Fruit juice intake is not related to children's growth

Unhealthy Food and Beverage Consumption in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-Analysis

This WHO-commissioned review contributed to the update of complementary feeding recommendations, synthesizing evidence on effects of unhealthy food and beverage consumption in children on overweight and obesity. We searched PubMed (Medline), Cochrane CENTRAL, and Embase for articles, irrespective of language or geography. Inclusion criteria were: 1) randomized controlled trials (RCTs), non-RCTs, cohort studies, and pre/post studies with control; 2) participants aged ≤10.9 y at exposure; 3) studies reporting greater consumption of unhealthy foods/beverages compared with no or low consumption; 4) studies assessing anthropometric and/or body composition; and 5) publication date ≥1971. Unhealthy foods and beverages were defined using nutrient- and food-based approaches. Risk of bias was assessed using the ROBINS-I (risk of bias in nonrandomized studies of interventions version I) and RoB2 [Cochrane RoB (version 2)] tools for nonrandomized and randomized studies, respectively. Narrative synthesis was complemented by meta-analyses where appropriate. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Of 26,542 identified citations, 60 studies from 71 articles were included. Most studies were observational (59/60), and no included studies were from low-income countries. The evidence base was low quality, as assessed by ROBINS-I and RoB2 tools. Evidence synthesis was limited by the different interventions and comparators across studies. Evidence indicated that consumption of sugar-sweetened beverages (SSBs) and unhealthy foods in childhood may increase BMI/BMI z-score, percentage body fat, or odds of overweight/obesity (low certainty of evidence). Artificially sweetened beverages and 100% fruit juice consumption make little/no difference to BMI, percentage body fat, or overweight/obesity outcomes (low certainty of evidence). Meta-analyses of a subset of studies indicated a positive association between SSB intake and percentage body fat, but no association with change in BMI and BMI z-score. High-quality epidemiological studies that are designed to assess the effects of unhealthy food consumption during childhood on risk of overweight/obesity are needed to contribute to a more robust evidence base upon which to design policy recommendations. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO as CRD42020218109.

Predictors of Age at Juice Introduction and Associations with Subsequent Beverage Intake in Early and Middle Childhood

BACKGROUND

The American Academy of Pediatrics recommends that if parents choose to introduce juice, they wait until ≥12 months, citing concerns of obesity and dental caries.

OBJECTIVES

We sought to identify correlates of early juice introduction (<6 months) and determine whether early introduction establishes a pattern of sugary beverage intake in childhood.

METHODS

Upstate KIDS is a prospective birth cohort study with follow-up through 7 years (n = 4989). The age of juice introduction was assessed from responses on periodic questionnaires from 4-18 months and categorized as <6,  6 to <12, and ≥12 months. Sociodemographic information was reported using vital records or maternal questionnaires. At 24, 30, and 36 months and 7 years, mothers reported their child's regular juice, soda, water, and milk intakes. The analysis was restricted to singletons and 1 randomly selected twin from each pair with information on juice introduction (n = 4067). We assessed associations of sociodemographic correlates with juice introduction using Cox proportional hazard models. The relations of juice introduction with beverage intake were evaluated using Poisson or logistic regression for adjusted risk ratios (aRR) or ORs, adjusting for sociodemographic covariates and total beverage intake.

RESULTS

Of the mothers, 25% and 74% introduced juice prior to 6 and 12 months, respectively. Younger maternal age; black or Hispanic race/ethnicity; lower educational attainment; Special Supplemental Nutrition Program for Women, Infants, and Children participation (yes); smoking during pregnancy; a higher pre-pregnancy BMI; a lower household income; and living in a townhouse/condominium or mobile home were associated with earlier juice introduction. Earlier juice introduction was related to a higher childhood juice intake, any soda intake, and lower water intake, holding total beverage intake constant [aRR, 1.5 (95% CI: 1.3-1.7; P-trend < 0.0001); adjusted OR 1.6 (95% CI: 1.0-2.4; P-trend = 0.01); aRR 0.9 (95% CI: 0.8-0.9; P-trend < 0.0001), respectively].

CONCLUSIONS

Markers of lower socioeconomic status are strongly associated with earlier juice introduction, which, in turn, relates to sugary beverage intake in childhood, potentially replacing water.

The association between Healthy Beverage Index and anthropometric measures among children: a cross-sectional study

PURPOSE

Several studies evaluated the associations between specific beverages and cardio-metabolic risks among children. However, the evidence on the association between patterns of the beverage consumption and children's anthropometric indices is rare. Therefore, this study was conducted to examine the association between Healthy Beverage Index (HBI) and anthropometric measures among 6-year-old girl children.

METHODS

In this cross-sectional study, 788 children selected from health centers in Tehran, Iran. Data on beverage intake, socio-demographic, physical activity, and anthropometric characteristics were evaluated using reliable and validated standard protocols. The predefined HBI was calculated based on the previous research.

RESULTS

After controlling for several confounders [mother age, mother body mass index, mother physical activity, socioeconomic status, children physical activity and energy intake, total oils (all kinds of oils like animal and plant oils), and total sweet foods (sweet foods except sweetened beverages)], being in the third compared to the first tertile of HBI among children was associated with increased odds of wasting (OR: 5.16; 95% CI 1.5-17.79) and underweight/wasting (OR: 1.81; 95% CI 1.07-3.07). Among the HBI components, just being in the third compared to the first tertile of high-fat milk was inversely associated with decreased odds of wasting (OR: 0.18; 95% CI 0.04-0.73).

CONCLUSIONS

The HBI among children was associated with higher odds of wasting and underweight/wasting. In addition, high-fat milk consumption decreased the odds of wasting among children. Further prospective studies need to confirm these results.

LEVEL OF EVIDENCE

Level V, descriptive cross-sectional study.

Orange juice intake and anthropometric changes in children and adolescents

OBJECTIVE

Evaluate associations between orange juice (OJ) consumption and anthropometric parameters.

DESIGN

Prospective cohort study assessing the association between OJ intake and changes in BMI and height-for-age Z-score (HAZ) using mixed linear regression.

SETTING

2004-2008, USA.

PARTICIPANTS

Children from the Growing Up Today Study II (n 7301), aged 9-16 years at enrollment.

RESULTS

OJ consumption was positively associated with 2-year change in HAZ in girls (mean (se)): 0·03 (0·01) for non-consumers, 0·03 (0·02) for 1-3 glasses/month, 0·06 (0·01) for 1-6 glasses/week and 0·09 (0·02) for ≥1 glass/d after full adjustment (Ptrend = 0·02). However, OJ consumption was not associated with 2-year change in BMI percentile (kg/m2, mean (se)): -0·44 (0·36) for non-consumers, 0·20 (0·41) for 1-3 glasses/month, -0·04 (0·34) for 1-6 glasses/week and -0·77 (0·62) for ≥1 glass/d in girls, Ptrend = 0·81; -0·94 (0·53) for non-consumers, -1·68 (0·52) for 1-3 glasses/month, -0·81 (0·38) for 1-6 glasses per week and -1·12 (0·61) for ≥1 glass/d in boys, Ptrend = 0·49.

CONCLUSION

OJ consumption was favourably associated with height growth but unrelated to excess weight gain. OJ may be a useful alternative to whole fruit in the event that whole fruit intake is insufficient.

A longitudinal study of fruit juice consumption during preschool years and subsequent diet quality and BMI

Background

The role of fruit juice in pediatric dietary guidelines continues to be controversial, particularly with respect to concerns about unhealthy dietary habits and the potential promotion of excessive weight gain. The objective of the current study was to determine the association between preschool fruit juice consumption and the following outcomes during childhood and adolescence: whole and total fruit intake, diet quality, likelihood of meeting current dietary recommendations, and BMI change.

