Obesity Risk Assessment Tool among 3–5 Year Olds: Validation with Biomarkers of Low-Grade Chronic Inflammation

Abstract

Background: Many families with young children practice nutrition, parenting, and lifestyle behaviors that set their children on trajectories for unhealthful weight gain. Potential adverse health effects of excessive body fat can result in the secretion of proinflammatory molecules and increased risk of inflammation and metabolic diseases. A pediatric obesity risk assessment tool named Healthy Kids (HK), demonstrated validity in a longitudinal study with child's measured BMI and 36-hour diet, screen, sleep, and activity logs. Our objective was to provide additional evidence of validity with low-income families with literacy issues using an inflammation index composed of four proinflammatory biomarkers. Methods: Parent/child pairs (n = 104) from Head Start and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provided HK, blood samples, and measured heights/weights. Select child inflammatory markers were discretized into two groups of HK scores. Data were analyzed with a mixed model adjusted for children's age and BMI. Results: A significant HK-time interaction effect was shown for the child inflammation index with two data collection points 1 year apart (p did = 0.039). This index increased over 12 months in children with less healthful behaviors (p = 0.007), but not in children with more healthful profiles (p = 0.58). Conclusions: Children with less healthful HK scores had an elevated inflammation index indicating a low-grade chronic systemic inflammatory state. Taken together with our previously published findings, the HK tool has potential as a rapid and easy-toadminister assessment of the family environment and the child's obesity risk. HK can be useful for federal nutrition programs for evaluation, risk assessment, goal setting, and/or program planning in clinical and community environments.

A Randomized Controlled Cluster Trial of an Obesity Prevention Program for Children with Special Health Care Needs: Methods and Implications

“…The child's nutrition intake was measured by the (1) Healthy Kids Checklist (HKC) [27,28] and (2) Food Frequency Questionnaire (FFQ) [29]. The HKC is a parent-reported measure of child dietary intake at home of fat, fiber, fruit/vegetable, calcium/dairy, and sweetened beverages, as well as nutrition behaviors, including eating in restaurants, breakfast skipping, and physical activity habits, and parent role-modeling of healthy eating.…”

“…The HKC is a parent-reported measure of child dietary intake at home of fat, fiber, fruit/vegetable, calcium/dairy, and sweetened beverages, as well as nutrition behaviors, including eating in restaurants, breakfast skipping, and physical activity habits, and parent role-modeling of healthy eating. The HKC uses visuals with text at a second-grade reading level and is validated for our target age population [27,28].…”

Feasibility of Colocating a Nutrition Education Program into a Medical Clinic Setting to Facilitate Pediatric Obesity Prevention

“…Reliability and validity has been demonstrated for the HK and MCMT measures. [38][39][40][41][42] HK and MCMT instruction guides were used to ensure consistent administration. 43,44 HK parent responses were coded using 5 response options or 5 points per item.…”

Obesity Risk Assessment Tool for Low-Income Spanish Speaking Immigrant Parents with Young Children: Validity with BMI and Biomarkers of Obesity

“…Another paradigm shift has occurred over 20 years, emphasizing the need for objective assessments of obesogenic behaviors to validate short self-report behavioral tools, in addition to the more traditional self-report measures. This was accomplished through the introduction of biologic objective measures [70], such as blood values to assess chronic low-grade inflammation [40], serum carotenoids to validate fruit and vegetable intakes [42], body mass index and other anthropometric markers [71], videotaping family meals to measure parenting practices [72], digital photography to measure dietary intake [73] and actigraphy devices to measure physical activity, sedentary behavior and sleep. The emphasis in all these methods are objective measurements to support or replace the more traditional parent-report methods.…”

“…In response to the identified need for valid assessment tools targeting families enrolled in these federal programs, a pediatric obesity risk assessment tool, Healthy Kids, replete with visuals that replace and clarify text [35] making it suitable for families with limited written English literacy, was created using the results from two extensive literature reviews [36,37], and cognitive interviews with low-income English-speaking parents [38,39]. Healthy Kids was demonstrated to be reliable and valid using the objective measures, inflammatory biomarkers [40] and BMI [41], and subjective measures, 24-h dietary recalls and 36-h activity logs [41].…”