Glucose variability in 6-12-month-old healthy infants.

Background: Metabolic programming of glucose homeostasis in the first 1,000 days of life may impact lifelong metabolic and cardiovascular health. Continuous glucose monitoring (CGM) devices may help measure the impact of dietary intake on glucose rhythms and metabolism in infants during the complementary feeding period. Objectives: Demonstrate the feasibility of CGM to measure and quantify glucose variability in response to infant feeding and to evaluate associations between macronutrient meal composition and glucose variability. Methods: The "FreeStyle Libre Pro®" device interstitial glucose meter was applied to the anterior thigh of 10 healthy 6-12-month-old infants. Parents recorded food intake, time of feeding, and used daily dairies to record sleep time and duration. Descriptive statistics were employed for food intake, sleep and key glycemic parameters over three full days. Mixed linear models were used to assess glycemic changes. Results: Mid-day, afternoon, and evening feeds contained >30 g carbohydrate and induced higher 2-h iAUC (3.42, 3.41, and 3.50 mmol/L*h respectively) compared to early and mid-morning feedings with ≤25 g carbohydrates (iAUC 2.72 and 2.81 mmol/L*h, p < 0.05). Early morning and evening milk feedings contained approximately 9 g of fat and induced a longer time to reach maximal glucose value (Tmax; 75 and 68 min, respectively) compared to lower fat feedings (2.9-5.9 g; Tmax range: 34-60 min; p < 0.05). Incremental glucose value at time of food intake (C0) increased significantly from 0.24 ± 0.39 mM in early morning to 1.07 ± 0.57 mM in the evening (p < 0.05). Over the day, 70% of glucose values remained within the normal range (3.5-5.5 mmol/L), 10% were between 5.5-10 mmol/L, and 20% were < 3.5 mmol/L. Conclusion: Our data support the feasibility of using CGM to measure glucose in 6-12-month-old infants. The observation of possible diurnal glucose variability and typical glucose values may have implications for future studies investigating metabolic adaptation to nutritional intake in early life.

A meta-analysis comparing the effectiveness of alternate day fasting, the 5:2 diet, and time-restricted eating for weight loss.

OBJECTIVE: The objective of this meta-analysis was to compare the effectiveness of different intermittent fasting (IF) regimens on weight loss, in the general population, and compare these to traditional caloric energy restriction (CER). METHODS: Three databases were searched from 2011 to June 2021 for randomized controlled trials (RCTs) that assessed weight loss and IF, including alternate day fasting (ADF), the 5:2 diet, and time-restricted eating (TRE). A random effect network analysis was used to compare the effectiveness between the three regimens. Meta-regression analysis was presented as weighted mean differences of body weight loss. RESULTS: The exploratory random effects network analysis of 24 RCTs (n = 1768) ranked ADF as the most effective, followed by CER and TRE. The meta-analysis showed that IF regimens resulted in similar weight loss to CER (mean difference 0.26 kg, 95% CI: -0.31 to 0.84; p = 0.37). Compliance was generally high (>80%) in trials shorter than 3 months. CONCLUSIONS: The present meta-analysis concludes that IF is comparable to CER and a promising alternative for weight loss. Among the three regimens, ADF showed the highest effectiveness for weight loss, followed by CER and TRE. Further well-powered RCTs with longer durations of intervention are required to draw solid conclusions.

Nutrient Intakes among Brazilian Children Need Improvement and Show Differences by Region and Socioeconomic Level.

