Position of the Academy of Nutrition and Dietetics: nutrition guidance for healthy children ages 2 to 11 years

Managing Undernutrition in Pediatric Oncology: A Consensus Statement Developed Using the Delphi Method by the Polish Society for Clinical Nutrition of Children and the Polish Society of Pediatric Oncology and Hematology

"Managing Undernutrition in Pediatric Oncology" is a collaborative consensus statement of the Polish Society for Clinical Nutrition of Children and the Polish Society of Pediatric Oncology and Hematology. The early identification and accurate management of malnutrition in children receiving anticancer treatment are crucial components to integrate into comprehensive medical care. Given the scarcity of high-quality literature on this topic, a consensus statement process was chosen over other approaches, such as guidelines, to provide comprehensive recommendations. Nevertheless, an extensive literature review using the PubMed database was conducted. The following terms, namely pediatric, childhood, cancer, pediatric oncology, malnutrition, undernutrition, refeeding syndrome, nutritional support, and nutrition, were used. The consensus was reached through the Delphi method. Comprehensive recommendations aim to identify malnutrition early in children with cancer and optimize nutritional interventions in this group. The statement underscores the importance of baseline and ongoing assessments of nutritional status and the identification of the risk factors for malnutrition development, and it presents tools that can be used to achieve these goals. This consensus statement establishes a standardized approach to nutritional support, aiming to optimize outcomes in pediatric cancer patients.

Nutritional counseling in childhood and adolescence: a systematic review

Healthy eating habits are the basis for good health status, especially for children and adolescents, when growth and development are still ongoing. Nutrition educational programs are essential to prevent and treat chronic diseases. Nutritional counseling (NC), as a collaborative process between the counselor and the client process, could help to achieve better outcomes. This review aims to collect information about the utilization of NC during childhood and adolescence and to highlight its possible impact on adherence/compliance rates, nutrition knowledge, status and dietary intake. The methods applied in this systematic review followed the instruction of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search in PubMed/Medline, Scopus, Web of Science, LILACS, and Science Direct included observational or randomized studies. RoB 2.0 and Robins-I tools was used for the risk of bias assessment in randomized and non-randomized studies, respectively. The quality of evidence was checked by the Mixed Methods Appraisal Tool system. A total of 21 articles were selected, computing 4,345 individuals. 11 achieved at least 4 stars quality level. The highest risk of bias for randomized studies was related to the randomization process. 42.9% of non-randomized studies had some concerns of bias, mainly because of a lack of control of all confounding factors. Different strategies of NC were used in children and adolescents with positive results for health or diseases. NC strategies can be effectively used in children and adolescents. In general, NC showed benefits in pediatrics age for anthropometric or body composition parameters, dietary intake, nutrition knowledge and physical activity improvement. Performing NC in pediatrics is challenging due to the counseling strategies that must be adapted in their contents to the cognitive ability of each age. More structured research must be done focused on this population. Investments in healthy eating behaviors in pediatrics can lead to better health outcomes in the future population with substantial benefits to society.

Systematic review registration

[https://www.crd.york.ac.uk/prospero/#recordDetails], identifier [CRD42022374177].

An Exploratory Mixed Method Cross-Sectional Study to Identify Opportunities to Increase Enrollment and Retention of Native Hawaiian Students in an Undergraduate Dietetic Program

BACKGROUND

Native Hawaiians (NH) are underrepresented in dietetics, contributing to less than 1% of the profession nationally. Increasing the number of NH Registered Dietitian Nutritionists (RDN) is one mechanism to facilitate improved health outcomes in disparate populations.

OBJECTIVES

1) Identify and summarize NH student interests in the field of nutrition and dietetics; 2) Identify and contextualize factors that support and prohibit achievement of academic goals and aspirations; 3) Identify NH students' responsibility to the community; 4) Explore the context around NH alumni enrollment in nutrition and dietetics and their perceived impact of RDNs in the community; 5) Identify and describe supporting agencies that foster academic and professional success.

DESIGN

This exploratory mixed-methods cross-sectional study surveyed all levels of NH nutrition and dietetics students in the University of Hawai'i (UH) System. In addition, in-depth interviews were conducted with NH students, NH alumni, and supporting agencies to identify supports and barriers, explore the context of NH enrollment in nutrition and dietetics, and the contribution of dietetics to the NH community.

PARTICIPANTS/SETTING

Eighty-one NH students enrolled in a nutrition course across the UH system were surveyed. Nine of the 81 NH students surveyed, eight NH alumni, and persons from 15 identified supporting agencies were interviewed.

ANALYSIS

Survey responses were descriptively analyzed. Open-ended survey questions and interviews were analyzed through content analysis. To ensure findings were guided by NH perspective, data were triangulated by researchers and a NH dietetics advisory council.

RESULTS

Food and chronic disease prevention and management were topics that drew NH students to the field. Bridge/scholarship programs supported NH academic achievement. Education-related cost was a perceived barrier. Alumni and students shared varying degrees of responsibility to serve the NH community. Increasing the connection between NH values and the nutrition and dietetics curriculum are an identified need.

CONCLUSION

Findings illuminate opportunities to drive future programmatic efforts. The framework used in this study should be adaptable to other programs to support overall dietetics diversity initiatives.

Nutrition and oral health in children with recently and previously diagnosed celiac disease

OBJECTIVES

To evaluate the nutritional and oral health status of children with previously diagnosed celiac disease (CD) who follow a gluten-free diet and recently diagnosed CD patients.

MATERIALS AND METHODS

Previously and recently diagnosed groups were formed from children with CD, aged 4 to 15 years. A questionnaire was completed about the children's dental history and nutritional and oral hygiene habits. All the children underwent an oral examination, and dmft-DMFT indices were determined. Dental plaque status, periodontal health, and dental enamel defects were recorded. Oral soft tissues were examined for the presence of lesions. Unstimulated salivary flow rate and pH value were evaluated.

RESULTS

A statistically significant difference was determined between the previously and recently diagnosed patients in terms of toothpaste preference (p=0.003), frequency of going to the dentist (p=0.039), and the types of dental treatment they had received (p=0.001). A statistically significant difference was determined between the previously and recently diagnosed patient groups in terms of dmft values (p=0.005).

CONCLUSIONS

Children with CD should be directed to a pediatric dentist to improve oral and dental health, relieve the symptoms of oral mucosal lesions, be informed about enamel defects, and be encouraged to use gluten-free oral care products.

CLINICAL RELEVANCE

The collaboration of pediatric gastroenterologists and pediatric dentists can prevent the progression of oral symptoms in children with CD and eliminate long-term complications in terms of both oral health and multisystemic problems.

