Diet quality is related to eating competence in cross-sectional sample of low-income females surveyed in Pennsylvania

A systematic review of observational studies exploring the relationship between health and non-weight-centric eating behaviours

Eating behaviour that does not centralise weight, otherwise known as weight-neutral, is associated with improved physical and psychological health, and greater health promoting behaviours. However, consolidated evidence is lacking. This study aimed to systematically evaluate 'health-centric' eating behaviour reflective of weight-neutral approaches, and their relationship with health (physical and mental) and health promoting behaviours. A systematic search was performed, identifying observational studies with adult populations, ≥1 physical/mental health outcome(s), and ≥1 validated measure(s) of health-centric eating behaviour. Study design, sample characteristics and outcomes were extracted and characterised into four domains. Our search identified 8281 records, with 86 studies, 75 unique datasets, and 78 unique exposures including 94,710 individuals. Eating behaviours included intuitive eating (n = 48), mindful eating (n = 19), and eating competence (n = 11). There were 298 outcomes identified for body composition, size, and physical health (n = 116), mental health and wellbeing (n = 123), health promoting behaviours (n = 51) and other eating behaviour (n = 8). Higher levels of intuitive eating, mindful eating and eating competence were significantly related to a lower BMI, better diet quality and greater physical activity. Higher intuitive and mindful eating were significantly related to lower levels of disordered eating, and depressive symptoms, and greater body image, self-compassion, and mindfulness. Greater eating competence and intuitive eating were significantly related to higher fruit and vegetable intake, and greater eating competence to higher fibre intake and better sleep quality. Our results demonstrate that 'health-centric' eating behaviours are related to a range of favourable health outcomes and engagement in health promoting behaviours. These findings help to enhance our understanding of eating behaviours that do not centre around body weight, providing support for health-centric eating behaviour in healthcare. Future research should focus on intervention studies and more diverse population groups.

Examination of eating competence in a geo-diverse sample with metabolic syndrome

Eating competence (EatC) is an intra-individual approach to eating attitudes and behaviors associated with greater well-being. EatC research has not included persons with confirmed metabolic syndrome (MetS). Therefore, EatC of persons with MetS was explored to identify unique associations and inform implementation of MetS lifestyle interventions using baseline data from a multisite, randomized trial of a 2-year lifestyle intervention with MetS. EatC, measured with the Satter Eating Competence Inventory 2.0 (ecSI 2.0™), was examined for relationships with bioclinical measures (e.g., blood pressure, lipids), medication use, BMI, waist circumference, fruit/vegetable intake, and psychosocial factors, (e.g., stress, mindfulness). Data were collected in person and video call by trained research personnel. EatC was examined as a continuous score and as a categorical variable with ecSI 2.0™ scores ≥ 32 considered eating competent. Participants (n = 618) were predominantly female (76%), White (74%), college educated (60%). Mean age was 55.5 ± 11 y. Mean ecSI 2.0™ was 29.9 ± 7.4 and 42% were eating competent. EatC was greater for males, persons who were older and food secure. Competent eaters (vs. non-eating competent) had lower waist circumference (112.7 ± 12.5 cm vs.116.8 ± 16.0 cm; P < 0.001) and BMI (35.0 ± 6.1 vs. 37.5 ± 7.3; P < 0.001). Serum triglycerides, HDL-cholesterol, fasting blood glucose, HbA1c, and blood pressure did not differ by EatC status. Compared to non-eating competent persons, competent eaters perceived less stress, were more mindful, indicated better physical function, and more habitual vegetable intake (all P < 0.001) and sensory awareness (P < 0.05). EatC in MetS paralleled the non-MetS profile. EatC was associated with a healthier psychosocial profile, waist circumference and BMI. Findings support further research to examine the mediational or moderating influence of EatC in the treatment of MetS.

Validation of the French-Canadian Translation of the ecSatter Inventory 2.0 in an Adult Sample

OBJECTIVE

Evaluate the psychometric proprieties of the French-Canadian translation of the Satter Eating Competence Inventory (FrCanada ecSI 2.0).

DESIGN

Cross-sectional validation study.

PARTICIPANTS AND SETTING

424 French-Canadian adult Facebook users (61.8% women, 96.0% White).

VARIABLES MEASURED

Eating competence and variables related to eating or body image.

ANALYSIS

Factor analyses to assess the structural validity. Cronbach α and intraclass correlation coefficient to estimate reliability. Chi-square test of independence, Student t test, and Pearson's correlations to assess construct validity.

RESULTS

The mean eating competence score was 33.0 ± 7.8; 62.0% of participants were considered competent eaters (total score ≥ 32/48). The original 4-factor structure was not reproduced (unsatisfactory fit indices and/or factor loadings). Therefore, it is recommended to use the global score-but not the subscale scores-of the FrCanada ecSI 2.0. The questionnaire showed good internal consistency (Cronbach α = 0.86) and test-retest reliability (intraclass correlation = 0.81). Competent and noncompetent eaters differed according to gender (39.5% vs 27.3% male; P = 0.03), age (49.3 ± 13.6 vs 42.7 ± 14.2 years; P < 0.01), education (62.3% vs 50.6% with a university degree; P = 0.03), intuitive eating (3.6 ± 0.5 vs 3.1 ± 0.6; P < 0.001), cognitive restraint (12.3 ± 3.3 vs 13.8 ± 3.7; P < 0.001), and body esteem (3.3 ± 0.8 vs 2.5 ± 0.8; P < 0.001).

CONCLUSION AND IMPLICATIONS

Results suggest that the FrCanada ecSI 2.0 is a valid and reliable tool to measure eating competence in French-Canadian adults.

Division of Responsibility in Child Feeding and Eating Competence: A Cross-Sectional Study in a Sample of Caregivers of Brazilian Children with Celiac Disease

The objective of this cross-sectional study was to assess eating competence (EC) and the adherence to the division of responsibility in child feeding (sDOR) of Brazilian caregivers of children with celiac disease (CD). It also examined the association between EC and sDOR, children's adherence to a gluten-free diet, and sociodemographic data. This study administered a survey set that included sociodemographic data, health-related data, eating habits, and the instruments ecSI2.0TMBR and sDOR.2-6yTM BR, validated for a Brazilian population. The sample comprised 50 caregivers of children with CD (between 24 and 72 months of age). The participants following a gluten-free diet (GFD) presented higher scores for all EC domains and the total EC. The total EC scores were higher for the participants over 40 y/o, frequently having meals as a family, with their children consuming more than three servings of fruit and at least one serving of vegetables daily and complying with a GFD. Different from the EC, the sDOR.2-6yTM scores did not differ between the participants complying with a GFD. The sDOR.2-6yTM mealtime structure domain scores were significantly associated with the EC eating attitude, food acceptance, contextual skills, and total. These findings support the need for greater attention to exploring the division of responsibility in feeding and EC in pediatric celiac disease, potentially enhancing intervention strategies for patients and their families.

Eating competence in caregivers of celiac children: A cross-sectional study performed in Brazil

OBJECTIVES

Eating competence is an intraindividual approach to eating, behaviors, and attitudes related to eating, with repercussions on the individual and family. In pediatric celiac disease, the family is involved in the gluten-free diet management, the only treatment available. A gluten-free diet might affect eating competence because gluten-free diet compliance requires knowledge about food, meal planning, and attention to food choices. The objective is to access eating competence in caregivers of children with celiac disease and the association between caregivers' eating competence, children's adherence to a gluten-free diet, and sociodemographic data of participants.

