Hot Papers in the Literature

Effects of a low glycemic load or a low-fat dietary intervention on body weight in obese Hispanic American children and adolescents: A randomized controlled trial

Am J Clin Nutr. 2013 Feb;97(2):276–285.

Mirza NM, Palmer MG, Sinclair KB, McCarter R, He J, Ebbeling CB, Ludwig DS, Yanovski JA.

Background: In Hispanic children and adolescents, the prevalence of obesity and insulin resistance is considerably greater than in non-Hispanic white children. A low-glycemic load diet (LGD) has been proposed as an effective dietary intervention for pediatric obesity, but to our knowledge, no published study has examined the effects of an LGD in obese Hispanic children.

Objective: We compared the effects of an LGD and a low-fat diet (LFD) on body composition and components of metabolic syndrome in obese Hispanic youth.

Design: Obese Hispanic children (7–15 y of age) were randomly assigned to consume an LGD or an LFD in a 2-y intervention program. Body composition and laboratory assessments were obtained at baseline and 3, 12, and 24 mo after intervention.

Results: In 113 children who were randomly assigned, 79% of both groups completed 3 mo of treatment; 58% of LGD and 55% of LFD subjects attended 24-mo follow-up. Compared with the LFD, the LGD decreased the glycemic load per kilocalories of reported food intakes in participants at 3 mo (P=0.02). Both groups had a decreased BMI z score (P<0.003), which was expressed as a standard z score relative to CDC age- and sex-specific norms, and improved waist circumference and systolic blood pressure (P<0.05) at 3, 12, and 24 mo after intervention. However, there were no significant differences between groups for changes in BMI, insulin resistance, or components of metabolic syndrome (all P>0.5).

Conclusions: We showed no evidence that an LGD and an LFD differ in efficacy for the reduction of BMI or aspects of metabolic syndrome in obese Hispanic youth. Both diets decreased the BMI z score when prescribed in the context of a culturally adapted, comprehensive weight-reduction program. This trial was registered at clinicaltrials.gov as NCT01068197.

PMID: 23255569 [PubMed - in process]

PMCID: PMC3545680 [Available on 2014/2/1]

Walkable communities and adolescent weight

Am J Prev Med. 2013 Feb;44(2):164–168.

Slater SJ, Nicholson L, Chriqui J, Barker DC, Chaloupka FJ, Johnston LD.

Background: Neighborhood design features have been associated with health outcomes, including the prevalence of obesity.

Purpose: This study examined the association between walkability and adolescent weight in a national sample of public secondary school students and the communities in which they live.

Methods: Data were collected through student surveys and community observations between February and August 2010, and analyses were conducted in Spring 2012. The sample size was 154 communities and 11,041 students. A community walkability index and measures of the prevalence of adolescent overweight and obesity were constructed. Multivariable analyses from a cross-sectional survey of a nationally representative sample of 8th-, 10th- and 12th-grade public school students in the U.S. were run.

Results: The odds of students being overweight (AOR 0.98, 95% CI=0.95, 0.99) or obese (AOR=0.97, 95% CI=0.95, 0.99) decreased if they lived in communities with higher walkability index scores.

Conclusions: Results suggest that living in more-walkable communities is associated with reduced prevalence of adolescent overweight and obesity.

PMID: 23332334 [PubMed - in process]

PMCID: PMC3553501 [Available on 2014/2/1]

Understanding contextual barriers, supports, and opportunities for physical activity among Mexican-origin children in Texas border colonias: A descriptive study

BMC Public Health. 2013 Jan 8;13(1):14. [Epub ahead of print]

Meyer MR, Sharkey JR, Patterson MS, Dean WR.

Background: The increasing numbers of colonias along the U.S.–Mexico border are characterized by disproportionately poor families of Mexican-origin, limited access to resources and health services, and heightened risk for obesity and diabetes. Despite consistent evidence supporting physical activity (PA) in prevention of chronic diseases, many individuals of Mexican-origin, including children, fail to meet PA recommendations. Environmental influences on PA, founded in ecological and social cognitive perspectives, have not been examined among children living in colonias. The purpose of this study was to identify and better understand (1) household and neighborhood environmental PA resources/supports, (2) perceived barriers to engaging in PA, and (3) PA offerings, locations, and transportation characteristics for Mexican-origin children living in colonias.

