August 2023


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Upcoming NCCOR Webinar Highlights the New Healthy Eating Index 2020 and Healthy Eating Index-Toddlers-2020

NCCOR, August 2023

Join NCCOR on September 7, 2023, from 2:00–3:30 p.m. ET for the next Connect & Explore webinar, “Measuring Diet Quality Across the Lifespan: Introducing the New Healthy Eating Index-Toddlers-2020 and Healthy Eating Index-2020.” This special 90-minute webinar will feature an expert panel of researchers who contributed to the new Healthy Eating Index (HEI).

HEI is a scoring system to assess how well foods align with dietary guidelines. The National Cancer Institute and the US Department of Agriculture developed the HEI and update it every five years. For the first time, the latest release includes two new scoring systems: HEI-2020 for children and adults aged 2 years and older, and the HEI-Toddlers-2020 for children aged 12 to 23 months.

Register for the next Connect & Explore webinar to learn more about these new HEI resources. Speakers will review highlights from the 2020 update, explain why a toddler focused version was needed, and describe how to assess dietary quality for this age group. The panel includes:

  • Jill Reedy, PhD, MPH, RD, National Institutes of Health
  • Marissa Shams-White, PhD, MSTOM, MS, MPH, National Institutes of Health
  • TusaRebecca Pannucci, PhD, MPH, RD, US Department of Agriculture
  • Jennifer Lerman, MPH, RD, National Institutes of Health
  • Kirsten Herrick, PhD, MSc, National Institutes of Health

Registration for the webinar is free but attendance is limited, so sign up early to secure a spot. Please consider sharing this information on your social networks using the hashtag #ConnectExplore. We will live-tweet the webinar, so follow the conversation at @NCCOR. For those who cannot attend, the webinar will be recorded and archived on

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Publications & Tools

NCCOR Toolbox: NCCOR Conference Posters Now Available Online

The new NCCOR Resource Library now contains many of our recent scientific posters. Scientific posters create succinct visual representations of research projects or study findings. NCCOR’s poster library provides a new way to learn about NCCOR’s work and can serve as a helpful model to graduate students learning how to graphically present public health research. To view NCCOR’s poster selections, choose “Scientific Poster” from the Publications Type drop-down menu.

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Determine Your Project’s Impact with a New Online Calculator from GusNIP NTAE

July 2023, Nutrition Incentive Club

The new GusNIP NTAE Nutrition Incentive Economic Impact Calculator estimates the economic impact of nutrition incentive projects that have unique qualities when compared to broader local food programs. It is geographically tailored using state groupings to approximate the economic impact. Consequently, nutrition incentive programs can use this powerful tool to estimate the statewide economic impact of their program. It also generates an easy-to-read infographic to share with team members, partners, funders, and/or policymakers. Learn more during a free webinar on August 16 from 1:00-2:00 pm ET.



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Healthy Eating Research Educational Resources for Parents and Providers Are Now Available in More Languages

July 2023, Healthy Eating Research

The Healthy Eating Research offers resources for parents and health professionals based on the guidance from our expert panels on healthy beverages for children ages 0 to 5 and healthy eating habits for children ages 2 to 8. Many healthy eating resources are now available in Spanish, and resources for healthy drinks are available in Spanish, Tagalog, and Vietnamese.


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Interactive Tool Provides Local Insights into Food Equity

July 2023, Partnership for a Healthier America

The Partnership for a Healthier America, in partnership with the University of Maryland Baltimore County, created a Food Equity Opportunity Map to help communities expand access to nutritious food. This interactive tool uses census and public health data to identify areas with high levels of food equity exists, areas that have opportunities for improvement, and where communities and programs can make the biggest impact.


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Childhood Obesity Research & News

School Meals Would Be Even Healthier if Compliant with U.S. Nutrition Standards, Study Finds

July 31, 2023, EurekAlert!

Today’s school meals are much healthier than they were for the parents of American kids, but still 1 in 4 school meals are of poor nutritional quality. The latest Dietary Guidelines for Americans (DGA), in place for 2020-25, call for meals with less sugar and salt and with more whole grains.

