Healthy Start Research Articles

Understanding Determinants of Pregnant Women's Knowledge of Lifestyle-Related Risk Factors: A Cross-Sectional Study.

Research indicates that a woman’s lifestyle during pregnancy influences her child’s health and development. Therefore, women need to possess sufficient knowledge regarding the elements of a healthy lifestyle during pregnancy. To date, there has been little research on the assessment of lifestyle knowledge of pregnant women in the perinatal healthcare setting. This study describes the development and application of a knowledge-based questionnaire for pregnancy to be used in a lifestyle intervention trial conducted in Germany. Within the trial, pregnant women receive counselling on lifestyle topics. These topics are based on the German initiative ‘Healthy Start—Young Family Network’ (GiL), which provides evidence-based recommendations regarding diet and lifestyle before and during pregnancy. These serve as a basis for health professionals who provide counselling on healthy lifestyle choices during the antenatal period. The questionnaire consists of eight items, each of which can be answered using ‘Yes’, ‘No’ or ‘Don’t know’. The pregnant women who completed the questionnaire at baseline around the twelfth week of gestation were recruited within the host trial from gynaecological practices in Germany. Demographic variables and the respondents’ answers to the questionnaire were analysed using descriptive statistics and regression analyses. Descriptive statistics show that more than 85% of participants answered the majority of questions (n = 5) correctly. Questions on whether tap water is safe and the normal range for gestational weight gain (GWG) were answered correctly by about 62% and 74% of the women, respectively, and the question on whether it is beneficial to obtain information on breastfeeding at an early stage was answered correctly by about 29%. The results of the regression analyses indicate that age, gestational week, education and income are positive predictors for answering the questionnaire correctly. Nullipara and migration background are predictors for answering the questions incorrectly. This study indicates that there are gaps in women’s knowledge regarding lifestyle during pregnancy. Particular focus on certain topics, such as breastfeeding and normal GWG ranges, is still required during counselling. Our analysis shows that migration background is a predictor of insufficient knowledge and incorrect answers to the questions. Women with such backgrounds require special attention during antenatal counselling in order to cater to their needs and the gaps in their knowledge.

Supermarket top-up of Healthy Start vouchers effectively increases fruit and vegetable purchases in low-income households

Supermarket top-up of Healthy Start vouchers effectively increases fruit and vegetable purchases in low-income households

DEVELOPMENT OF A SYSTEM OF INDIVIDUAL CALF DRINKING BASED ON RFID TECHNOLOGIES

The problem of optimizing the breeding of calves in the first days of life, including their drinking, remains one of the main ones. The drinking of calves with colostrum of the mother timely and in sufficient quantity is fundamentally important for a healthy start of their life. Tracking the drinking of calves with colostrum is possible with the use of RFID technologies. They are relevant today with the emergence of an increasing number of new application contexts, more effective labels and integration of new features. (Research purpose) The research purpose is developing a system of individual drinking of calves with colostrum based on RFID technologies. (Materials and methods) During the research the methods based on testing the stable operation of components and software were used in order to simulate the operation of the system in laboratory conditions. (Results and discussion) The article presents a scheme for the distribution of milk colostrum through the delivery vehicles based on a robotic module. This technology will make it possible to deliver maternal colostrum to the calf, automate the process without the use of complex communication systems of high costs and difficulties when installed on farms. The article described a prototype of an automated system that allows registering RFID tags in a database for further information processing and software to obtain and summarize data from RFID tags obtained from a prototype of an automated system. (Conclusions) The use of low-frequency RFID-tags is preferred, as they have better noise immunity, resistant to liquids and metals. Due to the small detection distance (which is required), the probability of errors during reading of the neighboring label decreases.

Is the healthy start scheme associated with increased food expenditure in low-income families with young children in the United Kingdom?

