What are the key food groups to target for preventing obesity and improving nutrition in schools?

OBJECTIVE: To determine differences in the contribution of foods and beverages to energy consumed in and out of school, and to compare consumption patterns between school canteen users and noncanteen users. DESIGN: Cross-sectional National Nutrition Survey, 1995. SETTING: Australia. SUBJECTS ON SCHOOL DAYS: A total of 1656 children aged 5-15 y who had weekday 24-h dietary recall data. RESULTS: An average of 37% of total energy intake was consumed at school. Energy-dense foods and beverages such as fat spreads, packaged snacks, biscuits and fruit/cordial drinks made a greater contribution to energy intake at school compared to out of school (P< or =0.01). Fast foods and soft drinks contributed 11 and 3% of total energy intake; however, these food groups were mostly consumed out of school. Fruit intake was low and consumption was greater in school. In all, 14% of children purchased food from the canteen and they obtained more energy from fast food, packaged snacks, desserts, milk and confectionary (P< or =0.05) than noncanteen users. CONCLUSIONS:: Energy-dense foods and beverages are over-represented in the Australian school environment. To help prevent obesity and improve nutrition in schools, biscuits, snack bars and fruit/cordial drinks brought from home and fast food, packaged snacks, and confectionary sold at canteens should be replaced with fruit and water.     

Measuring the 'obesogenic' food environment in New Zealand primary schools

Childhood obesity is an increasing health problem in New Zealand and many other countries. Information is needed to guide interventions that reduce the 'obesogenic' (obesity-promoting) elements of school environments. The aim of this study was to identify and measure the obesogenic elements of the school environment and the canteen sales of energy-dense foods and drinks. A self-completion questionnaire was developed for assessing each school's nutrition environment and mailed to a stratified random sample of New Zealand schools. The responses from primary schools (n = 200, response rate 61%) were analysed. Only 15.5% of schools had purpose-built canteen facilities and over half ran a food service for profit (31% profit to the school, 24.5% profit for the contractors). Only 16.5% of schools had a food policy, although 91% of those rated the policy as effective or very effective. The most commonly available foods for sale were pies (79%), juice (57%) and sausage rolls (54.5%). Filled rolls were the most expensive item (mean dollars 1.79) and fruit the least expensive (mean dollars 0.47). The ratio of 'less healthy' to 'more healthy' main choices was 5.6:1, for snacks it was 9.3:1 and for drinks it was 1.4:1. In contrast, approximately 60% of respondents said that nutrition was a priority for the school. Only 50% felt there was management support for healthy food choices and only 39% agreed that mainly nutritious food was offered by the food service. 'Less healthy' choices dominated food sales by more than 2:1, with pies being the top selling item (>55000 per week). We found that the food environment was not conducive to healthy food choices for the children at New Zealand schools and that this was reflected in the high sales of relatively unhealthy foods from the school food services. Programmes that improve school food through policies, availability, prices and school ethos are urgently needed.     

Canteen purchasing practices of year 1-6 primary school children and association with SES and weight status

OBJECTIVE: To identify sources of food eaten during the school day, the types of foods and frequency of purchases from the canteen and association with SES and weight status in primary school-aged children. METHOD: This cross-sectional study was conducted in the Hunter region of New South Wales. Primary schools were randomly selected from a list of government schools and 5,206 students in years 1-6 from the 16 participating schools were invited to participate in the study. RESULTS: Findings show the majority of children in the study bring their recess snack and lunch from home. However, the majority of children do use the school canteen and less healthy foods and high-sugar drinks are commonly purchased. CONCLUSIONS: This study confirms the relevance of the school canteen as a means of affecting children's eating habits. IMPLICATIONS: Improvement in the foods sold through schools provides an important contribution to model supportive environments for healthy food choices. Strategies should also be directed towards affecting the content of lunchboxes and the home environment.     

