Karina Lora

What's for Lunch? An Analysis of Lunch Menus in 83 Urban and Rural Oklahoma Child-Care Centers Providing All-Day Care to Preschool Children

BACKGROUND More than half of 3- to 6-year-old children attend child-care centers. Dietary intakes of children attending child-care centers tend to fall short of Dietary Reference Intakes (DRIs). OBJECTIVE Our aim was to examine macro-/micronutrient content of child-care center menus, compare menus to one third of DRIs, and determine menu differences by population density. METHODS A stratified, random, geographically proportionate sample of Oklahoma child-care centers was obtained. Child-care centers providing all-day care for 2- to 5-year-old children were contacted to complete a telephone questionnaire and asked to send in that months menus for the 3- to 4-year-old children. Overall means and standard deviations of the nutrient content of 5 days of lunch menus were calculated. Comparisons were made to both the 1- to 3-year-old and 4- to 8-year-old DRIs. One-sample t tests compared mean nutrient content of lunches to one third of the DRIs for the overall sample and urban/rural classification. Independent t tests compared nutrient content of urban and rural lunches. PARTICIPANTS/SETTING One hundred sixty-seven child-care centers were contacted; 83 completed the study (50% response). RESULTS Menus provided statistically significantly insufficient carbohydrate, dietary fiber, iron, vitamin D, and vitamin E. Calcium was higher than the 1- to 3-year-old DRI, but lower than the 4- to 8-year-old DRI. Folate was higher than the 1- to 3-year-old DRI, but not different from the 4- to 8-year-old DRI. Sodium was higher than the DRI for both age groups. Thirty-four child-care centers (41%) were classified as urban and 49 (59%) as rural. Urban menus provided less than the 4- to 8-year-old DRI for folate, but rural child-care center menus did not. CONCLUSIONS Oklahoma child-care center menus appear to provide adequate protein, magnesium, zinc, vitamin A, and vitamin C, but may be deficient in key nutrients required for good health and proper development in preschool-aged children. These issues can be addressed by including food and nutrition practitioners in the process to ensure child-care center menus are a useful resource and nutritionally appropriate for preschool children.

Association of childcare arrangement with overweight and obesity in preschool-aged children: a narrative review of literature

The time children spend in childcare overlaps with daily meals and opportunities to be active. Thus these environments have the opportunity to promote—or hinder—healthy weight gain among children who attend them. The purpose of this narrative review was to compile findings from studies examining childcare type and weight outcomes among preschool-age children. A literature search was conducted using PubMed, PsychInfo and ERIC. Inclusion criteria were infant- to 5-year-old children exposed to any type of childcare with a cross-sectional or longitudinal weight outcome. Among 385 studies screened, 18 were included. For comparison across studies, type of childcare was categorized as: childcare center, Head Start, nanny/babysitter, non-relative care/family childcare home and relative care. Four studies found no association with childcare type and obesity, and 10 studies reported mixed results by type of care or subpopulation analyses. Two studies found an overall positive association, and two reported an inverse association. There were differences in direction of associations and findings by type of care arrangement. For Head Start, three of eight studies demonstrated a negative relationship with obesity; none demonstrated a positive association. No other childcare type demonstrated this inverse association. Informal types of care (relative and non-relative care in a home) were positively associated with child obesity in 3 of 10 studies. This association was less commonly reported among formal childcare centers (2 of 15 studies). The majority of studies, however, reported mixed findings or no association by childcare type. Results suggested no consistent evidence for a relationship between childcare and obesity risk, except Head Start. This review exposed the need for a consistent definition of childcare type and the exploration of unmeasured confounders, such as the nutrition and physical activity environment of childcare settings, to understand how they contribute to or protect against the development of overweight/obesity among children.

