The Influence of Home and School Environments on Children's Diet and Physical Activity, and Body Mass Index: A Structural Equation Modelling Approach

Home-based cooking intervention with a smartphone app to improve eating behaviors in children aged 7-9 years: a feasibility study

Objective

To develop and evaluate the feasibility of a mobile application in Swiss households and assess its impact on dietary behavior and food acceptability between children who cooked with limited parental support (intervention group) with children who were not involved in cooking (control group).

Methods

A ten-week randomized controlled trial was conducted online in 2020. Parents were given access to a mobile-app with ten recipes. Each recipe emphasized one of two generally disliked foods (Brussels sprouts or whole-meal pasta). Parents photographed and weighed the food components from the child's plate and reported whether their child liked the meal and target food. The main outcome measures were target food intake and acceptability analyzed through descriptive analysis for pre-post changes.

Results

Of 24 parents who completed the baseline questionnaires, 18 parents and their children (median age: 8 years) completed the evaluation phase. Mean child baseline Brussel sprouts and whole-meal pasta intakes were 19.0 ± 24.2 g and 86.0 ± 69.7 g per meal, respectively. No meaningful differences in intake were found post-intervention or between groups. More children reported a neutral or positive liking towards the whole-meal pasta in the intervention group compared to those in the control group. No change was found for liking of Brussel sprouts.

Conclusions for practice

The intervention was found to be feasible however more studies on larger samples are needed to validate feasibility. Integrating digital interventions in the home and promoting meal preparation may improve child reported acceptance of some healthy foods. Using such technology may save time for parents and engage families in consuming healthier meals.

Students' consumption of high and low nutrition foods and reduced plate waste by schools' wellness-related policies and garden program participation

BACKGROUND

Participation in school-based programs that may support children's nutritious dietary behaviours varies across schools. We examined school participation in wellness-related policies, school-based garden programs and students' dietary behaviours.

METHODS

Among matching schools who did and did not participate in school-based garden programs, we analysed the lunches of 80 Pittsburgh Public Schools (PPS) students in 1st, 2nd, 6th and 7th grades during Autumn 2019 using digital food photography. We also acquired school wellness policy data. Using cross-sectional linear regression, we estimated the association between school-based garden programming, wellness-related policies and dietary outcomes, adjusting for grade.

RESULTS

School's implementation of nutrition services policies was negatively associated with energy wasted from lunch (β = - 44.7 , p = 0.01 ${\rm{\beta }}=-44.7,{p}=0.01$ ). The number of semesters the students' school had participated in the garden program was positively associated with students' whole grain consumption (β = 0.07 , p < 0.001 ${\rm{\beta }}=0.07,{p}\lt 0.001$ ).

CONCLUSIONS

Cross-sectional associations suggest that schools that are more engaged in wellness policies and garden programs may provide environments that are more supportive of students' nutrition than in other schools.

Factors associated with physical activity participation among children: a systematic review protocol

BACKGROUND

Reduced physical activity (PA) is one of the significant health concerns in adults and children alike. Despite the proven benefits of PA, most children, globally, do not meet the weekly criteria of enough PA to maintain health. The proposed systematic review is the review of the factors and will provide information on the factors associated with PA participation in children.

METHODS

The proposed systematic review will be conducted based on the methodology from the Cochrane Handbook for Systematic Reviews of Interventions. We will include observational studies (cross-sectional, case-control, and cohort studies), randomized controlled trials (RCTs), and non-randomized study designs for information on factors associated with PA participation among children. Studies with participants in the age range of 5-18 years, indulging in physical activity of 60 min per day for a minimum of 3 days a week, will be included. Studies including differently abled children, children under medical treatment, and those taking medications for illnesses such as neurological, cardiac, and mental health conditions will be excluded from the review. We will search MEDLINE (via PubMed and Web of Science), Scopus, EMBASE, CINAHL, Cochrane CENTRAL, and PEDro for English language publications published from the inception till October 2022. For additional studies, we will search websites such as the Australian Association for Adolescent Health International Association for Adolescent Health and a reference list of the included publications. Selection of studies, data extraction, and quality assessment of the included studies will be performed in duplicate. Quality assessment of the included studies will be performed using the Cochrane Risk of Bias tool (ROB-II) for RCTs, New-Castle Ottawa, for observational studies, and ROBINS-I (Risk of Bias for Non-Randomized studies of Interventions) for non-randomized study designs.

