Search

Children of Hispanic origin bear a high risk of obesity. Child weight gain trajectories are influenced by the family environment, including parent feeding practices. Excessive body fat can result in unhealthful metabolic and lipid profiles and increased risk of metabolic diseases. The objective was to estimate criterion validity of an obesity risk assessment tool targeting Spanish-speaking families of Mexican origin using anthropometric measures and blood values of their young children. A cross-sectional study design with five data collection sessions was conducted over an eight-week period and involved 206 parent/child dyads recruited at Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children in Northern California. Main outcome measures were criterion validity of Niños Sanos, a pediatric obesity risk assessment tool, using anthropometric measures and blood biomarkers. Niños Sanos scores were inversely related to child BMI-for-age percentiles (p = 0.02), waist-for-height ratios (p = 0.05) and inversely related to blood biomarkers for the metabolic index (p = 0.03) and lipid index (p = 0.05) and positively related to anti-inflammatory index (p = 0.047). Overall, children with higher Niños Sanos scores had more healthful lipid, metabolic and inflammatory profiles, as well as lower BMI-for-age percentiles and waist-to height ratios, providing evidence for the criterion validity of the tool. Niños Sanos can be used by child obesity researchers, by counselors and medical professionals during clinic visits as a screening tool and by educators as a tool to set goals for behavior change.

Children of Hispanic origin bear a high risk of obesity. Child weight gain trajectories are influenced by the family environment, including parent feeding practices. Excessive body fat can result in unhealthful metabolic and lipid profiles and increased risk of metabolic diseases. The objective was to estimate criterion validity of an obesity risk assessment tool targeting Spanish-speaking families of Mexican origin using anthropometric measures and blood values of their young children. A cross-sectional study design with five data collection sessions was conducted over an eight-week period and involved 206 parent/child dyads recruited at Head Start and the Special Supplemental Nutrition Program for Women, Infants and Children in Northern California. Main outcome measures were criterion validity of Niños Sanos, a pediatric obesity risk assessment tool, using anthropometric measures and blood biomarkers. Niños Sanos scores were inversely related to child BMI-for-age percentiles (p = 0.02), waist-for-height ratios (p = 0.05) and inversely related to blood biomarkers for the metabolic index (p = 0.03) and lipid index (p = 0.05) and positively related to anti-inflammatory index (p = 0.047). Overall, children with higher Niños Sanos scores had more healthful lipid, metabolic and inflammatory profiles, as well as lower BMI-for-age percentiles and waist-to height ratios, providing evidence for the criterion validity of the tool. Niños Sanos can be used by child obesity researchers, by counselors and medical professionals during clinic visits as a screening tool and by educators as a tool to set goals for behavior change.

PurposeWithin a medical clinic environment, pediatric obesity prevention education for families faces challenges. Existing long-term government-funded nutrition education programs have the expertise and staff to deliver. The purpose is to determine feasibility of colocating the Expanded Food and Nutrition Education Program (EFNEP) into a medical clinic setting to support pediatric obesity prevention.MethodsPhysicians from a large university teaching and research hospital (n = 73) and 4 small Medicaid-serving community clinics (n = 18) in the same geographic area in northern California were recruited and trained in the patient-referral protocol for a primary prevention intervention provided by EFNEP. The 8-week intervention deployed in the medical clinics, included general nutrition, physical activity and parenting topics anchored with guided goal setting and motivational modeling. Referral, enrollment, and attendance data were collected for 2 years. Parent and physician feasibility surveys, parent interviews and parent risk assessment tools were administered. Paired-sample t-test analysis was conducted.ResultsTwenty intervention series with parents of patients (n = 106) were conducted at 5 clinics. Physicians (n = 92) generated 686 referrals. Every 6 referrals generated 1 enrolled parent. Physicians (91%, n = 34) reported the intervention as useful to families. Parents (n = 82) reported improved child behaviors for sleep, screen time, physical activity, and food and beverage offerings (P < .0001) and at family mealtime (P < .001). Focus group interviews (n = 26) with 65 participants indicated that parents (97%) reacted positively to participating in the intervention with about a third indicating the classes were relevant to their needs.ConclusionThe intervention is a feasible strategy for the 5 medical clinics. Physicians referred and parents enrolled in the intervention with both physicians and parents indicating positive benefits. Feasibility is contingent u