Frequency of family meals and 6-11-year-old children's social behaviors

Family meals are regarded as an opportunity to promote healthy child development. In this brief report, we examined the relationship between frequency of family meals and childrens social behaviors in 6-11-year-olds. The 2007 U.S. National Survey of Childrens Health (NSCH) provided data on the frequency of family meals in a sample of 6-11-year-old children (N = 24,167). The following social behavior indicators were examined: child positive social skills, child problematic social behaviors, child engagement in school, and parental aggravation with the child. Individual logistic regression analyses were calculated in unadjusted and adjusted models. On average, families had 5.3 meals together per week. In adjusted models, more frequent family meals increased the odds of child positive social skills (OR = 1.08, 95% CI [1.02, 1.16]) and child engagement in school (OR = 1.11, 95% CI [1.06, 1.15]), and decreased the likelihood of child problematic social behaviors (OR = 0.92, 95% CI [0.87, 0.98]). There was no association between frequency of family meals and parental aggravation with the child (OR = 0.98, 95% CI [0.93, 1.04]). Findings support the promotion of family meals to benefit childrens development of healthy social behaviors.

Assessing Initial Validity and Reliability of a Beverage Intake Questionnaire in Hispanic Preschool-Aged Children

BACKGROUND Understanding the relationship between high-calorie beverage consumption and weight gain requires an accurate report of dietary intake. A critical need exists to develop and test the psychometrics of brief quantitative tools for minority pediatric populations. OBJECTIVE To modify the adult beverage intake questionnaire (BEVQ-15) for Hispanic preschool-aged children (BEVQ-PS) and test its validity and test-retest reliability in children aged 3 to 5 years. DESIGN Cross-sectional. The modified quantitative 12-beverage category questionnaire assessed consumption of water, fruit juice, sweetened juice drinks, whole milk, reduced-fat milk, low-fat milk, flavored milk, carbonated sweetened drinks, diet carbonated drinks, sweet tea, tea with or without artificial sweetener, and sport drinks consumed during the past month. Hispanic mothers (n=109) recruited from day-care centers provided one 4-day food intake record (FIR) and completed two BEVQ-PS surveys during a 2-week period for their preschool-aged child. Data collection was conducted through one-on-one interviews in Spanish. Validity was assessed by comparing amounts (in grams) and energy intake (in kilocalories) for each beverage category between the first BEVQ-PS and the mean of the FIRs using paired t tests and Pearsons correlation coefficient. Criteria for validity were nonsignificant mean differences in grams and kilocalories from the first BEVQ-PS and mean of the FIRs beverage categories, and significant correlation coefficients between beverage categories. Test-retest reliability was assessed by comparing grams and kilocalories for each beverage category in the first BEVQ-PS with those from the second BEVQ-PS using Pearsons correlation coefficient. The criterion for reliability was a significant correlation coefficient between beverage categories. Significance was set at P<0.05. RESULTS Mean differences between the first BEVQ-PS and FIR for water (42.4±23.1 g), sweetened juice drinks (-1.6±11.0 g), whole milk (18.3±9.91 g), sweetened carbonated drinks (-13.0±7.9 g), and total sugar-sweetened beverages (SSB) (1.4±8.9 g) were not significantly different, but were significantly correlated (r=0.20 to 0.37; P<0.05). Thus, validity criteria were met. With the exception of flavored milk and tea with or without artificial sweeteners, the remaining beverage categories-total beverages and SSB-in the first BEVQ-PS were correlated with those from the second BEVQ-PS (r=0.20 to 0.68; P<0.05), meeting reliability criteria. CONCLUSIONS Researchers and clinicians may use the BEVQ-PS to assess SSB, water, and whole-milk intake in Hispanic children. Additional modifications should be evaluated to assess total beverage intake.

Obesogenic environments in tribally-affiliated childcare centers and corresponding obesity rates in preschool children.

