Is it better at home with my family? The effects of people and place on children's eating behavior

Child food portion sizes in the home environment: how do parents decide?

The consumption of larger portion sizes (PS) of food has been implicated in the increased prevalence of childhood obesity. The home is usually the first place children learn about food, however, little is known about how parents determine child PS in the home environment. This narrative review aimed to explore parental beliefs, decisions, strategies and barriers to the provision of appropriate food PS for children in the home environment. Results indicate that parental decisions on child food PS are based on the amounts they serve themselves, personal intuition and knowledge of child appetite. Owing to the habitual nature of food provision, parental decisions on child PS may be taken without conscious thought and/or could be part of a complex decision-making process influenced by several interlinked factors, including parental childhood mealtime experiences, other family members and child weight status. Strategies to determine child-appropriate PS include modelling the desired PS behaviour, use of unit-based food packaging and PS estimation aids, and providing the child with a degree of autonomy to rely on their own appetite cues. A lack of knowledge/awareness of PS guidance is a key barrier identified by parents to the provision of age-appropriate PS, warranting the inclusion of salient child-appropriate PS guidance within national dietary recommendations. Further home-based interventions to improve the provision of appropriate child PS are required, leveraged on parental strategies already in use, as outlined in this review.

Influence of family parenting style on the formation of eating behaviors and habits in preschool children: The mediating role of quality of life and nutritional knowledge

To provide empirical support for understanding the effects of different family parenting styles on the development of preschool children's eating habits and to promote healthy child development. Using a randomized whole-group sampling method, full-time public kindergartens in three regions of China were selected as the study population of preschool children, and 1141 children's guardians in these regions were surveyed and evaluated. It was used to examine the differential effects of different family parenting styles (EMBU) on preschool children's eating behavior (CEBQ), while quality of survival (QLSCA) and nutritional literacy (NLS) played a mediating role in the process. The results showed that at the direct effect level, authoritative, authoritarian, coddling, and neglectful family parenting styles had significant effects on preschool children's eating behavior (-0.161 ≤ β ≤ 0.232, p < 0.05); at the indirect effect level, family survival quality (QLSCA), and nutritional literacy (NLS) under the influence of different family parenting styles (EMBU) on children's eating the total indirect effect was [OR] 0.273, 95%: CI 0.181-0.368. It is evident that it is imperative to develop good eating behaviors in children at preschool age.

Content and Validity of Claims Made about Food Parenting Practices in United Kingdom Online News Articles

The objective of this study was to qualitatively summarise the content of online news articles pertaining to food parenting practices and determine whether this content is substantiated by the scientific literature. News article data were identified and collected from United Kingdom online news published during 2010–2017 period using the News on the Web corpus. A coding framework was used to categorise the content of news articles to identify information related to food parenting practices. Then, claims made about food parenting practices were extracted from relevant news articles. Each claim was evaluated to determine the extent to which any claims were supported by the available scientific research evidence. The study identified ten claims across thirty-two relevant online news articles. Claims made across the news articles reported on the following food parenting practices: food restrictions, food-based threats and bribes, pressure to eat, use of food to control negative emotions, food availability, food preparation, and meal and snack routines. Eight out of the ten claims identified did not refer to scientific research evidence. News articles frequently lacked detail and information to explain to readers why and how the use of certain food parenting practices could have a lasting impact on children’s health outcomes. Considering the influence that news media has on parents, the reporting of food parenting practices in news articles should aim to provide a balanced view of the published scientific evidence and recognise the difficulties and barriers that prevent the use of helpful and healthy food parenting practices. The study results in this paper could be used to aid and structure of the dissemination of food parenting practice research findings in the media, inform public health education to influence perceptions of unhelpful food parenting practices, and promote parental use of responsive food parenting practices.

Frequency of family meals and food consumption in families at high risk of type 2 diabetes: the Feel4Diabetes-study

A family meal is defined as a meal consumed together by the members of a family or by having ≥ 1 parent present during a meal. The frequency of family meals has been associated with healthier food intake patterns in both children and parents. This study aimed to investigate in families at high risk for developing type 2 diabetes across Europe the association (i) between family meals' frequency and food consumption and diet quality among parents and (ii) between family meals' frequency and children's food consumption. Moreover, the study aimed to elucidate the mediating effect of parental diet quality on the association between family meals' frequency and children's food consumption. Food consumption frequency and anthropometric were collected cross-sectionally from a representative sample of 1964 families from the European Feel4Diabetes-study. Regression and mediation analyses were applied by gender of children. Positive and significant associations were found between the frequency of family meals and parental food consumption (β = 0.84; 95% CI 0.57, 1.45) and diet quality (β = 0.30; 95% CI 0.19, 0.42). For children, more frequent family meals were significantly associated with healthier food consumption (boys, β = 0.172, p < 0.05; girls, β = 0.114, p < 0.01). A partial mediation effect of the parental diet quality was shown on the association between the frequency of family meals and the consumption of some selected food items (i.e., milk products and salty snacks) among boys and girls. The strongest mediation effect of parental diet quality was found on the association between the frequency of family breakfast and the consumption of salty snacks and milk and milk products (62.5% and 37.5%, respectively) among girls.

