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NTRS 511

Fall 2015

A Community-Based Intervention in East Los Angeles Involving Children and with a Focus on Improving Vitamin D Nutriture

Silvia Martinez Stephanie Ng

Childhood Obesity in America

Childhood Obesity in America - Unhealthy diets, physical inactivity, sedentary lifestyle, and race - Obese children

- Unhealthy diets, physical inactivity, sedentary lifestyle, and race

- Obese children ages 6-18 years old =

17%

- Obesity rate in Latino children =

22.4%

Hypothesis

Provide nutrition education to parents and children

Outdoor physical activity for children

Emphasis on vitamin D Childhood obesity rates will decline

Specific Aim 1

To increase nutrition education for children ages 6 to 18 with an emphasis on vitamin
To increase nutrition education for children
ages 6 to 18 with an emphasis on vitamin D
intake in a one year period.
1 To increase nutrition education for children ages 6 to 18 with an emphasis on vitamin
Specific Aim 2
Specific Aim 2

To increase cutaneous vitamin D synthesis from sun exposure by encouraging children to participate more in outdoor physical activities in a one year period.

from sun exposure by encouraging children to participate more in outdoor physical activities in a one
Specific Aim 3 To teach parents on purchasing and making healthier food choices with an

Specific Aim 3

To teach parents on purchasing and making healthier food choices with an emphasis on increasing vitamin D intake in a one year period.

on purchasing and making healthier food choices with an emphasis on increasing vitamin D intake in
Background & Significance - Belvedere Community Regional Park - Overweight Latino youth ages 2-19 =
Background & Significance
- Belvedere Community Regional Park
- Overweight Latino youth ages 2-19 = 38%
- Obese Latino youth ages 2-19 = 21%
- Parents’ impact on children’s lifestyle
- Vitamin D deficiency linked to childhood obesity
- Negative impact on future
Vitamin D - 25 hydroxyvitamin D - Dietary food sources - fortified milk, cheese, eggs,

Vitamin D

- 25 hydroxyvitamin D

- Dietary food sources

- fortified milk, cheese, eggs, oily fish, mushrooms, cereals

- Sun exposure to UV rays

- Skin pigmentation

- more melanin in dark-pigmented individuals reduce absorption for Latino children

- Vitamin D deficiency in obese Latino children = 52%

Innovation

- Combined treatment of nutrition education and outdoor physical exercise

- Parental involvement

- No intervention in these East Los Angeles Latino communities

and outdoor physical exercise - Parental involvement - No intervention in these East Los Angeles Latino

Research Design

Research Design - Approved by Institutional Review Board (IRB) - Quasi-experimental research - Total of 200

- Approved by Institutional Review Board (IRB)

- Quasi-experimental research

- Total of 200 male and female children, aged 6-18

- East Los Angeles region

- Measurement of percentile & vitamin D levels

- @ 0, 3, 6, 9, and 12 month

Research Design: Recruitment Strategy

- Flyers, brochures, & postings on bulletin boards

- Attend health fairs at schools and community events

- Collaboration with health providers from local clinics

- School nurses in ELA

fairs at schools and community events - Collaboration with health providers from local clinics - School
fairs at schools and community events - Collaboration with health providers from local clinics - School
Research Design
Research Design

Specific Aim 1. To increase nutrition education with an emphasis on vitamin D intake for children between the ages of 6 to 18 in the one-year study

Daily group-based sessions, 1 hour duration

- English & Spanish

- Age group: 6-10, 11-13, 14-18 years old

- USDA guidelines

- Reading nutrition labels

- Understand serving size

- Importance of breakfast

- Sugar content in foods and beverages

- Recipes for healthy snacks

- Daily recording in food journals

of breakfast - Sugar content in foods and beverages - Recipes for healthy snacks - Daily

Measurements

- Height, weight, waist circumference

- Percentile

- underweight (BMI <5th percentile), healthy weight (BMI >5th and <85th percentile), overweight and obese (BMI >85th percentile)

- Vitamin D levels

- inadequate (below 20 ng/ml), adequate (20-30 ng/ml), optimal (30 ng/ml and above)

- 0, 3, 6, 9, and 12 months

levels - inadequate (below 20 ng/ml), adequate (20-30 ng/ml), optimal (30 ng/ml and above) - 0,
Research Design Specific Aim 2. To increase cutaneous vitamin D synthesis from sun exposure by

Research Design

Specific Aim 2. To increase cutaneous vitamin D synthesis from sun exposure by encouraging children to participate more in outdoor physical activities on a daily basis for one year.

