Dietary Intake and Physical Activity Summary Report The Missouri School-Age Children’s Health Services Program School Year 2001-2002 Division of Community Health Missouri Department of Health and Senior Services Dietary Intake and Physical Activity Summary Report Missouri School-Age Children’s Health Services Program: School Year 2001-2002 TABLE OF CONTENTS Illustrations.............................................................................................................................................ii Preface...................................................................................................................................................iii Background.............................................................................................................................................1 Data collection........................................................................................................................................1 Results.....................................................................................................................................................3 Frequency of intake by food group........................................................................................3 Top foods contributing to various nutrients................................................................................5 Nutrient intake by students............................................................................................................5 Height and weight measurements................................................................................................7 Responses to physical activity questions.................................................................................10 Discussion of results..........................................................................................................................12 References..............................................................................................................................................13 i ILLUSTRATIONS Tables: 1. Mean frequency of intake per day of Food Guide Pyramid Food Groups by sex and age................3 2. Percent of calories from the top two ranked foods contributing to selected nutrients.....................4 Figures: 1. Percent distribution of food frequency records...............................................................................1 2. Percent distribution of height and weight measurements ...............................................................1 3. Number of children participating by Missouri public school district (map)...................................2 4. Students meeting the recommended number of servings...............................................................3 5. Percent of male students meeting the Estimated Average Requirement (EAR).................................6 6. Percent of female students meeting the Estimated Average Requirement (EAR)..............................6 7. Percent of children overweight and at-risk for overweight...............................................................7 8. Percent of children overweight and at-risk for overweight by race/ethnicity...................................7 9. Percent of children who are overweight by county (map)..............................................................8 10. Three-year trend of percent of children overweight and at-risk for overweight.................................9 11. Time spent by students watching television.....................................................................................10 12. Participation by students in vigorous activity..................................................................................10 13. Number of days students attended physical education class.........................................................11 14. Time spent actually exercising in physical education class............................................................11 15. Time spent on stretching, strengthening, and bicycling or walking................................................11 ii PREFACE The Division of Community Health is pleased to present the second published report on nutritional data collected on school-age children who attend schools that participate in the Missouri School- Age Children’s Health Services Program (MSCHS). The MSCHS supports population-based health services for school-age children. The Section for Maternal, Child and Family Health administers