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Louey J, He J, Partridge SR, Allman-Farinelli M. Facilitators and barriers to healthful eating among adolescents in high-income countries: A mixed-methods systematic review. Obes Rev 2024; 25:e13813. [PMID: 39147385 DOI: 10.1111/obr.13813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 07/17/2024] [Accepted: 07/25/2024] [Indexed: 08/17/2024]
Abstract
Adolescent obesity continues to be a public health challenge with poor quality diets contributing to its etiology. As part of the process to plan health promotion and policy interventions, understanding adolescents perceived facilitators and barriers to healthful eating is important. An integrative convergent mixed-methods systematic review was used to synthesize qualitative and quantitative evidence from studies among adolescents aged 10-19 years in high-income countries. Medline, Embase, PsycInfo, and Scopus were searched for peer-reviewed articles published between 2010 and 2023 and exploring adolescents' perspectives on healthful eating and contemporary contextual factors. Transformed quantitative data were integrated with qualitative data. Text was coded into subthemes and themes using an inductive approach. Key facilitators included health and physical appearance; motivation; taste; nutrition knowledge, awareness, and skills; nutrition education access; availability and accessibility of healthful foods; family; and social influences and digital media. Key barriers included taste and cravings for unhealthful foods; mood; lack of motivation, awareness, knowledge, and skills; high availability and low cost of unhealthful foods; peers and social influences; ineffective school policies; high density of fast-food outlets; unhealthful food advertising; digital influences; and time constraints. Social, behavioral, digital, and food environmental factors should be considered from an adolescent perspective in the design of education, health promotion, and policy interventions.
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Affiliation(s)
- Jennifer Louey
- Nutrition and Dietetics, Sydney School of Nursing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jingju He
- Nutrition and Dietetics, Sydney School of Nursing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie R Partridge
- Nutrition and Dietetics, Sydney School of Nursing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Margaret Allman-Farinelli
- Nutrition and Dietetics, Sydney School of Nursing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Norman Å, Malek ME, Nyberg G, Patterson E, Elinder LS. Effects of Universal School-Based Parental Support for Children's Healthy Diet and Physical Activity-the Healthy School Start Plus Cluster-Randomised Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:963-977. [PMID: 38987407 PMCID: PMC11390772 DOI: 10.1007/s11121-024-01697-4] [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] [Accepted: 06/03/2024] [Indexed: 07/12/2024]
Abstract
Health promotion from an early age is key to preventing unhealthy weight development in childhood, and parental involvement is essential. The school-based Healthy School Start intervention aims to promote healthy dietary and activity habits in the home environment and prevent child obesity through parental support. This study evaluated the effectiveness of the third iteration of the programme on children's dietary and activity behaviours, and body composition through a cluster-randomised controlled trial. The trial included 17 schools (8 intervention) in disadvantaged areas in mid-Sweden with 353 families with 5- to 7-year-old children. The primary outcomes were intake of selected healthy and unhealthy foods and beverages measured using photography. Secondary outcomes were physical activity and sedentary time measured by accelerometry, and measured weight and height. All outcomes were assessed at baseline and post-intervention (8 months). Linear multi-level regression showed significant favourable effects of the intervention for intake of sweet beverages (b = - 0.17, p = 0.04), intake of healthy foods (b = 0.11, p = 0.04), and more time in moderate to vigorous physical activity during weekdays (b = 5.68, p = 0.02). An unfavourable sub-group effect of the intervention was found for children from families with low education regarding sedentary time on weekends (b = 23.04, p = 0.05). The results align with the previous two trials of the programme, indicating that school-based parental support is a useful approach for health promotion in young children in disadvantaged areas. Trial registration: ClinicalTrials.gov: No. NCT03390725, retrospectively registered on January 4, 2018, https://clinicaltrials.gov/ct2/show/NCT03390725 .
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Affiliation(s)
- Åsa Norman
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden.