School Menu Review Programme (PReME): evaluation of compliance with dietary recommendations during the period 2006-2020 in Catalonia

BACKGROUND

The School Menu Review Programme (PReME) has been offering complimentary revisions of meal plans to all schools in Catalonia since 2006. This study aims to assess the evolution of compliance with PReME's recommendations in the meals provided by school cafeterias in Catalonia during the period 2006-2020.

METHODS

Pre-post study with a sample of 6,387 meal plans from 2221 schools assessed during the period. The information was collected mainly by public health specialists within the annual technical and sanitary inspection of school kitchens and cafeterias. Meal plans were evaluated by Dietitian-Nutritionists team according to the criteria of the National Health System's "Consensus document on nutrition in schools" and the Public Health Agency of Catalonia's current guide "Healthy eating at school". Reports were sent to each participating school. A few months later, a new meal plan and another questionnaire were collected and evaluated in comparison with the first meal plan. Compliance with the recommendations was analysed based on the type of canteen management and the school category.

RESULTS

Compliance improved during the study period. The percentage of schools that complied with dietary recommendations in relation to the five PReME indicators (fresh fruit, pulses, daily vegetables, fresh food and olive oil for dressing) has steadily increased since PReME began, (over 70% in all indictors; p =  < 0.001), with variations depending on school category and cafeteria management. Furthermore, an improvement in the levels of compliance with de recommended food frequencies was observed. with statistically significant differences for all items (p < 0.001), except for pulses whose compliance had been high since the beginning of the study (p = 0.216).

CONCLUSIONS

The positive evolution in compliance with PReME's recommendations provides evidence of the programme's effectiveness, with an improvement in the quality of school meals delivered in Catalonia.

Judgments about appropriate foods for infants: Associations with parents’ own food preferences

When infants begin to eat solid foods (recommended at around 6 months of age), parents have a huge variety of choices in terms of what foods to offer. The present studies examine parents’ judgments about foods for infants. Participants included parents recruited from Prolific (n = 99), who were shown descriptions of foods offered to infants (including familiar and unfamiliar foods at 6-, 9-, and 12-months) and a set of control foods eaten by adults. Participants rated each food based on how appropriate they thought it was for an infant and how much they personally wanted to eat the food. Parents rated foods as more appropriate for infants if they were familiar (vs. unfamiliar) and offered to younger infants (6- vs. 12-month-olds, or infant foods vs. adult foods), but demonstrated the opposite pattern when considering whether they wanted to eat each food. Participants’ own food pickiness was related to their judgments about what they would eat, but not whether foods were appropriate for infants. Parents’ judgments of individual foods were inversely related: The more appropriate they rated each food for an infant, the less they were interested in eating that food. These findings are discussed in terms of potential barriers to engaging in social modeling (i.e., parents demonstrating eating and liking the foods they offer to their infants).

A descriptive assessment of a broad range of food-related parenting practices in a diverse cohort of parents of preschoolers using the novel Real-Time Parent Feeding Practices Survey

Background

Much of the research to-date on food parenting has evaluated typical use of various parent feeding practices via questionnaire. The Real-Time Parent Feeding Practices Measurement survey was developed for use within an Ecological Momentary Assessment (EMA) protocol to capture momentary use of parent feeding practices in real-time.

Methods

This manuscript describes the development of the EMA-based Real-Time Parent Feeding Practices survey and highlights initial descriptive data on the real-time use of 22 individual parent feeding practices (e.g., pressure-to-eat, guided choices, etc.) as reported via EMA by parents of preschool-aged children (n = 116) over a 10-day data collection time period. A total of 3382 eating occasions were reported, with an average of 29.2 reported eating occasions per participant.

Results

Results revealed that most participants used a variety of food-related parenting practices day-to-day that span four higher-order domains: structure, autonomy support, coercive control and indulgence. Supportive feeding practices, defined as those from the structure and autonomy support domains, were reported most frequently, with one or more structure behavior (e.g., specific mealtime rules/routines) was used at 88.9% of reported eating occasions and one or more autonomy support behavior (e.g., involvement of the child in meal preparation) was used at 87.3% of eating occasions. While unsupportive feeding practices, defined as practices from within the coercive control (e.g., pressure-to-eat) and indulgent (e.g., anticipatory catering) feeding domains, were reported less frequently, one or more behaviors from each of these domains were still reported at over 25% of all eating occasions.

Conclusions

Results of the current study take a next step towards deepening our understanding of the use of a broad range of food-related parenting practices in real-time. Findings revealed that the vast majority of practices used by parents fall within the structure and autonomy support domains. However, most parents did not exclusively use supportive or unsupportive practices, rather they used a combination of food-related parenting practices across all domains. Future research should continue to explore a broad range of food-related parenting practices and seek to understand how parent approaches to feeding are associated with long-term child outcomes, including dietary intake, food preferences, and eating patterns.

HomeStyles-2: Randomized controlled trial protocol for a web-based obesity prevention program for families with children in middle childhood

BACKGROUND

Parents are children's primary role models, are food and physical activity gatekeepers, and create the home structure/lifestyle environment. Thus, parents strongly influence children's weight-related behaviors and have the opportunity to cultivate a "culture of health" within the home. Yet, there is a dearth of evidence-based obesity prevention intervention programs, especially for families with children aged 6-11 years, commonly called middle childhood.

METHODS

The aim of the HomeStyles-2 online learning mode RCT is to determine whether this novel, age-appropriate, family intervention enables and motivates parents to shape home environments and weight-related lifestyle practices (i.e.,diet, exercise, sleep) to be more supportive of optimal health and reduced obesity risk in middle childhood youth more than those in the control condition. The RCT will include the experimental group and an attention control group. The participants will be parents with school-age children who are systematically randomly assigned by computer to study condition. The HomeStyles intervention is predicated on the social cognitive theory and a social ecological framework. The RCT will collect sociodemographic characteristics of the participant, child, and partner/spouse; child and parent health status; parent weight-related cognitions; weight-related behaviors of the parent and child; and weight-related characteristics of the home environment. Deliverables Enrollment for this study will begin in 2022.

DISCUSSION

This paper describes these aspects of the HomeStyles-2 intervention: rationale; sample eligibility criteria and recruitment; study design; experimental group intervention theoretical and philosophical underpinnings, structure, content, and development process; attention control intervention; survey instrument development and components; outcome measures; and planned analyses.

TRIAL REGISTRATION

ClinicalTrials.gov, Protocol #NCT04802291, Registered March 14, 2021.

Does social modeling increase infants' willingness to accept unfamiliar foods?

