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Title: Association between barriers and facilitators to meeting the Dietary Guidelines for Americans and body weight status of caregiver-child dyads: The HEALTH study

Author
item NICKLAS, THERESA - Children'S Nutrition Research Center (CNRC)
item LIU, YAN - Children'S Nutrition Research Center (CNRC)
item GIOVANNI, MARIA - California State University
item Jahns, Lisa
item TUCKER, KATHERINE - University Of Massachusetts
item Laugero, Kevin
item Bogle, Margaret
item Chester, Deirdra

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/25/2016
Publication Date: 5/18/2016
Citation: Nicklas, T.A., Liu, Y., Giovanni, M., Jahns, L.A., Tucker, K., Laugero, K.D., Bogle, M.L., Chester, D.N. 2016. Association between barriers and facilitators to meeting the Dietary Guidelines for Americans and body weight status of caregiver-child dyads: The HEALTH study. American Journal of Clinical Nutrition. doi:10.3945/ajcn.115.123372.

Interpretive Summary: Few Americans meet the Dietary Guidelines for Americans (DGA). The goal of this research was to examine the association between barriers and facilitators to DGA adherence and body mass index (BMI) in children and their primary caregiver. The study was conducted across six sites throughout the US. Barriers and facilitators to meeting the DGA were assessed using a validated questionnaire, and heights and weights were measured using standard procedures. Among the caregivers, BMI was positively associated with total barrier scores for the MyPyramid components of dietary recommendations. Facilitators to meeting vegetable and oils intake recommendations were negatively associated with caregiver BMI. Among the children, BMI was associated positively with total barriers and negatively with total facilitators. Our findings are among the first to show associations between BMI and barriers and facilitators to meeting the DGA for mother-child dyads.

Technical Abstract: Few Americans meet the Dietary Guidelines for Americans (DGA) yet, a large percentage are overweight. The goal of this research was to examine the association between barriers and facilitators to meeting the DGA and weight in a multi-site study. In a cross-sectional study, a total of 836 caregiver-child dyads completed the questionnaire across six sites among three race/ethnic groups participating in the HEALTH Study. Barriers and facilitators to meeting the DGA were assessed using a validated questionnaire which was developed specifically for the HEALTH Study. Heights and weights were measured. A series of bivariate regression analyses were conducted to examine the association between the caregivers BMI or the children BMI z-score and the barriers and facilitators to meeting the DGA, adjusting for appropriate covariates in the models. Path analysis was used to examine the relationship of caregivers and children barriers and facilitators to their relative BMI. Among children, the BMI z-score was associated positively (p< 0.001) with total barriers and negatively (p< 0.001) with total facilitators. Among their caregivers, BMI was positively associated only with total barrier scores (p< 0.0001). For each of the eight MyPyramid components, barriers were consistently positively associated (p< 0.0001) and facilitators were negatively associated (p<0.001) with BMI z-score in the children (with the exception of the fruit and physical activity components). For caregivers, most of the barriers to meeting recommendations for meat and beans, solid fats/alcohol/added sugars (SoFAAS), and physical activity components were positively associated (p<0.01) with BMI. Path analyses show that caregivers facilitators were significantly related to children's facilitators to meeting DGA recommendations (std ß= 0.12; p< 0.001). Our findings are among the first to show associations between weight and/or barriers and facilitators to meeting the DGA in a national, large sample of caregiver-child dyads.