Children eat what they are served: the imprecise regulation of energy intake

Responsive feeding practices among Arabic and Mongolian speaking migrant mothers in Australia: A qualitative study

Establishing healthy feeding habits during infancy is crucial for optimal growth. However, certain parental feeding and cultural practices might hinder the development of children's healthy eating behaviours. This research explored responsive feeding practices among migrant mothers in Australia. Semi-structured telephone interviews were conducted in their native language with 20 Arabic and 20 Mongolian-speaking migrant mothers with children under 2 years old or currently pregnant. Thematic analysis was conducted using the framework method. Both cultural groups followed a variety of feeding practices, including on demand responsive feeding or structured schedules. Arabic-speaking mothers tended to demonstrate responsive feeding practices more frequently than Mongolian-speaking mothers, except for those using formula feeding, who consistently followed a fixed feeding routine. When introducing solid foods, mothers from both groups often overlooked their babies' hunger and satiety cues, frequently pressuring their children to finish their entire plate. One cited reason for this was the challenge parents faced in identifying such cues. Arabic-speaking mothers often supplemented with formula top-ups after introducing solid foods, due to the belief that breast milk or solid foods alone might not sufficiently nourish their infants. Additionally, some Arabic-speaking mothers used food-based rewards to encourage eating. Mongolian mothers expressed a cultural preference for chubby babies, a potential reason why they may have been inclined to pressure-feed their children. Moreover, both groups reported using digital devices to distract their children during meals. This study highlights the necessity of tailoring future resources and services related to responsive feeding practices to accommodate diverse literacy levels and cultural backgrounds.

Food portion sizes: trends and drivers in an obesogenic environment

The prevalence of overweight and obesity in children and adults has increased worldwide. A strong environmental factor contributing to the obesity epidemic is food portion size (PS). This review evaluates the current evidence linking food PS to obesity, examines the effects of PS on energy intake (EI), and discusses the drivers of food PS selection. The leading causes of the rise in PS include globalisation, intensive farming methods, the impact of World War II, due to shortage of staple foods, and the notion of 'waste not, want not'. Large PS of energy-dense foods may stimulate overconsumption, leading to high EI levels. However, the studies have not shown a cause-and-effect relationship, due to confounding factors. Important mechanisms explaining the attractiveness of larger PS leading to higher EI levels are value for money, portion distortion, labels on food packaging, and tableware. Consumers depend on external rather than internal PS cues to guide consumption, irrespective of satiety levels. Further research is recommended on food consumption patterns to inform policymakers and provide information and insights about changes in diet.

Eating in the absence of hunger in 18-month-old children in a home setting

BACKGROUND

Eating in the absence of hunger (EAH), the susceptibility to eat despite satiety, may increase overweight. While EAH has been established in school-aged children, less is known about it during toddlerhood.

OBJECTIVES

This study assessed to what extent 18-month-old children eat in the absence of hunger, the stability of this behaviour at 24 months and the association of child eating behaviours with EAH.

METHODS

Children were presented with four palatable finger foods (total 275 kcal) after dinner. Univariate GLM's assessed the association between EAH, child satiety and eating behaviours and energy intake of dinner at 18 and 24 months (n = 206 and 103, respectively). Another GLM was run to assess the association between EAH at both time points.

RESULTS

Mean (±SD) energy intakes from dinner and finger foods were 240 kcal (±117) and 40 kcal (±37), respectively. No association was found between energy intake of dinner and finger foods. Enjoyment of food was significantly related to intake of finger foods (P = .005). EAH at 18 months predicted EAH at 24 months.

CONCLUSION

Eighteen-month-old children ate in the absence of hunger, irrespective of satiety. Thus, preceding energy intake was not compensated for. Other factors, for example, enjoyment of food seem to determine finger food intake.

The Role of Dishware Size in the Perception of Portion Size in Children and Adolescents with Obesity

Purpose: The influence of dishware on portion size perception in children and adolescents is inconclusive. This study investigated how children and adolescents with both obesity and a normal weight perceived portion size in different sized and shaped dishware items. Methods: The study included 60 children and adolescents with overweight and obesity (OBE) and 27 children and adolescents with normal weight (NW) aged from 9 to 17 years. The participants estimated quantities in three pairs of drinking glasses, one pair of bowls and two pairs of plates which varied in size and shape. The children were instructed to state intuitively which portion they would choose for big or small thirst/hunger. Thereafter they were asked to determine the exact amount by answering which dishware item contained the larger/smaller portion (cognitive evaluation). Results: There were no substantial differences in the intuitive evaluation of portion sizes between OBE and NW. During the cognitive evaluation, OBE estimated the amount of water in the glasses more correctly compared to NW (61% vs. 43%; p = 0.008); OBE estimated the amount of lentils in the bowls and on the plates significantly less correctly (39%) compared to NW (56%; p = 0.013). Conclusions: Habit formation and environmental stimuli might play a greater role in estimating food amounts in dishware than the child’s and adolescent’s body weight.