METHODS

This cross-sectional study used a snowball spread method by applying a questionnaire, including sociodemographic data, data related to health, eating habits, and the Satter Eating Competence Inventory version validated for the Brazilian population. The sample consisted of 220 Brazilian parents or caregivers of celiac disease children. The scores of the Satter Eating Competence Inventory version validated for the Brazilian population were described in terms of means, SDs, medians, and interquartile range. Student's t test and analysis of variance followed by Tukey's post hoc tests were applied, and the association with the variables of interest was analyzed using Pearson χ2 tests. The tests were conducted considering bilateral hypotheses and a 5% significance level.

RESULTS

Participants' sex, schooling level, and income did not affect their eating competence. Competent eaters were mostly those with normal weight, following a gluten-free diet, with children complying with a gluten-free diet, and who have meals with family and prepare them at home. Different from vegetable consumption, participants' eating competence did not differ considering the frequency of children's fruit consumption.

CONCLUSIONS

The caregivers of children with celiac disease have greater eating competence scores than general Brazilian adults, and caregivers of children with celiac disease who comply with the gluten-free diet have higher eating competence scores.

Disordered eating and eating competence in members of online irritable bowel syndrome support groups

BACKGROUND

This study seeks to evaluate eating competence and disordered eating likelihood among members of online support groups for irritable bowel syndrome (IBS) and determine whether eating competence and disordered eating likelihood varies according to IBS symptom severity and subtype.

METHODS

This cross-sectional study is based on an anonymous survey conducted from August to September 2021. Adults with IBS (N = 225) were recruited from online and social media IBS support forums. IBS symptom severity was assessed using the validated IBS Severity Scoring System (IBS-SSS), likelihood of disordered eating was assessed using the validated Eating Attitudes Test (EAT-26), and eating competence was assessed using the validated Satter Eating Competence Inventory (ecSI 2.0™). Multiple linear regression was used to predict EAT-26 total score from IBS-SSS score, age, and IBS subtype. ANOVAs were used to examine the relationships between IBS severity level, IBS subtype, and ecSI 2.0™ total score.

KEY RESULTS

Eating competence among the sample was low at 17% while 27% was classified as likely or very likely disordered eating. IBS severity was positively associated with EAT-26 score (p = 0.011) and ecSI 2.0™ score was significantly lower in the severe IBS group compared to the moderate IBS group (p = 0.016). No relationship was detected between IBS subtype and EAT-26 or ecSI 2.0™ scores.

CONCLUSIONS & INFERENCES

IBS severity was positively associated with disordered eating likelihood and negatively associated with eating competence. This sheds light on the importance of assessing eating competence and screening for disordered eating prior to selecting therapies for patients with IBS, particularly in females with severe symptoms.

Are Emotional Eating and Other Eating Behaviors the Missing Link in the Relationship between Inadequate Sleep and Obesity? A Systematic Review

Evidence is emerging to explain that the relationship between inadequate sleep and obesity could be influenced by emotional eating and other eating behaviors such as disinhibition. Therefore, our aim was to conduct a systematic review to analyze the potential role of emotional eating and other eating behaviors in the relationship between inadequate sleep and obesity. We conducted a comprehensive search on 2 databases (Medline and Scopus) looking for records from 1 January 2011 until 31 December 2022 without language restrictions. Cross-sectional, longitudinal, and interventional studies were included if they assessed the association between sleep and emotional eating, as well as the role of emotional eating on the relationship between inadequate sleep and obesity. Secondary outcomes included studies analyzing the link between sleep and other eating behaviors as well as their role in the sleep-obesity relationship. Our results showed that emotional eating and disinhibition play a significant role in the relationship between inadequate sleep and obesity, especially in women. Furthermore, we provide evidence of other eating behaviors (e.g., external eating, eating competence, and hunger), which are also associated with poor sleep outcomes. However, these behaviors do not seem to be determinants of the association between sleep and obesity. In conclusion, our results suggest that individuals with inadequate sleep who are prone to emotional eating and/or disinhibition may require tailored approaches for obesity prevention and treatment.

Eating Competence among Brazilian College Students

Eating competence (EC) is a biopsychosocial concept related to a healthier eating pattern. Studies have shown that weight gain and body shape and weight dissatisfaction are typical among college students, contributing to low self-esteem, risky eating behaviors, and a propensity to develop eating disorders. As eating habits are determinant factors for food choices that can be modified by eating behavior, this study aimed to evaluate EC in college students from Brazil, using the Brazilian version of the EC Satter Inventory (ecSI2.0™BR), and EC's association with health data. This cross-sectional study was conducted using an online survey spread using the snowball method. The self-report instrument was divided into three parts (socioeconomic and demographic data; health data; and ecSI2.0™BR). Recruitment took place through social networks, and 593 students from public and private universities from all five regions of Brazil participated in the survey. The EC average was 29.46 ± 8.67, and 46.2% of the sample were considered competent eaters. Total EC did not differ among gender and Brazilian region. Younger participants (up to 20 y/o) presented higher scores for total EC, contextual skills and food acceptance. The total EC and contextual skills of health sciences students did not differ from those of students in other areas, except for agricultural sciences in which students had lower total EC. Obese individuals and the participants who perceived themselves to be overweight had low scores for EC. This study confirmed the hypothesis that college students have low EC, causing worse health outcomes related to BMI, perceived body weight, and occurrence of hypertension and dyslipidemia.

The Positive Eating Scale: Associations with eating behavior, food choice, and body mass index

To further investigate the effects of positive eating on health, the present study focused on associations of the Positive Eating Scale (PES, the Pleasure when Eating and Satisfaction with Eating subscales) with eating behaviors, food intake, and body mass index (BMI) in a large sample of the general Swiss population. Participants (T1: n = 2795, 46.7 % men; T2: n = 1931, 46.5 % men) with a mean age of 60 (SD = 16) years at T1 (2019) and 62 (SD = 15) years at T2 (2021) completed the Swiss Food Panel 2.0 paper-and-pencil questionnaire which included the PES, eating behaviors, food intake, and BMI. The results showed that both restrained and reward eating in response to positive emotions were mostly negatively correlated with the PES subscales for men and women, whereas intuitive eating, diet-related health consciousness, and perceived health status were positively related to the PES subscales. Women tended to choose healthier foods and recorded higher eating satisfaction. BMI was negatively related to the PES subscale Satisfaction with Eating (β = -0.17) and positively related to the subscale Pleasure when Eating (β = 0.08) despite rather small correlations with healthier food choices and better diet quality. No significant effects of the PES subscales on change in BMI were detected over the two-year period. Since the PES subscales showed diverging associations with other eating behavior constructs, a combination into a total score may not be optimal. Overall, positive eating may be associated with more balanced eating habits and better perceived health status.

Everyday discrimination is a stronger predictor of eating competence than food insecurity or perceived stress in college students amidst COVID-19

Stress is a common experience of college students, which has been exacerbated by COVID-19. Perceived stress may help predict students’ eating behaviors. Eating competence is an adaptive model of eating characterized as being flexible, comfortable, and positive with food and eating, and reliable about getting enough nourishing and enjoyable food to eat. Eating competence is associated with numerous health benefits and may be developing and/or disrupted as young adults transition to college. No prior research has explored the associations of everyday discrimination and food insecurity with eating competence, and there is limited research on the eating competence of trans and gender nonconforming (TGNC) college students. This cross-sectional study sought to examine the associations of everyday discrimination, food insecurity, and perceived stress with eating competence in a sample of 1996 undergraduate students. Participants completed an online survey comprised of validated tools assessing socio-demographics, eating competence, everyday discrimination, food insecurity, and perceived stress and stress management. After accounting for covariates (gender, stress management), multivariate regression analyses were conducted, and the coefficients of partial determination revealed that everyday discrimination was the strongest predictor of eating competence. Results demonstrated that lower experience of everyday discrimination, less stress, and being food secure were associated with greater likelihood of being eating competent (EC). Men were more likely to be EC than women or TGNC identities. Since the experience of everyday discrimination was the strongest, inverse predictor of eating competence, addressing discrimination must be considered in future efforts to improve eating competence.

