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Hendriks-Hartensveld AEM, Havermans RC, Nederkoorn C, van den Heuvel E. Exploring within-meal variety to promote appeal of home-cooked meals in older adults. Appetite 2024; 197:107318. [PMID: 38548134 DOI: 10.1016/j.appet.2024.107318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/19/2024] [Accepted: 03/18/2024] [Indexed: 04/06/2024]
Abstract
Undernutrition is highly prevalent in older adults and poses a major threat to physical and mental wellbeing. To foster healthy eating (and healthy aging), strategies are needed to improve dietary quality of older adults. In this study, the feasibility of increasing food variety in home-cooked meals is explored as strategy to promote meat and vegetable consumption in community dwelling older adults. Adults aged 50 years or older (N = 253) evaluated pictures of traditional Dutch dinner meals with more or less variety in the vegetable or meat component in an online questionnaire. Specifically, four different variety 'levels' were presented: (1) no variety, (2) meat variety, (3) vegetable variety, and (4) variety in both meat and vegetables (mixed). Participants indicated for each meal picture how much they would like the meal, whether it represented an ideal portion size, and whether they would be able and willing to prepare the meal. We expected that with increasing variety, liking and ideal portion size would increase, while ability and willingness to prepare the meals would decrease. Results showed that the meals with meat variety and mixed variety were liked less than meals with vegetable variety or no variety. Participants were all highly willing to prepare the meals, but they were less willing to prepare the meals with meat variety and mixed variety compared to the meals with vegetable variety and no variety. All meals were evaluated as being too large, but the meals with vegetable variety and mixed variety were evaluated as more oversized than the meals without variety and with meat variety. These results suggest that encouraging older adults to include variety in home-cooked meals might be more challenging than anticipated.
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Affiliation(s)
- Anouk E M Hendriks-Hartensveld
- Department of Clinical Psychological Science, Faculty of Psychology & Neuroscience, Maastricht University, the Netherlands; Laboratory of Behavioural Gastronomy, Centre for Healthy Eating and Food Innovation, Maastricht University Campus Venlo, the Netherlands.
| | - Remco C Havermans
- Laboratory of Behavioural Gastronomy, Centre for Healthy Eating and Food Innovation, Maastricht University Campus Venlo, the Netherlands; Chair Youth, Food, and Health, Maastricht University Campus Venlo, the Netherlands
| | - Chantal Nederkoorn
- Department of Clinical Psychological Science, Faculty of Psychology & Neuroscience, Maastricht University, the Netherlands
| | - Emmy van den Heuvel
- Laboratory of Behavioural Gastronomy, Centre for Healthy Eating and Food Innovation, Maastricht University Campus Venlo, the Netherlands
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2
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Andreae C, Lennie TA, Chung ML. Diet variety sup the relationship between appetite and micronutrient intake in patients with heart failure. Eur J Cardiovasc Nurs 2023; 22:537-543. [PMID: 36172803 PMCID: PMC10050227 DOI: 10.1093/eurjcn/zvac093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/15/2022] [Accepted: 09/25/2022] [Indexed: 11/14/2022]
Abstract
AIMS Eating a varied diet promotes adequate micronutrient intake. Poor appetite could decrease the desire to eat a varied diet leading to dietary micronutrient insufficiencies. The interrelationships among appetite, diet variety, and dietary micronutrient intake have not been investigated in patients with heart failure (HF). The purpose of the study was to determine whether the relationship between appetite and micronutrient insufficiency was mediated through diet variety. METHODS AND RESULTS A total of 238 patients with HF, mean age 61 ± 12.1; 68% male, and 45% NYHA class III/IV were included in this secondary analysis. Data collection consisted of a 4-day food diary and self-reported appetite on a 10-point visual analogue scale. Micronutrient insufficiency was defined as the total number of 17 minerals and vitamins that were insufficient in the diet. Diet variety was calculated as the number of 23 food types consumed over the 4 days. Mediation analysis, controlling for covariates age, gender, NYHA class, and body mass index showed that diet variety mediated the relationship between appetite and micronutrient insufficiencies [indirect effect = -0.0828, 95% confidence interval (CI): -0.1585 to -0.0150]. There was no direct effect of appetite on micronutrient insufficiency (c´ = -0.1802; 95% CI = -0.3715 to.0111). CONCLUSIONS Diet variety played a previously unrecognized role in the relationship between appetite and dietary micronutrient intake in patients with HF. More research is needed to validate these associations in patients with HF.
