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Melvin Heyman

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Papers by Melvin Heyman

Weight Gain of Latino Infants at 6 and 12 months of Age: Maternal Depression and other Risk Factors

The FASEB Journal, 2009

Food insecurity is associated with maternal depression and child pervasive developmental symptoms in low-income Latino households

Journal of Hunger & Environmental Nutrition, 2018

The objective of this study was to investigate associations between household food insecurity, ma... more The objective of this study was to investigate associations between household food insecurity, maternal clinical depression, and child behavior problems in low-income Latino households. Data were collected from a cohort of 168 children and their Latina mothers recruited prenatally at two San Francisco hospitals from 2006 to 2007. Food insecurity at year four was associated with increased odds of maternal clinical depression at years four to five (adjusted OR 1.22, 95% confidence interval 1.03 to 1.43). Food insecurity at year four was associated with child pervasive developmental problems at year five (B=0.21, p=0.041) in adjusted models. The association between food insecurity at year four and oppositional defiant problems at year five was partially mediated (28.7% mediation, p=0.046) by maternal clinical depression in years four and five. Our results suggest that household food insecurity is associated with greater maternal depression, and both food insecurity and maternal depression uniquely predict certain types of child behavior problems. Assessing for and addressing household food insecurity may be beneficial additions to psychosocial interventions targeting maternal and child mental health.

Fruit Juice in Infants, Children, and Adolescents: Current Recommendations

Pediatrics, 2017

Historically, fruit juice was recommended by pediatricians as a source of vitamin C and as an ext... more Historically, fruit juice was recommended by pediatricians as a source of vitamin C and as an extra source of water for healthy infants and young children as their diets expanded to include solid foods with higher renal solute load. It was also sometimes recommended for children with constipation. Fruit juice is marketed as a healthy, natural source of vitamins and, in some instances, calcium. Because juice tastes good, children readily accept it. Although juice consumption has some benefits, it also has potential detrimental effects. High sugar content in juice contributes to increased calorie consumption and the risk of dental caries. In addition, the lack of protein and fiber in juice can predispose to inappropriate weight gain (too much or too little). Pediatricians need to be knowledgeable about juice to inform parents and patients on its appropriate uses.

Full fat milk consumption protects against severe childhood obesity in Latinos

Preventive Medicine Reports, 2017

Consumption of non-or low-fat dairy products is recommended as a strategy to lower the risk of ch... more Consumption of non-or low-fat dairy products is recommended as a strategy to lower the risk of childhood obesity. However, recent evidence suggests that consumption of whole fat dairy products may, in fact, be protective against obesity. Our objective was to determine the association between milk fat consumption and severe obesity among three-year-old Latino children, a population with a disproportionate burden of obesity and severe obesity. 24-hour-dietary recalls were conducted to determine child intake in San Francisco based cohort recruited in 2006-7. Mother-child dyads were weighed and measured. The 24-hour recall data was analyzed to determine participants' consumption of whole milk, 2% milk, and 1% milk. The milk consumption data was used to calculate grams of milk fat consumed. The cross-sectional association between milk fat intake and severe obesity (BMI ≥ 99th percentile) was determined using multivariable logistic regression. Data were available for 145 children, of whom 17% were severely obese. Severely obese children had a lower mean intake of milk fat (5.3 g vs. 8.9 g) and fewer drank any milk (79% versus 95% for not severely obese children (p b 0.01)). Among the potential confounders assessed, maternal BMI and maternal marital status were associated with severe obesity and were included in a multivariate model. In the multivariate model, higher milk fat consumption was associated with lower odds of severe obesity (OR 0.88 CI 0.80-0.97). Higher milk fat consumption is associated with lower odds of severe obesity among Latino preschoolers. These results call into question recommendations that promote consumption of lower fat milk.

Early exclusive breastfeeding is associated with longer telomeres in Latino preschool children

The American journal of clinical nutrition, 2016

Telomere length (TL) is a marker of cellular aging, with the majority of lifetime attrition occur... more Telomere length (TL) is a marker of cellular aging, with the majority of lifetime attrition occurring during the first 4 y. Little is known about risk factors for telomere shortening in childhood. We evaluated the relation between early life feeding variables and preschool TL. We assessed the relation between dietary, feeding, and weight-associated risk factors measured from birth and TL from blood samples taken at 4 y of age (n = 108) and 5 y of age (n = 92) in a cohort of urban, Latino children (n = 121 individual children). Feeding variables were evaluated in children with repeat measurements (n = 77). Mean TL (in bp) was associated with exclusive breastfeeding at 4-6 wk of age (adjusted coefficient: 353.85; 95% CI: 72.81, 634.89; P = 0.01), maternal TL (adjusted coefficient: 0.32; 95% CI: 0.11, 0.54; P < 0.01), and older paternal age (adjusted coefficient: 33.27; 95% CI: 4.10, 62.44; P = 0.03). The introduction of other foods or drinks in addition to breast-milk or replacemen...

