Alterations in growth and body composition during puberty. IV. Energy intake estimated by the youth-adolescent food-frequency questionnaire: validation by the doubly labeled water method

Validity of dietary assessment methods compared with doubly labeled water in children: A systematic review and meta-analysis

OBJECTIVES

We aimed to validate dietary assessment methods against the gold standard, doubly labeled water (DLW), for estimating total energy intake (TEI).

METHODS

PubMed, Scopus, Web of Science, and Google Scholar databases were searched until May 2023. Inclusion criteria encompassed studies involving participants aged 1-18 years, employing dietary assessment methods like food records, dietary histories, food frequency questionnaire (FFQ), or 24-h recalls estimating TEI alongside DLW to measure total energy expenditure (TEE). Data were pooled using random-effects meta-analysis models.

RESULTS

Thirty-three studies were identified, with sample sizes ranging from 9 to 118 participants. Meta-analysis of 22 studies identified underestimation of TEI (mean difference [MD] = -262.9 kcal/day [95% CI: -380.0, -145.8]; I2 = 93.55%) for food records compared with TEE estimated by DLW. Other dietary assessment methods, including food recalls (n = 9) (MD = 54.2 kcal/day [95% CI: -19.8, 128.1]; I2 = 49.62%), FFQ (n = 7) (MD = 44.5 kcal/day [95% CI: -317.8, 406.8]; I2 = 94.94%), and diet history (n = 3) (MD = -130.8 kcal/day [95% CI: -455.8, 194.1]; I2 = 77.48%), showed no significant differences in TEI compared with DLW-estimated TEE. All studies were of high quality.

CONCLUSION

Food records may underestimate TEI, yet additional research is needed to identify the most accurate methods for assessing children's dietary intake.

Association between nutritional status, body composition, and fitness level of adolescents in physical education in Casablanca, Morocco

Aim

This study aims to analyze and compare dietary intake, as well as to examine the associations between energy intake in terms of macronutrients, body composition, and physical fitness (PF) specifically cardiorespiratory endurance (CE) among a sample of young adolescents aged 15 to 18 years, who participate in physical education and sports sessions in public schools in Casablanca, Morocco.

Materials and methods

A total of 311 participants, including 156 girls and 154 boys, were included in the study. Each participant maintained a food diary for 3 days during the same study week. Additionally, body composition measurements were taken using bioelectrical impedance analysis (BIA). The PF was assessed using the validated mini-Cooper test (6 min).

Results

The results show that the participants had an average total energy intake of 2386.7 ± 492.7 kcal. A significant difference was observed between boys and girls, with average energy intakes of 2468.8 ± 531.1 kcal and 2304.0 ± 437.0 kcal, respectively. These dietary intakes were significantly lower than their needs and nutritional recommendations. The associations of nutritional status, sex, body mass index (BMI) and physical fitness (PF) were tested and a positive correlation was observed following an adequate intake of carbohydrates (CHO) and proteins on Vo2max, while a negative association was observed with regard to Body fat for both sexes. Boys exhibit significantly better PF than girls (p < 0.01). Obese participants had the lowest PF and an unbalanced nutritional status, the adolescents with a normal weight p < 0.01 displayed a high level of PF compared to individuals in other weight categories.

Conclusion

The PF is significantly associated with macronutrient intake status and body composition, especially BMI and BF. The Underweight, overweight, and obese students demonstrated poorer performance in physical fitness indices compared to normal-weight. Adolescents adhering to recommended CHO and protein intake levels tend to exhibit enhanced physical fitness. Implementing strategies to encourage students to maintain a balanced diet and engage in regular physical exercise is essential.

Total energy expenditure measured by doubly labeled water method in children and adolescents: a systematic review

Total energy expenditure (TEE) is essential for understanding the growth, development, and physical activity of children and adolescents. This study aimed to summarize the existing evidence on TEE measured using the doubly labeled water (DLW) technique in children and adolescents aged 1-18 years. Furthermore, this review compared TEE between obese and normal-weight participants. This systematic review used the PubMed, ScienceDirect, Web of Science, and EBSCO databases. These studies were limited to those published in English between January 2000 and December 2021. Articles presenting objectively measured data on the TEE of children and adolescents aged 1-18 years measured using the DLW method were included. Physical activity level (PAL; TEE/basal metabolic rate [BMR]) and BMR data were also obtained. The search strategy identified 2,351 articles, of which 63 (n=4,283 children and adolescents; 45.4% male) met the selection criteria. The participants in the 10 studies were overweight or obese (n=413). In our study, TEE increased in male and female participants aged 1-18 years. PAL increased with age in males (y=0.0272x+1.3887, r2=0.511) and females (y=0.0199x+1.401, r2=0.335), and the slope of PAL with age did not differ between males and females. The TEE of obese and overweight participants was higher than that of normal-weight participants, but the slope of TEE did not differ between normal-weight (y=132.99x+702.24, r2=0.877) and obese individuals (y=136.18x+1,037.9, r2=0.842). In conclusion, this review provides convincing evidence that daily TEE progressively increases with growth in males and females aged 1-18 years.

Cardiometabolic Risk is Positively Associated with Underreporting and Inversely Associated with Overreporting of Energy Intake Among European Adolescents: The Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Study

BACKGROUND

Dietary misreporting is the main limitation of dietary assessments and has been associated with BMI during youth. However there are no prior studies assessing misreporting and cardiometabolic risks (CMRs) in adolescence.

OBJECTIVES

To examine the associations between dietary misreporting and CMR factors in adolescents and to assess the potential bias in the association between CMR and energy intake (EI) driven by dietary misreporting.

METHODS

Two 24-hour dietary recalls were obtained from 1512 European adolescents (54.8% girls) aged 12.5-17.5 years. Physical activity was measured by accelerometry. Cut-offs suggested by Huang were applied to identify misreporters. Height, waist circumference (WC), the sum of 4 skinfold thicknesses, diastolic blood pressure (DBP), systolic blood pressure (SBP), and cardiorespiratory fitness (CRF) measurements were taken and serum triglycerides and total-/high-density lipoprotein cholesterol ratio were analyzed. A sex- and age-specific clustered CMR score (n = 364) was computed. Associations were investigated by multilevel regression analyses adjusting for age, sex, center, socioeconomic status, and physical activity.

RESULTS

Underreporting (24.8% adolescents) was significantly (P < 0.05) associated with a higher WC, waist-to-height ratio (WHeR), and sum of skinfold thickness, whereas overreporting (23.4% adolescents) was significantly associated with a lower WC, WHeR, sum of skinfold thickness, and SBP. Associations between CMR factors and EI were significantly affected by misreporting, considering various approaches. Significant, positive associations became inverse after adjusting for misreporting for WC and WHeR. The opposite was true for the sum of skinfold thickness, SBP, and CMR score. The associations between EI and DBP and CRF did not remain significant after adjusting for misreporting.

CONCLUSIONS

CMR factors differed among misreporting groups, and both abdominal and total fat mass indicators were more strongly associated with all forms of misreporting than was BMI. Moreover, misreporting seems to bias EI and CMR associations in adolescents. Therefore, energy misreporting should be taken into account when examining diet-CMR associations.

Validation of an Online Food Frequency Questionnaire against Doubly Labelled Water and 24 h Dietary Recalls in Pre-School Children

The development of easy-to-use and accurate methods to assess the intake of energy, foods and nutrients in pre-school children is needed. KidMeal-Q is an online food frequency questionnaire developed for the LifeGene prospective cohort study in Sweden. The aims of this study were to compare: (i) energy intake (EI) obtained using KidMeal-Q to total energy expenditure (TEE) measured via doubly labelled water and (ii) the intake of certain foods measured using KidMeal-Q to intakes acquired by means of 24 h dietary recalls in 38 children aged 5.5 years. The mean EI calculated using KidMeal-Q was statistically different (p < 0.001) from TEE (4670 ± 1430 kJ/24 h and 6070 ± 690 kJ/24 h, respectively). Significant correlations were observed for vegetables, fruit juice and candy between KidMeal-Q and 24 h dietary recalls. Only sweetened beverage consumption was significantly different in mean intake (p < 0.001), as measured by KidMeal-Q and 24 h dietary recalls. In conclusion, KidMeal-Q had a relatively short answering time and comparative validity to other food frequency questionnaires. However, its accuracy needs to be improved before it can be used in studies in pre-school children.

