- Author: Jeannette E. Warnert
The alliance aims to make plain water the easy, appealing substitute for sugary beverages – soda, energy drinks, fruit drinks, and sweetened coffee and tea drinks. The alliance is also actively working on the safety of tap water in the nation's schools and childcare settings.
“To make water the beverage of choice will require a movement,” said Christina Hecht, a member of the NPI team. “NPI will build bridges, spearhead the creation of shared resources, align messages, strategies and aims, and coordinate strong external communications.”
NPI was formed by UC Agriculture and Natural Resources in 2014 to conduct, evaluate and share research related to the impact of nutrition and physical activity on public health. The W.K. Kellogg Foundation has awarded NPI a $960,000 grant to coordinate the National Drinking Water Alliance for three years.
“Even when water is available, too many children and adults choose sugar-sweetened beverages,” said Hecht, who will serve as the National Drinking Water Alliance coordinator. “In our American diet, sugary drinks are the top source of added sugars for both adults and children, and, remarkably, they are the single largest source of calories for teens aged 14 to 18.”
But Hecht is quick to point out that if people are to make the switch to water, water needs to be easily accessible and they need to know that it is safe to drink.
High consumption of sugar-sweetened drinks is associated with obesity and other chronic health problems, such as heart disease and diabetes. UCLA scientists reported in March that the diabetes epidemic in California is “out of control.” The study says 55 percent of the state's population has prediabetes or diabetes – many of them are undiagnosed.
“Simply switching to water is a relatively easy lifestyle change that can have a big impact on the intake of added sugar and excess calories, reducing diabetes risk,” Hecht said. “It can also improve oral health.”
The National Drinking Water Alliance includes government agencies, education officials, researchers, water industries, and non-governmental organizations like the Center for Science in the Public Interest, American Academy of Pediatrics Campaign for Dental Health, and the American Heart Association. They believe by sharing knowledge, resources and connections, they will hasten progress toward their common goal.
Fortunately, the current state of safe drinking water in the U.S. is mostly favorable. About 90 percent of Americans get their water from public utilities and 95 percent of those supply safe water. In some areas, however, water can become contaminated on the path between utility and tap, typically with lead. Sometimes other contaminants can leach in through breaks in pipes.
“We all recognize that, if we are going to tell people to drink water, they need to have confidence that the tap water is safe,” Hecht said. “At the moment, we don't know the magnitude of the problem of unsafe drinking water. The alliance is highly focused on policy as the most effective tool to bring about broad change.”
The National Drinking Water Alliance plans a Congressional hearing on national drinking water and is developing best practices for effective access to safe drinking water in schools and childcare settings.
In 2009, more fruits, vegetables, whole grains and low-fat milk were included in the food package provided by USDA's Special Supplemental Nutrition Program for Women, Infants and Children (WIC). As a result, the quality of diets improved for the roughly 4 million children who are served by WIC, according to a study by researchers at UCSF Benioff Children's Hospital in Oakland, UC San Francisco and UC Agriculture and Natural Resources' Nutrition Policy Institute.
“Although the findings only showed significant improvement for consumption of greens and beans, the other areas for which WIC has put in important efforts – increased consumption of whole fruits rather than fruit juice, increased whole grains – all show trends in the right direction,” said lead author June Tester, a physician at UCSF Benioff Children's Hospital Oakland, “and there is opportunity for further study in the future when more years have passed after this landmark change in the WIC package.”
Diets of children age 2 to 4 compared
For the UC study, which will be published in the May issue of Pediatrics journal, researchers analyzed the diets of 1,197 children, ages 2 to 4 years, from low-income households before and after the 2009 change in the food package.
The researchers used the National Health and Nutrition Examination Survey (NHANES) to compare a nationally representative sample from 2003 to 2008 with diets in 2011 to 2012. The researchers calculated the Healthy Eating Index (HEI-2010), which is a score with 100 possible points measuring adherence to dietary guidelines, from two 24-hour diet recalls. For children in households using WIC, this score increased from 52.4 to 58.3 after the policy change. After adjusting for characteristics in the sample and trends in the comparison group, the researchers showed that there was an increase of 3.7 points that was attributable to the WIC package change. This represents important evidence of an improvement in the diets for these children in WIC households.