Brazil is the most populous country in South America. Using 24 h dietary data, we compared the nutrient intakes of 4-13-year-olds to reference values and tested for regional and socioeconomic (SES) differences. A considerable proportion reported intakes below the Estimated Average Requirements (EAR) for vitamins E (78.1%, 96.5%), D (100% for both), and calcium (80.5%, 97.7%) for 4-8 and 9-13-year-olds, respectively. Few exceeded Adequate Intakes (AI) for potassium or fiber. Older children reported greater inadequacies and, while there was regional variability, patterns of inadequacy and excess tended to be similar. For vitamin C, the percent of children below EAR in the Northeast and Southeast was lower than in the South. Most children, regardless of SES, had energy intakes within the Acceptable Macronutrient Distribution Ranges (AMDRs) for carbohydrates and protein. Over a quarter reported total energy from fat less than the AMDR, and inversely associated with SES (low 50.9%, moderate 26.0%, and high 15.0%), but also exceeding the percentage of energy recommendation for saturated fat, increasing with SES (low 18.1%, moderate 38.9%, and high 48.8%). The contrast observed between the diets of young Brazilians and recommendations underscores the need for individual and regional environmental interventions to promote healthier dietary patterns.

Development and Application of a Total Diet Quality Index for Toddlers.

For the first time, the 2020-2025 Dietary Guidelines for Americans include recommendations for infants and toddlers under 2 years old. We aimed to create a diet quality index based on a scoring system for ages 12 to 23.9 months, the Toddler Diet Quality Index (DQI), and evaluate its construct validity using 24 h dietary recall data collected from a national sample of children from the Feeding Infants and Toddlers Study (FITS) 2016. The mean (standard error) Toddler DQI was 49 (0.6) out of 100 possible points, indicating room for improvement. Toddlers under-consumed seafood, greens and beans, and plant proteins and over-consumed refined grains and added sugars. Toddler DQI scores were higher among children who were ever breastfed, lived in households with higher incomes, and who were Hispanic. The Toddler DQI performed as expected and offers a measurement tool to assess the dietary quality of young children in accordance with federal nutrition guidelines. This is important for providing guidance that can be used to inform public health nutrition policies, programs, and practices to improve diets of young children.

Nutrient Intake in Children 4-13 Years Old in Ibadan, Nigeria.

The paucity of adequate data on dietary and nutrient intakes of school-age children is a barrier to addressing malnutrition and associated risks in Nigeria. This study included 955 children aged 4-13 years from Ibadan, Nigeria, using a stratified random sampling design. Information on family socio-demographic characteristics was reported, and child anthropometrics were measured. Dietary intake data were collected using a multi-pass 24 h dietary recall method; 20% of subjects completed a second 24 h recall to estimate usual nutrient intakes. Means and distributions of usual intakes of energy and nutrients as well as prevalence of inadequacy were estimated. Usual energy intake (kcal/day) was 1345 and 1590 for younger (4-8 years) and older (9-13 years) age groups, respectively. The macronutrient intakes of most children did not conform to Adequate Macronutrient Distribution Ranges (AMDRs), which were characterized by a higher proportion of energy from carbohydrates and lower proportion from total fats. Protein intake was largely within the AMDR. Compared to recommendations, over 60% of 4-8-year-old children had inadequate intakes of calcium, copper, iron, folate, and vitamins A, D, and E. There were more micronutrient inadequacies in the older children. This study identifies nutrition gaps and suggests future research and education to improve child nutrition in Nigeria.

Evaluation of PIQNIQ, a Novel Mobile Application for Capturing Dietary Intake.

BACKGROUND: Accurate measurement of dietary intake is vital for providing nutrition interventions and understanding the complex role of diet in health. Traditional dietary assessment methods are very resource intensive and burdensome to participants. Technology may help mitigate these limitations and improve dietary data capture. OBJECTIVE: Our objective was to evaluate the accuracy of a novel mobile application (PIQNIQ) in capturing dietary intake by self-report. Our secondary objective was to assess whether food capture using PIQNIQ was comparable with an interviewer-assisted 24-h recall (24HR). METHODS: This study was a single-center randomized clinical trial enrolling 132 adults aged 18 to 65 y from the general population. Under a provided-food protocol with 3 menus designed to include a variety of foods, participants were randomly assigned to 1 of 3 food capture methods: simultaneous entry using PIQNIQ, photo-assisted recall using PIQNIQ, and 24HR. Primary outcomes were energy and nutrient content (calories, total fat, carbohydrates, protein, added sugars, calcium, dietary fiber, folate, iron, magnesium, potassium, saturated fat, sodium, and vitamins A, C, D, and E) captured by the 3 methods. RESULTS: The majority of nutrients reported were within 30% of consumed intake in all 3 food capture methods (n = 129 completers). Reported intake was highly (>30%) overestimated for added sugars in both PIQNIQ groups and underestimated for calcium in the photo-assisted recall group only (P < 0.001 for all). However, in general, both PIQNIQ methods had similar levels of accuracy and were comparable to the 24HR except in their overestimation (>30%) of added sugars and total fat (P < 0.001 for both). CONCLUSIONS: Our results suggest that intuitive, technology-based methods of dietary data capture are well suited to modern users and, with proper execution, can provide data that are comparable to data obtained with traditional methods. This trial was registered at clinicaltrials.gov as NCT03578458.

