Alisha J. Rovner

Associations of parenting styles, parental feeding practices and child characteristics with young children's fruit and vegetable consumption.

The purpose of this study was to investigate the role of parent and child characteristics in explaining childrens fruit and vegetable intakes. In 2008, parents of preschoolers (mean age 3.5 years) from 56 schools in Belgium-Flanders completed questionnaires including a parent and child fruit and vegetable food frequency questionnaire, general parenting styles (laxness, overreactivity and positive interactions), specific food parenting practices (child-centered and parent-centered feeding practices) and childrens characteristics (childrens shyness, emotionality, stubbornness, activity, sociability, and negative reactions to food). Multiple linear regression analyses (n = 755) indicated a significant positive association between childrens fruit and vegetable intake and parents intake and a negative association with childrens negative reactions to food. No general parenting style dimension or child personality characteristic explained differences in childrens fruit and vegetable intakes. Child-centered feeding practices were positively related to childrens fruit and vegetable intakes, while parent-centered feeding practices were negatively related to childrens vegetable intakes. In order to try to increase childrens fruit and vegetable consumption, parents should be guided to improve their own diet and to use child-centered parenting practices and strategies known to decrease negative reactions to food.

Are Children With Type 1 Diabetes Consuming a Healthful Diet? A Review of the Current Evidence and Strategies for Dietary Change

Purpose The purpose of this study is to review the literature on usual dietary intake in children with type 1 diabetes (T1D) and to discuss approaches to promote dietary change with potential efficacy. Methods Search strategies included a MEDLINE search for English-language articles that estimated usual dietary intake in children with T1D and a screening of the reference lists from original studies. The keywords used were diet, dietary intake, nutrition, type 1 diabetes, children, adolescents, and youth. Studies were included if they were observational, contained a sample of children with T1D, and estimated usual dietary intake. Results Nine studies fulfilled the criteria (6 US, 3 European). Of the 4 studies with a control group, 3 reported that both total fat and saturated fat intake were higher in the children with T1D. Six studies examined the percent of total calories from saturated fat; mean intake ranged from 11 to 15%, exceeding ADA recommendations (< 7%). Fruit, vegetable, and fiber intakes were low among children with T1D. No prior studies have addressed dietary change in this population. The behavior-change literature suggests that nutrition education alone is unlikely to be adequate, but that incorporation of behavioral approaches offers potential efficacy in promoting healthful dietary change. Conclusions Children with T1D are not meeting dietary guidelines, and in some areas their diets are less healthful than children without diabetes. As these dietary behaviors may affect the risk of long-term complications, the incorporation of behavioral approaches promoting healthy eating into routine clinical practice is warranted.

Food Sold in School Vending Machines Is Associated With Overall Student Dietary Intake

PURPOSEnTo examine the association between food sold in school vending machines and the dietary behaviors of students.nnnMETHODSnThe 2005-2006 U.S. Health Behavior in School-aged Children survey was administered to 6th to 10th graders and school administrators. Dietary intake in students was estimated with a brief food frequency measure. School administrators completed questions regarding food sold in vending machines. For each food intake behavior, a multilevel regression analysis modeled students (level 1) nested within schools (level 2), with the corresponding food sold in vending machines as the main predictor. Control variables included gender, grade, family affluence, and school poverty index. Analyses were conducted separately for 6th to 8th and 9th-10th grades.nnnRESULTSnIn all, 83% of the schools (152 schools; 5,930 students) had vending machines that primarily sold food of minimal nutritional values (soft drinks, chips, and sweets). In younger grades, availability of fruit and/or vegetables and chocolate and/or sweets was positively related to the corresponding food intake, with vending machine content and school poverty index providing an explanation for 70.6% of between-school variation in fruit and/or vegetable consumption and 71.7% in sweets consumption. Among the older grades, there was no significant effect of food available in vending machines on reported consumption of those food.nnnCONCLUSIONnVending machines are widely available in public schools in the United States. In younger grades, school vending machines were either positively or negatively related to the diets of the students, depending on what was sold in them. Schools are in a powerful position to influence the diets of children; therefore, attention to the food sold at school is necessary to try to improve their diets.

Emphasis on Carbohydrates May Negatively Influence Dietary Patterns in Youth With Type 1 Diabetes

OBJECTIVE To assess perceptions of healthful eating and the influence of diabetes management on dietary behaviors among youth with type 1 diabetes and parents. RESEARCH DESIGN AND METHODS Youth with type 1 diabetes (n = 35), ages 8–21 years, and parents participated in focus groups. Focus group recordings were transcribed and coded into themes. Clinical data were abstracted from the electronic medical record. RESULTS Central topics were perceptions of healthful eating and the impact of diabetes management on diet. An emphasis on limiting postprandial glycemic excursions occasionally contradicted the traditional perception of healthful eating, which emphasized consumption of nutrient-dense whole foods in favor of prepackaged choices. Whereas fixed regimens required more rigid diets, basal-bolus regimens provided more opportunities for unhealthful eating. Most youth perceived “refined” grains as more healthful grains. CONCLUSIONS For youth with type 1 diabetes and parents, an emphasis on carbohydrate quantity over quality may distort beliefs and behaviors regarding healthful eating.

