Does Breastfeeding Protect Against Pediatric Overweight? Analysis of Longitudinal Data From the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System

Objective. To examine whether increasing duration of breastfeeding is associated with a lower risk of overweight in a low-income population of 4-yearolds in the United States. Methods. Visit data were linked to determine prospectively the duration of breastfeeding (up to 2 years of age) and weight status at 4 years of age. Overweight among 4-year-old children was defined as a body mass index (BMI)-for-age at or above the 95th percentile based on the 2000 Centers for Disease Control and Prevention growth charts. Logistic regression was performed, controlling for gender, race/ethnicity, and birth weight. In a subset of states, links to maternal pregnancy records also permitted regression analysis controlling for mother’s age, education, prepregnancy BMI, weight gain during pregnancy, and postpartum smoking. Data from the Pediatric Nutrition Surveillance System, which extracts breastfeeding, height, and weight data from child visits to public health programs, were analyzed. In 7 states, data were linked to Pregnancy Nutrition Surveillance System data. A total of 177 304 children up to 60 months of age were included in our final pediatric-only analysis, and 12 587 were included in the pregnancy-pediatric linked analysis. Results. The duration of breastfeeding showed a dose-response, protective relationship with the risk of overweight only among non-Hispanic whites; no significant association was found among non-Hispanic blacks or Hispanics. Among non-Hispanic whites, the adjusted odds ratio of overweight by breastfeeding for 6 to 12 months versus never breastfeeding was 0.70 (95% confidence interval: 0.50–0.99) and for \u3e12 months versus never was 0.49 (95% confidence interval: 0.25– 0.95). Breastfeeding for any duration was also protective against underweight (BMI-for-age below the 5th percentile). Conclusion. Prolonged breastfeeding is associated with a reduced risk of overweight among non-Hispanic white children. Breastfeeding longer than 6 months provides health benefits to children well beyond the period of breastfeeding

Dynamics of the double burden of malnutrition and the changing nutrition reality

The double burden of malnutrition (DBM), defined as the simultaneous manifestation of both undernutrition and overweight and obesity, affects most low-income and middle-income countries (LMICs). This Series paper describes the dynamics of the DBM in LMICs and how it differs by socioeconomic level. This Series paper shows that the DBM has increased in the poorest LMICs, mainly due to overweight and obesity increases. Indonesia is the largest country with a severe DBM, but many other Asian and sub-Saharan African countries also face this problem. We also discuss that overweight increases are mainly due to very rapid changes in the food system, particularly the availability of cheap ultra-processed food and beverages in LMICs, and major reductions in physical activity at work, transportation, home, and even leisure due to introductions of activity-saving technologies. Understanding that the lowest income LMICs face severe levels of the DBM and that the major direct cause is rapid increases in overweight allows identifying selected crucial drivers and possible options for addressing the DBM at all levels

Incidence of Obesity Among Young US Children Living in Low-Income Families, 2008–2011

OBJECTIVE: To examine the incidence and reverse of obesity among young low-income children and variations across population subgroups. METHODS: We included 1.2 million participants in federally funded child health and nutrition programs who were 0 to 23 months old in 2008 and were followed up 24 to 35 months later in 2010–2011. Weight and height were measured. Obesity at baseline was defined as gender-specific weight-for-length \u3e/=95th percentile on the 2000 Centers for Disease Control and Prevention growth charts. Obesity at follow-up was defined as gender-specific BMI-for-age \u3e/=95th percentile. We used a multivariable log-binomial model to estimate relative risk of obesity adjusting for gender, baseline age, race/ethnicity, duration of follow-up, and baseline weight-for-length percentile. RESULTS: The incidence of obesity was 11.0% after the follow-up period. The incidence was significantly higher among boys versus girls and higher among children aged 0 to 11 months at baseline versus those older. Compared with non-Hispanic whites, the risk of obesity was 35% higher among Hispanics and 49% higher among American Indians (AIs)/Alaska Natives (ANs), but 8% lower among non-Hispanic African Americans. Among children who were obese at baseline, 36.5% remained obese and 63.5% were nonobese at follow-up. The proportion of reversing of obesity was significantly lower among Hispanics and AIs/ANs than that among other racial/ethnic groups. CONCLUSIONS: The high incidence underscores the importance of earlylife obesity prevention in multiple settings for low-income children and their families. The variations within population subgroups suggest that culturally appropriate intervention efforts should be focused on Hispanics and AIs/ANs

