Genetic and Epigenetic Contributions to Child Heath Outcomes in the STRONG Kids 2 Cohort Study

Objectives Childhood obesity is becoming a significant health concern in the United States, and the prevalence of excess weight increases continuously throughout the growing years. It has been proposed that genetic variation partly contributes to the susceptibility of obesity and its development during the early onset. Thus, this study focuses on the determination of the genome-wide signatures (GWAS) and epigenomic signatures (EWAS) of divergent weight for length z scores (WFLZ) in the first year of life. In addition, it attempts to relate the molecular findings to body composition, BMI, adipose tissue deposition, in the first 5 years of life. Our objective is to generate novel preliminary data on the contributions to child health outcomes. Our approach involves integrating genetic and epigenetic variations with factors such as diet and growth. Methods Initially, saliva samples of 426 children from SKP cohort were collected. Next, height and weight measurements were collected at intervals of 6 weeks, 3, 12, and 18 months, and 2, 3, 4 and 5 years. Measures such as maternal height and weight were also collected at the time points mentioned above. Furthermore, children were separated into three groups based on their WFLZ score trajectories (low-slow raising growth, mid stable growth and low-high rising growth) and it was demonstrated that there was a biological variation within the groups to investigate the genetic regulation of development in early life. For genomic analysis, DNA was extracted from infant saliva samples, fixed and quantified to used for genomic analysis. Results After statistical analysis 96 samples were chosen and genotyping were carried out using Illimuna Systems. Further results will be discussed at Nutrition 2021 Online. For the epigenetic analysis, EWAS analysis will be conducted and 850,000 methylation sites further will be investigated. We hypothesize that divergent growth factors in the first year of life will represent a unique epigenomic pattern and reveal new genetic targets modified by environmental variables. Conclusions This cohort study will provide valuable information about growth trajectories and genome and epigenome in the first 5 y of life. Funding Sources University of Illinois at Urbana-Champaign, FIRE Grant

Meeting Nutrition and Physical Activity Guidelines at 24-Months-of-Age Is Associated With Executive Function

Objectives Executive function (EF) and its constructs, cognitive flexibility (F), inhibitory self-control (ISC), emergent metacognition (EM), have been linked to overweight in older children. However, few studies have investigated toddler-aged children, when rapid neurophysiological development occurs. We hypothesized that the American Academy of Pediatrics (AAP) obesity prevention guidelines for toddlers would provide a useful framework for optimizing EF. Herein, the relationships between weight status, adherence to AAP guidelines and EF at 24 mo was examined. Methods Parents and 24-mo-old children (N = 246) were recruited from the STRONG Kids 2 cohort study. Weight-for-length z-scores (WFLz) were computed and weight status classified per WHO standards. Parents completed the Behavioral Rating Inventory of Executive Function for Preschoolers (BRIEF-P) to assess EF and reported physical activities per week (Sports, Play, and Active Recretion for Kids Survey), dietary intake (Block Food Frequency Questionnaires), and screen timeCommon Sense Media Survey). Toddlers met AAP recommendations if they consumed at least 5 servings of fruits and vegetables (FV), were physically active (PA), refrained from sugar-sweetened beverages (SSB) and limited screen time (ST) to less than 60 min per day. Results Using age- and sex-standardized scores, toddlers ranged between the 43rd and 46th percentile of EF, ISC, F and EM. 43% of toddlers were at risk of overweight or overweight/obese. Most toddlers met recommendations for PA (66%), ST (50%) and SSB(62%), but only 4% met FV recommendations. There was no significant difference in BRIEF-P based on weight status or FV recommendation adherence. Toddlers that met guidelines for limiting SSB had higher EF (mean difference = −0.329, p = 0.013), ISC (−0.206, p = 0.015) and EM (−0.406, p = 0.018) than those not meeting the guidelines. Toddlers who were physically active had higher EM (−0.235, p = 0.027) than those who were not physically active every day of the week. Conclusions Being physically active every day and abstaining from SSB may be of significance for improving EF in toddlers. Funding Sources Supported by the NIH, the National Dairy Council and a USDA National Needs fellowship (AM).

Bedtimes, Bedtime Routines, and Children’s Sleep across the First Two Years of Life

Study Objectives The first objective of this study was to determine whether establishing bedtime routines in the first year of life predicts better sleep outcomes (i.e., longer sleep duration, less nighttime waking, earlier bedtime, shorter sleep latency, fewer sleep problems) across the first two years of life. The second objective was to determine whether specific adaptive bedtime activities (e.g., book reading) were associated with sleep outcomes. The third objective was to describe changes in adaptive bedtime activities (hug/kiss caregiver, say goodnight to family) across the first two years of life. Methods Parents of 468 children from the STRONG Kids 2 birth cohort were surveyed about bedtime and bedtime routines, their child’s sleep duration, nighttime waking, sleep latency and sleep problems at 3, 12, 18, and 24 months of age. Results Cross-lagged panel models revealed partial evidence for reciprocal associations between bedtime routine consistency and adaptive bedtime activities and better sleep outcomes over time. Specifically, more bedtime routine consistency predicted less nighttime waking and sleep problems, and more bedtime adaptive activities predicted longer sleep duration and fewer sleep problems. Discussion The findings are discussed from a developmental perspective to highlight how consistency of bedtime routines established as early as three months of age may affect sleep outcomes and that the adaptive activities associated with these routines may increase in frequency over the first two years of life.