Background: Determine the relationship between obesogenic characteristics of childcare and child adiposity in tribally-affiliated centers in Oklahoma. Methods: The two-day Environment and Policy Assessment and Observation (EPAO) included a total environment (TE), nutrition (N), and physical activity (PA) score and took place in 11 centers across Oklahoma. Eighty-two preschool children (3-5 years) participated. Child height and weight were measured and overweight status (≥ 85th percentile for age and sex) was determined. Regression models, fit using Generalized Estimating Equations methodology to account for clustering by center were used and adjusted for center characteristics. Results: Participants were 3.8 (0.8) years old, 55% male, 67% American Indian (AI) and 38% overweight. A healthier TE and PA was associated with a reduced odds of overweight, which remained significant after adjusting for some center characteristics, but not all. A healthier TE, N, and PA was associated with lower BMI percentile, which remained significant after some center-level adjustments, but not all. Lower sedentary opportunity and sedentary time were no longer associated with reduced odds of overweight following adjustment. Lower opportunity for high sugar and high fat foods and minutes of active play were associated with reduced odds of overweight in some adjusted models. Conclusions: Collectively unadjusted and adjusted models demonstrate that some aspects of a healthier childcare center environment are associated with reduced odds of overweight and lower BMI percentile in preschool children attending tribally-affiliated childcare in Oklahoma. Future research should examine the association of childcare and health behaviors and further explore the role of potential confounders.

Influence of family structure on obesogenic behaviors and placement of bedroom TVs of American children: National survey of Children's Health 2007

OBJECTIVE To explore the relation between family structure and obesogenic attributes. METHODS Publicly available data from the 2007 National Survey of Childrens Health (n=55,094; 11.6 ± 0.04 years; 51.2% male) was analyzed in fall 2012. Predictor variables included marital status (two-parent biological [referent], two-parent blended, single-mother, and other) and number of children. Outcome variables included the presence of a bedroom television (BTV), elevated television (TV) viewing time, insufficient physical activity, and infrequent family meals. RESULTS Analysis of family structure revealed 63% biological, 11% blended, and 20% single-mother families. Twenty-three percent of children did not have siblings. When family structure variables were considered independently, children in blended (odds ratio (OR): 1.75; 95% confidence interval (CI) 1.45, 2.10) and single-mother homes (1.49; 1.28, 1.74) had higher odds of BTV. Children in blended families had higher odds of elevated TV viewing time (1.28; 1.08, 1.51). Single-mother homes had higher odds of infrequent family meals (1.28; 1.07, 1.52). Families with ≥ 2 children were less likely to have BTV (0.60; 0.54, 0.66) or elevated TV viewing time (0.74; 0.67, 0.82), and to irregularly dine together (0.89; 0.80, 0.99). CONCLUSION Diverse family structure was associated with more obesogenic behaviors and environments. The presence of siblings diminished, but did not eliminate, the risk.

Validity and reliability of an omega-3 fatty acid food frequency questionnaire for first-generation Midwestern Latinas.

This study tested the hypothesis that a culturally developed omega-3 (n-3) fatty acid food frequency questionnaire (FFQ) could be an accurate instrument to capture n-3 fatty acid food intakes of first-generation Midwestern Latinas. The goal of the study was to assess validity and test-retest reliability of an FFQ to estimate total n-3 fatty acid (total n-3), α-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) intakes. An n-3 FFQ was developed and pilot tested. Two FFQs and 3 nonconsecutive 24-hour recalls were collected from 162 participants. Pearson correlation and paired t test were used to test the hypothesis. Correlation of the 2 FFQs was 0.71 for total n-3, 0.65 for ALA, 0.74 for EPA, and 0.54 for DHA (P < .01). The means of the 2 FFQs and of the 24-hour recalls were not significantly different for total n-3 and ALA (P > .05), but were significantly different for EPA and DHA. The n-3 FFQ had acceptable reliability, validated only total n-3 and ALA, and provided relevant findings about the n-3 eating habits of Midwestern Latinas.

