An in-home intervention of parent-implemented strategies to increase child vegetable intake: results from a non-randomized cluster-allocated community trial

Application of behavioral economics for understanding health behaviors among adolescents and young adults

PURPOSE OF REVIEW

Behavioral economics (BE) concepts have become well studied tools in addressing patient issues, such as weight loss, smoking cessation, and medication adherence. Although predominantly studied in adult populations, emerging literature has shown BE's utility for adolescent/young adult (AYA) populations, offering a practical framework to safeguard AYA health and influence healthy decision making.

RECENT FINDINGS

We identified substantive areas in which BE concepts have been applied in AYA populations (e.g., substance use) and outline how these concepts have been used as a tool to identify individuals at risk for poor outcomes and to leverage behavioral insights to improve health behaviors.

SUMMARY

BE research holds significant promise as a tool for clinicians and researchers to encourage healthy decision making in AYA populations. Yet, there are opportunities for BE research to expand further into current trends impacting adolescent health, such as electronic nicotine delivery systems, social media apps, and coronavirus disease 2019 vaccinations. Furthermore, the full degree of BE utility remains to be explored, as few studies demonstrate the translation of associative findings into direct interventions. Additional work is needed to formalize BE techniques into best practices that clinicians can implement in their daily practice.

Perspective: Utilizing High Amylose Wheat Flour to Increase Dietary Fiber Intake of Children and Adolescents: A Health by Stealth Approach

Children and adolescents have consistently failed to meet recommended levels of dietary fiber consumption, thus making fiber a nutrient of concern. The importance of adequate dietary fiber intake to attain a healthy diet necessitates the identification of fiber-rich and readily consumed food sources by youth. Grain-based foods derived from whole grains represent a strategic initiative to increase dietary fiber consumption and is consistent with the American diet pattern. Increased intake of foods made from whole grains have been positively associated with improved health outcomes but are also less preferred among youth compared to refined grain products, which make up the majority of their carbohydrate intake. Advances in the commercialization and availability of high amylose wheat flour, a source of resistant starch fiber, provides an opportunity to remedy the suggested acceptability issues of whole grain products indicative of sensory factors, without compromising the amount of fiber ingested. Resistant starch fiber consumption has been associated with health benefits including improved blood sugar management, improved markers of digestive and gut health, increased satiety, and a reduced inflammatory response among adults. The limited studies that indicate fiber's direct benefit among youth are largely observational, thereby necessitating the need for more controlled trials for these age groups. Replacing traditional refined wheat flour with refined high amylose wheat flour has the unique ability to increase dietary fiber consumption without compromising desired sensory and finished product characteristics and thus can help increase dietary fiber consumption in children and adolescents who struggle to meet adequate intakes of fiber.

Fiber-rich foods delivered to Low-Income Households: A feasibility study of children with prediabetes and spillover effect on their caregivers

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Vegetables and whole grains delivered weekly to households with diabetes risk.

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Children with prediabetes increased liking of whole grains and vegetables.

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Children with prediabetes increased consumption of whole grains but not vegetables.

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Adults improved health outcomes but children did not, despite being study target.

Introduction

The incidence of pediatric prediabetes and type 2 diabetes mellitus (T2DM) is increasing, with those from low socioeconomic status (SES) households at increased risk. Dietary fiber (e.g., whole grains) is shown to improve glucose control and there is need for innovative strategies that address barriers to consumption (e.g., limited availability).

Methods

Food Overcoming our Diabetes Risk (FoodRx) was a pre-post study (N = 47) that provided 16 weeks of home-delivered whole grains, vegetables, and beans/legumes to households of low-income children in [blinded for submission] who had obesity and prediabetes. Child liking and intake (24-hour diet recalls) was evaluated. Anthropometrics and T2DM-related laboratory measurements (e.g. glycated hemoglobin) were measured for children, and for caregivers to evaluate potential spillover effect.

Results

Post-intervention, children increased liking of whole grains, vegetables, and beans/legumes (P < 0.05 for all). Child whole grain intake increased from 1.7 to 2.5 oz-equivalent servings/day (P < 0.001), and the percent of total grain intake that were whole increased from 30% to 44% (P < 0.001). Children’s body mass index, blood pressure, and serum triglyceride levels increased (+14.6 mg/dl, P = 0.04). Caregivers fasting glucose (-7.5 mg/dl; P = 0.03), fasting insulin (-2.5 μIU/ml, P = 0.0009) and homeostatic model assessment for insulin resistance (HOMA-IR) decreased (-0.8, P = 0.01).

Conclusions

Home deliveries of fiber rich foods improved liking and intake among children at risk for T2DM. There was spillover effect on caregivers, who demonstrated improvement in T2DM-related laboratory measurements instead of the children.

Effectiveness of Interventions to Promote Healthy Eating Habits in Children and Adolescents at Risk of Poverty: Systematic Review and Meta-Analysis

The objective of this review was to provide an up-to-date review of trials that include behavioral intervention on the eating habits of children and adolescents at risk of poverty, applying meta-analysis to estimate the size of the intervention effect. A systematic literature search was performed in the following databases: MEDLINE via Pubmed and via EBSCOhost, LILACS and IBECS via VHL. The MeSH terms were used: "social class", "poverty", "diet", "health promotion" (PROSPERO ID: 183900). A total of 14 articles were finally included in this systematic review. The primary results of the included studies were meta-analyzed with the RevMan 5.3 program, assuming a random effects model. Analysis of the overall effect showed combined standardized mean differences (SMD) of 0.16 (CI 95%: [0.03, 0.30], I² = 76%). The p-value for the Z statistic was 0.02, which reflects accuracy in the effect estimation. When establishing subgroups based on the intervention tracking time points, studies that provided longer-term follow-up data showed a combined SMD of 0.15 (CI 95%: [-0.02, 0.32], I² = 81%]). Small effects of behavioral interventions were found to promote healthy eating habits, but better effects were shown in cases where the invention was followed up in the long term.