Aplicação da triagem de risco nutricional em crianças e adolescentes hospitalizados com cardiopatia congênita

Introdução: A triagem nutricional em crianças é de extrema importância no ambiente hospitalar, pois é uma ferramenta simples e eficiente. Objetivo: Detectar o risco nutricional, a partir do método de triagem nutricional pediátrica Strong Kids, em crianças e adolescentes com cardiopatias congênitas. Método: Foram avaliados 81 crianças e adolescentes com cardiopatia congênita, até 48 horas de internação, no período de agosto de 2016 a maio de 2017. Dados foram coletados através de triagem nutricional pediátrica. A análise estatística se deu através do teste qui-quadrado, a fim de verificar o nível de significância, p < 0,05. Resultados: Dentre os resultados obtidos, houve maior prevalência de crianças com cardiopatia congênita internadas do gênero feminino 60,49% (n=49). De acordo com a classificação das fases de vida, a predominância ocorreu na fase pré-escolar 46,91%, seguida de lactentes 27,16%, adolescentes 13,58% e escolar 12,35%. Não houve déficit nutricional para 74,07%. Segundo o teste qui-quadrado, observou-se relevância do médio risco nutricional. Conclusão: A triagem nutricional pediátrica é fundamental na prática clínica, e sua melhor forma de avaliação é a intervenção nutricional precoce. Isto implicará um tratamento nutricional adequado, em especial para crianças com cardiopatia congênita.

Estudio piloto: riesgo nutricional al ingreso de la internación pediátrica

Introducción: La desnutrición al ingreso de la internación pediátrica es un factor de riesgo de mala evolución y está asociado a mayor morbimortalidad. El principal objetivo fue conocer la frecuencia de desnutrición y riesgo nutricional al inicio de la hospitalización en una muestra de pacientes pediátricos. Población y métodos: Diseño descriptivo, transversal. Se incluyeron pacientes de 1 mes a 14 años internados entre marzo y julio de 2016, en el Hospital Dr. Humberto Notti. Se aplicó un tamizaje nutricional (Strong Kids) valorando riesgo nutricional dentro de las 48hs. de ingreso hospitalario y se obtuvo diagnóstico nutricional con los datos antropométricos correspondientes. Para el análisis estadístico se utilizó Test de Fisher y t de Student. Resultados: Ingresaron 134 pacientes, edad 4 (1 a 9) años (mediana e IQR) y la duración de la internación fue de 4 (3 a 7) días. Al momento del ingreso el 17% presentaba desnutrición aguda y el 60% un riesgo nutricional moderado. Los pacientes con alto riesgo nutricional al ingreso tuvieron más frecuentemente dolor, cambio de peso, menor ingesta, diarrea y signos de desnutrición que los que tuvieron un riesgo nutricional moderado (Fisher < 0,0001). Conclusión: La desnutrición al ingreso de la hospitalización afecta a casi la quinta parte de los pacientes y más de la mitad presenta riesgo nutricional moderado lo que justifica la realización sistemática de la evaluación del riesgo nutricional

AVALIAÇÃO DO RISCO NUTRICIONAL DE CRIANÇAS HOSPITALIZADAS EM UM HOSPITAL PARTICULAR DE CASCAVEL, PR

Introdução: Desnutrição é uma doença nutricional, prevalente em países em desenvolvimento, que acarreta prejuízos ao crescimento e desenvolvimento, além de ter relação direta com taxa de mortalidade infantil. Tem origem multifatorial, associada à limitação de nutrientes ou a má utilização destes pelo organismo. Durante hospitalização é de extrema importância avaliar esse risco nutricional, através de triagem. A partir desta é possível realizar adequação do tratamento e intervenção nutricional precoce, possibilitando melhor evolução do paciente, diminuição do risco de morbimortalidade, permanência e custos de internação hospitalar, além de aumentar a rotatividade de leitos. Objetivo: O trabalho teve como objetivo avaliar o estado nutricional de crianças de um hospital particular na cidade de Cascavel, Pr. Métodos: Foi utilizada a ferramenta de triagem nutricional Strong Kids, que avalia o estado nutricional através da presença de doença de alto risco ou cirurgia de grande porte, perda de massa muscular ou adiposa (por meio de avaliação clinica subjetiva), características da ingestão alimentar e possíveis perdas (vômitos e diarreia) e perda de peso ou ausência de ganho em crianças menores de 1 ano. Cada item citado tem uma pontuação que no final da avaliação gera um score, de 0 a 5, identificando o risco nutricional. A ferramenta foi aplicada a indivíduos entre 1 mês e 18 anos, totalizando uma amostra de 116 pessoas. Resultados: Como resultados foram obtidos os seguintes dados: score 0 (baixo risco): 18,1%; score 1 (médio risco): 59,41%; score 2 (médio risco): 8,62%; score 3 (médio risco): 6,9%; score 4 (alto risco): 5,17%; score 5 (alto risco): 1,72%. Conclusão: Os resultados com score 0, considerado de baixo risco e sem necessidade de intervenção nutricional, ocupa apenas uma pequena parte da amostra total. Dessa forma, todo o restante da amostra necessita de maior atenção nutricional e possível intervenção. Palavras-chave: avaliação nutricional, triagem, desnutrição.