- Department of Clinical Neurosciences, Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden.
| | | | - Gisela Nyberg
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- The Swedish School of Sport and Health Sciences, Lidingövägen 1, 114 33, Stockholm, Sweden
| | - Emma Patterson
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- Section for Risk and Benefit Assessment, Swedish Food Agency, Box 622, 751 26, Uppsala, Sweden
| | - Liselotte Schäfer Elinder
- Department of Global Public Health, Karolinska Institutet, 171 77, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, 104 31, Stockholm, Sweden
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Mebarak M, Mendoza J, Romero D, Amar J. Healthy Life Habits in Caregivers of Children in Vulnerable Populations: A Cluster Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:537. [PMID: 38791757 PMCID: PMC11121232 DOI: 10.3390/ijerph21050537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 05/26/2024]
Abstract
Intervention programs aimed at mitigating the effects of chronic noncommunicable disease (CNDs) focus on promoting healthy lifestyle habits (HLH), especially in the early stages of life. Because of this, different typologies of caregivers have been identified according to HLH during middle childhood and adolescence. However, the available studies have focused on aspects such as nutrition, physical activity, and rest, ignoring other HLHs that are equally important for children's well-being. Likewise, few studies address HLH during the first five years of life and how caregivers affect children's health. In a sample of 544 caregivers of children aged zero to five years from low-income Colombian communities, we established a typology of attitudes toward different HLHs. The results indicate the presence of three clusters that grouped caregivers with (1) positive attitudes toward all HLHs, (2) toward some HLHs, and (3) relatively low positive attitudes toward all HLHs. Membership in clusters with less positive attitudes toward HLHs was also found to be associated with low educational levels and living in rural areas. This study detected profiles of caregivers who may have unhealthy lifestyles, so the results would allow social workers to design differential interventions on HLHs in non-industrialized countries.
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Affiliation(s)
- Moisés Mebarak
- Human Development Research Center, Universidad del Norte, Barranquilla 080020, Colombia; (M.M.); (J.A.)
- Department of Psychology, Universidad del Norte, Barranquilla 080020, Colombia;
| | - Juan Mendoza
- Department of Psychology, Universidad del Norte, Barranquilla 080020, Colombia;
| | - Duban Romero
- Human Development Research Center, Universidad del Norte, Barranquilla 080020, Colombia; (M.M.); (J.A.)
| | - José Amar
- Human Development Research Center, Universidad del Norte, Barranquilla 080020, Colombia; (M.M.); (J.A.)
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Wright-Pedersen S, Vidgen H, Abigail Badejo F, Gallegos D. The extent and nature of children's involvement in food practice research: a scoping review of qualitative studies. Public Health Nutr 2023; 26:2836-2848. [PMID: 37746758 PMCID: PMC10755441 DOI: 10.1017/s1368980023001891] [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] [Received: 04/29/2023] [Revised: 08/20/2023] [Accepted: 08/29/2023] [Indexed: 09/26/2023]
Abstract
OBJECTIVE Aligning with the United Nations Convention on the Rights of the Child, amplification of children's voice in food practice research aims to inform initiatives that cater to children's needs and thus improve nutritional outcomes. The aim of this study was to describe children's (aged 6-11 years) involvement across qualitative research investigating their food practice perspectives. DESIGN A scoping review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). Six electronic databases were searched up until March 2023 (Cochrane, CINAHL, Embase, ERIC, Medline and PsychInfo). The Wellcome Framework for young people's involvement in health research guided data extraction. Data were described according to inclusiveness, geography, food-related study topic, research stage and method, and child involvement. RESULTS The search identified 120 peer-reviewed studies (134 papers). Active participation was only seen within research implementation stages (i.e. data collection (n 134), analysis (n 31), dissemination (n 9) and re-design (n 7)). More passive forms of participation were identified in research design stages (i.e. agenda setting, resourcing and design). Studies that utilised participatory research methodologies and developmentally appropriate and engaging methods (e.g. PhotoVoice) saw more active participation by children. CONCLUSION This review identified a lack of opportunities for children's active participation in all stages of food practice research. Without a radical shift towards providing these opportunities, food and nutrition initiatives, policies or further research that do not meet the needs of children's food-related worlds will continue to be developed. Instead, researchers and their institutions need to advocate for and, where possible, provide voluntary opportunities for children to actively participate in food practice research.
