South Asian Children Research Articles

Infant and young children complementary feeding practices in South Asian families: a systematic review

BackgroundSub-optimum nutrition among children remains an important problem among South Asian families in the UK. Appropriate complementary feeding practices in the first 2 years of life greatly reduce the risk of obesity and stunting. The UK diaspora is hypothesised to have similar complementary feeding practices to their countries of origin (India, Pakistan, and Bangladesh); if so, this could inform practice in the UK via reverse translation of evidence. We aimed to undertake a systematic review and narrative synthesis of studies assessing complementary feeding practices, and the beliefs that underpin them, in children under 2 years old within South Asian families living in the UK, India, Pakistan, and Bangladesh. MethodsWe searched Medline, Embase, Global Health, Web of Science, OVID Maternity and Infant Care, Cochrane Library, Popline, and WHO Global Health Library from Jan 1, 1990, to June 30, 2016. The eligibility criteria were all primary research studies on complementary feeding practices in South Asian children aged 0–2 years, their families, or both, restricted to the English language. The search terms used were “children”, “feeding”, and “Asians” with their derivatives. Study selection, data extraction, and quality appraisal (EPPI-Centre weight of evidence) were performed by two independent researchers in a narrative synthesis approach. This study is registered with PROSPERO, number CRD42014014025. FindingsFrom 45 702 studies identified, 157 descriptive studies (115 cross-sectional, 19 cohort, 14 qualitative, one case-control, and eight mixed studies) were included. Ten were from the UK, 17 Pakistan, 84 India, 43 Bangladesh, and three a combination of these countries. Despite adoption of the WHO Infant and Young Children Feeding Guidelines (particularly timing and food choice), substantial evidence of non-recommended complementary feeding practices was identified. Factors that affected these practices persisting after migration included bicultural issues or low acculturation levels and conflicting information between health professionals, extended family, and religious and community leaders. By contrast, barriers to enforcement of WHO-recommended complementary feeding practices in South Asian countries included early marriage, conflicts about best use of mother's time, rural life, short birth intervals, and poverty. InterpretationThis is the first systematic review, to our knowledge, to study complementary feeding practices across these countries. Similar themes were noted between UK families and countries of origin despite their receiving close National Health Service input from birth (eg, health visitors, general practitioners). This study will inform reverse translation of effective interventions to the UK from their countries of origin to improve complementary feeding practices in these communities. FundingNone.

Cultural adaptation of a children's weight management programme for Bangladeshi and Pakistani families in the UK: a cluster-randomised feasibility study protocol.

BackgroundGroup-based children’s weight management programmes are widely available in the UK and evidence shows that these are effective in the short-term. No programmes have been specifically developed to meet the cultural requirements of UK minority ethnic communities. South Asian children are a high-risk group for obesity and its consequences; therefore, the study aim is to adapt an existing weight management programme for children aged 4-11 years and their families to ensure cultural relevance to Pakistani and Bangladeshi communities, and undertake a feasibility study of the adapted programme.Methods/designPakistani and Bangladeshi families of overweight children who have been offered the existing children’s weight management programme in Birmingham, UK, will be invited to interviews and focus groups to explore their experiences and views of the programme. These data, together with existing literature and service provider information, will inform adaptation of the programme to be more culturally relevant to these families. The feasibility study will employ a cluster-randomised design, and will assess success of programme adaptation and feasibility of programme delivery. Planned programmes will be randomised to be delivered as the adapted programme (intervention) or the standard programme (comparator) with a 2:1 ratio. The primary outcome will be the proportion of Pakistani and Bangladeshi families completing the adapted programme. To assess recruitment, retention and data collection methods to inform a future trial, we aim to recruit 80 participants. A range of assessments will be undertaken with participants pre-, post- and 6-months post-intervention.DiscussionThis study addresses the identified need to provide children’s weight management programmes that are suitable for minority ethnic communities. Whilst the focus of the intervention adaptation is on Pakistani and Bangladeshi communities, the programme will be developed to be flexibly delivered to meet the cultural needs of communities of all ethnic compositions. The feasibility study will directly compare the adapted and existing weight management programmes, and will enable a comprehensive evaluation of the success of the adaptation. Essential information will also be gathered to inform the design and sample size calculation of a future trial to evaluate intervention effectiveness.Trial registration ISRCTN81798055, registered: 13/05/2014.