Methods

The data were previously collected from 100 children enrolled in the Framingham Children’s Study at 3–6 years of age and subsequently followed for 10 years. Dietary data were collected annually using multiple sets of 3-day diet records. Compliance with dietary recommendations was estimated based on 2015–2020 Dietary Guidelines for Americans and diet quality was measured using the associated Healthy Eating Index (HEI). Mixed linear and logistic regression models were used for statistical analyses.

Results

Preschool children (3–6 years) who drank ≥1.0 (vs. < 0.5) cup of 100% fruit juice/day consumed 0.9 cups/day more total fruit (p < 0.0001) and 0.5 cups/day more whole fruit (p < 0.0001) during adolescence (14–18 years). Total HEI scores during adolescence for those with the highest preschool juice intakes were almost 6 points higher than those with the lowest fruit juice intakes (p = 0.0044). Preschoolers consuming < 0.5 cups/day of fruit juice had sharply declining whole fruit intake throughout childhood compared with those preschoolers consuming ≥1.0 cups/day who had stable intakes of whole fruit throughout childhood. Those children who consumed ≥0.75 cups/day of fruit juice during preschool (vs. less) were 3.8 times as likely to meet Dietary Guidelines for whole fruit intake during adolescence (p < 0.05). Finally, in multivariable models, there was no association between fruit juice consumption and BMI change throughout childhood.

Conclusion

These data suggest that preschool consumption of 100% fruit juice is associated with beneficial effects on whole fruit intake and diet quality without having any adverse effect on BMI during childhood and into middle adolescence.

A narrative review of the effects of sugar-sweetened beverages on human health: A key global health issue

The provision of healthy and safe food is vital for human health, and the addition of unnecessary sugars in foodstuffs is an important global issue, leading to multiple long- and short-term health issues and spiraling costs for individuals and governments alike. The negative effect of excess sugar consumption contributes to adverse health conditions, including obesity, type 2 diabetes, and poor oral health in both high and low resource settings. A key plank of governmental and health promotion bodies' nutritional guidance is to raise public awareness of "hidden" sugars, salt, and fats, such as found in processed foods and sugar-sweetened beverages (SSBs), and guide individuals to reduce their consumption. This rapid narrative review brings together some of the key issues identified in the literature around the consumption of SSBs, including patterns of consumption, the general impact on human health and nutrition, specific effects on oral health and the oral microbiome, and strategies to address over-consumption. The range of long-term adverse effects on health is often misunderstood or unknown by the public. However, some strategies have succeeded in reducing the consumption of SSBs, including public health strategies and interventions and the imposition of taxes or levies, and this article makes recommendations for action.

Associations between 100% Orange Juice Consumption and Dietary, Lifestyle and Anthropometric Characteristics in a Cross-Sectional Study of U.S. Children and Adolescents

Concerns about orange juice’s sugar content have spurred discussions regarding its potential contributions to childhood obesity. The objective of this study was to evaluate the association between 100% orange juice (OJ) consumption and dietary, lifestyle and anthropometric characteristics in children and adolescents. Baseline anthropometric, dietary and lifestyle data from the Growing Up Today Study I (GUTS I) and GUTS II were collected via self-reported questionnaires from 26,554 participants. The mean values of these variables were then computed for children grouped by categories of OJ consumption, and linear trend testing was used to determine whether OJ consumption was linearly related to these variables. Multivariate adjustment modeling was used to calculate odds ratios of being obese or overweight/obese by OJ consumption. Among both boys and girls, OJ intake was positively associated with height, height-for-age z-score (HAZ), intakes of total energy, total energy excluding OJ, fruits and non-starchy vegetables and physical activity. BMI, BMI z-score and BMI-for-age percentile did not differ by OJ consumption. After adjustment for cohort, age, race, total energy intake without OJ, physical activity and screen time, prevalence of overweight/obesity significantly decreased by OJ intake in boys compared to non-consumers (odds ratio (OR) and 95% confidence interval (CI)): 1.17 (1.02, 1.33) for 1–3 glasses per month, 1.11 (0.98, 1.26) for 1–6 glasses per week, 1.00 (0.85, 1.18) for 1 glass per day, 0.91 (0.73, 1.13) for ≥1 glass per day, p-trend = 0.0403). Prevalence of obesity similarly decreased by OJ intake in boys. Prevalence of overweight/obesity and obesity did not significantly differ by OJ intake in girls. The results indicate that children consuming more OJ tended to practice healthier dietary and lifestyle habits without increased prevalence or odds of obesity or overweight.

Food sources of free sugars in children's diet and identification of lifestyle patterns associated with free sugars intake: the GRECO (Greek Childhood Obesity) study

OBJECTIVE

Excessive free sugars consumption has a possible role in health issues, diet quality and obesity development. The present cross-sectional study aimed to identify the major food sources of free sugars in Greek children's diet and investigate possible associations of dietary patterns with free sugars intake.

DESIGN

Anthropometric measurements and information on dietary and physical activity habits were obtained. Energy and free sugars intake coming from foods were estimated and principal components analysis was applied to identify dietary patterns.

SETTING

The GRECO (Greek Childhood Obesity) study.

SUBJECTS

Nationwide sample of 3089 children (aged 10-12 years).

RESULTS

Adopting WHO criteria, 44·2 % of participants were categorized as having free sugars intake above 10 % of total energy intake. Mean contribution of free sugars to energy intake was 11·2 %, and the major food sources of free sugars differed from those of other childhood populations. Free sugars intake was not associated with overweight/obesity. Multiple linear regression analysis revealed that two lifestyle and dietary patterns, characterized by higher consumption of sweets, fast foods, fries, sugared drinks, frequently ordering/eating outside home and having meals in front of a screen (pattern 1) and higher consumption of whole fruits, 100 % fruit juices, vegetables, legumes and honey/jam (pattern 2), were positively associated with free sugars intake.

CONCLUSIONS

A large proportion of children exceeded the recommended cut-off and free sugars intake was associated with lifestyle patterns rather than single foods. Public health programmes aiming to reduce free sugars consumption should be tailored on promoting the correct dietary habits of specific childhood populations.

Satisfying America's Fruit Gap: Summary of an Expert Roundtable on the Role of 100% Fruit Juice

The 2015 to 2020 Dietary Guidelines for Americans (DGAs) recognize the role of 100% fruit juice in health and in helping people meet daily fruit recommendations and state that 100% fruit juice is a nutrient-dense beverage that should be a primary choice, along with water and low-fat/fat-free milk. The DGAs note that children are consuming 100% fruit juice within recommendations (that is, 120 to 180 mL/d for children aged 1 to 6 y and 236 to 355 mL/d for children aged 7 to 18 y). Evidence shows that compared to nonconsumers, those who consume 100% fruit juice come closer to meeting daily fruit needs and have better diet quality. In children, 100% fruit juice is associated with increased intakes of nutrients such as vitamin C, folate, and potassium. When consumed within the DGA recommendations, 100% fruit juice is not associated with overweight/obesity or childhood dental caries and does not compromise fiber intake. Preliminary data suggest that polyphenols in some 100% fruit juices may inhibit absorption of naturally occurring sugars. Given its role in promoting health and in helping people meet fruit needs, experts participating in a roundtable discussion agreed that there is no science-based reason to restrict access to 100% fruit juice in public health nutrition policy and programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Reducing or eliminating 100% fruit juice could lead to unintended consequences such as reduced daily fruit intake and increased consumption of less nutritious beverages (for example, sugar-sweetened beverages).