Opening up Australian preschoolers' lunchboxes

Objective: Early childhood services have been identified as key settings for promoting healthy eating and obesity prevention. However, little is known about the obesity‐related behaviours of preschool‐aged children or food‐related policies in these settings. The purpose of this study was to describe the contents of preschoolers' lunchboxes to inform future interventions. Methods: Cross‐sectional survey of 259 children attending preschools in the Sydney West and Sydney South West regions of New South Wales in 2008. Lunchbox data were collected using a purpose‐designed audit tool. Food and beverages were classified as fruit, vegetables, dairy, breads and cereals, ‘extra’ (energy‐dense) foods, ‘extra’ drinks or water. Results: Sandwiches and home‐cooked meals were the most frequently identified food item, found in 92% of children's lunchboxes, followed by fresh fruit. However, 60% of lunchboxes contained more than one serve of extra food or drink. Conclusion: While nutrition guidelines allow one to two serves of extra foods per day for preschool‐aged children, the majority of children appear to consume most of this allocation during their school day, potentially contributing to over‐consumption of extra foods and excess kilojoule intake. Implications: Preschool food policies may help to guide the content of children's lunchboxes, however this study emphasises the need for better communication and enforcement of these policies, as well as broader public policy changes.     

Changes in a middle school food environment affect food behavior and food choices

Increasing rates of obesity among children ages 12 to 19 years have led to recommendations to alter the school food environment. The purpose of this study was to determine whether there are associations between an altered school food environment and food choices of middle school students both in and outside of school. In a midsized western city, two of six middle schools allowed only bottled water in vending machines, only milk and fruit on à la carte menus, and offered a seasonal fruit and vegetable bar. Three years after the intervention was initiated, seventh- and eighth-grade students attending the two intervention schools and four control middle schools were surveyed about their food choices. A total of 2,292 surveys were completed. Self-reported frequency of consumption for nine food groups in the survey was low; consumption was higher outside than in school. Boys consumed more milk than girls although girls consumed more fruits and vegetables. Significant socioeconomic differences existed. Compared with students who paid the full lunch fee, students qualifying for free and reduced-price meals consumed more milk and juice in schools but less outside school; more candy and energy drinks in school; and more sweet drinks, candy, pastries, and energy drinks outside school. Students in intervention schools were 24% more likely to consume milk outside school, 27% less likely to consume juice in school, and 56% less likely to consume sweet pastries in school. There were no differences in fruit and vegetable consumption reported by children in control and intervention schools. Overall, there was a positive association between a modified school food environment and student food behavior in and outside school. Policies related to the school food environment are an important strategy to address the obesity epidemic in our country.     

Change in Dietary Energy Density after Implementation of the Texas Public School Nutrition Policy

Consumption of energy-dense foods has been associated with rising obesity rates and the metabolic syndrome. Reducing dietary energy density is an important strategy to address obesity, but few studies have examined the effect of nutrition policies on children's energy density. The study's objective was to assess the impact of the Texas Public School Nutrition Policy on children's energy density by using a pre- and post-policy evaluation. Analysis of variance/covariance and nonparametric tests compared energy density after the Texas policy change to intakes at baseline. Two years of lunch food records were collected from middle school students in Southeast Texas at three public middle schools: baseline (2001-2002) and 1 year after implementation of the Texas Policy (2005-2006). Students recorded the amount and source of foods consumed. The Texas Public School Nutrition Policy was designed to promote a healthy school environment by restricting portion sizes of high-fat and high-sugar snacks and sweetened beverages, fat content of foods, and serving of high-fat vegetables like french fries. Energy density (kcal/g): energy density−1 was the energy of foods only (no beverages) divided by the gram weight and has been previously associated with obesity and insulin resistance; energy density−2 included all food and beverages to give a complete assessment of all sources of calories. Following implementation of the Texas policy, students' energy density−1 significantly decreased from 2.80±1.08 kcal/g to 2.17±0.78 kcal/g (P<0.0001). Similarly, energy density−2 significantly decreased from 1.38±0.76 kcal/g to 1.29±0.53 kcal/g (P<0.0001). In conclusion, the Texas Public School Nutrition Policy was associated with desirable reductions in energy density, which suggests improved nutrient intake as a result of student school lunch consumption.     

