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1.
BMC Pregnancy Childbirth ; 24(1): 475, 2024 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-38997658

RESUMO

BACKGROUND: Experiences during the birth hospitalization affect a family's ability to establish and maintain breastfeeding. The Ten Steps to Successful Breastfeeding (Ten Steps) describe evidence-based hospital policies and practices shown to improve breastfeeding outcomes. We aim to describe hospitals' implementation of the Ten Steps, changes over time, and hospitals' implementation of a majority (≥ 6) of the Ten Steps by hospital characteristics and state. METHODS: The biennial Maternity Practices in Infant Nutrition and Care (mPINC) survey assesses all hospitals in the United States (including the District of Columbia and territories) that routinely provide maternity care services. We analyzed data from 2018, 2020, and 2022 survey cycles to describe trends in the prevalence of hospitals implementing maternity care policies and practices that are consistent with the Ten Steps. Differences were calculated using the absolute difference in percentage-points between 2018 and 2022. RESULTS: Between 2018 and 2022, the percentage of hospitals that implemented Step 2: Staff Competency and Step 5: Support Mothers with Breastfeeding increased 12 and 8 percentage points, respectively. The percentage of hospitals that implemented Step 6: Exclusive Breastfeeding Among Breastfed Infants was 7 percentage points lower in 2022 than 2018. Implementation of the remaining seven steps did not change by more than 5 percentage points in either direction between 2018 and 2022. Nationally, the percentage of hospitals that implemented ≥ 6 of the Ten Steps increased from 44.0% in 2018 to 51.1% in 2022. Differences were seen when comparing implementation of ≥ 6 of the Ten Steps by hospital characteristics including state, hospital size, and highest level of neonatal care offered. CONCLUSIONS: Nationally, maternity care policies and practices supportive of breastfeeding continued to improve; however, certain practices lost progress. Differences in implementation of the Ten Steps were observed across states and by certain hospital characteristics, suggesting more work is needed to ensure all people receive optimal breastfeeding support during their delivery hospitalization.


Assuntos
Aleitamento Materno , Humanos , Aleitamento Materno/estatística & dados numéricos , Estados Unidos , Feminino , Gravidez , Recém-Nascido , Política Organizacional , Serviços de Saúde Materna/estatística & dados numéricos , Política de Saúde
2.
Prev Chronic Dis ; 21: E17, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38512779

RESUMO

Introduction: Because limited data exist about factors related to sugar-sweetened beverage (SSB) intake among younger children, we investigated factors associated with SSB intake among US children aged 1 to 5 years. Methods: We examined SSB intake (0, 1-3, or ≥4 times/week) by using data from the 2021 National Survey of Children's Health. We performed a multinomial logistic regression to calculate adjusted odds ratios (aORs) for select sociodemographic and household factors associated with moderate (1-3 times/week) and high (≥4 times/week) SSB intake. Results: Overall, 36% of children consumed SSBs 1 to 3 times/week and 21% consumed 4 or more times/week. Both moderate and high SSB intake were associated with child's age, child's race and ethnicity, highest caregiver education level, household income, primary household language, and frequency of family meals. For example, children who lived in households with caregiver education level of high school graduate or less were significantly more likely to have moderate (aOR, 2.06) and high (aOR, 2.81) SSB intake than those who lived in households with caregiver education level of college degree or higher. High SSB intake was also associated with marginal household food sufficiency, nonmetropolitan statistical area status, and receipt of government food benefits. Conclusion: Several sociodemographic and household factors were significantly associated with SSB intake among children aged 1 to 5 years. Public health initiatives designed to address SSB intake among young children in various settings including pediatric health care, early care and education, and the child's home could consider key associated factors.


Assuntos
Bebidas , Bebidas Adoçadas com Açúcar , Criança , Humanos , Estados Unidos , Pré-Escolar , Etnicidade , Alimentos
3.
MMWR Morb Mortal Wkly Rep ; 69(53): 1969-1973, 2023 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-37498788

RESUMO

The American Academy of Pediatrics (AAP) recommends introducing complementary foods (i.e., any solid or liquid other than breast milk or infant formula) to infants at approximately age 6 months (1). Although a consensus on ideal timing is lacking, most experts agree that introduction of complementary foods before age 4 months is too early because of infant gastrointestinal and motor immaturity (1,2). In addition, early introduction prevents exclusively breastfed infants from reaching the recommended 6 months of exclusive breastfeeding (1) and might be associated with increased risk for overweight and obesity (3). Nationally representative data on complementary feeding are limited; state-level estimates have been previously unavailable. CDC analyzed 2016-2018 data from the National Survey of Children's Health (NSCH) (N = 23,743) to describe timing of complementary feeding introduction and prevalence of early introduction of complementary foods before age 4 months (early introduction) among children aged 1-5 years. Prevalence of early introduction was 15.6% nationally and varied geographically and across sociodemographic and infant feeding characteristics. These estimates suggest that approximately one in six infants are introduced to complementary foods before they are developmentally ready. Efforts by health care providers and others who might influence infant feeding practices could help decrease the number of infants who are introduced to complementary foods too early.


