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Roba AA, Başdaş Ö, Brewis A, Roba KT. Maternal and household factors affecting the dietary diversity of preschool children in eastern Ethiopia: a cross-sectional study. BMJ Open 2024; 14:e080616. [PMID: 38514138 PMCID: PMC10961529 DOI: 10.1136/bmjopen-2023-080616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE Investigate the association between the dietary diversity of preschool children and proximate factors including household food insecurity, maternal food choice, preferences, khat use, and levels of depressive symptoms. DESIGN Cross-sectional survey of randomly selected households. SETTING Haramaya Health and Demographic Surveillance site in Eastern Ethiopia, predominantly smallholder farming households. PARTICIPANTS 678 preschool children (24-59 months) and their mothers. METHODS The key outcome, the adequacy of dietary diversity of preschool children, was calculated using a 24-hour parental dietary recall. Binary logistic regression was then used to identify maternal and household factors associated with dietary adequacy versus inadequacy. RESULTS The majority (80.53%) of surveyed children had low dietary diversity (mean Dietary Diversity (MDD)) score of 3.06±1.70 on a 7-point scale). Approximately 80% of households exhibited food insecurity. Households with greater food security (adjusted OR (AOR)=1.96, 95% CI 1.19 to 3.23), healthier maternal food choice (AOR=2.19, 95% CI 1.12 to 4.31) and broader maternal food preferences (AOR=4.95, 95% CI 1.11 to 21.95) were all associated with higher dietary diversity of their preschool children (p≤0.05). Other covariates associated with adequate child dietary diversity included improved household drinking water sources (AOR=1.84, 95% CI 1.16 to 2.92) and family planning use (AOR=1.69, 95% CI 1.00 to 2.86). Despite predictions, however, maternal depression and khat consumption were not identified as factors. CONCLUSIONS The dietary diversity of preschool children is extremely low-a pattern observed in both food-secure and food-insecure households. Key factors include maternal selection of food for convenience and ease, preferences that do not include animal protein or healthier food choices, and lack of access to improved drinking water sources. Interventions around maternal food choice and preferences could improve preschool children's nutritional health.
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Affiliation(s)
- Aklilu Abrham Roba
- Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
- Institute of Health Science, Erciyes University, Kayseri, Turkey
| | - Öznur Başdaş
- Faculty of Health Science, Erciyes University, Kayseri, Turkey
| | - Alexandra Brewis
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
| | - Kedir Teji Roba
- Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
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van den Brand AJP, Hendriks-Hartensveld AEM, Havermans RC, Nederkoorn C. Child characteristic correlates of food rejection in preschool children: A narrative review. Appetite 2023; 190:107044. [PMID: 37717623 DOI: 10.1016/j.appet.2023.107044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/27/2023] [Accepted: 09/12/2023] [Indexed: 09/19/2023]
Abstract
Dietary habits formed in early childhood are key for establishing a healthy diet later in life. Picky eating and food neophobia - the two main forms of food rejection in young children - form an important barricade to establishing such healthy habits. Understanding these types of food rejection is thus essential for promoting healthy eating behaviour in both children and adults. To this end, the present narrative review aims to provide an overview of food rejection research in preschool-aged children, focusing on recent advances in the cognitive literature. Specifically, we evaluate the link between children's cognitive development, chemosensory perception and affective evaluation of food, food knowledge, decision-making strategies, anxiety and disgust sensitivity, and food rejection behaviour. Longitudinal and experimental studies are necessary to establish how the relationships between food rejection and cognitive processes develop over time and to determine their causal directions.
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Affiliation(s)
- Anouk J P van den Brand
- Department of Clinical Psychological Science, Faculty of Psychology & Neuroscience, Maastricht University, the Netherlands.
