ORCID Profile
0000-0002-4151-3502
Current Organisation
Deakin University
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Statistical data science | Behavioural epidemiology | Epidemiology | Nutritional epidemiology
Publisher: Elsevier BV
Date: 09-2021
Publisher: SAE International
Date: 03-04-2018
DOI: 10.4271/2018-01-0298
Publisher: JMIR Publications Inc.
Date: 19-04-2018
DOI: 10.2196/MHEALTH.9040
Publisher: JMIR Publications Inc.
Date: 29-10-2017
Publisher: Wiley
Date: 04-02-2019
DOI: 10.1111/PPE.12541
Abstract: A range of postnatal and maternal factors influences childhood obesity, but their relative importance remains unclear. This study aimed to assess the relative impact of postnatal rapid growth and maternal factors on early childhood growth trajectories. Secondary longitudinal analysis of pooled data from the Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program and the InFANT Extend Program (n = 977) was performed. Children's height and weight were collected at birth, 3, 9, 18, and 36/42 months. Body mass index-for-age and height-for-age z-scores (BAZ, HAZ) were computed using WHO growth standards. Mixed-effect polynomial regression models were fitted to examine BAZ and HAZ trajectories and their determinants. Rapid growth from birth to 3 months, maternal country of birth, and pre-pregnancy BMI were each independently associated with BAZ from 3 to 42 months. Children with rapid growth, those whose mothers were Australian-born, and those whose mothers were overweight/obese pre-pregnancy had higher BAZ from 3 to 42 months. Children with rapid growth had an increase in HAZ growth, but their average HAZ from 3 to 42 months was smaller than children without rapid growth. Children of tall mothers (above average height) had higher HAZ than those of short mothers (below average height). Average HAZ from 3 to 42 months did not differ by maternal country of birth. Children who experienced rapid growth from birth to 3 months, whose mothers were Australian-born or whose mothers were overweight/obese pre-pregnancy demonstrated less favourable growth trajectories across early childhood, potentially predispose them for development of future obesity.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Wiley
Date: 23-09-2022
DOI: 10.1111/MCN.13429
Abstract: The early and late introduction of complementary food, both prevalent in Ethiopia, are associated with morbidities, growth faltering and developmental risks in children. The interhousehold network around the primary caregiver's intrahousehold network is critical in influencing the age of introducing complementary foods. This study examined the influence of household composition and structures on complementary food introduction. This is a secondary data analysis of four Ethiopian Demographic and Health Surveys conducted between 2000 and 2016. The household structure and composition variables were calculated from household members' kinship status and attribute, respectively. The introduction of solid, semisolid or soft foods was dichotomised as whether the children within 6 to 8 months have been given complementary foods. Multivariable logistic regression with adjustment for the primary caregiver and household characteristics was run to examine the associations between household structure and composition variables and the introduction of complementary foods. The marginal effects (ME) were calculated to facilitate the practical interpretation of the study findings. Large households (>3 nonredundant contacts) with extended family or unrelated people (high effective size, ME = 6.01%, 95% confidence interval [CI]: -8.53, -3.49) lowered the proportion of children starting food within the recommended 6-8 months. Households with close kins (high constraint) (ME = 7.22%, 95% CI: -13.65, 28.09) and greater age ersity (ME = 0.65%, 95% CI: 0.15, 1.15) increased the proportion of children receiving complementary food at an appropriate age. This study revealed that interhousehold structure and composition influence the age of introduction of complementary foods. These factors, therefore, need to be considered in designing interventions to improve age at the introduction of complementary foods.