Fruit Juice in Infants, Children, and Adolescents: Current Recommendations

Historically, fruit juice was recommended by pediatricians as a source of vitamin C and as an extra source of water for healthy infants and young children as their diets expanded to include solid foods with higher renal solute load. It was also sometimes recommended for children with constipation. Fruit juice is marketed as a healthy, natural source of vitamins and, in some instances, calcium. Because juice tastes good, children readily accept it. Although juice consumption has some benefits, it also has potential detrimental effects. High sugar content in juice contributes to increased calorie consumption and the risk of dental caries. In addition, the lack of protein and fiber in juice can predispose to inappropriate weight gain (too much or too little). Pediatricians need to be knowledgeable about juice to inform parents and patients on its appropriate uses.

A systematic review of the association between consumption of sugar-containing beverages and excess weight gain among children under age 12

OBJECTIVE

A systematic review was conducted to address this clinical question: Does consumption of (non-dairy) sugar-containing beverages (SCBs) among children under age 12 result in excess weight gain?

METHODS

The authors searched four databases for controlled trials (randomized and non-randomized) and cohort studies published in English through March 29, 2016: PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL. Initial and full-text screening, data abstraction, and risk of bias assessment were performed independently and in duplicate.

RESULTS

Thirty-eight studies met inclusion criteria for this systematic review. One was a randomized controlled trial, and 37 were cohort studies. Though the results of these studies were mixed, the majority demonstrated a statistically significant positive association between SCB consumption in children under age 12 and total adiposity and central adiposity. In contrast, most studies that assessed 100 percent fruit juice consumption only with either total adiposity or central adiposity did not support an association. Among only children under age 5 at baseline, no studies examined central adiposity, but nearly all studies examining SCBs and total adiposity, and a majority examining only fruit juice consumption, demonstrated a statistically significant positive association.

CONCLUSION

Our results support a statistically significant positive association between SCBs and total and central adiposity among children under age 12. This association is most consistent for total adiposity among children <5. Our results for 100 percent fruit juice only suggest differences by age, as most studies among those < 12 were negative but most among those <5 were positive.

Longitudinal evaluation of 100% fruit juice consumption on BMI status in 2-5-year-old children

BACKGROUND

Obesity in childhood is related to multiple lifestyle factors. Our objective was to evaluate the relationship between consumption of 100% fruit juice and weight status over time among pre-school children.

METHODS

We used linear and logistic multivariable regression to evaluate body mass index (BMI) z-score and overweight/obese status as a function of 100% fruit juice intake for 8950 children examined at ages 2, 4 and 5 years as part of the Early Childhood Longitudinal Study-Birth Cohort, a representative sample of the United States.

RESULTS

Cross-sectional analysis at ages 4 and 5 years showed no difference in the prevalence of overweight and obesity between consistent juice drinkers and inconsistent/non-drinkers. Longitudinal analysis found that children who drank 100% juice consistently at age 2 years had greater increases in BMI z-score by age 4 years than infrequent/non-drinkers (P < 0.0001), a difference driven by lesser increases in height z-score (P = 0.0003) and slightly greater increases in weight z-score (P = 0.0550) among consistent juice drinkers over the 2 to 4 year time period. Additionally, consistent juice drinkers at age 2 had higher odds of becoming overweight by age 4 (adjusted odds ratio 1.30; CI 1.06-1.60). These differences in growth parameters were not noted between ages 4 and 5 years.

CONCLUSIONS

Drinking 100% fruit juice regularly at age 2 is associated with higher odds of becoming overweight between 2 and 4 years. Paediatricians and parents can discourage excessive fruit juice consumption as part of a larger effort to avoid unhealthy gain in BMI in young children.

Consumption of apples is associated with a better diet quality and reduced risk of obesity in children: National Health and Nutrition Examination Survey (NHANES) 2003-2010

Background

Most children do not meet the recommendation for fruit consumption. Apples are the second most commonly consumed fruit in the US; however, no studies have examined the association of total apple products, apples, apple sauce, and 100 % apple juice consumption on diet quality and weight/adiposity in children.

Methods

The purpose of this study was to examine the association between various apple consumption forms with diet quality and weight/adiposity in a nationally representative sample of children. Participants were children 2–18 years of age (N = 13,339) from the National Health and Nutrition Examination Survey 2003–2010. Intake was determined using a single interview administered 24-h diet recall. Apple product consumption was determined using the cycle-appropriate USDA Food and Nutrient Database for Dietary Studies food codes. Total diet quality and component scores were determined using the Healthy Eating Index-2010 (HEI). Anthropometrics were determined using standard methods. Covariate adjusted linear and logistic regressions were used to compare apple product consumers with non-consumers; sample weights were used. Probability was set at <0.01.

Results

Approximately 26 % of the population (n = 3,482) consumed some form of apple products. Consumers of apple products, whole apples, apple sauce, and 100 % apple juice had higher HEI scores than non-consumers: 50.4 ± 0.4 v 41.9 ± 0.3, 52.5 ± 0.5 v 42.7 ± 0.3, 52.1 ± 0.8 v 47.2 ± 0.4, and 51.4 ± 0.6 v 46.5 ± 0.4, respectively. Apple products and whole apple consumers had lower BMI z-scores than non-consumers: 0.4 ± 0.04 v 0.5 ± 0.03 and 0.3 ± 0.1 v 0.5 ± 0.02, respectively. Apple products and whole apple consumers were 25 % (0.59–0.95 99^th CI) and 30 % (0.52–0.95 99^th CI), respectively, were less likely to be obese than non-consumers.

Conclusions

Consumption of any form of apples contributed to the fruit recommendation of children and improved diet quality. Apples should be included in the diets of children as a component of an overall healthy diet.

A comparison of beverage intakes in US children based on WIC participation and eligibility

OBJECTIVE

To compare beverage intakes for 2- to 4-year-olds based on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation.

METHODS

Data from National Health and Nutrition Examination Survey, 2005-2010 were analyzed to assess beverage intakes for 2- to 4-year-olds. Children were classified as WIC participants, low-income nonparticipants, and higher-income nonparticipants. All beverages were manually coded into 6 categories: water, milk, 100% juice, fruit drinks, soda, and low-calorie/diet drinks. Grams, calories, and percent consumers of each beverage were compared across groups.

RESULTS

Special Supplemental Nutrition Program for Women, Infants, and Children participants had the highest 100% juice consumption (P = .001) and their milk consumption was similar to higher-income children. Higher-income nonparticipants drank significantly less fruit drink (P < .001) and soda (P = .001) than both the WIC participants and low-income nonparticipants.

CONCLUSIONS AND IMPLICATIONS

Participation in WIC was related to higher intakes of the beverages provided in food packages for 2- to 4-year-olds. Intakes of fruit juice and sugar-sweetened beverages should be addressed during the WIC nutrition education counseling sessions.

Complementary Feeding: Critical Considerations to Optimize Growth, Nutrition, and Feeding Behavior

This review focuses on complementary feeding (CF) in westernized settings where primary health concerns are risk of obesity and micronutrient inadequacy. The current evidence is reviewed for: (1) when CF should be introduced, (2) what foods (nutrients and food types) should be prioritized and avoided, and (3) how the infant should be fed. Special attention is paid to the underlying physiological differences between breast- and formula-fed infants that often result in distinctly different nutritional and health risks. This difference is particularly acute in the case of micronutrient inadequacy, specifically iron and zinc, but is also relevant to optimal energy and macronutrient intakes. Emphasis is placed on the complex interplay among infants' early dietary exposures; relatively high energy and nutrient requirements; rapid physical, social and emotional development; and the feeding environment-all of which interact to impact health outcomes. This complexity needs to be considered at both individual and population levels and in both clinical and research settings.