DISCUSSION

The proposed systematic review and meta-analysis will present a summary of the available evidence on factors associated with PA participation in children. The findings of this review will provide new insights into how exercise providers can improve PA participation among children and can also help healthcare workers, clinicians, researchers, and policymakers to plan long-term interventions targeting child health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42021270057.

A Descriptive Qualitative Study of the Perceptions of Regulatory Authorities, Parents, and School Canteen Owners in the South of Ecuador about the Challenges and Facilities Related to Compliance with the National Regulation for School Canteens

The prevalence of overweight and obesity in the Ecuadorian school population continues to increase. An important factor in children's nutrition is the food offered in school canteens. The objective of this study was to explore the perceptions of the challenges faced by and facilities of school canteens in the provinces of southern Ecuador in terms of complying with national regulations. For this qualitative descriptive study, semi-structured interviews were conducted in 2021 with six school canteen owners, six school directors, five health experts, and seven parents of children attending school from three provinces, Cañar, Azuay, and Morona Santiago, in Ecuador. The data were transcribed and subsequently analyzed in ATLAS ti. The participants indicated several challenges to comply with the regulations of school canteens, such as the expenses generated by them, the lack of control of street food vendors in the surroundings of the schools, and the lack of trained personnel. Regarding the facilities, they highlighted that the regulation for cleaning and hygiene are more easily fulfilled. Standards and control of the food stipend in school canteens are required to ensure a supply of healthy food for the children. Multiple challenges and strategies are proposed to improve the eating habits of the school population and to improve the nutrition of schoolchildren.

Are problematic eating behaviors from 4- to 7-year-old explained by genetic, shared factors or individual characteristics? A longitudinal twin study

Studies based on twins are ideal to disentangle the relative contribution of different factors in the development of eating behaviors. This study aims to evaluate if changes in problematic eating behaviors from 4 to 7 years old are more influenced by the genetics, the shared environment of twins, or by individual characteristics of each twin. A total of 86 caregivers (mostly mothers) of twins from the Generation XXI birth cohort provided information on eating behaviors at 4 and 7 years of age. A score of problematic eating behaviors was developed. The Common fate model and the ACE model were used to estimate the effect of shared, individual, and genetic characteristics on changes in eating behaviors. At the dyadic level (shared), the eating behavior score at 4 years old was significantly and positively associated with the eating behavior at 7 years of age (β = 0.402, 95% CI 0.063;0.657). At the individual level, no significant association was observed (β = 0.020, 95% CI -0.078;0.125). The ACE model also showed the shared environment as the major responsible for the changes in eating behaviors from 4 to 7 years old. It also showed that genetic characteristics decreased their relevance overtime. This study supports that changes in eating behaviors from 4 to 7 years of age are mostly associated with the shared environment rather than individual characteristics of each twin. These results are important to improve future strategies to promote healthy environments.

Maternal Emotional Intelligence and the Provision of Child Motor Affordances

Background: Mothers are not only the axis of an ecological subsystem for their children but are also capable of creating a significant emotional and psychological environment through constant and direct interaction. This leads to interactions and emotional connections with the children, supportive behaviors, and a long-term commitment to their upbringing and development. Aims: This study examined the relationship between maternal emotional intelligence (EI) and demographics on the availability of motor affordances in the home environment that are conducive to their child’s motor development. Methods: Mothers (N = 451) and homes of children aged 18–42 months were assessed using the Persian version of Affordances in the Home Environment for Motor Development-Self-Report (AHEMD-SR) and the Bar-On Emotional Intelligence Questionnaire. In addition, mothers’ physical activity (PA) experience and demographic data were collected. Results: Analyses indicated significant correlations between mothers’ education, level of PA, and income with EI and motor affordances. Conclusions: EI, PA experience, and select mother demographics were important to the availability of motor affordances in the home. One could also speculate, based on previous research, that such provision may affect the future motor development of the child. Future research should include a younger and more diverse population.

