Alternative thinking about starting points of obesity. Development of child taste preferences

Validity and reliability of the Persian version of food preferences questionnaire (Persian-FPQ) in Iranian adolescents

The assessment of dietary intakes and habits using reliable and youth-specific measurement tools during adolescence is essential. The aim of the present study was to culturally adapt and investigate the psychometric properties of the Persian version of the food preferences questionnaire (Persian-FPQ) among Iranian adolescents. This methodological cross-sectional study was conducted among 452 Persian-speaking adolescents, living in Isfahan, Iran. Translation of the FPQ was performed using forward-backward method. Intra Class Correlation (ICC) and Cronbach's α were used to assess test-retest reliability and internal consistency, respectively. Construct validity was investigated by using exploratory factor analysis (EFA). Divergent validity was determined using correlation analysis with Kessler Psychological Distress Scale (K-10). Known-group validity was assessed based on differences in mean food preference score between boys and girls and different categories of body mass index (BMI). The internal and external reliabilities for the Persian-FPQ were in the range of good to excellent in all domains (Cronbach's α: 0.76-0.96 and ICCs: 0.982-0.998). Boys had higher scores of food preferences than girls, indicating good known-group validity. Construct validity evaluated by EFA led to extraction of seven factors ("Vegetables", "Fruit", "Dairy", "Snacks", "Meat/Fish", "Starches" and "Miscellaneous foods"), explaining 37.8% of the variance. Divergent validity revealed significant negative correlations between five sub-scales of the Persian-FPQ and psychological distress. The Persian version of the FPQ is a reliable and valid instrument with applicability in a broad range of the population of Persian-speaking adolescents for assessing food preferences in community-based research projects.

Neophobia, sensory experience and child's schemata contribute to food choices

PURPOSE

The aim of the present review is to analyze dynamic interactions between nutrigenomics, environmental cues, and parental influence, which can all lead to children's neophobic reactions and its persistence in time.

METHODS

We reviewed studies available on electronic databases, conducted on children aged from birth to 18 years. We also considered official websites of Italian Institutions, providing advice on healthy eating during infancy.

RESULTS

Modern day societies are faced with an eating paradox, which has severe and ever-growing implications for health. In face of a wider availability of healthy foods, individuals instead often choose processed foods high in fat, salt and sugar content. Economic reasons surely influence consumers' access to foods. However, there is mounting evidence that food choices depend on the interplay between social learning and genetic predispositions (e.g., individual eating traits and food schemata). Neophobia, the behavioral avoidance of new foods, represents an interesting trait, which can significantly influence children's food refusal. Early sensory experiences and negative cognitive schemata, in the context of primary caregiver-child interactions, importantly contribute to the priming of children's food rejection.

CONCLUSIONS

As neophobia strongly affects consumption of healthy foods, it will be relevant to rule definitively out its role in the genesis of maladaptive food choices and weight status in longitudinal studies tracking to adulthood and, in meanwhile, implement early in life effective social learning strategies, to reduce long-term effects of neophobia on dietary patterns and weight status.

LEVEL OF EVIDENCE

Level II, controlled trials without randomization.

Children's Influence on Parents: the Bidirectional Relationship in Family Meal Selection

Feeding a child in the 21st century can be challenging. A child's diet is thought to be a parent's responsibility, and numerous studies have explored how parents influence their child's food intake through food availability, feeding practices, and modeling. However, this relationship is likely bidirectional such that the child influences the parent as well (sometimes called "pester power"). Pester power has been studied in grocery stores and restaurants. However, no research to date investigates how children influence parent's food selection when eating at home. This study addresses this gap by asking parent and child dyads (N = 79, 95% white) to create meals together and separately. Forty 6-8 and thirty-nine 13-15 year-olds participated. Most of the parents (97.5%) and children (49.4%) who participated were female; and parents reported an average annual income of over 80,000 dollars (68.3%). Mean differences in the nutrient content of the meals were analyzed using repeated measures ANOVAs to examine the strength of influence in the bidirectional relationship. Results suggested when children were present for meal selection, they exerted influence over their parents for more palatable items. When choosing foods as a dyad versus when the parent selected meals for the family, the foods contained more calories, sugar, and less fiber. Protein was the only nutrient that parents influenced in their child's selections. These findings have important implications for understanding the often-overlooked bidirectional dynamic of the feeding relationship, and the accompanying health outcomes of child dietary intake.

