Overweight, Undernourished and At Risk: Tackling Today s Childhood Nutrition Problems

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1 Overweight, Undernourished and At Risk: Tackling Today s Childhood Nutrition Problems Theresa A. Nicklas Professor Children s Nutrition Research Center Baylor College of Medicine

2 226929

3 Prevalence of High BMI for Age in Boys and Girls Aged 6 Through 19 Years, Ogden, C. L. et al. JAMA 2010;303:

4

5 The U.S. Obesity Problem Ø Over half of adults overweight Ø 40 million are obese Ø Major risk factor for diabetes, heart disease, some cancers Ø EsPmated 300,000 obesity- related deaths per year Ø Social costs nearly $300 billion a year

6 Forget Fear 2018, when 43 percent of Americans will be obese, according to data projecpons Americans are losing the baule of the bulge, according to new data that suggests nearly half the populapon will be obese a decade from now. NY Daily News, November 19, 2009

7 Overweight, Yet Undernourished People consume more calories than they need without meepng recommended intakes for several nutrients. One way to help these individuals is to improve the nutrient density of their diets.

8 In recent years, Americans have learned how to eat by learning what not to eat. Is it working? J Am Diet Assoc. September 2008;108(9)

9 Percentage of Energy Contributed by Foods Taken Away from Home in Children ( ) Male 20 Female y y Source: What We Eat in America, NHANES

10 EsPmated Percentages of Children Whose Usual Intakes are Below Minimum Recommended Amounts of MyPyramid Food Groups ( ) Total Fruits Male Female y y Whole Fruits y y Source: Krebs- Smith et al. J Nutr. 140: , 2010

11 EsPmated Percentages of Children Whose Usual Intakes are Below Minimum Recommended Amounts of MyPyramid Food Groups ( ) y Total Vegetables y Male Female Dark Green Vegetables y y Source: Krebs- Smith et al. J Nutr. 140: , 2010

12 EsPmated Percentages of Children Whose Usual Intakes are Below Minimum Recommended Amounts of MyPyramid Food Groups ( ) Orange Vegetables Male Female y y Legumes y y Source: Krebs- Smith et al. J Nutr. 140: , 2010

13 EsPmated Percentages of Children Whose Usual Intakes are Below Minimum Recommended Amounts of MyPyramid Food Groups ( ) Starchy Vegetables y y Male Female Other Vegetables y y Source: Krebs- Smith et al. J Nutr. 140: , 2010

14 EsPmated Percentages of Children Whose Usual Intakes are Below Minimum Recommended Amounts of MyPyramid Food Groups ( ) Milk Male Female y y Meat and Beans y y Source: Krebs- Smith et al. J Nutr. 140: , 2010

15 EsPmated Percentages of Children Whose Usual Intakes are Below Minimum Recommended Amounts of MyPyramid Food Groups ( ) Total Grains y y Male Female Whole Grains y y Source: Krebs- Smith et al. J Nutr. 140: , 2010

16 DistribuPon of Intake (cup equivalents) between Juice & Whole Fruit within the MyPyramid Fruit Group, US Children & Adolescents (2 18 years) Food Sources of Juice 100% fruit juice, not orange/ grapefruit (44%) 100% orange/grapefruit juice (41%) Fruit drinks (10%) Other (5%) Food Sources of Whole Fruit Apples and pears (38%) Bananas (16%) Other fruit and fruit salads (8%) Citrus fruits (8%) Melon (8%) Grapes (7%) Other (15%) Source: NaPonal Cancer InsPtute

17 DistribuPon of Intake (cup equivalents) among Subgroups within the MyPyramid Vegetable Group, US Children and Adolescents (2 18 years) Source: NaPonal Cancer InsPtute

18 Food Sources & Mean Intake of Empty Calories for Male & Female Children & Adolescents in the United States, RelaPve to DiscrePonary Calorie Allowance Among 2-18 year olds, about half of empty calories came from six specific foods: soda, fruit drinks, dairy desserts, grain desserts, pizza, and whole milk. The discreponary calorie allowance for each sex/age group is based on low acpvity levels, because most children and adolescents do not achieve the 60 minutes per day of cardio- respiratory acpvity recommended in naponal physical acpvity guidelines (21). 1: Includes cakes, cookies, donuts, pies, crisps, cobblers, granola bars. 2: Includes sodas, energy drinks, sports drinks, and sweetened bouled water including vitamin water. Source: Reedy et al. J Am Diet Assoc. 2010;110:

19 Nutrient vs. Energy Density Nutrient-dense foods are those that provide substantial amounts of vitamins and minerals and relatively fewer calories. Energy-dense foods are those that are high in calories for a given measure of food (kcal/100 g).

