- Email: [email protected]
95. Dietary Patterns and Weight Status of Saudi Arabian Adolescents
Poster Abstracts / 50 (2012) S16 –S95
rested state in a semi-recumbent position using a handheld RMR machine. An individualized nutrition plan of three meals and three snacks was developed and prepared by an RD, according to each camper’s (RMR). Dietary intake was monitored on a daily basis to ensure appropriate intake. Results: All camper’s BMI were ⬎ 97% with all having at least one obese parent.Results showed a mean loss of 4.6# with all but one camper losing weight.At 1-month F/U: 37.5% of campers continued to lose weight, 50% regained some of camp weightloss, but were still less than baseline. Only one camper gained above baseline weight.Although some weightgain was observed in 50% of campers at 1-month, BMIs continued to fall due to increases in linear growth. There were statistically significant reductions in BMI Z-scores from baseline to the end of camp (P ⬍ .005) and baseline to the 1-month F/U (P ⬍ .033).When comparing measured RMR to predictive equations the Harris Benedict underestimated energy needs in 77.7%, with the DRI Estimated Energy Requirements (EER-Sedentary) overestimating in 77.7% of campers.The Schofield equation overestimated 88.8% (gender specific equations) and underestimated 100% of campers (non-gender specific equation). All equations were compared within (⫹ 100/ ⫹ 200 kcals) of measured RMR, showing similar results. Conclusions: Indirect calorimetry if utilized in pediatric residential weight loss camp allows for broad treatment measures for an individualized camper care approach.Thus, promoting sustainable treatment outcomes in obese adolescents. Using RMRallows clinicians to shift the focus away from the “Dieting” stigma to promoting “Therapeutic Lifestyle Changes” (TLC) as the method for achieving positive health outcomes in obese adolescents. Providing adequate daily energy needs thru a well-balanced meal plan along with promoting group fun-based physical activities can produce healthful shifts in body compositions over time as well as limit post intervention wt. rebound.The study outcomes reveal the unreliability of predictive equations in estimating energy needs in obese adolescents. Sources of Support: MCHB/HRSA T79MC00011. 94. EVALUATION OF A NUTRITION EDUCATION INTERVENTION FOR ADOLESCENTS VISITING THE TEEN HEALTH VAN OF LUCILE PACKARD CHILDREN’S HOSPITAL Matthew J. Meyers, MPH1, Melinda K. Mount, RD2, Seth Ammerman, MD, FSAHM3, Olapeju M. Simoyan, MD, MPH1.
S59
Light Snack” tool, participants were asked to identify and analyze foods they enjoy and classify them based on personal judgment into the following categories: red-light (stop, think), yellow-light (yield, caution) and green-light (go).Pre- and post-intervention data on nutrition and food purchasing habits was collected for impact assessment. Dietary data was collected via 24-hour food recall and food purchasing data was collected through pre- and post-intervention shopping trips. For the shopping trips, each participant was given ten dollars and instructed to purchase snack-type foods and log their purchases. This study was approved by the Stanford University IRB. Results: A total of 19 adolescents (9 males, 10 females) average age 18.4 (range 15-23) completed the study. Data from the 24-hour food recall showed a statistically significant increase in consumption of protein group foods, and a trend towards increased consumption of dairy, fruit and grains, with a slight decrease in vegetable consumption. Shopping trip data showed a trend of decreases in total calories, protein, sugar, total fat and trans fat, and an increase in the amount of fiber and sodium consumed. Qualitative observation showed that participants had a low baseline level of nutrition knowledge and a sincere interest in nutrition education evidenced by their level of engagement, enjoyment of the project and reported application of skills taught in the intervention into their daily routine. Conclusions: The principal conclusion of this study is that this brief nutrition education intervention had an initial overall positive impact on these low income, at-risk adolescents’ nutrition and food buying habits.This study demonstrates that this type of intervention can serve as a model for future projects targeting nutrition and food buying habits in adolescents. Future studies should focus on implementing additional educational intervention sessions, utilizing both individual and small group formats, to maximize impact. Sources of Support: Funding for this study was provided by the Lucile Packard Foundation for Children’s Health, the Children’s Health Fund, and the Arnold P Gold Foundation. 95. DIETARY PATTERNS AND WEIGHT STATUS OF SAUDI ARABIAN ADOLESCENTS Fadia AlBuhairan, MBBS1, Hani Tamim, PhD2, Walid Tamimi, PhD1, Sulieman AlShahri, MBBS3, Ibrahim AlAlwan, MBBS2, Mohi Eldin Magzoub, MBBS2, NasrEldin Ahmed, MBBS2, Mohamed AlDubayee, MBBS1 1
