Association of prenatal participation in a public health nutrition program with healthy infant weight gain.

OBJECTIVES: We tested the hypothesis that early enrollment in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is associated with a reduced risk of rapid infant weight gain (RIWG). METHODS: We used a longitudinal cohort of mother-infant pairs (n = 157,590) enrolled in WIC in New York State from 2008 to 2009 and estimated the odds of RIWG, defined as a 12-month change in weight-for-age z score of more than .67, comparing infants of mothers enrolled during the first, second, or third trimester of pregnancy with those who delayed enrollment until the postpartum period. RESULTS: After adjusting for potential confounders, the odds of RIWG (odds ratio [OR] = 0.76; 95% confidence interval [CI] = 0.74, 0.79) were significantly lower for infants of women enrolling during the first trimester versus postpartum. Birth weight-for-gestational-age z score (OR = 0.33; 95% CI = 0.32, 0.33) attenuated the estimate of prenatal versus postpartum enrollment (OR = 0.92; 95% CI = 0.88, 0.95; first-trimester enrollees). CONCLUSIONS: The results demonstrate that prenatal WIC participation is associated with reduced risk of RIWG between birth and age 1 year. Improved birth weight for gestational age may be the mechanism through which early prenatal WIC enrollment protects against RIWG.

Fruit juice intake predicts increased adiposity gain in children from low-income families: weight status-by-environment interaction.

OBJECTIVE: Our goal was to test the hypothesis that increased fruit juice intake and parental restriction of children's eating are associated with increased adiposity gain and whether exposure to nutritional counseling predicted reduced adiposity gain among children. PATIENTS AND METHODS: A sample of parents or guardians of children aged 1 to 4 years who attended 1 of 49 Special Supplemental Nutrition Program for Women, Infants, and Children agencies in New York State were surveyed in 1999 or 2000 (N = 2801). The survey addressed children's dietary intake, parental feeding practices, and parental exposure to nutritional counseling messages to increase fruit, vegetable, and low-fat milk intakes. Each child's height and weight were measured approximately every 6 months for up to 48 months. A prospective cohort design was used in which survey variables were the predictors and the outcome was change in children's adiposity, defined as change in age- and gender-standardized BMI per month (ie, BMI z-score slope). RESULTS: Controlling for gender and ethnicity, the relationship between juice intake and adiposity gain depended on children's initial overweight status. Among children who were initially either at risk for overweight or overweight, increased fruit juice intake was associated with excess adiposity gain, whereas parental offerings of whole fruits were associated with reduced adiposity gain. Each additional daily serving of fruit juice was associated with an excess adiposity gain of 0.009 SD per month. Feeding restriction was greater among parents whose children were initially at risk for overweight or overweight compared with those at a healthy weight. Parental exposure to nutritional messages was not associated with reduced child adiposity gain. CONCLUSION: This study supports the Institute of Medicine recommendations to reduce fruit juice intake as a strategy for overweight prevention in high-risk children.

Spatiotemporal Bayesian analysis of Lyme disease in New York state, 1990-2000.

Mapping ordinarily increases our understanding of nontrivial spatial and temporal heterogeneities in disease rates. However, the large number of parameters required by the corresponding statistical models often complicates detailed analysis. This study investigates the feasibility of a fully Bayesian hierarchical regression approach to the problem and identifies how it outperforms two more popular methods: crude rate estimates (CRE) and empirical Bayes standardization (EBS). In particular, we apply a fully Bayesian approach to the spatiotemporal analysis of Lyme disease incidence in New York state for the period 1990-2000. These results are compared with those obtained by CRE and EBS in Chen et al. (2005). We show that the fully Bayesian regression model not only gives more reliable estimates of disease rates than the other two approaches but also allows for tractable models that can accommodate more numerous sources of variation and unknown parameters.

Rapid infant weight gain predicts childhood overweight.

OBJECTIVE: To determine among a contemporary cohort whether rapid weight gain between birth and 6 months is associated with risk of childhood overweight and if this risk differs by ethnicity and/or breast-feeding history. RESEARCH METHODS AND PROCEDURES: This was a cross-sectional survey in 1999 to 2000 of parents/guardians of children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children in New York State. Measurements were abstracted by chart review, including weight at birth and 6 months, and height and weight at time of survey and every 6 months subsequently. Overweight at 4 years of age was defined as a BMI > or = 95th age- and sex-specific percentiles. RESULTS: The study sample was 32% Hispanic, 19% black, and 49% white; 17% of children were overweight. Rate of infant weight gain (expressed in terms of 100 g/mo) was significantly associated with being overweight at 4 years (odds ratio, 1.4; 95% confidence interval, 1.3 to 1.6 after adjusting for history of breast-feeding, birth weight, and ethnicity). The odds of being overweight at 4 years of age for Hispanic children were twice those of non-Hispanic children (odds ratio, 2.2; 95% confidence interval, 1.5 to 3.3). The population-attributable risk of overweight at 4 years of age was 19% for children in the highest quintile of infant weight gain. DISCUSSION: Among this contemporary, multi-ethnic cohort, rapid infant weight gain was associated with increased risk of being overweight at 4 years of age, independently of potential confounders. Identification of the risk factors contributing to rapid weight gain during infancy might improve early recognition and guide strategies for optimal nutrition to prevent the development of childhood overweight.

Epidemic and spatial dynamics of Lyme disease in New york State, 1990-2000.

Lyme disease (LD) occurrence in New York State (NYS) has not only increased over time but also spread throughout the state from the original disease focus in southeastern NYS. Few studies have investigated this epidemic and spatial dynamic in great detail. Using data from the NYS Department of Health Lyme Registry Surveillance System, we summarized epidemic and spatial characteristics of LD in NYS for the 11-yr time period from 1990 through 2000. New epidemiological trends associated with age, sex, and residential influences on LD over time were found. An empirical Bayes approach was used to produce maps of smoothed incidence at different time points to give a foundation for future state and local health funding plans and education programs.