Análisis bibliométrico y revision temática de estudios en consumo infantil de 1974 a 2019

El papel de los niños como consumidores ha generado un gran interés en el marketing social, especialmente en los aspectos relacionados con la alimentación; sin embargo, hay campos como la regulación de la publicidad, el comportamiento digital y las actitudes de los niños hacia los productos, que hasta ahora no están completamente estudiados. Para apoyar las futuras investigaciones de la comunidad científica del marketing social sobre este tema, el presente estudio bibliométrico tuvo como objetivo investigar y describir las líneas y áreas de investigación en psicología, comportamiento y marketing social, en relación con el consumo infantil, para responder a la siguiente pregunta de investigación: ¿Cuáles son las publicaciones, autores y tendencias más importantes en la investigación sobre el consumo infantil en los últimos 45 años? Para ello, se analizaron 1375 artículos de 703 revistas con los paquetes Bibliometrix (R Studio), utilizando una metodología exploratoria y descriptiva, analizando 2588 palabras clave de autor y 1265 palabras clave adicionales con 2597 autores en la base de datos Scopus. Los indicadores cienciométricos muestran la existencia de cinco grupos temáticos relacionados con el consumo infantil. Se concluye que la producción científica sobre el consumo de niños y niñas debe abordar cuestiones de protección y regulación orientadas a la responsabilidad social, especialmente en las comunicaciones integradas de marketing y publicidad de las marcas alimentarias, con mayor y especial cuidado en el entorno digital, debido a la actual inmersión de la población infantil mundial y su creciente autonomía en la elección de contenidos, productos y marcas digitales.

Shared Dynamics of Food Decision-Making in Mother-Child Dyads

This study explored risk parameters of obesity in food decision-making in mother-child dyads. We tested 45 children between 8–12 years and their biological mothers to measure the decision weights of food health attributes, the decision weights of food taste attributes, self-regulated food decisions, and self-reported self-control scores. Maternal body mass index (BMI), and children's BMI-percentiles-for-age were also measured. We found a positive correlation between children's and their mothers' decision weights of taste attributes in food decision-making. We also found a positive correlation between children's BMI %iles and their mothers' BMIs. Children with overweight/obesity demonstrated lower correlations between health and taste ratings and a lower percentage of self-regulated food decisions (i.e., resisting to eat tasty but unhealthy foods or choosing to eat not-tasty but healthy foods) than children with healthy weight. Our findings suggested that the decision weights of taste attributes and weight status shared similar patterns in mother-child dyads. Also, the findings suggested that establishing dynamics of unhealthy food-decision making may increase the risk of childhood obesity. Helping children to develop the dynamics of healthy food-decision making by increasing the importance of health while decreasing the importance of taste may promote resilience to susceptibility to unhealthy eating and weight gain.

Does Responsiveness to Basic Tastes Influence Preadolescents' Food Liking? Investigating Taste Responsiveness Segment on Bitter-Sour-Sweet and Salty-Umami Model Food Samples

The objective of this study was to investigate the relationships between taste responsiveness and food liking in preadolescents. Model food samples of grapefruit juice (GF) and vegetable broth (VB) modified with four additions of sucrose and sodium chloride, respectively, were employed. Intensity perception for sweetness, sourness, and bitterness were measured in GF while saltiness and umami were measured in VB. The children (N = 148) also completed food choice, familiarity, stated liking and neophobia questionnaires. The test was conducted at school, with instructions provided remotely via video call. Four segments were defined differing in basic taste responsiveness. Segments and sucrose concentrations significantly affected liking for GF, while no significant effect of segments and sodium chloride concentrations occurred on liking for VB. An increasing sucrose concentration was positively associated with liking for GF only in the segment with low responsiveness to bitter and sour tastes. No significant differences across segments were found for food choice, familiarity, stated liking, and neophobia. Conclusively, relationships between taste responsiveness and liking are product and basic taste-dependent in addition to being subject-dependent. Strategies to improve acceptance by using sucrose as a suppressor for warning sensations of bitterness and sourness can be more or less effective depending on individual responsiveness to the basic tastes.