Appetite self-regulation declines across childhood while general self-regulation improves: A narrative review of the origins and development of appetite self-regulation

This narrative review discusses the origins and development of appetite self-regulation (ASR) in childhood (from infancy to age 6 or 7 years). The origins, or foundations, are the biological infrastructure associated with appetite regulation and appetite self-regulation. Homeostatic regulation in infancy is examined and then evidence about developmental change in components of ASR. The main ASR-related components covered are: delay-of-gratification, caloric compensation, eating in the absence of hunger, food responsiveness/hedonics and fussy eating. The research included behavioral measures, parent-reports of appetitive traits and fMRI studies. There were two main trends in the evidence: a decline across childhood in the components of ASR associated with food approach (and therefore an increase in disinhibited eating), and wide individual differences. The decline in ASR contrasts with general self-regulation (GSR) where the evidence is of an improvement across childhood. For many children, bottom-up automatic reactive processes via food reward/hedonics or food avoidance as in fussy eating, appear not to be matched by improvements in top-down regulatory capacities. The prominence of bottom-up processes in ASR could be the main factor in possible differences in developmental paths for GSR and ASR. GSR research is situated in developmental science with its focus on developmental processes, theory and methodology. In contrast, the development of ASR at present does not have a strong developmental tradition to access and there is no unifying model of ASR and its development. We concluded (1) outside of mean-level or normative changes in the components of ASR, individual differences are prominent, and (2) there is a need to formulate models of developmental change in ASR together with appropriate measurement, research designs and data analysis strategies.

The association of parenting practices with toddlers' dietary intake and BMI, and the moderating role of general parenting and child temperament

Objective:

The objective was to examine the association between parenting practices, toddler’s dietary intake and BMI. In addition, potential moderation of these associations by general parenting and child temperament was examined.

Design:

The current cross-sectional study assessed parenting practices using the Comprehensive Feeding Practices Questionnaire, general parenting using the Comprehensive General Parenting Questionnaire, child temperament using the Child Behavior Check List, and children’s dietary intake through parental questionnaires. Children’s weight and length were objectively measured to determine BMI z-scores. Associations were examined using multiple linear regression analyses. Moderation was examined using interaction terms.

Setting:

Home setting.

Participants:

393 Dutch toddlers (age 1–3 years) and their parents recruited through fifty childcare centres and preschools in the Netherlands.

Results:

Various practices were related to children’s diet and BMI. For instance, the availability of healthy foods is the most important predictor of healthy dietary intake (e.g. β = –0·35 for sweets; β = 0·18 for fruit). The association of availability with a healthier diet was strongest when parents scored low on the positive parenting style dimensions, including nurturance, structure and/or behavioural control. In addition, it seemed that a high availability of healthy foods and low availability of unhealthy foods is especially beneficial for children showing withdrawal/depressive, anxious or overactive behaviour, while encouraging balance and variety is not beneficial for these children. All other practices were related to children’s diet and/or BMI as well.

Conclusions:

The findings underline the importance of viewing the impact of parenting practices in the context of general parenting and child temperament.

Both increases and decreases in energy density lead to sustained changes in preschool children's energy intake over 5 days

BACKGROUND AND OBJECTIVE

To investigate preschool children's ability to self-regulate their energy intake, we assessed their response to increases or decreases in dietary energy density (ED) over 5 consecutive days, a period likely long enough for compensatory behavior.

METHODS

Using a crossover design, over 3 periods we served the same 5 daily menus to 49 children aged 3-5 y in their childcare centers. During each 5-day period, 3 main dishes and 1 snack per day were systematically varied in ED, from baseline ED to either higher ED (increased by 20%) or lower ED (decreased by 20%). All of the served items were weighed to determine individual intakes.

RESULTS

Modifying the ED of 4 dishes per day had a significant and sustained effect on preschool children's daily energy intake across 5 days. In the baseline condition, children's intakes were similar to daily energy needs (98 ± 2%), but serving higher-ED foods increased energy intake by 84 ± 16 kcal/d (to 105 ± 2% of needs) and serving lower-ED foods decreased energy intake by 72 ± 17 kcal/d (to 89 ± 2% of needs; both P < .0001). The patterns of daily energy intake over the 5 days did not differ across conditions (P = .20), thus there was no evidence that either surfeits or deficits in energy intake led to adjustment over this time period. Furthermore, the response to ED varied, as children with a higher weight status had greater amounts of overconsumption when served higher-ED foods and of underconsumption when served lower-ED foods compared to children with a lower weight status.

CONCLUSIONS

These findings counter the suggestion that preschool children's regulatory systems can be relied on to adjust intake in response to energy imbalances. Increasing or decreasing the ED of several foods per day leads to sustained changes in the energy intake of preschool children.

Parental beliefs about portion size, not children's own beliefs, predict child BMI

BACKGROUND

Increases in portion size are thought by many to promote obesity in children. However, this relationship remains unclear. Here, we explore the extent to which a child's BMI is predicted both by parental beliefs about their child's ideal and maximum portion size and/or by the child's own beliefs.

METHODS

Parent-child (5-11 years) dyads (N = 217) were recruited from a randomized controlled trial (n = 69) and an interactive science centre (n = 148). For a range of main meals, parents estimated their child's 'ideal' and 'maximum tolerated' portions. Children completed the same tasks.

RESULTS

An association was found between parents' beliefs about their child's ideal (β = .34, p < .001) and maximum tolerated (β = .30, p < .001) portions, and their child's BMI. By contrast, children's self-reported ideal (β = .02, p = .718) and maximum tolerated (β = -.09, p = .214) portions did not predict their BMI. With increasing child BMI, parents' estimations aligned more closely with their child's own selected portions.

CONCLUSIONS

Our findings suggest that when a parent selects a smaller portion for their child than their child self-selects, then the child is less likely to be obese. Therefore, public health measures to prevent obesity might include instructions to parents on appropriate portions for young children.