Adherence to a Mediterranean diet and plasma concentrations of lipid peroxidation in premenopausal women

BACKGROUNDnA Mediterranean diet has been associated with a reduced risk of cardiovascular disease and mortality. A possible mechanism is through a decrease in lipid peroxidation (LPO); however, evidence linking the Mediterranean diet with lower LPO in premenopausal women is sparse.nnnOBJECTIVEnWe investigated whether adherence to a Mediterranean diet was associated with lower LPO concentrations in premenopausal women.nnnDESIGNnTwo hundred fifty-nine healthy women aged 18-44 y were followed for ≤ 2 menstrual cycles. Plasma concentrations of F(2)-isoprostane (8-iso-PGF2α), 9-hydroxyoctadecadieneoic acid (9-HODE), and thiobarbituric acid reactive substances (TBARS) were measured ≤ 8 times per cycle at visits scheduled by using fertility monitors. Diet was assessed ≤ 4 times per cycle by using 24-h dietary recalls. The alternate Mediterranean Diet Score (aMED) (range: 0-9) was calculated on the basis of intake of vegetables, legumes, fruit, nuts, whole grains, red and processed meat, fish, and alcohol and the ratio of monounsaturated to saturated fat.nnnRESULTSnA 1-unit increase in aMED was associated with a 4.50% decrease in 8-iso-PGF2α concentrations (95% CI: -6.32%, -2.65%) and a 14.01% decrease in 9-HODE concentrations (95% CI: -17.88%, -9.96%) after adjustment for energy intake, age, race, body mass index, plasma ascorbic acid, and serum cholesterol. No significant association was observed between aMED and TBARS. A 1-unit increase in aMED was associated with a 1.39% increase (95% CI: 0.07%, 2.72%) in plasma ascorbic acid concentrations.nnnCONCLUSIONSnAdherence to a Mediterranean diet is associated with lower LPO and higher ascorbic acid concentrations. These results confirm that decreased LPO is a plausible mechanism linking a Mediterranean diet to reduced cardiovascular disease risk.

Whole Grains Are Associated with Serum Concentrations of High Sensitivity C-Reactive Protein among Premenopausal Women

In premenopausal women, elevated C-reactive protein (CRP) concentrations have been associated with an increased risk of negative reproductive outcomes. Whole grain consumption has been associated with lower CRP concentrations in older women; however, less is known about this relationship in younger women. We investigated whether whole grain intake was associated with serum high sensitivity CRP (hs-CRP) concentrations in young women. BioCycle was a prospective cohort study conducted at the University of Buffalo from 2005 to 2007, which followed 259 healthy women aged 18-44 y for <or= 2 menstrual cycles. hs-CRP concentrations were measured longitudinally <or= 8 times/cycle with visits standardized to menstrual cycle phase. Whole grain intake was estimated by 24-h recalls <or= 4 times/cycle. Servings were defined as 16 g or 125 mL of a 100% whole grain food. Whole grain intake was inversely associated with hs-CRP concentrations after adjusting for age, race, BMI, illness, and antiinflammatory drug use. Consumers of between 0 and 1 serving/d of whole grains had, on average, 11.5% lower hs-CRP concentrations (P = 0.02) and consumers of >or= 1 serving/d had 12.3% lower hs-CRP concentrations (P = 0.02) compared with nonconsumers. Women who consumed >or= 1 serving/d of whole grain had a lower probability of having moderate (P = 0.008) or elevated (P = 0.001) hs-CRP according to the AHA criteria compared with nonconsumers. Given that elevated concentrations of hs-CRP have been linked to adverse reproductive outcomes and pregnancy complications, interventions targeting whole grain consumption may have the potential to improve health status among young women.

Development and Validation of the Collaborative Parent Involvement Scale for Youths with Type 1 Diabetes

OBJECTIVEnTo develop and test a youth-report measure of collaborative parent involvement in type 1 diabetes management.nnnMETHODSnInitial item development and testing were conducted with 81 youths; scale refinement and validation were conducted with 122 youths from four geographic regions. Descriptive statistics, Cronbachs alpha, and factor analyses were conducted to select items comprising the scale. Correlations with parenting style and parent diabetes responsibility were examined. Multiple regression analyses examining associations with quality of life, adherence, and glycemic control were conducted to assess concurrent validity.nnnRESULTSnThe measure demonstrated strong internal consistency. It was modestly associated with parenting style, but not with parent responsibility for diabetes management. A consistent pattern of associations with quality of life and adherence provide support for the measures concurrent validity.nnnCONCLUSIONSnThis brief youth-report measure of parent collaborative involvement assesses a unique dimension of parent involvement in diabetes management associated with important youth outcomes.

