mHealth Improved Fruit and Vegetable Accessibility and Intake in Young Children.

OBJECTIVE: To explore the potential of mHealth using smartphones to improve fruit and vegetable intake in children. DESIGN: A 10-week randomized control and intervention pilot study. SETTING: Story time sessions at local libraries. PARTICIPANTS: A convenience sample of 30 parents and children (aged 3-8 years). INTERVENTION: Delivery of nutrition intervention through the mobile Jump2Health website, Facebook posts, and text messages. MAIN OUTCOME MEASURES: Electronic food photos of children's meals and snacks, 10-question survey related to fruit and vegetable consumption, reflectance spectroscopy via Veggie Meter to measure skin carotenoid levels, body mass index percentiles, and a mobile learning survey. ANALYSIS: Descriptive statistics and Wilcoxon matched-pairs signed-rank test. RESULTS: Veggie Meter values for children and parents showed significant week × treatment interactions in the intervention group compared with the control group for both children (P < .001 and parents (P < .001). CONCLUSIONS AND IMPLICATIONS: This pilot study offers a potentially effective program including a mobile Web site, social media, and test message components to increase fruit and vegetable intake of young children.

Jump2Health Website™ for Head Start parents to promote a healthy home environment: Results from formative research.

Background: In US, approximately 23% of children between the ages of 2-5 years are overweight or obese. Parents need access to information to create healthy home environments for obesity prevention, yet participation for in-person education programs is challenging. Web-based interventions are promising educational tools due to 24/7 availability. However, information is limited on their development and evaluation. Design and Methods: This study reports on a rigorous development process that included six focus group discussions (FGD) with stakeholders (three FGD each with parents and teachers) to assess education needs and inform the development of the Jump2Health Website™ by a multidisciplinary team. After development, the Website was evaluated by telephone interviews with stakeholders (five parents and six teachers) and reviewed by an expert panel of five Registered Dietitians. Results: Twenty Head Start parents and 22 Head Start teachers participated in the FGD. To address the needs identified by these stakeholders, the Website was designed to include components that were enabling and motivating, such as descriptions of health benefits by achieving the desired behaviours, short videos on easy meal preparation, and tip sheets on how to achieve healthy behaviours in easy, economical ways. Stakeholder evaluation of the Website indicated that the information was helpful, easy to use, and would be beneficial for parents. Conclusions: The development of Jump2Health Website™ was strengthened by FGD with stakeholders that assessed educational needs. Interviews with stakeholders and an expert panel review showed that the Website may be an effective educational method to teach parents about healthy behaviours related to obesity prevention.

Military Parents' Personal Technology Usage and Interest in e-Health Information for Obesity Prevention.

BACKGROUND: U.S. military families are experiencing high obesity rates similar to the civilian population. The Department of Defense's Military Health System (MHS) is one of the largest healthcare providers in the United States, serving approximately 9.2 million active duty service members, retirees, spouses, and children. The annual cost to the MHS for morbidities associated with being overweight exceeds $1 billion. The preschool age has been suggested as an opportune time to intervene for the prevention of obesity. Thus, this study investigated the current level of technology usage by military service member families and assessed their needs and interests in health/nutrition information. This needs assessment is crucial for researchers/educators to design further studies and intervention programs for obesity prevention in military families with young children. MATERIALS AND METHODS: In total, 288 military parents (233 Army and 55 Air Force) at two military bases whose children were enrolled in military childcare centers in the southwestern United States participated in a Technology Usage in Military Family (TUMF) survey in 2013. RESULTS AND CONCLUSIONS: Overall, both bases presented similar technology usage patterns in terms of computer and mobile device usage on the Internet. Air Force base parents had a slightly higher knowledge level of nutrition/health information than Army base parents. The TUMF survey suggested practical ways such as mobile applications/Web sites, social networks, games, etc., that health educators can use to disseminate nutrition/health information for obesity prevention among military families with young children.

Qualitative Evaluation of the Jump2Health™ Website for Parents of Preschool Children Shows Behavior Changes.

Few interventions have been shown to be successful in reducing child obesity, due in part to the challenges in reaching parents. Web-based nutrition intervention is becoming more feasible due to technology advancements and accessibility across income groups. However, studies on the effectiveness and acceptability of web-based interventions to teach parents about healthy behaviors are needed. The purpose of this study was to evaluate the Jump2Health™ Website intervention using qualitative interview methodology. A follow-up phone interview was conducted with 13 participants, approximately 1-to 2-month-postintervention. Participants reported making desired behavior changes in targeted areas and also considered the Website an effective learning method.

