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Elford A, Spence AC, Wakem A, Rozman M, Campbell KJ, Love P. Environmental sustainability and food provision in the early childhood and education setting. Public Health Nutr 2023; 26:2200-2210. [PMID: 37807888 DOI: 10.1017/s1368980023001908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To describe environmentally sustainable (ES) and healthy food provision practices in childcare services in Victoria, Australia. DESIGN Cross-sectional study. SETTING Childcare services providing food onsite. PARTICIPANTS Staff completed an online survey that explored ES food provision practices including purchasing seasonal/local food, food waste awareness/management, and food cost/child/d. A purposively sampled subgroup conducted weighed audits to determine compliance with guidelines and total waste, serving waste (prepared, not served) and plate waste. RESULTS Survey results found 8 % of services (n 129) had previously conducted food waste audits. Service audits (n 12) found 27 % total food waste (range: 9 % - 64 %). Statistically significant differences in plate waste were found between services who had previously conducted food waste audits (7 %) and those who had not (17 %) (P = 0·04). The most common ES practice was 'providing seasonal food'; the least common was 'maintaining a compost system' and 'less packaged foods'. Most services (95 %) purchased foods from supermarkets with 23 % purchasing from farmers' markets. This was statistically lower for regional/rural services (8 %), compared to metropolitan services (27 %) (P = 0·04). Twenty-seven per cent of services spent AUD2·50 or less per child per day on food. Only one audited service provided a menu compliant with childcare food provision guidelines. CONCLUSIONS Childcare settings procure and provide large volumes of food; however, food waste awareness appears limited, and environmentally sustainable food procurement practices may be less affordable and difficult to achieve. Understanding the impact of food waste awareness on food waste practices and food costs across time merits further research.
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Affiliation(s)
- Audrey Elford
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences (SENS), Deakin University, Burwood, VIC, Australia
| | - Alison C Spence
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences (SENS), Deakin University, Burwood, VIC, Australia
| | - Amy Wakem
- Nutrition Australia, Melbourne, VIC, Australia
| | | | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences (SENS), Deakin University, Burwood, VIC, Australia
| | - Penelope Love
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences (SENS), Deakin University, Burwood, VIC, Australia
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Hasnin S, Dev DA, Swindle T, Sisson SB, Pitts SJ, Purkait T, Clifton SC, Dixon J, Stage VC. Systematic Review of Reflection Spectroscopy-Based Skin Carotenoid Assessment in Children. Nutrients 2023; 15:nu15061315. [PMID: 36986046 PMCID: PMC10055935 DOI: 10.3390/nu15061315] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/30/2023] Open
Abstract
Assessing children's skin carotenoid score (SCS) using reflection spectroscopy (RS) is a non-invasive, widely used method to approximate fruit and vegetable consumption (FVC). The aims for the current review were to (1) identify distributions of SCS across demographic groups, (2) identify potential non-dietary correlates for RS-based SCS, (3) summarize the validity and reliability of RS-based SCS assessment, and (4) conduct meta-analyses of studies examining the correlation between RS-based SCS with FVC. A literature search in eight databases in June 2021 resulted in 4880 citations and peer-reviewed publications written in English that investigated children's (2-10 years old) SCS using RS. We included 11 studies (intervention = 3, observational = 8). Potential covariates included weight status, ethnicity, seasonal variation, age, sex, and income. Studies reported criterion validity with children's FVC but not with plasma carotenoid. Additionally, no studies reported the reliability of RS-based SCS in children. Among the 726 children included in the meta-analysis, the correlation between RS-based SCS and FVC was r = 0.2 (p < 0.0001). RS-based SCS is a valid method to quantify skin carotenoids for children's FVC estimation with the potential for evaluating nutrition policies and interventions. However, future research should use standardized protocol for using RS and establish how RS-based SCS can translate to the amount of daily FVC in children.
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Affiliation(s)
- Saima Hasnin
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - Dipti A Dev
- Department of Child, Youth and Family Studies, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
| | - Susan B Sisson
- Department of Allied Health Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126, USA
| | - Stephanie Jilcott Pitts
- Department of Public Health at the Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA
| | - Tirna Purkait
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, Lincoln, NE 68588, USA
| | - Shari C Clifton
- Robert M. Bird Health Sciences Library, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126, USA
| | - Jocelyn Dixon
- Department of Human Development and Family Science, East Carolina University, Greenville, NC 27834, USA
| | - Virginia C Stage
- Department of Agricultural and Human Sciences, North Carolina State University, Raleigh, NC 27695, USA
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Bean MK, Raynor HA, Thornton LM, de Jonge L, Mazzeo SE. Design and rationale for evaluating the impact of salad bars on elementary school students' fruit, vegetable, and energy intake: a wait list control, cluster randomized controlled trial. BMC Public Health 2022; 22:2304. [PMID: 36494649 PMCID: PMC9733053 DOI: 10.1186/s12889-022-14744-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Most children do not consume the recommended amount of fruit and vegetable (FV) servings. Changing the school food environment can be a cost-efficient, effective approach to improving children's dietary quality. There is great popular support for school salad bars as a means to increase children's FV intake within the National School Lunch Program (NSLP), yet empirical research is limited. Further, although FV consumption can facilitate healthy weight management if these foods replace high calorie items, there is a need to enhance understanding of salad bars' influence on children's diet quality and energy intake within the NSLP. This is particularly important to investigate in schools in communities characterized by high poverty, as students they serve are particularly likely to rely on school meals. METHODS This report describes the design and rationale of a federally-funded investigation that uses validated methods to evaluate school salad bars. This district plans to install salad bars into 141 elementary schools over 5-years, facilitating the conduct of a waitlist control, cluster randomized controlled trial. Specifically, 12 pairs of matched schools will be randomly selected: half receiving a salad bar (Intervention) and half serving pre-portioned FVs only, standard under the NSLP (Control). Thus, groups will have different FV presentation methods; however, all schools will operate under a policy requiring students to take at least one FV serving. Schools will be matched on Title I status and percent of racial/ethnic minoritized students. Intake will be objectively assessed at lunch in each school pair, prior to (baseline), and 4-6 weeks after salad bars are installed (post), yielding ~ 14,160 lunch observations throughout the study duration. Cafeteria sales and NSLP participation data will be obtained to determine how salad bars impact revenues. Finally, implementation factors and cafeteria personnel's perspectives will be assessed, to identify barriers and facilitators to salad bars use and inform sustainability efforts. Proposed methods and current status of this investigation due to COVID-19 are described. DISCUSSION Results will have great potential to inform school nutrition policies and programs designed to improve dietary quality and reduce obesity. TRIAL REGISTRATION Retrospectively registered (10/28/22) in clinicaltrials.gov (NCT05605483).
