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1.
Br J Nutr ; : 1-25, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31477198

RESUMO

Consumption of sugar sweetened beverages (SSBs) in infants and young children are less explored in Asian populations. The Growing in Singapore Towards healthy Outcomes (GUSTO) cohort study examined associations between SSB intakes at ages 18 months and 5 years with adiposity measures at age 6 years. We studied Singaporean infants/children with SSB intake assessed by food frequency questionnaires (FFQ) at ages 18 months (n=555) and 5 years (n=767). The median (interquartile range) for SSB intakes is 28(5.5-98) ml at age 18 months and 111 (57-198) ml at age 5 years. Associations between SSB intakes (100 ml/day increments and tertile categories) and adiposity measures (BMI standard deviation scores (s.d. unit), sum of skinfolds (SSFs)) and overweight/obesity status were examined using multivariable linear and Poisson regression models, respectively. After adjusting for confounders and additionally for energy intake, SSB intakes at age 18 months were not significantly associated with later adiposity measures and overweight/obesity outcomes. In contrast, at age 5 years, SSB intakes when modelled as 100ml/day increments were associated with higher BMI by 0.09 (95% CI: 0.02, 0.16) s.d. unit, higher SSF thickness by 0.68 (0.06, 1.44) mm, and increased risk for overweight/obesity by 1.2 times (1.07, 1.23) at age 6 years. Trends were consistent with SSB intakes modelled as categorical tertiles. In summary, SSB intake in young childhood is associated with higher risks of adiposity and risk for overweight/obesity. Public health policies working to reduce SSB consumption need to focus on prevention programs targeted at young children.

2.
Clin Nutr ; 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31493922

RESUMO

BACKGROUND & AIMS: Maternal metabolic disturbance arising from inappropriate meal timing or sleep deprivation may disrupt circadian rhythm, potentially inducing pregnancy complications. We examined the associations of maternal night-time eating and sleep duration during pregnancy with gestation length and preterm birth. METHODS: We studied 673 pregnant women from the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Maternal energy intake by time of day and nightly sleep duration were assessed at 26-28 weeks' gestation. Based on 24-h dietary recall, night-eating was defined as consuming >50% of total energy intake from 1900 to 0659 h. Short sleep duration was defined as <6 h night sleep. Night-eating and short sleep were simultaneously analyzed to examine for associations with a) gestation length using multiple linear regression, and b) preterm birth (<37 weeks' gestation) using logistic regression. RESULTS: Overall, 15.6% women engaged in night-eating, 12.3% had short sleep and 6.8% delivered preterm. Adjusting for confounding factors, night-eating was associated with 0.45 weeks shortening of gestation length (95% CI -0.75, -0.16) and 2.19-fold higher odds of delivering preterm (1.01, 4.72). Short sleep was associated with 0.33 weeks shortening of gestation length (-0.66, -0.01), but its association with preterm birth did not reach statistical significance (1.81; 0.76, 4.30). CONCLUSIONS: During pregnancy, women with higher energy consumption at night than during the day had shorter gestation and greater likelihood of delivering preterm. Misalignment of eating time with day-night cycles may be a contributing factor to preterm birth. This points to a potential target for intervention to reduce the risk of preterm birth. Observations for nightly sleep deprivation in relation to gestation length and PTB warrant further confirmation.