Pilot Study: Survey Tools for Assessing Parenting Styles and Family Contributors to the Development of Obesity in Arab Children Ages 6 to 12 Years.

OBJECTIVE: Our pilot study was conducted to test the reliability of the Caregiver's Feeding Styles Questionnaire (CFSQ) and the Family Nutrition and Physical Activity Assessment (FNPA) in a sample of Arab mothers. DESIGN: Twenty-five Arab mothers completed the CFSQ, FNPA, and the Participant Background Survey for the first administration. After 1-2 weeks, participants completed the CFSQ and the FNPA for the second administration. The two administrations of the surveys allowed for test/retest reliability of the CFSQ and the FNPA and to measure the internal consistency of the two surveys. RESULTS: Pearson's correlation between the first and second administrations or the 19-item scale (demandingness) and the 7-item scale (responsiveness) of the CFSQ were .95 and .86, respectively. As for the FNPA, Pearson's correlation was .80. The estimated reliabilities (Cronbach's alpha) of the CFSQ increased from .86 for the first administration to .93 for the second administration. However, the estimated reliabilities of the FNPA slightly increased from .58 for first administration to .59 for the second administration. CONCLUSION: In our pilot study of Arab mothers, the CFSQ and FNPA were shown to be promising in terms of reliability and content validity.

Lipid content in hepatic and gonadal adipose tissue parallel aortic cholesterol accumulation in mice fed diets with different omega-6 PUFA to EPA plus DHA ratios.

BACKGROUND & AIMS: Diets with low omega (ω)-6 polyunsaturated fatty acids (PUFA) to eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA) ratios have been shown to decrease aortic cholesterol accumulation and have been suggested to promote weight loss. The involvement of the liver and gonadal adipose tissue (GAT) in mediating these effects is not well understood. LDL receptor null mice were used to assess the effect of an atherogenic diet with different ω-6:EPA+DHA ratios on weight gain, hepatic and GAT lipid accumulation, and their relationship to atherosclerosis. METHODS: Four groups of mice were fed a high saturated fat and cholesterol diet (HSF ω-6) alone, or with ω-6 PUFA to EPA+DHA ratios up to 1:1 for 32 weeks. Liver and GAT were collected for lipid and gene expression analysis. RESULTS: The fatty acid profile of liver and GAT reflected the diets. All diets resulted in similar weight gains. Compared to HSF ω-6 diet, the 1:1 ratio diet resulted in lower hepatic total cholesterol (TC) content. Aortic TC was positively correlated with hepatic and GAT TC and triglyceride. These differences were accompanied by significantly lower expression of CD36, ATP-transporter cassette A1, scavenger receptor B class 1, 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR), acetyl-CoA carboxylase alpha, acyl-CoA synthetase long-chain family member 5, and stearoyl-coenzyme A desaturase 1 (SCD1) in GAT, and HMGCR, SCD1 and cytochrome P450 7A1 in liver. CONCLUSIONS: Dietary ω-6:EPA+DHA ratios did not affect body weight, but lower ω-6:EPA+DHA ratio diets decreased liver lipid accumulation, which possibly contributed to the lower aortic cholesterol accumulation.

Associations between tissue visfatin/nicotinamide, phosphoribosyltransferase (Nampt), retinol binding protein-4, and vaspin concentrations and insulin resistance in morbidly obese subjects.

Visfatin/Nampt, vaspin, and retinol binding protein-4 (RBP-4) play an important role in insulin resistance. The objectives of this study were to measure visfatin/Nampt, vaspin, and RBP-4 concentrations in blood, liver, muscle, subcutaneous, omental, and mesenteric adipose tissues in morbidly obese subjects and investigate their relationship to insulin resistance. Blood and tissue samples were collected from 38 morbidly obese subjects during Roux-en-Y surgery. Insulin resistance biomarkers were measured using standard kits. Visfatin/Nampt, vaspin, and RBP-4 gene expression levels in tissues were measured using real-time PCR. Their protein concentrations in blood and tissues were measured using ELISA kits. Diabetic subjects had significantly higher homeostasis model of assessment-insulin resistance and age and lower blood HDL-cholesterol concentrations than nondiabetic and prediabetic subjects. Diabetic and prediabetic subjects had significantly higher blood concentrations of visfatin/Nampt and vaspin than nondiabetic subjects. Liver RBP-4 concentrations were positively associated with blood glucose concentrations. Blood insulin resistance biomarker levels were positively associated with visfatin/Nampt concentrations in omental adipose tissue and liver, and vaspin concentrations in mesenteric adipose tissue. In conclusion, the correlations of visfatin/Nampt, vaspin, and RBP-4 with insulin resistance are tissue dependent.