A Risk Score for Childhood Obesity in an Urban Latino Cohort

The Journal of Pediatrics, 2016

Objective To assess whether individual obesity risk factors, present during gestation, and the fi... more Objective To assess whether individual obesity risk factors, present during gestation, and the first 6 months of life, can be combined into a simple prognostic model that has the ability to accurately predict childhood obesity at age 5 years in a high-risk cohort. Study design A total of 201 Latina women were recruited during pregnancy, and their infants followed longitudinally. Ten risk factors for childhood obesity were included in an initial logistic model; a second reduced model was created via stepwise deletion (confirmed with nonparametric conditional random forest classifier), after which 5 risk factors remained. From each model, an obesity risk equation was derived, and an obesity risk score was generated for each patient. Derived algorithms were assessed using discrimination, calibration, and via predictive statistics. Results Of the 166 children followed through age 5 years, 56 (32%) met criteria for childhood obesity. Discrimination accuracy for both derivation models was excellent, and after optimism-corrected bootstrapping, both models showed meaningful clinical performance. Both models were adequately calibrated, showed strong sensitivity and negative predictive value at conservatively set obesity risk thresholds, and displayed excellent specificity among those classified as highest risk. Birth weight z-score and change in weight-forage z-score between birth and 6 months were the risk factors with the strongest contribution to the obesity risk score. Conclusions Obesity risk algorithms are reliable in their prediction of childhood obesity and have the potential to be integrated into the electronic medical record. These models could provide a filter for directing early prevention resources to children with high obesity risk but should be evaluated in a larger external dataset.

Telomere length is associated with oppositional defiant behavior and maternal clinical depression in Latino preschool children

Translational psychiatry, Jan 16, 2015

Exposure to psychological stress and depression are associated with shorter white blood cell telo... more Exposure to psychological stress and depression are associated with shorter white blood cell telomere length (TL) in adults, possibly via associated lifelong oxidative stressors. Exposure to maternal depression increases risk for future depression and behavior problems in children, and Latino youth are at high risk. Few studies have evaluated the role of exposure to maternal depression or child behavior in relation to TL in children. We assessed early-childhood exposures to maternal depression from birth to the age of 5 years and child behavior from ages 3-5 years in a cohort of Latino children in relation to child leukocyte TL at ages 4 and 5 years. Children who had oppositional defiant behavior at 3, 4 or 5 years had shorter TL than those without by ~450 base pairs (P < 0.01). In multivariate analyses, independent predictors for shorter TL at 4 and 5 years of age included oppositional defiant disorder at 3, 4 or 5 years (β = -359.25, 95% CI -633.84 to 84.66; P = 0.01), exposure...

Maternal omega-3 fatty acid supplementation and risk for perinatal maternal depression

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2011

A systematic review was conducted to assess the possible association between omega-3 polyunsatura... more A systematic review was conducted to assess the possible association between omega-3 polyunsaturated fatty acid (PUFA) supplementation and intake in the perinatal period and the risk of maternal perinatal depression. Two PubMed searches and a BIOSIS Preview, a Web of Science and a PsychInfo search were conducted with the search terms 'DHA, pregnancy and depression' and 'omega-3 fatty acids, pregnancy and depression'. Ten articles - three longitudinal cohort studies, five randomized controlled trials and two pilot trials- that met selection criteria were reviewed. Six found no association, two found mixed results, and two found a positive association between omega-3 PUFAs and reduced incidence of maternal perinatal depression. The heterogeneity of results can be explained by dissimilar study designs, including differences in study duration, time period of measurement and number of participants, and in varied dosages and types of supplemental PUFAs. Some of the larger ...

The Active Balance Childhood Program for Improving Coping and Quality of Life in Chinese American Children

Nursing Research, 2010

Background-Interventions to teach children healthy and effective coping skills could help reduce ... more Background-Interventions to teach children healthy and effective coping skills could help reduce their risk for overweight. However, few studies have examined whether an intervention that teaches coping strategies in weight management can influence children's coping behavior and psychosocial well-being. Objective-To examine the efficacy of an interactive, child-centered, and family-based program in promoting effective coping, behavioral health, and quality of life in Chinese American children. Method-A randomized, controlled study of behavioral intervention in 67 Chinese American children (ages 8-10 years, normal weight and overweight) and their families. At baseline and 2, 6, and 8 months after baseline, children had anthropometric measurements and completed questionnaires related to coping skills and quality of life, and parents completed the Child Behavior Checklist. Results-Children in the intervention group reported using more active coping strategies and having a higher quality of life in the physical and emotional health domains than did children in the control group during the 8-month study. Children's behavioral problems did not differ between the intervention and control groups. Changes in coping and psychosocial well-being were not related to change in body mass index (BMI) in the entire group, except increased BMI is associated with decreased emotional quality of life. Discussion-This culturally appropriate behavioral intervention was effective in promoting healthy coping and improving quality of life in Chinese American children. Its utility for both optimal

Let's Move — Childhood Obesity Prevention from Pregnancy and Infancy Onward

New England Journal of Medicine, 2010

Maternal knowledge of infant feeding guidelines and label reading behaviours in a population of new mothers in San Francisco, California

Maternal & Child Nutrition, 2009

The objective of this study was to evaluate the relationship between maternal nutrition knowledge... more The objective of this study was to evaluate the relationship between maternal nutrition knowledge and maternal socio-demographics including participation in the Special Supplemental Women, Infants and Children's (WIC) Program. A cross-sectional study of new mothers at two San Francisco hospitals was conducted using some of the American Academy of Pediatrics' guidelines in a structured questionnaire to assess maternal nutritional knowledge. Maternal nutritional attitudes towards product nutrient labels were also assessed in a questionnaire format. Logistic regression models were used to evaluate the odds of having high maternal nutrition knowledge and of infrequently reading nutrition labels. In multivariate logistic regression models, higher maternal nutrition knowledge (defined as answering all four nutrition questions correctly) was associated with higher income levels defined as Ն$25 000/year, odds ratio (OR) 10.03 95% confidence interval (CI) (1.51-66.74), and in linear models, higher nutritional knowledge was associated with having more children (P < 0.01), a higher income (P = 0.01) and not being a WIC participant (P < 0.01). Mothers with higher incomes were also more likely to read product nutritional labels OR 4.24, 95% CI (1.24-14.51), compared with mothers with lower incomes as were mothers with higher education levels OR 3.32, 95% CI (1.28-8.63). In San Francisco, lower income mothers are at greatest risk for low maternal nutrition knowledge and not reading product nutritional labels. Higher household income was independently associated with increased maternal nutrition knowledge and likelihood of reading nutritional labels. More comprehensive interventions need to target low-income mothers including current WIC participants to help close the nutritional advantages gap conferred by income and education.