BackgroundHealthy Start is a food assistance programme in the United Kingdom (UK) which aims to provide a nutritional safety-net and enable low-income families on welfare benefits to access a healthier diet through the provision of food vouchers. Healthy Start was launched in 2006 but remains under-evaluated. This study aims to determine whether participation in the Healthy Start scheme is associated with differences in food expenditure in a nationally representative sample of households in the UK.MethodsCross-sectional analyses of the Living Costs and Food Survey dataset (2010–2017). All households with a child (0–3 years) or pregnant woman were included in the analysis (n = 4869). Multivariable quantile regression compared the expenditure and quantity of fruit and vegetables (FV), infant formula and total food purchases. Four exposure groups were defined based on eligibility, participation and income (Healthy Start Participating, Eligible Non-participating, Nearly Eligible low-income and Ineligible high-income households).ResultsOf 876 eligible households, 54% participated in Healthy Start. No statistically significant differences were found in FV or total food purchases between participating and eligible non-participating households, but infant formula purchases were lower in Healthy Start participating households. Ineligible higher-income households had higher purchases of FV.ConclusionThis study did not find evidence of an association between Healthy Start participation and FV expenditure. Moreover, inequalities in FV purchasing persist in the UK. Higher participation and increased voucher value may help to improve programme performance and counteract the harmful effects of poverty on diet.

Prenatal exposure to ambient air pollution and traffic and indicators of adiposity in early childhood: the Healthy Start study.

Prenatal exposure to ambient air pollution and traffic have been related to a lower birth weight and may be associated with greater adiposity in childhood. We aimed to examine associations of maternal exposure to ambient air pollution and traffic during pregnancy with indicators of adiposity in early childhood. We included 738 participants of the Colorado-based Healthy Start study whose height, weight, waist circumference and/or fat mass were measured at age 4-6 years. We estimated residential exposure to ambient concentrations of fine particulate matter (PM2.5) and ozone (O3) averaged by trimester and throughout pregnancy via inverse distance-weighted interpolation of central site monitoring data. We assessed the distance to the nearest major roadway and traffic density in multiple buffers surrounding the participants' homes. Associations of prenatal exposure to air pollution and traffic with overweight, waist circumference, percent fat mass and fat mass index (FMI) were assessed by logistic and linear regression. Associations of exposure to PM2.5 and O3 at the residential address during pregnancy with percent fat mass and FMI at age 4-6 years were inconsistent across trimesters. For example, second trimester PM2.5 was associated with a higher percent fat mass (adjusted difference 0.70% [95% CI 0.05, 1.35%] per interquartile range (IQR; 1.3 µg/m3) increase), while third trimester PM2.5 was associated with a lower percent fat mass (adjusted difference -1.17% [95% CI -1.84, -0.50%] per IQR (1.3 µg/m3) increase). Residential proximity to a highway during pregnancy was associated with higher odds of being overweight at age 4-6 years. We observed no associations of prenatal exposure to PM2.5 and O3 with overweight and waist circumference. We found limited evidence of associations of prenatal exposure to ambient PM2.5 and O3 with indicators of adiposity at age 4-6 years. Suggestive relationships between residential proximity to a highway during pregnancy and greater adiposity merit further investigation.

Early support: Evaluation of the pilot projects and the development of an implementation model

Abstract Early support is an overall concept of health promoting and preventive measures for families with children up to 3 years. This includes direct interventions for children as well as offers and measures for parents and other caregivers. Based on a first research project, which showed that health and social services are repeatedly confronted with stressful family situations, but that families are often only supported late or too late, there were implemented two pilot projects in an urban and rural area of Northern Italy (called South Tyrol). The projects were evaluated using a multimethod approach, analysing existing documentation, and through focus groups, interviews, and qualitative questionnaires. The results of all the different research methods show very uniformly that many professionals and responsible persons were insufficiently informed about the health promotional and preventive potential of early support and about the importance of a good collaboration and network for a healthy start in live at the beginning of the projects. It took two years of intensive process to improve cooperation, but also knowledge and competences in this area. Through the intensive coordinated cooperation in a core team of public social and health services and psychologists (family counselling), a significant improvement could be achieved not only for these members of this core team, but above all also for the entire departments of the collaborating services. Professionals reported that not only has the quality of their work improved significantly because of this process, but there is also a noticeable lightening of the workload, which must be of great importance in the burdening fields of social and health services. Building on the results of the evaluation of these projects a model was developed of how a system of early support that accompanies families in a healthy start can be implemented in the whole region. The implementation is approved for 2022. Key messages The aim of early support is to build systems to strengthen and support all families preventively. Interdisciplinary cooperation in early support teams led to improved quality of work and lower workloads.

