PARENTING, ENERGY DYNAMICS, AND LIFESTYLE DETERMINANTS OF CHILDHOOD OBESITY: NEW DIRECTIONS IN PREVENTION

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: TERMINATED
• Funding Source: HATCH
• Reporting Frequency: Annual
• Accession No.: 0212118
• Project No.: NJ14207
• Multistate No.: W-2005
• Project Start Date: Oct 1, 2012
• Project End Date: Sep 30, 2017

Project Director
Hoffman, DA, J.

Recipient Organization
RUTGERS, THE STATE UNIVERSITY OF NEW JERSEY
3 RUTGERS PLZA
NEW BRUNSWICK,NJ 08901-8559

Performing Department
Nutritional Sciences

Non Technical Summary
It is essential to improve our understanding of why a child may have too little to eat or, in some cases, too many calories. This issue is complicated by family income and it is necessary to understand how poverty may influence family diet. We are using data from crosee-section and longitundinal studies at various sitesild's life. These women have since participated in our study in which we collect data on their income and children's nutritional status for almost 10 years now. Several important research questions related to how well the children eat, level of food security, degree to which nutrition education influences later health, are being addressed. From this work, we will be able to provide better information as to which factors of a family, such as education or income, contribute more or less to the overall diet and health of a child. Therefore , possible changes in actions may include the use of different educational materials or approaches, different approaches to households with low food security, or the use of different questionnaires. Potential changes in conditions that may come from this work include a re-evaluation of food assistance policies for women and families in lowest levels of poverty, changes in educational programs for households with very low food security, and renewed emphasis on maternal-child nutrition education.We have now augmented the work described above with longitudinal and cross-sectional studies in other sites to further our understanding of the linkages between childhood obesity and parenting factors.

Animal Health Component

0%

Research Effort Categories

Basic

(N/A)

Applied

100%

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
703	6099	1010	70%
704	6099	3010	20%
704	6099	1170	10%

Knowledge Area
703 - Nutrition Education and Behavior; 704 - Nutrition and Hunger in the Population;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
1010 - Nutrition and metabolism; 3010 - Economics; 1170 - Epidemiology;

Keywords

nutrition

household

poverty

brazil

child

maternal nutrition education

mexico

Goals / Objectives
Using the results of objective 1 (above) develop resources such as translational research articles that community and public health professionals could use in implementing community programs that ultimately could change the trajectory of childhood obesity and overweight. Compare and contrast outcomes from 2006 W1005 objective 1 (field practice perspective) and objective 3 (parent-child interaction) with findings from seminal obesity-prevention research to identify successful child obesity prevention strategies as influenced by parenting.

Project Methods
This project will use secondary data analysis of children who participated in a randomized trial of dietary counseling on breastfeeding and dietary practices. Five hundred mother-child pairs were recruited between October 2001 and June 2002 in the maternity ward of a hospital that attends to low-income population, in Sao Leopoldo, Brazil, and the same children have been followed since. Inclusion criteria were full-term (> 37 weeks) babies with a birth weight ≥ 2500 g. Exclusion criteria were HIV-positive mothers, congenital malformations, and children admitted to the intensive care unit. Gender, race and data of birth were obtained from hospital records. Socioeconomic characteristics, such as maternal education and family income, were assessed when the children reached an age of 6 months by face-to-face interviews with mothers. At 3 to 4 years and 7 to 8 years old, two 24-hour dietary recalls for each child were collected on two non-consecutive days and the mean values were used in the analyses. The dietary information was entered in the program to support nutrition - NutWin (version 1.5, Sao Paulo, Brazil) in order to estimate energy and nutrients intake. Data collection and analyses did not include salt added during cooking and/or at the table, or the ingestion of pure water. Diet quality was computed using the Healthy Eating Index (HEI). Briefly, HEI is the sum of ten components (grains, fruits, vegetables, meat, milk, total fat, saturated fat, cholesterol, sodium, and variety), each representing different aspects of a healthful diet, and the recommendations depend on the energy requirements according to age group. Each of the ten components range in score from zero to ten. Thus, the composite HEI score can potentially range from a minimum of zero to a maximum score of 100. A total score of more than 80 was considered "good", scores of 51-80 indicated "needs improvement", and scores of less than 51 were considered "poor". All statistical analyses were performed using SPSS 16.0 (SPSS Inc, Chicago, IL). To determine changes in diet quality, we computed the HEI score (total and each component) that considers the recommendations for each age. HEI scores were similar for boys and girls, therefore analyses were carried out on both sexes together. Analyses of time effects (i.e., changes in diet intake at ages 3 to 4 and 7 to 8) were conducted using a paired t-test. McNemars test with the continuity correction was used to analyze change in prevalence. The result was expressed through mean differences and 95% confidence intervals (95% CIs) and statistical significance was set at p < 0.05. Efforts from this project will include university lectures on the subject of food security and poverty, continued education for the families, and field-based education in Brazil on the topic of poverty and nutrition. The project will be evaluated upon the end of the year based on publications submitted, number of students educated, the development of additional grant proposals, and a detailed strategic plan for additional activates that include conference symposia and educational materials.

