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Ryan ST, Okely AD, Chong KH, Stanley RM, Randle M, Waqa G, Yamanaka AB, Guerrero RL, Coleman P, Shallcross L, Wilkens LR, Deenik JL, Novotny R. Proportion and Correlates of Children in the US-Affiliated Pacific Region Meeting Sleep, Screen Time, and Physical Activity Guidelines. J Phys Act Health 2024; 21:567-577. [PMID: 38531347 DOI: 10.1123/jpah.2023-0463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/08/2024] [Accepted: 02/10/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Limited data on 24-hour movement behaviors of children aged 5-8 years exist globally. We describe the prevalence and sociodemographic associations of meeting physical activity (PA), sedentary recreational screen time (ST), and sleep guidelines among children from 11 jurisdictions in the US-Affiliated Pacific region. METHODS Cross-sectional representative data from 1192 children aged 5-8 years living in the US-Affiliated Pacific region were drawn from the baseline 2012-2014 Children's Healthy Living Program. Sleep and moderate- to vigorous-intensity PA were calculated from accelerometry. ST and sociodemographic data were collected from caregiver surveys. The percentage of children meeting the Asia-Pacific 24-hour movement guidelines for PA (≥60 min/d of moderate- to vigorous-intensity PA), sleep (≥9 and ≤ 11 h/d) and ST (≤2 h/d) were calculated. Generalized linear mixed models were used to examine associations with adiposity and sociodemographic variables. RESULTS Twenty-seven percent (95% confidence interval, 24.6-30.0) of children met integrated guidelines; 98% (96.2-98.0) met PA, 78% (75.4-80.0) met sleep, and 35% (32.6-38.0) met ST guidelines. Females (adjusted odds ratio = 1.40 [95% confidence interval, 1.03-1.91]) and those living in lower-middle-income jurisdictions (2.29 [1.49-3.54]) were more likely to meet ST guidelines. Overweight children (0.62 [0.40-0.96]), those aged 8 years (0.39 [0.22-0.69]), and children with caregivers of an education level of high school or beyond (0.44 [0.29-0.68]) were less likely to achieve ST guidelines. Children from midrange annual household incomes were less likely to meet combined guidelines (0.60 [0.39-0.92]). CONCLUSIONS Three-quarters of children are not meeting integrated Asia-Pacific 24-hour movement guidelines. Future strategies for reducing ST and increasing integrated guidelines compliance are needed.
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Affiliation(s)
- Sarah T Ryan
- Early Start, University of Wollongong, Wollongong, NSW, Australia
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
| | - Anthony D Okely
- Early Start, University of Wollongong, Wollongong, NSW, Australia
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
| | - Kar Hau Chong
- Early Start, University of Wollongong, Wollongong, NSW, Australia
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
| | - Rebecca M Stanley
- Early Start, University of Wollongong, Wollongong, NSW, Australia
- School of Health and Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, NSW, Australia
| | - Melanie Randle
- Faculty of Business and Law, University of Wollongong, Wollongong, NSW, Australia
| | - Gade Waqa
- Pacific Research Center for the Prevention of Obesity and NCDs, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Ashley B Yamanaka
- Human Nutrition, Food and Animal Sciences Department, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | | | - Patricia Coleman
- Cooperative Research, Extension, and Education Services, Northern Marianas College, Saipan, Northern Mariana Islands
| | - Leslie Shallcross
- Institute of Agriculture, Natural Resources and Extension, University of Alaska Fairbanks, Fairbanks, AK, USA
| | | | - Jonathan L Deenik
- Tropical Plant and Soil Sciences, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Rachel Novotny
- Human Nutrition, Food and Animal Sciences Department, University of Hawai'i at Mānoa, Honolulu, HI, USA
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Sultana M, Nichols M, Jacobs J, Karacabeyli D, Allender S, Novotny R, Brown V. The range of outcomes and outcome measurement instruments collected in multisectoral community-based obesity prevention interventions in children: A systematic review. Obes Rev 2024; 25:e13731. [PMID: 38432682 DOI: 10.1111/obr.13731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 01/14/2024] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
Multicomponent and multisectoral community-based interventions (CBIs) have proven potential in preventing overweight and obesity in children. Synthesizing evidence on the outcomes collected and reported in such CBIs is critical for the evidence of effectiveness and cost-effectiveness. This systematic review aimed to identify the range of outcomes and outcome measurement instruments collected and reported in multisectoral and multicomponent CBIs for obesity prevention in children. A systematic search updated an existing review and extended the search to 11 academic databases (2017-2023) and gray literature. Outcomes were classified into outcome domains, and common measurement instruments were summarized. Seventeen outcome domains from 140 unique outcomes were identified from 45 included interventions reported in 120 studies. The most frequently collected outcome domains included anthropometry and body composition (91% of included interventions), physical activity (84%), dietary intake (71%), environmental (71%), and sedentary behavior (62%). The most frequently collected outcomes from each of these domains included body mass index (89%), physical activity (73%), fruit and vegetable intake (58%), school environment (42%), and screen time (58%). Outcome measurement instruments varied, particularly for behavioral outcomes. Standardization of reported outcomes and measurement instruments is recommended to facilitate data harmonization and support quantifying broader benefits of CBIs for obesity prevention.
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Affiliation(s)
- Marufa Sultana
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Melanie Nichols
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Jane Jacobs
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Derin Karacabeyli
- Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaii at Manoa, Honolulu, Hawaii, USA
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Victoria, Australia
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Pope KJ, Lightfoot AF, Harrison LM, Getz D, Gittelsohn J, Ward D, Hannon TS, Erinosho T. Listening to the community: identifying obesity prevention strategies for rural preschool-aged children. Front Public Health 2024; 12:1372890. [PMID: 38883193 PMCID: PMC11177876 DOI: 10.3389/fpubh.2024.1372890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024] Open
Abstract
Multi-level interventions promoting healthy weight in rural preschool children aged 2-5 years are limited. With the goal of developing a community-informed obesity prevention intervention for rural preschool-aged children, the purpose of this descriptive study was to identify: (1) community settings and intervention strategies to prioritize for an intervention; (2) potential implementation challenges and solutions; and (3) immediate interventions the study team and community partners could collaboratively implement. Workshops occurred in two rural communities in Indiana (2 workshops) and North Carolina (2 workshops), with high obesity rates. A guide was developed to moderate discussions and participants voted to rank community settings and intervention strategies. There were 9-15 participants per workshop, including parents, childcare providers, and representatives of community organizations. Community settings identified as priorities for child obesity prevention included the home, educational settings (preschools), food outlets, recreational facilities, and social media. Priority intervention strategies included providing nutrition and physical activity education, increasing access to healthy foods and physical activity in the built environment, and enhancing food security. Potential intervention implementation challenges centered on poor parental engagement; using personalized invitations and providing transportation support to families were proffered solutions. Immediate interventions to collaboratively implement focused on making playgrounds esthetically pleasing for physical activity using game stencils, and nutrition education for families via quarterly newsletters. This participatory approach with community partners provided insight into two rural communities' needs for child obesity prevention, community assets (settings) to leverage, and potential intervention strategies to prioritize. Findings will guide the development of a multi-level community-based intervention.
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Affiliation(s)
- Katherine Jochim Pope
- Department of Applied Health Science, Indiana University Bloomington, Bloomington, IN, United States
| | - Alexandra F Lightfoot
- Department of Health Behavior, North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | - Deborah Getz
- Department of Applied Health Science, Indiana University Bloomington, Bloomington, IN, United States
| | - Joel Gittelsohn
- Department of International Health, Johns Hopkins University, Baltimore, MD, United States
| | - Dianne Ward
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Tamara S Hannon
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Temitope Erinosho
- Department of Applied Health Science, Indiana University Bloomington, Bloomington, IN, United States
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Dela Cruz R, Novotny R, Wilkens LR, Shvetsov YB, Yamanaka A, Butel J, Aflague TF, Coleman P, Shallcross L, Fleming T, Deenik J, Lee R. Mapa V, Boushey CJ. Diet Quality of Young Children in the US-Affiliated Pacific's Children's Healthy Living (CHL) Program. J Acad Nutr Diet 2023; 123:1781-1792. [PMID: 37562772 PMCID: PMC10840861 DOI: 10.1016/j.jand.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 06/16/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Childhood diet can impact health outcomes over the life course. Few studies have assessed dietary quality among infants and children in the US-Affiliated Pacific (USAP) region. OBJECTIVE The aim of this study was to examine the differences in diet quality among Pacific children in the Children's Healthy Living (CHL) program by Pacific jurisdiction and by their World Bank Income Group (WBIG) level. DESIGN This cross-sectional study used dietary records collected from 2012 to 2015. PARTICIPANTS/SETTING Data were collected on 2- to 8-year-old children (n = 3,529) enrolled in the Children's Healthy Living Program for Remote Underserved Minority Populations in the Pacific region, conducted in the USAP jurisdictions of Alaska, Hawai'i, American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Guam, Federated States of Micronesia (FSM islands include Chuuk, Kosrae, Pohnpei, Yap), Republic of the Marshall Islands (RMI), and Republic of Palau. MAIN OUTCOME MEASURE Diet quality was assessed using the Healthy Eating Index-2005 (HEI-2005). This HEI version was commensurate with the time of dietary data collection for the CHL project and previous studies, thus allowing cross-study comparisons. STATISTICAL ANALYSIS PERFORMED Means of total HEI-2005 scores between jurisdictions and their WBIG level were compared using linear models, with and without adjustment for age, sex, and dietary energy. RESULTS Differences in mean HEI-2005 scores among children were found between jurisdictions and their WBIG level. Alaska had the highest adjusted mean score (63.3). RMI had the lowest adjusted mean score (50.1). By WBIG, lower-middle income jurisdictions had the lowest adjusted mean HEI-2005 score (56.0), whereas high income jurisdictions had the highest adjusted mean HEI-2005 score (60.5). CONCLUSIONS Variation in children's diet quality was found between USAP jurisdictions, notably between jurisdictions of different WBIG levels. Future research is needed to deepen understanding of these differences in diet quality by WBIG level, such as whether differences may be attributable to the jurisdictions' varying food systems, and possibly explained by the nutrition transition. Understanding childhood diet quality in this region can inform approaches for nutrition programs in the Pacific region.
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Affiliation(s)
| | | | - Lynne R. Wilkens
- University of Hawai’i at Mānoa, Honolulu, HI
- University of Hawaii Cancer Center
| | - Yurii B. Shvetsov
- University of Hawai’i at Mānoa, Honolulu, HI
- University of Hawaii Cancer Center
| | | | - Jean Butel
- University of Hawai’i at Mānoa, Honolulu, HI
| | | | | | | | - Travis Fleming
- American Samoa Community College, Pago Pago, American Samoa
| | | | | | - Carol J. Boushey
- University of Hawai’i at Mānoa, Honolulu, HI
- University of Hawaii Cancer Center
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Bertrand-Protat S, Chen J, Jonquoy A, Frayon S, Thu Win Tin S, Ravuvu A, Caillaud C, Galy O. Prevalence, causes and contexts of childhood overweight and obesity in the Pacific region: a scoping review. OPEN RESEARCH EUROPE 2023; 3:52. [PMID: 38031554 PMCID: PMC10685071 DOI: 10.12688/openreseurope.15361.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/10/2023] [Indexed: 12/01/2023]
Abstract
Background Non-communicable diseases (NCDs) are a major threat to health and development and account for 75% of deaths in the Pacific Islands Countries and Territories (PICTs). Childhood obesity has been identified as a main risk factor for NCDs later in life. This review compiled overweight and obesity (OWOB) prevalence (anthropometric data) for children aged six to 12 years old living in the Pacific region and identified possible related causes. Methods We conducted a systematic search using PubMed, Google Scholar and ScienceDirect for articles published between January 1980 and August 2022. We also searched for technical reports from Ministries of Health. Guided by the eligibility criteria, two authors independently read the selected articles and reports to extract and summarise relevant information related to overweight and obesity. Results We selected 25 articles, two worldwide analyses of population-based studies and four national reports. Information revealed that childhood OWOB prevalence reached 55% in some PICTs. This review also indicated that age, gender and ethnicity were linked to children's weight status, while dietary practices, sleep time and level of physical activity played a role in OWOB development, as well as the living environment (socio-economic status and food availability), parenting practices and education level. Conclusion This review highlighted that anthropometric data are limited and that comparisons are difficult due to the paucity of surveys and non-standardized methodology. Main causes of overweight and obesity are attributed to individual characteristics of children and behavioural patterns, children's socio-economic environment, parenting practices and educational level. Reinforcement of surveillance with standardised tools and metrics adapted to the Pacific region is crucial and further research is warranted to better understand root causes of childhood OWOB in the Pacific islands. More robust and standardized anthropometric data would enable improvements in national strategies, multisectoral responses and innovative interventions to prevent and control NCDs.
