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Wang J, Cao Y, Wei X, Winkley K, Chang YS. Empowering parents to optimize feeding practices with preschool children (EPO-Feeding): A study protocol for a feasibility randomized controlled trial. PLoS One 2024; 19:e0304707. [PMID: 38829882 PMCID: PMC11146728 DOI: 10.1371/journal.pone.0304707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Parental feeding practices (PFPs) play a key role in fostering preschoolers' dietary habits and in mitigating the risk of childhood obesity. Nevertheless, parents often employ inappropriate feeding practices, leading to children's potential nutrition-related issues. Thus, research is needed to inform interventions that focus on optimizing feeding practices. METHODS This protocol describes the evaluation of a novel intervention-Empowering Parents to Optimize Feeding Practices (EPO-Feeding Program). The program will be evaluated with a two-arm feasibility randomized controlled trial (RCT) in Yangzhou, China. The program includes four weekly group-based training sessions led by healthcare professionals for parents of preschool children. The intervention incorporates sessions, group discussions, motivational interviewing, and supplementary materials (e.g., key messages and educational videos) aimed at enhancing parents' knowledge, skills, and behaviours related to feeding practices. The primary outcomes include i) implementation feasibility, primarily assessed through retention rates; and ii) program acceptability through a survey and qualitative process evaluation. Secondary outcomes encompass the potential impacts on i) PFPs, ii) parental perception of child weight (PPCW), iii) parenting sense of competence, iv) children's eating behaviours, and v) child weight status. Quantitative analyses include descriptive estimates for evaluating the feasibility and linear mixed regression analysis for testing the potential effects. Qualitative valuation will use thematic framework analysis. DISCUSSION If this study shows this program to be feasible to implement and acceptable to parents, it will be used to inform a fully powered trial to determine its effectiveness. The research will also help inform policy and practices in the context of child nutrition promotion, particularly regarding implementing group-based training sessions by healthcare providers in similar settings. TRIAL REGISTRATION Clinicaltrials.gov, Protocol #NCT06181773, 20/11/2023.
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Affiliation(s)
- Jian Wang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Xiaoxue Wei
- Department of Hematology and Oncology, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Kirsty Winkley
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
| | - Yan-Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, United Kingdom
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Wang J, Wu R, Wei X, Chang YS, Tang X, Zhu B, Cao Y, Wu Y, Zhu D. Bidirectional Associations between Parental Feeding Practices and Child Eating Behaviors in a Chinese Sample. Nutrients 2023; 16:44. [PMID: 38201874 PMCID: PMC10780825 DOI: 10.3390/nu16010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Child eating behaviors (CEBs) and parental feeding practices (PFPs) play critical roles in childhood obesity. However, the bidirectional relationships between CEBs and PFPs remain equivocal. This longitudinal study aimed to explore their bidirectional relationships. METHODS A convenience sample of 870 parents with preschoolers was recruited in this longitudinal study (Shanghai, China). Three non-responsive feeding practices (NFPs), three responsive feeding practices (RFPs), five CEBs, and covariates were collected using validated questionnaires at baseline and the 6-month follow-up. Cross-lagged analyses using structural equation modeling (SEM) were performed to examine their bidirectional relationships. RESULTS Eight hundred and fifty-three parents completed questionnaires, with a response rate of 98%. The mean age of their children at baseline was 4.39 years (standard deviation = 0.72 years). Eighteen out of sixty longitudinal cross-lagged paths were statistically significant. Parental encouragement of healthy eating and content-restricted feeding were found to be bidirectionally associated with child food fussiness. Four parent-driven associations and one child-driven association were identified between RFPs and CEBs. For example, monitoring was negatively associated with children's unhealthy eating habits (β = -0.066, standard error (SE) = 0.025, p < 0.01). Eight child-driven associations and one parent-driven association were observed between NFPs and CEBs. For example, higher child satiety responsiveness predicted a higher pressure to eat (β = 0.057, SE = 0.029, p < 0.01) and the use of food as a reward (β = 0.083, SE = 0.031, p < 0.01). CONCLUSIONS There were bidirectional, parent-driven, and child-driven associations. Parents should be encouraged to adopt RFPs to shape CEBs. Increasing parents' understanding of CEBs and providing them with reasonable coping strategies would help optimize PFPs.
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Affiliation(s)
- Jian Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (R.W.); (X.W.); (B.Z.)