| | - Anouk E M Hendriks-Hartensveld
- Department of Clinical Psychological Science, Faculty of Psychology & Neuroscience, Maastricht University, the Netherlands
| | - Remco C Havermans
- Laboratory of Behavioural Gastronomy, Centre for Healthy Eating and Food Innovation, Maastricht University Campus, Venlo, the Netherlands; 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
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3
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Markides BR, Hesketh KD, Maddison R, Laws R, Denney-Wilson E, Campbell KJ. Fussy Eating Rescue, a mobile-web app for responsive feeding practises among parents of toddlers: protocol for a pilot randomised controlled feasibility trial. Pilot Feasibility Stud 2023; 9:128. [PMID: 37481664 PMCID: PMC10362701 DOI: 10.1186/s40814-023-01278-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 03/10/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Fussy eating is most often a developmentally typical behaviour, generally presenting during toddlerhood. However, up to half of parents of young children are concerned about fussy eating, and this concern may mediate the use of nonresponsive feeding practises, such as coercive or unstructured feeding and using food to reward eating. Despite the high prevalence of parental concern for fussy eating and the negative impacts nonresponsive feeding practises have on children's health and diets, no previous digital intervention to improve the feeding practises of parents of toddlers concerned about fussy eating has been evaluated. AIM This article describes the protocol of a randomised controlled feasibility pilot aiming to evaluate Fussy Eating Rescue, a purely web app based intervention for parents of toddlers. The primary aim is to investigate feasibility and acceptability; secondary aims are to explore indications of intervention effect on parents' feeding practises or children's eating behaviours. METHODS Fussy Eating Rescue features include: (1) a Tracker, that allows parents to track repeated offers of food, (2) Topics, providing information on fussy eating, effective feeding strategies, and general nutrition, (3) Rescues, containing quick references to material supporting Topics contents, (4) Recipes, and (5) SMS notifications. Parents of toddlers (12-36 months old, n = 50) who have concerns about fussy eating will be recruited via Facebook. Parents will be randomised to an intervention group, which receives access to the app for 6 weeks, or to wait-listed control. Outcomes will be assessed at baseline and 6 weeks after app use, using online questionnaires and app usage statistics. Primary outcomes include participant retention rate, intervention engagement, app usability, perceived ease in using the app, perceived usefulness of the app, and user satisfaction. Secondary outcome measures include parents' feeding practises and children's eating behaviours. DISCUSSION Results will inform whether Fussy Eating Rescue is a feasible way to engage parents concerned for their toddler's fussy eating behaviours. If feasible and acceptable to users, a larger trial will further examine the efficacy of the Fussy Eating app in improving parents' feeding practises and children's eating behaviours. TRIAL REGISTRATION Prospectively registered with the Australian New Zealand Clinical Trials Registry on 15 July, 2021 (ACTRN12621000925842).
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Affiliation(s)
- Brittany Reese Markides
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Burwood, Victoria, Australia.
| | - Kylie D Hesketh
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Burwood, Victoria, Australia
| | - Ralph Maddison
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Burwood, Victoria, Australia
| | - Rachel Laws
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Burwood, Victoria, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, NSW, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University Burwood, Victoria, Australia
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Anzman‐Frasca S, Moding KJ, Forestell CA, Francis LA. Applying developmental science concepts to improve the applicability of children’s food preference learning research. CHILD DEVELOPMENT PERSPECTIVES 2022. [DOI: 10.1111/cdep.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Stephanie Anzman‐Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences University at Buffalo Buffalo New York USA
- Center for Ingestive Behavior Research University at Buffalo Buffalo New York USA
| | - Kameron J. Moding
- Department of Human Development & Family Studies Purdue University West Lafayette Indiana USA
| | | | - Lori A. Francis
- Department of Biobehavioral Health The Pennsylvania State University University Park Pennsylvania USA
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5
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Practical School Nutrition Program May Reduce Food Neophobia. Nutrients 2021; 13:nu13103541. [PMID: 34684541 PMCID: PMC8538047 DOI: 10.3390/nu13103541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/15/2022] Open
Abstract
The study’s purpose was to evaluate an intervention to reduce fruit and vegetable food neophobia and influence attitudes and behaviors among children using a four-month, non-experimental, before-and-after intervention. Participants were children aged 5–11 years in an intervention school (IS) and a control school (CS). Children were offered fruit or vegetable samples weekly utilizing school-specific psychosocial and educational practices to encourage participation. The outcomes of interest included attitudes measured using a written survey-based food neophobia scale (FNS), behavioral observations, and an oral survey. The post-intervention IS FNS score was significantly lower compared to pre-intervention (p = 0.04). Repeated-measures ANOVA revealed a statistically significant overall effect of time (p = 0.006). School type-time interaction was not significant (p = 0.57). Pre-intervention observational data showed the proportions finishing and taking another fruit and vegetable sample were higher in the CS (p < 0.001 for both). Post-intervention, the proportions taking the vegetable (p = 0.007) and the fruit (p < 0.001) were higher in the IS. The percentage tasting the vegetable was higher in the CS (p = 0.009). Offering samples of produce in school lunchrooms may reduce food neophobia. This intervention is an inexpensive program that volunteers can quickly implement.
