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Research Project: Epidemiology of Childhood Diet and Obesity

Location: Children's Nutrition Research Center

2020 Annual Report

Objective 1: The National Health and Nutrition Examination Survey (NHANES) (2001-2014 and later releases) will be used to identify diet-related risk factors for obesity, and other health outcomes in children, adolescents, and adults specifically: Objective 1A: Identify eating patterns in children, adolescents and adults by gender and ethnicity, Objective 1B: Examine the association between eating patterns and obesity and related health risk factors, Objective 1C: Examine the impact of individual foods, nutrients, and food-specific patterns on obesity and health outcomes in children, adolescents, and adults. Objective 1D: Identify the impact of eating patterns on dietary intake, nutrient adequacy, and diet quality. Objective 2: Examine the rural-urban differences in and associations between food security status, food availability, participation in Federal nutrition assistance programs, dietary intake, and obesity among children across the different age groups, i.e., 2-5 years, 6-11 years, 12-15 years and 16-18 years old. Subobjective 2A: Examine the rural-urban differences in food security status (FSS) of children across the various age groups. Subobjective 2B: Determine the association of FSS with food availability and participation in federal nutrition assistance programs (FNAP) among children, based on rural-urban residence. Subobjective 2C: Determine the association of FSS with dietary intake and diet quality among children, based on rural-urban residence. Subobjective 2D: Determine the association between FSS and weight status of children, based on rural-urban residence. Objective 3: Determine the relationship between children’s physical activity, diet, sedentary behavior, and sleep, on summer weight gain in children and the impact of parenting on these behaviors using data from the Early Childhood Longitudinal Kindergarten 2011 Cohort, the Family Life, Activity, Sun, Health, and Eating study and others as appropriate. Subobjective 3A: Conduct a systematic review and meta-analysis of interventions for obesity prevention and treatment among school-age children targeting the summer months when children are not in school, and assessing their impact on BMI, PA, diet, sedentary behavior, and sleep. Subobjective 3B: Determine the number and types of distinct categorical body mass index (BMI) percentile trajectories in a longitudinal early childhood cohort and examine whether children's physical activity (PA), diet, sedentary behavior, sleep timing, child care arrangements, and medication usage predict developmental trajectory membership in order to inform obesity prevention interventions. Subobjective 3C: Examine the relationship between adolescents' BMI, physical activity, sedentary behavior, sleep and diet during in-school and out-of-school times and the impact of parenting practices on these behaviors.

Today, an estimated 16% of US children and adolescents are overweight and 17% are obese, and the prevalence continues to rise. Obesity is the result of energy imbalance, and dietary behaviors associated with overweight need to be examined. The long-term objective of this project is to better understand eating patterns, impact of food security status, rural/urban differences, and seasonal differences in weight-related behaviors that influence obesity and other health risk factors in children, adolescents, and adults. Few attempts have been made to identify broader eating patterns and their association with weight status and other chronic disease risk factors. This project aims to identify eating patterns--in terms of food sources, food group consumption, and nutrient intake--that may be associated with obesity and other health risk factors in children, adolescents, and adults using extant datasets. Also, food insecurity is related to poor dietary behaviors that can lead to net positive energy balance and obesity. Thus, we aim to assess the impact of food security status on dietary intake and quality, food availability, participation in federal food assistance programs, and weight status based on rural/urban residence. Finally, we will examine other behavioral predictors of children’s weight gain (i.e., sleep, physical activity, sedentary behavior) using the school-summer paradigm. Together this research will facilitate a better understanding of how to behaviorally target interventions to prevent obesity during childhood.

