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Fyfe-Johnson AL, Reid MM, Jiang L, Chang JJ, Huyser KR, Hiratsuka VY, Johnson-Jennings MD, Conway CM, Goins TR, Sinclair KA, Steiner JF, Brega AG, Manson SM, O'Connell J. Social Determinants of Health and Body Mass Index in American Indian/Alaska Native Children. Child Obes 2023; 19:341-352. [PMID: 36170116 PMCID: PMC10316527 DOI: 10.1089/chi.2022.0012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: To examine the associations between social determinants of health (SDOH) and prevalent overweight/obesity status and change in adiposity status among American Indian and Alaska Native (AI/AN) children. Methods: The study sample includes 23,950 AI/AN children 2-11 years of age, who used Indian Health Service (IHS) from 2010 to 2014. Multivariate generalized linear mixed models were used to examine the following: (1) cross-sectional associations between SDOH and prevalent overweight/obesity status and (2) longitudinal associations between SDOH and change in adiposity status over time. Results: Approximately 49% of children had prevalent overweight/obesity status; 18% had overweight status and 31% had obesity status. Prevalent severe obesity status was 20% in 6-11-year olds. In adjusted cross-sectional models, children living in counties with higher levels of poverty had 28% higher odds of prevalent overweight/obesity status. In adjusted longitudinal models, children 2-5 years old living in counties with more children eligible for free or reduced-priced lunch had 15% lower odds for transitioning from normal-weight status to overweight/obesity status. Conclusions: This work contributes to accumulating knowledge that economic instability, especially poverty, appears to play a large role in overweight/obesity status in AI/AN children. Research, clinical practice, and policy decisions should aim to address and eliminate economic instability in childhood.
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Affiliation(s)
| | - Margaret M. Reid
- Health Systems, Management, and Policy, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Luohua Jiang
- Department of Epidemiology, University of California, Irvine, Irvine, CA, USA
| | - Jenny J. Chang
- School of Medicine, University of California, Irvine, Irvine, CA, USA
| | - Kimberly R. Huyser
- Department of Sociology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vanessa Y. Hiratsuka
- Center for Human Development, University of Alaska Anchorage, Anchorage, AK, USA
| | | | - Cheryl M. Conway
- Charles George Veterans Medical Center, Veterans Health Administration, Washington, DC, USA
| | - Turner R. Goins
- College of Health and Human Sciences, Western Carolina University, Cullowhee, NC, USA
| | | | - John F. Steiner
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| | - Angela G. Brega
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Joan O'Connell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
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Ramírez-Luzuriaga MJ, Kobes S, Sinha M, Knowler WC, Hanson RL. Increased Adiposity and Low Height-for-Age in Early Childhood Are Associated With Later Metabolic Risks in American Indian Children and Adolescents. J Nutr 2022; 152:1872-1885. [PMID: 35147199 PMCID: PMC9554900 DOI: 10.1093/jn/nxac031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/22/2021] [Accepted: 02/07/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Growth abnormalities in childhood have been related to later cardiometabolic risks, but little is known about these associations in populations at high risk of type 2 diabetes. OBJECTIVES We examined the associations of patterns of growth, including weight and height at ages 1-59 months, with cardiometabolic risk factors at ages 5-16 years. METHODS We linked anthropometric data collected at ages 1-59 months to cardiometabolic data obtained from a longitudinal study in a southwestern American Indian population at high risk of diabetes. Analyses included 701 children with ≥1 follow-up examination at ages 5-16 years. We derived age- and sex-specific weight-for-height z-scores (WHZ) and height-for-age z-scores (HAZ) at ages 1-59 months. We selected the highest observed WHZ and the lowest observed HAZ at ages 1-59 months and analyzed associations of z-scores and categories of WHZ and HAZ with cardiometabolic outcomes at ages 5-16 years. We used linear mixed-effects models to account for repeated measures. RESULTS Overweight/obesity (WHZ >2) at ages 1-59 months was significantly associated with increased BMI, fasting and 2-hour postload plasma glucose, fasting and 2-hour insulin, triglycerides, systolic blood pressure, diastolic blood pressure, and decreased HDL cholesterol at ages 5-16 years relative to normal weight (WHZ ≤1). For example, at ages 5-9 years, 2-hour glucose was 10.4 mg/dL higher (95% CI: 5.6-15.3 mg/dL) and fasting insulin was 4.29 μU/mL higher (95% CI: 2.96-5.71 μU/mL) in those with overweight/obesity in early childhood. Associations were attenuated and no longer significant when adjusted for concurrent BMI. A low height-for-age (HAZ < -2) at ages 1-59 months was associated with 5.37 mg/dL lower HDL (95% CI: 2.57-8.17 mg/dL) and 27.5 μU/mL higher 2-hour insulin (95% CI: 3.41-57.6 μU/mL) at ages 10-16 years relative to an HAZ ≥0. CONCLUSIONS In this American Indian population, findings suggest a strong contribution of overweight/obesity in early childhood to cardiometabolic risks in later childhood and adolescence, mediated through persistent overweight/obesity into later ages. Findings also suggest potential adverse effects of low height-for-age, which require confirmation.
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Affiliation(s)
| | - Sayuko Kobes
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Madhumita Sinha
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - William C Knowler
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
| | - Robert L Hanson
- Diabetes Epidemiology and Clinical Research Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ, USA
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D'Amico EJ, Palimaru AI, Dickerson DL, Dong L, Brown RA, Johnson CL, Klein DJ, Troxel WM. Risk and Resilience Factors in Urban American Indian and Alaska Native Youth during the Coronavirus Pandemic. AMERICAN INDIAN CULTURE AND RESEARCH JOURNAL 2021; 44:21-48. [PMID: 35719739 PMCID: PMC9205322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
American Indians and Alaska Natives suffer disproportionately from poverty and other inequities and are vulnerable to adverse health and socioeconomic effects of COVID-19. Using surveys and interviews (May - July 2020), we examined urban American Indian/Alaska Native adolescents' (N=50) health and behaviors, family dynamics, community cohesion, and traditional practice participation during COVID-19. About 20% of teens reported clinically significant anxiety and depression, 25% reported food insecurity, and 40% reported poor sleep. Teens also reported high family and community cohesion, and many engaged in traditional practices during this time. Although many teens reported problems, they also emphasized resilience strategies.
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Affiliation(s)
| | | | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs; Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine; 1640 Sepulveda Blvd., Suite 200; Los Angeles, CA
| | - Lu Dong
- RAND Corporation; 1776 Main St., Santa Monica, CA 90401
| | - Ryan A Brown
- RAND Corporation; 1776 Main St., Santa Monica, CA 90401
| | | | - David J Klein
- RAND Corporation; 1776 Main St., Santa Monica, CA 90401
| | - Wendy M Troxel
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, Pennsylvania 15213
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Gachupin FC, Caston E, Chavez C, Bernal J, Cager P, Harris D, John T, Remitera J, Garcia CA, Romero VM, Gchachu KE, Gchachu CR, Garcia K, Gchachu V, Gchachu BM, Rens E, Slowtalker J, Blew R, Tracy K, Figueroa T, Thomson CA, Ranjbar N, Hingle M, O’Connor T, Roe DJ, Grant V, Swick S, Joe JR. Primary Disease Prevention for Southwest American Indian Families During the COVID-19 Pandemic: Camp in a Box. FRONTIERS IN SOCIOLOGY 2021; 6:611972. [PMID: 33869562 PMCID: PMC8022461 DOI: 10.3389/fsoc.2021.611972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
The goal of the American Indian Youth Wellness Camp in a Box was to engage, educate and empower families to improve their health and overall well-being during the COVID-19 pandemic. Camp in a Box was a 9-week program, inclusive of a 1-week intensive camp component followed by an 8-week booster component with content focused on nutrition, mental health and physical activity education. The Camp in a Box is a Tribal/Urban Indian-University partnership, and materials were developed to replace an existing weeklong residential camp and to comply with social distancing guidelines. Fourteen American Indian families from Tribal/Urban Indian communities in the southwestern United States participated (36 children aged 2-18 years; 32 adults). The intensive camp week included daily materials for families to complete together, Monday through Friday. Materials were provided for approximately 4 h of activities per day. The booster sessions began after camp week and included approximately 4 h of supplementary activities designed to be completed at any time most convenient for the family over the course of the week. Activities were designed to encourage interaction among family members with materials and supplies for parents and youth to participate. Self-reported outcomes suggested that families changed their eating habits to include more vegetables, less sweets and junk food. Parents reported an increase in family physical activity and that the activities brought the family closer together. Our Camp in a Box program was feasible and well-received until school began. During camp week, 100% of recruited families participated; at Booster Week 8, ten families (71%) remained enrolled and active. Camp in a Box is a feasible alternative to residential camps for promotion of health behaviors associated with metabolic disease prevention among American Indian families. In contrast to residential camps for youth, Camp in a Box offers an opportunity to engage the entire family in health promotion activities.
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Affiliation(s)
- Francine C. Gachupin
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Evelyn Rens
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Jacquanette Slowtalker
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
| | - Robert Blew
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, United States
| | - Keyauni Tracy
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
| | - Ty Figueroa
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Cynthia A. Thomson
- University of Arizona Cancer Center, Tucson, AZ, United States
- Mel and Enid Zuckerman College of Public Health, Tucson, AZ, United States
| | - Noshene Ranjbar
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Melanie Hingle
- Department of Nutritional Sciences, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ, United States
| | - Teresia O’Connor
- USDA/ARS Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Denise J. Roe
- University of Arizona Cancer Center, Tucson, AZ, United States
- Mel and Enid Zuckerman College of Public Health, Tucson, AZ, United States
| | - Vernon Grant
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT, United States
| | - Shayna Swick
- University of Arizona, Tucson, AZ, United States
| | - Jennie R. Joe
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, United States
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Implementation of the Navajo fruit and vegetable prescription programme to improve access to healthy foods in a rural food desert. Public Health Nutr 2020; 23:2199-2210. [PMID: 32398182 DOI: 10.1017/s1368980019005068] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To utilise a community-based participatory approach in the design and implementation of an intervention targeting diet-related health problems on Navajo Nation. DESIGN A dual strategy approach of community needs/assets assessment and engagement of cross-sectorial partners in programme design with systematic cyclical feedback for programme modifications. SETTING Navajo Nation, USA. PARTICIPANTS Navajo families with individuals meeting criteria for programme enrolment. Participant enrolment increased with iterative cycles. RESULTS The Navajo Fruit and Vegetable Prescription (FVRx) Programme. CONCLUSIONS A broad, community-driven and culturally relevant programme design has resulted in a programme able to maintain core programmatic principles, while also allowing for flexible adaptation to changing needs.
