Shannon M. Robson

Macronutrient intake in preschoolers with cystic fibrosis and the relationship between macronutrients and growth

BACKGROUND Adequate nutrition is essential for growth in children with cystic fibrosis (CF). The new CF Foundation Clinical Practice Guidelines bring attention to monitoring macronutrient intake as well as total energy. METHODS Dietary intake of 75 preschool children with CF and pancreatic insufficiency was examined and compared to the Clinical Practice Guidelines. Regression analyses examined relationships between macronutrient intake and growth. RESULTS Approximately 45% of children met the 110% minimum recommended dietary allowance (RDA) recommendation. Children consumed 35.3% (6.1) of total daily energy intake from fat, 12.7% (1.7) from protein, and 52.0% (6.1) from carbohydrates. Percent energy from protein was associated with height growth. CONCLUSIONS Many preschoolers with CF are not meeting nutrition benchmarks for total energy and fat. To optimize nutrition early, dietary monitoring with frequent individualized feedback is needed. Optimizing intake of macronutrients that promote growth, especially fat and protein, should be a primary clinical target.

Barriers to Recruitment in Pediatric Obesity Trials: Comparing Opt-in and Opt-out Recruitment Approaches

Objective To compare the efficacy of opt‐in versus opt‐out recruitment methods in pediatric weight management clinical trials. Methods Recruitment of preschoolers and school‐age children across two obesity randomized controlled trials (RCTs) were compared using the same opt‐in recruitment approach (parents contact researchers in response to mailings). Opt‐in and opt‐out strategies (parents send decline postcard in response to mailings if they do not want to participate) were then compared across two preschool obesity RCTs. Results Opt‐in strategies yielded a significantly lower overall recruitment rate among preschoolers compared with school‐age children. Among preschoolers, an opt‐out strategy demonstrated a significantly higher overall recruitment rate compared with an opt‐in strategy with the main advantage in the number of families initially contacted. Conclusions Opt‐out recruitment strategies may be more effective in overcoming the barriers of recruitment in the preschool age‐group because it does not rely on parent recognition of obesity.

A Review of the Structural Characteristics of Family Meals with Children in the United States

Family meals are associated with a range of positive outcomes among children and adolescents. There is inconsistency, however, in the way in which studies have defined and measured family meals. Therefore, a systematic review of the literature was conducted to determine how studies describe family meals with the use of structural characteristics. The current review focused on studies in the United States that included children ages 2-18 y. A total of 33 studies were identified that characterized family meals with the use of ≥1 of the following structural features: frequency or mean number of family meals per week, length of family meal, people present at meal, and where meals occurred. No study characterized family meals by using all 4 family meal features, whereas most studies (81%) characterized family meals by using frequency or mean number of meals per week. Findings not only provide an initial understanding of the structural features used to define family meals but also point to the importance of developing a more comprehensive, sensitive assessment that can accurately capture the complex and multidimensional nature of family meals.

Clinic and Home-Based Behavioral Intervention for Obesity in Preschoolers: A Randomized Trial

Objective To test the hypotheses that an innovative skills‐based behavioral family clinic and home‐based intervention (LAUNCH) would reduce body mass index z score (BMIz) compared with motivational interviewing and to standard care in preschool‐aged children with obesity. Study design Randomized controlled trial with children between the ages of 2 and 5 years above the 95th percentile for body mass index for age and sex recruited from 27 pediatrician offices across 10 recruitment cycles between March 12, 2012 and June 8, 2015. Children were randomized to LAUNCH (an 18‐session clinic and home‐based behavioral intervention), motivational interviewing (delivered at the same frequency as LAUNCH), or standard care (no formal intervention). Weight and height were measured by assessors blinded to participant assignment. The primary outcome, BMIz at month 6 after adjusting for baseline BMIz, was tested separately comparing LAUNCH with motivational interviewing and LAUNCH with standard care using regression‐based analysis of covariance models. Results A total of 151 of the 167 children randomized met intent‐to‐treat criteria and 92% completed the study. Children were 76% White and 57% female, with an average age of 55 months and BMI percentile of 98.57, with no demographic differences between the groups. LAUNCH participants demonstrated a significantly greater decrease in BMIz (mean = −0.32, SD = ±0.33) compared with motivational interviewing (mean = −0.05, SD = ±0.27), P < .001, ω2 = 0.74 and compared with standard care (mean = −0.13, SD = ±0.31), P < .004, ω2 = 0.75. Conclusions In preschool‐age children, an intensive 6‐month behavioral skills‐based intervention is necessary to reduce obesity. Trial Registration Clinicaltrials.gov NCT01546727.

