Assistant Professor of Public Health Nutrition
Dr. Andrea Deierlein is a nutritional and reproductive epidemiologist who studies dietary and environmental determinant of obesity and metabolic health-related outcomes. Her previous work focused on predictors and outcomes of gestational weight gain including maternal obesity, postpartum weight retention, and gestational diabetes.
With the support of the National Institute of Environmental Health Sciences, she is expanding her research to investigate associations of prenatal and postnatal nutritional and environmental chemical exposures with disease outcomes.
Dr. Deierlein teaches Epidemiology for Global Health and Nutrition and Metabolism.
BS, Animal Science, Cornell University, Ithaca, NYMS, Health Nutrition, Columbia University, New York, NYMPH, Epidemiology, Columbia University, New York, NYPhD, Nutrition Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
Travel Scholarship, Be Our Voice Childhood Obesity Prevention Advocacy Training, Robert Wood Johnson Foundation (2013)New York Academy of Sciences Education Fellowship (2012)Postdoctoral Fellowship in Pediatric Environmental Health, Icahn School of Medicine at Mount Sinai (2010)Travel Scholarship, Researching Women’s Environmental Health: Food, Nutrition, and Obesity, University of Rochester Medical Center (2010)Travel Scholarship, Childhood Obesity Symposium, University of Southern California (2010)
Environmental Public Health ServicesEpidemiologyMaternal and Child HealthNutritionWomen's Health
Food assistance programs and income are associated with the diet quality of grocery purchases for households consisting of women of reproductive age or young childrenLitvak, J., Parekh, N., Juul, F., & Deierlein, A.
Journal titlePreventive Medicine
Volume138Women's diet quality during reproductive years and children's diet quality during early life influence long term health. Few studies have evaluated the impact of food assistance programs and income on the diet quality of grocery purchases made by households consisting of women of reproductive age and young children. We used data from the Food Acquisition and Purchase Survey 2012–2013 (FoodAPS) to evaluate how household income, Special Supplemental Nutrition Assistance Program for Women, Infants and Children (WIC) participation, and Supplemental Nutrition Assistance Program (SNAP) participation are related to the diet quality of grocery purchases made by households that include women of reproductive age or young children (n = 2436). The diet quality of household grocery purchases was assessed with the Healthy Eating Index (HEI) 2015. HEI-2015 total score (0−100) and component scores were evaluated according to household income (eligible for WIC: income-to-poverty ratio ≤ 185%; ineligible for WIC: income-to-poverty ratio > 185%) and WIC, SNAP, and WIC + SNAP participation. Median HEI-2015 total score was lowest among SNAP households and highest among income ineligible for WIC and WIC households (47.2 and 54.1, respectively). Compared to income ineligible for WIC households, WIC + SNAP and SNAP households had lower HEI-2015 whole fruit (β = −0.30, 95% CI: −0.59, −0.01 and β = −0.41, 95% CI: −0.63, −0.20, respectively) and total vegetable scores (β = −0.58, 95% CI: −0.83, −0.32 and β = −0.27, 95% CI: −0.45, −0.08, respectively). The diet quality of grocery purchases in this population varies according to household income and food assistance participation.
Patterns of weight change one year after delivery are associated with cardiometabolic risk factors at six years postpartum in Mexican womenSoria-Contreras, D. C., Trejo-Valdivia, B., Cantoral, A., Pizano-Zárate, M. L., Baccarelli, A. A., Just, A. C., Colicino, E., Deierlein, A. L., Wright, R. O., Oken, E., Téllez-Rojo, M. M., & López-Ridaura, R.
Issue1Pregnancy is a contributor to the obesity epidemic in women, probably through postpartum weight retention (PPWR), weight gain (PPWG), or a combination of both (PPWR + WG). The contribution of these patterns of postpartum weight change to long-term maternal health remains understudied. In a secondary analysis of 361 women from the prospective cohort PROGRESS, we evaluated the associations between patterns of weight change one year after delivery and cardiometabolic risk factors at six years postpartum. Using principal component analysis, we grouped cardiometabolic risk factors into: (1) body mass index (BMI), waist circumference (WC), homeostatic model assessment of insulin resistance (HOMA-IR), high-density lipoprotein cholesterol (HDL-c), triglycerides (TG), and glucose; (2) systolic (SBP) and diastolic blood pressure (DBP); and (3) low-density lipoprotein cholesterol and total cholesterol. Using path analysis, we studied direct (patterns of weight change-outcomes) and indirect associations through BMI at six years postpartum. Around 60% of women returned to their pregestational weight (reference) by one year postpartum, 6.6% experienced PPWR, 13.9% PPWG, and 19.9% PPWR + WG. Women with PPWR + WG, vs. the reference, had higher BMI and WC at six years (2.30 kg/m2, 95% CI [1.67, 2.93]; 3.38 cm [1.14, 5.62]). This was also observed in women with PPWR (1.80 kg/m2 [0.80, 2.79]; 3.15 cm [−0.35, 6.65]) and PPWG (1.22 kg/m2 [0.53, 1.92]; 3.32 cm [0.85, 5.78]). PPWR + WG had a direct association with HOMA-IR (0.21 units [0.04, 0.39]). The three patterns of weight change, vs. the reference, had significant indirect associations with HOMA-IR, glucose, TG, HDL-c, SBP, and DBP through BMI at six years. In conclusion, women with PPWR + WG are at high-risk for obesity and insulin resistance. Interventions targeting women during pregnancy and the first year postpartum may have implications for their long-term risk of obesity and cardiovascular disease.
