Family income and education were related with 30-year time trends in dietary and meal behaviors of American children and adolescents

School-level economic disadvantage and obesity in middle school children in central Texas, USA: a cross-sectional study

BACKGROUND

Although children of lower socio-economic status (SES) in the United States have generally been found to be at greater risk for obesity, the SES-obesity association varies when stratified by racial/ethnic groups-with no consistent association found for African American and Hispanic children. Research on contextual and setting-related factors may provide further insights into ethnic and SES disparities in obesity. We examined whether obesity levels among central Texas 8th grade students (n=2682) vary by school-level economic disadvantage across individual-level family SES and racial/ethnicity groups. As a secondary aim, we compared the association of school-level economic disadvantage and obesity by language spoken with parents (English or Spanish) among Hispanic students.

METHODS

Multilevel regression models stratified by family SES and ethnicity were run using cross-sectional baseline data from five school districts participating in the Central Texas CATCH Middle School project. For family SES, independent multi-level logistic regression models were run for total sample and by gender for each family SES stratum (poor/near poor/just getting by, living comfortably, and very well off), adjusting for age, ethnicity, and gender. Similarly, multi-level regression models were run by race/ethnic group (African American, Hispanic, and White), adjusting for age, family SES, and gender.

RESULTS

Students attending highly economically disadvantaged (ED) schools were between 1.7 (95% CI: 1.1-2.6) and 2.4 (95% CI: 1.2-4.8) times more likely to be obese as students attending low ED schools across family SES groups (p<.05). African American (OR(Adj) =3.4, 95% CI: 1.1-11.4), Hispanic (OR(Adj)=1.8, 95% CI 1.1-3.0) and White (OR(Adj)=3.8, 95% CI: 1.6-8.9) students attending high ED schools were more likely to be obese as counterparts at low ED schools (p<.05). Gender-stratified findings were similar to findings for total sample, although fewer results reached significance. While no obesity differences across school ED categories were found for Hispanic Spanish-speaking students, Hispanic English-speaking students (HES) attending high ED schools were 2.4 times more likely to be obese as HES students at low ED schools (p=.003).

CONCLUSION

Findings support the need to prioritize economically disadvantaged schools for obesity prevention efforts and support further exploration of school SES context in shaping children’s physical activity and dietary behaviors.

Dietary energy density in young children across Europe

OBJECTIVES

To describe energy density (ED; kcal g(-1)) of dietary intake of European children.

METHODS

From 16, 228 children who participated in the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS) baseline examination, 8551 children with 24-h dietary recalls (24-HDR), with plausible reported energy intakes and complete covariate information were included in the present analysis. ED was calculated using two methods: (1) ED including solid foods (EDF) and (2) ED including solid foods and energy-containing beverages (EDF&B). Beverage energy was calculated in kcal per day. Dietary characteristics and body mass index (BMI) z-score of children aged 2 to <6 years and 6 to <10 years were compared between children with an overall EDF below the <25th percentile, between the 25th and 75th percentile as well as above the >75th percentile. Standardised regression coefficients were estimated to assess the association between dietary characteristics, BMI z-score and ED of the diet.

RESULTS

Children with low EDF and EDF&B diets consumed less energy but higher quantity of food and beverages than children with high EDF and EDF&B diets. Consumption of caloric beverages decreased with increasing EDF&B of the diet owing to the relatively low ED of the beverages, in relation to solid foods. Generally, children with low EDF and EDF&B diets showed healthier food choices than peers with higher EDF and EDF&B diets. In this sample, EDF and EDF&B were not associated with BMI z-score.

CONCLUSION

Health promotion strategies should proclaim lower ED diets by means of foods with high water and low fat content and mainly fruit and vegetable components. Excluding caloric beverages from EDF calculation is a useful method to avoid misinterpretation of true exposure to a high energy dense diet. We recommend excluding caloric beverages from EDF calculation when investigating the effect of ED on a certain (health) outcome.

Evidence for efficacy and effectiveness of changes in eating frequency for body weight management

In self-reported diets of free living individuals, frequent eating is associated with higher energy intake, yet beliefs about the possible beneficial effect of higher eating frequency for managing body weight persist. Prospective cohort studies and controlled trials of manipulation of eating frequency published by 31 December 2012 were reviewed to assess whether variation in eating frequency may be an adjunct to weight management. Four prospective cohort studies were identified; 2 of these included adults followed for 10 y and 2 followed pre-adolescent/adolescent girls for 6 or 10 y. Within each age category, the findings of the 2 studies were contradictory. Six controlled trials with adult subjects serving as their own controls found no significant changes in body weight due to manipulation of eating frequency interventions lasting 6-8 wk. In 6 additional intervention trials of 8-52 wk duration, free-living adults were counseled to change the eating frequency of self-selected food intake with no significant differences in weight loss attributable to eating frequency. Overall, the consistency of the null findings from controlled trials of manipulation of eating frequency for promoting weight loss suggests that beliefs about the role of higher eating frequency in adult weight management are not supported by evidence. Interpretation of the evidence from published observational studies is complicated by differences in definition of eating frequency and limited knowledge of systematic and random errors in measurement of eating frequency.

