June 2021

National Institutes of Health Convenes Online Conference About Food Insecurity

Ensuring access to nutritious food is a key goal for preventing diet-related conditions, such as childhood obesity and type II diabetes. Income and geography, however, can impede a family’s ability to find or purchase a healthy diet for their children.

The COVID-19 pandemic has amplified these pre-existing disparities in food access. A nationally representative survey of households found that self-reported food insecurity jumped from 30% to 43% after the start of the pandemic. Approximately half of Black and Hispanic families surveyed reported not being able to afford food and expressed low confidence in their ability to secure food in the future.

Addressing these challenges requires an understanding of how socio-economic conditions and local food environments lead to food insecurity. The National Institutes of Health (NIH) is helping to lead this conversation by hosting a three-day virtual conference this September focused on diet-related health disparities.

The meeting titled “Food Insecurity, Neighborhood Food Environment & Nutrition Health Disparities: State of the Science,” will occur on September 21-23, 2021 from 12:30-5:30 p.m. ET.

Expert speakers will review current research related to food insecurity and the neighborhood food environment, and then identify research gaps and opportunities. Participants also will explore innovative research strategies that could inform policies and practices that help prevent diet-related health disparities, as well as promote health equity.

This online event is free and open to the public. It will feature panel discussions, networking opportunities, and two poster sessions. Participants must register by Sept. 7, 2021, to access the virtual meeting platform. 

Interested in submitting a poster? Abstracts are due by July 9, 2021 for a chance to receive an award.  

The event is funded in part by the National Cancer Institute, the National Heart, Lung, and Blood Institute, the National Institute on Minority Health and Health Disparities, the National Institute of Nursing Research, the Office of Disease Prevention and the Office of Nutrition Research. 

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NCCOR Toolbox: Childhood Obesity Across Research Borders: Social Determinants of Health

The full recording plus the speaker slides of part one of NCCOR’s summer webinar series, “Childhood Obesity Across Research Borders: Social Determinants of Health” are now available on the NCCOR website. This Connect & Explore webinar, hosted with the Fogarty International Center’s Center for Global Health Studies (CGHS), identified the synergies between childhood obesity research conducted in Latin America and among Latino populations in the United States. Speakers discussed the role that social determinants of health play in childhood obesity in the United States and Latin America, specifically in terms of migration and the social environment. A June 2021 special issue of Obesity Reviews, Childhood Obesity Prevention Across Borders: The Promise of US‐Latin American Research Collaboration was also just published on this topic.  

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New Sector Specific Resources to Promote Physical Activity

The Centers for Disease Control and Prevention recently launched a new webpage with sector specific ideas for promoting physical activity. Asking “Everyone Can Be Involved— What’s Your Role?,” the new resources are part of the Active People, Healthy Nation^SM campaign to help 27 million Americans become more physically active by 2027. Each sector page contains tailored policy and strategy ideas to increase movement, links to model programs, and resources to encourage their implementation. Sectors that are currently available include Arts and Culture, Employers, Government, and Education, with more sectors soon to be added. All resources are free and provided by the Division of Nutrition, Physical Activity, and Obesity at the National Center for Chronic Disease Prevention and Health Promotion.

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Webinar Recording: Offering Client Choice – Promoting Dignity in Food Pantries

Foodshare and the Connecticut Food Bank have made available their free webinar “Offering Client Choice: Promoting Dignity in Food Pantries.” It discusses how the COVID-19 pandemic has affected the work of food pantries, the importance of client choice for providing person-centered services, and different strategies for improving choices as communities recover from the pandemic. 

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Racial and Ethnic Disparities in Childhood Growth Trajectories

June 2, 2021, Journal of Racial and Ethnic Health Disparities

Childhood overweight and obesity are a primary social and public health concern. Over the past 30 years, rates of childhood overweight and obesity in the United States of America (USA) have drastically increased, particularly among Black and Latino/a populations. However, they tend to be underrepresented in the childhood obesity literature. This study expands previous literature by identifying different BMI growth trajectories for Black, Latino/a, and White children from birth to age nine. This study found a high prevalence rate of overweight and obesity in a predominantly low-income minority group. Using growth-based trajectory modeling, this study also found different growth trajectories by racial/ethnic groups, with Latino/a children having the most concerning growth trajectories from birth to 9 years. These findings demonstrate that ethnic/racial disparities in childhood overweight and obesity start as early as birth, indicating the need to devote more attention from researchers and health policy-makers to address these disparities as early as possible.