A biopsychosocial approach to processes and pathways in the development of overweight and obesity in childhood: Insights from developmental theory and research

Childhood obesity has reached alarming proportions in many countries. There is consensus that both biological (especially genetic) and environmental (including psychosocial) factors contribute to weight gain and obesity in childhood. Research has identified extensive risk or predictive factors for childhood obesity from both of these domains. There is less consensus about the developmental processes or pathways showing how these risk factors lead to overweigh/obesity (OW/OB) in childhood. We outline a biopsychosocial process model of the development of OW/OB in childhood. The model and associated scholarship from developmental theory and research guide an analysis of research on OW/OB in childhood. The model incorporates biological factors such as genetic predispositions or susceptibility genes, temperament, and homeostatic and allostatic processes with the psychosocial and behavioral factors of parenting, parental feeding practices, child appetitive traits, food liking, food intakes, and energy expenditure. There is an emphasis on bidirectional and transactional processes linking child biology and behavior with psychosocial processes and environment. Insights from developmental theory and research include implications for conceptualization, measurement, research design, and possible multiple pathways to OW/OB. Understanding the developmental processes and pathways involved in childhood OW/OB should contribute to more targeted prevention and intervention strategies in childhood.

The effectiveness of voluntary policies and commitments in restricting unhealthy food marketing to Canadian children on food company websites

Marketing unhealthy foods and beverages to children (M2K) fosters poor dietary patterns, increasing obesity and noncommunicable disease risk. Federal restrictions on M2K have been under development in Canada since 2016; however, at present, M2K is mostly self-regulated by food companies. This study aimed to compare M2K on Canadian websites of food companies with and without voluntary policies or commitments in this area. A systematic content analysis of company websites was conducted in spring/summer 2017 for major packaged food (n = 16), beverage (n = 12), and restaurant chain (n = 13) companies in Canada. M2K policies were sourced from company websites and published corporate documents. Sixteen companies (43%) reported national and/or global M2K policies, while 21 companies (57%) had no published policies. The websites of Canadian companies (n = 154) were scanned for child-directed products and marketing; type and frequency of marketing techniques were recorded. Child-directed marketing appeared on 19 websites of 12 companies (32%), including 9 companies with M2K policies. Websites featured products with unconventional flavours, colours, shapes, or child-oriented packaging, and used promotional characters, contests, games, activities, or lettering and graphics appealing to children. The nutritional quality of products marketed to children was evaluated using a nutrient profile model developed by Health Canada for proposed M2K regulations. Of the 217 products marketed to children, 97% exceeded Health Canada's proposed ∼5% Daily Value threshold for saturated fat, sodium, and/or sugars, 73% of which were products from 9 companies with policies. These findings highlight the limitations of self-regulation in restricting M2K on food company websites, reinforcing the need for government regulations.

Takeaway meal consumption and risk markers for coronary heart disease, type 2 diabetes and obesity in children aged 9-10 years: a cross-sectional study

OBJECTIVE

To investigate associations between takeaway meal consumption and risk markers for coronary heart disease, type 2 diabetes and obesity risk markers in children.

DESIGN

A cross-sectional, school-based observational study.

SETTING

85 primary schools across London, Birmingham and Leicester.

PARTICIPANTS

1948 UK primary school children in year 5, aged 9-10 years.

MAIN OUTCOME MEASURES

Children reported their frequency of takeaway meal consumption, completed a 24-hour dietary recall, had physical measurements and provided a fasting blood sample.

RESULTS

Among 1948 participants with complete data, 499 (26%) never/hardly ever consumed a takeaway meal, 894 (46%) did so <1/week and 555 (28%) did ≥1/week. In models adjusted for age, sex, month, school, ethnicity and socioeconomic status, more frequent takeaway meal consumption was associated with higher dietary intakes of energy, fat % energy and saturated fat % energy and higher energy density (all P trend <0.001) and lower starch, protein and micronutrient intakes (all P trend <0.05). A higher frequency of takeaway meal consumption was associated with higher serum total cholesterol and low-density lipoprotein (LDL) cholesterol (P trend=0.04, 0.01, respectively); children eating a takeaway meal ≥1/week had total cholesterol and LDL cholesterol 0.09 mmol/L (95% CI 0.01 to 0.18) and 0.10 mmol/L (95% CI 0.02 to 0.18) higher respectively than children never/hardly ever eating a takeaway meal; their fat mass index was also higher.

