RESUMEN

NHANES needs urgent attention to ensure its future, which is facing emerging challenges associated with data collection, stagnant funding that has undercut innovation, and the increased call for granular data for subpopulations and groups at risk. The concerns do not rest merely on securing more funding but focus on the need for a constructive review of the survey to explore new approaches and identify appropriate change. This white paper, developed under the auspices of the ASN's Committee on Advocacy and Science Policy (CASP), is a call to the nutrition community to advocate for and support activities to prepare NHANES for future success in a changing nutrition world. Furthermore, because NHANES is much more than a nutrition survey and serves the needs of many in health fields and even commercial arenas, effective advocacy must be grounded in alliances among the survey's diverse stakeholders so that the full range of expertise and interests can engage. This article highlights the complicated nature of the survey along with key overarching challenges to underscore the importance of a measured, thoughtful, comprehensive, and collaborative approach to considering the future of NHANES. Starting-point questions are identified for the purposes of focusing dialog, discussion forums, and research. In particular, the CASP calls for a National Academies of Sciences, Engineering, and Medicine study on NHANES to articulate an actionable framework for NHANES going forward. With a well-informed and integrated set of goals and recommendations that could be provided by such a study, a secure future for NHANES is more readily achievable.

Asunto(s)

Estado Nutricional , Humanos , Encuestas Nutricionales , Encuestas y Cuestionarios

RESUMEN

BACKGROUND: To reduce childhood hunger, the US Department of Agriculture funded a set of demonstration projects, including the Nevada Healthy, Hunger-Free Kids (HHFK) project. OBJECTIVE: The study objective was to test whether the Nevada HHFK project reduced child food insecurity (FI-C) among low-income households with young children. DESIGN: Households were randomly assigned to treatment and control groups, with outcomes measured using household surveys and administrative data. Survey data were collected at baseline (n=3,088) and follow-up (n=2,074) 8 to 12 months into the project. PARTICIPANTS/SETTING: Eligible households in Las Vegas, NV, had children under age 5 years, received Supplemental Nutrition Assistance Program (SNAP) benefits, and had incomes below 75% of the federal poverty level. INTERVENTION: Between June 2016 and May 2017, treatment households on SNAP received an additional $40 in monthly SNAP benefits per child under age 5 years. MAIN OUTCOME MEASURES: Key outcomes included FI-C (primary), food security among adults and households, and food expenditures (secondary). STATISTICAL ANALYSES PERFORMED: Differences between the treatment and control groups were estimated by a logistic regression model and controlling for baseline characteristics. Analyses were also performed on socioeconomic subgroups. RESULTS: The Nevada HHFK project did not reduce FI-C (treatment=31.2%, control=30.6%; P=0.620), very low food security among children (P=0.915), or food insecurity among adults (P=0.925). The project increased households' monthly food expenditures (including SNAP and out-of-pocket food purchases) by $23 (P<0.001). CONCLUSIONS: A demonstration project to reduce FI-C by increasing SNAP benefits to Las Vegas households with young children and very low income did not reduce FI-C or other food-insecurity measures. This finding runs counter to prior research showing that SNAP and similar forms of food assistance have reduced food insecurity. This project was implemented during a period of substantial economic growth in Las Vegas. Future research should explore the role of the economic context, children's ages, and household income in determining how increases in SNAP benefits affect food insecurity. CLINICALTRIALS. GOV IDENTIFIER: NCT04253743 (http://www.clinicaltrials.gov) FUNDING/SUPPORT: This article is published as part of a supplement supported by the US Department of Agriculture, Food and Nutrition Service.

Asunto(s)

Trastornos de la Nutrición del Niño/prevención & control , Asistencia Alimentaria/estadística & datos numéricos , Inseguridad Alimentaria/economía , Seguridad Alimentaria/economía , Pobreza/estadística & datos numéricos , Adulto , Preescolar , Composición Familiar , Femenino , Asistencia Alimentaria/economía , Seguridad Alimentaria/métodos , Humanos , Modelos Logísticos , Masculino , Nevada , Pobreza/economía , Evaluación de Programas y Proyectos de Salud