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Affiliation(s)
- Solene Bertrand-Protat
- Interdisciplinary Laboratory of Research in Education, EA 7483, University of New Caledonia, Noumea, New Caledonia
- Pacific Community, 95 Promenade Roger Laroque, Noumea, New Caledonia
| | - Juliana Chen
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Discipline of Nutrition and Dietetics, Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Aurélie Jonquoy
- Pacific Community, 95 Promenade Roger Laroque, Noumea, New Caledonia
| | - Stéphane Frayon
- Interdisciplinary Laboratory of Research in Education, EA 7483, University of New Caledonia, Noumea, New Caledonia
| | - Si Thu Win Tin
- Pacific Community, 95 Promenade Roger Laroque, Noumea, New Caledonia
| | - Amerita Ravuvu
- Pacific Community, 95 Promenade Roger Laroque, Noumea, New Caledonia
| | - Corinne Caillaud
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Discipline of Biomedical Informatics and Digital Health, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Olivier Galy
- Interdisciplinary Laboratory of Research in Education, EA 7483, University of New Caledonia, Noumea, New Caledonia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Taafaki MR, Taira D, Braun KL. Scoping Review of Interventional Studies in Chronic Disease for Native Hawaiian, Pacific Islander, and Filipino Populations in the United States. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2023; 82:58-66. [PMID: 37901666 PMCID: PMC10612424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Native Hawaiians (NHs), Pacific Islanders (PIs), and Filipinos experience health disparities in the United States (US) and need interventions that work for them. The purpose of this paper is to present a review of interventions designed to address chronic disease in Native Hawaiian, Pacific Islander, and Filipino populations in the US that were tested for clinical impact through a randomized controlled trial (RCT). Articles were identified through a search of 4 databases, citation chasing, and colleagues. The 23 included articles reported on 21 interventions addressing 4 chronic conditions-cancer, obesity, cardiovascular disease, and diabetes. All projects were guided by advisory groups, and all interventions were theory-based and tailored to the population, with culturally- and language-appropriate educational materials delivered by same-race individuals in familiar church, club, or home settings. About half were tested through cluster RCT. The majority of the interventions were successful, confirming the value of developing and delivering interventions in partnership with community. Given the growing numbers of NHs, PIs, and Filipinos in the US, more investigational studies are needed to develop and test culturally tailored and grounded interventions that meet the health needs of these populations.
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Affiliation(s)
- Munirih R. Taafaki
- John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI (MRT)
| | - Deborah Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai’i at Hilo, Hilo, HI (DT)
| | - Kathryn L. Braun
- Thompson School of Social Work & Public Health, University of Hawai’i at Mānoa, Honolulu, HI (KLB)
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Smith T, Chong KH, Cross P, Ipil M, Eliou P, Novotny R, Okely AD. Prevalence and socio-demographic distributions of meeting RMI Guidelines for Healthy Living among elementary school children in Majuro, Republic of Marshall Islands: a cross-sectional population-based survey. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 37:100783. [PMID: 37693881 PMCID: PMC10485679 DOI: 10.1016/j.lanwpc.2023.100783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/14/2023] [Accepted: 04/18/2023] [Indexed: 09/12/2023]
Abstract
Background Childhood obesity is high in Republic of Marshall Islands (RMI). We report the prevalence and socio-demographic distribution of selected obesity-related risk factors among children in Majuro, RMI. Methods Sixteen elementary schools were approached and students and parents in Grades 1, 3, and 5 invited to participate in this cross-sectional population-based survey. Accelerometry and a questionnaire were used to collect data on children's physical activity (PA), sleep, screen time and dietary behaviours. Descriptive statistics and mixed-effects logistic regression were used to examine differences in the proportions of children meeting selected RMI Healthy Living Guidelines by sex, school grade and school sector. Findings Thirteen schools and 958 children were recruited, of which 892 (52.2% girls; mean age 9.3 ± 1.8 years) provided useable data. Around 90% met the PA, 29% screen time, 13% sleep, 69% sugar-sweetened beverage and 56% highly processed food guidelines. The proportion meeting individual guidelines was higher among children in Grade 1 compared with Grade 5. Being a girl (0.27; 95% CI 0.16, 0.46) was associated with lower odds of meeting the PA recommendation. Compared with children from Grade 1, those in Grade 5 had lower odds of meeting the PA (0.28; 95% CI 0.15, 0.55), screen time (0.60; 95% CI 0.40, 0.89), sleep duration (0.33; 95% CI 0.18, 0.59), sugar-sweetened beverage (0.35; 95% CI 0.23, 0.53), and consumption of highly processed foods recommendations (0.49; 95% CI 0.33, 0.72). Interpretation While most children in RMI are adequately active, resources are needed to promote healthier levels of screen time, sleep, sugar-sweetened beverage and highly processed food consumption, especially among older children. Funding This study was funded by World Diabetes Foundation; Canvasback Missions, RMI; NHMRC Australia (APP1176858); Pacific Community.
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Affiliation(s)
- Tanner Smith
- Canvasback Missions Inc., P.O. Box 1771, Majuro, 96960, Marshall Islands
| | - Kar Hau Chong
- Early Start, School of Health and Society, Faculty of the Arts, Social Science and Humanities, University of Wollongong, NSW, 2522, Australia
| | - Penny Cross
- Early Start, School of Health and Society, Faculty of the Arts, Social Science and Humanities, University of Wollongong, NSW, 2522, Australia
| | - Maybelline Ipil
- Marshall Islands Epidemiology & Prevention Initiatives (MIEPI), P.O. Box 3666, Majuro, 96960, Marshall Islands
| | - Pranson Eliou
- RMI Public School System, State Department of Education, P.O. Box 3, Majuro, 96960, Marshall Islands
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI, 96822, USA
| | - Anthony D. Okely
- Early Start, School of Health and Society, Faculty of the Arts, Social Science and Humanities, University of Wollongong, NSW, 2522, Australia
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George EA, Nwankwo C, Castelo-Soccio L, Oboite M. Disorders in Children. Dermatol Clin 2023; 41:491-507. [PMID: 37236717 DOI: 10.1016/j.det.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Pediatric dermatoses can present at birth or develop over time. When managing dermatology conditions in children, caregiver involvement is important. Patients may have lesions that need to be monitored or need assistance with therapeutic administration. The following section provides a subset of pediatric dermatoses and notable points for presentation in skin of color patients. Providers need to be able to recognize dermatology conditions in patients of varying skin tones and provide therapies that address the condition and any associated pigmentary alterations.
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Affiliation(s)
| | - Christy Nwankwo
- University of Missouri, Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA
| | - Leslie Castelo-Soccio
- National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Michelle Oboite
- University of Pennsylvania, Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA; Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Ing CT, Clemens B, Ahn HJ, Kaholokula JK, Hovmand PS, Seto TB, Novotny R. Food Insecurity and Blood Pressure in a Multiethnic Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6242. [PMID: 37444090 PMCID: PMC10341426 DOI: 10.3390/ijerph20136242] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
Food insecurity is a social determinant of health and is increasingly recognized as a risk factor for hypertension. Native Hawaiians bear a disproportionate burden of hypertension and known risk factors. Despite this, the relative effects of food insecurity and financial instability on blood pressure have yet to be investigated in this population. This study examines the relative effects of food insecurity and financial instability on blood pressure, controlling for potential confounders in a multiethnic sample. Participants (n = 124) were recruited from a U.S. Department of Agriculture-funded study called the Children's Healthy Living Center of Excellence. Biometrics (i.e., blood pressure, weight, and height) were measured. Demographics, physical activity, diet, psychosocial variables, food insecurity, and financial instability were assessed via self-report questionnaires. Hierarchical linear regression models were conducted. Model 1, which included sociodemographic variables and known biological risk factors, explained a small but significant amount of variance in systolic blood pressure. Model 2 added physical activity and daily intake of fruit, fiber, and whole grains, significantly improving the model. Model 3 added financial instability and food insecurity, further improving the model (R2 = 0.37, F = 2.67, p = 0.031). Food insecurity, female sex, and BMI were significantly and independently associated with increased systolic blood pressure. These results suggest a direct relationship between food insecurity and systolic blood pressure, which persisted after controlling for physical activity, consumption of fruits, fiber, and whole grains, and BMI. Efforts to reduce food insecurity, particularly among Native Hawaiians, may help reduce hypertension in this high-risk population.
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Affiliation(s)
- Claire Townsend Ing
- Department of Native Hawaiian Health, University of Hawaii at Mānoa, 677 Ala Moana Boulevard, Honolulu, HI 96813, USA
| | - Brettany Clemens
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Mānoa, 2528 McCarthy Mall, Honolulu, HI 96822, USA
| | - Hyeong Jun Ahn
- Department of Complementary & Integrative Medicine, University of Hawaii at Mānoa, 651 Ilalo Street, Honolulu, HI 96813, USA
| | | | - Peter S. Hovmand
- Center for Community Health Integration, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Todd B. Seto
- Cardiovascular Diseases, Queen’s Medical Center, 550 S Beretania Street, Honolulu, HI 96813, USA
| | - Rachel Novotny
- Human Nutrition, Food and Animal Sciences, University of Hawaii at Mānoa, 1955 East-West Road, Honolulu, HI 96822, USA
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Esquivel MK, Aflague TF, Yamanaka AB, Guerrero RTL, Coleman P, Fialkowski MK, Shallcross L, Fleming T, Davis J, Boushey CJ, Wilkens LR, Braun K, Novotny R. Children's Dietary Intake by Early Care and Education Setting in the US Affiliated Pacific. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:437-446. [PMID: 37029080 PMCID: PMC10353568 DOI: 10.1016/j.jneb.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Examine differences in dietary intake of children aged 2-5 years in early care and education (ECE) setting in the US Affiliated Pacific (USAP). DESIGN Secondary analysis of cross-sectional data collected by the Children's Healthy Living program. PARTICIPANTS Children (n = 1,423) with complete dietary records and information on the ECE setting. MAIN OUTCOME MEASURES Dietary intake by ECE setting; Head Start (HS), other ECE (OE), and no ECE. ANALYSIS Comparison of mean dietary intake across ECE settings and multivariate logistic regression to evaluate ECE setting and likelihood for meeting dietary reference intake (DRI). RESULTS Children in HS and OE settings had a significantly higher intake of several food groups and nutrients, compared with no ECE; vegetables (0.4 cup-equivalents per thousand kcals [CETK] vs 0.3 CETK; P < 0.001), fruits (0.8 CETK vs 0.6 CETK; P = 0.001), milk (0.9 CETK for HS and 1.0 CETK for OE vs 0.8 CETK; P < 0.001). Sixty-five percent of the HS group met DRI and had greater odds of meeting calcium DRI (odds ratio, 1.8; 95% confidence interval, 1.2-2.7) compared with other groups. The OE group had the lowest proportion of children meeting recommended intakes for 19 out of 25 nutrients. CONCLUSIONS AND IMPLICATIONS Mean intakes of foods and nutrients for children across the USAP meet some, but not all, recommendations and intakes vary across children attending various ECE setting types. Additional research on the clinical importance of these differences and the impact of the complex food systems in the USAP may identify systematic strategies for improving diet among children.
