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BEVERAGE, FRUIT AND VEGETABLE INTAKES BY EARLY HEAD START-ELIGIBLE MOTHERS AND THEIR CHILDREN
Seung-yeon Lee, Sharon Hoerr, Rachel Schiffman and Hiram Fitzgerald
Michigan State University
The nutritional quality of foods served to children in Early Head Start (EHS) center programs can readily be assessed and regulated. However, in home-based programs oversight of nutritional quality is more difficult for several reasons. For example, home visiting programs tend to focus on the quality of the mother-child relationship, and not how to make healthy food choices. Nevertheless, weekly visits by EHS staff could affect diet quality, because mealtimes are a key opportunity for mother-child exchanges.
Good health and adequate food intake is crucial for normal physical and cognitive development of all children under three years of age, but low-income families are at high risk for poor nutritional status (Ruston & Kirk, 1996). Foods of special concern to the health status of Early Head Start families are beverages, fruits and vegetables. Milk is especially important as the main source of calcium for children's development and for mothers to reduce risk of osteoporosis. Because soda often replaces milk as a beverage, soda can negatively affect nutritional status (Ballew, Kuester & Gillsepie, 2000; Harnack, Stang & Story, 1999). Soft drink consumption has dramatically increased in the last decade and is thought to be one of the factors associated with development of obesity. Likewise, fruit juice, although a good source of vitamin C, can also be easily over-consumed, because of its sweet taste and convenience. High intakes of fruit juice can lead to diarrhea in young children and sometimes juice replaces milk consumption.
Health professionals promote the increased intakes of fruits and vegetables because of the inhibitory effects on chronic diseases like diabetes, stroke, obesity and some cancers (Steinmetz, & Potter, 1996). Perhaps due to limited money for foods and lack of knowledge, limited income families eat less fruits and vegetables compared to middle and high-income families (Anderson, Bybee, & Brown, 2001). In Michigan only 26 percent of women with income less than $10,000 reported eating the recommended five servings of fruits and vegetables a day (Michigan Department of Community Health, 1999).
By three years of age, children usually eat meals and regular foods with their families. Children's behaviors are determined in part by modeling the behaviors of adults. For this reason, and because diet quality is crucial for good health, we examined the diet quality of the EHS research project families and their controls. Two aspects are reported here: (a) the beverage consumption of mothers and their toddlers, and (b) the fruit and vegetable consumption and intentions of mothers.
The participants were 148 mother-child pairs from a medium size city in Michigan who were eligible for Early Head Start. Interviewers obtained 24-hour dietary recalls of each mother and toddler by interviewing the mothers using the USDA multiple pass method. Heights and weights were self-reported by mothers. Interviews took around one to two hours and mothers were paid $20.00 for each interview. Dietary data were entered into Nutritionist Pro (software from Food Bank, 2001) to assess nutrient intakes and servings of food from the USDA Food Guide Pyramid food groups. Amounts of beverages were determined including milk, 100 percent fruit juice and soft drinks. SPSS (Statistical Package for the Social Sciences, Version 10.0) was used for statistical analyses.
Eighty mother-toddler pairs were in the EHS program group and 68 pairs were in the control group. Because there were no differences between groups for food intake, data were combined. Around 77 percent of mothers were Caucasian American, 15 percent African American and the remainder were from other ethnic groups such as Hispanic, Native American, Vietnamese and Biracial. About 70 percent of mothers reported that the food intake on the day they were interviewed represented their usual meals and snacks. This was 76 percent for their toddlers. Around 30 percent of mothers and 39 percent of toddlers used dietary supplements. The average Body Mass Index (BMI= kg/m2) of mothers was 27.2; with 26 percent overweight (BMI 25-29.9) and 33 percent obese (BMI-30).
Mothers drank twice as much soda as milk (25 fl oz vs. 12 fl oz, respectively). Around 70 percent of mothers drank 8 fl oz soda compared to 39 percent of mothers who drank 8 fl oz milk, equal to one serving from the dairy group. Whole milk was consumed most frequently. Sixty-two toddlers drank 100 percent fruit juice (12-11 fl oz) and 22 consumed 12 fl oz, which is the level of excess intake according to the American Academy of Pediatrics. Most all toddlers (n = 133) drank milk (14-11 fl oz), and 45 also drank soda (8-5 fl oz).
Findings from three prior interviews (baseline, 14, and 24 months) showed a low incidence of mothers or toddlers consuming even one serving of fruits or vegetables. For example, at 24 months, only 39 percent of mothers consumed one serving of fruit and 70 percent consumed a serving of vegetables, including fried potatoes. At 36 months, 87 percent of mothers answered that eating fruits and vegetables was very important for their health, but only 22 percent reported that they usually ate at least two servings of fruits, and, 35 percent, at least three servings of vegetables a day. Although most mothers (N = 111) reported that they ate less than two servings of fruits or less than three servings of vegetables daily, most also reported intending to eat more in the near future.
Implications
These results give health professionals some direction to address the dietary quality of low-income mothers and their children. Furthermore, these findings illustrate an area of opportunity for policymakers to increase the synergetic effectiveness of the EHS program by including some nutrition education. For example, Project FRESH, a food and nutrition education collaborative between the Women, Infants and Children (WIC) program and county Extension offices, is available in most states during the summer to help low income families eat more fruits and vegetables. Project FRESH offers mothers on WIC a $20.00 coupon redeemable at farmer's markets for produce. Only 12 percent of the EHS research project mothers had participated in Project FRESH. For the large group of mothers who intended to eat more fruits and vegetables, nutrition educational programs, such as Project FRESH, could be quite beneficial. More active promotion of food and nutrition related programs, integrated with EHS, could provide support to help limited income parents improve their food choices and health.
References
Anderson, J.V., Bybee, D.I., Brown, R.M., McLean, D.F., Garcia, E.M., & Breer, M.L. (2001). 5 a day and vegetable intervention improves consumption in a low-income population. Journal of the American Dietetic Association, 101, 195-202.
Ballew, C., Kuester, S., & Gullsepie, C. (2000). Beverage Choices Affect Adequacy Of Children's Nutrient Intakes. Archives Of Pediatric Adolescent Medicine, 154, 1148-52.
Harnack, L., Stang, J., & Story, M.(1999). Soft Drink Consumption Among Us Children And Adolescents; Nutritional Consequences. Journal Of The American Dietetic Association, 99, 436-41.
Michigan Department of Community Health and Michigan Public Health Institute. (1999) Health Risk Behaviors 1996. Lansing, MI: Michigan Department of Community Health.
Ruxton, C. H. S., & Kirk, T .R.(1996). Relationships between social class, nutrient intake and dietary patterns in Edinburgh schoolchildren. International Journal of Food Science and Nutrition, 47, 341-349.
Steinmetz, K.A., & Potter, J.D. (1996). Vegetables, fruits and cancer prevention: a review. Journal of the American Dietetic Association, 96, 1027-1039.
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