PurposeWithin a medical clinic environment, pediatric obesity prevention education for families faces challenges. Existing long-term government-funded nutrition education programs have the expertise and staff to deliver. The purpose is to determine feasibility of colocating the Expanded Food and Nutrition Education Program (EFNEP) into a medical clinic setting to support pediatric obesity prevention.MethodsPhysicians from a large university teaching and research hospital (n = 73) and 4 small Medicaid-serving community clinics (n = 18) in the same geographic area in northern California were recruited and trained in the patient-referral protocol for a primary prevention intervention provided by EFNEP. The 8-week intervention deployed in the medical clinics, included general nutrition, physical activity and parenting topics anchored with guided goal setting and motivational modeling. Referral, enrollment, and attendance data were collected for 2 years. Parent and physician feasibility surveys, parent interviews and parent risk assessment tools were administered. Paired-sample t-test analysis was conducted.ResultsTwenty intervention series with parents of patients (n = 106) were conducted at 5 clinics. Physicians (n = 92) generated 686 referrals. Every 6 referrals generated 1 enrolled parent. Physicians (91%, n = 34) reported the intervention as useful to families. Parents (n = 82) reported improved child behaviors for sleep, screen time, physical activity, and food and beverage offerings (P < .0001) and at family mealtime (P < .001). Focus group interviews (n = 26) with 65 participants indicated that parents (97%) reacted positively to participating in the intervention with about a third indicating the classes were relevant to their needs.ConclusionThe intervention is a feasible strategy for the 5 medical clinics. Physicians referred and parents enrolled in the intervention with both physicians and parents indicating positive benefits. Feasibility is contingent u

The purpose of this paper is to describe a process for developing and validating outcome measures relevant to dietary quality behaviors targeted by Food Stamp Nutrition Education (FSNE). The ultimate goal is a measure that is valid, reliable, sensitive to change, and practical for use for a wide variety of FSNE evaluation purposes. The development process has incorporated input from FSNE stakeholders at the federal and state level and follows a systematic, research-driven approach that incorporates both qualitative and quantitative research and includes methods for identification of subject domains, selection of evaluation items, initial pretesting, and reduction of items. This type of research establishes the trustworthiness of new evaluation measures.

The purpose of this paper is to describe a process for developing and validating outcome measures relevant to dietary quality behaviors targeted by Food Stamp Nutrition Education (FSNE). The ultimate goal is a measure that is valid, reliable, sensitive to change, and practical for use for a wide variety of FSNE evaluation purposes. The development process has incorporated input from FSNE stakeholders at the federal and state level and follows a systematic, research-driven approach that incorporates both qualitative and quantitative research and includes methods for identification of subject domains, selection of evaluation items, initial pretesting, and reduction of items. This type of research establishes the trustworthiness of new evaluation measures.

Misreporting of dietary intake affects the validity of data collected and conclusions drawn in studies exploring diet and health outcomes. One consequence of misreporting is biological implausibility. Little is known regarding how accounting for biological implausibility of reported intake affects nutrient intake estimates in Hispanics, a rapidly growing demographic in the United States. Our study explores the effect of accounting for plausibility on nutrient intake estimates in a sample of Mexican-American women in northern California in 2008. Nutrient intakes are compared with Dietary Reference Intake recommendations, and intakes of Mexican-American women in a national survey are presented as a reference. Eighty-two women provided three 24-hour recalls. Reported energy intakes were classified as biologically plausible or implausible using the reported energy intakes to total energy expenditure cutoff of <0.76 or >1.24, with low-active physical activity levels used to estimate total energy expenditure. Differences in the means of nutrient intakes between implausible (n=36) and plausible (n=46) reporters of energy intake were examined by bivariate linear regression. Estimated energy, protein, cholesterol, dietary fiber, and vitamin E intakes were significantly higher in plausible reporters than implausible. There was a significant difference between the proportions of plausible vs implausible reporters meeting recommendations for several nutrients, with a larger proportion of plausible reporters meeting recommendations. Further research related to misreporting in Hispanic populations is warranted to explore the causes and effects of misreporting in studies measuring dietary intake, as well as actions to be taken to prevent or account for this issue.

