Frederick L. Trowbridge

Increasing Prevalence of Overweight Among US Low-income Preschool Children: The Centers for Disease Control and Prevention Pediatric Nutrition Surveillance, 1983 to 1995

Objective. To determine whether the prevalence of overweight in preschool children has increased among the US low-income population. Design. Analysis using weight-for-height percentiles of surveillance data adjusted for age, sex, and race or ethnicity. Setting. Data from 18 states and the District of Columbia were examined. a Subjects. Low-income children <5 years of age who were included in the Centers for Disease Control and Prevention Pediatric Nutrition Surveillance System. Results. The prevalence of overweight increased from 18.6% in 1983 to 21.6% in 1995 based on the 85th percentile cutoff point for weight-for-height, and from 8.5% to 10.2% for the same period based on the 95th percentile cutoff point. Analyses by single age, sex, and race or ethnic group (non-Hispanic white, non-Hispanic black, and Hispanic) all showed increases in the prevalence of overweight, although changes are greatest for older preschool children. Conclusion. Overweight is an increasing public health problem among preschool children in the US low-income population. Additional research is needed to explore the cause of the trend observed and to find effective strategies for overweight prevention beginning in the preschool years.

Summary and recommendations.

Iron deficiency affects the well being of > 1 billion people worldwide, with a range of adverse health and social consequences, yet efforts to address the problem have had only limited success. To better assess this issue and define more effective strategies, an international conference was convened in Atlanta, GA, in May 2001. Key policy issues discussed included setting a global goal for prevention and control of iron deficiency, building partnerships, and identifying ways to mobilize financial and human resources. The strengths and limitations of specific intervention strategies were discussed including iron fortification of staple foods and condiments, supplementation, dietary diversification, application of biotechnology to increase micronutrient content of staple foods, and public health measures such as infection control and provision of health care services. The importance of utilizing multiple and integrated strategies was emphasized. Representatives from several countries reported successful intervention programs as well as promising results in implementing new strategies. The critical role of effective communications was also emphasized, both to increase awareness of the impact of iron deficiency and to advocate for policy changes and resources to address the problem. The conference concluded with specific recommendations for action.

Alcohol and body weight in United States adults.

Alcohol contributes more than 10 per cent of the total caloric intake of adult drinkers in the United States. However, the effect of alcohol on body weight has not been adequately studied in the general population. The association between weight and frequency of alcohol consumption was examined in two national cross-sectional surveys: the Second National Health and Nutrition Examination Survey (HANESII; n = 10,929) and the Behavioral Risk Factor Surveys (BRFS; n = 18,388). Linear multiple regression was used to estimate the independent effect of alcohol on weight, adjusting for smoking, age, diet practices, physical activity, race, education, and height. Among men, alcohol had only a slight effect on weight in either survey. However, among women, alcohol was associated with a substantial reduction in weight, which was as large as the effect of smoking. Compared with nondrinkers, women who consumed alcohol 7-13 times per week had the greatest reduction in weight: -3.6 kg (95% confidence limits [CL] = -5.6, -1.5 kg) in HANESII and -3.2 kg (95% CL = -4.9, -1.5 kg) in BRFS. Alcohol confounded the association between smoking and weight, and among women it accounted for nearly 45 per cent of the weight-lowering effect of smoking. Alcohol also diminished the weight-lowering effect of smoking in men, while in women the smoking effect was slightly enhanced. Further studies are needed to understand the causal mechanisms by which alcohol is associated with body weight.

Negro-Caucasoid differences in permanent tooth emergence at a constant income level

Abstract Three-thousand, eight-hundred and sixty-eight low-income American Negro boys and girls showed systematic permanent advancement in tooth emergence compared with 5788 low-income boys and girls of European ancestry. Further matched to within

Alcohol use and health behavior lifestyles among U.S. women: the behavioral risk factor surveys

160 per-capita yearly income, the Negro boys and girls evidenced a 0.30 standard deviation emergence advancement of non-uniform or “patterned” nature, with the greatest temporal difference for the mandibular lateral incisors (0.72–0.73 S.D.) in both sexes.

Coordinated Strategies for Controlling Micronutrient Malnutrition: A Technical Workshop

Alcohol use is a complex behavior, occurring in the context of an overall health lifestyle. We used data from a nationally representative telephone survey (N = 12,467 women) to examine associations between binge drinking, chronic drinking, and other health behaviors. Certain health-risk behaviors (e.g., smoking, drunk driving, and seatbelt nonuse) tend to cluster with alcohol misuse. These may act synergistically, thus augmenting the negative health effects of alcohol misuse. Conversely, some health behaviors (e.g., eating or exercising, particularly in response to stress) are negatively associated with alcohol misuse and may serve similar functions for some women. Finally, binge drinking occurs more frequently among women who may have relatively restrictive eating behaviors and higher levels of interpersonal stress. Our findings suggest that alcohol prevention and treatment programs should address sociodemographic and health lifestyle factors that initially predispose an individual to engage in health-risk behaviors and should recognize the interdependent patterns of behaviors associated with alcohol misuse. This approach will help prevent substitutions, recurrence, or induction of detrimental behaviors and will identify potentially negative interactions between existing concurrent health-risk behaviors.

