1
|
Saltaouras G, Kyrkili A, Bathrellou E, Georgoulis M, Yannakoulia M, Bountziouka V, Smrke U, Dimitrakopoulos G, Kontogianni MD. Associations between Meal Patterns and Risk of Overweight/Obesity in Children and Adolescents in Western Countries: A Systematic Review of Longitudinal Studies and Randomised Controlled Trials. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1100. [PMID: 39334632 PMCID: PMC11430606 DOI: 10.3390/children11091100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/30/2024] [Accepted: 09/06/2024] [Indexed: 09/30/2024]
Abstract
Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity-MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this systematic review was to explore associations between meal patterns and the risk of childhood OV/OB and MUO in children/adolescents aged 2-19 years. Longitudinal studies and randomised controlled trials from PUBMED and Scopus published between January 2013 and April 2024 were retrieved. Twenty-eight studies were included, all of which reported on OV/OB risk, with none on MUO risk. Regular consumption of breakfast (n = 3) and family meals (n = 4) and avoiding dining while watching TV (n = 4) may be protective factors against childhood OV/OB, whereas meal skipping (primarily breakfast; n = 4) may be a detrimental factor. Mixed effects of meal frequency on OV/OB risk were observed; no effects of frequency of lunch or of fast-food consumption and of meals served at school were found. There was insufficient evidence to support the role of other patterns (meal timing, eating in other social contexts). Meals were mainly participant-identified, leading to increased heterogeneity. Research focusing on childhood MUO and the use of harmonised definitions regarding the assessment of meal patterns are highly warranted.
Collapse
Affiliation(s)
- Georgios Saltaouras
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17671 Athens, Greece; (G.S.); (A.K.); (E.B.); (M.G.); (M.Y.)
| | - Athanasia Kyrkili
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17671 Athens, Greece; (G.S.); (A.K.); (E.B.); (M.G.); (M.Y.)
| | - Eirini Bathrellou
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17671 Athens, Greece; (G.S.); (A.K.); (E.B.); (M.G.); (M.Y.)
| | - Michael Georgoulis
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17671 Athens, Greece; (G.S.); (A.K.); (E.B.); (M.G.); (M.Y.)
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17671 Athens, Greece; (G.S.); (A.K.); (E.B.); (M.G.); (M.Y.)
| | - Vasiliki Bountziouka
- Computer Simulation, Genomics and Data Analysis Laboratory, Department of Food Science and Nutrition, University of the Aegean, 81400 Lemnos, Greece;
- Department of Cardiovascular Science, College of Life Science, University of Leicester, Leicester LE1 7RH, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QP, UK
- Population, Policy and Practice Research and Teaching Department, GOS Institute of Child Health, University College London, London WC1N 1EH, UK
| | - Urška Smrke
- Faculty of Electrical Engineering and Computer Science, University of Maribor, 2000 Maribor, Slovenia;
| | - George Dimitrakopoulos
- Department of Informatics and Telematics, School of Digital Technology, Harokopio University of Athens, 17671 Athens, Greece;
| | - Meropi D. Kontogianni
- Department of Nutrition and Dietetics, School of Health Sciences and Education, Harokopio University of Athens, 17671 Athens, Greece; (G.S.); (A.K.); (E.B.); (M.G.); (M.Y.)
| |
Collapse
|
2
|
Kelly NR, Guidinger C, Swan DM, Thivel D, Folger A, Luther GM, Hahn ME. A brief bout of moderate intensity physical activity improves preadolescent children's behavioral inhibition but does not change their energy intake. J Behav Med 2024; 47:692-706. [PMID: 38671287 DOI: 10.1007/s10865-024-00495-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
Children in rural communities consume more energy-dense foods relative to their urban peers. Identifying effective interventions for improving energy intake patterns are needed to address these geographic disparities. The primary aim of this study was to harness the benefits of physical activity on children's executive functioning to see if these improvements lead to acute changes in eating behaviors. In a randomized crossover design, 91 preadolescent (8-10y; M age = 9.48 ± 0.85; 50.5% female; 85.7% White, 9.9% Multiracial, 9.9% Hispanic) children (86% rural) completed a 20-minute physical activity condition (moderate intensity walking) and time-matched sedentary condition (reading and/or coloring) ~ 14 days apart. Immediately following each condition, participants completed a behavioral inhibition task and then eating behaviors (total energy intake, relative energy intake, snack intake) were measured during a multi-array buffet test meal. After adjusting for period and order effects, body fat (measured via DXA), and depressive symptoms, participants experienced significant small improvements in their behavioral inhibition following the physical activity versus sedentary condition (p = 0.04, Hedge's g = 0.198). Eating behaviors did not vary by condition, nor did improvements in behavioral inhibition function as a mediator (ps > 0.09). Thus, in preadolescent children, small improvements in behavioral inhibition from physical activity do not produce acute improvements in energy intake. Additional research is needed to clarify whether the duration and/or intensity of physical activity sessions would produce different results in this age group, and whether intervention approaches and corresponding mechanisms of change vary by individual factors, like age and degree of food cue responsivity.
Collapse
Affiliation(s)
- Nichole R Kelly
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, USA.
- The Prevention Science Institute, University of Oregon, 6217 University of Oregon, Eugene, OR, USA.
| | - Claire Guidinger
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, USA
- The Prevention Science Institute, University of Oregon, 6217 University of Oregon, Eugene, OR, USA
| | - Daniel M Swan
- The Prevention Science Institute, University of Oregon, 6217 University of Oregon, Eugene, OR, USA
| | - David Thivel
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions, Clermont Auvergne University, Clermont-Ferrand, France
| | - Austin Folger
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, USA
- The Prevention Science Institute, University of Oregon, 6217 University of Oregon, Eugene, OR, USA
| | - Gabriella M Luther
- Counseling Psychology and Human Services, University of Oregon, 1215 University of Oregon, Eugene, OR 97403, USA
- The Prevention Science Institute, University of Oregon, 6217 University of Oregon, Eugene, OR, USA
| | - Michael E Hahn
- Human Physiology, University of Oregon, 1240 University of Oregon, Eugene, OR, USA
| |
Collapse
|
3
|
Salas-González MD, Loria-Kohen V, Jiménez-Ortega AI, López-Sobaler AM. [Nutritional factors related to insulin resistance in children and adolescents]. NUTR HOSP 2023; 40:51-54. [PMID: 37929895 DOI: 10.20960/nh.04956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Introduction Insulin resistance is described as a defect in the binding of insulin to its receptor and is associated with several diseases, including obesity and type 2 diabetes. Insulin resistance has been linked to vitamin and mineral deficiencies, especially those involved in oxidative stress. The Mediterranean diet, a diet based on the Healthy Eating Index or the Dietary Approaches to Stop Hypertension (DASH) diet are dietary patterns that have been associated with a lower risk of developing insulin resistance in children. Therefore, a diet rich in antioxidant vitamins and minerals, fiber, calcium, and polyunsaturated fatty acids and low in free sugars, sodium and saturated fatty acids may decrease the risk of insulin resistance in this age group. In addition, other nutritional factors, such as avoiding fast food, eating dinner with the family, not eating while watching TV or eating a sufficient and healthy breakfast on a regular basis seem to be associated with a lower risk of insulin resistance. Therefore, it is important to establish balanced daily eating habits to prevent and treat insulin resistance in schoolchildren and adolescents.
