Dietary sources of energy, solid fats, and added sugars among children and adolescents in the United States

Beverage patterns among Canadian children and relationship to overweight and obesity

Sweetened beverage intake has risen in past decades, along with a rise in prevalence of overweight and obesity among children. Our objective was to examine the relationship between beverage intake patterns and overweight and obesity among Canadian children. Beverage intake patterns were identified by cluster analysis of data from the cross-sectional Canadian Community Health Survey 2.2. Intake data were obtained from a single 24-hour recall, height and weight were measured, and sociodemographic data were obtained via interview. Data on children and adolescents aged 2-18 years who met inclusion criteria (n = 10 038) were grouped into the following categories: 2-5 years (male and female), 6-11 years (female), 6-11 years (male), 12-18 years (female), and 12-18 years (male). χ² test was used to compare rates of overweight and obesity across clusters. Logistic regression was used to determine the association between overweight and obesity and beverage intake patterns, adjusting for potential confounders. Clustering resulted in distinct groups of who drank mostly fruit drinks, soft drinks, 100% juice, milk, high-fat milk, or low-volume and varied beverages (termed "moderate"). Boys aged 6-11 years whose beverage pattern was characterized by soft drink intake (553 ± 29 g) had increased odds of overweight-obesity (odds ratio 2.3, 95% confidence interval 1.2-4.1) compared with a "moderate" beverage pattern (23 ± 4 g soft drink). No significant relationship emerged between beverage pattern and overweight and obesity among other age-sex groups. Using national cross-sectional dietary intake data, Canadian children do not show a beverage-weight association except among young boys who drink mostly soft drinks, and thus may be at increased risk for overweight or obesity.

Effect of the Supplemental Nutrition Assistance Program (SNAP) on frequency of beverage consumption among youth in the United States

As the largest federal food assistance program, the Supplemental Nutrition Assistance Program (SNAP) has potential to improve food choices among low-income populations. The program's impact on youth is important because they are represented in more than half of all SNAP households. This study estimates the impact of participation in SNAP, also known as the Food Stamp Program, on the frequency of soft drink, 100% fruit juice, and milk consumption among youth (ages 11 through 14) in the United States. A cohort of 3,126 youth from the Early Childhood Longitudinal Survey who were surveyed in 2004 (5th grade) and 2007 (8th grade) were used for the analysis. Multivariate linear regression with individual fixed effects was conducted to estimate the effect of SNAP participation on the frequency of consumption of each beverage type in the preceding week. The fixed effects controlled for factors specific to the youth, such as sex, race/ethnicity, and time-invariant bias in reporting SNAP participation or beverage consumption. Overall participation in SNAP increased from 19.5% to 20.3% between 2004 and 2007, with 14.4% reporting a different participation status in 2007 as compared with 2004. SNAP participation was not found to be predictive of the frequency of soft drink, 100% fruit juice, or milk consumption among youth. In its current state, SNAP may serve to replace lost income for qualifying households, but not alter their food and beverage choices. Interventions that support access to and incentivize the consumption of more healthful foods and beverages may be successful in improving the nutritional quality of intake.

Government can regulate food advertising to children because cognitive research shows that it is inherently misleading

The childhood obesity crisis has prompted repeated calls for government action to curb the marketing of unhealthy food to children. Food and entertainment industry groups have asserted that the First Amendment prohibits such regulation. However, case law establishes that the First Amendment does not protect "inherently misleading" commercial speech. Cognitive research indicates that young children cannot effectively recognize the persuasive intent of advertising or apply the critical evaluation required to comprehend commercial messages. Given this combination--that government can prohibit "inherently misleading" advertising and that children cannot adequately understand commercial messages--advertising to children younger than age twelve should be considered beyond the scope of constitutional protection.

Associations of television viewing with eating behaviors in the 2009 Health Behaviour in School-aged Children Study

OBJECTIVE

To examine associations of television viewing with eating behaviors in a representative sample of US adolescents.

DESIGN

Cross-sectional survey.

SETTING

Public and private schools in the United States during the 2009-2010 school year.

PARTICIPANTS

A total of 12,642 students in grades 5 to 10 (mean [SD] age, 13.4 [0.09] years; 86.5% participation).

MAIN EXPOSURES

Television viewing (hours per day) and snacking while watching television (days per week).

MAIN OUTCOME MEASURES

Eating (≥1 instance per day) fruit, vegetables, sweets, and sugary soft drinks; eating at a fast food restaurant (≥1 d/wk); and skipping breakfast (≥1 d/wk).