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Time trends in mid-upper-arm anthropometry from 1982 to 2011 in male children and adolescents from Kolkata, India. J Biosoc Sci 2020; 53:71-81. [PMID: 32070439 DOI: 10.1017/s0021932020000048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of this study was to investigate inter-generational changes in selected mid-upper-arm measurements of boys from Kolkata, India. The analysis was based on the anthropometric measurements of two cohorts of Bengali boys aged 7-16 from middle-class families, in 1982-83 and 2005-11. The two cohorts were compared in terms of their mid-upper-arm circumference (MUAC) and mid-upper-arm area (MUAA), mid-upper-arm muscle area (MUAMA), mid-upper-arm fat area (MUAFA) and Arm Fat Index (AFI). The significances of the differences were determined using two-way ANOVA. All features differed significantly between the examined cohorts and all showed a general positive secular trend. In most cases, the biggest differences were noted for 14- and 16-year olds and the smallest for the youngest boys. The contemporary boys seemed to have more favourable overall developmental conditions, probably related to socioeconomic progress in India over recent decades.
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Grant VM, Tomayko EJ, Kingfisher RD. Sleep and Physical Activity Patterns in Urban American Indian Children. Am J Health Behav 2020; 44:67-75. [PMID: 31783933 DOI: 10.5993/ajhb.44.1.7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: In this study, we examined patterns of obesity, physical activity (PA), sleep, and screen time in urban American Indian (AI) youth in the 6th-8th grade. Methods: A youth sample (N = 36) from 3 middle schools was recruited to participate in this observational sample of convenience. Youth completed a demographic and screen time survey, measurements of height and weight, and wore a wrist accelerometer continuously for 7 days to assess PA and sleep. Results: Approximately 42% of participants were overweight or obese. Average weekday screen time was 254.7±98.1 minutes. Compared to weekdays, weekend sedentary activity increased (weekday, 159.2±81.1 minutes vs weekend, 204.3±91.7 minutes; p = .03) and vigorous PA (weekday, 20.9±19.1 minutes vs weekend, 5.7±8.1 minutes; p = .0001) and moderate-to-vigorous PA (weekday, 192.65±62.3 minutes vs weekend, 141±71.7 minutes; p = .002) decreased. Compared to weekdays, weekend total sleep time (weekday, 512.8±48.6 minutes vs weekend, 555.3±84.3 minutes; p = .007) and time in bed (weekday, 487.3±49.6 minutes vs weekend, 528.6±71.2 minutes; p = .01) increased. Conclusions: Weekday to weekend shifts in PA and sleep must be considered when designing targeted obesity prevention interventions.
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Affiliation(s)
- Vernon M. Grant
- Center for American Indian and Rural Health Equity, Bozeman, MT;,
| | - Emily J. Tomayko
- School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR
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Brown MC, Shrestha U, Huber C, Best LG, O’Leary M, Howard B, Beresford S, Fretts AM. Characterizing the local food environment and grocery-store decision making among a large American Indian community in the north-central USA: qualitative results from the Healthy Foods Healthy Families Feasibility Study. Public Health Nutr 2019; 22:2653-2661. [PMID: 31124770 PMCID: PMC6718325 DOI: 10.1017/s1368980019001095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 01/03/2019] [Accepted: 02/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Perceptions of social-contextual food environments and associated factors that influence food purchases are understudied in American Indian (AI) communities. The purpose of the present study was to: (i) understand the perceived local food environment; (ii) investigate social-contextual factors that influence family food-purchasing choices; and (iii) identify diet intervention strategies. DESIGN This qualitative study consisted of focus groups with primary household shoppers and key-informant interviews with food retailers, local government food assistance programme directors and a dietitian. An inductive, constant comparison approach was used to identify major themes. SETTING A large AI reservation community in the north-central USA. PARTICIPANTS Four focus groups (n 31) and seven key-informant interviews were conducted in February and May 2016. RESULTS Perceptions of both the higher cost of healthy foods and limited access to these foods influenced the types of foods participants purchased. Dependence on government assistance programmes and the timing of benefits also contributed to the types of foods purchased. Participants described purchasing foods based on the dietary needs and preferences of their children. Suggestions for improving the purchase and consumption of healthy foods included: culturally relevant and family-centred cooking classes and workshops focused on monthly food budgeting. Participants also emphasized the importance of involving the entire community in healthy eating initiatives. CONCLUSIONS Cost and access were the major perceived barriers to healthy eating in this large rural AI community. Recommended interventions included: (i) family-friendly and culturally relevant cooking classes; (ii) healthy food-budgeting skills training; and (iii) approaches that engage the entire community.
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Affiliation(s)
- Meagan C Brown
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | | | - Corrine Huber
- Missouri Breaks Industries Research Inc., Eagle Butte, SD, USA
| | - Lyle G Best
- Missouri Breaks Industries Research Inc., Eagle Butte, SD, USA
| | - Marcia O’Leary
- Missouri Breaks Industries Research Inc., Eagle Butte, SD, USA
| | - Barbara Howard
- MedStar Health Research Institute and Georgetown and Howard Universities Center for Translational Sciences, Hyattsville, MD, USA
| | - Shirley Beresford
- Department of Epidemiology, Cardiovascular Health Research Unit, School of Public Health, University of Washington, 1959 NE Pacific Street, Box 357236, Seattle, WA 98195, USA
| | - Amanda M Fretts
- Department of Epidemiology, Cardiovascular Health Research Unit, School of Public Health, University of Washington, 1959 NE Pacific Street, Box 357236, Seattle, WA 98195, USA
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Mead E, Brown T, Rees K, Azevedo LB, Whittaker V, Jones D, Olajide J, Mainardi GM, Corpeleijn E, O'Malley C, Beardsmore E, Al‐Khudairy L, Baur L, Metzendorf M, Demaio A, Ells LJ. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database Syst Rev 2017; 6:CD012651. [PMID: 28639319 PMCID: PMC6481885 DOI: 10.1002/14651858.cd012651] [Citation(s) in RCA: 210] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Child and adolescent overweight and obesity has increased globally, and can be associated with significant short- and long-term health consequences. This is an update of a Cochrane review published first in 2003, and updated previously in 2009. However, the update has now been split into six reviews addressing different childhood obesity treatments at different ages. OBJECTIVES To assess the effects of diet, physical activity and behavioural interventions (behaviour-changing interventions) for the treatment of overweight or obese children aged 6 to 11 years. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS as well as trial registers ClinicalTrials.gov and ICTRP Search Portal. We checked references of studies and systematic reviews. We did not apply any language restrictions. The date of the last search was July 2016 for all databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) of diet, physical activity, and behavioural interventions (behaviour-changing interventions) for treating overweight or obese children aged 6 to 11 years, with a minimum of six months' follow-up. We excluded interventions that specifically dealt with the treatment of eating disorders or type 2 diabetes, or included participants with a secondary or syndromic cause of obesity. DATA COLLECTION AND ANALYSIS Two review authors independently screened references, extracted data, assessed risk of bias, and evaluated the quality of the evidence using the GRADE instrument. We contacted study authors for additional information. We carried out meta-analyses according to the statistical guidelines in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS We included 70 RCTs with a total of 8461 participants randomised to either the intervention or control groups. The number of participants per trial ranged from 16 to 686. Fifty-five trials compared a behaviour-changing intervention with no treatment/usual care control and 15 evaluated the effectiveness of adding an additional component to a behaviour-changing intervention. Sixty-four trials were parallel RCTs, and four were cluster RCTs. Sixty-four trials were multicomponent, two were diet only and four were physical activity only interventions. Ten trials had more than two arms. The overall quality of the evidence was low or very low and 62 trials had a high risk of bias for at least one criterion. Total duration of trials ranged from six months to three years. The median age of participants was 10 years old and the median BMI z score was 2.2.Primary analyses demonstrated that behaviour-changing interventions compared to no treatment/usual care control at longest follow-up reduced BMI, BMI z score and weight. Mean difference (MD) in BMI was -0.53 kg/m2 (95% confidence interval (CI) -0.82 to -0.24); P < 0.00001; 24 trials; 2785 participants; low-quality evidence. MD in BMI z score was -0.06 units (95% CI -0.10 to -0.02); P = 0.001; 37 trials; 4019 participants; low-quality evidence and MD in weight was -1.45 kg (95% CI -1.88 to -1.02); P < 0.00001; 17 trials; 1774 participants; low-quality evidence.Thirty-one trials reported on serious adverse events, with 29 trials reporting zero occurrences RR 0.57 (95% CI 0.17 to 1.93); P = 0.37; 4/2105 participants in the behaviour-changing intervention groups compared with 7/1991 participants in the comparator groups). Few trials reported health-related quality of life or behaviour change outcomes, and none of the analyses demonstrated a substantial difference in these outcomes between intervention and control. In two trials reporting on minutes per day of TV viewing, a small reduction of 6.6 minutes per day (95% CI -12.88 to -0.31), P = 0.04; 2 trials; 55 participants) was found in favour of the intervention. No trials reported on all-cause mortality, morbidity or socioeconomic effects, and few trials reported on participant views; none of which could be meta-analysed.As the meta-analyses revealed substantial heterogeneity, we conducted subgroup analyses to examine the impact of type of comparator, type of intervention, risk of attrition bias, setting, duration of post-intervention follow-up period, parental involvement and baseline BMI z score. No subgroup effects were shown for any of the subgroups on any of the outcomes. Some data indicated that a reduction in BMI immediately post-intervention was no longer evident at follow-up at less than six months, which has to be investigated in further trials. AUTHORS' CONCLUSIONS Multi-component behaviour-changing interventions that incorporate diet, physical activity and behaviour change may be beneficial in achieving small, short-term reductions in BMI, BMI z score and weight in children aged 6 to 11 years. The evidence suggests a very low occurrence of adverse events. The quality of the evidence was low or very low. The heterogeneity observed across all outcomes was not explained by subgrouping. Further research is required of behaviour-changing interventions in lower income countries and in children from different ethnic groups; also on the impact of behaviour-changing interventions on health-related quality of life and comorbidities. The sustainability of reduction in BMI/BMI z score and weight is a key consideration and there is a need for longer-term follow-up and further research on the most appropriate forms of post-intervention maintenance in order to ensure intervention benefits are sustained over the longer term.