Prevalence and correlates of achieving recommended physical activity levels among children living in rural South Asia-A multi-centre study.

BackgroundWe report the prevalence of recommended physical activity levels (RPALs) and examine the correlates of achieving RPALs in rural South Asian children and analyse its association with anthropometric outcomes.MethodsThis analysis on rural South Asian children aged 5–14 years (n = 564) is a part of the Chronic Disease Risk Factor study conducted at three sites in India (Chennai n = 146; Goa n = 218) and Bangladesh (Matlab; n = 200). Data on socio-demographic and lifestyle factors (physical activity (PA); diet) were collected using an interviewer-administered questionnaires, along with objective anthropometric measurements. Multivariate logistic regression models were used to examine whether RPALs (active travel to school (yes/no); leisure-time PA ≥ 1 h/day; sedentary-activity ≤ 2 h/day) were associated with socio-demographic factors, diet and other forms of PA. Multivariate linear regression models were used to investigate associations between RPALs and anthropometrics (BMI- and waist z-scores).ResultsThe majority of children (71.8 %) belonged to households where a parent had at least a secondary education. Two-thirds (66.7 %) actively travelled to school; 74.6 % reported ≥1 h/day of leisure-time PA and 55.7 % had ≤2 h/day of sedentary-activity; 25.2 % of children reported RPALs in all three dimensions. Older (10–14 years, OR = 2.0; 95 % CI: 1.3, 3.0) and female (OR = 1.7; 95 % CI: 1.1, 2.5) children were more likely to travel actively to school. Leisure-time PA ≥ 1 h/day was more common among boys (OR = 2.5; 95 % CI: 1.5, 4.0), children in Matlab, Bangladesh (OR = 3.0; 95 % CI: 1.6, 5.5), and those with higher processed-food consumption (OR = 2.3; 95 % CI: 1.2, 4.1). Sedentary activity ≤ 2 h/day was associated with younger children (5–9 years, OR = 1.6; 95 % CI: 1.1, 2.4), children of Goa (OR = 3.5; 95 % CI: 2.1, 6.1) and Chennai (OR = 2.5; 95 % CI: 1.5, 4.3) and low household education (OR = 2.1; 95 % CI: 1.1, 4.1). In multivariate analyses, sedentary activity ≤ 2 h/day was associated with lower BMI-z-scores (β = −0.3; 95 % CI: −0.5, −0.08) and lower waist-z-scores (β = −1.1; 95 % CI: −2.2, −0.07).ConclusionOnly one quarter of children in these rural areas achieved RPAL in active travel, leisure and sedentary activity. Improved understanding of RPAL in rural South Asian children is important due to rapid socio-economic transition.

Asthma management in British South Asian children: an application of the candidacy framework to a qualitative understanding of barriers to effective and accessible asthma care.

