Familial sources of encouragement and breast-feeding practices among women participating in the US Special Supplemental Nutrition Programme for Women, Infants and Children.

OBJECTIVE: To explore how sources of familial encouragement are associated with breast-feeding initiation and duration among a national sample participating in the US Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN: This study uses the 2013-2015 WIC Infant and Toddler Feeding Practices Study 2 (WIC ITFPS-2) data. Breast-feeding initiation was measured at the first month, while duration was derived from a composite of the first 13 months. The analysis used logistic and linear regression to explore the association between encouragement sources and breast-feeding outcomes. SETTING: A nationally representative sample of WIC participants in the USA. PARTICIPANTS: WIC participants who completed the 13-month interview of the WIC ITFPS-2 (n 2807). RESULTS: Encouragement was significantly associated with both initiation and duration. Each source of encouragement was associated with a 3·2 (95 % CI 2·8, 3·8) increase in odds of initiating breast-feeding in the unadjusted model and 3·0 (95 % CI 2·5, 3·6) increased odds, controlling for age, education, nativity, poverty status, race and ethnicity (<0·0001). When predicting log duration, each percent increase in source of encouragement was associated with an increasing duration on average by 0·003 d (95 % CI 0·2, 0·3, <0·0001). When controls were added, it was associated with an increase of an average of 0·002 d (95 % CI 0·2, 0·3) per percent increase in encouragement source (<0·0001). CONCLUSIONS: Women who receive encouragement appear to be more likely to breastfeed. Additional work is needed to explore sources of encouragement and how to include them in intervention work.

Differences in Cardiometabolic Biomarkers between Elementary School-Age Latinx Children with Obesity versus Healthy Weight.

OBJECTIVES: Low-income Latinx youth are disproportionately affected by obesity, which results in an increased risk of cardiometabolic abnormalities. Biomarker tracking may be useful for the early identification of obesity comorbidities in young Latinx children. Hence, we aimed to compare cardiometabolic biomarkers between age- and sex-matched pairs of elementary school-aged Latinx children with obesity versus healthy weight. METHODS: This case-control study compared cardiometabolic biomarkers between 13 pairs of age- and sex-matched elementary school-age (median 6.5 years) Latinx children with obesity (body mass index for age ≥ 95th percentile) as compared with their healthy weight (between the 5th and 85th percentiles) counterparts. Anthropometric measures and a fasted venous blood sample were taken for the analysis of lipids, glycemic, inflammatory, endocrine, and hepatic markers. Group differences were tested by the Mann-Whitney U or χ2 test. RESULTS: Cases had higher insulin (P = 0.003), hemoglobin A1c (P = 0.002), triglycerides (P = 0.023), and C-reactive protein (P < 0.001) and lower high-density lipoprotein (P = 0.002). Hepatic markers were similar, with alanine aminotransferase elevated among both groups. CONCLUSIONS: The aforementioned biomarkers may be more sensitive to higher adiposity risk in this young Latinx population; however, elevated hepatic markers may indicate an ethnic/genetic predisposition to abnormal liver function. Research should be replicated in a larger group to confirm these findings.

Patterns of Bone Mineral Accretion and Sex Differences in Healthy Term Vitamin D Replete and Breastfed Infants From Montreal, Canada: Bone Mass Reference Data.