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Affiliation(s)
- Christina Andreae
- Department of Health, Medicine and Caring Sciences, Linköping University, 581 83 Linköping, Sweden
- Centre for Clinical Research Sormland, Uppsala University, 631 88 Eskilstuna, Sweden
| | - Terry A. Lennie
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Misook L. Chung
- College of Nursing, University of Kentucky, 751 Rose Street, Lexington, KY 40536-0232, USA
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3
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Jansen DA, Sauve JL, Aubart SM. Importance of Variety to the Lives and Wellbeing of Elders. ACTIVITIES, ADAPTATION & AGING 2023. [DOI: 10.1080/01924788.2023.2174732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Debra A. Jansen
- College of Nursing and Health Sciences, University of Wisconsin-Eau Claire, USA
| | - Jennifer L. Sauve
- College of Nursing and Health Sciences, University of Wisconsin-Eau Claire, USA
| | - Stacie M. Aubart
- College of Nursing and Health Sciences, University of Wisconsin-Eau Claire, USA
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Hendriks-Hartensveld AE, Brodock JL, Hayes JE, Rolls BJ, Keller KL, Havermans RC. The relative importance of complexity, variety, and portion size in ice cream preference in Dutch and American participants. Food Qual Prefer 2022. [DOI: 10.1016/j.foodqual.2021.104523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Embling R, Pink AE, Gatzemeier J, Price M, D Lee M, Wilkinson LL. Effect of food variety on intake of a meal: a systematic review and meta-analysis. Am J Clin Nutr 2021; 113:716-741. [PMID: 33515033 PMCID: PMC7948867 DOI: 10.1093/ajcn/nqaa352] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/28/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many studies have shown that food variety-the presence of multiple foods and/or sensory characteristics within and across meals-increases intake. However, studies report mixed findings, and effect size remains unclear. OBJECTIVES A systematic review and meta-analysis were conducted to 1) synthesize data across experimental studies that examined effects of variety on total meal intake, relative to a control condition with comparatively less variety; 2) quantify support for this effect; and 3) assist in the identification of important moderating factors (registration: CRD42019153585). METHODS In November 2019, we searched the following databases for relevant experimental studies, published in English from 1980, with human participants: PubMed, Cochrane Library, Web of Science, ClinicalTrials.gov, PsycINFO, and OpenGrey. This search was updated in September 2020. Means, standard deviations, and sample sizes were extracted from included articles, and Hedges' g was used to calculate effect sizes. Risk of bias was assessed using the Cochrane Collaboration's tool. RESULTS Of 7259 references identified in an initial search, 34 articles consisting of 37 studies contained sufficient information for review, and data from 30 studies (39 comparisons) were included in the meta-analysis. Results from a random-effects model showed a significant small to medium effect of variety on intake (in weight and energy), with greater variety being associated with increased consumption (Hedges' g = 0.405; 95% CI: 0.259, 0.552). However, heterogeneity was considerable across studies (I2 = 84%), and this was unexplained by subgroup analyses based on form of variety, test foods, sensory characteristics, age, sex, and body weight. CONCLUSIONS Our findings support the conclusion that variety is a robust driver of food intake. However, risk of bias was high across studies, and this review highlights methodologic limitations of studies. It is recommended that further attention is given to the development of preregistered, well-powered randomized controlled studies in eating behavior research.
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Affiliation(s)
- Rochelle Embling
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Aimee E Pink
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, UK
- School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Jennifer Gatzemeier
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Menna Price
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Michelle D Lee
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Laura L Wilkinson
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, UK
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Embling R, Pink AE, Lee MD, Price M, Wilkinson LL. Consumer perception of food variety in the UK: an exploratory mixed-methods analysis. BMC Public Health 2020; 20:1449. [PMID: 32972376 PMCID: PMC7517603 DOI: 10.1186/s12889-020-09548-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 'Food variety' is a key term that is frequently used in dietary guidelines around the world. Consuming a variety of foods - be it within a meal, across meals, or as part of the whole diet - is one factor that has been shown to increase food intake. However, little is known about consumer understanding of variety, and this may be a potential barrier to the success of dietary guidelines in today's 'obesogenic' environment. This research sought to explore 1) consumer recognition of different forms of variety, and 2) consumer definitions of variety. METHODS In an online study (N = 240), participants were asked to discuss a range of photographs depicting different forms of variety, and to directly define the term 'food variety'. They were unaware of the research aim. RESULTS Using a mixed methods approach, directed content analysis of these data showed that individuals referenced multiple forms of variety in the presence of food photographs. However, when asked to define variety, participants tended to only discuss variety in the context of the whole diet. CONCLUSIONS These findings emphasise a need to educate consumers about variety to encourage adherence to dietary guidelines and help consumers better manage their own food intake.