Aortic cholesterol accumulation correlates with systemic inflammation but not hepatic and gonadal adipose tissue inflammation in low-density lipoprotein receptor null mice.

Inflammation is a major contributor to the development of atherosclerotic plaque, yet the involvement of liver and visceral adipose tissue inflammatory status in atherosclerotic lesion development has yet to be fully elucidated. We hypothesized that an atherogenic diet would increase inflammatory response and lipid accumulation in the liver and gonadal adipose tissue (GAT) and would correlate with systemic inflammation and aortic lesion formation in low-density lipoprotein (LDL) receptor null (LDLr-/-) mice. For 32 weeks, LDLr-/- mice (n = 10/group) were fed either an atherogenic (high saturated fat and cholesterol) or control (low fat and cholesterol) diet. Hepatic and GAT lipid content and expression of inflammatory factors were measured using standard procedures. Compared with the control diet, the atherogenic diet significantly increased hepatic triglyceride and total cholesterol (TC), primarily esterified cholesterol, and GAT triglyceride content. These changes were accompanied by increased expression of acyl-CoA synthetase long-chain family member 5, CD36, ATP-binding cassette, subfamily A, member 1 and scavenger receptor B class 1, and they decreased the expression of cytochrome P450, family 7 and subfamily a, polypeptide 1 in GAT. Aortic TC content was positively associated with hepatic TC, triglyceride, and GAT triglyceride contents as well as plasma interleukin 6 and monocyte chemoattractant protein-1 concentrations. Although when compared with the control diet, the atherogenic diet increased hepatic tumor necrosis factor α production, they were not associated with aortic TC content. These data suggest that the LDLr-/- mice responded to the atherogenic diet by increasing lipid accumulation in the liver and GAT, which may have increased inflammatory response. Aortic TC content was positively associated with systemic inflammation but not hepatic and GAT inflammatory status.

Assessment of the effect of acculturation on dietary and physical activity behaviors of Arab mothers in Lubbock, Texas.

OBJECTIVES: Our study was conducted to collect exploratory data on Arab mothers in the United States regarding their dietary and physical activity behaviors and to assess the relationship of acculturation to these behaviors. DESIGN: Focus groups and interviews were conducted to collect data on dietary and physical activity behaviors of Arab mothers in Lubbock, Texas. The Social Cognitive Theory guided the development of questions related to the role of acculturation on the dietary and physical activity behaviors. The Male Arab-American Acculturation Scale was used to measure acculturation. RESULTS: A bicultural dietary pattern of Arab mothers emerged. Negative behaviors included skipping meals, increased intake of high-fat fast foods and meat consumption, and lack of traditional physical activity. Some reported reasons for the negative behaviors included children's preferences, lack of access to traditional foods, preference for convenience, the low cost of some foods, and lack of time. Positive changes for some Arab mothers included healthier cooking techniques, reading nutritional labels, and making new healthy food choices due to increased awareness of healthy foods, availability and affordability of many healthy choices in the United States, and Arab mothers' attempts to enrich their families' meals with vegetables in order to keep the Arabic dietary pattern. CONCLUSION: Positive dietary and physical activity changes should be supported. Nutrition interventions are needed that address the major barriers to diet and physical activity changes reported by these Arab mothers.

Blood leptin and C-reactive protein provide more sensitive assessment than blood lipids and other inflammatory biomarkers in overweight university students.

