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To assess the association between child ultra-processed food (UPF) consumption and home-school learning environment characteristics during school closures due to the COVID-19 pandemic in schoolchildren with low- and middle income in Chile.
Cross-sectional. UPF consumption was collected using the Nova screener. We apply the structured days hypothesis (SDH) to assess home-school learning environment characteristics with three constructs that summarised school preparedness for online teaching and learning, school closure difficulties for caregivers and child routine. We explored associations between child UPF consumption and home-school environment characteristics using multivariate linear regression analyses after controlling for child demographic and school characteristics.
Low- and middle-income neighbourhoods in southeastern Santiago, Chile.
Children from the Food Environment Chilean Cohort (n 428, 8–10 years old).
Based on the Nova score, child mean consumption of UPF was 4·3 (sd 1·9) groups. We found a statistically significant negative association between child routine for eating, play and study and child UPF consumption when we adjusted for child sociodemographic (model 1: β = –0·19, (95 % CI –0·40, 0·02)) and school characteristics (model 2: β = –0·20, (95 % CI –0·41, 0·00)). Associations between school preparedness for online teaching or school closure difficulties and UPF were not statistically significant.
Variations in child routines during the COVID-19 pandemic were negatively associated with UPF intake in schoolchildren with low- and middle income. Our findings are consistent with the SDH, suggesting the school environment helps regulate eating behaviours. Future research should evaluate what happens when children return to in-person classes at school.
Restaurants may be important settings for interventions to reduce children’s energy intake. The objective of this study was to test the impact of a parent-focused social marketing campaign to promote healthy children’s meals on calories ordered and consumed by children at quick-service restaurants (QSR).
Using a repeated cross-sectional study design, two urban communities were randomised to intervention (IN) v. control (C) condition. A community-wide social marketing campaign was implemented in the IN community to empower Black and Latinx mothers who frequent QSR (priority population) to select healthier options for their child.
Data were collected in 2016 at QSR located within the communities pre- and post-IN and analysed in 2017.
Parents (n 1686; n 819 and n 867 for I and C conditions, respectively) were recruited after placing their QSR order; a survey, receipt and their child’s leftovers were collected.
Calories ordered did not differ significantly between the IN and C conditions (changeadj = –146·4 kJ (–35·0 kcal); 95 % CI –428·0 kJ (–102·3 kcal), 134·6 kJ (32·2 kcal)). In a sub-analysis of only the priority audience, children in the IN community ordered significantly fewer calories compared to C children in unadjusted models (changeunadj = –510·4 kJ (–122·0 kcal); 95 % CI –1013·4 kJ (–242·2 kcal), –7·5 kJ (–1·8 kcal)), but the trend did not persist after adjusting for covariates (changeadj = –437·2 kJ (–104·5 kcal); 95 % CI –925·5 kJ (–221·2 kcal), 50·6 kJ (12·1 kcal)). Calories consumed followed similar trends.
The campaign did not significantly reduce children’s QSR calories ordered or consumed. However, a quantitatively important mean reduction in calories was suggested among the priority audience, indicating potential for community-wide promotion of healthful children’s meals.
To examine children’s sugar-sweetened beverage (SSB) and water intakes in relation to implemented intervention activities across the social ecological model (SEM) during a multilevel community trial.
Children’s Healthy Living was a multilevel, multicomponent community trial that reduced young child obesity (2013–2015). Baseline and 24-month cross-sectional data were analysed from nine intervention arm communities. Implemented intervention activities targeting reduced SSB and increased water consumption were coded by SEM level (child, caregiver, organisation, community and policy). Child SSB and water intakes were assessed by caregiver-completed 2-day dietary records. Multilevel linear regression models examined associations of changes in beverage intakes with activity frequencies at each SEM level.
US-Affiliated Pacific region.
Children aged 2–8 years (baseline: n 1343; 24 months: n 1158).