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Affiliation(s)
- Rochelle Embling
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, SA2 8PP, UK.
| | - Aimee E Pink
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, SA2 8PP, UK
- School of Social Sciences, Nanyang Technological University, Singapore, 639818, Singapore
| | - Michelle D Lee
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, SA2 8PP, UK
| | - Menna Price
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, SA2 8PP, UK
| | - Laura L Wilkinson
- Department of Psychology, College of Human and Health Sciences, Swansea University, Swansea, SA2 8PP, UK
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Kemp A, Walton K, Rosario V, Charlton K, McMahon A. Audit of the national meal guidelines for home‐delivered and centre‐based meal programs. Australas J Ageing 2020; 39:e375-e381. [DOI: 10.1111/ajag.12806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Alice Kemp
- Faculty of Science, Medicine and Health School of Medicine University of Wollongong Wollongong NSW Australia
| | - Karen Walton
- Faculty of Science, Medicine and Health School of Medicine University of Wollongong Wollongong NSW Australia
- Illawarra Health & Medical Research Institute University of Wollongong Wollongong NSW Australia
| | - Vinicius Rosario
- Faculty of Science, Medicine and Health School of Medicine University of Wollongong Wollongong NSW Australia
| | - Karen Charlton
- Faculty of Science, Medicine and Health School of Medicine University of Wollongong Wollongong NSW Australia
- Illawarra Health & Medical Research Institute University of Wollongong Wollongong NSW Australia
| | - Anne McMahon
- Faculty of Science, Medicine and Health School of Medicine University of Wollongong Wollongong NSW Australia
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Yamamoto K, Tsuji T, Yamasaki K, Momoki C, Yasui Y, Habu D. Scoring methods used in the dietary variety score survey to predict malnutrition among older patients receiving home care. Int J Older People Nurs 2020; 15:e12301. [PMID: 32196974 DOI: 10.1111/opn.12301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 08/28/2019] [Accepted: 12/03/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND The dietary variety score (DVS), a simple dietary survey method for older adults, investigates the weekly frequency of consumption of the 10 food groups in Japan. The DVS is also associated with nutritional status. The original scoring method applied only to community-dwelling older adults, not to older patients receiving home care, who have little dietary variety. AIM Using three different scoring methods for the DVS, we examined which method was most likely to reflect the nutritional status of older patients receiving home care. METHODS This cross-sectional study was carried out on older patients receiving home care. Participant characteristics, the DVS (evaluated using three different scoring methods), and the Mini Nutritional Assessment-Short Form (MNA® -SF) survey were researched. A receiver operating characteristic (ROC) analysis was performed to find the cut-off value for the DVS. Multivariate analysis was performed, with malnutrition as the outcome, to investigate the extent to which the DVS is associated with malnutrition. RESULTS We studied 317 participants. The DVS could produce significant ROC curves using modified scoring methods A and B (p = .028 and .042) with nutritional status as the outcome. Cut-off value, sensitivity and specificity were 30 points, 60.9% and 55.9% in modified scoring method A and 5 points, 79.1%, and 35.6% in modified scoring method B. Results of the multivariate logistic regression analysis, in Model 1 dysphagia (odds ratio [95% confidence interval]: 3.85 [1.70-8.71]) and the DVS of modified scoring method A (2.00 [1.11-3.62]) were significant independent factors. In Model 2, dysphagia (3.57 [1.58-8.07]) and the DVS based on modified scoring method B (2.36 [1.24-4.47]) were significant independent factors. CONCLUSIONS Modified scoring method B was found to be most suitable for the dietary assessment of older patients receiving home care. IMPLICATIONS FOR PRACTICE Even in the absence of registered dietitians, any care staff member who is involved in providing nursing services during home-visits is capable of administering a dietary survey, when using the easy DVS scoring method.
