Parental influence on eating behavior: conception to adolescence

Macronutrient intake in stunted and non-stunted toddlers in Jember, Indonesia

Background

Stunting is a condition of toddlers who experience growth failure due to chronic nutrient deficiencies that must be addressed immediately, if children lack nutrients continuously, it can affect their nutritional status and will cause children to be shorter than their age. The purpose of this study was to determine the differences in macronutrient intake in stunted and non-stunted toddlers in Jember, Indonesia.

Design and methods

Type of analytical observational research with case control design, sampling technique using simple random sampling. The number of subjects needed in each group is 66 stunting toddlers and 66 non-stunting toddlers with total subjects used are 132 toddlers.

Results

There are differences in macronutrient intake: energy, protein, fat, and carbohydrates between stunted and non-stunted toddlers with a higher average value of food intake per day for non-stunted toddlers than for stunted toddlers.

Conclusions

There are differences in macronutrient intake between stunted and non-stunted toddlers in Jember, Indonesia with a p-value = 0.000 < 0.05.

How French children food representations and tastes vary according to their social backgrounds: a study of disparities in food habitus

The diet of individuals is influenced by social and cultural factors. Children's food tastes and representations, being principally transmitted by their parents, are likely to depend on their social backgrounds. As it is known that parents' feeding strategies and food education differ depending on their social positions, this study aimed at examining how food representations and tastes vary among children. A qualitative sociological study, using semi-structured interviews, was conducted with 40 children, aged from 9 to 11 years, from four French elementary schools. Results showed that children from disadvantaged social backgrounds mentioned less foods, seemed to have a less varied diet, to consume less vegetables, and to enjoy eating ultra-processed foods more than other children. Different food habitus were found, that can be put into perspective using Bourdieu's distinction theory, including different preoccupations regarding health and necessity among social groups. Disparities in children's food habitus could be theoretically linked with observed and growing social inequalities in health, when taking into consideration the potential practises that these habitus imply, and their probable effects on health. Participatory food education classes at school could aim to reduce such disparities, although some concerns and limits must be acknowledged.

The myth and reality of familial resemblance in dietary intake: a systematic review and meta-analysis on the resemblance of dietary intake among parent and offspring

Background

There is a strong societal belief that parents are role models for their child's dietary behaviours in early life that may persist throughout the life course. Evidence has shown inconclusive dietary resemblance in parent-child (PC) pairs. This systematic review and meta-analysis aimed to examine dietary resemblance between parent and children.

Methods

We systematically searched for studies on PC dietary resemblance, via six electronic databases (PubMed, Ovid MEDLINE, Embase, APA PsycNet, CINAHL, and Web of Science) and other grey sources of literature between 1980 and 2020. We performed quality effect meta-analysis model on transformed correlation coefficients (z) to examine the resemblance in dietary intakes including nutrient intakes, food group intakes and whole diet. Finally, the Fisher's transformed coefficient (z) was used for meta-regression analysis to identify potential moderators. Heterogeneity and inconsistency were examined using the Q and I² statistic. The study is registered on PROSPERO, CRD42019150741.

Findings

A total of 61 studies met the inclusion criteria for systematic review, 45 were included in the meta-analysis. Pooled analyses showed weak to moderate PC dietary intake associations for energy: (r: 0.19; 95% CI: 0.16, 0.22), fat (% energy): (r: 0.23; 95% CI: 0.16, 0.29), protein (% energy): (r: 0.24; 95% CI: 0.20, 0.27), carbohydrate (% energy): (r: 0.24; 95% CI: 0.19, 0.29), fruits and vegetable (g/d): (r: 0.28; 95% CI: 0.25, 0.32), confectionary food (g/d): (r: 0.20; 95% CI: 0.17, 0.23), and whole diet (r: 0.35; 95% CI: 0.28, 0.42). Dietary intakes associations by study characteristics, including population, study year, dietary assessment method, person reporting dietary intake, quality of the study, and study design were highly variable, but associations were similar between PC pairs.

Interpretation

The resemblance among parent-child pairs was weak to moderate for most aspects of dietary intakes. These findings challenge the social myth that parental dietary intake behaviour shapes their child's dietary intake.

Funding

None.

A Sociodemographic Analysis of the Impact of COVID-19-Related Schools' Closure on the Diet and Physical Activity of Children and Adolescents in Qatar

OBJECTIVES

To assess the impact of the COVID-19-related closure of government schools in Qatar on children and adolescents' dietary habits and physical activities and associated sociodemographic factors.

METHODS

An analytical cross-sectional study was conducted between June and August 2022 utilizing the national electronic health records system in Qatar to extract a sampling frame of students enrolled in governmental schools, specifically targeting students in 3rd to 9th grades, stratified by sex and developmental stage. A stratified sampling technique was employed to randomly select a proportionate number of students from each stratum, and data were collected through telephone interviews with the parents of selected students.

RESULTS

A total of 1546 interviews were completed by the end of the study. Of the included sample, 845 (54.7%) were between 8 and 11 years of age (middle childhood), while the rest were 12-15 years old (young teens and teenagers). Male to female ratio was almost 1:1. We found a significant decrease in the intake of vegetables, increases in the intake of soft drinks, fried food, fast food, and sweets, and a reduction in physical activity during schools' closure compared to before. Higher parental educational levels, maternal employment, and having a positive family history of obesity and/or overweight in first-degree relatives were significantly associated with adverse lifestyle changes during schools' closure.

CONCLUSION

The trends of lifestyle changes reported in this study during the periods of COVID-19-related schools' closure were found to be going in a health-compromising direction. These results underscore the importance of implementing targeted interventions to promote healthy lifestyles during such disruptions and emphasize the need to address lifestyle changes beyond emergencies and outbreaks to mitigate potential long-term health consequences, including the increased risk of non-communicable diseases.

Association between breast-feeding exposure and duration with offspring's dietary patterns over 1 year of age: a systematic review of observational studies

Some evidence suggests that breast-feeding may modify food preferences in the later years of life. The present study aimed to provide a systematic review of observational studies investigating the association between exposure to breast milk and its duration with data-driven or hypothesis-driven (or diet quality scores) dietary patterns over 1 year of age. The databases of PubMed, Scopus and Web of Science were searched for observational studies published from January 2010 until July 2021, which led to the identification of twenty-two eligible articles. There was considerable heterogeneity between studies in terms of assessment of exposure and outcome. Of the eleven studies that assessed data-driven dietary patterns, ten reported a significant association for at least one identified dietary pattern. Overall, being breast-fed and a longer duration of any/exclusive breast-feeding were associated with higher scores on healthy dietary patterns characterised mainly by high loadings of fruits, vegetables and whole grains. In comparison, a negative association was found for unhealthy dietary patterns rich in foods with high content of added sugar, salt and saturated fats. In terms of diet quality scores, nine out of eleven studies reported a significant positive association between the duration of any breast-feeding and adherence to recommended healthy diets or dietary guidelines. In conclusion, the evidence from this review was generally in support of the hypothesis indicating breast-feeding is associated with healthy dietary patterns at later ages. However, due to the methodological limitations in the available studies, further research is warranted to elucidate solid evidence on this topic.

Parental Nutritional Knowledge and Type of Diet as the Key Factors Influencing the Safety of Vegetarian Diets for Children Aged 12-36 Months

There are some concerns about the adequacy of vegetarian diets for pregnant women, infants, and young children because diets that exclude meat and other animal-based products increase the risk of nutrient deficiencies. The aim of the present study was to assess the nutritional knowledge of parents raising 12- to 36-month-old children on vegetarian diets and to evaluate the children's diets based on the recommendations formulated in the model food ration. The study involved a questionnaire survey that was completed by 326 women raising their children on various types of vegetarian diets and 198 women raising their children on an omnivorous diet. Mothers raising children on a lacto-ovo-vegetarian diet had the highest nutritional knowledge scores (15.8 points on average), whereas control group mothers and women raising children on a vegan diet had the lowest nutritional knowledge scores (average of 13.6 points). Parents who raised their children on more restrictive vegetarian diets were more aware of the risk of nutritional deficiencies and administered dietary supplements more frequently. A vegetarian diet can be safe for young children, but parents should be educated about the risk of nutritional deficiencies and the principles of healthy nutrition regardless of the administered diet, and effective communication between parents, pediatricians, and dietitians should be the cornerstone of every nutritional strategy in the management of vegetarian children.