Meal size is a critical driver of weight gain in early childhood

Larger serving sizes and more frequent eating episodes have been implicated in the rising prevalence of obesity at a population level. This study examines the relative contributions of meal size and frequency to weight gain in a large sample of British children. Using 3-day diet diaries from 1939 children aged 21 months from the Gemini twin cohort, we assessed prospective associations between meal size, meal frequency and weight gain from two to five years. Separate longitudinal analyses demonstrated that every 10 kcal increase in meal size was associated with 1.5 g/wk or 4% (p = 0.005) faster growth rate, while meal frequency was not independently associated with growth (β = 0.3 g/wk p = 0.20). Including both meal parameters in the model strengthened associations (meal size: β = 2.6 g/wk, p < 0.001; meal frequency: β = 1.0 g/wk, p = 0.001). Taken together, the implication is that meal size promotes faster growth regardless of frequency, but meal frequency has a significant effect only if meal size is assumed to be held constant. Clearer advice on meal size and frequency, especially advice on appropriate meal size, may help prevent excess weight gain.

Portion size: what we know and what we need to know

There is increasing evidence that the portion sizes of many foods have increased and in a laboratory at least this increases the amount eaten. The conclusions are, however, limited by the complexity of the phenomenon. There is a need to consider meals freely chosen over a prolonged period when a range of foods of different energy densities are available. A range of factors will influence the size of the portion size chosen: amongst others packaging, labeling, advertising, and the unit size rather than portion size of the food item. The way portion size interacts with the multitude of factors that determine food intake needs to be established. In particular, the role of portion size on energy intake should be examined as many confounding variables exist and we must be clear that it is portion size that is the major problem. If the approach is to make a practical contribution, then methods of changing portion sizes will need to be developed. This may prove to be a problem in a free market, as it is to be expected that customers will resist the introduction of smaller portion sizes, given that value for money is an important motivator.

Conditioned to eat while watching television? Low-income caregivers' perspectives on the role of snacking and television viewing among pre-schoolers

OBJECTIVE

Although television (TV) viewing is frequently paired with snacking among young children, little is known about the environment in which caregivers promote this behaviour. We describe low-income pre-schoolers' snacking and TV viewing habits as reported by their primary caregivers, including social/physical snacking contexts, types of snacks and caregiver rationales for offering snacks. These findings may support the development of effective messages to promote healthy child snacking.

DESIGN

Semi-structured interviews assessed caregiver conceptualizations of pre-schoolers' snacks, purpose of snacks, snack context and snack frequency.

SETTING

Interviews occurred in Boston, Massachusetts and Philadelphia, Pennsylvania, USA.

SUBJECTS

Forty-seven low-income multi-ethnic primary caregivers of children aged 3-5 years (92 % female, 32 % Hispanic/Latino, 34 % African American) described their child's snacking in the context of TV viewing.

RESULTS

TV viewing and child snacking themes were described consistently across racial/ethnic groups. Caregivers described snacks offered during TV viewing as largely unhealthy. Labels for TV snacks indicated non-nutritive purposes, such as 'time out', 'enjoyment' or 'quiet.' Caregivers' primary reasons for providing snacks included child's expectations, behaviour management (e.g. to occupy child) and social time (e.g. family bonding). Some caregivers used TV to distract picky children to eat more food. Child snacking and TV viewing were contextually paired by providing child-sized furniture ('TV table') specifically for snacking.

CONCLUSIONS

Low-income caregivers facilitate pre-schoolers' snacking and TV viewing, which are described as routine, positive and useful for non-nutritive purposes. Messages to caregivers should encourage 'snack-free' TV viewing, healthy snack options and guidance for managing children's behaviour without snacks or TV.

Mealtime Observations and Parent-Report: Correspondence Across Measurement and Implications for Intervention

This study explored the relationship between self-reported and observed mealtime behaviour and examined concurrent predictors of observed child and parent mealtime behaviour. The sample consisted of 67 parents of 1.5- to 6-year-old children experiencing difficulties with their child's mealtime, and 33 parents who were not concerned with their child's mealtime behaviour. Parent-reported and observed mealtime data, and parent-reported mealtime cognitions were collected. Regression analyses indicated that consistent with hypotheses, observed and parent-reported mealtime behaviour were related. Observed child behaviour was predicted by self-reported parenting behaviour and observed positive parent behaviour, as well as parental cognitions. Observed parent behaviour was predicted only by self-reported parenting mealtime behaviour.

Individual differences in susceptibility to large portion sizes among obese and normal-weight children

OBJECTIVE

Determine the association of children's susceptibility to large food portion sizes with appetite regulation and obesity.

METHODS

Normal-weight and obese non-Hispanic black children (n = 100) aged 5-6 years were observed in four dinner conditions of varying portion size; portions of all foods (except milk) offered were: 100% (677 kcal), 150% (1015 kcal), 200% (1353 kcal), or 250% (1691 kcal) of those in the reference condition (100%). Condition order was randomly assigned to 2-4 children who ate together at each meal. Child height and weight were measured and caregiver reports of child appetite were obtained. Hierarchical growth curve models were used to estimate associations of meal energy intake with portion size condition, child weight status, and appetite regulation traits, controlling for demographics.

RESULTS

Total energy intake increased across conditions of increasing food portion size (P < 0.001). The effect of portion size condition on total energy intake varied with food responsiveness (P = 0.05) and satiety responsiveness (P < 0.05), but not weight status (P = 0.682). Children with lower satiety responsiveness and greater food responsiveness showed greater increases in meal energy across conditions.

CONCLUSIONS

Children with poorer appetite regulation may be more vulnerable to obesogenic dietary environments offering large food portions than other children.

Association of eating speed and energy intake of main meals with overweight in Chinese pre-school children

OBJECTIVE

To investigate the association between eating behaviours (eating speed and energy intake of main meals) and overweight in pre-school children.

DESIGN

Cross-sectional study. Data consisted of measurements (height and weight), questionnaire information (eating behaviours of eating speed and overeating) and on-site observation data (meal duration and energy intake of main meals).

SETTING

Seven kindergartens in Beijing, China.