CONCLUSIONS

More frequent takeaway meal consumption in children was associated with unhealthy dietary nutrient intake patterns and potentially with adverse longer term consequences for obesity and coronary heart disease risk.

Sound preference test in animal models of addicts and phobias

Biased or too strong preference for a particular object is often problematic, resulting in addiction and phobia. In animal models, alternative forced-choice tasks have been routinely used, but such preference test is far from daily situations that addicts or phobic are facing. In the present study, we developed a behavioral assay to evaluate the preference of sounds in rodents. In the assay, several sounds were presented according to the position of free-moving rats, and quantified the sound preference based on the behavior. A particular tone was paired with microstimulation to the ventral tegmental area (VTA), which plays central roles in reward processing, to increase sound preference. The behaviors of rats were logged during the classical conditioning for six days. Consequently, some behavioral indices suggest that rats search for the conditioned sound. Thus, our data demonstrated that quantitative evaluation of preference in the behavioral assay is feasible.

Progress achieved in restricting the marketing of high-fat, sugary and salty food and beverage products to children

In May 2010, 192 Member States endorsed Resolution WHA63.14 to restrict the marketing of food and non-alcoholic beverage products high in saturated fats, trans fatty acids, free sugars and/or salt to children and adolescents globally. We examined the actions taken between 2010 and early 2016 - by civil society groups, the World Health Organization (WHO) and its regional offices, other United Nations (UN) organizations, philanthropic institutions and transnational industries - to help decrease the prevalence of obesity and diet-related noncommunicable diseases among young people. By providing relevant technical and policy guidance and tools to Member States, WHO and other UN organizations have helped protect young people from the marketing of branded food and beverage products that are high in fat, sugar and/or salt. The progress achieved by the other actors we investigated appears variable and generally less robust. We suggest that the progress being made towards the full implementation of Resolution WHA63.14 would be accelerated by further restrictions on the marketing of unhealthy food and beverage products and by investing in the promotion of nutrient-dense products. This should help young people meet government-recommended dietary targets. Any effective strategies and actions should align with the goal of WHO to reduce premature mortality from noncommunicable diseases by 25% by 2025 and the aim of the UN to ensure healthy lives for all by 2030.

Pester power and its consequences: do European children's food purchasing requests relate to diet and weight outcomes?

OBJECTIVE

Children may influence household spending through 'pester power'. The present study examined pestering through parent-child food shopping behaviours in relation to children's diet and weight status.

DESIGN

Cross-sectional and prospective analyses drawn from the IDEFICS study, a cohort study of parents and their children. Children's height and weight were measured and their recent diets were reported by parental proxy based on the Children's Eating Habits Questionnaire-FFQ at baseline and 2-year follow-up. Parents also completed questionnaires at both time points about pestering, including whether the child goes grocery shopping with them, asks for items seen on television and is bought requested food items.

SETTING

Participants were recruited from eight European countries for the IDEFICS study (non-nationally representative sample).

SUBJECTS

Study participants were children aged 2-9 years at enrolment and their parents. A total of 13 217 parent-child dyads were included at baseline. Two years later, 7820 of the children were re-examined.

RESULTS

Most parents (63 %) at baseline reported 'sometimes' acquiescing to their children's requests to purchase specific foods. Pestering was modestly associated with weight and diet. At baseline, children whose parents 'often' complied consumed more high-sugar and high-fat foods. Children who 'often' asked for items seen on television were likely to become overweight after 2 years (OR=1·31), whereas 'never' asking protected against overweight (OR=0·72).

CONCLUSIONS

Pestering was modestly related to diet and weight in cross-sectional, but not longitudinal analyses. Asking for items seen on television had the most robust relationships across child outcomes and over time.

The short-term effects of television advertisements of cariogenic foods on children's dietary choices

OBJECTIVE

To investigate the short-term influence of the advertising of cariogenic foods on children's dietary preferences, and the possible moderating effect of several factors on this influence.

METHODS

One-hundred and eighty-three children, 11-12 years of age, were exposed to advertisements showing sugary food and non-food items, in a within-subject counterbalanced design. Their preferences for unhealthy and healthy foods, and their ability to recall or recognise the advertisements, were measured following both sessions. Information on their dietary habits, leisure activities and sociodemographic details were obtained through a questionnaire completed by their parents. Their decayed, missing and filled teeth (DMFT) index, body weight and height were also recorded. A generalised linear mixed model was used to examine the differences in food preferences between experimental conditions, and the associations between children's preferences and the other factors assessed.