3.
Int J Behav Nutr Phys Act ; 16(1): 70, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438965

RESUMO

PURPOSE: Integrated 24-Hour Movement Guidelines provide specific recommendations on screen viewing (SV), moderate-to-vigorous physical activity (MVPA) and sleep to improve health of children and youth. However, few studies have examined whether these guidelines are met in young children, particularly in Asia. We evaluated adherence to integrated and individual guidelines and its predictors in 5.5-year-old Singaporean children. METHODS: Growing Up in Singapore towards Healthy Outcomes (GUSTO) is a mother-offspring birth cohort study. At age 5.5 years, child SV was reported by parents. Movement behaviours (MBs) were measured continuously using wrist-worn accelerometers over 7 consecutive days and nights. For accelerometer data including ≥3 days with ≥16 h/day we estimated mean (±SD) daily MVPA, SV and nighttime sleep duration across the week. Adherence to integrated (Canadian/Australian) guidelines was defined as meeting all individual guidelines: ≥60 min of MVPA/day, ≤2 h of screen time/day, and 9-11 h of sleep/night. Socio-demographic and maternal predictors collected at pregnancy enrolment and at 26-28 weeks' gestation were examined by multivariable logistic regression. RESULTS: Of 864 children followed up age 5.5 years, 547 (63.3%) had both valid ActiGraph and questionnaire data (51.7% boys and 58.3% Chinese ethnicity). Children averaged 101.9 (± 88.7) min/day SV, 67.3 (± 23.7) min/day MVPA and 480.6 (± 57.2) min/night sleep. Few children met integrated guidelines. Specifically, the proportions of children who met none, SV, MVPA, sleep and integrated guidelines were 11.2, 70.2, 59.6, 13.7 and 5.5%, respectively. Multivariable analysis showed that maternal activity and television (TV) viewing were associated with meeting integrated guidelines (insufficiently vs. highly active (OR [95% CI]): 0.11 [0.01, 0.95]; 2-3 vs. ≥ 3 h TV: 3.52 [1.02, 12.22]). Examining higher adherence to individual guidelines, Chinese ethnicity, younger maternal age and lower maternal TV and sleep time were associated with greater SV; male sex, Malay ethnicity, higher birth order and higher maternal activity level were associated with greater MVPA; and older maternal age was associated with adherence to sleep guideline. CONCLUSIONS: Beyond individual behaviours, consideration of the full spectrum of MBs may be important to improve children's health. However, few Singaporean children adhere to integrated 24-h movement guidelines. Maternal behaviours as early as during pregnancy could be important targets for future interventions aiming to promote these MBs in children.

4.
BMC Pediatr ; 19(1): 286, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31419962

RESUMO

BACKGROUND: Although infant media exposure has received attention for its implications on child development, upstream risk factors contributing to media exposure have rarely been explored. The study aim was to examine the relationship between maternal risk factors, infant television (TV) viewing, and later child cognition. METHODS: We used a prospective population-based birth cohort study, Growing Up in Singapore Towards healthy Outcomes (GUSTO), with 1247 pregnant mothers recruited in their first trimester. We first explored the relationship of infant TV exposure at 12 months and the composite IQ score at 4.5 years, as measured by the Kaufman Brief Intelligence Test, Second Edition (KBIT-2). Multivariable linear regressions were adjusted for maternal education, maternal mental health, child variables, birth parameters, and other relevant confounders. We then examined the associations of maternal risk factors with the amount of daily TV viewing of 12-month-old infants. Path analysis followed, to test a conceptual model designed a priori to test our hypotheses. RESULTS: The average amount of TV viewing at 12 months was 2.0 h/day (SD 1.9). TV viewing in hours per day was a significant exposure variable for composite IQ (ß = - 1.55; 95% CI: - 2.81 to - 0.28) and verbal IQ (ß = - 1.77; 95% CI: - 3.22 to - 0.32) at 4.5 years. Our path analysis demonstrated that lower maternal education and worse maternal mood (standardized ß = - 0.27 and 0.14, respectively, p < 0.01 for both variables) were both risk factors for more media exposure. This path analysis also showed that maternal mood and infant TV strongly mediated the relationship between maternal education and child cognition, with an exceptional model fit (CFI > 0.99, AIC 15249.82, RMSEA < 0.001). CONCLUSION: Infant TV exposure has a negative association with later cognition. Lower maternal education and suboptimal maternal mental health are risk factors for greater television viewing. Paediatricians have a role in considering and addressing early risks that may encourage television viewing.

5.
Proc Natl Acad Sci U S A ; 116(34): 16787-16792, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31383763

RESUMO

Attachment disorganization is a risk factor for difficulties in attention, social relationships, and mental health. Conceptually, attachment disorganization may indicate a breakdown in fear regulation resulting from repeated exposure to frightening maternal care. In addition, past research has examined the influence of stress-inducing contextual factors and/or child factors upon the development of disorganization. However, no past work has assessed whether infant neuroanatomy, important to stress regulation, moderates the association between maternal care and levels of disorganized behavior. Here, utilizing data from a subsample of 82 dyads taking part in the "Growing Up in Singapore towards Healthy Outcomes" (GUSTO) cohort, we assessed the prediction from maternal sensitive caregiving at 6 mo and levels of attachment disorganization at 1.5 y, as moderated by hippocampal and amygdala volume determined within the first 2 weeks of life. Results indicate a significant interaction between neonatal left hippocampal volume and maternal sensitivity upon levels of disorganized behavior. Although these results require substantiation in further research, if replicated, they may enable new strategies for the identification of processes important to child mental health and points for intervention. This is because neonatal neuroanatomy, as opposed to genetic variation and sociodemographic risk, may be more directly linked to stress responses within individuals.