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Affiliation(s)
- Monica Kazlausky Esquivel
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI.
| | - Tanisha F Aflague
- Consumer and Family Sciences, College of Natural and Applied Sciences, University of Guam, Mangilao, Guam
| | - Ashley B Yamanaka
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI
| | | | - Patricia Coleman
- Cooperative Research, Extension, and Education Services, Northern Marianas College, Saipan, Marianas Pacific
| | - Marie Kainoa Fialkowski
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI
| | - Leslie Shallcross
- Natural Resources and Extension, University of Alaska Fairbanks Institute of Agriculture, Fairbanks, AK
| | - Travis Fleming
- Agriculture, Community and Natural Resources Division, American Samoa Community College, Pago Pago, American Samoa
| | - James Davis
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI
| | - Carol J Boushey
- Nutrition Support Shared Resources, University of Hawai'i Cancer Center, Honolulu, HI
| | - Lynne R Wilkens
- Biostatistics Shared Resource, University of Hawai'i Cancer Center, Honolulu, HI
| | - Kathryn Braun
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI
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11
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Obita G, Alkhatib A. Effectiveness of Lifestyle Nutrition and Physical Activity Interventions for Childhood Obesity and Associated Comorbidities among Children from Minority Ethnic Groups: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15112524. [PMID: 37299488 DOI: 10.3390/nu15112524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Lifestyle physical activity (PA) and nutrition are known to be effective interventions in preventing and managing obesity-related comorbidities among adult populations but less so among children and adolescents. We examined the effectiveness of lifestyle interventions in children from minority ethnic populations in Western high-income countries (HICs). Our systematic review included 53 studies, involving 26,045 children from minority ethnic populations who followed lifestyle intervention programmes lasting between 8 weeks and 5 years with the aim of preventing and/or managing childhood obesity and associated comorbidities, including adiposity and cardiometabolic risks. The studies were heterogenous in terms of lifestyle intervention components (nutrition, PA, behavioural counselling) and settings (community vs. schools and after-school settings). Our meta-analysis included 31 eligible studies and showed no significant effects of lifestyle interventions when they focused on body mass index (BMI) outcomes (pooled BMI mean change = -0.09 (95% CI = -0.19, 0.01); p = 0.09). This was irrespective of the intervention programme duration (<6 months vs. ≥6 months), type (PA vs. nutrition/combined intervention) and weight status (overweight or obese vs. normal weight) as all showed nonsignificant effects in the sensitivity analysis. Nonetheless, 19 of the 53 studies reported reductions in BMI, BMI z-score and body fat percentage. However, the majority of lifestyle interventions adopting a quasi-design with combined primary and secondary obesity measures (11 out of 15 studies) were effective in reducing the obesity comorbidities of cardiometabolic risks, including metabolic syndrome, insulin sensitivity and blood pressure, in overweight and obese children. Preventing childhood obesity in high-risk ethnic minority groups is best achieved using combined PA and nutrition intervention approaches, which jointly target preventing obesity and its comorbidities, especially the outcomes of diabetes, hypertension and cardiovascular disease. Therefore, public health stakeholders should integrate cultural and lifestyle factors and contextualise obesity prevention strategies among minority ethnic groups in Western HICs.
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Affiliation(s)
- George Obita
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough TS1 3BX, UK
| | - Ahmad Alkhatib
- School of Health and Life Sciences, Teesside University, Tees Valley, Middlesbrough TS1 3BX, UK
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12
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Yamanaka AB, Strasburger S, Chow C, Butel J, Wilkens L, Davis JD, Deenik J, Shallcross L, Novotny R. Food and Physical Activity Environment in the US-Affiliated Pacific Region: The Children's Healthy Living Program. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:96-104. [PMID: 36372662 DOI: 10.1016/j.jneb.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To describe the quality of food and physical activity (PA) environments by World Bank Income level in jurisdictions from the Children's Healthy Living Program. DESIGN Baseline cross-sectional community data were analyzed from 11 jurisdictions categorized by World Bank Income levels to describe exposure to different food and PA outlets. The Children's Healthy Living Program was a multilevel, multijurisdictional prevalence study and community intervention trial that reduced child obesity in the US-Affiliated Pacific region. SETTING US-Affiliated Pacific region. PARTICIPANTS Food (n = 426) and PA (n = 552) Outlets. MAIN OUTCOME MEASURES Physical activity and food scores that reflect the quality of the outlets that support being physically active and healthy eating options, respectively. ANALYSIS Descriptive statistics are presented as means ± SD or percentages. RESULTS High-income-income level jurisdictions had higher food and PA scores than middle-income level jurisdictions. CONCLUSIONS AND IMPLICATIONS The US-Affiliated Pacific region has limited quality food and PA outlets in underserved communities at risk for obesity. The findings in this paper can be used to develop tools and design interventions to improve the food and PA environment to increase a healthier, active lifestyle.
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Affiliation(s)
- Ashley B Yamanaka
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawai'i at Manoa, Honolulu, HI.
| | - Sabine Strasburger
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawai'i at Manoa, Honolulu, HI
| | - Courtney Chow
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawai'i at Manoa, Honolulu, HI
| | - Jean Butel
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawai'i at Manoa, Honolulu, HI
| | - Lynne Wilkens
- Biostatistics and Informatics Shared Resource, University of Hawai'i Cancer Center, Honolulu, HI
| | - James D Davis
- Department of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu, HI
| | - Jonathan Deenik
- Department of Tropical Plant and Soil Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Manoa, Honolulu, HI
| | - Leslie Shallcross
- Health, Home and Family Development, Institute of Agriculture, Natural Resources and Extension, University of Alaska, Fairbanks, AK
| | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawai'i at Manoa, Honolulu, HI
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13
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Novotny R, Yamanaka AB, Dela Cruz R, Strasburger S, Boushey CJ, Butel J, Esquivel M, Aflague TF, Fleming T, Coleman P, Deenik J, Shallcross L, Wilkens LR. Food Group, Macronutrient Intake, and Metabolic Status in the US-Affiliated Pacific's Children's Healthy Living (CHL) Program. J Nutr 2023; 152:2898-2912. [PMID: 35927738 PMCID: PMC9839993 DOI: 10.1093/jn/nxac173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/17/2022] [Accepted: 08/02/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The Children's Healthy Living study provided dietary intake information for understudied Native Hawaiian and Other Pacific Islander (NHOPI) young children. OBJECTIVES Our objective was to describe food group and macronutrient intakes of NHOPI children in the US-Affiliated Pacific region (USAP), overall and by jurisdiction, income level, and metabolic status. METHODS We evaluated 2-8-y-olds (n = 3520) in a cross-sectional cluster sampled study using 2 d of dietary records completed by caregivers using provided tools, quantified by a specially developed food composition table and compared with US dietary recommendations. Overweight and obesity (OWOB) and acanthosis nigricans (AN) assessment (metabolic status) was completed by trained evaluators using standard tools. Demographic data were collected by questionnaire. Regression analysis identified differences in dietary component means by jurisdiction, World Bank income groups (WBIGs), and metabolic status, adjusted for age and sex. RESULTS Few children met US recommendations for vegetable (2.4%) and milk (4.1%) food groups. US macronutrient recommendations were generally met. Food group and macronutrient intakes were significantly different by jurisdiction and WBIG. Means for food groups, except meats, and macronutrients, except protein, were higher in overweight/obese (OWOB) compared with healthy-weight children. Grain intake of 7.25 (SE: 0.08) oz was higher (P < 0.05) and milk intake of 0.90 (SE: 0.05) cups was lower (P < 0.05) in children with OWOB compared with those without OWOB [grains: 7.17 (SE: 0.07) oz; and milk: 0.96 (SE: 0.04) cups]. Monounsaturated fat intake of 11.68 (SE: 0.10) % energy was higher in those with OWOB, compared with healthy-weight children [11.56 (SE: 0.08) % energy, P < 0.05]. CONCLUSIONS Young children's diets in the USAP did not meet milk, vegetable, or fruit intake recommendations. There was variability in dietary patterns across the USAP and by WBIG. Grain intake and monounsaturated fat intake were lower and milk intake was higher in children with better metabolic status.
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Affiliation(s)
- Rachel Novotny
- Human Nutrition, Food and Animal Sciences Department, University of Hawaii at Manoa, Honolulu HI, Hawai ʻi
| | - Ashley B Yamanaka
- Human Nutrition, Food and Animal Sciences Department, University of Hawaii at Manoa, Honolulu HI, Hawai ʻi
| | - Rica Dela Cruz
- Human Nutrition, Food and Animal Sciences Department, University of Hawaii at Manoa, Honolulu HI, Hawai ʻi
| | - Sabine Strasburger
- Human Nutrition, Food and Animal Sciences Department, University of Hawaii at Manoa, Honolulu HI, Hawai ʻi
| | | | - Jean Butel
- Human Nutrition, Food and Animal Sciences Department, University of Hawaii at Manoa, Honolulu HI, Hawai ʻi
| | - Monica Esquivel
- Human Nutrition, Food and Animal Sciences Department, University of Hawaii at Manoa, Honolulu HI, Hawai ʻi
| | | | | | | | - Jonathan Deenik
- Human Nutrition, Food and Animal Sciences Department, University of Hawaii at Manoa, Honolulu HI, Hawai ʻi
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14
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Ghofranipour F, Hamzavi Zarghani N, Mohammadi E, Mehrizi AAH, Tavousi M, De Craemer M, Cardon G. An internet-based educational intervention for mothers targeting preschoolers' weight management promotion (PWMP): a pilot study. BMC Public Health 2022; 22:2220. [PMID: 36447163 PMCID: PMC9707417 DOI: 10.1186/s12889-022-14543-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 11/03/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The prevalence of overweight and obesity among children has raised public health concerns. This study aimed to design and evaluate a behaviour change intervention program to promote weight management among Tehranian preschoolers. METHODS The PRECEDE-PROCEED model is one of the most popular models in health education used to develop and evaluate most educational interventions. In this one-group pre and post-pilot study, 13 mothers of preschoolers were recruited from preschools in Tehran (the capital of Iran), in August 2020. Mothers received a six-week educational intervention, including text messages and educational videos via WhatsApp, to increase their self-efficacy to overcome barriers changing their children's lifestyle. Mothers reported preschoolers' height and weight to assess Body Mass Index and filled out the Food Frequency Questionnaire, the Persian version of the children's health-related quality of life questionnaire, and demographic features. The "Children's physical activity and sedentary behaviors checklist," newly designed by the researchers, was also filled out by mothers. These behaviors were measured according to the minutes that children were involved in these activities in a day, and the days they spent in a week for them. All variables were measured at baseline, immediately after the intervention and three months later. Data analysis was performed using SPSS IBM statistics version 22. Friedman test was used to evaluate changes over time. RESULTS The findings demonstrated that the mean BMI z-score stayed steady between baseline, immediately after the intervention and after three months (P = 0.60). Besides, after three months, the intervention programme led to a decrease in soft drink consumption (P = 0.001), and an increase in parental perception of their child's general health (P = 0.05), the parental concern regarding their child's emotional and physical health (P = 0.002) and minutes of physical activity per day (P = 0.02). However, fruit intake decreased (P = 0.01), and simple sugar, such as cube, increased (P = 0.03). CONCLUSION Results from this study are promising but should be interpreted with caution and should be replicated on a larger scale and compared with a control group to evaluate whether effects are maintained in a larger sample.