Food Sources of Key Nutrients, Meal and Dietary Patterns among Children Aged 4-13 Years in Ibadan, Nigeria: Findings from the 2019 Kids Nutrition and Health Study.

This study examined the contribution of food to nutrient intake, meal and dietary patterns among children aged 4-8 and 9-13 years in the city of Ibadan, Nigeria. Multi-pass 24-hour dietary recalls were used to assess intakes. Prudent and traditional Southwestern Nigerian dietary patterns were identified among children. The top foods and beverages were defined by frequency and amount consumed. Meal patterns were described by the eating occasions, while cluster analysis probed dietary patterns. About 88% of children had at least three meals including breakfast (95%), lunch (85%), dinner (92%) and midmorning meals (48%), while about 60% ate snacks at least once daily. Sources of energy and key nutrients were limited (yam, cassava, rice, maize, bread and beans/peas/legumes). The amount consumed per consumer of cassava products (192.2, 256.0 g), yam (169.7, 256.0 g), legumes (115.3, 150.7 g), corn/maize (160.4, 195.2), and rice (138.4, 182.3 g) were high, while beef (15.2, 17.9 g), eggs (50.6, 49.2 g), fish (27.5, 30.6 g), milk (24.2, 27.0 g) and nuts and seeds (18.2, 19.7 g) were low for children ages 4-8 and 9-13 years, respectively. In conclusion, while the frequency of meals suggests a healthy pattern, the top foods could not provide adequate nutrient (especially micronutrient) intake, which is key to the development of the target population.

Global Landscape of Nutrient Inadequacies in Toddlers and Young Children.

Toddlers and young children need an adequate and diverse diet to provide all of the nutrients required for optimal growth and development. Unfortunately, inadequate intake of vitamins and minerals is still identified by the World Health Organization (WHO) as a major public health threat for young children. Organizations like the WHO and the World Bank focus primarily on iron, zinc, vitamin A, and iodine for children ≤5 years of age in low-income countries. In addition to the data from these organizations, individual-level food consumption surveys are needed to provide a fuller picture of food and nutrient intakes. Where studies are available, intakes of dietary fiber and vitamin D are generally below recommendations for toddlers and young children. Other nutrient gaps differ by country and are related to food availability and local dietary habits. For example, young children in the US regularly consume dairy products, and <10% fall below recommendations for calcium intake compared to 2- to 4-year-old toddlers in the Philippines where dairy food consumption is low, and 66-84% fall below calcium recommendations. Dietary intake studies can help to identify the foods and beverages most relevant to alleviate nutrient gaps and improve dietary intakes of toddlers and young children around the world.

The Special Supplemental Nutrition Program for Women, Infants, and Children is Associated with Several Changes in Nutrient Intakes and Food Consumption Patterns of Participating Infants and Young Children, 2008 Compared with 2016.

