A review of the influence of fathers on children's eating behaviours and dietary intake

Exploring the role of adolescents in healthier, more sustainable family meals: A decision study on meat consumption

OBJECTIVE

Can children's preferences make family meals healthier and more sustainable? Extending cultural evolution theory, we explored the children's role in a possible bottom-up transmission of meat preferences to their parents in the context of family meals.

METHODS

Fifty-seven parent-child dyads from Germany (age: Mchildren = 15.9 years, Mparents = 50.5 years; 67% daughters, 93% mothers; 14% of children and 0% of parents followed a vegetarian/vegan diet; 82% of children were still in school; 42% of parents had a bachelor's degree or higher) decided on a family meal through discussion, which was videotaped. Before and after discussing, dyad members separately stated their preferred meat proportion for the family meal.

RESULTS

In contrast to our hypotheses, on average children neither preferred less meat nor had a stronger influence on meat proportions in family meals than their parents. Daughters-despite a considerably lower preference for meat-did not reduce meat at family meals more than sons. Rather than demographic characteristics (i.e., age, gender), it was specific behaviors of children or dyads that predicted stronger influence on and eventually lower proportion of meat at family meals. These specific behaviors were following a vegetarian/vegan diet, general conflicts about meat-related aspects of family meals, and-in tendency-mentioning sustainability arguments in discussions.

CONCLUSIONS

Children can be part of the change toward healthier and more sustainable family foodways-which could improve the family's health-if they themselves eat accordingly and actively advocate for it.

Executive functioning is linked to feeding practices and food insecurity in Head Start mothers

Lower executive functioning is associated with more reactive, coercive general parenting practices. Parents who experience poverty, a chronic stressor, may have compromised executive functioning that impacts parenting practices, but less is known about the impact on parent feeding practices. This study examined associations between maternal executive functioning and feeding practices among families living in low-income contexts. Participants included 137 mothers of children enrolled in Head Start who completed the Behavior Rating Inventory of Executive Function-Adult version, Child Feeding Questionnaire, Feeding to Manage Child Behavior Questionnaire, and the USDA Food Security Module. Hierarchical linear regression examined the effect of maternal executive function on maternal feeding practices (monitoring of child food intake, food to soothe, and food as a reward) after adjusting for covariates. The moderating effect of food security on this association was also explored. Mothers were white (90%), non-Hispanic (96%), about half had a high school diploma or less (55%), and a third of households experienced food insecurity (35%). Maternal executive functioning explained 9% of the variance for monitoring of child food intake (β = 0.03, p = 0.0006) and 17% of the variance for food to soothe (β = -0.03, p < 0.0001), over and above the variance explained by food security status, employment status, and child BMI z-score. Lower maternal executive functioning was associated with lower odds of household food security (OR: 0.95, CI: 0.92, 0.99). Targeting maternal executive functioning or its environmental supports may be an effective intervention strategy to promote monitoring and less food to soothe, especially among families who experience stressors related to poverty. Longitudinal research is needed to replicate these findings, and to understand the relationship between parent executive function and child weight outcomes.

Redefining Roles-Fathers Play a Crucial Role in Shaping Children's Healthy Eating Behaviors: Cross-Sectional Observational Study

BACKGROUND/OBJECTIVES

Fathers have been largely understudied in feeding research, as most studies have focused on mothers. This study aims to explore the relationship between paternal feeding practices and child eating behaviors.

METHODS

This study employed a cross-sectional observational design. Fathers (n = 114) completed one-off self-reported questionnaires using the Child Feeding Practices Questionnaire and the Child Eating Behaviors Questionnaire from October 2023 to February 2024. Variations in feeding practices across sociodemographic factors were explored using correlational statistics. The generalized linear model was used to identify relationships between paternal feeding practices and child eating behaviors.

RESULTS

For young children, the availability of healthy food at home was positively associated with food approach behaviors, while paternal practices of pressuring and child control were linked to increased food avoidance. Among school-aged children, using food as a reward was positively associated with food approach behaviors, while using food to regulate emotions was linked to increased food avoidance. Restriction for weight control was associated with both food approach and avoidant behaviors. In adolescents, paternal monitoring of their diet and certain socioeconomic conditions were observed to be associated with their eating behaviors.

CONCLUSIONS

The findings provide valuable insights into the role of paternal feeding practices in shaping children's eating behaviors and highlight the potential for interventions targeting modifiable paternal behaviors to support healthy eating habits.

A qualitative study into the perceptions and needs of fathers with a migration background on parenting regarding energy balance-related behaviors

BACKGROUND

Overweight among adolescents is worldwide still considered a serious public health problem. Although both parents influence children's energy balance-related behavior, most studies have predominantly focused on mothers and white populations. Therefore, in this study, we contribute to the research by exploring the perceptions and needs of Dutch fathers with a migration background on parenting, specifically regarding promoting healthy energy balance-related behaviors among their children, and what motivates fathers to participate in parenting programs focused on these behaviors.

METHODS

We used a qualitative research design. Informal conversations (n = 2), semi-structured interviews (n = 11) and one focus group (n = 13) were conducted with professionals specialized in intercultural pedagogy and fathers participating in a parenting program organized by these professionals. Interviews and focus group were audio-recorded and transcribed. Atlas.ti 8 was used for theme detection, categorization, and classification using inductive and deductive approaches. The data was analyzed using grounded theory analysis.

RESULTS

Fathers joined parenting programs to improve their parenting skills and knowledge and address health and socio-cultural challenges. Furthermore, intergenerational differences were evident: second-generation fathers were more proactive in tackling parenting challenges related to healthy lifestyles. Fathers highlighted challenges related to parenting in two cultures. Although participating in the parenting program facilitated fathers in adopting a healthier lifestyle for both themselves and their families, improving communication with family members, and experiencing changes regarding gender dynamics within their household, influencing their teenage children, to adopt healthier habits remained a challenge, especially in comparison to younger children.

CONCLUSIONS

A deeper understanding of the needs, perceptions, and experiences of migrant populations concerning parenting regarding the promotion of healthy energy balance-related behaviors among their children can lead to better-tailored health promotion programs that prioritize cultural and linguistic inclusivity.

The impact of a fairytale-like story on the food choices of preschool children

The ongoing obesity epidemic is an indicator that traditional efforts towards diet change are insufficient, and interventions focusing mainly on restrictions of unhealthy food are of limited success. Therefore, approaches targeting food preferences should be integral in counteracting the current epidemic. However, food preferences are affected by a multitude of factors and are usually resistant to changes later in life. Hence, we tested whether the food choices of preschool children can be changed by a child-appropriate, interactive, fairytale-like narrative. We used two interactive stories: the first (experimental) story was about how two protagonists of similar age as the participants saved their hometown from being drained of color with the help of magic fruits or vegetables, while the second (control) story consisted of a similar plot that did not mention food. In Experiment 1, we used a crossover design with a one-week baseline measurement. After the experimental stories, healthy food choices (i.e., pieces of fruit vs. cookies, sweets, or cake) increased significantly relative to the one-week baseline, whereas no change was observed after the control story. In preregistered Experiment 2, we replicated these results with vegetables as healthy options using a random control design and investigated the longevity of the effects. The food-story effect on vegetable choices was similar to fruits (Exp. 1) and lasted for two weeks. These findings demonstrate that appropriate narratives about food can have a strong and lasting effect on the healthy food choices of preschool children and might promote healthy food consumption if incorporated into nutrition education.

Sharing the motherload: A review and development of the CO-Parent conceptual model for early childhood obesity prevention

Fathers remain under-represented in early childhood obesity prevention research and interventions, despite growing evidence that paternal biopsychosocial factors and behaviors from pre- and post-conception can influence lifelong offspring health. Informed by a literature review of high-quality evidence, "CO-Parent" (childhood obesity-Parent) is a new conceptual model underpinned by couple interdependence theory and a socioecological framework. Literature was searched for the concepts parental AND weight-related behaviors AND child weight or weight-related behaviors, in databases including MEDLINE, PsycINFO, Global Health, Scopus, and SocINDEX. Prior evidence syntheses were prioritized as source data to inform model development. "CO-Parent" illustrates the interdependent and independent effects of maternal and paternal weight, weight-related behaviors, and well-being, across preconception, pregnancy, postpartum, and the early years on child weight-related behaviors and weight up to age five. The influences of public policy, social, environmental, economic, community, and other complex modifiable mediating factors are included in the model. The "CO-Parent" conceptual model paves the way for a paradigm shift by recognizing fathers as key figures in early childhood obesity prevention initiatives, encouraging them to "share the motherload." It highlights both the independent and interdependent roles fathers play in the epidemiology of obesity starting from preconception. CO-Parent also provides the foundations necessary to guide future theory and research to be more inclusive of fathers to further understanding of the independent and interdependent influences of parents in early childhood obesity prevention.