Assuntos
Aleitamento Materno , Alimentos Infantis , Lactente , Feminino , Humanos , Criança , Estados Unidos/epidemiologia , Alimentos Infantis/efeitos adversos , Fenômenos Fisiológicos da Nutrição do Lactente , Fórmulas Infantis , Leite Humano , Obesidade
4.
MMWR Morb Mortal Wkly Rep ; 72(7): 165-170, 2023 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-36795611

RESUMO

Good nutrition in early childhood supports optimal growth, development, and health (1). Federal guidelines support a dietary pattern with daily fruit and vegetable consumption and limited added sugars, including limited consumption of sugar-sweetened beverages (1). Government-published dietary intake estimates for young children are outdated at the national level and unavailable at the state level. CDC analyzed data from the 2021 National Survey of Children's Health (NSCH)* to describe how frequently, according to parent report, children aged 1-5 years (18,386) consumed fruits, vegetables, and sugar-sweetened beverages, nationally and by state. During the preceding week, approximately one in three (32.1%) children did not eat a daily fruit, nearly one half (49.1%) did not eat a daily vegetable, and more than one half (57.1%) drank a sugar-sweetened beverage at least once. Estimates of consumption varied by state. In 20 states, more than one half of children did not eat a vegetable daily during the preceding week. In Vermont, 30.4% of children did not eat a daily vegetable during the preceding week, compared with 64.3% in Louisiana. In 40 states and the District of Columbia, more than one half of children drank a sugar-sweetened beverage at least once during the preceding week. The percentage of children drinking sugar-sweetened beverages at least once during the preceding week ranged from 38.6% in Maine to 79.3% in Mississippi. Many young children are not consuming fruits and vegetables daily and are regularly consuming sugar-sweetened beverages. Federal nutrition programs and state policies and programs can support improvements in diet quality by increasing access to and availability of fruits and vegetables and healthy beverages in places where young children live, learn, and play.


Assuntos
Frutas , Bebidas Adoçadas com Açúcar , Humanos , Criança , Pré-Escolar , Estados Unidos/epidemiologia , Verduras , Dieta , Bebidas/análise , Louisiana
5.
J Hum Nutr Diet ; 36(4): 1261-1269, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-36624691

RESUMO

BACKGROUND: Expressing milk (i.e., human milk) is common in the USA, but practices are unknown among families in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). This study of a WIC population explores the practice of and reasons for expressing milk in the first year postpartum. METHODS: We analysed data from a longitudinal study to examine milk expression at 1, 3, 5, 7, 9, 11, and 13 months postpartum among breastfeeding persons enrolled in WIC with term singletons. We cross-sectionally analysed the weighted prevalence of milk expression at each survey month and report reasons for milk expression in the first 7 months. RESULTS: Among the study participants who reported feeding human milk at Month 1, 70.4% expressed milk in the first 13 months postpartum. The prevalence of milk expression was 56.8% at Month 1 and decreased to 13.9% at Month 13 among those feeding any human milk that month. Reasons for expressing milk changed over time; in the first month, increasing milk supply, relieving engorgement, and having an emergency supply of milk were common. In later months, having a supply of milk available so that someone else could feed their infant was common. CONCLUSIONS: Clinicians, health educators, WIC staff, and others working with WIC families can promote optimal expressed milk feeding and storage practices. Extra attention and support may be especially important in the first months postpartum when milk expression is common. Support for persons who are expressing milk can be tailored for reasons of milk expression.


