1
|
Family Social Support and Weight-Related Behaviors of School-Age Children: An Exploratory Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148501. [PMID: 35886352 PMCID: PMC9318999 DOI: 10.3390/ijerph19148501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/04/2022] [Accepted: 07/09/2022] [Indexed: 01/27/2023]
Abstract
Families are a key provider of support that may encourage positive weight-related behaviors. Yet little is known about the relation of family support to children’s performance of weight-related behaviors. Mothers (N = 524) who completed an online survey were categorized as having low, moderate, or high family support for fruit/vegetable intake, breakfast intake, limiting sugar-sweetened beverage intake, physical activity, limiting sedentary screentime, and sleep. ANOVA revealed that children in families with high support for breakfast ate this meal significantly more often. Additionally, children in families with low support for limiting sugar-sweetened beverages had significantly greater intake. Surprisingly, families with moderate support for physical activity and sleep tended to have children with lower physical activity level, sleep duration, and sleep quality, and fewer days/week with set bedtimes than those with low and high support. Binomial logistic regression revealed that high family support for eating breakfast, limiting sugar-sweetened beverages, and getting sufficient sleep had greater odds of meeting recommendations for these behaviors. Findings suggest that greater family support for healthy weight-related behaviors tends to be associated with children’s performance of these behaviors. Future interventions should further examine the impact of different types of family support on weight-related behaviors to better understand this complex interplay.
Collapse
|
2
|
Barnes C, Hall A, Nathan N, Sutherland R, McCarthy N, Pettet M, Brown A, Wolfenden L. Efficacy of a school-based physical activity and nutrition intervention on child weight status: Findings from a cluster randomized controlled trial. Prev Med 2021; 153:106822. [PMID: 34599925 DOI: 10.1016/j.ypmed.2021.106822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/09/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
Despite the benefits of factorial designs in quantifying the relative benefits of different school-based approaches to prevent unhealthy weight gain among students, few have been undertaken. The aims of this 2 × 2 cluster randomized factorial trial was to evaluate the impact of a physical activity and nutrition intervention on child weight status and quality of life. Twelve primary schools in New South Wales, Australia randomly allocated to one of four groups: (i.) physical activity (150 min of planned in-school physical activity); (ii.) nutrition (a healthy school lunch-box); (iii.) combined physical activity and nutrition; or (iv.) control. Outcome data assessing child weight and quality of life were collected at baseline and 9-months post-baseline. Within Grades 4-6 in participating schools, 742 students participated in anthropometric measurements, including child body mass index (BMI) and waist circumference, at baseline and follow-up. Findings indicated that students that received the nutrition intervention had higher odds of being classified in the BMI category of underweight/healthy weight (OR 1.64 95%CI 1.07, 2.50; p = 0.0220), while those who received the physical activity intervention reported a lower waist circumference (mean difference - 1.86 95%CI -3.55, -0.18; p = 0.030). There were no significant effects of the nutrition or physical activity intervention on child BMI scores or child quality of life, and no significant synergistic effects of the two interventions combined. Future research assessing the longer-term impact of both intervention strategies, alone and combined, is warranted to better understand their potential impact on child health. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRN: ACTRN12616001228471.
Collapse
Affiliation(s)
- Courtney Barnes
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia.
| | - Alix Hall
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia
| | - Nicole McCarthy
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia
| | - Matthew Pettet
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia
| | - Alison Brown
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend 2287, New South Wales, Australia; School of Medicine and Public Health, The University of Newcastle, Callaghan 2308, New South Wales, Australia; Hunter Medical Research Institute, New Lambton 2305, New South Wales, Australia; Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan 2308, New South Wales, Australia
| |
Collapse
|
3
|
Glenn ME, Patlan K, Connor P, Stidsen C, Ball S, Peterson KE, Olsho LEW, Gola AAH, Copeland KA. Dietary Intakes of Children Enrolled in US Early Child-Care Programs During Child-Care and Non-Child-Care Days. J Acad Nutr Diet 2021; 122:1141-1157.e3. [PMID: 34455104 DOI: 10.1016/j.jand.2021.08.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Early-child-care (ECE) programs may substantially influence child diet quality. OBJECTIVE The Study of Nutrition and Activity in Child Care Settings describes the usual food group intake of preschool-aged children attending ECE programs relative to Dietary Guidelines for Americans (DGA) recommendations, comparing intakes during child-care and non-child-care days. DESIGN Meal observations and parent-completed food diaries in a cross-sectional nationally representative multistage cluster sample of Child and Adult Care Food Program-participating ECE programs. PARTICIPANTS/SETTING One thousand four hundred sixty-eight children aged 3 to 5 years attending 217 Child and Adult Care Food Program-participating ECE programs (eg, child-care centers and Head Start) during 2017. MAIN OUTCOME MEASURES Daily energy intake, daily US Department of Agriculture Food Pattern Food Group intakes, and percentage of daily intakes meeting 2015-2020 DGA Food Pattern recommendations. STATISTICAL ANALYSES PERFORMED Regression-adjusted usual intakes and percentage of children meeting recommendations were estimated using the National Cancer Institute method. Single-day mean intakes were used to test for statistical differences between child-care and non-child-care days. RESULTS Mean usual energy intake was 1,524 ± 19.3 kcal during child-care days and exceeded the recommended range at 1,702 ± 30.2 kcal during non-child-care days; single-day means indicated significantly lower energy intake on child-care days (P < 0.001). The percent of children meeting DGA recommendations on a child-care day varied by DGA food group: fruits (51.4%), grains (50.1%), dairy (42.5%), vegetables (6.5%), whole grains (4.6%), and protein foods (0.1%). Recommended limits on calories from added sugar and solid fats were met by 28.2% and 14.6% of children, respectively. Compared with mean food group intakes during a single child-care day, non-child-care day intakes were similar for fruits and vegetables, lower for dairy and whole grains, and higher for total grains, protein foods, and calories from added sugars and solid fats. CONCLUSIONS Although there is room to increase nutrient density inside and outside of child care, intakes on child-care days more closely align to DGAs.
Collapse
Affiliation(s)
| | | | - Patricia Connor
- Abt Associates, Cambridge, Massachusetts; Independent Child Nutrition Research Consultant, Massachusetts
| | - Chantal Stidsen
- Abt Associates, Cambridge, Massachusetts; Mathematica, Cambridge, Massachusetts
| | - Sarah Ball
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Karen E Peterson
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan
| | | | - Alice Ann H Gola
- US Department of Agriculture Food and Nutrition Service, Alexandria, Virginia; Westat, Rockville, Maryland
| | - Kristen A Copeland
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|
4
|
Leme ACB, Hou S, Fisberg RM, Fisberg M, Haines J. Adherence to Food-Based Dietary Guidelines: A Systemic Review of High-Income and Low- and Middle-Income Countries. Nutrients 2021; 13:nu13031038. [PMID: 33807053 PMCID: PMC8004702 DOI: 10.3390/nu13031038] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
Research comparing the adherence to food-based dietary guidelines (FBDGs) across countries with different socio-economic status is lacking, which may be a concern for developing nutrition policies. The aim was to report on the adherence to FBDGs in high-income (HIC) and low-and-middle-income countries (LMIC). A systematic review with searches in six databases was performed up to June 2020. English language articles were included if they investigated a population of healthy children and adults (7–65 years), using an observational or experimental design evaluating adherence to national FBDGs. Findings indicate that almost 40% of populations in both HIC and LMIC do not adhere to their national FBDGs. Fruit and vegetables (FV) were most adhered to and the prevalence of adhering FV guidelines was between 7% to 67.3%. HIC have higher consumption of discretionary foods, while results were mixed for LMIC. Grains and dairy were consumed below recommendations in both HIC and LMIC. Consumption of animal proteins (>30%), particularly red meat, exceeded the recommendations. Individuals from HIC and LMIC may be falling short of at least one dietary recommendation from their country’s guidelines. Future health policies, behavioral-change strategies, and dietary guidelines may consider these results in their development.
Collapse
Affiliation(s)
- Ana Carolina B. Leme
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada; (S.H.); (J.H.)
- Center of Excellence in Nutrition and Feeding Difficulties, PENSI Institute, Sabará Children’s Hospital, José Luis Egydio Setúbal Foundation, São Paulo 01228-200, Brazil;
- Correspondence:
| | - Sophia Hou
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada; (S.H.); (J.H.)
| | - Regina Mara Fisberg
- Department of Nutrition, School of Public University of São Paulo, São Paulo 01246-904, Brazil;
| | - Mauro Fisberg
- Center of Excellence in Nutrition and Feeding Difficulties, PENSI Institute, Sabará Children’s Hospital, José Luis Egydio Setúbal Foundation, São Paulo 01228-200, Brazil;
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada; (S.H.); (J.H.)
| |
Collapse
|
5
|
Burkholder S, Jilcott Pitts S, Wu Q, Bayles J, Baybutt R, Stage VC. Skin Carotenoid Status Over Time and Differences by Age and Sex Among Head Start Children (3-5 Years). JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:103-109. [PMID: 33349596 PMCID: PMC8042778 DOI: 10.1016/j.jneb.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/21/2020] [Accepted: 10/24/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Examine differences in skin carotenoid status (SCS) based on time, age, and sex of preschool-aged children enrolled in Head Start (HS) in North Carolina. DESIGN Data were collected using surveys from participating families. preschool-aged children's SCS were measured 3 times over a 6-month period. SETTING Three HS centers in North Carolina. PARTICIPANTS One hundred twelve children aged 3-5 years, enrolled in HS. MAIN OUTCOME MEASURE(S) Differences in SCS assessed using the Veggie Meter (Longevity Link, Salt Lake City, UT) based on time, sex, and age. ANALYSIS One-way ANOVA to assess SCS at time 1 between sex and age (n = 112). Repeated measures ANOVA with a Greenhouse-Geisser correction for assessment of SCS over time (n = 45) using Bonferroni correction. RESULTS On average, children were aged 4 years, African American (81.3%), male (57%), and had a mean SCS of 266 (SD = 82.9). Skin carotenoid status (Veggie Meter units) were significantly different over time (P < 0.001). Significant differences were observed between ages (P = 0.01) and sex (P < 0.01). CONCLUSIONS AND IMPLICATIONS The Veggie Meter is a promising tool to assess fruit and vegetable intake but needs to be validated in preschool-aged children as it has been in adults. Sex and age are potential confounders which should be assessed in future studies using the Veggie Meter.