Actual neighborhood-level crime predicts body mass index z-score changes in a multi-racial/ethnic sample of children

Longitudinal studies are warranted to clarify the influence crime has on health outcomes in children especially children representing multiple racial/ethnic backgrounds. To address this need, the current study examined whether neighborhood-level crime predicted changes in body mass index z (BMIz) scores in 373 White (W), 627 African American (AA), 1020 Hispanic (H), and 88 Asian (A), five to ten year-old boys and girls living in urban neighborhoods. Heights and weights were assessed at baseline (2012) and three-years later and used to calculate BMIz scores. Characteristics of zip codes where students lived during the three-year period were obtained at baseline from various sources. The Crime Risk Index (CRI) for each zip code was calculated using actual crime statistics. Multiple linear regression analyses were conducted to examine associations between baseline CRI and follow-up BMIz scores while controlling for other variables including BMIz at baseline. The CRI and BMIz scores differed significantly by race/ethnicity with the highest values for both noted in H. Regression analyses indicated that the CRI accounted for a significant percentage of the variance in follow-up BMIz scores in the overall sample. When race/ethnicity was considered, the CRI predicted follow-up BMIz scores only in W children. The CRI was not significantly associated with BMIz scores in the other races/ethnicities. The impact actual, neighborhood-level crime has on BMI in children is complex. Based on the existing evidence, considering actual crime as a primary target in obesity prevention would be premature especially in racial/ethnicity minority children living in urban areas.

The accuracy of parent-reported height and weight for 6–12 year old U.S. children

BackgroundPrevious studies have examined correlations between BMI calculated using parent-reported and directly-measured child height and weight. The objective of this study was to validate correction factors for parent-reported child measurements.MethodsConcordance between parent-reported and investigator measured child height, weight, and BMI (kg/m2) among participants in the Neighborhood Impact on Kids Study (n = 616) was examined using the Lin coefficient, where a value of ±1.0 indicates perfect concordance and a value of zero denotes non-concordance. A correction model for parent-reported height, weight, and BMI based on commonly collected demographic information was developed using 75% of the sample. This model was used to estimate corrected measures for the remaining 25% of the sample and measured concordance between correct parent-reported and investigator-measured values. Accuracy of corrected values in classifying children as overweight/obese was assessed by sensitivity and specificity.ResultsConcordance between parent-reported and measured height, weight and BMI was low (0.007, − 0.039, and − 0.005 respectively). Concordance in the corrected test samples improved to 0.752 for height, 0.616 for weight, and 0.227 for BMI. Sensitivity of corrected parent-reported measures for predicting overweight and obesity among children in the test sample decreased from 42.8 to 25.6% while specificity improved from 79.5 to 88.6%.ConclusionsCorrection factors improved concordance for height and weight but did not improve the sensitivity of parent-reported measures for measuring child overweight and obesity. Future research should be conducted using larger and more nationally-representative samples that allow researchers to fully explore demographic variance in correction coefficients.

The Association Between Fruit and Vegetable Consumption and Fruit and Vegetable Stage of Change in Underserved Communities Engaging With Cooperative Extension Services

Objective: To compare differences in fruit and vegetable (FV) intake and FV stage of change in 2 diverse communities engaging with cooperative extension services (Extension). Methods: Cross‐sectional study of FV behaviors of community members enrolled in a team‐based challenge offered by Extension. t test and chi‐square analyses examined differences in FV intake and FV stage of change. Linear regression examined the relationship between FV stage of change and FV intake, adjusting for demographics. Results: There was a significant (P = .01) difference in staging between the African American and Hispanic communities. Of individuals in the African American community, 60% were in the preparation stage; in the Hispanic community, 55% were in the precontemplation/contemplation stage. The FV stage of change was significantly associated with daily FV intake (&bgr; = .53; P < .001). Conclusions and Implications: To promote consumption of FVs better, nutrition education programs such as Extension should differentiate based on stages of change among subpopulations.