RESULTS

Television viewing was inversely related to intake of fruit (adjusted odds ratio, 0.92; 95% CI, 0.88-0.96) and vegetables (0.95; 0.91-1.00) and positively related to intake of candy (1.18; 1.14-1.23) and fast food (1.14; 1.09-1.19) and skipping breakfast (1.06; 1.02-1.10) after adjustment for socioeconomic factors, computer use, and physical activity. Television snacking was related to increased intake of fruit (adjusted odds ratio, 1.06; 95% CI, 1.02-1.10), candy (1.20; 1.16-1.24), soda (1.15; 1.11-1.18), and fast food (1.09; 1.06-1.13), independent of television viewing. The relationships of television viewing with fruit and vegetable intake and with skipping breakfast were essentially unchanged after adjustment for television snacking; the relationships with intake of candy, soda, and fast food were moderately attenuated. Age and race/ethnicity modified relationships of television viewing with soda and fast food intake and with skipping breakfast.

CONCLUSION

Television viewing was associated with a cluster of unhealthy eating behaviors in US adolescents after adjustment for socioeconomic and behavioral covariates.

Position of the Academy of Nutrition and Dietetics: use of nutritive and nonnutritive sweeteners

It is the position of the Academy of Nutrition and Dietetics that consumers can safely enjoy a range of nutritive sweeteners and nonnutritive sweeteners (NNS) when consumed within an eating plan that is guided by current federal nutrition recommendations, such as the Dietary Guidelines for Americans and the Dietary Reference Intakes, as well as individual health goals and personal preference. A preference for sweet taste is innate and sweeteners can increase the pleasure of eating. Nutritive sweeteners contain carbohydrate and provide energy. They occur naturally in foods or may be added in food processing or by consumers before consumption. Higher intake of added sugars is associated with higher energy intake and lower diet quality, which can increase the risk for obesity, prediabetes, type 2 diabetes, and cardiovascular disease. On average, adults in the United States consume 14.6% of energy from added sugars. Polyols (also referred to as sugar alcohols) add sweetness with less energy and may reduce risk for dental caries. Foods containing polyols and/or no added sugars can, within food labeling guidelines, be labeled as sugar-free. NNS are those that sweeten with minimal or no carbohydrate or energy. They are regulated by the Food and Drug Administration as food additives or generally recognized as safe. The Food and Drug Administration approval process includes determination of probable intake, cumulative effect from all uses, and toxicology studies in animals. Seven NNS are approved for use in the United States: acesulfame K, aspartame, luo han guo fruit extract, neotame, saccharin, stevia, and sucralose. They have different functional properties that may affect perceived taste or use in different food applications. All NNS approved for use in the United States are determined to be safe.

A conceptual model for training after-school program staffers to promote physical activity and nutrition

BACKGROUND

After-school programs (ASPs, 3 pm to 6 pm) have been called upon to increase the amount of daily physical activity children accumulate and improve the nutritional quality of the snacks served. To this end, state and national physical activity and nutrition (PAaN) policies have been proposed. Frontline staff who directly interact with children on a daily basis are charged with the responsibility to meet policy goals. Without appropriate skills, staffers' ability to achieve such goals is limited. The gap between policies and improvements in PAaN must be bridged through professional development training. This article describes the development of an ASP staff professional development training program.

METHODS

A systematic review was performed to identify relevant theoretical perspectives, empirical evidence, and recommended best practices relating to promoting PAaN of children.

RESULTS

A comprehensive professional development framework was developed that incorporated the key elements identified from the review. These elements were distilled into 5 primary categories and conceptually referred to as the 5 Ms: mission-clearly defined policy/standards for PAaN; motivate-providing choices, developmentally appropriate activities, feedback, and encouragement; manage-structuring and managing the environment for safety, routines, and discipline; monitor-ongoing evaluation of PAaN; and maximize-incorporating all former Ms.

CONCLUSIONS

The application of this training framework should lead to improved implementation and eventual achievement of policy goals for PAaN in ASPs. These competencies need to be developed in all ASPs if widespread improvements in PAaN within the ASP setting are to be realized.

Banning all sugar-sweetened beverages in middle schools: reduction of in-school access and purchasing but not overall consumption

OBJECTIVE

To determine whether state policies that regulate beverages in schools are associated with reduced in-school access and purchase of sugar-sweetened beverages (SSBs) and reduced consumption of SSBs (in and out of school) among adolescents.

DESIGN

Cross-sectional.

SETTING

Public schools in 40 states.

PARTICIPANTS

Students sampled in fifth and eighth grades (spring 2004 and 2007, respectively).

MAIN EXPOSURES

State policies that ban all SSBs and state policies that ban only soda for 2006-2007.

MAIN OUTCOME MEASURES

In-school SSB access, in-school SSB purchasing behavior, and overall SSB consumption (in and out of school) in eighth grade.

