November 2019


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NCCOR Resources for Students

November 15, 2019, NCCOR

With the school year in full swing, NCCOR is excited to launch a brand new resource for students—the NCCOR Student Hub.

The NCCOR Student Hub will highlight all the tools and resources that public health and other graduate students studying diet and physical activity can use to enhance coursework and research projects.

NCCOR’s resources can assist students in all types of health programs to select the most appropriate measures or datasets for projects. NCCOR’s tools have also been used to enhance thesis and capstone projects by allowing students to successfully conduct systematic reviews and meta analyses, develop childhood obesity interventions, analyze secondary data sets, and much more.

Here are some of NCCOR’s tools that students can use:

The Measures Registry Resources Suite encompasses three tools relevant to childhood obesity research and evaluation.

  • The Measures Registry is a searchable database of nearly 1,400 diet and physical activity measures relevant to childhood obesity research.
  • The Measures Registry User Guides walk users through the process of using the Measures Registry to select appropriate measures.
  • The Measures Registry Learning Modules highlight key concepts from the four domain-specific Measures Registry User Guides in 5 to 15-minute videos.

Some of NCCOR’s other resources include:

  • The Youth Compendium of Physical Activities provides a list of 196 common activities in which youth participate and the estimated energy cost associated with each activity.
  • NCCOR’s Catalogue of Surveillance Systems provides easy to navigate, one-stop access to over 100 publicly available datasets relevant to childhood obesity research and evaluation.
  • Connect & Explore Webinars—check out NCCOR’s archive of webinars that cover a variety of childhood obesity related topics with experts from the field.

Learn more about these resources in the brand-new NCCOR Student Resources Guide. For professors, there’s also a new factsheet with information about incorporating NCCOR’s tools into the classroom.

Tell us how you’ve used NCCOR’s tools and have your work featured in a webinar or case study! This is a great opportunity for students to get work recognized by the public health community. For those who are interested, email NCCOR at

To stay up-to-date on NCCOR’s latest tools and resources for students, join the NCCOR Student Hub. This quarterly e-newsletter will feature a case study of a student using one of the tools and will also share other childhood obesity events and resources. Make sure to select ‘Student’ when signing up!

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Publications & Tools

NCCOR's Toolbox

If you know a public health student or are one yourself, check out this Q&A for the Measures Registry to learn how and why you should use this free, searchable database of nearly 1,400 high quality diet and physical activity measures.

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School Meals Help Millions of Kids Grow Up Healthy

This new infographic from the Robert Wood Johnson Foundation shows changes in school meals. For example, 99% of U.S. schools meet USDA’s healthier meals standards that took effect in 2012.

See the infographic here

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Report to Congress on CDC's Childhood Obesity Research Demonstration Project

CDC’s Childhood Obesity Research Demonstration (CORD) project was an effort to implement effective interventions to reduce obesity among lower-income children (aged 2-12).

Read the report

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Childhood Obesity Research & News

Added Sugars Intake Among US Infants and Toddlers

Journal of the Academy of Nutrition and Dietetics, November 14, 2019


Limited information is available on added sugars consumption in US infants and toddlers.


To present national estimates of added sugars intake among US infants and toddlers by sociodemographic characteristics, to identify top sources of added sugars, and to examine trends in added sugars intake.


Cross-sectional analysis of 1 day of 24-hour dietary recall data.


A nationally representative sample of US infants aged 0 to 11 months and toddlers aged 12 to 23 months (n=1,211) during the period from 2011 through 2016 from the National Health and Nutrition Examination Survey. Trends were assessed from 2005-2006 through 2015-2016 (n=2,795).

Main outcome measures

Among infants and toddlers, the proportion consuming any added sugars, the average amount of added sugars consumed, percent of total energy from added sugars, and top sources of added sugars intake.

Statistical analysis

Paired t tests were used to compare differences by age, sex, race/Hispanic origin, family income level, and head of household education level. Trends were tested using orthogonal polynomials. Significance was set at P<0.05.


