Assessing the Effectiveness of Federal Food Assistance Programs
(Evidence Center-Initiated)

In 2022, the White House published the National Strategy on Hunger, Nutrition, and Health, which addresses ending hunger and enhancing healthy eating in the United States. One of the strategy’s key pillars is, “Improve Food Access and Affordability: End hunger by making it easier for everyone—including individuals in urban, suburban, rural, and Tribal communities, and territories—to access and afford food.” The report indicates that school meals have the potential to impact children’s nutrition and other key outcomes and can be used as an intervention to improve child health and child hunger. Additionally, expanding Supplemental Nutrition Assistance Program (SNAP) could impact nutrition and food security for low-income Americans. However, recent systematic reviews on these topics either do not exist or did not adequately address these topics.

The Texas A&M Agriculture, Food, & Nutrition Evidence Center initiated systematic reviews examining the association between universal free school meals and the SNAP on diet quality and various health and behavioral outcomes. These reviews will provide timely state-of-the-evidence assessments that can be used by policymakers when considering the implementation of these important programs.

Assessing Excess Adiposity in Children and Adolescents
(In Support of the World Health Organization)

The World Health Organization (WHO) is working on comprehensive guidelines to address obesity in children and adolescents through an integrated, primary health care strategy that respects their varied backgrounds and aims to improve health, functioning and reduce obesity-related disabilities. The WHO’s International Classification of Diseases ICD-11, a global diagnostic tool for diseases, classifies obesity as a chronic condition characterized by excessive fat accumulation that can harm health, yet there is no universal standard for gauging excess fat in young people due to differing measurement techniques and body fat characteristics.

Accurate diagnosis of obesity in youth is critical to prevent long-term health effects and to avoid the repercussions of misdiagnosis, such as stigmatization and mental health issues. With the widespread obesity crisis and available treatments, there is a pressing need to accurately determine the presence and severity of obesity in individuals and populations. While BMI is the common indirect indicator of body fat used by the WHO, it is recognized as an imperfect measure because it cannot differentiate between fat and muscle mass. In clinical practice, more precise methods like skinfold thickness, DXA, and BIA could offer a more accurate assessment of fat composition, even though such methods are more complex and less practical for large populations. A diagnostic test accuracy systematic review evaluates how well a test can identify a condition. These reviews cover a wide range of health issues, encompassing both well-defined diseases and conditions with available treatments, and consider various types of diagnostic methods.

The Texas A&M Agriculture, Food, & Nutrition Evidence Center will complete a diagnostic test accuracy systematic review that aims to evaluate the precision of BMI-for-age and sex as well as other tests, or their combinations, for identifying excess adiposity and classifying obesity severity in infants, children, and adolescents globally. These results will be of key relevance to support the normative work of WHO in the integrated management of children and adolescents with obesity in all their diversity for improved health, functioning and reduced obesity-associated disabilities.

Examining the Relationship Between Exposure to Endocrine Disruptors and Obesity Among Children and Adolescents
(In Support of the World Health Organization)

Obesity represents a global public health challenge, affecting individuals of all age groups, from children and adolescents to adults. A 2016 estimate revealed that worldwide 5.6% of adolescents aged 10-19 were classified as obese. Obesity is a complex condition that is influenced by many factors beyond diet and exercise. Endocrine-disrupting chemicals found in numerous household products, including plastics, food packaging, building materials, and pesticides, may contribute to altered metabolism and weight gain among children and adolescents, contributing to the risk of obesity.

The WHO is currently developing a practice- and science-informed, people-centered guideline for the integrated management of children and adolescents with obesity in all their diversity using a primary health care approach. The WHO Guideline Development Group prioritized several topics, including the relationship between endocrine disruptor exposure and obesity, the evidence of which will inform WHO guideline development. The Evidence Center will conduct a systematic review examining the relationship between endocrine disruptors and obesity in children and adolescents in support of this important work.

Scoping Review and Research Gap Analysis of Contaminants and Agricultural Production of Food for Human Consumption
(Funded by the U.S. Food and Drug Administration)

The Closer to Zero initiative aims to reduce child exposure to four environmental contaminants found in food: arsenic, lead, cadmium, and mercury. The U.S. Food and Drug Administration (FDA) has prioritized these four elements due to their relative toxicity, prevalence in the food supply, and the relative contribution of food as a source of exposure. Young children are prioritized because of the impact exposure to these contaminants can have on development, particularly neurodevelopment. 

The Evidence Center was commissioned to perform a scoping review and research gap analysis to assess the availability of scientific evidence in the peer-reviewed literature examining arsenic, lead, cadmium, and mercury contamination in agricultural production of food for human consumption. The work will focus on contaminant sources related to soil amendments, growing and growth conditions, harvest practices, and related scientific topics, contaminant content in foods, including grains, vegetables, fruits, seafood (fish and shellfish), and meat and poultry; and technologies and methodologies such as detection methods and manufacturing methods for contaminant mitigation. The Evidence Center will produce a report and publish the literature scoping review and research gap analysis.

Systematic Review of Composition, Variability, and Bioavailability of Potential Contaminants in Human Milk and Infant Formula 
(Funded by the U.S. Food and Drug Administration)

The Closer to Zero initiative aims to reduce child exposure to specific environmental contaminants found in food that are prioritized based on the relative toxicity, prevalence in the food supply, and the relative contribution of food as a source of exposure to these contaminants. Young children are prioritized because of the impact exposure to these contaminants can have on development, particularly neurodevelopment. The Evidence Center was commissioned to conduct a systematic review and synthesis of the scientific literature, including grading of the overall evidence related to contaminants in human milk and infant formula, focusing on heavy metals and other relevant potential components. Identification of the available published evidence will allow for the clarification of knowledge gaps and research needs to account for these potential routes of dietary exposure for infants and young children. A suite of systematic reviews will be produced and published.