BACKGROUND: In 2009 the USDA's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) updated the food packages provided to participants. OBJECTIVES: This study investigates associations between WIC participation and nutrients and food groups consumed using data from the Feeding Infants and Toddlers Study's 2008 and 2016 nationwide, cross-sectional surveys of children <4 y, weighted to be representative of the US population. METHODS: The study data included 2892 children aged 6-47.9 mo in 2008 and 2635 in 2016. Differences were analyzed by WIC participation, survey year, and child age (infants 6-11.9 mo old, toddlers 12-23.9 mo old, preschoolers 24-47.9 mo old). Usual nutrient intake distributions were estimated using National Cancer Institute methodology. Daily food group consumption differences were tested via multivariate regression. All analyses controlled for income. RESULTS: In 2016 18.6% of infants had iron intakes below the estimated average requirement (EAR), compared to 7.6% in 2008; 87% of WIC infants met the EAR, compared with 69% of non-WIC infants. In 2016 37% of WIC preschoolers met saturated fat guidelines, compared with 25% in 2008; in both years, fewer than one-third of non-WIC preschoolers met the guidelines. More WIC infants than non-WIC infants consumed infant cereals in 2016 (58% compared with 45%, respectively). More WIC infants ate vegetables daily in 2016 than in 2008 (74% compared with 59%, respectively).  In 2016, as compared with 2008, more WIC infants consumed baby-food vegetables (55% compared with 29%, respectively) and fruits (56% compared with 41%, respectively). In 2016 47% of WIC preschoolers drank low-fat milk, compared with 19% of non-WIC preschoolers. CONCLUSIONS: Infant iron intakes are concerning, although more WIC infants meet the EAR. WIC infants' vegetable intakes have improved; baby-food vegetables have become important contributors to their intakes. In 2016 WIC children were more likely than non-WIC children to shift to lower-fat milks at 2 y of age, likely contributing to lower saturated fat intakes.

Dairy Intake Would Reduce Nutrient Gaps in Chinese Young Children Aged 3-8 Years: A Modelling Study.

Dairy foods are under-consumed among Chinese children. We modeled the impact of increased dairy consumption on nutrient inadequacy and assessed whether the consumption of formulated milk powder for children ≥3 years (FMP3+) is useful for reducing nutrient gaps. Data from 3-8-year-old children, with completed socio-demographic and dietary measurements from the China Health and Nutrition Survey 2015, were used (n = 1122). Dietary intakes were modeled in two scenarios: Scenario 1 added FMP3+ or cow's milk to reported diet to reach recommended dairy intakes; Scenario 2 replaced the currently consumed milk with an equal volume of FMP3+. Reported nutrient intakes were compared with each model. Only 32.5% of children consumed dairy products; the average intake amount in total was 48.6 g/day. Most children (97.6%) did not meet dairy intake recommendation. Inadequate nutrient intakes were observed for calcium, potassium, thiamin, riboflavin, vitamin C and selenium. In Scenario 1, both FMP3+ and cow's milk improved the intake of all analyzed nutrients. In Scenario 2, FMP3+ substitution increased the intake of most nutrients, and reduced the proportion of children with an inadequate intake of vitamin C, thiamin, vitamin A, iron, zinc and potassium. Thus, increasing dairy consumption would reduce nutrient gaps, and FMP3+ is a good food source to help children meet nutrient requirements.

Investigation of number of replicate measurements required to meet cigarette smoke chemistry regulatory requirements measured under Canadian intense smoking conditions.

There has been increased interest in recent years in regulatory reporting of cigarette smoke toxicants. There is a great deal of diversity in current regulatory standards around the world in terms of the identities of regulated toxicants, and the number of replicate analyses stipulated for their measurement. Furthermore, analytical methods developed collaboratively by several organisations and intended for regulatory analysis generally differ in their recommended replicate numbers to those stipulated by regulators. In view of these inconsistencies, we undertook an exercise to examine the most appropriate numbers of replicates required for regulatory analysis of cigarette smoke toxicants. A one-point-in-time sampling exercise was undertaken of the German cigarette market, with 161 brands sampled and analysed in a single laboratory using Canadian Intense smoking conditions. Seven replicate measurements were made for each analyte and product, other than nicotine, CO and nicotine-free dry particulate matter for which eight replicate measurements were made. After confirming the absence of order of analysis effects, a variety of statistical tests (such as group assessment, paired comparisons, linear regression models and ratio analysis) were conducted examining mean values, SDs and CVs to identify the role of numbers of analytical replicates on data quality. The statistical analysis showed no difference in mean values for any of the 18 toxicants irrespective of replicate numbers (between 3 and 7 or 8). The large majority of analytes showed no difference in data variability with replicate number; but some very small differences (much lower than within product variability) were observed for a minority of compounds. Similarly, paired analysis showed no significant differences between mean values obtained using different replicate numbers in most cases, apart from very low differences (<5%) for a small number. Linear regression analysis showed correlations around 96 to 98% (other than crotonaldehyde at 91%) between values obtained with 3 vs 7 replicates. Similarly, per product mean value ratio analysis showed 95% consistency between values obtained with 3 and 7 replicates. We therefore conclude that three replicates is sufficient for precise determination of cigarette mainstream smoke toxicant emissions, and that use of 7 replicates as stipulated in some regulator jurisdictions does not offer any greater accuracy or precision.