School and district wellness councils and availability of low-nutrient, energy-dense vending fare in Minnesota middle and high schools

The Child Nutrition and WIC Reauthorization Act of 2004 required school districts participating in the federal school meals program to establish by the start of the 2006-2007 school year policies that included nutrition guidelines for all foods sold on school campus during the school day and policy development involving key stakeholders. For many schools, policy development was done by wellness councils. This study examined the association between having a wellness council and availability of low-nutrient, energy-dense foods/beverages in school vending machines following enactment of the federal legislation. In 2006-2007, Minnesota middle (n=35) and high (n=54) school principals reported whether their school and district had a wellness council. Trained research staff observed foods/beverages in vending machines accessible to students. Low-nutrient, energy-dense foods/beverages (snacks >3 g fat or >200 calories/serving, and soda, fruit/sport drinks and reduced-fat/whole milk) were grouped into seven categories (eg, high-fat baked goods) and a food score was calculated. Higher scores indicated more low-nutrient, energy-dense vending fare. Multivariate linear regression, adjusted for school characteristics, was used to examine associations between scores and a three-category council variable (district-only; district and school; no council). Among schools, 53% had district-only councils, 38% district and school councils, and 9% had no council. Schools with both a district and school council had a significantly lower mean food score than schools without councils (P=0.03). The potential of wellness councils to impact availability of low-nutrient, energy-dense vending fare is promising. There may be an added benefit to having both a school and district council.     

The Ubiquity of Energy-Dense Snack Foods: A National Multicity Study

Objectives. We assessed the availability and accessibility of energy-dense snacks in retail stores whose primary merchandise was not food and whether these varied by store type, region, or socioeconomic factors.Methods. We conducted systematic observations of 1082 retail stores in 19 US cities and determined the availability and accessibility of 6 categories of energy-dense snack foods.Results. Snack food was available in 41% of the stores; the most common forms were candy (33%), sweetened beverages (20%), and salty snacks (17%). These foods were often within arm''s reach of the cash register queue. We observed snack foods in 96% of pharmacies, 94% of gasoline stations, 22% of furniture stores, 16% of apparel stores, and 29% to 65% of other types of stores. Availability varied somewhat by region but not by the racial or socioeconomic characteristics of nearby census tracts.Conclusions. Energy-dense snack foods and beverages, implicated as contributors to the obesity epidemic, are widely available in retail stores whose primary business is not food. The ubiquity of these products may contribute to excess energy consumption in the United States.Obesity rates continue to rise in the United States.¹ Coincident with this rise have been increases in the amount of energy consumed and shifts in the locations and patterns of food consumption by Americans.^2–4 Practices that have become increasingly common are eating away from home, snacking, and consuming sweetened beverages and energy-dense foods such as salty snacks.⁴ One study suggested that nearly all of the increase in calorie consumption in the United States between the late 1970s and the mid-1990s was in the form of snacks.⁴ The individual food items contributing the most to increases in energy consumed were sweetened beverages and salty snacks.⁴ Sweetened beverages have been associated with obesity and weight gain in both observational and intervention studies.⁵Sweetened beverages and energy-dense snack foods are sold at nearly all grocery stores as well as most restaurants, and are available from snack counters and vending machines in many workplaces and schools. They are also available in retail stores that primarily sell other types of items and services. The widespread availability of energy-dense snack foods may contribute to the obesity epidemic in 2 ways: (1) by providing more opportunities to acquire these foods and (2) by providing cues to people suggesting that they snack.To understand the potential magnitude of this problem, we conducted observations in stores in 19 cities across the United States. Our objectives were to determine the proportion of retail establishments whose primary merchandise was not food that sold energy-dense snack foods and to assess whether and how that proportion varied by store type, region of the country, and socioeconomic status of the surrounding area.     

Dietary energy density is associated with energy intake and weight status in US adults