the MSCHS through contracts with schools, school districts, and local public health agencies. Federal funding through the Title V Maternal and Child Health Block Grant supports the efforts of the Division to contract with the Harvard University School of Public Health to use the Harvard Food Frequency Questionnaire (FFQ) survey in Missouri. To support this project, the Division has worked with Harvard to customize and validate the FFQ for use among Missouri students. The Division wishes to to acknowledge and thank the following individuals for their contributions: (cid:178) Ms. Rita Arni and staff of the Nutrition Policy and Education Unit, Division of Community Health, for their expertise in dietary assessment. (cid:178) Ms. Dana Schmitz and the staff of the Office of Surveillance, Evaluation and Planning, Divi- sion of Community Health, for developing the surveillance system, providing techni- cal assistance to the MSCHS contractors, quality control of the data analysis, and authorship of this report. (cid:178) Ms. Helaine Rockett and the staff of the Harvard University School of Public Health for analy- sis of the data and leadership in standardized dietary intake assessment. (cid:178) All of the administrators, school nurses, and teachers in the MSCHS participating schools for their commitment to improving the dietary health of their students. In a very real sense, this report is early fruit of the promise of federal, state and local collaborations and public-private partnerships to improve the nutritional health status of all Missourians. Paula F. Nickelson, Director Division of Community Health Missouri Department of Health and Senior Services iii Dietary Intake and Physical Activity Summary Report Missouri School-Age Children’s Health Services Program: School Year 2001-2002 B ackground: Many acute and chronic However, these records are included in the FFQ diseases, such as rickets, diabetes, high analysis. In addition, 70 records did not pass blood pressure, heart disease, anemia exclusion criteria of improbable height and and obesity, are linked to improper dietary weight for age and sex. Figures 1 and 2 illus- intake and inadequate physical activities in both trates the age distribution. adults and children. As the prevalence of Figure 1. Percent distribution of food frequency overweight and obesity increase in our youth, records among school-age children (n=16,777). future generations of Americans are at greater risk 19.2% of developing these life-threatening diseases. Important tools in monitoring the health status of our children are anthropometric measurements and the Harvard Food Frequency Questionnaire 10.3% (FFQ) which measures a variety of food intake and physical activities among school children. The data collected by using the tools provide a 70.5% basis for the identification of inadequate nutri- ent intake, lack of physical activity, and preva- 9-10 years old lence of obesity which is important in designing 11-14 years old intervention strategies and programs aimed at 15-18 years old modifying and improving school children’s dietary intake and physical activity. Figure 2. Percent distribution of height and weight measurements collected among school- D ata collection: During the 2001-2002 age children (n=22,274). school year, through the Missouri School- Age Children’s Health Services Program, 13.4% the Missouri Department of Health and Senior Services collected dietary intake information as assessed by the Harvard FFQ from a total of 7.6% 22,347 children, with 16,777 children’s records included in the analysis after passing exclusion 79.0% criteria of improbable caloric intake. This involved a combination of 313 non-public schools and public school districts (one or 9-11 years old more schools submitted data within the district). 12-14 years old Height and weight measurements were col- 15-18 years old lected from 26,757 children within these same participating schools with 22,274 records Note: Differences in age groups are due to the included in the analysis. Of those records source of the data reporting: the FFQ analysis is excluded, 4,413 were from children measured completed by the Harvard School of Public in previous years who were determined to be Health, and the height and weight data is overweight or underweight, so were remeasured analyzed by the Centers for Disease Control and in the current year to assess their progress. Prevention (CDC). 