Ruby Natale

BMI, waist circumference, and selected cardiovascular disease risk factors among preschool-age children

In adults, overweight is often associated with other cardiovascular disease (CVD) risk factors. We determined whether these associations were also present in young children. This study examined the relationships between elevated BMI (≥85th and ≥95th percentiles for age and sex) and the highest quintile of waist circumference (WC) with CVD risk factors, including fasting triglyceride (TGL), high‐ and low‐density lipoprotein (HDL and LDL), total cholesterol (TC), non‐HDL cholesterol, and C‐reactive protein (CRP) in 3,644 3‐ to 6‐year‐old children included in the 1999–2008 National Health and Nutrition Examination Surveys (NHANES). Results showed that 20% (highest quintile) of the sample had a TC >170 mg/dl, LDL >109 mg/dl, TGL >103 mg/dl, non‐HDL >128 mg/dl, CRP >0.13 mg/dl, WC >57.2 cm, and HDL <42 mg/dl. Increased BMI and WC were associated with increased CRP levels in non‐Hispanic black boys and girls, Hispanic boys, and non‐Hispanic white girls, whereas elevated TGL and non‐HDL cholesterol and low HDL cholesterol were generally associated with elevated BMI and WC in Hispanic children. TC and LDL cholesterol were not significantly associated with elevated weight in 3‐ to 6‐year‐olds. BMI and WC were similar in predicting the same risk factors. In summary, this analysis shows that in preschool‐age children, greater BMI and WC are associated with biomarkers that are related to CVD risk, but these associations vary by ethnicity. Child health providers should consider using both BMI and WC to identify young children who may be at risk for elevated CVD biomarkers.

Design and methods for evaluating an early childhood obesity prevention program in the childcare center setting.

BackgroundMany unhealthy dietary and physical activity habits that foster the development of obesity are established by the age of five. Presently, approximately 70 percent of children in the United States are currently enrolled in early childcare facilities, making this an ideal setting to implement and evaluate childhood obesity prevention efforts. We describe here the methods for conducting an obesity prevention randomized trial in the child care setting.Methods/designA randomized, controlled obesity prevention trial is currently being conducted over a three year period (2010-present). The sample consists of 28 low-income, ethnically diverse child care centers with 1105 children (sample is 60% Hispanic, 15% Haitian, 12% Black, 2% non-Hispanic White and 71% of caregivers were born outside of the US). The purpose is to test the efficacy of a parent and teacher role-modeling intervention on children’s nutrition and physical activity behaviors. . The Healthy Caregivers-Healthy Children (HC2) intervention arm schools received a combination of (1) implementing a daily curricula for teachers/parents (the nutritional gatekeepers); (2) implementing a daily curricula for children; (3) technical assistance with meal and snack menu modifications such as including more fresh and less canned produce; and (4) creation of a center policy for dietary requirements for meals and snacks, physical activity and screen time. Control arm schools received an attention control safety curriculum. Major outcome measures include pre-post changes in child body mass index percentile and z score, fruit and vegetable and other nutritious food intake, amount of physical activity, and parental nutrition and physical activity knowledge, attitudes, and beliefs, defined by intentions and behaviors. All measures were administered at the beginning and end of the school year for year one and year two of the study for a total of 4 longitudinal time points for assessment.DiscussionAlthough few attempts have been made to prevent obesity during the first years of life, this period may represent the best opportunity for obesity prevention. Findings from this investigation will inform both the fields of childhood obesity prevention and early childhood research about the effects of an obesity prevention program housed in the childcare setting.Trial registrationTrial registration number: NCT01722032

Effect of a Child Care Center-Based Obesity Prevention Program on Body Mass Index and Nutrition Practices Among Preschool-Aged Children

This study examined the effect of an early childhood obesity prevention program on changes in Body Mass Index (BMI) z-score and nutrition practices. Eight child care centers were randomly assigned to an intervention or attention control arm. Participants were a multiethnic sample of children aged 2 to 5 years old (N = 307). Intervention centers received healthy menu changes and family-based education focused on increased physical activity and fresh produce intake, decreased intake of simple carbohydrate snacks, and decreased screen time. Control centers received an attention control program. Height, weight, and nutrition data were collected at baseline and at 3, 6, and 12 months. Analysis examined height, weight, and BMI z-score change by intervention condition (at baseline and at 3, 6, and 12 months). Pearson correlation analysis examined relationships among BMI z-scores and home activities and nutrition patterns in the intervention group. Child BMI z-score was significantly negatively correlated with the number of home activities completed at 6-month post intervention among intervention participants. Similarly, intervention children consumed less junk food, ate more fresh fruits and vegetables, drank less juice, and drank more 1% milk compared to children at control sites at 6 months post baseline. Ninety-seven percent of those children who were normal weight at baseline were still normal weight 12 months later. Findings support child care centers as a promising setting to implement childhood obesity prevention programs in this age group.