Assuntos
Aleitamento Materno , Leite Humano , Lactente , Criança , Feminino , Humanos , Estudos Longitudinais , Pobreza , Período Pós-Parto
6.
Prev Chronic Dis ; 20: E114, 2023 Dec 14.
Artigo em Inglês | MEDLINE | ID: mdl-38096123

RESUMO

Introduction: Although breastfeeding is the ideal source of nutrition for most infants, racial and ethnic disparities exist in its initiation. Surveillance rates based on aggregated data can challenge the understanding and monitoring of effective, culturally appropriate interventions among racial and ethnic subgroups. Aggregated data have historically estimated breastfeeding rates among a few large racial and ethnic groups. We examined differences in breastfeeding initiation rates by disaggregation of data to finer subgroups of race and ethnicity. Methods: We analyzed births from January 1, 2020, through December 31, 2021, in 48 states and the District of Columbia by using National Vital Statistics System birth certificate data. Data indicate whether an infant received any breast milk during birth hospitalization and include self-reported maternal race and ethnicity. Cross-tabulations of race and ethnicity by breastfeeding initiation were calculated and compared across aggregated and disaggregated categories. Results: The overall prevalence of breastfeeding initiation was 84.0%, ranging from 74.5% (mothers identifying as Black) to 94.0% (mothers identifying as Japanese). The aggregated prevalence of breastfeeding initiation among mothers identifying as Hispanic was 86.8%; disaggregated estimates by Hispanic origin ranged from 82.2% (Puerto Rican) to 90.9% (Cuban). Conclusion: Substantial variation in the prevalence of breastfeeding initiation across disaggregated racial or ethnic categories exists. Disaggregation of racial and ethnic data unmasked differences that could reflect variations in cultural practices or systemic barriers to breastfeeding. Understanding why these differences exist could guide public health practitioners' efforts to improve and tailor breastfeeding support.


Assuntos
Aleitamento Materno , Etnicidade , Grupos Raciais , Feminino , Humanos , Lactente , Aleitamento Materno/estatística & dados numéricos , Mães , Estados Unidos
7.
Matern Child Nutr ; 19(4): e13541, 2023 10.
Artigo em Inglês | MEDLINE | ID: mdl-37415299

RESUMO

Infants younger than 4 months are not ready for complementary foods/drinks (any solid or liquid other than breast milk or infant formula). Almost half of US infants participate in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), which provides nutrition education and support to low-income families. We describe the prevalence of early introduction (<4 months) of complementary foods/drinks and examine the association of milk feeding type (fully breastfed, partially breastfed or fully formula fed) with early introduction of complementary foods/drinks. We used data from 3310 families in the longitudinal WIC Infant and Toddler Feeding Practices Study-2. We described the prevalence of early introduction of complementary foods/drinks and modeled the association of milk feeding type at Month 1 with early introduction of complementary foods/drinks using multi-variable logistic regression. Thirty-eight percent of infants were introduced early to complementary foods/drinks (<4 months). In adjusted models, infants who were fully formula fed or partially breastfed at Month 1 were 75% and 57%, respectively, more likely to be introduced early to complementary foods/drinks compared with fully breastfed infants. Almost two in five infants were given complementary foods/drinks early. Formula feeding at Month 1 was associated with higher odds of early introduction of complementary foods/drinks. There are opportunities to support families participating in WIC to prevent early introduction of complementary foods/drinks and promote child health.


Assuntos
Aleitamento Materno , Fenômenos Fisiológicos da Nutrição do Lactente , Lactente , Humanos , Feminino , Comportamento Alimentar , Fórmulas Infantis , Leite Humano
8.
Am J Public Health ; 112(S8): S826-S835, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36288529

RESUMO

Iron deficiency and the more severe sequela, iron deficiency anemia, are public health problems associated with morbidity and mortality, particularly among pregnant women and younger children. The 1998 Centers for Disease Control and Prevention recommendations for prevention and control of iron deficiency in the United States is old and does not reflect recent evidence but is a foundational reference for many federal, clinical, and program guidelines. Surveillance data for iron deficiency are sparse at all levels, with critical gaps for pregnant women and younger children. Anemia, iron deficiency, and iron deficiency anemia are often conflated but should not be. Clinical guidelines for anemia, iron deficiency, and iron deficiency anemia give inconsistent recommendations, causing nonsystematic assessment of iron deficiency. Screening for iron deficiency typically relies on identifying anemia, despite anemia's low sensitivity for iron deficiency. In the National Health and Nutrition Examination Survey, more than 70% of iron deficiency is missed among pregnant women and children by relying on hemoglobin for iron deficiency screening. To improve assessment and diagnosis and strengthen surveillance, better and more complete data and updated foundational guidance on iron deficiency and anemia are needed that consider new evidence for measuring and interpreting laboratory results. (Am J Public Health. 2022;112(S8):S826-S835. https://doi.org/10.2105/AJPH.2022.306998).