1 Figure 3. Number of children participating in the Missouri School-Age Children’s Health Services Program by Missouri public school district in school year 2001-2002*. D 2 - 50 51 - 150 151 - 300 301 - 500 501 - 800 *Note: Non-public school participation was reported in accordance with the public school district in which the school was located. 2 F requency of intake by food group: The by the Food Guide Pyramid. In comparing the mean frequency in which students ate mean intake of foods from the other Food foods from the five Food Guide Pyramid Groups, the students, regardless of age or Food Groups is displayed in Table 1. Students’ gender, did not consume enough foods found mean intake of foods from the Milk and Fruits in the Meat, Breads/Cereals, and Vegetables categories were comparable to the minimum Groups. The highest mean frequency of intake recommended number of servings as advised was from foods in the Sweets and Fats Groups. Table 1. Mean frequency of intake per day of Food Guide Pyramid Food Groups by sex and age. Minimum Recom- 9-10 9-10 11-13 11-13 14-18 14-18 All All mended yr old yr old yr old yr old yr old yr old Males Females Number Males Females Males Females Males Females n=8,254 n=8,523 of n=73 n=92 n=6,488 n=6,781 n=1,693 n=1,650 Servings Meat 2.0 1.2 0.9 1.2 1.1 1.6 1.3 1.3 1.1 Bread/ 6.0 2.3 2.3 2.3 2.4 3.1 3.1 2.5 2.5 Cereals Milk 2.0 2.2 2.2 2.6 2.4 2.6 2.1 2.6 2.3 Vegetables 3.0 2.3 2.2 2.0 2.0 2.4 2.3 2.1 2.1 Fruits 2.0 2.1 2.6 2.2 2.3 2.1 2.1 2.2 2.3 Sweets minimal 2.7 2.3 3.0 2.8 3.8 3.5 3.1 2.9 Fats minimal 3.2 3.0 3.4 3.4 4.5 4.1 3.6 3.5 Source: Harvard Food Frequency Questionnaire Figure 4. Percent of all students whose frequency of intake by food group is comparable to the minimum recommended servings in the Food Guide Pyramid (n=8,254 males, n=8,523 females). 40% Fruits 38% All Females 21% All Males Vegetables 22% 54% Milk 60% 5% Bread/Cereals 6% 13% Meat 18% 0% 20% 40% 60% 80% 100% Percentage Source: Harvard Food Frequency Questionnaire Table 1 indicates that male students consistently Figure 4 indicates that foods from the Milk and consumed higher frequencies of foods from the Fruits Food Groups were frequently consumed Meat Group than females. Older students (14- at the same level as the minimum recommended 18 years old) of both genders more frequently servings in the Food Guide Pyramid. Foods from consumed foods from the Meat, Bread/Cereals, the Bread/Cereals Group were the least fre- Sweets, and Fats Food Groups than their quently consumed by both male and female younger counterparts. students. 3 Table 2. Percent of calories from the top two ranked foods contributing to selected nutrients. Males Females #1 Ranked #2 Ranked #1 Ranked #2 Ranked % % % % Food Food Food Food Cold Cold Calories Milk 12.24 Breakfast 5.07 Milk 11.08 Breakfast 5.26 Cereal Cereal Carbo- Milk 10.24 Soft Drinks 6.87 Milk 8.97 Soft Drinks 6.35 hydrate Chicken or Chicken or 9 Protein Milk 19.39 6.38 Milk 18.46 6.86 Turkey, Fried Turkey, Fried to 10 year Fat Milk 11.40 French Fries 6.81 Milk 10.42 French Fries 7.27 olds Cold Cold Spaghetti or Steak or Iron Breakfast 34.97 3.77 Breakfast 36.31 Other 3.36 Roast Beef Cereal Cereal Pasta+Sauce Cold Cold Calcium Milk 45.41 Breakfast 8.99 Milk 43.63 Breakfast 9.77 Cereal Cereal Calories Milk 11.65 French Fries 5.00 Milk 10.73 French Fries 5.00 Carbo- Milk 9.60 Soft Drinks 7.88 Milk 8.71 Soft Drinks 7.22 hydrate Chicken or Chicken or 11 Protein Milk 19.17 Turkey, Fried 6.49 Milk 18.26 Turkey, Fried 6.69 to 13 Fat Milk 10.82 French Fries 7.19 Milk 9.95 French Fries 7.15 year olds Cold Cold Steak or Bread, Toast, Iron Breakfast 33.24 3.61 Breakfast 33.05 3.57 Roast Beef or Rolls Cereal Cereal Cold Cold Calcium Milk 45.04 Breakfast 8.48 Milk 42.94 Breakfast 8.58 Cereal Cereal Calories Milk 8.07 French Fries 6.30 Milk 6.17 French Fries 5.99 Carbo- Soft Drinks 11.50 Milk 6.29 Soft Drinks 11.11 French Fries 8.51 hydrate Hamburgers, Chicken or 14 Protein Milk 13.85 Meatballs, 7.00 Milk 11.56 7.73 Turkey, Fried to or Meatloaf 18 year Fat French Fries 8.68 Milk 7.90 French Fries 8.51 Cheese 6.42 olds Cold Cold Bread, Toast, Bread, Toast, Iron Breakfast 30.64 4.35 Breakfast 30.52 5.26 or Rolls or Rolls Cereal Cereal Calcium Milk 37.26 Cheese 9.13 Milk 31.07 Cheese 10.12 Source: Harvard Food Frequency Questionnaire 4 T op foods contributing to various nutri- Medicine, National Academies of Sciences. The ents: The top foods contributing to the DRIs replace and expand the Recommended various nutrients and the percent contrib- Dietary Allowances (RDAs). The DRIs are made uting to total calories