Overweight is an inflammatory disease, and today's overweight university students will be tomorrow's overweight employees and parents; however, few studies have focused on the link between overweight and inflammation in university students. We hypothesized that students at higher body mass index (BMI) and percent body fat (BF%) would have higher blood concentrations of lipids and inflammatory biomarkers. A cross-sectional study including 110 university students was conducted at Texas Tech University. Overweight was determined by BMI using measured height and weight, and BF% was determined using bioelectric impedance analysis. Serum triglyceride and cholesterol concentrations were measured using enzymatic methods. Plasma concentrations of leptin, adiponectin, C-reactive protein (CRP), interleukin-6, and tumor necrosis factor α were measured using an enzyme-linked immunosorbent assay. Our results showed that higher BMI was associated with increased blood concentrations of CRP, leptin, and triglyceride (only in male subjects) and decreased blood adiponectin concentrations in university students. In addition, BF% was significantly correlated with blood concentrations of leptin and CRP. Female students had significantly higher blood concentrations of leptin, adiponectin, and CRP than did male students. In conclusion, blood inflammatory biomarkers, especially leptin and CRP, provide a more sensitive and accurate assessment than blood cholesterol and triglyceride for overweight individuals in this population. Leptin, adiponectin, and CRP are sex-dependent inflammatory biomarkers.

Obesity in rural youth: looking beyond nutrition and physical activity.

Contributors to excessive obesity in rural youth include well-documented nutrition and physical activity behaviors. However, emerging research suggests that preventing excessive weight gain and smoking during pregnancy, teen pregnancy, and child abuse also could reduce obesity in this vulnerable population. These traditional and emerging, nontraditional factors need to be addressed within the confines of current challenges faced by rural communities. An enhanced ecological model provides a framework for combining traditional and nontraditional factors into a more comprehensive approach that addresses the complexity of the issues contributing to youth obesity.

Effects of TV in the bedroom on young Hispanic children.

PURPOSE: The main purposes of this study were to assess TV viewing among Hispanic young children and to examine effects of having a TV in the child's bedroom (TVIB). DESIGN AND SETTING: A quasi-experimental design was used to evaluate an intervention program that is collecting longitudinal data in West Texas. However, the current report uses only the baseline data of the ongoing study. SUBJECTS: Predominantly low-income and Hispanic parents/guardians (N=315) and their children of 5 to 9 years (N=597). MEASURES: Children's anthropometric measures were obtained. Their overweight status was determined based on age- and gender-adjusted body mass index. A demographic questionnaire, acculturation scale (brief version of Acculturation Rating Scale for Mexican Americans II), and family survey were used among parents. ANALYSIS: Descriptive statistics, t-tests, χ(2) tests, and logistic regressions were used. RESULTS: Most children (70%) have TVIB; more than 30% were or were at risk of overweight. Demographic characteristics did not significantly predict TVIB. Children with TVIB spent .93 hours more daily watching TV/DVD (t=3.07; df=283; p=.003), and children (at one site) ate more fast food (χ(2)=5.46; df=1; p=.019), compared with children without TVIB whose parents better supported physical activity (t=2.11; df=275; p=.039). CONCLUSION: Most children in this low-income and Hispanic sample have TVIB, which is associated with unhealthy behaviors.

Formative assessment in the development of an obesity prevention component for the expanded food and nutrition education program in Texas.

This study conducted formative research (surveys, focus groups) to assess the nutrition education needs of clients in the Texas Expanded Food and Nutrition Education Program prior to curriculum revision. Participants were current Expanded Food and Nutrition Education Program participants in 3 Texas cities (Austin, Houston, San Antonio). Data were used to tailor the curriculum to the target population. This research provides evidence that members of the target audience can provide valuable insights into a particular topic. Formative work prior to intervention development should be conducted to identify key issues regarding a particular topic and to evaluate potential educational approaches.

Creating healthful home food environments: results of a study with participants in the expanded food and nutrition education program.

OBJECTIVE: To evaluate a modified curriculum for the 6-session Texas Expanded Food and Nutrition Education Program (EFNEP) promoting healthful home food environments and parenting skills related to obesity prevention. DESIGN: Two-group randomized control trial; intervention versus usual EFNEP curriculum. SETTING: Texas EFNEP classes. PARTICIPANTS: 1,104 EFNEP clients in 100 classes. INTERVENTION: Six short videos, with goal setting, problem solving, guided discussion, and handouts, incorporated into existing EFNEP classes. MAIN OUTCOME MEASURES: Body mass index (BMI), diet, psychosocial variables with baseline measurements, immediately post, and 4 months later. ANALYSIS: Mixed-model repeated measures analysis of variance. RESULTS: 100 classes were randomized (54 intervention/46 comparison), with 1,006 participants at baseline (582 intervention, 424 comparison, 97% women, 89% Hispanic). Significant improvements over time were found for both groups' consumption of most food items and nutrients, and nearly all psychosocial variables, regardless of study group. Only the intervention group had a significant BMI decrease at post. Fidelity to the intervention class session structure was high, and comments from intervention staff and clients were positive. CONCLUSION AND IMPLICATIONS: Existing EFNEP programs in local communities could have a significant impact on family dietary behaviors for populations at risk of obesity. Replication with similar populations is warranted.