Progress 10/01/12 to 09/30/17

Outputs
Target Audience:The Target Audience for this project includes nutrition and public health faculty and extension specialists. We have extended our efforts to engage with faculty from minority and underrepresented groups in New Jersey through a new collaboration with the School of Nursing and we are working with Mexican immigrants in New Brunswick. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Two major sympsosia, once in the US and one in Brazil, had data presented from this project, reaching approximately 150 students and over 300 faculty. One major symposium in May 2017 included faculty from Mexico and Rutgers to discuss health disparities and factors associated with childhood obesity in Mexico and among the Mexican population in NJ. This symposium reached approximately 50 faculty and presentations have been forwarded to extension faculty. We will also present the data and training to faculty in Oxaca and Puebla, Mexico in Feb 2018. How have the results been disseminated to communities of interest?Data have been presented two major Oxacan community groups and will be presented to faculty in Mexico in Feb 2018. Presented preliminary data at International Congress on Nutrition, 2017. Submitted data to ASN 2018 conference. Results will be disseminated to communities through family education programs in the state (e.g. Extension), school nurse associations, and state programs. Impact will be large with upwards of 30-40 communities, and over 10,000 parents. Results will be published in journals that reach upwards of 2,000 professionals. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Goal 1 We have completed data collection in both pilot groups and have completed data collection and are currently analyzing data for preparation for conference posters and through the submission of research papers in 2017 and 2018. Goal 2 has been accomplished using previous data from a longitudinal cohort that found feeding patterns in infancy are not influenced by nutrition education when poverty is too severe. These data are being presented to nurses and health professionals during symposia and soon through publications. We have also completed a review article that discussed the current knowledge in the area of maternal autonomy, early nutrition, and childhood nutrition and health. We are currently writing four research papers on the topic that will be disseminated to university faculty and students. We have presented our findings in formal classrooms and at two local and one international conference. This has resulted in new collaborations with the School of Nursing to develop research protocols on maternal autonomy and childhood nutritional status in New Brunswick and partner communities in Mexico.

Publications

• Type: Book Chapters Status: Published Year Published: 2016 Citation: Daniel J. Hoffman and Pamela L. Barrios. 2016. Changes in Body Composition from Infancy through Childhood in: The Biology Behind the First 1,000 Days. Klaus Kraemer, C. Karakochuk, Kyly C. Whitfield, and Tim Green, editors. CRC Press.

Progress 10/01/15 to 09/30/16

Outputs
Target Audience:Health professionals and the general public are the target audience for the outputs of this research Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Two major symposia, once in the US and one in Brazil, had data presented from this project, reaching approximately 150 students and over 300 faculty. Also, we are in the process of writing two research papers on the topic that will be disseminated to university faculty and students. How have the results been disseminated to communities of interest?Preliminary work has been presented in formal classrooms and scientific conferences What do you plan to do during the next reporting period to accomplish the goals?We will fully integrate new data with collected data and complete the analyses necessary. Results will be disseminated to communities through family education programs in the state (e.g. Extension), school nurse associations, and state programs. Impact will be large with upwards of 30-40 communities, and over 10,000 parents. Results will be published in journals that reach upwards of 2,000 professionals.

Impacts
What was accomplished under these goals? Towards goal 1, we have completed data collection in both pilot groups, but ran into staffing issues that slowed completion of data collection. We anticipate all data will be collected by the middle of 2017 and this goal will be fully accomplished once data collection is completed. Towards goal 2, we have completed a review article that discussed the current knowledge in the area of maternal autonomy and childhood nutrition. This has been accomplished using previous data from a longitudinal cohort that found feeding patterns in infancy are not influenced by nutrition education when poverty is too severe. These data are being presented to nurses and health professionals during symposia and soon through publications. Once published, this will have broad impact on the profession.

Publications

• Type: Conference Papers and Presentations Status: Other Year Published: 2016 Citation: Development of a Maternal Autonomy Questionnaire in Brazil: Pilot Test. P.L. Barrios, D.J. Hoffman, Y.v. Rodgers. Rutgers Univ. Experimental Biology, San Diego, Apr 2-6, 2016.

Progress 10/01/14 to 09/30/15

Outputs
Target Audience: Nothing Reported Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Nothing Reported How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Compile complete pilot data for analyses and dissemination.