RESUMEN

BACKGROUND: The 2010 Child Nutrition reauthorization called for the independent evaluation of innovative strategies to reduce the risk of childhood hunger or improve the food security status of households with children. OBJECTIVE: The research question was whether the Packed Promise intervention reduces child food insecurity (FI-C) among low-income households with children. DESIGN: This study was a cluster randomized controlled trial of 40 school districts and 4,750 eligible, consented households within treatment and control schools. PARTICIPANTS/SETTING: Data were collected at baseline (n = 2,859) and 2 follow-ups (n = 2,852; n = 2,790) from households with children eligible for free school meals in participating schools in 12 rural counties within the Chickasaw Nation territory in south central Oklahoma in 2016 to 2018. INTERVENTION: Each month of the 25-month intervention, for each eligible child, enrolled households could choose from 5 types of food boxes that contained shelf-stable, nutritious foods ($38 food value) and a $15 check for purchasing fruits and vegetables. MAIN OUTCOME MEASURES: The primary outcome was FI-C. Other outcomes included household and adult food security, very low food security among children, and food expenditures. STATISTICAL ANALYSES PERFORMED: Differences between the treatment and control groups were estimated by a regression model controlling for baseline characteristics. RESULTS: The Packed Promise project did not significantly reduce FI-C at 12 months (29.3% prevalence in the treatment group compared with 30.1% in the control group; P = 0.123) or at 18 months (28.2% vs 28.7%; P = 0.276), but reduced food insecurity for adults by 3 percentage points at 12 months (P = 0.002) but not at 18 months (P = 0.354). The intervention led to a $27 and a $16 decline in median household monthly out-of-pocket food expenditures at 12 and 18 months, respectively. CONCLUSIONS: An innovative intervention successfully delivered nutritious food boxes to low-income households with children in rural Oklahoma, but did not significantly reduce FI-C. Improving economic conditions in the demonstration area and participation in other nutrition assistance programs among treatment and control groups might explain the lack of impact.ClinicalTrials.gov ID: NCT04316819 (http://www.clinicaltrials.gov). FUNDING/SUPPORT: This article is published as part of a supplement supported by the US Department of Agriculture, Food and Nutrition Service.

Asunto(s)

Indio Americano o Nativo de Alaska/estadística & datos numéricos , Asistencia Alimentaria , Seguridad Alimentaria/métodos , Abastecimiento de Alimentos/métodos , Pobreza/estadística & datos numéricos , Adulto , Niño , Trastornos de la Nutrición del Niño/prevención & control , Análisis por Conglomerados , Composición Familiar , Femenino , Asistencia Alimentaria/economía , Seguridad Alimentaria/economía , Abastecimiento de Alimentos/economía , Humanos , Masculino , Oklahoma , Evaluación de Programas y Proyectos de Salud , Análisis de Regresión , Población Rural/estadística & datos numéricos

RESUMEN

OBJECTIVE: To explore eating patterns and snacking among US infants, toddlers and pre-school children. DESIGN: The Feeding Infants and Toddlers Study (FITS) 2008 was a cross-sectional national survey of children aged 6-47 months, weighted to reflect US age and racial/ethnic distributions. Dietary data were collected using one multiple-pass 24h recall. Eating occasions were categorized as meals, snacks or other (comprised of all feedings of breast milk and/or infant formula). The percentage of children consuming meals and snacks and their contribution to total energy, the number of snacks consumed per day, energy and nutrients coming from snacks and the most commonly consumed snacks were evaluated by age. SETTING: A national sample of US infants, toddlers and pre-school children. SUBJECTS: A total of 2891 children in five age groups: 6-8 months (n 249), 9-11 months (n 256), 12-23 months (n 925), 24-35 months (n 736) and 36-47 months (n 725). RESULTS: Snacks were already consumed by 37 % of infants beginning at 6 months; by 12 months of age, nearly 95 % were consuming at least one snack per day. Snacks provided 25 % of daily energy from the age of 12 months. Approximately 40 % of toddlers and pre-school children consumed fruit and cow's milk during snacks; about 25 % consumed 100 % fruit juice. Cookies were introduced early; by 24 months, 57 % consumed cookies or candy in a given day. CONCLUSIONS: Snacking is common, contributing significantly to daily energy and nutrient needs of toddlers and pre-school children. There is room for improvement, however, with many popular snacking choices contributing to excess sugar.

Asunto(s)

Dieta , Ingestión de Energía , Bocadillos , Animales , Bebidas , Conducta Infantil , Preescolar , Estudios Transversales , Encuestas sobre Dietas , Femenino , Frutas , Conductas Relacionadas con la Salud , Humanos , Lactante , Fórmulas Infantiles , Masculino , Recuerdo Mental , Leche , Leche Humana , Valor Nutritivo , Estados Unidos