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Affiliation(s)
- Kaoru Yamamoto
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, Japan
| | - Taeko Tsuji
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, Japan
| | - Kazuyo Yamasaki
- Division of Visiting Nursing, Nishinomiya Social Welfare Corporation, Hyogo, Japan
| | - Chika Momoki
- Department of Food and Nutrition, Faculty of Contemporary Human Life Science, Tezukayama University, Nara, Japan
| | - Yoko Yasui
- Department of Clinical Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, Japan
| | - Daiki Habu
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, Japan
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Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 9:CD012573. [PMID: 31482606 PMCID: PMC6953356 DOI: 10.1002/14651858.cd012573.pub3] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
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Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
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10
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Hollands GJ, Carter P, Anwer S, King SE, Jebb SA, Ogilvie D, Shemilt I, Higgins JPT, Marteau TM. Altering the availability or proximity of food, alcohol, and tobacco products to change their selection and consumption. Cochrane Database Syst Rev 2019; 8:CD012573. [PMID: 31452193 PMCID: PMC6710643 DOI: 10.1002/14651858.cd012573.pub2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Overconsumption of food, alcohol, and tobacco products increases the risk of non-communicable diseases. Interventions to change characteristics of physical micro-environments where people may select or consume these products - including shops, restaurants, workplaces, and schools - are of considerable public health policy and research interest. This review addresses two types of intervention within such environments: altering the availability (the range and/or amount of options) of these products, or their proximity (the distance at which they are positioned) to potential consumers. OBJECTIVES 1. To assess the impact on selection and consumption of altering the availability or proximity of (a) food (including non-alcoholic beverages), (b) alcohol, and (c) tobacco products.2. To assess the extent to which the impact of these interventions is modified by characteristics of: i. studies, ii. interventions, and iii. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, and seven other published or grey literature databases, as well as trial registries and key websites, up to 23 July 2018, followed by citation searches. SELECTION CRITERIA We included randomised controlled trials with between-participants (parallel group) or within-participants (cross-over) designs. Eligible studies compared effects of exposure to at least two different levels of availability of a product or its proximity, and included a measure of selection or consumption of the manipulated product. DATA COLLECTION AND ANALYSIS We used a novel semi-automated screening workflow and applied standard Cochrane methods to select eligible studies, collect data, and assess risk of bias. In separate analyses for availability interventions and proximity interventions, we combined results using random-effects meta-analysis and meta-regression models to estimate summary effect sizes (as standardised mean differences (SMDs)) and to investigate associations between summary effect sizes and selected study, intervention, or participant characteristics. We rated the certainty of evidence for each outcome using GRADE. MAIN RESULTS We included 24 studies, with the majority (20/24) giving concerns about risk of bias. All of the included studies investigated food products; none investigated alcohol or tobacco. The majority were conducted in laboratory settings (14/24), with adult participants (17/24), and used between-participants designs (19/24). All studies were conducted in high-income countries, predominantly in the USA (14/24).Six studies investigated availability interventions, of which two changed the absolute number of different options available, and four altered the relative proportion of less-healthy (to healthier) options. Most studies (4/6) manipulated snack foods or drinks. For selection outcomes, meta-analysis of three comparisons from three studies (n = 154) found that exposure to fewer options resulted in a large reduction in selection of the targeted food(s): SMD -1.13 (95% confidence interval (CI) -1.90 to -0.37) (low certainty evidence). For consumption outcomes, meta-analysis of three comparisons from two studies (n = 150) found that exposure to fewer options resulted in a moderate reduction in consumption of those foods, but with considerable uncertainty: SMD -0.55 (95% CI -1.27 to 0.18) (low certainty evidence).Eighteen studies investigated proximity interventions. Most (14/18) changed the distance at which a snack food or drink was placed from the participants, whilst four studies changed the order of meal components encountered along a line. For selection outcomes, only one study with one comparison (n = 41) was identified, which found that food placed farther away resulted in a moderate reduction in its selection: SMD -0.65 (95% CI -1.29 to -0.01) (very low certainty evidence). For consumption outcomes, meta-analysis of 15 comparisons from 12 studies (n = 1098) found that exposure to food placed farther away resulted in a moderate reduction in its consumption: SMD -0.60 (95% CI -0.84 to -0.36) (low certainty evidence). Meta-regression analyses indicated that this effect was greater: the farther away the product was placed; when only the targeted product(s) was available; when participants were of low deprivation status; and when the study was at high risk of bias. AUTHORS' CONCLUSIONS The current evidence suggests that changing the number of available food options or altering the positioning of foods could contribute to meaningful changes in behaviour, justifying policy actions to promote such changes within food environments. However, the certainty of this evidence as assessed by GRADE is low or very low. To enable more certain and generalisable conclusions about these potentially important effects, further research is warranted in real-world settings, intervening across a wider range of foods - as well as alcohol and tobacco products - and over sustained time periods.