100% orange juice consumption is associated with better diet quality, improved nutrient adequacy, decreased risk for obesity, and improved biomarkers of health in adults: National Health and Nutrition Examination Survey, 2003-2006

BACKGROUND

Consumption of 100% orange juice (OJ) has been positively associated with nutrient adequacy and diet quality, with no increased risk of overweight/obesity in children; however, no one has examined these factors in adults. The purpose of this study was to examine the association of 100% OJ consumption with nutrient adequacy, diet quality, and risk factors for metabolic syndrome (MetS) in a nationally representative sample of adults.

METHODS

Data from adults 19+ years of age (n = 8,861) participating in the National Health and Nutrition Examination Survey 2003-2006 were used. The National Cancer Institute method was used to estimate the usual intake (UI) of 100% OJ consumption, selected nutrients, and food groups. Percentages of the population below the Estimated Average Requirement (EAR) or above the Adequate Intake (AI) were determined. Diet quality was measured by the Healthy Eating Index-2005 (HEI-2005). Covariate adjusted logistic regression was used to determine if consumers had a lower odds ratio of being overweight or obese or having risk factors of MetS or MetS.

RESULTS

Usual per capita intake of 100% OJ was 50.3 ml/d. Among consumers (n = 2,310; 23.8%), UI was 210.0 ml/d. Compared to non-consumers, consumers had a higher (p < 0.05) percentage (% ± SE) of the population meeting the EAR for vitamin A (39.7 ± 2.5 vs 54.0 ± 1.2), vitamin C (0.0 ± 0.0 vs 59.0 ± 1.4), folate (5.8 ± 0.7 vs 15.1 ± 0.9), and magnesium (51.6 ± 1.6 vs 63.7 ± 1.2). Consumers were also more likely to be above the AI for potassium (4.1 ± 0.8 vs 1.8 ± 0.2). HEI-2005 was significantly (p < 0.05) higher in consumers (55.0 ± 0.4 vs 49.7 ± 0.3). Consumers also had higher intakes of total fruit, fruit juice, whole fruit, and whole grain. Consumers had a lower (p < 0.05) mean body mass index (27.6 ± 0.2 vs 28.5 ± 0.1), total cholesterol levels (197.6 ± 1.2 vs 200.8 ± 0.75 mg/dL), and low density lipoprotein-cholesterol levels (112.5 ± 1.4 vs 116.7 ± 0.93 mg/dL). Finally, compared to non-consumers of 100% OJ, consumers were 21% less likely to be obese and male consumers were 36% less likely to have MetS.

CONCLUSION

The results suggest that moderate consumption of 100% OJ should be encouraged to help individuals meet the USDA daily recommendation for fruit intake and as a component of a healthy diet.

Impact of orange juice consumption on macronutrient and energy intakes and body composition in the US population

OBJECTIVE

The present study evaluated the contribution of 100 % orange juice (OJ) consumption to the intakes of macronutrients and energy and its impact on body composition.

DESIGN

A cross-sectional study was conducted. The main exposure was OJ consumption based on two non-consecutive 24 h diet recalls. Macronutrient and energy intakes and body composition parameters were outcome measures. All statistical analyses were carried out using SAS and SUDAAN statistical software packages to allow for multistage sample designs.

SETTING

The US population and its subgroups.

SUBJECTS

The US population aged ≥4 years (n 13 971) from the National Health and Nutrition Examination Survey 2003-2006, conducted by the National Center for Health Statistics.

RESULTS

In this US population, OJ consumers had lower BMI and healthier lifestyle behaviours (including lower alcohol consumption and smoking as well as higher exercise level) than non-consumers (P < 0.05). After adjusting for covariates, OJ consumers had higher daily intakes of carbohydrate, total sugar, total fat and energy than non-consumers (P < 0.01). However, these linear trends still remained even after OJ was removed from the food list of items consumed. Adult OJ consumers had lower BMI, waist circumference and percentage body fat than non-consumers (P < 0.01), as well as lower odds ratio for overweight and obesity (P < 0.01). These effects were not seen in children and adolescents, where there was no significant difference in BMI, waist circumference and percentage body fat in OJ consumers compared with non-consumers.

CONCLUSIONS

OJ consumption was associated with healthier body composition in adults; while there were no significant associations between OJ consumption and body composition in children and adolescents.

Dietary patterns and their changes in early childhood

BACKGROUND

Early childhood is a critical period for shaping and influencing feeding behaviours which have implications for future health. Understanding the food consumption patterns and their shifts over time can provide guidance to health care providers and nutrition specialists who provide nutrition counselling and develop nutrition messages.

OBJECTIVES

To examine feeding patterns of 1-5 year old children and their changes with age.

METHODS

Across-sectional questionnaire study designed to obtain information on basic demographic indicators and feeding habits was conducted in Prague and all 13 regions of the Czech Republic. The carers of 1,130 children aged 1 to 5 years were approached in public places. Obtained data were computerized, descriptive statistics and t-tests for food intake frequency by age, breast-feeding status, sex, maternal education, and domicile were calculated. The difference was considered significant when P value was < 0.05.

RESULTS

The median duration of breast-feeding of children not breast-fed at the time of the interview was 9 months; 29.5% one-year olds were still breast-fed at the time of the interview. Median number of meals per day was 4 in 1 and 5 year olds and 5 in children 2 to 4 years old. The diet of one-year-olds, albeit with lower fruit and vegetable consumption and low fish consumption, was close to recommendations. The milk and milk products, fruit, vegetable, and poultry intake frequency significantly decreased with age. The meat and grains groups, smoked meat and meat products, sweets, and fried food intake frequency significantly increased with age. Fish consumption remained low. Higher vegetable intake frequency was associated with breast-feeding, maternal education, and female sex. Higher fruit consumption was associated with breast-feeding and living in Prague. Higher meat group intake frequency was associated with male sex.

CONCLUSIONS

Our data confirm that the dietary habits are formed early in the life. Enhancement of multi-channel delivery of nutrition messages for feeding of toddlers and pre-schoolers and for the improvement of family eating habits are needed.

One hundred percent orange juice consumption is associated with better diet quality, improved nutrient adequacy, and no increased risk for overweight/obesity in children

The purpose of this study was to examine the association of 100% orange juice (OJ) consumption by children 2 to 18 years of age (n = 7250) participating in the 2003 to 2006 National Health and Nutrition Examination Survey with intakes of select nutrients, MyPyramid food groups, diet quality-measured by the Healthy Eating Index-2005, weight status, and associated risk factors. The National Cancer Institute method was used to estimate the usual intake of 100% OJ consumption, selected nutrients, and MyPyramid food groups. Percentages of the population below the Estimated Average Requirement were determined. Covariate adjusted logistic regression was used to determine if consumers had a lower odds ratio of being overweight or obese. Usual per capita intake of 100% OJ was 1.7 oz/d. Among consumers, the usual intake of 100% OJ for children (n = 2183; 26.2% of population) was 10.2 oz/d. Consumers had higher (P < .05) energy intakes than nonconsumers (9148 ± 113 vs 8625 ± 473 kJ). However, there were no differences in weight or body mass index in consumers and nonconsumers, and there was no significant difference in the risk of being overweight or obese between consumers and nonconsumers (odds ratio, 0.86; 95% confidence interval, 0.70-1.05). Compared with nonconsumers, consumers had a higher (P < .01) percentage (% ± SE) of the population meeting the Estimated Average Requirement for vitamin A (19.6 ± 2.0 vs 30.2 ± 1.4), vitamin C (0.0 ± 0.0 vs 29.2 ± 1.2), folate (1.3 ± 0.3 vs 5.1 ± 0.6), and magnesium (25.5 ± 2.0 vs 39.0 ± 11). The Healthy Eating Index-2005 was significantly (P < .01) higher in consumers (52.4 ± 0.4 vs 48.5 ± 0.3). Consumers also had higher intakes of total fruit, fruit juice, and whole fruit. Moderate consumption of 100% OJ should be encouraged in children as a component of a healthy diet.