Infancy is a period of rapid bone growth and mineral accretion; nonetheless, reference data remain scarce for this age group. The purpose of this report is to generate reference data for bone mass in breastfed vitamin D replete infants and investigate patterns of bone mineral accretion and sex differences. This is a secondary analysis from a double-blinded randomized controlled trial (NCT00381914). Healthy term breastfed (exclusively or mixed) infants were randomized to different doses of oral vitamin D supplementation (400-1600 IU/d) and followed prospectively from 1 to 12 mo. Plasma 25-hydroxyvitamin D (LC-MS/MS), bone mineral content (BMC; whole body (WB) and lumbar spine (LS)) and bone mineral density (BMD; LS) were measured at 1, 3, 6, 9, and 12 mo by dual-energy x-ray absorptiometry (Hologic Discovery 4500A) with no effect of supplementation on bone outcomes. For the purpose of this analysis, 63 infants with adequate plasma 25-hydroxyvitamin D ≥ 50 nmol/L at baseline, were included. Differences over time and between sexes were tested using mixed model repeated measures ANOVA. Infants (31 males, 32 females) were 39.5 ± 1.1 wk gestational age at birth and appropriate for gestational age. WB BMC, LS BMC, and LS BMD increased by 143.2%, 116.8%, and 31.1% respectively across infancy. WB BMC was higher (4.2% - 9.4%; p = 0.03) in males than in females across the study. After adjusting WB BMC for weight, length or head BMC, sex differences were not evident. LS BMC and LS BMD did not vary by sex. LS BMD growth charts for both sexes combined, were generated using LMS chartmaker. WB BMC more than doubles during the first year of life confirming the importance of skeletal growth and the need for age-specific reference data in infancy. Sex differences in BMC, if any, are mostly driven by differences in body size.

Feasibility of the automatic ingestion monitor (AIM-2) for infant feeding assessment: a pilot study among breast-feeding mothers from Ghana.

OBJECTIVE: Passive, wearable sensors can be used to obtain objective information in infant feeding, but their use has not been tested. Our objective was to compare assessment of infant feeding (frequency, duration and cues) by self-report and that of the Automatic Ingestion Monitor-2 (AIM-2). DESIGN: A cross-sectional pilot study was conducted in Ghana. Mothers wore the AIM-2 on eyeglasses for 1 d during waking hours to assess infant feeding using images automatically captured by the device every 15 s. Feasibility was assessed using compliance with wearing the device. Infant feeding practices collected by the AIM-2 images were annotated by a trained evaluator and compared with maternal self-report via interviewer-administered questionnaire. SETTING: Rural and urban communities in Ghana. PARTICIPANTS: Participants were thirty eight (eighteen rural and twenty urban) breast-feeding mothers of infants (child age ≤7 months). RESULTS: Twenty-five mothers reported exclusive breast-feeding, which was common among those < 30 years of age (n 15, 60 %) and those residing in urban communities (n 14, 70 %). Compliance with wearing the AIM-2 was high (83 % of wake-time), suggesting low user burden. Maternal report differed from the AIM-2 data, such that mothers reported higher mean breast-feeding frequency (eleven v. eight times, P = 0·041) and duration (18·5 v. 10 min, P = 0·007) during waking hours. CONCLUSION: The AIM-2 was a feasible tool for the assessment of infant feeding among mothers in Ghana as a passive, objective method and identified overestimation of self-reported breast-feeding frequency and duration. Future studies using the AIM-2 are warranted to determine validity on a larger scale.

External and Internal Load Measures During Preseason Training in Men Collegiate Soccer Athletes.

ABSTRACT: Fields, JB, Merigan, JM, Gallo, S, White, JB, and Jones, MT. External and internal load measures during preseason training in men collegiate soccer athletes. J Strength Cond Res 35(9): 2572-2578, 2021-Collegiate athletes are exposed to high volume loads during preseason training. Monitoring training load can inform training and recovery periods. Therefore, the purpose was to examine changes in and bidirectional relationship between external and internal load metrics in men collegiate soccer athletes (n = 20; age, 20 ± 1 year). Internal load measures of heart rate variability (HRV), salivary testosterone (T) and cortisol (C), and self-assessment wellness and ratings of perceived exertion scales were collected daily. External load measures of total distance, player load, high-speed distance, high inertial movement analysis, and repeated high-intensity efforts were collected in each training session using global positioning system/global navigation satellite system technology. A 1-way analysis of variance determined weekly changes in external load, physiological, hormonal, and subjective self-assessment measures of internal load. Bidirectional prediction of external load markers and self-assessment measures on physiological and hormonal markers of internal load were assessed by hierarchical linear regression models (p < 0.05). External load measures, C, energy, sleep, and rate of perceived exertion (RPE) decreased (p < 0.01), whereas T, T:C ratio, anger, depression, and vigor increased (p < 0.01) from week 1 to week 2. Morning C positively predicted afternoon external load and post-training RPE (p < 0.05); T:C ratio negatively predicted afternoon external load and post-training RPE (p < 0.05); and morning HRV negatively predicted post-training RPE (p = 0.031). Despite reduced hormonal stress and external load across weeks, negative perceptions of fatigue increased, suggesting fatigue patterns may have a delayed response. Load may have a more belated, chronic effect on perceptions of fatigue, whereas hormonal changes may be more immediate and sensitive to change. Practitioners may wish to use a variety of external and internal load measures to understand athletes' stress responses to training.

