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Papers by Jill Kaar

Title: Maternal Vegetable Intake During and After Pregnancy Authors: Alison Tovar (alison_tovar@u... more Title: Maternal Vegetable Intake During and After Pregnancy Authors: Alison Tovar (alison_tovar@uri.edu) Jill Kaar (JILL.KAAR@ucdenver.edu) Karen Mccurdy (Kmccurdy@uri.edu) Alison Field (alison_field@brown.edu) Dana Dabelea (Dana.Dabelea@ucdenver.edu) Maya Vadiveloo (maya_vadiveloo@uri.edu) Version: 2 Date: 16 May 2019 Author’s response to reviews: Thank you for the invitation to re-revise and resubmit our manuscript now entitled “Maternal Vegetable Intake During and After Pregnancy" (PRCH-D-18-01413.” We have revised the paper based on the reviewers’ comments and believe that the manuscript has been strengthened by their suggestions. Below, please find our point-by-point response to the reviewer comments (in italics). Changes to the manuscript have been highlighted in grey.

Contemporary Endocrinology, 2019

Appetite, 2019

Modifiable aspects of the family environment that contribute to overweight in younger children ha... more Modifiable aspects of the family environment that contribute to overweight in younger children have been identified, including parental feeding practices, child eating behaviors, and parenting practices related to eating and household routines. Maternal depression influences many of these factors, yet research examining pathways that may link maternal depression through the family environment to child weight is lacking. The current study examined parental feeding practices, child eating behaviors, and eating and household routines as potential mediators between maternal depressive symptoms and child weight at age six. The study also tested for differential effects of early versus concurrent maternal depressive symptoms. Methods: Longitudinal data on 1130 mothers and their children who participated in the Infant Feeding Practices Study II (IFSP II) and its Year 6 Follow-Up study were analyzed. A multi-step, multiple mediator model assessed direct and indirect relationships between early depressive symptoms (two months post-partum) and concurrent depressive symptoms with child Body Mass Index (BMI) z scores at age six. Potential mediators included parental feeding practices, child eating behaviors, and eating and household routines. Results: Higher early depressive symptoms directly explained lower child BMI z scores. Early depression also worked through concurrent depression, the child's food responsiveness, and the hours the child slept on week nights to explain higher child BMI z scores. Parental efforts to make sure the child eats enough directly predicted lower child weight but did not mediate the effects of early or concurrent maternal depressive symptoms. Conclusions: The findings suggest the need for greater attention to the relationships between maternal depression and child weight as a critical step toward developing effective obesity prevention strategies.

The Journal of pediatrics, 2017

To examine associations of demographic, perinatal, and infant feeding characteristics with offspr... more To examine associations of demographic, perinatal, and infant feeding characteristics with offspring body composition at approximately 5 months of age. We collected data on 640 mother/offspring pairs from early pregnancy through approximately 5 months of age. We assessed offspring body composition with air displacement plethysmography at birth and approximately 5 months of age. Linear regression analyses examined associations between predictors and fat-free mass, fat mass, and percent fat mass (adiposity) at approximately 5 months. Secondary models further adjusted for body composition at birth and rapid infant growth. Greater prepregnant body mass index and gestational weight gain were associated with greater fat-free mass at approximately 5 months of age, but not after adjustment for fat-free mass at birth. Greater gestational weight gain was also associated with greater fat mass at approximately 5 months of age, independent of fat mass at birth and rapid infant growth, although t...

The Journal of pediatrics, 2014

To determine whether adequate vs excessive gestational weight gain (GWG) attenuated the associati... more To determine whether adequate vs excessive gestational weight gain (GWG) attenuated the association between maternal obesity and offspring outcomes. Data from 313 mother-child pairs participating in the Exploring Perinatal Outcomes among Children study were used to test this hypothesis. Maternal prepregnancy body mass index (BMI) and weight measures throughout pregnancy were abstracted from electronic medical records. GWG was categorized according to the 2009 Institute of Medicine criteria as adequate or excessive. Offspring outcomes were obtained at a research visit (average age 10.4 years) and included BMI, waist circumference (WC), subcutaneous adipose tissue (SAT) and visceral adipose tissue, high-density lipoprotein cholesterol, and triglyceride levels. More overweight/obese mothers exceeded the Institute of Medicine GWG recommendations (68%) compared with normal-weight women (50%) (P < .01). Maternal prepregnancy BMI was associated with worse childhood outcomes, particularl...