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Chawner LR, Hetherington MM. Utilising an integrated approach to developing liking for and consumption of vegetables in children. Physiol Behav 2021; 238:113493. [PMID: 34116053 DOI: 10.1016/j.physbeh.2021.113493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 02/07/2023]
Abstract
Children eat too few vegetables and this is attributed to disliked flavours and texture as well as low energy density. Vegetables confer selective health benefits over other foods and so children are encouraged to eat them. Parents and caregivers face a challenge in incorporating vegetables into their child's habitual diet. However, liking and intake may be increased through different forms of learning. Children learn about vegetables across development from exposure to some vegetable flavours in utero, through breastmilk, complementary feeding and transitioning to family diets. Infants aged between 5 and 7 m are most amenable to accepting vegetables. However, a range of biological, social, environmental and individual factors may act independently and in tandem to reduce the appeal of eating vegetables. By applying aspects of learning theory, including social learning, liking and intake of vegetables can be increased. We propose taking an integrated and individualised approach to child feeding in order to achieve optimal learning in the early years. Simple techniques such as repeated exposure, modelling, social praise and creating social norms for eating vegetables can contribute to positive feeding experiences which in turn, contributes to increased acceptance of vegetables. However, there is a mismatch between experimental studies and the ways that children eat vegetables in real world settings. Therefore, current knowledge of the best strategies to increase vegetable liking and intake gained from experimental studies must be adapted and integrated for application to home and care settings, while responding to individual differences.
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Affiliation(s)
- L R Chawner
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK.
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7
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Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2020; 5:CD008552. [PMID: 32449203 PMCID: PMC7273132 DOI: 10.1002/14651858.cd008552.pub7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
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Hodder RK, O'Brien KM, Stacey FG, Tzelepis F, Wyse RJ, Bartlem KM, Sutherland R, James EL, Barnes C, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2019; 2019:CD008552. [PMID: 31697869 PMCID: PMC6837849 DOI: 10.1002/14651858.cd008552.pub6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 August 2019. We searched Proquest Dissertations and Theses in May 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 78 trials with 214 trial arms and 13,746 participants. Forty-eight trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 20 of the 78 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is very low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 4.45 g as-desired consumption of vegetables (SMD 0.42, 95% CI 0.23 to 0.60; 18 trials, 2004 participants; mean post-intervention follow-up = 8.2 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.34, 95% CI 0.10 to 0.57; 9 trials, 3022 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.36 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; 11 trials, 3078 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) and unintended adverse consequences of interventions (2 trials), limiting their assessment. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 78 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low-quality evidence that child-feeding practice may lead to, and moderate-quality evidence that multicomponent interventions probably lead to small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Fiona G Stacey
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
- University of NewcastlePriority Research Centre in Physical Activity and NutritionCallaghanAustralia
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanNew South WalesAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Erica L James
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Luke Wolfenden
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
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Appleton KM, Barrie E, Samuel TJ. Modelling positive consequences: Increased vegetable intakes following modelled enjoyment versus modelled intake. Appetite 2019; 140:76-81. [PMID: 31055009 DOI: 10.1016/j.appet.2019.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 04/07/2019] [Accepted: 05/02/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Modelling has previously been demonstrated to encourage healthy eating, but the importance of modelling the behaviour versus modelling the positive consequences of the behaviour is unknown. This work investigated the impact of modelling carrot intake (the behaviour) and modelling carrot enjoyment (the positive consequences) on subsequent liking and consumption of carrots and sweetcorn. METHODS 155 children aged 7-10 years were randomized to hear a story where fictional characters consumed a picnic with either: no mention of carrot sticks (control) (N = 45); mention of carrot sticks that all characters ate (modelling intake) (N = 60); or mention of carrot sticks that the characters like (modelling enjoyment) (N = 50). Carrot and sweetcorn liking and intake were measured before and after the story during a 5 min task. RESULTS Carrot liking and intake after a story were higher following the story modelling carrot enjoyment compared to the stories not modelling enjoyment (smallest β = 0.16, p = 0.05), and in those with higher pre-story carrot liking and intake (smallest β = 0.25, p < 0.01). Sweetcorn liking and intake after a story were associated with pre-story sweetcorn liking and intake (smallest β = 0.28, p < 0.01), and sweetcorn intake was lower following the story modelling carrot enjoyment compared to the stories not modelling enjoyment (β = -0.17, p = 0.04). CONCLUSIONS These findings demonstrate a role for modelling enjoyment to encourage vegetable liking and intake, although effects sizes were small. These findings also suggest a benefit from modelling the positive consequences of a behaviour for encouraging healthy food intake in children, while limited effects were found for modelling the behaviour itself.
