HDL-C ratio, elevated non-HDL-C, elevated LDL cholesterol (LDL-C), and elevated TG across quintiles of dietary carbohydrate and fat intakes. RESULTS: Percentage of energy from carbohydrate was positively associated with elevated TG and low HDL-C but inversely associated with elevated TC and elevated LDL-C in both men and women. Energy-adjusted carbohydrate intake also showed a positive association with low HDL-C. Dietary fat intakes had the opposite associations with lipid abnormalities than results for carbohydrate. CONCLUSION: High carbohydrate diet is undesirable with regard to increased TG and reduced HDL-C despite the benefit for LDL-C. Dietary strategies emphasizing appropriate macronutrient intakes by the type of lipid abnormalities are recommended for the prevention of cardiovascular disease in Korean adults.

Prevalence and Determinants of Overweight and Obesity in Children and Adolescents from Migrant and Seasonal Farmworker Families in the United States-A Systematic Review and Qualitative Assessment.

Overweight and obesity (OW/OB) is a pressing health concern among migrant and seasonal farmworker (MSFW) families in the US. The limited number of previously reported research on MSFW families suggests that their unique sociodemographic characteristics and lifestyle predispose them to poor health outcomes including OW/OB. We aimed to synthesize and assess available data on the prevalence and modifiable health determinants of OW/OB in MSFW children and adolescents. Literature search, study selection, data extraction and synthesis, and qualitative assessment of selected studies were performed independently by two authors. Ten cross-sectional studies met the inclusion criteria: articles or dissertations investigating prevalence and association between health determinants and OW/OB in MSFW children and adolescents (<20 years) in the US. The prevalence of OW, OB, and OW/OB ranged from 10%-33%, 15%-37%, and 31%-73%, respectively. Children's education, household food insecurity, parents' weight status, parents' distorted perception of their children's weight status, and parents' participation in the federal nutrition assistance program were significantly associated with the children's and adolescents' risk of OW/OB. Promotion of culturally relevant public health programs and implementation of a systematic health surveillance plan for MSFWs and their children should be emphasized to combat OW/OB among MSFW children and adolescents.

The Relationship Between Dietary Acculturation and Type 2 Diabetes Risk Among Asian Indians in the U.S.

Asian Indians have a high prevalence of type 2 diabetes in the U.S. (17.4-29 %). This study examined the relationship between dietary acculturation of Asian Indians in the U.S. and their future risk for type 2 diabetes. A validated Asian Indian Dietary Acculturation Measure (AIDAM) and the Finnish Diabetes Risk Score (FINDRISC) were completed by 153 Asian Indians in the U.S. via a cross-sectional web-survey. Correlations and relative risk ratios were used to examine the association between AIDAM and FINDRISC. A significantly larger proportion of Non-Indian Oriented participants (44.7 %) had higher FINDRISC scores (scores 7-26) compared to the Asian Indian Oriented group (27.9 %) (p = .024), and also had increased relative predictive risk for type 2 diabetes (relative risk ratio = 1.6). A positive association between dietary acculturation and diabetes risk was evident in our sample, which highlights the importance of assessing dietary acculturation in non-native groups when investigating type 2 diabetes risk factors.

Total Water Intake from Beverages and Foods Is Associated with Energy Intake and Eating Behaviors in Korean Adults.

Water is essential for the proper functioning of the body. Even though a recommendation exists for adequate water intake for Koreans, studies identifying actual water intake from all beverages and foods consumed daily in the Korean population are limited. Thus, we estimated total water intake from both beverages and foods and its association with energy intake and eating behaviors in Korean adults. We used a nationally representative sample of 25,122 Korean adults aged ≥19 years, from the Korean National Health and Nutrition Examination Survey 2008-2012. We performed multiple regression analyses, adjusting for sociodemographic and health-related variables to investigate the contribution of overall energy and dietary intakes and eating behaviors to total water intake. The mean total water intake excluding plain water was 1071 g (398 g from beverages and 673 g from foods) and the estimated plain water intake was 1.3 L. Among Korean adults, 82% consumed beverages (excluding plain water) and these beverages contributed to 10% of daily energy intake and 32% of total water intake from beverages and foods. For every 100 kcal/day in energy intake, water intake consumed through beverages and foods increased by 18 g and 31 g, respectively. Water intake from beverages and foods was positively associated with energy from fat and dietary calcium, but inversely associated with energy density and energy from carbohydrates. When there was a 5% increase in energy intake from snacks and eating outside the home, there was an increase in water intake from beverages of 13 g and 2 g, respectively. Increased daily energy intake, the number of eating episodes, and energy intake from snacks and eating outside the home predicted higher water intake from beverages and foods. Our results provide evidence suggesting that various factors, including sociodemographic status, dietary intakes, and eating behaviors, could be important contributors to the water intake of Korean adults. Findings from this cross-sectional analysis may provide insight into strategies for promoting adequate water intake among Koreans.

