A Community-based Healthy Living Promotion Program Improved Self-esteem Among Minority Children.

OBJECTIVES: Improving self-esteem, dietary habits, and physical activity is essential for long-term success in childhood obesity prevention. The aim is to evaluate the effects of a healthy living promotion program, Healthy Kids-Houston, on BMI, dietary habits, self-esteem, and physical activity among minority children. METHODS: The after-school program was implemented at community centers in low-income neighborhoods with close proximity to public schools. The program consisted of 3 6-week sessions. Each week, children attended 2 2-hour sessions. Each 2-hour session in the intervention included 90 minutes of structured physical activities and 30 minutes of nutrition and healthy habit lessons. The control group received typical enrichment programs. Outcomes were measured before the intervention and at the end of each 6-week session. RESULTS: We enrolled 877 children (age 10.2 ±â€Š0.1 years (mean ±â€ŠSE); body mass index z score: 1.49 ±â€Š0.1; 52.0% boys; 72.6% Hispanic) in the program with 524 children received the intervention at 14 community centers and 353 children served as control at 10 community centers. The intervention led to no improvements in BMI z score (P = 0.78) and dietary habits (P = 0.46). Significant improvements (P ≤ 0.02) were detected in the amount of exercise that a child perceived to be required to offset a large meal and in several key self-esteem scores. No improvements were detected in physical activities (P ≥ 0.21). CONCLUSIONS: The improvement in some key self-esteem scores and nutrition knowledge may act as a mediator to motivate these children to adopt a healthier lifestyle in the future.

Characterizing lunch meals served and consumed by pre-school children in Head Start.

OBJECTIVE: To examine the variability of food portions served and consumed by African-American and Hispanic-American pre-school children attending Head Start. DESIGN: Cross-sectional. SETTING: Food consumption by pre-schoolers (n 796) enrolled in sixteen Head Start centres in Houston, Texas (51 % boys, 42 % African-American, mean age 4 years) were assessed during 3 d of lunch meals using digital photography. Descriptive statistics and multilevel regression models, adjusting for classroom and school clustering effects, were determined. SUBJECTS: Head Start pre-schoolers aged 3­5 years. RESULTS: Mean amount served was 2428 kJ (580 kcal) and 572 g. Mean intake was 1421 kJ (339 kcal) and 331 g: 20 % protein, 46 % carbohydrate and 34 % fat. Plate waste was 43 % (range: 38 % (fruit) to 61 % (vegetables)). Mean CV of food served was 29 %: 33 % for entrées, 44 % for vegetables, 60 % for fruit and 76 % for starches. Mean CV of food consumed was 46 %: 58 % for entrées, 86 % for fruit, 96 % for vegetables and 111 % for starches. Total gram amount of food served was positively correlated with consumption (r = 0·43, P < 0·001). CONCLUSIONS: Plate waste and variation in amounts served and consumed were substantial; amounts served were associated with amounts consumed. Large portion sizes may contribute to paediatric obesity by promoting excessive intake at meals. Understanding factors influencing portion sizes provides insight about specific intervention strategies that can be used in obesity prevention programmes.

Resemblance of dietary intakes of snacks, sweets, fruit, and vegetables among mother-child dyads from low income families.

The objective of this study was to determine the correlation between intake of snacks, sweets, fruit, vegetables, and energy in low-income mother-child dyads. This was a secondary analysis of data collected from Head Start centers in Houston, Texas and Birmingham, Alabama. Twenty four hour dietary recalls for one weekend day were collected from mother (mean 31.8 yrs [range: 20.1-72.4 yrs])-child (mean 4.4 yrs [range 2.8-5.8 yrs]) dyads (N=650). Means±SD were calculated for intake of food categories and energy. Pearson's partial correlation coefficients were used to detect associations between the intakes of the dyads. Main outcome measures were the correlations between the intake of snacks, sweets, fruit, vegetables, and energy in the mother-child dyads. Partial correlations showed that children's intake of snacks, sweets, fruit, vegetables, and energy were all correlated with the mother's intake of these foods/energy (all p<0.001). Children's intake of fruit was correlated with the mother's intake of vegetables (p<0.001); children's energy intake was correlated with mother's intake of sweets, fruit, and vegetables (all p<0.001). It is important that food and nutrition professionals provide the guidance needed that encourages intake of nutrient-dense snacks and fruit and vegetables in mothers so they can model healthier food consumption behaviors for their children.

