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PubMed2003

Zinc deficiency, infectious disease and mortality in the developing world.

Zinc deficiency places children in many low-income countries at increased risk of illness and death from infectious diseases. Randomized controlled trials of zinc supplementation provide the best estimate of this risk through demonstrated preventive benefits. In six of nine trials that evaluated prevention of diarrhea, significantly lower incidence of diarrhea occurred in the zinc group than in the controls; a pooled analysis demonstrated 18% (95% confidence interval, 7-28%) less diarrhea. In five trials, a lower rate of pneumonia infection was found in the zinc-supplemented groups, and there was some indication of a preventive effect in three trials with a clinical malaria outcome. Zinc was also found to have a therapeutic benefit in seven trials of acute diarrhea and five of persistent diarrhea. Studies to evaluate the effect of zinc supplementation on mortality are under way, but a recently published study from India identified a 68% reduction in mortality in small-for-gestational-age term infants that were supplemented with zinc from 1 to 9 mo of age. The important effects of zinc deficiency are now clear, and nutrition programs should address this prevalent problem.

Communicable Disease Control↗
PubMed2006

Has the WIC incentive to formula-feed led to an increase in overweight children?

We explored the relationship between the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and overweight status in children, with a focus on WIC's provision of infant formula, through secondary analyses and review of existing literature. Because of the complexity involved and the lack of previous research on the combined link between WIC, breast-feeding, and overweight status, we considered evidence for each of these relations separately. Using food-cost data from the WIC's 1996 Participant and Program Characteristics Survey, we found that the state-level average for 1 y of program benefits for women who formula-fed was over twice the value of program benefits for those who breast-fed (BF). This difference in benefit levels, or formula incentive, was negatively associated with both the in-hospital and 6-mo BF rates in state-level multiple regression models. Despite WIC's efforts to promote BF, other large-scale studies have found a negative association of program participation with BF rates. An inverse association of BF on subsequent overweight in children also has been shown in a number of studies. Despite this accumulating evidence for the protective effect of BF, it has not been seen in African American or Latino populations. In sum, there is reason to be concerned that WIC's incentive to formula-feed may have led to an increase in overweight children; yet there is too much uncertainty about the issue to conclude that this is so. Further research is needed to understand this relationship, as is the development of applied interventions to increase BF rates.

Black or African American↗
PubMed2003

Consumption of fish from polluted waters by WIC participants in east Harlem.

To minimize exposure to neurotoxins such as mercury, polychlorinated biphenyls (PCBs), dioxins, and pesticide residues, the New York State Department of Health issues health advisories about consumption of certain fish and shellfish caught from polluted local waters. Fetal exposure causes cognitive developmental deficits in children. Consumption of fish was assessed. We surveyed 220 WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) participants. Of the participants, 10% ate fish and shellfish caught in local polluted waters. Statistically significant factors associated with eating local, noncommercial fish included male gender and knowledge of the health advisory. Locally caught fish and crabs are consumed; thus, in utero and childhood exposure to these neurotoxins occurs. Interventions to promote safer choices of fish are needed.

Adolescent↗
PubMed2002

Linking WIC and immunization services to improve preventive health care among low-income children in WIC.

Children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are at risk for low immunization coverage and other adverse health-related outcomes. Immunization-promoting strategies in WIC have been shown to produce dramatic improvements in immunization coverage. This evaluation of a local WIC initiative in Milwaukee is the first study to evaluate the impact of these strategies on improving the utilization of other clinical preventive services at the medical home. The use of more intensive immunization-promoting strategies in WIC may improve utilization of well child care visits and receipt of other clinical preventive services in the medical home.

Child↗
PubMed2005

Alcohol consumption among low-income pregnant Latinas.