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK;
| | - Ruxing Wu
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (R.W.); (X.W.); (B.Z.)
| | - Xiaoxue Wei
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (R.W.); (X.W.); (B.Z.)
| | - Yan-Shing Chang
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London SE1 8WA, UK;
| | - Xianqing Tang
- Department of Children’s Disease Prevention, Jinyang Community Health Service Center, Shanghai 200136, China;
| | - Bingqian Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (R.W.); (X.W.); (B.Z.)
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 70182 Örebro, Sweden;
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Yinghui Wu
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (R.W.); (X.W.); (B.Z.)
| | - Daqiao Zhu
- School of Nursing, Shanghai Jiao Tong University, Shanghai 200025, China; (J.W.); (R.W.); (X.W.); (B.Z.)
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Ishikawa M, Morinaga Y, Haraikawa M, Akiyama Y, Sasaki K, Horie S, Yoshiike N, Yamazaki Y, Yokoyama T. Gap between the concerns of healthcare professionals and parents' perceptions regarding dietary habits for 18-month- and 3-year-old children in Japan. BMC Public Health 2023; 23:1891. [PMID: 37777710 PMCID: PMC10544123 DOI: 10.1186/s12889-023-16743-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/12/2023] [Indexed: 10/02/2023] Open
Abstract
BACKGROUND A gap has been reported between healthcare professionals' (hereafter "professionals") recognition of preschool children's diets and parents' perception of concern. This study investigated the gap between the concerns reported by professionals and parents' perceptions regarding health and dietary habits by age (18 months and 3 years) and gender in Japan. METHODS The study design consisted of a cross-sectional, multilevel survey. The request letters were sent to all households with target children with the cooperation of local governments. After obtaining written informed consent from parents, questionnaires were distributed to them. The survey included 30 items on children's concerns about health and dietary habits. At the health checkup, parents indicated whether they were concerned in response to each item, and responded child's height and weight and birth height and weight. Next, the professionals provided counseling to the parents at a health checkup. After that, the professionals noted their concerns in response to the same 30 items as those given to parents. The participation rates were 82.9% (18 months) and 82.8% (3 years). Data of 239 persons for 18 months and 223 persons for 3 years old were analyzed. In the statistical analysis, the items that were judged as concerning by professionals but not by parents were identified; likewise, the items that were of concern to parents but not to professionals were identified. Sensitivity, false negative rate, specificity, false positive rate, and Youden index were calculated to analyze the discordance rate for each item. RESULTS Many parents in this study were concerned about the issues that professionals did not consider to be concerning. Moreover, the parents worried about more issues for 3-year-olds than for 18-month-olds. The items for which ≥ 10 professionals indicated concerns and with higher discordance between the professionals and parents for both boys and girls were "picky eating" for 18-month-olds and "inconsistent amount of food" for 3-year-olds. CONCLUSIONS The concerns that professionals have with respect to children's diets and the things that parents worry about show gaps. It might be necessary to provide professional counseling for parents to develop a correct understanding of their children's dietary habits.
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Affiliation(s)
- Midori Ishikawa
- Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan.
| | - Yumiko Morinaga
- Department of Nursing Science, Faculty of Health and Welfare Science, Okayama Prefectural University, 111 Kuboki, Soja-Shi, Okayama, 719-1197, Japan
| | - Mayu Haraikawa
- Department of Child Studies, Faculty of Education, Seitoku University, 550 Iwase, Matsudo, Chiba, 271-8555, Japan
| | - Yuka Akiyama
- Department of Health Sciences, School of Medicine, University of Yamanashi, 1110, Shimokato, Chuo, Yamanashi, 409-3898, Japan
| | - Kemal Sasaki
- Department of Food and Health Sciences, Faculty of Human Life Sciences, Jissen Women's University, 4-1-1 Osakaue, Hino, Tokyo, 191-8510, Japan
| | - Saki Horie
- Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan
| | - Nobuo Yoshiike
- Graduate School of Health Sciences, Aomori University of Health and Welfare, 58-1 Mase, Hamadate, Aomori, 030-8505, Japan
| | - Yoshihisa Yamazaki
- Child Health Center, Aichi Children's Health and Medical Center, 426-7 Morioka, Obu, Aichi, 474-8710, Japan
