fruit&and&vegetable&consump4on&in& by#isabel#a.#ramos# … · 2019. 11. 12. ·...
TRANSCRIPT
By Isabel A. Ramos Fruit and vegetable consump4on in preschool-‐aged, low-‐income Mexican-‐American children:
a longitudinal analysis
By Isabel Ramos August 20th, 2012
Overview
• Background • Purpose & Hypotheses • Methods • Results • Discussion • Future Study
Background
• Childhood Obesity – 12.5 million children obese (Ogden et. al, 2012 ) – Measuring Overweight and Obesity
• Adult Body Mass Index (BMI) versus Child BMI – Based on a percenMle
» Weight, height, age, and sex – Centers for Disease & PrevenMon (CDC)
» Overweight > 85th & < 95th
» Obese > 95th
hTp://www.swollenthumb.com/2009/11/treat-‐your-‐career-‐like-‐you-‐would-‐a-‐child/
2010 Prevalence of obesity in low-‐income children aged 2 to 4 years
hTp://www.cdc.gov/obesity/data/childhood.html
Prevalence of obesity in low-‐income children
• United States – Young children < 5-‐years-‐old (PedNSS, 2011)
• NaMonal average -‐ 14.5% • New Jersey -‐ 18.4%
– Highest in the states
Prevalence of Obesity in Mexican-‐American Children
(Flegal et al. 2004)
DistribuMon of Hispanic PopulaMon
Mexican-‐American Risks
• High prevalence for cardiovascular disease and Type 2 diabetes mellitus (Fryar et al., 2012, Fortmeier-‐Saucier et al., 2008)
– Adults and adolescents • Precursor to these disease states – Metabolic Syndrome (3 or more risk factors)
• High fasMng insulin in the blood • High blood pressure • Abdominal obesity • High Triglycerides • Low High Density Lipoprotein (HDL)
• Can these risk factors develop at an early age?
Risk Factor Preschool-‐aged Hispanic Children
High fasMng insulin levels (hyperinsulinemia) associated with BMI. (Shea et al., 2003)
Hyperinsulinemia
High Blood Pressure
Low HDL Cholesterol
Hypertension Cardiovascular Disease Diabetes
Abdominal Obesity
Metabolic Syndrome
High Triglycerides
Stroke
Quality of Diet
(Perichart-‐Perera et al., 2010)
Fruits & Vegetables (FV) Reduce Risk Factor
• Increase of fruit and fruit juice consumpMon – Reduced SBP and DBP
• Increase of vegetable consumpMon – Reduced SBP
(Damasceno et al., 2011)
hTp://www.gvh.org/Main/TourYourGroceryStore.aspx
Child nutriMon and health is important for growth and prevenMon of diseases.
But what geneMc and environmental factors play a role in FV consumpMon?
GeneMc Factor
• Taste Preference – Heritable trait – SensiMvity to biTer-‐tasMng foods (Drewnowski et al., 1997)
• Cruciferous vegetables (e.g., broccoli) • Nontasters, tasters, and super tasters
– Low consumpMon of vegetables in preschool-‐aged children • Super tasters
– Higher consumpMon of vegetables • Non-‐tasters • 0.5 cups more
hTp://summitjourneytowellness.blogspot.com/2010/10/journey-‐to-‐wellness_20.html
(Bell & Tepper, 2006)
Socio-‐Economic Status
• Inverse relaMonship between energy density in food and energy costs (Drewnowski & Specter, 2004) – Energy dense foods
• Lowest cost opMon • Refined grains, added sugars, and fats • Low FV consumpMon
• Neighborhood Socio-‐Economic Status posiMvely associated with FV intake (Dubowitz et al., 2008)
Food Insecurity
Higher rates of food insecurity associated with lower intakes of fruits and vegetables.
(Dave et al., 2009)
Neighborhood and Home
• Low-‐income neighborhoods – Bodegas
• Limited on “healthier” foods – More expensive
• FV availability in the home – Parents advocate FV consumpMon
• More FV in home • Higher consumpMon FV
IMAGE: Bodega in Brooklyn, via Flickr user Paul Kostro.
hTp://www.webmd.com/parenMng/raising-‐fit-‐kids/weight/slideshow-‐filling-‐foods
(Cummins & Macintryre, 2006)
(Dave et al., 2010, Fisher et al., 2002, Worobey et al., 2010)
Low FV ConsumpMon in Children
(Basch et al., 1994)
Is low FV consumpMon linked to the overall dietary nutrient intake?