Relationship Between External Load and Self-Reported Wellness Measures Across a Men's Collegiate Soccer Preseason.

ABSTRACT: Fields, JB, Lameira, DM, Short, JL, Merrigan, JM, Gallo, S, White, JB, and Jones, MT. Relationship between external load and self-reported wellness measures across a collegiate men's soccer preseason. J Strength Cond Res 35(5): 1182-1186, 2021-Monitoring athlete training load is important to training programming and can help balance training and recovery periods. Furthermore, psychological factors can affect athlete's performance. Therefore, the purpose was to examine the relationship between external load and self-reported wellness measures during soccer preseason. Collegiate men soccer athletes (n = 20; mean ± SD age: 20.3 ± 0.9 years; body mass: 77.9 ± 6.8 kg; body height: 178.87 ± 7.18cm; body fat: 10.0 ± 5.0%; V̇o2max: 65.39 ± 7.61ml·kg-1·min-1) participated. Likert scale self-assessments of fatigue, soreness, sleep, stress, and energy were collected daily in conjunction with the Brief Assessment of Mood (vigor, depression, anger, fatigue, and confusion). Total distance (TD), player load (PL), high-speed distance (HSD, >13 mph [5.8 m·s-1]), high inertial movement analysis (IMA, >3.5 m·s-2), and repeated high-intensity efforts (RHIEs) were collected in each training session using positional monitoring (global positioning system/global navigation satellite system [GPS/GNSS]) technology. Session rate of perceived exertion (sRPE) was determined from athlete's post-training rating (Borg CR-10 Scale) and time of training session. Multilevel models revealed the bidirectional prediction of load markers on fatigue, soreness, sleep, energy, and sRPE (p < 0.05). Morning ratings of soreness and fatigue were predicted by previous afternoon's practice measures of TD, PL, HSD, IMA, RHIE, and sRPE. Morning soreness and fatigue negatively predicted that day's afternoon practice TD, PL, HSD, IMA, RHIE, and sRPE. Morning ratings of negative mood were positively predicted by previous day's afternoon practice HSD. In addition, negative morning mood states inversely predicted HSD (p = 0.011), TD (p = 0.002), and PL (p < 0.001) for that day's afternoon practice. Using self-reported wellness measures with GPS/GNSS technology may enhance the understanding of training responses and inform program development.

Nutritional Intake and Bone Health Among Adults With Probable Undiagnosed, Untreated Celiac Disease: What We Eat in America and NHANES 2009-2014.