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Affiliation(s)
- Emma Mead
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Tamara Brown
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | - Karen Rees
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Liane B Azevedo
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Victoria Whittaker
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Dan Jones
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Joan Olajide
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
| | - Giulia M Mainardi
- School of Medicine, University of São PauloDepartment of Preventive MedicineSão PauloBrazilCEP 01246 903
| | - Eva Corpeleijn
- University Medical Centre GroningenDepartment of EpidemiologyHanzeplein 1GroningenNetherlands9713 GZ
| | - Claire O'Malley
- Durham University Queen's CampusSchool of Medicine, Pharmacy and HealthDurhamUKTS17 6BH
| | | | - Lena Al‐Khudairy
- Warwick Medical School, University of WarwickDivision of Health SciencesCoventryUKCV4 7AL
| | - Louise Baur
- The University of SydneyDepartment of Paediatrics and Child HealthLocked Bag 4001WestmeadAustraliaNSW 2145
| | - Maria‐Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich‐Heine‐University DüsseldorfCochrane Metabolic and Endocrine Disorders GroupMoorenstr. 5DüsseldorfGermany40225
| | | | - Louisa J Ells
- Teesside UniversityHealth and Social Care InstituteMiddlesbroughUKTS1 3BA
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Subica AM, Grills CT, Villanueva S, Douglas JA. Community Organizing for Healthier Communities: Environmental and Policy Outcomes of a National Initiative. Am J Prev Med 2016; 51:916-925. [PMID: 27712948 DOI: 10.1016/j.amepre.2016.06.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 06/17/2016] [Accepted: 07/05/2016] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Childhood obesity is disproportionately prevalent in communities of color, partially because of structural inequities in the social and built environment (e.g., poverty, food insecurity, pollution) that restrict healthy eating and active living. Community organizing is an underexamined, grassroots health promotion approach that empowers and mobilizes community residents to advocate for, and achieve, environmental and policy changes to rectify these structural inequities. This paper presents outcomes of the Robert Wood Johnson Foundation's Communities Creating Healthy Environments initiative: the first national program to apply community organizing to combat childhood obesity-causing structural inequities in communities of color. METHODS Twenty-one community-based organizations and tribal nations (grantees) conducted 3-year community organizing-based interventions primarily designed to increase children's healthy food and safe recreational access. Grantees' policy wins (environmental and policy changes resulting from grantee interventions) were measured from 2009 to 2014 using semi-structured interviews conducted quarterly and 6 months post-grant, and independently coded and reviewed in 2015 by researchers and expert community organizers. RESULTS The 21 grantees achieved 72 policy wins (mean=3.43, SD=1.78) across six domains: two directly addressed childhood obesity by enhancing children's healthy food (37.50%) and recreational access (33.33%), whereas four indirectly addressed obesity by promoting access to quality health care (8.33%); clean environments (9.73%); affordable housing (8.33%); and discrimination- and crime-free neighborhoods (2.78%). CONCLUSIONS These findings provide compelling evidence that community organizing-based interventions designed and led by community stakeholders can achieve diverse environmental and policy solutions to the structural inequities that foment childhood obesity in communities of color.
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Affiliation(s)
- Andrew M Subica
- Center for Healthy Communities, University of California Riverside School of Medicine, Riverside, California
| | - Cheryl T Grills
- Psychology Applied Research Center, Loyola Marymount University, Los Angeles, California.
| | - Sandra Villanueva
- Psychology Applied Research Center, Loyola Marymount University, Los Angeles, California
| | - Jason A Douglas
- Environmental Studies, San Jose State University, San Jose, California
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Fleischhacker S, Roberts E, Camplain R, Evenson KR, Gittelsohn J. Promoting Physical Activity Among Native American Youth: a Systematic Review of the Methodology and Current Evidence of Physical Activity Interventions and Community-wide Initiatives. J Racial Ethn Health Disparities 2016; 3:608-624. [PMID: 27294756 PMCID: PMC4911341 DOI: 10.1007/s40615-015-0180-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 10/13/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
Abstract
Promoting physical activity using environmental, policy, and systems approaches could potentially address persistent health disparities faced by American Indian and Alaska Native children and adolescents. To address research gaps and help inform tribally led community changes that promote physical activity, this review examined the methodology and current evidence of physical activity interventions and community-wide initiatives among Native youth. A keyword-guided search was conducted in multiple databases to identify peer-reviewed research articles that reported on physical activity among Native youth. Ultimately, 20 unique interventions (described in 76 articles) and 13 unique community-wide initiatives (described in 16 articles) met the study criteria. Four interventions noted positive changes in knowledge and attitude relating to physical activity but none of the interventions examined reported statistically significant improvements on weight-related outcomes. Only six interventions reported implementing environmental, policy, and system approaches relating to promoting physical activity and generally only shared anecdotal information about the approaches tried. Using community-based participatory research or tribally driven research models strengthened the tribal-research partnerships and improved the cultural and contextual sensitivity of the intervention or community-wide initiative. Few interventions or community-wide initiatives examined multi-level, multi-sector interventions to promote physical activity among Native youth, families, and communities. More research is needed to measure and monitor physical activity within this understudied, high risk group. Future research could also focus on the unique authority and opportunity of tribal leaders and other key stakeholders to use environmental, policy, and systems approaches to raise a healthier generation of Native youth.
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Affiliation(s)
- Sheila Fleischhacker
- Senior Public Health & Science Policy Advisor, Office of Nutrition Research, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Two Democracy Plaza, Room 635, 6707 Democracy Boulevard MSC 5461, Bethesda, Maryland 20892-5461, – office 301-594-7440, mobile – 301-640-1396, fax – 301-480-3768
| | - Erica Roberts
- Doctoral Candidate, University of Maryland School of Public Health, Department of Behavioral and Community Health, 7923 Eastern Ave, Apt 1001, Silver Spring, MD 20910, voice – 410-236-7016
| | - Ricky Camplain
- Doctoral Student, University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, 137 East Franklin Street, Suite 303A, Chapel Hill, NC 27514, voice – 505-658-5262
| | - Kelly R. Evenson
- Research Professor of Epidemiology, University of North Carolina, Gillings School of Global Public Health, Department of Epidemiology, 137 E Franklin Street, Suite 306, Chapel Hill, NC 27514, voice – 919-966-4187
| | - Joel Gittelsohn
- Johns Hopkins University, Bloomberg School of Public Health, Department of International Health, Center for Human Nutrition, 615 N. Wolfe Street, Rm W2041, Baltimore, MD 21205, voice – 410-955-3927
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Subica AM, Grills CT, Douglas JA, Villanueva S. Communities of Color Creating Healthy Environments to Combat Childhood Obesity. Am J Public Health 2016; 106:79-86. [PMID: 26562108 PMCID: PMC4695934 DOI: 10.2105/ajph.2015.302887] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2015] [Indexed: 11/04/2022]
Abstract
Ethnic and racial health disparities present an enduring challenge to community-based health promotion, which rarely targets their underlying population-level determinants (e.g., poverty, food insecurity, health care inequity). We present a novel 3-lens prescription for using community organizing to treat these determinants in communities of color based on the Robert Wood Johnson Foundation's Communities Creating Healthy Environments initiative, the first national project to combat childhood obesity in communities of color using community organizing strategies. The lenses--Social Justice, Culture-Place, and Organizational Capacity-Organizing Approach--assist health professional-community partnerships in planning and evaluating community organizing-based health promotion programs. These programs activate community stakeholders to alter their community's disease-causing, population-level determinants through grassroots policy advocacy, potentially reducing health disparities affecting communities of color.
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Affiliation(s)
- Andrew M Subica
- Andrew M. Subica is with the Center for Healthy Communities, School of Medicine, University of California, Riverside. Cheryl T. Grills, Jason A. Douglas, and Sandra Villanueva are with the Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA
| | - Cheryl T Grills
- Andrew M. Subica is with the Center for Healthy Communities, School of Medicine, University of California, Riverside. Cheryl T. Grills, Jason A. Douglas, and Sandra Villanueva are with the Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA
| | - Jason A Douglas
- Andrew M. Subica is with the Center for Healthy Communities, School of Medicine, University of California, Riverside. Cheryl T. Grills, Jason A. Douglas, and Sandra Villanueva are with the Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA
| | - Sandra Villanueva
- Andrew M. Subica is with the Center for Healthy Communities, School of Medicine, University of California, Riverside. Cheryl T. Grills, Jason A. Douglas, and Sandra Villanueva are with the Psychology Applied Research Center, Loyola Marymount University, Los Angeles, CA
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Brusseau TA, Finkelstein T, Kulinna PH, Pangrazi C. Health-related fitness of American Indian youth. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2014; 85:257-261. [PMID: 25098022 DOI: 10.1080/02701367.2014.893050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
UNLABELLED A physically fit lifestyle is important for American Indian (AI) youth who are at risk for hypokinetic diseases, particularly type 2 diabetes. Some evidence exists on the physical activity patterns of AI youth, but there is little information on their health-related fitness. PURPOSE The purpose of this study was to describe the health-related fitness levels of youth living in an AI community. METHOD Participants included youth from 5th to 9th grade (N = 85) in a Southwestern U.S. AI community. Youth were of AI descent and were 12.36 +/- 1.68 years of age. Participants completed 5 parts of the FITNESSGRAM fitness test during physical education. The tests included the Progressive Aerobic Cardiorespiratory Endurance Run fitness test (cardiovascular fitness), curl-up (muscular endurance), pushup (muscular strength), sit-and-reach (flexibility), and body mass index (estimated body composition). RESULTS Results were similar to other youth studies with some of the students reaching the healthy fitness zone for muscular strength (28%), body composition (30%), flexibility (60%), aerobic fitness (63%), and muscular endurance (74%). CONCLUSIONS Findings highlight the capacity for improvement for students across all of the components of health-related fitness.