A recipe for health: A descriptive qualitative study examining paternal influence and the establishment of children's healthy eating habits in Singapore

This study aimed to explore Singaporean fathers' perceived influence over their children's eating habits. A descriptive qualitative study design was used. Convenience sampling was used to recruit fathers of children aged 3-21 years old from a general paediatric outpatient clinic in a tertiary public hospital. Data were collected from September 2023 to January 2024. Fifteen fathers were interviewed until data saturation. A semi-structured interview guide was used to conduct virtual interviews and thematic analysis was used for data analysis. Three themes and nine subthemes were identified. The three themes were: (1) laying a good foundation, (2) circumstances shaping perspectives, and (3) agents of future behavioural change. Fathers perceived themselves as influencing their children's eating habits by laying a good foundation and that their perspectives were influenced by their circumstances such as lack of time and gender roles. Fathers identified elements that could initiate their future behaviour change to better influence their children's eating habits. These findings provide nuanced insights into paternal perceptions, for the future development of father-specific interventions to enhance their influence in promoting good eating habits among their children. Healthcare professionals can encourage paternal involvement through providing health education on healthy nutrition for their children to both mothers and fathers in the clinical setting. Healthcare professionals can also organize hands-on events that teach about food exploration and nutrition for fathers to take part in with their children.

Validation of a brief food parenting measure for fathers: A test of factorial validity, measurement invariance, internal reliability, and concurrent validity

Fathers are underrepresented in food parenting research partly due to the lack of succinct, theory-informed, and father-mother equivalent food parenting measurement tools. To address this, we 1) tested the factorial validity of a brief food parenting measure utilizing a subset of items from the Comprehensive Feeding Practices Questionnaire (CFPQ) to represent coercive control, structure, and autonomy support, 2) assessed the extent to which the brief tool works similarly in fathers and mothers (i.e., measurement invariance), and 3) evaluated its internal reliability and concurrent validity. Participants included 1071 fathers of children aged 2-6 years and 487 of their co-parents (mothers) from the Fathers & Families study. Fathers and mothers responded to 16 CFPQ items, and fathers reported on children's diets. Confirmatory factor analysis (CFA) was used to test factorial validity. Multi-group CFA was used to examine measurement invariance across fathers and mothers. Internal reliability was examined using Cronbach's alpha and the Spearman-Brown coefficient. Concurrent validity was assessed utilizing multiple logistic regressions to examine associations between the three food parenting factors and children's intakes of fruit, vegetables, sugar-sweetened beverages (SSBs), and fast food. CFA confirmed a three-factor model with 11 items, including coercive control (four items), structure (five items), and autonomy support (two items). Multi-group CFA indicated measurement invariance across fathers and mothers. Internal reliability was established. Concurrent validity was strong for structure, but weaker for coercive control and autonomy support. Further refinements are encouraged to enhance items' utility in characterizing fathers' food parenting practices, including in different social and cultural contexts.

Understanding Caregivers' Influence on Preschoolers' Eating Behaviors: An Integrative Review Guided by the Theory of Planned Behavior

BACKGROUND/OBJECTIVES

Primary caregivers of children play a significant role in developing their dietary behaviors. Guided by the Theory of Planned Behavior (TPB), this integrative review aimed to synthesize studies examining how personal and household characteristics, caregivers' dietary beliefs, intentions, and feeding practices influence the eating behaviors of preschool-aged children (2-5 years).

METHODS

PubMed, CINAHL, and PsycINFO databases were searched for peer-reviewed articles published between January 2014 and September 2024. The expanded PRISMA 2020 checklist was used to guide the literature search and report the results. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) was also used to evaluate the quality of the selected articles.

RESULTS

A total of 10 studies were included in the final analysis. The studies revealed that preschoolers' eating behaviors were significantly influenced by personal characteristics (e.g., caregivers' BMI, and weight perceptions) and household factors (e.g., food availability). Additionally, caregivers' feeding practices, such as restriction, modeling, and permissiveness, played a pivotal role in shaping children's eating habits. Although caregivers expressed intentions to provide a healthy diet, they often faced barriers, including conflicting work schedules, financial constraints, and logistical challenges, which impeded their ability to consistently promote healthy eating behaviors.

CONCLUSIONS

Caregivers' beliefs, intentions, and feeding practices are pivotal in shaping preschoolers' eating behaviors. However, the limited available literature and the underexplored mechanisms linking these factors make it challenging to draw solid conclusions. Future research should address these gaps and consider integrating caregiver-focused factors into tailored interventions to promote healthier eating habits in preschool-aged children. This can aid healthcare professionals in designing culturally and contextually sensitive strategies for improving childhood nutrition.

Maternal Well-Being and Child Appetitive Traits at 5 Years Old: Findings from the ROLO Longitudinal Birth Cohort Study

Background: Maternal depression has been linked with increased risk of childhood obesity. Furthermore, maternal negative affectivity in early childhood has been associated with food fussiness. We explored the relationship between longitudinal maternal well-being mid-pregnancy, at 2 years and 5 years postpartum and children's appetitive traits at 5 years of age. Methods: This is a secondary analysis of the ROLO (randomized control trial of low glycemic diet in pregnancy) longitudinal birth cohort study including pregnancy (n = 279), 2 years (n = 168), and 5 years (n = 295) postpartum. Maternal well-being was measured using the World Health Organization-Five Well-Being Index. Children's appetitive traits were measured at 5 years of age using the Children's Eating Behavior Questionnaire. Bivariate correlation and then linear regression, adjusted for potential confounders, were used to determine relationships between maternal well-being at each timepoint and offspring's appetitive traits at 5 years old. Results: Mean maternal well-being was higher at 5 years postpartum (63.3%) than mid-pregnancy (58.2%) or at 2 years postpartum (61.0%) (p = 0.001). No relationships were observed between maternal well-being mid-pregnancy and child's appetitive traits at 5 years. In adjusted regression, at 2 years postpartum, maternal well-being was negatively associated with "Emotional Overeating" (B = -0.029, p = 0.024), "Satiety Responsiveness" (B = -0.040, p = 0.014), "Slowness Eating" (B = -0.072, p = <0.001), and "Emotional Undereating" (B = -0.054, p = 0.010) and positively associated with "Enjoyment of Food" (B = 0.050, p = 0.007). Maternal well-being at 5 years postpartum was negatively associated with "Satiety Responsiveness" (B = -0.025, p = 0.033) and "Slowness Eating" (B = -0.031, p = 0.024). Conclusion: Maternal well-being in early childhood may influence children's appetitive traits; however, further research is required to fully explore this relationship.

Screen Time Use and Ultra-Processed Food Consumption in Adolescents: A Focus Group Qualitative Study

BACKGROUND

Sedentary lifestyles and ultra-processed food (UPF) consumption contribute to a high prevalence of overweight and obesity among adolescents. Screen time may be associated with higher UPF consumption and affect eating behaviors substantially.

OBJECTIVE

The aim of this study was to explore adolescents' perceptions, attitudes, and motivations concerning the consumption of UPF when using screens; investigate their perceived educational needs regarding nutrition; and explore their knowledge about UPF.

DESIGN

This was a qualitative study using focus groups.

PARTICIPANTS/SETTING

Four focus groups with 30 adolescents aged 12 to 16 years at a Spanish high school were recruited in May 2022. Participants were chosen using purposive sampling based on a theoretical saturation criterion.

ANALYSES

Focus group discussions were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis.

RESULTS

Three themes emerged from the thematic analysis. Participants explained that most of their meals were eaten in front of screens. They confirmed more consumption of UPF at breakfast, as mid-afternoon snacks, on weekends, and during their main meals when alone. Participants reported that the high consumption of UPF during social gatherings was related to its easy availability, convenience, and palatability. Adolescents expressed that eating in front of screens and exposure to UPF advertising led to compulsive and impulsive consumption of these products. They described UPF as addictive and unhealthy. Although participants had little awareness of UPF health effects, they expressed interest in learning about healthy eating habits. Parental attitudes toward food were considered by the participants as relevant in establishing their eating behaviors.

CONCLUSIONS

Loneliness, social gatherings, and parental attitudes toward UPF consumption emerged as important influences on adolescents' dietary behaviors in front of screens. In addition, availability, palatability, and exposure to advertising were key factors reported to influence adolescents' UPF consumption in front of screens. Addressing these influences through nutritional and educational interventions, as well as regulating the adolescent obesogenic environment and managing screen time could help modulate these effects.