Institutional factors associated with college students' healthy physical activity and body composition: A first semester follow-up

Objective: The first aim of this study was to examine changes in freshman college students' health-enhancing physical activity (PA) and body composition across the first semester. Secondly, this study aimed to explore the role of socio-ecological variables on these processes. Methods: A sample of 166 participants (108 females, 58 males, M_age = 18.14[.96]) completed self-report pre-and posttest data on vigorous PA (VPA), moderate-to-vigorous PA (MVPA), and body mass index (BMI). Results: The results showed a statistically significant increase in BMI, but no statistically significant changes in VPA or MVPA. The findings revealed that our socio-ecological model predicted .71, .39, and .92 percent of the end of the year VPA, MVPA, and BMI, respectively. The findings highlighted the positive role of peer support, positive motivation, and university's Recreational Services on measured healthy behaviors. Conclusions: These findings suggest a need to increase college students' VPA.

Associations among retrospective parenting styles, retrospective food parenting, and current eating behaviors in Chinese adults

The current study explored the relationships between retrospective parenting styles and food parenting in childhood (≤ 12 years old) and Chinese adults' current maladaptive and adaptive eating behaviors. We recruited 501 Chinese adults (50.30% men, aged 19-46 years). A set of questionnaires were used to measure retrospective parenting styles (i.e., emotional warmth, rejection, and overprotection), food parenting (i.e., parental concern, monitoring, pressure to eat, and restriction), and current maladaptive (i.e., disordered eating) and adaptive (i.e., intuitive eating) eating behaviors. Correlation and mediation analyses were employed to analyze these data. Results revealed that retrospective parenting styles and food parenting were significantly related to current maladaptive and adaptive eating behaviors in both Chinese men and women. Mediation analyses showed that higher retrospective parental warmth was related to higher retrospective parental concern which, in turn, was related to higher current disordered eating in men (indirect effect = 0.14, 95% CI 0.08, 0.24). Furthermore, higher retrospective parental overprotection was related to higher retrospective parental pressure to eat which, in turn, was related to higher current disordered eating in men (indirect effect = 0.06, 95% CI 0.01, 0.14). For women, higher retrospective parental warmth was associated with higher retrospective parental concern which, in turn, was associated with lower current intuitive eating in women (indirect effect = -0.04, 95% CI = -0.10, -0.01). Furthermore, higher retrospective parental overprotection was associated with higher retrospective parental concern which, in turn, was associated with lower current intuitive eating in women (indirect effect = -0.03, 95% CI = -0.08, -0.004). The findings indicate the importance of including childhood parenting styles and food parenting in future research and intervention of adults' current maladaptive and adaptive eating behaviors.

Control and Chaos: Caregiver's Basic Psychological Need Frustration is Associated With the Socioemotional Climate When Feeding

OBJECTIVE

The socioemotional climate when feeding is a focus in childhood obesity prevention efforts. However, little is known about why caregivers create nonsupportive or supportive climates. This cross-sectional study used a Self-Determination Theory perspective to identify factors associated with the socioemotional climate when feeding in ethnically diverse families with low income.

METHODS

Caregivers of children aged 2-5 years (n = 66) completed the Parent Socioemotional Context of Feeding Questionnaire, the Basic Psychological Need (BPN) Satisfaction and Frustration Scale, and demographic surveys at baseline. Multivariable regressions assessed the association between BPN satisfaction/frustration with autonomy-supportive, structured, controlling, and chaotic feeding climates.

RESULTS

Participants were predominately Hispanic/Latinx (86.6%), women (92.5%), and born outside the US (60%). Their BPN frustration was positively associated with controlling (β = 0.96; SE = 0.26; P = 0.001) and chaotic (β = 0.79; SE = 0.27; P = 0.01) feeding.

CONCLUSIONS AND IMPLICATIONS

This analysis suggests that BPN frustration is associated with controlling and chaotic feeding and may be important to consider when encouraging responsive feeding.

Parental influences on children's dairy products consumption: a narrative review

OBJECTIVE

To review research on the influence of parent-related factors on children's dairy products consumption.

DESIGN

A search of electronic databases and a narrative synthesis of the literature were conducted. English-language articles were included if they reported data relating to parental influences on children's consumption of dairy products and if statistical significance was reported.

SETTING

Studies were carried out in the USA (n 8) and in a range of countries across Europe (n 12) and Asia (n 5).

PARTICIPANTS

The subjects of this research were children aged between 2 and 12 years of age, from a range of geographical locations.

RESULTS

Twenty-five studies met the inclusion criteria. The studies examined children's dairy products consumption in relation to parental socio-economic status (education level and income) (n 12), home availability (n 2), home food environment (n 3), parental dairy products consumption (n 4), parent feeding practices (n 3), parents' beliefs and attitudes (n 3) and parental nutrition knowledge (n 3). Results on the association between socio-economic status and children's dairy products consumption varied; however, studies reporting a significant association generally observed a positive relationship. Fifteen studies reported children's total dairy products intake as an outcome measure, with the remaining studies reporting intake of milk or other dairy products as individual foods.

CONCLUSIONS

This review identified literature exploring a range of parental factors in relation to children's dairy products intake. However, there were limited numbers of studies published within each category of modifiable factors. Further research on the parent-related determinants of dairy products consumption in children is required in order to identify potential intervention targets in this age group.

Bayesian spatial modeling of childhood overweight and obesity prevalence in Costa Rica

BACKGROUND

Childhood overweight and obesity levels are rising and becoming a concern globally. In Costa Rica, the prevalence of these conditions has reached alarming values. Spatial analyses can identify risk factors and geographical patterns to develop tailored and effective public health actions in this context.

METHODS

A Bayesian spatial mixed model was built to understand the geographic patterns of childhood overweight and obesity prevalence in Costa Rica and their association with some socioeconomic factors. Data was obtained from the 2016 Weight and Size Census (6 - 12 years old children) and 2011 National Census.

RESULTS

Average years of schooling increase the levels of overweight and obesity until reaching an approximate value of 8 years, then they start to decrease. Moreover, for every 10-point increment in the percentage of homes with difficulties to cover their basic needs and in the percentage of population under 14 years old, there is a decrease of 7.7 and 14.0 points, respectively, in the odds of obesity. Spatial patterns show higher values of prevalence in the center area of the country, touristic destinations, head of province districts and in the borders with Panama.

CONCLUSIONS

Especially for childhood obesity, the average years of schooling is a non-linear factor, describing a U-inverted curve. Lower percentages of households in poverty and population under 14 years old are slightly associated with higher levels of obesity. Districts with high commercial and touristic activity present higher prevalence risk.

Feeding characteristics in infancy affect fruit and vegetable consumption and dietary variety in early childhood

BACKGROUND/OBJECTIVES

Previous studies have shown an association between breastfeeding and higher fruit and vegetable consumption and the level of dietary variety in children. However, few studies have reported this association on the feeding characteristics. Therefore, this study examined the association of the feeding characteristics with the consumption of fruit and vegetable and dietary variety in children.

SUBJECTS/METHODS

This study recruited 802 participants from their parents with information on their feeding, and 24-h dietary recall. The associations of the feeding characteristics with fruit and vegetable consumption and dietary variety score (DVS) were analyzed using a multiple logistic regression model.

RESULTS

Compared to the feeding type of exclusive breastfed children, exclusive formula-fed children had a significant association with a lower DVS (odds ratio [OR], 0.42, 95% confidence interval [CI], 0.23-0.77). Fruit and vegetable consumption was classified into 6 groups: non-salted vegetables (NSV), salted vegetables (SV), fruit (F), total vegetables (TV), non-salted vegetables + fruit (NSVF), and total vegetables + fruit (TVF). According to the mean level of fruit and vegetable consumption, compared to the duration of total breastfeeding for 6 month or less, a greater duration of breastfeeding for 12 mon had a significant association with a higher intake of NSVF and TVF (OR, 1.85, 95% CI, 1.20-2.85 and OR, 1.89, 95% CI, 1.22-2.92). On the other hand, the early introduction of formula feeding for 4 mon had a significant association with a lower intake of F and NSVF (OR, 0.59, 95% CI, 0.38-0.91 and OR, 0.63, 95% CI, 0.40-0.99).

CONCLUSIONS

These results confirm that breastfeeding is associated with higher fruit and vegetable consumption and dietary variety, whereas formula feeding is associated with lower fruit and vegetable consumption and dietary variety. Therefore, the feeding characteristics in infants may affect fruit and vegetable consumption and dietary variety in children.