Total Energy Expenditure in Obese Kuwaiti Primary School Children Assessed by the Doubly-Labeled Water Technique

The aim of this pilot study was to assess body composition and total energy expenditure (TEE) in 35 obese 7–9 years old Kuwaiti children (18 girls and 17 boys). Total body water (TBW) and TEE were assessed by doubly-labeled water technique. TBW was derived from the intercept of the elimination rate of deuterium and TEE from the difference in elimination rates of ¹⁸O and deuterium. TBW was used to estimate fat-free mass (FFM), using hydration factors for different ages and gender. Fat mass (FM) was calculated as the difference between body weight and FFM. Body weight was not statistically different but TBW was significantly higher (p = 0.018) in boys (44.9% ± 3.3%) than girls (42.4% ± 3.0%), while girls had significantly higher estimated FM (45.2 ± 3.9 weight % versus 41.6% ± 4.3%; p = 0.014). TEE was significantly higher in boys (2395 ± 349 kcal/day) compared with girls (1978 ± 169 kcal/day); p = 0.001. Estimated physical activity level (PAL) was significantly higher in boys; 1.61 ± 0.167 versus 1.51 ± 0.870; p = 0.034. Our results provide the first dataset of TEE in 7–9 years old obese Kuwaiti children and highlight important gender differences to be considered during the development of school based interventions targeted to combat childhood obesity.

Correlates of dietary energy misreporting among European adolescents: the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study

This study examined the correlates of dietary energy under-reporting (UR) and over-reporting (OV) in European adolescents. Two self-administered computerised 24-h dietary recalls and physical activity data using accelerometry were collected from 1512 adolescents aged 12·5-17·5 years from eight European countries. Objective measurements of height and weight were obtained. BMI was categorised according to Cole/International Obesity Task Force (IOTF) cut-off points. Diet-related attitudes were assessed via self-administered questionnaires. Reported energy intake (EI) was compared with predicted total energy expenditure to identify UR and OV using individual physical activity objective measures. Associations between misreporting and covariates were examined by multilevel logistic regression analyses. Among all, 33·3 % of the adolescents were UR and 15·6 % were OV when considering mean EI. Overweight (OR 3·25; 95 % CI 2·01, 5·27) and obese (OR 4·31; 95 % CI 1·92, 9·65) adolescents had higher odds for UR, whereas underweight individuals were more likely to over-report (OR 1·67; 95 % CI 1·01, 2·76). Being content with their own figures (OR 0·61; 95 % CI 0·41, 0·89) decreased the odds for UR, whereas frequently skipping breakfast (OR 2·14; 95 % CI 1·53, 2·99) was linked with higher odds for UR. Those being worried about gaining weight (OR 0·55; 95 % CI 0·33, 0·92) were less likely to OV. Weight status and psychosocial weight-related factors were found to be the major correlates of misreporting. Misreporting may reflect socially desirable answers and low ability to report own dietary intakes, but also may reflect real under-eating in an attempt to lose weight or real over-eating to reflect higher intakes due to growth spurts. Factors influencing misreporting should be identified in youths to clarify or better understand diet-disease associations.

Food availability, modeling and restriction: How are these different aspects of the family eating environment related to adolescent dietary intake?

OBJECTIVES

To examine individual associations between aspects of the family eating environment (home food availability, parental modeling, and food restriction) and adolescent dietary intake and explore the combined relationship (i.e., environment profiles) between these aspects of the family eating environment and adolescent dietary intake.

METHODS

Adolescents [14.4 years old (SD = 2.0)] and their parents (N = 2383 parent-adolescent pairs] participated in 2 coordinated, population-based studies. Adolescent surveys were completed at school and parent surveys were conducted via mail or phone.

RESULTS

Healthy home food availability was positively associated with fruit/vegetable intake and negatively associated with soda and snack food intake in adolescents. Healthy parental modeling was negatively associated with adolescent soda consumption. Food restriction was positively associated with fruit/vegetable consumption and snack food intake. Examination of family eating environment profiles revealed that it was the home food availability component of the profiles that was associated with observed differences in fruits/vegetable consumption, whereas the parental modeling and food restriction components contributed to differences in soda and snack foods consumption.

CONCLUSIONS

Findings indicate that among the three aspects of the family eating environment explored, making healthy food available at home was most consistently associated with healthy dietary intake in adolescents.

Agreement between Two Methods of Dietary Data Collection in Male Adolescent Academy-Level Soccer Players

Collecting accurate and reliable nutritional data from adolescent populations is challenging, with current methods providing significant under-reporting. Therefore, the aim of the study was to determine the accuracy of a combined dietary data collection method (self-reported weighed food diary, supplemented with a 24-h recall) when compared to researcher observed energy intake in male adolescent soccer players. Twelve Academy players from an English Football League club participated in the study. Players attended a 12 h period in the laboratory (08:00 h–20:00 h), during which food and drink items were available and were consumed ad libitum. Food was also provided to consume at home between 20:00 h and 08:00 h the following morning under free-living conditions. To calculate the participant reported energy intake, food and drink items were weighed and recorded in a food diary by each participant, which was supplemented with information provided through a 24-h recall interview the following morning. Linear regression, limits of agreement (LOA) and typical error (coefficient of variation; CV) were used to quantify agreement between observer and participant reported 24-h energy intake. Difference between methods was assessed using a paired samples t-test. Participants systematically under-reported energy intake in comparison to that observed (p < 0.01) but the magnitude of this bias was small and consistent (mean bias = −88 kcal·day⁻¹, 95% CI for bias = −146 to −29 kcal·day⁻¹). For random error, the 95% LOA between methods ranged between −1.11 to 0.37 MJ·day⁻¹ (−256 to 88 kcal·day⁻¹). The standard error of the estimate was low, with a typical error between measurements of 3.1%. These data suggest that the combined dietary data collection method could be used interchangeably with the gold standard observed food intake technique in the population studied providing that appropriate adjustment is made for the systematic under-reporting common to such methods.

Systematic review to identify and appraise outcome measures used to evaluate childhood obesity treatment interventions (CoOR): evidence of purpose, application, validity, reliability and sensitivity

BACKGROUND

Lack of uniformity in outcome measures used in evaluations of childhood obesity treatment interventions can impede the ability to assess effectiveness and limits comparisons across trials.

OBJECTIVE

To identify and appraise outcome measures to produce a framework of recommended measures for use in evaluations of childhood obesity treatment interventions.

DATA SOURCES

Eleven electronic databases were searched between August and December 2011, including MEDLINE; MEDLINE In-Process and Other Non-Indexed Citations; EMBASE; PsycINFO; Health Management Information Consortium (HMIC); Allied and Complementary Medicine Database (AMED); Global Health, Maternity and Infant Care (all Ovid); Cumulative Index to Nursing and Allied Health Literature (CINAHL) (EBSCOhost); Science Citation Index (SCI) [Web of Science (WoS)]; and The Cochrane Library (Wiley) - from the date of inception, with no language restrictions. This was supported by review of relevant grey literature and trial databases.

REVIEW METHODS

Two searches were conducted to identify (1) outcome measures and corresponding citations used in published childhood obesity treatment evaluations and (2) manuscripts describing the development and/or evaluation of the outcome measures used in the childhood intervention obesity evaluations. Search 1 search strategy (review of trials) was modelled on elements of a review by Luttikhuis et al. (Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev 2009;1:CD001872). Search 2 strategy (methodology papers) was built on Terwee et al.'s search filter (Terwee CB, Jansma EP, Riphagen II, de Vet HCW. Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res 2009;18:1115-23). Eligible papers were appraised for quality initially by the internal project team. This was followed by an external appraisal by expert collaborators in order to agree which outcome measures should be recommended for the Childhood obesity Outcomes Review (CoOR) outcome measures framework.

