See Me, Hear Me, Know Me: Perspectives on Diet and Physical Activity Influences among Teens Living in Rural Texas Communities.

Teens in rural communities are at greater risk of obesity than teens in urban areas. Diet and physical activity influence obesity risk. Understanding their perspectives is an important step in intervention design. This qualitative investigation explored teen perspectives on how living in a rural community influenced their diet and physical activity choices. Forty parent-teen pairs were recruited. Data collection included surveys and telephone interviews. This paper reports teen perspectives identified in the first interview. Thematic analysis was used to code and analyze the data. Findings revealed that the primary factor driving teens' diet and physical activity behaviors was the teens themselves. They clearly understood their role in the choices they made, although they acknowledged not always making the healthiest choice. This belief was driven by their motivation to engage in healthy behaviors, which was influenced by the perceived benefits derived from making healthy choices and from the synergistic relationship between diet and physical activity. Diet and physical activity, in turn, were influenced by the environment, particularly the home, social, and community environments. Family and friends were particularly influential, as well as resource availability. These findings can serve as a foundation for designing interventions tailored to this population.

An SMS Text Message-Based Type 2 Diabetes Prevention Program for Hispanic Adolescents With Obesity: Qualitative Co-Design Process.

BACKGROUND: SMS text message-based interventions are a promising approach for reaching and engaging high-risk youths, such as Hispanic adolescents with obesity, in health promotion and disease prevention opportunities. This is particularly relevant, given that SMS text messaging is widely accessible and available and that adolescents are frequent texters. Including youths in the development of SMS text message content can lead to more acceptable and relevant messaging; however, few studies include this group as cocollaborators. OBJECTIVE: This study aimed to use a co-design process to inform the development of SMS text messages that promote healthy physical activity (PA) and sleep behaviors among Hispanic adolescents with obesity. METHODS: The co-design framework uses multiple methods across several phases. Self-determination theory and a literature review of SMS text message-based interventions guided the background and research phases. In the co-design phase, Hispanic adolescents (n=20) completed in-depth interviews to identify barriers and facilitators of PA and sleep, preferences for ways to emphasize key self-determination theory constructs (autonomy, competence, and relatedness), and suggestions for making SMS text message content engaging. In the design and content phase, interview findings were used to develop initial SMS text messages, which were then evaluated in the early evaluation phase by experts (n=6) and adolescents (n=6). Feedback from these panels was integrated into the SMS text message content during refinement. RESULTS: The background phase revealed that few SMS text message-based interventions have included Hispanic adolescents. Common barriers and facilitators of activity and sleep as well as preferences for ways in which SMS text messages could provide autonomy, competence, and relatedness support were identified in the co-design phase. The youths also wanted feedback about goal attainment. Suggestions to make SMS text messages more engaging included using emojis, GIFs, and media. This information informed an initial bank of SMS text messages (N=116). Expert review indicated that all (116/116, 100%) SMS text messages were age and culturally appropriate; however, some (21/116, 18.1%) did not adequately address youth-identified barriers and facilitators of PA and sleep, whereas others (30/116, 25.9%) were not theoretically adherent. Adolescents reported that SMS text messages were easy to understand (116/116, 100%), provided the support needed for behavior change (103/116, 88.8%), and used mostly acceptable language (84/116, 72.4%). Feedback was used to refine and develop the final bank of 125 unique text messages. CONCLUSIONS: Using a co-design process, a theoretically grounded, appealing, and relevant bank of SMS text messages promoting healthy PA and sleep behaviors to adolescents was developed. The SMS text messages will be further evaluated in a pilot study to assess feasibility, acceptability, and preliminary efficacy. The co-design process used in this study provides a framework for future studies aimed at developing SMS text message-based strategies among high-risk adolescents. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1016/j.cct.2023.107117.

Diet Quality among Pre-Adolescent African American Girls in a Randomized Controlled Obesity Prevention Intervention Trial.