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Affiliation(s)
- K M Appleton
- Research Centre for Behaviour Change, Department of Psychology, Faculty of Science and Technology, Bournemouth University, UK.
| | - E Barrie
- Research Centre for Behaviour Change, Department of Psychology, Faculty of Science and Technology, Bournemouth University, UK
| | - T J Samuel
- Research Centre for Behaviour Change, Department of Psychology, Faculty of Science and Technology, Bournemouth University, UK
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10
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De Cock N, Van Lippevelde W, Vangeel J, Notebaert M, Beullens K, Eggermont S, Deforche B, Maes L, Goossens L, Verbeken S, Moens E, Vervoort L, Braet C, Huybregts L, Kolsteren P, Van Camp J, Lachat C. Feasibility and impact study of a reward-based mobile application to improve adolescents' snacking habits. Public Health Nutr 2018; 21:2329-2344. [PMID: 29607800 PMCID: PMC11106033 DOI: 10.1017/s1368980018000678] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/12/2018] [Accepted: 02/22/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Adolescents' snacking habits are driven by both explicit reflective and implicit hedonic processes. Hedonic pathways and differences in sensitivity to food rewards in addition to reflective determinants should be considered. The present study evaluated the feasibility and impact of a mobile phone-delivered intervention, incorporating explicit reflective and implicit rewarding strategies, on adolescents' snack intake. DESIGN Adolescents (n 988; mean age 14·9 (sd 0·70) years, 59·4 % boys) completed a non-randomized clustered controlled trial. Adolescents (n 416) in the intervention schools (n 3) were provided with the intervention application for four weeks, while adolescents (n 572) in the control schools (n 3) followed the regular curriculum. Outcomes were differences in healthy snacking ratio and key determinants (awareness, intention, attitude, self-efficacy, habits and knowledge). Process evaluation data were collected via questionnaires and through log data of the app. RESULTS No significant positive intervention effects on the healthy snack ratio (b=-3·52 (se 1·82), P>0·05) or targeted determinants were observed. Only 268 adolescents started using the app, of whom only fifty-five (20·5 %) still logged in after four weeks. Within the group of users, higher exposure to the app was not significantly associated with positive intervention effects. App satisfaction ratings were low in both high and low user groups. Moderation analyses revealed small positive intervention effects on the healthy snack ratio in high compared with low reward-sensitive boys (b=1·38 (se 0·59), P<0·05). CONCLUSIONS The intervention was not able to improve adolescents' snack choices, due to low reach and exposure. Future interventions should consider multicomponent interventions, teacher engagement, exhaustive participatory app content development and tailoring.
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Affiliation(s)
- Nathalie De Cock
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, Ghent 9000, Belgium
| | | | - Jolien Vangeel
- Leuven School for Mass Communication Research, KU Leuven, Leuven, Belgium
| | - Melissa Notebaert
- Leuven School for Mass Communication Research, KU Leuven, Leuven, Belgium
| | - Kathleen Beullens
- Leuven School for Mass Communication Research, KU Leuven, Leuven, Belgium
| | - Steven Eggermont
- Leuven School for Mass Communication Research, KU Leuven, Leuven, Belgium
| | - Benedicte Deforche
- Department of Public Health, Ghent University, Ghent, Belgium
- Physical Activity, Nutrition and Health Research Unit, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lea Maes
- Department of Public Health, Ghent University, Ghent, Belgium
| | - Lien Goossens
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Sandra Verbeken
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Ellen Moens
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Leentje Vervoort
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington DC, USA
| | - Patrick Kolsteren
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, Ghent 9000, Belgium
| | - John Van Camp
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, Ghent 9000, Belgium
| | - Carl Lachat
- Department of Food Safety and Food Quality, Ghent University, Coupure Links 653, Ghent 9000, Belgium
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11
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Strategies to increase preschoolers' vegetable liking and consumption: The role of reward sensitivity. Food Qual Prefer 2018. [DOI: 10.1016/j.foodqual.2018.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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12
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Hodder RK, O'Brien KM, Stacey FG, Wyse RJ, Clinton‐McHarg T, Tzelepis F, James EL, Bartlem KM, Nathan NK, Sutherland R, Robson E, Yoong SL, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2018; 5:CD008552. [PMID: 29770960 PMCID: PMC6373580 DOI: 10.1002/14651858.cd008552.pub5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2018. We searched Proquest Dissertations and Theses in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 63 trials with 178 trial arms and 11,698 participants. Thirty-nine trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fourteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Nine studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 63 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.There is very low quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 3.50 g as-desired consumption of vegetables (SMD 0.33, 95% CI 0.13 to 0.54; participants = 1741; studies = 13). Multicomponent interventions versus no intervention may have a very small effect on child consumption of fruit and vegetables (SMD 0.35, 95% CI 0.04 to 0.66; participants = 2009; studies = 5; low-quality evidence), equivalent to an increase of 0.37 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; participants = 3078; studies = 11; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for four studies reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 63 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low- and low-quality evidence respectively that child-feeding practice and multicomponent interventions may lead to very small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up is required and future research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
