The Effect of Dietary Intake On
BMI in School-Aged Children
Amanda Nila, Sree Raji, and Erica Timmermann
Thesis Advisor:
Julie Moreschi MS, RD, LDN
Introduction
• Childhood obesity is rising
– Epidemic
• Overweight/obese children:
– Experience adverse effects during childhood; physical and
psychological [1].
• Mexican American children have higher prevalence.
– Data from NHANES shows that:
• 22.1% of boys and 19.9% girls are obese [2].
– The number of Hispanics living in the U.S. has increased by
60% in the last decade.
– By 2050, expected that 97 million or ¼ of the U.S.
population will be Hispanic [3].
1. Philipsen NM, Philipsen NC. Childhood overweight: Prevention strategies for parents. J PERINAT EDUC. 2008;17(1):44-47.
2. Centers for Disease Control and Prevention. NHANES Surveys (1976–1980 and 2003–2006). Available at website:
http://www.cdc.gov/obesity/childhood/prevalence.html Assessed December 1, 2008.
3. Morales LS, Kington RS, Escarce JJ. Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes. J Health Care Poor Underserved.
2002; 13 (4): 477-503
Introduction Continued…
• According to a recent NHANES survey, obesity has increased from 6.5% to
17% in children aged 6-11. [2].
• In Illinois:
– 12.9% of children were obese and 15.7% of children were considered
overweight in 2007 [4-5].
• In Chicago:
– 15.8% of children were obese while 18.7% were considered
overweight in 2007 [6-7].
• In Dupage County:
– 9% of high school students were overweight or obese.
• 4% females
• 12% males [8]
2. Centers for Disease Control and Prevention. NHANES Surveys (1976–1980 and 2003–2006). Available at website: http://www.cdc.gov/obesity/childhood/prevalence.html Assessed December 1,
2008.
4. Centers for Disease Control and Prevention YRBSS. Youth online: comprehensive results Illinois 2007 dietary behaviors percentage of students who were obese. Available at website:
http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?ByVar=CI&cat=5&quest=507&loc=IL&year=2007 Assessed January 15, 2009.
5. Centers for Disease Control and Prevention YRBSS. Youth online: comprehensive results Illinois 2007 dietary behaviors percentage of students who were overweight. Available at website:
http://apps.nccd.cdc.gov/yrbss/QuestyearTable.asp?Loc=IL&submit1=GO&cat=5&Quest=506&oldLoc=CH&Year=2007&ByVar=CI&colval=2007&rowval1=Sex&rowval2=None&compval=&
Graphval=yes&path= Assessed January 15, 2009
6. Centers for Disease Control and Prevention YRBSS. Youth online: comprehensive results chicago, il 2007 percentages of student who were obese. Available at website:
http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?ByVar=CI&cat=5&quest=507&loc=CH&year=2007 Assessed January 15, 2009.
7. Centers for Disease Control and Prevention YRBSS. Youth online: comprehensive results chicago, il 2007 percentages of students who were overweight. Available at website:
http://apps.nccd.cdc.gov/yrbss/QuestyearTable.asp?Loc=CH&submit1=GO&cat=5&Quest=506&oldLoc=IL&Year=2007&ByVar=CI&colval=2007&rowval1=Sex&rowval2=None&compval=&
Graphval=yes&path= Assessed January 15, 2009.
8. DuPage County Healthy Department. Iplan 2010: Obesity. Available at website: http://www.dupagehealth.org/iplan2010/adobe-pdf/ch11.pdf. Accessed November 4, 2009.
Review of Literature
Protein Intake
Recommendations for dairy intake:
• Age 9 to 14:
• 3 cups/day of fat free or low fat dairy [9].
• Currently, intake is low:
• Dairy intake is 2 or less servings/day [10].
• Increase in reduced fat and fat-free milk [11].
9. MyPyramid.gov. Inside the Pyramid. How much food from the milk group is needed day? Available at website:
http://www.mypyramid.gov/pyramid/milk_amount.aspx. Accessed December 5th.
10. Huang T, McCrory MA. Dairy intake, obesity, and metabolic health in children and adolescents: knowledge and gaps. Nutrition Reviews. 2005; 63
(3): 71-80.
