THE HOME FOOD ENVIRONMENT: LINKING HOME FOOD AVAILABILITY WITH NUTRITIONAL HEALTH AND CHRONIC DISEASE RISK

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: COMPLETE
• Funding Source: HATCH
• Reporting Frequency: Annual
• Accession No.: 1006600
• Project Start Date: Jul 1, 2015
• Project End Date: Jun 30, 2017
• Program Code: [(N/A)]- (N/A)

Recipient Organization
COLORADO STATE UNIVERSITY
(N/A)
FORT COLLINS,CO 80523

Performing Department
Food Science & Human Nutrition

Non Technical Summary
Preventing and treating childhood obesity and related comorbidities remains an important focus for patient oriented intervention research. Availability of key foods in the home environment has been associated with positive health behaviors and weight status for families of preschoolers. The home food availability data has been linked with child dietary intake and weight status. However, studies have primarily been limited to describing food groups (e.g., fruits and vegetables), focusing recommendations on increasing the availability of such foods or to limit others (e.g., soda and juice). Home environment research has largely been related to child health and dietary intake, leaving significant gaps in understanding how the home environment interacts with parent dietary intake and chronic disease risk, and how these parameters are then associated with child weight status. We believe it is critical to evaluate parent's diet/health and these associations with the home environment as parents function as the gatekeepers of as well as role models within the home environment.For this grant we propose to complete two studies: the first study will develop a metric for evaluating home food quality by utilizing the Healthy Eating Index methodology on previously collected data (parent-report of home food availability and child dietary intake); the second study will explore the relationships between parent health and the physical home environment by collecting new data from parents of preschool-aged children utilizing both self-report and in-person data collection techniques. This study will gather information on food availability and physical activity devices in the home (home environment), parent dietary intake, parent physical activity, parent health history, parent anthropometrics (height, weight, waist circumference, blood pressure), parent biomarkers (total cholesterol, HDL, total triglycerides, HbA1c) as well as child weight status (height, weight). Data from this second study will be provided to participants as part of a health report at the conclusion of the study. Additionally, participants will be encouraged to visit our Live Eat Play Colorado (www.liveeatplay.colostate.edu) for information on living a healthy lifestyle. The contribution of these studies will be significant as they have the potential to positively inform home environment family-based intervention designs for the prevention and treatment of obesity as well as providing an enhanced, research-friendly, valid tool for measuring the home environment.

Animal Health Component

100%

Research Effort Categories

Basic

(N/A)

Applied

100%

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
724	6020	1010	50%
703	6020	1010	50%

Knowledge Area
703 - Nutrition Education and Behavior; 724 - Healthy Lifestyle;

Subject Of Investigation
6020 - The family and its members;

Field Of Science
1010 - Nutrition and metabolism;

Keywords

home food environment

obesity

preschool

healthy eating index

family

Goals / Objectives
The overall goal of this project is to address the gaps in home food and activity environment research. We will accomplish this goal through the following specific aims:Aim 1: A) To describe the relationship between child dietary intake, home food availability, and nutrition-based indices of food quality to derive an overall Child Diet Quality (CDQ) score and a Home Food Quality (HFQ) score. B) To establish the relationship of home food quality with a child's dietary quality.Aim 2: A) To explore if home food availability is correlated with parent dietary intake, parent chronic disease risk, and how these factors then associate with child weight status. B) To utilize the metrics developed in Aim 1 to evaluate if HFQ has similar associations for parent dietary intake and relationships with child weight status.