RESULTS

The proportions of eighth-grade students who reported in-school SSB access and purchasing were similar in states that banned only soda (66.6% and 28.9%, respectively) compared with states with no beverage policy (66.6% and 26.0%, respectively). In states that banned all SSBs, fewer students reported in-school SSB access (prevalence difference, -14.9; 95% CI, -23.6 to -6.1) or purchasing (-7.3; -11.0 to -3.5), adjusted for race/ethnicity, poverty status, locale, state obesity prevalence, and state clustering. Results were similar among students who reported access or purchasing SSBs in fifth grade compared with those who did not. Overall SSB consumption was not associated with state policy; in each policy category, approximately 85% of students reported consuming SSBs at least once in the past 7 days. Supplementary analyses indicated that overall consumption had only a modest association with in-school SSB access.

CONCLUSION

State policies that ban all SSBs in middle schools appear to reduce in-school access and purchasing of SSBs but do not reduce overall consumption.

Implementing Heart Healthy Dietary Guidelines

Over recent decades, abundant scientific evidence has led to authoritative dietary guidelines and recommendations for heart healthy eating and lifestyle behaviors. But most children and adults do not regularly achieve these goals. Consequently, our focus must now be on helping individual patients and our communities implement these guidelines in everyday life. This article reviews current evidence for insights and practical techniques that can help individuals move from ideal goals to real practice of heart healthy nutrition and lifestyle behaviors.

Factors associated with sugar-sweetened beverage intake among United States high school students

This cross-sectional study examined associations of demographic characteristics, weight status, availability of school vending machines, and behavioral factors with sugar-sweetened beverage (SSB) intake, both overall and by type of SSB, among a nationally representative sample of high school students. The 2010 National Youth Physical Activity and Nutrition Study data for 11,209 students (grades 9-12) were used. SSB intake was based on intake of 4 nondiet beverages [soda, other (i.e., fruit-flavored drinks, sweetened coffee/tea drinks, or flavored milk), sports drinks, and energy drinks]. Nationwide, 64.9% of high school students drank SSB ≥1 time/d, 35.6% drank SSB ≥2 times/d, and 22.2% drank SSB ≥3 times/d. The most commonly consumed SSB was regular soda. Factors associated with a greater odds for high SSB intake (≥3 times/d) were male gender [OR = 1.66 (95% CI = 1.41,1.95); P < 0.05], being non-Hispanic black [OR = 1.87 (95% CI = 1.52, 2.29); P < 0.05], eating at fast-food restaurants 1-2 d/wk or eating there ≥3 d/wk [OR = 1.25 (95% CI = 1.05, 1.50); P < 0.05 and OR = 2.94 (95% CI = 2.31, 3.75); P < 0.05, respectively] and watching television >2 h/d [OR = 1.70 (95% CI = 1.44, 2.01); P < 0.05]. Non-Hispanic other/multiracial [OR = 0.67 (95% CI = 0.47, 0.95); P < 0.05] and being physically active ≥60 min/d on <5 d/wk were associated with a lower odds for high SSB intake [OR = 0.85 (95% CI = 0.76, 0.95); P < 0.05]. Weight status was not associated with SSB intake. Differences in predictors by type of SSB were small. Our findings of significant associations of high SSB intake with frequent fast-food restaurant use and sedentary behaviors may be used to tailor intervention efforts to reduce SSB intake among high-risk populations.

Effects of breastfeeding and low sugar-sweetened beverage intake on obesity prevalence in Hispanic toddlers

BACKGROUND

Few studies have examined the independent and additive effects of breastfeeding (BF) and sugar-sweetened beverage (SSB) intake in early life on overweight and obesity prevalence.

OBJECTIVE

The objective was to assess the effects of BF and SSB intake on the prevalence of overweight and obesity in Hispanic toddlers.

DESIGN

Nutrition data were collected via phone surveys with caregivers of 1483 Hispanic children (2-4 y of age) from the Los Angeles County Women, Infants, and Children (WIC) program. BF history at 2-4 y of age was categorized as follows: no BF, >1 wk to <6 mo BF, 6 to <12 mo BF, and ≥12 mo BF. SSB intake at 2-4 y of age was categorized as follows: high SSB (≥2 SSBs/d), mid SSB (1 SSB/d), and no SSB. The height and weight of the children were measured by WIC staff and stored in the Integrated Statewide Information System. Binary logistic regressions assessed the effects of BF and SSB categories on overweight and obesity prevalence.