Objective: The aim was to evaluate differences in nutritional intake of calcium, vitamin D, and phosphorus; serologic indices of these nutrients; and bone health among adults with and without probable, undiagnosed celiac disease (CD).Method: Cross-sectional data from What We Eat in America and the National Health and Nutrition Examination Survey 2009-2014 including self-reported dietary and supplement intake from one day of 24-hour recalls, serologic indicators, and dual x-ray absorptiometry scans were analyzed in adults with probable undiagnosed CD, who tested positive on the immunoglobulin A endomysial antibody assay (n = 48) and controls (n = 13,634). Statistical analysis included multiple linear regression modeling controlled for age, sex, race/ethnicity, energy intake, and poverty income ratio.Results: The prevalence of probable undiagnosed CD was 1 in 285. Probable CD status was associated with a 251.6 mg (95% confidence interval [CI], 72.3-432.9) higher daily total calcium intake. The total dietary and supplement intake of those with probable CD was significantly higher in calcium density (103.4 mg/1,000 kcal; 95% CI, 25.6-181.1) and phosphorus density (46.7 mg/1,000 kcal; 95% CI, 3.1-90.3). Probable CD status was associated with higher dairy consumption by 0.7 cups per day (95% CI, 0.2-1.2) and higher serum phosphorus concentrations (4.0 mg/dL vs 3.8 mg/dL, p = 0.011). No differences in serum calcium, vitamin D, or alkaline phosphatase levels were observed between groups. Probable CD status was also associated with a -0.1 g/cm2 (95% CI, -0.2 to -0.0) lower femur bone mineral density (BMD) and a -0.1 g/cm2 (95% CI, -0.1 to -0.0) lower femoral neck BMD. No differences in total spine BMD were observed.Conclusions: Adults with probable undiagnosed CD had lower bone density than adults without CD, despite also reporting higher total calcium intake and nutritional density of both calcium and phosphorus.

Normative Data for Lean Mass and Fat Mass in Healthy Predominantly Breast-Fed Term Infants From 1 Month to 1 Year of Age.

BACKGROUND: A leaner body phenotype in infancy plays an important role in the early life prevention of obesity. However, there is a dearth of reference data for body composition in infancy. This study aimed to create a normative reference dataset for lean (LM) and fat (FM) mass and accretion rates in healthy infants. METHODS: Healthy term-born infants (35 boys; 35 girls) were studied at ≤ 1, 3, 6, 9, and 12 mo of age for growth and compared to World Health Organization standards. LM (g) and FM (g) were measured using DXA (APEX version 13.3:3, Hologic 4500A) in infant whole-body mode. Sex specific reference curves were generated using the LMS method (LMSchartmaker, Medical Research Council, UK). RESULTS: Infants were predominantly white (82.9%), breastfed (98.4% ≥ 3 mo), and grew in length and weight within World Health Organization Z-score ranges for normal growth across infancy. LM accretion was 327.4 ± 12.5 g/mo representing 95% increment in LM. Boys had more LM compared to girls at 12 mo (7807.4 ± 1114.0 vs 6817.4 ± 1016.1 g; p = 0.008). FM accretion was 114.3 ± 12.0 g/mo representing 114% increment in FM with no difference between the sexes. CONCLUSIONS: This data, which is based on a healthy sample of infants, characterizes LM and FM accretion during the first year of life and will aid in the interpretation of body composition.

Sociodemographic predictors of exclusive breast-feeding among low-income women attending a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programme.

OBJECTIVE: To describe infant feeding practices and predictors of exclusive breast-feeding among women attending a local Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) programme. DESIGN: Cross-sectional survey. Outcomes included reported infant feeding practices at 3 and 6 months, timing and reasons for introduction of formula. Descriptive statistics, χ 2 tests and logistic regression were used describe the sample and explore relationships between variables. SETTING: Loudoun County, VA, USA. SUBJECTS: A sample of 190 predominantly Hispanic women attending local WIC clinics. RESULTS: Overall, 84 % of women reported ever breast-feeding and 61 % of infants received formula in the first few days of life. Mothers who reported on infant feeding practices were less likely to exclusively breast-feed (34 v. 45 %) and more likely to provide mixed feeding (50 v. 20 %) at 3 months compared with 6 months, respectively. Significant (P<0·05) predictors of exclusive breast-feeding at 3 months included setting an exclusive breast-feeding goal and completing some high school (compared with completing high school or more). Only education remained a significant predictor of exclusive breast-feeding at 6 months. CONCLUSIONS: A high proportion of women reported giving formula in the first few days of life and many changed from mixed to exclusive breast-feeding or formula by 6 months, suggesting possibly modifiable factors. Further investigation can help drive direct service- as well as policy and systems-based interventions to improve exclusive breast-feeding.