SUBJECTS

Pre-school children (n 1138; age range 3·1-6·7 years old) from seven kindergartens participated in the study.

RESULTS

The multivariate-adjusted odds ratio of overweight in participants with parent-reported 'more than needed food intake' was 3·02 (95 % CI 2·06, 4·44) compared with the 'medium food intake' participants, and higher eating speed was associated with childhood overweight. For the two observed eating behaviours, each 418·7 kJ (100 kcal) increase of lunch energy intake significantly increased the likelihood for overweight by a factor of 1·445, and each 5-min increase in meal duration significantly decreased the likelihood for overweight by a factor of 0·861. Increased portions of rice and cooked dishes were significantly associated with overweight status (OR = 2·274; 95 % CI 1·360, 3·804 and OR = 1·378; 95 % CI 1·010, 1·881, respectively).

CONCLUSIONS

Eating speed and excess energy intake of main meals are associated with overweight in pre-school children.

Influencing and modifying children's energy intake: the role of portion size and energy density

Childhood obesity is of concern worldwide. The portion size (PS) and energy density (ED) of food are two major determinants of children's energy intake (EI). Trends towards increasing PS are most apparent and best documented in the USA, where PS of numerous food products have increased in the marketplace over the past three decades, particularly high-energy dense foods. Analyses of population-level dietary surveys have confirmed this trend in children for both in- and out-of-home eating, and a plethora of observational evidence positively associates PS, ED and adiposity in children. A limited number of intervention studies provide clear evidence that children, even as young as 2 years, respond acutely to increasing PS, with some studies also demonstrating the additive effects of increased ED in promoting excessive EI. However, most of the evidence is based on children aged 3-6 years and there is a paucity of data in older children and adolescents. It is unclear whether decreasing PS can have the opposite effect on children's EI but recent acute studies have demonstrated that the incorporation of lower energy dense foods, such as fruit and vegetables, into children's meals down-regulates EI. Although a direct causal link between PS and obesity remains to be established, the regular consumption of larger PS of energy dense foods do favour obesity-promoting eating behaviours in children. Further research is required to establish the most feasible and effective interventions and policies to counteract the deleterious impact of PS and ED on children's EI.

Portion sizes for children are predicted by parental characteristics and the amounts parents serve themselves

BACKGROUND

Children's energy intakes are influenced by the portions they are served. Factors influencing the amounts adults offer children are not well described.

OBJECTIVE

We assessed whether the amounts that were served to and consumed by children at meals were related to amounts that parents served themselves.

DESIGN

In this repeated-measures, cross-sectional observational study, 145 parents and their preschoolers (82 Hispanic, 57 African American, 6 unidentified) were recruited from Head Start settings in Houston, TX. The amounts served to and consumed by children and parents during 3 at-home evening meals were measured and analyzed. We assessed children's and parents' heights and weights, and body mass indexes (BMIs) were calculated. Associations between portions served for parents and children and between amounts served to and consumed by children were evaluated. Multiple linear regression was used to determine whether maternal characteristics (race-ethnicity, sociodemographic factors, and caregivers' BMIs) predicted the amounts caregivers served to children.

RESULTS

The amounts that parents served themselves were significantly associated with the amounts that they served to their children (r = 0.51, P < 0.0001). Multiple regression analysis showed that African American parents (compared with Hispanics) served more food to themselves and to their children (P < 0.01, R² = 6.9%) and that employed (compared with unemployed) parents served more food to their children (P = 0.025, R² = 3.3%). The amounts served to children were strongly associated with the amounts children consumed (r = 0.88, P < 0.0001). When parents served more to themselves, they also served more to their children (P < 0.001).

CONCLUSIONS

These findings underscore the strong relation between portions offered by caregivers and the amounts children consume at a meal and suggest that factors unrelated to the child (such as the amount a parent serves himself or herself) are important predictors of children's consumption. Efforts aimed at improving parents' recognition of developmentally appropriate portions for young children could be useful for future obesity-prevention efforts.

Healthy incentive scheme in the Irish full-day-care pre-school setting

A pre-school offering a full-day-care service provides for children aged 0-5 years for more than 4 h/d. Researchers have called for studies that will provide an understanding of nutrition and physical activity practices in this setting. Obesity prevention in pre-schools, through the development of healthy associations with food and health-related practices, has been advocated. While guidelines for the promotion of best nutrition and health-related practice in the early years' setting exist in a number of jurisdictions, associated regulations have been noted to be poor, with the environment of the child-care facility mainly evaluated for safety. Much cross-sectional research outlines poor nutrition and physical activity practice in this setting. However, there are few published environmental and policy-level interventions targeting the child-care provider with, to our knowledge, no evidence of such interventions in Ireland. The aim of the present paper is to review international guidelines and recommendations relating to health promotion best practice in the pre-school setting: service and resource provision; food service and food availability; and the role and involvement of parents in pre-schools. Intervention programmes and assessment tools available to measure such practice are outlined; and insight is provided into an intervention scheme, formulated from available best practice, that was introduced into the Irish full-day-care pre-school setting.

Portion size variably affects food intake of 6-year-old and 4-year-old children in Kunming, China

Age and portion size have been found to influence food intake in American children but have not been examined in an international context. This study evaluated the association between age and the effects of portion size on the food intake of kindergarteners in Kunming, China. Using a within-subjects crossover design in a classroom setting, 173 children in two age groups, mean age 4.2 years and 6.1 years, were served a predefined reference, small (-30%) and large (+30%) portion of rice, vegetables, and a protein source during lunchtime over three consecutive days. Each portion was weighed before and after the meal to determine amount of food consumed. Linear mixed modeling, controlling for repeated measures and clustering by classroom, was used to compare food intake under small and large portion size conditions to the reference portion. Children ate significantly less food when served small portions. When served a large portion, 6-year-old children increased food intake while 4-year-old children decreased food intake in comparison to the reference portion. Findings indicate that portion size affects food intake in Chinese children 4-6-years old. Older children show larger increases in food intake with increased portion size than do younger children.