CONCLUSIONS

The frequency of family meals is positively associated with improved food consumption patterns (i.e., higher intake of fruits and vegetables and reduced consumption of sweets) in both parents and children. However, the association in children is partially mediated by parents' diet quality. The promotion of consuming meals together in the family could be a potentially effective strategy for interventions aiming to establish and maintain healthy food consumption patterns among children.

TRIAL REGISTRATION

The Feel4Diabetes-study is registered with the clinical trials registry (NCT02393872), http://clinicaltrials.gov , March 20, 2015.

WHAT IS KNOWN

• Parents' eating habits and diet quality play an important role in shaping dietary patterns in children • Family meals frequency is associated with improved diet quality of children in healthy population What is New: • Frequency of family meals was significantly associated with healthier food consumption among parents and children in families at high risk of type 2 diabetes in six European countries. • Parental diet quality mediates the association between family meals frequency and the consumption of some selected food items among children.

Diet Quality of Australian Children and Adolescents on Weekdays versus Weekend Days: A Secondary Analysis of the National Nutrition and Physical Activity Survey 2011-2012

Daily routines may influence children and adolescents’ eating patterns, however the influence of days of the week on dietary intake has rarely been explored. This study aimed to examine discretionary choices intake in the context of diet quality on weekdays versus weekends. A secondary analysis was conducted using the Australian National Nutrition and Physical Activity Survey 2011–2012. Differences in discretionary choices intake and diet quality on weekdays versus weekends, were examined using ANCOVA analyses. Associations between child and parent-proxy characteristics and weekday/weekend discretionary choices intake were examined using multivariable regression models. Primary analyses included 2584 Australian 2–17-year-olds. There were small differences in discretionary choices intake and diet quality between weekdays and weekends in all age subgroups. Compared to weekdays, intakes on weekends were characterized by a higher intake of discretionary choices, and lower total Dietary Guidelines Index for Children and Adolescents (DGI-CA) scores across the age subgroups (all p < 0.01). Parent-proxy discretionary choices intake and child age were predictors of weekday and weekend discretionary choices intake. Parent-proxy obesity weight status compared with healthy weight status was a predictor of weekend intake, while parent-proxy education level was a predictor of weekday discretionary choices intake. Future intervention strategies should target discretionary choices intake on both weekdays and weekends.

Predictors of vegetable consumption in children and adolescents: analyses of the UK National Diet and Nutrition Survey (2008-2017)

Children's vegetable consumption is generally below national recommendations in the UK. This study examined predictors of vegetable intake by children aged 1·5-18 years using counts and portion sizes derived from 4-d UK National Diet and Nutrition Survey food diaries. Data from 6548 children were examined using linear and logit multilevel models. Specifically, we examined whether demographic variables predicted vegetable consumption, whether environmental context influenced portion sizes of vegetables consumed and which food groups predicted the presence (or absence) of vegetables at an eating occasion (EO). Larger average daily intake of vegetables (g) was predicted by age, ethnicity, equivalised income, variety of vegetables eaten and average energy intake per d (R2 0·549). At a single EO, vegetables were consumed in larger portion sizes at home, with family members and at evening mealtimes (Conditional R2 0·308). Within EO, certain configurations of food groups such as carbohydrates and protein predicted higher odds of vegetables being present (OR 12·85, 95 % CI 9·42, 17·54), whereas foods high in fats, sugars and salt predicted a lower likelihood of vegetable presence (OR 0·03, 95 % CI 0·02, 0·04). Vegetables were rarely eaten alone without other food groups. These findings demonstrate that only one portion of vegetables was eaten per d (median) and this was consumed at a single EO, therefore falling below recommendations. Future research should investigate ways to encourage vegetable intake at times when vegetables are not regularly eaten, such as for breakfast and as snacks, whilst considering which other, potentially competing, foods are presented alongside vegetables.

Association between parental attitudes towards their offspring's diet and children's actual dietary habits - The SENDO project

INTRODUCTION

the preschool stage is a critical period for teaching and modeling healthy habits to positively influence children's health and wellbeing throughout their lifetime.