Cup introduction, drink type and vitamin supplementation in preterm babies at 11-25 months

BACKGROUND

  To avoid adverse effects of prolonged bottle use, the recommendations are that full-term babies are introduced to cups from 6 months and discouraged bottles from 12 months old. There are no recommendations for preterm babies. In the UK, the Department of Heath recommends the introduction of vitamin supplements, alongside the transition from formula to cow's milk. The present study aimed to determine age of cup introduction in a group of preterm babies, identify drinks offered from bottles versus cups and the types of cups used, and establish the prevalence and appropriateness of vitamin supplementation.

METHODS

  A validated postal questionnaire was sent to the parents of 369 babies born <34 weeks of gestation at Queen Charlottes Neonatal Unit; 104 sent in 2003 and 265 sent in 2004-2005. The questionnaire was sent when the babies were calculated to be between 12 and 18 months (all ages stated are uncorrected). A separate questionnaire was sent for each baby from multiple pregnancies.

RESULTS

  The questionnaire return rate was 46% (n = 169). Length of gestation (P < 0.001), hospital stay (P = 0.009), birth weight (P = 0.002) and maternal age (P < 0.001) were significantly greater and more mothers were of European origin (P = 0.036) for those babies for whom questionnaires were returned compared to nonresponders. Infant gender did not differ. Fifty-seven percent had been introduced to a cup before 12 months, distribution was: 58% (n = 53) of singletons, 54% (n = 37) of twins and 67% (n = 6) of triplets. This rose to 80% before 13 months. Thirteen percent (n = 22) had not started drinking from a cup and 17% (n = 29) only used cups at the time of the questionnaire. Cow's milk had been introduced to 69% (n = 117) of all babies and 32% (n = 54) were still on formula (10 on both and eight were on neither; hence, the figures do not sum to 100%). Cow's milk was drunk from bottles by 56% (n = 95) and formula by 31% (n = 52). A significantly greater proportion of twins and triplets were drinking cow's milk compared to singletons [80% (n = 62) versus 60% (n = 55) P = 0.005] and significantly fewer were drinking formula [22% (n = 17) versus 40% (n = 37) P = 0.012]. Water was the drink most commonly given from a cup (80%) (n = 135) followed by juice, which was given to 64% (n = 108). Juice drinks were given by bottle in 16% (n = 27). Fifty-two percent (n = 88) used a 'spill-proof' cup some of the time. Vitamins were given as recommended in 18% (n = 31), given even though not recommended in 12% (n = 20), not given but recommended in 49% (n = 83) and appropriately not given in 21% (n = 35). A greater percentage of twins and triplets, compared to singletons, were not commenced on vitamins, even though they were no longer drinking formula.

CONCLUSIONS

  The present study reports baseline data on cup introduction in preterm babies both from singleton and multiple births. The data suggest that education about appropriate bottle drinks, timing of cup introduction, suitable cups and the correct use of vitamin drops is required. However, because the profile of responders differed from nonresponders, these results may not be applicable to all preterm babies.

Dietary intakes and physical activity among preschool-aged children living in rural American Indian communities before a family-based healthy lifestyle intervention

OBJECTIVE

To report dietary intake and physical activity among preschool-aged children living in rural American Indian communities before participation in a family-based healthy lifestyle intervention and to compare data to current age-specific recommendations.

SUBJECTS/DESIGN

One hundred thirty-five preschool-aged children, living in rural American Indian communities, provided diet and physical activity data before participating in a 2-year randomized healthy lifestyle intervention. Three 24-hour dietary recalls assessed nutrient and food and added sugar intake, which were compared to the National Academy of Science's Dietary Reference Intakes, the US Department of Agriculture's MyPyramid, and American Heart Association recommendations. Time watching television and moderate plus vigorous activity was compared to MyPyramid and American Academy of Pediatrics recommendations.

STATISTICAL ANALYSIS

Nutrient, food group, added sugar intake, and time watching television and in moderate or vigorous activity were compared to recommendations by computing the percent of recommendations met. Nonparametric tests identified differences in diet and physical activity among age groups and normal and overweight children (body mass index <85th and > or = 85th percentile).

RESULTS

Average nutrient intakes met recommendations whereas food group intakes did not. Mean fruit and vegetable intakes for 2- to 3-year-olds were 0.36 c/day fruit and 0.45 c/day vegetables and, for 4- to 5-year-olds, 0.33 c/day fruit and 0.48 c/day vegetables. Both age groups reported consuming more than 50 g added sugar, exceeding the recommendation of 16 g. Overweight vs normal weight children reported significantly more sweetened beverage intake (8.0+/-0.10 vs 5.28+/-0.08 oz/day, P<0.01). On average, all children reported watching television 2.0 hours/day and significant differences were observed for total television viewing and nonviewing time between overweight and normal weight children (8.52+/-0.6 vs 6.54+/-0.6 hours/day, P<0.01). All children engaged in <20 minutes/day of moderate or vigorous activity.

CONCLUSIONS

Overall, children in this sample did not meet MyPyramid recommendations for fruits or vegetables and exceed added sugar intake recommendations. Television viewing time and time when the television was on in the home was highly prevalent along with low levels of moderate or vigorous activity. The Healthy Children Strong Families intervention we studied has potential for improving nutrition and physical activity among preschool-aged children living in rural American Indian communities.

Girls' early sweetened carbonated beverage intake predicts different patterns of beverage and nutrient intake across childhood and adolescence

BACKGROUND

Information is limited on persistence of early beverage patterns throughout childhood and adolescence and their influence on long-term dietary intake.

OBJECTIVE

To describe changes in beverage intake during childhood and assess beverage and nutrient intake from ages 5 to 15 years among girls who were consuming or not consuming sweetened carbonated beverages (soda) at age 5 years.

DESIGN/SUBJECTS

Participants were part of a longitudinal study of non-Hispanic white girls and their parents (n=170) assessed biennially from age 5 to 15 years starting fall 1996.

STATISTICAL ANALYSES

At each assessment, intakes of beverages (milk, fruit juice, fruit drinks, soda, and tea/coffee), energy, macronutrients, and micronutrients were assessed using three 24-hour recalls. Analyses of longitudinal changes and the interaction between beverage type and age were conducted using a mixed modeling approach. Girls were categorized as either soda consumers or nonconsumers at age 5 years. A mixed modeling approach was used to assess longitudinal differences and patterns of change in beverage and nutrient intake between soda consumption groups.

RESULTS

Early differences in soda intake were predictive of later soda and milk intake and of differences in selected nutrients. Relative to girls who were not consuming soda beverages at age 5 years, soda consumers at age 5 years had higher subsequent soda intake, lower milk intake, higher intake of added sugars, lower protein, fiber, vitamin D, calcium, magnesium, phosphorous, and potassium from ages 5 to 15 years.