BACKGROUND: Due to changing cultural norms, Latinas of childbearing age residing in the U.S. may be at increasing risk of drinking harmful levels of alcohol during pregnancy, and may also be unaware of the risks for Fetal Alcohol Spectrum Disorders associated with this behavior. We assessed the prevalence of alcohol consumption in a sample of low-income pregnant Latinas and examined risk factors for alcohol use in the periconceptional period. METHODS: As part of a larger intervention trial, a cross-sectional in-home interview study was conducted among a sample of 100 pregnant low-income Latinas receiving services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in San Diego County, California. RESULTS: Fifty-seven percent of respondents indicated they were either life-time abstainers or had not consumed any alcohol in the periconceptional period. Forty-three percent reported some alcohol use in the three months prior to recognition of the current pregnancy, and 20% reported at least one binge episode of four or more standard drinks during that time frame. Five percent reported drinking seven or more drinks per week, and 8% continued drinking alcohol after recognition of pregnancy. Significant predictors of any alcohol use in the periconceptional period included English language/higher level of acculturation, younger maternal age, lower parity, higher level of education, younger age at first drink, and having ever smoked. Women who were aware of alcohol warning messages and /or had more knowledge of the Fetal Alcohol Syndrome (FAS) were significantly more likely to have consumed alcohol in the periconceptional period. Frequency of periconceptional use of alcohol did not differ between women who planned or did not plan the pregnancy. CONCLUSION: The prevalence and pattern of early pregnancy alcohol consumption in this sample of Latinas is similar to patterns noted in other race/ethnic groups in the U.S. Level of knowledge about FAS and awareness of warning messages was not protective for early pregnancy alcohol consumption, suggesting that specific knowledge was insufficient to prevent exposure or that other factors reinforce maintenance of alcohol consumption in early pregnancy. Selective interventions in low-income Latinas are warranted, and should be focused on women of reproductive age who are binge or frequent drinkers and who are at risk of becoming pregnant.

Acculturation↗
PubMed2004

Posttraumatic stress disorder in pregnancy: prevalence, risk factors, and treatment.

OBJECTIVE: To estimate the prevalence of posttraumatic stress disorder and its treatment in economically disadvantaged pregnant women. METHODS: The sample included 744 pregnant Medicaid-eligible women from Women, Infants and Children Supplemental Nutrition Program sites in 5 counties in rural Missouri and the city of St. Louis. Race (black and white) was proportional to clients seen at each site. Women were assessed by using standardized measures of posttraumatic stress disorder, 18 other psychiatric disorders, environmental stressors, and pregnancy characteristics. Logistic regression identified risk factors associated with posttraumatic stress disorder. RESULTS: Posttraumatic stress disorder prevalence was 7.7% (n = 57/744). Comorbid disorders were common. Women with posttraumatic stress disorder were 5 times more likely to have a major depressive episode (odds ratio 5.17; 95% confidence interval 2.61, 10.26) and more than 3 times as likely to have generalized anxiety disorder (odds ratio 3.25; 95% confidence interval 1.22, 8.62). Besides these comorbid disorders, risk factors for posttraumatic stress disorder included a history of maternal separation for 6 months and multiple traumatic events. Although most women with posttraumatic stress disorder reported moderate impairment in their daily lives, only 7 of the 57 women with this disorder reported speaking with any health professional about it in the last 12 months. CONCLUSIONS: The prevalence of posttraumatic stress disorder in pregnancy and low treatment rates suggest that screening for this disorder should be considered in clinical practice. LEVEL OF EVIDENCE: II-2

Adolescent↗
PubMed1995

What predicts breastfeeding intention in Mexican-American and non-Hispanic white women? Evidence from a national survey.

We examined the effects of a series of predictors on the prepartum intention to breastfeed in both Mexican-American and non-Hispanic white women. A national sample included 430 Mexican-American women and 3659 non-Hispanic white women who had a pregnancy in 1988. Prenatal behavioral, sociodemographic, and biomedical information was obtained through the 1988 National Maternal and Infant Health Survey. Two dependent variables were constructed to identify significant predictors of breastfeeding intention: exclusive versus partial and bottle-feeding, and exclusive and partial versus bottle-feeding. Results from the multiple logistic regression models indicated that advice to breastfeed at prenatal care was the strongest predictor of intentions in both Mexican-American (OR = 2.15, OR = 1.86) and non-Hispanic white mothers (OR = 2.29, OR = 3.61). In Mexican-Americans the father's being Hispanic was negatively associated with breastfeeding intention (OR = 0.63). In non-Hispanic whites the advice to formula feed at the Women, Infants, and Children's nutrition program was a significant negative predictor of breastfeeding intention (OR = 0.33, for exclusive and partial breastfeeding vs exclusive bottle-feeding). These results have important implications for public health policy and practice.