On average (± sd), communities implemented 74 ± 39 SSB and 72 ± 40 water activities. More than 90 % of activities targeted both beverages together. Community-level activities (e.g. social marketing campaign) were most common (61 % of total activities), and child-level activities (e.g. sugar counting game) were least common (4 %). SSB activities across SEM levels were not associated with SSB intake changes. Additional community-level water activities were associated with increased water intake (0·62 ml/d/activity; 95 % CI: 0·09, 1·15) and water-for-SSB substitution (operationalised as SSB minus water: –0·88 ml/d/activity; 95 % CI: –1·72, –0·03). Activities implemented at the organization level (e.g. strengthening preschool wellness guidelines) and policy level (e.g. SSB tax advocacy) also suggested greater water-for-SSB substitution (P < 0·10).
Community-level intervention activities were associated with increased water intake, alone and relative to SSB intake, among young children in the Pacific region.
To describe characteristics of self-identified popular diet followers and compare mean BMI across these diets, stratified by time following diet.
Cross-sectional, web-based survey administered in 2015.
Non-localised, international survey.
Self-selected followers of popular diets (n 9019) were recruited to the survey via social media and email announcements by diet community leaders, categorised into eight major diet groups.
General linear models were used to compare mean BMI among (1) short-term (<1 year) and long-term (≥1 year) followers within diet groups and (2) those identifying as ‘try to eat healthy’ (TTEH) to all other diet groups, stratified by time following the specific diet. Participants were 82 % female, 93 % White and 96 % non-Hispanic. Geometric mean BMI was lower (P < 0·05 for all) among longer-term followers (≥1 year) of whole food, plant-based (WFPB), vegan, whole food and low-carb diets compared with shorter-term followers. Among those following their diet for 1–5 years (n 4067), geometric mean BMI (kg/m2) were lower (P < 0·05 for all) for all groups compared with TTEH (26·4 kg/m2): WFPB (23·2 kg/m2), vegan (23·5 kg/m2), Paleo (24·6 kg/m2), vegetarian (25·0 kg/m2), whole food (24·6 kg/m2), Weston A. Price (23·5 kg/m2) and low-carb (24·7 kg/m2).
Our findings suggest that BMI is lower among individuals who made active decisions to adhere to a specific diet, particularly more plant-based diets and/or diets limiting highly processed foods, compared with those who simply TTEH. BMI is also lower among individuals who follow intentional eating plans for longer time periods.
To assess parental awareness of per-meal energy (calorie) recommendations for children’s restaurant meals and to explore whether calorie awareness was associated with parental sociodemographic characteristics and frequency of eating restaurant food.
Cross-sectional online survey administered in July 2014. Parents estimated calories (i.e. kilocalories; 1 kcal=4·184 kJ) recommended for a child’s lunch/dinner restaurant meal (range: 0–2000 kcal). Responses were categorized as ‘underestimate’ (<400 kcal), ‘accurate’ (400–600 kcal) and ‘overestimate’ (>600 kcal). Confidence in response was measured on a 4-point scale from ‘very unsure’ to ‘very sure’. Logistic regressions estimated the odds of an ‘accurate’ response and confident response (‘somewhat’ or ‘very sure’) by parental sociodemographic characteristics and frequency of eating from restaurants. Sampling weights based on demographics were incorporated in all analyses.
Parents (n 1207) of 5–12-year-old children.
On average, parents estimated 631 (se 19·4) kcal as the appropriate amount for a 5–12-year-old child’s meal. Thirty-five per cent answered in the accurate range, while 33·3 and 31·8 % underestimated and overestimated, respectively. Frequent dining at restaurants, lower income and urban geography were associated with lower odds of answering accurately. Parents’ confidence in their estimates was low across the sample (26·0 % confident) and only 10·1 % were both accurate and confident.
Parent education about calorie recommendations for children could improve understanding and use of menu labelling information in restaurants. Targeted strategies are recommended to ensure that such efforts address, rather than exacerbate, health disparities.
To understand perspectives of stakeholders during initial district-wide implementation of a Breakfast in the Classroom (BIC) model of the School Breakfast Program.
Qualitative data were collected from twenty-nine focus groups and twenty interviews with stakeholders in a school district early in the process of implementing a BIC model of the School Breakfast Program.
Ten elementary schools within a large, urban school district in the USA that served predominantly low-income, racial/ethnic minority students.
Purposively selected stakeholders in elementary schools that had implemented BIC for 3–6 months: students (n 85), parents/guardians (n 86), classroom teachers (n 44), cafeteria managers (n 10) and principals (n 10).