Risk of depression in pregnant women with low-normal serum Vitamin B12.

High prevalence rates of both Vitamin B12 insufficiency and depressive symptoms exist in pregnant women. Although the association between depressive symptoms and certain nutrient deficiencies like iron, folate, or Vitamin B12 has been established, the specific relationship between low-normal serum Vitamin B12 levels and depressive symptoms in pregnant women in the United States has not been studied closely. Using 2005-2006 National Health and Nutrition Examination Survey data, a secondary analysis was conducted to examine the association between low-normal serum Vitamin B12 level and depression, as measured by a score of 10 or higher on the Patient Health Questionnaire-9, in pregnant women (N = 174). In bivariate regression models, Vitamin B12 level, experiencing poverty, and pre-pregnancy body mass index (BMI) were significant predictors of depression. In multivariate logistic regression models, pregnant women with low-normal serum Vitamin B12 levels (OR = 3.82, 95% CI [1.10-13.31], p < 0.04) were 3.82 times more likely to experience depression, controlling for sociodemographic characteristics, pre-pregnancy BMI, and the biomarkers hemoglobin and folate. Identifying and treating pregnant women with low-normal Vitamin B12 levels may enhance prenatal depression management.

Impact of Vitamin D Supplementation on Gross Motor Development of Healthy Term Infants: A Randomized Dose-Response Trial.

UNLABELLED: In addition to benefits for bone health, vitamin D is implicated in muscle function in children and adults. AIMS: To determine if vitamin D dosage positively correlated with gross motor development at 3 and 6 months of age. We hypothesized that higher doses would be associated with higher scores for gross motor skills. METHODS: A consecutive sample of 55 healthy, term, and breastfed infants from Montreal, Canada were recruited from a randomized trial of vitamin D supplementation between 2009 and 2012. Infants were randomized to 400 International Units (IU) (n = 19), 800 IU (n = 18) or 1,200 IU (n = 18) vitamin D3/day. Motor performance at 3 and 6 months was quantified by the Alberta Infant Motor Scale (AIMS). Plasma vitamin D3 metabolites were measured by tandem mass spectrometry. RESULTS: AIMS scores did not differ at 3 months. However, total AIMS scores and sitting subscores were significantly higher at 6 months in infants receiving 400 IU/day compared to 800 IU/day and 1,200 IU/day groups (p < .05). There were weak negative correlations with length and C-3 epimer of 25(OH)D. CONCLUSIONS: In contrast to our hypothesis, gross motor achievements were significantly higher in infants receiving 400 IU/day vitamin D. Our findings also support longer infants being slightly delayed.

The change in plasma 25-hydroxyvitamin D did not differ between breast-fed infants that received a daily supplement of ergocalciferol or cholecalciferol for 3 months.

The biological equivalency of ergocalciferol (D2) and cholecalciferol (D3) has been debated; several comparisons have appeared in the adult literature but are scarce in pediatrics. The objective of this study was to compare increases in plasma 25-hydroxyvitamin D [25(OH)D] concentrations and attainment of 50 and 75 mol/L status cutoffs following 3 mo of daily supplementation with D2 compared with D3. Healthy, breast-fed, 1-mo-old infants (n = 52) received 10 µg (400 ic) of either D2 or D3 daily. At 1 and 4 mo of age, plasma 25-hydroxyergocalciferol and 25-hydroxycholecalciferol concentrations were determined by liquid chromatography tandem MS (LC-MS/MS) and total 25(OH)D by chemiluminescent immunoassay (DiaSorin Liaison). Data were analyzed using t tests and χ² by intent to treat. A total of 23% of infants were deficient (≤24.9 nmol/L) at baseline and 2% at follow-up on the basis of LC-MS/MS. At 4 mo, 96% were breastfed and there were no differences in compliance, breastfeeding rates, or sun exposure among groups. The change in total 25(OH)D measured by LC-MS/MS did not differ between the D2 (17.6 ± 26.7 nmol/L) and D3 (22.2 ± 20.2 nmol/L) groups. In the combined groups, the baseline plasma 25(OH)D concentration was inversely related to the change in total 25(OH)D (r = -0.52; P < 0.001). Overall, 86% of infants met the 50 nmol/L cutoff at follow-up; however, fewer infants in the D2 group (75%) met this level compared with the D3 group (96%) (P < 0.05). Similar results were obtained by immunoassay. In conclusion, the increase in the 25(OH)D concentration among the D2 and D3 groups did not differ, suggesting daily intake of either isoform is acceptable for infants <4 mo.