Predictors of gestational weight gain in a low-income hispanic population: Sociodemographic characteristics, health behaviors, and psychosocial stressorsDolin, C. D., Gross, R. S., Deierlein, A. L., Berube, L. T., Katzow, M., Yaghoubian, Y., Brubaker, S. G., & Messito, M. J.
Journal titleInternational journal of environmental research and public health
Issue1Hispanic women have a higher prevalence of weight associated complications in pregnancy. This ethnic disparity is likely related to behavior patterns, social circumstances, environmental exposures, and access to healthcare, rather than biologic differences. The objective was to determine associations between sociodemographic characteristics, health behaviors, and psychosocial stressors and gestational weight gain (GWG) in low-income Hispanic women. During pregnancy, information on sociodemographic characteristics, health behaviors, and psychosocial stressors were collected. Linear regression estimated mean differences in GWG by selected predictors. Multinomial logistic regression estimated odds of inadequate and excessive GWG by selected predictors. Five-hundred and eight women were included, 38% had inadequate and 28% had excessive GWG; 57% with a normal pre-pregnancy BMI had inadequate GWG. Compared to women with normal BMI, women with overweight or obesity were more likely to have excessive GWG (aRRR = 1.88, 95% CI: 1.04, 3.40 and aRRR = 1.98, 95% CI: 1.08, 3.62, respectively). Mean total GWG was higher among women who were nulliparous (ß = 1.34 kg, 95% CI: 0.38, 2.29) and those who engaged in ≥3 h of screen time daily (ß = 0.98 kg, 95% CI: 0.02, 1.94), and lower among women who were physically active during pregnancy (ß = −1.00 kg, 95% CI: −1.99, −0.03). Eating breakfast daily was associated with lower risk of inadequate GWG (aRRR = 0.47, 95% CI: 0.26, 0.83). Depressive symptoms and poor adherence to dietary recommendations were prevalent, but none of the psychosocial or dietary variables were associated with GWG. In this cohort of primarily immigrant, low-income, Hispanic women, there were high rates of poor adherence to diet and physical activity recommendations, and a majority of women did not meet GWG guidelines. Modifiable health behaviors were associated with GWG, and their promotion should be included in prenatal care.
Total and trimester-specific gestational weight gain and infant anthropometric outcomes at birth and 6 months in low-income Hispanic familiesDeierlein, A. L., Messito, M. J., Katzow, M., Berube, L. T., Dolin, C. D., & Gross, R. S.
Journal titlePediatric Obesity
Issue3Objective: To describe total and trimester-specific gestational weight gain (GWG) among low-income Hispanic women and determine whether these GWG exposures are associated with infant anthropometric outcomes at birth and 6 months. Study Design: Data were from 448 mother-infant pairs enrolled in the Starting Early child obesity prevention trial. Prenatal weights were used to calculate total GWG and 2nd and 3rd trimester GWG rates (kg/week) and categorized as inadequate, adequate, and excessive according to the 2009 Institute of Medicine recommendations. Multivariable linear and modified Poisson regressions estimated associations of infant anthropometric outcomes (birthweight, small-for-gestational age [SGA], large-for-gestational age [LGA], rapid weight gain, and weight-for-age, length-for-age, and weight-for-length z-scores at 6 months) with GWG categories. Results: For total GWG, 39% and 27% of women had inadequate and excessive GWG, respectively. 57% and 46% had excessive GWG rates in the 2nd and 3rd trimesters, respectively, with 29% having excessive rates in both trimesters. Inadequate total GWG was associated with lower infant weight and length outcomes (ß range for z-scores = −0.21 to −0.46, p < 0.05) and lower risk of LGA (adjusted Relative Risk, aRR = 0.38; 95% confidence intervals, CI: 0.16, 0.95) and rapid weight gain (aRR = 0.72; 95%CI: 0.51, 1.00). GWG rates above recommendations in the 2nd trimester or 2nd/3rd trimesters were associated with greater weight outcomes at birth and 6 months (ß range for z-scores = 0.24 to 0.35, p < 0.05). Conclusions: Counseling women about health behaviors and closely monitoring GWG beginning in early pregnancy is necessary, particularly among populations at high-risk of obesity.
Trends and Patterns of Phthalates and Phthalate Alternatives Exposure in Pregnant Women from Mexico City during 2007-2010Wu, H., Kupsco, A. J., Deierlein, A. L., Just, A. C., Calafat, A. M., Oken, E., Braun, J. M., Mercado-Garcia, A., Cantoral, A., Téllez-Rojo, M. M., Wright, R. O., & Baccarelli, A. A.
