Elevated LDL-C, high blood pressure, and low peak V ˙ O2 associate with platelet mitochondria function in children-The Arkansas Active Kids Study.

Purpose: To evaluate the association of platelet (PL) mitochondria respiration with markers of cardiovascular health in children ages 7-10 years. Methods: PL mitochondrial respiration (n = 91) was assessed by high resolution respirometry (HRR): Routine (R) respiration, complex (C) I linked respiration (CI), and maximal uncoupled electron transport capacity of CII (CIIE) were measured. The respiratory control ratio (RCR) was calculated as the ratio of maximal oxidative phosphorylation capacity of CI and CI leak respiration (PCI/LCI). Peak V ˙ O2 (incremental bike test) and body composition (dual-energy X-ray absorptiometry) were measured. Multiple generalized linear regression analysis was used to model the association of measures by HRR with variables of interest: adiposity, low-density lipoprotein (LDL-C) and triglyceride (TG) status (normal vs. elevated) HOMA2-IR, blood pressure status (normal vs. high), and demographics. Results: R and CI-linked respiration positively associated with adiposity, high blood pressure (HBP), and peak V ˙ O2. R and CI-linked respiration had inverse association with age and elevated LDL-C. CIIE was higher in children with elevated LDL-C (log-ß = -0.54, p = 0.010). HBP and peak V ˙ O2 interacted in relation to RCR (log-ß = -0.01, p = 0.028). Specifically, RCR was lowest among children with HBP and low aerobic capacity (i.e., mean peak V ˙ O2 -1SD). HOMA2-IR did not associate with measures of PL mitochondria respiration. Conclusion: In PL, R and CI-linked mitochondrial respiration directly associate with adiposity, peak V ˙ O2 and HBP. Elevated LDL-C associates with lower CI-linked respiration which is compensated by increasing CII respiration. PL bioenergetics phenotypes in children associate with whole-body metabolic health status.

Cardiorespiratory Fitness Associates with Blood Pressure and Metabolic Health of Children-The Arkansas Active Kids Study.

INTRODUCTION: High blood pressure (HBP) in children causes preclinical damage to the heart and accelerates atherosclerosis. Current pharmacological treatments have limited ability to prevent end-organ damage, particularly that of the kidneys. A contrasting element between adult versus pediatric HPB treatment is the emphasis in adults on exercise regimens that target increments in cardiorespiratory fitness (CRF; peak oxygen consumption [V˙O2peak]). The aim of this study was to evaluate the association of CRF with blood pressure percentiles and blood pressure status in children with normal and excessive adiposity (NA vs EA). An exploratory aim was to measure associations of CRF with (a) other cardiovascular disease risk factors commonly found in children with HBP and (b) kidney function. METHODS: Children (n = 211) attended one study visit. CRF was measured using an incremental bike test and body composition by dual-energy x-ray absorptiometry. Fat-free mass (FFM) index was calculated as kilograms of FFM per square meter. Multiple logistic and linear regression analyses were used to model the probability of HBP and other variables of interest (plasma lipids, HOMA2-IR, alanine aminotransferase, and estimated glomerular filtration rate) against V˙O2peak. RESULTS: CRF interacted with adiposity status in predicting the probability of HBP. Each additional milliliter per minute per FFM index in V˙O2peak decreased the odds of HBP by 8% in the EA group only (odds ratio = 0.92, 95% confidence interval = 0.87-0.99). Systolic and diastolic blood pressure percentiles decreased, and estimated glomerular filtration rate increased with increasing CRF in both adiposity-level groups. HOMA2-IR and alanine aminotransferase decreased with increasing CRF in children with EA only. CONCLUSIONS: Higher CRF associated with decreased probability of clinical HBP, lower insulin resistance, and improved liver function in children with EA. Yet blood pressure percentiles and kidney function improved with increasing CRF irrespective of adiposity status.

The Arkansas Active Kids Study: Identifying contributing factors to metabolic health and obesity status in prepubertal school-age children.