Considerations for a Social Media Physical Activity Program: Exploratory Study

BACKGROUND

Social media may be a powerful platform to combat parents' and children's low physical activity levels.

OBJECTIVE

This study surveyed parents' beliefs about physical activity in order to expand the extant literature concerning the interest in and the design of an effective and feasible social media physical activity (SMPA) program.

METHODS

Primary caregivers (n=250; 215 [86%] mothers, 164 [65.6%] White) of children aged 6-12 years completed an online questionnaire. Interest was examined through responses on the questionnaire; beliefs (ie, perceptions, knowledge, and support) about physical activity were examined using Spearman correlations; and to support the SMPA program design, researchers examined a combination of multiple-choice and free-response questions. For the free-response questions, the researchers performed open coding related to perceived benefits, barriers, and motivators.

RESULTS

Parent respondents (n=215, 86%) were interested in a SMPA program tailored for families. Regarding beliefs, parents exhibited a monotonic relationship between 2 questions related to perceptions of physical activity levels in their children (r_s(250)=.310, P<.001), knowledge about physical activity and motor skills (r_s(250)=.328, P<.001), and support of physical activity and motor skills (r_s(250)=.385, P<.001). Parents perceived benefits of a SMPA program, highlighting family time and health. Barriers included time constraints, a lack of motivation, and environmental factors.

CONCLUSIONS

Parents are interested in supporting healthy family behaviors using a SMPA program. An effective program should emphasize motor skill activities, be fun and family oriented, and incorporate incentives, goal setting, and advice and tips. SMPA also needs to address identified barriers, such as those regarding time and environment.

Associations Between Physical Activity and Gross Motor Skills in Parent–Child Dyads

This study examines the associations of physical activity and gross motor skills in parent–child dyads. Parent–child dyads (N = 61, 84% mothers, children aged 8–11 years) participated in this study. Anthropometrics were self-reported through Qualtrics. Physical activity was assessed using accelerometers. Motor skills were measured through four skills: catch, kick, throw, and jump. These skills were assessed using process (i.e., performance criteria of the Test of Gross Motor Development-3) and product (i.e., catch percentage and jump distance) measures. A complete motor skill score was computed by standardizing both process and product scores and summing them. Correlation coefficients and ordinary least square regressions were computed to examine the associations of physical activity and motor skills. Parents’ and children’s moderate to vigorous physical activity were significantly associated (β = 0.30 ± 0.11; p = .008). Parents’ and children’s motor skills were significantly associated (β = 0.46 ± 0.18; p = .012). Understanding parent determinants can support effective interventions targeting children’s low physical activity levels and improving motor competence. Our results highlight the importance of parents’ physical activity and motor skills, which are significantly associated with those of their children. These parent factors may be a key consideration for effective family-based physical activity interventions.

Influence of home/school environments on children's obesity, diet, and physical activity: the SUECO study protocol

OBJECTIVE

The SUECO study examines the relationship between urban obesogenic environments and health outcomes among school-age children in the city of Madrid, Spain. We will study how features of the urban environment (related to the food- and the physical activity environment) associate with children's anthropometrics, eating habits, and physical activity levels.

METHOD

We describe the study protocol of this multilevel study in a representative sample of school-age children in the city of Madrid (2017; n=5,961 children ages 3-12). Main outcome variables include anthropometrics (body mass index, waist circumference, and body fat), healthy and unhealthy consumption measures, and physical activity measures. The primary explanatory variables are grouped into food environment (e.g., unhealthy food retailers' density) and physical activity environment (e.g., walkability, physical activity opportunities) variable categories. Multilevel models will be used to calculate the associations between each indicator and obesity and physical inactivity.

Association between the school physical activity environment, measured and self-reported student physical activity and active transport behaviours in Victoria, Australia

Background

Environments within schools including the physical, social-cultural and policy/practice environments have the potential to influence children’s physical activity (PA) behaviours and weight status. This Australian first study comprehensively examined the association(s) of physical, social-cultural and policy/practice environments with PA, active transport (AT) and weight status among regional primary school children.

