Dietary Recommendations for Children and Adolescents

The most frequent cardiovascular risk factors in Brazilian aged 80 years or older

To identify the most frequent cardiovascular risk factors (CRFs) in Brazilian participants. Sample of 113 individuals aged 80 to 95 years (83.4 + 2.9 years), of both sexes, from Presidente Prudente, São Paulo state. Waist circumference (WC), body mass index, percentage of total body fat (% BF), hypertension, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, and glucose were used for characterization of risk factors. The chi-square test was used to assess proportions of risk factors and Student's t test to compare the results between the sexes. High prevalence of risk factor was observed, mainly hypertension (67.3%) and % BF (79.6%). Male participants presented higher weight, height, and WC (p < .001), and female participants, higher TC and % BF (p < .001). Only 7.1% of male and 4.2% of female participants showed no risk factors, and 71.3% of male and 85.9% of female participants had three or more. The participants presented a high prevalence of CRFs, particularly percentage of body fat and hypertension, and, in addition, female participants also presented TC.

Omega-3 Fatty Acids From Fish, Other Nutrient Intake, and Lifestyle Factors

The omega-3 fatty acids found mostly in seafood are essential nutrients that may help prevent or control a number of diseases; however, the evidence for this is not conclusive. The positive effects may be because of other dietary and lifestyle factors. Therefore, we investigated the association between fish intake and other nutrition indicators and lifestyle and demographic factors among children. The study employed grade-4 student data of the 2000-2004 Hawaii Nutrition Education Needs Assessment Survey. In a sample 666 children (mean age = 9.57 ± 0.06 years, 55.6% female, 62.4% Asian/Pacific Islander), analysis indicated that fish consumption is positively associated with healthy lifestyle indicators, such as physical activity and a healthy body mass index. Fish consumption is also positively associated with protein and kilocalories intake but not with fruits and vegetables consumption. Findings suggest that the positive health behaviors linked to fish consumption may lie more in physical activity than in diet behaviors. Given that fish consumption is important for children, interventions promoting fish consumption in a balanced diet with fruit and vegetable, as well as other positive lifestyle behaviors are warranted.

Fish consumption by children in Canada: Review of evidence, challenges and future goals

Fish consumption is of great importance to children's health and is essential for neurodevelopment, which begins in pregnancy and continues throughout early childhood and into adolescence. However, fish consumption presents conflicting health outcomes associated with its nutritional benefits and its adverse contaminant risks, because both avoiding fish as well as the consumption of contaminated fish can potentially harm children. This may be challenging to communicate. The present review was performed to assess the current knowledge and recommendations around 'smart' fish-consumption decisions. Health Canada advises, as well as other advisories and guides, that fish should be consumed for its health benefits, while also informing consumers, especially women and children, to limit certain fish consumption. The current literature must attempt to handle the challenges inherent in communicating the dilemmas of children's fish consumption. Incorporation of new knowledge translation strategies are proposed as a means to raise the level of knowledge about optimal fish consumption practices.

Effects of reduced juice allowances in food packages for the women, infants, and children program

OBJECTIVES

In 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) implemented revisions to the composition and quantities of WIC food packages. Juice allowances were reduced by approximately half. This report describes changes in purchases of 100% juice and other beverages among WIC participants after the WIC revisions.

METHODS

Scanner data from a New England supermarket chain were used to assess juice and other beverage purchases among 2137 WIC-participating households during a 2-year period (N = 36 051 household-months). Purchased beverage amounts were compared before (January-September 2009) and after (January-September 2010) implementation of the revised WIC packages. Generalized estimating equation models were used.

RESULTS

Before the revisions, WIC juice accounted for two-thirds of purchased juice volume among WIC households. After implementation of the revisions, WIC juice purchases were reduced on par with allowance changes (43.5% of juice volume, 95% confidence interval [CI] 41.9%-45.1%). This reduction was only partly compensated for by an increase of 13.6% (8.4%-19.0%) in juice purchases using personal and other non-WIC funds. In total, juice purchases declined by 23.5% (21.4%-25.4%) from an adjusted monthly total of 238 oz to 182 oz per household. WIC households increased purchases of fruit drinks by 20.9% (14.9%-27.3%) and other noncarbonated beverages by 21.3% (12.1%-31.2%) but purchased 12.1% (8.1%-15.0%) less soft drinks.

CONCLUSIONS

After the WIC revisions, total purchases of 100% juice among WIC households declined by about a quarter, with little compensation occurring from non-WIC funds for juice and other beverages. The public health impact of the shift in beverage purchase patterns could be significant.

Longitudinal evaluation of milk type consumed and weight status in preschoolers

OBJECTIVE

To evaluate relationships between type of milk consumed and weight status among preschool children.

DESIGN

Longitudinal cohort study.

SETTING

The Early Childhood Longitudinal Study, Birth Cohort, a representative sample of US children.

PARTICIPANTS

10 700 US children examined at age 2 and 4 years.

MAIN OUTCOME MEASURES

Body mass index (BMI) z score and overweight/obese status as a function of milk type intake.

RESULTS

The majority of children drank whole or 2% milk (87% at 2 years, 79.3% at 4 years). Across racial/ethnic and socio-economic status subgroups, 1%/skim milk drinkers had higher BMI z scores than 2%/whole milk drinkers. In multivariable analyses, increasing fat content in the type of milk consumed was inversely associated with BMI z score (p<0.0001). Compared to those drinking 2%/whole milk, 2- and 4-year-old children drinking 1%/skim milk had an increased adjusted odds of being overweight (age 2 OR 1.64, p<0.0001; age 4 OR 1.63, p<0.0001) or obese (age 2 OR 1.57, p<0.01; age 4 OR 1.64, p<0.0001). In longitudinal analysis, children drinking 1%/skim milk at both 2 and 4 years were more likely to become overweight/obese between these time points (adjusted OR 1.57, p<0.05).

CONCLUSIONS

Consumption of 1%/skim milk is more common among overweight/obese preschoolers, potentially reflecting the choice of parents to give overweight/obese children low-fat milk to drink. Nevertheless, 1%/skim milk does not appear to restrain body weight gain between 2 and 4 years of age in this age range, emphasising a need for weight-targeted recommendations with a stronger evidence base.

Childhood serum fatty acid quality is associated with adult carotid artery intima media thickness in women but not in men

Childhood nutrition may play a role in the development of cardiovascular disease risk in adulthood. We examined the links between childhood dietary fatty acid quality and adult subclinical atherosclerosis in a cohort of 374 males and 449 females, aged 3-18 y at baseline in 1980, followed for 27 y. Serum cholesterol ester fatty acid (CEFA) percentages were analyzed as markers of dietary fatty acid intake. Adulthood carotid artery intima media thickness (cIMT, μm), adjusted for childhood and adulthood lipid and nonlipid risk markers, was used as the outcome. In women, after adjustment for age and childhood nonlipid risk markers, the childhood saturated CEFA (B = 11.3; P = 0.011), monounsaturated CEFA (B = 2.5; P = 0.025), and n3 (ω3) polyunsaturated CEFA (B = 16.2; P = 0.035) percentages were directly associated with adult cIMT. In contrast, the n6 (ω6) polyunsaturated CEFA percentage was negatively associated with cIMT (B = -2.3; P = 0.008). Similar relationships were observed between childhood dietary intake data and adult cIMT. In men, these associations were generally weak and nonsignificant (P > 0.05) after controlling for confounders. These longitudinal data suggest that fat quality as reflected in the serum cholesterol ester fraction in childhood is associated with adult cIMT in women.

