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* Disparities in Breastfeeding for African American Mothers


* Lessons in Feeding Children During COVID-19 Pandemic


* Impact of Revised WIC Food Packages



Gaps remain when it comes to feeding children. The majority of policy efforts both before and during the pandemic have focused on weekday meals, which has left millions of children hungry when schools are not in session. And, despite considerable policy progress, high rates of food insecurity among families suggest that recent efforts have been insufficient. Before the pandemic, the federal nutrition safety net included 5 major US Department of Agriculture programs aimed at alleviating child hunger. In a recent New England Journal of Medicine commentary, authors, including Nutrition Today Editorial board member Sheila Fleishhacker, PhD, JD, spoke of the gaps in the ongoing efforts to help children impacted by the pandemic. During the pandemic, schools have struggled to maintain adequate participation in programs offering to-go meals. Possibly this is because they have tried to implement modified meal programs upon short notice while communicating changing US Department of Agriculture guidance to families.


The authors identify a few programs that have been implemented, such as the Pandemic Electronic Benefits Transfer, congressional allocation of emergency of Supplemental Nutrition Assistance Program (SNAP) benefits, and the Coronavirus Aid, Relief, and Economic Security Act that provided stimulus checks to eligible families.


These programs are helpful, but their limitations give pause for not only their current impact, but also future needs in implementation needs, such as the size of the SNAP benefit, which may be inadequate due to increasing food prices, loss of access to other reliable sources of food, and loss of family income due to job loss. These problems mean that limited SNAP benefits need to stretch further than usual during the pandemic, and benefits were not increased to the 40% of SNAP participants who were already receiving the maximum benefit. During the pandemic the loose and not always well-coordinated web of efforts to feed children on weekends and during instructional breaks did not reach all children. Participation rates were low in programs that provide food during weekends and instructional breaks, and the reach of these programs was typically limited to children who live close to participating sites.


Long-term federal approaches appear to be needed, and continued innovation will be vital for reducing food insecurity among children. Pandemic-related waivers and innovations have created an opportunity to permanently strengthen the federal nutrition safety net. According to the authors, "any changes should be based on careful evaluation of the effectiveness of pandemic-related programs and with an eye toward feeding as many hungry children as possible. The ultimate goal should be to ensure that children have adequate access to food on all days of the week, all year long, and in all settings."


Source: Poole MK, Fleischhacker SE, Bleich SN. Addressing child hunger when school is closed-considerations during the pandemic and beyond. N Engl J Med January 20, 2021 DOI: 10.1056/NEJMp2033629



Revisions to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), one of the largest US safety net programs, were made in 2009 to be more congruent with dietary guidelines. Downstream they may improve infant cognitive development, according to researchers who analyzed data from a cohort of 1222 women and children enrolled in the Conditions Affecting Neurocognitive Development and Learning in Early Childhood study from 2006 to 2011. Measures of growth and cognitive and socioemotional development were compared between WIC recipients and nonrecipients before and after policy revision. Overall, infants of women who received the WIC food package showed small but significant increases in length-for-age z scores at 12 months of age (0.33, representing approximately one-fifth of a standard deviation) compared with infants of women who did not receive the revised WIC package. In addition, the Bayley Scales of Infant Development cognitive composite score showed a 4.3-point increase at 24 months of age (approximately one-third of a SD) compared with infants of women who did not receive the revised WIC package.


No effects on growth at age 24 months or on cognitive development at age 4 to 6 years were noted, however, which suggests that the impact of the WIC program during pregnancy may fade over time. This study provides some of the first evidence that children of mothers who received the revised WIC food package during pregnancy had improved developmental outcomes in the first 2 years of life. These findings highlight the value of WIC in improving early developmental outcomes among vulnerable children. The need to implement and expand policies supporting the health of marginalized groups has never been more salient, particularly given the nation's economic and social disparities.


Source: Guan A, Hamad R, Batra A, Bush NR, Tylavsky FA, LeWinn KZ, The revised WIC food package and child development: a quasi-experimental study. Pediatrics 2021;147(2):e20201853; doi:



An abundance of data underscores the importance of breastfeeding and human milk for the optimal health of infants, children, mothers, and society. But while breastfeeding initiation rates have increased to more than 80% in the United States, a disparity exists for African American mothers and infants. In this group, breastfeeding is initiated approximately only 69% of the time. A new study to help identify the best strategies and practices to improve breastfeeding in the African American community leverages the opinions, knowledge, and experiences of subject matter experts with national and international exposure to policies and practices influencing African American breastfeeding initiation rates. The insight from the expert was compared with focus group data with African American mothers who identified the facilitators of and barriers to breastfeeding initiation. The comparison highlighted fundamental issues related to breastfeeding disparities, including the continued presence of stereotyping, disparities in approaches to care based on culture, and lack of access/resources in specific communities and locations.


Source: Hinson TD, Skinner AC, Spatz DL. Subject matter experts identify health equity concerns in breastfeeding for African American women [published online December 15, 2020]. J Perinat Neonatal Nurs; doi: 10.1097/JPN.0000000000000486



Studies in the past have linked coffee and caffeine consumption to incident arrhythmias. Now a new study based on pooled data from 3 large epidemiological studies indicates coffee intake was linked to a lower risk of heart failure. To develop a greater understanding of lifestyle and behavioral factors associated with negative impacts on cardiovascular health, researchers from multiple institutions in this country designed the current study to assess the impact of responses related to dietary domains on incident cardiovascular disease risk. Investigators used data from the Framingham Heart Study in their primary analysis and checked these results to validate them in cohorts from the Cardiovascular Heart Study and the Atherosclerosis Risk in Communities (ARIC) study.


Dietary variables used in the analyses included red meat consumption, whole milk consumption, and coffee consumption. Outcomes of interest included time to incident coronary heart disease, heart failure, and stroke. In their initial analyses, coffee consumption was the only dietary factor that was significantly associated with any of the outcomes of interest. Specifically, increased caffeinated coffee consumption was associated with a significantly reduced risk of heart failure (hazard ratio [HR], 0.95 per cup per day [95% confidence interval, 0.91-0.99]; P = .02) and stroke (HR, 0.94 per cup/day [95% confidence interval, 0.89-0.99]; P = .02) but not coronary heart disease (P = .21) or cardiovascular disease (P = .59). In univariable analyses, increased coffee consumption was significantly associated with decreased risk of heart failure in the Cardiovascular Health Study (HR, 0.86 per cup/day [95% confidence interval, 0.78-0.96]; P = .005) and also in the ARIC study (HR, 0.98 per cup/day [95% confidence interval, 0.96-0.99]; P = .048).


The study provides clinicians with additional evidence on the impact of coffee intake on risk of heart failure, coronary heart disease, and stroke in patients with no prior history of cardiovascular disease.


More work needs to be done, however. Study limitations included inability to determine the type of coffee consumed and manner of brewing, potential variability in measurement for 1 cup of coffee, and inability to account for other sources of caffeine such as energy drinks, caffeinated teas, and soda. But in the meantime, enjoy your cups of Morning Jo!


Source: Stevens LM, Linstead E, Hall JL, Kao DP. Association between coffee intake and incident and heart failure risk-a machine learning analysis of the FHS, ARIC, and CHS. Circ Heart Fail 2021;14:e006799; doi: 10.1161/CIRCHEARTFAILURE.119.006799