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Szovati S, Morrison CF, Couch SC. Nutritional Status of Allogeneic Hematopoietic Stem Cell Transplant Recipients and Post-transplant Outcomes. Nutr Cancer 2023; 75:1200-1210. [PMID: 36895184 DOI: 10.1080/01635581.2023.2186261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
This study investigated the relationship between nutritional status of hematopoietic stem cell transplant (HSCT) recipients pre-/post-transplant and outcomes post-transplant. A secondary data analysis was conducted of 18 patients 2-weeks pre-transplant and 3 weeks post-transplant. Nutrients/food servings analyzed from 24-dietary recalls were scored for diet quality, antioxidant status, and energy adequacy (≥75% of recommended targets). Patient outcomes included frequency/severity of gastrointestinal (GI) symptoms, mucositis, % weight change, acute graft vs. host disease (aGVHD), length of stay (LOS), hospital readmission, intensive care unit (ICU) admission, and plasma albumin and cytokine levels. Pre-transplant, patients consumed more calories, total and saturated fat (% kcals) and less carbohydrate (% kcals) vs. post-transplant. Higher vs. lower pre-transplant diet quality was related to positive weight change (p <. 05), and greater interleukin-10 (p <. 05). Energy inadequacy pre-transplant was related to more aGVHD post-transplant (p < 0.05). Post-transplant, higher diet quality was related to greater plasma albumin (p <. 05), shorter LOS (p <. 05), no ICU admissions (p <. 01), and more GI symptoms (p <. 05); higher antioxidant status was related to greater albumin (p <. 05); and energy adequacy was related to shorter LOS (p <. 05). Optimizing dietary quality, antioxidant status and energy adequacy pre-/post -transport are important considerations to improve patient outcomes after HSCT.
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Affiliation(s)
- Stephanie Szovati
- College of Allied Health Sciences, Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Caroline F Morrison
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA.,College of Medicine, Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Sarah C Couch
- College of Allied Health Sciences, Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati, Cincinnati, OH, USA
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Conrey SC, Burrell AR, Brokamp C, Burke RM, Couch SC, Niu L, Mattison CP, Piasecki A, Payne DC, Staat MA, Morrow AL. Neighbourhood socio-economic environment predicts adiposity and obesity risk in children under two. Pediatr Obes 2022; 17:e12964. [PMID: 36350200 PMCID: PMC9788269 DOI: 10.1111/ijpo.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neighbourhood socio-economic environment (SEE) is associated with obesity in older children and adults, but little is known about this relationship in younger children. Breastfeeding is an important preventative of adiposity in childhood, but its relationship with neighbourhood SEE is unknown. AIMS We assessed differences in adiposity and obesity in children before age two by neighbourhood SEE, controlling for family socio-demographics and breastfeeding duration. MATERIALS AND METHODS Family socio-demographics, child body mass index z scores (BMIz), and breastfeeding duration were collected at periodic study visits from participants in PREVAIL (n = 245), a birth cohort in Cincinnati, OH. Addresses were assigned a Deprivation Index score, a validated measure of SEE, and dichotomized into highest SEE (least deprived quartile of scores) and not highest SEE (remaining quartiles). Longitudinal and Poisson models assessed differences in BMIz by SEE over the second year of life and obesity risk at age two, respectively (highest SEE, reference), while attenuation of obesity risk by breastfeeding duration was tested in mediation models. RESULTS Residing outside of the highest SEE neighbourhoods was associated with an increased BMIz of 0.04 (95%CI 0.02, 0.06) per month of life and increased obesity risk at age two (aRR: 3.7, 95%CI 1.2, 16.2), controlling for family socio-demographics. Breastfeeding duration attenuated >9% of the obesity risk attributable to SEE (mediated RR: 3.4, 95%CI 1.1, 14.8). DISCUSSION In the PREVAIL Cohort, residing outside of the highest SEE neighbourhoods predicted a significant increase in BMIz and obesity risk in children before age two, a relationship that was partially mediated by breastfeeding duration. CONCLUSION Breastfeeding support may play an important role in reducing obesity rates in children in lower SEE neighbourhoods.
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Affiliation(s)
- Shannon C. Conrey
- Department of Environmental and Public Health SciencesUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Department of Infectious DiseaseCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Allison R. Burrell
- Department of Environmental and Public Health SciencesUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Department of Infectious DiseaseCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Cole Brokamp
- Department of Environmental and Public Health SciencesUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Department of Biostatistics and EpidemiologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Rachel M. Burke
- Division of Viral DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Sarah C. Couch
- Department of Rehabilitation, Exercise and Nutrition SciencesUniversity of Cincinnati College of Allied Health SciencesCincinnatiOhioUSA
| | - Liang Niu
- Department of Environmental and Public Health SciencesUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Claire P. Mattison
- Division of Viral DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
- Cherokee Nation AssuranceArlingtonVirginiaUSA
| | - Alexandra Piasecki
- Division of Viral DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Daniel C. Payne
- Division of Foodborne, Waterborne, and Environmental DiseasesCenters for Disease Control and PreventionAtlantaGeorgiaUSA
| | - Mary A. Staat
- Department of Environmental and Public Health SciencesUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Department of Infectious DiseaseCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Ardythe L. Morrow
- Department of Environmental and Public Health SciencesUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Department of Infectious DiseaseCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
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Couch SC, Helsley RN, Siegel FU, Saelens BE, Magazine M, Eckman MH, Summer S, Fenchel M, King EC, Bhatt DL, Steen DL. Design and rationale for the supermarket and web-based intervention targeting nutrition (SuperWIN) for cardiovascular risk reduction trial. Am Heart J 2022; 248:21-34. [PMID: 35218725 DOI: 10.1016/j.ahj.2022.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE The prevalence of chronic diseases is increasing largely due to suboptimal dietary habits. It is not known whether individualized, supermarket-based, nutrition education delivered by registered dietitians, utilizing the advantages of the in-store and online environments, and electronically collected purchasing data, can increase dietary quality. METHODS AND RESULTS The supermarket and web-based intervention targeting nutrition (SuperWIN) for cardiovascular risk reduction trial is a randomized, controlled dietary intervention study. Adults identified from a primary care network with 1 or more risk factors were randomized at their preferred store to: (1) standard of care plus individualized, point- of-purchase nutrition education; (2) standard of care plus individualized, point- of-purchase nutrition education enhanced with online shopping technologies and training; or (3) standard of care alone. Educational sessions within each store's clinic and aisles, emphasized the dietary approaches to stop hypertension (DASH) diet. The primary assessment was an intention-to-treat comparison on the effects of the dietary interventions on mean change in DASH score (90-point range) from baseline to 3 months (post-intervention). Additional outcomes included blood pressure, lipids, weight, purchasing behavior, food literacy, and intervention feedback. Between April 2019 to February 2021, 267 participants were randomized (20 excluded due to coronavirus disease pandemic). Median age was 58 years, 69% were female, 64% had a college degree, 53% worked full-time, 64% were obese, 73% were treated with blood pressure and 42% with cholesterol medications, and most had low-to-moderate diet quality. CONCLUSION The SuperWIN trial was designed to provide a rigorous evaluation of the efficacy of 2 novel, comprehensive, supermarket-based dietary intervention programs.
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Strong H, Harry O, Westcott E, Kidwell KM, Couch SC, Peairs A, Britto MT, Crosby LE. Weight status and health behaviors of adolescents and young adults with sickle cell disease: The emerging risk for obesity. Pediatr Hematol Oncol 2021; 38:265-271. [PMID: 33150822 PMCID: PMC9188326 DOI: 10.1080/08880018.2020.1838010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Historically, youth with sickle cell disease (SCD) were at risk for being underweight, but recent data suggests this population is replicating obesity trends of youth in the United States. The current observational study assessed the weight status and health behaviors of 44 adolescents and young adults with SCD via a self-report survey and chart review. Using height and weight data closest to survey completion date, 27% of participants were either overweight or obese. With respect to obesogenic risk behaviors, 77% ate fast food 1-3 times per week, 25% had no fruits/vegetables with any of their meals, 11% drank no water, and 57% watched 4 or more hours of television per day. Though more research is needed, this preliminary study adds to the SCD literature suggesting an emerging shift toward obesity in this population. As such, adolescents with SCD may benefit from interventions to decrease obesity risk factors as being overweight or obese has the potential to worsen SCD-related symptoms and complications.
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Affiliation(s)
- Heather Strong
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, United States of America,Corresponding Author: Heather Strong, 3333 Burnet Ave, MLC 3015, Cincinnati, OH 45229, 513-517-1119,
| | - Onengiya Harry
- Section of Pediatric Rheumatology, Department of Pediatrics, Brenner Children’s Hospital, Winston-Salem, United States of America
| | - Emilie Westcott
- Clinical Nutrition Department, Dayton Children’s Hospital, Dayton, United States of America
| | - Katherine M. Kidwell
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, United States of America
| | - Sarah C. Couch
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, United States of America
| | - Abigail Peairs
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati, Cincinnati, United States of America
| | - Maria T. Britto
- James Anderson Center for Health Systems Excellence and Center for Innovation in Chronic Disease Care, Cincinnati Children’s Hospital Medical Center, Cincinnati, United States of America,Department of Pediatrics, University of Cincinnati, Cincinnati, United States of America
| | - Lori E. Crosby
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, United States of America,Department of Pediatrics, University of Cincinnati, Cincinnati, United States of America
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Bejarano CM, Carlson JA, Conway TL, Saelens BE, Glanz K, Couch SC, Cain KL, Sallis JF. Physical Activity, Sedentary Time, and Diet as Mediators of the Association Between TV Time and BMI in Youth. Am J Health Promot 2021; 35:613-623. [PMID: 33423502 DOI: 10.1177/0890117120984943] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE This study examined dietary indicators, sedentary time, and physical activity as potential mediators of the association between TV time and BMIz in youth. DESIGN Cross-sectional study in 2 independent samples of youth. SETTING Data collection occurred by mail and telephone for adolescents and either at home or in medical settings for children. SAMPLE 928 youth ages 12-16 and 756 youth ages 6-12 and a parent. MEASURES TV time, snacking/eating while watching TV, and a 3-day dietary recall were assessed via child/parent report. Physical activity and sedentary time were assessed by accelerometer wear. ANALYSIS Direct and indirect associations (through 8 diet and activity variables) of TV time with BMIz were tested in boys and girls in each sample. RESULTS TV time had a positive association with BMIz in 6-12 year old boys and girls. Direct associations emerged between TV time and the diet/activity variables, and between diet/activity variables and BMIz. Snacking/eating while watching TV had a significant positive association with BMIz in younger boys and mediated the association between TV time and BMIz (β = .06, p = .019; 25% attenuation). CONCLUSIONS Snacking/eating while watching TV may be a possible reason TV time is consistently associated with obesity in youth. Targeting reductions in TV time and associated snacking could improve health impacts.
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Affiliation(s)
- Carolina M Bejarano
- Clinical Child Psychology Program, 4202University of Kansas, Lawrence, KS, USA.,Center for Children's Healthy Lifestyles and Nutrition, 4204Children's Mercy Hospital, Kansas City, MO, USA
| | - Jordan A Carlson
- Center for Children's Healthy Lifestyles and Nutrition, 4204Children's Mercy Hospital, Kansas City, MO, USA
| | - Terry L Conway
- Herbert Wertheim School of Public Health and Human Longevity Science, 8784University of California San Diego, CA, USA
| | - Brian E Saelens
- Department of Pediatrics, University of Washington & 7274Seattle Children's Research Institute', Seattle, WA, USA
| | - Karen Glanz
- Perelman School of Medicine and School of Nursing, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah C Couch
- Department of Rehabilitation, Exercise and Nutrition Sciences, 212546University of Cincinnati, College of Allied Health Sciences, Cincinnati, OH, USA
| | - Kelli L Cain
- Herbert Wertheim School of Public Health and Human Longevity Science, 8784University of California San Diego, CA, USA
| | - James F Sallis
- Herbert Wertheim School of Public Health and Human Longevity Science, 8784University of California San Diego, CA, USA
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Liese AD, Couch SC, The NS, Crandell JL, Lawrence JM, Crume TL, Mayer-Davis EJ, Zhong VW, Urbina EM. Association between diet quality indices and arterial stiffness in youth with type 1 diabetes: SEARCH for Diabetes in Youth Nutrition Ancillary Study. J Diabetes Complications 2020; 34:107709. [PMID: 32888787 PMCID: PMC7673264 DOI: 10.1016/j.jdiacomp.2020.107709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 07/22/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023]
Abstract
AIMS We studied the association of three distinct diet quality indices and two measures of arterial stiffness in youth and young adults (YYA) aged 10 to 30 with T1D. METHODS Cross-sectional (n = 1421) and longitudinal (n = 520) analyses were conducted in T1D YYA participating in the SEARCH for Diabetes in Youth Study. The diet quality indices included the Dietary Approaches to Stop Hypertension (DASH) index, the Healthy Eating Index 2015 (HEI-2015), and a modified Mediterranean Diet Quality Index (mKIDMED). Arterial stiffness was measured with pulse wave velocity (PWV) and augmentation index (AIx) obtained using a SphygmoCor-Vx device and tonometer. RESULTS Average diet quality was moderate to poor, with mean scores of 41 (DASH, range 0-80), 55 (HEI-2015, range 0-100), 3.7 (mKIDMED, range - 3-12). None of the diet quality scores was associated with the central PWV or Aix, independent of demographic, clinical and lifestyle factors, body mass index and HbA1c. Longitudinal data yielded consistent findings with cross-sectional results. CONCLUSIONS This study suggests that diet quality may not function as an independent risk factor for arterial stiffening in YYA with T1D. These findings do not diminish the importance of consuming a quality diet for the management of diabetes, as demonstrated in previous work.