Is overweight at 12 months associated with differences in eating behaviour or dietary intake among children selected for inappropriate bottle use?

Bottle feeding beyond the recommended weaning age of 12 months is a risk factor for childhood obesity. This paper describes a sample of toddlers at high risk for obesity: prolonged bottle users from a low-income multi-ethnic community. We report here baseline mealtime and feeding behaviour, 24 h dietary recall and bottle intake data for Feeding Young Children Study (FYCS) participants, by overweight (≥85% weight-for-length) status. FYCS enrolled 12-13-month-olds from urban nutrition programmes for low-income families in the United States who were consuming ≥2 bottles per day. Our sample was predominately Hispanic (62%), 44% of mothers were born outside of the United States and 48% were male. Overall, 35% were overweight. Overweight status was not associated with mealtime/feeding behaviours, bottle use or dietary intake. Most (90%) children ate enough, were easily satisfied and did not exhibit negative (e.g. crying, screaming) mealtime behaviours, per parent report. The sample's median consumption of 4 bottles per day accounted for 50% of their total calories; each bottle averaged 7 ounces and contained 120 calories. Mean daily energy intake, 1098.3 kcal day(-1) (standard deviation = 346.1), did not differ by weight status, nor did intake of fat, saturated fat, protein or carbohydrates. Whole milk intake, primarily consumed via bottles, did not differ by weight status. Thus, overweight 12-13-month-olds in FYCS were remarkably similar to their non-overweight peers in terms of several obesity risk factors. Findings lend support to the set-point theory and prior work finding that weight and intake patterns in the first year of life alter subsequent obesity risk.

Focus on prevention, diagnosis and treatment of hypertension in children and adolescents

The European Society of Hypertension has recently published its recommendations on prevention, diagnosis and treatment of high blood pressure in children and adolescents. Taking this contribution as a starting point the Study Group of Hypertension of the Italian Society of Pediatrics together with the Italian Society of Hypertension has conducted a reappraisal of the most recent literature on this subject. The present review does not claim to be an exhaustive description of hypertension in the pediatric population but intends to provide Pediatricians with practical and updated indications in order to guide them in this often unappreciated problem.

This document pays particular attention to the primary hypertension which represents a growing problem in children and adolescents. Subjects at elevated risk of hypertension are those overweight, with low birth weight and presenting a family history of hypertension. However, also children who do not present these risk factors may have elevated blood pressure levels. In pediatric age diagnosis of hypertension or high normal blood pressure is made with repeated office blood pressure measurements that show values exceeding the reference values. Blood pressure should be monitored at least once a year with adequate methods and instrumentation and the observed values have to be interpreted according to the most updated nomograms that are adjusted for children’s gender, age and height. Currently other available methods such as ambulatory blood pressure monitoring and home blood pressure measurement are not yet adequately validated for use as diagnostic instruments. To diagnose primary hypertension it is necessary to exclude secondary forms. The probability of facing a secondary form of hypertension is inversely proportional to the child’s age and directly proportional to blood pressure levels. Medical history, clinical data and blood tests may guide the differential diagnosis of primary versus secondary forms. The prevention of high blood pressure is based on correct lifestyle and nutrition, starting from childhood age. The treatment of primary hypertension in children is almost exclusively dietary/behavioral and includes: a) reduction of overweight whenever present b) reduction of dietary sodium intake c) increase in physical activity. Pharmacological therapy will be needed rarely and only in specific cases.

Associations of food stamp participation with dietary quality and obesity in children

OBJECTIVE

To determine if obesity and dietary quality in low-income children differed by participation in the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program.

METHODS

The study population included 5193 children aged 4 to 19 with household incomes ≤130% of the federal poverty level from the 1999-2008 NHANES. Diet was measured by using 24-hour recalls.

RESULTS

Among low-income US children, 28% resided in households currently receiving SNAP benefits. After adjusting for sociodemographic differences, SNAP participation was not associated with a higher rate of childhood obesity (odds ratio = 1.11, 95% confidence interval [CI]: 0.71-1.74). Both SNAP participants and low-income nonparticipants were below national recommendations for whole grains, fruits, vegetables, fish, and potassium, while exceeding recommended limits for processed meat, sugar-sweetened beverages, saturated fat, and sodium. Zero percent of low-income children met at least 7 of 10 dietary recommendations. After multivariate adjustment, compared with nonparticipants, SNAP participants consumed 43% more sugar-sweetened beverages (95% CI: 8%-89%), 47% more high-fat dairy (95% CI: 7%, 101%), and 44% more processed meats (95% CI: 9%-91%), but 19% fewer nuts, seeds, and legumes (95% CI: -35% to 0%). In part due to these differences, intakes of calcium, iron, and folate were significantly higher among SNAP participants. Significant differences by SNAP participation were not evident in total energy, macronutrients, Healthy Eating Index 2005 scores, or Alternate Healthy Eating Index scores.

CONCLUSIONS

The diets of low-income children are far from meeting national dietary recommendations. Policy changes should be considered to restructure SNAP to improve children's health.

Does childhood nutrition influence adult cardiovascular disease risk?--insights from the Young Finns Study

There is a paucity of detailed information about the role of childhood food patterns or on the impact of individual nutrients on adulthood cardiovascular disease (CVD). We review here the reports that have investigated these questions in the Young Finns Study with its 3596 subjects at baseline, aged 3 to 18 years. All the participants filled in a food habit questionnaire, and half of them provided a 48-hour dietary recall interview. In adulthood, cardiovascular risk factors as well as structural and functional markers of subclinical atherosclerosis were measured, i.e. carotid artery intima media thickness (IMT), and measurements of arterial elasticity and brachial artery endothelial function. Our data demonstrate that dietary patterns can already be identified in childhood. These patterns remain relatively stable over the life-course and associate with cardiovascular risk factors and vascular markers of subclinical atherosclerosis. For example, a traditional dietary pattern characterized by low intakes of fruits and vegetables was associated with elevated increased adulthood IMT especially in men, whereas a diet with a high intake of vegetables was independently associated with increased arterial elasticity in both genders. Our findings and the current literature suggest that childhood nutrition has a significant role in the progression of CVD.

The current state of dyslipidemia in Korean children and adolescents and its management in clinical practice

Cardiovascular disease (CVD) is a leading cause of death worldwide including Korea. The risk factors of CVD are known as positive family history of early CVD, obesity, hypertension, diabetes, and dyslipidemia. Among those, dyslipidemia is one of modifiable risk factors. Dyslipidemia starts in childhood and progress to adulthood. Furthermore, dyslipidemia cause atherosclerosis and is closely related to other CVD risks. On the rationale that early identification and control of pediatric dyslipidemia will reduce the risk and severity of CVD in adulthood, the National Heart, Lung, and Blood Institute guidelines expanded to universal screening for lipid levels. However, there was no guideline for lipid screening and management in Korean children and adolescents yet. This review deals with the rationale of early identification and control of pediatric dyslipidemia along with the current Korean status of pediatric dyslipidemia. This review also deals with how to screen, diagnosis, and treatment of pediatric dyslipidemia.