Despite a rich knowledge base about infants' social learning and studies observing social referencing in other species in food contexts, we know surprisingly little about social learning about food among human infants. This gap in the literature is particularly surprising considering that feeding unfamiliar foods to infants is a very common experience as infants begin to eat solid foods. The present study examines whether parental social modeling influences infants' willingness to accept unfamiliar foods. In two Zoom sessions, parents will be asked to feed unfamiliar foods to their 6- to 24-month-old infants (different unfamiliar foods in each session). In both sessions, infants' food acceptance and rejection will be measured. In the first session, parents will be asked to do what they would typically do; spontaneous social modeling will be recorded. In the second session, parents will be instructed to model eating the unfamiliar food. We will examine associations between infants' willingness to eat unfamiliar foods, parent social modeling, and extant parent and infant characteristics.

Nutrient and Food Group Intakes among U.S. Children (2-5 Years) Differ by Family Income to Poverty Ratio, NHANES 2011-2018

Family income may influence nutrient and food group intakes among preschool children, thus increasing risk of nutrient deficiencies. This study compared nutrient and food group intakes and diet quality among a U.S. sample of children 2–5 years of age by family income to poverty ratio (PIR) based on National Health and Nutrition Examination Survey (2011–2018) data (n = 2249). Regression analyses were used to compare dietary intakes based on proxy-reported 24-h dietary recalls and Healthy Eating Index-2015 total scores by low PIR versus mid-high PIR levels adjusted for covariates. PIR levels varied by child race/ethnicity and household reference person’s sex, marital status, and education. More than half of the children in the low PIR group (56%) were reported to have received WIC benefits in the past year. Marginally lower calcium (p = 0.008) and lower fiber intakes, lower total HEI-2015 scores, and lower intakes of fruits and whole grain foods (all p < 0.007) were observed among children in low PIR households compared to mid-high PIR households. However, iron intakes were higher (p = 0.0003) among children in low PIR households compared to mid-high PIR households. Lack of other differences in nutrient and food group intakes may be attributable to WIC benefits.

Community-based culinary and nutrition education intervention promotes fruit and vegetable consumption

OBJECTIVE

The main objective of this study was to evaluate the impact of the Market to MyPlate (M2MP) program on fruit and vegetable consumption and cooking behaviours. Secondary objectives were to examine factors that affected participant retention and program completion, and analyse program feedback provided by participants.

DESIGN

This study conducted a mixed methods evaluation embedded within a cluster randomised controlled trial of the M2MP intervention. Adult participants completed a pre- and post-program survey reporting on their fruit and vegetable consumption and cooking behaviours. A subsample participated in structured interviews, providing feedback about M2MP and the impact of the program.

SETTING

Seven weekly classes took place in community centres and extension offices in central Illinois.

PARTICIPANTS

120 adults and their families participated. Class cohorts were randomly assigned to one of three treatment groups: (1) nutrition education and cooking classes with produce allocations (PAE, n 39); (2) nutrition education and cooking classes only (EO, n 36) or (3) control group (n 45).

RESULTS

Compared to control, PAE participants reported larger increases from pre- to post-intervention in fruit (P = 0·001) and vegetable consumption (P = 0·002), with no differences in cooking frequency. Interview analyses identified key themes in behaviour changes due to M2MP, including reported increases in dietary variety, cooking self-efficacy and children's participation in cooking.

CONCLUSIONS

PAE participants who received an intervention that directly increased their access to fresh produce (via produce allocations) increased their reported fruit and vegetable consumption. Though participants' cooking frequency did not change, interviewees reported increased variety, cooking confidence and family participation in cooking.

Low-income mothers' perspectives on the involvement of family members in child feeding

Nearly all research on child feeding has focused on mothers. Very little is known about other family members' roles in feeding children nor how mothers engage with these family members regarding child feeding. The objective of this study was to examine mothers' perceptions of other family members' child feeding roles and practices within low-income families, including the challenges experienced and strategies employed by mothers when sharing responsibility for child feeding. Low-income mothers (n = 100) of pre-adolescent children participated in semi-structured interviews regarding child feeding including shared responsibility for child feeding. A content analysis was then conducted to identify main themes in mothers' responses, with three main themes arising from the interviews. First, many family members were actively involved in child feeding and food-related decision-making. The majority of mothers (85%) reported that another family member was involved in feeding their child including fathers and father figures, who were involved in feeding in 63% of families. Other family members, mainly grandparents, were involved in feeding in 35% of families. Mothers identified several concerns regarding their child's eating when with other family members, particularly when grandparents fed children. Finally, mothers employed several strategies to control their children's eating when children were cared for by other family members. Future interventions to promote healthy child feeding among low-income families may benefit from helping mothers negotiate child feeding with other family members, particularly grandparents, and supporting family members' engagement in child feeding.

The Effects of a Science-Based Community Intervention on Health Outcomes in Minority Children: The Translational Health in Nutrition and Kinesiology Program

BACKGROUND

This study evaluated the effects of a novel nutrition and movement science after-school program integrating laboratory experiences for minority children. Laboratory experiences demonstrated how the body moves, functions, and performs in response to exercise and healthy nutrition.

METHODS

A total of 76 children from 4 after-school programs that were primarily Latino and black were randomly assigned to either an experimental translational health in nutrition and kinesiology (THINK; n = 46) or standard curriculum that served as the control group (CON; n = 30). An analysis of covariance controlling for baseline values was used to compare differences between THINK and CON after the 4-month intervention.

RESULTS

Following the program, THINK participants evidenced lower triceps and subscapular skinfold thickness (P < .01 and <.05, respectively). THINK students showed greater improvements in aerobic fitness, grip strength, and agility than CON (P < .01, <.01, and <.05, respectively). Participants in THINK also demonstrated higher scores on their nutrition habits/behaviors questionnaire (P < .01), nutrition science (P < .05), and exercise fitness tests (P < .001) than CON.

CONCLUSION

An innovative curriculum featuring nutrition and kinesiology education interfaced with hands-on laboratory experiences and physical activities can improve physical outcomes and health-related behaviors in after-school programs serving minority children.

Parental Feeding Practices and Child-Related Factors are Associated with Overweight and Obesity in Children and Adolescents with Autism Spectrum Disorder

Atypical eating behaviors displayed by children with autism spectrum disorder (ASD) predispose them to unhealthy weight gain. We determined the factors associated with body weight status among 261 children with ASD (3-18 years) at nine autism intervention centers. Their mothers completed a self-administered questionnaire on sociodemographic background, parenting style, parental feeding practices, parenting stress, sleep habits, eating behaviors, and autism severity. Children with older age, non-full term gestational age, high maternal perceived weight, high maternal concern about child weight, and low pressure to eat were more likely to be overweight and obese. Obesity is a major concern among children with ASD. Healthy weight management programs for parents should incorporate appropriate feeding practices and a healthy perception of body weight.

