Screen Media use is Higher among Preschool Children from More Chaotic Homes

Early childhood is a critical time for children’s growth and development. One factor that may impair healthy development during the preschool years is excessive screen media use. U.S children under the age of 5 average twice the amount of recommended screen time. This research brief shows that screen media use is higher among children from households with more chaos

How does the UK childcare energy-balance environment influence 3-to-4-year-olds’ anthropometry? A cross-sectional exploration

ABSTRACT Objectives To assess the association between time spent in care, the childcare energy-balance environment, and preschool-aged children’s Body Mass Index z-score (z-BMI), waist-to-height ratio (WHR), and sum of skinfolds thickness (SST). Design Cross-sectional study. Setting and participants 3-to-4-year-old children were recruited from 30 childcare centres in Cambridgeshire (UK) in 2013. Main outcome measures Objectively measured height and weight was used to calculate BMI z-score; waist circumference and height were used to generate WHR; subscapular and tricep skinfolds were used to calculate SST. Associations between childcare attendance, the nutrition, physical activity, and overall childcare environment, and three anthropometric outcomes were explored using two-level hierarchical regression models, adjusting for demographic and family-based confounders. Results Valid data were available for 196 children (49% female). Time spent in care, the nutrition, physical activity, and overall childcare environment were not associated with children’s z-BMI score, WHR, and SST. Conclusions Childcare environment and level of attendance were not associated with UK preschool-aged children’s anthropometry. The childcare environment has been central to intervention efforts to prevent/ reduce early childhood obesity, yet other factors, including child-, family-, wider environmental, and policy-level factors warrant substantial attention when considering obesity prevention strategies for young children

The relationship between childcare and adiposity, body mass and obesity-related risk factors: protocol for a systematic review of longitudinal studies

BACKGROUND: The rising prevalence of obesity, particularly in childhood, is a global public health emergency. There is some evidence that exposure to non-parental childcare before age 6 years is associated with subsequent development of obesity and obesity-related behaviours such as physical activity, sedentary behaviour, sleep, diet and stress, although these findings are inconsistent. It is possible that the relationship between early childcare and later obesity and obesity-related behaviours depends on characteristics of childcare exposure such as type (i.e. informal versus formal care), duration (i.e. number of years spent in childcare), intensity (e.g. number of hours per week) and timing (i.e. age of onset of childcare) of care received. The relationship may also be moderated by socio-demographic characteristics of children and their families. We will conduct a systematic review exploring longitudinal associations between childcare (type, duration, intensity and timing) and measures of adiposity and body mass, physical activity, sedentary behaviour, sleep, diet and stress. We will also assess whether these relationships vary by socio-demographic factors. METHODS: We will include studies that explore longitudinal associations between childcare attendance in children aged <6 years not in primary school at first assessment and body weight, adiposity, physical activity, diet, sleep and stress. We will limit studies to those involving middle- and high-income countries. Two independent reviewers will screen search results in two stages: (1) title and abstract and (2) and full text. One reviewer will extract relevant data and a second will verify this information. We will assess risk of bias of included studies using an adaption of the United States Department of Agriculture National Evidence Library Bias Assessment Tool. We will tabulate and summarise results narratively. We may conduct meta-analysis if at least five studies report comparable data. DISCUSSION: To our knowledge, this will be the first systematic review to summarise the existing evidence on longitudinal associations between childcare and adiposity, body mass and obesity-related risk factors. The results will be of relevance to other researchers, childcare practitioners and policy makers. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42015027233.British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, National Institute for Health Research, Wellcome Trus

Associations between timing and quality of solid food introduction with infant weight-for-length z-scores at 12 months: Findings from the Nurture cohort

This study assesses associations of the timing and quality of solid foods introduced during infancy with weight-for-length (WFL) z-scores at 12 months within the Nurture cohort. Women from North Carolina self-reported sociodemographics, the timing and type of solid food introduction, and reasons for introducing solids; infant anthropometrics were measured every 3 months through 1 year (n = 666). Frequency (0–5x/day) infants consumed fruits and vegetables was used to compute a mean (4–12 months) healthy food score (HFS), and sweets, french fries, snacks, and ice cream was used to compute a mean unhealthy food score (UnHFS). Multivariable-adjusted generalized linear models were used to examine the relationship of early solid food introduction, HFS quartiles (Q), UnHFS quartiles, and interactions between these variables with WFL z-scores at 12 months (n = 449). Exploratory analyses evaluated WFL z-scores among 4 groups of infants with high/low HFS and high/low UnHFS. On average, mothers were 28 years with a pre-pregnancy BMI of 30.5 kg/m2; 65% were Non-Hispanic Black, and 59% had incomes z-scores. Infants in Q3 and Q4 of the UnHFS had higher WFL z-scores (0.75–0.79 ± 0.09) compared to infants in Q1 (0.42 ± 0.0.9), p \u3c 0.05. Frequent unhealthy food intake was associated with higher WFL z-scores at 12-months, underscoring the importance of reducing unhealthy food intake in the first year

Promoting breastfeeding in child care through state regulation.