Whole grain intakes in the diets of Irish children and teenagers

A growing body of evidence supports the inclusion of whole grain foods in the diet to help prevent certain chronic diseases. Although much of the research has been conducted in adult cohorts, it is thought that younger populations may also benefit from whole-grain-rich diets. The aim of the present study was to quantify the intake of whole grain in Irish children and teenagers, and assess the major sources of intake. Data used in the present study were from the National Children's Food Survey and the National Teens' Food Survey, which used 7 d food diaries to collect data on habitual food and beverage consumption in representative samples of Irish children and teenagers. Results showed that over 90 % of children (5–12 years) and over 86 % of teenagers (13–17 years) are consumers of whole grain, with mean daily intakes of 18·5 and 23·2 g/d, respectively. Ready-to-eat breakfast cereals made the greatest contribution to whole grain intakes for both children and teenagers (59·3 and 44·3 %), followed by bread (14·4 and 26·5 %), with wheat being the major source of intake, accounting for over 65 % of all whole grains consumed. Whole grain consumers had significantly higher intakes of fibre, P and Mg in comparison with non-consumers of whole grain, even though whole grain intakes in this sample were well below the recommendation of three servings or 48 g/d. The present study characterises, for the first time, the patterns of whole grain consumption in Irish children and teenagers and shows whole grain intake to be low.

National trends in beverage consumption in children from birth to 5 years: analysis of NHANES across three decades

Background

Given the epidemic of childhood obesity, it is crucial to assess food and beverage intake trends. Beverages can provide a large number of calories and since consumption patterns seem to develop at a young age we examined beverage consumption trends over three decades. The objective of this study was to assess the beverage (milk, fruit juice, fruit drinks, tea, soy beverages, and soft drinks) consumption trends in children <1-5 years of age.

Methods

Data from individuals ages <1-5 years participating in the National Health and Nutrition Examination Survey (NHANES) from 1976–1980, 1988–1994 and 2001–2006 were used to assess beverage consumption and associated calorie and nutrient intakes.

Results

During the NHANES 1976–1980 and 1988–1994 periods, approximately 84–85% of children were consuming milk, whereas only 77% were consuming milk during NHANES 2001–2006. Flavored milk intake was relatively low, but increased to 14% during the last decade (p < 0.001). Fruit juice consumption increased dramatically during NHANES 2001–2006 to more than 50% of the population compared to about 30% in the older surveys (p < 0.001). No significant changes were observed in fruit drink intake across all three decades with 35-37% of this population consuming fruit drinks. At least 30% of children consumed soft drinks. Milk was the largest beverage calorie contributor in all three decades surveyed and was the primary contributor of calcium (52-62%), phosphorus (37-42%), magnesium (27-28%), and potassium (32-37%). Fruit juice and fruit drinks each provided 8-10% of calories with soft drinks providing 5-6% of calories. Fruit juice was an important provider of potassium (16-19%) and magnesium (11%). Fruit drinks provided less than 5% of nutrients examined and soft drinks provided very little of the nutrients evaluated.

Conclusions

Given concerns about childhood obesity and the need to meet nutrition requirements, it is prudent that parents, educators and child caretakers replace some of the nutrient poor beverages young children are currently consuming with more nutrient dense sources like low-fat and fat-free milk.

A qualitative study of interviewer-administered physical activity recalls by children

BACKGROUND

Qualitative methods were used to better understand how to obtain interviewer-administered recalls of physical activity from children.

METHODS

Subjects were 24 third- and fifth-grade children from 1 school in Columbia, South Carolina. Cognitive interviews targeted different retention intervals (about the same or previous school day). Round 1's protocols used an open format and had 4 phases (obtain free recall, review free recall, obtain details, review details). Round 2's protocols used a chronological format and had 3 phases (obtain free recall, obtain details, review details). Trained coders identified discrepancies across interview phases in children's recalls of physical activity at physical education (PE) and recess. Based on the school's schedule, children's reports of PE and recess were classified as omissions (scheduled but unreported) or intrusions (unscheduled but reported).

RESULTS

Across interview phases, there were numerous discrepancies for Round 1 (regardless of grade, sex, or retention interval) but few discrepancies for Round 2. For Rounds 1 and 2, respectively, 0% and 0% of children omitted PE, while 33% and 0% intruded PE; 44% and 56% of children omitted recess, while 33% and 0% intruded recess.

CONCLUSIONS

Results provide important information for facilitating interviewer-administered recalls of physical activity with elementary-age children.

Reducing childhood obesity by eliminating 100% fruit juice

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.

Is the obesity epidemic worsening the cardiovascular risk factor profile of children? Evidence from two Québec samples measured 10 years apart

BACKGROUND

The impact of the obesity epidemic on cardiovascular health in young people is of increasing concern. However, data on secular trends in CVD indicators are outdated and mixed.

METHODS

This study compared lipid profiles and insulin of 9-10 year olds in 2008 (n = 605) and 1999 (n = 779). Data were drawn from two population-based samples of youth: the 1999 Québec Child and Adolescent Health and Social Survey and the 2008 Québec Longitudinal Study of Child Development.

RESULTS

Mean body mass index (BMI) Z-scores were higher in 2008 than in 1999 in both boys (0.37 vs 0.12, p = 0.004) and girls (0.32 vs 0.05, p = 0.0004). After adjusting for maturity stage, height, BMI Z-score, age and household income, high-density lipoprotein cholesterol was 0.12 mmol/L (p < 0.05) and 0.10 mmol/L (p < 0.05) higher in 2008 than 1999 in boys and girls, respectively. Total cholesterol, low density lipoprotein cholesterol and insulin were not significantly different between 2008 and 1999.

CONCLUSIONS

Despite higher BMI Z-scores in 2008, differences in cardiometabolic indicators between 1999 and 2008 were small and may not be clinically meaningful. Surveillance to closely monitor trends in cardiometabolic indicators in Canadian youth is needed.

Fluid Balance and Dehydration in the Young Athlete

Many young athletes train and compete under conditions that put their body fluid balance at risk, and hypohydration is usually the major concern. Another less frequent condition is hyperhydration that—if accompanied by other risk factors—may cause hyponatremia. Water and electrolyte losses during physical activities occur primarily from sweat. Such losses have been identified mostly in active (but nonathletic) young populations under laboratory settings. Studies have been trying to estimate fluid losses in the athletic population under field conditions, taking into account the sport modality and environmental conditions. Besides these external conditions, young athletes adopt different drinking attitudes, which may depend on knowledge, education, and the opportunities to drink during the break periods as well as fluid availability. Focusing on the young athlete, this review will discuss water and sodium losses from sweat, the effects of hypohydration on performance, and fluid intake attitudes within and during practices and competitions. Some considerations related to the methods of identifying hydration status and guidelines are also given, with the understanding that they should be individually adapted for the athlete and activity. The young athlete, parents, coaches, and athletic/health professionals should be aware of such information to prevent fluid imbalances and the consequent hazardous effects on performance and health.