BACKGROUND: Laboratory-based investigations indicate that the consumption of foods with a low energy density (kcal/g) decreases energy intake. Although low-energy-dense diets are recommended for weight management, relations between energy density, energy intake, and weight status have not been clearly shown in free-living persons. OBJECTIVES: A representative US sample was used to determine whether dietary energy density is associated with energy intake, the weight of food consumed, and body weight and to explore the influence of food choices (fruit, vegetable, and fat consumption) on energy density and body weight. DESIGN: A cross-sectional survey of adults (n = 7356) from the 1994-1996 Continuing Survey of Food Intakes by Individuals and two 24-h dietary recalls were used. RESULTS: Men and women with a low-energy-dense diet had lower energy intakes (approximately 425 and 275 kcal/d less, respectively) than did those with a high-energy-dense diet, even though they consumed more food (approximately 400 and 300 g/d more, respectively). Normal-weight persons had diets with a lower energy density than did obese persons. Persons with a high fruit and vegetable intake had the lowest energy density values and the lowest obesity prevalence. CONCLUSIONS: Adults consuming a low-energy-dense diet are likely to consume more food (by weight) but to have a lower energy intake than do those consuming a higher-energy-dense diet. The energy density of a variety of dietary patterns, including higher-fat diets, can be lowered by adding fruit and vegetables. Our findings support the hypothesis that a relation exists between the consumption of an energy-dense diet and obesity and provide evidence of the importance of fruit and vegetable consumption for weight management.     

Calibration and reliability of a school food checklist: a new tool for assessing school food and beverage consumption

There is a pressing need in Australia and other countries to develop systems for monitoring secular trends in childhood obesity and related behavioural and environmental determinants. Energy from foods and beverages consumed at school is an accessible indicator of children's eating patterns and we have developed a school food checklist (SFC) to measure this. The SFC records the number of serves and source (home, canteen, vending machine) of 20 food and beverage categories. This study aims to assess the accuracy and to calibrate the SFC by comparing it to a weighed record (WR) and to evaluate inter-recorder reliability. Participants were 910 primary school children aged 5 to 12 years from a rural township in Victoria, Australia. WR were collected from a non-random sub-sample of 106 and a second sub-sample (n=46) had intake measured twice using the SFC to assess inter-recorder reliability. Mean energy values were 2992 kJ +/- 924 and 3008 kJ +/- 952 for the SFC and WR respectively and the correlation coefficient was strong (Pearson r = 0.77). The mean difference between the WR and SFC methods was 15 kJ (95% CI, -107 kJ to 138 kJ) and the limits of agreement (+2 standard deviations) were +/- 1270 kJ. The SFC overestimated the energy/serve of breads and fruit drinks and under-estimated energy/serve from fat spreads, biscuits/crackers, muesli/fruit bars and fruit. Inter-recorder reliability was good (kappa 0.51). The SFC was designed to measure energy from food and beverages in schools. It has good accuracy and reliability and the revised version should further improve accuracy of the instrument.     

Predictors of changes in adolescents' consumption of fruits, vegetables and energy-dense snacks

Understanding the predictors of developmental changes in adolescent eating behaviours is important for the design of nutrition interventions. The present study examined associations between individual, social and physical environmental factors and changes in adolescent eating behaviours over 2 years. Consumption of fruits, vegetables and energy-dense snacks was assessed using a Web-based survey completed by 1850 adolescents from years 7 and 9 of secondary schools in Victoria, Australia, at baseline and 2 years later. Perceived value of healthy eating, self-efficacy for healthy eating, social modelling and support, and home availability and accessibility of foods were assessed at baseline. Self-efficacy for increasing fruit consumption was positively associated with the change in fruit and vegetable consumption, while self-efficacy for decreasing junk food consumption was inversely associated with the change in energy-dense snack consumption. Home availability of energy-dense foods was inversely associated with the change in fruit consumption and positively associated with the change in energy-dense snack consumption, while home availability of fruits and vegetables was positively associated with the change in vegetable consumption. Perceived value of healthy eating and modelling of healthy eating by mothers were positively associated with the change in fruit consumption. Support of best friends for healthy eating was positively associated with the change in vegetable consumption. Self-efficacy and home availability of foods appear to be consistent predictors of change in fruit, vegetable and energy-dense snack consumption. Future study should assess the effectiveness of methods to increase self-efficacy for healthy eating and to improve home availability of healthy food options in programmes promoting healthy eating among adolescents.     

Significant increase in young adults' snacking between 1977-1978 and 1994-1996 represents a cause for concern!

