Shifts in the recent distribution of energy intake among U.S. children aged 2-18 years reflect potential abatement of earlier declining trends

Trends and Urban-Rural Disparities of Energy Intake and Macronutrient Composition among Chinese Children: Findings from the China Health and Nutrition Survey (1991 to 2015)

The nutrition status of children is gaining more attention with a rapid nutrition transition. This study aimed to investigate trends and urban-rural differences in dietary energy and macronutrient composition among Chinese children. A total of 7565 participants aged 6 to 17 years were obtained from three rounds (1991, 2004 and 2015) of the Chinese Health and Nutrition Survey (CHNS). The individual diet was evaluated via three consecutive 24-hour dietary recalls and compared with the Chinese Dietary Reference Intakes (DRIs). From 1991 to 2015, there was a significant increase in children’s fat intake, the proportion of energy intake from fat, and the proportion of children with more than 30% of energy from fat and less than 50% of energy from carbohydrates (p < 0.001). Compared with the DRI, the proportion with higher fat and lower carbohydrate intakes were, respectively, 64.7% and 46.8% in 2015. The urban-rural disparities in fat and carbohydrate intake gradually narrowed, while the gap in protein intake increased notably over time (p < 0.001). Chinese children experienced a rapid transformation to a low-carbohydrate and high-fat diet. Urban-rural disparities persistently existed; further nutritional interventions and education were of great significance, so as to ensure a more balanced diet for Chinese children.

Impact of promoting healthy infant feeding practices on energy intake and anthropometric measures of children up to 6 years of age: A randomised controlled trial

BACKGROUND

The first 2 years of life are the window of opportunity to promote healthy feeding practices. Thus, the present study aimed to assess the impact of a health workers training in infant dietary guidelines on energy intake and anthropometric measurement into childhood.

METHODS

Cluster randomised field trial (NCT00635453) was conducted in Porto Alegre, Brazil. Healthcare centres were randomised into intervention (n = 9) and control (n = 11) groups. In intervention sites, health workers were trained to promote healthy feeding practices based on the Brazilian guideline for children's nutrition. Pregnant women who were in the last trimester of pregnancy were registered as potential mothers who would receive dietary counselling from the health workers. Energy and macronutrient intake and anthropometric measurements were obtained from children at ages 6 months, 12 months, 3 years and 6 years from low-income families.

RESULTS

At age 3 years, intervention group had lower consumption of energy [-92.5 kcal; 95% confidence interval (CI) = -153.5 to -31.5], carbohydrates (-11.9 g; 95% CI = -19.9 to -2.3), and total fat (-3.9 g; 95% CI = -6.2 to -1.2), compared to the control group. At 6 years of age, children in the intervention group had lower waist circumference (-1.3 cm; 95% CI = -2.7 to -0.0), triceps (-1.3 mm; 95% CI = -2.5 to -0.0) and subscapular skinfolds (-1.3 mm; 16 95% CI = -2.6 to -0.0) thickness measurements compared to those in the control group.

CONCLUSIONS

The health workers training to promote infant healthy feeding practices resulted in lower energy, carbohydrates and fat intake at 3 years and lower waist circumference, triceps and subscapular skinfolds measurements at 6 years.

The longitudinal relationship between dietary intake, physical activity and muscle strength among adolescents