Neck circumference: a useful screening tool of cardiovascular risk in children

OBJECTIVE

Early identification of cardiovascular risk factors consists an essential target for public health. The current study aims to examine the association between neck circumference and several cardiovascular risk factors and to compare it with well-established anthropometric indices.

METHODS

Demographic, anthropometric (body weight and height, waist, hip and neck circumference [WC, HC and NC, respectively]), biochemical (total cholesterol, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, triglycerides [TG], fasting plasma glucose and serum insulin), clinical (pubertal stage, systolic and diastolic blood pressure [SBP and DBP, respectively]) and lifestyle (dietary intake, physical activity level) data were collected from 324 children (51.5% boys; 48.5% girls) aged 9-13 in Greece. Body mass index z-score (BMI z-score), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), homeostasis model assessment (HOMA-IR), quantitative insulin sensitivity check index (QUICKI) and fasting glucose to insulin ratio (FGIR) were calculated.

RESULTS

All indices (BMI z-score, NC, WC, HC, WHR and WHtR) were correlated with SBP, HDL and insulin-related indices (insulin, HOMA-IR, QUICKI and FGIR) and all indices except WHR with TG. LDL was correlated with BMI z-score, WC, WHR and WHtR, whereas DBP was correlated with BMI z-score, WC, HC and WHtR. In multivariate analysis, HDL, TG, SBP, insulin, HOMA-IR, QUICKI and FGIR were associated with all anthropometric indices; DBP with WC, HC, NC and WHtR; LDL with BMI z-score, WC, HC and WHtR.

CONCLUSIONS

NC is associated with most cardiovascular disease risk factors. These associations are comparable with those observed for BMI z-score, WC, HC, WHR and WHtR. NC could be a simple, alternative screening tool of cardiovascular risk in children.

The proof is in the pudding: children prefer lower fat but higher sugar than do mothers

OBJECTIVE

Although there are established age-related differences in sweet preferences, it remains unknown whether children differ from mothers in their preference for and perception of fat (creaminess). We examined whether individual differences in sucrose and fat preferences and perception are related to age, genotype and lifestyle.

SUBJECTS

Children 5-10 years-old (n=84) and their mothers (n=67) chose the concentration of sucrose and fat most preferred in pudding and sucrose most preferred in water using identical, two-alternative, forced-choice procedures, and ranked pudding samples for intensity of sweetness and creaminess. Subjects were also weighed and measured for height, as well as genotyped for a sweet-receptor gene (TAS1R3).

RESULTS

Children preferred higher concentrations of sucrose in water (P=0.03) and in pudding (P=0.05) and lower concentrations of fat in pudding (P<0.01) than did mothers. Children and mothers were equally able to rank the intensity of different concentrations of fat (P=0.12) but not sucrose in pudding (P=0.01). Obese and lean children and mothers did not differ in preferences, but obese mothers were less able to correctly rank the concentration of fat in pudding than were lean mothers (P=0.03). Mothers who smoked preferred a higher concentration of sucrose than did those who never smoked (P<0.01). Individual differences in sweet preference were associated with genetic variation within the TAS1R3 gene in mothers but not children (P=0.04).

CONCLUSION

Irrespective of genotype, children prefer higher concentrations of sugar but lower concentrations of fat in puddings than do their mothers. Thus, reduced-fat foods may be better accepted by children than adults.

Association between different growth curve definitions of overweight and obesity and cardiometabolic risk in children

BACKGROUND

Overweight and obesity in young people are assessed by comparing body mass index (BMI) with a reference population. However, two widely used reference standards, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) growth curves, have different definitions of overweight and obesity, thus affecting estimates of prevalence. We compared the associations between overweight and obesity as defined by each of these curves and the presence of cardiometabolic risk factors.

METHODS

We obtained data from a population-representative study involving 2466 boys and girls aged 9, 13 and 16 years in Quebec, Canada. We calculated BMI percentiles using the CDC and WHO growth curves and compared their abilities to detect unfavourable levels of fasting lipids, glucose and insulin, and systolic and diastolic blood pressure using receiver operating characteristic curves, sensitivity, specificity and kappa coefficients.

RESULTS

The z scores for BMI using the WHO growth curves were higher than those using the CDC growth curves (0.35-0.43 v. 0.12-0.28, p < 0.001 for all comparisons). The WHO and CDC growth curves generated virtually identical receiver operating characteristic curves for individual or combined cardiometabolic risk factors. The definitions of overweight and obesity had low sensitivities but adequate specificities for cardiometabolic risk. Obesity as defined by the WHO or CDC growth curves discriminated cardiometabolic risk similarly, but overweight as defined by the WHO curves had marginally higher sensitivities (by 0.6%-8.6%) and lower specificities (by 2.6%-4.2%) than the CDC curves.

INTERPRETATION

The WHO growth curves show no significant discriminatory advantage over the CDC growth curves in detecting cardiometabolic abnormalities in children aged 9-16 years.

Dietary patterns and metabolic syndrome risk factors among adolescents

PURPOSE

Unbalanced diets and decreased physical activity have contributed to increased prevalence of obesity and metabolic syndrome in adolescents. We have performed a systematic review and data analysis to examine the association between dietary pattern and metabolic syndrome risk factors in adolescents.

METHODS

We searched the PubMed and BioMedLib databases for appropriate articles published during the past 10 years and selected 6 articles. The studies reviewed applied factor analysis or cluster analysis to extract dietary patterns. For data analysis, we examined the association between dietary patterns and the prevalence of metabolic syndrome risk factors using data of 3,168 adolescents (13 to 18 years) obtained from 4 consecutive Korean Nutrition Health and Nutrition Examination Surveys (1998, 2001, 2005, and 2007 to 2009).

RESULTS

Our systematic review confirmed that western dietary patterns are positively associated with metabolic syndrome risk factors such as obesity and elevated triglycerides, while traditional dietary patterns were negatively associated. Data analysis found that the number of adolescents aged 16 to 18 years who had "Rice & Kimchi" dietary pattern decreased, while the number having western dietary patterns increased during the 1998 to 2009 time frame. There were no changes in the dietary patterns in adolescents aged 13 to 15 years. The risk of elevated serum triglycerides and reduced serum high density lipoprotein cholesterol was high in the "Rice & Kimchi" dietary pattern compared to the other dietary pattern groups.

CONCLUSION

Because adolescents' dietary patterns are changing continuously and have long-term effects, further studies on the dietary patterns of adolescents and their health effects into adulthood are necessary.

