Laura Caulfield

Johns Hopkins Bloomberg School of Public Health | JHSPH · Department of International Health

Objective To examine the association between red and processed meat consumption and total food expenditures in US households and explore whether households could reduce food costs by substituting these meats with other protein sources such as poultry, seafood, eggs and plant proteins. Design Cross-sectional study using data from the National House...

OBJECTIVE Plant-based dietary patterns emphasize plant foods and minimize animal-derived foods. We investigated the association between plant-based dietary patterns and diabetes in a community-based U.S. sample of Black and White adults. RESEARCH DESIGN AND METHODS We included middle-aged adults from the Atherosclerosis Risk in Communities (ARIC)...

Objectives Infant growth is recognized to vary over the short term, with periods of greater and lesser linear growth velocity. Our objectives were to (1) examine the potential differences in overall growth profiles between children who experienced cumulative growth faltering in the first year of life consistent with that seen by many children livin...

Background Breastfeeding imparts numerous health and social benefits for families. Barriers deter some individuals from breastfeeding. Rates are lower among certain populations, including participants of the federally funded Women, Infants, and Children's Program (WIC). Women, Infants, and Children's Program provides low‐income pregnant and postpar...

Relatively little is known about how the diet of chronically undernourished children may impact cardiometabolic biomarkers. The objective of this exploratory study was to characterise relationships between dietary patterns and the cardiometabolic profile of 153 3–5-year-old Peruvian children with a high prevalence of chronic undernutrition. We coll...

Background: Environmental enteric dysfunction increases the likelihood of micronutrient deficiencies among infants, but few studies have assessed the potential impact of gut health on urinary iodine concentration (UIC) among this vulnerable group. Objectives: We describe the trends of iodine status among infants from 6 to 24 mo old and examine t...

This study explored strategies to improve adolescent food security using semi-structured in-depth interviews with 9 policy advocates, 12 parents and 15 adolescents aged between 17 and 20 years, living in households who were eligible for the Supplemental Nutrition Assistance Program in 2020. This study was part of a larger evaluation of adolescent f...

This study evaluated differences in overall diet quality, diet quality components, and food-related contextual factors between adolescents with food security and those with food insecurity. Mixed methods analysis was conducted on data from three 24-h dietary recalls from 61 adolescents ages 14–19 years old living in Baltimore, Maryland, USA in 2020...

Background The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) promotes and supports breastfeeding for low-income women and children. A prior review reported negative associations of WIC with breastfeeding outcomes. WIC food package changes in 2009 increased breastfeeding support. Objective The objectives of this syst...

Poor complementary feeding (CF) challenges early childhood growth. We examined the trends and influencing factors of CF practices among children aged 6-23 months in Côte d'Ivoire. Using data from Demographic and Health Surveys (DHS, 1994-2011) and Multiple Indicator Cluster Surveys (MICS, 2000-2016), the trends and predictors of World Health Organi...

Background: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is intended to improve maternal and child health outcomes. In 2009, the WIC food package changed to better align with national nutrition recommendations. Purpose: To determine whether WIC participation was associated with improved maternal, neonatal-bir...

Infant feeding practices impact children's nutritional and health status, influencing growth and development. This study aimed to analyse the evolution of infant feeding practices from 9 to 24 months of age, considering infant and young child feeding (IYCF) indicators and food processing. The infant feeding practices in children from the Brazilian...

Due to the high prevalence of childhood obesity, it is imperative to assess the relationship children’s access to food retailers and obesity. However, the influence of methodological decisions on these associations has been understudied. We examined relationships between different measures of geospatial food environment (using 4 data sources, and 2...

BACKGROUND The use of digital communication platforms to improve health behaviors has increased dramatically in the last decade. Public health practitioners have adopted digital media and marketing technologies such as text messages, mobile applications, and social media to reach diverse populations. However, the relative effectiveness of different...

