Sarah C. Couch

Food neophobia in childhood affects dietary variety.

OBJECTIVE To determine whether children with food neophobia (unwillingness to try new foods) have more restrictive diets than children without neophobia. SUBJECTS Seventy children were classified into 3 groups based on scores obtained on the Food Neophobia Scale: neophobic group, score greater than 41; neophilic group, score less than 27; and average group, score of 28 to 40. DESIGN Dietary data were collected and analyzed for 3 days selected randomly. The dependent variables measured were energy and nutrient intakes, servings of each Food Guide Pyramid group, and Health Eating Index (HEI) scores. STATISTICAL ANALYSES chi 2, 1-way analysis of covariance, and Scheffé multiple comparisons tests were conducted. RESULTS The 3 groups were similar with respect to the number of children meeting two thirds of the RDA/DRI for energy and most nutrients. The exception was vitamin E: fewer neophobic children met two thirds of the recommended value for this nutrient than average and neophilic children. The overall HEI score was significantly lower for the neophobic group compared with the average and neophilic groups. The HEI index showed that children with neophobia had a higher intake of saturated fat and less food variety than children without food neophobia. APPLICATIONS Dietitians should emphasize increased food variety for children within the context of a healthful diet. Research should be conducted to determine the effects of dietary variety on quality of diet and health of children.

The Efficacy of a Clinic-Based Behavioral Nutrition Intervention Emphasizing a DASH-Type Diet for Adolescents with Elevated Blood Pressure

OBJECTIVE To examine the efficacy of a 3-month clinic-based behavioral nutrition intervention emphasizing a diet high in fruits, vegetables, and low fat dairy (DASH intervention) versus routine outpatient hospital-based nutrition care (RC) on diet and blood pressure (BP) in adolescents with elevated BP. STUDY DESIGN Fifty-seven adolescents with a clinical diagnosis of prehypertension or hypertension (systolic BP or diastolic BP, 90(th) to 99(th) percentile) were randomly assigned to DASH or RC. SBP, DBP, 3-day diet recall, weight, and height were assessed at pretreatment, post-treatment, and 3 months later (follow-up). RESULTS In completer analysis, DASH versus RC had a greater decrease in SBP z scores from baseline to post-treatment (P < 0.01) and a trend for a greater decrease in SBP z scores from baseline through follow-up (P = .07). DBP z scores changed similarly for conditions from baseline through follow-up. Relative to RC, DASH had a greater increase in intake of fruits (P < .001), potassium and magnesium (P < .01), and a greater decrease in total fat (P < .05) from baseline to post-treatment. From baseline through follow-up, DASH versus RC had a greater increase in low fat dairy (P < .001). CONCLUSIONS The DASH intervention proved more effective than RC in improving SBP and diet quality in adolescents with elevated BP.

Obesogenic Neighborhood Environments, Child and Parent Obesity The Neighborhood Impact on Kids Study

BACKGROUND Identifying neighborhood environment attributes related to childhood obesity can inform environmental changes for obesity prevention. PURPOSE To evaluate child and parent weight status across neighborhoods in King County (Seattle metropolitan area) and San Diego County differing in GIS-defined physical activity environment (PAE) and nutrition environment (NE) characteristics. METHODS Neighborhoods were selected to represent high (favorable) versus low (unfavorable) on the two measures, forming four neighborhood types (low on both measures, low PAE/high NE, high PAE/low NE, and high on both measures). Weight and height of children aged 6-11 years and one parent (n=730) from selected neighborhoods were assessed in 2007-2009. Differences in child and parent overweight and obesity by neighborhood type were examined, adjusting for neighborhood-, family-, and individual-level demographics. RESULTS Children from neighborhoods high on both environment measures were less likely to be obese (7.7% vs 15.9%, OR=0.44, p=0.02) and marginally less likely to be overweight (23.7% vs 31.7%, OR=0.67, p=0.08) than children from neighborhoods low on both measures. In models adjusted for parent weight status and demographic factors, neighborhood environment type remained related to child obesity (high vs low on both measures, OR=0.41, p<0.03). Parents in neighborhoods high on both measures (versus low on both) were marginally less likely to be obese (20.1% vs 27.7%, OR=0.66, p=0.08), although parent overweight did not differ by neighborhood environment. The lower odds of parent obesity in neighborhoods with environments supportive of physical activity and healthy eating remained in models adjusted for demographics (high vs low on the environment measures, OR=0.57, p=0.053). CONCLUSIONS Findings support the proposed GIS-based definitions of obesogenic neighborhoods for children and parents that consider both physical activity and nutrition environment features.