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Affiliation(s)
- Melanie K. Bean
- grid.224260.00000 0004 0458 8737Department of Pediatrics, School of Medicine, Children’s Hospital of Richmond at Virginia Commonwealth University, Box 980140, Richmond, VA 23298 USA
| | - Hollie A. Raynor
- grid.411461.70000 0001 2315 1184Department of Nutrition, University of Tennessee, Knoxville, 1215 W. Cumberland Ave, Knoxville, TN 37996 USA
| | - Laura M. Thornton
- grid.410711.20000 0001 1034 1720Department of Psychiatry, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Lilian de Jonge
- Department of Nutrition and Food Studies, 10349 Democracy Ln, Suite 306, Fairfax, VA 22030 USA
| | - Suzanne E. Mazzeo
- grid.224260.00000 0004 0458 8737Department of Psychology, Virginia Commonwealth University, Box 842018, Richmond, VA 23284 USA
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Kerr EM, Hewitt L, Ryan ST, Norman J, Kelly B, Hammersley ML, Lum M, Okely AD. Correlates of children's dietary intake, physical activity and sedentary behavior in home-based childcare: A systematic review. Prev Med Rep 2022; 30:101999. [PMID: 36237835 PMCID: PMC9551212 DOI: 10.1016/j.pmedr.2022.101999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 09/20/2022] [Accepted: 09/24/2022] [Indexed: 11/30/2022] Open
Abstract
This systematic review assessed the correlates of children's dietary intake, physical activity and sedentary behavior in home-based childcare. A systematic search of five databases with articles published between January 2000 and July 2021 was conducted. Articles were included if they contained data from a home-based childcare (birth-5 years) setting; were a quantitative study that reported children's dietary intake, physical activity or sedentary behavior; included variables associated with children's dietary intake, physical activity or sedentary behavior; and were published in English. Correlates were categorized using McLeroy’s social ecological framework. Risk of bias was assessed using the Office of Health Assessment and Translation (OHAT) Risk of Bias Rating Tool. Fifteen studies met the inclusion criteria; six assessed children's dietary intake, and nine assessed physical activity and/or sedentary behaviors. Studies were conducted in the USA (n = 12) and Canada (n = 3). Seventy-three correlates were identified, for children's dietary intake (n = 11), physical activity (n = 35) and sedentary behavior (n = 27). Ethnicity and the food provided to children were associated with children's dietary intake in two studies; both from the same study sample. Indoor play space was positively associated with physical activity in two separate studies. No consistent associations for children's dietary intake, physical activity, or sedentary behavior outcomes were found between studies, however few studies assessed the same correlates. High-quality studies conducted in different countries that assess the nutrition and physical activity environments in home-based childcare using reliable and consistent methods are needed. This review was registered with PROSPERO, no. CRD42019103429.
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Affiliation(s)
- Erin M. Kerr
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
- Corresponding author.
| | - Lyndel Hewitt
- Illawarra Health Medical Research Institute, Wollongong, NSW, Australia
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, New South Wales 2500, Australia
| | - Sarah T. Ryan
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Jennifer Norman
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
- Illawarra Health Medical Research Institute, Wollongong, NSW, Australia
| | - Bridget Kelly
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Megan L. Hammersley
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
| | - Melanie Lum
- Hunter New England Population Health, Wallsend, New South Wales 2287, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales 2300, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales 2308, Australia
| | - Anthony D. Okely
- Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, NSW, Australia
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Kasman M, Hammond RA, Purcell R, Heuberger B, Moore TR, Grummon AH, Wu AJ, Block JP, Hivert MF, Oken E, Kleinman K. An agent-based model of child sugar-sweetened beverage consumption: implications for policies and practices. Am J Clin Nutr 2022; 116:1019-1029. [PMID: 36041179 PMCID: PMC9535525 DOI: 10.1093/ajcn/nqac194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/08/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND A strong body of evidence links young children's intake of sugar-sweetened beverages (SSBs) with myriad negative outcomes. OBJECTIVES Our research provides insight into whether and to what extent potential intervention strategies can reduce young children's consumption of SSBs. METHODS We built an agent-based model (ABM) of SSB consumption representing participants in the Project Viva longitudinal study between ages 2 and 7 y. In addition to extensive data from Project Viva, our model used nationally representative data as well as recent, high-quality literature. We tested the explanatory power of the model through comparison to consumption patterns observed in the Project Viva cohort. Then, we applied the model to simulate the potential impact of interventions that would reduce SSB availability in 1 or more settings or affect how families receive and respond to pediatrician advice. RESULTS Our model produced age-stratified trends in beverage consumption that closely match those observed in Project Viva cohort data. Among the potential interventions we simulated, reducing availability in the home-where young children spend the greatest amount of time-resulted in the largest consumption decrease. Removing access to all SSBs in the home resulted in them consuming 1.23 (95% CI: 1.21, 1.24) fewer servings of SSBs per week on average between the ages of 2 and 7 y, a reduction of ∼60%. By comparison, removing all SSB availability outside of the home (i.e., in schools and childcare) had a smaller impact (0.77; CI: 0.75, 0.78), a reduction of ∼40%. CONCLUSIONS These results suggest that interventions reducing SSB availability in the home would have the strongest effects on SSB consumption.
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Affiliation(s)
- Matt Kasman
- Center on Social Dynamics and Policy, Brookings Institution, Washington, DC, USA
| | - Ross A Hammond
- Center on Social Dynamics and Policy, Brookings Institution, Washington, DC, USA
- Brown School at Washington University in St. Louis, St. Louis, MO, USA
- The Santa Fe Institute, Santa Fe, NM, USA
| | - Rob Purcell
- Center on Social Dynamics and Policy, Brookings Institution, Washington, DC, USA
| | - Benjamin Heuberger
- Center on Social Dynamics and Policy, Brookings Institution, Washington, DC, USA
| | - Travis R Moore
- ChildObesity180, Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, USA
- Department of Community Health, School of Arts and Sciences, Tufts University, Medford, MA, USA
| | - Anna H Grummon
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Allison J Wu
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Jason P Block
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Ken Kleinman
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts–Amherst, Amherst, MA, USA
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Bekelman TA, Johnson SL, Steinberg RI, Martin CK, Sauder KA, Luckett-Cole S, Glueck DH, Hsia DS, Dabelea D. A Qualitative Analysis of the Remote Food Photography Method and the Automated Self-Administered 24-hour Dietary Assessment Tool for Assessing Children's Food Intake Reported by Parent Proxy. J Acad Nutr Diet 2022; 122:961-973. [PMID: 34767972 PMCID: PMC9038614 DOI: 10.1016/j.jand.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/31/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Accuracy and participant burden are two key considerations in the selection of a dietary assessment tool for assessing children's full-day dietary intake. OBJECTIVE The aim of this study was to identify barriers experienced by parents and burden when using two technology-based measures of dietary intake to report their child's intake: the Remote Food Photography Method (RFPM) and the Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24). DESIGN Qualitative, semistructured, focus groups were conducted with parents who served as proxy reporters of their child's dietary intake using the two different dietary assessment methods (ie, RFPM and ASA24) 1 week apart. PARTICIPANTS/SETTING This study was conducted in 2019 and included 32 parents of children aged 7 to 8 years in Colorado and Louisiana. MAIN OUTCOME MEASURES Barriers adhering to the protocol and burden with the RFPM and ASA24. QUALITATIVE ANALYSES Qualitative content analysis and Atlas.ti software were used to analyze and interpret focus group data. RESULTS For the RFPM, parents described missing photos due to unobserved intake, forgetting to capture images, disruption of mealtimes, and child embarrassment when meals were photographed at school. For the ASA24, parents described the time commitment as the main source of burden and the need to expand the food database to include additional ethnic foods and restaurant items. The main strengths were ease of use for the RFPM and the consolidated workload for the ASA24. CONCLUSIONS The barriers experienced by parents and burden differed by method, highlighting the importance of considering the unique characteristics of each assessment tool when designing a pediatric dietary assessment study and interpreting findings.
