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Atkins LA, Spence AC, Szymlek-Gay EA. Iron Nutrition of Pre-Schoolers in High-Income Countries: A Review. Nutrients 2023; 15:nu15112616. [PMID: 37299582 DOI: 10.3390/nu15112616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
Pre-schoolers are vulnerable to iron deficiency, which, in high-resource countries, is mainly caused by suboptimal or poorly absorbable iron intakes. This review examines the prevalence of inadequate iron intakes and status, and the non-dietary factors associated with these, among children aged between 2 and 5 years within high-income countries. It then considers the quality of the pre-schooler diet in terms of dietary factors, dietary patterns, and iron intakes. Additionally, it discusses the assessment of iron bioavailability and examines the various methods used to estimate the amount of absorbable iron in pre-schooler diets. Knowledge of the adequacy of iron intakes and bioavailability of iron intakes, and dietary patterns associated with iron intakes can facilitate the design and implementation of effectively targeted community-based intervention studies to improve iron intakes and iron bioavailability to minimise the risk of iron deficiency.
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Affiliation(s)
- Linda A Atkins
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Alison C Spence
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
| | - Ewa A Szymlek-Gay
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC 3220, Australia
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2
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Wang X, Xu Y, Tan B, Duan R, Shan S, Zeng L, Zou K, Zhao L, Xiong J, Zhang L, Rong S, Cheng G. Development of the Chinese preschooler dietary index: a tool to assess overall diet quality. BMC Public Health 2022; 22:2428. [PMID: 36572858 PMCID: PMC9791773 DOI: 10.1186/s12889-022-14672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/18/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Diet quality in early childhood has a long-term impact on health outcomes. However, there are scarce dietary indexes for Chinese preschool children, and the existing indexes had limited validity and reliability. This study thus aimed to develop a dietary index for preschool children based on the Chinese Dietary Guideline and Chinese Dietary Reference Intakes and to assess their overall diet quality using the China Health and Nutrition Survey (CHNS). METHODS The Chinese Preschooler Dietary Index (CPDI) included 11 components, covering 9 food group components and two nutrient components. The total scores of CPDI ranged from 0 to 90, with a higher score indicating greater diet quality. This study assessed the diet quality of 1742 preschoolers aged two to five years old from CHNS using the CPDI. Dietary intake data were obtained using three-day 24-h diet recalls, and sociodemographic information was also collected. Cochran-Mantel-Haensel (CMH) test was used to explore the association between demographic and CPDI total scores. The principal component analysis, correlation analysis and Cronbach's alpha were used to evaluate the relative reliability and validity of the CPDI. Finally, a stepwise multiple regression analysis was performed to explore potential influencing factors of CPDI. RESULTS Among the 1742 CHNS preschool children, more than 70% resided in rural areas and 41.2% of the sample were raised in a low-income family. The mean CPDI score of the preschoolers was 38.8 ± 12.9. Higher diet scores were correlated with higher energy and nutrient intake. Children with higher age (β = 0.93, SE = 0.26, P = 0.0003), raised in a home with higher household income (β = 3.11, SE = 0.27, P < 0.0001) or living in urban areas (β = -4.44, SE = 0.66, P < 0.0001) were associated with higher CPDI scores. CONCLUSIONS The CPDI is useful in evaluating the diet quality of preschool children. Based on the CPDI, the diet quality of Chinese preschoolers needs to be improved, especially in rural areas.
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Affiliation(s)
- Xiaoyu Wang
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - Yujie Xu
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - Bingbing Tan
- grid.13291.380000 0001 0807 1581Department of Nutrition and Food Safety, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ruonan Duan
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China ,grid.470966.aShanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China ,grid.412793.a0000 0004 1799 5032Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shufang Shan
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
| | - Linan Zeng
- grid.13291.380000 0001 0807 1581Department of Pharmacy, Evidence-Based Pharmacy Center, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University), West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kun Zou
- grid.13291.380000 0001 0807 1581Department of Pharmacy, Evidence-Based Pharmacy Center, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University), West China Second University Hospital, Sichuan University, Chengdu, China
| | - Li Zhao
- grid.13291.380000 0001 0807 1581Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Jingyuan Xiong
- grid.13291.380000 0001 0807 1581Healthy Food Evaluation Research Center, West China School of Public Health and West China Fourth Hospital,, Sichuan University, Chengdu, China
| | - Lingli Zhang
- grid.13291.380000 0001 0807 1581Department of Pharmacy, Evidence-Based Pharmacy Center, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University), West China Second University Hospital, Sichuan University, Chengdu, China
| | - Shuang Rong
- grid.412787.f0000 0000 9868 173XDepartment of Nutrition Hygiene and Toxicology, Academic of Nutrition and Health, School of Public Health, Medical College, Wuhan University of Science and Technology, Wuhan, China
| | - Guo Cheng
- grid.461863.e0000 0004 1757 9397Laboratory of Molecular Translational Medicine, Center for Translational Medicine, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041 People’s Republic of China
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Herawati HD, Putri AG, Purnamasari Y, Rahayu HK, Triastanti RK, Purnamasari SD, Lestari P. Nutrition Education using Booklet Media with and Without Counseling and the Association with Home Food Availability and Parent Feeding Practices in Preschool Children. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Fruit and vegetable consumption among preschool children in Indonesia is lower than recommendations, which may be due to types of food availability at home and unhealthy feeding practices such as restriction and parent pressure. Providing nutrition education through booklets and counseling on healthy food (fruit and vegetable) consumption can help to provide information to parent’s thus resulting healthy behavior, compared to merely providing booklets without counseling.
AIM: The aim of this study is to determine the effect of nutrition education using booklets with counseling versus without counseling on home food availability and parent feeding practices in preschool children.
METHODS: A quasi-experimental study utilized a pre-test and post-test design with a control group. Sampling methods included both purposive sampling and simple random sampling. Purposive sampling was used to select Danurejan district as the sub-district with the highest obesity percentage in Yogyakarta Municipality. Meanwhile, simple random sampling was applied to select children and schools (Early Childhood Education Program Pendidikan Anak Usia Dini [PAUD] or kindergartens Taman Kanak-kanak [TK]). There were 56 people (28 intervention and 28 controls) taken from 4 PAUD/TK. The intervention group received nutrition education using booklets as well as one 30–60 min counseling session carried out at the participant’s home. The control group was provided with booklets, but did not receive counseling. The pre-test was carried out before nutrition education was given, and the post-test was conducted 30 days after the nutrition education. Fruit and vegetable availability at home were assessed using questionnaire, and parent feeding practices were assessed using the Comprehensive Food Feeding Questionnaire. The statistical tests used to assess outcomes between groups included pair t-test, Wilcoxon, Mann–Whitney, and independent t-test.
RESULTS: There were increase in healthy eating guidance and monitoring before and after nutrition education was provided in the intervention group (p = 0.00; p < 0.05), but no differences were found in restriction, child control, and parent pressure (p = 0.11, p = 0.48, p = 0.28; p ≥ 0.05). There was a decrease in child control behavior before and after nutrition education in the control group (p = 0.00; p < 0.05), but there were no differences in healthy eating guidance, monitoring, restriction, and parent pressure (p = 0.17, p = 0.18, p = 0.53, 0.62; p ≥ 0.05).
CONCLUSIONS: Results demonstrate that using counseling in addition to nutrition education booklets can increase mother’s implementation use of healthy eating guidance and monitoring, with the potential to promote healthy weight within families.
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Hernández-Ruiz Á, Díaz-Jereda LA, Madrigal C, Soto-Méndez MJ, Kuijsten A, Gil Á. Methodological Aspects of Diet Quality Indicators in Childhood: A Mapping Review. Adv Nutr 2021; 12:2435-2494. [PMID: 34192740 PMCID: PMC8634546 DOI: 10.1093/advances/nmab053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/12/2021] [Accepted: 04/02/2021] [Indexed: 01/16/2023] Open
Abstract
Diet quality indicators (DQIns) are tools that aim to assess an individual's overall diet quality. Previous reviews focused mainly on health-related outcomes but did not provide detailed information about components, assessment variables, or important methodological issues for the development and application of DQIns in the pediatric age. The current mapping review aims to provide comprehensive guidance regarding DQIns developed through a priori methodology in children aged ≤14 y that have been applied worldwide. A mapping review was conducted, whereby 1665 original articles describing the development, modifications, and updates of DQIns, published up to June 26, 2020, in English and Spanish, were retrieved. A total of 139 articles were identified and classified into 13 subgroups. There were 10 overall DQIns: Healthy Eating Indexes (n = 25), Dietary Diversity Scores (n = 20), Diet Quality Indexes (n = 16), Food Variety Scores (n = 11), Healthy and Unhealthy Scores (n = 11), Feeding and Eating Indexes (n = 10), Diet Quality Scores (n = 5), Nutritional Adequacy and Micronutrients Indexes (n = 5), Dietary Guidelines Indexes (n = 5), and Other Healthy Diet Indexes (n = 13). Three additional subgroups of dietary and lifestyle indicators found were Mediterranean Diet Indexes (n = 10), Diet-Lifestyle Indexes (n = 5), and Breakfast Quality Indexes (n = 3). This compilation of DQIns will help researchers select the most appropriate tool for future epidemiological studies by considering a careful selection of information about the assessment components, scoring methods, and key methodological issues. The main limitations of this review are that, due to its nature, a risk-of-bias assessment was not performed and the article screening was completed in 2 databases (PubMed/MEDLINE and Scopus). More research is needed to identify health-related outcomes associated with DQIns in the pediatric population, using clearer and more standardized methodological criteria.
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Affiliation(s)
| | | | - Casandra Madrigal
- Iberoamerican Nutrition Foundation (FINUT), Granada, Spain
- Department of Nutrition and Food Science, Faculty of Pharmacy, University of Granada, Granada, Spain
| | | | - Anneleen Kuijsten
- Division of Human Nutrition and Health, Wageningen University, Wageningen, Netherlands
| | - Ángel Gil
- Iberoamerican Nutrition Foundation (FINUT), Granada, Spain
- Department of Biochemistry and Molecular Biology II, University of Granada, Granada, Spain
- Institute of Nutrition and Food Technology “José Mataix,” Biomedical Research Center, University of Granada, Granada, Spain
- Biosanitary Research Institute ibs.GRANADA, Granada University Hospital Complex, Granada, Spain
- CIBEROBN (Physiopathology of Obesity and Nutrition), Instituto de Salud Carlos III, Madrid, Spain
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Jiang Q, Tovar A, Risica PM, Cooksey Stowers K, Schwartz M, Lombardi C, Kang A, Mena NZ, Gans KM. Ethnic Differences in Family Childcare Providers' Nutrition- and Activity-Related Attitudes and Barriers. J Obes 2021; 2021:6697006. [PMID: 34659829 PMCID: PMC8516587 DOI: 10.1155/2021/6697006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 05/07/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022] Open
Abstract
Objective The aim of the study is to examine family childcare providers' (FCCPs) attitudes and perceived barriers related to nutrition, physical activity (PA), and screen time (ST) behaviors of preschool children, exploring differences by provider ethnicity. Design Baseline survey data from a cluster-randomized trial. Participants. Around 168 FCCPs completed a telephone survey, and 126 completed both telephone and in-person surveys. Main Outcome Measures. Phone and in-person surveys include 44 questions to assess FCCPs attitudes and perceived barriers regarding nutrition, PA, and ST in the family childcare home. Analysis. Associations by ethnicity (Latinx vs. non-Latinx) were assessed by ANOVA, adjusting for provider education and Bonferroni correction. Results Some FCCP attitudes were consistent with national obesity prevention guidelines; for example, most FCCPs agreed that they have an important role in shaping children's eating and PA habits. However, many FCCPs agreed with allowing children to watch educational TV and did not agree that children should serve themselves at meals. Adjusting for education, there were statistically significant differences in attitude and perceived barrier scores by provider ethnicity. For example, Latinx FCCPs were more likely to agree that they should eat the same foods as children(p < .001) but less likely to agree that serving the food at meal and snack time is the adult's responsibility (p < .001). Latinx FCCPs were more like to perceive barriers related to children's safety playing outside (p < .001). Conclusions and Implications. While FCCPs hold some nutrition-, PA-, and ST-related attitudes consistent with national guidelines, training opportunities are needed for FCCPs to improve knowledge and skills and overcome perceived barriers related to nutrition and PA. Latinx FCCPs, in particular, may need culturally tailored training and support to overcome misperceptions and barriers.
