Beyond maternal education: Socio-economic inequalities in children's diet in the ABCD cohort

Auditory sequence learning with degraded input: children with cochlear implants ('nature effect') compared to children from low and high socio-economic backgrounds ('nurture effect')

Implicit sequence learning (SL) is crucial for language acquisition and has been studied in children with organic language deficits (e.g., specific language impairment). However, language delays are also seen in children with non-organic deficits, such as those with hearing loss or from low socioeconomic status (SES). While some children with cochlear implants (CI) develop strong language skills, variability in performance suggests that degraded auditory input (nature) may affect SL. Low SES children typically experience language delays due to environmental deprivation (nurture). The purpose of this study was to investigate nature versus nurture effects on auditory SL. A total of 100 participants were divided into normal hearing (NH) children, young adults, CI children from high-moderate SES, and NH children from low SES who were tested with two Serial Reaction Time (SRT) tasks with speech and environmental sounds, and with cognitive tests. Results showed SL for speech and nonspeech stimuli for all participants, suggesting that SL is resilient to degradation of auditory and language input and that SL is not specific to speech. Absolute reaction time (RT) (reflecting a combination of complex processes including SL) was found to be a sensitive measure for differentiating between groups and between types of stimuli. Specifically, normal hearing groups showed longer RT for speech compared to environmental stimuli, a prolongation that was not evident for the CI group, suggesting similar perceptual strategies applying for both sound types; and RT of Low SES children was the longest for speech stimuli compared to other groups of children, evidence of the negative impact of language deprivation on speech processing. Age was the largest contributing factor to the results (~ 50%) followed by cognitive abilities (~ 10%). Implications for intervention include speech-processing targeted programs, provided early in the critical periods of development for low SES children.

Is underweight associated with poorer diet, nutrient status, bone and cardiometabolic health, and school performance in Danish 8-11-year-olds?

PURPOSE

Underweight, i.e. low body mass index for age and sex, may indicate undernutrition, but despite high prevalence, this aspect is largely overlooked in children in high-income countries. We explored if dietary intake, nutrient status, body composition, bone mineralization, cardiometabolic markers and school performance differed in schoolchildren with underweight compared to normal- and overweight.

METHODS

We used cross-sectional data from 815 Danish 8-11-year-old children collected in 2011. Intake of foods, macronutrients and key micronutrients (vitamin D, vitamin B12, calcium, iron, zinc and selenium) was assessed by 7-day dietary records. Measurements included anthropometry, dual-energy X-ray absorptiometry and tests of attention and reading skills. Fasting blood samples were analyzed for biomarkers of iron, long-chain n-3 fatty acids and vitamin D status as well as blood lipids, insulin and growth markers.

RESULTS

Eighty-three (10.2%) children had underweight and were shown to have a lower intake of energy, red meat, protein and zinc and higher intake of added sugar than children with normal- and overweight. They also had higher fish intake relative to overweight, but blood biomarkers did not differ between groups. Children with underweight had lower fat percent and bone mineralization compared to peers with normalweight, but apart from lower insulin, they did not differ in overall cardiometabolic health or school performance.

CONCLUSION

Although we found some differences in diet, there were no considerable differences in nutrient status, cardiometabolic health or school performance between children with underweight and their normalweight peers. However, the lower bone mineralization is a concern and needs further investigation.

Adherence to the Mediterranean diet and changes in body mass index

BACKGROUND

Diet is considered a determinant of weight status, however, more evidence is needed for children. The Mediterranean diet (MedDiet) is one of the healthiest worldwide. This study analyzes the prospective association between adherence to the MedDiet at baseline and changes in standardized body mass index (zBMI) and the incidence of excessive weight.

METHODS

1389 children participated with a follow-up of 15 months. Weight, height, and adherence to the MedDiet were measured (baseline and follow-up).