6.
Int J Nurs Stud ; 99: 103385, 2019 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-31442783

RESUMO

BACKGROUND: Besides physical and mental changes from childbirth, first-time mothers are also confronted with challenges associated with the demands of adapting to their roles as new parents. While positive effects of home-based psychoeducation intervention for mothers have been demonstrated, limited studies have developed and examined more accessible and cost-effective web-based psychoeducational interventions for mothers. OBJECTIVE: To examine the effectiveness of web-based and home-based postnatal psychoeducational interventions for first-time mothers during the early postpartum period. METHODS: A randomized controlled three-group pre-test and post-tests experimental design was adopted. Data were collected over five months, from October 2016 to August 2017, in a public tertiary hospital in Singapore from 204 primiparas who were randomly allocated to the web-based psychoeducation group, the home-based psychoeducation group, or the control group. The measured outcomes included maternal parental self-efficacy, social support, psychological well-being, satisfaction with postnatal care, and cost-effectiveness evaluation. Data were collected at four time points: the baseline, and three post-tests at one month, three and six months post-delivery. RESULTS: When compared to the control group, the web-based intervention improved self-efficacy at post-test 1 (mean difference = 2.68, p = 0.028) and reduced postnatal depression at post-test 3 (mean difference = -1.82, p = 0.044), while the home-based intervention did not show significant effect on these two outcomes at all post-tests. Both web-based and home-based interventions helped mothers to get better social support at all post-tests than those in the control group. Mothers in both web-based and home-based intervention groups were more satisfied with the postnatal care than those in the control group at all post-test time points (except for web-based group at post-test 1). There were no differences in anxiety scores among the three groups. When compared to the home-based intervention, the web-based intervention showed noninferior effect on all outcomes at all post-tests. CONCLUSION: The web-based intervention had better effects on improving self-efficacy, social support, and postnatal depression, which should be introduced to first-time mothers for better postnatal care.

7.
Appetite ; 142: 104371, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31323246

RESUMO

Parents' feeding practices have been shown to be associated with children's food intake and weight status, but little is known about feeding practices in Asian countries. This study used behavioral observation to explore the feeding practices of 201 mothers of 4.5 year-old children in Singapore during an ad libitum buffet lunch. Feeding practices were coded from videos, focusing on behaviors used to prompt the child to eat more food (autonomy-supportive and coercive-controlling prompts to eat, suggesting items from buffet), those to reduce intake (restriction, questioning food choice), and those related to eating rate (hurrying or slowing child eating). Child outcome measures included energy consumed, variety of food items selected, and BMI. Maternal restriction and trying to slow child eating rate were associated with higher energy consumed by the child (r = 0.19 and 0.13, respectively; p < 0.05). Maternal autonomy-supportive prompts and restriction were associated with a greater variety of items selected by children (r = 0.19 and 0.15, respectively; p < 0.05). The frequency of maternal feeding practice use differed across ethnic groups, with Malay mothers using the most prompts to eat (p < 0.05), Chinese mothers most likely to question a child's food choice (p < 0.01), and Indian mothers the last likely to tell the child to eat faster (p < 0.001). There were no differences between ethnic groups for other feeding practices. No associations were found between feeding practices and child BMI. It is possible that feeding practices related to restriction and slowing child eating are adopted in response to children who consume larger portions, although longitudinal or intervention studies are needed to confirm the direction of this relationship and create local recommendations.

