What are American children eating? Implications for public policy.
TL;DR: This review is organized around a series of policy issues looking at these new food consumption patterns, their relationship to the Dietary Guidelines, and their impact on children's health.
Abstract: As the health and demographic profile of the U.S. population changes, the food consumption patterns of American children have also changed. This review is organized around a series of policy issues looking at these new food consumption patterns, their relationship to the Dietary Guidelines, and their impact on children's health.
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TL;DR: Prevalence and trends in overweight among children and adolescents in the US population and variation in the prevalence by sex, age, race-ethnicity, income, and educational level are described.
Abstract: We describe prevalence and trends in overweight among children and adolescents (6 to 17 years old) in the US population and variation in the prevalence by sex, age, race-ethnicity, income, and educational level. Height and weight were measured in nationally representative surveys conducted between 1963 and 1994: cycles II (1963 to 1965) and III (1966 to 1970) of the National Health Examination Survey (NHES) and the National Health and Nutrition Examination Surveys (NHANES I, 1971 to 1974; NHANES II, 1976 to 1980; and NHANES III, 1988 to 1994). Overweight was defined by the age- and sex-specific 95th percentile of body mass index (BMI) from NHES II and III. BMI values between the 85th and 95th percentiles were considered an area of concern, because at this level there is increased risk for becoming overweight. Approximately 11% of children and adolescents were overweight in 1988 to 1994, and an additional 14% had a BMI between the 85th and 95th percentiles. The prevalence of overweight did not vary systematically with race-ethnicity, income, or education. Overweight prevalence increased over time, with the largest increase between NHANES II and NHANES III. Examination of the entire BMI distribution showed that the heaviest children were markedly heavier in NHANES III than in NHES, but the rest of the distribution of BMI showed little change. Data are limited for assessing the causes of the rapid change in the prevalence of overweight. The increased overweight prevalence in US children and adolescents may be one manifestation of a more general set of societal effects. Childhood overweight should be addressed from a public health perspective.
1,395 citations
TL;DR: Nutrition education messages targeted to children and/or their parents should encourage limited consumption of soft drinks and policies that limit children's access to soft drinks at day care centers and schools should be promoted.
Abstract: Objective To determine whether carbonated soft drink consumption is associated with consumption of milk, fruit juice, and the nutrients concentrated in these beverages. Design Data collected as part of the 1994 Continuing Survey of Food Intakes by Individuals were analyzed. Information on food and nutrient intake was derived from 2 days of dietary recall data collected via an in-person interview. Subjects and participants Nationally representative sample of people of all ages residing in the United States (response rate=76.2%). Analyses were restricted to children aged 2 to 18 years (N=l,810). Statistical analyses performed Logistic regression analyses were conducted to predict the odds of low milk and juice consumption by soft drink consumption level. To determine whether intake of select nutrients varied by soft drink consumption, multiple linear regression modeling was conducted. Analyses were conducted using sample weights and software appropriate for the survey design. Results Energy intake was positively associated with consumption of nondiet soft drinks. For example, mean adjusted energy intake was 1,830kcal/day for school-aged children who were nonconsumers of soft drinks compared with 2,018kcal/day for children in this age group who consumed an average of 9 oz of soda or more per day. Those in the highest soft drink consumption category consumed less milk and fruit juice compared with those in the lowest consumption category (nonconsumers). Conclusions Nutrition education messages targeted to children and/or their parents should encourage limited consumption of soft drinks. Policies that limit children's access to soft drinks at day care centers and schools should be promoted. J Am Diet Assoc. 1999;99:436-441.
802 citations
TL;DR: Children and teens in the United States follow eating patterns that do not meet national recommendations, and nutrition education and intervention are needed among US children.
Abstract: Objectives. To determine the proportion of youth meeting national recommendations for food group intake and to identify food intake patterns. Design. The US Department of Agriculture9s 1989–1991 Continuing Surveys of Food Intakes by Individuals were used to estimate food intake. Intake was determined from 3 days of diet by disaggregating foods into their component ingredients and using weights that correspond to servings. Participants. The sample included 3307 youth, 2 to 19 years of age, living in the 48 conterminous United States. Main Outcome Measures. Mean number of servings and percentage of individuals meeting national recommendations for food group intake according to demographic characteristics, patterns of intake, and nutrient profiles associated with each pattern. Results. Mean numbers of servings per day were below minimum recommendations for all food groups except the dairy group (ages 2 to 11). Percentages of youth meeting recommendations ranged from ∼30% for fruit, grain, meat, and dairy to 36% for vegetables. Sixteen percent of youth did not meet any recommendations, and 1% met all recommendations. The pattern of meeting all recommendations resulted in nutrient intakes above the recommended dietary allowances and was high in fat. Conversely, meeting none of the recommendations resulted in intakes well below the recommended dietary allowances for some nutrients. Total fat and added sugars averaged 35% and 15% of energy, respectively, and levels were similar among most demographic groups. Conclusion. Children and teens in the United States follow eating patterns that do not meet national recommendations. Nutrition education and intervention are needed among US children.
611 citations
TL;DR: Validity and reliability studies of recalls, records, food frequency questionnaires, diet histories, and observations among children were reviewed and correlations between the validation standard and dietary method were generally higher for recalls and records than FFQs.
432 citations
TL;DR: What US children are eating is reviewed and trends in food and nutrient intakes as well as the impact of school meals on children's diets are explored to improve the nutritional well-being of children.