Chemosensory continuity from prenatal to postnatal life in humans: A systematic review and meta-analysis

Throughout pregnancy, fetuses are exposed to a range of chemosensory inputs influencing their postnatal behaviors. Such prenatal exposure provides the fetus with continuous sensory information to adapt to the environment they face once born. This study aimed to assess the chemosensory continuity through a systematic review and meta-analysis of existing evidence on chemosensory continuity from prenatal to first postnatal year. Web of Science Core. Collections, MEDLINE, PsycINFO, EBSCOhost ebook collection was searched from 1900 to 2021. Studies identified from the search were grouped according to type of stimuli the fetuses were exposed to prenatally that the neonatal infants' responses to were being evaluated, namely flavors transferred from the maternal diet, and the odor of their own amniotic fluid. Of the 12 studies that met the eligibility criteria for inclusion (k = 6, k = 6, respectively in the first and the second group of studies), and eight studies (k = 4, k = 4, respectively) provided sufficient data suitable for meta-analysis. Infants, during their first year of life, oriented their heads for significantly longer durations in the direction of the prenatally experienced stimuli with large pooled effect sizes (flavor stimuli, d = 1.24, 95% CI [0.56, 1.91]; amniotic fluid odor, d = 0.853; 95% CI [.632, 1.073]). The pooled effect size for the duration of mouthing behavior was significant in response to prenatal flavor exposure through maternal diet (d = 0.72; 95% CI [0.306, 1.136]), but not for the frequency of negative facial expressions (d = -0.87, 95% CI [-2.39, 0.66]). Postnatal evidence suggests that there is a chemosensory continuity from fetal to the first year of postnatal life.

Parental Perceptions on the Importance of Nutrients for Children with Autism Spectrum Disorder (ASD) and the Coping Strategies: A Qualitative Study

Autism Spectrum Disorder (ASD) is a developmental disorder that comes with co-occurring eating behavior such as limited food varieties, selective food intake, and repetitive eating patterns, contributing to significant challenges for their parents. Many parents find mealtimes difficult and develop anxiety or stress about their child’s nutrition, health, and overall well-being. Hence, parents must equip themselves with the correct awareness and nutrition knowledge. An online open-ended semi-structured interview was conducted among fifteen parents from the community-rehabilitation program center to explore their understanding of nutrition’s importance and the possible coping strategies when facing challenges. The interview sessions were recorded, followed by three researchers’ coding processes. Data were then subjected to thematic analysis. The interview sessions suggested that the parents were aware of the autism trait eating behavior and had a general knowledge about nutrition. However, it was quite challenging when it came to preparation. Nevertheless, the parents are able to manage the challenges with unique kinds of coping strategies. In addition, a complete educational dietary intervention program including psychosocial aspects for parents is recommended for better effectiveness.

Caregiver and adolescent intuitive eating behavior: associations with weight change during family-based treatment for anorexia nervosa

PURPOSE

Intuitive eating (IE) is an adaptive eating construct for which little research exists in eating disorder (ED) samples. IE is negatively correlated with disordered eating behaviors in healthy adolescents and adults, and similar associations have been found in adults with EDs. This study aims to examine IE in a treatment seeking sample of adolescents and their caregivers to understand the role of IE in weight gain during FBT.

METHODS

Descriptive statistics and bivariate correlations were calculated in a sample of 47 pairs of adolescent patients and their caregivers who initiated outpatient FBT at a large academic medical center. Analyses examined associations between caregiver and adolescent IE on the Intuitive Eating Scale (IES), change in percent expected body weight (%EBW) by session 4 and end of treatment (EOT), clinical impairment, and ED pathology.

RESULTS

Significant correlations were found between aspects of adolescent IE, ED symptoms, and clinical impairment. Caregiver IES scores (Reliance on Hunger and Satiety Cues, Body-Food Choice Congruence, IES Total) were negatively related to adolescent ED symptoms (EDE-Q Weight Concerns, EDE-Q Shape Concerns, EDE-Q Global) at baseline. Caregiver IE (Eating for Physical Rather than Emotional Reasons) was positively associated with adolescent weight gain at FBT session 4 and EOT, even when statistically adjusting for gender and initial level of care.

CONCLUSION

Study results were consistent with past research indicating adolescent IE is negatively associated with ED behaviors, cognitions, and impairment. This study is the first to provide evidence that caregiver IE is positively associated with adolescent weight gain in FBT and is the first to provide evidence that caregiver IE is negatively related to adolescent ED symptoms. Future research should examine adolescent and caregiver IE throughout FBT to understand the role of IE in treatment response.

LEVEL OF EVIDENCE

Level III: Evidence obtained from cohort or case-control analytic studies.

Community coalition efforts to prevent childhood obesity: two-year results of the Shape Up Under 5 study

BACKGROUND

Cross-sector collaborations and coalitions are promising approaches for childhood obesity prevention, yet there is little empirical evidence about how they affect change. We hypothesized that changes in knowledge of, and engagement with, childhood obesity prevention among coalition members can diffuse through social networks to influence policies, systems, and environments.

METHODS

We studied a community coalition (N = 16, Shape Up Under 5 "SUU5 Committee") focused on early childhood obesity prevention in Somerville, MA from 2015-17. Knowledge, engagement, and social network data were collected from Committee members and their network contacts (n = 193) at five timepoints over two years. Policy, systems, and environment data were collected from the SUU5 Committee. Data were collected via the validated COMPACT Stakeholder-driven Community Diffusion survey and analyzed using regression models and social network analysis.

RESULTS

Over 2 years, knowledge of (p = 0.0002), and engagement with (p = 0.03), childhood obesity prevention increased significantly among the SUU5 Committee. Knowledge increased among the Committee's social network (p = 0.001). Significant changes in policies, systems, and environments that support childhood obesity prevention were seen from baseline to 24 months (p = 0.003).

CONCLUSION

SUU5 had positive effects on "upstream" drivers of early childhood obesity by increasing knowledge and engagement. These changes partially diffused through networks and may have changed "midstream" community policies, systems, and environments.

The effects of snack foods of different energy density on self-served portions and consumption in preschool children

It is recommended that preschoolers serve themselves their own food portions; however, it is unclear what factors influence the amount they select for consumption, and particularly how their selected portions are influenced by food properties such as energy density, volume, and weight. We offered preschool children snacks differing in energy density (ED) and investigated the effects on the amounts they served and then consumed. In a crossover design, 52 children aged 4-6 y (46% girls; 21% overweight) ate an afternoon snack on 2 days in their childcare classrooms. Before each snack time, children served the amount they would like to eat of 4 snacks presented in equal volumes but differing in ED (higher-ED: pretzels, cookies; lower-ED: strawberries, carrots). Across the 2 sessions, children were given their self-served amount of either pretzels (3.9 kcal/g) or strawberries (0.3 kcal/g) and intake was measured. Later, children tasted all 4 snacks and rated liking. Results showed that the portions children served themselves were influenced by their liking ratings (p = 0.0006), but after accounting for liking, the volumes they served were similar for all 4 foods (p = 0.27). At snack time, children ate a greater proportion of self-served strawberries (92 ± 4%) than pretzels (73 ± 4%; p = 0.0003), but because of the ED difference they consumed 55 ± 4 kcal more from pretzels than strawberries (p < 0.0001). The difference in snack intake by volume was not attributable to liking ratings (p = 0.87). That children served a consistent volume of similarly-liked snacks suggests that their portions were affected more by visual cues than by weight or energy content. Despite eating a greater volume of lower-ED strawberries, children consumed more energy from the higher-ED pretzels, highlighting the contribution of energy density to children's energy intake.

Challenges around Child-Feeding Practices with ‘Comida Chatarra’: A Qualitative Study to Understand the Role of Sociocultural Factors in Caregiver Feeding Decisions

A massive incorporation of ultra-processed products into young children’s diets worldwide and in Mexico has been documented. The aim of this study is to understand the role of sociocultural factors in principal caregivers’ decisions to give a type of ultra-processed food to children under age five, called ‘comida chatarra’ (‘junk food’ in English), usually includes sugar-sweetened beverages, sweet and salty snacks, and sweet breakfast cereals. We conducted a descriptive, observational qualitative study. The research was conducted in urban and rural communities in two Mexican states. Twenty-four principal caregivers were equally distributed between the two states and types of communities. They were interviewed in person. Phenomenology underpinned this study. Results highlight the preponderant role of culture in food choices and feeding practices with junk food. Local culture influences child-feeding with ultra-processed products through social norms, knowledge, or socially constructed attitudes. These social norms, built in the context of abundant ultra-processed products and omnipresent marketing, ‘justify’ children’s consumption of junk food. They acquire these products from the principal caregivers, family members, and neighbors, among others, who reward and pamper them. These actors also define what amount (small amounts) and when (after meals as snacks) children are given these products. Cultural factors must be considered in the development of effective public policies and programs that aim to change the culture around ultra-processed products among children and avoid their consumption.

