Kristen A. Copeland

Dietary patterns associated with fat and bone mass in young children

BACKGROUND Obesity and osteoporosis have origins in childhood, and both are affected by dietary intake and physical activity. However, there is little information on what constitutes a diet that simultaneously promotes low fat mass and high bone mass accrual early in life. OBJECTIVE Our objective was to identify dietary patterns related to fat and bone mass in children during the age period of 3.8-7.8 y. DESIGN A total of 325 children contributed data from 13 visits over 4 separate study years (age ranges: 3.8-4.8, >4.8-5.8, >5.8-6.8, and >6.8-7.8 y). We performed reduced-rank regression to identify dietary patterns related to fat mass and bone mass measured by dual-energy X-ray absorptiometry for each study year. Covariables included race, sex, height, weight, energy intake, calcium intake, physical activity measured by accelerometry, and time spent viewing television and playing outdoors. RESULTS A dietary pattern characterized by a high intake of dark-green and deep-yellow vegetables was related to low fat mass and high bone mass; high processed-meat intake was related to high bone mass; and high fried-food intake was related to high fat mass. Dietary pattern scores remained related to fat mass and bone mass after all covariables were controlled for (P < 0.001-0.03). CONCLUSION Beginning at preschool age, diets rich in dark-green and deep-yellow vegetables and low in fried foods may lead to healthy fat and bone mass accrual in young children.

Societal Values and Policies May Curtail Preschool Children’s Physical Activity in Child Care Centers

BACKGROUND AND OBJECTIVES: Three-fourths of US preschool-age children are in child care centers. Children are primarily sedentary in these settings, and are not meeting recommended levels of physical activity. Our objective was to identify potential barriers to children’s physical activity in child care centers. METHODS: Nine focus groups with 49 child care providers (55% African American) were assembled from 34 centers (inner-city, suburban, Head Start, and Montessori) in Cincinnati, Ohio. Three coders independently analyzed verbatim transcripts for themes. Data analysis and interpretation of findings were verified through triangulation of methods. RESULTS: We identified 3 main barriers to children’s physical activity in child care: (1) injury concerns, (2) financial, and (3) a focus on “academics.” Stricter licensing codes intended to reduce childrens injuries on playgrounds rendered playgrounds less physically challenging and interesting. In addition, some parents concerned about potential injury, requested staff to restrict playground participation for their children. Small operating margins of most child care centers limited their ability to install abundant playground equipment. Child care providers felt pressure from state mandates and parents to focus on academics at the expense of gross motor play. Because children spend long hours in care and many lack a safe place to play near their home, these barriers may limit childrens only opportunity to engage in physical activity. CONCLUSIONS: Societal priorities for young children—safety and school readiness—may be hindering children’s physical development. In designing environments that optimally promote children’s health and development, child advocates should think holistically about potential unintended consequences of policies.

Adiposity and TV viewing are related to less bone accrual in young children

OBJECTIVE To examine the relation between baseline fat mass and gain in bone area and bone mass in preschoolers studied prospectively for 4 years, with a focus on the role of physical activity and TV viewing. STUDY DESIGN Children were part of a longitudinal study in which measures of fat, lean and bone mass, height, weight, activity, and diet were taken every 4 months from ages 3 to 7 years. Activity was measured by accelerometer and TV viewing by parent checklist. We included 214 children with total body dual energy x-ray absorptiometry (Hologic 4500A) scans at ages 3.5 and 7 years. RESULTS Higher baseline fat mass was associated with smaller increases in bone area and bone mass over the next 3.5 years (P < .001). More TV viewing was related to smaller gains in bone area and bone mass accounting for race, sex, and height. Activity by accelerometer was not associated with bone gains. CONCLUSIONS Adiposity and TV viewing are related to less bone accrual in preschoolers.

Comparison of Menus to Actual Foods and Beverages Served in North Carolina Child-Care Centers

Menus from child-care centers are an important source of information for parents, researchers, and child-care regulators, but previous research suggests that menus do not accurately represent foods served. The purpose of this study was to compare menus with actual foods and beverages served to children in child-care centers. Menus were collected and a dietary observation was conducted to document all foods and beverages served to children during the course of 1 day in 84 child-care centers in North Carolina in the fall of 2005. Frequencies of foods and beverages on the menus vs those served were computed by eating occasion, food category, and individual foods and beverages. Of the 254 meals and snacks served, 131 (52%) meals and snacks matched entirely what was stated on the menu. Of the 820 individual foods and beverages served, 710 (86.6%) matched those listed on the menus. An additional 110 foods and beverages were served but not listed on the menus. Grains, juice, and vegetables were served less often than indicated on the menus, and milk, protein-rich foods, fruits, mixed dishes, and foods of low nutritional value were served more often than listed on the menus. Overall, just over half of all meals and snacks matched menus, and nearly 90% of individual foods and beverages served matched those stated on menus. Parents of children in child care and dietetics practitioners providing consultation to child-care centers can encourage not only provision of healthy foods and beverages, but also accurate menus in child care.