RESULTS

Exposure to food advertisements significantly decreased the selection of healthy foods. Children with a higher DMFT index chose a higher percentage of unhealthy foods, and children who spent more time watching television chose an increased number of healthy foods, after their exposure to food advertisements. Regardless of condition, girls selected fewer foods than boys. Children with a higher DMFT index selected more unhealthy foods than children with a lower DMFT index. Obese children chose an increased number of healthy foods than those who were overweight and normal weight.

CONCLUSIONS

Food advertisements can divert, for a short time, children's preference over healthy food choices, and could lead to changes in their eating habits, which may put them at higher risk of dental diseases and obesity.

Food advertising, children's food choices and obesity: interplay of cognitive defences and product evaluation: an experimental study

OBJECTIVES

To investigate the role of product evaluations, nutritional and persuasion knowledge on children's food choices conducted because of limited evidence about the role of product evaluations on consumer choices in conjunction with cognitive defences.

DESIGN

A randomised controlled 2 × 2 factorial experiment with an exposure to a food and a control (toy) advertisement conducted in a non-laboratory setting at an annual event traditionally visited by families.

SUBJECTS

Children aged 7-13 years with biometric/weight data representative of the general Australian population.

MEASUREMENTS

Height and weight (converted into body mass index z-scores) measured in addition to children's nutritional and persuasion knowledge, product evaluations, age and gender.

RESULTS

The factors that undermine children's cognitive defences relate to taste, social appeal of foods and low nutritional and persuasion knowledge. An interplay between the above-mentioned factors was also observed, identifying four groups among young consumers, alluding to a complex and at times impulsive nature of children's decisions: (1) knowledgeable children with less positive product evaluations choosing a healthy snack; (2) knowledgeable but hedonism-oriented children seeking peer conformity choosing an advertised product; (3) knowledgeable children who chose a snack belonging to the same product category; and (4) less knowledgeable children with positive product evaluations and low nutritional knowledge choosing snacks from the advertised product category. Obese children were more likely to belong to a cluster of less knowledgeable and hedonism-oriented children.

CONCLUSIONS

The problem of consumption of less healthy foods is complex and multiple factors need to be considered by health practitioners, social marketers and parents to address the issue of childhood obesity. Nutritional knowledge alone is not sufficient to ensure children make healthier food choices and emphasis should also be placed on persuasion knowledge education, targeting of peer norms, self-efficacy and stricter regulation of advertising aimed at children.

Laboratory Determined Sugar Content and Composition of Commercial Infant Formulas, Baby Foods and Common Grocery Items Targeted to Children

Excess added sugar consumption is tied to poor health outcomes in children. The sugar content of beverages and foods children are exposed to is mostly unknown, yet this information is imperative for understanding potential risks from overconsumption of sugars in early life. We determined actual sugar content by conducting a blinded laboratory analysis in infant formulas, breakfast cereals, packaged baked goods and yogurts. One hundred samples were sent to an independent laboratory for analysis via gas chromatography. Sugar content and composition was determined and total sugar was compared against nutrition labels. Of the 100 samples analyzed, 74% contained ≥20% of total calories per serving from added sugars. Nutrient label data underestimated or overestimated actual sugars and ~25% of all samples had actual total sugar values that were either <10% or >10% of labeled total sugar. Many products that are frequently marketed to and consumed by infants and young children contain sugars in amounts that differ from nutrition labels and often in excess of recommended daily levels. These findings provide further support for adding more comprehensive sugar labeling to food and beverage products, specifically those marketed to, or commonly consumed by, children.

Sodium and sugar in complementary infant and toddler foods sold in the United States

OBJECTIVES

To evaluate the sodium and sugar content of US commercial infant and toddler foods.

METHODS

We used a 2012 nutrient database of 1074 US infant and toddler foods and drinks developed from a commercial database, manufacturer Web sites, and major grocery stores. Products were categorized on the basis of their main ingredients and the US Food and Drug Administration's reference amounts customarily consumed per eating occasion (RACC). Sodium and sugar contents and presence of added sugars were determined.

