Measuring the healthfulness of children's diets and the role of the home food environment

Although diet is well recognized as key to good health in children, methods for assessing diet and an understanding of the environmental factors that influence children's diets are limited.. One widely used method to evaluate diet quality is HEI-2010, but the utility of this method has not been previously examined in children. In this study, we found that children with higher HEI-2010 scores were more likely to meet micronutrient requirements (mean micronutrient adequacy ratio 82.4±1.9 vs. 60.8±1.6) and less likely to over-consume energy (+2.1±4.7 % vs. +17.8±3.2%) compared to children with lower HEI scores. However, HEI-2010 did not adequately assess some components of diet in young children (ages 2 to 12). For example, children who received the maximum HEI score for the dairy component often consumed less than the recommended level of for calcium (-21%), vitamin D (-3%) and vitamin A (-11%) compared to children who met the dairy Dietary Guideline. Overall, HEI-2010 was an effective tool for assessing nutrient quality in the diets of older children, but had important flaws when used in younger children. These findings led us to use the Dietary Guidelines rather than HEI-2010 to measure the association between the availability of foods in the home and child diet. We found that parents of African American children were less likely to report always having fruit (percent difference from reference,-12%) and low-fat milk(-10%), and more likely to report dark greens(+10%) in their homes compared to white children. Children who always vs. rarely, had a food in their homes were more likely to meet the dietary guideline for that food: OR (95% CI); Fruit: 2.61(1.01, 6.75), Dark greens: 3.33(0.76, 14.40), and low-fat milk: 1.44(1.04, 2.00). Children who always, compared to rarely, had soft drinks available were more likely to exceed the recommended empty calorie limit from calories in soft drinks: 1.92(1.34, 2.74). Many of the current dietary methods were first developed for adults and later applied to children. By thoroughly examining the utility of these tools for children, and, when necessary, developing child specific versions of tools, we can uncover important intervention targets, such as increasing the availability of healthy foods in the home.Doctor of Philosoph