Participants' comments on changes in the revised special supplemental nutrition program for women, infants, and children food packages: the Maryland food preference study.

The Institute of Medicine recommended changes in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages to help families from diverse populations establish more healthful dietary patterns. A cross-sectional study conducted during summer 2007 included interviews and focus groups with 223 WIC participants throughout Maryland. The objectives were to examine participants' responses to food package changes, to identify racial/ethnic differences, and to assess costs. All participants (100%) consumed fruits and vegetables. They preferred fresh for taste, but many endorsed canned and frozen for convenience and cost. Most women (56%) and children (69%) consumed whole milk and did not want reduced-fat milk. Few participants (13%) consumed soy products and most were uninterested in future consumption. Participants endorsed whole-wheat bread as more healthful and reported that they (59%) and their children (51%) would increase consumption if provided by WIC. Non-Hispanic participants preferred peanut butter over beans, Hispanic participants reported that they (44%) and their children (57%) would consume more beans (substituting for peanut butter) if provided by WIC. There were few differences in preferences between African-American and white participants. Hispanics differed from non-Hispanics in preference for beans and dislike of frozen and canned vegetables, suggesting the importance of choices. The proposed food packages were cost-neutral, except when extensive substitutions with soy products were allowed. By providing fruits and vegetables, reduced-fat options, and increased opportunities for nutrition education, the revised food packages may reduce the risk of obesity among low-income women, infants, and children.

Development and validation of a toddler silhouette scale.

The purpose of this study is to develop and validate a toddler silhouette scale. A seven-point scale was developed by an artist based on photographs of 15 toddlers (6 males, 9 females) varying in race/ethnicity and body size, and a list of phenotypic descriptions of toddlers of varying body sizes. Content validity, age-appropriateness, and gender and race/ethnicity neutrality were assessed among 180 pediatric health professionals and 129 parents of toddlers. Inter- and intrarater reliability and concurrent validity were assessed by having 138 pediatric health professionals match the silhouettes with photographs of toddlers. Assessments of content validity revealed that most health professionals (74.6%) and parents of toddlers (63.6%) ordered all seven silhouettes correctly, and interobserver agreement for weight status classification was high (kappa = 0.710, r = 0.827, P < 0.001). Most respondents reported that the scale represented toddlers aged 12-36 months (89%) and was gender (68.5%) and race/ethnicity (77.3%) neutral. The inter-rater reliability, based on matching silhouettes with photographs, was 0.787 (Cronbach's alpha) and the intrarater reliability was 0.855 (P < 0.001). The concurrent validity, based on the correlation between silhouette choice and the weight-for-length percentile of each toddler's photograph, was 0.633 (P < 0.001). In conclusion, a valid and reliable toddler silhouette scale that may be used for male or female toddlers, aged 12-36 months, of varying race/ethnicity was developed and evaluated. This scale may be used clinically or in research settings to assess parents' perception of and satisfaction with their toddler's body size. Interventions can be targeted toward parents who have inaccurate perceptions of or are dissatisfied with their toddler's body size.

Effect of varying glycemic index meals on blood glucose control assessed with continuous glucose monitoring in youth with type 1 diabetes on basal-bolus insulin regimens.

OBJECTIVE: The purpose of this study was to test the effect of high glycemic index (HGI) and low glycemic index (LGI) meals on blood glucose levels using continuous blood glucose monitoring in youths with type 1 diabetes. RESEARCH DESIGN AND METHODS: A total of 20 youths on basal-bolus regimens consumed macronutrient-matched HGI and LGI meals 1 day each in a controlled setting in varying order following consumption of a standardized evening meal. Medtronic MiniMed Continuous Glucose Monitoring Systems were used to assess blood glucose (BG) profiles. RESULTS: Participants demonstrated significantly lower daytime mean BG, BG area >180 mg/dl, and high BG index when consuming LGI meals but no differences for daytime BG area <70 mg/dl, daytime low BG index, or any nighttime values. Significantly more BG values <80 mg/dl were treated on LGI days. CONCLUSIONS: Findings indicate that consumption of an LGI diet may reduce glucose excursions, improving glycemic control.