Project Methods
AIM 1LEAP Study Data (previously collected and entered into an Access database)a. Children's Dietary Intake. A Food Frequency Questionnaire (The Block Kids Food Screener ages 2-17,) was used to collect dietary intake data via parent report. This screener assesses intake by food group and reports the outcomes in number of servings and calories consumed.38,39b. Home Food and Activity Environment Assessment (Home-IDEA). The home environment was assessed using the Home-IDEA (described in Section II - Reasons for Undertaking Work). Parents completed the Home-IDEA, reporting data for food availability (131 items), physical activity equipment (16 items) and electronic/ sedentary devices (12 items).10Application of Healthy Eating Index (HEI) Scores to LEAP Dataa. Children's Dietary Quality (CDQ) scores. Children's dietary intake data will be coded per USDA's Food and Nutrient Database for Dietary Studies and linked to the MyPyramid Equivalents database to estimate HEI scores. Data will be categorized into the 12 food items of the HEI to generate a composite HEI score. These CDQ scores will provide an estimate of dietary quality as recommended by the US Dietary Guidelines for Americans.25,40b. Home Food Quality (HFQ) scores. The same HEI 12 food item categories, described for CFQ scores, will be used to categorize the home food availability data into a food group composite score. Measuring this environmental component score requires that all available foods be counted once, providing an overall balance of foods available within the home verses the actual intake of foods.26 Home food category scores will be summed and classified using the HEI scale of 1-100 to generate the HFQ score.AIM 2A convenience sample (n=100) of parents with children ages 3-5 will be recruited from northern Colorado preschools. An information letter describing the study objectives will be provided to participating preschool centers. This letter will indicate that participation consists of informed consent, completion of survey instruments, and attendance to a family night where biophysical measures and dietary recall will be collected in-person. Interested participants will notify study staff of their intent to participate via contact information provided in the initial information letter. A take-home packet containing informed consent, parent surveys, and the Home-IDEA will be provided to interested participants, to be completed 1-3 days prior to participation in the family night. a. Home Environment. Home food availability and activity devices will be assessed using the Home-IDEA.b. Parent Dietary Intake. Parent dietary intake will be assessed using an in-person multi-pass 24-hr dietary recall interview, performed by trained research staff.c. Parent Physical Activity (PA). Self-report of recent PA levels will be captured using the International Physical Activity Questionnaire (IPAQ).d. Parent Chronic Disease Risk. Chronic disease risk will be measured using self-report and objectively collected biophysical data (height, weight, BMI, waist circumference, blood pressure, resting heart rate,total cholesterol, HDL, and HbA1C). e. Child's Weight Status. Child's weight status (BMI) will be calculated from child height and weight, and converted to BMIz (EpiInfo software, v.7 CDC, Atlanta, GA). Child height and weight will be collected in-person by trained research staff during the family night.f. Demographics. Participants will provide information on age, sex, race/ethnicity, SES, education, food assistance program participation, and geographic location (rural/urban).

Progress 07/01/15 to 06/30/17

Outputs
Target Audience:This study was conducted with 85 mother-child dyads from 16 preschools in rural, eastern Colorado communities.others had a mean age of 32.4 years, 68% were low-income, 29% had a high school education or less, and 55% identified as Hispanic. Children (47% female) were4.5 (± 0.7) years of age on average, and 59% identified as Hispanic. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Funding from this grant provided support for a doctoral student and her dissertation work. Further 3 other graduate students (nutrition and public health) worked on this project and were trained in dietary, anthropometric, and biochemicalassessments.. All students developed cultural competency in working with a health disparate population. How have the results been disseminated to communities of interest?Study results have not yet been reported to the communities. However, after each assessment, particiapants recieved a 'health report card' which listed their health metrics. Educational materials were also included to promote healthful eating and activity behaviors. What do you plan to do during the next reporting period to accomplish the goals? Nothing Reported