11. American Dietetic Association: Position of the American Dietetic Association: Nutrition guidance for healthy children Ages 2 to 11 Years. J Am
Diet Assoc. 2008; 108: 1038-1047.
Protein Intake
Recommendations for meat and bean intake:
• Age 9 to 14:
• 5 oz/day [12].
• 2003-2004 NHANES survey:
• Protein intake was 13.4% of total calories [13].
• 15% of total calories
• Protein intake has been relatively stable
• But, children’s total fat intake has increased drastically [14].
12. MyPyramid.gov. How much food from the meat and beans group is needed? Available at website:
http://www.mypyramid.gov/pyramid/meat_amount_table.html. Assesses January 15
13. WebMD. Protein: are you getting enough? Available at website: http://www.webmd.com/food-recipes/nutrition-labels-9/protein. Accessed
September 30th.
14. American Dietetic Association: Position of the American Dietetic Association: Nutrition guidance for healthy children Ages 2 to 11 Years. J Am
Diet Assoc. 2008; 108: 1038-1047.
Protein Intake and BMI
• Dairy Intake:
• Association between low dairy intake and greater gains in body fat
during childhood [15].
• Higher intakes of dairy products were associated with lower body fat
[16].
• Children who consumed 3 or more servings of dairy had a lower BMI,
even with a higher energy intake [17].
• Meat and Bean Intake:
• Consumption of a variety of food including meats that are mixed
meats, poultry, seafood, eggs, pork, and beef were positively
associated with overweight status among children [18].
• Has been known that many non-meat eaters or vegetarians are
thinner with notably lower BMI’s than meat eaters [19].
15. Moore L, Bradlee L, Gao D, Singer M. Low dairy intake in early childhood predicts excess body fat gain. Obes. 2006: 14(6): 1010-1909.
16. Carruth BR, Skinner JD. The role of dietary calcium and other nutrients in moderating body fat in preschool children. International Journal of Obesity &
Related Metabolic Disorders. 2001;25(4):559.
17. Fiorito LM, Ventura AK, Mitchell DC, Smiciklas-Wright H, Birch LL. Girls’ dairy intake, energy intake, and weight status. J Am Diet Assoc.
2006;106(11):1851-1855.
18. Nicklas TA, Yang S, Baranowski T, Zakeri I, Berenson G. Eating patterns and obesity in children: the bogalusa heart study. Am J Prev Med. 2003;25(1):9
19. Appleby PN, Thorogood M, Mann JI, Key TJ. Low body mass index in non-meat eater: the possible roles of animal fat, dietary fibre and alcohol.
International Journal of Obesity. 1997; 9: 454-460.
Fruit and Vegetable Intake
• Recommended servings of fruits and
vegetables for school-aged children are:
– 1 ½ cups fruit
– 2-3 cups vegetables
– ~ 5 servings/day (20-21).
• Consumption remains low in children
– Only 21.4% of students ate ≥ 5 servings seven
days before the survey (22).
20. Fruits and Veggies More Matter. For boys-fruit and veggie daily intake. Available at website: http://www.fruitsandveggiesmorematters.org/?page_id=59. Accessed
November 22, 2008.
21. Fruits and Veggies More Matter. For girls-fruit and veggie daily intake. Available at website: http://www.fruitsandveggiesmorematters.org/?page_id=60. Accessed
November 22, 2008.
22. Centers for Disease Control and Prevention. Youth online: comprehensive results. Available at website:
http://apps.nccd.cdc.gov/yrbss/QuestYearTable.asp?cat=5&Quest=508&Loc=XX&Year=Trend&compval=&Graphval=no&path=byHT&loc2=&colval=Race&rowval1=All&r
owval2=Sex&ByVar=CI&Submit2=GO. Accessed November 20, 2008.
Fruit and Vegetable Intake
• Fruit and Vegetable Intake is Low:
– Boys when compared to girls (23).
– Latino and Hispanic ethnic children (Puerto Rican, Mexican American, Cuban
American) (24, 25).
– In high poverty neighborhoods, which have fewer grocery stores, when
compared to children from low poverty neighborhoods with more grocery
stores closer to one’s home (26).
• Fruit and Vegetable Intake Increases:
– With rising income (25).