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Affiliation(s)
- Sophie Wright-Pedersen
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), 62 Graham Street, South Brisbane, QLD4101, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), 149 Victoria Park Road, Kelvin Grove, QLD4059, Australia
| | - Helen Vidgen
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), 149 Victoria Park Road, Kelvin Grove, QLD4059, Australia
| | - Foluke Abigail Badejo
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), 62 Graham Street, South Brisbane, QLD4101, Australia
| | - Danielle Gallegos
- Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology (QUT), 62 Graham Street, South Brisbane, QLD4101, Australia
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology (QUT), 149 Victoria Park Road, Kelvin Grove, QLD4059, Australia
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Konner M, Eaton SB. Hunter-gatherer diets and activity as a model for health promotion: Challenges, responses, and confirmations. Evol Anthropol 2023; 32:206-222. [PMID: 37417918 DOI: 10.1002/evan.21987] [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] [Received: 09/19/2021] [Revised: 07/27/2022] [Accepted: 04/17/2023] [Indexed: 07/08/2023]
Abstract
Beginning in 1985, we and others presented estimates of hunter-gatherer (and ultimately ancestral) diet and physical activity, hoping to provide a model for health promotion. The Hunter-Gatherer Model was designed to offset the apparent mismatch between our genes and the current Western-type lifestyle, a mismatch that arguably affects prevalence of many chronic degenerative diseases. The effort has always been controversial and subject to both scientific and popular critiques. The present article (1) addresses eight such challenges, presenting for each how the model has been modified in response, or how the criticism can be rebutted; (2) reviews new epidemiological and experimental evidence (including especially randomized controlled clinical trials); and (3) shows how official recommendations put forth by governments and health authorities have converged toward the model. Such convergence suggests that evolutionary anthropology can make significant contributions to human health.
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Affiliation(s)
- Melvin Konner
- Department of Anthropology, Program in Anthropology and Human Biology, Emory University, Atlanta, Georgia, USA
| | - S Boyd Eaton
- Department of Radiology, Emory University School of Medicine (Emeritus), Adjunct Lecturer, Department of Anthropology, Emory University, Atlanta, Georgia, USA
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Beşparmak A, Kaya N. Adaptation of the Food Literacy Questionnaire for school children to Turkish: validity and reliability study. Eur J Pediatr 2023:10.1007/s00431-023-05010-3. [PMID: 37165075 DOI: 10.1007/s00431-023-05010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 04/11/2023] [Accepted: 04/28/2023] [Indexed: 05/12/2023]
Abstract
Food literacy is the ability to understand the nature of food and its level of importance, to obtain, process, analyze, and use information about food. This study aims to translate and cross-culturally adapt the Food Literacy Questionnaire for school children (FLQ-sc) into Turkish and to study its psychometric properties of reliability and validity. The study was conducted with 303 students aged 12-14 in Kayseri, Turkey. A pilot study was conducted with 36 students, and a test-retest was conducted with 219 students, 2 weeks after the first study was performed. Data were collected with the sociodemographic data form and FLQ-sc. Linguistic, content, face, and construct validity were evaluated for validity. Cronbach's alpha and intraclass correlation coefficients (ICCs) were calculated for the reliability evaluation. Model validity was tested with confirmatory factor analysis. Root mean square error of approximation (RMSEA), χ2/SD, and goodness-of-fit index (GFI) statistics were in good agreement. Comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square error of approximation (SRMR) statistics were at acceptable levels (RMSEA = 0.033, χ2/SD = 1.324, GFI = 0.958, CFI = 0.944, TLI = 0.939, SRMR = 0.063). The Cronbach's alpha coefficient for the total scale score was quite good (0.795). The ICC for test-retest reliability was good (0.874) for the total scale score. Conclusion: The Turkish version of the Food Literacy Questionnaire for school children (FLQ-sc) is a valid and reliable measurement tool and can be used to evaluate food literacy levels in Turkish children aged 12-14. What is Known: • It is important to acquire knowledge and skills in food literacy from childhood because the behaviors learned during childhood and adolescence regarding food intake and preparation continue into adulthood. • In addition to the limited scales evaluating the food literacy levels of children, there is no scale evaluating the food literacy levels of Turkish children between the ages of 12 and 14. What is New: • The Turkish version of FLQ-sc is a valid and reliable scale for evaluating the food literacy levels of Turkish school children. • Scale is a suitable tool to ensure the comparison of food literacy levels in different student groups and measure abstract concepts such as education.
