Food Group, Macronutrient Intake, and Metabolic Status in the US-Affiliated Pacific's Children's Healthy Living (CHL) Program

Abstract

Background: The Children's Healthy Living study provided dietary intake information for understudied Native Hawaiian and Other Pacific Islander (NHOPI) young children.

Objectives: Our objective was to describe food group and macronutrient intakes of NHOPI children in the US-Affiliated Pacific region (USAP), overall and by jurisdiction, income level, and metabolic status.

Methods: We evaluated 2-8-y-olds (n = 3520) in a cross-sectional cluster sampled study using 2 d of dietary records completed by caregivers using provided tools, quantified by a specially developed food composition table and compared with US dietary recommendations. Overweight and obesity (OWOB) and acanthosis nigricans (AN) assessment (metabolic status) was completed by trained evaluators using standard tools. Demographic data were collected by questionnaire. Regression analysis identified differences in dietary component means by jurisdiction, World Bank income groups (WBIGs), and metabolic status, adjusted for age and sex.

Results: Few children met US recommendations for vegetable (2.4%) and milk (4.1%) food groups. US macronutrient recommendations were generally met. Food group and macronutrient intakes were significantly different by jurisdiction and WBIG. Means for food groups, except meats, and macronutrients, except protein, were higher in overweight/obese (OWOB) compared with healthy-weight children. Grain intake of 7.25 (SE: 0.08) oz was higher (P < 0.05) and milk intake of 0.90 (SE: 0.05) cups was lower (P < 0.05) in children with OWOB compared with those without OWOB [grains: 7.17 (SE: 0.07) oz; and milk: 0.96 (SE: 0.04) cups]. Monounsaturated fat intake of 11.68 (SE: 0.10) % energy was higher in those with OWOB, compared with healthy-weight children [11.56 (SE: 0.08) % energy, P < 0.05].

Conclusions: Young children's diets in the USAP did not meet milk, vegetable, or fruit intake recommendations. There was variability in dietary patterns across the USAP and by WBIG. Grain intake and monounsaturated fat intake were lower and milk intake was higher in children with better metabolic status.

Keywords: Pacific; children; food group; nutrient; obesity.

FIGURE 1

Flowchart of study selection (n = 3520) from the Children's Healthy Living Program. ^aBaseline data. Jurisdictions: Alaska, American Samoa, CNMI, Guam, and Hawai‘i. ^bJurisdictions: Chuuk, Kosrae, Pohnpei, Republic of Palau, Republic of the Marshall Islands, Yap. ^cSome communities in the intervention trial were only assessed for demographic information and anthropometry. ^d100 children of ∼150 per community were assessed for diet. AN, acanthosis nigricans; CNMI, Commonwealth of the Northern Mariana Islands.

FIGURE 2

Food group intake above recommendations (41) in the (A) full sample (n = 3520) and (B) by jurisdiction in the US-Affiliated Pacific, Children's Healthy Living Program. All food groups, except meat, were significantly different between jurisdictions and World Bank income group (P < 0.05, Wald test). Jurisdiction sample: Chuuk (n = 123), Kosrae (n = 125), Pohnpei (n = 187), Yap (n = 190), American Samoa (n = 588), Palau (n = 166), Marshall Islands (n = 191), Alaska (n = 308), CNMI (n = 546), Guam (n = 666), and Hawai‘i (n = 430). CNMI, Commonwealth of the Northern Mariana Islands; RMI, Republic of the Marshall Islands.

FIGURE 3

Macronutrient intake as a percentage of energy above recommendation (42) in (A) the full sample (n = 3520), (B) by Pacific jurisdiction and World Bank income groups, and (C) by macronutrient type in the Children's Healthy Living Program. In (B) carbohydrates and fats are significantly different between jurisdictions (P < 0.05, Wald test). In (C) all macronutrients shown, except protein, are significantly different between jurisdiction and World Bank income group (P < 0.05, Wald test). Jurisdiction sample: Chuuk (n = 123), Kosrae (n = 125), Pohnpei (n = 187), Yap (n = 190), American Samoa (n = 588), Palau (n = 166), Marshall Islands (n = 191), Alaska (n = 308), CNMI (n = 546), Guam (n = 666), and Hawai‘i (n = 430). CNMI, Commonwealth of the Northern Mariana Islands; RMI, Republic of the Marshall Islands.