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Research Project: Eating Patterns and Obesity Prevention in Children

Location: Children's Nutrition Research Center

2022 Annual Report

Objective 1: Characterize the food and activity environments in which teens in rural areas live, work, and play and their perceptions regarding obesity, challenges to eating healthfully and being physically active, and ways in which technology might be useful in helping them engage in healthy behaviors. Objective 2: In low-income Hispanic families with children ages 4 to 5 at baseline, examine the following parent feeding and child eating behaviors based on data from an existing data set: Objective 2A: the direction of effects between parent feeding styles and child eating behaviors; Objective 2B: how parent feeding styles and child eating behaviors at baseline predict individual growth curve trajectories for child body mass index (BMI) across three time points 18 months apart (ages 4 to 5 at baseline; ages 5 1/2 to 6 1/2 at Time 2; ages 7 to 8 at Time 3); Objective 2C: how child eating behaviors interact with parent feeding styles in predicting child BMI overtime. Objective 3: Assess the psychometrics of sub-scales of food and physical activity parenting and whether there is differential item functioning among a sample of ethnically and racially diverse fathers. Objective 4: Describe fathers' use of parenting practices that support healthful nutrition and physical activity for their children and how this varies by demographic factors (race/ethnicity, education, income), household responsibilities, and co-parenting alliance. Objective 5: Develop and assess the feasibility of child obesity prevention videos for mothers to better engage them during a father targeted obesity prevention program. Objective 6: Assess three aspects of infant temperament: 1) surgency, negative affectivity, and affiliation/orienting by direct observation; 2) infant eating behaviors as measured by several sucking parameters, for example maximal suck pressure, burst rate and reductions in pressure during bottle feeding, and 3) infant adiposity by dual-energy x-ray absorptiometry, and characterize the associations between these traits.

Obesity is the most prevalent nutrition-related pediatric problem in the US and most child obesity prevention interventions have not been effective. Although there has been disagreement regarding the reasons for this lack of documented success, likely reasons include not understanding or adequately addressing: a) the role of place of residence on obesity risk; b) how parents influence child behaviors; c) how to accurately assess intervention effects; d) cultural influences; and/or e) the role of child characteristics, such as temperament, on obesity risk. Using an approach informed by the Socio-Ecological Model, four independent research projects will address these knowledge gaps. We will conduct mixed methods research to understand factors that influence obesity risk of rural adolescents and the ways in which technology may be used to help them make healthy choices. Additionally, we will take an intensive look at the family by assessing how feeding styles and practices influence child eating behaviors, and assess how to independently engage both fathers and mothers in obesity prevention interventions and accurately assess father's food and physical activity parenting behaviors. Researchers will also examine the role of child temperament on infant feeding behavior and adiposity.