Children don't eat enough green vegetables
“Vegetables are part of a healthful diet, but in general, children don't eat enough of them,” Tester said. Using the Healthy Eating Index, the researchers calculated the Greens and Beans score, which counts dark green vegetables and includes any legumes, such as beans and peas, that were not already counted as protein foods on a different score.
After the food package was changed, the Greens and Beans score increased for children in WIC but not for their counterparts. Roughly half of the children in WIC households had eaten some vegetables, whereas only one in five non-WIC children had consumed any green vegetables at all in the two days their parents were surveyed.
Important policy change
The change in the WIC food package is an important policy change in the effort to improve the quality of diets of young children, said Tester, a pediatrician.
Tester noted that the results of this study will be useful to the Institute of Medicine committee that is reviewing and assessing the nutritional status and food needs of the WIC-eligible population and the impact of the 2009 revision to WIC food packages. The committee will make recommendations for changing the food packages.
Establishing healthy eating patterns
“Increasing consumption of nutritious foods such as green leafy vegetables and whole grains in the low-income children served by WIC will help them establish healthier eating patterns for their future,” said co-author Patricia Crawford, UC Cooperative Extension nutrition specialist with UC ANR's Nutrition Policy Institute.
The switch from whole milk to low-fat milk was well received by the clientele and did not result in decreased milk consumption among the preschoolers, noted Tester, Crawford and co-author Cindy Leung, postdoctoral scholar at UCSF Center for Health and Community.
This study is the first to report on the significant improvements in diet quality in young children associated with the WIC package change using a nationally representative sample, and the first to do so with the updated Healthy Eating Index (HEI-2010). The National Institutes for Health funded this study.
Para leer la versión en español de este artículo, visite http://ucanr.edu/sites/Spanish/Noticias/?uid=6735&ds=199.
The “Technology and Design Innovation to Support 21st Century School Nutrition” project will assess the impact of using a “SmartMeal” technology platform, distributed points of sale and staff promotion of school meals at 12 SFUSD middle and high schools. Sixty percent of the district's students are eligible for free and reduced-price meals, as part of the National School Lunch Program, the country's largest child nutrition program. The researchers say that improving dietary intake among low-income youth is essential to reducing obesity, and schools are arguably the most important venue for change.
“Improving school meals is critical for addressing social inequities to healthful food access, said Lorrene Ritchie, Ph.D., RD, UCANR Nutrition Policy Institute director, Cooperative Extension specialist and co-primary investigator. “Poor nutrition is a primary cause of the obesity epidemic that threatens the health of American children, especially in low-income communities. We are targeting schools for interventions because most school-age children spend half of their waking hours and consume up to half of their daily calories in school.”
“This project will test whether we can change behavior by addressing the reality of today's adolescent lifestyles,” said Kristine Madsen, MD, associate professor in the School of Public Health and co-primary investigator.
“Mobile phones are ubiquitous among teens from diverse economic backgrounds, which makes this technology an ideal tool for promoting healthful food choices and nutrition education.”
The Nutrition Policy Institute was created in 2014 by UC Agriculture and Natural Resources, the division of the University of California charged with sharing research-based information with the public about healthy communities, nutrition, agricultural production and environmental stewardship. NPI seeks to improve nutrition and health in low-income communities in California and the nation by engaging in research and communications that inform, build and strengthen policy. Visit NPI online at http://npi.ucanr.edu. SFUSD's Future Dining Experience (http://www.sfusdfuturedining.org/) is funded by USDA and the Sara & Evan Williams Foundation.
The U.S. government should promote plain drinking water as the beverage of choice, according to comments submitted today by the University of California's Nutrition Policy Institute (NPI) at a public meeting for oral testimony on the Scientific Report of the 2015 Dietary Guidelines Advisory Committee. The institute also urged the U.S. Department
of Agriculture to add a symbol for water to its MyPlate graphic.
NPI experts said the government should employ strong language encouraging consumption of plain drinking water as a strategy in the fight against childhood obesity. Studies have established that Americans' single largest source of added sugars is sugar-sweetened beverages, that sugar-sweetened beverages are among the top sources of calories for U.S. children and teens, and that there are income and racial disparities in sugar-sweetened beverage consumption.
