Background: The home environment, which includes parenting practices, is an important setting in which children develop their health behaviors. We examined the role of parenting practices in the home environment among underserved youth.Methods: We examined baseline data of a family-focused pediatric obesity intervention. Parenting practices (monitoring, discipline, limit setting of soda/snacks [SS] and screen media [SM], pressure to eat, and reinforcement) and availability of fruits/ vegetables (FV) and sugar-sweetened beverages (SSBs), family meals, television (TV) watching during meals, TVs in the home, owning active video games/sports equipment, and household food security were assessed in 301 parent/caregivers of overweight/ obese children (ages 7-12 years; BMI ‡ 85th percentile). Associations were evaluated using Spearman's rank correlation coefficients and logistic regression models adjusted for potential confounders.Results: Parents/caregivers (ages 22-67 years) were largely Hispanic/Latino (74.1%), female (92.4%), and reported high levels of limit setting SS and low levels of pressure to eat. Parent age, gender, country of birth, and years living in the United States accounted for differences among several parenting practices. Adjusted logistic regression models identified several statistically significant associations, including: Monitoring was positively associated with availability FV (odds ratio [OR] = 2.19; 95% confidence interval [CI], 1.25, 3.82); limit setting SS was inversely associated with availability of SSBs (OR = 0.40; 95% CI, 0.21, 0.75); and limit setting SM was inversely associated with TV viewing during family meals (OR = 0.51; 95% CI, 0.31, 0.85). Nearly 40% of our population was food insecure, and food insecurity was positively associated with pressure to eat (OR = 1.77; 95% CI, 1.01, 3.15).Conclusions: Parenting practices play an important role in the home environment, and longitudinal studies are needed to examine these associations in the context of family-focused pediatric obesity interventions.

Background Lifestyle assessment and intervention tools are useful in promoting pediatric weight management. The present study aimed to establish convergent validity and reliability for a quick simple measure of food intake and physical activity/sedentary behaviour. The HABITS questionnaire can be used to identify and monitor behavioural intervention targets. Methods Thirty-five youths (ages 7–16 years) were recruited from the waiting area of the Jacobi Medical Center Child and Teen Health Services. To establish convergent validity for the HABITS questionnaire, study participants completed the HABITS questionnaire, a 24-h recall and a modified version of the Modifiable Activity Questionnaire for Adolescents (MAQ). Participants completed a second HABITS questionnaire within 1 month to assess test–retest reliability. Internal consistency for dietary and physical activity/sedentary behaviour subscales was assessed using Cronbach’s alpha, and test–retest reliability was assessed using Cohen’s Kappa coefficient. Spearman’s rank correlation coefficients were calculated for individual items using the 24-h recall and the MAQ as reference standards. Results The HABITS questionnaire subscales showed moderate internal consistency (Cronbach’s alpha of 0.61 and 0.59 for the dietary and physical activity/sedentary behaviour subscale, respectively). The test–retest reliability was 0.94 for the dietary subscale and 0.87 for the physical activity/sedentary behaviour subscale. Several items on the HABITS questionnaire were moderately correlated with information reported in the MAQ and the 24-h recall (r = 0.38–0.59, P < 0.05). Conclusions The HABITS questionnaire can reliably be used in a paediatric setting to quickly assess key dietary and physical activity/sedentary behaviours and to promote behaviour change for weight management.