Consuming an unhealthy diet increases health risks. This study assessed the impact of a culturally adapted behaviorally innovative obesity prevention intervention (The Butterfly Girls and the Quest for Founder's Rock) on diet quality in pre-adolescent non-Hispanic Black/African American girls. The RCT consisted of three groups (experimental, comparison, and waitlist control); block randomization allocated participants to each group. The two treatment groups varied in terms of whether or not they set goals. Data were collected at baseline (prior to receiving the intervention), post 1 (3 months post-baseline), and post 2 (6 months post-baseline). Two dietitian-assisted 24 h dietary recalls were collected at each timepoint. Healthy Eating Index 2015 (HEI-2015) was used to determine diet quality. A total of 361 families were recruited; 342 completed baseline data collection. No significant differences in overall HEI score or component scores were observed. To attain more equitable health outcomes, future efforts to promote dietary intake change among at-risk children should explore other behavior change procedures and employ more child-friendly dietary assessment methods.

Validated assessment tools for screen media use: A systematic review.

OBJECTIVE: Accurate measurement of adult and child screen media use are needed to robustly assess its impact on health outcomes. Our objective was to systematically review screen media use measurement tools that have been validated against an objective "gold standard" tool. METHODS: The search strategy was initially conducted in Medline Ovid and translated to Embase, Web of Science, PsychInfo and Cochrane. A modified natural language search was conducted in Google Scholar and IEEE. The initial search was conducted in March 2021, and an updated search was conducted in June 2022. Additional studies were included from the references. Studies had to describe the validation of a tool to measure screen media use on participants of any age against a 'gold standard' or comparable objective measure. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was used to assess the criterion validity. Four authors reviewed the titles in two rounds and extracted data. RESULTS: Twenty-nine articles were included in the review. Studies measured TV, computer, mobile device and social media site screen media use through: self or parent report, direct or video observation, computer and mobile device use tracking programs, and through other novel devices such as wearable devices and cameras. Correlations of self or parent report of screen media with the gold standard were lower than correlations of technology-based measures, and video observation with the gold standard. The COSMIN criterion validity ratings ranged from poor to excellent; most of the studies received a global score of fair or poor. CONCLUSIONS: Technology based validated tools that more directly measure screen use are emerging that have been validated against a gold standard for measuring screen use. However, practical, objective measures of diverse types of screen media use that have been tested on diverse populations are needed to better understand the impact of screen media use on the development and physical and mental health of children and adults.

Fit24, a digital health intervention to reduce type 2 diabetes risk among Hispanic youth: Protocol for a feasibility pilot study.

BACKGROUND: Poor physical activity (PA) and sleep behaviors in Hispanic adolescents contributes to increased risk for type 2 diabetes. Commonly owned digital devices and services like smartphones and text-messaging are highly used among adolescents and are promising intervention tools for reaching this age group. Personal activity trackers assess activity and sleep, making them ideal tools for addressing these behaviors. We propose to examine the feasibility of a 12-week intervention that uses theoretically grounded text messages and a Fitbit device to improve PA and sleep among Hispanic adolescents with obesity, as compared to a wait-list control group with a Fitbit device only. METHODS: Participants (N = 48; 14-16 years) will be randomized (1:1) to the intervention or wait-list control group. Youth in the intervention will receive a Fitbit Charge 5 and daily text messages. Youth in the wait-list control group will receive a Fitbit Charge 5 and information on PA and sleep guidelines. RESULTS: Feasibility will be examined by collecting process evaluation data on the following criteria: (1) recruit 48 Hispanic adolescents 14-16 years; (2) retain 85% of participants for post-assessments; (3) Fitbit wear ≥4 days/week and respond to 80% of text messages when prompted; (4) ≤10% technical issues; and (5) obtain 80% satisfaction from participants. DISCUSSION: This study will advance our knowledge on the feasibility of digital prevention strategies to promote PA and sleep behaviors to reduce T2D risk among Hispanic youth. If feasible, this approach has the potential to be a scalable, cost-effective diabetes prevention strategy among high-risk youth. TRIAL REGISTRATION: NCT04953442, registered on July 8, 2021.