Protocol for a family-centered behavioral intervention to reduce early childhood caries: the MySmileBuddy program efficacy trial

BACKGROUND

Although largely preventable through diet management and topical fluoride use, early childhood caries (ECC) often progresses to severity that necessitates surgical repair. Yet repair often fails to mitigate caries progression. Needed is an effective behavioral intervention to address underlying behavioral causes.

METHODS

This randomized controlled trial will evaluate the efficacy of a behaviorally focused, family-centered intervention, the MySmileBuddy Program (MSB Program), to reduce ECC progression in high-risk preschoolers in New York City. Recruitment will target 858 children ages 24-71 months with ECC and their parents from primary care medical and dental clinics. The study aims to assess the MSB Program's efficacy to: (1) decrease ECC progression measured 12-months post-randomization; and (2) enhance adoption of a low cariogenic diet and twice-daily fluoridated toothpaste use compared to control group. Potential causal pathways (mediators and moderators) will be explored. The MSB Program equips community health workers (CHWs) with an app that facilitates multilevel risk assessment and provides motivational interviewing-based counseling to inform parents about the caries process, develop personalized goals, and create family-level action plans to achieve targeted behaviors. Social support from CHWs (4 interactions during the 6-month intervention, supplemented by up to 4 in-person/remote contacts throughout the 12-month study period, based on need) is bolstered by automated text messages. Participants will be randomized to a Control Group (paper-based educational handout plus toothbrushes and fluoridated toothpaste for the child) or Intervention Group (MSB Program, two tooth-brushing observations with feedback and instruction, and toothbrushes and toothpaste for the entire family). All children will receive visual ICDAS dental examinations and parents will complete study measures at baseline and 12-months. An incentive up to $150 plus round-trip transit cards ($5.50 value) will be provided.

DISCUSSION

This study hypothesizes that the MSB Program can reduce ECC progression in a high-risk population. Sufficient incentives and a focus on establishing rapport between participants and CHWs are anticipated to mitigate recruitment and retention challenges. If successful, this study will advance the long-term goal of reducing pediatric oral health disparities by demonstrating the efficacy of an acceptable and feasible intervention that shifts attention from dental repair to behavioral risk mitigation.

TRIAL REGISTRATION

Trial registration was completed on 4/13/2021 through the U.S. National Library of Medicine ClinicalTrials.gov website (Identifier: NCT04845594).

Adherence to Food-Based Dietary Guidelines: A Systemic Review of High-Income and Low- and Middle-Income Countries

Research comparing the adherence to food-based dietary guidelines (FBDGs) across countries with different socio-economic status is lacking, which may be a concern for developing nutrition policies. The aim was to report on the adherence to FBDGs in high-income (HIC) and low-and-middle-income countries (LMIC). A systematic review with searches in six databases was performed up to June 2020. English language articles were included if they investigated a population of healthy children and adults (7–65 years), using an observational or experimental design evaluating adherence to national FBDGs. Findings indicate that almost 40% of populations in both HIC and LMIC do not adhere to their national FBDGs. Fruit and vegetables (FV) were most adhered to and the prevalence of adhering FV guidelines was between 7% to 67.3%. HIC have higher consumption of discretionary foods, while results were mixed for LMIC. Grains and dairy were consumed below recommendations in both HIC and LMIC. Consumption of animal proteins (>30%), particularly red meat, exceeded the recommendations. Individuals from HIC and LMIC may be falling short of at least one dietary recommendation from their country’s guidelines. Future health policies, behavioral-change strategies, and dietary guidelines may consider these results in their development.

Valid and Reliable Measure of Adherence to Satter Division of Responsibility in Feeding

OBJECTIVE

To examine the validity and psychometrics of sDOR.2-6y, a 12-item measure of adherence to the Satter Division of Responsibility in Feeding (sDOR).

DESIGN

Cross-sectional survey.

SETTING

Online respondents in central Pennsylvania.

PARTICIPANTS

117 parents (94% female, 77% White, 62% in ≥1 income-based assistance program) of preschoolers aged 2-6 years (28% moderate/high nutrition risk).

MAIN OUTCOME MEASURES

The sDOR.2-6y and Nutrition Screening Tool for Every Preschooler (NutriSTEP), a measure of child nutrition risk and other validated measures of eating behavior and parent feeding practices.

ANALYSIS

Relationships were evaluated with Pearson r, t tests, ANOVA, or chi-square. Factor structure was investigated using principal components analysis with varimax rotation. Binary logistic regression and general linear model controlling for low-income status compared with sDOR.2-6y and NutriSTEP scores. Linear regression predicted NutriSTEP and Satter Eating Competence Inventory 2.0 scores from sDOR.2-6y.

RESULTS

The sDOR.2-6y ranged from 16-32 (mean, 25.9 ± 3.3; n = 114). Parents of youth at nutrition risk had lower sDOR.2-6y scores (P = 0.004). Each 1 point sDOR.2-6y increase decreased nutrition risk odds by 21% (95% confidence interval, 0.675-0.918; P = 0.002). The sDOR.2-6y scores were higher with less restriction and pressure to eat (both P < 0.001) and were associated with feeding style. Specificity was 87% with sDOR.2-6y cutoff ≥24; sensitivity was 66% with cutoff ≥26.

CONCLUSIONS AND IMPLICATIONS

The sDOR.2-6y accurately and reliably indicated adherence of low-income mothers to sDOR. Larger, diverse samples for future studies are recommended.

Current Systems-Level Evidence on Nutrition Interventions to Prevent and Treat Cardiometabolic Risk in the Pediatric Population: An Evidence Analysis Center Scoping Review

Improving and maintaining cardiometabolic health remains a major focus of health efforts for the pediatric population. Recent research contributes understanding of the systems-level nutrition factors influencing cardiometabolic health in pediatric individuals. This scoping review examines current evidence on interventions and exposures influencing pediatric cardiometabolic health to inform registered dietitian nutritionists working at each systems level, ranging from individual counseling to public policy. A literature search of MEDLINE, CINAHL, Cochrane Databases of Systematic Reviews, and other databases was conducted to identify evidence-based practice guidelines, systematic reviews, and position statements published in English from January 2017 until April 2020. Included studies addressed nutrition interventions or longitudinal exposures for participants 2 to 17 years of age who were healthy or had cardiometabolic risk factors. Studies were categorized according level of the social-ecological framework addressed. The databases and hand searches identified 2614 individual articles, and 169 articles were included in this scoping review, including 6 evidence-based practice guidelines, 141 systematic reviews, and 22 organization position statements. The highest density of systematic reviews focused on the effects of dietary intake (n = 58) and interventions with an individual child or family through counseling or education (n = 54). The least frequently examined levels of interventions or exposures were at the policy level (n = 12). Registered dietitian nutritionists can leverage this considerable body of recent systematic reviews to inform a systems-level, collaborative approach to prevention and treatment of pediatric cardiometabolic risk factors.

