BACKGROUND/OBJECTIVES: Obesity and other predictors of type 2 diabetes disproportionally affect Hispanic and Black children in the US compared to non-Hispanic White (NHW) children. Yet, the prevalence of prediabetes in children remains unestablished, and guidelines for screening young children are lacking. This study examined the relationships between demographic factors and prediabetes in vulnerable youth in central Texas. SUBJECTS/METHODS: This is a cross-sectional analysis of baseline data from 976 3rd-5th graders (7-12 years) who participated in TX Sprouts, a school-based gardening, nutrition, and cooking trial in 16 elementary schools serving mainly children from minority backgrounds and lower-income households. Measures collected included age, sex, ethnicity, free/reduced-priced school lunch (FRL) status, parent educational attainment (questionnaires), BMI from height (stadiometer) and weight (TANITA scale), and prediabetes status from fasting plasma glucose (FPG) and HbA1c. Regressions examined cross-sectional associations between demographics and FPG, HbA1c, and prediabetes. RESULTS: Children were 47% male, 67% Hispanic, and 10% Black, with a mean age of 9.3 years; 71% received FRL, 50% had overweight/obesity, and 26% had prediabetes. Prediabetes rates were 2.8 and 4.8 times higher in Hispanic and Black children compared to NHW children, respectively (p ≤ 0.001), and 1.5 times higher in children with obesity versus normal BMI (p = 0.02). Children of parents with only an 8th-grade education, some high school education, or a high school degree had 3.1, 2.7, and 2.2 times higher odds of having prediabetes compared to children of college graduates, respectively (p ≤ 0.004). Analyses with FPG and HbA1c yielded similar results. CONCLUSION: These findings suggest a potential need for earlier screening, more comprehensive testing guidelines, and prevention programs tailored toward minority children, children with obesity, and children of parents with low educational attainment. Future research should explore this finding in a larger, nationally representative sample.

Breakfast consumption is associated with lower obesity prevalence and cardiometabolic risk and higher dietary quality (DQ) in children. Low-income, Hispanic populations are disproportionately affected by obesity and cardiometabolic risks. This study examined the relationship between breakfast consumption groups (BCG) on anthropometric, metabolic, and dietary parameters in predominately low-income, Hispanic children from 16 Texas schools. Cross-sectional data were from TX Sprouts, a school-based gardening, nutrition, and cooking randomized controlled trial. Anthropometric measurements included height, weight, body mass index, body fat percent via bioelectrical impedance, waist circumference, and blood pressure. Metabolic parameters included fasting plasma glucose, insulin, glycated hemoglobin, cholesterol, and triglycerides. DQ and BCG were assessed via two 24-h dietary recalls. Multivariate multiple regression examined relationships between BCG and anthropometric, metabolic, and dietary parameters. This study included 671 students (mean age 9 years, 58% Hispanic, 54% female, 66% free/reduced lunch, 17% breakfast skippers). No relationships were observed between BCG and anthropometric or metabolic parameters. BCG had higher DQ; higher daily protein, total sugar, and added sugar intake; and lower daily fat intake. Skipping breakfast was associated with lower DQ; higher daily fat intake; and lower daily protein intake. Longitudinal research examining breakfast quality on cardiometabolic outcomes in low-income, Hispanic children is warranted.