The Commonwealth Medical College 2Lucile Packard Children’s Hospital 3Stanford University
King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Services 2King Saud bin Abdulaziz University for Health Sciences 3Ministry of Education
Purpose: The main objective of this pilot study was to assess the impact of a brief nutritional education intervention on adolescents’ dietary and food purchasing habits. Methods: A convenience sample of low-income at-risk adolescents was recruited from three partner sites of a mobile health clinic targeting uninsured and homeless youth. At all three sites - a Boys’ and Girls’ Club, an LGBTQ community center, and a charter continuation high school – recruitment consisted of on-site presentations from research staff and postings on social media and message boards. Inclusion criteria limited enrollment to English speakers aged 15-25. Assent and parental consent were obtained for minors; those 18 years of age and older self-consented. The intervention consisted of two group nutrition education sessions led by a registered dietitian. The first was designed to stimulate discussion about food choices, introduce basic nutrition principles and provide opportunities to practice identifying the healthfulness of foods. The second intervention session took place in a local grocery store where participants were given the task of applying techniques from the previous session to create personal snack lists. Employing a “Traffic-
Purpose: Adolescents constitute a large proportion of Saudi Arabian society. However, they continue to lack attention from health and social institutions, because culturally and historically, individuals have been categorized only as being children or adults. The JEELNA “Our Generation” study is a national study looking at the health needs of Saudi Arabian adolescents. The aim of this reported part of the study is to identify the dietary behaviors and weight status of adolescents. Methods: A cross-sectional study was conducted in Riyadh region during 2011. Multistage stratified clustered random sampling was carried out to select intermediate and secondary male and female schools. Students at participating schools were invited to participate in the study. Participating students responded to a self-administered questionnaire designed for the sake of the study and which contained questions about dietary patterns, body image, and exercise. Each student also had his/her weight and height measured and body mass index (BMI) calculated. Data analysis was done using Statistical Analysis System (SAS).
1
S60
Poster Abstracts / 50 (2012) S16 –S95
Results: The preliminary analysis shows that a total of 1719 students participated; 59% were female. Twenty-four percent of students never or rarely ever had breakfast; 19% reported that they don’t eat any fruits, and 14% do not eat any vegetables. Thirty-three percent of students reported drinking one carbonated beverage per day, and 18% had ⫽3 carbonated beverages/day. Fortunately, the majority of students (66%) did not drink energy drinks. When it came to activities, almost half of the students (47%) did not engage in any form of exercise during the preceding week, 49% spent 2 or more hours/day watching television, and 43% spent 2 or more hours/day online. With regards to their weight, 25% of students were overweight or obese, and 18% were underweight. Only 37% were satisfied with their body image, whereas 50% believed that they should lose weight. The most common methods of attempting to lose weight was through cutting down on nutritional intake and exercising; only 1% tried losing weight by using weight loss medications or inducing vomiting. Conclusions: Adolescents from Riyadh region of Saudi Arabia exhibit some poor dietary habits and sedentary lifestyle. Their weight status is of concern, with both underweight and overweight/obesity being prevalent conditions. Dissatisfaction with body image is also very common. Health promotion programs for adolescents specifically targeting nutrition and lifestyle are recommended. Sources of Support: King Abdullah International Medical Research Center.