Background: The use of digital communication platforms to improve health behaviors has increased dramatically over the last decade. Public health practitioners have adopted digital communication technologies such as text messages, mobile apps, and social media to reach diverse populations. However, the effectiveness of digital communication platfo...

Objectives The Baby-Friendly Hospital Initiative is an effective intervention to support maternal practices around breastfeeding. However, little is known about its impact on participants of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The purpose of this study was to evaluate whether Baby Friendly Hospital (BFH...

The Reversing the Negative cardiovascular Effects on Weight (ReNEW) Clinic is a prospective cohort study in children and adolescents (≤21 years) at the Johns Hopkins Children’s Center. Cross-sectional analysis between diet quality using the Alternative Healthy Eating Index (AHEI-2010), pro-inflammatory potential using the Children’s Dietary Inflamm...

Background Poor growth in early childhood has been considered irreversible after 2–3 years of age and has been associated with morbidity and mortality over the short-term and with poor economic and cognitive outcomes over the long-term. The MAL-ED cohort study was performed in eight low-income settings with the goal of evaluating relationships betw...

Objective To evaluate the impact of a multi-level, multi-component (MLMC) adult obesity intervention on beverage intake in Native American adults living in five geographically and culturally diverse tribal communities. Design A 14-month, community-randomised, MLMC design was utilised, with three communities randomised to Intervention and two commu...

Background Breastfeeding is known to reduce risk of enteropathogen infections, but protection from specific enteropathogens is not well characterized. Objective To estimate the association between full breastfeeding (days fed breast milk exclusively or with non-nutritive liquids) and enteropathogen detection. Design 2,145 newborns were enrolled i...

Findings on the role of Mediterranean-style diet (MSD) on duration of pregnancy and birth weight have been inconsistent and based largely on Non-Hispanic white populations, making it unclear as to whether they could extend to African Americans who are at a higher risk of unfavorable birth outcomes. Our study addresses this gap using a large urban,...

Background Development of clinical risk factors linked to metabolic syndrome (MetS) in adolescence is associated with higher incidence of atherosclerotic cardiovascular events in adulthood. Given the increasing burden of obesity and MetS in African-American (AA) youth, there is a need to establish the relation of MetS with modifiable risk factors s...

The WHO recommends exclusive breastfeeding for the first 6 months of life. However, the transition of the infants' diet to partial breastfeeding with the addition of animal milks and/or solids typically occurs earlier than this. Here, we explored factors associated with the timing of an early transition to partial breastfeeding across seven sites o...

Background Substantial evidence exists surrounding the health risks of breast milk substitutes (BMS) in place of exclusive breastfeeding among infants < 6 months of age in resource-poor settings. Yet, mothers’ experiences of selecting and purchasing BMS brands have not been well studied to date. This qualitative study explored the factors influenci...

Breastfeeding mothers often report perceived insufficient milk (PIM) believing their infant is crying too much, which leads to introducing formula and the early abandonment of breastfeeding. We sought to determine if infant crying was associated with reported PIM (yes/no) and number of problems associated with lactation (lactation problem score [LP...

Adequate dietary intake is critical to prevent adverse pregnancy outcomes. India has a high burden of maternal and child morbidity and mortality, but there is a lack of adequate tools to assess dietary intake. We validate a food frequency questionnaire (FFQ), New-Interactive Nutrition Assistant-Diets in India Study of Health (NINA-DISH), among preg...

In pregnant women, studies are lacking on the relationship of vegetable and animal flesh (poultry, red meat and seafood) intake with inflammation, especially in low-and middle-income countries. We conducted a cohort study of pregnant women receiving antenatal care at BJ Medical College in Pune, India. The dietary intake of pregnant women was querie...

Objective: In 2011-2012, severe El Niño Southern Oscillation (ENSO) conditions (La Niña) led to massive flooding and temporarily displacement in the Peruvian Amazon. Our aims were to examine the impact of this ENSO exposure on child diets, in particular: (1) frequency of food consumption patterns, (2) the amount of food consumed (g/d), (3) dietary...