Plate size and children's appetite: effects of larger dishware on self-served portions and intake

OBJECTIVES

Dishware size is thought to influence eating behaviors, but effects on children's self-served portion sizes and intakes have not been studied. We aimed to evaluate whether larger dishware increased children's self-served portion sizes and intake during meals.

METHODS

A within-subjects experimental design was used to test the effects of dishware size (ie, plates and bowls) on children's self-served portion sizes and intakes in a naturalistic setting. Subjects were predominantly African American elementary school-aged children (n = 42) observed on repeated occasions during school lunch. Children served themselves an entree and side dishes using either child- or adult-size dishware, which represented a 100% increase in the surface area of plates and volume of bowls across conditions. Condition order was randomly assigned and counterbalanced across 2 first-grade classrooms. Entrées of amorphous and unit form were evaluated on separate days. Fruit and vegetable side dishes were evaluated at each meal. Fixed portions of milk and bread were provided at each meal.

RESULTS

Children served more energy (mean = 90.1 kcal, SE = 29.4 kcal) when using adult-size dishware. Adult-size dishware promoted energy intake indirectly, where every additional calorie served resulted in a 0.43-kcal increase in total energy intakes at lunch (t = 7.72, P = .001).

CONCLUSIONS

Children served themselves more with larger plates and bowls and consumed nearly 50% of the calories that they served. This provides new evidence that children's self-served portion sizes are influenced by size-related facets of their eating environments, which, in turn, may influence children's energy intake.

External influences on children's self-served portions at meals

OBJECTIVE

Large portions promote intake among children, but little is known about the external influences of the eating environment on children's self-selected portion sizes. This research experimentally tested effects of the amount of entree available and serving spoon size on children's self-served entree portions and intakes at dinner meals. A secondary objective was to identify child and family predictors of self-served entree portion sizes.

DESIGN

A 2 × 2 within-subjects design was used, in which the amount of a pasta entree available for self-serving (275 vs 550 g) and the serving spoon size (teaspoon vs tablespoon) were systematically varied. The serving bowl size and portion sizes of all other foods offered were held constant across conditions. Conditions were spaced 1 week apart and randomly assigned. Weighed self-served entree portions and food intakes as well as demographics, maternal feeding styles and child/maternal anthropometrics were measured.

SUBJECTS

Participants were 60 ethnically diverse children aged 4-6 years and their mothers.

RESULTS

Mixed models revealed that children served themselves 40% more entree when the amount available was doubled (P<0.0001) and 13% more when the serving spoon size was tripled (P<0.05). Serving spoon size and the amount of entree available indirectly influenced children's intake, with larger self-served portion sizes related to greater entree intakes (P<0.0001). Greater self-served portions and energy intakes at the meal were seen among those children whose mothers reported indulgent or authoritarian feeding styles (P<0.001).

CONCLUSION

Children's self-served portion sizes at meals are influenced by size-related facets of the eating environment and reflect maternal feeding styles.

A narrative literature review of the development of obesity in infancy and childhood

This narrative review explains the development of excess weight gain in babies and children. It takes a life course approach which includes genetics, pre-conception, pregnancy, infancy and childhood. The paper focuses on feeding behaviours, physical activity, parental influences and the wider social and environmental context. Risk factors which can cumulatively lead to excess childhood weight gain include: under- or overweight during pregnancy; the presence of diabetes during pregnancy; low or high birth weight; having obese parents; early weaning; prolonged formula feeding; rapid weight gain in the first year; disinhibited eating patterns and the consistent availability of energy dense food at home; feeding practices which are not responsive to the child's cues; insufficient sleep among preschool children; sedentary parents; low parental education; living in poor socio-economic circumstances; absence, or perceived absence, of safe play areas; parents who lack time or confidence to authoritatively parent; environments where there is poor access to affordable lower energy dense foods; and parents who do not accept that excess weight is a health problem. Recommendations for health professionals are made.

Do children eat less at meals when allowed to serve themselves?

BACKGROUND

The effect of self-serving on young children's energy intake is not well understood.

OBJECTIVE

The objective was to examine individual differences in the effects of plated and self-served entrée portions on children's energy intake.

DESIGN

Two within-subjects experiments were used to examine ad libitum intake at meals in 63 children aged 3-5 y when 400 g of a pasta entrée was either plated or available for children to self-serve. Child age, sex, BMI, and responsiveness to increasing portion size (defined as individual slope estimates relating ad libitum intake of the entrée across a range of entrée portions) were evaluated as predictors of self-served portions.

RESULTS

Children's entrée and meal intakes did not differ between the self-served and plated conditions for the total sample or by child weight status. However, larger self-served entrée portions were associated with greater entrée and meal intakes. Children who served themselves larger entrée portions tended to be overweight and more responsive to portion size (ie, greater increases in entrée intake as plated portion size increased). Last, self-served portion predicted both entrée and meal intake over and above BMI z score and responsiveness to portion.

CONCLUSIONS

Contrary to our hypothesis, relative to plated portions, allowing children to self-serve the entrée portion did not reduce energy intake. Children who were more responsive to portion-size effects were likely to self-serve and eat larger entrée portions. Self-serving is not a one-size-fits-all approach; some children may need guidance and rules to learn how to self-select appropriate portion sizes.