RESUMEN

BACKGROUND: The Summer Electronic Benefit Transfers for Children (SEBTC) demonstration piloted summer food assistance through electronic benefit transfers (EBTs), providing benefits either through the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) or the Supplemental Nutrition Assistance Program (SNAP) EBT. OBJECTIVE: To inform food assistance policy and describe how demonstrations using WIC and SNAP models differed in benefit take-up and impacts on food security and children's food consumption. DESIGN: Sites chose to deliver SEBTC using the SNAP or WIC EBT system. Within each site, in 2012, households were randomly assigned to a benefit group or a no-benefit control group. PARTICIPANTS: Grantees (eight states and two Indian Tribal Organizations) selected school districts serving many low-income children. Schoolchildren were eligible in cases where they had been certified for free or reduced-price meals during the school year. Before the demonstration, households in the demonstration sample had lower incomes and lower food security, on average, than households with eligible children nationally. INTERVENTION: Grantees provided selected households with benefits worth $60 per child per summer month using SNAP or WIC EBT systems. SNAP-model benefits covered most foods. WIC-model benefits could only be used for a specific package of foods. OUTCOME MEASURES: Key outcomes were children's food security (assessed using the US Department of Agriculture food security scale) and food consumption (assessed using food frequency questions). STATISTICAL ANALYSES: Differences in mean outcomes between the benefit and control groups measured impact, after adjusting for household characteristics. RESULTS: In WIC sites, benefit-group households redeemed a lower percentage of SEBTC benefits than in SNAP sites. Nonetheless, the benefit groups in both sets of sites had similar large reductions in very low food security among children, relative to no-benefit controls. Children receiving benefits consumed more healthful foods, and these impacts were larger in WIC sites. CONCLUSIONS: Results suggest the WIC SEBTC model deserves strong consideration.

Asunto(s)

Asistencia Alimentaria/estadística & datos numéricos , Abastecimiento de Alimentos/métodos , Política Nutricional , Pobreza/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/estadística & datos numéricos , Adolescente , Niño , Composición Familiar , Femenino , Humanos , Masculino , Pobreza/legislación & jurisprudencia , Distribución Aleatoria , Estaciones del Año , Estados Unidos

RESUMEN

INTRODUCTION: Solving the childhood obesity problem will require strategies for changes in policy, the environment, the community, and the family. Filling the data gap for children younger than 4 years could facilitate interventions aimed at this critical age group. The objective of this study was to describe parents' and caregivers' perceptions of the healthfulness of their young child's diet and body weight and to assess their adherence to the American Academy of Pediatrics' 5-2-1-0 recommendations. METHODS: We conducted a descriptive analysis of parents' and caregivers' survey data for 887 infants younger than 12 months, 925 toddlers aged 12 to 23.9 months, and 1,461 preschoolers aged 24 to 47.9 months. Data were from the national, cross-sectional 2008 Feeding Infants and Toddlers Study (FITS). RESULTS: Most parents considered their child's weight to be about right but were more likely to think their child was underweight (8%-9%) than overweight (2%-3%). Most parents thought their child consumed enough fruits and vegetables: however, only 30% of preschoolers met the recommendation for 5 daily servings. Only 2% of toddlers met the recommendation for no screen time, whereas 79% of preschoolers met the recommendation to limit daily screen time to 2 hours or less. About 56% of toddlers and 71% of preschoolers met the recommendation of at least 1 hour of daily outdoor play. About 56% of toddlers and 52% of preschoolers met the recommendation to limit consumption of sugar-sweetened beverages. CONCLUSION: The FITS 2008 findings underscore the ongoing need for research on policies and strategies to prevent childhood obesity from infancy through preschool. Health care providers can play a vital role because they are an important and early point of contact for parents.

Asunto(s)

Cuidadores/psicología , Dieta/psicología , Adhesión a Directriz , Actividad Motora , Padres/psicología , Bebidas , Lactancia Materna/estadística & datos numéricos , Cuidadores/estadística & datos numéricos , Fenómenos Fisiológicos Nutricionales Infantiles , Preescolar , Estudios Transversales , Dieta/normas , Métodos de Alimentación , Femenino , Humanos , Lactante , Masculino , Encuestas Nutricionales , Pediatría , Estados Unidos

RESUMEN

OBJECTIVE: To describe feeding practices and food consumption of infants and children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN: National, cross-sectional analysis of 24-hour dietary recall data from the 2008 Feeding Infants and Toddlers Study. PARTICIPANTS: Random sample of infants (6-11 months of age), toddlers (12-23 months of age), and preschoolers (24-47 months of age); WIC participants (n = 794) and nonparticipants (n = 2,477). MAIN OUTCOME MEASURES: Breastfeeding rates, introduction to solids, food consumption. ANALYSIS: Used weighted descriptive statistics, chi-square tests, and t tests to identify dietary outcomes unique to WIC participants vs nonparticipants. RESULTS: Compared with nonparticipants, fewer WIC infants were breastfed (P < .01) and consumed any vegetable (P < .05) but more consumed 100% juice (P < .05). Fewer WIC toddlers and preschoolers consumed any fruit vs nonparticipants (P < .01). The WIC toddlers were more likely to consume any sweet vs nonparticipants (P < .05), especially sugar-sweetened beverages (P < .01). Over 80% of all preschoolers consumed any sweet, and nearly half consumed sugar-sweetened beverages on an average day. CONCLUSIONS AND IMPLICATIONS: Findings identify feeding and dietary issues that begin during infancy and are also present in toddler and preschool stages. These findings are useful for WIC nutritionists and health care practitioners to encourage the early development of healthful eating patterns.