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Affiliation(s)
- Fazlollah Ghofranipour
- grid.412266.50000 0001 1781 3962Department of Health Education and Health Promotion, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Najmeh Hamzavi Zarghani
- grid.412266.50000 0001 1781 3962Department of Health Education and Health Promotion, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Eesa Mohammadi
- grid.412266.50000 0001 1781 3962Department of Nursing, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
| | - Ali Asghar Haeri Mehrizi
- grid.417689.5Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Mahmoud Tavousi
- grid.417689.5Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Marieke De Craemer
- grid.5342.00000 0001 2069 7798Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
| | - Greet Cardon
- grid.5342.00000 0001 2069 7798Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium
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15
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Pollock S, Swamy MR, Tremblay ES, Shen L. Acanthosis nigricans in the pediatric population: a narrative review of the current approach to management in primary care. PEDIATRIC MEDICINE (HONG KONG, CHINA) 2022; 5:42. [PMID: 36420374 PMCID: PMC9678372 DOI: 10.21037/pm-21-70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Objective This narrative review aims to provide readers with a comprehensive overview of the current literature of acanthosis nigricans (AN) in the pediatric and adolescent population, including best practices for identifying the condition, with a focus on the recommended management in the primary care setting to enable early and enhanced intervention. Background AN is frequently seen in obese and overweight children and adolescents. Current research suggests an association with insulin resistance, type 2 diabetes mellitus, and obesity, and often primary care physicians are the first point of contact for individuals with this dermatologic condition. However, identifying the condition at an early stage may be difficult. Methods We identified case and cross-sectional studies, clinical trials, and literature reviews of pediatric AN for ages 0 to 18 years in the United States and internationally. We considered publications for background from before the year 2000 and publications for approach to management from after the year 2000. Conclusions AN in the pediatric population can be a harbinger for underlying metabolic syndrome and insulin resistance. A thorough investigation and appropriate screening of children at risk, with a focus on early identification of the dermatologic condition and its associated comorbidities in the primary care setting, and early treatment is recommended to prevent long term consequences and decrease the risk of cardiovascular complications.
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Affiliation(s)
- Samara Pollock
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | | | | | - Lisa Shen
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
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16
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Victorino CA, Faria JCP, Sawamura LS, de Souza FIS, Sarni ROS. Association between acanthosis nigricans and overweight with hypertension in children and adolescents from low-income families. Rev Assoc Med Bras (1992) 2022; 68:1721-1725. [PMID: 36449800 PMCID: PMC9779977 DOI: 10.1590/1806-9282.20220852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/03/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to describe the prevalence of acanthosis nigricans and high blood pressure in children and adolescents from low-income families, and to verify the association of elevated blood pressure with nutritional status and the presence of acanthosis nigricans. METHODS This is a cross-sectional and controlled study with 232 children and adolescents from an institution for low-income families. Pubertal stage, body mass index Z-score, waist-to-height circumference ratio (increased waist-to-height circumference ratio >0.5), the presence of acanthosis nigricans, and blood pressure were assessed. RESULTS The prevalence of excess weight and the change in waist-to-height circumference ratio was 37.9%. Acanthosis nigricans and increased blood pressure occurred in 20.3 and 34.8%, respectively. The prevalence of acanthosis nigricans and hypertension was higher in individuals with excess weight (p<0.001; p<0.001) and with an increased waist-to-height circumference ratio (p=0.009; p<0.001). Logistic regression showed a significant and independent association of body mass index Z-score (OR 2.35; 95%CI 1.52-3.65; p<0.001) and the presence of acanthosis nigricans (OR 2.43; 95%CI 1.12-5.23; p=0.023) with elevated blood pressure. CONCLUSION Acanthosis nigricans and elevated blood pressure occurred in one-fifth and one-third of the individuals in an institution for children from low-income families. Overweight and the presence of acanthosis nigricans increased the risk of high blood pressure more than twofold.
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Affiliation(s)
- Camila Augusta Victorino
- Centro Universitário Faculdade de Medicina do ABC – Santo André (SP), Brazil.,Universidade Nove de Julho – São Paulo (SP), Brazil
| | - João Carlos Pina Faria
- Centro Universitário Faculdade de Medicina do ABC – Santo André (SP), Brazil.,Universidade Nove de Julho – São Paulo (SP), Brazil.,Corresponding author:
| | - Luciana Satiko Sawamura
- Centro Universitário Faculdade de Medicina do ABC – Santo André (SP), Brazil.,Universidade Municipal de São Caetano do Sul – São Caetano do Sul (SP), Brazil
| | - Fabíola Isabel Suano de Souza
- Centro Universitário Faculdade de Medicina do ABC – Santo André (SP), Brazil.,Universidade Federal de São Paulo – São Paulo (SP), Brazil
| | - Roseli Oselka Saccardo Sarni
- Centro Universitário Faculdade de Medicina do ABC – Santo André (SP), Brazil.,Universidade Federal de São Paulo – São Paulo (SP), Brazil
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17
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Yin Z, Liang Y, Howard JT, Errisuriz V, Estrada VM, Martinez C, Li S, Ullevig S, Sosa E, Olmstead T, Small S, Ward DS, Parra-Medina D. ¡Míranos! a Comprehensive Preschool Obesity Prevention Program in Low-Income Latino Children: One-year Results of a Clustered Randomized Controlled Trial. Public Health Nutr 2022; 26:1-26. [PMID: 36357340 PMCID: PMC10172390 DOI: 10.1017/s1368980022002439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Test a culturally tailored obesity prevention intervention in low-income, minority preschool-age children. DESIGN A three-group clustered randomized controlled trial. SETTING Twelve Head Start Centers were randomly assigned to a center-based intervention, a combined center- and home-based intervention, or control using a 1:1:1 ratio. The center-based intervention modified center physical activity and nutrition policies, staff practices, and child behaviors, while the home-based intervention supported parents for obesity prevention at home. STUDY OUTCOMES The primary endpoint was change in children's body mass index (BMI; kg/m2) at posttest immediately following completion of the 8-month intervention. Secondary endpoints included standardized scores for BMI (BMIz) and body weight (WAZ), and BMI percentiles (BMI pctl). PARTICIPANTS Three-year-old children enrolled in Head Start in San Antonio, Texas, with written parent consent (N=325), 87% Latino; 57% female with mean age (SD) of 3.58 years (0.29). RESULTS Change in BMI at posttest was 1.28 (0.97), 1.28 (0.87), and 1.41 (0.71) in the center+home-based intervention, center-based intervention, and control, respectively. There was no significant difference in BMI change between center+home-based intervention and control or center-based intervention and control at posttest. BMIz (adjusted difference -0.12 [95% CI, -0.24 to 0.01], p = .06) and WAZ (adjusted difference, -0.09 [-0.17 to -0.002], p = .04) were reduced for children in center+home-based intervention compared to control group. CONCLUSIONS There was no reduction in BMI at posttest in children who received the intervention. Findings shed light on methodological challenges in childhood obesity research and offer future directions to explore health equity-oriented obesity prevention.
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Affiliation(s)
- Zenong Yin
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Yuanyuan Liang
- The University of Maryland, School of Medicine, Department of Epidemiology and Public Health, Baltimore, Maryland, USA
| | - Jeffrey T. Howard
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Vanessa Errisuriz
- The University of Texas at Austin, Latino Research Institute, Austin, Texas, USA
| | - Vanessa Marie Estrada
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Cristina Martinez
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Shiyu Li
- UT Health San Antonio, School of Nursing, San Antonio, Texas, USA
| | - Sarah Ullevig
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Erica Sosa
- The University of Texas at San Antonio, Department of Public Health, HCaP, San Antonio, Texas, USA
| | - Todd Olmstead
- The University of Texas at Austin, LBJ School of Public Affairs, Texas, USA
| | - Sharon Small
- Parent/Child Incorporated of San Antonio and Bexar County, San Antonio, Texas, USA
| | - Dianne Stanton Ward
- Department of Nutrition Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, USA
| | - Deborah Parra-Medina
- The University of Texas at Austin, Latino Research Institute, Austin, Texas, USA
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18
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Afify AA, Fathy G, Elzawahry M, Taha SI. Assessment of serum chemerin levels in acanthosis nigricans: A case-control study. J Cosmet Dermatol 2022; 21:6414-6421. [PMID: 35976067 DOI: 10.1111/jocd.15311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/13/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Acanthosis nigricans (AN) is an asymptomatic skin condition linked to several underlying systemic conditions. Chemerin is an adipokine that increases during inflammatory disorders such as metabolic syndrome (MetS). AIMS This case-control study investigates the link between AN and the underlying MetS and serum levels of chemerin in individuals with obesity. PATIENTS/METHODS Twenty-five adults with AN and obesity (body mass index [BMI] > 30 kg/m2 ), 25 adults with obesity but no AN, and 25 healthy controls (BMI < 30 kg/m2 ) had their lipid profiles and serum chemerin concentrations examined. RESULTS The neck (80.0%) and axilla (68.0%) were the most common sites of AN. In participants with obesity, either alone or with AN, serum chemerin concentrations were significantly higher than in the control group (p < 0.001). Participants with obesity and AN had significantly higher levels of cholesterol, triglycerides (TG), low-density lipoprotein cholesterol (LDL-c), and serum chemerin levels (p < 0.001), and significantly lower high-density lipoprotein cholesterol (HDL-c) levels (p < 0.001) when compared to participants with obesity alone. All participants with obesity and AN (100%) and 88% of those with obesity alone had MetS. Logistic regression revealed that systolic blood pressure >130 mmHg, diastolic blood pressure >85 mmHg, waist circumference >90 cm, TG >150 mg/dl, HDL-c <45 mg/dl, fasting blood glucose >100 mg/dl, and serum chemerin >300 ng/ml were significant (p < 0.05) risk factors for AN. CONCLUSIONS Acanthosis nigricans is a non-invasive and reliable sign of the underlying MetS and increased serum chemerin levels among individuals with obesity.
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Affiliation(s)
- Ahmed Abdelfattah Afify
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ghada Fathy
- Dermatology, Venereology and Andrology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Sara Ibrahim Taha
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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19
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Dela Cruz R, Wolfe E, Yonemori KM, Fialkowski MK, Wilkens LR, Coleman P, Lameko-Mua S, Johnson E, Gilmatam D, Sigrah C, Shomour M, Remengesau S, Alfred J, Acosta M, Ettienne R, Deenik J, Tanisha A, Salazar KA, Novotny R, Boushey CJ. Exploring Foods of the Pacific: Cultural Food Identity in the US Affiliated Pacific Region. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:247-252. [PMID: 36118154 PMCID: PMC9460762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Indigenous peoples of the Pacific have seen major shifts in dietary patterns due to foreign colonization, which introduced an array of new foods. Today, foods considered traditional and acculturated are consumed in various extents. However, the definitions and identity of traditional versus acculturated foods has become unclear as many introduced foods have been incorporated into Pacific cultures. The purpose of this study was to capture culturally relevant definitions of traditional, acculturated, and locally grown foods among 10 jurisdictions of the US-Affiliated Pacific (USAP) region with a focus on fruits and vegetables. Questionnaires were used to capture definitions of these terms, and to identify a list of foods (n=121) as traditional, acculturated, and/or locally grown in addition to classify them into food groups (ie, fruit, vegetable, starch, and/or grain). For the most part, definitions of traditional, acculturated, and locally grown were agreed upon by participating USAP jurisdictions, with some supplementary caveats presented by different jurisdictions. More foods were identified as acculturated (n=75) than traditional (n=37). Fruits (n=55) were the most frequent designation and about a third were vegetables (n=44). The majority of the jurisdictions reported growing at least half of the food items. This is the first study to identify and classify foods of the Pacific from the perspective of those indigenous to the USAP region. Understanding these similarities and differences in how food is classified and identified, through the lens of those from the Pacific, is crucial for nutrition education, and understanding what foods are locally grown is important for future sustainability.
