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Household Factors, Family Behavior Patterns, and Adherence to Dietary and Physical Activity Guidelines Among Children at Risk for Obesity
Abstract
To describe the proportion of children adhering to recommended physical activity and dietary guidelines, and examine demographic and household correlates of guideline adherence.
Cross-sectional (pre-randomization) data from a behavioral intervention trial designed to prevent unhealthy weight gain in children.
A total of 421 children (aged 5-10 years) at risk for obesity (body mass index percentile, 70-95).
Physical activity (accelerometry), screen time (parent survey), and fruit and vegetable and sugar-sweetened beverage intake (24-hour dietary recall).
Proportions meeting guidelines were calculated. Logistic regression examined associations between demographic and household factors and whether children met recommended guidelines for (1) physical activity (≥ 60 min/d), (2) screen time (≤ 2 h/d), (3) fruit and vegetable intake (≥ 5 servings/d), and (4) sugar-sweetened beverage avoidance.
Few children met more than 1 guideline. Only 2% met all 4 recommended guidelines and 19% met none. Each guideline had unique sociodemographic and domain-specific household predictors (ie, availability of certain foods and beverages, media, and active play and exercise equipment).
Families equipped to promote healthy child behavior patterns in 1 activity or dietary domain may not be in others. Results have implications for the development of interventions to affect children's weight-related behaviors and growth trajectories.
Copyright © 2015 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.
... Characteristics of the 53 included studies are summarised in Additional file 2. Studies were conducted across eighteen countries; the majority were from the US (n = 9) [19,[42][43][44][45][46][47][48][49], Brazil (n = 9) [50][51][52][53][54][55][56][57][58] and Australia (n = 5) [25,[59][60][61][62], and seven provided data from more than one country [63][64][65][66][67][68][69]. Studies were published between 2007 [46] and 2022 [57,58], with the majority (87%) published within the last decade. ...
... Forty-nine studies employed a cross-sectional design and four used a longitudinal design [59,[70][71][72] with follow-up durations ranging between two [70,71] and six [72] years post baseline. Most studies included adolescents (n = 31) [25, 42, 44, 46-48, 50-58, 63, 64, 66, 68, 72-83], thirteen included children (n = 13) [43,49,61,62,65,67,69,70,[84][85][86][87][88], seven included both children and adolescents (n = 7) [19,45,59,60,71,89,90], one included adolescents and young adults (n = 1) [91], and only one study included young adults only (n = 1) [92]. Participants' ages ranged from five [19, 49, 59-61, 70, 89] [19, 25, 42, 44-68, 71, 72, 74-92]. ...
... PA and SB were measured using accelerometers in nine [44, 46, 49, 59-61, 71, 84, 87] and four [44,59,60,71] studies, respectively, and were either self-reported or parent-reported in the other studies. For dietary data collection, questionnaires (e.g., a set of questions in a survey pack) were the most prevalent instrument used (n = 28) [45, 48, 50-54, 56-58, 61, 62, 68, 69, 71, 73, 74, 79-83, 85, 86, 88-90, 92], followed by food frequency questionnaires (FFQ) (n = 16) [25, 42, 43, 59, 60, 64, 65, 67, 70, 72, 75-78, 87, 91], 24-h dietary recall (n = 8) [19,44,46,49,55,63,64,66], a diet diary (n = 1) [84], and multiple-pass recall methods (n = 1) [47]. PA was presented using varied units including daily MVPA [25,44,59,60,63,64,71,87], daily PA [68,82,89], moderate physical activity (MPA) [44], vigorous physical activity (VPA) [44,65],weekly MVPA [19, 43, 50, 55, 66, 74, 78,83,88], days per week of PA [19,42,51,54,57,79,80,92], MPA [91], and VPA [48], meeting PA recommendations [46,47,49,61,62,76,81,84], weekly [53,56,67,70,88,90] or daily [45,86] sport participation and playing outside, weekly sports at a club [69,70,72,77], frequency and duration of weekly leisure time [52,72,75,77], days per week of active commuting [52,70,81], days per week of physical education [48], and other PA/ sport at school [48,52,70,75,81] and non-school [48,73,81], activity preferences [85], and PA score [58]. ...
Background
Physical activity (PA), sedentary behaviour (SB) and diet play an important role in the physical and mental health of young people. Understanding how these behaviours cluster, and the impact of clusters on health is important for the development of public health interventions. This review examines the prevalence of clusters of PA, sedentary time, and dietary behaviours, and how clusters relate to physical and mental health indicators among children, adolescents and young adults.
Methods
Electronic (PubMed, Web of Science and Scopus) and manual searches were conducted for articles that were (i) observational studies including children, adolescents and/or young adults aged 5–24 years, (ii) examined the 'patterning', ‘clustering’, or ‘co-existence’ of each of PA, dietary behaviour and SB, and (iii) published in English up to and including July 2022. In addition to information on clustering, data on physical and mental health outcomes were extracted where reported. Included studies were assessed using the Cochrane risk of bias for observational studies. A narrative synthesis was conducted due to high heterogeneity. This review was registered with PROSPERO (CRD42021230976).
Results
Forty-nine cross-sectional studies and four prospective cohort studies from eighteen countries reporting data from 778,415 individual participants were included. A broad range of clusters (n = 172) were found (healthy, unhealthy, and mixed). Mixed clusters were common (n = 98), and clusters of high diet quality, low PA and high SB were more prevalent in girls, while mixed clusters of high PA, high SB and low diet quality were more prevalent in boys. Unhealthy clusters comprising low moderate to vigorous PA, low consumption of fruits and vegetables, and high screen time were prevalent, particularly in those from lower socioeconomic status families. Compared to those with healthy behavioural clusters, those with unhealthy and mixed clusters had a higher adiposity, higher risk of cardiovascular disease, poorer mental health scores, and lower cardiorespiratory fitness.
Conclusions
PA, SB and diet cluster in healthy, unhealthy and mixed patterns in young people that differ across sociodemographic characteristics. Unhealthy clusters are associated with poorer health outcomes. Intervention strategies targeting un-clustering multiple unhealthy behaviours should be developed and evaluated for their impact on health outcomes.
... Children-and parent-related factors, such as gender, level of education, and body mass index (BMI), have been shown to be associated with the eating behavior of the children (10)(11)(12)(13). A study showed that the highest daily intake of fruit was reported in girls in Albania (55%) and in Denmark and Switzerland (both at 51%). ...
... Despite some improvement, these findings are consistent with the findings from Study 1, previously conducted among children in Ticino (34). The results are also consistent with other studies with a similar population (10,36,(38)(39)(40). As in the first study, all non-adherers for SSD were overconsumers, as well as the majority of non-adherers for proteins were over-consumers (in the previous study, for meat 72% were over-consumers, while for eggs 71% were under-consumers). ...
... The influence of parents was also seen in the finding that children whose parents had a low level of education were more likely to adhere to the guidelines for cereal consumption. While a European study showed that overall children whose parents had a lower level of education were less likely to eat vegetables, fruit, pasta, and other low-sugar and low-fat foods (10,13,56), according to another study, children whose parents have high education and thus a higher income, have a lower-quality diet, as parents do not have time for food preparation and children often eat outside, with less parental control (57). Further, higher educated parents might think that cereals are not a good source of food, as the idea of pasta causing people to get overweight or obese is quite spread, and parents might thus limit food access with the aim of preventing overweight (58). ...
Objectives: To describe the adherence of the children to the Swiss Society for Nutrition (SSN) dietary guidelines, assess determinants of adherence, and compare these findings with a previous study in the same population.
Methods: Data from 312 children ages 5–12 were collected through a survey and a 2-day food record. The associations of children- and parent-related factors with adherence of the children to guidelines were assessed by logistic regression analyses.
Results: SSN guidelines were not met for any food category, although there were improvements: vegetables (4.5% in this study vs. 0% in the previous study), sweets, snacks, and soft drinks (SSD) (12.5 vs. 9.5%), and fruit (45.5 vs. 10.4%). Higher Body Mass Index (BMI) in children was associated with higher adherence to guidelines for protein intake. Higher parental BMI was associated with higher adherence to vegetables. Parental lower educational level was associated with higher adherence for cereal.
Conclusion: Despite improvements since the last eating behavior assessment in this population, children consume too little fruit, vegetables, cereal, and milk and dairy products, and too much SSD and proteins. Further efforts are needed to promote healthy eating to children and achieve adherence to guidelines.
... The low numbers of children meeting guidelines for fruit and vegetable consumption in this study (11.7%) may have reduced our ability to document associations between demographic and fruit and vegetable consumption. Kunin-Batson et al. reported that older children were more likely to meet fruit and vegetable guidelines, females were less likely to meet fruit and vegetable guidelines and parent education was not significantly related to adherence to fruit guidelines (49). This study showed demographic covariates were not significantly related to adherence to sugar-sweetened beverages guidelines. ...
... Kunin-Batson et al. reported that age, gender, and parents' education were strongly associated with adherence to sugar-sweetened beverages guidelines. Children who met guidelines for sugar-sweetened beverage avoidance were more likely to be younger and to have parents with at least a college education (49). In other studies, children of parents who had at least a college education were more likely to meet guidelines for sugar-sweetened beverage consumption (50). ...
... Our study showed that demographic covariates were not significantly related to adherence to physical activity guidelines. Kunin-Batson et al. reported that age and gender were strongly associated with physical activity, but parental education was not associated (49). As many as 40% of participants in this study did not meet screen time recommendations. ...
Background and aim
The world is experiencing an alarming increase in prevalence of childhood obesity. The aim of this study was to determine the demographic determinants of obesity and adherence to dietary and physical activity guidelines among children aged 4 to 6 years old in Behbahan city, southwest Iran, in 2016.
Methods
This cross-sectional study was conducted on 120 preschool children aged 4 to 6 years old in Behbahan city, southwest Iran, in 2016. Multi-stage random sampling was done. The weight and height of the children were measured with standard methods. The demographic and behavioral factors data were collected in self report questionnaires which were completed by the children’s mothers. The Chi-square test, Independent-samples t-tests, One-way analysis of variances and logistic regression analysis were used for data analysis. SPSS software (version 22) was employed.
Results
This study showed that 88.3% of the children did not meet the guideline of 5 servings per day of fruit and vegetables. Only 2.5% met the guideline of 60 minutes of structured physical activity every day. Sex and mother’s occupation status were associated with adhering to screen time guideline. This study found a significant difference in the mean of screen time between sexes. Boys were more likely to meet the screen time guideline. A significant association between adhering to physical activity guidelines and mother’s occupation status was revealed. Significant statistical relationship between demographic factors and BMI categories was not illustrated. Demographic covariates were not significantly related to adherence to dietary and physical activity guidelines.
Conclusion
In preventive programs of obesity among 4 to 6-year-old children key lifestyle behaviors and demographic factors need to be considered.
... Few studies have examined adherence to the '5-2-1-0' recommendations collectively and assessed predictors of attainment. [18][19][20][21][22][23][24][25] Furthermore, there is a paucity of studies that have assessed the association of '5-2-1-0' recommendations with BMI z-score or weight status in preschool-aged children, 26,27 which is important to consider given that 80% of children in this age group use screens daily. 28 Of the studies examining adherence to the '5-2-1-0' recommendations, most have relied on self-reported data [20][21][22][23][24] and have focused on school aged children [19][20][21][22] or adolescents 18,21,23 instead of preschoolers. ...
... [18][19][20][21][22][23][24][25] Furthermore, there is a paucity of studies that have assessed the association of '5-2-1-0' recommendations with BMI z-score or weight status in preschool-aged children, 26,27 which is important to consider given that 80% of children in this age group use screens daily. 28 Of the studies examining adherence to the '5-2-1-0' recommendations, most have relied on self-reported data [20][21][22][23][24] and have focused on school aged children [19][20][21][22] or adolescents 18,21,23 instead of preschoolers. [24][25][26] No study to our knowledge has A C C E P T E D M A N U S C R I P T Khalsa et al. ...
... 13 Several studies have now shown that attainment of the '5-2-1-0' recommendations is low. 18,19,21,24,25 One possible explanation for low attainment is that even though the message is straightforward and easy to remember, it can be difficult for families to implement. As '5-2-1-0' is a composite of four separate recommendations, each recommendation requires a specific behavior change. ...
Obesity prevention guidelines recommend children eat ≥ 5 servings of fruits and vegetables, view ≤ 2 h of screen time, participate in 1 h of physical activity, and consume 0 sugar-sweetened beverages daily, commonly known as '5-2-1-0'. We sought to determine: the extent to which preschool-aged children attending child care meet these guidelines, predictors of attainment, and associations of attainment with weight status. We analyzed in 2016, 24-hour dietary, physical activity, and screen time data collected in 2009-10 from 398 preschool-aged children in 30 child-care centers in Cincinnati, OH. Dietary intake, screen time and body-mass index (BMI) were obtained by research staff during child care and from parents when at home. Accelerometers measured physical activity. Mixed-effects models and generalized estimating equations were used to determine associations between '5-2-1-0' recommendations, demographic variables, and BMI z-scores. Average child age was 4.3 ± 0.7 years; 26% had a BMI ≥ 85th percentile. Seventeen percent of children with complete dietary data (n = 307) consumed ≥ 5 servings of fruits and vegetables and 50% consumed 0 sugar-sweetened beverages. < 1% with complete physical activity data (n = 386) met the activity recommendation; 81% of children (n = 379) had ≤ 2 h of screen time. Only 1 child met all of the '5-2-1-0' recommendations. There were no consistent demographic predictors of attaining individual recommendations. An additional hour of screen time was associated with a 0.11 (SD 0.06) increase in BMI z-score. Our data suggests there is ample room to increase fruit and vegetable intake and physical activity in preschool-aged children.
... [12][13][14] Parents can have a strong positive influence on their child's eating habits by making fruits and vegetables available, modeling consumption, and voicing support for healthy behaviors. 15 Children also contribute to the healthy home environment by requesting fruits and vegetables in the home, grocery shopping with parents, and asking to have their favorite fruits and vegetables within reach. 15,16 These studies [12][13][14][15][16] indicated that children and parents interact to create the family food environment and that cooking meals at home may improve diet quality. ...
... 15 Children also contribute to the healthy home environment by requesting fruits and vegetables in the home, grocery shopping with parents, and asking to have their favorite fruits and vegetables within reach. 15,16 These studies [12][13][14][15][16] indicated that children and parents interact to create the family food environment and that cooking meals at home may improve diet quality. ...
... 15 Children also contribute to the healthy home environment by requesting fruits and vegetables in the home, grocery shopping with parents, and asking to have their favorite fruits and vegetables within reach. 15,16 These studies [12][13][14][15][16] indicated that children and parents interact to create the family food environment and that cooking meals at home may improve diet quality. ...
Objective:
Evaluate the effect of a community-based, experiential cooking and nutrition education program on consumption of fruits and vegetables and associated intermediate outcomes in students from low-income families.
Design:
Quasi-experimental program evaluation by pre-post survey of participating students and their parents.
Setting:
Underserved elementary and middle schools in Chicago.
Participants:
Students (n = 271; 65% girls, 44% Hispanic, 32% African American; 94% eligible for free/reduced price lunch) in grades 3-8 selected by school staff to participate by variable inclusion criteria. 59% of students who applied returned both pre- and post-surveys.
Intervention(s):
Ten-week (2 h/wk) chef-instructor-led program held in cafeteria kitchens after school.
Main outcome measure(s):
Changes in student nutrition knowledge, cooking self-efficacy, fruit and vegetable liking and consumption, and communication to family about healthy eating.
Analysis:
Changes from beginning to end of program were analyzed with paired t test. Results were considered significant at P < .05.
Results:
Increased nutrition knowledge score from 0.6 to 0.8, cooking self-efficacy score from 3.2 to 3.6, and vegetable consumption score from 2.2 to 2.4 (all P < .05). Increased score for communication about healthy eating (4.1 to 4.4; P < .05) 6 months after the end of the course.
Conclusions and implications:
Experiential cooking and nutrition education programs led by chef-instructors may be effective ways to improve nutrition in low-income communities.
... Beverages can be consumed in a variety of settings, including in the home, at school/work, at social occasions, and when eating out. Consistent with the social-ecological model of health promotion 13 , understanding the social, cultural and physical factors that impact on the home food environment is important in addressing the challenges of obesity, especially for children [14][15][16][17][18][19][20] . Pre-adolescent children, are highly susceptible to factors in the home environment, have little purchasing autonomy outside of the home, and are rapidly developing food tastes and habits 21 . ...
... A unique finding in this study was that overall self-reported sugary drink consumption was higher among those with tertiary education compared to those with only high school education or other/no education which contrasts with existing literature 19,24,38,39 . Similarly, a higher proportion of low-income households had children of any age that consumed low or Downloaded from https://www.cambridge.org/core. ...