BackgroundIn the UK, people of South Asian origin with asthma experience excess morbidity, with hospitalisation rates three times those of the majority White population and evidence suggests that South Asian children with asthma are more likely to suffer uncontrolled symptoms and hospital admissions with acute asthma compared to White British children. This paper draws on data from The Management and Interventions for Asthma (MIA) study to identify the operation of barriers to optimal care and good asthma control for South Asian children.MethodsThe MIA study followed a multi-phase, iterative, participatory design, underpinned by the socio-ecological model. Findings presented here are from face-to face, semi-structured interviews with South Asian (Indian, Pakistani and Bangladeshi origin) parents and carers of a child with asthma (n = 49). Interviews were conducted in English or relevant South Asian languages using specially trained community facilitators. Data were transcribed verbatim and analysed according to the principles of interpretive thematic analysis, facilitated by the use of NVivo.ResultsSeven dimensions of candidacy are identified: identification of candidacy; navigation; the permeability of asthma services; appearances at health services; adjudications; offers and resistance and operating conditions in the local production of candidacy. The analysis demonstrates several ways in which a potential lack of alignment between the priorities and competencies of British South Asian families and the organization of health services combine to create vulnerabilities and difficulties in effectively managing childhood asthma.ConclusionsHealthcare systems have a responsibility to develop services that are sensitive and appropriate to the needs of their communities. In South Asian communities, further efforts are required to raise awareness of symptoms and effectively communicate how, when and where to seek help for children. There is a need for improved diagnosis and consistent, effectively communicated information, especially regarding medication. Parents made several suggestions for improving services: presentations about asthma at easily accessible community venues; an advice centre or telephone helpline to answer queries; opportunities for sharing experiences with other families; having information provided in South Asian languages; longer GP appointments; extended use of asthma nurses; and better education for healthcare professionals to ensure consistency of care and advice.

Cross-ethnic friendships, psychological well-being, and academic outcomes: Study of South Asian and White children in the UK

We examined whether two interpersonal processes, self-disclosure and affirmation of ideal self, mediated the relationship between cross-ethnic friendships and psychological well-being and academic outcomes. We conducted a cross-sectional survey with 484 secondary school children (243 White European, 241 South Asian British; Mage = 11.10, 220 boys, 264 girls) recruited from 35 multiethnic classrooms. Results of multilevel structural equation modeling revealed mediational effects of self-disclosure between cross-ethnic friendships and psychological well-being for only South Asian children. Affirmation also mediated the association between cross-ethnic friendships and both psychological well-being and academic outcomes for South Asian children. For White European children, affirmation mediated the association between cross-ethnic friendships and psychological well-being. Further analyses demonstrated that self-disclosure resulting from cross-ethnic friendship quality facilitated affirmation, which in turn promoted both sets of outcomes. Findings demonstrate that cross-ethnic friendships in multiethnic settings contribute to well-being through the generation of positive interpersonal processes.

Development and evaluation of an intervention for the prevention of childhood obesity in a multiethnic population: the Born in Bradford applied research programme

BackgroundThere is an absence of evidence about interventions to prevent or treat obesity in early childhood and in South Asian populations, in whom risk is higher.ObjectivesTo study patterns and the aetiology of childhood obesity in a multiethnic population and develop a prevention intervention.DesignA cohort of pregnant women and their infants was recruited. Measures to compare growth and identify targets for obesity prevention, sensitive to ethnic differences, were collected. A feasibility randomised controlled trial (RCT) was undertaken.SettingBradford, UK.ParticipantsA total of 1735 mothers, 933 of whom were of South Asian origin.InterventionA feasibility trial of a group-based intervention aimed at overweight women, delivered ante- and postnatally, targeting key modifiable lifestyle behaviours to reduce infant obesity.Main outcome measuresThe feasibility and acceptability of the pilot intervention.Data sourcesRoutine NHS data and additional bespoke research data.Review methodsA systematic review of diet and physical activity interventions to prevent or treat obesity in South Asian children and adults.ResultsRoutine measures of growth were accurate. The prevalence of risk factors differed between mothers of white British ethnicity and mothers of Pakistani ethnicity and weight and length growth trajectories differed between Pakistani infants and white British infants. Prediction equations for risk of childhood obesity were developed. An evidence-based intervention was evaluated in a pilot RCT and was found to be feasible and acceptable.LimitationsThis was a single-centre observational study and a pilot evaluation.ConclusionsThe programme has been successful in recruiting a unique multiethnic childhood obesity cohort, which has provided new evidence about modifiable risk factors and biethnic growth trajectories. A novel group-based behavioural change intervention has been developed and successfully piloted. A multisite cluster RCT is required to evaluate effectiveness.Trial registrationCurrent Controlled Trials ISRCTN56735429.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

The costs of stunting in South Asia and the benefits of public investments in nutrition.