Collapse
Affiliation(s)
- Sarah Burkholder
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC
| | - Stephanie Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Qiang Wu
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, NC
| | - Jocelyn Bayles
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC
| | - Richard Baybutt
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC
| | - Virginia C Stage
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC.
| |
Collapse
|
6
|
Helmick M, Esmond AC, Hedrick V, Zoellner J, You W, Hill JL. The Adoption of the Healthy Eating Standards in Local Afterschool Programs Does Not Improve Quality of Snacks. THE JOURNAL OF SCHOOL HEALTH 2019; 89:809-817. [PMID: 31397496 DOI: 10.1111/josh.12822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Revised: 01/23/2018] [Accepted: 04/22/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES In 2011, the National Afterschool Association adopted the Healthy Eating and Physical Activity (HEPA) standards to address snack quality and physical activity in afterschool programs. Although research has indicated promise in the adoption of these policies by national organizations, less is known about local adoption, implementation, and effectiveness. In this study, we aimed to compare the quality of snacks served at program sites pre- and post-adoption and to determine the quality of non-program snacks compared to program snacks. METHODS An interrupted time series design was used to measure snack quality and consumption at 3 policy adopting sites and 2 non-policy adopting sites that served as a comparison control. Trained research staff collected snack type, brand, and amount consumed using a modified quarter-waste method. Analysis on nutrient content of snacks was completed using Nutrition Data System for Research software. RESULTS Adoption of the HEPA standards among policy adopting sites did not result in significantly better snack quality. Across all sites, program snacks were healthier than non-program snacks. CONCLUSION Pursuing additional components of the HEPA standards related to implementation may be necessary to significantly improve snack quality. Environmental supports such as limiting the amount of non-program snacks available onsite may improve snack quality.
Collapse
Affiliation(s)
- Meagan Helmick
- Radford University Carilion, 101 Elm Ave SE, Roanoke, VA 24013
| | | | - Valisa Hedrick
- 295 West Campus Drive, 338 Wallace Hall, Blacksburg, VA 24061
| | | | - Wen You
- 250 Drillfield Drive, 304 Hutcheson Hall, Blacksburg, VA 24061
| | - Jennie L Hill
- University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, NE 68198
| |
Collapse
|
7
|
Dietary patterns as a red flag for higher risk of eating disorders among female teenagers with and without type I diabetes mellitus : Adolescents with type I diabetes mellitus are a risk factor for eating disorders: a case-control study. Eat Weight Disord 2019; 24:151-161. [PMID: 28913823 DOI: 10.1007/s40519-017-0442-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 09/06/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Female adolescents with type I diabetes mellitus (TIDM) have an increased risk of developing eating disorders (ED) due to the dietary recommendations. OBJECTIVE Investigate the association between dietary intake and increased risk of ED. METHODS Case-control study with 50 T1DM female adolescents (11-16 years) and 100 healthy peers (CG). Measures included food frequency questionnaire (FFQ-PP), Child-EDE.12, economic and anthropometric data. RESULTS Comparing female adolescents with T1DM vs CG, the first had higher intake of: bread, cereal, rice, and pasta (29.7 vs 23.8%, p = 0.001), vegetables (6.5 vs 2.8%, p < 0.001), milk yogurt and cheese (9.9 vs 7.6%, p = 0.032), fat, and oils (8.2 vs 5.9%, p = 0.003), besides higher fiber intake (19.2 vs 14.7%, p = 0.006) and lower consumption of sweets (13.6 vs 30.7%, p < 0.001). No differences on ED psychopathology (Child-EDE subscales and global score) were found between groups. In unadjusted association between the ED psychopathology and dietary intake, a diet rich in fiber was significantly associated with both the global and eating concern scores. Among CG, increased intake of meat, poultry, fish, and eggs and decreased bread, cereal, rice, and pasta consumption were significantly associated with higher ED psychopathology. When BMI and age are adjusted, the association between fiber intake and ED psychopathology is no longer significant among diabetic participants; however, in the CG, this association remains. CONCLUSIONS The study suggests that an association between dietary intake and ED psychopathology might exist in female adolescents with and without TIDM and that careful evaluation of the dietary profile and risk of developing an ED should be considered in clinical practice. LEVEL OF EVIDENCE Level III, case-control study.
Collapse
|
8
|
Landry MJ, Khazaee E, Markowitz AK, Vandyousefi S, Ghaddar R, Pilles K, Asigbee FM, Gatto NM, Davis JN. Impact of food security on glycemic control among low-income primarily Hispanic/Latino children in Los Angeles, California: A cross-sectional study. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2018; 14:709-724. [PMID: 31749895 DOI: 10.1080/19320248.2018.1491367] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Studies examining the impact of food insecurity on metabolic markers are limited, specifically in Hispanic youth. This study was a cross-sectional analysis of 218 3rd-5th grade students (83% Hispanic and 49% male). Anthropometrics, blood glucose, insulin, and lipids via fasting blood draw, dietary intake via Block screener, and a 5-item food security scale were collected. HOMA-Insulin Resistance was calculated. Multivariate analyses of covariance were used to examine differences in glucose and insulin indices, adiposity, metabolic and dietary intake variables between categories of food security. Food secure children had greater glycemic control and decreased insulin resistance compared to food insecure children.
Collapse
Affiliation(s)
- M J Landry
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| | - E Khazaee
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| | - A K Markowitz
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| | - S Vandyousefi
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| | - R Ghaddar
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| | - K Pilles
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| | - F M Asigbee
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| | - N M Gatto
- School of Community and Global Health, Claremont Graduate University, Claremont, CA
| | - J N Davis
- Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX
| |
Collapse
|
9
|
de Wild VW, de Graaf C, Jager G. Use of Different Vegetable Products to Increase Preschool-Aged Children’s Preference for and Intake of a Target Vegetable: A Randomized Controlled Trial. J Acad Nutr Diet 2017; 117:859-866. [DOI: 10.1016/j.jand.2016.11.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
|
10
|
Setayeshgar S, Ekwaru JP, Maximova K, Majumdar SR, Storey KE, McGavock J, Veugelers PJ. Dietary intake and prospective changes in cardiometabolic risk factors in children and youth. Appl Physiol Nutr Metab 2017; 42:39-45. [PMID: 27959641 DOI: 10.1139/apnm-2016-0215] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2023]
Abstract
Only few studies examined the effect of diet on prospective changes in cardiometabolic (CM) risk factors in children and youth despite its importance for understanding the role of diet early in life for cardiovascular disease in adulthood. To test the hypothesis that dietary intake is associated with prospective changes in CM risk factors, we analyzed longitudinal observations made over a period of 2 years among 448 students (aged 10-17 years) from 14 schools in Canada. We applied mixed effect regression to examine the associations of dietary intake at baseline with changes in body mass index, waist circumference (WC), systolic and diastolic blood pressure (SBP and DBP), and insulin sensitivity score between baseline and follow-up while adjusting for age, sex, and physical activity. Dietary fat at baseline was associated with increases in SBP and DBP z scores (per 10 g increase in dietary fat per day: β = 0.03; p < 0.05) and WC (β = 0.31 cm; p < 0.05) between baseline and follow-up. Every additional gram of sodium intake at baseline was associated with an increase in DBP z score of 0.04 (p < 0.05) between baseline and follow-up. Intake of sugar, vegetables and fruit, and fibre were not associated with changes in CM risk factors in a statistically significant manner. Our findings suggest that a reduction in the consumption of total dietary fat and sodium may contribute to the prevention of excess body weight and hypertension in children and youth, and their cardiometabolic sequelae later in life.
Collapse
Affiliation(s)
- Solmaz Setayeshgar
- a School of Public Health, Population Health Intervention Research Unit, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB T6G 2T4, Canada
| | - John Paul Ekwaru
- a School of Public Health, Population Health Intervention Research Unit, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB T6G 2T4, Canada
| | - Katerina Maximova
- b School of Public Health, University of Alberta, 3-268 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB T6G 1C9, Canada
| | - Sumit R Majumdar
- c Division of General Internal Medicine, Department of Medicine, University of Alberta, 5-112 Clinical Sciences, 11350-83 Avenue, Edmonton, AB T6G 2R8, Canada
| | - Kate E Storey
- a School of Public Health, Population Health Intervention Research Unit, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB T6G 2T4, Canada
| | - Jonathan McGavock
- d Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, 511 JBRC, Children's Hospital Research Institute of Manitoba, 715 McDermot Ave., Winnipeg, MB R3E 3P4, Canada
| | - Paul J Veugelers
- a School of Public Health, Population Health Intervention Research Unit, University of Alberta, 3-50 University Terrace, 8303 112 Street, Edmonton, AB T6G 2T4, Canada
| |
Collapse
|
11
|
Ronto R, Ball L, Pendergast D, Harris ND. Food Literacy at Secondary Schools in Australia. THE JOURNAL OF SCHOOL HEALTH 2016; 86:823-831. [PMID: 27714873 DOI: 10.1111/josh.12440] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 03/08/2016] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Food literacy can encourage adolescents to develop healthy dietary patterns. This study examined home economics teachers' (HET) perspectives of the importance, curriculum, self-efficacy, and food environments regarding food literacy in secondary schools in Australia. METHODS A 20-item cross-sectional survey was completed by 205 HETs. The survey focused on the importance of aspects of food literacy, HETs' self-efficacy, and attitudes toward food literacy and schools' food environments. Data were analyzed descriptively, and associations between participants' demographic characteristics and perceptions were investigated by chi-square analyses. RESULTS HETs rated aspects of food literacy including preparing and cooking food, knowing about healthy foods and food safety and hygiene practices as very important. They indicated animal welfare, where food comes from, and plan and manage time for food shopping to be the least important aspects of food literacy. HETs reported that students' involvement in food literacy activities resulted in healthier diets and improved food practices, but the schools' food environments are not comprehensively supportive of food literacy. CONCLUSIONS HETs report that food literacy is very important for adolescents to learn. The focus is more on microaspects in comparison to macroaspects of food literacy. Schools' food environments are ideally positioned to shape dietary intake of adolescents but their potential is not being realized.