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Affiliation(s)
- Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States of America.
| | - Sarah C Couch
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati Medical Center, Cincinnati, OH, United States of America.
| | - Natalie S The
- Department of Health Sciences, Furman University, Greenville, SC, United States of America.
| | - Jamie L Crandell
- Department of Biostatistics, Gillings School of Global Public Health, School of Nursing, University of North Carolina, Chapel Hill, NC, United States of America.
| | - Jean M Lawrence
- Department of Research & Evaluation, Division of Epidemiologic Research Kaiser Permanente Research, Pasadena, CA, United States of America.
| | - Tessa L Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States of America.
| | - Victor W Zhong
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States of America.
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States of America.
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Couch SC, Saelens BE, Khoury PR, Dart KB, Hinn K, Mitsnefes MM, Daniels SR, Urbina EM. Dietary Approaches to Stop Hypertension Dietary Intervention Improves Blood Pressure and Vascular Health in Youth With Elevated Blood Pressure. Hypertension 2020; 77:241-251. [PMID: 33190559 DOI: 10.1161/hypertensionaha.120.16156] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This randomized control trial assessed the post-intervention and 18-month follow-up effects of a 6-month dietary approaches to stop hypertension (DASH)-focused behavioral nutrition intervention, initiated in clinic with subsequent telephone and mail contact, on blood pressure (BP) and endothelial function in adolescents with elevated BP. Adolescents (n=159) 11 to 18 years of age with newly diagnosed elevated BP or stage 1 hypertension treated at a hospital-based clinic were randomized. DASH participants received a take-home manual plus 2 face-to-face counseling sessions at baseline and 3 months with a dietitian regarding the DASH diet, 6 monthly mailings, and 8 weekly and then 7 biweekly telephone calls focused on behavioral strategies to promote DASH adherence. Routine care participants received nutrition counseling with a dietitian consistent with pediatric guidelines established by the National High Blood Pressure Education Program. Outcomes, measured pre- and post-intervention and at 18-months follow-up, included change in BP, change in brachial artery flow-mediated dilation, and change in DASH score based on 3-day diet recalls. Adolescents in DASH versus routine care had a greater improvement in systolic BP (-2.7 mm Hg, P= 0.03, -0.3 z-score, P=0.03), flow-mediated dilation (2.5%, P=0.05), and DASH score (13.3 points, P<0.0001) from baseline to post-treatment and a greater improvement in flow-mediated dilation (3.1%, P=0.03) and DASH score (7.4 points, P=0.01) to 18 months. The DASH intervention proved more effective than routine care in initial systolic BP improvement and longer term improvement in endothelial function and diet quality in adolescents with elevated BP and hypertension. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00585832.
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Affiliation(s)
- Sarah C Couch
- From the Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati (S.C.C.)
| | - Brian E Saelens
- Department of Pediatrics, University of Washington Seattle Children's Research Institute (B.E.S.)
| | - Philip R Khoury
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center (P.R.K., M. M. M., E.M.U.)
| | - Katherine B Dart
- Department of Nutrition, Northside Hospital, Atlanta, GA (K.B.D.)
| | - Kelli Hinn
- Department of Nutrition, VA Medical Center, Richmond (K.H.)
| | - Mark M Mitsnefes
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center (P.R.K., M. M. M., E.M.U.)
| | - Stephen R Daniels
- Department of Pediatrics, University of Colorado School of Medicine, Denver (S.R.D.)
| | - Elaine M Urbina
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center (P.R.K., M. M. M., E.M.U.)
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Ortega A, Bejarano CM, Cushing CC, Staggs VS, Papa AE, Steel C, Shook RP, Sullivan DK, Couch SC, Conway TL, Saelens BE, Glanz K, Frank LD, Cain KL, Kerr J, Schipperijn J, Sallis JF, Carlson JA. Differences in adolescent activity and dietary behaviors across home, school, and other locations warrant location-specific intervention approaches. Int J Behav Nutr Phys Act 2020; 17:123. [PMID: 32993715 PMCID: PMC7526379 DOI: 10.1186/s12966-020-01027-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 09/16/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Investigation of physical activity and dietary behaviors across locations can inform "setting-specific" health behavior interventions and improve understanding of contextual vulnerabilities to poor health. This study examined how physical activity, sedentary time, and dietary behaviors differed across home, school, and other locations in young adolescents. METHODS Participants were adolescents aged 12-16 years from the Baltimore-Washington, DC and the Seattle areas from a larger cross-sectional study. Participants (n = 472) wore an accelerometer and Global Positioning Systems (GPS) tracker (Mean days = 5.12, SD = 1.62) to collect location-based physical activity and sedentary data. Participants (n = 789) completed 24-h dietary recalls to assess dietary behaviors and eating locations. Spatial analyses were performed to classify daily physical activity, sedentary time patterns, and dietary behaviors by location, categorized as home, school, and "other" locations. RESULTS Adolescents were least physically active at home (2.5 min/hour of wear time) and school (2.9 min/hour of wear time) compared to "other" locations (5.9 min/hour of wear time). Participants spent a slightly greater proportion of wear time in sedentary time when at school (41 min/hour of wear time) than at home (39 min/hour of wear time), and time in bouts lasting ≥30 min (10 min/hour of wear time) and mean sedentary bout duration (5 min) were highest at school. About 61% of daily energy intake occurred at home, 25% at school, and 14% at "other" locations. Proportionately to energy intake, daily added sugar intake (5 g/100 kcal), fruits and vegetables (0.16 servings/100 kcal), high calorie beverages (0.09 beverages/100 kcal), whole grains (0.04 servings/100 kcal), grams of fiber (0.65 g/100 kcal), and calories of fat (33 kcal/100 kcal) and saturated fat (12 kcal/100 kcal) consumed were nutritionally least favorable at "other" locations. Daily sweet and savory snacks consumed was highest at school (0.14 snacks/100 kcal). CONCLUSIONS Adolescents' health behaviors differed based on the location/environment they were in. Although dietary behaviors were generally more favorable in the home and school locations, physical activity was generally low and sedentary time was higher in these locations. Health behavior interventions that address the multiple locations in which adolescents spend time and use location-specific behavior change strategies should be explored to optimize health behaviors in each location.
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Affiliation(s)
- Adrian Ortega
- Clinical Child Psychology Program and Schiefelbusch Institute for Life Span Studies, University of Kansas, 1000 Sunnyside Avenue, Lawrence, Kansas, USA
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, 610 E. 22nd Street, Kansas City, MO, USA
| | - Carolina M Bejarano
- Clinical Child Psychology Program and Schiefelbusch Institute for Life Span Studies, University of Kansas, 1000 Sunnyside Avenue, Lawrence, Kansas, USA
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, 610 E. 22nd Street, Kansas City, MO, USA
| | - Christopher C Cushing
- Clinical Child Psychology Program and Schiefelbusch Institute for Life Span Studies, University of Kansas, 1000 Sunnyside Avenue, Lawrence, Kansas, USA
| | - Vincent S Staggs
- Biostatistics & Epidemiology, Health Services & Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
- School of Medicine, University of Missouri-Kansas City, Kansas City, USA
| | - Amy E Papa
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, 610 E. 22nd Street, Kansas City, MO, USA
| | - Chelsea Steel
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, 610 E. 22nd Street, Kansas City, MO, USA
| | - Robin P Shook
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, 610 E. 22nd Street, Kansas City, MO, USA
| | - Debra K Sullivan
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Sarah C Couch
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - Terry L Conway
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Brian E Saelens
- Department of Pediatrics, University of Washington & Seattle Children's Research Institute, Seattle, Washington, USA
| | - Karen Glanz
- Perelman School of Medicine and School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence D Frank
- School of Community and Regional Planning, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelli L Cain
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Jacqueline Kerr
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
| | - Jasper Schipperijn
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - James F Sallis
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, California, USA
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Jordan A Carlson
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, 610 E. 22nd Street, Kansas City, MO, USA.
- School of Medicine, University of Missouri-Kansas City, Kansas City, USA.
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Tooze JA, The NS, Crandell JL, Couch SC, Mayer-Davis EJ, Koebnick C, Liese AD. An Approach for Examining the Impact of Food Group-Based Sources of Nutrients on Outcomes with Application to PUFAs and LDL in Youth with Type 1 Diabetes. Nutrients 2020; 12:E941. [PMID: 32231085 PMCID: PMC7230845 DOI: 10.3390/nu12040941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 11/16/2022] Open
Abstract
Traditionally, nutritional epidemiologists have utilized single nutrient or dietary pattern approaches to examine diet-health relationships. However, the former ignores that nutrients are consumed from foods within dietary patterns, and, conversely, dietary patterns may provide little information on mechanisms of action. Substitution provides a framework for estimating diet-health relationships while holding some nutrient intakes constant. We examined substitution effects of polyunsaturated fatty acids (PUFAs) in the SEARCH Nutrition Ancillary Study in the context of food group source. PUFAs were calculated from fatty acids 18:3, 20:5, and 22:6 (n-3), and 18:2 and 20:4 (n-6) from a food frequency questionnaire, quantified by food group. Models were adjusted for other fat intake, carbohydrates, protein, age, race, gender, and diabetes duration. Participants (n = 1441) were 14 years old on average, 51% female, with type 1 diabetes for 3.6 years. Mean intake of PUFAs was 14.9 g/day, and the highest PUFA sources were nonsolid fats, nuts, grains, red/processed meats, sweets/desserts, and high-fat chicken. PUFAs from nuts were inversely associated with low-density lipoprotein cholesterol (LDL) (p = 0.03) and PUFAs from high-fat chicken were positively associated with LDL (p < 0.01). Substituting nuts for chicken was associated with -7.4 mg/dL in LDL. These findings illustrate the importance of considering food group-based sources of nutrients when examining diet-health relationships.
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Affiliation(s)
- Janet A. Tooze
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
| | - Natalie S. The
- Department of Health Sciences, Furman University, Greenville, SC 29613, USA;
| | - Jamie L. Crandell
- School of Nursing and Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA;
| | - Sarah C. Couch
- Department of Rehabilitation, Exercise, and Nutrition Sciences, University of Cincinnati Medical Center, Cincinnati, OH 45267-0394, USA;
| | - Elizabeth J. Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599;
| | - Corinna Koebnick
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, CA 91101, USA;
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
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Chen AC, Ramirez FD, Rosenthal DN, Couch SC, Berry S, Stauffer KJ, Brabender J, McDonald N, Lee D, Barkoff L, Nourse SE, Kazmucha J, Wang CJ, Olson I, Selamet Tierney ES. Healthy Hearts via Live Videoconferencing: An Exercise and Diet Intervention in Pediatric Heart Transplant Recipients. J Am Heart Assoc 2020; 9:e013816. [PMID: 31973598 PMCID: PMC7033874 DOI: 10.1161/jaha.119.013816] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Pediatric heart transplant recipients have high‐risk cardiovascular profiles that can affect their long‐term outcomes; however, promoting exercise and healthy diet has not been a major focus in the field. The objective of this study was to test the feasibility and impact of a supervised exercise and diet intervention delivered via live videoconferencing in this population. Methods and Results Patients 8 to 19 years of age at least 1 year post heart transplantation were enrolled. The 12‐ to 16‐week intervention phase included live video–supervised exercise (×3/week) and nutrition (×1/week) sessions. The 12‐ to 16‐week maintenance phase included ×1/week live video–supervised exercise and nutrition sessions and ×2/week self‐directed exercise sessions. Cardiac, vascular, nutritional, and functional health indices were obtained at baseline, after intervention, and after maintenance. Fourteen patients (median age, 15.2; interquartile range, 14.3–16.7 years) at a median of 3.3 (interquartile range, 1.5–9.7) years after heart transplant completed the intervention. Patients attended 89.6±11% of exercise and 88.4±10% of nutrition sessions during the intervention and 93.4±11% of exercise and 92.3±11% of nutrition sessions during maintenance. After intervention, body mass index percentile (median, −27%; P=0.02), endothelial function (median, +0.29; P=0.04), maximum oxygen consumption (median, +2 mL/kg per minute; P=0.002). Functional Movement Screening total score (median, +2.5; P=0.002) and daily consumption of saturated fat (median, −6 g; P=0.02) improved significantly. After maintenance, improvements in maximum oxygen consumption (median, +3.2 mL/kg per minute; P=0.02) and Functional Movement Screening total score (median, +5; P=0.002) were sustained. Conclusions In pediatric heart transplant recipients, a live video–supervised exercise and diet intervention is feasible. Our results demonstrate excellent adherence with significant improvements in cardiovascular and functional health. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02519946.