23. Bere E, Brug J, Klepp K. Why do boys eat less fruit and vegetables than girls?. Public Health Nutrition. 2007; 11(3): 321-325.
24. Basch CE, Zybert P, Shea S. 5-A-DAY: Dietary behavior and the fruit and vegetable intake of latino children. Am J Public Health. 1994;84(5):814-818.
25. Krebs-Smith SM, Cook DA, Subar AF, Cleveland L, Friday J, Kahle LL. Fruit and vegetable intakes of children and adolescents in the united states. Archives of
pediatrics & adolescent medicine. 1996;150(1): 81-86.
26. Mushi-Brunt C, Haire-Joshu D, Elliiot M, Brownson R. Fruit and vegetable intake and obesity in preadolescent children: the role of neighborhood poverty and
grocery store access. American Journal of Health Education. 2007; 38(5): 258-265.
Fruits and Vegetables
and Effect on BMI:
• Low energy density (27)
– Water (28)
– Fiber
– Reduces calories, promotes satiety, and aids in weight
management (28).
• An increased consumption of fruits and
vegetables:
– Could displace less healthy, higher energy-dense foods
(29).
27. Centers for Disease Control and Prevention. Can eating fruits and vegetables help people to manage their weight?. Available at
website: http://www.cdc.gov/nccdphp/dnpa/nutrition/pdf/rtp_practitioner_10_07.pdf. Accessed November 20, 2008.
28. Rolls BJ, Ello-Martin JA, Tohill BC. What can intervention studies tell us about the relationship between fruit and vegetable
consumption and weight management? Nutr Rev. 2004;62(1):1-17.
29. Sherry B. Food behaviors and other strategies to prevent and treat pediatric overweight. Int J Obes. 2005;29:S116-S126.
Carbohydrate Intake
•
Function of CHO:
- Primary source of energy for the body
- Direct source of fuel to the brain (30).
- Act on the brain chemical serotonin (increasing the level),
making us feel calmer and less irritable (31).
•
Recommendation for grain intake: (32).
• 9-13 year: Boys: 6 oz, Girls: 5 oz.
• 14- 18 year: Boys: 7 oz, Girls: 6 oz.
30 Carbohydrates? Calming effect (2008). American Dietetics Association. Website: http://eatright.org/cps/rde/xchg/ada/hs.xsl/home_4669_ENU_HTML.htm
31. USDA, Available at: http://www.health.gov/dietaryguidelines/dga2005/document/html/chapter7.htm, Accessed December 10, 2008.
32. MyPyramid.gov. Inside the Pyramid. How much food from the grain group is needed day? Available at website:
http://www.mypyramid.gov/pyramid/milk_amount.aspx. Accessed January 15th.
Carbohydrate Intake
•
Consumption pattern:
– Low intake of whole grains and fiber
– High in refined CHO like baked goods, candy, and sugar drinks.
– Sugar drinks accounts for 30% of daily caloric intake (33), & are the highest among
12-18 yrs (34).
•
Consumption of refined CHO & sugar drinks among
children have increased.
– Replaced by less healthy, high caloric intake [35].
– Soft drink consumption (40% of daily intake); which is 4 -5 times above the
recommended intake of 32 g [36].
– High intake of fries & chips [37].
33. Tam C.S, Garnett S.P, Cowell C.T, Campbell. K, Cabrera. G, & Baur L.A. Soft drink consumption and excess weight gain in australian school students: results from nepean study. Int J Obes, 2006;30: 1091-1093.
34. Vos, M.B, Kimmons, J.E, & Gillespie, C. Dietary fructose consumption among us children and adults: the third national health and nutrition examination survey. Medscape Journal of Medicine,2008; 10(7), 160.
35. Wilson, T.A, Adolph, A.L, & Butte, N.F. Nutrient adequacy and diet quality in non-overweight and overweight Hispanic children of low socioeconomic status: the viva la familia study . J Am Diet Assoc., 2009;
109(1012-1021),
36. Lenny R.V., Marlene B.S., & Kelly D.B. Effects of soft drink consumption on nutrition and health: A systematic review and meta-analysis. American Journal of Public Health, 2007; 97(4), 667-675.