8.
Cereb Cortex ; 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31339998

RESUMO

Maternal depression is associated with disrupted neurodevelopment in offspring. This study examined relationships among postnatal maternal depressive symptoms, the functional reward network and behavioral problems in 4.5-year-old boys (57) and girls (65). We employed canonical correlation analysis to evaluate whether the resting-state functional connectivity within a reward network, identified through an activation likelihood estimation (ALE) meta-analysis of fMRI studies, was associated with postnatal maternal depressive symptoms and child behaviors. The functional reward network consisted of three subnetworks, that is, the mesolimbic, mesocortical, and amygdala-hippocampus reward subnetworks. Postnatal maternal depressive symptoms were associated with the functional connectivity of the mesocortical subnetwork with the mesolimbic and amygdala-hippocampus complex subnetworks in girls and with the functional connectivity within the mesocortical subnetwork in boys. The functional connectivity of the amygdala-hippocampus subnetwork with the mesocortical and mesolimbic subnetworks was associated with both internalizing and externalizing problems in girls, while in boys, the functional connectivity of the mesocortical subnetwork with the amygdala-hippocampus complex and the mesolimbic subnetworks was associated with the internalizing and externalizing problems, respectively. Our findings suggest that the functional reward network might be a promising neural phenotype for effects of maternal depression and potential intervention to nurture child behavioral development.

9.
Nutr Neurosci ; : 1-10, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331255

RESUMO

Objectives: Minerals deficiencies during pregnancy have been shown to be associated with poorer cognitive outcomes in offspring. This study aimed to investigate associations of maternal plasma zinc and magnesium concentrations with cognitive development in 4-year old children from the Growing Up in Singapore Towards healthy Outcome cohort. Methods: Maternal plasma zinc and magnesium concentrations were measured at 26-28 weeks' gestation. The Lollipop test of school readiness, tests of working memory, number knowledge, receptive vocabulary, and phonological awareness were performed in children at 4 years. Associations were examined in 715 mother-offspring pairs using linear regressions adjusted for key confounders. Results: Maternal plasma zinc and magnesium concentrations were 812 ± 144 µg/L and 19.9 ± 1.8 mg/L (mean±SD); 19% and 71% of mothers were zinc deficient and magnesium insufficient, respectively. After adjustment for multiple testing, higher maternal zinc concentrations (per SD increment) were associated with 0.35 higher scores in Lollipop subtest 2 of picture description and spatial identification (95% CI: 0.13, 0.58); higher maternal magnesium concentrations (per SD increment) were associated with 0.65 higher scores in Lollipop subtest 4 of letters and writing identification (95% CI: 0.23, 1.07). Discussion: No significant associations were observed for other tests, suggesting little long term influences of maternal zinc and magnesium on child's cognitive development.

10.
Artigo em Inglês | MEDLINE | ID: mdl-31327686

RESUMO

BACKGROUND: Prenatal maternal depression may have long-term impacts on amygdala-cortical development. This study explored associations of prenatal maternal depressive symptoms on the amygdala-cortical structural covariance of the offspring from birth to early childhood, derived from a longitudinal birth cohort. METHODS: Structural magnetic resonance imaging was performed to obtain the amygdala volume and cortical thickness at each time point. Prenatal maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale at 26 weeks of pregnancy. Regression analysis was used to examine the effects of the Edinburgh Postnatal Depression Scale on a structural coupling between the amygdala volume and cortical thickness at birth (n = 167) and 4.5 years of age (n = 199). RESULTS: Girls whose mothers had high prenatal maternal depressive symptoms showed a positive coupling between the amygdala volume and insula thickness at birth (ß = .617, p = .001) but showed a negative coupling between the amygdala volume and inferior frontal thickness at 4.5 years of age (ß = -.369, p = .008). No findings were revealed in boys at any time point. CONCLUSIONS: The development of the amygdala-prefrontal circuitry is vulnerable to environmental factors related to depression. Such a vulnerability might be sex dependent.

11.
Sleep Health ; 5(3): 257-265, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31208709

RESUMO

OBJECTIVES: Adequate sleep duration and good sleep quality are considered essential for development, especially during periods of major neurodevelopmental change. Still, relations between parent-reported habitual sleep and emerging cognitive abilities within the first year of life are not well studied. Here, we examined relations between habitual sleep measures and an aspect of cognitive functioning, relational memory, which emerges as early as 6 months of age, as compared to other abilities (ie, recognition memory and attentional orienting), both of which are considered to emerge earlier in development. PARTICIPANTS: Participants were a subset of 267 healthy typically developing 6-month-olds taking part in the Growing Up in Singapore towards Healthy Outcomes cohort study. MEASUREMENTS: Sleep duration, sleep latency, and number and duration of night awakenings were derived from the Brief Infant Sleep Questionnaire (BISQ). Short sleep was defined as <10 hours per day, categorized as "not recommended" based on the National Sleep Foundation recommendations. Associations between sleep variables and infants' performance on 2 relational memory tests (deferred imitation and relational binding) were examined independently using hierarchical (blockwise entry) linear regression. Associations between sleep and recognition memory and attentional orienting were also explored. RESULTS: Habitual short sleepers had poorer relational memory recall in the deferred imitation task compared with 'typical' sleepers (10-18 hours per day). Shorter sleep latency was related to a greater proportion of correct responses for certain aspects of relational binding. There were no associations between sleep and recognition memory or attention. CONCLUSIONS: Our findings suggest that habitual sleep duration and short sleep latency associate with 6-month-olds' relational memory, suggesting a preferential association with memory tasks that are sensitive to development during the second half of the first year.