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Affiliation(s)
- Traci A Bekelman
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, Aurora, Colorado; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado.
| | - Susan L Johnson
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz
| | - Rachel I Steinberg
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, Aurora, Colorado
| | - Corby K Martin
- Ingestive Behavior, Weight Management & Health Promotion Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana; Human Phenotyping Core, Nutrition Obesity Research Center, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, Aurora, Colorado; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz
| | - Sophie Luckett-Cole
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, Aurora, Colorado; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Deborah H Glueck
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, Aurora, Colorado; Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz
| | - Daniel S Hsia
- Ingestive Behavior, Weight Management & Health Promotion Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, Colorado School of Public Health, Aurora, Colorado; Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado; Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz
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Elford A, Gwee C, Veal M, Jani R, Sambell R, Kashef S, Love P. Identification and Evaluation of Tools Utilised for Measuring Food Provision in Childcare Centres and Primary Schools: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4096. [PMID: 35409781 PMCID: PMC8998327 DOI: 10.3390/ijerph19074096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Children aged 2-11 years spend significant hours per week in early childhood education and care (ECEC) and primary schools. Whilst considered important environments to influence children's food intake, there is heterogeneity in the tools utilised to assess food provision in these settings. This systematic review aimed to identify and evaluate tools used to measure food provision in ECEC and primary schools. METHODS The Preferred Reporting Items for Systematic Reviews (PRISMA) was followed. Publications (2003-2020) that implemented, validated, or developed measurement tools to assess food provision within ECEC or primary schools were included. Two reviewers extracted and evaluated studies, cross checked by a third reviewer and verified by all authors. The Academy of Nutrition and Dietetics Quality Criteria Checklist (QCC) was used to critically appraise each study. RESULTS Eighty-two studies were included in the review. Seven measurement tools were identified, namely, Menu review; Observation; Weighed food protocol; Questionnaire/survey; Digital photography; Quick menu audit; and Web-based menu assessment. An evidence-based evaluation was conducted for each tool. CONCLUSIONS The weighed food protocol was found to be the most popular and accurate measurement tool to assess individual-level intake. Future research is recommended to develop and validate a tool to assess service-level food provision.
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Affiliation(s)
- Audrey Elford
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3216, Australia;
| | - Cherice Gwee
- Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia; (C.G.); (M.V.)
| | - Maliney Veal
- Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia; (C.G.); (M.V.)
| | - Rati Jani
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD 4222, Australia;
| | - Ros Sambell
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Perth, WA 6027, Australia;
| | - Shabnam Kashef
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Penelope Love
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3216, Australia;
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Kear K, Stotz S, Love K, Cox GO, Birch LL, Cotwright CJ. Assessing health disparities in foods and beverages served in early care and education programs across Georgia. Pediatr Obes 2021; 16:e12787. [PMID: 33729706 DOI: 10.1111/ijpo.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 07/22/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity disproportionately impacts children who are Black and Hispanic, those who live in rural communities and those who have low income. Predisposition to obesity early in life is profoundly impacted by feeding habits during the preschool years. The early care and education (ECE) setting impacts children's health by providing daily meals. OBJECTIVE The goal of this study was to identify whether or not health disparities in foods and beverages served in ECE programs in Georgia exist based on socioeconomic, demographic and geographic variables. METHODS A random sample was drawn from 3054 ECE programs across the state of Georgia. The likelihood of serving specific foods and beverages in ECE programs in the previous day was measured. Percentages and frequencies, logistic regressions, Spearman's rho and Odds ratio tests determined outcomes. RESULTS A total of 974 surveys were returned. Data were stratified based on the income level of the participant families, race of enrolled children and geographic location of the ECE program. Disparities existed between programs based on race of enrolled children and geographic location. For example, although the odds of providing sweets increased by 0.6% as the percentage of Black children enrolled increased, the provision of healthier foods, such as the odds of providing fruits (P = .001), vegetables (P = .001) and protein (P = .001) also increased. However, after results were adjusted for covariates findings did not remain significant. CONCLUSIONS Future research focused on evaluating the foods and beverages provided in ECE programs and the relationship of how income, race and location are related may provide further understanding about the disproportionate childhood obesity rates in America.
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Affiliation(s)
- Kathryn Kear
- Department of Foods and Nutrition, University of Georgia College of Family and Consumer Sciences, Athens, Georgia, USA
| | - Sarah Stotz
- Centers for American Indian and Alaska Native Health, University of Colorado Denver - Anschutz Medical Campus, Denver, Colorado, USA
| | - Kim Love
- K.R. Love Quantitative Consulting and Collaboration, Athens, Georgia, USA
| | - Ginnefer O Cox
- Department of Foods and Nutrition, University of Georgia College of Family and Consumer Sciences, Athens, Georgia, USA
| | - Leann L Birch
- Department of Foods and Nutrition, University of Georgia College of Family and Consumer Sciences, Athens, Georgia, USA
| | - Caree J Cotwright
- Department of Foods and Nutrition, University of Georgia College of Family and Consumer Sciences, Athens, Georgia, USA
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Elliott S, McCloskey ML, Johnson SL, Mena NZ, Swindle T, Bellows LL. Food Photography as a Tool to Assess Type, Quantity, and Quality of Foods in Parent-Packed Lunches for Preschoolers. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:164-173. [PMID: 33189584 DOI: 10.1016/j.jneb.2020.10.007] [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: 06/18/2020] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Explore using food photography to assess packed lunches in a university-based Early Childhood Center and contextualize these photographs through parent interviews. METHODS An explanatory sequential design was used. Packed lunches were photographed to assess the type and quantity of foods offered and consumed by Child and Adult Food Care Program components (fruit, vegetable, grain, and protein) and quality of foods offered using the Healthy Meal Index. Parent interviews aimed to understand motivations and behaviors related to packing lunch. RESULTS Data were collected on 401 lunches. Only 16.2% of lunches met all Child and Adult Food Care Program requirements. Most lunches included fruit (84%) and grains (82%), whereas fewer included vegetables (44%). Portion sizes were large, especially for grains (2.7 ± 1.5 servings). In interviews (n = 24), parents expressed tension between offering healthful items and foods they knew their child would eat, as well as concern about children going hungry. CONCLUSIONS AND IMPLICATIONS Food photography is a feasible methodology to capture parent-packed lunches for preschoolers and may have utility in nutrition education, particularly related to age-appropriate portion sizes.
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Affiliation(s)
- Savanah Elliott
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Morgan L McCloskey
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Noereem Z Mena
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Laura L Bellows
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO.
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Höchsmann C, Martin CK. Review of the validity and feasibility of image-assisted methods for dietary assessment. Int J Obes (Lond) 2020; 44:2358-2371. [PMID: 33033394 DOI: 10.1038/s41366-020-00693-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/02/2020] [Accepted: 09/26/2020] [Indexed: 11/09/2022]
Abstract
Accurately quantifying dietary intake is essential to understanding the effect of diet on health and evaluating the efficacy of dietary interventions. Self-report methods (e.g., food records) are frequently utilized despite evident inaccuracy of these methods at assessing energy and nutrient intake. Methods that assess food intake via images of foods have overcome many of the limitations of traditional self-report. In cafeteria settings, digital photography has proven to be unobtrusive and accurate and is the method of choice for assessing food provision, plate waste, and food intake. In free-living conditions, image capture of food selection and plate waste via the user's smartphone, is promising and can produce accurate energy intake estimates, though accuracy is not guaranteed. These methods foster (near) real-time transfer of data and eliminate the need for portion size estimation by the user since the food images are analyzed by trained raters. A limitation that remains, similar to self-report methods where participants must truthfully record all consumed foods, is intentional and/or unintentional underreporting of foods due to social desirability or forgetfulness. Methods that rely on passive image capture via wearable cameras are promising and aim to reduce user burden; however, only pilot data with limited validity are currently available and these methods remain obtrusive and cumbersome. To reduce analysis-related staff burden and to allow real-time feedback to the user, recent approaches have aimed to automate the analysis of food images. The technology to support automatic food recognition and portion size estimation is, however, still in its infancy and fully automated food intake assessment with acceptable precision not yet a reality. This review further evaluates the benefits and challenges of current image-assisted methods of food intake assessment and concludes that less burdensome methods are less accurate and that no current method is adequate in all settings.
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Affiliation(s)
| | - Corby K Martin
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.