Collapse
Affiliation(s)
- Rimante Ronto
- School of Medicine & Menzies Health Institute Queensland, Building GO5 Room 3.16, Gold Coast Campus, Griffith University, Queensland 4222, Australia.
| | - Lauren Ball
- Menzies Health Institute Queensland, School of Allied Health sciences, Building G16 Room 2.50, Gold Coast Campus, Griffith University, Queensland 4222, Australia.
| | - Donna Pendergast
- School of Education and Professional Studies, Art, Education and Law Group, Building M10 Room 2.37, Mount Gravatt Campus, Griffith University, Queensland 4122, Australia.
| | - Neil D Harris
- School of Medicine & Menzies Health Institute Queensland, Building GO5 Room 3.13, Gold Coast Campus, Griffith University, Queensland 4222, Australia.
| |
Collapse
|
12
|
Trofholz AC, Tate AD, Draxten ML, Rowley SS, Schulte AK, Neumark-Sztainer D, MacLehose RF, Berge JM. What's Being Served for Dinner? An Exploratory Investigation of the Associations between the Healthfulness of Family Meals and Child Dietary Intake. J Acad Nutr Diet 2016; 117:102-109. [PMID: 27666378 DOI: 10.1016/j.jand.2016.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/03/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Little is known about the healthfulness of foods offered at family meals or the relationship between the food's healthfulness and child overall dietary intake. OBJECTIVE This exploratory study uses a newly developed Healthfulness of Meal Index to examine the association between the healthfulness of foods served at family dinners and child dietary intake. DESIGN Direct observational, cross-sectional study. PARTICIPANTS/SETTING Primarily low-income, minority families (n=120) video recorded 8 days of family dinners and completed a corresponding meal screener. Dietary recalls were completed on the target child (6 to 12 years old). The Healthfulness of Meal Index was used to measure meal healthfulness and included component scores for whole fruit, 100% juice, vegetables, dark green vegetables, dairy, protein, added sugars, and high-sodium foods. MAIN OUTCOME MEASURES Child dietary intake measured by three 24-hour dietary recalls. STATISTICAL ANALYSES PERFORMED Linear regression models estimated the association between the healthfulness of foods served at dinner meals and overall child HEI. RESULTS The majority of coded meals included foods from protein and high-sodium components; more than half included foods from dairy and vegetable components. Nearly half of the meals had an added-sugar component food (eg, soda or dessert). Few meals served foods from fruit, 100% juice, or dark green vegetable components. Many components served at family dinner meals were significantly associated with child daily intake of those same foods (ie, dark green vegetable, non-dark green vegetables, dairy, and added sugars). The Healthfulness of Meal Index total score was significantly associated with child HEI score. CONCLUSIONS This study represents the first report of a new methodology to collect data of foods served at family dinners. Results indicated a significant association between the majority of components served at family dinner meals and child overall dietary intake. Validation of the Healthfulness of Meal Index and video-recorded family meal methodology is needed to strengthen these research methods for use in future studies.
Collapse
|
13
|
Szwarc S. Putting Facts over Fears: Examining Childhood Anti-Obesity Initiatives. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2016. [DOI: 10.2190/yfcn-kw9u-fdvv-7k2n] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Communities and healthcare professionals are calling for a variety of public school anti-obesity initiatives, which need to be approached with caution. With no reliable or accepted clinical measure of obesity in growing children, many children are being inappropriately labeled and stigmatized as fat. The vast majority of children do not have weight problems. While intuitive, these programs are not evidence-based and none to date has proven effective in reducing long-term obesity. But they are resulting in unprecedented levels of body hatred, unhealthy and inappropriate weight loss attempts, fears of food, increased susceptibility to media messages, eating disorders, nutritional deficits, and weight discrimination. This article reviews the evidence surrounding childhood obesity and the health paradigm which has been shown to give lasting positive outcomes for children's health and well-being.
Collapse
|
14
|
Pawellek I, Grote V, Rzehak P, Xhonneux A, Verduci E, Stolarczyk A, Closa-Monasterolo R, Reischl E, Koletzko B. Association of TAS2R38 variants with sweet food intake in children aged 1-6 years. Appetite 2016; 107:126-134. [PMID: 27475756 DOI: 10.1016/j.appet.2016.07.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 01/28/2023]
Abstract
We aimed at studying whether genetic variants of the TAS2R38 gene are associated with energy intake from sweet tasting foods, total energy and macronutrient intake and body weight in children. Children (n = 691) from five European countries were genotyped for the first variant site rs713598 of the TAS2R38 bitter receptor gene. Three-day dietary records were obtained yearly from one to six years of age. Foods were categorized in sweet and non-sweet-tasting. Mixed models were used to describe group differences in food and nutrient intake and BMI z-score over time. TAS2R38 genotype was related to energy intake from sweet tasting foods: Children with PP and PA genotype consumed an average 83 kJ/d (95% CI 21 to 146; p = 0.009) more sweet tasting foods than children with AA genotype and a mean 56 kJ/d (95% CI 15 to 98; p = 0.007) more energy from energy dense sweet products. Intake of sweet tasting foods was lower in girls than boys and differed between countries. TAS2R38 genotype was not associated with the intake of energy, macronutrients, sugar, single food groups and BMI z-score. Despite many other factors influencing food preference and intake in children, actual intake of sweet food items is associated with TAS2R38 genotype. Children with PP or PA genotype consume more (energy dense) sweet tasting foods.
Collapse
Affiliation(s)
- Ingrid Pawellek
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstrasse 4, 80337, Munich, Germany
| | - Veit Grote
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstrasse 4, 80337, Munich, Germany
| | - Peter Rzehak
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstrasse 4, 80337, Munich, Germany
| | - Annick Xhonneux
- CHC St Vincent, Rue François Lefèbvre, 207, 4000, Liège-Rocourt, Belgium
| | - Elvira Verduci
- Department of Pediatrics, San Paolo Hospital, University of Milan, Via Antonio di Rudinì, 8, 20142, Milano, Italy
| | - Anna Stolarczyk
- Children's Memorial Health Institute, Dept. of Gastroenterology, Hepatology and Pediatrics, Al. Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Ricardo Closa-Monasterolo
- Pediatrics Research Unit, Universitat Rovira i Virgili, IISPV, C/ Sant Llorenç 21, 43201, Reus, Spain
| | - Eva Reischl
- Research Unit of Molecular Epidemiology and Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Berthold Koletzko
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstrasse 4, 80337, Munich, Germany.
| | | |
Collapse
|
15
|
Shim JE, Kim J, Lee Y. Fruit and Vegetable Intakes of Preschool Children Are Associated With Feeding Practices Facilitating Internalization of Extrinsic Motivation. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2016; 48:311-317.e1. [PMID: 26925802 DOI: 10.1016/j.jneb.2016.01.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 01/15/2016] [Accepted: 01/21/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine the association between feeding practices and both fruit and vegetable intakes of preschoolers. DESIGN Cross-sectional; data collected from 2009 to 2010. SETTING Child care centers enrolled in the cohort of the Synergistic Theory and Research on Obesity and Nutrition Group Kids program. PARTICIPANTS Three hundred and sixteen mother-child dyads were recruited in the baseline survey as primary caregivers of children aged 2-5 years. MAIN OUTCOME MEASURES Ten aspects of maternal feeding practices were measured using a Comprehensive Feeding Practices Questionnaire. The frequency of children's fruit and vegetable consumption was estimated by mothers. ANALYSIS Spearman's rank order correlation and linear regression analysis between parental feeding practices and both fruit and vegetable consumption were adjusted for potential confounders. Pearson's correlation coefficients among 10 parental feeding practices were calculated. RESULTS Children in the study consumed fruit 1.7 ± 0.9 times per day and vegetables 1.4 ± 0.8 times per day. Feeding practices of building a healthy home food environment and involvement were positively related and those of restriction for health were negatively related to children's vegetable consumption (P < .001); moreover, encouraging balance and variety and monitoring were positively related to children's fruit consumption (P < .001). CONCLUSIONS AND IMPLICATIONS The results of this study suggest that both fruit and vegetable intakes of preschool children are more likely to increase if parents employ feeding practices that encourage child autonomy, competence, and relatedness.