CONCLUSIONS

Soda consumption at age 5 years predicted patterns of nutrient intake that persisted during childhood and into adolescence. Diets of soda consumers were higher in added sugars and lower in protein, fiber, calcium, vitamin D, magnesium, phosphorous, and potassium. Findings provide a more complex picture regarding the emergence of early beverage patterns and their predictive effects on nutrient intake across childhood and adolescence.

Relationship between 100% juice consumption and nutrient intake and weight of adolescents

PURPOSE

This study investigated the associations among 100% juice consumption, nutrient intake, and measures of weight in adolescents.

DESIGN

A cross-sectional secondary analysis of data from adolescents aged 12 to 18 years (n = 3939) participating in the National Health and Nutrition Examination Survey 1999-2002 was conducted to assess nutrient and weight in categories of 100% juice consumption.

METHODS

Least square means and logistic regression analyses were generated, and were adjusted for gender, age, ethnicity, and energy intake. Analyses were Bonferroni corrected with an effective p value of .0125.

RESULTS

Twenty-eight percent of adolescents (51% male, 42% Hispanic, 25% non-Hispanic white, 29% non-Hispanic black) consumed 100% juice the day of the recall. The mean amount of 100% juice consumed was 3.7 ounces (2.2% of energy intake). Compared with non-juice consumers, carbohydrate, fiber, vitamins C and B6, folate, potassium, copper, magnesium, and iron intakes of juice consumers were higher, and intakes of fat and saturated fatty acids were lower. Those consuming greater than 6 ounces of juice consumed more servings of fruit and less discretionary fat and added sugar than nonconsumers. No differences were found in weight by juice consumption group.

CONCLUSION

In conclusion, when compared with non-juice consumers, adolescents consuming 100% juice did not show mean increased weight measures. Juice provided valuable nutrients, and consumption was associated with lower intakes of total fat, saturated fatty acids, discretionary fat, and added sugars and with higher intakes of whole fruit; however, consumption was not associated with decreased intake of milk, meat, or grains.

Association between fruit juice consumption and self-reported body mass index among adult Canadians

BACKGROUND

The prevalence of obesity and being overweight is rising among adult Canadians and diet is recognised as one of the main causes of obesity. The consumption of fruit and vegetables is shown to be protective against obesity and being overweight but little is known about the association of fruit juice consumption and obesity and being overweight. The present study aimed to investigate the association between fruit juice consumption and self-reported body mass index (BMI) among adult Canadians.

METHODS

This analysis is based on the Canadian Community Health Survey, Cycle 3.1. A regression method was used to assess the association of fruit juice consumption with self-reported BMI in 18-64-year-old Canadians who had been adjusted for sex, age, total household income, education, self-rated health, and daily energy expenditure. Because the analysis is based on a cross-sectional dataset, it does not imply a cause and effect relationship.

RESULTS

Almost 38.6% of adult Canadians reported a fruit juice intake of 0.5-1.4 times per day and 18.2% consumed fruit juice more than 1.5 times per day. Participants with normal weight were likely to consume more fruit juice than obese individuals. Regression analysis showed a negative association between fruit juice consumption and BMI after adjusting for age, sex, education, marital status, income, total fruit and vegetable intake, daily energy expenditure, and self-rated health. On average, for each daily serving of fruit juice, a -0.22 unit (95% confidence interval = -0.33 to -0.11) decrease in BMI was observed.

CONCLUSIONS

The results obtained showed a moderate negative association between fruit juice intake and BMI, which may suggest that a moderate daily consumption of fruit juice is associated with normal weight status.

Changes in family variables among normal and overweight preschoolers

PURPOSE

The purpose of this study was to examine differences in the weight and height of normal and overweight children in variables relating to the individual, home/family and community across a six month time period. RESEARCH QUESTIONS/HYPOTHESES: What are the ecological factors that influence the body mass index (BMI) of preschool children?

SIGNIFICANCE

The rate of overweight preschool children aged 2 to 5 years has more than doubled in the past 30 years. Low socioeconomic and ethnic minority groups have higher rates. Research shows a strong correlation between a child's size (height, weight, and BMI) and the ecological factors present in the family's environment.

METHODS

This study is a secondary data analysis from a cross sectional study of 200 Mexican American children ages 2-3 years old receiving WIC services. The sample consisted of 100 children with a BMI > 95% for age and 100 children with a BMI of <85% for age. Variables and measurements included: host/child (BMI percentile, diet, TV watching hours); agent/food (feeding assistance); microsystem/parent (parental BMI, acculturation level, employment, physical activities); microsystem/home (stimulation, TV hours); and microsystem/mother-child relationship (NCAST Teaching Scale).This study is limited to populations with similar characteristics.

RESULTS

Both overweight and normal weight children showed decreases in BMI, but maintained their between group differences even while slimming down (p = .000). Overweight children consumed significantly more fruit, bread and other carbohydrates, and total calories, than did normal weight children. Both groups of children increased significantly in their consumption of water, fruit juice and juice drinks, as well as meat and other protein. Maternal BMIs for overweight children were higher than those for the mothers of the normal weight children and increased across time. More overweight children ate in the presence of another person. The interaction patterns between mothers and overweight children were significantly more positive and responsive than were the interaction patterns of mothers and normal weight children.

DISCUSSION/CONCLUSION

multiple ecological factors influence the BMI of the preschooler leading to obesity. Nurses can use these findings to teach parents about the importance managing the environmental factors that contribute to childhood obesity and growth.

Inappropriate bottle use: an early risk for overweight? Literature review and pilot data for a bottle-weaning trial

Identifying early risk factors for childhood obesity is critical, as weight in infancy and early childhood tracks to later periods. Continued bottle use - primarily from excess milk intake - is emerging as a potential risk factor for early childhood overweight. Over three fourths of US infants drink from bottles beyond the recommended weaning age of 12 months, and two thirds of UK infants use a bottle at 18 months. This paper is divided into three parts. Part 1 reviews the literature on beverage intake, weight and bottle use in young children. Part II describes pilot data on milk bottle use and weight in 12-60-month-olds, collected prior to a randomized controlled (RCT) trial of a bottle-weaning intervention. Median daily milk bottle consumption at 12 months was 5.0 (interquartile range = 3-6). Among 12-36-month-olds, current users were significantly more likely to be >95th% weight-for-height (19% vs. 0%, P < 0.02), and more were >85% weight-for-height (27% vs. 11%, P < 0.11), vs. non-users. In contrast, current bottle use was not associated with either overweight or obesity in 37-60-month-olds. Part III describes the RCT, begun in fall 2008. It is enrolling 464 parent/12-month-old dyads from a nutrition assistance programme for low-income families. Children's bottle use, anthropometrics, dietary intake and nutrient density (via 24 h recall) are assessed quarterly through 24 months of age. For the intervention, site nutritionists employ a project-developed, visually attractive flip chart. An observational study nested within the RCT will describe dietary changes during this period of feeding transitions.

Can pure fruit and vegetable juices protect against cancer and cardiovascular disease too? A review of the evidence

While it is widely accepted that fruit and vegetables (F&V) lower the risk of cancer, and cardiovascular disease (CVD), the role of pure fruit and vegetable (PFV) juices is often downplayed. This review poses two questions: Are the protective benefits of F&V dependent upon constituents lacking in PFV juices (e.g. fibre)? Do PFV juices impact on disease risk when considered separately from F&V? Studies comparing the effects of fibre and antioxidants were reviewed, yielding the finding that the impact of F&V may relate more strongly to antioxidants, than to fibre. For the second question, high-quality published studies that considered PFV juices were reviewed. The impact of PFV juices on cancer risk was weakly positive, although a lack of human data and contradictory findings hampered conclusions. For CVD, there was convincing evidence from epidemiological and clinical studies that PFV juices reduced risk via a number of probable mechanisms. It was concluded that the view that PFV juices are nutritionally inferior to F&V, in relation to chronic disease risk reduction, is unjustified.