RESULTS

Three hundred and seventy-nine manuscripts describing 180 outcome measures met eligibility criteria. Appraisal of these resulted in the recommendation of 36 measures for the CoOR outcome measures framework. Recommended primary outcome measures were body mass index (BMI) and dual-energy X-ray absorptiometry (DXA). Experts did not advocate any self-reported measures where objective measurement was possible (e.g. physical activity). Physiological outcomes hold potential to be primary outcomes, as they are indicators of cardiovascular health, but without evidence of what constitutes a minimally importance difference they have remained as secondary outcomes (although the corresponding lack of evidence for BMI and DXA is acknowledged). No preference-based quality-of-life measures were identified that would enable economic evaluation via calculation of quality-adjusted life-years. Few measures reported evaluating responsiveness.

LIMITATIONS

Proposed recommended measures are fit for use as outcome measures within studies that evaluate childhood obesity treatment evaluations specifically. These may or may not be suitable for other study designs, and some excluded measures may be more suitable in other study designs.

CONCLUSIONS

The CoOR outcome measures framework provides clear guidance of recommended primary and secondary outcome measures. This will enhance comparability between treatment evaluations and ensure that appropriate measures are being used. Where possible, future work should focus on modification and evaluation of existing measures rather than development of tools de nova. In addition, it is recommended that a similar outcome measures framework is produced to support evaluation of adult obesity programmes.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

What factors are associated with frequent unhealthy snack-food consumption among Australian secondary-school students?

OBJECTIVE

To examine demographic and behavioural correlates of unhealthy snack-food consumption among Australian secondary-school students and the association between their perceptions of availability, convenience and intake with consumption.

DESIGN

Cross-sectional survey of students' eating, physical activity and sedentary behaviours using validated instruments administered via an online questionnaire.

SETTING

Australian secondary schools across all states/territories.

SUBJECTS

Secondary-school students aged 12-17 years participating in the 2009-10 National Secondary Students' Diet and Activity (NaSSDA) survey (n 12 188).

RESULTS

Approximately one in five students (21 %) reported consuming unhealthy snack foods ≥14 times/week ('frequent snackers'). After adjusting for all covariates, older students and those with a BMI of ≥25 kg/m² were less likely to be frequent snackers, while students who reported high fast-food and high sugar-sweetened beverage consumption and those who watched television for >2 h/d were more likely to snack frequently. Furthermore, after adjusting for all covariates and demographic factors, students who agreed that snack foods are usually available at home, convenient to buy and that they eat too many snack foods were more likely to be snacking frequently. Conversely, students who agreed that fruit is a convenient snack were less likely to be frequent snackers.

CONCLUSIONS

Frequent unhealthy snack-food consumption appears to cluster with other poor health behaviours. Perceptions of availability and convenience are factors most readily amenable to change, and findings suggest interventions should focus on decreasing the availability of unhealthy snack foods in the home and promoting healthier options such as fruit as convenient snacks.

Framework of outcome measures recommended for use in the evaluation of childhood obesity treatment interventions: the CoOR framework

INTRODUCTION

Consensus is lacking in determining appropriate outcome measures for assessment of childhood obesity treatments. Inconsistency in the use and reporting of such measures impedes comparisons between treatments and limits consideration of effectiveness. This study aimed to produce a framework of recommended outcome measures: the Childhood obesity treatment evaluation Outcomes Review (CoOR) framework.

METHODS

A systematic review including two searches was conducted to identify (1) existing trial outcome measures and (2) manuscripts describing development/evaluation of outcome measures. Outcomes included anthropometry, diet, eating behaviours, physical activity, sedentary time/behaviour, fitness, physiology, environment, psychological well-being and health-related quality of life. Eligible measures were appraised by the internal team using a system developed from international guidelines, followed by appraisal from national external expert collaborators.

RESULTS

A total of 25,486 papers were identified through both searches. Eligible search 1 trial papers cited 417 additional papers linked to outcome measures, of which 56 were eligible. A further 297 outcome development/evaluation papers met eligibility criteria from search 2. Combined, these described 191 outcome measures. After internal and external appraisal, 52 measures across 10 outcomes were recommended for inclusion in the CoOR framework.

CONCLUSION

Application of the CoOR framework will ensure greater consistency in choosing robust outcome measures that are appropriate to population characteristics.

Dietary determinants of hepatic steatosis and visceral adiposity in overweight and obese youth at risk of type 2 diabetes

BACKGROUND

Dietary determinants of hepatic steatosis, an important precursor for nonalcoholic fatty liver disease, are undefined.

OBJECTIVE

We explored the roles of sugar and fat intake as determinants of hepatic steatosis and visceral obesity in overweight adolescents at risk of type 2 diabetes.

DESIGN

This was a cross-sectional study of dietary patterns and adipose tissue distribution in 74 overweight adolescents (aged: 15.4 ± 1.8 y; body mass index z score: 2.2 ± 0.4). Main outcome measures were hepatic steatosis (≥5.5% fat:water) measured by magnetic resonance spectroscopy and visceral obesity (visceral-to-subcutaneous adipose tissue ratio ≥0.25) measured by magnetic resonance imaging. Main exposure variables were dietary intake and habits assessed by the Harvard Youth Adolescent Food Frequency Questionnaire.

RESULTS

Hepatic steatosis and visceral obesity were evident in 43% and 44% of the sample, respectively. Fried food consumption was more common in adolescents with hepatic steatosis than in adolescents without hepatic steatosis (41% compared with 18%; P = 0.04). Total fat intake (β = 0.51, P = 0.03) and the consumption of >35% of daily energy intake from fat (OR: 11.8; 95% CI: 1.6, 86.6; P = 0.02) were both positively associated with hepatic steatosis. Available carbohydrate (β = 0.54, P = 0.02) and the frequent consumption of soda were positively associated with visceral obesity (OR: 6.4; 95% CI: 1.2, 34.0; P = 0.03). Daily fiber intake was associated with reduced odds of visceral obesity (OR: 0.82; 95% CI: 0.68, 0.98; P = 0.02) but not hepatic steatosis.

CONCLUSION

Hepatic steatosis is associated with a greater intake of fat and fried foods, whereas visceral obesity is associated with increased consumption of sugar and reduced consumption of fiber in overweight and obese adolescents at risk of type 2 diabetes.

Youth dietary intake and weight status: healthful neighborhood food environments enhance the protective role of supportive family home environments

The aim of this study is to investigate individual and joint associations of the home environment and the neighborhood built environment with adolescent dietary patterns and body mass index (BMI) z-score. Racially/ethnically and socioeconomically diverse adolescents (n=2682; 53.2% girls; mean age14.4 years) participating in the EAT 2010 (Eating and Activity in Teens) study completed height and weight measurements and surveys in Minnesota middle and high schools. Neighborhood variables were measured using Geographic Information Systems data. Multiple regressions of BMI z-score, fruit and vegetable intake, and fast food consumption were fit including home and neighborhood environmental variables as predictors and also including their interactions to test for effect modification. Supportive family environments (i.e., higher family functioning, frequent family meals, and parent modeling of healthful eating) were associated with higher adolescent fruit and vegetable intake, lower fast food consumption, and lower BMI z-score. Associations between the built environment and adolescent outcomes were fewer. Interaction results, although not all consistent, indicated that the relationship between a supportive family environment and adolescent fruit and vegetable intake and BMI was enhanced when the neighborhood was supportive of healthful behavior. Public health interventions that simultaneously improve both the home environment and the neighborhood environment of adolescents may have a greater impact on adolescent obesity prevention than interventions that address one of these environments alone.

Eating Behaviors Among Early Adolescent African American Girls and Their Mothers

African American (AA) girls aged 10–12 living in urban communities designated as food deserts have a significantly greater prevalence of overweight and obesity than girls that age in the general population. The purpose of our study was (a) to examine the agreement in nutritional intake between AA girls aged 10–12 and their mothers and (b) to determine if the girls’ weight categories were associated with their or their mothers demographic characteristics, eating behaviors, nutritional intake, and health problem. A cross-sectional descriptive study was conducted in predominantly low-income AA communities in Chicago. Forty-three dyads of early adolescent AA girls and their mothers responded to food frequency and eating habits questionnaires. There was a strong and significant correlation between mother’s and daughter’s kilocalories consumed ( r = .61). Our study suggests that interventions aimed at improving eating behaviors in early adolescent AA girls should include their mothers.

