spicing up healthy snacks for better health

Spicing Up Healthy Snacks for Better Health

Craig A. Johnston, Ph.D.Jennette L. Palcic, Ph.D.

Baylor College of MedicineDepartment of Pediatrics-Nutrition

Children’s Nutrition Research Center

Calories From Snacks Are Up

A Major Shift:•Steady increase over the last 3 decades

Approximately 100% increase in # of snacksAlmost 3 snacks per day

•Prevalence of “snackers” increasesFrom 48% to 78%

• More calories are coming from snacksUp to 27% of caloric intake

Source: Piernas & Popkin, 2010; Health Aff

Prevalence of Overweight & Obesity in Children (Ages 6-11)

• 36.5% At risk of Overweight or Overweight• 19.9% Overweight• Obesity has quadrupled over 25 years • African American, Hispanic American & Native

American children have highest obesity prevalence

Source: Ogden et al., JAMA, 2006

Mixed Findings

• No association between meal patterns and overweight status

• Snacking frequency positively associated with rates of obesity

• Overall, it is unclear the role that snacking plays.

Source: Nicklas et al, 2003; Am J Prev MedKerr et al, 2009: Br J Nutr

Elana’s study

• The Following are slides that we received from Elana- Will need to be only shown on presentation day.

Source: NFCS, 1977-78; CSFII 1994-98; WWEIA, NHANES 2005-06, 1 day, 9-12 year olds

Number of Eating Occasions in a Day

3.9 4.85.8

Percent

1977-78 1994-98 2005-06

Percent

2-4 5-6 7-8 9+Number of eating occasions

1977-78 1994-98 2005-06

Frequency of Eating Occasions

Percent Reporting Meals1977-78

2005-06

Difference

Breakfast

Dinner

Ate breakfast, lunch, and dinner . . . 77 70 - 7

Source: NFCS 1977-78; WWEIA, NHANES 2005-06; 1 day; 9-12 year olds

Percent

0 1-2 3-4 5+

Number of snacking occasions

1977-78 1994-98 2005-06

Frequency of Snacking

Top 10 Foods Reported as Snacksby 9-12 year-old children

BeveragesSavory snacks from grainsCandy

FruitsCookies & barsIce cream

Potato chips & French friesCakes, doughnuts, pastries, piesPizza, burritos, tacos

Sandwiches

soft drinksfruit drinksmilkfruit juices

popcorntortilla chipspretzelscrackers

applesbananasgrapesoranges

chocolate chip cookiescrème-filled choc. cookiessugar cookiesbrownies

Source: WWEIA, NHANES 2005-06, 1 day, 9-12 year olds

Characteristics of Our Sample

• 6.5 eating episodes observed daily2.5 of these explained by meals

• No difference in eating episodes based on weight status

• No association between BMI percentile and number of eating episodes

• Upon visual inspectionInformation obtained from a “backpack raid”

Snack Intervention Substitution of nutritious snack foodsBackpack Raid 1 oz portion of peanuts or ¾

oz PB given daily at school

What We Know:• US children have

inadequate intake of micronutrients (less than RDA)

• Mexican American children have been shown to have the most nutritionally deficient diets

• Obesity is increasingly becoming associated with poor nutrition = “Malnourished Obese”

Nutrient Adequacy

May 2008

Our Approach: Positive Messaging• Family Focused• A message for everyone• Find foods that are:

Closer in value to preferred foodsReadily acceptableNot perceived as “diet food”Healthy for all children

FLOW Methods and Main GoalsIntensive Intervention (II)

• Received a book

• Spends “intervention time” in study hall/health class

• Daily contact (Mon- Fri)

• 1 weekly nutrition education session

• 4 weekly physical activity sessions • A daily snack intervention at school of 1 oz peanuts or ¾ oz peanut butter

• A way to improve eating patterns- Skipping/Adding meals- Reduce hunger

• Improve snacking habits- Nutrient-rich for nutrient-poor- Proper portion- Satiety- Combination foods

Better Weights at 2 Years in Treatment

Baseline 1 year 2 years

SH ILI

Treatment

Control

Maintenance Effects:Change in BMI over time, 2 years; Cohorts 1+2

Remains above baseline

SIGNIFICANT

Source: Johnston et al., 2010; Obesity

Percentage

zBMI decrease ormaintenancezBMI increase

ILIILI SH SHBaseline to 1 Baseline to 2 years

Source: Johnston et al., 2010; Obesity

Important Biomarkers• Improved Lipids

– Total cholesterol– “Bad” LDL cholesterol– Triglycerides - trending down

• Improved Anthropometrics – ie. smaller waists

• Improved Quality of Life

hsC-RP

Inflammatory Markers

BASELINE

Spicing up Nutrition Education

Jennette Palcic, PhD

Nutrition Education Simple and Positive

• Categorizing foods− big bite− little bite− portion right

• Satiety− Choosing “filling options”− Determining when you have had “enough”− Addressing adolescent dietary habits (ie. Eating patterns, meal skipping, snack choices)

Peanut Eaters Have Better Bodies and Better DietsRATIONALE for peanut snack intervention

WE SAW AT BASELINE:•Inflammatory markers higher in at risk and overweight children •Peanut eaters less likely to be overweight•Peanut eaters had better nutritional profile

Normal Weight OverweightPeanut or PB 60% 40%

NO peanut or PB 36% 64%

Hunger Significantly Decreased after Snack Intervention

Hunger ratingsM p

Baseline 5.723 months 4.63 .0016 months 4.60 .01

Probable explanations:–Nutrient dense–Satiating–Acceptable–Affordable

Healthy SnackingWe’ve also learned how to get kids to eat vegetables

At baseline the majority

ate veggies “zero” days per

Eat Your Vegetables!

• Randomized children to – Regular Exposure– Pairing with peanut butter

• Significant differences at 3 months– Pairing group ate more (oz)– Pairing group ate a greater variety

Cooking with Kids

Recipe Ideas

Other Benefits

• Kids excited about trying new foods• A hands-on approach helps• Shift from

– These are the foods you need to stop eating• Moving towards

– These are the foods (that you like) you need to start eating

The Motto of YES Charter Schools

WHATEVERIT

TAKES!

“The Current Epidemics of Chronic Diseases are a Result of Discordance Between Our

Ancient Genes and Modern Lifestyle.”

Eaton et al., The Paleolithic Prescription. 1988.

Nature vs. Nurture

spicing up healthy snacks for better health

presentation day

daily snack intervention

us children

children ages

year oldsx

year oldscharacteristics

rda mexican american

intervention time

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