Wide variability in physical activity environments and weather-related outdoor play policies in child-care centers within a single county of Ohio

OBJECTIVES To examine the variability of physical activity environments and outdoor play policies in child care centers and to determine whether this variability is associated with the demographic characteristics of the child care centers surveyed. DESIGN Early Learning Environments Physical Activity and Nutrition Telephone Survey. SETTING Child care centers in Hamilton County (greater Cincinnati area), Ohio, during the period from 2008 to 2009. PARTICIPANTS Directors of all 185 licensed full-time child care centers in Hamilton County. OUTCOME MEASURES Descriptive measures of playground and indoor physical activity environments and weather-related outdoor play policies. RESULTS Of 185 eligible child care centers, 162 (88%) responded to our survey. Of the 162 centers that responded, 151 (93%) reported an on-site playground, but slightly more than half reported that their playgrounds were large, that they were at least one-third covered in shade, or that they had a variety of portable play equipment. Only half reported having a dedicated indoor gross motor room where children could be active during inclement weather. Only 32 centers (20%) allowed children to go outside in temperatures below 32°F (0°C), and 70 centers (43%) reported allowing children outdoors during light rain. A higher percentage of children receiving tuition assistance was associated with lower quality physical activity facilities and stricter weather-related practices. National accreditation was associated with more physical activity-promoting practices. CONCLUSION We found considerable variability in the indoor and outdoor physical activity environments offered by child care centers within a single county of Ohio. Depending on the outdoor play policy and options for indoor physical activity of a child care center, childrens opportunities for physical activity can be curtailed as a result of subfreezing temperatures or light rain. Policy changes and education of parents and teachers may be needed to ensure that children have ample opportunity for daily physical activity.

Flip flops, dress clothes, and no coat: clothing barriers to children's physical activity in child-care centers identified from a qualitative study

BackgroundThree-quarters of 3-6 year-old children in the U.S. spend time in childcare; many spend most of their waking hours in these settings. Daily physical activity offers numerous health benefits, but activity levels vary widely across centers. This study was undertaken to explore reasons why physical activity levels may vary. The purpose of this paper is to summarize an unexpected finding that child-care providers cited was a key barrier to childrens physical activity.MethodsNine focus groups with 49 child-care providers (55% black) from 34 centers (including inner-city, suburban, Head Start and Montessori) were conducted in Cincinnati, OH. Three independent raters analyzed verbatim transcripts for themes. Several techniques were used to increase credibility of findings, including interviews with 13 caregivers.ResultsTwo major themes about clothing were: 1) childrens clothing was a barrier to childrens physical activity in child-care, and 2) clothing choices were a significant source of conflict between parents and child-care providers. Inappropriate clothing items included: no coat/hat/gloves in the wintertime, flip flops or sandals, dress/expensive clothes, jewelry, and clothes that were either too loose or too tight. Child-care providers explained that unless there were enough extra coats at the center, a single child without a coat could prevent the entire class from going outside. Caregivers suggested several reasons why parents may dress their child inappropriately, including forgetfulness, a rushed morning routine, limited income to buy clothes, a childs preference for a favorite item, and parents not understanding the importance of outdoor play. Several child-care providers favored specific policies prohibiting inappropriate clothing, as many reported limited success with verbal or written reminders to bring appropriate clothing.ConclusionInappropriate clothing may be an important barrier to childrens physical activity in child-care settings, particularly if the clothing of a few children preclude physical activity for the remaining children. Center directors and policy makers should consider devising clear and specific policies for the types of clothing that will be permitted in these settings so that childrens active play opportunities are not curtailed. To enhance compliance, parents may need education about the importance and benefits of active play for childrens development.

The relationship between physical activity and diet and young children's cognitive development: A systematic review

Objective Given the high prevalence of suboptimal nutrition and low activity levels in children, we systematically reviewed the literature on the relationship between physical activity and dietary patterns and cognitive development in early childhood (six months to five years). Methods In February 2016, we conducted two different searches of MEDLINE, PsycINFO, and ERIC. Each search included either physical activity (including gross motor skills) or diet terms, and neurocognitive development outcome terms. Included studies were in English, published since 2005, and of any study design in which the physical activity or diet measure occurred prior to age five. Results For physical activity, twelve studies (5 cross-sectional, 3 longitudinal and 4 experimental) were included. Eleven studies reported evidence suggesting that physical activity or gross motor skills are related to cognition or learning. Both acute bouts and longer term exposures showed benefit. For diet, eight studies were included consisting of secondary analyses from longitudinal cohort studies. A healthier dietary pattern was associated with better cognitive outcomes in all studies, although some of the reported associations were weak and the measures used varied across the studies. Conclusions Physical activity and healthy diets in early childhood are associated with better cognitive outcomes in young children. The paucity of literature and the variability in the type and quality of measures used highlight the need for more rigorous research. Given that the early childhood years are critical for both obesity prevention and neurocognitive development, evidence that the same healthy behaviors could promote both should inform future interventions.