Objective
Most research investigating sugar-sweetened beverages (SSBs) and health, conducted at the individual or household level, ignores potentially important intra-household dynamics. We analysed self-reported consumption relationships between children and adults, and between children of different ages, as well as the associations between intra-household consumption, body mass index and socio-demographic characteristics.
Design
A cross-sectional analysis of survey data from Kantar Fast Moving Consumer Goods panellists in September 2017.
Setting
Great Britain
Participants
Random sample of 603 households with children under 18 who regularly purchase non-alcoholic beverages.
Results
Low or no-sugar/diet beverages dominate consumption across all age categories, particularly children under 12 years. SSB consumption increased as children became older. Children’s reported consumption of SSBs and low or no-sugar/diet beverages was positively associated with consumption by adults; a child in adolescence had over nine times the odds of consuming SSBs (adjusted OR 9.55, 95% CI 5.38, 17.00, p<0.001), and eight times the odds of consuming low or no-sugar/diet drinks (adjusted OR 8.12, 95% CI 4.71, 13.97, p<0.001), if adults did so. In households with multiple children, consumption patterns of older siblings were associated with those of the younger; notably a perfect correlation between children 0-6 years consuming SSBs if siblings 13-18 years did so, and children 7-12 years had 22 times the odds of consuming SSBs if siblings 13-18 years did so (OR 22.33, 95% CI 8.60, 58.01, p<0.001).
Conclusions
Multiple policies, targeting children as well as adults, such as fiscal levers and advertisement restrictions, are needed to reduce and prevent consumption of SSBs.
... Although many interventions provide free access to programming, there are other costs related to PA participation, including transportation to and from the intervention locations 25,36,37 and proper equipment/attire to participate in the activity. 38,39 Subsequently, if the intervention does not properly account for associated costs, engaging in the PA intervention will be difficult, especially for children from families with low socioeconomic status. 16 While all 3 spheres are important to accessibility, mobility options can be the most impactful when developing a community-based PA intervention. ...
... Despite the G5AP providing free access to recreational facilities across London, there are still financial barriers for children to use the G5AP, such as equipment to participate (eg, skates, swimsuits, proper footwear) and mobility options. 25,[36][37][38][39] The results show that G5AP has been successful at overcoming economic accessibility, as the odds of overall use and use of the G5AP at the BGCL increase significantly as neighborhood MHHI decreases. Providing a free pass to the entire population can increase PA opportunities for those in low-income neighborhoods without the stigmatization associated with a family registering for a discount program. ...
Background:
Children's sedentary lifestyles and low physical activity levels may be countered using population-level interventions. This study examines factors influencing the use of a free community-wide physical activity access pass for grade 5 students (G5AP).
Methods:
A natural experiment with longitudinal data collection. A sample of 881 children completed the 9-month follow-up survey self-reporting where they used the G5AP. Two analyses were conducted: Getis-Ord GI* geographic cluster analysis of the spatial distribution of users, and logistic regression examining the relationship between use and accessibility (informational, economic, and geographic) and mobility options, while accounting for intrapersonal and interpersonal factors.
Results:
Overall, 44.9% of children used the G5AP with clusters of high use in urban areas and low use in the suburbs. Other factors significantly related to G5AP included gender (girls), informational accessibility (active recruitment), economic accessibility (median household income), geographic accessibility (facilities within 1.6 km of home), and mobility options (access to Boys & Girls Club bus).
Conclusions:
This study found that a diverse population of children used the G5AP. To continue being successful, community-based physical activity interventions need to ensure that the intervention increases geographic, economic, and informational accessibility and provides mobility options that are available to the target population.
... Mothers' primary role in creating the home food environment and serving as role models for eating behaviors has been identified as a contributor to early childhood overweight and obesity [46,47]. Additionally, lower education attainment and low socioeconomic status within families have been associated with frequent consumption of sweetened drinks, fast food, and a lower intake of fruits and vegetables [6,48,49]. ...
The prevalence of obesity has increased significantly in developing nations over the past decade, particularly among adolescent girls. To assess the scale of this epidemic among female adolescents in South Africa, a systematic review was undertaken to investigate the connection between diet and obesity. Multiple databases (Google Scholar, Science Direct, Cochrane Library, PubMed, and Web of Science) were searched to identify studies investigating the associations between diet and various adiposity indices as outcomes. Of the 56 studies identified, 7 met the inclusion criteria. The age range of participants spanned from 11 to 21 years. Tabulation was used to report the data, study by study. The consumption of nutrients from animal sources exhibited a positive correlation with higher BMI-for-age Z scores (p = 0.02). Eating habits such as sporadic family meals (p ≤ 0.02), irregular breakfast consumption (p ≤ 0.05), and a high energy intake derived from fat were linked to an increased risk of adiposity. Additionally, factors such as socioeconomic status and residential location revealed associations with certain dietary intakes and adiposity. As more studies identify the causative role of diet in obesity, there is an urgent need for policy intervention and strategies to address the growing non-communicable disease burden in South Africa.
... На првом месту, деца уче да буду физички активна посматрајући физичку активност својих родитеља, а на другом, она формирају позитивне ставове према ФА на основу позитивних ставова које исказују њихови родитељи. Штавише, показано је да се степен ФА може преносити трансгенерацијски, односно да су деца физички активних родитеља и сама физички активна, као и да томе уче своју децу (Kunin-Batson et al., 2015). Истраживања која су спроведена у различитим социо-културним окружењима показала су да постоји већа вероватноћа да деца учествују у ФА, уколико су један, a нарочито оба родитеља и сами укључени у ФА или су то били раније (Ilić, 2012 Мере изолације (енг. ...
The importance of physical activity (PA) for the psychological well-being of children is well documented. COVID-19 lockdown implied a severe reduction in organized and unorganized PA. Our goal was to examine how parents perceive their children's PA and their own PA related behaviours during the first month of COVID-19 lockdown in Serbia compared to the usual circumstances, to investigate the relationship between parents' evaluations of PA and children's PA level during the lockdown, and to examine the relationship between children's PA level and changes in psychological well-being and daily routines. The sample included 127 parents of preschool and school children. We constructed a questionnaire assessing sociodemographic information, parents' ratings of children's PA, their own children's PA-related behaviours, their evaluations of children's PA engagement before and during the lockdown, and their perception of psychological well-being and daily routines of their children during the lockdown. Results showed that the amount of daily PA in children decreased during the lockdown, especially the organized forms, which indicated that online PA programs have failed to replace regular PE classes and sports training. Also, parents valued regular forms of organized PA more than their online counterparts. We confirmed the relationship between parental evaluations and children's PA and showed that it depends on the specific aspect of PA the parents valued. Parents perceived that changes in children's psychological well-being and daily routines during the lockdown were of moderate intensity. PA frequency was related to attention, mood swings and PC and TV use. Our study offers several practical recommendations for children's PA in restrictive circumstances.
... [1] Patterns of parents' PA can be used as a predictor of children's patterns of activity and the risk of many related health outcomes such as obesity and overweight. [9] To generate evidence for better designing of effective policies and planning of interventional program, we assessed the PA inequality in Iranian students and their parents at the national level as well as according to the regional level of socioeconomic status (SES). ...
Background:
As a health-related behavior, physical activity (PA) differs according to individual's socioeconomic status (SES). This study aimed to assess the socioeconomic difference in leisure-time PA among Iranian students and their parents at national and regional levels.
Study design:
Nationwide cross-sectional study.
Methods:
This study was conducted as part of a national survey conducted in 2015 among 14400 Iranian students and their parents. Total PA level was measured as the average hours spent on PA per week. Nonlinear principal component analysis was used to construct the households' SES based on household's assets, type of house ownership, occupation of fathers and the educational levels of fathers and mothers. Concentration index was applied to measure the inequality in the PA level in parents and students.
Results:
Complete data of 13313 students and their parents were available. At the national level, students spent more hours of PA per week (3.753 h per week [h/w]) as compared to their parents. Moreover, PA h/w was higher in fathers (3.488 h/w) as compared to mothers (2.763 h/w). The lowest means of mother's and student's PA were found in the highest SES region. At national level, the concentration indices (CI) of father's and mother's PA were -0.050 (95% CI = -0.067 ~ -0.030) and -0.028 (95% CI = -0.044 ~ -0.012), respectively, indicating pro-poor inequality, but the CI value of student PA was non-significant (CI = -0.007, 95% CI = -0.023-0.008).
Conclusions:
Given that the mother's and student's PA level was low in the high SES regions, it is suggested that focused PA planning may further increase the level of PA across higher SES regions and might be effective in reducing the PA inequality.
... For these reasons, federal guidelines recommend that young children ages 2 to 5 years should consume foods that are more nutrient-dense than calorie-dense; such food groups include low-fat milk/dairy, lean meat and beans, fruit, vegetables, and whole grains [9][10][11][12][13] . However, only 14% of US children currently consume recommended servings of fruits and vegetables for their age ranges [14] , suggesting a need to understand how to best support healthful diet for young children nationwide. ...
The study purpose was to determine associations between proximity to grocery stores and Early Care and Education programs’ (i.e., ECEs) classroom nutrition practices and barriers, by ECE context (Head Start, community-based childcare [CBC], and family child care homes [FCCHs]). A statewide cross-sectional survey was implemented in Oklahoma ECEs. Directors reported classroom nutrition practices with the Nutrition and Physical Activity Self-Assessment tool, and barriers to implementation. Locations of 457 grocery stores statewide were determined by in-person audit. Geocoded ECEs were considered within a “low proximity” area if no grocery stores were available within a 0.25-mile radius for urban, or 10-mile radius for rural, ECEs. From November 2019 to February 2020, 54 Head Starts, 159 CBCs, and 160 FCCHs participated. 31.0% were considered as low proximity. Head Starts demonstrated the highest classroom nutrition scores for mealtime practices, and nutrition education and policy. While proximity to grocery stores was not related to classroom nutrition practices for any ECE context (p>0.05), FCCHs located within a low proximity area reported barriers to implementing those practices more often compared to FCCHs in an area within accessible proximity of grocery store. Thus, proximity to grocery stores was related to barriers in FCCHs only; those provider’s experiences and perceptions may be most susceptible to influence of the community nutrition environment, compared to other ECE contexts. Contrary to studies in residential areas and schools, nutrition environments were not related to nutrition practices in ECEs. ECEs may serve as protective micro-environments supporting health for children residing in nearby low-access communities.
... In younger age groups, the findings of previous studies are also similar to those of the current study. In a sample of 521 children aged 5-10 years (all weight categories), Kunin-Batson et al. showed that only 14% of children met the guideline of five servings of fruit/vegetables per day, and 42% met the guidelines regarding the consumption of sugar-sweetened beverages, while the percentage of those meeting both guidelines was even lower (8%) [23]. Still, no differences between overweight/obese children and their normal weight peers were identified. ...
Childhood obesity increases the risk for metabolic disorders, but is also related to nutritional deficiencies, such as anemia and hypovitaminosis D. Although children/adolescents with overweight/obesity may have higher energy intake, their diet quality and diversity may be low. The present study aimed to evaluate the consumption of foods against the national food-based dietary guidelines in children and adolescents with overweight or obesity in Greece. Sociodemographic, anthropometric and lifestyle data were collected from a sample of 1467 children 2–18 years old (962 obese, 505 overweight, 51.2% females) in 2014–2017. The results of this study show that the consumption of dairy products, fruit, vegetables, legumes and fish by children/adolescents with overweight or obesity was lower than the national recommendations (ranging from a minimum of 39.5% for fish, to a maximum of 75.5% for cereal/potato/rice). Only the consumption of meat/poultry was found to exceed the national recommendation (estimated coverage of 131.3%). Moreover, a large proportion of participants regularly consumed various unhealthy foods/beverages. The present findings indicate that the majority of children/adolescents with overweight/obesity do not comply with the national food-based dietary guidelines in Greece. The implementation of new strategies to promote healthy diets among children/adolescents with overweight/obesity are urgently required.
... Such a relationship has been observed even among poor indigenous populations in Mexico. 22,23 The third mechanism through which families may affect children's weight is through the accepted level of activity 24 and exercise, [25][26][27] as well as diet. [28][29][30] Family meal patterns have a major influence on overweight and obesity. ...
Background: This study is a longitudinal analysis of how the transition of a mother, father, or any other family member to obesity affects the likelihood of children 5–12 years of age becoming adolescents with overweight or obesity during the 7–10-year period between 2002 and the period from 2009 to 2012 in Mexico.
Methods: The study used two rounds of the Mexican Family Life Survey, a multipurpose random national survey that collected information on 8441 households, including 38,233 individuals in 2002 and successfully followed up with 3202 children until the period from 2009 to 2012. We used logistic regressions to calculate how family characteristics related to the evolution of body mass indexes among children, controlling for individual, family weight-related characteristics, and the socioeconomic level of the family.
Results: The transition of any family member toward obesity is more relevant in determining the transition to obesity among normal-weight children than socioeconomic level of the family and individual characteristics, such as sex, schooling, and occupation.
Conclusions: The transition of any family member toward obesity is associated with the transition to obesity among normal-weight children. A family-based approach to obesity prevention has yet to be incorporated into national policies.
... The results obtained in the present study matched previous studies in children and adolescents that used k-Means analysis to identify food consumption patterns, dietary intakes and lifestyle variables (Landsberg et al. 2010;Magee, Caputi, and Iverson 2013;Sanchez et al. 2007;Lioret et al. 2008;Sabbe et al. 2008;Gharib and Rasheed 2011;Grieger, Scott, and Cobiac 2012;Heng and Several studies have identified a healthier or traditional food consumption in children, with higher scores of vegetables, fruits, and dairy products (Rathnayaka, Selvanathan, and Selvanathan 2019;Kunin-Batson et al. 2015;Heng and House 2018;Landsberg et al. 2010). Other studies described non-traditional or mixed food consumption as unhealthy consumption patterns with high scores of soft drinks, sweets, and chocolates, and energy drinks (Gharib and Rasheed 2011;Magee, Caputi, and Iverson 2013;Grieger, Scott, and Cobiac 2012;Sanchez et al. 2007). ...
Background: Promoting a healthy diet and lifestyle to reduce the national burden of nutrition-related problems among Palestinians requires an understanding of food consumption trends and patterns. Few studies have examined the food consumption patterns with the macro and micronutrient intakes and nutrition risk factors. The objective of this study was to study the food frequency and nutrient intake consumption patterns of Palestinian schoolchildren and their associations with the socioeconomic and risk factors. This is a national cross-sectional descriptive study conducted on Palestinian schoolchildren from the West Bank. The study examined the food consumption patterns of the macro and micronutrient intakes and nutrition risk factors among 1945 students aged 11-16 years. The data collected using the food frequency questionnaire and 24-hour recall that was administered by trained field workers. Food groups’ classification, nutrient intakes, body mass index (BMI) Z-scores, and socioeconomic di"erences were examined across the food groups’ patterns of consumption. We employed Z-score and K-Means cluster analysis to identify food consumption patterns and to examine factors associated with nutrient intakes. The food frequency results identified three food consumption clusters including the traditional, non-traditional, and mixed pattern. A total of 796 students (41%) were in traditional cluster, 458 (23.5%) in non-traditional cluster, and 691(35.5%) in mixed cluster. The nutrient intakes identified three clusters (High, Moderate, and Low consumption patterns) out of macronutrient, vitamins, and minerals categories. Most of the students located in the low consumption cluster for macronutrient, vitamins, and minerals clusters (66.9%, 67.7%, and 64 %) respectively. The traditional cluster was associated with healthy, non-obese, and physically active students and the non-traditional cluster was associated with unhealthy and obese students, but both shown significantly di"erent across the identified clusters. Imbalance in dietary intakes among schoolchildren reflects a lack of dietary diversity. High sugar, fats and oils, and beverages consumption, low consumption of grains, fruits, beans and legumes, and meat are noticed in Palestinian schoolchildren. The findings indicated the importance of considering the food groups' intake variations among Palestinian schoolchildren. As the segments relate to children’s health, nutrition diet programs should consider the high scores of non-traditional and mixed food consumption among school’s children.
... Furthermore, boys were found to be more likely to achieve 45 min of MVPA per day and 60 min of MVPA per day. Again this finding is consistent with previous research on gender specific associations (Kunin-Batson et al., 2015). This current study with Irish children of lower SES suggests that a positive relationship may exist between MVPA participation and boys. ...
