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DIETARY AND ANTHROPOMETRIC STATUS CF

6-12 YEAR OLD JAPANESE CHILDREN
WHO LIVE IN THE UNITED STATES

presented by

JUN K0 ISHIHARA

has been accepted towards fulfillment
of the requirements for

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MSU is An Affirmative Adlai/Equal Opportunity Institution
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DIETARY AND ANTHROPOMETRIC STATUS OF
6-12 YEAR OLD JAPANESE CHILDREN WHO LIVE IN THE UNITED STATES.

By

Junko Ishihara

A THESIS
Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF SCIENCE

Department of Food Science and Human Nutrition

1996

ABSTRACT

DIETARY AND ANTHROPOMETRIC STATUS OF
6-12 YEAR OLD JAPANESE CHILDREN WHO LIVE IN THE UNITED STATES.

By

Junko Ishihara

Westemization of lifestyle affects diet and anthropometric status in immigrants. This
study was designed to investigate the dietary and anthropometric status of
Japanese children who have lived in the US from 1 to 96 months. All values were
adjusted for age and sex Compared to children who lived in the US. for 1-2 months,
body mass index increased by 15% and triwps skinfolds increased by 3.7% in those
children who lived in the US. 48-96 months. Children who lived in the US. 1-12
months expended 62i2kcallkg body weight per day whereas children who lived in
the US. 48-96 months expended 59i2kcallkg body weight per day. The average
age for both groups of children were 8.3 years. Children consumed mean of
1779:50 kcal per day. Fat intake was 29.41.0796 of the kilowlories with no change

relative to length of stay. However, milk consumption increased from 0.6 to 1.7

servings per day.

ACKNOWLEDGMENTS

My sincere appreciation is extended to the following people for their
contributions to this study:

Dr. Rachel Schemmel, my advisor, who provided the opportunity for me to
complete my degree and whose professionalism and optimism are much to be
admired.

Dr. Norma Bobbitt, Dr. Sharon Hoerr and Dr. Won Song for their most helpful
advice and insight regarding this study.

Dr. Norris Bryson from Department of Education, MSU, Ms. Sharalyn
Brandell, Superintendent, Lakeview School District, Battle Creek, Mr. Katsumi
Takasaki, Principal, Battle Creek Japanese School, and Mr. Ted Takagi, Chair and
members of the Japanese Parent Committee for their understanding, cooperation
and support for the project.

Undergraduate students, Yukari Aoshima and Stephanie VanDeventer for
their valuable assistance in data collection, and Jennifer Torrenti for her assistance
in data calculations related to snacking patterns of children.

Dr. Rob Tempelman for explaining and helping with the statistical procedure.

My family and my fiance, David, for their support.

My appreciation is also extended to the Graduate School and Vice-Provost
for University Outreach, Dr. Votruba, of Michigan State University for an All-

University Outreach Grant to support the project.

iii

TABLE OF CONTENTS

LIST OF TABLES .............................................................................................. vi

LIST OF FIGURES ............................................................................................ vii

CHAPTER I

INTRODUCTION ............................................................................................... 1

CHAPTER II

LITERATURE REVIEW ..................................................................................... 5
Culture and food behavior ...................................................................... 6
Measurement of food intake ................................................................... 8
Nutrient composition of food ................................................................... 14
Significance of anthropometric measurements in children .................... 15

CHAPTER III

ANTHROPOMETRIC STATUS AND DIETARY FAT INTAKE OF 6-12 YEAR—OLD

JAPANESE CHILDREN WHO LIVE IN THE UNITED STATES ...................... 17
Introduction ............................................................................................. 18
Method .................................................................................................... 20
Results .................................................................................................... 26
Discussion ............................................................................................... 29

CHAPTER IV

FOOD GROUP INTAKE FROM THE FOOD GUIDE PYRAMID AND SNACKING
PATTERNS OF 6-12-YEAR-OLD JAPANESE CHILDREN WHO LIVE IN THE

UNITED STATES ............................................................................................... 51
Introduction ............................................................................................. 52
Method .................................................................................................... 54
Results and discussion ........................................................................... 56

CHAPTER V

APPLICATION OF THIS RESEARCH ............................................................... 70

iv

APPENDICES ..................................................................................................... 72
Appendix A Approval from University Committee on Research Involving

Human Subjects (UCRIHS) .............................................................. 72
Appendix B. Consent form ...................................................................... 73
Appendix C. Twenty-four hours diet record form .................................... 74
Appendix D. Direction for filling out twenty-four hours diet record form. 75
Appendix E. Food frequency questions ................................................... 76
Appendix F. Demographic questions ....................................................... 77
BIBLIOGRAPHY ................................................................................................... 78

LIST OF TABLES
Table 3-1. Height, might, triceps skinfold and mlculated body mass index (BMI) of

Japanese children age 6 to 12 living in the US .................................................. 34
Table 3-2. Daily energy intake and fat intake of Japanese school children age 6 to
12 living in the US ............................................................................................... 35
Table 3-3. Daily energy expenditure and hour of physical activity of Japanese school
children age 6 to 12 living in the US ................................................................... 36
Table 3-4. Daily fat intake per 1000 kcal of Japanese school children living in the
US ........................................................................................................................ 37
Table 3-5. Anthropometry and fat intake in relationship to % energy intake from fat of
Japanese children who live in the US ................................................................ 38
Table 3-6. Anthropometry and fat intake in relationship to length of residence in the
US. of Japanese children who live in the US .................................................... 39
Table 3-7-1. Correlation coefficient matrices for anthropometric and dietary intake
variables of Japanese children living in the US ................................................. 40
Table 3-7-2. Correlation coefficient matrices for boys ........................................ 41
Table 3-7-3. Correlation coefficient matrices for girls ......................................... 42

Table 4—1. Consumption of food groups from Food Guide Pyramid in relationship to
length of residence in the US .............................................................................. 63

Table 4-2. Energy intake from snacking of Japanese children who live in the US. in
relationship to length of residence in the US ...................................................... 64

LIST OF FIGURES
Fig 3—1. Body mass index (BMI) and Triceps skinfold (TSF) for Japanese children

living in the US ..................................................................................................... 43
Fig 3—2. Fat intakes in relationship to age ........................................................... 44
Fig 3-3. Correlation between length of stay and BMI ......................................... 46
Fig 3-4. Correlation between length of stay and TSF ........................................ 47

Fig 3-5. BMI in this study compared to the BMI from Japanese National Nutrition
Survey and Second National Health and Nutrition Examination Survey
(NHANESII) .......................................................................................................... 48

Fig 3-6. TSF in this study compared to the 50th %tile TSF of Second National Health
and Nutrition Examination Survey (NHANESII) .................................................. 50

Fig 4-1. Percentage of Japanese children who consumed the servings of
bread/cereallricelpasta group recommended in Food Guide Pyramid ........ 65

Fig 4-2. Percentage of Japanese children who consumed the servings of
vegetable group recommended in Food Guide Pyramid ............................. 66

Fig 43. Percentage of Japanese children who consumed the servings of fruit
group recommended in Food Guide Pyramid ................................................. 67

Fig 4-4. Percentage of Japanese children who consumed the servings of
milk/cheeselyogurt group recommended in Food Guide Pyramid ............... 68

Fig 4—5. Percentage of Japanese children who consumed the servings of
meatlpoultryffishllegumelegglnut group recommended in Food Guide
Pyramid ........................................................................................................ 69

vii

CHAPTER I

INTRODUCTION

2
It is important to identify the nutrient intake of individuals or groups of people

when dealing with problems of chronic diseases. As difficult as it is to get accurate
information about food intakes, and the translation of food intake into nutrient intake,
it is even more difficult to alter food habits to promote overall health in the individual.
The best place to begin to change food behavior is with the children (Van Horn et
al., 1993).

In the US, there is a large discrepancy between dietary recommendations
and food behavior (Patterson et al., 1990; Kant et al., 1991 ). Attention to food
habits is important in order to assure a healthy society (Allison et al., 1993). The
best time to develop good food habits is during childhood. Children are good
imitators (Alford and Bogle, 1982) and children adapt their food habits to their
culture.

The Western diet, with its high amount of protein, is one which has been
documented to support good growth in children (Chusilp et al., 1992; Allen, 1994).

Usually, the Western diet also has a high amount of fat. It is also a diet, which has
routinely been criticized for its high quantity of fat, and low quantity of complex
carbohydrates (Morbidity and Mortality Weekly Report, 1994). Recently, such diets
have been associated with a high prevalence of obesity and all of the chronic
diseases which accompany obesity and high dietary fat intakes (Kuczmarski et al,
1994; Miller et al, 1994).

Traditional Asian diet is unlike the Westem diet. The diets of the elderly of

Asian heritage are different from other elderly populations (10m et al., 1993).

3
Likewise, among the Asian ethnic groups, underweight in the elderly is more

common than obesity. The native Japanese diet is one which provides a high intake
of complex carbohydrates in the form of grains (rice, noodles), fruits and vegetables
and is low in fat (Kim et al., 1993).

Developed countries such as the US. have a high prevalence of obesity,
cardiovascular disease, diabetes, and certain types of cancer such as breast and
prostate (Abraham et al., 1983), which are associated with excessive intakes of
energy or fat. Furthermore, migration of people to the US. (and their presumed
adoption of the Western diet), is frequently associated with an increased incidence
of chronic diseases. This has been demonstrated by comparisons of Irish who lived
in Boston with those who live in Ireland. The incidence of cardiovascular disease is
much higher for those Irish who migrated to the US. than for those who remained in
Ireland (Brown et al., 1970). The same is true for Japanese who have migrated to
Hamii compared to those who remained in Japan (Stemmerrnann, 1985; Curb and
Marcus, 1991). This is also true among native American populations as illustrated
by the Pima Indians and their much higher prevalence of diabetes after adoption of
the Western diet compared to their native diets (Bennett et al., 1982). With the
ever-increasing global interactions, the adoption of the Western diet has become
commonplace, not only upon migration to a Western country, but also within the
country, as the economy improves.