Comparison of physical activity energy expenditure in Japanese adolescents assessed by EW4800P triaxial accelerometry and the doubly labelled water method

The present study compared the accuracy of triaxial accelerometry and the doubly labelled water (DLW) method for measuring physical activity (PA) in Japanese adolescents. A total of sixty adolescents aged 12–15 years were analysed. The total energy expenditure (TEE) was measured over 7 d by the DLW method and with an EW4800P triaxial accelerometer (Panasonic Corporation). The measured (RMRm) and predicted RMR (RMRp) were 5·7 (sd 0·9) and 6·0 (sd 1·0) MJ/d, respectively. TEE measured by the DLW method and accelerometry using RMRm or RMRp were 11·0 (sd 2·6), 10·3 (sd 1·9), and 10·7 (sd 2·1) MJ/d, respectively. The PA levels (PAL) measured by the DLW method using RMRm or RMRp were 1·97 (sd 0·31) and 1·94 (sd 0·31) in subjects who exercised, and 1·85 (sd 0·27) and 1·74 (sd 0·29) in subjects who did not exercise. The percentage of body fat correlated significantly with the percentage difference between RMRmv. RMRp, TEE, PA energy expenditure (PAEE) and PAL using RMRp, and PAL using RMRm assessed by the DLW method and accelerometry. The present data showed that while accelerometry estimated TEE accurately, it did not provide the precise measurement of PAEE and PAL. The error in accelerometry was attributed to the prediction error of RMR and assessment in exercise.

Responses of Youth With Diabetes and Their Parents to the Youth Eating Perceptions Survey

The purpose of this study was to investigate the perceptions of youth with diabetes mellitus (DM) and their parents/guardians about issues related to eating habits and to identify the relationships between treatment and lifestyle/daily care factors, youth characteristics, and eating habits of youth with DM. Methods included medical chart review and a written survey for youth with DM (n = 125) aged 10 to 20 years and their parents/guardians (n = 125) at Miller Children’s Hospital in Long Beach, California. Healthier eating was associated with stronger parent-youth relationships (P = .000), eating meals at home (P = .047), parent/guardian involvement in DM management (P = .039), younger age of youth (P = .008), and youth being male (P = .017) but not with treatment duration, special meetings with a registered dietitian, parent/guardian age, BMI z score, race/ethnicity, or language of youth. This study suggests that family-centered interventions for youth with DM should promote strong parent-youth relationships, eating at home, parent involvement in DM management for younger patients with special attention to transition to self-care among older patients, and healthy food choices for older youth with DM, especially girls.

Applicability of the doubly labelled water method to the rhinoceros auklet, Cerorhinca monocerata

The doubly labelled water (DLW) method is an isotope-based technique that is used to measure the metabolic rates of free-living animals. We validated the DLW method for measuring metabolic rates in five rhinoceros auklets (Cerorhinca monocerata) compared with simultaneous measurements using the respirometric method. We calculated the CO(2) production rate of four auklets (mean initial body mass: 552 g±36 s.d.) injected with DLW, using the one- and two-pool models. The metabolic rate during the 24-h measurements in a respirometric chamber for resting auklets averaged 16.30±1.66 kJ h(-1) (n = 4). The metabolic rates determined using the one- and two-pool models in the DLW method for the same period as the respirometric measurement averaged 16.61±2.13 kJ h(-1) (n = 4) and 16.16±2.10 kJ h(-1) (n = 4), respectively. The mean absolute percent error between the DLW and respirometric methods was 8.04% using the one-pool model and was slightly better than that with the two-pool model. The differences in value between the DLW and respirometric methods are probably due to oxygen isotope turnover, which eliminated only 10-14% of the initial enrichment excess.

A comparison and validation of child versus parent reporting of children's energy intake using food frequency questionnaires versus food records: who's an accurate reporter?

BACKGROUND & AIMS

The aim of this study was to (i) to compare the accuracy of reporting for child's total energy intake from a food frequency questionnaire (FFQ) completed independently by the mother, father and child in comparison to total energy expenditure (TEE) measured using doubly labeled water (DLW) (ii) compare the accuracy of the weighed food record (WFR) and DLW.

METHODS

Healthy weight children (mean ± SD age 9.8 ± 1.3 years, n = 6 girls/3 boys) and their parents independently completed an FFQ about children's intake. A 4-day WFR of child intake was recorded simultaneously. The accuracy of energy intakes reports were determined by the absolute and percentage differences between estimated energy intake and TEE measured by DLW.

RESULTS

The mean difference (limits of agreement LOA, ± 2SD) when compared to DLW was; child 130 (-1518, 1258) kcal or (113 ± 35% of TEE); father 398 (0,796) kcal or (121 ± 13%); mother 807 (-213, 1824) kcal or (144 ± 26%) and for the WFR -153 (1089, -1395) kcal or 95 ± 32%.

CONCLUSIONS

Children were the most accurate reporters when compared to their parents, with fathers more accurate than mothers. The 4-day WFR was approximately equal to the child report FFQ in estimating EI in children 8-11 years.

Under- and over-reporting of energy intake in slovenian adolescents

OBJECTIVE

To examine under- and over-reporting of energy intake (EI) among adolescents and to compare relative food and nutrient intakes of under-reporters (UR), over-reporters (OR), and the whole population to acceptable reporters (AR).

DESIGN

All adolescents completed food frequency questionnaires at regional health centers, and a subgroup also completed a 3-day weighed dietary protocol at home.

SETTING

This study is a part of the first national representative study on dietary habits of Slovenian adolescents.

PARTICIPANTS

In total, 2,813 adolescents entering high school (10% of the population); participation rate was 95%.

MAIN OUTCOME MEASURES

Absolute EI and relative intakes of food and nutrients.

ANALYSIS

Prodi (version 5.2 expert plus, Nutri-Science, Stuttgart, Germany, 2004) software was used to evaluate dietary intakes; t test, analysis of variance, and Mann-Whitney testing were used for differences between means, and chi-square was used for differences between proportions. Level of significance was set at P = .05.

RESULTS

The prevalence of UR and OR was 34% and 10% among boys, and 27% and 11% among girls. Under-reporters reported lower energy percentage from carbohydrates, higher energy percentage from fats and proteins, and higher micronutrient densities than AR.

CONCLUSIONS AND IMPLICATIONS

Under-reporting and over-reporting are widespread among Slovenian adolescents. Exclusion of UR and OR does not influence mean value of EI when assessing the diet of a group as a whole.

Energy-Dense Snack Food Intake in Adolescence: Longitudinal Relationship to Weight and Fatness

OBJECTIVE

The longitudinal relationship between the consumption of energy-dense snack (EDS) foods and relative weight change during adolescence is uncertain. Using data from the Massachusetts Institute of Technology Growth and Development Study, the current analysis was undertaken to examine the longitudinal relationship of EDS food intake with relative weight status and percentage body fat and to examine how EDS food consumption is related to television viewing.

RESEARCH METHODS AND PROCEDURES

One hundred ninety-six nonobese premenarcheal girls 8 to 12 years old were enrolled between 1990 and 1993 and followed until 4 years after menarche. At each annual follow-up visit, data were collected on percentage body fat (%BF), BMI z score, and dietary intake. Categories of EDS foods considered were baked goods, ice cream, chips, sugar-sweetened soda, and candy.

RESULTS

At study entry, girls had a mean +/- SD BMI z score of -0.27 +/- 0.89, consumed 2.3 +/- 1.7 servings of EDS foods per day, and consumed 15.7 +/- 8.1% of daily calories from EDS foods. Linear mixed effects modeling indicated no relationship between BMI z score or %BF and total EDS food consumption. Soda was the only EDS food that was significantly related to BMI z score over the 10-year study period, but it was not related to %BF. In addition, a significant, positive relationship was observed between EDS food consumption and television viewing.

DISCUSSION

In this cohort of initially nonobese girls, overall EDS food consumption does not seem to influence weight status or fatness change over the adolescent period.

