March 2023

Connecting Research to Communities: The 2022 NCCOR Annual Report

NCCOR, March 2023

The 2022 NCCOR Annual Report, Connecting Research to Communities, is now available online. The report highlights NCCOR’s unique role facilitating collaboration among researchers and practitioners working in children’s health. It also features NCCOR’s newest tools, which offer accessible, research-based resources to help communities create environments where all residents can thrive. Featured projects include:

• Create Thriving, Activity-Friendly Communities: Making the Case for Investments in Activity-Friendly Communities
  Geared towards facilitating conversations with local leaders, NCCOR’s new tool helps communities make the business case for investing in more sidewalks, trails, and parks to increase quality of life and spur economic activity. It contains a suite of user-friendly materials, including slides, talking points, and a factsheet, that are based on years of NCCOR’s physical activity research.

• Economic Indicators Library
  The library contains 10 research-based data indicators that influence local quality of life, such as housing affordability, green space, and air quality. Communities can prioritize indicators as they plan for local improvements or measure the benefits of activity-friendly spaces.

• NCCOR Published Research
  In addition to connecting with communities, NCCOR continues to produce research for scientists, health providers, and public health practitioners. The Annual Report contains a summary of NCCOR’s latest publications, including papers focused on active travel to school, pedestrian safety, and the pandemic’s continued impact on early childhood care centers.

In addition to project profiles, this year’s report contains a list of conferences, webinars, presentations, and a detailed list of NCCOR members making it an excellent introduction to NCCOR for those who are new to childhood obesity research and a helpful catalog of recent achievements in the field. Copies are available to download on the NCCOR website.

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New Connect & Explore Webinar Explores Updated Recommendations for Childhood Obesity Treatment

NCCOR, March 2023

Join NCCOR on Tuesday, March 28^th from 3:00-4:00 p.m. ET for the next Connect & Explore webinar, Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity. Authors of the American Academy of Pediatrics’ new clinical practice guideline for children with overweight and obesity will discuss their key recommendations and explore potential impacts for childhood obesity programs. The webinar will also review the new “CDC Extended BMI-for-age Growth Charts,” which updated BMI percentiles based on data for children and adolescents with obesity. Speakers include:

• Sarah Hampl, MD, FAAP, University of Missouri-Kansas City School of Medicine
• Sandra Hassink, MD, FAAP, American Academy of Pediatrics Institute for Healthy Childhood Weight
• Cynthia Ogden, PhD, Centers for Disease Control and Prevention

The new treatment guideline informs pediatricians and other pediatric allied health care professionals about the standard of care for evaluating and treating children with overweight and obesity and related comorbidities. It promotes an approach that considers the child’s health status, family system, community context, and resources for treatment to create the best evidence-based treatment plan. It is based on a comprehensive evidence review of controlled and comparative effectiveness trials and high-quality longitudinal and epidemiologic studies.

This webinar is free, but you must register to receive access. Space is limited so tell a colleague and register today! For more information about NCCOR Connect & Explore webinars, please visit the NCCOR website at www.nccor.org/webinars.

Please consider sharing this information on your social networks using the hashtag #ConnectExplore. We will live-tweet the event, so be sure to follow the conversation at @NCCOR. For those who cannot attend, the webinar will be recorded and archived on www.nccor.org.

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NCCOR Toolbox: March is National Nutrition Month

March is National Nutrition Month, a month aimed at learning about making informed food choices and developing healthful eating and physical activity habits. NCCOR has a variety of tools and resources to assess diet and the food environment, including NCCOR’s landmark tool, the Measures Registry Resource Suite. The Suite offers research tools to help researchers, practitioners, and students understand key measurement concepts and find appropriate measures for research and evaluation projects. NCCOR’s Measures Registry User Guides are a great resource for those seeking detailed instructions on how to find the best measure for their work. Each User Guide section features a case study that walks you through the process of finding the right measure for your research question, provides an overview of measurement, and describes general principles of measure selection for each of the four domains. Examples of diet-related case studies include: examining influences on diet among population subgroups, examining implications of different foods offered in vending machines, and improving healthy eating behaviors in independent neighborhood restaurants. In addition, NCCOR’s Measures Registry Learning Modules are ideal for users newer to research and evaluation, or those who need a refresher on key research concepts. The Learning Modules walk you through measurement selection on your own time through 5 to 15-minute modules in the four major domains.