Collapse
Affiliation(s)
- María Dolores Salas-González
- Departamento de Nutrición y Ciencia de los Alimentos. Facultad de Farmacia. Universidad Complutense de Madrid. Grupo de Investigación VALORNUT-UCM (920030)
| | - Viviana Loria-Kohen
- Departamento de Nutrición y Ciencia de los Alimentos. Facultad de Farmacia. Universidad Complutense de Madrid. Grupo de Investigación VALORNUT-UCM (920030)
| | | | - Ana M López-Sobaler
- Departamento de Nutrición y Ciencia de los Alimentos. Facultad de Farmacia. Universidad Complutense de Madrid. Grupo de Investigación VALORNUT-UCM (920030). IdISSC
| |
Collapse
|
4
|
Salas-González MD, Lozano-Estevan MDC, Aparicio A, Bermejo LM, Loria-Kohen V, Ortega RM, López-Sobaler AM. Breakfast Quality and Insulin Resistance in Spanish Schoolchildren: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1181. [PMID: 36673935 PMCID: PMC9859171 DOI: 10.3390/ijerph20021181] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/02/2023] [Accepted: 01/06/2023] [Indexed: 06/01/2023]
Abstract
Background: Breakfast has traditionally been considered one of the most important meals of the day; however, there is little evidence for the influence of breakfast quality and insulin resistance (IR). This study aimed to assess the quality of breakfast in a group of schoolchildren, and its association with IR. Methods: A cross-sectional study with 852 children (8−13 years) was carried out. Fasting plasma glucose, insulin and anthropometric parameters were measured. A three-day dietary record was used to assess their diet and to calculate the Breakfast Quality Index (BQI). The sample was divided into tertiles according to the BQI (tertile 3: better breakfast quality). The homeostatic model was used to assess insulin resistance (HOMA-IR), and IR was defined as HOMA-IR > 3.16. Results: The prevalence of IR was 5.2%. The mean BQI score was 4.50 ± 1.25, and boys had lower scores than girls. Children in the BQI tertile 3 had a better global diet quality. In boys, being in the BQI tertile 3 was associated with a lower risk of IR (OR [95% CI]: 0.10 [0.01−0.77], p < 0.05). Conclusions: A higher-quality breakfast was associated with better overall diet quality and a lower risk of IR, especially in boys.
Collapse
Affiliation(s)
- María Dolores Salas-González
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
| | - María del Carmen Lozano-Estevan
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
| | - Aránzazu Aparicio
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
- IdISSC, 28040 Madrid, Spain
| | - Laura M. Bermejo
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
- IdISSC, 28040 Madrid, Spain
| | - Viviana Loria-Kohen
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
| | - Rosa M. Ortega
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
- IdISSC, 28040 Madrid, Spain
| | - Ana M. López-Sobaler
- VALORNUT Research Group, Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, 28040 Madrid, Spain
- IdISSC, 28040 Madrid, Spain
| |
Collapse
|
5
|
McGovern C, Rifas-Shiman SL, Switkowski KM, Woo Baidal JA, Lightdale JR, Hivert MF, Oken E, Aris IM. Association of cow's milk intake in early childhood with adiposity and cardiometabolic risk in early adolescence. Am J Clin Nutr 2022; 116:561-571. [PMID: 35441227 PMCID: PMC9348987 DOI: 10.1093/ajcn/nqac103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/05/2022] [Accepted: 04/12/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prior studies have provided conflicting evidence regarding associations of pediatric milk consumption with subsequent adiposity. OBJECTIVES We aimed to estimate associations of the consumption frequency and fat content of early childhood milk intake with early adolescent adiposity and cardiometabolic risk. METHODS We analyzed data collected prospectively from 796 children in Project Viva, a Boston-area prebirth cohort. Parents reported the frequency (times/day) and fat content [higher-fat: whole (3.25%) or 2% milk; lower-fat: 1% or skim milk] of cow's milk consumed in early childhood (mean, 3.2 years) via food-frequency questionnaires. We measured adiposity and cardiometabolic markers in early adolescence (mean, 13.2 years) and conducted multivariable regressions to assess associations adjusted for baseline parental and child sociodemographic, anthropometric, and dietary factors. RESULTS In early childhood, mean milk intake was 2.3 times/day (SD, 1.2 times/day), and 63% of children drank primarily higher-fat milk. The early childhood BMI z-score (BMIz) was inversely associated with the fat content of milk consumed in early childhood. After adjustment for baseline parent and child factors, early childhood intake of higher-fat compared with lower-fat milk was associated with lower adiposity; however, the 95% CIs for most adiposity outcomes-except for the odds of overweight or obesity (OR, 0.60; 95% CI, 0.38-0.93)-crossed the null after adjustment for the baseline child BMIz and BMIz change between ages 2 and 3 years. Early childhood consumption of higher-fat milk (compared with lower-fat milk) was not associated with adverse cardiometabolic outcomes. The frequency of cow's milk consumption in early childhood was not associated with adiposity or cardiometabolic risk in early adolescence. CONCLUSIONS Consumption of higher-fat cow's milk in early childhood was not associated with increased adiposity or adverse cardiometabolic health over a decade later. Our findings do not support current recommendations to consume lower-fat milk to reduce the risk of later obesity and adverse cardiometabolic outcomes. This trial was registered at clinicaltrials.gov as NCT02820402.