37. Colapinto C.K., Fitzgerald A, Taper.J, & Veugelers P.J. Children's preference for large portions: Prevalence, determinants and consequences. Journal of the American Dietetic Association, 107(7), 2007; 1183-1190
Carbohydrate Intake
• Snacking vs. family income:
– Potato chips, and sugar beverage consumption are
higher for LSE [38].
– Hispanic children (4-19 yrs, overweight children)
LSE, low in fiber & high in added sugar (36,37).
– Higher BMI low intake of soluble fiber compared
to normal weight [39].
38. Briefel, R. R., & Johnson, C. J. (2004). Secular trends in dietary intake in the United States. Annual
Review of Nutrition, 2004; 24: 401-431.
39. Ventura, E.E, Davis, J.N, & Alexander, K.E.. Dietary intake and the metabolic syndrome in
overweight latino children. J Am Diet Assoc., 2008; 108, 1355-1359.
Rationale
• Health risks are astronomical
– Impact on the U.S. health care system [21].
• $98 billion to $129 billion has been spent on obesity related
complications.
– Obese children tend to become obese adults [18].
– Health related consequences:
•
•
•
•
•
•
•
•
High cholesterol levels
High blood pressure
Asthma
Sleep apnea
Type two diabetes
Peer pressure
Low self-esteem
Poor body dissatisfaction
40. Centers for Disease Control and Prevention. Childhood overweight and obesity: Consequences. Available at website:
http://www.cdc.gov/obesity/childhood/consequences.html Assessed December 1, 2008.
41. Koplan JP, Liverman CT, Kraak VI. Preventing childhood obesity: health in the balance: executive summary. J Am Diet Assoc. 2005; 105 (1): 131-138.
Rationale
• Limited research:
– Meat and bean intake
• BMI
• Childhood obesity
• Type of meat/seafood/beans
– Fruit/vegetable intake
• BMI
• In children
• Existing research has conflicting
results
Inclusion/Exclusion Criteria
• Inclusion criteria:
– 4th through 8th grade students in the selected
Midwest suburban schools.
– Currently active within the after school program while
present on the day of data collection.
– Students with a signed parent/guardian consent form
on file with the school.
• Exclusion Criteria:
– Those not enrolled within the after school program in
the selected Midwest suburban schools.
– No parent consent form on file.
The Survey
• School Physical Activity & Nutrition survey (SPAN)
– School-Based Nutrition Monitoring student questionnaire
– http://www.sph.uth.tmc.edu/catch/catch_em/MeasureToolsDesc_01.htm
• Two versions of the questionnaire that were updated in 2004 were used.
– The 56 question, 4th grade version was used for students in 4th grade.
– The 74 question, 8th and 11th grade version was used for students in 5th through 8th
grade.
• Both versions of the questionnaire had identical purposes
– Were used to measure dietary intake of different foods from each food group and
student demographics for comparison to BMI data collected previously.
• Administration protocols were also available with the SPAN tool.
Anthropometrics
• Spring BMI was collected in March 2009 by
the school nurse.
– Weight (to the nearest ¼ pound)
– Height (to the nearest ¼ inch)
BMI Calculations
• Calculated for Spring 2009.
• CDC Child and Teen BMI Calculator
– http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx.
– Age: Date of birth provided by the school district
– Weight (to the nearest ¼ pound)
– Height (to the nearest ¼ inch)
Survey Data Collection
• Data collection took place in April and May 2009.
– At each of the designated after school areas at each school.
– Took approximately 45 minutes
• Explanation and distribution of the survey
• Completion by the subjects
• After data collection was completed:
–
ID numbers & after school program enrollment date was retrieved from the school
district.