Four primary themes emerged, which were interpreted based on the Diffusion of Innovations model. School staff had changed their perceptions of both the relative disadvantages and costs related to time and effort of BIC over time; the majority of each stakeholder group expressed an appreciation for BIC; student breakfast consumption varied from day to day, related to compatibility of foods with child preferences; and stakeholders held mixed and various impressions of BIC’s potential impacts.
The study underscores the importance of engaging school staff and parents in discussions of BIC programming prior to its initiation to pre-emptively address concerns related to cost, relative disadvantages and compatibility with child preferences and school routines/workflow. Effectively communicating with stakeholders about positive impacts and nutritional value of the meals may improve support for BIC. These findings provide new information to policy makers, districts and practitioners that can be used to improve implementation efforts, model delivery and outcomes.
To understand stakeholders’ perspectives on food waste in a universal free School Breakfast Program implementing a Breakfast in the Classroom model.
Semi-structured focus groups and interviews were conducted with school district stakeholders. Inductive methods were used to code resulting transcripts, from which themes were identified. The analysis provides a thematic analysis of stakeholders’ perspectives on food waste in the School Breakfast Program.
Ten elementary schools in a large urban school district implementing a universal free Breakfast in the Classroom model of the US national School Breakfast Program.
Elementary-school students (n 85), parents (n 86), teachers (n 44), cafeteria managers (n 10) and school principals (n 10).
Stakeholders perceived food waste as a problem and expressed concern regarding the amount of food wasted. Explanations reported for food waste included food-related (palatability and accessibility), child-related (taste preferences and satiation) and programme-related (duration, food service policies, and coordination) factors. Milk and fruit were perceived as foods particularly susceptible to waste. Several food waste mitigation strategies were identified by participants: saving food for later, actively encouraging children’s consumption, assisting children with foods during mealtime, increasing staff support, serving smaller portion sizes, and composting and donating uneaten food.
Stakeholders recognized food waste as a problem, reported myriad contributing factors, and have considered and employed multiple and diverse mitigation strategies. Changes to the menu and/or implementation logistics, as well as efforts to use leftover food productively, may be possible strategies of reducing waste and improving the School Breakfast Program’s economic, environmental and nutritional impact.
Approximately one-third of children in the USA are either overweight or obese. Understanding the perceptions of children is an important factor in reversing this trend.
An online survey was conducted with children to capture their perceptions of weight, overweight, nutrition, physical activity and related socio-behavioural factors.
Within the USA.
US children (n 1224) aged 8–18 years.
Twenty-seven per cent of children reported being overweight; 47·1 % of children overestimated the rate of overweight/obesity among US children. A higher percentage of self-classified overweight children (81·9 %) worried about weight than did self-classified under/normal weight children (31·1 %). Most children (91·1 %) felt that it was important to not be overweight, for both health-related and social-related reasons. The majority of children believed that if someone their age is overweight they will likely be overweight in adulthood (93·1 %); get an illness such as diabetes or heart disease in adulthood (90·2 %); not be able to play sports well (84·5 %); and be teased or made fun of in school (87·8 %). Children focused more on food/drink than physical activity as reasons for overweight at their age. Self-classified overweight children were more likely to have spoken with someone about their weight over the last year than self-classified under/normal weight children.
Children demonstrated good understanding of issues regarding weight, overweight, nutrition, physical activity and related socio-behavioural factors. Their perceptions are important and can be helpful in crafting solutions that will resonate with children.
To examine the relationship between intake of whole grains and BMI Z-score in rural children.
General linear models and logistic regression were used to examine the cross-sectional associations between whole grain intake and BMI Z-score, prevalence and odds ratios of overweight and obesity. Dietary intake was assessed using the Block Food Screener for ages 2–17 years. Children were classified into three categories according to servings of whole grain intake: <1·0 serving/d, 1·0–1·5 servings/d and >1·5 servings/d.
The CHANGE (Creating Healthy, Active and Nurturing Growing-up Environments) study, an obesity prevention intervention in elementary schools in eight rural US communities in California, Mississippi, Kentucky and South Carolina.
Seven hundred and ninety-two children attending 3rd–6th grade.