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Affiliation(s)
- Qianxia Jiang
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI, USA
| | - Patricia M. Risica
- Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA
| | - Kristen Cooksey Stowers
- University of Connecticut Institution for Collaboration in Health, Interventions and Policy, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- University of Connecticut Rudd Center for Food Policy and Obesity, Hartford, CT, USA
| | - Marlene Schwartz
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- University of Connecticut Institution for Collaboration in Health, Interventions and Policy, Storrs, CT, USA
- University of Connecticut Rudd Center for Food Policy and Obesity, Hartford, CT, USA
| | - Caitlin Lombardi
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Augustine Kang
- Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Noereem Z. Mena
- Food Science and Human Nutrition Department, Colorado State University, Fort Collins, CO, USA
| | - Kim M. Gans
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
- University of Connecticut Institution for Collaboration in Health, Interventions and Policy, Storrs, CT, USA
- University of Connecticut Rudd Center for Food Policy and Obesity, Hartford, CT, USA
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Effect of Cryoconcentration Assisted by Centrifugation-Filtration on Bioactive Compounds and Microbiological Quality of Aqueous Maqui (Aristotelia chilensis (Mol.) Stuntz) and Calafate (Berberis microphylla G. Forst) Extracts Pretreated with High-Pressure Homogenization. Processes (Basel) 2021. [DOI: 10.3390/pr9040692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to evaluate the effect of cryoconcentration assisted by centrifugation-filtration on the bioactive compounds and the microbiological quality of aqueous maqui (Aristotelia chilensis (Mol.) Stuntz) and calafate (Berberis microphylla G. Forst) extracts pretreated with high-pressure homogenization (HPH). Aqueous extracts were prepared from fresh fruits which were treated with HPH (predefined pressure and number of passes). The best pretreatment was determined by aerobic mesophilic, fungal, and yeast counts. Treated extracts were frozen at −30 °C in special tubes and centrifuged at 4000 rpm for 10 min to obtain the cryoconcentrated product. The optimal pretreatment conditions for HPH were 200 MPa and one pass in which the extracts exhibited no microorganism counts. Cryoconcentration by freezing and subsequent centrifugation-filtration in a single cycle showed high process efficiency (>95%) in both soluble solids and bioactive compounds (total polyphenols and anthocyanins) and antioxidant capacity of the fresh fruits and extracts. The HPH treatment and subsequent cryoconcentration assisted by centrifugation-filtration is an efficient technology to obtain concentrates with good microbiological quality and a high content of bioactive compounds.
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Atkins LA, McNaughton SA, Spence AC, Szymlek-Gay EA. Dietary patterns of Australian pre-schoolers and associations with haem and non-haem iron intakes. Eur J Nutr 2021; 60:3059-3070. [PMID: 33484317 DOI: 10.1007/s00394-020-02477-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/21/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To describe Australian pre-schooler dietary patterns and examine their associations with dietary iron intakes. METHODS Dietary data of children (n = 812, 2 to < 6 years old) from the 2011-12 National Nutrition and Physical Activity Survey were collected via two non-consecutive 24-h recalls and analysed using AUSNUT 2011-13. Usual food and nutrient intakes were estimated via Multiple Source Method. Principal component analysis was used to extract dietary patterns from 32 food groups. Associations between dietary patterns and energy-adjusted iron intakes were assessed using linear regression, accounting for the complex survey design. RESULTS Mean (SD) usual total dietary and haem iron intakes were 6.3 (1.9) and 0.5 (0.3) mg/day, respectively. Three dietary patterns were identified, explaining 14% of the variance. Pattern 1 (positive loadings for cheese, breads, fats and oils, and water) was positively associated with total dietary iron intakes (β = 0.08, 95% CI 0.01, 0.15). Pattern 3 (positive loadings for red meat, fortified fruit and vegetable products, and sauces and spreads) was negatively associated with total dietary iron (β = - 0.08, 95% CI - 0.14, - 0.01) and non-haem iron (β = - 0.09, 95% CI - 0.15, - 0.02) intakes. No dietary patterns were associated with haem iron intakes. CONCLUSIONS Three main patterns characterise Australian pre-schooler diets. The pattern with which dietary iron is positively associated is predominately characterised by non-haem iron sources and non-iron-fortified foods. Future research is required to estimate the iron bioavailability of Australian pre-schooler diets.
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Affiliation(s)
- Linda A Atkins
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sarah A McNaughton
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Alison C Spence
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Ewa A Szymlek-Gay
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
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Dalwood P, Marshall S, Burrows TL, McIntosh A, Collins CE. Diet quality indices and their associations with health-related outcomes in children and adolescents: an updated systematic review. Nutr J 2020; 19:118. [PMID: 33099309 PMCID: PMC7585689 DOI: 10.1186/s12937-020-00632-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/30/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To describe a-priori diet quality indices used in children and adolescents, appraise the validity and reliability of these indices, and synthesise evidence on the relationship between diet quality and physical and mental health, and growth-related outcomes. METHODS Five electronic databases were searched until January 2019. An a-priori diet quality index was included if it applied a scoring structure to rate child or adolescent (aged 0-18-years) dietary intakes relative to dietary or nutrient guidelines. Diagnostic accuracy studies and prospective cohort studies reporting health outcomes were appraised using the Academy of Nutrition and Dietetics Quality Criteria Checklist. RESULTS From 15,577 records screened, 128 unique paediatric diet quality indices were identified from 33 countries. Half of the indices' scores rated both food and nutrient intakes (n = 65 indices). Some indices were age specific: infant (< 24-months; n = 8 indices), child (2-12-years; n = 16), adolescent (13-18 years; n = 8), and child/adolescent (n = 14). Thirty-seven indices evaluated for validity and/or reliability. Eleven of the 15 indices which investigated associations with prospective health outcomes reported significant results, such as improved IQ, quality of life, blood pressure, body composition, and prevalence of metabolic syndrome. CONCLUSIONS Research utilising diet quality indices in paediatric populations is rapidly expanding internationally. However, few indices have been evaluated for validity, reliability, or association with health outcomes. Further research is needed to determine the validity, reliability, and association with health of frequently utilised diet quality indices to ensure data generated by an index is useful, applicable, and relevant. REGISTRATION PROSPERO number: CRD42018107630 .
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Affiliation(s)
- Phoebe Dalwood
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences & Medicine, Bond Universtiy, Robina, Queensland, 4226, Australia
| | - Skye Marshall
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences & Medicine, Bond Universtiy, Robina, Queensland, 4226, Australia.
- Nutrition Research Australia, Sydney, New South Wales, Australia.
| | - Tracy L Burrows
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Ashleigh McIntosh
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences & Medicine, Bond Universtiy, Robina, Queensland, 4226, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, 2308, Australia
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Fox K, Gans K, McCurdy K, Risica PM, Jennings E, Gorin A, Papandonatos GD, Tovar A. Rationale, design and study protocol of the 'Strong Families Start at Home' feasibility trial to improve the diet quality of low-income, ethnically diverse children by helping parents improve their feeding and food preparation practices. Contemp Clin Trials Commun 2020; 19:100583. [PMID: 32637721 PMCID: PMC7327278 DOI: 10.1016/j.conctc.2020.100583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/18/2020] [Accepted: 06/07/2020] [Indexed: 12/28/2022] Open
Abstract
There is an urgent need to create effective interventions that help parents establish a healthy diet among their children early in life, especially among low-income and ethnically and racially diverse families. U.S. children eat too few fruits, vegetables and whole grains, and too many energy dense foods, dietary behaviors associated with increased morbidity from chronic diseases. Parents play a key role in shaping children's diets. Best practices suggest that parents should involve children in food preparation, and offer, encourage and model eating a variety of healthy foods. In addition, while parents help to shape food preferences, not all children respond in the same way. Certain child appetitive traits, such as satiety responsiveness (sensitivity to internal satiety signals), food responsiveness (sensitivity to external food cues), and food fussiness may help explain some of these differences. Prior interventions to improve the diet of preschool children have not used a holistic approach that targets the home food environment, by focusing on food quality, food preparation, and positive feeding practices while also acknowledging a child's appetitive traits. This manuscript describes the rationale and design for a 6-month pilot randomized controlled trial, Strong Families Start at Home, that randomizes parents and their 2-to 5-year old children to either a home-based environmental dietary intervention or an attention-control group. The primary aim of the study is to explore the feasibility and acceptability of the intervention and evaluation and to determine the intervention's preliminary efficacy on child diet quality, feeding practices, and availability of healthy foods in the home.
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Affiliation(s)
- Katelyn Fox
- Department of Nutrition and Food Science, University of Rhode Island, 41 Lower College Road, Room 125, Kingston, RI, 02881, USA
| | - Kim Gans
- Department of Human Development and Family Studies, and Institute for Collaboration in Health, Interventions, and Policy, University of Connecticut, Storrs, CT, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | - Karen McCurdy
- Department of Human Development & Family Studies, University of Rhode Island, Kingston, RI, USA
| | - Patricia Markham Risica
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Ernestine Jennings
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Alpert Medical School of Brown University, Providence, RI, USA
| | - Amy Gorin
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| | | | - Alison Tovar
- Department of Nutrition and Food Science, University of Rhode Island, Kingston, RI, USA
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Exploring the Provider-Level Socio-Demographic Determinants of Diet Quality of Preschool-Aged Children Attending Family Childcare Homes. Nutrients 2020; 12:nu12051368. [PMID: 32403299 PMCID: PMC7284878 DOI: 10.3390/nu12051368] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 01/12/2023] Open
Abstract
Since food preferences develop during early childhood and contribute to dietary patterns that can track into adulthood, it is critical to support healthy food environments in places where children spend significant amounts of time in, such as childcare. It is important to understand what factors influence the diet quality of children cared for in family childcare homes (FCCH). METHODS This study used baseline data from a cluster-randomized trial in FCCH, Healthy Start/Comienzos Sanos. Surveys capturing providers' socio-demographic characteristics were completed. Food and beverage consumptions were estimated using the Dietary Observation in Childcare protocol, and diet quality was calculated using the Healthy Eating Index (HEI)-2015. Comparison of mean HEI scores by provider socio-demographic variables were completed using ANOVAs, followed by multiple linear regression models for significant variables. Post-hoc ANOVA models compared mean HEI-2015 sub-components by income and ethnicity. RESULTS Significant differences in mean HEI-2015 scores were found for provider income level (less than $25,000, HEI: 64.8 vs. $25,001-$50,000: 62.9 vs. $75,001 or more: 56.2; p = 0.03), ethnicity (Non-Latinx: 56.6 vs. Latinx: 64.4; p = 0.002), language spoken outside of childcare (English: 58.6 vs. Spanish: 64.3, p = 0.005), and language spoken in childcare (English: 59.6 vs. Spanish: 64.4; p = 0.02). In linear regression models, a higher provider income ($75,001 or more) was negatively and significantly associated with the total HEI-2015 scores (β = -9.8, SE = 3.7; p = 0.009) vs. lower income (less than $25,000). When entering provider income and ethnicity to the same model, adjusting for Child and Adult Food Program (CACFP), only ethnicity was significant, with Latinx being positively associated with total HEI-2015 scores vs. non-Latinx (β = 6.5, SE = 2.4; p = 0.007). Statistically significant differences were found by ethnicity and language for greens/beans, total protein, and seafood and plant protein HEI-2015 component scores. DISCUSSION Lower income, and Latinx providers cared-for children had higher diet quality in FCCH compared to the other providers. Future studies should better understand what specific foods contribute to each of the HEI-2015 components in order to better tailor trainings and interventions.