RESULTS

All but 2 of the 657 infant vegetables, dinners, fruits, dry cereals, and ready-to-serve mixed grains and fruits were low sodium (≤140 mg/RACC). The majority of these foods did not contain added sugars; however, 41 of 79 infant mixed grains and fruits contained ≥1 added sugar, and 35 also contained >35% calories from sugar. Seventy-two percent of 72 toddler dinners were high in sodium content (>210 mg/RACC). Toddler dinners contained an average of 2295 mg of sodium per 1000 kcal (sodium 212 mg/100 g). Savory infant/toddler snacks (n = 34) contained an average of sodium 1382 mg/1000 kcal (sodium 486 mg/100 g); 1 was high sodium. Thirty-two percent of toddler dinners and the majority of toddler cereal bars/breakfast pastries, fruit, and infant/toddler snacks, desserts, and juices contained ≥1 added sugar.

CONCLUSIONS

Commercial toddler foods and infant or toddler snacks, desserts, and juice drinks are of potential concern due to sodium or sugar content. Pediatricians should advise parents to look carefully at labels when selecting commercial toddler foods and to limit salty snacks, sweet desserts, and juice drinks.

Influence of food companies' brand mascots and entertainment companies' cartoon media characters on children's diet and health: a systematic review and research needs

Reducing the extent and persuasive power of marketing unhealthy foods to children worldwide are important obesity prevention goals. Research is limited to understand how brand mascots and cartoon media characters influence children's diet. We conducted a systematic review of five electronic databases (2000-2014) to identify experimental studies that measured how food companies' mascots and entertainment companies' media characters influence up to 12 diet-related cognitive, behavioural and health outcomes for children under 12 years. Eleven studies met the inclusion criteria. Studies used 21 unique popular media characters, but no brand mascots. Results suggest that cartoon media character branding can positively increase children's fruit or vegetable intake compared with no character branding. However, familiar media character branding is a more powerful influence on children's food preferences, choices and intake, especially for energy-dense and nutrient-poor foods (e.g. cookies, candy or chocolate) compared with fruits or vegetables. Future research should use a theoretically grounded conceptual model and larger and more diverse samples across settings to produce stronger findings for mediating and moderating factors. Future research can be used to inform the deliberations of policymakers, practitioners and advocates regarding how media character marketing should be used to support healthy food environments for children.

Perception of fattening foods in Italian children and adolescents

The present study aimed to analyze, in Italian children and adolescents, the beliefs about which foods are fattening, the appreciation of fattening foods, and the perception of some socio-cultural attributes of them. 244 children (F: 125, M: 119, aged 8-11) and 305 adolescents (F: 153; M: 152, aged 11-14) from Bologna, Northern Italy, were asked to indicate five fattening foods. For each of the indicated foods, a yes-no answer was required to the question: "is this food special for you?", and to six questions concerning socio-cultural attributes of the food, which were modelled using a latent variable with two classes named "traditional" and "modern". Pearson's chi square tests revealed, both in boys and girls, significant associations between the age class and the foods indicated as fattening: lean meat, condiments, non-sweet fruit and vegetables were more often indicated as fattening by children than by adolescents. Overall, boys showed higher appreciation and perception of fashionability of fattening foods. Girls appreciated less bread and pasta, and indicated more often than boys these foods as fattening. The different food perception of between age classes and sexes can be respectively explained by a better dietary awareness of adolescents, and by girls worrying about their look more than boys.

Associations between weight status and liking scores for sweet, salt and fat according to the gender in adults (The Nutrinet-Santé study)

BACKGROUND/OBJECTIVES

As taste preferences may be associated with obesity, the present study investigated whether obese subjects presented heightened liking for the sensations of sweet, salt and fat.

SUBJECTS/METHODS

Liking scores were determined by a questionnaire including 83 items on liking for sweet or fatty foods, and the preferred extent of seasoning with salt, sweet or fat. Data from 46909 adults included in the French web-based observational cohort of the Nutrinet-Santé study were collected and weighted according to the national population census. Relationships between liking scores and body mass index (BMI) as categorical or linear explanatory variable were assessed separately by gender using covariance and linear regression analyses, adjusted for age, education level, living area, smoking and alcohol.

RESULTS

Overall liking scores for salt and fat were linearly positively linked to BMI in men and women (P≤0.001) and were higher in obese than in normal-weight individuals. The score difference between BMI categories was greater in women for fat liking only. For sweet liking, results differed between gender and compounding factors. Liking for added sugar and sweet foods was positively linked to BMI in women unlike in men; liking for natural sweetness was negatively linked to BMI in both genders.