Much cross-sectional research has shown that childhood physical activity participation has a positive relationship with markers of wellbeing, such as self-esteem and quality of life, and physical activity participation may serve as protective mechanism against some mental illnesses including depression. The aim of the current study was to examine the relationship between gender, physical activity, screen time, body mass index and wellbeing in Irish school children (N=705; mean age: 8.74 ± 0.52 years) from social disadvantage. In Northern Ireland, schools included in the 2010 Multiple Deprivation Measure (NIMDM) were invited to participate. Schools included for participation in the Republic of Ireland were from the Delivering Equality of Opportunity in Schools (DEIS) index. Data gathered included accelerometry (physical activity), self-report (screen time and wellbeing), and anthropometric measurements. Physical activity was objectively measured during eight consecutive days using Actigraph GT1M and GT3X devices, using stringent accelerometer protocol. Screen time activities were derived using questions adapted from the Health Promotion Agencies National Children’s Survey in Northern Ireland. The KIDSCREEN-27 is a health-related quality of life measurement, and this tool was used by participants to self-report their health and wellbeing. Results suggest that boys accumulated more minutes of daily screen time than girls, however, boys were more physically active when compared to girls. Wellbeing scores for gender showed inverse associations with daily screen time. Standard multiple regression revealed that gender, physical activity, screen time and body mass index (combined) explained little variance in the prediction of wellbeing. Results indicate the importance of gender-based considerations for physical activity and screen time with children from social disadvantage. The inverse relationship found between overall screen time and wellbeing across both gender types provides important information, and will help guide future healthy lifestyle interventions for Irish children of low-income communities.
... 3,4 However, less than half of children in the USA are meeting the federal physical activity recommendations, 5 and even fewer (14%) consume the recommended servings of fruits and vegetables for their age ranges. 6 Nevertheless, while physical activity and diet have been primary targets of obesitypreventing intervention studies, many have been unsuccessful 7 ; scientists have therefore suggested a need to identify a more comprehensive focus to aid in health-related behavioural change. Shorter sleep duration in childhood is associated with higher current and future weight status, 8 and researchers suggest trends in decreasing sleep duration for US children are paralleled to the national increase in obesity. ...
Aim
This study aimed to assess the relationship between the family environment and behaviours with objective child sleep quality.
Methods
Twenty‐four children (aged 2–5 years) and their parents participated. Child sleep was assessed by accelerometer. Health of the family environment was quantified using the Family Nutrition and Physical Activity Screening Tool (FNPA). Exact Wilcoxon rank sum tests and linear regression were used to determine associations between FNPA scores and child sleep.
Results
Healthier Total FNPA, Physical Activity FNPA, and Sleep Routine scores were associated with earlier bedtime. Healthier Sleep Routine score was associated with more total minutes of sleep per night. Healthier screen time‐related FNPA construct scores were associated with earlier bedtime.
Conclusions
A composite score of family environment and behaviours, including physical activity‐ and nutrition‐related constructs, was related to child sleep quality. Focus should be placed on the obesogenic family environment and healthy sleep routines to promote overall health among pre‐school‐aged populations.
... Most notably, operationalization of the "daily" or "per day" aspect of the recommendation differs. Meeting the MVPA recommendation has been operationalized as: at least 60 minutes per day when averaged across a week [9][10][11][12][13][14] ; at least 60 minutes on all 7 days of the week [15][16][17][18][19][20][21][22][23][24][25][26][27] ; and at least 60 minutes on at least 5 28 or at least 6 days 7 per week. The percentages of children and youth who meet the recommendation differ, based on how it is operationalized. ...
Background:
Exergaming is associated with positive health benefits; however, little is known about what motivates young people to exergame.
Objective:
This study aimed to develop a new Reasons to Exergame (RTEX) scale and describe its psychometric properties (Study 1) including test-retest reliability (Study 2). We also examined the test-retest reliability of self-report exergaming behavior measures (Study 2).
Methods:
We identified scale items in consultation with experts. In Study 1, we conducted an Exploratory Factor Analysis of RTEX and examined how the factors identified relate to exergaming frequency and intensity in a population-based sample of 272 young adults. In Study 2, we examined the test-retest reliability of RTEX factors and self-report measures of past-week exergaming frequency and intensity among 147 college students.
Results:
We identified four factors in RTEX: exergaming for fitness, exergaming for enjoyment, preferring exergaming over other gaming options, and choosing exergaming over competing interests (eg, sports). Test-retest reliability of RTEX factors (ICC 0.7-0.8) and self-report exergaming frequency (ICC 0.4-0.9) was adequate. Exergaming for fitness and enjoyment were positively associated with the frequency of exergaming with friends and family, and with exergaming intensity. Preferring exergaming over other gaming options and choosing exergaming over competing interests (eg, sports) were not related to exergaming behavior.
Conclusions:
RTEX is a psychometrically sound scale with four factors that measure reasons to exergame. Replication of these findings is needed in larger, more diverse samples.
... Fuemmeler, Anderson, and Masse (2011) investigating the parent-child correlation in accelerometer derived measures of physical activity found that from different intensity of PA vigorous PA was significantly related. Children, who are physically active, are likely to be active also in adult life (Kunin-Batson et al., 2015) that in turn may have positive impact on their children's physical activity. ...
Background. It is well known that parents influence physical activity of their children. Determining the factors
related to parents’ perception of the importance of physical activity and physical fitness enables enhancing the
promotion of physical activity among children in the future.
Methods. A total of 237 parents of children aged between 5 and 10 years participated in the study. Confirmatory
factor analysis was used to estimate factor structure of the questionnaire “Parents Perceptions of the Importance
of Physical Activity and Their Children´s Ability Questionnaire”. To investigate the differences between groups
Independent-sample t-test was used. Cohen’s d was used to estimate effect size.
Results. Confirmatory factor analyses showed that the eight-issue two-factorial model psychometric parameters
were acceptable in order to assess parents’ perception of the importance of physical activity and ability (RMSEA =
.072; NFI = .97; CFI = .98; NNFI = .98). Parents who were physically active in the past and were active in the present
evaluated the importance of physical activity more than inactive parents. Parents’ assessments of the importance of
physical activity and ability were not significantly different depending on parents’ education, university or secondary/
high education.
Conclusion. The questionnaire used is a valid measure of parents´ assessments of the importance of physical
activity and physical ability of the Estonian school students. The questionnaire enables us to identify parents’
assessments of the importance of physical activity and physical ability, which may be considered as one of the factors
related to children’s physical activity.
Keywords: parents’ evaluations, physical activity, children, confirmation factor analysis
... The analysis of body shape allows researchers to evaluate the effect of environmental and genetic factors on the biological adaptation of human populations. Several studies have shown that environmental conditions such as altitude (Pawson, Huicho, Muro, & Pacheco, 2001), household factors (Kunin-Batson et al., 2015), or nutritional status (Grellety & Golden, 2016;Myatt, Duffield, Seal, & Pasteur, 2009), among others, influence the development of the human body proportions. Anthropometric variables are widely accepted as important tools aimed at evaluating the health and nutritional status on children (de Onis & Habicht, 1996). ...
Introduction
Large shape variations take place during the growth process of children, including quantitative mass and size increase plus qualitative changes in their body shape. The aim of the present study is to apply Geometric Morphometric techniques in order to visualize and quantify such body shape differences in healthy children aged 6–59 months with optimal nutritional status.
Materials and methods
Anthropometrical measurements of weight, height, and middle‐upper arm circumference were used to assess nutritional status on a sample of 258 Senegalese (n = 154) and Spanish (n = 104) children. A set of 36 anatomical and/or osteologically‐based landmarks were identified on the body of the children along with 108 semi‐landmarks used to capture curvature attributes on the frontal view of the body image. A specific method was developed to place and photograph children, as well as to locate landmarks, treat images and calculate semi‐landmarks. Shape differences among children were analyzed in terms of age, sex, and population origin, taking into consideration allometry effects.
Results
Our results indicate significant differences in shape and size for all the three factors under study before removing size effect (p < .0001), and in shape after the size correction (p < .01). Only the ontogenetic effect persisted in the size of studied individuals after size‐effects correction (p < .0001). Morphometric significant differences were described regarding age for PC1 and population origin in PC2 before removing size effect. Between‐population morphometric differences were sorted along PC1 after size correction.
Discussion
Geometric Morphometric techniques are useful to study morphometric changes in the anterior whole‐body view of children under 5 years old, allowing a precise description of shape changes observed when age and population origin are considered.
... 60,61 Other factors, such as parents' university education, lead to a better nutrition although it does not significantly increase the intake of fruits and vegetables. 62,63 Conclusion An adequate nutrition together with moderate-intense PA according to age is essential to maintain the child and adolescent's health and an optimum performance. To achieve it, an adequate intake of CH, adapted to the type and level of activity, age, and weight is fundamental, as is drinking isotonic beverages drinks rich in CH to replenish them during exercise. ...
Child athletes require a healthy and balanced nutrition according to the type and intensity of the sport activity. This review aims to provide integrated and updated information to establish adequate nutritional guidelines for these children, essentially avoiding deficiencies or unbalances that can be harmful for their health. A lack of vitamins and minerals can affect their health especially at long term and depending on the type of sport and age of the child. The diet must be controlled without any nutritional supplements. It is also important to know which nutrients can improve performance of the child athlete during both training and competition. In conclusion, the contribution of macro- and micronutrients to the diet, together with an adequate hydration according to the energy expenditure must be controlled for child athletes to ensure a good status of health.
... We achieved a significant reduction in BMI and fat in children and their parents in a brief period but the challenge will be to preserve this reduction long term. In Mexico City, in another study in preschoolers, with more human and financial support, the adherence to the intervention was very low and in those who remained for 6 months, there were no significant changes in their weight or BMI, only in their habits [45], however, experts recommend to first obtain changes in the habits of children [6,46,47]. In children and parents there was a decrease in unhealthy habits associated with adiposity, although, for children it was easier to change more habits and keep them stable for 3-4 months of follow-up than what it was observed in parents, as well as the adherence in terms of attendance to appointments. ...
Interventions in children with adiposity decrease less than 0.2 the body mass index (BMI) z-score less than 0.2 and only in 21–23% of cases. Experts recommend focusing on the habits of a healthy lifestyle (HLS) but considering the sociocultural context of children and their parents. Our objective was to achieve a higher percentage of success in lowering the BMI z-score in children with adiposity and their parents through a pilot program “Sacbe” based on HLS, sensitive to the sociocultural context previously explored and with the active participation of parents. This is a pilot study in children aged 8 to 18 years with adiposity according to the BMI z-score. The program consisted of two workshops on HLS and nutrition given by the pediatric endocrinologist in group sessions with 3–5 families and reinforcements in each visit by registered dietitians. We recorded lifestyle habits and anthropometric characteristics of children and their parents at the baseline visit and every month for 3–4 months. Forty-nine families, 55 children and 64 parents participated, 60% of the children were female, the average age was 13.95 ± 3.3 years, 72.7% and 86.7% lowered the z score of the BMI due to intention to treat and protocol analysis (p < 0.001), respectively; BMI z-score decreased by 0.22 ± 0.21, from 2.13 ± 0.57 to 1.91 ± 0.58 (p < 0.001). In total, 83% of the parents involved were mothers, the average age was 45.8 ± 9.4 years, 77% lost weight and body fat (p < 0.001), the frequency of unhealthy habits decreased. The results of “Sacbe” exceeded expectations by combining the active participation of parents, sessions in groups, and the education on various components of an HLS inside sociocultural context. The main challenge will be to standardize and reproduce this type of complex interventions, as well as to assure long-term success.
... Although most school children spend most of their day time at school, significant health and dietary behaviors are acquired long before school age and are enforced daily either by parental modeling, feeding style, or availability of the desired food choices during breakfast or dinner. 69 It is therefore critical for interventions targeting children to incorporate both the school and the home environment to be effective in promoting a sustainable healthy lifestyle. 70 This systematic review found parental engagement in all 3 age groups to be critical for successful interventions aimed at modifying dietary behavior or weight loss. ...
... Although most school children spend most of their day time at school, significant health and dietary behaviors are acquired long before school age and are enforced daily either by parental modeling, feeding style, or availability of the desired food choices during breakfast or dinner. 69 It is therefore critical for interventions targeting children to incorporate both the school and the home environment to be effective in promoting a sustainable healthy lifestyle. 70 This systematic review found parental engagement in all 3 age groups to be critical for successful interventions aimed at modifying dietary behavior or weight loss. ...
Context
Establishing healthy dietary practices at an early age is crucial, as dietary behaviors in childhood track to adulthood.
Objective
The purpose of this systematic review was to identify factors associated with successful nutrition education interventions conducted in children and published between 2009 and 2016.
Data Sources
Using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines, relevant studies were identified through the PubMed, Web of Science, ScienceDirect, and ERIC (Educational Resources Information Center) databases.
Study Selection
Studies published in English between 2009 and 2016 that included a nutrition education intervention among children aged 2 to 19 years were included. Review articles, abstracts, qualitative or cross-sectional studies, and studies targeting children with special nutritional needs were excluded.
Data Extraction
Four authors screened and determined the quality of the studies using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system and extracted the data from the articles.
Data Analysis
Forty-one studies were included: 7 targeted preschool children, 26 targeted elementary school children, and 8 targeted secondary school children. A total of 46% met their primary objectives of nutrition education intervention, while the rest either partially achieved or did not achieve their stated objectives.
Results
Successful interventions targeting school children engaged parents by means of face-to-face sessions, identified specific behaviors to be modified, and assured fidelity by training teachers or recruiting trained experts to deliver the intervention. In addition, they allowed adequate dosage, with an intervention duration of at least 6 months, and used age-appropriate activities.
Conclusions
Interventions with a multicomponent approach that were age appropriate and of adequate duration (≥ 6 months), that engaged parents, and that ensured fidelity and proper alignment between the stated objectives, the intervention, and the desired outcomes were more likely to succeed.
... Only 2.5% engaged in 60 minutes of structured physical activity every day and 40% did not limit screen-time viewing to 2 hours per day or less. It was reported by Kunin-Batson et al. that physical activity recommendations were met by only 36% of the children in the St. Paul area of Minneapolis, USA, which was higher and better than the results of our study, screen time recommendations were met by 48% which was rather similar to that reported by our study, the guidelines for avoidance of sugar-sweetened beverage was met by 42% which was higher and better than the results of our study, while 14% met the guidelines for 5 servings of fruits and vegetables per day which was rather similar to that reported by our study (21). In the study of Aranceta Bartrina et al., 83% of Spanish children reported low fruit and vegetable intake (<5 servings/d) (26). ...
Background and aim
The body mass index (BMI) of Iranian preschoolers is noticeably increasing. Thus, studying the factors influencing BMI in preschool children is crucial. The purpose of this study was to identify the effects of lifestyle factors on BMI of preschool children, residing in Behbahan city, southwest Iran, in 2016.
Methods
A total of 120 preschool children, aged 4 to 6 years, participated in this cross-sectional study. Multi-stage random sampling was done. Using researcher-developed questionnaires whose validity and reliability was confirmed, demographic and lifestyle data were obtained, as the questionnaires were completed by the subject’s mothers. Lifestyle factors included physical activity, fruit and vegetable consumption, sugar-free beverage intake, and screen time. Multiple logistic regression was conducted to analyze the influence of lifestyle-related behaviors on BMI. Data were analyzed by means of the SPSS 22 software and p<0.05 was resulted as the meaningful level of statistics.
Results
The average BMI values for children was 15.13±1.90 kg/m2. A total of 88.3% of children did not receive 5 cups of fruits and vegetables each day. Also, 12.5% consumed more than one serving of sweetened beverages per day. Only 2.5% engaged in 60 minutes of structured physical activity every day and 40% did not limit screen-time viewing to 2 hours per day or less. The findings indicated that the physical activity and screen time affected the BMI (p<0.05), and the duration of physical activity had inverse relationship with obesity, and screen time was directly related to obesity.
Conclusion
Understanding the factors affecting the BMI of preschool children can inform the development of interventions to impact children’s weight-related behavior and it can be used as the basis for future healthy body weight policies. Efforts to lower the obesity rate of preschoolers should be focused on the lifestyle behaviors, especially on the physical activity and screen time.
... Most notably, operationalization of the "daily" or "per day" aspect of the recommendation differs. Meeting the MVPA recommendation has been operationalized as: at least 60 minutes per day when averaged across a week [9][10][11][12][13][14] ; at least 60 minutes on all 7 days of the week [15][16][17][18][19][20][21][22][23][24][25][26][27] ; and at least 60 minutes on at least 5 28 or at least 6 days 7 per week. The percentages of children and youth who meet the recommendation differ, based on how it is operationalized. ...
Background:
This study describes and compares the percentages of Canadian children and youth who adhere to different operational definitions of the moderate-to-vigorous physical activity (MVPA) recommendation of 60 minutes per day.