Methods

Data were from two childhood obesity monitoring systems in regional Victoria, Australia. Measured height and weight were collected from students in Year 2 (aged approx. 7–8 years), Year 4 (9–10 years), and Year 6 (11–12 years). Self–reported PA behaviour, including AT were collected from students in Year 4 and 6 and a sub-sample wore an ActiGraph (wGT3X-BT) accelerometer for 7-days. A school physical activity environment audit was completed by the school principal and responses were used to calculate school physical activity environment scores (PAES) and active transport environment scores (ATES). Mixed effects logistic regression was used to assess the relationship between the proportion of students meeting the PA guidelines (≥60mins/day of moderate-to-vigorous PA) and PAES tertiles (low, medium, high) and those using AT and school ATES tertiles, controlling for gender, school size/type and socioeconomic composition.

Results

The analysed sample included 54/146 (37%) schools and 3360/5376 (64%) students. In stratified analysis, girls in schools with a medium PAES score were more likely to meet the objectively measured PA guideline compared to low PAES score (OR 2.3, 95%CI 1.27, 4.16). Similarly, students in schools with a medium or high ATES score had higher odds of self-reported AT (medium OR 3.15, 95%CI 1.67, 5.94; high OR 3.71, 95%CI: 1.80, 7.64). No association between PAES or ATES and weight status were observed. Self-reported AT among boys (OR 1.59, 95%CI 1.19, 2.13) and girls (OR 1.56, 95%CI 1.08, 2.27) was associated with higher odds of meeting self-reported PA guidelines on all 7-days than those who did not report using AT.

Conclusions

In this study of regional Victorian primary schools, PA environments were only associated with girls’ adherence to PA guidelines. School AT environments were strongly associated with students’ AT behaviours and with increased likelihood of students being physically active.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01151-6.

[Community food environment and presence of food swamps around schools in a Brazilian metropolis]

The study aimed to assess the community food environment and the existence of food swamps around schools in a Brazilian metropolis. This was an ecological study in public and private schools in Belo Horizonte, Minas Gerais State, Brazil, with a 250-meter buffer as the analytical unit. The study included all preschool, elementary, and middle schools. In relation to the schools, the study evaluated administrative regimen (public versus private), type of teaching, and per capita income in the schools' census tracts. Information was also compiled on the retail food establishments inside the buffer zone around the schools. The food environment was characterized only according to the establishments around the schools that sold food for immediate consumption. Analysis of the buffers revealed that 97.4% of the schools had at least one establishment in the vicinity that sold food for immediate consumption. The most available establishments around schools were snack bars, restaurants, and bars. Schools located in higher-income census tracts showed higher mean numbers of all establishments in their vicinity, except for grocery stores and supermarkets. In addition, 54.6% of the schools were in neighborhoods classified as food swamps. The results that the among the target categories, there was a predominance of establishments that mainly sell ultra-processed foods such as bars and snack bars in the vicinity of schools in Belo Horizonte, which exposes children and adolescents to an unhealthy food environment.

Management of Childhood Obesity-Time to Shift from Generalized to Personalized Intervention Strategies

As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.

Management of Childhood Obesity—Time to Shift from Generalized to Personalized Intervention Strategies

As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.

Management of Childhood Obesity-Time to Shift from Generalized to Personalized Intervention Strategies

As a major public health concern, childhood obesity is a multifaceted and multilevel metabolic disorder influenced by genetic and behavioral aspects. While genetic risk factors contribute to and interact with the onset and development of excess body weight, available evidence indicates that several modifiable obesogenic behaviors play a crucial role in the etiology of childhood obesity. Although a variety of systematic reviews and meta-analyses have reported the effectiveness of several interventions in community-based, school-based, and home-based programs regarding childhood obesity, the prevalence of children with excess body weight remains high. Additionally, researchers and pediatric clinicians are often encountering several challenges and the characteristics of an optimal weight management strategy remain controversial. Strategies involving a combination of physical activity, nutritional, and educational interventions are likely to yield better outcomes compared to single-component strategies but various prohibitory limitations have been reported in practice. This review seeks to (i) provide a brief overview of the current preventative and therapeutic approaches towards childhood obesity, (ii) discuss the complexity and limitations of research in the childhood obesity area, and (iii) suggest an Etiology-Based Personalized Intervention Strategy Targeting Childhood Obesity (EPISTCO). This purposeful approach includes prioritized nutritional, educational, behavioral, and physical activity intervention strategies directly based on the etiology of obesity and interpretation of individual characteristics.