The Emerging Prevalence of Obesity within Families in Europe and its Associations with Family Socio-Demographic Characteristics and Lifestyle Factors; A Cross-Sectional Analysis of Baseline Data from the Feel4Diabetes Study

The Feel4Diabetes study is a type 2 diabetes prevention program that recruited 12,193 children [age: 8.20 (±1.01) years] and their parents from six European countries. The current work used pre-intervention data collected from 9576 children-parents pairs, to develop a novel family obesity variable and to examine its associations with family sociodemographic and lifestyle characteristics. Family obesity, defined as the presence of obesity in at least two family members, had a prevalence of 6.6%. Countries under austerity measures (Greece and Spain) displayed higher prevalence (7.6%), compared to low-income (Bulgaria and Hungary: 7%) and high-income countries (Belgium and Finland: 4.5%). Family obesity odds were significantly lower when mothers (OR: 0.42 [95% CI: 0.32, 0.55]) or fathers (0.72 [95% CI: 0.57, 0.92]) had higher education, mothers were fully (0.67 [95% CI: 0.56, 0.81]) or partially employed (0.60 [95% CI: 0.45, 0.81]), families consumed breakfast more often (0.94 [95% CI: 0.91 0.96]), more portions of vegetables (0.90 [95% CI: 0.86, 0.95]), fruits (0.96 [95% CI: 0.92, 0.99]) and wholegrain cereals (0.72 [95% CI: 0.62, 0.83]), and for more physically active families (0.96 [95% CI: 0.93, 0.98]). Family obesity odds increased when mothers were older (1.50 [95% CI: 1.18, 1.91]), with the consumption of savoury snacks (1.11 [95% CI: 1.05, 1.17]), and increased screen time (1.05 [95% CI: 1.01, 1.09]). Clinicians should familiarise themselves with the risk factors for family obesity and choose interventions that target the whole family. Future research should explore the causal basis of the reported associations to facilitate devising tailored family-based interventions for obesity prevention.

'Our time is precious': An exploration of parental feeding behaviours for boys with Duchenne muscular dystrophy

INTRODUCTION

Due to the increased risk of obesity for boys with Duchenne muscular dystrophy (DMD), recent guidelines recommend that dietary intake is carefully managed. Parents play an important role in the development of their child's eating behaviours and patterns. However, despite what is known about the increased risk of obesity for children with DMD, little is known about parental feeding behaviours in this population. The objective of this study was to qualitatively explore the experiences of parents of children with DMD around their child's weight management and understand what influences their feeding behaviours.

METHODS

This paper reports a secondary data analysis. Semi-structured, individual interviews were conducted and analysed using qualitative description.

RESULTS

Thirteen parents were interviewed for the study. Three themes were developed: (1) parent responses to healthcare provider interactions, (2) mixed emotions contributing to feeding approach and (3) variable parenting feeding styles. Within the third theme, two subthemes arose including (1) control and preoccupation and (2) striking a balance.

CONCLUSION

Given the potential impact of higher weights on the progression of DMD, it is important that healthcare providers explore feeding behaviours with families. However, it is essential that healthcare providers consider the impact of these conversations on parents, as well as the broader issues that may place additional pressure on the lives of families.

Produce Prescriptions and a Path Toward Food Equity for Children

This Viewpoint discusses the benefits of produce prescriptions to support nutrition security and food equity.

Food Insecurity, Federal Nutrition Support, and Parent Feeding Practices During COVID-19: A 1-Year Follow-up Study

OBJECTIVES

COVID-19 caused stark increases in food insecurity. To maintain food provision, policy changes to the National School Lunch Program (NSLP) and Supplemental Nutrition Assistance Program (SNAP) were instated. This longitudinal study examined (1) food security patterns across the timeline of COVID-19; (2) the relationship among food security patterns, NSLP/SNAP use, and parent feeding practices; and (3) parent perceptions of NSLP/SNAP policy changes.

METHODS

A total of 333 US parents completed online surveys during the COVID-19 pandemic: May 2020 (T1), September 2020 (T2), and May 2021 (T3). Food security and parent feeding practices were reported at each time point; pre-COVID-19 behaviors were retrospectively reported at T1. Use and perceptions of NSLP/SNAP policy changes were reported at T3. We examined associations between food security and parent feeding practices using repeated-measures mixed models.

RESULTS

The percentage of parents with very low food security increased from pre-COVID-19 (9.6%) to T1 (29.1%) and remained elevated at T3 (16.8%). One-third (31.2%) of families fluctuated between food security and food insecurity, with 27.0% remaining food insecure at T3. Thirty percent of consistently food-insecure families reported not receiving school-provided meals, and 45% did not receive SNAP benefits. Most parents reported that pickup school meal sites (71.4%), Pandemic Electronic Benefit Transfer cards (51.4%), and increased SNAP benefits (79.6%) were beneficial. Initial changes in parent feeding practices reported at T1 returned to pre-COVID-19 levels by T3, yet concern for child overweight remained significantly elevated.

CONCLUSION

Continued policy efforts to support food-insecure families via expanded food access in NSLP/SNAP are critical.

Parental feeding practices as potential moderating or mediating factors in the associations between children's early and later growth

BACKGROUND

Given inconsistent results in the literature, our objective was to examine the role of early parental feeding practices in children's growth.

METHODS

Analyses were based on 1245 children from the EDEN mother-child cohort. Parental feeding practices were assessed at the 2-year follow-up by using the Comprehensive Feeding Practices Questionnaire. International Obesity Task Force BMI z-scores were derived from weight and height assessed at 2, 4, 6, and 8 years. Associations between parental feeding practices and child BMI z-scores at 4, 6 and 8 years were assessed by multivariable linear regressions, notably adjusted for 2-year BMI z-score. Analyses were stratified by child sex when relevant. Moreover, interaction and mediation analyses were respectively performed to assess whether parental feeding practices could moderate or mediate the associations between early and later growth.

RESULTS

For a given BMI z-score at 2 years, parental restriction for weight at 2 years was positively associated with child BMI z-scores from 4 to 8 years (at 8 years: β [95% CI] = 0.09 [0.01; 0.16]). Among boys only, high use of food as a reward was positively associated with later BMI z-scores (at 8 years: β [95% CI] = 0.15 [0.03; 0.27]). Parental feeding practices were not moderating factors in the associations between early and later growth. Parental restriction for weight was a mediating factor in the associations between 2-year BMI z-score and BMI z-scores up to 8 years (mediation: 2.69% [0.27%; 5.11%] of the total effect at 8 years).

CONCLUSIONS

Restriction for weight reasons, often used by parents in response to the child's high appetite in infancy, appears to lie on the pathway between early and later BMI, but not restriction for health, suggesting that parental way of restricting the child's food intake matters.

Parental mindful eating practices and mindful eating interventions are associated with child emotional eating

The family environment, which involves parent eating behaviors and feeding practices, influences child intake and eating behaviors. Specifically, parental emotional eating or emotional feeding practices may lead to emotional eating in the child. Mindful eating practices may decrease emotional eating behaviors. The purpose of this narrative review was to investigate the influence of parental mindful eating on emotional eating behaviors of their children or adolescents. A secondary purpose of this review was to determine whether a family-based or child mindful eating intervention improves child emotional eating directly or through the improvements of the parent and parental role modeling. EBSCOhost was used to simultaneously search 5 databases. The search was limited to full-text, peer-reviewed articles in the English language. Seven studies, 4 cross-sectional studies and 3 intervention studies, were identified. Across studies, measures of mindful and emotional eating differed. Among the cross-sectional studies, parental mindful eating/feeding or mindful parenting were either directly or indirectly related to decreased emotional eating in the child or adolescent. The effect was unclear among the intervention studies; however, these were pilot feasibility studies. Overall, parental mindful eating is associated with emotional eating behaviors among children and adolescents. Additional studies with a randomized controlled design are needed to evaluate parent mindful eating interventions on child and adolescent eating behaviors. Additionally, future trials need to use similar validated measures to ensure consistent quality data collection and allow for comparison of findings across studies.

