Examining the link between diet quality and patterns with metabolic parameters in historically underserved and ethnically diverse pediatric populations

Childhood overweight and obesity prevalence is a prominent public health crisis in the United States that contributes to increases in associated cardiometabolic diseases, all of which disproportionately affect racial/ethnic subgroups. Dietary habits are modifiable behaviors that have been shown to inflect changes in cardiometabolic parameters. Specifically, breakfast consumption is touted to have protective effects on cardiometabolic health and increase dietary quality. Many interventions aim to increase breakfast consumption and/or improve dietary quality through limiting processed foods and promoting whole foods. The purpose of this research was to elucidate relationships between cardiometabolic parameters, dietary patterns, and dietary quality in a historically underserved and ethnically diverse pediatric population. Baseline and post-intervention data were used from TX Sprouts, a school-based gardening, cooking, and nutrition education randomized controlled trial. The first aim was to examine and compare metabolic syndrome prevalence between existing definitions and elucidate racial-/ethnic-specific characteristics within each definition to clarify the utility of those definitions for a clinical population. There is no standardized definition for metabolic syndrome in pediatric populations, and research has highlighted racial/ethnic differences in metabolic syndrome prevalence but lacked recommendations to improve screening and provide equitable diagnoses. The second aim was to evaluate the impact of TX Sprouts on changes in breakfast consumption and the effect of changes in breakfast consumption on cardiometabolic outcomes. The third aim was to examine the effect of TX Sprouts on dietary quality using the NOVA food classification system, which classifies foods based on level of processing. Research was warranted because there are no known experimental studies that have examined the impact of a school-based gardening, cooking, and nutrition education intervention on breakfast consumption nor diet quality using the NOVA system in a predominately low-income, non-White population. The results of this research highlighted potential biases that exist in proposed pediatric metabolic syndrome definitions and recommend alternative biomarkers to better predict metabolic syndrome. Furthermore, increases in breakfast consumption were shown to improve glucose metabolism in a high-risk pediatric population, and TX Sprouts was effective at increasing unprocessed food and decreasing ultra-processed food consumption. Interventions targeting historically underserved populations are needed to improve dietary intake and quality to support cardiometabolic health.Nutritional Science