Prevalence of metabolic syndrome and obesity in adolescents aged 12 to 19 years: comparison between the United States and Korea.

This study compared the prevalence of metabolic syndrome (MetS), its risk factors, and obesity in adolescents in the United States (US) and Korea. Data were obtained from 2003-2004 US National Health and Nutrition Examination Survey (NHANES) and 2005 Korea NHANES for adolescents aged 12-19 yr in the US (n=734) and in Korea (n=664). The 2007 International Diabetes Federation (IDF) pediatric definition for diagnosis of MetS and the 2000 US Growth Charts and 2007 Korea Growth Charts for assessment of obesity were utilized. The prevalence of metabolic syndrome in US and Koreans was 5.5% and 2.5%, respectively. The prevalence of obesity was 18.1% in US compared to 9.0% in Koreans. The prevalence of abdominal obesity, hyperglycemia, and hypertriglyceridemia were higher in the US, whereas that of low HDL-C levels was higher in Korea. Despite the doubled prevalence for the single entities of MetS and obesity in the US, the prevalence of MetS in obese US and Koreans did not differ (20.8% and 24.3%, respectively). In conclusion, there are differences in the prevalence of MetS, obesity, and the individual MetS risk factors between the US and Korean adolescents; however, the risk of MetS among obese adolescents is similar in both countries.

Assessment of the diet quality of US adults in the Lower Mississippi Delta.

BACKGROUND: The Lower Mississippi Delta (LMD) is a region at high risk of nutritionally related diseases. Assessing LMD diet quality is important in policy making, monitoring service outcomes, and designing sustainable research interventions. OBJECTIVE: The purpose was to assess the diet quality of LMD adults by using the Healthy Eating Index (HEI) to 1) identify potential and needed interventions, 2) determine population subgroups needing special attention, and 3) compare regional intakes with national intakes. DESIGN: Data were obtained from a representative cross-sectional telephone survey (n = 1699), Foods of our Delta Study 2000, by using the US Department of Agriculture's multiple-pass 24-h recall methodology and random-digital-assisted dialing with selection of one adult per household. The diet quality of LMD adults was compared with that of white and African American adults in the National Health and Nutrition Examination Survey (NHANES), 1999-2000. RESULTS: Age, race, and income of LMD adults affected overall diet quality. African Americans had lower grain, vegetable, milk, and variety scores than did whites. The consumption of grains and vegetables was associated with lower odds ratios for being overweight. The LMD adults had a lower HEI score than did the adults in NHANES 1999-2000 (60.1 compared with 63.4), and more LMD adults ate a poor diet (24.8% compared with 18.3%). CONCLUSION: Low-income and young-adult households in the LMD are in need of nutrition interventions with an emphasis on increasing grain, fruit, and vegetable intakes. Because socioeconomic factors affect diet quality, a multimodal, longitudinal approach appears needed to improve nutritional health.

Poverty and food intake in rural America: diet quality is lower in food insecure adults in the Mississippi Delta.

OBJECTIVE: To determine if measures of diet quality differ between food insecure and food secure adults in a rural high-risk population. DESIGN: Random digit dialing telephone survey of a cross-section of the population designed to collect data on food intake, household demographics, and food security status. SETTING: A representative sample of adults who live in 36 counties in the Lower Mississippi Delta region of Arkansas, Louisiana, and Mississippi. SUBJECTS: One thousand six hundred seven adults, both white and African American. MAIN OUTCOME MEASURES: Food security status and diet quality, as defined by adherence to the Healthy Eating Index and Dietary Reference Intakes by determinations from self-reported food intake (1 day intake). STATISTICAL ANALYSES: Regression analysis, t tests, Wald statistic, and beta tests were employed. RESULTS: Food secure adults scored higher on Healthy Eating Index than food insecure adults (P=0.0001), but the regression model showed no differences when multiple factors were included. Food secure individuals consistently achieved higher percentages of the Dietary Reference Intakes (specifically Estimated Average Requirements and Adequate Intakes) than food insecure individuals, with the greatest differences seen for vitamin A (P<0.0001), copper (P=0.0009), and zinc (P=0.0022) and very little difference for vitamins C (P=0.68) and E (P=0.32). Both populations consumed diets extremely low in fiber. CONCLUSIONS: Food insecurity is associated with lower quality diets in this population. It is acknowledged that serious limitations are associated with the use of one 24-hour recall and for comparison between food intake and assessment of food security. These findings still suggest a pressing need for nutrition interventions to improve dietary intake in these at-risk impoverished individuals.