Efficacy of a child-centred and family-based program in promoting healthy weight and healthy behaviors in Chinese American children: a randomized controlled study

Journal of Public Health, 2009

Objective To examine the efficacy of an interactive, child-centred and family-based program in pr... more Objective To examine the efficacy of an interactive, child-centred and family-based program in promoting healthy weight and healthy lifestyles in Chinese American children. Design A randomized controlled study of a culturally sensitive behavioral intervention. Subjects Sixty-seven Chinese American children (ages, 8-10 years; normal weight and overweight) and their families. Measurements Anthropometry, blood pressure, measures of dietary intake, physical activity, knowledge and self-efficacy regarding physical activity and diet at baseline and 2, 6 and 8 months after baseline assessment. Results Linear mixed modeling indicated a significant effect of the intervention in decreasing body mass index, diastolic blood pressure and fat intake while increasing vegetable and fruit intake, actual physical activity and knowledge about physical activity. Conclusion This interactive child-centred and family-based behavioral program appears feasible and effective, leading to reduced body mass index and improved overweight-related health behaviors in Chinese American children. This type of program can be adapted for other minority ethnic groups who are at high risk for overweight and obesity and have limited access to programs that promote healthy lifestyles.

Risk factors for macrosomia in infants born to Latina women

Journal of Perinatology, 2008

Objective: To assess risk factors for macrosomic infant birth among Latina women. Study Design: P... more Objective: To assess risk factors for macrosomic infant birth among Latina women. Study Design: Prospective study of Latina women recruited during pregnancy from prenatal clinic at San Francisco General Hospital. Information was obtained through a structured interview and review of medical records. Result: A total of 11% of women delivered macrosomic infants (birth weight >4000 g). In unadjusted analyses, significant risk factors for macrosomia included older maternal age, increasing gravidity, previous history of macrosomic birth and pre-pregnancy overweight. After adjusting for confounders using multivariate analyses, older mothers (10-year increments) had an elevated risk of macrosomia (odds ratio (OR) 2.59; 95% confidence interval (CI) 1.28 to 5.24). Conclusion: Efforts to reduce macrosomia in Latina women should focus on older mothers.

Body Mass Index and Elbow Range of Motion in a Healthy Pediatric Population: A Possible Mechanism of Overweight in Children

Journal of Pediatric Gastroenterology & Nutrition, 2008

Background-Childhood overweight has become a serious health problem among children and adolescent... more Background-Childhood overweight has become a serious health problem among children and adolescents in the United States. No previous study, to our knowledge, has analyzed the effect of body mass index (BMI) on range of motion and carrying angle of the elbow joint in a healthy pediatric population. The primary objective of this study was to determine the effect of BMI on orthopedic parameters of the elbow joint, including range of motion, flexion, extension, and carrying angle. Study Participants and Methods-Healthy children age 2 to 18 years (mean 12.0 ± 3.9 years) were recruited at an urban pediatric orthopedic clinic as pediatric orthopedic patients or as the siblings or friends of patients. Measures of range of motion (flexion and extension) and carrying angle of 226 elbows and of BMI from 113 study participants were analyzed. Results-BMI was negatively correlated with right and left elbow range of motion (r = −0.54, P <0.01; r = −0.43, P <0.01) and right and left elbow flexion (r = −0.59, P <0.01; r = −0.50, P <0.01). BMI had a positive correlation with right elbow extension (r = 0.20, P = 0.04). BMI did not correlate with left elbow extension or right or left carrying angle. After adjustment for age, sex, and ethnic group, BMI was associated with right (P <0.01) and left (P <0.01) elbow range of motion. Conclusions-These data demonstrate that increased BMI in children is negatively correlated with range of motion of the elbow joint. Further studies are needed to evaluate the consequences of impaired range of motion associated with overweight on activity levels and energy expenditure in growing children and adolescents.

Risk Factors for Obesity and High Blood Pressure in Chinese American Children: Maternal Acculturation and Children’s Food Choices

Journal of Immigrant and Minority Health, 2009

The objective of this study is to explore risk factors associated with overweight and high blood ... more The objective of this study is to explore risk factors associated with overweight and high blood pressure in Chinese American children. Students and their parents were recruited from Chinese language schools in the San Francisco Bay Area. Data were collected on 67 children and their mothers, and included children's weight, height, waist and hip circumferences, blood pressure, level of physical activity, dietary intake, usual food choice, knowledge about nutrition and physical activity, and selfefficacy regarding diet and physical activity. Mothers completed questionnaires on demographic data and acculturation. About 46% of children had a body mass index exceeding the 85th percentile. Lower level of maternal acculturation is a risk factor for overweight and higher waist to hip ratio. Children's unhealthy food choices were predictive of high body mass index and high systolic blood pressure, whereas older age and less physical activity in children were predictors of high diastolic blood pressure. Developing culturally sensitive and developmentally appropriate interventions to reduce overweight and high blood pressure is critical to reduce health disparities among minority children.