Assuntos
Anemia Ferropriva , Anemia , Deficiências de Ferro , Criança , Feminino , Humanos , Gravidez , Estados Unidos/epidemiologia , Inquéritos Nutricionais , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/epidemiologia , Anemia Ferropriva/prevenção & controle , Hemoglobinas/análise
9.
Am J Public Health ; 112(S8): S817-S825, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36122314

RESUMO

The first 1000 days begins with pregnancy and ends at the child's second birthday. Nutrition throughout the life course, and especially during the first 1000 days, supports maternal health and optimal growth and development for children. We give a high-level summary of the state of nutrition in the first 1000 days in the United States. We provide examples where continued efforts are needed. We then discuss select opportunities to strengthen federal research and surveillance, programs, and communication and dissemination efforts aimed at improving nutrition and positively, and equitably, influencing the health and well-being of mothers and children. (Am J Public Health. 2022;112(S8):S817-S825. https://doi.org/10.2105/AJPH.2022.307028).


Assuntos
Estado Nutricional , Gravidez , Criança , Feminino , Estados Unidos , Humanos
10.
MMWR Morb Mortal Wkly Rep ; 71(25): 813-819, 2022 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-35737575

RESUMO

Among pregnant women, anemia, a condition of low hemoglobin concentration, can increase risk for maternal and fetal morbidity and mortality, including premature delivery, and other adverse outcomes (1). Iron deficiency is a common cause of anemia, and during pregnancy, iron requirements increase (2). Surveillance of anemia during pregnancy in the United States is limited. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participant and Program Characteristics (PC) data provide an opportunity to establish national and WIC state agency-level* anemia surveillance for WIC participants. National and state agency anemia prevalences among pregnant WIC participants at enrollment were examined using 2008-2018 WIC-PC data. Across all 90 WIC agencies (50 states, the District of Columbia [DC], five territories, and 34 Indian Tribal Organizations), anemia prevalence among pregnant WIC participants at enrollment increased significantly, from 10.1% in 2008 to 11.4% in 2018 (13% increase). Anemia prevalence increased significantly in 36 (64%) of the 56 agencies in states, DC, and territories, and decreased significantly in 11 (20%). Prevalence of anemia overall and by pregnancy trimester were higher among non-Hispanic Black or African American (Black) women than among other racial or ethnic groups. Anemia prevalence was higher among women assessed during the third trimester of pregnancy than among those assessed during first or second trimesters. Routine anemia surveillance using WIC enrollment anemia data can identify groups at higher risk for iron deficiency. Findings from this report indicate that anemia continues to be a problem among low-income women and reinforces the importance of efforts that ensure these women have access to healthier, iron-rich foods before and during pregnancy. This includes ensuring that eligible women are enrolled in WIC early during pregnancy.


Assuntos
Anemia , Assistência Alimentar , Deficiências de Ferro , Anemia/epidemiologia , Criança , Feminino , Humanos , Lactente , Ferro , Pobreza , Gravidez , Gestantes , Cuidado Pré-Natal , Estados Unidos/epidemiologia
11.
Matern Child Nutr ; 17(2): e13093, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33006242

RESUMO

Prenatal breastfeeding intentions impact breastfeeding practices. Racial/ethnic disparities exist in breastfeeding rates; it is unknown if prenatal intentions and meeting intentions differ by race/ethnicity. A longitudinal cohort of USDA's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) which enrolled participants beginning in 2013 were used to estimate prenatal intentions for breastfeeding initiation, exclusive breast milk feeds at 1 and 3 months by race/ethnicity (n = 2070). Meeting intentions were determined by reported breast milk consumption at birth, 1 month and 3 months. Multivariable logistic regression was used to determine the association of race/ethnicity with meeting intentions. There were no differences in prenatal breastfeeding intentions between non-Hispanic White and non-Hispanic Black women (initiation: 86.9% and 87.2%; Month 1: 52.3% and 48.3%; Month 3: 43.8% and 40.9%; respectively), but a higher percentage of Hispanic women intended to breastfeed at all time points (95.5%, 68.3% and 56.4%; respectively, P < 0.05). Among women who intended to breastfeed at Month 1, non-Hispanic Black and Hispanic women had significantly lower odds of meeting intentions compared with non-Hispanic White women after adjusting for covariates (aORs: 0.63 [95% CI: 0.41, 0.98]; 0.64 [95% CI: 0.44, 0.92], respectively). Similar findings were seen for Month 3. Despite no differences in breastfeeding intentions, non-Hispanic Black women were less likely to meet their breastfeeding intentions than non-Hispanic White women. Hispanic women were more likely to intend to breastfeed yet were less likely to meet their intentions. This suggests that non-Hispanic Black and Hispanic women face challenges to meeting their longer breastfeeding intentions. Understanding how racism, bias and discrimination contribute to women not meeting their breastfeeding intentions may help efforts to reduce breastfeeding disparities.