Complementary foods and flavor experiences: setting the foundation

Increased fruit and vegetable consumption early in life may lead to life-long intake of fruits and vegetables, which in turn may be beneficial for weight control and other health outcomes in later life. Although health officials worldwide recommend delaying solid foods until 6 months of age, younger infants often receive solid food, which may affect later obesity rates. The timing of introduction to solid foods is important both nutritionally and developmentally and may affect acceptance of foods both in infancy and later in life. Infants can clearly discriminate the flavors of different fruits and vegetables. Repeated flavor experiences promote the willingness to eat a variety of foods: infants will consume more of foods that have a familiar flavor and are more accepting of novel flavors if they have experience with flavor variety. Many flavors that the mother either ingests or inhales are transmitted to her milk and/or amniotic fluid. Mothers can help the transition from a diet exclusively of milk or formula to a mixed diet by providing the infant familiar flavors in both milk or formula and solid foods. Exposure to a variety of flavors during and between meals appears to facilitate acceptance of novel foods. Providing novelty in the context of a familiar food might prove to be an optimal combination to progressively accustom infants to a diversity of novel foods. When repeatedly exposing infants to flavors of some vegetables that have bitter tastes, mothers should focus not on infants' facial expressions but on their willingness to eat the food and should continue to provide repeated opportunities to taste the food. Introducing children repeatedly to individual as well as a variety of fruits and vegetables, both within and between meals, might help them be more accepting of fruits and vegetables, which is difficult to enhance beyond toddlerhood.

Is there an association between socioeconomic status and body mass index among adolescents in Mauritius?

There are no documented studies on socioeconomic status (SES) and body mass index (BMI) among Mauritian adolescents. This study aimed to determine the relationships between SES and BMI among adolescents with focus on diet quality and physical activity (PA) as mediating factors. Mauritian school adolescents (n = 200; 96 males, 104 females) were recruited using multistage sampling. Participants completed a self-reported questionnaire. Height and weight were measured and used to calculate BMI (categorised into underweight, healthy-weight, overweight, obese). Chi-square test, Pearson correlation, and Independent samples t-test were used for statistical analysis. A negative association was found between SES and BMI (χ(2) = 8.15%, P < 0.05). Diet quality, time spent in PA at school (P = 0.000), but not total PA (P = 0.562), were significantly associated with high SES. Poor diet quality and less time spent in PA at school could explain BMI discrepancies between SES groups.

Effect of phytochemicals on phase II enzyme expression in infant human primary skin fibroblast cells

Phase II metabolising enzymes enable the metabolism and excretion of potentially harmful substances in adults, but to date it is unclear whether dietary phytochemicals can induce phase II enzymes differently between adults and infants. We investigated the expression of phase II enzymes in an in vitro model of primary skin fibroblasts at three different developmental stages, 1 month, 2 years and adult, to examine potential differences in age-related phase II enzymes in response to different phytochemicals (5-20 μm) including sulphoraphane, quercetin and catechin. Following phytochemical treatment, a significant increase in mRNA of glutathione S-transferase A1 (GSTA1) and NAD(P)H:quinone oxidoreductase 1 (NQO1) was observed, with the most marked increases seen in response to sulphoraphane (3-10-fold for GSTA1, P = 0·001, and 6-35-fold for NQO1, P = 0·001-0·017). Catechin also induced 3-5-fold changes in NQO1 transcription, whereas quercetin had less effect on NQO1 mRNA induction in infant cells. Moreover, NQO1 protein levels were significantly increased in 2-year-old and adult cell models in response to sulphoraphane treatment. These results suggest that metabolic plasticity and response to xenobiotics may be different in infants and adults; and therefore the inclusion of phytochemicals in the infant diet may modulate their induction of phase II metabolism, thereby providing increased protection from potentially harmful xenobiotics in later life.

Evaluating Parents and Adult Caregivers as “Agents of Change” for Treating Obese Children: Evidence for Parent Behavior Change Strategies and Research Gaps

This scientific statement addresses parents and adult caregivers (PACs) as “agents of change” for obese children, evaluating the strength of evidence that particular parenting strategies can leverage behavior change and reduce positive energy balance in obese youth. The statement has 3 specific aims. The first is to review core behavior change strategies for PACs as used in family-based treatment programs and to provide a resource list. The second is to evaluate the strength of evidence that greater parental “involvement” in treatment is associated with better reductions in child overweight. The third is to identify research gaps and new opportunities for the field. This review yielded limited and inconsistent evidence from randomized controlled clinical trials that greater PAC involvement necessarily is associated with better child outcomes. For example, only 17% of the intervention studies reported differential improvements in child overweight as a function of parental involvement in treatment. On the other hand, greater parental adherence with core behavior change strategies predicted better child weight outcomes after 2 and 5 years in some studies. Thus, the literature lacks conclusive evidence that one particular parenting strategy or approach causally is superior to others in which children have a greater focus in treatment. A number of research gaps were identified, including the assessment of refined parenting phenotypes, cultural tailoring of interventions, examination of family relationships, and incorporation of new technologies. A conceptual model is proposed to stimulate research identifying the determinants of PAC feeding and physical activity parenting practices, the results of which may inform new treatments. The statement addresses the need for innovative research to advance the scope and potency of PAC treatments for childhood obesity.

Predictors of obesity in childhood, adolescence, and adulthood in a birth cohort

To determine how characteristics of pregnancy, birth, and early infancy are related to offspring obesity at three critical developmental periods. Mothers were followed through pregnancy and 10-15 years after. Offspring data were obtained through medical record review. Maternal and offspring characteristics were examined to predict obesity in childhood (ages 4-5 years), adolescence (ages 9-14 years), and early adulthood (ages 19-20 years). The original cohort included 802 children born to 795 women. Children who were twins, who had died, or whose mothers had died were excluded (n=25). Medical records of 68.5% of the remaining 777 children documented a height and weight at childhood, adolescence, or early adulthood. Relative risks (RRs) to predict obesity at early adulthood were 12.3 for childhood and 45.1 at adolescence. RRs were also significant to predict obesity at early adulthood between the mother's obesity at prepregnancy (RR=6.4), 4-5 years postpregnancy (RR=6.3), and 10-15 years postpregnancy (RR=6.2). Excluding these variables from the multivariate models and adjusting by gender, birth insurance, and mother's marital status at delivery, the best model to predict obesity at childhood included birth weight, weight gain in infancy, and delivery type. At adolescence, it included maternal pregnancy smoking status, gestational weight gain, and weight gain in infancy, and in early adulthood, included maternal pregnancy smoking status, gestational weight gain, and birth weight. Maternal pregnancy smoking status, gestational weight gain, and weight gain in infancy have long-term effects on offspring. Maternal obesity is the strongest predictor of obesity at all times studied.

Methods and baseline characteristics of a randomized trial treating early childhood obesity: the Positive Lifestyles for Active Youngsters (Team PLAY) trial

There are few effective obesity interventions directed towards younger children, particularly young minority children. This paper describes the design, intervention, recruitment methods, and baseline data of the ongoing Positive Lifestyles for Active Youngsters (Team PLAY) study. This randomized controlled trial is designed to test the efficacy of a 6-month, moderately intense, primary care feasible, family-based behavioral intervention, targeting both young children and their parent, in promoting healthy weight change. Participants are 270 overweight and obese children (ages 4 to 7 years) and their parents, who were recruited from a primarily African American urban population. Parents and children were instructed in proven cognitive behavioral techniques (e.g. goal setting, self-talk, stimulus control and reinforcement) designed to encourage healthier food choices (more whole grains, fruits and vegetables, and less concentrated fats and sugar), reduce portion sizes, decrease sweetened beverages and increase moderate to vigorous physical activity engagement. The main outcome of this study is change in BMI at two year post enrollment. Recruitment using reactive methods (mailings, TV ads, pamphlets) was found to be more successful than using only a proactive approach (referral through physicians). At baseline, most children were very obese with an average BMI z-score of 2.6. Reported intake of fruits and vegetables and minutes of moderate to vigorous physical activity engagement did not meet national recommendations. If efficacious, Team PLAY would offer a model for obesity treatment directed at families with young children that could be tested and translated to both community and primary care settings.