Trends in Mean Nutrient Intakes of US Infants, Toddlers, and Young Children from 3 Feeding Infants and Toddlers Studies (FITS).

BACKGROUND: Many updates to young child feeding recommendations have been published over the past decade, but concurrent intake trends have not been assessed. OBJECTIVE: The aim of this study was to evaluate adequacy and trends in energy and nutrient intakes of US infants and children aged 0-47.9 mo through use of Feeding Infants and Toddlers Study (FITS) data from 2002, 2008, and 2016. METHODS: FITS are cross-sectional surveys of parents/caregivers of infants and young children (FITS 2002, n = 2962; FITS 2008, n = 3276; FITS 2016, n = 3235). Dietary intakes were assessed by telephone with trained interviewers using the Nutrition Data System for Research. Mean ± SE nutrient intakes were calculated. Diet adequacy was assessed with the nutrient adequacy ratio (NAR) for 17 nutrients and the corresponding mean adequacy ratio. RESULTS: Energy and macronutrient intakes were generally stable across surveys, but significant decreases for saturated fat and total sugars and an increase in fiber were observed among 6-11.9-mo-olds and 12-23.9-mo-olds (P-trend < 0.0001). Mean sodium intakes exceeded Adequate Intakes (AI) for all ages, whereas fiber intakes were universally below the AI. Nutrients with the lowest NAR values were vitamin D (range 0.41-0.67/1.00) and vitamin E (range 0.60-0.79/1.00 for 2008 and 2016). For iron, infants aged 6-11.9 mo had the lowest NAR values at 0.77-0.88/1.00, compared to 0.85-0.89/1.00 for 12-47.9-mo-olds. Potassium was low from 12 to 47.9 mo (NAR range 0.55-0.63/1.00 across survey years). The nutrients with the greatest decline in mean intakes were iron and vitamins D and E among 6-11.9-mo-olds, and vitamin D and potassium among 12-23.9-mo-olds in 2016 compared to 2002. CONCLUSIONS: The diets of US infants and young children were generally adequate for most micronutrients and stable over time, but sodium intakes were too high, and nutrient gaps still existed, especially for vitamins D, E, and fiber across ages and for iron among infants.

FITS and KNHS Overview: Methodological Challenges in Dietary Intake Data Collection among Infants, Toddlers, and Children in Selected Countries.

The FITS (Feeding Infants and Toddlers Study) and KNHS (Kids Nutrition and Health Study) are large-scale cross-sectional surveys designed to explore eating patterns, nutrient intakes, and food sources of nutrients among infants and children. FITS and KNHS use data from national surveys when available, but when data are not available for age groups of interest, we collect data using similar methods. So far, we have applied a common analysis approach in Australia, China, Mexico, the Philippines, Russia, and the United States. Although dietary data collection methods shared similarities, other aspects of the survey methodology differed considerably. Food composition tables varied, limiting accurate intake estimates to a short list of nutrients in some countries. Age groups and food grouping systems were not consistent, and the level of detail varied. Not all surveys recorded details about the meals or times when foods were consumed. Nonetheless, the FITS and KNHS have standardized age categories and food groupings, so comparisons can be made, and we have imputed missing values to complete data sets for nutrients of interest. We have also supported primary data collection to fill gaps. This manuscript provides an overview of the individual studies and country data that comprise the current FITS and KNHS.