One such country is Japan. It has an ever increasing number of American-

type fast food restaurants, which muld indiwte that people are moving from the

4
traditional Japanese diet to a Western diet In contrast to 8.7% fat intake by

Japanese in 1955, it jumped up to 25.4% in 1990 (Ministry of Health and Welfare,
Japan, 1993). Little information is available on how rapidly diet changes take place,
whetherornotchangecan beforestalled, and whetherornotthere are certain
factors such as the nutrition knowledge of the mother which will impact on dietary
changes.

National Center of Health Statistics (NCHS) has done surveys which covers
White, Blacks and Hispanics, but has not done surveys for the Asian population
(National Health and Nutrition Examination Survey 1976-80; Hispanic Health and
Nutrition Examination Survey, 1982-84). Since the Asians are the third fastest
growing population in the US, predicted to be triple of 1992 by the year 2020
(Fusaro, 1994), those data would not be representative without the information of
Asian population. Dietary and anthropometric data of Asian are needed. Prevention
of chronic disease begins with a nation's children. WW.MI§§W_MII
investigate dietary behavior of Japanese children who ,now live in the US. Mtbtbeir:
. parents. The parents are associated with various Japanese businesses within the
stateofMicbigarL Many sudzlcompaniesare located in the Battle Creek area and

the Japanese families have lived in the US. for varying lengths of time.

CHAPTER II

LITERATURE REVIEW

 

Culture and food behavior.

Cultural forces shape food intake and other behaviors (Terry, 1994).
Homver, the incorporation of cultural factors into dietary assessments and
interventions are all too often neglected or superficial. Culture influences food
behavior and the food environment (Bass, et al. 1979; Terry, 1993). Observation of
neighborhoods, homes in which people live, shopping practices, food availability,
food storage, and food preparation all contribute to a better understanding of dietary
behaviors.

The home environment gmatly impacts culture. The home functions as a
learning center, which was confirmed by rewarch by Bobbitt and Paolucci (1975).
Their classical study affirmed that the home is the primary environment for learning
for children, especially prior to attending school. Additionally, the home serves as a
learning center for all family members over the life cycle. For young, middle and
older family categories, "feeding the family was ranked as the most frequent learning
activity" (Bobbitt and Paolucci, 1975). The home is the environment that transmits
culture and there are cultural influences on food choices and preferences which, in
turn, impact nutritional status.

The acculturation, the adaptation in culture, happens sometime on this
transmission process of culture in the home environment. The change does not
likely appear suddenly. A study in Mexican-American family shomd that the food-
related roles in Mexicans who immigrated to the US. remained wife's job which is a

tradition of Mexican culture (Yetley, 1981 ). A study in Chinese immigrants in

7
Australia shomd the first generation Chinese—Australians kept more traditional,

organized and structumd family pattern than the second generation did (Rosenthal,
1990). Nrother study on Chinese students who studied in the US. reported that
those students form an ethnic enclave of their own, and tended to remain in their
original culture just like the first generation immigrant group (Kang, 1972).

The two most influential factors that relate to the acculturation are probably
length of stay in the different culture and age of adaptation. Acculturation of
Vietnamese immigrants and Haitian immigrants in the US. had been reported (Tran,

1992; Clement, 1991). Both studies shomd that acculturation had significant
relationship with age and length of the residence. Dietary habits is one of the
largest portions that contribute to the acculturation. A study in Asian Indian
immigrants to the US. reported that acaulturation of their dietary habits of
vegetarianism occurred in relationship to the factors such as marital status, age,
sex, length of stay in the US. and ccste (Gupta, 1975). Fruit and vegetable
consumption was inversely related to the length of US. residence in Mexican
mmen (Chavez et al, 1994). A study in Germany revealed that adaptation of
immigrant children to the German way of life was easier and more complete for
younger children, particularly those who arrived in Germany before beginning
school (Schrader, 1978). The author of the article says that six year olds is the

vulnerable age at which the enculturation, the transmission of the culture, begins.

 

Measurement of food intake:

Gibson (1990) has classified methods for the evaluation of food intake into
two categories, one vrhich gives quantitative information and the other qualitative.
Quantitative methods are dietary recalls and records, designed to measure the
quantity of foods consumed by individuals over a short period of time. Qualitative
methods include a dietary history and a food frequency questionnaire, designed to
obtain information about food consumed during a longer period of time. Food

frequency questionnaire can also be a semiquantitative method.

24-Hour Diet Recalls. In the 24-hour recall method, the investigator, in an
interview, helps me subject to recall the exact food intake for the previous day.
Detailed descriptions of the foods, beverages, vitamin and mineral supplements
consumed are recorded. Cooking methods, recipes, time of day food is consumed,
brand names, especially for fast foods and cereals, are recorded by the interviemr.

Quantities of the food consumed are estimated in household units by use of plates,
glasses, cups, spoons of various sizes or with food models (Gibson, 1990).

For assessing the average food intake of large populations, the dietary recall
is effective as mll as economical. One of the limitations of such a retrospective
method includes the inability of the subject to recall what was eaten yesterday
(Young and Trulson, 1960). Many people eat without paying much attention to the
type and amount of food eaten (Dwyer et al., 1987). This is associated with the fact

that eating behavior is habitual and requires little attention (Anderson, 1980).

9
Omission of foods, which are not major parts of the meal, is apt to occur (Greger &

Etnyre 1978, Krantzler et al. 1982). Memory may also be a problem, especially for
the elderly (Bazarre et al. 1983) and young children (Emmons and Hayes, 1973).
Another problem is that some individuals also want to be perceived as eating a good
diet, so they may report eating food which they perceive as "healthy" even though
they may not have consumed it (Madden et al. 1976). Some subjects may elaborate
on what they have eaten, inventing details of foods consumed that are reasonable
but not actually consumed (Dwyer 1987).

In addition, children have had little previous experience with food and food
preparation which interferes with their ability to assess food intakes accurately (Lytle
et al. 1993). The authors (Lytle et al. 1993) concluded that food diaries or food
records for children 10 years and under greatly enhanwd the accuracy of the food
intake and concluded that this was a valid procedure for assessing food intake.
Investigators such as Van Horn et al. (1993) and Lytle et al. (1993) suggest that 24—
hour recalls without parental assistance are valid in children as young as 8 years of
age. Homver, according to Hertzler et al. (1993) information reported by pre-

schoolers is not sufficiently accurate to calculate nutrient intakes.

Dietary record. Dietary record is a prospective method for obtaining
information about food consumed. The number of days that food intake is recorded
must be sufficient to obtain information about usual food intake (Sempos et al.,

1984, St. Jeor et al., 1983, White et al., 1981, Guthrie and Crocetti, 1985). The food

10
eaten and the amount is recorded at the time of consumption. In the seven-day

dietary record, Gersovitz et al. (1978) reported that, in general, mean nutrient
intakes mre the same as those recorded by measurement of actual intake. There
mre Mo exceptions, means for kilocalories and thiamin mre slightly lomr when
calculated from the seven-day record compared to actual intake. Gersovitz et al.
(1978) also reported that adult age, gender, education, site or interviewer
differences did not affect validity of the seven-day record.

When Gersovitz et al. (1978) used a seven-day record, they reported that the
number of food records returned and the usability and the accuracy of the records
tended to decline by the 5th, 6th and 7th days. At first, 85% ofthe records mre able
tobeused, whereas bythe7th day, only60%oftherecordsmreabletobeused.
Among adolescents, and when requesting seven-day records, Sprauve and Dodds
(1965) received only 45% useable records. Subject dropout during the course of the
study, may impact the final results. However, Dierks and Morse (1965) reported that
theymre able to use 95% ofthethree-dayfood intake recordsofpreschool
children. In general, one mekend day and two mek days provide as useful
information as seven or more days (Guthrie and Crocetti, 1985).

There are considerable differences between food intakes reported for mek-
days vs. mek-end days (Thompson et al. 1986). Hackett et al. (1983) reported that
the dietary diary or record and interview to estimate the food intake of children was a
very effective method to obtain food intake data on children. This was also the

procedure used in the Young Runners/Young Wrestlers study at MSU (Schemmel et

11
al., 1988) and it ms effective.

Homver, there are some problems associated with obtaining accurate food
intake records. Subjects may have forgotten to record their intakes on the assigned
day and decide to substitute a different day which impacts on the representativeness
of the three-day records. Failure to record all foods, especially condiments or added
fats and mats, contributes to an underestimation of nutrient intakes (Sempos et al.,
1984, St Jeor et al., 1983; White et al., 1981). Another limitation is that food intake
may be altered during the recording period. Subjects may also find it burdensome to
do the detailed recording (Dwyer, 1988). Compared to the 24-hour recall, the

problems related to memory are eliminated.

Diet history. A dietary history procedure was developed by Burke (1938),
who was the research nutritionist for the Harvard (Boston) longitudinal studies of
growth and development of children (Dwyer, 1988; Burke, 1947) in the 1930's. The
dietary history method attempts to describe the subject's usual intake over several
months or years, collects general information about the subject's overall health
habits, forrnsacheckonthedatagivenand includesathree-dayfood diaryor

record (Lee and Nieman, 1993).

Food frequency questionnaire (FFQ). The food frequency questionnaire is
designed to assess the quality of food intake of individuals. It consists of lists of

food items or food groups and inquires about frequency of food consumption of the

12
listed foods (Dwyer, 1988; Lee and Nielsen 1993). In general, respondents identify

whether the food is eaten daily, mekly, monthly or seldom. Some FFQ have portion
size to allow the respondent to indicate the approximate amount of the food eaten.
When that is not included, the investigator assumes a "standard" serving size
portion was consumed. Standard portion sizes vary according to the age of the child
(Alford and Bogle, 1982). An advantage of the FFQ is that it can be self-
administered or administered by interviemrs who are not mll trained (Dwyer,

1988).

FFQ vary and may be designed to elicit smcific responses about food
intakes which may impact on Vitamin A or saturated fat or fat intake, for example.
Commonly used food frequency questionnaires include those recently developed
and recommended by Block (Brown and Griebler, 1993; Block et al., 1990; Block et

al., 1989) or by erlett (Feskanich et al., 1993; VVillett et al., 1985).

Assessment of portion size. One of the major stumbling blocks in the
assessment of food intakes is related to the ability of the responders to assess
portion size. This may be a more serious drawback among some respondents such
as children or the elderly (Gibson, 1990). For example, Dwyer et al., (1987)
reported that children remember portions of the foods they like as being larger than
portions of food they do not like. In 24-hour recalls, Gersovitz et al. (1978) have
demonstrated that portion size of small servings is overestimated and that of large

servings is underestimated (Flat slope syndrome).