Dietary ketosis enhances memory in mild cognitive impairment

We randomly assigned 23 older adults with mild cognitive impairment to either a high carbohydrate or very low carbohydrate diet. Following the 6-week intervention period, we observed improved verbal memory performance for the low carbohydrate subjects (p = 0.01) as well as reductions in weight (p < 0.0001), waist circumference (p < 0.0001), fasting glucose (p = 0.009), and fasting insulin (p = 0.005). Level of depressive symptoms was not affected. Change in calorie intake, insulin level, and weight were not correlated with memory performance for the entire sample, although a trend toward a moderate relationship between insulin and memory was observed within the low carbohydrate group. Ketone levels were positively correlated with memory performance (p = 0.04). These findings indicate that very low carbohydrate consumption, even in the short term, can improve memory function in older adults with increased risk for Alzheimers disease. While this effect may be attributable in part to correction of hyperinsulinemia, other mechanisms associated with ketosis such as reduced inflammation and enhanced energy metabolism also may have contributed to improved neurocognitive function. Further investigation of this intervention is warranted to evaluate its preventive potential and mechanisms of action in the context of early neurodegeneration.

Fetal erythrocyte phospholipid polyunsaturated fatty acids are altered in pregnancy complicated with gestational diabetes mellitus

Insulin resistance and altered maternal metabolism in gestational diabetes mellitus (GDM) may impair fetal arachidonic acid (AA) and docosahexaenoic acid (DHA) status. The objectives were to test the hypothesis that fetal polyunsaturated fatty acids would be altered with GDM and identify factors related to fetal phospholipid (PL) AA and DHA. Maternal and cord vein erythrocyte PL fatty acids were determined in GDM (n=13) and healthy pregnant women (controls, n=12). Cord vein erythrocyte PL AA and DHA concentrations were significantly lower in GDM vs. controls. Maternal blood hemoglobin A1C was inversely correlated to fetal erythrocyte PL DHA and AA in controls and GDM (n=25). Pregravid body mass index was negatively associated with fetal PL DHA. The data support the hypothesis that there is impairment in fetal accretion of DHA and AA in GDM.

Diet and blood pressure in children

Purpose of review The prevalence of hypertension among children in the US is increasing in concert with rising obesity rates. Leading health organizations agree that elevated blood pressure should be managed in children; however, data on the relation between diet and lifestyle and blood pressure in this age group are sparse and controversial. The purpose of this review is to summarize the current evidence regarding nutrients, foods, and dietary patterns and their role in blood pressure elevation and in the treatment of pediatric hypertension. Recent findings There is clear evidence that avoidance of excess weight gain in early life is important for the prevention of future hypertension and that weight reduction is an important therapeutic intervention for the prevention and treatment of hypertension in overweight children. Similarly, reduction in dietary sodium may be beneficial for children who are salt sensitive, but this trait cannot be easily measured. Children who were breast-fed or consume a diet rich in fruits, vegetables, and dairy foods tend to have lower blood pressure in adolescence. How these foods lower blood pressure is unclear. Summary Data supporting the efficacy of dietary interventions for preventing or treating high blood pressure are limited. Future studies should emphasize adequate sample size, adjustment for confounding factors, use of standardized blood pressure techniques, and random assignment of children in intervention trials. Additionally, because adherence to dietary interventions may be particularly problematic among children, innovative nutrition intervention approaches are needed that address the unique needs and circumstances of this age group.

Evolution of meal patterns and food choices of Japanese-American females born in the United States.

Objectives: To examine trends in meal patterns and food choices across two generations of Japanese-American females born in the USA.Design: Cross-sectional cohort study.Setting: Gardena, a suburb of Los Angeles, California.Subjects: One-hundred and seventy-six Japanese-American females, participating in a morning exercise class from December 1998 to January 1999.Intervention: Eighty-eight Nisei (second generation) mothers and their Sansei (third generation) daughters completed a food frequency questionnaire, answering questions regarding meal patterns and consumption frequency of 51 food items.Results: The Sansei ate fewer meals per day compared with the Nisei. Mean frequencies of takeout foods and eating out were higher in the Sansei vs the Nisei. Mean intake of meats and eggs were similar between the two groups. However, mean consumption of traditional Japanese complement foods including fish, vegetables and legumes was lower in the Sansei vs the Nisei. Intake of more ‘Westernized’ accessory foods, including salty snacks, regular soft drinks and alcoholic beverages, was higher in the Sansei vs the Nisei.Conclusion: Findings from this study indicate that meal patterns and food choices have changed in succeeding generations of Japanese-American females from traditional fare to a diet containing many complement and accessory foods that are higher in fat, sugar, sodium and calories. Health professionals should be advised to consider the whole diet in making nutrition recommendations to this population as well as providing information to this group on the nutritional benefits of many traditional foods.European Journal of Clinical Nutrition (2000) 54, 665–670.