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Affiliation(s)
- Aslıhan Beşparmak
- Department of Nutrition and Dietetics, Faculty of Health Science, Nuh Naci Yazgan University, Kayseri, Turkey.
| | - Neşe Kaya
- Department of Nutrition and Dietetics, Faculty of Health Science, Nuh Naci Yazgan University, Kayseri, Turkey
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Rizvi JZ, Kumar P, Kulkarni MM, Kamath A. Outcome of structured health education intervention for obesity-risk reduction among junior high school students: Stratified cluster randomized controlled trial (RCT) in South India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:400. [PMID: 36824075 PMCID: PMC9942130 DOI: 10.4103/jehp.jehp_369_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Obesity has been identified as a serious global health concern whose prevalence doubles almost every 10 years. Health education regarding physical activity and healthy diet imparted to adolescents could prove to be fruitful in reducing obesity-risk. Objectives of this study were to evaluate the effect of health education intervention on knowledge, attitude, and practices (KAP) regarding obesity-risk reduction and to estimate the postinterventional change in body mass index (BMI) and total body fat (%) among adolescent school children in South India. MATERIALS AND METHODS Stratified cluster randomized controlled trial was carried out among 398 students recruited at baseline including 206 and 192 participants in intervention and control group respectively selected through simple random sampling from eligible government aided and private schools to assess KAP regarding physical activity and diet using pretested and validated questionnaire by making three school visits 6 months apart. Anthropometric measurements were recorded in first and third visit only, while health education intervention was given in first visit to intervention and third visit to control group after taking their responses on the questionnaire. Data were entered and analyzed using SPSS version 15. RESULTS Overall dropout rate was 13.5% with dropout in intervention and control group being 12.6% and 14.5% respectively, making 180 participants in intervention and 164 in control group available for analysis. Mean physical activity KAP score improved significantly from 16.19 ± 4.61 to 19.46 ± 10.07 in intervention group. Mean dietary KAP score also improved significantly from 21.38 ± 4.07 to 23.43 ± 4.53 in intervention group (p < 0.001). Mean BMI decreased significantly within intervention group (p < 0.001) as compared to control group (p = 0.908). Based on cut-off level for total body fat (%) to categorize obesity-risk among participants, statistically significant decline in proportions from 26.1% to 13.3% was observed in intervention group (p < 0.001). CONCLUSION Results depicted better KAP in intervention group than control group in all the three visits while it improved significantly within both groups. Hence, the health education was found to be effective in improving the overall KAP regarding modifiable risk factors of obesity among the study participants. Further studies to screen the adolescents for obesity-risk and successive health education sessions must be carried within schools in order to bring about change in knowledge, attitude, and practices regarding obesity-risk.
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Affiliation(s)
- Jaun Z. Rizvi
- Department of Community Medicine, Mayo Institute of Medical Sciences, Gadia, Barabanki, Uttar Pradesh, India (225001), Ex-Postgraduate Student Cum Tutor, Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pawan Kumar
- Principal and Controller, RVRS Government Medical College, Bhilwara, Rajasthan, India (311001), Ex- Professor, Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Muralidhar M. Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Asha Kamath
- Department of Data Science, Manipal Academy of Higher Education, Manipal, Karnataka (576104), Ex- Associate Professor (Biostatistics), Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Shang HT, Ouyang Z, Chen C, Duan CF, Bai T, Hou XH. Prevalence and risk factors of belching disorders: A cross-sectional study among freshman college students. J Dig Dis 2022; 23:705-712. [PMID: 36779520 DOI: 10.1111/1751-2980.13159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVES Belching disorders seriously affect quality of life; however, their prevalences and risk factors remain unknown. The aim of our study was to determine the prevalence and risk factors, particularly lifestyle factors, of belching disorders among freshman college students in central China. METHODS A cross-sectional study was conducted in September 2019 in Huazhong University of Science and Technology (Wuhan, Hubei Province, China). The subjects were asked to complete a self-administered questionnaire for data collection, including sociodemographic information, lifestyle factors, and gastrointestinal symptoms. Belching disorder was diagnosed based on the Rome IV criteria. Univariate and multivariate logistic regression analyses were performed to determine the risk factors for belching disorders. RESULTS A total of 3335 subjects were enrolled, and 78.26% were men. Among them, 1.95% (65/3335) reported belching disorders. Significant differences in the Pittsburgh Sleep Quality Index (PSQI), Student-Life Stress Inventory (SLSI) scores, and consumption of whole grains, black tea, coffee were found between the belching and non-belching groups. Multivariate logistic regression analysis showed that coffee consumption at least once weekly and a high total SLSI score (over mean + standard deviation) were independent risk factors for belching disorders, while intake of whole grains at least once weekly was a protective factor. CONCLUSIONS Excessive belching is a common disorder among freshman college students in central China. Lifestyle factors, including consumption of whole grains and coffee, and stress, were associated with belching disorders. Therefore, dietary intervention may be a potential management for belching disorders.