BACKGROUND: Studies on children and adolescents suggest a large increase in the role of snacking; however, little is know about changes in the snacking behavior of young adults. METHODS: USDA's nationally representative surveys from 1977-1978 to 1994-1996 are used to study snacking trends among 8,493 persons 19-29 years old. RESULTS: Snacking prevalence increased from 77 to 84% between 1977-1978 and 1994-1996. The nutritional contribution of snacks to total daily energy intake went from 20 to 23%, primarily because energy consumed per snacking occasion increased by 26% and the number of snacks per day increased 14%. The mean daily caloric density (calorie per gram of food) of snacks increased from 1.05 to 1.32 calories. The energy contribution of high-fat desserts to the total calories from snacking decreased (22 to 14%), however, this food group remained the most important source of energy. The energy contribution of high-fat salty snacks doubled. Sweetened and alcoholic beverages remained important energy contributors. CONCLUSION: This large increase in total energy and energy density of snacks among young adults in the United States may be contributing to our obesity epidemic.     

Compliance with nutrition standards in Mexican schools and their effectiveness: a repeated cross-sectional study

Background

Mexico approved mandatory nutrient-based standards for foods sold in schools in 2011. The aim of this study was to analyse the association between compliance with nutrition standards for foods sold in schools and children’s school snacks.

Methods

Data came from three surveys representative of Mexican elementary schools in 13 states and their students (2012, 2013 and 2015); n?=?645 children from N?=?99 different schools. Information on foods sold in schools and snacks consumed by children was collected through direct observation. Compliance with the standards was defined as the proportion of foods sold in school which met nutrition criteria established by the standards. Snacks were classified as healthy if they contained at least one fruit or vegetable and had no sugar-sweetened beverages. Robust logistic regression models for cross-sectional and repeated surveys aggregated at the school-level were fitted to quantify the association between school compliance with standards and healthy snacks.

Results

On average across waves 27% of foods sold complied with nutrition standards; 18% of children consumed a healthy snack. For snacks purchased in school, a 10% increase in school compliance with the standards was associated with a 32% increase in the odds of a healthy snack (OR?=?1.32; 95%CI 1.09,1.61); no association was observed for snacks brought from home. The odds of a healthy snack increased over time in schools where compliance with the standards improved (OR?=?3.89; 95%CI 1.47,10.31) but not in those where compliance remained constant or decreased.

Conclusions

Only a small proportion of children are eating healthy snacks in school. School compliance with standards increases the likelihood of a healthy snack if it is bought at school. Our findings support better implementation of the standards and additional strategies to enhance the policy to achieve its aim of reducing childhood obesity.

     

Development and Validation of a Beverage and Snack Questionnaire for Use in Evaluation of School Nutrition Policies

School nutrition policies limiting access to sweetened beverages, candy, and salty snacks have the potential to improve the health of children. To effectively evaluate policy success, appropriate and validated dietary assessment instruments are needed. The objective of this study was to develop and validate a beverage and snack questionnaire suitable for use among young adolescents. A new 19-item Beverage and Snack Questionnaire (BSQ) was administered to middle school students on two occasions, 2 weeks apart, to measure test-retest reliability. The questionnaire inquired about frequency of consumption, both at school and away from school, of soft drinks, salty snacks, sweets, milk, and fruits and vegetables. Students also completed 4-day food records. To assess validity, food-record data were compared with BSQ data. Forty-six students of diverse backgrounds from metropolitan Seattle, WA, participated in this study. Participants answered the BSQ during class time and completed the food record at home. Pearson correlation coefficients assessed test-retest reliability and validity. Using frequency per week data, the test-retest reliability coefficients were r=0.85 for fruits and vegetables consumed at school and r=0.74 and r=0.72 for beverages and sweets/snacks, respectively, consumed at school. Correlations ranged from r=0.73 to 0.77 for foods consumed outside of school. Compared with the criterion food record, validity coefficients were very good: r=0.69 to 0.71 for foods consumed at school and r=0.63 to 0.70 for foods consumed away from school. The validity coefficients for the 19 individual food items ranged from r=0.56 to 0.87. This easy-to-administer 19-item questionnaire captures data on sugar-sweetened beverages, salty snacks, sweets, milk, and fruit and vegetables as well as a more lengthy and expensive food record does. The BSQ can be used by nutrition researchers and practitioners to accurately evaluate student consumption of foods that are the focus of school nutrition policies.     

