Fruits and Vegetables: Promoting Proper Nutrition to Cultivate Better Infant Health

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Fruits and Vegetables for By Firstname Lastname Infant Health

By Sara Bernate Angulo

Photo by Heather Annette Miller, CC-BY-NC-2.0

Obesity—a disease of staggering severity, though unfortunately much too familiar in this day and age. As rates increase among both adults and children, the obesity epidemic continues to worsen in the U.S.1,2 Obesity is associated with increased risk for diseases and decreased quality of life. Thankfully, researchers worldwide have made strides to understand and address this public health concern, identifying factors such as diet and exercise for prevention and treatment. Research has indicated that the risk of obesity can stem from diet and eating behaviors as early as the first two years of life.3,4 As such, improving infant diet is a major focus for preventing the development of obesity later in life. This is precisely the focus of Dr. Heather Wasser, a nutrition assistant professor in the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill (UNC-CH). She earned her BS from Fontbonne University, her RD credential from Cornell University, and both her MPH and PhD from UNC. In addition to her education, her extensive experiences working as a clinical dietitian and a project specialist, coordinator, and nutrition consultant for the N.C. Department of Health and Human Services have cultivated a professional focus on behavioral nutritional interventions that promote infant and toddler health. “Almost all of my research comes from life experiences and observation,” Dr. Wasser shared.5 Indeed, her interest in public health began with an observation. In undergraduate school, as a nanny for a wealthy family and an intern for a public health organization that provided summer meals for children of low-income families, Dr. Wasser had a first-hand account of the wide-ranging racial, economic, and health disparities of St. Louis, Missouri, where she lived at the time. After earning her RD credential and MPH, Dr. Wasser’s involvement with the state and local health departments to improve nutrition in childcare centers led her to identify child health promotion as her field of specialization. Yet it wasn’t until she spoke with UNC-CH researchers about a study assessing infant care risk of obesity that Dr. Wasser identified nutrition research as her intended professional career. In the early years, Dr. Wasser’s research looked at infant temperament and feeding behaviors. Previous studies had suggested that caregivers use fussiness as a cue to begin complimentary feeding, defined as the feeding of food and drinks in addition to breastmilk or formula. In a cross-sectional study with a cohort of lowincome black mother-infant pairs, Dr. Wasser assessed the association between maternal perception of infant temperament and complimentary feeding. The results found that babies who are perceived as fussy are more likely to be introduced by caregivers to complimentary foods before four months of age, a practice that does not adhere to feeding guidelines and recommendations.6 In fact, professionals recommend exclusive breastfeeding for the first 6 months of life, followed by complimentary feeding.7 The study also found that caloric intake may be higher for infants receiving complimentary feeding before 4 months of age, which may result in infant weight gain and, subsequently, obesity.6 Thus, these results call for maternal perception of infant behavior to be accounted for as an important factor for infant feeding in future research. They also call for the development of counseling

Dr. Heather Wasser

methods that equip mothers with the knowledge to respond to infant behavior in ways that promote healthy feeding. Additionally, since most interventions targeted one primary caregiver, usually the mother, Dr. Wasser then studied how feeding practices vary by the type of caregiver, such as mothers, fathers, and grandparents. Her findings showed that non-maternal caregivers are highly involved in infant feeding, and as such, may increase the intake of obesity-related foods and drinks and decrease the likelihood of exclusive or continued breastfeeding.8 Thus, the results supported interventions that target multiple family members, not just mothers. In accordance with these results, Dr. Wasser will be testing a multi-component, family-based intervention through Growing Healthy Together, a randomized controlled trial that aims to promote healthy infant size and growth during the first two years of life.9 Her target population is African American families, as the literature shows that African American infants have a higher prevalence of obesity.10 The intervention’s components include home visits, newsletters, an information toolkit, and text messages, all of which provide guidance