Publisher: Springer Science and Business Media LLC
Date: 09-12-2023
Publisher: Oxford University Press (OUP)
Date: 21-07-2020
Abstract: To examine the longitudinal and bidirectional association between nighttime sleep duration and emotional and behavioral problems (EBPs) over 15 months among preschool children. Data of children aged 2 to 6 years from the control group of the Danish Healthy Start Study, a 15-month obesity prevention intervention, were used. Nighttime sleep duration was measured using a 7-day sleep record. EBPs were assessed by the Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) score and Prosocial Behavior (SDQ-PSB) score. Multivariable regression models were conducted to examine the bidirectional associations between changes in nighttime sleep duration and SDQ scores. With adjustment for child, family factors, and parental stress level, every hour extra nighttime sleep at baseline was associated with a 1.02 decrease in SDQ-TD score and 77% lower odds of having an abnormal SDQ-TD score (≥90th percentile) at the follow-up (p = 0.01). Children who increased their nighttime sleep duration over the 15-month demonstrated a similar concurrent reduction in SDQ-TD score (β = −1.28, p = 0.02) compared with those who decreased or had no change in nighttime sleep duration. After additional adjustment for sleep problem and habit variables, the significant associations remained. No associations were found between nighttime sleep duration and SDQ-PSB scores. Examination of SDQ scores as predictors of subsequent changes in nighttime sleep duration showed no significant associations. Among preschool children, longer nighttime sleep duration was associated with a decline in EBPs, but not vice versa. Our study provides new longitudinal evidence to support sleep interventions to improve EBPs in early childhood. Clinical trials: The Healthy Start Study: t2/show/NCT01583335 Trial registration: ID NCT01583335
Publisher: Springer Science and Business Media LLC
Date: 03-04-2023
DOI: 10.1038/S41366-023-01301-9
Abstract: Childhood overweight and obesity are influenced by a range of prenatal and postnatal factors. Few studies have explored the integrative pathways linking these factors and childhood overweight. This study aimed to elucidate the integrative pathways through which maternal pre-pregnancy body mass index (BMI), infant birth weight, breastfeeding duration, and rapid weight gain (RWG) during infancy are associated with overweight outcomes in early childhood from ages 3 to 5 years. Pooled data from seven Australian and New Zealand cohorts were used ( n = 3572). Generalized structural equation modelling was used to examine direct and indirect associations of maternal pre-pregnancy BMI, infant birth weight, breastfeeding duration, and RWG during infancy with child overweight outcomes (BMI z -score and overweight status). Maternal pre-pregnancy BMI was directly associated with infant birth weight (β 0.01, 95%CI 0.01, 0.02), breastfeeding duration ≥6 months (OR 0.92, 95%CI 0.90, 0.93), child BMI z -score (β 0.03, 95%CI 0.03, 0.04) and overweight status (OR 1.07, 95%CI 1.06, 1.09) at ages 3–5 years. The association between maternal pre-pregnancy BMI and child overweight outcomes was partially mediated by infant birth weight, but not RWG. RWG in infancy exhibited the strongest direct association with child overweight outcomes (BMI z -score: β 0.72, 95%CI 0.65, 0.79 overweight status: OR 4.49, 95%CI 3.61, 5.59). Infant birth weight was implicated in the indirect pathways of maternal pre-pregnancy BMI with RWG in infancy, breastfeeding duration, and child overweight outcomes. The associations between breastfeeding duration (≥6 months) and lower child overweight outcomes were fully mediated by RWG in infancy. Maternal pre-pregnancy BMI, infant birth weight, breastfeeding duration and RWG in infancy act in concert to influence early childhood overweight. Future overweight prevention interventions should target RWG in infancy, which showed the strongest association with childhood overweight and maternal pre-pregnancy BMI, which was implicated in several pathways leading to childhood overweight.
Publisher: Elsevier BV
Date: 11-2022
DOI: 10.1093/JN/NXAC152
Publisher: Informa UK Limited
Date: 15-05-2023
Publisher: Elsevier BV
Date: 11-2020
DOI: 10.1093/CDN/NZAA157
Publisher: Springer Science and Business Media LLC
Date: 06-07-2021
DOI: 10.1038/S41366-021-00892-5
Abstract: The role of infant feeding practices in longitudinal growth trajectories in children remains equivocal. This study utilised two longitudinal approaches to examine the associations of infant feeding mode (breastfeeding, mixed feeding, formula feeding), breastfeeding duration, and the timing of solid foods introduction with body mass index (BMI) z-score in early childhood. Secondary analyses of data from the Healthy Beginnings Trial were conducted. Infant feeding practices were reported by mothers at 6, 12, and 24 months of child age. Child weight and length were measured at birth, 12, 24, 42, and 60 months. Two longitudinal approaches: linear spline multilevel model (LSMM) and group-based trajectory modelling (GBTM) were used to describe BMI z-score trajectories and assess its associations with infant feeding practices. The LSMM approach demonstrated that the breastfeeding group showed lower BMI z-scores from ages 12 to 60 months than the mixed feeding and formula feeding groups. Children who were breastfed for ≥ 6 versus < 6 months exhibited a lower BMI z-score trajectory from ages 12 to 60 months. Results from the GBTM approach revealed that the mixed feeding (OR: 1.83, 95%CI 1.04, 3.21) and the formula feeding group (OR: 2.00, 95%CI 0.67, 5.92) showed a tendency for higher odds of following the "High BMIz" trajectory than the breastfeeding group. Breastfeeding duration ≥6 versus < 6 months was linked with lower odds of following the "High BMIz" trajectory (OR 0.65, 95%CI 0.43, 0.98). Both approaches revealed no evidence of an association between the timing of solid foods introduction and BMI z-score trajectory. The two longitudinal approaches revealed similar findings that infant feeding mode and breastfeeding duration, but not the timing of solid foods introduction, were associated with BMI z-score trajectory in early childhood. The findings provide robust longitudinal evidence to encourage and support extended breastfeeding for childhood obesity prevention.