BACKGROUND: There is a need to directly and accurately conceptualize and measure food insecurity in children as part of surveillance and public health efforts. OBJECTIVE: The aim of this study was to compare parent and child perceptions of child-level food security status via questionnaires within a large, ethnically diverse population. METHODS: Cross-sectional baseline data from a cluster-randomized controlled trial involving primarily low-income, Hispanic third- to fifth-grade students and their parents were used for analysis. The sample consisted of 2408 dyadic (parent and child) pairs. Parents completed the 8-item child-referenced Household Food Security Survey Module and their responses were compared with an adaption of the 5-item Child Food Security Assessment completed by their child. Levels of association between child and parent perceptions within dyads were calculated using Goodman and Kruskals γ statistic. A mixed-effects binomial logistic regression model was used to model discordance as a function of child, parent, and household sociodemographic characteristics. RESULTS: The child sample was 53% girls, mean age of 9 y, and 63% were Hispanic. The parent sample was 86% women and 65% Hispanic. Child and parent perceptions of child-level food security agreed only 21.7% of the time. There was a weak positive association between child and parent perceptions of child-level food security (γ = 0.162, P < 0.001). Children perceived themselves as less food secure than their parents perception 70.1% of the time. Household receipt of Supplemental Nutrition Assistance Program benefits was associated with greater odds of discordant food security perceptions, whereas female children, older children, and parents not working were characteristics associated with lower odds of discordant perceptions. CONCLUSIONS: Results, in combination with the existing literature, suggest that parent perceptions of child-level food insecurity may underestimate child-level food insecurity experiences. Inaccurate estimations or underestimations of the true prevalence of child-level food insecurity could be detrimental to maternal and child health efforts. This trial was registered at clinicaltrials.gov as NCT02668744.

BACKGROUND: A key goal of the Dietary Guidelines for Americans 2015-2020 is to reduce added sugar intake by increasing public knowledge about added sugars. However, research has not shown if knowledge of added sugar recommendations is associated with intake. OBJECTIVES: To determine the relation between parent and child knowledge of added sugar recommendations with added sugar intake in primarily low-income and Hispanic third- to fifth-grade students. METHODS: Analysis examined baseline, cross-sectional data from TX Sprouts, a 1-y cooking, gardening, and nutrition clustered randomized controlled trial. Participants were 685 parent-child dyads from 16 elementary schools in the greater Austin area. Parents and children completed a survey to assess knowledge of added sugar recommendations. Children completed two 24-h dietary recalls to assess average intake of added sugars. Mixed effects linear regression models were used to estimate associations between child and parent knowledge of added sugar recommendations and average total added sugar intake. RESULTS: Children who correctly identified the added sugar recommendation consumed lower amounts of added sugar compared with children who did not correctly identify the recommendation (34.8 ± 2.7 compared with 41.0 ± 2.5 g; P = 0.003), after adjusting for sociodemographic characteristics. Parent knowledge of added sugar recommendations was not associated with child intake. CONCLUSIONS: Child knowledge of added sugar recommendations was associated with lower intake of added sugars. Findings suggest that child nutrition education should focus on increasing knowledge of national recommendations. Future research should investigate a causal relation between added sugar knowledge and intake in elementary-aged children.

Food insecurity (FI) is adversely associated with physical and mental wellbeing in children. The mechanism underlying this association is assumed to be dietary intake; however, evidence has been mixed. This study examined the relationship between self-reported FI and dietary quality among low-income children. Cross-sectional data were used from TX Sprouts, a school-based cooking, gardening, and nutrition intervention. A sample of 598 children completed two 24-h dietary recalls and a questionnaire including an adapted version of the 5-item Child Food Security Assessment (CFSA). Food security was categorized as food secure or FI based on summed CFSA scores. Dietary quality was assessed using the Health Eating Index-2015 (HEI-2015). Mixed effects linear regression models examined associations between FI and dietary quality. Children were 64% Hispanic, 55% female, and were 9.2 years old on average. Adjusting for sociodemographic characteristics, BMI percentile, and energy intake, FI was associated with lower HEI-2015 total scores (β = -3.17; 95% CI = -5.28, -1.06; p = 0.003). Compared to food secure children, FI children had lower greens and beans (2.3 vs. 1.9, p = 0.016), seafood and plant protein (2.0 vs. 1.6, p = 0.006), and added sugar (7.4 vs. 8.0, p = 0.002) component scores. Interventions targeting low-income and FI children should investigate ways to improve dietary quality.