Feeding Patterns of Infants and Toddlers: The Mexico Case Study.

Understanding the feeding patterns of Mexican infants and toddlers has required large efforts due to the lack of recent reliable data. The double burden of obesity and micronutrient undernutrition is a public health problem in Mexico. This chapter reviews a series of papers reporting the FITS (Feeding Infants and Toddlers Study) Mexico effort. Secondary data analyses from a nationally representative sample of over 5,000 children from the Mexican National Nutrition and Health Study 2012 ENSANUT (Encuesta Nacional de Salud y Nutrición) were used to review the feeding and drinking patterns of Mexican infants and young children. Feeding patterns in Mexican children are established early in life. Low rates of exclusive breastfeeding were found in infants under 6 months of age. Only half of 6- to 47.9-month-old children consumed fruits, and 80% did not consume any vegetables (including potatoes) on the day of the survey. From the age of 12 months, more than 80% consumed sweets or sweetened beverages on any given day. For nutrients, 61% of infants 6-11.9 months old did not meet the estimated average requirement for iron, indicating a nutritional risk. High intakes of food groups with poor micronutrient and high energy levels might explain the nutritional condition for the Mexican population. Mexican experts have used this information to make recommendations and establish complementary feeding guidelines for healthy infants. Public policy and practice must now change accordingly.

The 2016 Feeding Infants and Toddlers Study (FITS): Dietary Intakes and Practices of Children in the United States from Birth to 48 Months.

FITS (the Feeding Infants and Toddlers Study) 2016 is a national, cross-sectional survey to evaluate the diets and feeding practices of US infants and children <48 months (n = 3,235). Dietary intakes were assessed using 24-h recalls, including a replicate subsample (n = 799), to estimate usual intake distributions and compliance with dietary reference intakes using the National Cancer Institute method. Infant feeding practices and 1-day food group consumption were assessed by age and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Initiation and duration of breastfeeding were higher in 2016 compared to previous FITS surveys. Nutrient intakes of infants were largely adequate, except for vitamins D and E and iron (18% did not meet the iron recommendations at 6-11.9 months). WIC-participating infants were more likely to meet iron recommendations, potentially due to higher use of infant formula. More nutrient inadequacies were noted among toddlers and preschoolers, including low intakes of potassium (12+ months), fiber (12+ months), and vitamins D and E (12+ months), combined with high intakes of sodium and added sugars, especially among WIC participants, and saturated fat among those 24-36 months. These imbalances result from low intakes of vegetables and whole grains, and high intakes of processed meats, sweetened bakery foods, and sugar-sweetened beverages.

Changes in Biomarkers of Exposure on Switching From a Conventional Cigarette to Tobacco Heating Products: A Randomized, Controlled Study in Healthy Japanese Subjects.