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Affiliation(s)
- Rica Dela Cruz
- University of Hawai‘i Cancer Center, Honolulu, HI (RDC, EW, KMY, LRW, KAS, CJB)
| | - Eric Wolfe
- University of Hawai‘i Cancer Center, Honolulu, HI (RDC, EW, KMY, LRW, KAS, CJB)
| | - Kim M. Yonemori
- University of Hawai‘i Cancer Center, Honolulu, HI (RDC, EW, KMY, LRW, KAS, CJB)
| | - Marie K. Fialkowski
- University of Hawai‘i, College of Tropical Agriculture and Human Resources, Honolulu, HI (MKF, JD, RN)
| | - Lynne R. Wilkens
- University of Hawai‘i Cancer Center, Honolulu, HI (RDC, EW, KMY, LRW, KAS, CJB)
| | - Patricia Coleman
- Northern Marianas College, Saipan, Northern Mariana Islands (PC)
| | | | - Emihner Johnson
- Island Food Community of Pohnpei, Pohnpei, Federated States of Micronesia (EJ)
| | - Daisy Gilmatam
- Yap Health Services, Yap, Federated States of Micronesia (DG)
| | - Cecilia Sigrah
- Kosrae Community Health Center, Kosrae, Federated States of Micronesia (CS)
| | - Moria Shomour
- Chuuk State Division of Public Health, Federated States of Micronesia (MS)
| | | | - Julia Alfred
- Ministry of Health, Majuro, Republic of the Marshall Islands (JA)
| | | | | | - Jonathan Deenik
- University of Hawai‘i, College of Tropical Agriculture and Human Resources, Honolulu, HI (MKF, JD, RN)
| | | | | | - Rachel Novotny
- University of Hawai‘i, College of Tropical Agriculture and Human Resources, Honolulu, HI (MKF, JD, RN)
| | - Carol J. Boushey
- University of Hawai‘i Cancer Center, Honolulu, HI (RDC, EW, KMY, LRW, KAS, CJB)
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20
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Güven M, Anık A, Ünüvar T, İlgün Gürel D, Şendur N. Cutaneous manifestations of obesity in Turkish children: A comparative study. Pediatr Dermatol 2022; 39:513-519. [PMID: 35285075 DOI: 10.1111/pde.14978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cutaneous changes in obese adults have been investigated in numerous studies, but this issue has not been adequately investigated in children. OBJECTIVES We aimed to determine the prevalence of skin manifestations in children with obesity by comparing them to normal-weight children. METHODS A cross-sectional study was conducted between June 2017 and January 2019 in which 82 children with obesity and 86 normal-weight healthy control children were enrolled. Study participants had detailed full-body skin examinations performed by the same dermatologist; mycological and Wood's lamp examinations were performed when necessary. Sociodemographic and anthropometric measurements of the participants were recorded. RESULTS Striae distensae were the most common skin manifestation in children with obesity; striae were significantly higher in the obese than in the control group (72% vs. 26.7%, p < .001). The anatomical distribution of the striae distensae in the groups differed significantly. Striae distensae were most commonly observed on the buttocks in the control group, while the thighs were the most common site in the obese group. Acanthosis nigricans (63.4% vs. 3.5%, p < .001), acrochordons (17.1% vs. 1.2%, p < .001), keratosis pilaris (32.9% vs. 17.4%, p = .021), intertrigo (11% vs. 0%, p = .001), folliculitis (31.7% vs. 5.8%, p < .001), seborrheic dermatitis (12.2% vs. 3.5%, p = .035) and facial erythema (7.3% vs. 0%, p = .012) were found to be statistically significantly more common in the obese group compared to the control group. CONCLUSIONS Obesity in children is associated with numerous cutaneous manifestations. Further study is needed to identify whether weight loss can reduce skin manifestations in obese children.
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Affiliation(s)
- Münevver Güven
- Department of Dermatology, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Ahmet Anık
- Department of Pediatric Endocrinology, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Tolga Ünüvar
- Department of Pediatric Endocrinology, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Deniz İlgün Gürel
- Department of Pediatrics, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Neslihan Şendur
- Department of Dermatology, Aydın Adnan Menderes University Faculty of Medicine, Aydın, Turkey
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21
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Bonuck K, Collins-Anderson A, Schechter CB, Felt BT, Chervin RD. Effects of a Sleep Health Education Program for Children and Parents on Child Sleep Duration and Difficulties: A Stepped-Wedge Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2223692. [PMID: 35881396 PMCID: PMC9327577 DOI: 10.1001/jamanetworkopen.2022.23692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
IMPORTANCE Preschool-aged children often lack sufficient sleep and experience sleep difficulties. A consistent bedtime routine, falling asleep alone, and other sleep practices reduce difficulties and increase sleep duration. OBJECTIVE To evaluate the effects of a preschool-based sleep health literacy program on children's sleep duration and difficulties and on parent sleep knowledge, attitudes, self-efficacy, and beliefs 9 and 12 months after the program. DESIGN, SETTING, AND PARTICIPANTS This stepped-wedge cluster randomized clinical trial was implemented across the 2018-2019 school year. Head Start preschool personnel delivered interventions and collected outcomes data at baseline and 4 follow-ups. Seven Head Start agencies across New York State were randomized to implement interventions in either fall 2018 or winter and spring 2019. Outcomes were ascertained at 9- and 12-month follow-up. From March 19 through September 28, 2018, Head Start staff recruited (a) English- or Spanish-speaking parents (b) of children 3 years of age on or about September 2018 (c) who planned to remain at the site through the school year. Altogether, 519 parent-child (aged 3 years) dyads completed baseline and (any) follow-up data. INTERVENTIONS A 2-week classroom curriculum for children, a 1-hour parent workshop, and 1-on-1 parent discussions at home or school. MAIN OUTCOMES AND MEASURES Outcomes were the pre- vs postintervention differences measured at baseline and 9-month follow-up for parent-reported child school-night sleep duration per sleep logs, mild or moderate sleep difficulties per a validated questionnaire, and the total and domain scores for parent sleep knowledge, attitudes, self-efficacy, and beliefs. A modified intention-to-treat analysis excluding participants with only baseline data was used. RESULTS The mean (SD) age at enrollment of 519 children was 2.7 (0.1) years, 264 (50.9%) were girls, 196 (37.8%) lived in Spanish-speaking households, and 5 (0.9%) identified as Alaskan Native or American Indian, 17 (3.2%) as Asian American or Pacific Islander, 57 (10.8%) as Black, 199 (37.8%) as White, and 63 (12.0%) as other. Mean sleep durations increased nonsignificantly from baseline by 5.6 minutes (95% CI, -2.3 to 13.6 minutes; P = .17) at 9-month follow-up and by 6.8 minutes (95% CI, 0.2-13.7 minutes; P = .06) at 12-month follow-up. There was a slight improvement in parental knowledge (1.13 unit increase from baseline; 95% CI, 0.13-2.12 units), but no significant outcomes for parent sleep attitudes (0.16 unit increase from baseline; 95% CI, -0.46 to 0.77 units), self-efficacy (-0.13 unit decrease from baseline; 95% CI, -1.02 to 0.76 units) and beliefs (-0.20 unit decrease from baseline; 95% CI, -0.56 to 0.16 units). Intervention effects for child sleep difficulties were not significant (odds ratio, 1.13; 95% CI, 0.62-2.09). Fewer than 1 in 4 parents accurately perceived their child's sleep difficulty at 12 months. CONCLUSIONS AND RELEVANCE The findings of this large pragmatic, stepped-wedge cluster randomized clinical trial, albeit largely negative, may have implications for the sustained impact, focus, and potential population-level effects of sleep education programs. Future research should evaluate the effects of more recurrent programming that emphasizes recognition of sleep problems and whether small increments of sleep across months and years in early childhood have meaningful effects. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03556462.
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Affiliation(s)
- Karen Bonuck
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Clyde B. Schechter
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Ronald D. Chervin
- Sleep Disorders Center, University of Michigan, Ann Arbor
- Department of Neurology, University of Michigan, Ann Arbor
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22
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Dela Cruz R, Wolfe E, Yonemori KM, Fialkowski MK, Wilkens LR, Coleman P, Lameko-Mua S, Johnson E, Gilmatam D, Sigrah C, Shomour M, Remengesau S, Alfred J, Acosta M, Ettienne R, Deenik J, Aflague TF, Nelson R, Salazar KA, Novotny R, Boushey CJ. Consumption of Traditional Fruits and Vegetables among Children in the US-Affiliated Pacific Region. Curr Dev Nutr 2022; 6:nzac101. [PMID: 35854938 PMCID: PMC9283104 DOI: 10.1093/cdn/nzac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 01/24/2022] [Accepted: 06/01/2022] [Indexed: 11/14/2022] Open
Abstract
Background Traditional Pacific diets have many health benefits, including maintenance of a healthy weight and prevention of various diseases. Few studies have evaluated the frequency at which traditional diets are consumed in the Pacific, especially among children. Objectives This study examined the frequency of traditional and acculturated fruit and vegetable (F&V) intake among children in the US-affiliated Pacific (USAP) region. Methods Diet records of 3319 children ages 2 to 8 y old were analyzed for frequency of traditional or acculturated F&V intake within USAP jurisdictions of American Samoa, Commonwealth of the Northern Mariana Islands (CNMI), Federated States of Micronesia (FSM; FSM island states include Chuuk, Kosrae, Pohnpei, and Yap), Guam, Hawaii, Republic of the Marshall Islands (RMI), and Republic of Palau. Results Of the 95,304 food items recorded among participating children in the USAP jurisdictions, 15.2% were F&Vs. Of the 10 jurisdictions, children in the islands of Chuuk, Kosrae, Yap, and Pohnpei recorded the highest frequencies of traditional F&V intake relative to their total F&V intake (67.8%, 64.8%, 56.7%, and 52.5%, respectively). American Samoa and RMI recorded moderate frequency of traditional F&V intake (38.9% and 46.4%, respectively), whereas children in Hawaii, Guam, and CNMI recorded the lowest frequencies of traditional F&V intake relative to their total F&V intake (10.4%, 12.4%, and 15.3%, respectively). Children in Hawaii, Guam, Palau, and CNMI recorded high frequencies of acculturated F&V intake (37.8%, 31.2%, 34.5%, and 27.9%, respectively). Conclusions Overall, children in the USAP jurisdictions participating in this study recorded a low frequency of F&V intake. The differences in traditional F&V intake found between the USAP islands may be due to variation in economic income level and external influences on social and cultural norms among the island populations and variations of cost, accessibility, and convenience of each category of food to each island's population.
