Food Marketing to Children and Youth Threat or Opportunity? (2006) / Chapter Skim
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2 Health, Diet, and Eating Patterns of Children and Youth
2 Health, Diet, and Eating Patterns of Children and Youth
Pages 39-90
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From 1963 to 2002, rates of obesity tripled for older children ages 611 years and adolescents ages 1219 years. For consistency between Institute of Medicine (IOM)
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adequacy to meet basic metabolic needs to the more recent focus on ensuring dietary quality while avoiding calorie excesses. The current goal is to promote a lifestyle for children and youth that incorporates nutrient-dense foods and beverages into their diet, and balances their calorie consumption with levels of physical activity sufficient to create energy balance at a healthy weight.1 This chapter provides an overview of the dietary intake, eating patterns, and sources of nutrients for infants and toddlers, younger children, school-aged children, and adolescents.
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The increasing prevalence over the past three decades of children who are obese, defined in this report as children and youth who have a BMI equal to or greater than the 95th percentile of the age- and gender-specific BMI charts developed by the CDC, and those who are at risk for becoming obese, defined in this report as children and youth who have a BMI between the 85th and 95th percentile of the age- and gender-specific CDC BMI charts, makes it the most common serious contemporary public health concern faced by young people in the United States (IOM, 2005b; Land, 2005)
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. Between 1999 and 2002, the prevalence of obesity was 10.3 percent for younger children ages 25 years, 15.8 percent among children ages 6 11 years, and 16.1 percent among adolescents ages 1219 years (Hedley et al., 2004)
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III (19881994) body weight data in the revised year 2000 charts of BMI standards for children ages 6 years or older.
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, attributed in part to increased consumption of sweetened beverages (such as carbonated soft drinks, fruit drinks, and sweetened teas) and reduced consumption of milk -- the primary source of calcium in U.S.
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Today, by contrast, dietary quality emphasizes the principles of adequacy, variety, proportionality, and moderation, as well as reinforcing recommendations for a high intake of fruits, vegetables, and whole grains; nutrient-dense foods providing sufficient calories that are balanced with daily physical activity levels; and limited consumption of total fat, saturated fat, trans fatty acids, cholesterol, sodium, and added sugars (DHHS and USDA, 2005)
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These recommendations and guidelines collectively include the Dietary Reference Intakes (DRIs) , the Dietary Guidelines for Americans, and the Food Guide Pyramid (FGP)
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. Energy intakes based on the EER for proposed food consumption patterns have been developed for boys and girls ages 2 to 18 years for three physical activity levels -- sedentary, low active, and active (USDA, 2003a; Appendix D, Table D-1)
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The key recommendations of the Dietary Guidelines, summarized in Box 2-1, are based on a preponderance of the scientific evidence of nutritional factors that are important in lowering the risk of chronic disease and promoting health, including specific recommendations for weight management, physical activity, food safety, and consumption patterns among food groups, saturated fats, trans fats, cholesterol, sugars, other carbohydrates, sodium and potassium, and alcoholic beverages (DHHS and USDA, 2005)
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noted that, based on available food consumption data, children's and adolescents' dietary intakes of saturated fatty acids, trans fatty acids, and sodium are higher than recommended (DHHS and USDA, 2004)
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Sources of Nutrient and Food Intake Information Major sources of information about the food and nutrient intakes of nationally representative groups of children and youth are the USDA's older Nationwide Food Consumption Survey (NFCS) (through 1977)
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. Children ages 12 years and older typically reported their own dietary intake information (Enns et al., 2002; Troiano et al., 2000)
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Other foods and beverages revealed a modest increase in percentage of total calorie intake during this period, such as carbonated soft drinks (3 percent to 5.5 percent) , fruit drinks (1.8 percent to 3.1 percent)
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population were high-calorie, low-nutrient foods and beverages (e.g., sweets and carbonated soft drinks) , which contributed nearly one third of all the calories consumed (Block, 2004; Appendix D, Table D-7)
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. Only an estimated 25 percent of children and adolescents had usual total fat intakes that were 30 percent of energy or less (Gleason and Suitor, 2001)
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Nonetheless increased consumption of processed foods and a greater frequency of eating away from home have contributed to the increased sodium intakes observed over the past three decades. Nutrient Intakes Compared with the Dietary Reference Intakes and Dietary Guidelines Usual nutrient intakes of U.S.
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. Other analyses of foods indicate that dairy foods and ingredients contribute more than 60 percent of the dietary calcium, nearly 25 percent of total fat, 39 percent of saturated fat, and 31 percent of cholesterol to the total dietary intakes of children and adolescents from birth to 19 years of age (Weinberg et al., 2004)
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. A total fat intake of 3040 percent of calories is recommended for children ages 13 years and 2035 percent of calories for ages 418 years (IOM, 2002; Appendix D, Table D-2)
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. Data from 19881994 showed an improvement in that about one-quarter of individuals under age 20 years had saturated fat intakes less than the recommended 10 percent of total calories (Carriquiry et al., 1997)
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. USDA dietary intake and survey data show that on average, older children ages 611 years consumed 2123 teaspoons per day of added sugars in diets that provided 1,800 2,000 calories, adolescent girls ages 1219 years consumed 23 teaspoons in an 1,800-calorie diet, and adolescent boys consumed 34 teaspoons in a 2,700calorie diet (Enns et al., 2002, 2003)
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. Approximately 75 percent (children ages 46 years and adolescent girls ages 1418 years)
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Dietary Intake and Eating Pattern Trends Mean Food Intakes and Changes Between the 1970s and 1990s Children's and adolescents' nutrient intakes reflect their food and beverage choices, which have changed substantially over time. In general, there have been increases in consumption of sweetened carbonated soft drinks, noncitrus juices/nectars, and fruit drinks/ades; grain mixtures such as pasta with sauces, rice dishes, and pizza; salty snacks; fried potatoes; candy; lowfat and skim milk; and cheese.