Journal of Developmental Origins of Health and Disease, 2014

Objective: To examine the association of cord blood leptin with body mass index (BMI) growth velo... more Objective: To examine the association of cord blood leptin with body mass index (BMI) growth velocity from birth to 12 months of age among infants exposed and not exposed to over-nutrition in utero (defined as maternal overweight/obesity or presence of gestational diabetes). Methods: 185 infants enrolled in the Exploring Perinatal Outcomes among Children study (76 exposed and 109 not exposed) had leptin and insulin measured in cord blood. Longitudinal weight and length measures in the first 12 months of life (average 4 per participant) obtained from medical records were used to compute BMI growth rates. Mixed models were used to examine associations of cord blood leptin with growth. Results: Compared with unexposed infants, those exposed had significantly higher cord blood insulin (8.64 v. 6.97 uU/ml, P<0.01) and leptin levels (8.89 v. 5.92 ng/ml, P=0.05) as well as increased birth weights (3438.04 v. 3306.89 g, P=0.04). There was an inverse relationship between cord leptin level...

Circulation, Jan 22, 2016

Poor lifestyle behaviors are leading causes of preventable diseases globally. Added sugars contri... more Poor lifestyle behaviors are leading causes of preventable diseases globally. Added sugars contribute to a diet that is energy dense but nutrient poor and increase risk of developing obesity, cardiovascular disease, hypertension, obesity-related cancers, and dental caries. For this American Heart Association scientific statement, the writing group reviewed and graded the current scientific evidence for studies examining the cardiovascular health effects of added sugars on children. The available literature was subdivided into 5 broad subareas: effects on blood pressure, lipids, insulin resistance and diabetes mellitus, nonalcoholic fatty liver disease, and obesity. Associations between added sugars and increased cardiovascular disease risk factors among US children are present at levels far below current consumption levels. Strong evidence supports the association of added sugars with increased cardiovascular disease risk in children through increased energy intake, increased adipos...

Community Mental Health Journal

Due to an error during the production process, the original version of this article erroneously i... more Due to an error during the production process, the original version of this article erroneously included two tables unrelated to the text and a reference to those tables. These have now been removed and the original article has been updated.

The FASEB Journal, 2014

Our aim was to describe parent/child neophobia, parent offering of new foods, and concordance in ... more Our aim was to describe parent/child neophobia, parent offering of new foods, and concordance in food preferences between parent-child dyads. University email listservs were used to recruit parents of preschoolers (2-5 y) to complete an online REDCap survey about picky eating. Scales were selected from The Child Feeding Questionnaire+ (offering new foods and pressure to eat), the Child Food Neophobia Scale and 80 items to determine parent-child food preferences. Concordance (% agreement) and Pearson correlations were calculated in SAS 9.4. The significance level was set at alpha = .05. Respondents (n=258) included mothers (86%), were white (83%), and college educated (65%). Most children (mean age = 40.6 mo ±13.8), were perceived to be of healthy weight (80%) and “good eaters” (60%). Parent (22.0 ± 7.3) and child neophobia (30.0 ± 9.2) correlated significantly (r=.41,p<.01). Offering new foods to children was inversely associated with child (r=-.52, p<.01) and parent neophobia (r=-.40, p<.01) and pressure...