Methods: Data for this study were collected by promotora-researchers (indigenous community health workers trained in research methods) using face-to-face interviews conducted in Spanish. The sample consists of 94 mother–child dyads from Texas border colonias in Hidalgo County. Interviews included questionnaire items addressing PA barriers, household and neighborhood environmental support assessments conducted with each dyad, and open-ended questions that were coded to identify availability and locations of PA opportunities and transportation options. Descriptive statistics were calculated and differences between genders, birth countries, and BMI categories of children were determined using chi-square tests.

Results: All children were of Mexican-origin. The most frequently reported barriers were unleashed dogs in the street, heat, bad weather, traffic, no streetlights, and no place like a park to exercise. Prominent locations for current PA included schools, home, and parks. Common PA options for children were exercise equipment, running, playing, and sports. Environmental assessments identified exercise equipment (bicycles/tricycles, balls, etc..), paved/good streets, yard/patio space, and social norms as the most frequent household or neighborhood resources within these colonias. Differences in PA barriers, options, and environmental resources for genders, birth countries, and BMI categories were detected.

Conclusions: This study suggests that PA environmental resources, barriers, and opportunities for colonias children are similar to previous studies and distinctively unique. As expected, built resources in these communities are limited and barriers exist; however, knowledge of PA opportunities and available PA resources within colonias households and neighborhoods offers insight to help guide future research, policy, and PA initiatives.

PMID: 23297793 [PubMed - as supplied by publisher]

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

BMC Public Health. 2013 Jan 28;13(1):78. [Epub ahead of print]

Natale R, Scott SH, Messiah SE, Schrack MM, Uhlhorn SB, Delamater A.

Background: Many unhealthy dietary and physical activity habits that foster the development of obesity are established by the age of five. Presently, approximately 70 percent of children in the United States are currently enrolled in early childcare facilities, making this an ideal setting to implement and evaluate childhood obesity prevention efforts. We describe here the methods for conducting an obesity prevention randomized trial in the child care setting.

Methods/design: A randomized, controlled obesity prevention trial is currently being conducted over a three year period (2010–present). The sample consists of 28 low-income, ethnically diverse child care centers with 1105 children (sample is 60% Hispanic, 15% Haitian, 12% Black, 2% non-Hispanic White and 71% of caregivers were born outside of the US). The purpose is to test the efficacy of a parent and teacher role-modeling intervention on children's nutrition and physical activity behaviors. The Healthy Caregivers-Healthy Children (HC2) intervention arm schools received a combination of (1) implementing a daily curricula for teachers/parents (the nutritional gatekeepers); (2) implementing a daily curricula for children; (3) technical assistance with meal and snack menu modifications such as including more fresh and less canned produce; and (4) creation of a center policy for dietary requirements for meals and snacks, physical activity and screen time. Control arm schools received an attention control safety curriculum. Major outcome measures include pre-post changes in child body mass index percentile and z score, fruit and vegetable and other nutritious food intake, amount of physical activity, and parental nutrition and physical activity knowledge, attitudes, and beliefs, defined by intentions and behaviors. All measures were administered at the beginning and end of the school year for year one and year two of the study for a total of 4 longitudinal time points for assessment.

Discussion: Although few attempts have been made to prevent obesity during the first years of life, this period may represent the best opportunity for obesity prevention. Findings from this investigation will inform both the fields of childhood obesity prevention and early childhood research about the effects of an obesity prevention program housed in the childcare setting.

Trial registration: Trial registration number: NCT01722032.

PMID: 23356862 [PubMed - as supplied by publisher]

Evaluating the implementation of expert committee recommendations for obesity assessment

Clin Pediatr (Phila). 2013 Feb;52(2):131–138.

Sharifi M, Rifas-Shiman SL, Marshall R, Simon SR, Gillman MW, Finkelstein JA, Taveras EM.

The increasing prevalence of childhood overweight/obesity and their associated morbidities are well established, yet rates of diagnosis and screening for related conditions by clinicians are low. Expert Committee recommendations were released in 2007 to facilitate management of pediatric overweight/obesity. From well-child visits to a Massachusetts multisite group practice, we randomly selected 1 visit per child in 2006 (n=56 374) and in 2008 (n=69 681) and used electronic health record data to identify children with incident overweight or obesity (BMI ≥85th percentile) and ascertained whether clinicians assigned relevant ICD-9 (International Classification of Diseases, Ninth Revision) codes and ordered laboratory tests recommended for children ≥10 years old. In the year following the release of recommendations, a large majority of children 2 to 17 years old with a BMI ≥85th percentile lack diagnosis codes for overweight/obesity and recommended laboratory orders for assessment of obesity-related comorbidities for children 10 years and older, suggesting the need to augment current approaches to increase uptake of guidelines.