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Affiliation(s)
- Gareth J Hollands
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Patrice Carter
- University College LondonCentre for Outcomes Research and Effectiveness1‐19 Torrington PlaceLondonUKWC1E 7HB
| | - Sumayya Anwer
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Sarah E King
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
| | - Susan A Jebb
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - David Ogilvie
- University of CambridgeMRC Epidemiology UnitBox 285Cambridge Biomedical CampusCambridgeUKCB2 0QQ
| | - Ian Shemilt
- University College LondonEPPI‐Centre10 Woburn SquareLondonUKWC1H 0NR
| | - Julian P T Higgins
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolUKBS8 2PS
| | - Theresa M Marteau
- University of CambridgeBehaviour and Health Research UnitForvie SiteRobinson WayCambridgeUKCB2 0SR
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Tsuji T, Yamamoto K, Yamasaki K, Hayashi F, Momoki C, Yasui Y, Ohfuji S, Fukushima W, Habu D. Lower dietary variety is a relevant factor for malnutrition in older Japanese home-care recipients: a cross-sectional study. BMC Geriatr 2019; 19:197. [PMID: 31349800 PMCID: PMC6659217 DOI: 10.1186/s12877-019-1206-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 07/09/2019] [Indexed: 01/10/2023] Open
Abstract
Background Nutritional status of the older people is affected by various life-style factors. Although dietary habit is one of the life-style factors, it is unknown which of older home-care recipients’ dietary habits are associated with malnutrition. The purpose of this study was to examine the association of dietary variety, as an evaluation index for dietary habits, with malnutrition in Japanese older home-care recipients. Methods This cross-sectional study was conducted in a single city, Hyogo Prefecture, Japan between July and October 2016. Three hundred thirty-three community-dwelling older care recipients (aged 65 years or older who were receiving home-visit nursing care services) were enrolled. Their nutritional status (Mini Nutritional Assessment®-short form: MNA®-SF), dietary variety (Food frequency score [FFS]), socio-demographic characteristics (age, sex, marital status, etc.), health indicators (comorbidity [Charlson Comorbidity Index] and dysphagia status [Dysphagia Severity Scale]) were assessed. The participants were classified into two groups: malnourished (0–7 points) and non-malnourished (8–14 points), according to their MNA®-SF scores. Multivariate logistic regression analysis was used to examine the factors associated with malnutrition. Results A total of 317 participants were analyzed (118 men, 199 women, median age: 84 years). Compared to the fourth (highest) quartile of FFS, odds ratios (OR) (95% confidence intervals [CI]) of the third, second, and first (lowest) quartiles of FFS were 1.08 (0.42–2.80), 1.29 (0.56–2.98), and 2.30 (1.02–5.19), respectively (p for trend = 0.049). Higher Charlson Comorbidity Index score and the presence of dysphagia were also significantly associated with malnutrition (OR: 2.08, 95% CI: 1.08–4.00 and OR: 3.86, 95% CI: 2.08–7.17, respectively). Conclusion Lower dietary variety was significantly associated with malnutrition in Japanese older home-care recipients.
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Affiliation(s)
- Taeko Tsuji
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka, 558-8585, Japan
| | - Kaoru Yamamoto
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka, 558-8585, Japan
| | - Kazuyo Yamasaki
- Division of Visiting Nursing, Nishinomiya Social Welfare Corporation, Hyogo, Japan
| | - Fumikazu Hayashi
- Office of Epidemiology, Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Chika Momoki
- Department of Food and Nutrition, Faculty of Contemporary Human Life Science, Tezukayama University, Nara, Japan
| | - Yoko Yasui
- Department of Clinical Nutrition, Graduate School of Human Life Science, Osaka City University, Osaka, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Daiki Habu
- Department of Medical Nutrition, Graduate School of Human Life Science, Osaka City University, 3-3-138 Sugimoto, Sumiyoshi-ku, Osaka, 558-8585, Japan.