RESULTS

In comparison with the no-BF participants, the odds of obesity were lower in the ≥12-mo-BF participants (OR: 0.55; 95% CI: 0.37, 0.83; P = 0.004). In comparison with high-SSB participants, the odds of obesity were lower in the no-SSB participants (OR: 0.69; 95% CI: 0.47, 1.00; P = 0.047). In comparison with the combined no-BF/high-SSB participants, the odds of obesity were lower in the ≥12-mo BF/no-SSB participants (OR: 0.39; 95% CI: 0.19, 0.80; P = 0.01).

CONCLUSION

The results suggest that BF for ≥1 y and low SSB intake during the toddler years can have profound effects on reducing the prevalence of obesity in Hispanic toddlers.

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.

Global nutrition transition and the pandemic of obesity in developing countries

Decades ago, discussion of an impending global pandemic of obesity was thought of as heresy. But in the 1970s, diets began to shift towards increased reliance upon processed foods, increased away-from-home food intake, and increased use of edible oils and sugar-sweetened beverages. Reductions in physical activity and increases in sedentary behavior began to be seen as well. The negative effects of these changes began to be recognized in the early 1990s, primarily in low- and middle-income populations, but they did not become clearly acknowledged until diabetes, hypertension, and obesity began to dominate the globe. Now, rapid increases in the rates of obesity and overweight are widely documented, from urban and rural areas in the poorest countries of sub-Saharan Africa and South Asia to populations in countries with higher income levels. Concurrent rapid shifts in diet and activity are well documented as well. An array of large-scale programmatic and policy measures are being explored in a few countries; however, few countries are engaged in serious efforts to prevent the serious dietary challenges being faced.

Dietary Patterns and Body Mass Index in Children with Autism and Typically Developing Children

To determine whether dietary patterns (juice and sweetened non-dairy beverages, fruits, vegetables, fruits & vegetables, snack foods, and kid's meals) and associations between dietary patterns and body mass index (BMI) differed between 53 children with autism spectrum disorders (ASD) and 58 typically developing children, ages 3 to 11, multivariate regression models including interaction terms were used. Children with ASD were found to consume significantly more daily servings of sweetened beverages (2.6 versus 1.7, p=0.03) and snack foods (4.0 versus 3.0, p=0.01) and significantly fewer daily servings of fruits and vegetables (3.1 versus 4.4, p=0.006) than typically developing children. There was no evidence of statistical interaction between any of the dietary patterns and BMI z-score with autism status. Among all children, fruits and vegetables (p=0.004) and fruits alone (p=0.005) were positively associated with BMI z-score in our multivariate models. Children with ASD consume more energy-dense foods than typically developing children; however, in our sample, only fruits and vegetables were positively associated with BMI z-score.

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.

Permissive parental feeding behavior is associated with an increase in intake of low-nutrient-dense foods among American children living in rural communities

Parents play an important role in shaping children's eating habits. Few studies have evaluated the influence of both parenting style and parenting practices on child outcomes such as dietary intake. During spring 2007, 99 parent-child dyads from four rural US areas participated in this cross-sectional study. Child food intake was reported during two interviewer-administered, parent-assisted 24-hour recalls. Diet quality was defined as the average number of low-nutrient-dense (LND) foods consumed. Validated questionnaires were used to assess parental feeding practices and feeding style. Pearson correlations identified relationships among child food intake, parental feeding style typologies, and covariates. Regression analyses were used to predict child diet quality. Sixty percent of children and 76% of parents were overweight or obese. A permissive feeding style, which is highly responsive to a child's requests and sets few demands on him or her, was the most common (n=37) parental feeding style. This feeding style was associated with child intake of LND foods (r=0.3; P<0.001) and moderated the relationship between parental feeding practices and child intake of LND foods. In the presence of a permissive feeding style, higher levels of monitoring were associated with child intake of LND foods (β=.69; P<0.05). Parental feeding style may alter the effectiveness of parental feeding practices on children's food intake. More research is needed to understand the parent-child feeding relationship in the context of parental feeding styles and practices.

Sugar sweetened beverage consumption by Australian children: implications for public health strategy

Background

High consumption of sugar sweetened beverages (SSBs) has been linked to unhealthy weight gain and nutrition related chronic disease. Intake of SSB among children remains high in spite of public health efforts to reduce consumption, including restrictions on marketing to children and limitations on the sale of these products in many schools. Much extant literature on Australian SSB consumption is out-dated and lacks information on several key issues. We sought to address this using a contemporary Australian dataset to examine purchase source, consumption pattern, dietary factors, and demographic profile of SSB consumption in children.

Methods

Data were from the 2007 Australian National Children's Nutrition and Physical Activity Survey, a representative random sample of 4,834 Australian children aged 2-16 years. Mean SSB intake by type, location and source was calculated and logistic regression models were fitted to determine factors associated with different levels of consumption.