SESSION II: EATING DISORDERS 2 96. HYPOMAGNESEMIA IN ADOLESCENTS WITH EATING DISORDERS HOSPITALIZED FOR MEDICAL INSTABILITY Kristin S. Raj, MD1, Casey Keane-Miller, RD2, Neville H. Golden, MD1. 1
Stanford University School of Medicine 2Lucile Packard Children’s Hospital Purpose: Hypomagnesemia in patients with eating disorders is poorly characterized, particularly amongst adolescents. We sought to assess the prevalence of hypomagnesemia and the clinical characteristics of adolescents hospitalized with an eating disorder who developed hypomagnesemia. Methods: A retrospective chart review of adolescents aged 10-21 years with an eating disorder hospitalized for medical stabilization from January 2007-December 2010 was conducted. The prevalence of hypomagnesemia was determined. Clinical characteristics of subjects with hypomagnesemia were compared to those of subjects with normal magnesium levels and hypophosphatemia. Results: Eighty-six of 541 eligible subjects (15.9%) developed hypomagnesemia. Forty subjects (47%) with hypomagnesemia admitted to purging in the year before admission, with 88% purging during the prior month. Compared to those with normal serum magnesium levels, subjects with hypomagnesemia were older (p⫽0.0001), more likely to be purging (p⫽0.04), and more likely to have an alkaline urine (p⫽0.01). They did not differ in eating disorder diagnosis, BMI, or other electrolyte disturbances. Hypomagnesemia developed later in the course of refeeding than did hypophosphatemia (p⬍0.001) and was associated with a higher caloric intake (p⬍0.001). Subjects who developed both deficiencies lost more weight than those with one deficiency or no deficiency (p⬍0.001). Conclusions: Hypomagnesemia is prevalent in adolescents hospitalized for an eating disorder and is associated with purging and alkaline urine. Hypomagnesemia develops later in the course of refeeding than hypophosphatemia. Magnesium levels should continue
to be monitored after the more immediate risk of hypophosphatemia has passed, especially in those with a high urine pH or purging history. Sources of Support: This work was supported in part by the Stanford University School of Medicine, Medical Scholars Fellowship. 97. ASSOCIATION BETWEEN PARENTING STYLE AND ADOLESCENT UNHEALTHY WEIGHT CONTROL BEHAVIORS Max Zubatsky, MA. University of Minnesota Purpose: While the overall prevalence of eating disorders in adolescence is low, the prevalence of engaging in disordered eating behaviors is high among adolescents. Thus, it is important to identify variables within the home environment that are associated with disordered eating behaviors in order to identify targets for prevention. The main purpose of this study is to identify the association between parenting style (i.e. authoritative, authoritarian, permissive, neglectful) and adolescent disordered eating behaviors. Methods: The current study uses longitudinal data from a five year study to examine the associations between parenting style and disordered eating behaviors among adolescents. Data from adolescents (n ⫽ 2516) participating in Project EAT, a population-based study from 31 Minnesota schools, were used in the analysis. Time 1 (1999) data were collected using in-class assessments of adolescents from Minneapolis/St. Paul schools and Time 2 (2004) data were collected using mailed surveys five years later. General Linear Models were used to predict adolescent reported disordered eating behaviors at Time 2 from adolescent reported parenting style at Time 1. Sex, age, cohort year, race, ethnicity and socioeconomic status were controlled for in the study. Results: The two highest associations between parenting styles and adolescent disordered eating occurred between both maternal parenting style and adolescent female less extreme behaviors (F⫽4.57, p⬍.05) and female binge eating behaviors (F⫽3.91, p⬍.05). Adolescent females who had authoritarian mothers at Time 1 reported the highest probability of less extreme weight control behaviors at Time 2 (70.1%) compared to adolescent females with authoritative (57.2%) or permissive (57.9%) mothers at Time 1. In addition, adolescent females who had authoritarian mothers at Time 1 reported more binge eating behaviors (17.1%) at Time 2, compared to adolescent females who had authoritative (8.3%) or permissive (10.7%) mothers at Time 1.There were no significant associations between paternal parenting style and adolescent girls’ or boys’ disordered eating behaviors. Conclusions: Findings from the current study suggest that maternal authoritarian parenting style may serve as a risk factor for eating disordered behaviors in adolescents. Prevention and treatment efforts targeting disordered eating behaviors in adolescents may benefit from addressing authoritarian parenting styles in relation to youth disordered eating behaviors. Sources of Support: The co-authors on this poster presentation served as the primary academic sources of support (Jerica Berge, Marla Eisenberg, Dianne Neumark-Sztainer). Additionally, members of the initial construction of the Project EAT data set offered input and support. 98. ATTITUDES OF NURSES AND RESIDENTS CARING FOR ADOLESCENTS WITH AN EATING DISORDER