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Affiliation(s)
- Angela C Chen
- Division of Pediatric Cardiology Department of Pediatrics Stanford University Medical Center Palo Alto CA
| | | | - David N Rosenthal
- Division of Pediatric Cardiology Department of Pediatrics Stanford University Medical Center Palo Alto CA
| | - Sarah C Couch
- Department of Rehabilitation, Exercise and Nutrition Sciences University of Cincinnati Medical Center Cincinnati OH
| | | | - Katie J Stauffer
- Division of Pediatric Cardiology Department of Pediatrics Stanford University Medical Center Palo Alto CA
| | - Jerrid Brabender
- Division of Pediatric Cardiology Department of Pediatrics Stanford University Medical Center Palo Alto CA
| | - Nancy McDonald
- Division of Pediatric Cardiology Department of Pediatrics Stanford University Medical Center Palo Alto CA
| | - Donna Lee
- Division of Pediatric Cardiology Department of Pediatrics Stanford University Medical Center Palo Alto CA
| | - Lynsey Barkoff
- Division of Pediatric Cardiology Department of Pediatrics Stanford University Medical Center Palo Alto CA
| | - Susan E Nourse
- Division of Pediatric Cardiology Department of Pediatrics Stanford University Medical Center Palo Alto CA
| | - Jeffrey Kazmucha
- Division of Pediatric Cardiology Department of Pediatrics Stanford University Medical Center Palo Alto CA
| | - C Jason Wang
- Division of General Pediatrics, and Center for Policy, Outcomes and Prevention Stanford University Palo Alto CA
| | - Inger Olson
- Division of Pediatric Cardiology Department of Pediatrics Stanford University Medical Center Palo Alto CA
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology Department of Pediatrics Stanford University Medical Center Palo Alto CA
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11
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Hildebrandt JL, Couch SC. Cardiovascular Risk and Diet in Children. Lifestyle Medicine 2019. [DOI: 10.1201/9781315201108-76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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12
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Chen AC, Rosenthal DN, Couch SC, Berry S, Stauffer KJ, Brabender J, McDonald N, Lee D, Barkoff L, Nourse SE, Kazmucha J, Wang CJ, Olson I, Selamet Tierney ES. Healthy hearts in pediatric heart transplant patients with an exercise and diet intervention via live video conferencing-Design and rationale. Pediatr Transplant 2019; 23:e13316. [PMID: 30393915 DOI: 10.1111/petr.13316] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/12/2018] [Accepted: 10/02/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric heart transplant (PedHtx) patients have increased cardiovascular risk profiles that affect their long-term outcomes and quality of life. We designed a 12- to 16-week diet and exercise intervention delivered via live video conferencing to improve cardiovascular health. Our methodology and baseline assessment of the first 13 enrolled patients are reported. METHODS Inclusion criteria are as follows: (a) 8-19 years old; (b) heart transplant >12 months; (c) ability to fast overnight; (d) cardiac clearance by cardiologist; and (e) presence of an adult at home during exercise sessions for patients <14 years old. Exclusion criteria are as follows: (a) acute illness; (b) latex allergy; (c) transplant rejection <3 months ago; and (d) multi-organ transplantation. The intervention consists of one diet and three exercise sessions weekly via live video conferencing. Study visits are conducted at baseline, intervention completion, and end of maintenance period. RESULTS A total of 13 participants (15.2 [2.3] years) have been enrolled. Median percent-predicted VO2 max was 56.8 [20.7]% (10 patients <70%). Ten patients had abnormal endothelial function (reactive hyperemia index <1.9; 1.4 [0.325]) and 11 patients had stiff arteries (pulse wave velocity ≧5.5 m/s for 15-19 years, ≧4.5 m/s for 8-14 years; 5.6 [0.7] m/s). Patients had suboptimal diets (saturated fat: 22.7 [23.8] g/d, sodium: 2771 [1557] mg/d) and were sedentary at a median of 67.5 [13.8]% of their time. CONCLUSIONS Baseline assessment confirms that PedHtx patients have abnormal cardiac, vascular, and functional health indices, poor dietary habits, and are sedentary. These results support the rationale to test the feasibility and impact of a non-pharmacologic lifestyle intervention in this patient population.
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Affiliation(s)
- Angela C Chen
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
| | - David N Rosenthal
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
| | - Sarah C Couch
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Samuel Berry
- American Council on Exercise, San Diego, California
| | - Katie J Stauffer
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
| | - Jerrid Brabender
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
| | - Nancy McDonald
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
| | - Donna Lee
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
| | - Lynsey Barkoff
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
| | - Susan E Nourse
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
| | - Jeffrey Kazmucha
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
| | - C Jason Wang
- Division of General Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Palo Alto, California
| | - Inger Olson
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University Medical Center, Palo Alto, California
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13
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Summer SS, Couch SC, Shah AS, McNeill MP, Peairs AD. Evaluating a dietary pattern in adolescents with type 1 diabetes mellitus: The dash-d approach. Diabetes Manag (Lond) 2019; 9:28-38. [PMID: 31363362 PMCID: PMC6667171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Adolescents with type 1 diabetes (T1DM) must consider multiple factors in diet planning, including glycemic control and cardiovascular disease prevention, while ensuring adequate nutrition for growth. We examined diet composition, quality, and compliance for two dietary patterns - the traditional Dietary Approaches to Stop Hypertension (DASH) and a modified version of DASH in this population. METHODS AND FINDINGS Two feeding studies were conducted. First, adolescents with T1DM consumed their usual diet for 3 days followed by traditional DASH for 6 days. Next, DASH menus were adjusted to align with T1DM nutrition guidelines, and this modified DASH for Diabetes (DASH-D) was tested on a new group of adolescents with T1DM for 6 days, following 3 days of usual diet. Usual diet was measured via 24-hr dietary recalls. Dietary composition of DASH-D was compared to DASH and usual diet. Eighteen adolescents (9/group) participated. Compared to usual diet, intake of protein, fiber, fruit, vegetables, lean meats, and low-fat dairy were higher, while saturated fat and added sugar were lower, in DASH-D. Percent energy from fat was higher, and from carbohydrate lower, in DASH-D versus traditional DASH, with food group intake reflecting these patterns. Participants consumed 87% of foods provided for DASH, and 98% of foods provided for DASH-D. In both DASH iterations, participants met national guidelines for fat, saturated fat, fiber, and fruit/vegetable intake, while usual diet fell short of these recommendations. CONCLUSIONS The novel DASH-D pattern meets guidelines and may be a viable option for achieving nutrition goals for adolescents with T1DM.
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Affiliation(s)
- Suzanne S Summer
- Clinical Translational Research Center, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, Ohio 45229, USA
| | - Sarah C Couch
- Department of Nutritional Sciences, University of Cincinnati, College of Allied Health Sciences, 3202 Eden Ave., Cincinnati, OH 45267, USA
| | - Amy S Shah
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, Ohio 45229, USA
| | - Meghan P McNeill
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave., Cincinnati, Ohio 45229, USA
| | - Abigail D Peairs
- Department of Nutritional Sciences, University of Cincinnati, College of Allied Health Sciences, 3202 Eden Ave., Cincinnati, OH 45267, USA
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Kahkoska AR, Shay CM, Couch SC, Crandell J, Dabelea D, Gourgari E, Lawrence JM, Liese AD, Pihoker C, Reboussin BA, The N, Mayer-Davis EJ. Sociodemographic associations of longitudinal adiposity in youth with type 1 diabetes. Pediatr Diabetes 2018; 19:1429-1440. [PMID: 30129111 PMCID: PMC6249094 DOI: 10.1111/pedi.12753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 12/29/2022] Open
Abstract
Excess adiposity is common in youth with type 1 diabetes, yet little is known about the sociodemographic factors that predict longitudinal trajectories of body fat. We analyzed data from 363 females and 379 males with type 1 diabetes over ~9 years of follow-up (mean baseline age 12.8 ± 2.3 years in females, 13.2 ± 2.4 years in males). Estimated body fat percentage (eBFP) was calculated with validated sex- and race/ethnicity-specific equations. Group-based modeling identified three eBFP trajectories for each sex. All female trajectories showed gradual increases, while male trajectories showed gradual decreases (<5% in eBFP) that plateaued around 7 years of diabetes duration. Female trajectories showed differences in baseline eBFP: Group F1 (38.0%), mean eBFP 27.8 ± 3.0%: Group F2 (47.9%), mean eBFP 33.9 ± 3.0%: and Group F3 (14.1%), mean eBFP 41.7 ± 4.1%. Male trajectories also showed differences in baseline eBFP: Group M1 (57.2%), mean eBFP 22.0 ± 3.0%: Group M2 (30.9%), mean eBFP 33.9 ± 3.0%: and Group M3 (12.9%), mean eBFP 36.1 ± 3.7%. In multinomial models, adjusted for clinical factors (eg, insulin regimen, insulin dose, and hemoglobin A1c), females who reported a single-parent household (adjusted odds ratio [aOR] = 3.34, 95% confidence interval [CI]: 1.49, 7.47), parental education of less than a college degree (aOR = 3.79, 95% CI: 1.60, 9.60), and a lack of private health insurance (aOR = 3.74, 95% CI: 1.45, 9.60), and a household income of less than $75 000 per year (aOR = 3.13, 95% CI: 1.27, 7.70) were approximately three to four times more likely to be in the highest eBFP trajectory group relative to the lowest eBFP trajectory group. Males who reported a household income of <$75 000/year were almost twice as likely to be in the Group M3 than the Group M1 in the unadjusted model only (aOR = 1.79, 95% CI: 0.91, 4.01 vs unadjusted OR: 2.48, 95% CI: 1.22, 5.06). Lower socioeconomic status may be associated with excess body fat throughout adolescence in type 1 diabetes, particularly among females.
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Affiliation(s)
- Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC;
| | | | - Sarah C. Couch
- Department of Rehabilitation, Exercise and Nutrition Sciences, University of Cincinnati. Cinncinati, OH;
| | - Jamie Crandell
- School of Nursing and Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC;
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO;
| | - Evgenia Gourgari
- Department of Pediatrics, Georgetown University, Washington, DC;
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA;
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, University of Southern Carolina, Columbia, SC;
| | | | - Beth A. Reboussin
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC;
| | - Natalie The
- Department of Health Sciences, Furman University, Greenville, South Carolina;
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC;
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC;
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Saelens BE, Glanz K, Frank LD, Couch SC, Zhou C, Colburn T, Sallis JF. Two-Year Changes in Child Weight Status, Diet, and Activity by Neighborhood Nutrition and Physical Activity Environment. Obesity (Silver Spring) 2018; 26:1338-1346. [PMID: 30138547 PMCID: PMC6108436 DOI: 10.1002/oby.22247] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/27/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The aim of this study was to examine 2-year changes in weight status and behaviors among children living in neighborhoods differing on nutrition and activity environments. METHODS A prospective observational study, the Neighborhood Impact on Kids study, was conducted in King County, Washington, and San Diego County, California. Children 6 to 12 years old and a parent or caregiver completed Time 1 (n = 681) and Time 2 (n = 618) assessments. Children lived in neighborhoods characterized as "high/favorable" or "low/unfavorable" in nutrition and activity environments, respectively (four neighborhood types). Child BMI z score and overweight or obesity status were primary outcomes, with diet and activity behaviors as behavioral outcomes. RESULTS After adjusting for sociodemographics and Time 1 values, children living in two of the three less environmentally supportive neighborhoods had significantly less favorable BMI z score changes (+0.11, 95% CI: 0.01-0.21; + 0.12, 95% CI: 0.03-0.21), and all three less supportive neighborhoods had higher overweight or obesity (relative risks, 1.41-1.49; 95% CI: 1.13-1.80) compared with children in the most environmentally supportive neighborhoods. Changes in daily energy intake and sedentary behavior by neighborhood type were consistent with observed weight status changes, with unexpected findings for physical activity. CONCLUSIONS More walkable and recreation-supportive environments with better nutrition access were associated with better child weight outcomes and related behavior changes.