RESULTS

Multiple logistic regression analysis revealed that a high increase in zBMI was associated with lower odds of eating vegetables once [OR 0.74 (95% CI 0.57-0.98)] or more a day [OR 0.68 (95% CI 0.49-0.95)], nuts 2-3 times/week [OR 0.74 (95% CI 0.56-0.97)] or 2 cups of yogurt or/and cheese daily [OR 0.74 (95% CI 0.55-0.99)]. Not consuming each food item was used as reference. Multiple linear regression analysis showed a negative (β = -0.010, p = 0.040) association between the MedDiet at baseline and changes in zBMI at follow-up, significance disappeared (p = 0.082) after final adjustment for baseline zBMI.

CONCLUSION

Baseline MedDiet was not significantly associated with the incidence of excessive weight at follow-up. The MedDiet was positively associated with changes in zBMI, however the effect size was small.

IMPACT

The present longitudinal study contributes knowledge regarding the adherence to Mediterranean diet as a predictive variable of weight status evolution in children. Higher adherence to the Mediterranean diet at baseline was prospectively and inversely associated with changes in zBMI after 15 months of follow-up. Consuming vegetables, nuts, and yoghurt/cheese according to the recommendations reduces the likelihood of having a high increase in zBMI after 15 months of follow-up.

Prevalence of the Double Burden of Malnutrition among Adolescents: Associations with Lifestyle Behaviors and Clusters of Social Determinants

The double burden of malnutrition (DBM) is a condition in which malnutrition coexists with overweight, reflecting a new layer of malnutrition. Our objectives were to assess prevalence; test associations between DBM and 24-hour movement behaviors; and investigate whether DBM is associated with clusters of social determinants. Methods: This multicenter cross-sectional study included 1152 adolescents (12 to 17 years old) from four Brazilian cities. Body mass index (BMI, kg/m2) was used to estimate overweight, and the adopted cutoff points took into account the curves established for age and sex: Z-score > 1 and ≤2 (overweight) and Z-score > 2 (obesity). The serum concentration of 25-hydroxyvitamin D [25(OH)D] was stratified into three levels: vitamin D deficiency ≤ 20 ng/mL; vitamin D insufficiency = 21-29 ng/mL; optimal vitamin D ≥ 30 ng/mL. We used multilevel Poisson regression models to estimate prevalence ratios (PRs) and their respective 95% confidence intervals (95%CI) and to analyze the association between DBM and covariates. A significance level of p < 0.05 was considered. Cluster analyses were performed by applying a combination of hierarchical and non-hierarchical methods. Results: A population prevalence of DBM of 7.3% (95% CI: 5.9-8.9) was revealed. A percentage of 19.2% (95% CI: 17.0-21.6) of adolescents were overweight, and 8.3% (95% CI: 6.8-10.1) were obese. A total of 41.5% (95% CI: 38.7-44.4) had vitamin D deficiency, and 25.8% (95% CI: 23.4-28.4) had vitamin D insufficiency. However, 24-hour movement behaviors were not associated with DBM. Adolescents living in the southern region of the country, from public schools whose mothers have higher education, have a 1.94 [PR = 2.94 (95% CI: 1.20-7.23)] times greater chance of developing DBM. These results highlight the importance of specific factors to improve the nutritional health of adolescents, considering the specific social determinants identified in this study.

Maternal mental health is associated with children's frequency of family meals at 12 and 24 months of age

Diet during the child's first years is important for growth and development. In toddlerhood, higher diet quality is reported among children eating meals together with family. Although previous literature has documented several associations between maternal mental health and early child feeding practices, less is known about the relationship between maternal mental health and child frequency of shared family meals. This study explores associations between maternal symptoms of anxiety and depression, measured by The Hopkins Symptoms Checklist (SCL-8), and toddler participation in family meals. We used cross-sectional data from the Norwegian study Early Food for Future Health, in which participants responded to questionnaires at child age 12 (n = 455) and 24 months (n = 295). Logistic regression was used to explore associations between maternal mental health and child having regular (≥5 per week) or irregular (<5 per week) family meals (breakfast and dinner), adjusting for relevant child and maternal confounding variables. Children of mothers with higher scores of anxiety and depression had higher odds of Irregular family meals at both timepoints; (OR: 2.067, p = 0.015) and (OR: 2.444, p = 0.023). This is one of few studies exploring associations between maternal mental health and child frequency of shared family meals in early childhood, a period where the foundation for life-long health is shaped. Given the high prevalence of mental ailments and disorders, these findings are important and may inform future public health interventions. Further exploration of this relation is needed, including longitudinal research to test predictive associations and qualitative studies to increase insight and understanding.