Acculturation, Dietary Practices and Risk for Childhood Obesity in an Ethnically Heterogeneous Population of Latino School Children in the San Francisco Bay Area

Journal of Immigrant and Minority Health, 2011

Infant Formula, Tea, and Water Supplementation of Latino Infants at 4-6 Weeks Postpartum

Journal of Human Lactation, 2011

The American Academy of Pediatrics recommends exclusive breastfeeding until 6 months-of-age. The ... more The American Academy of Pediatrics recommends exclusive breastfeeding until 6 months-of-age. The authors examined prevalence and risk factors for use of infant formulas, water, and teas at 4-6 weeks in Latino infants in the San Francisco Bay Area, a group at high risk for future obesity. They recruited a cohort of pregnant Latina women (N = 201). Infant dietary recall and postpartum depressive symptoms were assessed at 4-6 weeks. The authors found that 105 women (53.1%) were feeding infant formulas and 48 (25.4%) were supplementing with tea or water. Of those providing water or tea, 60.0% were providing daily supplementation. In multivariate analyses, risk for infant supplementation with water or tea was associated with postpartum depressive symptoms (relative risk, 1.8; 95% confidence interval, 1.1-3.0), cesarean delivery (relative risk, 1.9; 95% confidence interval, 1.3-2.9), and infant formula use (relative risk, 1.3; 95% confidence interval, 1.1-1.6). Early supplementation with ...

Breastfeeding Offers Protection Against Obesity in Children of Recently Immigrated Latina Women

Journal of Community Health, 2013

Breastfeeding has been found to have a protective effect on subsequent development of obesity in ... more Breastfeeding has been found to have a protective effect on subsequent development of obesity in childhood, particularly in white, non-Hispanic populations. The protective effect of nursing for more than 12 months in children of Latina women is less clear, which may be due to differences in levels of acculturation in previously studied populations. We evaluated the association between breastfeeding for 12 months or more and risk for obesity in a cohort of children of recently immigrated relatively unacculturated Latina mothers. Maternal characteristics at birth, including length of stay in the United States, breastfeeding habits at 4-6 weeks of age, 6 months, and 1 year, and anthropometric measurements were obtained for a cohort of 196 children participating in a prospective study. At 1 year of age 39.0 % of infants were being breastfed. Being breastfed at 1 year of age was associated with a decreased risk of obesity in both univariate (odds ratio (OR) 0.49, 95 % confidence interval (CI) 0.21-0.83) and multivariate models (OR 0.39, 95 % CI 0.02-0.93) adjusting for maternal BMI, marital status, education level, country of origin, age, years of living in the United States, and child's birth weight at 3 years of age, regardless of mother's acculturation status using length of stay in the United States as a proxy for acculturation. The association with breastfeeding persisted at 4 years of age as a protective factor for obesity (OR 0.29, 95 % CI 0.11-0.80). Breastfeeding for longer than 12 months provides a significant protective effect on the development of obesity in early childhood in a cohort of children of highrisk recently immigrated Latina women in San Francisco who were relatively unacculturated to the United States.

Pilot Study of an Individually Tailored Educational Program by Mail to Promote Healthy Weight in Chinese American Children

Journal for Specialists in Pediatric Nursing, 2008

PURPOSE-To test the feasibility and impact of an individually tailored educational intervention t... more PURPOSE-To test the feasibility and impact of an individually tailored educational intervention to promote healthy weight in Chinese American children (ages 8-10). DESIGN-A pre-and post-test study (N = 57) using standardized instruments to measure children's usual food choices, knowledge of nutrition and physical activity needs, and time spent engaging in physical and sedentary activities. RESULTS-We found improvement after the intervention in all three areas. PRACTICE IMPLICATIONS-Healthcare providers need to provide parents and children with specific recommendations regarding children's weight statuses, dietary intake, and levels of activity. Search terms Children; Chinese American; individually tailored; obesity; weight management The U.S. Department of Health and Human Services (USDHHS) has declared obesity prevention to be a top research priority. At risk for overweight and overweight in children are defined as a body mass index (BMI) greater than the 85th and 95th percentiles, respectively, based on age-and sex-specific BMI growth charts (Centers for Disease Control and Prevention [CDC], 2000). Childhood obesity has affected many ethnic groups, including Chinese Americans. Recent data indicate that 31% of Chinese Americans ages 6-11 years have a BMI greater than the 85th percentile (Tarantino, 2002). Several physical and psychosocial health problems are associated with childhood obesity, including cardiovascular disease, sleep disorders, type 2 diabetes mellitus, low self-esteem, and social withdrawal. Chinese Americans are at a higher risk of developing cardiovascular disease and type 2 diabetes mellitus and at lower BMI than are non-Hispanic Whites, possibly because of genetic differences in body composition and metabolic responses (Tan, Ma, Wai, Chew, & Tai,

Maternal sociodemographic characteristics and the use of the Iowa Infant Attitude Feeding Scale to describe breastfeeding initiation and duration in a population of urban, Latina mothers: a prospective cohort study

International Breastfeeding Journal, 2013

Background The World Health Organization recommends exclusive breastfeeding until 6 months of age... more Background The World Health Organization recommends exclusive breastfeeding until 6 months of age. Maternal attitudes toward infant feeding are correlated with chosen feeding method and breastfeeding duration. The Iowa Infant Feeding Attitude Scale (IIFAS) has been used to assess attitudes towards breastfeeding prenatally and is predictive of breastfeeding decisions in certain population groups. Methods In a cohort of pregnant Latina women recruited from two hospitals in the San Francisco Bay Area (n=185), we administered the IIFAS prior to delivery. Information regarding feeding choice, maternal sociodemographic information, and anthropometrics were collected at 6 months and 1 year postpartum. Analysis of predictors for breastfeeding initiation, breastfeeding at 6 and 12 months and exclusive breastfeeding at 6 months were evaluated using multivariate logistic regression adjusting for potential confounders. Results In our cohort of Latina mothers, breastfeeding a previous infant was...