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Affiliation(s)
- Brian E. Saelens
- Seattle Children’s Research Institute, Seattle, Washington
- University of Washington, Department of Pediatrics, Seattle, Washington
| | - Karen Glanz
- Emory University; now at University of Pennsylvania, Department of Biostatistics and Epidemiology, Philadelphia, Pennsylvania
| | - Lawrence D. Frank
- University of British Columbia, School of Community and Regional Planning, Vancouver, British Columbia
| | - Sarah C. Couch
- University of Cincinnati, Department of Rehabilitation, Exercise, and Nutrition Sciences, Cincinnati, Ohio
| | - Chuan Zhou
- Seattle Children’s Research Institute, Seattle, Washington
- University of Washington, Department of Pediatrics, Seattle, Washington
| | - Trina Colburn
- Seattle Children’s Research Institute, Seattle, Washington
| | - James F. Sallis
- San Diego State University; now at University of California - San Diego, Department of Family Medicine and Public Health
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The NS, King IB, Couch SC, Crandell JL, Dabelea D, Liese AD, Mayer-Davis EJ. Plasma trans-palmitoleic acid is associated with cardio-metabolic risk factors in youth with type 1 diabetes. Diabetes Metab 2017; 44:181-184. [PMID: 28583347 DOI: 10.1016/j.diabet.2017.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/07/2017] [Accepted: 02/07/2017] [Indexed: 01/18/2023]
Affiliation(s)
- N S The
- Department of Health Sciences, Furman University, Greenville, SC, USA.
| | - I B King
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - S C Couch
- Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - J L Crandell
- Department of Biostatistics, Gillings School of Global Public Health and School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - D Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - A D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - E J Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
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Couch SC, Crandell J, King I, Peairs A, Shah AS, Dolan LM, Tooze J, Crume T, Mayer-Davis E. Associations between long chain polyunsaturated fatty acids and cardiovascular lipid risk factors in youth with type 1 diabetes: SEARCH Nutrition Ancillary Study. J Diabetes Complications 2017; 31:67-73. [PMID: 27836680 PMCID: PMC5384101 DOI: 10.1016/j.jdiacomp.2016.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/17/2016] [Accepted: 10/02/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE In this longitudinal study we explored the relationships between plasma n-3 and n-6 polyunsaturated fatty acids (PUFAs) and Δ5 and Δ6 desaturase activities (D5D and D6D, respectively) and fasting lipids in youth with type 1 diabetes (T1D). METHODS Incident cases of T1D in youth <20years of age who were seen for a baseline study visit (N=914) and a 1-year follow-up visit (N=416) were included. Fasting blood samples were obtained at each visit and plasma phospholipid n-6 PUFAs were measured, which included linoleic acid (LA), dihomo-γ-linolenic acid (DGLA) and arachidonic acid (AA); n-3 PUFAs included α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Estimated D5D and D6D were calculated as FA product-to-precursor ratios, where D5D=AA/DGLA and D6D=DGLA/LA. To examine the longitudinal relationships between long chain PUFAs, desaturase activities and fasting plasma lipids in youth with T1D mixed effects models were used for each individual PUFAs, D5D and D6D, adjusted for demographics, clinic site, diabetes duration, insulin regimen, insulin dose/kg, HbA1c, insulin sensitivity score, and body mass index with random effects to account for the repeated measurements. FINDINGS Favorable lipid associations were found between LA and low-density lipoprotein (LDL) cholesterol (β=-0.58, p<0.05); AA, plasma triglycerides (TG) (β=-0.04, p<0.05) and TG/high-density lipoprotein (HDL)-C ratio (β=-0.04, p<0.05); and D5D, plasma TG (β=-0.2, p<0.05) and TG/HDL-cholesterol ratio (β=-0.23, p<0.05). Findings were mixed for the n-3 PUFAs and DGLA: ALA was positively associated with plasma TG (β=0.33, p<0.05) and HDL cholesterol (β=9.86, p<0.05); EPA was positively associated with total cholesterol (β=8.17, p<0.05), LDL cholesterol (β=5.74, p<0.01) and HDL cholesterol (β=2.27, p<0.01); and DGLA was positively associated with TG/HDL-cholesterol ratio (β=0.05, P<0.05). CONCLUSION Findings suggest that the most abundant PUFA, LA as well as its metabolic bi-product AA, may be important targets for CVD lipid risk factor reduction in youth with T1D.
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Affiliation(s)
- Sarah C Couch
- 3202 Eden Avenue, French Building East, Room 364, University of Cincinnati Medical Center, Cincinnati, OH 45267-0394.
| | - Jamie Crandell
- Carrington Hall #7460, School of Nursing and Department of Biostatistics, UNC, Chapel Hill, NC 27599.
| | - Irena King
- MSC 10 5550, University of New Mexico, Albuquerque, NM 87131.
| | - Abigail Peairs
- 3202 Eden Avenue, French Building East, Room 364, University of Cincinnati Medical Center, Cincinnati, OH 45267-0394.
| | - Amy S Shah
- 3333 Burnett Avenue, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229.
| | - Lawrence M Dolan
- 3333 Burnett Avenue, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229.
| | - Janet Tooze
- 1 Medical Center Blvd, Wake Forest School of Medicine, Winston-Salem, NC 27157.
| | - Tessa Crume
- 13001 E. 17th Place, University of Colorado, Aurora, CO 80045.
| | - Elizabeth Mayer-Davis
- 1700 Martin Luther King Drive, Departments of Nutrition and Medicine, UNC, Chapel Hill, NC 27599.
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Peairs AD, Shah AS, Summer S, Hess M, Couch SC. Effects of the dietary approaches to stop hypertension (DASH) diet on glucose variability in youth with Type 1 diabetes. Diabetes Manag (Lond) 2017; 7:383-391. [PMID: 29333199 PMCID: PMC5763547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Glucose variability (GV) independently increases risk for vascular events in patients with diabetes. The Dietary Approaches to Stop Hypertension (DASH) dietary pattern emphasizes fruits, vegetables, whole grains, lean meats, and low fat dairy and has the potential to reduce postprandial blood glucose (BG) excursions, however, its effect on GV is not known. The purpose of this work was to assess feasibility and collect preliminary data on the efficacy of the DASH diet on GV in adolescents with type 1 diabetes (T1D). METHODS Twenty one adolescents recruited from the Diabetes Center of Cincinnati Children's Hospital Medical Center with T1D (11-17y) participated in one of two phases of a controlled feeding study. The first phase tested the acceptability and blood glucose response to a traditional DASH diet (DASH) and the second phase tested a DASH diet specifically modified for diabetes (DASH-D) to improve glucose response to meals. For each phase, participants consumed first their usual diet, and then a controlled DASH diet while wearing continuous glucose monitoring (CGM) systems for 3 days of each diet. All foods were provided to the patients during the DASH dietary periods and 24 h dietary recalls were conducted during the usual diet periods to assess daily intake. RESULTS Sixteen participants (14.1 +/- 2.2y) were included in final analyses (DASH n=7, DASH-D n=9). Both DASH diets were significantly higher in fruits, vegetables, fiber, vitamin A, and % energy from protein than usual intakes. DASH was higher in carbohydrate (CHO) (60 vs. 50%) and lower in fat (21 vs. 36%) than usual intake, resulting in higher GV (Standard Deviation and Lability Index) and more low BG excursions (3 ± 2.8 vs. 7.1 ± 3.3, p=0.024). DASH-D was modified to better match CHO and fat content of patients' usual intakes in phase 1 (50/30/20 for CHO/fat/pro respectively, which resulted in no difference in GV between DASH-D and usual intake. There were also trends for lower average BG (144.1 vs. 168.9, p=0.072) and less percentage of time spent in the hyperglycemic range (39.3 ± 25.5 vs. 54.1 ± 19.4, p=0.07) on DASH-D compared to usual intake. CONCLUSION The DASH dietary pattern tended to result in less hyperglycemia and an overall lower BG compared to usual care. Modifying a traditional DASH diet by increasing heart healthy fats improves glycemic response to DASH and may be beneficial for long term cardiovascular benefits in youth with T1D.
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Affiliation(s)
- Abigail D. Peairs
- Department of Rehabilitation Exercise, and Nutritional Sciences, University of Cincinnati, USA
| | - Amy S. Shah
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, USA
| | - Suzanne Summer
- Clinical Translational Research Center, Cincinnati Children’s Hospital Medical Center (CCHMC), USA
| | - Melody Hess
- Department of Rehabilitation Exercise, and Nutritional Sciences, University of Cincinnati, USA
| | - Sarah C. Couch
- Department of Rehabilitation Exercise, and Nutritional Sciences, University of Cincinnati, USA
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Robson SM, Couch SC, Peugh JL, Glanz K, Zhou C, Sallis JF, Saelens BE. Parent Diet Quality and Energy Intake Are Related to Child Diet Quality and Energy Intake. J Acad Nutr Diet 2016; 116:984-90. [PMID: 27050725 PMCID: PMC4884510 DOI: 10.1016/j.jand.2016.02.011] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/08/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Parents' diets are believed to influence their children's diets. Previous studies have not adequately and simultaneously assessed the relationship between parent and child total diet quality and energy intakes. OBJECTIVE Our aim was to investigate whether parent and child diet quality and energy intakes are related. DESIGN We conducted a cross-sectional analysis using baseline dietary intake data from the Neighborhood Impact on Kids study collected in 2007 to 2009. PARTICIPANTS/SETTING Participants were parents and 6- to 12-year-old children from households in King County (Seattle area), WA, and San Diego County, CA, targeted by Neighborhood Impact on Kids were recruited. Eligible parent-child dyads (n=698) with two or three 24-hour dietary recalls were included in this secondary analysis. MAIN OUTCOME MEASURES Child diet quality (Healthy Eating Index-2010, Dietary Approaches to Stop Hypertension score, and energy density [for food only]) and energy intake were derived from the dietary recalls using Nutrition Data Systems for Research. STATISTICAL ANALYSES PERFORMED Multiple linear regression models examined the relationship between parent diet quality and child diet quality, and the relationship between parent energy intake and child energy intake. In both analyses, we controlled for parent characteristics, child characteristics, household education, and neighborhood type. RESULTS Parent diet quality measures were significantly related to corresponding child diet quality measures: Healthy Eating Index-2010 (standardized β=.39; P<0.001); Dietary Approaches to Stop Hypertension score (β=.33; P<0.001); and energy density (β=.32; P<0.001). Parent daily mean energy intake (1,763±524 kcal) was also significantly related (β=.30; P<0.001) to child daily mean energy intake (1,751±431 kcal). CONCLUSIONS Parent and child intakes were closely related across various metrics of diet quality and for energy intake. Mechanisms of influence are likely to be shared food environments, shared meals, and parent modeling.
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Affiliation(s)
- Shannon M. Robson
- Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE; (T) 302-831-6674; (F) 302-831-4261; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 3015, Cincinnati, OH 45229
| | - Sarah C. Couch
- Department of Nutritional Sciences, University of Cincinnati, 3202 Eden Avenue, Cincinnati, OH 45267-0394; (T) 513-558-7504; (F) (513) 558-7494
| | - James L. Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 3015, Cincinnati, OH 45229; (P) 513-636-4336; (F) 513-636-0084
| | - Karen Glanz
- University of Pennsylvania Perelman School of Medicine and School of Nursing, 801 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; (P) (215) 898-0613; (F) 215-573-5315
| | - Chuan Zhou
- Seattle Children's Research Institute and Department of Pediatrics, University of Washington,2001 Eighth Ave, Suite 400, Seattle, WA 98121; (P) (206) 884-1028; (F) (206) 884-7801
| | - James F. Sallis
- Department of Family Medicine and Public Health, University of California, 3900 5 Avenue, Suite 310, San Diego, CA 92103; (P) 619-260-5535; (F) 619-260-1510
| | - Brian E. Saelens
- Seattle Children's Research Institute and Department of Pediatrics, University of Washington,2001 Eighth Ave, Suite 400, Seattle, WA 98121; (P) 206-884-7800; (F) 206.884-7801
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Zhong VW, Lamichhane AP, Crandell JL, Couch SC, Liese AD, The NS, Tzeel BA, Dabelea D, Lawrence JM, Marcovina SM, Kim G, Mayer-Davis EJ. Association of adherence to a Mediterranean diet with glycemic control and cardiovascular risk factors in youth with type I diabetes: the SEARCH Nutrition Ancillary Study. Eur J Clin Nutr 2016; 70:802-7. [PMID: 26908421 PMCID: PMC4935596 DOI: 10.1038/ejcn.2016.8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/20/2015] [Accepted: 01/17/2016] [Indexed: 02/07/2023]
Abstract
Background/Objectives This study aimed to determine the association between a Mediterranean diet and glycemic control and other cardiovascular risk factors among youth with type 1 diabetes (T1D). Subjects/Methods Incident T1D cases aged <20 years at diagnosis between 2002 and 2005 were included. Participants were seen at baseline (N=793), 1-year (N=512) and 5-year follow-up visits (N=501). Mediterranean diet score was assessed using a modified KIDMED index (mKIDMED). Multivariate linear regression and longitudinal mixed model were applied to determine the association between mKIDMED score and log-HbA1c, lipids, blood pressure (BP), and obesity. Results In cross-sectional analyses using baseline data, for individuals with an HbA1c of 7.5%, a two-point higher mKIDMED score (one standard deviation) was associated with 0.15% lower HbA1c (P=0.02). A two-point higher mKIDMED score was associated with 4.0 mg/dL lower total cholesterol (TC) (P=0.006), 3.4 mg/dL lower low-density lipoprotein (LDL)-C (P=0.004), 3.9 mg/dL lower non-high-density lipoprotein (non-HDL)-C (P=0.004), and 0.07 lower LDL-C/HDL-C ratio (P=0.02). Using longitudinal data, a two-point increase in mKIDMED score was associated with 0.01% lower log-HbA1c (P=0.07), 1.8 mg/dL lower TC (P=0.05), 1.6 mg/dL lower LDL-C (P=0.03), and 1.8 mg/dL lower non-HDL-C (P=0.03) than would otherwise have been expected. HbA1c mediated about 20% of the association for lipids in both cross-sectional and longitudinal models. An unexpected positive association between mKIDMED score and systolic BP was found among non-Hispanic white youth in cross-sectional analyses (P=0.009). Mediterranean diet was not associated with obesity. Conclusions Mediterranean diet may improve glycemic control and cardiovascular health in T1D youth.
