Nicola Davison

A Food Store Intervention Trial Improves Caregiver Psychosocial Factors and Children's Dietary Intake in Hawaii

Diet‐related chronic diseases are at epidemic levels in low‐income ethnic minority populations. The purpose of this study is to decrease risk for obesity in children by modifying the food environment and conducting point‐of‐purchase promotions that will lead to changes in psychosocial factors and behaviors associated with healthier food choices among low‐income communities with a preponderance of Native Hawaiians and Pacific Islanders. We implemented an intervention trial over a 9–11‐month period in five food stores in two low‐income multiethnic communities in Hawaii, targeting both children and their adult caregivers. The Healthy Foods Hawaii (HFH) intervention consisted of an environmental component to increase store stocking of nutritious foods, point‐of‐purchase promotions, interactive sessions, and involved local producers and distributors. We evaluated the impact of the program on 116 child–caregiver dyads, sampled from two intervention and two comparison areas before and after intervention implementation. Program impacts were evaluated using multivariable linear regression. The HFH program had a significant impact on caregiver knowledge and the perception that healthy foods are convenient. Intervention children significantly increased their Healthy Eating Index (HEI) score for servings of grains, their total consumption of water, and showed an average 8.5 point (out of 90 total, eliminating the 10 points for variety, giving a 9.4% increase) increase in overall HEI score. A food store intervention was effective in improving healthy food knowledge and perception that healthy foods are convenient among caregivers, and increased the consumption of several targeted healthy foods by their children. Greater intensity, sustained food system change, and further targeting for children are needed to show greater and sustained change in food‐related behaviors in low‐income Native Hawaiian and Pacific Islander communities.

Nutritional Characteristics and Body Mass Index of Children in the Commonwealth of the Northern Mariana Islands

Children in the Commonwealth of the Northern Mariana Islands have been shown to have nutrient deficiencies, but data were estimated from a non-population-based sample. The current study is a cross-sectional assessment of 420 Commonwealth of the Northern Mariana Islands children, 6 months to 10 years old. Diet, height, and weight were measured. Dietary intake was collected with a 24-hour dietary recall and analyzed using the Pacific Tracker dietary assessment tool. Prevalence of dietary nutrient adequacy was estimated by the Estimated Average Requirement cut-point method. Fiber intake was one-third Adequate Intake (AI) and sodium intake was above the Tolerable Upper Intake Level for all ages. Calcium intake was half the AI for 4 to 8 years old, and less than half the AI for 9 to 10 years old. Meat/meat alternatives were double the recommendation, while all other food groups were below the recommendation for all ages. Prevalence of dietary nutrient adequacy for vitamin A, vitamin C, vitamin E, folate, magnesium, and phosphorus was lowest among 9- to 10-year-olds. Based on body mass index-for-age percentiles, 45% of 7- to 10-year-olds, 26% of 4- to 6-year-olds, and 25% of 2- to 3-year-olds were overweight or obese. Increasing whole grain, fruit, vegetable, and dairy intakes; reducing meat intakes and high-calorie foods and drinks; and increasing physical activity could improve nutrient intakes and body mass index status in this population.

A comparison of two systems for entering and assessing dietary data for a research study.

To reduce the cost of analyzing dietary data for research studies, we evaluated the accuracy of an entry and assessment system that could be used by trained food and nutrition professionals who did not routinely perform this type of task. We compared intakes from 24-hour recalls for 175 adult women and 185 schoolchildren using two methods for entry of dietary data. For the standard method, registered dietitians who routinely evaluate dietary data entered the recalls using a professional data entry program, RapidCalc. For the second method, other food and nutrition professionals were trained by the registered dietitians to use the Pacific Tracker program, a consumer-friendly dietary assessment system. Both programs use the same food composition table. Mean food group and nutrient intakes were similar for the two methods, differing by <10% on average for both adults and children. Correlations were also high, ranging from 0.77 to 0.96 for the women and from 0.76 to 0.94 for the children. For adults and children combined, mean energy intakes were remarkably close, at 2,067 kcal/d for RapidCalc and 2,072 kcal/d for Pacific Tracker, although absolute differences in energy intakes were >300 kcal/d for 23% of the women and 30% of the children. Costs are much lower with the Pacific Tracker method, unless the fees for the standard method are subsidized. We conclude that the Pacific Tracker method provides an accurate and cost-effective method of dietary data entry for research purposes.