Characteristics of energy under-reporting in children and adolescents

Under-reporting (UR) of food intake is an issue of concern, as it may distort the relationships studied between diet and health. This topic has been scarcely addressed in children. The objective of the study was to assess the extent of UR in French children and investigate associated covariates. A total of 1455 children aged 3-17 years were taken from the nationally representative cross-sectional French étude Individuelle Nationale des Consommations Alimentaires (INCA2) dietary survey (2006-7). Food intake was reported in a 7 d diet record. Socio-economic status, sedentary behaviour, weight perception variables and food habits were collected by questionnaires. Weight and height were measured. Under-reporters were identified according to the Goldberg criterion adapted to children. Multivariate logistic regressions investigated the associations between UR and covariates. Rates of under-reporters were 4·9 and 26·0 % in children aged 3-10 and 11-17 years, respectively (P < 0·0001), without significant differences between boys and girls. Overall, UR was positively associated with a lower socio-economic status, overweight, skipping breakfast and dinner, a higher contribution of proteins to energy intake (EI), and a lower contribution of simple carbohydrates to EI. Under-reporters aged 3-10 years also had a higher sedentary behaviour and a lower snack-eating frequency. In adolescents, UR was also associated with a less-frequent school canteen attendance, a perception of being overweight, a wish to weigh less, and current and past restrictive diets. In conclusion, under-reporters differ from plausible reporters in several characteristics related to diet, lifestyle, weight status and socio-economic status. Therefore, it is important to consider this differential UR bias when investigating diet-disease associations in children.

A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labeled water

Measuring dietary intake in children enables the assessment of nutritional adequacy of individuals and groups and can provide information about nutrients, including energy, food, and eating habits. The aim of this review was to determine which dietary assessment method(s) provide a valid and accurate estimate of energy intake by comparison with the gold standard measure, doubly labeled water (DLW). English-language articles published between 1973 and 2009 and available from common nutrition databases were retrieved. Studies were included if the subjects were children birth to age 18 years and used the DLW technique to validate reported energy intake by any other dietary assessment method. The review identified 15 cross-sectional studies, with a variety of comparative dietary assessment methods. These included a total of 664 children, with the majority having <30 participants. The majority of dietary assessment method validation studies indicated a degree of misreporting, with only eight studies identifying this to a significant level (P<0.05) compared to DLW estimated energy intake. Under-reporting by food records varied from 19% to 41% (n=5 studies) with over-reporting most often associated with 24-hour recalls (7% to 11%, n=4), diet history (9% to 14%, n=3), and food frequency questionnaires (2% to 59%, n=2). This review suggested that the 24-hour multiple pass recall conducted over at least a 3-day period that includes weekdays and weekend days and uses parents as proxy reporters is the most accurate method to estimate total energy intake in children aged 4 to 11 years, compared to total energy expenditure measured by DLW. Weighed food records provided the best estimate for younger children aged 0.5 to 4 years, whereas the diet history provided better estimates for adolescents aged≥16 years. Further research is needed in this area to substantiate findings and improve estimates of total energy expenditure in children and adolescents.

Energy intake misreporting among children and adolescents: a literature review

While adults' energy intake misreporting is a well-documented phenomenon, relatively little is known about the nature and extent of misreporting among children and adolescents. Children's and adolescents' dietary reporting patterns are likely to be distinct because of their ongoing cognitive and social development. These developmental differences present unique challenges to aspects of dietary reporting, such as food knowledge, portion size estimation and response editing. This review of 28 articles describes energy intake misreporting among children and adolescents. Like adults, children and adolescents tended to underreport energy, with the largest biases observed with food records. Even when mean reported energy intake was close to its expected value, approximately half of all individuals were classified as misreporters, and overreporting appeared to be more common than it is among adults. Associations between numerous characteristics and misreporting were explored in the literature, with the most consistent findings for age and adiposity. Two predictors for adults, gender and social desirability, were not consistent factors among children and adolescents. The review concludes by highlighting knowledge gaps and recommendations for future research and practice.

Validation of an FFQ and options for data processing using the doubly labelled water method in children

OBJECTIVE

To validate an FFQ designed to estimate energy intake in children against doubly labelled water (DLW). To investigate how quality control and standard beverage portion sizes affect the validity of the FFQ.

DESIGN

Thirty healthy children, aged 4-6 years, participated. Total energy expenditure (EE) was measured by the DLW method during an observation period of 15 d. At the end of this period parents filled out an FFQ designed to assess the child's habitual energy intake (EI) of the preceding four weeks.

SETTING

Validation study in The Netherlands.

SUBJECTS

Thirty healthy children (fifteen boys and fifteen girls), aged 4-6 years.

RESULTS

Mean EI (6117 (sd 1025) kJ/d) did not differ significantly from mean EE (6286 (sd 971) kJ/d; P = 0·15); the mean EI:EE ratio was 0·98. The Pearson correlation coefficient between EI and EE was 0·62. The Bland-Altman plot showed no systematic bias and a constant bias close to zero. Less intensive quality control of the FFQ maintained the mean EI:EE ratio and decreased the correlation slightly. Using standard instead of individually measured beverage portion sizes decreased the mean EI:EE ratio, but maintained the correlation.

CONCLUSIONS

It can be concluded that the developed FFQ is a valid instrument to estimate mean energy intake in a group of 4- to 6-year-old children and performs reasonably well to rank the subjects with respect to energy intake. It is therefore a useful instrument to estimate energy intake in children in surveys and epidemiological studies in The Netherlands.

Weight control behaviors and dietary intake among adolescents and young adults: longitudinal findings from Project EAT

BACKGROUND

Cross-sectional research has found that dieting during adolescence and the use of extreme weight control behaviors are related to less healthful dietary patterns; however, little is known regarding longitudinal relationships.

OBJECTIVE

To describe patterns of weight control behavior over 5 years and examine relationships with nutritional outcomes in adolescents and young adults.

DESIGN

Population-based, longitudinal study in Minnesota. Youth completed Time 1 surveys in 1998-1999, and Time 2 surveys were completed in 2003-2004.

SUBJECTS/SETTING

The Project EAT (Eating Among Teens) survey and the Youth and Adolescent Food Frequency Questionnaire were completed by 1,242 females and 1,007 males in school classrooms at Time 1 and by mail at Time 2. OUTCOME MEASURES AND STATISTICAL ANALYSES PERFORMED: Generalized linear modeling was used to predict each Time 2 outcome of interest (ie, meal and snack frequencies and dietary intake) across patterns of healthful and unhealthful weight control behavior (ie, never-engaging, stopping, starting, and persisting).

RESULTS

Approximately 45% of females and 17% of males reported persistent use of unhealthful weight control behaviors at both time points. Persisting to use only healthful weight control behaviors was reported by 10% of females and 15% of males. Among females, persistent use of unhealthful weight control behavior was associated (P<0.05) with measures of poorer dietary intake (eg, lower intakes of calcium and vegetables) and less frequent meals, whereas persistent use of healthful weight control behavior was associated with measures (P<0.05) of better dietary intake (eg, less fast food and fewer sugar-sweetened drinks). Among males, few associations were observed between dietary intake and either unhealthful or healthful weight control behavior.

CONCLUSIONS

Health professionals should guide youth who have weight concerns by encouraging healthful eating habits to achieve or maintain appropriate weight and nutrition goals.

Longitudinal and secular trends in adolescent whole-grain consumption, 1999-2004

BACKGROUND

The replacement of refined grains in the diet with whole grains may help prevent chronic disease and excess weight gain, but intakes in adolescents are often lower than recommended.

OBJECTIVES

This study aimed to examine demographic disparities and 5-y longitudinal and secular trends (1999-2004) in whole-grain intake among 2 cohorts of Minnesota adolescents.

DESIGN

Whole-grain intake was examined among 996 adolescent males and 1222 adolescent females who were Project EAT (Eating Among Teens) participants in 1999 and 2004. Multinomial logistic regression models were used to examine demographic differences in whole-grain intake. Mixed linear regression models were used to estimate 1) longitudinal trends among 2 cohorts of adolescents during developmental transitions and 2) age-matched secular trends between the cohorts at middle adolescence.

