The Effects of a Multisector, Multilevel Intervention on Child Dietary Intake: California Childhood Obesity Research Demonstration Study.

Consuming too few fruits and vegetables and excess fat can increase the risk of childhood obesity. Interventions which target mediators such as caregivers' dietary intake, parenting strategies, and the family meal context can improve children's diets. A quasi-experimental, pre-post intervention with four conditions (healthcare (HC-only), public health (PH-only), HC + PH, and control) was implemented to assess the effects of the interventions and the effects of the mediators. HC (implemented with the Obesity Care Model) and PH interventions entailed capacity building; policy, system, and environment changes; and a small-scale media campaign to promote healthy eating. Linear mixed models were used to assess intervention effects and the mediation analysis was performed. Predominantly Hispanic/Latino children and caregivers from rural communities in Imperial County, California, were measured at baseline (N = 1186 children/848 caregivers) and 12 months post-baseline (N = 985/706, respectively). Children who were overweight/obese in the HC-only condition (M = 1.32) consumed more cups of fruits at the 12-month follow-up than those in the control condition (M = 1.09; p = 0.04). No significant mediation was observed. Children in the PH-only condition consumed a significantly higher percentage of energy from fat (M = 36.01) at the follow-up than those in the control condition (M = 34.94, p < 0.01). An obesity intervention delivered through healthcare settings slightly improved fruit intake among at-risk children, but the mechanisms of effect remain unclear.

Examining multiple parenting behaviors on young children's dietary fat consumption.

OBJECTIVE: To understand the association between parenting and children's dietary fat consumption, this study tested a comprehensive model of parenting that included parent household rules, parent modeling of rules, parent mediated behaviors, and parent support. DESIGN: Cross-sectional. SETTING: Baseline data from the MOVE/me Muevo project, a recreation site-based obesity prevention and control intervention trial. PARTICIPANTS: Five hundred forty-one parents of children between the ages of 5 and 8 years and living in San Diego County. MAIN OUTCOME MEASURE: Children's fat consumption based on parent report using a short food frequency questionnaire. ANALYSIS: A hierarchical linear regression was conducted. In exploratory analyses, a stepwise backward elimination approach was used. RESULTS: Children's fat consumption was positively associated with parent household rules (P < .01) and negatively associated with parent modeling of rules (P < .01). CONCLUSIONS AND IMPLICATIONS: Controlling parenting behaviors, such as rule setting, are associated with more frequent fat consumption, whereas role modeling healthful behaviors is associated with less frequent fat consumption. Changing parenting behaviors with regard to how they feed their children is a logical avenue for improving eating behaviors.

Retaining school children and families in community research: lessons from the Study of Children's Activity and Nutrition (SCAN).

Retaining school-aged study participants poses a major challenge in any longitudinal research study. Dropouts produce bias in the remaining sample and this loss may affect study findings and their interpretation. Dominant factors that influence retention in pediatric research studies include family versus individual participation, patient management strategies of study personnel, knowledge about the condition or therapy, age and gender factors, credibility within the community, monetary incentives, and altruism. Eleven years after baseline assessment, Studies of Children's Activity and Nutrition boasts a 53% retention of the original biethnic cohort in San Diego. Retention occurred partly due to a trained measurement team which completed sequential observations primarily in family homes and implemented continuous participant follow-up procedures. Approaches for increasing student retention based on carefully designed studies and adherence indicators can assist researchers seeking maximum retention of school-aged participants.

Tracking dietary intake in white and Mexican-American children from age 4 to 12 years.

OBJECTIVE: To examine the tracking (ie, the stability over time) of dietary intake in Mexican-American and white children aged 4 to 12 years. SUBJECTS: Children 4 years of age (n=351) were assessed at baseline and 65% (n=228) completed the 8-year study. DESIGN: Cardiovascular disease-related dietary intake was defined as energy, percent of energy from fat, and sodium (mg/1,000 kcal). From age 4 to 7 years, a modified 24-hour recall with observation of lunch and dinner and interview of the primary food preparer for unobserved foods was used to describe dietary intake. For children aged 11 to 12 years, a standardized 24-hour recall was used. STATISTICAL ANALYSES: A mixed effects model that adjusted for sex, ethnicity, and measurement wave allowed for separation of shorter-term variations in diet from more stable ("between subject") variations. Extent of between-subject variance is an indication of tracking. RESULTS: From age 4 to age 7, there were statistically significant between-subject variance components for energy (P<.00001), percent of energy from fat (P<.00001), and sodium per 1,000 kcals (P<.001); for ages 11 and 12, energy intake was significant (P<.00001). There were no significant associations for dietary intake from age 4 to 12 years. CONCLUSIONS/APPLICATIONS: It seems that dietary intakes are stable over short periods and at earlier ages compared with longer intervals and later ages. Nutrition interventions are needed in childhood and throughout adolescence.