- New Resources Highlight the Impact of COVID-19 on the National School Lunch Program
- There’s Still Time to Register for Next Week’s NCCOR Annual Showcase!
PUBLICATIONS & TOOLS
- NCCOR Toolbox: Indoor Recess Relief with the Youth Compendium Fact Sheet for Elementary Teachers
- New Position Paper States "Healthful Food for Children is the Same as Adults"
- New Obesity Interventions Graphic Helps Community Groups Plan Interventions
CHILDHOOD OBESITY RESEARCH & NEWS
- Quality Improvement Initiative Increases Breastfeeding Rates in Mississippi
- Consuming Sweeteners During Pregnancy May Affect Baby’s Microbiome and Obesity Risk
- New Approach Can Help Identify Young Children Most at Risk for Obesity
New Resources Highlight the Impact of COVID-19 on the National School Lunch Program
Two new publications demonstrate how the National School Lunch Program (NSLP) adapted during the COVID-19 pandemic to continue vital nutrition services. Based on feedback from school lunch professionals, these publications describe lessons learned and innovative new approaches to meal delivery.
- Child Nutrition Program Meal Service During Coronavirus (COVID-19) Best Practices for Parent Pick-Up of Meals and Snacks
This factsheet from the U.S. Department of Agriculture’s Food and Nutrition Service includes updated information about the program’s current waivers and flexibilities that permit schools to distribute meals outside of the lunch room setting. It also shares tips from successful programs on how to improve traffic flow, verify eligibility, and manage alternative pick-up locations. The factsheet concludes with communication and outreach suggestions.
- Recognizing and Supporting School Meal Programs as a Critical Nutrition Safety Net: Lessons from COVID-19
This research brief from Health Eating Research (HER) describes how 12 of the nation’s largest school food service authorities adapted their school-based programs for mobile delivery. The HER report summarizes qualitative and quantitative data and offers policy implications to prepare for future crises. Direct quotations from interviewees illustrate how programs pivoted in a time of crisis to meet the needs of their communities.
The NSLP is a bulwark against childhood malnutrition. In 2019, it provided 4.9 billion nutritious lunches to nearly 30 million children. Pandemic-related closures in 2020 disrupted services, but the program sustained meal delivery, especially for households at high risk for food insecurity. The majority of meals served in 2020 (76.9%) qualified for free or reduced pricing, which was a slight increase from previous years.
For more information about the NLSP’s flexible strategies for the current school year please visit: www.fns.usda.gov/nslp.
There’s Still Time to Register for Next Week’s NCCOR Annual Showcase!
Join us on Monday, February 7 from 1:00-2:00 p.m. ET for the Annual NCCOR Showcase. Join an expert panel of speakers will present an overview of the following NCCOR projects:
- Youth Active Travel to School Project— Learn more about the key challenges and proposed next steps to improve the surveillance and measurement of youth active travel to school.
- Economics of Built Environments Improvement— Discover key economic indicators that demonstrate the value of promoting physical activity through environmental change.
- Advancing Measurement to Address Childhood Obesity— Explore measurement priorities for new research on diverse aspects of childhood obesity.
- A Toolkit for Evaluating Childhood Healthy Weight Programs— Gain new insights on how to improve the effectiveness and sustainability of your program with NCCOR’s newest tool.
This webinar will be ideal for those who are new to NCCOR or are seeking a streamlined overview of the latest in childhood obesity research. Register today! The event is free, but attendance is limited. So, tell a colleague and don’t forget to sign up. You must register to receive webinar access. For those who cannot attend, the webinar will be recorded and archived on www.nccor.org/webinars/.
Publications & Tools
NCCOR Toolbox: Indoor Recess Relief with the Youth Compendium Fact Sheet for Elementary Teachers
During the winter months, bitterly cold weather can mean indoor recess for elementary students. NCCOR’s Youth Compendium Fact Sheet for Elementary Teachers can help plan activities to keep students moving even when they are not on the playground. Examples of activities include jumping jacks, hopping, and skipping. Many of these activities can also be adapted to the online learning environment. This fact sheet can be used in conjunction with NCCOR’s Youth Compendium Fact Sheet for Physical Education Teachers, which assists educators in creating lesson plans for physical education classes.
New Position Paper States "Healthful Food for Children is the Same as Adults"
The Society of Nutrition Education and Behavior has published a new position paper arguing that “there are no differences between healthful food for children aged 2 and older than those for adults, except for age-appropriate adjustments in texture and portion size.” The paper, which was published in the Journal of Nutrition Education and Behavior details the origins of marketing food to children. It then offers recommendations for creating new cultural norms as an alternative to children’s menus, which often feature ultra-processed energy dense foods. The paper provides strategies for implementing policy changes and health marketing initiatives.