During 2011 to 2016, 84.4% of infants and toddlers consumed added sugars on a given day. A greater proportion of toddlers (98.3%) consumed added sugars than infants (60.6%). The mean amount of added sugars toddlers consumed was also more compared with infants (5.8 vs 0.9 tsp). Non-Hispanic black toddlers (8.2 tsp) consumed more added sugars than non-Hispanic Asian (3.7 tsp), non-Hispanic white (5.3 tsp), and Hispanic (5.9 tsp) toddlers. A similar pattern was observed for percent energy from added sugars. For infants, top sources of added sugars were yogurt, baby food snacks/sweets, and sweet bakery products; top sources among toddlers were fruit drinks, sugars/sweets, and sweet bakery products. The mean amount of added sugars decreased from 2005-2006 through 2015-2016 for both age groups; however, percent energy from added sugars only decreased among infants.


Added sugars intake was observed among infants/toddlers and varied by age and race and Hispanic origin. Added sugars intake, as a percent of energy, decreased only among infants from 2005 to 2016.

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Factors During Pregnancy May Affect Early Childhood Weight

EurekAlert!, November 6, 2019

In a study published in Pediatric Obesity, a child’s high and increasing body mass index between ages two and six years was strongly associated with pre-pregnancy obesity and overweight in the child’s mother; modestly associated with maternal type 1 diabetes, type 2 diabetes, gestational diabetes that required medication, and excessive weight gain during pregnancy; and slightly associated with breastfeeding for six months or less.

The study included 71,892 children born in 2007-2011. The findings highlight the importance of public health efforts to reduce maternal obesity and may be useful for understanding the impact of maternal diabetes during pregnancy on childhood obesity.

“Our results highlight the importance of public health efforts to reduce maternal obesity and provide important information to understand the impact of maternal diabetes during pregnancy on childhood obesity,” the authors wrote.

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Family Eating Behavior and Child Eating Patterns Differences Between Children with and Without Siblings

Journal of Nutrition Education and Behavior, November 6, 2019


To examine the differences in family eating behaviors and child eating patterns in children with siblings (nonsingletons) and without siblings (singletons).


Cross-sectional analysis of mother–child dyads of 5–7-year-old children, (nonsingletons with a 2-to-4-year-old sibling) was conducted. Anthropometrics were measured. Mothers completed questionnaires and a child dietary log. Healthy Eating Index 2010 (HEI) score was calculated. Linear regression models adjusting for child age, child sex, maternal body mass index, and hours-away-from-home were conducted, with a revised P < .021.


Sixty-eight mother–child dyads (27 singletons, 41 nonsingletons) participated. Singletons exhibited less healthy family eating behaviors (β = −4.98, SE = 1.88, P = .003), and lower total HEI scores than did nonsingletons (average: β = −8.91, SE =2.40, P = .001). On average, singletons had lower scores in 3 HEI components compared with nonsingletons (P < .021 for all).


In this sample, singleton children exhibited less healthy eating behaviors. Additional investigation into parent-level differences is warranted.

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Study: A Mother's Warmth, Sensitivity Can Mitigate Obesity Risk Factors in Infants

EurekAlert!, November 5, 2019

The deleterious effects that obesity has on an individual’s health and the difficulty of reversing it in adults are well-known, ranging from diabetes and heart disease to cancer. For these reasons, obesity prevention in babies and children in populations at high risk is increasingly seen as a critical way to address the obesity epidemic.

However, most studies on factors that contribute to obesity in very young children haven’t focused on the populations most at risk.

An ongoing longitudinal University at Buffalo study presented in Las Vegas at ObesityWeek is among the first to explore how mother-infant behaviors during feeding and active play (non-feeding situations) affect infants and children in families with low socioeconomic status. Nearly all of the mothers in the study had used cigarettes, alcohol, marijuana or cocaine.

The UB study, which will also be published in the journal Obesity, was one of five award-winning papers highlighted at ObesityWeek, the world’s largest obesity conference, a partnership of The Obesity Society and the American Society for Metabolic and Bariatric Surgery.