20 Research RecommendaPons Develop a scientifically valid definition for nutrient density that could be useful on the food label. Determine what criteria are necessary for foods to meet this definition. Rationale: Over the past decade, a widespread concern has been that some foods may be classified as less nutrient dense than others and these foods may be eaten at the expense of other foods that are, by comparison, better sources of essential nutrients. To assist consumers in making wise food choices, a method is needed to convey the nutrient density of a food on the label.

21 What is Nutrient Profiling? Nutrient profiling is the science of ranking foods based on their nutrient composition Education Help consumers and clients identify and select nutrient-rich foods in preference to discretionary calories Innovation Stimulate innovation and competition in the marketplace for more nutrient-rich foods Regulation Mandated or self-regulation by industry

22 Which of These Foods are Nutrient Dense? LETTUCE OLIVES & PICKLES AVOCADO EGGS 100% FRUIT JUICE

23 Which of These Foods are Nutrient Dense? Sports Drinks White Bread Chocolate Milk 1% Raisins Canned Vegetables Chicken Livers, Lobster, Oysters, Shrimp

24 Industry Nutrient Profiles: Focus on What to Avoid Unilever Kraft PepsiCo McDonald s Hannaford Disney Energy Yes Yes Yes Yes Sugar Yes Yes Yes Yes Yes Total Fat Yes Yes Yes Yes Sat Fat Yes Yes Yes Yes Yes Trans Fat Yes Yes Yes Yes Yes Cholesterol Yes Yes Sodium Yes Yes Yes Yes Yes Other Portions +Nutrients +Nutrients RDA/ Portions +Nutrients

25 Selected Nutrient Profile Models Score Nutritional Quality Index (NQI) Ratio of Recommended to Restricted Food Components (RRR) Naturally Nutrient Rich Macronutrients Protein, fiber, MUFA, CHO Protein, fiber Protein, fiber, MUFA Vitamins Minerals Nutrients to limit A, C, thiamin, riboflavin, B 6, B 12, niacin Ca, Fe Total fat, SFA, cholesterol A, C Ca, Fe Energy, SFA, total sugar, cholesterol, Na A, C, D, E, thiamin, riboflavin, B 12, folate Ca, Fe, Zn, K

26 Do We Need to Change Our Paradigm in NutriPon EducaPon? Shifting Consumer Messages From Foods to Avoid to Cost Availability Foods to Include (Nutrient-Dense) Culturally Appropriate to Nutritional Consequences and Health Outcomes Building a Healthier, Radiant Diet Based on Individual Foods Based on (on average) Total Diet A Combination of Two Approaches Consumer Education and Messaging

27 Nutrient Density Ø Many unanswered questions Ø Ongoing research is needed

28 Nutrient Density Issues Unresolved Ø Ø Ø Ø Ø Ø Ø Ø Single Foods vs. Combination Foods Nutrients to encourage vs. those to limit - number of nutrients and amounts Bioavailability Naturally Nutrient Rich vs. Fortification Phytonutrients Herbs vs. Artificial Sweeteners Incomplete Nutrient Databases Outdated DRI s (specially Vitamins D & E

29 Single Foods versus CombinaPon Foods Pizza Vegetables Cheese (Mozzarella) Tomato Sauce White Flour Thin Crust Grilled Skinless Chicken Black Olives Pepperoni

30 ADA Reports: Practice Paper of the American Dietetic Association: Nutrient Density: Meeting Nutrient Goals within Calorie Needs. JADA 2007;107(5):

31 Unanswered QuesPons 1. What nutrients should be considered in the definition of nutrient density? 2. Should the nutrients used to assess nutrient density be based on the key nutrients that are representative of the different food groups? 3. Should nutrient density consider beneficial/protective food components that are not considered to be nutrients? 4. How many nutrients are required to make a food nutrientdense? 5. What about foods that are energy- and nutrient-dense? 6. Should nutrient density be defined differently for naturally nutrient-dense vs. fortified nutrient-dense foods?

32 The ultimate test is whether nutrient profile models will communicate nutrition information in a way that is both useful and valuable to the consumer. Buss D. PepsiCo s Smart Spot to be overhauled. New Nutr Bus 2007;12:1-5.

33 Are You Confused??? So Am I So will the Consumer A lot of work is needed to Develop a scientifically-based, valid definition of nutrient density within the context of energy density. Develop effective nutrition education programs and consumer messages. Evaluate nutrient density in terms of the total diet and health outcomes.

34 Does MyPyramid RecommendaPons (as a total package) Result in BeUer Health Outcomes?

35 Newsweek, Dec. 26, 2005/Jan. 2, 2006

36 Thank you! ^^

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