Kevin C. Mathias

Trends in Food and Beverage Sources among US Children and Adolescents: 1989-2010

Despite the historical rise and recent plateau of child overweight and obesity, levels remain exceedingly high. To understand these trends and identify targets for intervention it is important to examine concomitant trends in childrens diets. The objective of our analysis was to describe 21-year trends in total energy intake and the major food and beverage sources of energy among 2- to 18-year-olds in the United States. Six nationally representative surveys were examined in 2012, the Continuing Survey of Food Intakes by Individuals (1989-1991 and 1994-1996, 1998) and the National Health and Nutrition Examination Survey (2003-2004, 2005-2006, 2007-2008, and 2009-2010). Total energy intake among US children and adolescents rose considerably from 1989 to 2004, and subsequently declined through 2010. Seven sources were consistently major contributors across all time points: sugar-sweetened beverages, pizza, full-fat milk, grain-based desserts, breads, pasta dishes, and savory snacks. Intakes of full-fat milk, meats and processed meat products, ready-to-eat cereals, burgers, fried potatoes, fruit juice, and vegetables decreased from 1989-2010 whereas intakes of nonfat milk, poultry, sweet snacks and candies, and tortilla- and corn-based dishes increased linearly over the 21-year period. Significant nonlinear time trends were observed with recent decreases in intakes of sugar-sweetened beverages, pizza, pasta dishes, breads and rolls, and savory snacks and recent increases in intake of fruit. Energy intakes of US children began to decline in 2003-2004 and continued to decline through 2009-2010. However, among preschool children (aged 2 to 5 years) and children from low-income families, total energy intakes in 2009-2010 still remained significantly higher than in 1989-1991.

Foods and Beverages Associated with Higher Intake of Sugar-Sweetened Beverages

BACKGROUND Although consumption of sugar-sweetened beverages (SSBs) is associated with higher caloric intakes, the amount SSBs contribute to higher intakes has not been addressed. PURPOSE To estimate the amount SSBs contribute to higher caloric intakes and determine how the diets of SSB consumers and nonconsumers differ. METHODS The What We Eat In America, NHANES 2003-2010 surveys were combined into a sample of 13,421 children; analyses were conducted in December 2012. To determine the contribution of SSBs to higher caloric intakes, total non-SSB intake (food + non-SSB beverages) of SSB consumers and nonconsumers were compared using linear regression models controlling for demographic and socioeconomic factors. Analyses also compared intakes between nonconsumers and SSB consumers with different amounts of SSB consumption. RESULTS For children aged 2-5 years and 6-11 years, total non-SSB intakes did not differ between nonconsumers and SSB consumers at any level of SSB consumption, indicating that SSBs were primarily responsible for the higher caloric intakes among SSB consumers. A similar finding was observed among children aged 12-18 years; however, both food and SSB contributed to higher caloric intakes of adolescents consuming ≥500 kcal of SSBs. Among those aged 12-18 years, higher intakes of foods (e.g., pizza, burgers, fried potatoes, and savory snacks) and lower intakes of non-SSB beverages (e.g., fluid milk and fruit juice) were associated with increased SSB intake. CONCLUSIONS Sugar-sweetened beverages are primarily responsible for the higher caloric intakes of SSB consumers, and SSB consumption is associated with intake of a select number of food and beverage groups, some of which are often unhealthy (e.g., pizza and grain-based desserts).

Individual differences in susceptibility to large portion sizes among obese and normal‐weight children

Determine the association of childrens susceptibility to large food portion sizes with appetite regulation and obesity.

Screen-based sedentary behavior and associations with functional strength in 6-15 year-old children in the United States

BackgroundPhysical strength is associated with improved health outcomes in children. Heavier children tend to have lower functional strength and mobility. Physical activity can increase children’s strength, but it is unknown how different types of electronic media use impact physical strength.MethodsData from the NHANES National Youth Fitness Survey (NNYFS) from children ages 6–15 were analyzed in this study. Regression models were conducted to determine if screen-based sedentary behaviors (television viewing time, computer/video game time) were associated with strength measures (grip, leg extensions, modified pull-ups, plank) while controlling for potential confounders including child age, sex, BMI z-score, and days per week with 60+ minutes of physical activity. Grip strength and leg extensions divided by body weight were analyzed to provide measures of relative strength together with pull-ups and plank, which require lifting the body.ResultsThe results from the regression models showed the hypothesized inverse association between TV time and all strength measures. Computer time was only significantly inversely associated with the ability to do one or more pull-ups.ConclusionsThis study shows that television viewing, but not computer/videogames, is inversely associated with measures of child strength while controlling for child characteristics and physical activity. These findings suggest that “screen time” may not be a unified construct with respect to strength outcomes and that further exploration of the potential benefits of reducing television time on children’s strength and related mobility is needed.

Modeled Dietary Impact of Pizza Reformulations in US Children and Adolescents.