New Obesity Interventions Graphic Helps Community Groups Plan Interventions
A new two-page graphic titled What Works Fact Sheet: Obesity Prevention and Control summarizes the level of evidence for obesity interventions in health care schools, communities, and worksites. Created by The Community Guide, the new graphic illustrates findings from the Community Preventive Services Task Force (CPSTF) recommendations. The Community Guide notes that the graphic may be viewed online or printed as a handout, making it useful for communications with decision makers and partners.
Childhood Obesity Research & News
Quality Improvement Initiative Increases Breastfeeding Rates in Mississippi
January 25, EurekAlert!
CHAMPS (Communities and Hospitals Advancing Maternity Practices), a multi-year quality improvement (QI) initiative in the state of Mississippi led by Boston Medical Center (BMC) researchers, has increased breastfeeding rates and reduced racial inequities in breastfeeding. These results, published in Pediatrics, demonstrate that the successful implementation of Baby-Friendly Hospital Initiative guidance can lead to increased rates of breastfeeding, skin-to-skin contact for mother and baby immediately after birth, and rooming-in practices (keeping mother and baby together in the same hospital room) while also reducing racial inequities.
In 1991, the World Health Organization and United Nations Children’s Fund launched the Baby-Friendly Hospital Initiative with the goal of improving breastfeeding rates globally. This initiative helps hospitals support new mothers to successfully initiate and continue breastfeeding their babies. Hospitals that achieve certain goals, including successfully implementing the Ten Steps to Successful Breastfeeding as well as not marketing baby formula in the hospital, are designated Baby Friendly.
There is a wealth of data that demonstrates the benefits of breastfeeding for both mother and child. Breastfed children perform better on intelligence tests and are less likely to be overweight, obese or develop diabetes later in life. For women who breastfeed, there is a reduced risk of breast and ovarian cancers.
However, breastfeeding rates remain low in certain geographic areas and among specific populations in the US. Historically, in Mississippi, along with many other southern states, there are low breastfeeding rates and higher rates of infant mortality and morbidity. Data from 2014, prior to the start of CHAMPS, showed that Mississippi had the lowest breastfeeding rates in the US – the initiation rate was 57.5 percent, which was nearly 10 points less than any other state. During that same time, African American breastfeeding rates were the lowest in the country due to several barriers including institutional racism, poverty and traumatic experiences. In addition, rates of heart disease, obesity and diabetes in Mississippi are at some of the highest levels seen nationally.
“Two of the biggest factors that play into breastfeeding outcomes are race or racism and where you live, which the CHAMPS program addresses at the hospital level, providing the information and support necessary to help all new mothers be successful with breastfeeding,” said Laura Burnham, MPH, associate director of the Center for Health Equity, Education, & Research at BMC and the study’s first author.
The Mississippi CHAMPS program enrolled 39 of the 43 birthing hospitals in the state in the QI initiative, which took place between January 2015 and December 2019. Hospitals received coaching and technical assistance to help them implement the Baby-Friendly Hospital Initiative. Key stakeholders, including local breastfeeding experts and lactation consultants, as well as local and statewide organizations, also provided support during the initiative. Hospitals submitted monthly data on breastfeeding (initiation and exclusivity), skin-to-skin care, and rooming-in practices to the CHAMPS team. These data were reported back to the hospitals and analyzed to track statistically significant changes over time.
During the course of the study, rates for breastfeeding initiation rose overall by 10 percentage points. For Black mother-baby dyads, rates increased by 21 points; for White mother-baby dyads, rates increased by four percent. Exclusive breastfeeding rates increased by 11 percent, with higher monthly increases among Black mother-baby dyads. Skin-to-skin rates for both vaginal and cesarean births increased as well, from 31 to 91 percent and 20 to 86 percent, respectively, in both Black and White mother-baby dyads. In addition, rooming-in rates among Black and White mother-baby dyads increased from 19 to 86 percent. In addition, when CHAMPS launched in Mississippi in 2014, there were zero Baby-Friendly Hospitals in the state; there are currently 22.
Other notable findings include a significant decrease – from 79 to 11 percent – in the number of hospitals distributing free formula sample packs to patients, and there was a significant reduction in the hospitals that accepted free formula from manufacturers. This demonstrates the hospitals’ commitment to achieving and retaining the Baby-Friendly designation.
Over the course of the initiative, CHAMPS conducted 100 training sessions throughout Mississippi, training 1,837 hospital staff. In addition, CHAMPS helped launch the first Baby Café in Mississippi; there are now 15 across the state.