Assuntos
Aleitamento Materno , Etnicidade , Pré-Escolar , Feminino , Hispânico ou Latino , Humanos , Lactente , Recém-Nascido , Intenção , Leite Humano , Gravidez
12.
MMWR Morb Mortal Wkly Rep ; 69(47): 1787-1791, 2020 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-33237894

RESUMO

The American Academy of Pediatrics (AAP) recommends introducing complementary foods (i.e., any solid or liquid other than breast milk or infant formula) to infants at approximately age 6 months (1). Although a consensus on ideal timing is lacking, most experts agree that introduction of complementary foods before age 4 months is too early because of infant gastrointestinal and motor immaturity (1,2). In addition, early introduction prevents exclusively breastfed infants from reaching the recommended 6 months of exclusive breastfeeding (1) and might be associated with increased risk for overweight and obesity (3). Nationally representative data on complementary feeding are limited; state-level estimates have been previously unavailable. CDC analyzed 2016-2018 data from the National Survey of Children's Health (NSCH) (N = 23,927) to describe timing of complementary feeding introduction and prevalence of early introduction of complementary foods before age 4 months (early introduction) among children aged 1-5 years. Prevalence of early introduction was 31.9% nationally and varied geographically and across sociodemographic and infant feeding characteristics. These estimates suggest that many infants are introduced to complementary foods before they are developmentally ready. Efforts by health care providers and others who might influence infant feeding practices could help decrease the number of infants who are introduced to complementary foods too early.


Assuntos
Fenômenos Fisiológicos da Nutrição do Lactente , Humanos , Lactente , Fatores de Tempo , Estados Unidos
13.
MMWR Morb Mortal Wkly Rep ; 68(34): 745-748, 2019 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-31465319

RESUMO

Surveillance of U.S. breastfeeding duration and exclusivity has historically reported estimates among all infants, regardless of whether they had initiated breastfeeding. These surveillance estimates have consistently shown that non-Hispanic black (black) infants are less likely to breastfeed, compared with other racial/ethnic groups.* Less is known about disparities in breastfeeding duration when calculated only among infants who had initiated breastfeeding, compared with surveillance estimates based on all infants. CDC analyzed National Immunization Survey-Child (NIS-Child) data for infants born in 2015 to describe breastfeeding duration and exclusivity at ages 3 and 6 months among all black and non-Hispanic white (white) infants, and among only those who had initiated breastfeeding. When calculated among all infants regardless of breastfeeding initiation, breastfeeding differences between black and white infants were 14.7 percentage points (95% confidence interval [CI] = 10.7-18.8) for any breastfeeding at age 3 months and were significantly different for both any and exclusive breastfeeding at both ages 3 and 6 months. Among only infants who had initiated breastfeeding, the magnitude of black-white differences in breastfeeding rates were smaller. This was most notable in rates of any breastfeeding at 3 months, where the percentage point difference between black and white infants was reduced to 1.2 (95% CI = -2.3-4.6) percentage points and was no longer statistically significant. Black-white disparities in breastfeeding duration result, in part, from disparities in initiation. Interventions both to improve breastfeeding initiation and to support continuation among black mothers might help reduce disparities.


Assuntos
Negro ou Afro-Americano/psicologia , Aleitamento Materno/etnologia , Mães/psicologia , População Branca/psicologia , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Aleitamento Materno/psicologia , Aleitamento Materno/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Humanos , Lactente , Mães/estatística & dados numéricos , Fatores de Tempo , Estados Unidos , População Branca/estatística & dados numéricos , Adulto Jovem
14.
Birth ; 46(2): 318-325, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30402907