Pricing effects on food choices

Individual dietary choices are primarily influenced by such considerations as taste, cost, convenience and nutritional value of foods. The current obesity epidemic has been linked to excessive consumption of added sugars and fat, as well as to sedentary lifestyles. Fat and sugar provide dietary energy at very low cost. Food pricing and marketing practices are therefore an essential component of the eating environment. Recent studies have applied economic theories to changing dietary behavior. Price reduction strategies promote the choice of targeted foods by lowering their cost relative to alternative food choices. Two community-based intervention studies used price reductions to promote the increased purchase of targeted foods. The first study examined lower prices and point-of-purchase promotion on sales of lower fat vending machine snacks in 12 work sites and 12 secondary schools. Price reductions of 10%, 25% and 50% on lower fat snacks resulted in an increase in sales of 9%, 39% and 93%, respectively, compared with usual price conditions. The second study examined the impact of a 50% price reduction on fresh fruit and baby carrots in two secondary school cafeterias. Compared with usual price conditions, price reductions resulted in a four-fold increase in fresh fruit sales and a two-fold increase in baby carrot sales. Both studies demonstrate that price reductions are an effective strategy to increase the purchase of more healthful foods in community-based settings such as work sites and schools. Results were generalizable across various food types and populations. Reducing prices on healthful foods is a public health strategy that should be implemented through policy initiatives and industry collaborations.     

The consumption of energy dense snacks and some contextual factors of snacking may contribute to higher energy intake and body weight in adults

Preventing obesity (OB) among adults is a public health priority. One factor that seems to contribute to OB, due to the extra energy intake it involves, is the greater consumption of snacks. Whether snacking promotes OB in adults is however a source of controversy in the literature at present. The aim of this paper was to evaluate the effects of snacking on body weight status, along with contextual factors such as snacking location, food source, timing, and social context of snacking. To better understand the nature of snacking behavior, seven currently used definitions of snacking were described. Studies published prior to November 2020 were identified by searching the PubMed and Scopus databases, with thirty-three observational studies being identified and included. The consumption of energy-dense snacks may contribute to higher energy intake and weight in adult populations. The context in which adults snacks—such as eating alone, outside home or work, late in the day, in front of a TV or computer—is also important for this behavior. However, the lack of consensus on the definition of snacks in the literature makes these considerations suggestive rather than objective. Better-designed research is needed to determine the prospective association between snacking behavior and weight status in adults. Snacking may be an important behavior that can be modified to prevent obesity on the population level. Social education focused on promoting morning snacks and replacing energy-dense snacks by more nutritious ones, e.g. fruit and vegetables, may thus be beneficial.     

New Zealand children's dietary intakes during school hours

Aim:  To describe the dietary habits of New Zealand schoolchildren during school hours.
Methods:  The present study was a secondary analysis of New Zealand's national nutrition survey of schoolchildren (2002 National Children's Nutrition Survey). It includes a subset of 2247 children aged 5–14 years, surveyed to recall a school day. A 24-hour dietary recall was collected in the home of the child. Food or beverage consumption during the morning (9:00 a.m.−11:59 a.m.) and at lunch time (12:00 noon−2:00 p.m.) was based on whether energy intake during these times was above zero. Foods consumed and nutrient intakes during these two time periods were ascertained.
Results:  Approximately 80% of children consumed some food or beverage during the morning and over 90% during lunch time. Older children were less likely than younger children to consume foods or beverages during lunch time. Snack foods, fruit and biscuits were the food groups most consumed during the morning, while sandwiches and fruit were the most popular foods during lunch time. Children obtained approximately one-third of their daily nutrient intakes during school hours. Food and nutrient intakes differed by ethnicity both during the morning and at lunch time.
Conclusions:  Children's food consumption at school could be improved—particularly morning snack quality. Encouraging healthier selections sourced from home is vital as well as ensuring that healthy options are available for purchase, and Pacific children need the most encouragement to choose wisely.     