Collapse
Affiliation(s)
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Karen M Switkowski
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Jennifer A Woo Baidal
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Columbia University Irving Medical Center, New York, NY, USA
| | - Jenifer R Lightdale
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Diabetes Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- Department of Nutrition, Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| |
Collapse
|
6
|
Monzon AD, Patton SR, Koren D. Childhood diabetes and sleep. Pediatr Pulmonol 2022; 57:1835-1850. [PMID: 34506691 DOI: 10.1002/ppul.25651] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/18/2021] [Accepted: 08/26/2021] [Indexed: 12/18/2022]
Abstract
Sleep modulates glucose metabolism, both in healthy states and in disease. Alterations in sleep duration (insufficient and excessive) and obstructive sleep apnea may have reciprocal ties with obesity, insulin resistance and Type 2 diabetes, as demonstrated by emerging evidence in children and adolescents. Type 1 diabetes is also associated with sleep disturbances due to the influence of wide glycemic fluctuations upon sleep architecture, the need to treat nocturnal hypoglycemia, and the need for glucose monitoring and insulin delivery technologies. In this article, we provide an extensive and critical review on published pediatric literature regarding these topics, reviewing both epidemiologic and qualitative data, and provide an overview of the pathophysiology linking sleep with disorders of glucose homeostasis.
Collapse
Affiliation(s)
- Alexandra D Monzon
- Department of Psychology and Applied Behavioral Science, Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA
| | - Susana R Patton
- Department of Biomedical Research, Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, Florida, USA
| | - Dorit Koren
- Department of Pediatrics, Pediatric Endocrinology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
7
|
Family Social Support and Weight-Related Behaviors of School-Age Children: An Exploratory Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148501. [PMID: 35886352 PMCID: PMC9318999 DOI: 10.3390/ijerph19148501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/04/2022] [Accepted: 07/09/2022] [Indexed: 01/27/2023]
Abstract
Families are a key provider of support that may encourage positive weight-related behaviors. Yet little is known about the relation of family support to children’s performance of weight-related behaviors. Mothers (N = 524) who completed an online survey were categorized as having low, moderate, or high family support for fruit/vegetable intake, breakfast intake, limiting sugar-sweetened beverage intake, physical activity, limiting sedentary screentime, and sleep. ANOVA revealed that children in families with high support for breakfast ate this meal significantly more often. Additionally, children in families with low support for limiting sugar-sweetened beverages had significantly greater intake. Surprisingly, families with moderate support for physical activity and sleep tended to have children with lower physical activity level, sleep duration, and sleep quality, and fewer days/week with set bedtimes than those with low and high support. Binomial logistic regression revealed that high family support for eating breakfast, limiting sugar-sweetened beverages, and getting sufficient sleep had greater odds of meeting recommendations for these behaviors. Findings suggest that greater family support for healthy weight-related behaviors tends to be associated with children’s performance of these behaviors. Future interventions should further examine the impact of different types of family support on weight-related behaviors to better understand this complex interplay.
Collapse
|
8
|
Abstract
One of the top chronic diseases in the United States is pediatric obesity. As such, many pediatricians will have conversations with patients and families regarding the health effects of this disease process. This article will provide a broad overview of many of the popular diets as well as evidence for their effectiveness. Lastly, recommendations for healthy eating and nutritional counseling with patients and families will be discussed. [Pediatr Ann. 2022;51(3):e88-e92.].
Collapse
|
9
|
Kracht CL, Wilburn JG, Broyles ST, Katzmarzyk PT, Staiano AE. Association of Night-Time Screen-Viewing with Adolescents' Diet, Sleep, Weight Status, and Adiposity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020954. [PMID: 35055781 PMCID: PMC8775933 DOI: 10.3390/ijerph19020954] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 02/07/2023]
Abstract
Night-time screen-viewing (SV) contributes to inadequate sleep and poor diet, and subsequently excess weight. Adolescents may use many devices at night, which can provide additional night-time SV. Purpose: To identify night-time SV patterns, and describe differences in diet, sleep, weight status, and adiposity between patterns in a cross-sectional and longitudinal manner. Methods: Adolescents (10–16 y) reported devices they viewed at night and completed food recalls. Accelerometry, anthropometrics, and imaging were conducted to measure sleep, weight status, and adiposity, respectively. Latent class analysis was performed to identify night-time SV clusters. Linear regression analysis was used to examine associations between clusters with diet, sleep, weight status, and adiposity. Results: Amongst 273 adolescents (12.5 ± 1.9 y, 54% female, 59% White), four clusters were identified: no SV (36%), primarily cellphone (32%), TV and portable devices (TV+PDs, 17%), and multiple PDs (17%). Most differences in sleep and adiposity were attenuated after adjustment for covariates. The TV+PDs cluster had a higher waist circumference than the no SV cluster in cross-sectional analysis. In longitudinal analysis, the primarily cellphone cluster had less change in waist circumference compared to the no SV cluster. Conclusions: Directing efforts towards reducing night-time SV, especially TV and PDs, may promote healthy development.
Collapse
|
10
|
Strączek K, Horodnicka-Józwa A, Szmit-Domagalska J, Jackowski T, Safranow K, Petriczko E, Walczak M. Familial dietary intervention in children with excess body weight and its impact on eating habits, anthropometric and biochemical parameters. Front Endocrinol (Lausanne) 2022; 13:1034148. [PMID: 36531483 PMCID: PMC9751449 DOI: 10.3389/fendo.2022.1034148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/04/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Obesity is considered a civilisation disease which increases mortality and impairs quality of life, also among children and adolescents. The prevalence of overweight and obesity is steadily increasing in the developmental age population. Environmental factors are responsible for the main reason of excessive adipose tissue accumulation. Among these, poor eating habits and lack of exercise play the largest role. Familial prevalence of obesity and family dietary patterns also receive significant attention. Many specialists believe that the treatment of obesity should be multidirectional, effective and minimally invasive. Therefore, effective and safe methods are being investigated to effectively reduce body weight and improve eating habits. Dietary education programmes are an alternative to improve the health status of obese and overweight children and adolescents. To be fully effective, these programmes should involve the whole family. AIM OF THE STUDY In the face of constantly increasing prevalence of overweight and obesity in the developmental age population and the lack of effective methods to combat its occurrence, it seems appropriate to try to assess the effectiveness of a one-year-long dietary education of children and adolescents with excess body weight on their eating habits and the eating habits of their mothers, as well as selected anthropometric and biochemical parameters in these children using a simple educational tool, the Healthy Food Pyramid. PATIENTS AND METHODS The study group consisted of 68 children with overweight and obesity, patients of the Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age of the Pomeranian Medical University in Szczecin. The study used a proprietary questionnaire to assess dietary habits. Patients participated in six individual educational meetings over a twelve-month period. Eating habits were assessed in children and mothers before and after dietary intervention. Sixty-seven questionnaires before and after the dietary intervention were used for analysis. RESULTS Sixty-eight children completed the study. Those who did not complete the study came from families living in rural areas and their mothers mostly had primary or vocational education. One-year dietary education resulted in significant improvements in body weight, waist and hip circumference, WHtR and selected measured carbohydrate and lipid metabolism parameters with the exception of total cholesterol. The one-year dietary intervention did not have the same effect on the change in dietary habits in children and in their mothers.