Data and methods:
Data for 6- to 17-year-olds (n = 5,608) were collected from 2007 through 2015 as part of the Canadian Health Measures Survey. MVPA was measured using the Actical accelerometer. The MVPA recommendation was operationalized as accumulating 60 minutes of MVPA every day, on most days, and on average.
Results:
Data from the most recent cycle of the Canadian Health Measures Survey indicate that 7% of children and youth accumulated at least 60 minutes of MVPA on at least 6 out of 7 days, and 33% achieved a weekly average of at least 60 minutes per day. Boys accumulated more MVPA than did girls, and 6- to 11-year-olds accumulated more MVPA than did 12- to 17-year-olds. Regardless of how adherence to the recommendation is operationalized, MVPA levels among Canadian children and youth did not change over the 9-year period from 2007 to 2015.
Interpretation:
The majority of Canadian children do not meet the physical activity recommendation, regardless of the operational definition used. However, the discrepancies between results based on different interpretations of the 60-minutes-per-day recommendation highlight the importance of explicitly reporting how recommendations are operationalized to avoid misinterpreting trends and comparisons.
... Pada era modern ini ibu cenderung memilih makanan praktis seperti junk food dan fast food yang kandungan lemaknya tinggi. 3,4 Hal tersebut dilakukan oleh sebagian besar ibu karena preferensi makanan pada anak. Selain itu, kehadiran teman sebaya dan lingkungan pun memengaruhi perilaku anak yang tidak menyukai mengonsumsi aneka ragam makanan sesuai dengan gizi seimbang. ...
Kesehatan dan gizi yang buruk pada anak usia sekolah dapat menghambat pertumbuhan fisik, perkembangan, dan kecerdasan. Konsumsi pangan masyarakat Indonesia belum sesuai dengan pesan gizi seimbang. Aplikasi Sayang ke Buah Hati (SEHATI) diharapkan dapat menjadi alat strategi promosi kesehatan untuk meningkatkan asupan zat gizi anak dan pengetahuan ibu menerapkan konsumsi aneka ragam makanan gizi seimbang. Tujuan penelitian ini menganalisis perbedaan asupan zat gizi anak dan pengetahuan ibu menerapkan konsumsi aneka ragam makanan gizi seimbang pada anak sekolah dasar sebelum dengan sesudah diterapkan aplikasi SEHATI. Periode penelitian 2–18 Maret 2017 di SDIT Jabal Nur Yogyakarta. Subjek adalah ibu yang memiliki anak usia sekolah dasar (8–12 tahun) dan anaknya yang memenuhi kriteria penelitian. Penelitian ini merupakan randomized controlled trial (RCT). Pengambilan sampel dilakukan secara acak. Kelompok intervensi mendapatkan pemasangan aplikasi SEHATI dan kontrol diberikan pendidikan kesehatan, tiap-tiap kelompok terdiri atas 30 responden. Data diolah dengan uji nonparametrik, yaitu uji t berpasangan pada data yang berdistribusi normal dan uji Mann-Whitney pada data yang tidak berdistribusi normal. Terdapat perbedaan bermakna penggunaan aplikasi SEHATI terhadap peningkatan pengetahuan ibu pada kelompok intervensi (25,9%; p≤0,001), terjadi peningkatan skor asupan zat gizi anak pada kelompok intervensi yang bermakna, yaitu karbohidrat (13,8%; p=0,038) dan vitamin A (51,5%; p=0,005). Simpulan, terdapat perbedaan peningkatan asupan zat gizi dan pengetahuan ibu menerapkan konsumsi aneka ragam makanan gizi seimbang pada anak sekolah dasar sebelum dengan sesudah penggunaan aplikasi SEHATI.
... The majority of parents reported only having SSBs available at home sometimes and child intake of SSBs was low compared to national intake data [7]. Previous studies among children 2.5 to 7 years old [39], 5-10 years old [40], and adolescents aged 11 years [41] also showed that SSB availability was associated with child intake among well-educated parents. ...
Beverage intake can influence child diet quality in a positive or negative manner depending on the beverage type and amounts consumed. Parenting practices such as role modeling and control of home beverage availability have been associated with child beverage intake, whereas examination of the influence of parental beverage nutrition knowledge has been more limited. The purpose of this study was to examine the relationships between sugar-sweetened and dairy beverage intake among children (9–12 years) and home and parental factors. A questionnaire was administered among a convenience sample of parents (n = 194) to assess beverage nutrition knowledge, beverage intake and home availability of beverages. Children completed a questionnaire to estimate usual beverage intake. Daily sugar-sweetened beverage intake by children ranged from 0.4 to 48 oz. Logistic regression analysis was used to examine relationships. Parents were mostly female, white, well educated, and employed. Home availability of sugar-sweetened and dairy beverages was positively associated with child sugar-sweetened (OR = 1.48, p = 0.03) and dairy beverage intake (OR = 1.34, p = 0.03), respectively. Parent dairy beverage intake was associated with child dairy beverage intake (OR = 1.06, p = 0.01). Parent knowledge about sugar in beverages was related to child dairy beverage intake (OR = 1.46, p = 0.02), whereas calcium/dairy knowledge and general beverage nutrition knowledge were not related to child beverage intake. Parenting practices and knowledge may play a role in determining child beverage intake.
... ethnic minority) (13). Compared with their peers, children who adhere to recommendations are also more likely to come from higherincome families and have parents with higher levels of education (14,15). Studies that examined proxy measures of treatment adherence, including programme completion, motivation to make lifestyle changes, and perceived barriers and support, have reported that (i) non-completers (vs. ...
... Covariates were varied and most commonly included child's age, gender, ethnicity, socio-economic status and BMI. Twenty-three studies used regression (24,25,27,(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)43,44,46,(49)(50)(51)(52)56,77) and eleven used (40) 1 100 Accessibility ...
Objective:
As numerous factors in the home environment have been related to children's fruit and vegetable (F&V) consumption as a component of a healthy diet, the purpose of the present systematic review was to examine these factors specifically for children aged 6-12 years.
Design:
Relevant observational studies published in English between January 2007 and December 2015 were obtained through electronic database searches. Studies were included if the researchers reported on a potentially modifiable measure of the home physical, political and sociocultural environment related to child F&V consumption.
Results:
Of the thirty-three articles reviewed, overall methodological quality was poor with twenty studies rated as weak, mainly due to cross-sectional design (majority of studies), selection bias, convenience sampling and voluntary participation. Half of the studies had strong-moderate ratings for using valid and/or reliable tools while for the other half, psychometric properties were either not reported or weak. The most consistent evidence for children's combined F&V consumption was found for availability and accessibility of F&V, parental role modelling of F&V and maternal intake of F&V.
Conclusions:
A vast array of home environment components and their influence on children's consumption of fruits and/or vegetables have been studied in recent years. Specific components of the home environment may have more influence than others, but more compelling evidence is needed to draw strong conclusions. Recommendations are made for future studies to be based upon conceptual/theoretical models to provide consistency in defining the home environment and investigation of potential moderators, such as personal or contextual factors.
... Recent research links home availability of sugar-sweetened beverages and fruits and vegetables to higher consumption levels. 22,47,48 HSH needs to be repeated with a larger sample size to detect significant relationships among home environment scales, other SCT constructs and dietary intake. ...
Background:
Effective childhood obesity prevention programs for preschool children are limited in number and focus on changes in the child care environment rather than the home environment.
Purpose:
The purpose of this project was to develop and test the feasibility of a home environment obesity prevention program that incorporates mindful eating strategies and Social Cognitive Theory (SCT) constructs. Home Sweet Home is specifically designed for rural parents and grandparents of preschool-age children.
Methods:
HSH was developed using community-based participatory research practices and constructs from the SCT. Three community-based education sessions were delivered. Pre- and post-intervention data were collected from 47 grandparents and mothers.F.
Results:
Three of the four selected behavioral outcomes improved between pre- and post-intervention. The number of hours engaged in sedentary behaviors and intake of "red light" foods decreased while three of four mindful eating scores increased. Graduates of the program were able to decrease the number of "red light" foods available in their homes.
Discussion:
Improvements in mindful eating and several key behaviors were observed after a three week mindful eating/home environment intervention.
Translation to health education practice:
Health educators should incorporate mindful eating strategies and use the SCT when designing childhood obesity prevention programs.
... In addition, the ToyBox-intervention targeted four behaviours instead of only focusing on drinking behaviour of preschoolers. A recent study of Kunin-Batson and colleagues (2015) indicated that parents prefer to focus on only one healthy child behaviour instead of several health behaviours [46]. Also, the intensity (a minimum of one hour a week) might have been too limited and the time spent on drinking behaviour (a total of six weeks) might have been too short. ...
Background
Within the ToyBox-study, a kindergarten-based, family-involved intervention was developed to prevent overweight and obesity in European preschoolers, targeting four key behaviours related to early childhood obesity, including water consumption. The present study aimed to examine the effect of the ToyBox-intervention (cluster randomized controlled trial) on water intake and beverage consumption in European preschoolers and to investigate if the intervention effects differed by implementation score of kindergartens and parents/caregivers.
Method
A sample of 4964 preschoolers (4.7±0.4 years; 51.5% boys) from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, Spain) was included in the data analyses. A standardized protocol was used and parents/caregivers filled in socio-demographic data and a food-frequency questionnaire. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample and for the six country-specific samples. Based on the process evaluation questionnaire of teachers and parents/caregivers, an implementation score was constructed. To assess differences in water intake and beverage consumption by implementation score in the total sample, multilevel repeated measures analyses were performed.
Results
Limited intervention effects on water intake from beverages and overall beverage consumption were found. However, important results were found on prepacked fruit juice consumption, with a larger decrease in the intervention group compared to the control group. However, also a decline in plain milk consumption was found. Implementation scores were rather low in both kindergartens and parents/caregivers. Nevertheless, more favorable effects on beverage choices were found in preschoolers whose parents/caregivers and kindergarten teachers had higher implementation scores compared to those with lower implementation scores.
Conclusion
The ToyBox-intervention can provide the basis for the development of more tailor-made interventions. However, new strategies to improve implementation of interventions should be created.
In England (UK), at the start of the COVID-19 pandemic the public were required to reduce their physical contacts to slow the spread of COVID-19. We investigated the factors associated with children having: 1) close contact with family members from outside their household (‘non-adherent behaviour’); and 2) low well-being (Revised Child Anxiety and Depression Scale). We conducted an online cross-sectional survey, completed at any location of the participant’s choice between 8 and 11 June 2020 in parents (n = 2,010) who were aged eighteen years or over and had a school-aged child (4–18 years old). Parents reported that 15% (n = 309) of children had non-adherent contact and that 26% (n = 519) had low well-being. We used a series of binary logistic regressions to investigate associations between outcomes and child and parent characteristics. Children had higher odds of having non-household contact when they had special educational needs [adjusted odds ratio, 2.19 (95% CI, 1.47 to 3.27)], lower well-being [2.65 (95% CI, 2.03 to 3.46)], were vulnerable to COVID-19 [2.17 (95% CI, 1.45 to 3.25)], lived with someone who was over 70 years old [2.56 (95% CI, 1.55 to 4.24)] and their parent had low well-being [1.94 (95% CI, 1.45 to 2.58)]. Children had higher odds of lower well-being when they had special educational needs [4.13 (95% CI, 2.90 to 5.87)], were vulnerable to COVID-19 [3.06 (95% CI, 2.15 to 4.36)], lived with someone else who was vulnerable to COVID-19 [2.08 (95% CI, 1.64 to 2.64)], or lived with someone who was over 70 years old [2.41 (95% CI, 1.51 to 3.83)]. Many children came into contact with non-household family members, mainly for childcare. Factors relating to COVID-19, children’s well-being and education were also important. If school closures are needed in future, addressing these issues may help reduce contact.
Purpose:
The '5-2-1-0' guidelines recommend that children: eat ≥5 servings of fruits/vegetables ('5'), have ≤2 hours of screen-time ('2'), have ≥1 hour of activity ('1'), and drink 0 sugar-sweetened beverages ('0') daily. The pediatric emergency department (PED) treats children at risk for obesity and tobacco smoke exposure (TSE). We examined body mass index (BMI), overweight, obesity, TSE, and '5-2-1-0' rates in children with TSE in the PED.
Design:
Cross-sectional study of PED children.
Setting:
The PED of a children's hospital.
Sample:
Children with TSE >6 months-5 years old (N = 401).
Measures:
Sociodemographics, '5-2-1-0' behaviors, BMI, and cotinine-confirmed TSE.
Analysis:
Associations between '5-2-1-0' and sociodemographics were examined with logistic regression.
Results:
Mean (SD) age = 2.4 (1.6) years; 53.1% were Black; 65.8% had low-income; and 93.4% had TSE. Of 2-5-year-olds, mean (SD) BMI percentile was 66.2 (30.1), 16.1% were overweight and 20.6% were obese. In total, 10.5% attained '5', 72.6% attained '2', 57.8% of 2-5-year-olds attained '1', and 9.8% attained '0'. Compared to White children, "other" race children were more likely to meet '5' (aOR(95% CI):4.67(1.41, 5.45)); 2-5-years-olds (aOR(95%CI):0.60(0.38, 0.95)) and Black children (aOR(95%CI):0.36(0.21, 0.60)) were at decreased odds to meet '2' compared to younger or White children, respectively. Compared to younger children, 2-5-year-olds were at decreased odds to meet '0' (aOR(95%CI):0.08(0.02, 0.26)).
Conclusion:
Racially diverse, low-income children with TSE had low '5-2-1-0' attainment. Interventions are needed to improve lifestyle habits in this population.
Global childhood obesity increased more than 8fold over 40 years, inducing a very large personal, societal and economic burden. Effects of available treatments are less than satisfactory, therefore effective prevention is of high priority. In this narrative review, we explore preventive opportunities. The available evidence indicates large benefits of improving nutrition and lifestyle during early life, such as promoting breastfeeding and improving the quality of infant and early childhood feeding. Promoting healthy eating patterns and limiting sugar containing beverage consumption from early childhood onwards are of great benefit. Regular physical activity and limited sedentary lifestyle and screen time alone have limited effects but are valuable elements in effective multicomponent strategies. The home environment is important, particularly for young children, and can be improved by educating and empowering families. School and community based interventions can be effective, such as installing water fountains, improving cafeteria menus and facilitating regular physical activity. Reducing obesogenic risk factors through societal standards is essential for effective prevention and limiting socioeconomic disparity; these may comprise food, drink and physical activity standards for daycares and schools, general food quality standards, front of pack food labelling, taxation of unhealthy foods, restriction of food advertisements to children, and others. Effective prevention of childhood obesity is not achieved by single interventions but by integrated multicomponent approaches involving multiple stakeholders that address children, families and societal standards. Paediatricians and their organisations should be proactive in supporting and empowering families to support their children's health, and in promoting societal measures that protect children.
Purpose
To examine the association between parents and children meeting physical activity (PA) guidelines, by gender, among 8–12 year old children with BMI ≥75th percentile
Design and methods
This was a secondary analysis of baseline data from a school-based healthy weight management intervention in Minnesota for 8–12 year old children. Survey data about PA participation were collected from 2014 through 2018. Analyses entailed descriptive statistics and multivariate logistic regression controlling for child age, race/ethnicity, BMIz, child's perception of parent support for activity, and number of sports played.
Results
Children's (n = 132) mean age was 9.32 ± 0.89 years, 49% were female, 63% were members of racial/ethnic minority groups, and 33% met PA Guidelines (≥60 minutes daily). Parents' (n = 132) mean age was 39.11 ± 7.05 years, mean BMI of 30.90 ± 8.44, 94% were female, 42% were members of racial/ethnic minority groups, and 57% met PA Guidelines for Americans (≥150 minutes moderate or >75 minutes vigorous PA weekly). There was no association between parents and children meeting PA guidelines for the total sample (OR = 1.43, 95% CI = 0.63–3.24, p = 0.39) or girls (OR = 0.65, 95% CI = 0.18–2.33, p = 0.51). Boys whose parents met PA guidelines had 3.84 times greater odds of meeting PA guidelines (95% CI = 1.28–13.4, p = 0.04).
Conclusions
PA interventions for boys may benefit from focus on parents' PA. Further research should investigate correlates of girls' PA.
Practice implications
Pediatric nurses working with children to increase PA should encourage parents' PA. For parents of boys, this may increase the child's PA. Considered broadly, nurses should be aware of gender influences on children's engagement in PA.
Background:
Play equipment at home could be targeted in interventions to increase children's physical activity (PA), but evidence is mixed, potentially because current methods do not reflect children's lived experience. This study investigated associations between combinations of equipment and PA.