12.
PLoS One ; 14(5): e0214791, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31100065

RESUMO

OBJECTIVES: To assess whether epigenetic mechanisms affecting gene expression may be involved in the pathogenesis of early-onset myopia, we performed genome-wide DNA methylation analyses of umbilical cord tissues, and assessed any associations between CpG site-specific methylation and the development of the disorder when the children were 3 years old. METHODS: Genome-wide DNA methylation profiling of umbilical cord samples from 519 Singaporean infants involved in a prospective birth cohort 'Growing Up in Singapore Towards healthy Outcomes' (GUSTO) was performed using the Illumina Infinium HumanMethylation450K chip microarray. Multivariable logistic regression models were used to assess any associations between site-specific CpG methylation of umbilical cord tissue at birth and myopia risk in 3 year old children, adjusting for potential confounders. Gene expression of genes located near CpG sites that demonstrated statistically significant associations were measured in relevant ocular tissues using human and mouse fetal and adult eye samples. RESULTS: We identified statistically significant associations between DNA methylation levels at five CpG sites and early-onset myopia risk after correcting for multiple comparisons using a false discovery rate of 5%. Two statistically significant CpG sites were identified in intergenic regions: 8p23(p = 1.70×10-7) and 12q23.2(p = 2.53×10-7). The remaining 3 statistically significant CpG sites were identified within the following genes: FGB (4q28, p = 3.60×10-7), PQLC1 (18q23, p = 8.9×10-7) and KRT12 (17q21.2, p = 1.2×10-6). Both PQLC1 and KRT12 were found to be significantly expressed in fetal and adult cornea and sclera tissues in both human and mouse. CONCLUSIONS: We identified five CpG methylation sites that demonstrate a statistically significant association with increased risk of developing early-onset myopia. These findings suggest that variability in the neonatal cord epigenome may influence early-onset myopia risk in children. Further studies of the epigenetic influences on myopia risk in larger study populations, and the associations with adulthood myopia risk are warranted.

13.
Brain Struct Funct ; 224(5): 1885-1895, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31055646

RESUMO

Maternal care influences child hippocampal development. The hippocampus is functionally organized along an anterior-posterior axis. Little is known with regards to the extent maternal care shapes offspring anterior and posterior hippocampal (aHPC, pHPC) functional networks. This study examined maternal behavior, especially maternal sensitivity, at 6 months postpartum in relation to aHPC and pHPC functional networks of children at age 4 and 6 years. Maternal sensitivity was assessed at 6 months via the "Maternal Behavior Q Sort (MBQS) mini for video". Subsequently, 61 and 76 children underwent resting-state functional magnetic resonance imaging (rs-fMRI), respectively, at 4 and 6 years of age. We found that maternal sensitivity assessed at 6 months postpartum was associated with the right aHPC functional networks in children at both 4 and 6 years of age. At age 4 years, maternal sensitivity was associated positively with the right aHPC's functional connectivity with the sensorimotor network and negatively with the aHPC's functional connectivity with the top-down cognitive control network. At 6 years of age, maternal sensitivity was linked positively with the right aHPC's functional connectivity with the visual-processing network. Our findings suggested that maternal sensitivity in infancy has a long-term impact on the anterior hippocampal functional network in preschool children, implicating a potential role of maternal care in shaping child brain development in early life.

