Debra B. Reed

Obesity in Rural Youth: Looking beyond Nutrition and Physical Activity.

Contributors to excessive obesity in rural youth include well-documented nutrition and physical activity behaviors. However, emerging research suggests that preventing excessive weight gain and smoking during pregnancy, teen pregnancy, and child abuse also could reduce obesity in this vulnerable population. These traditional and emerging, nontraditional factors need to be addressed within the confines of current challenges faced by rural communities. An enhanced ecological model provides a framework for combining traditional and nontraditional factors into a more comprehensive approach that addresses the complexity of the issues contributing to youth obesity.

Associations between Tissue Visfatin/Nicotinamide, Phosphoribosyltransferase (Nampt), Retinol Binding Protein-4, and Vaspin Concentrations and Insulin Resistance in Morbidly Obese Subjects

Visfatin/Nampt, vaspin, and retinol binding protein-4 (RBP-4) play an important role in insulin resistance. The objectives of this study were to measure visfatin/Nampt, vaspin, and RBP-4 concentrations in blood, liver, muscle, subcutaneous, omental, and mesenteric adipose tissues in morbidly obese subjects and investigate their relationship to insulin resistance. Blood and tissue samples were collected from 38 morbidly obese subjects during Roux-en-Y surgery. Insulin resistance biomarkers were measured using standard kits. Visfatin/Nampt, vaspin, and RBP-4 gene expression levels in tissues were measured using real-time PCR. Their protein concentrations in blood and tissues were measured using ELISA kits. Diabetic subjects had significantly higher homeostasis model of assessment-insulin resistance and age and lower blood HDL-cholesterol concentrations than nondiabetic and prediabetic subjects. Diabetic and prediabetic subjects had significantly higher blood concentrations of visfatin/Nampt and vaspin than nondiabetic subjects. Liver RBP-4 concentrations were positively associated with blood glucose concentrations. Blood insulin resistance biomarker levels were positively associated with visfatin/Nampt concentrations in omental adipose tissue and liver, and vaspin concentrations in mesenteric adipose tissue. In conclusion, the correlations of visfatin/Nampt, vaspin, and RBP-4 with insulin resistance are tissue dependent.

Lipid content in hepatic and gonadal adipose tissue parallel aortic cholesterol accumulation in mice fed diets with different omega-6 PUFA to EPA plus DHA ratios

BACKGROUND & AIMS Diets with low omega (ω)-6 polyunsaturated fatty acids (PUFA) to eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) ratios have been shown to decrease aortic cholesterol accumulation and have been suggested to promote weight loss. The involvement of the liver and gonadal adipose tissue (GAT) in mediating these effects is not well understood. LDL receptor null mice were used to assess the effect of an atherogenic diet with different ω-6:EPA+DHA ratios on weight gain, hepatic and GAT lipid accumulation, and their relationship to atherosclerosis. METHODS Four groups of mice were fed a high saturated fat and cholesterol diet (HSF ω-6) alone, or with ω-6 PUFA to EPA+DHA ratios up to 1:1 for 32 weeks. Liver and GAT were collected for lipid and gene expression analysis. RESULTS The fatty acid profile of liver and GAT reflected the diets. All diets resulted in similar weight gains. Compared to HSF ω-6 diet, the 1:1 ratio diet resulted in lower hepatic total cholesterol (TC) content. Aortic TC was positively correlated with hepatic and GAT TC and triglyceride. These differences were accompanied by significantly lower expression of CD36, ATP-transporter cassette A1, scavenger receptor B class 1, 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR), acetyl-CoA carboxylase alpha, acyl-CoA synthetase long-chain family member 5, and stearoyl-coenzyme A desaturase 1 (SCD1) in GAT, and HMGCR, SCD1 and cytochrome P450 7A1 in liver. CONCLUSIONS Dietary ω-6:EPA+DHA ratios did not affect body weight, but lower ω-6:EPA+DHA ratio diets decreased liver lipid accumulation, which possibly contributed to the lower aortic cholesterol accumulation.