Results

SSB consumption was high and age-associated differences in patterns of consumption were evident. Over 77% of SSB consumed was purchased via supermarkets and 60% of all SSB was consumed in the home environment. Less than 17% of SSB was sourced from school canteens and fast food establishments. Children whose parents had lower levels of education consumed more SSB on average, while children whose parents had higher education levels were more likely to favour sweetened juices and flavoured milks.

Conclusions

SSB intake by Australian children remains high and warrants continued public health attention. Evidence based and age-targeted interventions, which also recognise supermarkets as the primary source of SSB, are recommended to reduce SSB consumption among children. Additionally, education of parents and children regarding the health consequences of high consumption of both carbonated and non-carbonated SSBs is required.

Etiologies of obesity in children: nature and nurture

Childhood obesity is a profoundly complex problem and serves as an example of a biospsychosocial issue. Scientific inquiry has provided incredible insight into the complex etiology of weight gain but must be viewed as an interaction between a human's propensity to conserve calories for survival in a world with an abundance of it. This article provides a brief overview divided between biological (nature) and psychosocial and behavioral (nurture) factors.

Policies to support obesity prevention for children: a focus on of early childhood policies

Policies at many levels may help to shape environments that promote healthy weight and prevent obesity. We present policies to support obesity prevention for young children. We highlight policy Sand environmental systems change examples in the areas of promoting breastfeeding and providing healthy affordable food and information about food in community and child care settings and promoting physical activity in child care and the community. We address the role of the health care system and health care professionals to shape and advocate for policy and environmental systems change and provide resources for pediatric health care professionals to engage in community-based advocacy.

Beverage intake in low-income parent-child dyads

Beverage consumption adds to daily energy intake and often exceeds the recommended amount for discretionary energy. Previous research has shown that children are consuming sugar-sweetened beverages (SSB) in greater frequency and the relationship between parent-child dyads in beverage consumption is meaningful due to the parental influence on the development of beverage consumption behaviors. In particular, low-income families are at greater risk for obesity and higher levels of SSB consumption. The current investigation assessed habitual beverage intake among low-income parent-child dyads (N=95) with children between the ages of 9-17 years. The sample (46% African American; 45% Caucasian) had a mean body mass index (BMI) for the parents of 31.8±8.9 kg/m(2), while the mean BMI percentile for age and gender for the children was 70.3±31.3. Both parents and children consumed fewer nutrient-dense beverages and more energy-dense beverages than the recommended amount. The mean daily energy intake from beverages was 451±236 kcal for the parents and 457±237 kcal for the children. Correlations between parent-child dyad intake was also evident, identifying parents as potential role models and gatekeepers of the home food environment. Future interventions to prevent childhood obesity in low-income populations should address beverage intake, particularly SSB consumption, and determine the degree to which this behavior is learned behavior in the home.

Dietary energy density is associated with body weight status and vegetable intake in U.S. children

The objective was to determine the relationship between dietary energy density (ED; kcal/g) and measured weight status in children. The present study used data from a nationally representative sample of 2442 children between 2 and 8 y old who participated in the 2001-2004 NHANES. Survey measures included 24-h dietary recall data, measurement of MyPyramid servings of various food groups, and anthropometry. The relationship among dietary ED, body weight status as calculated using the 2000 CDC growth charts, and food intake was evaluated using quartiles of ED. Additionally, other dietary characteristics associated with ED among children are described. Specific survey procedures were used in the analysis to account for sample weights, unequal selection probability, and the clustered design of the NHANES sample. In this sample, dietary ED was positively associated with body weight status in U.S. children aged 2-8 y. Obese children had a higher dietary ED than lean children (2.08 ± 0.03 vs. 1.93 ± 0.05; P = 0.02). Diets high in ED were also found to be associated with greater intakes of energy and added sugars, more energy from fat; and significantly lower intake of fruits and vegetables. Interventions that lower dietary ED by means of increasing fruit and vegetable intake and decreasing fat consumption may be an effective strategy for reducing childhood obesity.

High calorie, low nutrient food/beverage intake and video gaming in children as potential signals for addictive behavior

Little is known about the co-occurrence of health risk behaviors in childhood that may signal later addictive behavior. Using a survey, this study evaluated high calorie, low nutrient HCLN intake and video gaming behaviors in 964 fourth grade children over 18 months, with stress, sensation-seeking, inhibitory control, grades, perceived safety of environment, and demographic variables as predictors. SEM and growth curve analyses supported a co-occurrence model with some support for addiction specificity. Male gender, free/reduced lunch, low perceived safety and low inhibitory control independently predicted both gaming and HCLN intake. Ethnicity and low stress predicted HCLN. The findings raise questions about whether living in some impoverished neighborhoods may contribute to social isolation characterized by staying indoors, and HCLN intake and video gaming as compensatory behaviors. Future prevention programs could include skills training for inhibitory control, combined with changes in the built environment that increase safety, e.g., implementing Safe Routes to School Programs.