BACKGROUND: We report the design, protocol and statistical analysis plan for the Arkansas Active Kids (AAK) Study. The study investigates the complex relationships between factors that contribute to metabolic health and obesity status in prepubertal school-age children in the state of Arkansas. AIM: We aim to identify modifiable behavioral and environmental factors and phenotypes related to metabolic health that are associated with obesity status that, if addressed effectively, can aid in designing effective intervention strategies to improve fitness and reduce obesity in children. METHODS: We analyzed dietary and physical activity data from two national surveys (National Survey of Children's Health and Youth Risk Behavior Surveillance System). We then conducted detailed surveys to collect dietary, physical activity, socio-demographic, and environmental data from a sample of 226 prepubertal Arkansas children. In the same sample of prepubertal children, we also collected extensive physiologic data to further study associations between physical activity and metabolic health. RESULTS: All study visits included detailed measures of vital signs, energy expenditure, components of physical fitness, body composition and the collection of biological samples for determination of metabolic analytes. CONCLUSION: The observational, environmental and physiological results will be used to craft multivariate statistical models to identify which variables define 'phenotype signatures' that associate with fitness level and obesity status.

An Adaptable Pediatrics Faculty Mentoring Model.

An effective faculty mentoring program (FMP) is 1 approach that academic departments can use to promote professional fulfillment, faculty retention, and mitigate the risks of faculty burnout. Mentoring has both direct benefits for junior faculty mentees as they navigate the academic promotion process with their mentors, in addition to broader departmental and institutional benefits, with regard to recruitment, retention, and academic productivity. We describe a successful FMP model that has been adapted for use in 6 other pediatrics departments, summarizing the key personnel, mentoring process, and program evaluation methods. Important lessons learned and a generalizable mentoring "model" are provided. Program evaluation indicates a positive effect for the FMP on enhanced faculty self-efficacy, job satisfaction, and career development. The importance of communication, oversight, feedback, accountability, and valuing all faculty members is emphasized. Strategies to promote faculty engagement and the critical role of departmental leadership in prioritizing mentorship are discussed. The success of academic medical departments is inextricably linked to its commitment to the career development of individual faculty members at all levels and in all academic pathways. With our findings, we support the positive impact of a formal FMP in promoting enhanced self-efficacy and career satisfaction, which directly benefits the department and institution through enhanced productivity, retention, successful promotion, and overall professional fulfillment.

Energy Contents of Frequently Ordered Restaurant Meals and Comparison with Human Energy Requirements and U.S. Department of Agriculture Database Information: A Multisite Randomized Study.

BACKGROUND: Excess energy intake from meals consumed away from home is implicated as a major contributor to obesity, and ∼50% of US restaurants are individual or small-chain (non-chain) establishments that do not provide nutrition information. OBJECTIVE: To measure the energy content of frequently ordered meals in non-chain restaurants in three US locations, and compare with the energy content of meals from large-chain restaurants, energy requirements, and food database information. DESIGN: A multisite random-sampling protocol was used to measure the energy contents of the most frequently ordered meals from the most popular cuisines in non-chain restaurants, together with equivalent meals from large-chain restaurants. SETTING: Meals were obtained from restaurants in San Francisco, CA; Boston, MA; and Little Rock, AR, between 2011 and 2014. MAIN OUTCOME MEASURES: Meal energy content determined by bomb calorimetry. STATISTICAL ANALYSIS PERFORMED: Regional and cuisine differences were assessed using a mixed model with restaurant nested within region×cuisine as the random factor. Paired t tests were used to evaluate differences between non-chain and chain meals, human energy requirements, and food database values. RESULTS: Meals from non-chain restaurants contained 1,205±465 kcal/meal, amounts that were not significantly different from equivalent meals from large-chain restaurants (+5.1%; P=0.41). There was a significant effect of cuisine on non-chain meal energy, and three of the four most popular cuisines (American, Italian, and Chinese) had the highest mean energy (1,495 kcal/meal). Ninety-two percent of meals exceeded typical energy requirements for a single eating occasion. CONCLUSIONS: Non-chain restaurants lacking nutrition information serve amounts of energy that are typically far in excess of human energy requirements for single eating occasions, and are equivalent to amounts served by the large-chain restaurants that have previously been criticized for providing excess energy. Restaurants in general, rather than specific categories of restaurant, expose patrons to excessive portions that induce overeating through established biological mechanisms.

Accuracy of stated energy contents of restaurant foods.