Cross-Sectional Analysis of Family Factors Associated with Lifestyle Habits in a Sample of Italian Primary School Children: The I-MOVE Project

The acquisition of healthy dietary and exercise habits during childhood is essential for maintaining these behaviors during adulthood. In early childhood, parents have a profound influence on a child's lifestyle pursuits, serving as both role models and decision-makers. The present study examines family factors as potential contributors to healthy lifestyle habits and their child's overall diet quality among a sample of primary school children. A secondary aim is to evaluate several aspects of diet quality using the Mediterranean adaptation of the Diet Quality Index-International (DQI-I). This cross-sectional study involved 106 children enrolled in a primary school located in Imola, Italy. Data were collected from October to December 2019 using an interactive tool used to assess parent characteristics, children's lifestyle, food frequency (ZOOM-8 questionnaire), and actigraph accelerometers to capture children's physical activity and sedentary behavior. Adherence to the Mediterranean Diet (expressed by KIDMED Index) was positively associated with fathers' educational level, parental sport participation, and the parent's overall nutritional knowledge. Higher mothers' educational level was inversely associated with children's leisure screen time. Parents' nutritional knowledge was positively related to children's average daily minutes of organized sport activities. The better score for DQI-I was for consumption adequacy, followed by variety and moderation. The lowest score was for overall balance. The present study reinforces the importance of family factors in young children's lifestyle choices, particularly their dietary, leisure time, and exercise habits.

Eating Behavior and Obesity in a Sample of Spanish Schoolchildren

From the point of view of prevention, it is convenient to explore the association between eating behavior and the obese phenotype during school and adolescent age. The aim of the present study was to identify eating behavior patterns associated with nutritional status in Spanish schoolchildren. A cross-sectional study of 283 boys and girls (aged 6 to 16 years) was carried out. The sample was evaluated anthropometrically by Body Mass Index (BMI), waist-to-height ratio (WHtR) and body fat percentage (%BF). Eating behavior was analyzed using the CEBQ "Children's Eating Behavior Questionnaire". The subscales of the CEBQ were significantly associated with BMI, WHtR and %BF. Pro-intake subscales (enjoyment of food, food responsiveness, emotional overeating, desire for drinks) were positively related to excess weight by BMI (β = 0.812 to 0.869; p = 0.002 to <0.001), abdominal obesity (β = 0.543-0.640; p = 0.02 to <0.009) and high adiposity (β = 0.508 to 0.595; p = 0.037 to 0.01). Anti-intake subscales (satiety responsiveness, slowness in eating, food fussiness) were negatively related to BMI (β = -0.661 to -0.719; p = 0.009 to 0.006) and % BF (β = -0.17 to -0.46; p = 0.042 to p = 0.016).

Self-Reported Parental Healthy Dietary Behavior Relates to Views on Child Feeding and Health and Diet Quality

The aim of this cross-sectional study was to investigate whether parental views on child feeding and its impact on health differ between those parents whose self-perception was that they followed a healthy diet to those who do not. Furthermore, differences in the child's diet quality and weight were compared between the groups. Parents of 2-6-year-old children (n = 738), recruited from child health clinics throughout Finland, answered semi-structured questionnaires on their views on child feeding and health as well as their child's diet quality. Participants were divided into two groups based on their self-perceived report of following a healthy diet: health-conscious (HC, n = 396) and non-health-conscious (non-HC, n = 342) parents. HC parents considered health, eating behavior, and nutrient-related factors more often when feeding their child than non-HC parents (<0.001 < p < 0.03). Moreover, they more commonly considered diet to have an important impact on their child's long-term health than the non-HC parents (<0.001 < p < 0.05). Children of HC parents were more likely to have a good diet quality (p = 0.01) and lower BMI-SDS values (p = 0.015) than those of non-HC parents. Parental health consciousness was linked with better diet quality and healthier weight in their children. This information may be useful in the regular clinical monitoring of children's health.

School lunchboxes as an opportunity for health and environmental considerations: a scoping review

Very little research has focussed on children's school lunchboxes from both a health and environment standpoint. This scoping review explores studies that considered children's lunchbox food consumption trends at school and the environmental impacts of lunchbox contents. We conducted a scoping review of peer-reviewed literature with a focus on lunchboxes of children in preschool or primary school settings that contained food packed from home, through the lens of food and nutrition in combination with environmental outcomes-particularly food and/or packaging waste. The review included 10 studies, with articles from Australia, USA, Spain, New Zealand and the UK. Half of them were intervention studies aiming to shift knowledge levels and attitudes of teachers, parents and children with regard to reducing packaged food choices and food waste, and improving dietary habits. Acknowledging the complexity of lunchbox packing and consumption practices, this review recommends the consideration of socio-ecological influences on children's health and sustainability behaviour, and mobilizing their pro-environmental agency.

Associations Among Parents' Eating Behaviors, Feeding Practices, and Children's Eating Behaviors

Parental feeding practices influence children's eating behaviors, yet it is not well-understood whether parents' own eating behaviors are associated with their feeding practices. The purpose of this study was to examine associations among parents' eating behaviors, parental feeding practices, and children's eating behaviors. A cross-sectional study was conducted with 76 parents of children from an elementary school in Tampa, FL. Parents completed three questionnaires with topics related to parent eating behaviors, parental feeding practices, and children's eating behaviors. Multiple regression analysis was performed, controlling for demographic covariates. Parents who reported to eat more fruits per day (β = 0.15), eat more than one kind of fruit each day (β = 0.33), eat more than one kind of vegetable each day (β = 0.29), eat 2 or more vegetables at the main meal (β = 0.36), plan meals (β = 0.19), and keep vegetables ready for the child to eat (β = 0.25) indicated that they use more positive reinforcement feeding practices (all p ≤ 0.001). There were significantly positive associations between positive reinforcement and children's eating fruits or vegetables like apples, bananas or carrots as snacks (β = 1.03) and eating more than one kind of vegetable a day (β = 1.03; all p < 0.001). No other variables had any significant associations. Findings of this study indicate that there are potential associations among parent's own eating behaviors, feeding practices, and children's eating behaviors. Further research is needed to determine the mechanism of these relationships. Targeting these parental factors may be an effective way to maximize the impact of nutrition interventions on children's dietary behavior changes.

Individual and family predictors of ultra-processed food consumption in Spanish children: The SENDO project

BACKGROUND

Ultra-processed food (UPF) consumption is increasing exponentially, becoming a matter of concern for Public Health, given its adverse health effects.

OBJECTIVE

To identify individual and faGmily factors predicting UPF consumption in childhood.

DESIGN

The SENDO project is an ongoing prospective dynamic cohort of Spanish children. In this study, we used baseline information of participants recruited between January 2015 and June 2021. Dietary information was collected with a validated semi-quantitative FFQ, and food items were classified using the NOVA classification. Individual and family factors associated with UPF consumption (P < 0·20) in univariate analyses were introduced in a model of generalised estimating equations which accounted for intra-cluster correlations between siblings.

SETTING

The SENDO project (Spain), 2015-2021.

PARTICIPANTS

Spanish children are recruited at the age of 4-5 years and followed yearly through online questionnaires completed by parents.

RESULTS

In this sample of 806 participants (49 % girls; mean age 5 years (sd: 0·90)), the mean UPF consumption was 37·64 % of total energy intake (sd: 9·59). Large family size and longer exposure to screens predicted higher consumption of UPF. On the other hand, better knowledge of children's dietary recommendations, healthy dietary attitudes towards child's eating habits and longer breastfeeding were associated with lower consumption of UPF. All these factors accounted for approximately 16 % of the variability on the consumption of UPF in childhood.

CONCLUSION

Since most of the factors identified in this study are modifiable, they should be considered in public health strategies aimed at promoting healthy dietary habits in early life.

Parental Feeding Practices and Children's Eating Behaviours: An Overview of Their Complex Relationship

Several studies have found an association between eating behaviours and weight status and obesity risk in childhood. Children's eating behaviours arise from a combination of genetic and environmental factors. Parents appear to play a central role in their development as the main responsible for shaping children's feeding environment and eating experiences. The purpose of this paper is to review the literature on parental influences on eating behaviours across childhood, mainly focusing on parental feeding practices. The associations between parental feeding practices and children's eating behaviours have been extensively studied. However, most of the findings come from cross-sectional studies, so the possibility of reverse causality cannot be ruled out (i.e., children's behaviours influencing parents). Most recently, a few longitudinal studies with a cross-lagged design have shown that the relationship between children's eating behaviours and parental feeding practices seems to be bidirectional, where it is not straightforward whether parental feeding practices are a predictor or a consequence of children's eating behaviours. Children's eating behaviours influence parents to adopt certain feeding practices, but these practices also influence children's behaviours over time. Parental feeding practices may have the potential to shape children's eating behaviours and should be targeted to promote the development of non-obesogenic traits. However, parent-child interactions are complex and therefore both parent and child characteristics and the family dynamics should be considered.