Progress Report
For Objectives 1A and 1C, secondary data analyses using the national data set (National Health and Nutrition Examination Survey) was conducted. Data sets were obtained and data sets were prepared for analyses, which was completed. This resulted in meeting the milestones for objectives 1A and 1C. The most notable results showed in two studies that consumption of specific foods (i.e. cheese, milk, vegetables, seafood, ready-to eat- cereals, fruits including 100 percent fruit juice, bread/rolls/tortillas and mixed dishes) contributed significantly to short fall nutrients or nutrients of public health concern. Awareness of nutrient intake and food sources is essential for designing interventions to increase the nutrient density of diets in adolescents and adults. The third study provided detailed information on the introduction of baby cereals, other complementary foods and intakes of nutrients that require special attention during early life (birth to 23 years of age). For Objective 2A, the data for the specific variables needed for the proposed analyses were extracted from an Analyses of National Health and Nutrition Examination Survey (NHANES) data set. These data were prepared for analysis. However, the data on rural-urban residence are not freely available and a request has been submitted to the National Center for Health Statistics' Research Data Center (RDC) to obtain access to this restricted-use data to assess the rural-urban differences in food security status (FSS) among children; however, due to the COVID-19 pandemic, there is a delay in processing the request. These data are also required for our future objectives that assess rural-urban differences in the association of FSS with food availability, participation in Federal Nutrition Assistance Programs, diet quality, and weight status among children. We will analyze the data as soon as we obtain approval to access the restricted data. For Objective 2B, we assessed the association of diet quality with participation in school meals only and school meals plus Supplemental Nutrition Assistance Program (SNAP) among children 5-18 years old using 2013-2014 NHANES data. Results indicated that school meal plus SNAP participation did not significantly improve the overall diet quality of low-income children relative to comparable non-participants. We also assessed the impact of the Child and Adult Care Food Program's (CACFP) new meal guidelines on children's dietary intake among children 3-5 years old. Results indicated that the new meal guidelines helped improve intakes of certain food groups and nutrients of public health concern. For Objective 3A, a systematic search of relevant databases was conducted to identify summertime obesity prevention and treatment programs. Abstracts and titles were reviewed for relevance. Full text articles were gathered for all relevant articles. We evaluated all studies to determine if they met the criteria for inclusion. A total of 43 interventions were identified for inclusion in a systematic review. We have created tables to organize the studies according to the type of intervention (e.g., summer camp, community program, residential camp), the behaviors targeted (e.g., physical activity, sleep, diet) and have categorized studies according to whether they were attempting to prevent or treat obesity in children. Finally, we have organized the studies according to the outcomes that were used to assess effectiveness of the intervention (e.g., weight, body mass index, physical activity levels, diet, etc.). We have developed a standardized form to guide pooling of the data from the articles in order to facilitate synthesis of findings across studies. Research progress included a narrative review of the interventions that involved a physical activity intervention. Our findings suggest that while summer day camp interventions were successful at increasing physical activity among children, there appears to be a lack of evidence that these interventions impact weight status. We will systematically examine this conclusion in our future analyses.

1. Food sources of shortfall nutrients among U.S. adolescents. Adolescents have greater nutrient needs compared to other age groups, and many do not adhere to the Dietary Guidelines for Americans/MyPlate recommendations. Researchers in Houston, Texas, conducted a study using existing datasets to identify food sources of shortfall nutrients (i.e. nutrients that are under-consumed relative to national recommendations) consumed by adolescents. Some of the food subgroups commonly consumed by adolescents made a significant contribution to shortfall nutrient intakes in the diet (i.e., vitamins A, C, D, and E, folate, calcium, magnesium, fiber, potassium, and iron). Awareness of nutrient intakes and food sources is essential to establish dietary guidance in a practical context.

2. Benefits of introducing complementary foods in the diets of infants and toddlers. Understanding which foods are introduced in the diet and when provides valuable information on complementary feeding. Fortified baby rice cereal is the most common first solid food given to infants, often followed by other baby cereals. Researchers in Houston, Texas, examined food patterns among infants and toddlers consuming rice or non-rice baby cereals versus cereal non-consumers using existing datasets. Baby cereal consumer groups, compared to non-consumers, had higher intakes of carbohydrates, iron, calcium, magnesium, zinc, and vitamin E. Infants 0–3 month and 4–6 month among the baby cereal consumption groups consumed other solid foods, including baby foods and beverages, sweetened beverages, coffee and tea, 100% juice, vegetables (excluding potatoes), fruit, sugars, milk and yogurt, and mixed dishes. This study provided detailed information on the introduction of baby cereals which was associated with other complementary foods and better intakes of nutrients that require special attention during early life.