Community Healthy Workers Fill in the Gaps for Participants Who Became Lost to Follow-up in a Healthy Start Program.

The purpose of this mixed methods study was to solicit information from Community Health Workers (CHWs) in order to further understand reasons for Healthy Start participants becoming lost to follow-up after delivery. Four CHWs from a local Healthy Start Program completed questionnaires for participants in their caseloads who had become lost to follow-up from the program (n = 146) between Sep 2018 and Jan 2020. The questionnaire included open ended items about ease of contact before and after delivery, changes in contact information, compliance with prenatal care visits, other life challenges (such as housing, legal, transportation, and family support), family size, living arrangements, working/student status, and substance use. Participants were categorized by ease of contact throughout participation into Easy (28.8%), Easy then Difficult (11%) and Difficult (60.3%). Responses to questions were reviewed and coded to identify common themes. Groups differed on: having a change in contact information, having challenges with transportation, having lots of help, having other children between 6 and 10years old, compliance with prenatal care, and race being non-Black. Areas where groups differed may indicate possible reasons for participants becoming lost to follow up after delivery. The descriptive results from this study can help CHWs address these issues with participants during prenatal care, when they are easier to contact, to develop contingency plans for remaining in contact after delivery.

Advanced glycation end product intake during pregnancy and offspring allergy outcomes: A Prospective cohort study

Associations have been shown between concurrent assessment of dietary intake of advanced glycation end products (AGEs) and childhood allergic outcomes. We examined the association between maternal AGEs intake and development of offspring asthma, wheeze, atopic dermatitis, allergic rhinitis and food allergies, and sought to determine whether the intake of AGEs was associated with cord sera cytokines/chemokines. Pregnant women ≥16years were recruited in the Healthy Start study, a prospective pre-birth cohort from Colorado (N=1410). The analysis included 962 dyads with adequate diet (≥2 recalls) and allergy outcome details. AGEs intake was estimated for each mother by matching intakes reported using 24-h dietary recalls during pregnancy to a reference database of commonly consumed foods' AGEs values. Child diagnoses of asthma and allergies up to 8years were obtained from electronic medical records. Cord sera cytokines and chemokines were analysed in a subset (N=462) of children. The median [IQR] AGEs intake for the overall sample was 11,919kU/day [8293, 16,573]. Unadjusted analysis showed a positive association between maternal AGEs intake in pregnancy and rhinitis up to 8years of age (HR=1.03; 95% CI: 1.01, 1.06), but the association was attenuated and no longer significant in adjusted models (HR=1.01; 95% CI: 0.98, 1.04). Both adjusted and unadjusted models showed no associations between AGEs intake in pregnancy and any of the other outcomes (p>.05). There were no significant associations between any cytokine or chemokine measured and AGEs intake or any of the outcomes studied (p>.05). The study showed that maternal AGEs intake was not associated with offspring asthma and allergy outcomes. AGEs exposure during pregnancy may not have the same impact on child development as postnatal exposure.