Asunto(s)

Conducta Alimentaria , Asistencia Alimentaria , Encuestas Nutricionales , Lactancia Materna , Niño , Preescolar , Estudios Transversales , Composición Familiar , Frutas , Humanos , Lactante , Factores Socioeconómicos , Estados Unidos/epidemiología , Verduras

RESUMEN

Although pediatric providers have traditionally assessed and treated childhood obesity and associated health-related conditions in the clinic setting, there is a recognized need to expand the provider role. We reviewed the literature published from 2005 to 2012 to (1) provide examples of the spectrum of roles that primary care providers can play in the successful treatment and prevention of childhood obesity in both clinic and community settings and (2) synthesize the evidence of important characteristics, factors, or strategies in successful community-based models. The review identified 96 articles that provide evidence of how primary care providers can successfully prevent and treat childhood obesity by coordinating efforts within the primary care setting and through linkages to obesity prevention and treatment resources within the community. By aligning the most promising interventions with recommendations published over the past decade by the Institute of Medicine, the American Academy of Pediatrics, and other health organizations, we present nine areas in which providers can promote the prevention and treatment of childhood obesity through efforts in clinical and community settings: weight status assessment and monitoring, healthy lifestyle promotion, treatment, clinician skill development, clinic infrastructure development, community program referrals, community health education, multisector community initiatives, and policy advocacy.

Asunto(s)

Servicios de Salud del Niño/normas , Servicios de Salud Comunitaria/normas , Obesidad Infantil/prevención & control , Obesidad Infantil/terapia , Servicios Preventivos de Salud/normas , Atención Primaria de Salud/normas , Niño , Servicios de Salud del Niño/organización & administración , Servicios de Salud Comunitaria/organización & administración , Conducta Cooperativa , Adhesión a Directriz , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud/normas , Humanos , Comunicación Interdisciplinaria , Modelos Organizacionales , Grupo de Atención al Paciente/normas , Educación del Paciente como Asunto , Obesidad Infantil/diagnóstico , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Servicios Preventivos de Salud/organización & administración , Atención Primaria de Salud/organización & administración , Desarrollo de Programa , Derivación y Consulta/normas , Conducta de Reducción del Riesgo , Resultado del Tratamiento

RESUMEN

Because childhood obesity is such a threat to the physical, mental, and social health of youth, there is a great need to identify effective strategies to reduce its prevalence. The objective of this study was to estimate the mean calories from added sugars that are saved by switching sugar-sweetened beverages (including soda, fruit-flavored drinks, and sport drinks) and flavored milks consumed to unflavored low-fat milk (<1% fat) at meals and water between meals. Simulation analyses used 24-hour dietary recall data from the third School Nutrition Dietary Assessment Study (n=2,314), a 2005 national cross-sectional study of schools and students participating in the National School Lunch Program, to estimate changes in mean calories from added sugars both at and away from school. Overall, these changes translated to a mean of 205 calories or a 10% savings in energy intake across all students (8% among children in elementary school and 11% in middle and high schools). Eighty percent of the daily savings were attributed to beverages consumed away from school, with results consistent across school level, sex, race/ethnicity, and weight status. Children's consumption of sugar-sweetened beverages at home contributed the greatest share of empty calories from added sugars. Such findings indicate that parental education should focus on the importance of reducing or eliminating sugar-sweetened beverages served at home. This conclusion has implications for improving children's food and beverage environments for food and nutrition educators and practitioners, other health care professionals, policy makers, researchers, and parents.

Asunto(s)

Dieta Reductora , Sacarosa en la Dieta/administración & dosificación , Ingestión de Energía/efectos de los fármacos , Política Nutricional , Obesidad/prevención & control , Edulcorantes/administración & dosificación , Adolescente , Bebidas , Niño , Fenómenos Fisiológicos Nutricionales Infantiles/fisiología , Estudios Transversales , Sacarosa en la Dieta/efectos adversos , Relación Dosis-Respuesta a Droga , Ingestión de Energía/fisiología , Femenino , Servicios de Alimentación , Humanos , Masculino , Obesidad/epidemiología , Obesidad/etiología , Instituciones Académicas , Edulcorantes/efectos adversos , Estados Unidos

