
Maternal and Child Health Library
This and past issues of the MCH Alert are available at http://www.mchlibrary.info/alert/archives.html
February 19, 2010
Special Notice: A forum on curbing childhood obesity will be held on
Tuesday, March 2, 2010, from 8:30 a.m. to 2:30 p.m. at the National
Press Club in Washington, DC. The forum coincides with the release of
the March 2010 edition of Health Affairs, which is devoted to childhood
obesity. Funded by the Robert Wood Johnson Foundation, the issue
includes an analysis of the epidemic of childhood obesity and contains
papers focused on the roles of families, schools, food and agricultural
policy, and clinical health care in addressing the problem. More
information will appear in the March 5, 2010, issue of MCH Alert.
1. National Campaign Launched to Tackle the Challenge of
Childhood Obesity
2. New Tool Compares Food Environments of U.S. Counties
3. Study Investigates Correlates of Whole-Grain Intake
Among Adolescents and Young Adults
4. Authors Assess Relationship Between Childhood Obesity,
Other Cardiovascular Risk Factors, and Premature Death
5. Article Examines Dynamics of Chronic Health Conditions
Among Children
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1. NATIONAL CAMPAIGN LAUNCHED TO TACKLE THE CHALLENGE OF CHILDHOOD
OBESITY
Let's Move is a new campaign launched at the White House on February 9,
2010, to facilitate public- and private-sector commitments toward the
national goal of solving the problem of childhood obesity within a
generation. The campaign's Web site, a collaboration of the
administration and the U.S. Departments of Health and Human Services,
Agriculture, and Education, provides families, schools, and communities
with tools to help children be more active, eat better, and get
healthy. Multimedia content includes audio and video of the campaign's
launch event, a blog, and public service announcements. The Kids'
Collection features activity books, games, videos, posters, and
materials for adolescents. A link to the Presidential Memorandum
creating the Task Force on Childhood Obesity and options for joining
the call to action and receiving e-mail updates on new features, tips,
and tools are also provided. The Web site is available at http://www.letsmove.gov
Readers: At the campaign's launch, the administration also announced
the formation of the Partnership for a Healthier America, a nonpartisan
alliance of organizations with the common goal of improving children's
health by preventing obesity. Partners and founders include the Robert
Wood Johnson Foundation, the California Endowment, Kaiser Permanente,
Nemours, the W. K. Kellogg Foundation, and the Alliance for a Healthier
Generation. More information is available at http://www.ahealthieramerica.org
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2. NEW TOOL COMPARES FOOD ENVIRONMENTS OF U.S. COUNTIES
Your Food Environment Atlas is an online mapping tool that assembles
statistics on food environment indicators and provides a spatial
overview of a community's ability to access healthy food and its
success in doing so. The atlas was developed by the U.S. Department of
Agriculture's Economic Research Service, with support from federal
agencies, academia, and the private sector. The atlas assembles food
environment factors within three broad categories (food choices, health
and well-being, community characteristics) and currently includes 90
indicators -- most at the county level. Users can create maps showing
the variation in a single indicator across the United States, view all
the county-level indicators for a selected county, or use the advance
query tool to identify counties sharing the same degree of multiple
indicators. The atlas is designed to stimulate research on the
determinants of food choices and diet quality and inform policymakers
as they address diet and public health. The atlas is available at http://www.ers.usda.gov/FoodAtlas
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3. STUDY INVESTIGATES CORRELATES OF WHOLE-GRAIN INTAKE AMONG
ADOLESCENTS
AND YOUNG ADULTS
"The findings of this study indicate that interventions designed to
promote improvements in whole-grain intake should address confidence to
consume whole grains, taste preferences for whole-grain products, and
the availability of these foods in settings where youth frequently eat
meals (schools, home, restaurants)," state the authors of an article
published in the February 2010 issue of the Journal of the American
Dietetic Association. Most adolescents and young adults should consume
three or more ounce-equivalent servings of whole-grain products per
day. However, U.S. national survey data indicate that the average young
person consumes one or fewer ounce-equivalent servings per day. Prior
research has identified demographic correlates of poor whole-grain
intake among young people and adults, and a small number of studies
have reported barriers to the consumption of whole-grain foods. The
article describes a study to identify factors based on social cognitive
theory (personal, socioenvironmental, and behavioral factors)
influencing whole-grain intake in a diverse, population-based sample of
young people in Minnesota.