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Sisson SB, Sleet K, Rickman R, Love C, Bledsoe A, Williams M, Jernigan VBB. Impact of the 2017 Child and Adult Care Food Program Meal Pattern Requirement Change on Menu Quality in Tribal Early Care Environments: The Food Resource Equity and Sustainability for Health Study. Curr Dev Nutr 2020; 4:12-22. [PMID: 32258995 PMCID: PMC7101482 DOI: 10.1093/cdn/nzz094] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 05/28/2019] [Accepted: 08/06/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Native American (NA) children have a high prevalence of obesity contributing to lifespan health disparities. Dietary intake is important to promote healthy weight gain, growth, and development. In 2017, the USDA enforced changes to the Child and Adult Care Food Program (CACFP). The CACFP provides reimbursement to qualifying Early Care and Education (ECE) programs that serve foods that uphold the program's nutrition requirements. OBJECTIVE This study had the following 2 objectives: 1) Describe a novel index to evaluate ECE menus based on revised CACFP requirements (accounting for food substitutions) and best practices for 3- to-5-y-old children, and 2) analyze CACFP requirement and best practice compliance and nutrient changes in 9 NA ECE programs before and after enforcement of the revised CACFP requirements. METHODS This longitudinal study is within a larger community-based participatory research study. Menus and meals served were evaluated for 1 wk at each of 9 programs before and after enforcement of the revised meal patterns. Nutrient analysis, CACFP requirement and best practice compliance, and substitution quality were evaluated. Differences were determined using a paired t-test or Wilcoxon matched test. This trial was registered at clinicaltrials.gov as NCT03251950. RESULTS Total grams of fiber consumed increased (5.0 ± 1.2 compared with 5.9 ± 0.8 g, P = 0.04) and total grams of sugar consumed decreased (53.8 ± 12.6 compared with 48.4 ± 7.9 g, P = 0.024), although room for further improvement exists. Although total grams of fat remained unchanged, grams of saturated fat significantly increased (7.8 ± 1.4 compared with 10.5 ± 3.4, P = 0.041). Other nutrients remained unchanged. Overall CACFP requirement and best practice compliance scores improved, although this finding was not statistically significant. No significant changes in food quality associated with substitutions occurred. CONCLUSIONS This study provides early evidence to support the beneficial impact of the revised CACFP requirements. Understanding barriers to compliance within rural NA communities would be an important next step in enhancing the health of vulnerable children.
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Affiliation(s)
- Susan B Sisson
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Kaysha Sleet
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Rachel Rickman
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Charlotte Love
- Center for Indigenous Health Research and Policy, Oklahoma State University, Tulsa, OK
| | - Alexandria Bledsoe
- Center for Indigenous Health Research and Policy, Oklahoma State University, Tulsa, OK
| | - Mary Williams
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Tulsa, OK
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Reale S, Simpson RM, Marr C, Carstairs SA, Cecil JE, Hetherington MM, Caton SJ. Snack Portion Sizes for Preschool Children Are Predicted by Caregiver Portion Size, Caregiver Feeding Practices and Children's Eating Traits. Nutrients 2019; 11:E3020. [PMID: 31835571 PMCID: PMC6950396 DOI: 10.3390/nu11123020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/28/2019] [Accepted: 12/05/2019] [Indexed: 12/20/2022] Open
Abstract
Caregivers are mostly responsible for the foods young children consume; however, it is unknown how caregivers determine what portion sizes to serve. This study examined factors which predict smaller or larger than recommended snack portion sizes in an online survey. Caregivers of children aged 2 to 4 years were presented with 10 snack images, each photographed in six portion sizes. Caregivers (n = 659) selected the portion they would usually serve themselves and their child for an afternoon snack. Information on child eating traits, parental feeding practices and demographics were provided by caregivers. Most caregivers selected portions in line with recommended amounts for preschool children, demonstrating their ability to match portion sizes to their child's energy requirements. However, 16% of caregivers selected smaller than recommended low energy-dense (LED, e.g., fruits and vegetables) snacks for their child which was associated with smaller caregiver's own portion size, reduced child food liking and increased satiety responsiveness. In contrast, 28% of caregivers selected larger than recommended amounts of high energy-dense (HED, e.g., cookies, crisps) snacks for their child which were associated with larger caregiver's own portion size, greater frequency of consumption, higher child body mass index (BMI), greater pressure to eat and lower child food liking. These findings suggest that most caregivers in this study select portions adjusted to suit their child's age and stage of development. Future interventions could provide support to caregivers regarding the energy and nutrient density of foods given the relatively small portion sizes of LED and large portions of HED snacks offered to some children.
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Affiliation(s)
- Sophie Reale
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK; (S.R.); (R.M.S.); (C.M.)
| | - Rebecca M. Simpson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK; (S.R.); (R.M.S.); (C.M.)
| | - Colette Marr
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK; (S.R.); (R.M.S.); (C.M.)
| | - Sharon A. Carstairs
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews KY16 9TF, UK; (S.A.C.); (J.E.C.)
| | - Joanne E. Cecil
- Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews KY16 9TF, UK; (S.A.C.); (J.E.C.)
| | | | - Samantha J. Caton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield S1 4DA, UK; (S.R.); (R.M.S.); (C.M.)
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Bekelman TA, Bellows LL, McCloskey ML, Martin CK, Johnson SL. Assessing dinner meals offered at home among preschoolers from low-income families with the Remote Food Photography Method. Pediatr Obes 2019; 14:e12558. [PMID: 31347302 PMCID: PMC6991120 DOI: 10.1111/ijpo.12558] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/18/2019] [Accepted: 05/29/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND The high prevalence of obesity among preschoolers may be partially explained by the type and quantity of foods offered by parents and left unconsumed by preschoolers. OBJECTIVES (a) To compare foods offered and consumed at dinner to the Dietary Guidelines for Americans (DGAs) and the Child and Adult Care Food Program (CACFP) standards and (b) to examine the types, quantities, and nutrient composition of foods offered to and consumed by preschoolers and their plate waste. METHODS Participants were recruited from six Head Start/preschool centres. The Remote Food Photography Method was used to document dinner meals over 1 week (n = 153 meals). Energy and nutrients for foods offered, consumed, and plate waste were calculated. Foods offered and consumed were compared with the DGAs and CACFP standards. RESULTS Foods and beverages offered at dinner equaled 506 kcal, which is 36% of the DGA-recommended total daily energy intake. Meals offered and consumed were high in fat and sodium and low in fibre. Adherence to CACFP standards was low for fruits (25%) and milk (2%) and moderate for vegetables (63%). Mean plate waste (29%) was similar across food types. CONCLUSIONS Opportunities exist to improve preschoolers' adherence to the DGAs and CACFP standards by enhancing the quality of dinner meals offered to them.
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Affiliation(s)
- Traci A Bekelman
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Laura L Bellows
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado
| | - Morgan L McCloskey
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, Colorado
| | - Corby K Martin
- Pennington Biomedical Research Center, Ingestive Behavior, Weight Management & Health Promotion Laboratory, Baton Rouge, Louisiana
| | - Susan L Johnson
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Tovar A, Benjamin-Neelon SE, Vaughn AE, Tsai M, Burney R, Østbye T, Ward DS. Nutritional Quality of Meals and Snacks Served and Consumed in Family Child Care. J Acad Nutr Diet 2019; 118:2280-2286. [PMID: 30497638 DOI: 10.1016/j.jand.2018.08.154] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 08/23/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Improving the nutritional quality of food, including beverages, served in early care and education settings should enhance children's diet quality. However, few studies have explored the relationship between what is served and consumed in family child-care homes (FCCHs). OBJECTIVE To describe the nutritional quality of food served to children in FCCHs and to assess the extent to which children eat what is served. DESIGN This study was a cross-sectional analysis using baseline data (n=166) from a cluster-randomized controlled trial (2013-2016). PARTICIPANTS/SETTING Eligible FCCHs in central North Carolina had to have at least two children between 18 months and 4 years, have been in business for at least 2 years, and serve at least one meal and one snack. MAIN OUTCOME MEASURES Food was captured using the Diet Observation at Child Care protocol. STATISTICAL ANALYSES Frequencies, means, and multivariate analysis were used to examine the relationship between food served and consumed by food groups and by Healthy Eating Index (HEI-2010). RESULTS Children consumed between 61% and 80% of what was served, with vegetables having the lowest percent consumed (61.0%). Total HEI-2010 score for food served was 63.6 (10.4) and for food consumed was 61.7 (11.5) out of a 100-point maximum. With regards to food served, FCCH providers came close to meeting HEI-2010 standards for dairy, whole fruit, total fruit, and empty calories. However, providers appeared to fall short when it came to greens and beans, seafood and plant proteins, total vegetables, whole grains, and fatty acids. They also exceeded recommended limits for sodium and refined grains. CONCLUSIONS Although FCCHs are serving some healthy food, mainly fruit, dairy, and few empty calories, there is room for improvement with regards to vegetables, grains, seafood and plant protein, fatty acids, and sodium. Future trainings should help providers find ways to increase the serving and consumption of these foods.