Journal titleEnvironmental Science and Technology
Page(s)1740-1749Phthalates are associated with several adverse health outcomes, but few studies have evaluated phthalate exposures in Mexican populations, particularly pregnant women. Between 2007 and 2011, 948 pregnant women from Mexico City were recruited as part of the PROGRESS cohort. We quantified 17 metabolites of phthalates and phthalate alternatives in urine samples collected during the second and third trimesters and examined temporal trends of metabolite concentrations, within-person reproducibility, and relations of individual metabolites with sociodemographic, lifestyle, and occupational factors. Concentrations of mono-2-ethyl-5-carboxypentyl terephthalate, a metabolite of the alternative phthalate di-2-ethylhexyl terephthalate, increased monotonically from 2007 to 2010 (31% per year; 95% confidence interval = 23 and 39%). We observed moderate to high correlations among metabolites collected at the same visit, but there was high variability between second and third trimester phthalate metabolite concentrations (intraclass correlation coefficients = 0.17-0.35). In general, higher socioeconomic status was associated with higher phthalate concentrations. Some metabolites were associated with maternal age and education, but no consistent patterns were observed. Women working in the home and those who worked in administration had higher concentrations of several phthalate metabolites relative to students, professionals, and those in customer service. Biomonitoring efforts are warranted to investigate present and future exposure trends and patterns.
Correlates of Prenatal Diet Quality in Low-Income Hispanic WomenThomas Berube, L., Messito, M. J., Woolf, K., Deierlein, A., & Gross, R.
Journal titleJournal of the Academy of Nutrition and Dietetics
Page(s)1284-1295Background: Low-income Hispanic women are at-risk of poor prenatal diet quality. Correlates associated with prenatal diet quality in this group of women are understudied. Objective: The objective of this study was to examine the associations between financial, cultural, psychosocial, and lifestyle correlates and prenatal diet quality in low-income Hispanic women. Design: This cross-sectional analysis used data from pregnant women enrolled in the Starting Early Trial, a randomized-controlled trial of a primary-care based child obesity prevention program beginning in pregnancy. The trial enrolled women from clinics affiliated with a large urban medical center in New York City from 2012 to 2014. Financial, cultural, psychosocial, and lifestyle variables were collected using a comprehensive baseline questionnaire. Usual dietary intakes over the past year were assessed using the Block Food Frequency Questionnaire 2005 bilingual version. Participants: The study enrolled low-income Hispanic women between 28 and 32 gestational weeks (N=519). Main outcome measures: Prenatal diet quality was measured by the Healthy Eating Index 2015. Statistical analyses performed: Unadjusted and adjusted multivariable linear regression analyses were performed to determine independent associations between financial, cultural, psychosocial, and lifestyle correlates and Healthy Eating Index 2015 total score. Results: Overall prenatal diet quality was poor (mean Healthy Eating Index 2015 total score=69.0±9.4). Most women did not meet the maximum score for total vegetables (65.3%), whole grains (97.1%), dairy (74.8%), fatty acids (84.4%), refined grains (79.8%), sodium (97.5%), saturated fats (92.9%), and added sugars (66.5%). Women who reported screen time ≤2 hours/day, physical activity before and/or during pregnancy, and being born outside the United States had higher mean Healthy Eating Index 2015 total score than women with screen time >2 hours/day, no physical activity, and those born in the United States. Conclusions: Prenatal diet quality of low-income pregnant Hispanic women was suboptimal. This cross-sectional study revealed associations between cultural and lifestyle factors and prenatal diet quality in low-income Hispanic women. Longitudinal studies are needed to determine long-term influences and specific behaviors to target for effective intervention studies.
Development of a technology-assisted food frequency questionnaire for elementary and middle school children: Findings from a pilot studyDeierlein, A. L., Bihuniak, J. D., Nagi, E., Litvak, J., Victoria, C., Braune, T., Weiss, R., & Parekh, N.
Issue5Background: This pilot study collected preliminary data for the modification of the VioScreen Food Frequency Questionnaire (FFQ), an adult-validated, self-administered, web-based dietary assessment tool for use in older children. Methods: A convenience sample of 55 children, aged 6–14 years, completed the VioScreen FFQ and 3-day diet record (reference standard). Caregivers completed a short sociodemographic questionnaire. Reported dietary intakes from the VioScreen FFQ and 3-day diet record were calculated using standard nutrient databases, and descriptive statistics were used to examine differences in food/beverage items and portion sizes between the two methods. Informal focus groups obtained user feedback and identified components of the VioScreen FFQ that required modifications. Results: The highest de-attenuated Pearson correlation coefficients between the VioScreen FFQ and 3-day diet record were observed for iron (r = 0.69), saturated fat (r = 0.59), and vegetables (r = 0.56), and the lowest were for whole grains (r = 0.11) and vitamin C (r = 0.16). Qualitative feedback was overall positive, and six technological modifications were identified. Conclusion: Findings from this pilot study provided valuable information on the process of evaluating the use of the VioScreen FFQ among older children, and will inform the future development of a modified version for this population.
Do Women Know Their Prepregnancy Weight?Thomas, D. M., Oken, E., Rifas-Shiman, S. L., Téllez-Rojo, M., Just, A., Svensson, K., Deierlein, A. L., Chandler-Laney, P. C., Miller, R. C., McNamara, C., Phelan, S., Yoshitani, S., Butte, N. F., & Redman, L. M.