Contemporary Clinical Trials Communications, 2021

St ud y pr ot oc ol fo r a sc ho ol-ba se d si ng le gr ou p pr ag ma ti c tr ia l to pr om ot e ... more St ud y pr ot oc ol fo r a sc ho ol-ba se d si ng le gr ou p pr ag ma ti c tr ia l to pr om ot e re si li en ce in yo ut h: Bu il di ng Re si li en ce fo r He al th y Ki ds Jo ey A. Le e a , Er in He be rl ei n b , Em il y Py le b , Th om as Ca ug hl an b , Da rv i Ra ha ma n b , c , Ma rg ar et Sa bi n b , Ji ll L. Ka ar c , * a Un iv er si ty of Co lo ra do Co lo ra do Sp ri ng s, De pa rt me nt of He al th Sc ie nc es , Co lo ra do Sp ri ng s, CO , US A b Ch il dr en 's Ho sp it al Co lo ra do , Co lo ra do Sp ri ng s, Co lo ra do Sp ri ng s, CO , US A c Un iv er si ty of Co lo ra do Sc ho ol of Me di ci ne , De pa rt me nt of Pe di at ri cs , Au ro ra , CO , US A ARTICLE INFO Ke y wo rd s : He al th co ac h Me n ta l he al th Re si li en ce Sc ho ol we ll ne ss So ci al-em ot io na l le ar n in g ABSTRACT Ba ck gr ou nd : Th er e is a gr ow in g pr ev a le nc e of me n ta l he al th di s or de rs am on g yo ut h. He lp in g yo ut h de ve lo p sk il ls th at pr o mo te an d su p po rt me n ta l we ll-be in g is an im po r ta nt st ra t eg y fo r ad dr es s in g th is pu b li c he al th co n ce rn. Bu il d in g Re si li en ce fo r He al th y Ki ds (H ea lt hy Ki ds) is a sc ho ol-ba se d pr o gr am de si gn ed to im pr ov e re si li en cy in yo ut h ag ed 9-13 ye ar s ol d us in g an in no v a ti ve he al th co ac h in g fr am e wo rk. Me th od s : He al th y Ki ds is a mu lt i-ph as ed in te r ve n ti on th at ai ms to im pr ov e yo ut h re si li en ce us in g a 6-we ek , 1: 1 he al th co ac h in g pr o gr am. Th e pr o gr am de ve l op s yo ut h re si li en ce an d wa s de ri ve d fr om mo d el s fo r de ve l op in g yo ut h re si li en ce : Po s i ti ve Re la ti on sh ip s, Co p in g, Sk il l De ve l op me nt , He al th y Li fe st yl e, Se ns e of Cu l tu re , an d Co n ne ct ed ne ss. Ef fe c ti ve ne ss of th e in te r ve n ti on wi ll be ev al u at ed us in g a si n gl e-gr ou p, pr ag ma ti c tr ia l de si gn wi th pr et es t-po st te st an d fo l lo w-up as se ss me nt s up to 12 mo nt hs. Pr oc es s me a su re s wi ll ev al u at e yo ut h' s ac ce pta nc e an d sa t is fa c ti on of th e pr o gr am an d at te n da nc e ra te s. Ef fe c ti ve ne ss wi ll be ev al u at ed by ex am in in g ch an ge s in re si li en ce an d me n ta l he al th in di ca to rs fr om pr e-to-po st pr o gr am an d tr ac k in g su s ta in me nt of ch an ge s in me n ta l he al th in di ca to rs ov er ti me. Di sc us si on : Gi ve n th e pr ag ma ti c na tu re of th e st ud y de si gn to wo rk wi th ge n er al ly he al th y po p u la ti on s of st ude nt s, we ex pe ct sm al l, bu t su s ta in ab le , im pr ov e me nt s in yo ut h re si li en ce to be ac hi ev ed th ro ug h th e in te r ve nti on. Fu r th er , th is st ud y wi ll pr o vi de in si gh t in to th e po te n ti al ef fe c ti ve ne ss of us in g he al th co ac h in g as a st ra teg y to su p po rt an d pr o mo te yo ut h me n ta l we ll-be in g in sc ho ol se t ti ng s. Tr ia l re gi st ra ti on : Cl in ic al Tr ia ls. go v Id en ti fi er : NC T0 42 02 91 3. Re g is te re d De ce m be r 18 , 20 19. * Co rr es po nd in g au th or. De pa rt me nt of Pe di at ri cs , Di vi si on of En do cr in ol og y, Un iv er si ty of Co lo ra do Sc ho ol of Me di ci ne , 13 12 3 Ea st 16 th Av en ue , B2 65 , Au ro ra , CO , 80 04 5, US A. E-ma il ad dr es s: ji ll .k aa r@ cu an sc hu tz .e du (J .L. Ka ar).