- Let’s Get Moving - 30 minutes

- variety of dance classes

- hip-hop, contemporary, salsa, traditional Aztec dancing, and zumba

- Game Play - 30 minutes

- sports

- dodgeball, kickball, flag football, soccer, baseball, swimming, street hockey, track & field, and volleyball.

- dodgeball, kickball, flag football, soccer, baseball, swimming, street hockey, track & field, and volleyball.

Research Design

Specific Aim 3: To teach parents on purchasing and making healthier food choices with an emphasis on increasing vitamin D intake in a one year period.

Parent workshops (12 sessions/year)

- 5 classes = focus on healthy eating and nutrition-related topics

- Understand nutrition labels,

- Fat and sugar content

- Portion size

- 7 classes = healthy food preparation

- Meals with same ingredient

- Integrating vitamin D into their diet

size - 7 classes = healthy food preparation - Meals with same ingredient - Integrating vitamin

Statistical Analysis

Paired t-testing

Regression analysis

Statistical significance at p-value = 0.05

Timeline

Timeline

Timeline

Limitations

1. Inaccurate reporting in children’s daily food journals

- additional dietary control may be challenging

2. Non-compliance in children

- parents must sign daily forms of child’s intake and exercise

3. Lack of parental involvement

- long working hours

- they have purchasing power

- involved in cooking meals for families

Expected Outcomes

- Maintain healthy BMI/ percentile for children and adults

- Adequate vitamin D levels by end of one year program

- 10 years anthropometric measurements of participants

- adequate vitamin D levels

- healthy BMI range (adults) or percentile (child)

measurements of participants - adequate vitamin D levels - healthy BMI range (adults) or percentile (child)

References

Au, L. Rogers, G., Harris, S., Dywer, J., Jacques, P., & Sacheck, J. (2013) Associations of Vitamin D Intake with 25-Hydroxyvitamin D in Overweight and Racially/Ethnically Diverse US Children. Journal of the Academy of Nutrition and Dietetics, 113, 1511-1516. Belenchia, A., Tosh, A., Hillman, L., & Peterson, C. (2013). Correcting vitamin D insufficiency improves insulin sensitivity in obese adolescents: A randomized controlled trial. American Journal of Clinical Nutrition, 97, 774-781. Clinuvel Pharmaceuticals. Melanin in biology (2015). Retrieved November 23, 2015, from http://www.clinuvel.com/en/skin-science/melanin-in-biology Costanzo P., & Woody E. (1985). Domain-Specific Parenting Styles and their Impact on the Child’s Development of Particular Deviance: The example of obesity proneness. Journal of Social Clinical Psychology, 4, 425-445. Dietary Guidelines for Americans. (2015). Retrieved November 13, 2015, from http://www.cnpp.usda.gov/DietaryGuidelines Dong, Y., Pollock, N., Stallmann- Jorgensen, I., Gutin, B., Lan, L, Chen, T., & Zhu, H. (2010). Low 25-Hydroxyvitamin D Levels in Adolescents: Race, Season, Adiposity, Physical Activity, and Fitness. Pediatrics, 125, 1104-111. Earthman, C., Beckman, L., Masodkar, K., & Sibley, S. (2011). The link between obesity and low circulating 25-hydroxyvitamin D concentrations: Considerations and implications. International Journal of Obesity Related Metabolic Disorder, 387-396. Golan, M. (2006). Parents as agents of change in childhood obesity - from research to practice. International Journal of Pediatric Obesity. 1(2), 66-76. Hammond, R. & Levine, R. (2010). The economic impact of obesity in the United States. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 3,

285-295.

Harel, Z., Flanagan, P., Forcier, M., & Harel, D. (2010) Low Vitamin D Status Among Obese Adolescents: Prevalence and Response to Treatment. Journal of Adolescent Health, 48, 448-452. Ogden C., Carroll M., & Curtin L. (2010). Prevalence of high body mass index in US children and adolescents, 2007-2008. Journal of the American Medical Association, 10, 242–249. Robinson, T. (2001). Television Viewing and Childhood Obesity. Pediatric Clinics of North America, 48(4), 1017-1025. Stark L., Collins F., Jr., Osnes P., & Stokes T. (1986). Using Reinforcement and Cueing to increase healthy snack food choices in preschoolers. Journal of Applied Behavior Analysis, 4, 367-379. Strauss, R., & Knight, J. (1999). Influence of the Home Environment on the Development of Obesity in Children. Pediatrics. 103(6), 1-8. Turer, C., Lin, H., & Flores, G. (2013). Prevalence of vitamin D Deficiency among Overweight and Obese US Children. Pediatrics. 131 (1), 252-263.