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I Beverage Patterns and Diet Quality in US Children Thesis Presented in Partial Fulfillment of the Requirements for the Degree M

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I Beverage Patterns and Diet Quality in US Children Thesis Presented in Partial Fulfillment of the Requirements for the Degree M Beverage Patterns and Diet Quality in US Children Thesis Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Andrea Marie Lane B.S. Graduate Program in Allied Medicine The Ohio State University 2017 Master’s Examination Committee: Dr. Christopher A. Taylor, Advisor Dr. Colleen K. Spees Dr. Keeley J. Pratt i Copyrighted by Andrea Marie Lane 2017 ii Abstract The purpose of this study was to investigate the beverage patterns and the potential differences between sugar-sweetened beverage (SSB) intake and diet quality in different weight categories of US children aged 2-18 years old. A cross-sectional study design was used to examine the dietary and anthropometric data collected from the National Health and Nutrition Examination Survey 2005-2012. Diet quality was measured using the Healthy Eating Index (HEI) 2010. Beverage pattern data was divided into groups based on age and weight categorization. Diet quality was analyzed by SSB consumption, which was broken down into non-consumer, limited consumers, and high consumers within each age and weight group. The most reported beverages and those consumed highest by volume were: water, milk, and soda for children and adolescents 6-18 years old in all three weight groups. While in young children 2-5 years old in all three weight groups, these were water, milk, and juice. The quantity of SSB children drink was associated with a difference in HEI scores more so than their weight status. Higher SSB intake was associated with lower overall HEI scores, as well as lower fruit, whole grains, and empty calorie scores compared to non- consumption. Pediatric healthy diet and lifestyle interventions should focus on limiting the consumption of SSB in youth regardless of weight status. ii Vita October 27, 1992 ........................................... Born - Columbus, Ohio May 2015 ....................................................... B.S. Human Nutrition, The Ohio State University 2015-2017 ..................................................... MS/DI Program in Medical Dietetics The Ohio State University Field of Study Major Field: Allied Medicine iii Table of Contents Abstract ................................................................................................................. ii Vita ....................................................................................................................... iii List of Tables ....................................................................................................... vii List of Figures ..................................................................................................... viii Chapters: 1. Introduction ................................................................................................ 1 Beverage Choices and Diet Quality in US Children ........................ 1 Statement of Problem ..................................................................... 2 Purpose of Study ............................................................................. 2 Research Questions ........................................................................ 3 Definition of Terms .......................................................................... 4 List of Abbreviations ........................................................................ 6 2. Review of Literature ................................................................................... 7 Overview ......................................................................................... 7 Causes and Consequences of Overweight and Obesity in Youth ... 9 Dietary Recommendations ............................................................ 10 Diet Quality and Current Trends .................................................... 12 Factors of Diet Quality and Energy Intake ..................................... 15 Beverage Trends ........................................................................... 16 Sugar-sweetened Beverages and Obesity .................................... 19 iv Sugar-sweetened Beverages Interventions .................................. 22 Beverages and Diet Quality .......................................................... 25 Summary ....................................................................................... 27 3. Methodology ............................................................................................ 28 Overview of the Study ................................................................... 28 Research Questions ...................................................................... 29 Overview of NHANES ................................................................... 29 Subjects ........................................................................................ 30 Data Sources ................................................................................ 31 Data Preparation ........................................................................... 32 Data Analysis ................................................................................ 36 Protection of Human Rights .......................................................... 37 4. Results and Discussion ............................................................................ 38 Demographics ............................................................................... 38 Beverages Consumed by US Children Across Age and Weight Status ............................................................................................ 38 Diet Quality by Sugar-sweetened Beverages Consumption in US Children ......................................................................................... 43 Diet Quality by Weight Status and SSB Consumption in the 2-5 Year Olds ...................................................................................... 44 Diet Quality by Weight Status and SSB Consumption in the 6-11 Year Olds ...................................................................................... 46 v Diet Quality by Weight Status and SSB Consumption in the 12-18 Year Olds ...................................................................................... 48 Overall Trends and Conclusion ..................................................... 49 5. Beverage Patterns and Diet Quality by Weight in US Children .............. 52 Abstract ......................................................................................... 52 Introduction ................................................................................... 53 Methods ........................................................................................ 54 Results .......................................................................................... 57 Discussion ..................................................................................... 59 Conclusion .................................................................................... 62 References ......................................................................................................... 63 Appendix A: Tables and Figure .......................................................................... 73 vi List of Tables Table 1: Healthy Eating Index 2010 Scales and Scoring Procedures ................. 34 Table 2: Sample sizes of weight status by age group for analysis...................... 74 Table 3: Volume of Beverages Consumed in Grams by Age and Weight Status 76 Table 4: Calories from Beverages by Age and Weight Status ........................... 77 Table 5: Calories from Added Sugars in Beverages by Age and Weight Status 78 Table 6: Diet Quality by Weight and SSB Consumption for 2-5 year olds .......... 79 Table 7: Diet Quality by Weight and SSB Consumption for 6-11 year olds ........ 80 Table 8: Diet Quality by Weight and SSB Consumption for 12-18 year olds ...... 81 Table 9: Proportion of children in the three levels of SSB Consumption by Age and Weight ............................................................................................ 82 vii List of Figures Figure 1: Prevalence of Obesity and Extreme Obesity in US Children and Adolescents Aged 2 to 19 Years From 1988-1994 Through 2013-2014 .............................................................................................. 8 Figure 2: Proportion of children 2-5 years old who reported consumption of each beverage in their 24-hour dietary recall. .............................................. 74 Figure 3: Proportion of children 6-11 years old who reported consumption of each beverage in the 24-hour dietary recall ................................................. 75 Figure 4: Proportion of children 12-18 years old who reported consumption of each beverage in the 24-hour dietary recall ......................................... 75 viii Chapter 1: Introduction Beverage Choices and Diet Quality in US Children Throughout the last few decades childhood obesity trends have risen causing many negative immediate and long-term health consequences for those youth dealing with the excess weight. Childhood obesity puts children and adolescents at higher risk for obesity later in life and diseases such as type 2 diabetes, atherosclerosis, and sleep apnea1. The type of foods and beverages a child consumes are key contributing factors of weight management. Children in the United States are not following the dietary guidelines for a healthy lifestyle and disease prevention2. Beverages choices and their contribution to energy intake have changed
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