Impacts
What was accomplished under these goals? Key findings: Aim 1: The Home Inventory for Describing Eating and Activity (Home-IDEA) is a validated checklist for assessing food items (n=108) present in the home at a single time-point. The Healthy Eating Index (HEI) is a measure ofdietquality in conformance to the Dietary Guidelines for Americans. A Home-IDEA Quality Score was developed using the HEI-2010 algorithm and evaluated against the National Food Acquisition and Purchase Survey (FoodAPS) food-at-home data set.Content validity testing resulted in 104 foods being retained. Internal criterion testing demonstrated that 42 foods (40%), changed component scores by >­5%; however, no single food changed a total Home-IDEA Quality total score by >5%. Testing of hypothetical HFEs resulted in a range of scores in the expected directions, establishing sensitivity to varied HFEs. Comparing the FoodAPS and Home-IDEA quality scores established external criterion validity. Paired t-tests indicated the means for all components/total score of the FoodAPS and Home-IDEA scores were significantly different (p<0.05). However, these differences were not practically significant. The Home-IDEA inventory (representative food items) had similar range and sensitivity for detecting differences in the HFE when compared to the complete HFE inventories (complete inventory of foods).This study demonstrated the Home-IDEA quality score can accurately assess the overall quality of the HFE, thus contributing a novel approach for examining home food environments. Aim 2:The most common maternal CVD risk factors were increased waist circumference (69%), overweight/obesity (68%), low HDL-C (49%), high triglycerides (48%), and metabolic syndrome (39%). All CVD risk factors, other than hypertension, had greater prevalence in a low-income subset. The majority of children were in the healthy weight category (61%) and more than one third were in the overweight (30%) or obese (7%) categories. Linear regression indicated that child BMI percentile increased by 6.2 percentile points for each additional maternal CVD risk factor present (F=2.805, p=0.045). In this sample, mothers with young children had a high prevalence of multiple CVD risk factors, which may additively contribute to child weight status. This indicates the need for public health interventions at the family level to address maternal and child health. The Home-IDEA Quality Score Total Scores ranged from 73.2-76.0. Maternal HEI was poor, with Total Scores ranging from 45.8-52.7. The Home-IDEA Quality Score Total Score was significantly related to the Maternal HEI Total Score (r=0.31, p=0.004). Individual component scores were not significantly related. Linear regression indicated that Maternal HEI Total Score increased by 0.65 points for each one-point increase in the Home-IDEA Quality Score Total Score. The Home-IDEA Quality Score successfully categorized the HFE and predicted maternal dietary quality.

Publications

• Type: Conference Papers and Presentations Status: Published Year Published: 2017 Citation: Hibbs-Shipp, S.K., Johnson, S.L., Boles, R., Nelson, T., Wdowik, M., Bellows, L.L. Maternal Health Matters  The Home Food Environment and Cardiometabolic Risk Factors. FASEB Journal, April 2017, 31:961.21
• Type: Theses/Dissertations Status: Submitted Year Published: 2018 Citation: Hibbs-Shipp, S.K. (2018). Healthy Homes: Exploring the Quality of the Home Food Environment and Maternal Health Factors (doctoral dissertation). Colorado State University, Fort Collins, Colorado.
• Type: Journal Articles Status: Other Year Published: 2018 Citation: Hibbs-Shipp, S.K., Bellows, L.L., Johnson, S.L., Boles, R. Development of a Quality Score for the Home Food Environment Using the Home-IDEA Checklist and the HEI-2010 Scoring Algorithm. To be submitted to the Journal of the Academy of Nutrition and Dietetics.
• Type: Journal Articles Status: Other Year Published: 2018 Citation: Hibbs-Shipp, S.K., Nelson, T., Johnson, S.L., Boles, R., , Wdowik, M., Bellows, L.L. Maternal Health Matters - Maternal Cardiovascular Risk Factors and Child Weight Status. To be submitted to Preventing Chronic Disease

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

Outputs
Target Audience:Mothers of young children (ages 3-5) were recruited from 12 Colorado Head Starts/preschools in northern Colorado. Study participants completed to date include 80 mothers. Analyses of demographics on 58 participants reveal that mothers are between the ages 22-51, mean age 33.4 ± 6.7 years, 60% Hispanic, 38% ≤ high school education, 55% ≤185% of poverty; participants' children were 53% female, 66% Hispanic, 38% overweight/obese. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Training and professional development opportunities were provided for undergraduate and graduate students in Nutritional Sciences and Public Health: REDCap (Research Electronic Data Capture system)Database initiation and management training modules (The Colorado Clinical & Translational Sciences Institute (CCTSI); 4 graduate students, 1 undergraduate student Lillian Fountain Smith Nutrition Conference (Department of Food Science and Human Nutrition at Colorado State University); 4 graduate students, 1 undergraduate student Data analyses (student mentoring - 2 faculty, 1 graduate student) How have the results been disseminated to communities of interest?The health outreach portion of the study - the personalized "Health Report Card" has been provided to each individual participant (n=80). What do you plan to do during the next reporting period to accomplish the goals?Aim 1: Conduct analyses to determine a Home Food Quality Score Aim 2: Complete data collection on 100 participants, analyze data, present findings at a national conference and develop manuscripts for publication.