Exploring parental secretive eating of sugary foods and drinks, and its associations with food consumption in families

As a way of modeling healthier eating habits for their children, parents may intentionally avoid consuming sugary foods and drinks (SFDs) in their presence but consume these on other occasions (later referred to as parental secretive eating). This study aimed to 1) explore the prevalence of parental secretive eating, 2) investigate the associations between parental secretive eating and SFD consumption in parents and children, and 3) qualitatively explore the reasons for parental secretive eating. Participants were Finnish mothers (n = 362), fathers (n = 123), and their 3-6-year-old children (n = 403); this data was collected in 2017 as part of the baseline assessment of the DAGIS intervention. Parents reported how often they avoided eating SFDs in the presence of their child, completed food frequency questionnaires for themselves and their child, and responded to an open-ended question of explaining reasons for secretive eating. The overall prevalence of parental secretive eating was 68%. It was more common among mothers than fathers (p < 0.001) and most prevalent in chocolate (61%) and sweets (59%). Parental secretive eating was positively associated with SFD consumption both among mothers (ꞵ = 0.274, p < 0.001) and fathers (ꞵ = 0.210, p = 0.028) in linear regression models adjusted for parents' and child's age, child's gender, parental education level, and number of household members. Mothers' or fathers' secretive eating and child's SFD consumption were not associated (ꞵ = 0.031, p = 0.562; ꞵ = -0.143; p = 0.167). Three themes describing reasons for parental secretive eating were found: family food rules, avoiding child's requests, and aspiration for healthy modeling. In conclusion, parental secretive eating may play an important role in determining SFD consumption in families with preschoolers. Additional research is needed to determine whether parents can prevent their own eating habits from influencing their child through secretive eating.

Effectiveness of a Social-Media-Based Diet and Physical Activity Programme for Fathers in Japan: A Randomised Controlled Trial

Provision of healthy lifestyle support for fathers can improve the lifestyles and health awareness of not only fathers but also their children and families. Few studies have examined the effectiveness of education targeting healthy fathers provided via social media. Hence, we aimed to clarify the effects of providing fathers with information on healthy lifestyle habits via social media on their awareness and behaviours regarding diet, physical activity, and healthcare, in addition to such a programme's indirect effects on their children. This randomised controlled trial included 73 fathers of primary school children in Japan. The intervention group received information on 'healthy lifestyle', 'lifestyle-related diseases', 'healthy diet', and 'healthy physical activity' via social media six times every 2 weeks. Data were collected before, 3 months after, and 4 months after the intervention. The intervention was effective in improving some awareness regarding diet, physical activity, and healthcare. In addition, the fathers in the intervention group demonstrated significantly improved interest in their child's diet and exercise habits. Social-media-based diet and physical activity programmes for fathers improved their awareness and behaviour. Therefore, social-media-based health education programmes can be an important tool for increasing fathers' interest in their own health and in their children's lifestyles.

Replicability, adaptability and long-term impact of the 'Healthy Youngsters, Healthy Dads' program in Newcastle, Australia

'Healthy Youngsters, Healthy Dads' (HYHD) targets fathers to improve the health of their preschool-aged children. In a previous randomized trial, fathers and children experienced meaningful improvements in physical activity and eating behaviours. The next phase is to test the replicability and adaptability of HYHD when delivered in the community by trained facilitators. Fathers/father-figures and children aged 3-5 years were recruited from Newcastle, Australia into a 9-week, non-randomized trial with assessments at baseline, 10 weeks, and 12 months. The primary outcome was achievement of pre-registered targets for recruitment (≥ 96 dyads), attendance (≥ 70%), compliance (completing ≥ 70% of home-based tasks), fidelity (≥ 80% of content delivered as intended) and program satisfaction (≥ 4/5). Secondary outcomes included physical activity, nutrition, screen time and parenting measures. Process targets were surpassed for recruitment (140 fathers, 141 children), attendance (79% for fathers-only workshops, 81% for father-child sessions), compliance (80% of home-tasks completed), fidelity (99% for education, ≥ 97% for practical) and program satisfaction (4.8/5). Mixed effects regression models revealed significant effects in fathers for moderate-to-vigorous physical activity, co-physical activity, dietary intake and parenting practises, which were maintained at 12 months. Significant effects were also established for screen time at 10 weeks only. For children, significant effects were observed for screen time and dietary intake at 10 weeks, while effects on energy-dense, nutrient-poor foods and healthy, nutrient-dense core food intake were maintained at 12 months. Findings demonstrate the replicability and adaptability of HYHD when delivered in the community by local trained facilitators. Further investigation into how to optimally scale-up HYHD is warranted.

Indian fathers' perceptions of young childcare and feeding - A qualitative study

The role of parents in fostering children's healthy habits is a robust area of research. However, most of the existing literature predominantly focuses on mothers' parenting practices. Given the emergence of nuclear, dual earning families and the recent surge in maternal employment in urban India, fathers' engagement in child rearing and feeding warrants attention. The purpose of this research was to document the views of Indian fathers about paternal parenting practices, with an emphasis on children's diet among other health behaviors. Thirty-three fathers of children aged 6-59 months from Kolkata, India took part in semi-structured interviews conducted either face-to-face or over Zoom/telephone in Hindi, Bengali, and English. The interviews were audio recorded, transcribed verbatim, and translated to English. The transcribed data were subjected to thematic analysis informed by the Template Analysis technique. Themes were detected using the NVivo software program. Overall, these Indian fathers played an important role in early childhood care and feeding as reflected in the following seven themes: (i) Involvement of fathers in various childcare activities; (ii) Implementation of responsive and non-responsive feeding practices; (iii) Concerns regarding fussy and slow eating; (iv) Concerns regarding excessive screen time; (v) Paternal vs maternal parenting; (vi) Barriers to routine engagement of fathers in childcare; (vii) Desire for more nutrition and health knowledge. This enhanced understanding of paternal parenting behavior supports the inclusion of fathers in future family-focused lifestyle interventions aimed at improving children's health outcomes, including their dietary habits.

An Evaluation of &iexcl;Haz Espacio Para Papi!, a Culturally Tailored Nutrition and Physical Activity Pilot Program for Mexican-Heritage Fathers

Fathers are potential leaders of healthy behavior changes in their families. Culturally tailored programs are needed to support behavior changes within families, including Latino families; however, there have been few father-focused nutrition programs for Latino families. This study evaluated the immediate effects of ¡Haz Espacio Para Papi! (Make Room for Daddy!; HEPP), a six-week, father-focused, family-centered program focused on nutrition and physical activity near the Texas-Mexico border. A modified stepped-wedge study design included a treatment group for the HEPP pilot and a wait-listed control group. Pre/post-tests included instant skin carotenoid scores, the self-reported dietary intake of fruits and vegetables (FV), and healthy dietary behavior scores (HDBSs). A 2 × 2 mixed analysis of variance evaluated changes in outcomes across time and between groups for 42 fathers with pre/post-test measures. There were no statistically significant changes in fathers' VM scores and FV intake across time or between groups. Fathers' HDBSs increased across time (p ≤ 0.01, 95% CI [0.23, 1.38]). Age, educational attainment, and the number of children living in the household did not have a significant effect on the program outcomes (p > 0.05). The HEPP program may guide the design of future father-focused nutrition interventions aimed at dietary behavior changes.

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

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

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

"You just have to spread it thin": Perceptions and feeding experiences of Australian fathers of young children living with disadvantage

The role of fathers in feeding is an emerging field within child feeding literature. Fathers have unique contributions to make to family mealtimes and child eating behaviours. However, qualitative research on fathers' experiences is limited, especially in the context of disadvantage. This study explored fathers' perceptions of their roles and feeding practices and their lived experience of disadvantage through a symbolic interactionism lens. Twenty-five Australian fathers of children aged six months to five years who experienced socioeconomic disadvantage participated in semi-structured interviews. Five themes were constructed from reflexive thematic analysis: (i) responsibilities for foodwork are based on strengths, opportunities, and values, (ii) negotiating fatherhood identity from a place of tension to acceptance, (iii) struggling with financial and mental strain, and food insecurity, (iv) managing adversity whist prioritising feeding children, and (v) paternal feeding practices are driven by values, adversity, and emotions. The division of foodwork was contingent on family capability and employment, maternal gatekeeping, paternal attitudes and values, and intergenerational, cultural and gender norms around earning and childrearing. Economic, environmental, and emotional stressors triggered changes to fathers' feeding practices, often contradicting their ideals (e.g., providing alternative meals, using rewards and electronic devices, unstructured settings). Fathers described income and food-based strategies to protect children's food intake, which may involve caregivers forgoing meals. These findings provide insight into fathers' feeding experiences through recognising personal, interpersonal, and systemic enablers and barriers. Promoting optimal feeding practices should include targeted feeding support and broader structural interventions to address inequality. Fathers' experiences as they navigate child mealtime interactions within a context of adversity can be used to inform child feeding interventions to improve child health and development.

Dads at Mealtimes: Associations between Food Security, Household and Work Chaos, and Paternal Feeding Practices among Australian Fathers Living with Disadvantage

Understanding how fathers engage in feeding while experiencing disadvantage is important for family-focused interventions. A cross-sectional online survey involving 264 Australian fathers was conducted to explore feeding involvement and the relationships between feeding practices, food insecurity, and household and work chaos. Practices related to coercive control, structure, and autonomy support were measured for two age groups (<2 years and 2-5 years). Multivariable linear regression was used to examine the associations for each practice. Three-quarters of the sample were food insecure, impacting adults more than children, and correlated with household chaos. Food insecurity was associated with increased 'persuasive feeding' and 'parent-led feeding' in younger children. Household chaos was positively associated with coercive control practices in both younger and older child groups, with the strongest associations for 'using food to calm' and 'overt restriction', respectively. In older child groups, household chaos was negatively associated with 'offer new foods' and 'repeated presentation of new foods'. Structure practices had no significant relationships with any factors, and work chaos did not predict any feeding practices. These findings emphasize a need for societal and structural support to address food insecurity and household chaos. Tailored strategies are crucial to support fathers in responsive feeding.