rested state in a semi-recumbent position using a handheld RMR machine. An individualized nutrition plan of three meals and three snacks was developed and prepared by an RD, according to each camper’s (RMR). Dietary intake was monitored on a daily basis to ensure appropriate intake. Results: All camper’s BMI were ⬎ 97% with all having at least one obese parent.Results showed a mean loss of 4.6# with all but one camper losing weight.At 1-month F/U: 37.5% of campers continued to lose weight, 50% regained some of camp weightloss, but were still less than baseline. Only one camper gained above baseline weight.Although some weightgain was observed in 50% of campers at 1-month, BMIs continued to fall due to increases in linear growth. There were statistically significant reductions in BMI Z-scores from baseline to the end of camp (P ⬍ .005) and baseline to the 1-month F/U (P ⬍ .033).When comparing measured RMR to predictive equations the Harris Benedict underestimated energy needs in 77.7%, with the DRI Estimated Energy Requirements (EER-Sedentary) overestimating in 77.7% of campers.The Schofield equation overestimated 88.8% (gender specific equations) and underestimated 100% of campers (non-gender specific equation). All equations were compared within (⫹ 100/ ⫹ 200 kcals) of measured RMR, showing similar results. Conclusions: Indirect calorimetry if utilized in pediatric residential weight loss camp allows for broad treatment measures for an individualized camper care approach.Thus, promoting sustainable treatment outcomes in obese adolescents. Using RMRallows clinicians to shift the focus away from the “Dieting” stigma to promoting “Therapeutic Lifestyle Changes” (TLC) as the method for achieving positive health outcomes in obese adolescents. Providing adequate daily energy needs thru a well-balanced meal plan along with promoting group fun-based physical activities can produce healthful shifts in body compositions over time as well as limit post intervention wt. rebound.The study outcomes reveal the unreliability of predictive equations in estimating energy needs in obese adolescents. Sources of Support: MCHB/HRSA T79MC00011. 94. EVALUATION OF A NUTRITION EDUCATION INTERVENTION FOR ADOLESCENTS VISITING THE TEEN HEALTH VAN OF LUCILE PACKARD CHILDREN’S HOSPITAL Matthew J. Meyers, MPH1, Melinda K. Mount, RD2, Seth Ammerman, MD, FSAHM3, Olapeju M. Simoyan, MD, MPH1.
S59
Light Snack” tool, participants were asked to identify and analyze foods they enjoy and classify them based on personal judgment into the following categories: red-light (stop, think), yellow-light (yield, caution) and green-light (go).Pre- and post-intervention data on nutrition and food purchasing habits was collected for impact assessment. Dietary data was collected via 24-hour food recall and food purchasing data was collected through pre- and post-intervention shopping trips. For the shopping trips, each participant was given ten dollars and instructed to purchase snack-type foods and log their purchases. This study was approved by the Stanford University IRB. Results: A total of 19 adolescents (9 males, 10 females) average age 18.4 (range 15-23) completed the study. Data from the 24-hour food recall showed a statistically significant increase in consumption of protein group foods, and a trend towards increased consumption of dairy, fruit and grains, with a slight decrease in vegetable consumption. Shopping trip data showed a trend of decreases in total calories, protein, sugar, total fat and trans fat, and an increase in the amount of fiber and sodium consumed. Qualitative observation showed that participants had a low baseline level of nutrition knowledge and a sincere interest in nutrition education evidenced by their level of engagement, enjoyment of the project and reported application of skills taught in the intervention into their daily routine. Conclusions: The principal conclusion of this study is that this brief nutrition education intervention had an initial overall positive impact on these low income, at-risk adolescents’ nutrition and food buying habits.This study demonstrates that this type of intervention can serve as a model for future projects targeting nutrition and food buying habits in adolescents. Future studies should focus on implementing additional educational intervention sessions, utilizing both individual and small group formats, to maximize impact. Sources of Support: Funding for this study was provided by the Lucile Packard Foundation for Children’s Health, the Children’s Health Fund, and the Arnold P Gold Foundation. 95. DIETARY PATTERNS AND WEIGHT STATUS OF SAUDI ARABIAN ADOLESCENTS Fadia AlBuhairan, MBBS1, Hani Tamim, PhD2, Walid Tamimi, PhD1, Sulieman AlShahri, MBBS3, Ibrahim AlAlwan, MBBS2, Mohi Eldin Magzoub, MBBS2, NasrEldin Ahmed, MBBS2, Mohamed AlDubayee, MBBS1 1