RESUMEN

OBJECTIVE: Describe the study design, data collection methods, 24-hour dietary recall protocol, and sample characteristics of the Feeding Infants and Toddlers Study (FITS) 2008. DESIGN: A cross-sectional study designed to obtain information on the diets and feeding patterns of US infants, toddlers, and preschoolers ages birth to 47 months. Telephone interviews with parents and caregivers were conducted from June 2008 through January 2009 and included a household interview to recruit the household and collect information on household and child demographics and nutrition-related characteristics, and a dietary interview, including a 24-hour dietary recall collected using the 2008 Nutrition Data System for Research. A second dietary recall was collected on a random subsample to estimate usual nutrient intake distributions. Data collection instruments were built on those used in FITS 2002, with expanded survey content to address emerging issues in childhood nutrition and obesity. The dietary protocol was improved to increase reporting accuracy on portion sizes, and a bridging study was conducted to test effects of the changes in the food model booklet and protocol since FITS 2002 (n=240 cases aged 4 to 23 months). SUBJECTS: A national random sample of 3,273 infants, toddlers, and preschoolers from birth up to age 4 years, with 2 days of dietary intake data for 701 cases. RESULTS: Among sampled households with an age-eligible child, the response rate was 60% for the recruitment interview. Of recruited households, the response rate for the dietary interview was 78%. CONCLUSIONS: The FITS 2008 provides rigorous, well-tested methods and survey questions for nutrition researchers to use in other dietary studies of young children. FITS 2008 findings on the food and nutrient intakes of US children from birth up to age 4 years can inform dietetics practitioners, pediatric health practitioners, and policymakers about the dietary issues of young children.

Asunto(s)

Dieta/estadística & datos numéricos , Diseño de Investigaciones Epidemiológicas , Conducta Alimentaria , Encuestas Nutricionales/métodos , Fenómenos Fisiológicos Nutricionales Infantiles , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Fenómenos Fisiológicos Nutricionales del Lactante , Recién Nacido , Masculino , Recuerdo Mental , Estados Unidos

RESUMEN

OBJECTIVES: To assess the usual nutrient intakes of 3,273 US infants, toddlers, and preschoolers, aged 0 to 47 months, surveyed in the Feeding Infants and Toddlers Study (FITS) 2008; and to compare data on the usual nutrient intakes for the two waves of FITS conducted in 2002 and 2008. DESIGN: The FITS 2008 is a cross-sectional survey of a national random sample of US children from birth through age 47 months. Usual nutrient intakes derived from foods, beverages, and supplements were ascertained using a telephone-administered, multiple-pass 24-hour dietary recall. SUBJECTS: Infants aged birth to 5 months (n=382) and 6 to 11 months (n=505), toddlers aged 12 to 23 months (n=925), and preschoolers aged 24 to 47 months (n=1,461) were surveyed. METHODS: All primary caregivers completed one 24-hour dietary recall and a random subsample (n=701) completed a second 24-hour dietary recall. The personal computer version of the Software for Intake Distribution Estimation was used to estimate the 10th, 25th, 50th, 75th, and 90th percentiles, as well as the proportions below and above cutoff values defined by the Dietary Reference Intakes or the 2005 Dietary Guidelines for Americans. RESULTS: Usual nutrient intakes met or exceeded energy and protein requirements with minimal risk of vitamin and mineral deficiencies. The usual intakes of antioxidants, B vitamins, bone-related nutrients, and other micronutrients were adequate relative to the Adequate Intakes or Estimated Average Requirements, except for iron and zinc in a small subset of older infants, and vitamin E and potassium in toddlers and preschoolers. Intakes of synthetic folate, preformed vitamin A, zinc, and sodium exceeded Tolerable Upper Intake Level in a significant proportion of toddlers and preschoolers. Macronutrient distributions were within acceptable macronutrient distribution ranges, except for dietary fat, in some toddlers and preschoolers. Dietary fiber was low in the vast majority of toddlers and preschoolers, and saturated fat intakes exceeded recommendations for the majority of preschoolers. The prevalence of inadequate intakes, excessive intake, and intakes outside the acceptable macronutrient distribution range was similar in FITS 2002 and FITS 2008. CONCLUSIONS: In FITS 2008, usual nutrient intakes were adequate for the majority of US infants, toddlers, and preschoolers, except for a small but important number of infants at risk for inadequate iron and zinc intakes. Diet quality should be improved in the transition from infancy to early childhood, particularly with respect to healthier fats and fiber in the diets of toddlers and preschoolers.

Asunto(s)

Fenómenos Fisiológicos Nutricionales Infantiles/fisiología , Fenómenos Fisiológicos Nutricionales del Lactante/fisiología , Evaluación Nutricional , Política Nutricional , Necesidades Nutricionales , Preescolar , Estudios Transversales , Dieta/estadística & datos numéricos , Grasas de la Dieta/administración & dosificación , Fibras de la Dieta/administración & dosificación , Suplementos Dietéticos/estadística & datos numéricos , Ingestión de Energía/fisiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Micronutrientes/administración & dosificación , Micronutrientes/deficiencia , Encuestas Nutricionales , Estados Unidos , Destete