South Asia is home to the largest number of stunted children worldwide: 65 million or 37% of all South Asian children under 5 were stunted in 2014. The costs to society as a result of stunting during childhood are high and include increased mortality, increased morbidity (in childhood and later as adults), decreased cognitive ability, poor educational outcomes, lost earnings and losses to national economic productivity. Conversely, investing in nutrition provides many benefits for poverty reduction and economic growth. This article draws from analyses conducted in four sub‐Saharan countries to demonstrate that investments in nutrition can also be very cost‐effective in South Asian countries. Specifically, the analyses demonstrate that scaling up a set of 10 critical nutrition‐specific interventions is highly cost‐effective when considered as a package. Most of the interventions are also very cost‐effective when considered individually. By modelling cost‐effectiveness of different scale‐up scenarios, the analysis offers insights into ways in which the impact of investing in nutrition interventions can be maximized under budget constraints. Rigorous estimations of the costs and benefits of nutrition investments, similar to those reported here for sub‐Saharan countries, are an important next step for all South Asian countries in order to drive political commitment and action and to enhance allocative efficiency of nutrition resources.

Challenges in Collating Spirometry Reference Data for South-Asian Children: An Observational Study.

Availability of sophisticated statistical modelling for developing robust reference equations has improved interpretation of lung function results. In 2012, the Global Lung function Initiative(GLI) published the first global all-age, multi-ethnic reference equations for spirometry but these lacked equations for those originating from the Indian subcontinent (South-Asians). The aims of this study were to assess the extent to which existing GLI-ethnic adjustments might fit South-Asian paediatric spirometry data, assess any similarities and discrepancies between South-Asian datasets and explore the feasibility of deriving a suitable South-Asian GLI-adjustment.MethodsSpirometry datasets from South-Asian children were collated from four centres in India and five within the UK. Records with transcription errors, missing values for height or spirometry, and implausible values were excluded(n = 110).ResultsFollowing exclusions, cross-sectional data were available from 8,124 children (56.3% male; 5–17 years). When compared with GLI-predicted values from White Europeans, forced expired volume in 1s (FEV1) and forced vital capacity (FVC) in South-Asian children were on average 15% lower, ranging from 4–19% between centres. By contrast, proportional reductions in FEV1 and FVC within all but two datasets meant that the FEV1/FVC ratio remained independent of ethnicity. The ‘GLI-Other’ equation fitted data from North India reasonably well while ‘GLI-Black’ equations provided a better approximation for South-Asian data than the ‘GLI-White’ equation. However, marked discrepancies in the mean lung function z-scores between centres especially when examined according to socio-economic conditions precluded derivation of a single South-Asian GLI-adjustment.ConclusionUntil improved and more robust prediction equations can be derived, we recommend the use of ‘GLI-Black’ equations for interpreting most South-Asian data, although ‘GLI-Other’ may be more appropriate for North Indian data. Prospective data collection using standardised protocols to explore potential sources of variation due to socio-economic circumstances, secular changes in growth/predictors of lung function and ethnicities within the South-Asian classification are urgently required.

General intelligence is associated with subclinical inflammation in Nepalese children: A population-based plasma proteomics study