1 3
Guthrie (1984) reported that subjects had difficulty assessing the amount of a

food eaten without the assistance of measuring devices. Subjects mre able to
assess standard portion sizes of milk as a beverage, butter for toast, sugar on cereal
and size of tossed salad better than standard portions for dry cereal, orange juice,
tuna or fruit salads. Guthrie (1984) concluded that subjects needed to be provided
some aid to estimate portion size. Bolland et al. (1988) reported that the group of
subjects who had training with food models significantly improved in estimating
portion size compared to subjects without training.

Various methods have been developed to assist subjects in estimating
portion size. In the dietary intervention study on children (DISC), models mre
generic in nature, and did not depict any food. Models included rectangles, circles,
wedges, thickness indicators, cups, mounds, bowls, spoons and other shapes. Van
Horn et al. (1993) concluded that this was an effective procedure. In the Young
Runners study at Michigan State University such a procedure was also found to be
effective (Schemmel et al., 1986, Schemmel et al., 1988).

Hunter et al. (1988) suggest that specifying a standard serving size in FFQ
does not introduce a large error. Kuehneman et al. (1994) compared the
effectiveness of four different methods to evaluate the ability of care givers of young
children to assess portion size in a FFQ. Compared to use of graduated food
models, plastic food models and food pictures, these authors (Kuehneman et al.,
1994), reported that use of standard serving sizes was most accurate for

determining portion size. Gibson (1990) suggests that standard serving size is

14
effective in FFQ, but that should not be used when gathering quantitative dietary

data by food diaries or dietary mcalls.

Nutrient comfl'on of foods:

The collection of food intake data is usually done to obtain an assessment of
nutrient intakes. As was true for food intake information, precautions must be taken
to assure that the best possible food composition data are used. The United States
Department of Agriculture (USDA) has the largest and most complete nutrient
content of food data (Handbook No. 8, 1976-1986) in the world (Dwyer, 1988). The
USDA attempts to develop mean values for nutrients in foods based on the US.
available food supply. For example, if 80% of carrots eaten in the US. are grown in
California and 20% in Michigan, then the mean values for nutrients in carrots grown
in California would be mighted higher than the mean values for carrots grown in
Michigan. Thus, nutrient values tend to be representative of the foods eaten. Many
food composition tables rely on USDA data. Homver, USDA data are not identified
as to source or brand name. The USDA Data Bank and Handbook contain 5300
food items for up to 70 different macro- or micro-nutrients (US General Accounting
Office, 1993). Prepared foods are not included in the USDA Handbook Others,
such as Pennington (1993), have developed food composition tables for single food
items as mll as prepared foods but food composition data are based on USDA
analytical data.

Newfood products are being developed at a rapid rate. Some of these food

1 5
products may be added to the Handbook For some nutrients, good analytical data

are not yet developed (Rand, 1985). In viewof some ofthe drawbacks ofthe food
composition tables, and nutrient data bases, precautions need to be exercised when
making precise conclusions about nutrient intake. This is even more true about the
numerous computerized dietary assessment systems which have become widely
available. These nwd to be updated on a routine basis to assure the most accurate

information on the nutrient composition of foods is included.

Signjcance of antlrgggmtrk measurerrients in children:

Height and might are widely used measurements which are sensitive
indicators of growth and development of children. For children, might for age,
height for age and might for height are frequeme used to assess the growth of
children. Weight for age in children from six months to seven years of age is an
index of acute malnutrition, and is widely used to assess protein energy malnutrition
and over nutrition, especially in infancy when the measurement of length is difficult
(Gibson, 1990). Homver, might for age does not take into account height
differences. Height for age can be used as an index of nutritional status of
population group when the children are stunted because of the condition of periodic
or chronic undemutrition. Weight for height reflects the current state of nutrition
wlereas height for age reflects past nutritional status (Waterlow et al., 1977).
Weight for height is relatively independent of age between one and ten years

(Gibson, 1990).

16
Percentile standards for might for height, and height for age for each gender

have been developed for American children of diverse backgrounds (Hamill et al.,
1979). A might to height index such as the Quetelet index may indicate a relative
fatness (Garrow& Webster, 1985) but it is less closely related to bodyfatthan the
skinfold thickness (Womersley and Dumin, 1977).

Skinfold thicknesses provide an estimate of the size of the subcutaneous fat
depots, which, in tum, provides an estimate of the total body fat (Dumin and
Rahaman, 1967). Siri equation (Siri, 1961) or Brozek equation (Brozek, 1963) are
frequently used to calculate body fat percentage for adults. Homver, these
equations are not applicable to children (Lohman, 1981, Slaughter, 1984). Several
researchers tried to investigate the equation to calculate the body fat percentage by
skinfold thickness measurements in children. Weststrate and Deurenberg (1989) did
a study to validate the body density calculated by use of theoretically defined
prediction equations. These equations mre constructed on the basis of Siri’s and
Brozek’s equations, and they mre sex- and age dependent. Moreover, Deurenberg
et al. (1990) tested these equations in 378 boys and girls, aged 7-20 years. The
result indicated that the assessment of percentage body fat from skinfold
thicknesses had a prediction error of 3-5%, and which was highest in perepumnal
children. Homver, Lehman (1986) suggested that the equations to calculate the

body fat from skinfold thicknesses should be used with caution in children.

CHAPTER III

ANTHROPOMETRIC STATUS AND DIETARY FAT INTAKE OF 6-12-YEAR-OLD
JAPANESE CHILDREN WHO IJVE IN THE UNITED STATES

17

INTRODUCTION

In Western countries, obesity and excessive intakes of energy and fat are
associated with a high prevalence of chronic diseases such as cardiovascular
disease, diabetes, and some types of cancer (Abraham, 1983). In the United
States, chronic diseases associated with the obesity have been a serious public
health issue for years. Obesity in childhood is especially critical because it
frequently leads to obesity in adulthood (Rimm & Rimm, 1976). Data from First
and Second National Health Nutrition Surveys (NHANES l and NHANES ll)
indicated that prevalence of obesity in children, age 6-11, had increased from
22.5% to 27.1% between 1963 and 1980 in the US (Gortmaker et al., 1987).

When immigrants come to the US, acculturation occurs, and their life
styles, including diet, shift to patterns which are similar to people who reside in
the US (Yang 8 Fox, 1979). Intakes of energy and fat were significantly higher in
US-bom Chinese women than foreign-bom Chinese (Schultz, et al., 1994).
Anthropometric status and prevalence of certain diseases also change. Tanner
indicated (1976) that a secular trend in stature of Japanese children who
immigrated in the US occurred up to the late 19503. After that, the trend shifted
and their stature remained slightly shorter than Caucasians. Japanese adults
who have migrated to Hawaii and California had a higher prevalence of obesity
(12.9%, BMI 2 27.8) compared to those who remained in Japan (3.2%) (Curb &
Marcus, 1991). Prevalence of diabetes increased in Pima Indians after adoption

of the Western diet compared to their native diets (Bennet et al., 1982). It is

18

19
evident that the Westemization of the people has a great impact on changing

health status.

F urthennore, the Westemization of the diet, anthropometric changes and
prevalence of certain diseases can also occur in the people’s original countries
today. The obesity is becoming more common among societies other than
Western culture. According to the data from Japanese National Nutrition Survey
(Ministry of Health and Welfare, Japan, 1993), obesity is defined by combination
of triceps and subscapular skinfold thickness of 40 mm for adult males and 50
mm for adult females. Prevalence obesity in Japanese adults was 13.4% in men
and 17.1% in women in 1991. theki et al. (1990) reported that in Japan the
prevalence of juvenile obesity (125% or more of relative weight) was 1 in 100
adolescent boys and 2 in 100 adolescent girls, age 12—14, in Japan. It is
presumed that obesity had not been a problem before the economic
development of the country because the traditional Japanese diet was low in fat
(Kim et al., 1993). Data collected in the Japanese National Nutrition Survey
indicated that the average Japanese diet contained only 8.7% of energy from fat
in 1955 (Ministry of Health and Welfare, Japan, 1993). However percent energy
intake from fat jumped up to 25.4% in 1990.

Little information is available on how rapidly dietary and anthropometric
changes occur in Japanese children living under the influential circumstance of
Western culture. Therefore, this study will investigate the amount of dietary fat
and anthropometric status in those children who have lived in the US from one

month to 8 years. The study will also evaluate those parameters associated with

20
month to 8 years. The study will also evaluate those parameters associated with

fat intake and anthropometric status including such items as saturated and
polyunsaturated fatty acid intakes, and percentage of kilocalories which come
from fat, and physical activity.

The specific hypotheses tested are: (1) Japanese children who have lived
in the US for 5 years or more have greater intakes of energy and fat, and have
higher BMI and larger triceps skinfold measurements than those who have lived
in the US for 1 year or less. Those who have lived in the US for 2-4 years have
intermediate amount intakes of energy and fat, BMI and triceps skinfold. (2)
Japanese children who consume more of their energy from fat consume more
energy and fat, and have higher BMI and larger triceps skinfold. (3) There is a
positive correlation between length of residence in the US and BMI, TSF, energy
intake and fat intakes. (4) There is a negative correlation between length of

residence and physical activity.

METHOD
Mike—181

Subjects are 59 healthy Japanese children (33 females, 26 males, ages 6 to
12 years) who attend Saturday school in Battle Creek, Michigan. They were born in
Japan, but now they live in Michigan or Indiana with their families, as temporary
residents. One or both of their parents work for companies that have branches in
Battle Creek, Jackson, Goldwater or Kalamazoo, Michigan or Goshen, Indiana. The

Japanese children attend US schools during the mek, but attend Saturday school

21
to study Japanese language and mathematics. It is assumed that the children are

exposed to Western culture outside of the home at the public school, while the
other hand, the children have a traditional family life at home.