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12
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Food-variety-focused labelling does not increase ideal portion size, expected fullness or snack intake. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2018.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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13
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Assessment and Treatment of the Anorexia of Aging: A Systematic Review. Nutrients 2019; 11:nu11010144. [PMID: 30641897 PMCID: PMC6356473 DOI: 10.3390/nu11010144] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/04/2019] [Accepted: 01/07/2019] [Indexed: 12/30/2022] Open
Abstract
(1) Background: Appetite loss in older people, the ‘Anorexia of Aging’ (AA), is common, associated with under-nutrition, sarcopenia, and frailty and yet receives little attention. This review had two aims: describe interventions for AA and their effectiveness, and identify the methods of appetite assessment. (2) Methods: Study inclusion: participants aged ≥65, intervention for AA, and appetite assessment, any design, and comparator. Exclusion: studies on specific health cohorts. Searches in four databases with hand searching of references and citing works. Two researchers independently assessed eligibility and quality. (3) Results: Authors screened 8729 titles, 46 full texts. Eighteen articles were included describing nine intervention types: education (n = 1), exercise (n = 1), flavor enhancement (n = 2), increased meal variety (n = 1), mealtime assistance (n = 1), fortified food (n = 1), oral nutritional supplement (ONS) (n = 8), amino acids (n = 1), and medication (n = 2). Three studies evaluated combinations: education + exercise, ONS + exercise, and ONS + medication. Five intervention types exhibited favorable effects on appetite but in single datasets or not replicated. Appetite was assessed predominantly by Likert (n = 9), or visual analogue scales (n = 7). (4) Conclusions: A variety of interventions and methods of appetite assessments were used. There was a lack of clarity about whether AA or undernutrition was the intervention target. AA is important for future research but needs standardized assessment so that effectiveness of a range of interventions can be fully explored.
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Grammatikopoulou MG, Gkiouras K, Theodoridis X, Tsisimiri M, Markaki AG, Chourdakis M, Goulis DG. Food insecurity increases the risk of malnutrition among community-dwelling older adults. Maturitas 2019; 119:8-13. [DOI: 10.1016/j.maturitas.2018.10.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 12/22/2022]
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15
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Clancy A, Walton K, Charlton K, Mcmahon A, Ringland E, Williams P, Tapsell L. Service providers' and health professionals' views and suggestions for the Australian National Meal Guidelines for the Commonwealth Home Support Program. Nutr Diet 2018; 76:290-295. [DOI: 10.1111/1747-0080.12485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/21/2018] [Accepted: 09/12/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Annabel Clancy
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | - Karen Walton
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | - Karen Charlton
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | | | - Emma Ringland
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | - Peter Williams
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
| | - Linda Tapsell
- School of MedicineUniversity of Wollongong Wollongong New South Wales Australia
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16
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Mikami Y, Watanabe Y, Edahiro A, Motokawa K, Shirobe M, Yasuda J, Murakami M, Murakami K, Taniguchi Y, Furuya J, Hirano H. Relationship between mortality and Council of Nutrition Appetite Questionnaire scores in Japanese nursing home residents. Nutrition 2018; 57:40-45. [PMID: 30153578 DOI: 10.1016/j.nut.2018.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 04/25/2018] [Accepted: 05/05/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE This 1-y cohort study examined whether Council of Nutrition Appetite Questionnaire (CNAQ) scores predicted mortality in 316 elderly Japanese residents of five nursing homes (60 men, 256 women; mean age: 84.9 ± 8.3 y). METHODS The baseline survey included participant characteristics (e.g., age, sex, height, weight, and medical history), and Barthel Index (BI), Clinical Dementia Rating (CDR), Mini Nutritional Assessment-Short Form (MNA®-SF), CNAQ, Simplified Nutritional Appetite Questionnaire (SNAQ; simplified CNAQ), and SNAQ for the Japanese elderly (SNAQ-JE) scores. RESULTS Following the baseline survey, mortality data were collected for 1 y; during this time, 62 participants (19.6%) died. The deceased group's CNAQ scores (25.1 ± 4.8) were significantly lower than those of the survival group (28 ± 3.6; P < 0.001). After adjusting for age, sex, medical history, BI, CDR, and MNA®-SF scores in Cox proportional regression, CNAQ (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.85-0.97; P = 0.004), SNAQ (HR, 0.84; 95% CI, 0.75-0.93; P = 0.001), and SNAQ-JE (HR, 0.84; 95% CI, 0.76-0.92; P < 0.001) scores were related to mortality. CONCLUSIONS This study showed that CNAQ scores were inversely associated with 1-y mortality. Furthermore, appetite assessment using the CNAQ predicted the death of Japanese nursing home residents. Similarly, the SNAQ and SNAQ-JE scores were inversely associated with 1-y mortality.