Improving child cognition in impoverished countries is a public health priority. Yet, biological pathways and associated biomarkers of impaired cognition remain poorly understood and largely unknown, respectively. This study aimed to explore and quantify associations between functional plasma protein biomarkers and childhood intellectual test performance. We applied proteomics to quantify proteins in plasma samples of 249 rural Nepalese children, 6–8years of age who, 1year later at 7–9years of age, were administered the Universal Nonverbal Intelligence Test (UNIT). Among 751 plasma proteins quantified, 22 were associated with UNIT scores, passing a false discovery rate threshold of 5.0% (q<0.05). UNIT scores were higher by 2.3–9.2 points for every 50% increase in relative abundance of two insulin-like growth factor binding proteins (IGFBPs), six subclasses of apolipoprotein (Apo) and transthyretin, and lower by 4.0–15.3 points for each 50% increase in relative abundance of 13 proteins predominantly involved in inflammation. Among them, IGFBP-acid labile subunit, orosomucoid 1 (ORM1), Apo C-I, and pyruvate kinase isoenzymes M1/M2 jointly explained 37% of the variance in UNIT scores. After additional adjustment for height-for-age Z-score and household socio-economic status as indicators of long-term nutritional and social stress, associations with 6 proteins involved in inflammation, including ORM1, α-1-antichymotrypsin, reticulocalbin 1, and 3 components of the complement cascade, remained significant (q<0.05). Using untargeted proteomics, stable, constitutive facets of subclinical inflammation were associated with lower developmental test performance in this rural South Asian child population. Plasma proteomics may offer opportunities to identify functional, antecedent biomarkers of child cognitive development.

Blood Lead Levels and Potential Risk Factors for Lead Exposures Among South Asians in New York City

New York City’s South Asian children and pregnant women have a disproportionate burden of elevated blood lead levels. This study is the first to investigate blood lead levels and risk factors for lead exposures among South Asian New Yorkers. A survey and a finger-stick blood lead test using a portable analyzer were administered to 230 South Asian adults and children. Blood lead levels of 5 µg/dL or higher were found in 20 % of the adults and 15 % of the children, as compared to 5 % of adults and 2.5 % of children citywide. Factors associated with elevated blood lead levels were recent repair work at home, not speaking English, Bangladeshi or Indian ethnicity, and occupational risk factors. Public health professional should be aware that South Asians may be at an increased risk for elevated blood lead levels.

Pediatric Inflammatory Bowel Disease Among South Asians Living in British Columbia, Canada: A Distinct Clinical Phenotype.

Inflammatory bowel disease (IBD) incidence is increasing among low-risk populations. This study examined a cohort of Canadian South Asian (SA) children with IBD to determine if their disease course differed from non-SA (NSA) children. Children of SA ethnicity diagnosed with IBD between 1997 and 2012 were identified and compared with NSA children. Data on duration and the type of presenting symptoms, disease phenotype, corticosteroid exposure (CS), exclusive enteral nutrition use, time to commencement of immunomodulator (IM), biologic therapy, and surgical intervention were extracted. Overall, 160 SA children were identified and compared with 783 NSA patients (Crohn's disease [CD]: 44% versus 72%; ulcerative colitis [UC]: 43% versus 21%; IBD-Unclassified: 13% versus 7%; P < 0.001). SA patients were predominantly second-generation Canadians (92%) and had shorter symptom duration (2 versus 4 months; P < 0.001). SA CD patients were less likely to have a parent with IBD (1% versus 14%; P = 0.003). SA patients had more extensive colonic disease (CD: 55% versus 35%; P = 0.005; UC: 77% versus 58%; P = 0.006); SA CD patients presented with more complicated disease (B2/B3: 39% versus 27%; P = 0.006) and UC patients presented with more severe disease (49% versus 23%; P < 0.001). In SA CD patients, CS use was higher (70% versus 58%; P = 0.045), and IM and biologic therapy were commenced earlier (P = 0.027; P = 0.047). SA UC patients were more likely to need CS and IM (P = 0.024; P < 0.001). These data describe an ethnically unique clinical phenotype, where SA children have a higher proportion of UC, shorter symptom duration, more extensive colonic disease, and are more likely to require earlier escalation of therapy.

Adiposity and response to an obesity prevention intervention in Pakistani and Bangladeshi primary school boys and girls: a secondary analysis using the BEACHeS feasibility study

ObjectivesAs a secondary analysis of the BEACHeS study, we hypothesised there would be sex differences in Pakistani and Bangladeshi school children when examining adiposity and their response to an obesity...