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Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Fiona G Stacey
- University of Newcastle, Hunter Medical Research Institute, Priority
Research Centre in Health Behaviour, and Priority Research Centre in
Physical Activity and NutritionSchool of Medicine and Public HealthCallaghanAustralia2287
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Tara Clinton‐McHarg
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Erica L James
- University of Newcastle, Hunter Medical Research InstituteSchool of Medicine and Public HealthUniversity DriveCallaghanAustralia2308
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanAustralia2308
| | - Nicole K Nathan
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Emma Robson
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Sze Lin Yoong
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
| | - Luke Wolfenden
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
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Anzman-Frasca S, Ventura AK, Ehrenberg S, Myers KP. Promoting healthy food preferences from the start: a narrative review of food preference learning from the prenatal period through early childhood. Obes Rev 2018; 19:576-604. [PMID: 29266778 DOI: 10.1111/obr.12658] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/03/2017] [Accepted: 06/19/2017] [Indexed: 01/16/2023]
Abstract
The palatable, energy-dense foods that characterize modern environments can promote unhealthy eating habits, along with humans' predispositions to accept sweet tastes and reject those that are sour or bitter. Yet food preferences are malleable, and examining food preference learning during early life can highlight ways to promote acceptance of healthier foods. This narrative review describes research from the past 10 years focused on food preference learning from the prenatal period through early childhood (ages 2-5 years). Exposure to a variety of healthy foods from the start, including during the prenatal period, early milk-feeding and the introduction to complementary foods and beverages, can support subsequent acceptance of those foods. Yet development is plastic, and healthier food preferences can still be promoted after infancy. In early childhood, research supports starting with the simplest strategies, such as repeated exposure and modelling, reserving other strategies for use when needed to motivate the initial tasting necessary for repeated exposure effects to begin. This review can help caregivers and practitioners to promote the development of healthy food preferences early in life. Specific implementation recommendations, the role of individual differences and next steps for research in this area are also discussed.
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Affiliation(s)
- S Anzman-Frasca
- Department of Pediatrics, University at Buffalo, Buffalo, NY, USA
| | - A K Ventura
- Department of Kinesiology, California Polytechnic State University, San Luis Obispo, CA, USA
| | - S Ehrenberg
- Department of Pediatrics, University at Buffalo, Buffalo, NY, USA
| | - K P Myers
- Department of Psychology, Bucknell University, Lewisburg, PA, USA
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Moens E, Goossens L, Verbeken S, Vandeweghe L, Braet C. Parental feeding behavior in relation to children's tasting behavior: An observational study. Appetite 2018; 120:205-211. [PMID: 28864254 DOI: 10.1016/j.appet.2017.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 07/13/2017] [Accepted: 08/28/2017] [Indexed: 12/19/2022]
Abstract
Children's eating habits are shaped in part by parental feeding practices. While maladaptive practices have already received a lot of research attention, the effects of adaptive strategies, especially in elementary school aged children of different weight status, are less examined. This study examines how parents (1) model and (2) encourage their child to taste an unknown food. Thereby, attention is paid to the distinction between encouraging what (i.e. adaptive type of encouragement) and the amount (i.e. maladaptive type of encouragement) children eat/drink. Twenty-five families with a child with overweight and 30 families with a child of healthy weight (7-13 years) participated in a taste task. Both the child's tasting behavior and the parents' modelling and encouragement behavior were observed and related to the child's age and weight status. As 94.3% of the children tasted the unknown food, weight status differences between tasters and non-tasters could not be investigated. Only 26.9% of the parents used modelling to enhance tasting behavior; this was unrelated to age and weight status. 77.4% of the parents encouraged their children to taste (encouragement of what children eat/drink), and this was significantly more prevalent in parents of younger children and of healthy-weight children. 21.1% of the parents also encouraged their children to finish the juice (encouragement of amount children eat/drink) and this was also more prevalent in parents of the healthy-weight group. These results evidenced that parental modelling is not often used to enhance tasting behavior in children. In contrast, parental encouragement was frequently observed, especially in parents of younger children and of healthy-weight children. Encouragement, however, seems difficult to measure and more research on adaptive parental encouragement is needed.