RESUMEN

OBJECTIVES: To describe current infant-feeding practices and current food group consumption patterns of infants and toddlers and to compare 2008 data with 2002 data to identify shifts in these practices and food consumption over time. DESIGN: The Feeding Infants and Toddlers Study (FITS) 2008 is a cross-sectional survey of a national random sample of US children from birth up to age 4 years. Data for three age subgroups (infants 4 to 5.9 months and 6 to 11.9 months and toddlers 12 to 23.9 months) were used from the 2002 (n=2,884) and 2008 surveys (n=1,596). STATISTICAL METHODS: All analyses use sample weights that reflect the US population aged 4 to 24 months. Descriptive statistics (means, proportions, and standard errors) and t tests were calculated using SUDAAN (release 9, 2005, Research Triangle Park Institute, Research Triangle Park, NC). RESULTS: These data show a higher percentage of infants receiving breast milk from 4 to 11.9 months of age with a concurrent decreasing percentage of infants receiving formula, which is significantly different from data for the 9- to 11.9-month-old age group. The use of complementary foods also appears to be delayed in FITS 2008: There is a significantly lower proportion of infants consuming infant cereal at 9 to 11.9 months in FITS 2008 compared to 2002 data. Fruit and vegetable consumption remains lower than desired. Significant reductions in the percentage of infants and toddlers consuming any desserts or candy, sweetened beverages, and salty snacks were seen in 2008. CONCLUSIONS: The findings presented here provide important insights to the content of messages and types of interventions that are still needed to improve the diets of infants and toddlers.

Asunto(s)

Lactancia Materna/estadística & datos numéricos , Dieta/estadística & datos numéricos , Dieta/tendencias , Conducta Alimentaria , Destete , Fenómenos Fisiológicos Nutricionales Infantiles , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Alimentos Infantiles/estadística & datos numéricos , Fórmulas Infantiles , Fenómenos Fisiológicos Nutricionales del Lactante , Recién Nacido , Masculino , Encuestas Nutricionales

Asunto(s)

Fenómenos Fisiológicos Nutricionales Infantiles/fisiología , Dieta , Conductas Relacionadas con la Salud , Fenómenos Fisiológicos Nutricionales del Lactante/fisiología , Preescolar , Encuestas sobre Dietas , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estados Unidos

RESUMEN

OBJECTIVE: To describe the food consumption patterns of US children aged 2 and 3 years. DESIGN: Descriptive analysis of data collected in the Feeding Infants and Toddlers Study 2008 based on a single 24-hour dietary recall collected by telephone. SUBJECTS: A national random sample of children aged 2 and 3 years (n=1,461). STATISTICAL ANALYSES PERFORMED: The percentage of children consuming foods from specific food groups was estimated for the full sample of children aged 2 and 3 years and separately by year of age. RESULTS: About a third of 2-year-olds and a quarter of 3-year-olds consumed whole milk at least once in a day. About 70% of 2- and 3-year-olds consumed vegetables as a distinct food item at least once in day. French fries and other fried potatoes were the most commonly consumed vegetable. Almost three quarters of children (73%) consumed fruit as a distinct food item at least once in a day, and 59% consumed 100% juice. Fresh fruit was the most commonly consumed type of fruit. About 85% of children consumed some type of sweetened beverage, dessert, sweet, or salty snack in a day. Percentages of children consuming such foods were consistently higher for 3-year-olds than for 2-year-olds. CONCLUSIONS: Parents and caregivers should be encouraged to expose young children to a wide variety of fruits and vegetables, whole grains, low-fat dairy products, and healthier fats, and to limit consumption of low-nutrient, energy-dense foods and beverages. Dietary guidance should stress the fact that children in this age group have high nutrient needs and relatively low energy requirements, leaving little room for such foods. Parents need advice that is specific, practical, and actionable.

Asunto(s)

Fenómenos Fisiológicos Nutricionales Infantiles/fisiología , Dieta , Grasas de la Dieta/administración & dosificación , Sacarosa en la Dieta/administración & dosificación , Necesidades Nutricionales , Bebidas/estadística & datos numéricos , Preescolar , Estudios Transversales , Productos Lácteos , Dieta/estadística & datos numéricos , Dieta/tendencias , Ingestión de Energía/fisiología , Femenino , Preferencias Alimentarias/fisiología , Frutas , Humanos , Masculino , Política Nutricional , Encuestas Nutricionales , Estados Unidos , Verduras