Are food and beverage purchases in households with preschoolers changing?: a longitudinal analysis from 2000 to 2011

BACKGROUND

U.S. dietary studies from 2003 to 2010 show decreases in children's caloric intake. We examined purchases of consumer packaged foods/beverages in the U.S. between 2000 and 2011 among households with children aged 2-5 years.

PURPOSE

To describe changes in consumer packaged goods (CPG) purchases between 2000 and 2011 after adjusting for economic indicators, and explore differences by race, education, and household income level.

METHODS

CPG purchase data were obtained for 42,753 U.S. households with one or more child aged 2-5 years using the Nielsen Homescan Panel. Top sources of purchased calories were grouped, and random effects regression was used to model the relationship between calories purchased from each group and race, female head of household education, and household income. Models adjusted for household composition, market-level unemployment rate, prices, and quarter, with Bonferroni correction for multiple comparisons (α=0.05).

RESULTS

Between 2000 and 2011, adjusted total calories purchased from foods (-182 kcal/day) and beverages (-100 kcal/day) declined significantly. Decreases in purchases of milk (-40 kcal); soft drinks (-27 kcal/day); juice and juice drinks (-24 kcal/day); grain-based desserts (-24 kcal/day); savory snacks (-17 kcal/day); and sweet snacks and candy (-13 kcal/day) were among the major changes. Changes in CPG purchases differed significantly by race, female head of household education, and household income.

CONCLUSIONS

Trends in CPG purchases suggest that solid fats and added sugars are decreasing in the food supply of U.S. preschoolers. Pronounced differences by race, education, and household income persist.

Association of self-reported sleep duration with eating behaviors of American adults: NHANES 2005-2010

BACKGROUND

Published evidence suggests an inverse association between sleep duration and body weight status.

OBJECTIVE

We examined the association of sleep duration with eating behaviors reported by adult Americans to understand the relation between sleep duration and body weight status.

DESIGN

This cross-sectional study used sleep duration and dietary data from the continuous NHANES conducted from 2005 to 2010 (n = 15,199, age ≥20 y). Eating behaviors examined included the following: reporting of and energy from main meals (breakfast, lunch, and dinner) and snacks (before breakfast, after dinner, and after 2000 h), intermeal intervals, time of day of main meal reporting, and intakes of macronutrients and beverages. Multiple regression methods were used to examine the independent association of hours of sleep duration grouped as short (≤6 h), average (7-8 h), and long (≥9 h) with eating behavior outcomes.

RESULTS

Relative to average-duration sleepers, a smaller percentage of short-duration sleepers mentioned breakfast, lunch (women only), and dinner in the recall (P ≤ 0.04). They also reported a lower mean percentage of energy from main meals but higher energy from all snacks (P ≤ 0.0004) and after 2000 h (P = 0.03). Short-duration sleepers reported the earliest eating time of the first episode and the latest time of the last eating episode. Absolute amounts of sugar and caffeine and percentage of energy from beverages (women only) were higher in short-duration sleepers. However, the total number of eating episodes and energy intake were not related with sleep duration.

CONCLUSIONS

Short-duration sleepers began eating earlier and ended their eating later in the day, but despite the longer eating period, they did not report more eating events. Profiles of the relative contribution of main meals and snacks, at or after 2000 h eating, and beverages in short-duration sleepers were suggestive of eating behaviors that may increase energy intake, but 24-h energy intake did not differ among categories of sleep duration.

40-year trends in meal and snack eating behaviors of American adults

BACKGROUND

Understanding changes in profiles of eating behaviors over time may provide insights into contributors to upward trajectories of obesity in the US population. Yet little is known about whether or not characteristics of meal and snack eating behaviors reported by adult Americans have changed over time.

OBJECTIVE

To examine time trends in the distribution of day's intake into individual meal and snack behaviors and related attributes in the US adult population.

DESIGN

The study was observational with cross-sectional data from national surveys fielded over 40 years.

PARTICIPANTS/SETTING

Nationally representative dietary data from nine National Health and Nutrition Examination Surveys conducted from 1971-1974 to 2009-2010 (N=62,298 participants aged 20-74 years) were used to describe eating behaviors.

OUTCOMES EXAMINED

The respondent-labeled eating behaviors examined included main meals (breakfast, lunch, and dinner), and snacks (before breakfast, between breakfast and lunch, between lunch and dinner, after dinner, or other). For each eating behavior, percent of reporters, relative contribution to 24-hour energy intake, the clock time of report, and intermeal/snack intervals were examined.

STATISTICAL ANALYSIS

Multivariable logistic and linear regression methods for analysis of complex survey data adjusted for characteristics of respondents in each survey.