Sugar-sweetened beverage taxes in Brazil

OBJECTIVES

We investigated whether taxing sugar-sweetened beverages (SSBs) would improve the diets of households in Brazil.

METHODS

We used household food consumption data that the Brazilian Institute of Geography and Statistics collected in 2002-2003 from a nationally representative sample of 48,470 Brazilian households. The consumption of SSBs is expressed as the total SSB calories consumed and as the SSB percentage of the total calories purchased. We investigated price elasticity with regression models, controlling for demographic variables, income, and prices of all other foods and drinks.

RESULTS

Increases in the price of SSBs led to reductions in consumption. A 1.00% increase in the price of SSBs led to a 0.85% reduction of SSB calories consumed (1.03% reduction for the poor and 0.63% for the nonpoor). Increased income had a positive effect on SSB consumption, but the effect was less than half the size of the price elasticity (0.41% increase in SSB calories consumed for every 1.00% increase in income).

CONCLUSIONS

High SSB price elasticity in Brazil indicates that a tax on purchased weight or volume would lead to reductions in SSB consumption.

Eating and activity habits of overweight children on weekdays and weekends

OBJECTIVE

To determine whether eating, sedentary, and physical activity behaviors differ on weekdays and weekends in a sample of children who are overweight and obese.

METHODS

Eighty-one children aged 6-9 years old who were overweight or obese and enrolled in a weight management program completed three-day food diaries and three-day Previous Day Physical Activity Recalls (PDPARs) for two weekdays and one weekend day. All data were obtained at baseline prior to intervention delivery.

RESULTS

Children consumed a greater percentage of calories from fat (t = 2.15, p = 0.04) and fewer fruits (t = 6.83, p < 0.001), vegetables (t = 2.91, p = 0.002), non-nutrient dense (NND) snack foods (t = 5.58, p < 0.001), and sweetened drinks (t = 2.91, p = 0.005) on weekends. Children watched more television (t = 5.25, p < 0.001), expended more energy (t = 4.37, p < 0.001), and spent a greater percentage of time in moderate-to-vigorous physical activity (p < 0.001) on weekends compared to weekdays.

CONCLUSIONS

Findings demonstrate a number of differences in children's eating and activity habits on weekends and weekdays. They also suggest that attending to differences in food intake and activity habits on weekdays and weekends separately may help to identify periods of high risk, which could be modified with effective intervention approaches.

TRIAL REGISTRATION NUMBERS

NCT00259324, NCT00200265.

Industry progress to market a healthful diet to American children and adolescents

CONTEXT

The IOM released an expert committee report in 2005 that assessed the nature, extent, and influence of food and beverage marketing practices on the diets and health of American children and adolescents. The report concluded that prevailing marketing practices did not support a healthful diet and offered recommendations for diverse stakeholders to promote a healthful diet. The investigators evaluated progress made by food, beverage, and restaurant companies; trade associations; entertainment companies; and the media to achieve the IOM report recommendations over 5 years.

EVIDENCE ACQUISITION

A literature review was conducted of electronic databases and relevant government, industry, and media websites between December 1, 2005, and January 31, 2011. Evidence selection was guided by the IOM LEAD principles (i.e., locate, evaluate, and assemble evidence to inform decisions) and five qualitative-research criteria, and it was validated by data and investigator triangulation. The investigators selected and categorized 117 data sources into two evidence tables used to evaluate industry progress (i.e., no, limited, moderate, and extensive).

EVIDENCE SYNTHESIS

Food and beverage companies made moderate progress; however, limited progress was made by other industry subsectors. Industry stakeholders used integrated marketing communications (IMC) to promote primarily unhealthy products, which threaten children's and adolescents' health and miss opportunities to promote a healthy eating environment.

CONCLUSIONS

Diverse industry stakeholders have several untapped opportunities to advance progress by promoting IMC to support a healthful diet; substantially strengthening self-regulatory programs; supporting truthful and non-misleading product labeling and health claims; engaging in partnerships; and funding independent evaluations of collective efforts.