Children's food consumption during television viewing

BACKGROUND: Television viewing is associated with childhood obesity. Eating during viewing and eating highly advertised foods are 2 of the hypothesized mechanisms through which television is thought to affect children's weight. OBJECTIVES: Our objectives were to describe the amounts and types of foods that children consume while watching television, compare those types with the types consumed at other times of the day, and examine the associations between children's body mass index (BMI) and the amounts and types of foods consumed during television viewing. DESIGN: Data were collected from 2 samples. The first sample consisted of ethnically diverse third-grade children, and the second consisted predominantly of Latino fifth-grade children. Three nonconsecutive 24-h dietary recalls were collected from each child. For each eating episode reported, children were asked whether they had been watching television. Height and weight were measured by using standard methods and were used to calculate BMI. RESULTS: On weekdays and weekend days, 17-18% and approximately 26% of total daily energy, respectively, were consumed during television viewing in the 2 samples. Although the fat content of the foods consumed during television viewing did not differ significantly from that of the foods consumed with the television off, less soda, fast food, fruit, and vegetables were consumed with the television on. The amount of food consumed during television viewing was not associated with children's BMI, but in the third-grade sample, the fat content of foods consumed during television viewing was associated with BMI. CONCLUSIONS: A significant proportion of children's daily energy intake is consumed during television viewing, and the consumption of high-fat foods on weekends may be associated with BMI in younger children.     

Storing Empty Calories and Chronic Disease Risk: Snack-Food Products,Nutritive Content,and Manufacturers in Philadelphia Corner Stores

Corner stores are part of the urban food environment that may contribute to obesity and diet-related diseases, particularly for low-income and minority children. The snack foods available in corner stores may be a particularly important aspect of an urban child’s food environment. Unfortunately, there is little data on exactly what snack foods corner stores stock, or where these foods come from. We evaluated snack foods in 17 Philadelphia corner stores, located in three ethnically distinct, low-income school neighborhoods. We recorded the manufacturer, calories, fat, sugar, and sodium for all snack items, excluding candy and prepared foods. We then compared the nutritive content of assessed snack items to established dietary recommendations and a school nutrition standard. In total, stores stocked 452 kinds of snacks, with only 15% of items common between all three neighborhoods. Total and unique snacks and snack food manufacturers varied by neighborhood, but distributions in snack type varied negligibly: overall, there were no fruit snacks, no vegetable snacks, and only 3.6% of all snacks (by liberal definition) were whole grain. The remainder (96.4% of snacks) was highly processed foods. Five of 65 manufacturers supplied 73.4% of all kinds of snack foods. Depending on serving size definition, 80.0-91.5% of snack foods were “unhealthy” (by the school nutrition standard), including seven of 11 wholegrain products. A single snack item could supply 6-14% of a day’s recommended calories, fat, sugar, and sodium on average (or 56-169% at the extreme) for a “typical” child. We conclude that corner store snack food inventories are almost entirely unhealthful, and we discuss possible implications and next steps for research and intervention.     

Correlates of Dietary Energy Sources with Cardiovascular Disease Risk Markers in Mexican School-Age Children

Dietary and lifestyle changes in Mexico have been linked to an increase in chronic diseases such as obesity and cardiovascular disease. Important dietary changes such as an increase in the consumption of energy-dense foods (high in oils, animal or processed fats, and sugars) have been recently reported. The objective of this study was to identify how key dietary energy sources correlated with other indexes of cardiovascular disease in a Mexican school-age population. From 2004 to 2006, a convenience sample (n=228) of 9- to 13-year-olds, 48.2% girls and 51.8% boys, from three public urban schools were included. Anthropometric, blood pressure, and dietary assessment (two multiple pass 24-hour recalls) were done. More than half of children did not meet the fruit and vegetable recommended intake. High-fat dairy foods (14% of total energy intake), refined carbohydrates (13.5%), red/processed meat (8.5%), added sugars/desserts (7%), corn tortilla (6.5%), and soft drinks/sweetened beverages (5%) were the highest dietary energy sources consumed. In a subgroup of children (n=185), a fasting blood sample was collected for biochemical analysis. A positive association was observed between glucose and diastolic blood pressure with the intake of soft drinks/sweetened beverages, insulin concentrations and the intake of white bread, and triglyceride concentrations with the intake of added fats. Unhealthful dietary energy sources are frequently consumed by these children. Culturally competent nutrition counseling should be offered to Mexican-American children and their families with a significant risk of cardiovascular disease. Efforts should be made to design and implement nutrition education and health promotion strategies in schools.