Maternal determinants of dietary patterns in infancy and early childhood in the Growing up in New Zealand cohort

Given the importance of diet in early life, assessing children's diet is crucial to guide interventions. Using data from a nationally generalizable New Zealand (NZ) birth cohort we examined children's dietary patterns at 9- (n = 6259), 24- (n = 6292), and 54-months (n = 6131), and their association with maternal sociodemographic and health behaviours. At each time-point, children's dietary patterns were identified using principal components analysis. We then used multivariate linear regression to examine associations between each pattern and maternal variables. At 9-, 24- and 54-months, two dietary patterns were identified, explaining 36.4%, 35.3% and 33.6% of children's intake variability, respectively. Refined high in sugar, salt and fat dietary pattern, at all time-points, was characterized by high positive loadings in white/refined breads and cereals, and items with high sugar, sodium, and fat content. At 24-months, Refined high in sugar, salt and fat also included a high positive loading with protein food groups. Fruit and vegetables dietary pattern, at all time-points, had high positive loadings for fruits and vegetables (with type varying across time-points). Fruit and vegetables also included high loading in whole grain options of breads and cereals at 24-months and the protein food group was part of this dietary pattern at 9- and 54-months. Children's scores on the Refined high in sugar, salt and fat pattern had strong associations with maternal smoking habits, education level, ethnicity, and maternal scores in the "Junk" and "Traditional/White bread" dietary patterns (constructed from an antenatal interview). Children's scores on the Fruit and vegetables pattern had strong associations with the maternal scores in the dietary pattern "Health Conscious". Interventions to improve diet in early life in NZ need to be responsive to ethnicity and suitable for people of all education levels. Interventions that improve maternal health behaviours may also improve children's diet.

Factors Affecting Inequality in the Quality Diets: A Scoping Review

OBJECTIVES

the current dietary pattern is found increasingly unsafe, unstable, and unequal for a huge part of the populations. Disadvantaged populations were usually known by less healthy diets and were at a higher risk of disease in comparison with high socioeconomic groups. The current scoping review study aims at indicating the effective factors on inequality in the quality of diets.

METHODS

the academic databases, including Scopus, Web of science, PubMed, Scientific Information Database, Islamic World Science Citation Center, Google scholar search engine, World Health Organization, and the website of the European Union, until April 2021, were systematically reviewed. We used vote counting technique to identify the effective factors causing inequality in the quality of diets.

RESULTS

The factors that have caused inequality in the quality of diets were divided into 3 categories of demographic, lifestyle, and socioeconomic. It was found that any increase in age, income, education, different ethnic groups, smoking, and occupational statues increased inequality in diet quality. Also, as a factor physical activity, could reduce inequality in diet quality. Moreover, type of residence in terms of access to food, dominant available food, and culture of the area could cause inequality in diet quality.

CONCLUSIONS

According to the results of this study, the effective factors on inequality in the quality of diet are demographic and socioeconomic factors that cannot be manipulated by policy makers. Nevertheless, increasing the knowledge of individuals, improving their lifestyle, and providing subsidies to poorer individuals reduce inequality in the quality of the diets.

Inequalities in anemia among Peruvian children aged 6–59 months: A decomposition analysis

Objective

To quantify the inequalities of anemia in Peruvian children aged 6–59 months and uncover its contributing factors.