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The Effects of Dietary and Lifestyle Interventions Among Pregnant Women with Overweight or Obesity on Early Childhood Outcomes: An Individual Participant Data Meta-Analysis from Randomised Trials

June 2, 2021, BMC Medicine

The impact of maternal obesity extends beyond birth, being independently associated with an increased risk of child obesity. Current evidence demonstrates that women provided with a dietary intervention during pregnancy improve their dietary quality and have a modest reduction in gestational weight gain. However, the effect of this on longer-term childhood obesity-related outcomes is unknown. 

Methods
We conducted an individual participant data meta-analysis from RCTs in which women with a singleton, live gestation between 10+0 and 20+0 weeks and body mass index (BMI) ≥ 25 kg/m2 in early pregnancy were randomized to a diet and/or lifestyle intervention or continued standard antenatal care and in which longer-term maternal and child follow-up at 3–5 years of age had been undertaken. The primary childhood outcome was BMI z-score above the 90th percentile. Secondary childhood outcomes included skinfold thickness measurements and body circumferences, fat-free mass, dietary and physical activity patterns, blood pressure, and neurodevelopment. 

Results
Seven primary trials where follow-up of participants occurred were identified by a systematic literature search within the International Weight Management in Pregnancy (i-WIP) Collaborative Group collaboration, with six providing individual participant data. No additional studies were identified after a systematic literature search. A total of 2529 children and 2383 women contributed data. Approximately 30% of all child participants had a BMI z-score above the 90th percentile, with no significant difference between the intervention and control groups (aRR 0.97; 95% CI 0.87, 1.08; p=0.610). There were no statistically significant differences identified for any of the secondary outcome measures. 

Conclusions
In overweight and obese pregnant women, we found no evidence that maternal dietary and/or lifestyle intervention during pregnancy modifies the risk of early childhood obesity. Future research may need to target the pre-conception period in women and early childhood interventions. 

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Prenatal Exposure to Ambient Air Pollutants and Early Infant Growth and Adiposity in the Southern California Mother’s Milk Study

June 5, 2021, Environmental Health

Prior epidemiological and animal work has linked in utero exposure to ambient air pollutants (AAP) with accelerated postnatal weight gain, which is predictive of increased cardiometabolic risk factors in childhood and adolescence. However, few studies have assessed changes in infant body composition or multiple pollutant exposures. Therefore, the objective of this study was to examine relationships between prenatal residential AAP exposure with infant growth and adiposity. 

Methods
Residential exposure to AAP (particulate matter < 2.5 and 10 microns in aerodynamic diameter [PM2.5, PM10]; nitrogen dioxide [NO2]; ozone [O3]; oxidative capacity [Oxwt: redox-weighted oxidative potential of O3 and NO2]) was modeled by spatial interpolation of monitoring stations via an inverse distance-squared weighting (IDW2) algorithm for 123 participants from the longitudinal Mother’s Milk Study, an ongoing cohort of Hispanic mother-infant dyads from Southern California. Outcomes included changes in infant growth (weight, length), total subcutaneous fat (TSF; calculated via infant skinfold thickness measures) and fat distribution (umbilical circumference, central to total subcutaneous fat [CTSF]) and were calculated by subtracting 1-month measures from 6-month measures. Multivariable linear regression was performed to examine relationships between prenatal AAP exposure and infant outcomes. Models adjusted for maternal age, pre-pregnancy body mass index, socioeconomic status, infant age, sex, and breastfeeding frequency. Sex interactions were tested, and effects are reported for each standard deviation increase in exposure. 

