In this study, the effects of a 12-month multidisciplinary education program on the health status, dietary quality, and eating habits of children and adolescents attending community childcare centers were investigated. A total of 88 participants aged 7 to 17 years from 7 community childcare centers in Gyeonggi-do were enrolled. The intervention consisted of 12 multidisciplinary education sessions covering topics such as nutrition, exercise, and psychological education. All participants received the same education, and the effectiveness of the program was evaluated by categorizing them into a high participation group (HPG) and a low participation group (LPG) based on their participation rates. After intervention, in physical activities, moderate-intensity exercise was significantly reduced in the LPG, and there was no significant difference in psychological parameters. However, notable differences were observed in nutritional data. After intervention, intakes of calorie, carbohydrate, protein, and fat were significantly increased in both groups, and in particular, the change was found to be greater in HPG. Additionally, dietary fiber intake compared to the 2015 Korean Dietary Reference Intakes was increased in both groups. Daily food intake also increased dietary fiber intake in HPG, and meat and fruit intake was increased in LPG. In the nutrition quotient, there was a significant difference in HPG’s pre- and post-scores in the diversity category, and in nutrient adequacy ratio (NAR), the NAR of phosphorus was increased in both groups. The findings of this study suggest that multidisciplinary education implemented at community childcare centers primarily enhanced nutrition-related factors rather than physical activity or psychological aspects.
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To investigate adipokines (vaspin, omentin-1, adiponectin and leptin) and their correlation with hepatosteatosis degree in obese/overweight (O/O) children. We analyzed adipokine levels of 81 children (49 O/O, [body mass index (BMI) > 95th] and 32 non-obese (BMI = 5-85th) admitted to the pediatric outpatient clinic. Serum triglyceride, glucose, low density lipoprotein-cholesterol, total cholesterol, high density lipoprotein-cholesterol, alanine aminotransferase, aspartate aminotransferase (AST), insulin, HbA1c levels and leptin, omentin-1, vaspin, adiponectin levels were studied. O/O children with hepatosteatosis were divided into grades 1, 2 and 3 according to the degree of hepatosteatosis determined by ultrasonography. While AST (p = 0.001), triglyceride (p = 0.006), BMI percentile (p = 0.000), HOMA index (p = 0.002), systolic blood pressure (p = 0.02), leptin (p = 0.001), omentin-1 (p = 0.001), adiponectin (p = 0.001) levels were higher, vaspin level was lower (p = 0.008) in the (O/O) group compared to the controls. There was a positive correlation between HDL and vaspin, and a negative correlation between HDL and omentin-1 in the O/O group. Also it was observed that as the degree of hepatosteotosis increased, leptin (p = 0.004), omentin-1 (p = 0.001) levels were increased. There was no significant change in vaspin level (p = 0.128). The high levels of omentin-1, leptin and adiponectin have an association with the development of hepatosteatosis in O/O children.
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Through a survey on dietary intake of children and adolescents with brain lesions, the present study aimed to analyze the current status of nutrient intake and examine the effect of high-protein nutrient drink on their nutritional and muscle statuses. The study participants were 90 juvenile participants aged 8–19 years, with brain lesions. The participants were provided with a protein nutrient drink for 12 weeks and a questionnaire survey on dietary intake was performed to analyze the level of nutrient intake before and after ingestion. The physical measurements were taken to determine the improvements in nutrient and muscle statuses. The results showed that, before the intake of protein nutrient drink as a supplement, the participants exhibited lower height, weight, and body mass index than those of the standard levels of healthy individuals, and the level of nutrient intake through diet was lower than those of the required and recommended levels of nutrient intake for Koreans. Conversely, after the intake of protein nutrient drink for 12 weeks, the level of nutrient intake and physical statuses such as weight showed significant improvements. In addition, the muscle status had undergone approximately 10% of change during the intervention with no significant difference. Thus, to ensure an adequate level of nutrient supply to children and adolescents with brain lesions, there is an urgent need to develop a guideline of nutrient intake. The findings in this study are expected to serve as the basic data for such guidelines.
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In this study, the association between dietary pattern and lifestyle in predicting hypertension (HTN) among 425 overweight and obese children and adolescents aged 6 to 18 years was evaluated. In the current cross-sectional study, the lifestyle-scoring algorithm was developed considering the Iranian Health Reform Plan (HRP) criterion. HTN was defined according to standard protocols. Hierarchical linear regression models were used for the analysis. The prevalence of overweight/obesity was 5.82%. The results showed that systolic and diastolic blood pressure (SBP, DBP) had significant positive correlation with age (p < 0.001 and p < 0.001) and body mass index (BMI) (p < 0.005 and p < 0.007), respectively. Moreover, DBP had a significant correlation with fruit consumption of less than 2 servings per day versus no consumption (p = 0.014, B = 0.444), fruit consumption of more than 2 servings per day versus no consumption (p = 0.014, B = 0.480), and vegetable consumption less than 3 servings per day versus no consumption (p = 0.045, B = −0.374). Moreover, DBP had a significant correlation with fast foods/junk foods consumption of 1–2 items per week versus almost daily consumption (p = 0.047, B = −0.177). The final model could predict 32.1% of HTN by SBP and DBP (R2 = 0.32). According to our findings, lower intake of vegetables and fruits, higher amounts of fast foods, higher age and BMI could be potent predictors of high blood pressure among Iranian children and adolescents.