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Affiliation(s)
| | - Eric Wolfe
- University of Hawaii Cancer Center, Honolulu, Hawaii
| | | | - Marie K Fialkowski
- University of Hawaii, College of Tropical Agriculture and Human Resources, Honolulu, Hawaii
| | | | | | | | - Emihner Johnson
- Island Food Community of Pohnpei, Pohnpei, Federated States of Micronesia
| | - Daisy Gilmatam
- Yap Health Services, Yap, Federated States of Micronesia
| | - Cecilia Sigrah
- Kosrae Community Health Center, Kosrae, Federated States of Micronesia
| | - Moria Shomour
- Chuuk State Division of Public Health, Federated States of Micronesia
| | | | - Julia Alfred
- Ministry of Health, Majuro, Republic of the Marshall Islands
| | | | | | - Jonathan Deenik
- University of Hawaii, College of Tropical Agriculture and Human Resources, Honolulu, Hawaii
| | | | - Randall Nelson
- Northern Marianas College, Saipan, Northern Mariana Islands
| | | | - Rachel Novotny
- University of Hawaii, College of Tropical Agriculture and Human Resources, Honolulu, Hawaii
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23
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Understanding the perceptions of parents and preschool principals on the determinants of weight management among Iranian preschoolers: A directed qualitative content analysis. PLoS One 2022; 17:e0270244. [PMID: 35737692 PMCID: PMC9223302 DOI: 10.1371/journal.pone.0270244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/07/2022] [Indexed: 11/19/2022] Open
Abstract
The current study aimed to understand the perceptions and experiences of Iranian parents and principals of preschool children on weight management based on the PRECEDE-PROCEED Model (PPM), a comprehensive structure for assessing health needs for designing, implementing, and evaluating health promotion, and other public health programs. PRECEDE provides a structure for planning a targeted and focused public health program, and PROCEED provides a structure for implementing and evaluating the program. Data were gathered from 17 preschoolers’ parents and two principals using semi-structured interviews in the preschool setting in Tehran, the capital of Iran, in 2019. Data were analyzed manually through directed content analysis based on constructs in phases two and three of the PPM, simultaneously with data collection. This study identified genetic, behavioral (e.g., food preferences, physical activity, sedentary behaviors, the effect of parents’, peers’, principals’ and teachers’ behavior and also influence of grandparents’ and neighbors’ behaviors) and environmental (e.g., home, grandparents’ home and preschool) factors from the epidemiological construct. Also, predisposing (e.g., child’s attitude, parent’s and principals’ attitude, as well as parents’ knowledge and parents’ and principals’ beliefs), enabling (e.g., parental skills and skills of the principals and teachers, rules and laws in the preschools, and availability), and reinforcing (e.g., family support and influences, teachers’ encouragement and influences, and peers’ influences) factors were identified from the educational and ecological construct. Additionally, “quality of child-parent relationship” was determined as a new factor affecting preschoolers’ weight management promotion; however, it was not in the PPM. In the study, parents’ and principals’ experiences regarding preschoolers’ weight management promotion confirmed the genetic, behavioral, environmental, predisposing, enabling and reinforcing factors of the PPM. “Quality of child-parent relationship” factor may be related to the culture and family relationship type of Iranian people, which is suggested to be investigated in future studies.
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24
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Novotny R, Yamanaka AB, Butel J, Boushey CJ, Dela Cruz R, Aflague T, Coleman P, Shallcross L, Fleming T, Wilkens LR. Maintenance Outcomes of the Children's Healthy Living Program on Overweight, Obesity, and Acanthosis Nigricans Among Young Children in the US-Affiliated Pacific Region: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2214802. [PMID: 35666503 PMCID: PMC9171559 DOI: 10.1001/jamanetworkopen.2022.14802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Importance Few obesity prevention trials among children have demonstrated sustainable outcomes in the long term. Objectives To sustain a community-wide decrease in the prevalence of overweight and obesity among young children in the US-affiliated Pacific region. Design, Setting, and Participants In the Children's Healthy Living community-randomized clinical trial, hierarchical modeling comparing the change in intervention and control communities accounted for community randomization (community clustering with jurisdictions), and adjusted for the age and sex distribution of the assessed children in a cross-sectional design. The outcome measures were repeated in communities rather than among individual children. A total of 27 communities in 5 jurisdictions (Hawai'i, Alaska, Commonwealth of the Northern Mariana Islands, American Samoa, and Guam) of the US-affiliated Pacific region were included. Participants included children aged 2 to 8 years in the 27 selected communities from October 1, 2012 (4329 in time 1 [baseline]) to August 31, 2015 (4043 in time 2 [intervention end]) and from January 1, 2019, to April 30, 2020 (1469 in time 3 [maintenance period]). Study analysis was completed March 25, 2022. Interventions Nineteen activities addressed training, policies, systems, and environments of communities and 6 target behaviors of children (consumption of fruit and vegetables, water, and sugar-sweetened beverages; sleep; physical activity; and screen time) during a 2-year intervention period. Continued partnership with community coalitions, ongoing academic training of community partners, and use of trial data during a 6-year maintenance period. Main Outcomes and Measures The primary outcome was measured anthropometry; secondary outcomes were the presence of acanthosis nigricans, dietary intake derived from 2 days of food records, and survey questions on screen time and sleep disturbance. Results Among the 9840 children included in the analysis (4866 girls [49.5%] and 4974 boys [50.5%]; 6334 [64.4%] aged 2-5 years), the intervention group showed significant improvements compared with the control group from times 1 to 3 in prevalence of overweight plus obesity (d = -12.60% [95% CI, -20.92% to -4.28%]), waist circumference (d = -1.64 [95% CI, -2.87 to -0.41] cm), and acanthosis nigricans prevalence (d = -3.55% [95% CI, -6.17% to -0.92%]). Significant improvements were also observed from times 2 to 3 in prevalence of overweight plus obesity (d = -8.73% [95% CI, -15.86% to -1.60%]) but not in waist circumference (d = -0.81 [95% CI, -1.85 to 0.23] cm). Conclusions and Relevance This randomized clinical trial found that the outcomes of the Children's Healthy Living intervention were maintained and enhanced 6 years after the intervention among young children in the US-affiliated Pacific region. The prevalence of overweight, obesity, and acanthosis nigricans was further reduced in communities, suggesting that multilevel multicomponent interventions may help reduce child overweight and obesity in this region. Trial Registration ClinicalTrials.gov Identifier: NCT01881373.
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Affiliation(s)
- Rachel Novotny
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu
| | - Ashley B. Yamanaka
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu
| | - Jean Butel
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu
| | - Carol J. Boushey
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu
- Population Sciences in the Pacific Program, University of Hawai‘i Cancer Center, Honolulu
| | - Rica Dela Cruz
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu
| | - Tanisha Aflague
- Cooperative Extension and Outreach, College of Natural & Applied Sciences, University of Guam, Mangilao
| | - Patricia Coleman
- Cooperative Research, Extension, and Education Services, Northern Marianas College, Saipan
| | - Leslie Shallcross
- Health, Home and Family Development, Institute of Agriculture, Natural Resources and Extension, University of Alaska, Fairbanks
| | - Travis Fleming
- Community and Natural Resources Division (Land Grant Program), American Samoa Community College, Pago Pago
| | - Lynne R. Wilkens
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa, Honolulu
- Population Sciences in the Pacific Program, University of Hawai‘i Cancer Center, Honolulu
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25
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Oh C, Carducci B, Vaivada T, Bhutta ZA. Interventions to Promote Physical Activity and Healthy Digital Media Use in Children and Adolescents: A Systematic Review. Pediatrics 2022; 149:186945. [PMID: 35503334 DOI: 10.1542/peds.2021-053852i] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify effective interventions that promote healthy screen time use and reduce sedentary behavior in school-age children and adolescents (SACA) in all settings, over the last 20 years. METHODS Searches were conducted from 2000 until March 2021 using PubMed, Embase, Medline, PsycINFO, Ovid SP, The Cochrane Library, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, and the WHO regional databases, including Google Scholar and reference lists of relevant articles and reviews. Randomized-controlled trials and quasi-experimental studies assessing interventions to reduce sedentary behaviors and screen time in healthy SACA (aged 5-19.9 years) globally. Data were extracted by 2 reviewers and where possible, pooled with a random-effects model. RESULTS The review included 51 studies, of which 23 were included in meta-analyses with 16 418 children and adolescents. Nondigital randomized-controlled trials reported a small, but significant reduction of TV-specific screen time (minutes per day) (mean difference, -12.46; 95% confidence interval, -20.82 to -4.10; moderate quality of evidence) and sedentary behavior (minutes per day) (mean difference, -3.86; 95% confidence interval, -6.30 to -1.41; participants = 8920; studies = 8; P = .002; moderate quality of evidence) as compared with control groups. For quasi-experimental studies, nondigital interventions may make little or no difference on screen time (minutes per day) or sedentary behavior (minutes per day), given the high uncertainty of evidence. Most studies were conducted in a high-income country. Generalizability of results to low- and middle- income countries remain limited. CONCLUSIONS Public health policies and programs will be necessary to reduce excessive sedentary behavior and screen time, especially in the post-coronavirus disease 2019 reality.
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Affiliation(s)
- Christina Oh
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Bianca Carducci
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Tyler Vaivada
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.,Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada.,Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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26
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Aflague TF, Badowski G, Sanchez H, Sablan D, Schroeder CM, Sanchez E, Leon Guerrero RT. Improving Willingness to Try Fruits and Vegetables and Gross Motor Skills in Preschool Children in Guam. Nutrients 2021; 14:nu14010093. [PMID: 35010968 PMCID: PMC8747019 DOI: 10.3390/nu14010093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 11/16/2022] Open
Abstract
Early childhood interventions have the potential to promote long-term healthy eating and physical activity habits to prevent obesity. However, research studies including indigenous young children are lacking. This study examined the effectiveness of the Food Friends®: Fun with New Foods™ and Get Movin’ with Mighty Moves™ (FFMM) curricula on willingness to try fruits and vegetables (FV) and gross motor (GM) skills among preschoolers in Guam. A pre-post community-based study included preschoolers from Head Start (HS), gifted and talented education (Pre-GATE), and Pre-Kindergarten programs during school years (SY) 2017–2018 and 2018–2019. In SY2017–2018, the intervention group had a significant increase in imported FV when compared with the other three groups. No significant differences between groups were found on the other FV scales. Regarding gross motor skills, no significant differences between groups were found. In SY2018–2019, the intervention group had a significant increase in all FV scales except imported FV when compared with the enhanced intervention group. With gross motor skills, no significant differences were found between groups on its progress. These results warrant FFMM adaptations for the prevention of obesity among Guam preschoolers.
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Affiliation(s)
- Tanisha F. Aflague
- College of Natural and Applied Sciences, University of Guam, Mangilao, GU 96923, USA; (G.B.); (H.S.)
- Correspondence: ; Tel.: +1-671-735-2026
| | - Grazyna Badowski
- College of Natural and Applied Sciences, University of Guam, Mangilao, GU 96923, USA; (G.B.); (H.S.)
| | - Hyett Sanchez
- College of Natural and Applied Sciences, University of Guam, Mangilao, GU 96923, USA; (G.B.); (H.S.)
| | - Dwight Sablan
- Office of Research & Sponsored Programs, University of Guam, Mangilao, GU 96923, USA; (D.S.); (R.T.L.G.)
| | | | - Eloise Sanchez
- Division of Curriculum & Instruction, Guam Department of Education, Barrigada, GU 96913, USA;
| | - Rachael T. Leon Guerrero
- Office of Research & Sponsored Programs, University of Guam, Mangilao, GU 96923, USA; (D.S.); (R.T.L.G.)
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27
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Butel J, Braun KL, Nigg CR, Leon Guerrero R, Fleming T, Bersamin A, Coleman P, Novotny R. Estimating intervention dose of the multilevel multisite children's healthy living program intervention. Transl Behav Med 2021; 10:989-997. [PMID: 31116404 DOI: 10.1093/tbm/ibz073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Increased community collective efficacy (CE), defined as social cohesion among neighbors and their willingness to intervene for common good, is associated with improved community health outcomes. However, processes to increase CE and estimate its dose within an intervention are not well understood. The 2 year Children's Healthy Living (CHL) intervention aimed to improve child behaviors known to affect obesity. We used data from CHL to estimate CE dose and examine its association with a successful outcome from CHL-reduction in children's recreational screen time. Monthly reports from nine intervention communities were quantified, and CE dose was calculated for each community overall, at 4 time intervals (6, 12, 18, and 24 months), and for each CE building block-social bonding, social bridging, social leveraging, empowerment, and civic engagement. CE dose at each time interval and change in screen time was correlated using Spearman's rho. Next, communities were categorized as having a high CE dose or a low CE dose, and differences between four high-dose and five low-dose communities were compared using a two-tailed t-test. The correlation between change in screen time and CE dose was significant (rs = 0.83, p = .003). Significantly more activities facilitating empowerment and civic engagement were conducted in high-dose communities, which were more likely to show improvements in screen time, than in low-dose communities. This method of estimating an intervention's CE dose and examining change over time and effect of CE and its building blocks on intervention outcomes shows promise.