“Expanding access to breastfeeding support in Mississippi is a critical component of addressing health equity for families both in the short and long term,” said Anne Merewood, PhD, MPH, the study’s corresponding author and director of the director of Center for Health Equity, Education, & Research at BMC. “We know that there are tremendous health benefits related to breastfeeding for both mother and child, and we need to identify sustainable solutions to maintain these efforts in the future.”
This project was supported through grants from the W.K. Kellogg Foundation (Grant Reference No. P3036679) and the Bower Foundation (Grant Reference Number 2017-186).
Consuming Sweeteners During Pregnancy May Affect Baby’s Microbiome and Obesity Risk
January 14, EurekAlert!
A new study investigates the link between consuming sweeteners during pregnancy and a child’s risk of obesity. Pregnant rats fed with stevia or aspartame gave birth to pups that had a higher risk of obesity and specific changes in their gut microbiome. The findings highlight the importance of maternal nutrition during pregnancy.
Could artificial sweeteners increase the obesity risk of your unborn child and even change the bacterial populations in their gut? This question is at the heart of a new study in Frontiers in Nutrition, which finds that when rat mothers consumed sweeteners during pregnancy, their offspring tended to have a higher body fat percentage. The rat pups also showed changes in gut microbial communities, with increases in propionate- and butyrate-producing microbes and reductions in lactose-fermenting species, which could explain the weight gains. The results suggest that maternal diet during pregnancy can significantly affect obesity risk in children.
The effects of sweeteners on offspring
Many people use low-calorie sweeteners as a healthier alternative to sugar, but they may have some unexpected effects in pregnancy. While they are largely non-toxic in adults, previous research suggests that prenatal consumption by mothers can affect obesity risk and the microbiome in infants. However, no-one had examined this in detail to understand the specific changes in microbial populations and their potential link to obesity.
“We know that a mother’s diet during pregnancy plays an extremely important role in determining whether their offspring will develop certain diseases later in life,” said Prof Raylene Reimer of the University of Calgary, and senior author on the study.
“In this study, we were interested in determining how consuming low calorie sweeteners during pregnancy, specifically the artificial sweetener aspartame or the natural alternative stevia, affected the gut bacteria and obesity risk of offspring.”
To investigate this, the researchers fed aspartame, stevia or plain water to pregnant rats. Once the rats gave birth, the researchers weighed the rat pups and investigated their gut microbiomes to assess how the sweeteners had affected them.
Minimal effect in mothers
Strikingly, the sweeteners had minimal effects in the rat mothers, but had significant effects in their offspring. The pups born of sweetener-fed mothers gained more weight, had a higher body fat percentage, and showed key changes in their gut microbiomes, with increases in propionate- and butyrate-producing microbes and reductions in lactose-fermenting species. These changes in microbial fermentation in the gut may have caused weight gain in the pups.
“Even though the offspring never consumed the low-calorie sweeteners themselves, their gut bacteria and obesity risk were influenced by the sweeteners that their mothers consumed during pregnancy,” said Reimer.
“We found that specific bacteria and their enzymes were linked to how much weight the offspring gained and how much body fat they accumulated.”
So, what do the findings mean for expectant mothers? The study was performed in rats, and so isn’t directly applicable to humans, but previous human studies have shown a similar link between consuming sweeteners during pregnancy and higher infant body mass index. Further research will provide clearer guidance for mothers, but for now it may be worth giving the sweeteners a miss while pregnant.
“A mother’s diet during pregnancy is very important for the short- and long-term health of their infants,” said Reimer. “Following dietary guidelines and staying within the recommended weight gain guidelines for pregnancy are key steps to take.”
New Approach Can Help Identify Young Children Most at Risk for Obesity
January 10, Penn State Eberly College of Science
Newly developed risk scores synthesize genetic information into an easy-to-interpret metric that could help clinicians identify young children most at risk of developing obesity.
The study, led by researchers at Penn State, used novel statistical methods to establish scoring criteria using data collected from young children. The research also demonstrates that robust results are attainable from studies that are orders-of-magnitude smaller than typical genetic studies when comprehensive data is collected over time and used in conjunction with powerful statistical tools.
“About 18% of children in the United States are obese, and 6% are severely obese,” said Sarah Craig, assistant research professor of biology at Penn State. “If we can identify children most at risk, we might be able to prevent obesity from developing in the first place. In this study, we produced risk scores based on genetic information that clinicians could potentially use to identify young children who would most benefit from intervention strategies.”
This study is part of a larger project called INSIGHT (Intervention Nurses Start Infants Growing on Healthy Trajectories), coordinated through the Penn State Health Milton S. Hershey Medical Center, in which researchers and clinicians work together to identify biological and social risk factors for obesity and the impacts of responsive parenting interventions during a child’s early life. The research team collected longitudinal data — periodically 8 times between birth and three years of age — including weight, height, and behavioral and environmental variables—on nearly 300 children. They also collected a blood sample for genetic analyses from each of the children, which served as the basis for developing risk scores. The team published their results in a paper appearing in the journal Econometrics and Statistics.