The research was led by Kai Ling Kong, PhD, assistant professor of pediatrics in the Division of Behavioral Health in the Jacobs School of Medicine and Biomedical Sciences at UB.

Kong’s team found that a mother’s warmth and sensitivity during active play, non-feeding interactions, was associated with reduced obesity risk from infancy to second grade.

“The prenatal period is a sensitive period of health and disease development,” said Kong. “Insults that happen in the womb have lifelong consequences. But despite perturbations in fetal development, our study shows that it is possible to mitigate the effect of these exposures during early childhood by warmth, responsive and sensitive parenting in one’s home environment, especially in active play.”

While the early interactions were between mothers and infants, some of the later interactions involved infants and a primary caregiver; the study refers to all of the caregivers as mothers.

Prenatal and early childhood stress

The researchers focused on infants whose mothers had engaged in substance use (cigarettes, alcohol, marijuana or cocaine) during pregnancy and who had low socioeconomic status.

Prenatal exposure to any of these substances can subject a fetus to significant adverse effects, including poor nutrition and inadequate blood or oxygen flow, which can result in permanent neuroendocrine changes and metabolic dysfunction.

After birth, the infants experienced additional stresses stemming from the socioeconomic challenges the mothers faced. More than 80% of mothers in the study were receiving Temporary Assistance for Needy Families benefits, and 85% were single.

More than 95% had engaged in substance use during pregnancy. Seventy-five percent were African American. More than 36% of the children at 7 years old in the study were assessed as having obesity, which is nearly double the national childhood obesity rate of 18.5%.

Study co-author Rina Das Eiden, PhD, of Penn State University and formerly of UB, recruited mothers from two hospitals in Western New York, as part of an ongoing longitudinal study that was originally designed to examine developmental outcomes among children of mothers who used cocaine in the context of exposure to multiple substances.

“We wanted to examine if early home environments that promote comfort and pleasurable behaviors that are an alternative to eating can mitigate young children’s food-seeking behavior and thus alter the trajectory of weight gain,” said Kong.

“To date, most of the research on parental influences on children’s weight has focused on the food domain of the home environment,” she said. “There is a lack of understanding as to how, or if, positive parenting during active play (non-food domain of home environment) can play a role in promoting healthful lifestyles of the children.”

By the end of the study, 172 families had participated. Mother-infant interactions in the UB laboratory during feeding and non-feeding situations were studied when the infants were 1 month old and 7 months old.

Maternal warmth and body mass index

Infants of mothers exhibiting less warmth during free-play interactions when infants were 7 months old were associated with steeper body mass index trajectories, while the infants of mothers exhibiting more warmth during these interactions were not. This finding provides initial evidence that early mother-child interactions during free-play had an enduring positive effect on the health outcomes of the children, especially obesity risk trajectories.

“The findings indicate that mother-infant free-play interactions are more important than mother-infant interactions during feeding for child health outcomes, especially the development of obesity,” Kong said.

She added that the findings demonstrate that such interactions provide a critical target for intervention. For example, an early intervention program in which parents are instructed how to identify and respond sensitively to infant hunger and satiety cues, with a goal to promote self-regulation, has demonstrated success in minimizing early rapid weight gain.

“Results from our current study extend this prior work, indicating that such interventions beginning in early infancy and focusing on play interactions may have long lasting impact on obesity risk among high-risk children,” she said.

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Understanding Childhood Obesity in the US: The NIH Environmental Influences on Child Health Outcomes (ECHO) Program

International Journal of Obesity, October 24, 2019


Few resources exist for prospective, longitudinal analysis of the relationships between early life environment and later obesity in large diverse samples of children in the United States (US). In 2016, the National Institutes of Health launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate influences of environmental exposures on child health and development. We describe demographics and overweight and obesity prevalence in ECHO, and ECHO’s potential as a resource for understanding how early life environmental factors affect obesity risk.


In this cross-sectional study of 70 extant US and Puerto Rico cohorts, 2003–2017, we examined age, race/ethnicity, and sex in children with body mass index (BMI) data, including 28,507 full-term post-birth to <2 years and 38,332 aged 2–18 years. Main outcomes included high BMI for age <2 years, and at 2–18 years overweight (BMI 85th to <95th percentile), obesity (BMI ≥ 95th percentile), and severe obesity (BMI ≥ 120% of 95th percentile).