Publisher: Wiley
Date: 28-12-2020
DOI: 10.1111/IJPO.12766
Abstract: The respective contribution of total, daytime and nighttime sleep duration in childhood obesity remains unclear. To assess the longitudinal association between developmental trajectories of sleep duration and BMI z‐score in early childhood. Data were from the Melbourne INFANT program, a prospective cohort with 4‐month‐old infants being followed‐up until age 60 months (n = 528). Sleep duration (total, daytime, nighttime) and BMI z‐score were measured using questionnaire at ages 4, 9, 18, 43 and 60 months. Group‐based trajectory modelling was used to describe longitudinal trajectories from ages 4 to 60 months. Multivariable logistic regression was conducted to assess the association between sleep duration and BMI z‐score trajectories. Three nighttime sleep duration trajectory groups were identified: “Long stable” (10.5 to 11.0 hours, 61%), “catchup long” (8.0 to 11.5 hours, 23%) and “short stable” (8.7 to 9.8 hours, 16%) nighttime sleepers. BMI z‐score trajectory groups were classified as “low‐BMIz” (−1.5 to −0.5 unit, 21%), “mid‐BMIz” (−0.5 to 0.5 unit, 58%) and “high‐BMIz” (0.8 to 1.4 unit, 21%). With adjustment for child and maternal covariates, both “catchup long” (OR 3.69 95%CI 1.74, 7.92) and “long stable” nighttime sleepers (OR 4.27 95%CI 2.21, 8.25) revealed higher odds of being in the “mid‐BMIz” than the “high‐BMIz” group. By contrast, total or daytime sleep duration trajectories were not associated with BMI z‐score trajectories. Longer nighttime, but not total or daytime, sleep duration was associated with lower BMI z‐score trajectories in early childhood. Our findings reinforce the importance of nighttime sleep for healthy body‐weight development in early childhood.
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.BRAT.2021.103950
Abstract: Child neglect robustly predicts many behavioral problems and adulthood mental disorders, but little is known about its association with daily lifestyles and psychological development during childhood, particularly in the longitudinal study. We aimed to examine the association of child neglect with physical activity (PA), screen time (ST), eating habits (EHs), and depression/self-esteem using a two-wave follow-up study of primary schoolchildren in Wuhan, China. Data of 1085 schoolchildren aged 8-10 years (boys: 53.5%) were analyzed. Child neglect, lifestyles, and depression/self-esteem were collected in 2018 (T1) and 2019 (T2). Autoregressive cross-lagged models (ARCLMs) were fitted to explore the interrelationships among these variables. In ARCLM including child neglect and lifestyles, higher child neglect at T1 was significantly associated with higher ST and more risky EHs at T2, while insignificantly associated with PA. In ARCLM including child neglect and depression/self-esteem, lower T1 child neglect significantly predicted a higher T2 depression, but insignificantly for T2 self-esteem. In ARCLM including all variables, child neglect still significantly predicted later ST and depression, but insignificantly predicted EHs. Our study underscores that child neglect is strongly intertwined with ST, EHs, and depression during childhood. The prevention of child neglect may promote some healthy lifestyles and depression in children.
Publisher: Wiley
Date: 17-10-2021
DOI: 10.1111/IJPO.12861
Abstract: The overall impact of interventions targeting multiple behaviours remains largely unexplored. This study adopted an integrative lifestyle pattern analysis approach to assess the overall effectiveness of an early childhood intervention on change across multiple behaviours. The Melbourne INFANT program was a 15‐month cluster‐randomized controlled trial involving 4‐month‐old infants and their parents at baseline in 2008 ( n = 542). The intervention included six education sessions helping parents to promote a healthy diet, physical activity and limit sedentary behaviour in their infants. Participants were followed‐up twice post‐intervention, at ages 3.6 (2011) and 5 years (2013), to assess sustained effects of the intervention. Previous principal component analyses identified two lifestyle patterns from dietary intake, outdoor time and television viewing time. Random effect linear regression models were conducted to assess the impact of the intervention on lifestyle patterns. The intervention group had a lower ‘Discretionary consumption and TV’ lifestyle pattern score than the control group at all time points with adjusted mean difference: −0.29, 95% CI −0.49, −0.09, p = 0.004 post‐intervention at age 1.5 years −0.29, 95% CI −0.54, −0.04, p = 0.02 at the first follow‐up (age 3.6 years) and −0.21, 95% CI −0.43, 0.01, p = 0.06 at the second follow‐up (age 5.0 years). No evidence of between‐group differences was found for the ‘Fruit, vegetables and outdoor’ lifestyle pattern score. This early childhood intervention designed to promote change in more than one obesity‐related behaviour was effective in improving correlated unhealthy lifestyle behaviours. Lifestyle pattern analysis is a useful and interpretable approach for evaluating multi‐behavioural interventions.