BACKGROUND: The relationship of gestational diabetes mellitus (GDM), exclusive breastfeeding (EBF), and sugar-sweetened beverages (SSBs) on obesity prevalence in children has rarely been evaluated. OBJECTIVE: This study examined the association of GDM status, EBF, and SSB with obesity prevalence in children (1-5 y). METHODS: Data are from the 2014 Los Angeles County WIC Survey, which included 3707 mothers and their children (1-5 y). RESULTS: Compared with GDM offspring who were not EBF, GDM offspring who were EBF had lower odds of obesity, as did non-GDM offspring who were and were not EBF. Compared with GDM offspring with high-concurrent SSB intake (>3 servings/d) and no EBF, GDM offspring with high SSB intake and EBF did not have lower odds of obesity, whereas those with GDM, low SSB (≤1 serving/d), and EBF had lower odds of obesity. Using non-GDM, EBF, and low SSB as referent, non-GDM offspring who were not EBF, with either high or low SSB, had approximately a fourfold increase in odds of obesity. CONCLUSIONS: In GDM offspring, EBF is only associated with lower obesity levels if later SSB intake is also low, whereas EBF is protective against obesity in non-GDM offspring regardless of high or low later SSBs intake.

BACKGROUND: Numerous school-based interventions have used cooking and gardening approaches to improve dietary intake; however, research is limited on the mediation effect of dietary psychosocial factors on the link between the intervention and increased vegetable intake, particularly in children from low-income and racial and ethnic minority US families. OBJECTIVE: Our aim was to examine the effects of the Texas Sprouts intervention on dietary psychosocial factors related to intake of vegetables, and whether these psychosocial factors mediate the link between the intervention and increased intake of vegetables in schoolchildren from low-income and racial and ethnic minority US families. DESIGN: This was an analysis of data on secondary outcomes from the Texas Sprouts program, a 1-year school-based gardening, nutrition, and cooking cluster randomized controlled trial consisting of elementary schools that were randomly assigned to either the Texas Sprouts intervention or to control. PARTICIPANTS/SETTING: Participants were 2,414 third- through fifth-grade students from low-income and racial and ethnic minority US families from 16 schools (8 intervention and 8 control) in Austin, TX. INTERVENTION: The intervention group received eighteen 60-minute gardening, nutrition, and cooking student lessons in an outdoor teaching garden and 9 monthly parent lessons throughout the academic year. MAIN OUTCOME MEASURES: Child psychosocial and dietary measures were collected at baseline and post intervention via validated questionnaires. STATISTICAL ANALYSES PERFORMED: Generalized linear mixed models assessed the intervention effects on dietary psychosocial factors. Mediation analyses examined whether these psychosocial factors mediated the link between the intervention and increased child vegetable intake. RESULTS: Children in Texas Sprouts, compared with controls, showed significant increases in the mean scores of gardening attitudes, cooking self-efficacy, gardening self-efficacy, nutrition and gardening knowledge, and preferences for fruit and vegetables (all, P < .001). Each of the dietary psychosocial factors mediated the association between the Texas Sprouts intervention and child vegetable intake. CONCLUSIONS: Besides targeting dietary behaviors, future school-based interventions should also focus on understanding the mechanisms through which teaching children to cook and garden influence dietary psychosocial factors as mediators of change in healthy eating behaviors.