14.
Br J Nutr ; 121(11): 1303-1312, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30935438

RESUMO

Evidence on long-term influences of maternal vitamin B12 deficiency or concentrations on infant cognition is limited. We examined associations between maternal plasma vitamin B12 and cognitive development in 24-month-old infants. Maternal plasma vitamin B12 concentrations were measured at 26-28 weeks' gestation; infant cognitive development was assessed with the Bayley Scales of Infant and Toddler Development-III at 24 months, for 443 mother-infant pairs from the Growing Up in Singapore Towards Healthy Outcomes cohort. Linear regressions adjusted for key confounders examined associations of maternal vitamin B12 with cognitive, receptive and expressive language, fine and gross motor subscales. Co-occurrence of maternal vitamin B12 with folate or vitamin B6 insufficiencies on child's cognition was explored. Average maternal plasma vitamin B12 concentrations was 220·5 ± 80·5 pmol/l; 15 % and 41 % of mothers were vitamin B12 deficient (<148 pmol/l) and insufficient (148-220·9 pmol/l), respectively. Infants of mothers with vitamin B12 deficiency had 0·42 (95 % CI -0·70, -0·14) sd lower cognitive scores, compared with infants of mothers with sufficient vitamin B12. Co-occurrence of maternal vitamins B12 and B6 insufficiencies was associated with 0·37 (95 % CI -0·69, -0·06) sd lower cognitive scores in infants compared with infants of mothers sufficient in both vitamins. No significant associations were observed with other subscales. Study findings suggest the possible need to ensure adequate vitamin B12 during pregnancy. The impact of co-occurrence of maternal B-vitamins insufficiencies on early cognitive development warrants further investigation.

15.
Public Health Nutr ; 22(11): 1990-2000, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30940257

RESUMO

OBJECTIVE: Dietary intake of toddlers has been of growing interest due to its long-term consequences on health. However, previous works have focused largely on Caucasian populations and less is known about Asian toddlers. We aimed to validate a semi-quantitative FFQ designed to assess dietary intakes of 18-month-old toddlers in a multi-ethnic Asian cohort. DESIGN: An FFQ of ninety-four food items, identified based on food records of 12-month-old GUSTO children, the Southampton Women's Survey 12 Month Infancy Questionnaire and inputs from paediatric dietitians, was filled out two weeks before the 18th-month clinic visit. As the reference method, two non-consecutive 24 h recalls (24HR) were administered during and two weeks after the clinic visit. FFQ nutrient intakes were validated against averaged 24HR nutrient intakes, using the Wilcoxon signed-rank test, Spearman's rank-order correlation, cross-classification and the Bland-Altman method. SETTING: Data from the Singapore Growing Up in Singapore Towards Healthy Outcomes (GUSTO) mother-offspring birth cohort.ParticipantsToddlers (n 188) aged 18 months. RESULTS: Absolute nutrient intakes from the FFQ were significantly higher than from the 24HR, except for vitamin A. After energy adjustments, r range was 0·56-0·78 (macronutrients) and 0·40-0·54 (micronutrients). De-attenuation increased r to 0·58-0·96 and 0·45-0·65 for macro- and micronutrients, respectively. Of participants, ≥82·4 % (macronutrients) and ≥77·7 % (micronutrients) were classified in the same and adjacent quartiles. No clear systematic increase in intake differences with increasing mean intake was observed in Bland-Altman plots. CONCLUSIONS: This FFQ can provide a satisfactory assessment of toddlers' energy-adjusted nutrient intakes, as well as accurately rank them in a group.

16.
BMC Public Health ; 19(1): 397, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975203

RESUMO

BACKGROUND: Iron deficiency is the most prevalent nutrient deficiency and the most common cause of anaemia worldwide. Because of the increased iron requirements during pregnancy, iron deficiency can lead to maternal anaemia and reduced newborn iron stores. We examined the proportion and risk factors of iron deficiency among pregnant women in a developed Asian country. METHODS: Within a prospective cohort in Singapore, 985 Asian women were assessed for iron status at 26-28 weeks' gestation, with plasma ferritin and soluble transferrin receptor (sTfR) measurements. Iron status was determined according to plasma ferritin concentrations at ≥30 µg/L (iron sufficiency), 15 to < 30 µg/L (modest iron depletion) and < 15 µg/L (severe iron depletion). Multivariable ordinal logistic regression was used to analyze risk factors for modest and severe iron depletion. RESULTS: The median (25-75th percentile) plasma ferritin concentration was 24.2 (19.9-30.6) µg/L. Overall, 660 (67.0%) and 67 (6.8%) women had modest and severe iron depletion, respectively. Higher plasma sTfR was observed in women with severe iron depletion than among those with iron sufficiency (median 17.6 versus 15.5 nmol/L; p < 0.001). Age < 25 years (odds ratio 2.36; 95% confidence interval 1.15-4.84), Malay (2.05; 1.30-3.24) and Indian (1.98; 1.14-3.44) ethnicities (versus Chinese), university qualification (1.64; 1.13-2.38), multiparity (1.73; 1.23-2.44) and lack of iron-containing supplementation (3.37; 1.25-8.53) were associated with increased odds of modest and severe iron depletion. CONCLUSIONS: Nearly three-quarters of Singaporean women were iron deficient in the early third trimester of pregnancy. These results suggest universal screening and supplementation of at-risk pregnancies may be evaluated as a preventive strategy. TRIAL REGISTRATION: NCT01174875 . Registered 1 July 2010 (retrospectively registered).