Progress Report
For Objective 1, research continued on exploratory mixed-methods research to understand factors that influence the obesity risk of rural adolescents and the ways in which technology may be used to help them make healthy choices. This year we continued to develop and refine a strategic plan to facilitate recruitment and enrollment. We began by identifying zip codes for rural Texas areas. Having a zip code database of rural areas enables us to target recruitment efforts to specific organizations within these areas (e.g., schools or physicians); further, when a family contacts us, this database enables us to quickly identify whether they are eligible for participation in the study. To date, we have made contacts and initiated recruitment in all four regions of Texas (Gulf Coastal Plains, North Central Plains, Great Plains, and Basin/Province Range). Examples of continuing recruitment efforts include phone calls, emails, flyers, social media postings, and notices in newsletters and websites. Flyers have been shared with colleagues who live in or have connections in rural Texas counties. Our student interns have identified libraries and cooperative extension agents in all four regions and have distributed flyers at their respective schools to attract other students from rural Texas areas. The top three recruitment sources to date this year are: word of mouth, libraries, and schools. As of the date of this report's submission, a total of 29 parent/teen dyads have been enrolled in the study and of these, 17 dyads have been enrolled this year. Recruitment challenges include the ongoing disruption due to the COVID-19 pandemic, lack of follow-up from recruitment contacts, busy schedules, and life events (e.g., car accident, sick with COVID) encountered by families initially interested in the study, and no response to follow-up calls and emails. Additionally, some organizations in these rural communities have demonstrated hesitancy or unwillingness to share recruitment materials because our center is not as well-recognized in regions outside of the Gulf Coastal Plains of Texas. We have experienced a slow-down in recruitment since the beginning of summer break which may be caused by a variety of events occurring within the state and nationally. Similarly, data collection challenges have included busy schedules and life events encountered by families (e.g., COVID, summer training activities for student athletes) and limited or no response to follow-up calls and emails to complete or schedule data collection activities. Finally, we decided to conduct a scoping review of interventions promoting healthy diet and/or physical activity (PA) behaviors to school age children (Kindergarten–12th grade) in the US. A research librarian performed a systematic search of five databases and identified 1,513 articles based on our search. Student interns from Rice University (Houston, Texas) have reviewed the results and identified 51 articles that potentially meet the inclusionary criteria. We are preparing to begin data extraction. For Objective 3, researchers are finalizing the psychometric analysis of sub-scales of food and physical activity (PA) parenting and whether questionnaires work as well among fathers of diverse ethnicity and race. As indicated in our research plan, this study leverages existing data on Hispanic fathers on their use of food and PA parenting practices (funded by the National Heart, Lung and Blood Institute [NHLBI] (R34HL131726), by adding data collection on an ethnically and racially diverse sample of fathers. The goal was to collect data on 150 non-Hispanic fathers each in years one and two and 100 fathers in year three (400 fathers total) to complement the planned 200 Hispanic fathers from the NHLBI funded study. We have completed data collection with 378 non-Hispanic fathers recruited for our USDA study. This study included 55.0% white, 27.5% black, 10.1% Asian, 7.4% other (American-Indian, Hawaiian/Pacific Islander, mixed race and self-identified as other) fathers. We were 22 fathers shy of the goal of 400 non-Hispanic fathers, but the current sample is more than sufficient to complete Objectives 3 and 4. Data analyses is complete to assess if the questionnaires captured fathers' use of food and PA parenting practices in reliable ways among the diverse sample of fathers, and whether the same questionnaire can be used to assess food and PA parenting practices among fathers of different race or ethnicity. For Objective 6, we have completed approximately 75% of the coding of infant temperament for the electronic recordings of 68 infants at ages 4 and 12 months. Specifically, we have completed 100% of the coding of two aspects of infant temperament (positive affect and interest/persistence) using the coding scheme proposed in the original Project Plan, which codes the presence/absence of behaviors in 10-15 second time spans (called "epochs"). Initial analyses suggested that these held promise for detecting the development of adiposity across the first year of life, however, they lack sensitivity of moment-to-moment variations in the very young infants (i.e., the 4-month-olds). Therefore, we have started to recode the videos in 1-second epochs and currently we have coded ~50% of the available recordings. In the next phase of the study we will finish coding the video recording, clean the databases (for example, we will screen for unfeasible values) and conduct data analysis to identify those temperament-related behaviors which associate with feeding behaviors and adiposity at this young age.

1. Infant smiles may indicate risk of excess weight gain. How an infant interacts with caregivers can shape the caregivers' feeding behaviors of the infant. Researchers at the Children's Nutrition Research Center in Houston, Texas, analyzed how much pleasure infants exhibited at four months of age during age-appropriate based games played either with their mother (peek-a-boo) or with study team members in the absence of their mother (puppet game), and took adiposity measurements concurrently, and at a year of age. Infants who made more happy noises and showed more happy facial expressions when playing with their mother had gained less weight at 12 months of age. The opposite was true for games played with strangers (members of our research team); babies who made these expressions of happiness in this game gained more weight by 12 months of age. These results provide new information about which infants might be at risk for rapid weight gain across the first year of life.

2. Adherence of a DASH diet reduces type 2 diabetes. Diet plays a major role in the development and prevention of type 2 diabetes (T2D). The development of diabetes is marked by sequential problems with several aspects of glucose homeostasis. Researchers at the Children’s Nutrition Research Center in Houston, Texas, asked a population of older US adults about what they had been eating over the past year, and created a score for each person, indicating how close their typical diet was to the Dietary Approaches to Stop Hypertension (DASH) diet. These scores were analyzed for their relationship to glycemic control, which indicates whether people are likely to be progressing towards a diagnosis of T2D. We found that adhering to a DASH diet improved glycemic control, and so likely reduces the risk of T2D, in the early stages of progression towards T2D, but not later ones, and all these health benefits were derived from the aspects of a DASH diet that encourage consuming more plant-based foods, not other components (e.g., consuming low-fat dairy). These results suggest that consuming plant-based foods may help prevent T2D in healthy individuals, but not once an individual has T2D, helping clinicians tailor dietary advice to the individual needs of their patients.