Effects of TV in the Bedroom on Young Hispanic Children

Purpose. The main purposes of this study were to assess TV viewing among Hispanic young children and to examine effects of having a TV in the childs bedroom (TVIB). Design and Setting. A quasi-experimental design was used to evaluate an intervention program that is collecting longitudinal data in West Texas. However, the current report uses only the baseline data of the ongoing study. Subjects. Predominantly low-income and Hispanic parents/guardians (N = 315) and their children of 5 to 9 years (N = 597). Measures. Childrens anthropometric measures were obtained. Their overweight status was determined based on age- and gender-adjusted body mass index. A demographic questionnaire, acculturation scale (brief version of Acculturation Rating Scale for Mexican Americans II), and family survey were used among parents. Analysis. Descriptive statistics, t-tests, X2 tests, and logistic regressions were used. Results. Most children (70%) have TVIB; more than 30% were or were at risk of overweight. Demographic characteristics did not significantly predict TVIB. Children with TVIB spent .93 hours more daily watching TV/DVD (t = 3.07; df = 283; p = .003), and children (at one site) ate more fast food (X2 = 5.46; df = 1; p = .019), compared with children without TVIB whose parents better supported physical activity (t = 2.11; df = 275; p = .039). Conclusion. Most children in this low-income and Hispanic sample have TVIB, which is associated with unhealthy behaviors. (Am J Health Promot 2011;25[5]:310-318.)

Formative assessment in the development of an obesity prevention component for the expanded food and nutrition education program in Texas.

This study conducted formative research (surveys, focus groups) to assess the nutrition education needs of clients in the Texas Expanded Food and Nutrition Education Program prior to curriculum revision. Participants were current Expanded Food and Nutrition Education Program participants in 3 Texas cities (Austin, Houston, San Antonio). Data were used to tailor the curriculum to the target population. This research provides evidence that members of the target audience can provide valuable insights into a particular topic. Formative work prior to intervention development should be conducted to identify key issues regarding a particular topic and to evaluate potential educational approaches.

Aortic cholesterol accumulation correlates with systemic inflammation but not hepatic and gonadal adipose tissue inflammation in low-density lipoprotein receptor null mice

Inflammation is a major contributor to the development of atherosclerotic plaque, yet the involvement of liver and visceral adipose tissue inflammatory status in atherosclerotic lesion development has yet to be fully elucidated. We hypothesized that an atherogenic diet would increase inflammatory response and lipid accumulation in the liver and gonadal adipose tissue (GAT) and would correlate with systemic inflammation and aortic lesion formation in low-density lipoprotein (LDL) receptor null (LDLr-/-) mice. For 32 weeks, LDLr-/- mice (n = 10/group) were fed either an atherogenic (high saturated fat and cholesterol) or control (low fat and cholesterol) diet. Hepatic and GAT lipid content and expression of inflammatory factors were measured using standard procedures. Compared with the control diet, the atherogenic diet significantly increased hepatic triglyceride and total cholesterol (TC), primarily esterified cholesterol, and GAT triglyceride content. These changes were accompanied by increased expression of acyl-CoA synthetase long-chain family member 5, CD36, ATP-binding cassette, subfamily A, member 1 and scavenger receptor B class 1, and they decreased the expression of cytochrome P450, family 7 and subfamily a, polypeptide 1 in GAT. Aortic TC content was positively associated with hepatic TC, triglyceride, and GAT triglyceride contents as well as plasma interleukin 6 and monocyte chemoattractant protein-1 concentrations. Although when compared with the control diet, the atherogenic diet increased hepatic tumor necrosis factor α production, they were not associated with aortic TC content. These data suggest that the LDLr-/- mice responded to the atherogenic diet by increasing lipid accumulation in the liver and GAT, which may have increased inflammatory response. Aortic TC content was positively associated with systemic inflammation but not hepatic and GAT inflammatory status.

Blood leptin and C-reactive protein provide more sensitive assessment than blood lipids and other inflammatory biomarkers in overweight university students

Overweight is an inflammatory disease, and todays overweight university students will be tomorrows overweight employees and parents; however, few studies have focused on the link between overweight and inflammation in university students. We hypothesized that students at higher body mass index (BMI) and percent body fat (BF%) would have higher blood concentrations of lipids and inflammatory biomarkers. A cross-sectional study including 110 university students was conducted at Texas Tech University. Overweight was determined by BMI using measured height and weight, and BF% was determined using bioelectric impedance analysis. Serum triglyceride and cholesterol concentrations were measured using enzymatic methods. Plasma concentrations of leptin, adiponectin, C-reactive protein (CRP), interleukin-6, and tumor necrosis factor α were measured using an enzyme-linked immunosorbent assay. Our results showed that higher BMI was associated with increased blood concentrations of CRP, leptin, and triglyceride (only in male subjects) and decreased blood adiponectin concentrations in university students. In addition, BF% was significantly correlated with blood concentrations of leptin and CRP. Female students had significantly higher blood concentrations of leptin, adiponectin, and CRP than did male students. In conclusion, blood inflammatory biomarkers, especially leptin and CRP, provide a more sensitive and accurate assessment than blood cholesterol and triglyceride for overweight individuals in this population. Leptin, adiponectin, and CRP are sex-dependent inflammatory biomarkers.