Collapse
Affiliation(s)
- Kamilla Strączek
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
- *Correspondence: Kamilla Strączek,
| | - Anita Horodnicka-Józwa
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Justyna Szmit-Domagalska
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Jackowski
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Poland
| | - Elżbieta Petriczko
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| | - Mieczysław Walczak
- Department of Paediatrics, Endocrinology, Diabetology, Metabolic Diseases and Cardiology of the Developmental Age, Pomeranian Medical University, Szczecin, Poland
| |
Collapse
|
11
|
Patel SM, Sisson SB, Stephens HA, Williams BD, Hoffman LA, Salvatore AL. Family Child Care Providers' Nutrition Practices and Policies: Happy Healthy Homes. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:1066-1071. [PMID: 34635431 PMCID: PMC8671233 DOI: 10.1016/j.jneb.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Determine the impact of family child care home providers' nutrition knowledge, confidence, and perceived barriers on program nutrition best practices and written nutrition policies. METHODS Cross-sectional analysis of self-reported surveys of 49 female providers in Oklahoma City analyzed with Spearman correlation, multivariate linear and logistic regression (α < 0.05). RESULTS Confidence and barriers were significantly correlated (rs(47) = -0.4, P = 0.004). Independent variables explained 36% of practices (r2 = 0.357). Nutrition knowledge (standard β = 0.442, P = 0.001) and confidence (standard β = 0.358, P = 0.008) were significantly associated with practices; barriers were not. No significant association between independent variables and written policies resulted. CONCLUSIONS AND IMPLICATIONS Provider nutrition knowledge and confidence appear to be suitable targets to improve nutrition practices. Further research can evaluate possible influences on the presence and quality of family child care home written nutrition policies and specific nutrition policy topics associated with healthier nutrition practices.
Collapse
Affiliation(s)
- Sarah M Patel
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Susan B Sisson
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
| | - Holly A Stephens
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Bethany D Williams
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Department of Nutrition and Exercise Physiology, Washington State University Health Sciences Spokane, Spokane, WA
| | - Leah A Hoffman
- Department of Nutritional Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Alicia L Salvatore
- Department of Health Promotion Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, OK; Institute for Research on Equity and Community Health (iREACH), Christiana Care Health System, Wilmington, DE
| |
Collapse
|
12
|
Holmes JF, St. Laurent CW, Spencer RMC. Unhealthy Diet Is Associated With Poor Sleep in Preschool-Aged Children. J Genet Psychol 2021; 182:289-303. [PMID: 33876710 PMCID: PMC8764816 DOI: 10.1080/00221325.2021.1905598] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
Unhealthy dietary choices are associated with poor sleep in children through adults. Yet, how diet and sleep are related in early childhood, when diet is reliant on parent choices around food availability, is unknown. The authors aimed to explore how frequency of fruit, vegetable, fast food, and soda consumption are associated with preschool children's sleep quality. They also considered how parenting factors may impact the relationship between children's sleep and diet. Actigraphy data were collected from 383 children 33-70 months old. Caregivers reported on child food and beverage frequency, demographics, and health items. Parenting strategies were assessed using the Parenting Scale. Multiple linear regression was used to examine associations between sleep and dietary measures with socioeconomic status, race-ethnicity, physical activity, and body mass index as covariates. Shorter nap duration was associated with more frequent consumption of fruits and vegetables (B = -3.6, p = .03). Shorter nighttime and 24-hr sleep durations were associated with more frequent consumption of fast food (B = -6.5, p = .01; B = -5.8, p = .01). Shorter nighttime sleep and later sleep onset were associated with more frequent soda consumption (B = -9.2, p = .01; B = 0.23, p = .001). Use of ineffective parenting strategies was negatively associated with fruit and vegetable consumption (r = -.29, p = .01) and positively associated with soda consumption (r = .25, p = .02) but was unrelated to sleep measures. Thus, ineffective parenting strategies may underlie child access to unhealthy foods, which, in turn, contributes to poor sleep. Encouraging healthier dietary habits and educating caregivers on how to reinforce such practices may lead to better sleep outcomes in early childhood.
Collapse
Affiliation(s)
- Jennifer F. Holmes
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst
| | | | - Rebecca M. C. Spencer
- Department of Psychological & Brain Sciences, University of Massachusetts, Amherst
- Neuroscience & Behavior Program, University of Massachusetts, Amherst
- Institute for Applied Life Sciences, University of Massachusetts, Amherst
| |
Collapse
|
13
|
Periyathambi N, Sukumar N, Weldeselassie Y, Saravanan P. Impact of maternal HbA 1c on offspring glucose at 4-7 years of age: role of childhood adiposity and other potential confounders. Diabetologia 2021; 64:1447-1448. [PMID: 33754157 DOI: 10.1007/s00125-021-05433-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Nishanthi Periyathambi
- Population, Evidence and Technologies, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Nithya Sukumar
- Population, Evidence and Technologies, Division of Health Sciences, University of Warwick, Coventry, UK
- Academic Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton, UK
| | - Yonas Weldeselassie
- Population, Evidence and Technologies, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ponnusamy Saravanan
- Population, Evidence and Technologies, Division of Health Sciences, University of Warwick, Coventry, UK.
- Academic Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton, UK.
| |
Collapse
|
14
|
Alkhalidy H, Orabi A, Alzboun T, Alnaser K, Al-Shami I, Al-Bayyari N. Health-Risk Behaviors and Dietary Patterns Among Jordanian College Students: A Pilot Study. Front Nutr 2021; 8:632035. [PMID: 34055850 PMCID: PMC8160432 DOI: 10.3389/fnut.2021.632035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/19/2021] [Indexed: 12/31/2022] Open
Abstract
Background/Aims: Health promotion and the incorporation of health-protective behaviors in people's lifestyles have a great role in enhancing individuals' overall health and well-being. College students are at increased risk of developing unhealthy dietary and lifestyle behaviors. A cross-sectional pilot study was conducted to assess the health-risk behaviors among undergraduate college students at Jordan University of Science and Technology. Methods: The final sample included 136 students, with a mean age of 21.1 ± 2.37 years, mostly females (69%). A self-reported questionnaire was used for data collection about dietary and lifestyle behaviors among college students. The questionnaire consisted of four parts: sociodemographic characteristics, body weight classifications, lifestyle behaviors, and dietary patterns and intake, and eating behaviors. Results: Most of the students did not meet the daily recommendations for fruit (76%) and vegetable (82%) intake. Males were significantly consuming fast food more frequently (p = 0.019), and smoked cigarettes (p < 0.001) or hookah (p = 0.015) more frequently than did females. Further, the majority met the recommendations for physical activity (81%), but exceeded recommendations for sedentary behavior. Females were more likely to have normal weight or be underweight (OR = 4.865), to have a fear of weight gain (OR = 3.387), and to have the recommended sleeping hours (OR = 7.685) than were males. Conclusion: The results indicate the health-risk behaviors and the gender-related differences among college students.