| | - Tetsuji Yokoyama
- Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan
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Liu Y, Yu G, Li Z, Kong Y, Yang R, Yin C, Sun X. A Responsive Feeding Questionnaire Based on Self-Determination Theory for Caregivers of Chinese Toddlers. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:447-456. [PMID: 37032195 DOI: 10.1016/j.jneb.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 02/20/2023] [Accepted: 02/24/2023] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To develop and test the psychometric properties of a responsive feeding questionnaire (RFQ) on the basis of Self-Determination Theory for caregivers of toddlers aged 12-24 months in China. DESIGN Item generation, preliminary evaluation items, refinement questionnaire, and psychometric properties testing. SETTING Toddlers' caregivers from Shandong Province, China, were surveyed online between June 2021 and February 2022 (n = 616). MAIN OUTCOME MEASURE Content, face, and construct validity and reliability of the RFQ. ANALYSIS Content validity was performed on the basis of expert panel feedback and cognitive interviews among caregivers. Construct validity was evaluated using principal component analysis with varimax rotation. Test-retest reliability was conducted with a sample of 105 caregivers. RESULTS Over 3 phases of testing, a new instrument was developed to measure responsive feeding in toddler caregivers. The instrument was reliable, with an internal consistency of 0.87 and an intraclass correlation of 0.92. The principal component analysis identified a 3-factor solution (autonomy support, positive involvement, appropriate response) aligning with a theoretical framework from Self-Determination Theory. The final version of the instrument included 23 items. CONCLUSIONS AND IMPLICATIONS The 23-item RFQ has been validated in a Chinese population. Future research needs to validate this instrument in other countries and with children of different ages.
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Affiliation(s)
- Yan Liu
- School of Nursing, Qingdao University, Qingdao, Shandong, China.
| | - Guiling Yu
- Qingdao Women and Children's Hospital, Qingdao, Shandong, China.
| | - Zhihui Li
- Qingdao Women and Children's Hospital, Qingdao, Shandong, China
| | - Yan Kong
- Qingdao Women and Children's Hospital, Qingdao, Shandong, China
| | - Rui Yang
- School of Nursing, Qingdao University, Qingdao, Shandong, China
| | - Chunlan Yin
- Qingdao Women and Children's Hospital, Qingdao, Shandong, China
| | - Xiaodi Sun
- School of Nursing, Qingdao University, Qingdao, Shandong, China
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Le Q, Greaney ML, Lindsay AC. Nonresponsive Parenting Feeding Styles and Practices and Risk of Overweight and Obesity among Chinese Children Living Outside Mainland China: An Integrative Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4090. [PMID: 36901101 PMCID: PMC10002266 DOI: 10.3390/ijerph20054090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Chinese immigrants are a fast-growing population group in many parts of the world. Childhood obesity is increasingly a public health problem among Chinese living outside mainland China. Evidence suggests that parenting feeding styles and practices critically influence children's eating behaviors and risk of being overweight or obese. Therefore, the objectives of this review were to identify and synthesize the evidence from studies examining the associations between parenting feeding styles, feeding practices, and risk of overweight and obesity among children of Chinese parents outside mainland China. A systematic search of four electronic databases (CINAHL, Medline, PsycINFO, and PubMed) was conducted to identify peer-reviewed studies published in English between January 2000 and March 2022. Fifteen studies met the inclusion criteria and were included in the review. Findings of some of the reviewed studies showed that parenting feeding styles and practices varied according to children's age, gender, weight, and parents' acculturation levels. The two most identified parenting feeding styles were indulgent and authoritarian. Parents classified as having indulgent and/or authoritarian feeding styles reported using several feeding practices with unintended detrimental effects, such as pressuring children to eat and restricting or controlling child food intake (type and amount). Some of these feeding practices were associated with an increased risk of child overweight. The findings of this review provide important information that can inform the design interventions to address modifiable nonresponisve parental feeding practices such as pressuring, restricting, and controlling that meet the specific needs of Chinese parents and children outside mainland China.