Use of an Observational Comparative Strategy Demonstrated Construct Validity of a Measure to Assess Adherence to the Satter Division of Responsibility in Feeding

BACKGROUND

Currently developed parent feeding measures do not exclusively measure behaviors compatible with theoretical underpinnings of the Satter Division of Responsibility in Feeding for Children Aged 2 to 6 Years (sDOR.2-6y). A measure of adherence to sDOR.2-6y has been constructed and shown to have translational validity.

OBJECTIVE

To examine the construct validity of the 15 sDOR.2-6y items.

DESIGN

Observations from in-home mealtime video-capture in a household with a child aged 2 to 6 years were compared with parent sDOR.2-6y responses. One sDOR.2-6y item about mealtime regularity was compared with mealtime data provided in the Automated Self-Administered 24-Hour Dietary Assessment Tool that had been completed by a larger sample of parents that included the smaller sample of video-capture participants.

PARTICIPANTS/SETTING

Parents of preschool children aged 2 to 6 years in central Pennsylvania participated in Automated Self-Administered 24-Hour Dietary Assessment Tool online dietary assessment (n = 61) from May to November 2013 or in-home mealtime video-capture (n = 20) during October 2013 or both (n = 16).

MAIN OUTCOME MEASURES

Consensus of three trained sDOR coders of plausible parent sDOR.2-6y item responses after video viewing, parent responses to sDOR.2-6y items, and mealtime regularity from three Automated Self-Administered 24-Hour Dietary Assessment Tool recalls.

STATISTICAL ANALYSIS

Data analysis included identification of codeable 5-minute segments, coding by three sDOR experts, intraclass correlation coefficient, and determination of coder congruence to establish plausible sDOR.2-6y responses and comparison between coder-observed and parent sDOR.2-6y responses.

RESULTS

Video-capture participants were mostly women, White, and overweight with a mean ± standard deviation age of 35.3 ± 6.4 years. Postvideo debriefing supported the observed meal as typical in location, timing, and composition. Of 273 coding decisions, coder congruence was inadequate or dissonant for 3.7% and intraclass correlation coefficient was 0.81 (0.77 to 0.84; P < 0.001). Parent and congruent coder responses were in agreement for nearly 70% of the possible comparisons. Of the original 15 items, three were deemed not valid, nine of the remaining 12 were considered valid, and three could not be invalidated.

CONCLUSIONS

Congruence between observed and self-reported behaviors supported additional validation and scoring studies with the 12-item sDOR.2-6y to assess adherence of parents to sDOR.

Impact of preconception, pregnancy, and postpartum culinary nutrition education interventions: a systematic review

CONTEXT

Frequent consumption of home-prepared meals is associated with higher diet quality in children and adults. Therefore, increasing the culinary skills of women and couples during their childbearing years may be an effective strategy for the prevention of overweight and obesity.

OBJECTIVE

To determine the impact of culinary nutrition-education interventions for women with or without their partners during preconception, pregnancy, or postpartum (PPP) on parental cooking skills, nutrition knowledge, parent/child diet quality, or health outcomes.

DATA SOURCES

Eligibility criteria were defined using a PICOS framework. A systematic search strategy was developed to identify eligible studies and was implemented in 11 electronic databases. Reference lists of selected systematic reviews were manually searched for additional studies.

DATA EXTRACTION

Study characteristics and outcomes were extracted from eligible studies by 1 reviewer and checked by a second reviewer.

DATA ANALYSIS

A narrative synthesis of the findings of eligible studies was prepared including descriptive statistics. Reporting was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and Synthesis Without Meta-Analysis in systematic reviews reporting guideline.

RESULTS

A total of 6951 articles were identified from the search strategy and 31 studies during pregnancy or postpartum were included. By category, the number of studies with a favorable outcome per total number of studies measuring outcome were as follows: parental food/cooking skills (n = 5 of 5), nutrition knowledge (n = 6 of 11), parent/child diet quality (n = 10 of 19), infant feeding (n = 6 of 11), eating behavior (n = 2 of 5), maternal (n = 2 of 5) and child anthropometry (n = 6 of 10), mental health and development n = (2 of 3), and clinical indictors (n = 1 of 1).

CONCLUSIONS

Culinary nutrition-education interventions during pregnancy and the postpartum period show promise in improving cooking skills, diet quality, and a variety of health-related outcomes. The precise effect of these interventions during PPP is limited by the quality and heterogeneity of study designs to date.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42020154966.

Complementary feeding practices and their association with adiposity indicators at 12 months of age

Nutrition during the first 1000 days of life represents a window of opportunity to reduce the risk of metabolic dysfunctions later in life. Exclusive breastfeeding (EBF) and adequate introduction of solid foods are essential to promote metabolic and nutritional benefits. We evaluated the association of infant feeding practices from birth to 6 months (M) with adiposity indicators at 12 M. We performed a secondary analysis of 106 healthy term infants born from a cohort of healthy pregnant women. Type of breastfeeding (exclusive or nonexclusive), the start of complementary feeding (CF) (before (<4 M) or after (≥4 M)), and adiposity (body mass index - BMI, body mass index-for-age - BMI/A, waist circumference - WC, and waist circumference-length ratio - WLR) were evaluated at 12 M using descriptive statistics, mean differences, X2, and linear regression models. During the first 6 M, 28.3% (n = 30) of the infants received EBF. Early CF (<4 M) was present in 26.4% (n = 28) of the infants. Children who started CF < 4 M were less breastfed, received added sugars as the most frequently introduced food category, and showed higher BMI, BMI/A, WC, and WLR; those who consumed added sugars early (<4 M) had a higher WC. Starting CF < 4 M was the main factor associated with a higher WC at 12 M. Unhealthy infant feeding practices, such as lack of EBF, early CF, and early introduction of sugars, may be associated with higher adiposity at 12 M.

De-implementation of detrimental feeding practices: a pilot protocol

BACKGROUND

Early childhood educators (ECEs) often use detrimental feeding practices and are slow to implement positive feeding practices. Nevertheless, few studies have aimed to understand and change ECEs' feeding practices. This gap needs to be addressed because implementation (i.e., adding new, evidence-based practices) and de-implementation (i.e., stopping low-value or harmful practices) are distinct processes that require unique strategies.