Fully synchronizing school meals with these new standards could positively impact hundreds of thousands of children into their adulthood, with the added benefit of saving billions in lifetime medical costs, Friedman School of Nutrition Science and Policy investigators report July 31 in The American Journal of Clinical Nutrition. By modeling the national implementation of updated school lunch guidelines, the research team found even incomplete compliance by schools would lead to overall reductions in short- and long-term health issues for participating K-12 students.

“On average, school meals are healthier than the food American children consume from any other source including at home, but we’re at a critical time to further strengthen their nutrition,” says senior author Dariush Mozaffarian, a cardiologist and Jean Mayer Professor of Nutrition at the Friedman School. “Our findings suggest a real positive impact on long-term health and health care costs with even modest updates to the current school meal nutrition standards.”

The researchers utilized a simulation model to derive a data-driven estimate of three changes to the school meal program, including limiting percent of energy from added sugar to lower than 10% of total energy per meal, requiring all grain foods to be whole grain, and lowering sodium content to the Chronic Disease Risk Reduction amount for sodium intake in the 2020-2025 DGA.

A portion (35%) of these dietary changes were estimated to continue into adulthood. If all schools fully complied with the new standards, these were estimated to prevent more than 10,600 deaths per year due to fewer diet-related diseases, saving over $19 billion annually in health care-related costs during later adulthood. The worst-case estimate, in which schools remained with their current food offerings, saved a little over half as many lives and health care dollars.

School meals aligning to new dietary guidelines for added sugars, sodium, and whole grains would have modest, but important, short-term health benefits for children. For example, these changes were estimated to reduce elementary and middle school students’ body mass index (BMI) by 0.14 and systolic blood pressure by 0.13 mm Hg. Benefits were about half as large for high school students because fewer older students eat school-provided meals.

“Using a comparative risk assessment model, our estimations are based on the best available, nationally representative data on children and adults and the best available evidence on how dietary changes in childhood relate to BMI and blood pressure, how dietary changes persist into adulthood, and how diet influences disease in adulthood,” says first author Lu Wang, a postdoctoral fellow at the Friedman School. “Our new results indicate that even small changes to strengthen school nutrition policies can help students live longer, healthier lives.”

The study’s findings, which cannot prove the outcomes they describe but are derived from a mathematical model based on the best available demographic and health data, are timely given the United States Department of Agriculture’s recent commitment to updating the school meal nutrition standards to align with the 2020-2025 dietary guidelines. The price to fully implement new school meal standards is yet to be determined, but previous alignments suggest it would add at least another $1 billion nationally to the cost of these programs, or only about 5 percent of the total predicted annual long-term health care savings this change would yield.


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The Effect of Poverty on the Relationship between Household Education Levels and Obesity in U.S. Children and Adolescents: An Observational Study

July 29, 2023, The Lancet Regional Health Americas


Although ample evidence has shown the link between childhood obesity and socioeconomic status including family income and household education levels, the mediating role of poverty in the association between household education levels and childhood obesity is unclear. This study aimed to quantify the extent to which family poverty levels contribute to the association between household education levels and obesity among US children and adolescents.


This cohort study used the nationally representative data of 21,754 US children and adolescents aged 6–17 years (National Health and Nutrition Examination Survey 1999–2018). We applied mediation analysis of the association between household education levels (less than high school, high school, and college or above) and obesity mediated through poverty (≤138% vs. >138% federal poverty level), adjusting for demographic characteristics of household head and their offspring. Obesity was defined as age- and sex-specific body mass index in the 95th percentile or greater using the 2000 Centers for Disease Control and Prevention growth charts.


Among 21,754 children and adolescents (weighted N = 43,544,684; mean age, 11.6 years; female, 49%), 9720 (weighted percentage, 33.0%) were classified as living in poverty and 4671 (weighted percentage, 19.1%) met the criteria for obesity. Low household education level (less than high school) showed increased risks of poverty (adjusted relative risk [95% CI], 5.82 [4.90–6.91]) and obesity (adjusted relative risk [95% CI], 1.94 [1.68–2.25]) compared to high household education level (college or above). We also quantified that poverty mediated 18.9% of the association between household education levels and obesity among children and adolescents. The mediation effect was consistently observed across age, gender, and race/ethnicity.


