Background: Parents' use of food as reward has been linked to children's dietary intake, but the association with children's eating behaviour and overweight risk is less clear. Objectives: To examine the temporal association of using food as reward with eating behaviour, body mass index (BMI) and weight status of children. Methods: Participants were 3642 children of the population-based Generation R Study in the Netherlands (8.3% overweight/obese). Repeated assessments were collected at child ages 4 and 9 years, including measured anthropometrics and parent reports on feeding practises and eating behaviour. Results: Linear regressions and cross-lagged models indicated that parents' use of food as reward at child age 4 years predicted Emotional Overeating and Picky Eating at age 9 years. Reversely, higher Emotional Overeating and Food Responsiveness scores were associated with more use of food as reward over time. Using food as reward was not associated with children's satiety response, BMI or overweight risk. Conclusions: A vicious cycle may appear in which children who display food approach behaviour are rewarded with food by their parents, which in turn might contribute to the development of unhealthy eating habits (emotional eating, fussiness). These findings warrant further research, to facilitate evidence-based recommendations for parents.

Background China has made remarkable progress in maternal and child health (MCH) over the last thirty years, but socio-economic inequalities persist. Ethnicity has become an important determinant of poor MCH outcomes, but little rigorous analytical work has been done in this area. To understand the socio-economic factors that explain ethnic variation in uptake of MCH care, we report the findings from an analysis in Sichuan province. Methods We linked data from the 2003, 2008 and 2013 National Health Service Surveys in Sichuan Province. The ethnic disparities in uptake of maternal care (completing 5 antenatal visits, giving birth in hospital and receiving a caesarean section) and childhood immunization (Bacillus Calmette Guerin (BCG), three doses of diphtheria (DPT) and measles immunization) were examined by geographical (Han district/county vs. ethnic minority county) and individual-based (Han women/children vs. ethnic minority women/children) comparisons. We also examined variation by distance to township and county hospitals, women’s education, parity and age using weighted multilevel Poisson regressions with random intercept at district/county level. Results Ethnic inequalities in maternal care were marked, both at the geographical (district/county) and the individual level. The % of births in hospital was 90.7% among women in Han districts, compared to 83.3% among women living in Han counties (crude RR 0.93; 95% CI 0.75–1.15), 53.8% among Han women living in ethnic minority counties (crude RR 0.57; 95% CI 0.36–0.93), and 13.5% among ethnic minority women living in ethnic minority counties (crude RR 0.18; 95% CI 0.06–0.57). Adjusting the analysis for survey year, education, parity and distance to county level hospital weakened the association between geographical/individual ethnicity and uptake of maternity care, but associations remained remarkably strong. Coverage of childhood immunization was much higher than uptake of maternity care, and inequalities by ethnicity were much less pronounced. Conclusion Lessons can be learned from China’s successful immunization programme to further reduce inequalities in access to maternity care among ethnic minority populations in remote areas. Bringing the services closer to the women’s homes and strengthening health promotion from the township to the village level may encourage more women to seek antenatal care and give birth in hospital. Electronic supplementary material The online version of this article (10.1186/s12884-019-2371-y) contains supplementary material, which is available to authorized users.

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Background Children with Autism Spectrum Disorders (ASD) tend to be selective in their food intake which may compromise their diet quality. While ASD diagnoses capture severe levels of impairment, autistic traits vary on a continuum throughout the population. Yet, little is known about how autistic traits relate to diet quality at the population level. Objectives This study examines the association between autistic traits in early childhood and diet quality in mid-childhood and explores the mediating role of food selectivity. Design Participants were children (n = 4092) from the population-based Generation R Study. Parents reported their child's autistic traits at 1.5, 3 and 6 years, food selectivity at 4 years and food intake at 8 years from which a diet quality score was derived. Associations of autistic traits and autistic trait trajectory (identified using Latent Class Growth Modelling) with diet quality were examined using multiple linear regression models. The indirect effect of food selectivity in the association between autistic traits at 1.5 years and diet quality was examined using mediation analysis. Results : Autistic traits were associated with diet quality (e.g. 1.5 years: β = -0.09, 95%CI: -0.13, -0.06). Two classes captured the autistic trait trajectories from 1.5 to 6 years: children with “low and stable” (95%) and “high and increasing” (5%) mean scores. Children in the high and increasing group had poorer diet quality than the low and stable group (β = -0.28, 95%CI: -0.44, -0.11). Food selectivity mediated the association between autistic traits at 1.5 years and diet quality at 8 years (βindirect = -0.03, 95%CI: -0.03, -0.02). Conclusions Autistic traits in early childhood are associated with poorer diet quality in mid-childhood, and food selectivity appears to mediate this association. Interventions intended to optimize nutrition in children with elevated autistic traits may integrate behavioral strategies to support parents’ responding to their child's food selectivity.