Nutrient Intakes • FV are rich in anMoxidants and nutrients (Van Duyn et al., 2000; USDA, 2011)
– Common nutrients found in FV (e.g., vitamin A, C, E, K, folate, potassium, fiber) – ProtecMve effects against disease states
• 2008 Feeding Infants and Toddlers Study (FITS) – Cross-‐secMonal naMonal survey of US children (birth to 47 months) – Nutrient analyses on nutrient intakes from a 24-‐hour dietary recall
(BuTe et al., 2010)
Low-‐income Mexican-‐American preschoolers: Are they at risk?
The RING Project
• Rutgers Infant NutriMon & Growth (RING) project – Longitudinal design
• Birth to age 5 – Recruitment criteria
• Special Supplemental NutriMon Program for Women, Infants, and Children (WIC) Program from New Brunswick, NJ – Gross family income: <185th or below the poverty line
• Hispanic or Black • Formula-‐feed only
hTp://texaswic.dshs.state.tx.us/wiclessons/english/nutriMon/Feeding-‐Your-‐Child.asp
Data CollecMon
• Human Subject cerMfied research assistants (RA) – One bilingual RA
• During recruitment at WIC – Maternal prepregnancy weight, height, and age – Maternal demographics (e.g., ethnicity, years of educaMon) – Infant’s birth date, weight, and length
• 2-‐day Home visits – 3, 6, 12 months and 1, 2, 3, 4, 5 years – Measured for weight, length, and arm circumference – Obtained 48-‐hour diet recalls
Purpose
• Longitudinal analysis at age 2 and 4 years, to explore nutrient intake in the overall diet, FV consumpMon, and its associaMon with weight status.
hTp://laMnalista.com/2012/07/changing-‐percepMons-‐of-‐childhood-‐obesity-‐within-‐the-‐laMno-‐community/
Hypotheses
• Mexican-‐American preschoolers’ overall diet analyses: 1. An increase in percent carbohydrate intake as the
children age from 2 to 4 years, which will decrease percent protein and percent fat intake.
As per 2008 FITS, 2. Micronutrient intake, specifically vitamin A, vitamin C, vitamin K, and folate, will meet the set Dietary Reference Intake values at both Mme points.
3. Micronutrient intakes, specifically vitamin E & potassium, and dietary fiber will not meet the set DRI values at both Mme points.
Hypotheses (conMnued)
• In separaMng fruit and vegetable intake from the 48-‐hour diet recalls: 4. ParMcipants will not meet fruit and vegetable recommendaMons set by the 2010 USDA dietary guidelines at age 2 or at age 4 years.
5. ParMcipants will increase in weight status as they age, due to low fruit and vegetable consumpMon.
Subjects
• Subjects – Mexican-‐American children
• Data at 2 and 4 years of age • N size = 37 (17 girls, 20 boys)
• Measurements – Weight, height, BMI-‐for-‐age percenMle
• Anthro WHO sosware
– 48-‐hour diet recalls • ExcepMons: 24-‐hour diet recalls
– Atypical diet, sick child, insufficient informaMon
Data PreparaMon
• Dietary Reference Intakes (DRI) – Nutrients
• USDA MyPlate for preschoolers (2010) – 2-‐year-‐olds
• 1 cup fruit, 1 cup vegetable – 4-‐year-‐olds
• 1.5 cups fruit, 1-‐1.5 cups vegetables
StaMsMcal Analyses
• Independent sample t-‐tests, paired-‐sample t-‐tests, and Spearman correlaMon coefficients
• StaMsMcal significance – p < 0.05
Results
0"
10"
20"
30"
40"
50"
60"
70"
80"
90"
100"
BM
I-for
-age
(%)!
Age (years)!2-Year-Old" 4-Year-Old"
Comparing percent BMI-‐for-‐age at age 2 and 4 years.