Impact of changing school start times on parent sleep

ObjectiveTo examine the impact of changing school start times on sleep in parents of students in elementary, middle, and high school. MethodsAnnual surveys were completed by parents of K-12 students (n = 8190-10,592 per year) before (pre-change) and for 2 years (post-change, follow-up) after implementation of new school start times (elementary school [ES]: 60 minutes earlier, middle school [MS]: 40-60 minutes later, high school [HS]: 70 minutes later), providing parent self-reported weekday bedtime and wake time, sleep quality, and feeling tired. ResultsSignificant level-by-year interactions were found for parent bedtime, wake time, and sleep duration (all p < .0001). Post hoc analyses show ES parents reporting earlier bedtimes and wake times at post-change, with no change in sleep duration, while MS and HS parents reported later post-change wake times. Post-change, more MS and HS parents reported sufficient sleep duration (p < .0001) and good sleep quality (p < .0001), with fewer HS parents reporting feeling tired (p < .0001). ConclusionsThis is the first study to consider the impact of a policy change aimed at improving child sleep on parent sleep. Healthy school start times has a significantly positive downstream effect on secondary school parents’ sleep and daytime functioning, with minimal impact reported by parents of elementary school students.

Views of 4-5-Year-Old Children with No Nursery or Kindergarten Experience about School

To have a successful school life, a child must be able to make a healthy start to this period both socially and mentally. For this, children's views about school have a strong potential to affect their entire lives. The research aimed to examine the views of 4-5-year-old children who have not started any formal school yet. The study group consisted of 12 children aged between 4-5 years who have not started kindergarten from the province of Rize in Turkey. For the study; an open-ended, concentrated interview and drawing methods were applied with a small group. The data obtained from the group interviews with the children and the interpretation of the drawings were analyzed using the descriptive analysis technique. Based on the data, it was concluded that the family and the media are among the strong information sources of children about school and that positive features are frequently repeated. Negative features included crowding, rules, etc. The results also revealed that children who have no school experience and those who attend a pre-school education institution full-time have similar views about the school.

Improving Vitamin D Intake in Young Children-Can an Infographic Help Parents and Carers Understand the Recommendations?

Vitamin D deficiency is a serious public health issue in the United Kingdom. Those at increased risk, such as pregnant women, children under 5 years and people from ethnic groups with dark skin, are not all achieving their recommended vitamin D. Effective vitamin D education is warranted. A qualitative study was undertaken to evaluate the acceptability and understanding of a vitamin D infographic, developed using recommendations from previous research. Fifteen parents/carers, recruited through local playgroups and adverts on popular parent websites, participated in focus groups and telephone interviews. The majority were female, White British and educated to degree level. A thematic analysis methodology was applied. The findings indicated that understanding and acceptability of the infographic were satisfactory, but improvements were recommended to aid interpretation and create more accessible information. These included additional content (what vitamin D is; other sources; its health benefits; methods/doses for administration and scientific symbols used) and improved presentation (eye-catching, less text, simpler language, more images and a logo). Once finalized, the infographic could be a useful tool to educate families around vitamin D supplementation guidelines, support the UK Healthy Start vitamins scheme and help improve vitamin D status for pregnant and lactating women and young children.

Prenatal exposure to per- and polyfluoroalkyl substances and child adiposity at age 5 years: a multipollutant analysis