Parental concerns towards children and adolescents with epilepsy in Sri Lanka—Qualitative study

PurposeSocial, cultural, psychological and many other factors significantly impact the lives of epileptic children and their families. Parental concerns towards their children are less known in south Asian children with epilepsy. We aimed to identify the parental concerns regarding their children and adolescents with epilepsy in Sri Lanka. MethodsWe carried out qualitative study in 3 districts of Sri Lanka, comprising 16 in-depth interviews with parents of children and adolescents with epilepsy and 3 focus group discussions with primary caregivers of epileptic children and key informants (schoolteachers, public health staffs). Content analysis of the interview data was performed. ResultsParental concerns were spread among seven themes that emerged from the content analysis. These concerns were about the child's functioning in areas such as physical, behavioural, psychological and social, education, concerns related to anti-epileptic therapy and epilepsy as a disease. Parents were more concerned about their child's safety, educational achievements and future prospects in terms of employment and marriage. Unpredictability of seizures, fear of stigma and unawareness of epilepsy were the main reasons voiced by the parents for having such concerns. Increased concern and perception of vulnerability was seen among parents whose children had epilepsy and co-morbid illness. ConclusionsParental concerns towards their children and adolescents show a multidimensional construct. Unpredictability of seizures, fear of stigma and unawareness of epilepsy were identified as key influential factors in moulding the parental concerns.

Recalibration of overweight–obesity prevalence from body-mass index in UK children of South Asian and black African origin: cross-sectional study based on National Child Measurement Programme data

BackgroundThe accurate assessment of overweight–obesity prevalence in UK children of South Asian and black African origin (in whom its consequences are especially adverse) is an important challenge. However, body-mass index (BMI), the marker of body fatness used in most national surveys, differs in its association to body fatness between ethnic groups, which biases ethnic comparisons of body fatness based on BMI. We recalibrated BMI values for ethnicity to assess overweight–obesity prevalence more accurately in UK South Asian and black African children in recent survey data from the National Child Measurement Programme (NCMP), an inclusive assessment programme in English primary schools. MethodsDeuterium dilution measurements of body fat and BMI were collated from four recent UK population-based studies (three in schools selected to provide balanced ethnic representation) in 873 children of South Asian, black African, and white European origin aged 9−11 years. Data were analysed with linear regression models to determine the age-adjusted and sex-adjusted BMI differences in South Asian and black African children compared with white Europeans at an equivalent level of body fatness (denoted by fat mass index [kg/m5], which is uncorrelated with height). These BMI adjustments were applied to NCMP 2012–13 survey data in 489 146 children aged 10–11 years to determine ethnic-specific overweight–obesity prevalences; standard NCMP overweight–obesity definitions were used. FindingsBMI adjustments for equivalent body fatness were +1·11 kg/m2 and +0·98 kg/m2 for South Asian boys and girls, respectively, and −1·20 kg/m2 and −1·66 kg/m2 for black African boys and girls, respectively; these adjustments were applied to NCMP data for South Asian and black African children. Overweight–obesity was recorded in 14 538 of 38 201 South Asian children (38·1%, 95% CI 37·6–38·5) and 9839 of 22 672 black African children (43·4%, 42·8–44·0) before BMI adjustment and in 18 145 of 38 201 (47·5%, 47·0–48·0) and 7065 of 22 672 (31·2%, 30·6–31·8), respectively, after adjustment; overweight–obesity was recorded in 92 002 of 292 467 white European children (31·5%, 95%CI 31·3–31·6). InterpretationUse of ethnic-specific BMI adjustments to obtain comparable assessments of body fatness substantially changed observed overweight–obesity prevalences in ethnic minority groups. Adjusted BMI particularly emphasised the substantial overweight–obesity burden in South Asian children, an important priority for prevention. FundingThis research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South London and by grants from the British Heart Foundation (PG/11/42/28895), the Child Growth Foundation (GR 10/03), and the Wellcome Trust (WT094129MA).