RESUMEN

OBJECTIVE: To examine the distribution of diabetic medications among adults with type 2 diabetes, and the association between glucose control and treatment approach in the US population. METHODS: Interview and prescription medication data from the 1999-2004 National Health and Nutrition Examination Survey (NHANES) were used to determine the treatment approach for US adults with type 2 diabetes. Mean glycosylated hemoglobin (HbA1c) and the proportion of adults meeting recommended guidelines for glucose control were estimated for each treatment approach. The most important study limitation was that participants were not asked what type of diabetes they had. Among adults with diabetes, a classification algorithm was used to identify those with type 2 diabetes. RESULTS: During 1999-2004, approximately 60% of adults with type 2 diabetes used oral agents only to manage their diabetes. The distribution of oral treatment therapies changed over time (p < 0.01); the most prevalent treatment shifted from sulfonylurea monotherapy in 1999-2000 (23.0%) to any oral agent regimen containing thiazolidinedione (TZD) in 2003-2004 (21.4%). Overall, only 52.2% of adults with type 2 diabetes met the American Diabetes Association (ADA) goal for HbA1c control (<7.0%) during 1999-2004. Across oral agent treatment categories, the proportion with HbA1c controlled at the 7.0 level was significantly lower (p < 0.01) for those on triple therapy (31.9%) (TZD, sulfonylurea, and metformin), than those on metformin alone (62.2%), likely reflecting a progressive treatment approach of prescribing additional medications for those with uncontrolled HbA1c levels. CONCLUSIONS: Use of multiple oral agents among adults with type 2 diabetes has increased (sulfonylurea and metformin, p = 0.03, triple therapy, p = 0.02). However, nearly half of adults with type 2 diabetes have HbA1c levels above ADA guidelines for control, indicating that available treatments could be used more optimally, and new diabetic agents may be needed.

Asunto(s)

Bases de Datos Factuales , Diabetes Mellitus Tipo 2/terapia , Hemoglobina Glucada/metabolismo , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/etnología , Femenino , Humanos , Hipoglucemiantes/administración & dosificación , Insulina/administración & dosificación , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Sobrepeso/epidemiología , Estados Unidos/epidemiología , Adulto Joven

Asunto(s)

Fenómenos Fisiológicos Nutricionales Infantiles/fisiología , Dieta/normas , Servicios de Alimentación/normas , Política Nutricional , Instituciones Académicas , Adolescente , Animales , Niño , Preescolar , Estudios Transversales , Ambiente , Femenino , Promoción de la Salud , Humanos , Masculino , Planificación de Menú , Valor Nutritivo , Obesidad/epidemiología , Obesidad/etiología , Obesidad/prevención & control , Estados Unidos/epidemiología

RESUMEN

BACKGROUND: Changes to school food environments and practices that lead to improved dietary behavior are a powerful strategy to reverse the childhood obesity epidemic. OBJECTIVES: To estimate the effects of school food environments and practices, characterized by access to competitive foods and beverages, school lunches, and nutrition promotion, on children's consumption of sugar-sweetened beverages, low-nutrient energy-dense foods, and fruits/vegetables at school. DESIGN: Cross-sectional study using data from the third School Nutrition Dietary Assessment Study, a nationally representative sample of public school districts, schools, and children in school year 2004-2005. Data from school principals and foodservice directors, school menu analysis, and on-site observations were used to characterize school food environments and practices. Dietary intake was assessed using 24-hour recalls. SUBJECTS/SETTING: The sample consists of 287 schools and 2,314 children in grades one through 12. STATISTICAL ANALYSES PERFORMED: Ordinary least squares regression was used to identify the association between school food environments and practices (within elementary, middle, and high schools) and dietary outcomes, controlling for other school and child/family characteristics. RESULTS: Sugar-sweetened beverages obtained at school contributed a daily mean of 29 kcal in middle school children and 46 kcal in high school children across all school children. Attending a school without stores or snack bars was estimated to reduce sugar-sweetened beverage consumption by 22 kcal per school day in middle school children (P<0.01) and by 28 kcal in high school children (P<0.01). The lack of a pouring rights contract in a school reduced sugar-sweetened beverage consumption by 16 kcal (P<0.05), and no à la carte offerings in a school reduced consumption by 52 kcal (P<0.001) in middle school children. The most effective practices for reducing energy from low-energy, energy-dense foods were characteristics of the school meal program; not offering french fries reduced low-nutrient, energy-dense foods consumption by 43 kcal in elementary school children (P<0.01) and sugar-sweetened beverage consumption by 41 kcal in high school children (P<0.001). CONCLUSIONS: To improve children's diet and reduce obesity continued changes to school food environments and practices are essential. Removing sugar-sweetened beverages from school food stores and snack bars, improving à la carte choices, and reducing the frequency of offering french fries merit testing as strategies to reduce energy from low-nutrient, energy-dense foods at school.