The longitudinal relationship between muscle strength, dietary intake and physical activity among adolescents is not well understood. We investigated the trend and longitudinal effects of dietary intakes and physical activity scores on muscle strength in adolescents. This prospective cohort study consisted of 436 adolescents (134 males; 302 females) aged 13 years at baseline (2012) who were followed up at the ages of 15 (2014) and 17 (2016) years, respectively. We measured muscle strength using a calibrated hand dynamometer, estimated dietary intake with a 7-d dietary history and physical activity scores with a validated physical activity questionnaire for older children. A generalised estimating equation was used to examine the effect of dietary intakes and physical activity on muscle strength changes. The analysis was performed separately by sex. The muscle strength for males and females had increased within the 5-year period. The dietary intakes (energy and macronutrients) also increased initially but plateaued after the age of 15 years for both sexes. Females recorded a significant declining trend in physical activity scores compared with males as they grew older. A significant positive longitudinal relationship was found between protein (β = 0·035; P = 0·016), carbohydrate intake (β = 0·002; P = 0·013) and muscle strength among males. However, no longitudinal relationship was found between dietary intake, physical activity and muscle strength among females. Higher protein and carbohydrate intake among males was associated with higher muscle strength but was not observed in females. Nutrition and physical activity focusing on strength building are required in early adolescence and need to be tailored to males and females accordingly.

A Clinical Trial to Increase Self-Monitoring of Physical Activity and Eating Behaviors Among Adolescents: Protocol for the ImPACT Feasibility Study

Background

Severe obesity among youths (BMI for age≥120th percentile) has been steadily increasing. The home environment and parental behavioral modeling are two of the strongest predictors of child weight loss during weight loss interventions, which highlights that a family-based treatment approach is warranted. This strategy has been successful in our existing evidence-based pediatric weight management program, Brenner Families in Training (Brenner FIT). However, this program relies on face-to-face encounters, which are limited by the time constraints of the families enrolled in treatment.

Objective

This study aims to refine and test a tailored suite of mobile health (mHealth) components to augment an existing evidence-based pediatric weight management program.

Methods

Study outcomes will include acceptability from a patient and clinical staff perspective, feasibility, and economic costs relative to the established weight management protocol alone (ie, Brenner FIT vs Brenner FIT + mHealth [Brenner mFIT]). The Brenner mFIT intervention will consist of 6 mHealth components designed to increase patient and caregiver exposure to Brenner FIT programmatic content including the following: (1) a mobile-enabled website, (2) dietary and physical activity tracking, (3) caregiver podcasts (n=12), (4) animated videos (n=6) for adolescent patients, (5) interactive messaging, and (6) in-person tailored clinical feedback provided based on a web-based dashboard. For the study, 80 youths with obesity (aged 13-18 years) and caregiver dyads will be randomized to Brenner FIT or Brenner mFIT. All participants will complete baseline measures before randomization and at 3- and 6-month follow-up points.

Results

This study was approved by the Institutional Review Board in July 2019, funded in August 2019, and will commence enrollment in April 2020. The results of the study are expected to be published in the fall/winter of 2021.

Conclusions

The results of this study will be used to inform a large-scale implementation-effectiveness clinical trial.

International Registered Report Identifier (IRRID)

PRR1-10.2196/18098

Nutritional problems in childhood and adolescence: a narrative review of identified disparities

To inform programmes and policies that promote health equity, it is essential to monitor the distribution of nutritional problems among young individuals. Common nutritional problems include overall low diet quality, the underconsumption and overconsumption of certain dietary components, unhealthy meal and snack patterns, problematic feeding practices and disordered eating. The objective of the present narrative review was to summarise recent evidence of disparities among US children (2-19 years) according to age, sex, socio-economic status, ethnicity/race and rural-urban location. Searches in PubMed® and MEDLINE® were completed to identify peer-reviewed research studies published between January 2009 and January 2019. Findings from the ninety-nine reviewed studies indicate adolescent females, young individuals from lower socio-economic households and individuals who identify as non-Hispanic Black race are particularly vulnerable populations for whom targeted strategies should be developed to address evidence of increased risk with regards to multiple aspects of nutritional wellbeing. Limitations of the existing evidence relate to the accuracy of self-reported dietary data; the need for consistent definitions of disordered eating; the focus on individual dietary components v. patterns; the complexities of categorising socio-economic status, ethnicity/race, and rural and urban areas; and the cross-sectional, observational nature of most research designs. There is an urgent need for research to address these limitations and fill a large gap in evidence on rural-urban differences in nutritional problems. It will further be important for future studies to build greater understanding of how nutritional problems cluster among population groups.