• ID numbers were written on the survey
• The 1st page with the student’s name was discarded for confidentiality
Statistical Analysis
• SPSS version 17.0
– Descriptive Statistics
– Chi-Square
Population
Gender
Schools Attended
School 1
School 2
School 3
School 4
School 5
16%
18%
Male
46%
54%
Female
16%
16%
34%
Ages
Lunch Participation
9%
Age 10-11
45%
55%
Age 12-14
BMI Percentile
20%
80%
< 85th
Percentile
≥ 85th
Percentile
23%
19%
49%
None
Free
Reduced
Free/Reduced
BMI Percentile
22%
58%
≥ 85th
Percentile
≥ 95th
Percentile
Relationship Between Dietary
Protein Intake And BMI Status
Among School-Aged Children
Erica Timmermann
Null Hypothesis
Ho1: There is no association between BMI status in school-aged
children and various protein containing foods:
• Ho1a: Hamburger meat, hot
dogs, sausage, steak, bacon,
or rib intake
• Ho1b: Fried meat intake
• Ho1c: Peanut/peanut butter
intake
• Ho1d: Cheese intake
• Ho1e: Milk intake
• Ho1f: Yogurt/cottage cheese
intake
• Ho1g: Bean intake
• Ho1h: Frozen dessert intake
• Ho1i: Type of milk usually
consumed
Hamburger, Hot Dog, Sausage, Steak, Bacon, or Rib Intake
(x2= 0.176, p= 0.675; Accepted)
Total Intake
Yes
42%
58%
≥ 85th Percentile
< 85th Percentile
Yes
47%
53%
No
No
41%
Yes
59%
No
Fried Meat Intake
(x2= 2.534, p= 0.111; Accepted)
Total Intake
Yes
42%
58%
No
≥ 85th Percentile
< 85th Percentile
37%
Yes
40%
60%
No
63%
Yes
No
Peanut/Peanut Butter Intake
(x2= 0.121, p= 0.728; Accepted)
Total Intake
23%
Yes
No
77%
≥ 85th Percentile
< 85th Percentile
27%
73%
22%
Yes
Yes
No
No
78%
Cheese Intake
(x2= 0.753, p= 0.386; Accepted)
Total Intake
Yes
43%
57%
≥ 85th Percentile
< 85th Percentile
33%
Yes
67%
No
No
Yes
46%
54%
No
Milk Intake
(x2= 0.560, p= 0.454; Accepted)
Total Intake
20%
Yes
No
80%
≥ 85th Percentile
< 85th Percentile
13%
87%
22%
Yes
Yes
No
No
78%
Yogurt/Cottage Cheese Intake
(x2= 0.029, p= 0.864; Accepted)
Total Intake
Yes
40%
No
60%
≥ 85th Percentile
< 85th Percentile
43%
57%
40%
Yes
No
60%
Yes
No
Bean Intake
(x2= 1.162, p= 0.281; Accepted)
Total Intake
29%
Yes
No
71%
≥ 85th Percentile
< 85th Percentile
40%
Yes
No
60%
26%
74%
Yes
No
Frozen Dessert Intake
(x2= 4.352, p= 0.037; Rejected)
Total Intake
39%
Yes
61%
No
≥ 85th Percentile
< 85th Percentile
13%
Yes
No
87%
42%
Yes
58%
No
Milk Usually Consumed
(x2= 1.084, p= 0.298; Accepted)
Total Intake
Regular
39%
61%
Low, Skim,
nonfat, 1/2%
≥ 85th Percentile
< 85th Percentile
Regular
Regular
43%
57%
Low, skim,
nonfat, 1/2%
36%
64%
Low, skim,
nonfat, 1/2%
Association of Fruit and Vegetable Intake on
BMI Status in School-Aged Children
By: Amanda Nila
Null Hypothesis
Ho1: There is no association between BMI status
in school-aged children and various fruit and
vegetable consumption:
– Ho1a: Vegetable intake
– Ho1b: Fruit intake
– Ho1c: Fruit Juice intake
– Ho1d: Knowledge of recommended fruit and
vegetable intake
Vegetable Intake
(x2=0.152, p = 0.697, Accepted)
Total Intake
Yes
44%
No
56%
< 85th Percentile
40%
≥ 85th Percentile
Yes
60%
No
Yes
46%
54%
No
Fruit Intake
(x2= 1.077, p= 0.299, Accepted)
Total Intake
18%
Yes
82%
< 85th Percentile
No
≥ 85th Percentile
15%
27%
73%
Yes
Yes
No
No