Data for the analysis were drawn from Project EAT (Eating Among
Teens)-II, the second wave of a population-based study designed to
examine determinants of dietary intake and weight status among young
people. The sample for the current study included 1,110 males (44.8
percent) and 1,368 females (55.2 percent) who completed both an
in-class survey in junior or senior high school (1998-1999, Time 1) and
a mailed food frequency questionnaire 5 years later (2003-2004, Time
2). The mean age of participants in the younger cohort was age
approximately 12.8 at Time 1 and 17.2 at Time 2; for the older cohort
it was 15.9 at Time 1 and 20.5 at Time 2. The analyses examined daily
intake of whole grain by sex and then used separate models to examine
each potential correlate of whole-grain intake, stratified by sex and
cohort and adjusted for other sociodemographic characteristics.
The authors found that
- Among adolescents, males and females had similarly low mean
intakes of whole grains. Sex differences were not statistically
significant among young adults, either.
- Home availability of whole-grain bread, greater preference for
the taste of whole-grain bread, and self-efficacy to consume three or
more daily whole-grain servings were positively associated with
whole-grain intake among males and females of both age cohorts.
- Young people who consumed fast food more frequently ate fewer
whole-grain servings.
The authors conclude that "to improve the availability of whole-grain
breads and other products at home, parents as well as youth may need to
be provided additional tools to help them identify and prepare
whole-grain products. The observation of an inverse relationship
between fast-food intake and whole-grain intake further suggests there
is a need to improve the availability of whole-grain products in
restaurants."
Larson NI, Neumark-Sztainer D, Story M, et al. 2010. Whole-grain intake
correlates among adolescents and young adults: Findings from Project
EAT. Journal of the American Dietetic Association 110(2):230-237.
Abstract available at http://www.adajournal.org/article/S0002-8223(09)01810-0/abstract
Readers: More information is available from the following MCH Library
resources:
- Nutrition in Children and Adolescents: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_childnutr.html
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4. AUTHORS ASSESS RELATIONSHIP BETWEEN CHILDHOOD OBESITY, OTHER
CARDIOVASCULAR RISK FACTORS, AND PREMATURE DEATH
"Obesity in children who do not have diabetes is associated with an
increased rate of death from endogenous causes during early adulthood,
an association that may be partially mediated by the development of
glucose intolerance and hypertension in childhood. In contrast, the
cholesterol level in childhood is not a major determinant of premature
death in this population," write the authors of an article published in
the February 11, 2010, issue of the New England Journal of Medicine.
Cardiovascular risk factors are common in children. Although
early-onset diabetes has been shown to raise mortality rates, and the
relationship between cardiovascular risk factors during adulthood and
early death is well defined, little is known about the way in which
cardiovascular risk factors that are present during childhood affect
life span. In the study described in this article, the authors assessed
the extent to which obesity, glucose intolerance, hypertension, and
hypercholesterolemia in children without diabetes predicted premature
death (defined as death before age 55) in American Indians in Arizona.
Study participants included 4,857 children and adolescents (ages 5-20)
who lived in a well-defined geographic area of the Gila River Indian
Community of Arizona and had at least 4/8 Pima or Tohono O'odham Indian
heritage, did not have diabetes, and underwent one or more research
examinations between February 1966 and December 2003. During the
examinations, researchers assessed the extent to which body mass index
(BMI), 2-hour plasma glucose level during a 75-g oral glucose-tolerance
test, and blood pressure and total cholesterol levels predicted
premature death. The baseline examination was the first examination at
which all these variables were measured. The analyses included data
from the date of the baseline examination until the person's death, the
person's 55th birthday, or the end of 2003, whichever came first.
Models were used to test for associations between the baseline
childhood risk factors and time of death, with adjustment for baseline
age, sex, Pima or Tohono O'odham Indian heritage, and birth year.
The authors found that
- There were 166 deaths from endogenous causes during the follow-up
period.
- Children in the highest quartile of age-standardized and
sex-standardized BMI had significantly higher rates of death from
endogenous causes than did children in the lowest quartile.
- Children in the highest quartile of glucose level had a 73
percent higher risk of premature death from endogenous causes than
children in the lowest quartile. Adjustment for childhood BMI reduced
the magnitude of the association.