Pilot Study: Survey toolS for ASSeSSing PArenting StyleS And fAmily ContributorS to the develoPment of obeSity in ArAb Children AgeS 6 to 12 yeArS

OBJECTIVE Our pilot study was conducted to test the reliability of the Caregivers Feeding Styles Questionnaire (CFSQ) and the Family Nutrition and Physical Activity Assessment (FNPA) in a sample of Arab mothers. DESIGN Twenty-five Arab mothers completed the CFSQ, FNPA, and the Participant Background Survey for the first administration. After 1-2 weeks, participants completed the CFSQ and the FNPA for the second administration. The two administrations of the surveys allowed for test/retest reliability of the CFSQ and the FNPA and to measure the internal consistency of the two surveys. RESULTS Pearsons correlation between the first and second administrations or the 19-item scale (demandingness) and the 7-item scale (responsiveness) of the CFSQ were .95 and .86, respectively. As for the FNPA, Pearsons correlation was .80. The estimated reliabilities (Cronbachs alpha) of the CFSQ increased from .86 for the first administration to .93 for the second administration. However, the estimated reliabilities of the FNPA slightly increased from .58 for first administration to .59 for the second administration. CONCLUSION In our pilot study of Arab mothers, the CFSQ and FNPA were shown to be promising in terms of reliability and content validity.

Perceived parenting behaviors may predict young adolescents’ body fatness

The prevalence of overweight among children and adolescents has been increasing. Not only individual but also environmental factors are important in the etiology of overweight or obesity. Of the environmental factors, parents have been considered to be the greatest influence on a childs dietary behavior and body weight status. Parenting styles and their relevant dimensions have long been found to be associated with adolescents’ developmental outcomes, but little is known about associations between perceived parenting behaviors and adolescents’ body fatness. The present study examined adolescents’ perceptions of parenting behaviors and measures of body fatness. The randomly selected study sample consisted of 106 13–15 year olds from Houston MSA. Parenting style variables were created statistically including by cluster analysis and factor analysis. Indicators of body fatness included body weight, waist circumference, skinfold thickness and body mass index (BMI). A two-cluster solution for both maternal and paternal parenting style represented authoritative versus non-authoritative parenting. Two parenting factors derived were maternal/paternal nurturing and control. Maternal authoritative parenting style was associated with having adolescents who are less fat. Maternal control was positively associated with adolescents’ body weight, waist, subscapular skinfold, BMI and the tendency to be overweight. Maternal nurturing was related to BMI in the “normal” category. None of paternal parenting styles or dimensions appeared to be significantly related to adolescents’ body fatness.

Jump2Health Website™ for Head Start parents to promote a healthy home environment: Results from formative research

Background: In US, approximately 23% of children between the ages of 2-5 years are overweight or obese. Parents need access to information to create healthy home environments for obesity prevention, yet participation for in-person education programs is challenging. Web-based interventions are promising educational tools due to 24/7 availability. However, information is limited on their development and evaluation. Design and Methods: This study reports on a rigorous development process that included six focus group discussions (FGD) with stakeholders (three FGD each with parents and teachers) to assess education needs and inform the development of the Jump2Health Website™ by a multidisciplinary team. After development, the Website was evaluated by telephone interviews with stakeholders (five parents and six teachers) and reviewed by an expert panel of five Registered Dietitians. Results: Twenty Head Start parents and 22 Head Start teachers participated in the FGD. To address the needs identified by these stakeholders, the Website was designed to include components that were enabling and motivating, such as descriptions of health benefits by achieving the desired behaviours, short videos on easy meal preparation, and tip sheets on how to achieve healthy behaviours in easy, economical ways. Stakeholder evaluation of the Website indicated that the information was helpful, easy to use, and would be beneficial for parents. Conclusions: The development of Jump2Health Website™ was strengthened by FGD with stakeholders that assessed educational needs. Interviews with stakeholders and an expert panel review showed that the Website may be an effective educational method to teach parents about healthy behaviours related to obesity prevention. Significance for public health Overweight and obesity in preschool children are at undesirable levels, reflecting a need for parent education programs that address a comprehensive set of obesigenic behaviors (diet, family meals, physical activity, sleep, and screen time) and meet parental needs in terms of accessibility and appeal. Formative evaluation with stakeholders (parents, teachers, and nutrition experts) was useful in shaping the development of the Jump2Health Website™. Websites may be able to overcome some of the challenges of traditional in-person education programs as parents can learn at their own pace and schedule. Parents may be able to obtain information from a website that they would have not felt comfortable asking their paediatrician. Stakeholders suggested that shorter text passages and additional topics on weight control and bullying be included. To provide more access and appeal, a mobile website for smartphones and other supportive materials (newsletters, text messages, and an interactive discussion blog) may be needed.