Obesity Is Significantly Associated With Cardiovascular Disease Risk Factors in 2- to 9-Year-Olds

The objective of this analysis was to estimate the prevalence of cardiovascular disease risk factors in ethnically diverse young children. A retrospective medical chart review identified overweight/obese 2‐ to 9‐year‐old children (N=147) from a local pediatric clinic who were matched (for age, sex, and ethnicity) with normal weight patients from the 2005–2010 National Health and Nutrition Examination Survey (N=294). Comparisons of mean systolic blood pressure and diastolic blood pressure, total, and high‐density lipoprotein (HDL) cholesterol were conducted. Results showed that compared with the population‐based normal‐weight sample, the local overweight/obese sample was significantly more likely to have diastolic prehypertension (15% vs 75%, P<.0001), systolic prehypertension (10% vs 43%, P<.0001), and the lowest quintile of HDL cholesterol (19% vs 34%, P=.003). At this young age, excess weight is significantly associated with cardiovascular disease risk factors. These results suggest that overweight/obese children in this age group should be monitored closely to prevent potential chronic disease risk.

Obesity Prevention Program in Childcare Centers: Two-Year Follow-Up.

Purpose: To assess the impact of an early childhood obesity prevention intervention “Healthy Caregivers–Healthy Children” (HC2) on dietary patterns and body mass index percentile (PBMI) over 2 school years. Design: Randomized controlled trial. Setting: Childcare centers. Participants: Low-income families. Intervention: Intervention centers (N = 12) received HC2 which consisted of (1) menu modifications, (2) a healthy eating and physical activity curriculum for children, and (3) a parent curriculum for healthy meal preparation, reinforced through a role-modeling curriculum. Control centers (N = 16) received an injury prevention/safety intervention. Measures: Child PBMI and parent report of child’s consumption of fruits/vegetables and unhealthy food. Analysis: Confirmatory factor analysis verified the psychometric properties of factor scores for children’s consumption of fruits/vegetables and unhealthy food. Growth curve analysis assessed the impact of HC2 on change in consumption of fruits/vegetables and unhealthy food and PBMI over 2 school years. Results: Children in the intervention group (n = 754) had a negative slope (β = −1.95, standard error [SE] = 0.97, P = .04), indicating less increase in PBMI versus control children (n = 457). Stratified analyses showed that obese children in the intervention arm had a significantly higher increase in fruit/vegetable consumption versus control group obese children (β = 0.24, SE = 0.08, P = .003). Conclusion: The HC2 intervention resulted in the maintenance of healthy PBMI over 2 preschool years among low-income multiethnic children. These findings support efforts to implement healthy weight programs in the childcare setting.

Ethnicity, Household Food Security, and Nutrition and Activity Patterns in Families With Preschool Children

OBJECTIVE This study evaluated the relationship between food security and child nutritional intake, sedentary behavior, and body mass index (BMI) and potential moderation by ethnic subgroup membership. DESIGN Cross-sectional data analysis from baseline data of a preschool intervention trial. SETTING Twenty-eight subsidized child care centers in Miami-Dade County, FL. PARTICIPANTS Children ages 2 to 5 (n = 1,211) and their caregivers. MAIN OUTCOME MEASURE The BMI percentile and the following 4 factors (via confirmatory factor analysis): food security, consumption of fruits/vegetables, consumption of unhealthy foods, and sedentary behaviors. ANALYSIS Separate linear mixed models tested relationships between food security and main outcome measures with an interaction term to test for possible moderation by ethnicity. RESULTS Results indicated a significant relationship (P < .05) between food security and child consumption of fruit/vegetables, consumption of unhealthy foods, and sedentary behavior, but not with BMI percentile. With greater food security, Haitians reported greater consumption of fruit/vegetables and sedentary behavior. With greater food security, Cubans and non-Hispanic whites reported less consumption of unhealthy foods, while Haitians reported greater consumption. CONCLUSIONS AND IMPLICATIONS Results showed higher food security was associated with higher consumption of fruit/vegetables, consumption of unhealthy foods, and sedentary behavior, but this was moderated by ethnicity. Implications for healthy weight interventions among low-income preschoolers should focus on the importance of food security and tailor intervention strategies for diverse ethnic groups accordingly.