Collapse
Affiliation(s)
- Hana Alkhalidy
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Aliaa Orabi
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Tamara Alzboun
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Khadeejah Alnaser
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid, Jordan
| | - Islam Al-Shami
- Department of Clinical Nutrition and Dietetics, Faculty of Allied Health Science, The Hashemite University, Zarqa, Jordan
| | - Nahla Al-Bayyari
- Department of Nutrition and Food Technology, Faculty of Al-Huson University College, Al-Balqa Applied University, Al-Salt, Jordan
| |
Collapse
|
15
|
Siqueira de Andrade MI, Oliveira JS, Leal VS, Cabral PC, de Lira PIC. Independent predictors of insulin resistance in Brazilian adolescents: Results of the study of cardiovascular risk in adolescents-Brazil. PLoS One 2021; 16:e0246445. [PMID: 33561171 PMCID: PMC7872259 DOI: 10.1371/journal.pone.0246445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 01/19/2021] [Indexed: 12/16/2022] Open
Abstract
Considering the current changes in dietary patterns and the increasing prevalence of excess weight throughout the world, several studies have reported insulin resistance, which is a key driver of many chronic diseases, to be an important public health problem in all age groups. Therefore, the aim of the present study was to identify the prevalence and independent predictors of insulin resistance in Brazilian adolescents. A cross-sectional study was conducted with a probabilistic, representative sample of Brazilian adolescents (n = 37,023) who participated in the Study of Cardiovascular Risk in Adolescents. Data were collected on demographic, socioeconomic, lifestyle, anthropometric, and biochemical characteristics as well as antioxidant micronutrient intake (vitamins A, C, E, zinc, and selenium). Insulin resistance was determined using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and classified based on the 75th percentile of the sample distribution. Insulin resistance was detected in 27% of the adolescents and was more prevalent among those aged 12 to 14 years (PR: 1.26 [95%CI: 1.13;1.41]), those residing in the southern and south-eastern regions of the country (PR: 1.47 [95%CI: 1.27;1.70]), those who were physically inactive (PR: 1.12 [95%CI: 1.02;1.23]), and those did not consume alcohol (PR: 1.50 [95%CI: 1.13;1.99]). The prevalence of insulin resistance was 2.5-fold higher among individuals with severe obesity (PR: 2.49 [95%CI: 2.07;3.00]). Waist circumference indicative of cardiovascular risk and high serum triglyceride levels increased the likelihood of insulin resistance (PR: 1.37 [95%CI: 1.19;1.59] and 1.60 [95%CI: 1.45;1.78], respectively). The prevalence of the outcome was higher among adolescents in the lower quartiles of vitamin E intake (p<0.05). In the present study, the prevalence of insulin resistance was high among Brazilian adolescents and we identified sociodemographic, lifestyle, anthropometric, biochemical, and dietary predictors of this outcome.
Collapse
Affiliation(s)
| | - Juliana Souza Oliveira
- Departamento de Nutrição, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
- Núcleo de Nutrição, Centro Acadêmico de Vitória, Universidade Federal de Pernambuco, Vitória de Santo Antão, Pernambuco, Brazil
| | - Vanessa Sá Leal
- Departamento de Nutrição, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
- Núcleo de Nutrição, Centro Acadêmico de Vitória, Universidade Federal de Pernambuco, Vitória de Santo Antão, Pernambuco, Brazil
| | - Poliana Coelho Cabral
- Departamento de Nutrição, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | |
Collapse
|
16
|
[Role of breakfast and its quality in the health of children and adolescents in Spain]. NUTR HOSP 2021; 38:396-409. [PMID: 33724048 DOI: 10.20960/nh.03398] [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: 11/02/2022] Open
Abstract
Introduction Eating breakfast is a healthy habit that should be encouraged since childhood. When it provides nutritional quality, it is an important daily meal. The consumption of dairy products, cereals, and fruits at breakfast is associated with healthier dietary patterns, with a beneficial impact on the overall quality of the diet. In Spain, as in many other countries, the proportion of children who eat breakfast daily is very high, decreasing somewhat in adolescence. However, the quality of breakfast leaves room for improvement, with a low proportion of children/adolescents with high nutritional quality breakfasts. Children/adolescents who eat breakfast regularly have a higher intake of various nutrients (especially vitamins and minerals) than those who do not eat breakfast. Although the evidence is not entirely conclusive, numerous studies have shown various benefits when comparing the population that eats breakfast regularly versus those who do not, such as cardiometabolic risk parameters (obesity, diabetes, blood pressure and lipid profile) and cognitive functions. Breakfast should be included in healthy eating plans, since it allows incorporating foods that are difficult to consume in other meals and may contribute to reducing the risk of developing cardiometabolic diseases. In order to promote the intake of a healthy breakfast, it is essential to act on the sociodemographic and cultural factors that influence compliance and quality, such as age, nutritional education (mainly parents and children/adolescents, but also other family members, school mates, friends...), carrying it out as a family, adapting it to the tastes of each population and balancing quality and costs.
Collapse
|
17
|
Facilitators and barriers to healthy food selection at children's sports arenas in Norway: a qualitative study among club managers and parents. Public Health Nutr 2020; 24:1552-1558. [PMID: 33040764 PMCID: PMC8025096 DOI: 10.1017/s1368980020003985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To investigate club managers’ and parents’ experiences with food selection at handball halls in order to identify facilitators and barriers to the availability of healthy food. Design: Individual interviews with club managers (n 6) and focus groups (n 5) with parents (n 21) were conducted. Interviews were recorded and transcribed verbatim, transcripts were coded in NVivo and the analysis was guided by thematic analysis. Setting: Interviews were conducted at five handball clubs with varying socio-economic user populations and sizes in the area of Oslo, Norway. Participants: The club managers were responsible for food selection at the handball clubs. The participating parents had one or two active children between the ages of 6 and 12 years who took part in the clubs. Results: The club managers and parents generally described food selection at the handball halls as unhealthy and wanted a healthier selection of food. The club managers’ primary barriers to providing a healthier food selection included the potential to lose profits, limited facilities and time to prepare these foods. The parents often valued unhealthy food, as they believed that it supported the social environment and served as a reward for the children. Trainers were perceived as important role models for the promotion of healthy eating. The participants thought that national guidelines could facilitate healthy food environments in sports arenas. Conclusion: Healthier food options in sports settings could be facilitated through national guidelines that describe healthy foods and establish who is responsible for providing healthy food selections.