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Langford R, Bonell CP, Jones HE, Pouliou T, Murphy SM, Waters E, Komro KA, Gibbs LF, Magnus D, Campbell R. The WHO Health Promoting School framework for improving the health and well-being of students and their academic achievement. Cochrane Database Syst Rev 2014:CD008958. [PMID: 24737131 DOI: 10.1002/14651858.cd008958.pub2] [Citation(s) in RCA: 272] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The World Health Organization's (WHO's) Health Promoting Schools (HPS) framework is an holistic, settings-based approach to promoting health and educational attainment in school. The effectiveness of this approach has not been previously rigorously reviewed. OBJECTIVES To assess the effectiveness of the Health Promoting Schools (HPS) framework in improving the health and well-being of students and their academic achievement. SEARCH METHODS We searched the following electronic databases in January 2011 and again in March and April 2013: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, Campbell Library, ASSIA, BiblioMap, CAB Abstracts, IBSS, Social Science Citation Index, Sociological Abstracts, TRoPHI, Global Health Database, SIGLE, Australian Education Index, British Education Index, Education Resources Information Centre, Database of Education Research, Dissertation Express, Index to Theses in Great Britain and Ireland, ClinicalTrials.gov, Current controlled trials, and WHO International Clinical Trials Registry Platform. We also searched relevant websites, handsearched reference lists, and used citation tracking to identify other relevant articles. SELECTION CRITERIA We included cluster-randomised controlled trials where randomisation took place at the level of school, district or other geographical area. Participants were children and young people aged four to 18 years, attending schools or colleges. In this review, we define HPS interventions as comprising the following three elements: input to the curriculum; changes to the school's ethos or environment or both; and engagement with families or communities, or both. We compared this intervention against schools that implemented either no intervention or continued with their usual practice, or any programme that included just one or two of the above mentioned HPS elements. DATA COLLECTION AND ANALYSIS At least two review authors identified relevant trials, extracted data, and assessed risk of bias in the trials. We grouped different types of interventions according to the health topic targeted or the approach used, or both. Where data permitted, we performed random-effects meta-analyses to provide a summary of results across studies. MAIN RESULTS We included 67 eligible cluster trials, randomising 1443 schools or districts. This is made up of 1345 schools and 98 districts. The studies tackled a range of health issues: physical activity (4), nutrition (12), physical activity and nutrition combined (18), bullying (7), tobacco (5), alcohol (2), sexual health (2), violence (2), mental health (2), hand-washing (2), multiple risk behaviours (7), cycle-helmet use (1), eating disorders (1), sun protection (1), and oral health (1). The quality of evidence overall was low to moderate as determined by the GRADE approach. 'Risk of bias' assessments identified methodological limitations, including heavy reliance on self-reported data and high attrition rates for some studies. In addition, there was a lack of long-term follow-up data for most studies.We found positive effects for some interventions for: body mass index (BMI), physical activity, physical fitness, fruit and vegetable intake, tobacco use, and being bullied. Intervention effects were generally small but have the potential to produce public health benefits at the population level. We found little evidence of effectiveness for standardised body mass index (zBMI) and no evidence of effectiveness for fat intake, alcohol use, drug use, mental health, violence and bullying others; however, only a small number of studies focused on these latter outcomes. It was not possible to meta-analyse data on other health outcomes due to lack of data. Few studies provided details on adverse events or outcomes related to the interventions. In addition, few studies included any academic, attendance or school-related outcomes. We therefore cannot draw any clear conclusions as to the effectiveness of this approach for improving academic achievement. AUTHORS' CONCLUSIONS The results of this review provide evidence for the effectiveness of some interventions based on the HPS framework for improving certain health outcomes but not others. More well-designed research is required to establish the effectiveness of this approach for other health topics and academic achievement.
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Affiliation(s)
- Rebecca Langford
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK, BS8 2PS
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Barriers and facilitators to following the Dietary Guidelines for Americans reported by rural, Northern Plains American-Indian children. Public Health Nutr 2014; 18:482-9. [PMID: 24679830 DOI: 10.1017/s136898001400041x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The Dietary Guidelines for Americans (DGA) promote healthy dietary choices for all Americans aged 2 years and older; however, the majority of Americans do not meet recommendations. The goal of the present study was to identify both barriers and facilitators to adherence to DGA recommendations for consumption of five recommended food groups: grains (specifically whole grains), vegetables, fruits, meat/beans and milk (specifically reduced-fat/non-fat), among American-Indian children. DESIGN Nominal group technique sessions were conducted to identify and prioritize children's perceived barriers and facilitators to following the DGA, as presented in the 'MyPyramid' consumer education icon. After response generation to a single question about each food group (e.g. 'What sorts of things make it harder (or easier) for kids to follow the MyPyramid recommendation for vegetables?'), children individually ranked their top five most salient responses. Ranked responses are presented verbatim. SETTING A rural Northern Plains American-Indian reservation, USA. SUBJECTS Sixty-one self-selected fifth-grade children. RESULTS Core barriers for all food groups studied included personal preference (i.e. 'don't like') and environmental (i.e. 'cost too much'; 'store is too far to get them'; 'grandma don't have'). Core facilitators included suggestions, i.e. 'make a garden and plant vegetables'; 'tell your friends to eat healthy'. CONCLUSIONS Barriers and facilitators are dissimilar for individual food groups, suggesting that dietary interventions should target reduction of barriers and promotion of facilitators specific to individual food groups recommended by the DGA.
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Crotty Alexander LE, Marsh BJ, Timmer AM, Lin AE, Zainabadi K, Czopik A, Guarente L, Nizet V. Myeloid cell sirtuin-1 expression does not alter host immune responses to Gram-negative endotoxemia or Gram-positive bacterial infection. PLoS One 2013; 8:e84481. [PMID: 24386389 PMCID: PMC3873454 DOI: 10.1371/journal.pone.0084481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 11/14/2013] [Indexed: 11/20/2022] Open
Abstract
The role of sirtuin-1 (SIRT1) in innate immunity, and in particular the influence of SIRT1 on antimicrobial defense against infection, has yet to be reported but is important to define since SIRT1 inhibitors are being investigated as therapeutic agents in the treatment of cancer, Huntington’s disease, and autoimmune diseases. Given the therapeutic potential of SIRT1 suppression, we sought to characterize the role of SIRT1 in host defense. Utilizing both pharmacologic methods and a genetic knockout, we demonstrate that SIRT1 expression has little influence on macrophage and neutrophil antimicrobial functions. Myeloid SIRT1 expression does not change mortality in gram-negative toxin-induced shock or gram-positive bacteremia, suggesting that therapeutic suppression of SIRT1 may be done safely without suppression of myeloid cell-specific immune responses to severe bacterial infections.
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Affiliation(s)
- Laura E Crotty Alexander
- Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America ; Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Brenda J Marsh
- Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System, San Diego, California, United States of America ; Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Anjuli M Timmer
- Department of Pediatrics, University of California San Diego, San Diego, California, United States of America
| | - Ann E Lin
- Department of Pediatrics, University of California San Diego, San Diego, California, United States of America
| | - Kayvan Zainabadi
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Agnieszka Czopik
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Leonard Guarente
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - Victor Nizet
- Department of Pediatrics, University of California San Diego, San Diego, California, United States of America ; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, San Diego, California, United States of America
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Abstract
BACKGROUND Native American youth have greater rates of overweight/obesity than same-aged youth from the general population. Even though dietary shifts are suspected, surprisingly little information exists concerning the dietary patterns of contemporary Native American adolescents. AIM This study examines the dietary composition of Native American adolescents residing in upstate New York at the Akwesasne Mohawk Nation. The goal of this investigation is to assess the food patterns of Akwesasne adolescents via a total diet approach. PARTICIPANTS/SETTING AND METHODS: The sample is comprised of 246 Mohawk adolescents between the ages of 10-16.9 years of age residing at the Akwesasne Mohawk Nation. Food frequency data was collected from adolescents via interview during a cross-sectional study investigating their exposure to environmental pollutants. RESULTS AND CONCLUSION Nutrient-dilute but energy-dense foods characterize most of the top 10 dietary sources of energy, carbohydrates, and fat. Although micronutrient intakes are by and large adequate in the sample, micronutrients are most often derived from highly fortified food sources. Adolescent diets contain few naturally-occurring sources of many micronutrients, especially folate and iron. A narrow variety of foods dominate the top dietary sources across both macronutrient and micronutrients, strongly suggesting the need for increased dietary diversity within this age group.