Background: Few studies have focused on quantitatively analyzing nutrients from infant diets, compromising complementary feeding evaluation and health promotion worldwide. Objectives: This study aimed to describe dietary intake in infants from 9 to 24 mo of age, determining nutrient intakes associated with the risk of underweight, wasting, and s...

Rapid weight gain increases risks of obesity and associated co-morbidities. The objective was to reduce the rate of body mass index (BMI) growth (BMI z score), relative to control. Secondary outcomes were toddler-mother physical activity, mealtime interactions and fruit/vegetable intake. The randomized three-arm, eight-session, 4-month trial, condu...

Background: Multiple factors constrain the trajectories of child cognitive development, but the drivers that differentiate the trajectories are unknown. We examine how multiple early life experiences differentiate patterns of cognitive development over the first 5 years of life in low-and middle-income settings. Methods: Cognitive development of...

Objective To estimate the total energy and micronutrient intakes of children 9–24 months of age and evaluate the probability of adequacy (PA) of the diet in seven MAL-ED sites. Design Cohort study. Food intake was registered monthly using 24-h recalls beginning at 9 months. We estimated PA for thirteen nutrients and overall mean PA (MPA) by site a...

Background: Maternal iron absorption during pregnancy can be evaluated using RBC incorporation of orally administered stable iron isotope. This approach underestimates true maternal absorption of iron as it does not account for absorbed iron that is transferred to the fetus or retained within the placenta. Objective: Our objective was to re-eval...

Objectives 1) To describe the trends of complementary feeding since 2010; 2) to understand the factors influencing the sub-optimal feeding practices; and 3) to generate recommendations to inform future interventions. Methods Mixed methods study with an iterative, two phase design. Phase 1: quantitative data analysis of 13 key complementary feeding...

Objectives To evaluate associations between maternal adherence to Mediterranean-style diet during pregnancy and pregnancy outcomes. Methods The data originate from the Boston Birth Cohort (BMC), an urban, low-income, multiethnic cohort study which enrolled mother-infant dyads upon delivery at Boston Medical Center (Boston, MA) beginning in 1998. D...

Importance Breast milk substitutes (BMS) are important nutritional products evaluated in clinical trials. Concerns have been raised about the risk of bias in BMS trials, the reliability of claims that arise from such trials, and the potential for BMS trials to undermine breastfeeding in trial participants. Existing clinical trial guidance does not...

Background: Undernutrition in early childhood has historically been considered irreversible after 2-3 years of age and has been associated with morbidity and mortality over the short-term and poor economic and cognitive outcomes over the long-term. We used longitudinal data to determine which factors are associated with positive changes in absolute...

Objective The objective was to examine the association between symptoms of maternal mental health problems and child diet and nutritional status in South Kivu, Democratic Republic of Congo. Design Maternal depression and anxiety symptoms were measured by the Hopkins Symptom Checklist-25 (HSCL-25), and post-traumatic stress was measured by the Harv...

Background It is unclear if the intakes of different types of protein have changed over time. Objective We delineated trends in types of protein (beef, pork, lamb or goat, chicken, turkey, fish, dairy, eggs, legumes, and nuts and seeds) in US children (2-<12 years) and adolescents (12–19 years) from 1999 to 2010. Methods We used 6 repeated cross-...

[This corrects the article DOI: 10.1371/journal.pone.0227839.].

Background: In developing countries, maternal mental health problems have been linked to sub-optimal child feeding practices and child underweight and stunting, but little is known about how maternal mental health is associated with mothers' own diets and nutritional status. The objective of the study was to investigate the association between men...

Background & aims: Women with bacterial vaginosis (BV) have increased risk of sexually transmitted infections and other adverse health outcomes. Based on the composition of their vaginal microbiota, women can broadly be classified into low-Lactobacillus (termed molecular-BV) and Lactobacillus-dominated profiles. Our objective was to determine the...