The Commonwealth Medical College 2Lucile Packard Children’s Hospital 3Stanford University
King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Services 2King Saud bin Abdulaziz University for Health Sciences 3Ministry of Education
Purpose: The main objective of this pilot study was to assess the impact of a brief nutritional education intervention on adolescents’ dietary and food purchasing habits. Methods: A convenience sample of low-income at-risk adolescents was recruited from three partner sites of a mobile health clinic targeting uninsured and homeless youth. At all three sites - a Boys’ and Girls’ Club, an LGBTQ community center, and a charter continuation high school – recruitment consisted of on-site presentations from research staff and postings on social media and message boards. Inclusion criteria limited enrollment to English speakers aged 15-25. Assent and parental consent were obtained for minors; those 18 years of age and older self-consented. The intervention consisted of two group nutrition education sessions led by a registered dietitian. The first was designed to stimulate discussion about food choices, introduce basic nutrition principles and provide opportunities to practice identifying the healthfulness of foods. The second intervention session took place in a local grocery store where participants were given the task of applying techniques from the previous session to create personal snack lists. Employing a “Traffic-
Purpose: Adolescents constitute a large proportion of Saudi Arabian society. However, they continue to lack attention from health and social institutions, because culturally and historically, individuals have been categorized only as being children or adults. The JEELNA “Our Generation” study is a national study looking at the health needs of Saudi Arabian adolescents. The aim of this reported part of the study is to identify the dietary behaviors and weight status of adolescents. Methods: A cross-sectional study was conducted in Riyadh region during 2011. Multistage stratified clustered random sampling was carried out to select intermediate and secondary male and female schools. Students at participating schools were invited to participate in the study. Participating students responded to a self-administered questionnaire designed for the sake of the study and which contained questions about dietary patterns, body image, and exercise. Each student also had his/her weight and height measured and body mass index (BMI) calculated. Data analysis was done using Statistical Analysis System (SAS).
1
S60
Poster Abstracts / 50 (2012) S16 –S95
Results: The preliminary analysis shows that a total of 1719 students participated; 59% were female. Twenty-four percent of students never or rarely ever had breakfast; 19% reported that they don’t eat any fruits, and 14% do not eat any vegetables. Thirty-three percent of students reported drinking one carbonated beverage per day, and 18% had ⫽3 carbonated beverages/day. Fortunately, the majority of students (66%) did not drink energy drinks. When it came to activities, almost half of the students (47%) did not engage in any form of exercise during the preceding week, 49% spent 2 or more hours/day watching television, and 43% spent 2 or more hours/day online. With regards to their weight, 25% of students were overweight or obese, and 18% were underweight. Only 37% were satisfied with their body image, whereas 50% believed that they should lose weight. The most common methods of attempting to lose weight was through cutting down on nutritional intake and exercising; only 1% tried losing weight by using weight loss medications or inducing vomiting. Conclusions: Adolescents from Riyadh region of Saudi Arabia exhibit some poor dietary habits and sedentary lifestyle. Their weight status is of concern, with both underweight and overweight/obesity being prevalent conditions. Dissatisfaction with body image is also very common. Health promotion programs for adolescents specifically targeting nutrition and lifestyle are recommended. Sources of Support: King Abdullah International Medical Research Center.