Indian fathers are involved in nurturing healthy behaviours in adolescents: A qualitative inquiry

BACKGROUND

Indian adolescents exhibit unhealthy food behaviours and inactive lifestyles which increase their risk of developing obesity and associated negative health consequences. The family food environment represents a vital setting to nurture healthy lifestyle behaviours in adolescents, with parents influencing their adolescents' dietary and physical activity behaviours. Yet, much of the existing evidence exploring parental influences predominantly focuses on mothers while fathers' engagement in instilling healthy dietary and physical activity behaviours is understudied, more so in the context of developing economies like India. Therefore, this qualitative study was designed to understand Indian fathers' views on instilling healthy behaviours in their children.

METHODS

Convenience sampling along with snowball sampling techniques were employed to recruit fathers of adolescents aged 10-19 years from Kolkata city, India. Informed by the research aim and review of literature, an interview guide was developed and pre-tested. Interviews were carried out either in person or virtually (Zoom/telephone) in English/Hindi/Bengali as per the preference of the participants. All interactions were audio recorded, transcribed verbatim, and translated to English for the purpose of data analysis. The transcripts were analysed thematically using NVivo software program. Themes were identified using both inductive and deductive approaches.

RESULTS

A total 36 fathers participated in the interviews. Seven main themes were identified: (i) Involvement of fathers in adolescent upbringing (i.e. engagement in meal preparation, food shopping, educational activities, physical activity); (ii) Family food environment (i.e. setting food rules, having meals with children, making food available); (iii) Challenges to instilling healthy behaviours in adolescents (i.e. adolescents' sedentary lifestyle and liking for unhealthy foods); (iv) Barriers to routine involvement in adolescent upbringing (i.e. time constraints due to paid employment, poor socio-economic status); (v) Adolescent nutrition education: (vi) Dual burden of malnutrition (i.e. awareness of malnutrition, no knowledge about government-led health programs for adolescents); (vii) Paternal knowledge.

CONCLUSIONS

The emerging themes reveal that Indian fathers played a crucial role in instilling healthy dietary and physical activity behaviour in their adolescents through various parenting practices such as purchasing nutritious food, enforcing food rules, disseminating nutrition-related knowledge, and encouraging adolescents to participate in moderate-to-vigorous intensity outdoor sports. This provides strong support for the inclusion of fathers in sustainable family-focused lifestyle interventions to maximise the nurturing care required by adolescents as well as assist in normalising the representation of fathers in health and welfare policies designed for adolescents.

The contribution of Australian fathers in getting food on the table among families with young children

OBJECTIVE

To explore how fathers with young children contributed to healthy home food provisioning and the factors enabling or inhibiting their involvement in family food tasks.

DESIGN

Cross-sectional study using purpose-designed online survey. The survey assessed the level of responsibilities and practices in family food tasks, food agency (Cooking and Food Provisioning Action Scale), and use of resources to support involvement in family food tasks. Data collection took place over 3 weeks in November-December 2020 when various COVID-19-related restrictions were in place. Descriptive and regression analyses were used to assess psychosocial factors influencing responsibilities in family food tasks and food agency.

SETTING

Online survey.

PARTICIPANTS

Included in the analysis were 435 Australian fathers with children aged under 5 years.

RESULTS

Between 75 and 77 % of fathers in this study reported having at least half of the responsibilities in meal planning, shopping, and cooking. Health was frequently considered when deciding what to eat, but few used nutrition or food labels when shopping, tried new recipes or modified recipes to make them healthier. Involvement in family food tasks was promoted by a higher food agency, but time spent in employment was a significant barrier to reported food agency and greater involvement in food tasks. There was a high interest in resources to support healthy home food provisioning.

CONCLUSIONS

The findings suggest the need to consider father-specific strategies to overcome time barriers and opportunities to enhance their capabilities for healthy home food provisioning.

Weight trajectories from birth to 5 years and child appetitive traits at 7 years of age: a prospective birth cohort study

Rapid prenatal and postnatal weight gain seem to alter appetite regulation and hypothalamic functions through different pathways; however, little is known on how early life growth trajectories may influence appetitive traits in school-age. We aimed to explore the associations between weight trajectories from birth to 5 years and appetitive traits at 7. Participants were from the Generation XXI birth cohort (n 3855). Four weight trajectories were investigated: 'normal weight gain' (closely overlaps the 50th percentile in the weight-for-age curve), 'weight gain during infancy' (low birth weight and weight gain mainly during infancy), 'weight gain during childhood' (continuous weight gain since birth) and 'persistent weight gain' (always showing higher weight than the average). Appetitive traits were assessed through the Children's Eating Behaviour Questionnaire. Associations were tested using generalised linear models, adjusted for maternal and child characteristics. Compared with 'normal weight gain', those in the other growth trajectories showed greater enjoyment of food and eating in response to food stimuli (i.e. Food Responsiveness) but were less able to compensate for prior food intake and ate faster at 7 (i.e. less Satiety Responsiveness and Slowness in Eating). Also, those with 'weight gain during infancy' showed to have greater Emotional Overeating and less Emotional Undereating and were fussier. Associations were stronger if greater weight gain occurred during infancy. Early infancy seems to be a sensitive period in the development of later appetitive traits. The control of rapid growth during infancy, besides strategies focused on the overall environment where children are living, is necessary.

Spicing up food interactions: Development of a healthy food education activity targeting fathers and their young children

BACKGROUND

Childhood obesity rates have been rapidly increasing worldwide. Several actions to reduce this trend have addressed maternal feeding practices. However, research reports an unwillingness to taste healthful foods expressed by children and fathers, which represents a major obstacle to a healthy diet in the family household. The present study aims to propose and qualitatively evaluate an intervention to increase fathers' involvement with their families' healthy eating through exposure to new/disliked healthy foods.

METHODS

Fifteen Danish families took part in a 4-week online intervention involving picture book reading, a sensory experience session and the cooking of four recipes with four targeted vegetables (celeriac, Brussels sprouts, spinach and kale) and two spices (turmeric and ginger). Interviews were conducted with the families and the content was analysed through a blended or abductive approach.

RESULTS

Participating in the activities motivated children and fathers to try new vegetables and spices, and increased fathers' sense of self-efficacy toward cooking, tasting new foods and healthy feeding. For the family, the intervention acted as a trigger to consume a higher variety of vegetables and spices and prompted feelings of "food joy". The outcomes observed are of importance considering the relatively low cost and the remote approach of the intervention.

CONCLUSIONS

The results highlight the fact that fathers play an important role in the home food environment. We conclude that fathers should be included to a higher extent in food and nutrition strategies aimed at promoting healthy weight development in their children.

Familial resemblance and family-based heritability of nutrients intake in Iranian population: Tehran cardiometabolic genetic study

BACKGROUND

We aimed to investigate the familial resemblance of dietary intakes, including energy and nutrients, and the family-based heritability of dietary intake in different age-sex dyads of the Tehran cardiometabolic genetic study.

METHODS

This cross-sectional study was conducted on 9,798 participants, aged ≥ 18 years, with complete data in each of the third, fourth, fifth, and sixth surveys of the Tehran Cardiometabolic Genetic study, who were eligible to enter the current study based on inclusion and exclusion criteria. Nutrient intake was determined using a valid and reliable food frequency questionnaire (FFQ). FCOR command of the S.A.G.E. software was used to estimate the intra-class correlation coefficients of all relative pairs to verify the family resemblance of dietary nutrient intakes. Classical likelihood-based is used to assess the family-based heritability of dietary nutrient traits.

RESULTS

There were 4338 families with a mean family size of 3.20 ± 2.89, including 1 to 32 members (2567 constituent pedigrees and 1572 singletons) and 3627 sibships. The mean ± SD age of participants was 42.0 ± 15.2 years, and 44.5% were males. The heritability of nutrient intake ranged from 3 to 21%. The resemblance degree of energy intake and most nutrients between spouses or between parents and children is weak to moderate; however, a high resemblance of intake was observed for some food components, especially among spouses, including trans fatty acids (TFAs) (r:0.70), chromium (r:0.44), fiber(r:0.35), pantothenic acid (r:0.31), and vitamin C(r:0.31). Based on our findings, the resemblance of nutrient intake in spouses was greater than in parent-offspring. The similarity in parent-offspring nutrient intake was different, and the correlation in mother-girls nutrient intakes was greater than other parent-child correlations. Also, the lowest resemblance in nutrient intake was observed among siblings.