Publisher: Wiley
Date: 28-07-2021
DOI: 10.1111/MCN.13187
Abstract: Post‐partum depression (PPD) is a serious mental health problem, which can impair maternal behaviours and adversely affect the cognitive, emotional and behavioural development of children. This study aims to explore the impact of maternal depressive symptoms at 3 months post‐partum (baseline) on child diet at 18 months of age (follow‐up). This study used longitudinal data from 263 first‐time mothers from the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Extend. Women self‐reported depressive symptoms (10‐item Center for Epidemiological Studies Depression Scale [CES‐D]) and child diet (fruits, vegetables and discretionary foods). Multiple linear regression analyses were used to explore the relationship between maternal depressive symptoms at baseline and child fruit and vegetable intake and discretionary food intake (g day −1 ) at follow‐up. Baseline maternal depressive symptoms were associated with higher childhood consumption of discretionary foods at 18 months of age ( β = 0.45, 95% confidence interval [CI] 0.03 to 0.87, P = 0.034 [adjusted]). There was no evidence of association for maternal depressive symptoms and child intake of fruits and vegetables. Further longitudinal studies are warranted to confirm these findings, with the hope of translating this knowledge into optimal clinic care and improved physical and mental health for mother and child.
Publisher: Public Library of Science (PLoS)
Date: 25-03-2020
Publisher: JMIR Publications Inc.
Date: 25-04-2018
DOI: 10.2196/MHEALTH.9303
Publisher: JMIR Publications Inc.
Date: 26-09-2017
Abstract: he first year of life is an important window to initiate healthy infant feeding practices to promote healthy growth. Interventions delivered by mobile phone (mHealth) provide a novel approach for reaching parents however, little is known about the effectiveness of mHealth for child obesity prevention. he objective of this study was to determine the feasibility and effectiveness of an mHealth obesity prevention intervention in terms of reach, acceptability, and impact on key infant feeding outcomes. quasi-experimental study was conducted with an mHealth intervention group (Growing healthy) and a nonrandomized comparison group (Baby’s First Food). The intervention group received access to a free app and website containing information on infant feeding, sleep and settling, and general support for parents with infants aged 0 to 9 months. App-generated notifications directed parents to age-and feeding-specific content within the app. Both groups completed Web-based surveys when infants were less than 3 months old (T1), at 6 months of age (T2), and 9 months of age (T3). Survival analysis was used to examine the duration of any breastfeeding and formula introduction, and cox proportional hazard regression was performed to examine the hazard ratio for ceasing breast feeding between the two groups. Multivariate logistic regression with adjustment for a range of child and parental factors was used to compare the exclusive breastfeeding, formula feeding behaviors, and timing of solid introduction between the 2 groups. Mixed effect polynomial regression models were performed to examine the group differences in growth trajectory from birth to T3. total of 909 parents initiated the enrollment process, and a final s le of 645 parents (Growing healthy=301, Baby’s First Food=344) met the eligibility criteria. Most mothers were Australian born and just under half had completed a university education. Retention of participants was high (80.3%, 518/645) in both groups. Most parents (226/260, 86.9%) downloaded and used the app however, usage declined over time. There was a high level of satisfaction with the program, with 86.1% (143/166) reporting that they trusted the information in the app and 84.6% (170/201) claiming that they would recommend it to a friend. However, some technical problems were encountered with just over a quarter of parents reporting that the app failed to work at times. There were no significant differences between groups in any of the target behaviors. Growth trajectories also did not differ between the 2 groups. n mHealth intervention using a smartphone app to promote healthy infant feeding behaviors is a feasible and acceptable mode for delivering obesity prevention intervention to parents however, app usage declined over time. Learnings from this study will be used to further enhance the program so as to improve its potential for changing infant feeding behaviors.