Impacts
What was accomplished under these goals? Aim 1: Investigators have developed and began to implement a process for development of the Home Food Quality (HFQ) score. This three-step process includes: Map individual food items from Home-IDEA (food availability tool) to the Food and Nutrient Database for Dietary Studies (FNDDS). Use nutrient info from FNDDS to calculate food patterns via the Food Patterns Equivalents Database (FPED) Convert FPED to HEI2010 Index using SAS code from HEI website. Currently, we are in the midst of Step 1, mapping the Home IDEA to the FNDDS. Aim 2: A) To date, data has been collected on 80 participants, with preliminary data analyses conducted on 58 participants. Recruitment is on-going. Preliminary findings indicate the following: Cardiometabolic risk factor prevalence:Mothers were 72% overweight/obese, 74% had central adiposity (waist circumference ≥35 in), 47% had HDL-cholesterol (HDL-C) < 50 mg/dL, 31% had HBA1c > 5.7%, and dietary intake was poor with an HEI2010 mean score of 47.5 ± 14.9. Home Food Environment: The presence of multiple types of sugar sweetened beverages (SSB) in the home was positively correlated with HbA1c(rs=.38,p<.01), and the presence of multiple types of child-friendly foods was negatively correlated with maternal intake of both whole grains (rs=-.30, p<.05) and total fruit (rs=-.29, p<.05). Dietary intake: Health Eating Index (HEI) total fruit (rs=0.32,p<.05) and total score (rs=0.26, p<.05) categories were positively correlated with HDL-C. HEI total fruit was negatively correlated with diastolic blood pressure (rs=-0.35,p<.01). Nut (rs=-0.28,p<.05) and soy (rs=-0.49,p<.01) intakes were negatively correlated with HbA1c. Child weight status: Child BMIz was positively correlated with maternal BMI (rs=.35, p<.01), negatively correlated with maternal HDL-C (rs=-0.32, p<.05). Maternal diet was not correlated with child BMI. B) Aim 2.B will commence upon the completion of Aim 1.

Publications

• Type: Conference Papers and Presentations Status: Accepted Year Published: 2016 Citation: Hibbs-Shipp, S., Johnson, S.L., Boles, R., Nelson, T., Wdowik, M., Bellows, L. Maternal Health Matters: The Home Food Environment and Chronic Disease Risk. Presented at Colorado State Universitys Graduate Showcase, November 15, 2016.
• Type: Conference Papers and Presentations Status: Under Review Year Published: 2017 Citation: Hibbs-Shipp, S., Johnson, S.L., Boles, R., Nelson, T., Wdowik, M., Bellows, L. Maternal Health Matters: Home Food Environment and Cardiometabolic Risk Factors. Submitted to Experimental Biology 2017.

Progress 07/01/15 to 09/30/15

Outputs
Target Audience: Nothing Reported Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Students and professional research staff working on this project have been trained: 1.In IRB Human Subjectsand Responsible Conduct of Research protocols; 2. To administer the ASA-24 dietary recall as well as other measures according to NHANES methodologies (e.g. height, weight; waist:hip circumference). 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?Aim 1: Conduct analyses to determine a Home Food Quality Score Aim 2: Recruit and collect data on 100 participants

Impacts
What was accomplished under these goals? Aim 1: Data was cleaned and is ready to be analyzed Aim 2: Survey instruments were refined/developed; investigators were trained; IRB submitted and approved; preschool center and participant recruitment has begun.

Publications