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Affiliation(s)
- Jean Butel
- Colege of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Kathryn L Braun
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Claudio R Nigg
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI, USA
| | | | | | | | | | - Rachel Novotny
- Colege of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu, HI, USA
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Byrne R, Terranova CO, Trost SG. Measurement of screen time among young children aged 0-6 years: A systematic review. Obes Rev 2021; 22:e13260. [PMID: 33960616 PMCID: PMC8365769 DOI: 10.1111/obr.13260] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/16/2022]
Abstract
The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.
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Affiliation(s)
- Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Caroline O. Terranova
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
| | - Stewart G. Trost
- School of Exercise and Nutrition Sciences, Faculty of Health, Centre for Children's Health Research (CCHR)Queensland University of Technology (QUT)South BrisbaneQueenslandAustralia
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Novotny R, Earle ME, Jung YO, Julian GJ, Hill E, Leon Guerrero RT, Coleman P, Deenik J, Boushey C, Wilkens LR. University of Hawai'i Cancer Center Connection: Pacific Tracker (PacTrac) Version 3.1 Diet and Physical Activity Assessment Tool for the Pacific Region. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2021; 80:165-168. [PMID: 34278324 PMCID: PMC8280357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Pacific Tracker (PacTrac) is a web-based diet and physical activity assessment program created to analyze dietary recall or dietary record data from the Pacific region. Version 3.1 modifications make the tool available for public use (under check it out) to enter, analyze, view and print out data; and for research use, for saving and downloading of multiple entries in a research mode. PacTrac 3.1 (https://nappactrac31.ctahr.hawaii.edu/default.htm) is managed through the Children's Healthy Living Center of Excellence (CHL Center) at the College of Tropical Agriculture and Human Resources at the University of Hawai'i, in collaboration with the University of Hawai'i Cancer Center.
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Affiliation(s)
- Rachel Novotny
- Department Human Nutrition Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI (RN, EH)
| | - Maj E Earle
- University of Hawai'i Cancer Center, Honolulu, HI (MEE, YOJ, GJJ, CB, LRW)
| | - Yun Oh Jung
- University of Hawai'i Cancer Center, Honolulu, HI (MEE, YOJ, GJJ, CB, LRW)
| | - Greg Joel Julian
- University of Hawai'i Cancer Center, Honolulu, HI (MEE, YOJ, GJJ, CB, LRW)
| | - Erik Hill
- Department Human Nutrition Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI (RN, EH)
| | | | | | - Jonathan Deenik
- Department of Tropical Plant and Soil Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, HI (JD)
| | - Carol Boushey
- University of Hawai'i Cancer Center, Honolulu, HI (MEE, YOJ, GJJ, CB, LRW)
| | - Lynne R Wilkens
- University of Hawai'i Cancer Center, Honolulu, HI (MEE, YOJ, GJJ, CB, LRW)
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Yamanaka AB, Davis JD, Wilkens LR, Hurwitz EL, Fialkowski MK, Deenik J, Leon Guerrero RT, Novotny R. Determination of Child Waist Circumference Cut Points for Metabolic Risk Based on Acanthosis Nigricans, the Children's Healthy Living Program. Prev Chronic Dis 2021; 18:E64. [PMID: 34166179 PMCID: PMC8269744 DOI: 10.5888/pcd18.210021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Waist circumference is a common anthropometric measure for predicting abdominal obesity and insulin resistance. We developed optimal waist circumference cut points for children aged 2 to 8 years in the US-Affiliated Pacific (USAP) region based on the relationship of waist circumference and acanthosis nigricans in this population. METHODS We conducted a cross-sectional analysis from the Children's Healthy Living Program's 2012-2013 data on 4,023 children. We used receiver-operating characteristic analysis to determine the sensitivity and specificity for acanthosis nigricans across waist circumference, by sex and age. We determined optimal waist circumference cutoff points corresponding to Youden index (J), (equal to [sensitivity + specificity] - 1), with acanthosis nigricans. We compared these cut points with the 90th percentile. RESULTS The 90th-percentile cut points for boys aged 2 to 5 years (58.15 cm) and 6 to 8 years (71.63 cm) were slightly higher than for girls in both age groups (aged 2-5 y, 57.97 cm; 6-8 y: 70.37 cm). The optimal cut points (corresponding to the highest sensitivity and specificity) were as follows: for boys aged 2 to 5 years, 90th percentile (58.25 cm; sensitivity, 48.0%; specificity, 91.5%); for boys aged 6 to 8 years, 78th percentile (63.59 cm; sensitivity, 86.8%; specificity, 82.8%); for girls aged 2 to 5 years, 62nd percentile (53.27 cm; sensitivity, 71.4%; specificity, 63.1%), and for girls aged 6 to 8 years, 80th percentile (63.63 cm; sensitivity, 55.4%; specificity, 82.9%). CONCLUSION Among USAP children, waist circumference was a reasonable predictor for acanthosis nigricans. Further analysis is warranted to examine causes of acanthosis nigricans at lower-than-expected waist circumference percentiles. The cut points can be used for early detection of metabolic risk.
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Affiliation(s)
- Ashley B Yamanaka
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawai'i
- College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, 1955 East West Rd, Agricultural Sciences 216, Honolulu, Hawai'i 96822.
| | - James D Davis
- Department of Biostatistics and Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | - Lynne R Wilkens
- Biostatistics and Informatics Shared Resource, University of Hawai'i Cancer Center, Honolulu, Hawai'i
| | - Eric L Hurwitz
- Office of Public Health Studies, Thompson School of Social Work and Public Health, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | - Marie K Fialkowski
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | - Jonathan Deenik
- Department of Tropical Plant and Soil Sciences, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawai'i
| | | | - Rachel Novotny
- Department of Human Nutrition, Food and Animal Science, College of Tropical Agriculture and Human Resources, University of Hawai'i at Mānoa, Honolulu, Hawai'i
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da Costa Peres CM, Gardone DS, Costa BVDL, Duarte CK, Pessoa MC, Mendes LL. Retail food environment around schools and overweight: a systematic review. Nutr Rev 2021; 78:841-856. [PMID: 31968100 DOI: 10.1093/nutrit/nuz110] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
CONTEXT The presence of retail food establishments around schools can be a potentiating or protective factor for overweight in students, depending on access to these places as well as types of foods available therein. The hypothesis for this study was that a greater density and proximity of retail food establishments around schools influence the weight of students. OBJECTIVE To systematically review the available observational literature on the association between retail food establishments around schools and the occurrence of overweight and obesity in schoolchildren and adolescents. DATA SOURCES Observational studies were searched in the MEDLINE, EMBASE, and SCOPUS databases published until May 2019. DATA EXTRACTION Two independent reviewers extracted relevant data. DATA ANALYSIS Data on the 31 included studies were summarized with narrative synthesis according to meta-analyses of observational studies in epidemiology, exploring the type of food establishments around schools and analyzing qualitatively the impact of proximity or density on overweight and obesity rates. CONCLUSION Of the 31 articles, a direct association between proximity or density of establishments (mainly fast food restaurants, convenience stores, grocery stores) around schools and overweight and obesity in children and adolescents were found in 14 studies. However, authors of 13 papers found no association and inverse association was presented in 4 papers. The studies presented different methods of classification, location, and analysis of retail food establishments, making it difficult to conclude the real influence that the presence of these establishments near schools have on the nutritional status of children and adolescents. Therefore, future studies should consider the use of longitudinal designs and standardized analysis of the food environment around schools to better understand this food environment and its influence on health-related behaviors.
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Affiliation(s)
- Carla Marien da Costa Peres
- Post-Graduate Program in Nutrition and Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Danielle Soares Gardone
- Post-Graduate Program in Nutrition and Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Bruna Vieira de Lima Costa
- Post-Graduate Program in Nutrition and Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Camila Kümmel Duarte
- Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Milene Cristine Pessoa
- Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Larissa Loures Mendes
- Post-Graduate Program in Nutrition and Health, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.,Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Taghizadeh S, Farhangi MA. The effectiveness of pediatric obesity prevention policies: a comprehensive systematic review and dose-response meta-analysis of controlled clinical trials. J Transl Med 2020; 18:480. [PMID: 33317542 PMCID: PMC7734784 DOI: 10.1186/s12967-020-02640-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/27/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Childhood obesity persists as a serious public health problem. In the current meta-analysis, we summarized the results of controlled trials that evaluated the effect of obesity prevention policies in children and adolescents. METHODS Three databases (SCOPUS, PubMed and Embase) were searched for studies published before the 6th April 2020, by reported outcome measures of body mass index (BMI) and BMI-Zscore. Forty-seven studies reported BMI, while 45 studies reported BMI-Zscore as final outcome. RESULTS The results showed that the obesity-prevention policies had significant effect in reducing BMI (WMD: - 0.127; CI - 0.198, - 0.056; P < 0.001). These changes were not significant for BMI-Zscore (WMD: - 0.020; CI - 0.061, 0.021; P = 0.340). In dose-response meta-analysis, a non-linear association was reported between the duration of intervention and BMI (Pnonlinearity < 0.001) as well as BMI-Zscore (Pnonlinearity = 0.023). In subgroup analysis, the more favorite results were observed for 5-10 years old, with combination of physical activity and diet as intervention materials. CONCLUSION In conclusion, the obesity prevention policies in short-term periods of less than 2 years, in rather early age of school with approaches of change in both of diet and physical activity, could be more effective in prevention of childhood obesity. Trial registration PROSPERO registration number: CRD42019138359.
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Affiliation(s)
- Shahnaz Taghizadeh
- Student Research Committee, Department of Community Nutrition, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdieh Abbasalizad Farhangi
- Drug Applied Research Center, Tabriz University of Medical Sciences, Attar Nishabouri St., POBOX: 14711, 5166614711, Tabriz, Iran.
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Abstract
PURPOSE OF REVIEW Childhood obesity is increasing substantially in many Pacific island countries and poses an urgent and serious challenge. The Sustainable Development Goals set by the United Nations and the NCD Roadmap created at the request of the Pacific Finance and Economic Ministers identify prevention and control of noncommunicable diseases as core priorities. Among the various risk factors responsible for the development of noncommunicable diseases (NCDs), overweight and obesity are particularly of concern with the potential to negate many of the health benefits that have contributed to increased life expectancy. With the increase in childhood obesity across the region, it has become apparent that surveillance data remains a challenge; however, it is essential to inform the development of effective policies and strategies to tackle the challenge of childhood obesity in the Pacific region. RECENT FINDINGS The paper highlights the paucity of childhood obesity surveillance data available in the Pacific region and how the absence of a standardised tool to collect this data makes it difficult to do comparative analysis between countries. Drawing on a global protocol and identifying the gaps that currently exist in the region, the paper aims to highlight opportunities via which childhood obesity surveillance data can be improved to monitor better childhood obesity across the Pacific region.