RESUMO

BACKGROUND: Hospitals that provide maternity care can play an important role in providing or directing mothers to postdischarge breastfeeding support, which improves breastfeeding duration especially when providing multiple support modes. This study described 2007-2015 national trends in postdischarge breastfeeding supports among United States maternity care hospitals. METHODS: Data were from the Maternity Practices in Infant Nutrition and Care survey, a biennial census of maternity care hospitals in the United States and territories. Hospitals reported whether they provided nine support types, which we categorized into three support modes: physical contact (eg, return visits), active reaching out (eg, telephone calls), and referrals (eg, to lactation consultants). We calculated prevalence of each support type, each support mode, and providing all three support modes for each survey year and examined trends over 2007-2015. For 2015, we assessed differences by hospital- and area-level characteristics. RESULTS: Prevalence of providing all three support modes increased from 24% (2007) to 31% (2015). Nearly all (99%) hospitals provided referrals in each survey year. Fewer offered physical contact and active reaching out. However, from 2007 to 2015, the prevalence of physical contact increased from 39% to 46%; active reaching out increased from 54% to 64%. In 2015, smaller and rural hospitals were more likely to provide all three discharge supports. CONCLUSIONS: Prevalence of offering referrals was high, but there is room for improvement in providing physical contact and active reaching out to ensure multiple modes of support are available to help mothers reach their breastfeeding goals.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Promoção da Saúde , Maternidades/estatística & dados numéricos , Encaminhamento e Consulta/tendências , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Recém-Nascido , Alta do Paciente , Educação de Pacientes como Assunto , Cuidado Pós-Natal/organização & administração , Gravidez , Estados Unidos
15.
MMWR Morb Mortal Wkly Rep ; 66(48): 1313-1317, 2017 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-29216029

RESUMO

Breast milk is the recommended nutrition for infants. For preterm infants, when mother's milk is not available, pasteurized donor milk is recommended (1). Non-Hispanic black mothers are at increased risk for having a preterm birth and for not breastfeeding (2,3); however, it is not known whether demographic disparities exist in the use of breast milk in neonatal intensive care units (NICUs). Data from CDC's 2015 Maternity Practices in Infant Nutrition and Care (mPINC) survey, which does not collect patient-level demographics, were linked to the 2011-2015 U.S. Census Bureau's American Community Survey (ACS)* to examine use of breast milk in NICUs based on demographic makeup of the hospital's postal code area. Among U.S. hospitals with a NICU, the use of mother's own milk and donor milk were examined by the percentage of non-Hispanic black (black) residents in the hospital postal code area, categorized as being above or below the national average (12.3%). In postal codes with >12.3% black residents, 48.9% of hospitals reported using mothers' own milk in ≥75% of infants in the NICU, and 38.0% reported not using donor milk, compared with 63.8% and 29.6% of hospitals, respectively, in postal codes with ≤12.3% black residents. Further investigation is needed to understand variations in breast milk use in NICUs. Targeted efforts to increase breast milk use in hospitals located in postal codes where the percentage of black mothers is above the national average might help ensure more equitable access to breast milk for preterm and other high-risk infants.


Assuntos
Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Leite Humano , Negro ou Afro-Americano/psicologia , Negro ou Afro-Americano/estatística & dados numéricos , Aleitamento Materno/etnologia , Aleitamento Materno/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Mães/psicologia , Mães/estatística & dados numéricos , Medição de Risco , Estados Unidos
16.
Public Health Nutr ; 19(14): 2535-9, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27019390

RESUMO

OBJECTIVE: We explored how Americans aged ≥2 years who consumed the recommended amount of fruits and vegetables on a given day incorporated fruits and vegetables into their diet compared with those who did not consume recommended amounts. DESIGN: We used 1 d of dietary recall data from the National Health and Nutrition Examination Survey (NHANES) 2007-2010 to examine cross-sectional differences in mean intakes of fruits and vegetables in cup-equivalents by meal, source and form between the two groups. SETTING: USA. SUBJECTS: NHANES 2007-2010 participants aged ≥2 years (n 17 571) with 1 d of reliable 24 h recall data. RESULTS: On a given day, the proportions of fruits and vegetables consumed at different meals were similar between those who consumed recommended amounts and those who did not. Among adults, 59-64 % of their intake of fruits was consumed at breakfast or as a snack and almost 90 % came from retail outlets regardless of whether they consumed the recommended amount or not. Adults who consumed the recommended amount of fruits ate more fruits in raw form and with no additions than those who did not. Among children and adults, 52-57 % of vegetables were consumed at dinner by both groups. Retail outlets were the main source of vegetables consumed (60-68 %). CONCLUSIONS: Our findings indicate that habits of when, where and how consumers eat fruits and vegetables might not need to change but increasing the amount consumed would help those not currently meeting the recommendation.