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Obesity-related clinical decision support tools in electronic health records (EHRs) can improve pediatric care, but the degree of adoption of these tools is unknown. DocStyles 2015 survey data from US pediatric healthcare providers (n = 1,156) were analyzed. Multivariable logistic regression identified provider characteristics associated with three EHR functionalities: automatically calculating body mass index (BMI) percentile (AUTO), displaying BMI trajectory (DISPLAY), and flagging abnormal BMIs (FLAG). Most providers had EHRs (88%). Of those with EHRs, 90% reporting having AUTO, 62% DISPLAY, and 54% FLAG functionalities. Only provider age was associated with all three functionalities. Compared to providers aged > 54 years, providers < 40 years had greater odds for: AUTO (adjusted odds ratio [aOR], 3.0; 95% confidence interval [CI], 1.58–5.70), DISPLAY (aOR, 2.07; 95% CI, 1.38–3.12), and FLAG (aOR, 1.67; 95% CI, 1.14–2.44). Future investigations can elucidate causes of lower adoption of EHR functions that display growth trajectories and flag abnormal BMIs.
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Diet-related behavioral modification for healthy eating and lifestyle is required to improve childhood obesity. The present study aimed to develop customized nutritional intervention protocol and education program to find barriers to adhere healthy diet and lifestyle for moderate to severe obese children and adolescents and their families. Theoretical framework approaches can be used to change behavior and achieve goals. Previous studies that described the relationship between behavioral modification and nutrition education theory were reviewed. The social cognitive theory and transtheoretical model were employed with behavioral changes to target a healthful diet and lifestyle. The nutrition care process (NCP) model was adopted to customize nutrition care for the participants. Customized nutritional intervention protocol was developed following as the four steps of the NCP. Firstly, nutrition status of the participants was assessed by the nutrition expert. Nutrition problems were described as “inadequate energy intake,” “overweight/obesity,” or “food and nutrition-related knowledge deficit.” All nutrition sessions were designed for nutrition intervention to give nutritional knowledge and a practical mission in real life for individual goal setting and self-control. Meal planning, portion control, healthy snack selection and cooking with fruits and vegetables were consisted of five components of the nutrition education session. During each session, the participants and their families were interviewed by a nutrition expert for monitoring and evaluating diet-related goal setting and achievement. A theoretical and evidence-based nutritional intervention was developed for the secondary to tertiary prevention of childhood obesity. This nutrition intervention protocol and program might be helpful for the further research on childhood obesity.
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Pediatric malnutrition is an enormous health issue all around the world and its distribution is different in distinct areas of a country. This study has been designed to report the anthropometric status and some socio-economic factors among 2–5 years old children from Golestan province of Iran to show a better view of pediatric health status and better planning for future actions. This study was carried out by clustered-randomized sampling method on 1,382 of 2–5 years old children in urban and rural areas of Golestan province. Anthropometric measurements were performed and World Health Organization child growth standards were used for further analyses. The prevalence of stunting in boys and girls were 7.4% and 7.5% in urban and 4.1% and 5.4% in rural areas. The prevalence of underweight in boys and girls were 6.9% and 4.7% in urban and 5.7% and 4.4% in rural areas. The prevalence of subjects being at risk for overweight were 17.8% and 11.7% in boys and girls, respectively, in urban areas and were 11.1% and 9.2% in rural areas, respectively. There was a marginally significant difference between urban boys and girls in terms of weight status (p = 0.067). In this study remarkably high prevalence of malnutrition, especially a high dominance of overweight, was reported in Golestan province of Iran. Follow-up investigation to identify the cause of malnutrition and to establish public health policies are needed to revise these health issues in Golestan province of Iran.
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One contributing factor to the obesity epidemic is the large portion sizes served in restaurants. However, no study has looked at the parents' desire for smaller-portioned meals for their children at restaurants in the U.S. This study examined parents' preference for restaurants to offer smaller, lower-priced child portions for their children and reasons for the preference. Multivariable logistic regression was used to estimate adjusted odds ratios (ORs) for the association between preference for child portions and variables on parental sociodemographic characteristics and weight status. About 70% of parents said they would prefer that restaurants offer smaller, lower-priced child portions of all menu offerings. The adjusted odds of preferring child portions were significantly higher among Hispanic parents (OR, 1.95 vs. non-Hispanic whites) but significantly lower among parents with lower education (≤ high school, OR, 0.64; some college, OR, 0.69 vs. college graduate) and parents residing in the Midwest or West (Midwest, OR, 0.61; West, OR, 0.58 vs. South). The most common reason for preferring child portions of all meals was “wanting my child to eat healthier foods that are not offered on the children's menu” (72%). These findings can be used to encourage restaurants and other venues to consider offering child portions of healthier menu items.
