March 2020

Just Released: NCCOR’s 2019 Annual Report

March 25, 2020

This month, NCCOR released the 2019 Annual Report, “Building the Future,” which highlights accomplishments from its tenth year. Here’s a glimpse into some of what NCCOR did last year!

In 2019, NCCOR:

• Released the Measures Registry Learning Modules, a series of 5 to 15-minute videos that highlight concepts from the four domain-specific Measures Registry User Guides. Launched in September the modules received nearly 12,000 pageviews by the end of the year.
• Held the first two in a series of three workshops, supported by The JPB Foundation, aimed at understanding what we need to measure, including newer domains to NCCOR like sleep and sedentary behavior as it relates to childhood obesity. The first workshop focused on advancing measurement of individual behaviors related to childhood obesity and the second focused on advancing measurement for high-risk populations and communities related to childhood obesity.” In January 2020, NCCOR published a white paper online, resulting from the first workshop, called “Advancing Measurement of Individual Behaviors Related to Childhood Obesity: Implications and Recommendations for the Field.”
• Launched the Student Hub e-newsletter, a new quarterly e-newsletter for graduate students and faculty, highlighting NCCOR resources that are helpful for coursework and research projects.
• Completed six sessions of its Collaborative Learning Project—a virtual learning platform spearheaded by NCCOR’s Engaging Health Care Providers and Systems Workgroup. This project brought together experts from medical, academic, and community-based organizations. The Workgroup is synthesizing the collected information to inform the development of an evaluation toolkit for community-based healthy weight programs.
• Disseminated information about childhood obesity research tools and resources for the field at nine conferences across the country: Active Living Conference, Society of Behavioral Medicine Annual Conference, Healthy Eating Research Annual Conference, Society for Public Health Education Annual Conference, the Future of Food and Nutrition Graduate Student Research Conference, CDC’s Division of Nutrition, Physical Activity, and Obesity (DNPAO) National Training, American Society for Nutrition 2019, Childhood Obesity Conference 2019, and the American Public Health Association Annual Meeting.

Read the Annual Report here to learn more about NCCOR’s accomplishments in 2019!

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NCCOR's Toolbox

Check out NCCOR’s Student Hub, a unique online resource for graduate students and faculty with information and resources that will support coursework and research projects in diet and physical activity.

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“New Nutrition Facts Label: What’s in It for You?” FDA Education Campaign

This campaign is designed to increase awareness of the new Nutrition Facts label for packaged foods, which reflects updated scientific information, including the link between diet and chronic diseases such as obesity and heart disease. It is intended for the general population and sub-populations at increased risk of nutrition-related chronic disease.

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Healthy Eating Research Nutrition Guidelines for the Charitable Food System

In 2019, Healthy Eating Research convened a panel of experts in the charitable food system, nutrition, and food policy fields to create clear, specific recommendations for evidence-based nutrition guidelines tailored to the unique needs and capacity of the charitable food system.

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Quality Assessment of Community Evidence (QACE) Tools

The QACE Tools were developed to support public health researchers and practitioners in using the best available evidence in practice, programs, and policy.

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Healthy Food Policy Project Database

The Healthy Food Policy Project (HFPP) identifies and elevates local laws that seek to promote access to healthy food while also contributing to strong local economies, an improved environment, and health equity, with a focus on socially disadvantaged and marginalized groups.

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The Compendium of Federal Datasets Addressing Health Disparities

The Compendium of Federal Datasets Addressing Health Disparities is a compilation of information on health equity data from the Department of Health and Human Services. This compendium is a useful resource for exploring data related to socioeconomic factors and social determinants of health.

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Association of Childhood Obesity with Risk of Early All-Cause and Cause-Specific Mortality: A Swedish Prospective Cohort Study

March 18, 2020, PLOS Medicine

Background

Pediatric obesity is associated with increased risk of premature death from middle age onward, but whether the risk is already increased in young adulthood is unclear. The aim was to investigate whether individuals who had obesity in childhood have an increased mortality risk in young adulthood, compared with a population-based comparison group.