Assuntos
Dieta , Comportamento Alimentar , Frutas , Verduras , Adulto , Criança , Estudos Transversais , Humanos , Inquéritos Nutricionais , Estados Unidos
17.
Matern Child Nutr ; 12(1): 39-50, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24934272

RESUMO

Hispanic women have higher rates of neural tube defects and report lower total folic acid intakes than non-Hispanic white (NHW) women. Total folic acid intake, which is associated with neural tube defect risk reduction, has been found to vary by acculturation factors (i.e. language preference, country of origin, or time spent in the United States) among Hispanic women. It is unknown whether this same association is present for blood folate status. The objective of this research was to assess the differences in serum and red blood cell (RBC) folate concentrations between NHW women and Mexican American (MA) women and among MA women by acculturation factors. Cross-sectional data from the 2001-2010 National Health and Nutrition Examination Survey (NHANES) were used to investigate how blood folate concentrations differ among NHW or MA women of childbearing age. The impact of folic acid supplement use on blood folate concentrations was also examined. MA women with lower acculturation factors had lower serum and RBC folate concentrations compared with NHW women and to their more acculturated MA counterparts. Consuming a folic acid supplement can minimize these disparities, but MA women, especially lower acculturated MA women, were less likely to report using supplements. Public health efforts to increase blood folate concentrations among MA women should consider acculturation factors when identifying appropriate interventions.


Assuntos
Aculturação , Deficiência de Ácido Fólico/prevenção & controle , Ácido Fólico/sangue , Defeitos do Tubo Neural/prevenção & controle , Adolescente , Adulto , Estudos Transversais , Assistência à Saúde Culturalmente Competente , Suplementos Nutricionais , Eritrócitos/química , Feminino , Ácido Fólico/uso terapêutico , Deficiência de Ácido Fólico/sangue , Deficiência de Ácido Fólico/etnologia , Deficiência de Ácido Fólico/fisiopatologia , Alimentos Fortificados , Humanos , Americanos Mexicanos , Defeitos do Tubo Neural/epidemiologia , Defeitos do Tubo Neural/etnologia , Defeitos do Tubo Neural/etiologia , Inquéritos Nutricionais , Cuidado Pré-Concepcional , Prevalência , Risco , Estados Unidos/epidemiologia , População Branca , Adulto Jovem
18.
Birth Defects Res A Clin Mol Teratol ; 103(6): 517-26, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25884850

RESUMO

BACKGROUND: Red blood cell (RBC) folate concentrations are a potential biomarker of folate-sensitive neural tube defect (NTD) risk in the population. The purpose of this analysis was to describe women in the U.S. population with RBC folate concentrations below those associated with optimal NTD prevention. METHODS: We used data from the 2007 to 2012 National Health and Nutrition Examination Survey (NHANES) to assess the RBC folate status of U.S. women of childbearing age relative to risk categories for NTD risk based on RBC folate concentrations. We defined suboptimal RBC folate concentrations as those associated with a prevalence of ≥9 NTDs per 10,000 live births. RESULTS: Among nonpregnant women age 12 to 49 years, 22.8% (95% Confidence Interval: 21.1, 24.6) had suboptimal RBC folate concentrations. Women had greater odds of having a suboptimal RBC folate concentration if they did not use dietary supplements containing folic acid; had mandatorily fortified enriched cereal grain products as their only source of folic acid; were non-Hispanic black or Hispanic; or were current smokers. CONCLUSION: Based on RBC folate concentrations, we would predict that the majority of U.S. women of reproductive age are not at increased risk for folate sensitive NTDs in the presence of mandatory folic acid fortification. Prevention policies and programs can be aimed at population subgroups identified as having higher predicted risk for folate-sensitive NTDs based on RBC folate concentrations.


Assuntos
Biomarcadores/sangue , Eritrócitos/química , Ácido Fólico/sangue , Defeitos do Tubo Neural/epidemiologia , Inquéritos Nutricionais/estatística & dados numéricos , Medição de Risco/estatística & dados numéricos , Adolescente , Adulto , Feminino , Ácido Fólico/análise , Humanos , Gravidez , Medição de Risco/métodos , Estados Unidos/epidemiologia
19.
Br J Nutr ; 113(12): 1965-77, 2015 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-25917925

