USDA Nutrition Evidence Library: methodology used to identify topics and develop systematic review questions for the birth-to-24-mo population.

The USDA's Nutrition Evidence Library (NEL) specializes in conducting food- and nutrition-related systematic reviews that are used to inform federal government decision making. To ensure the utility of NEL systematic reviews, the most relevant topics must be addressed, questions must be clearly focused and appropriate in scope, and review frameworks must reflect the state of the science. Identifying the optimal topics and questions requires input from a variety of stakeholders, including scientists with technical expertise, as well as government policy and program leaders. The objective of this article is to describe the rationale and NEL methodology for identifying topics and developing systematic review questions implemented as part of the "Evaluating the evidence base to support the inclusion of infants and children from birth to 24 months of age in the Dietary Guidelines for Americans--the B-24 Project." This is the first phase of a larger project designed to develop dietary guidance for the birth to 24-mo population in the United States.

Dietary energy density and body weight in adults and children: a systematic review.

Energy density is a relatively new concept that has been identified as an important factor in body weight control in adults and in children and adolescents. The Dietary Guidelines for Americans 2010 encourages consumption of an eating pattern low in energy density to manage body weight. This article describes the systematic evidence-based review conducted by the 2010 Dietary Guidelines Advisory Committee (DGAC), with support from the US Department of Agriculture's Nutrition Evidence Library, which resulted in this recommendation. An update to the committee's review was prepared for this article. PubMed was searched for English-language publications from January 1980 to May 2011. The literature review included 17 studies (seven randomized controlled trials, one nonrandomized controlled trial, and nine cohort studies) in adults and six cohort studies in children and adolescents. Based on this evidence, the 2010 Dietary Guidelines Advisory Committee concluded that strong and consistent evidence in adults indicates that dietary patterns relatively low in energy density improve weight loss and weight maintenance. In addition, the committee concluded that there was moderately strong evidence from methodologically rigorous longitudinal cohort studies in children and adolescents to suggest that there is a positive association between dietary energy density and increased adiposity. This review supports a relationship between energy density and body weight in adults and in children and adolescents such that consuming diets lower in energy density may be an effective strategy for managing body weight.

Predictors of body size stigmatization in Hispanic preschool children.

OBJECTIVE: The purpose of the current study was to verify the occurrence of body size stigmatization in Hispanic preschoolers who are "at risk" for obesity and to examine potential predictors of body size stigmatization. METHODS AND PROCEDURES: At a local preschool, 70 lower-socioeconomic, Hispanic caregivers and their preschoolers participated. Preschoolers completed an attribution task including positive and negative adjectives to assess body size stigmatization. Child's perceived size and caregiver's body dissatisfaction were assessed using a line drawing ranging in size from very underweight figures to very overweight figures. Adult and child body indices were then assessed. RESULTS: Body size stigmatization in child participants was observed. Stepwise multiple regressions revealed that child BMI was the only significant predictor of the number of positive adjectives the child assigned to the overweight picture. As child BMI increased, the number of positive adjectives assigned to the overweight picture decreased. Two predictors, caregiver body dissatisfaction with self and caregiver BMI, significantly predicted the number of negative traits the child assigned to the overweight figure. Caregivers with higher BMIs and increased body dissatisfaction were most likely to have children who showed negative body size stigmatization. DISCUSSION: Increasing rates of obesity have not led to greater acceptance of the obese and even children who are at greater risk for obesity show body size stigmatization at early ages. Caregivers are influential in the development of body size stigmatization in children and must be considered in the development of programs aimed at reducing stigmatization and obesity.

Mothers of preschoolers report using less pressure in child feeding situations following a newsletter intervention.