“It is clear from the evidence that a major contributor to obesity is sugary drinks,” said NPI Director Lorrene Ritchie. “And the healthiest alternative to sugary drinks is plain water.”
NPI noted that the Advisory Committee's 2015 scientific report said, “Strategies are needed to encourage the U.S. population to drink water when they are thirsty.” MyPlate – the infographic used by USDA to portray the recommendations in the Dietary Guidelines for Americans – is the “ideal platform” from which to encourage water consumption, according to NPI. In its comments, the institute said, “the addition of a water symbol will enable MyPlate to promote water consumption along with its other strong messages about a healthy diet.”
Ritchie said NPI is encouraging the public to join them in sending a message to the government. “Tell Washington to make water first for thirst and ask the USDA to reinforce it with an icon for water on MyPlate,” she said.
NPI developed a “Take Action!” page on its website with easy-to-follow guidelines for submitting comments on the Dietary Guidelines for Americans. The “Take Action!” web page is located at http://npi.ucanr.edu/water.
The Nutrition Policy Institute was created in 2014 by UC Agriculture and Natural Resources, the division of the University of California system charged with sharing research-based information with the public about healthy communities, nutrition, agricultural production and environmental stewardship. The institute seeks to improve eating habits and reduce obesity, hunger and chronic disease risk in California children and their families and beyond. Visit NPI online at http://npi.ucanr.edu.
- Author: Jeannette E. Warnert
The research, funded by the Robert Wood Johnson Foundation, shows that more preschool-aged children have ready access to water during all activities, mealtimes and snacktimes, indoors and out, when they are in Head Start, private and public centers and licensed family home daycare.
“This is so important for child nutrition and obesity prevention,” said Lorrene Ritchie, the director of the UC Nutrition Policy Institute and the study's principal author. “We've learned from older children that many of them never drink plain water, so they're not used to it and don't like the taste.”
In fact, national surveys in the early 2000s found that, on any given day, 84 percent of 2- to 5-year-old children drank sugar-sweetened beverages like sodas, sports drinks and fruit punch. The calories amounted to 11 percent of the children's total energy intake. At the same time more than one-quarter of young children in the U.S. did not drink plain water on any given day.
“Humans evolved to drink water, so our bodies don't register very well the calories in juices, sodas and sweetened beverages,” Ritchie said. “Giving a child a cup of Hi-C, Capri Sun, SunnyD or other sweetened beverage is like setting a sugar bowl in front of them. It's sweet and goes down easy, but they're consuming calories very quickly without realizing it.”
In 2008, University of California researchers documented the types of beverages served to children in childcare settings. They found that one-fifth of the childcare providers served whole milk, 2 percent offered flavored milk, and 27 percent gave children juice more than once per day. A small fraction, about 8 percent, served sugar-sweetened beverages to the children. Only 28 percent always served water with meals and snacks, and 36 percent served no water at all.
“Fully one-quarter of children are already overweight or obese when they enter kindergarten,” Ritchie said. “It was clear from the research that we needed to focus on the beverages in childcare.”
The UC research informed the writing of Assembly Bill 2084 by Rep. Julia Brownley in early 2010. The measure passed, was signed by Gov. Brown and went into effect in January 2012. Also in 2010, Congress enacted legislation, based on UC and other research, that requires drinking water be available all day in childcare facilities that take part in the federally funded Child and Adult Care Food Program.
“The UC Nutrition Policy Institute's research was tracked provision by provision into groundbreaking state legislation,” said Kenneth Hecht, Nutrition Policy Institute coordinator. “NPI research is now the basis for the law of the land.”
After the state and federal laws went into effect, Ritchie and her research team embarked on a second study to determine the impact of the legislation on beverages served in childcare settings. At the time of the second survey, 77 percent of providers had self-serve water available indoors and 78 percent had it available outdoors. Nearly half of the providers served water with meals and snacks.
Children in programs following the new law have access to drinking water throughout the day and at meal and snack times. Children are no longer offered whole milk (after age 2), flavored milk or sugar-sweetened beverages and given no more than one glass of 100 percent juice each day.
“We've made great strides using research to inform policy, but there is still much to do to improve the nutrition of young children,” Ritchie said. “We are sticking with it.”