Adolescent↗
PubMed1995

The use of human ecology and epidemiology in nonorganic failure to thrive.

Children with nonorganic failure to thrive (NOFTT) comprise a population at risk for small stature, poor growth, slower development, and lower intellectual outcomes. These children are often seen in the Women, Infants, and Children Supplemental Nutrition Program (WIC) and child health clinics and in caseloads of high-risk families. Public health nurses may not be sure how to intervene in the problem of NOFTT because of its multifactorial etiology. A model of nursing care that addresses the many factors that affect the development of NOFTT can enable the public health nurse to appropriately care for the child with NOFTT. The Eco-Epi model, a combination of human ecology and epidemiology, is a conceptual model that can provide a framework for the public health nurse to plan interventions. Even though children with NOFTT are the target population for this model, it can be applied to other public health nursing populations at risk for multifactorial problems. In the Eco-Epi model, the epidemiological concepts of agent (food), host (child), and environment (home) are examined in the context of the microsystem (parent-child interaction, daily activities of the family), the mesosystem (interactions between different environments), and the exosystem (the child's community). The concepts of microsystem, mesosystem, and exosystem are from the theory of human ecology. Examples of how the model works to assess a family and design interventions are provided.

Ecology↗
PubMed1996

Use of public health nursing services: relationship to adequacy of prenatal care and infant outcome.

Timing of initial public health nurse contact and number of nurse contacts were examined for their relationship to adequacy of prenatal physician care, infant birthweight, and gestational age. Three historical cohort groups were drawn from three downstate Illinois counties: 1) public health nursing clients (N = 506); 2) Women, Infant, and Children Nutrition Program clients (N = 314); and 3) clients receiving neither of these services (N = 403). Data were obtained from local health department records and a state birth certificate data tape. Descriptive statistics and logistic and multiple regression were used to analyze data. Timing of initial public health contact was significantly correlated to adequacy of prenatal physician contact and infant gestational age. No relationship was found between either timing of initial public health nursing contact or number of these contacts and infant birthweight. The number of public health nursing and physician contacts exerted an additive effect on birthweight and gestational age. Findings lend support for case-finding activities that result in public health nursing contacts early in pregnancy. The importance of multidisciplinary approaches to prenatal care is suggested.

Adult↗
PubMed1986

Postprandial blood pressure reduction in healthy elderly.

Previous studies have identified postprandial systolic blood pressure reductions in old, frail institutionalized subjects, which do not occur in healthy, young subjects, after a morning meal. To evaluate the relative contributions of state of health and time of day to this potentially dangerous abnormality in cardiovascular homeostasis, we measured sitting systolic blood pressure and heart rate before and at intervals after a noon meal, and in identical fashion without a meal, in 21 healthy, community-dwelling elderly subjects (73 +/- 6 years of age) attending a nutrition program. Systolic blood pressure changed a maximum of -11 +/- 9 (SD) mmHg (P = .006, analysis of variance) by 60 minutes after the meal, in contrast to 1 +/- 7 mmHg (NS) by 60 minutes, when no meal was given (P less than .0001, meal versus control studies). There was a highly significant inverse correlation between postprandial and basal sitting systolic blood pressure changes (R = -0.60, P = .004). Healthy community-dwelling elderly demonstrate postprandial reductions in systolic blood pressure which correlate with basal sitting systolic blood pressure. This is consistent with age- and hypertension-related impairment in baroreflex compensation for the hypotensive stress of eating.

Aged↗
PubMedDate not supplied

Mother-infant interaction and breastfeeding outcome 6 weeks after birth.