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Fruit, Vegetable, and Sugar-Sweetened Beverage Intake Among Young Children, by State — United States, 2021

February 17, 2023, Centers for Disease Control and Prevention—Good nutrition in early childhood supports optimal growth, development, and health. Federal guidelines support a dietary pattern with daily fruit and vegetable consumption and limited added sugars, including limited consumption of sugar-sweetened beverages. Government-published dietary intake estimates for young children are outdated at the national level and unavailable at the state level. CDC analyzed data from the 2021 National Survey of Children’s Health (NSCH) to describe how frequently, according to parent report, children aged 1–5 years (18,386) consumed fruits, vegetables, and sugar-sweetened beverages, nationally and by state. During the preceding week, approximately one in three (32.1%) children did not eat a daily fruit, nearly one half (49.1%) did not eat a daily vegetable, and more than one half (57.1%) drank a sugar-sweetened beverage at least once. Estimates of consumption varied by state. In 20 states, more than one half of children did not eat a vegetable daily during the preceding week. In Vermont, 30.4% of children did not eat a daily vegetable during the preceding week, compared with 64.3% in Louisiana. In 40 states and the District of Columbia, more than one half of children drank a sugar-sweetened beverage at least once during the preceding week. The percentage of children drinking sugar-sweetened beverages at least once during the preceding week ranged from 38.6% in Maine to 79.3% in Mississippi. Many young children are not consuming fruits and vegetables daily and are regularly consuming sugar-sweetened beverages. Federal nutrition programs and state policies and programs can support improvements in diet quality by increasing access to and availability of fruits and vegetables and healthy beverages in places where young children live, learn, and play.

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Breastfeeding 2023

February 7, 2023, The Lancet—Breastfeeding has proven health benefits for both mothers and babies in high-income and low-income settings alike. Yet, less than 50% of babies worldwide are breastfed according to WHO recommendations. For decades, the commercial milk formula industry has used underhand marketing strategies, designed to prey on parents’ fears and concerns, to turn the feeding of infants and young children into a multibillion-dollar business—generating revenues of about $55 billion each year.

This three-paper Series outlines the multifaceted and highly effective strategies used by commercial formula manufacturers to target parents, health-care professionals, and policy-makers. The industry’s dubious marketing practices—in breach of the breastfeeding Code—are compounded by lobbying of governments, often covertly via trade associations and front groups, against strengthening breastfeeding protection laws and challenging food standard regulations.

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Defining Progress in Childhood Obesity Solutions Through Structural Changes

February 2023, National Academies Press—The Roundtable on Obesity Solutions of the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine held a virtual public workshop, Defining Progress in Obesity Solutions through Structural Changes, on October 25, 2022. The workshop focused on methods to assess progress in addressing structural drivers of obesity. Presentations explored innovative approaches and performance indicators that could be used to gauge progress in obesity solutions as well as strategies to hold leaders and decision makers accountable. Workshop sessions covered topics such as the science, strengths, and limitations of body mass index (BMI), and a review of structural drivers of obesity in a variety of systems – political and economic, environmental, health care, and sociocultural – along with current approaches used to measure progress in those systems. This publication summarizes the presentation and discussion of the workshop.

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National Institutes of Health Nutrition Research Report

2020-2021, National Institutes of Health—The National Institutes of Health (NIH), part of the U.S. Department of Health and Human Services (HHS), is the nation’s medical research agency. NIH is made up of 27 institutes and centers (ICs), each with a research agenda that often focuses on specific diseases or body systems. NIH supports biomedical and behavioral research and training in nutrition as it relates to human development, health maintenance, disease prevention, and disease treatment.

Nutrition is a factor in many diseases and an integral part of overall health, development, and well-being. As a result, research interests in the nutritional sciences extend far beyond those of a single institute. Biomedical and behavioral nutrition research and training in FY20 and FY21 was supported by 24 NIH ICs and the NIH Office of the Director.

The NIH nutrition research portfolio includes extramural and intramural research as well as research training. In FY21, 81 percent of the nutrition research portfolio was extramural research, conducted by hundreds of institutions in the United States and in several countries across the world. Many of the research projects funded by NIH are based on ideas developed by individual investigators from institutions of higher education, independent hospitals, and other research organizations. Most of the intramural research was performed in laboratories on the NIH campus in Bethesda, Maryland—including the Clinical Center. NIH also has research facilities throughout the country.

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Population-Scaled, School-Based Physical Activity Intervention Can Help Prevent Childhood Obesity

February 22, 2023, EurekAlert!

A new Slovenian population-scaled, school-based study shows that by providing additional physical education lessons to young children is effective in preventing childhood obesity, according to findings published in Obesity, The Obesity Society’s (TOS) flagship journal.