The Family Level Assessment of Screen Use-Mobile Approach: Development of an Approach to Measure Children's Mobile Device Use.

BACKGROUND: There is a strong association between increased mobile device use and worse dietary habits, worse sleep outcomes, and poor academic performance in children. Self-report or parent-proxy report of children's screen time has been the most common method of measuring screen time, which may be imprecise or biased. OBJECTIVE: The objective of this study was to assess the feasibility of measuring the screen time of children on mobile devices using the Family Level Assessment of Screen Use (FLASH)-mobile approach, an innovative method that leverages the existing features of the Android platform. METHODS: This pilot study consisted of 2 laboratory-based observational feasibility studies and 2 home-based feasibility studies in the United States. A total of 48 parent-child dyads consisting of a parent and child aged 6 to 11 years participated in the pilot study. The children had to have their own or shared Android device. The laboratory-based studies included a standardized series of tasks while using the mobile device or watching television, which were video recorded. Video recordings were coded by staff for a gold standard comparison. The home-based studies instructed the parent-child dyads to use their mobile device as they typically use it over 3 days. Parents received a copy of the use logs at the end of the study and completed an exit interview in which they were asked to review their logs and share their perceptions and suggestions for the improvement of the FLASH-mobile approach. RESULTS: The final version of the FLASH-mobile approach resulted in user identification compliance rates of >90% for smartphones and >80% for tablets. For laboratory-based studies, a mean agreement of 73.6% (SD 16.15%) was achieved compared with the gold standard (human coding of video recordings) in capturing the target child's mobile use. Qualitative feedback from parents and children revealed that parents found the FLASH-mobile approach useful for tracking how much time their child spends using the mobile device as well as tracking the apps they used. Some parents revealed concerns over privacy and provided suggestions for improving the FLASH-mobile approach. CONCLUSIONS: The FLASH-mobile approach offers an important new research approach to measure children's use of mobile devices more accurately across several days, even when the child shares the device with other family members. With additional enhancement and validation studies, this approach can significantly advance the measurement of mobile device use among young children.

Associations of prenatal phthalate exposure with neurobehavioral outcomes in 4.5- and 7.5-month-old infants.

Phthalates are ubiquitous endocrine-disrupting chemicals, and research indicates that prenatal exposure to some phthalates may affect neurodevelopment. In a prospective birth cohort study, five first-morning urine samples collected across pregnancy were pooled and the following phthalate biomarkers assessed: sum of di-(2-ethylhexyl) phthalate metabolites (ΣDEHP), sum of diisononyl phthalate metabolites (ΣDINP), sum of dibutyl phthalate metabolites (ΣDBP), sum of anti-androgenic metabolites (ΣAA), monoethyl phthalate (MEP), and sum of all phthalate metabolites (ΣAll). The Ages & Stages Questionnaires® (ASQ), a standardized parent-reported, age-adapted screening tool, measured communication, personal-social, problem solving, and motor domains in infants at 4.5 and 7.5 months (n = 123). Adjusting for maternal age, annual household income, gestational age at birth, infant age at assessment, and sex, repeated-measures generalized linear regression models were used to examine associations between prenatal phthalate urine biomarker concentrations and domain scores (assuming a Poisson distribution). Beta estimates were exponentiated back to the domain scale for ease of interpretation. Mothers were mostly white and college-educated, and most reported an annual household income of ≥$60,000. Associations of phthalate concentrations with ASQ outcomes are presented as follows: (1) anti-androgenic phthalate metabolites (ΣDEHP, ΣDINP, ΣDBP, and ΣAA), (2) MEP, which is not anti-androgenic, and (3) ΣAll. Overall, anti-androgenic phthalates were associated with higher (i.e., better) scores. However, there were exceptions, including the finding that a one-unit increase in ΣDBP was associated with a 12% increase in problem solving scores in 4.5-month-old females (ß = 1.12; 95% CI: 0.99, 1.28; p = 0.067) but a 85% decrease for 7.5-month-old females (ß = 0.54; 95% CI: 0.3, 0.99; p = 0.047). In contrast, MEP was associated with poorer scores on several outcomes. Sex- and timepoint-specific estimates demonstrated a one-unit increase in MEP was associated with: a 52% decrease in personal-social scores in 7.5-month-old males (ß = 0.66; 95% CI: 0.46, 0.95; p = 0.02), a 39% decrease in fine motor scores in 7.5-month-old males (ß = 0.72; 95% CI: 0.52, 0.98; p = 0.035), and a 6% decrease in fine motor scores in 4.5-month-old females (ß = 0.94; 95% CI: 0.88, 0.99; p = 0.03). A one-unit increase in ΣAll was associated with a 4% increase in personal-social scores in 4.5-month-old males (ß = 1.04; 95% CI: 0.99, 1.1; p = 0.08) but a 17% decrease in 7.5-month-old males (ß = 0.85; 95% CI: 0.73, 0.99; p = 0.03). These data suggest age- and sex-specific associations of prenatal phthalates with infant neurobehavior. The current findings should be confirmed by longitudinal studies with larger sample sizes.

