Nutrient Intake,Diet Quality,and Weight Measures in Breakfast Patterns Consumed by Children Compared with Breakfast Skippers: NHANES 2001–2008

Most studies showing that children consuming breakfast have better nutrient intakes, diet quality, and lower weight than breakfast skippers have the incorrect premise that breakfast meals are homogeneous.The purpose of this study was to classify breakfast meals into patterns and determine the association of the breakfast patterns with daily and breakfast nutrient intakes, diet quality, and weight. Data from children (2–18 years of age; N = 14,200) participating in the National Health and Nutrition Examination Survey 2001–2008 were used. Intake was determined from one day 24-hour dietary recalls. Diet quality was measured using the Healthy Eating Index-2005 (HEI-2005). Body mass index (BMI) z-scores were determined. Twelve patterns (including No Breakfast [∼19% of population]), explaining 63% of the variance in energy from breakfast, were examined. Covariate adjusted general linear models were used to compare outcome variables of consumers of different patterns with breakfast skippers. The p value was Bonferroni corrected (< 0.05/12 = < 0.0042). Consumers of the Eggs/Grain/Meat, Poultry, Fish (MPF)/ Fruit Juice (FJ) and MPF/ Grain/FJ patterns showed higher daily intakes of saturated fats, solid fats, and sodium and lower daily intakes of added sugars than breakfast skippers. Consumers of most breakfast patterns showed higher daily intakes of some nutrients of public health concern (dietary fiber, vitamin D, calcium, and potassium); however, those consuming the Grain or MPF/Grain/FJ pattern did not. Consumers of the Grain/Lower Fat Milk (LFM)/Sweets/FJ, Presweetened (PS) Ready-to-eat Cereal (RTEC)/ LFM, RTEC/LFM, Cooked Cereal/Milk/FJ, and Whole Fruit patterns had higher total HEI-2005 scores than breakfast skippers; those consuming the MPF/ Grain/FJ pattern had lower diet quality than breakfast skippers. Consumption of the Grain/ LFM/Sweets/FJ, PSRTEC/whole milk, Soft Drinks/ FJ/Grain/Potatoes, RTEC/whole milk, and Cooked Cereal/ Milk/ FJ patterns was associated with lower BMI z-scores than seen in breakfast skippers. There are dietary and weight advantages of consuming breakfast, especially breakfasts that include grains, cereals, LFM, and fruit/ FJ, in contrast to the potential adverse effects of skipping breakfast.     

Unmet Need for Therapy Among Children with Autism Spectrum Disorder: Results from the 2005–2006 and 2009–2010 National Survey of Children with Special Health Care Needs

Objectives We examined population-based trends in unmet need for therapy service in children with autism spectrum disorder (ASD) compared to other children with special health care needs (CSHCN), and identified factors associated with unmet need for therapy. Methods A pooled cross-sectional comparison of the 2005–2006 and 2009–2010 waves of the National Survey for Children with Special Health Care Needs (NS-CSHCN) was used. Weighted bivariate analyses were used to compare children ages 3–17 years with ASD (n = 5113) to other CSHCN (n = 71,294) on unmet need for therapy services. Survey weighted multivariate models were used to examine child, family, and contextual characteristics associated with unmet need. Results A greater percentage of children with ASD across both surveys were reported to need therapy than other children with CSHCN. Among children with a reported need, children with ASD were 1.4 times more likely to report an unmet need for therapy compared to other CSHCN (OR 1.42, 95 % CI 1.18–1.71). Variables significantly associated with unmet need for therapy services included not receiving a well-child visit in the past year (OR 5.81, CI 3.83–8.81), surveyed in 2009 (OR 1.42, CI 1.18–1.71), child being female (OR 1.27, CI 1.05–1.53), uninsured (OR 1.72, CI 1.15–2.56), and having greater functional limitation (OR 2.44, CI 1.80–3.34). Conclusions for Practice Children with ASD require supportive services such as occupational, physical, and speech therapy but are less likely to receive such services than other CSHCN. Receiving a well-child visit in the past year was strongly associated with receipt of needed therapy services.     