METHODS

We will develop a de-implementation strategy for detrimental feeding practices using evidence-based quality improvement (EBQI) sessions to engage stakeholders and draw on the Niven process model for de-implementation. Then, we will investigate the effects of the de-implementation strategy in a proof-of-principle study. The de-implementation strategy will be evaluated in 2 partnering childcare agencies using a pre-post, within-site design. For our primary outcome, we will interview educators throughout the school year to assess the feasibility and acceptability of the intervention and survey them with standard measures for assessing feasibility and acceptability. For secondary outcomes, we will investigate its effects on the use of detrimental and evidence-based feeding practices by teachers and impacts on child BMI and diet.

DISCUSSION

The current study will establish the feasibility and acceptability of our de-implementation approach and will provide preliminary data toward 3 predicted secondary outcomes: (1) decreased detrimental feeding practices by ECEs, (2) increased adoption of and fidelity to nutrition promotion practices, and (3) improved child dietary outcomes. These results are expected to contribute to the uptake and sustainability of mealtime interventions to improve the diets of young children. Results will also apply to the field of implementation science by informing processes for developing de-implementation approaches in a community setting.

Effect of Aging Time on Meat Quality of Longissimus Dorsi from Yunling Cattle: A New Hybrid Beef Cattle

Simple Summary

Beef is in great demand in many countries. Consumers are more inclined to buy beef with good tenderness, color, flavor, and healthy fatty acid composition. Beef that has been aged is often more suitable for cooking and processing. A research gap exists regarding the analysis of meat quality during the aging process in Yunling cattle, a new hybrid beef cattle bred by Chinese researchers. This study measured a set of indicators of Yunling beef and other two breeds as controls (Simmental cattle, an excellent beef cattle breed used around the world, and Wenshan cattle, a local beef cattle breed in southern China), including the pH, water loss rate, cooking loss, Warner-Bratzler shear force, myofibrillar fragmentation index, inosine 5′-monophosphate, color, and fatty acid profiles. In addition, some growth performance and carcass characteristics were determined. The results showed that the pH, water holding capacity, growth performance, and carcass traits of Yunling and Simmental cattle were basically the same and better, respectively, than those of Wenshan cattle. Aging time had no effect on beef fatty acid composition, with Yunling beef showing a healthier fatty acid profile versus the other two breeds. With increased aging time, the tenderness and color of Yunling beef became more suitable for cooking and sensory characteristics. Therefore, this study suggests that Yunling beef should be used for cooking and processing after aging.

Abstract

The beef aging process is essential for compliance with certain major requisites, such as sensory characteristics for cooking and meat processing. Meat quality analysis of Yunling cattle, a new hybrid beef cattle bred by Chinese researchers, during the aging process, represents a major research gap. To explore Yunling beef initially, indicators associated with meat quality during the aging process of Yunling, Simmental, and Wenshan cattle were measured. In addition, some important economic traits were detected in the three breeds, including growth performance and carcass characteristics. The results showed that the growth performance, carcass traits, pH, and water holding capacity of Yunling and Simmental cattle were basically the same and better, respectively, than those of Wenshan cattle. The proportions of individual fatty acids in Yunling beef were healthier than in the other two breeds. Aging time did not affect the fatty acid profiles of the beef (p > 0.05). The contents of certain fatty acids in the three beef types displayed some differences in terms of days of aging (p < 0.05). The tenderness and meat color were better in the Yunling beef as the aging time increased, indicating that Yunling beef aged for 7 days was more suitable for cooking, exhibiting better sensory characteristics. Thus, a 7-day short-term aging process is very effective in improving the quality of Yunling beef. Our study attempted to fill a gap in the Yunling beef quality analysis during aging, providing further evidence for Yunling beef improvement.

Show or tell: Children's learning about food from action vs verbal testimony

BACKGROUND

Childhood obesity continues to be a critical health concern in the United States. Nonetheless, interventions that focus on delivering verbal lessons about food and health to children in preschool classrooms have had only modest effects.

OBJECTIVES

The present study examines the relative effectiveness of showing vs telling children about food to promote healthy eating, with a focus on unfamiliar foods and vegetables.

METHODS

Three- to six-year-old children (n = 71) were tested in a laboratory study in which they watched videos of two people eating apple-broccoli puree. One person took five bites of the food; the other said they liked the food.

RESULTS

Children did not differentiate between the food they saw someone eat and the food they heard someone talk about. Children's food intake was negatively associated with parent reports of children's eating behavior on the Food Fussiness subscale of the Child Eating Behavior Questionnaire. We found similar patterns in an analogous toy task. In an unfamiliar object task, children selected the action demonstration as the right way to use the object.

CONCLUSIONS

We find no evidence that action vs verbal testimony is more persuasive in guiding children's food choices, but action testimony may be persuasive in other domains. The associations between children's food intake and pickiness provide growing evidence of alignment between parent assessments of their children's typical eating behavior and children's food choices in laboratory studies.

Snack Development for School Feeding Programs in Africa: A Scoping Review

The benefits of school feeding have been well documented. As such, school feeding programs have continuously gained popularity in developing countries. However, challenges and potential opportunities persist, calling for a review of school feeding for long-term sustainability. South Africa has an opportunity to improve their National School Nutrition Program (NSNP) by including an energy-dense snack that would increase the recommended dietary allowance (RDA) of school children to meet at least 25% of their energy requirements. The objective of this scoping review was to conduct a review and an appraisal of studies on snack food development for school feeding programs in Africa. Eligible studies had to report snack development for school feeding programs in Africa. We conducted an electronic search in National Research Foundation (NRF) NEXUS, Elton B. Stephens Company (EBSCO), International Food Information Service (IFIS), Nutrition and Food Sciences Center for Agriculture and Bioscience International (CABI.ORG), and Google Scholar. Of the 429 articles identified, nine studies were included in the final review-five from within South Africa and four from elsewhere in Africa. Data extracted included the study design, intervention, outcomes, relevant findings, and limitations. Results were presented in a narrative summary. The review findings showed that energy-rich staple foods and food fortification were commonly used in snack development. The popular snack products developed included porridges and biscuits. While most studies reported nutritional outcomes, few studies reported on sensory acceptability tests and only two studies conducted a cost analysis. This review of previous snack development initiatives for school feeding programs in Africa underscores the importance of establishing the sustainability of any food product developed. The findings of this review have the potential to inform future snack product development for school feeding programs.

