Para I Famagu'on-ta: Fruit and Vegetable Intake, Food Store Environment, and Childhood Overweight/Obesity on Guam

Abstract

BACKGROUND: Many studies support the influential role that the food store environment (FSE) has on children’s dietary intake and weight status. PURPOSE: To test if availability and access to fruits and vegetables (FV) in food stores is associated with prevalence of early childhood (2 – 8 years) overweight/obesity (≥85th BMI percentile) in selected communities on Guam; To test if actual FV intake of young children influences the relationship between the FSE and early childhood overweight/obesity prevalence. METHODS: FSE factors, including fresh FV score and presence of store by store type were assessed using the CX3 Food Availability and Marketing Survey that was amended for the Children’s Healthy Living (CHL) Program community trial and measured at baseline. Anthropometry and characteristic data of children (2 to 8 years; n=466) were collected across all communities and BMI z-scores and categories calculated using the 2000 CDC growth charts. Geographic coordinates of participant residences and food stores were obtained to construct ArcGIS maps and to calculate food store scores within 1 mile of participant residence. Food and Activity Logs (FAL) data of a sub-sample of child participants (n = 355) were collected to calculate FV and energy intakes. Bivariate correlations and logistic regression evaluated associations. RESULTS: A total of 111 stores were surveyed of which the majority was small markets (73%) and the remaining were convenience stores (16%) and large grocery/supermarkets (11%). Supermarkets and large grocery stores averaged the highest FV scores that met the standards for availability. About 1/5th and 1/10th of participants met fruit and vegetable intake recommendations, respectively, while nearly half of them exceeded recommendations for energy intake. A significant negative correlation was found between presence of small market nearest to participant residence and BMI z-score (r=- 0.129, p<0.05); and positive correlation found between presence of convenience store nearest to participant residence and BMI z-score (r=0.092, p<0.05). Logistic regression analysis yielded non-significant associations. CONCLUSION: High density of small markets may be an opportunity for FSE intervention but further investigations of other FSE factors with more communities are needed to understand the FSE’s influence on Guam.