Diet quality of children in the United States by body mass index and sociodemographic characteristics

Authors: Thomson, Jessica; LANDRY, ALICIA - University Of Central Arkansas; TUSSING-HUMPHREYS, LISA - University Of Illinois; Goodman, Melissa

Submitted to: Obesity Science & Practice
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 11/3/2019
Publication Date: 2/25/2020
Publication URL: https://handle.nal.usda.gov/10113/6937371
Citation: Thomson, J.L., Landry, A.S., Tussing-Humphreys, L.M., Goodman, M.H. 2020. Diet quality of children in the United States by body mass index and sociodemographic characteristics. Obesity Science & Practice. 6(1):84-98. https://doi.org/10.1002/osp4.388.
DOI: https://doi.org/10.1002/osp4.388

Interpretive Summary: Unhealthy dietary behaviors established early in life can lead to obesity in childhood that follows into adulthood. Hence assessing child diet quality is particularly important for addressing current and future health issues. Determining diet quality among child populations defined by weight status is crucial given the high prevalence of childhood obesity present in the United States. To date, diet quality scores have not been published in the peer-reviewed literature for American children by body mass index (BMI) status. Therefore, the purpose of this research was to describe and provide reliable estimates of diet quality of American children by BMI category and by sociodemographic characteristics within BMI category. Diet quality scores were low (50%-55% of maximum score) for children in all categories of BMI and did not differ among categories. Within BMI categories, children between 2-5 years of age generally had higher diet quality scores as compared to children between 6-11 and 12-18 years of age. Additionally, boys with normal weight had higher diet quality scores than boys with underweight, and Mexican American children with normal weight and overweight had higher diet quality scores than African American children with normal weight and overweight, respectively. For all populations of children included in this study, diet quality scores were low both quantitatively and qualitatively (majority with failing grade).

Technical Abstract: The purpose of this research was to use the Healthy Eating Index-2015 (HEI-2015) to describe the diet quality of United States children by categories of body mass index (BMI) and by sociodemographic characteristics within categories of BMI using a nationally representative sample. Three cycles of National Health and Nutrition Examination Survey’s dietary datasets (2009-2014) were used to calculate HEI-2015 total and component scores using the population ratio method for children 2-18 years of age (N=8,894). Diet quality scores were computed by BMI (underweight, normal weight, overweight, and obese) and by age (2-5, 6-11, and 12-18 years), gender, race/ethnicity (non-Hispanic black, non-Hispanic white, Mexican American, other Hispanic, and other race), and family poverty to income ratio (below and at/above poverty threshold) within BMI. Means and 95% confidence intervals were computed for HEI-2015 total and component scores. HEI-2015 total mean scores were 50.4, 55.2, 55.1, and 54.0 for children with underweight, normal weight, overweight, and obesity, respectively, and were not significantly different. Significant differences in HEI-2015 total mean scores were present for age group within BMI (higher for youngest age group in normal weight, overweight, and obesity), BMI within male gender (higher for normal weight versus underweight), and race/ethnicity within BMI (higher for Mexican Americans versus non-Hispanic blacks in normal weight and overweight). Within BMI categories, significant differences in component mean scores were present for age and race/ethnicity groups. For all populations of children represented in this study, total diet quality scores were low quantitatively and qualitatively.