Eating patterns and health outcomes among children and adolescents

The high prevalence of overweight among children and adolescents in the U.S. is a major public health concern; therefore, research regarding eating behavior for this population subgroup is a priority. The current study was conducted to identify whether fruit and vegetable and whole grain food intake separately influenced overweight or chronic disease risk factors in a large nationally representative sample of children and adolescents based on National Health and Nutrition Examination Survey (NHANES) data. School meal participation was also explored as a potential explanatory variable for intake of fruits and vegetables and whole grain foods.;Lunch meal dietary intake data were collected according to lunchroom meal observation procedures among 129 children in two schools in the Minneapolis, MN metropolitan area for an initial study. Dietary intake data based on the 1999-2004 NHANES for children and adolescents were used in two subsequent studies. SAS and SAS-callable SUDAAN software (SAS Institute, Inc. Cary, NC) were used to analyze data. T-test, multiple linear regression, and logistic regression analyses were used to test for associations between dietary intake and weight status or risk factors for chronic disease by gender controlling for confounding factors and between dietary intake and source of school lunch.;In the initial study, intake for the lunch meal among children eating the school lunch was higher in protein, vitamins A, D, and K, and calcium, and lower in energy, fat, carbohydrate, vitamin E, and sugar compared to children eating a bagged lunch. The ratios of mean protein and calcium consumption to minimum required values tended to be greater for children eating school lunch compared to those eating bag lunches.;Children eating bag lunches had lower total fruit and vegetable intakes, as well as higher meal energy density compared to children eating school lunch. Both groups had very low whole grain intake. Overall, the school lunch provided more total fruits and vegetables, and micronutrients, and less fat compared to bagged lunches from home.;In the first study based on NHANES data among children (6-11 years), fruit intake and intake of fruit and vegetables combined were not significantly associated with overweight or obesity. However in boys, higher vegetable and fat intakes were positively associated with overweight or obesity. No associations were observed between fiber and added sugar intakes and overweight or obesity for either boys or girls. Higher energy intake and total food consumption among all children and boys were positively associated with overweight or obesity. However, energy density was not significantly associated with overweight or obesity for all children or for boys. Contrary to some previous findings among children and adolescents, these results did not support a positive relationship between fruit and vegetable consumption and healthy weight among children. In this study, children consumed a large proportion of vegetables as potatoes which could have been prepared with added fat (e.g., French fries), providing a possible explanation for the unexpected findings.;In the second study based on NHANES data among adolescents (12-19 years), less than one-third consumed > 0.5 whole grain ounce equivalents/day. Higher whole grain intake was associated with lower refined grain intake and higher carbohydrate, fiber, folate and energy intakes. Higher whole grain intake was associated with lower BMI, BMI z-score, waist, thigh and arm circumference among boys, but not girls. However, after further adjustment for food group intake, the association between higher whole grain intake and BMI in boys only approached significance (p=0.067). With higher whole grain intake for boys and girls, fasting insulin levels were lower, while HDL-cholesterol was higher for girls and homocysteine concentrations were lower for boys. Serum and RBC folate levels were higher for boys and girls with greater whole grain intake. Overall, these results were favorable for documenting benefits from consumption of whole grain foods among adolescents in terms of weight status and chronic disease risk factors.;In conclusion, children who ate school lunch had more favorable macro- and micronutrient, and energy intakes compared to those who brought a bag lunch from home. An inverse association did not exist between fruit and vegetable intakes and weight status among children. Whole grain intake exerted positive effects among adolescents regarding weight status and risk factors for chronic disease differentially by gender. In general, results from the initial study and the second study based on NHANES data produced expected results indicating that health professionals should focus efforts on improving intake of fruits, vegetables, and whole grain foods to meet recommendations. Results from the first study based on NHANES data indicate that the preparation of fruits and vegetables may be an important factor to consider when examining the relationship between intake and weight status among children. Further longitudinal research is required to clarify inconsistencies in findings.