Correlates of fruit and vegetable intakes in US children

The objective of this study was to assess the quality of the current intakes of fruits and vegetables compared to the Dietary Guidelines for Americans in US children and adolescents and identify factors related to low fruit and vegetable intake. This descriptive study examined differences in fruit and vegetable intakes by age, sex, ethnicity, poverty level, body mass index, and food security status utilizing data from the 1999-2002 National Health and Nutrition Examination Survey. Six thousand five hundred thirteen children and adolescents ages 2 to 18 years, who were respondents to the 1999-2002 National Health and Nutrition Examination Survey. Mean fruit and vegetable intakes were computed using 24-hour recalls for individuals and compared using analysis of variance. Leading contributors to fruit and vegetable intake were identified using frequency analysis. Children aged 2 to 5 years had significantly higher total fruit and juice intakes than 6- to 11- and 12- to 18-year-olds. Total vegetable and french fry intake was significantly higher among 12- to 18-year-old adolescents. Regarding sex differences, boys consumed significantly more fruit juice and french fries than girls. In addition, non-Hispanic African-American children and adolescents consumed significantly more dark-green vegetables and fewer mean deep-yellow vegetables than Mexican-American and non-Hispanic white children and adolescents. Total fruit consumption also differed significantly among race/ethnicities and household income. Children and adolescents most at risk for higher intakes of energy-dense fruits and vegetables (fruit juice and french fries) were generally boys, and adolescents, at risk for overweight or overweight and living in households below 350% of the poverty level.

Benefits of Breakfast for Children and Adolescents: Update and Recommendations for Practitioners

A number of studies report health benefits for children and adolescents who consume breakfast. Breakfast skipping is fairly common in children and adolescents and increases as children age. Breakfast can enhance children's diets by positively contributing to daily nutrient intake, augmenting intake of key nutrients such as fiber and calcium, and provides an opportunity to help meet the recommendations of the Dietary Guidelines for Americans. Breakfast also is associated with more healthful food choices. Cross-sectional studies support that eating breakfast more often may help children and adolescents maintain a healthful weight. However, the results from longitudinal studies are inconclusive and suggest that more research is needed to clarify this relationship, including understanding the mediating effects of initial weight status, dieting behavior, and physical activity levels. Breakfast consumption may provide some benefit toward cognitive function and academic achievement, but more research is needed. Breakfast is one facet of a healthy lifestyle that may help contribute to the short- and long-term health and well-being of children and adolescents. Health practitioners can promote healthy breakfast consumption in children and adolescents by addressing barriers to eating breakfast and focusing on individuals who may be more likely to skip breakfast on a regular basis.

Beverage consumption patterns of children born at different risk of obesity

BACKGROUND

Increased intake of sugar-sweetened beverages and fruit juice has been associated with overweight in children.

OBJECTIVE

This study prospectively assessed beverage consumption patterns and their relationship with weight status in a cohort of children born at different risk for obesity.

METHODS AND PROCEDURES

Participants were children born at low risk (n = 27) or high risk (n = 22) for obesity based on maternal prepregnancy BMI (kg/m(2)). Daily beverage consumption was generated from 3-day food records from children aged 3-6 years and coded into seven beverage categories (milk, fruit juice, fruit drinks, caloric and non-caloric soda, soft drinks including and excluding fruit juice). Child anthropometric measures were assessed yearly.

RESULTS

High-risk children consumed a greater percentage of daily calories from beverages at age 3, more fruit juice at ages 3 and 4, more soft drinks (including fruit juice) at ages 3-5, and more soda at age 6 compared to low-risk children. Longitudinal analyses showed that a greater 3-year increase in soda intake was associated with an increased change in waist circumference, whereas a greater increase in milk intake was associated with a reduced change in waist circumference. There was no significant association between change in intake from any of the beverage categories and change in BMI z-score across analyses.

DISCUSSION

Children's familial predisposition to obesity may differentially affect their beverage consumption patterns. Future research should examine the extent to which dietary factors may play a role in pediatric body fat deposition over time.

A Review of the Relationship Between 100% Fruit Juice Consumption and Weight in Children and Adolescents

Studies assessing a relationship between consumption of 100% fruit juice by children and adolescents and weight are contradictory. The purpose of this review was to assess the 9 cross-sectional and 12 longitudinal studies that have looked at this association. Of the 9 cross-sectional studies reviewed, only 3 reported any association. Those studies used small, local convenience samples of preschool children; furthermore, selection criteria were not well defined. One found that preschool children consuming ≥ 12 fluid oz/day of 100% fruit juice had a higher prevalence of overweight than those who consumed less than 12 oz/day (32% vs 9%). Later, a separate study showed that this relationship held only for apple juice. Another study demonstrated an association of overweight and energy from juice. These 3 studies were not nationally representative. Only 3 of the longitudinal studies showed an association between 100% fruit juice consumption and weight; 1 found an association only in adolescent girls, and 2 reported an association in children who were already overweight. None of the longitudinal studies was nationally representative, but 5 had sample sizes of at least 1000, 2 were ethnically diverse, and 3 had geographically separate sites, suggesting that the findings could be applicable to wider populations. Based on the currently available evidence, it can be concluded that there is no systematic association between consumption of 100% fruit juice and overweight in children or adolescents. Data do support consumption of 100% fruit juice in moderate amounts and suggest that consumption of 100% fruit juice may be an important strategy to help children meet the current recommendations for fruit.

Recommendations for treatment of child and adolescent overweight and obesity

In this article, we review evidence about the treatment of obesity that may have applications in primary care, community, and tertiary care settings. We examine current information about eating behaviors, physical activity behaviors, and sedentary behaviors that may affect weight in children and adolescents. We also review studies of multidisciplinary behavior-based obesity treatment programs and information about more aggressive forms of treatment. The writing group has drawn from the available evidence to propose a comprehensive 4-step or staged-care approach for weight management that includes the following stages: (1) Prevention Plus; (2) structured weight management; (3) comprehensive multidisciplinary intervention; and (4) tertiary care intervention. We suggest that providers encourage healthy behaviors while using techniques to motivate patients and families, and interventions should be tailored to the individual child and family. Although more intense treatment stages will generally occur outside the typical office setting, offices can implement less intense intervention strategies. We not ony address specific patient behavior goals but also encourage practices to modify office systems to streamline office-based care and to prepare to coordinate with professionals and programs outside the office for more intensive interventions.

Recommendations for prevention of childhood obesity

The majority of US youth are of healthy weight, but the majority of US adults are overweight or obese. Therefore, a major health challenge for most American children and adolescents is obesity prevention-today, and as they age into adulthood. In this report, we review the most recent evidence regarding many behavioral and practice interventions related to childhood obesity, and we present recommendations to health care providers. Because of the importance, we also suggest approaches that clinicians can use to encourage obesity prevention among children, including specific counseling strategies and practice-based, systems-level interventions. In addition, we suggest how clinicians may interact with and promote local and state policy initiatives designed to prevent obesity in their communities.