Sugar-sweetened and artificially sweetened beverage consumption and adiposity changes: a national longitudinal study

BackgroundIn response to increasing policy action and public concern about the negative health effects of sugar-sweetened beverages (SSBs), artificially sweetened beverages (ASBs) are increasingly being promoted. These beverages have been linked with obesity and diabetes in recent experimental work. This study examined associations between SSB and ASB consumption and changes in adiposity in a nationally representative sample of UK children. MethodsWe conducted a longitudinal study of 13 170 children aged 7–11 years from the UK Millennium Cohort Study. Data were collected between Jan 1, 2008, and Feb 28, 2009, and between Jan 1 and Dec 31, 2012. Logistic regression was used to assess sociodemographic and behavioural correlates of SSB and ASB consumption at least once per week at age 11 years. Linear regression examined associations between consumption of SSB and ASB and changes in adiposity measures between ages 7 and 11 years. Analyses were adjusted for characteristics and behaviours previously associated with adiposity: age, sex, ethnic group, household income, country of residence, portions of fruit consumed per day, breakfast consumption, days per week of sport or exercise, hours spent watching television per weekday, and mode of transport to school. FindingsAt age 11 years, boys were more likely than girls to consume SSBs at least once per week (4061 [62·3%] of 6519 vs 3936 [59·1%] of 6651). South Asian children were more likely than white children to consume SSBs at least once per week (8603 [78·8%] of 10 918 vs 738 [58·4%] of 1264) but less likely to consume ASBs (51·7% vs 66·3%). Daily SSB consumption was associated with increases in body-mass index (BMI) between ages 7 and 11 (+0·22 kg/m2, 95% CI 0·11–0·34). Daily ASB consumption was associated with increased percentage body fat at age 11 years (+1·18%, 0·81–1·54) and further increases between ages 7 and 11 (+0·35%, 0·09–0·61). InterpretationResults of this study show that consumption of SSBs and ASBs is associated with increases in BMI and percentage body fat in UK children. Emerging policy responses to address health concerns about SSBs should consider encouraging drinking water as a substitute rather than ASBs. FundingNone.

Beyond height and weight: a programme of school nurse assessed skinfold measurements from white British and South Asian origin children aged 4–5 years within the Born in Bradford cohort study

ObjectiveTo describe the feasibility, reliability and additional information gained from collecting additional body fatness measures (beyond height and weight) from UK reception year children.DesignProspective cohort study.SettingBradford, UK.Participants2458 reception year children...

Sleep duration and risk markers for type 2 diabetes: a cross-sectional study in children aged 9–10 years

BackgroundShorter sleep duration has been associated with obesity, increased cardiovascular morbidity, and mortality in adults and with obesity in children. However, effects on childhood risk markers for cardiometabolic disease have been little studied. We examined associations between self-reported sleep duration and cardiometabolic risk markers in children and whether sleep duration might explain ethnic differences in insulin resistance. MethodsThis was a cross-sectional study of 4560 children aged 9–10 years, predominantly of white European, South Asian, and black African origin, from 200 UK primary schools. Children were asked to recall usual time of going to sleep and awakening on a school day. Fasting blood samples provided concentrations of serum insulin, plasma glucose, HbA1c, and serum lipids. Physical measures included height, weight, bioimpedance, and blood pressures. Multilevel linear regression models examined the association of sleep duration (in hours) with blood markers and anthropometric measures, adjusted for sex, age quartiles, month, ethnicity, socioeconomic status, observer (physical measures only), and random effect for school; percentange changes are given for log transformed outcomes. Informed consent was obtained from parents or children, and ethics approval was given by the Multicentre Research Ethics Committee (Wales). FindingsMedian sleep duration was 10·5 h (95% central range 8–12). On average, white European children slept longer than South Asian and black African children (10·4 h/night, 10·2, and 10·1, respectively). There were strong inverse graded associations between sleep duration, adiposity, and diabetes risk markers. Per hour increase in sleep duration was associated with 0·8 kg/m3 lower ponderal index (95% CI 1·2–0·3), 0·03 kg/m5 lower fat-mass index (0·05–0·0), 1·73% lower HOMA (homoeostatis model assessment) insulin resistance (0·50–3·91), 2·43% lower fasting glucose (0·86–3·97), and 0·19% lower HbA1c (0·0–0·39) after adjustment. Associations with diabetes risk markers remained after adjustment for adiposity and objective measures of physical activity. Sleep duration did not account for ethnic differences in insulin resistance, and was unrelated to blood pressure and serum lipids. InterpretationThe inverse association between type 2 diabetes risk markers and sleep duration in childhood is novel. Intervention studies are needed to establish causal associations, especially since increased sleep duration might offer a strategy for early prevention of type 2 diabetes. FundingThis research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (South London) and by grants from Diabetes UK and the Wellcome Trust.