Methods:
Data were from the Mothers and their Children's Health study and the Australian Longitudinal Study on Women's Health. Mothers (n = 2409) indicated the types of fixed active (eg, trampolines), portable active (eg, bicycles), and electronic (eg, computers) equipment at home, and the number of days children (n = 4092, aged 5-12 y, 51% boys) met PA guidelines. Latent class analysis was used to identify combinations of equipment, and linear regressions were used to investigate associations with PA.
Results:
Compared with children with high active (fixed and portable) and medium electronic equipment, children with portable active and medium (B = -0.53; 95% confidence interval, -0.72 to -0.34) or high (B = -0.58; 95% confidence interval, -0.83 to -0.33) electronic equipment met the guidelines on fewer days. Children with similar active equipment (but more electronic equipment) met the PA guidelines on fewer days (mean difference = -0.51, SE = 0.14, P = .002).
Conclusion:
Having the right combination of play equipment at home may be important for children's PA.
Background:
This study examined the distribution of objectively measured physical activity (PA) and sedentary time of fifth-grade students during school, leisure time, and physical education (PE) classes. Demographic, anthropometric, and PA data were collected from 17 representative Finnish schools.
Methods:
To estimate the PA and sedentary time, participants (N = 592) wore wGT3X-BT ActiGraphs for 7 consecutive days. Comparisons were made between genders and different BMI groups.
Results:
From the study sample, 43.7% met the moderate to vigorous PA (MVPA) guidelines. Participants spent 62.2% of the day sedentary and 8.2% in moderate and vigorous activities. Boys performed more MVPA than girls, and girls were more sedentary during school days. Boys had more MVPA than girls in leisure time, but there were no differences in sedentary time. However, an examination of PA assessed during PE classes revealed no differences between boys and girls. Normal-weight boys engaged in more MVPA than overweight and obese boys. No differences were found for girls.
Conclusions:
The PE levels differ between different BMI groups in leisure time and during school but not during PE lessons. PA for overweight children should be targeted and compulsory PE time should be increased to achieve the PA guidelines.
Objective
To explore parent perceptions of child weight status and 5210 nutrition messaging recommendations, including daily consumption of 5 fruits and vegetables, limiting child screen time to ≤2 hours, incorporating 1 hour of daily physical activity, and no consumption of sugary, sweetened beverages.
Methods
Using the Convergence Model of Communication as a framework, qualitative focus groups (n = 5) were conducted at 4 Head Start sites across 1 Ohio County. Twenty-eight parents aged 20–60 years comprised the groups. A deductive analysis technique with respondent validation was used.
Results
Parents have limited understanding of 5210 messages delivered by the program. Parent food preferences, family finances, and children's picky eating were identified as barriers to integrating healthy eating habits at home. Parents prefer practical strategies regarding how to integrate healthy eating habits into the home environment. Participants expressed concern about children's psychological health and happiness vs weight status.
Conclusions and Implications
Understanding parental perceptions of 5210 messaging and program-reported weight status may assist Head Start programs in addressing childhood obesity through focused parent education and support.
Objectives:
Pediatric obesity and chronic pain are two of the most significant public health crises affecting youth today. Despite the high number of youth experiencing both chronic pain and obesity, little research has been done examining their relationship. This study aims to both replicate and extend this research base.
Methods:
A retrospective chart review of 99 patients presenting for evaluation in a pediatric pain clinic was conducted. Demographic information, including patient weight status, and self-report measures completed by both patients and their parents, including the Pain Frequency-Severity-Duration scale, the Functional Disability Inventory (FDI) and the Pain Catastrophizing Scale were examined.
Results:
Abdominal pain was the most frequently reported primary pain diagnosis category, with headache, diffuse musculoskeletal, localized musculoskeletal, and back pain categories reported from greatest to least frequency. Results show that 29% of our sample was obese. Age was related to weight status such that older children were more likely to have a higher BMI. Among school-aged children, a higher BMI percentile was associated with greater parent-reported pain catastrophizing. Those youth categorized as obese had higher parent-reported FDI scores than those in the normal weight group. Post-hoc comparisons identified that this finding was only significant for girls in our sample. Further, youth categorized as obese were more likely to have a longer pain duration than those classified as normal weight.
Discussion:
The results of this study add to the growing literature regarding the importance of taking weight status into account when intervening with youth with chronic pain.
This paper proposes an exercise recommendation system for treating obesity that provides systematic recommendations for exercise and diet. Five body indices are considered as indicators for recommend exercise and diet. The system also informs users of prohibited foods using health data including blood pressure, blood sugar, and total cholesterol. To maximize the utility of the system, it displays recommendations for both indoor and outdoor activities. The system is equipped with multimode sensors, including a three-axis accelerometer, a laser, a pressure sensor, and a wrist-mounted sensor. To demonstrate the effectiveness of the system, field tests are carried out with three participants over 20 days, which show that the proposed system is effective in treating obesity.
Background:
Non-alcoholic fatty liver disease is the most frequent liver abnormality observed in overweight or obese children and is strongly associated with metabolic syndrome and insulin resistance.
Objectives:
(i) To evaluate the effect of a 22-week multidisciplinary intervention program on hepatic fat fraction in overweight or obese children and (ii) to examine the effect of the intervention on cardiometabolic risk factors, self-esteem and well-being.
Methods:
A total of 160 children, 9-11 years, will be recruited by pediatricians and randomly assigned to control (N = 80) or intervention (N = 80) groups. The control group will receive a family-based lifestyle and psycho-educational program (2 days/month), while the intervention group will attend the same lifestyle education and psycho-educational program plus the exercise program (3 days/week). The duration of training sessions will be 90 min of exercise, including warm-up, moderate to vigorous aerobic activities, and strength exercises. The primary outcome is the change in hepatic fat fraction (magnetic resonance imaging, MRI). Secondary outcomes include cardiometabolic risk factors such as total adiposity (dual Xray absorptiometry), visceral adiposity (MRI), functional peak aerobic capacity (cardiopulmonary exercise testing), blood pressure, muscular fitness, speed–agility, and fasting blood insulin, glucose, C-reactive protein, alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase, lipid profile and psychological measurements (questionnaires). All the measurements will be evaluated at baseline prior to randomization and after the intervention.
Discussion:
This study will provide insight in the efficacy of a multidisciplinary intervention program including healthy lifestyle education, psycho-education and supervised exercise to reduce hepatic fat and cardiometabolic risk in overweight children.
Fast food has become a prominent feature of the diet of children in the United States and, increasingly, throughout the world. However, few studies have examined the effects of fast-food consumption on any nutrition or health-related outcome. The aim of this study was to test the hypothesis that fast-food consumption adversely affects dietary factors linked to obesity risk.
This study included 6212 children and adolescents 4 to 19 years old in the United States participating in the nationally representative Continuing Survey of Food Intake by Individuals conducted from 1994 to 1996 and the Supplemental Children's Survey conducted in 1998. We examined the associations between fast-food consumption and measures of dietary quality using between-subject comparisons involving the whole cohort and within-subject comparisons involving 2080 individuals who ate fast food on one but not both survey days.
On a typical day, 30.3% of the total sample reported consuming fast food. Fast-food consumption was highly prevalent in both genders, all racial/ethnic groups, and all regions of the country. Controlling for socioeconomic and demographic variables, increased fast-food consumption was independently associated with male gender, older age, higher household incomes, non-Hispanic black race/ethnicity, and residing in the South. Children who ate fast food, compared with those who did not, consumed more total energy (187 kcal; 95% confidence interval [CI]: 109-265), more energy per gram of food (0.29 kcal/g; 95% CI: 0.25-0.33), more total fat (9 g; 95% CI: 5.0-13.0), more total carbohydrate (24 g; 95% CI: 12.6-35.4), more added sugars (26 g; 95% CI: 18.2-34.6), more sugar-sweetened beverages (228 g; 95% CI: 184-272), less fiber (-1.1 g; 95% CI: -1.8 to -0.4), less milk (-65 g; 95% CI: -95 to -30), and fewer fruits and nonstarchy vegetables (-45 g; 95% CI: -58.6 to -31.4). Very similar results were observed by using within-subject analyses in which subjects served as their own controls: that is, children ate more total energy and had poorer diet quality on days with, compared with without, fast food.
Consumption of fast food among children in the United States seems to have an adverse effect on dietary quality in ways that plausibly could increase risk for obesity.
Media, from television to the "new media" (including cell phones, iPads, and social media), are a dominant force in children's lives. Although television is still the predominant medium for children and adolescents, new technologies are increasingly popular. The American Academy of Pediatrics continues to be concerned by evidence about the potential harmful effects of media messages and images; however, important positive and prosocial effects of media use should also be recognized. Pediatricians are encouraged to take a media history and ask 2 media questions at every well-child visit: How much recreational screen time does your child or teenager consume daily? Is there a television set or Internet-connected device in the child's bedroom? Parents are encouraged to establish a family home use plan for all media. Media influences on children and teenagers should be recognized by schools, policymakers, product advertisers, and entertainment producers. Pediatrics 2013;132:958-961.
Background:
Eating more fruits and vegetables adds underconsumed nutrients to diets, reduces the risks for leading causes of illness and death, and helps manage body weight. This report describes trends in the contributions of fruits and vegetables to the diets of children aged 2-18 years.
Methods:
CDC analyzed 1 day of 24-hour dietary recalls from the National Health and Nutrition Examination Surveys from 2003 to 2010 to estimate trends in children's fruit and vegetable intake in cup-equivalents per 1,000 calories (CEPC) and trends by sex, age, race/ethnicity, family income to poverty ratio, and obesity status. Total fruit includes whole fruit (all fruit excluding juice) and fruit juice (from 100% juice, foods, and other beverages). Total vegetables include those encouraged in the Dietary Guidelines for Americans, 2010 (i.e., dark green, orange, and red vegetables and legumes), white potatoes, and all other vegetables.
Results:
Total fruit intake among children increased from 0.55 CEPC in 2003-2004 to 0.62 in 2009-2010 because of significant increases in whole fruit intake (0.24 to 0.40 CEPC). Over this period, fruit juice intake significantly decreased (0.31 to 0.22 CEPC). Total vegetable intake did not change (0.54 to 0.53 CEPC). No socio-demographic group met the Healthy People 2020 target of 1.1 CEPC vegetables, and only children aged 2-5 years met the target of 0.9 CEPC fruits.
Conclusions:
Children's total fruit intake increased because of increases in whole fruit consumption, but total vegetable intake remained unchanged.
Implications for public health practice:
Increased attention to the policies and food environments in multiple settings, including schools, early care and education, and homes might help continue the progress in fruit intake and improve vegetable intake.
The home environment is an important influence on the sedentary behaviour and physical activity of children, who have limited independent mobility and spend much of their time at home. This article reviews the current evidence regarding the influence of the home physical environment on the sedentary behaviour and physical activity of children aged 8--14 years. A literature search of peer reviewed articles published between 2005 and 2011 resulted in 38 observational studies (21 with activity outcomes, 23 with sedentary outcomes) and 11 experimental studies included in the review. The most commonly investigated behavioural outcomes were television watching and moderate to vigorous physical activity. Media equipment in the home and to a lesser extent the bedroom were positively associated with children's sedentary behaviour. Physical activity equipment and the house and yard were not associated with physical activity, although environmental measures were exclusively self-reported. On the other hand, physical activity equipment was inversely associated with sedentary behaviours in half of studies. Observational studies that investigated the influence of the physical and social environment within the home space, found that the social environment, particularly the role of parents, was important. Experimental studies that changed the home physical environment by introducing a television limiting device successfully decreased television viewing, whereas the influence of introducing an active video game on activity outcomes was inconsistent. Results highlight that the home environment is an important influence on children's sedentary behaviour and physical activity, about which much is still unknown. While changing or controlling the home physical environment shows promise for reducing screen based sedentary behaviour, further interventions are needed to understand the broader impact of these changes. Future studies should prioritise investigating the influence of the home physical environment, and its interaction with the social environment, on objectively measured sedentary time and home context specific behaviours, ideally including technologies that allow objective measures of the home space.
Pediatric primary care is an important setting in which to address obesity prevention, yet relatively few interventions have been evaluated and even fewer have been shown to be effective. The development and evaluation of cost-effective approaches to obesity prevention that leverage opportunities of direct access to families in the pediatric primary care setting, overcome barriers to implementation in busy practice settings, and facilitate sustained involvement of parents is an important public health priority. The goal of the Healthy Homes/Healthy Kids (HHHK 5-10) randomized controlled trial is to evaluate the efficacy of a relatively low-cost primary care-based obesity prevention intervention aimed at 5 to 10 year old children who are at risk for obesity. Four hundred twenty one parent/child dyads were recruited and randomized to either the obesity prevention arm or a contact control condition that focuses on safety and injury prevention. The HHHK 5-10 obesity prevention intervention combines brief counseling with a pediatric primary care provider during routine well-child visits and follow-up telephone coaching that supports parents in making home environmental changes to support healthful eating, activity patterns, and body weight. The contact control condition combines the same provider counseling with telephone coaching focused on safety and injury prevention messages. This manuscript describes the study design and baseline characteristics of participants enrolled in the HHHK 5-10 trial.
Background:
Reducing sugar-sweetened beverage (SSB) consumption is a recommended strategy to promote optimal health.
Objective:
The objective was to describe trends in SSB consumption among youth and adults in the United States.
Design:
We analyzed energy intake from SSBs among 22,367 youth aged 2-19 y and 29,133 adults aged ≥20 y who participated in a 24-h dietary recall as part of NHANES, a nationally representative sample of the US population with a cross-sectional design, between 1999 and 2010. SSBs included soda, fruit drinks, sports and energy drinks, sweetened coffee and tea, and other sweetened beverages. Patterns of SSB consumption, including location of consumption and meal occasion associated with consumption, were also examined.
Results:
In 2009-2010, youth consumed a mean (±SE) of 155 ± 7 kcal/d from SSBs, and adults consumed an age-adjusted mean (±SE) of 151 ± 5 kcal/d from SSBs--a decrease from 1999 to 2000 of 68 kcal/d and 45 kcal/d, respectively (P-trend < 0.001 for each). In 2009-2010, SSBs contributed 8.0% ± 0.4% and 6.9% ± 0.2% of daily energy intake among youth and adults, respectively, which reflected a decrease compared with 1999-2000 (P-trend < 0.001 for both). Decreases in SSB consumption, both in the home and away from home and also with both meals and snacks, occurred over the 12-y study duration (P-trend < 0.01 for each).
Conclusion:
A decrease in SSB consumption among youth and adults in the United States was observed between 1999 and 2010.
The purpose of this study was to quantitatively combine and examine the results of studies pertaining to physical activity and cognition in children. Studies meeting the inclusion criteria were coded based on design and descriptive characteristics, subject characteristics, activity characteristics, and cognitive assessment method. Effect sizes (ESs) were calculated for each study and an overall ES and average ESs relative to moderator variables were then calculated. ESs (n = 125) from 44 studies were included in the analysis. The overall ES was 0.32 (SD = 0.27), which was significantly different from zero. Significant moderator variables included publication status, subject age, and type of cognitive assessment. As a result of this statistical review of the literature, it is concluded that there is a significant positive relationship between physical activity and cognitive functioning in children.
Children in households of lower socioeconomic status (SES) are more likely to be overweight/obese. We aimed to determine if home physical activity (PA) environments differed by SES and to explore home environment mediators of the relation of family SES to children's PA and sedentary behavior.
Participants were 715 children aged 6 to 11 from the Neighborhood Impact on Kids (NIK) Study. Household SES was examined using highest educational attainment and income. Home environment was measured by parent report on a survey. Outcomes were child's accelerometer-measured PA and parent-reported screen time. Mediation analyses were conducted for home environment factors that varied by SES.
Children from lower income households had greater media access in their bedrooms (TV 52% vs. 14%, DVD player 39% vs. 14%, video games 21% vs. 9%) but lower access to portable play equipment (bikes 85% vs. 98%, jump ropes 69% vs. 83%) compared to higher income children. Lower SES families had more restrictive rules about PA (2.5 vs. 2.0). Across SES, children watched TV/DVDs with parents/siblings more often than they engaged in PA with them. Parents of lower SES watched TV/DVDs with their children more often (3.1 vs. 2.5 days/week). Neither total daily and home-based MVPA nor sedentary time differed by SES. Children's daily screen time varied from 1.7 hours/day in high SES to 2.4 in low SES families. Media in the bedroom was related to screen time, and screen time with parents was a mediator of the SES--screen time relationship.
Lower SES home environments provided more opportunities for sedentary behavior and fewer for PA. Removing electronic media from children's bedrooms has the potential to reduce disparities in chronic disease risk.