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Affiliation(s)
- Ellen Moens
- Department of Developmental & Personality Psychology, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium.
| | - Lien Goossens
- Department of Developmental & Personality Psychology, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium
| | - Sandra Verbeken
- Department of Developmental & Personality Psychology, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium
| | - Laura Vandeweghe
- Department of Developmental & Personality Psychology, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium
| | - Caroline Braet
- Department of Developmental & Personality Psychology, Ghent University, H. Dunantlaan 2, 9000 Ghent, Belgium
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15
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Eating behavior traits associated with demographic variables and implications for obesity outcomes in early childhood. Appetite 2017; 120:482-490. [PMID: 29024677 DOI: 10.1016/j.appet.2017.10.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/19/2017] [Accepted: 10/04/2017] [Indexed: 11/21/2022]
Abstract
Despite ongoing investigation of children's eating behaviors to better understand the etiology of childhood obesity, few studies have aimed to determine differences in eating behavior based on psycho-social variables reflective of 'stressful' life circumstance. Cross-sectional data collected from parents of 977 Australian children (2.0-5.0 years) in an online survey was used to determine associations between parent-reported Children's Eating Behavior Questionnaire [CEBQ] sub-scales, child BMI z-scores and psycho-social variables. When examined individually, all CEBQ sub-scales, except Slowness in Eating, were associated with BMI z-score (Food Responsiveness B = 0.226, p = 0.003, Enjoyment of Food B = 0.169, p = 0.035, Food Fussiness B = -0.139, p = 0.024, Satiety Responsiveness B = -0.318, p = 0.001). On examining CEBQ sub-scales along with psycho-social demographic variables, only Food Responsiveness and Satiety Responsiveness were retained, along with being a boy, child age, and parent BMI. Food Responsiveness was positively associated with parental stress and child age and negatively with parent BMI, while Enjoyment of Food was positively associated with child sleep duration, single parent status, and negatively with breastfeeding less than 6 months and parental depression. Satiety Responsiveness was positively associated with parent BMI and child age, and negatively with child sleep duration, while Food Fussiness was positively associated with child age and breastfeeding less than 6 months, and negatively with sleep duration, parental depression and single parent status. Attention to eating behaviors and associated psycho-social variables may provide opportunity for targeted obesity prevention initiatives.
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16
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Walton K, Kuczynski L, Haycraft E, Breen A, Haines J. Time to re-think picky eating?: a relational approach to understanding picky eating. Int J Behav Nutr Phys Act 2017; 14:62. [PMID: 28476160 PMCID: PMC5420103 DOI: 10.1186/s12966-017-0520-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/26/2017] [Indexed: 01/28/2023] Open
Abstract
Background Estimates of picky eating are quite high among young children, with 14-50% of parents identifying their preschoolers as picky eaters. Dietary intake and preferences during the preschool years are characterized by slowing growth rates and children developing a sense of autonomy over their feeding and food selection. We argue that the current conceptualization of picky eating defines acts of resistance or expressions of preference (acts of autonomy) by a child as deviant behaviour. This conceptualization has guided research that uses a unidirectional, parent to child approach to understanding parent-child feeding interactions. Objectives By reviewing the current feeding literature and drawing parallels from the rich body of child socialization literature, we argue that there is a need to both re-examine the concept and parent/clinician perspectives on picky eating. Thus, the objective of this paper is two-fold: 1) We argue for a reconceptualization of picky eating whereby child agency is considered in terms of eating preferences rather than categorized as compliant or non-compliant behaviour, and 2) We advocate the use of bi-directional relational models of causality and appropriate methodology to understanding the parent-child feeding relationship. Discussion Researchers are often interested in understanding how members in the parent-child dyad affect one another. Although many tend to focus on the parent to child direction of these associations, findings from child socialization research suggest that influence is bidirectional and non-linear such that parents influence the actions and cognitions of children and children influence the actions and cognitions of parents. Bi-directional models of causality are needed to correctly understand parent-child feeding interactions. Conclusions A reconceptualization of picky eating may elucidate the influence that parental feeding practices and child eating habits have on each other. This may allow health professionals to more effectively support parents in developing healthy eating habits among children, reducing both stress around mealtimes and concerns of picky eating.
