1. CONCLUSIONS & IMPLICATIONS
A Comparison of Nutrient Intake/Adequacy, Diet Quality, and Obesity Prevalence in Low-Income Children (2-18y) Based on Participation in the Supplemental Nutrition Assistance Program: NHANES
MJ Landry1, CE O’Neil2, TA Nicklas3, VL Fulgoni III4 1Louisiana State University, Baton Rouge, LA; 2LSU AgCenter, Baton Rouge, LA; 3USDA/ARS CNRC, Baylor College of Medicine, Houston, TX; 4Nutrition Impact, LLC, Battle Creek, MI
RESULTS
SUBJECTS & METHODS II
ABSTRACT
Covariate-adjusted linear regression was used to compare nutrient intake, weight status, including BMI, BMI z-score, and % overweight, obese, and overweight or obese.
Covariate-adjusted logistic regression was used to assess the likelihood of being overweight, obese, and overweight or obese with SNAP participation as a reference group.
A p-value of <0.01 was considered significant for the linear and logistic regression.
Appropriate sample weights were used to ensure national representation
Objective: Determine if nutrient intake/adequacy, diet quality, and weight/adiposity parameters in low-income children differed by participation in the Supplemental Nutrition Assistance Program (SNAP).
Design, Setting, Subjects: The study compared low-income children 2-18 years in the SNAP (n=3,008) with eligible, non-SNAP participants (n=2,517) using data from the National Health and Nutrition Examination Survey Intake was determined using 24-hour recalls; usual intake (UI; National Cancer Institute method) was used to determine the percentage of the populations below Estimated Average Requirements or above Adequate Intakes. The Healthy Eating Index-2010 (HEI) was used to determine diet quality. Covariate adjusted linear and logistic regressions were determined using appropriate sample weights; p<0.01. BMI (kg/m2) was calculated from measured height and weight; adiposity status was determined using established age- and gender-specific cut points.
Results: There were no differences in total energy, micronutrient, and macronutrient intake between the groups. The total HEI score was higher (45.7±0.8 v 43.6±0.7) in non-SNAP children than for those in SNAP, as were scores for whole fruit (2.1±0.1 v 1.7±0.1cups). There was a higher prevalence of obesity (≥95th percentile) for children in SNAP versus non-SNAP (19±2 v 13±2%). The likelihood for being obese was 33% lower (99% CI: p<0.01) for non-SNAP children. Conclusions: Overall, dietary intake/adequacy/quality was poor in all low-income children; those in SNAP were more likely to be obese than non-SNAP participants. Further studies are needed to determine potential enablers and barriers to better diet in both groups of low-income children and reasons for weight discrepancies among groups of low-income children.
RESULTS SUMMARY
Non-Hispanic Blacks were more likely to be SNAP participants than non-SNAP participants.
Usual intake of dietary fibers was higher in non-SNAP participants compared to SNAP participants. Nutrient adequacy was low overall in both groups.
Total HEI-2010 scores were higher in non-SNAP participants than in SNAP participants.
Component scores for whole fruit, total fruit, and empty calories (reversed scored) were higher in non-SNAP participants.
Overall diet quality was poor in both SNAP and non-SNAP participating children.
The likelihood for being obese was lower (OR: 0.67; 99% CI: P<0.01) for non-SNAP participants
The Healthy Eating Index-2010 (HEI-2010) provides an indication of how closely the population is adhering to the 2010 Dietary Guidelines for Americans. The HEI-2010 has 12 components and the maximum score, or the sum of the component scores, is 100 points.
STUDY LIMITATIONS
INTRODUCTION
The cross-sectional design of NHANES precludes determining cause and effect relationships.
Data were subject to non-sampling errors, including under- or over-reporting.
Potential for unmeasured confounding by other lifestyle factors such as social, environmental, and behavioral factors, and length of SNAP participation.
Nearly one in two American children will receive SNAP assistance during their childhood.
There is limited research, measuring the effects of SNAP participation on diet quality, nutrient adequacy, and weight/adiposity in children.
The purpose of this study was to examine the associations of SNAP participation in a nationally representative sample of children 2-18 y versus SNAP-eligible children who were non- participants for nutrient intake/adequacy, diet quality, and weight/adiposity measures.
CONCLUSIONS & IMPLICATIONS
Reforming the structure of the SNAP and its benefits would be a substantial task.
Proponents suggest reform and added regulations are needed to improve nutrition, weight, and overall health of SNAP beneficiaries.
Adding additional regulations, which would restrict the use of SNAP benefits, could have major implications and a large economic cost.
Regardless of SNAP participation, the diets of low-income children need improvement.
Further studies are needed to determine potential enablers and barriers to better diet in both groups of low-income children and reasons for weight discrepancies among these groups of low- income children.
SUBJECTS AND METHODS I
This study combined data from US children 2 to 18 y (n=5,525) participating in the NHANES who resided in a household with an income <130% of the Federal Poverty Level.
Nonparticipants were classified as; individuals who were SNAP benefit eligible; however, they had not received SNAP benefits within twelve months of the interview.
To determine energy and nutrient intake, the USDA Food and Nutrient Database for Dietary Studies, versions 2.0, 3.0, 4.1, and 5.0 were used for NHANES, , , , and , respectively.
The National Cancer Institute (NCI) method was used to estimate the usual intake (UI).
Diet quality was determined using the Healthy Eating Index-2010 (HEI).
ACKNOWLEDGEMENTS
Partial support was received from the United States Department of Agriculture/ Agricultural Research Service (USDA/ARS) through specific cooperative agreement , USDA Hatch Project LAB 94209, and the LSU Ogden Honors College.