BACKGROUND AND AIM: Prenatal exposure to per- and polyfluoroalkyl substances (PFAS) is linked to lower birthweight and adiposity at birth. In some but not all previous studies, prenatal PFAS predict greater childhood BMI. However, few have directly measured child adiposity. We hypothesized that prenatal PFAS would be positively associated with child adiposity, evaluated using a precise method. METHODS: Pregnant women enrolled in the Healthy Start study (2009-2014). Blood samples were collected at a median of 27 weeks of gestation. Eleven PFAS were quantified in maternal serum; five were detected in 75% of participants and analyzed here. Child body composition at age 5 years was assessed using air displacement plethysmography. Adiposity was calculated as fat mass/total body mass x 100%. Three statistical approaches estimated associations between prenatal PFAS and child adiposity: single pollutant linear regression models; multipollutant linear regression model; and Bayesian Kernel Machine Regression (BKMR). Multipollutant models included five PFAS and a common covariate set. RESULTS:Among 340 participants, median child adiposity was 20.2% [interquartile range: 8.6%]. Pairwise Spearman correlations between PFAS were moderate to high (range: 0.32-0.78). In single pollutant models, each ln-unit increase in perfluorooctanoate (PFOA) was associated with 1.3% (95% CI 0.2, 2.5) greater child adiposity; no other PFAS was associated with adiposity. In the multipollutant model, PFOA was more strongly associated with adiposity than in the single pollutant model and there was an inverse association between perfluorodecanoate (PFDA) and adiposity; all variance inflation factors were 5. BKMR confirmed PFOA as the only PFAS with a posterior inclusion probability 0.3, but also showed a weak inverse association with PFDA. No pairwise interactions between exposures or strong non-linear trends were detected. CONCLUSIONS:Prenatal exposure to PFOA was positively associated with child adiposity at age 5. Multipollutant linear regression and BKMR produced similar results in this relatively simple scenario. KEYWORDS: PFAS, Obesity and metabolic disorders, Mixtures analysis, Children’s Environmental Health

Ambient air pollution exposure during pregnancy and cardio-metabolic markers in cord blood: The Healthy Start study

BACKGROUND AND AIM: Prenatal air pollution exposure has been associated with adverse cardiometabolic outcomes in childhood. It is unknown whether evidence of metabolic disruption associated with air pollution may be identified at birth. We estimated associations between maternal residential exposure to air pollution during pregnancy and metabolic and lipid biomarkers in cord blood collected at delivery. METHODS: This study included 812 mother-infant pairs enrolled in the prospective, Colorado-based Healthy Start study (2009-2014). Using inverse-distance-weighted interpolation of data obtained from stationary monitors, we estimated daily particulate matter ≤2.5 micrometers (PM2.5) and ozone (O3) concentrations at participant residences. Daily estimates were averaged by trimester, full pregnancy, and the 7- and 30- days prior to delivery. Outcomes were cord blood concentrations of glucose, insulin, leptin, total and high-density lipoprotein cholesterol, free fatty acids, and triglycerides. Glucose-insulin ratio was calculated as an indirect measure of insulin sensitivity. We used multiple linear regression to estimate associations between PM2.5 and O3 and cord blood metabolic and lipid biomarkers. Covariates included maternal, infant, and meteorological characteristics. RESULTS:Higher O3 exposure, during both recent and longer-term exposure periods during pregnancy, was consistently associated with higher insulin and lower glucose-insulin ratio in cord blood. For example, an interquartile range increase in full pregnancy O3 (6.3 ppb) was associated with a 0.12 log-µIU/ml (95% confidence interval: 0.03, 0.21) increase in cord blood insulin, after adjusting for covariates. There was limited evidence supporting positive associations between PM2.5 and leptin and O3 and total cholesterol. There were inverse associations between PM2.5 and triglycerides, during certain periods of pregnancy. CONCLUSIONS:Prenatal air pollution exposure was associated with cardiometabolic biomarkers in cord blood, most notably for O3 and insulin. Future studies should examine whether these changes persist into childhood and their implications on offspring health. KEYWORDS: prenatal exposure, air pollution, lipids, metabolism, neonate

Associations between green space, air pollution and birthweight in Sydney Metropolitan Area, Australia