Policies supporting breastfeeding vary by state, but little is known about the geographical aspects of this variation. This study describes state breastfeeding licensing and administrative regulations targeting child care settings, compares regulations with national standards, and examines the spatial patterning and clustering of these regulations throughout the United States (US). We compared regulations for child care centers (centers) and family child care homes (homes) with national standards for: (1) general breastfeeding support; (2) designated place for breastfeeding; (3) no solids before infants are four months of age; and (4) no formula for breastfed infants without parent permission. We scored state regulations as 0 = standard not addressed, 1 = standard partially addressed, and 2 = standard fully addressed. We considered each regulation individually, and also summed scores to provide an overall rating of regulations by state. We mapped regulations using geographic information systems technology, and explored overall and local spatial autocorrelation using global and local variants of Moran's I. Five states had regulations for centers and two for homes that addressed all four standards. Mean regulation scores were 0.35, 0.20, 0.98, 0.74 for centers, and 0.17, 0.15, 0.79, 0.58 for homes. Local Moran's I revealed that New York and Pennsylvania had substantially stronger regulations than their adjacent states, while Florida had weaker regulations than its neighbors. Overall, few states had regulations that met breastfeeding standards. We identified some patterns of spatial correlation, suggesting avenues for future research to better understand distributions of regulations across the US.This is the final published version of the article. It was first published in the Maternal and Child Health Journal here: http://link.springer.com/article/10.1007%2Fs10995-014-1560-6

Nutrition practices of nurseries in England. Comparison with national guidelines.

Recent national guidelines call for improved nutrition within early years settings. The aim of this cross-sectional study was to describe foods and beverages served in nurseries, assess provider behaviors related to feeding, and compare these practices to national guidelines. We administered a mailed survey to a random sample of nurseries across England, stratifying by tertile of deprivation. A total of 851 nurseries returned the survey (54.3% response rate). We fitted separate multivariate logistic regression models to estimate the association of deprivation with each of the 13 food and beverage guidelines and the seven provider behavior guidelines. We also conducted a joint F-test for any deprivation effect, to evaluate the effect of the guidelines combined. After adjusting for confounders, we observed differences in the frequency of nurseries that reported serving healthier foods across the tertiles of deprivation (p = 0.02 for joint F test). These adjusted results were driven mainly by nurseries in more deprived areas serving more whole grains (OR 1.57 (95% CI 1.00, 2.46)) and legumes, pulses, and lentils (1.40 (1.01, 2.14)). We also observed differences in the frequency of nurseries reporting more provider behaviors consistent with national guidelines across the tertiles of deprivation (p = 0.01 for joint F test). Nurseries in more deprived areas were more likely to dilute juice with water (2.35 (1.48, 3.73)), allow children to select their own portions (1.09 (1.06, 1.58)), and sit with children during meals (1.84 (1.07, 3.15)). While nurseries in the most deprived areas reported serving more healthy foods, a large percentage were still not meeting national guidelines. Policy and intervention efforts may increase compliance with national guidelines in nurseries in more deprived areas, and across England.This work was undertaken by the Centre for Diet and Activity Research (CEDAR), a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Funding from the British Heart Foundation, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research and the Wellcome Trust under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.This is the final published version. It first appeared at http://www.sciencedirect.com/science/article/pii/S0195666314005145#

Preventing childhood obesity in early care and education settings: lessons from two intervention studies: Obesity prevention in early care and education

Obesity prevention in young children is a public health priority. In the United States, nearly 10% of children less than five years of age are obese and most attend some form of out-of-home child care. While a number of interventions have been conducted in early care and education settings, few have targeted the youngest children in care or the less formal types of child care like family child care homes. Additionally, only two previous studies provided recommendations to help inform future interventions

Associations of childcare type, age at start, and intensity with body mass index trajectories from 10 to 42 years of age in the 1970 British Cohort Study

Background: Attending childcare is related to greater childhood obesity risk, but there are few long-term follow-up studies. We aimed to examine the associations of childcare type, age at start, and intensity with body mass index body mass index (BMI) trajectories from ages 10 to 42 years. Methods: The sample comprised 8234 individuals in the 1970 British Cohort Study, who had data on childcare attendance (no, yes), type (formal, informal), age at start (4-5, 3-3.99, 0-2.99 years old), and intensity (1, 2, 3, 4-5 days/week) reported at age 5 years and 32 563 BMI observations. Multilevel linear spline models were used to estimate the association of each exposure with the sample-average BMI trajectory, with covariate adjustment. A combined age at start and intensity exposure was also examined. Results: Attending vs not attending and the type of childcare (none vs formal/informal) were not strongly related to BMI trajectories. Among participants who attended childcare 1 to 2 days a week, those who started when 3 to 3.99 years old had a 0.197 (−0.004, 0.399) kg/m2 higher BMI at age 10 years than those who started when 4 to 5 years old, and those who started when 0 to 2.99 years old had a 0.289 (0.049, 0.529) kg/m2 higher BMI. A similar dose-response pattern for intensity was observed when holding age at start constant. By age 42 years, individuals who started childcare at age 0 to 2.99 years and attended 3 to 5 days/week had a 1.356 kg/m2 (0.637, 2.075) higher BMI than individuals who started at age 4 to 5 years and attended 1 to 2 days/week. Conclusions: Children who start childcare earlier and/or attend more frequently may have greater long-term obesity risk