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McCloskey ML, Johnson SL, Bekelman TA, Martin CK, Bellows LL. Beyond Nutrient Intake: Use of Digital Food Photography Methodology to Examine Family Dinnertime. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:547-555.e1. [PMID: 30826162 PMCID: PMC6511478 DOI: 10.1016/j.jneb.2019.01.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 01/03/2019] [Accepted: 01/23/2019] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To explore the feasibility of using an image-based food photography methodology (Remote Food Photography Method) in a rural, low-resource audience and use the photos to examine the context of family dinner. DESIGN Parents used the SmartIntake app on study-issued tablets to take before and after photos of their and their child's dinner for about 7 nights and participated in a mini-focus group to discuss their experience with the Remote Food Photography Method. SETTING Six Head Start/preschool centers in rural Colorado. PARTICIPANTS Mother-child dyads (n = 31). VARIABLES MEASURED Number and quality of photos received, participant feedback, meal timing, concordance, location, preparation, and quality. ANALYSIS The researchers assessed feasibility via practicality (percent photos received) and acceptability (general inductive approach used to analyze mini-focus group transcripts for participant feedback); time stamps, meal quality, and food preparation scales were used to analyze dinner photos. RESULTS The majority of photographs (738 of 864) were received. Participants reacted favorably to the methodology; for some, it led to greater self-reflection about mealtime. Mother-child dyads usually ate dinner at the same time and often ate the same food. Children were frequently served protein and refined grains and were rarely served whole grains or fruit. Many families relied on convenience foods. CONCLUSIONS AND IMPLICATIONS Digital food photography was feasible in this audience. Photos yielded a holistic picture of family dinnertime: meal timing, location, concordance in parent-child meals, level of preparation, and meal quality.
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Affiliation(s)
- Morgan L McCloskey
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Traci A Bekelman
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Laura L Bellows
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO.
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Reliability and Validity of Digital Imagery Methodology for Measuring Starting Portions and Plate Waste from School Salad Bars. J Acad Nutr Diet 2018; 118:1482-1489. [PMID: 29656934 DOI: 10.1016/j.jand.2018.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 02/01/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Scientifically sound methods for investigating dietary consumption patterns from self-serve salad bars are needed to inform school policies and programs. OBJECTIVE To examine the reliability and validity of digital imagery for determining starting portions and plate waste of self-serve salad bar vegetables (which have variable starting portions) compared with manual weights. DESIGN/METHODS In a laboratory setting, 30 mock salads with 73 vegetables were made, and consumption was simulated. Each component (initial and removed portion) was weighed; photographs of weighed reference portions and pre- and post-consumption mock salads were taken. Seven trained independent raters visually assessed images to estimate starting portions to the nearest ¼ cup and percentage consumed in 20% increments. These values were converted to grams for comparison with weighed values. STATISTICAL ANALYSES Intraclass correlations between weighed and digital imagery-assessed portions and plate waste were used to assess interrater reliability and validity. Pearson's correlations between weights and digital imagery assessments were also examined. Paired samples t tests were used to evaluate mean differences (in grams) between digital imagery-assessed portions and measured weights. RESULTS Interrater reliabilities were excellent for starting portions and plate waste with digital imagery. For accuracy, intraclass correlations were moderate, with lower accuracy for determining starting portions of leafy greens compared with other vegetables. However, accuracy of digital imagery-assessed plate waste was excellent. Digital imagery assessments were not significantly different from measured weights for estimating overall vegetable starting portions or waste; however, digital imagery assessments slightly underestimated starting portions (by 3.5 g) and waste (by 2.1 g) of leafy greens. CONCLUSIONS This investigation provides preliminary support for use of digital imagery in estimating starting portions and plate waste from school salad bars. Results might inform methods used in empirical investigations of dietary intake in schools with self-serve salad bars.
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Nicklas T, Islam NG, Saab R, Schulin R, Liu Y, Butte NF, Apolzan JW, Myers CA, Martin CK. Validity of a Digital Diet Estimation Method for Use with Preschool Children. J Acad Nutr Diet 2018; 118:252-260. [PMID: 28637631 PMCID: PMC5735022 DOI: 10.1016/j.jand.2017.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 05/04/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND The validity of using the Remote Food Photography Method (RFPM) for measuring food intake of minority preschool children's intake is not well documented. OBJECTIVE Our aim was to determine the validity of intake estimations made by human raters using the RFPM compared with those obtained by weighing all foods and beverages consumed by 3- to 5-year-old children (weighed method). DESIGN We conducted a cross-sectional observational study. PARTICIPANTS/SETTINGS A convenience sample of 54 3- to 5-year-old Hispanic and African-American children were observed during a 12-hour period at Baylor Metabolic Research Unit between June 2013 and January 2014. MAIN OUTCOME MEASURES All foods/beverages consumed by the children were provided by Baylor research coordinators who took and wirelessly transmitted before-and-after pictures of the trays to trained human raters at the Pennington Biomedical Research Center who estimated grams consumed. Energy and macronutrients were calculated using the Food and Nutrient Database for Dietary Studies or food facts data provided by manufacturers. STATISTICAL ANALYSES Paired t test, mean differences, and Bland-Altman limits of agreement were performed. RESULTS Compared to the weighed method, the rater method significantly overestimated total intake by 34±71 g (P<0.0001), with a mean percent error of 2.9% (root mean square error=7.1%), and total energy intake by 75±102 kcal (P<0.0001), with a mean percent error of 7.5% (root mean square error=12.3%). The standard error for the macronutrient intakes ranged from 11.0% to 20.2%. The Bland-Altman approach demonstrated a positive slope for the rater method relative to the weighed method for total intake in grams (P=0.006), carbohydrate (P=0.01), and protein (P=0.01) (ie, magnitude of the bias increased with increasing intakes). CONCLUSIONS The rater method overestimated total intake in grams and energy in kilocalories in minority preschool children in a well-controlled condition and needs to be further tested in a free-living environment.
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Affiliation(s)
- Theresa Nicklas
- USDA/Agriculture Research Services, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX; Phone: 713-798-7087, Fax: 7137987130,
| | - Noemi G. Islam
- USDA/Agriculture Research Services, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX; Phone: 713-798-7037,
| | - Rabab Saab
- USDA/Agriculture Research Services, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX; Phone: 713-798-7135,
| | - Rebecca Schulin
- Pennington Biomedical Research Center, Baton Rouge, LA; Phone: 225-763-3058, (formerly)
- Texas Children’s Hospital, Houston, TX; Phone: 504-982-2376, (currently)
| | - Yan Liu
- USDA/Agriculture Research Services, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX; Phone: 713-798-6745,
| | - Nancy F. Butte
- USDA/Agriculture Research Services, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX; Phone: 713-798-7179,
| | - John W. Apolzan
- Pennington Biomedical Research Center, Baton Rouge, LA; Phone: 225-763-2827,
| | - Candice A. Myers
- Pennington Biomedical Research Center, Baton Rouge, LA; Phone: 225-763-2849,
| | - Corby K. Martin
- Pennington Biomedical Research Center, Baton Rouge, LA 70808; Phone: 225-763-2585, Fax: 225-763-3022.
