title: SNAP Participation and Diet-Sensitive Cardiometabolic Risk Factors in Adolescents.
abstract: BACKGROUND
  Previous research suggests participation in the Supplemental Nutrition Assistance Program (SNAP) is associated with poorer adult cardiometabolic health; the extent to which these associations extend to adolescents is unknown. Differences in diet quality, obesity, and cardiometabolic risk factors were examined among SNAP participants, income-eligible nonparticipants, and higher-income adolescents.
  
  
  METHODS
  The study population comprised 4,450 adolescents ≤300% federal poverty level from the 2003-2010 National Health and Nutrition Examination Survey. Generalized linear models were used to examine associations between SNAP participation and the Alternate Healthy Eating Index-2010. Linear and logistic regression models were used to examine associations between SNAP participation, obesity, and risk factors comprising the metabolic syndrome. Data were analyzed in 2015.
  
  
  RESULTS
  All surveyed adolescents consumed inadequate amounts of vegetables, fruits, whole grains, and long-chain fatty acids, while exceeding limits for sugary beverages, processed meats, and sodium. Although there were few dietary differences, SNAP participants had 5% lower Alternate Healthy Eating Index-2010 scores versus income-eligible nonparticipants (95% CI=-9%, -1%). SNAP participants also had higher BMI-for-age Z scores (β=0.21, 95% CI=0.01, 0.41), waist circumference Z scores (β=0.21, 95% CI=0.03, 0.39), and waist-to-height ratios (β=0.02, 95% CI=0.00, 0.03) than higher-income nonparticipants. SNAP participation was not associated with most cardiometabolic risk factors; however, SNAP participants did have higher overall cardiometabolic risk Z scores than higher-income nonparticipants (β=0.75, 95% CI=0.02, 1.49) and income-eligible nonparticipants (β=0.55, 95% CI=0.03, 1.08).
  
  
  CONCLUSIONS
  Adolescent SNAP participants have higher levels of obesity, and some poorer markers of cardiometabolic health compared with their low-income and higher-income counterparts.
authors.affiliation: Center for Health and Community, University of California, San Francisco, California. Electronic address: cindyleung@post.harvard.edu.
authors.forename: Cindy W
authors.initials: CW
authors.lastname: Leung
authors.affiliation: University of California, San Francisco Benioff Children's Hospital Oakland, Oakland, California.
authors.forename: June M
authors.initials: JM
authors.lastname: Tester
authors.affiliation: Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.affiliation: Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
mesh_terms: D000293:Adolescent; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D004032:Diet / Q000191:economics / Q000592:standards*; D005247:Feeding Behavior; D005260:Female; D063105:Food Assistance; D006801:Humans; D007182:Income; D008297:Male; D024821:Metabolic Syndrome / Q000191:economics / Q000453:epidemiology* / Q000209:etiology; D009749:Nutrition Surveys; D009753:Nutritive Value; D063766:Pediatric Obesity / Q000191:economics / Q000453:epidemiology; D011203:Poverty; D012307:Risk Factors