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Dietary Patterns and Risk of Obesity and Early Childhood Caries in Australian Toddlers: Findings from an Australian Cohort Study. Nutrients 2019; 11:nu11112828. [PMID: 31752293 PMCID: PMC6893454 DOI: 10.3390/nu11112828] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/01/2019] [Accepted: 11/13/2019] [Indexed: 11/16/2022] Open
Abstract
We examined associations between dietary patterns at 12 months, characterised using multiple methodologies, and risk of obesity and early childhood caries (ECC) at 24–36 months. Participants were Australian toddlers (n = 1170) from the Study of Mothers’ and Infants’ Life Events affecting oral health (SMILE) birth cohort. Principal Components Analysis (PCA) and the Dietary Guideline Index for Children and Adolescents (DGI-CA) were applied to dietary intake data (1, 2 or 3-days) at 12 months, and regression analysis used to examine associations of dietary patterns with body mass index Z-score and presence of ECC at 24–36 months. Two dietary patterns were extracted using PCA: family diet and cow’s milkanddiscretionary combination. The mean DGI-CA score was 56 ± 13 (out of a possible 100). No statistically significant or clinically meaningful associations were found between dietary pattern or DGI-CA scores, and BMI Z-scores or ECC (n = 680). Higher cow’s milk and discretionary combination pattern scores were associated with higher energy and free sugars intakes, and higher family diet pattern scores and DGI-CA scores with lower free sugars intakes. The association between dietary patterns and intermediate outcomes of free sugars and energy intakes suggests that obesity and/or ECC may not yet have manifested, and thus longitudinal investigation beyond two years of age is warranted.
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Development of a diet quality index to assess adherence to Canadian dietary recommendations in 3-year-old children. Public Health Nutr 2019; 23:385-393. [PMID: 31511104 DOI: 10.1017/s1368980019002039] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Little is known about the diet quality of preschool children in Canada. We adapted an established diet quality index for European preschool children to align with the Canadian context and applied the index to dietary data of 3-year-old children to assess patterns of diet quality. DESIGN Our diet quality index (DQI-C) consists of four components that align with Canada's Food Guide (Vegetables and Fruit, Grain Products, Milk and Alternatives and Meat and Alternatives) and two components that account for less healthy intakes (Candy/Snacks, and Sugar-Sweetened Beverages (SSB)). The ratio between consumption v. recommended intakes is calculated for each component and summed to give a total score from 0 to 6. SETTING Alberta, Canada. PARTICIPANTS The DQI-C was applied to FFQ data from 1260 3-year-old children. RESULTS Mean DQI-C was 3·69 (sd 0·6). Most children met recommendations for Vegetables and Fruit (73 %) and Meat and Alternatives (70 %); however, fewer met recommendations for Milk and Alternatives (38 %) and Grain Products (13 %). Children in the lowest quartile for DQI-C score consumed a mean of 82 g of Candy/Snacks and 193 g of SSB daily, whereas those in the highest quartile consumed 45 g/d and 17 g/d of Candy and Snacks and SSB, respectively. CONCLUSION This DQI-C score is useful for ranking Canadian preschool children according to their overall diet quality. There is room for improvement for consumptions of Grain Products, Meat and Alternatives, Candy/Snacks and SSB, which could be a target for initiatives to improve diet quality of preschool children in Canada.
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Keshani P, Hossein Kaveh M, Faghih S, Salehi M. Improving diet quality among adolescents, using health belief model in a collaborative learning context: a randomized field trial study. HEALTH EDUCATION RESEARCH 2019; 34:279-288. [PMID: 30915431 DOI: 10.1093/her/cyz009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 02/22/2019] [Indexed: 06/09/2023]
Abstract
This study aimed to assess the impact of educational intervention, based on health belief model (HBM) and collaborative learning techniques on diet quality in adolescents. In this field trial study, 311 students aged 13-15 years old were included, of which 163 and 148 allocated in the experimental and comparison groups, respectively. They were selected through a stratified random sampling from 16 urban, secondary schools in 4 educational districts of Shiraz, the largest city in southern Iran. The revised children diet quality index was used to assess their diet quality. Using HBM as a framework for targeting determinants of dietary behavior, the intervention was performed in a collaborative learning context during the educational year (2015-16). Constructs of HBM and diet quality were measured before and after the intervention. All HBM's constructs and knowledge had significantly improved in the experimental group and mean differences were increased after the intervention. Diet quality improved in the experimental group (P < 0.001), which was significantly different from the comparison group (P = 0.001). The findings support the integration of appropriate models/theories into the context of collaborative learning methods to target large number of behavioral determinants, and ultimately increase the effectiveness of the educational interventions amongst adolescents.
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Affiliation(s)
- Parisa Keshani
- School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hossein Kaveh
- Research Center for Health Sciences. Institute of Health. Shiraz University of Medical Sciences. Shiraz, Iran
| | - Shiva Faghih
- Nutrition Research Center, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Moosa Salehi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Risica PM, Tovar A, Palomo V, Dionne L, Mena N, Magid K, Ward DS, Gans KM. Improving nutrition and physical activity environments of family child care homes: the rationale, design and study protocol of the 'Healthy Start/Comienzos Sanos' cluster randomized trial. BMC Public Health 2019; 19:419. [PMID: 30999881 PMCID: PMC6472069 DOI: 10.1186/s12889-019-6704-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early childhood is a crucial time to foster healthy eating and physical activity (PA) habits, which are critical for optimal child health, growth and development. Child care facilities are important settings to promote healthy eating and PA and prevent childhood obesity; however, almost all prior intervention studies have focused on child care centers and not family child care homes (FCCH), which care for over 1.6 million U.S. children. METHODS This paper describes Healthy Start/Comienzos Sanos, a cluster-randomized trial evaluating the efficacy of a multicomponent intervention to improve nutrition and PA environments in English and Spanish-speaking FCCH. Eligible child care providers complete baseline surveys and receive a two-day FCCH observation of the home environment and provider practices. Parent-consented 2-5 year-old children are measured (height, weight, waist circumference), wear accelerometers and have their dietary intake observed during child care using validated protocols. FCCH providers are then randomly assigned to receive an 8-month intervention including written materials tailored to the FCCH providers' need and interest, videos, peer support coaching using brief motivational interviewing, and periodic group meetings focused on either nutrition and PA (Intervention) or reading readiness (Comparison). Intervention materials focus on evidence-based nutrition and physical activity best practices. The initial measures (surveys, two-day observation of the FCCH and provider practices, child diet observation, physical measures, and accelerometer) are assessed again 8 and 12 months after the intervention starts. Primary outcomes are children's diet quality (Healthy Eating Index), time in moderate and vigorous PA and sedentary PA during child care. Secondary outcomes include FCCH provider practices and foods served, and PA environments and practices. Possible mediators (provider attitudes, self-efficacy, barriers and facilitators) are also being explored. Process evaluation measures to assess reach, fidelity and dose, and their relationship with dietary and PA outcomes are included. DISCUSSION Healthy Start/Comienzos Sanos fills an important gap in the field of childhood obesity prevention by rigorously evaluating an innovative multicomponent intervention to improve the nutrition and physical activity environments of FCCH. TRIAL REGISTRATION (# NCT02452645 ) ClinicalTrials.gov Trial registered on May 22, 2015.
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Affiliation(s)
- Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881 USA
| | - Vanessa Palomo
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
| | - Laura Dionne
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
| | - Noereem Mena
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881 USA
| | - Kate Magid
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
| | - Diane Stanton Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7461 USA
| | - Kim M. Gans
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912 USA
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT 06269 USA
- Institute for Collaboration in Health, Interventions and Policy, University of Connecticut, Storrs, CT 06269 USA
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Gans KM, Tovar A, Jiang Q, Mello J, Dionne L, Kang A, Mena NZ, Palomo V, Risica PM. Nutrition-Related Practices of Family Child Care Providers and Differences by Ethnicity. Child Obes 2019; 15:167-184. [PMID: 30707598 PMCID: PMC6909752 DOI: 10.1089/chi.2018.0083] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Child care settings play an important role in shaping children's eating behaviors; yet few studies have included family child care homes (FCCHs). We examined provider-reported nutrition-related practices in FCCHs and observed adherence to nutrition guidelines from the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC), exploring differences by provider ethnicity. METHODS We assessed baseline data from a cluster-randomized trial, including surveys with FCCH providers and observational data collected at the FCCH. We examined provider-reported nutrition-related practices and if providers met NAP SACC guidelines using observational data. Differences by ethnicity were assessed using chi-square and multivariate log-linear analysis adjusting for education. RESULTS Providers completed a telephone survey (n = 166, 100% female and 72% Hispanic) and participated in 2 full-day observations (n = 119). Many providers reported engaging in positive nutrition-related practices. Significant differences by ethnicity included the following: Hispanic providers less likely to report feeding practices that were responsive to children's self-regulation, but also less likely to report eating and drinking unhealthy foods/beverages in front of children and having screens on during meals and more likely to report seeking nutrition trainings. Using observational data, only 10 of 26 NAP SACC practices were met by >60% of providers. Few ethnic differences in meeting guidelines were found (7 of 26 practices). CONCLUSIONS While providers engage in some positive nutrition practices, improvement is needed to ensure that all providers actually meet evidence-based guidelines. Ethnic differences in certain practices underscore the need for culturally relevant trainings. TRIAL REGISTRATION NUMBER NCT02452645.
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Affiliation(s)
- Kim M. Gans
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Interventions and Policy, University of Connecticut, Storrs, CT
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Qianxia Jiang
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT
- Institute for Collaboration on Health, Interventions and Policy, University of Connecticut, Storrs, CT
| | - Jennifer Mello
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
| | - Laura Dionne
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
| | - Augustine Kang
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
| | - Noereem Z. Mena
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Vanessa Palomo
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
| | - Patricia Markham Risica
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI
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Chen LW, Fung SM, Fok D, Leong LP, Toh JY, Lim HX, Pang WW, Tan KH, Chong YS, Yap F, Godfrey KM, Lee YS, Chong MFF. The Development and Evaluation of a Diet Quality Index for Asian Toddlers and Its Perinatal Correlates: The GUSTO Cohort Study. Nutrients 2019; 11:nu11030535. [PMID: 30832217 PMCID: PMC6472180 DOI: 10.3390/nu11030535] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 12/13/2022] Open
Abstract
Early childhood diet may have lifelong influences on health outcomes, yet development of indices to assess diet quality is scarce in toddlers, especially in Asian countries. We aimed to develop and evaluate a Diet Quality Index (DQI) in a multi-ethnic Asian mother⁻offspring cohort and identify perinatal correlates of early childhood diet. Based primarily on the Singapore dietary guidelines, the DQI includes seven food components: rice, bread and alternatives; fruit; vegetables; meat and alternatives; milk and dairy products; whole grains; and foods high in sugar. The DQI was developed using parental report of Food Frequency Questionnaires (FFQ) data for 18-month-old toddlers (n = 561). The mean ± SD of DQI for the study toddlers was 44.2 ± 8.9 (theoretical range: 0⁻65). A higher DQI (better diet quality) was associated with higher intakes of several nutrients and food groups (e.g., vegetables, dietary fibre, and beta-carotene; all p < 0.001). Further construct validity was demonstrated by substantial agreement between the FFQ-DQI and 24-hour-recall-DQI (Intraclass-correlation-coefficient: 0.70). Independent predictors of lower DQI included higher maternal pre-pregnancy BMI [β(95% CI): -0.23(-0.39, -0.07)], Malay ethnicity [-1.88(-3.67, -0.09)], lower household income [-1.97(-3.91, -0.03)], lower education level [-2.57(-4.85, -0.28)] and never breastfeeding [-6.17(-11.06, -1.28)]. We developed a valid DQI for assessing the overall quality of the diets of Asian toddlers.