Materials and methods

We conducted a cross-sectional study based on the secondary data analysis of the 2021 Peruvian Demographic and Health Survey (DHS). Our sample included Peruvian children aged 6–59 months with complete data for the variables of interest. Anemia was defined as having a hemoglobin level of less than 11 g/dL, adjusted by altitude. Erreygers Concentration Index (ECI) and concentration curves were computed to estimate the socio-economic inequality in anemia among Peruvian children. Moreover, ECI was decomposed to figure out the contributing factors to the inequality of anemia and the residual variation.

Results

Nationwide, the prevalence of anemia in Peruvian children was 29.47%. We found a pro-poor inequality regarding anemia at the national level (ECI = −0.1848). The determinants included in the model explained 81.85% of the overall socio-economic inequality in anemia. The largest contribution to inequality was from household- and community-related factors. Having a higher mother’s education level (26.26%) and being from the highlands (24.91%) were the major significant contributors to the overall health inequality.

Conclusion

Almost one-third of Peruvian children have anemia. A pro-poor inequality of anemia in Peruvian children was found. Public policies ought to address the major contributing factors of anemia inequality.

Maternal diet quality and associations with body composition and diet quality of preschool children: A longitudinal study

BACKGROUND

Nutrition, associated with nutritional status, influences the growth of children. This study aimed to identify the association between maternal diet quality and the diet and body composition of their children.

METHODS

This is a prospective longitudinal study with mother-child pairs. To assess diet quality, nutritional status, and socioeconomic data, two interviews in the children's first and third months of life (2011-2016) and one interview when children were of preschool age (2017-2019) were performed. Diet quality was assessed based on daily food consumption and frequency, considering: 1) food groups, based on the Brazilian food pyramid; 2) level of processing, according to the NOVA classification (unprocessed and/or minimally processed foods, processed foods and ultra-processed foods). One-way ANOVA with Tukey post hoc and Kruskal-Wallis with Dunn's post hoc tests were used to evaluate the influence of factors on children's diet quality. Pearson and Spearman's correlations were used to evaluate the relationship between maternal and children's diet quality, maternal schooling level, and child age. Along with the nutritional assessment of children, multiple linear regression models assessed the impact of covariables on maternal and children's diet quality.

RESULTS

Eighty-three mother-child pairs participated in this study. The more frequent the maternal consumption of unprocessed and/or minimally processed foods, the higher the consumption of these foods by children (r = +0.30; p = 0.006) and the lower their subscapular skinfold (SSF) thickness (p = 0.011; β = -0.278). On the other hand, the higher the maternal consumption of ultra-processed foods, the higher the children's tricipital skinfold (TSF) thickness (p = 0.010; β = +0.274) and SSF (p = 0.043; β = +0.222).

CONCLUSION

Maternal diet quality was associated with the diet and body composition of children.

Prospective Association of Maternal Educational Level with Child's Physical Activity, Screen Time, and Diet Quality

Evidence has identified unhealthy lifestyle behaviors as the main contributors to obesity in children, so it is essential to identify factors that could influence children’s lifestyles. The objective of the present study was to analyze the association of baseline maternal educational level with child’s physical activity, screen time, and dietary habits at follow-up. This community-based cohort study was carried out between 2012 and 2014 and included 1405 children aged 8 to 10 years old. Maternal educational level was used as an indicator of child’s socioeconomic status. Physical activity, screen time, and dietary habits were assessed by validated questionnaires. The odds of having commercially baked goods for breakfast [OR 1.47 (95% CI 1.03 to 2.10)], going more than once a week to a fast-food restaurant [OR 1.64 (95% CI 1.20 to 2.26)], and taking sweets and candys several times a day [OR 3.23 (95% CI 2.14 to 4.87) were significantly higher among children whose mothers had a lower educational level compared to their peers whose mothers had a higher level. These associations held for taking sweets and candy several times a day after additional adjustment for the corresponding dietary behavior at baseline. Maternal educational level was inversely associated (p < 0.001) with child’s screen time at follow up and being in the lowest maternal educational category was associated with an increased odds of surpassing the maximum recommended time of screen time of 120 min per day (OR (95% CI) 1.43 (1.07 to 1.90), p = 0.016). Maternal education is a predictor for unhealthy dietary habits and high screen time in children.

