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Title:   Author  item
                                            NICKLAS, THERESA - Baylor College Of Medicineitem
                                            LUI, YAN - Baylor College Of Medicineitem
                                            MARIA, GIOVANNI - California State Universityitem
                                            Jahns, Lisaitem
                                            TUCKER, KATHERINE - University Of Massachusettsitem
                                            Laugero, Kevin
  Submitted to: Journal of the Academy of Nutrition and Dietetics
                                    Publication Type: Peer Reviewed Journal
                                    Publication Acceptance Date: 12/30/2014
                                    Publication  Date: N/A
                                    Citation: N/AInterpretive 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 weight (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 children's BMI and barriers and facilitators to meeting the DGA.
                                Technical Abstract: Few Americans meet the Dietary Guidelines for Americans (DGA). Objective: 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. Design: A cross-sectional study. Participants/Setting: A total of 836 caregiver-child dyads completed the questionnaire across six sites among three race/ethnic groups participating in the HEALTH Study. Main Outcome Measures: Barriers and facilitators to meeting the DGA were assessed using a validated questionnaire. Heights and weights were
measured. Statistical Analyses: A series of bivariate regression analyses were conducted to examine the association between the caregivers' BMI or the children's BMI z-score and the barriers and
facilitators to meeting the DGA, adjusting for appropriate covariates in the models. Path analysis was used to develop a framework that simultaneously examined the relationship of caregivers' and children's barriers and facilitators to their relative BMIs. Results: Among the children, the BMI z-score
was associated positively (p<0.001) with total barriers and negatively (p<0.001) associated with total facilitators. Among the 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 component). For caregivers, most of the barriers to meeting recommendations for the eight MyPyramid components were positively associated (p<0.01) with BMI (with the exception of grain, milk, oils, and vegetable components). Facilitators to meeting vegetable and oils intake recommendations was the only score negatively associated (p<0.01) with caregivers BMI. Path analyses shows that Caregivers' facilitators significantly predicted children's facilitators to
meeting DGA recommendations (std ß= 0.12; p<0.001). For the children, but not the caregivers,facilitators to meeting DGA recommendations were related to lower BMI (std ß= -0.09;p=0.028). Conclusions: Our findings are among the first to show associations between children's BMI zscore and barriers and facilitators to meeting the DGA.


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