Macronutrients
Micronutrients
Potassium Intake
0
500
1000
1500
2000
2500
3000
3500
4000 Po
tassium (m
g)
DRI
RING * *
Vitamin E Intake
0
1
2
3
4
5
6
7
8
Vitamin E (m
g)
DRI
RING
p = 0.04
*
*
Vitamin K Intake
0
10
20
30
40
50
60 Vi
tam
in K
(ug)!
DRI"RING"
p = 0.08
*
Top Fruits Consumed
2-‐Year-‐Olds • Whole Fruit
– Apple (40.5%, n=15) – Banana (18.9%, n=7) – Orange (13.5%, n=5) – Grapes (13.5%, n=5)
• 100% Juice – Orange (35.1%, n=13) – Apple (21.6%, n=8) – Mixed (16.2%, n=6) – Grape (8.1%, n=3)
4-‐Year-‐Olds • Whole Fruit
– Banana (32.4%, n=12) – Orange (16.2%, n=6) – Apple (13.5%, n=5) – Grapes (5.4%, n =2)
• 100% Juice – Orange (32.4%, n=12) – Apple (24.3%, n=9) – Mixed (16.2%, n=6) – Grape (5.4%, n=2)
Top Vegetables Consumed
2-‐Year-‐Olds • Bean (37.8%, n=14) • Potato (21.6%, n=8) • Carrot (10.8%, n=4) • Vegetable Soup (10.8%, n=4) • Potato Chip (10.8%, n=4) • LeTuce (10.8%, n=4) • Ketchup (5.4%, n=2) • French Fries (5.4%, n=2)
4-‐Year-‐Olds • Tomato Sauce (29.7%,
n=11) • French Fries (21.6%, n=8) • Carrot (13.5%, n=5) • Corn (13.5%, n=5) • Ketchup (13.5%, n=5) • Potato Chip (10.8%, n=4) • Vegetable Soup (5.4%, n=2) • Pea (5.4%, n=2)
Mean FV ConsumpMon
Fruit & Vegetable Scores
• PosiMve relaMonship between fruit consumpMon and vegetable consumpMon in 4-‐year-‐olds (r = 0.507, p = 0.001 ).
FV consumpMon and BMI PercenMle
• Total fruit and vegetable consumpMon was not associated with children’s BMI percenMle at 2-‐ or 4-‐years old.
• NegaMve correlaMon between vegetable consumpMon and children’s BMI percenMle at age 4 years (r= -‐0.353, p = 0.032).
In overall diet analyses: 1. 2-‐year-‐olds è 4-‐year-‐olds
% Carbohydrate é % Fat ê
2.
Review of Findings
2-‐Year-‐Olds 4-‐Year-‐Olds
Vitamin A ✔ ✔
Vitamin C ✔ ✔
Vitamin K ✔ ✗
Folate ✔ ✔
⇀
⇀
✗
3. AIer separa4ng fruits and vegetables from overall diet:
4. ⇀
Fruit consumpMon Vegetable consumpMon (4-‐year-‐olds) 5. FV Children’s BMI PercenMle
BUT V Children’s BMI PercenMle AND é Children’s BMI PercenMle from age 2-‐ to 4-‐years-‐old
2-‐Year-‐Olds 4-‐Year-‐Olds
Fruit ✔ ✔
Vegetable ✗ ✗
2-‐Year-‐Olds 4-‐Year-‐Olds
Vitamin E ✗ ✗
Potassium ✗ ✗
Dietary Fiber ✗ ✗
⇀
⇀
Strengths
• Homogenous cohort of subject – Mexican-‐American
• Longitudinal data • Face-‐to-‐face 48-‐hour diet recalls versus telephone interviews (e.g., FITS)
• Bilingual research assistants – Language barrier
LimitaMons
• Small sample size – Labor intensive
• Unavailable 48-‐hour diet records – 24-‐hour acceptable – Reduce representaMveness
• Inaccurate esMmates of foods – E.g., tablespoons instead of cups
• Low educaMon – UMlized literature-‐based approximaMons
Future Study
• Longitudinal study (2-‐ to 5-‐ year-‐olds) – Larger sample size – More data collecMon Mme points
• Every 6 months
– Method to reduce parMcipant drop-‐outs – Dietary recall protocol of 72-‐hours or more – Explore associaMons between FV consumpMon and unhealthy food choices.
hTp://eatright.org
Importance
• Mexican-‐American children are at high risk for obesity and other comorbidiMes. – T2DM – Cardiovascular disease
• Nutrients are essenMal – PrevenMon and reducMon of disease states – Found in FV
• Help future studies in developing nutriMon intervenMons for these low-‐income Mexican-‐American preschoolers.