Beverage patterns, diet quality, and body mass index of US preschool and school-aged children

OBJECTIVE

To evaluate diet quality and body mass index (BMI) by beverage patterns in children aged 2 to 11 years.

DESIGN

Beverage patterns were formed using 24-hour dietary recall diet variables from the 2001-2002 National Health and Nutrition Examination Survey. Diet quality was assessed using energy, micronutrient intakes, and Healthy Eating Index (HEI) scores (a 100-point scale that measures adherence to the Dietary Guidelines for Americans).

SUBJECTS/SETTING

Children, aged 2 to 5 years (n=541) and 6 to 11 years (n=793), were selected from 2001-2002 National Health and Nutrition Examination Survey data.

STATISTICAL ANALYSIS

Cluster analysis was used to identify beverage patterns in preschool and school-aged children. General linear models were used to compare HEI scores, energy, micronutrient intakes, and BMI across beverage clusters.

RESULTS

Four and five beverage clusters were identified for preschool and school-aged children, respectively. In preschool children, mean HEI differed between the fruit juice cluster (79.0) vs the high-fat milk cluster (70.9, P<0.01); however, both fruit juice and high-fat milk clusters had the highest micronutrient intakes. Mean HEI differed significantly across beverage patterns for school-aged children (from 63.2 to 69.9, P<0.01), with the high-fat milk cluster having the best diet quality, reflected by HEI and micronutrient intakes. Adjusted mean BMI differed significantly across beverage clusters only in school-aged children (from 17.8 to 19.9, P<0.05).

CONCLUSIONS

Beverage patterns were related to diet quality among preschool and school-aged children, but were only related to BMI in school-aged children. Children from all clusters could benefit by consuming fewer calorically sweetened beverages and increasing micronutrient-dense foods.

Comparison of the intakes of sugars by young children with and without dental caries experience

BACKGROUND

Relationships among sugars and dental caries in contemporary societies are unclear. The authors describe young children's intakes of nonmilk extrinsic (NME) and intrinsic/milk sugars and relate those intakes to dental caries.

METHODS

The authors conducted cross-sectional analyses of dietary data collected from the Iowa Fluoride Study using three-day diaries for subjects at ages 1, 2, 3, 4 and 5 years and for subjects aged 1 through 5 years according to dental caries experience at 4.5 to 6.9 years of age. They categorized foods and beverages as containing NME or intrinsic/milk sugars.

RESULTS

Subjects' total, NME, food NME and intrinsic/milk sugars intakes at ages studied did not differ between subjects with and without caries experience. Beverage NME sugars intakes at age 3 years predicted caries (P < .05) in logistic regression models adjusted for age at dental examination and for fluoride intake.

CONCLUSIONS

Dental caries is a complex, multifactorial disease process dependent on the presence of oral bacteria, a fermentable carbohydrate substrate and host enamel. A simple NME-intrinsic/milk sugars categorization appears insufficient to capture the complex dietary component of the caries process.

CLINICAL IMPLICATIONS

Cariogenicity is more likely a function of the food and/or beverage vehicle delivering the sugar and the nature of exposure-that is, frequency and length of eating events-than of the sugar's categorization.

Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis

In a meta-analysis of 88 studies, we examined the association between soft drink consumption and nutrition and health outcomes. We found clear associations of soft drink intake with increased energy intake and body weight. Soft drink intake also was associated with lower intakes of milk, calcium, and other nutrients and with an increased risk of several medical problems (e.g., diabetes). Study design significantly influenced results: larger effect sizes were observed in studies with stronger methods (longitudinal and experimental vs cross-sectional studies). Several other factors also moderated effect sizes (e.g., gender, age, beverage type). Finally, studies funded by the food industry reported significantly smaller effects than did non-industry-funded studies. Recommendations to reduce population soft drink consumption are strongly supported by the available science.

Are dietary intakes and eating behaviors related to childhood obesity? A comprehensive review of the evidence

The purpose of this article is to comprehensively review studies that have examined the relation between diet and childhood obesity. The review specifically considers the roles of total energy intake and energy density; dietary composition; individual foods, food groups, and dietary patterns; beverage consumption; and eating behaviors. The paper also discusses methodological considerations and future research directions and concludes by summarizing the evidence presented and highlighting the ethical issues surrounding providing dietary advice.

Meeting adequate intake for dietary calcium without dairy foods in adolescents aged 9 to 18 years (National Health and Nutrition Examination Survey 2001-2002)

BACKGROUND

In the United States, >50% of dietary calcium is provided by milk and milk products. Calcium intakes in the United States are inadequate for many children, and a large proportion do not drink milk or consume dairy products. However, no studies have addressed whether dairy-free diets can provide adequate calcium while meeting other nutrient recommendations.

OBJECTIVE

To determine the highest calcium intake for adolescents obtained from dairy-free diets, and to examine the relationship between intakes of calcium-fortified foods, using citrus juice as an example, and maximal calcium intakes.

DESIGN

In the National Health and Nutrition Examination Survey 2001 to 2002, 65 females and 62 males, aged 9 to 18 years, reported no intake of dairy. We used linear programming to generate diets with maximal calcium intake, while meeting Dietary Reference Intakes for a set of nutrients, limiting energy and fat intakes, and not selecting food quantities exceeding amounts usually eaten in the population.

RESULTS

With food use and energy and fat constraints, diets formulated by linear programming provided 1,150 and 1,411 mg/day of calcium for girls and boys, respectively. With the Dietary Reference Intakes constraints, these decreased to 869 and 1,160 mg/day. When we introduced 1.5 servings of fortified juice to the diets, the highest calcium intake increased to 1,302 mg/day for girls and to 1,640 mg/day for boys.

CONCLUSIONS

Adequate intake for calcium cannot be met with dairy-free diets while meeting other nutrient recommendations. To meet the adequate intake for calcium without large changes in dietary patterns, calcium-fortified foods are needed. In addition, greater physical activity and responsible sunlight exposure should be encouraged to promote vitamin D adequacy.

Fruit juice intake predicts increased adiposity gain in children from low-income families: weight status-by-environment interaction

OBJECTIVE

Our goal was to test the hypothesis that increased fruit juice intake and parental restriction of children's eating are associated with increased adiposity gain and whether exposure to nutritional counseling predicted reduced adiposity gain among children.

PATIENTS AND METHODS

A sample of parents or guardians of children aged 1 to 4 years who attended 1 of 49 Special Supplemental Nutrition Program for Women, Infants, and Children agencies in New York State were surveyed in 1999 or 2000 (N = 2801). The survey addressed children's dietary intake, parental feeding practices, and parental exposure to nutritional counseling messages to increase fruit, vegetable, and low-fat milk intakes. Each child's height and weight were measured approximately every 6 months for up to 48 months. A prospective cohort design was used in which survey variables were the predictors and the outcome was change in children's adiposity, defined as change in age- and gender-standardized BMI per month (ie, BMI z-score slope).

RESULTS

Controlling for gender and ethnicity, the relationship between juice intake and adiposity gain depended on children's initial overweight status. Among children who were initially either at risk for overweight or overweight, increased fruit juice intake was associated with excess adiposity gain, whereas parental offerings of whole fruits were associated with reduced adiposity gain. Each additional daily serving of fruit juice was associated with an excess adiposity gain of 0.009 SD per month. Feeding restriction was greater among parents whose children were initially at risk for overweight or overweight compared with those at a healthy weight. Parental exposure to nutritional messages was not associated with reduced child adiposity gain.

CONCLUSION

This study supports the Institute of Medicine recommendations to reduce fruit juice intake as a strategy for overweight prevention in high-risk children.