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Affiliation(s)
- Julia Ravenscroft
- Department of Anthropology, University at Albany , 1400 Washington Avenue, Albany, NY 12222 , USA
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Holm JE, Lilienthal KR, Poltavski DV, Vogeltanz-Holm N. Relationships between health behaviors and weight status in American Indian and white rural children. J Rural Health 2013; 29:349-59. [PMID: 24088209 DOI: 10.1111/jrh.12010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Preventing obesity in childhood is an increasingly important public health goal. Prevention efforts can be improved by better understanding relationships between health behaviors and overweight and obesity. This study examined such relationships in young American Indian and white children living in the rural United States. METHODS Self-report measures of diet, screen time (passive and active), and physical activity were combined with cardiovascular fitness in cross-sectional analyses to predict weight categories based on body mass index percentiles in 306 American Indian and white children (aged 8-9 years) from a rural area in the upper Midwestern United States. FINDINGS Multinomial logistic regression models were statistically significant for girls (χ2 [20] = 42.73, P < .01), boys (χ2 [20] = 50.44, P < .001), American Indian (χ2 [20] = 36.67, P < .05), and white children (χ2 [20] = 55.99, P < .001). Obesity was associated with poorer cardiovascular fitness in girls (OR = 0.82), boys (OR = 0.83), American Indian (OR = 0.79), and white children (OR = 0.85), and with passive screen time in girls (OR = 1.69), boys (OR = 2.1), and white children (OR = 1.81). Overweight was associated with passive screen time (OR = 2.24) and inversely with active screen time (OR = 0.54), but only in boys. CONCLUSIONS Logistic regression models were more successful at predicting obesity than overweight in all groups of participants. Poorer cardiovascular fitness showed the strongest and most consistent association with obesity, but passive screen time was also a significant and important contributor to the prediction of obesity in most prediction models. Prediction models were similar in girls, boys, American Indian, and white children.
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Affiliation(s)
- Jeffrey E Holm
- Department of Psychology and Center for Health Promotion and Prevention Research, University of North Dakota, Grand Forks, North Dakota
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Story M, Hannan PJ, Fulkerson JA, Rock BH, Smyth M, Arcan C, Himes JH. Bright Start: Description and main outcomes from a group-randomized obesity prevention trial in American Indian children. Obesity (Silver Spring) 2012; 20:2241-9. [PMID: 22513491 PMCID: PMC3407274 DOI: 10.1038/oby.2012.89] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of the Bright Start study was to develop and test the effectiveness of a school environment intervention, supplemented with family involvement, to reduce excessive weight gain by increasing physical activity and healthy eating practices among kindergarten and first-grade American Indian children. Bright Start was a group-randomized, school-based trial involving 454 children attending 14 schools on the Pine Ridge Reservation in South Dakota. Children were followed from the beginning of their kindergarten year through the end of first grade. Main outcome variables were mean BMI, mean percent body fat, and prevalence of overweight/obese children. The goals of the intervention were to: increase physical activity at school to at least 60 min/day; modify school meals and snacks; and involve families in making behavioral and environmental changes at home. At baseline, 32% of boys and 25% of girls were overweight/obese. Although the intervention was not associated with statistically significant change in mean levels of BMI, BMI-Z, skinfolds or percentage body fat, the intervention was associated with a statistically significant net decrease of 10% in the prevalence of overweight. Intervention children experienced a 13.4% incidence of overweight, whereas the control children experienced a corresponding incidence of 24.8%; a difference of -11.4% (P = 0.033). The intervention significantly reduced parent-reported mean child intakes of sugar-sweetened beverages, whole milk, and chocolate milk. Changes in duration of school physical activity were not significant. Because obesity is the most daunting health challenge facing American Indian children today, more intervention research is needed to identify effective approaches.
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Affiliation(s)
- Mary Story
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
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20
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Weedn AE, Ang SC, Zeman CL, Darden PM. Obesity prevalence in low-income preschool children in Oklahoma. Clin Pediatr (Phila) 2012; 51:917-22. [PMID: 22523274 DOI: 10.1177/0009922812441861] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the prevalence of overweight and obesity in low-income preschool children in Oklahoma and to identify potential race/ethnic disparities. METHODS Subjects included 39,151 children aged 2 to 4 years who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in 2009. Body mass index percentiles were calculated from the child's height, weight, sex, and age. RESULTS In 2009, 30.7% of Oklahoma's children in WIC were overweight, including 13.7% obese. Disparities by race/ethnicity were greatest for obese children: prevalence was 18.8% for American Indians (odds ratio [OR] = 1.8, confidence interval [CI] = 1.54-2.03) and 17.2% for Hispanics (OR = 1.6, CI = 1.52-1.73) compared with 11.8% for non-Hispanic whites, whereas African Americans were less obese (OR = 0.9, CI = 0.79-0.98). CONCLUSION Obesity rates in low-income Oklahoma children are highest among American Indians and Hispanic children. Interventions aimed at these high-risk groups need to be explored.
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Affiliation(s)
- Ashley E Weedn
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Schell LM, Gallo MV. Overweight and obesity among North American Indian infants, children, and youth. Am J Hum Biol 2012; 24:302-13. [PMID: 22378356 PMCID: PMC3514018 DOI: 10.1002/ajhb.22257] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 01/18/2012] [Accepted: 01/22/2012] [Indexed: 11/12/2022] Open
Abstract
The frequency of overweight and obesity among North American Indian children and youth exceeds that of other ethnic groups in the United States. This observation is based on studies using body mass index as the primary measure of overweight and obesity. In the mid-20th century, there were regional differences among North American Indian groups in sub-adults' size and shape and only a few Southwestern groups were characterized by high rates of overweight and obesity. In most populations, the high prevalence of overweight and obesity developed in the last decades of the 20th century. Childhood obesity may begin early in life as many studies report higher birth weights and greater weight-for-height in the preschool years. Contributing factors include higher maternal weights, a nutritional transition from locally caught or raised foods to store bought items, psychosocial stress associated with threats to cultural identity and national sovereignty, and exposure to obesogenic pollutants, all associated to some degree with poverty. Obesity is part of the profile of poor health among Native Americans in the US and Canada, and contributes to woefully high rates of diabetes, cardiovascular disease, and early mortality. Interventions that are culturally appropriate are needed to reduce weights at all points in the lifespan.
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Affiliation(s)
- Lawrence M Schell
- Center for the Elimination of Minority Health Disparities, University at Albany, New York, USA.
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Berg CJ, Daley CM, Nazir N, Kinlacheeny JB, Ashley A, Ahluwalia JS, Greiner KA, Choi WS. Physical activity and fruit and vegetable intake among American Indians. J Community Health 2012; 37:65-71. [PMID: 21630108 PMCID: PMC3259287 DOI: 10.1007/s10900-011-9417-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The American Indian population has among the highest rates of obesity in the United States. Thus, it is critical to understand factors related to this epidemic (e.g., physical activity, nutrition) among this ethnic minority population. The current study examined factors related to engaging in at least 4 days of physical activity (PA) per week and factors related to consuming at least 5 fruits and vegetables (FV) per day among a sample of American Indians in the Midwest. We used multiple methods to recruit participants for this study, including recruitment at pow wows, focus groups, health fairs, new student orientation for American Indian students, and other venues. A total of 998 American Indians (76% participation rate) completed a survey assessing sociodemographics, physical activity level, fruit and vegetable intake, and perceptions regarding the recommendations for physical activity and fruit and vegetable intake. Factors associated with exercising ≥4 days in the past week (44.77% of the sample) include being younger (P = .002), being male (P < .001), having at least some college education (P = .048), eating ≥5 FV per day, and higher perceived number of days of PA recommended (P < .001). Factors associated with eating ≥5 servings of FV per day (37.01% of the sample) included exercising ≥4 days in the past week (P < .001) and higher perceived number of servings of FV recommended (P < .001). These findings highlight the importance of education in enhancing engagement in positive weight control behaviors and the importance of addressing both physical activity and nutrition among the American Indian population.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA 30322, USA.
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Abstract
This paper describes the disparities in the U.S. childhood obesity epidemic, mainly based on recent nationally representative data. The prevalence of overweight and obesity has increased since the late 1970s; the over time shifts (changes) in distributions of various body fatness measures indicate that U.S. children have become fatter and the obese groups gained more body fat, especially more central obesity, as indicated by waist circumference. However, considerable between-group and regional disparities exist in the prevalence, fatness measures, and over time trends. The disparities and trends are complex, which reflects the complexity and dynamics in obesity etiology. Clearly, some population groups are affected more seriously than others. Native American children have the highest prevalence of obesity, whereas Asians have the lowest rate among all ethnic groups. Preschool age children have a lower obesity prevalence than older children. Young people in some states and cities are twice more likely to be overweight or obese than those living in other regions. Low-socioeconomic status is associated with obesity only among some population groups, e.g. white children and adolescents. Vigorous, effective interventions are needed to promote healthy lifestyles among U.S. young people and to reduce disparities in obesity.
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Affiliation(s)
- Youfa Wang
- Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Noonan CW, Brown BD, Bentley B, Conway K, Corcoran M, FourStar K, Freide P, Hemlock B, Wagner S, Wilson T. Variability in childhood asthma and body mass index across Northern Plains American Indian communities. J Asthma 2010; 47:496-500. [PMID: 20560824 DOI: 10.3109/02770901003759436] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE There are sparse data on the variability in childhood asthma across different Native American communities and the corresponding associations with known risk factors such as high body mass index and family history. The purpose of this study is to evaluate cross-sectional data on childhood asthma prevalence, body mass index, and other descriptive variables among Native Americans in five rural Northern Plains Indian reservation communities. METHODS A school-based screening program was conducted on four Northern Plains Indian Reservations. The 1852 children (96% Native American, 4th through 12th grades) were screened for asthma status, body mass index (BMI), and family history. RESULTS Approximately 9.5% of students reported current asthma. Current asthma varied significantly across the four reservation sites, ranging from 5.7% to 12.6%. Current asthma was also positively associated with BMI and family history of asthma. CONCLUSIONS The intertribal differences in asthma prevalence noted here emphasize the need for further understanding the intertribal environmental, social, and behavioral factors that are associated with childhood asthma and obesity. Such knowledge can help inform disease prevention or disease management strategies that encompass the unique characteristics of tribal communities and culture.
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Affiliation(s)
- Curtis W Noonan
- Center for Environmental Health Sciences, The University of Montana, Missoula, MT 59812, USA.