Background Globally more than 150 million children under age 5 years were stunted in 2018, primarily in low- and middle-income countries (LMICs), and the impact of early-onset, persistent stunting has not been well explored. To explore the association between early-onset persistent stunting in children and cognitive development at 5 years of age, a...

A child’s diet contains nutrients and other substances that influence intestinal health. This study aimed to evaluate the relations between complementary feeding, intestinal barrier function, and environmental enteropathy (EE) in infants. Data from 233 children were obtained from the Brazilian site of the MAL-ED cohort study. Habitual dietary intak...

Considering the high burden of micronutrient deficiencies in Bangladeshi children, this analysis aimed to identify the factors associated with micronutrient deficiencies and association of plasma micronutrient concentration trajectories from 7 to 24 months with the concentrations at 60 months of age. Plasma samples were collected at 7, 15, 24, and...

Background: Several distinct plant-based diet indices (PDIs) have been developed to characterize adherence to plant-based diets. Objective: We contrasted 5 PDIs in a community-based cohort by assessing characteristics of the diet and evaluating whether these PDIs are associated with risk of incident hypertension. Methods: Using FFQ data from a...

Abstract Objectives Bacterial vaginosis (BV), a clinical condition characterized by decreased vaginal Lactobacillus spp., is difficult to treat. We examined associations between micronutrient intake and a low-Lactobacillus vaginal microbiota as assessed by molecular methods (termed “molecular-BV”). Methods This cross-sectional analysis utilized dat...

Background: Environmental enteric dysfunction (EED) is thought to increase the risk of micronutrient deficiencies, but few studies adjust for dietary intakes and systemic inflammation. Objective: We tested whether EED is associated with micronutrient deficiency risk independent of diet and systemic inflammation, and whether it mediates the relat...

Background Previous studies have documented the cardiometabolic health benefits of plant‐based diets; however, these studies were conducted in selected study populations that had narrow generalizability. Methods and Results We used data from a community‐based cohort of middle‐aged adults (n=12 168) in the ARIC (Atherosclerosis Risk in Communities)...

Background: Child cognitive development is influenced by early-life insults and protective factors. To what extent these factors have a long-term legacy on child development and hence fulfillment of cognitive potential is unknown. Objective: The aim of this study was to examine the relation between early-life factors (birth to 2 y) and cognitive...

Objectives: To estimate the usual energy and micronutrient intakes of children 9-24 mo of age and evaluate the probability of adequacy of the diet in 7 MAL-ED sites. Methods: Breastfeeding was evaluated biweekly from enrolment (≤17 d old) through 24 mo; beginning at 9 mo, monthly 24-hour recalls (up to 17 recalls/child) were used to quantify int...

Objectives: To identify clusters of cognitive developmental trajectories and associated differentiating factors of children aged 6 to 60 months old in 5 low to middle-income sites. Methods: We followed 835 children and assessed anthropometry at enrolment (≤ 17 d old); bi-weekly illness data (0-24 and 60 mo); non-diarrheal and diarrheal stools (0...

Objectives: We tested whether environmental enteric dysfunction (EED) is associated with risk of micronutrient deficiencies adjusting for diet and systemic inflammation, and whether it mediates the relation between intake and micronutrient status. Methods: Data from 1283 children in the MAL-ED birth cohort were examined to evaluate risk of anemi...

Objectives: To identify factors associated with improvement ('catch-up') in height and weight from 24-60 mo of age, and to determine whether associated factors differ depending on the metric used (absolute or relative difference from WHO growth standards). Methods: At seven MAL-ED sites, 942 children had anthropometry data at 24 and 60 mo, as we...

Objectives: Recently, several distinct diet indices have been developed to characterize adherence to plant-based diets. We deconstructed and compared 6 plant-based diet indices (PDI) in a community-based cohort with respect to their scoring and their associations with incident hypertension. Methods: Using food frequency questionnaire data from m...

Background: Poor growth in early childhood has been associated with increased risk of mortality and morbidity, as well as long-term deficits in cognitive development and economic productivity. Objectives: Data from the MAL-ED cohort study were used to identify factors in the first 2 y of life that are associated with height-for-age, weight-for-a...