Page(s)1161-1167Objective: Prepregnancy weight may not always be known to women. A model was developed to estimate prepregnancy weight from measured pregnancy weight. Methods: The model was developed and validated using participants from two studies (Project Viva, n = 301, model development; and Fit for Delivery [FFD], n = 401, model validation). Data from the third study (Programming Research in Obesity, Growth, Environment and Social Stressors [PROGRESS]), which included women from Mexico City, were used to demonstrate the utility of the newly developed model to objectively quantify prepregnancy weight. Results: The model developed from the Project Viva study validated well with low bias (R2 = 0.95; y = 1.02x − 0.69; bias = 0.68 kg; 95% CI: −4.86 to 6.21). Predictions in women from FFD demonstrated good agreement (R2 = 0.96; y = 0.96x + 4.35; bias = 1.60 kg; 95% CI: −4.40 to 7.54; error range = −11.25 kg to 14.73 kg). High deviations from model predictions were observed in the Programming Research in PROGRESS (R2 = 0.81; y = 0.89x + 9.61; bias = 2.83 kg; 95% CI: −7.70 to 12.31; error range = −39.17 kg to 25.73 kg). The model was programmed into software (https://www.pbrc.edu/research-and-faculty/calculators/prepregnancy/). Conclusions: The developed model provides an alternative to determine prepregnancy weight in populations receiving routine health care that may not have accurate knowledge of prepregnancy weight. The software can identify misreporting and classification into incorrect gestational weight gain categories.
Lead exposure during childhood and subsequent anthropometry through adolescence in girlsFailed generating bibliography.Abstract
Journal titleEnvironment International
Page(s)310-315Introduction: Cross-sectional studies suggest that postnatal blood lead (PbB) concentrations are negatively associated with child growth. Few studies prospectively examined this association in populations with lower PbB concentrations. We investigated longitudinal associations of childhood PbB concentrations and subsequent anthropometric measurements in a multi-ethnic cohort of girls. Methods: Data were from The Breast Cancer and the Environment Research Program at three sites in the United States (U.S.): New York City, Cincinnati, and San Francisco Bay Area. Girls were enrolled at ages 6–8 years in 2004–2007. Girls with PbB concentrations collected at ≤10 years old (mean 7.8 years, standard deviation (SD) 0.82) and anthropometry collected at ≥3 follow-up visits were included (n = 683). The median PbB concentration was 0.99 μg/d (10th percentile = 0.59 μg/dL and 90th percentile = 2.00 μg/dL) and the geometric mean was 1.03 μg/dL (95% Confidence Interval (CI): 0.99, 1.06). For analyses, PbB concentrations were dichotomized as <1 μg/dL (n = 342) and ≥1 μg/dL (n = 341). Anthropometric measurements of height, body mass index (BMI), waist circumference (WC), and percent body fat (%BF) were collected at enrollment and follow-up visits through 2015. Linear mixed effects regression estimated how PbB concentrations related to changes in girls’ measurements from ages 7–14 years. Results: At 7 years, mean difference in height was −2.0 cm (95% CI: −3.0, −1.0) for girls with ≥1 μg/dL versus <1 μg/dL PbB concentrations; differences persisted, but were attenuated, with age to −1.5 cm (95% CI: −2.5, −0.4) at 14 years. Mean differences for BMI, WC, and BF% at 7 years between girls with ≥1 μg/dL versus <1 μg/dL PbB concentrations were −0.7 kg/m 2 (95% CI: −1.2, −0.2), −2.2 cm (95% CI: −3.8, −0.6), and −1.8% (95% CI: −3.2, −0.4), respectively. Overall, these differences generally persisted with advancing age and at 14 years, differences were −0.8 kg/m 2 (95% CI: −1.5, −0.02), −2.9 cm (95% CI: −4.8, −0.9), and −1.7% (95% CI: −3.1, −0.4) for BMI, WC, and BF%, respectively. Conclusions: These findings suggest that higher concentrations of PbB during childhood, even though relatively low by screening standards, may be inversely associated with anthropometric measurements in girls.
Processing level and diet quality of the US grocery cart: Is there an association?Juul, F., Simões, B. D. S., Litvak, J., Martinez-Steele, E., Deierlein, A., Vadiveloo, M., & Parekh, N.
Journal titlePublic Health Nutrition
Page(s)2357-2366Objective: The majority of groceries purchased by US households are industrially processed, yet it is unclear how processing level influences diet quality. We sought to determine if processing level is associated with diet quality of grocery purchases. Design: We analysed grocery purchasing data from the National Household Food Acquisition and Purchase Survey 2012-2013. Household grocery purchases were categorized by the NOVA framework as minimally processed, processed culinary ingredients, processed foods or ultra-processed foods. The energy share of each processing level (percentage of energy; %E) and Healthy Eating Index-2015 (HEI-2015) component and total scores were calculated for each household's purchases. The association between %E from processed foods and ultra-processed foods, respectively, and HEI-2015 total score was determined by multivariable linear regression. Foods purchased by households with the highest v. lowest ultra-processed food purchases and HEI-2015 total score <40 v. ≥60 were compared using linear regression. Setting: USA. Participants: Nationally representative sample of 3961 households. Results: Processed foods and ultra-processed foods provided 9·2 (se 0·3) % and 55·8 (se 0·6) % of purchased energy, respectively. Mean HEI-2015 score was 54·7 (se 0·4). Substituting 10 %E from minimally processed foods and processed culinary ingredients for ultra-processed foods decreased total HEI-2015 score by 1·8 points (β = -1·8; 95 % CI -2·0, -1·5). Processed food purchases were not associated with diet quality. Among households with high ultra-processed food purchases, those with HEI-2015 score <40 purchased less minimally processed plant-foods than households with HEI-2015 score ≥60. Conclusions: Increasing purchases of minimally processed foods, decreasing purchases of ultra-processed foods and selecting healthier foods at each processing level may improve diet quality.