Nutritional Quality of Meals Compared to Snacks in Child Care

BACKGROUND Most young children are in child care. Previous studies suggest that children may receive insufficient vegetables, and foods and beverages with added sugars, fats, and sodium in these settings. None have compared the nutritional quality of meals to snacks. METHODS Directors from 258 full-day child-care centers in two urban counties of southwestern Ohio were surveyed via telephone in the fall of 2009 about their nutrition practices, and asked to provide a current menu. Lunch and afternoon snack menus were categorized according to average weekly frequency for fruits, vegetables, lean meats, juice (100%), and sweet or salty foods served. Frequencies were compared by meal occasion (lunch vs. snack) using the Fisher exact test. RESULTS Most (60%) directors reported serving 2% milk to children ≥3 years; 31% served whole milk. Menu analysis demonstrated the composition of lunches differed from snacks (p<0.0001) in all food categories. A total of 87% centers rarely (<1 time per week) listed nonstarchy vegetables for snacks, but 67% of centers included them at lunch ≥3 times per week. Juice (100%) was on snack menus >2 times per week in 37% centers, but in only 1 center as a regular component of lunch. Similarly, 87% centers listed sweet and salty foods at snack ≥3 times per week, but rarely at lunch. CONCLUSIONS Despite efforts to improve childrens diets in child care, meals-and particularly snacks-still lack whole fruits and nonstarchy vegetables and contain added sugars and fats. Snacks represent a missed opportunity to improve the nutritional quality of foods served in childcare.

Pediatricians May Address Barriers Inadequately When Referring Low-Income Preschool-Aged Children to Behavioral Health Services

Background. Low-income parents often seek help from pediatricians for early childhood social-emotional problems but seldom follow through with referrals to behavioral health services. Objective. We sought to understand low-income parents’ experiences seeking help from pediatricians for social-emotional problems and how those experiences influenced decisions about accessing behavioral health services. Methods. We conducted 20 semi-structured interviews with low-income parents with concerns about their children’s behavior or emotions. Participants were asked about experiences seeking help from pediatricians and decision-making about accessing behavioral health services. Results. Three themes emerged: (1) Participants described reluctance to recognize social-emotional problems, which was often reinforced by doctors’ reassurance. (2) Participants reported pediatricians did not meet their expectations about testing, providing explanations/advice, or addressing behavior on-site. (3) Participants had unclear expectations of behavioral health services. Conclusions. Primary care mechanisms that reliably educate parents about behavioral trajectories and the role of behavioral health providers may improve follow-up rates.

Attainment of ‘5-2-1-0’ obesity recommendations in preschool-aged children

Obesity prevention guidelines recommend children eat ≥ 5 servings of fruits and vegetables, view ≤ 2 h of screen time, participate in 1 h of physical activity, and consume 0 sugar-sweetened beverages daily, commonly known as ‘5-2-1-0’. We sought to determine: the extent to which preschool-aged children attending child care meet these guidelines, predictors of attainment, and associations of attainment with weight status. We analyzed in 2016, 24-hour dietary, physical activity, and screen time data collected in 2009–10 from 398 preschool-aged children in 30 child-care centers in Cincinnati, OH. Dietary intake, screen time and body-mass index (BMI) were obtained by research staff during child care and from parents when at home. Accelerometers measured physical activity. Mixed-effects models and generalized estimating equations were used to determine associations between ‘5-2-1-0’ recommendations, demographic variables, and BMI z-scores. Average child age was 4.3 ± 0.7 years; 26% had a BMI ≥ 85th percentile. Seventeen percent of children with complete dietary data (n = 307) consumed ≥ 5 servings of fruits and vegetables and 50% consumed 0 sugar-sweetened beverages. < 1% with complete physical activity data (n = 386) met the activity recommendation; 81% of children (n = 379) had ≤ 2 h of screen time. Only 1 child met all of the ‘5-2-1-0’ recommendations. There were no consistent demographic predictors of attaining individual recommendations. An additional hour of screen time was associated with a 0.11 (SD 0.06) increase in BMI z-score. Our data suggests there is ample room to increase fruit and vegetable intake and physical activity in preschool-aged children.