An adapted version of the Wechsler Preschool and Primary Scale of Intelligence—Third Edition (WPPSI-III) was administered to assess cognitive functioning among 1,253 5-year-old children from the Malnutrition and Enteric Disease (MAL-ED) study—an international, multisite study investigating multiple aspects of child development. In this study, the f...

Background and objectives: The association between plant-based diets, incident CKD, and kidney function decline has not been examined in the general population. We prospectively investigated this relationship in a population-based study, and evaluated if risk varied by different types of plant-based diets. Design, setting, participants, & measure...

Introduction: Previous studies of plant-based diets and chronic diseases have limited generalizability because most have been conducted among vegetarians or Adventists who may have healthier lifestyles than the general population. Hypothesis: We hypothesized that plant-based diets are associated with lower risk of cardiovascular disease and all-cau...

Feeding of infant formula using contaminated bottles may be an important transmission pathway of enteric pathogens during early life. Determinants of suboptimal bottle hygiene and the feasibility and acceptability of intervention strategies have not been well assessed. We evaluated the extent of bottle contamination, its contributing factors, and o...

Obesity prevalence is high in Native American (NA) adults, and there is a critical need to establish and implement evidence-based social, behavioral, and policy interventions that are theoretically informed. The use of multilevel, multicomponent (MLMC) interventions has been shown to be an effective strategy for comprehensive health behavior change...

Objective To delineate trends in types of protein in US adults from 1999 to 2010, we examined the mean intake of beef, pork, lamb or goat, chicken, turkey, fish, dairy, eggs, legumes, and nuts and seeds (grams per kilogram of body weight) among adults and according to subgroups, including chronic disease status. Design Six cycles of the repeated c...

Objective In resource-constrained facilities or during resuscitation, immediate paediatric weight estimation remains a fundamental challenge. We aimed to develop and validate weight estimation models based on ulna length and forearm width and circumference measured by simple and portable tools; and to compare them against previous methods (advanced...

Maternal mental health problems are associated with poor child growth and sub‐optimal child feeding practices, yet little qualitative research has been conducted to assess mothers' perceptions on how psychological distress impacts their ability to care for and feed their children. The current study took place in South Kivu, DR Congo, and was nested...

Background Food insecurity remains a major factor contributing to poor nutritional status of many populations, but approaches to improving household food insecurity have not been widely evaluated, especially in severely food insecure settings. Objective To assess the effectiveness of a US Agency for International Development Office of Food for Pea...

Background: In many countries, there are growing numbers of persons living with a prior diagnosis of cancer, due to the aging population and more successful strategies for treatment. There is also growing evidence of the importance of healthful diet and weight management for survivorship, yet many long-term cancer survivors are not successfully fo...

Food security, defined as the capacity to acquire preferred food at all times, can manifest in many dimensions. Following a mixed methods approach used in India and Burkina Faso, we developed a 58-item experience-based measure in the Peruvian Amazon, based on investigator observations, relevant literature, and pre-testing with community field worke...

Food insecurity contributes to poor nutritional status of many populations, but long-term approaches to improving household food insecurity have not been widely evaluated. This study evaluates the effectiveness of four interventions, Women’s Empowerment Groups (WEG), Prevention of Malnutrition in Children under 2 Approach (PM2A), Farmer Field Schoo...

Objective The present study aimed to describe breast-feeding, complementary feeding and determining factors for early complementary feeding from birth to 8 months of age in a typical Brazilian low-income urban community. Design A birth cohort was conducted ( n 233), with data collection twice weekly, allowing close observation of breast-feeding, c...

Background: Plant-based diets, often referred to as vegetarian diets, are associated with health benefits. However, the association with mortality is less clear. Objective: We investigated associations between plant-based diet indexes and all-cause and cardiovascular disease mortality in a nationally representative sample of US adults. Methods:...