CONCLUSIONS

Our findings suggested a weak-to-moderate similarity between the nutrient intakes of parents and offspring. The resemblance degree in nutrient intake varied between different family pairs; the strongest correlation of nutrients was observed between spouses, which includes TFAs, chromium, fiber, pantothenic acid, and vitamin C. The lowest correlation of nutrients was between siblings, such as carbohydrates, thiamine, niacin, and vitamin K. An individual's nutrient intake can somewhat be influenced by genetics, family relationships, and the effects of parents, although the significant influence of environmental factors should not be ignored.

Concurrent Undernutrition and Overnutrition within Indian Families between 2006 and 2021

Background

The double burden of malnutrition (DBM), characterized by concurrent undernutrition and overnutrition, is a growing global concern. Families share resources and eating behaviors and programs often target households, yet evidence of the DBM at the family level is scarce.

Objectives

This study examined trends and inequality in the intrahousehold DBM in India between 2006 and 2021.

Methods

Data were from 3 waves of India's National Family Health Survey (NFHS 2006, 2016, and 2021). We examined 3 types of household member (with children aged <5 y) combinations: mother-child (N = 328,039 across 3 waves), father-child, and parent (mother and father)-child (N = 47,139 for each pair). The DBM was defined as one or more individuals with undernutrition (either wasting or stunting in children or underweight in adults) and one or more overweight individuals within the same household. DBM was examined over time, at national and subnational levels, and by residence and wealth.

Results

Nearly all DBM was in the form of an overweight parent and an undernourished weight or stunted child. The prevalence of parent-child DBM increased from 15% in 2006 to 26% in 2021. Father-child pairs experienced the most rapid DBM increase, from 12% in 2006 to 22% in 2021, an 83% increase, driven by increasing overweight among men. In 2021, the DBM was highest in North-Eastern and Southern states, and among relatively rich households from urban areas. The increase in the DBM was faster in rural areas and among poor households compared with that in urban areas and rich households. Urban-rural and rich-poor inequalities in the DBM have decreased over time.

Conclusions

The intrahousehold DBM has increased over time, affecting 1 in 4 households in India in 2021. Family-based interventions that can simultaneously address child underweight and parent overweight are required to address India's increasing intrahousehold DBM.

Eating for honour: A cultural-ecological analysis of food behaviours among adolescent girls in the southern plains of Nepal

Access to adequate and nutritious food is important for the current and future health of adolescent girls. Interventions often focus on the individual as responsible for their own health ignoring the complex structural issues that underlie optimal nutrition. In South Asia gender inequalities have been noted as an important determinant of poor nutrition among women and their young children, but analysis of adolescent girls' diets and what influences these are rarely undertaken. Therefore, we sought to analyse the factors affecting what and where girls' eat and what affects their behaviour in the plains of Nepal, using a cultural-ecological approach. We analysed a secondary qualitative dataset of focus group discussions with adolescent girls aged 12-19 years old, young mothers, mothers-in-law, and older female key informants. Eating was heavily influenced by patriarchal norms. Boys had preferential access to food, money, and freedom of movement to appreciate their future role in providing for the family. Food was an investment, and boys were perceived to have more nutritional need than girls. Girls were not perceived to be a good return on investment of food, and eating practices sought to prepare them for life as a subservient daughter-in-law and wife. Obedience and sacrifice were valued in girls, and they were expected to eat less and do more housework than boys. Girls' eating and behaviour was constrained to maintain self and family honour. Interventions should acknowledge cultural influences on eating and engage multiple actors in addressing harmful gender norms which limit eating and prevent girls from reaching their potential.

Associations between parental and pre-adolescents' physical activity and diet quality: The role of parental child care involvement and child's sex

BACKGROUND

Research has demonstrated the importance of the family environment in the eating and activity levels of offspring. We examined the cross-sectional associations between moderate-to-vigorous physical activity (MVPA) and diet quality of parents and the MVPA and diet quality of pre-adolescents. Interactions were tested to assess whether the child's sex and the parental level of involvement in daily child care moderated these associations.

METHODS

Data from 2467 pre-adolescents (age 11.5 ± 0.2 years; collected in 2015-2016) and their parents or caregivers from a large-scale prospective birth cohort study in Amsterdam (ABCD-study) was used. Parents and pre-adolescents individually reported their diet quality and physical activity. Child care involvement was assessed using the Caregiver Child Interaction Scale. With hierarchical linear regression analyses, we assessed the independent contribution of fathers and mothers.

RESULTS

An association between mother-child MVPA was found (β = 0.013; 95 % CI: 0.006;0.021). The association between father-child MVPA was only significant for highly involved fathers (β = 0.014; 95 % CI: 0.004;0.023). The child's sex did not change these MVPA associations. Regarding diet quality, associations were found between mother-child diet quality score (DQS) (β = 0.254; 95 % CI: 0.192;0.316) and father-child DQS, with stronger associations between fathers and sons (β = 0.234; 95 % CI: 0.169;0.298) than between fathers and daughters (β = 0.114; 95 % CI: 0.047;0.181). Parental levels of involvement did not change these associations.

CONCLUSION

These findings demonstrate that both parental behaviours represent an important factor in physical activity and diet quality in pre-adolescents in a sex-specific manner. As such, it is essential to include both parents in research to obtain the necessary insights for developing effective interventions to promote children's healthy eating and physical activity behaviours.

Family Mealtimes: A Systematic Umbrella Review of Characteristics, Correlates, Outcomes and Interventions

Systematic reviews have examined the multitude of studies investigating family mealtimes and their importance to child/adolescent health and psychosocial outcomes, but the focus of each is limited to specific aspects of family meals (e.g., frequency) and/or specific outcomes (e.g., nutrition). Their findings require synthesis and so a systematic umbrella review was undertaken. Databases were searched to identify systematic reviews (with or without meta-analysis/meta-synthesis) addressing at least one of the following questions: what are the characteristics and/or correlates of family mealtimes; what outcomes are associated with family mealtimes; are interventions aimed at promoting family mealtimes effective? Forty-one eligible reviews were retrieved. Their findings demonstrate that families with children/adolescents typically eat together at least a few days each week. More frequent family meals are predicted by a more positive mealtime environment, more positive attitudes towards family meals, the presence of younger children, and families having more time. Greater family meal frequency protects children/adolescents against a poorer diet, obesity, risk behaviours, poorer mental health and wellbeing, and poorer academic outcomes. Findings from interventions seeking to promote family mealtimes are mixed. This umbrella review provides a comprehensive and integrated understanding of research into family mealtimes, establishing where evidence is sound and where further research is needed.

Where is the father? Challenges and solutions to the inclusion of fathers in child feeding and nutrition research

Despite an increasing acknowledgement of fathers' involvement in and impact on children's lives, fathers remain underrepresented in child feeding and childhood obesity prevention research, interventions, and actions. Built on our own experiences with conducting research with fathers and recent evidence on this topic, this Research in Practice article has three aims. It will first substantiate the importance of including and studying fathers in the field of child feeding and childhood obesity prevention based on recent study results. Secondly, the article will present and discuss barriers to fathers' inclusion and participation (why isn't it happening?), among other issues, by drawing on sociological and gender ideological insights. Finally, it will provide recommendations and suggestions related to recruitment, focus and methods that can facilitate fathers' involvement in future research, interventions, and practice. Taken together, this article aims to provide tools for giving fathers a voice in the field of child nutrition and by doing so, to decrease maternal-only "burden" of care. We hope our experiences and theoretical reflections will inspire and support researchers and practitioners to be as successful as possible in the realm of family care.

Examining the associations between mothers' motivation to regulate their own eating behaviors, food parenting practices and perceptions of their child's food responsiveness

Based on the Self-Determination Theory, this study examined: 1) how mothers' autonomous and controlled motivation to regulate their own eating behaviors relate to their food parenting practices, and 2) whether and how child food responsiveness (i.e., reactivity and attraction to food) interact with mothers' motivation to predict maternal food parenting practices. Participants were 296 French Canadian mothers of at least one child aged between 2 and 8 years old. Results of partial correlation analyses (controlling for demographics and controlled motivation) showed that maternal autonomous motivation to regulate their own eating behaviors was positively related to autonomy-promoting (i.e., child involvement) and structure-based (i.e., modeling, creating a healthy environment, monitoring) food parenting practices. In contrast, controlling for demographics and autonomous motivation, maternal controlled motivation was positively associated with food-related practices based on coercive control (i.e., the use of food to regulate the child's emotions, the use of food as a reward, pressure to eat, restriction for weight reasons, and restriction for health reasons). Furthermore, the child's food responsiveness was found to interact with mothers' motivation to regulate their own eating behaviors in the prediction of maternal food parenting practices such that mothers with high autonomous motivation or low controlled motivation were found to react with more structure-based (i.e., creating a healthy environment) and autonomy-based (i.e., child involvement) practices, as well as less controlling practices (i.e., the use of food to regulate the child's emotions), to a child who is highly responsive to food. In conclusion, findings suggest that guiding mothers toward developing a more autonomous and less controlled motivation to regulate their own eating behaviors might help them adopt more autonomy-promoting and structure-based and less controlling feeding practices, especially with children who are highly responsive to food.