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Affiliation(s)
- Ling-Wei Chen
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore.
- HRB Centre for Diet and Health Research, School of Public Health, Physiotherapy, and Sports Science, University College Dublin, Dublin 4, Ireland.
| | - Si Ming Fung
- Food Science and Technology Programme, Department of Chemistry, National University of Singapore, Singapore 117543, Singapore.
| | - Doris Fok
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore.
| | - Lai Peng Leong
- Food Science and Technology Programme, Department of Chemistry, National University of Singapore, Singapore 117543, Singapore.
| | - Jia Ying Toh
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, A*STAR, Singapore 117609, Singapore.
| | - Hui Xian Lim
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, A*STAR, Singapore 117609, Singapore.
| | - Wei Wei Pang
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore.
| | - Kok Hian Tan
- Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore.
- Duke-NUS Graduate Medical School, Lee Kong Chian School of Medicine, Singapore 169857, Singapore.
| | - Yap-Seng Chong
- Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore.
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, A*STAR, Singapore 117609, Singapore.
| | - Fabian Yap
- Duke-NUS Graduate Medical School, Lee Kong Chian School of Medicine, Singapore 169857, Singapore.
- Department of Paediatrics Endocrinology, KK Women's and Children's Hospital, Singapore 229899, Singapore.
| | - Keith M Godfrey
- Medical Research Council Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK.
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore.
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, A*STAR, Singapore 117609, Singapore.
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital and National University Health System, Singapore 119074, Singapore.
| | - Mary Foong-Fong Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, A*STAR, Singapore 117609, Singapore.
- Clinical Nutrition Research Centre, Singapore Institute for Clinical Sciences, A*STAR, Singapore 117599, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117549, Singapore.
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Boles RE, Johnson SL, Burdell A, Davies PL, Gavin WJ, Bellows LL. Home food availability and child intake among rural families identified to be at-risk for health disparities. Appetite 2019; 134:135-141. [DOI: 10.1016/j.appet.2018.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/28/2018] [Accepted: 12/07/2018] [Indexed: 01/28/2023]
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Burggraf C, Teuber R, Brosig S, Meier T. Review of a priori dietary quality indices in relation to their construction criteria. Nutr Rev 2018; 76:747-764. [PMID: 30053192 PMCID: PMC6130981 DOI: 10.1093/nutrit/nuy027] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A multitude of indices measure the healthiness of dietary patterns. Because validation results with respect to health outcomes do not sufficiently facilitate the choice of a specific dietary quality index, the decision of which index to use for a particular research objective should be based on other criteria. This review aims to provide guidance on which criteria to focus upon when choosing a dietary index for a specific research question. A review of 57 existing specifications of dietary quality indices was conducted, taking explicitly into account relevant construction criteria explicated in the Organisation for Economic Co-operation and Development handbook on constructing composite indicators. Index construction choices regarding the following criteria were extracted: theoretical framework, indicator selection, normalization and valuation functions, and aggregation methods. Preferable features of dietary indices are discussed, and a summarizing toolbox is provided to help identify indices with the most appropriate construction features for the respective study aim and target region and with regard to the available database. Directions for future efforts in the specification of new diet quality indices are given.
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Affiliation(s)
- Christine Burggraf
- Leibniz-Institute of Agricultural Development in Transition Economies, Halle, Germany
- Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Ramona Teuber
- Department of Food and Resource Economics, Faculty of Science, University of Copenhagen, Frederiksberg C, Denmark
| | - Stephan Brosig
- Leibniz-Institute of Agricultural Development in Transition Economies, Halle, Germany
| | - Toni Meier
- Institute for Agricultural and Nutritional Sciences, Martin Luther University Halle-Wittenberg, Halle, Germany
- Competence Cluster for Nutrition and Cardiovascular Health (nutriCARD), Jena-Halle-Leipzig, Germany
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Marshall SA, Ip EH, Suerken CK, Arcury TA, Saldana S, Daniel SS, Quandt SA. Relationship between maternal depression symptoms and child weight outcomes in Latino farmworker families. MATERNAL & CHILD NUTRITION 2018; 14:e12614. [PMID: 29740933 PMCID: PMC6298031 DOI: 10.1111/mcn.12614] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 03/06/2018] [Accepted: 03/15/2018] [Indexed: 12/14/2022]
Abstract
This study sought to characterize depressive symptoms among mothers in Latino farmworker families, determine if maternal depression increases children's risk of obesity, and ascertain whether relevant risk factors such as physical activity, diet, and feeding style mediate this relationship. Mothers from 248 families completed the 10-item Center for Epidemiologic Studies Depression Scale 9 times over a 2-year period. Four distinct patterns were used to describe mothers: few symptoms, moderate episodic symptoms, severe episodic symptoms, and chronic symptoms. Approximately two-thirds of women experienced moderate symptoms of depression at least once. Children of mothers fitting each pattern were compared. At the end of the study, children of mothers with severe episodic and chronic symptoms were significantly more likely to be overweight and obese than children of mothers with few symptoms (p < .05). After controlling for covariates, differences in weight status for children of mothers with severe episodic symptoms remained significant. Children of mothers with either moderate episodic or chronic symptoms were fed in a less responsive fashion (p < .05), and children of chronically symptomatic mothers had lower diet quality (p < .01). Although nonresponsive feeding has been linked to childhood obesity, in this analysis, feeding style did not mediate the relationship between maternal depression and diet quality. Elevated levels of depressive symptoms are common in this population, and those symptoms, especially when severe or chronic in nature, may increase children's risk of obesity. Additional research is needed to characterize the pathways through which maternal depression influences children's weight.
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Affiliation(s)
| | - Edward H. Ip
- Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | | | | | | | | | - Sara A. Quandt
- Wake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
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Quandt SA, Trejo G, Suerken CK, Pulgar CA, Ip EH, Arcury TA. Diet Quality among Preschool-Age Children of Latino Migrant and Seasonal Farmworkers in the United States. J Immigr Minor Health 2017; 18:505-512. [PMID: 26514151 DOI: 10.1007/s10903-015-0304-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Dietary quality has been linked to obesity in children. Obesity among children of farmworker families exceeds that of other US Hispanic children. Knowledge of their dietary quality is needed to understand the origins and prevention of this obesity. Mothers (n = 237) of 3-year old children in farmworker families completed 3 24-hour recalls with trained interviewers using the Nutrition Data System for Research (NDS-R). Output was used to calculate total and component scores of the Revised Children's Diet Quality Index (RC-DQI). Mean total score was 62 (range 36-86) of an optimal score of 90. Scores for total fat, total grains, excess juice and iron were >80 % of the optimum, but scores for added sugar, whole grains, fruits, and vegetables were considerably lower. Children in farmworker families have low overall dietary quality. Intervention targeted to specific food issues may be an efficient way to addressing the problem.
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Affiliation(s)
- Sara A Quandt
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Grisel Trejo
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Cynthia K Suerken
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Camila A Pulgar
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Edward H Ip
- Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
| | - Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA
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Parent packs, child eats: Surprising results of Lunch is in the Bag's efficacy trial. Appetite 2017; 121:249-262. [PMID: 29079478 DOI: 10.1016/j.appet.2017.10.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 09/18/2017] [Accepted: 10/23/2017] [Indexed: 11/21/2022]
Abstract
Early care and education (ECE) centers that require lunch brought from home provide an uncluttered view of parent-child dietary interactions in early childhood. Children's eating from parent-provided bag lunches was observed at 30 ECE centers in Texas, with 15 randomly assigned to the Lunch is in the Bag intervention to improve the lunch meal and 15 to a wait-list control condition. Study participants were parent and child aged 3-5 years (N = 633 dyads). Data were collected at baseline (pre-intervention) and follow-ups at weeks 6 (post-intervention), 22 (pre-booster), and 28 (post-booster). Changes effected in the children's lunch eating-e.g., increase of 14 percent in prevalence of children eating vegetables (SE = 5, P = 0.0063)-reciprocated changes in parent lunch-packing. Irrespective of intervention, however, the children consumed one-half to two-thirds of the amounts of whatever foods the parents packed, and the eat-to-pack ratio did not change across time. Thus, children's lunch eating at the ECE centers appeared to be regulated by perceptual cues of food availability rather than food preferences or internal cues of hunger and satiety.
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Ip EH, Marshall SA, Arcury TA, Suerken CK, Trejo G, Skelton JA, Quandt SA. Child Feeding Style and Dietary Outcomes in a Cohort of Latino Farmworker Families. J Acad Nutr Diet 2017; 118:1208-1219. [PMID: 28966049 DOI: 10.1016/j.jand.2017.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 07/27/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND The high level of obesity in Latino children, especially in farmworker families, may be partly attributed to feeding styles of parents. Feeding styles used in Latino farmworker families have not been well characterized. OBJECTIVE This study sought to identify and describe feeding styles used by mothers in farmworker families with 2.5- to 3.5-year-old children, describe how styles change over time, and characterize the relationship of feeding styles to dietary outcomes and measures of overweight and obesity. DESIGN This was a longitudinal cohort study, with families participating for a 2-year period; surveys were administered to mothers with varying frequency depending on the instrument, and dietary measurements were collected at baseline and 12 and 24 months. PARTICIPANTS/SETTING Eligible participants were self-identified Latino women with a co-resident child aged 2.5 to 3.5 years old and at least one household member engaged in farm work during the previous year. The sample included 248 farmworker families enrolled between 2011 and 2012 in the Niños Sanos study, a longitudinal investigation of Latino mothers and their young children in rural North Carolina. Eleven families provided incomplete dietary data, so the analysis included 237 families. Fifteen families were lost to follow-up and 12 withdrew during the course of the study. MAIN OUTCOME MEASURES Feeding style was assessed using items from the Caregiver's Feeding Style Questionnaire, selected dietary components were assessed using the Revised Children's Diet Quality Index, and weight outcomes were determined using body mass index-for-age percentile. Performance on the Caregiver's Feeding Style Questionnaire items was used to assign mothers to one of four feeding style states. STATISTICAL ANALYSES PERFORMED Exploratory factor analysis was conducted on baseline data to verify the replicability of the factor structure of the instrument Caregiver's Feeding Style Questionnaire. Hidden Markov Model analysis was used to delineate different subtypes of feeding style. Multivariable mixed-effects regression models were used to assess the impact of feeding style on selected dietary components, energy intake, and body mass index-for-age percentile. RESULTS Four distinct states emerged from the Hidden Markov Model: low parent-centered (PC)/moderate child-centered (CC) feeding style (28% at baseline), high PC/CC without physical control (24%), high PC/CC (26%), and moderate PC/CC (22%). The low PC/moderate CC state increased in prevalence over time. Compared to high PC/CC, the low PC/moderate CC state was associated with greater intake of added sugars (P<0.01), lower intake of whole grains and vegetables (P<0.01), and lower overall diet quality (P<0.05). Children in low PC/moderate CC also had higher mean body mass index percentiles (76.2 percentile vs 66.7 percentile in high PC/CC; P<0.001). CONCLUSIONS High PC feeding along with high CC feeding is associated with improved diet quality and weight outcomes for children in the study.