RESULTS

In 1999, 11% of adolescent males and 13% of adolescent females reported that they consumed more than one daily serving of whole grains. Whole-grain intake was lowest among youth of the Native American and white races and among youth of high socioeconomic status. During the transition from middle to late adolescence, whole-grain intake increased by a mean of 0.14 daily servings among adolescent males and 0.09 daily servings among adolescent females. No significant changes in whole-grain intake were shown among either sex during the transition from early to middle adolescence. Yeast breads, popcorn, and ready-to-eat breakfast cereals were major sources of whole grains in 1999 and 2004.

CONCLUSION

Findings suggest the need to advance efforts that target improvements in the amount of whole-grain foods selected by adolescents.

Dietary patterns and home food availability during emerging adulthood: do they differ by living situation?

OBJECTIVE

The objective of the present work was to cross-sectionally examine and compare dietary behaviours and home food environments by young adults' living situation.

DESIGN

Using data from Project EAT (Eating Among Teens)-II, a large diverse youth cohort originally sampled in Minnesota, linear regression was used to examine self-reported meal frequency, dietary intake and home food availability outcomes by living situation (i.e. living with parents, renting an apartment/house or living on a college campus).

SUBJECTS

Young adults (n 1687), mean age 20.5 years.

RESULTS

Results suggested that young adults living with their parents or in rented apartments/houses had less frequent meals, poorer dietary intake and less healthy home food availability compared with those living on campus. These findings were evident even after controlling for sociodemographic factors (e.g. race/ethnicity, socio-economic status), particularly among females.

CONCLUSIONS

Although few emerging adults consume diets that are consistent with national recommendations, those living with parents and in rented apartments/houses may represent particularly at-risk groups. These differences in dietary factors across living situations appear to exist beyond the sociodemographic differences in these populations. Effective nutrition and healthy eating promotion strategies are needed for young adults.

Disparities in dietary intake, meal patterning, and home food environments among young adult nonstudents and 2- and 4-year college students

We examined whether young adult meal patterning, dietary intake, and home food availability differed among nonstudents, 2-year college students, and 4-year college students (N = 1687; mean age = 20.5 years). Unadjusted analyses showed that few young adults consumed optimal diets and, compared with 4-year college students, nonstudents and 2-year students consumed fewer meals and poorer diets. After controlling for sociodemographics and living arrangements, we found that over half of the observed associations remained significant (P < .05). Nutrition interventions are needed for young adults, particularly specific at-risk groups.

Energy intake of Swedish overweight and obese children is underestimated using a diet history interview

Estimating energy intake (EI) of a child by using a diet history interview (DHI) method may be a challenge because of difficulty for the child to remember what has been eaten as well as to report portion sizes. The aim of this research was to validate reported EI from a DHI in children classified as overweight or obese by comparing the reported EI to total energy expenditure (TEE) measured by 2 objective measures. Eighty-five 10.5- +/- 1.1-y-old overweight and obese children, with help from 1 or 2 parents, reported their EI 2 wk retrospectively in a DHI. Reported EI was compared with TEE, as measured by SenseWear armband (n = 85) and the doubly-labeled water (DLW) method (n = 21), during the same period as the DHI. Reported EI was underestimated by 14% when validated against both the armband and DLW method. Underestimation did not differ between boys and girls. However, the EI of obese children was underestimated by 22%, which is twice the rate as for the overweight children (95% CI: 0.55, 3.08). Underestimated EI was negatively correlated with BMI (r = -0.38; P = <0.01) as well as age (r = -0.21; P = 0.05). EI is underestimated to a higher extent among children with higher BMI and higher age when using a DHI method. The findings show the importance of validating dietary intake of children in general and in overweight and obese children in particular.

Are family meal patterns associated with overall diet quality during the transition from early to middle adolescence?

OBJECTIVE

To examine longitudinal associations of participation in regular family meals (>or= 5 meals/week) with eating habits and dietary intake during adolescence.

DESIGN

Population-based, longitudinal study (Project EAT: Eating Among Teens). Surveys were completed in Minnesota classrooms at Time 1 (1998-1999) and by mail at Time 2 (2003-2004).

SETTING

Baseline surveys were completed in Minneapolis/St. Paul, Minnesota, schools and by mail at follow-up.

PARTICIPANTS

677 adolescents (303 males and 374 females) who were in middle school at Time 1 (mean age = 12.8 +/- 0.74 years) and high school at Time 2 (mean age = 17.2 +/- 0.59 years).

MAIN OUTCOME MEASURES

Dietary intake, frequency of meals, and fast-food intake patterns.

ANALYSIS

Generalized linear modeling stratified by gender and adjusted for race/ethnicity, socioeconomic status, and the Time 1 outcome.

RESULTS

Regular family meals were positively associated with Time 2 frequency of breakfast, lunch, and dinner meals for males and breakfast and dinner meals for females. Among males, regular family meals were negatively associated with Time 2 fast-food intake. Regular family meals were also positively associated with Time 2 mean daily intakes of vegetables, calcium-rich food, fiber, calcium, magnesium, potassium, iron, zinc, folate, and vitamins A and B(6) among both genders.

CONCLUSIONS AND IMPLICATIONS

Regular family meals during early adolescence may contribute to the formation of healthful eating habits 5 years later. Parents should be made aware of the importance of shared mealtime experiences.

Low-income, African American adolescent mothers and their toddlers exhibit similar dietary variety patterns

OBJECTIVE

To examine the relationship between maternal and toddler dietary variety.

DESIGN

Longitudinal; maternal and toddler dietary data were collected at 13 months; anthropometry was collected at 13 and 24 months.

SETTING

Data were collected in homes.

PARTICIPANTS

109 primiparous, low-income, African American adolescent mothers and toddlers.

MAIN OUTCOME MEASURES

Maternal and toddler dietary variety and toddler obesity at 24 months.

ANALYSIS

Correlations were computed to estimate associations between maternal and toddler dietary variety at 13 months; multiple logistic regression analyses were conducted to estimate associations between maternal and toddler diet and toddler growth.

RESULTS

Maternal and toddler fruit, vegetable, snack, meat, dairy, and soda variety were significantly correlated. There was no association between maternal and toddler dietary variety and obesity at 24 months. Adolescent mothers who purchased groceries consumed more fruits and vegetables and provided more variety for their toddlers than those who relied on others to purchase groceries.

CONCLUSIONS AND IMPLICATIONS

Adolescent mothers and toddlers exhibited similar dietary patterns; consuming more sweets and less fruits and vegetables than recommended. Toddlerhood is an optimal time to address healthful dietary patterns and to help adolescent mothers influence grocery purchasing decisions. Goals are to establish healthful dietary patterns and reduce pediatric obesity.

Does television viewing predict dietary intake five years later in high school students and young adults?

Background

Prior research has found that television viewing is associated with poor diet quality, though little is known about its long-term impact on diet, particularly during adolescence. This study examined the associations between television viewing behavior with dietary intake five years later.

Methods

Survey data, which included television viewing time and food frequency questionnaires, were analyzed for 564 middle school students (younger cohort) and 1366 high school students (older cohort) who had complete data available at Time 1 (1998–1999) and five years later at Time 2 (mean age at Time 2, 17.2 ± 0.6 and 20.5 ± 0.8 years, respectively). Regression models examined longitudinal associations between Time 1 television viewing behavior and Time 2 dietary intake adjusting for sociodemographic characteristics, Time 1 dietary intake, and Time 2 total daily energy intake.

Results

Respondents were categorized as limited television users (<2 hours/daily), moderately high television viewers (2–5 hours/daily), and heavy television viewers (≥5 hours/daily). Among the younger cohort, Time 1 heavy television viewers reported lower fruit intake and higher sugar-sweetened beverage consumption than the other two groups. Among the older cohort, watching five or more hours of television per day at Time 1, predicted lower intakes of fruits, vegetables, whole grain and calcium-rich foods, and higher intakes of trans fat, fried foods, fast food menu items, snack products, and sugar-sweetened beverages (products commonly advertised on television) five years later.

Conclusion

Television viewing in middle and high school predicted poorer dietary intake five years later. Adolescents are primary targets of advertising for fast food restaurants, snack foods, and sugar-sweetened beverages, which may influence their food choices. Television viewing, especially during high school, may have long-term effects on eating choices and contribute to poor eating habits in young adulthood.

