Purpose: Infant appetite predicts weight gain, yet whether appetite affects infant feeding choices remains underexplored. We explored how measures of infant appetite were associated with early infancy feeding type and changes in feeding type across infancy.

Methods: We followed 80 term infants (55% female, parents 48% Hispanic, 32% Black, 33% Spanish speaking), from 1-2 months through 6 months. At enrollment, parents completed the Baby Eating Behavior Questionnaire (BEBQ), a widely used and validated scale measuring core appetite traits. At enrollment and 6 months, we collected feeding type: exclusive breastmilk; mixed – predominant breastmilk; mixed – predominant formula; and exclusive formula. We defined breastmilk decrease as moving from a more predominant breastmilk category to a less predominant category. We used Fisher’s exact tests, t-tests, and ANOVA to explore bivariate associations and logistic regression to assess odds of feeding type and feeding changes by BEBQ domains.

Results: 91% of infants were followed for the entire study period and had a mean birth weight and gestational age of 3.39 kg and 39 weeks, respectively. A third (35%) were fed exclusively breastmilk at 1 month, 13% predominantly breastmilk, 11% predominantly formula, and 28% exclusively formula. Exclusive breastmilk, predominant breastmilk, and predominant formula reduced by 6%, 7%, and 8%, respectively, with most (56%) fed exclusively formula at 6 months. Mean BEBQ scores were similar to other populations: General Appetite 4.3; Food Responsiveness 2.6; Enjoyment of Food 4.7; Satiety Responsiveness 2.1; Slowness of Eating 2.6. Race, but not ethnicity or birth weight, was associated with feeding type. General Appetite scores were 0.43 higher for Hispanic infants. Higher Food Responsiveness score was associated with lower odds of exclusive breastmilk at baseline (OR 0.53, 95%CI: 0.29-0.95) and remained after adjusting for race and ethnicity. We did not find associations between Food Responsiveness at feeding type at 6 months or other BEBQ domains and feeding type at any time. Decreasing the predominance of breastmilk was not associated with significant differences in appetite.

Conclusion: Food responsiveness was associated with odds of breastmilk exclusivity and could be used for screening to identify potential need for breastfeeding support in early infancy.

Purpose: Summer meal programs offered through schools and non-profit organizations provide children with free meals during the summer months to address increased summer food insecurity in the United States (US). We aimed to 1) compare demographic characteristics of summer meal program participants and non-participants, and 2) examine the association between summer meal participation and child nutrition-related outcomes, including food security, diet quality and body mass index (BMI) z-scores.
Methods: This secondary analysis used the 2017-2018 US National Health and Nutrition Examination Survey. We included data of children ages 5 to 18 without missing values on variables of interest, including children’s summer meal participation (yes vs. no; question asked of those eligible for free or reduced-price school meals), food security at the household and child level (secure vs. insecure), the Healthy Eating Index-2015, and BMI z-scores (n=500). Demographic characteristics included child age, sex, race/ethnicity, and family income. For aim 1, chi-square (categorical) and t-tests (continuous) were used. For aim 2, logistic (food security), linear (BMI z-scores) regressions, and gamma regression with log link (HEI-2015) were conducted.
Results/findings: In this sample of children eligible for free or reduced-price school meals, 36% participated in a summer meal program. Child mean age was 11(SD 3.7) with 56% female, 64% non-White, and 62% from low-income households. No demographic differences by summer meal participation were found. Summer meal participation was not significantly associated with household food security (OR 0.97, 95% CI: 0.63-1.49), child food security (OR 1.26, 95% CI: 0.69-2.27), diet quality (percent change 0.99, 95% CI 0.94-1.05) and BMI z-scores (mean difference 0.28, 95% CI: -0.05-0.60).
Conclusions: Our findings do not support the positive impacts of summer meal programs on child nutrition-related outcomes. However, this cross-sectional study did not capture potential reverse causality (ie. those with severe food insecurity, poorer diet quality or overweight may be more likely to participate). The summer meal program impacts might also be diluted as the outcomes were assessed throughout the year, not immediately after the program. Longitudinal and experimental studies are warranted to better evaluate summer meal programs’ impact on child nutrition-related outcomes.