Collapse
Affiliation(s)
- Jae Eun Shim
- Department of Food and Nutrition, Daejeon University, Daejeon, South Korea
| | - Juhee Kim
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC.
| | - Yoonna Lee
- Department of Food and Nutrition, Shingu College, Seongnam, South Korea
| |
Collapse
|
16
|
Wijtzes AI, Jansen W, Bouthoorn SH, Kiefte-de Jong JC, Jansen PW, Franco OH, Jaddoe VWV, Hofman A, Raat H. PROP taster status, food preferences and consumption of high-calorie snacks and sweet beverages among 6-year-old ethnically diverse children. MATERNAL AND CHILD NUTRITION 2016; 13. [PMID: 26878993 DOI: 10.1111/mcn.12240] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 10/06/2015] [Accepted: 10/16/2015] [Indexed: 12/30/2022]
Abstract
A healthy diet is important for optimal growth and development in children. Food preferences are a main determinant of children's intake. The aim of this study was to examine the associations of 6-n-propylthiouracil (PROP) taster status (taste sensitivity to PROP) with children's food preferences and consumption of high-calorie snacks and sweet beverages among ethnically diverse children. We analysed data from 5585 6-year-old children enrolled in the Generation R Study, a birth cohort study in Rotterdam, the Netherlands. PROP taster status was evaluated using a suprathreshold screening solution. Food preferences of the children were assessed by a two-stage protocol using photographs of eight food items (candy, chocolate, mayonnaise, whipped cream, soup, potato chips, carrot and bread), yielding both hedonic ratings (1-3) and rank order scores (1-8). Univariate and multivariable linear and logistic regression analyses were performed, using tasters as the reference group. Non-tasters had a slightly higher preference for carrots (β: -0.07; 95% CI: -0.13, -0.02 and β: -0.15; 95% CI: -0.27, -0.02 for hedonic ratings and rank order scores, respectively) and bread (hedonic ratings; β: -0.06; 95% CI: -0.11, -0.01) compared with tasters. No differences were found in children's preference for sweet, fat or salty food items. Furthermore, there were no associations of PROP taster status with the consumption of high-calorie snacks ≥ 2 times/day (aOR: 1.06; 95% CI: 0.91,1.24) or sweet beverages ≥ 3 glasses/day (aOR: 1.06; 95% CI: 0.92,1.23). Other factors relating to the family food environment may be more important for young children's food preferences and consumption of high-calorie snacks and sweet beverages than their innate taste sensitivity.
Collapse
Affiliation(s)
- Anne I Wijtzes
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Social Development, City of Rotterdam, Rotterdam, the Netherlands
| | - Selma H Bouthoorn
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Pauline W Jansen
- Department of Child, and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Paediatrics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- The Generation R Study Group, Erasmus Medical Center, Rotterdam, the Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
17
|
Harmon BE, Smith N, Pirkey P, Beets MW, Blake CE. The Impact of Culinary Skills Training on the Dietary Attitudes and Behaviors of Children and Parents. AMERICAN JOURNAL OF HEALTH EDUCATION 2015. [DOI: 10.1080/19325037.2015.1056862] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
18
|
Haack SA, Byker CJ. Recent population adherence to and knowledge of United States federal nutrition guides, 1992-2013: a systematic review. Nutr Rev 2014; 72:613-26. [PMID: 25209465 DOI: 10.1111/nure.12140] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The Dietary Guidelines for Americans dictates the federal nutrition programs, policies, and recommendations of the United States. Corresponding nutrition guides have been established to help educate the public about the dietary intake patterns recommended in these guidelines as well as to ameliorate the US obesity epidemic and its health-related outcomes. The purpose of this systematic review was to summarize population adherence to and knowledge of these guiding US nutrition guides issued since 1992, including the Food Guide Pyramid, MyPyramid, and MyPlate. Of the 31 studies included in the review, 22 examined adherence, 6 examined knowledge, and 3 examined both adherence and knowledge. Across studies, adherence to nutrition guides was low, with participants consuming inadequate levels of fruit, vegetables, and dairy in particular. Knowledge of nutrition guides increased over time since publication and decreased with age of the participants. An association between knowledge of and adherence to nutrition guides was not found. Disparities in knowledge and adherence existed across demographic groups. Based on these findings, it is suggested that federal dietary guidance can be strengthened by increasing dissemination of nutrition guides to the public and tailoring promotional activities to specific demographic and socioeconomic groups.
Collapse
Affiliation(s)
- Sarah A Haack
- Health and Human Development, Montana State University, Bozeman, Montana, USA
| | | |
Collapse
|
19
|
Toselli S, Brasili P, Di Michele R, Spiga F. Perception of fattening foods in Italian children and adolescents. SPRINGERPLUS 2014; 3:402. [PMID: 25184104 PMCID: PMC4149680 DOI: 10.1186/2193-1801-3-402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 07/29/2014] [Indexed: 11/10/2022]
Abstract
The present study aimed to analyze, in Italian children and adolescents, the beliefs about which foods are fattening, the appreciation of fattening foods, and the perception of some socio-cultural attributes of them. 244 children (F: 125, M: 119, aged 8-11) and 305 adolescents (F: 153; M: 152, aged 11-14) from Bologna, Northern Italy, were asked to indicate five fattening foods. For each of the indicated foods, a yes-no answer was required to the question: "is this food special for you?", and to six questions concerning socio-cultural attributes of the food, which were modelled using a latent variable with two classes named "traditional" and "modern". Pearson's chi square tests revealed, both in boys and girls, significant associations between the age class and the foods indicated as fattening: lean meat, condiments, non-sweet fruit and vegetables were more often indicated as fattening by children than by adolescents. Overall, boys showed higher appreciation and perception of fashionability of fattening foods. Girls appreciated less bread and pasta, and indicated more often than boys these foods as fattening. The different food perception of between age classes and sexes can be respectively explained by a better dietary awareness of adolescents, and by girls worrying about their look more than boys.
Collapse
Affiliation(s)
- Stefania Toselli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Patricia Brasili
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Rocco Di Michele
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Federico Spiga
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
20
|
Affiliation(s)
- Janice L. Herring
- a Department of Physical Education and Health , California State University , Stanislaus, 801 W. Monte Vista Ave., Turlock , CA , 95382 E-mail:
| |
Collapse
|
21
|
Müller K, Libuda L, Diethelm K, Huybrechts I, Moreno LA, Manios Y, Mistura L, Dallongeville J, Kafatos A, González-Gross M, Cuenca-García M, Sjöström M, Hallström L, Widhalm K, Kersting M. Lunch at school, at home or elsewhere. Where do adolescents usually get it and what do they eat? Results of the HELENA Study. Appetite 2013; 71:332-9. [PMID: 24055659 DOI: 10.1016/j.appet.2013.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 09/04/2013] [Accepted: 09/05/2013] [Indexed: 11/27/2022]
Abstract
Considering the lack of uniformity regarding school meals in Europe, information on adolescents' school lunch patterns is of public health importance. Thus, the aim of this analysis was to describe and evaluate lunchtime energy and food intake of European adolescents at different lunch locations. Data on nutritional and health-related parameters were derived from the HEalthy Lifestyle in Europe by Nutrition in Adolescence Cross-Sectional Study (HELENA-CSS). A sub-sample of 891 adolescents (47% male) with plausible data on total and lunchtime energy intake (2 × 24 h recall) as well as usual lunch location was considered. Food intake was compared to lunch of the Optimized Mixed Diet (OMD) for children and adolescents. Although energy intake was nearly in line with the recommendations, food intake was suboptimal compared to the OMD regardless of usual lunch location. Adolescents had more potatoes and less sweets at school, and more drinks (water, coffee and tea) and vegetables at home when each compared with the other locations. Food intake of adolescents getting their lunch elsewhere was characterized by the smallest amounts of potatoes and the highest amounts of sweets. Although lunch patterns may differ among countries, schools in Europe do not seem to reveal all their potential to offer access to a healthy lunch for adolescents yet.
Collapse
Affiliation(s)
- Katrin Müller
- Research Institute of Child Nutrition (FKE), Dortmund, Germany; University of Applied Sciences (DHfPG), Institute for Prevention and Public Health, Hermann Neuberger Sportschule 3, D-66123 Saarbrücken, Germany(2).
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Nutritional status and dietary intakes of children aged 6 months to 12 years: findings of the Nutrition Survey of Malaysian Children (SEANUTS Malaysia). Br J Nutr 2013; 110 Suppl 3:S21-35. [DOI: 10.1017/s0007114513002092] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The dual burden of malnutrition reportedly coexists in Malaysia; however, existing data are scarce and do not adequately represent the nutritional status of Malaysian children. The Nutrition Survey of Malaysian Children was carried out with the aim of assessing the nutritional status in a sample of nationally representative population of children aged 6 months to 12 years. A total of 3542 children were recruited using a stratified random sampling method. Anthropometric measurements included weight, height, mid-upper arm circumference, and waist and hip circumferences. Blood biochemical assessment involved analyses of Hb, serum ferritin, and vitamins A and D. Dietary intake was assessed using semi-quantitative FFQ, and nutrient intakes were compared with the Malaysian Recommended Nutrient Intakes (RNI). The prevalence of overweight (9·8 %) and obesity (11·8 %) was higher than that of thinness (5·4 %) and stunting (8·4 %). Only a small proportion of children had low levels of Hb (6·6 %), serum ferritin (4·4 %) and vitamin A (4·4 %), but almost half the children (47·5 %) had vitamin D insufficiency. Dietary intake of the children was not compatible with the recommendations, where more than one-third did not achieve the Malaysian RNI for energy, Ca and vitamin D. The present study revealed that overnutrition was more prevalent than undernutrition. The presence of high prevalence of vitamin D insufficiency and the inadequate intake of Ca and vitamin D are of concern. Hence, strategies for improving the nutritional status of Malaysian children need to consider both sides of malnutrition and also put emphasis on approaches for the prevention of overweight and obesity as well as vitamin D insufficiency.
Collapse
|
23
|
Leung CW, Blumenthal SJ, Hoffnagle EE, Jensen HH, Foerster SB, Nestle M, Cheung LW, Mozaffarian D, Willett WC. Associations of food stamp participation with dietary quality and obesity in children. Pediatrics 2013; 131:463-72. [PMID: 23439902 PMCID: PMC3581840 DOI: 10.1542/peds.2012-0889] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine if obesity and dietary quality in low-income children differed by participation in the Supplemental Nutrition Assistance Program (SNAP), formerly the Food Stamp Program. METHODS The study population included 5193 children aged 4 to 19 with household incomes ≤130% of the federal poverty level from the 1999-2008 NHANES. Diet was measured by using 24-hour recalls. RESULTS Among low-income US children, 28% resided in households currently receiving SNAP benefits. After adjusting for sociodemographic differences, SNAP participation was not associated with a higher rate of childhood obesity (odds ratio = 1.11, 95% confidence interval [CI]: 0.71-1.74). Both SNAP participants and low-income nonparticipants were below national recommendations for whole grains, fruits, vegetables, fish, and potassium, while exceeding recommended limits for processed meat, sugar-sweetened beverages, saturated fat, and sodium. Zero percent of low-income children met at least 7 of 10 dietary recommendations. After multivariate adjustment, compared with nonparticipants, SNAP participants consumed 43% more sugar-sweetened beverages (95% CI: 8%-89%), 47% more high-fat dairy (95% CI: 7%, 101%), and 44% more processed meats (95% CI: 9%-91%), but 19% fewer nuts, seeds, and legumes (95% CI: -35% to 0%). In part due to these differences, intakes of calcium, iron, and folate were significantly higher among SNAP participants. Significant differences by SNAP participation were not evident in total energy, macronutrients, Healthy Eating Index 2005 scores, or Alternate Healthy Eating Index scores. CONCLUSIONS The diets of low-income children are far from meeting national dietary recommendations. Policy changes should be considered to restructure SNAP to improve children's health.