85%
Fruit Juice Intake
(x2= 0.005, p= 0.942, Accepted)
Total Intake
Yes
46%
No
54%
< 85th Percentile
≥ 85th Percentile
Yes
47%
53%
No
Yes
46%
54%
No
Knowledge of Recommended Fruit & Vegetable Intake
(x2=2.412, p= 0.120, Accepted)
Total Intake
12%
2-4 Servings
88%
< 85th Percentile
5 Servings
≥ 85th Percentile
0%
2-4 Servings
5 Servings
100%
15%
2-4 Servings
85%
5 Servings
The Effect of Carbohydrate Intake on BMI
Status on Grade School Children
By Sree Raji
Null Hypothesis
Ho1: There is no association between BMI status in schoolaged children and various carbohydrate containing foods:
• Ho1a: Rice, Pasta, Noodles,
Spaghetti
• Ho1b: White bread, Bagel,
Buns, Rolls, Tortillas
• Ho1c: Whole Wheat bread,
Bagel, Buns, Rolls, Tortillas
• Ho1d: Hot and cold cereals
• Ho1e: French fries and
chips
•
•
•
•
•
•
Ho1f: High sugar drinks
Ho1g: Regular sodas
Ho1h: Diet Sodas
Ho1i: Frozen desserts
Ho1j: Sweet Desserts
Ho1k: Chocolate Candy
Rice, Pasta, Noodles
(x2=3.054, p=0.081; Accepted)
Total Intake
34%
Yes
No
65%
<85th Percentile
47%
52%
≥ 85th Percentile
29%
Yes
No
71%
Yes
No
White Bread, Buns, Bagels, Tortillas, Rolls
(x2=.909, p=0.340; Accepted)
Total Intake
Yes
28%
No
66%
<85th Percentile
20%
80%
≥ 85th Percentile
33%
Yes
No
67%
Yes
No
Whole Wheat Bread, Buns, Bagels, Tortillas, Rolls
(x2=1.929, p=0.165; Accepted)
Total Intake
49%
Yes
No
50%
<85th Percentile
33%
≥ 85th Percentile
Yes
67%
No
46%
53%
Yes
No
Hot and Cold Cereals
(x2=.322, p=0.571, Accepted)
Total Intake
Yes
39%
58%
<85th Percentile
47%
53%
No
≥ 85th Percentile
Yes
No
39%
61%
Yes
No
French Fries, Chips
(x2= 7.441, p= 0.006; Rejected)
Total Intake
55% 45%
Yes
No
<85th Percentile
≥ 85th Percentile
13%
Yes
87%
No
48%
53%
Yes
No
Kool-aid, Sports Drink, Fruit Flavored Drinks
(x2= 1.205, p=0.272; Accepted)
Total Intake
Yes
54% 46%
No
<85th Percentile
33%
≥ 85th Percentile
Yes
67%
No
Yes
49%
51%
No
Regular Sodas, Soft Drinks
(x2= 1.598, p=0.206; Accepted)
Total Intake
34%
Yes
No
66%
<85th Percentile
20%
≥ 85th Percentile
Yes
80%
No
37%
Yes
63%
No
Diet Sodas, Soft Drinks
(x2= 2.525, p=0.112; Accepted)
Total Intake
28%
Yes
66%
<85th Percentile
48%
53%
No
≥ 85th Percentile
26%
Yes
No
75%
Yes
No
Frozen Desserts- Ice Creams, Frozen Yogurt, Popsicle
(x2= 4.352, p=0.037; Rejected)
Total Intake
Yes
37%
64%
<85th Percentile
13%
≥ 85th Percentile
Yes
87%
No
No
Yes
42%
58%
No
Desserts- Sweet Rolls, Doughnuts, Cookies,
Pies, Cakes
(x2= 0.581, p=0.446; Accepted)
Total Intake
45%
Yes
No
55%
<85th Percentile
≥ 85th Percentile
Yes
47%
53%
No
42%
58%
Yes
No
Chocolate Candy
(x2= .551, p=0.458; Accepted)
Total Intake
Yes
38%
No
61%
<85th Percentile
47%
53%
≥ 85th Percentile
36%
Yes
No
64%
Yes
No
Dietary Component
Intake (%)
Fruit
56/68 (82%)
Milk
59/74 (80%)
White Bread
25/73 (66%)
Regular Sodas
49/74 (66%)
Frozen Desserts
47/74 (64%)
Hamburger, Hot Dog, Sausage, Steak, Bacon, or Rib
43/74 (58%)
Cheese
42/74 (57%)
Vegetables
40/72 (56%)
Fries, Chips
41/74 (55%)
Fruit Juice
39/72 (54%)
Sugar Sweetened Drinks
40/74 (54%)
Whole Wheat Bread
37/74 (50%)
Sweet Desserts
33/74 (45%)
Fried Meat
31/74 (42%)
Yogurt/Cottage Cheese
29/71 (40%)