Eating Competence Among Caregivers of Toddlers: Associations With Caregiver and Child Overweight/Obesity

OBJECTIVE

To examine the association between caregiver eating competence and child overweight/obesity and caregiver obesity.

DESIGN

Longitudinal cohort.

SETTING

A large US children's hospital.

PARTICIPANTS

Caregiver-child dyads (n = 288 with complete data at 2 time points) were sampled in 2017-2019 from those who received care at Nationwide Children's Hospital.

MAIN OUTCOME MEASURE(S)

Child overweight/obesity at 24 months of age (body mass index [BMI]) z-score >2 per World Health Organization standards and caregiver weight status (underweight/healthy [BMI < 25 kg/m2], overweight [BMI ≥ 25 and < 30 kg/m2], or obese [BMI ≥ 30 kg/m2]).

ANALYSIS

Log-binomial models examined the relationship between caregiver eating competence (ecSatter Inventory) at 18 months and child overweight/obesity at 24 months of age. Proportional odds models investigated the relationship between caregivers' eating competence and weight status.

RESULTS

Eating competent caregivers had more than twice the odds (odds ratio, 2.11; 95% confidence interval, 1.30-3.42) of having a lower BMI category and had lower average BMI than noneating competent caregivers. Child overweight/obesity at 24 months did not differ by caregiver eating competence.

CONCLUSIONS AND IMPLICATIONS

Although child overweight/obesity did not vary by caregiver eating competence, caregiver eating competence was related to their weight status. Longer-term studies are needed to clarify the role of caregiver eating competence as children develop. Promoting caregivers' eating competence may translate into healthier behaviors and skills for caregivers and their children long term.

Eating Competence and Aspects Related to a Gluten-Free Diet in Brazilian Adults with Gluten-Related Disorders

This cross-sectional study aims to assess eating competence (EC—an intra-individual approach to food, behaviors, and attitudes related to food) and aspects related to a gluten-free diet (GFD) in Brazilian adults with gluten-related disorders (GRDs). The research was conducted using an online survey with a self-reported instrument consisting of 40 items, organized into three parts: (I) Socioeconomic and demographic data; (II) the Brazilian version of the Eating Competence Satter Inventory (ec-SI2.0™BR); and (III) questions about adherence and difficulties in following the gluten-free diet. EC was measured by the ecSI2.0™BR instrument, with scores ≥32 were considered competent eaters. The instrument was applied nationwide through the GoogleForms® platform from 14 February 2022 to 30 March 2022. The publicity for the recruitment was supported by Brazilian celiac local and national associations (Acelbras and Fenacelbra), pages of food services or personal pages of tips and posts about gluten-related disorders, and specialized stores that offer gluten-free foods. The recruitment occurred through social networks (emails, Facebook groups, WhatsApp, and Instagram). A total of 1030 Brazilians with GRDs answered the questionnaire. Most participants were female, aged 40 years or older, with an income >R$3000, and a high education level. The main difficulty regarding adherence to GFD was the high cost of gluten-free foods. Individuals younger than 40 years old had lower EC scores, with no differences between men and women. Increasing socioeconomic status, schooling, and culinary practices increased the total score. Participants who “never/almost never” felt socially judged because their diet had higher scores for total EC. Competent eaters GRD individuals (EC ≥ 32) were mostly individuals aged ≥40 y/o; with income > R$3000; following a GFD; satisfied with purchased gluten-free products; consuming gluten-free products prepared at home, mainly by themselves; who do not feel judged because of the GRD and who feel that they can live a normal life with GRD. Our study showed that individuals who strictly adhere to the GFD have higher scores on eating competence than those who sometimes follow the treatment.

Eating Competence, Food Consumption and Health Outcomes: An Overview

Eating Competence (EC) is one behavioral perspective of eating practices that has been associated with a healthy lifestyle. It emphasizes eating pleasure, self-regulation of eating, body weight satisfaction, and regular meal frequency that includes food variety without focusing on dietary guidelines. EC is composed of four components (Eating Attitude, Food Acceptance, Internal Regulation, and Contextual Skill), and its assessment is performed using the Eating Competence Satter Inventory (ecSI2.0™), developed and validated in English for an adult population. EC has been associated with diet quality and health indicators for various population groups and the development of skills that increase EC might be a strategy to improve nutritional health, and prevent obesity and other chronic diseases. In this sense, this study presents an overview of the background, concepts, features, and possible associations among EC, food consumption, and health outcomes. The high prevalence of diseases associated with food/nutrition draws attention to the necessity to broaden the view on food and its relationship with health and well-being, considering not only nutrients and food combinations but also the behavioral dimensions of eating practices. Healthy nutritional recommendations that take into account attitudes and behaviors are in accordance with the EC behavioral model. Studies on eating behavior emphasize the need to better understand attitudes towards food and eating in the general population using validated instruments. In this context, measuring EC and its association with health outcomes seems to be relevant to nutritional health. The complexity of food choices has been examined in social, behavioral, and biological sciences, representing a great challenge for applying unique and simple theoretical models. Multiple methods are required, as no single theory can fully explain food selection.

Enhanced Eating Competence Is Associated with Improved Diet Quality and Cardiometabolic Profile in Finnish Adults with Increased Risk of Type 2 Diabetes

Eating competence (EC) is characterized by positive attitudes towards food and eating, having regular meals, eating a variety of foods, and internally regulated eating. We investigated the associations of changes in EC with changes in lifestyle, anthropometrics and biomarkers of glucose and lipid metabolism in 2291 adults at increased risk of type 2 diabetes as part of the StopDia study conducted in primary healthcare. EC and diet quality were assessed with validated digital questionnaires. During the intervention, the participants received either (1) the digital lifestyle intervention, (2) the combined digital and face-to-face group-based lifestyle intervention, or (3) standard care. EC increased among the participants independent of the intervention type. Increase in EC was associated with an increase in diet quality, high-density lipoprotein (HDL) cholesterol, and with a decrease in body mass index and waist circumference, regardless of baseline EC. Of the subdomains of EC, the contextual skills, food acceptance and eating attitudes were associated with various of these changes. Our results thus suggest that EC could be a potential target in lifestyle interventions aiming to improve the cardiometabolic health of people at type 2 diabetes risk.

Eating Competence among Brazilian Adults: A Comparison between before and during the COVID-19 Pandemic

The coronavirus pandemic started a worldwide emergency, and tight preventive actions were necessary to protect the population, changing individuals' daily habits. Dwelling and working at home can change dietary habits, affect food choice and access, as well as the practice of physical activity. In this regard, this study's goal was to compare eating competence (EC) among Brazilian adults before and during the coronavirus pandemic, using the Brazilian version of the eating competence Satter inventory (ecSI2.0™BR) with the "retrospective post-then-pre" design. This cross-sectional study was performed from 30 April to 31 May 2021 among a convenience sample of the Brazilian adult population using an online platform (Google® Forms). In the studied sample (n = 302 in which 76.82% were females), EC total score lowered during the pandemic (31.69 ± 8.26 vs. 29.99 ± 9.72; p < 0.005), and the decrease was worst after the beginning of the pandemic among those who reported weight gain, decreased the consumption of fruit and vegetables, and increased the consumption of sugary beverages. The contextual skill component seems relevant in this scenario, where our life and routines were changed entirely, demonstrating that the ability to manage the food context is essential, especially when sanitary and economic situations represent a new challenge.