The influence of Chile's food labeling and advertising law and other factors on dietary and physical activity behavior of elementary students in a peripheral region: a qualitative study

BACKGROUND

In 2016, Chile implemented the Food Labeling and Advertising Law to fight childhood obesity through front-of-package food labelling, marketing restrictions and school activities and programs. Nevertheless, little is known on its influence on key stakeholders in vulnerable peripheral regions of the country. This study aimed at identifying important influencing factors including the Food Labeling and Advertising Law on dietary habits and physical activity patterns of second graders in Chile, as perceived by school representatives and the children themselves.

METHODS

Semi-structured interviews with four school directors and 17 groups of three second graders, informal interviews with 9 key teachers and 4 food services staff complemented with documented observations were carried out in four primary schools of the Chilean city of Punta Arenas, in the Magallanes Punta Arenas region. The different sources allowed for triangulation of results.

RESULTS

FLAL seems to have a negligible influence on young children's diet and physical activity in the study region. Barriers are children's deeply rooted dietary habits, excessive screen-time, the parents' lacking problem awareness, limited time for parenting practices and bad role modeling. Environmental barriers are overloaded schools due to insufficient coordination between governmental entities, lacking funds for sound teacher training and unsafe neighborhoods limiting children's play.

CONCLUSIONS

Policy interventions aimed at reducing childhood obesity need to include and empower schools, families and local communities as active partners and consider their framework conditions for greater influence on dietary habits and physical activity.

Evaluation of a cluster-randomized controlled trial: Communities for Healthy Living, family-centered obesity prevention program for Head Start parents and children

BACKGROUND

This study reports the outcomes of Communities for Healthy Living (CHL), a cluster randomized obesity prevention trial implemented in partnership with Head Start, a federally-funded preschool program for low-income families.

METHODS

Using a stepped wedge design, Head Start programs (n = 16; Boston, MA, USA) were randomly assigned to one of three intervention start times. CHL involved a media campaign and enhanced nutrition support. Parents were invited to join Parents Connect for Healthy Living (PConnect), a 10-week wellness program. At the beginning and end of each school year (2017-2019), data were collected on the primary outcome of child Body Mass Index z-score (BMIz) and modified BMIz, and secondary outcomes of child weight-related behaviors (diet, physical activity, sleep, media use) and parents' weight-related parenting practices and empowerment. Data from 2 years, rather than three, were utilized to evaluate CHL due to the COVID-19 pandemic. We used mixed effects linear regression to compare relative differences during intervention vs. control periods (n = 1274 vs. 2476 children) in (1) mean change in child BMIz and modified BMIz, (2) the odds of meeting child health behavior recommendations, (3) mean change in parenting practices, and (4) mean change in parent empowerment. We also compared outcomes among parents who chose post-randomization to participate in PConnect vs. not (n = 55 vs. 443).

RESULTS

During intervention periods (vs. control), children experienced greater increases in BMIz and modified BMIz (b = 0.06, 95% CI = 0.02,0.10; b = 0.07, 95% CI = 0.03, 0.12), yet were more likely to meet recommendations related to three of eight measured behaviors: sugar-sweetened beverage consumption (i.e., rarely consume; Odds Ratio (OR) = 1.5, 95% CI = 1.2,2.3), water consumption (i.e., multiple times per day; OR = 1.6, 95% CI = 1.2,2.3), and screen time (i.e., ≤1 hour/day; OR = 1.4, 95% CI = 1.0,1.8). No statistically significant differences for intervention (vs. control) periods were observed in parent empowerment or parenting practices. However, parents who enrolled in PConnect (vs. not) demonstrated greater increases in empowerment (b = 0.17, 95% CI = 0.04,0.31).

CONCLUSIONS

Interventions that emphasize parent engagement may increase parental empowerment. Intervention exposure was associated with statistically, but not clinically, significant increases in BMIz and increased odds of meeting recommendations for three child behaviors; premature trial suspension may explain mixed results.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03334669 , Registered October 2017.

Nutrition Education in Medical Schools: What do Medical Students Think?

Objective

To examine medical students' perceptions of the nutrition education received and their ability to apply that knowledge in clinical settings.

Methods

This is a qualitative study using a structured survey with free responses to solicit the perspective of US medical students regarding their nutrition education. A national online survey was distributed by the American Academy of Pediatrics, Section on Pediatric Trainees. An expert committee in nutrition education evaluated and conducted a thematic analysis of the survey responses.

Results

Twenty-four surveys were completed (10 medical students and 14 pediatric interns). The survey revealed students were not satisfied with the nutrition education they received in several areas including nutritional recommendations for obesity and prediabetes/diabetes; nutritional needs during pregnancy, childhood, and adolescent age-related dietary recommendations; cultural influences on diet and eating habits; and food insecurity. Students also reported a lack of confidence in providing healthful nutrition counseling to adolescent patients and delivering culturally appropriate nutrition advice.

Conclusions

Survey responses revealed the need for improvements in several areas of nutrition curricula related to health and chronic disease management and suggest broader social determinants of health such as cultural influences on nutrition practices and food insecurity. The results of this survey provide unique insight into the medical student perspective on nutrition education and can inform the development of future medical school nutrition curriculums.

Mental health matters: Parent mental health and children's emotional eating

Parents' symptoms of anxiety and depression are associated with their increased likelihood of using nonresponsive feeding practices and with children's elevated obesity risk. These feeding practices, particularly persuasive-controlling feeding practices, have further been linked to children's emotional eating, including both emotional overeating and undereating. To help future research identify points of interventions to reduce children's maladaptive eating behaviors, the goal of this study was to determine whether persuasive-controlling feeding practices mediated the link between parent mental health and children's emotional eating. Feeding practices were measured by the FPSQ. Anxiety was measured by the GAD-7. Depression was measured by the CESD-R. Emotional eating was measured by the CEBQ. Survey data were collected from 259 U.S. parents of preschool children as a part of a larger study. Results from structural equation modeling showed that nonresponsive feeding behaviors mediated the relationship between parent mental health and children's emotional eating. Future longitudinal studies and clinical trials should examine whether and how persuasive-controlling feeding practices explain the link between parents' mental health and children's maladaptive eating behaviors, including emotional eating.

The association between parents' stress and parental feeding practices and feeding styles: Systematic review and meta-analysis of observational studies

In the extended UNICEF framework of early childhood nutrition, parents' stress is associated with parental feeding style. However, no comprehensive review has examined the association between parents' stress and feeding styles and practices. The objective of our review was to synthesise the current literature examining the association between parents' stress and their feeding practices and/or styles, among parents of children ≤ 5 years old. We searched; MEDLINE, EMBASE, PSYCHINFO and CINAHL from 2019 to 2021. Two investigators independently extracted relevant data and assessed the study quality and the certainty of evidence. Data were pooled using generic inverse variance with fixed effects (<5 comparisons) or random effects (≥5 comparisons) and expressed as correlation coefficients with 95% confidence intervals (CI). Between study heterogeneity was assessed using Cochran's Q and quantified with I2 . We identified 6 longitudinal and 11 cross-sectional studies, of which 4 studies provided sufficient data to be pooled. A very small correlation between general stress and restrictive feeding practices was observed (r = 0.06 [95% CI: 0.01-0.12]; no substantial heterogeneity (I2  = 0.00%, PQ  < 0.85, very low certainty). No correlation between general stress and feeding pressure was identified (r = 0.06 [95% CI: -0.02 to 0.15]). Results showed that both general and parenting stress were associated with suboptimal breastfeeding practices and unresponsive feeding styles. Conclusion: This study demonstrated a low-to-moderate quality of literature for the inclusion of parents' stress in the extended UNICEF care model of child nutrition. Future research needs to explore this relationship longitudinally and in ethnic diverse populations to inform tailored interventions that promote responsive feeding practices.