Results
NO2 was associated with greater infant weight gain (β = 0.14, p = 0.02) and TSF (β = 1.69, p = 0.02). PM10 and PM2.5 were associated with change in umbilical circumference (β = 0.73, p = 0.003) and TSF (β = 1.53, p = 0.04), respectively. Associations of Oxwt (pinteractions < 0.10) with infant length change, umbilical circumference, and CTSF were modified by infant sex. Oxwt was associated with attenuated infant length change among males (β = -0.60, p = 0.01), but not females (β = 0.16, p = 0.49); umbilical circumference among females (β = 0.92, p = 0.009), but not males (β = -0.00, p = 0.99); and CTSF among males (β = 0.01, p = 0.03), but not females (β = 0.00, p = 0.51). 

Conclusion
Prenatal AAP exposure was associated with increased weight gain and anthropometric measures from 1-to-6 months of life among Hispanic infants. Sex-specific associations suggest differential consequences of in utero oxidative stress. These results indicate that prenatal AAP exposure may alter infant growth, which has potential to increase childhood obesity risk. 

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Association Between Childhood Consumption of Ultraprocessed Food and Adiposity Trajectories in the Avon Longitudinal Study of Parents and Children Birth Cohort

June 14, 2021, JAMA Pediatrics

Reports of associations between higher consumption of ultraprocessed foods (UPF) and elevated risks of obesity, noncommunicable diseases, and mortality in adults are increasing. However, associations of UPF consumption with long-term adiposity trajectories have never been investigated in children. 

Objective  To assess longitudinal associations between UPF consumption and adiposity trajectories from childhood to early adulthood. 

Design, Setting, and Participants  This prospective birth cohort study included children who participated in the Avon Longitudinal Study of Parents and Children (ALSPAC) in Avon County, southwest England. Children were followed up from 7 to 24 years of age during the study period from September 1, 1998, to October 31, 2017. Data were analyzed from March 1, 2020, to January 31, 2021. 

Exposures  Baseline dietary intake data were collected using 3-day food diaries. Consumption of UPF (applying the NOVA food classification system) was computed as a percentage of weight contribution in the total daily food intake for each participant and categorized into quintiles. 

Main Outcomes and Measures  Repeated recordings of objectively assessed anthropometrics (body mass index [BMI; calculated as weight in kilograms divided by height in meters squared], weight, and waist circumference) and dual-energy x-ray absorptiometry measurements (fat and lean mass indexes [calculated as fat and lean mass, respectively, divided by height in meters squared] and body fat percentage). Associations were evaluated using linear growth curve models and were adjusted for study covariates. 

Results  A total of 9025 children (4481 [49.7%] female and 4544 [50.3%] male) were followed up for a median of 10.2 (interquartile range, 5.2-16.4) years. The mean (SD) UPF consumption at baseline was 23.2% (5.0%) in quintile 1, 34.7% (2.5%) in quintile 2, 43.4% (2.5%) in quintile 3, 52.7% (2.8%) in quintile 4, and 67.8% (8.1%) in quintile 5. Among those in the highest quintile of UPF consumption compared with their lowest quintile counterpart, trajectories of BMI increased by an additional 0.06 (95% CI, 0.04-0.08) per year; fat mass index, by an additional 0.03 (95% CI, 0.01-0.05) per year; weight, by an additional 0.20 (95% CI, 0.11-0.28) kg per year; and waist circumference, by an additional 0.17 (95% CI, 0.11-0.22) cm per year. 

Conclusions and Relevance  These findings suggest that higher UPF consumption is associated with greater increases in adiposity from childhood to early adulthood. Robust public health measures that promote minimally processed foods and discourage UPF consumption among children are urgently needed to reduce obesity in England and globally.

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New Study Finds Fast-Food Companies Spending More on Ads, Targeting Black and Hispanic Youth

June 17, 2021, Eureka Alert

The fast-food industry spent $5 billion on advertising in 2019, and the advertisements disproportionately targeted Black and Hispanic youth, according to new research published today by the Rudd Center for Food Policy and Obesity at the University of Connecticut. The new report, Fast Food FACTS 2021, finds that the industry’s annual ad spending in 2019 increased by over $400 million since 2012, and that children and teens were viewing on average more than two fast food TV ads per day.