Engaging Fathers Through Nutrition Behavior Communication Change Does Not Increase Child Dietary Diversity in a Cluster Randomized Control Trial in Rural Ethiopia

BACKGROUND

Adding food vouchers or paternal nutrition behavior change communication (BCC) activities to maternal BCC may improve child diets and household food security but their effect is unknown.

OBJECTIVES

We assessed whether maternal BCC, maternal and paternal BCC, maternal BCC and a food voucher, or maternal and paternal BCC and a food voucher improved nutrition knowledge, child diet diversity scores (CDDS), and household food security.

METHODS

We implemented a cluster randomized control trial in 92 Ethiopian villages. Treatments were as follows: maternal (M) BCC only; maternal BCC and paternal BCC (M+P); maternal BCC and food vouchers (M+V); and maternal BCC, food vouchers, and paternal BCC (M+V+P). Effects were assessed using generalized estimating equations.

RESULTS

Maternal BCC and paternal BCC increased the maternal and paternal knowledge of optimal infant and young child feeding practices by 4.2-6.8 percentage points (P < 0.05) and by 8.3-8.4 percentage points (P < 0.01), respectively. Combining maternal BCC with either paternal BCC or the food voucher increased CDDS by 21.0%-23.1% (P < 0.05). The treatments M, M+V, and M+P increased the proportion of children who met minimum acceptable diet standards by 14.5, 12.8, and 20.1 percentage points, respectively (P < 0.01). Adding paternal BCC to the maternal BCC treatment or to the maternal BCC and voucher treatment did not lead to a larger increase in CDDS.

CONCLUSIONS

Increased paternal involvement does not necessarily translate into improvements in child feeding outcomes. Understanding the intrahousehold decision-making dynamics that underlie this is an important area for future research. This study was registered at clinicaltrials.gov as NCT03229629.

Parenthood as a Window of Opportunity for Dietary Changes: Perspectives From Uruguayan Parents

Research on behavioral and social science has demonstrated that transitions throughout a person's life course, as the life event of becoming a parent, represent an opportunity for dietary changes. However, research in this area has been mostly restricted to developed European and North American countries and has shown ambiguous results. The present work aimed to gain an in-depth understanding on the changes in eating habits caused by the transition to parenthood and to explore factors influencing those changes in Uruguay, a Latin American country. Forty-two in-depth interviews with Uruguayan parents from diverse social-economic backgrounds were conducted. The narrations by the interviewees evidenced mostly positive changes during three stages in the transition: pregnancy, the first months with the baby, and the beginning of complementary feeding. Most informants perceived changes mainly in terms of increased consumption of fruits, vegetables, and pulses; increased consumption of homemade meals; and decreased consumption of ultra-processed foods, fast foods, and fried foods. Reasons for these changes included adaptation of meals to the child's needs and schedule, feeling of responsibility for the child's health, and willingness to be a good role model. Factors influencing changes in eating habits were identified in some levels of the socioecological model and included socioeconomic status; price of fruits, vegetables, and fish; low accessibility of good quality fish; perceived time pressure; father's low interest on healthy eating; social support; and access to nutrition information. Findings suggest that parenthood represents a window of opportunity for favorable changes in eating habits. However, barriers constraining those changes should be addressed by stakeholders.

Measurement invariance of the comprehensive feeding practices questionnaire in dual-earner parents with adolescent children in Chile

The Comprehensive Feeding Practices Questionnaire (CFPQ) has been evaluated in international studies, but the evaluation of its psychometric properties in Spanish, and in particular for parents of adolescents is still limited, and the invariance of measurement according to gender has not been evaluated. Therefore, the objectives of this study were: (1) To adapt the five-factor model of the CFPQ instrument to Spanish; (2) To examine the psychometric properties of this adaptation; and (3) To evaluate the measurement invariance of the model to verify the equivalence of measurement of the perceptions of food parenting practices between mothers and fathers belonging to nuclear, dual-earner families with adolescent children. Participants were 946 mothers and fathers from Southern Chile. Results showed that the conceptual equivalence for the CFPQ was achieved. An exploratory factor analysis was performed for a five-factor model: Monitoring, Child control, Restriction for weight control, Modeling and Environment. Horn's parallel analysis identified four factors, while factor loading analysis determined the removal of the environment factor. Confirmatory factor analysis presented good reliability values. Convergent and discriminant validity was confirmed, and medium-to-high levels of goodness of fit were obtained, eliminating two items. Results supported a final model of four factors and 19 items. Multigroup analysis of the measurement model verified the configural and metric invariance between fathers and mothers, while the scalar and strict partial invariance was verified. These findings are a relevant guide to measure factorial scores in the four-factor model of the CFPQ, establishing a characterization of feeding practices of parents and adolescents.

'My Mom Got Influenced by Yours': The persuasiveness of mom influencers in relation to mothers' food assessments and decisions

Childhood obesity is a worldwide health problem with a range of short- and long-term health and social consequences; however, the World Health Organization (WHO) argues that this epidemic is preventable and reversible. The biggest dietary gatekeepers of children are their parents and more specifically mothers, whose attitudes and consumption choices are nowadays often affected by the opinions of influencers on social network sites (SNSs). Using two experimental studies, the current paper investigates how mothers' food assessments and decisions for their children are affected by sponsored posts on social media. The first study adopted a two-level between-subjects experiment (N = 81), which showed that mothers like sponsored Instagram posts better when they are posted by a mom influencer (i.e. a mother who accumulated a large following on social media and often engages in sponsored partnerships with brands) compared to a brand. This consequently positively affected source credibility, post engagement, purchase intention and the child appropriateness of the food. In the second experiment, a two-by-two between-subjects design (N = 169) showed that while a typical mom influencer is perceived as less effective in promoting food compared to an expert (i.e. a pediatric nutritionist) mom influencer due to lower credibility, a typical mom influencer is more efficient in promoting unhealthy foods through higher influencer-brand congruence.

"We think about the quantity more": factors influencing emerging adults' food outlet choice in a university food environment, a qualitative enquiry

BACKGROUND

In recent decades, the food environment has seen rapid transformation globally, altering food availability and access along with how people interact with the food environment and make food-related choice.

OBJECTIVES & METHOD

This explorative study aimed to identify the factors that shape the decision-making process for food outlet choices among emerging adults in a Ghanaian University food environment. The study uses focus group discussions in combination with novel dyadic interviews with best friend pairs. Verbatim transcripts were analysed thematically using NVivo 12.

RESULTS

Drawing on socio-ecological model (SEM) of behaviour, the study used testimony from 46 participants aged 18-25, 47% female, including individuals from major ethnicities and religions in Ghana, and identified three interwoven levels of influence shaping emerging adults' choices of food outlet. The main factors influencing food outlet choice were identified as food prices, spatial accessibility, budget, and food quantity/satiety with additional factors including hygiene, variety of foods, food quality and taste preferences as well as societal factors such as ambience and peer influence.

CONCLUSION

Multi-component approaches that combine structural level interventions in food retailing along with individual level components may be effective at changing emerging adult consumption behaviour in SSA, although this needs to be studied.

Impact of the 'Healthy Youngsters, Healthy Dads' program on physical activity and other health behaviours: a randomised controlled trial involving fathers and their preschool-aged children

Background

Targeting fathers may be a key strategy to increase physical activity among their preschool-aged children, but limited research exists in this area. The primary study aim was to examine the impact of a lifestyle program for fathers and their preschool-aged children on child physical activity levels.

Methods

A total of 125 fathers (aged: 38 ± 5.4 years, BMI: 28.1 ± 4.9 kg/m²) and 125 preschool-aged children (aged: 3.9 ± 0.8 years, BMI z-score: 0.3 ± 0.9, 39.2% girls) recruited from Newcastle, Australia, NSW were randomised to (i) the Healthy Youngsters, Healthy Dads (HYHD) program, or (ii) wait-list control group. The program included two fathers-only workshops (2 h each) and eight father-child weekly educational and practical sessions (75 min each), plus home-based activities targeting family physical activity and nutrition. Assessments took place at baseline, 10-weeks (post-intervention) and 9-months follow-up. The primary outcome was the children’s mean steps/day at 10-weeks. Secondary outcomes included: co-physical activity, fathers’ physical activity levels and parenting practices for physical activity and screen time behaviours, children’s fundamental movement skill (FMS) proficiency, plus accelerometer based light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), screen time and adiposity for fathers and children. Process measures included; attendance, satisfaction, fidelity and retention. Linear mixed models estimated the treatment effect at all time-points for all outcomes.

Results

Intention-to-treat analyses revealed a significant group-by-time effect for steps per day at 10-weeks (+ 1417, 95%CI: 449, 2384) and 9-months follow-up (+ 1480, 95%CI: 493, 2467) in intervention children compared to control. There were also favourable group-by-time effects for numerous secondary outcomes including fathers’ physical activity levels, children’s FMS proficiency, and several parenting constructs. No effects were observed for both fathers’ and children’s accelerometer based LPA or MVPA, co-physical activity, screen-time and adiposity measures. Process evaluation data revealed very high levels of satisfaction, attendance, retention, and intervention fidelity.