Parents accurately perceive problematic eating behaviors but overestimate physical activity levels in preschool children

PURPOSE

The aim of this study is to examine the associations between parents' perceptions of their child's physical activity and eating behaviors to actual physical activity, body mass index percentage (BMI%), and body fat percentage (BF%). A secondary aim is to examine additional parental determinants to child's physical activity.

METHODS

Participants were preschool children (N = 114, 59 females, M_age= 4.06) from three University-sponsored centers and parents (N = 114, 107 mothers). Parents self-reported physical activity, perceptions of child's physical activity, and completed "The Child Eating Behavior Questionnaire". Children physical activity was collected with accelerometers.

RESULTS

Whereas 97% of the 68 parents with children meeting physical activity guidelines accurately identified their child as active, 93% of the 14 parents with children not meeting physical activity guidelines inaccurately identified their child as active (X²(1, N = 82) = 0.58, p = 0.446)). Regarding eating behaviors, child BMI% was moderately correlated with parent's perceptions of their child's Emotional Overeating (r(74) = 0.416, p < 0.001) and Food Responsiveness (r(74) = 0.543, p < 0.001). Parent's engagement in vigorous physical activity demonstrated a positive relationship to child's physical activity (r(78) = 0.297, p = 0.008).

CONCLUSION

Parents of inactive children have inaccurate perceptions of their child's physical activity. The association between children's BMI% and eating behaviors indicates parents can accurately perceive problematic eating behaviors. Parents, who accurately perceive their child's behaviors, may be in a better position to identify deficiency and seek early intervention. Additionally, parent's physical activity may have implications to children's physical activity.

LEVEL OF EVIDENCE

Level V: Descriptive cross-sectional study.

Factor Analysis Reduces Complex Measures of Nutrition Environments in US Elementary and Middle Schools into Cohesive Dimensions in the Healthy Communities Study

BACKGROUND

Although it has been recommended that schools be the hub of efforts to improve child nutrition, research describing school nutrition environments in US public schools and their associations with child health is limited.

OBJECTIVE

This study aimed to evaluate the applicability of factor analysis methods to characterize school nutrition environments by identifying underlying factors, or dimensions, in the observed data and to examine the relation between school nutrition environment dimensions and child anthropometric and dietary outcomes.

METHODS

This study examined a cross-sectional sample of 4635 US children aged 4-15 y from 386 US elementary and middle schools from the Healthy Communities Study (2013-2015). Data collected from schools were used to create 34 variables that assessed the school nutrition environment. To identify dimensions of school nutrition environments, exploratory factor analysis was conducted with orthogonal rotation, and factor scores were derived using methods to account for sporadic missing data. Mixed-effects regression models adjusted for child- and community-level variables and clustered by community and school examined the associations of school nutrition environment dimensions with child anthropometric and dietary outcomes.

RESULTS

Six dimensions of school nutrition environments were derived: nutrition education, food options, wellness policies, dining environment, unhealthy food restriction, and nutrition programs. The unhealthy food restriction dimension was negatively associated with added sugar intake (β = -1.13, P < 0.0001), and the wellness policies dimension was positively associated with waist circumference (β = 0.57, P = 0.01).

CONCLUSIONS

This study demonstrates how factor analysis can reduce multiple measures of complex school nutrition environments into conceptually cohesive dimensions for purposes of assessing the relation of these dimensions to student health-related outcomes. Findings were mixed and indicate that the restriction of unhealthy foods in school is associated with lower added sugar intake. Additional, longitudinal studies are needed to substantiate the utility of this method for identifying promising school nutrition environments.