Consumption of calcium among African American adolescent girls.

OBJECTIVE: To determine the adequacy of calcium intake of children by demographic group in the Lower Mississippi Delta (LMD) and compare to national statistics. DESIGN: FOODS 2000 was used to examine the dietary calcium intake of LMD children and compare it to US children in the Continuing Survey of Food Intakes by Individuals (CSFII) 1994-1996, 1998. SETTING AND PARTICIPANTS: The sample of 465 non-Hispanic children 3-17 years of age who live in 36 counties of the LMD was identified by using list-assisted random digit dialing methods. MAIN OUTCOME MEASURES: The t tests and z tests were performed for within- and between-sample comparisons. Logistic regression, controlling for energy, race, sex, age, and nutrition assistance was used as a measure of the association of sample characteristics with meeting adequate intake (AI) for calcium. An algorithm was used to calculate the rankings of calcium consumption from food categories. RESULTS: Children in the LMD consumed significantly less calcium (P < .05) than children in the US sample. Percent of AI for calcium decreased as age increased. Persons who consumed less than the AI for calcium include females, Blacks, those not receiving nutritional assistance, and older children. Less than 22% of LMD and 27% of US 9- to 17-year-old children met their calcium AI. Sources of calcium were similar across subgroups and all included milk as their top contributor to calcium intake. CONCLUSION: Interventions are needed to increase adolescents' calcium consumption, with particular focus on 9- to 17-year-old African American girls.

Child health-related quality of life and household food security.

OBJECTIVE: To examine the association of household food insecurity with child self- or proxy-reported health-related quality of life (HRQOL). DESIGN: Cross-sectional telephone survey from January 1, 2000, through June 30, 2000. PARTICIPANTS: Three hundred ninety-nine children who live in 36 counties of the Delta region of Arkansas, Louisiana, and Mississippi. MAIN OUTCOME MEASURES: Household food insecurity status was measured using the US Household Food Security Scale. Child HRQOL was measured by the Pediatric Quality of Life Inventory, QL version 4.0. Analysis Summary statistics, linear and logistic regressions, incorporating survey weights, performed with SUDAAN version 8. RESULTS: Household food insecurity was significantly associated with total child HRQOL (P<.05) and physical function (P<.05), adjusted for child age, ethnicity, gender, and family income. Children aged 3 through 8 years in food insecure households were reported by parents to have lower physical function (P = .001), while children aged 12 through 17 years reported lower psychosocial function (P = .007). Black males in food insecure households reported lower physical function (P<.05) and lower total HRQOL (P<.05). CONCLUSIONS: Children who live in food insecure households have poorer HRQOL. The effect on physical or psychosocial function may differ by age, ethnicity, and gender. Food security should be considered an important risk factor for child health.

Influences on fruit and vegetable consumption by low-income black American adolescents.

OBJECTIVE: The purpose of this study was to identify personal, behavioral, and environmental factors influencing fruit and vegetable consumption among 10- to 13-year-old low-income black American youth in the lower Mississippi Delta region. Social Cognitive Theory, along with other theoretical constructs, guided focus group questions and analysis. DESIGN: A qualitative study using focus group methodology. SETTING: Enrichment program of a sports summer camp for low-income youth. PARTICIPANTS: Forty-two adolescents (21 female, 21 male) participated in 6 focus groups. MAIN OUTCOME MEASURES: Personal, behavioral, and environmental influences on fruit and vegetable consumption. ANALYSIS: Content analysis methods were used by 3 independent reviewers to identify themes within the focus group transcripts. Themes were summarized and then categorized into the 3 domains of Social Cognitive Theory. RESULTS: The major themes were taste, availability, extended family influence, visual proof of the benefits of fruit and vegetable consumption, and the need for gender-specific behavioral skills. CONCLUSIONS AND IMPLICATIONS: This formative research will aid in the development of a culturally relevant nutrition intervention for low-income black American adolescents in the lower Mississippi Delta region. The results indicate that this group is more likely to respond to interventions that use role models who can provide proof that fruit and vegetable consumption is related to improved health.