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Brown B, Noonan C, Bentley B, Conway K, Corcoran M, FourStar K, Gress S, Wagner S. Acanthosis nigricans among Northern Plains American Indian children. J Sch Nurs 2010; 26:450-60. [PMID: 20595701 DOI: 10.1177/1059840510376383] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The purpose of this study is to present cross-sectional and prospective data on acanthosis nigricans (AN) prevalence in the context of other risk factors for diabetes including high body mass index (BMI), abnormal blood pressure (BP), physical inactivity and family history of diabetes among Northern Plains American Indian (AI) children. Standardized health measures were collected in 2,520 K-12th-grade AI students for AN, BMI, and BP. Data were also collected on family history of diabetes and physical activity. Approximately, 9.7% of the participants were positive for AN. AN was associated with high BMI, abnormal BP, and diabetes family history. Sports participation was inversely associated with AN. Among children measured the prior year, relative risk (and 95% confidence interval [CI]) for obesity and incident AN was 9.8 (4.2-23.0) compared to normal weight. These findings suggest there is utility in measuring this marker of insulin resistance in this at-risk population.
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Circle of life: rationale, design, and baseline results of an HIV prevention intervention among young American Indian adolescents of the Northern Plains. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2010; 11:101-12. [PMID: 19798577 DOI: 10.1007/s11121-009-0153-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In spite of significant disparities in sexual health outcomes for American Indian youth, no studies exist examining the effectiveness of HIV-prevention interventions. Circle of Life is an HIV-prevention intervention specifically developed for American Indian middle-school youth. We describe the rationale, methodology, and baseline results of a longitudinal randomized trial of Circle of Life conducted among American Indian youth aged 11-15 in a reservation community. The innovative design includes two pre-intervention waves to determine patterns of behavior prior to the intervention that might be associated with a differential impact of the intervention on sexual risk. We used one-way analysis of variance and chi-square tests to test for significant differences between randomized group assignment at each baseline wave and generalized estimating equations (GEE) to test significant differences in the rate of change in outcomes by group longitudinally. We present the collaborative and adaptive strategies for consenting, assenting, and data collection methodology in this community. Achieved response rates are comparable to other similar studies. Results from the two baseline waves indicate that few outcomes significantly varied by randomized intervention assignment. Ten percent of youth reported having had sex at Wave 1, rising to 15% at Wave 2. Among those who had had sex, the majority (>70%) reported using a condom at last sex. The project is well positioned to carry out the longitudinal assessments of the intervention to determine the overall impact of the Circle of Life and the differential impact by pre-intervention patterns of behavior across youth.
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Seo DC, Sa J. A meta-analysis of obesity interventions among U.S. minority children. J Adolesc Health 2010; 46:309-23. [PMID: 20307819 DOI: 10.1016/j.jadohealth.2009.11.202] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2008] [Revised: 05/26/2009] [Accepted: 11/16/2009] [Indexed: 12/26/2022]
Abstract
PURPOSE To quantitatively evaluate the efficacy of interventions designed to prevent or treat obesity among U.S. minority children using meta-analytic techniques. METHODS A total of 40 intervention trials involving 10,725 children aged 6-19 years were examined. RESULTS Interventions with more components showed a higher mean effect size than those with fewer components: among 32 controlled trials, d = .07 for one-component (n = 6); d = .08 for two-component (n = 15); d = .33 for three-component (n = 10); and d = .71 for four-component (n = 1) interventions. Interventions with parental involvement (n = 22, d = .21) and lifestyle interventions (n = 14, d = .34) showed a greater mean effect size than those without parental involvement (n = 10, d = .05) or lifestyle interventions (n = 18, d = .04), despite the fact that their 90% confidence intervals overlapped. Among uncontrolled trials (n = 8), two-component interventions (n = 5) yielded d = .86 and three-component interventions (n = 3) yielded d = .96. CONCLUSIONS Evidence indicates that, among U.S. minority children, obesity interventions with three or more components might be more efficacious than those using fewer components. Parental involvement, lifestyle change, culturally-based adaptation, and interactive computer programs seem to show promise in the reduction of obese minority children.
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Affiliation(s)
- Dong-Chul Seo
- Department of Applied Health Science, Indiana University, Bloomington, Indiana 47405, USA.
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Bustos P, Muñoz S, Vargas C, Amigo H. Evolution of the nutritional situation of indigenous and non-indigenous Chilean schoolchildren. Ann Hum Biol 2009; 36:298-307. [DOI: 10.1080/03014460902729536] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Patricia Bustos
- Department of Nutrition, University of Chile, Santiago, Chile
| | - Sergio Muñoz
- Division of Clinical Epidemiology, University of La Frontera, Temuco, Chile
| | - Claudio Vargas
- Department of Nutrition, University of Chile, Santiago, Chile
| | - Hugo Amigo
- Department of Nutrition, University of Chile, Santiago, Chile
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Sharma S, Cao X, Gittelsohn J, Ethelbah B, Anliker J. Nutritional composition of commonly consumed traditional Apache foods in Arizona. Int J Food Sci Nutr 2009; 59:1-10. [DOI: 10.1080/09637480701525970] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Anthropometric Characteristics of Pakistani School Children Living in Bahrain. J Immigr Minor Health 2009; 11:205-14. [DOI: 10.1007/s10903-008-9166-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 06/26/2008] [Indexed: 10/21/2022]
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Brim SN, Rudd RA, Funk RH, Callahan DB. Asthma prevalence among US children in underrepresented minority populations: American Indian/Alaska Native, Chinese, Filipino, and Asian Indian. Pediatrics 2008; 122:e217-22. [PMID: 18595967 DOI: 10.1542/peds.2007-3825] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The purpose of this work was to estimate asthma prevalence among US children in racial minority subgroups who have been historically underrepresented in the pediatric asthma literature. These subgroups include American Indian/Alaska Native, Chinese, Filipino, and Asian Indian children. We also explored the association between these race categories and asthma after adjusting for demographic and sociodemographic characteristics and explored the effect of place of birth as it relates to current asthma. PATIENTS AND METHODS Data on all 51944 children aged 2 to 17 years from the 2001-2005 National Health Interview Survey were aggregated and analyzed to estimate the prevalence of current asthma, lifetime asthma, and asthma attacks according to race and place of birth. Logistic regression was used to determine adjusted odds ratios for current asthma according to race and place of birth while controlling for other demographic and sociodemographic variables. RESULTS National estimates of current asthma prevalence among the children in the selected minority subgroups ranged from 4.4% in Asian Indian children to 13.0% in American Indian/Alaska Native children. Overall, children born in the United States had greater adjusted odds of reporting current asthma than did children born outside of the United States. CONCLUSIONS Smaller racial and ethnic minority groups are often excluded from asthma studies. This study reveals that, among children from different Asian American subgroups, wide variation may occur in asthma prevalence. We also found that children born in the United States were more likely than children born outside of the United States to have current asthma.
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Affiliation(s)
- Susan N Brim
- Centers for Disease Control and Prevention, Air Pollution and Respiratory Health Branch, National Center for Environmental Health, CDC Chamblee Campus, 4770 Buford Hwy, Mail Stop F58, Atlanta, GA 30341, USA
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Jollie-Trottier T, Holm JE, McDonald JD. Correlates of overweight and obesity in american Indian children. J Pediatr Psychol 2008; 34:245-53. [PMID: 18499740 DOI: 10.1093/jpepsy/jsn047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify risk factors that may contribute to the development and/or maintenance of overweight and obesity in American Indian children. METHODS The sample consisted of 291 tribally enrolled American Indian children. Body mass index (BMI) was measured by a tribal program and children completed self-report measures during health class. Hierarchical multiple regression analyses were conducted for 232 children and included three blocks of predictor variables (diet and physical activity, weight-related attitudes, and psychosocial variables). RESULTS Thirty-three percent of children were obese and 20% were overweight. Diet and physical activity (7.6%) and weight-related attitudes (31.9%) made significant contributions, explaining 39.5% of the variance in BMI. CONCLUSIONS Greater BMI scores were related to healthier food choice intentions, more hours of television viewing, greater body dissatisfaction, higher negative attitudes toward body size, and more weight loss attempts.
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Kumanyika SK. Environmental influences on childhood obesity: ethnic and cultural influences in context. Physiol Behav 2007; 94:61-70. [PMID: 18158165 DOI: 10.1016/j.physbeh.2007.11.019] [Citation(s) in RCA: 231] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 11/15/2007] [Indexed: 12/22/2022]
Abstract
Ethnicity is associated with differences in food-related beliefs, preferences, and behaviors, and cultural influences may contribute to the higher than average risk of obesity among children and youth in U.S. ethnic minority populations. However, cultural attitudes and beliefs are not the only potential source of ethnic variation in childhood obesity prevalence and should not be studied in isolation. Demographic, socio-structural, and environmental variables must also be considered. Available evidence indicates ethnic differences along several pathways that may increase risks of obesity development during gestation, infancy, childhood and adolescence. These include above-average prevalence of obesity in adult females and of maternal diabetes during pregnancy, parental attitudes and practices that may lead to overfeeding children, above-average levels of consumption of certain high calorie foods and beverages, and inadequate physical activity. Environments with lower than average neighborhood availability of healthful foods and higher than average availability of fast food restaurants, along with exposure to ethnically targeted food marketing may contribute to reliance on high calorie foods and beverages, and these foods may be socially and culturally valued. Attitudes about and environmental contexts for physical activity are also relevant. Increasingly, it is acknowledged that individual behaviors and lifestyles, e.g. food choices or child feeding practices, are responsive to the ecological contexts in which they are practiced. Focusing attention on the fluid interactions of cultural influences with contextual factors, of recognized importance for the study of childhood undernutrition, can also lead to further understanding of how to address ethnic disparities in childhood obesity.