BackgroundImplementing evidence-based recommendations for treating pediatric overweight and obesity is challenging in low-resource settings. We conducted a randomized controlled trial to evaluate the effects of implementing the American Academy of Pediatrics overweight/obesity recommendations using a Standard Care approach alone or with the addition of an enhanced program in a safety-net pediatric primary care setting (located in Bronx, New York, United States).MethodsIn a 12-month trial, families of children (age 7–12 years; body mass index ≥85th American percentile for age and sex; 74% self-identified as Hispanic/Latino; n = 360) were randomly assigned to receive Standard Care Alone or Standard Care + Enhanced Program. An English/Spanish bilingual staff provided the Standard Care Alone consisting of quarterly semi-structured pediatrician visits targeting family-based behavioral changes. The Standard Care + Enhanced Program was enriched with eight Skill-Building Core and monthly Post-Core Support sessions.ResultsThe mean body mass index Z-score declined in both arms (P < 0.01) with no significant difference between the Standard Care Alone (0.12 kg [SE: 0.03]) and Standard Care + Enhanced Program (0.15 kg [SE: 0.03]) arm (P = 0.15). Compared to the Standard Care Alone, the Standard Care + Enhanced Program resulted in significantly greater improvements in total cholesterol (P = 0.05), low-density lipoprotein cholesterol (P = 0.04), aspartate aminotransferase (P = 0.02), and alanine transaminase (P = 0.03) concentrations.ConclusionsSafety-net primary care settings can provide efficacious pediatric weight management services. Targeted family-based behavioral counseling helps overweight/obese children achieve a modest body mass index Z-score improvement. A more intensive lifestyle intervention program may improve some metabolic parameters.Trial registrationClinicalTrials.gov Identifier: NCT00851201. Registered 23 February 2009.Electronic supplementary materialThe online version of this article (10.1186/s12966-017-0639-z) contains supplementary material, which is available to authorized users.

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Background: It is known that 15-30% overweight/obese adults do not suffer cardiometabolic consequences. There is limited literature examining factors that can be used to assess cardiometabolic health in overweight/obese children. If such factors can be identified, they would aid in differentiating those most in need for aggressive management.Methods: Baseline data from 7-to 12-year-old, overweight, and obese children enrolled in a weight management program at an urban hospital were analyzed. Homeostatic model assessment for insulin resistance (HOMA-IR) < 2.6 was used to define insulinsensitive and HOMA-IR ‡ 2.6 was used to defined insulin-resistant participants. Demographics, physical activity measures, and cardiometabolic risk factors were compared between the two phenotypes. Odds ratios (ORs) examining the association between intermediate endpoints (metabolic syndrome [MetS], nonalcoholic fatty liver disease [NAFLD], systemic inflammation, and microalbuminuria) and the two metabolic phenotypes were evaluated.Results: Of the 362 overweight/obese participants, 157 (43.5%) were insulin sensitive and 204 (56.5%) were insulin resistant. Compared to the insulin-sensitive group, the insulin-resistant group was older (8.6 -1.6 vs. 9.9 -1.7; p < 0.001) and had a higher BMI z-score (1.89 -0.42 vs. 2.04 -0.42; p = 0.001). After multivariable adjustment, compared to the insulin-sensitive group, the insulin-resistant group had higher odds of having MetS (OR, 5.47; 95% confidence interval [CI]: 1.72, 17.35; p = 0.004) and NAFLD (OR, 8.66; 95% CI, 2.48, 30.31; p = 0.001), but not systemic inflammation (OR, 1.06; 95% CI: 0.56, 2.03; p = 0.86) or microalbuminuria (OR, 1.71; 95% CI, 0.49, 6.04; p = 0.403).Conclusions: Using a HOMA-IR value of ‡ 2.6, clinical providers can identify prepubertal and early pubertal children most at risk. Focusing limited resources on aggressive weight interventions may lead to improvement in cardiometabolic health.