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Parent packs, child eats: Surprising results of Lunch is in the Bag's efficacy trial. Appetite 2017; 121:249-262. [PMID: 29079478 DOI: 10.1016/j.appet.2017.10.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/18/2017] [Accepted: 10/23/2017] [Indexed: 11/21/2022]
Abstract
Early care and education (ECE) centers that require lunch brought from home provide an uncluttered view of parent-child dietary interactions in early childhood. Children's eating from parent-provided bag lunches was observed at 30 ECE centers in Texas, with 15 randomly assigned to the Lunch is in the Bag intervention to improve the lunch meal and 15 to a wait-list control condition. Study participants were parent and child aged 3-5 years (N = 633 dyads). Data were collected at baseline (pre-intervention) and follow-ups at weeks 6 (post-intervention), 22 (pre-booster), and 28 (post-booster). Changes effected in the children's lunch eating-e.g., increase of 14 percent in prevalence of children eating vegetables (SE = 5, P = 0.0063)-reciprocated changes in parent lunch-packing. Irrespective of intervention, however, the children consumed one-half to two-thirds of the amounts of whatever foods the parents packed, and the eat-to-pack ratio did not change across time. Thus, children's lunch eating at the ECE centers appeared to be regulated by perceptual cues of food availability rather than food preferences or internal cues of hunger and satiety.
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Nicklas T, Saab R, Islam NG, Wong W, Butte N, Schulin R, Liu Y, Apolzan JW, Myers CA, Martin CK. Validity of the Remote Food Photography Method Against Doubly Labeled Water Among Minority Preschoolers. Obesity (Silver Spring) 2017; 25:1633-1638. [PMID: 28758370 PMCID: PMC5573622 DOI: 10.1002/oby.21931] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to determine the validity of energy intake (EI) estimations made using the remote food photography method (RFPM) compared to the doubly labeled water (DLW) method in minority preschool children in a free-living environment. METHODS Seven days of food intake and spot urine samples excluding first void collections for DLW analysis were obtained on thirty-nine 3- to 5-year-old Hispanic and African American children. Using an iPhone, caregivers captured before and after pictures of each child's intake, pictures were wirelessly transmitted to trained raters who estimated portion size using existing visual estimation procedures, and energy and macronutrients were calculated. Paired t tests, mean differences, and Bland-Altman limits of agreement were performed. RESULTS The mean EI was 1,191 ± 256 kcal/d using the RFPM and 1,412 ± 220 kcal/d using the DLW method, resulting in a mean underestimate of 222 kcal/d (-15.6%; P < 0.0001) that was consistent regardless of intake. The RFPM underestimated EI by -28.5% in 34 children and overestimated EI by 15.6% in 5 children. CONCLUSIONS The RFPM underestimated total EI when compared to the DLW method among preschoolers. Further refinement of the RFPM is needed for assessing the EI of young children.
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Affiliation(s)
- Theresa Nicklas
- USDA/Agriculture Research Services, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX. USA
- CORRESPONDING AUTHORS: Theresa Nicklas, USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Department of Pediatrics, 1100 Bates Avenue, Houston, TX 77030, , Phone: 713-798-7087, Fax: 713-798-7130, Corby K. Martin, PhD, FTOS, Associate Professor, Director, Ingestive Behavior Laboratory, Fellow of The Obesity Society, Pennington Biomedical Research Center, 6400 Perkins Rd., Baton Rouge, LA 70808, Phone: 225-763-2585, FAX: 225-763-3022,
| | - Rabab Saab
- USDA/Agriculture Research Services, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX. USA
| | - Noemi G. Islam
- USDA/Agriculture Research Services, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX. USA
| | - William Wong
- USDA/Agriculture Research Services, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX. USA
| | - Nancy Butte
- USDA/Agriculture Research Services, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX. USA
| | - Rebecca Schulin
- Pennington Biomedical Research Center, Baton Rouge, LA. USA
- Texas Children’s Hospital, Houston, TX. USA
| | - Yan Liu
- USDA/Agriculture Research Services, Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX. USA
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Sisson SB, Stoner J, Li J, Stephens L, Campbell JE, Lora KR, Arnold SH, Horm D, DeGrace B. Tribally Affiliated Child-Care Center Environment and Obesogenic Behaviors in Young Children. J Acad Nutr Diet 2016; 117:433-440. [PMID: 27927584 DOI: 10.1016/j.jand.2016.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/12/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Child-care centers are an integral part of life for many families with young children. American Indian children are at elevated health risk because of higher levels of obesity and associated health behaviors. OBJECTIVE Our aim was to assess the child-care environment and children's physical activity (PA) and dietary intake in young children attending tribally affiliated child care. DESIGN We conducted a cross-sectional study. PARTICIPANTS/SETTING Participants were from 11 tribally affiliated child-care centers across Oklahoma and included 82 children aged 3 to 5 years old. MAIN OUTCOME MEASURES Classroom observations were conducted using the Environmental and Policy Assessment Observation to measure PA and nutrition environments. Children wore an ActiGraph GT3X accelerometer and lunchtime plate waste was observed. STATISTICAL ANALYSES Descriptive statistics, including mean±standard deviation and frequencies, were calculated for the children's behaviors and environment. RESULTS The total environment score was 23.9±5.2 (maximum=43). The nutrition score was 12.5±3.1 (maximum=21). The PA score was 11.7±2.2 (maximum=22). The participants were 3.8±0.1 years old, 55% were male, 67% were American Indian, and 38% were overweight or obese. Accelerometers were worn for 5.9±1.7 hours, excluding naptime. Children accumulated 4.3±2.2 min/h of moderate to vigorous PA, 4,294±1,883 steps/day, and 12.1±3.7 steps/min. At lunch, children were served 510±241 kcal, and consumed 387±239 kcal. Lunches consisted of 47% carbohydrate, 20% protein, and 33% fat. Total number of F/V served was 2.9±1.9 and consumed was 2.3±1.8, while whole grains served and consumed were 0.3±0.4 and 0.2±0.4, respectively, and lean proteins served and consumed were 0.3±0.4 and 0.2±0.4, respectively. CONCLUSIONS This study describes obesogenic aspects of the child-care environment and identifies areas for improvement. Children did not accumulate adequate PA or consume calories or fat excessively. Children consumed multiple F/V; however, more whole grains and lean proteins could be provided. Future research might investigate how the healthfulness of the child-care environment can be improved by counseling providers on nutrition and PA strategies to prevent obesity.
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Stanhope KK, Kay C, Stevenson B, Gazmararian JA. Measurement of obesity prevention in childcare settings: A systematic review of current instruments. Obes Res Clin Pract 2016; 11:52-89. [PMID: 27377860 DOI: 10.1016/j.orcp.2016.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/26/2016] [Accepted: 06/11/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The incidence of childhood obesity is highest among children entering kindergarten. Overweight and obesity in early childhood track through adulthood. Programs increasingly target children in early life for obesity prevention. However, the published literature lacks a review on tools available for measuring behaviour and environmental level change in child care. The objective is to describe measurement tools currently in use in evaluating obesity-prevention in preschool-aged children. METHODS Literature searches were conducted in PubMed using the keywords "early childhood obesity," "early childhood measurement," "early childhood nutrition" and "early childhood physical activity." Inclusion criteria included a discussion of: (1) obesity prevention, risk assessment or treatment in children ages 1-5 years; and (2) measurement of nutrition or physical activity. RESULTS One hundred thirty-four publications were selected for analysis. Data on measurement tools, population and outcomes were abstracted into tables. Tables are divided by individual and environmental level measures and further divided into physical activity, diet and physical health outcomes. Recommendations are made for weighing advantages and disadvantages of tools. CONCLUSION Despite rising numbers of interventions targeting obesity-prevention and treatment in preschool-aged children, there is no consensus for which tools represent a gold standard or threshold of accuracy.