Tween sex differences in snacking preferences during television viewing

Television viewing is associated with an increased risk in childhood obesity. Research surrounding food habits of tweens largely bypasses snacking preferences while watching television in the home. The aim of this cross-sectional study was to describe snacking prevalence by tween sex and to describe parental rules surrounding snacking while watching television at home. Survey data were obtained in 2008 from 4th- through 6th-grade students (n=1,557) who attended 12 New England schools. Complete self-reported measures (n=1,448) included demographics, household and bedroom television ownership, television watching frequency, snacking prevalence, snacking preferences, and parental rules regarding snacking while watching television. Comparisons were generated using χ(2) analyses. Overall, the majority of children (69.2%) snacked "sometimes" or "always" during television viewing, with the majority of responses (62.9%) categorized as foods. The most popular food snacks for both sexes in this sample were salty snacks (47.9%), with fruits and vegetables ranking a distant second (18.4%). Girls (22.6%) selected fruits and vegetables more frequently than boys (14.7%) (P=0.003). Of those drinking beverages (n=514), boys selected sugar-sweetened beverages more often than girls (43.5% vs 31.7%; P=0.006), and girls chose juice more often than boys (12.3% vs 6.1%; P=0.02). Overall, approximately half (53.2%) of the students consumed less-healthy snacks while watching television. Interventions for parents and both sexes of tweens focusing on healthy snacking choices may have long-term beneficial outcomes.

Obesogenic diets may differentially alter dopamine control of sucrose and fructose intake in rats

Chronic overeating of obesogenic diets can lead to obesity, reduced dopamine signaling, and increased consumption of added sugars to compensate for blunted reward. However, the specific role of diet composition yet remains unknown. To study this, Sprague-Dawley male rats were fed a high-energy diet with high fat and low carbohydrate content (HFHE), a fat-sugar combination high-energy diet (FCHE), or standard chow for 24 weeks. We found that both high-energy diets produced substantial body weight gain compared to chow-fed controls. To investigate dopamine control of short (2-h) intake of palatable sucrose or fructose solutions, rats were pretreated peripherally (IP) with equimolar doses (0-600 nmol/kg) of the dopamine D1 (SCH23390) and D2 (raclopride) subtype-specific receptor antagonists. The results showed an overall increase in the efficacy of D1 and D2 receptor antagonists on suppression of intake in obese rats compared to lean rats, with effects differing based on diets and test solutions. Specifically, SCH23390 potently reduced both sucrose and fructose intake in all groups; however, lower doses were more effective in HFHE rats. In contrast, raclopride was most effective at reducing fructose intake in the obese FCHE rats. Thus, it appears that obesity due to the consumption of combinations of dietary fat and sugar rather than extra calories from dietary fat alone may result in reduced D2 receptor signaling. Furthermore, such deficits seem to preferentially affect the control of fructose intake. These findings demonstrate for the first time a plausible interaction between diet composition and dopamine control of carbohydrate intake in diet-induced obese rats. It also provides additional evidence that sucrose and fructose intake is regulated differentially by the dopamine system.

Children, adolescents, obesity, and the media

Obesity has become a worldwide public health problem. Considerable research has shown that the media contribute to the development of child and adolescent obesity, although the exact mechanism remains unclear. Screen time may displace more active pursuits, advertising of junk food and fast food increases children's requests for those particular foods and products, snacking increases while watching TV or movies, and late-night screen time may interfere with getting adequate amounts of sleep, which is a known risk factor for obesity. Sufficient evidence exists to warrant a ban on junk-food or fast-food advertising in children's TV programming. Pediatricians need to ask 2 questions about media use at every well-child or well-adolescent visit: (1) How much screen time is being spent per day? and (2) Is there a TV set or Internet connection in the child's bedroom?

Innate and learned preferences for sweet taste during childhood

PURPOSE OF REVIEW

In nature, carbohydrates are a source of energy often equated with sweetness, the detection of which is associated with powerful hedonic appeal. Intakes of processed carbohydrates in the form of added sugars and sugar-sweetened beverages have risen consistently among all age groups over the last two decades. In this review, we describe the biological underpinnings that drive the consumption of sweet-tasting foods among pediatric populations.

RECENT FINDINGS

Scientific literature suggests that children's liking for all that is sweet is not solely a product of modern-day technology and advertising but reflects their basic biology. In fact, heightened preference for sweet-tasting foods and beverages during childhood is universal and evident among infants and children around the world. The liking for sweet tastes during development may have ensured the acceptance of sweet-tasting foods, such as mother's milk and fruits. Moreover, recent research suggests that liking for sweets may be further promoted by the pain-reducing properties of sugars.

SUMMARY

An examination of the basic biology of sweet taste during childhood provides insight, as well as new perspectives, for how to modify children's preferences for and intakes of sweet foods to improve their diet quality.

Nutritional policies and standards for snacks served in after-school programmes: a review

OBJECTIVE

To review and synthesize existing national and state organizations' policies related to the nutritional quality of snacks served in after-school programmes (ASP; 15.00-18.00 hours) in the USA.

DESIGN

Systematic review of websites and corresponding documentation describing national and state-level ASP organizations' policies, standards, guidelines and/or recommendations for the nutritional quality of snacks served within the ASP setting.