Asunto(s)

Fenómenos Fisiológicos Nutricionales Infantiles/fisiología , Dieta/normas , Ingestión de Energía/fisiología , Ambiente , Servicios de Alimentación/normas , Instituciones Académicas , Adolescente , Animales , Bebidas/efectos adversos , Niño , Preescolar , Estudios Transversales , Grasas de la Dieta/administración & dosificación , Grasas de la Dieta/efectos adversos , Ingestión de Alimentos/fisiología , Femenino , Distribuidores Automáticos de Alimentos/estadística & datos numéricos , Humanos , Masculino , Valor Nutritivo , Obesidad/epidemiología , Obesidad/prevención & control , Estados Unidos

RESUMEN

BACKGROUND: Access to foods and beverages on school campuses, at home, and other locations affects children's diet quality, energy intake, and risk of obesity. OBJECTIVES: To describe patterns of consumption of "empty calories"--low-nutrient, energy-dense foods, including sugar-sweetened beverages--by eating location among National School Lunch Program (NSLP) participants and nonparticipants. DESIGN: Cross-sectional study using 24-hour dietary recall data from the 2004-2005 third School Nutrition Dietary Assessment Study. SUBJECTS/SETTING: A nationally representative sample of 2,314 children in grades one through 12, including 1,386 NSLP participants. STATISTICAL ANALYSES PERFORMED: Comparisons, using t tests, of the proportion of children consuming low-nutrient, energy-dense foods and beverages, mean daily energy and energy from low-nutrient, energy-dense foods, and energy density by NSLP participation status. RESULTS: On a typical school day, children consumed 527 "empty calories" during a 24-hour period. Eating at home provided the highest mean amount of energy from low-nutrient, energy-dense foods (276 kcal vs 174 kcal at school and 78 kcal at other locations). NSLP participants consumed less energy from sugar-sweetened beverages at school than nonparticipants (11 kcal vs 39 kcal in elementary schools and 45 kcal vs 61 kcal in secondary schools, P<0.01), but more energy from low-nutrient, energy-dense solid foods such as french fries and higher-fat baked goods in secondary schools (157 kcal vs 127 kcal, P<0.01). Participants were not more likely to consume sugar-sweetened beverages or low-nutrient, energy-dense foods at home or other locations. School lunch participants' consumption at school was less energy-dense than nonparticipants' consumption at school (P<0.01). Energy density was highest for consumption at locations away from home and school. CONCLUSIONS: Improving home eating behaviors, where the largest proportion of total daily and energy from low-nutrient, energy-dense foods are consumed (especially from sugar-sweetened beverages, chips, and baked goods) is warranted. At schools, consumption of energy from low-nutrient, energy-dense foods may be reduced by limiting access to competitive foods and beverages, enforcing strong school wellness policies, and minimizing the frequency of offering french fries and similar potato products and higher-fat baked goods in school meals or à la carte.

Asunto(s)

Fenómenos Fisiológicos Nutricionales Infantiles/fisiología , Dieta/normas , Ingestión de Energía/fisiología , Servicios de Alimentación/normas , Obesidad/epidemiología , Instituciones Académicas , Adolescente , Bebidas , Niño , Preescolar , Estudios Transversales , Grasas de la Dieta/administración & dosificación , Grasas de la Dieta/efectos adversos , Sacarosa en la Dieta/administración & dosificación , Sacarosa en la Dieta/efectos adversos , Ingestión de Alimentos/fisiología , Femenino , Alimentos/clasificación , Alimentos/normas , Humanos , Masculino , Encuestas Nutricionales , Valor Nutritivo , Obesidad/etiología , Estados Unidos

Asunto(s)

Dieta , Grasas de la Dieta/administración & dosificación , Dietética/métodos , Evaluación Nutricional , Dieta/etnología , Dieta/psicología , Dieta/tendencias , Dietética/tendencias , Composición Familiar , Conducta Alimentaria/etnología , Conducta Alimentaria/psicología , Conductas Relacionadas con la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Política Nutricional , Estados Unidos

RESUMEN

This review focuses on dietary intake and dietary supplement use among the U.S. population age 1-74 based on four National Health and Nutrition Examination Surveys conducted in 1971-74, 1976-80, 1988-94, and 1999-2000. Secular trends in intake of energy, macronutrients, cholesterol, sodium, calcium, iron, folate, zinc, vitamins A and C, fruits, vegetables, and grain products are summarized. During the 30-year period, mean energy intake increased among adults, and changed little among children age 1-19, except for an increase among adolescent females. Factors contributing to increases in energy intake include increases in the percentage of the population eating away from home (particularly at fast-food restaurants), larger portion sizes of foods and beverages, increased consumption of sweetened beverages, changes in snacking habits, and improved dietary methodology. Dietary supplement use increased among adult men and women, decreased among children age 1-5, and was stable for children age 6-11 and adolescents.

Asunto(s)

Dieta/tendencias , Ingestión de Energía , Conducta Alimentaria , Encuestas Nutricionales , Adolescente , Adulto , Anciano , Niño , Preescolar , Suplementos Dietéticos , Femenino , Preferencias Alimentarias , Humanos , Lactante , Masculino , Persona de Mediana Edad , Restaurantes , Estados Unidos