CONCLUSIONS

This study demonstrates that the relationship between liking and BMI differs according to the gender in its magnitude for fat and in its nature for sweet, unlike that for salt. Liking for sweet and fat may be linked to overconsumption of the corresponding foods, especially in women. This warrants further investigation.

Children's knowledge of packaged and fast food brands and their BMI. Why the relationship matters for policy makers

Studies regarding the advancing challenges of obesity in many countries are beginning to converge on the importance of early food exposure and consumption patterns. Across two studies (Study 1, 34 boys, 35 girls; Study 2, 40 boys, 35 girls, ages 3-6), child knowledge of brands offering products high in sugar, salt and fat was shown to be a significant predictor of child BMI, even after controlling for their age and gender and when also considering the extent of their TV viewing. Additionally, two different collage measures of brand knowledge (utilized across the two studies) performed similarly, suggesting that this measure may be serving as a surrogate indicator of an overall pattern of product exposure and consumption. Policy implications are discussed.

Young children's food brand knowledge. Early development and associations with television viewing and parent's diet

Brand knowledge is a prerequisite of children's requests and choices for branded foods. We explored the development of young children's brand knowledge of foods highly advertised on television - both healthy and less healthy. Participants were 172 children aged 3-5 years in diverse socio-economic settings, from two jurisdictions on the island of Ireland with different regulatory environments. Results indicated that food brand knowledge (i) did not differ across jurisdictions; (ii) increased significantly between 3 and 4 years; and (iii) children had significantly greater knowledge of unhealthy food brands, compared with similarly advertised healthy brands. In addition, (iv) children's healthy food brand knowledge was not related to their television viewing, their mother's education, or parent or child eating. However, (v) unhealthy brand knowledge was significantly related to all these factors, although only parent eating and children's age were independent predictors. Findings indicate that effects of food marketing for unhealthy foods take place through routes other than television advertising alone, and are present before pre-schoolers develop the concept of healthy eating. Implications are that marketing restrictions of unhealthy foods should extend beyond television advertising; and that family-focused obesity prevention programmes should begin before children are 3 years of age.

Perceptions and choices of Brazilian children as consumers of food products

In order to identify children's perceptions about food choices and their behavior as consumers and influencers of food purchases, 16 focus groups were conducted with 71 students aged 8-10 years. Transcriptions were submitted to lexical analysis using the Alceste software. The initial contextual unit broke down into 1469 elementary contextual units, 84% of which were retained in the descending hierarchical classification. Results from the larger and more specific classes are reported here. Children were students from public schools where energy-dense nutrient-poor (EDNP) food consumption was severely restricted, but these foods were still bought by the children themselves or requested from their parents. Television shows and advertisements motivated food consumption in general, and consumption of EDNP foods was associated with social events and eating outside the home. Situations that emphasize the pleasure and satisfaction of not eating according to food guidelines are being addressed by traditional educational strategies directed at the individual. Appealing to the senses and employing visual stimuli to get to the affective component of children's attitudes seems to be an alternative tool for promoting healthy eating, instead of the traditional approach based on recommendations and restrictions.

A survey of the reformulation of Australian child-oriented food products

BACKGROUND

Childhood obesity is one of the most pressing public health challenges of the 21st century. Reformulating commonly eaten food products is a key emerging strategy to improve the food supply and help address rising rates of obesity and chronic disease. This study aimed to monitor reformulation of Australian child-oriented food products (products marketed specifically to children) from 2009-2011.

METHODS

In 2009, all child-oriented food products in a large supermarket in metropolitan Adelaide were identified. These baseline products were followed up in 2011 to identify products still available for sale. Nutrient content data were collected from Nutrient Information Panels in 2009 and 2011. Absolute and percentage change in nutrient content were calculated for energy, total fat, saturated fat, sugars, sodium and fibre. Data were descriptively analysed to examine reformulation in individual products, in key nutrients, within product categories and across all products. Two methods were used to assess the extent of reformulation; the first involved assessing percentage change in single nutrients over time, while the second involved a set of nutrient criteria to assess changes in overall healthiness of products over time.