Are Dietary Patterns Associated with Depression in U.S. Adults?

Nutrition is one of the most important modifiable determinants for and consequences of both mental and physical heath. Depression has become an increasingly important public health issue. We tested whether dietary patterns derived from food group intake are associated with depression in U.S. adults in a cross-sectional study with national population. This study included 4180 men and 4196 women aged 20-79 years in the 2007-2010 National Health and Nutrition Examination Surveys (NHANES), with complete data of one 24-h dietary recall, sociodemographics, lifestyles, and Patient Health Questionnaires (PHQ-9) for screening depression. Two major dietary patterns identified by factor analysis were investigated for their associations with presence of depression (PHQ-9 score ≥10) by using linear and multivariate logistic regressions. One of two major patterns, labeled "Western" dietary pattern was characterized by high intakes of nonwhole grain, white potatoes, cheese, meat, discretionary oil and fat, and added sugar; the second dietary pattern that was labeled "Healthy" dietary pattern was characterized by high intakes of whole grains, vegetables, fruits, fish, nuts and seeds. The "Western" dietary pattern was not significantly associated with depression in both men and women. The "Healthy" dietary pattern scores were inversely associated with the PHQ-9 depression scores and odd ratios (ORs) of depression after adjustment for covariates in women but not in men. The OR of depression in women with the highest quintile of "Healthy" dietary pattern scores was 0.60 (95% confidence interval [CI]: 0.42-0.85, P < .001) compared to the lowest quintile as a reference. These findings warrant future interventions or clinical trials in elucidating causal and effect relations of depression and dietary patterns, an important public health concern.

Nutritional health attitudes and behaviors and their associations with the risk of overweight/obesity among child care providers in Michigan Migrant and Seasonal Head Start centers.

BACKGROUND: Children enrolled in Migrant and Seasonal Head Start (MSHS) programs are at high risks of health problems. Although non-family child care providers play important roles on children's health status as role models, educators, program deliverers, and information mediators, little is known about their nutritional health attitudes and behaviors, and weight status. Therefore, we investigated nutritional health attitudes and behaviors and their associations with overweight/obesity among child care providers in Michigan MSHS centers. METHODS: A total of 307 child care providers aged ≥ 18 years working in 17 Michigan MSHS centers were included in this cross-sectional study conducted in 2013. An online survey questionnaire was used to collect data on nutritional health attitudes and behaviors of child care providers. Weight status was categorized into normal weight (18.5 ≤ BMI < 25 kg/m(2)), overweight (25 ≤ BMI < 30 kg/m(2)), and obese (BMI ≥ 30 kg/m(2)) based on child care providers' self-reported height and weight. Factor analysis was performed to investigate patterns of nutritional health attitudes and behaviors. Multivariate logistic regression was conducted to estimate the odds ratios (ORs) and 95 % confidence intervals (CIs) of overweight/obesity across tertiles of pattern scores taking the lowest tertile group as the reference group after adjustment for potential confounding variables. RESULTS: Three patterns of nutritional health attitudes and behaviors were identified: pattern 1) "weight loss practices with weight dissatisfaction", pattern 2) "healthy eating behaviors", and pattern 3) "better knowledge of nutrition and health". The pattern 1 scores were positively associated with overweight/obesity (Tertile 2 vs. Tertile 1: OR = 5.81, 95 % CI = 2.81-12.05; Tertile 3 vs. Tertile 1: OR = 14.89, 95 % CI = 6.18-35.92). Within the pattern 2, the OR for overweight/obesity in individuals with the highest scores was 0.37 (95 % CI = 0.19-0.75) compared with those with the lowest scores. However, the pattern 3 was not associated with the risk of overweight/obesity. CONCLUSIONS: Our findings support that nutrition education or health interventions targeting MSHS child care providers are urgently necessary. These efforts might be an efficient and effective approach for improving the nutritional health status of young children enrolled in MSHS programs.