Misreporting of dietary intake affects the validity of data collected and conclusions drawn in studies exploring diet and health outcomes. One consequence of misreporting is biological implausibility. Little is known regarding how accounting for biological implausibility of reported intake affects nutrient intake estimates in Hispanics, a rapidly growing demographic in the United States. Our study explores the effect of accounting for plausibility on nutrient intake estimates in a sample of Mexican-American women in northern California in 2008. Nutrient intakes are compared with Dietary Reference Intake recommendations, and intakes of Mexican-American women in a national survey are presented as a reference. Eighty-two women provided three 24-hour recalls. Reported energy intakes were classified as biologically plausible or implausible using the reported energy intakes to total energy expenditure cutoff of <0.76 or >1.24, with low-active physical activity levels used to estimate total energy expenditure. Differences in the means of nutrient intakes between implausible (n=36) and plausible (n=46) reporters of energy intake were examined by bivariate linear regression. Estimated energy, protein, cholesterol, dietary fiber, and vitamin E intakes were significantly higher in plausible reporters than implausible. There was a significant difference between the proportions of plausible vs implausible reporters meeting recommendations for several nutrients, with a larger proportion of plausible reporters meeting recommendations. Further research related to misreporting in Hispanic populations is warranted to explore the causes and effects of misreporting in studies measuring dietary intake, as well as actions to be taken to prevent or account for this issue.

BackgroundCurrently, no simplified approach to estimating food costs exists for a large, nationally representative sample.ObjectiveThe objective was to compare 2 approaches for estimating individual daily diet costs in a population of low-income women in California.DesignCost estimates based on time-intensive method 1 (three 24-h recalls and associated food prices on receipts) were compared with estimates made by using less intensive method 2 [a food-frequency questionnaire (FFQ) and store prices]. Low-income participants (n = 121) of USDA nutrition programs were recruited. Mean daily diet costs, both unadjusted and adjusted for energy, were compared by using Pearson correlation coefficients and the Bland-Altman 95% limits of agreement between methods.ResultsEnergy and nutrient intakes derived by the 2 methods were comparable; where differences occurred, the FFQ (method 2) provided higher nutrient values than did the 24-h recall (method 1). The crude daily diet cost was $6.32 by the 24-h recall method and $5.93 by the FFQ method (P = 0.221). The energy-adjusted diet cost was $6.65 by the 24-h recall method and $5.98 by the FFQ method (P < 0.001).ConclusionsAlthough the agreement between methods was weaker than expected, both approaches may be useful. Additional research is needed to further refine a large national survey approach (method 2) to estimate daily dietary costs with the use of this minimal time-intensive method for the participant and moderate time-intensive method for the researcher.