“Our results show the importance of sustainable, long-lasting, physical activity programs set in schools for children’s health at both the individual and the population level. While this study analysed only the effectiveness of such program for obesity prevention, physical activity programs are likely to benefit growth and development, improve fitness, enhance mental health and boost cognitive performance of the children, and should be a cornerstone of educational and health policies,” said Maroje Sorić, MD, PhD, University of Zagreb in Croatia. Sorić is one of the study’s senior authors.

Although the beneficial health effects of initiating physical activity intervention programs during childhood are well documented, most of this evidence comes from short-term efficacy trials conducted in well-controlled settings, usually without implementing large-scale or scalable population-based approaches. Experts explain the current lack of successfully implemented school-based physical activity interventions in real-world settings impedes the fight against childhood obesity. The present study leverages a natural experiment that provided the opportunity to examine the effectiveness of Healthy Lifestyle, a real-world, population-based, longitudinal physical activity intervention on body mass index (BMI) in children aged 6-to-14 years. The intervention is derived from a previous and successful small-scale physical activity intervention in individual Slovenian schools.

Between 2011–2018, Healthy Lifestyle was a nationwide intervention introduced in 216 Slovenian schools with more than 34,000 participants compared with the same number of schools and non-participants. Generalized estimating equations were used to estimate the effects of differing levels of exposure to the intervention (i.e., from 1-5 years) on BMI in children with normal weight, overweight or obesity at baseline.

The intervention provided two additional physical education lessons in first through six grades and three additional lessons in seventh to ninth grades. The additional lessons were not part of the required curricula but were organized to take place immediately after regular school hours. Once children obtained written parental consent, their participation was compulsory. The intervention was offered to all children in an individual school and organized as an elective course. The maximum number of children per class was between 16–30.

Physical education specialist teachers associated with the program were required to provide at least 12 different sports per triennium, and had to prioritize the three most established sports in the local environment. The teachers also had to provide information on healthy dietary and lifestyle habits regarding energy balance, limiting the consumption of snacks and sugar-sweetened beverages and promoting a diverse diet.

The intervention was designed through a bottoms-up approach, meaning that schools were totally independent in selecting the contents and form of work. The parents of participants did not receive any educational materials nor were they involved in the intervention in any way.

Results revealed that BMI was lower in the intervention group, irrespective of participation duration or baseline weight status. The difference in BMI increased with the program duration, with maximal effects seen after three-to-four years of participation, and was consistently larger for children with obesity, peaking at 1.4 kg/m2 for girls with obesity and peaking at 0.9 kg/m2 for boys with obesity. The program started to become effective at reversing obesity after three years, whereas the lowest numbers needed to treat were observed after five years.

“The analysed outcomes of our intervention confirmed that introducing two-to-three additional education lessons per week to reach one hour per day can provide children with enough high-intensity physical activity to re-balance energy consumption and expenditure, and reverse numerous cases of obesity in school settings. Since all the contents of the intervention were planned and implemented by physical education specialist teachers, our case emphasises the importance of not only sufficient quantity but also of sufficient quality of organized physical activity of higher intensity that provides strong enough impulse to trigger positive transformative processes in body composition and beyond,” said study senior author Gregor Starc, PhD, University of Ljubljana in Slovenia.

“This study demonstrates that small changes to physical activity programming in schools can, given enough time, make a significant difference in health outcomes, including obesity. This study speaks to two well-known facets of successful health-related programs. The first is that structural components of an individual’s environment, such as additional physical activity classes, can significantly influence health outcomes. The second is that long-term consistency plays a key role in weight-related outcomes. This study’s outcomes open the discussion around the need to consider other small incremental changes that could be made to children’s environment, such as diet or marketing, and the need to measure these changes under real-world conditions over a long-sustained period of time,” said Travis Masterson, PhD, Broadhurst Career Development Professor for the Study of Health Promotion and Disease Prevention, The Pennsylvania State University. Masterson was not associated with the research study.

The study, titled “Effectiveness of a Population-scaled, School-based Physical Activity Intervention for the Prevention of Childhood Obesity” will be published in the March 2023 print edition of Obesity.

Other study authors include Gregor Jurak and Shawnda A. Morrison, University of Ljubljana in Slovenia. Petra Jurić, University of Zagreb in Croatia, is the corresponding author.

These analyses were conducted within the STOP project, funded by the European Commission’s Horizon 2020 research and innovation program under Grant Agreement No. 774548. The content of this document reflects only the authors’ views, and the European Commission is not liable for any use that may be made of the information it contains. Limited non-specific funding was provided also by the Slovenian National Research Agency program P5-0142 Bio-psycho- social context of kinesiology. Jurić’s work was funded by the Croatian Science Foundation, Grant Number DOK-2018-09-8532.