Patterns and trends in the intake distribution of manufactured and homemade sugar-sweetened beverages in pre-tax Mexico, 1999-2012

OBJECTIVE

To describe trends across the intake distribution of total, manufactured and homemade sugar-sweetened beverages (SSB) from 1999 to 2012, focusing on high SSB consumers and on changes by socio-economic status (SES) subgroup.

DESIGN

We analysed data from one 24 h dietary recall from two nationally representative surveys. Quantile regression models at the 50th, 75th and 90th percentiles of energy intake distribution of SSB were used.

SETTING

1999 Mexican National Nutrition Survey and 2012 Mexican National Health and Nutrition Survey.ParticipantsSchool-aged children (5-11 years) and women (20-49 years) for trend analyses (n 7718). Population aged &gt;1 year for 2012 (n 10 096).

RESULTS

Over the 1999-2012 period, there were significant increases in the proportion of total and manufactured SSB consumers (5·7 and 10·7 percentage points), along with an increase in per-consumer SSB energy intake, resulting in significant increases in per-capita total SSB energy intake (142, 247 and 397 kJ/d (34, 59 and 95 kcal/d) in school-aged children and 155, 331 and 456 kJ/d (37, 79 and 109 kcal/d) in women at the 50th, 75th and 90th percentile, respectively). Total and manufactured SSB intakes increased sharply among low-SES children but remained similar among high-SES children during this time span.

CONCLUSIONS

Large increases in SSB consumption were seen between 1999 and 2012 during this pre-tax SSB period, particularly for the highest consumers. Trends observed in school-aged children are a clear example of the nutrition transition experienced in Mexico. Policies to discourage high intake of manufactured SSB should continue, joined with strategies to encourage water and low-calorie beverage consumption.

Obesity in Type 1 Diabetes: Pathophysiology, Clinical Impact, and Mechanisms

There has been an alarming increase in the prevalence of obesity in people with type 1 diabetes in recent years. Although obesity has long been recognized as a major risk factor for the development of type 2 diabetes and a catalyst for complications, much less is known about the role of obesity in the initiation and pathogenesis of type 1 diabetes. Emerging evidence suggests that obesity contributes to insulin resistance, dyslipidemia, and cardiometabolic complications in type 1 diabetes. Unique therapeutic strategies may be required to address these comorbidities within the context of intensive insulin therapy, which promotes weight gain. There is an urgent need for clinical guidelines for the prevention and management of obesity in type 1 diabetes. The development of these recommendations will require a transdisciplinary research strategy addressing metabolism, molecular mechanisms, lifestyle, neuropsychology, and novel therapeutics. In this review, the prevalence, clinical impact, energy balance physiology, and potential mechanisms of obesity in type 1 diabetes are described, with a special focus on the substantial gaps in knowledge in this field. Our goal is to provide a framework for the evidence base needed to develop type 1 diabetes-specific weight management recommendations that account for the competing outcomes of glycemic control and weight management.

Dietary intake and lifestyle behaviors of children in Mauritius

The purpose of the study was to explore the dietary intake, fruit, vegetable and energy intake and lifestyle behaviors among Mauritian children. A validated questionnaire was used, assessing dietary intake, mean energy intake, mean body mass index (BMI), lifestyle behaviors as well as nutritional knowledge (NK) among males and females. 336 children aged 6–12 years (165 males and 171 females) from 8 public primary schools were recruited. Statistical analyses revealed that children consumed less nutritious foods such as fruits, vegetables and whole grains and more of refined and calorie-laden foods, with no significant differences across genders. Mean energy intake of children was 1522 ± 282.4 kcal per day while mean BMI was 17.5 ± 4.03 kg/m². Majority of children had a low-to-moderate physical activity level (PAL), with males being more active than females on average (P = 0.021). 88.7% of children watched TV for more than an hour daily, with 84.8% of them reporting to be eating during the process. Females were more likely to be breakfast skippers (P = 0.003). Maximum frequency of snacking was twice daily (72.7%) while consumption of fast food was once or twice weekly (44.0%). Results indicate the need for intervention with aim of improving the dietary and life quality of children in Mauritius.