Associations among diet, the gastrointestinal microbiota, and negative emotional states in adults.

Objective: Habitual diet impacts mood and the human gastrointestinal (GI) microbiota. Yet, studies infrequently control for diet when evaluating associations between mood and GI microbiota. Accordingly, we aimed to investigate relationships among diet, GI microbiota, and mood in adults without mood disorders by conducting a cross-sectional examination of dietary intake, subjective emotional state, and fecal microbial taxa abundances. Methods: Adults (N = 133; 25-45 years of age) without physician-diagnosed mood disorders were studied. Fecal DNA was extracted, and the V4 region of the 16S rRNA gene was sequenced. Sequences were analyzed using QIIME2. Subjective mood state was assessed using the 42-item Depression, Anxiety, and Stress Scale (DASS-42). Habitual dietary intake was measured with the National Cancer Institute's Diet History Questionnaire II, and diet quality was evaluated with the 2010 Healthy Eating Index (HEI). Results: Relationships were observed between 28 bacterial taxa and DASS-42 scores. Sex-dependent associations were observed among 21 bacterial taxa and DASS-42 scores, including an inverse relationship between Anxiety scale scores and Bifidobacterium in females and an inverse relationship between Depression scale scores and Lactobacillus in males. HEI total fruit and dairy components were inversely associated with Depression and Stress scales, respectively. Conclusions: These results suggest GI microbes are related to mood in adults without diagnosed mood disorders and that these relationships differ by sex and are influenced by dietary fiber intake. Incorporating dietary intake data in gut-microbiota-brain studies may help clarify the roles of specific microbes and dietary components in mental health symptoms.

Implementation and Evaluation of the Abriendo Caminos Program: A Randomized Control Trial Intervention for Hispanic Children and Families.

OBJECTIVE: To describe the methodology of a family-focused, culturally tailored program, Abriendo Caminos, for the prevention of excess weight gain in children. DESIGN: Randomized control trial with outcome assessment at pretest, posttest, and 6 months after intervention or abbreviated-attention control group. SETTING: Community setting across 5 sites (Illinois, California, Iowa, Texas, and Puerto Rico). PARTICIPANTS: Mexican American and Puerto Rican families (parent and 1 child aged 6-18 years). A sample size of 100 families (50 intervention and 50 control) per site (n = 500) will provide adequate power to detect intervention effects. INTERVENTION: Families will participate in 6 weekly, 2-hour group workshops on nutrition education through combined presentations and activities, family wellness, and physical activity. MAIN OUTCOME MEASURES: The primary outcome is prevention of excess weight gain in children; secondary outcomes include changes in child diet, specifically fruit, vegetable, and sugar-sweetened beverage consumption, and changes in parents' diets and improvement of family routines. Measures will be collected at baseline, postintervention, and 6 months after. ANALYSIS: Modeling to assess changes within and between experimental groups will be checked using standard methods including assessment of model fit, influence diagnostics, adjusted R2, and multicollinearity. Significance of effects will be examined using Type III tests.