Sugar and artificially sweetened beverage consumption and adiposity changes: National longitudinal study.

BackgroundIn response to increasing policy action and public concern about the negative health effects of sugar-sweetened beverages (SSBs), there is increased promotion of artificially sweetened beverages (ASBs). These have been linked with obesity and diabetes in recent experimental work. This study examined associations between SSB and ASB consumption and changes in adiposity in a nationally representative sample of UK children.MethodsWe conducted a longitudinal study of 13,170 children aged 7–11 years in the UK Millennium Cohort Study, collected in 2008 and 2012. Logistic regression was used to assess socio-demographic and behavioural correlates of weekly SSB and ASB consumption at 11 years. Linear regression examined associations between SSB/ASB consumption and changes in adiposity measures between 7 and 11 years.ResultsBoys were more likely to consume SSBs weekly (62.3 % v 59.1 %) than girls at age 11 years. South Asian children were more likely to consume SSBs weekly (78.8 % v 58.4 %) but less likely to consume ASBsweekly (51.7 % v 66.3 %) than White children. Daily SSB consumption was associated with increases in percentage body fat between ages 7 and 11 (+0.57 %, 95 % confidence intervals 0.30;0.83). Daily ASB consumption was associated with increased percentage body fat at age 11 (+1.18 kg/m2, 0.81;1.54) and greater increases between ages 7 and 11 (+0.35 kg/m2, 0.09;0.61).ConclusionConsumption of SSBs and ASBs was associated with BMI and percentage body fat increases in UK children. Obesity prevention strategies which encourage the substitution of SSBs with ASBs may not yield the adiposity benefits originally intended and this area should be a focus for further research.

Preventing caries in young children of immigrant Bangladeshi families in New York: perspectives of mothers and paediatricians.

Childhood caries is common in South Asian immigrant families. Few children visit a dentist by 12 months, as recommended by current guidelines. The paediatric visit has important potential for linking children to preventive care. The aim of this study was to understand the barriers and facilitators to caries prevention for young children of immigrant Bangladeshi families in New York. Qualitative data were collected as a preliminary step in the development of an oral health counselling intervention for South Asian children. Qualitative interviews on child feeding and oral health prevention were conducted with Bangladeshi mothers. Qualitative interviews were conducted with paediatricians regarding their experiences with providing care. The data were analysed using standard qualitative approaches. Paediatric practices serving low income Bangladeshi immigrants in New York City. 26 mothers of children aged 6-24 months receiving services in five paediatric settings and 15 paediatricians providing care in these settings. Both mothers and their paediatricians described risky feeding practices, communication problems and a lack of compliance. Oral health for young children was a low priority for some mothers. Most, however, were concerned about childhood caries but lacked skills or resources to decrease caries risk. Results support our plan to develop an empowerment-based counselling intervention to address caries risk in children. Paediatric dentists should be aware of the barriers to caries prevention in this group.

An assessment of methods used in the investigation of iron status: findings in a population of young British South Asian children

AimsTo assess the value of laboratory tests available for the investigation of iron status in a population of young British South Asian children.MethodsBlood count, red cell distribution width (RDW), percentage...