Contemporary School Psychology, 2021

Objective In response to the rise in mental health needs among youth, a school-based resilience i... more Objective In response to the rise in mental health needs among youth, a school-based resilience intervention was implemented for sixth graders at an urban middle school. The goal of this analysis is to examine improvements in key mental health parameters among students who endorsed negative affectivity at baseline. Method A total of 285 11-12-year-olds (72% white, 18% Hispanic, 55% female) participated in a single-arm, non-randomized 6-week 1:1 school-based coaching intervention, Healthy Kids. Youth completed validated surveys at baseline and 6-week follow-up assessing depression/anxiety symptoms, bullying, self-efficacy, academic pressure, grit, and resilience. Participants were determined to have elevated negative affectivity if they reported mild-to-severe symptoms for both depression and anxiety symptoms. General linear models examined differences between groups for each mental health parameter, as well as change in outcomes from baseline to follow-up. Results A third of participants (38%) at baseline endorsed negative affectivity. Youth who endorsed negative affectivity were more often female (71% vs 29%; p < 0.001) and identified as victims of cyberbullying (25% vs 8%; p < 0.001). Youth with baseline negative affectivity scored lower for self-efficacy (total 70.5 vs 86.8; p < 0.0001). Baseline negative affectivity was a significant moderator for change in mental health parameters. Post-intervention, those who endorsed baseline negative affectivity, medium effect sizes were observed for self-efficacy (g = 0.6; 95%CI 0.3, 0.9; p < 0.001) and anxiety symptoms (g = − 0.70; 95%CI − 1.0, − 0.4; p < 0.001). Among all youth, there were significant medium intervention effects in resilience (g = 0.5; 95%CI 0.3, 0.7; p < 0.001) and self-efficacy (g = 0.7; 95%CI 0.4, 0.9; p < 0.001). Conclusions A universal resiliency program may improve self-efficacy and symptoms of anxiety among youth experiencing negative affectivity, while improving resilience and self-efficacy among all youth. Our findings suggest a universal schoolbased coaching program benefits all youth, while also specifically targeting the needs of youth with negative affectivity who are most at risk for mental health concerns.

Appetite, 2021

Experimental research suggests that passive flavor transfer from maternal diet to the infant via ... more Experimental research suggests that passive flavor transfer from maternal diet to the infant via amniotic fluid and breastmilk may improve infant vegetable intake. This secondary analysis examined associations between maternal (prenatal and postnatal) and infant vegetable intake in 696 mothers with eligible dietary data from the U.S. longitudinal Infant Feeding Practices Study II. Adjusted mixed models examined associations between 4 levels of maternal vegetable intake (mean splits of high/low on prenatal and postnatal food frequency questionnaires) and repeated measures of infant vegetable intake frequency (times/day, from monthly surveys). Mothers were on average 29.5 years old, mostly non-Hispanic White (86.2%) and educated (84.0% ≥some college). In base models, mothers with consistently high vegetable intake (vs. consistently low) reported more frequent infant vegetable intake. In multivariable models, infant vegetable intake was significantly more frequent amongst mothers with consistently high prenatal/high postnatal intake (0.9 times/day) versus consistently low intake (0.8 times/day). In this sample, maternal vegetable consumption was associated with frequency of infant vegetable consumption; consistently high vegetable intake across prenatal and postnatal periods was most strongly associated with infant intake. While infant vegetable intake is multifactorial, maternal prenatal and postnatal vegetable intake appeared to have a small but significant influence.

Journal of Pediatric Surgery, 2021

Economic, social, and psychologic stressors are associated with an increased risk for abusive inj... more Economic, social, and psychologic stressors are associated with an increased risk for abusive injuries in children. Prolonged physical proximity between adults and children under conditions of severe external stress, such as witnessed during the COVID-19 pandemic with "shelter-in-place orders", may be associated with additional increased risk for child physical abuse. We hypothesized that child physical abuse rates and associated severity of injury would increase during the early months of the pandemic as compared to the prior benchmark period. We conducted a nine-center retrospective review of suspected child physical abuse admissions across the Western Pediatric Surgery Research Consortium. Cases were identified for the period of April 1-June 30, 2020 (COVID-19) and compared to the identical period in 2019. We collected patient demographics, injury characteristics, and outcome data. There were no significant differences in child physical abuse cases between the time periods in the consortium as a whole or at individual hospitals. There were no differences between the study periods with regard to patient characteristics, injury types or severity, resource utilization, disposition, or mortality. Apparent rates of new injuries related to child physical abuse did not increase early in the COVID-19 pandemic. While this may suggest that pediatric physical abuse was not impacted by pandemic restrictions and stresses, it is possible that under-reporting, under-detection, or delays in presentation of abusive injuries increased during the pandemic. Long-term follow-up of subsequent rates and severity of child abuse is needed to assess for unrecognized injuries that may have occurred.