Sprouts Growing Healthy Habits: Curriculum Development and Pilot Study.

High rates of childhood obesity and the impact this has on children's health make it important to establish a healthy lifestyle during the early school years. This pilot study explored the impact of a newly developed healthy habits curriculum. The Sprouts: Growing Healthy Habits curriculum presents topics such as energy balance, healthy sleep habits, and food groups through short activities and interactive book-reading. A nonrandomized controlled experimental study design was used to assess impact. Fifty-seven children between 5 and 6 years of age participated from two elementary schools (36 from the intervention school, 21 from the control school). Knowledge was assessed pre- and post-intervention in five content areas (farm to table, bedtime routines, portion size, energy expenditure, sugar content of beverages) using card sorting, ranking, and sequence activities. Within- and between-school comparisons were conducted using differences between groups and mixed modeling approaches. Within the intervention school, significant increases in knowledge were observed for farm to table, sugar content of beverages, and bedtime routines. For the control school, there was a significant increase in knowledge of portion sizes. Considering between-schools, only change in knowledge of bedtime routines remained significant, with greater increases in the intervention school. Results seem promising given the short dosage of curriculum. Increases in knowledge of healthy habits in early childhood may help in promoting healthy behaviors and combatting the effects of obesity.

Home feeding environment and picky eating behavior in preschool-aged children: A prospective analysis.

OBJECTIVE: Picky eating is prevalent in young children and is associated with poor dietary quality and nutrient deficiencies. Identifying predictors of picky eating could inform the development of anticipatory feeding guidance for parents and caregivers of young children. This study identified the association between factors of the home feeding environment with picky eating behavior in a cohort of preschool-aged children. METHODS: Parents of preschool-aged children (n = 497) completed questionnaires including measures of the home feeding environment (i.e., television during mealtime, family mealtime routines, and feeding practices) and child picky eating behavior. The questionnaire was repeated one year later, in which 326 parent-child dyads participated. Logistic regression was used to determine the cross-sectional and prospective associations between home feeding environment measures and child picky eating behavior outcomes. RESULTS: Child control over feeding and watching television during mealtime were associated with higher odds of picky eating behavior in both cross-sectional and prospective analyses. A higher sense of positive climate during family meals and mealtime ritualization was associated with lower odds of picky eating behavior one year later. CONCLUSION: The home feeding environment plays a role in the development of young children's picky eating behavior. Avoiding the television and maintaining parent control of food choices during mealtimes could lead to improvements in children's food preferences and dietary intake.

Predictors and Outcomes of Mealtime Emotional Climate in Families With Preschoolers.

Objective: Mealtime emotional climate (MEC) is related to parent feeding and mental health, and possibly to child food consumption. However, MEC has been inconsistently assessed with a variety of coding schemes and self-report instruments, and has not been examined longitudinally. This study aims to characterize MEC systematically using an observational, count-based coding scheme; identify whether parent feeding or mental health predict MEC; and examine whether MEC predicts child food consumption and weight. Methods: A subsample of parents (n = 74) recruited from a larger study completed questionnaires when children were about 37 months, participated in a home visit to videotape a mealtime when children were about 41 months, and completed questionnaires again when children were about 51 months old. Maternal and child positive and negative emotions were coded from videotaped mealtimes. Observational data were submitted to cluster analyses, to identify dyads with similar emotion expression patterns, or MEC. Logistic regression was used to identify predictors of MEC, and Analysis of Covariance was used to examine differences between MEC groups. Results: Dyads were characterized as either Positive Expressers (high positive, low negative emotion) or All Expressers (similar positive and negative emotion). Increased food involvement feeding practices were related to decreased likelihood of being an All Expresser. Positive Expressers reported that their children ate more healthy food, compared with All Expressers. Conclusions: Observed MEC is driven by maternal emotion, and may predict child food consumption. Food involvement may promote positive MEC. Improving MEC may increase child consumption of healthy foods.