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Affiliation(s)
- Shiriki K Kumanyika
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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Malina RM, Reyes MEP, Tan SK, Buschang PH, Little BB. Overweight and obesity in a rural Amerindian population in Oaxaca, Southern Mexico, 1968-2000. Am J Hum Biol 2007; 19:711-21. [PMID: 17661349 DOI: 10.1002/ajhb.20622] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The purpose of this study was to evaluate secular change in the prevalence of overweight and obesity in a rural Zapotec Indian community in southern Mexico between 1968 and 2000. Cross-sectional surveys of children 6-13 years, adolescents 13-17 years, and adults 19 years of age and older resident in a rural community in Oaxaca were conducted in 1968/1971, 1978, and 2000. Individuals present in the 1968, 1978, and 2000 surveys provided a small longitudinal component. Height and weight were measured; the BMI was calculated. International criteria for overweight and obesity were used. Overweight and obesity were virtually absent in school children 6-13 years in 1968 and 1978 and in adolescents in 1978. Small proportions of children (boys, 5%; girls, 8%) and adolescents (boys, 3%; girls, 15%) were overweight in 2000; two children (1%) and no adolescents were obese. Among adults, 7% of males and 19% of females were overweight and <1% of males and 4% of females were obese in 1971/1978, but 46% of males and 47% of females were overweight; and 5% of males and 14% of females were obese in 2000. The trends for children, adolescents, and adults were confirmed in the longitudinal subsamples. In conclusion, overweight and obesity are not presently a major problem in children and adolescents in this rural Zapotec community. Overweight, in particular, and to a lesser extent obesity have increased in prevalence among adults since the late 1970s. The results suggest adulthood as a critical period for onset of overweight and obesity in this sample.
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Affiliation(s)
- Robert M Malina
- Department of Health and Physical Education, Tarleton State University, Stephenville, Texas 76402, USA.
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Johnson TG, Kulinna PH, Darst PW, Pangrazi RP. School day physical activity patterns of Pima Indian children in two communities. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2007; 78:364-368. [PMID: 17941540 DOI: 10.1080/02701367.2007.10599433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Tyler G Johnson
- Department of Physical Education, Arizona State University, USA
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Casey PH, Simpson PM, Gossett JM, Bogle ML, Champagne CM, Connell C, Harsha D, McCabe-Sellers B, Robbins JM, Stuff JE, Weber J. The association of child and household food insecurity with childhood overweight status. Pediatrics 2006; 118:e1406-13. [PMID: 17079542 DOI: 10.1542/peds.2006-0097] [Citation(s) in RCA: 245] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The prevalence of childhood overweight status is increasing. Some have suggested that childhood overweight is associated with food insecurity, defined as limited or uncertain access to enough nutritious food. OBJECTIVES The purpose of this work was to assess the association of household and child food insecurity with childhood overweight status. METHODS The National Health and Nutrition Examination Survey 1999-2002 uses a stratified multistaged probability sample and collects a broad array of data from a nationally representative sample of US citizens. All children 3 to 17 years old in this sample are included in these analyses. We measured BMI categorized as at risk for overweight or greater (> or = 85%) or overweight (> or = 95%) and household and child food security/insecurity using the US Food Security Scale. RESULTS When compared with children from food-secure households, children from food-insecure households were more likely to demonstrate significant associations with being at risk for overweight or greater in the following demographic categories: 12 to 17 years, girls, white, and in households with income < 100% and > 4 times the federal poverty level. Household food insecurity is associated with child overweight status in children aged 12 to 17, girls, and children who live in households with incomes > 4 times the federal poverty level. Child food insecurity demonstrated the same associations with being at risk for overweight or greater, as did household food insecurity, but associations were also seen in 3- to 5-year-old children, boys, and Mexican American children. Child food insecurity is significantly associated with child overweight status for children aged 12 to 17, girls, white children, and children in families with income < or = 100% poverty level. Controlling for ethnicity, gender, age, and family poverty index level, childhood food insecurity is associated with a child being at risk for overweight status or greater, but not overweight status. CONCLUSIONS Household and child food insecurity are associated with being at risk for overweight and overweight status among many demographic categories of children. Child food insecurity is independently associated with being at risk for overweight status or greater while controlling for important demographic variables. Future longitudinal research is required to determine whether food insecurity is causally related to child overweight status.
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Affiliation(s)
- Patrick H Casey
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences and Arkansas Children's Hospital Research Institute, 800 Marshall St, 512-26, Little Rock, AR 72202, USA.
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Abstract
The purpose of this article was to examine whether a nutritional transition has occurred among American Indians (AI) by evaluating related articles and government health statistics. Findings indicate that although the primary health risk for the AI population around 1970 was undernutrition, now there is an obesity epidemic among all age groups that is associated with a loss of traditional food practices and reduced physical activity. Deaths caused by cardiovascular disease, diabetes mellitus, and cancer have outpaced death from infectious disease. With abundant high-energy foods and limited physical activity, the acculturated environment has resulted in obesity and increased mortality from chronic diseases. To improve AI health and survival, the obesity epidemic must be approached in a concerted, culturally appropriate manner with encouragement of traditional foods and safe opportunities for physical activity.
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Retnakaran R, Hanley AJG, Connelly PW, Harris SB, Zinman B. Elevated C-reactive protein in Native Canadian children: an ominous early complication of childhood obesity. Diabetes Obes Metab 2006; 8:483-91. [PMID: 16918582 DOI: 10.1111/j.1463-1326.2005.00533.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Subclinical inflammation has been proposed as a pathophysiologic mechanism linking obesity with vascular and metabolic disease. Native North American populations are experiencing high prevalence rates of both (i) childhood obesity and (ii) adult cardiovascular disease (CVD) and type 2 diabetes. Thus, we sought to determine whether subclinical inflammation is an early complication of obesity in Native children. METHODS Serum concentrations of the inflammatory biomarker C-reactive protein (CRP) were assessed in a population-based, cross-sectional study of the Sandy Lake Oji-Cree community of Northern Ontario, Canada, involving 228 children aged 10-19 years (mean age 14.8). RESULTS Median CRP in this population was 0.5 mg/l (interquartile range 0.18-1.79 mg/l). CRP levels were higher than age-matched reference data from the Third National Health and Nutrition Examination Survey (NHANES III). Importantly, fully 15.8% of the children of this community had CRP concentrations between 3 and 10 mg/l, a range that identifies adults at high risk of CVD. Moreover, increasing CRP concentration in this paediatric population was associated with an enhanced CV risk profile, consisting of increased adiposity, higher insulin resistance, worsening lipid profile (higher total cholesterol, triglycerides, low-density lipoprotein cholesterol, apolipoprotein B and total cholesterol : high-density-lipoprotein cholesterol ratio), increased leptin and decreased adiponectin. On multivariate analysis, waist circumference and interleukin-6 (IL-6) emerged as independent determinants of CRP concentration. CONCLUSION Subclinical inflammation is an early complication of childhood obesity in Native children and may foreshadow an increased burden of CVD and type 2 diabetes in the future.
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Affiliation(s)
- R Retnakaran
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
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Garaulet M, Hernández-Morante JJ, Tébar FJ, Zamora S, Canteras M. Two-dimensional predictive equation to classify visceral obesity in clinical practice. Obesity (Silver Spring) 2006; 14:1181-91. [PMID: 16899799 DOI: 10.1038/oby.2006.135] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Visceral obesity assessment is not easy, and although computed tomography (CT) is an accurate tool, this technique is expensive and sometimes not suitable in clinical practice. We developed a new two-dimensional elliptical anthropometric equation to classify visceral obesity and evaluated the validity and the reliability of the new equation compared with CT. RESEARCH METHODS AND PROCEDURES We collected anthropometric and CT data from overweight/obese subjects (n = 61, BMI = 32.4 +/- 3.7 kg/m2). A validation group of 32 subjects was also selected. An equation for the assessment of visceral obesity was developed using multiple regression analysis. Once validated, the equation was compared with previous models. Tests for accuracy included mean differences, analysis of diagnostic, R2, Snedecor's F-test, and Bland-Altman plot. RESULTS Multiple regression analysis revealed that the sagittal and coronal diameters and the triceps skinfold were significant contributors to the model. The final equation was: visceral area (VA)/subcutaneous area (SA)predicted = 0.868 + 0.064 x sagittal diameter - 0.036 x coronal diameter - 0.022 x triceps skinfold. Patients with visceral-subcutaneous area ratio (VA/SA) > 0.42 were classified as having visceral obesity. The predictive equation was valid, showing a significant association with VA/SA assessed by CT (VA/SA(CT); r = 0.68; p < 0.0001). Paired Student's t test showed no significant differences with VA/SACT (p = 0.541). The reliability was high [F(24/60) = 2.12; p = 0.01]. DISCUSSION The new two-dimensional and elliptical predictive equation is valid to assess visceral obesity and is more precise than previous models.
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Affiliation(s)
- Marta Garaulet
- Department of Physiology, University of Murcia, 30100 Murcia, Spain.
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Gittelsohn J, Anliker JA, Sharma S, Vastine AE, Caballero B, Ethelbah B. Psychosocial determinants of food purchasing and preparation in American Indian households. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2006; 38:163-8. [PMID: 16731451 DOI: 10.1016/j.jneb.2005.12.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Accepted: 12/28/2005] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Obesity and other diet-related chronic diseases affect American Indians at high rates, yet little is known about food use behaviors in this population, or of psychosocial factors that influence these behaviors. The study objective was to address this gap. DESIGN Cross-sectional; part of baseline collection for an intervention trial. SETTING White Mountain and San Carlos Apache reservations, Arizona. PARTICIPANTS Main household food shoppers and preparers of 270 randomly selected households on two American Indian reservations. ANALYSIS Multivariate linear regression. VARIABLES MEASURED Primary independent variables were healthy food knowledge, self-efficacy and intentions, assessed using multi-question scales. Dependent variables were frequency of purchasing healthy foods and a healthiness of cooking methods score. RESULTS Higher-fat and/or higher-sugar items were commonly purchased, with limited purchasing of healthier alternatives. Pre-prepared foods are a substantial component of the diet. Cooking methods which add or have little impact on the fat content of foods were more commonly employed than methods which reduce fat. Food acquisition and use behaviors were predicted by food use intentions. Food intention scores were predicted by food self-efficacy; food self-efficacy by food knowledge. CONCLUSIONS AND IMPLICATIONS These findings support the use of food knowledge, self-efficacy, and intentions in understanding food-related behavior in this setting.