BackgroundCurrently, no simplified approach to estimating food costs exists for a large, nationally representative sample.ObjectiveThe objective was to compare 2 approaches for estimating individual daily diet costs in a population of low-income women in California.DesignCost estimates based on time-intensive method 1 (three 24-h recalls and associated food prices on receipts) were compared with estimates made by using less intensive method 2 [a food-frequency questionnaire (FFQ) and store prices]. Low-income participants (n = 121) of USDA nutrition programs were recruited. Mean daily diet costs, both unadjusted and adjusted for energy, were compared by using Pearson correlation coefficients and the Bland-Altman 95% limits of agreement between methods.ResultsEnergy and nutrient intakes derived by the 2 methods were comparable; where differences occurred, the FFQ (method 2) provided higher nutrient values than did the 24-h recall (method 1). The crude daily diet cost was $6.32 by the 24-h recall method and $5.93 by the FFQ method (P = 0.221). The energy-adjusted diet cost was $6.65 by the 24-h recall method and $5.98 by the FFQ method (P < 0.001).ConclusionsAlthough the agreement between methods was weaker than expected, both approaches may be useful. Additional research is needed to further refine a large national survey approach (method 2) to estimate daily dietary costs with the use of this minimal time-intensive method for the participant and moderate time-intensive method for the researcher.

Determining optimal intervention dose to meet time constraints of the teacher while maximizing behavioral impact for students has proven challenging. This study investigated the influence of intervention dose on 7th & 8th grade participants’ dietary and physical activity (PA) behaviors. Participants were assigned randomly to a: 1) 6 week-12 session nutrition intervention [treatment#1], or 2) 3 week-6 session nutrition intervention [treatment#2] with data collected pre/post intervention. Using ANCOVA, measures assessed dietary and PA self-efficacy and behaviors. Ethnically diverse participants (n=107) were included in the analyses (46% male). All students set two goals: one dietary and one PA regardless of dose. Treatment#1 resulted in similar outcomes compared to treatment#2 with no significant differences between groups. As a result, we recommend that teachers using the 12 week intervention give students the option of setting new goals after the 6th lesson to maintain motivation.

Determining optimal intervention dose to meet time constraints of the teacher while maximizing behavioral impact for students has proven challenging. This study investigated the influence of intervention dose on 7th & 8th grade participants’ dietary and physical activity (PA) behaviors. Participants were assigned randomly to a: 1) 6 week-12 session nutrition intervention [treatment#1], or 2) 3 week-6 session nutrition intervention [treatment#2] with data collected pre/post intervention. Using ANCOVA, measures assessed dietary and PA self-efficacy and behaviors. Ethnically diverse participants (n=107) were included in the analyses (46% male). All students set two goals: one dietary and one PA regardless of dose. Treatment#1 resulted in similar outcomes compared to treatment#2 with no significant differences between groups. As a result, we recommend that teachers using the 12 week intervention give students the option of setting new goals after the 6th lesson to maintain motivation.

Determining optimal intervention dose to meet time constraints of the teacher while maximizing behavioral impact for students has proven challenging. This study investigated the influence of intervention dose on 7th & 8th grade participants’ dietary and physical activity (PA) behaviors. Participants were assigned randomly to a: 1) 6 week-12 session nutrition intervention [treatment#1], or 2) 3 week-6 session nutrition intervention [treatment#2] with data collected pre/post intervention. Using ANCOVA, measures assessed dietary and PA self-efficacy and behaviors. Ethnically diverse participants (n=107) were included in the analyses (46% male). All students set two goals: one dietary and one PA regardless of dose. Treatment#1 resulted in similar outcomes compared to treatment#2 with no significant differences between groups. As a result, we recommend that teachers using the 12 week intervention give students the option of setting new goals after the 6th lesson to maintain motivation.

We developed a short food behavior checklist (FBC) to evaluate the impact of nutrition education on fruit and vegetable intake among ethnically diverse women in the Food Stamp Nutrition Education Program (FSNEP) and the Expanded Food and Nutrition Education Program (EFNEP). To validate the FBC, interviewers collected three 24-hour dietary recalls as well as responses to 11 FBC behavioral questions about fruits and vegetables from 100 English-speaking, low-income women at baseline. A randomly selected subgroup (n = 59) provided a blood sample for analysis of total serum carotenoids at baseline and follow-up. After 6 hours of nutrition education, the treatment group reported significant improvements in three of the seven FBC questions related to fruit and vegetable intake, while no significant changes occurred in the control group. Furthermore, six of the seven FBC questions were significantly correlated with total serum carotenoids. This short, culturally neutral FBC is a valid and reliable indicator of fruit and vegetable consumption. Compared with the 24-hour dietary recall, it is also less time-consuming to administer, code and analyze, with a reduced respondent burden.