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To examine whether sugar-sweetened beverage (SSB) intake during infancy is associated with dental caries by age 6, a longitudinal analysis of 1,274 U.S. children was conducted using data from the 2005-2007 Infant Feeding Practices Study II and the 2012 Follow-up Study at 6 years of age. The exposure variables were maternal-reported SSB intakes during infancy (i.e., any SSB intake during infancy, age at SSB introduction during infancy, and average frequency of SSB intake during 10-12 months of age). The outcome variable was maternal-reported dental caries of their 6-year-old in his/her lifetime. Multivariable logistic regression analyses were used to calculate adjusted odds ratios (aOR) for associations of SSB intake during infancy with having dental caries among 6-year-olds after controlling for baseline characteristics of children and mothers and child's tooth brushing habits and sweet food intake at follow-up. Based on maternal recall, almost 40% of 6-year-olds had dental caries in their lifetime. Adjusted odds of having dental caries was significantly associated with higher frequency of SSB intake during 10-12 months (aOR=1.83 for ≥3 times/week, vs. none). Any SSB intake during infancy and age at SSB introduction during infancy were not associated with dental caries. In conclusion, frequent SSB intake during 10-12 months of age significantly increased the likelihood of having dental caries among 6-year-olds. Late infancy may be an important time for mothers to establish healthy beverage practices for their children. These findings can be used to inform efforts to reduce dental caries among children.
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There has been growing concern about the role of sugar-sweetened beverages (SSBs) in the development of obesity. This study investigated factors associated with SSB intake among Korean children (7-12 years) and adolescents (13-18 years). We examined associations between SSB intake and demographic and dietary factors using nationally representative data from the 2008-2011 Korea National Health and Nutrition Examination Survey, and 3,179 children and 2,242 adolescents were included in the final analysis. We calculated adjusted odds ratios (ORs) for factors associated with high SSB intake (≥ 300 ml/day) by multivariable logistic regression. The mean daily SSB intake of school children was 98.7 ml/day, with a mean of 64.7 ml/day for those aged 7-12 years and 120.2 ml/day for those aged 13-18 years. SSB intake of ≥ 300 ml/day was found in 12.0% of the children and adolescents. Factors associated with a greater OR for high SSB intake were high energy intake (≥ 125% of EER; OR = 3.17 for boys aged 7-12 years, OR = 2.74 for girls aged 7-12 years, OR = 3.0 for girls aged 13-18 years), low milk consumption (< 1 cup/day; OR = 1.93 for boys aged 7-12 years; OR = 2.53 for girls aged 7-12 years; OR = 1.83 for boys aged 13-18 years), and not meeting the recommended fruit and vegetable intake (< 400 g/day; OR = 1.71 for boys aged 7-12 years). Being overweight and obese was significantly associated with greater ORs for high SSB intake among boys aged 7-12 years (OR = 1.72). These findings may be used to develop targeted education programs for reducing SSB intake and encouraging healthier food choices.
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This study was performed to investigate the status of food restriction and the list of restricted foods in children with moderate to severe atopic dermatitis (AD), and to find out the effect of food restriction on the changes in nutrient intake and the severity of the disease. Sixty two patient children aged 12 months to 13 years presenting AD with a SCORing of Atopic Dermatitis (SCORAD) index between 20 and 50 were enrolled. The presence of food limitation, and list of restricted foods were surveyed through the caretakers and the patients were divided into 3 groups by the number of restricted food: non-restricted group, one to three restricted group, and more than three restricted group. Dietary intake was assessed for 3 months using a food frequency questionnaire (FFQ). Half of the subjects restricted foods. The restriction was higher in the order of soda, food additives, walnut, peanut, and other nuts as a single food item; and shellfish and crustacean group, processed foods, nuts, milk & dairy products, and meats as a food group. More than three restricted group ingested more fruits and less fish and meats, resulting in high consumption of vitamin C (p = 0.027). No significant difference in the ratio of nutrient intake by the number of restricted foods was observed in other nutrients. Significant improvement of AD symptom was observed in non-restricted group (p = 0.036) and one to three restricted group (p = 0.003). It is necessary to provide proper nutrition information and systematic and continuous nutrition management for balanced nutrient intake and disease improvement in children with AD.
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This study compared birth stature, parents' stature, and food and nutrient intakes between normal and short stature Korean children visiting a growth clinic. A total of 143 growth clinic visitors agreed to participate in the study. Out of the 143 subjects, 37 children with height below the fifth percentile (short stature group) and 58 children with height above the twenty-fifth percentile (normal group) were included in the study analysis. Data were collected through a survey of parents or guardians of children and anthropometric measurements. The ratio of short stature in either parent was significantly higher in short stature group. The mean intakes of protein, fat, calcium, and iron were lower in short stature children compared to normal children. Among five major food groups, the intake frequency of vegetables and fruits was significantly lower in short stature group and that of meat·fish·egg·legume group was also significantly lower in short stature group. In further analysis categorized into 11 detail food groups, the intake frequency of fruit group and legume group was significantly lower in short stature group. Nutritional counseling should be provided to emphasize adequate intake of various food groups including vegetables, fruits, and legumes to short stature children visiting a growth clinic.
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