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Affiliation(s)
- Kaitlyn K Stanhope
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - Christi Kay
- HealthMPowers, 3200 Pointe Pkwy NW # 400, Norcross, GA 30092, United States
| | - Beth Stevenson
- HealthMPowers, 3200 Pointe Pkwy NW # 400, Norcross, GA 30092, United States
| | - Julie A Gazmararian
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Abstract
AbstractObjectiveTo determine and compare the effect of two interventions in reducing the plate waste of school lunches.DesignA between-group analysis was conducted among children from three primary schools: (i) a group receiving intervention A, designed for children and focusing on nutrition education and food waste; (ii) a group receiving intervention B, intended for teachers and focusing on the causes and consequences of food waste; and (iii) a control group with no intervention. For each child, physical weighing of individual meals and leftovers was performed on three non-consecutive weeks at baseline (T0), 1 week (T1, short term) and 3 months (T2, medium term) following the intervention. Plate waste was recorded for a total of 1742 lunches during 14 d over eight different menus.SettingPortuguese public primary schools in the city of Porto.SubjectsAll fourth-grade children (n 212) attending the three preselected schools.ResultsAfter intervention A focusing on nutrition education designed for children, a decrease in soup waste was observed compared with the control group. The effect was greater at T1 (−11·9 (se 2·8) %; P<0·001) than at T2 (−5·8 (se 4·4) %; P=0·103). The plate waste of identical main dishes decreased strongly at T1 (−33·9 (se 4·8) %; P<0·001). However, this effect was not found at T2 (−13·7 (se 3·2) %; P<0·001). After intervention B involving teachers, plate waste decreased at T2 (−5·5 (se 1·9) % for soup; −5·4 (se 2·4) % for identical main dishes).ConclusionsNutrition education designed for children was more effective in the short than the medium term. Thus, this kind of intervention was not effective in reducing food waste in the medium term. In contrast, an intervention focusing on teachers revealed better results in the medium term than in the short term.
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Macronutrient and micronutrient intakes of children in Oklahoma child-care centres, USA. Public Health Nutr 2015; 19:1498-505. [PMID: 26278280 DOI: 10.1017/s1368980015002372] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine macronutrients and micronutrients in foods served to and consumed by children at child-care centres in Oklahoma, USA and compare them with Dietary Reference Intakes (DRI). DESIGN Observed lunch nutrients compared with one-third of the age-based DRI (for 1-3 years-olds and 4-8-year-olds). Settings Oklahoma child-care centres (n 25), USA. SUBJECTS Children aged 3-5 years (n 415). RESULTS Regarding macronutrients, children were served 1782 (sd 686) kJ (426 (sd 164) kcal), 22·0 (sd 9·0) g protein, 51·5 (sd 20·4) g carbohydrate and 30·7 (sd 8·7) % total fat; they consumed 1305 (sd 669) kJ (312 (sd 160 kcal), 16·0 (sd 9·1) g protein, 37·6 (sd 18·5) g carbohydrate and 28·9 (sd 10·6) % total fat. For both age-based DRI: served energy (22-33 % of children), protein and carbohydrate exceeded; consumed energy (7-13 % of children) and protein exceeded, while carbohydrate was inadequate. Regarding micronutrients, for both age-based DRI: served Mg (65·9 (sd 24·7) mg), Zn (3·8 (sd 11·8) mg), vitamin A (249·9 (sd 228·3) μg) and folate (71·9 (sd 40·1) µg) exceeded; vitamin E (1·4 (sd 2·1) mg) was inadequate; served Fe (2·8 (sd 1·8) mg) exceeded only in 1-3-year-olds. Consumed folate (48·3 (sd 38·4) µg) met; Ca (259·4 (sd 146·2) mg) and Zn (2·3 (sd 3·0) mg) exceeded for 1-3-year-olds, but were inadequate for 4-8-year-olds. For both age-based DRI: consumed Fe (1·9 (sd 1·2) mg) and vitamin E (1·0 (sd 1·7) mg) were inadequate; Mg (47·2 (sd 21·8) mg) and vitamin A (155·0 (sd 126·5) µg) exceeded. CONCLUSIONS Lunch at child-care centres was twice the age-based DRI for consumed protein, while energy and carbohydrate were inadequate. Areas of improvement for micronutrients pertain to Fe and vitamin E for all children; Ca, Zn, vitamin E and folate for older pre-schoolers. Adequate nutrients are essential for development and the study reveals where public health nutrition experts, policy makers and care providers should focus to improve the nutrient density of foods.
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Romo-Palafox MJ, Ranjit N, Sweitzer SJ, Roberts-Gray C, Hoelscher DM, Byrd-Williams CE, Briley ME. Dietary Quality of Preschoolers' Sack Lunches as Measured by the Healthy Eating Index. J Acad Nutr Diet 2015; 115:1779-88. [PMID: 26190228 DOI: 10.1016/j.jand.2015.05.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Eating habits are developed during the preschool years and track into adulthood, but few studies have quantified dietary quality of meals packed by parents for preschool children enrolled in early care and education centers. OBJECTIVE Our aim was to evaluate the dietary quality of preschoolers' sack lunches using the Healthy Eating Index (HEI) 2010 to provide parents of preschool children with guidance to increase the healthfulness of their child's lunch. DESIGN This study is a cross-sectional analysis of baseline dietary data from the Lunch Is in the Bag trial. PARTICIPANTS A total of 607 parent-child dyads from 30 early care and education centers in Central and South Texas were included. MAIN OUTCOME MEASURES Total and component scores of the HEI were computed using data obtained from direct observations of packed lunches and of children's consumption. STATISTICAL ANALYSIS Three-level regression models with random intercepts at the early care and education center and child level were used; all models were adjusted for child sex, age, and body mass index (calculated as kg/m(2)). RESULTS Mean HEI-2010 total scores were 58 for lunches packed and 52 for lunches consumed, out of 100 possible points. Mean HEI component scores for packed and consumed lunches were lowest for greens and beans (6% and 8% of possible points), total vegetables (33% and 28%), seafood and plant proteins (33% and 29%), and whole grains (38% and 34%); and highest for empty calories (85% and 68% of possible points), total fruit (80% and 70%), whole fruit (79% and 64%), and total protein foods (76% and 69%). CONCLUSIONS Parents of preschool children pack lunches with low dietary quality that lack vegetables, plant proteins, and whole grains, as measured by the HEI. Education of parents and care providers in early care and education centers is vital to ensure that preschoolers receive high dietary-quality meals that promote their preference for and knowledge of a healthy diet.
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Factors affecting fruit and vegetable school lunch waste in Wisconsin elementary schools participating in Farm to School programmes. Public Health Nutr 2015; 18:2855-63. [PMID: 25728060 DOI: 10.1017/s1368980015000385] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To examine characteristics potentially associated with school lunch fruit and vegetable waste, both overall and pre/post implementation of the Healthy, Hunger-Free Kids Act. DESIGN Multi-year (2010-2013) cross-sectional study using pre- and post-meal digital photographs of students' school lunch trays to estimate fruit and vegetable availability and consumption. Fruit and vegetable items were categorized for factors suspected to impact waste: prior farm to school years, placement (main menu, salad bar), procurement (local, conventional), preparation (cooked, raw) and meal component (entrée, side, topping). Analyses to assess within-category differences in waste volume were performed using a Tobit model. SETTING Wisconsin elementary schools participating in farm to school programmes, USA. SUBJECTS Children in third to fifth grade. RESULTS Many within-factor differences were detected overall and/or across time. Cooked fruits were wasted less than raw, while cooked vegetables were wasted more than raw. Where identified, locally sourced items were wasted more than conventionally sourced (+0·1 cups, P<0·0001) and salad bar items more than main menu items (+0·01 cups, P<0·0001). Increasing prior farm to school years decreased waste (-0·02 cups, P<0·0001). Items previously tried were wasted at the same volume whether reported as liked or not. New school lunch meal pattern requirement implementation did not uniformly impact fruit and vegetable waste across all categories and there was no change in waste for seven of fifteen assessed categories. CONCLUSIONS Many factors impact elementary students' school lunch waste. These factors may be helpful for school food-service authorities to consider when planning school menus.