Poverty mediated the association between the low educational status of household heads and their offspring’s obesity. Our findings highlight the importance of reducing obesity risk among the low-income population to minimize the burden of intergenerational health disparities due to socioeconomic status.


Japan Society for the Promotion of Sciences (22K17392).


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Link Found Between Childhood Television Watching and Adulthood Metabolic Syndrome

July 24, 2023, EurekAlert!

A University of Otago study has added weight to the evidence that watching too much television as a child can lead to poor health in adulthood.

The research, led by Professor Bob Hancox, of the Department of Preventive and Social Medicine, and published this week in the journal Pediatrics, found that children who watched more television were more likely to develop metabolic syndrome as an adult.

Metabolic syndrome is a cluster of conditions including high blood pressure, high blood sugar, excess body fat, and abnormal cholesterol levels that lead to an increased risk of heart disease, diabetes and stroke.

Using data from 879 participants of the Dunedin study, researchers found those who watched more television between the ages of 5 and 15 were more likely to have these conditions at age 45.

Television viewing times were asked at ages 5, 7, 9, 11, 13 and 15. On average, they watched just over two hours per weekday.

“Those who watched the most had a higher risk of metabolic syndrome in adulthood,” Professor Hancox says.

“More childhood television viewing time was also associated with a higher risk of overweight and obesity and lower physical fitness.”

Boys watched slightly more television than girls and metabolic syndrome was more common in men, than women (34 percent and 20 per cent respectively). The link between childhood television viewing time and adult metabolic syndrome was seen in both sexes however, and may even be stronger in women.

There was little evidence that watching less television as an adult reduced the association between childhood television viewing and adult health.

“While, like any observational study, researchers cannot prove that the association between television viewing at a young age directly causes adult metabolic syndrome, there are several plausible mechanisms by which longer television viewing times could lead to poorer long-term health.

“Television viewing has low energy expenditure and could displace physical activity and reduce sleep quality,” he says.

“Screentime may also promote higher energy intake, with children consuming more sugar-sweetened beverages and high-fat dietary products with fewer fruit and vegetables. These habits may persist into adulthood.”

The results are important because screen times have increased in recent years with new technologies.

“Children today have far more access to screen-based entertainment and spend much more time being sedentary. It is likely that this will have even more detrimental effects for adult health.

“These findings lend support to the World Health Organisation recommendation that children and young teenagers should limit their recreational screen time.”


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Ultra-Processed Foods Largely Missing from U.S. Food Policy

July 20, 2023, New York University

Few federal and state policies consider ultra-processed foods, but policy activity is growing.

Ultra-processed foods—including industrially produced packaged snacks, fruit-flavored drinks, and hot dogs—have been linked to health issues ranging from weight gain to certain cancers. So where are the food policies helping Americans to steer clear of these foods?

A new study published in the American Journal of Preventive Medicine finds that only a small number of U.S. policies consider ultra-processed foods, lagging behind countries such as Belgium, Brazil, and Israel.

“In some countries, ultra-processed foods have been directly integrated into national dietary guidelines and school food programs, but in the U.S., few policies directly target ultra-processed foods,” said Jennifer Pomeranz, associate professor of public health policy and management at NYU School of Global Public Health and the first author of the study.

After decades of focusing on single nutrients such as protein, fat, and carbohydrates in nutrition science and food policy, a growing body of evidence shows that there is more to dietary quality than nutrients.

“It’s clear that the extent of processing of a food can influence its health effects, independent of its food ingredients or nutrient contents. Ultra-processed foods generally contain ‘acellular nutrients’—nutrients lacking any of the natural intact food structure of the source ingredient—and other industrial ingredients and additives that together can increase risk of weight gain, diabetes, and other chronic diseases,” said study co-author Dariush Mozaffarian, the Jean Mayer Professor of Nutrition at the Friedman School of Nutrition Science and Policy at Tufts.

Only a few countries around the world directly regulate ultra-processed foods, but those that do have limited its consumption in schools and recommend eating less ultra-processed food in dietary guidelines. The U.S. Dietary Guidelines for Americans, which inform the country’s food and nutrition policies, do not currently mention ultra-processed food. However, the scientific advisory committee for the 2025-2030 U.S. Dietary Guidelines has been tasked with evaluating research related to ultra-processed foods consumption as it relates to weight gain.