Collapse
Affiliation(s)
- Cindy W. Leung
- Departments of Nutrition, and,Epidemiology, Harvard School of Public Health, and
| | - Susan J. Blumenthal
- Health and Medicine Program, Center for the Study of the Presidency and Congress, Washington, District of Columbia
| | - Elena E. Hoffnagle
- Health and Medicine Program, Center for the Study of the Presidency and Congress, Washington, District of Columbia
| | - Helen H. Jensen
- Department of Economics, Iowa State University, Ames, Iowa; and
| | - Susan B. Foerster
- Health and Medicine Program, Center for the Study of the Presidency and Congress, Washington, District of Columbia
| | - Marion Nestle
- Department of Nutrition, Food Studies and Public Health, New York University, New York, New York
| | | | | | - Walter C. Willett
- Departments of Nutrition, and,Epidemiology, Harvard School of Public Health, and,Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
24
|
Earl GL, Henstenburg JA. Dietary approaches to hypertension: a call to pharmacists to promote lifestyle changes. J Am Pharm Assoc (2003) 2013; 52:637-45. [PMID: 23023845 DOI: 10.1331/japha.2012.10241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To describe guideline updates regarding a dietary approach to preventing or treating hypertension and to encourage pharmacists to provide education to patients on the Dietary Approaches to Stop Hypertension (DASH) diet and reducing dietary sodium intake. DATA SOURCES Abstracts and published articles identified by searching Medline (January 2001 to July 2011) and International Pharmaceutical Abstracts (January 2001 to July 2011) using the terms hypertension, cardiovascular risk, risk reduction behavior, health behavior, community pharmacy services, counseling, diet, and sodium-restricted diet, as well as reports from the Institute of Medicine and Dietary Guidelines for Americans 2010. DATA SYNTHESIS In the Dietary Guidelines for Americans 2010, the recommended daily dietary sodium intakes for individuals with hypertension, chronic kidney disease, and diabetes was reduced to less than 1,500 mg per day. All other healthy individuals are recommended to achieve dietary sodium intakes of less than 2,300 mg per day. Americans are consuming excessive amounts of dietary sodium in the form of processed foods, which poses a barrier to blood pressure control. Pharmacists should recommend the DASH diet as a way to reduce intake of dietary sodium and use available nutrition resources found on the ChooseMyPlate.gov and Food and Drug Administration websites. Pharmacists should integrate approaches using behavioral and motivational strategies to provide education that is culturally sensitive and appeals to individuals with marginal health literacy. CONCLUSION Community and ambulatory practice pharmacists, as well as collaborative practice models between pharmacists and physicians, should optimize medication management and incorporate lifestyle interventions that reduce dietary sodium intake as part of a comprehensive approach to improve hypertension outcomes.
Collapse
Affiliation(s)
- Grace L Earl
- Philadelphia College of Pharmacy, University of the Sciences, 600 S. 43rd St., Philadelphia, PA 19104, USA.
| | | |
Collapse
|
25
|
Mushi-Brunt C, Haire-Joshu D, Elliott M, Brownson R. Fruit and Vegetable Intake and Obesity in Preadolescent Children. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2007.10598980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Christina Mushi-Brunt
- a Department of Health Sciences , Indiana University-Purdue University Indianapolis , Coleman Hall 301, Indianapolis , IN , 46202
| | - Debra Haire-Joshu
- b Obesity Prevention Center , Saint Louis University, School of Public Health , 3545 Lafayette Ave., Ste. 300, St. Louis , MO , 63104
| | - Michael Elliott
- c Prevention Research Center , Saint Louis University, School of Public Health , 3545 Lafayette Ave., Ste 300, St. Louis , MO , 63104
| | - Ross Brownson
- d Prevention Research Center , Saint Louis University, School of Public Health , 3545 Lafayette Ave., Ste 300, St. Louis , MO , 63104
| |
Collapse
|
26
|
Wohldmann. Examining the Relationship Between Knowing and Doing: Training for Improving Food Choices. AMERICAN JOURNAL OF PSYCHOLOGY 2013; 126:449-58. [DOI: 10.5406/amerjpsyc.126.4.0449] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
27
|
Validation of a home food inventory among low-income Spanish- and Somali-speaking families. Public Health Nutr 2012; 16:1151-8. [PMID: 23034097 DOI: 10.1017/s1368980012004508] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To refine and validate an existing home food inventory (HFI) for low-income Somali- and Spanish-speaking families. DESIGN Formative assessment was conducted using two focus groups, followed by revisions of the HFI, translation of written materials and instrument validation in participants’ homes. SETTING Twin Cities Metropolitan Area, Minnesota, USA. SUBJECTS Thirty low-income families with children of pre-school age (fifteen Spanish-speaking; fifteen Somali-speaking) completed the HFI simultaneously with, but independently of, a trained staff member. Analysis consisted of calculation of both item-specific and average food group kappa coefficients, specificity, sensitivity and Spearman’s correlation between participants’ and staff scores as a means of assessing criterion validity of individual items, food categories and the obesogenic score. RESULTS The formative assessment revealed the need for few changes/additions for food items typically found in Spanish-speaking households. Somali-speaking participants requested few additions, but many deletions, including frozen processed food items, non-perishable produce and many sweets as they were not typical food items kept in the home. Generally, all validity indices were within an acceptable range, with the exception of values associated with items such as ‘whole wheat bread’ (k = 0.16). The obesogenic score (presence of high-fat, high-energy foods) had high criterion validity with k = 0.57, sensitivity = 91.8%, specificity = 70.6% and Spearman correlation = 0.78. CONCLUSIONS The revised HFI is a valid assessment tool for use among Spanish and Somali households. This instrument refinement and validation process can be replicated with other population groups.
Collapse
|
28
|
Salvo D, Frediani JK, Ziegler TR, Cole CR. Food group intake patterns and nutrient intake vary across low-income Hispanic and African American preschool children in Atlanta: a cross sectional study. Nutr J 2012; 11:62. [PMID: 22931188 PMCID: PMC3487737 DOI: 10.1186/1475-2891-11-62] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 08/17/2012] [Indexed: 11/25/2022] Open
Abstract
Background The food group intake patterns of low income Hispanic and African American preschool children are not well documented. The aim of this study was to perform a food group intake analysis of low income minority preschool children and evaluate how macronutrient and micronutrient intake compares to Dietary Reference Intakes (DRI). Methods A cross sectional study design using three-day food diaries analyzed by dietary analysis software (Nutrient Database System for Research) was used. Children were recruited from well-child clinics at Children’s Healthcare of Atlanta at Hughes Spalding and North Dekalb Grady Satellite Clinic, Atlanta, GA. Low-income, African American and Hispanic preschool age children (n = 291) were enrolled. A total of 105 completed and returned the 3-day food diaries. Chi-squared tests were used to assess demographic variables. The mean percentage of intake per day of specific food groups and sub-groups were obtained (servings of given food group/total daily servings). Food intake data and proportion of children meeting DRIs for macro- and micronutrients were stratified by race/ethnicity, nutritional status, and caloric intake, and were compared using t-tests. Regression models controlling for age, BMI and sex were obtained to assess the effect of total caloric intake upon the proportional intake of each studied food group. Results The mean age of African American children was 2.24 ± 1.07 years and Hispanic children 2.84 ± 1.12 years. African Americans consumed more kcal/kg/day than Hispanics (124.7 ± 51 vs. 96.9 ± 33, p < 0.05). Hispanics consumed more fruits (22.0 ± 10.7% vs. 14.7 ± 13.7%, p < 0.05), while African Americans consumed more grains (25.7 ± 7.8% vs. 18.1 ± 6.4%, p < 0.05), meats (20.7 ± 9.0% vs. 15.4 ± 6.1%, p < 0.05), fats (9.8 ± 5.4% vs. 7.0 ± 5.8%, p < 0.05), sweet drinks (58.7 ± 17.1% vs. 41.3 ± 14.8%, p < 0.05) and low-fat dairy products (39.5 ± 19.3% vs. 28.9 ± 12.6%, p < 0.05). Among Hispanics, the proportional intake of fruits, fats and grains varied by total caloric intake, while no difference by total caloric intake was found for the dietary patterns of African Americans. Micronutrient intake also differed significantly between African American and Hispanic children. Conclusions Food group intake patterns among low-income children differ by ethnic group. There is a need for more research to guide program design and target nutritional interventions for this population.
