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Shook RP, Halpin K, Carlson JA, Davis A, Dean K, Papa A, Sherman AK, Noel-MacDonnell JR, Summar S, Krueger G, Markenson D, Hampl S. Adherence With Multiple National Healthy Lifestyle Recommendations in a Large Pediatric Center Electronic Health Record and Reduced Risk of Obesity. Mayo Clin Proc 2018; 93:1247-1255. [PMID: 30060957 DOI: 10.1016/j.mayocp.2018.04.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/31/2018] [Accepted: 04/19/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the utility of a routine assessment of lifestyle behaviors incorporated into the electronic health record (EHR) to quantify lifestyle practices and obesity risk at a pediatric primary care center. PATIENTS AND METHODS Participants included 24,255 patients aged 2 to 18 years whose parent/caregiver completed a self-report lifestyle assessment during a well-child examination (January 1, 2013, through June 30, 2016). Cross-sectional analyses of age, race/ethnicity, body mass index, and lifestyle assessment responses were performed. Outcome measures included prevalence of patients meeting consensus recommendations for physical activity; screen time; and dairy, water, and fruit/vegetable consumption and the odds of obesity based on reported lifestyle behaviors. RESULTS Prevalence of meeting recommendations for lifestyle behaviors was highest for physical activity (84%), followed by screen time (61%) and consumption of water (51%), dairy (27%), and fruits/vegetables (10%). Insufficient physical activity was the strongest predictor of obesity (odds ratio [OR], 1.65; 95% CI, 1.51-1.79), followed by excess screen time (OR, 1.36; 95% CI, 1.27-1.45). Disparities existed across ages, races/ethnicities, and sexes for multiple lifestyle habits. Youth who met 0 or 1 lifestyle recommendation were 1.45 to 1.71 times more likely to have obesity than those meeting all 5 recommendations. CONCLUSION Healthy behaviors vary in prevalence, as does their association with obesity. This variation is partially explained by age, sex, and race/ethnicity. Meeting national recommendations for specific behaviors is negatively associated with obesity in a dose-dependent manner. These findings support the assessment of lifestyle behaviors in primary care as one component of multilevel initiatives to prevent childhood obesity.
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Affiliation(s)
- Robin P Shook
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO.
| | - Kelsee Halpin
- Division of Pediatric Endocrinology and Diabetes, Children's Mercy Kansas City, Kansas City, MO
| | - Jordan A Carlson
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO
| | - Ann Davis
- Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO; Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | - Kelsey Dean
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO
| | - Amy Papa
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO
| | - Ashley K Sherman
- Department of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO
| | | | - Shelly Summar
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO
| | - Gary Krueger
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO
| | - Deborah Markenson
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO
| | - Sarah Hampl
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO; Center for Children's Healthy Lifestyles and Nutrition, Kansas City, MO
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