The study population had diverse race/ethnicity and maternal demographics. Each outcome was more common with increasing age and varied with race/ethnicity. High BMI prevalence (95% CI) was 4.7% (3.5, 6.0) <1 year, and 10.6% (7.4, 13.7) for 1 to <2 years; overweight prevalence increased from 13.9% (12.4, 15.9) at 2–3 years to 19.9% (11.7, 28.2) at 12 to <18 years. ECHO has the statistical power to detect relative risks for ‘high’ BMI ranging from 1.2 to 2.2 for a wide range of exposure prevalences (1–50%) within each age group.


ECHO is a powerful resource for understanding influences of chemical, biological, social, natural, and built environments on onset and trajectories of obesity in US children. The large sample size of ECHO cohorts adopting a standardized protocol for new data collection of varied exposures along with longitudinal assessments will allow refined analyses to identify drivers of childhood obesity.

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Childhood Obesity Linked to Structural Differences in Key Brain Regions

EurekAlert!, October 23, 2019

Obesity in children is associated with differences in brain structure in regions linked to cognitive control compared to the brains of children who are normal weight, according to new research from the University of Cambridge.

However, the scientists who led the study stress that it is not possible to say whether obesity causes these brain changes or whether the children are obese because their brain structures are different.

Around 124 million children worldwide are thought to be obese. In the UK, almost one in five children are overweight or obese when they start primary school and this figure increases to one in three by the time they begin secondary school. Children who are overweight or obese are more likely to become obese adults, and have an increased risk of poorer health outcomes in later life including diabetes, heart disease and cancer.

Previous studies have linked being overweight with scoring lower on various measures of executive function, an umbrella term for several functions such as self-control, decision making, working memory (temporarily holding information for processing) and response to rewards. Broadly speaking, executive function refers to a set of processes that enable planning, problem solving, flexible reasoning and regulation of behaviours and emotions.

To examine if this link existed in children, researchers at the University of Cambridge and Yale University analysed data from 2,700 children between the ages of 9-11 years who had been recruited as part of the National Institutes of Health Adolescent Brain Cognitive Development (NIH ABCD) Study. The results of their study are published today in the journal Cerebral Cortex.

In particular, the researchers looked at the thickness of the cortex, the outer layer of the brain – our so-called ‘grey matter’ – and compared it to each child’s body mass index (BMI). They also analysed results from tests of executive function.

The team found an association between increased BMI and significant reductions in the average (mean) thickness of the cortex, as well as thinning in the pre-frontal region of the cortex, an area associated with cognitive control. This relationship remained after accounting for factors including age, sex, race, parental education, household income and birth-weight.

The researchers also found that increased BMI was associated with poorer performance at tests to measure executive function.

“We saw very clear differences in brain structure between children who were obese and children who were a healthy weight,” says the study’s first author Dr Lisa Ronan from the Department of Psychiatry at the University of Cambridge.

“It’s important to stress that the data does not show changes over time, so we cannot say whether being obese has changed the structure of these children’s brain or whether innate differences in their brains lead them to become obese.”

The NIH ABCD Study will follow these children as they grow older and Dr Ronan hopes this will enable them to see whether structural differences in the brain change over time and exactly how they relate to obesity. In particular, it may help them understand whether managing a child’s weight will make a difference to their executive function.

When the team used waist circumference and waist-to-height ratio as a measure of obesity, they found that these, too, were associated with reduced executive function, but the link between cortical thickness was more complicated, with some regions showed reduced thickness while others showed increased thickness.

“This unique and openly available dataset has allowed us to examine the relationships between brain structure, cognitive functions and body weight,” adds Professor Paul Fletcher, also at Cambridge’s Department of Psychiatry. “The links that we observed suggest that there are very real structural brain and cognitive differences in children who are obese. The findings contribute a small part towards our growing understanding of the causes and consequences of obesity in children.”

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