Hypervulnerability of the adolescent prefrontal cortex to nutritional stress via reelin deficiency

Overconsumption of high-fat diets (HFDs) can critically affect synaptic and cognitive functions within telencephalic structures such as the medial prefrontal cortex (mPFC). The underlying mechanisms, however, remain largely unknown. Here we show that adolescence is a sensitive period for the emergence of prefrontal cognitive deficits in response to HFD. We establish that the synaptic modulator reelin (RELN) is a critical mediator of this vulnerability because (1) periadolescent HFD (pHFD) selectively downregulates prefrontal RELN⁺ cells and (2) augmenting mPFC RELN levels using transgenesis or prefrontal pharmacology prevents the pHFD-induced prefrontal cognitive deficits. We further identify N-methyl-d-aspartate-dependent long-term depression (NMDA-LTD) at prefrontal excitatory synapses as a synaptic signature of this association because pHFD abolishes NMDA-LTD, a function that is restored by RELN overexpression. We believe this study provides the first mechanistic insight into the vulnerability of the adolescent mPFC towards nutritional stress, such as HFDs. Our findings have primary relevance to obese individuals who are at an increased risk of developing neurological cognitive comorbidities, and may extend to multiple neuropsychiatric and neurological disorders in which RELN deficiency is a common feature.

Added Sugars Intake Across the Distribution of US Children and Adult Consumers: 1977-2012

BACKGROUND

Public health organizations in the United States have recently increased focus on reducing population consumption of added sugars.

OBJECTIVE

The objective of this study is to provide in-depth information on national trends in added sugars consumption and to examine both the mean and distribution of added sugars intake from 1977 to 2012.

DESIGN

We conducted a descriptive study using six cross-sectional nationally representative surveys of food intake in the United States: the 1977-1978 National Food Consumption Survey (n=29,668), the 1989-1991 Continuing Survey of Food Intake by Individuals (n=14,827), the 1994-1998 Continuing Survey of Food Intake by Individuals (n=19,027), the 2003-2004 National Health and Nutrition Examination Survey (NHANES; n=8,273), the 2009-2010 NHANES (n=9,042), and the 2011-2012 NHANES (n=16,451).

STATISTICAL ANALYSIS

We examined the key dependent variables, calories from added sugars and percentage of total energy intake from added sugars, at the mean and by quintiles of added sugars consumption for children (2 to 18 years) and adults (19 years and older) across the survey years. We also examined trends in added sugars intakes from foods and beverages. We used ordinary least squares regression to examine linear trends between survey years and multinomial logistic regressions to examine sociodemographic characteristics by quintile of added sugars consumption. We adjusted estimates by race, income, sex, and education.

RESULTS

The US mean adjusted intake of added sugars remains high. In 2011-2012, children and adults consumed 326 kcal/day and 308 kcal/day, respectively, of added sugars, or 14% and 17%, respectively, of total their energy. For both children and adults, there was a considerable increase in calories from added sugars from 1977 to 2003, followed by a substantial decline from 2003 to 2012. There was no decline in the percentage of total energy intake from added sugars from 2003 to 2012. Changes over time were consistent across each quintile of added sugars consumption. The highest quintile of consumption was more likely to be male and in children was more likely to be non-Hispanic white.

CONCLUSIONS

Despite a decline in consumption of added sugars since 2003 in the United States, mean adjusted added sugars intakes continue to be above the recommended level of 10% of the total energy intake. Changes in added sugars consumption from 1977 through 2012 occurred evenly across the distribution of added sugars intakes.