- No significant associations were observed between death rates and
childhood cholesterol levels or blood pressure.
The authors conclude that "childhood obesity is becoming increasingly
prevalent around the globe. Our observations, combined with those of
other investigators, suggest that failure to reverse this trend may
have wide-reaching consequences for the quality of
life and longevity."
Franks PW, Hanson RL, Knowler WC, et al. 2010. Childhood obesity, other
cardiovascular risk factors, and premature death. New England Journal
of Medicine 362(6):485-493. Full text available at http://content.nejm.org/cgi/content/full/362/6/485
Readers: More information is available from the following MCH Library
resources:
- Overweight and Obesity in Children and Adolescents: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_overweight.html
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5. ARTICLE EXAMINES DYNAMICS OF CHRONIC HEALTH CONDITIONS AMONG CHILDREN
"Our study is among the first to examine increasing prevalence of
chronic conditions in a cohort over time in the United States and to
document the patterns of change in chronic conditions in different
cohorts over several years," state the authors of an article published
in the February 17, 2010, issue of JAMA, The Journal of the American
Medical Association. The article examines changes in the incidence,
rates of remission, and prevalence of obesity and other chronic
conditions at any time in 6 years in three nationally representative
cohorts of children.
The study sample included children born to mothers who were ages 14-21
in 1979 and who participated in the National Longitudinal Survey of
Labor Market Experience, Youth Cohort. Cohort 1 included children ages
2-8 in 1988, cohort 2 included children ages 2-8 in 1994, and cohort 3
included children ages 2-8 in 2000. Each cohort was followed for 6
years. At each interview, mothers were asked whether their child had
any physical, emotional, or mental condition that prevented him or her
from attending school regularly, doing regular schoolwork, or doing
usual childhood activities or that required frequent attention or
treatment from a health professional, regular use of any medication, or
use of special equipment. The researchers calculated prevalence of any
chronic condition and conditions in four subgroups (asthma, other
physical problem, behavior or learning problem, obesity) in the first
and last year for all cohorts grouped together and for each cohort
individually. Next, for any chronic condition and subgroups, the
researchers calculated incidence, persistence (proportion of children
initially with a chronic condition who also had the condition at the
end of the study period), and "new cases" (proportion of conditions
reported in the final year of each study period that were not present
at the beginning). Then, they calculated the prevalence of having a
chronic condition during any part of the 6-year study period for any
chronic condition and subcategories of conditions of all cohorts.
Finally, they compared differences in prevalence, incidence,
persistence, new cases, and prevalence of having a chronic condition
during any part of the 6-year study period between consecutive cohorts.
They also examined the association between sociodemographic variables
and prevalence of having a chronic condition during any part of the
6-year study period in models that included all participants.
The authors found that
- Data were available for 2,337 children in cohort 1, 1,759
children in cohort 2, and 905 children in cohort 3.
- The end-study prevalence of having any chronic condition was 12.8
percent for cohort 1, 25.1 percent for cohort 2, and 26.6 percent for
cohort 3.
- Among all children, 7.4 percent reported a chronic condition both
at baseline and at the end of the study period, 13.4 percent
represented new cases, and 9.3 percent reported a chronic condition at
baseline that remitted by the study's end.
- The prevalence of having a chronic condition during any part of
the 6-year study period increased by approximately 10 percent with each
cohort, with 51.5 percent of cohort 3 reporting a chronic condition
during the most recent study period.
- The prevalence of having a chronic condition during any part of
the 6-year study period was 46.6 percent among black children and 42.3
percent among Hispanic children, compared with 36.8 percent among
non-Hispanic white children.
The authors conclude that "chronic conditions in childhood are common
and dynamic, underscoring the benefits of continuous, comprehensive
health services for all children to adjust treatment of chronic
conditions, promote remission, and prevent onset of new conditions."
Van Cleave J, Gortmaker SL, Perrin JM. 2010. Dynamics of obesity and
chronic health conditions among children and youth. JAMA: Journal of
the American Medical Association 303(7):623-630. Free full-text
available at http://jama.ama-assn.org/cgi/content/full/303/7/623?home
Readers: More information is available from the following MCH Library
resources:
- Children and Youth with Special Health Care Needs: Knowledge Path at
http://mchlibrary.info/KnowledgePaths/kp_CSHCN.html
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and
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