Resource dilution in maternal feeding practices after birth of a secondborn

Firstborn children have higher prevalence of obesity than secondborn siblings. The birth of a sibling typically results in resource dilution when mothers begin to divide their time and attention between two children. This mixed-methods analysis applies the family systems process of resource dilution to test the hypothesis that characteristics of the secondborn impact how parents feed the firstborn. Participants (n = 76) were mothers of consecutively born firstborn and secondborn siblings who participated in the INSIGHT trial and an observational cohort. Quantitative analyses involved multilevel models to test if characteristics of secondborns (temperament at 16 weeks, appetite at 28 weeks) were associated with maternal feeding practices of firstborns (structure and control-based feeding) at 1, 2, and 3 years, adjusting for firstborn child characteristics. A purposive subsample (n = 30) of mothers participated in semi-structured interviews to contextualize potential sibling influences on maternal feeding practices during infancy and toddlerhood. Quantitative data showed secondborn temperament and appetite were associated with how mothers fed their firstborn. Qualitative data explained maternal feeding practices in three primary ways: 1) Mothers explained shifting predictable meal and snack routines after birth of the secondborn, but did not perceive sibling characteristics as the source; 2) Family chaos following the secondborn's birth led to "survival mode" in feeding; and 3) Social support was protective against feeding resource dilution. The family systems process of resource dilution is a focus for future research and support for families during key transitions and a direction for efforts to reduce risk for child obesity.

Perceived Role of Asian Indian Fathers in Florida During Mealtimes: Factors to Consider for Their Involvement in Childhood Obesity Prevention

Research has shown that fathers play an important role in children's mealtimes and dietary habits; yet, little is known about the factors that affect how fathers perceive this role, especially among Asian Indians. This study aimed to examine how Asian Indian fathers perceive their role during child mealtimes and the factors that are associated with fathers' mealtime perceptions. Eighty Asian Indian fathers of 6- to 11-year-old children completed an online survey including measures of demographics, acculturation, gender roles, nutrition knowledge, parental self-efficacy, perceived child weight, and the role of father at mealtime (ROFM). Data were analyzed using descriptive statistics and linear regression. Participants perceived a moderately high level of responsibility during child mealtimes. Regression analysis showed that fathers who had higher income, perceived child weight as being higher, and had higher self-efficacy in feeding children healthy food had higher ROFM. Higher father nutrition knowledge was correlated with lower perceived ROFM, indicating a lack of confidence in utilizing their nutrition knowledge during child mealtimes. The results indicate potential targets to improve Asian Indian fathers' involvement during child mealtimes. These results could be utilized to enhance their engagement in child mealtime healthy eating practices and for childhood obesity prevention.

The impact of a community social marketing campaign on children's meal orders and consumption: main outcomes from a group randomised controlled trial

OBJECTIVE

Restaurants may be important settings for interventions to reduce children's energy intake. The objective of this study was to test the impact of a parent-focused social marketing campaign to promote healthy children's meals on calories ordered and consumed by children at quick-service restaurants (QSR).

DESIGN

Using a repeated cross-sectional study design, two urban communities were randomised to intervention (IN) v. control (C) condition. A community-wide social marketing campaign was implemented in the IN community to empower Black and Latinx mothers who frequent QSR (priority population) to select healthier options for their child.

SETTING

Data were collected in 2016 at QSR located within the communities pre- and post-IN and analysed in 2017.

PARTICIPANTS

Parents (n 1686; n 819 and n 867 for I and C conditions, respectively) were recruited after placing their QSR order; a survey, receipt and their child's leftovers were collected.

RESULTS

Calories ordered did not differ significantly between the IN and C conditions (changeadj = -146·4 kJ (-35·0 kcal); 95 % CI -428·0 kJ (-102·3 kcal), 134·6 kJ (32·2 kcal)). In a sub-analysis of only the priority audience, children in the IN community ordered significantly fewer calories compared to C children in unadjusted models (changeunadj = -510·4 kJ (-122·0 kcal); 95 % CI -1013·4 kJ (-242·2 kcal), -7·5 kJ (-1·8 kcal)), but the trend did not persist after adjusting for covariates (changeadj = -437·2 kJ (-104·5 kcal); 95 % CI -925·5 kJ (-221·2 kcal), 50·6 kJ (12·1 kcal)). Calories consumed followed similar trends.

CONCLUSION

The campaign did not significantly reduce children's QSR calories ordered or consumed. However, a quantitatively important mean reduction in calories was suggested among the priority audience, indicating potential for community-wide promotion of healthful children's meals.

Identifying Future Study Designs for Mental Health and Social Wellbeing Associated with Diets of a Cohort Living in Eco-Regions: Findings from the INSUM Expert Workshop

Diets influence our mental health and social wellbeing (MHSW) in multiple ways. A rising community concept, Eco-Regions, has gained interest. The research project "Indicators for assessment of health effects of consumption of sustainable, organic school meals in Ecoregions" (INSUM) aims to develop future-oriented research approaches to measure the potential health effects of more sustainable and healthy diets. This first part of the project focuses on MHSW with the goal to identify suitable study designs and indicators. The methodology is based on a 2-day workshop with an interdisciplinary group of experts. This paper describes commonly applied research methods on the nexus between diet and MHSW as presented by the experts and summarises key points from the discussions. The results show that the dominating tool to investigate MSHW is questionnaires. Questionnaires vary largely depending on the research design, such as participants or distribution channels. Cohort studies addressing families and including in-depth interventional and/or experimental studies may be suitable for an Eco-Region investigation. Those MHSW studies can be conducted and combined with measurements of somatic health effects. We conclude that indicators should be seen as complementary rather than independent. Explorative research designs are required to investigate complex Eco-Regions.

Dietary Supplements among Children Ages 0-3 Years in Poland-Are They Necessary?

(1) Background: One of the ways to prevent nutritional deficiencies may be supplementation. Experts have observed the increased use of dietary supplements, not only in adults but also in children. Considering controversies among dietary supplements and possible errors in children's feeding, the goal of our research was to evaluate use and reasons behind supplementation in terms of children's diet analysis. (2) Methods: Our research involved 507 legal guardians of the youngest children (up to 3 years of age) and was conducted via a questionnaire. (3) Results: 79% of all children received dietary supplements. The analysis of children's diets showed a need to implement omega-3 acids and vitamin D supplementation, which was very low in children. On the other hand, vitamin C, vitamin B, vitamin A, and copper levels were extremely high. (4) Conclusions: Popularity of dietary supplements in Polish children aged 0-3 years old is an omnipresent issue. Although the reasoning behind administering nutritional supplements to children seems justified, considering the supply of vitamin D and omega-3 fatty acids, it seems justified to increase parents' knowledge in this regard in terms of the use and means to choose the best supplement possible, as dietary supplementation should always be tailored to individual needs.

Parental Lifestyle Changes and Correlations with Children's Dietary Changes during the First COVID-19 Lockdown in Greece: The COV-EAT Study

The aim of this study was to investigate changes in the eating behaviour of parents during the first lockdown implemented in Greece due to COVID-19 and to explore possible associations with corresponding changes in the eating behaviour of their children. A quantitative cross-sectional study was performed using an online questionnaire. The study sample consisted of 397 parents with children aged 2−18 years, who were recruited from 63 municipalities in Greece. It was observed that the percentage of parents and children reporting consumption of breakfast during the lockdown period increased by 10.6% and 5%, respectively. Also, 75% of the parents increased their snack consumption and 61% their sweets consumption. Parents increased home-cooking during lockdown (6.4 times/week), compared to 5.6 times/week before (p < 0.001), which was associated with decreased consumption of fast foods for both parents and children (p < 0.001 for all comparisons) and also correlated with increased consumption of fruit and vegetables for children (p < 0.05). More than half parents tried to lose weight during lockdown (58.4%). In conclusion, both favourable (home-cooking) and unfavourable (increased snacking) lifestyle changes during the first COVID-19 lockdown in Greece were reported for parents.

The Relationships between Parenting Practices and Child Health-Related Behaviors in Children with Intellectual Disability: The Moderating Role of Child Body Weight Status

This study aimed to examine the associations between parenting practices and child health-related behaviors, and the moderating role of child body weight status in children with intellectual disability (ID). A cross-sectional study was conducted among a sample of children with ID in Hong Kong; 440 participants were included in this study. All the variables investigated were collected from questionnaires, except body weight status, which was objectively measured. Logistic regression analysis was used to examine the associations between parenting practices and children's unhealthy behaviors. Interaction items were added to investigate the moderation effect of child body weight status, adjusting for significant background characteristics. Results showed that the parenting practices of "restricting access to unhealthy food and sedentary behaviors (RA)" (OR range: 0.63-0.64) and "using food or sedentary behaviors as rewards (UR)" (OR range: 1.28-1.60) were significantly associated with some eating behaviors, but not with sedentary behaviors. Body weight status significantly moderated these associations. Only RA showed favorable effects on some eating behaviors in children with overweight and obesity (OR range: 0.17-0.28), whereas the effects of UR differed by body weight status. Future research should focus on developing educational interventions which encourage parents to use practices that are tailored towards children's individual characteristics.