BACKGROUND: Smoking is a leading cause of numerous human disorders including pulmonary disease, cardiovascular disease, and cancer. Disease development is primarily caused by exposure to cigarette smoke constituents, many of which are known toxicants. Switching smokers to modified risk tobacco products (MRTPs) has been suggested as a potential means to reduce the risks of tobacco use, by reducing such exposure. METHODS: This randomized, controlled study investigated whether biomarkers of toxicant exposure (BoE) were reduced when smokers switched from smoking combustible cigarettes to using a novel (glo™/THP1.0) or in-market comparator (iQOS/THS) tobacco heating product (THP). One hundred eighty Japanese smokers smoked combustible cigarettes during a 2-day baseline period, followed by randomization to either continue smoking cigarettes, switch to using mentholated or non-mentholated variants of glo™, switch to using a non-mentholated variant of iQOS, or quit nicotine and tobacco product use completely for 5 days. Baseline and post-randomization 24-h urine samples were collected for BoE analysis. Carbon monoxide was measured daily in exhaled breath (eCO). RESULTS: On day 5 after switching, urinary BoE (excluding for nicotine) and eCO levels were significantly (p < .05) reduced by medians between 20.9% and 92.1% compared with baseline in all groups either using glo™ or iQOS or quitting tobacco use. Between-group comparisons revealed that the reductions in the glo™ groups were similar (p > .05) to quitting in many cases. CONCLUSIONS: glo™ or iQOS use for 5 days reduced exposure to smoke toxicants in a manner comparable to quitting tobacco use. THPs are reduced exposure tobacco products with the potential to be MRTPs. IMPLICATIONS: This clinical study demonstrates that when smokers switched from smoking combustible cigarettes to using tobacco heating products their exposure to smoke toxicants was significantly decreased. In many cases, this was to the same extent as that seen when they quit smoking completely. This may indicate that these products have the potential to be reduced exposure and/or reduced risk tobacco products when used by smokers whose cigarette consumption is displaced completely. CLINICAL TRIAL REGISTRATIONS: ISRCTN14301360 and UMIN000024988.

Nicotine pharmacokinetics of electronic cigarettes: A review of the literature.

E-cigarettes are battery-powered electronic devices from which users can inhale nicotine following its aerosolisation from a liquid solution. Some regulators and public health bodies consider e-cigarettes as potentially playing a major role in tobacco harm reduction. Their ability to provide nicotine to smokers in both amount and in a manner and form generally similar to cigarette smoking have been proposed as key components to help smokers reduce or cease the use of combustible cigarettes. Nicotine pharmacokinetic studies of e-cigarettes have been performed for a number of years and are beginning to show how nicotine delivery is evolving as the products themselves evolve. In this review, we provide a critical overview of the literature to describe what is known about nicotine delivery from e-cigarettes. We will discuss how the progression of e-cigarette design, development, and user familiarity has allowed increases in nicotine availability to the user, in the context of how much and how rapidly nicotine is delivered during acute-use periods. This review will also provide insight into current research gaps and highlight the potential utility of modelling and the standardisation of methodologies used to assess nicotine delivery to facilitate identification of products that are best suited to displace cigarette smoking among adult smokers.

WIC and non-WIC Infants and Children Differ in Usage of Some WIC-Provided Foods.

Background: USDA's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides expert-chosen supplemental foods to improve the diets and health of low-income infants and children <5 y of age, but dietary behaviors of WIC participants are not well characterized. Objective: The purpose of this analysis was to examine differences in food consumption patterns between WIC participants and nonparticipants. Methods: FITS 2016 is a nationwide cross-sectional study of children <4 y (n = 3235). Data were weighted to provide US population-representative results. Children were categorized as WIC participants or nonparticipants, with the latter divided into lower- and higher-income nonparticipants. Group differences were assessed via the Wald test (demographics) and Rao-Scott modified chi-square test (breastfeeding prevalence). Differences in percentage consuming WIC-provided and selected other foods between WIC participants and nonparticipants were evaluated with the use of ORs and 95% CIs. Results: WIC infants were less likely to breastfeed than were higher-income nonparticipants at 0-5.9 mo (45% compared with 74%) and less likely than both nonparticipant groups at 6-11.9 mo (30% compared with 49-60%). WIC 6- to 11.9-mo-olds were more likely to consume infant cereals and vegetables than were lower-income nonparticipants. WIC 12 to 23.9-mo-olds were more likely to drink whole milk (which WIC provides at this age) than were nonparticipants (72% compared with 59-64%), whereas WIC participants 24-47.9 mo were more likely to drink low- and nonfat milks (which WIC provides at this age) than were nonparticipants (45% compared with 13-22%). WIC participants 6-47.9 mo were more likely to drink juice than were nonparticipants. Conclusions: Continued improvements in early dietary patterns are warranted for WIC and non-WIC children. Breastfeeding among WIC participants is a continuing challenge. Findings suggest that baby-food cereals, vegetables, and fruits (all provided by WIC) contribute importantly to WIC infants' diets, whereas WIC children are more likely to use lower-fat milks after 2 y of age than are non-WIC participants.