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Affiliation(s)
- V W Zhong
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | - A P Lamichhane
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | - J L Crandell
- School of Nursing and Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - S C Couch
- Department of Nutritional Sciences, University of Cincinnati, Cincinnati, OH, USA
| | - A D Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - N S The
- Department of Health Sciences, Furman University, Greenville, SC, USA
| | - B A Tzeel
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | - D Dabelea
- Department of Epidemiology, University of Colorado, Denver, CO, USA
| | - J M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - S M Marcovina
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - G Kim
- Seattle Children's Hospital, Seattle, WA, USA
| | - E J Mayer-Davis
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA.,Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Nourse SE, Olson I, Popat RA, Stauffer KJ, Vu CN, Berry S, Kazmucha J, Ogareva O, Couch SC, Urbina EM, Tierney ESS. Live Video Diet and Exercise Intervention in Overweight and Obese Youth: Adherence and Cardiovascular Health. J Pediatr 2015; 167:533-9.e1. [PMID: 26154402 DOI: 10.1016/j.jpeds.2015.06.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 04/27/2015] [Accepted: 06/04/2015] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To evaluate adherence of overweight and obese adolescents to a live video lifestyle intervention. The impact on vascular and functional health was also assessed. STUDY DESIGN Twenty adolescents 14.5 ± 2.1 years of age with body mass index z-score 1.94 ± 0.43 were enrolled. The 12-week intervention included 3-times-weekly videoconference sessions with a trainer and weekly diet consultations. Adherence was evaluated by completion rate and percentage of sessions attended. Vascular health indices and traditional cardiovascular risk factors were obtained at baseline and study end. RESULTS Seventeen participants (85%) completed the intervention. The participants attended 93 ± 11% of scheduled sessions. Reasons for absences included illness/injury (23%), school activities (21%), holidays (18%), forgetting the appointment (8%), Internet connectivity issues (7%), and family emergency (7%). Significant changes were observed in waist-hip ratio (0.87 ± 0.08 vs 0.84 ± 0.08, P = .03), total (159 ± 27 vs 147 ± 23 mg/dL, P = .004) and low-density lipoprotein cholesterol levels (91 ± 20 vs 81 ± 18 mg/dL, P = .004), volume of inspired oxygen per heartbeat at peak exercise (69 ± 16 vs 72 ± 15%, P = .01), and functional movement score (13 ± 2 vs 17 ± 1, P < .001). Participants with abnormal vascular function at baseline showed improvement in endothelial function and arterial stiffness indices (P = .01 and P = .04, respectively). CONCLUSIONS A 12-week live video intervention promotes adherence among overweight and obese adolescents and shows promise for improving vascular and functional health. Integrating telehealth into preventive care has the potential to improve cardiovascular health in the youth at risk.
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Affiliation(s)
- Susan E Nourse
- Division of Cardiology, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA
| | - Inger Olson
- Division of Cardiology, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA
| | - Rita A Popat
- Division of Epidemiology, Department of Health Research and Policy, Stanford School of Medicine, Palo Alto, CA
| | - Katie J Stauffer
- Division of Cardiology, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA
| | - Chau N Vu
- Division of Cardiology, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA
| | - Samuel Berry
- Division of Cardiology, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA
| | - Jeffrey Kazmucha
- Division of Cardiology, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA
| | - Olga Ogareva
- Division of Cardiology, Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA
| | - Sarah C Couch
- Department of Nutritional Sciences, University of Cincinnati, Cincinnati, OH
| | - Elaine M Urbina
- Division of Cardiology, Department of Pediatrics, University of Cincinnati, Cincinnati, OH
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Lamichhane AP, Crandell JL, Jaacks LM, Couch SC, Lawrence JM, Mayer-Davis EJ. Longitudinal associations of nutritional factors with glycated hemoglobin in youth with type 1 diabetes: the SEARCH Nutrition Ancillary Study. Am J Clin Nutr 2015; 101:1278-85. [PMID: 25948670 PMCID: PMC4441810 DOI: 10.3945/ajcn.114.103747] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 04/02/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Improved glycated hemoglobin (Hb A1c) delays the progression of microvascular and macrovascular complications in individuals with type 1 diabetes (T1D). We previously showed that higher baseline intakes of n-3 (ω-3) fatty acids and leucine are associated with preserved β cell function 2 y later in youth with T1D. OBJECTIVE In the current study, we extend this work to explore the longitudinal associations of nutritional factors with Hb A1c in youth with T1D. DESIGN We included 908 T1D youth with baseline and follow-up Hb A1c measurements. Nutritional factors assessed at baseline were as follows: breastfeeding status and timing of complimentary food introduction; intakes of leucine, carbohydrates, protein, fat, and fiber estimated from a food-frequency questionnaire (FFQ); and plasma biomarkers for vitamins D and E, eicosapentaenoic acid (EPA), and docosahexaenoic acid. We fit linear regression models adjusted for baseline Hb A1c, sociodemographic variables, diabetes-related variables, time between baseline and follow-up visits, saturated fat, physical activity, and for FFQ-derived nutrients, total calories. The vitamin D model was further adjusted for season and body mass index z score. RESULTS The mean ± SD age and diabetes duration at baseline was 10.8 ± 3.9 y and 10.1 ± 5.8 mo, respectively. A total of 9.3% of participants had poor Hb A1c (value ≥9.5%) at baseline, which increased to 18.3% during follow-up (P < 0.0001). Intakes of EPA (β = -0.045, P = 0.046), leucine (β = -0.031, P = 0.0004), and protein (β = -0.003, P = 0.0002) were significantly negatively associated with follow-up Hb A1c after adjustment for confounders. Intake of carbohydrates was significantly positively (β = 0.001, P = 0.003) associated with follow-up Hb A1c after adjustment for confounders. CONCLUSIONS Several nutritional factors may be associated with Hb A1c during early stages of disease progression in youth recently diagnosed with T1D. In addition to the overall role of major macronutrients such as carbohydrates and protein, leucine and n-3 fatty acid intakes, such as of EPA, may be important for long-term glycemic control.
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Affiliation(s)
- Archana P Lamichhane
- From the Department of Nutrition, Gillings School of Global Public Health (APL), the Department of Nutrition, Gillings School of Global Public Health and School of Medicine (EJM-D), and the Departments of Nursing and Biostatistics (JLC), University of North Carolina, Chapel Hill, NC; the Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH (SCC); the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (JML), and the Hubert Department of Global Health, Emory University, Atlanta, GA (LMJ).
| | - Jamie L Crandell
- From the Department of Nutrition, Gillings School of Global Public Health (APL), the Department of Nutrition, Gillings School of Global Public Health and School of Medicine (EJM-D), and the Departments of Nursing and Biostatistics (JLC), University of North Carolina, Chapel Hill, NC; the Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH (SCC); the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (JML), and the Hubert Department of Global Health, Emory University, Atlanta, GA (LMJ)
| | - Lindsay M Jaacks
- From the Department of Nutrition, Gillings School of Global Public Health (APL), the Department of Nutrition, Gillings School of Global Public Health and School of Medicine (EJM-D), and the Departments of Nursing and Biostatistics (JLC), University of North Carolina, Chapel Hill, NC; the Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH (SCC); the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (JML), and the Hubert Department of Global Health, Emory University, Atlanta, GA (LMJ)
| | - Sarah C Couch
- From the Department of Nutrition, Gillings School of Global Public Health (APL), the Department of Nutrition, Gillings School of Global Public Health and School of Medicine (EJM-D), and the Departments of Nursing and Biostatistics (JLC), University of North Carolina, Chapel Hill, NC; the Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH (SCC); the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (JML), and the Hubert Department of Global Health, Emory University, Atlanta, GA (LMJ)
| | - Jean M Lawrence
- From the Department of Nutrition, Gillings School of Global Public Health (APL), the Department of Nutrition, Gillings School of Global Public Health and School of Medicine (EJM-D), and the Departments of Nursing and Biostatistics (JLC), University of North Carolina, Chapel Hill, NC; the Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH (SCC); the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (JML), and the Hubert Department of Global Health, Emory University, Atlanta, GA (LMJ)
| | - Elizabeth J Mayer-Davis
- From the Department of Nutrition, Gillings School of Global Public Health (APL), the Department of Nutrition, Gillings School of Global Public Health and School of Medicine (EJM-D), and the Departments of Nursing and Biostatistics (JLC), University of North Carolina, Chapel Hill, NC; the Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH (SCC); the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA (JML), and the Hubert Department of Global Health, Emory University, Atlanta, GA (LMJ)
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23
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Wang S, Crandell JL, Couch SC, King IB, Lawrence JM, Dabelea D, Lamichhane AP, Kim G, Bell RA, Zhu S, Mayer-Davis EJ. Plasma nutrient biomarkers are associated with waist-to-height ratio in youth with type 1 diabetes. J Nutr 2015; 145:579-86. [PMID: 25733475 PMCID: PMC4336536 DOI: 10.3945/jn.114.203133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/26/2014] [Accepted: 12/09/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Plasma fatty acids (FAs) and micronutrients have been associated with central obesity in adults; however, previous studies of these associations in adults have yielded mixed results. In addition, no comparable research has been conducted among youth with type 1 diabetes (T1D). OBJECTIVE We investigated the cross-sectional and longitudinal associations between plasma nutrient biomarkers and waist-to-height ratio (WHtR) in youth with T1D. METHODS These analyses included 1324 youth aged 3-20 y at T1D diagnosis with a baseline visit in the SEARCH (Search for Diabetes in Youth) Study and a subset of 1178 of these youth with a follow-up visit an average of 23 mo (range: 16-40 mo) after their baseline visit. Plasma phospholipid FAs and vitamins were measured, and estimated desaturase activities were calculated at baseline. Anthropometric measurements and diabetes-related assessments were collected at each visit. Multiple linear regression was used to examine the association between plasma nutrient biomarkers and WHtR. RESULTS In cross-sectional analysis, plasma palmitic acid (P = 0.004), dihomo-γ-linolenic acid (DGLA; P = 0.017) and Δ6 desaturase (D6D; P = 0.006) were positively correlated with WHtR after adjustment of confounders. Oleic acid (OA; P = 0.002), linoleic acid (LA; P = 0.015), Δ9 desaturase 18 (D9D-18; P = 0.027), and vitamin D (P < 0.0001) were negatively correlated with WHtR after adjustment. Weight status was an effect modifier (P < 0.05). In normal-weight youth, vitamin D (P = 0.003) was negatively associated with WHtR. In obese youth, stearic acid (P = 0.037), DGLA (P < 0.0001), and D6D (P < 0.0001) were positively associated and OA (P = 0.0008), D9D-18 (P = 0.0006), and vitamin D (P < 0.0001) were negatively associated with WHtR. In longitudinal analysis, baseline linoleic acid (P = 0.018), n-6:n-3 (ω-3:ω-6) FA ratio (P = 0.029), vitamin D (P = 0.003), and vitamin E (P < 0.0001) were negatively correlated with WHtR at follow-up only in obese participants. CONCLUSIONS In T1D youth, plasma FAs and vitamins are associated with WHtR and are modified by weight status. These associations are particularly marked in obese youth.
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Affiliation(s)
- Shanshan Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, China Departments of Nutrition and Medicine and
| | - Jamie L Crandell
- School of Nursing and Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Sarah C Couch
- Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH
| | - Irena B King
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM
| | - Jean M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | | | - Grace Kim
- Seattle Children's Hospital, Seattle, WA
| | - Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC; and
| | - Shankuan Zhu
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, China Obesity and Body Composition Research Center, Chronic Disease Research Institute, School of Public Health, Zhejiang University, Hangzhou, China
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Couch SC, Glanz K, Zhou C, Sallis JF, Saelens BE. Home food environment in relation to children's diet quality and weight status. J Acad Nutr Diet 2014; 114:1569-1579.e1. [PMID: 25066057 DOI: 10.1016/j.jand.2014.05.015] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 05/14/2014] [Indexed: 12/11/2022]
Abstract
The objective of this cohort study was to explore relationships among the home food environment (HFE), child/parent characteristics, diet quality, and measured weight status among 699 child-parent pairs from King County, WA, and San Diego County, CA. HFE variables included parenting style/feeding practices, food rules, frequency of eating out, home food availability, and parents' perceptions of food costs. Child dietary intake was measured by 3-day recall and diet quality indicators included fruits and vegetables, sweet/savory snacks, high-calorie beverages, and Dietary Approaches to Stop Hypertension (DASH) score. Individual linear regression models were run in which child BMI z score and child diet quality indicators were dependent variables and HFE variables and child/parent characteristics were independent variables of interest. Fruit and vegetable consumption was associated with parental encouragement/modeling (β=.68, P<0.001) and unhealthful food availability (-0.27, P<0.05); DASH score with food availability (healthful: 1.3, P<0.01; unhealthful: -2.25, P<0.001), food rules (0.45, P<0.01), and permissive feeding style (-1.04, P<0.05); high-calorie beverages with permissive feeding style (0.14, P<0.01) and unhealthful food availability (0.21, P<0.001); and sweet/savory snacks with healthful food availability (0.26, P<0.05; unexpectedly positive). Children's BMI z score was positively associated with parent's use of food restriction (0.21, P<0.001), permissive feeding style (0.16, P<0.05), and concern for healthy food costs (0.10, P<0.01), but negatively with verbal encouragement/modeling (-0.17, P<0.05), and pressure to eat (-0.34, P<0.001). Various HFE factors associated with parenting around eating and food availability are related to child diet quality and weight status. These factors should be considered when designing interventions for improving child health.