CONTEXT: National recommendations for the prevention and treatment of obesity emphasize reducing energy intake. Foods purchased in restaurants provide approximately 35% of the daily energy intake in US individuals but the accuracy of the energy contents listed for these foods is unknown. OBJECTIVE: To examine the accuracy of stated energy contents of foods purchased in restaurants. DESIGN AND SETTING: A validated bomb calorimetry technique was used to measure dietary energy in food from 42 restaurants, comprising 269 total food items and 242 unique foods. The restaurants and foods were randomly selected from quick-serve and sit-down restaurants in Massachusetts, Arkansas, and Indiana between January and June 2010. MAIN OUTCOME MEASURE: The difference between restaurant-stated and laboratory-measured energy contents, which were corrected for standard metabolizable energy conversion factors. RESULTS: The absolute stated energy contents were not significantly different from the absolute measured energy contents overall (difference of 10 kcal/portion; 95% confidence interval [CI], -15 to 34 kcal/portion; P = .52); however, the stated energy contents of individual foods were variable relative to the measured energy contents. Of the 269 food items, 50 (19%) contained measured energy contents of at least 100 kcal/portion more than the stated energy contents. Of the 10% of foods with the highest excess energy in the initial sampling, 13 of 17 were available for a second sampling. In the first analysis, these foods contained average measured energy contents of 289 kcal/portion (95% CI, 186 to 392 kcal/portion) more than the stated energy contents; in the second analysis, these foods contained average measured energy contents of 258 kcal/portion (95% CI, 154 to 361 kcal/portion) more than the stated energy contents (P <.001 for each vs 0 kcal/portion difference). In addition, foods with lower stated energy contents contained higher measured energy contents than stated, while foods with higher stated energy contents contained lower measured energy contents (P <.001). CONCLUSIONS: Stated energy contents of restaurant foods were accurate overall. However, there was substantial inaccuracy for some individual foods, with understated energy contents for those with lower energy contents.

Comparison between dietary assessment methods for determining associations between nutrient intakes and bone mineral density in postmenopausal women.

It is important to identify the role of nutrition in the treatment and prevention of osteoporosis. The goal of this study was to compare the equivalency of nutrient intakes assessed by diet records and the Arizona Food Frequency Questionnaire and the associations of these nutrients with bone mineral density (BMD). This is a secondary analysis of cross-sectional data that was analyzed from six cohorts (fall 1995 to fall 1997) of postmenopausal women (n=244; 55.7+/-4.6 years) participating in a 12-month, block-randomized, clinical trial. One-year dietary intakes were assessed using 8 days of diet records and the Arizona Food Frequency Questionnaire. Participants' BMD was measured at the lumbar spine (L2-L4), femur trochanter, femur neck, Ward's triangle, and total body using dual-energy x-ray absorptiometry. Linear regression analyses (P< or =0.05) were adjusted for the effects of exercise, hormone therapy use, body weight at 1 year, years post menopause, and total energy intake. Significant correlations (r=0.30 to 0.70, P< or =0.05) between dietary assessment methods were found with all dietary intake variables. Iron and magnesium were consistently and significantly positively associated with BMD at all bone sites regardless of the dietary assessment method. Zinc, dietary calcium, phosphorous, potassium, total calcium, and fiber intakes were positively associated with BMD at three or more of the same bone sites regardless of the dietary assessment method. Protein, alcohol, caffeine, sodium, and vitamin E did not have any similar BMD associations. Diet records and the Arizona Food Frequency Questionnaire are acceptable dietary tools used to determine the associations of particular nutrients and BMD sites in healthy postmenopausal women.

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.

Validity of self-reported dietary intake at school meals by American Indian children: the Pathways Study.

OBJECTIVE: To examine the validity of a modified diet record-assisted 24-hour recall in third-grade (8 to 10 years old) American Indian children. DESIGN: The children were trained to record their food intake using diet records, and then they recalled their 24-hour food intakes, using the diet records as memory prompts, during interviews by trained staff using the Minnesota Nutrition Data System (NDS; version 2.6, 1993, Food database version 8A, Nutrient database version 23; Nutrition Coordinating Center, University of Minnesota, Minneapolis). The modified method added training in portion size estimation. Direct observation of the children's intakes during school meals was used to validate the accuracy of their self-reported recalls. SUBJECTS: Eighty third-grade children recruited from schools from four of the American Indian Nations participating in the Pathways Study. Statistical analyses performed Pearson correlations were used for nutrient level data. A mixed regression model (PROC MIXED), with no other fixed effects and site as a random effect, was used to test the null hypothesis that the difference between recalled and observed intakes was zero (H(o): beta(o)=0). Food intake data were obtained from the Nutrition Data System Record Reports. RESULTS: There were no significant differences between recalled and observed energy intakes for the school meals combined or for either meal individually. Percentages of energy intake from fat, protein, and carbohydrate from recalls were not significantly different from those observed for the combined school meals. Pearson correlations for energy and energy-providing nutrients ranged from 0.52 to 0.86 for both meals, from 0.55 to 0.86 for school lunch, and from 0.61 to 0.86 for school breakfast. Agreement between recalled and observed food items was 75%. Children recalled 57% of food quantities within +/-10% of observed quantities. CONCLUSIONS: At the group level, American Indian children were able to accurately report the macronutrient proportions of their total energy intake, and their reporting of total energy intake (+13% of criterion) compares favorably with that of other ethnic groups of children of similar age. They were able to accurately recall the majority of foods that they were independently observed consuming during school meals.