This project was approved by the University Committee on Research
Involving Human Subjects (UCRIHS) at Michigan State University fall, 1994 (IRB#
94-501, Appendix A). The project was conducted with the approval and cooperation
of the Board of Battle Creek Japanese School (BCJS) and Mr. Takasaki, the
principal. In order to get the approval of the project, investigators met with the board
members and Mr. Takasaki at MSU to explain the duty and benefit of the subjects.
Investigators also visited BCJS to meet with Japanese parents’ school committee.
The agreement between the BCJS and investigators required the investigators
conpensate the each subject by providing feedback with nutritional and
anthropometric information.

The consent form (Appendix B) and questionnaires mre handed out to the
students in the Japanese school class. The signing of the consent form by subjects'
parents indicated a willingness to participate in the study. Fifty nine out of a potential
of 83 students, or 71% participated in the study. All 55 households responded for at

least one of the children in their house, and 4 households responded for 2 children.

Data collection ure:
Food records. Food intakes for thme days (3-day food record form,
Appendix C) mre recorded by their parents in Japanese language. They mre

asked to include amounts of food eaten, brand names and recipes for mixed dishes.

22
Also requested mre the time of day the food was eaten where the food was eaten.

Written directions included two-dimensional food model pictures for filling out portion
size (Appendix D) mre given to the parents. Three-day food record include two
mekdays and one mekend day. Subjects turned their food records into an
investigator (J.l.) at school. After collecting the food records, the investigator
intervimd some parents over the telephone when the information in food record

needed further clarification.

Food Questionnaire. A Block Screening Questionnaire for fat intake (Block
et al., 1989) was modified and used (Appendix E). The questionnaire was designed
to screen the subjects with high fat intake from meats and snacks. Questions were
translated from English to Japanese, and asked orally to each student by a
Japanese-speaking investigator (J.l.). Those questions sought information about

howfrequently those students eat certain type of foods.

Demographic data. An instrument was developed to elicit demographic
data (Appendix F). This questionnaire asked questions about child's age, sex,
number of years of residence in the US and previous residence in the US, and
physical activity.

Mcasummcnt of height and weight. Height and might mre measured
following standardized promdures (Lohman, 1988). Measuren'ents mre carried

out by a trained investigator (J.l.).

23
Height was measured using a tape measure and a right-angle headboard.

Nonstretchable tape measure was attached to a flat, vertical wall surface. The wall
did not have a baseboard, and the subjects stood on bare floor. The subjects’ feet
mre bare, and flat on floor. Heels mre close together and against the wall.
Shoulders mre relaxed, and arms extended. Head, shoulder blades, and buttocks
mre against the wall. The subjects looked out straight The investigator placed the
right-angle headboard on the highest level of the head, and read the measurement
on eye level. The measurement was read to the nearest 0.1 cm, and was done
twice for each subject to insure accuracy. If there were differences in measurments,
the average of the two heights was used to determine height.

Weight was measured using a balance-beam scale. The subjects mre light
clothing and no shoes. The subjects stood still in the middle of the scale’s platform
without touching anything and with body might equally distributed on both feet. The
measurements mre read to the nearest 1/4 lb., and mre done twice for each
subject to insure accuracy. If there were difference in measurements, average of the

two mights was used to determine body might.

Measurement of triceps skinfold. The triceps skinfold is located at the back
of left upper arm midway between the acromion and olecranon processes. The arm
was folded to locate the midpoint. The arm was relaxed and hung freely during the
skinfold measurement. The measurement was taken by separating the skin and
subcutaneous tissue from the muscle. This was done by picking up the skin and

subcutaneous tissue with the thumb and forefinger of the left hand at a distance 1

24
cm from the mark or site at which the Lange caliper is to be placed, and pulling the

fold amy from the underlying muscle. The fold was pinched and held while taking
the measurement. Homver, the pressure on the fold was completely exerted by the
caliper. The dial was read to the nearest 0.5 mm. The reading was done three
times for each subject to insure accuracy. If there mre difference in readings, the

average of the three measurements was used to determine triceps skinfold of
subjects.

W:

Dietary intake measurements. Computer analyses of the food records for
mean daily intakes and percent Recommended Dietary Allowance (RDA) of energy
and fat including total fat, saturated fatty acid, polyunsaturated fatty acid,
monounsaturated fatty acid and cholesterol were done by Nutritionist IV, Version 3.0
(N-squared computing, Salem, OR, 1993). Total fat, saturated fatty acid,
polyunsaturated fatty acid and cholesterol intakes mre divided by energy intake
and converted to 911000 kcal.

Percent energy intake from fat was calculated for each subject. Based on
percent energy intake from fat subjects mre divided into four groups; 24% or less,
25-29%, 30-34%, 35% or more. These cut off points mre determined based on the
average percent energy intake of 29.4% in our subjects.

Fat intake score was calculated individually from modified Block Food

Questionnaire (Block et al., 1989). Points (less than once per month=0, 2-3 times

25
per months=1, 1-2 times per mek=2, 3-4 times per mek=3, 5+ times per mek=4)

mre added for 16 categories of foods high in fat.

Anthropometric measurements. Body Mass Index (BMI) for each
individual was calculated using Quetelet’s index (erz). BMI for each individual was
adjusted for age and sex by using the mean value from Second National Health and
Nutrition Examination Survey (NCHS, 1987). Triceps skinfold measurements
mre adjusted for age and sex by using the 50th percentile value from Second

National Health and Nutrition Examination Survey (NCHS, 1987).

Physical activity. Energy expenditure of each subject was estimated from
resting energy expenditure (REE) and physical activity. REE for each subject mre
calculated using the equations by WHO (1985). Then REE was divided by 24 to
obtain REE per hour. REE per hour for each subject was multiplied by sum of each
activity hour, multiplied by activity factor (sleeping=1 .0; sitting, eating etc.=1.5;

walking=2.5; and vigorous sports=7.0) (Dumin & Passmore, 1967).

Length of residence in the US. Based on the length of residence in the US,
subjects mre divided in to five groups; 1-12 months, 13-24 months, 25-36 months,

37-48 months and 49 months or more.

Statistics . Means and standard errors of means mre calculated by using

the Statistical Package for the Social Science, Version 6.1 (SPSS Inc., Chicago. IL,

26
1994). Analysis of variance was done among the quintiles based on the length of

residence in the US and among quartiles based on percent energy intake from fat in
relationship to percent RDA of energy intake, fat intakes per 1000 kcal including
saturated fatty acid, polyunsaturated fatty acid, cholesterol, adjusted BMI and
adjusted TSF. Duncan’s multiple range test was used to identify the significant
difference among the means.

Correlation coefficients mre calculated in relationship to age, length of
residence, adjusted BMI and TSF, fat intakes per 1000 kcal including total fat,
saturated fatty acid, polyunsaturated fatty acid, and cholesterol, and fat intake

scores based on Block food screening questionnaire (Block et al., 1989).

RESULTS

Means and standard errors of means of height, might and TSF, and BMI
according to subjects’ age and sex are presented in Table 1. The mean BMI and
TSF for the all subjects was 17.1104 (1 7010.6 for boys; 17210.5 for girls) and
12.2:05 (110.107 for boys; 13.2108 for girls), respectively. Height, migh, BMI and
TSF for both boys and girls increased with age. The smallest TSF for both boys and
girls mre at the age of 6 (8611.6 mm, 86:21 mm, respectively). Height, body
might, BMI and TSF of subjects increased with age, homver there mre not
significant differences between boys and girls.

Means and standard errors of means of energy intake, fat intakes including
total fat, saturated fat, polyunsaturated fat and cholesterol, and energy expenditure

according subject’s age and sex are presented in Table 2. Mean:SEM of energy

27
intake for the entire population was 1779:50 kcal (1831 1:86 for boys; 1739:60 for

girls). Mean intake of energy increased with age, homver there mre not significant
differences between boys and girls. The mean fat intakes including total fat,
saturated fat, polyunsaturated fatty acid and cholesterol mre 595:2] g, 21011.2
9, 10.94.05 9 and 320i15 mg, respectively. The mean fat intakes including total fat,
saturated fat, polyunsaturated fatty acid and cholesterol for boys were 59.3127 9,
20.5:19 g, 11.2i0.9 g, and 309:21 mg, respectively. The mean fat intakes
including total fat, saturated fat, polyunsaturated fatty acid and cholesterol for girls
mre 59.7i3.5 g, 21 .41-1 .7 g, 10.7i0.6 g, and 3301-22 mg, respectively. There were
no significant differences in fat intakes in different age and sex groups.

Energy expenditure and physical activities of Japanese school children living
in the US are presented in Table 3. Energy expenditure increased in both boys and
girls with age, although it did differ beMen boys and girls. Hours of resting tended
to decrease with age, homver hours of other activities did not change among
different age groups. None of the hours of activities change with age.

Daily fat intake per 1000 kcal according subject’s age and sex are
presented in Table 4. About 30% of total fat was consumed as saturated fat by
all ages and sexes, and about 15 % was consumed as polyunsaturated fatty
acid. The ratio of saturated fatty acid and polyunsaturated fatty acid was about 2
to 1 for all age and sex. None of the fat intakes per 1000 kcal were significantly
different among different age and sex groups.

The mean and standard error of mean for %kcal from fat for all subjects mre

29.4 :l: 0.7 %. In quartile groups divided by % energy intake from fat, saturated fatty

28
acid intake and polyunsaturated fatty acid intake had significant increase as %

energy intake from fat increase (P<0.01) (T able 5). There was a significant
difference between first group and forth group in energy intake. Homver, there mre
no significant changes in energy intake, cholesterol, TSF, BMI and energy
expenditure with the increase of % energy intake from fat.

In five groups divided by length of residence in the US (Table 6), TSF and
BMI increased significantly in subjects who are living in the US longer. Homver,
there was no significant increases in energy intake, saturated fat, polyunsaturated
fatty acid, cholesterol, fat intake score and energy expenditure with length of
residence in the US.

Table 7-1 summarizes the correlation between the potential variable in this
study. Age- and sex-adjusted BMI and TSF for entire subjects correlated each other
(P<0.01), indicating that both measurements are in the agreement in terms of the
measurement of body mass of our subjects. The parallel between BMI and TSF is
illustrated in Figure 1.