Obesity in preschoolers: behavioral correlates and directions for treatment

Nearly 14% of American preschoolers (ages 2-5) are obese (BMI ≥ 95th percentile for age and gender), yet this group has received little attention in the obesity intervention literature. This review examines what is known about behavioral correlates of obesity in preschoolers and the developmental context for lifestyle modification in this age group. Information was used to critically evaluate existing weight management prevention and intervention programs for preschoolers and formulate suggestions for future intervention research development. A systematic search of the medical and psychological/behavioral literatures was conducted with no date restrictions, using PubMed, PsycInfo, and MEDLINE electronic databases and bibliographies of relevant manuscripts. Evidence suggests several modifiable behaviors, such as sugar sweetened beverage intake, television use, and inadequate sleep, may differentiate obese and healthy weight preschoolers. Developmental barriers, such as food neophobia, food preferences, and tantrums challenge caregiver efforts to modify preschoolers' diet and activity and parental feeding approaches, and family routines appear related to the negative eating and activity patterns observed in obese preschoolers. Prevention programs yield modest success in slowing weight gain, but their effect on already obese preschoolers is unclear. Multi-component, family-based, behavioral interventions show initial promise in positive weight management for already obese preschoolers. Given that obesity intervention research for preschoolers is in its infancy, and the multitude of modifiable behavioral correlates for obesity in this age group, we discuss the use of an innovative and efficient research paradigm (Multiphase Optimization Strategy; MOST) to develop an optimized intervention that includes only treatment components that are found to empirically reduce obesity in preschoolers.

Self-reported academic grades and other correlates of sugar-sweetened soda intake among US adolescents

High consumption of sugar-sweetened drinks has been associated with obesity and other adverse health consequences. This cross-sectional study examined the association of demographic characteristics, weight status, self-reported academic grades, and behavioral factors with sugar-sweetened soda intake among a nationally representative sample of US high school students. Analysis was based on the 2009 national Youth Risk Behavior Survey and included 16,188 students in grades 9 through 12. The main outcome measure was daily sugar-sweetened soda intake (eg, drank a can, bottle, or glass of soda [excluding diet soda] at least one time per day during the 7 days before the survey). Nationally, 29.2% of students reported drinking sugar-sweetened soda at least one time per day. Logistic regression analyses showed factors significantly associated with sugar-sweetened soda intake at least one time per day included male sex (adjusted odds ratio [OR]=1.47), Hispanic ethnicity (vs whites; OR=0.81), earning mostly B, C, and D/F grades (vs mostly As; OR=1.26, 1.66, and 2.19, respectively), eating vegetables fewer than three times per day (OR=0.72), trying to lose weight (OR=0.72), sleeping <8 hours (OR=1.18), watching television >2 hours/day (OR=1.71), playing video or computer games or using a computer for other than school work >2 hours/day (OR=1.53), being physically active at least 60 minutes/day on <5 days during the 7 days before the survey (OR=1.19), and current cigarette use (OR=2.01). The significant associations with poor self-reported academic grades, inadequate sleep, sedentary behaviors, and cigarette smoking suggest research should examine why soda consumption is associated with these behaviors to inform the design of future nutrition interventions.

Sugar-sweetened and diet beverage consumption is associated with cardiovascular risk factor profile in youth with type 1 diabetes

The prevalence of cardiovascular disease (CVD) risk factors among youth with type 1 diabetes is high and associated with age, gender, and race/ethnicity. It has also been shown that youth with type 1 diabetes often do not follow dietary recommendations. The objective of this cross-sectional observational study was to explore the association of sugar-sweetened and diet beverage intake with A1c, plasma lipids, adiponectin, leptin, systolic, and diastolic blood pressure in youth with type 1 diabetes. We examined data from 1,806 youth age 10-22 years with type 1 diabetes, of which 22% were minority (10% Hispanic, 8% African Americans, 4% other races) and 48% were female. Sugar-sweetened beverage, diet beverage, and mineral water intake was assessed with a food frequency questionnaire. After adjustment for socio-demographic and clinical covariates, physical activity and total energy intake, high sugar-sweetened beverage intake (at least one serving per day vs. none), was associated with higher levels of total cholesterol, LDL cholesterol, and plasma triglycerides, but not with A1c. High diet beverage intake was associated with higher A1c, total cholesterol, LDL cholesterol, and triglycerides. These associations were partially confounded by body mass index, saturated fat and total fiber intake. High sugar-sweetened beverage intake may have an adverse effect on CVD risk in youth with type 1 diabetes. Diet beverage intake may be a marker of unhealthy lifestyle which, in turn, is associated with worse metabolic control and CVD risk profile in these youth. Youth with diabetes should be encouraged to minimize sugar-sweetened beverage intake.

Vitamin D deficiency, adiposity, and cardiometabolic risk in urban schoolchildren

OBJECTIVE

To determine the relationship between serum vitamin D levels and cardiometabolic risk factors independent of adiposity in urban schoolchildren.

STUDY DESIGN

We assessed the relationships among serum 25-hydroxyvitamin D [25(OH)D], adiposity measured by body mass index (BMI) z-score (BMIz), and 6 cardiometabolic risk factors (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, interleukin-6, and C-reactive protein [CRP]) in a cross-sectional sample of 263 racially and ethnically diverse schoolchildren from the Boston area during late winter. Multivariate regression analyses adjusting for sociodemographic characteristics and BMIz examined associations of 25(OH)D and cardiometabolic risk factors.

RESULTS

Overall, 74.6% of the children were vitamin D deficient [25(OH)D <50 nmol/L; mean, 41.8 ± 13.7 nmol/L]; 45% were overweight or obese (20% and 25%, respectively; BMIz = 0.75 ± 1.1). The 25(OH)D level was not associated with BMIz, but was positively associated with the cardiometabolic risk factor CRP (β = 0.03; P < .05). BMIz was associated with elevated triglycerides (β = 0.13), CRP (β = 0.58), and interleukin-6 (β= 0.14) and low high-density lipoprotein cholesterol (β = -0.09; all P < .01).

CONCLUSIONS

Vitamin D deficiency is highly prevalent during the late winter months in urban schoolchildren living in the northeastern United States. This widespread deficiency may contribute to the lack of associations between 25(OH)D and both BMIz and cardiometabolic risk factors. The association between 25(OH)D and CRP warrants further study.