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Affiliation(s)
- Amerita Ravuvu
- Non-Communicable Disease Policy & Planning Adviser, Public Health Division, Pacific Community (SPC), C/- Pacific Community (SPC), Private Mail Bag, Suva, Fiji.
| | - Gade Waqa
- Pacific Research Centre for the Prevention of Obesity and Non-Communicable Diseases (C-POND), Fiji Institute of Pacific Health Research, College of Medicine, Nursing & Health Sciences, Fiji National University (FNU), Suva, Fiji
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Role of social ecological model level on young Pacific children's sugar-sweetened beverage and water intakes: Children's Healthy Living intervention. Public Health Nutr 2020; 24:2318-2323. [PMID: 33234187 DOI: 10.1017/s1368980020004796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine children's sugar-sweetened beverage (SSB) and water intakes in relation to implemented intervention activities across the social ecological model (SEM) during a multilevel community trial. DESIGN Children's Healthy Living was a multilevel, multicomponent community trial that reduced young child obesity (2013-2015). Baseline and 24-month cross-sectional data were analysed from nine intervention arm communities. Implemented intervention activities targeting reduced SSB and increased water consumption were coded by SEM level (child, caregiver, organisation, community and policy). Child SSB and water intakes were assessed by caregiver-completed 2-day dietary records. Multilevel linear regression models examined associations of changes in beverage intakes with activity frequencies at each SEM level. SETTING US-Affiliated Pacific region. PARTICIPANTS Children aged 2-8 years (baseline: n 1343; 24 months: n 1158). RESULTS On average (± sd), communities implemented 74 ± 39 SSB and 72 ± 40 water activities. More than 90 % of activities targeted both beverages together. Community-level activities (e.g. social marketing campaign) were most common (61 % of total activities), and child-level activities (e.g. sugar counting game) were least common (4 %). SSB activities across SEM levels were not associated with SSB intake changes. Additional community-level water activities were associated with increased water intake (0·62 ml/d/activity; 95 % CI: 0·09, 1·15) and water-for-SSB substitution (operationalised as SSB minus water: -0·88 ml/d/activity; 95 % CI: -1·72, -0·03). Activities implemented at the organization level (e.g. strengthening preschool wellness guidelines) and policy level (e.g. SSB tax advocacy) also suggested greater water-for-SSB substitution (P < 0·10). CONCLUSIONS Community-level intervention activities were associated with increased water intake, alone and relative to SSB intake, among young children in the Pacific region.
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Van Meter AR, Anderson EA. Evidence Base Update on Assessing Sleep in Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 49:701-736. [PMID: 33147074 DOI: 10.1080/15374416.2020.1802735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Sleep is vital to youth well-being and when it becomes disturbed - whether due to environmental or individual factors - mental and physical health suffer. Sleep problems can also be a symptom of underlying mental health disorders. Assessing different components of sleep, including quality and hygiene, can be useful both for identifying mental health problems and for measuring changes in well-being over time. However, there are dozens of sleep-related measures for youth and it can be difficult to determine which to select for a specific research or clinical purpose. The goal of this review was to identify sleep-related measures for clinical and/or research use in youth mental health settings, and to update the evidence base on this topic. METHOD We generated a list of candidate measures based on other reviews and searched in PubMed and PsycINFO using the terms "sleep" AND (measure OR assessment OR questionnaire) AND (psychometric OR reliability OR validity). Search results were limited to studies about children and adolescents (aged 2-17) published in English. Additional criteria for inclusion were that there had to be at least three publications reporting on the measure psychometrics in community or mental health populations. Sleep measures meeting these criteria were evaluated using the criteria set by De Los Reyes and Langer (2018). RESULTS Twenty-six measures, across four domains of sleep - insomnia, sleep hygiene, sleepiness, sleep quality - met inclusion criteria. Each measure had at least adequate clinical utility. No measure(s) emerged as superior across psychometric domains. CONCLUSION Clinicians and researchers must evaluate sleep measures for each use case, as the intended purpose will dictate which measure is best. Future research is necessary to evaluate measure performance in transdiagnostic mental health populations, including youth with serious mental illness.
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Affiliation(s)
- Anna R Van Meter
- Department of Psychiatry, Zucker Hillside Hospital.,Feinstein Institutes for Medical Research, Institute for Behavioral Science.,Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
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Whelan J, Strugnell C, Allender S, Korn AR, Brown AD, Orellana L, Hayward J, Brown V, Bell C, Moodie M, Peeters A, Nichols M. Protocol for the measurement of changes in knowledge and engagement in the stepped wedge cluster randomised trial for childhood obesity prevention in Australia: (Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND)). Trials 2020; 21:763. [PMID: 32887655 PMCID: PMC7650215 DOI: 10.1186/s13063-020-04692-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 08/16/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Community-based interventions have shown promise in addressing the childhood obesity epidemic. Such efforts rely on the knowledge of key community members and their engagement with the drivers of obesity in their community. This paper presents the protocol for the measurement and evaluation of knowledge and engagement among community leaders within a whole-of-community systems intervention across 10 large intervention communities in Australia. METHODS We will investigate the role of stakeholder knowledge and engagement in the implementation and effectiveness of the stepped wedge cluster randomised trial in ten communities in Victoria, Australia. Data will be collected using the Stakeholder-driven Community Diffusion Survey (SDCD) to measure levels of knowledge and engagement prior to commencement (2019), across the three separate levels of governance within the intervention at five time points. Primary outcomes will be baseline overall knowledge and engagement scores across the three levels of governance and change in overall knowledge and engagement over time. DISCUSSION We hypothesise there will be heterogeneity between intervention sites on levels of knowledge and engagement and that these differences will be associated with variability in implementation success. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618001986268 . Registered on 11 December 2018.
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Affiliation(s)
- Jillian Whelan
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Claudia Strugnell
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Steven Allender
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Ariella R. Korn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, USA
| | - Andrew D. Brown
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | | | - Josh Hayward
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Vicki Brown
- Institute for Health Transformation, Deakin Health Economics, Deakin University, Geelong, Australia
| | - Colin Bell
- Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Marj Moodie
- Institute for Health Transformation, Deakin Health Economics, Deakin University, Geelong, Australia
| | - Anna Peeters
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
| | - Melanie Nichols
- Institute for Health Transformation, Global Obesity Centre, Deakin University, Geelong, Australia
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Townsend MS, Shilts MK, Chester D. USDA Research Combats Childhood Obesity: A Collection of Projects that Integrate Research, Education, and Extension Targeting Low-Income, Ethnically Diverse Children and Families. Child Obes 2020; 16:S1-S3. [PMID: 32857608 DOI: 10.1089/chi.2020.29006.mst] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Mical K Shilts
- Department of Family and Consumer Sciences, California State University at Sacramento, Sacramento, CA, USA
| | - Deirdra Chester
- National Institute of Food and Agriculture, U. S. Department of Agriculture, Washington, DC, USA
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Franse CB, Boelens M, Fries LR, Constant F, van Grieken A, Raat H. Interventions to increase the consumption of water among children: A systematic review and meta-analysis. Obes Rev 2020; 21:e13015. [PMID: 32167233 PMCID: PMC7317453 DOI: 10.1111/obr.13015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 02/21/2020] [Indexed: 12/17/2022]
Abstract
The aim of this study was to conduct a systematic review and meta-analysis on the effectiveness of interventions to increase children's water consumption. A systematic literature search was conducted in seven electronic databases. Studies published in English before 18 February 2019 that evaluated any type of intervention that measured change in water consumption among children aged 2 to 12 years by applying any type of design were included. Of the 47 interventions included in the systematic review, 24 reported a statistically significant increase in water consumption. Twenty-four interventions (17 randomized controlled trials and seven studies with other controlled designs) were included in the meta-analysis. On average, children in intervention groups consumed 29 mL/d (confidence interval [CI] = 13-46 mL/d) more water than did children in control groups. This effect was larger in eight interventions focused specifically on diet (MD = 73 mL/d, CI = 20-126 mL/d) than in 16 interventions focused also on other lifestyle factors (MD = 15 mL/d, CI = 1-29 mL/d). Significant subgroup differences were also found by study setting and socioecological level targeted but not by children's age group, intervention strategy, or study design. In conclusion, there is evidence that, on average, lifestyle interventions can lead to small increases in children's daily water consumption. More research is needed to further understand the specific intervention elements that have the greatest effect.
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Affiliation(s)
- Carmen B. Franse
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Mirte Boelens
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | | | | | - Amy van Grieken
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
| | - Hein Raat
- Department of Public HealthErasmus University Medical CenterRotterdamThe Netherlands
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Hawley NL, Suss R, Cash HL, Aitaoto N, Samoa R, Ayers B, McElfish P. Diabetes Prevention and Care Programs in the US-Affiliated Pacific Islands: Challenges, Innovation, and Recommendations for Effective Scale-Up. Curr Diab Rep 2019; 19:24. [PMID: 30919169 DOI: 10.1007/s11892-019-1139-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW This review describes some of the unique challenges faced by the US-Affiliated Pacific Islands (USAPIs) in addressing diabetes prevention and care and presents innovative population-level strategies that have been employed to address them. RECENT FINDINGS Challenges include an unhealthy food environment and a strained health care infrastructure, both compounded by geography. Innovations in addressing these challenges include attempts to modify the food environment, a focus on early life prevention, and task shifting among the health workforce. Many of the successful interventions share a focus on culture, community, and capacity building. Although the USAPIs are uniquely challenged by environmental, structural, and health system barriers, there have been a number of innovative and successful strategies employed that highlight the resilience of these island nations in addressing their current disease burden when provided with the opportunity and resources to do so. Health policies to protect, support, and promote diabetes prevention and care are essential and may be informed by the interventions described.
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Affiliation(s)
- Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA.
| | - Rachel Suss
- Yale College, Yale University, New Haven, CT, USA
| | - Haley L Cash
- Regional Epidemiology Unit, Pacific Island Health Officers' Association, Honolulu, HI, USA
| | - Nia Aitaoto
- Department of Nutrition and Integrative Physiology, College of Health, University of Utah, Salt Lake City, UT, USA
| | - Raynald Samoa
- Department of Diabetes, Endocrinology and Metabolism, City of Hope Hospital, Los Angeles, CA, USA
| | - Britni Ayers
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl McElfish
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Gittelsohn J, Novotny R, Trude ACB, Butel J, Mikkelsen BE. Challenges and Lessons Learned from Multi-Level Multi-Component Interventions to Prevent and Reduce Childhood Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 16:ijerph16010030. [PMID: 30586845 PMCID: PMC6339209 DOI: 10.3390/ijerph16010030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/10/2018] [Accepted: 12/20/2018] [Indexed: 12/12/2022]
Abstract
Multi-level multi-component (MLMC) strategies have been recommended to prevent and reduce childhood obesity, but results of such trials have been mixed. The present work discusses lessons learned from three recently completed MLMC interventions to inform future research and policy addressing childhood obesity. B’more Healthy Communities for Kids (BHCK), Children’s Healthy Living (CHL), and Health and Local Community (SoL) trials had distinct cultural contexts, global regions, and study designs, but intervened at multiple levels of the socioecological model with strategies that address multiple components of complex food and physical activity environments to prevent childhood obesity. We discuss four common themes: (i) How to engage with community partners and involve them in development of intervention and study design; (ii) build and maintain intervention intensity by creating mutual promotion and reinforcement of the intervention activities across the multiple levels and components; (iii) conduct process evaluation for monitoring, midcourse corrections, and to engage stakeholder groups; and (iv) sustaining MLMC interventions and its effect by developing enduring and systems focused collaborations. The paper expands on each of these themes with specific lessons learned and presents future directions for MLMC trials.
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Affiliation(s)
- Joel Gittelsohn
- Center for Human Nutrition, International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
| | - Rachel Novotny
- Children's Healthy Living Center of Excellence, College of Tropical Agriculture and Human Resources ⁻ University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.
| | - Angela Cristina Bizzotto Trude
- Center for Human Nutrition, International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA.
| | - Jean Butel
- Children's Healthy Living Center of Excellence, College of Tropical Agriculture and Human Resources ⁻ University of Hawai'i at Mānoa, Honolulu, HI 96822, USA.
| | - Bent Egberg Mikkelsen
- Department of Learning & Philosophy, Aalborg University, A.C. Meyers Vænge 15, DK-2450 Copenhagen SV, Denmark.
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