Children's Fruit and Vegetable Preferences Are Associated with Their Mothers' and Fathers' Preferences

Children’s preference for fruit and vegetables must emerge during childhood. At children’s homes, mothers and fathers influence children’s developing food preferences with their own preferences and actions. The purpose of the study was to reveal the association parents have with their children’s fruit and vegetable preferences. The study was conducted in a sample of Finnish mothers and fathers of 3–5-year-old children. The participants were recruited, and questionnaires distributed through early childhood education and care centers in 2014 and 2015. The results showed considerable variance in the children’s preferences, and were more similar with their father’s, than their mother’s preference. There was an association between mother’s and children’s preference for “strong-tasting vegetables and berries“ (p = 0.005), “sweet-tasting fruit“ (p < 0.001) and “common vegetables“ (p = 0.037). Fathers preferences associated with children’s preferences for “strong-tasting vegetables and berries“ (p = 0.003). Food neophobia decreased children’s “strong-tasting vegetables and berries“ (p < 0.001) and “sweet-tasting fruit“ (p < 0.001) preferences. The father’s more relaxed attitude towards eating decreased children’s preferences for “strong-tasting vegetables and berries“ (p = 0.031) and “sweet-tasting fruit“ (p = 0.003). These findings indicate a need for more targeted strategies for increasing children’s preferences for fruit and vegetables and highlight the importance of taking both parents equally into account.

Eating Competence Associated with Food Consumption and Health Outcomes among Brazilian Adult Population

This study aimed to associate Eating Competence (EC) with food consumption and health outcomes in the Brazilian adult population. Researchers developed a questionnaire to associate EC with sociodemographic information, health outcomes, and food consumption. Data on body weight and height was referred to by participants in the questionnaire, and body mass index (BMI) was calculated and classified. A question to evaluate the perception of body size was included. After constructing the questionnaire items, content validation and semantic evaluation were performed following the Delphi method with a group of judges composed of 26 health professionals. The judges evaluated the sociodemographic information, health outcomes, and food consumption items associated with the eating competence instrument (previously validated in Brazilian-Portuguese). The final version of the questionnaire was composed of 33 items. Our results confirmed good reliability, responsiveness, and internal consistency. A total of 1810 Brazilians answered the questionnaire. Most of the participants were female, up to 40 years old, with a high education level and high income. Most of the participants did not report diabetes or hypertension. The EC total score did not differ among males and females. Individuals up to 40 years old presented a lower total score. The increase in educational level and income also increased EC total score. Excess weight individuals showed lower EC compared to the normal weight/underweight. Individuals who consumed fruits and/or vegetables five or more days/week presented the best scores for total EC.

Internally regulated eating style: a comprehensive theoretical framework

Internally regulated eating style, the eating style that is driven by internal bodily sensations of hunger and satiation, is a concept that has received increasing attention in the literature and health practice over the last decades. The various attempts that have been made so far to conceptualise internally regulated eating have taken place independently of one another, and each sheds light on only parts of the total picture of what defines internally regulated eating. This has resulted in a literature that is rather fragmented. More importantly, it is not yet clear which are the characteristics that comprise this eating style. In this paper, we identify and describe the full spectrum of these characteristics, namely, sensitivity to internal hunger and satiation signals, self-efficacy in using internal hunger and satiation signals, self-trusting attitude for the regulation of eating, relaxed relationship with food and tendency to savour the food while eating. With this research, we introduce a common language to the field and we present a new theoretical framework that does justice not just to the full breadth of characteristics that are necessary for the internally regulated eating style but also to the associations between them and the potential mechanisms by which they contribute to this eating style.

Eating Competence among a Select Sample of Brazilian Adults: Translation and Reproducibility Analyses of the Satter Eating Competence Inventory

This study aimed to translate and validate the Satter Eating Competence Inventory (ecSI2.0^TM) from English to Brazilian Portuguese. The process included three steps: (i) translation and back-translation of the original ecSI2.0^TM to Brazilian Portuguese; (ii) evaluation of its reproducibility; (iii) a pilot study to validate the Brazilian version of the Satter Eating Competence Inventory (ecSI2.0^TMBR) for a selected sample of the Brazilian adult population (internal consistency and factor validity). The reproducibility (test–retest reliability) was verified using the intraclass correlation coefficient (ICC) obtained by the responses of 32 Brazilian adults. All domains of the ecSI2.0^TMBR and the total score showed ICC > 0.8. Considering the entire questionnaire, none of the domains presented significant divergences among the participants’ responses (p < 0.001). In the pilot study with 662 individuals, 74.9% (n= 496) were female, mean age was 40.33 ± 12.55, and they presented a higher level of schooling and income. Analyses revealed Cronbach’s alpha coefficients of 0.869 for the ecSI2.0^TMBR total scale, 0.793 for Eating Attitudes, 0.527 for Internal Regulation, 0.728 for Food Acceptance, and 0.822 for Contextual Skills. In general, the ecSI2.0™BR presented good acceptability, showing total floor and ceiling effects of ≤0.6%. Factor validity was examined by confirmatory factor analysis. The four domains presented a good fit in the confirmatory factor analysis: RMSEA = 0.0123 (95% CI: 0–0.0266); CFI = 0.998; χ² = 75.9; df = 69; p = 0.266. The ecSI2.0^TMBR is the first tool designed to measure eating competence (EC) in the Brazilian population, showing good reproducibility and internal consistency. We expect the ecSI2.0^TMBR will support innovative research to investigate the association of EC and health outcomes, as well as new strategies based on emerging behavioral theories to enhance nutritional education policy.

Eating Competence Is Associated with Lower Prevalence of Obesity and Better Insulin Sensitivity in Finnish Adults with Increased Risk for Type 2 Diabetes: The StopDia Study

A healthy diet prevents type 2 diabetes but is often difficult to adhere to. This cross-sectional study aimed to investigate whether eating competence is associated with diet or risk factors and prevalence of type 2 diabetes in individuals screened for type 2 diabetes risk. Eating competence is an indicator of food acceptance, positive attitudes, internal regulation and contextual skills related to food and eating. In total, 3147 Finnish adults aged 18-74 at an increased risk for type 2 diabetes identified via online risk screening participated in the baseline examinations of the Stop Diabetes (StopDia) study. The participants filled out the digital questionnaire on food intake, physical activity and sleep, and the Satter Eating Competence Inventory 2.0^TM (ecSI 2.0^TM). In addition, anthropometric and laboratory measurements were performed at primary healthcare centres. Eating competent individuals (37%, classified by ecSI 2.0^TM) had a better quality of diet (p < 0.05 for all). Additionally, eating competence was associated with a lower prevalence of previously undiagnosed type 2 diabetes, abdominal obesity, metabolic syndrome and hypertriglyceridaemia, and with better insulin sensitivity (p < 0.05 for all). However, these associations, except for metabolic syndrome, were at least partly mediated by body mass index. Eating competence is associated with a healthy diet and could, thus, in the long term, support the prevention of type 2 diabetes.

Satter Eating Competence Inventory Subscale Restructure After Confirmatory Factor Analysis

OBJECTIVE

To examine the structural validity of the empirically and theoretically derived Satter Eating Competence Inventory (ecSI 2.0).

METHODS

Confirmatory factor analyses with 3 databases and a merger with 3 additional data sets (n = 2,010) from demographically heterogeneous samples.