Collapse
Affiliation(s)
- Deborah Salvo
- ACTSI, General Clinical Research Center, Emory University Hospital, 1364 Clifton Road, Suite GG-23, Atlanta, GA 30322, USA
| | | | | | | |
Collapse
|
29
|
Food intake of European adolescents in the light of different food-based dietary guidelines: results of the HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study. Public Health Nutr 2011; 15:386-98. [DOI: 10.1017/s1368980011001935] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveSince inadequate food consumption patterns during adolescence are not only linked with the occurrence of obesity in youth but also with the subsequent risk of developing diseases in adulthood, the establishment and maintenance of a healthy diet early in life is of great public health importance. Therefore, the aim of the present study was to describe and evaluate the food consumption of a well-characterized sample of European adolescents against food-based dietary guidelines for the first time.DesignThe HELENA (Healthy Lifestyle in Europe by Nutrition in Adolescence) Study is a cross-sectional study, whose main objective was to obtain comparable data on a variety of nutritional and health-related parameters in adolescents aged 12·5–17·5 years.SettingTen cities in Europe.SubjectsThe initial sample consisted of more than 3000 European adolescents. Among these, 1593 adolescents (54 % female) had sufficient and plausible dietary data on energy and food intakes from two 24 h recalls using the HELENA-DIAT software.ResultsFood intake of adolescents in Europe is not optimal compared with the two food-based dietary guidelines, Optimized Mixed Diet and Food Guide Pyramid, examined in this study. Adolescents eat half of the recommended amount of fruit and vegetables and less than two-thirds of the recommended amount of milk (and milk products), but consume much more meat (and meat products), fats and sweets than recommended. However, median total energy intake may be estimated to be nearly in line with the recommendations.ConclusionThe results urge the need to improve the dietary habits of adolescents in order to maintain health in later life.
Collapse
|
30
|
Ritchie LD, Raman A, Sharma S, Fitch MD, Fleming SE. Dietary intakes of urban, high body mass index, African American children: family and child dietary attributes predict child intakes. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2011; 43:236-243. [PMID: 21530411 DOI: 10.1016/j.jneb.2010.03.169] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2008] [Revised: 03/15/2010] [Accepted: 03/24/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To identify family and child nutrition and dietary attributes related to children's dietary intakes. DESIGN African American children (ages 8-11 years, n = 156), body mass index > 85th percentile, from urban, low-income neighborhoods. Baseline, cross-sectional data collected as part of an ongoing diabetes prevention intervention. Dietary intakes were collected by 3-day food diary to assess total energy, percent fat, discretionary fat, added sugar, whole grains, vegetables, fruit, meat, and dairy. Questionnaires on nutrition and dietary attributes administered to children and parents were used to develop 5 diet-related indices: child knowledge, child preferences, child snack habits, child beverage habits, and family food habits. RESULTS A higher child nutrition knowledge score was significantly related to a lower starchy vegetable intake. Higher scores on the child snack habits index were significantly related to higher intakes of fruit, total fruits and vegetables, total fruits and nonstarchy vegetables, and to lower intakes of added sugars. A higher score on the family food habits index was significantly related to lower intakes of total energy and discretionary fat. CONCLUSIONS AND IMPLICATIONS Targeting both child and family food and nutrition attributes may be used to promote more healthful eating among urban, low-income, overweight African American children.
Collapse
Affiliation(s)
- Lorrene D Ritchie
- The Dr. Robert C. and Veronica Atkins Center for Weight and Health, University of California, Berkeley, CA, USA
| | | | | | | | | |
Collapse
|
31
|
Food consumption patterns of infants and toddlers: where are we now? ACTA ACUST UNITED AC 2010; 110:S38-51. [PMID: 21092767 DOI: 10.1016/j.jada.2010.09.001] [Citation(s) in RCA: 174] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 08/23/2010] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To describe current infant-feeding practices and current food group consumption patterns of infants and toddlers and to compare 2008 data with 2002 data to identify shifts in these practices and food consumption over time. DESIGN The Feeding Infants and Toddlers Study (FITS) 2008 is a cross-sectional survey of a national random sample of US children from birth up to age 4 years. Data for three age subgroups (infants 4 to 5.9 months and 6 to 11.9 months and toddlers 12 to 23.9 months) were used from the 2002 (n=2,884) and 2008 surveys (n=1,596). STATISTICAL METHODS All analyses use sample weights that reflect the US population aged 4 to 24 months. Descriptive statistics (means, proportions, and standard errors) and t tests were calculated using SUDAAN (release 9, 2005, Research Triangle Park Institute, Research Triangle Park, NC). RESULTS These data show a higher percentage of infants receiving breast milk from 4 to 11.9 months of age with a concurrent decreasing percentage of infants receiving formula, which is significantly different from data for the 9- to 11.9-month-old age group. The use of complementary foods also appears to be delayed in FITS 2008: There is a significantly lower proportion of infants consuming infant cereal at 9 to 11.9 months in FITS 2008 compared to 2002 data. Fruit and vegetable consumption remains lower than desired. Significant reductions in the percentage of infants and toddlers consuming any desserts or candy, sweetened beverages, and salty snacks were seen in 2008. CONCLUSIONS The findings presented here provide important insights to the content of messages and types of interventions that are still needed to improve the diets of infants and toddlers.
Collapse
|
32
|
Mackert M, Kahlor L, Tyler D, Gustafson J. Designing e-health interventions for low-health-literate culturally diverse parents: addressing the obesity epidemic. Telemed J E Health 2010; 15:672-7. [PMID: 19694596 DOI: 10.1089/tmj.2009.0012] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Child and adolescent obesity is a significant problem contributing to long-term trends in adult obesity. Educating parents about strategies for raising healthy children is complicated by the problem of low health literacy. E-health provides new opportunities to educate lowhealth-literate audiences, and this project was intended as formative research to guide design of interventions for low-health-literate parents. Focus groups were conducted with African American, Hispanic, and white parents (n = 43), 18 years of age or older, and at or below median income for the region. Each focus group included the following: a discussion of parents' general use of the Internet for health information, the demonstration of a Web site designed specifically for low-health-literate users, and asking participants about ideas under consideration for future interventions. Participants use search engines to look for health information and use heuristics, such as position in search results, to evaluate Web site quality. Some participants avoid information from .edu and .gov domains due to perceived complexity, and there was an almost-universal lack of trust in the government for health information. University researchers, by contrast, were trusted sources as information providers. Content and usability that meet the needs of extremely low-literate audiences may be perceived as slow and lacking depth by more literate and Internet-savvy users. E-health can be used to educate low-health-literate audiences, but interventions designed for these users must be layered in terms of content and usability to meet varying levels of functional and media literacy.
Collapse
Affiliation(s)
- Michael Mackert
- Department of Advertising, The University of Texas at Austin, TX 78712, USA.
| | | | | | | |
Collapse
|
33
|
Abstract
OBJECTIVE To quantify the intake of grain and whole grain, and their food sources, as well as to investigate the age and time trends over the last decade in a sample of German children and adolescents. METHODS Dietary records from the Dortmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study were used for conducting this work. A total of 5067 3-day weighed dietary records of 821 2- to 18-year-old children and adolescents collected between 1997 and 2008 were analysed using linear mixed-effect models, in which the means of the data and the covariance structure (children of the family, repeated measurements) were modelled. RESULTS Mean whole-grain intake was between 20 and 33 g/day in the sample and highest in 13-18 year olds. No whole grain intake was recorded in 19% of all dietary records. Total grain intake increased significantly with age (P<0.0001), even after adjustment for energy intake. Whole-grain intake (g/day) increased significantly with age in the unadjusted model (P<0.0001). This increase disappeared after adjustment for energy intake (P>0.05) and became a negative trend after adjustment for grain intake (P<0.01). There were no significant time trends during the study period. Bread had the highest effect on grain intake in the total sample (50%), followed by rice/pasta (21%), cake (13%), grain (9%), RTECs (5%) and muesli (2%). CONCLUSIONS The whole-grain intake in this sample of German children and adolescents was far below the FBDG. The decreasing percentage of whole grain per grain intake with age contradicts the common concept of stable dietary habits during childhood and adolescents.
Collapse
|
34
|
Mozaffarian RS, Wiecha JL, Roth BA, Nelson TF, Lee RM, Gortmaker SL. Impact of an organizational intervention designed to improve snack and beverage quality in YMCA after-school programs. Am J Public Health 2010; 100:925-32. [PMID: 19833987 PMCID: PMC2853616 DOI: 10.2105/ajph.2008.158907] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the quality of snacks and beverages served at YMCA after-school programs before and after the programs' participation in a YMCA Learning Collaborative. METHODS We collected data on the types and brands of snacks and beverages (including fresh fruits and vegetables, whole grains, foods with trans fats, water, and sugar-sweetened beverages) served daily during 3 different time periods spanning 14 months in total, and the components of the healthy eating standards. We compared snack and beverage quality before and after the intervention. RESULTS Weekly servings of fresh fruits and vegetables (1.3 vs 3.9; P = .02) and weekly servings of fruits and vegetables as a whole (1.9 vs 5.2; P = .009) increased from baseline to postintervention; weekly servings of desserts (1.3 vs 0.5; P = .049), foods with added sugars (3.9 vs 2.4; P = .03), and foods containing trans fats (2.6 vs 0.7; P = .01) decreased. After the intervention, all YMCAs offered water daily, and none served sugar-sweetened beverages. The percentage of calories from fruits and vegetables significantly increased after the intervention, whereas the percentage of calories from foods containing trans fats and added sugars decreased. CONCLUSIONS A learning collaborative can disseminate healthy eating standards among participating organizations and facilitate improvements in the quality of after-school snacks and beverages.