After adjusting for age, sex, race/ethnicity, physical activity and state of residence, whole grain intake was inversely associated with BMI Z-score (0·90 v. 0·61 in the lowest v. the highest whole grain intake category; P trend = 0·01). Children who consumed >1·5 servings of whole grains/d had a 40 % lower risk of being obese (OR = 0·60; 95 % CI 0·38, 0·95, P = 0·02) compared with children who consumed <1·0 serving/d. Further adjustment for potential dietary predictors of body weight (fruit, vegetable and dairy intakes) did not change the observed associations.
Increasing the intake of whole grains as part of an overall healthy lifestyle may be beneficial for children to achieve and maintain a healthy weight.
Low serum vitamin D, which largely affects ethnic minorities, is associated with obesity and other chronic diseases. Little is known about racial/ethnic differences in intake, particularly in children, or if any differences are associated with differences in serum 25-hydroxyvitamin D (25(OH)D). The objective of the present study was to determine whether racial/ethnic differences in dietary vitamin D intake exist and whether they explain differences in 25(OH)D.
Vitamin D intakes (Block Kids 2004 FFQ) and 25(OH)D were measured. Race/ethnicity was parent-reported (white (37·9 %), Hispanic (32·4 %), black (8·3 %), Asian (10·3 %), multi-racial/other (11·0 %)). Multivariable analyses were conducted to examine the associations among dietary vitamin D and race/ethnicity, as well as 25(OH)D, independent of BMI Z-score and other covariates.
Elementary/middle schools in Somerville, MA, USA, during January–April 2010.
Schoolchildren (n 145) in 4th–8th grade.
Only 2·1 % met the 2011 RDA (15 μg/d (600 IU/d)). Average dietary intake was 3.5 (sd 2.2) μg/d (140 (sd 89·0) IU/d). No racial/ethnic differences in intake were evident. Most (83·4 %) were 25(OH)D deficient (<20 ng/ml; 16·0 (sd 6·5) ng/ml). In ANOVA post hoc analyses, 25(OH)D levels were lower in Hispanics than whites (14·6 (sd 6·1) ng/ml v. 17·9 (sd 4·6) ng/ml; P < 0·01). Dietary vitamin D was associated with 25(OH)D overall (P < 0·05), but did not explain the racial/ethnic differences in 25(OH)D.
Most children in this north-east US sample did not meet dietary recommendations for vitamin D and were vitamin D deficient. Dietary vitamin D did not explain the difference in 25(OH)D between Hispanic and white children. Further research is needed to determine if changes in dietary vitamin D by race/ethnicity can impact 25(OH)D levels.
To create, validate and assess the reliability of a checklist to measure
calcium intake in children.
Calcium intakes from a checklist and parent-assisted 24-h dietary recall were
compared. Checklist reliability was assessed separately.
After-school programmes in the United States.
Forty-two children (18 males, 24 females, age = 8.0 ± 0.9 years)
participated in the validation analysis and 49 children (28 males, 21
females, age = 7.5 ± 0.9 years) in the reliability analysis.
No differences in mean calcium intakes were found by method or gender. The
checklist correlated well with recall among girls (r = 0.65, P = 0.01) but not
boys (r = −0.33, P = 0.19). Agreement over time was above 80%
for most foods.
The calcium checklist is useful for assessing calcium intake among groups of
6–10-year-old children in settings that preclude parental
assistance. More research is needed to improve accuracy among boys.
Defining “community” from a research perspective is difficult. Communities consist of environmental, social, and geographic components. In addition, race, ethnicity, socio-economic status (SES), and group memberships often play roles in community identity. Barry Wellman and Scot Wortley urge that to truly understand and influence a community, and most certainly to conduct research within communities, one must take into account the varied nature of relationships and networks and how they may work together synergistically to meet the needs of community members. Using the Social Ecological Model, with its delineation of multiple spheres of influence (individual-interpersonal-organizational-community-public policy), community-based research has attempted to reach this understanding. Although dramatic shifts have not yet been realized, many studies suggest improved health behaviors and healthy environments, which indicate a promising future for community intervention work. The discussion that follows reviews the theory and rationale for community-based interventions, the socialecological approach to understanding and studying obesity, and the progress and promise of community interventions.
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