BACKGROUND AND AIM: Low birthweight is one of the most common pregnancy complications. Previous studies have shown that while higher quantities of green space are associated with higher birthweights, exposure to ambient air pollution is associated with lower birthweights. These results might be related since green space is theorized to buffer air pollution harms; however, evidence of interactions between these exposures on birthweight remains inadequate. Therefore, aim of this study was to investigate how the association between air pollution (NO2, PM2.5, SO2 and O3) term birthweight is affected by quantity of green space. METHODS: 79,430 births recorded in Sydney in 2016 and 2017 were included in the analysis. Multilevel linear regression with random intercepts for statistical area level 2 (SA2) were developed to assess association between air pollutants and birthweight. Furthermore, interaction terms between air pollutants and green space quantity were fitted in the model to examine potential effect modification. RESULTS:Higher PM2.5, NO2 and SO2 was associated with lower birthweight, while increase in O3 exposure was associated with higher birthweight (all p0.05). Higher green space quantity was associated with lower birthweight (p0.05). Interactions between green space quantity and NO2 and PM2.5 were identified (p0.05), indicating that increasing green space may help to mitigate harms of moderate levels of NO2 and PM2.5 on birthweight. CONCLUSIONS:Improving access to green spaces in cities may help support a healthy start in life by mitigating harms from certain air pollutants. Replication in different contexts and consideration of potentially contrasting results with different types of green space should be further investigated. KEYWORDS: Green space, Birth outcomes, air pollution

Green space, neighborhood walkability and cardiometabolic health in early pregnancy: The Healthy Start study

BACKGROUND AND AIM: Green space and neighborhood walkability have been associated with cardiometabolic health, but relationships with cardiometabolic markers during pregnancy are unclear. We estimated associations of residential green space and neighborhood walkability with cardiometabolic health in early pregnancy. METHODS: We included 1208 pregnant women enrolled in the Colorado-based Healthy Start study (2009-2014). During a study visit in early pregnancy (median 17 weeks of gestation), we measured systolic and diastolic blood pressure and collected fasting blood samples. We measured serum glucose and insulin and calculated the Homeostatic Model for Assessment of Insulin Resistance (HOMA-IR). We used the average Normalized Difference Vegetation Index (NDVI) in circular buffers of 250m, 500m and 1000m surrounding the participants’ homes to estimate exposure to green space. The walkability of the Census block group of the maternal residence was assessed by the National Walkability Index of 2010. Associations of green space and neighborhood walkability with cardiometabolic markers in early pregnancy were assessed by linear regression, adjusting for covariates. RESULTS:A higher average NDVI in all buffer sizes was associated with a lower diastolic blood pressure and (non-significantly) lower systolic blood pressure in early pregnancy. For example, women in the highest tertile of green space in a buffer of 500m (NDVI ≥0.21) had a 1.21mmHg [95%CI -2.23, -0.20] lower diastolic blood pressure than women in the lowest tertile. Additionally, pregnant women who lived in the most walkable neighborhoods had a 3.41mmHg [95%CI -5.31, -1.51] lower systolic and 2.18mmHg [95%CI -3.73, -0.63] lower diastolic blood pressure than women residing in the least walkable neighborhoods. We found no associations of green space or neighborhood walkability with glucose, insulin or HOMA-IR. CONCLUSIONS:In this racially and ethnically diverse population, higher exposure to residential green space and higher neighborhood walkability were associated with lower systolic and diastolic blood pressure in early pregnancy. KEYWORDS: Green space, Walkability, Female, Obesity and metabolic disorders

A Methodological Approach for Evaluating the Enterprise Community Healthy Start Program in Rural Georgia: An Analysis Using Linked PRAMS, Birth Records and Program Data.

Community Healthy Start program evaluations are often limited by a lack of robust data and rigorous study designs. This study describes an enhanced methodological approach using local program data linked with existing population-level datasets for external comparison to evaluate the Enterprise Community Healthy Start (ECHS) program in two rural Georgia counties and presents results from the evaluation. ECHS program data were linked to birth records and the Pregnancy Risk Assessment Monitoring System (PRAMS) for 869 women who delivered a live birth in Burke and McDuffie counties from 2010 to 2011. Multivariate logistic regressions with and without propensity score methods modeled the association between ECHS participation and maternal health indicators and pregnancy outcomes. 107 ECHS participants and 726 non-participants responded to PRAMS and met eligibility criteria. Compared with non-participants, ECHS participants were younger, completed fewer years of education, and were more likely to be non-Hispanic Black, unmarried, insured with Medicaid, participating in WIC, and having an unintended pregnancy. Models with and without propensity score weighting derived similar results: there was a positive association between ECHS participation and receiving adequate or adequate plus prenatal care (p < 0.05); no statistically significant associations were observed between ECHS participation and any other health behaviors, health care access and utilization measures or pregnancy outcomes. Rigorous evaluation of a local Healthy Start program using linked PRAMS and birth records with a population-based external comparison group and propensity score methods is an enhanced and feasible approach that can be applied in other local and state jurisdictions.