OBJECTIVE: This study explored the relationship of early postpartum maternal-infant interactions to breastfeeding outcome at 6 weeks postpartum. DESIGN: Prospective, comparative descriptive study. SETTING: Women, Infants, and Children Supplemental Nutrition Program and Comprehensive Perinatal Services Programs in northern California. PARTICIPANTS: Forty-two Latina participants were recruited in the 3rd trimester of pregnancy. Eligibility criteria included age 18 years or older, primiparous at recruitment, antepartum desire to breastfeed 8 weeks or longer postpartum, planned hospital birth, full-term vaginal birth of a healthy newborn, and an uncomplicated, immediate postpartum course for mother and newborn, including being discharged together. MAIN OUTCOME MEASURES: The study examined breastfeeding dyads' early postpartum scores on Barnard's Nursing Child Assessment Feeding Scale (NCAFS) in relation to breastfeeding outcome 6 weeks postpartum. NCAFS tests were performed 28-90 hours postpartum in the participants' homes, and breastfeeding status was assessed by phone contact 6 weeks postpartum. RESULTS: Dyads continuing to breastfeed at 6 weeks postpartum had significantly higher early postpartum NCAFS scores than did dyads who had weaned from the breast by 6 weeks postpartum. CONCLUSIONS: Optimal maternal-infant interactions, as evidenced by higher scores on Barnard's NCAFS, were related to longer breastfeeding duration. Lower scores on the NCAFS, suggesting difficulties in maternal-infant interaction, were related to weaning earlier than planned.

Adult↗
PubMed1996

Using focus group interviews to understand school meal choices.

Focus groups were used to examine adolescents' participation in school nutrition programs, their opinions about the meals served in these programs, and their suggestions for improving the meals. A pilot and four focus group interviews were conducted with ninth grade students in five geographically distinct regions of Florida. Male students and those from rural areas were more likely to participate in school meal programs than were females and those from suburban and urban areas. Students expressed intense dislike and distrust of school meals. School meals were criticized for taste, appearance, small serving sizes, and cost. Students overwhelmingly favored commercial food vendors serving lunch at school. Suggestions for improving school meals included improving the taste and appearance of food, offering a wider variety of foods, serving more fresh fruit and vegetables, lowering the price, increasing the serving sizes, teaching food service workers how to cook, and offering more condiments.

Adolescent↗
PubMed2004

Prenatal stress alters cardiovascular responses in adult rats.

Environmental factors in early life are clearly established risk factors for cardiovascular disease in later life. Most studies have focused on nutritional programming and analysed basal cardiovascular parameters rather than responses. In the present study we have investigated whether prenatal stress has long-term effects on cardiovascular responses in adult offspring. Female pregnant Sprague-Dawley rats were subjected to stress three times daily from day 15 to day 21 of gestation. Litters from stressed and control females were cross-fostered at birth to control for mothering effects. When the offspring were 6 months old, blood pressure was measured in the conscious rats through implanted catheters at rest, during restraint stress and during recovery. Basal haemodynamic parameters were similar in the different groups but the pattern of cardiovascular responses during stress and recovery differed markedly between prenatally stressed (PS) and control animals. PS rats had higher and longer-lasting systolic arterial pressure elevations to restraint stress than control animals. They also showed elevated systolic and diastolic blood pressure values during the recovery phase. PS rats demonstrated a greater increase in blood pressure variability compared with control animals during exposure to restraint stress, and showed more prolonged heart rate responses to acute stress and delayed recovery than controls. There was no effect of prenatal stress on baroreflex regulation of heart rate. PS females showed a greater increase in systolic arterial pressure and blood pressure variability and delayed heart rate recovery following return to the home cage then did PS males. These findings demonstrate for the first time that prenatal stress can induce long-term, sex-related changes in the sensitivity of the cardiovascular system to subsequent stress.

Adrenergic alpha-Agonists↗
PubMed1999

Measuring environmental tobacco smoke exposure in infants and young children through urine cotinine and memory-based parental reports: empirical findings and discussion.

