title: Consumption of apples is associated with a better diet quality and reduced risk of obesity in children: National Health and Nutrition Examination Survey (NHANES) 2003-2010.
abstract: BACKGROUND
  Most children do not meet the recommendation for fruit consumption. Apples are the second most commonly consumed fruit in the US; however, no studies have examined the association of total apple products, apples, apple sauce, and 100 % apple juice consumption on diet quality and weight/adiposity in children.
  
  
  METHODS
  The purpose of this study was to examine the association between various apple consumption forms with diet quality and weight/adiposity in a nationally representative sample of children. Participants were children 2-18 years of age (N = 13,339) from the National Health and Nutrition Examination Survey 2003-2010. Intake was determined using a single interview administered 24-h diet recall. Apple product consumption was determined using the cycle-appropriate USDA Food and Nutrient Database for Dietary Studies food codes. Total diet quality and component scores were determined using the Healthy Eating Index-2010 (HEI). Anthropometrics were determined using standard methods. Covariate adjusted linear and logistic regressions were used to compare apple product consumers with non-consumers; sample weights were used. Probability was set at <0.01.
  
  
  RESULTS
  Approximately 26 % of the population (n = 3,482) consumed some form of apple products. Consumers of apple products, whole apples, apple sauce, and 100 % apple juice had higher HEI scores than non-consumers: 50.4 ± 0.4 v 41.9 ± 0.3, 52.5 ± 0.5 v 42.7 ± 0.3, 52.1 ± 0.8 v 47.2 ± 0.4, and 51.4 ± 0.6 v 46.5 ± 0.4, respectively. Apple products and whole apple consumers had lower BMI z-scores than non-consumers: 0.4 ± 0.04 v 0.5 ± 0.03 and 0.3 ± 0.1 v 0.5 ± 0.02, respectively. Apple products and whole apple consumers were 25 % (0.59-0.95 99(th) CI) and 30 % (0.52-0.95 99(th) CI), respectively, were less likely to be obese than non-consumers.
  
  
  CONCLUSIONS
  Consumption of any form of apples contributed to the fruit recommendation of children and improved diet quality. Apples should be included in the diets of children as a component of an overall healthy diet.
authors.affiliation: Louisiana State University Agricultural Center, 261 Knapp Hall, Baton Rouge, LA, 70803, USA. coneil1@lsu.edu.
authors.forename: Carol E
authors.initials: CE
authors.lastname: O'Neil
authors.affiliation: Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, 77030, USA. tnicklas@bcm.edu.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Nicklas
authors.affiliation: Nutrition Impact, LLC, Battle Creek, MI, 49014, USA. VIC3RD@aol.com.
authors.forename: Victor L
authors.initials: VL
authors.lastname: Fulgoni
mesh_terms: D000293:Adolescent; D002648:Child; D000067576:Child Health; D002675:Child, Preschool; D004035:Diet Therapy / Q000379:methods*; D005247:Feeding Behavior; D005260:Female; D063427:Food Quality; D006801:Humans; D008297:Male; D027845:Malus; D009749:Nutrition Surveys / Q000379:methods / Q000706:statistics & numerical data; D009752:Nutritional Status; D009765:Obesity / Q000188:drug therapy / Q000517:prevention & control*