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Affiliation(s)
- Qun Le
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA 01854, USA
| | - Mary L. Greaney
- Department of Health Studies, University of Rhode Island, Kingston, RI 02881, USA
| | - Ana Cristina Lindsay
- Department of Exercise and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA
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The correlation between different operationalisations of parental restrictive feeding practices and children's eating behaviours: Systematic review and meta-analyses. Appetite 2023; 180:106320. [PMID: 36210017 DOI: 10.1016/j.appet.2022.106320] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/05/2022] [Accepted: 09/23/2022] [Indexed: 12/12/2022]
Abstract
Strategies used by parents to restrict children's access to highly palatable but unhealthy foods have been described collectively as restrictive feeding practices. Ironically, evidence shows these practices may foster maladaptive eating behaviours and increase children's risk of obesity. This systematic review and series of meta-analyses aim to estimate the relationships between different operationalisations of parental restrictive feeding practices and children's eating behaviours measured by either the Children's Eating Behaviour Questionnaire (Wardle et al., 2001) or eating in the absence of hunger paradigm. PsycINFO, Medline Complete, CINAHL, Scopus and Web of Science databases were searched on April 22nd 2021 for terms relating to restrictive feeding practices, children and eating behaviours. Eligible studies (n = 24) reported a correlation between restrictive feeding and children's (2-12-years) eating behaviours. Meta-analyses were conducted on different operationalisations of restrictive feeding practices and different eating behaviours where there were three or more effects to analyse. Studies that were not meta-analysed were synthesised qualitatively. All studies were quality assessed using a standard checklist. Restrictive feeding (Child Feeding Questionnaire; Birch et al., 2001), was significantly correlated with higher food responsiveness, food fussiness, emotional overeating, and lower slowness in eating. Overt restriction (Feeding Practices and Structure Questionnaire, E. Jansen et al., 2014) was significantly correlated with higher food responsiveness. The qualitative synthesis suggests overt restriction is related to maladaptive eating behaviours, but that other operationalisations of restrictive feeding, especially covert restriction, are not. Future research should examine whether covert restriction provides an alternative, non-harmful approach to restriction, by which parents can control children's diet quality without negatively impacting their eating behaviours.
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Lv Y, Wu M, Ma C, Hao X, Zeng X. Assessment of the status quo of social responsibility performance of inclusive kindergartens: Evidence from China. PLoS One 2022; 17:e0272742. [PMID: 36441714 PMCID: PMC9704561 DOI: 10.1371/journal.pone.0272742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Abstract
China is determined to accomplish universal preschool education by asking the kindergartens to participate in social responsibility programs. This study intends to assess the level of participation of inclusive kindergartens in social responsibility programs. This study uses the Delphi expert method, integrated ISO26000 International Standard Guidelines for Social Responsibility, CSR (Corporate Social Responsibility) Scale, and the characteristics of the preschool education industry to construct a social responsibility evaluation model for inclusive kindergartens. It includes five dimensions (responsibility management, customer responsibility, employee responsibility, social service, and organizational responsibility) to show the social responsibility status of kindergartens. Data was collected from 832 respondents from 27 provinces, cities, and regions in China. This study reveals that the overall performance of social responsibility of inclusive kindergarten (3.67) is better, while organization responsibility (3.91) shows the highest performance. In comparison, customer (3.63) and staff responsibility (3.63) deliver average performance, and responsibility management (3.56) offers lower performance. The statistical analysis shows that the nature of kindergartens, whether inclusive or not, the number of classes, years of establishment, the distribution area, and performance are different. Kindergartens should have certain social values, including specific behaviors and participating in social activities in the spirit of social service. They should ensure preschool teacher's professional and vocational development through multiple subjects' synergetic governance. In addition to fulfilling the teachers' social responsibility and professional development, the findings can put forward the cooperation with the government, social organizations, and kindergartens to improve teachers' professional quality and social responsibility.