Health behaviors and weight status of childhood cancer survivors and their parents: similarities and opportunities for joint interventions

Childhood cancer survivors are at increased risk for chronic health conditions that may be influenced by their cancer treatment and unhealthy lifestyle behaviors. Despite the possibility that interventions targeting the survivor-parent dyad may hold promise for this population, a clearer understanding of the role of family factors and the lifestyle behaviors of both survivors and parents is needed. A mailed cross-sectional survey was conducted in 2009 to assess weight status (body mass index), lifestyle behaviors (eg, diet, physical activity), and the quality of the parent-child relationship among 170 childhood cancer survivors who were treated at MD Anderson Cancer Center and 114 of their parents (80% mothers). Survivors were more physically active and consumed more fruits and vegetables than their parents. However, fewer than half of survivors or parents met national guidelines for diet and physical activity, and their weight status and fat intakes were moderately correlated (r=.30-.57; P<0.001). Multilevel models showed that, compared with survivors with better than average relationships, those with poorer than average relationships with their parents were significantly more likely to consume high-fat diets (P<0.05). Survivors and their parents may thus benefit from interventions that address common lifestyle behaviors, as well as issues in the family environment that may contribute to an unhealthy lifestyle.

Beverage patterns and trends among school-aged children in the US, 1989-2008

BACKGROUND

High intake of sugar-sweetened beverages in childhood is linked to increased risk of obesity and type II diabetes later in life. Using three nationally representative surveys of dietary intake, we investigated beverage patterns and trends among US school-aged children from 1989/91 to 2007/08.

METHODS

3, 583 participants ages 6-11 y old were included. We reported per capita trends in beverage consumption, percent consuming, and amount per consumer for the following categories of beverages: sugar-sweetened beverages (SSB), caloric nutritional beverages (CNB) and low calorie beverages (LCB). Statistically significant differences were tested using the Student's t test in Stata 11.

RESULTS

While per capita kcal contribution from total beverages remained constant over the study period, per capita consumption of SSBs increased and CNBs decreased in similar magnitude. The substantial increase in consumption of certain SSBs, such as fruit drinks and soda, high fat high sugar milk, and sports drinks, coupled with the decrease in consumption of high fat low sugar milk was responsible for this shift. The percent consuming SSBs as well as the amount per consumer increased significantly over time. Per capita intake of total milk declined, but the caloric contribution from high fat high sugar milk increased substantially. Among ethnicities, important differences in consumption trends of certain SSBs and 100% juice indicate the complexity in determining strategies for children's beverage calorie reduction.

CONCLUSIONS

As upward trends of SSB consumption parallel increases in childhood obesity, educational and policy interventions should be considered.

Dietary sources of animal and plant protein intake among Flemish preschool children and the association with socio-economic and lifestyle-related factors

Background

The aims of this study were to assess the intake of animal, plant and food group-specific protein, and to investigate their associations with socio-economic and lifestyle-related factors in Flemish preschoolers.

Methods

Three-day estimated dietary records were collected from 661 preschoolers aged 2.5-6.5 y (338 boys and 323 girls). Multiple linear regression analysis was used to investigate the association between animal, plant, and food group-specific protein intake and socio-economic and lifestyle factors.

Results

Animal proteins (mean 38 g/d) were the main source of total protein (mean 56 g/d), while mean plant protein intake amounted to 18 g/d. The group of meat, poultry, fish and eggs was the main contributor (51%) to animal protein intake, followed by milk and milk products (35%). Bread and cereals (41%) contributed most to the plant protein intake, followed by low-nutritious, energy-dense foods (21%). With higher educated fathers and mothers as reference, respectively, preschoolers with lower secondary and secondary paternal education had lower animal, dairy-, and meat-derived protein intakes, and those with lower secondary and secondary maternal education consumed less plant, and bread and cereal-derived proteins. Compared to children with high physical activity levels, preschoolers with low and moderate physical activity had lower animal and plant protein intakes. Significantly higher potatoes and grains-, and fish- derived proteins were reported for children of smoking mothers and fathers, respectively, compared to those of non-smoking mothers and fathers.

Conclusions

The total protein intake of Flemish preschoolers was sufficient according to the recommendations of the Belgian Superior Health Council. Parental level of education and smoking status might play a role in the sources of children's dietary proteins.

Dietary behaviors related to cancer prevention among pre-adolescents and adolescents: the gap between recommendations and reality

BACKGROUND

Diet is thought to play an important role in cancer risk. This paper summarizes dietary recommendations for cancer prevention and compares these recommendations to the dietary behaviors of U.S. youth ages 8-18.

METHODS

We identified cancer prevention-related dietary recommendations from key health organizations and assessed dietary consumption patterns among youth using published statistics from the National Health and Nutrition Examination Survey, the national Youth Risk Behavior Survey, and other supplemental sources.

RESULTS

Cancer prevention guidelines recommend a diet rich in fruits, vegetables, and whole grains, recommend limiting sugary foods and beverages, red and processed meats, sodium, and alcohol, and recommend avoiding foods contaminated with carcinogens. However, youth typically do not meet the daily recommendations for fruit, vegetable, or whole grain consumption and are over-consuming energy-dense, sugary and salty foods.

CONCLUSIONS

A large discrepancy exists between expert recommendations about diet and cancer and actual dietary practices among young people and points to the need for more research to better promote the translation of science into practice. Future research should focus on developing and evaluating policies and interventions at the community, state and national levels for aligning the diets of youth with the evolving scientific evidence regarding cancer prevention.

Management of metabolic syndrome in children and adolescents

Concomitantly with the increasing prevalence of childhood obesity, the prevalence of metabolic syndrome (MS) is rising among children and adolescents, leading to fears for future epidemics of type 2 diabetes mellitus and cardiovascular disease in the young. This makes the accurate identification and the appropriate treatment of children and adolescents with MS an important priority for health care systems. This review will focus on the management of each component of MS, including the nonalcoholic fatty liver disease (NAFLD), which is currently considered as the hepatic component of the syndrome. The most relevant target of treatment of MS in children and adolescents is the abdominal obesity. To this end, we will discuss the efficacy of dietary approaches, possibly coupled with regular physical activity, on eliciting visceral fat reduction. We will also highlight several aspects of the treatment of the high triglyceride/low high-density lipoprotein cholesterol phenotype, including the use of non-pharmacological measures, and indications for instituting drug therapies. Part of this review will address treatment of glucose abnormalities, including the benefits of lifestyle modification alone, and the potential adjunctive role of hypoglycemic drugs. The treatment of hypertension in children with MS also requires a multifaceted approach and the available data of this topic will be examined. The remainder of this review will address treatment to reverse NAFLD and prevent progression to end-stage disease.

Parental eating attitudes and indicators of healthy eating in a longitudinal randomized dietary intervention trial (the STRIP study)

OBJECTIVE

To examine the effects of child-oriented dietary intervention on parental eating attitudes and dietary behaviour.

DESIGN

In the prospective, randomized Special Turku Coronary Risk Factor Intervention Project for Children (the STRIP study), a cohort of Finnish families took part in a nutritional intervention trial focused on the quality of their children's fat intake since the age of 8 months. Health-related and hedonic eating attitudes of the parents were measured after 10 years of dietary intervention using a validated Health and Taste Attitude Scales (HTAS) questionnaire (n 660). Parents' eating behaviour was studied using a 1 d food record (n 491).

SETTING

Finland.

SUBJECTS

Mothers and fathers (n 660) of the STRIP children.