Fruit and vegetable intake correlates during the transition to young adulthood

BACKGROUND

During the transition from adolescence to young adulthood, the intake of fruit and vegetables tends to decline, and national survey data indicate that few young adults consume the recommended amounts. This study aimed to identify longitudinal correlates of follow-up fruit and vegetable intake in early young adulthood.

METHODS

Surveys and food frequency questionnaires were completed by 1495 adolescent participants in high school classrooms at baseline (in 1998-1999; mean age=15.9 years, SD=0.8) and by mail at follow-up (in 2003-2004; mean age=20.4 years, SD=0.8). In 2007, linear regression methods were used to identify baseline factors associated with follow-up fruit and vegetable intake.

RESULTS

Baseline taste preferences, perceived benefits of healthy eating, fast-food intake, time spent watching television, family-meal frequency, and home food availability were correlates of both fruit and vegetable intake during young adulthood across gender. After adjusting for baseline intake, the only correlate of both fruit and vegetable intake during young adulthood across gender was taste preferences.

CONCLUSIONS

The findings suggest that nutrition interventions for adolescents should provide opportunities for them to taste more fruit and vegetables, and should address supports for healthy eating both within and outside the home environment.

Associations between the Youth/Adolescent Questionnaire, the Youth/Adolescent Activity Questionnaire, and body mass index z score in low-income inner-city fourth through sixth grade children

BACKGROUND

Diet and physical activity are important factors in the etiology, prevention, and treatment of chronic diseases such as obesity and its associated comorbidities. Accurate measures of diet and activity are critical in understanding how these lifestyle and behavioral factors covary to affect health status.

OBJECTIVE

The purpose of this study was to investigate the relation between body mass index (BMI) z score and self-report measures of diet and activity, the Youth/Adolescent Questionnaire (YAQ) and the Youth/Adolescent Activity Questionnaire (YAAQ), respectively.

DESIGN

Participants were 1092 students in grades 4 through 6 from 10 schools in a US city in the middle Atlantic region with >or=50% of students eligible for free or reduced-price meals. Students were assessed at baseline and again after 2 y. The relation between self-reported energy intake (YAQ) and activity (physical and sedentary) (YAAQ) and BMI z score was explored from both a cross-sectional and longitudinal perspective.

RESULTS

The YAQ (energy intake) and YAAQ (physical and sedentary activity) did not relate to BMI z score in the expected directions from either a cross-sectional or longitudinal perspective.

CONCLUSION

In this large, racially diverse sample, the YAQ and the YAAQ were not significantly associated with BMI z score or changes in BMI z score.

Self-management behaviors, racial disparities, and glycemic control among adolescents with type 2 diabetes

OBJECTIVE

Type 2 diabetes is a growing problem among adolescents, but little is known about self-management behaviors in this population. Our aim was to examine self-management behaviors and glycemic control among adolescents with type 2 diabetes.

METHODS

From 2003 to 2005, a telephone survey of adolescents with type 2 diabetes was performed. Chart review obtained most recent glycated hemoglobin and clinical characteristics. Analyses compared patient characteristics and self-management behaviors to recent glycated hemoglobin levels.

RESULTS

Of 139 patients contacted, 103 (74%) completed the study. The mean age was 15.4 years: 69% were girls, 47% were white, and 46% were black. Mean glycated hemoglobin was 7.7%, and the average duration of diabetes was 2.0 years. More than 80% of patients reported > or = 75% medication compliance, and 59% monitored blood glucose > 2 times daily. However, patients reported frequent episodes of overeating, drinking sugary drinks, and eating fast food. More than 70% of patients reported exercising > or = 2 times a week, but 68% reported watching > or = 2 hours of television daily. Nonwhite patients had higher glycated hemoglobin and hospitalizations per year compared with white patients. In multivariable analyses, nonwhite race remained significantly associated with higher glycated hemoglobin even after adjusting for age, gender, BMI, insurance status, and other factors. Nonwhite patients were more likely to watch > or = 2 hours of television per day (78% vs 56%), to report exercising < or = 1 time per week (35% vs 21%), and to drink > or = 1 sugary drink daily (27% vs 13%).

CONCLUSION

Although patients reported good medication and monitoring adherence, they also reported poor diet and exercise habits and multiple barriers. Nonwhite race was significantly associated with poorer glycemic control even after adjusting for covariates. This may, in part, be related to disparities in lifestyle behaviors. Additional studies are indicated to further assess self-management behaviors and potential racial disparities in adolescents with type 2 diabetes.

A Review of Family Meal Influence On Adolescents’ Dietary Intake

Recent concerns about adolescent nutrition and unhealthy weights have prompted an examination of the myriad influences on dietary intake during adolescence. Included here are a summary of the literature on family influence on dietary intake, specifically during adolescence and within the family context, a summary of family meal patterns, and a systematic review of the known influences of family meals on dietary intake. Because of the complexity of families in today’s society, models were developed to depict the broad context of familial influences on adolescent nutritional behaviours and attitudes and to describe what is known and not known about family meal influences on adolescent dietary intake and quality. A systematic review of the literature revealed seven articles specifically related to adolescents, family meals, and dietary intake, which were analyzed for strength of evidence and plausibility. In spite of data collection methods relying on self-report, results suggested that family meals were associated with improved dietary intakes. Families in today’s societies are complex. Nevertheless, parents have the potential to influence positively, through family meals, what food is provided, where it is provided (e.g., home, restaurant), and within what type of atmosphere it is provided.

Family Meals during Adolescence Are Associated with Higher Diet Quality and Healthful Meal Patterns during Young Adulthood

BACKGROUND

Cross-sectional research in adolescents has found that eating family meals is associated with better nutritional intake.

OBJECTIVE

To describe meal patterns of young adults and determine if family meal frequency during adolescence is associated with diet quality, meal frequency, social eating, and meal structure during young adulthood.

DESIGN

Population-based, 5-year longitudinal study in Minnesota.

SUBJECTS/SETTING

Surveys and food frequency questionnaires were completed by 946 female students and 764 male students in high school classrooms at Time 1 (1998-1999; mean age 15.9 years) and by mail at Time 2 (2003-2004; mean age 20.4 years).

STATISTICAL ANALYSES PERFORMED

Multiple linear regression models were used to predict mean levels of young adult outcomes from adolescent family meal frequency. Probability testing of trends in each outcome across ordered categories of family meal frequency used linear contrasts.

RESULTS

Family meal frequency during adolescence predicted higher intakes of fruit (P<0.05), vegetables (P<0.01), dark-green and orange vegetables (P=0.001), and key nutrients and lower intakes of soft drinks (P<0.05) during young adulthood. Frequency of family meals also predicted more breakfast meals (P<0.01) in females and for both sexes predicted more frequent dinner meals (P<0.05), higher priority for meal structure (P<0.001), and higher priority for social eating (P<0.001). Associations between Time 1 family meals and Time 2 dietary outcomes were attenuated with adjustment for Time 1 outcomes but several associations were still statistically significant.

CONCLUSIONS

Family meals during adolescence may have a lasting positive influence on dietary quality and meal patterns in young adulthood.

Issues in dietary intake assessment of children and adolescents

Studies of food habits and dietary intakes face a number of unique respondent and observer considerations at different stages from early childhood to late adolescence. Despite this, intakes have often been reported as if valid, and the interpretation of links between intake and health has been based, often erroneously, on the assumption of validity. However, validation studies of energy intake data have led to the widespread recognition that much of the dietary data on children and adolescents is prone to reporting error, mostly through under-reporting. Reporting error is influenced by body weight status and does not occur systematically across different age groups or different dietary survey techniques. It appears that the available methods for assessing the dietary intakes of children are, at best, able to provide unbiased estimates of energy intake only at the group level, while the food intake data of most adolescents are particularly prone to reporting error at both the group and the individual level. Moreover, evidence for the existence of subject-specific responding in dietary assessments challenges the assumption that repeated measurements of dietary intake will eventually obtain valid data. Only limited progress has been made in understanding the variables associated with misreporting in these age groups, the associated biases in estimating nutrient intakes and the most appropriate way to interpret unrepresentative dietary data. Until these issues are better understood, researchers should exercise considerable caution when evaluating all such data.