RESULTS

Findings supported retaining all 16 items and migration of the item I trust myself to eat enough for me from the Internal Regulation to Eating Attitudes subscales, providing 4 distinct but correlated subscales and an adequately fitting model, χ²(98) = 1,364.27, P < .001, comparative fit index = .91, root mean square error of approximation = .07, 95% confidence interval, 0.07-0.08, standardized root mean square residual = .05.

CONCLUSION AND IMPLICATIONS

Psychometric integrity of the 16-item ecSI 2.0 was affirmed. Continued examination is recommended with cultural and linguistically diverse samples and network analyses to identify dynamic interactions among items.

Eating Competent Parents of 4th Grade Youth from a Predominantly Non-Hispanic White Sample Demonstrate More Healthful Eating Behaviors than Non-Eating Competent Parents

The purpose of this study was to determine if the associations between eating competence (EC) and eating behaviors that were found in a USA sample of predominantly Hispanic parents of 4th grade youth could be replicated in a USA sample of predominantly non-Hispanic white parents of 4th graders. Baseline responses from parents (n = 424; 94% white) of youth participating in a year-long educational intervention were collected using an online survey. Validated measures included the Satter Eating Competence Inventory (ecSI 2.0^TM), in-home fruit/vegetable (FV) availability, healthful eating behavior modeling, and FV self-efficacy/outcome expectancies (SE/OE). Data were analyzed with general linear modeling and cluster analyses. The findings replicated those from the primarily Hispanic sample. Of the 408 completing all ecSI 2.0^TM items, 86% were female, 65% had a 4-year degree or higher, and 53% were EC (ecSI 2.0^TM score ≥ 32). Compared with non-EC parents, EC modeled more healthful eating, higher FV SE/OE, and more in-home FV availability. Behaviors clustered into those striving toward more healthful practices (strivers; n = 151) and those achieving them (thrivers; n = 255). Striver ecSI 2.0^TM scores were lower than those of thrivers (29.6 ± 7.8 vs. 33.7 ± 7.6; p < 0.001). More EC parents demonstrated eating behaviors associated with childhood obesity prevention than non-EC parents, encouraging education that fosters parent EC, especially in tandem with youth nutrition education.

Parent Food and Eating Behavior Assessments Predict Targeted Healthy Eating Index Components

OBJECTIVE

To examine the ability of parent response to assessments of in-home availability of 20 fruits and vegetables (FV), self-efficacy/outcome expectancy to prepare FV that their child would eat, modeling of FV eating behavior, and eating competence to predict parents' targeted Healthy Eating Index-2010 (HEI) scores at baseline.

DESIGN

Cross-sectional survey.

SETTING

Sixty-one classrooms in 8 northern Colorado elementary schools over 4 years participating in Fuel for Fun (FFF), a school-based culinary and physical activity intervention.

PARTICIPANTS

Parents and guardians (n = 71) of fourth-grade youths from participating classrooms.

MAIN OUTCOME MEASURE(S)

Healthy Eating Index-2010 scores as derived from 24-hour recalls administered with the Automated Self-Administered 24-hour dietary assessment tool.

ANALYSIS

Generalized linear regression models tested the predictive validity of survey assessments for targeted HEI components. Results were considered statistically significant at P ≤ .05.

RESULTS

In-home FV availability predicted total fruit (P = .01), whole fruit (P = .001), and total vegetable (P = .01) HEI, and parent modeling of FV eating behavior predicted total fruit (P = .01) and whole fruit (P = .02) HEI. However, these survey measures were not associated with other HEI components, including total HEI. Parent self-efficacy/outcome expectancy to prepare FV that their child would eat or like was not associated with total HEI or HEI components. Eating competence did not predict total HEI but was associated with seafood and plant proteins in the anticipated direction (P = .04).

CONCLUSIONS AND IMPLICATIONS

The results demonstrated construct validation of some parent Fuel for Fun survey assessments with targeted HEI components. Additional assessment in larger and more diverse samples is warranted so that nutrition education and behavior researchers may use these valid and reliable, brief, low-cost, and easy-to-use survey instruments as a proxy for dietary intake.

The effects of acceptance and commitment therapy on eating behavior and diet delivered through face-to-face contact and a mobile app: a randomized controlled trial

Background

Internal motivation and good psychological capabilities are important factors in successful eating-related behavior change. Thus, we investigated whether general acceptance and commitment therapy (ACT) affects reported eating behavior and diet quality and whether baseline perceived stress moderates the intervention effects.

Methods

Secondary analysis of unblinded randomized controlled trial in three Finnish cities. Working-aged adults with psychological distress and overweight or obesity in three parallel groups: (1) ACT-based Face-to-face (n = 70; six group sessions led by a psychologist), (2) ACT-based Mobile (n = 78; one group session and mobile app), and (3) Control (n = 71; only the measurements). At baseline, the participants’ (n = 219, 85% females) mean body mass index was 31.3 kg/m² (SD = 2.9), and mean age was 49.5 years (SD = 7.4). The measurements conducted before the 8-week intervention period (baseline), 10 weeks after the baseline (post-intervention), and 36 weeks after the baseline (follow-up) included clinical measurements, questionnaires of eating behavior (IES-1, TFEQ-R18, HTAS, ecSI 2.0, REBS), diet quality (IDQ), alcohol consumption (AUDIT-C), perceived stress (PSS), and 48-h dietary recall. Hierarchical linear modeling (Wald test) was used to analyze the differences in changes between groups.

Results

Group x time interactions showed that the subcomponent of intuitive eating (IES-1), i.e., Eating for physical rather than emotional reasons, increased in both ACT-based groups (p = .019); the subcomponent of TFEQ-R18, i.e., Uncontrolled eating, decreased in the Face-to-face group (p = .020); the subcomponent of health and taste attitudes (HTAS), i.e., Using food as a reward, decreased in the Mobile group (p = .048); and both subcomponent of eating competence (ecSI 2.0), i.e., Food acceptance (p = .048), and two subcomponents of regulation of eating behavior (REBS), i.e., Integrated and Identified regulation (p = .003, p = .023, respectively), increased in the Face-to-face group. Baseline perceived stress did not moderate effects on these particular features of eating behavior from baseline to follow-up. No statistically significant effects were found for dietary measures.

Conclusions

ACT-based interventions, delivered in group sessions or by mobile app, showed beneficial effects on reported eating behavior. Beneficial effects on eating behavior were, however, not accompanied by parallel changes in diet, which suggests that ACT-based interventions should include nutritional counseling if changes in diet are targeted.

Trial registration

ClinicalTrials.gov (NCT01738256), registered 17 August, 2012.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0654-8) contains supplementary material, which is available to authorized users.

Impact of a Weight Management Intervention on Eating Competence: Importance of Measurement Interval in Protocol Design

PURPOSE

To examine changes in eating competence (EC) in 12-month weight loss intervention.

DESIGN

Randomized, parallel-arm with weight loss phase (baseline to month 4) and weight-maintenance phase (months 4-12).

SETTING

Face-to-face in University classrooms, supervised and self-directed fitness sessions at University fitness center, and home.

PARTICIPANTS

Premenopausal, mostly college-educated Pennsylvania women, body mass index >25 (n = 101).

INTERVENTION

Twenty-eight, 1-hour classes tailored for extremes of the Dietary Guidelines' fat recommendations, based on social cognitive theory, problem-based learning delivery over 12 months. Exercise component included supervised and self-directed stretching, aerobics, and strength training.

MEASURES

Anthropometrics, lipid profile, blood pressure, 24-hour dietary recalls, cognitive behavioral measures, Satter Eating Competence Inventory (ecSI).

ANALYSIS

General linear model repeated measures analysis of variance for outcome variables.

