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Title: Consumption of apples is associated with a better diet quality and reduced risk of obesity in children: National Health and Nutrition Examination Survey (NHANES) 2003-2010

Author
item O'NEIL, CAROL - Louisiana State University Agcenter
item NICKLAS, THERESA - Children'S Nutrition Research Center (CNRC)
item FULGONI III, VICTOR - Nutrition Impact, Llc

Submitted to: Nutrition Journal
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/8/2015
Publication Date: 5/14/2015
Citation: O'Neil, C.E., Nicklas, T.A., Fulgoni III, V.L. 2015. Consumption of apples is associated with a better diet quality and reduced risk of obesity in children: National Health and Nutrition Examination Survey (NHANES) 2003-2010. Nutrition Journal. 14:48.

Interpretive Summary: No studies have examined the association of apple product consumption and diet quality or weight in children. The purpose of this study was to examine the association between various forms of apple consumption with diet quality and body weight in children. Children who consumed any form of apples had better diet quality and were less likely to be obese than non consumers. Apples should be encouraged as part of a healthy diet.

Technical Abstract: Most children do not meet the recommendation for fruit consumption. Apples are the second most commonly consumed fruit in the US; however, no studies have examined the association of total apple products, apples, apple sauce, and 100 % apple juice consumption on diet quality and weight/adiposity in children. The purpose of this study was to examine the association between various apple consumption forms with diet quality and weight/adiposity in a nationally representative sample of children. Participants were children 2-18 years of age (N= 13,339) from the National Health and Nutrition Examination Survey 2003-2010. Intake was determined using a single interview administered 24-h diet recall. Apple product consumption was determined using the cycle-appropriate USDA Food and Nutrient Database for Dietary Studies food codes. Total diet quality and component scores were determined using the Healthy Eating Index-2010 (HEI). Anthropometrics were determined using standard methods. Covariate adjusted linear and logistic regressions were used to compare apple product consumers with non-consumers; sample weights were used. Probability was set at <0.01. Approximately 26 % of the population (n=3,482) consumed some form of apple products. Consumers of apple products, whole apples, apple sauce, and 100 % apple juice had higher HEI scores than non-consumers: 50.4+/-0.4 v 41.9 +/- 0.3, 52.5 +/- 0.5 v 42.7 +/- 0.3, 52.1 +/- 0.8 v 47.2 +/- 0.4, and 51.4 +/- 0.6 v 46.5 +/- 0.4, respectively. Apple products and whole apple consumers had lower BMI z-scores than non-consumers: 0.4 +/- 0.04 v 0.5 +/- 0.03 and 0.3 +/- 0.1 v 0.5'±'0.02, respectively. Apple products and whole apple consumers were 25 % (0.59-0.95 99(th) CI) and 30 % (0.52-0.95 99((th) CI), respectively, were less likely to be obese than non-consumers. Consumption of any form of apples contributed to the fruit recommendation of children and improved diet quality. Apples should be included in the diets of children as a component of an overall healthy diet.