Dietary Patterns During Pregnancy are Associated with Gestational Weight Gain.

Objective The role of diet during pregnancy on gestational weight gain is unclear. This study aimed to evaluate the hypothesis that dietary patterns during pregnancy are differentially associated with the adequacy of gestational weight gain at different stages of pregnancy. Methods A total of 391 pregnant women in National Health and Nutrition Examination Survey (NHANES) 2003-2006 were included. Dietary intake was obtained using a National Cancer Institute's food-frequency questionnaire. Results Three dietary patterns were identified by factor analysis with 36 food groups among pregnant women, and they were named according to food group factor loadings: 'mixed', 'healthy', and 'western'. The 'mixed' pattern characterized by a high intake of meat, dairy products, fruits, vegetables, potatoes, nuts and seeds and sweets. After adjusting for maternal sociodemographic variables and physical activity level, women in the highest tertile of 'mixed' pattern score had significantly greater odds of being in the inadequate gestational weight gain compared to those in the lowest tertile (adjusted odds ratio (AOR) 4.72; 95 % CI 1.07-20.94). Women in the mid tertile of the 'mixed' pattern had significantly lower odds of being in the excessive gestational weight gain compared to those in the lowest tertile (AOR 0.39; 95 % CI 0.15-0.99). Conclusion These results suggest that a diet high in meat, dairy products, fruits, vegetables, potatoes, and nuts and seeds during pregnancy might be associated with reducing excessive gestational weight gain.

Dietary quality differs by consumption of meals prepared at home vs. outside in Korean adults.

BACKGROUND/OBJECTIVES: Eating out has been reported to have negative effects on nutritional status. However, eating out can include meals prepared at home and eaten outside. Conversely, meals eaten at home can be brought from outside, as take-out and home deliveries have become common in Korea. Thus, we tested whether or not meal preparation location influences daily diet quality. SUBJECTS/METHODS: From the Korea National Health and Nutrition Examination Survey (KNHANES) 2007-2009, 4,915 Korean adults (20-64 years) were classified into two groups: home-made meal group (HMG), who ate ≥ 2 meals per day prepared at home (n = 4,146), and non-home-made meal group (NHMG), who ate ≥ 2 meals per day prepared outside home (n = 769). Daily diet quality was determined by energy intake, nutrient intake, Dietary Variety Score (DVS), and Diet Diversity Score (DDS). RESULTS: Compared to the HMG, the NHMG was more likely to consist of men, single, employed, educated and of a higher economic status (all, P < 0.01). The NHMG showed higher energy intakes (1,776 vs. 2,116 kcal/day) with higher percentages of energy from protein (15 vs. 23%) and fat (14 vs. 16%) and lower intakes of dietary fiber, phosphorus, potassium, niacin, and vitamin C (all, P < 0.01) than the HMG, with some variations among age groups. The NHMG tended to consume foods prepared by frying and grilling and had more one-dish meals such as bibimbap, noodles, and dumplings but also showed higher dietary diversity. CONCLUSIONS: It should be noted that home-made meals do not necessarily guarantee a healthy diet, and the effects of meal preparation location on nutritional status might vary depending on socio-demographic characteristics.

Food Group Intakes as Determinants of Iodine Status among US Adult Population.

Adequate intake of iodine is essential for proper thyroid function. Although dietary reference intakes for iodine have been established, iodine intake cannot be estimated due to the lack of data on iodine contents in foods. We aimed to determine if food group intakes can predict iodine status assessed by urinary iodine concentration (UIC) from spot urine samples of 5967 US adults in the National Health and Nutrition Examination Survey (NHANES) 2007-2012. From an in-person 24-h dietary recall, all foods consumed were aggregated into 12 main food groups using the individual food code of the US Department of Agriculture (USDA); dairy products, meat/poultry, fish/seaweed, eggs, legumes/nuts/seeds, breads, other grain products, fruits, vegetables, fats/oils, sugars/sweets, and beverages. Chi-square test, Spearman correlation, and multiple linear regression analyses were conducted to investigate the predictability of food group intakes in iodine status assessed by UIC. From the multiple linear regressions, the consumption of dairy products, eggs, and breads, and iodine-containing supplement use were positively associated with UIC, whereas beverage consumption was negatively associated with UIC. Among various food group intakes, dairy product intake was the most important determinant of iodine status in both US men and women. Subpopulation groups with a high risk of iodine deficiency may need nutritional education regarding the consumption of dairy products, eggs, and breads to maintain an adequate iodine status. Efforts toward a better understanding of iodine content in each food and a continued monitoring of iodine status within US adults are both warranted.