OBJECTIVE: To determine the impact of written intervention materials on child feeding practices of mothers and on physical activity behaviors of preschoolers. DESIGN: Mothers were divided into 3 groups: newsletter (n = 30), booklet (n = 31), and control (n = 31). Questionnaires were completed before and after a 12-week intervention. SETTING: Mail correspondence. PARTICIPANTS: White (90%), full-time mothers (76%) in their thirties (68%). INTERVENTIONS: Nutrition and activity information was provided as twelve 4-page weekly newsletters or one 52-page booklet. MAIN OUTCOME MEASURES: Child feeding factors, physical activity practices. ANALYSIS: Child feeding factors were analyzed using Kruskal-Wallis and Wilcoxon. Physical activity practices were analyzed using 2-way chi-square and sign tests. The significance level was set at .0125. RESULTS: There was a significant decrease in the "pressure to eat" score for participants in the newsletter group (2.5 +/- 1.0 to 2.1 +/- 1.0, P < .01). No other differences in feeding practices were observed. At baseline, 43% of the mothers said their child spent at least 1 hour per day in active play, and 63% said their child watched television less than 2 hours per day. A significant increase in outdoor play was reported in the newsletter (P < .01) and control (P < .01) groups. CONCLUSIONS AND IMPLICATIONS: This study is one of the first to indicate that child feeding practices may be modifiable.

Impact of curriculum-based bone loading and nutrition education program on bone accrual in children.

The purpose of this study was to investigate the influence of jumping activities and nutrition education on bone accretion in prepubescents. Fourth-grade children were divided into four groups: jumping (n = 61), nutrition (n = 9), jumping plus nutrition (n = 14), and control (n = 28). Interventions spanned the fourth and fifth grade academic years. Assessments were gathered at 0, 8 and 20 months. Baseline BMD values were (mean +/- SD): lumbar (0.752 +/- 0.095 g/cm2), neck (0.794 +/- 0.089 g/cm2) and total (0.907 +/- 0.060 g/cm2). There was a significant increase in BMD over time. However, the interventions produced no significant effects. Twice weekly jumping and/or biweekly nutrition education did not influence bone accrual.

Bone density and young athletic women. An update.

High-school girls and collegiate women have tremendous opportunities to participate in athletic teams. Young girls are also playing in club and select teams at an early age and often, year-round. There are many benefits for participating in sport and physical activity on both the physical and mental health of girls and women. Decreased risk for heart disease and diabetes mellitus, along with improved self-esteem and body-image, were among the first reported benefits of regular physical activity. In addition, sport participation and physical activity is also associated with bone health. Athletes have a greater bone mineral density compared with non-active and physically active females. The increase in bone mass should reduce the risk of fragility fractures in later life. There appears to be a window of opportunity during the development of peak bone mass in which the bone is especially responsive to weight-bearing physical activity. Impact loading sports such as gymnastics, rugby or volleyball tend to produce a better overall osteogenic response than sports without impact loading such as cycling, rowing and swimming. Relatively little is known about the impact of retiring from athletics on bone density. It appears that former athletes continue to have a higher bone density than non-athletes; however, the rate of bone loss appears to be similar in the femoral neck. The positive impact of sports participation on bone mass can be tempered by nutritional and hormonal status. It is not known whether female athletes need additional calcium compared with the general female population. Due to the increased energy expenditure of exercise and/or the pressure to obtain an optimal training bodyweight, some female athletes may develop low energy availability or an eating disorder and subsequently amenorrhoea and a loss of bone mineral density. The three inter-related clinical disorders are referred to as the 'female athlete triad'. This article presents a review of the relationship between sports training and bone health, specifically bone mineral density, in young athletic women.

Perceptions of health status and play activities in parents of overweight Hispanic toddlers and preschoolers.

Childhood overweight among lower socioeconomic, Hispanic children has increased. Interviews regarding health status and play patterns were conducted with 76 predominantly Hispanic mothers of overweight toddlers and preschoolers served by Women, Infants, and Children (WIC). Most participants believed their child was healthy and half were unconcerned about their child's weight. Most parents reported having a safe place to play and access to a playground, although gender differences were found. Access to an outside play area was related to amount of active play activities. Children watched an average of 1.7 hours per day of television. Health professionals must partner with parents to address childhood obesity.