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Ip EH, Marshall SA, Saldana S, Skelton JA, Suerken CK, Arcury TA, Quandt SA. Determinants of Adiposity Rebound Timing in Children. J Pediatr 2017; 184:151-156.e2. [PMID: 28242030 PMCID: PMC5404387 DOI: 10.1016/j.jpeds.2017.01.051] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/02/2016] [Accepted: 01/20/2017] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Adiposity rebound (AR) or BMI (body mass index) rebound refers to the increase in BMI following the minimum BMI in early childhood. Early AR (before age 5) is predictive of adult obesity. To determine how 4 domains - demographics, maternal BMI, food security, and behavioral characteristics - may affect timing of AR. STUDY DESIGN A total of 248 children, ages 2.5-3.5 years, in Latino farmworker families in North Carolina were examined at baseline and every 3 months for 2 years. BMI was plotted serially for each child and the onset of BMI rebound was determined by visual inspection of the graphs. Given the ages of the children, all rebounds were detected before age 5 years and were deemed "early," whereas other children were classified as "nonrebounders." Classes were then compared in terms of the 4 domains with the use of bivariate analyses and linear mixed models. RESULTS A total of 131 children demonstrated early rebound, 59 children were nonrebounders, and a further 35 had inconclusive data. Parents of early rebounders were less likely to have documentation permitting legal residence in the US. Mothers of early rebounders were on average 3 BMI units heavier. Sex, household food security, diet quality, caloric intake, and daily activity did not differ between classes. In multivariable analysis, female sex, limited maternal education, increased maternal BMI, and increased caloric intake were significant predictors of early rebound. CONCLUSION High maternal BMI was the strongest predictor of early BMI rebound, but increased caloric intake also was significant. Limiting excess calories could delay premature AR and lower the risk of future obesity.
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Affiliation(s)
- Edward H. Ip
- Department of Biostatistical Sciences, Wake Forest School of
Medicine
| | - Sarah A. Marshall
- Department of Biostatistical Sciences, Wake Forest School of
Medicine
| | - Santiago Saldana
- Department of Biostatistical Sciences, Wake Forest School of
Medicine
| | | | | | - Thomas A. Arcury
- Department of Family and Community Medicine, Wake Forest School of
Medicine
| | - Sara A. Quandt
- Department of Epidemiology and Prevention, Wake Forest School of
Medicine
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Kranz S, Brauchla M, Campbell WW, Mattes RD, Schwichtenberg AJ. High-Protein and High-Dietary Fiber Breakfasts Result in Equal Feelings of Fullness and Better Diet Quality in Low-Income Preschoolers Compared with Their Usual Breakfast. J Nutr 2017; 147:445-452. [PMID: 28077732 PMCID: PMC5320397 DOI: 10.3945/jn.116.234153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/29/2016] [Accepted: 12/13/2016] [Indexed: 11/14/2022] Open
Abstract
Background: In the United States, 17% of children are currently obese. Increasing feelings of fullness may prevent excessive energy intake, lead to better diet quality, and promote long-term maintenance of healthy weight.Objective: The purpose of this study was to develop a fullness-rating tool (aim 1) and to determine whether a high-protein (HP), high-fiber (HF), and combined HP and HF (HPHF) breakfast increases preschoolers' feelings of fullness before (pre) and after (post) breakfast and pre-lunch, as well as their diet quality, as measured by using a composite diet quality assessment tool, the Revised Children's Diet Quality Index (aim 2).Methods: Children aged 4 and 5 y (n = 41; 22 girls and 19 boys) from local Head Start centers participated in this randomized intervention trial. Sixteen percent of boys and 32% of girls were overweight or obese. After the baseline week, children rotated through four 1-wk periods of consuming ad libitum HP (19-20 g protein), HF (10-11 g fiber), HPHF (19-21 g protein, 10-12 g fiber), or usual (control) breakfasts. Food intake at breakfast was estimated daily, and for breakfast, lunch, and snack on day 3 of each study week Student's t tests and ANOVA were used to determine statistical differences.Results: Children's post-breakfast and pre-lunch fullness ratings were ≥1 point higher than those of pre-breakfast (aim 1). Although children consumed, on average, 65 kcal less energy during the intervention breakfasts (P < 0.007) than during the control breakfast, fullness ratings did not differ (P = 0.76). Relative to the control breakfast, improved diet quality (12%) was calculated for the HP and HF breakfasts (P < 0.027) but not for the HPHF breakfast (aim 2).Conclusions: Post-breakfast fullness ratings were not affected by the intervention breakfasts relative to the control breakfast. HP and HF breakfasts resulted in higher diet quality. Serving HP or HF breakfasts may be valuable in improving diet quality without lowering feelings of satiation or satiety. This trial was registered at clinicaltrials.gov as NCT02122224.
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Ward DS, Welker E, Choate A, Henderson KE, Lott M, Tovar A, Wilson A, Sallis JF. Strength of obesity prevention interventions in early care and education settings: A systematic review. Prev Med 2017; 95 Suppl:S37-S52. [PMID: 27693295 DOI: 10.1016/j.ypmed.2016.09.033] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 09/20/2016] [Accepted: 09/23/2016] [Indexed: 10/20/2022]
Abstract
2010-2015; INTERNATIONAL: Given the high levels of obesity in young children, numbers of children in out-of-home care, and data suggesting a link between early care and education (ECE) participation and overweight/obesity, obesity prevention in ECE settings is critical. As the field has progressed, a number of interventions have been reviewed yet there is a need to summarize the data using more sophisticated analyses to answer questions on the effectiveness of interventions. We conducted a systematic review of obesity prevention interventions in center-based ECE settings published between 2010 and 2015. Our goal was to identify promising intervention characteristics associated with successful behavioral and anthropometric outcomes. A rigorous search strategy resulted in 43 interventions that met inclusion criteria. We developed a coding strategy to assess intervention strength, used a validated study quality assessment tool, and presented detailed descriptive information about interventions (e.g., target behaviors, intervention strategies, and mode of delivery). Intervention strength was positively correlated with reporting of positive anthropometric outcomes for physical activity, diet, and combined interventions, and parent engagement components increased the strength of these relationships. Study quality was modestly related to percent successful healthy eating outcomes. Relationships between intervention strength and behavioral outcomes demonstrated negative relationships for all behavioral outcomes. Specific components of intervention strength (number of intervention strategies, potential impact of strategies, frequency of use, and duration of intervention) were correlated with some of the anthropometric and parent engagement outcomes. The review provided tentative evidence that multi-component, multi-level ECE interventions with parental engagement are most likely to be effective with anthropometric outcomes.
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Affiliation(s)
- Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States.
| | - Emily Welker
- Healthy Eating Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Ashley Choate
- Healthy Eating Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | | | - Megan Lott
- Healthy Eating Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, South Kingstown, RI, United States
| | - Amanda Wilson
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, United States
| | - James F Sallis
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, United States
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The Predictors of Diet Quality among Australian Children Aged 3.5 Years. J Acad Nutr Diet 2016; 116:1114-1126.e2. [DOI: 10.1016/j.jand.2015.12.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 12/11/2015] [Indexed: 11/18/2022]
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Pereira-da-Silva L, Rêgo C, Pietrobelli A. The Diet of Preschool Children in the Mediterranean Countries of the European Union: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060572. [PMID: 27338427 PMCID: PMC4924029 DOI: 10.3390/ijerph13060572] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/31/2016] [Accepted: 05/31/2016] [Indexed: 11/18/2022]
Abstract
This systematic review discusses data on the dietary intake of preschool children living in the Mediterranean countries of the European Union, including the comparison with a Mediterranean-like diet and the association with nutritional status. Specifically, data from the multinational European Identification and Prevention on Dietary and life style induced health effects in children and infants (IDEFICS) study and national studies, such as the Estudo do Padrão Alimentar e de Crescimento Infantil (EPACI) study and Geração XXI cohort in Portugal, ALimentando la SAlud del MAñana (ALSALMA) study in Spain, Étude des Déterminants pré-et postnatals précoces du développement et de la santé de l’ENfant (EDEN) cohort in France, Nutrintake 636 study in Italy, and Growth, Exercise and Nutrition Epidemiological Study in preSchoolers (GENESIS) cohort in Greece, were analyzed. In the majority of countries, young children consumed fruit and vegetables quite frequently, but also consumed sugared beverages and snacks. High energy and high protein intakes mainly from dairy products were found in the majority of countries. The majority of children also consumed excessive sodium intake. Early high prevalence of overweight and obesity was found, and both early consumption of energy-dense foods and overweight seemed to track across toddler and preschool ages. Most children living in the analyzed countries showed low adherence to a Mediterranean-like diet, which in turn was associated with being overweight/obese. Unhealthier diets were associated with lower maternal educational level and parental unemployment. Programs promoting adherence of young children to the traditional Mediterranean diet should be part of a multi-intervention strategy for the prevention and treatment of pediatric overweight and obesity.
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Affiliation(s)
- Luís Pereira-da-Silva
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon 1169-056, Portugal.
- Pediatric Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon 1169-045, Portugal.
| | - Carla Rêgo
- Faculty of Medicine, Porto University, Porto 4200-319, Portugal.
- Center for Health Technology and Services Research (CINTESIS), Porto 4200-3129, Portugal.
- Child and Adolescent Service, Hospital CUF Porto, Porto 4200-180, Portugal.
| | - Angelo Pietrobelli
- Pediatric Unit, Verona University Medical School, Verona 37134, Italy.
- Pennington Biomedical Research Center, Baton Rouge, LA 70808, USA.
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Kong A, Buscemi J, Stolley MR, Schiffer LA, Kim Y, Braunschweig CL, Gomez-Perez SL, Blumstein LB, Van Horn L, Dyer AR, Fitzgibbon ML. Hip-Hop to Health Jr. Randomized Effectiveness Trial: 1-Year Follow-up Results. Am J Prev Med 2016; 50:136-44. [PMID: 26385162 PMCID: PMC4718844 DOI: 10.1016/j.amepre.2015.07.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 06/30/2015] [Accepted: 07/13/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The preschool years provide a unique window of opportunity to intervene on obesity-related lifestyle risk factors during the formative years of a child's life. The purpose of this study was to assess the impact of a preschool-based obesity prevention effectiveness trial at 1-year follow-up. DESIGN RCT. SETTINGS/PARTICIPANTS Primarily African American children (aged 3-5 years, N=618) attending Head Start preschool programs administered by Chicago Public Schools. METHODS Eighteen preschools were randomly assigned in 2007-2008 to receive either (1) a 14-week teacher-delivered intervention focused on healthy lifestyle behaviors or (2) a 14-week teacher-delivered general health curriculum (control group). MAIN OUTCOME MEASURES The primary outcome, BMI, was measured at baseline, postintervention, and 1-year follow-up. Diet and screen time behaviors were also assessed at these time points. Multilevel mixed effects models were used to test for between-group differences. Data were analyzed in 2014. RESULTS Significant between-group differences were observed in diet, but not in BMI z-score or screen time at 1-year follow-up. Diet differences favored the intervention arm over controls in overall diet quality (p=0.02) and in subcomponents of diet quality, as measured by the Healthy Eating Index-2005, and in fruit intake (servings/day, excludes juice) (p=0.02). Diet quality worsened more among controls than the intervention group at 1-year follow-up. CONCLUSIONS The adaptation of Hip-Hop to Health Jr. produced modest benefits in diet quality but did not significantly impact weight gain trajectory. Not unlike other effectiveness trials, this real-world version delivered by Head Start teachers produced fewer benefits than the more rigorous efficacy trial. It is important to understand and build upon the lessons learned from these types of trials so that we can design, implement, and disseminate successful evidence-based programs more widely and effectively. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT00241878.