5-2-1-almost none: parents' perceptions of changing health-related behaviors in their obese child

OBJECTIVE

Recent clinical pediatric practice guidelines reiterate the importance of key messages to prevent childhood overweight and obesity, including the consumption of at least five servings of fruits or vegetables each day, a limit to screen time (time spent watching TV, using a computer, and playing video games) of two hours or less per day, engagement in at least one hour of physical activity per day, and the consumption of no sugary beverages each day. The perceptions of primary caregivers of obese children of these key messages are less clear. We explored parents' (or caregivers') awareness of and confidence in adopting a variation of the expert committee's recommended (5-2-1-Almost None [AN]) behaviors.

MATERIALS AND METHODS

Before the initiation of treatment, parents of obese children completed a survey designed to explore their awareness of and confidence in adopting 5-2-1-AN behaviors. Qualitative and quantitative analyses were conducted to assess how aware these families are of 5-2-1-AN behaviors and how confident they would be of their ability to guide adoption of these specific behaviors.

RESULTS

Parents from 193 families indicated that weight management depends substantially on physical activity (63%). However, parents rated as less important consuming fruits and vegetables (17%), controlling portions (13%), eliminating sugary drinks (4%), reducing screen time (3%), eating breakfast each morning (1%), and having family dinners (1%). Almost universally, respondents reported significantly reduced confidence in helping their child adopt nonspecific lifestyle changes in eating and physical activity versus the targeted behaviors identified in 5-2-1-AN.

CONCLUSION

Parents surveyed for this clinical study readily accept certain aspects of the 5-2-1-AN message as factors in healthy living. Despite low levels of reported awareness of the message, the consumption of almost no sugary drinks was the only actionable behavior in the 5-2-1-AN message that parents felt significantly more confident they could achieve than the nonspecific goal of improved eating. These perceptions can be used to help guide the adoption of 5-2-1-AN strategies as well as help clinicians target messages for specific healthy behavior adoption.

Social, economic and demographic correlates of overweight and obesity in primary-school children: preliminary data from the Healthy Growth Study

OBJECTIVE

To record the prevalence of overweight and obesity in urban primary-school children in relation to several socio-economic and demographic factors.

DESIGN

Cross-sectional.

SETTING/SUBJECTS

A representative sample of 729 schoolchildren (379 male and 350 female), aged 9-13 years, stratified by parental educational level, was examined in the urban region of Athens. Weight and height were measured using standard procedures. The International Obesity Task Force thresholds were used for the definition of overweight and obesity. Several socio-economic and demographic data and the child's 'popularity' score were also recorded with specifically designed standardized questionnaires.

RESULTS

The prevalence of overweight and obesity was 29·6 % and 11·1 %, respectively. Annual family income of € 12,000-20,000 (OR = 1·58), residence ownership (OR = 1·63) and the grandmother as the child's primary caregiver (OR = 1·38) were significantly associated with higher odds of childhood overweight and obesity. Non-Greek parental nationality (OR = 0·72) and higher 'popularity' scores of children (OR = 0·42) were significantly associated with lower odds of overweight and obesity. The grandmother as the child's primary caregiver and an annual family income of € 12,000-20,000 remained significantly associated with childhood overweight and obesity after adding all significant correlates of childhood overweight and obesity observed at the bivariate level in a multivariate regression model (OR = 1·51 and 1·61, respectively).

CONCLUSIONS

Among family income, residence ownership, child's primary caregiver, parental nationality and popularity scores that were identified as significant correlates of childhood overweight and obesity at the bivariate level, lower family income and grandmother as the child's primary caregiver were the only factors that remained significantly associated with childhood overweight and obesity at a multivariate level.

Energy compensation in enterally fed children

Limited exposure to solid food in early childhood may affect the development of appetite regulation. We used formal satiation studies to assess energy compensation in children who have been artificially fed. Subjects were 11 children, median age 4.5 years (range 1-10) who were formerly (n=4) or currently (n=5) mainly tube fed or supplement fed (n=2), with a range of surgical or neurodevelopmental problems. On 2 separate days a high-energy preload (HEP) and low-energy preload (LEP) drink were given followed by a multi-item test lunch. A compensation index (COMPX) score was derived as follows: COMPX (%)=[(Meal(lep)-Meal(hep))/(Preload(hep)-Preload(lep))]× 100. The median (range) COMPX of the participants was 70% (-73% to 178%). The 8 boys tended to compensate more (median 99%) than the 3 girls (30%; P Mann-Whitney=0.1), but there was no clear association of compensation with age. Although a small preliminary study, this suggests that children who have been artificially fed demonstrate energy compensation comparable to that of normally fed children.

Does children's energy intake at one meal influence their intake at subsequent meals? Or do we just think it does?

It is widely believed that young children are able to adjust their energy intake across successive meals to compensate for higher or lower intakes at a given meal. This conclusion is based on past observations that although children's intake at individual meals is highly variable, total daily intakes are relatively constant. We investigated how much of this reduction in variability could be explained by the statistical phenomenon of the variability of individual components (each meal) always being relatively larger than the variability of their sum (total daily intake), independent of any physiological compensatory mechanism. We calculated, theoretically and by simulation, how variable a child's daily intake would be if there was no correlation between intakes at individual meals. We simulated groups of children with meal/snack intakes and variability in meal/snack intakes based on previously published values. Most importantly, we assumed that there was no correlation between intakes on successive meals. In both approaches, the coefficient of variation of the daily intakes was roughly 15%, considerably less than the 34% for individual meals. Thus, most of the reduction in variability found in past studies was explained without positing strong 'compensation'. Although children's daily energy intakes are indeed considerably less variable than their individual components, this phenomenon was observed even when intakes at each meal were simulated to be totally independent. We conclude that the commonly held belief that young children have a strong physiological compensatory mechanism to adjust intake at one meal based on intake at prior meals is likely to be based on flawed statistical reasoning.