Weight perception, weight control intentions, and dietary intakes among adolescents ages 10–15 years in the United StatesDeierlein, A. L., Malkan, A., Litvak, J., & Parekh, N.
Journal titleInternational journal of environmental research and public health
Issue6Background: To examine associations of adolescents’ weight status perception and weight control intentions with dietary intakes. Methods: Cross-sectional data from adolescents aged 10–15 in the National Health and Nutrition Examination Surveys, 2005–2014 (n = 4940). Adolescents responded to questions regarding weight perception and if they were trying to change their weight. Intakes of calories, protein, carbohydrate, fat, saturated fat, sugar, and fiber were assessed using 24-h dietary recalls. Multivariable linear regression estimated associations of intakes with weight perception and weight control intentions. Results: The majority of adolescents perceived their weight as “about right”; however, 45% and 46% of boys and girls, respectively, reported trying to change their weight. Weight perception was not associated with intakes, with the exception of lower sugar (−13.65 g, 95% CI: −23.06, −4.23) and higher percent calories from protein (1.01%, 95% CI: 0.16, 1.87) in boys with overweight/obesity who perceived themselves as overweight, as well as lower percent calories from saturated fat (−1.04%, 95% CI: −2.24, −0.17) among girls with normal weight who perceived themselves as overweight. Weight control intentions were associated with intakes in boys only. Compared to boys who never tried to lose weight, boys who tried to lose weight consumed fewer calories (−188.34 kcal, 95% CI: −357.67, −19.01), a lower percent of calories from fat (−1.41%, 95% CI: −2.80, −0.02), and a greater percent of calories from protein (1.48%, 95% CI: 0.41, 2.55). Conclusions: Despite perceiving weight as “about right”, many adolescents reported trying to change their weight, which was associated with some dietary intakes. Efforts may be necessary to educate adolescents on healthy nutrition and weight management behaviors.
Concerns About Current Breast Milk Intake Measurement for Population-Based StudiesThomas Berube, L., Gross, R., Messito, M. J., Deierlein, A., Katzow, M., & Woolf, K.
Journal titleJournal of the Academy of Nutrition and Dietetics
Phenol concentrations during childhood and subsequent measures of adiposity among young girlsDeierlein, A. L., Wolff, M. S., Pajak, A., Pinney, S. M., Windham, G. C., Galvez, M. P., Rybak, M., Calafat, A. M., Kushi, L. H., Biro, F. M., & Teitelbaum, S. L.
Journal titleAmerican Journal of Epidemiology
Page(s)581-592Phenolic compounds represent a class of environmental chemicals with potentially endocrine-disrupting capabilities. We investigated longitudinal associations between childhood exposure to phenols, from both manmade and natural sources, and subsequent measures of adiposity among girls enrolled in the Breast Cancer and the Environment Research Program between 2004 and 2007. Baseline (ages 6-8 years) urinary concentrations were obtained for creatinine and phenol metabolites: enterolactone, genistein, daidzein, benzophenone-3, bisphenol A, the sum of parabens (methyl, ethyl, and propyl parabens), 2,5-dichlorophenol, and triclosan. Body mass index (weight (kg)/height (m)2), waist circumference, and percent body fat were measured at annual or semiannual examinations through 2015 (n = 1,017). Linear mixed-effects regression was used to estimate how baseline concentrations of phenols (tertile groups) were related to changes in girls' adiposity measurements from ages 7 through 15 years. Enterolactone was inversely associated with body mass index, waist circumference, and percent body fat, while 2,5-dichlorophenol was positively associated with these measurements. A nonmonotonic association was observed for triclosan and girls' adiposity; however, it was due to effect modification by baseline overweight status. Triclosan was positively associated with adiposity only among overweight girls. These results suggest that exposure to specific phenols during childhood may influence adiposity through adolescence.
Is meeting the recommended dietary allowance (RDA) for protein related to body composition among older adults?: Results from the Cardiovascular Health of Seniors and Built Environment StudyBeasley, J. M., Deierlein, A. L., Morland, K. B., Granieri, E. C., & Spark, A.