Sleep Health, 2021

OBJECTIVE Poor sleep is common among adolescents and associated with impaired mood and health-rel... more OBJECTIVE Poor sleep is common among adolescents and associated with impaired mood and health-related quality of life (HRQOL). Transgender individuals are at increased risk of mood problems hypothesized to be due to minority stress; however, no research has investigated associations between sleep and mood in this population. We aimed to examine sleep, mood, and HRQOL in transgender adolescent males. DESIGN & SETTING Transgender males age 13-16 were recruited from a U.S. gender diversity clinic. MEASUREMENTS Participants completed one week of home actigraphy monitoring. Questionnaires assessed insomnia symptoms, chronotype, mood, and HRQOL. Pearson correlations between sleep, mood, and HRQOL were examined. RESULTS A total of 10 participants completed study measures during the school year. Participants obtained less than the recommended 8-10 hours of sleep per night, and half of participants endorsed insomnia symptoms. Greater insomnia symptoms were correlated with higher anxiety (P = .04) and depression (P = .04) symptoms, and poorer Psychosocial HRQOL (P = .03). Earlier weekday and weekend bed and wake times and earlier weekday sleep midpoint were associated with better Wellbeing HRQOL. No other significant correlations between sleep and mood or HRQOL variables were found. CONCLUSIONS Anxiety and depression symptoms were associated with self-reported insomnia symptoms, while HRQOL was associated with both insomnia symptoms and objective sleep timing in this sample of adolescent transgender males. Clinicians should assess both sleep and mood symptoms in this population and future research should evaluate the impact of improved sleep and gender-affirming care on mood and HRQOL for transgender adolescents.

Journal of Investigative Medicine, 2020

Mentorship is a critical component of career development, particularly in academic medicine. Peer... more Mentorship is a critical component of career development, particularly in academic medicine. Peer mentorship, which does not adhere to traditional hierarchies, is perhaps more accessible for underrepresented groups, including women and minorities. In this article, we review various models of peer mentorship, highlighting their respective advantages and disadvantages. Structured peer mentorship groups exist in different settings, such as those created under the auspices of formal career development programs, part of training grant programs, or through professional societies. Social media has further enabled the establishment of informal peer mentorship through participatory online groups, blogs, and forums that provide platforms for peer-to-peer advice and support. Such groups can evolve rapidly to address changing conditions, as demonstrated by physician listserv and Facebook groups related to the COVID-19 pandemic. Peer mentorship can also be found among colleagues brought together...

Childhood Obesity, 2020

Introduction: To identify longitudinal sleep trajectories in early childhood and examine the infl... more Introduction: To identify longitudinal sleep trajectories in early childhood and examine the influence of sleep duration on obesity risk via BMI percentile (BMIp). Methods: Sleep, physical activity, and television viewing were measured in a cohort of 301 children, starting in 2001-2002, when children were 3 years and followed them through age 6. Nighttime sleep, daytime naps, and sleep duration were calculated. A series of latent growth curve models were used to estimate predictors of rate of change in sleep duration and BMIp overtime. A parallel process latent growth model examined the longitudinal relationship between sleep duration and BMIp simultaneously. Results: Most children (>80%) slept >10 hours per night across ages 3 to 6 years, despite the majority of children (>66%) having bedtimes after 9 pm. Sleep duration decreased on average by 0.22 (95% CI 0.20-0.24) hours each year of age (p < 0.001), while BMIp increased on average by 1.76 (95% CI 1.18-2.34) each year of age (p < 0.001). Baseline sleep duration predicted the BMIp slope factor, over and above strong effects of baseline BMIp. This indicated that greater sleep duration at baseline was predictive of decreased BMIp over time (unstandardized coefficient = -1.52 (95% CI 0.34-2.71, p = 0.012). Conclusions: Longer sleep duration at age 3 predicted decreased BMIp from ages 3 to 6. These findings indicate that focusing on sleep behaviors in children before age 3 may be a priority for pediatric providers with a goal of decreasing obesity risk.