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Affiliation(s)
- Angela Kong
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois; University of Illinois Cancer Center, Chicago, Illinois; Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois.
| | - Joanna Buscemi
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois; Cancer Education and Career Development Program, University of Illinois at Chicago, Chicago, Illinois
| | - Melinda R Stolley
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois; University of Illinois Cancer Center, Chicago, Illinois; Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Linda A Schiffer
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Yoonsang Kim
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Carol L Braunschweig
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois
| | - Sandra L Gomez-Perez
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois; Cancer Education and Career Development Program, University of Illinois at Chicago, Chicago, Illinois
| | - Lara B Blumstein
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Linda Van Horn
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alan R Dyer
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Marian L Fitzgibbon
- Institute of Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois; University of Illinois Cancer Center, Chicago, Illinois; Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; School of Public Health, University of Illinois at Chicago, Chicago, Illinois
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Cheng G, Duan R, Kranz S, Libuda L, Zhang L. Development of a Dietary Index to Assess Overall Diet Quality for Chinese School-Aged Children: The Chinese Children Dietary Index. J Acad Nutr Diet 2016; 116:608-17. [PMID: 26825477 DOI: 10.1016/j.jand.2015.11.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/24/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND A composite measure of diet quality is preferable to an index of nutrients, food groups, or health-promoting behaviors in dietary assessment. However, to date, such a tool for Chinese children is lacking. OBJECTIVE Based on the current Chinese Dietary Guidelines and Dietary Reference Intakes, a dietary index for Chinese school-aged children, the Chinese Children Dietary Index was developed to assess overall diet quality among children in South China. DESIGN Dietary data were recorded using 24-hour recalls among 1,719 children aged 7 to 15 years between March and June 2013. Inactivity data and sociodemographic information were also collected. The Chinese Children Dietary Index included 16 components, which incorporated nutrients, foods/food groups, and health-promoting behaviors. The range of possible Chinese Children Dietary Index scores was 0 to 160, with a higher score indicating better diet quality. STATISTICAL ANALYSIS PERFORMED Pearson/Spearman correlation was used to assess relative validity using correlations between total Chinese Children Dietary Index score and age, body mass index (BMI; calculated as kg/m(2)), inactivity, whole-grain intake, frequency of fried-foods intake, nutrient adequacy ratios for energy intake and 12 nutrients not included in the Chinese Children Dietary Index, and the mean adequacy ratio. Finally, a stepwise multiple regression analysis was performed to indicate the factors correlated with Chinese Children Dietary Index. RESULTS Mean Chinese Children Dietary Index score of this sample was 88.1 points (range=34.2 to 137.8), the Chinese Children Dietary Index score of girls was higher than that of boys and decreased with higher age. Children with higher Chinese Children Dietary Index had lower body mass index and spent less time being inactive. Positive associations were observed between Chinese Children Dietary Index and the majority of nutrient adequacy ratios and the mean adequacy ratio. Age, paternal educational level, and family size were correlated with Chinese Children Dietary Index. CONCLUSIONS The Chinese Children Dietary Index successfully differentiated diets and, therefore, it can be used to rank-order overall diet quality among Chinese children. As the results showed, diet quality among Chinese children needs to be improved, especially in adolescents.
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Assessing the Nutritional Quality of Diets of Canadian Adults Using the 2014 Health Canada Surveillance Tool Tier System. Nutrients 2015; 7:10447-68. [PMID: 26703721 PMCID: PMC4690095 DOI: 10.3390/nu7125543] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 11/10/2015] [Accepted: 11/27/2015] [Indexed: 12/03/2022] Open
Abstract
The 2014 Health Canada Surveillance Tool (HCST) was developed to assess adherence of dietary intakes with Canada’s Food Guide. HCST classifies foods into one of four Tiers based on thresholds for sodium, total fat, saturated fat and sugar, with Tier 1 representing the healthiest and Tier 4 foods being the unhealthiest. This study presents the first application of HCST to assess (a) dietary patterns of Canadians; and (b) applicability of this tool as a measure of diet quality among 19,912 adult participants of Canadian Community Health Survey 2.2. Findings indicated that even though most of processed meats and potatoes were Tier 4, the majority of reported foods in general were categorized as Tiers 2 and 3 due to the adjustable lenient criteria used in HCST. Moving from the 1st to the 4th quartile of Tier 4 and “other” foods/beverages, there was a significant trend towards increased calories (1876 kcal vs. 2290 kcal) and “harmful” nutrients (e.g., sodium) as well as decreased “beneficial” nutrients. Compliance with the HCST was not associated with lower body mass index. Future nutrient profiling systems need to incorporate both “positive” and “negative” nutrients, an overall score and a wider range of nutrient thresholds to better capture food product differences.
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Schwartz MB, O'Connell M, Henderson KE, Middleton AE, Scarmo S. Testing Variations on Family-Style Feeding To Increase Whole Fruit and Vegetable Consumption among Preschoolers in Child Care. Child Obes 2015; 11:499-505. [PMID: 26280874 DOI: 10.1089/chi.2015.0038] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Preschoolers do not consume whole fruit and vegetables (FVs) in recommended quantities. Two strategies to increase FV intake were tested. METHODS One Head Start preschool participated. Two variations of family-style feeding were compared to usual practice: (1) Fruits, vegetables, and milk were served before the main meal (first course); and (2) fruits, vegetables, and milk were served before the main meal and meats and grains were removed from the table after the first serving (combination). A within-subject crossover design was used to test each condition for three meals. The amount of food served and consumed was weighed and converted to Child and Adult Care Feeding Program (CACFP) standard serving sizes for analysis. RESULTS Eighty-five children ages 3-5 participated. The sample was 81% Hispanic with diverse racial backgrounds. Thirty percent of the children were overweight. FV consumption was at CACFP recommended levels at baseline and remained consistent across conditions. The average amount served for each meal component was at or above CACFP recommendations for all foods except milk, which was consistently served in small portions. Meat and grains servings were frequently 2-3 times larger than CACFP recommendations. Milk consumption was significantly higher in the Combined intervention for two meals. Children ate significantly less meat during the Combined intervention for one meal. CONCLUSIONS The intervention led to significant increases in milk consumption, which was the only underconsumed meal component. These strategies should be tested with children who have lower baseline intake of FVs.
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Affiliation(s)
- Marlene B Schwartz
- 1 Rudd Center for Food Policy and Obesity, University of Connecticut , Hartford, CT
| | - Meghan O'Connell
- 1 Rudd Center for Food Policy and Obesity, University of Connecticut , Hartford, CT
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Tovar A, Mena NZ, Risica P, Gorham G, Gans KM. Nutrition and Physical Activity Environments of Home-Based Child Care: What Hispanic Providers Have to Say. Child Obes 2015; 11:521-9. [PMID: 26332455 PMCID: PMC4599130 DOI: 10.1089/chi.2015.0040] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND It is important to understand the perceptions and beliefs of family child care providers (FCCPs) regarding which factors influence children's physical activity (PA), screen-time (ST), and dietary behaviors in order to develop and implement appropriate obesity prevention interventions. The aim of this qualitative study was to explore the aforementioned perceptions and beliefs of FCCPs in Rhode Island. METHODS Four focus groups (n = 30) were held with FCCPs. Providers were female, Hispanic, and Spanish speaking. Providers were asked about different aspects of feeding, PA, and ST behaviors. Themes were coded using NVivo10 (QSR International Pty Ltd, Doncaster, Victoria, Australia). Content analysis was used to analyze final themes. RESULTS Providers understood the importance of providing opportunities for healthy eating and PA for the children they cared for, but there was room for improvement, especially with regard to certain feeding and ST practices. Several barriers were evident, including the lack of physical infrastructure for PA, cultural beliefs and practices related to child feeding, and difficulties working with parents to provide consistent messages across environments. CONCLUSIONS Given that FCCPs are aware of the importance of healthy eating and PA, there is a need to address the specific barriers they face, and operationalize some of their knowledge into practical everyday actions. This formative work will inform the development of a culturally relevant, multicomponent intervention for ethnically diverse FCCPs to improve the food and PA environments of their homes, which should, in turn, improve the dietary, PA, and ST behaviors of the 2- to 5-year-old children they care for.
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Affiliation(s)
- Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Noereem Z. Mena
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Patricia Risica
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI
| | - Gemma Gorham
- Institute for Community Health Promotion, Brown University School of Public Health, Providence, RI
| | - Kim M. Gans
- Department of Human Development and Family Studies and Center for Health Interventions and Prevention, University of Connecticut, Storrs, CT
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Magriplis E, Farajian P, Risvas G, Panagiotakos D, Zampelas A. Newly derived children-based food index. An index that may detect childhood overweight and obesity. Int J Food Sci Nutr 2015; 66:623-32. [PMID: 26186030 DOI: 10.3109/09637486.2015.1056109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A food index (FI) based on a priory knowledge was developed to assess the role of diet on overweight (OW) and obesity (OB) in school-aged children. This included «positive» and «negative» foods based on research evidence and food guidelines, with scores set accordingly. Statistical tests were used to strengthen the sensitivity of the index. The FI was validated using data from the GRECO study. The score ranged from 17 to 53.5 (mean 34.8 ± 5.01) and was inversely associated with body mass index (BMI) (-0.057 ± 0.02; 95% CI -0.098, -0.017) and waist circumference (WC) (-0.08 ± 0.03, 95% CI: -0.137, -0.022). Associations remained significant upon adjusting for age, gender and physical-inactivity (p = 0.02 ad 0.013, respectively). When stratified by gender, the association between FI and WC was not significant for boys (p = 0.08). The association with BMI remained significant for females and males (p = 0.047 and 0.037, respectively). The derived FI seems a valuable tool in detecting OW in children.
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Affiliation(s)
- E Magriplis
- a Department of Food Science and Human Nutrition, Unit of Human Nutrition , Agricultural University of Athens , Athens , Greece
| | - P Farajian
- a Department of Food Science and Human Nutrition, Unit of Human Nutrition , Agricultural University of Athens , Athens , Greece
| | - G Risvas
- a Department of Food Science and Human Nutrition, Unit of Human Nutrition , Agricultural University of Athens , Athens , Greece
| | - D Panagiotakos
- b Department of Science and Dietetics-Nutrition , Harokopio University , Athens , Greece , and
| | - A Zampelas
- a Department of Food Science and Human Nutrition, Unit of Human Nutrition , Agricultural University of Athens , Athens , Greece .,c Department of Nutrition and Health , College of Food and Agriculture, United Arab Emirates University , Al Ain , United Arab Emirates
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34
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Development and evaluation of a stand-alone index for the assessment of small children’s diet quality. Public Health Nutr 2015; 18:1941-9. [DOI: 10.1017/s1368980014002535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AbstractObjectiveTo construct and evaluate an independent Children’s Index of Diet Quality (CIDQ).DesignA food consumption questionnaire, which contained twenty-five multiple-item questions on eating and food intake, was formulated and evaluated against 7 d food records. Key questions that best reflected a healthy diet, defined in criteria set by the nutrient recommendations, were searched and validated by correlation and analyses of receiver-operating characteristic curves.SettingsA cohort of a young population of South-West Finland.SubjectsParticipants (n 400) were 2–6-year-old children.ResultsFifteen questions were identified to best depict the children’s diet quality in reference to the recommendations. These questions were scored, summarized and further constructed into a three-class index (good, moderate and poor dietary quality) where higher scores depicted better diet quality. The CIDQ cut-off score of 14 points for good dietary quality had a sensitivity of 0·59 and a specificity of 0·82 and the cut-off score of 10 points, for at least moderate dietary quality, had a sensitivity of 0·77 and a specificity of 0·69. Higher index scores were related to higher dietary intakes of several vitamins, lower dietary intakes of SFA and cholesterol, and further with lower serum cholesterol and higher serum vitamin C concentrations.ConclusionsThe three-class food index was found to represent diet quality as defined in recommendations and evaluated against nutrient intakes from food diaries and biochemical markers. This self-standing index could provide an effective and low-burden method to obtain information about diet quality and guide future recommendations.