Dietary iron is associated with bone mineral density in healthy postmenopausal women.

Healthy nonsmoking postmenopausal women (n = 242; ages 40-66 y) were included in the Bone, Estrogen, and Strength Training (BEST) Study. Bone mineral density (BMD) was measured at five sites (lumbar spine L2-L4, trochanter, femur neck, Ward's triangle and total body) using dual energy X-ray absorptiometry (DXA). Mean nutrient intakes were assessed using a 3-d diet record. Regression models were calculated using each BMD site as the dependent variable and iron as the independent variable. Covariates included in the models were years past menopause, fat-free mass, fat mass, use of hormone replacement therapy, total energy intake and dietary intake of protein and calcium. Using linear models, iron was associated with greater BMD at all sites (P < or = 0.01), even after adjusting for protein and/or calcium. Increasing levels of iron intake (>20 mg) were associated with greater BMD at several bone sites among women with a mean calcium intake of 800-1200 mg/d. Elevated iron intake was not associated with greater BMD among women with higher (>1200 mg/d) or lower calcium intakes (<800 mg/d). Dietary iron may be a more important factor in bone mineralization than originally thought and, its combined effect with calcium on BMD warrants exploration in future studies.

Changes in the nutrient content of school lunches: results from the Pathways study.

BACKGROUND: Pathways, a randomized trial, evaluated the effectiveness of a school-based multicomponent intervention to reduce fatness in American-Indian schoolchildren. The goal of the Pathways food service intervention component was to reduce the fat in school lunches to no more than 30% of energy from fat while maintaining recommended levels of calories and key nutrients. METHODS: The intervention was implemented by school food service staff in intervention schools over a 3-year period. Five consecutive days of school lunch menu items were collected from 20 control and 21 intervention schools at four time periods, and nutrient content was analyzed. RESULTS: There was a significantly greater mean reduction in percent energy from fat and saturated fat in the intervention schools compared to the control schools. Mean percentages of energy from fat decreased from 33.1% at baseline to 28.3% at the end of the study in intervention schools compared to 33.2% at baseline and 32.2% at follow-up in the control schools (P<0.003). There were no statistically significant differences for calories or nutrients between intervention and control schools. CONCLUSIONS: The Pathways school food lunch intervention documented the feasibility of successfully lowering the percent of energy from fat, as part of a coordinated obesity prevention program for American-Indian children.

Impact of the Pathways food service intervention on breakfast served in American-Indian schools.

BACKGROUND: Pathways was a multisite, multicomponent obesity prevention intervention for American-Indian schoolchildren. The goal of the school breakfast and lunch component was to reduce fat content of school meals to 30% or fewer calories from fat without compromising dietary quality. METHODS: An intensive 3-year intervention was implemented with school food service staff. Five consecutive days of school breakfast menu and recipe information was collected at 20 control and 19 intervention schools at four time intervals. Data were analyzed at nutrient and (in final year) food levels. RESULTS: Average total fat decreased in intervention schools from 16.0 grams at baseline to 13.6 grams by end of study, compared with 16.6 and 16.7 grams at baseline and final measurement in control schools (P<0.030). Percentage of calories from saturated fat were also significantly reduced from 12.0 to 8.9%, compared with 12.1 to 10.6% in control schools (P<0.014). There were no significant differences in total energy or other nutrients by treatment condition across four time points. Food-level data revealed a consistent pattern of more lower-fat items served in intervention schools compared to control schools. CONCLUSIONS: Pathways was successful in achieving its overall goal of reducing dietary fat in meals served for school breakfasts.