RESULTS

A total of 40% (n = 40) completed the ecSI. Overall, education and supervised exercise session attendance were 77% and 88%, respectively. Similar weight loss for lower and moderate fat groups (6.7 kg and 5.4 kg). The EC was unchanged baseline to month 4 but increased significantly from months 4 to 12, baseline to month 12 for both groups. The EC change baseline to month 12 was inversely associated with weight change from baseline to months 4 and 12.

CONCLUSION

Weight management interventions, likely to introduce concerns with eating attitudes, behaviors, and foods, can reduce EC. Short-term measurement of EC change captures these consequent adjustments without opportunity to regain self-efficacy. Extending the measurement interval better reflects intervention impact on EC.

Collection Methods for the 24-Hour Dietary Recall as Used in the Expanded Food and Nutrition Education Program

OBJECTIVE

Identify practices for the collection of the 24-hour dietary recall (24HR) as used by the Expanded Food and Nutrition Education Program (EFNEP) to assess the fidelity with which dietary data are collected.

METHODS

An electronic survey sent nationally to all 75 EFNEP coordinators to assess methodology for collection, staff training, and coding of 24HR.

RESULTS

A total of 67 surveys were returned, 53 of which were usable: 57% of programs used multiple collection periods (previous day vs previous 24 hours), 36% did not use a consistent number of passes in recall collection; only 17% exclusively used the validated 5-pass method; 88% trained paraprofessionals for ≤8 hours on recall collection and >6 different training programs were used; and 86% of programs used multiple coders.

CONCLUSIONS AND IMPLICATIONS

The wide variation in reported collection, training, and coding practices raises concerns about the validity of the recall data and the appropriateness of combining data from multiple programs. To improve consistency, EFNEP could establish standardized methods for training, data collection, and data entry for the 24HR. These results may encourage the national program office to establish programmatic change that will support the fidelity of collection methods across all programs.

Relationships of eating competence, sleep behaviors and quality, and overweight status among college students

Little is known about the relationships between eating competence (intra-individual approach to eating and food-related attitudes and behaviors that entrain positive bio-psychosocial outcomes) and sleep behaviors and quality in college students, a high-risk group for poor eating habits, weight gain, and inadequate sleep. Thus, data from full-time college students (N=1035; 82% White; 61% female) aged 18-24 years from 5 U.S. universities were obtained from online questionnaires (eating competence (ecSI), Pittsburg Sleep Quality Index (PSQI), physical activity, demographics) and physical assessments (measured height, weight), to explore sleep behavior and quality between eating-competent (EC; ecSI score≥32) and non-EC groups (ecSI<32). Generalized linear models controlling for gender, body mass index, and physical activity were utilized. A higher proportion of those in the EC group reported adequate sleep quality (67% vs. 57% in non-EC, p=0.001), sleep duration of ≥7 h nightly (58% vs. 50% in non-EC, p=0.007), and infrequent daytime dysfunction (72% vs. 65% in non-EC, p=0.02). When ecSI scores were grouped as tertiles, those in the highest tertile reported a higher prevalence of no sleep disturbances (7% vs. 2% in the lowest ecSI tertile, p=0.006) and lower prevalence of sleep medication use (10% vs. 15% in the lowest ecSI tertile, p=0.04). Results suggest that competent eaters are more likely to have better overall sleep quality and fewer sleep-related issuescompared to less competent eaters. These findings may inform future longitudinal studies, and health promotion and weight management interventions for young adults.

Middle school-aged child enjoyment of food tastings predicted interest in nutrition education on osteoporosis prevention

BACKGROUND

NEEDs for Bones (NFB), based on the Health Belief Model, is a 4-lesson osteoporosis-prevention curriculum for 11- to 14-year-olds. This study examined the relationship between enjoyment of food tastings and interest in NFB.

METHODS

NFB was administered by teachers as part of standard practice and evaluated after the fourth lesson using a 21-item survey. Significant clustering of students within classrooms required use of random-intercept multilevel ordinal regression models in SAS proc GLIMMIX, with students nested within classrooms. Analyses considered tasting experience, eating attitudes, sex, grade, and cohort.

RESULTS

Students (N = 1619; 50% girls) participated from 85 fourth to eighth grade classrooms (47% sixth grade and 31% seventh grade) in 16 Pennsylvania SNAP-Ed eligible schools over 2 academic years. For all foods tasted, students who did not enjoy the food tasting were less interested in the lesson than students who did enjoy the food tasting (all p < .001); refried beans (odds ratio [OR] = 0.30), soy milk (OR = 0.55), cranapple juice (OR = 0.51), sunflower kernels (OR = 0.48), and Swiss cheese (OR = 0.49). The relationship persisted net of covariates.

CONCLUSIONS

Enjoyment of food tasting activities can predict interest in nutrition education on osteoporosis prevention, supporting resource allocation and inclusion of food tasting activities in school-age nutrition education.

Preliminary Finnish measures of eating competence suggest association with health-promoting eating patterns and related psychobehavioral factors in 10-17 year old adolescents

Eating competence is an attitudinal and behavioral concept, based on The Satter Eating Competence Model. In adults, it has been shown to be associated with a higher quality of diet. Eating competence or its association with the quality of diet has not been studied in adolescents. The aim of the current study was to explore the utility of using a preliminary Finnish translation of the ecSI 2.0 for evaluating presumed eating competence and its association with food selection, meal patterns and related psychobehavioral factors in 10–17 year old adolescents. Altogether 976 10–17 years old Finnish adolescents filled in the study questionnaire. When exploring the construct validity of ecSI 2.0, the confirmatory factor analysis (CFA) indicated acceptable model fit and all four components of the ecSI 2.0 (eating attitudes, food acceptance, internal regulation of food intake, management of eating context) correlated with each other and were internally consistent. Over half (58%) of the adolescents scored 32 or higher and were thus classified as presumably eating competent (pEC). Eating competence was associated with greater meal frequency, more frequent consumption of vegetables and fruits, and more health-promoting family eating patterns. In addition the pEC, adolescents more often perceived their body size as appropriate, had less often tried to lose weight and had a higher self-esteem and a stronger sense of coherence than the not pEC ones. Family eating patterns and self-esteem were the main underlying factors of eating competence. In conclusion, this preliminary study suggests eating competence could be a useful concept to characterize eating patterns and related behaviors and attitudes in adolescents. However, these preliminary findings need to be confirmed in further studies with an instrument fully validated for this age group.

About Eating: an online program with evidence of increased food resource management skills for low-income women

OBJECTIVE

Produce and evaluate About Eating (AE), an online program for low-income women aligned with the Satter eating competence model, congruent with best practices for nutrition education of low-income audiences.

METHODS

Responses from iterative cognitive interviews and online surveys with diverse samples of low-income women informed lesson revisions. The researchers conducted a randomized controlled trial of AE with low-income women to determine its impact on dietary behavior and food security.

RESULTS

In all, 284 women reviewed at least 1 AE lesson and endorsed it. After AE, women (n = 288) increased in use of food resource management skills (eg, using a budget [P = .008] and planning meals to include all food groups [P = .002]). About Eating participants who were food secure had more confidence in managing money for food (P = .002) and keeping track of food-related purchases (P = .02) than food-insecure persons.

CONCLUSIONS AND IMPLICATIONS

Mixed-methods research with life stage and geodiverse samples confirmed the usefulness of AE. Food security assessment may enhance interpretation of intervention effectiveness.