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Spence AC, Campbell KJ, Crawford DA, McNaughton SA, Hesketh KD. Mediators of improved child diet quality following a health promotion intervention: the Melbourne InFANT Program. Int J Behav Nutr Phys Act 2014; 11:137. [PMID: 25366542 PMCID: PMC4230360 DOI: 10.1186/s12966-014-0137-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 10/20/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Young children's diets are currently suboptimal. Given that mothers have a critical influence on children' diets, they are typically a target of interventions to improve early childhood nutrition. Understanding the maternal factors which mediate an intervention's effect on young children's diets is important, but has not been well investigated. This research aimed to test whether maternal feeding knowledge, maternal feeding practices, maternal self-efficacy, and maternal dietary intakes acted as mediators of the effect of an intervention to improve child diet quality. METHODS The Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program was a cluster-randomized controlled trial, conducted from 2008-2010. This novel, low-dose, health promotion intervention was delivered quarterly over 15 months and involved educational activities, promotion of peer discussion, a DVD and written materials. Post-intervention, when children were approximately 18 months of age, child diets were assessed using multiple 24-hour recalls and a purpose-developed index of diet quality, the Obesity Protective Dietary Index. Maternal mediators were assessed using a combination of previously validated and purpose-deigned tools. Mediation analysis was conducted using the test of joint significance and difference of coefficients methods. RESULTS Across 62 parents' groups in Melbourne, Australia, 542 parents were recruited. Post- intervention, higher maternal feeding knowledge and lower use of foods as rewards was found to mediate the direct intervention effect on child diet quality. While other aspects of maternal feeding practices, self-efficacy and dietary intakes did not act as mediators, they were associated with child diet quality. CONCLUSIONS Mediation analysis of this novel health promotion intervention showed the importance of maternal feeding knowledge and use of foods as rewards in impacting child diet quality. The other maternal factors assessed were appropriate targets but further research on how to impact these in an intervention is important. This evidence of intervention efficacy and mediation provides important insights for planning future interventions. TRIAL REGISTRATION Current Controlled Trials ISRCTN81847050, registered 23 November 2007.
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Affiliation(s)
- Alison C Spence
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - Karen J Campbell
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - David A Crawford
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - Sarah A McNaughton
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
| | - Kylie D Hesketh
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood, Victoria, 3125, Australia.
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Marshall S, Burrows T, Collins CE. Systematic review of diet quality indices and their associations with health-related outcomes in children and adolescents. J Hum Nutr Diet 2014; 27:577-98. [PMID: 24524271 DOI: 10.1111/jhn.12208] [Citation(s) in RCA: 121] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Diet quality indices add an important dimension to dietary assessment. The aim of this systematic review was to: (i) identify and describe the attributes and applications of diet quality indices developed for use or used in paediatric populations; (ii) describe associations between these diet quality indices and health-related variables in paediatric populations; and (iii) identify factors that are associated with diet quality in paediatric populations worldwide. METHODS Studies were identified by searching electronic databases for relevant papers from 1980 to October 2013 using keywords. Inclusion criteria were original studies that utilised a quantitative measure of diet quality in children and adolescents aged 0-18 years. RESULTS One hundred and nineteen studies met the inclusion criteria, from which 80 different diet quality indices were identified. The majority of studies had >1000 participants and were of acceptable quality. Of the 56 studies that investigated health-related outcomes, weight status was the most researched. Europe produced the most number of diet quality indices (n = 27 indices). Of the 119 studies, seven intervention studies were identified. Paediatric diet quality indices were found to be associated with environmental, behavioural and maternal factors. CONCLUSIONS The use of diet quality indices in paediatric populations is a rapidly expanding area of research in diverse populations internationally. In economically disadvantaged countries, diet quality indices may be predictive of child growth. However, prospective cohort, intervention and validation studies are required to draw stronger conclusions concerning risk of future disease in paediatric populations in general.
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Affiliation(s)
- S Marshall
- Nutrition and Dietetics, Faculty of Health, School of Health Sciences, The University of Newcastle, Callaghan, NSW, Australia
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Huijgen NA, van de Kamp ME, Twigt JM, de Vries JH, Eilers PH, Steegers EA, Laven JS, Steegers-Theunissen RP. The Preconception Dietary Risk score; a simple tool to assess an inadequate habitual diet for clinical practice. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.clnme.2013.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Spence AC, McNaughton SA, Lioret S, Hesketh KD, Crawford DA, Campbell KJ. A health promotion intervention can affect diet quality in early childhood. J Nutr 2013; 143:1672-8. [PMID: 23966329 DOI: 10.3945/jn.113.177931] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Initiatives to promote children's nutrition and prevent childhood obesity are vital. Dietary patterns are a useful way to characterize whole diets, though no previous early childhood health promotion trial to our knowledge has assessed intervention impact using this approach. This research aimed to assess the effect of a healthy eating and physical activity intervention on young children's dietary patterns. The Melbourne Infant Feeding Activity and Nutrition Trial Program was a health promotion, cluster-randomized controlled trial involving 542 families. Child diets were assessed by multiple 24-h recalls postintervention at ~18 mo of age. An Obesity Protective Dietary Index (OPDI) was created and dietary patterns were also assessed by principal components analysis (PCA). These outcomes were used to compare intervention and control participants to test the effectiveness of the intervention. Children in the intervention arm scored higher (15.6 ± 5.9) than those in the control arm (14.5 ± 6.7) for the OPDI (scores out of 30, P = 0.01). Three dietary patterns were identified by PCA; however, the scores did not substantially differ between the intervention and control arms. In conclusion, this paper presents novel results in both the evaluation of an early childhood health promotion intervention and the assessment of child dietary patterns. The results highlight the capacity for such an initiative to improve child diets and the need for further research in this area.
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Affiliation(s)
- Alison C Spence
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood Victoria, Australia
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Bell LK, Golley RK, Magarey AM. Short tools to assess young children's dietary intake: a systematic review focusing on application to dietary index research. J Obes 2013; 2013:709626. [PMID: 24198966 PMCID: PMC3807550 DOI: 10.1155/2013/709626] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 04/19/2013] [Accepted: 07/18/2013] [Indexed: 11/18/2022] Open
Abstract
Dietary indices evaluate diet quality, usually based on current dietary guidelines. Indices can therefore contribute to our understanding of early-life obesity-risk dietary behaviours. Yet indices are commonly applied to dietary data collected by onerous methods (e.g., recalls or records). Short dietary assessment instruments are an attractive alternative to collect data from which to derive an index score. A systematic review of studies published before April 2013 was conducted to identify short (≤50 items) tools that measure whole-of-diet intake of young children (birth-five years) and are applicable to dietary indices, in particular screening obesogenic dietary behaviours. The search identified 3686 papers of which 16, reporting on 15 tools (n = 7, infants and toddlers birth-24 months; n = 8, preschoolers 2-5 years), met the inclusion criteria. Most tools were food frequency questionnaires (n = 14), with one innovative dietary questionnaire identified. Seven were tested for validity or reliability, and one was tested for both. Six tools (n = 2, infants and toddlers; n = 4, preschoolers) are applicable for use with current dietary indices, five of which screen obesogenic dietary behaviours. Given the limited number of brief, valid and reliable dietary assessment tools for young children to which an index can be applied, future short tool development is warranted, particularly for screening obesogenic dietary behaviours.
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Affiliation(s)
- Lucinda K. Bell
- Department of Nutrition and Dietetics, Flinders University, Bedford Park, SA, 5042, Australia
- Department of Nutrition and Dietetics, Flinders Clinical and Molecular Medicine, School of Medicine, Flinders Medical Centre, Flinders University, Adelaide, SA, Australia
| | - Rebecca K. Golley
- Public Health Group, Sansom Institute of Health Research, University of South Australia, 5000, Australia
| | - Anthea M. Magarey
- Department of Nutrition and Dietetics, Flinders University, Bedford Park, SA, 5042, Australia
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Vyncke KE, Huybrechts I, Dallongeville J, Mouratidou T, Van Winckel MA, Cuenca-García M, Ottevaere C, González-Gross M, Moreno LA, Kafatos AG, Leclercq C, Sjöström M, Molnár D, Stehle P, Breidenassel C, Marcos A, Manios Y, Widhalm K, Gilbert CC, Gottrand F, De Henauw S. Intake and serum profile of fatty acids are weakly correlated with global dietary quality in European adolescents. Nutrition 2013; 29:411-9.e1-3. [PMID: 23312763 DOI: 10.1016/j.nut.2012.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 06/06/2012] [Accepted: 07/05/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The present study assessed whether compliance with the Food-Based Dietary Guidelines is related to habitual fatty acid (FA) intake and blood lipid parameters. METHODS Dietary information was collected by two non-consecutive 24-h recalls in 1804 European adolescents. Compliance with the Food-Based Dietary Guidelines was expressed by calculating the Diet Quality Index for Adolescents (DQI-A). Blood samples were collected in a randomly selected subset (n = 552). Relations between FA intake/serum concentrations and DQI-A were tested with multilevel regression analysis to correct for the study design (clustering within cities). Analyses were stratified for gender; age was entered as a covariate. RESULTS Better DQI-A scores were related to increased proportional intakes of energy from total fat, saturated FA, monounsaturated FA, and cholesterol (P < 0.001), whereas no significant association was observed with polyunsaturated FA intakes. In adolescents with higher compared with lower DQI-A scores, dairy products contributed more (21.0% versus 12.7%) and low-nutrient, energy-dense items contributed less (17.2% versus 26.3%) to the intake of total fat. A positive association was observed between the DQI-A scores and serum concentrations of eicosapentaenoic acid and docosahexaenoic acid (all P < 0.005). The latter, however, was significant only in girls. In boys, higher DQI-A scores were inversely associated with serum cholesterol concentrations (P < 0.05). CONCLUSION Although compliance with the Food-Based Dietary Guidelines was not always associated with a favorable FA intake pattern, a significant favorable association with some serum biomarkers was observed. This outcome underlines the importance of considering dietary habits instead of single-nutrient intakes.
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Choi Y, You Y, Go KA, Tserendejid Z, You HJ, Lee JE, Lee S, Park HR. The prevalence of obesity and the level of adherence to the Korean Dietary Action Guides in Korean preschool children. Nutr Res Pract 2013; 7:207-15. [PMID: 23766882 PMCID: PMC3679330 DOI: 10.4162/nrp.2013.7.3.207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 01/17/2023] Open
Abstract
The objective of this study was to investigate the associations between the prevalence of overweight and obesity and the degree of adherence to the Korean Dietary Action Guides for Children (KDAGC). In a cross-sectional study based on a child care center-based survey in Seoul, Korea, we collected parental-reported questionnaires (n = 2,038) on children's weight and height, frequency of fruit and vegetable consumption, and the quality of dietary and activity behaviors based on the 2009 KDAGC Adherence Index (KDAGCAI) which was developed as a composite measure of adherence to the KDAGC. Overweight and obesity were determined according to age- and sex-specific BMI percentile from the 2007 Korean national growth chart. Associations were assessed with generalized linear models and polytomous logistic regression models. Approximately 17.6% of Korean preschool children were classified as overweight or obese. Obese preschoolers had lower adherence to the KDAGCAI compared to those with lean/normal weight. Preschoolers with a high quality of dietary and activity behaviors had a 51% decreased odds ratio (OR) of being obese (highest vs. lowest tertile of KDAGCAI-score, 95% CI 0.31, 0.78; P = 0.001); the associations were more pronounced among those who were older (P = 0.048) and lived in lower income households (P = 0.014). A greater frequency of vegetable consumption, but not fruit, was associated with a borderline significant reduction in the prevalence of obesity. Our findings support the association between obesity prevention and high compliance with the Korean national dietary and activity guideline among preschool children.
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Affiliation(s)
- Yuni Choi
- Women's Health Research Institute, Sookmyung Women's University, Seoul 140-742, Korea. ; Department of Food and Nutrition, Sookmyung Women's University, Seoul 140-742, Korea
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Kranz S, McCabe GP. Examination of the five comparable component scores of the diet quality indexes HEI-2005 and RC-DQI using a nationally representative sample of 2-18 year old children: NHANES 2003-2006. J Obes 2013; 2013:376314. [PMID: 24163762 PMCID: PMC3791824 DOI: 10.1155/2013/376314] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 06/18/2013] [Accepted: 07/11/2013] [Indexed: 11/18/2022] Open
Abstract
Obesity has been associated with low diet quality and the suboptimal intake of food groups and nutrients. Two composite diet quality measurement tools are appropriate for Americans 2-18 years old: the Healthy Eating Index (HEI) 2005 and the Revised Children's Diet Quality Index (RC-DQI). The five components included in both indexes are fruits, vegetables, total grains, whole grains, and milk/dairy. Component scores ranged from 0 to 5 or 0 to 10 points with lower scores indicating suboptimal intake. To allow direct comparisons, one component was rescaled by dividing it by 2; then, all components ranged from 0 to 5 points. The aim of this study was to directly compare the scoring results of these five components using dietary data from a nationally representative sample of children (NHANES 2003-2006, N = 5,936). Correlation coefficients within and between indexes showed less internal consistency in the HEI; age- and ethnic-group stratified analyses indicated higher sensitivity of the RC-DQI. HEI scoring was likely to dichotomize the population into two groups (those with 0 and those with 5 points), while RC-DQI scores resulted in a larger distribution of scores. The scoring scheme of diet quality indexes for children results in great variation of the outcomes, and researchers must be aware of those effects.