BACKGROUND: Cooking interventions have been linked to reductions in obesity and improvements in dietary intake in children. OBJECTIVE: To assess whether child cooking involvement (CCI) was associated with fruit intake (FI), vegetable intake (VI), vegetable preference (VP), and vegetable exposure (VE) in children participating in the Texas, Grow! Eat! Go! (TGEG) randomized controlled trial. METHODS: Baseline data from TGEG included 1231 3rd grade students and their parents. Conducted in 28 low-income, primarily Hispanic schools across Texas, TGEG schools were assigned to: 1) Coordinated School Health (CSH) only (control group), 2) CSH plus gardening and nutrition intervention (Learn, Grow, Eat & Go! or LGEG group), 3) CSH plus physical activity intervention (Walk Across Texas or WAT group), and 4) CSH plus LGEG plus WAT (combined group). Height, weight, dietary intake, VE, VP, and CCI were collected at baseline and postintervention. Linear regressions were used to assess the relation between baseline CCI and fruit and vegetable (FV) intake, VE, and VP. A priori covariates included age, sex, race/ethnicity, and TGEG treatment group. RESULTS: Children who were always involved in family cooking had higher VP and VE when compared with children who were never involved in family cooking (β = 3.26; 95% CI: 1.67, 4.86; P < 0.01 and β = 2.26; 95% CI: 0.67, 3.85; P < 0.01, respectively). Both VI and FI were higher for children who were always involved in family cooking compared with children who never cooked with their family (β = 2.45; 95% CI: 1.47, 3.44; P < 0.01 and β = 0.93; 95% CI: 0.48, 1.39; P < 0.01, respectively). VI and fruit consumption were higher for children who reported being sometimes involved in family cooking compared with children who were never involved in family cooking, (β = 1.47; 95% CI: 0.51, 2.42; P < 0.01, and β = 0.64; 95% CI: 0.20, 1.08; P < 0.01, respectively). CONCLUSIONS: Results show a positive relation between family cooking and FV intake and preference in high-risk, minority children.

Knowing which barriers to buying and preparing/cooking vegetables at home are linked with the home availability of vegetables and how food-security status impacts this relationship will facilitate the tailoring of future public health interventions. Baseline data were used from an elementary-school-based intervention. Data on household food-security status, availability of vegetables at home, and barriers to buying and preparing/cooking vegetables were collected from 1942 parents. Differences between food-secure and food-insecure households were examined for barriers to buying and preparing/cooking vegetables. Mixed-effects linear regression was used to estimate the associations between barriers to buying and preparing/cooking vegetables and food-security status on the home availability of vegetables. Food insecurity was reported in 27% of households. Food-insecure households were significantly more likely to report barriers to buying and preparing/cooking vegetables. The barriers to purchasing/cooking vegetables score was associated with a decrease in the home availability of vegetables score (β = -0.77; 95% CI: -0.88, -0.65; p < 0.001). Compared to food-secure households, food-insecure households were 15% less likely to have home vegetable availability (β = -1.18; 95% CI: -1.45, -0.92; p < 0.001). Although home availability of vegetables does not guarantee consumption, this study identified specific barriers that were associated with availability that can be targeted in future interventions seeking to improve vegetable consumption in the homes of low-income families.

Background

The effects of breastfeeding (BF) on metabolic syndrome (MetS) and diabetes mellitus in children exposed to gestational diabetes mellitus (GDM) in utero have rarely been evaluated.

Objective

This study assessed BF and GDM in relation to the prevalence of prediabetes and MetS in Hispanic children and adolescents (8-19 y).

Methods

This is a longitudinal study with 229 Hispanic children (8-13 y) with overweight/obesity, family history of diabetes, and an average of four annual visits (AV). Participants were categorized as follows: never (negative for prediabetes/MetS at all AVs), ever (positive for prediabetes/MetS at any visit), intermittent (positive for prediabetes/MetS at 1-2 AVs), and persistent (positive for prediabetes/MetS at greater than or equal to 3 AVs).

Results

Compared with GDM offspring who were not BF (referent), GDM offspring who were BF had lower odds of persistent prediabetes (OR = 0.18; 95% CI, 0.04-0.82; P = 0.02) and MetS (OR = 0.10; 95% CI, 0.02-0.55; P = 0.008). Compared with referent group, non-GDM offspring who were BF, and non-GDM offspring not BF had lower odds of persistent prediabetes (OR = 0.10; 95% CI, 0.03-0.39; P = 0.001; OR = 0.05; 95% CI, 0.01-0.11; P < 0.001) and MetS (OR = 0.14; 95% CI, 0.04-0.59; P = 0.01 and OR = 0.04; 95% CI, 0.01-0.11; P < 0.001).

Conclusions

These results show BF is protective against prediabetes and MetS in offspring regardless of GDM status.