Impacts
What was accomplished under these goals? Towards goal 1, we have completed data collection in one pilot group and are obtaining pilot data from a second group.

Publications

Progress 10/01/13 to 09/30/14

Outputs
Target Audience: We have initiatied data collection on diet and body composition in children in Mexico who are part of a cohort studying family structure and dynamics and nutritional status. These data will inform our group as to how specific family characteristics are associated with diet and growth, data that will be used to produce lectures, information sheets, publications and other products to be dissemintated to lay and health professionals. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? Funding from this project was used to train two students, one graduate student and one undergraduate, on methodology related to determining maternal autonomy. Both students conducted literature reviews and wrote documents to improve their scientific writing. These documents were used to supplement our application for ethical approval by our collaborating institution in Brazil. Furthermore, both students were trained in the elements of questionnaire validation and development. Additional training including presentation techniques as students were required to present their findings and plans to our research group and collaborators in Brazil and Mexico. How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals? The PD will give lectures at several universities in Brazil and Mexico to disseminate the protocols and prjejcts developed and receive feedback on how to best accomplish the additional goals and disseminate the information developed. These lectures and protocols will be major products and reported in the next two quarters.

Impacts
What was accomplished under these goals? Specific research activities conducted included baseline testing of specific questions among Latin American women, and determination that a more intensive validtion process would be required. The majority of this work took place in summer and early fall of 2015. Thus, a questionnaire for use in Brazilian and Mexican women has been developed and will be validated in Brazil beginning March 2015. This is later than expected as ethical approval took much longer than originally anticipated. However, through our new collaboration in Mexico, the questionnaire is being validated using a parallel protocol so that the number of women can be larger than originally planned. In addition, we initiated data collection on diet and body composition in children in Mexico who are part of a cohort to study family structure and dynamics and nutritional status. These data will inform our group as to how specific family characteristics are associated with diet and growth, data thtat will be used for lectures, information sheets, publications, and other products to be disseminated to lay and health professionals. We have accomplished several of the goals, including submitting papers for publication and producing lectures. These will be fully accomplished in the next quarter as the PD travels to Brazil for lectures and protocol completion. In addition, a collaboration with the National Institute of Nutrition of Mexico has been developed and will allow us to create new and innovative goals related to the overall objective of this program.

Publications

Progress 10/01/12 to 09/30/13

Outputs
Target Audience: Our target audience is primarily nutrition scientists and nutrition professionals. We have reached approximately 300 professionals through conference presentations and seminars. We also reached approximately 80 students through classroom instruction at Rutgers. One seminar was given at an international confernce (Brazil) in which elements of this work was incorporated into a lecture on interdisciplinary research in global health. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided? We have presented seminars at the Experimental Biology meeting (annual meeting of the Amercian Society for Nutrition) as well as at the Brazilian Conference on Food and Nutrition, reaching between 180 and 300 nutrition professionals at these events. How have the results been disseminated to communities of interest? Conference presentations and seminars. What do you plan to do during the next reporting period to accomplish the goals? We are going to continue data collection and data analysis for publications and seminars. We are also working on an online course to be developed by May 2014.

Impacts
What was accomplished under these goals? The accomplishments related to our specific goals are as follows: 1) Major activities completed / experiments conducted; The major activities completed included the preparation the protocol required for data collection to begin. We are still working on the investigator's blog as this is a secondary goal for the project, but we expect to have it fully functional and broadly disseminated by the summer of 2014. 2) Data collected; We have initiated data collection onapproximately 350 12 year-old children who have participated in this longitudinal study since birth. Additional variables include body composition and diet that will be related to the nutrition education each mother received during the first year of her child's life. These data will be analyzed when fully collected in late 2013. 3) Summary statistics and discussion of results. Briefly, from the data collected, we are finding that diet quality did not differ between the intervention and control groups at 7-8 years of age (HEI score 65·2 (sd 9·5) v. 64·9 (sd 8·5)). Regarding changes in diet quality from pre-school to school age, we observed the tracking of diet quality in the control group and the loss of the intervention effect in the intervention group. In both groups, the score for fruit and milk intake decreased, while that for saturated fat and dietary variety intake increased. The score for the intakes of grains, meat and legumes, and total fat remained constant for all children. The present data provide evidence that diet quality tracks during childhood since the total HEI score did not differ over time in the control group. 4) Key outcomes or other accomplishments realized. Supplemental funding allowed us toexplore the role of maternal autonomy on childhood health and nutrition. We modified a questionaire developed in Asia as a model to be used in Latino communities. We have adopted additional questions and deleted culturally inappropriate questions and are now testing the modifed tool in a Brazilian community in Boston. Once the tool is found to be valid, using a multi-pass technique in both personal sessions as well as focus groups, the modifed tool will be field tested in Brazil. The outcome of this tool will be new workshops on the use of the tool and the application of the data for dietary studies. This work will be published and presented at conference proceedings. We completed the proposed symposium as described and are planning additional workshops for 2014.

