PROGRAM | Nutrition Science

By: Adriana Verdezoto Alvarado Chair: Shannon Robson

ABSTRACT

The social ecological model recognizes that health is impacted by interactions between the intrapersonal, interpersonal, community, institutional, and/or broader societal influences. Diet is intimately connected to health and disease. In children, eating behaviors are often influenced by the home food environment that is controlled by caregivers. The home food environment is conceptualized as components related to the physical (e.g., availability of food, accessibility to foods within the home) and social (e.g., family food rules, frequency of family meals) opportunities to consume foods within the home environment. Thus, the home food environment can influence a child’s food preferences and eating behaviors ultimately impacting overall diet quality, which subsequently may impact health. This dissertation explores the relationship between factors in the home environment, diet quality, and cardiometabolic health in children.

The first study, a systematic review, examined the impact of behavioral-based interventions on cardiometabolic outcomes in 6-to-12-year-old children at risk for type 2 diabetes. Four randomized controlled trials met the inclusion criteria, revealing that while behavioral interventions positively affected weight status, there were no significant changes in blood sugar, blood pressure, or cholesterol levels. None of the four studies included in the review measured diet quality as an outcome of the intervention, which may serve as a precursor to health. Better understanding the relationship between diet quality and health especially in pediatric populations, where risk factors for disease may be minimal, is important to best identify intervention targets.

The second study explored the relationship between the physical home food environment and diet quality, weight status, and cardiometabolic biomarkers in 44 children aged 6 to 12 years old from 29 households. The physical home food environment was measured by an obesogenic score and availability of specific food groups (e.g., fruits and vegetables, sweet and salty snack foods, sugar sweetened beverages). The obesogenic score was significantly associated with z-BMI (b=0.03, p = 0.029), but not diet quality or cardiometabolic biomarkers. Within the home food environment, availability of fruits and vegetables was positively associated with diet quality (b = 0.73, p = 0.005) and negatively associated with total-cholesterol (b = -1.54, p = 0.014) and low-density lipoprotein cholesterol levels (b = -1.31, p = 0.010). Increased availability of sweet and salty snack foods in the home environment and availability of sugar sweetened beverages was positively associated with higher fasting blood glucose (b=0.65, p=0.033) and insulin levels (b=5.60, p=0.035) respectively. However, the availability of sweet and salty snack foods and sugar sweetened beverages were not significantly associated with diet quality or other cardiometabolic biomarkers. These findings highlighted that the home food environment, especially the availability of fruits and vegetables might have the greatest influence on diet quality and measures of cardiometabolic health.

Given the influence of the home food environment within the interpersonal level on individual eating behaviors, the third study evaluated the feasibility of an intervention to increase the accessibility of fruits and vegetables for children within the home food environment. Thirty-two parents with a 6-12-year-old child participated in a pre-post study. The study was an eight-week virtual intervention where parents established weekly goals to make two fruits and three vegetables more accessible based upon location, form (cooked or ready-to-eat) or visibility. The intervention demonstrated high feasibility given a high retention rate (94%), mean attendance of 7.4 out of 8 sessions, goal adherence of 3.6 of 5 goals per week, and high parent satisfaction. Understanding the efficacy of an intervention focused on fruit and vegetable accessibility in the home food environment will be an important next step.

Considering the ecological framework, this dissertation underscores the importance of understanding the influences within the home environment on child health. The home food environment, specifically availability of fruits and vegetables, might be an important target to positively influence diet quality, which may promote the maintenance of cardiometabolic health in children.

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