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Ollberding NJ, Couch SC, Woo JG, Kalkwarf HJ. Within- and between-individual variation in nutrient intake in children and adolescents. J Acad Nutr Diet 2014; 114:1749-58.e5. [PMID: 24819232 DOI: 10.1016/j.jand.2014.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 03/07/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Little is known regarding the number of 24-hour recalls required to rank-order children and adolescents on usual intake for diet-disease studies. OBJECTIVE To determine the within- to between-individual variance ratios and number of 24-hour recalls required to rank-order individuals on usual intake for select macro- and micronutrients in a large, multiracial/ethnic sample of children and adolescents. DESIGN Cross-sectional survey. PARTICIPANTS/SETTING Children and adolescents ages 6 to 17 years participating in the 2007-2008 and 2009-2010 National Health and Nutrition Examination Survey (NHANES). MAIN OUTCOME MEASURES Variance ratios for predefined sex, age (children age 6 to 11 years, adolescents age 12 to 17 years), and racial/ethnic groups (Mexican American/Hispanic, non-Hispanic black, and non-Hispanic white). STATISTICAL ANALYSIS Mixed-effects linear regression models were used to estimate within- and between-individual variance components for selected nutrients. The number of 24-hour recalls required to rank-order participants on usual intake (absolute values and energy-adjusted) was obtained from the nutrient variance ratios for various levels of accuracy. RESULTS Variance ratios were more than 1 for all nutrients examined. High values (variance ratio >3) were observed for protein, saturated and unsaturated fatty acids, cholesterol, and several micronutrients. Variance ratios for absolute nutrient intakes were similar for both sexes within age groups, but higher for children than for adolescents. A total of six to nine and three to six 24-hour recalls were typically sufficient to rank-order children and adolescents, respectively, on usual intake with an accuracy of r=0.8. Additional recalls were required to achieve the same accuracy for energy-adjusted nutrients. Variance ratios were similar for adolescents across racial/ethnic groups, but highly variable in children. CONCLUSIONS A total of six to nine 24-hour recalls may represent a reasonable trade-off between accuracy and participant burden for rank-ordering nutrient intakes in children and adolescents. Additional research is required to determine whether this may be reduced using statistical modeling-based approaches and the number of recalls children and adolescents will reliably complete.
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The NS, Crandell JL, Thomas J, Couch SC, Shah AS, Maahs DM, Dabelea D, Marcovina SM, D'Agostino RB, Mayer-Davis EJ. Correlates of medical nutrition therapy and cardiovascular outcomes in youth with type 1 diabetes. J Nutr Educ Behav 2013; 45:661-668. [PMID: 23891147 PMCID: PMC3825757 DOI: 10.1016/j.jneb.2013.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 06/04/2013] [Accepted: 06/09/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To examine whether the types of medical nutrition therapies (MNTs) taught to and used by youth with type 1 diabetes (T1D) vary by sociodemographic characteristics and cardiovascular (CVD) risk factors. DESIGN Cross-sectional study. SETTING The SEARCH for Diabetes in Youth study is a population-based cohort of individuals with clinical diagnosed diabetes. PARTICIPANTS A total of 1,191 individuals with T1D. MAIN OUTCOME MEASURES Types of MNTs and frequency of use. ANALYSIS Bivariate analysis and multivariate linear regression (P < .05) RESULTS: More race/ethnic minorities (vs whites), individuals with parents with less than a high school education (vs high school or higher education), and overweight/obese (vs underweight/normal weight) were taught additional MNTs. For underweight/normal weight individuals exclusively taught carbohydrate counting, those who used this approach "often" had lower hemoglobin A1c (8.6% vs 8.9%) and triglycerides (73.5 vs 84.1 mg/dL) than those who used it "sometimes/never." "Often" use of additional MNTs beyond carbohydrate counting was not associated with better mean values for CVD risk factors. CONCLUSIONS AND IMPLICATIONS In individuals with T1D, race/ethnic minorities, individuals with parents with less than a high school education, and overweight/obese individuals are taught more MNTs. Further research is needed to understand the effectiveness of the various MNTs on CVD risk factors, and to identify how to translate nutrition knowledge to behavior and metabolic status.
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Affiliation(s)
- Natalie S The
- Department of Health Sciences, Furman University, Greenville, SC
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Sahay RD, Couch SC, Missoni S, Sujoldzić A, Novokmet N, Duraković Z, Rao MB, Milanović SM, Vuletić S, Deka R, Rudan P. Dietary patterns in adults from an Adriatic Island of Croatia and their associations with metabolic syndrome and its components. Coll Antropol 2013; 37:335-342. [PMID: 23940972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Adriatic islanders have a high prevalence of metabolic syndrome (MetS) although they have traditionally practiced an active lifestyle and adhered to a Mediterranean diet. We performed a cross-sectional study to identify dietary patterns in a sample of 1442 adults from the island of Hvar, and determined whether MetS and its components: waist-circumference, serum triglycerides, fasting plasma glucose, HDL-cholesterol, and blood pressure, were related to an altered pattern of the traditional Mediterranean diet. Dietary intake was assessed by a food frequency questionnaire. MetS was defined using the International Diabetes Federation criteria. Our study showed that dietary patterns in this population have diversified from the traditional diet. Principal component analysis identified three major patterns. The meat, alcohol, and fish pattern (MAFp), sweets, grains, and fats pattern (SGFp), and an olive-oil, vegetables, and fruits pattern (OVFp) explained 30.6% of total dietary variance. The MAFp associated significantly with MetS (p = 0.027) and high plasma glucose (p = 0.006).
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Affiliation(s)
- Rashmi D Sahay
- University of Cincinnati, College of Medicine, Department of Environmental Health, Cincinnati, Ohio 45267, USA.
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Couch SC, Crandell JL, Shah AS, Dolan LM, Merchant AT, Liese AD, Lawrence JM, Pihoker C, Mayer-Davis EJ. Fructose intake and cardiovascular risk factors in youth with type 1 diabetes: SEARCH for diabetes in youth study. Diabetes Res Clin Pract 2013; 100:265-71. [PMID: 23540682 PMCID: PMC3764988 DOI: 10.1016/j.diabres.2013.03.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/01/2013] [Accepted: 03/06/2013] [Indexed: 12/11/2022]
Abstract
AIMS High consumption of dietary fructose has been shown to contribute to dyslipidemia and elevated blood pressure in adults, but there are few data in youth, particularly those at greater risk of cardiovascular disease (CVD). The aim of this study was to examine the association between fructose intake and CVD risk factors in a diverse population of youth with type 1 diabetes (T1D). METHODS This was a cross-sectional analysis of data from the SEARCH for Diabetes in Youth study, including 2085 youth ages 10-22 years with T1D, of which 22% were racial/ethnic minority and 50% were female. A semi-quantitative food frequency questionnaire was used to assess intake. RESULTS Median daily fructose consumption was 7.9% of total calories. Fructose intake was positively associated with triglycerides (p<.01), but not with total cholesterol, LDL-cholesterol, HDL-cholesterol, or blood pressure after adjustment for physical activity and socio-demographic, clinical, and dietary covariates. An increase in fructose intake of 22 g (equivalent to a 12 oz can of soda) was associated with 23% higher odds of borderline/high versus low triglycerides (p<.005). CONCLUSION These data suggest that children with T1D should moderate their intake of fructose, particularly those with borderline or high triglycerides.
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Affiliation(s)
- Sarah C Couch
- Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, OH 45267-0394, United States.
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Frank LD, Saelens BE, Chapman J, Sallis JF, Kerr J, Glanz K, Couch SC, Learnihan V, Zhou C, Colburn T, Cain KL. Objective assessment of obesogenic environments in youth: geographic information system methods and spatial findings from the Neighborhood Impact on Kids study. Am J Prev Med 2012; 42:e47-55. [PMID: 22516503 DOI: 10.1016/j.amepre.2012.02.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 02/15/2012] [Accepted: 02/15/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND GIS-based walkability measures designed to explain active travel fail to capture "playability" and proximity to healthy food. These constructs should be considered when measuring potential child obesogenic environments. PURPOSE The aim of this study was to describe the development of GIS-based multicomponent physical activity and nutrition environment indicators of child obesogenic environments in the San Diego and Seattle regions. METHODS Block group-level walkability (street connectivity, residential density, land-use mix, and retail floor area ratio) measures were constructed in each region. Multiple sources were used to enumerate parks (∼900-1600 per region) and food establishments (∼10,000 per region). Physical activity environments were evaluated on the basis of walkability and presence and quality of parks. Nutrition environments were evaluated based on presence and density of fast-food restaurants and distance to supermarkets. Four neighborhood types were defined using high/low cut points for physical activity and nutrition environments defined through an iterative process dependent on regional counts of fast-food outlets and overall distance to parks and grocery stores from census block groups where youth live. RESULTS To identify sufficient numbers of children aged 6-11 years, high physical activity environment block groups had at least one high-quality park within 0.25 miles and were above median walkability, whereas low physical activity environment groups had no parks and were below median walkability. High nutrition environment block groups had a supermarket within 0.5 miles, and fewer than 16 (Seattle) and 31 (San Diego) fast-food restaurants within 0.5 miles. Low nutrition environments had either no supermarket, or a supermarket and more than 16 (Seattle) and 31 (San Diego) fast-food restaurants within 0.5 miles. Income, educational attainment, and ethnicity varied across physical activity and nutrition environments. CONCLUSIONS These approaches to defining neighborhood environments can be used to study physical activity, nutrition, and obesity outcomes. Findings presented in a companion paper validate these GIS methods for measuring obesogenic environments.
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Affiliation(s)
- Lawrence D Frank
- Schools of Population and Public Health and Community and Regional Planning, University of British Columbia, Vancouver, Canada.
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Saelens BE, Sallis JF, Frank LD, Couch SC, Zhou C, Colburn T, Cain KL, Chapman J, Glanz K. Obesogenic neighborhood environments, child and parent obesity: the Neighborhood Impact on Kids study. Am J Prev Med 2012; 42:e57-64. [PMID: 22516504 PMCID: PMC3332077 DOI: 10.1016/j.amepre.2012.02.008] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 02/02/2012] [Accepted: 02/15/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND Identifying neighborhood environment attributes related to childhood obesity can inform environmental changes for obesity prevention. PURPOSE To evaluate child and parent weight status across neighborhoods in King County (Seattle metropolitan area) and San Diego County differing in GIS-defined physical activity environment (PAE) and nutrition environment (NE) characteristics. METHODS Neighborhoods were selected to represent high (favorable) versus low (unfavorable) on the two measures, forming four neighborhood types (low on both measures, low PAE/high NE, high PAE/low NE, and high on both measures). Weight and height of children aged 6-11 years and one parent (n=730) from selected neighborhoods were assessed in 2007-2009. Differences in child and parent overweight and obesity by neighborhood type were examined, adjusting for neighborhood-, family-, and individual-level demographics. RESULTS Children from neighborhoods high on both environment measures were less likely to be obese (7.7% vs 15.9%, OR=0.44, p=0.02) and marginally less likely to be overweight (23.7% vs 31.7%, OR=0.67, p=0.08) than children from neighborhoods low on both measures. In models adjusted for parent weight status and demographic factors, neighborhood environment type remained related to child obesity (high vs low on both measures, OR=0.41, p<0.03). Parents in neighborhoods high on both measures (versus low on both) were marginally less likely to be obese (20.1% vs 27.7%, OR=0.66, p=0.08), although parent overweight did not differ by neighborhood environment. The lower odds of parent obesity in neighborhoods with environments supportive of physical activity and healthy eating remained in models adjusted for demographics (high vs low on the environment measures, OR=0.57, p=0.053). CONCLUSIONS Findings support the proposed GIS-based definitions of obesogenic neighborhoods for children and parents that consider both physical activity and nutrition environment features.
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Affiliation(s)
- Brian E Saelens
- Seattle Children's Research Institute, Washington 98145-5005, USA.
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Martin LJ, Lee SY, Couch SC, Morrison J, Woo JG. Shared genetic contributions of fruit and vegetable consumption with BMI in families 20 y after sharing a household. Am J Clin Nutr 2011; 94:1138-43. [PMID: 21831991 PMCID: PMC3173028 DOI: 10.3945/ajcn.111.015461] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Obesity has a strong genetic basis, but the identification of genetic variants has not resulted in improved clinical care. However, phenotypes that influence weight, such as diet, may have shared underpinnings with obesity. Interestingly, diet also has a genetic basis. Thus, we hypothesized that the genetic underpinnings of diet may partially overlap with the genetics of obesity. OBJECTIVE Our objective was to determine whether dietary intake and BMI share heritable components in adulthood. DESIGN We used a cross-sectional cohort of parents and adult offspring (n = 1410) from the Princeton Follow-up Study. Participants completed Block food-frequency questionnaires 15-27 y after sharing a household. Heritability of dietary intakes was estimated by using variance components analysis. Bivariate genetic analyses were used to estimate the shared effects between BMI and heritable dietary intakes. RESULTS Fruit, vegetable, and protein consumption exhibited moderate heritability [(mean ± SE) 0.26 ± 0.06, 0.32 ± 0.06, and 0.21 ± 0.06, respectively; P < 0.001], but other dietary intakes were modest (h(2) < 0.2). Only fruit and vegetable consumption exhibited genetic correlations with BMI (ρ(g) = -0.28 ± 0.13 and -0.30 ± 0.13, respectively; P < 0.05). Phenotypic correlations with BMI were not significant. CONCLUSIONS We showed that fruit, vegetable, and protein intakes are moderately heritable and that fruit and vegetable consumption shares underlying genetic effects with BMI in adulthood, which suggests that individuals genetically predisposed to low fruit and vegetable consumption may be predisposed to higher BMI. Thus, obese individuals who have low fruit and vegetable consumption may require targeted interventions that go beyond low-calorie, plant-based programs for weight management.