Publications

• Type: Journal Articles Status: Published Year Published: 2013 Citation: Rauber F, Hoffman DJ, Vitolo MR. Diet quality from pre-school to school age in Brazilian children: a 4-year follow-up in a randomised control study. Br J Nutr. 2013 Aug 23:1-7

Progress 10/01/11 to 09/30/12

Outputs
OUTPUTS: Specific outputs from this project for the past year include one manuscript that is going to be submitted in Feb of 2013. Two abstracts have been produced that will be presented at Experimental Biology 2013 in Boston, MA. In April of 2012 one presentation was made at Experimental Biology 2012 in San Diego, CA where we presented a summary of our preliminary results. Other products from the past year include three new lectures that have been incorporated into our undergraduate and graduate courses. Specifically, a new course in "Nutrition and Health in Developing Countries" was approved by our department and these lectures form the basis for the section on food policy, food security, and maternal nutrition. The results of our research to date will be incorporated in two symposia planned for 2013. First, in May we will host a symposium on "Health and Politics in Latin America" where parts of our project will be presented to a university audience. In October of 2013, as part of the annual Russell Nutrition Symposium, additional results will be presented within the context of factors that influence child nutritional status. This symposium reaches about 200 students and professionals from the tri-state area. PARTICIPANTS: Nothing significant to report during this reporting period. TARGET AUDIENCES: The primary target audiences for our work include academics, students, and policy makers. We have been successful in communicating our results and plans to a broad academic audience through seminars and conference presentation. We also use our data and the results of this project to develop lectures that reach approximately 150 students in the US and about 25 students in developing countries. We also try and target our information to engage policy makers who focus on lower income parts of NJ (e.g. Camden) and developing countries. One innovative outcome of this project is the development of a service-learning course in which students (undergrad and grad) learn about food security in a global context and participate in a course in Brazil where they visit a malnutrition treatment center and attend home visits in shantytowns. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
The analysis of data conducted a student working on this project resulted in several outcomes. First, we have determined that household food security may be a mediating factor in the effectiveness of nutrition education. This has prompted a need to revise plans for policy recommendations based on these data. Second, it is clear from our data that the most food insecure households have limited means to modify household food consumption. Based on these data we are preparing a grant application to further study this question in a different community. The results of these analyses will be presented at a national nutrition meeting, described above, and we will engage with other partners from this Multistate project to determine additional potential outcomes that can be achieved in the United States.

Publications

• No publications reported this period

Progress 01/01/11 to 12/31/11

Outputs
OUTPUTS: No major outputs for this calendar year, we are working on new protocols. PARTICIPANTS: Nothing significant to report during this reporting period. TARGET AUDIENCES: Not relevant to this project. PROJECT MODIFICATIONS: Not relevant to this project.

Impacts
None to date. We have used some data for developing new proposals that were submitted in 2011, but funding has not been awarded yet.

Publications

• No publications reported this period

Progress 01/01/10 to 12/31/10

Outputs
OUTPUTS: No major output at this time. PARTICIPANTS: Not relevant to this project. TARGET AUDIENCES: Not relevant to this project. PROJECT MODIFICATIONS: Not relevant to this project.

Impacts
No major outcomes at this time.

Publications

• No publications reported this period

Progress 01/01/09 to 12/31/09

Outputs
OUTPUTS: Revision of major teaching materials on obesity and food security. Preparation of materials for statewide partnership on obesity. Consulted with state and private agencies on obesity for a total of 42 hours. Total of four seminars on obesity. PARTICIPANTS: Not relevant to this project. TARGET AUDIENCES: Teachers, physicians, dietitians, state health employees. PROJECT MODIFICATIONS: Not relevant to this project.

Impacts
Improved knowledge of stakeholders at school, state, and professional level for teachers, legislators, and physicians.

Publications

• No publications reported this period

Progress 01/01/08 to 12/31/08

Outputs
OUTPUTS: We are preparing a protocol with the State of New Jersey to advance the use of height and weight data on children to assess childhood overweight in New Jersey. PARTICIPANTS: Nothing significant to report during this reporting period. TARGET AUDIENCES: State officials, school officials, parents of school-age children. PROJECT MODIFICATIONS: Nothing significant to report during this reporting period.

Impacts
No major outcomes.

Publications

• No publications reported this period