Caregiver Burdens and Preventive Dental Care for Children with Autism Spectrum Disorder,Developmental Disability and/or Mental Health Conditions: National Survey of CSHCN, 2009–2010

Objective The purpose of this study is to examine the burdens of caregivers on perception of the need and receipt of preventive dental care for a subset of children with special health care needs—children with Autism Spectrum disorder, developmental disability and/or mental health conditions (CASD/DD/MHC). Methods The authors used the 2009–2010 National Survey of CSHCN. The survey included questions addressing preventive dental care and caregivers’ financial, employment, and time-related burdens. The associations of these burdens on perceptions and receipt of preventive dental care use were analyzed with bivariate Chi square analyses and multinomial logistic regressions for CASD/DD/MHC (N = 16,323). Results Overall, 16.3 % of CASD/DD/MHC had an unmet preventive dental care need. There were 40.0 % of caregivers who reported financial burden, 20.3 % who reported employment burden, and 10.8 % who reported time burden. A higher percentage of caregivers with financial burden, employment burden, and time-related burden reported that their CASD/DD/MHC did not receive needed preventive dental care (14.1, 16.5, 17.7 % respectively) compared to caregivers without financial, employment, or time burdens (9.0, 9.6 %, 11.0 % respectively). Caregivers with financial burden (adjusted multinomial odds ratio, 1.38 [95 % CI 1.02, 1.86] and employment burden (adjusted multinomial odds ratio, 1.45 [95 % CI 1.02, 2.06] were more likely to report that their child did not receive preventive dental care despite perceived need compared to caregivers without financial or employment burdens. Conclusions for practice Unmet needs for preventive dental care were associated with employment and financial burdens of the caregivers of CASD/DD/MHC.     

Associations of Alcoholic Beverage Consumption with Dietary Intake,Waist Circumference,and Body Mass Index in US Adults: National Health and Nutrition Examination Survey 2003-2012

Background

Findings from studies of alcohol and obesity measures (eg, waist circumference [WC] and body mass index [BMI; calculated as kg/m²]) are conflicting. Residual confounding by dietary intake, inconsistent definitions of alcohol consumption across studies, and the inclusion of former drinkers in the nondrinking comparison group can contribute to the mixed literature.

Socioeconomic Status,Food Security,and Dental Caries in US Children: Mediation Analyses of Data From the National Health and Nutrition Examination Survey, 2007–2008

Objectives. We examined associations of household socioeconomic status (SES) and food security with children’s oral health outcomes.Methods. We analyzed 2007 and 2008 US National Health and Nutrition Examination Survey data for children aged 5 to 17 years (n = 2206) to examine the relationship between food security and untreated dental caries and to assess whether food security mediates the SES–caries relationship.Results. About 20.1% of children had untreated caries. Most households had full food security (62%); 13% had marginal, 17% had low, and 8% had very low food security. Higher SES was associated with significantly lower caries prevalence (prevalence ratio [PR] = 0.77; 95% confidence interval = 0.63, 0.94; P = .01). Children from households with low or very low food security had significantly higher caries prevalence (PR = 2.00 and PR = 1.70, respectively) than did children living in fully food-secure households. Caries prevalence did not differ among children from fully and marginally food-secure households (P = .17). Food insecurity did not appear to mediate the SES–caries relationship.Conclusions. Interventions and policies to ensure food security may help address the US pediatric caries epidemic.Tooth decay (dental caries) is the most prevalent disease worldwide and the most common pediatric disease in the United States.1,2 From 1999 to 2004, the prevalence of untreated tooth decay was 24.5% for children aged 6 to 11 years and 19.6% for adolescents aged 12 to 19 years.3 Untreated tooth decay can lead to difficulties eating and sleeping, pain, the need for invasive restorative treatment, emergency department visits and inpatient hospitalizations, poor quality of life, systemic health problems, and, in rare cases, death.4–7 To date, most public health efforts aimed at addressing the pediatric caries epidemic have focused on tooth-level interventions (e.g., topical fluorides, dental sealants). Although disparities in oral health are considered a measure of social injustice,8 comparatively less research has been conducted on the social determinants of pediatric oral health.9Low socioeconomic status (SES), one of the strongest determinants of caries in children,10–12 is associated with food insecurity,10–17 defined as inadequate access to food resulting in food shortages, disrupted eating patterns, and hunger.18 Food insecurity, in turn, is associated with oral health–related behaviors, including increased fermentable carbohydrate intake,19,20 a risk factor for dental caries.21,22 The American Dietetic Association recognizes the link between nutrition and oral health,23 and numerous studies have drawn associations between dietary factors and disparities in dental caries.24 Collectively, these studies suggest that food insecurity is related to caries and is a potential mechanism linking SES and caries, but these relationships have not yet been evaluated empirically. We used nationally representative data from the United States to test 3 hypotheses: (1) food insecurity is positively associated with untreated dental caries, (2) food insecurity mediates the SES–caries relationship, and (3) food insecurity mediates the SES–caries relationship differentially for children from higher- versus lower-SES households.     