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Beets MW, Weaver RG, Tilley F, Turner-McGrievy B, Huberty J, Ward DS, Freedman DA. Salty or sweet? Nutritional quality, consumption, and cost of snacks served in afterschool programs. THE JOURNAL OF SCHOOL HEALTH 2015; 85:118-124. [PMID: 25564980 PMCID: PMC4432474 DOI: 10.1111/josh.12224] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 07/10/2014] [Accepted: 07/12/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Snacks served in afterschool programs (ASPs, 3-6 pm) represent an important opportunity to promote healthy eating. ASP policies suggest a fruit/vegetable is served daily, while sugar-sweetened foods/beverages and artificially flavored snacks are eliminated. Limited information exists on the types of snacks served in ASPs, if snacks meet existing nutrition policies, whether children eat the snacks, and their cost. METHODS Direct observation of snacks served and consumed was collected in 20 ASPs serving over 1700 elementary age children. The number of days that snacks were served/week was evaluated for compliance with nutrition policies. Costs of snacks were collected via receipts. RESULTS Programs served desserts and artificially flavored salty snacks on 2.7 and 2.1 days/week. Fruits and vegetables were served 0.6 and 0.1 days/week, respectively. Sugar-sweetened beverages were served 1.8 days/week. Of the children (N = 383) observed, 75% to 100% consumed the snack served, with 95% and 100% of served fruits/vegetables consumed. No ASP served fruit/vegetables daily, 18 served sugar-sweetened foods, 16 served artificially flavored snacks, and 14 served sugar-sweetened beverages. Desserts and salty snacks cost $0.27-$0.32/snack vs $0.38-$0.40/snack for vegetables/fruits. CONCLUSIONS The quality of snacks failed to meet nutrition policies and consists of predominately high-sugar and artificially flavored options. Strategies to improve snack offerings in ASPs while addressing price barriers are required.
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Beets MW, Tilley F, Weaver RG, Turner-McGrievy G, Moore JB, Webster C. From policy to practice: addressing snack quality, consumption, and price in after-school programs. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:384-389. [PMID: 24268299 PMCID: PMC4028441 DOI: 10.1016/j.jneb.2013.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/27/2013] [Accepted: 10/11/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate a community partnership between after-school programs (ASPs) and grocery stores to provide discounted pricing on snacks to meet the National Afterschool Association Healthy Eating Standards that call for serving a fruit or vegetable (FV) daily while eliminating sugar-based foods and beverages. METHODS A single-group, pretest with multiple posttest design (spring, 2011-2013) in 4 large-scale ASPs serving 500 children/d was used, along with direct observation of snacks served, consumed, and cost. RESULTS At baseline, FV, sugar-sweetened beverages, and desserts were served 0.1 ± 0.5, 1.7 ± 2.0, and 2.0 ± 1.4 d/wk. By spring, 2013, FV increased to 5.0 ± 0.0 d/wk, whereas sugar-sweetened beverages and desserts were eliminated. A total of 84% of children consumed the fruit; 59% consumed the vegetables. Cost associated with purchasing snacks resulted in a $2,000-$3,000 savings over a standard 180-day school year. CONCLUSIONS AND IMPLICATIONS This partnership can serve as a model for successfully meeting nutrition policies established for ASP snacks.
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Affiliation(s)
- Michael W Beets
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC.
| | - Falon Tilley
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Robert G Weaver
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Gabrielle Turner-McGrievy
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Justin B Moore
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Collin Webster
- Department of Physical Education, College of Education, University of South Carolina, Columbia, SC
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Towards comprehensive global monitoring of food environments and policies to reduce diet-related non-communicable diseases. Public Health Nutr 2014; 16:2101-4. [PMID: 24182451 DOI: 10.1017/s1368980013002887] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Beets MW, Tilley F, Kyryliuk R, Weaver RG, Moore JB, Turner-McGrievy G. Children select unhealthy choices when given a choice among snack offerings. J Acad Nutr Diet 2014; 114:1440-6. [PMID: 24935610 DOI: 10.1016/j.jand.2014.04.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
Abstract
Out-of-school-time programs serve snacks to millions of children annually. State and national snack policies endorse serving more-healthful options, such as fruits, yet often allow less-healthful options, such as cookies and chips, to be served simultaneously. To date, no studies have examined the choices children make when provided with disparate snack options in out-of-school-time programs. An experimental study with randomized exposures was conducted that exposed children (5 to 10 years old) to the following conditions: whole or sliced fruit; whole/sliced fruit, sugar-sweetened snacks (eg, cookies) and flavored salty (eg, nacho cheese-flavored tortilla chips) snacks; and whole/sliced fruit and less-processed/unflavored grain snacks (eg, pretzels), during a 2-week period representing 18 snack occasions (morning and afternoon) during summer 2013. The percentage of children who selected snacks, snack consumption, and percent of serving wasted were calculated and analyzed using repeated-measures analyses of variance with Bonferroni adjustments. A total of 1,053 observations were made. Sliced fruit was selected more than whole fruit across all conditions. Fruit (sliced or whole) was seldom selected when served simultaneously with sugar-sweetened (6% vs 58%) and flavored salty (6% vs 38%) snacks or unflavored grain snacks (23% vs 64%). More children consumed 100% of the sugar-sweetened (89%) and flavored salty (82%) snacks compared with fruit (71%); 100% consumption was comparable between fruit (59%) and unflavored grain snacks (49%). Approximately 15% to 47% of fruit was wasted, compared with 8% to 38% of sugar-sweetened, flavored salty, and unflavored grain snacks. Snack policies that encourage out-of-school-time programs to serve fruit require clear language that limits offering less-healthful snack options simultaneously.
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Dietary intake by Dutch 1- to 3-year-old children at childcare and at home. Nutrients 2014; 6:304-18. [PMID: 24406847 PMCID: PMC3916863 DOI: 10.3390/nu6010304] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/10/2013] [Accepted: 12/24/2013] [Indexed: 11/17/2022] Open
Abstract
The goal of the current study was to assess dietary intake in a large sample (N=1016) of Dutch toddlers (1-3 years old), both at childcare and at home. Dietary intake during two weekdays was recorded using an observation format applied by childcare staff for intake at childcare, and partially pre-coded dietary journals filled out by parents for intake at home. Children's intake of energy, macronutrients and energy balance-related food groups (fruit, vegetables, sweet snacks, savoury snacks) were compared with Dutch dietary guidelines. In addition, differences between the dietary intake by various subgroups (based on gender, age, childcare attendance, socio-economic status of childcare centre) were explored using multilevel regression analyses, adjusting for nesting of children within centres. Energy intake was high relative to dietary guidelines, and children consumed more or less equal amounts of energy at home and at childcare. Dietary fibre, fruit and vegetable and snack intakes were low. Intake at childcare mainly consisted of carbohydrates, while intake at home contained more proteins and fat. The findings imply various opportunities for childcare centres to improve children's dietary intake, such as providing fruit and vegetables at snacking moments. In addition, the findings underline the importance of assessing dietary intake over a whole day, both at childcare and at home, to allow intake to be compared with dietary guidelines.
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