PMID: 23378479 [PubMed - in process]

Reducing calories and added sugars by improving children's beverage choices

J Acad Nutr Diet. 2013 Feb;113(2):269–275.

Briefel RR, Wilson A, Cabili C, Hedley Dodd A.

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.

PMID: 23351631 [PubMed - in process]

Development and feasibility of an objective measure of patient-centered communication fidelity in a pediatric obesity intervention

J Nutr Educ Behav. 2013 Feb 7. pii: S1499-4046(12)00666-5. doi: 10.1016/j.jneb.2012.10.006. [Epub ahead of print]

Ledoux T, Hilmers A, Watson K, Baranowski T, O'Connor TM.

Objective: To develop a measure of person-centered communication (PCC) and demonstrate feasibility for use in primary care child obesity interventions.

Methods: Helping Healthy Activity and Nutrition Directions was a primary care intervention for families of overweight or obese 5- to 8-year-old children. The PCC Coding System (PCCCS) was based on theory and a validated motivational interviewing instrument. The PCCCS provided global scores, and total, positive, and negative PCC utterance frequencies. Three trained coders tested reliability of the PCCCS on audio recordings of sessions with 30 families. Potential uses of the PCCCS were demonstrated.

Results: The PCCCS demonstrated good inter-rater reliability for utterance frequencies but not for global scores.

Conclusions and implications: The PCCCS is a reliable and feasible measure of PCC utterances. More research is needed to improve inter-rater reliability of the PCC global scale. The PCCCS may be used in the future to test fidelity of PCC interventions.

PMID: 23395302 [PubMed - as supplied by publisher]

CHILE: An evidence-based preschool intervention for obesity prevention in Head Start

J Sch Health. 2013 Mar;83(3):223–229.

Davis SM, Sanders SG, FitzGerald CA, Keane PC, Canaca GF, Volker-Rector R.

Background: Obesity is a major concern among American Indians and Hispanics. The Child Health Initiative for Lifelong Eating and Exercise (CHILE) is an evidence-based intervention to prevent obesity in children enrolled in 16 Head Start (HS) Centers in rural communities. The design and implementation of CHILE are described.

Methods: CHILE uses a socioecological approach to improve dietary intake and increase physical activity. The intervention includes: a classroom curriculum; teacher and food service training; family engagement; grocery store participation; and health care provider support.

Results: Lessons learned from CHILE include the need to consider availability of recommended foods; the necessity of multiple training sessions for teachers and food service; the need to tailor the family events to local needs; consideration of the profit needs of grocery stores; and sensitivity to the time constraints of health care providers.

Conclusions: HS can play an important role in preventing obesity in children. CHILE is an example of a feasible intervention that addresses nutrition and physical activity for preschool children that can be incorporated into HS curricula and aligns with HS national performance standards.

PMID: 23343323 [PubMed - in process]

PMCID: PMC3556909 [Available on 2014/3/1]

Collaborative school-based obesity interventions: Lessons learned from 6 southern districts

J Sch Health. 2013 Mar;83(3):213–222.

Jain A, Langwith C.

Background: Although studies have shown that school-based obesity interventions can be effective, little is known about how to translate and implement programs into real-world school settings.

Methods: Semistructured interviews were conducted in spring 2012 with 19 key informants who participated in a multifaceted childhood obesity intervention involving school nurses and wellness coordinators in 6 school districts and over 100 schools.

Results: The intervention changed form according to the needs and interests of the school districts. Despite funding support, schools and nurses had little capacity to address childhood obesity without the help of the coordinator. Initiating programs at the beginning of the school year was particularly difficult for schools. Applying for grants from internal and external sources and assisting with planning and logistics for wellness activities were significant activities of the coordinator. Although some school personnel and families preferred a focus on wellness rather than obesity, those working with individual at-risk children and families found the experience especially gratifying.

Conclusions: In contrast to controlled studies, real-world implementation of obesity interventions in schools that are intended to create sustained change requires flexibility in intervention design, timing, and personnel. A single change agent focused on obesity-related activities was essential to success.