Acknowledgements CommiQee Members John Worobey Ph.D. Carol Byrd-‐Bredbenner Ph.D., R.D. Daniel Hoffman Ph.D. RING Project Estrella Dorwani-‐Torres B.A. Carolina Espinosa M.S. Jennifer Collado B.S. Jamila Peña B.S. Luisa Rodriguez B.S. Claudia Costancia Jessica Alarcon Kaitlyn Rafferty Felise OrMz Elisa Mendez
Administra4ve Assistants Dolores Wardrop Kevin McCarthy Wendy Creevy Support at School Carmen Acevedo Barbara Tangel M.S., R.D. Harriet Worobey M.A. Graduate Students Nipa Patel M.S. Pamela Barrios M.S. Jennifer MarMn-‐Biggers M.S., R.D.
Family & Friends
THANK YOU!
NICHD Grants R03 39697 and R01 47338
QuesMons?
hTp://www.themotherhuddle.com/gewng-‐kids-‐to-‐eat-‐their-‐vegetables/
Low FV ConsumpMon
• Low FV consumpMon – US FV average -‐ 2.1 servings per day (Cullen et al., 2001) – “5-‐A-‐Day” (Dennison, Rockwell, & Baker, 1998)
• 0.5 cups/day of vegetables – Hispanic populaMon (Basch, Zybert, & Shea, 1994)
• 6.8% met dietary recommendaMons for FV
– Mexican children (Perez-‐Lizaur, Kaufer-‐Horwitz, & Plazas, 2008) • Only 1 serving per day of FV combined
• High FV consumpMon at an early age (Krebs-‐Smith et al., 2010)
Macronutrient & Fiber Intakes • 2008 Feeding Infant and Toddler Study (FITS)
– Cross-‐secMonal naMonal survey of US children (birth to 47 months) – Nutrient analyses on nutrient intakes from a 24-‐hour dietary recall
• UMlized Dietary Reference Intakes (DRI) values to determine adequate nutrient intake in children’s diets
Overall findings
Hypo #1: An increase in percent carbohydrate intake as the children age from 2 to 4 years, which will decrease percent protein and percent fat intake.
• Result – Percent carbohydrate increase
Hypo #2: Micronutrient intake, specifically vitamin A, vitamin C, vitamin K, and folate, will meet the set Dietary Reference Intake values at both 4me points.
• Results – Vitamin A, vitamin C, and folate met DRI values. Vitamin K met DRI values in 2-‐year-‐olds but not 4-‐year-‐olds
• Previous studies – 2008 FITS children
• Met vitamin A, vitamin C, vitamin K and folate
Hypo #3: Micronutrient intakes, specifically vitamin E, potassium, and fiber, will not meet the set by DRI values at both 4me points.
• Results – Potassium, vitamin E, and fiber did not meet DRI values.
• Previous studies – 37% FITS parMcipants did not meet vitamin E recommendaMons
– Potassium intake recommendaMon was not met in FITS children nor in Mexican-‐American children from the Mier et al. (2007) study.
Hypo #4: Par4cipants will not meet fruit and vegetable recommenda4ons set by the 2010 USDA dietary guidelines at age 2 or at age 4 years.
• Results
– Children met fruit recommendaMons but they did not meet vegetable recommendaMons at either age.
• Previous studies
– Higher fruit intakes than white, non-‐Hispanic children (Lorson et al., 2009)
– Only 1 serving of fruit and vegetable combined in Mexican children
– FITS parMcipants had 1 vegetable per day (Fox et al., 2010) – Vegetable intake at 0.76 cups (Lorson et al., 2009)
Hypo #5: Par4cipants will increase in weight status as they age, due to low fruit and vegetable consump4on.
• Results – No associaMon between FV consumpMon and weight status at either age.
• Previous studies – Other studies have not found this link. – Obese mother increases risk for children (Whitaker, 2004)
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