Although age- and sex-adjusted BMI and TSF did not correlate with intakes
of energy or any of fats, they mre negatively correlated with energy expenditure of
the subpcts (P<0.05). Age- and sex-adjusted BMI and TSF mre positively linearly
correlated with length of residence in the US (P<0.01), however intakes of energy
and fat did not correlate with BMI and TSF. These results may suggest that in this
group it is rather the change in subjects’ physical activity that changes their

anthropometric status rather than change in their diet, although the inverse

29
correlation between length of residence in US and energy expenditure was not

significant.

Energy intake significantly correlated with %kcal of fat, total fat intake, and
saturated fat intake (P<0.01). %kcal of fat correlated with energy intake, total fat
intake, saturated fat intake, and polyunsaturated fatty acid intake (P<0.01). Total fat
intake correlated with energy intake, %kcal of fat, saturated fatty acid intake and
polyunsaturated fatty acid intake (P<0.01). Saturated fatty acid intake correlated with
energy intake, %kcal of fat, total fat intake and cholesterol intake (P<0.01).
polyunsaturated fatty acid intake correlated with %kcal of fat, total fat intake
(P<0.01) and energy expenditure (P<0.05), and inversely correlated with length of
residence in US (P<0.05). Figure 2 illustrates the parallel of three fat intakes. Fat

intake score inversely correlated with BMI (P<0.05).

DISCUSSION

Based on data from the Third National Health and Nutrition Examination
Survey (NHANES III), total energy intake and percent energy from fat in the US
population were 2095i20 kcal and 34.0:l:O.2 %, respectively (MMWR, 1994).
Compared to NHANES II, the percent of energy from fat decreased in NHANES
III. However, it was still lower (25.4%) in Japanese population (Ministry of Health
and Welfare, Japan, 1993). Data from NHANES III also indicated that average of
total energy intake and percent of energy from fat for age 6-11 in the US were
1897i25.0kcal and 34.010.4%. Subjects of this study tended to have lower

energy intake (1979:50kcal) and percent energy intake from fat (29.4:0.7%)

30
compared to NHANES III data. Homver, percent energy intake from fat in this

subjects mre about 4% higher than Japanese counterparts living in Japan (Ministry
of Health and Welfare, Japan, 1993).

BMI of the subjects in this study were compared (Figure 5) to NHANES lI
(NCHS, 1987) and Japanese National Nutrition Survey (Ministry of Health and
Welfare, Japan, 1993). Norms of BMI in US and Japanese children in Japan
were very similar for both boys and girls. Tanner (1976) summarized growth of
Japanese children in the US. He reported that a secular trend in stature of
Japanese children in the US occurred up to the late 19503, but after that the
trend stopped and their adult stature remained slightly shorter than Caucasians.
He also compared the statures for Japanese living in the US and for Japanese
living in Japan. A similar secular trend occurred in Japan, so that the statures of
Japanese living in the US and in Japanese living in Japan were very close. In
1957, the average growth spurt of Japanese boys was initiated at 13.8 years of
age and this age dropped to 12.8 years by 1977 (Tanner et al., 1982).
Nowadays, the mean height and weight of Japanese boys and girls from age 2
to 18 (Ministry of Health and Welfare, Japan, 1993) fall in between 50th and
90th percentile of National Center for Health Statistics growth chart (Hammil, et
al., 1979).

In this study, BMI of Japanese children living in the US followed norms of
US and Japanese counterparts living in Japan in both boys and girls even

though there were slight variations because of the small sample size (Figure 5).

31
We assumed that the growth spurt and puberty were assumed not to affect the

subjects in terms of BMI because they were younger than 12 years old.

theki et al. (1992) studied the skinfold thickness in Japanese children
age 3-11 years old to define the standards for Japanese children and compare
their racial characteristics in skinfold to British children. In their study, boys had
their thinnest TSF at the age 5 (Mean = 8.3mm), and girls had the thinnest TSF
at the age of 6 (Mean = 9.5mm). The study indicated that TSF in Japanese
children mre similar to results of British Caucasian children. The smallest TSF
in our study occurred at age of 6, but we mre unable to identify whether or not it
occurred at a younger age, since our youngest subjects were 6 years of age.

Means and standard errors of means of TSF from subjects of our study
mre compared (Figure 6) to the data from NHANES ll (NCHS, 1987). TSF from
our subjects mre slightly larger than the norms of similar aged US counterparts.
Homver, the standard errors of means mre quite large in our subjects because
of small sample size.

The result that both BMI and TSF adjusted for age and sex significantly
correlated with subjects’ length of residence in the US indicates that the longer
the children live in the US, the higher their BMI and larger their TSF are in the
Japanese children who live in the US for 1 months to 5 years (Table 7-1, Figure
3 and 4). In this study neither energy intake nor energy expenditure significantly
correlated with length of residence. BMI and TSF did not correlate with energy
intake but negatively correlated with energy expenditure. This would suggest

that the physical activity, rather than diet, had a greater affect on their

32
anthropometric status. Further study of energy expenditure and energy intake

with larger population in relationship to length of residence may be worthwhile
since BMI and TSF did correlate with length of residence.

There was a significant correlation between energy intake and fat intakes
(total fat and saturated fat). This result would indicate that children who consume
more energy also consume more fat, especially saturated fat. According to the
data from JNNS, Japanese, in 1955, consumed only 14% of fat from animal
source, which is primary source of saturated fat. Homver they consumed 40%
of fat from animal source in 1991 (Ministry of Health and Welfare, Japan, 1993).
The source of dietary fat may be an important parameter to look at the dietary
change.

Fat intake score by modified Block Screening Questionnaire did not
correlate with any variables except for the negative correlation with BMI. It is
assumed that the screening questionnaire did not adequately represent this
particular subjects. From 3-day food records filled out by subjects, several foods
mre found to be high in fat and consumed often, but mre not on the Screening
Questionnaire. Such items that may be appropriate to be included in the
Questionnaire when it is used for Japanese subjects are: fried foods such as stir
fried foods, fried rice or fried tofu; vegetable oils such as sesame oil used in
cooking etc.

In summary, BMI and TSF of Japanese children living in the US are
affected strongly by their length of residence and physical activity, but not by

food intakes. Food intakes mre not affected by length of residence. It is

33
assumed that diets of those children did not change because they lived at home

where the diet did not differ much from diets they would have in Japan.

34

Table 3-1. Height, might, triceps skinfold and calculated body mass index (BMI) of
Japanese school children age 6 to 12 living in the US.

 

 

 

 

 

 

Age n Height Body Weight BMI Triceps
(cm) (kg) (kg/m2) skinfold (mm)
Boys
GSyear<7 5 118.4:1.4 22.3:1.4 15.9:0.9 8.6:1.6
7Syear<8 8 123.1 :1 .2 24.4:1.0 16.0:0.5 11.3:0.8
BSyear<9 4 124.7:2.7 23.5:2.5 15.0:0.9 93:22
9Syear<10 4 133.4:2.9 32.2:3.5 17.9:1.3 12.8:1.8
10$year<11 3 137.7:2.6 43.1 :2.4 22.7:1.1 15.1:2.7
11Syear<12 1 149.0 35.8 16.1 8.0
12$year<13 1 146.2 39.4 18.4 11.0
Girls
6Syear<7 2 108.6:2.9 16.4:0.2 14.0:0.9 8.6:2.1
7Syear<8 7 121 .7:1 .7 23.6:2.4 15.8:1.1 12.0:2.2
BSyear<9 5 128.5:0.8 28.8:2.5 17.4:1.4 14.7:3.0
9Syear<10 8 133.5:1.9 31.1:2.4 17.3:1.0 12.5:1.2
10$year<11 7 137.5:1.5 34.4:2.1 18.1:0.9 14.0:1.1
11Syear<12 3 148.7:4.8 41 7:52 18.7:1.2 15.8:0.9
12$year<13 1 147.5 46.1 21.2 14.7
ANOVA in age 0.000* 0.000" 0.000* 0.031*
ANOVA in sex NS NS NS NS
Means : SEM
* Significant (p<0.05)

NS: Not significant

35

Table 32. Daily energy intake and fat intakes of Japanese school children age 6-12
living in the US.

 

 

 

 

 

 

Age Energy Total fat Sat. Fat‘ PU FA” MU FA° Cholesterol
intake (kcal) (g) (g) (g) (g) (mg)
m
BSyear<7 1751 :169 60:7 21 :3 12:1 19:3 355:44
7Syear<8 1636: 66 50:4 16:1 9:1 15:1 238:30
8Syear<9 1779:231 65: 14 24:6 1 1 :2 21 :7 333:35
9Syear<10 2186:338 65:17 22:6 15:4 19:6 340:8?
10$year<1 1 1935:349 59:10 19:3 10:2 17:3 307:37
11Syear<12 2423 95 47 17 23 488
125year<13 1667 46 14 8 14 246
Silk

6Syear<7 1464: 28 54:8 18:4 10:5 14:3 227:26
7Syear<8 1698:158 59:10 23:5 1 1 :1 17:3 397:50
8Syear<9 1589: 65 49:4 18:2 10:1 15:1 360:84
QSyear<10 1725:104 58:3 19:1 11:2 19:2 267:23
10Syear<11 1992:167 73:12 27:5 11:2 23:4 332:53
11Syear<12 1738:132 59:6 21:2 11:1 16:2 344:44
12Syear<13 1655 50 20 1 1 15 354
ANOVA 0.031" NS NS NS NS NS
in age
ANOVA NS NS NS NS NS N8
in sex

Means : SEM

* Significant (p<0.05)

NS: Not significant

' Saturated fatty acid

b Polyunsaturated fatty acid

° Monounsaturated fatty acid

36

Table 3-3. Daily energy expenditure and hour of physical activity of Japanese school
children age 6-12 living in the US.