The risk scores — called “polygenic risk scores” because they are based on many genetic locations across the genome — distill vast genetic information into an easy-to-grasp number. Typically, the scores incorporate information from a number of single nucleotide polymorphisms (SNPs), or locations in the genome where single letters of the DNA alphabet can vary among people, that are most related to the metrics of interest — in this case, growth rates and obesity.
“Previous attempts to produce polygenic risk scores for obesity were developed using genetic information from adults or older children and include anywhere from a hundred to two million SNPs,” said Kateryna Makova, professor of biology and Verne M. Willaman Chair of Life Sciences at Penn State. “Such high numbers are challenging and potentially expensive to consistently reproduce, especially in a clinical setting. We produced two score options with far fewer SNPs — one with 24 and one with 5 — that nonetheless can provide valuable information to researchers and clinicians.”
The research team used novel statistical techniques from a field called functional data analysis to identify the SNPs most related to obesity, which were then incorporated into the scores.
“Unlike many genetic studies, which collect data on a single measurement, like for instance body mass index — BMI, and at a single point of time, we took advantage of the longitudinal data collected over time,” said Francesca Chiaromonte, professor of statistics and Huck Chair in Statistics for the Life Sciences at Penn State. “Several measurements of weight and height over time yield a growth curve for each child, and we can analyze the shapes of the curves for the children in our cohort using functional data analysis. We took advantage of this richer data at every step of the analysis.”
Genetic data yields millions of SNPs that must be analyzed, and the team used several techniques to narrow down the pool to the SNPs most related to the growth curves and measures of obesity.
“We first evaluated the impact of each SNP individually on obesity-related measures, as a way to remove those that were clearly not related,” said Ana Kenney, graduate student in statistics at Penn State at the time of the research and now a postdoctoral researcher at the University of California, Berkeley. “Some studies choose to stop at this step, however we narrowed down the pool even more by looking at all the remaining SNPs simultaneously and eliminating those that did not appear to have an impact when considered along with others.”
This process yielded 24 SNPs that the researchers incorporated into a polygenic risk score. The scores, built based on growth curves, turned out also to be related to other, more commonly used measures; they were higher in children with higher conditional weight gain—the change in weight gain over the first 6 months — and with rapid infant weight gain — a predictor of obesity later in life.
The research team further narrowed the pool to five of the most “stable” SNPs — the SNPs that had the most impact even when they perturbed the data. From these five SNPS, they produced a second score that could be used as a simpler alternative.
“Although the score with 24 SNPs is more powerful than the score with 5 SNPs, we verified that both are useful measures of obesity risk, and we believe either could be used in a clinical setting,” said Matthew Reimherr, associate professor of statistics at Penn State. “A score that requires fewer SNPs to be typed should make it easier to produce in clinics.”
Notably, the scores produced in this study also predicted obesity in older children and in adults, which the research team verified using publicly available datasets. However, scores produced from other studies that were based on obesity information in adults did not translate to the young children in this study.
“This suggests that the genetic signals related to obesity that we see in early childhood are critical across the lifecourse,” said Ian Paul, professor of pediatrics and public health sciences at Penn State College of Medicine. “However, as people age, they start manifesting other parts of their genetic composition. Scores based on early signals seem to be more robust throughout a person’s lifetime. This highlights the need for more studies that focus on identifying risk and preventing obesity in young children, particularly in the ‘first 1000 days’ spanning pregnancy and the first two years after birth.”
The study also demonstrates that smaller studies that deeply characterize individuals and take advantage of functional data analysis techniques can be a powerful alternative to typical large-scale genetic studies.
“These techniques can open doors to smaller labs with fewer resources,” said Craig. “By working carefully and rigorously to collect longitudinal data from more targeted cohorts, and by using powerful statistical techniques, you can still manage to find useful information with a study that is orders-of-magnitude smaller than typical GWAS studies.”
In addition to Craig, Makova, Chiaromonte, Kenney, Reimherr and Paul, the research team includes Junli Lin, a research associate at Penn State at the time of the research; Leann Birch, late professor of foods and nutrition at the University of Georgia who helped lead INSIGHT; Jennifer Savage, director for the Center of Childhood Obesity Research and associate professor of nutritional sciences at Penn State; and Michele Marini, research technologist and statistician for the Center of Childhood Obesity Research at Penn State.
This work is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); the Penn State Eberly College of Science; the Penn State Institute for Computational and Data Sciences; the Penn State Huck Institutes of the Life Sciences; and the Pennsylvania Department of Health using Tobacco CURE funds. Additional support was provided by the National Science Foundation.