The authors declared no conflicts of interest.

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Associations Between Household Frequency of Cooking Dinner and Ultraprocessed Food Consumption and Dietary Quality Among US Children and Adolescents

February 16, 2023, Childhood Obesity

Introduction: Dietary quality is poor and intake of ultraprocessed foods (UPFs) is high among children and adolescents in the United States. Low dietary quality and high UPF intake are associated with obesity and higher risk of diet-related chronic diseases. It is unknown whether household cooking behavior is related to improved dietary quality and lower consumption of UPFs among US children and adolescents.

Methods: Nationally representative data from the 2007–2010 National Health and Nutrition Examination Survey (n = 6032 children and adolescents ≤19 years of age) were used to examine the relationships between household cooking frequency of evening meals and children’s dietary quality and UPF intake using multivariate linear regression models adjusted for sociodemographics. Two 24-hour diet recalls were used to assess UPF intake and dietary quality [Healthy Eating Index-2015 (HEI-2015)]. Food items were categorized according to Nova classification to obtain the UPF percent of total energy intake.

Results: A higher household frequency of cooking dinner was associated with lower UPF intake and higher overall dietary quality. Compared to children in households cooking dinner 0–2 times per week, children in households cooking dinner 7 times/week had lower intake of UPFs [β = −6.30, 95% confidence interval (CI) −8.81 to −3.78, p < 0.001] and marginally higher HEI-2015 scores (β = 1.92, 95% CI −0.04 to 3.87, p = 0.054). The trends toward lower UPF intake (p-trend <0.001) and higher HEI-2015 scores (p-trend = 0.001) with increasing cooking frequency were significant.

Conclusions: In this nationally representative sample of children and adolescents, more frequent cooking at home was associated with lower intake of UPFs and higher HEI-2015 scores.

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ECHO Researchers Investigate the Effect of the Healthy, Hunger-Free Kids Act on the Body Mass Index of School-Aged Children

February 13, 2023, Environmental influences on Child Health Outcomes

Collaborative ECHO research led by Aruna Chandran, MD, MPH and Emily Knapp, PhD of the Johns Hopkins Bloomberg School of Public Health, examines how the body mass index (BMI) trends of school-aged children have changed following the implementation of the 2010 Healthy, Hunger-Free Kids Act (HHFKA). Researchers analyzed height and weight data from over 14,000 children in the ECHO Program and found an overall decrease in BMI following the implementation of the HHFKA. These results suggest a reversal of the pre-implementation trends, which indicated that BMI was increasing from year to year, particularly among adolescents and children from lower-income families. This research, titled “Changes in Body Mass Index Among School-Aged Children Following Implementation of the Healthy, Hunger-Free Kids Act,” is published in JAMA Pediatrics.

“The National School Lunch Program and School Breakfast Program (NSLP) provides free or low-cost meals to over 30 million children annually, providing an estimated 50% of students’ caloric intake each school day,” said Dr. Chandran. “The Healthy, Hunger-Free Kids Act was the first legislation in nearly 3 decades aimed at improving the nutritional quality of breakfast, lunch, and snacks sold at schools.”

Childhood obesity is a serious health concern, affecting nearly 1 in 5 children in America, that has long-term consequences for health and quality of life. While many studies have already shown the success of the HHFKA in improving the quality of school meals, there are still gaps in understanding the effect of this policy on childhood BMI.

For this study, researchers analyzed height and weight measurements collected between January 2005 and March 2020 from children ages 5 to 18 years across 50 ECHO cohorts in the United States. They used these measurements to calculate each child’s BMI, then adjusted those measurements based on the child’s age and sex. Using this data, the researchers compared yearly BMI trends from before and after the implementation of the HHFKA.

The researchers found that increasing BMI trends from the decade before the HHFKA was implemented were reversed after the law was implemented. This effect was also observed in adolescents, who tend to have more autonomy in purchasing their own meals and snacks during the school day but still benefited from HHFKA implementation.

“School meals and snacks represent a key opportunity for intervention to combat the childhood obesity epidemic, given the high rates of participation in school meal programs and the significant proportion of caloric intake that children receive at school,” said Dr. Knapp. “This is particularly important for children in lower-income families, who are more likely to participate in the NSLP and are at higher risk of obesity.”

In the future, researchers should continue to the examine the effects of improving the nutritional quality of school meals on childhood obesity. Results from this study can also help policymakers evaluate future policies related to improving school meals and snacks.

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