The Satter Eating Competence Inventory for Low-income persons is a valid measure of eating competence for persons of higher socioeconomic position

Eating competence is an important behavioral construct, shown to be associated with healthful lifestyle practices, including dietary quality, weight management, physical activity, and sleep duration. A 16-item instrument to measure eating competence, the Satter Eating Competence Inventory was previously validated in a general sample and subsequently, a 16-item instrument was developed to address specific concerns of low-income persons; 12 items were common to both instruments. The purpose of this study was to determine if the low-income version could be applied to a general audience, simplifying intervention evaluation and facilitating cross-study comparison. Both surveys were fully completed by 127 parents (89% white; 35.8 ± 5.3 y; 86% college graduates; 51% eating competent) of preschool-age children; 96 of whom were not considered low-income. Cognitive interviews with 14 parents of varying eating competence levels clarified and confirmed findings. Scores were highly correlated (r = .98) and only 2 of the 96 were not congruently classified for eating competence. Mean difference between the two versions was .24 ± 1.55. The general audience version explained 95% of the variance in the low-income version score. Findings support the low-income version of the Satter Eating Competence Inventory for general audience use as the Satter Eating Competence Inventory 2.0.

Dietary pattern and its association with the prevalence of obesity, hypertension and other cardiovascular risk factors among Chinese older adults

AIM

This article examined the association between dietary patterns and cardiovascular risk factors in Chinese older adults.

METHODS

For this study, older adults with one or more cardiovascular risk factors or a history of cardiovascular disease were randomly selected using health check medical records from the Changshu and Beijing Fangshan Centers for Disease Control and Prevention. Exploratory factor analysis and cluster analysis was used to extract dietary pattern factors. Log binomial regression analysis was used to analyse the association between dietary patterns and chronic disease related risk factors.

RESULTS

Four factors were found through factor analysis. A high level of internal consistency was obtained, with a high Cronbach's alpha coefficient of 0.83. Cluster analysis identified three dietary patterns: healthy diet, Western diet, and balanced diet. Findings in this sample of Chinese adults correspond to those reported in previous studies, indicating that a Western diet is significantly related to likelihood of having obesity, hypertension and the metabolic syndrome. The identification of distinct dietary patterns among Chinese older adults and the nutritional status of people with chronic diseases suggest that the three dietary patterns have a reasonable level of discriminant validity.

CONCLUSIONS

This study provides evidence that a FFQ is a valid and reliable tool to assess the dietary patterns of individuals with chronic diseases in small- to medium-size urban and rural settings in China. It also validates the significant association between dietary pattern and cardiovascular disease risk factors, including body mass index, blood pressure, triglycerides, and metabolic conditions. Clinical diagnosis of chronic disease further confirmed this relationship in Chinese older adults.

Development of a tool to assess adherence to a model of the division of responsibility in feeding young children: using response mapping to capacitate validation measures

BACKGROUND

Accurate early assessment and targeted intervention with problematic parent/child feeding dynamics is critical for the prevention and treatment of child obesity. The division of responsibility in feeding (sDOR), articulated by the Satter Feeding Dynamics Model (fdSatter), has been demonstrated clinically as an effective approach to reduce child feeding problems, including those leading to obesity. Lack of a tested instrument to examine adherence to fdSatter stimulated initial construction of the Satter Feeding Dynamics Inventory (fdSI). The aim of this project was to refine the item pool to establish translational validity, making the fdSI suitable for advanced psychometric analysis.

METHODS

Cognitive interviews (n = 80) with caregivers of varied socioeconomic strata informed revisions that demonstrated face and content validity. fdSI responses were mapped to interviews using an iterative, multi-phase thematic approach to provide an instrument ready for construct validation.

RESULTS

fdSI development required five interview phases over 32 months: Foundational; Refinement; Transitional; Assurance; and Launching. Each phase was associated with item reduction and revision. Thirteen items were removed from the 38-item Foundational phase and seven were revised in the Refinement phase. Revisions, deletions, and additions prompted by Transitional and Assurance phase interviews resulted in the 15-item Launching phase fdSI. Only one Foundational phase item was carried through all development phases, emphasizing the need to test for item comprehension and interpretation before psychometric analyses.

CONCLUSIONS

Psychometric studies of item pools without encrypted meanings will facilitate progress toward a tool that accurately detects adherence to sDOR. Ability to measure sDOR will facilitate focus on feeding behaviors associated with reduced risk of childhood obesity.

Eat, sleep, work, play: associations of weight status and health-related behaviors among young adult college students

PURPOSE

To examine relationships of sleep, eating, and exercise behaviors; work time pressures; and sociodemographic characteristics by weight status (healthy weight [body mass index or BMI < 25] vs. overweight [BMI ≥ 25]) of young adults.

DESIGN

Cross-sectional.

SETTING

Nine U.S. universities.

SUBJECTS

Enrolled college students (N = 1252; 18-24 years; 80% white; 59% female).

MEASURES

Survey included the Pittsburgh Sleep Quality Index (PSQI), Three-Factor Eating Questionnaire (TFEQ), Satter Eating Competence Inventory (ecSI), National Cancer Institute Fruit/Vegetable Screener, International Physical Activity Questionnaire, Work Time Pressure items, and sociodemographic characteristics.

ANALYSIS

Chi-square and t-tests determined significant bivariate associations of sociodemographics, sleep behaviors, eating behaviors, physical activity behavior, and work time pressures with weight status (i.e., healthy vs. overweight/obese). Statistically significant bivariate associations with weight status were then entered into a multivariate logistic regression model that estimated associations with being overweight/obese.

RESULTS

Sex (female), race (nonwhite), older age, higher Global PSQI score, lower ecSI total score, and higher TFEQ Emotional Eating Scale score were significantly (p < .05) associated with overweight/obesity in bivariate analyses. Multivariate logistic regression analysis showed that sex (female; odds ratio [OR] = 2.05, confidence interval [CI] = 1.54-2.74), older age (OR = 1.35, CI = 1.21-1.50), higher Global PSQI score (OR = 1.07, CI = 1.01-1.13), and lower ecSI score (OR = .96, CI = .94-.98), were significantly (p < .05) associated with overweight/obesity.

CONCLUSION

Findings suggest that obesity prevention interventions for college students should include an education component to emphasize the importance of overall sleep quality and improving eating competence.

Interest in dietary pattern, social capital, and psychological distress: a cross-sectional study in a rural Japanese community

Background

Among life-style factors affecting mental health, dietary habits are becoming a public health concern in their relation to psychological distress and social capital. We examined associations between interest in dietary pattern, social capital, and psychological distress with a population-based cross-sectional study in rural Japan.

Methods

A total of 16,996 residents of a rural town in northern Japan aged 30–79 years participated in this questionnaire survey. The questionnaire gathered data about socio-demographic variables, psychological distress, issues related to dietary habits, including interest in dietary pattern, and the social capital factors of reciprocity and sense of community belonging. Factors related to psychological distress were analyzed by using multiple logistic regression analysis.

Results

A high interest in dietary pattern was significantly associated with a high level of social capital. In addition, an association between interest in dietary pattern and frequencies of intake of vegetables and fruits was confirmed. The multiple logistic regression analyses showed significant associations between interest in dietary pattern, social capital, frequency of intake of vegetables, and psychological distress after adjusting for socio-demographic variables. Low interest in dietary pattern was positively associated with psychological distress after adjusting for socio-demographic variables (OR = 2.18; 95%CI: 1.69-2.81). Low levels of both reciprocity and sense of community belonging were associated with psychological distress after adjusting for socio-demographic variables (OR = 3.46 with 95%CI of 2.10–5.71 for reciprocity, and OR = 7.42 with 95%CI of 4.64–11.87 for sense of community belonging).

Conclusion

Low interest in dietary pattern, low frequency of intake of vegetables, and low levels of social capital were significantly associated with psychological distress after adjusting for socio-demographic variables.