Trends in racial/ethnic and income disparities in foods and beverages consumed and purchased from stores among US households with children, 2000-2013

BACKGROUND

It is unclear whether racial/ethnic and income differences in foods and beverages obtained from stores contribute to disparities in caloric intake over time.

OBJECTIVE

We sought to determine whether there are disparities in calories obtained from store-bought consumer packaged goods (CPGs), whether brands (name brands compared with private labels) matter, and if disparities have changed over time.

DESIGN

We used NHANES individual dietary intake data among households with children along with the Nielsen Homescan data on CPG purchases among households with children. With NHANES, we compared survey-weighted energy intakes for 2003-2006 and 2009-2012 from store and nonstore sources by race/ethnicity [non-Hispanic whites (NHWs), non-Hispanic blacks (NHBs), and Hispanic Mexican-Americans) and income [≤185% federal poverty line (FPL), 186-400% FPL, and >400% FPL]. With the Nielsen data, we compared 2000-2013 trends in calories purchased from CPGs (obtained from stores) across brands by race/ethnicity (NHW, NHB, and Hispanic) and income. We conducted random-effect models to derive adjusted trends and differences in calories purchased (708,175 observations from 64,709 unique households) and tested whether trends were heterogeneous by race/ethnicity or income.

RESULTS

Store-bought foods and beverages represented the largest component of dietary intake, with greater decreases in energy intakes in nonstore sources for foods and in store sources for beverages. Beverages from stores consistently decreased in all subpopulations. However, in adjusted models, reductions in CPG calories purchased in 2009-2012 were slower for NHB and low-income households than for NHW and high-income households, respectively. The decline in calories from name-brand food purchases was slower among NHB, Hispanic, and lowest-income households. NHW and high-income households had the highest absolute calories purchased in 2000.

CONCLUSIONS

Across 2 large data sources, we found decreases in intake and purchases of beverages from stores across racial/ethnic and income groups. However, potentially beneficial reductions in calories purchased were more pronounced in some subgroups over others.

Prevalence and characteristics of misreporting of energy intake in US children and adolescents: National Health and Nutrition Examination Survey (NHANES) 2003–2012

Using data from the National Health and Nutrition Examination Survey (NHANES) 2003–2012, we investigated the prevalence and characteristics of under- and over-reporting of energy intake (EI) among 14 044 US children and adolescents aged 2–19 years. For the assessment of EI, two 24-h dietary recalls were conducted with the use of the US Department of Agriculture Automated Multiple-Pass Method. Under-, plausible and over-reporters of EI were identified using two methods: based on the 95 % confidence limits (1) for agreement between the ratio of EI:BMR and a physical activity level for sedentary lifestyle (1·55) and (2) of the expected ratio of EI:estimated energy requirement (EER) of 1·0. BMR was calculated using Schofield’s equations. EER was calculated using equations from the US Dietary Reference Intakes, assuming ‘low active’ level of physical activity. The risk of being an under- or over-reporter compared with a plausible reporter was analysed using multiple logistic regression. Percentages of under-, plausible and over-reporters were 13·1, 81·5 and 5·4 %, respectively, based on EI:BMR and 18·8, 72·3 and 8·8 %, respectively, based on EI:EER. Under-reporting was associated with older age, non-Hispanic blacks (compared with non-Hispanic whites) and overweight and obesity (compared with normal weight). Over-reporting was associated with younger age, lower family poverty income ratio, normal weight and the first survey cycle. Similar findings were obtained when analysing only the first 24-h recall data from NHANES 1999–2012 (n 22 949). In conclusion, we found that EI misreporting remains prevalent and differential in US children and adolescents.