Low Urinary Iodine Concentrations Associated with Dyslipidemia in US Adults.

Iodine is an essential component of the thyroid hormone which plays crucial roles in healthy thyroid function and lipid metabolism. However, the association between iodine status and dyslipidemia has not been well established at a population level. We aimed to test the hypothesis that the odds of dyslipidemia including elevated total cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and apolipoprotein B, and lowered high-density lipoprotein (HDL) cholesterol and HDL/LDL ratio are associated with urinary iodine concentration (UIC) in a population perspective. Data of 2495 US adults (≥20 years) in the National Health and Nutrition Examination Survey 2007-2012 were used in this study. Two subgroups (i.e., UIC below vs. above the 10th percentile) were compared of dyslipidemia as defined based on NCEP ATP III guidelines. The differences between the groups were tested statistically by chi-square test, simple linear regressions, and multiple logistic regressions. Serum lipid concentrations differed significantly between two iodine status groups when sociodemographic and lifestyle covariates were controlled (all, p < 0.05). Those with the lowest decile of UIC were more likely to be at risk for elevated total cholesterol (>200 mg/dL) (adjusted odds ratio (AOR) = 1.51, 95% confidence interval (CI): 1.03-2.23) and elevated LDL cholesterol (>130 mg/dL) (AOR = 1.58, 95% CI: 1.11-2.23) and lowered HDL/LDL ratio (<0.4) (AOR = 1.66, 95% CI: 1.18-2.33), compared to those with UIC above the 10th percentile. In US adults, low UIC was associated with increased odds for dyslipidemia. Findings of the present cross-sectional study with spot urine samples highlight the significant association between UIC and serum lipids at population level, but do not substantiate a causal relationship. Further investigations are warranted to elucidate the causal relationship among iodine intakes, iodine status, and serum lipid profiles.

Pre-Pregnancy Weight Status Is Associated with Diet Quality and Nutritional Biomarkers during Pregnancy.

Although the positive association between pre-pregnancy overweight and obesity with excessive gestational weight gain is well known, it is not clear how pre-pregnancy weight status is associated with gestational weight gain through maternal diet during pregnancy. This study aimed to examine the relationship between pre-pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Our study included 795 U.S. pregnant women from the National Health and Nutrition Examination Survey, 2003-2012. Pre-pregnancy body mass index (BMI) was calculated based on self-reported pre-pregnancy weight and height. The cutoff points of <18.5 (underweight), 18.5-24.9 (normal), 25.0-29.9 (overweight), and 30 kg/m² (obese) were used to categorize pregnant women's weight status. Diet quality during pregnancy was assessed by the Healthy Eating Index (HEI)-2010 based on a 24-h recall. Multivariable logistic regressions were used to estimate the odds ratios (OR) and 95% confidence intervals (CI). For all pregnant women included in this study, the mean HEI-2010 (±standard error of the mean (SEM)) was 50.7 (±0.9). Women with obese pre-pregnancy BMI demonstrated significantly lower HEI-2010 compared to those with underweight and normal pre-pregnancy BMI, respectively. In an unadjusted model, women with pre-pregnancy obesity BMI had increased odds for being in the lowest tertile of HEI-2010 (33.4 ± 0.5) compared to those with underweight pre-pregnancy BMI (OR 5.0; 95% CI 2.2-11.4). The inverse association between pre-pregnancy overweight and obesity status and diet quality during pregnancy persisted even after we controlled for physical activity levels (adjusted OR (AOR) 3.8; 95% CI 1.2-11.7, AOR 5.4; 95% CI 2.0-14.5, respectively). Serum folate concentration (ng/mL) was significantly higher in underweight women compared to overweight women (23.4 ± 1.7 vs. 17.0 ± 0.8, p < 0.05). Serum iron concentration (ng/dL) was significantly higher in normal weight women compared to overweight women (86.2 ± 5.0 vs. 68.9 ± 3.0, p < 0.05). An inverse association was found between pre-pregnancy weight status and diet quality and maternal nutritional biomarkers during pregnancy. Poor diet quality as measured by HEI-2010 was shown among overweight and obese women. Nutrition education and interventions need to be targeted to those women entering pregnancy as overweight and obese.