and support for breastfeeding, responsive and complimentary feeding, addressing sleep and crying, and limiting infant TV/media exposure.9 There are two groups, each composed of infants, mothers, and the mothers’ identified study partners: the intervention group, which will receive the intervention, and the control group. This 5-year study will collect data starting from each woman’s 28th week of pregnancy, continuing until the infants are 15 months old. The results of this project will determine which intervention components, or combination of components, best improves fruit and vegetable intake and minimizes junk food intake. This determination is critical in informing public health initiatives for obesityprevention in infants. As for Dr. Wasser, she shares, “If I can help parents feed kids under the age of five vegetables and make progress on vegetable intake in children, I’ll feel like I’ve had a successful career.”5 In the future, Dr. Wasser is interested in shifting her research focus toward parents. There is growing evidence on the negative impact of maternal postpartum depression (PPD), a form of depression that occurs after having a baby, on maternal and infant health.11 For mothers, PPD impairs their psychological health, caregiving ability, relationships, and overall quality of life. For infants, PPD negatively impacts their cognitive, social, and physical development. Notably, PPD disturbs feeding practices and result in infants who are fed inadequately, some of whom may become overweight and develop obesity later in life.12 These consequences have highlighted a need to develop interventions that address mental health, especially in low-income families. Additionally, Dr. Wasser notes the importance of involving non-maternal caregivers in interventions that aim to optimize infant health. Fathers, grandparents, siblings, and even childcare centers and providers contribute to the way children are raised and the foods and behaviors to which they are exposed. Thus, Dr. Wasser hopes to work on developing interventions to reduce postpartum depression and improve co-parenting for healthy infant diet and growth.

References

Figure 1. Mother feeds baby complimentary foods. Photo courtesy of Wikimedia Commons, CC-BY-SA-4.0 Figure 2. Healthy infant and toddler feeding is the foundation for optimal child and adult health. Photo by Alexas_Photos, Pixabay

1.Hales, C.M.; Carroll, M.D.; Fryar, C.D.; Ogden, C.L. NCHS Data Brief, no 360. https://www.cdc.gov/nchs/data/databriefs/db360-h.pdf (accessed February 24, 2021). 2.Hales, C.M.; Carroll, M.D.; Fryar, C.D.; Ogden, C.L. NCHS Data Brief, no 288. https://www.cdc.gov/nchs/data/databriefs/db288.pdf (accessed February 24, 2021). 3.Baird, J.; Fisher, D.; Lucas, P.; Kleijnen, J.; Roberts, H.; Law, C. BMJ. 2005, 331(7522), 929. 4.Thompson, A. L.; Bentley, M. E. Soc Sci Med. 2013, 97, 288–296. 5.Interview with Heather Wasser, Ph.D. 2/24/21 6.Wasser, H.M.; Bentley, M.E.; Borja, J.B.; Goldman, B.D.; Adair, L.S.; Thompson, A.L.; Slining, M. Pediatrics. 2011, 127(2), 229-237. 7.Recommendations and Benefits: Breastfeeding. https://www.cdc. gov/nutrition/infantandtoddlernutrition/breastfeeding/recommendations-benefits.html (accessed February 24, 2021). 8.Wasser, H.M.; Thompson, A.L.; Siega-Riz, A.M.; Adair, L.S.; Hodges, E.A.; Bentley, M.E. Appetite. 2013, 71, 7-15 9.Wasser, H. M.; Thompson, A. L.; Suchindran, C. M.; Hodges, E. A.; Goldman, B. D.; Perrin, E. M.; Faith, M. S.; Bulik, C. M.; Heinig, M. J.; Bentley, M. E. Contemp Clin Trials. 2017, 60, 24–33. 10.Taveras, E. M.; Gillman, M. W.; Kleinman, K.; Rich-Edwards, J. W.; Rifas-Shiman, S. L. Pediatrics. 2010, 125(4), 686–695. 11.Slomian, J.; Honvo, G.; Emonts, P.; Reginster, J. Y.; Bruyère, O. Women’s Health (London, England). 2019, 15. 12.Gaffney, K.F.; Kitsantas, P; Brito, A.; Swamidoss, C.S.S. J Pediatr Health Care. 2012, 28, 43-50.