Collapse
|
18
|
Jimenez MP, Oken E, Gold DR, Luttmann-Gibson H, Requia WJ, Rifas-Shiman SL, Gingras V, Hivert MF, Rimm EB, James P. Early life exposure to green space and insulin resistance: An assessment from infancy to early adolescence. ENVIRONMENT INTERNATIONAL 2020; 142:105849. [PMID: 32593049 PMCID: PMC7784302 DOI: 10.1016/j.envint.2020.105849] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 05/13/2023]
Abstract
BACKGROUND Recent studies suggest that greater exposure to natural vegetation, or "green space" is associated with lower diabetes risk, possibly through increasing physical activity. However, there is limited research on green space and insulin resistance in youth. We hypothesized greater green space at early-life sensitive time periods would be associated with lower insulin resistance in youth. METHODS We used data from Project Viva (N = 460), a pre-birth cohort study that recruited pregnant women in eastern Massachusetts, 1999-2002, and followed offspring into adolescence. We defined residential green space exposure at infancy (median age - 1.1 years), early childhood (3.2 years), mid-childhood (7.7 years), and early adolescence (12.8 years), using 30 m resolution Landsat satellite imagery to estimate the Normalized Difference Vegetation Index [NDVI]. Our main outcome was early adolescence estimated insulin resistance (HOMA-IR). We used multiple imputation to account for missing data and multiple linear regression models adjusted for age, sex, race/ethnicity, parental education, household income, and neighborhood median household income. RESULTS The highest green space tertile had the highest percentage of white participants (85%), college-educated mothers (87%) and fathers (85%), and households with income higher than US$70,000 (86%). Unadjusted models showed that participants living in the highest green space tertile at infancy had a 0.15 unit lower HOMA-IR (95% CI: -0.23, -0.06) in early adolescence, than those living in the lowest tertile. However, in adjusted models, we did not observe evidence of associations between green space from infancy to early adolescence and HOMA-IR in early adolescence, although some point estimates were in the hypothesized direction. For example, participants in the highest green space tertile in infancy had 0.03 units lower HOMA-IR (95%CI: -0.14, 0.08) than those living in the lowest tertile. CONCLUSIONS Exposure to green space at early life sensitive time periods was not associated with HOMA-IR in youth. Early-life longitudinal studies across diverse populations are needed to confirm or refute our results.
Collapse
Affiliation(s)
- Marcia P Jimenez
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Diane R Gold
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Heike Luttmann-Gibson
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Weeberb J Requia
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Sheryl L Rifas-Shiman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Veronique Gingras
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Marie-France Hivert
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Eric B Rimm
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Peter James
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
19
|
Gallagher D, Andres A, Fields DA, Evans WJ, Kuczmarski R, Lowe WL, Lumeng JC, Oken E, Shepherd JA, Sun S, Heymsfield SB. Body Composition Measurements from Birth through 5 Years: Challenges, Gaps, and Existing & Emerging Technologies-A National Institutes of Health workshop. Obes Rev 2020; 21:e13033. [PMID: 32314544 PMCID: PMC7875319 DOI: 10.1111/obr.13033] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 12/14/2022]
Abstract
Body composition estimates are widely used in clinical research and field studies as measures of energy-nutrient balance, functionality and health. Despite their broad relevance and multiple applications, important gaps remain in techniques available for accurately and precisely quantifying body composition in infants and children from birth through 5 years. Identifying these gaps and highlighting research needs in this age group were the topics of a National Institutes of Health workshop held in Bethesda, MD, USA, 30-31 May 2019. Experts reviewed available methods (multicompartment models, air-displacement plethysmography, dual-energy X-ray absorptiometry, weight-length and height indices, bioimpedance analysis, anthropometry-skinfold techniques, quantitative magnetic resonance, optical imaging, omics and D3-creatine dilution), their limitations in this age range and high priority research needs. A summary of their individual and collective workshop deliberations is provided in this report.
Collapse
Affiliation(s)
- Dympna Gallagher
- New York Obesity Research Center, Division of Endocrinology, Dept. of Medicine, Columbia University Irving Medical Center, New York, New York, USA.,Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Aline Andres
- Arkansas Children's Nutrition Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - David A Fields
- Department of Pediatrics, Division of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - William J Evans
- Nutritional Sciences and Toxicology, University of California, Berkeley, California, USA
| | - Robert Kuczmarski
- Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - William L Lowe
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Julie C Lumeng
- Department of Pediatrics, Medical School, Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - John A Shepherd
- Department of Epidemiology and Population Sciences, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
| | - Shumei Sun
- Department of Pediatrics, Medical School, Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Steven B Heymsfield
- Pennington Biomedical Research Center, LSU System, Baton Rouge, Louisiana, USA
| |
Collapse
|
20
|
Nutritional problems in childhood and adolescence: a narrative review of identified disparities. Nutr Res Rev 2020; 34:17-47. [PMID: 32329426 DOI: 10.1017/s095442242000013x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To inform programmes and policies that promote health equity, it is essential to monitor the distribution of nutritional problems among young individuals. Common nutritional problems include overall low diet quality, the underconsumption and overconsumption of certain dietary components, unhealthy meal and snack patterns, problematic feeding practices and disordered eating. The objective of the present narrative review was to summarise recent evidence of disparities among US children (2-19 years) according to age, sex, socio-economic status, ethnicity/race and rural-urban location. Searches in PubMed® and MEDLINE® were completed to identify peer-reviewed research studies published between January 2009 and January 2019. Findings from the ninety-nine reviewed studies indicate adolescent females, young individuals from lower socio-economic households and individuals who identify as non-Hispanic Black race are particularly vulnerable populations for whom targeted strategies should be developed to address evidence of increased risk with regards to multiple aspects of nutritional wellbeing. Limitations of the existing evidence relate to the accuracy of self-reported dietary data; the need for consistent definitions of disordered eating; the focus on individual dietary components v. patterns; the complexities of categorising socio-economic status, ethnicity/race, and rural and urban areas; and the cross-sectional, observational nature of most research designs. There is an urgent need for research to address these limitations and fill a large gap in evidence on rural-urban differences in nutritional problems. It will further be important for future studies to build greater understanding of how nutritional problems cluster among population groups.