Maternal diet quality during pregnancy is associated with biomarkers of metabolic risk among male offspring.

Limited data exist on the association between maternal diet quality during pregnancy and metabolic traits in offspring during early childhood, which is a sensitive period for risk of obesity-related disorders later in life. We aimed to examine the association of maternal diet quality, as indicated by the Healthy Eating Index-2010 (HEI), in pregnancy with offspring metabolic biomarkers and body composition at age 4-7years. We used data from 761 mother-offspring pairs from the Healthy Start study to examine sex-specific associations of HEI >57 vs ≤57 with offspring fasting glucose, leptin, cholesterol, HDL, LDL, percentage fat mass, BMI z score and log-transformed insulin, 1/insulin, HOMA-IR, adiponectin, triacylglycerols, triacylglycerols:HDL, fat mass, and sum of skinfolds. Multivariable linear regression models accounted for maternal race/ethnicity, age, education, smoking habits during pregnancy and physical activity, and child's age. During pregnancy, mean (SD) HEI score was 55.0 (13.3), and 43.0% had an HEI score >57. Among boys, there was an inverse association of maternal HEI with offspring glucose, insulin, HOMA-IR and adiponectin. For instance, maternal HEI >57 was associated with lower fasting glucose (-0.11; 95% CI -0.20, -0.02mmol/l), and lower concentrations of: insulin by 15.3% (95% CI -24.6, -5.0), HOMA-IR by 16.3% (95% CI -25.7, -5.6) and adiponectin by 9.3% (95% CI -16.1, -2.0). Among girls, there was an inverse association of maternal HEI with insulin and a positive association with LDL. However, following covariate adjustment, all estimates among girls were attenuated to the null. Greater compliance with the USA Dietary Guidelines via the HEI may improve the maternal-fetal milieu and decrease susceptibility for poor metabolic health among offspring, particularly boys. Future studies are warranted to confirm these associations and determine the underlying mechanisms.

The effects of a preschool-based intervention for Early Childhood Education and Care teachers in promoting healthy eating and physical activity in young children: A cluster randomised controlled trial.

The need for excess weight gain prevention in disadvantaged young children is widely recognised. Early Childhood Education and Care teachers are potential key actors in early interventions to prevent overweight and obesity. This study examines the effects of a preschool-based intervention for teachers in promoting healthy eating and physical activity in young children. A cluster randomised controlled trial was conducted at 41 preschools in a deprived area of Amsterdam, The Netherlands. The intervention consisted of 2 programmes that were applied in succession: A Healthy Start and PLAYgrounds for TODdlers. The study period was 9 months. Primary outcomes were assessed via questionnaires and included teachers’ knowledge, attitude, food/activity-related practices, and level of confidence in promoting healthy behaviours. Secondary outcomes in this study were teachers’ and children’s BMI (z-score), body composition, dietary intake and physical activity level. Intention-to-treat analyses were performed using linear mixed models. In total, 115 teachers and 249 children (mean age 3.0 (0.2) years) were included. A positive effect on teachers’ knowledge about the Dutch dietary guidelines was found after the programme A Healthy Start (difference = 1.38; 1-sided 95% CL = 0.29; p = 0.02). This effect was not sustained at 9 months (difference = 0.34; 1-sided 95% CL = -0.76; p = 0.31). The overall intervention had a positive effect on 3 of the 5 attitude statements regarding a healthy lifestyle (difference ranged from 0.34 to 0.55) and on the practice scale Activity-related-Modelling (difference = 0.16; 1-sided 95% CL = 0.06; p = 0.01). No intervention effects were observed on food-related practice scales and the level of confidence in promoting healthy behaviours. At this stage, no effects were seen on teachers’ and children’s BMI (z-score). This study contributes to the professional development of Early Childhood Education and Care teachers and addresses the call for interventions to prevent overweight/obesity and to minimise health inequalities in young children.