Ultra-Processed Foods and Health Outcomes: A Narrative Review

The nutrition literature and authoritative reports increasingly recognise the concept of ultra-processed foods (UPF), as a descriptor of unhealthy diets. UPFs are now prevalent in diets worldwide. This review aims to identify and appraise the studies on healthy participants that investigated associations between levels of UPF consumption and health outcomes. This involved a systematic search for extant literature; integration and interpretation of findings from diverse study types, populations, health outcomes and dietary assessments; and quality appraisal. Of 43 studies reviewed, 37 found dietary UPF exposure associated with at least one adverse health outcome. Among adults, these included overweight, obesity and cardio-metabolic risks; cancer, type-2 diabetes and cardiovascular diseases; irritable bowel syndrome, depression and frailty conditions; and all-cause mortality. Among children and adolescents, these included cardio-metabolic risks and asthma. No study reported an association between UPF and beneficial health outcomes. Most findings were derived from observational studies and evidence of plausible biological mechanisms to increase confidence in the veracity of these observed associations is steadily evolving. There is now a considerable body of evidence supporting the use of UPFs as a scientific concept to assess the 'healthiness' of foods within the context of dietary patterns and to help inform the development of dietary guidelines and nutrition policy actions.

Nutritional problems in childhood and adolescence: a narrative review of identified disparities

To inform programmes and policies that promote health equity, it is essential to monitor the distribution of nutritional problems among young individuals. Common nutritional problems include overall low diet quality, the underconsumption and overconsumption of certain dietary components, unhealthy meal and snack patterns, problematic feeding practices and disordered eating. The objective of the present narrative review was to summarise recent evidence of disparities among US children (2-19 years) according to age, sex, socio-economic status, ethnicity/race and rural-urban location. Searches in PubMed® and MEDLINE® were completed to identify peer-reviewed research studies published between January 2009 and January 2019. Findings from the ninety-nine reviewed studies indicate adolescent females, young individuals from lower socio-economic households and individuals who identify as non-Hispanic Black race are particularly vulnerable populations for whom targeted strategies should be developed to address evidence of increased risk with regards to multiple aspects of nutritional wellbeing. Limitations of the existing evidence relate to the accuracy of self-reported dietary data; the need for consistent definitions of disordered eating; the focus on individual dietary components v. patterns; the complexities of categorising socio-economic status, ethnicity/race, and rural and urban areas; and the cross-sectional, observational nature of most research designs. There is an urgent need for research to address these limitations and fill a large gap in evidence on rural-urban differences in nutritional problems. It will further be important for future studies to build greater understanding of how nutritional problems cluster among population groups.

Brazilian Children's Dietary Intake in Relation to Brazil's New Nutrition Guidelines: a Systematic Review

PURPOSE OF REVIEW

This systematic review reports the latest scientific evidence, from cross-sectional and cohort studies, describing the dietary intake of children and adolescents from Brazil. The goal of the review was to describe intakes according to Brazil's new food classification system (NOVA) which classifies foods according to the degree of processing, i.e., unprocessed/minimally processed, processed culinary ingredients, processed food, and ultra-processed food. Due to a paucity of data using the NOVA classification system, studies with other intake descriptors were included.

RECENT FINDINGS

Results using the NOVA system showed a somewhat high intake of (ultra-)processed items, than of minimally processed items. Studies using other methods of dietary assessment showed not only high intake of sources rich in fat, sugar, and sodium, most of them processed items (e.g., savory snacks and sweets) but also intake of fruit, vegetables, and whole grains. Overall, the literature was marred by inconsistencies and variation in study definitions and methods making it hard to make firm conclusions regarding the dietary intake of Brazilian children. The development of tools to evaluate the complexities of dietary intake is much needed. Such a tool needs to be accepted and adopted by numerous study groups, to describe dietary status among Brazilian children and devise the most effective, and to evaluate the success of nutrition education programs.

Changes in diet quality 6 and 12 months post-intervention: the Healthy Habits, Healthy Girls: a Brazilian study

ABSTRACT Objective To determine the sustainability of food quality in an obesity-prevention strategy for adolescent girls. Methods The study is a randomized controlled trial with 253 girls (Mean=15.61, 95% Confidence Interval 15.51-15.72) enrolled in 10 vocational schools in São Paulo. The diet intake was determined using a “Food Frequency Questionnaire” and analyzed according to the Brazilian Healthy Eating Index-Revised adequacy, moderation, and overall scores. The adolescents’ dietary intake was compared to the baseline 6 months and 12 months post-intervention. Descriptive statistics and analyses of covariance were used, considering a 5% significance level. Results Significant increases were found on the components total fruits (F=6.98, p<0.01), total vegetables (F=5.76, p=0.02), beans (F=5.96, p=0.02), and whole cereals (F=12.35, p<0.001). However, there was also a significant decrease on the scores for milk and dairy (F=6.48, p=0.02), and oils (F=5.98, p=0.02). At 12-month post intervention, improvement on the overall score was found (F=3.89, p=0.05), but there was a decrease on the component whole cereals (F=11.85, p<0.001), as well as in milk and dairies (F=6.38, p=0.02). Despite no significant effect for the SoFAAS component, a moderate effect size was revealed (d=0.56). Conclusion There were significant effects on some diet quality components and for the overall scores at 6-month and 12-month post intervention. Therefore, sustainable dietary changes should be the focus of obesity prevention programs for adolescents. Socio-economic influences on diet behaviors would also need to be acknowledged.

Contributions of Early Care and Education Programs to Diet Quality in Children Aged 3 to 4 Years in Central North Carolina

BACKGROUND

Parents and early care and education (ECE) are the key influencers of young children's diets, but there is limited information about how each contribute to children's overall diet quality.

OBJECTIVE

This study aimed to determine what proportion of children's dietary intake occurs within the ECE setting and whether diet quality is higher at ECE centers and, consequently, on weekdays than weekends.

DESIGN

This cross-sectional analysis of a larger cluster randomized controlled trial used multiple 24-hour dietary intakes measured through a combination of the Dietary Observation in Child Care protocol and parent-reported food diaries.

PARTICIPANTS/SETTING

Participants (N=840) included children aged 3 to 4 years enrolled in ECE centers in central North Carolina for whom 24-hour dietary intake was captured via observation of meals and snacks consumed at ECE and parent-report of all remaining meals and snacks. Data were collected from 2015 to 2016.

MAIN OUTCOME MEASURES

Diet quality at ECE and elsewhere was evaluated using the Healthy Eating Index 2015.

STATISTICAL ANALYSES PERFORMED

Mixed-effects models were used to determine differences in mean Healthy Eating Index 2015 component and total scores. Models were adjusted for children's age and sex and accounted for clustering within ECE centers and families.