Methods and findings

In this prospective cohort study, we linked nationwide registers and collected data on 41,359 individuals. Individuals enrolled at age 3–17.9 years in the Swedish Childhood Obesity Treatment Register (BORIS) and living in Sweden on their 18th birthday (start of follow-up) were included. A comparison group was matched by year of birth, sex, and area of residence. We analyzed all-cause mortality and cause-specific mortality using Cox proportional hazards models, adjusted according to group, sex, Nordic origin, and parental socioeconomic status (SES). Over 190,752 person-years of follow-up (median follow-up time 3.6 years), 104 deaths were recorded. Median (IQR) age at death was 22.0 (20.0–24.5) years. In the childhood obesity cohort, 0.55% (n = 39) died during the follow-up period, compared to 0.19% (n = 65) in the comparison group (p < 0.001). More than a quarter of the deaths among individuals in the childhood obesity cohort had obesity recorded as a primary or contributing cause of death. Male sex and low parental SES were associated with premature all-cause mortality. Suicide and self-harm with undetermined intent were the main cause of death in both groups. The largest difference between the groups lay within endogenous causes of death, where children who had undergone obesity treatment had an adjusted mortality rate ratio of 4.04 (95% CI 2.00–8.17, p < 0.001) compared with the comparison group. The main study limitation was the lack of anthropometric data in the comparison group.

Conclusions

Our study shows that the risk of mortality in early adulthood may be higher for individuals who had obesity in childhood compared to a population-based comparison group.

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Biomarker in Saliva Predicts Childhood Obesity Risk

March 6, 2020, EurekAlert!

A molecular marker in saliva is associated with the emergence of childhood obesity in a group of preschool-aged Hispanic children.

The intriguing discovery, reported in the journal BMC Medical Genetics, supports ongoing efforts to identify biomarkers associated with the emergence of childhood obesity before body mass index (BMI) is designated as obese, said Shari Barkin, MD, MSHS, director of Pediatric Obesity Research at Monroe Carell Jr. Children’s Hospital at Vanderbilt.

“Understanding the factors that predispose children to obesity is important and will pave the way toward better prevention and early intervention,” said Barkin, William K. Warren Foundation Professor of Medicine and chief of the Division of General Pediatrics.

The prevalence of pediatric obesity has been increasing at an alarming rate, Barkin noted, with a disproportionate burden in Hispanic populations. Pediatric obesity is associated with the onset of later comorbidities including Type 2 diabetes, high blood pressure and cancer.

“Right now, we only have crude markers to predict the emergence of obesity; we wait until the BMI is a certain number to intervene,” Barkin said. “We’re looking for markers that will allow us to intervene much earlier.”

Barkin and her colleagues collected saliva samples at baseline from children who were enrolled in the Growing Right Onto Wellness (GROW) trial. A total of 610 parent-preschool child pairs, 90% of whom were Hispanic, received high-dose behavioral intervention during a three-year study period. At enrollment, the children were at-risk for obesity, but not yet obese.

“Even though many of the children in our intervention group compared to our control group improved their nutrition, maintained physical activity consistent with guidelines and got sufficient sleep, 30% of them still emerged into obesity,” Barkin said. “This sheds new light on how we think about the interaction of behavior and genetics and how that might contribute to health disparities.”

The investigators had collected saliva as an easily accessible, non-invasive tissue that they hoped would reveal genetic and epigenetic factors that might predispose a child to obesity.

In a previous study, they analyzed saliva samples from a subset of the enrolled children for methylation of genes associated with obesity. Methylation is an epigenetic “mark” on DNA that regulates gene expression. They found that methylation at 17 DNA sites in the child’s baseline saliva was associated with the mother’s BMI and waist circumference, suggesting that obesity risk may be transmitted from mother to child.

Now, they have evaluated associations between baseline salivary methylation and objective changes in child BMI after three years in the study.

“At baseline, these children were all non-obese, but based on their maternal BMI, their DNA was methylated differently at 17 sites,” Barkin said. “Now we know that some of them emerged into obesity. We asked, ‘Could we have predicted that from differences in methylation, even after accounting for maternal BMI and assessing other behavioral factors?’”

The answer looks like it is “yes.” The investigators found that methylation of a gene called NRF1, which has roles in adipose tissue inflammation, was associated with childhood obesity. A child with the NRF1 methylation at baseline had a threefold increased odds of being obese three years later, after controlling for maternal BMI and other factors.