Parental influence on children's early eating environments and obesity risk: implications for prevention

Most childhood obesity prevention efforts have focused on school-age children and adolescents and have had limited success. We argue that the first years of life, including the prenatal period, the postnatal suckling period and the transition to the modified adult diet, may provide opportunities for preventive interventions. These early periods are characterized by high plasticity and rapid transitions, and parents have a high degree of control over children's environments and experiences. Observational and experimental evidence reveal persistent effects of early environments on eating behavior and obesity risk, suggesting that interventions should be tested during these early periods. The central task parents have in early development points to their potential as key targets and agents of change in early preventive interventions. In this paper, we review evidence of early environmental effects on children's eating and obesity risk, highlighting ways that parental feeding practices and parents' own behaviors impact these outcomes and calling for further experimental research to elucidate whether these factors are indeed promising targets for childhood obesity preventive interventions.

How many calories are on our plate? Expected fullness, not liking, determines meal-size selection

The availability of highly palatable food is thought to stimulate the selection of larger meals (leading to weight gain and obesity). In this article, we explore aspects of this proposition. Specifically, we scrutinize two basic assumptions: (i) palatable energy-dense foods are more rewarding (desired), and (ii) these palatable foods are selected in relatively larger portions. In combination with palatability, we also consider the relative role for "expected satiation"-the extent to which a food is expected to deliver satiation. A total of 17 commonly consumed foods were assessed by 28 normal-weight participants at lunchtime. Critically, our measure of food reward and expected satiation involves comparisons between foods based on equicaloric portions. When assessed in this way, we find that food reward and ideal portion sizes (in kcal) are both closely associated with expected satiation, but not with "expected liking." Low expected satiation (not expected liking) predicts the selection of large portion sizes (in kcal) and foods with this characteristic tend to be more energy dense and are regarded as less (not more) rewarding (when compared calorie for calorie). Together, these findings challenge the role of palatability in meal-size selection and they highlight the importance of expected satiation, a "nonaffective" component of food reward.

What maternal factors influence the diet of 2-year-old children living in deprived areas? A cross-sectional survey

Objective

To investigate the maternal factors associated with poor diet among disadvantaged children.

Design

Survey of 300 mothers of 2-year-old children from areas of high deprivation in Scotland (response rate 81 %). A diet quality score was derived from reported consumption of carbohydrates, protein, fruit and vegetables, dairy products and restriction of sugary fatty foods.

Results

Most children (85 %) were classified as having a poor quality diet (low diet quality score). Mothers’ general knowledge about healthy eating was high, but did not predict the quality of the children’s diet. Lower frequencies of food preparation and serving, such as cooking with raw ingredients, providing breakfast daily and the family eating together, were also associated with a poorer diet. Regression modelling identified five significant factors. An increased risk of a poor diet was associated with mothers being unlikely to restrict sweets (OR = 21·63, 95 % CI 2·70, 173·30) or finding it difficult to provide 2–3 portions of fruit daily (OR = 2·94, 95 % CI 1·09, 7·95). Concern that the child did not eat enough increased the risk of a poor diet (OR = 2·37, 95 % CI 1·09, 5·16). Believing a healthy diet would help the child eat more reduced the risk of having a poor diet (OR = 0·28, 95 % CI 0·11, 0·74), as did providing breakfast daily (OR = 0·22, 95 % CI 0·05, 0·99).

Conclusions

Interventions to improve children’s diet could promote more positive intentions about preparing and serving of foods, particularly of specific meals at which the family eats together. The benefits of these behaviours to the child (improved diet, weight control) should be emphasised.

Validation of energy requirement equations for estimation of breast milk consumption in infants

Objective

To test equations for calculating infants’ energy requirements as a simple and reliable instrument for estimating the amount of breast milk consumed in epidemiological studies where test-weighing is not possible.

Design

Infants’ energy requirements were calculated using three different equations based on reference data and compared with actual energy intakes assessed using the 3 d weighed dietary records of breast-fed infants from the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) Study.

Setting

A sub-sample of 323 infants from the German DONALD Study who were predominantly breast-fed for at least the first four months of life, and who had 3 d weighed dietary records and repeated body weight measurements within the first year of life.

Subjects

Healthy, term infants breast-fed for at least 4 months, 0–12 months of age.

Results

The overall differences between measured energy intake and calculated energy requirements were quite small, never more than 10 % of total energy intake, and smaller than the mean variance of energy intake between the three days of recording. The equation of best fit incorporated body weight and recent growth, while the worst fit was found for the equation not considering body weight.

Conclusions

Breast milk consumption in fully and partially breast-fed infants can be reasonably quantified by calculating the infants’ individual energy requirements via simple equations. This provides a feasible approach for estimating infant energy intake in epidemiological studies where test-weighing of breast milk is not possible.

Short-term dietary compensation in free-living adults

Evidence suggests that compensatory behaviors operate in infants and pre-school children, such that the high variance characteristic of single eating occasions is much reduced over the day. However, the concept has not been fully explored in adults. The present within-subject, observational study investigated short-term dietary compensation patterns in fifty, weight-stable, normal weight (n=27), overweight (n=14), and obese (n=9) free-living adults (11 M, 39 F; age 30+/-11 y; BMI 26.3+/-5.9). Twenty four-hour diet recalls were obtained for 7 consecutive days, by the multi-pass technique. Each 24-h period was divided into 7 eating occasions. The coefficient of variation for energy intake was calculated for each adult, for each eating occasion, and over each 24-h period. Sub-group variability was assessed by BMI and frequency of consumption of sweetened energy-yielding beverages. The mean coefficient of variation for energy intake for the 7 eating occasions was 110.5%, compared to 28.9% for the day as a whole. Correlations between energy intakes at successive eating events were uniformly negative. No significant differences were noted in the sub-group analyses. Significantly greater variation in energy intake was noted for snacks compared to meals (P<0.0001). These data suggest that adults regulate energy intake over a 24-h period more closely than they do at individual eating occasions, similar to the pattern previously observed in children. Further studies of compensatory responses by larger sub-groups of individuals at risk for weight gain are warranted.