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Affiliation(s)
- Lisa J Martin
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA.
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Tandon PS, Zhou C, Chan NL, Lozano P, Couch SC, Glanz K, Krieger J, Saelens BE. The impact of menu labeling on fast-food purchases for children and parents. Am J Prev Med 2011; 41:434-8. [PMID: 21961472 PMCID: PMC3185295 DOI: 10.1016/j.amepre.2011.06.033] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 04/15/2011] [Accepted: 06/10/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nutrition labeling of menus has been promoted as a means for helping consumers make healthier food choices at restaurants. As part of national health reform, chain restaurants will be required to post nutrition information at point-of-purchase, but more evidence regarding the impact of these regulations, particularly in children, is needed. PURPOSE To determine whether nutrition labeling on restaurant menus results in a lower number of calories purchased by children and their parents. METHODS A prospective cohort study compared restaurant receipts of those aged 6-11 years and their parents before and after a menu-labeling regulation in Seattle/King County (S/KC) (n=75), with those from a comparison sample in nonregulated San Diego County (SDC) (n=58). Data were collected in 2008 and 2009 and analyzed in 2010. RESULTS In S/KC, there was a significant increase from pre- to post-regulation (44% vs 87%) in parents seeing nutrition information, with no change in SDC (40% vs 34%). Average calories purchased for children did not change in either county (823 vs 822 in S/KC, 984 vs 949 in SDC). There was an approximately 100-calorie decrease for the parents postregulation in both counties (823 vs 720 in S/KC, 895 vs 789 in SDC), but no difference between counties. CONCLUSIONS A restaurant menu-labeling regulation increased parents' nutrition information awareness but did not decrease calories purchased for either children or parents.
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Affiliation(s)
- Pooja S Tandon
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, University of Washington, USA.
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Krikorian R, Shidler MD, Dangelo K, Couch SC, Benoit SC, Clegg DJ. Dietary ketosis enhances memory in mild cognitive impairment. Neurobiol Aging 2010; 33:425.e19-27. [PMID: 21130529 DOI: 10.1016/j.neurobiolaging.2010.10.006] [Citation(s) in RCA: 208] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 08/30/2010] [Accepted: 09/10/2010] [Indexed: 12/17/2022]
Abstract
We randomly assigned 23 older adults with mild cognitive impairment to either a high carbohydrate or very low carbohydrate diet. Following the 6-week intervention period, we observed improved verbal memory performance for the low carbohydrate subjects (p = 0.01) as well as reductions in weight (p < 0.0001), waist circumference (p < 0.0001), fasting glucose (p = 0.009), and fasting insulin (p = 0.005). Level of depressive symptoms was not affected. Change in calorie intake, insulin level, and weight were not correlated with memory performance for the entire sample, although a trend toward a moderate relationship between insulin and memory was observed within the low carbohydrate group. Ketone levels were positively correlated with memory performance (p = 0.04). These findings indicate that very low carbohydrate consumption, even in the short term, can improve memory function in older adults with increased risk for Alzheimer's disease. While this effect may be attributable in part to correction of hyperinsulinemia, other mechanisms associated with ketosis such as reduced inflammation and enhanced energy metabolism also may have contributed to improved neurocognitive function. Further investigation of this intervention is warranted to evaluate its preventive potential and mechanisms of action in the context of early neurodegeneration.
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Affiliation(s)
- Robert Krikorian
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH 45267-0559, USA.
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Couch SC, Saelens BE. Factors associated with pediatric hypertension in Mexico. ACTA ACUST UNITED AC 2009; 109:992-5. [PMID: 19465180 DOI: 10.1016/j.jada.2009.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 03/03/2009] [Indexed: 11/30/2022]
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Couch SC, Saelens BE, Levin L, Dart K, Falciglia G, Daniels SR. The efficacy of a clinic-based behavioral nutrition intervention emphasizing a DASH-type diet for adolescents with elevated blood pressure. J Pediatr 2008; 152:494-501. [PMID: 18346503 DOI: 10.1016/j.jpeds.2007.09.022] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2007] [Revised: 07/05/2007] [Accepted: 09/10/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the efficacy of a 3-month clinic-based behavioral nutrition intervention emphasizing a diet high in fruits, vegetables, and low fat dairy (DASH intervention) versus routine outpatient hospital-based nutrition care (RC) on diet and blood pressure (BP) in adolescents with elevated BP. STUDY DESIGN Fifty-seven adolescents with a clinical diagnosis of prehypertension or hypertension (systolic BP or diastolic BP, 90(th) to 99(th) percentile) were randomly assigned to DASH or RC. SBP, DBP, 3-day diet recall, weight, and height were assessed at pretreatment, post-treatment, and 3 months later (follow-up). RESULTS In completer analysis, DASH versus RC had a greater decrease in SBP z scores from baseline to post-treatment (P < 0.01) and a trend for a greater decrease in SBP z scores from baseline through follow-up (P = .07). DBP z scores changed similarly for conditions from baseline through follow-up. Relative to RC, DASH had a greater increase in intake of fruits (P < .001), potassium and magnesium (P < .01), and a greater decrease in total fat (P < .05) from baseline to post-treatment. From baseline through follow-up, DASH versus RC had a greater increase in low fat dairy (P < .001). CONCLUSIONS The DASH intervention proved more effective than RC in improving SBP and diet quality in adolescents with elevated BP.
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Affiliation(s)
- Sarah C Couch
- Department of Nutritional Sciences, University of Cincinnati, Cincinnati, OH 45267-0394, USA.
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Affiliation(s)
- Sarah C Couch
- Department of Nutritional Sciences, University of Cincinnati Medical Center, 3202 Goodman Avenue, Cincinnati, OH 45267-0394, USA.
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Stanton SG, Ryerson E, Moore SL, Sullivan-Mahoney M, Couch SC. Hearing screening outcomes in infants of pregestational diabetic mothers. Am J Audiol 2005; 14:86-93. [PMID: 16180972 DOI: 10.1044/1059-0889(2005/008)] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2004] [Accepted: 05/02/2005] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Hearing screening results for newborns of diabetic mothers were compared with those of nondiabetic controls. METHOD This study was a retrospective chart review of mothers with pregestational diabetes mellitus and their neonates (n=73) who received newborn hearing screening between January 1, 2000, and May 1, 2002. A group of nondiabetic mothers and their infants (n=73), with birth dates that matched the diabetic group, served as controls. A 2-tiered hearing screening protocol, employing distortion product otoacoustic emission (DPOAE) and automated auditory brainstem response (A-ABR) screening techniques, was used. RESULTS The DPOAE screening failure rate was 5.5% (4/73) for babies in the nondiabetic control group and 11.0% (8/73) for infants of diabetic mothers; this difference was not statistically significant. The A-ABR failure rate was 9.1% (1/11) for the diabetic group compared with 0% (0/4) for the controls, but the A-ABR was measured for only a small number of participants in each group. The frequency of premature birth and abnormal birth weight was significantly greater for the infants of diabetic mothers compared with controls. CONCLUSIONS Given the greater frequency of prematurity and abnormal birth weight in the population of neonates born to diabetics, additional research using A-ABR is recommended.
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Affiliation(s)
- Susan G Stanton
- Communication Sciences and Disorders, University of Cincinnati, Cincinnati, OH 45267-0379, USA.
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Abstract
PURPOSE OF REVIEW The prevalence of hypertension among children in the US is increasing in concert with rising obesity rates. Leading health organizations agree that elevated blood pressure should be managed in children; however, data on the relation between diet and lifestyle and blood pressure in this age group are sparse and controversial. The purpose of this review is to summarize the current evidence regarding nutrients, foods, and dietary patterns and their role in blood pressure elevation and in the treatment of pediatric hypertension. RECENT FINDINGS There is clear evidence that avoidance of excess weight gain in early life is important for the prevention of future hypertension and that weight reduction is an important therapeutic intervention for the prevention and treatment of hypertension in overweight children. Similarly, reduction in dietary sodium may be beneficial for children who are salt sensitive, but this trait cannot be easily measured. Children who were breast-fed or consume a diet rich in fruits, vegetables, and dairy foods tend to have lower blood pressure in adolescence. How these foods lower blood pressure is unclear. SUMMARY Data supporting the efficacy of dietary interventions for preventing or treating high blood pressure are limited. Future studies should emphasize adequate sample size, adjustment for confounding factors, use of standardized blood pressure techniques, and random assignment of children in intervention trials. Additionally, because adherence to dietary interventions may be particularly problematic among children, innovative nutrition intervention approaches are needed that address the unique needs and circumstances of this age group.
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Affiliation(s)
- Sarah C Couch
- Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
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Cragun DL, Couch SC, Prows CA, Warren NS, Christianson CA. A success of a genetics educational intervention for nursing and dietetic students: A model for incorporating genetics into nursing and allied health curricula. J Allied Health 2005; 34:90-6. [PMID: 16032915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Allied health care professionals and nurses provide genetic-related client services, such as eliciting family medical history information and discussing the genetic component of health conditions. However, these professionals report a lack of confidence in their ability to perform genetic services and have little formal education in genetics. A barrier to incorporating genetics into allied health curricula includes the limited flexibility to expand curricula. This barrier was addressed by incorporating a Web-based tutorial on basic genetics and a lecture on the genetics of diabetes into preexisting undergraduate nutrition courses for nursing and dietetic students. The vast majority of students enrolled in these required courses participated in the intervention. Most participants agreed that genetics is important to their future career. Following the intervention, students' knowledge of genetics and confidence in their ability to provide genetic-related services increased significantly. Despite the short-term success and positive student evaluations, a single educational intervention does not appear to be sufficient for students to become proficient in performing the recommended genetic competencies for all health care professionals. Recommendations and resources for incorporating genetics into allied health curricula are included.
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Affiliation(s)
- Deborah L Cragun
- Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4006, Cincinnati, OH 45229-3039, USA.
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Abstract
OBJECTIVE To investigate the changes in dietary variety over time in children and to determine the relationship between dietary variety and diet quality. DESIGN Dietary data were collected from fourth and fifth grade students for 14 consecutive days by a registered dietitian. SETTING Colerain School District of Cincinnati, Ohio. PARTICIPANTS There were 33 children involved in the study. MAIN OUTCOME MEASURES Two cumulative dietary variety scores were estimated. The first was based on the Food Guide Pyramid groups: grain, fruit, vegetable, dairy, and meat (GFVDM). The second was based on the groups highlighted by the 2000 Dietary Guidelines for variety: grain, fruit, and vegetable (GFV). Diets were analyzed for energy and nutrient content. ANALYSIS Analysis of variance and Pearson correlation coefficients. RESULTS Dietary variety increased over time up to 14 days. A significant difference (P <.0001) was found for the cumulative GFVDM and GFV variety scores on days 3, 7, and 14. Positive correlations were found between the GFVDM and GFV variety scores and vitamin C and fiber. CONCLUSIONS AND IMPLICATIONS This study suggests that a 2-week period is necessary to capture food variety in children. Some associations were found between dietary variety and diet quality. New tools are needed to measure dietary variety in children.
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Affiliation(s)
- Grace A Falciglia
- Department of Nutritional Sciences, University of Cincinnati Medical Center, Cincinnati, Ohio 45267-0394, USA.
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Gribble LS, Falciglia G, Davis AM, Couch SC. A curriculum based on social learning theory emphasizing fruit exposure and positive parent child-feeding strategies: a pilot study. J Am Diet Assoc 2003; 103:100-3. [PMID: 12525801 DOI: 10.1053/jada.2003.50011] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study examined the effectiveness of a nutrition intervention program to enhance children's knowledge, preference, and intake of whole fruit and to decrease parents' use of controlling child-feeding behaviors. Subjects were fifth- and sixth-grade students (children aged 10-12 years) from Cincinnati, Ohio. Nine parent-child pairs completed the study. Seventeen parent-child pairs who expressed interest but were unable to attend more than one session served as controls. Based on the Social Learning Theory, the curriculum combined child-focused interactive lessons and skill-building activities with parent-focused lessons on child-feeding strategies to increase the fruit intake of children. Change in children's knowledge, preference, and intake of fruit and parents' use of controlling child-feeding strategies were measured in a pretest/posttest manner using validated questionnaires. There was a significant increase in knowledge scores and fruit intake by children in the experimental vs the control group. Fruit preference scores were similar between groups. Additionally, there was a significant decrease in use of controlling child-feeding strategies by parents in the intervention vs the control group.