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Affiliation(s)
- Hai Tao Shang
- Department of Gastroenterology, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong Province, China
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Zhen Ouyang
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Can Chen
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Chao Fan Duan
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Tao Bai
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Xiao Hua Hou
- Division of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
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9
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Melguizo-Ibáñez E, González-Valero G, Puertas-Molero P, Alonso-Vargas JM. Emotional Intelligence, Physical Activity Practice and Mediterranean Diet Adherence-An Explanatory Model in Elementary Education School Students. CHILDREN 2022; 9:children9111770. [PMID: 36421219 PMCID: PMC9688524 DOI: 10.3390/children9111770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/01/2022] [Accepted: 11/17/2022] [Indexed: 11/19/2022]
Abstract
Currently, there is a global concern with regard to the lifestyles of young people. This study aims to study the association between Mediterranean diet adherence, emotional intelligence and physical activity practice in teenagers in the last cycle of elementary education. In turn, this objective is divided into (a) developing an explanatory model of the practice of physical activity, Mediterranean diet adherence and emotional intelligence; and (b) developing a multi-group model according to the gender of the participants. A descriptive, cross-sectional, comparative study was conducted in a sample of 293 elementary school students (M = 11.45; S.D = 0.31). The instruments used were an ad hoc socio-demographic questionnaire, the Trait Meta Mood Scale-24, the KIDMED questionnaire and the Physical Activity Questionnaire for Older Children. The results show that males show a positive relationship between adherence to the Mediterranean diet and emotional intelligence and between emotional intelligence and physical activity. In contrast, in the case of females, a negative relationship was observed between emotional intelligence and physical activity. In conclusion, it can be seen that gender plays a fundamental role in adolescence, being a key factor influencing an active and healthy lifestyle.
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Arlinghaus KR, Stang JS. Population-Engaged Approaches to Improving Adolescent Nutrition. J Nutr 2021; 151:1371-1372. [PMID: 33978161 DOI: 10.1093/jn/nxab111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/18/2021] [Accepted: 03/26/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Katherine R Arlinghaus
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
| | - Jamie S Stang
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, MN, USA
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11
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Weiss MR, Allen ML, Landeo-Gutierrez JS, Lew JP, Aziz JK, Mintz SS, Lawlor CM, Becerra BJ, Preciado DA, Nino G. Defining the patterns of PAP adherence in pediatric obstructive sleep apnea: a clustering analysis using real-world data. J Clin Sleep Med 2021; 17:1005-1013. [PMID: 33538691 DOI: 10.5664/jcsm.9100] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY OBJECTIVES The implementation of positive airway pressure (PAP) therapy to treat obstructive sleep apnea in children is a complex process. PAP therapy data are highly heterogeneous in pediatrics, and the clinical management cannot be generalized. We hypothesize that pediatric PAP users can be subgrouped via clustering analysis to guide tailored interventions. METHODS PAP therapy data for 250 children with obstructive sleep apnea were retrospectively examined using unsupervised hierarchical cluster analysis based on (1) PAP tolerance (average hours on days used) and (2) consistency of PAP use (percentage of days used). Clinical features in each cluster were defined, and a tree decision analysis was generated for clinical implementation. RESULTS We were able to subclassify all 250 children (median age = 11.5 years) into five clusters: A (13.6%), B (29.6%), C (17.6%), D (16.4%), and E (22.8%). The clusters showed significant differences in PAP use patterns (Kruskal-Wallis P value < 1e-16). The most consistent PAP use patterns were seen in clusters A, B, and C. Major differences across clusters included the prevalence of obesity, PAP setting, developmental delay, and adenotonsillectomy. We also identified important differences in mask acceptance, OSA severity, and individual responses to PAP therapy based on objective apnea-hypopnea reductions in PAP downloads. CONCLUSIONS A simple method to subset PAP use patterns in children can be implemented by analyzing cloud-based PAP therapy data. This novel approach may contribute to optimization of PAP therapy in children of all ages based on real-world evidence at the individual level.