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Affiliation(s)
- Kathryn Walton
- Department of Family Relations and Applied Nutrition, University of Guelph, 50 Stone Rd. E, Guelph, ON, N1G 2W1, Canada.
| | - Leon Kuczynski
- Department of Family Relations and Applied Nutrition, University of Guelph, 50 Stone Rd. E, Guelph, ON, N1G 2W1, Canada
| | - Emma Haycraft
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Andrea Breen
- Department of Family Relations and Applied Nutrition, University of Guelph, 50 Stone Rd. E, Guelph, ON, N1G 2W1, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, 50 Stone Rd. E, Guelph, ON, N1G 2W1, Canada
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de Ridder D, Kroese F, Evers C, Adriaanse M, Gillebaart M. Healthy diet: Health impact, prevalence, correlates, and interventions. Psychol Health 2017; 32:907-941. [DOI: 10.1080/08870446.2017.1316849] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Denise de Ridder
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| | - Floor Kroese
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| | - Catharine Evers
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| | - Marieke Adriaanse
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
| | - Marleen Gillebaart
- Department of Social Health and Organizational Psychology, Utrecht University, Utrecht, The Netherlands
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Adding a reward increases the reinforcing value of fruit. Br J Nutr 2017; 117:611-620. [PMID: 28382893 DOI: 10.1017/s0007114517000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Adolescents' snack choices could be altered by increasing the reinforcing value (RV) of healthy snacks compared with unhealthy snacks. This study assessed whether the RV of fruit increased by linking it to a reward and if this increased RV was comparable with the RV of unhealthy snacks alone. Moderation effects of sex, hunger, BMI z-scores and sensitivity to reward were also explored. The RV of snacks was assessed in a sample of 165 adolescents (15·1 (sd 1·5) years, 39·4 % boys and 17·4 % overweight) using a computerised food reinforcement task. Adolescents obtained points for snacks through mouse clicks (responses) following progressive ratio schedules of increasing response requirements. Participants were (computer) randomised to three experimental groups (1:1:1): fruit (n 53), fruit+reward (n 60) or unhealthy snacks (n 69). The RV was evaluated as total number of responses and breakpoint (schedule of terminating food reinforcement task). Multilevel regression analyses (total number of responses) and Cox's proportional hazard regression models (breakpoint) were used. The total number of responses made were not different between fruit+reward and fruit (b -473; 95 % CI -1152, 205, P=0·17) or unhealthy snacks (b410; 95 % CI -222, 1043, P=0·20). The breakpoint was slightly higher for fruit than fruit+reward (HR 1·34; 95 % CI 1·00, 1·79, P=0·050), whereas no difference between unhealthy snacks and fruit+reward (HR 0·86; 95 % CI 0·62, 1·18, P=0·34) was observed. No indication of moderation was found. Offering rewards slightly increases the RV of fruit and may be a promising strategy to increase healthy food choices. Future studies should however, explore if other rewards, could reach larger effect sizes.
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Palatable food consumption in children: interplay between (food) reward motivation and the home food environment. Eur J Pediatr 2017; 176:465-474. [PMID: 28132093 DOI: 10.1007/s00431-017-2857-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 12/18/2016] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
UNLABELLED To understand the importance of the home food environment on unhealthy food consumption in children high in reward sensitivity, this study tested the hypothesis that the home availability of unhealthy food moderates the effect of reward sensitivity on children's fast-food consumption frequency, exerted via food cue responsiveness. Children between 7.5 and 14 years (n = 174, 50.6% boys) reported on reward sensitivity and food cue responsiveness (by means of the subscale 'external eating'). Their height and weight were measured. Parents reported on their children's fast-food consumption frequency, food cue responsiveness (by means of the subscale 'food responsiveness'), and on the home availability of unhealthy foods. Two moderated mediation models were conducted, one with the parent- and one with the child-reported food cue responsiveness as mediator. Findings suggested that with a high home availability of unhealthy foods, (a) a higher fast-food consumption frequency was found in children high in reward sensitivity and (b) the relation between reward sensitivity and the fast-food consumption frequency was mediated by external eating. CONCLUSIONS The findings point at the importance of the home food environment in children high in reward sensitivity. They suggest to limit the home availability of unhealthy foods. What is Known: • Reward sensitivity (RS) is positively associated with children's palatable food consumption • In adolescents, this effect is mediated by food cue responsiveness, which determines the strength of an individual's motivation to obtain food when perceiving food cues What is New: • Children high in RS may be more vulnerable to palatable food cues in their everyday food environment because of a higher food cue responsiveness • The home food environment may be an important determining factor of the palatable food consumption of these children.
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Reward sensitivity and body weight: the intervening role of food responsive behavior and external eating. Appetite 2017; 112:150-156. [PMID: 28108344 DOI: 10.1016/j.appet.2017.01.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 12/23/2016] [Accepted: 01/16/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND During the last three decades, the prevalence of childhood overweight and obesity has increased worldwide. It is well established that different child-related factors such as food approach behaviors (i.e. eating behaviors that imply movements towards food) contribute to the development of overweight. However, research is lacking on the underlying mechanisms leading to food approach behaviors, which in turn lead to overweight. SUBJECT/METHODS Via parent-report questionnaires, we investigated the relation between the personality trait reward sensitivity and body weight in a convenience sample of 211 children aged 2.5-9 years. We further investigated the intervening role of food approach behaviors in the association between reward sensitivity and body weight. RESULTS Unexpectedly, there was no direct association between reward sensitivity and body weight. Despite the absence of a direct effect, a significant indirect association was found between reward sensitivity and body weight through the intervening food approach variables (i.e. food responsive behavior and external eating). CONCLUSIONS These results highlight the importance of the focus on eating behaviors as well as trait characteristics in prevention programs for overweight.