RESULTS

Over the 40-year span examined reports of each individual named main meal (or all three main meals) declined, but reports of only two out of three meals or the same meal more than once increased; the percentage of 24-hour energy from snacks reported between lunch and dinner or snacks that displaced meals increased; clock times of breakfast and lunch were later, and intervals between dinner and after-dinner snack were shorter. Changes in several snack reporting behaviors (eg, report of any snack or ≥2 snacks), were significant in women only.

CONCLUSIONS

Several meal and snack eating behaviors of American adults changed over time, with a greater change in snack behaviors of women relative to men.

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

Recent national surveys suggest that child obesity in the United States may have reached a plateau, but corresponding trends in energy intake have not been examined in depth. This article evaluates medium-term trends in children's reported energy intake by using 4 waves of national dietary surveillance from 2003-2004 to 2009-2010. The analysis uses up to 2 24-h dietary recalls, incorporating methods that address challenges in estimating usual intake, accounting for intraindividual variance and covariates such as the presence of atypical consumption days. Quantile regression was used to assess disparities in intake among sociodemographic subgroups at extremes of the distribution as well as at the median, and the potential influence of misreporting was evaluated. Results indicated that after an initial decline in intakes across all age groups through 2007-2008, there were significant increases of ∼90 kcal/d at the median among adolescents in 2009-2010, whereas intakes in younger children remained steady. Among adolescent boys, the recent increase was larger at the 90th percentile than at the median. Intake trends did not vary by race/ethnic group, among whom intakes were similar at the upper end of the distribution. Misreporting did not influence trends over time, but intakes were lower in younger children and higher in older children after excluding misreporters. Overall, findings suggest that declines in children's energy intake from 2003-2004 through 2007-2008 were consistent with the obesity plateau observed in most age and gender subgroups through 2009-2010. However, there is evidence of increased intakes among adolescents in 2009-2010, which may threaten the earlier abatement in overweight in this older age group.

Variation in meal-skipping rates of Korean adolescents according to socio-economic status: results of the Korea Youth Risk Behavior Web-based Survey

Objectives

To identify and evaluate the trend of meal-skipping rates among Korean adolescents with their contributing causes and the influence of household income level on meal skipping.

Methods

Using 2008, 2010, and 2012 data from the Korea Youth Risk Behavior Web-based Survey of 222 662 students, a cross-sectional study with subgroup analysis was performed. We calculated odds ratios for skipping each meal 5 or more times in a week by household socio-economic status using a multiple logistic regression model. The secular change in the meal-skipping rates by the students' family affluence scale was analyzed by comparing the meal-skipping students within each subgroup and odds ratios for the same event over time.

Results

Through 2008 to 2012, most of the meal-skipping rates generally showed a continuous increase or were almost unchanged in both sexes, except for breakfast skipping in several subgroups. Students in low-income households not living with both parents had the highest meal-skipping rates and odds ratios for frequent meal skipping. In a time-series subgroup analysis, the overall odds ratios for the same event increased during 2008 to 2012, with a slight reduction in the gap between low and higher income levels with regard to meal skipping during 2010 to 2012.

Conclusions

Household socio-economic status and several other factors had a significant influence on Korean adolescent meal-skipping rates. Although the gap in eating behavior associated with household socio-economic differences is currently decreasing, further study and appropriate interventions are needed.

A review of the nutritional value of legumes and their effects on obesity and its related co-morbidities

Since the 1970s, the proportion of overweight and obese people in the United States has grown at an alarming rate. An awareness of the consequences of obesity on the health and well-being of individuals is evident in the plethora of strategic plans at the local and national levels, most of which have largely fallen short of their goals. If interventions continue to be unsuccessful, it is estimated that approximately three of four Americans will be overweight or obese by 2020. Prevention of excess weight gain can be accomplished with relatively small changes in lifestyle behaviours to control body weight. Small sustainable changes are perhaps better than efforts to achieve larger changes that cannot be sustained. Legumes can be a valuable food by which the needs of the undernourished or under-served populations could be met. They can be incorporated into meat products, such as sausages and burgers, to lower the energy density of these foods while providing important nutrients. Replacing energy-dense foods with legumes has been shown to have beneficial effects on the prevention and management of obesity and related disorders, such as cardiovascular disease, diabetes and the metabolic syndrome. This review explores the nutritional value and obesity-related health benefits of legume consumption while focusing on pulses.

Increasing socioeconomic disparities in adolescent obesity

Recent reports suggest that the rapid growth in youth obesity seen in the 1980s and 1990s has plateaued. We examine changes in obesity among US adolescents aged 12-17 y by socioeconomic background using data from two nationally representative health surveys, the 1988-2010 National Health and Nutrition Examination Surveys and the 2003-2011 National Survey of Children's Health. Although the overall obesity prevalence stabilized, this trend masks a growing socioeconomic gradient: The prevalence of obesity among high-socioeconomic status adolescents has decreased in recent years, whereas the prevalence of obesity among their low-socioeconomic status peers has continued to increase. Additional analyses suggest that socioeconomic differences in the levels of physical activity, as well as differences in calorie intake, may have contributed to the growing obesity gradient.