Caregivers' Role in the Effectiveness of Two Dutch School-Based Nutrition Education Programmes for Children Aged 7-12 Years Old

Childhood eating behaviours can track into adulthood. Therefore, programmes that support early healthy eating, including school-based nutrition education programmes, are important. Although school-based programmes may be beneficial in improving nutrition knowledge, impact on actual fruit and vegetable (FV) intake is generally limited as FV intake is also influenced by the home environment. The current study includes secondary analyses of data from an evaluation study on Dutch nutrition education and examined the role of caregivers’ health promotion behaviours (HPB) in influencing healthy eating behaviours in primary school children (n = 1460, aged 7–12 years) and whether caregivers’ HPB contribute to programme effectiveness. Children’s nutrition knowledge, FV intake and caregivers’ HPB (FV/sugar-sweetened beverages/sweets provision to take to school, cooking together and talking about healthy food at home) were measured by child-reported questionnaires at baseline, during, and 6 months post-programme. Results indicated that caregivers’ HPB was positively associated with children’s healthy eating behaviours and that programme effectiveness was highest in those in the lower HPB subcategory. In conclusion, children with less encouragement to eat healthily at home potentially benefit more from school-based nutrition education programmes than children receiving more encouragement. This highlights the important role of the home environment in supporting healthy eating behaviour in children.

Family characteristics, perceived environment for physical activity, and childhood obesity: An approach with structural equation models

OBJECTIVES

To evaluate the direct and indirect effects of family characteristics and the perceived neighborhood environment on obesity risks among schoolchildren.

METHODS

Through phone contact with the child's mothers/guardians, the perceptions about the aspects of the neighborhood that could limit or promote health. Physical activity, socioeconomic data, self-reported weight and height, and ultra-processed consumption of the respondents were evaluated, in addition to the screen time of both mothers and children. A hybrid model of structural equations was used to test the direct and indirect effects of family and environmental variables on childhood obesity.

SETTING

Belo Horizonte, Minas Gerais, Brazil.

SUBJECTS

A total of 322 children from 9 to 10 years old from municipal schools and their respective mothers/guardians.

RESULTS

Childhood obesity was positively associated with obesity among mothers/guardians and with the latent variable "socioeconomic status (SES)." It was observed that the child's guardians positively influenced childhood obesity through their own habits, such as screen time and consumption of ultra-processed products, with obesity of mothers/guardians as mediators of both associations. There were no direct and indirect effects of the latent variables of the perceived environment in childhood obesity.

CONCLUSION

Family characteristics are important determinants of childhood obesity and should be considered when designing prevention strategies. Parental perceptions of neighborhood characteristics did not have an influence on childhood obesity.

Interventions to increase the consumption of water among children: A systematic review and meta-analysis

The aim of this study was to conduct a systematic review and meta-analysis on the effectiveness of interventions to increase children's water consumption. A systematic literature search was conducted in seven electronic databases. Studies published in English before 18 February 2019 that evaluated any type of intervention that measured change in water consumption among children aged 2 to 12 years by applying any type of design were included. Of the 47 interventions included in the systematic review, 24 reported a statistically significant increase in water consumption. Twenty-four interventions (17 randomized controlled trials and seven studies with other controlled designs) were included in the meta-analysis. On average, children in intervention groups consumed 29 mL/d (confidence interval [CI] = 13-46 mL/d) more water than did children in control groups. This effect was larger in eight interventions focused specifically on diet (MD = 73 mL/d, CI = 20-126 mL/d) than in 16 interventions focused also on other lifestyle factors (MD = 15 mL/d, CI = 1-29 mL/d). Significant subgroup differences were also found by study setting and socioecological level targeted but not by children's age group, intervention strategy, or study design. In conclusion, there is evidence that, on average, lifestyle interventions can lead to small increases in children's daily water consumption. More research is needed to further understand the specific intervention elements that have the greatest effect.