Publisher: Public Library of Science (PLoS)
Date: 02-11-2020
Publisher: Oxford University Press (OUP)
Date: 13-07-2023
DOI: 10.1093/IJE/DYAC142
Abstract: Behavioural patterns help to understand the influence of multiple health behaviours on childhood outcomes. Behavioural patterns derived using different data reduction techniques can be non-identical and may differentially associate with childhood outcomes. This study aimed to compare associations of behavioural patterns derived from three methods with three childhood outcomes. Data were from the Healthy Active Preschool and Primary Years study when children were 6–8 years old (n = 432). Cluster analysis (CA), latent profile analysis (LPA) and principal component analysis (PCA) were used to derive behavioural patterns from children’s diet, physical activity, sedentary behaviour and sleep data. Behavioural data were obtained through parent report and accelerometry. Children’s height, weight and waist circumference were measured by trained study staff. Health-related quality of life data were obtained using the Pediatric Quality of Life Inventory and academic performance scores were from a national test. Associations between derived patterns from each method and each of the outcomes were tested using linear regression (adjusted for child age and sex and parent education). Three patterns were each derived using CA and LPA, and four patterns were derived using PCA. Each method identified a healthy, an unhealthy and a mixed (comprising healthy and unhealthy behaviours together) pattern. Differences in associations were observed between pattern groups from CA and LPA and pattern scores from PCA with the three outcomes. Discrepancies in associations across pattern derivation methods suggests that the choice of method can influence subsequent associations with outcomes. This has implications for comparison across studies that have employed different methods.
Publisher: Wiley
Date: 05-05-2022
DOI: 10.1111/IJPO.12928
Abstract: Rapid weight gain (RWG) in infancy is strongly associated with subsequent obesity risk, but little is known about the factors driving RWG. This study explored the child and maternal factors associated with infant RWG. Data from seven Australian and New Zealand cohorts were used (n = 4542). Infant RWG was defined as a change in weight z‐score ≥0.67 from birth to age 1 year. Univariable and multivariable logistic regression assessed the association between child and maternal factors and infant RWG in each cohort. Meta‐analysis was conducted to obtain pooled effect sizes. Multivariable analyses revealed boys were more likely to experience RWG (OR 1.42 95% CI 1.22, 1.66) than girls. Higher birth weight in kg (OR 0.09, 95% CI 0.04, 0.20) and gestational age in weeks (OR 0.69, 95% CI 0.48, 0.98) were associated with lower RWG risk. Children who were breastfed for ≥6 months showed lower RWG risk (OR 0.45, 95% CI 0.38, 0.53). Children of native‐born versus overseas‐born women appeared to have higher RWG risk (OR 1.37, 95% CI 0.99, 1.90). Maternal smoking during pregnancy increased RWG risk (OR 1.60, 95% CI 1.28, 2.01), whereas children who started solids ≥6 months (OR 0.77, 95% CI 0.63, 0.93) and children with siblings (OR 0.68, 95% CI 0.57, 0.81) showed lower RWG risk in univariable analysis, but these associations were attenuated in multivariable analysis. No association was found for maternal age, education, marital status and pre‐pregnancy BMI. Maternal country of birth, smoking status, child sex, birth weight, gestational age, infant feeding and parity were potential determinants of infant RWG.
Publisher: Wiley
Date: 23-01-2020
DOI: 10.1002/OBY.22688
Abstract: This study examined the relative impact of breastfeeding duration and timing of solids introduction on BMI z score (BMIz) trajectory in early childhood. This study conducted secondary analyses of data from the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Program (N = 542), a prospective cohort study with data collected at birth and 3, 9, 18, 42, and 60 months. Linear spline multilevel models were performed. Differential growth rates were observed from birth to 3 months and from 9 to 18 months by breastfeeding duration (≥ 6 vs. < 6 months) and timing of solids introduction (before vs. after 6 months). Children who were breastfed for ≥ 6 versus < 6 months had lower BMIz at all ages from 3 to 60 months. The difference remained after adjusting for child and maternal factors, and the adjusted mean differences in BMIz at 3, 9, 18, 42, and 60 months were -0.34, -0.44, -0.13, -0.19, and -0.23, respectively. Children who received solids before versus after 6 months of age had higher BMIz at 18 and 42 months, but adjustment for child and maternal factors attenuated these differences. Longer breastfeeding duration was associated with lower BMIz to 5 years of age, providing further support for infant feeding guidelines to prolong breastfeeding duration for healthy growth.
Publisher: Wiley
Date: 26-04-2021
DOI: 10.1002/OBY.23136
Start Date: 2024
End Date: 09-2027
Amount: $448,801.00
Funder: Australian Research Council
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