Assuntos
Anemia Ferropriva/epidemiologia , Ferritinas/sangue , Ferro na Dieta/administração & dosagem , Complicações Hematológicas na Gravidez/epidemiologia , Adulto , Anemia Ferropriva/sangue , Anemia Ferropriva/diagnóstico , Biomarcadores/sangue , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Ferro/sangue , Gravidez , Complicações Hematológicas na Gravidez/sangue , Complicações Hematológicas na Gravidez/diagnóstico , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Receptores da Transferrina/sangue , Fatores de Risco , Singapura , Adulto Jovem
17.
Int J Obes (Lond) ; 43(7): 1334-1343, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30940915

RESUMO

OBJECTIVES: Screen-viewing in late childhood has been associated with adiposity and blood pressure (BP), but evidence is lacking at younger ages. To investigate the prospective associations of total and device-specific screen-viewing at age 2-3 years with BMI, sum of skinfold thicknesses and BP among Singaporean children at age 3-5 years. METHODS: As part of the Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort, mothers/caregivers reported the time per day their 2 and 3-year-old children watched/used television, handheld devices and computers. Average screen-viewing time (total, television and handheld-devices) at ages 2 and 3 years was used in the analyses. Height; weight; triceps, biceps and subscapular skinfold thicknesses; and systolic and diastolic BP were measured at ages 3, 4 and 5. Associations of screen-viewing with BMI, sum of skinfold thicknesses and BP in 956 children were investigated using repeated-measures linear regression models. Analyses were further stratified by sex as we found significant interaction. RESULTS: Among boys and girls combined, screen-viewing was positively associated with sum of skinfold thicknesses, but not with BMI or BP. Sex-specific analyses showed significant associations with both BMI and sum of skinfold thicknesses in boys, but not in girls. Screen-viewing was not associated with BP in boys or girls. The increases in mean (95% CI) BMI per hour increase in daily total, television and handheld-devices screen-viewing among boys were 0.12 (0.03, 0.21), 0.18 (0.06, 0.30) and 0.11 (-0.07, 0.29) kg/m2, respectively. The corresponding increases in mean sum of skinfold thicknesses were 0.68 (0.29, 1.07), 0.79 (0.26, 1.32) and 1.18 (0.38, 1.99) mm. CONCLUSIONS: Greater screen-viewing at age 2-3 years was associated with later adiposity at 3-5 years in boys, but not in girls. In light of the increasing use of screen devices and cardiometabolic risk in young children, these findings may have important public health implications.

18.
Int J Obes (Lond) ; 43(7): 1344-1353, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30923368

RESUMO

BACKGROUND: Lower inhibitory control has been associated with obesity. One prediction is that lower inhibitory control underlies eating behaviours that promote increased energy intakes. This study examined the relationships between children's inhibitory control measured using the Stop Signal Task (SST), body composition and eating behaviours, which included self-served portion size, number of servings, eating rate, and energy intake at lunch and in an eating in the absence of hunger (EAH) task. METHODS: The sample included 255 6-year-old children from an Asian cohort. Stop-signal reaction time (SSRT) was used as an index of inhibitory control. Children participated in a recorded self-served lunchtime meal, followed by the EAH task where they were exposed to energy-dense snacks. Behavioural coding of oral processing was used to estimate eating rates (g/min). BMI, waist circumference and skinfolds were used as indices of adiposity. RESULTS: Children with lower inhibitory control tended to self-serve larger food portions (p = 0.054), had multiple food servings (p = 0.006) and significantly faster eating rates (p = 0.041). Inhibitory control did not predict energy intake at lunch (p = 0.17) or during the EAH task (p = 0.45), and was unrelated to measures of adiposity (p > 0.32). Twenty percent of the children in the sample had problems focusing on the SST and were described as 'restless'. Post-hoc analysis revealed that these children had lower inhibitory control (p < 0.001) and consumed more energy during the EAH task (p = 0.01), but did not differ in any other key outcomes from the rest of the sample (p > 0.1). CONCLUSIONS: Children with lower inhibitory control showed a trend to select larger food portions, had multiple food servings and faster eating rates, but were equally as responsive to snacks served in the absence of hunger as children with better inhibitory control. Inhibitory control may impact a number of eating behaviours, not limited to energy-dense snacks.