 

 

 

 

 

 

Age EE‘ Resting” Very lightc Light" Heavy'
(year) (kcal) (hour) (hour) (hour) (hour)
821$
6Syear<7 1507: 77 96:02 12.7:0.4 05:02 13:02
7Syear<8 1589: 39 93:01 12.9:0.4 06:03 13:03
8Syear<9 1488: 85 93:03 13.0:0.7 1.0:0.6 0.7:0.2
QSyear<10 2234:202 9.1 :0.4 10.3:0.8 15:07 30:05
10$year<11 2079: 38 92:02 12.8:0.9 13:09 08:03
11Syear<12 2010 7.0 15.5 0.0 1.5
12Syear<13 1974 9.0 13.7 0.3 1.0
9E

6Syear<7 1258: 14 10.0:0.0 11.9:0.6 1.4:0.6 0.7:0.0
7Syear<8 1526: 99 96:03 12.9:0.4 0.3:0.1 1.1:0.2
8Syear<9 1760:102 9.5:0.2 12.2:0.5 10:03 13:03
9Syear<10 1837: 93 87:02 13.4:0.4 06:02 13:02
10$year<11 1742: 68 87:02 13.8:0.3 0.4:0.1 1.1:0.2
11Syear<12 2003:184 9.0:0.6 12.1:1.5 1.4:0.8 1.5:0.3
12$year<13 2308 9.0 1 1.7 0.3 3.0
ANOVA infiege 0.000* 0.000* NS NS NS
ANOVA in sex NS NS NS NS NS

Means : SEM

* Significant (p<0.01)

NS: Not significant
' Energy expenditure calculated from resting energy expenditure and physical activity factors.
(See method section.)

" Hours of sleeping.

° Hours of sitting and eating.

d Hours of walking.

° Hours of vigurous excersise.

37
Table 3-4. Daily fat intake per 1000 kcal of Japanese school children living in the US.

 

 

 

 

 

 

Age Total fat Sat. Fat' PUFA" MUFA‘ Cholesterol
(yeaQ (g/1000kcal) (g/1000kcal) (gl1000kcal) (g/1000kcal) (mg/1000kcal)
_B_0_‘l§
6Syear<7 34:2 12:1 7:1 19:5 210:29
7Syear<8 31 :2 10:1 6:1 15:3 143:14
8Syear<9 36:4 13:2 6:1 21 :6 197:33
9Syear<10 28:4 9:2 7:1 19:4 149:16
10$year<11 31 :1 10:0 5:0 17:5 164:24
11Syear<12 39 19 7 23 201
12$year<13 28 8 5 14 147
we

6Syear<7 37:4 12:3 7:3 9:2 155:21
7Syear<8 34:2 13:1 6:0 10:1 236:25
8Syear<9 31 :2 1 1 :1 6:1 10:1 224:45
QSyear<10 34:2 11:1 6:1 11:1 161 :21
10$year<11 35:3 13:2 5:1 1 1:1 165:16
11Syear<12 34:1 12:0 6:0 9:1 197:15
12$year<13 30 12 7 9 214
ANOVA NS NS NS NS N8
in age
ANOVA NS NS NS NS NS
in sex

Means : SEM

NS: Not significant

‘ Saturated fatty acid

" Polyunsaturated fatty acid

° Monounsaturated fatty acid

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TSF (mm). BMI

TSF (mm), BMI

43

 

3O

20‘

 

104

 

 

 

Age
a) Boys

 

3O

20‘

 

oooooo

10‘ -

.......

 

 

 

Age
b) Gids

Fig. 3-1 Body mass index (BMI) and Triceps skinfold 0' SF) for

Japanese children living in the US.

A-flteaivv—Awavhu F\-h\ ion-Jluuc. can.“

 

 

 

 

so
401
3
x
O
8 mi
3 . .. .I.
7? _. ..... g I Total fat
_. ......... I ........ . . ............ ------
.3 101 'h' .I. '3'? ‘1 "Q "2“
g IE 5 a. "“53: i Saturated fat
"' I
:3 o . . . . . . . 'D‘PUFA
a 7 a 9 1o 11 12
Age
(8). All subjects

Fig. 3—2 Fat intakes in relationship to age

45

 

 

 

 

 

 

 

 

 

 

50
401
301
33
g 20~ -
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Age
b) Boys
50
40<
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x
o
8 201
P
32 . ‘
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.3 104 _g_ .I.
10
E H 13? fl H H
‘6
u. 0 . , T
8 7 8 9 10 11 12
Age
c)Gi11$

Fig. 3-2 Fat intakes in relationship to age

IIH

Total fat
'iHSaturated fat

.2.
D PUFA

I
TTotaI fat

-I
‘-

Saturated fat

_z_
w PUFA

BMI

TSF (mm)

46

 

 

 

 

 

 

 

 

24
22<
20‘
10«
161
14< '
12 , f . v
0 20 40 60 00 100
Length of stay (months)
Fig 3-3. Correlation between length of stay and BMI
30
20-
. l
10‘ . o
0 v . . .
0 20 40 60 00 100
Length of stay (months)

Fig 3-4. Correlation between length of stay and TSF

47

 

 

 

 

 

26

24-

22a:

20‘

10‘

.L.

16- I BMI from NHANES"

141 "I‘i'eMI from JNNS
'2' .2. .
m 12 , Y , , , , D BMI from this study

6 7 a 9 10 11 12
Age
a) Boys

BMI for Japanese National Nutrition Survey (JNNS) is calculated form the
height and weight norms by using equation of Weight (kg) 1 Height (m)2.

Fig 3-5 (a). BMI in this study compared to the BMI from Japanese
National Nutrition Survey and Second National Health and Nutrition
Examination Survey (NHANESII).

48

 

26
24«
22«
201
181
_I_

16~ I BMI from NHANESII

14. “i“BMI from JNNS

 

 

 

I
12 , , , , , v , TBMI from this study

 

Age
b) Girls

BMI for Japanese National Nutrition Survey (JNNS) is calculated form the
height and weight norms by using equation of Weight (kg) I Height (m)2.

Fig 3-5 (b). BMI in this study compared to the BMI from Japanese
National Nutrition Survey and Second National Health and Nutrition
Examination Survey (NHANESII).

49

 

20
18‘ ‘l—
16‘

14‘

 

12'

 

 

 

 

E .3.
I TSF
E, a1
33 _r ,Tsr from
t- 6 1 . . , , , , NHANES"
a 7 a 0 10 11 12
Age
a) Boys

Fig 3-6 (a). TSF in this study compared to the 50th %tile TSF of
Second National Health and Nutrition Examination Survey

(NHANESM.

 

20

18"

16'

  

. ”a---
‘4 -0" no

 

12"

 

10'

 

 

 

A I
E TTSF
E, 0
(u,3 _l 'TSF from
1— 0 , r , . , , 1 ‘ NHANES"
e 7 a 0 10 11 12
Age
b) Girls

Fig 3-6 (b). TSF in this study compared to the 50th %tile TSF of
Second National Health and Nutrition Examination Survey
(NHANESII).

CHAPTER N
FOOD GROUP INTAKE FROM THE FOOD GUIDE PYRAMID AND SNACKING

PATTERNS OF 6-12-YEAR-OLD JAPANESE CHILDREN WHO IJVE IN THE
UNITED STATES

51

INTRODUCTION

The Food Guide Pyramid was developed by United States Department of
Agriculture (USDA) to help people select a nutritionally adequate diet (Welsh et al.,
1994). The Food Guide Pyramid graphically illustrates the recommended servings of
6 food groups which are: 6-11 servings of bread/cereallricelpasta group; 3-5
servings of vegetable group; 2-4 servings of fruit group; 2-3 servings of
milklyogurt/cheese group; 2-3 servings of meatlpoultry/flshllegumesleggslnuts
group; and sparse use of fats/oilslsweets group (USDA, 1992).

Several authors (Patterson et al., 1990, Krebs-Smith et al., 1995, Basch et
al., 1994)havereportedthatpeopleintheUSdonoteatas recommended inthe
Food Guide Pyramid, and diets are especially low in fruits and vegetables. Based on
the data of the Second National Health and Nutrition Examination Survey
(NHANESII), 45% of the US population consumed no servings of fruit or fruit juice,
md 22% consumed no servings of vegetables (Patterson et al., 1990). Based on the
data of Continuing Surveys of Food Intakes by Individuals (CSFII), only 32% of
American adults’ fruit and vegetable intakes met the total of 5 servings (Krebs-Smith
et al., 1995). Basch et al. (1994) reported that only 6.8% of children consumed a
total of 5 servings from fruits and vegetables.

In contrast, the native Asian diet is one Wnich provides a high intake of
complex carbohydrates in the form of grains (rice, noodles), fruits and vegetables
(Kim et al., 1993). However, as acculturation occurs in immigrants to the US, their

diets tend to become high in meatlpoultryfflshllegumes/eggslnuts and

52

53
milklyogurtlcheese groups, and low in grain, fruits and vegetables (Yang et al.,

1979)

This study was designed to investigate the number of servings of food from
the various food groups that were selected by Japanese children who lived in the
US from 1 month to 8 years. Their selections were evaluated according to the
recommended servings in the Food Guide Pyramid. Specific hypotheses tested
were as follows: (1) Japanese children who have lived in the US for 5 years or
more consume fewer servings of bread/cereallricelpasta, fruits and vegetables
than those who have lived in the US for 1 year or less. Those who have lived in
the US for 2-4 years eat intermediate amounts of bread/cereallricelpasta, fruits
and vegetables, (2) Japanese children who have lived in the US for 5 years or
more consume more servings of meatlpoultrylflshllegumesleggslnuts,
milk/yogurtlcheese and sweetsl‘fatsloils group than those who have lived in the
US for 1 year or less. Those who have lived in the US for 2-4 years eat
intermediate amounts of meatlpouItryfl'lshllegumesleggslnuts,
milk/yogurtlcheese and sweets/fatsloils. In anoflwer aspect of this study, the energy
intake from snacks was investigated. The hypothesis tested was that Japanese
children who lived in the US for 5 years or more consumed more energy (kcal)
from snacks than those who lived in the US for 1 year or less. Those who lived in

the US for 2-4 years consumed intermediate energy from snacks.

METHOD
$312951

Subjects are 59 healthy Japanese children (33 females, 26 males), ages 6 to
12 years, who attend Saturday school in Battle Creek, Michigan. They were born in
Japan, but nowthey live in Michigan or Indiana with their families, as temporary
residents. One or both of their parents work for Japanese companies that have
branches in Battle Creek, Jackson, Goldwater or Kalamazoo, Michigan or Goshen,
Indiana. The Japanese children attend US schools during the week, but attend
Saturday school to study Japanese language and mathematics classes. It is
assumed that these children are exposed to Western culture outside of the home at
the public school, while they have a traditional family life at home.