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Longitudinal Associations Between Symptoms of ADHD and BMI From Late Childhood to Early Adulthood

June 2021, Pediatrics

BACKGROUND AND OBJECTIVES: Attention-deficit/hyperactivity disorder (ADHD) and obesity are 2 frequent conditions that co-occur, which has implications for the management of both conditions. We hypothesized that ADHD symptoms predict BMI and vice versa from late childhood (10–12 years) up to early adulthood (20–22 years). 

METHODS: Participants were adolescents in the Netherlands (n = 2773, 52.5% male, mean age = 11 years at baseline, 5 waves up to mean age 22) from the Tracking Adolescents’ Individual Lives Survey cohort. We examined bidirectional relationship between ADHD symptoms (hyperactivity/impulsivity and inattention) and BMI using the random intercept cross-lagged panel model. Time-varying covariates were pubertal status, stimulant use, depressive symptoms, and family functioning, and socioeconomic status was a time-invariant covariate. 

RESULTS: We found a time-invariant association of BMI with hyperactivity and impulsivity, but not with inattention, which was slightly stronger in female adolescents (female: r = 0.102; male: r = 0.086, P < .05). No longitudinal direct effects were found between ADHD symptoms and BMI during this period. 

CONCLUSIONS: Over the course of adolescence, the link between ADHD and BMI is stable and is predominantly with hyperactive and impulsive symptoms rather than inattention. There was no direct effect of ADHD symptoms on BMI increase nor of BMI on enhanced ADHD symptoms during this developmental period. The findings point to a shared genetic or familial background and/or potential causal effects established already earlier in childhood, thus suggesting that intervention and prevention programs targeting overweight and obesity in children with ADHD should be implemented in early childhood. 

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Added Sugars in Formulas Predict Rapid Weight Gain in Infants and Toddlers

June 22, 2021, American Society for Nutrition

A new study published in The Journal of Nutrition concluded that added sugars in infant formulas predict rapid weight gain in infants and toddlers.

Although studies have reported a positive relationship between infant formulas and excessive weight gain in infants and toddlers, a complete understanding of this phenomenon has been challenging. Trials comparing intakes of low-protein compared with high-protein formulas have failed to identify conclusive connections to body weight or adiposity, suggesting that other factors are at play. It is well established that high intake of added sugars is positively correlated with overweight and obesity in children and adults. However, the relation between added sugars specifically from infant formulas and rapid weight gain is not clear. To determine the contribution of added sugars in formulas compared with those in beverages and foods (i.e. table foods) on rapid weight gain, Kai Ling Kong (Children’s Mercy Kansas City, University of Missouri-Kansas and University of Kansas Medical School) and colleagues analyzed data from three 24-hour dietary recalls for infants (9 – 12 months of age) and toddlers (13 – 15 months of age).

Sources of sugars included milk-based (breast milk and/or formulas) or table foods. Based on the World Health Organization’s infant growth charts, the number of major percentile thresholds crossed from birth to point-of-contact assessment was determined as an indicator of rapid weight gain. Participants crossing a higher threshold percentile were considered to have an upward crossing; participants crossing a lower threshold or staying in the same band between major percentiles were considered to not have an upward crossing.

Infants consumed more added sugars daily than toddlers. Added sugars from all sources were significantly related to rapid weight gain, and these sources differed by age group. Specifically, the majority of added sugars consumed by infants were from formulas, while the majority of added sugars consumed by toddlers were from table foods. Study findings reveal that added sugars in formulas predict rapid weight gain as early as 9 months, and daily amounts of added sugars consumed by primarily formula-fed individuals are almost double those of primarily breast-fed individuals. Furthermore, this study demonstrated that the contribution from added sugars in predicting rapid weight gain was stronger than that of protein.

A corresponding editorial by Gemma Bridge (Queen Mary University of London) states that the low rate of exclusive breastfeeding and high rate of alternative feeding methods, including infant formulas, could have profound impacts on child health. Efforts to market, sale, and consume toddler milk are both unnecessary and possibly harmful to child health.

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