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Affiliation(s)
- Yurie Mikami
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | | | - Ayako Edahiro
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Keiko Motokawa
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Maki Shirobe
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Jun Yasuda
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | | | - Kohji Murakami
- Department of Special Needs Dentistry, Division of Hygiene and Oral Health, Showa University School of Dentistry, Tokyo, Japan
| | - Yu Taniguchi
- Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Junichi Furuya
- Department of Oral Health Sciences for Community Welfare, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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17
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Vadiveloo M, Principato L, Morwitz V, Mattei J. Sensory variety in shape and color influences fruit and vegetable intake, liking, and purchase intentions in some subsets of adults: a randomized pilot experiment. Food Qual Prefer 2018; 71:301-310. [PMID: 31105386 DOI: 10.1016/j.foodqual.2018.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dietary variety increases food intake, but it is unclear if sensory differences elicit increases in eating-related behaviors. Using a 4×3 between-subject pilot experiment, we examined if increasing sensory variety (control, color, shape, both color and shape) and priming individuals to notice differences or similarities in the foods (positive, neutral, negative) influenced ad libitum proximal intake, liking, and willingness to purchase pears and peppers among 164 Greater Boston adults >18y/o. MANOVA was used to examine associations between sensory variety (independent variable) and six dependent measures. We tested for interactions between sensory variety condition and individual-level factors that may influence food intake. There was no main effect of sensory variety condition for any dependent measure. However, interactions between sensory variety condition and age, overweight status, and prime were detected. Adults with overweight (vs. adults of normal weight) ate more pear with color variety (7.2 vs. 4.4 oz, p=0.01). Pear intake was also higher among adults with overweight in the color variety (7.2 oz) vs. combination variety (4.4 oz) condition. Adults ≥36y/o ate more peppers (3.5 oz) in the color variety condition versus other conditions (2.1-2.2 oz, p=0.04). Participants primed to notice differences were more willing to purchase pears in the color variety (5.0 ± 0.5) versus control (3.7 ± 0.5) condition. Color variety may modestly increase proximal intake, liking, and purchase intentions for fruits and vegetables in some subsets of adults. Our preliminary findings encourage more research to determine if color variety can be used to improve diet quality of targeted populations.
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Affiliation(s)
- Maya Vadiveloo
- Harvard T.H. Chan School of Public Health, Department of Nutrition, 665 Huntington Ave, Bldg 2, Boston, MA 02115, USA
| | - Ludovica Principato
- Rome Tre University, Department of Business Studies, Via Silvio D'Amico, 77, 00145 Rome, Italy
| | - Vicki Morwitz
- New York University, Stern School of Business, 40 West 4th Street, Room 807, New York, NY 10012, USA
| | - Josiemer Mattei
- Harvard T.H. Chan School of Public Health, Department of Nutrition, 665 Huntington Ave, Bldg 2, Boston, MA 02115, USA
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18
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Clegg ME, Williams EA. Optimizing nutrition in older people. Maturitas 2018; 112:34-38. [PMID: 29704915 DOI: 10.1016/j.maturitas.2018.04.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 03/29/2018] [Accepted: 04/02/2018] [Indexed: 01/09/2023]
Abstract
Older adults are at increased risk of malnutrition, for a variety of physiological and psychological reasons. This has implications for health, quality of life, independence and economic circumstances. Improvements in nutrition are known to bring tangible benefits to older people and many age-related diseases and conditions can be prevented, modulated or ameliorated by good nutrition. However, practical and realistic approaches are required to optimize diet and food intake in older adults. One area where improvements can be made relates to appetite. Encouraging older adults to prepare meals can increase appetite and food intake, and providing opportunities for older adults to eat a wide variety of foods, in company, is a simple strategy to increase food intake. The protein requirement of older adults is subject to controversy and although considered the most satiating macronutrient, it appears that protein does not elicit as great a satiating effect in older adults as it does in younger individuals. This indicates that there is potential to increase protein intake without impacting on overall energy intake. Other areas where simple practical improvements can be made include both packaging of foods that are easy to prepare and the education of older adults on the safe storage and preparation of food. Research into improving the diets and nutritional status of older adults has indicated that many of the strategies can be easily and cost-effectively undertaken.