Conclusion

Engaging fathers in a lifestyle program is a promising strategy to increase physical activity among preschool-aged children. Additional benefits to fathers’ physical activity levels, children’s FMS proficiency and parenting practices further support the importance of engaging fathers to improve family health outcomes.

Trial Registration

Australian New Zealand Clinical Trials Registry: ACTRN12619000105145. Registered 24/01/2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13424-1.

Parents' Modeling During the COVID-19 Pandemic: Influences on Family Members' Diet Quality and Satisfaction With-Food-Related Life in Dual-Earner Parents With Adolescent Children

Reciprocal family influences in the food domain have been little explored, particularly during the COVID-19 pandemic. To fill in this gap, this study explored actor and partner effects between parents' food modeling and parents' and their adolescent children's diet quality and satisfaction with food-related life (SWFoL); and the mediating role of diet quality between modeling and SWFoL. This study used a cross-sectional design. A sample of 430 different-sex dual-earner parents and one adolescent child were recruited in Rancagua, Chile, between March and June 2020. Parents answered the modeling dimension of the Comprehensive Feeding Practices Questionnaire. Parents and adolescents answered the Adapted Healthy Eating Index (AHEI) and the SWFoL Scale. Analyses were conducted using the Actor-Partner Interdependence Model and structural equation modeling. Results showed that one parent's modeling enhanced diet quality for themselves, their partner, and the adolescents. Parents' modeling was associated with their own SWFoL, directly and via their own diet quality. There were positive associations between mothers' modeling and adolescents' SWFoL; between mothers' diet quality and fathers' SWFoL; and between mothers' modeling and fathers' SWFoL via the fathers' diet quality. Parents' modeling can improve the three family members' diet quality, while mothers' modeling and diet quality showed to improve fathers' and adolescents' SWFoL.

Resemblance of nutrient intakes in three generations of parent-offspring pairs: Tehran lipid and Glucose Study

The degree of maintaining nutrient intake patterns, conformed in the family, for offspring into adulthood is unknown. The aim of this study was to investigate the correlation between nutrient intakes in three younger-middle-older generations of Tehranian adults by sex. Of individuals who participated in 2012–15 phase of the Tehran Lipid and Glucose Study, 1286 families (4685 subjects), who had at least two members of the family with complete data in two or three generations were entered in this cross-sectional study. The energy and nutrient intakes of parents and their young or adult offspring or grandparents-grandson/granddaughter dyads were compared. The differences were estimated using pairwise t-test and partial correlation. Data of parents with their offspring were paired based on living arrangement. There were 857 fathers (mean age: 55.4±11.1) and 1394 mothers (mean age: 50.1±11.4). The mean age of grandfathers and grandmothers were 69.4±7.9 and 63.7±8.5 respectively. The significant correlation in fathers-sons and father-daughter (living with their parents) pairs were observed for 9 and 7 nutrients, respectively. Correlations for most nutrients were significant for mother-daughter or sons (living with their parents) dyads. The mean percentage of energy from total fat and trans-fatty acids of sons or daughters (living with their parents) were higher than their parents. For most nutrients, there were no significant adjusted correlations between parents-adult offspring (living independent of their parents) dyads. Also few nutrient intakes of grandparents-grandson or granddaughter dyads were correlated. The nutrient intakes of adult offspring were not associated with their parents; this correlation for younger and older generations disappeared. There were weak to moderate correlation between nutrient intakes of parent-offspring dyads that lived with their parents. The resemblance was higher for mother-offspring than father-offspring. Overall, total fat and trans-fatty acid intakes of young offspring were higher than their parents.

Relationship of parental feeding practices and diet with children's diet among South Asians in Canada

BACKGROUND

South Asian children's diets are considered unhealthy, yet the relationship with food parenting among South Asians is understudied.

METHODS

In a cross-sectional study, questionnaires were administered to dyads of Canadian South Asian elementary and high school children and a parent. Relationships between parental factors (perceived responsibility, restriction, pressure to eat, monitoring, home food environment, nutrition knowledge and intake of fruits and vegetables (FV), sugary beverages (SB) and sweets and fast foods (SWFF) and children's intake of FV, SB and SWFF were assessed by linear regression adjusted for sociodemographics. Subgroup differences by children's age and acculturation were explored by interaction analysis.

RESULTS

291 children (age 9.8 ± 3.2 years) had mean daily intake frequencies of 3.1 ± 2.0 FV, 1.0 ± 0.9 SB and 2.1 ± 1.5 SWFF. Positive associations were found between parent and child intake of FV (standardized beta (ß) = 0.230, [95%CI 0.115, 0.345], p < 0.001), SB (β = 0.136 [0.019, 0.252], p = 0.02), and SWFF (β = 0.167 [0.052, 0.282], p = 0.005). Parental monitoring was associated with lower children's SWFF intake (ß = -0.131 [-0.248, -0.015], p = 0.03). Among those expressing less Western culture, parental SWFF intake was associated with child's SB intake (β = 0.255 [0.085, 0.425], p = 0.004). Among those expressing less traditional culture, positive home food environment was associated with lower child SWFF intake (β = -0.208 [-0.374, -0.042], p = 0.015).

CONCLUSION

South Asian children's diets have stronger relationships with their parents' diets than with food parenting practices or nutrition knowledge, though parental monitoring was associated with lower unhealthy food intake. However, with greater acculturation, the home food environment was more important for unhealthy food intake.

The Lived Experiences of Fathers in Mealtimes: A Thematic Synthesis of Qualitative Literature

The paternal experience of family mealtimes is an emerging field within qualitative literature. Previous quantitative studies suggest that differences exist between fathers’ and mothers’ mealtime behaviours, particularly in response to fussy eating. However, qualitative research has not yet focused exclusively on fathers’ fussy eating experiences. This metasynthesis aimed to provide insights into the general paternal experience, inclusive of their fussy eating responses. Thematic synthesis methodology was adopted to achieve this process and consisted of a systematic search resulting in the inclusion of 16 studies (18 papers). The direct quotations presented within each study were subjected to three stages of analysis to produce three analytical themes, supported by eight descriptive themes. The analytical themes presented were: (1) environmental influences on fathers’ mealtime experiences; (2) attitudes and emotions of fathers during mealtimes; and (3) observable behaviours of fathers during mealtimes. These themes highlighted the complexity of the mealtime experience from a paternal perspective. Multidirectional relationships were identified between each mealtime component (i.e., the environment, attitudes, emotions and behaviours) as evidenced by the paternal commentary presented. The findings also provided insights into fathers’ fussy eating experiences, recognising that fathers should be considered as individuals in the presence of mealtime intervention.

The resemblance of dietary intakes in three generations of parent-offspring pairs: Tehran lipid and glucose study

The degree of similarity between dietary intakes of offspring and their parents may be different across various countries. This study aimed to investigate the correlation between food group intakes and dietary quality in three younger-middle-older generations by living arrangements. Individuals who participated in the 5th survey of the Tehran Lipid and Glucose Study, 1286 families (4685 subjects) with complete data for two or three generations were entered in this cross-sectional study. Genetic data management system from Progeny Software was used to error-check family data pedigree details. Dietary data were gathered using a valid and reliable food frequency questionnaire. The healthy eating index score was computed. Data of parents with their offspring were compared using paired t-test and partial correlation. The mean ages of grandfathers and grandmothers were 69.4 ± 7.9 and 63.7 ± 8.5 respectively. Of girls and boys who lived with their parents, about 59% were 20 years or older. The correlation of parents' dietary intake and their young offspring who lived with them was higher than that of parents and adult offspring who lived independently from their parents. The correlation of dietary quality and food group intakes in mother-offspring dyads (mother-son: 0.37, mother-daughter: 0.44) were higher than father-offspring (father-son: 0.34, father-daughter: 0.25) dyads. The dietary quality of parents was higher than that of offspring in both living statuses. The dietary intake of adult married offspring was not correlated with their parents; also there was no correlation between the dietary quality of younger and older generations. There were weak to moderate similarities between food group intakes of parent-offspring dyads that lived with their parents.

How Does the Family Influence Adolescent Eating Habits in Terms of Knowledge, Attitudes and Practices? A Global Systematic Review of Qualitative Studies

Promoting healthy eating habits can prevent adolescent obesity in which family may play a significant role. This review synthesized findings from qualitative studies to identify family barriers and facilitators of adolescent healthy eating in terms of knowledge, attitudes, and practices (KAP). A literature search of four databases was completed on 31 July 2020; qualitative studies that explored family factors of adolescent (aged 10 to 19 years) eating habits were included. A total of 48 studies were identified, with the majority being from North America and sampled from a single source. Ten themes on how family influences adolescent dietary KAP were found: Knowledge—(1) parental education, (2) parenting style, and (3) family illness experience; Attitudes—(4) family health, (5) cultivation of preference, and (6) family motivation; Practices—(7) home meals and food availability, (8) time and cost, (9) parenting style, and (10) parental practical knowledge and attitudes. This review highlights five parental characteristics underlying food parenting practices which affect adolescents’ KAP on healthy eating. Adolescents with working parents and who are living in low-income families are more vulnerable to unhealthy eating. There is a need to explore cultural-specific family influences on adolescents’ KAP, especially regarding attitudes and food choices in Asian families.