Developing global guidance on human milk banking

Donor human milk is recommended by the World Health Organization both for its advantageous nutritional and biological properties when mother's own milk is not available and for its recognized support for lactation and breastfeeding when used appropriately. An increasing number of human milk banks are being established around the world, especially in low- and middle-income countries, to facilitate the collection, processing and distribution of donor human milk. In contrast to other medical products of human origin, however, there are no minimum quality, safety and ethical standards for donor human milk and no coordinating global body to inform national policies. We present the key issues impeding progress in human milk banking, including the lack of clear definitions or registries of products; issues around regulation, quality and safety; and ethical concerns about commercialization and potential exploitation of women. Recognizing that progress in human milk banking is limited by a lack of comparable evidence, we recommend further research in this field to fill the knowledge gaps and provide evidence-based guidance. We also highlight the need for optimal support for mothers to provide their own breastmilk and establish breastfeeding as soon as and wherever possible after birth

Power and Sample Size Calculations for Interval-Censored Survival Analysis

We propose a method for calculating power and sample size for studies involving interval-censored failure time data that only involves standard software required for fitting the appropriate parametric survival model. We use the framework of a longitudinal study where patients are assessed periodically for a response and the only resultant information available to the investigators is the failure window: the time between the last negative and first positive test results. The survival model is fit to an expanded data set using easily computed weights. We illustrate with a Weibull survival model and a two-group comparison. The investigator can specify a group difference in terms of a hazards ratio. Our simulation results demonstrate the merits of these proposed power calculations. We also explore how the number of assessments (visits), and thus the corresponding lengths of the failure intervals, affect study power. The proposed method can be easily extended to more complex study designs and a variety of survival and censoring distributions

2018 Global Nutrition Report

The 2018 Global Nutrition Report shares insights into the current state of global nutrition, highlighting the unacceptably high burden of malnutrition in the world. It identifies areas where progress has been made in recent years but argues that it is too slow and too inconsistent. It puts forward five critical steps that are needed to speed up progress to end malnutrition in all its forms and argues that, if we act now, it is not too late to achieve this goal. In fact, we have an unprecedented opportunity to do so

Adherence to Antimicrobial Inhalational Anthrax Prophylaxis among Postal Workers, Washington, D.C., 2001

In October 2001, two envelopes containing Bacillus anthracis spores were processed at the Washington, D.C., Processing and Distribution Center of the U.S. Postal Service; inhalational anthrax developed in four workers at this facility. More than 2,000 workers were advised to complete 60 days of postexposure prophylaxis to prevent inhalational anthrax. Interventions to promote adherence were carried out to support workers, and qualitative information was collected to evaluate our interventions. A quantitative survey was administered to a convenience sample of workers to assess factors influencing adherence. No anthrax infections developed in any workers involved in the interventions or interviews. Of 245 workers, 98 (40%) reported full adherence to prophylaxis, and 45 (18%) had completely discontinued it. Experiencing adverse effects to prophylaxis, anxiety, and being <45 years old were risk factors for discontinuing prophylaxis. Interventions, especially frequent visits by public health staff, proved effective in supporting adherence

Agency, ‘good motherhood’ and ‘a load of mush’: Constructions of baby-led weaning in the press

In this age of ‘intensive motherhood’, new mothers are flooded with information on the best ways in which to raise their children. One of the key issues is infant feeding, in particular, the timing and method of weaning their children onto solid food. This paper examines a new approach called ‘baby-led weaning’ (BLW) in which the child feeds themselves instead of being spoon-fed, that came into popular parenting culture in recent years, considering the ways in which it is represented in National and International newspapers. The media search database Proquest International Newsstand, was searched for ‘baby-led weaning’, producing an eventual sample of 78 articles from a number of countries. The articles were subjected to a critical discursive psychological analysis. The key themes that emerged from the newspapers focused around two main areas; the infant as agentive in their eating behaviours; and, constructions of maternal identities and resisting ‘good motherhood’