Background Developing dietary strategies to prevent excess weight gain during childhood is critical to stem the current obesity epidemic and associated adverse cardiometabolic consequences. Objectives We aimed to assess how participation in a family-based weight-management intervention affected nutrient biomarkers and cardiometabolic risk factors (CMRFs) in children (7–12 y old; n = 321) with baseline BMI z score (BMIz) ≥85th percentile. Methods This was a secondary analysis from a randomized-controlled, parallel-arm clinical trial. Families of children, recruited from a largely Hispanic population, were assigned to Standard Care (SC; American Academy of Pediatrics overweight/obesity recommendations), or SC + Enhanced Program (SC + EP; 8 skill-building cores, monthly support sessions, targeted diet/physical activity strategies). Nutrient biomarkers (plasma carotenoids, fat-soluble vitamins, RBC fatty acid profiles, desaturase indexes) and CMRFs were measured in archived blood samples collected at baseline and the end of the 1-y intervention. Results Children in both groups had significantly lower trans fatty acid and higher pentadecylic acid (15:0), PUFA n–3, and β-carotene concentrations, indicative of decreased hydrogenated fat and increased dairy, vegetable oil, fish, and fruit/vegetable intake, respectively. Similar changes were seen in de novo lipogenesis and desaturase indexes, as well as CMRFs (BMIz, lipid profile, inflammation, adipokines, liver enzymes) in both groups. Using multiple logistic regression, increase in carotenoids and decrease in endogenously synthesized SFA, MUFA, PUFA n–6, and desaturase indexes were associated with improvements in BMIz, blood pressure, lipid profile, glucose metabolism, inflammatory biomarkers, adipokines, and liver enzymes. Trans fatty acids were associated with improvements in BMIz, glucose metabolism, and leptin, with less favorable effects on inflammatory markers and adiponectin. Conclusions Providing targeted family-based behavioral counseling, as part of SC, can help overweight/obese children adopt healthier eating patterns that are associated with modest improvements in BMIz and several CMRFs. Limited additional benefit was observed with SC + EP. These results provide critical data to design subsequent interventions to increase the impact of family-based obesity prevention programs. This trial was registered at clinicaltrials.gov as NCT00851201.

Background Parental involvement has been shown to favorably affect childhood weight management interventions, but whether these interventions influence parental diet and cardiometabolic health outcomes is unclear. Objective To evaluate whether a 1-year family-based childhood weight management intervention altered parental nutrient biomarker concentrations and cardiometabolic risk factors (CMRF). Methods Secondary analysis from a randomized-controlled, parallel-arm clinical trial (NCT00851201). Families were recruited from a largely Hispanic population and assigned to either Standard Care (SC; American Academy of Pediatrics overweight/obesity recommendations), or Standard Care + Enhanced Program (SC + EP; targeted diet/physical activity strategies, skill building and monthly support sessions). Nutrient biomarkers (plasma carotenoids and fat-soluble vitamins, RBC fatty acid profiles) and CMRF (BMI, blood pressure, glucose, insulin, lipoprotein profile, inflammatory and endothelial dysfunction markers, adipokines) were measured in archived samples collected from parents of participating children at baseline and end of the 1-year intervention. Results Parents in both groups (SC = 106 and SC + EP = 99) had significant reductions in trans fatty acid (–14%), and increases in MUFA (2%), PUFAn-6 (2%), PUFAn-3 (7%) and beta-carotene (20%) concentrations, indicative of lower partially-hydrogenated fat and higher vegetable oil, fish, and fruit/vegetable intake, respectively. Significant reductions in hsCRP (–21%) TNFα (–19%), IL-6 (–19%) and triglycerides (–6%) were also observed in both groups. An additional significant improvement in serum insulin concentrations (–6%) was observed in the SC + EP parents. However, no major reductions in BMI or blood pressure, and significant unfavorable trajectories in LDL-cholesterol and endothelial dysfunction markers (P-selectin, sICAM, thrombomodulin) were observed. Higher carotenoid, MUFA, PUFA (n-6 and n-3), and lower SFA and trans fatty acid concentrations were associated with improvements in circulating glucose and lipid measures, inflammatory markers, and adipokines. Conclusions The benefits of a family-based childhood weight management intervention can spill over to parents, resulting in apparent healthier dietary shifts that are associated with modest improvements in some CMRF. Lay Summary The benefits of a family-based lifestyle intervention focused on children with overweight and obesity can spill-over to parents, improving diet quality and some cardiometabolic risk factors.

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