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Vandeweghe L, Moens E, Braet C, Van Lippevelde W, Vervoort L, Verbeken S. Perceived effective and feasible strategies to promote healthy eating in young children: focus groups with parents, family child care providers and daycare assistants. BMC Public Health 2016; 16:1045. [PMID: 27716268 PMCID: PMC5050921 DOI: 10.1186/s12889-016-3710-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 09/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the current study is to identify strategies to promote healthy eating in young children that can be applied by caregivers, based on their own perceptions of effectiveness and feasibility. Whereas previous research mainly focused on parental influences on children's eating behavior, the growing role of other caregivers in the upbringing of children can no longer be denied. METHODS Four focus groups were conducted with three types of caregivers of post-weaning children under 6 years old: parents (n = 14), family child care providers (n = 9), and daycare assistants (n = 10). The audiotaped focus group discussions were transcribed and imported into Nvivo 10.0 for thematic analysis. The behaviors put forward by the caregivers were categorized within three broad dimensions: global influences, general behaviors, and specific feeding practices. RESULTS Perceived effective strategies to promote healthy eating behavior in children included rewards, verbal encouragement, a taste-rule, sensory sensations, involvement, variation, modeling, repeated exposure, and a peaceful atmosphere. Participants mainly disagreed on the perceived feasibility of each strategy, which largely depended on the characteristics of the caregiving setting (e.g. infrastructure, policy). CONCLUSIONS Based on former research and the current results, an intervention to promote healthy eating behaviors in young children should be adapted to the caregiving setting or focus on specific feeding practices, since these involve simple behaviors that are not hindered by the limitations of the caregiving setting. Due to various misconceptions regarding health-promoting strategies, clear instructions about when and how to use these strategies are necessary.
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Affiliation(s)
- Laura Vandeweghe
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Ellen Moens
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Wendy Van Lippevelde
- Department of Public Health, Ghent University, De Pintelaan 185, 9000 Ghent, Belgium
| | - Leentje Vervoort
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
| | - Sandra Verbeken
- Department of Developmental, Personality and Social Psychology, Ghent University, Henri Dunantlaan 2, 9000 Ghent, Belgium
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Vandeweghe L, Vervoort L, Verbeken S, Moens E, Braet C. Food Approach and Food Avoidance in Young Children: Relation with Reward Sensitivity and Punishment Sensitivity. Front Psychol 2016; 7:928. [PMID: 27445898 PMCID: PMC4919346 DOI: 10.3389/fpsyg.2016.00928] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/06/2016] [Indexed: 02/04/2023] Open
Abstract
It has recently been suggested that individual differences in Reward Sensitivity and Punishment Sensitivity may determine how children respond to food. These temperamental traits reflect activity in two basic brain systems that respond to rewarding and punishing stimuli, respectively, with approach and avoidance. Via parent-report questionnaires, we investigate the associations of the general motivational temperamental traits Reward Sensitivity and Punishment Sensitivity with Food Approach and Food Avoidance in 98 preschool children. Consistent with the conceptualization of Reward Sensitivity in terms of approach behavior and Punishment Sensitivity in terms of avoidance behavior, Reward Sensitivity was positively related to Food Approach, while Punishment Sensitivity was positively related to Food Avoidance. Future research should integrate these perspectives (i.e., general temperamental traits Reward Sensitivity and Punishment Sensitivity, and Food Approach and Avoidance) to get a better understanding of eating behavior and related body weight.
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Affiliation(s)
- Laura Vandeweghe
- Department of Developmental, Personality and Social Psychology, Ghent University Ghent, Belgium
| | - Leentje Vervoort
- Department of Developmental, Personality and Social Psychology, Ghent University Ghent, Belgium
| | - Sandra Verbeken
- Department of Developmental, Personality and Social Psychology, Ghent University Ghent, Belgium
| | - Ellen Moens
- Department of Developmental, Personality and Social Psychology, Ghent University Ghent, Belgium
| | - Caroline Braet
- Department of Developmental, Personality and Social Psychology, Ghent University Ghent, Belgium
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