State-Mandated Nutrition, Physical Activity, and Screen Time Policies in Child Care Centers

Background. The child care center (CCC) environment presents opportunities for healthy weight promotion in preschoolers. Our study examined the current state of CCC adherence to nutrition, physical activity, and screen time legislative regulations and the differences in their adherence by center socioeconomic position (SEP: low, middle, high) in Miami-Dade County. Method. In 34 CCC, we used the Environment and Policy Assessment and Observation tool to evaluate nutrition, physical activity, and screen time practices during 1-school day. Results. Twenty-five of the centers (73.5%) were participants of the Child and Adult Care Food Program. Almost 80% of the centers adhered to serving low-fat/fat-free milk to children older than 2 years. Only 34.5% served vegetables and 75.9% served whole fruits during meals/snacks. Ninety-four percent of the centers had quiet and active play incorporated into their daily routines. All centers adhered to the 2-hour screen time limit for children older than 2 years. Low- and middle-SEP centers fared better in the serving of fruits, vegetables, and low-fat/fat-free milk. The centers averaged 1 hour in outdoor play regardless of SEP. High-SEP centers had no TV or screen time during day of observation. Conclusion. CCC practices highlight opportunities for improvement in nutrition, physical activity, and screen time practices in the prevention of overweight in early childhood.

Communities Putting Prevention to Work: Results of an Obesity Prevention Initiative in Child Care Facilities

ABSTRACT Obesity is a significant public health issue affecting even our youngest children. Given that a significant amount of young children are enrolled in child care, the goal of this project was to evaluate the effectiveness of a child care facility-based obesity prevention program. Over 1,000 facilities participated in the study. The intervention consisted of teacher trainings and technical assistance focused around the implementation of four policies: snack, beverage, physical activity, and screen time. Changes in teacher’s attitudes and beliefs, as well as improvements in healthy lifestyle practices, were assessed. Results revealed significant improvements in child care center practices, such as: (1) the amount of health-related lessons provided to students increased t(664) = −6.09, P < 0.00; (2) the amount of outdoor physical activity increased t(702) = −3.83, P < 0.000; (3) the amount of screen time decreased t(686) = −2.52, P < 0.01; (4) the amount of juice served decreased t(577) = −7.38, P < 0.000; and (5) the amount of junk food decreased t(568) = −2.73, P < 0.006. The findings from this study can be easily disseminated and potentially serve as a model for improving the quality of nutrition and physical activity practices in child care facilities.

Obesity and cardiometabolic disease risk factors among US adolescents with disabilities

AIM To generate prevalence estimates of weight status and cardiometabolic disease risk factors among adolescents with and without disabilities. METHODS Analysis of the 1999-2010 National Health and Nutrition Examination Survey data was conducted among 12-18 years old with (n = 256) and without disabilities (n = 5020). Mean values of waist circumference, fasting glucose, high-density-lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure and metabolic syndrome (MetS, ≥ 3 risk factors present) were examined by the following standardized body mass index (BMI) categories for those with and without disabilities; overweight (BMI ≥ 85(th) - < 95(th) percentile for age and sex), obesity (BMI ≥ 95(th) percentile) and severe obesity (BMI ≥35 kg/m(2)). Linear regression models were fit with each cardiometabolic disease risk factor independently as continuous outcomes to show relationships with disability status. RESULTS Adolescents with disabilities were significantly more likely to be overweight (49.3%), obese (27.6%) and severely obese (12%) vs their peers without disabilities (33.1%, 17.5% and 3.6%, respectively, P ≤ 0.01 for all). A higher proportion of overweight, obese and severely obese children with disabilities had abnormal SBP, fasting lipids and glucose as well as MetS (18.9% of overweight, 32.3% of obese, 55% of severely obese) vs their peers without disabilities (9.7%, 16.8%, 36.3%, respectively). US adolescents with disabilities are over three times as likely to have MetS (OR = 3.45, 95%CI: 1.08-10.99, P = 0.03) vs their peers with no disabilities. CONCLUSION Results show that adolescents with disabilities are disproportionately affected by obesity and poor cardiometabolic health vs their peers with no disabilities. Health care professionals should monitor the cardiometabolic health of adolescents with disabilities.

Ages and Stages Questionnaire: Social–Emotional as a Teacher-Report Measure

Universal screening of social–emotional deficits in preschool children is a promising avenue for detecting children in need of early intervention. Due to the enormity of this task, it is vital that the instruments used in universal screening be brief, inexpensive, and capable of accurately measuring social–emotional development. The Ages and Stages Questionnaire: Social–Emotional (ASQ:SE) fulfills these requirements, but has been established only as a parent-report instrument, which makes it difficult to assess preschool-based child behavior and reporter bias. The current study examined the reliability and validity of the ASQ:SE in a sample of 443 preschool children and their teachers. Overall, the teacher-report ASQ:SE produced promising findings, including adequate internal consistency reliability (α = .73-.74) and strong concurrent validity. Further studies should include discriminant validity analyses, and more representative samples to allow for generalization of results.