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Affiliation(s)
- Laura Siem Gribble
- Department of Nutritional Sciences, College of Allied Health Sciences, University of Cincinnati, OH 45267, USA
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Kaistha A, Deckelbaum RJ, Starc TJ, Couch SC. Overrestriction of dietary fat intake before formal nutritional counseling in children with hyperlipidemia. Arch Pediatr Adolesc Med 2001; 155:1225-30. [PMID: 11695931 DOI: 10.1001/archpedi.155.11.1225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To assess the nutritional adequacy of the diets of children with hyperlipidemia following medically unsupervised low-fat diets compared with children receiving unrestricted diets. DESIGN Case comparison study. PATIENTS AND OTHER PARTICIPANTS Forty-six children were referred to the Children's Cardiovascular Health Center, Columbia-Presbyterian Medical Center, New York, NY, for treatment of hyperlipidemia who had achieved the Step I diet recommendations for total fat before formal nutritional counseling (mean age +/- SE, 9.7 +/- 0.3 years; sex distribution, 24 boys [53%]; ethnicity, 26 Latinos [57%] and 20 whites [43 %]; body mass index +/- SE, 22.4 +/- 0.7 kg/m(2)), and 34 healthy children participating in well-child visits at a local pediatric practice (mean age +/- SE, 10.2 +/- 0.4 years; sex distribution, 18 boys [54%]; ethnicity, 19 Latinos [57%] and 15 whites [43%]; body mass index +/- SE, 22.5 +/- 1.1 kg/m(2)). MAIN OUTCOME MEASURES Three-day food records were analyzed by a registered dietitian using the Minnesota Nutrient Data System. Outcome measures were intakes of calories, total and saturated fats, carbohydrate, protein, essential fatty acids, fat-soluble vitamins, folate, vitamin C, calcium, iron, and zinc. RESULTS The percentage of calories from fat and saturated fat was significantly lower in the hyperlipidemic population (mean +/- SE, hyperlipidemic vs control subjects: total fat, 22.7% +/- 0.7% vs 34.5% +/- 0.6%, P<.001; saturated fat, 7.9% +/- 0.3% vs 12.9% +/- 0.4%, P<.001). The caloric intake in controls was 17% higher than in patients with hyperlipidemia. Ninety percent of the decrease in calories in the hyperlipidemic group could be accounted for by the decrease in total fat intake. After adjusting for calories, no significant difference was noted between the groups for any of the vitamins and minerals mentioned earlier. CONCLUSION Our findings suggest that before formal nutritional counseling, overzealous dietary fat restriction can occur in children with hypercholesterolemia.
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Affiliation(s)
- A Kaistha
- Department of Pediatrics, Columbia-Presbyterian Medical Center, PH 15E, 630 W 168th St, New York, NY 10032, USA
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Abstract
OBJECTIVE To determine whether children with food neophobia (unwillingness to try new foods) have more restrictive diets than children without neophobia. SUBJECTS Seventy children were classified into 3 groups based on scores obtained on the Food Neophobia Scale: neophobic group, score greater than 41; neophilic group, score less than 27; and average group, score of 28 to 40. DESIGN Dietary data were collected and analyzed for 3 days selected randomly. The dependent variables measured were energy and nutrient intakes, servings of each Food Guide Pyramid group, and Health Eating Index (HEI) scores. STATISTICAL ANALYSES chi 2, 1-way analysis of covariance, and Scheffé multiple comparisons tests were conducted. RESULTS The 3 groups were similar with respect to the number of children meeting two thirds of the RDA/DRI for energy and most nutrients. The exception was vitamin E: fewer neophobic children met two thirds of the recommended value for this nutrient than average and neophilic children. The overall HEI score was significantly lower for the neophobic group compared with the average and neophilic groups. The HEI index showed that children with neophobia had a higher intake of saturated fat and less food variety than children without food neophobia. APPLICATIONS Dietitians should emphasize increased food variety for children within the context of a healthful diet. Research should be conducted to determine the effects of dietary variety on quality of diet and health of children.
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Couch SC, Isasi CR, Karmally W, Blaner WS, Starc TJ, Kaluski D, Deckelbaum RJ, Ginsberg HN, Shea S, Berglund L. Predictors of postprandial triacylglycerol response in children: the Columbia University Biomarkers Study. Am J Clin Nutr 2000; 72:1119-27. [PMID: 11063438 DOI: 10.1093/ajcn/72.5.1119] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Predictors of postprandial lipemia have not been explored in children. OBJECTIVE Our objective was to determine whether the postprandial triacylglycerol response is associated with low HDL-cholesterol and high fasting triacylglycerol concentrations and family history of early-onset ischemic heart disease (IHD) in children. DESIGN We administered a standardized fat load (52.5 g fat/m(2)) to 60 children (mean age: 14.0 y), 20 with and 40 without a family history of early-onset IHD, and to 29 mothers, all recruited from families enrolled in the Columbia University Biomarkers Study. Plasma lipid and retinyl palmitate concentrations were measured in the fasting state and 3, 6, and 8 h after the oral fat load. RESULTS In children, postprandial lipemia, as indicated by the incremental area under the triacylglycerol response curve, was associated with elevated fasting triacylglycerol concentrations (>/=1.13 mmol/L; P: < 0.01), with low fasting HDL-cholesterol concentrations (</=0.91 mmol/L; P: < 0.01), and with the combination of low HDL-cholesterol and high triacylglycerol concentrations (P: < 0.05). Family history of IHD, baseline LDL-cholesterol concentration, and apolipoprotein E genotype were not associated with the postprandial triacylglycerol or retinyl palmitate response. The mothers had fasting triacylglycerol concentrations similar to those of their children but a more prolonged response with higher triacylglycerol concentrations at 6 and 8 h (P: < 0.01 and P: < 0.05, respectively). CONCLUSIONS In children, a delayed postprandial triacylglycerol response to a fat load is associated with the combination of high fasting triacylglycerol and low HDL-cholesterol concentrations. Predictors of postprandial triacylglycerol concentrations may be similar in children and adults.
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Affiliation(s)
- S C Couch
- Departments of Pediatrics and Medicine, Columbia University, New York, NY 10032, USA
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Couch SC, Cross AT, Kida K, Ros E, Plaza I, Shea S, Deckelbaum R. Rapid westernization of children's blood cholesterol in 3 countries: evidence for nutrient-gene interactions? Am J Clin Nutr 2000; 72:1266S-1274S. [PMID: 11063468 DOI: 10.1093/ajcn/72.5.1266s] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study was to examine potential factors that modify blood cholesterol among children in countries in which dietary and lifestyle habits are becoming westernized. Population data on serum total and lipoprotein cholesterol, anthropometric indexes, and dietary intake were reviewed and compared for children aged 1-18 y from Japan, Spain, and the United States. The data show that total serum cholesterol in Japanese and Spanish children recently exceeded the 75th percentile for US children, primarily reflecting LDL cholesterol, although both LDL and HDL cholesterol contributed. Adiposity indexes do not explain the trends observed. Total and saturated fat intakes increased substantially in both Japan and Spain but in Japan are still lower than intakes in the United States. The Hegsted equation was used to relate differences in serum cholesterol to dietary fat intake. Changes in total serum cholesterol followed established dietary correlations among children in Spain, but not in Japan. Serum cholesterol in Japanese children was predicted to be 0.20-0.32 mmol/L lower than in US children; actual concentrations were considerably higher. These results suggest that a rapid westernization of children's blood cholesterol concentrations has occurred in Japan and Spain. Changes in fat intake predict changes in blood cholesterol in Spain, but not in Japan. Differences in genetic response to diet in certain populations, such as the Japanese, may explain higher blood cholesterol concentrations with lower fat intakes compared with the United States.
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Affiliation(s)
- S C Couch
- Institute of Human Nutrition, the Departments of Pediatrics and Medicine, and the School of Public Health, Columbia University, New York, USA
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Isasi CR, Shea S, Deckelbaum RJ, Couch SC, Starc TJ, Otvos JD, Berglund L. Apolipoprotein epsilon2 allele is associated with an anti-atherogenic lipoprotein profile in children: The Columbia University BioMarkers Study. Pediatrics 2000; 106:568-75. [PMID: 10969104 DOI: 10.1542/peds.106.3.568] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We examined associations between allelic variation in the apo epsilon gene, which codes for apolipoprotein E, and plasma lipid levels in children. MATERIALS AND METHODS We analyzed genotype and fasting lipid levels, including lipid particle size by nuclear magnetic resonance spectroscopy, in 515 children from 297 families. RESULTS Children carrying the apo epsilon2 allele (1 or 2 epsilon2 alleles; n = 45) had higher mean high-density lipoprotein (HDL) cholesterol level (49.5 +/- 13.0 vs 42.4 +/- 8.9 mg/dL) and lower mean low-density lipoprotein (LDL) cholesterol level (82.2 +/- 48.6 vs 105.9 +/- 45.0 mg/dL) compared with apo epsilon3/epsilon3 children (n = 322). Mean HDL size was larger and mean level of the atheroprotective large HDL subpopulation was higher among apo epsilon2 carriers compared with epsilon3/epsilon3 children (9.5 +/- 0.4 vs 9.3 +/-.4 nm, and 32.8 +/- 9.9 vs 27.6 +/- 8.2 mg/dL). In multivariate models adjusting for age, sex, ethnicity, family history, body mass index, and fasting triglyceride level, the apo epsilon2 allele was independently predictive of higher levels of HDL cholesterol and the large HDL subpopulation and of lower level of LDL cholesterol. CONCLUSION The apo epsilon2 allele is associated with an anti-atherogenic lipid pattern in children.apolipoprotein epsilon, children, cholesterol.
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Affiliation(s)
- C R Isasi
- Department of Medicine, Columbia University, New York, New York 10032, USA
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Wijendran V, Bendel RB, Couch SC, Philipson EH, Cheruku S, Lammi-Keefe CJ. Fetal erythrocyte phospholipid polyunsaturated fatty acids are altered in pregnancy complicated with gestational diabetes mellitus. Lipids 2000; 35:927-31. [PMID: 10984116 DOI: 10.1007/s11745-000-0602-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Insulin resistance and altered maternal metabolism in gestational diabetes mellitus (GDM) may impair fetal arachidonic acid (AA) and docosahexaenoic acid (DHA) status. The objectives were to test the hypothesis that fetal polyunsaturated fatty acids would be altered with GDM and identify factors related to fetal phospholipid (PL) AA and DHA. Maternal and cord vein erythrocyte PL fatty acids were determined in GDM (n = 13) and healthy pregnant women (controls, n = 12). Cord vein erythrocyte PL AA and DHA concentrations were significantly lower in GDM vs. controls. Maternal blood hemoglobin A1C was inversely correlated to fetal erythrocyte PL DHA and AA in controls and GDM (n = 25). Pregravid body mass index was negatively associated with fetal PL DHA. The data support the hypothesis that there is impairment in fetal accretion of DHA and AA in GDM.
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Affiliation(s)
- V Wijendran
- Department of Nutritional Sciences, University of Connecticut, Storrs 06269-4017, USA
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Abstract
OBJECTIVES To examine trends in meal patterns and food choices across two generations of Japanese-American females born in the USA. DESIGN Cross-sectional cohort study. SETTING Gardena, a suburb of Los Angeles, California. SUBJECTS One-hundred and seventy-six Japanese-American females, participating in a morning exercise class from December 1998 to January 1999. INTERVENTION Eighty-eight Nisei (second generation) mothers and their Sansei (third generation) daughters completed a food frequency questionnaire, answering questions regarding meal patterns and consumption frequency of 51 food items. RESULTS The Sansei ate fewer meals per day compared with the Nisei. Mean frequencies of takeout foods and eating out were higher in the Sansei vs the Nisei. Mean intake of meats and eggs were similar between the two groups. However, mean consumption of traditional Japanese complement foods including fish, vegetables and legumes was lower in the Sansei vs the Nisei. Intake of more 'Westernized' accessory foods, including salty snacks, regular soft drinks and alcoholic beverages, was higher in the Sansei vs the Nisei. CONCLUSION Findings from this study indicate that meal patterns and food choices have changed in succeeding generations of Japanese-American females from traditional fare to a diet containing many complement and accessory foods that are higher in fat, sugar, sodium and calories. Health professionals should be advised to consider the whole diet in making nutrition recommendations to this population as well as providing information to this group on the nutritional benefits of many traditional foods. European Journal of Clinical Nutrition (2000) 54, 665-670.
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Affiliation(s)
- Y Kudo
- Department of Health Sciences, Program in Dietetics and Nutrition Education, University of Cincinnati Medical Center, Cincinnati, OH 04267-0394, USA
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Couch SC, Schwarzman F, Carroll J, Koenigsberger D, Nordli DR, Deckelbaum RJ, DeFelice AR. Growth and nutritional outcomes of children treated with the ketogenic diet. J Am Diet Assoc 1999; 99:1573-5. [PMID: 10608955 DOI: 10.1016/s0002-8223(99)00387-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- S C Couch
- Department of Health Sciences, University of Cincinnati Medical Center, Ohio 45221-0394, USA
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