RESUMO

Serum and erythrocyte (RBC) total folate are indicators of folate status. No nationally representative population data exist for folate forms. We measured the serum folate forms (5-methyltetrahydrofolate (5-methylTHF), unmetabolised folic acid (UMFA), non-methyl folate (sum of tetrahydrofolate (THF), 5-formyltetrahydrofolate (5-formylTHF), 5,10-methenyltetrahydrofolate (5,10-methenylTHF)) and MeFox (5-methylTHF oxidation product)) by HPLC-MS/MS and RBC total folate by microbiologic assay in US population ≥ 1 year (n approximately 7500) participating in the National Health and Nutrition Examination Survey 2011-2. Data analysis for serum total folate was conducted including and excluding MeFox. Concentrations (geometric mean; detection rate) of 5-methylTHF (37·5 nmol/l; 100 %), UMFA (1·21 nmol/l; 99·9 %), MeFox (1·53 nmol/l; 98·8 %), and THF (1·01 nmol/l; 85·2 %) were mostly detectable. 5-FormylTHF (3·6 %) and 5,10-methenylTHF (4·4 %) were rarely detected. The biggest contributor to serum total folate was 5-methylTHF (86·7 %); UMFA (4·0 %), non-methyl folate (4·7 %) and MeFox (4·5 %) contributed smaller amounts. Age was positively related to MeFox, but showed a U-shaped pattern for other folates. We generally noted sex and race/ethnic biomarker differences and weak (Spearman's r< 0·4) but significant (P< 0·05) correlations with physiological and lifestyle variables. Fasting, kidney function, smoking and alcohol intake showed negative associations. BMI and body surface area showed positive associations with MeFox but negative associations with other folates. All biomarkers showed significantly higher concentrations with recent folic acid-containing dietary supplement use. These first-time population data for serum folate forms generally show similar associations with demographic, physiological and lifestyle variables as serum total folate. Patterns observed for MeFox may suggest altered folate metabolism dependent on biological characteristics.


Assuntos
Ácido Fólico/sangue , Inquéritos Nutricionais , Estado Nutricional , Adolescente , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Criança , Pré-Escolar , Cromatografia Líquida de Alta Pressão , Eritrócitos/química , Etnicidade , Feminino , Humanos , Lactente , Leucovorina/sangue , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Valores de Referência , Fatores Sexuais , Espectrometria de Massas em Tandem , Tetra-Hidrofolatos/sangue , Estados Unidos/epidemiologia , Adulto Jovem
20.
J Nutr ; 144(2): 170-6, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24306216

RESUMO

Whether folic acid fortification and supplementation at the population level have led to a higher prevalence of vitamin B-12 deficiency in the absence of anemia remains to be examined among a nationally representative sample of older U.S. adults. We assessed the prevalence of low vitamin B-12 status in the absence of anemia or macrocytosis before and after fortification among adults aged >50 y using cross-sectional data from the NHANES 1991-1994 (prefortification) and 2001-2006 (postfortification). We compared the prefortification and postfortification prevalence of multiple outcomes, including serum vitamin B-12 deficiency (<148 pmol/L) and marginal deficiency (148-258 pmol/L) with and without anemia (hemoglobin <130 g/L for men, <120 g/L for women) and with and without macrocytosis (mean cell volume >100 fL) using multinomial logistic regression, adjusting for age, sex, ethnicity, body mass index, C-reactive protein, and vitamin B-12 supplement use. Prefortification and postfortification serum vitamin B-12 deficiency without anemia [4.0 vs. 3.9%; adjusted prevalence ratio (aPR) (95% CI): 0.98 (0.67, 1.44)] or without macrocytosis [4.2 vs. 4.1%; aPR (95% CI): 0.96 (0.65, 1.43)] remained unchanged. Marginal deficiency without anemia [25.1 vs. 20.7%; aPR (95% CI): 0.82 (0.72, 0.95)] or without macrocytosis [25.9 vs. 21.3%; aPR (95% CI): 0.82 (0.72, 0.94)] were both significantly lower after fortification. After fortification, higher folic acid intake was associated with a lower prevalence of low serum B-12 status in the absence of anemia or macrocytosis. Results suggest that the prevalence of low serum B-12 status in the absence of anemia or macrocytosis among older U.S. adults did not increase after fortification. Thus, at the population level, we found no evidence to support concerns that folic acid adversely affected the clinical presentation of vitamin B-12 deficiency among older adults.


Assuntos
Suplementos Nutricionais , Ácido Fólico/farmacologia , Alimentos Fortificados , Hemoglobinas/metabolismo , Deficiência de Vitamina B 12/epidemiologia , Vitamina B 12/sangue , Complexo Vitamínico B , Idoso , Anemia Macrocítica/sangue , Estudos Transversais , Dieta , Feminino , Ácido Fólico/efeitos adversos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Prevalência , Estados Unidos/epidemiologia , Deficiência de Vitamina B 12/sangue , Deficiência de Vitamina B 12/etiologia , Complexo Vitamínico B/efeitos adversos , Complexo Vitamínico B/sangue , Complexo Vitamínico B/farmacologia
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