Exploring Children's Physical Activity Behaviours According to Location: A Mixed-Methods Case Study

The school environment is ideally placed to facilitate physical activity (PA) with numerous windows of opportunity from break and lunch times, to lesson times and extracurricular clubs. However, little is known about how children interact with the school environment to engage in PA and the other locations they visit daily, including time spent outside of the school environment i.e., evening and weekend locations. Moreover, there has been little research incorporating a mixed-methods approach that captures children’s voices alongside objectively tracking children’s PA patterns. The aim of this study was to explore children’s PA behaviours according to different locations. Sixty children (29 boys, 31 girls)—35 key stage 2 (aged 9–11) and 25 key stage 3 (aged 11–13)—wore an integrated global positioning systems (GPS) and heart rate (HR) monitor over four consecutive days. A subsample of children (n = 32) were invited to take part in one of six focus groups to further explore PA behaviours and identify barriers and facilitators to PA. Children also completed a PA diary. The KS2 children spent significantly more time outdoors than KS3 children (p = 0.009). Boys engaged in more light PA (LPA) when on foot and in school, compared with girls (p = 0.003). KS3 children engaged in significantly more moderate PA (MPA) at school than KS2 children (p = 0.006). Focus groups revealed fun, enjoyment, friends, and family to be associated with PA, and technology, costs, and weather to be barriers to PA. This mixed methodological study highlights differences in the PA patterns and perceptions of children according to age and gender. Future studies should utilize a multi-method approach to gain a greater insight into children’s PA patterns and inform future health policies that differentiate among a range of demographic groups of children.

Longitudinal Analysis Between Maternal Feeding Practices and Body Mass Index (BMI): A Study in Asian Singaporean Preschoolers

Bidirectional studies between maternal feeding practices with subsequent child weight are limited, with no studies in Asian populations. In longitudinal analyses, we assessed the directionality of the associations between maternal feeding practices and body mass index (BMI) in preschoolers. Participants were 428 mother child dyads from the GUSTO (Growing Up in Singapore Toward healthy Outcomes) cohort. Feeding practices were assessed using the Comprehensive Feeding Practices Questionnaire (CFPQ) at age 5 y. Child BMI was measured at ages 4 and 6 y. BMI and maternal feeding practices subscales were transformed to SD scores and both directions of their associations examined with multivariable linear regression and pathway modeling. Higher BMI at age 4 was associated with lower encouragement of balance and variety (β = −0.33; 95%CI: −0.53, −0.13), lower pressure to eat (β = −0.49; −0.68, −0.29) and higher restriction (β = 1.10; 0.67, 1.52) at age 5, adjusting for confounders and baseline feeding practices at 3 years. In the reverse direction, only pressure and restriction at age 5 were associated with lower and higher child BMI at age 6 years, respectively. After the adjustment for baseline BMI at age 5, the association with pressure was attenuated to non-significance (β = 0.01 (−0.01, 0.03), while the association with restriction remained significant (β = 0.02; 0.002, 0.03). Overall, associations from child BMI to maternal restriction for weight control and pressure feeding practices was stronger than the association from these maternal feeding practices to child BMI (Wald's statistics = 24.3 and 19.5, respectively; p < 0.001). The strength and directionality suggests that the mothers in the Asian population were likely to adopt these feeding practices in response to their child's BMI, rather than the converse.

Clinical Trial Registry Number and Website 

This study was registered at clinicaltrials.gov as NCT01174875 (www.clinicaltrials.gov, NCT01174875).

Food packaging cues as vehicles of healthy information: Visions of millennials (early adults and adolescents)

Because packaging has become an important marketing tool, firms must know what type of packaging can affect consumers' packaging cues. Also, still today there is little attention paid to the relevance of educating millennials about the importance of a healthier lifestyle and eating. The aim is to analyse the effects of young consumers with varying degrees of healthy lifestyles and food involvement on packaging cues. Also, the paper analyses differences between early adults and adolescents millennials. Using a sample of 890 millennials (300 early adults and 590 adolescents) and SEM methodology, interesting results are reached. Some healthy habits affect food involvement, and this is related to informative packaging cues. Some differences among both groups of millennials are found. The results/ findings would be valuable for the marketers and administration in the food industry to formulate marketing packaging strategies and to promote a healthier lifestyle and food consumption among millennials.