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Affiliation(s)
- Sibylle Kranz
- Department of Nutrition Science, Purdue University, 204 Stone Hall, 700 W. State Street, West Lafayette, IN 47907, USA
- *Sibylle Kranz:
| | - George P. McCabe
- Department of Statistics, College of Science, Purdue University, 932 Mathematical Sciences Building, 150 N. University Street, West Lafayette, IN 47907-2067, USA
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Marshall S, Watson J, Burrows T, Guest M, Collins CE. The development and evaluation of the Australian child and adolescent recommended food score: a cross-sectional study. Nutr J 2012; 11:96. [PMID: 23164095 PMCID: PMC3546018 DOI: 10.1186/1475-2891-11-96] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 11/14/2012] [Indexed: 11/15/2022] Open
Abstract
Background Diet quality tools have been developed to assess the adequacy of dietary patterns for predicting future morbidity and mortality. This study describes the development and evaluation of a brief food-based diet quality index for use with children at the individual or population level. The Australian Child and Adolescent Recommended Food Score (ACARFS) was developed to reflect adherence to the Dietary Guidelines for Children and Adolescents in Australia and modelled on the approach of the US Recommended Food Score. Methods The ACARFS has eight sub-scales and is scored from zero to 73. The diet quality score was evaluated by assessing correlation (Spearman’s correlations) and agreement (weighted κ statistics) between ACARFS scores and nutrient intakes, derived from a food frequency questionnaire in 691 children (mean age 11.0, SD 1.1) in New South Wales, Australia. Nutrient intakes for ACARFS quartiles were compared with the relevant Australian nutrient reference values. Results ACARFS showed slight to substantial agreement (κ 0.13-0.64) with nutrient intakes, with statistically significant moderate to strong positive correlations with all vitamins, minerals and energy intake (r = 0.42-0.70). ACARFS was not related to BMI.Participants who scored less than the median ACARFS were more likely to have sub-optimal intakes of fibre, folic acid and calcium. Conclusion ACARFS demonstrated sufficient accuracy for use in future studies evaluating diet quality. Future research on its utility in targeting improvements in the nutritional quality of usual eating habits of children and adolescents is warranted.
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Affiliation(s)
- Skye Marshall
- Lighthouse Nutrition Pty Ltd, 1/23 Namitjira Place, Ballina 2478NSW, Australia
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Sabinsky MS, Toft U, Andersen KK, Tetens I. Development and validation of a Meal Index of dietary Quality (Meal IQ) to assess the dietary quality of school lunches. Public Health Nutr 2012; 15:2091-9. [PMID: 22717318 PMCID: PMC10271702 DOI: 10.1017/s1368980012001012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 01/31/2012] [Accepted: 02/27/2012] [Indexed: 11/06/2022]
Abstract
OBJECTIVE School lunch programmes are one strategy to promote healthier dietary habits in children, but better evaluation tools for assessing the dietary quality of such programmes are needed. The aim of the present study was to develop and validate a simple index to assess the dietary quality of school lunches for children aged 7-13 years. DESIGN A Meal Index of dietary Quality (Meal IQ) was developed to consist of seven components (nutrients and food groups) based on dietary issues for children aged 7-13 years, which were identified in a national dietary survey. The Meal IQ was validated against calculated nutrient contents of school lunches both provided by the school and brought from home. SETTING At eight public schools from all over Denmark, data were collected on 191 individual lunches brought from home (which is most common in Denmark) and thirty-one lunches provided as part of a school food programme. In addition thirty-two lunches provided at eighteen other public schools were included. SUBJECTS A total of 254 school lunches. RESULTS A higher Meal IQ score was associated with a higher overall dietary quality, including lower contents of fat, saturated fat and added sugars, higher contents of fibre, various vitamins and minerals, and more fruits, vegetables and fish. CONCLUSIONS The Meal IQ is a valid and useful evaluation tool for assessing the dietary quality of lunches provided by schools or brought to school from home.
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Affiliation(s)
- Marianne S Sabinsky
- Department of Nutrition, Technical University of Denmark, Mørkhøj Bygade 19, DK-2860 Søborg, Denmark.
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Boyer LE, Laurentz S, McCabe GP, Kranz S. Shape of snack foods does not predict snack intake in a sample of preschoolers: a cross-over study. Int J Behav Nutr Phys Act 2012; 9:94. [PMID: 22866912 PMCID: PMC3480937 DOI: 10.1186/1479-5868-9-94] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 07/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the past decade, the proportion snacking has increased. Snack foods consumed are predominantly not nutritious foods. One potential venue to increase children's diet quality is to offer healthy snack foods and we explored if shaped snack foods would lead to increased consumption. METHODS We investigated the consumption of high-fiber snacks (banana bread, pancakes, and sandwiches) served either in normal (round, square) or shaped (heart, hands, animals) form to preschoolers 2-5 years old attending a local child care center (n = 21). The 9 weeks long, prospective, cross-over intervention study was designed to expose each child repeatedly to each snack in each shape (4 times per snack). Snacks were served as morning or afternoon snack and caretakers' reports were used to account for the child's consumption of a meal preceding the study snack (breakfast or lunch). RESULTS There was no significant difference in snack consumption between the shaped and normal snacks. However, the mean energy intake from snacks was significantly greater for Caucasian children compared with Asian children. Further, Asian children consumed much less banana bread than the other two snacks. Overall, children who had not eaten breakfast or lunch prior to the morning or afternoon snack ate significantly more calories from the snacks (84.1 kcal, p-value < 0.0001). CONCLUSION Findings of this study confirm previous research that the shape of the foods does not affect snack consumption in children. However, we also report two unexpected findings: a) the strong interaction between ethnicity and snack consumption and b) that Asian children consumed much less banana bread than Caucasian children. The role of children's ethnic background profoundly affects snack preference and must be considered in the study of children's eating behaviors and in interventions to promote healthy eating habits.
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Affiliation(s)
- Lauren E Boyer
- Department of Nutrition Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN 47907-2059, USA
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Early diet quality in a longitudinal study of Australian children: associations with nutrition and body mass index later in childhood and adolescence. J Dev Orig Health Dis 2011; 3:21-31. [DOI: 10.1017/s2040174411000717] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Smithers LG, Golley RK, Brazionis L, Lynch JW. Characterizing whole diets of young children from developed countries and the association between diet and health: a systematic review. Nutr Rev 2011; 69:449-67. [PMID: 21790612 DOI: 10.1111/j.1753-4887.2011.00407.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Early childhood is an important nutritional period that involves the transition from a milk-based diet to ordinary foods. A systematic review was conducted of studies that applied whole-of-diet analysis of children aged 1-5 years to examine associations between diet and nutrition, health, and development. Literature searches identified 40 articles using dietary indices, principal component analysis, or cluster analysis. Reports that applied indices (n = 23, 18 indices) were cross-sectional, and most measured diet quality or variety. Articles reporting principal component or cluster analyses (n =17) described between two and six dietary patterns, and most identified healthy, unhealthy, and traditional patterns. In cross-sectional analyses, mixed associations were found between index or pattern scores and nutrient intake (n = 10), nutritional biomarkers (n = 1), and anthropometry (n = 10). Five reports from two birth cohorts showed healthier dietary patterns were associated with better lean mass, cognition, and behavior, but not with bone mass or body mass index at later ages. Few studies have characterized the diets of children under 5 years of age and linked diet with health. Given the limited evidence, research establishing the predictive validity of whole-of-diet methods in childhood is needed.
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Affiliation(s)
- Lisa G Smithers
- Discipline of Public Health, University of Adelaide, Australia.
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Zuercher JL, Wagstaff DA, Kranz S. Associations of food group and nutrient intake, diet quality, and meal sizes between adults and children in the same household: a cross-sectional analysis of U.S. households. Nutr J 2011; 10:131. [PMID: 22123043 PMCID: PMC3281797 DOI: 10.1186/1475-2891-10-131] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 11/28/2011] [Indexed: 11/10/2022] Open
Abstract
Background One might assume that individuals living in the same household have similar dietary intakes of food groups and nutrients. However, the manner in which an adult's dietary intake affects children's food consumption, diet quality (defined as meeting intake recommendations), and meal sizes is understudied to date. The objective of this study was to estimate these relationships between minor children and the female or male head of household. Methods Dietary intakes of one randomly selected child of each age group (2-5, 6-11, or 12-18 years old (n = 2,380)) and that of the female/male head of household ((HH), proxy for mother and father) using multiple 24-hour recalls from the Continuing Survey of Food Intake by Individuals (CSFII) 1994-1996 was coded to reflect food group and nutrient density (servings/grams per 1,000 kcal). Linear or logistic regression models were used to determine the association between intakes, whether individuals' diets trended toward meeting her/his intake recommendations, and whether individuals were in the highest quintile for food group densities at four distinct eating occasions (breakfast, brunch/lunch, supper/dinner, or other) in each subject group. Stata's survey commands were used to fit linear or logistic regression models and obtain adjusted regression coefficients or odds ratios. Results Associations between food group/nutrient densities were significant but weak to moderate. Adults with diets that trended toward meeting their intake recommendations doubled the odds for children to have diets that trended toward meeting the recommendations; for many meals, adults consuming in the highest quintile for food group density predicted that children's intakes were also in the highest quintile. Conclusions Female and male adults living in the same household significantly affect children's food group and nutrient intakes, diet quality, and meal sizes. There is an urgent need for in-depth analysis to elucidate the underlying mechanisms, especially for studies involving both the female and male HH.
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Affiliation(s)
- Jennifer L Zuercher
- Department of Foods and Nutrition, Purdue University, 700 W, State Street, West Lafayette, IN 47906, USA
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Abstract
In this article, we review studies that have used dietary indexes to assess different aspects of diet in relation to health outcomes and sociodemographic factors in childhood populations of developed countries. Eighty-four papers published from 1980 to mid-2010 including 90 unique dietary indexes were reviewed. Seventy-two indexes were developed (or have been adapted) specifically for childhood populations; 38 of these were used to assess diet-disease associations, mostly of diet and obesity. In the majority of these studies, small inverse associations between dietary indexes and obesity indexes were shown. Children who were younger, female, and from high-income families had better dietary quality scores. Forty-nine indexes (of 90) were compared with other aspects of dietary intakes or behaviors, with correlations ranging from very low to modest (∼r = 0.05-0.50). Only 2 validation studies compared an index with nutritional biomarkers, and correlations were quite weak for most plasma nutrients (P < 0.10). Overall, a large number of indexes have been created and used, but the majority of studies are descriptive. Fewer analytic studies on index-health associations have been performed, and most analyses insufficiently adjusted for confounders. Thus, prospective and intervention research in diverse populations is needed to further test these tools. In conclusion, indexes are potentially useful methods for dietary assessment, because they offer valuable information on overall dietary patterns in children. However, understanding the advantages and limitations when applying them in research and public health settings is important, and more research is needed to further develop their utility.
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Affiliation(s)
- Chrystalleni Lazarou
- Department of Nutrition Science-Dietetics, Harokopio University, Athens, Greece.
| | - P. K. Newby
- Department of Pediatrics, Boston University School of Medicine, and Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118
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Lazarou C, Panagiotakos DB, Spanoudis G, Matalas AL. E-KINDEX: A Dietary Screening Tool to Assess Children's Obesogenic Dietary Habits. J Am Coll Nutr 2011; 30:100-12. [DOI: 10.1080/07315724.2011.10719949] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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