Child Autistic Traits, Food Selectivity, and Diet Quality: A Population-Based Study

BACKGROUND

Children with Autism Spectrum Disorders (ASDs) tend to be selective in their food intake, which may compromise their diet quality. While ASD diagnoses capture severe levels of impairment, autistic traits vary on a continuum throughout the population. Yet, little is known about how autistic traits relate to diet quality at the population level.

OBJECTIVES

This study examines the association between autistic traits in early childhood and diet quality in mid-childhood and explores the mediating role of food selectivity.

METHODS

Participants were children (n = 4092) from the population-based Generation R Study. Parents reported their child's autistic traits at 1.5, 3, and 6 years; food selectivity at 4 years; and food intake at 8 years, from which a diet quality score was derived. Associations of autistic traits and the autistic trait trajectory (identified using Latent Class Growth Modelling) with diet quality were examined using multiple linear regression models. The indirect effect of food selectivity in the association between autistic traits at 1.5 years and diet quality was examined using mediation analysis.

RESULTS

Autistic traits were associated with diet quality (e.g., 1.5 years: β = -0.09; 95% CI: -0.13 to -0.06). Two classes captured the autistic trait trajectories from 1.5 to 6 years: children with "low and stable" (95%) and "high and increasing" (5%) mean scores. Children in the high and increasing group had poorer diet quality than those in the low and stable group (β = -0.28; 95% CI: -0.44 to -0.11). Food selectivity mediated the association between autistic traits at 1.5 years and diet quality at 8 years (βindirect = -0.03; 95% CI: -0.03 to -0.02).

CONCLUSIONS

Autistic traits in early childhood are associated with poorer diet quality in mid-childhood, and food selectivity appears to mediate this association. Interventions intended to optimize nutrition in children with elevated autistic traits may integrate behavioral strategies to support parents' responding to their child's food selectivity.

Family meal participation is associated with dietary intake among 12-month-olds in Southern Norway

BACKGROUND

Family meal participation is associated with healthier eating among children and adolescents. Less is known about family meal participation among infants and toddlers. The objective of the present study was to explore whether family meal participation at 12 months of age is associated with dietary intake and whether a potential relationship differs according to maternal education or child sex.

METHODS

Follow-up data from children born to mothers participating in the Norwegian Fit for Delivery (NFFD) trial during pregnancy were used to assess the frequency of intake of 11 dietary items according to frequency of participating in the respective family meals. Dietary differences according to seldom (0-3 times/week) or often (4-7 times/week) participating in each respective meal category were assessed in linear regression models. Potential dose-response associations with frequency of participation in all family meal categories combined were also estimated. Models were adjusted for maternal randomization status, education, and child sex.

RESULTS

The sample comprised 408 children. A total of 74, 53 and 74% had breakfast, lunch, and dinner with family ≥4 times/week, respectively, while 39% had supper and 27% between-meal snacks with family ≥4 times/week. Having family dinner ≥4 times/week was associated with more frequent intake of vegetables, homemade infant cereal, milk, and water, and less frequent intake of commercial infant foods while the other family meal categories were associated with fewer dietary outcomes. For each additional meal category eaten with family ≥4 times/week, frequency of vegetable intake (β = 0.45), water (β = 0.17), and milk (β = 0.09) per day increased, while commercial infant cereal was eaten less frequently (β = - 0.18). The inverse association between family meals and commercial infant cereal was only evident in children born to mothers in the intervention group. Several associations with diet were stronger and only significant among boys.

CONCLUSIONS

Being fed in the context of family meals at 12 months of age was associated with a more favorable diet. Including the infant in family meals has potential in the promotion of early nutritional health.