After the approval of the University Committee on Research Involving Human
Subjects (UCRIHS) at Michigan State University fall, 1994 (IRB # 94-501, Appendix
A), subjects mre reunited by letters to the parents of the subjects. The consent
form (Appendix B), and questionnaires were handed out to the students in the
Japanese school classes. The signing of the consent form by subjects' parents
indicated a willingness to participate in the study. Fifty nine out of a potential of 83
students, or 71% participated in the study. All 55 households responded for at least
one of the children in their house, and 4 households responded for 2 children.

An instrument had been developed to elicit demographic data (Appendix F).
This questionnaire asked questions about the child's age, sex, number of years of

residence in the US and previous residence in the US. Subjects were divided into

55
five groups based on the length of residence in the US; 1-12 months, 13-24 months,

25-36 months, 37-48 months and 49 months or more.

Data collection Mm:
Food intakes for three days (3-day food record form, Appendix C) for all

subjects we recorded by their parents in Japanese language. They were asked to
include amounts of food eaten, brand names and recipes for mixed dishes. Also
requestedwerethetimeofdaythefood waseaten andwherethefoodwaseaten.
Written directions included two-dimensional food model pictures for filling out portion
size (Appendix D) were given to the parents. The thme-day food record included two
mekdays and one weekend day. Subjects submitted their food records to an
investigator (J.l.) at school. If the food record needed further clarification, the

investigator interviewed the parents over the telephone.

Data analxggg:

Dietary intake measurements. Computer analyses of the food records were
done by using Nutritionist IV, Version 3.0 (N-squared computing, Salem, OR, 1993).
Servings offoodforeach subjectwere classified intothe6food groups based onthe
Food Guide Pyramid [(1) bread/cereallricelpasta group; (2) vegetable group; (3) fruit
9WD: (4) milk/Yogufl/Gheese 9WD: (5) meaflpoumyffishflegumesleggslnuts QFOUP;
and (6) fats/oilslsweets group], and the quantity of servings from each food group

were computed for each subject

56
Total daily energy intake (kcal) and daily energy intake from snacks were

computed. The percent of energy (kcal) from snacks was calculated. The percent of
energy (kml) from each snack (morning, afternoon, and evening) compared to

energy from all snacks was determined for each child.

Statistics. Means and standard errors of means were calculated by using
the Statistical Package for the Social Science, Version 6.1 (SPSS Inc., Chicago, IL,
1994). Analyses of variance were done for the five groups, based on the length of
residence in the US, in relationship to each of the six food groups. Percentage of
individuals who consumed less than the recommended servings, the recommended
servings, and more than the recommended servings were calculated for each food
group. Duncan’s multiple range test was used to identify the significant difference
among the means.

Analysis of variance (ANOVA) was done for the percent energy intake from
all snacks among five groups based on length of residence. ANOVA was also done
for the percent of energy from each snack (morning snacks, afternoon snacks, and

evening snacks).

RESULTS AND DISCUSSION
Means and standard errors of the mean for consumption of foods based on

the Food Guide Pyramid are presented in Table 4-1 relative to length of residence in

57
the US. Percentage of individuals who consumed the servings of food groups

recommended in Food Guide Pyramid are presented in Fig. 4—1 to Fig. 4-5.

When the mean servings of bread/cereallricelpasta group were compared
among the five groups for length of residence in the US, the consumption tended to
decrease as subjects lived in the US longer, although the decrease was not
significant (Table 4-1 ). Subjects in the first group, the group with 1-12 months
residence in the US, met the recommendation by Food Guide Pyramid (Table 41).

Mean of bread/cereallricelpasta group consumption by all subjects was 5.8
servings(T able 4—1). The value is slightly lower than the minimum of 6 servings, that
were recommended in Food Guide Pyramid. Sixty one percent of subjects did not
consume the minimum of 6 servings of bread/cerealln'ce/pasta group (Fig. 41).

About 40% of bread/cereallricelpasta group was consumed as rice, and
about 20% was consumed as breads in all subjects. Noodles were the third most
popular starch. Rest of the bread/cereal/n’celpasta group was consumed as
breakfast cereals, potatoes, corn and wheat flour. None of the foods in
breadlcereallricalpasta group seemed to have change among the five groups for
length of residence in the US.

There was not significant difference in servings of vegetable group among
thefivegroupsforlength ofresidence in the US. However, thefifth groupwasthe
only group that did not meet the recommendation in vegetable group.

Mean of vegetable group consumption was in the range of the recommended

35 servings in Food Guide Pyramid (Table 4-1). About 60% of all subjects

58
consumed the recommended or more than the recommended servings of vegetables

(Fig. 4-2). However, 40% of subjects did not consume the recommended servings of
vegetables. Popularly consumed vegetables were iceberg lettuce, Chinese
cabbage, cabbage, carrets, onion, green onion, spinach, tomato, broccoli,
cucumber, daikon radish, man sprouts, and a variety of seaweeds such as wakame,
kombu, and hijiki. Less frequently used vegetables were asparagus, bamboo shoots,
burdock root, egg plant, green beans, green pepper, and pea pods. Varieties of
Japanese mushrooms such as shiitake, enoki and shimeji were also frequently
used.

There was not significant difference in servings of fruit group among the five
groups for length of residence in the US. However, the fifth group was the only one
that did not meet the recommendation of 2-3 servings for fruit group. Mean of fruit
group consumption by all subjects was in the range of the recommendation of 2-3
servings in Food Guide Pyramid (T able 4-1). Forty four percent of the subjects
consumed the recommended or more than recommended servings of fruit (Fig. 4—3).
However, 56% of subjects did not consume the recommended servings of fruits.

About half of fruit group was consumed as fresh fruits, and half was
consumed as fruit juice. The most frequently consumed fruits were oranges,
bananas, strawberries, peaches, apples and waterrnelons. The most frequently
consumed fruit juices were apple and orange.

In general, the consumption of milk/yogurt/cheese increased as children lived

in the US longer (T able 4-1). The increase from O.6i0.2 sewings to 1.72302 servings

59
between first and third groups, and from 0.6i0.2 servings to 1.73305 servings

Damn first and fifth groups were significant (p<0.05). Mean of servings in all
groups did not meet the recommendation of milk/yogurtlcheese group. Mean
consumption of milk/yogurtlcheese by all subjects was fewer than 4 servings, which
was recommended for children in Food Guide Pyramid (T able 4-1). Only 3% (2
individuals) of all of the subjects consumed 4 servings of milk/yogurtlcheese group
per day (Fig. 4—4). More than 80% of all subjects did not even consume 2 servings of
milk group, which was the recommendation for adults.

Over 90% of milk/yogurtlcheese group was consumed as fluid milk Yogurt
and cheese comprised about 5% each. About 40% offluid milk was skim or lowfat
milk Consumption of skim or lowfat milk tended to increase as subjects stayed in the
US longer, whereas consumption of whole milk did not have much change among
the five groups for length of residence in the US. This tendency indicated that
Japanese children consumed more milk, especially as lowfat milk as they lived in the
US longer. LoMat milk was introduwd to Japan relatively recently, but the citizens
of Japan still prefer whole milk to lowfat milk

There was not significant increase in meat/poultrylfishllegumes/eggslnuts
consumption among the five groups of length of residence in the US. All five groups
consumed excessive servings of meat/poultrylfish/legumesleggslnuts group. Mean
consumption of maatlpoultrylfishllegumesleggslnuts by all subjects were more than
3 servings of meat/poultryl'fishllegumesleggslnuts group, which was recommended

in Food Guide Pyramid (T able 4-1). About 85% of subjects consumed more than 3

60
servings of meatlpoultrylfish/legumesleggslnuts group (Fig. 4-5). Subjects who

consumedtherecommendedamountof2-3servingsof
meat/poultrylfishllegumesleggslnuts were 11.9%.

About 40% of meatlpoultryl‘fishllegumesleggslnuts group was consumed as
meat or poultry, and about 20% was consumed as Iegurnes. About 20% of
meatlpoultrylfish/legumesleggslnuts group was consumed as eggs, and about 20%
was consumed as fish. Nuts were not consumed very much. Consumption of meat
and poultry tended to increase as the subjects stayed longer in the US. Frequently
consumed meats were pork, chicken, beef and ham. Variety of fish was consumed
by subjects, mainly at breakfast and dinner. The most frequently consumed fish or
seafood were tuna, mackerel, flounder, pike, sardine, clam, shrimp, squid, and
octopus. Legumes were consumed mainly at breakfast and dinner. The most
frequently consumed legumes were soy products such as tofu, fried tofu, natto and
misc.

Subjects consumed 5.7 servings of fats/oilslsmets group. There was no
significant difference in consumption of fats/oilslsmets group among the five groups
of length of residence. Fats and oils were frequently consumed as vegetable oils for
stir fried or pan fried food in the meals. Sweets were mainly consumed between
meals. Frequently consumed mats were candies, cookies, cakes and carbonated
beverages.

In Japan, average consumption of bread/cereallricelpasta group, vegetable

group, fruit group meat/poultlyl‘fishllegumesleggslnuts group and milk/yogurtlcheese

61
group were 3559, 2559, 1129, 2859 and 1299, respectively (Japanese National

Nutrition Survey, Ministry of Health and Welfare, Japan, 1993). They are emdiently
converted to 1302 of dry rice, 12 cups of raw vegetables, 0.5-1 cup of rawfruits, 10
oz of meat and half cup of milk (Zeman, 1991). Except for the milklyogurtlcheese
group, all the groups seems to meet the servings recommended by Food Guide
Pyramid. Base on this information, it was assumed that Japanese children who have
lived in the US for 1 month to eight years would have adequate food intake of all the
food groups except for milk/yogurtlcheese group based on Food Guide Pyramid.

There were not significant differences in energy intake from shacks among
the five groups for length of residence in the US. Therefore, data were collapsed to
assess the energy intake from snacks for all children. Japanese children in the US
consumed 17.211 .0% of energy (kcal) from snacks (T able 4—2). Morning, afternoon
and evening snacks were consumed 2.7%, 11.2%, 3.7% of the total day’s energy
intake, respectively. Ninety eight percent of the subjects consumed the aftemoon
snack Children had the greatest kilocalorie from afternoon snack It is assumed that
Japanese children living in the US did not change their snacking patterns.