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Affiliation(s)
- Yang Lv
- College of Teachers, Chengdu University, Chengdu, China
| | - Min Wu
- School of Public Administration, Sichuan University, Chengdu, China
- * E-mail:
| | - Chenwei Ma
- School of Public Administration, Sichuan University, Chengdu, China
| | - Xinxin Hao
- School of Public Administration, Sichuan University, Chengdu, China
| | - Xun Zeng
- School of Management, Sichuan University of Science and Engineering, Zigong, China
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Understanding the perceptions of parents and preschool principals on the determinants of weight management among Iranian preschoolers: A directed qualitative content analysis. PLoS One 2022; 17:e0270244. [PMID: 35737692 PMCID: PMC9223302 DOI: 10.1371/journal.pone.0270244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/07/2022] [Indexed: 11/19/2022] Open
Abstract
The current study aimed to understand the perceptions and experiences of Iranian parents and principals of preschool children on weight management based on the PRECEDE-PROCEED Model (PPM), a comprehensive structure for assessing health needs for designing, implementing, and evaluating health promotion, and other public health programs. PRECEDE provides a structure for planning a targeted and focused public health program, and PROCEED provides a structure for implementing and evaluating the program. Data were gathered from 17 preschoolers’ parents and two principals using semi-structured interviews in the preschool setting in Tehran, the capital of Iran, in 2019. Data were analyzed manually through directed content analysis based on constructs in phases two and three of the PPM, simultaneously with data collection. This study identified genetic, behavioral (e.g., food preferences, physical activity, sedentary behaviors, the effect of parents’, peers’, principals’ and teachers’ behavior and also influence of grandparents’ and neighbors’ behaviors) and environmental (e.g., home, grandparents’ home and preschool) factors from the epidemiological construct. Also, predisposing (e.g., child’s attitude, parent’s and principals’ attitude, as well as parents’ knowledge and parents’ and principals’ beliefs), enabling (e.g., parental skills and skills of the principals and teachers, rules and laws in the preschools, and availability), and reinforcing (e.g., family support and influences, teachers’ encouragement and influences, and peers’ influences) factors were identified from the educational and ecological construct. Additionally, “quality of child-parent relationship” was determined as a new factor affecting preschoolers’ weight management promotion; however, it was not in the PPM. In the study, parents’ and principals’ experiences regarding preschoolers’ weight management promotion confirmed the genetic, behavioral, environmental, predisposing, enabling and reinforcing factors of the PPM. “Quality of child-parent relationship” factor may be related to the culture and family relationship type of Iranian people, which is suggested to be investigated in future studies.
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Xu J. The Roles of Family and School Members in Influencing Children's Eating Behaviours in China: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030315. [PMID: 35327687 PMCID: PMC8947546 DOI: 10.3390/children9030315] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 12/22/2022]
Abstract
This review explores the influences of family and school members on children in China, in order to promote healthy eating behaviours among children and prevent childhood malnutrition in the Global South. Family members and school members are defined as parents, guardians (such as grandparents and other relatives), siblings, peers, and teachers. A search of four databases returned 94 articles, 18 of which met the eligibility criteria. Most of the included studies were from mainland China; a few were from Hong Kong and Taiwan. More quantitative than qualitative studies were found, among which, cross-sectional studies were dominant. The 18 papers included in the study explored the influences of family members and school members on the eating behaviours of children, based on seven themes: (1) social–demographic characteristics, (2) food intake of parents, (3) nutritional knowledge and health awareness of family or school members, (4) parents’ perceptions of their children’s body weight, (5) feeding strategies of family members, (6) family relationships, and (7) intergenerational differences of caregivers. In the current analysis, parental education levels, mother’s occupation, health awareness of parents and teachers, and positive feeding styles, such as encouraging healthy eating and controlling overeating, were positively correlated with the healthy eating behaviours of children. Meanwhile, healthy eating behaviours of children were negatively associated with caregivers’ lack of nutritional knowledge, misperception of weight, instrumental and/or emotional feeding, and working on nonstandard shifts. More related research using cross-disciplinary approaches is needed and there should be more discussions about how teachers, siblings, and peers affect the dietary behaviours of children.
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Affiliation(s)
- Jianlin Xu
- School of Geography, University of Leeds, Leeds LS2 9JT, UK
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Wang J, Zhu D, Cheng X, Liuzhou Y, Zhu B, Montgomery S, Cao Y. Maternal perception of child weight and concern about child overweight mediates the relationship between child weight and feeding practices. Public Health Nutr 2022; 25:1-10. [PMID: 35000661 PMCID: PMC9991628 DOI: 10.1017/s1368980022000040] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine the mediating effects of maternal perception of child weight (weight perception) and concern about overweight (weight concern) on the paths between child weight and maternal feeding practices. SETTING Pudong District, Shanghai, China. PARTICIPANTS A convenience sample of 1164 mothers who were primary caregivers of preschool children. RESULTS Sixty per cent of the mothers perceived their overweight/obese children as normal weight or even underweight. The disagreement between actual child weight and maternal weight perception was statistically significant (Kappa = 0·212, P < 0·001). Structural equation modelling indicated that weight perception fully mediated the relationship between child BMI Z-scores and pressure to eat. Weight concern fully mediated the relationships between child BMI Z-scores and the other three feeding practices. The serial mediating effects of weight perception and concern were statistically significant for the paths between child BMI Z-score and monitoring (β = 0·035, P < 0·001), restriction (β = 0·022, P < 0·001), and food as a reward (β = -0·017, P < 0·05). CONCLUSION Child weight may influence maternal feeding practices through weight perception and concern. Thus, interventions are needed to increase the accuracy of weight perception, which may influence several maternal feeding practices and thereby contribute to child health.