OBJECTIVE: This study examined the reliability and potential biases of two urine collection methods from which cotinine measures were obtained and the validity of memory-based parental reports of their children's exposure to environmental tobacco smoke (ETS). DESIGN: Structured interviews were conducted with mothers of infants and young children to obtain memory-based estimates of recent ETS exposure. Urine samples were collected through standard and cotton roll collection methods for cotinine analysis. SETTING: All interviews took place at an off-campus research facility. Urine samples were collected at the study office or the subjects' homes. PARTICIPANTS: Mothers were recruited from San Diego county sites of the Women, Infants, and Children (WIC) Supplemental Food and Nutrition Program. Sample 1 (infants) consisted of eight boys and eight girls aged 1-44 months (mean = 12.6 months). Sample 2 (children) included 10 boys and 10 girls aged 3-8 years (mean = 61.2 months). MAIN OUTCOME MEASURES: Urine cotinine and memory-based parent reports of ETS exposure from structured interviews. RESULTS: There was overall high reliability for urine cotinine measures and no effect of collection method on urine cotinine levels. Memory-based reports obtained from smoking mothers showed moderately strong and consistent linear relationships with urine cotinine measures of their infants and children (r = 0.50 to r = 0.63), but not for reports obtained from non-smoking mothers. CONCLUSIONS: Memory-based parental reports of short-term ETS exposure can play an important role in quantifying ETS exposure in infants and children.

Child↗
PubMedDate not supplied

Influence of vitamin A consumption on resting metabolic rate and fasting respiratory quotient in severely obese subjects.

OBJECTIVE: To study whether or not the amount of vitamin A consumed affects the resting metabolic rate (RMR) and fat oxidation at rest in severely obese subjects. MATERIALS AND METHODS: In 239 obese subjects, RMR and fasting respiratory quotient (RQ) were determined by indirect calorimetry. Vitamin A consumption was calculated by the Czech PC program 'Nutrition'. The relation between the intake of vitamin A and RMR and RQ was tested by simple regression. High and low vitamin A consumers were defined by an upper and a lower quintile of vitamin A intake (>842 vs. <382 IU/day). RESULTS: The RMR for high and low vitamin A consumers were 7,693.5 +/- 1,557 and 7,479.8 +/- 1,708 kJ/day, respectively, while the corresponding values for fasting RQ were 0.800 +/- 0.077 and 0.809 +/- 0.049, respectively. No significant correlation was found between vitamin A consumption and both RMR and RQ. Similarly, there was no significant difference in RMR and RQ, as well as weight, body mass index, body fat, waist girth and food quotient between the two groups characterized by high and low consumption of vitamin A. However, the energy intake of high vitamin A consumers was significantly higher than that of low vitamin A consumers, due to higher carbohydrate and protein intake. CONCLUSION: There was no significant correlation between the vitamin A intake and RMR or RQ in obese subjects determined in this study.

Adipose Tissue↗
PubMed1992

Prevalence and intraoral distribution of coronal and root caries in middle-aged and older adults.

This work describes the prevalence and intraoral distribution of coronal and root caries in 326 predominantly white, educated, middle-aged and older adults. Study participants were recruited from Tufts Geriatric Outreach Program, Nutritional Status Study (NSS), and the Forsyth Root Caries Study. Eighty-five percent of participants reported visiting their dentist in the last year. The median number of teeth was 21 in the 65+ age-group, and 40% of participants had coronal caries and 33% had root carious lesions. The mean coronal and root caries (DFS) was higher and the proportion of decayed surfaces to all decayed and filled surfaces (%D/DFS) was lower than in other comparable studies. A comparative analysis of intraoral distribution of coronal and root caries and their relation with age is discussed.

Adult↗
PubMed2000

Evaluating WIC.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has enjoyed extraordinary bipartisan support stemming from the widespread belief that research studies have proven that WIC "works." Although some studies suggest real dietary and health improvements, the greatest benefits only apply to WIC's prenatal program (just a small part of the total program). Even here, weaknesses in the research render the findings highly uncertain. The three most significant weaknesses are (1) selection bias, (2) simultaneity bias, and (3) lack of generalizeability. The resulting uncertainty places WIC's possible impacts on infant mortality, prematurity, and birthweight on a range from zero to substantial. For infants, children, and postpartum and breastfeeding mothers, the only impacts seem to be small to modest effects on anemia and nutrient intake. This paper does not argue that WIC's weaknesses justify abandoning or even cutting the program. On the contrary, there should be a sustained effort to make the program more effective. This effort should start with a policy debate about WIC's role and impacts, coupled with a grant of greater flexibility to state and local WIC agencies to open the program to innovation and experimentation. To increase WIC's positive impacts, we propose a series of possible reforms, each to be thoroughly evaluated.

Child, Preschool↗