Although some will insist that the 2010 Dietary Guidelines for Americans offers the same “moderation, variety, and balance” mantra as provided previously, this argument is clearly unfounded. Rather, this document represents an important step forward for nutrition scientists, public health professionals, and the general public. As our first Dietary Guidelines document based on a systematic, evidence-based review of the literature embedded in a holistic view of the complexity of our food environment, this publication will serve well to inform individual Americans which dietary patterns are proven effective in improving health outcomes. It will also provide a versatile template by which public health agencies can design, implement, and evaluate nutrition-related programs; and food manufacturers can contribute by developing and marketing more healthful food items. We can be encouraged that nutrition scientists will continue to not only get it right but also get it better. After all, as scientific understanding of how health and nutrition are related evolves, so should our dietary recommendations.
To identify sociodemographic and environmental correlates of sweetened beverages (regular soft drinks, fruit juice) among children of pre-school age.
Children's dietary intake, food behaviours and screen time were measured by parental report. A Geographic Informational System was used to assess the number of grocery stores and fast-food restaurants available within 1 km of the children's residence. Multivariate log-binomial regression models were constructed to determine correlates of drinking soft drinks during the previous week.
Edmonton region, Canada.
Children aged 4 and 5 years (n 2114) attending a public health unit for immunization were recruited for a cohort study on determinants of childhood obesity, between 2005 and 2007.
Children from neighbourhoods with low socio-economic status (relative risk (RR) = 1·17, 95 % CI 0·98, 1·40) or who participated in >2 h of screen time daily (RR = 1·28, 95 % CI 1·13, 1·45) were significantly more likely to have consumed regular soft drinks within the last week. Those who lived within 1 km of a grocery store were significantly less likely to consume regular soft drinks (RR = 0·84, 95 % CI 0·73, 0·96). Children who participated in >2 h of screen time daily (RR = 1·16, 95 % CI 1·06, 1·27) were more likely to exceed the recommended weekly number of servings of fruit juice.
Socio-economic and built environment factors are associated with soft drink consumption in children of pre-school age. These findings may help health professionals to advocate for policies that reduce soft drink consumption among children.
Few studies have examined the correlates of objectively measured amounts of sedentary time and physical activity in young children. We evaluated the demographic, biological, behavioral, social, and environmental correlates of the amount of sedentary time and moderate-to-vigorous physical activity (MVPA) as measured by accelerometry in preschool-aged children.
We obtained baseline measurements of physical activity by using an Actical accelerometer among 337 preschool-aged children (aged 2-5) of overweight or obese mothers. For children, we defined sedentary time as less than 12 counts per 15 seconds and MVPA as 715 or more counts per 15 seconds. Body mass index of the mother and child (calculated from measured height and weight) and maternal physical activity as measured by accelerometer were included as potential correlates. Mothers self-reported all other potential correlates. We used multivariable linear regression analyses to examine correlates of the amount of sedentary time and MVPA.
Children had an average of 6.1 hours per day of sedentary time and 14.9 minutes per day of MVPA. In multivariable analysis, boys (P <.001) had fewer minutes per day of sedentary time, whereas older children (P <.001), boys (P <.001), children in high-income households (>$60,000/y [P = .005]), and children who spent more time outdoors (P = .001) had more MVPA.
Both modifiable and nonmodifiable factors were correlated with preschool children's amount of MVPA, which can be helpful when designing interventions for this age group. The lack of correlates for sedentary time indicates the need for further investigation into this behavior.
Individual, home social and physical environment correlates of electronic media (EM) use among children were examined and pattern of differences on school and weekend days.
Youth (n = 298) aged 11 to 12 years self-reported time spent using EM (TV, video/DVD, computer use, and electronic games) on a typical school and a weekend day, each dichotomized at the median to indicate heavy and light EM users. Anthropometric measurements were taken. Logistic regression examined correlates of EM use.
In total, 87% of participants exceeded electronic media use recommendations of ≤ 2 hrs/day. Watching TV during breakfast (OR = 3.17) and after school (OR = 2.07), watching TV with mother (OR = 1.96), no rule(s) limiting time for computer game usage (OR = 2.30), having multiple (OR = 2.99) EM devices in the bedroom and BMI (OR = 1.15) were associated with higher odds of being heavy EM user on a school day. Boys (OR = 2.35) and participants who usually watched TV at midday (OR = 2.91) and late at night (OR = 2.04) had higher odds of being a heavy EM user on the weekend.
Efforts to modify children's EM use should focus on a mix of intervention strategies that address patterns and reinforcement of TV viewing, household rules limiting screen time, and the presence of EM devices in the child's bedroom.
Higher screen-viewing levels increase the risk of obesity. Understanding the correlates of screen viewing is an important first step in designing interventions but there is lack of information on the correlates among Spanish children. This study examined associations among environmental, sociocultural, age variables and screen viewing among Spanish children.
Children completed a questionnaire about time spent in screen viewing. BMI was assessed and children were classified into obesity groups using International Obesity Task Force cut-off points. Parents completed a questionnaire about sociodemographic, environmental and sociocultural variables.
Participants were 247 primary and 256 secondary school-aged children and their parents. Time spent in screen viewing increased with age. Males spent more time than females in screen viewing. Greater access to bedroom media sources was associated with higher screen viewing. Younger children from single-parent households and older children having a younger parent, siblings and a father who was not working were higher screen-viewers on weekends and weekdays, respectively. For older children parental TV viewing time appeared to be a significant correlate, while parental rules was a determinant predictor for younger children on weekdays.
Environmental and sociocultural factors influence the time children spend in screen viewing. Parents play a central role in child's screen viewing; therefore, interventions that target environmental and family TV viewing practices are likely to be effective.
To examine the association between screen time (ST) (ie, television/DVD/video and computer use) guidelines and risk factors for cardiovascular disease, type 2 diabetes mellitus, and fatty liver diseases in mid-adolescence.
Cross-sectional.
High schools in Sydney, Australia.
Grade 10 students (N = 496; 58% boys; mean [SD] age, 15.4 [0.4] years).
Body mass index, waist circumference, cardiorespiratory endurance, dietary factors, socioeconomic status, and pubertal status.
Screen time was categorized as less than 2 hours per day or 2 or more hours per day and calculated for weekday, weekend, and the entire week. Fasting blood samples were analyzed for levels of high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides, insulin, and glucose; homeostasis model assessment of insulin resistance (HOMA-IR); levels of alanine aminotransferase, gamma-glutamyltransferase, and high-sensitivity C-reactive protein; and blood pressure. Abnormal results were categorized according to published guidelines.
Mean ST for all students was 3.1 hours per day and for weekdays and weekend days, 2.6 hours per day and 4.4 hours per day, respectively. Boys were more likely to exceed ST guidelines than girls (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.67-4.38). There were no significant associations between ST guidelines and metabolic risk factors among girls. After adjusting for potential confounders, boys who exceeded ST guidelines on weekdays were more likely to have elevated HOMA-IR (adjusted OR, 2.42; 95% CI, 1.11-5.28) and insulin levels (adjusted OR, 2.73; 95% CI, 1.43-5.23).
Adolescent boys with ST of 2 or more hours per day on weekdays have twice the risk of abnormal levels of insulin and HOMA-IR compared with peers with ST less than 2 hours per day on weekdays. These results suggest there is an increased risk of insulin resistance among adolescent boys who do not meet ST guidelines on weekdays.
Sugar-sweetened beverage (SSB) consumption may increase risk for unnecessary weight gain. To develop interventions discouraging consumption, more insight is needed about cognitive and environmental predictors related to the decrease in SSB consumption. The present paper aims (1) to describe the relationship between potential cognitive determinants of change (attitudes, subjective norms, perceived behavioural control and intentions) and perceived environmental factors (family food rule and home availability of SSB) with changes in SSB consumption between baseline and 4-month follow-up and (2) to study whether the relationships between the environmental factors and SSB consumption are mediated by the cognitive determinants. Information on possible predictors and SSB intake at baseline and 4-month follow-up was provided by 348 Dutch adolescents (aged 12-13 years) through online questionnaires that were completed at school. Multilevel logistic regression and mediation analyses were used to determine direct and indirect associations between predictors and behaviour. The present results show that a high perceived behavioural control to decrease intake at baseline was associated with a decrease in consumption of SSB between baseline and follow-up (OR = 0.53). Low availability and a stricter family food rule were associated with a decrease in SSB consumption between baseline and follow-up (OR = 2.39, 0.54). The association between availability and decrease in SSB consumption was for 68 % mediated by perceived behavioural control to drink less. In conclusion, interventions to decrease SSB intake should focus on improving attitudes and perceived behavioural control to reduce intake, and on limiting home availability and stimulating stricter family food rules regarding SSB consumption.
The accuracy of dietary energy assessment tools is critical to understanding the role of diet in the increasing rate of obesity.
The purposes of our study in overweight adolescent boys and girls were 1) to assess the energy reporting bias of diet records against the referent of total energy expenditure (TEE) and 2) to compare the methods of determining energy needs by using measured metabolizable energy intake (MEI) and TEE.
Twenty girls [12-15 y, body mass index (in kg/m2) = 33.0 +/- 5] and 14 boys (12-14 y, body mass index = 27.4 +/- 4) participated in 2- to 3-wk metabolic balance studies. TEE was measured by using doubly labeled water (TEE(DLW)), and MEI was measured by bomb calorimetry of composite daily diet, urine, and fecal collections. Food records were collected before each study.
Food records underreported TEE(DLW) by 35 +/- 20%. Underreporting of energy intake was correlated with all macronutrient intake concentrations (g or kcal) (P < 0.0001). A multiple regression model showed that 86.4% of the variance in underreporting error was explained by dietary fat (g), BMI, and sex. The intrasubject CV was 3.9% for TEE(DLW) and 9.9% for MEI. MEI for weight stability (MEI(wtstb)) averaged 99 +/- 11% of TEE.
The increased underreporting of dietary intake with increasing body weight in teens may explain in part previous reports noting that there has been an increased incidence of obesity, although energy intakes have not appeared to increase. MEI(wtstb) and TEE(DLW) gave similar estimates of energy needs. This trial was registered at clinicaltrials.gov as NCT 00592137.
Sedentary behavior and physical activity are not mutually exclusive behaviors. The relative risk of overweight for adolescents who are highly sedentary and highly physically active is unclear. A better understanding of the relationship between sedentary behaviors, physical activity, and body mass index (BMI) would provide insight for developing interventions to prevent or reduce overweight.
Using the physical activity module of the School Health Action, Planning and Evaluation System (SHAPES), we collected data from 25,060 students in grades 9 through 12 from 76 secondary schools in Ontario, Canada. Sex-specific logistic regression analyses were performed to examine how BMI, weight perceptions, social influences, team sports participation, and smoking behavior were associated with being 1) high active-high sedentary, 2) low active-low sedentary, and 3) low active-high sedentary.
Low active-high sedentary boys were more likely to be overweight than high active-low sedentary boys (adjusted odds ratio [AOR], 1.60; 95% confidence interval [CI], 1.01-2.58). When compared with high active-low sedentary girls, girls who were low active-high sedentary (OR, 2.24; 95% CI, 1.23-4.09) or high active-high sedentary (OR, 1.91; 95% CI, 1.01-3.61) were more likely to be overweight.
Sedentary behavior may moderate the relationship between physical activity and overweight. Developing a better understanding of sedentary behavior in relation to physical activity and overweight is critical for preventing and reducing overweight among youth.
Current physical activity guidelines acknowledge the importance of total health enhancing physical activity (HEPA) compared to leisure time physical activity or exercise alone. Assessing total HEPA may result in different levels of adherence to these as well as the strength and/or direction of associations observed between total HEPA and socio-demographic correlates. The aim of this study was to estimate the proportion of the population adhering to the recommendation of at least 30 minutes of HEPA on most days, and to examine the influences of socio-demographic correlates on reaching this recommendation.
Swedish adults aged 18-74 years (n = 1470) were categorized, based on population data obtained using the IPAQ, into low, moderately and highly physically active categories. Independent associations between the physical activity categories and socio-demographic correlates were studied using a multinomial logistic regression.
Of the subjects, 63% (95% CI: 60.5-65.4) adhered to the HEPA recommendation. Most likely to reach the highly physical active category were those aged < 35 years (OR = 1.8; 95% CI: 1.1-3.3), living in small towns (OR = 1.8; 95% CI: 1.1-2.7) and villages (OR = 2.4; 95% CI: 1.6-3.7), having a BMI between 25.0-29.9 kg/m2 (OR = 2.7; 95% CI: 1.4-5.3) having a BMI < 25 kg/m2 (OR = 2.5; 95% CI: 1.3-4.9), or having very good (OR = 2.1; 95% CI: 1.3-3.3) or excellent self-perceived health (OR = 4.1; 95% CI: 2.4-6.8). Less likely to reach the high category were women (OR = 0.6; 95% CI: 0.5-0.9) and those with a university degree (OR = 0.5; 95% CI: 0.3-0.9). Similar, but less pronounced associations were observed for the moderate group. Gender-specific patterns were also observed.
Almost two-thirds of the Swedish adult population adhered to the physical activity recommendation. Due to a large diversity in levels of physical activity among population subgroups, social-ecological approaches to physical activity promotion may be warranted.
We quantified the public health benefit of fruits and vegetables on the prevention of cancer and cardiovascular disease (CVD), using currently available human data.
We reviewed over 250 observational studies on cancer and CVD. Relative risks (RRs) for high versus low intake of fruits and vegetables were obtained. The preventable proportion of chronic diseases, i.e. the per cent of cases attributable to low consumption of fruits and vegetables, was estimated using three scenarios: best guess, optimistic (using stronger RRs) and conservative (using weaker RRs and eliminating the contribution of smoking and/or drinking). The preventable proportion was calculated for increasing average intake from the current 250 g day(-1) to the recommended 400 g day(-1) among the general Dutch population.
It is estimated that in the Netherlands cancer incidence could be reduced by 19% (12,000 cases annually, best guess), ranging from 6% (conservative) to 28% (optimistic). Cardiovascular deaths could be reduced by 16% (8000 deaths annually, best guess), ranging from 6% to 22%. Evidence is most abundant for gastrointestinal cancers, followed by hormone-related cancers, but limited for other sites and CVD.
Increasing consumption of fruits and vegetables carries a large public health potential. Population trials and biological mechanisms should eventually provide scientific proof of their efficacy. The available evidence is sufficient to justify public health education and promotion aimed at a substantial increase in the consumption of fruits and vegetables.
Understanding the factors that influence physical activity can aid the design of more effective interventions. Previous reviews of correlates of youth physical activity have produced conflicting results.
A comprehensive review of correlates of physical activity was conducted, and semiquantitative results were summarized separately for children (ages 3-12) and adolescents (ages 13-18). The 108 studies evaluated 40 variables for children and 48 variables for adolescents.
About 60% of all reported associations with physical activity were statistically significant. Variables that were consistently associated with children's physical activity were sex (male), parental overweight status, physical activity preferences, intention to be active, perceived barriers (inverse), previous physical activity, healthy diet, program/facility access, and time spent outdoors. Variables that were consistently associated with adolescents' physical activity were sex (male), ethnicity (white), age (inverse), perceived activity competence, intentions, depression (inverse), previous physical activity, community sports, sensation seeking, sedentary after school and on weekends (inverse), parent support, support from others, sibling physical activity, direct help from parents, and opportunities to exercise.
These consistently related variables should be confirmed in prospective studies, and interventions to improve the modifiable variables should be developed and evaluated.
We examined relationships between the presence of television during meals and children's food consumption patterns to test whether children's overall food consumption patterns, including foods not normally advertised, vary systematically with the extent to which television is part of normal mealtime routines.
Ninety-one parent-child pairs from suburbs adjacent to Washington, DC, recruited via advertisements and word of mouth, participated. Children were in the fourth, fifth, or sixth grades. Socioeconomic data and information on television use were collected during survey interviews. Three nonconsecutive 24-hour dietary recalls, conducted with each child, were used to construct nutrient and food intake outcome variables. Independent sample t tests were used to compare mean food and nutrient intakes of children from families in which the television was usually on during 2 or more meals (n = 41) to those of children from families in which the television was either never on or only on during one meal (n = 50). Multiple linear regression models, controlling for socioeconomic factors and other covariates, were used to test strength of associations between television and children's consumption of food groups and nutrients.
Children from families with high television use derived, on average, 6% more of their total daily energy intake from meats; 5% more from pizza, salty snacks, and soda; and nearly 5% less of their energy intake from fruits, vegetables, and juices than did children from families with low television use. Associations between television and children's consumption of food groups remained statistically significant in multiple linear regression models that controlled for socioeconomic factors and other covariates. Children from high television families derived less of their total energy from carbohydrate and consumed twice as much caffeine as children from low television families. There continued to be a significant association between television and children's consumption of caffeine when these relationships were tested in multiple linear regression models.