SETTING

ASP can play a critical role in a child's daily dietary intake. State and national organizations have developed policies to assist ASP in selecting nutritionally appropriate snacks, yet no widely accepted standards exist. By reviewing the extent of existing policies, recommendations for uniform policies can be made.

SUBJECTS

Policy documentation.

RESULTS

A total of seventeen organizations representing five unique snack policies comprised of thirteen different food items were identified. The most widely recognized snack policy, which the majority of state and national ASP organizations endorsed and upon which other snack policies were modelled, was the US Department of Agriculture reimbursement programmes. Consistently, policies endorsed serving fruits/vegetables, whole grains and milk/dairy products, and limiting foods high in fats/sugar/energy (calories). Two policies focused predominantly on total energy and macronutrient composition of snacks, a single policy suggested limits on sugar-sweetened beverages, and three endorsed serving water daily. A proposed set of general guidelines for ASP was developed based on uniformity in recommendations across policies.

CONCLUSIONS

The proposed set of nutritional guidelines will assist policy makers and ASP providers in selecting and serving nutritionally appropriate snacks that contribute to a child's overall healthful daily dietary intake.

Consumption of sugar-sweetened beverages among adults with type 2 diabetes

OBJECTIVE

To examine patterns of sugar-sweetened beverage (SSB) consumption among U.S. adults with type 2 diabetes in 2003-2006.

RESEARCH DESIGN AND METHODS

We analyzed 24-h dietary recall data from the National Health and Nutrition Examination Survey 2003-2006 to estimate SSB consumption levels among 1,090 adults (aged ≥ 20 years) with type 2 diabetes overall and by diagnosis and control status of their diabetes.

RESULTS

In 2003-2006, 45% of adults with diabetes consumed SSBs on a given day, obtaining an average of 202 calories and 47 g of sugar. Undiagnosed adults with diabetes were significantly more likely to consume SSBs than diagnosed adults (60 vs. 38% diagnosed/uncontrolled [P < 0.001] and 43% diagnosed/controlled [P = 0.001]) and were less likely to consume diet beverages (18 vs. 50% diagnosed/uncontrolled [P < 0.001] and 40% diagnosed/controlled [P < 0.001]). Men consumed significantly more SSBs than women (P = 0.027), younger adults (aged 20-44) more than older adults (45-64 and ≥ 65; P < 0.001), non-Hispanic black more than whites (P = 0.010); and low-income individuals (quartile 1) more than higher-income individuals (quartile 3, P = 0.040; quartile 4, P = 0.013). For most demographic and body weight categories, adults who were undiagnosed consumed more sugar from SSBs than adults who were diagnosed.

CONCLUSIONS

SSB consumption is high among adults with diabetes, particularly among those who are undiagnosed.

Diet quality is positively associated with 100% fruit juice consumption in children and adults in the United States: NHANES 2003-2006

BACKGROUND

One hundred percent fruit juice (100% FJ) has been viewed by some as a sweetened beverage with concerns about its effect on weight. Little regard has been given to the contribution of 100% FJ to diet quality.

METHODS

In this study data from the 2003-2006 National Health and Nutrition Examination Survey were used to examine the association of 100% FJ consumption with diet quality in participants 2-5 years of age (y) (n = 1665), 6-12 y (n = 2446), 13-18 y (n = 3139), and 19+y (n = 8861). Two 24-hour dietary recalls were used to determine usual intake using the National Cancer Institute method. Usual intake, standard errors, and regression analyses (juice independent variable and Healthy Eating Index-2005 [HEI-2005] components were dependent variables), using appropriate covariates, were determined using sample weights.

RESULTS

The percentage of participants 2-5 y, 6-12 y, 13-18 y, and 19+y that consumed 100% FJ was 71%, 57%, 45%, and 62%, respectively. Usual intake of 100% FJ (ounce [oz]/day) among the four age groups was: 5.8 ± 0.6, 2.6 ± 0.4, 3.7 ± 0.4, and 2.4 ± 0.2 for those in age groups 2-5 y, 6-12 y, 13-18 y, and 19+y, respectively. Consumption of 100% FJ was associated with higher energy intake in 6-12 y, 13-18 y, and 19+y; and higher total, saturated, and discretionary fats in 13-18 y participants. Consumption of 100% FJ was associated with higher total HEI-2005 scores in all age groups (< 0.0001). In 100% FJ consumers, total and whole fruit consumption was higher and intake of added sugars was lower in all age groups.

CONCLUSIONS

Usual intake of 100% FJ consumption exceeded MyPyramid recommendations for children 2-5 y, but was associated with better diet quality in all age groups and should be encouraged in moderation as part of a healthy diet.