OBJECTIVES

to evaluate the association between parental attitudes towards their offspring's dietary habits in Spanish children aged 4 to 7 years participating in the SEguimiento Del Niño para un Desarrollo Óptimo (SENDO) project.

METHODS

we defined an index to measure information on parental attitudes towards their offspring's diet (0 to 8 points), and another one to measure children's actual dietary habits (0 to 19 points). A higher score meant healthier attitudes and healthier habits, respectively. Information was collected through an online questionnaire completed by parents. We calculated crude and multivariable-adjusted odds ratios (OR) and 95 % confidence intervals (CI) for children's healthy dietary habits associated with parental scores in the parental attitudes index. Generalized estimation equations (GEE) were used to account for intra-cluster correlation between siblings.

RESULTS

a total of 423 preschoolers (52.3 % boys, mean age 5.3 years) were included in the analyses. Half of the children (51 %) reported unhealthy dietary habits, whereas 56 % of parents reported high adherence to the healthy eating index. Compared to those in the lowest category, the children whose parents were in the highest category in the parental attitudes index showed significantly higher odds of having healthy dietary habits (OR: 2.91; 95 % CI: 1.30-6.53, p for trend = 0.004).

CONCLUSIONS

our results support a direct association between parental attitudes and their offspring's dietary habits, suggesting that public health interventions aimed at improving children's dietary habits should shift from the individual- to a family-based approach.

Interventions to Promote Healthy Meals in Full-Service Restaurants and Canteens: A Systematic Review and Meta-Analysis

Out-of-home eating is increasing, but evidence about its healthiness is limited. The present systematic review and meta-analysis aimed to elucidate the effectiveness of full-service restaurant and canteen-based interventions in increasing the dietary intake, food availability, and food purchase of healthy meals. Studies from 2000-2020 were searched in Medline, Scopus, and Cochrane Library using the PRISMA checklist. A total of 35 randomized controlled trials (RCTs) and 6 non-RCTs were included in the systematic review and analyzed by outcome, intervention strategies, and settings (school, community, workplace). The meta-analysis included 16 RCTs (excluding non-RCTs for higher quality). For dietary intake, the included RCTs increased healthy foods (+0.20 servings/day; 0.12 to 0.29; p < 0.001) and decreased fat intake (-9.90 g/day; -12.61 to -7.19; p < 0.001), favoring the intervention group. For food availability, intervention schools reduced the risk of offering unhealthy menu items by 47% (RR 0.53; 0.34 to 0.85; p = 0.008). For food purchases, a systematic review showed that interventions could be partially effective in improving healthy foods. Lastly, restaurant- and canteen-based interventions improved the dietary intake of healthy foods, reduced fat intake, and increased the availability of healthy menus, mainly in schools. Higher-quality RCTs are needed to strengthen the results. Moreover, from our results, intervention strategy recommendations are provided.

Understanding the food-family relationship: A qualitative research in a Chilean low socioeconomic context

Our life is comprised of, among other things, many food and eating decisions. Therefore, we are in a constant relationship with food. Although many health providers and researchers have recommended having a positive relationship with food for better health and well-being, what the human relationship with food entails is still unclear. The aim of this study is to explore the relationship with food among families in Chile, a country that has the highest rate of obesity among OECD countries. In this qualitative study, we conducted eight focus groups in three regions of Chile (North, Center, and South). We recruited women living with their partners and children who represented the family point of view. For data analysis, we used the Atlas.ti program and conducted a thematic analysis. We found that the family relationship with food had five dimensions: (1) An identity dimension that allowed families to describe themselves or some of their family members; (2) an emotional dimension in which family expressed feelings and emotions through food; (3) a social dimension in which family members got together through food; (4) a health dimension in which family related to food to obtain benefits from it or to avoid enemy food; (5) a practical dimension in which families were organized around food tasks. Our findings show that the relationship that Chilean families have with food is a complex phenomenon. All the dimensions should be taken in consideration to create or improve interventions that seek to improve eating habits or prevent nutrition-related diseases from a family perspective.