Differences and Agreement in Perception of Child Picky Eating Among Center- and Home-Based Childcare Providers and Parents and Its Impact on Utilized Mealtime Strategies.

Picky eating is a problematic eating behavior caregivers may encounter with children under their care. A picky eater (PE) is typically characterized as consuming a narrow range of food, as well as rejecting several food items. Much of the literature regarding PEs involves parents, although use of nonparental childcare arrangements in the United States has increased in the past several decades. Although data on parental mealtime strategies exist, little is known about how parent and childcare provider pickiness perceptions differ between types of childcare, such as center-based childcare (CBCC) and home-based childcare (HBCC), or how these perceptions influence the mealtime strategies utilized. The objectives of this study were to (1) compare perceptions of child pickiness between parents and childcare providers, (2) compare percent agreement in pickiness perception between the dyads of CBCC parents and providers and HBCC parents and providers, and (3) identify mealtime strategy utilization based on pickiness perception. A total of 52 child, parent, and childcare provider triads participated in the study and completed the Mealtime Assessment Survey and the Parent/Teacher Mealtime Strategy Survey regarding the same child. Results showed that parents are 1.4 times more likely than childcare providers to perceive a child as being picky, HBCC parents and providers are 1.4 times more likely to perceive a child as being picky than CBCC parents and providers, CBCC parents and providers disagree more in their perception of child pickiness than HBCC parents and providers (41% vs 26%), and finally, perception of child pickiness has a greater influence on mealtime strategies utilized by parents. These results can be used to focus intervention efforts aimed at improving child eating habits across the home and childcare location.

The impact of environmental, parental and child factors on health-related behaviors among low-income children.

Multi-level factors act in concert to influence child weight-related behaviors. This study examined the simultaneous impact of variables obtained at the level of the home environment (e.g., mealtime ritualization), parent (e.g., modeling) and child (e.g., satiety responsiveness) with the outcomes of practicing healthy and limiting unhealthy child behaviors (PHCB and LUCB, respectively) in a low-income U.S. SAMPLE: This was a cross sectional study of caregivers of preschool children (n = 432). Caregivers were interviewed using validated scales. Structural equation modeling was used to examine associations with the outcomes. Adjusting for study region, demographics and caregiver's body mass index, we found significant associations between PHCB and higher mealtime ritualizations (ß: 0.21, 95% confidence interval [CI]: 0.11; 0.32, more parental modeling (ß: 0.39, 95% CI: 0.27; 0.49) and less parental restrictive behavior (ß: -0.19, 95% CI: -0.29; -0.10). More parental covert control (ß: 0.44, 95% CI: 0.35; 0.54), more parental overt control (ß: 0.14, 95% CI: 0.03; 0.25) and less parental permissive behavior (ß: -0.25, 95% CI: -0.34; -0.09) were significantly associated with LUCB. Findings suggest the synergistic effects of mealtime ritualizations and covert control at the environmental-level and parental modeling, overt control, restrictive and permissive behavior at the parent-level on the outcomes. Most factors are modifiable and support multidisciplinary interventions that promote healthy child weight-related behaviors.

Lipoprotein Biomarkers and Risk of Cardiovascular Disease: A Laboratory Medicine Best Practices (LMBP) Systematic Review.