Purpose: Dental caries is a major public health issue in the United States among children. This paper describes the design and results of baseline analysis of a cluster-randomized controlled trial to determine the effectiveness of an oral health intervention in reducing incidence of dental caries among children in grades K-2. Inclusion criteria at the school level was if >75% of the children were enrolled in the free/reduced lunch program. Our overall project goal is to clinically evaluate the effects of a school-based behavioral intervention to reduce the risk of dental caries, and improve dietary habits in a cohort of kindergarten through 2nd grade (K-2) children. Coordinated Approach to Child Health (CATCH) is an evidence-based, theoretically-grounded coordinated school health program, and has undergone several cluster-randomized controlled trials (CRCT) demonstrating sustainable long-term effectiveness in improving eating and physical activity behaviors, and reductions in obesity prevalence among low-income, diverse children.
Methods and results: Our primary aim is to conduct a school-based CRCT to determine the efficacy of CATCH Healthy Smiles in reducing child incidence of dental caries at the tooth surface level in the primary teeth (dfs) as measured using International Caries Detection and Assessment System. A total of 1083 children were recruited in kindergarten and following through 2nd grade enrolled across 34 schools serving low-income, ethnically-diverse children in Houston, Texas, USA. Baseline data was collected among participating children across two school years in 2022-2023 and 2023-2024 to measure prevalence of dental caries in the primary teeth at the tooth level (dft), and permanent teeth at the tooth and tooth surface level (DFT and DFS respectively). Parent surveys were used to collect data on child oral health behaviors, dietary intake, household food security, and teachers completed surveys on school nutrition environment. We will present the results of the baseline data, data collection for which was completed in December 2023.
Conclusion: These data will provide important insights on dental caries prevalence, dietary behaviors, household food insecurity and school nutrition environment among young children from low-income communities.

Purpose: Children with obesity experience poorer weight-related quality of life (WRQoL), a subjective measure of their perspective of the impact of health on social, physical, and mental well-being. Family practices (physical activity and diet) and the home environment (chaos) have been associated with child weight. However, the interplay among family nutrition and physical activity practices, household chaos, and child WRQoL is poorly understood. The purpose of this sub-study within the TEAM UP pragmatic clinical trial was to examine the associations and interactions of these variables among intensive health behavior and lifestyle treatment-seeking youth with obesity ages 6 to 15 years.

Methods: This observational study tested the effects of family health practices as reported by parents using the Family Nutrition and Physical Activity Questionnaire and household environment using the Confusion, Hubbub, and Order Scale on WRQoL measured by the Sizing Them Up questionnaire of n=739 youth. The bivariate relationships were evaluated using linear regression models. Two-way interactions assessed whether family health practices moderated the relationship between household chaos and child WRQoL.

Results/findings: The mean WRQoL score was 59.0±13.6 (range: 21 to 80). Household chaos (M=13.0±3.7) negatively predicted overall WRQoL, p<.0001. Overall positive family nutrition and physical activity practices (M=50.8±6.2) positively predicted overall WRQoL, p=0.023. Household chaos was a moderator of family nutrition and physical activity practices and WRQoL such that children with households high in chaos in conjunction with low scores in positive nutrition and physical activity practices experienced poorer WRQoL on the physical scale, p=0.013. No other interactions were observed.

Conclusions: Greater household chaos predicted poorer WRQoL, while positive family nutrition and physical activity practices, like eating meals at home with family, refraining from drinking sweetened beverages, and refraining from excessive screen time, were predictive of improved overall WRQoL. Regarding weight-related physical quality of life, youth with high levels of household chaos and poorer family nutrition and physical activity habits were at greatest risk. Understanding factors that contribute to household chaos to support families in reducing chaos and improving family health practices are important modifiable targets for improving subjective well-being in youth with obesity.