Hepatic Fat in Early Childhood Is Independently Associated With Estimated Insulin Resistance: The Healthy Start Study.

Fatty liver disease is a common metabolic abnormality in adolescents with obesity but remains understudied in early childhood. To describe hepatic fat deposition in prepubertal children and examine cross-sectional associations with metabolic markers and body composition. Data were from 286 children ages 4 to 8 years old in the Healthy Start Study, a longitudinal prebirth cohort in Colorado (USA). Assessments included magnetic resonance imaging to quantify hepatic and abdominal fats, fasting blood draws to measure metabolic markers, and air displacement plethysmography to measure body composition (fat mass and fat-free mass). The median (interquartile range) for hepatic fat was 1.65% (1.24%, 2.11%). Log-transformed hepatic fat was higher in Hispanic [mean (95% CI): 0.63 (0.52, 0.74)] vs non-Hispanic white children [0.46 (0.38, 0.53), P = 0.01] and children with overweight/obesity [0.64 (0.49, 0.79)] vs normal-weight [0.47 (0.40, 0.53), P = 0.02]. Higher log-hepatic fat was associated with higher insulin [β (95% CI): 1.47 (0.61, 2.33) uIU/mL, P = 0.001] and estimated insulin resistance (homeostatic model assessment) [0.40 (0.20, 0.60), P < 0.001] in the full sample and glucose [5.53 (2.84, 8.21) mg/dL, P < 0.001] and triglycerides [10.92 (2.92,18.91) mg/dL, P = 0.008] in boys, in linear regression models adjusted for sociodemographics, maternal/perinatal confounders, and percentage body fat. Log-hepatic fat was also associated with abdominal subcutaneous adipose tissue [SAT; 7.37 (1.12,13.60) mm2, P = 0.02] in unadjusted models, but this was attenuated and insignificant after adjusting for confounders. While hepatic fat was low in children 4 to 8 years old, it was independently associated with estimated insulin resistance and exhibited sex-specific associations with glucose and triglycerides, suggesting hepatic fat may be an early indicator of metabolic dysfunction in youth.

The maternal diet index in pregnancy is associated with offspring allergic diseases: the Healthy Start study.

A systematic review showed limited associations between pregnancy diet and offspring allergy. We developed a maternal diet index during pregnancy that was associated with offspring allergy outcomes. Data came from Healthy Start, a Colorado pre-birth cohort of mother/offspring dyads. Food propensity questionnaires were completed during pregnancy. Offspring allergic rhinitis, atopic dermatitis, asthma, wheeze, and food allergy diagnosis up to age four were verified from electronic medical records. Data were randomized into test and replication sets. The index included the weighted combination of variables that best predicted a combined outcome of any allergy in the test set. Index utility was verified in the replication set. Separate adjusted and unadjusted logistic models estimated associations between the index and each offspring allergy diagnosis in the full sample. The index included weighted measures of intake of vegetables, yogurt, fried potatoes, rice/grains, red meats, pure fruit juice, and cold cereals. Vegetables and yogurt were associated with the prevention of any allergy, while other components were associated with increased disease. In adjusted models, a one-unit increase in the index was significantly associated with reduced odds of offspring allergic rhinitis (odds ratio (CI) 0.82 [0.72-0.94]), atopic dermatitis (0.77 [0.69-0.86]), asthma (0.84 [0.74-0.96]), and wheeze (0.80 [0.71-0.90]), but not food allergy (0.84 [0.66-1.08]). This is the first study that has shown associations between an index of maternal dietary intake during pregnancy and multiple offspring allergic diseases. The results give hope for prevention of allergic diseases in utero.