Background and Objective Approximately 20% of US children and adolescents consume pizza on any given day; and pizza intake is associated with higher intakes of energy, sodium, and saturated fat. The reformulation of pizza products has yet to be evaluated as a viable option to improve diets of the US youth. This study modeled the effect on nutrient intakes of two potential pizza reformulation strategies based on the standards established by the Nestlé Nutritional Profiling System (NNPS). Methods Dietary intakes were retrieved from the first 24hr-recall of the National Health and Nutrition Examination Survey (NHANES) 2011–12, for 2655 participants aged 4–19 years. The composition of pizzas in the NHANES food database (n = 69) were compared against the NNPS standards for energy, total fat, saturated fat, sodium, added sugars, and protein. In a reformulation scenario, the nutrient content of pizzas was adjusted to the NNPS standards if these were not met. In a substitution scenario, pizzas that did not meet the standards were replaced by the closest pizza, based on nutrient content, that met all of the NNPS standards. Results Pizzas consistent with all the NNPS standards (29% of all pizzas) were significantly lower in energy, saturated fat and sodium than pizzas that were not. Among pizza consumers, modeled intakes in the reformulation and substitution scenarios were lower in energy (-14 and -45kcal, respectively), saturated fat (-1.2 and -2.7g), and sodium (-143 and -153mg) compared to baseline. Conclusions Potential industry wide reformulation of a single food category or intra-category food substitutions may positively impact dietary intakes of US children and adolescents. Further promotion and support of these complimentary strategies may facilitate the adoption and implementation of reformulation standards.

Missing Lunch Is Associated with Lower Intakes of Micronutrients from Foods and Beverages among Children and Adolescents in the United States

BACKGROUND In the United States, the lunch meal contributes more than 20% of the daily intakes of most micronutrients for children and adolescents consuming lunch. Seven percent to 20% of children and adolescents in the United States do not eat lunch on a given day. OBJECTIVE To identify differences in total micro- and macronutrient intakes of children consuming and missing lunch on a given day. DESIGN Cross-sectional secondary analysis of the combined National Health and Nutrition Examination Surveys 2009-2010 and 2011-2012. Dietary intake was assessed using the first day 24-hour recall of each respondent. PARTICIPANTS AND SETTINGS The National Health and Nutrition Examination Survey sample represents the total noninstitutionalized civilian population residing in the United States. The sample used in this study included 4,755 children aged 4 to 18 years with complete data for all analyses. MAIN OUTCOME MEASURES Total day, lunch, and nonlunch micronutrients, macronutrients, solid fats, and added sugar intakes were examined. STATISTICAL ANALYSES PERFORMED Linear regression models controlling for age, sex, race/ethnicity, household poverty status, and weekend were used to compare dietary intakes of lunch consumers and nonconsumers. Intakes from nonlunch sources were examined to determine the extent to which differences between lunch consumers and nonconsumers could be attributed to the lunch meal. RESULTS Missing lunch was associated with lower micronutrient intakes, with the lunch meal primarily responsible for the higher micronutrient intakes of lunch consumers compared with nonconsumers. Missing lunch was also associated with lower energy, fiber, and sodium intakes. Added sugar and solid fat intakes of lunch consumers and nonconsumers were not significantly different. CONCLUSIONS This study identifies potential concerns for children missing lunch with respect to micronutrient intakes and shows that the lunches consumed by children in the United States are an important source of essential nutrients, but also less healthful dietary components.

Protein and Energy Intakes Are Skewed toward the Evening among Children and Adolescents in the United States: NHANES 2013–2014

Background: Emerging evidence suggests that the timing, amount at individual eating occasions, and distribution of protein and energy intakes throughout the day may affect health.Objective: We examined the timing, amounts, and distribution of protein and energy intakes throughout the day among participants aged 4-18 y in the United States in the context of chronobiology and nutrition.Methods: This cross-sectional analysis included 2532 participants aged 4-18 y who completed the first interviewer-administered 24-h dietary recall in NHANES 2013-2014. Descriptive statistics for intakes across the day were provided as percentiles, means ± SEMs, and percentages of nonconsumers. Statistical differences between intakes across the day were tested with the use of individual-level fixed-effects regression models. Cumulative distribution functions were used to examine the timing of the first and last caloric eating occasion.Results: Mean ± SEM protein (grams) and energy (percentage of the day) intakes were significantly higher (P < 0.05) in the evening than in the morning among all age groups. The percentage of participants aged 4-8, 9-13, and 14-18 y who had their first eating occasion at or after 1100 was 4%, 14%, and 20%, respectively, and the percentage who had their last eating occasion at or after 2100 was 8%, 19%, and 34%, respectively.Conclusions: Protein and energy intakes among participants aged 4-18 y in this study were largest in the evening and midday and smallest in the morning and afternoon. Clinical trials are needed to assess any potential impact such dietary behaviors may have on health outcomes related to metabolic dysfunction in children and adolescents.