Purpose:
This study presents step-determined physical activity trends in Czech adolescents with different activity levels over a period of ten years.
Methods:
This was a ten-year cross-sectional randomized study of PA data collected by wearable devices in Czech adolescents recruited from secondary schools between 2009 and 2018. Pedometers Yamax Digiwalker SW-700 were used to monitor weekly PA in 1,855 boys and 2,648 girls 15–19 years of age recruited from 155 schools in the Czech Republic. Trends for average steps/day and percent of accumulating various levels of steps/day (< 10,000, 10,000 – 13,000, > 13,000 steps/day) were analyzed by sex. Valid daily data were limited to 1,000 – 30,000 steps/day. Participants were classified as low-active (< 10,000 steps/day), moderately active (10,000 – 13,000 steps/day), and high active (> 13,000 steps/day).
Results/findings:
There was a statistically significant decrease in average steps/day between 2009–2010 and 2017–2018 in boys from 12,355 ± 3,936 steps/day to 10,054 ± 3,730 steps/day and girls from 11,501 ± 3,278 steps/day to 10,216 ± 3,288 steps/day. The percent accumulating <10,000 steps/day increased by 21% in boys and by 12% in girls. The percent achieving > 13,000 steps/day decreased by 17% in boys and by 10% in girls. The most active weekday was Friday, and the least active day overall was Sunday.
Conclusions:
This study confirms a temporal decrease in average steps/day of adolescent Czech boys and girls over the ten-year monitoring period. Objectively collected evidence indicates an overall decrease in Czech adolescents’ steps/day over a ten-year period concurrent with an increase in the percent of boys and girls accumulating <10,000 steps/day. The results point to small differences in the structure of weekly steps/day of adolescents with different overall activity level. These trends are concerning as they portend a decline in physical activity as adolescents transition to adulthood and continue to age, which also may have major health implications.

PURPOSE:
The Adaptive Eating Scale (AES) assesses a multidimensional construct representing gentle nutrition (GN), infrequent food cravings (IFC), enjoyment of food (EF), and hunger responsivity (HR). This study tested concurrent validity of the AES with measures of health, diet, and eating behaviors.

METHODS:
This is a secondary analysis of data from a cross-sectional study of eating behaviors among college students who received course credit to complete validated web-based and physical measures. Body mass index (BMI) was calculated from researcher measured height and weight. Mental health was assessed with the Center for Epidemiological Studies on Depression scale (CESD) and the Rosenberg Self-Esteem Scale (RSES). Diet quality was assessed with Start the Conversation (STC), a brief food frequency screener. Dietary intake of carotenoid rich food (i.e., fruit and vegetables) was assessed with reflection spectroscopy of skin tissue (Veggie Meter ®, Longevity Link Corp, Salt Lake City, UT). Eating behaviors were assessed with the Emotional Eating Subscale (EES) of the Motivation to Eat measure and the Reliance on Hunger and Satiety (RHS) subscale of the Intuitive Eating Scale 2. AES total and subscale scores were correlated (Pearsons) with BMI, CESD, RSES, STC, Veggie Meter scores, EES, and RHS.

RESULTS:
Participants included 849 students (M age=21 years, SD=2.6; 55% females, 33% Hispanic, 15% African American, 36% Asian). AES total was significantly (p’s < .05) associated with BMI (r = -.08), mental health [CESD (r = -.41), RSES (r = .35)], diet quality [carotenoid intake (r = -.07)] and eating behaviors [RHS (r = .33), and EES (r = -.42)]. All subscales were significantly (p’s < .05) positively (r’s ranged from .10 to .35) associated with RSES and RHS and negatively (r’s ranged from -.12 to -.42) associated with CESD and EES. Associations between subscales and BMI and diet were mixed.

CONCLUSION:
The AES total demonstrated concurrent validity with valid measures of physical and mental health, diet quality, and eating behaviors. Validity of subscales was mixed. The AES may be used to study adaptive eating. However, more research is needed on the validity of the AES in different samples and populations.

Purpose: During pregnancy, consuming a healthy diet, participating in physical activity and GWG within guideline ranges are recommended to improve health outcomes for mothers and children. There is limited data on adherence to these recommendations and whether there are differences between groups of women. This study reports the proportion of pregnant women meeting dietary, physical activity and GWG recommendations, and associations with maternal characteristics.