Creating Behavioral Vacuums

Screen media use has increased dramatically in children in the past decade, contributing to increasing rates of sedentary behavior in children. Excessive screen media use is related to poor social skills and increased likelihood of being overweight and obese. Behavioral economic theory has been used to examine the relationship between sedentary behavior and physical activity and whether an increase or decrease in one leads to a reciprocal response in the other. Health care providers should be aware of the behavioral “vacuum” that is created when patients are told to decrease sedentary behavior and assist patients with filling that void with nonsedentary behaviors.

Poor Adherence to US Dietary Guidelines for Children and Adolescents in the National Health and Nutrition Examination Survey Population

BACKGROUND

Poor diet quality in childhood and adolescence is associated with adverse health outcomes throughout life, yet the dietary habits of American children and how they change across childhood and adolescence are unknown.

OBJECTIVES

This study sought to describe diet quality among children and adolescents by assessing adherence to the 2010 Dietary Guidelines for Americans (DGA) and to determine whether any differences in adherence occurred across childhood.

DESIGN, SETTING, AND PARTICIPANTS

We employed a cross-sectional design using data from the National Health and Nutrition Examination Survey (NHANES). Of 9,280 children aged 4 to 18 years who participated in NHANES from 2005 to 2010, those with insufficient data on dietary recall (n=852) or who were pregnant or lactating during the time of interview (n=38) were excluded from the final study sample (n=8,390).

MAIN OUTCOME MEASURES

We measured adherence to the DGA using the Healthy Eating Index 2010 (HEI-2010) and stratified participants into three age groups (4 to 8, 9 to 13, and 14 to 18 years of age). We analyzed each of 12 HEI-2010 components and total HEI-2010 score.

RESULTS

The youngest children had the highest overall diet quality due to significantly greater scores for total fruit, whole fruit, dairy, and whole grains. These children also had the highest scores for sodium, refined grains, and empty calories. Total HEI-2010 scores ranged from 43.59 to 52.11 out of 100, much lower than the minimum score of 80 that is thought to indicate a diet associated with good health.

CONCLUSIONS

Overall, children and adolescents are failing to meet the DGA and may be at an increased risk of chronic diseases throughout life. By analyzing which food groups show differences between age groups, we provide data that can inform the development of dietary interventions to promote specific food groups targeting specific ages and improve diet quality among children and adolescents.

Estimating usual intakes mainly affects the micronutrient distribution among infants, toddlers and pre-schoolers from the 2012 Mexican National Health and Nutrition Survey

Objective

To compare estimates from one day with usual intake estimates to evaluate how the adjustment for within-person variability affected nutrient intake and adequacy in Mexican children.

Design

In order to obtain usual nutrient intakes, the National Cancer Institute’s method was used to correct the first 24 h dietary recall collected in the entire sample (n 2045) with a second 24 h recall collected in a sub-sample (n 178). We computed estimates of one-day and usual intakes of total energy, fat, Fe, Zn and Na.

Setting

2012 Mexican National Health and Nutrition Survey.

Subjects

A total of 2045 children were included: 0–5·9 months old (n 182), 6–11·9 months old (n 228), 12–23·9 months old (n 537) and 24–47·9 months old (n 1098). From these, 178 provided an additional dietary recall.

Results

Although we found small or no differences in energy intake (kJ/d and kcal/d) between one-day v. usual intake means, the prevalence of inadequate and excessive energy intake decreased somewhat when using measures of usual intake relative to one day. Mean fat intake (g/d) was not different between one-day and usual intake among children >6 months old, but the prevalence of inadequate and excessive fat intake was overestimated among toddlers and pre-schoolers when using one-day intake (P<0·05). Compared with usual intake, estimates from one day yielded overestimated prevalences of inadequate micronutrient intakes but underestimated prevalences of excessive intakes among children aged >6 months.

Conclusions

There was overall low variability in energy and fat intakes but higher for micronutrients. Because the usual intake distributions are narrower, the prevalence of inadequate/excessive intakes may be biased when estimating nutrient adequacy if one day of data is used.