We developed a short food behavior checklist (FBC) to evaluate the impact of nutrition education on fruit and vegetable intake among ethnically diverse women in the Food Stamp Nutrition Education Program (FSNEP) and the Expanded Food and Nutrition Education Program (EFNEP). To validate the FBC, interviewers collected three 24-hour dietary recalls as well as responses to 11 FBC behavioral questions about fruits and vegetables from 100 English-speaking, low-income women at baseline. A randomly selected subgroup (n = 59) provided a blood sample for analysis of total serum carotenoids at baseline and follow-up. After 6 hours of nutrition education, the treatment group reported significant improvements in three of the seven FBC questions related to fruit and vegetable intake, while no significant changes occurred in the control group. Furthermore, six of the seven FBC questions were significantly correlated with total serum carotenoids. This short, culturally neutral FBC is a valid and reliable indicator of fruit and vegetable consumption. Compared with the 24-hour dietary recall, it is also less time-consuming to administer, code and analyze, with a reduced respondent burden.

The United States is experiencing an epidemic of obesity in both adult and children, particularly among low-income populations. In fact, overweight has replaced malnutrition as the most prevalent nutritional problem among the poor. We examine this seemingly paradoxical relationship and explore the causes and consequences of overweight, obesity and food insecurity. In a UC Cooperative Extension Body Weight and Health Workgroup study of 561 low income Latino mothers and their young children, we found important differences in the association between family food insecurity and overweight status for mothers and their children. Forty percent of the women were overweight and 37% obese, and 22% of their children were overweight. Furthermore, U.S.-born mothers who were food insecure as children were more likely to be obese adults. Awareness and understanding of the link between food insecurity and weight gain will facilitate the efforts of schools, food assistance programs, the food industry and others in the community to provide effective nutritional programs.

Food security is defined as access by all people at all times to enough food for an active, healthy life. In a study of 212 low-income Latino households in California, 45% were food insecure without hunger; 13% food insecure with moderate hunger; and 3% food insecure with severe hunger. Food insecurity was associated with a decline in household supplies of both nutritious and less nutritious foods. Among preschool children, the number of servings per day of all food groups was significantly correlated with household food supplies. A strong safety net to improve food security in low-income populations must include educational strategies and provision of nutritious foods to support a good diet at home and away from home.

The United States is experiencing an epidemic of obesity in both adult and children, particularly among low-income populations. In fact, overweight has replaced malnutrition as the most prevalent nutritional problem among the poor. We examine this seemingly paradoxical relationship and explore the causes and consequences of overweight, obesity and food insecurity. In a UC Cooperative Extension Body Weight and Health Workgroup study of 561 low income Latino mothers and their young children, we found important differences in the association between family food insecurity and overweight status for mothers and their children. Forty percent of the women were overweight and 37% obese, and 22% of their children were overweight. Furthermore, U.S.-born mothers who were food insecure as children were more likely to be obese adults. Awareness and understanding of the link between food insecurity and weight gain will facilitate the efforts of schools, food assistance programs, the food industry and others in the community to provide effective nutritional programs.

Food security is defined as access by all people at all times to enough food for an active, healthy life. In a study of 212 low-income Latino households in California, 45% were food insecure without hunger; 13% food insecure with moderate hunger; and 3% food insecure with severe hunger. Food insecurity was associated with a decline in household supplies of both nutritious and less nutritious foods. Among preschool children, the number of servings per day of all food groups was significantly correlated with household food supplies. A strong safety net to improve food security in low-income populations must include educational strategies and provision of nutritious foods to support a good diet at home and away from home.