Location influences snacking behavior of US infants, toddlers and preschool children.

BACKGROUND: Compare at-home and away-from-home snacking patterns of US infants and young children. METHODS: A secondary analysis was conducted using nationwide, cross-sectional dietary survey data from the US Feeding Infants and Toddlers Study (FITS) 2008. The sample included infants (6-11.9 months, n = 505), toddlers (12-23.9 months, n = 925), preschool children (24-47.9 months, n = 1461). Weighted population descriptive statistics (means and standard errors) were calculated using SAS. Significance was determined at P ≤ 0.05. The main outcome measures of the analyses were the percent of children consuming snacks by location (at home, away from home) and snacking period (morning, afternoon and evening), energy and food groups consumed during snacks. RESULTS: Snacking at home was more prevalent than snacking away from home (toddlers, 73% vs 27%; preschoolers, 67% vs 33%). Away-from-home snacks provided about 50 additional calories per day for toddlers (346 vs 298 kcal/day, P ≤ 0.05) and preschoolers (371 vs 326 kcal/day, P ≤ 0.05) versus snacks consumed at home. Caregivers made similar snack choices for toddlers and preschoolers (milk/milk products, fruit/juice, grains and sweets) but differed in frequency of consumption by location. Among toddlers, milk/milk products were the most frequently consumed snacks at home (66%), while sweets were the top snacks consumed away from home (69%). Among preschoolers, sweets were the top snacks both at home (60%) and away (83%). CONCLUSIONS: Location is an important factor influencing snacking patterns of young children and should be considered when developing feeding guidelines. This data may be of use in the upcoming development of dietary guidelines in the U.S. for the population aged 0-2 years.

Usual Nutrient Intakes from the Diets of US Children by WIC Participation and Income: Findings from the Feeding Infants and Toddlers Study (FITS) 2016.

Background: A recent report of the National Academies of Sciences, Engineering, and Medicine (NASEM) outlined priority nutrients for infants and children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Objective: The objective of this study was to assess usual nutrient intakes from foods and beverages (not supplements) among US children aged <4 y by WIC participation status. Methods: A national random sample of children aged <4 y (n = 3,235) from the Feeding Infants and Toddlers Study (FITS) 2016 was categorized by WIC participation status (participants, lower-income nonparticipants, or higher-income nonparticipants) and age (younger infants aged 0-5.9 mo, older infants aged 6-11.9 mo, toddlers aged 12-23.9 mo, or preschoolers aged 24-47.9 mo). All participants contributed one 24-h dietary recall, with a second recall from a representative subsample (n = 799). Usual intakes and compliance with federal dietary recommendations were estimated by using the National Cancer Institute method. Differences between WIC participants and either lower-income nonparticipants or higher-income nonparticipants were tested using t tests. Results: The diets of infants (aged <12 mo) were nutritionally adequate in general. Older infants participating in WIC had higher compliance with iron and vitamin D guidelines than either group of nonparticipants and greater compliance with calcium, zinc, and potassium guidelines than higher-income nonparticipants. WIC toddlers had a higher risk of inadequate calcium and excessive sodium intakes than higher-income nonparticipants. Eight percent of WIC toddlers exceeded added sugar guidelines compared with either nonparticipant group (∼2%). WIC toddlers and preschoolers had a lower risk of inadequate vitamin D intake than lower-income nonparticipants, but inadequacy was >75% across all subgroups. WIC preschoolers had higher compliance with saturated fat guidelines but lower compliance with sodium and added sugar guidelines than higher-income nonparticipants. Conclusions: WIC participants had better intakes of iron (ages 6-23.9 mo), zinc and potassium (ages 6-11.9 mo), saturated fat (ages 24-47.9 mo), and vitamin D (all ages). Regardless of WIC participation status, most infants and children met the calcium and zinc guidelines, but large proportions had intakes not meeting the recommendations for iron (ages 6-11.9 mo), vitamin D, potassium, fiber, saturated fat, and sodium.