Food is never enough: nature and nurture's influence on children's food dose evaluation

This study investigated whether if socioeconomic factors and\or food palatability influence food amount evaluation among children. Ninety-four children, 10-15 years old, living in Mali in Africa, and 124 living in northern Italy were asked to evaluate an amount of palatable and non palatable candies. The evaluations were compared both to the real number of candies and to that given by the other group. Both Italian and Malian children underestimated the edible candies, interestingly however Malian children did not underestimate altered candies. The data suggest that food dose underestimation is a transcultural characteristic. Evaluation of palatable food is not influenced by socio cultural factors. Underestimation could be a biological protective factor against food shortage; in case of food abundance it could play a role in onset and maintenance of obesity.

Child nutrition and growth: butterfly effects?

The international symposium organised by the Danone Institute as a pre-congress satellite of the European Nutrition Societies Congress, in Paris, in July 2007, brought together experts of child nutrition and behaviour. These experts coming from several countries of Europe and North America shared their views on the impact of numerous factors affecting child eating and health in present-day developed societies. Topics included nutritional influences during foetal life, early life development of food likes and dislikes, neophobia, ability for energy regulation, impact of media and advertisement, etc. Most contributions addressed the obesity epidemics and the problems associated with body weight control. Other aspects of child health were also considered, for example the nutritional challenge of adequately feeding children with type 1 diabetes. The nine speakers were asked to underline practical strategies to improve nutrition in early life, so as to maximise health, growth and quality of life in today's environment. The present paper is a summary of the ideas expressed by the experts, highlighting agreements, convergences, and occasional disagreements between expert opinions.

Recommendations for prevention of childhood obesity

The majority of US youth are of healthy weight, but the majority of US adults are overweight or obese. Therefore, a major health challenge for most American children and adolescents is obesity prevention-today, and as they age into adulthood. In this report, we review the most recent evidence regarding many behavioral and practice interventions related to childhood obesity, and we present recommendations to health care providers. Because of the importance, we also suggest approaches that clinicians can use to encourage obesity prevention among children, including specific counseling strategies and practice-based, systems-level interventions. In addition, we suggest how clinicians may interact with and promote local and state policy initiatives designed to prevent obesity in their communities.

Effects of lifestyle on the onset of puberty as determinant for breast cancer

Breast cancer is more than ever the leading cause of death in women. In this article, we investigate the influence of lifestyle factors, and in particular nutrition (i.e. soft drinks), on physical development, puberty, breast growth and menarche to understand the potential impact of these environmental and lifestyle factors on the induction of breast cancer susceptibility. A questionnaire was obtained from 1146 girls of 10 schools in Belgian Limburg, attending the second year of secondary school. Their mean age was about 13 years. The analyses of the data were performed with 'survival analysis', in particular with the 'Cox regression' model for menarche. This project was conducted in the school year of 1999-2000. In the univariate and multivariate analysis investigating the most important variables of the period from birth to the age of menarche, there was clear evidence that lifestyle factors, including nutrition, have an effect on breast development and menarche. The following variables were significantly related to breast development and menarche: body mass index, drinking high-carbohydrate drinks, i.e. soft drinks, height of the father and the mother, weight of the mother at the start of pregnancy, history of mononucleosis, origin and education of the parents and physical activity. Lifestyle factors, including nutrition (i.e. soft drinks), affect the age at puberty and menarche. The same factors are known to be related to breast cancer risk. Better control of these variables during puberty might reduce breast cancer risk later in life.

Estimation of exposure to food-packaging materials. 2: Patterns of intakes of packaged foods in Irish Children aged 5–12 years

In the European Union (EU), many assumptions are employed to calculate the intake of migrating chemicals from food packaging. However, very little is known about the actual intake of packaged food, the type of this food and the type of packaging used for this food. The objective of the current study was to examine intakes of packaged food in children aged 5-12 years to provide information on the types of food that are packaged and the type of packaging used. To do this, a food-consumption database, which also recorded information on packaging, was merged with a packaging database, which provided information on the contact layers of packaging. Foods were classified into EU Food categories according to European Council Directive EC 85/575/EEC (European Council 1985), which determined their food type (i.e. aqueous, acidic, alcoholic and fatty). The mean daily intake of all packaged food was 1195 g day-1 with an upper intake of 1959 g day-1 (97.5th percentile); the intake of food packaged in plastic was 993 g day-1 with an upper percentile of 1692 g day-1 (97.5th percentile). The mean daily intake of fat from all packaged food was 62 g day-1, with an upper intake of 100 g day-1 (97.5th percentile). When this was investigated further, it was found that the mean fat intake from packaged 'fatty' foods only was 32 g day-1, with an upper intake of 61 g day-1 (97.5th percentile). The food that contributed most to fat intake was milk. As many food chemical intake assessments are moving towards probabilistic methods, probabilities of a food being packaged and the probability of the type of packaging used were determined. The probability of food being packaged was 0.88. Some foods not 100% packaged included fruit, vegetables, liquid beverages non-alcoholic (includes water) and bread. Probabilities were also derived for the packaging types used for food. It can be concluded that not all the individual assumptions used in the EU exposure assessment are conservative, but in combination they are conservative.