Collapse
Affiliation(s)
- Rebecca S Mozaffarian
- Department of Society, Human Development, and Health, Harvard School of Public Health, USA
| | | | | | | | | | | |
Collapse
|
35
|
Harrington KF, Kohler CL, McClure LA, Franklin FA. Fourth graders' reports of fruit and vegetable intake at school lunch: does treatment assignment affect accuracy? JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2009; 109:36-44. [PMID: 19103321 PMCID: PMC2620190 DOI: 10.1016/j.jada.2008.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 06/13/2008] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Dietary interventions with children often use self-reported data to assess efficacy despite that objective methods rarely support self-report findings in validation studies. This study compared fourth graders' self-reported to observed lunch fruit and vegetable intake to determine if the accuracy of self-reported intake varied by treatment condition. DESIGN Matched randomized follow-up design examined three treatment groups (high and low intensity interventions and control) post-intervention. SUBJECTS/SETTING Three hundred seventy-nine middle-school children participating in a randomized controlled trial of a school-based fruit and vegetable intervention were observed during school lunch one day and asked to recall intake the following day. MAIN OUTCOME MEASURES Food items were coded as: "match," "omission," or "intrusion." Students were classified as accurate if all food items matched, otherwise inaccurate. Matched foods' portions were compared for accuracy. Servings were computed for total fruit and vegetable intake. ANALYSES Accuracy for fruits and vegetables were compared in separate analyses and tested for multiple potential associates: treatment condition, sex, race, body mass index, subsidized meal eligibility, school district, fruit/vegetable availability, age, and test scores. Fitted multivariable regression models included variables found to be significant in univariate or chi(2) analyses. RESULTS Variables found to be significant for fruit item accuracy were availability at lunch, body mass index, and subsidized lunch eligibility. For vegetable item accuracy, availability at lunch was significant. No differences were found for food portions or for efficacy of the intervention between the two methods of dietary data collection: observation and self-report. CONCLUSIONS Condition assignment did not bias recalled fruit and vegetable intakes among fourth graders.
Collapse
Affiliation(s)
- Kathleen Fleege Harrington
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, School of Medicine, University of Alabama at Birmingham, 619 19th Street South, OHB 138, Birmingham, Alabama 35249-7337, Phone: 205-996-5889, FAX: 205-975-6118,
| | - Connie L. Kohler
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, RPHB 227, Birmingham, AL 35294-0022, Phone 205-975-8071, FAX: 205-934-9325,
| | - Leslie A. McClure
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, RPHB 327, Birmingham, AL 35294-0022, Phone: 205-934-5924,
| | - Frank A. Franklin
- Department of Maternal and Child Health, School of Public Health, University of Alabama at Birmingham, 1665 University Blvd, RPHB 320, Birmingham, AL 35294-0022, Phone: 205-934-7161,
| |
Collapse
|
36
|
Associations between self-reported fruit and vegetable consumption and home availability of fruit and vegetables among Greek primary-school children. Public Health Nutr 2008; 11:1142-8. [PMID: 18167168 DOI: 10.1017/s1368980007001553] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To examine whether the self-reported fruit and vegetable consumption of Greek primary-school children is associated with the home availability of fruit and vegetables. DESIGN Cross-sectional study. SETTING Five primary schools in the city of Pyrgos in south-west Greece. SUBJECTS One hundred and sixty-seven students in fifth and sixth grades. METHODS Fruit and vegetable consumption was assessed using an FFQ. Home availability of fruit and vegetables was assessed using a modified version of a US home availability questionnaire. Participant BMI was assessed and parental education obtained by self-report. Hierarchical regression models that took account of the clustering of participants in schools were used to examine the relationship between consumption and availability after controlling for parental education and BMI. RESULTS Regression analyses showed that home availability of fruit was a significant predictor of consumption (beta=0.524, Z=9.77, P<0.001) in a model that explained 46 % of the overall variance. Home availability of vegetables was a significant predictor of vegetable intake (beta=0.378, Z=6.23, P<0.001) in a model that explained 29 % of the overall variance. CONCLUSION Home availability of fruit and vegetables was associated with consumption among Greek primary-school children. The association between home availability of fruit and intake was higher than the associations that have been reported in other samples. Results support focusing on the home availability of fruit and vegetables as a potential mediator of consumption that could be manipulated as a means of increasing fruit and vegetable intake among children.
Collapse
|
37
|
SATOH A, MENZAWA K, LEE S, HATAKEYAMA A, SASAKI H. Dietary guidance for obese children and their families using a model nutritional balance chart. Jpn J Nurs Sci 2007. [DOI: 10.1111/j.1742-7924.2007.00077.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
38
|
Jago R, Baranowski T, Baranowski JC. Fruit and vegetable availability: a micro environmental mediating variable? Public Health Nutr 2007; 10:681-9. [PMID: 17381953 DOI: 10.1017/s1368980007441441] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesTo examine the association between fruit and vegetable (F&V) availability and consumption, the possible influences on this association, research gaps, and implications for developing strategies to increase F&V consumption.DesignSystematic review of studies that have examined associations between F&V availability and consumption.ResultsQualitative studies conducted among children and adults indicated that greater availability was associated with greater consumption. This finding was supported by cross-sectional studies among children. Availability was associated with dietary psychosocial variables such as preferences, and it appears that availability may moderate the relationship between these psychosocial variables and consumption. Intervention studies attempting to increase availability have resulted in increased consumption, and availability has predicted change in consumption over an 18-month period.DiscussionAvailability appears to be a key proximal determinant of consumption, especially of F&V, and thereby provides a target for change. However, the mechanisms that relate these variables are unclear and there is a need to clarify the direction of causality. We suggest that the possible causal mechanisms may include: (1) availability simply facilitates increased consumption; (2) the visual cues of available food may stimulate consumption; and (3) available food exposure may increase preference, which leads to increased consumption. Each of these possibilities requires close examination, as do policy-level interventions.ConclusionF&V availability is associated with increased consumption. Research that elucidates the mechanisms between availability and intake, and tests policy-level interventions, is needed to advance increased availability as a public health procedure.
Collapse
Affiliation(s)
- Russell Jago
- Department of Exercise, Nutrition and Health Sciences, Centre for Exercise and Health, University of Bristol, Tyndall Avenue, Bristol, BS8 1TP, UK.
| | | | | |
Collapse
|
39
|
Chen AK, Roberts CK, Barnard RJ. Effect of a short-term diet and exercise intervention on metabolic syndrome in overweight children. Metabolism 2006; 55:871-8. [PMID: 16784957 DOI: 10.1016/j.metabol.2006.03.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2005] [Revised: 02/13/2006] [Indexed: 01/19/2023]
Abstract
Overweight and the metabolic syndrome are increasing radically in children. The present study was designed to examine the effects of lifestyle modification in 16 children who were placed on a high-fiber, low-fat diet in a 2-week residential program where food was provided ad libitum and daily aerobic exercise was performed. In each subject, pre- and postintervention fasting blood was drawn. Insulin (27.2 +/- 3.5 vs 18.3 +/- 1.7 microU/mL, P < .01), homeostasis model assessment for insulin resistance (5.79 +/- 0.81 vs 4.13 +/- 0.38, P < .05), and body weight (92.0 +/- 7.0 vs 88.0 +/- 6.8 kg, P < .01) were reduced significantly. Total cholesterol (165 +/- 7.8 vs 127 +/- 7.4 mg/dL, P < .01), low-density lipoprotein (94.1 +/- 8.2 vs 68.5 +/- 6.7 mg/dL, P < .01), triglycerides (146 +/- 16.2 vs 88.1 +/- 8.1 mg/dL, P < .01), and total cholesterol-high-density lipoprotein (4.16 +/- 0.30 vs 3.34 +/- 0.30, P < .01) and low-density lipoprotein-high-density lipoprotein ratios (2.41 +/- 0.3 vs 1.86 +/- 0.2, P < .01) were reduced, with no change in high-density lipoprotein observed (42.3 +/- 2.4 vs 40.8 +/- 3.0 mg/dL). Systolic blood pressure (130 +/- 3.1 vs 117 +/- 1.8 mm Hg, P < .001) and diastolic blood pressure (74.3 +/- 3.0 vs 67.2 +/- 2.3 mm Hg, P = .01) also decreased. Most notably, before the intervention, 7 of the 16 subjects were classified with metabolic syndrome. After the 2-week intervention, despite remaining overweight, reversal of metabolic syndrome was noted in all 7 subjects. All of these changes occurred despite only modest improvements in the percentage of body fat (37.5% +/- 1.1% vs 36.4% +/- 1.2%, P < .01) and body mass index (33.2 +/- 1.9 vs 31.8 +/- 1.9 kg/m(2), P < .01). These results indicate that a short-term rigorous diet and exercise regimen can reverse metabolic syndrome, even in youth without documented atherosclerosis.
Collapse
Affiliation(s)
- Andrew K Chen
- Department of Physiological Science, University of California, Los Angeles, CA 90095, USA
| | | | | |
Collapse
|
40
|
Dietary habits of the population of rural Galicia (NW Spain): Towards the development of a dietary education programme. Food Chem 2006. [DOI: 10.1016/j.foodchem.2005.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
41
|
Abstract
Os guias alimentares possuem duas propostas: a primeira, ser um guia de saúde pública, e a segunda, uma ferramenta de educação nutricional. Este trabalho objetiva apresentar um histórico dos guias alimentares e suas características, bem como abordar os guias dietéticos desenvolvidos especificamente para crianças. Foi realizado um levantamento bibliográfico dos últimos dez anos, em base de dados Medline utilizando as palavras-chave guia alimentar, guia dietético infantil e pirâmide alimentar infantil. Desde 1916, os guias alimentares vêm sendo desenvolvidos a fim de traduzir as recomendações de uma dieta saudável para população, porém somente a partir de 1999 foi desenvolvido pelo United States Departament of Agriculture um guia alimentar para crianças. Observou-se que os guias alimentares infantis, de modo geral, foram elaborados recentemente. Poucos países os desenvolveram de acordo com o hábito alimentar das crianças, utilizando alimentos típicos da idade e tamanho das porções específicas para essa faixa etária, considerando a limitada capacidade gástrica das crianças. Conclui-se que é muito importante desenvolver, implementar e validar os guias alimentares infantis, pois são uma ferramenta de educação nutricional para a formação de hábitos saudáveis e para a prevenção de doenças crônicas.