Journal titleJournal of Nutrition, Health and Aging
Page(s)790-796Objective: Studies suggest protein intake may be associated with lower body weight, but protein has also been associated with preservation of lean body mass. Understanding the role of protein in maintaining health for older adults is important for disease prevention among this population. Design: Cross-sectional study of the relationship of dietary protein on body composition. Setting: New York City community centers. Participants: 1,011 Black, White, and Latino urban men and women 60-99 years of age. Measurements: Protein intake was assessed using two interviewer-administered 24-hour recalls, and body composition was assessed using bioelectrical impedance analysis (BIA) of fat mass (kg) (FM), fat free mass (kg) (FFM), and impedance resistance (Ohms). Statistical Analysis: Indices of FM and FFM were calculated by dividing BIA measurements by height squared (m2), and percent FFM was calculated by dividing FFM by the sum of FM and FFM. Log linear models adjusting for age (continuous), race/ethnicity, education, physical activity (dichotomized at the median), hypertension, diabetes, and total calories (continuous). Results: Just 33% of women and 50% of men reported meeting the RDA for protein. Both fat free mass index (FFMI) and fat mass index (FMI) were negatively associated with meeting the RDA for protein (Women: FFMI -1.78 95%CI [-2.24, -1.33], FMI -4.12 95% CI [-4.82, -3.42]; Men: FFMI -1.62 95% CI [-2.32, -0.93] FMI -1.80 95% CI [-2.70, -0.89]). After accounting for confounders, women and men consuming at least 0.8 g/kg/day had a 6.2% (95% CI: 5.0%, 7.4%) and a 3.2% (95% CI 1.1%, 5.3%) higher percent fat free mass, respectively. Conclusions: FFM, FFMI, FM, and FMI were inversely related to meeting the RDA for protein. Meeting the RDA for protein of at least 0.8g/kg/day was associated with a higher percentage of fat free mass among older adults. These results suggest meeting the protein recommendations of at least 0.8 g/kg/day may help to promote lower overall body mass, primarily through loss of fat mass rather than lean mass.
Longitudinal associations of phthalate exposures during childhood and body size measurements in young girlsDeierlein, A. L., Wolff, M. S., Pajak, A., Pinney, S. M., Windham, G. C., Galvez, M. P., Silva, M. J., Calafat, A. M., Kushi, L. H., Biro, F. M., & Teitelbaum, S. L.
Page(s)492-499Background: Phthalates are environmental chemicals that may play a role in the development of obesity. Few studies have investigated longitudinal associations between postnatal phthalate exposures and subsequent anthropometric measurements in children. Methods: We collected data as part of The Breast Cancer and Environment Research Program at three US sites. A total of 1,239 girls, aged 6-8 years, were enrolled in 2004-2007. We categorized baseline phthalate exposures, assessed from creatinine-corrected urinary concentrations of low-molecular weight phthalate metabolites, as low, <78; medium, 78 to <194; and high, ≥194 μg/g creatinine and of high-molecular weight phthalates as low, <111; medium, 111-278; and high, ≥278 μg/g creatinine. Anthropometric measurements were collected through 2012 (n = 1,017). Linear mixed effects regression estimated how baseline low and high-molecular weight phthalate concentrations related to changes in girls' body mass index (BMI), height, and waist circumference at ages 7-13 years. Results: Low-molecular weight phthalates were positively associated with gains in BMI and waist circumference. Predicted differences in BMI and waist circumference between girls with high versus low concentrations of low-molecular weight phthalates increased from 0.56 (95% confidence interval [CI]: -0.02, 1.1) to 1.2 kg/m2 (95% CI: 0.28, 2.1) and from 1.5 (95% CI: -0.38, 3.3) to 3.9 cm (95% CI: 1.3, 6.5), respectively. High-molecular weight phthalates were negatively associated with height but only among girls who were normal weight at baseline (BMI ≤ 85th percentile). Conclusion: Phthalates, specifically low-molecular weight phthalates, have small but detectable associations with girls' anthropometric outcomes. Low-molecular weight phthalates showed stronger associations than other types of phthalates.
Comparison of the nutrient content of children's menu items at US restaurant chains, 2010-2014Deierlein, A. L., Peat, K., & Claudio, L.
Journal titleNutrition Journal
Issue1Objective: To determine changes in the nutritional content of children's menu items at U.S. restaurant chains between 2010 and 2014. Methods: The sample consisted of 13 sit down and 16 fast-food restaurant chains ranked within the top 50 US chains in 2009. Nutritional information was accessed in June-July 2010 and 2014. Descriptive statistics were calculated for nutrient content of main dishes and side dishes, as well as for those items that were added, removed, or unchanged during the study period. Results: Nutrient content of main dishes did not change significantly between 2010 and 2014. Approximately one-third of main dishes at fast-food restaurant chains and half of main dishes at sit down restaurant chains exceeded the 2010 Dietary Guidelines for Americans recommended levels for sodium, fat, and saturated fat in 2014. Improvements in nutrient content were observed for side dishes. At sit down restaurant chains, added side dishes contained over 50 % less calories, fat, saturated fat, and sodium, and were more likely to contain fruits/vegetables compared to removed sides (p∈<∈0.05 for all comparisons). Added side dishes at fast-food restaurant chains contained less saturated fat (p∈<∈0.05). Conclusions: The majority of menu items, especially main dishes, available to children still contain high amounts of calories, fat, saturated fat, and sodium. Efforts must be made by the restaurant industry and policy makers to improve the nutritional content of children's menu items at restaurant chains to align with the Dietary Guidelines for Americans. Additional efforts are necessary to help parents and children make informed choices when ordering at restaurant chains.
Analysis of the Caloric and Macronutrient Content of Meal Options Offered to Children at Popular Restaurant ChainsDeierlein, A., Coffman, K., & Claudio, L.
Journal titleInternational Journal of Child Health and Nutrition
Diet Quality of Urban Older Adults Age 60 to 99 Years: The Cardiovascular Health of Seniors and Built Environment StudyDeierlein, A. L., Morland, K. B., Scanlin, K., Wong, S., & Spark, A.