Rapid westernization of children's blood cholesterol in 3 countries: evidence for nutrient-gene interactions?

The aim of this study was to examine potential factors that modify blood cholesterol among children in countries in which dietary and lifestyle habits are becoming westernized. Population data on serum total and lipoprotein cholesterol, anthropometric indexes, and dietary intake were reviewed and compared for children aged 1-18 y from Japan, Spain, and the United States. The data show that total serum cholesterol in Japanese and Spanish children recently exceeded the 75th percentile for US children, primarily reflecting LDL cholesterol, although both LDL and HDL cholesterol contributed. Adiposity indexes do not explain the trends observed. Total and saturated fat intakes increased substantially in both Japan and Spain but in Japan are still lower than intakes in the United States. The Hegsted equation was used to relate differences in serum cholesterol to dietary fat intake. Changes in total serum cholesterol followed established dietary correlations among children in Spain, but not in Japan. Serum cholesterol in Japanese children was predicted to be 0.20-0.32 mmol/L lower than in US children; actual concentrations were considerably higher. These results suggest that a rapid westernization of childrens blood cholesterol concentrations has occurred in Japan and Spain. Changes in fat intake predict changes in blood cholesterol in Spain, but not in Japan. Differences in genetic response to diet in certain populations, such as the Japanese, may explain higher blood cholesterol concentrations with lower fat intakes compared with the United States.

Elevated lipoprotein lipids and gestational hormones in women with diet-treated gestational diabetes mellitus compared to healthy pregnant controls.

The objective of this study was to describe plasma and lipoprotein perturbations in gestational diabetes mellitus (GDM) compared to controls, and determine if alterations in lipids are related to gestational hormones and/or glucose control. Maternal HbA1c, free fatty acids (FFA), beta-estradiol, progesterone, prolactin, and plasma, very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), high-density lipoprotein (HDL), HDL2 and HDL3 triglyceride (TG), cholesterol, and dietary intake were determined for women with diet-treated GDM and controls in a longitudinal design. Subjects (N = 25/group) were matched for age, race, and body-mass index (BMI). Women with GDM had significantly higher HbA1c than controls, although both groups were within the normal range (4%-6%). However, body weight gain was less for women with GDM. There was a trend for higher plasma FFAs at 37-38 weeks in GDM versus controls. Plasma and lipoprotein TG among the groups increased over the third trimester, and mean concentrations were greater for women with GDM. In GDM versus controls, VLDL and HDL3 TGs were higher at all times, HDL and HDL2 TGs at 33-34 and 37-38 weeks, and LDL TGs at 37-38 weeks. In VLDL, core lipids (TG + cholesterol) increased over gestation and were greater in GDM. In HDL, the TG/cholesterol ratio was greater in GDM. In GDM versus controls, plasma progesterone and prolactin were higher at all times; beta-estradiol was elevated at 37-38 weeks. HbA1c, progesterone, and prolactin correlated with all lipoprotein TG fractions. Exaggerated hypertriglyceridemia, particularly in the VLDL and HDL fractions, is a feature of GDM. The increase in VLDL TG is likely due to an increase in VLDL synthesis, whereas particle enrichment in TG is a plausible explanation for changes in HDL TG. Slight perturbations in glucose control and gestational hormones in diet-treated GDM may contribute to the observed increase in plasma and lipoprotein TG.

Impact of Parental Food Choices on Child Food Neophobia

This study examined the impact of parental food choices on childrens willingness to try new foods. The participants were 33 students in Grades 5 and 6 in one public school in Cincinnati, Ohio. One parent per student completed the Food Neophobia Scale (FNS) and food records. Outcome measures included (a) FNS scores for both parents and children, and (b) Healthy Eating Index (HEI) scores and number of different foods consumed by parents only. Parent-child FNS scores were significantly correlated. Negative associations occurred between the parent HEI fruit score and the child FNS score and the number of different foods consumed by the parent and the child FNS score. Findings suggest that parental food choices influence childrens responses to new foods.