Collapse
Affiliation(s)
| | | | - Eliane de Abreu Soares
- Universidade Federal do Rio de Janeiro, Brasil; Universidade do Estado do Rio de Janeiro, Brasil
| |
Collapse
|
42
|
Fiorito LM, Mitchell DC, Smiciklas-Wright H, Birch LL. Dairy and dairy-related nutrient intake during middle childhood. JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION 2006; 106:534-42. [PMID: 16567149 PMCID: PMC2531148 DOI: 10.1016/j.jada.2006.01.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2004] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To characterize patterns of dairy intake among girls in middle childhood. DESIGN Longitudinal data were used to characterize girls' patterns of dairy intake at age 5, 7, 9, and 11 years. SUBJECTS Participants were 151 girls from predominately middle-class and exclusively non-Hispanic white families living in central Pennsylvania. STATISTICAL ANALYSES Intakes of dairy, energy, macronutrients, vitamin D, calcium, and phosphorus were assessed using three 24-hour dietary recalls in 151 non-Hispanic white girls at age 5, 7, 9, and 11 years. Analyses of changes over time were conducted using repeated measures analysis of variance. McNemar's chi(2) test was used to analyze change in percentage of dairy consumers over time. RESULTS From age 5 to 11 years, girls' total dairy intake remained stable. Total milk consumption declined, due to a decline in intake of milk as a beverage, while intakes of cheese and dairy desserts increased. Much of the decline in milk intake from age 5 to 11 years, especially for milk as a beverage, was due to a reduction in the percentage of girls consuming milk as a beverage, not simply due to a decline in the servings of milk as a beverage consumed by consumers. On average, girls met vitamin D recommendations over time; however, by age 9 and 11 years girls failed to meet calcium and phosphorus recommendations. CONCLUSIONS Although girls' dairy intake was stable over time, at age 7, 9, and 11 years girls did not meet the recommended three servings per day, leading to suboptimal intakes of calcium and phosphorus at age 9 and 11 years. Increasing milk intake among all children should continue to be a major focus of interventions.
Collapse
Affiliation(s)
- Laura M Fiorito
- Department of Human Development and Family Studies, The Pennsylvania State University, 129 Noll Laboratory, University Park, PA 16802, USA
| | | | | | | |
Collapse
|
43
|
Barbosa RMS, Carvalho CGDN, Franco VC, Salles-Costa R, Soares EA. Avaliação do consumo alimentar de crianças pertencentes a uma creche filantrópica na Ilha de Paquetá, Rio de Janeiro, Brasil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2006. [DOI: 10.1590/s1519-38292006000100015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVOS: comparar o consumo alimentar de pré-escolares, pertencentes a uma creche filantrópica, em dois períodos (no ato da matrícula e após seis meses), com base na proposta da Pirâmide Alimentar Infantil Norte-Americana e através do Índice de Alimentação Saudável (IAS). MÉTODOS: relativamente à avaliação dietética, foi utilizada a história alimentar da criança com o responsável, no ato da matrícula; após seis meses de frequência da criança, utilizou-se o método de pesagem de alimentos (na creche) e registro alimentar (na residência). Posteriormente, compararam-se as médias das porções consumidas nos dois períodos, de cada grupo alimentar, utilizando o teste "t" Student, a fim de se verificar a diferença estatística entre os grupos. Considerou-se o nível de significância de 5%. Igualmente, avaliou-se o IAS, nos dois períodos. RESULTADOS: observou-se uma diferença significativa (p<0,05) entre a média das porções de frutas e vegetais, com base na Pirâmide Alimentar Americana, e um escore satisfatório do Índice de Alimentação Saudável, após seis meses de frequência da criança na creche. CONCLUSÕES: a freqüência à creche parece trazer benefícios para a nutrição de crianças pertencentes à estratos socioeconômicos menos favorecidos.
Collapse
|
44
|
Striegel-Moore RH, Thompson DR, Affenito SG, Franko DL, Barton BA, Schreiber GB, Daniels SR, Schmidt M, Crawford PB. Fruit and vegetable intake: Few adolescent girls meet national guidelines. Prev Med 2006; 42:223-8. [PMID: 16406116 DOI: 10.1016/j.ypmed.2005.11.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Revised: 11/16/2005] [Accepted: 11/22/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine longitudinal changes in daily fruit and vegetable consumption among black and white adolescent girls and calculate the percent of girls who met the Healthy People 2010 recommendations. METHODS Girls (1186 black and 1126 white) who participated in the National Heart, Lung, and Blood Institute Growth Health Study (NGHS) were included if they had completed a 3-day food diary for at least one of six annual assessments visits, beginning at ages 11 or 12. Mixed models estimated the association of visit and race with (a) average daily consumption of fruits and vegetables and (b) the probability of meeting intake recommendations on one or more out of 3 days. RESULTS For girls of both races, fruit and vegetable consumption increased with age; white girls showed a greater increase in fruit and nutrient-rich vegetable intake than black girls. Across visits, girls consumed considerably fewer than the recommended daily servings of fruits (1.0-1.5), vegetables (1.7-2.5), or nutrient-rich vegetables (0.25). Most girls (95%) failed to meet Healthy People 2010 recommendations. CONCLUSIONS Public health efforts are needed to meet Healthy People 2010 objectives.
Collapse
Affiliation(s)
- Ruth H Striegel-Moore
- Department of Psychology, Wesleyan University, 207 High Street, Middletown, CT 06459, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Goodwin DK, Knol LK, Eddy JM, Fitzhugh EC, Kendrick O, Donohue RE. Sociodemographic correlates of overall quality of dietary intake of US adolescents. Nutr Res 2006. [DOI: 10.1016/j.nutres.2006.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
46
|
Affiliation(s)
- Robert Murray
- Borden Center for Nutrition and Wellness, Ohio State University, Division of Gastroenterology and Nutrition, Columbus Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA.
| | | | | |
Collapse
|
47
|
Abstract
Obesity now is recognized as a national epidemic. An estimated 64% of the US population is classified as overweight or obese. Environmental factors, such as increased food portions and sedentary lifestyles, have contributed to this epidemic. The epidemic affects children, with 15% of children in the United States aged one to 19 years overweight or obese. Numerous government agencies (eg, US Food and Drug Administration, Medicare, Internal Revenue Service) are working with the health care community to combat obesity. This article describes causes of obesity and offers possible solutions, such as healthy lifestyle changes, surgical options, and medication therapy.
Collapse
Affiliation(s)
- Janet Shortt
- Bon Secours Richmond St. Mary's Hospital, Richmond, VA, USA
| |
Collapse
|
48
|
Calderon KS, Yucha CB, Schaffer SD. Obesity-related cardiovascular risk factors: intervention recommendations to decrease adolescent obesity. J Pediatr Nurs 2005; 20:3-14. [PMID: 15834354 DOI: 10.1016/j.pedn.2004.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The incidence of adolescent obesity is increasing dramatically in the United States with associated risks of hypertension, adverse lipid profiles, and Type II diabetes. Unless reversed, this trend predicts an epidemic of adult cardiovascular disease. Interventions at home, at school, and in the community are required to empower teens to increase physical activity and to modify eating habits. This article describes assessment for obesity-related health problems as well as scientific guidelines and research-based intervention strategies to decrease obesity in adolescents.
Collapse
|
49
|
Bruss MB, Morris JR, Dannison LL, Orbe MP, Quitugua JA, Palacios RT. Food, culture, and family: exploring the coordinated management of meaning regarding childhood obesity. HEALTH COMMUNICATION 2005; 18:155-75. [PMID: 16083409 DOI: 10.1207/s15327027hc1802_4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Increased rates of childhood obesity combined with more accessible information about the relationship between diet, physical activity and inactivity, and chronic diseases suggest the need for analyzing the complex process of receiving and transmitting messages related to child feeding practices. This study examined the perceptions of childhood obesity within 1 multiethnic community, the Commonwealth of the Northern Mariana Islands. In particular, through the use of focus groups, individuals indicated that sociocultural, familial, and official nutritional messages were most influential to their health care behaviors. The coordinated management of meaning (CMM) theory was used to gain insight into how individuals negotiate competing messages occurring at different levels of meaning. Given its focus on cultural influences (parallel to the concepts of archetypes), CMM proved especially relevant for understanding child feeding beliefs, values, attitudes, and practices in diverse ethnic populations. Implications for future health communication research that might draw from a CMM approach were identified, as well as pragmatic endeavors that focus on the development, implementation, and evaluation of culturally appropriate interventions in the prevention of childhood obesity.
Collapse
Affiliation(s)
- Mozhdeh B Bruss
- Department of Family and Consumer Sciences, Western Michigan University, Kalamazoo, MI 49008, USA.
| | | | | | | | | | | |
Collapse
|
50
|
Kranz S, Smiciklas-Wright H, Siega-Riz AM, Mitchell D. Adverse effect of high added sugar consumption on dietary intake in American preschoolers. J Pediatr 2005; 146:105-11. [PMID: 15644832 DOI: 10.1016/j.jpeds.2004.08.077] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the effect of Dietary Reference Intakes (DRI)-recommended added sugar intake levels on nutrient and food group consumption by preschoolers. STUDY DESIGN This was a cross-sectional study of 2- to 5-year-olds in the United States Department of Agriculture Continuing Survey of Food Intake by Individuals (CSFII), 1994 to 1996, and 1998 (n = 5437). Main food sources of added sugar were established. For five categories (< or =10% energy from added sugar, 11% to 15%, 16% to 20%, 21% to 25%, and >25%), mean nutrient and food group consumption and proportion of children not meeting the DRI were ascertained. The nonparametric test for trend indicated significance of changes. Analysis was stratified by age (2- to 3-year-olds versus 4- to 5-year-olds), and survey design corrected to maintain the nationally representative character of the data. RESULTS The majority of children consumed less than 25% of energy from added sugar; the main sources were fruit and or soft drinks and desserts. Increasing added sugar consumption was paralleled by decreasing nutrient and food group intakes and increasing proportions of children with intakes below the DRI. Calcium intake was insufficient in large proportions of children consuming 16% or more from added sugar. CONCLUSIONS In preschoolers, the new DRI for added sugar are reason for concern. Further research is needed to investigate the effects of the DRI on diet quality, body weight, and health status in young children.
Collapse
Affiliation(s)
- Sibylle Kranz
- Department of Nutritional Sciences, Pennsylvania State University, State College, PA 16802, USA.
| | | | | | | |
Collapse
|