Collapse
|
21
|
Emond JA, Longacre MR, Titus LJ, Hendricks K, Drake KM, Carroll JE, Cleveland LP, Dalton MA. Fast food intake and excess weight gain over a 1-year period among preschool-age children. Pediatr Obes 2020; 15:e12602. [PMID: 32003947 PMCID: PMC7262320 DOI: 10.1111/ijpo.12602] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 10/20/2019] [Accepted: 11/18/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Fast food is cross-sectionally associated with having overweight and obesity in young children. OBJECTIVES To examine whether fast food intake independently contributes to the development of overweight and obesity among preschool-age children. METHODS Prospective cohort of 3- to 5-year-old children (n = 541) followed for 1 year. Children's height and weight were objectively measured at baseline and study end. Parents reported their child's fast food intake frequency in the past week from 11 chain fast food restaurants in six online follow-up surveys, completed approximately 8 weeks apart. Poisson regression with robust standard errors modelled the risk of a child increasing in weight status (ie, transitioning from a having a healthy weight to having overweight or from having overweight to having obesity) over the study period in relation to their average weekly fast food intake, adjusted for sociodemographics, child obesogenic behaviours, and parent weight status. RESULTS At baseline, 18.1% of children had overweight and 9.8% had obesity; 8.1% of children transitioned to a greater weight status over the 1-year period. Mean fast food intake frequency among consumers was 2.1 (SD: 1.4) times per week. The risk of increasing in weight status increased linearly with each additional time fast food was consumed in an average week over the study year (RR: 1.38; 95% CI, 1.13-1.67; P < .01). CONCLUSIONS Greater fast food intake over 1 year was associated with increasing weight status during that time in this preschool-age cohort.
Collapse
Affiliation(s)
- Jennifer A. Emond
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Meghan R. Longacre
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Linda J. Titus
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Department of Epidemiology, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Kristy Hendricks
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Keith M. Drake
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Jennifer E. Carroll
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Lauren P. Cleveland
- Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard School of Medicine, Boston, Massachusetts
| | - Madeline A. Dalton
- Department of Biomedical Data Sciences, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Department of Pediatrics, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| |
Collapse
|
22
|
Obesogenic Lifestyle and Its Influence on Adiposity in Children and Adolescents, Evidence from Mexico. Nutrients 2020; 12:nu12030819. [PMID: 32204522 PMCID: PMC7146202 DOI: 10.3390/nu12030819] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 12/16/2022] Open
Abstract
Overweight (OW) and obesity (OB) during childhood/adolescence are major public health problems in Mexico. Several obesogenic lifestyle (OL) risk factors have been identified, but the burden and consequences of them in Mexican children/adolescents remain unclear. The objective of this study was to estimate the prevalence of OL components and describe their relationships with adiposity, and OW/OB. A population-based cross-sectional study of Mexican children/adolescents with nutritional assessment, data collection on daily habits and adiposity as fat-mass index (FMI) by dual-energy X-ray absorptiometry was performed. Individual OL-components: “inactivity,” “excessive screen time,” “insufficient sleep,” “unhealthy-diet”, were defined according to non-adherence to previously published healthy recommendations. Results: 1449 subjects were assessed between March 2015 to April 2018. Sixteen percent of subjects had all four OL-components, 40% had three, 35% had two, 9% had one, and 0.5% had none. A cumulative OL score showed a significant dose–response effect with FMI. The combination of inactivity, excessive screen time, and insufficient sleep showed the highest risk association to OW/OB and higher values of FMI. Conclusions: The prevalence of OL-components was extremely high and associated with increased adiposity and OW/OB. Several interventions are needed to revert this major public health threat.
Collapse
|
23
|
Stahlmann K, Hebestreit A, DeHenauw S, Hunsberger M, Kaprio J, Lissner L, Molnár D, Ayala-Marín AM, Reisch LA, Russo P, Tornaritis M, Veidebaum T, Pohlabeln H, Bogl LH. A cross-sectional study of obesogenic behaviours and family rules according to family structure in European children. Int J Behav Nutr Phys Act 2020; 17:32. [PMID: 32138743 PMCID: PMC7059256 DOI: 10.1186/s12966-020-00939-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/21/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND There has been an increase in children growing up in non-traditional families, such as single-parent and blended families. Children from such families have a higher prevalence of obesity and poorer health outcomes, but research on the relationship with obesogenic behaviours is limited. OBJECTIVES Therefore, the aim of this study was to investigate whether there are associations between family structures and obesogenic behaviours and related family rules in European children and adolescents. METHODS The sample included 7664 children (mean age ± SD: 10.9 ± 2.9) from 4923 families who were participants of the multi-centre I.Family study (2013/2014) conducted in 8 European countries. Family structure was assessed by a detailed interview on kinship and household. Obesogenic behaviours (screen time, sleep duration, consumption of sugar-sweetened beverages (SSBs)) and family rules (rules for computer and television, bedtime routine, availability of SSBs during meals) were determined by standardized questionnaires. Multilevel mixed-effects linear and logistic regression models were used to model the associations of family structure with obesogenic behaviours and family rules. Sex, age, parental education level, number of children and adults in the household and BMI z-score were covariates in the models. Two-parent biological families were set as the reference category. RESULTS Children from single-parent families were less likely to have family rules regarding screen time (OR: 0.62, 95% CI: 0.40-0.94, p = 0.026) with higher reported hours of screen time per week (β = 2.70 h/week, 95% CI: 1.39-4.00, p < 0.001). The frequency of weekly SSB consumption differed by family structure in a sex-specific manner: girls from single-parent (β = 3.19 frequency/week, 95% CI: 0.91-5.47, p = 0.006) and boys from blended/adoptive families (β = 3.01 frequency/week, 95% CI: 0.99-5.03, p = 0.004) consumed more SSBs. Sleep duration, bedtime routines and availability of SSBs during meals did not differ between children from these family structures. Parental education did not modify any of these associations. CONCLUSIONS Parents in non-traditional family structures appear to experience more difficulties in restricting screen time and the intake of SSBs in their children than parents in traditional two-parent family structures. Our findings therefore suggest that additional support and effective strategies for parents in non-traditional families may help to reduce obesogenic behaviours in children from such family types.
Collapse
Affiliation(s)
- Katharina Stahlmann
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Antje Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Monica Hunsberger
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jaakko Kaprio
- Institute of Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dénes Molnár
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Alelí M Ayala-Marín
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Lucia A Reisch
- Department of Management, Society and Communication, Copenhagen Business School, Frederiksberg, Denmark
| | - Paola Russo
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | | | - Toomas Veidebaum
- Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia
| | - Hermann Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Leonie H Bogl
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
- Institute of Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland.