Effect of different dosages of oral vitamin D supplementation on vitamin D status in healthy, breastfed infants: a randomized trial.

IMPORTANCE: Vitamin D supplementation in infancy is required to support healthy bone mineral accretion. A supplement of 400 IU of vitamin D per day is thought to support plasma 25-hydroxyvitamin D (25[OH]D) concentrations between 40 and 50 nmol/L; some advocate 75 to 150 nmol/L for bone health. OBJECTIVE: To investigate the efficacy of different dosages of vitamin D in supporting 25(OH)D concentrations in infants. DESIGN, SETTING, AND PARTICIPANTS: Double-blind randomized clinical trial conducted among 132 one-month-old healthy, term, breastfed infants from Montréal, Québec, Canada, between March 2007 and August 2010. Infants were followed up for 11 months ending August 2011 (74% completed study). INTERVENTION: Participants were randomly assigned to receive oral cholecalciferol (vitamin D3) supplements of 400 IU/d (n=39), 800 IU/d (n=39), 1200 IU/d (n=38), or 1600 IU/d (n=16). MAIN OUTCOMES AND MEASURES: The primary outcome was a plasma 25(OH)D concentration of 75 nmol/L or greater in 97.5% of infants at 3 months. Secondary outcomes included 25(OH)D concentrations of 75 nmol/L or greater in 97.5% of infants at 6, 9, and 12 months; 25(OH)D concentrations of 50 nmol/L or greater across all times; growth; and whole body and regional bone mineral content. Data were analyzed by intention to treat using available data, logistic regression, and mixed-model analysis of variance. RESULTS: By 3 months, 55% (95% CI, 38%-72%) of infants in the 400-IU/d group achieved a 25(OH)D concentration of 75 nmol/L or greater vs 81%(95% CI, 65%-91%) in the 800-IU/d group, 92% (95% CI, 77%-98%) in the 1200-IU/d group, and 100% in the 1600-IU/d group. This concentration was not sustained in 97.5% of infants at 12 months in any of the groups. The 1600-IU/d dosage was discontinued prematurely because of elevated plasma 25(OH)D concentrations. All dosages established 25(OH)D concentrations of 50 nmol/L or greater in 97% (95% CI, 94%-100%) of infants at 3 months and sustained this in 98% (95% CI, 94%-100%) to 12 months. Growth and bone mineral content did not differ by dosage. CONCLUSIONS AND RELEVANCE: Among healthy, term, breastfed infants, only a vitamin D supplement dosage of 1600 IU/d (but not dosages of 400, 800, or 1200 IU/d) increased plasma 25(OH)D concentration to 75 nmol/L or greater in 97.5% of infants at 3 months. However, this dosage increased 25(OH)D concentrations to levels that have been associated with hypercalcemia. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00381914.

A Quasi-Experimental Assessment of the Effect of the 2009 WIC Food Package Revisions on Breastfeeding Outcomes.