Purposive facebook recruitment endows cost-effective nutrition education program evaluation

BACKGROUND

Recent legislation established a requirement for nutrition education in federal assistance programs to be evidence-based. Recruitment of low-income persons to participate and evaluate nutrition education activities can be challenging and costly. Facebook has been shown to be a cost-effective strategy to recruit this target audience to a nutrition program.

OBJECTIVE

The purpose of our study was to examine Facebook as a strategy to recruit participants, especially Supplemental Nutrition Assistance Program Education (SNAP-Ed) eligible persons, to view and evaluate an online nutrition education program intended to be offered as having some evidence base for SNAP-Ed programming.

METHODS

English-speaking, low-income Pennsylvania residents, 18-55 years with key profile words (eg, Supplemental Nutrition Assistance Program, Food bank), responded to a Facebook ad inviting participation in either Eating Together as a Family is Worth It (WI) or Everyone Needs Folic Acid (FA). Participants completed an online survey on food-related behaviors, viewed a nutrition education program, and completed a program evaluation. Facebook set-up functions considered were costing action, daily spending cap, and population reach.

RESULTS

Respondents for both WI and FA evaluations were similar; the majority were white, <40 years, overweight or obese body mass index, and not eating competent. A total of 807 Facebook users clicked on the WI ad with 73 unique site visitors and 47 of them completing the program evaluation (ie, 47/807, 5.8% of clickers and 47/73, 64% of site visitors completed the evaluation). Cost per completed evaluation was US $25.48; cost per low-income completer was US $39.92. Results were similar for the FA evaluation; 795 Facebook users clicked on the ad with 110 unique site visitors, and 73 completing the evaluation (ie, 73/795, 9.2% of ad clickers and 73/110, 66% of site visitors completed the evaluation). Cost per valid completed survey with program evaluation was US $18.88; cost per low-income completer was US $27.53.

CONCLUSIONS

With Facebook we successfully recruited low-income Pennsylvanians to online nutrition program evaluations. Benefits using Facebook as a recruitment strategy included real-time recruitment management with lower costs and more efficiency compared to previous data from traditional research recruitment strategies reported in the literature. Limitations prompted by repeated survey attempts need to be addressed to optimize this recruitment strategy.

Eating competence of college students in an introductory nutrition course

OBJECTIVE

Describe eating competence, a positive and flexible way of conceptualizing eating attitudes and behaviors, in students enrolled in an introductory nutrition course.

METHODS

Online completion of the Satter Eating Competence Inventory (ecSI) and self-assessment of eating disorder status by 557 students (343 ages 18-20 years and 180 ages 21-26 years; 377 females) at the beginning of 1 semester. Analysis of variance and post hoc Tukey adjusted tests were used.

RESULTS

The mean ecSI score was 30.7 ± 0.29; 47.4% were classified as eating competent, or ecSI ≥ 32. Mean ecSI was higher for males than females (29.4 ± 0.95 vs 27.4 ± 0.77; P < .001). Mean ecSI was higher for students who never had an eating disorder, compared with those reporting current (32.0 ± 0.43 vs 22.9 ± 1.91; P < .001) or past (28.8 ± 0.93; P < .01) eating disorders.

CONCLUSIONS AND IMPLICATIONS

Students had limited eating competence, but a majority of males were eating competent. Students who had never had an eating disorder had higher eating competence than students with current or past disorders. Examining nutrition courses as currently taught may reveal ways courses could contribute to eating competence.

Evaluation of About Being Active, an online lesson about physical activity shows that perception of being physically active is higher in eating competent low-income women

BACKGROUND

Eating competence (EC) has been associated with positive health outcomes such as reduced cardiovascular risk and higher diet quality. This study compared reported physical activity and EC in 512 low-income women participating in an online program that included a physical activity lesson and assessed response to this lesson.

METHODS

Educational intervention and surveys were completed online. EC was assessed with the Satter Eating Competence Inventory for Low-Income (ecSI/LI).

RESULTS

Participants were mostly white, <31 years, overweight/obese (60%), and food insecure (58%). EC was higher for those who self-reported being physically active (30.1 ± 8.3 vs. 24.9 ± 8.1; P<0.001) and were active for ≥ 30 minutes/day (29.9 ± 8.3 vs. 26.3 ± 8.6), even with age, weight satisfaction, and BMI controlled. EC of obese physically active persons was higher than normal weight, but physically inactive women. The physical activity module was well received with responses unrelated to time involved or physical activity level.

CONCLUSIONS

Low-income women were interested in learning about physical activity and responded positively to online delivery. Overall EC levels were low, but higher for physically active women, supporting efforts to enhance EC. Additional research is needed to determine if EC is associated with responses to physical activity education.

Facebook is an effective strategy to recruit low-income women to online nutrition education

OBJECTIVE

Nutrition education research recruitment expense and effort are substantial; sample selection is crucial for intervention assessment. Effectiveness and cost of Facebook to recruit low-income women to an online nutrition program were examined, including biopsychosocial characteristics of Facebook responders.

METHODS

An ad appeared on the Facebook page of low-income women, 18-45 years old, living in Pennsylvania to invite access to an online nutrition program. Eligible persons completed surveys about food-related behaviors including eating competence, food security, and assistance program use.

RESULTS

Of 465 people who clicked on the ad, 81 completed the eligibility survey, and 62 were eligible; 52 completed a preprogram survey. Completers were mostly white (79%), overweight/obese (mean body mass index 36.2 ± 12.9), and not eating competent (75%). Low-income status was identified for 75% (n = 39) of completers. Total recruitment cost over 19 days was $596.71.

CONCLUSIONS AND IMPLICATIONS

Facebook appears to be an effective tool to recruit low-income women to nutrition education projects.

Eating competence of Hispanic parents is associated with attitudes and behaviors that may mediate fruit and vegetable-related behaviors of 4th grade youth

Parent self-efficacy, outcome expectancies, and behaviors toward cooking and fruits and vegetables mediate children's eating. Eating competence, an intra-individual approach to food-related attitudes and behaviors, is associated with healthful outcomes but has not been studied as a moderator of parent food-related behaviors that mediate healthful eating in 4th grade children. Parents (n = 339; 78% Hispanic, 89% female) of 4th graders who participated in an impact study of the Cooking with Kids curriculum in Santa Fe, NM schools eligible for Supplemental Nutrition Assistance Program Education completed the following surveys: Satter eating competence inventory for low-income (ecSI/LI) (16 items, Likert scale, possible score 0-48); modeling behaviors related to food preparation and fruits/vegetables (11 items, Likert scale, possible score 0-33); self-efficacy/outcome expectancies (SE/OE) (12 items, Likert scale, possible score 12-60); and availability of fruits/vegetables (20 items, possible score 0-20). Higher scores indicate more desired behaviors. The mean ecSI/LI score was 33.6 ± 8.5; 59% were eating competent, i.e., ecSI/LI ≥ 32. Eating-competent parents demonstrated more modeling (16.3 ± 5.0 vs. 14.0 ± 4.3; P < 0.001), greater SE/OE (53.7 ± 10.1 vs. 51.2 ± 8.5; P = 0.03), and greater in-home fruit/vegetable availability (12.7 ± 3.0 vs. 11.9 ± 3.2; P = 0.02). Two clusters of modeling behavior were defined: achievers and strivers. Modeling achievers (34.9 ± 6.9) were more eating competent (P < 0.001) than strivers (30.3 ± 8.9). Eating competence moderated parent food-related behaviors. Measuring eating competence may contribute to understanding parent behavior as a mediator in school-based nutrition interventions.