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
24
|
Tombeau Cost K, Korczak D, Charach A, Birken C, Maguire JL, Parkin PC, Szatmari P. Association of Parental and Contextual Stressors With Child Screen Exposure and Child Screen Exposure Combined With Feeding. JAMA Netw Open 2020; 3:e1920557. [PMID: 32022883 DOI: 10.1001/jamanetworkopen.2019.20557] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Parents may use screen exposure or screen exposure combined with feeding for infants and toddlers to alleviate their own stress. OBJECTIVE To evaluate the association of individual and contextual stressors with child screen exposure (CSE) and CSE combined with feeding (CSE+F) in children aged 7 to 18 months as measured by parent-reported use and variation in quantity of CSE and CSE+F. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional, population-based study drew parent-child participants from TARGet Kids, a network of primary health care research settings throughout Toronto, Ontario, Canada, between November 1, 2011, and July 31, 2018. The included children were aged 7 to 18 months. Exclusion criteria were health conditions affecting growth, acute conditions, chronic conditions, severe developmental delay, and families who were unable to communicate in the English language. Data were analyzed from April 1, 2019, to July 31, 2019. EXPOSURES Parenting stress, child age, child negative affectivity, family living arrangements, and family income were assessed with parent-completed questionnaires. MAIN OUTCOMES AND MEASURES The primary outcome was CSE and the variation in CSE, which represented the amount of background and engaged use of screens (television, videos or DVDs, video games, computers, and mobile devices) in a typical week. The secondary outcome was CSE+F, which represented the frequency of breakfast, lunch, dinner, and snack consumption during screen exposure in a typical week. Both CSE and CSE+F were assessed with the parent-completed Nutrition and Health Questionnaire; Infant Behavior Questionnaire, Revised Very Short; and Parenting Stress Index, Short Form. RESULTS The final sample size was 1085 children for the analysis of CSE and 1083 children for the analysis of CSE+F. Among 914 respondents, the children's mean (SD) age was 11.6 (2.3) months, and 478 (52.3%) were male. Among 910 respondents, 839 (92.2%) were mothers, with a mean (SD) age among 873 respondents of 34.4 (4.2) years. In a typical week, 581 of 779 children (74.6%) were reported to have any CSE, and 321 of 874 children (36.7%) had some CSE+F. Higher parenting stress levels (odds ratio [OR], 1.01; 95% CI, 1.00-1.02; P = .04) and older child age (OR, 1.43; 95% CI, 1.01-2.03; P = .04) were associated with CSE. Higher parenting stress levels (incidence rate [IR], 1.00; 95% CI, 1.00-1.01; P = .002) and lower household income (IR, 1.26; 95% CI, 1.10-1.45; P = .01) were associated with increased CSE. Older child age (OR, 1.79; 95% CI, 1.35-2.38; P < .001) and lower household income (OR, 2.54; 95% CI, 1.72-3.74; P < .001) were associated with CSE+F. Lower household income (IR, 1.21; 95% CI, 1.03-1.42; P = .02) was associated with increased CSE+F. CONCLUSIONS AND RELEVANCE This study found that parenting stress, income, and child age were associated with CSE, and child age and household income were associated with CSE+F. Given these findings, interventions to improve parental coping mechanisms may decrease child screen exposure.
Collapse
Affiliation(s)
| | - Daphne Korczak
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alice Charach
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catherine Birken
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sick Kids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Pediatrics, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Patricia C Parkin
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Sick Kids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Paediatric Outcomes Research Team, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
25
|
Banna J, Richards R, Jones B, Anderson AK, Reicks M, Cluskey M, Gunther C, Hongu NK, Lora K, Misner S, Monroe-Lord L, Topham G, Wong SS, Lim E. Describing Independent Eating Occasions among Low-Income Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030981. [PMID: 32033251 PMCID: PMC7037151 DOI: 10.3390/ijerph17030981] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 01/31/2020] [Accepted: 02/02/2020] [Indexed: 12/26/2022]
Abstract
The purpose of this formative, cross-sectional study was to describe independent eating occasions (iEOs) among a convenience sample of low-income early adolescents (10–13 years, n = 46) in 10 U.S. states, including environmental context, foods selected and reasons for selection, and parental rules about foods consumed. Participants took pictures of all foods consumed over 24 h and participated in semi-structured interviews to describe the context of each eating occasion using the pictures as a guide. Responses based on a total of 304 eating occasions were coded to classify foods based on United States Department of Agriculture (USDA) MyPlate food groups and to characterize parental rules and reasons for food selection. Average age was 10.9 ± 1.1 years and 60% were female. Approximately 58% of eating occasions were classified as iEOs with approximately 65% as snacks. Most iEOs took place at home. Foods frequently consumed during iEOs were from the sweets, total fruit, dairy, and whole fruit food categories. Primary parental rules for iEOs focused on avoiding certain foods and not eating too much. Early adolescents selected foods for convenience, taste preferences, and availability. Foods selected during iEOs were based on parent, household and early adolescent factors, which could be addressed to influence overall diet quality.
Collapse
Affiliation(s)
- Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, University of Hawaii-Manoa, Honolulu, HI 96822, USA
- Correspondence: ; Tel.: +1-808-956-7857
| | - Rickelle Richards
- Department of Nutrition, Dietetics & Food Science, Brigham Young University, Provo, UT 84602, USA;
| | - Blake Jones
- Department of Psychology, Brigham Young University, Provo, UT 84602, USA;
| | - Alex Kojo Anderson
- Department of Foods and Nutrition, University of Georgia, Athens, GA 30602, USA;
| | - Marla Reicks
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN 55108, USA;
| | - Mary Cluskey
- School of Biological and Population Health Sciences, Nutrition, Oregon State University, Corvallis, OR 97331, USA; (M.C.); (S.S.W.)
| | - Carolyn Gunther
- Department of Human Sciences, Ohio State University, Human Nutrition Program, Columbus, OH 43210, USA;
| | - Nobuko Kay Hongu
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85721, USA; (N.K.H.); (S.M.)
| | - Karina Lora
- Department of Exercise and Nutrition Sciences, George Washington University, Washington, DC 20052, USA;
| | - Scottie Misner
- Department of Nutritional Sciences, University of Arizona, Tucson, AZ 85721, USA; (N.K.H.); (S.M.)
| | - Lillie Monroe-Lord
- Center for Nutrition, Diet and Health, University of the District of Columbia, Washington, DC 20008, USA;
| | - Glade Topham
- Couple and Family Therapy Program, Kansas State University, Manhattan, KS 66506, USA;
| | - Siew Sun Wong
- School of Biological and Population Health Sciences, Nutrition, Oregon State University, Corvallis, OR 97331, USA; (M.C.); (S.S.W.)
| | - Eunjung Lim
- Department of Quantitative Health Sciences, University of Hawaii-Manoa, Honolulu, HI 96813, USA;
| |
Collapse
|