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Affiliation(s)
- Jian Wang
- Shanghai Jiao Tong University School of Nursing, 200025Shanghai, People's Republic of China
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Daqiao Zhu
- Shanghai Jiao Tong University School of Nursing, 200025Shanghai, People's Republic of China
| | - Xuwen Cheng
- Department of Children's Disease Prevention, Jinyang Community Health Service Center, Shanghai, People's Republic of China
| | - Yicong Liuzhou
- Department of Nursing, Shanghai Children's Medical Center, Shanghai, People's Republic of China
| | - Bingqian Zhu
- Shanghai Jiao Tong University School of Nursing, 200025Shanghai, People's Republic of China
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
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Guo S, Wang Y, Fries LR, Li Y, Zhang N, Zhang H, Wei H, Jiang X, Shang L. Infant and preschooler feeding behaviors in Chinese families: A systematic review. Appetite 2021; 168:105768. [PMID: 34688731 DOI: 10.1016/j.appet.2021.105768] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/18/2021] [Accepted: 10/19/2021] [Indexed: 11/02/2022]
Abstract
A systematic review was conducted on the literature on feeding behaviors in Chinese families of children under 6 years old. Forty relevant publications were identified, of which 33 were published in Chinese, 7 in English. All studies were questionnaire-based and used a cross-sectional research design. Approximately half of the studies reported a score for each feeding practice/style, based on a Likert scale; the other half dichotomized these scores into a percentage of the population that reported frequent use of the behaviors. The most commonly reported feeding style of Chinese caregivers was a locally defined "active response" style that somewhat resembled authoritative parenting. The most commonly reported feeding practices were praise, encouraging trying new foods, encouragement of balanced diet and encouragement of healthy eating. Some behaviors showed a great deal of variance in prevalence between studies, which may be at least partially due to differences in methodology and how behaviors were defined. Some feeding behaviors varied in frequency depending on the child's age, although longitudinal studies are needed to better understand how these evolve over time. Child body composition was also associated with feeding behaviors use, although the direction of the association cannot be determined due to the cross-sectional nature of the research. There is still an important gap in the literature regarding the feeding behaviors of non-maternal caregivers, as grandparents often play an important role in childcare in China.
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Affiliation(s)
- Shibo Guo
- Department of Pediatric, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, Shaanxi, China.
| | - Yue Wang
- Department of Health Statistics, The Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, The Fourth Military Medical University, Changle West Road 169#, Xi'an, Shaanxi, 710032, China.
| | | | - Yilin Li
- Nestlé Research, Beijing, China.
| | - Nini Zhang
- Department of Pediatric, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, Shaanxi, China.
| | - Haiyue Zhang
- Department of Health Statistics, The Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, The Fourth Military Medical University, Changle West Road 169#, Xi'an, Shaanxi, 710032, China.
| | - Haixia Wei
- Department of Pediatric, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, Shaanxi, China.
| | - Xun Jiang
- Department of Pediatric, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, Shaanxi, China.
| | - Lei Shang
- Department of Health Statistics, The Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, The Fourth Military Medical University, Changle West Road 169#, Xi'an, Shaanxi, 710032, China.