RESULTS

Of 120 products, 40 remained unchanged in nutrient composition from 2009-2011 and 80 underwent change. The proportions of positively and negatively reformulated products were similar for most nutrients surveyed, with the exception of sodium. Eighteen products (15%) were simultaneously positively and negatively reformulated for different nutrients. Using percentage change in nutrient content to assess extent of reformulation, nearly half (n = 53) of all products were at least moderately reformulated and just over one third (n = 42) were substantially reformulated. The nutrient criteria method revealed 5 products (6%) that were positively reformulated and none that had undergone negative reformulation.

CONCLUSION

Positive and negative reformulation was observed to a similar extent within the sample indicating little overall improvement in healthiness of the child-oriented food supply from 2009-2011. In the absence of agreed reformulation standards, the extent of reformulation was assessed against criteria developed specifically for this project. While arbitrary in nature, these criteria were based on reasonable assessment of the meaningfulness of reformulation and change in nutrient composition. As well as highlighting nutrient composition changes in a number of food products directed to children, this study emphasises the need to develop comprehensive, targeted and standardised reformulation benchmarks to assess the extent of reformulation occurring in the food supply.

Is carbohydrate intake in the first years of life related to future risk of NCDs?

Studies on children's carbohydrate intake, especially fibre intake, and its associations with later health are rare. The current recommendations for fibre intake in children are based on average assumptions and data extrapolated from intakes in adults. Generally, increase in whole-grain consumption and decrease in sucrose intake are considered healthy. Due to fibre's high bulk volume however, excessive dietary fibre has been feared to decrease energy density have effects on growth, at least in developing countries and in children consuming very restricted diets. Furthermore, it has been speculated that if fats are reduced from the diet, it may become high in sucrose. In STRIP study, which is a long-term, randomized controlled trial designed to decrease the exposure of children to known risk factors of atherosclerosis, carbohydrate intakes have been investigated in detail in children aged 13 months to 9 years. The intervention was successful in decreasing saturated fat intake and cholesterol concentrations throughout childhood and adolescence. The study results also show that a higher than average fibre intake does not displace energy or disturb growth in children and that children with high fibre intake have better dietary quality than those with low fibre intake. Dietary fibre intake associated with lower serum total cholesterol concentrations whereas increases in total carbohydrate, sucrose and fructose intakes associated with increases in serum triglyceride concentrations. In conclusion, from the point of view of CHD risk factor prevention, efforts aiming at increasing the fibre intake while restricting that of refined sugar seem justified in the child population in developed countries.

CLINICAL TRIAL REGISTRATION INFORMATION

NCT00223600.

Can schools save kids' palates? Cooking from scratch in schools--the greatest food service challenge of our time

School District Food Service Departments are faced with the enormous task of feeding children in the United States up to two thirds of the meals that they consume during the week at school. The shift in food production since the 1970s produced a trend away from scratch-cooked foods and resulted in more meals created from processed foods. The United States has reached a tipping point where the health of the current generation is compromised by increasing health risks of diet-related disease. Schools have been identified as a critical environment in which there is an opportunity to effect change in what children eat. As a result, in the last 10 years, there has been a resurgence of interest in freshly prepared meals in schools. This article explores one chef’s transition from the private sector to the public sector and the experiences of working with school districts to successfully transform their school food service operations into a scratch cooking model.

Contingent choice. Exploring the relationship between sweetened beverages and vegetable consumption

Adults and children are repeatedly exposed to the pairing of food and drink as found in meal deals and "combos". There may arise from this indoctrination, a contingent relationship between drink context and food preference. Our multi-method research examines food and drink combining. A survey-based study examines the food and drink pairing preferences of adults (N=60), while a laboratory study with young children (N=75, aged three to five) examines the role of drink context on vegetable consumption. The adult survey finds strong food and drink combining preferences. The pairing of soft drinks with calorie dense foods is regarded favorably, while the pairing of soft drinks with vegetables is not. In child food trials, vegetable consumption is not influenced by the child's fussiness but is influenced by the drink accompaniment. In limited contexts, these findings demonstrate the contingent relationship between drink context and food consumption. Both palate preference and associative learning may be mechanisms driving the effects of drink context on food consumption. The findings suggest simple consumer strategies that might be employed to change dietary patterns (e.g., drink water with meals), and hold straightforward policy implications (e.g., increase water as the default option in meal deals).