BACKGROUND: Controversy exists about the incremental utility of nontraditional lipid biomarkers [e.g., apolipoprotein (apo) B, apo A-I, and non-HDL-C] in improving cardiovascular disease (CVD) risk prediction when added to a conventional model of traditional risk factors (e.g., total cholesterol, LDL cholesterol, HDL cholesterol, sex, age, smoking status, and blood pressure). Here we present a systematic review that was conducted to assess the use of nontraditional lipid biomarkers including apo B, apo A-I, apo B/A-I ratio, and non-HDL-C in improving CVD risk prediction after controlling for the traditional risk factors in populations at risk for cardiovascular events. CONTENT: This systematic review used the Laboratory Medicine Best Practices (LMBP™) A-6 methods. A total of 9 relevant studies published before and including July 2015 comprised the evidence base for this review. Results from this systematic review indicated that after the adjustment for standard nonlipid and lipid CVD risk factors, nontraditional apolipoprotein biomarkers apo B (overall effect = relative risk: 1.31; 95% CI, 1.22-1.40; 4 studies) and apo B/apo A-I ratio (overall effect = relative risk: 1.31; 95% CI, 1.11-1.38; 7 studies) resulted in significant improvement in long-term CVD risk assessment. SUMMARY: Available evidence showed that nontraditional lipid biomarkers apo B and apo B/apo I ratio can improve the risk prediction for cardiovascular events after controlling for the traditional risk factors for the populations at risk. However, because of insufficient evidence, no conclusions could be made for the effectiveness of apo A-I and non-HDL-C lipid markers to predict the CVD events, indicating a need for more research in this field.

The Independent and Cumulative Effect of Early Life Risk Factors on Child Growth: A Preliminary Report.

BACKGROUND: Early life risk factors may promote faster infant growth leading to childhood obesity. We examined growth patterns (birth to 12 months) and their association with early life risk factors. METHODS: Participants were drawn from an ongoing birth cohort of 351 mothers. Child weight and length were obtained at birth, 6 weeks, and 3, 6, 9, and 12 months. Independent variables and demographics were tested as risk factors for inclusion in the cumulative risk score if they were significantly associated with change in weight-for-length z-scores (WFLZ; month 12 minus birth) or based on established evidence for an association with child growth. Multiple regression was used to determine the association of change in WFLZ with low maternal education, low month 3 postpartum maternal weight loss, and nonexclusive breastfeeding by month 3 (use of formula) or their cumulative risk. Trajectory groups were identified using semiparametric mixture models and their association with the risk factors and cumulative risk score was tested using logistic regression. RESULTS: Nonexclusive breastfeeding by month 3 was associated with greater WFLZ increase. We identified three trajectory groups: low-rising (14.5%), mid-stable (59.4%), and high-rising (26.1%). Low-rising versus mid-stable group membership doubled with nonexclusive breastfeeding by month 3 (odds ratio [OR] = 2.24; 95% confidence interval [CI] = 1.05-4.80), but increased the most among children who had three risk factors compared to none (OR = 4.82; 95% CI = 1.14-20.32). No relationships were observed with high-rising growth. CONCLUSIONS: Early life risk factors influence the development of growth trajectories during the first year in a cumulative fashion.

Health literacy and parent attitudes about weight control for children.

The purpose of this study was to examine associations between parental health literacy and parent attitudes about weight control strategies for young children. Parental low health literacy has been associated with poor child health outcomes, yet little is known about its relationship to child weight control and weight-related health information-seeking preferences. Data were drawn from the STRONG Kids Study, a Midwest panel survey among parents of preschool aged children (n = 497). Parents endorsed an average of 4.3 (SD =2.8) weight loss strategies, 53% endorsed all three recommended weight loss strategies for children, and fewer than 1% of parents endorsed any unsafe strategies. Parents were most likely to seek child weight loss information from healthcare professionals but those with low (vs. adequate) health literacy were significantly less likely to use the Internet or books and more likely to use minister/clergy as sources. Poisson and logistic regressions showed that higher health literacy was associated with endorsement of more strategies overall, more recommended strategies, and greater odds of endorsing each specific recommended strategy for child weight control, after adjusting for parent age, education, race/ethnicity, income, marital status, weight concern, and child BMI percentile. Findings suggest that health literacy impacts parental views about child weight loss strategies and health information-seeking preferences. Pediatric weight loss advice to parents should include assessment of parent attitudes and prior knowledge about child weight control and facilitate parent access to reliable sources of evidence-informed child weight control information.

