Physical Environment, Diet Quality, and Body Weight in a Group of 12-year-old Children from Four Public Schools in Puerto Rico

Abstract

Objective: Physical environment influences diet and has been proposed as a determinant of childhood obesity. This cross-sectional study explored physical environment and its associations with diet quality and weight status in a sample of 114 12-year-old children from 4 public schools in the metropolitan area of San Juan, PR. Methods: Physical environment was assessed by asking questions regarding the availability and accessibility of healthy and unhealthy foods and food outlets as well as of recreational and sports facilities and equipment. Food intake was determined using a 24-hour diet-recall questionnaire, with the gathered data being used to assess diet quality and calculate the Healthy Eating Index (HEI)-2010. The HEI includes 12 components that are used to determine the compliance of a given diet with federal guidelines. HEI-2010 total score ranges from 0 to100 and is divided into the following classifications: poor (≤50), needs improvement (51-80), and good (>80). Body mass index was computed using measured weight and height and categorized according to the CDC Growth Charts. Results: Thirty-six percent of the participating children were overweight or obese. Nearly 57% had poor diet quality. The lowest HEI-2010 component scores were found for total fruits, whole fruits, total vegetables, whole grains, seafood and plant proteins, and fatty acids. However, diet quality was not associated with weight status or physical environment factors. Compared to the other children in the study, overweight or obese children reported having a significantly (p<0.05) lower availability of unhealthy foods and the highest access to recreational and sports facilities at home but also lower utilization of recreational and sports facilities at school and reduced participation in the school breakfast program. Conclusion: This study showed that some home- and school-environment factors influenced body weight in the children in this sample. However, these same factors did not appear to affect diet quality.