Trends and patterns in height and weight status of low‐income U.S. children

Participants in a November 1991 workshop concluded that coordinated strategies for controlling malnutrition due to iodine, iron, vitamin A and other micronutrients deficiencies are technically feasible and should be given consideration in planning control efforts. Coordinated surveys involving clinical, biochemical and dietary assessment of multiple micronutrients are feasible. Multiple fortification is also possible using such vehicles as salt, processed rice or sugar. Supplementation efforts can be integrated with existing health care programs. Food-based strategies are also effective. The best examples have been community-based and have included a strong nutrition and health education component designed to change food consumption patterns, improve food preservation and preparation practices, and link income-generating activities with food production activities. Successful coordinated efforts will require a strong political commitment and a supportive infrastructure. Specific recommendations include the formation of national coordinating bodies for micronutrient deficiency control, establishment of a micronutrient information network and expansion of technical exchange and training.

Arm Circumference v. Weight-for-Height in Nutritional Assessment: Are the Findings Comparable?

To better define the trends and patterns of growth for low-income children, we studied the anthropometry data collected by the second National Health and Nutrition Examination Survey (NHANES II) and the CDC Pediatric Nutrition Surveillance System (PNSS). Based on NHANES II, we found that low-income children appear to have a greater prevalence of shortness (low height-for-age), but do not have a greater prevalence of overweight (high weight-for-height) when compared with children from higher income families. Based on 12 states that were monitored continuously by the PNSS from 1980 to 1989, low-income children under 5 years of age appear to have a stable trend of height and weight status, with the exception of Asian children, most of whom were from Southeast Asian refugee background, showed a dramatic improvement in height status. However, based on PNSS data for the years 1977 to 1990 from Louisiana and Michigan, school-aged children and adolescents appear to have become slightly taller as well as having significant increases in body weight in relation to height. An additional investigation is needed to verify this trend of increasing excess weight among older, low-income children.

Methodological issues in nutrition surveillance: the CDC experience.

Arm circumference has been proposed as an alternative to weight-for-height as a measure of acute malnutrition because of its low cost and ease of performance particularly for rapid field assessments of nutritional status in circumstances where resources and trained personnel are limited. Few studies however have compared the 2 methods as a measure of acute malnutrition. We used data from rapid nutrition assessments conducted during 1984-85 in Burkina Faso Guinea and Niger to compare the prevalence of malnutrition as measured by these 2 indices employing commonly used cut-offs for severe and moderate malnutrition. The prevalence of severe malnutrition was 5% using the cut-off of arm circumference 12.5 cm and and 1% using the cut-off of weight-for-height 70% of median; for moderate malnutrition (arm circumference 13.5 cm and weight-for-height 80% of median) the corresponding prevalences were 20 and 8%. For severe malnutrition the sensitivity of arm circumference compared with weight-for-height was 54% with a specificity of 95%. For moderate malnutrition sensitivity and specificity were 75 and 85% respectively. Raising the arm circumference cut-offs used to define severe and moderate malnutrition resulted in higher sensitivity but yielded lower specificity. Our results indicate that considerable different prevalence rates were obtained with the 2 measures at the cut-offs used and that despite substantial overlap arm circumference and weight-for-height identify somewhat different children as malnourished. Further work needs to focus on functional outcomes such as morbidity and mortality comparing children with low arm circumference to those with low weight-for-height to better evaluate the relative usefulness of the 2 measuring techniques in identifying children at nutritional risk. (authors modified)

Prevention and Control of Iron Deficiency: Priorities and Action Steps

Nutrition surveillance systems serve to provide state- and locality-specific data that are useful for the management of public health nutrition programs. Current systems, such as the Pediatric and Pregnancy Nutrition Surveillance Systems coordinated by the Centers for Disease Control (CDC), collect program-based data focused on nutrition problems in infants, children, and pregnant women. These systems provide highly useful information, but also present significant methodological challenges relating to representativeness, quality control, and indicator sensitivity/specificity. As the importance of nutritional risk factors for chronic disease is increasingly recognized, the concept of nutrition surveillance must be expanded beyond maternal and child nutrition to include nutrition-related behaviors and risk factors in adolescents and adults. The Behavioral Risk Factor Surveillance System (BRFSS), coordinated by CDC, collects telephone survey data that include information on nutrition-related issues such as overweight, weight-loss practices, and cholesterol screening. In addition, a school-based surveillance system is being established by CDC in coordination with state education agencies to assess adolescent health behaviors, including nutrition. The operation of these nutrition surveillance systems presents significant methodological issues that must be considered in interpreting and using the data for public health purposes.