Weight Gain of Latino Infants at 6 and 12 months of Age: Maternal Depression and other Risk Factors

The FASEB Journal, 2009

Food insecurity is associated with maternal depression and child pervasive developmental symptoms in low-income Latino households

Journal of Hunger & Environmental Nutrition, 2018

The objective of this study was to investigate associations between household food insecurity, ma... more The objective of this study was to investigate associations between household food insecurity, maternal clinical depression, and child behavior problems in low-income Latino households. Data were collected from a cohort of 168 children and their Latina mothers recruited prenatally at two San Francisco hospitals from 2006 to 2007. Food insecurity at year four was associated with increased odds of maternal clinical depression at years four to five (adjusted OR 1.22, 95% confidence interval 1.03 to 1.43). Food insecurity at year four was associated with child pervasive developmental problems at year five (B=0.21, p=0.041) in adjusted models. The association between food insecurity at year four and oppositional defiant problems at year five was partially mediated (28.7% mediation, p=0.046) by maternal clinical depression in years four and five. Our results suggest that household food insecurity is associated with greater maternal depression, and both food insecurity and maternal depression uniquely predict certain types of child behavior problems. Assessing for and addressing household food insecurity may be beneficial additions to psychosocial interventions targeting maternal and child mental health.

Fruit Juice in Infants, Children, and Adolescents: Current Recommendations

Pediatrics, 2017

Historically, fruit juice was recommended by pediatricians as a source of vitamin C and as an ext... more Historically, fruit juice was recommended by pediatricians as a source of vitamin C and as an extra source of water for healthy infants and young children as their diets expanded to include solid foods with higher renal solute load. It was also sometimes recommended for children with constipation. Fruit juice is marketed as a healthy, natural source of vitamins and, in some instances, calcium. Because juice tastes good, children readily accept it. Although juice consumption has some benefits, it also has potential detrimental effects. High sugar content in juice contributes to increased calorie consumption and the risk of dental caries. In addition, the lack of protein and fiber in juice can predispose to inappropriate weight gain (too much or too little). Pediatricians need to be knowledgeable about juice to inform parents and patients on its appropriate uses.

Full fat milk consumption protects against severe childhood obesity in Latinos

Preventive Medicine Reports, 2017

Consumption of non-or low-fat dairy products is recommended as a strategy to lower the risk of ch... more Consumption of non-or low-fat dairy products is recommended as a strategy to lower the risk of childhood obesity. However, recent evidence suggests that consumption of whole fat dairy products may, in fact, be protective against obesity. Our objective was to determine the association between milk fat consumption and severe obesity among three-year-old Latino children, a population with a disproportionate burden of obesity and severe obesity. 24-hour-dietary recalls were conducted to determine child intake in San Francisco based cohort recruited in 2006-7. Mother-child dyads were weighed and measured. The 24-hour recall data was analyzed to determine participants' consumption of whole milk, 2% milk, and 1% milk. The milk consumption data was used to calculate grams of milk fat consumed. The cross-sectional association between milk fat intake and severe obesity (BMI ≥ 99th percentile) was determined using multivariable logistic regression. Data were available for 145 children, of whom 17% were severely obese. Severely obese children had a lower mean intake of milk fat (5.3 g vs. 8.9 g) and fewer drank any milk (79% versus 95% for not severely obese children (p b 0.01)). Among the potential confounders assessed, maternal BMI and maternal marital status were associated with severe obesity and were included in a multivariate model. In the multivariate model, higher milk fat consumption was associated with lower odds of severe obesity (OR 0.88 CI 0.80-0.97). Higher milk fat consumption is associated with lower odds of severe obesity among Latino preschoolers. These results call into question recommendations that promote consumption of lower fat milk.

Early exclusive breastfeeding is associated with longer telomeres in Latino preschool children

The American journal of clinical nutrition, 2016

Telomere length (TL) is a marker of cellular aging, with the majority of lifetime attrition occur... more Telomere length (TL) is a marker of cellular aging, with the majority of lifetime attrition occurring during the first 4 y. Little is known about risk factors for telomere shortening in childhood. We evaluated the relation between early life feeding variables and preschool TL. We assessed the relation between dietary, feeding, and weight-associated risk factors measured from birth and TL from blood samples taken at 4 y of age (n = 108) and 5 y of age (n = 92) in a cohort of urban, Latino children (n = 121 individual children). Feeding variables were evaluated in children with repeat measurements (n = 77). Mean TL (in bp) was associated with exclusive breastfeeding at 4-6 wk of age (adjusted coefficient: 353.85; 95% CI: 72.81, 634.89; P = 0.01), maternal TL (adjusted coefficient: 0.32; 95% CI: 0.11, 0.54; P < 0.01), and older paternal age (adjusted coefficient: 33.27; 95% CI: 4.10, 62.44; P = 0.03). The introduction of other foods or drinks in addition to breast-milk or replacemen...