Hot/Cold Cereal
29/72 (39 %)
Candy
28/73 (38%)
Rice, Pasta, Noodles
25/73 (34%)
Bean
21/73 (29%)
Diet Sodas
21/70 (28%)
Peanuts/Peanut Butter
17/73 (23%)
<85th Percentile
≥ 85th Percentile
Fruit
11/15 (73%)
45/53 (85%)
Milk
13/15 (87%)
45/59 (78%)
White Bread
12/15 (80%}
37/55 (67%)
Regular Sodas
12/15 (80%)
37/59 (63%)
Frozen Desserts
13/15 (87%)
34/59 (58%)
Hamburger, Hot Dog, Sausage, Steak, Bacon, or Rib
8/15 (53%)
35/59 (59%)
Cheese
10/15 (67%)
32/59 (54%)
Vegetables
9/15 (60%)
31/57 (54%)
Fries, Chips
13/15 (57%)
28/59 (48%)
Fruit Juice
8/15 (53%)
31/57 (54%)
Sugar Sweetened Drinks
10/15 (67%)
30/59 (51%)
Whole Wheat Bread
10/16 (67%)
27/58 (47%)
Sweet Desserts
8/15 (53%)
25/59 (43%)
Fried Meat
9/15 (60%)
22/59 (37%)
Yogurt/Cottage Cheese
6/14 (43%)
23/57 (40%)
Hot/Cold Cereal
7/15 (47%)
22/57 (39%)
Candy
7/15 (47%)
21/58 (36%)
Rice, Pasta, Noodles
8/15 (53%)
17/58 (29%)
Bean
6/15 (40%)
15/58 (26%)
Diet Sodas
7/15 (47%)
14/55 (26%)
Peanuts/Peanut Butter
4/15 (27%)
13/58 (22%)
Dietary Component
Interesting Findings
• Milk Consumption:
– < 85th percentile drank more regular milk
– ≥ 85th percentile drank more low, skim, or non-fat milk
• 80-90% reported consuming milk
• 60-80% reported drinking regular soda
• Bean Intake:
– ¾ of population responded to having no beans
• Staple Food [42]
• Fried Meat:
– < 85th percentile ate more fried meat
– ≥ 85th percentile ate less fried meat
42. Jimenez-Cruz A, Bacardi-Gascon M, Turnbull W, Rosales-Gray P, Severino-Lugo I. A flexible, low-gylcemic index, mexican-style diet in
overweight and obese subjects with type 2 diabetes improves metabolic parameters during a 6-week treatment period. Diabetes Care 26;2003:
1970-2003.
Interesting Findings Continued…
• Fruit & Vegetable Consumption:
– 100% within the <85th percentile indicated they should eat 2-4
servings of fruit and vegetables/day
• Normal weight & eating below recommendations
– Those in the higher BMI category had a higher fruit intake
– Those in the lower BMI category had a higher vegetable intake
• Carbohydrate Intake:
– 53% of ≥ 85th percentile reported as not eating fries, chips; and frozen
dessert intake
– 71% & 75% who were ≥ 85th percentile respectively reported that they
did not consume rice, pasta and noodle and diet soda.
– 80% of <85th percentile reported as consuming Regular soda & Pop.
Strengths & Limitations
Strengths:
• Even number of males and
females
• Even distribution from
schools
• Surveys distributed by the
same interns each time
• Pre-test distribution
protocols
Limitations:
• Questions not uniformed
within surveys used
– Limited questions on fruit and
vegetable intake
• Small Sample Size (n=74)
• No Intervention
• One day survey distribution
– Absent Students
• Children answering the
survey
Future Applications
• Continue research on what is contributing to high BMI
– Research physical activity vs. sedentary lifestyle
– Research portion sizes
– Fat Consumption
• Parent proxy
• Food Diaries
• Food Availability
• Acculturation of the American diet
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period. Diabetes Care 26;2003: 1970-2003.
Questions