Abstract: It is the position of the American Dietetic Association that children ages 2 to 11 years should achieve optimal physical and cognitive development, attain a healthy weight, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity. The health status of American children has generally improved over the past three decades. However, the number of children who are overweight has more than doubled among 2- to 5-year-old children and more than tripled among 6- to 11-year-old children, which has major health consequences. This increase in childhood overweight has broadened the focus of dietary guidance to address children's over consumption of energy-dense, nutrient-poor foods and beverages and physical activity patterns. Health promotion will help reduce diet-related risks of chronic degenerative diseases, such as cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. This position paper reviews what US children are eating and explores trends in food and nutrient intakes as well as the impact of school meals on children's diets. Dietary recommendations and guidelines and the benefits of physical activity are also discussed. The roles of parents and caregivers in influencing the development of healthy eating behaviors are highlighted. The American Dietetic Association works with other allied health and food industry professionals to translate dietary recommendations and guidelines into achievable, healthful messages. Specific recommendations to improve the nutritional well-being of children are provided for dietetics professionals, parents, and caregivers.
412 citations
References
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TL;DR: The most prominent contributors to mortality in the United States in 1990 were tobacco, diet and activity patterns, alcohol, microbial agents, toxic agents, firearms, sexual behavior, motor vehicles, and illicit use of drugs.
Abstract: Objective. —To identify and quantify the major external (nongenetic) factors that contribute to death in the United States. Data Sources. —Articles published between 1977 and 1993 were identified through MEDLINE searches, reference citations, and expert consultation. Government reports and compilations of vital statistics and surveillance data were also obtained. Study Selection. —Sources selected were those that were often cited and those that indicated a quantitative assessment of the relative contributions of various factors to mortality and morbidity. Data Extraction. —Data used were those for which specific methodological assumptions were stated. A table quantifying the contributions of leading factors was constructed using actual counts, generally accepted estimates, and calculated estimates that were developed by summing various individual estimates and correcting to avoid double counting. For the factors of greatest complexity and uncertainty (diet and activity patterns and toxic agents), a conservative approach was taken by choosing the lower boundaries of the various estimates. Data Synthesis. —The most prominent contributors to mortality in the United States in 1990 were tobacco (an estimated 400000 deaths), diet and activity patterns (300 000), alcohol (100 000), microbial agents (90 000), toxic agents (60 000), firearms (35 000), sexual behavior (30 000), motor vehicles (25 000), and illicit use of drugs (20 000). Socioeconomic status and access to medical care are also important contributors, but difficult to quantify independent of the other factors cited. Because the studies reviewed used different approaches to derive estimates, the stated numbers should be viewed as first approximations. Conclusions. —Approximately half of all deaths that occurred in 1990 could be attributed to the factors identified. Although no attempt was made to further quantify the impact of these factors on morbidity and quality of life, the public health burden they impose is considerable and offers guidance for shaping health policy priorities. (JAMA. 1993;270:2207-2212)
5,468 citations
TL;DR: Overweight during adolescence has important social and economic consequences, which are greater than those of many other chronic physical conditions and discrimination against overweight persons may account for these results.
Abstract: Background and Methods Overweight in adolescents may have deleterious effects on their subsequent self-esteem, social and economic characteristics, and physical health. We studied the relation between overweight and subsequent educational attainment, marital status, household income, and self-esteem in a nationally representative sample of 10,039 randomly selected young people who were 16 to 24 years old in 1981. Follow-up data were obtained in 1988 for 65 to 79 percent of the original cohort, depending on the variable studied. The characteristics of the subjects who had been overweight in 1981 were compared with those for young people with asthma, musculoskeletal abnormalities, and other chronic health conditions. Overweight was defined as a body-mass index above the 95th percentile for age and sex. Results In 1981, 370 of the subjects were overweight. Seven years later, women who had been overweight had completed fewer years of school (0.3 year less; 95 percent confidence interval, 0.1 to 0.6; P = 0.009...
1,657 citations
TL;DR: It is suggested that television viewing may cause obesity in at least some children and adolescents and the potential effects of obesity on activity and the consumption of calorically dense foods are consistent with this hypothesis.
Abstract: The association of television viewing and obesity in data collected during cycles II and III of the National Health Examination Survey was examined. Cycle II examined 6,965 children aged 6 to 11 years and cycle III examined 6,671 children aged 12 to 17 years. Included in the cycle III sample were 2,153 subjects previously studied during cycle II. These surveys, therefore, provided two cross-sectional samples and one prospective sample. In all three samples, significant associations of the time spent watching television and the prevalence of obesity were observed. In 12- to 17-year-old adolescents, the prevalence of obesity increased by 2% for each additional hour of television viewed. The associations persisted when controlled for prior obesity, region, season, population density, race, socioeconomic class, and a variety of other family variables. The consistency, temporal sequence, strength, and specificity of the associations suggest that television viewing may cause obesity in at least some children and adolescents. The potential effects of obesity on activity and the consumption of calorically dense foods are consistent with this hypothesis.
1,183 citations
TL;DR: The mortality findings of this study match closely those of the Build and Blood Pressure Study 1959 based on the experience of 412 million insured persons.
1,174 citations
TL;DR: It is indicated that overweight at 35 y can be predicted from BMI at younger ages, and the prediction is excellent at age 18 y, good at 13 y, but only moderate at ages younger than 13 y.
802 citations