Perceived parenting behaviours predict young adolescents' nutritional intake and body fatness.

This study investigated whether perceptions of parenting behaviours predict young adolescents' nutritional intake and body fatness. The randomly selected study sample consisted of 106 13-15 years olds from Houston Metropolitan Statistical Area. Parenting style variables were created by cluster analysis and factor analysis. A two-cluster solution for both maternal and paternal parenting style represented authoritative vs. non-authoritative parenting. Two parenting dimension factors derived were maternal/paternal nurturing and control. For adolescents' energy and nutrient intake, greater maternal nurturing appeared to be most beneficial given its association with lower consumption of total kilocalorie and lower saturated fat intake. Paternal nurturing was associated with lower sodium intake, whereas paternal control predicted lower percentage of kilocalories from carbohydrate and percentage Dietary Reference Intake for dietary fibre, and greater percentage of kilocalories from total fat. Maternal authoritative parenting and lower maternal control over their adolescents may have protective effects against having heavier and fatter adolescents given their associations with adolescents' body weight, sub-scapular skinfold, waist circumference, body mass index, and the tendencies of being at risk of overweight and being overweight. None of paternal parenting styles or dimensions appeared to be significantly related to adolescents' body fatness.

Pre- and post-season dietary intake, body composition, and performance indices of NCAA division I female soccer players.

Little published data describe the dietary and physiological profiles of intercollegiate female soccer players; therefore, the purpose of this investigation was to report baseline dietary data, anthropometrics, and performance indices of soccer women during rigorous pre-season training (2 sessions/day) and then during the post-competitive season. Members of a NCAA Division I women's soccer squad completed 3-day diet records, anthropometrics, and physical tests, including VO2peak. Average body mass was 62 kg with 16% body fat, and no significant pre to post differences were observed. Total energy, carbohydrate (CHO), protein, and fat intakes were significantly greater during the pre-season. Pre-season energy intake met the DRI for females with an "active" lifestyle (37 kcal/kg). While CHO intake failed to meet minimum recommendations to promote glycogen repletion (7-10 g/kg), protein and fat intakes were above minimum recommendations. Pre- and post-season intakes of several micronutrients were marginal (<75% of the DRI) including vitamin E, folate, copper, and magnesium. VO2peak significantly improved from pre- to post-season (42 and 50 ml/kg/min). In this study female soccer players appeared to meet caloric needs during periods of training but failed to meet minimum CHO and micronutrient recommendations. Foods higher in protein and fat displaced more CHO-rich and nutrient-dense foods within athletes' energy requirements and satiety limits.

Nutrient Intakes of Third Graders: Results from the Child and Adolescent Trial for Cardiovascular Health (CATCH) Baseline Survey.

The purpose of this article is to report on baseline intakes of 1874 third-grade children representing a subsample of the Child and Adolescent Trial for Cardiovascular Health (CATCH) cohort. Intakes were assessed using a single, food record-assisted, 24-hour recall. The sample is unique in that it is drawn from four states and includes students from various ethnic backgrounds. Nutrients of interest include total energy, sodium, dietary cholesterol, and percent of energy from total fat and saturated fat. At baseline, third-grade students were consuming above nationally recommended levels of energy from fat, saturated fat, and sodium. The CATCH findings show a mean energy intake of 2031 kcal with significant differences by sex. Significant differences by site were seen for percent of energy from total fat, saturated fat, and dietary cholesterol. Children from Minnesota consumed the lowest proportion of energy from total fat and saturated fat while children from Texas had the highest proportion of energy from total fat and saturated fat. Intake of dietary cholesterol was lowest in Minnesota and highest in Louisiana. Nutrient differences by ethnic group were seen only for energy, with African Americans having the highest energy intake and Hispanics having the lowest energy intake. The number of meals consumed from school food service significantly influenced children's nutrient, intake; children consuming two meals from school food service had significantly greater intakes of energy, saturated fat, and dietary cholesterol compared to students consuming one or no meals from school food-service. The results are compared to other national nutritional surveys of children.