RESULTS

The parents of the intervention families had a higher level of interest in healthy eating compared with control parents. The interest in natural products or hedonic eating attitudes did not differ between the groups. The parents' general health interest was associated with low saturated fat intake, fruit and vegetable consumption, fibre intake and seeking pleasure in eating, but it was not associated with BMI. The intervention also improved the quality of dietary fat among parents with the lowest level of interest in healthy eating.

CONCLUSIONS

Parents' general health interest was associated with regular dietary counselling as well as with healthier food choice behaviour. However, the dietary intervention that focused especially on the quality of the child's fat intake also enhanced specific changes in the family's fat consumption without a high level of interest in healthy eating.

[To find out the life habits and risk factors of adolescents seen in the Health Centres of two semi-urban populations using a structured open response clinical interview]

OBJECTIVE

To investigate the habits and risk factors of adolescents from two Health Centres in two semi-urban populations using a structured clinical interview with open questions.

DESIGN

Cross-sectional descriptive study.

SETTING

Two semi-urban populations from the Malaga area.

PARTICIPANTS

Adolescents aged between 16 and 18 years old. We selected 5 medical clinics out of the 19 clinics in the Health Centres, using stratified random sampling. A total of 204 adolescents were included, with 62 (30.39%) of them not attending.

OUTCOMES

42.3% were overweight or obese. The BMI and MBP ratio was R=0.4 They ate fruit, vegetables or dairy products at least once a day 54.2%, 57.8% and 24.5%, respectively. 32.3% of the male teenagers and 63.5% of females did not exercise regularly. 21.8% were smokers, and this was related to a low socio-economical level (OR: 3.38 P=0.001 95% CI: 1.27 to 9) and with abandoning education (OR: 2.88 P=0.015 CI 95%. 1.20 to 6,86). 56.3% usually drink and this habit was also related to abandoning education. (OR: 3.5 95% CI: 1.43 to 8.94). 10.6% of the teenagers consumed illegal substances and their group of friends in 36.6% of the cases. 12.1% had unprotected sex. 12.4% and 13.4% did not use a crash helmet or seat belt, respectively. 24.2% have driven in a drunken state at some point. 20.4% have felt depressed at least once.

CONCLUSIONS

Risk factors and life style habits prevalent in reference to weight, fruit, vegetables and dairy products consumption, sport, smoking, alcohol and depression problems have been similar to the ones found in other studies that have used anonymous surveys. Prevalence of substance abuse has been lower.

Considering statins for cholesterol-reduction in children if lifestyle and diet changes do not improve their health: a review of the risks and benefits

Children who appear healthy, even if they have one or more recognized cardiovascular risk factors, do not generally have outcomes of cardiovascular or other vascular disease during childhood. Historically, pediatric medicine has not aggressively screened for or treated cardiovascular risk factors in otherwise healthy children. However, studies such as the P-Day Study (Pathobiological Determinants of Atherosclerosis in Youth), and the Bogalusa Heart Study, indicate that healthy children at remarkably young ages can have evidence of significant atherosclerosis. With the increasing prevalence of pediatric obesity, can we expect more health problems related to the consequences of pediatric dyslipidemia, hypertriglyceridemia, and atherosclerosis in the future? For many years, medications have been available and used in adult populations to treat dyslipidemia. In recent years, reports of short-term safety of some of these medications in children have been published. However, none of these studies have detailed long-term follow-up, and therefore none have described potential late side-effects of early cholesterol-lowering therapy, or potential benefits in terms of reduction of or delay in cardiovascular or other vascular end-points. In 2007, the American Heart Association published a scientific statement on the use of cholesterol-lowering therapy in pediatric patients. In this review paper, we discuss some of the current literature on cholesterol-lowering therapy in children, including the statins that are currently available for use in children, and some of the cautions with using these and other cholesterol-lowering medications. A central tenet of this review is that medications are not a substitute for dietary and lifestyle interventions, and that even in children on cholesterol-lowering medications, physicians should take every opportunity to encourage children and their parents to make healthy diet and lifestyle choices.

Caloric beverage consumption patterns in Mexican children

BACKGROUND

Mexico has seen a very steep increase in child obesity level. Little is known about caloric beverage intake in this country as well as all other countries outside a few high income countries. This study examines overall patterns and trends in all caloric beverages from two nationally representative surveys from Mexico.

METHODS

The two nationally representative dietary intake surveys (1999 and 2006) from Mexico are used to study caloric beverage intake in 17, 215 children. The volume (ml) and caloric energy (kcal) contributed by all beverages consumed by the sample subjects were measured. Results are weighted to be nationally representative.

RESULTS

The trends from the dietary intake surveys showed very large increases in caloric beverages among pre-school and school children. The contribution of whole milk and sugar-sweetened juices was an important finding. Mexican pre-school children consumed 27.8% of their energy from caloric beverages in 2006 and school children consumed 20.7% of their energy from caloric beverages during the same time. The three major categories of beverage intake are whole milk, fruit juice with various sugar and water combinations and carbonated and noncarbonated sugared-beverages.

CONCLUSION

The Mexican government, greatly concerned about obesity, has identified the large increase in caloric beverages from whole milk, juices and soft drinks as a key target and is initiating major changes to address this problem. They have already used the data to shift 20 million persons in their welfare and feeding programs from whole to 1.5% fat milk and in a year will shift to nonfat milk. They are using these data to revise school beverage policies and national regulations and taxation policies related to an array of less healthful caloric beverages.

Consumption of whole grains is associated with improved diet quality and nutrient intake in children and adolescents: the National Health and Nutrition Examination Survey 1999–2004

Objective

To examine the association of consumption of whole grains (WG) with diet quality and nutrient intake in children and adolescents.

Design

Secondary analysis of cross-sectional data.

Setting

The 1999–2004 National Health and Nutrition Examination Survey.

Subjects

Children aged 2–5 years (n 2278) and 6–12 years (n 3868) and adolescents aged 13–18 years (n 4931). The participants were divided into four WG consumption groups: ≥0 to <0·6, ≥0·6 to <1·5, ≥1·5 to <3·0 and ≥3·0 servings/d. Nutrient intake and diet quality, using the Healthy Eating Index (HEI)-2005, were determined for each group from a single 24 h dietary recall.

Results

The mean number of servings of WG consumed was 0·45, 0·59 and 0·63 for children/adolescents at the age of 2–5, 6–12 and 13–18 years, respectively. In all groups, HEI and intakes of energy, fibre, vitamin B6, folate, magnesium, phosphorus and iron were significantly higher in those consuming ≥3·0 servings of WG/d; intakes of protein, total fat, SFA and MUFA and cholesterol levels were lower. Intakes of PUFA (6–12 years), vitamins B1 (2–5 and 13–18 years), B2 (13–18 years), A (2–5 and 13–18 years) and E (13–18 years) were higher in those groups consuming ≥3·0 servings of WG/d; intakes of added sugars (2–5 years), vitamin C (2–5 and 6–12 years), potassium and sodium (6–12 years) were lower.

Conclusions

Overall consumption of WG was low. Children and adolescents who consumed the most servings of WG had better diet quality and nutrient intake.