The effect of a low-glycemic diet vs a standard diet on blood glucose levels and macronutrient intake in children with type 1 diabetes.

A low-glycemic index (GI) diet may lower postprandial hyperglycemia and decrease the risk for postabsorptive hypoglycemia in people with type 1 diabetes. However, insufficient evidence exists on the efficacy of a low-GI diet to support practice recommendations. The goal of this study was to examine the blood glucose response to and the macronutrient composition of low-GI meals vs usual meals consumed ad libitum at home in children with type 1 diabetes. A within-subject, crossover design was employed. Twenty-three participants were recruited between June and August 2006. Participants wore a continuous blood glucose monitoring system and completed diet diaries on 2 days. On 1 day, participants consumed their usual meal; on another day, participants consumed low-GI meals ad libidum. Order of the 2 days was counterbalanced. The mean GI was 34+/-6 for the low-GI day and 57+/-6 for the usual meal day (P<0.0001). During the low-GI day, mean daytime blood glucose values (125+/-28 mg/dL [6.9+/-1.5 nmol/L] vs 185+/-58 mg/dL [10.3+/-3.2 nmol/L], P<0.001), blood glucose area above 180 mg/dL (4,486+/-6,138 vs 26,707+/-25,038, P<0.006), and high blood glucose index (5.1+/-5.1 vs 13.6+/-7.6, P<0.001) were lower compared to the usual mean day. During the low-GI day, subjects consumed more fiber (24.5+/-12.3 g vs 14.5+/-6.1 g, P<0.007) and less fat (45.7+/-12.2 g vs 76.8+/-32.4 g, P<0.005); however, there were no differences in energy, carbohydrate, or protein intake. In this pilot study, a low-GI diet was associated with improved diet quality and a reduction in hyperglycemia.

Perceived Benefits, Barriers, and Strategies of Family Meals among Children with Type 1 Diabetes Mellitus and Their Parents: Focus- Group Findings

Dietary management of type 1 diabetes mellitus has become much less restrictive and more flexible in recent years due to contemporary insulin regimens, which may afford families of children with type 1 diabetes mellitus greater ease in sharing family meals. Although these treatment advancements might facilitate family meals, overall demands of diabetes management can influence familys perceived or actual ability to do so. Youths with type 1 diabetes mellitus (ages 8 to 20 years) and parents participated in separate focus groups. Thirty-five youths with type 1 diabetes mellitus (mean age=15.1+/-3.6 years) and their parents participated in 21 focus groups (12 youth groups, nine parent groups). Although there was substantial variability in how often family meals occurred, both parents and youths consistently perceived family meals as valuable and enjoyable. The major barrier to family meals discussed by both youths and parents was busy schedules. Strategies for having family meals that were discussed by parents included shopping to ensure availability of the foods needed to prepare meals, planning, and cooking meals in advance, and using simplified cooking methods. These findings suggest that a family-focused approach to nutrition interventions in this population, as opposed to one targeting the child with diabetes only, can improve the chance for successful dietary change.

Development and Validation of the Type 1 Diabetes Nutrition Knowledge Survey

OBJECTIVE The purpose of this study was to develop a survey of general and diabetes-specific nutrition knowledge for youth with type 1 diabetes and their parents and to assess the survey’s psychometric properties. RESEARCH DESIGN AND METHODS A multidisciplinary pediatric team developed the Nutrition Knowledge Survey (NKS) and administered it to youth with type 1 diabetes (n = 282, 49% females, 13.3 ± 2.9 years) and their parents (82% mothers). The NKS content domains included healthful eating, carbohydrate counting, blood glucose response to foods, and nutrition label reading. Higher NKS scores reflect greater nutrition knowledge (score range is 0–100%). In youths, glycemic control was assessed by A1C, and dietary quality was determined by the Healthy Eating Index-2005 (HEI-2005) derived from 3-day diet records. Validity was based on associations of NKS scores with A1C and dietary quality. Reliability was assessed using the Kuder-Richardson Formula 20 (KR-20) and correlations of domain scores to total score. RESULTS Mean NKS scores (23 items) were 56.9 ± 16.4% for youth and 73.4 ± 12.5% for parents. The KR-20 was 0.70 for youth and 0.59 for parents, representing acceptable internal consistency of the measure. In multivariate analysis, controlling for youth age, family income, parent education, diabetes duration, and insulin regimen, parent NKS scores were associated with corresponding youth A1C (β = −0.13, P = 0.03). Both parent (β = 0.20, P = 0.002) and youth (β = 0.25, P < 0.001) NKS scores were positively associated with youth HEI-2005 scores. CONCLUSIONS The NKS appears to be a useful measure of general and diabetes-specific nutrition knowledge for youth with type 1 diabetes and their parents.