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Affiliation(s)
- Miriam R Weiss
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC
| | - Michelle L Allen
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC
| | - Jeremy S Landeo-Gutierrez
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC.,Department of Pediatrics, George Washington University, Washington, DC
| | - Jenny P Lew
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC.,Department of Pediatrics, George Washington University, Washington, DC
| | - Julia K Aziz
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC.,Department of Pediatrics, George Washington University, Washington, DC
| | - Sylvan S Mintz
- Department of Pediatrics, George Washington University, Washington, DC
| | - Claire M Lawlor
- Department of Pediatrics, George Washington University, Washington, DC.,Division of Pediatric Otorhinolaryngology, Children's National Hospital, George Washington University, Washington, DC
| | - Benjamin J Becerra
- Department of Information and Decision Sciences, California State University, San Bernardino, California
| | - Diego A Preciado
- Department of Pediatrics, George Washington University, Washington, DC.,Division of Pediatric Otorhinolaryngology, Children's National Hospital, George Washington University, Washington, DC
| | - Gustavo Nino
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, George Washington University, Washington, DC.,Department of Pediatrics, George Washington University, Washington, DC
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12
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Bailey AD, Fulgoni III VL, Shah N, Patterson AC, Gutierrez-Orozco F, Mathews RS, Walsh KR. Nutrient Intake Adequacy from Food and Beverage Intake of US Children Aged 1-6 Years from NHANES 2001-2016. Nutrients 2021; 13:nu13030827. [PMID: 33802295 PMCID: PMC8002201 DOI: 10.3390/nu13030827] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 02/26/2021] [Accepted: 02/28/2021] [Indexed: 11/26/2022] Open
Abstract
The early years, between the ages of one and six, are a period of rapid physical, social and cognitive growth and a nutritionally adequate diet is an important factor for optimum development. We investigated the micronutrient adequacy and status of young US children aged 1–6 years (n = 9848) using 24-h dietary recall interviews completed by parents and caregivers participating in the National Health and Nutrition Examination Survey (NHANES) 2001–2016. data. The proportion of the sample not meeting the Dietary Reference Intakes (DRI) increased with increasing age and was most pronounced for calcium. Despite adequate iron intake, 7.4% and 2.5% had signs of iron deficiency and anemia based on serum ferritin and hemoglobin levels, with younger children and WIC participants at most risk and Non-Hispanic Black children the least. Vitamin B6 intake was adequate, but 6.4% had serum pyridoxal-5-phosphate deficiency. For vitamin E, 69% had intakes below the estimated average requirement (EAR), yet serum deficiency was only detected in 0.9%. Vitamin D intake was inadequate for 87%, but true deficiency may be overestimated. Mean DHA intake was 24 mg/d, well below expert recommendations of 70–100 mg/day. Iron and vitamin B6 deficiency and inadequate calcium, fiber, choline, potassium and DHA intakes are a concern for a significant percentage of young children. The discrepancy between nutrient intakes and serum deficiency levels needs to be further investigated.
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Affiliation(s)
- Ariana D.L. Bailey
- Medical and Scientific Affairs, RB|Mead Johnson Nutrition Institute, Evansville, IN 47721, USA; (N.S.); (A.C.P.); (F.G.-O.); (K.R.W.)
- Correspondence:
| | | | - Neil Shah
- Medical and Scientific Affairs, RB|Mead Johnson Nutrition Institute, Evansville, IN 47721, USA; (N.S.); (A.C.P.); (F.G.-O.); (K.R.W.)
- Gastroenterology Department, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Ashley C. Patterson
- Medical and Scientific Affairs, RB|Mead Johnson Nutrition Institute, Evansville, IN 47721, USA; (N.S.); (A.C.P.); (F.G.-O.); (K.R.W.)
| | - Fabiola Gutierrez-Orozco
- Medical and Scientific Affairs, RB|Mead Johnson Nutrition Institute, Evansville, IN 47721, USA; (N.S.); (A.C.P.); (F.G.-O.); (K.R.W.)
| | | | - Kelly R. Walsh
- Medical and Scientific Affairs, RB|Mead Johnson Nutrition Institute, Evansville, IN 47721, USA; (N.S.); (A.C.P.); (F.G.-O.); (K.R.W.)
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