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While overall reported energy intakes were below the REA, children ages 611 years had intakes of discretionary fat and added sugars that were higher than levels consistent with the healthy eating pattern suggested by the FGP. These food intake patterns reveal that children are not achieving optimal diet quality and nutrient density.
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. Carbonated soft drinks are low in nutrient density but are not particularly calorie dense because of their high water content.
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The data suggest that increased access and availability of nutrient-dense foods and decreased access to low-nutrient foods in schools, homes, and other places will moderate low-nutrient food and calorie intake. Increasing added sugars intake in younger children ages 25 years from CSFII 19941996 and 1998 was associated with decreasing intakes of sev
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Data from the national dietary surveys indicate that beverage consumption habits have changed for children and adolescents over the past 35 years. Between 1965 and 2001, the intake of sweetened beverages (e.g., carbonated soft drinks and fruit drinks)
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. However, 1200 1012 1000 901 862 800 grams/day 667 614 584 600 374 334 330 400 191 174 177 200 0 1965 1977 1989 1996 Year Total milk Fruit drinks Soft drinks FIGURE 2-4 Trends in milk consumption versus carbonated soft drinks and fruitflavored beverage consumption in U.S.
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African American girls consumed fewer milk products than white or Hispanic/Latino girls at all ages. Sweetened carbonated soft drinks and fruit drinks/ades consumption generally increased with age in both genders, with boys increasingly consuming more than girls as age increased (Storey et al., 2004)
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Finding: Sweetened beverage consumption (e.g., carbonated soft drinks and fruit drinks) by children and adolescents has increased considerably over the past 35 years and is now a leading source of added sugars, especially in adolescents' diets.
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In 19941996, snacks contributed 378 calories per day for younger children ages 25 years, 462 calories for older children ages 611 years, and 612 calories for adolescents ages 12
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18 years, representing an estimated 25 percent of total calorie intake (compared to an estimated 20 percent in 19771978)
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. An increase in portion size was significant for RTE cereals consumed by older children ages 611 years and adolescent boys ages 12 19 years, fruit drinks and spaghetti with tomato sauce consumed by adolescent boys, and carbonated soft drinks consumed by adolescent girls.
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Approximately one-third or more of their calories are derived from foods purchased outside of the home, nearly one-half of which is obtained at full serve restaurants and quick serve restaurants that contain higher fat content than food consumed at home. In 19941996, food consumed by children and adolescents ages 2 17 years that was prepared away from home, compared to food prepared at home, contained more total fat (36.1 versus 31.6 percent of calories)
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Nutrient and Calorie Intakes The usual nutrient intakes, from both foods and dietary supplements, of young (46 months) and older (711 months)
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, and fruit drinks (43 percent) , and to a lesser extent carbonated soft drinks (12 percent)
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The calcium density of the diet was negatively associated with intake of 100 percent juice, fruit drinks, and carbonated soft drinks. The AAP recommendations for limiting 100 percent juice consumption-age of introduction and amount consumed (to 46 oz/day)
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. As seen in Figure 2-7, NHANES data reveal that non-Hispanic black and Mexican-American children and adolescents ages 619 years have a greater prevalence of obesity (with a BMI equal to or greater than the 95th percentile of the CDC BMI charts)
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50 40 30 20 Percentage 10 0 Total Total Total Blacks Blacks Blacks Whites Whites Whites Mexican Mexican Mexican Combined Americans Americans Americans At Risk + Obese At Risk (85 percentile BMI 95 Obese (BMI 95 percentile) percentile)
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. When compared with higher income households that were food insufficient, defined as inadequacy in the amount of food intake because of limited money or resources, low-income food insufficient households had more obese children.
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The diets of children participating in WIC generally were similar to the diets of income-eligible, nonparticipants and higher income children. Notable exceptions were higher intakes of calories, total fat, saturated fat, cholesterol, and sodium compared to the higher income children (Cole and Fox, 2004)
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compared to 10 percent in the low-income group and 22 percent in the higher income group. The available evidence reveals that compared with the higher income group, slightly more of the lowest income children consumed less than three meals per day and did not eat breakfast; they had lower intakes of calcium and higher intakes of total fat, saturated fat, and sodium.
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Unlike the national population, though, the increase in overall sweetened beverage intake in Bogalusa was due to an increase in the amount of tea with sugar consumed, as the amount of fruit drinks and carbonated soft drinks did not change significantly (Rajeshwari et al., 2005)
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Children and adolescents today have higher than recommended intakes of saturated fatty acids, trans fatty acids, and sodium. Moreover, dietary intakes of calcium, potassium, fiber, magnesium, and vitamin E are sufficiently low to warrant concern.
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2003. Ready-to-eat cereal consump tion: Its relationship with BMI and nutrient intake of children ages 4 to 12 years.
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1998. Assessment of energy intake underreporting by doubly labeled water and observations on reported nutrient intakes in children.
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2004. The relationship between healthful eating practices and dental caries in children ages 25 years in the United States, 19881994.
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20022005. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients)
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National and health correlates, NHANES III, 1988 to 1994. Arch Pediatr Adolesc Med 157(8)
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2005. What We Eat in America, NHANES 2001 2002: Usual Nutrient Intakes from Food Compared to Dietary Reference Intakes.
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: The Bogalusa Heart Study. J Am Diet Assoc 105(2)
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1999. Food and Nutrient Intakes by Children, 199496, 1998, Table Set 17.
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