Journal titleJournal of the Academy of Nutrition and Dietetics
Page(s)279-287There are few studies that evaluate dietary intakes and predictors of diet quality in older adults. The objectives of this study were to describe nutrient intakes and examine associations between demographic, economic, behavioral, social environment, and health status factors and diet quality. Cross-sectional data were from black, white, and Hispanic adults, age 60 to 99 years, living independently in New York City and participating in the Cardiovascular Health of Seniors and the Built Environment Study, 2009-2011 (n=1,306). Multivariable log-linear regression estimated associations between selected factors and good diet quality, defined as a Healthy Eating Index score more than 80 (based on the 2005 Dietary Guidelines for Americans [HEI-2005]). Dietary intakes were similar for men and women; intakes of energy, fiber, and the majority of micronutrients were less than recommendations, whereas intakes of fats, added sugar, and sodium were within the upper range or exceeded recommendations. Hispanic ethnicity (relative risk [RR]=1.37; 95% CI 1.07 to 1.75), energy intake <~1,500 kcal/day (RR=1.93; 95% CI, 1.37 to 2.71), adherence to a special diet (RR=1.23; 95% CI: 1.02 to 1.50), purchasing food at supermarkets at least once/week (RR=1.34; 95% CI, 1.04 to1.74), and being married/living with a partner (RR=1.37; 95% CI, 1.10 to 1.71) were positively associated with HEI-2005 score more than 80. Consuming at least one restaurant meal/day was negatively associated with HEI-2005 score more than 80 (RR=0.69; 95%CI, 0.50-0.94). These findings identify specific groups of older adults, such as blacks or those who live alone, who may benefit from dietary interventions, as well as specific modifiable behaviors among older adults, such as eating restaurant meals or shopping at supermarkets, which may be targeted through interventions.
Local food environments are associated with girls' energy, sugar-sweetened beverage and snack-food intakesDeierlein, A. L., Galvez, M. P., Yen, I. H., Pinney, S. M., Biro, F. M., Kushi, L. H., Teitelbaum, S., & Wolff, M. S.
Journal titlePublic Health Nutrition
Page(s)2194-2200Objective: To describe availability and frequency of use of local snack-food outlets and determine whether reported use of these outlets was associated with dietary intakes. Design: Data were cross-sectional. Availability and frequency of use of three types of local snack-food outlets were reported. Daily dietary intakes were based on the average of up to four 24 h dietary recalls. Multivariable linear regression models estimated average daily intakes of energy, sugar-sweetened beverages (SSB) and snack foods/sweets associated with use of outlets. Setting: Multi-site, observational cohort study in the USA, 2004-2006. Subjects: Girls aged 6-8 years (n 1010). Results: Weekly frequency of use of local snack-food outlets increased with number of available types of outlets. Girls with access to only one type of outlet reported consuming food/beverage items less frequently than girls with access to two or three types of outlets (P < 0·001). Girls' daily energy, SSB and snack foods/sweets intakes increased with greater use of outlets. Girls who reported using outlets > 1 to 3 times/week consumed 0·27 (95 % CI 0·13, 0·40) servings of SSB more daily than girls who reported no use. Girls who reported using outlets > 3 times/week consumed 449·61 (95 % CI 134·93, 764·29) kJ, 0·43 (95 % CI 0·29, 0·58) servings of SSB and 0·38 (95 % CI 0·12, 0·65) servings of snack foods/sweets more daily than those who reported no use. Conclusions: Girls' frequency of use of local snack-food outlets increases with the number of available types of outlets and is associated with greater daily intakes of energy and servings of SSB and snack foods/sweets.
An anthropometric model to estimate neonatal fat mass using air displacement plethysmographyDeierlein, A. L., Thornton, J., Hull, H., Paley, C., & Gallagher, D.
Journal titleNutrition and Metabolism
Volume9Background: Current validated neonatal body composition methods are limited/impractical for use outside of a clinical setting because they are labor intensive, time consuming, and require expensive equipment. The purpose of this study was to develop an anthropometric model to estimate neonatal fat mass (kg) using an air displacement plethysmography (PEA POD Infant Body Composition System) as the criterion. Methods. A total of 128 healthy term infants, 60 females and 68 males, from a multiethnic cohort were included in the analyses. Gender, race/ethnicity, gestational age, age (in days), anthropometric measurements of weight, length, abdominal circumference, skin-fold thicknesses (triceps, biceps, sub scapular, and thigh), and body composition by PEA POD were collected within 1-3 days of birth. Backward stepwise linear regression was used to determine the model that best predicted neonatal fat mass. Results: The statistical model that best predicted neonatal fat mass (kg) was: -0.012 -0.064*gender + 0.024*day of measurement post-delivery -0.150*weight (kg) + 0.055*weight (kg) 2 + 0.046*ethnicity + 0.020*sum of three skin-fold thicknesses (triceps, sub scapular, and thigh); R 2 = 0.81, MSE = 0.08 kg. Conclusions: Our anthropometric model explained 81% of the variance in neonatal fat mass. Future studies with a greater variety of neonatal anthropometric measurements may provide equations that explain more of the variance.