Pediatric Diabetes, 2020

Background: Individual health behaviors (i.e., eating habits, sedentary lifestyle) are associated... more Background: Individual health behaviors (i.e., eating habits, sedentary lifestyle) are associated with type 2 diabetes (T2D). Health behavior profiles specific to adolescents with T2D have not been described. Objective: To identify health behavior profiles in adolescents with T2D and examine how these profiles change over time. Methods: Diet (via food frequency questionnaire) and activity behaviors (via 3-day physical activity recall) examined at baseline, 6 and 24 months from participants in the TODAY study were used for this analysis. Latent profile analysis identified profiles of health behaviors within three time points and latent transition probabilities were estimated to examine the change from baseline to 6 months (n=450) and baseline to 24 months (n=415). Multinomial logistic regressions were used to examine if the assigned TODAY treatment group [Metformin (Met), Met + Rosiglitazone (Rosi), or Met + Lifestyle] predicted change in health behavior profiles. Results: Three profiles emerged: "most sedentary", "healthy eaters" and "active and eat most." At 6 months, 50% of males and 29% of females in the Met + Lifestyle treatment group improved in their health behavior profile. Among males only, the Met + Lifestyle treatment group were more likely to improve their profiles from baseline to 6 months (p=0.01).

Journal of Pediatric Endocrinology and Metabolism, 2019

Background Sex differences in body composition are appreciated throughout the lifespan with proba... more Background Sex differences in body composition are appreciated throughout the lifespan with probable contributions from sex steroids: testosterone and estrogen. The purpose of this longitudinal observational study was to determine if sex differences in body composition emerge during the first months of life in healthy infants, corresponding to the age at which male infants produce endogenous testosterone. Methods Linear growth and body composition parameters using air displacement plethysmography were obtained from 602 healthy infants after birth and again at 5 months of age. Rate of change in body composition parameters were compared between sexes. Results Sex differences in length, total mass, fat free mass (FFM), and percent fat mass (%FM) were present both at birth and at 5 months (p < 0.001 for all), with males having greater total mass and FFM but lower %FM. Gain in %FM over the first 5 months was significantly lower in males (p = 0.0004). This difference was secondary to a...

BMC Pregnancy and Childbirth, 2019

Background: Improved understanding of vegetable intake changes between pregnancy and postpartum m... more Background: Improved understanding of vegetable intake changes between pregnancy and postpartum may inform future intervention targets to establish healthy home food environments. Therefore, the goal of this study was to explore the changes in vegetable intake between pregnancy and the postnatal period and explore maternal and sociodemographic factors that are associated with these changes. Methods: We examined sociodemographic, dietary, and health characteristics of healthy mothers 18-43y from the prospective Infant Feeding Practices II cohort (n = 847) (2005-2012). Mothers completed a modified version of the diet history questionnaire, a food-frequency measure, developed by the National Cancer Institute. We created four categories of mothers, those that were: meeting vegetable recommendations post-but not prenatally (n = 121; improved intake), not meeting vegetable recommendations during pregnancy and postnatally (n = 370; stable inadequate), meeting recommendations pre-but not postnatally (n = 123; reduced intake), and meeting recommendations at both time points (n = 233; stable adequate). To make our results more relevant to public health recommendations, we were interested in comparing the improved vegetable intake group vs. stable inadequate vegetable intake group, as well as those that reduced their vegetable intake compared to the stable adequate vegetable intake group. Separate multivariable-adjusted logistic regression were used to examine sociodemographic predictors of improved vs. stable inadequate and reduced vs. stable adequate vegetable intake. Results: Women with improved vegetable intake vs. stable inadequate smoked fewer cigarettes while women with reduced vegetable intake vs. stable adequate were more likely to experience less pregnancy weight gain. In adjusted models, employed women had greater odds of reduced vegetable intake (OR = 1.64 95% CI 1.14-2.36). In exploratory analyses, employment was associated with greater odds of reduced vegetable intake among lowincome (OR = 1.79; 95% CI 1.03-3.1), but not higher income women (OR = 1.31; 95% CI 0.94-1.84). After further adjustment for paid maternity leave, employment was no longer associated with vegetable intake among lower income women (OR: 1.53; 95% CI: 0.76-3.05). Conclusions: More women with reduced vs. stable adequate vegetable intake were lower income and worked full time. Improved access to paid maternity leave may help reduce disparities in vegetable quality between lower and higher income women.