Parental perception of child weight in the first two years-of-life: a potential link between infant feeding and preschoolers' diet.

Approximately 23% of preschoolers are overweight or obese. Establishing a healthy dietary lifestyle at an early age can improve later child diet and body weight. This study examined the determinants of past infant feeding practices that do not follow standard feeding recommendations (breastfeeding for less than 6 months duration, cow's milk prior to the first year of age and solid foods at or before 4 months of age). It also examined the role of parental perception of child weight in the first 2 years-of-life on past infant feeding practices as well as current child diet and body weight. Families of 497 preschoolers aged 22-63 months (39.0 ± 8.2) were recruited from 30 child care centers in East-Central Illinois. Main findings indicate that past infant feeding practices were common and varied by socio-demographic factors including race/ethnicity, parental education and child gender. Children perceived as overweight in the first 2 years-of-life tended to breastfeed for lesser duration. Additionally, the majority (79.8%) of preschoolers who were classified as overweight using BMI percentile were perceived as non-overweight by the parent in the first 2 years-of-life. Mean daily total fatty/sugary food intake was higher among those perceived to be non-overweight in the first 2 years-of-life. These findings have identified parental perception of child weight in the first 2 years-of-life as a modifiable risk factor for unhealthy child diet and obesity among preschoolers.

Childhood overweight/obesity and pediatric asthma: the role of parental perception of child weight status.

Childhood obesity and asthma are on the rise in the U.S. Clinical and epidemiological data suggest a link between the two, in which overweight and obese children are at higher risk for asthma. Prevention of childhood obesity is preferred over treatment, however, in order to be receptive to messages, parents must perceive that their child is overweight. Many parents do not accurately assess their child's weight status. Herein, the relation between parental perceptions of child weight status, observed body mass index (BMI) percentiles, and a measure of child feeding practices were explored in the context of asthma, food allergy, or both. Out of the children with asthma or food allergy that were classified as overweight/obese by BMI percentiles, 93% were not perceived as overweight/obese by the parent. Mean scores for concern about child weight were higher in children with both asthma and food allergy than either condition alone, yet there were no significant differences among the groups in terms of pressure to eat and restrictive feeding practices. In summary, parents of children with asthma or food allergy were less likely to recognize their child's overweight/obese status and their feeding practices did not differ from those without asthma and food allergy.

Pancreatic cancer in Saudi patients treated at tertiary institution. Ten years retrospective study.

OBJECTIVES: To describe presentation, management, and outcome, and determine prognostic factors for pancreatic cancer patients. METHODS: A retrospective review of patients diagnosed with pancreatic cancer at King Abdulaziz Medical City, Riyadh, Saudi Arabia during the period from January 2000 to December 2010. Descriptive statistics were conducted on the collected data and survival was estimated using the Kaplan Meier estimate. Univariate and multiple regression analyses were carried out. RESULTS: The medical records of 179 patients were reviewed. The patients' median age was 63 years ranging from 15-96 years, and 116 (64.8%) of them were male. The one-year survival rate was 39% and the 5-year survival was 10%. The median overall survival (OS) was 6.9 months. Age at diagnosis, grade, T stage, N stage, M stage, TNM stage group, and the combined stage group (stage III/IV versus others), site of distant metastasis, carcinoembryonic antigen (CEA), carbohydrate antigen 19-9, surgery and chemotherapy were significant predictors for OS on an univariate Cox proportional hazards regression analysis. A multiple regression model including all the significant predictors was conducted. Age at the time of diagnosis and M stage were significant variables. CONCLUSION: Our patients present at a younger age and have better 5-year survival compared with the United States Surveillance Epidemiology and End Results data, which deserves further evaluation. Age and disease stage were identified as independent prognostic factors for survival in this patient population.