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Nunes LM, Führ J, Belin CHS, Moreira PR, Neves RO, de Brito ML, Morando LA, Mariath AAS, Gomes E, Bernardi JR. Complementary feeding methods in the first year of life: a study protocol for a randomized clinical trial. Trials 2021; 22:687. [PMID: 34627344 PMCID: PMC8501700 DOI: 10.1186/s13063-021-05647-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/20/2021] [Indexed: 12/01/2022] Open
Abstract
Background The traditional spoon-feeding approach to introduction of solid foods during the complementary feeding period is supported by consensus in the scientific literature. However, a method called Baby-Led Introduction to SolidS (BLISS) has been proposed as an alternative, allowing infants to self-feed with no adult interference. To date, there have been no trials in the Brazilian population to evaluate the effectiveness of BLISS in comparison to the traditional approach. Methods/design To evaluate and compare three different complementary feeding methods. Data on 144 mother-child pairs will be randomized into intervention groups by methods: (A) strict Parent-Led Weaning; (B) strict Baby-Led Introduction to SolidS; and (C) a mixed method. Prospective participants from Porto Alegre, Brazil, and nearby cities will be recruited through the Internet. The interventions will be performed by nutritionists and speech therapists, at 5.5 months of age of the child, at a private nutrition office equipped with a test kitchen where meals will be prepared according to the randomized method. The pairs will be followed up at 7, 9, and 12 months of age. Data will be collected through questionnaires designed especially for this study, which will include a 24h child food recall, questionnaires on the child’s and parents’ eating behavior, oral habits, eating difficulties, and choking prevalence. At 12 months of age, children will undergo blood collection to measure hemoglobin, ferritin, and C-reactive protein, saliva collection for analysis of genetic polymorphisms, and oral examination. Anthropometric parameters (child and maternal) will be measured at the baseline intervention, at a 9 month home visit, and at the end-of-study visit at the hospital. The primary outcome will be child growth and nutritional status z-scores at 12 months; secondary outcomes will include iron status, feeding behavior, acceptability of the methods, dietary variety, choking, eating behaviors, food preferences, acceptance of bitter and sweet flavors, suction, oral habits, oral hygiene behavior, dental caries, gingival health status, and functional constipation. Discussion The trial intends to ascertain whether there are potential advantages to the BLISS complementary feeding method in this specific population, generating data to support families and healthcare providers. Trial registration Brazilian Clinical Trials Registry (ReBEC): RBR- 229scm number U1111-1226-9516. Registered on September 24, 2019.
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Affiliation(s)
- Leandro Meirelles Nunes
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul (UFRGS) Medical School, Porto Alegre, Brazil.,Neonatology Section, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
| | - Jordana Führ
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul (UFRGS) Medical School, Porto Alegre, Brazil
| | - Christy Hannah Sanini Belin
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul (UFRGS) Medical School, Porto Alegre, Brazil
| | - Paula Ruffoni Moreira
- Graduate Program in Food, Nutrition and Health, Universidade Federal do Rio Grande do Sul (UFRGS) Nutrition Department, Medical School, Porto Alegre, Brazil
| | - Renata Oliveira Neves
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul (UFRGS) Medical School, Porto Alegre, Brazil.
| | - Mariana Lopes de Brito
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul (UFRGS) Medical School, Porto Alegre, Brazil
| | - Lorenzo Andreazza Morando
- Department of Surgery and Orthopedics, Universidade Federal do Rio Grande do Sul (UFRGS) Dentistry School, Porto Alegre, Brazil
| | - Adriela Azevedo Souza Mariath
- Department of Surgery and Orthopedics, Universidade Federal do Rio Grande do Sul (UFRGS) Dentistry School, Porto Alegre, Brazil
| | - Erissandra Gomes
- Department of Surgery and Orthopedics, Universidade Federal do Rio Grande do Sul (UFRGS) Dentistry School, Porto Alegre, Brazil
| | - Juliana Rombaldi Bernardi
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul (UFRGS) Medical School, Porto Alegre, Brazil.,Graduate Program in Food, Nutrition and Health, Universidade Federal do Rio Grande do Sul (UFRGS) Nutrition Department, Medical School, Porto Alegre, Brazil.,Nutrition Department, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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The Organic Food Choice Pattern: Are Organic Consumers Becoming More Alike? Foods 2021; 10:foods10050983. [PMID: 33946339 PMCID: PMC8145405 DOI: 10.3390/foods10050983] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 11/23/2022] Open
Abstract
There is no doubt that the search for organic products is already more than a trend; it is an indisputable reality. More and more people are opting for a healthier lifestyle that starts with food, which has awakened a growing interest in understanding the reasons for these purchases. The motivational attributes of consumers’ decisions regarding the consumption of organic products are the main aim of this study. The survey included 250 respondents that filled a questionnaire by email and by personal interviews. We used a non-probabilistic sampling method, namely convenience sampling and the best–worst scaling method to analyze 10 attributes of organic purchasing decisions. Then, we studied the impact of the classification variables age, gender, academic level, place of residence, children under 18 living at home, and place of purchase of organic products on the attributes. Applying a chi-square test, we only obtained statistically significant differences for children under 18 living at home and the certification warranty (p = 0.011). The results show the dominance of credence attributes and egoistic motivations on organic consumption and may indicate a path towards the standardization of the organic consumer profile. This study emphasized that we may be facing a new organic consumer, for whom health-related factors are not just significant but overwhelming as well.
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