19.
Nutrients ; 11(3)2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30832217

RESUMO

Early childhood diet may have lifelong influences on health outcomes, yet development of indices to assess diet quality is scarce in toddlers, especially in Asian countries. We aimed to develop and evaluate a Diet Quality Index (DQI) in a multi-ethnic Asian mother⁻offspring cohort and identify perinatal correlates of early childhood diet. Based primarily on the Singapore dietary guidelines, the DQI includes seven food components: rice, bread and alternatives; fruit; vegetables; meat and alternatives; milk and dairy products; whole grains; and foods high in sugar. The DQI was developed using parental report of Food Frequency Questionnaires (FFQ) data for 18-month-old toddlers (n = 561). The mean ± SD of DQI for the study toddlers was 44.2 ± 8.9 (theoretical range: 0⁻65). A higher DQI (better diet quality) was associated with higher intakes of several nutrients and food groups (e.g., vegetables, dietary fibre, and beta-carotene; all p < 0.001). Further construct validity was demonstrated by substantial agreement between the FFQ-DQI and 24-hour-recall-DQI (Intraclass-correlation-coefficient: 0.70). Independent predictors of lower DQI included higher maternal pre-pregnancy BMI [ß(95% CI): -0.23(-0.39, -0.07)], Malay ethnicity [-1.88(-3.67, -0.09)], lower household income [-1.97(-3.91, -0.03)], lower education level [-2.57(-4.85, -0.28)] and never breastfeeding [-6.17(-11.06, -1.28)]. We developed a valid DQI for assessing the overall quality of the diets of Asian toddlers.


Assuntos
Dieta/estatística & dados numéricos , Dieta Saudável/métodos , Avaliação Nutricional , Adulto , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Estudos de Coortes , Laticínios/análise , Dieta/métodos , Inquéritos sobre Dietas , Feminino , Frutas , Humanos , Lactente , Masculino , Fenômenos Fisiológicos da Nutrição Materna , Carne/análise , Política Nutricional , Gravidez , Reprodutibilidade dos Testes , Singapura , Verduras , Grãos Integrais
20.
Obesity (Silver Spring) ; 27(3): 470-478, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30707510

RESUMO

OBJECTIVE: The aim of this study was to investigate the independent associations between age-specific annual weight gain from birth to age 4 years and fat deposition in metabolically distinct compartments at age 4.5 years in a South Asian longitudinal birth cohort. METHODS: Volumetric abdominal magnetic resonance imaging with comprehensive segmentation of deep and superficial subcutaneous adipose tissue (SAT) and visceral adipose tissues (VAT) was performed in 316 children (150 boys and 166 girls in three ethnic groups; 158 Chinese, 94 Malay, and 64 Indian) aged 4.5 years. Associations between fat volumes and annual relative weight gain conditional on past growth were assessed overall and stratified by sex and ethnicity. RESULTS: Conditional relative weight gain had stronger associations with greater SAT and VAT at age 4.5 years in girls than boys and in Indians compared with Malay and Chinese. Overall, the magnitude of association was the largest during 2 to 3 years for SAT and 1 to 2 years for VAT. Despite similar body weight, Indian children and girls had the highest deep and superficial SAT volumes at age 4.5 years (all interactions P < 0.05). No significant sex or ethnic differences were observed in VAT. With increasing BMI, Indian children had the highest tendency to accumulate VAT, and girls accumulated more fat than boys in all depots (all interactions P < 0.001). CONCLUSIONS: Indian ethnicity and female sex predisposed children to accumulate more fat in the VAT depot with increasing conditional relative weight gain in the second year of life. Thus, 1 to 2 years of age may be a critical window for interventions to reduce visceral fat accumulation.

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