Automatic, wearable-based, in-field eating detection approaches for public health research: a scoping review

Dietary intake, eating behaviors, and context are important in chronic disease development, yet our ability to accurately assess these in research settings can be limited by biased traditional self-reporting tools. Objective measurement tools, specifically, wearable sensors, present the opportunity to minimize the major limitations of self-reported eating measures by generating supplementary sensor data that can improve the validity of self-report data in naturalistic settings. This scoping review summarizes the current use of wearable devices/sensors that automatically detect eating-related activity in naturalistic research settings. Five databases were searched in December 2019, and 618 records were retrieved from the literature search. This scoping review included N = 40 studies (from 33 articles) that reported on one or more wearable sensors used to automatically detect eating activity in the field. The majority of studies (N = 26, 65%) used multi-sensor systems (incorporating > 1 wearable sensors), and accelerometers were the most commonly utilized sensor (N = 25, 62.5%). All studies (N = 40, 100.0%) used either self-report or objective ground-truth methods to validate the inferred eating activity detected by the sensor(s). The most frequently reported evaluation metrics were Accuracy (N = 12) and F1-score (N = 10). This scoping review highlights the current state of wearable sensors' ability to improve upon traditional eating assessment methods by passively detecting eating activity in naturalistic settings, over long periods of time, and with minimal user interaction. A key challenge in this field, wide variation in eating outcome measures and evaluation metrics, demonstrates the need for the development of a standardized form of comparability among sensors/multi-sensor systems and multidisciplinary collaboration.

Feasibility and Acceptability of a Culturally Tailored Website to Increase Fruit and Vegetable Intake and Physical Activity Levels in African American Mother-Child Dyads: Observational Study

BACKGROUND

African American youth (aged 8-14 years) do not adhere to national dietary and physical activity guidelines. Nonadherence to these recommendations contributes to disproportionate rates of obesity compared with their white counterparts. Culturally tailored electronic health (eHealth) solutions are needed to communicate nutrition and physical activity messages that resonate with this target population.

OBJECTIVE

This study aimed to identify the impact of exposure to a website hosting culturally tailored cartoons to inspire fruit and vegetable uptake and physical activity levels in African American mother-child dyads.

METHODS

Statistical analysis included paired sample t tests to evaluate knowledge gains, self-efficacy, and readiness to change. Adapted items from Prochaska's Stages of Change toward the following 4 behaviors were assessed with pre- and posttest surveys: (1) fruit and vegetable selection on my plate, (2) meal preparation, (3) fruit and vegetable selection outside of home, and (4) physical activity. Open-ended comments on videos from mother-child dyads were used to determine user acceptance. Observations of repeated responses during content analysis informed coding and development of key themes.

RESULTS

A final sample size of 93 mother-child dyads completed the study. Mothers reported significant improvement from precontemplation or contemplation stages to preparation or action stages for (1) fruit and vegetable selection on her plate (P=.03), (2) meal preparation for her family (P=.01), (3) fruit and vegetable selection outside the home (P<.001), and (4) physical activity (P<.001). Significant improvements were found in knowledge, stage of change, and self-efficacy for the 4 target behaviors of interest (P<.001). Children's open-ended commentary reported vicarious learning and positive character identification with brown-skinned cartoons exhibiting healthful food and exercise behaviors. Mothers commented on the lack of accessible produce in their neighborhoods not depicted in the cartoon videos.

CONCLUSIONS

Culturally adapted cartoons that incorporate tailored preferences by African American families, such as race or demography, may help increase adherence to target health behaviors when developing eHealth behavior solutions.

The Associations between Body Mass Index of Seven- and Eight-Year-Old Children, Dietary Behaviour and Nutrition-Related Parenting Practices

Background and objective: Body mass index (BMI) is one of the key indicators used to measure the growth of children. It could be affected by the children’s nutrition, which is essential for the proper development of the child. Nutrition of children could be affected by many environmental factors, for example, the socioeconomic environment of the family. The aim of this study was to identify the associations between the BMI of seven- and eight-year-old children, dietary behaviour and nutrition-related parenting practices. Materials and Methods: The study was carried out as part of the World Health Organization European Childhood Obesity Surveillance Initiative (WHO COSI). Data were collected using two instruments: objective anthropometric measurements and a questionnaire. The target participant group was 3969 Lithuanian first-formers. Factor analysis was used to summarise questions from the family form. Linear regression analysis was used to identify the associations between various factors and the BMI value of the children. The association between two groups of factors was analysed using Spearman correlation. Results: Factors of dietary behaviour like unhealthy food and proteins were significantly positively associated with BMI in children, while consumption of plant-based, dairy and confectionery items was significantly negatively associated with BMI. Factors of nutrition-related parenting practices like control of unhealthy food, food as a reward or punishment, and mealtime were significantly positively associated with BMI, while encouragement, pressure to eat, and liberal attitude were significantly negatively associated with BMI. The strongest associations were between control of unhealthy food and unhealthy food; cost of and preferences for food and plant-based food; variety of food and proteins; variety of food and plant-based food compared to other associations. Conclusions: The dietary behaviour and nutrition-related parenting practices were associated with BMI in children.