SESSION II: EATING DISORDERS 2 96. HYPOMAGNESEMIA IN ADOLESCENTS WITH EATING DISORDERS HOSPITALIZED FOR MEDICAL INSTABILITY Kristin S. Raj, MD1, Casey Keane-Miller, RD2, Neville H. Golden, MD1. 1
Stanford University School of Medicine 2Lucile Packard Children’s Hospital Purpose: Hypomagnesemia in patients with eating disorders is poorly characterized, particularly amongst adolescents. We sought to assess the prevalence of hypomagnesemia and the clinical characteristics of adolescents hospitalized with an eating disorder who developed hypomagnesemia. Methods: A retrospective chart review of adolescents aged 10-21 years with an eating disorder hospitalized for medical stabilization from January 2007-December 2010 was conducted. The prevalence of hypomagnesemia was determined. Clinical characteristics of subjects with hypomagnesemia were compared to those of subjects with normal magnesium levels and hypophosphatemia. Results: Eighty-six of 541 eligible subjects (15.9%) developed hypomagnesemia. Forty subjects (47%) with hypomagnesemia admitted to purging in the year before admission, with 88% purging during the prior month. Compared to those with normal serum magnesium levels, subjects with hypomagnesemia were older (p⫽0.0001), more likely to be purging (p⫽0.04), and more likely to have an alkaline urine (p⫽0.01). They did not differ in eating disorder diagnosis, BMI, or other electrolyte disturbances. Hypomagnesemia developed later in the course of refeeding than did hypophosphatemia (p⬍0.001) and was associated with a higher caloric intake (p⬍0.001). Subjects who developed both deficiencies lost more weight than those with one deficiency or no deficiency (p⬍0.001). Conclusions: Hypomagnesemia is prevalent in adolescents hospitalized for an eating disorder and is associated with purging and alkaline urine. Hypomagnesemia develops later in the course of refeeding than hypophosphatemia. Magnesium levels should continue
to be monitored after the more immediate risk of hypophosphatemia has passed, especially in those with a high urine pH or purging history. Sources of Support: This work was supported in part by the Stanford University School of Medicine, Medical Scholars Fellowship. 97. ASSOCIATION BETWEEN PARENTING STYLE AND ADOLESCENT UNHEALTHY WEIGHT CONTROL BEHAVIORS Max Zubatsky, MA. University of Minnesota Purpose: While the overall prevalence of eating disorders in adolescence is low, the prevalence of engaging in disordered eating behaviors is high among adolescents. Thus, it is important to identify variables within the home environment that are associated with disordered eating behaviors in order to identify targets for prevention. The main purpose of this study is to identify the association between parenting style (i.e. authoritative, authoritarian, permissive, neglectful) and adolescent disordered eating behaviors. Methods: The current study uses longitudinal data from a five year study to examine the associations between parenting style and disordered eating behaviors among adolescents. Data from adolescents (n ⫽ 2516) participating in Project EAT, a population-based study from 31 Minnesota schools, were used in the analysis. Time 1 (1999) data were collected using in-class assessments of adolescents from Minneapolis/St. Paul schools and Time 2 (2004) data were collected using mailed surveys five years later. General Linear Models were used to predict adolescent reported disordered eating behaviors at Time 2 from adolescent reported parenting style at Time 1. Sex, age, cohort year, race, ethnicity and socioeconomic status were controlled for in the study. Results: The two highest associations between parenting styles and adolescent disordered eating occurred between both maternal parenting style and adolescent female less extreme behaviors (F⫽4.57, p⬍.05) and female binge eating behaviors (F⫽3.91, p⬍.05). Adolescent females who had authoritarian mothers at Time 1 reported the highest probability of less extreme weight control behaviors at Time 2 (70.1%) compared to adolescent females with authoritative (57.2%) or permissive (57.9%) mothers at Time 1. In addition, adolescent females who had authoritarian mothers at Time 1 reported more binge eating behaviors (17.1%) at Time 2, compared to adolescent females who had authoritative (8.3%) or permissive (10.7%) mothers at Time 1.There were no significant associations between paternal parenting style and adolescent girls’ or boys’ disordered eating behaviors. Conclusions: Findings from the current study suggest that maternal authoritarian parenting style may serve as a risk factor for eating disordered behaviors in adolescents. Prevention and treatment efforts targeting disordered eating behaviors in adolescents may benefit from addressing authoritarian parenting styles in relation to youth disordered eating behaviors. Sources of Support: The co-authors on this poster presentation served as the primary academic sources of support (Jerica Berge, Marla Eisenberg, Dianne Neumark-Sztainer). Additionally, members of the initial construction of the Project EAT data set offered input and support. 98. ATTITUDES OF NURSES AND RESIDENTS CARING FOR ADOLESCENTS WITH AN EATING DISORDER