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Affiliation(s)
- Miriam E Clegg
- Oxford Brookes Centre for Nutrition and Health, Department of Sport, Health Sciences and Social Work, Faculty of Health and Life Sciences, Oxford Brookes University, Gipsy Lane, Oxford OX3 0BP, UK.
| | - Elizabeth A Williams
- Department of Oncology & Metabolism, Human Nutrition Unit, The University of Sheffield, Beech Hill Road, Sheffield, S10 2RX, UK
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Abstract
PURPOSE OF REVIEW In accordance with US dietary guidance, incorporating variety into the diet can align with energy balance, though greater food variety in some categories may make energy balance more challenging. Thus, experimental and epidemiologic evidence is summarized on the relationship between food variety, food and energy intake, and energy balance. RECENT FINDINGS Lab-based, experimental research consistently demonstrates that greater variety within foods or sensory characteristics of food increases food and energy intake within an eating occasion. Epidemiologic evidence is less consistent, potentially driven by differing methodologies, particularly in defining and measuring food variety. Moreover, the effect of variety on energy balance appears to be moderated by food energy density. Integrating insights from experimental and epidemiologic research are essential for strengthening food variety guidance including developing evidence-based definitions of food variety, understanding moderators of the relationship, and developing practical guidance interpretable to consumers.
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Affiliation(s)
- Hollie A Raynor
- Department of Nutrition, University of Tennessee, 1215 Cumberland Avenue, 229 JHB, Knoxville, TN, 37996, USA.
| | - Maya Vadiveloo
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
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20
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Vilela S, Hetherington MM, Oliveira A, Lopes C. Tracking diet variety in childhood and its association with eating behaviours related to appetite: The generation XXI birth cohort. Appetite 2018; 123:241-248. [PMID: 29305889 DOI: 10.1016/j.appet.2017.12.030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/31/2017] [Accepted: 12/31/2017] [Indexed: 12/23/2022]
Abstract
Research on the influence of early eating habits on eating behaviours related to appetite using a prospective approach is scarce, especially in children. The aim of this study was to explore the relationship between changes in diet variety from 4 to 7 years of age and appetitive traits measured at 7 years of age. Participants are from the population-based birth cohort Generation XXI (2005-2006). The present analysis included 4537 children with complete data on a food frequency questionnaire (FFQ) at both ages, and on the Children's Eating Behaviour Questionnaire at 7y. A healthy diet variety index (HDVI) was calculated at both ages using data from the FFQ. To assess tracking of diet variety, tertiles of HDVI scores were calculated and then re-categorized as 'maintain: low', 'maintain: high', 'increase' and 'decrease'. Although the HDVI score decreased from 4 to 7y (p < .001), it showed a high stability, a positive predictive value, and a fair agreement. Increasing diet variety, compared to maintaining a low variety, was inversely associated with the 'Desire to Drink' (β = -0.090, 95%CI: 0.174; -0.006) and 'Satiety Responsiveness' (β = -0.119, 95%CI: 0.184; -0.054) subdimensions and positively with 'Enjoyment of Food' (β = 0.098, 95%CI: 0.023; 0.172) and 'Emotional Overeating' (β = 0.073, 95%CI: 0.006; 0.139). Those classified as either increase or maintain a high diet variety, in comparison with maintaining a low variety, had lower scores of 'Food Fussiness'. In conclusion, diet variety decreased from 4 to 7y with a fair tracking. Children with a higher diet variety were less fussy, had a lower desire to drink and a higher general interest in food.
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Affiliation(s)
- Sofia Vilela
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, nº 135, 4050-600 Porto, Portugal.
| | | | - Andreia Oliveira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, nº 135, 4050-600 Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Carla Lopes
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, nº 135, 4050-600 Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina, Universidade do Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
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Dashti HS, Mogensen KM. Recommending Small, Frequent Meals in the Clinical Care of Adults: A Review of the Evidence and Important Considerations. Nutr Clin Pract 2016; 32:365-377. [DOI: 10.1177/0884533616662995] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Hassan S. Dashti
- Department of Nutrition, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Kris M. Mogensen
- Department of Nutrition, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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