Innovative Techniques for Evaluating Behavioral Nutrition Interventions

Assessing outcomes and the impact from behavioral nutrition interventions has remained challenging because of the lack of methods available beyond traditional nutrition assessment tools and techniques. With the current high global obesity and related chronic disease rates, novel methods to evaluate the impact of behavioral nutrition-based interventions are much needed. The objective of this narrative review is to describe and review the current status of knowledge as it relates to 4 different innovative methods or tools to assess behavioral nutrition interventions. Methods reviewed include 1) the assessment of stress and stress responsiveness to enhance the evaluation of nutrition interventions, 2) eye-tracking technology in nutritional interventions, 3) smartphone biosensors to assess nutrition and health-related outcomes, and 4) skin carotenoid measurements to assess fruit and vegetable intake. Specifically, the novel use of functional magnetic resonance imaging, by characterizing the brains responsiveness to an intervention, can help researchers develop programs with greater efficacy. Similarly, if eye-tracking technology can enable researchers to get a better sense as to how participants view materials, the materials may be better tailored to create an optimal impact. The latter 2 techniques reviewed, smartphone biosensors and methods to detect skin carotenoids, can provide the research community with portable, effective, nonbiased ways to assess dietary intake and quality and more in the field. The information gained from using these types of methodologies can improve the efficacy and assessment of behavior-based nutrition interventions.

The Husky Byte Program: Delivering Nutrition Education One Sound Byte at a Time

As food gatekeepers, parents have the opportunity to establish healthful eating patterns for their children. Nutrition education efforts directed toward parents will therefore have themost impact on family foodways. However, parents often have difficulty attending the traditional mode of education, nutrition classes, because of lack of child care, transportation, time, ormotivation.At theUniversity ofConnecticut, the authors responded to this problem by creating the Husky Byte program, designed to deliver short, unambiguous nutrition education messages. This innovative program considers time constraints, employs principles of adult learning theory, and is easily accessible to adults in community settings.

Tribally Affiliated Child-Care Center Environment and Obesogenic Behaviors in Young Children

BACKGROUND Child-care centers are an integral part of life for many families with young children. American Indian children are at elevated health risk because of higher levels of obesity and associated health behaviors. OBJECTIVE Our aim was to assess the child-care environment and childrens physical activity (PA) and dietary intake in young children attending tribally affiliated child care. DESIGN We conducted a cross-sectional study. PARTICIPANTS/SETTING Participants were from 11 tribally affiliated child-care centers across Oklahoma and included 82 children aged 3 to 5 years old. MAIN OUTCOME MEASURES Classroom observations were conducted using the Environmental and Policy Assessment Observation to measure PA and nutrition environments. Children wore an ActiGraph GT3X accelerometer and lunchtime plate waste was observed. STATISTICAL ANALYSES Descriptive statistics, including mean±standard deviation and frequencies, were calculated for the childrens behaviors and environment. RESULTS The total environment score was 23.9±5.2 (maximum=43). The nutrition score was 12.5±3.1 (maximum=21). The PA score was 11.7±2.2 (maximum=22). The participants were 3.8±0.1 years old, 55% were male, 67% were American Indian, and 38% were overweight or obese. Accelerometers were worn for 5.9±1.7 hours, excluding naptime. Children accumulated 4.3±2.2 min/h of moderate to vigorous PA, 4,294±1,883 steps/day, and 12.1±3.7 steps/min. At lunch, children were served 510±241 kcal, and consumed 387±239 kcal. Lunches consisted of 47% carbohydrate, 20% protein, and 33% fat. Total number of F/V served was 2.9±1.9 and consumed was 2.3±1.8, while whole grains served and consumed were 0.3±0.4 and 0.2±0.4, respectively, and lean proteins served and consumed were 0.3±0.4 and 0.2±0.4, respectively. CONCLUSIONS This study describes obesogenic aspects of the child-care environment and identifies areas for improvement. Children did not accumulate adequate PA or consume calories or fat excessively. Children consumed multiple F/V; however, more whole grains and lean proteins could be provided. Future research might investigate how the healthfulness of the child-care environment can be improved by counseling providers on nutrition and PA strategies to prevent obesity.