“This is a proof-of-principle study; it needs to be repeated with larger numbers of children,” Barkin said. “But even with small numbers, we found a really important signal using salivary epigenetics.”

The study demonstrates the utility of using saliva for epigenetic studies and points to at least one gene, NRF1, that should be more extensively studied for its role in the emergence of obesity.

“Most studies have looked for factors in children who are already obese,” Barkin said. “Our study demonstrates that there are already changes in the physiology — a pathway to obesity — even before the phenotype of obesity emerges. If we can define a predictive epigenetic signature, we can intervene earlier to reduce health disparities in common conditions like obesity.”

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The Association Between the 2009 WIC Food Package Change and Early Childhood Obesity Risk Varies by Type of Infant Package Received

March 2020, Journal of the Academy of Nutrition and Dietetics

Background

In 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages were updated. WIC-participating children in Los Angeles County receiving the new food package, compared with the old, had lower obesity risk at age 4.

Objective

To determine if the association between the new WIC food package and obesity varies by type of infant WIC food package received.

Design

Longitudinal study using administrative data on children participating in WIC in Los Angeles County continuously from birth until age 4. Children were compared across periods: Before (period 1: born 2003-2004), straddling (period 2: born 2005-2008), and after (period 3: born 2009-2011) the food package change. Children were further grouped as Fully Breastfed, Mostly Breastfed, Mostly Formula Fed, and Fully Formula Fed based on the type of food packages received during the first year of life.

Participants/setting

WIC-participating children in Los Angeles County between 2003 and 2016 (N=116,991).

Main outcome measures

Weight-for-height z-score growth trajectories from 0 to 4 years and obesity (body mass index-for-age≥95th percentile) at age 4.

Statistical analyses performed

Children were matched across periods on infant feeding group; age, sex, race or ethnicity, and initial weight status; maternal education and language; and family poverty. Sex-stratified piecewise linear spline mixed models and Poisson regression models were fit to the data.

Results

No differences across periods were observed for children in the Fully Breastfed group. Boys in the Mostly Breastfed (relative risk [RR]=1.27, 95% CI=1.17 to 1.38), Mostly Formula Fed (RR=1.07, 95% CI=1.02 to 1.13), and Fully Formula Fed (RR=1.13, 95% CI=1.06 to 1.20) groups in period 1 had higher obesity risk than their counterparts in period 3; girls in the Mostly Breastfed group in period 1 had a higher obesity risk than those in period 3 (RR=1.17, 95% CI=1.07 to 1.28).

Conclusions

The association between the WIC food package change and obesity varied by type of infant food package received, with the strongest associations observed for those who were mostly breastfed.

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Responding Positively to “Children Who Like to Eat”: Parents’ Experiences of Skills-Based Treatment for Childhood Obesity

February 2020, Appetite

This study aims to understand the challenges parents of preschoolers with obesity face. We assessed parents’ experiences of a group treatment program focused on parenting skills; the treatment program was evaluated in a randomized controlled trial in Stockholm County. After completing the program’s 10 weekly sessions, parents were invited to participate in a semi-structured interview. The interviews were audio recorded, transcribed and analyzed using thematic analysis. In total, 36 parents (67% mothers, mean age 39 years, 33% foreign background, 50% with university degree) were interviewed. Two main themes were developed: Emotional burden and Skills and strength from others. Emotional burden encompassed the parents’ experiences of raising a child with obesity. Parents spoke about the difficulties of managing their child’s appetite and of seeking help and treatment, as well as their feelings about the social stigma attached to obesity. Skills and strength from others encompassed the parents’ experiences of participating in group treatment. Parents reported that they appreciated the practical behavior change techniques taught, especially those regarding food and how to make everyday life more predictable, and said the focus on parenting skills gave them the confidence to apply the techniques in everyday life. Parents also highlighted the strength of the group setting, saying it enabled them to discuss perceived challenges and learn from other parents. Our findings show that childhood obesity carries social and emotional implications for parents, and that an intervention that provides parents with skill-building and a discussion space can help in negotiating these implications. This suggests that childhood obesity intervention programs benefit from including a parent-based approach which offers training in parenting skills and support in managing socially and emotionally challenging situations.

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