Evaluating body fat in girls and female adolescents: advantages and disadvantages of dual-energy X-ray absorptiometry.

BACKGROUND: Within the past 10 y, dual-energy X-ray absorptiometry (DXA) has become one of the most widely used methods of measuring human body composition. However, DXA has not been fully evaluated against an independent criterion method of measuring body fatness in young females. OBJECTIVE: Our objective was to determine the bias and agreement between DXA and a 4-compartment model in predicting the percentage of fat mass (%FM) in a multiethnic group of young females. DESIGN: The %FM values measured by DXA of 73 white, 43 African American, 14 Hispanic, and 11 Asian females with a mean (+/- SD) age of 13.0 +/- 1.9 y were compared with the 4-compartment values, which were based on measurements of body density, body water, and bone mineral content. RESULTS: The %FM values measured by the 2 methods were correlated at r = 0.90 with an SEE of 3.3%; Bland-Altman analysis indicated an average bias of 3.9%. After nullification of the average bias, an individual estimate of %FM by DXA could be underestimated or overestimated by 6.7% when compared with the 4-compartment value. CONCLUSIONS: DXA is an appropriate method for estimating body composition in a group of young females because its bias and limits of agreement are independent of age, ethnicity, and body fatness. However, the limits of agreement of 6.7% could cause an individual FM value to be underestimated or overestimated by 28% relative to the 4-compartment value. Therefore, DXA may not be the optimal method of measuring the body fatness of young females.

Role of infant feeding practice, sex, and age on fatness and subcutaneous fat distribution in infancy: Longitudinal analysis of multiple skinfold measurements.

The aim of this study was to determine whether subcutaneous fatness and fat distribution differ on the basis of feeding practice and sex during the first 6 months of life. Longitudinal principal components analysis (PCA) was done on skinfolds measured at five sites in 45 breast-fed and 41 formula-fed infants. The first component represented fatness, the second component change in fatness, and the third component upper body/lower body fat distribution. Analysis of the components indicated that fatness and the proportion of lower body fat were greater in breast-fed than in formula-fed infants; however, when race was included as a predictor, the differences in lower body fat did not persist. The interpretation of components and the group differences were confirmed by repeated measures analysis of variance (ANOVA) on the sum of skinfolds (fatness) or simple skinfold ratios (fat distribution). Group differences for fatness and upper body/lower body fat persisted when race was included as a predictor. Longitudinal PCA of another indicator, the Rohrer index, suggested that fatness was greater in formula-fed than breast-fed infants. Collectively, these findings suggest that formula-fed infants have less subcutaneous fat than breast-fed infants; however, formula-fed infants may have either more internal fat or more lean body mass. Am. J. Hum. Biol. 9:179-190, 1997. © 1997 Wiley-Liss, Inc.

High prevalence of food insecurity and hunger in households in the rural Lower Mississippi Delta.

CONTEXT: Residents of the Lower Mississippi Delta of Arkansas, Louisiana, and Mississippi are at risk for food insecurity since a high proportion of the population live in households with incomes below the poverty level and have reduced access to food and decreased availability of a variety of foods. However, the magnitude of the problem is unknown because presently only nationwide and state estimates of food insecurity are available. PURPOSE: This study was conducted by the Lower-Mississippi Delta Nutrition Intervention Research Consortium to determine the prevalence of household food insecurity, identify high-risk subgroups in the Lower Delta, and compare to national data. METHODS: A 2-stage stratified cluster sample representative of the population in 36 counties in the Lower Delta was selected using list-assisted random digit dialing telephone methodology. A cross-sectional telephone survey of 1662 households was conducted in 18 of the 36 counties using the US Food Security Survey Module. FINDINGS: Twenty-one percent of Lower Delta households were food insecure, double the 2000 nationwide rate of 10.5%. Within the Lower Delta, groups with the highest rates of food insecurity were households with income below $15,000, black households, and households with children. The prevalence of hunger in Delta households with white children was 3.2% and in households with black children was 11.0%, compared to nationwide estimates of 0.3% and 1.6%. CONCLUSIONS: The Lower Mississippi Delta is characterized by a high prevalence of food insecurity and hunger. Future efforts to identify the household and community determinants of food insecurity to reduce its high prevalence are indicated.