The dietary patterns of children from families in which television viewing is a normal part of meal routines may include fewer fruits and vegetables and more pizzas, snack foods, and sodas than the dietary patterns of children from families in which television viewing and eating are separate activities.
This report presents the revised growth charts for the United States. It summarizes the history of the 1977 National Center for Health Statistics (NCHS) growth charts, reasons for the revision, data sources and statistical procedures used, and major features of the revised charts.
Data from five national health examination surveys collected from 1963 to 1994 and five supplementary data sources were combined to establish an analytic growth chart data set. A variety of statistical procedures were used to produce smoothed percentile curves for infants (from birth to 36 months) and older children (from 2 to 20 years), using a two-stage approach. Initial curve smoothing for selected major percentiles was accomplished with various parametric and nonparametric procedures. In the second stage, a normalization procedure was used to generate z-scores that closely match the smoothed percentile curves.
The 14 NCHS growth charts were revised and new body mass index-for-age (BMI-for-age) charts were created for boys and girls (http://www.cdc.gov/growthcharts). The growth percentile curves for infants and children are based primarily on national survey data. Use of national data ensures a smooth transition from the charts for infants to those for older children. These data better represent the racial/ethnic diversity and the size and growth patterns of combined breast- and formula-fed infants in the United States. New features include addition of the 3rd and 97th percentiles for all charts and extension of all charts for children and adolescents to age 20 years.
Created with improved data and statistical curve smoothing procedures, the United States growth charts represent an enhanced instrument to evaluate the size and growth of infants and children.
This report provides detailed information on how the 2000 Centers for Disease Control and Prevention (CDC) growth charts for the United States were developed, expanding upon the report that accompanied the initial release of the charts in 2000.
The growth charts were developed with data from five national health examination surveys and limited supplemental data. Smoothed percentile curves were developed in two stages. In the first stage, selected empirical percentiles were smoothed with a variety of parametric and nonparametric procedures. In the second stage, parameters were created to obtain the final curves, additional percentiles and z-scores. The revised charts were evaluated using statistical and graphical measures.
The 1977 National Center for Health Statistics (NCHS) growth charts were revised for infants (birth to 36 months) and older children (2 to 20 years). New body mass index-for-age (BMI-for-age) charts were created. Use of national data improved the transition from the infant charts to those for older children. The evaluation of the charts found no large or systematic differences between the smoothed percentiles and the empirical data.
The 2000 CDC growth charts were developed with improved data and statistical procedures. Health care providers now have an instrument for growth screening that better represents the racial-ethnic diversity and combination of breast- and formula-feeding in the United States. It is recommended that these charts replace the 1977 NCHS charts when assessing the size and growth patterns of infants, children, and adolescents.
Physical activity declines during adolescence, but the underlying reasons remain unknown.
We prospectively followed 1213 black girls and 1166 white girls enrolled in the National Heart, Lung, and Blood Institute Growth and Health Study from the ages of 9 or 10 to the ages of 18 or 19 years. We used a validated questionnaire to measure leisure-time physical activity on the basis of metabolic equivalents (MET) for reported activities and their frequency in MET-times per week; a higher score indicated greater activity.
The respective median activity scores for black girls and white girls were 27.3 and 30.8 MET-times per week at base line and declined to 0 and 11.0 by year 10 of the study (a 100 percent decline for black girls and a 64 percent decline for white girls, P<0.001). By the age of 16 or 17 years, 56 percent of the black girls and 31 percent of the white girls reported no habitual leisure-time activity. Lower levels of parental education were associated with greater decline in activity for white girls at both younger ages (P<0.001) and older ages (P=0.005); for black girls, this association was seen only at the older ages (P=0.04). Pregnancy was associated with decline in activity among black girls (P<0.001) but not among white girls, whereas cigarette smoking was associated with decline in activity among white girls (P<0.001). A higher body-mass index was associated with greater decline in activity among girls of both races (P< or =0.05).
Substantial declines in physical activity occur during adolescence in girls and are greater in black girls than in white girls. Some determinants of this decline, such as higher body-mass index, pregnancy, and smoking, may be modifiable.
Television viewing has been associated with increased violence in play and higher rates of obesity. Although there are interventions to reduce television viewing by school-aged children, there are none for younger children.
To develop and evaluate an intervention to reduce television viewing by preschool children.
Randomized controlled trial conducted in 16 preschool and/or day care centers in rural upstate New York.
Children aged 2.6 through 5.5 years.
Children attending intervention centers received a 7-session program designed to reduce television viewing as part of a health promotion curriculum, whereas children attending the control centers received a safety and injury prevention program.
Change in parent-reported child television/video viewing and measured growth variables.
Before the intervention, the intervention and control groups viewed 11.9 and 14.0 h/wk of television/videos, respectively. Afterward, children in the intervention group decreased their television/video viewing 3.1 h/wk, whereas children in the control group increased their viewing by 1.6 h/wk, for an adjusted difference between the groups of -4.7 h/wk (95% confidence interval, -8.4 to -1.0 h/wk; P =.02). The percentage of children watching television/videos more than 2 h/d also decreased significantly from 33% to 18% among the intervention group, compared with an increase of 41% to 47% among the control group, for a difference of -21.5% (95% confidence interval, -42.5% to -0.5%; P =.046). There were no statistically significant differences in children's growth between groups.
This study is the first to show that a preschool-based intervention can lead to reductions in young children's television/video viewing. Further research is needed to determine the long-term effects associated with reductions in young children's television viewing.
Features of the metabolic syndrome are becoming increasingly evident in children. Decreased physical activity is likely to be an important etiological factor, as shown previously for subjective measures of physical activity in selected groups. The purpose of this study was to examine the relationship between the metabolic syndrome and objectively measured physical activity and whether fitness modified this relationship.
A total of 589 Danish children (310 girls, 279 boys, mean [+/-SD] age 9.6 +/- 0.44 years, mean weight 33.6 +/- 6.4 kg, mean height 1.39 +/- 0.06 m) were randomly selected. Physical activity was measured with the uni-axial Computer Science & Applications accelerometer (MTI actigraph) worn at the hip for at least 3 days (>/=10 h/day) and fitness with a maximal bike test. As outcomes, we measured sitting systolic and diastolic blood pressure, degree of adiposity (sum of four skinfolds), and, finally, insulin, glucose, triglicerides, and HDL cholesterol in fasting blood samples. The outcome variables were statistically normalized and expressed as the number of SDs from the mean. (i.e., Z scores). A metabolic syndrome risk score was computed as the mean of these Z scores. Multiple linear regression was used to test the association between physical activity and metabolic risk, adjusted primarily for age, sex, sexual maturation, ethnicity, parental smoking, socioeconomic factors, and the Computer Science & Applications unit, as well as for fitness. Robust SEs were computed by clustering on school.
All children were in the nondiabetic range of fasting glucose. Metabolic risk was inversely related to physical activity (P = 0.008). The relationship was weakened after adjustment for fitness, but there was a significantly positive interaction between physical activity and fitness.
Physical activity is inversely associated with metabolic risk, independently of potential confounders. The interaction between physical activity and fitness suggests that the potential beneficial effect of activity may be greatest in children with lower cardiorespiratory fitness.
This Policy Statement was retired April 2016
The current epidemic of inactivity and the associated epidemic of obesity are being driven by multiple factors (societal, technologic, industrial, commercial, financial) and must be addressed likewise on several fronts. Foremost among these are the expansion of school physical education, dissuading children from pursuing sedentary activities, providing suitable role models for physical activity, and making activity-promoting changes in the environment. This statement outlines ways that pediatric health care providers and public health officials can encourage, monitor, and advocate for increased physical activity for children and teenagers.
In response to low consumption levels of fruits and vegetables by Supplemental Nutrition Assistance Program (SNAP) participants,
the USDA Food and Nutrition Service created the Healthy Incentives Pilot (HIP) to test the efficacy of providing a 30% incentive
for purchases of targeted fruits and vegetables (TFVs). Four to six months after implementation, mean daily TFV intake for
adult HIP participants was 0.22 cup-equivalents higher (24% higher) than for control-group SNAP participants. These impact
estimates with a random-assignment research design generally agree with previously published nonexperimental elasticity estimates,
which imply that a pure price reduction of 30% would increase fruit and vegetable consumption by about 20%.
Objectives To describe the percentage of children who met physical activity and screen-time recommendations and to examine demographic differences. Recommendations for school-aged children include 60 minutes of daily moderate-to-vigorous physical activity and no more than 2 hours per day of screen-time viewing.
Design Cross-sectional study.
Setting Data from the 2009-2010 National Health and Nutrition Examination Survey, a representative sample of the US population.
Participants Analysis included 1218 children 6 to 11 years of age.
Main Exposures Age, race/ethnicity, sex, income, family structure, and obesity status.
Main Outcome Measures Proxy-reported adherence to physical activity and screen-time recommendations, separately and concurrently.
Results Based on proxy reports, overall, 70% of children met physical activity recommendations, and 54% met screen-time viewing recommendations. Although Hispanics were less likely to meet physical activity recommendations (adjusted odds ratio [aOR], 0.60 [95% CI, 0.38-0.95]), they were more likely to meet screen-time recommendations compared with non-Hispanic whites (aOR, 1.69 [95% CI, 1.18-2.43]). Only 38% met both recommendations concurrently. Age (9-11 years vs 6-8 years: aOR, 0.57 [95% CI, 0.38-0.85]) and obesity (aOR, 0.53 [95% CI, 0.38-0.73]) were inversely associated with concurrent adherence to both recommendations.
Conclusions Fewer than 4 in 10 children met both physical activity and screen-time recommendations concurrently. The prevalence of sedentary behavior was higher in older children. Low levels of screen-time viewing may not necessarily predict higher levels of physical activity.
Few previous studies have investigated consumption distributions of sugar-sweetened beverages (SSBs) over time and individual-level associations despite recent interest in SSBs regarding obesity control.
To assess consumption patterns and individual-level associations.
Trend and cross-sectional analyses of 24-hour dietary recall data and demographic characteristics and socioeconomic status (SES) drawn from National Health and Nutrition Examination Survey (1999-2000, 2001-2002, 2003-2004, 2005-2006, and 2007-2008) data.
Children (aged 2 to 11 years, n=8,627), adolescents (aged 12 to 19 years, n=8,922), young adults (aged 20 to 34 years, n=5,933), and middle-aged and elder adults (aged ≥35 years, n=16,456).
Age-stratified regression analyses for SSBs overall and by subtypes.
The prevalence of heavy total SSB consumption (≥500 kcal/day) increased among children (4% to 5%) although it decreased among adolescents (22% to 16%) and young adults (29% to 20%). Soda was the most heavily consumed SSB in all age groups except for children. Prevalence of soda consumption decreased, whereas heavy sports/energy drink consumption tripled (4% to 12%) among adolescents. Black children and adolescents showed higher odds of heavy fruit drink consumption (odds ratios 1.71 and 1.67) than whites. Low-income children had a higher odds of heavy total SSB consumption (odds ratio 1.93) and higher energy intake from total SSBs and fruit drinks (by 23 and 27 kcal/day) than high-income children. Adolescents with low- vs high-educated parents had higher odds of heavy total SSB consumption (odds ratio 1.28) and higher energy intake from total SSBs and soda (by 27 and 21 kcal/day). Low vs high SES was associated with a higher odds of heavy consumption of total SSBs, soda, and fruit drinks among adults.
Prevalence of soda consumption fell, but consumption of nontraditional SSBs rose. Heterogeneity of heavy consumption by SSB types across racial/ethnic subpopulations and higher odds of heavy SSB consumption among low-SES populations should be considered in targeting policies to encourage healthful beverage consumption.
The Healthy Hunger-Free Kids Act of 2010 presents an opportunity to change the nutritional quality of foods served in low-income childcare centers, including Head Start centers.
Excessive fruit juice consumption is associated with increased risk for obesity. Moreover, there is recent scientific evidence that sucrose consumption without the corresponding fiber, as is commonly present in fruit juice, is associated with the metabolic syndrome, liver injury, and obesity.
Given the increasing risk of obesity among preschool children, we recommend that the US Department of Agriculture’s Child and Adult Food Care Program, which manages the meal patterns in childcare centers such as Head Start, promote the elimination of fruit juice in favor of whole fruit for children.
Income and race/ethnicity are associated with differences in dietary intakes that may contribute to health disparities among members of the US population.
To examine alignment of intakes of food groups and energy from solid fats, added sugars, and alcohol with the 2005 Dietary Guidelines for Americans and MyPyramid, by family income and race/ethnicity.
Data from the National Health and Nutrition Examination Survey, a cross-sectional, nationally representative survey, for 2001-2004.
Persons aged ≥2 years for whom reliable dietary intake data were available (n=16,338) were categorized by income (lowest, middle, and highest) and race/ethnicity (non-Hispanic white, non-Hispanic black, and Mexican American).
The National Cancer Institute method was used to estimate the proportions of adults and children in each income and race/ethnic group whose usual intakes met the recommendations.
Higher income was associated with greater adherence to recommendations for most food groups; the proportions meeting minimum recommendations among adults in the highest income group were double that observed for the lowest income group for total vegetables, milk, and oils. Fewer differences by income were apparent among children. Among the race/ethnic groups, the proportions meeting recommendations were generally lowest among non-Hispanic blacks. Marked differences were observed for milk-15% of non-Hispanic black children met the minimum recommendations compared with 42% of non-Hispanic white children and 35% of Mexican-American children; a similar pattern was evident for adults. One in five Mexican-American adults met the dry beans and peas recommendations compared with approximately 2% of non-Hispanic whites and non-Hispanic blacks. Most adults and children consumed excess energy from solid fats and added sugars irrespective of income and race/ethnicity.
The diets of some subpopulations, particularly individuals in lower-income households and non-Hispanic blacks, are especially poor in relation to dietary recommendations, supporting the need for comprehensive strategies to enable healthier dietary intake patterns.
To synthesise reviews investigating physical activity and depression, anxiety, self-esteem and cognitive functioning in children and adolescents and to assess the association between sedentary behaviour and mental health by performing a brief review.
Searches were performed in 2010. Inclusion criteria specified review articles reporting chronic physical activity and at least one mental health outcome that included depression, anxiety/stress, self-esteem and cognitive functioning in children or adolescents.
Four review articles reported evidence concerning depression, four for anxiety, three for self-esteem and seven for cognitive functioning. Nine primary studies assessed associations between sedentary behaviour and mental health. Physical activity has potentially beneficial effects for reduced depression, but the evidence base is limited. Intervention designs are low in quality, and many reviews include cross-sectional studies. Physical activity interventions have been shown to have a small beneficial effect for reduced anxiety, but the evidence base is limited. Physical activity can lead to improvements in self-esteem, at least in the short term. However, there is a paucity of good quality research. Reviews on physical activity and cognitive functioning have provided evidence that routine physical activity can be associated with improved cognitive performance and academic achievement, but these associations are usually small and inconsistent. Primary studies showed consistent negative associations between mental health and sedentary behaviour.
Association between physical activity and mental health in young people is evident, but research designs are often weak and effects are small to moderate. Evidence shows small but consistent associations between sedentary screen time and poorer mental health.
We sought to document increases in caloric contributions from sugar-sweetened beverages and 100% fruit juice among US youth during 1988-2004.
We analyzed 24-hour dietary recalls from children and adolescents (aged 2-19) in 2 nationally representative population surveys: National Health and Nutrition Examination Survey III (1988-1994, N = 9882) and National Health and Nutrition Examination Survey 1999-2004 (N = 10 962). We estimated trends in caloric contribution, type, and location of sugar-sweetened beverages and 100% fruit juice consumed.
Per-capita daily caloric contribution from sugar-sweetened beverages and 100% fruit juice increased from 242 kcal/day (1 kcal = 4.2 kJ) in 1988-1994 to 270 kcal/day in 1999-2004; sugar-sweetened beverage intake increased from 204 to 224 kcal/day and 100% fruit juice increased from 38 to 48 kcal/day. The largest increases occurred among children aged 6 to 11 years ( approximately 20% increase). There was no change in per-capita consumption among white adolescents but significant increases among black and Mexican American youths. On average, respondents aged 2 to 5, 6 to 11, and 12 to 19 years who had sugar-sweetened beverages on the surveyed day in 1999-2004 consumed 176, 229, and 356 kcal/day, respectively. Soda contributed approximately 67% of all sugar-sweetened beverage calories among the adolescents, whereas fruit drinks provided more than half of the sugar-sweetened beverage calories consumed by preschool-aged children. Fruit juice drinkers consumed, on average, 148 (ages 2-5), 136 (ages 6-11), and 184 (ages 12-19) kcal/day. On a typical weekday, 55% to 70% of all sugar-sweetened beverage calories were consumed in the home environment, and 7% to 15% occurred in schools.