In summary, Japanese children who lived in the US for 1 months to 8 years
consumed recommended serving of fruits and vegetables in Food Guide Pyramid.
They consumed 4-5 sewings of bread/cereallrice/pasta group. They consumed
fewer milk/yogurtlcheese group than recommended, and they consumed more
meatlpoultrylfishllegumesleggs/nuts group than recommended. There was a

significant increase in milk group among the five groups for residence in US,

62
indicating that Japanese children who lived in the US longer consumed more

servings of foods from milk/yogurtlcheese group. However, there was no change
among the other food groups in relationship to the length of residence in the US.
There was no significant change in energy intake from snacks in relationship to the

length of residence in the US.

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4.08. .V.NH...o .mbwmb omwa... N..LHN.m .
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> 11 servings "j

65

 

"/ '/
H H , ,
1r (,l’lc/t’4 ,
/ U

254/7" ’.

V 2 V/ 1w
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' l

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/’/ / ‘I’, If] 4 7,.
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61.0%

Fig 4-1. Percentage of Japanese children who consumed the servings of
bread/cereal/rice/pasta group recommended in Food Guide Pyramid .

   

>4 servings #\ \\
1 3.6°/ p
\\
\
2-4 servings 5 , //5 <2 servings
30.5% V/ 55.9%
/

Fig. 4-2 Percentage of Japanese children who consumed the servings of
vegetable group recommended in Food Guide Pyramid

67

>5 servings 5*
15.3%

   
  

/ <3 servings
40.7%

3-5 servings r“
44.1%

Fig. 4-3 Percentage of Japanese children who consumed the servings of fruit
group recommended in Food Guide Pyramid

68

>3 servings \

 

P < 2 servings
83.1%

Fig. 4-4 Percentage of Japanese children who consumed the servings of
milk/cheeselyogurt group recommended in Food Guide Pyramid

69

< 2 servings
3.4%

    
 

      

“Pepi 2-3 servings
\\:>\',\,\_ 1 1.9%

 

>3 servings 7
84.7%

Fig. 4—5 Percentage of Japanese children who consumed the servings of
meat/pouItry/fish/Iegume/egglnut group recommended in Food Guide Pyramid

CHAPTER V
APPIJCATION OF THIS RESEARCH

70

71
Although there have been several investigations relative to changing eating

behavior, hoping thereby to improve diets, there has been little or no research
relative to maintenance of the positive qualities of native diets, as people migrate to
the US. This research was an unique one which addressed the latter issue by
exploring the rate at which food habits change and the impact of dietary changes on
nutritional and anthropometric status.

Japanese children who lived in the US for one month to eight years had
relatively good quality of diet such high intake of fruits and vegetables and lower
intake of fat compared to the various data of American children. However, the
findings from this study also indicated that Japanese children who were exposed to
the Western society changed their anthropometric status. Although stereotype of
Asian children is usually thin and small, it is important for dietitians to be aware that
Asian children can be in the risk of obesity when they stayed in the US for several
years.

The foods that were eaten frequently by Japanese children in this study an
be used to develop a food frequency questionnaire for Asian population. To
investigate the dietary intake of Asian population is necessary, and data from this
study vm‘ll provide the selections that Japanese children would make.

Finally, the data from this study can be a comparative data when dietary and
anthropometric assessment of Asian population is done in the future. Data of Asian

people are necessary because the Asian is the third increasing race in the US.

APPENDICES

72
APPENDIX A

Approval from University Committee on Research Involving Human Subjects

    

OFFICE OF
RESEARCH

AND

GRADUATE
STUDIES
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€25 Minimisation Building
Enuammemmm
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MUfiSflH’
FAX:517/432-Ii7l

“WasuMmmnann
”MimMWWnWWW

(UCRIHS)
MICHIGAN STATE

 

 

UNIVERSITY

December 2, 1994

To: Rachel Schemmel
302 0.x. Trout Psnu Bldg.
RE: IRBI: 94-501
TITLE: CULTURAL IMPACT ON DIET CHANGES DIET 8UALITY
AND PREVALENCE OF OBESITY IN CHILDREN F

JAPANESE HERITAGE LIVING IN THE UNITED STATES
REVISION REQUESTED: N/A
CATEGORY: -c
APPROVAL DATE: 11/30/94

The University Committee on Research Involving Human Subjects'(UCRIHS)

review of this project is complete. I am pleased to adv se that the

rights and welfare of the human subjects appear to be adequately

protected and methods to obtain informed consent are appropriate.

1herecf’org, the UCRIHS approved this project including any revision
ate a ove.

RENBHAL: UCRIHS approval is valid for one calendar year, beginning with
the approval date shown above. Investigators planning to
continue a project be end one year must use the green renewal
form (enclosed with t e original agproval letter or when a
pro ect is renewed) to seek u date certification. There is a
max mum of four such expedite renewals ssible. Investigators
wishing to continue a project beyond tha time need to submit it
again or complete rev ew.

REVISIONS: UCRIHS must review any changes in procedures involving human
subjects, rior to initiation of t e change. If this is done at
the time o renewal, please use the reen renewal form. To
revise an approved protocol at ana 0 her time during the year
send your wr tten request to the CRIHS Chair, requesting revised
approval and referencing the project's IRB I and title. Include
in our request a desor ption of the change and any revistd
ins ruments, consent forms or advertisements that are app icable.

PROBLEMS

CHANGESII Should either of the followin arise during the course of the
work, investigators must noti UCRIHS promptly: (1) problems
(unexpected side effects comp aints, e c.) involVing uman
subjects or {2) changes in the research environment or new
information ndicating greater risk to the human sub'ects than
existed when the protocol was previously reviewed an approved.

If we can be of any future help, lease do not hesitate to contact us
at (517)355-2180 or FAX (517)] 6- 171.

Sincerel

  
 
  
 

avid s. u.£;h., P
UCRIR8 Chair

DEWijm

73
APPENDIX 8
Date

You and your child are being asked to participate in a study by the Department of
Food Science and Human Nutrition and the Department of Family and Child Ecology at
Midwigan State UnMrsity. One of our investigators, Junko Ishihara, is a Japanese
graduate student studying in the US. and will use the information to obtain thesis
material for her Masters graduate degree in Human Nutrition. The purpose of her study
is to investigate dietary habits, nutrient quality and growth parameters in 6-12 year old
children of Japanese heritage who live in the US and a similar U.S. group of children.

You will be completing a 3—day food intake record and 24—hour activity record for
him/her and to answer a few questions about length of stay in US. It will take
approximately 15 minutes to fill out the food intake record for one day. The investigators will
supply directions on how to fill out the food record. We will measure your child's height,
weight, and triceps skinfolds at school, which will take 15 to 30 minutes. Helshe will be
asked some questions about how frequently helshe eats certain foods. All information
collected is confidential. You will receive a personal feedback about your child’s physical
growth compared to the standards for Japanese and American children and about your
child’s nutrient intake.

Participation inthestudy isentirely voluntary. You maywithdrawfromthe studyat
any time without penalty. You may also decide not to answer certain questions if you wish.
You indicate your voluntary agreement to participate by completing and retuming this form.
If you have any questions regarding this study, you may call (517) 355-3944 (Ishihara) or
(517) 353-9629 (Schemmel).

Thank you!

Phase m‘nt mr name:
address:

 

telephone number.

 

Please gig n your name

 

 

lnvestigators' signatures
Junko Ishihara Rachel Schemmel, Ph.D.
Graduate Student in Human Nutrition Professor of Human Nutrition

 

Norma Bobbitt, Ph.D.
Professor, Family and Child Ecology

Day

Date

74

APPENDIX C
TWENTY-FOUR HOUR DIET RECORD

 

Food

Breakfast

ingredient Amount
(I'IOW ”898M”

Time ofday and where
eaten

 

Snack

 

Lunch

 

 

Dinner

 

Snack

 

Doyoueatthesefoodsregulariy? Yes

No

75
APPENDIX D

Directions for filling out the
TWENTY-FOUR HOUR DIET RECORD

(1) Fill out the day and date of the diet record for three days, including two week
days and one weekend day.

(2) Record the names of foods eaten for meals and snacks for three days.

Please indicate if you skip meal.

(3) For mixed dishes, mention if they are home made or manufacture made. If
home made, provide the names of ingredients for recipes and how it was
prepared at home. If manufacture made, identify brand name and as precise as
possible.

(4) List amount eaten in cups, grams, servings. (Please refer to the sample of
the diet record and pictures.)

(5) Record the time of day that you ate the food for each meal. Record where
the foods were eaten such as at home, school lunch, carried lunch, restaurant
etc.

76

 

APPENDIX E
Food Frequency Questions
Check how often you eat the following foods.
Less 2-3
than times
once per per
month month

1 -2
times

week

times

times

week

 

Hamburgers or cheeseburgers with
bun

 

Beef, such as steaks, roasts

 

Fried fish, chicken, or pork

 

Hot dogs, franks

 

Cold sandwich meats, ham, etc.

 

Salad dressings, mayonnaise (not
diet or low calorie)

 

Margarine or butter

 

Peanut butter

 

5998

 

Baconorsausage

 

Cheeseorcheesespread

 

Whole milk

 

Deep fried vegetables (French

fried potatoes, vegetable tempura
etc.)

 

Potato chips, corn chips (Doritos,
etc.)

 

Icecream

 

Donuts, sweet rolls, cakes,
cookies, pies

 

 

 

 

 

 

 

Adaptedfrom: Block, G., etal. 1989. J. Nutr. Educ. 21:199-207.

 

77
APPENDIX F

Demographic Questions

Answer following questions about your child.
1. What is his/her age?

years

2. What is his/her sex? (Check one)
Girl Boy

3. Does helshe take any vitamins? (Check one)
Yes No

4. How long has helshe been living in the United States?
years and months

5. Did helshe live in Japan before coming to the US?
years and months

6. Fill in the average number of hours per 24 hours that you perform each activity.

 

 

 

 

 

 

ACTIVITY Hours per 24 hrs
Sleeping hours
Sitting (Studying, watching TV, Car/bus riding, etc.) hours
Eating hours
Walking minutes
Vigorous sports (Swimming, Bicycling, Aerobics, minutes
Basketball, etc.)

 

 

 

 

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