Health Insurance and Access to Care for Families with Young Children in California, 2001–2005: Differences by Immigration Status

Objectives To examine differences and trends in health insurance coverage and access to care for California families by immigration status. Methods Cross-sectional data on 37,236 families with young children <18 years of age from the 2001, 2003 and 2005 California Health Interview Survey are used to assess trends in health insurance and access to care for children and their parents by four immigration dyads: (1) both are Citizens; (2) child is a legal resident/citizen, and parent is legal resident (Documented); (3) child is a citizen, and parent is undocumented (Mixed); and (4) both are Undocumented. Results Before and after adjustment for covariates, only children in Undocumented dyads were less likely than Citizen dyads to have insurance (OR = 0.20, CI: 0.16–0.26) and all three measures of access: physician visits (OR = 0.69, CI: 0.52–0.91), dental visits (OR = 0.47, CI: 0.35–0.63), and a regular source of care (OR = 0.51, CI: 0.37–0.69). Parents in all non-Citizen dyads had poorer access than Citizen dyads across all measures, with the exception of dental visits and a regular source for parents in Documented dyads. Children of all dyads except Citizens were more likely to be insured in 2005 vs. 2001. The largest gain was for undocumented dyad children with 2.77 times higher odds (CI: 1.62–4.75) of being insured in 2005 vs. 2001. All children dyads except Mixed were also more likely to have a physician visit. For parents, there was only a decrease in insurance coverage for Citizen dyads (OR = 0.79, CI: 0.67–0.93) and few changes in access. Conclusions While there were relatively few disparities and some improvements in insurance coverage and access for children in California (except for undocumented children), concomitant changes for parents were not observed. Without attention to the family in health care reforms, disparities may not fully resolve for children and may continue or even increase for parents.     

Risk Determinants of Dental Caries and Oral Hygiene Status in 3–15 Year-Old Recent Immigrant and Refugee Children in Saskatchewan,Canada: A Pilot Study

This study aimed to identify the risk determinants of caries and record oral hygiene status in recent immigrant and refugee children residing in Saskatoon and Regina, Saskatchewan, Canada. Convenience samples of 133, 3–15 year-old recent immigrant and refugee children, and 86 adult guardians were recruited. Clinical examination of children and survey of their guardians explored the presence of at least one decayed tooth in the child’s mouth; and the knowledge, attitudes, behaviors, among other aspects in adult participants. Refugee children had statistically significant higher decayed, missing, filled teeth (DMFT) scores (mean dmft/DMFT score 5.80 ± 4.24) than immigrant children (mean dmft/DMFT score 3.52 ± 3.78 (p < 0.001). Adult immigrants had significantly higher proficiency in English language, knowledge about preventive components like fluoride and dental floss compared to refugee adults. The results of this study confirm the poorer state of oral health among refugee and immigrant children compared to Canadian children.     

Obesogenic Dietary Practices of Latino and Asian Subgroups of Children in California: An Analysis of the California Health Interview Survey, 2007–2012

Objectives. We examined obesogenic dietary practices among Latino and Asian subgroups of children living in California.Methods. We analyzed 2007, 2009, and 2011–2012 California Health Interview Survey data to examine the differences in dietary practices among Mexican and non-Mexican Latino children and 7 ethnic subgroups of Asian children. We used multivariable regression to examine the sociodemographic factors associated with specific dietary practices.Results. Latino subgroups of children had few differences in obesogenic dietary practices, whereas Asian subgroups of children exhibited significant differences in several obesogenic dietary practices. Korean and Filipino children were more likely than Chinese children to consume fast food and have low vegetable intake. Filipino children, followed by Japanese children, had the most obesogenic dietary practices compared with Chinese children, who along with South Asian children appeared to have the least obesogenic dietary practices. In general, income, education, and acculturation did not explain the dietary differences among Asian groups.Conclusions. Our findings suggest the need to disaggregate dietary profiles of Asian and Latino children and to consider nontraditional sociodemographic factors for messaging and counseling on healthy dietary practices among Asian populations.Dietary practices among pediatric racial and ethnic minority groups highlight possible contributions to the nation’s significant obesity disparities. High consumption of sugar- sweetened beverages (SSBs) and fast food and low consumption of fruits and vegetables have been found among Latino and African American children compared with White children.1–4 These dietary differences have been associated with environmental factors such as access to fresh foods and social factors such as family income, education level, and acculturation. Many of these factors have been understudied among Asian children. This gap in the literature is problematic given the emerging evidence that Asian children have notable differences in dietary practices compared with White children and that Asian Americans with the same body mass index (BMI; defined as weight in kilograms divided by the square of height in meters) are at a higher risk for cardiovascular diseases and type 2 diabetes than non-Hispanic Whites.5–8 Furthermore, children of various Asian and Latino ethnic groups with distinct historical, migration, and social contexts are generally grouped together in research analyses, making it difficult to understand the ethnicity-specific salient roles that education, income, and acculturation may play in specific dietary practices.9,10Acculturation has been described as both a protective factor and a risk factor for healthy dietary practices among immigrants. For example, acculturation among Latinos has been associated with higher consumption of fruits and vegetables but also with higher rates of fast food and sugary food consumption in both pediatric and adult Latino populations.11–13 Less is known about the role of acculturation in dietary practices among Asian and Latino ethnic subgroups.5,6,14,15 We examined dietary practices within ethnic subgroups of Latino and Asian children and the associated role of sociodemographic factors. On the basis of the thin literature that has examined dietary practices among Latino subgroups of children, we hypothesized that children of Mexican descent would have healthy dietary practices compared with other Latino groups and that Asian ethnic groups of children would show a wide variety of dietary practices. In addition, we hypothesized that acculturation, after controlling for education and income, would have an independent effect on dietary practices for all ethnic groups of children.     