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Background: Prior studies have reported inconsistent results or less well-explored associations between sex hormones and non-alcoholic fatty liver disease (NAFLD). Here, we aimed to investigate the associations of NAFLD with sex steroids and sex hormone-binding globulin (SHBG) in the population-based study and conduct a comprehensive systematic review and meta-analysis of all published observational studies. Methods: Analyses included 755 men and 1109 women with available data on sex steroids, SHBG, and ultrasound-based NAFLD from the Rotterdam Study. Multivariable regression models were used to examine the associations. Additionally, we searched five databases from inception to 1 April 2022 and performed a systematic review and meta-analysis. Random-effects (DerSimonian-Laird) method was used for meta-analysis, odds ratios (ORs) were calculated for the effect estimate, subgroup and leave-one-out sensitivity analyses were conducted, and meta-regression was performed to explore the pooled statistics with high heterogeneity. Results: In the Rotterdam Study, lower levels of SHBG were associated with NAFLD in both sexes, while lower testosterone was associated with NAFLD only among women. Similarly, the meta-analysis of 16 studies indicated no sex-specific association between SHBG and NAFLD (men: OR = 0.37, 95%CI 0.21–0.53; women: OR = 0.40, 95%CI 0.21–0.60), yet there was a sex-specific association between testosterone and NAFLD (men: OR = 0.59, 95%CI 0.42–0.76; women: OR = 1.06, 95%CI 0.68–1.44). Moreover, men with NAFLD had lower estradiol levels than those without NAFLD. Conclusions: Lower SHBG levels were associated with NAFLD in both sexes, but testosterone levels were associated in a sex-specific manner. In addition, our results showed estradiol with the potential as a protective factor for NAFLD in healthy men.

Objectives Appropriate tools for measuring and tracking diet quality on a global scale are lacking. Such instruments need to be easy-to-use across various settings, and based on a metric associated with non-communicable diseases (NCDs) and key nutrient intakes. We developed and evaluated a diet quality screener among women in a high-income country setting. Methods The Prime Diet Quality Score (PDQS), a new food-based global diet quality index, shown to predict multiple NCDs among large U.S. cohorts, and associated with nutrient intake adequacy in low and middle-income countries (LMICs), was used to develop a short-form diet screener. Participants were recruited via Amazon MTurk to complete two 24-hour diet recalls (ASA24) and two screeners (PDQS-24HR and PDQS-30D) 7–30 days apart. Spearman rank correlation and linear regression were used to evaluate correlations and associations between usual nutrient intakes assessed by ASA24 and the PDQS values. We also compared the associations of the two score values with nutrient intakes by including them simultaneously in a regression model, and using a Wald test. Results The final sample included 290 U.S. women of reproductive age (41 ± 11). The median time required for completing the PDQS-24HR was 4.9 minutes, compared to 21 minutes for the ASA24. The rank correlations of the PDQS-24HR with energy-adjusted intakes of some key nutrients were 0.53 (fiber), 0.50 (β-carotene), 0.37 (folate), 0.31 (vitamin B6), 0.36 (vitamin C), 0.40 (vitamin E), 0.48 (potassium), 0.51 (magnesium), 0.25 (zinc), 0.21 (iron), 0.17 (PUFAs), −0.34 (added sugar), and −0.19 (SFA) (all P < 0.05). Correlations of the PDQS for vitamin B1 and calcium were null. Associations of nutrient intakes with the PDQS-30D were not significantly different from those with the PDQS-24HR. Conclusions The results of an initial evaluation of a stand-alone, PDQS-based diet quality screener among U.S. women are promising. Associations between the PDQS and nutrient intakes were of variable strength but in the expected directions. The lack of correlation for calcium intake warrants further examination: it may be partially attributed to the neutral scoring of key sources of this nutrient in U.S. diet. Future work should include piloting the screener across LMICs, and among children and adolescents. Funding Sources IMMANA Postdoctoral Fellowship(SG).

Objectives Dietary patterns (DPs) in childhood have been associated with neurodevelopmental disorders and cognitive performance in children. However, little is known about the underlying neurobiological mechanisms. We aimed to examine associations of DPs in early and mid-childhood with pre-adolescent brain morphology in a large population-based cohort. Methods We studied children's DPs at ages 1 and 8 and their associations with volumetric (total brain, hippocampus and amygdala) and surface-based brain measures (cortical thickness, surface area and gyrification) at age 10 years in a prospective population-based cohort in the Netherlands. High-resolution T1-weighted magnetic resonance images were collected in 3210 children. Brain measures were extracted using FreeSurfer. Dietary intake was assessed using age-specific food-frequency questionnaires. We derived DPs as diet quality scores based on dietary guidelines and identified Western and Prudent DPs using principal component analyses. We used multiple linear regression and surface-based analyses adjusting for multiple testing (Benjamini-Hochberg method) to examine associations with brain measures. Results Higher adherence to a Western DP at age 8 years was associated with a smaller total brain volume (B = –7.84, 95% CI –13.06, –2.61), whereas higher adherence to a Prudent DP at age 8 years was associated with a larger total brain volume (B = 8.45, 95% CI 4.25, 12.65). In addition, children with higher diet quality and better adherence to a Prudent DP showed greater gyrification and larger surface area, mostly clustered in the prefrontal cortex. At age 1 year, no statistically significant associations between DPs and global or surface-based brain measures were observed. No volumetric differences were found in the hippocampus or amygdala at both ages. Conclusions We are the first to show in a large population-based setting that dietary patterns in mid-childhood are associated with brain structural alterations, with a prudent diet being linked to a more optimal development. These findings suggest that a healthy diet is important for children's brain development, which may explain part of the previously demonstrated relation between dietary patterns and psychosocial well-being and cognitive performance in children. Funding Sources This project did not receive any funding.