Children and adolescents today derive 10% to 15% of total calories from sugar-sweetened beverages and 100% fruit juice. Our analysis indicates increasing consumption in all ages. Schools are a limited source for sugar-sweetened beverages, suggesting that initiatives to restrict sugar-sweetened beverage sales in schools may have an only marginal impact on overall consumption. Pediatricians' awareness of these trends is critical for helping children and parents target suboptimal dietary patterns that may contribute to excess calories and obesity.
Few studies have used dietary pattern analysis, a useful method to summarize dietary intake, in adolescents.
Examine sociodemographic and socioenvironmental correlates of habitual dietary patterns.
Data for this cross-sectional/prospective analysis were drawn from Project EAT (Eating Among Teens), a population-based study.
Project EAT-I (Time 1), collected data on 4,746 adolescents in 1998-1999. Project EAT-II (Time 2) resurveyed 53% (n=2,516) of the original cohort 5 years later in 2003-2004. Dietary intake was assessed using the Youth/Adolescent Food Frequency Questionnaire. MAIN OUTCOME MEASURES/STATISTICAL ANALYSIS PERFORMED: Factor analysis identified four dietary patterns at Time 1 (vegetable, fruit, starchy food, and snack food) and Time 2 (vegetable and fruit, fast food, starchy food, and snack food). Linear regression was used to examine the relationship of Time 1 socioeconomic status and race (mutually adjusted) on factor scores for each dietary pattern, and then of Time 1 socioenvironmental characteristics (adjusted for socioeconomic status and race) on these factor scores.
In prospective analyses, socioeconomic status, family meal frequency, and home availability of healthy food were positively associated with the vegetable and fruit and starchy food patterns and inversely associated with the fast food pattern. Home availability of unhealthy food was inversely associated with the vegetable and fruit and starchy food patterns and positively associated with the fast food and snack food patterns. Maternal, paternal, and peer support for healthy eating were positively associated with the vegetable and fruit pattern and inversely associated with the fast food pattern. Similar associations were seen in cross-sectional analyses.
Multiple correlates of dietary patterns were identified. Health professionals should target these factors to improve the dietary quality of habitual eating practices in adolescents by encouraging parents to decrease home availability of unhealthy food while increasing availability of healthy food, family meal frequency, and parental support for healthy eating.
Abstract: In the United States, children are not consuming the recommended intakes for fruits and vegetables, which increases the risk for several diseases later in life. To identify factors related to low fruit and vegetable intake in U.S. children, we utilized the National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2001- 2002 examining the relationship of fruit and vegetable intake with age, gender, ethnicity, poverty level, BMI, and food security status. Data from 6,863 children ages 2-18 years were obtained from the combined NHANES data sets. The weighted sample was comprised of 50.7% males and 49.3% females. The mean age of the sample was 10.2 ± 0.08, with a mean BMI percentile of 63.4 ± 0.75, mean family poverty-income ratio of 2.4 ± 0.06, and mean energy intake of 2,057.6 ± 19.6. With regards to BMI percentile, 12-18 year olds between the 5th85th percentiles for BMI had significantly higher fruit intake (excluding citrus, melons, and berries) (0.66 ± 0.04, P= 0.032) than 12-18 year olds between the 85t95th and above the 95th BMI percentile (0.5 ± 0.06, 0.48 ± 0.04, respectively). Mean daily fruit intake also differed by poverty-income ratio status. Total mean daily fruit intake was significantly higher in children living in households above 350% of the federal poverty level (1.64 ± 0.06, P= 0.00 1) than those children living in households between 130-350% and below 130% of the federal poverty level (1.25 ± 0.06, 1.34 ± 0.07, respectively). Regarding food security status, total mean daily fruit intake was found to be significantly lower (P< 0.05) among children in food insecure households than among children in households classified as food secure. Males living in households determined food insecure without hunger had significantly lower mean daily fruit intakes (1.17 ± 0.093) than males in households fully food secure and marginally food secure (1.44 ± 0.066 and 1.54 ± 0.147, respectively) (P< 0.024). Females living in households determined food insecure with hunger had significantly lower mean daily fruit intakes (0.885 ± 0.126, P< 0.007) than females living in households fully food secure, marginally food secure, and food insecure without hunger (1.39 ± 0.064, 1.31 ± 0.127, 1.47 ± 0.128, respectively). Total fruit consumption also differed significantly among ethnic ities for 6-11 school age children. Mexican American children had significantly higher mean daily fruit intakes (1.7 ± 0.08) than non-Hispanic white (1.3± 0.09, P< 0.001). In addition, mean daily vegetable consumption of dark-green and deep-yellow vegetables differed by race/ethnicity, also. Specifically, non-Hispanic black children consumed significantly higher mean daily dark-green vegetables (0.1 ± 0.01, P< 0.047) and lower mean daily deep-yellow vegetables (0.06 ± 0.01, P< .001) than Mexican American (0.05 ± .01, 0.09 ± 0.02, respectively) and non-Hispanic white children (0.06 ± 0.01, 0.12 ± 0.01, respectively). In regards to leading contributors of total fruit and vegetable intake among 2-18 year old U.S. children, French-fries and potato chips contributed to more than 30% of total vegetable intake while fruit juice contributed to more than 30% of total fruit intake. This study shows differences in mean and leading contributors to total vegetable and fruit intakes among age categories and gender in conjunction with poverty status, ethnicity or food security status. Children most at risk for higher proportions of fruit juice, French-fries, and potato chips contributing to total fruit and vegetable intake were generally non-Hispanic black children, at risk for overweight or overweight, living in households 130% below the federal poverty level, and living in households considered marginally food secure or food insecure. These children need to be especially targeted for nutritional interventions and policy. Thesis (M.S.)--Ohio State University, 2006. Includes bibliographical references (leaves 42-50).
The objective of this study was to assess the quality of the current intakes of fruits and vegetables compared to the Dietary Guidelines for Americans in US children and adolescents and identify factors related to low fruit and vegetable intake. This descriptive study examined differences in fruit and vegetable intakes by age, sex, ethnicity, poverty level, body mass index, and food security status utilizing data from the 1999-2002 National Health and Nutrition Examination Survey. Six thousand five hundred thirteen children and adolescents ages 2 to 18 years, who were respondents to the 1999-2002 National Health and Nutrition Examination Survey. Mean fruit and vegetable intakes were computed using 24-hour recalls for individuals and compared using analysis of variance. Leading contributors to fruit and vegetable intake were identified using frequency analysis. Children aged 2 to 5 years had significantly higher total fruit and juice intakes than 6- to 11- and 12- to 18-year-olds. Total vegetable and french fry intake was significantly higher among 12- to 18-year-old adolescents. Regarding sex differences, boys consumed significantly more fruit juice and french fries than girls. In addition, non-Hispanic African-American children and adolescents consumed significantly more dark-green vegetables and fewer mean deep-yellow vegetables than Mexican-American and non-Hispanic white children and adolescents. Total fruit consumption also differed significantly among race/ethnicities and household income. Children and adolescents most at risk for higher intakes of energy-dense fruits and vegetables (fruit juice and french fries) were generally boys, and adolescents, at risk for overweight or overweight and living in households below 350% of the poverty level.
A calibration study was conducted to determine the threshold counts for two commonly used accelerometers, the ActiGraph and the Actical, to classify activities by intensity in children 5 to 8 years of age. Thirty-three children wore both accelerometers and a COSMED portable metabolic system during 15 min of rest and then performed up to nine different activities for 7 min each, on two separate days in the laboratory. Oxygen consumption was measured on a breath-by-breath basis, and accelerometer data were collected in 15-s epochs. Using receiver operating characteristic curve (ROC) analysis, cutpoints that maximised both sensitivity and specificity were determined for sedentary, moderate and vigorous activities. For both accelerometers, discrimination of sedentary behaviour was almost perfect, with the area under the ROC curve at or exceeding 0.98. For both the ActiGraph and Actical, the discrimination of moderate (0.85 and 0.86, respectively) and vigorous activity (0.83 and 0.86, respectively) was acceptable, but not as precise as for sedentary behaviour. This calibration study, using indirect calorimetry, suggests that the two accelerometers can be used to distinguish differing levels of physical activity intensity as well as inactivity among children 5 to 8 years of age.
A reduced questionnaire was developed by successively omitting segments of the full (98-item) Block questionnaire and calculating the correlations between nutrient estimates produced by the full and reduced versions. The reduced version contains 60 food items and requires 17 minutes to administer by an interviewer. It is intended to capture all nutrients in the diet, as is the full version. The reduced version was validated against three four-day records in a group of middle-aged women, and against two seven-day records collected 10-15 years ago in a group of older men. The absolute value of macronutrients estimated by the reduced questionnaire was lower than food-record estimates, but most micronutrients were not underestimated. For macronutrients correlations with food records were slightly lower with the reduced questionnaire, but for micronutrients there was only slight or no reduction in correlations as a result of using the reduced version. The brief version may be useful in studies that cannot allow the 30-35 minutes required for the full-length questionnaire.
The rising prevalence of obesity in children has been linked in part to the consumption of sugar-sweetened drinks. Our aim was to examine this relation.
We enrolled 548 ethnically diverse schoolchildren (age 11.7 years, SD 0.8) from public schools in four Massachusetts communities, and studied them prospectively for 19 months from October, 1995, to May, 1997. We examined the association between baseline and change in consumption of sugar-sweetened drinks (the independent variables), and difference in measures of obesity, with linear and logistic regression analyses adjusted for potentially confounding variables and clustering of results within schools.
For each additional serving of sugar-sweetened drink consumed, both body mass index (BMI) (mean 0.24 kg/m2; 95% CI 0.10-0.39; p=0.03) and frequency of obesity (odds ratio 1.60; 95% CI 1.14-2.24; p=0.02) increased after adjustment for anthropometric, demographic, dietary, and lifestyle variables. Baseline consumption of sugar-sweetened drinks was also independently associated with change in BMI (mean 0.18 kg/m2 for each daily serving; 95% CI 0.09-0.27; p=0.02).
Consumption of sugar-sweetened drinks is associated with obesity in children.
Our purpose was to identify factors associated with the physical activity in young children.
Participants were 214 children (aged 3-5 years) enrolled in 10 childcare centers who were monitored for physical activity with an accelerometer during 2 continuous days (48 hours). Mean daily activity counts, activity counts between 9 AM and 5 PM, and percentage of time spent in vigorous activity were determined. The factors investigated were age, childcare center, season, sex, body mass index (BMI), history of preterm birth, participation in organized activities, parental BMI, and parental educational level. Regression analyses were used to identify factors associated with each of the activity measures.
A statistical model including sex, history of preterm birth, childcare center, and father's BMI accounted for 22%, 37%, and 23% of the variance in total daily counts, counts between 9 AM and 5 PM, and percentage of time spent in daily vigorous activity, respectively. Childcare center was the highest individual predictor of activity. Boys were more active than girls in all activity measures except counts between 9 AM and 5 PM. Children born preterm were less active than children born at term, and high activity levels in the child were associated with a low BMI in fathers.
The findings indicate that sex, history of preterm birth, childcare center, and father's BMI influence the daily physical activity of young children.
This study aims to identify correlates of fruits and vegetables from within the domains of personal factors (taste preferences, health/nutrition attitudes, weight/body concerns, and self-efficacy), behavioral factors (meal frequency, fast food intake, and weight control behaviors), and socio-environmental factors (social support for healthy eating, family meal patterns, food security, socio-economic status, and home availability of fruits/vegetables). This study further aims to identify correlates of home availability and taste preferences for fruits/vegetables, and to explore patterns of interaction between availability and taste preferences.
The population included 3957 adolescents from 31 public middle and high schools in Minnesota. Structural equation modeling was used for model testing.
The strongest correlates of fruit/vegetable intake were home availability of fruits/vegetables and taste preferences of fruits/vegetables. The final model explained 13% of the variance in fruit/vegetable intake, 45% of the variance in home availability, and 28% of the variance in taste preferences. Correlates of home availability included social support for healthy eating, family meal patterns, family food security, and socio-economic status. Correlates of taste preferences included health/nutrition attitudes and home availability of fruits/vegetables. A test of interaction effects indicated that when home availability of fruits/vegetables was low, intake patterns did not differ, regardless of taste preferences. In contrast, even when taste preferences for fruits/vegetables were low, if fruits/vegetables were available, intake increased.
Interventions to increase fruit/vegetable intake in adolescents need to target socio-environmental factors such as greater availability of fruits/vegetables.
Trends between 1977/1978 and 1994/1998 in the prevalence, amounts, and sources of soft drink consumption were examined among youth age 6 to 17 years.
Dietary intake data were examined from three national surveys: the Nationwide Food Consumption Survey 1977/1978 (n=8,908), and the combined Continuing Survey of Food Intakes by Individuals 1994/1996, and the Supplemental Children's Survey 1998 (n=3,177). Soft drinks were defined as carbonated beverages (all United States Department of Agriculture database codes starting with 924) and included flavored waters and juice drinks. Subjects/Setting A national sample of youth ages 6 to 17 years were interviewed for each of the 3 surveys.
t tests were conducted to examine between-survey changes in soft drink consumption and sources of soft drinks.
The prevalence of soft drink consumption among youth ages 6 to 17 years increased 48%, from a prevalence of 37% in 1977/1978 to 56% in 1994/1998. Mean intake of soft drinks more than doubled, from 5 fl oz to 12 fl oz per day. Although the home environment remained the largest source of children's soft drink access, an increasing share was obtained from restaurants and fast-food establishments (+53%), vending machines (+48%), and other sources (+37%).
Away-from-home sources of soft drink are an important factor for dietitians to consider when evaluating the dietary intake and nutritional status of youths.
Despite the increasing availability of low- and reduced-fat foods, Americans continue to consume more fat than recommended, which may be a contributing factor to the obesity epidemic. This investigation examined relationships between liking and household availability of high- and low-fat foods and their association with dietary fat intake.
A food frequency questionnaire assessed percent calories from fat consumed over the past year in 85 men and 80 women. Participants reported their degree of liking 22 "high-fat foods" (>45% calories from fat) and 22 "low-fat foods" (<18% calories from fat), and the number and percentage (number of high- or low-fat foods/total number of foods x 100) of these high- and low-fat foods in their homes.
Hierarchical regression analyses examined the ability of liking and household availability of low- and high-fat foods to predict percent dietary fat intake. After controlling for age, sex, and BMI, liking ratings for high- and low-fat foods and the interaction of liking for low-fat foods by the percentage of low-fat foods in the household were significant predictors of percent dietary fat consumed. Greater liking of high-fat foods and lower liking of low-fat foods, both alone and combined with a lower percentage of low-fat foods in the home, were predictive of higher dietary fat intake.
Interventions designed to reduce dietary fat intake should target both decreasing liking for high-fat foods and increasing liking for low-fat foods, along with increasing the proportion of low-fat foods in the household.
Watching television in childhood and adolescence has been linked to adverse health indicators including obesity, poor fitness, smoking, and raised cholesterol. However, there have been no longitudinal studies of childhood viewing and adult health. We explored these associations in a birth cohort followed up to age 26 years.
We assessed approximately 1000 unselected individuals born in Dunedin, New Zealand, in 1972-73 at regular intervals up to age 26 years. We used regression analysis to investigate the associations between earlier television viewing and body-mass index, cardiorespiratory fitness (maximum aerobic power assessed by a submaximal cycling test), serum cholesterol, smoking status, and blood pressure at age 26 years.
Average weeknight viewing between ages 5 and 15 years was associated with higher body-mass indices (p=0.0013), lower cardiorespiratory fitness (p=0.0003), increased cigarette smoking (p<0.0001), and raised serum cholesterol (p=0.0037). Childhood and adolescent viewing had no significant association with blood pressure. These associations persisted after adjustment for potential confounding factors such as childhood socioeconomic status, body-mass index at age 5 years, parental body-mass index, parental smoking, and physical activity at age 15 years. In 26-year-olds, population-attributable fractions indicate that 17% of overweight, 15% of raised serum cholesterol, 17% of smoking, and 15% of poor fitness can be attributed to watching television for more than 2 h a day during childhood and adolescence.
Television viewing in childhood and adolescence is associated with overweight, poor fitness, smoking, and raised cholesterol in adulthood. Excessive viewing might have long-lasting adverse effects on health.