Breastfeeding rates among infants participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are consistently lower than those of WIC nonparticipants. The 2009 WIC food package revisions were intended to incentivize breastfeeding among the WIC population. To examine the effectiveness of this policy change, we estimated an intent-to-treat regression-adjusted difference-in-difference model with propensity score weighting, an approach that allowed us to control for both secular trends in breastfeeding and selection bias. We used novel data from the Feeding Infants and Toddlers Survey from 2008 and 2016. We defined our treatment group as infants eligible for WIC based on household income and our control group as infants in households with incomes just above the WIC eligibility threshold. The breastfeeding outcomes we analyzed were whether the infants were ever breastfed, breastfed through 6 months, and breastfed exclusively through 6 months. We observed significant increases in infants that were ever breastfed in both the treatment group (10 percentage points; p < 0.01) and the control group (15 percentage points; p < 0.05); however, we did not find evidence that the difference between the two groups was statistically significant, suggesting that the 2009 revisions may not have had an effect on any of these breastfeeding outcomes.

Factors associated with dietary acculturation among international students at the University of Georgia.

OBJECTIVE: Western diet is associated with chronic disease risk, and degree of dietary acculturation can impact susceptibility. This study sought to understand the factors associated with changes in food consumption habits among international students at a large public university in the southern US. PARTICIPANTS: A convenience sample of 173 international students representing 41 countries at The University of Georgia participated in the survey. METHODS: This cross-sectional online survey assessed dietary habits, perception of healthy eating, and level of acculturation using previously validated measures. RESULTS: Highest number of participants were from China (19.2%), 89.0% were graduate students with an average age of 27.5 ± 4.83 years. The majority (62.0%) of participants were dietary acculturated with affordability and accessibility determining types of food consumption, as fewer whole foods and more processed foods were consumed in the U.S. CONCLUSIONS: Findings suggest dietary acculturation may be driven by economic factors, making the transition to Westernized food items a convenient and cost-effective choice among international students.

Vitamin D supplementation and gross motor development: A 3-year follow-up of a randomized trial.

BACKGROUND: Vitamin D status during pregnancy, early childhood and season-at-birth are implicated in gross motor development (GMD). AIM: To test whether vitamin D intake in infancy and season-at-birth affect GMD in early childhood. STUDY DESIGN: 3-year follow up study of a single-center trial. SUBJECTS: Healthy infants (n = 116) were allocated to 400 (standard-of-care), 800 or 1200 IU/day of vitamin D3 supplementation from 1 to 12 months; n = 70 returned for follow-up at 3-years. OUTCOME MEASURES: The main outcome was GMD using the Peabody Developmental Motor Scales-2 which includes gross motor quotient (GMQ) and stationary, locomotion and object manipulation subtests. RESULTS: GMQ scores were normal (≥85) in 94 %. An interaction between dosage group and season-at-birth (p = 0.01) was observed for GMQ and stationary standardized score; among winter/spring born children, the 1200 IU/d scored higher vs. 400 and 800 IU/d groups. Object manipulation standardized score was higher (p = 0.04) in children in the 1200 vs. 400 IU/d group, without interaction with season-at-birth. CONCLUSIONS: GMD in young children who received 400 IU/d of supplemental vitamin D in infancy is not influenced by season-at-birth. This dose of vitamin D of 400 IU/d as recommended in North America adequately supports GMD. The modest enhancement in GMD with 1200 IU/d in winter/spring born children requires further study.

Vitamin D Intake and Meeting Recommendations Among Infants Participating in WIC Nationally.