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Affiliation(s)
- Joel Gittelsohn
- Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205-2179, USA.
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Trifiletti LB, Shields W, Bishai D, McDonald E, Reynaud F, Gielen A. Tipping the scales: obese children and child safety seats. Pediatrics 2006; 117:1197-202. [PMID: 16585315 DOI: 10.1542/peds.2005-1379] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To shed light on the extent to which childhood obesity affects the types of appropriate child safety seats for young children, by providing an estimate of the number of US children whose weight renders them unable to use safely the majority of child safety seat types currently available. METHODS The types of appropriate child safety seats were assessed by using National Highway Traffic Safety Administration 2005 Child Safety Seat Ease of Use Ratings. Estimates of the numbers of children weighing above the maximal weight for those child safety seats were calculated by using the tabulations of growth curves based on National Health and Nutrition Examination Survey 1999 to 2000 data that were assembled by the National Center for Health Statistics and the US Census for the year 2000. RESULTS A total of 283,305 children 1 to 6 years of age would have a difficult (if not impossible) time finding a safe child safety seat because of their age and weight. The vast majority of these children are 3 years of age and weigh >40 lb (182,661 children). For these children, there are currently only 4 child safety seat types available, each of which costs between $240 and $270. CONCLUSIONS This study determined that there is limited availability of child safety seat types for the ever-increasing number of obese young children. There are substantial numbers of children who weigh more than the upper weight limit for most currently available child safety seats. While we await reductions in the childhood obesity epidemic, options for maximizing the protection of obese children in automobiles must be identified.
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Affiliation(s)
- Lara B Trifiletti
- Columbus Children's Research Institute, Center for Injury Research and Policy, Ohio State University, Columbus, Ohio, USA.
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Curran S, Gittelsohn J, Anliker J, Ethelbah B, Blake K, Sharma S, Caballero B. Process evaluation of a store-based environmental obesity intervention on two American Indian Reservations. HEALTH EDUCATION RESEARCH 2005; 20:719-29. [PMID: 15872001 DOI: 10.1093/her/cyh032] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Obesity and other diet-related chronic diseases are widespread in American Indian communities. Inadequate access to healthy food on many reservations has led to a high-fat, high-sugar diet. The purpose of this paper is to report on the results of the process evaluation of a food store-based program to improve diet on two American Indian reservations. Process data were collected from 11 intervention stores to document the implementation of the Apache Healthy Stores (AHS) program. Process evaluation instruments recorded the stocking of promoted foods, presence of in-store communication materials, implementation of and participation in the cooking demonstrations and taste tests, and the transmission of mass-media messages. At the store level, the program was implemented with a high level of dose and reach, and a moderate to high level of fidelity. At the community level, the AHS program was implemented with a moderate degree of fidelity and dose. At the individual level, the cooking demonstrations and taste tests reached a large number of community members with a high dose. Implementing the AHS program on multiple levels (store, community, individual) was challenging, and differed between levels. Overall, improvements were seen from start to finish as program staff monitored, documented and responded to barriers to implementation. Process data will be tied to outcomes and will be useful for the planning of future store-based programs.
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Affiliation(s)
- Sarah Curran
- Center for Human Nutrition, Johns Hopkins University, Bloomberg School of Public Health, Cambridge, MA 02138, USA.
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Bloomgarden ZT. Insulin Resistance in Children and in the Polycystic Ovarian Syndrome. Metab Syndr Relat Disord 2005; 3:294-304. [DOI: 10.1089/met.2005.3.294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
The increasing prevalence of pediatric overweight has caused the medical community to begin searching for ways to deal with this new pediatric medical problem. The Centers for Disease Control developed the Body Mass Index (BMI) growth charts, which came into use in 2000. Primary care providers are seeking education on this relatively new topic. This article provides fundamental information based on the medical evidence for pediatricians to learn how to care for their overweight pediatric patients in the office setting.
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Affiliation(s)
- Karen L Young
- Department of Pediatrics, University of Arkansas for Medical Sciences, College of Medicine, Arkansas Children's Hospital, Little Rock, AR 72202, USA
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Bloomgarden ZT. Second World Congress on the Insulin Resistance Syndrome: mediators, pediatric insulin resistance, the polycystic ovary syndrome, and malignancy. Diabetes Care 2005; 28:1821-30. [PMID: 15983348 DOI: 10.2337/diacare.28.7.1821] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Paradis G, Lévesque L, Macaulay AC, Cargo M, McComber A, Kirby R, Receveur O, Kishchuk N, Potvin L. Impact of a diabetes prevention program on body size, physical activity, and diet among Kanien'keha:ka (Mohawk) children 6 to 11 years old: 8-year results from the Kahnawake Schools Diabetes Prevention Project. Pediatrics 2005; 115:333-9. [PMID: 15687441 DOI: 10.1542/peds.2004-0745] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Report the 8-year impact on body size, physical activity, and diet of a community-based diabetes prevention program for elementary-school children in a Kanien'keha:ka (Mohawk) community in Canada. METHODS Follow-up (1994-1996) of subjects in the intervention and comparison community and repeat cross-sectional measurements in the intervention community alone from 1994 to 2002. Measures included triceps and subscapular skinfold thicknesses, body mass index (BMI), weekly number of 15-minute episodes of physical activity, run/walk test times, television watching, and consumption of sugared foods, fatty foods, and fruits and vegetables. RESULTS The longitudinal data of 1994-1996 showed some early positive effects of the program on skinfold thickness but not on BMI, physical activity, fitness, or diet. Repeat cross-sectional measures from 1994 to 2002 showed increases in skinfold thickness and BMI. Physical activity, fitness, and television watching showed favorable trends from 1994 to 1999 that were not sustained in 2002. Key high-fat and high-sugar foods consumption decreased, as did consumption of fruits and vegetables. CONCLUSIONS Although early results showed some successes in reducing risk factors for type 2 diabetes, these benefits were not maintained over 8 years.
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Affiliation(s)
- Gilles Paradis
- Direction de Santé Publique de Montréal and Division of Preventive Medicine, McGill University Health Center, Montreal, Quebec, Canada.
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Grant AM, Ferguson EL, Toafa V, Henry TE, Guthrie BE. Dietary factors are not associated with high levels of obesity in New Zealand Pacific preschool children. J Nutr 2004; 134:2561-5. [PMID: 15465748 DOI: 10.1093/jn/134.10.2561] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pacific children living in New Zealand (NZ) are prone to excessive weight gain. In this study, we assessed the anthropometric status of 2- to 5-y-old Pacific children (n = 60) in relation to their macronutrient intakes. Measurements of height (n = 56), weight (n = 60), midarm circumference, and triceps skinfold thickness (n = 58), and 2-d weighed food records (n = 60) and demographic data were collected. Z-score results (mean +/- SD) showed that these children were tall (0.61 +/- 1.1) and heavy (1.67 +/- 1.1) for their age, and had high arm-muscle-area-for-height (geometric mean, 2.05). Over 64 and 45% of children were classified as overweight (including obesity) and obese, respectively. The percentage of energy contributed by fat in their diets met recommendations. In contrast, the percentage of energy contributed by sugar was high. The macronutrient intakes of children classified as obese (n = 32) compared with non-obese (n = 24) did not differ; however, their adjusted energy intakes were higher [5.79 (1.4) vs. 4.97 (1.4) MJ/d; P = 0.01]. Overweight and obesity were very common among very young NZ Pacific children, although the dietary etiology was not elucidated. These results emphasize the urgent need for obesity prevention for NZ Pacific children that begins early in life to avoid a future public health crisis.
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Affiliation(s)
- Andrea M Grant
- Department of Human Nutrition, University of Otago, Dunedin, NZ, USA
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Abstract
Native Americans face some of the highest rates of obesity and diabetes in the world. Despite numerous education programs to reduce obesity among Native Americans, little attention has been paid to reducing fructose, particularly in the form of high-fructose corn syrup in beverages. Considerable data indicate that energy from beverages does not displace energy from other foods throughout the day, often leading to energy imbalance, and numerous studies have documented that beverages are a leading contributor to energy intakes among Native Americans. Prevention programs that target pregnant women and parents of infants and very young children are necessary to halt the epidemic of obesity among Native Americans; one approach may be by promoting sugar-free beverages.
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Affiliation(s)
- Christopher M Wharton
- Department of Nutrition, Arizona State University, 7001 E. Williams Field Rd., Mesa, AZ 85212, USA
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Lohman T, Thompson J, Going S, Himes JH, Caballero B, Norman J, Cano S, Ring K. Indices of changes in adiposity in American Indian children. Prev Med 2003; 37:S91-6. [PMID: 14636813 DOI: 10.1016/j.ypmed.2003.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pathways, a randomized trial, evaluated the effectiveness of a school-based obesity prevention program on body composition changes in American Indian children. Several body composition methods were compared in intervention and control schools for assessing body composition changes. METHODS Body composition methods, including skinfolds, bioelectric impedance analysis (BIA), body mass index (BMI), and using a combination of body composition methods were selected to assess 3-year changes in PBF in 705 children within 21 intervention schools and 663 children within 20 control schools. The study equation using skinfolds, BIA, and BMI was developed on a previous sample of American Indian children using deuterium oxide dilution as the criterion method. RESULTS Body fat changes among methods for the intervention sample ranged from 5.4% (BMI method) to 7.1% (combination of methods) and for the control sample, from 5.8% (BMI method) to 7.3% (combination of methods). The study equation estimates were significantly higher than the other methods and the BMI equation estimates were significantly lower than the other methods except by BIA. The BIA equation showed a significantly larger standard deviation of the difference over the 3-year intervention than each of the other methods indicating less reliability for detecting body composition changes. CONCLUSIONS Within the Pathways large scale intervention trial with American Indian children, we found comparable yet significantly different mean PBF changes among methods. However, BIA was not as reliable as skinfolds and the combination of BIA, skinfolds, and body weight in assessing PBF changes.
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Affiliation(s)
- Tim Lohman
- Department of Physiology, University of Arizona, Tucson, AZ 85721, USA.
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