PMID: 23343322 [PubMed - in process]

Management of newly diagnosed Type 2 Diabetes Mellitus (T2DM) in children and adolescents

Pediatrics. 2013 Feb;131(2):364–382.

Copeland KC, Silverstein J, Moore KR, Prazar GE, Raymer T, Shiffman RN, Springer SC, Thaker VV, Anderson M, Spann SJ, Flinn SK.

Over the past 3 decades, the prevalence of childhood obesity has increased dramatically in North America, ushering in a variety of health problems, including type 2 diabetes mellitus (T2DM), which previously was not typically seen until much later in life. The rapid emergence of childhood T2DM poses challenges to many physicians who find themselves generally ill-equipped to treat adult diseases encountered in children. This clinical practice guideline was developed to provide evidence-based recommendations on managing 10- to 18-year-old patients in whom T2DM has been diagnosed. The American Academy of Pediatrics (AAP) convened a Subcommittee on Management of T2DM in Children and Adolescents with the support of the American Diabetes Association, the Pediatric Endocrine Society, the American Academy of Family Physicians, and the Academy of Nutrition and Dietetics (formerly the American Dietetic Association). These groups collaborated to develop an evidence report that served as a major source of information for these practice guideline recommendations. The guideline emphasizes the use of management modalities that have been shown to affect clinical outcomes in this pediatric population. Recommendations are made for situations in which either insulin or metformin is the preferred first-line treatment of children and adolescents with T2DM. The recommendations suggest integrating lifestyle modifications (ie, diet and exercise) in concert with medication rather than as an isolated initial treatment approach. Guidelines for frequency of monitoring hemoglobin A1c (HbA1c) and finger-stick blood glucose (BG) concentrations are presented. Decisions were made on the basis of a systematic grading of the quality of evidence and strength of recommendation. The clinical practice guideline underwent peer review before it was approved by the AAP. This clinical practice guideline is not intended to replace clinical judgment or establish a protocol for the care of all children with T2DM, and its recommendations may not provide the only appropriate approach to the management of children with T2DM. Providers should consult experts trained in the care of children and adolescents with T2DM when treatment goals are not met or when therapy with insulin is initiated. The AAP acknowledges that some primary care clinicians may not be confident of their ability to successfully treat T2DM in a child because of the child's age, coexisting conditions, and/or other concerns. At any point at which a clinician feels he or she is not adequately trained or is uncertain about treatment, a referral to a pediatric medical subspecialist should be made. If a diagnosis of T2DM is made by a pediatric medical subspecialist, the primary care clinician should develop a comanagement strategy with the subspecialist to ensure that the child continues to receive appropriate care consistent with a medical home model in which the pediatrician partners with parents to ensure that all health needs are met.

PMID: 23359574 [PubMed - in process]

Association of beverage consumption with obesity in Mexican American children

Public Health Nutr. 2013 Jan 11:1–7. [Epub ahead of print]

Beck AL, Tschann J, Butte NF, Penilla C, Greenspan LC.

Objective: To determine the association of beverage consumption with obesity in Mexican American school-aged children.

Design: Cross-sectional study using the baseline data from a cohort study. Mothers and children answered questions about the frequency and quantity of the child's consumption of soda, diet soda, other sugar-sweetened beverages, 100 % fruit juice, milk and water. The questions were adapted from the Youth/Adolescent FFQ. Children were weighed and measured. Data were collected on the following potential confounders: maternal BMI, household income, maternal education, maternal occupational status, maternal acculturation, child physical activity, child screen time and child fast-food consumption. Logistic regression was used to examine the association between servings (240 ml) of each beverage per week and obesity (BMI ≥95th percentile).

Setting: Participants were recruited from among enrolees of the Kaiser Permanente Health Plan of Northern California. Data were collected via an in-home assessment.

Subjects: Mexican American children (n 319) aged 8–10 years.

Results: Among participants, 20% were overweight and 31% were obese. After controlling for potential confounders, consuming more servings of soda was associated with increased odds of obesity (OR=1.29; P<0.001). Consuming more servings of flavoured milk per week was associated with lower odds of obesity (OR=0.88; P=0.004). Consumption of other beverages was not associated with obesity in the multivariate model.

Conclusions: Discouraging soda consumption among Mexican American children may help reduce the high obesity rates in this population.

PMID: 23308395 [PubMed - as supplied by publisher]