Body mass index, sex, interview protocol, and children's accuracy for reporting kilocalories observed eaten at school meals

This pilot study investigated body mass index (BMI; calculated as kg/m(2)), sex, interview protocol, and children's accuracy for reporting kilocalories. Forty 4th-grade children (20 low-BMI: >or=5th and <50th percentiles, 10 boys, 15 African American; 20 high-BMI: >or=85th percentile, 10 boys, 15 African American) were observed eating school meals (breakfast, lunch) and interviewed either that evening about the prior 24 hours or the next morning about the previous day, with 10 low-BMI (5 boys) and 10 high-BMI (5 boys) children per interview protocol. Five kilocalorie variables were analyzed using separate four-factor (BMI group, sex, race, interview protocol) analyses of variance. No effects were found for reported or matched kilocalories. More kilocalories were observed (P<0.02) and omitted (P<0.05) by high-BMI than low-BMI children. For intruded kilocalories, means were smaller (better) for high-BMI girls than high-BMI boys, but larger for low-BMI girls than low-BMI boys (interaction P<0.04); low-BMI girls intruded the most while high-BMI girls intruded the least. For interview protocol, omitted and intruded kilocalories were higher (worse), although not significantly so (P values <0.11), for interviews about the previous day than the prior 24 hours. These results illuminate relations of BMI, sex, interview protocol, and children's reporting accuracy, and are consistent with results concerning BMI and sex from studies with adults.

Dietary intake among youth with diabetes: the SEARCH for Diabetes in Youth Study

OBJECTIVE

To describe dietary intake among a large cohort of youth with type 1 or type 2 diabetes and to compare their intake with current nutrition recommendations.

DESIGN

SEARCH for Diabetes in Youth is a multicenter study of diabetes in youth. Diet was assessed among youth aged 10 to 22 years who attended a SEARCH research clinic visit and completed a previous-week food frequency questionnaire that included foods to reflect the ethnic and regional diversity represented by the cohort.

SUBJECTS/SETTING

Included were 1,697 youth with physician-diagnosed diabetes mellitus (89% type 1 diabetes, 11% type 2 diabetes), with diabetes mellitus duration of at least 12 months.

STATISTICAL ANALYSES

Descriptive data and comparisons with nutrition recommendations were unadjusted. Analyses of covariance with adjustment for total energy, clinic site, sex, race/ethnicity, age, and parental education were used to compare intake according to diabetes type.

RESULTS

Percent of energy from total fat was consistent at 37% to 38% across subgroups of age (10 to 14 years, >15 years) and diabetes type (ie, type 1 or type 2). Youth with type 2 diabetes consumed less calcium, magnesium, and vitamin E than youth with type 1 diabetes (P<0.01 for each). Intake of sweetened carbonated beverages among older (aged >15 years) youth with type 2 diabetes was twice that of older youth with type 1 diabetes (P<0.01). Only 6.5% of the cohort met American Diabetes Association recommendations of <10% of energy from saturated fat. Less than 50% met recommendations for total fat, vitamin E, fiber, fruits, vegetables, and grains, although a majority met recommendations for vitamin C, calcium, and iron.

CONCLUSIONS

Overall, dietary intake in this large cohort of youth with diabetes substantially failed to meet current recommendations. There is a critical need for improvement in dietary intake in youth with diabetes.

Adolescents involved in weight-related and power team sports have better eating patterns and nutrient intakes than non-sport-involved adolescents

OBJECTIVE

To examine eating habits and energy and nutrient intake among adolescents participating in weight-related and power team sports and non-sport-involved adolescents.

DESIGN

Data were drawn from Project EAT (Eating Among Teens), which was conducted with 4,746 adolescents from 31 middle and high schools in the Minneapolis/St Paul metropolitan area.

SETTING

Urban secondary schools.

SUBJECTS

Adolescents reporting participation in a weight-related sport, a power team sport, or no consistent participation in a sport.

MAIN OUTCOME MEASURES

Meal and snack frequency, mean energy and nutrient intake, and mean physical activity.

STATISTICAL ANALYSES PERFORMED

Analyses were conducted by sex across the three groups. General linear models were used to compare mean energy and nutrient intake, composite nutrient adequacy, and mean physical activity across the three groups. Percentages of youth meeting nutrient recommendations were compared across the three groups using chi(2) tests.

RESULTS

For both males and females, youth involved in weight-related sports ate breakfast more frequently than non-sport-involved peers (females: 3.6 and 3.2 times per week, respectively, P<0.01; males: 4.7 and 3.7 times per week, respectively, P<0.01). Weight-related and power team sport-involved youth also had higher mean protein, calcium, iron, and zinc intakes than non-sport-involved peers. However, adolescent females had low calcium intake, regardless of sports involvement (weight-related sports 1,091 mg/day, power team sports 1,070 mg/day, and non-sport-involved 1,028 mg/day, P<0.05).

CONCLUSIONS

Sport-involved adolescents have better eating habits and nutrient intake than their non-sport-involved peers. However, they are still in need of nutrition interventions, particularly around calcium intake.

Children's dietary reporting accuracy over multiple 24-hour recalls varies by body mass index category

This secondary analysis investigated the influence of body mass index (BMI) category and sex on reporting accuracy during multiple 24-hour dietary recalls. On three occasions, each of 79 children (40 girls) was observed eating school meals and interviewed the next morning about the previous day's intake, with ≥ 25 days between any two consecutive occasions for a child. Using age/sex BMI percentiles, we categorized 48 children as healthy weight (≥ 5(th) percentile <85(th)), 14 as at risk of overweight (≥ 85(th) percentile <95(th)), and 17 as overweight (≥95(th) percentile). A repeated-measures analysis was conducted for each of five outcomes (number of items observed eaten, number of items reported eaten, omission rate, intrusion rate, total inaccuracy). For items observed, BMI category x trial was marginally significant (P=0.079); over trials, this outcome was stable for healthy-weight children, decreased and stabilized for at-risk-of-overweight children, and was stable and decreased for overweight children. This outcome was greatest for overweight children and least for healthy-weight children (P=0.015). For items reported, no significant effects were found. For omission rate (P=0.028) and intrusion rate (P=0.083), BMI category x trial was significant and marginally significant; over trials, both decreased for healthy-weight children, decreased and stabilized for at-risk-of-overweight children, and increased and stabilized for overweight children. Total inaccuracy decreased slightly over trials (P=0.076); this outcome was greater for boys than for girls (P=0.049). Results suggest that children's dietary reporting accuracy over multiple recalls varies by BMI category. Validation studies with adequate samples for each BMI category, sex, and race are needed.

Validation of a pre-coded food diary used among 13-year-olds: comparison of energy intake with energy expenditure

OBJECTIVE

To validate energy intake (EI) estimated from pre-coded food diaries against energy expenditure (EE) measured with a validated position-and-movement monitor (ActiReg) in groups of 13-year-old Norwegian schoolchildren.

DESIGN

Two studies were conducted. In study 1 the monitoring period was 4 days; participants recorded their food intake for four consecutive weekdays using food diaries and wore the ActiReg during the same period. In study 2 the monitoring period was 7 days; participants recorded their food intake for four consecutive days but wore the ActiReg for a whole week.

SETTINGS

Participants were recruited from grade 8 in a school in and one outside Oslo (Norway).

SUBJECTS

Forty-one and 31 participants from study 1 and 2, respectively, completed the study.

RESULTS

The group average EI was 34% lower than the measured EE in study 1 and 24% lower in study 2. The width of the 95% confidence limits of agreement in a Bland-Altman plot for EI and EE varied from -0.2 MJ to 8.2 MJ in study 1 and from -2.3 MJ to 6.9 MJ in study 2. The Pearson correlation coefficients between reported energy intake and expenditure were 0.47 (P=0.002) in study 1 and 0.74 (P<0.001) in study 2.

CONCLUSION

The data showed that there was substantial variability in the accuracy of the food diary at the individual level. Furthermore, the diary underestimated the average energy intake. The ability of the food diary to rank individuals according to energy intake was found to be good in one of the studies and moderate in the other.