A Low Glycemic Index and Glycemic Load Diet Decreases Insulin-like Growth Factor-1 among Adults with Moderate and Severe Acne: A Short-Duration, 2-Week Randomized Controlled Trial

Background

A high glycemic index (GI) and glycemic load (GL) diet may stimulate acne proliferative pathways by influencing biochemical factors associated with acne. However, few randomized controlled trials have examined this relationship, and this process is not completely understood.

Remember Me? Exposure to Unfamiliar Food Brands in Television Advertising and Online Advergames Drives Children’s Brand Recognition,Attitudes, and Desire to Eat Foods: A Secondary Analysis from a Crossover Experimental-Control Study with Randomization at the Group Level

BackgroundLimitations in current Australian regulatory provisions may be identified by demonstrating the effect of different marketing methods on children’s recognition and attitudes toward unhealthy food brands.ObjectiveTo investigate how exposure to different marketing techniques from television (TV) and online food advertising affects children’s brand recall, recognition, and attitudinal responses toward brands and brand consumers and children’s desire to eat the advertised products.DesignSecondary analysis of data from a crossover experimental-control study.Participants/settingIn all, 154 children (7 to 12 years) completed the study, conducted at four 6-day holiday camps from April 2016 to January 2017 in New South Wales, Australia. Children were assigned to a single-media (n=76) or multiple-media (n=78) condition.InterventionAll children viewed 10 TV food advertisements in a cartoon on three occasions. For one of the brands, one set of children additionally played online “advergames” featuring the brand.Main outcome measuresChildren’s recognition and attitudes toward brands and brand consumers and children’s desire to eat the product were reported via a brand recognition and attitude survey pre- and postintervention. Marketing techniques were categorized.Statistical analysisPre- and postintervention brand recognition and relationships between brand recognition and attitudes by media condition and desire to eat the product were examined using generalized linear mixed models and linear mixed models.ResultsThere was a significant increase in the number of brands recognized postexposure by children in both media groups (mean difference=3.8, P<0.0001). The majority of brands appealed to children. Children who reported wanting to eat the advertised products rated brands more positively than children who did not express a desire to eat the products. A larger proportion of children who played the advergames (36%) rated brand consumers as “cool” than children who viewed the TV advertisements only (19%) (P<0.001). Anti-adult themes, fun and humor, and parent pleasing were techniques unique to some of the most recognized and favored advertisements.ConclusionsThe marketing communications increased children’s brand recognition and elicited positive attitudinal responses. These findings indicate a need for policy makers to consider additional regulations to protect children from the persuasive influence of unhealthy food advertising.     

A Population Study of 5 to 15 Year Olds: Full Time Maternal Employment not Associated with High BMI. The Importance of Screen-Based Activity,Reading for Pleasure and Sleep Duration in Children’s BMI

To describe the relationship between maternal full time employment and health-related and demographic variables associated with children aged 5–15 years, and the factors associated with child overweight/obesity. Data from a chronic disease and risk factor surveillance system were limited to children aged 5–15 years whose mothers responded on their behalf (n = 641). Univariate/multivariate analyses described the differences between mothers who did and did not work full time. The same data were analysed comparing children who are overweight/obese against those with a normal BMI. The children of mothers who worked full time are more likely to be older, live in a household with a higher household income, be an only child or have one sibling or other child in the household, have a sole mother family structure and not spend any time reading for pleasure. No relationship was found between maternal employment and BMI. Compared with children of normal weight, those who were overweight/obese were more likely to spend no time studying, spend more than 2 h per day in screen-based activity and sleep less than 10 h per night. Child BMI status was not related to maternal employment. Although this analysis included eight diet related variables none proved to be significant in the final models.This study has shown that mothers’ working status is not related to children’s BMI. The relationship between overweight/obesity of children and high levels of screen-based activity, low levels of studying, and short sleep duration suggests a need for better knowledge and understanding of sedentary behaviours of children.