A Risk Score for Childhood Obesity in an Urban Latino Cohort

The Journal of Pediatrics, 2016

Objective To assess whether individual obesity risk factors, present during gestation, and the fi... more Objective To assess whether individual obesity risk factors, present during gestation, and the first 6 months of life, can be combined into a simple prognostic model that has the ability to accurately predict childhood obesity at age 5 years in a high-risk cohort. Study design A total of 201 Latina women were recruited during pregnancy, and their infants followed longitudinally. Ten risk factors for childhood obesity were included in an initial logistic model; a second reduced model was created via stepwise deletion (confirmed with nonparametric conditional random forest classifier), after which 5 risk factors remained. From each model, an obesity risk equation was derived, and an obesity risk score was generated for each patient. Derived algorithms were assessed using discrimination, calibration, and via predictive statistics. Results Of the 166 children followed through age 5 years, 56 (32%) met criteria for childhood obesity. Discrimination accuracy for both derivation models was excellent, and after optimism-corrected bootstrapping, both models showed meaningful clinical performance. Both models were adequately calibrated, showed strong sensitivity and negative predictive value at conservatively set obesity risk thresholds, and displayed excellent specificity among those classified as highest risk. Birth weight z-score and change in weight-forage z-score between birth and 6 months were the risk factors with the strongest contribution to the obesity risk score. Conclusions Obesity risk algorithms are reliable in their prediction of childhood obesity and have the potential to be integrated into the electronic medical record. These models could provide a filter for directing early prevention resources to children with high obesity risk but should be evaluated in a larger external dataset.

Telomere length is associated with oppositional defiant behavior and maternal clinical depression in Latino preschool children

Translational psychiatry, Jan 16, 2015

Exposure to psychological stress and depression are associated with shorter white blood cell telo... more Exposure to psychological stress and depression are associated with shorter white blood cell telomere length (TL) in adults, possibly via associated lifelong oxidative stressors. Exposure to maternal depression increases risk for future depression and behavior problems in children, and Latino youth are at high risk. Few studies have evaluated the role of exposure to maternal depression or child behavior in relation to TL in children. We assessed early-childhood exposures to maternal depression from birth to the age of 5 years and child behavior from ages 3-5 years in a cohort of Latino children in relation to child leukocyte TL at ages 4 and 5 years. Children who had oppositional defiant behavior at 3, 4 or 5 years had shorter TL than those without by ~450 base pairs (P < 0.01). In multivariate analyses, independent predictors for shorter TL at 4 and 5 years of age included oppositional defiant disorder at 3, 4 or 5 years (β = -359.25, 95% CI -633.84 to 84.66; P = 0.01), exposure...

Maternal omega-3 fatty acid supplementation and risk for perinatal maternal depression

The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 2011

A systematic review was conducted to assess the possible association between omega-3 polyunsatura... more A systematic review was conducted to assess the possible association between omega-3 polyunsaturated fatty acid (PUFA) supplementation and intake in the perinatal period and the risk of maternal perinatal depression. Two PubMed searches and a BIOSIS Preview, a Web of Science and a PsychInfo search were conducted with the search terms 'DHA, pregnancy and depression' and 'omega-3 fatty acids, pregnancy and depression'. Ten articles - three longitudinal cohort studies, five randomized controlled trials and two pilot trials- that met selection criteria were reviewed. Six found no association, two found mixed results, and two found a positive association between omega-3 PUFAs and reduced incidence of maternal perinatal depression. The heterogeneity of results can be explained by dissimilar study designs, including differences in study duration, time period of measurement and number of participants, and in varied dosages and types of supplemental PUFAs. Some of the larger ...

The Active Balance Childhood Program for Improving Coping and Quality of Life in Chinese American Children

Nursing Research, 2010

Background-Interventions to teach children healthy and effective coping skills could help reduce ... more Background-Interventions to teach children healthy and effective coping skills could help reduce their risk for overweight. However, few studies have examined whether an intervention that teaches coping strategies in weight management can influence children's coping behavior and psychosocial well-being. Objective-To examine the efficacy of an interactive, child-centered, and family-based program in promoting effective coping, behavioral health, and quality of life in Chinese American children. Method-A randomized, controlled study of behavioral intervention in 67 Chinese American children (ages 8-10 years, normal weight and overweight) and their families. At baseline and 2, 6, and 8 months after baseline, children had anthropometric measurements and completed questionnaires related to coping skills and quality of life, and parents completed the Child Behavior Checklist. Results-Children in the intervention group reported using more active coping strategies and having a higher quality of life in the physical and emotional health domains than did children in the control group during the 8-month study. Children's behavioral problems did not differ between the intervention and control groups. Changes in coping and psychosocial well-being were not related to change in body mass index (BMI) in the entire group, except increased BMI is associated with decreased emotional quality of life. Discussion-This culturally appropriate behavioral intervention was effective in promoting healthy coping and improving quality of life in Chinese American children. Its utility for both optimal

Let's Move — Childhood Obesity Prevention from Pregnancy and Infancy Onward

New England Journal of Medicine, 2010

Maternal knowledge of infant feeding guidelines and label reading behaviours in a population of new mothers in San Francisco, California

Maternal & Child Nutrition, 2009

The objective of this study was to evaluate the relationship between maternal nutrition knowledge... more The objective of this study was to evaluate the relationship between maternal nutrition knowledge and maternal socio-demographics including participation in the Special Supplemental Women, Infants and Children's (WIC) Program. A cross-sectional study of new mothers at two San Francisco hospitals was conducted using some of the American Academy of Pediatrics' guidelines in a structured questionnaire to assess maternal nutritional knowledge. Maternal nutritional attitudes towards product nutrient labels were also assessed in a questionnaire format. Logistic regression models were used to evaluate the odds of having high maternal nutrition knowledge and of infrequently reading nutrition labels. In multivariate logistic regression models, higher maternal nutrition knowledge (defined as answering all four nutrition questions correctly) was associated with higher income levels defined as Ն$25 000/year, odds ratio (OR) 10.03 95% confidence interval (CI) (1.51-66.74), and in linear models, higher nutritional knowledge was associated with having more children (P < 0.01), a higher income (P = 0.01) and not being a WIC participant (P < 0.01). Mothers with higher incomes were also more likely to read product nutritional labels OR 4.24, 95% CI (1.24-14.51), compared with mothers with lower incomes as were mothers with higher education levels OR 3.32, 95% CI (1.28-8.63). In San Francisco, lower income mothers are at greatest risk for low maternal nutrition knowledge and not reading product nutritional labels. Higher household income was independently associated with increased maternal nutrition knowledge and likelihood of reading nutritional labels. More comprehensive interventions need to target low-income mothers including current WIC participants to help close the nutritional advantages gap conferred by income and education.