To understand how U.S. policymakers have already addressed ultra-processed foods in policies, the researchers gathered all federal and state statutes, bills, resolutions, regulations, proposed rules, and Congressional Research Services reports related to “highly processed” and “ultra-processed” food.

They identified only 25 policies—eight at the federal level and 17 at the state—that were proposed or passed between 1983 and 2022. The vast majority (22 of 25) were proposed or passed since 2011, showing that U.S. policy making on ultra-processed foods is quite recent.

The U.S. policies on ultra-processed foods tend to mention them as contrary to healthy diets. Most policies had to do with healthy eating for children, including limiting ultra-processed foods in schools and teaching kids about nutrition. Another common theme was the relatively higher price of healthy food versus ultra-processed foods. Only one policy (a Massachusetts school food bill) actually defined ultra-processed foods, and three policies sought to address the broader food environment by providing incentives to small retailers to stock healthy foods.

“The emerging policy language in the U.S. on ultra-processed foods is consistent with international policies on the topic. We would urge a more robust discussion and consideration of ultra-processed foods for future policymaking,” added Pomeranz. “The United States should consider processing levels in school food policies—especially to update the ‘Smart Snack’ rules—and to ensure the U.S. Dietary Guidelines reflect the evidence on ultra-processed foods and health.”

Jerold Mande of the Harvard T.H. Chan School of Public Health and Nourish Science was also a co-author of the study. The research was supported by the National Institutes of Health (2R01HL115189-06A1).


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Racial Discrimination Increases Risk for Childhood Obesity

July 11, 2023, New York University

Children who experience racial discrimination are more likely to later have a higher body mass index (BMI) and larger waistline, according to a new study published in JAMA Network Open. The findings illustrate that racial discrimination may be a risk factor for young people developing obesity—above and beyond other socioeconomic factors such as family income.

“Exposure to racial discrimination must be acknowledged as both a social determinant of obesity and a significant contributor to obesity disparities among children and adolescents,” said Adolfo Cuevas, assistant professor of social and behavioral sciences at the NYU School of Global Public Health and the study’s lead author.

Childhood obesity is a major public health issue in the U.S., affecting nearly one in five children and teens. Black and Hispanic youth experience even higher rates of obesity, which research shows may stem from factors such as poverty, neighborhood access to healthy foods, and single-parent households.

A growing body of research finds that another known stressor, racial discrimination, puts people at risk for a range of health issues, including sleep problems, high cortisol levels, and poor mental health. While racial discrimination has been linked to higher BMI in adults, less is known about its impact on children and adolescents.

The researchers examined data from 6,463 children ages 9 to 11 from across the U.S. who took part in the Adolescent Brain Cognitive Development (ABCD) study from 2017 to 2019. They first measured young people’s experiences of racial discrimination by asking them to reflect on whether they were treated unfairly by others based on their race or ethnicity. A year later, they measured the participants’ BMI (calculated using weight and height) and waist circumference.

The researchers found that kids who experienced greater racial discrimination had higher BMI and larger waist circumference a year later, even when adjusting for known socioeconomic risk factors for obesity, including household income and parents’ level of education. They conclude that reducing exposure to racial discrimination and its detrimental effects on wellbeing early in life could help limit the risk of weight gain across the lifespan.

“We tested discrimination at one time point, but it’s important to recognize that prolonged exposure to racial discrimination has the potential to further increase the risk of obesity. Therefore, preventing or at least mitigating the impact of discrimination sooner than later could potentially reduce the risk of obesity,” said Cuevas, who is also a scholar in the Center for Anti-Racism, Social Justice and Public Health at the NYU School of Global Public Health.

“It is crucial for researchers, clinicians, educators, and policymakers to join forces with communities to establish evidence-based strategies aimed at preventing exposure to racial discrimination in order to improve obesity at the population level,” he added.

In addition to Cuevas, study authors include Brennan Rhodes-Bratton and Shu Xu of NYU; Danielle Krobath, Jesulagbarami Omolade, and Aniyah Perry of Tufts; and Natalie Slopen of Harvard. The ABCD study was supported by the National Institutes of Health and additional federal partners.


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