Dietary Outcomes of the 'Healthy Youngsters, Healthy Dads' Randomised Controlled Trial

(1) Background: The effect of fathers on dietary intake in preschool-aged children is under-explored. The aims were to: (i) evaluate the efficacy of a family-based lifestyle intervention, Healthy Youngsters, Healthy Dads, on change in dietary intake in fathers and their preschool-aged children post-intervention (10 weeks) and at 9 months follow-up compared to a waitlist control group and (ii) investigate associations in father-child dietary intakes. (2) Methods: Linear mixed models estimated group-by-time effects for all dietary outcomes, measured by food frequency questionnaires. Cohen's d determined effect sizes, while correlation tests determined associations in father-child dietary intakes. (3) Results: For children, medium group-by-time effects sizes were identified at 10 weeks for sodium intake (d = 0.38) and percentage energy from core foods (d = 0.43), energy-dense, nutrient-poor (EDNP) foods (d = 0.43) and prepacked snacks (d = 0.45). These findings were sustained at 9 months follow-up. For fathers, medium to large, group-by-time effect sizes were identified at 10 weeks for energy intake (d = 0.55), sodium intake (d = 0.64) and percentage energy from core foods (d = 0.49), EDNP foods (d = 0.49), and confectionary (d = 0.36). For all of these dietary variables, except sodium, effects were sustained at 9 months. Moderate to strong associations existed in father-child dietary intakes for some of the dietary variables. (4) Conclusions: Although further research is required, this study provides preliminary support for targeting fathers as agents of change to improve dietary intakes in their preschool-aged children.

Adolescent-Reported Latino Fathers' Food Parenting Practices and Family Meal Frequency Are Associated with Better Adolescent Dietary Intake

Most studies of food-related parenting practices, parental meal involvement, and adolescent dietary intake have focused on maternal influences; studies of paternal influences, particularly among marginalized groups, are lacking. This study examined lower-income, Latino fathers' food parenting practices and involvement in planning meals, buying/preparing foods, and family meal frequency, separately and in combination, to identify relationships with adolescent food intake. Baseline data were used from Latino adolescents (10-14 years, n = 191, 49% boys) participating with their fathers in a community-based overweight/obesity prevention intervention. Fathers reported sociodemographic characteristics. Adolescents reported frequency of fathers' food parenting practices, fathers' food/meal involvement, and family meals and participated in 24 h dietary recalls. The analysis included regression models using GLM (generalized linear mixed model) and PLM (post GLM processing) procedures. Most fathers were married, employed full-time, and had annual incomes below USD 50,000. Favorable fathers' food parenting practices were associated with adolescent intake of more fruit and vegetables and fewer sugar-sweetened beverages, sweets/salty snacks, and less fast food (p < 0.05 or p < 0.01). No independent effects of family meal frequency or fathers' food/meal involvement were observed on adolescent dietary outcomes. Additional analyses showed favorable food parenting practices in combination with frequent family meals were associated with adolescents having a higher intake of fruit (p = 0.011). Latino fathers can have an important positive influence on adolescent dietary intake.

Infant sugar sweetened beverage and 100% juice consumption: Racial/ethnic differences and links with fathers' consumption in a longitudinal cohort

The consumption of sugar-sweetened beverages (SSB) and 100% juice before age 12 months is discouraged. We examine racial/ethnic differences in SSB and 100% juice consumption when infants were 6- and 12-months old and examine links between fathers’ and infants’ beverage consumption. Participants were from a longitudinal cohort of infants and their parents (recruited 2016–2018), followed from birth until the child was 24 months. In 2020, we analyzed data collected when infants were 6- (N = 352 infants and 168 fathers) and 12-months (N = 340 infants and 152 fathers) old. Based on maternal report, 13% of infants consumed 100% juice at 6 months and 31% at 12 months. Two percent of infants consumed SSB at 6 months and 7% at 12 months. In models adjusting for income and education, Black/African American (Black/AA) and Hispanic infants were 5–6 times as likely at 6 months and 3 times as likely at 12 months to consume 100% juice compared with non-Hispanic white and Asian infants. At 12 months, Black/AA and Hispanic infants were 6–7 times as likely to consume SSB than non-Hispanic white and Asian infants after adjusting for covariates. In unadjusted models, infants were more likely to consume 100% juice and SSB at 12 months when their fathers were high consumers (>12times/month) of the beverage; effects were no longer significant after adjusting for income, race/ethnicity, education and maternal beverage consumption. Results highlight the need to implement culturally responsive interventions promoting healthy beverage consumption in infants prior to birth and should concurrently target fathers, in addition to mothers.

Changes in Fathers' Body Mass Index, Sleep, and Diet From Prebirth to 12 Months Postbirth: Exploring the Moderating Roles of Parenthood Experience and Coparenting Support

BACKGROUND

While research has examined prenatal to postnatal changes in women's weight, sleep, and diet, much less is known about these changes among fathers.

PURPOSE

This study aimed to (a) examine changes in fathers' body mass index (BMI), sleep, and diet from 1 month before birth to 5-6 months following birth, and from 5-6 months to 11-12 months following birth and (b) explore the moderating roles of parenthood experience and coparenting support.

METHODS

169 fathers (mean age 35.5 years, 58.9% White) participated. Fathers completed an intake survey shortly after their infant's birth to recall their height and weight, nighttime sleep hours, fruit and vegetable intake, soda intake, and fast food intake for the month prior to birth. When their child was 6 and 12 months old, fathers reported their weight, sleep, and diet again for the past 4 weeks (i.e., 4 week periods spanning 5-6 months and 11-12 months following birth). Generalized estimating equations were used to answer our research questions.

RESULTS

Fathers reported higher BMI (Δ = 0.22 kg/m2; 95% confidence interval [CI] = 0.06, 0.38; p = .008) and less nighttime sleep duration (Δ = -0.21 hr; 95% CI = -0.38, -0.05; p = .012) at 5-6 months following birth compared to 1 month prior to birth. Fathers' diet remained stable over the three timepoints. No evidence was found to support the moderating roles of parenthood experience and coparenting support on fathers' weight and behavior changes.

CONCLUSIONS

5-6 months following birth may be an important point of intervention for fathers to promote a return to prebirth BMI and sleep levels.

Combined effects of weight change trajectories and eating behaviors on childhood adiposity status: A birth cohort study

Previous studies have suggested that infant rapid weight change can be associated with an increased weight later in life. However, the weight change trajectory in early life over time and which childhood lifestyle behaviors may modify the risk of rapid weight change have not been characterized. Using our ongoing birth cohort study, we have addressed these issues. Nine follow-up time points (birth, 3, 6, 9, 12, 18, 24, 36, and 48 months) were used to calculate the change between two adjacent weight-for-age z-scores (WAZ-change), and then WAZ-change trajectories were defined via group-based trajectory modeling. The solitary, independent and combined effects of WAZ-change trajectories and each lifestyle factor (eating behaviors, physical activity, media exposure time and total sleep duration) on childhood adiposity measures at age 4 years were determined using multivariate regression analysis. Overall, 84 (38%) children had a steady growth trajectory from birth to 4 years, while the other 137 (62%) children had an early infancy rapid growth trajectory, particularly in the first three months. Compared to children with steady growth, children with early infancy rapid growth had a significantly higher body mass index, waist circumference, and subcutaneous fat. Moreover, weight change trajectory and three eating behaviors (i.e. food responsiveness, satiety responsiveness and food fussiness), not only had independent effects, but also combined (synergistic) effects on the majority of adiposity measures. Our results extend the current literature and provide a potentially valuable model to aid clinicians and health professionals in designing early-life interventions targeting specific populations, specific ages and specific lifestyle behaviors to prevent childhood overweight/obesity.

Pediatric Hypertension: Parent Perspectives

Clinical practice guidelines for diagnosis and management of pediatric hypertension have been available for decades. Yet, most cases of hypertension in children are undiagnosed. Provider and system-based factors, such as the complexity of diagnostic standards, and a failure among physicians to recognize the importance of hypertension in children, play a role in underdiagnosis. It is unclear, however, how patient and family behaviors impact the diagnosis and treatment of pediatric hypertension. We aimed to explore the perspectives of parents whose children have had multiple high blood pressure readings or have been diagnosed with hypertension to inform clinicians with areas for practice improvement. In a 2 site qualitative study, we interviewed parents of 15 children diagnosed with hypertension. Results from semi-structured interviews with parents revealed barriers to the diagnosis of pediatric hypertension, including uncertainty about the diagnosis and concerns around the accuracy of blood pressure measurements. Delay in diagnosis and lack of child engagement emerged as obstacles to the treatment of pediatric hypertension.