Characterizing dinner meals served and consumed by low-income preschool children.

BACKGROUND: A dinner meal is consumed by approximately 95% of preschool children, yet few studies have characterized the dinner meal within a broader environmental context. The primary goal of this study was to identify the average quantities of foods served and consumed at the dinner meal by preschool children. A secondary goal was to look at factors that influenced the total amounts of food and energy consumed among preschoolers at the dinner meal. METHOD: Food intake at a family dinner meal was measured using digital photography in African-American and Hispanic-American preschool children (n = 231). Pictorial records were converted to gram and energy estimates of food served and consumed; grams were converted to kilocalories for each food using Nutrition Data System for Research (NDSR) nutritional software. Foods were categorized by groups/subgroups. Comparison of means and coefficient of variation was examined overall and by food groups for food grams (and energy) served, consumed, and wasted. The relationship of mother/child characteristics to amounts served and consumed were analyzed by regression and analysis of variance (ANOVA). RESULTS: Plate waste was high; 30% of the foods served to the child at the dinner meal were not consumed. The amounts of food and beverage served and consumed varied within and among the food groups studied. The proportion of children served a major food group at the dinner meal varied considerably: 44% fruit/juice, 97% vegetables, 99% grains, 97% meats, 74% dairy, 66% sweetened beverages, 92% fat and oils, and 40% sweets and sugars. The amount of food served was positively associated with the amount consumed (p < 0.0001). Energy density of the dinner meal was positively associated with energy intake consumed (p < 0.0001). CONCLUSIONS: Plate waste and variation in amounts served and consumed was substantial. The amount of food served was positively associated with the amount of food consumed by preschool children.

N-nitroso compounds: assessing agreement between food frequency questionnaires and 7-day food records.

BACKGROUND: N-nitroso compounds are recognized as important dietary carcinogens. Accurate assessment of N-nitroso intake is fundamental to advancing research regarding its role with cancer. Previous studies have not used a quantitative database to estimate the intake of these compounds in a US population. OBJECTIVE: To address this gap, a database of N-nitroso values was developed in conjunction with an existing food frequency questionnaire (FFQ). In this article we report on the relative validity of the FFQ instrument modified to estimate intake of N-nitroso compounds. DESIGN: Intake estimates of 23 N-nitroso compounds from the FFQ were compared with those from 7-day food records in a cross-sectional study conducted from January 2005 through June 2006. SUBJECTS: A sample of 98 healthy adult subjects (aged 50.42+/-12.84 years) completed an FFQ and then recorded foods and beverages consumed on 7-day food records. RESULTS: Crude and energy-adjusted N-nitroso compounds intakes were significantly higher in the FFQ than the 7-day food records (P<0.001). Spearman correlations for crude and energy-adjusted N-nitroso intakes ranged from 0.004 to 0.48. By tertiles of N-nitiroso compounds, there was moderate agreement (kappa>0.30) for five compounds. Higher estimates of N-nitroso compounds by FFQ was explained by a greater proportion of subjects who reported eating foods high in N-nitroso compounds on FFQ than reported on 7-day food records. CONCLUSION: The modified FFQ with N-nitroso values is a useful tool for assessing N-nitroso intakes relative to a group, and captures all food items with N-nitroso compounds, including those foods with high concentrations and eaten sporadically.

Construction of an N-nitroso database for assessing dietary intake.