Physical Activity, Sleep Patterns and Diet Habits as Well as the Prevalence of Obesity among Adolescents: A Cross Sectional Study from Ha'il City in Saudi Arabia

Obesity is expected to increase in the Kingdom of Saudi Arabia (KSA). Therefore, the objective of this study was to determine the physical activity, sleep patterns and diet habits as well as the prevalence of obesity among adolescents from Ha’il City. A cross-sectional study was conducted with 1598 adolescent students (663 males and 935 females) aged 12−15 years who were randomly selected from different schools in Ha’il. Body mass index (BMI) was used to classify participants as underweight, normal weight, overweight and obese (class and class II). Moreover, physical activity, sleep patterns and diet habits were recorded. The prevalence of obesity was 52.1%. Obesity is significantly more prevalent in females compared to males (62.9% vs. 36.59%, p < 0.001). Moreover, students in the third grade are the most obese in comparison with the first and the second educational level (p < 0.001). Additionally, students aged 15 years old are the most obese compared to 12 years, 13 years and 14 years (p < 0.001). Additionally, the results showed that students who suffer from obesity eat food when they feel higher stress and tension scores and that they do not eat their meals regularly. Additionally, 79% of those who eat fried food daily are obese. It was reported that 61.1% of students in this study were physically inactive. Furthermore, 58.4% of students have a higher proportion of insufficient sleeping duration (>7 h per night) (p < 0.001). This increased rate of obesity is higher in females compared to males and it was related to inactivity as well as perturbed sleep and eating habits. Therefore, we recommend an obesity prevention program including health education in Ha’il City, KSA.

Influences of Child Temperament and Household Chaos on Preschoolers' Emotional Eating

Background: Emotional eating has been linked to child temperament and family environment factors, such as household chaos. However, few studies have examined how child and home characteristics independently and together influence children's overeating and undereating in response to negative emotions. Objective: The current study examined associations among child temperament, household chaos, and emotional eating in children 18-24 months of age, and interaction effects were also tested. Methods: The study included an analysis sample of 371 families participating in the larger STRONG Kids2 longitudinal birth cohort study (N = 468). The Early Childhood Behavior Questionnaire was used to assess child temperament at 18 months, and the Confusion, Hubbub, and Order Scale was used to assess disorganization in the household at 24 months. Child emotional eating at 24 months was assessed using parental reports of the Child Eating Behavior Questionnaire. Results: Negative affectivity and household chaos were independently associated with child emotional overeating. Negative affectivity, effortful control, and household chaos were significantly associated with emotional undereating. No significant interactions were found. Conclusions: Child temperament and household environment independently influence emotional eating in young children, highlighting the need to consider these factors in early prevention. Longitudinal studies are warranted to determine mechanisms that may be involved in these relations.

Parenting style and its effect on eating disorders and substance abuse across the young population

This article attempts to examine the occurrence of two behavioural changes, namely, substance abuse and eating disorders in order of onset mediated by ineffective parenting styles during young age. The four parenting styles and their consequential behavioural adverse effects are taken as the focal point of this study and are synthesized to provide an outlook on the status of ineffective parenting and deviant offspring behaviours. A review of literature was primarily undertaken to examine the characteristic features of ineffective parenting. A causal relationship was then drawn between the onset of behavioural disorders with an emphasis on substance abuse and eating disorders, along the parenting spectrum. We probed into the order and directionality of the offspring behavioural changes against ineffective parenting. The current available data shows the superimposition of the parenting style spectrum on a bell-shaped distribution of behavioural outcomes as exemplified by authoritarian, permissive and neglectful parenting as a prime determinant of several disorders among the young age; parenting styles being at the extremities of the parenting spectrum. The sweet spot of parenting, mainly associated to the authoritative approach, bears the most positive effect on the growing child. The extreme ends of parenting as per the varying degree of responsiveness and demandingness, generally observed in authoritarian and neglectful parenting precipitate concomitant deviant behaviours cascading from one another; intricately linking substance abuse and eating disorders. A number of studies describe the isolated effects of ineffective parenting on the development of substance abuse and eating disorders during the adolescent period. However, the relationship between both eating disorders and substance abuse is underplayed and need to be stressed upon to tailor behaviour-specific targeted therapies and restore the normalcy of these altered behaviours.

How the parenting style adopted can lead to a concurrent amalgam of disordered eating patterns and substance abuse.

How disordered eating behaviours and substance abuse are initiated as coping strategies to deal with the consequences of poor parenting.

Isolation of specific risk factors to deter the development of those deviant behaviours in addition to improvement of parenting methods.

How involved are parents in their child's early years setting's food decisions and practices?

As childhood obesity and poor nutrition rates in England continue to rise, parents and childcare practitioners have key partnership roles in ensuring young children have healthy balanced diets. Yet little is known about parents' understanding and involvement in their childcare settings' food decisions and practices, and how this might be strengthened. Semi-structured interviews were carried out with a purposive sample of 59 parents with one or more children attending early years settings in England. Framework analysis was used to explore the interviews. Epstein's model of parental partnerships was adapted as a reflective lens for the findings, and their implication for early years' policy and practice. Parents reported a lack of two-way communication on food, and of opportunities for active, meaningful engagement around food and healthy eating outside of one-to-one discussions of their child's specific needs and requirements. Some parents reported a lack of trust in the food related information provided by their childcare setting. As young children spend more time in formal childcare, it is increasingly important that trusting collaborative relationships are built between parents and childcare practitioners to ensure that children have the best start in life. This study adds to the limited literature on parental involvement in early years settings. Findings suggest that more policy work and development is needed in the early years sector, particularly in ensuring clear and accessible guidelines on food in early years settings are readily available, and that practitioners and parents have more clarity about their mutual roles and responsibilities in this.

Socio-Demographic, Self-Control, Bullying, Parenting, and Sleep as Proximal Factors Associated with Food Addiction among Adolescents

Adolescence is considered an important period of neurodevelopment. It is a time for the emergence of psychosocial vulnerabilities, including symptoms of depression, eating disorders, and increased engagement in unhealthy eating behaviours. Food addiction (FA) in adolescents is an area of study where there has been substantial growth. However, to date, limited studies have considered what demographic characteristics of adolescents may predispose them to endorse greater symptoms of FA. Studies have found a variety of factors that often cluster with and may influence an adolescent's eating behaviour such as sleep, level of self-control, and parenting practices, as well as bullying. Therefore, this study investigated a range of socio-demographic, trait, mental health, and lifestyle-related profiles (including self-control, parenting, bullying, and sleep) as proximal factors associated with symptoms of FA, as assessed via the Yale Food Addiction Scale for Children (YFAS-C) in a large sample of Australian adolescents. Following data cleaning, the final analysed sample included 6587 students (age 12.9 years ± 0.39; range 10.9-14.9 years), with 50.05% identifying as male (n = 3297), 48.5% as female (n = 3195), 1.02% prefer not to say (n = 67), and 0.43% as non-binary (n = 28). Self-control was found to be the most significant predictor of total FA symptom score, followed by female gender, sleep quality, and being a victim of bullying. Universal prevention programs should therefore aim to address these factors to help reduce the prevalence or severity of FA symptoms within early adolescent populations.

Struggling with overweight or obesity in children - fathers' perceptions and experiences of contributing factors, role and responsibility

PURPOSE

The family environment is crucial in the prevention and treatment of childhood obesity; however, there is a lack of knowledge concerning paternal perceptions and experiences in childhood weight management. The aim of this study was to explore (i) perceptions of contributing factors to childhood overweight and obesity among fathers of children with overweight or obesity and (ii) the fathers' experiences of their parental role caring for a child with overweight or obesity.

METHOD

A qualitative content analysis was conducted of data from semi-structured in-depth interviews with eight Norwegian fathers of ten children and adolescents with overweight or obesity.

RESULTS

The analysis identified one overall theme; Feeling uncertain and struggling to understand their own responsibility for the child's overweight or obesity, which consists of two themes; 1)Trying hard to figure out the child's obesity as a complex interaction of factors and 2)Family functioning-negotiating roles and responsibility in parenthood.

CONCLUSION

Fathers must be met with understanding about their uncertainty and their struggle to understand their individual responsibility for their child's weight excess. It can be necessary to address the significance of family functioning, collaboration, responsibility within the familiy in addition to structural responsibility in clinical dialogues and counselling in order to help with weight management.