Efficacy of a child-centred and family-based program in promoting healthy weight and healthy behaviors in Chinese American children: a randomized controlled study

Journal of Public Health, 2009

Objective To examine the efficacy of an interactive, child-centred and family-based program in pr... more Objective To examine the efficacy of an interactive, child-centred and family-based program in promoting healthy weight and healthy lifestyles in Chinese American children. Design A randomized controlled study of a culturally sensitive behavioral intervention. Subjects Sixty-seven Chinese American children (ages, 8-10 years; normal weight and overweight) and their families. Measurements Anthropometry, blood pressure, measures of dietary intake, physical activity, knowledge and self-efficacy regarding physical activity and diet at baseline and 2, 6 and 8 months after baseline assessment. Results Linear mixed modeling indicated a significant effect of the intervention in decreasing body mass index, diastolic blood pressure and fat intake while increasing vegetable and fruit intake, actual physical activity and knowledge about physical activity. Conclusion This interactive child-centred and family-based behavioral program appears feasible and effective, leading to reduced body mass index and improved overweight-related health behaviors in Chinese American children. This type of program can be adapted for other minority ethnic groups who are at high risk for overweight and obesity and have limited access to programs that promote healthy lifestyles.

Risk factors for macrosomia in infants born to Latina women

Journal of Perinatology, 2008

Objective: To assess risk factors for macrosomic infant birth among Latina women. Study Design: P... more Objective: To assess risk factors for macrosomic infant birth among Latina women. Study Design: Prospective study of Latina women recruited during pregnancy from prenatal clinic at San Francisco General Hospital. Information was obtained through a structured interview and review of medical records. Result: A total of 11% of women delivered macrosomic infants (birth weight >4000 g). In unadjusted analyses, significant risk factors for macrosomia included older maternal age, increasing gravidity, previous history of macrosomic birth and pre-pregnancy overweight. After adjusting for confounders using multivariate analyses, older mothers (10-year increments) had an elevated risk of macrosomia (odds ratio (OR) 2.59; 95% confidence interval (CI) 1.28 to 5.24). Conclusion: Efforts to reduce macrosomia in Latina women should focus on older mothers.

Body Mass Index and Elbow Range of Motion in a Healthy Pediatric Population: A Possible Mechanism of Overweight in Children

Journal of Pediatric Gastroenterology & Nutrition, 2008

Background-Childhood overweight has become a serious health problem among children and adolescent... more Background-Childhood overweight has become a serious health problem among children and adolescents in the United States. No previous study, to our knowledge, has analyzed the effect of body mass index (BMI) on range of motion and carrying angle of the elbow joint in a healthy pediatric population. The primary objective of this study was to determine the effect of BMI on orthopedic parameters of the elbow joint, including range of motion, flexion, extension, and carrying angle. Study Participants and Methods-Healthy children age 2 to 18 years (mean 12.0 ± 3.9 years) were recruited at an urban pediatric orthopedic clinic as pediatric orthopedic patients or as the siblings or friends of patients. Measures of range of motion (flexion and extension) and carrying angle of 226 elbows and of BMI from 113 study participants were analyzed. Results-BMI was negatively correlated with right and left elbow range of motion (r = −0.54, P <0.01; r = −0.43, P <0.01) and right and left elbow flexion (r = −0.59, P <0.01; r = −0.50, P <0.01). BMI had a positive correlation with right elbow extension (r = 0.20, P = 0.04). BMI did not correlate with left elbow extension or right or left carrying angle. After adjustment for age, sex, and ethnic group, BMI was associated with right (P <0.01) and left (P <0.01) elbow range of motion. Conclusions-These data demonstrate that increased BMI in children is negatively correlated with range of motion of the elbow joint. Further studies are needed to evaluate the consequences of impaired range of motion associated with overweight on activity levels and energy expenditure in growing children and adolescents.

Risk Factors for Obesity and High Blood Pressure in Chinese American Children: Maternal Acculturation and Children’s Food Choices

Journal of Immigrant and Minority Health, 2009

The objective of this study is to explore risk factors associated with overweight and high blood ... more The objective of this study is to explore risk factors associated with overweight and high blood pressure in Chinese American children. Students and their parents were recruited from Chinese language schools in the San Francisco Bay Area. Data were collected on 67 children and their mothers, and included children's weight, height, waist and hip circumferences, blood pressure, level of physical activity, dietary intake, usual food choice, knowledge about nutrition and physical activity, and selfefficacy regarding diet and physical activity. Mothers completed questionnaires on demographic data and acculturation. About 46% of children had a body mass index exceeding the 85th percentile. Lower level of maternal acculturation is a risk factor for overweight and higher waist to hip ratio. Children's unhealthy food choices were predictive of high body mass index and high systolic blood pressure, whereas older age and less physical activity in children were predictors of high diastolic blood pressure. Developing culturally sensitive and developmentally appropriate interventions to reduce overweight and high blood pressure is critical to reduce health disparities among minority children.