Methods: We conducted telephone/online surveys with pregnant women receiving antenatal care from public maternity services in one health district in Australia (August 2020-August 2022). Women’s self-reported dietary intake (food frequency questionnaire), physical activity (International Physical Activity Questionnaire) and GWG were examined using descriptive statistics, and associations with maternal characteristics analysed through multi-variable linear and logistic regression.

Results/findings: From 5062 surveys, 33% of women reported GWG within the guidelines, while 25% reported GWG below and 42% above the guidelines. Only 0.1% met all five food group recommendations (lowest=0.3% met breads/cereals recommendation; highest=63% met fruit recommendation). The mean dietary guideline index score was 62 (SD:10) out of 90. Thirty-four percent of women met the physical activity guidelines. Women with a pre-pregnancy BMI outside of recommended ranges had higher odds of not meeting their GWG recommendations. Women who were married/living with partner had higher diet quality and lower odds of GWG above recommendations, but lower odds of meeting physical activity recommendations. Women in full/part time employment had higher diet quality and higher odds of meeting physical activity recommendations. Women with tertiary education had higher diet quality and lowers odds of meeting physical activity recommendations. Younger women had higher odds of meeting physical activity recommendations however higher odds of GWG below recommendations. Women with gestational diabetes had higher diet quality, but higher odds of GWG below the guidelines. GWG below recommendations and physical activity below recommendations were associated with lower diet quality, however GWG and physical activity were not associated.

Conclusions: Most pregnant women did not meet dietary, physical activity or GWG recommendations. Interventions to improve these preventive health risks during pregnancy, and that address the wider determinants of health, are needed to optimise health outcomes and reduce health inequalities.

An Exploration of Trends in Self-Reported Physical Activity Behaviors Among Pregnant Individuals Age 16+ in the United States, 2011-2020
Jordan Lewis a,b (Presenting, Corresponding), Imelda Gutierreza, Samantha F. Ehrlich, PhDa,b
aUniversity of Tennessee, Knoxville, Department of Public Health
bUniversity of Tennessee, Knoxville, Department of Kinesiology, Recreation, and Sports Studies

Purpose: The aim of this study is to describe the prevalence and trends in physical activity (PA) during pregnancy in the U.S. between 2011 and 2020.

Methods: Pregnant people from 16-44 who participated in the National Health and Nutrition Examination Survey (NHANES) between January 2011 and March 2020 were included (n=280). PA was measured in the domains of sedentary behavior, work activity, transportation activity (i.e., walking or biking), and recreational activity, and included both moderate and vigorous intensity PA (MVPA). Recreational PA was further divided according to the Physical Activity Guidelines for Americans: 150 minutes or more per week of moderate intensity PA (MPA), 75 minutes or more of vigorous intensity PA (VPA), or 150 minutes or more of a combination of MPA and VPA (MVPA). Survey cycles 2011-2014 were compared to cycles in 2015-2020 using t-tests and chi-square statistics.

Results/Findings: Respondents were 28.90 years old (95% CI: 27.90,28.89), on average; 52.93% identified as non-Hispanic white and 78.31% married. Overall, respondents spent an average of: 5.35 hours/week in moderate to vigorous intensity activity for transportation, 11.98 hours/week in MVPA at work, and 3.65 hours/week in recreational MVPA. Most PA metrics remained stable over time, except for sedentary behavior and meeting the PA guidelines, and perhaps moderate intensity activity at work. There was the suggestion of an increase in moderate intensity work activity (i.e., from 8.65 hours/week to 12.15 hours/week, p=0.05). Decreases were observed for sedentary behavior (i.e., from 36.56 hours/week to 33.88 hours/week, p=0.02) and the prevalence of meeting PA guidelines (i.e., from 65.66% to 43.72%, p<0.01) over this period.

Conclusions: Among pregnant individuals in the U.S., sedentary time decreased from 2011-2014 to 2015-2020, but so did the prevalence of meeting PA guidelines for recreational MVPA.