OBJECTIVE: To report and examine associations with infant vitamin D intake and meeting recommendations among a national sample participating in Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN: Secondary analysis from the 2013-2015 WIC Infant Toddler Feeding Practices Study-2. PARTICIPANTS: US Infants. VARIABLES MEASURED: Total reported vitamin D intake from diet and supplementation at the time of data collection. ANALYSIS: Descriptive statistics and generalized estimating equations. RESULTS: The median total vitamin D intake ranged from 5.43 (95% confidence interval, 5.40-5.46) mcg/d at month 1 to 8.18 (95% confidence interval, 8.11-8.20) mcg/d at month 13, with 16% to 36% of infants meeting the infant vitamin D recommendation over that time. Overall, 6% to 12% of all participants reported supplementation across all time points. Although most (between 78% to 98%) of supplemented breastfed infants met the recommendation, very few were supplemented as a group. Hence, breastfed infants were less likely to meet the recommendation than those who were formula fed across at time points except month 1 (P < 0.001 for all). Whereas infant age, feeding type, and/or their interaction were significant predictors of both receiving supplementation and meeting the recommendation, mother/caregiver nativity (P = 0.006) and parity (P = 0.01 and P < 0.001) predicted receiving supplementation, and child sex (P < 0.001) and mother/caregiver race/ethnicity (P < 0.001) predicted meeting the recommendation. CONCLUSIONS AND IMPLICATIONS: Among a national sample of infants participating in WIC between 2013-2015, a high proportion were not meeting the current vitamin D recommendation. The WIC program is 1 resource for promoting strategies for increasing the number of American infants meeting D recommendations, but a coordinated approach involving other health care providers is likely needed. Future research exploring the reason for lack of supplementation, from both the perspective of parents and providers and the clinical impact of low vitamin D intake, is warranted.

Research at the Academy of Nutrition and Dietetics: What, How, and Why?

Research is essential to further advance our understanding of the role of nutrition and dietetics in maintenance and improvement of health. Research is also essential for nutrition and dietetics practitioners to create and provide evidence-based interventions, including medical nutrition therapy provided by registered dietitian nutritionists. Given this critical role of research, the Academy of Nutrition and Dietetics (Academy) has a variety of resources to assist its members in accessing, understanding, participating in, conducting, and disseminating nutrition research. These resources are comprehensive and include opportunities to participate in research (eg, Nutrition Research Network and Data Science Center), tools to aggregate practice data (Nutrition Care Process and Terminology and the Academy of Nutrition and Dietetics Informatics Infrastructure), funding opportunities to support primary research (eg, Academy Foundation), resources to understand the latest research informing evidence-based practice (eg, Evidence Analysis Center), and avenues for sharing research findings (eg, Food & Nutrition Conference & Expo™). The aim of this article is to encourage Academy members to get involved in research by describing Academy-based research resources and opportunities to contribute to nutrition and dietetics research, as well as describe specific examples of research conducted at the Academy. The information presented can serve as a framework to guide members in engaging in research through the Academy.

Treatment of Obesity: Beyond the Diet.

Obesity affects 2 of 5 Americans, and nearly 1 of 10 is considered severely obese, with the greatest risk of morbidity and mortality. A reduction in body weight of 2% to 5% can lead to improvements in cardiovascular health, with weight loss maintenance associated with the best health outcomes. Lifestyle interventions that focus on changes in diet and physical activity behaviors are best to maintain weight loss. This article provides a review of the treatment of adult obesity with a focus on dietary interventions.

A Cross-Sectional Study of Psychological Flexibility as a Mediator for the Relationship Between Acculturative Stress and Cardiovascular Health Behaviors Among Second-Generation Arab Americans.

INTRODUCTION: Second-generation Arab Americans may be at risk for poor cardiovascular health behaviors, but these behaviors are poorly understood. The purpose of this study was to examine the effects of acculturative stress and psychological flexibility on cardiovascular health behaviors among second-generation Arab Americans. METHOD: In a cross-sectional study, survey data were collected in 2018 at local mosques, churches, and a university campus. Cardiovascular health behaviors were measured with a questionnaire based on the American Heart Association Life's Simple 7. Acculturative stress and psychological flexibility were assessed using reliable and valid measures. RESULTS: Participants (n = 325) with higher acculturative stress were significantly more likely to report intermediate overall cardiovascular health behaviors (p = .01) and poor to intermediate diet (p = .00). Psychological flexibility partially mediated poor/intermediate smoking (p = .02) and intermediate diet (p = .00) scores. DISCUSSION: Nurses may consider the role of acculturation when designing culturally sensitive interventions to promote cardiovascular health in second-generation populations.