Dietary N-nitroso compounds are carcinogens synthesized during food processing from two main classes of precursors, oxides of nitrogen and amines or amides. Quantification of the dietary intake of N-nitroso compounds is significant to human cancers, including those of the stomach and upper gastro-intestinal tract, colon, and brain. Previous studies investigating these cancers primarily used proxy estimates of N-nitroso intake and not a full and complete database. In this report, we describe the development of a database to be used in conjunction with a food frequency questionnaire (FFQ) or twenty-four hour dietary records. Published analytical data for N-nitroso compounds were compiled and evaluated for inclusion in the database. The final database consisted of 23 different N-nitroso compounds for 500 foods from 39 different food subgroups. Next, database foods were matched to foods in a standard FFQ by imputation, or calculated value, or assumed zero. Using the FFQ modified with N-nitroso values, we evaluated the ability to compute N-nitroso intakes for a sample of healthy control subjects of cancer epidemiological studies. N-nitroso content of food items ranged from <0.01µg/100 g. to 142 µg/100 g and the richest sources were sausage, smoked meats, bacon, and luncheon meats. The database is useful to quantify N-nitroso intake for observational and epidemiological studies.

The association of child and household food insecurity with childhood overweight status.

CONTEXT: The prevalence of childhood overweight status is increasing. Some have suggested that childhood overweight is associated with food insecurity, defined as limited or uncertain access to enough nutritious food. OBJECTIVES: The purpose of this work was to assess the association of household and child food insecurity with childhood overweight status. METHODS: The National Health and Nutrition Examination Survey 1999-2002 uses a stratified multistaged probability sample and collects a broad array of data from a nationally representative sample of US citizens. All children 3 to 17 years old in this sample are included in these analyses. We measured BMI categorized as at risk for overweight or greater (> or = 85%) or overweight (> or = 95%) and household and child food security/insecurity using the US Food Security Scale. RESULTS: When compared with children from food-secure households, children from food-insecure households were more likely to demonstrate significant associations with being at risk for overweight or greater in the following demographic categories: 12 to 17 years, girls, white, and in households with income < 100% and > 4 times the federal poverty level. Household food insecurity is associated with child overweight status in children aged 12 to 17, girls, and children who live in households with incomes > 4 times the federal poverty level. Child food insecurity demonstrated the same associations with being at risk for overweight or greater, as did household food insecurity, but associations were also seen in 3- to 5-year-old children, boys, and Mexican American children. Child food insecurity is significantly associated with child overweight status for children aged 12 to 17, girls, white children, and children in families with income < or = 100% poverty level. Controlling for ethnicity, gender, age, and family poverty index level, childhood food insecurity is associated with a child being at risk for overweight status or greater, but not overweight status. CONCLUSIONS: Household and child food insecurity are associated with being at risk for overweight and overweight status among many demographic categories of children. Child food insecurity is independently associated with being at risk for overweight status or greater while controlling for important demographic variables. Future longitudinal research is required to determine whether food insecurity is causally related to child overweight status.

Household food insecurity is associated with adult health status.

The prevalence of household food security, which reflects adequacy and stability of the food supply, has been measured periodically in the United States and occasionally in high-risk groups or specific regions. Despite a plausible biological mechanism to suggest negative health outcomes of food insecurity, this relation has not been adequately evaluated. This study was conducted in the Lower Mississippi Delta region to examine the association between household food insecurity and self-reported health status in adults. A two-stage stratified cluster sample representative of the population in 36 counties in the Delta region of Arkansas, Louisiana, and Mississippi was selected using list-assisted random digit dialing telephone methodology. After households were selected and screened, a randomly selected adult was interviewed within each sampled household. Data were collected to measure food security status and self-reported mental, physical, and general health status, using the U.S. Food Security Survey Module and the Short Form 12-item Health Survey (SF-12). Data were reported on a sample of 1488 households. Adults in food-insecure households were significantly more likely to rate their health as poor/fair and scored significantly lower on the physical and mental health scales of the SF-12. In regression models controlling for income, gender, and ethnicity, the interaction between food insecurity status and race was a significant predictor of fair/poor health and lower scores on physical and mental health. Household food insecurity is associated with poorer self-reported health status of adults in this rural, high-risk sample in the Lower Mississippi Delta.