Gestational weight gain and predicted changes in offspring anthropometrics between early infancy and 3 yearsDeierlein, A. L., Siega-Riz, A. M., Herring, A. H., Adair, L. S., & Daniels, J. L.
Journal titlePediatric Obesity
Page(s)134-142Objective: To determine how gestational weight gain (GWG), categorized using the 2009 Institute of Medicine recommendations, relates to changes in offspring weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length z-scores (WLZ) between early infancy and 3 years. Methods: Women with singleton infants were recruited from the third cohort of the Pregnancy, Infection, and Nutrition Study (2001-2005). Term infants with at least one weight or length measurement during the study period were included (n = 476). Multivariable linear mixed effects regression models estimated longitudinal changes in WAZ, LAZ and WLZ associated with GWG. Results: In early infancy, compared with infants of women with adequate weight gain, those of women with excessive weight gains had higher WAZ, LAZ and WLZ. Excessive GWG ≥ 200% of the recommended amount was associated with faster rates of change in WAZ and LAZ and noticeably higher predicted mean WAZ and WLZ that persisted across the study period. Conclusions: GWG is associated with significant differences in offspring anthropometrics in early infancy that persisted to 3 years of age. More longitudinal studies that utilize maternal and paediatric body composition measures are necessary to understand the nature of this association.
Long–term consequences of obesity in pregnancy for the motherDeierlein, A., & Siega-Riz, A. M. In , & , Maternal Obesity.
Page(s)81-86Current knowledge argues that pregnancy serves as a preview of a woman’s long-term health. The numerous physiological changes during pregnancy, which stress the metabolic system , can reveal subclinical disease states as well as identify new ones [2,3]. Evidence for this assertion exists in studies that have examined the association between gestational diabetes mellitus (GDM) and subsequent type 2 diabetes mellitus (T2DM) , as well as hypertensive disorders during pregnancy and subsequent cardiovascular disease risk factors . Whether pregnancy is on the causal pathway or simply a time period that allows these chronic diseases to be unmasked remains yet to be determined. Obese women are more likely to be at higher risk of developing complications such as GDM, hypertensive disorders, and pre-eclampsia during pregnancy [6–9]. In this chapter we will focus on the evidence for the association between gestational weight gain and postpartum weight retention among obese women, as well as the association between obesity and lack of breastfeeding, and how these associations are potentially interrelated to cause further disease in obese women. Postpartum weight retention. Pregnancy and its associated weight gain may be potential “triggers” for the development of obesity in women [10,11]. Pooled estimates of average absolute postpartum weight retention in units of body mass index (BMI) (kg/m2) are 2.42 (95% CI: 2.32–2.52) at six weeks, 1.14 (95% CI: 1.04–1.25) at six months, and 0.46 (95% CI: 0.38–0.54) at twelve months postpartum . These estimates suggest that most women will lose the majority of weight that is associated with pregnancy within one year postpartum. However, many studies have observed a wide range of variation in postpartum weight retention [13,14], with as many as 20% of women having substantial postpartum weight retention ranging over 5kg (11lbs) .
Maternal Glucose and Child BMI in the YoungDeierlein, A. In , & , Food and Nutritional Components in Focus.
Physical activity during pregnancy and risk of hyperglycemiaDeierlein, A. L., Siega-Riz, A. M., & Evenson, K. R.
Journal titleJournal of Women's Health
Page(s)769-775Objective: To determine the association between moderate and vigorous physical activities (MVPA) during midpregnancy and the risk of hyperglycemia. Methods: Data were from 1437 pregnant women. Frequency, duration, and intensity of MVPA during the previous 7 days were collected via questionnaire at 17-22 weeks' gestation. Modes of MVPA included work, recreation, transportation, caregiving, and indoor and outdoor household activities. Hyperglycemia was defined as a glucose concentration ≥130 mg/dL on a 1-hour, 50-g glucose challenge test or gestational diabetes mellitus (GDM) assessed at ∼27 weeks' gestation. Multivariable Poisson regression estimated risks of hyperglycemia associated with total and mode-specific MVPA. Results: There were 269 women (18.7%) with hyperglycemia. Any metabolic equivalent (MET) hours/week of recreational MVPA was associated with a 27% lower risk of hyperglycemia (adjusted relative risk, [aRR] 0.73, 95% confidence interval [95%CI] 0.54-0.99). Multiplicative interaction terms were significant for prepregnancy body mass index (BMI) and recreational MVPA (p=0.01). Among women with prepregnancy BMI <25 kg/m 2, recreational MVPA was associated with a 48% lower risk of hyperglycemia (aRR 0.52, 95%CI 0.33-0.83) compared to women who reported none. There was no association of hyperglycemia and recreational MVPA among women with prepregnancy BMI <25 kg/m 2. Conclusions: Recreational MVPA during pregnancy is associated with a lower risk of hyperglycemia, specifically among women with prepregnancy BMI <25 kg/m 2. Further research is warranted to determine recommended amounts and intensities of physical activity and to discern whether there are differences in the effects of physical activity between specific modes of physical activity or among subgroups of women in relation to hyperglycemia.
Postpartum Weight Retention, Chronic Disease, and Optimal Inter-Pregnancy IntervalGillman, M. W., Poston, L., & Deierlein, A. In , & , Maternal Obesity.