were very similar for both up of the following reference values: Estimated male and female students. Food intake contrib- Average Requirement (EAR), Recommended uting to iron varied between boys and girls in Dietary Allowance (RDA), Adequate Intake (AI), the two younger age groups; boys in both and Tolerable Upper Intake Level (UL). EAR is younger age groups consumed steak or roast used to assess the adequancy of diets of groups beef as the second-ranked food item whereas 9 of people; the EAR exceeds the requirement for to 10 year old girls consumed half of the group, and falls below spaghetti or other pasta plus the requirement for the other sauce and 11 to 13 year old half. The RDA is a recom- girls consumed bread, toast mended intake for indi- or rolls. There was also some viduals; the RDA repre- shift in food choices be- sents the level of intake tween these two younger age sufficient to meet the groups and their older coun- nutrient requirement for terparts. The second-ranked almost all healthy individu- food contributing to calcium was cold breakfast als in a particular life stage and gender group. cereal whereas in the diets of 14-18 year olds, The AI was developed for those situations in cheese was the second-ranked food (milk which a RDA could not be determined scientifi- remained the top-ranked food). Also for foods cally; the AI is at a level that is thought to meet or contributing to total calories, the 9-10 year olds exceed the requirements of almost all healthy consumed cold breakfast cereal the second individuals in a particular life stage and gender most (milk the top-most), but the two older age group, based upon the science available. The groups consumed french fries as the second UL is the level of average daily nutrient intake that most common food contributing to total calo- is likely to create no risk of adverse health effects ries. In addition, the 9-10 year olds and 11-13 for almost all individuals. year olds had soft drinks as the second-ranked Figures 5 and 6 present the percent of students food contributing to carbohydrates whereas the who met the recommended levels (EAR or AI) 14-18 year olds had soft drinks as the top- of various nutrients. In general, students were ranked food. For the two younger age groups, more likely to not meet the recommended milk contributed the most to total fat and french levels for calcium, vitamin E, and folate, with fries second, and in the older children the top fewer than 70 percent of the students meeting food contributing to fat was french fries and the recommended amounts. Overall, males and then milk or cheese (for males and females, females presented very similar patterns in nutri- respectively). These differences between the ent intake with the exception of calcium which younger and older students seems to indicate a was 5-11 percent lower and vitamin E which shift to poorer food choices as children get was 3-9 percent higher in the female population older. than the male counterparts. Also, iron intake was N utrient intake by students: Nutrient 10 percent lower in the 14-18 year old females intake was assessed using the Dietary compared to males of the same age. The 14-18 Reference Intakes (DRIs). The DRIs is a set year old age group consistently had the lowest of four nutrient-based reference values for use in percent of students meeting nutrient intake assessing and planning diets. The DRIs are requirements compared to their younger coun- released periodically for selected nutrients by terparts except for intake of vitamin E, which was the Food and Nutrition Board of the Institute of higher than the other age groups. 5 Figure 5. Percent of male students meeting the Estimated Average Requirement (EAR) or Adequate Intake (AI). 9-10 yrs old 11-13 yrs old 14-18 yrs old ALL Males ■ ■ 100% % e 80% 86%80%78%79% 73%74%72%73% 83%82%67%79% 85%84%79%83% 67%69%2%68% 8986%74%84% %%64%% ag 60% 6 5556 57 t n e %%%% c 7 r 40% 3333 e 333 P 20% 0% Calcium Iron Zinc Vitamin Vitamin Folate Vitamin Vitamin C B6 A E Nutrients Source: Harvard Food Frequency Questionnaire Figure 6. Percent of female students meeting the Estimated Average Requirement (EAR) or Ad- equate Intake (AI). 9-10 yrs old 11-13 yrs old 14-18 yrs old ALL Females ■ ■ age1680000%%% 79%81%68%78% 72%72%68%71% 83%83%66%79% 84%84%74%82% 70%69%57%67% 88%87%79%86% 61%59%73%62% t n e c r 40% %% % Pe 26283%27 2 20% 0% Calcium Iron Zinc Vitamin Vitamin Folate Vitamin Vitamin C B6 A E Nutrients Source: Harvard Food Frequency Questionnaire 6