Acculturation, Dietary Practices and Risk for Childhood Obesity in an Ethnically Heterogeneous Population of Latino School Children in the San Francisco Bay Area

Journal of Immigrant and Minority Health, 2011

Infant Formula, Tea, and Water Supplementation of Latino Infants at 4-6 Weeks Postpartum

Journal of Human Lactation, 2011

The American Academy of Pediatrics recommends exclusive breastfeeding until 6 months-of-age. The ... more The American Academy of Pediatrics recommends exclusive breastfeeding until 6 months-of-age. The authors examined prevalence and risk factors for use of infant formulas, water, and teas at 4-6 weeks in Latino infants in the San Francisco Bay Area, a group at high risk for future obesity. They recruited a cohort of pregnant Latina women (N = 201). Infant dietary recall and postpartum depressive symptoms were assessed at 4-6 weeks. The authors found that 105 women (53.1%) were feeding infant formulas and 48 (25.4%) were supplementing with tea or water. Of those providing water or tea, 60.0% were providing daily supplementation. In multivariate analyses, risk for infant supplementation with water or tea was associated with postpartum depressive symptoms (relative risk, 1.8; 95% confidence interval, 1.1-3.0), cesarean delivery (relative risk, 1.9; 95% confidence interval, 1.3-2.9), and infant formula use (relative risk, 1.3; 95% confidence interval, 1.1-1.6). Early supplementation with ...

Breastfeeding Offers Protection Against Obesity in Children of Recently Immigrated Latina Women

Journal of Community Health, 2013

Breastfeeding has been found to have a protective effect on subsequent development of obesity in ... more Breastfeeding has been found to have a protective effect on subsequent development of obesity in childhood, particularly in white, non-Hispanic populations. The protective effect of nursing for more than 12 months in children of Latina women is less clear, which may be due to differences in levels of acculturation in previously studied populations. We evaluated the association between breastfeeding for 12 months or more and risk for obesity in a cohort of children of recently immigrated relatively unacculturated Latina mothers. Maternal characteristics at birth, including length of stay in the United States, breastfeeding habits at 4-6 weeks of age, 6 months, and 1 year, and anthropometric measurements were obtained for a cohort of 196 children participating in a prospective study. At 1 year of age 39.0 % of infants were being breastfed. Being breastfed at 1 year of age was associated with a decreased risk of obesity in both univariate (odds ratio (OR) 0.49, 95 % confidence interval (CI) 0.21-0.83) and multivariate models (OR 0.39, 95 % CI 0.02-0.93) adjusting for maternal BMI, marital status, education level, country of origin, age, years of living in the United States, and child's birth weight at 3 years of age, regardless of mother's acculturation status using length of stay in the United States as a proxy for acculturation. The association with breastfeeding persisted at 4 years of age as a protective factor for obesity (OR 0.29, 95 % CI 0.11-0.80). Breastfeeding for longer than 12 months provides a significant protective effect on the development of obesity in early childhood in a cohort of children of highrisk recently immigrated Latina women in San Francisco who were relatively unacculturated to the United States.

Pilot Study of an Individually Tailored Educational Program by Mail to Promote Healthy Weight in Chinese American Children

Journal for Specialists in Pediatric Nursing, 2008

PURPOSE-To test the feasibility and impact of an individually tailored educational intervention t... more PURPOSE-To test the feasibility and impact of an individually tailored educational intervention to promote healthy weight in Chinese American children (ages 8-10). DESIGN-A pre-and post-test study (N = 57) using standardized instruments to measure children's usual food choices, knowledge of nutrition and physical activity needs, and time spent engaging in physical and sedentary activities. RESULTS-We found improvement after the intervention in all three areas. PRACTICE IMPLICATIONS-Healthcare providers need to provide parents and children with specific recommendations regarding children's weight statuses, dietary intake, and levels of activity. Search terms Children; Chinese American; individually tailored; obesity; weight management The U.S. Department of Health and Human Services (USDHHS) has declared obesity prevention to be a top research priority. At risk for overweight and overweight in children are defined as a body mass index (BMI) greater than the 85th and 95th percentiles, respectively, based on age-and sex-specific BMI growth charts (Centers for Disease Control and Prevention [CDC], 2000). Childhood obesity has affected many ethnic groups, including Chinese Americans. Recent data indicate that 31% of Chinese Americans ages 6-11 years have a BMI greater than the 85th percentile (Tarantino, 2002). Several physical and psychosocial health problems are associated with childhood obesity, including cardiovascular disease, sleep disorders, type 2 diabetes mellitus, low self-esteem, and social withdrawal. Chinese Americans are at a higher risk of developing cardiovascular disease and type 2 diabetes mellitus and at lower BMI than are non-Hispanic Whites, possibly because of genetic differences in body composition and metabolic responses (Tan, Ma, Wai, Chew, & Tai,

Maternal sociodemographic characteristics and the use of the Iowa Infant Attitude Feeding Scale to describe breastfeeding initiation and duration in a population of urban, Latina mothers: a prospective cohort study

International Breastfeeding Journal, 2013

Background The World Health Organization recommends exclusive breastfeeding until 6 months of age... more Background The World Health Organization recommends exclusive breastfeeding until 6 months of age. Maternal attitudes toward infant feeding are correlated with chosen feeding method and breastfeeding duration. The Iowa Infant Feeding Attitude Scale (IIFAS) has been used to assess attitudes towards breastfeeding prenatally and is predictive of breastfeeding decisions in certain population groups. Methods In a cohort of pregnant Latina women recruited from two hospitals in the San Francisco Bay Area (n=185), we administered the IIFAS prior to delivery. Information regarding feeding choice, maternal sociodemographic information, and anthropometrics were collected at 6 months and 1 year postpartum. Analysis of predictors for breastfeeding initiation, breastfeeding at 6 and 12 months and exclusive breastfeeding at 6 months were evaluated using multivariate logistic regression adjusting for potential confounders. Results In our cohort of Latina mothers, breastfeeding a previous infant was...