Are family meal patterns associated with overall diet quality during the transition from early to middle adolescence?

1. Are family meal patterns associated with overall diet quality during the transition from early to middle adolescence? Teri L. Burgess-Champoux, PhD, RD, LD; Nicole I. Larson, MPH, RD Dianne Neumark-Sztainer, PhD, MPH, RD; Peter J. Hannan, MStat; and Mary Story, PhD, RD Division of Epidemiology and Community Health, School of Public Health University of Minnesota BACKGROUND RESULTS CONCLUSIONS • Adolescence: • Energy and nutrient needs elevated to meet needs for rapid physical growth and development. • Adolescent dietary intakes of fruits, vegetables, whole grains, and calcium-rich foods were below the recommended levels for both males and females (NHANES, 1999-2002; Cook and Friday, 2004). • Poor intakes of fiber, potassium, magnesium, and vitamins A and E were also identified as potential problems for this age group (Moshfegh et al. 2005). Family meals: • Cross-sectional studies have shown that eating frequent family meals is positively associated with enhanced diet quality for adolescents (Neumark-Sztainer et al. 2003; Gillman et al. 2000). • Present study extends and builds upon previous cross-sectional research. • Key Findings: • Continuity of regular family meals for males and females during the transition from early to middle adolescence was as follows: None (32.2%, n=215), Time 1 only (37.8%, n=252), Time 2 only (8%, n=53), and at both Time 1 and Time 2 (22.1%, n=149). • Continuity of regular family meals was positively associated with mean daily intakes of vegetables, calcium-rich foods, calcium, magnesium, potassium, iron, zinc, vitamin B-6, folate, and fiber for both male and female adolescents at Time 2 (p<0.05) (data not shown). • Time 2 mean daily intakes of fruits, vegetables, whole grains, potassium, magnesium, vitamin E, and fiber were below the recommended levels for both genders across categories of regular family meals (data not shown). • Adolescents who participated in regular family meals reported healthier diets and meal patterns compared to adolescents without regular family meals. • Our findings are consistent with previous cross-sectional studies and extend these findings due to the longitudinal design. • Study limitations: • Use of self-reported data which are susceptible to social desirability bias. • Limitations of the food frequency questionnaire to accurately assess dietary intake. • Reduced representativeness resulting from non-response at Time 2. • Observational study; therefore, unable to establish causality. RESEARCH QUESTIONS AND STUDY HYPOTHESIS IMPLICATIONS FOR FUTURE RESEARCH AND PRACTICE • Research Questions: • Do family meal patterns during early adolescence (middle school) predict diet quality five years later in middle (high school) adolescence? • Do family meal patterns during early adolescence (middle school) predict meal patterns (e.g. meal frequency) five years later in middle (high school) adolescence? • Hypothesis: • We hypothesized that adolescents who had consistent family meals during early to middle adolescence would have better overall diet quality and eating patterns at follow-up compared to adolescents who did not have regular family meals. • Regular family meals during the transition from early to middle adolescence contribute to the formation of future healthy eating habits and may shape recommendations to parents, healthcare providers, and educators regarding the importance of shared mealtime experiences. • Disseminating information regarding mealtime strategies, the development of food preparation skills for parent and child, and the provision of simple, healthy recipes are key ingredients which may help promote family meals. • Future research should investigate the various levels of influence (i.e. community, school, family, and individual) which effect the provision of regular family meals. METHODS AND STUDY DESIGN REFERENCES • Project EAT (Eating Among Teens) I and II: • Study design: Population-based, longitudinal study (N=> 2500) in middle schools and high schools in St. Paul/Minneapolis area. • Primary aim: To examine socio-environmental, personal, and behavioral determinants of dietary intake and weight status among adolescents. • Study sample: • n= 313 (45%) male, n= 389 (55%) female adolescents • Mean age at Time 1 = 12.8 years; mean age at Time 2 = 17.2 years • Race/ethnicity: 37% White, 23% Asian, 41% African-American/Hispanic/Other • SES: 16% low, 19% low-middle, 32% middle, 18% upper-middle, 15% high Measures: • Time 1 (1998-1999), Time 2 (2003-2004) • Classroom surveys and the Youth and Adolescent Food Frequency Questionnaire (YAQ); (Rockett et al. 1995). Statistical Analyses: • Gender-stratified generalized linear modeling across the four family meal categories adjusted for race/ethnicity, SES, and the Time 1 outcome. • Propensity weighting for non-response bias. • Cook AJ, Friday JE. Pyramid servings intakes in the United States, 1999-2002, 1 day. Beltsville, MD:USDA Agricultural Research Service, Community Nutrition Research Group, CNRG Table Set 3.0. • Moshfegh A, Goldman J, Cleveland L. What We Eat in America, NHANES 2001-2002: Usual nutrient intakes from food compared to dietary reference intakes. USDA Agricultural Research Service, 2005. • Neumark-Sztainer D, Hannan PJ, Story M, Croll J, Perry C. Family meal patterns: Associations with sociodemographic characteristics and improved dietary intake among adolescents. Journal of the American Dietetic Association.2003;103:317-322. • Gillman MW, Rifas-Shiman SL, Frazier AL, Rockett HA, Camargo CA, Field AE, Berkey CS, Colditz GA. Familly dinner and diet quality among older children and adolescents. Archives of Family Medicine.2000;9:235-240. • Rockett HR, Wolf AM, Colditz GA. Development and reproducibility of a food frequency questionnaire to assess diets of older children and adolescents. Journal of the American Dietetic Association.1995;95:336-340. This study was supported by Grant R40 MC 00319 (PI: D. Neumark-Sztainer) from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services. Analyses were supported by the Bell Institute of Health and Nutrition, General Mills and by the Adolescent Health Protection Research Training Program grant number T01-DP000112 (PI: L. Bearinger) from the Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (DHHS). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. This study was supported by Grant R40 MC 00319 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, Department of Health and Human Services. Also supported in part by Adolescent Health Protection Research Training grant number T01-DP000112 from the Center for Disease Control and Prevention (CDC), DHHS.