RESULTS

Children consumed approximately 40% of daily energy, nutrients, and food groups at ECE centers. The mean total Healthy Eating Index 2015 score was higher for foods and beverages consumed at ECE centers (58.3±0.6) than elsewhere (52.5±0.6) (P<0.0001). The mean total Healthy Eating Index 2015 score was also higher on weekdays (58.5±0.5) than on weekends (51.3±0.5) (P<0.0001).

CONCLUSIONS

Children consume a majority of dietary intake away from ECE centers. Overall, diet quality is low, but the quality of foods consumed by children at ECE centers is higher than that consumed elsewhere. ECE centers remain an important source of nutrition and further investigation is warranted to identify ways to support both ECE centers and families to provide healthier eating environments.

Position of the Academy of Nutrition and Dietetics: Benchmarks for Nutrition in Child Care

It is the position of the Academy of Nutrition and Dietetics that early care and education (ECE) programs should achieve recommended benchmarks to meet children's nutrition needs and promote children's optimal growth in safe and healthy environments. Children's dietary intake is influenced by a number of factors within ECE, including the nutritional quality of the foods and beverages served, the mealtime environments, and the interactions that take place between children and their care providers. Other important and related health behaviors that may influence the development of obesity include children's physical activity, sleep, and stress within child care. Recent efforts to promote healthy eating and improve other health behaviors in ECE include national, state, and local policy changes. In addition, a number of interventions have been developed in recent years to encourage healthy eating and help prevent obesity in young children in ECE. Members of the dietetics profession, including registered dietitian nutritionists and nutrition and dietetics technicians, registered, can work in partnership with ECE providers and parents to help promote healthy eating, increase physical activity, and address other important health behaviors of children in care. Providers and parents can serve as role models to support these healthy behaviors. This Position Paper presents current evidence and recommendations for nutrition in ECE and provides guidance for registered dietitian nutritionists; nutrition and dietetics technicians, registered; and other food and nutrition practitioners working with parents and child-care providers. This Position Paper targets children ages 2 to 5 years attending ECE programs and highlights opportunities to improve and enhance children's healthy eating while in care.

Development of a diet quality index to assess adherence to Canadian dietary recommendations in 3-year-old children

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.

Incorporating Technology Into the iCook 4-H Program, a Cooking Intervention for Adults and Children: Randomized Controlled Trial

BACKGROUND

Families who cook, eat, and play together have been found to have more positive health outcomes. Interventions are needed that effectively increase these health-related behaviors. Technology is often incorporated in health-related interventions but is not always independently assessed.

OBJECTIVE

The objective of this study was to describe challenges and facilitators to incorporating technology into the iCook 4-H intervention program.

METHODS

Dyads (n=228) composed of children (mean 9.4, SD 0.7 years old) and an adult primary meal preparer (mean 39.0, SD 8 years) were randomly assigned to a control (n=77) or treatment group (n=151). All treatment group dyads participated in 6 in-person sessions designed to increase families cooking, eating, and playing together. We incorporated Web-based between-session technological components related to the curriculum content throughout the intervention. Assessments were completed by both groups at baseline and at 4, 12, and 24 months; they included measured anthropometrics for children, and online surveys about camera and website skill and use for dyads. Session leaders and participants completed open-ended process evaluations after each session about technological components. We computed chi-square analysis for sex differences in technological variables. We tested relationships between video posting frequency and outcomes of interest (cooking frequency, self-efficacy, and skills; dietary intake; and body mass index) with Spearman correlations. Process evaluations and open-ended survey responses were thematically analyzed for beneficial and inhibiting factors, including technological components in the curriculum.

RESULTS

Only 78.6% (81/103) of children and 68.3% (71/104) of adults reported always being comfortable accessing the internet postintervention. Boys reported being more comfortable than girls with technological tasks (P<.05). Children who posted more videos had a higher level of cooking skills at 4 months postintervention (r=.189, P=.05). Barriers to website usage reported most frequently by children were lack of accessibility, remembering, interactivity, motivation, time, and lack of parental encouragement.

CONCLUSIONS

Incorporating technological supports, such as cameras and websites, into children's programs may help produce improved outcomes. Identifying barriers to and patterns of technology usage need to be considered when developing future child health promotion interventions.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN54135351; https://www.isrctn.com/ISRCTN54135351.

Dietary diversities score and anthropometric characteristics in Iranian elementary school children

Dietary diversity scoring is a good method to assess quality of individual's diet. The study aimed to investigate the association between dietary diversity and body mass index among elementary school students in the south of Tehran, Iran. This cross-sectional study was conducted on elementary school students, age range of 7-12 years old, in 2015. Data were collected using a personal information questionnaire and three 24-h recall questionnaires. Dietary diversity score was calculated from the number of food groups in these questionnaires. A total of 536 students, 258 (48.1%) female and 278 (51.9%) male, were recruited in the study. The mean age of the students was 9.43 ± 1.73 years. Seafood consumption was more frequent and beans was lower frequent in students at higher BMI (≥95th percentile) than the other children (34% vs 25% and 71% vs 83%, respectively, p<0.05). However, the statistical analysis failed to find significant relationships between children’s body mass index (BMI) with consumption of diary, vegetable, fruits, protein, fat, and junk food intake. The association between children's BMI with seafood and beans consumption confirmed in multivariate analysis (OR= 1.50 and 0.52, respectively, p<0.05). The study finding showed that seafood and beans consumption may influence on elementary student BMI.

Deconstructing the Family Meal: Are Characteristics of the Mealtime Environment Associated with the Healthfulness of Meals Served?

BACKGROUND

Multiple studies and guidelines emphasize the benefits associated with family meals. However, family meals are not well defined and little research has been conducted to determine whether mealtime characteristics are associated with the healthfulness of foods served.

OBJECTIVE

The objective of this study was to define and measure specific mealtime characteristics and examine whether these characteristics are associated with the healthfulness of meals served to young children from low-income families, as measured by the Healthy Meal Index (HMI).

PARTICIPANTS/SETTING

Study participants included 272 young children from low-income families residing in southeast Michigan during 2011 to 2013.

DESIGN

For this cross-sectional study, parents videorecorded 757 mealtimes that were coded for four mealtime variables and meal healthfulness using the HMI. Mealtime characteristics included Eating at a Table (vs not), Served Family-Style (vs not), TV Off (vs not), and Parent Partakes (sits and eats or drinks with child) (vs not). A Family Meal was defined as a meal that had all four measured mealtime characteristics.

MAIN OUTCOME MEASURES

All meals were scored using the HMI, which has two components: the HMI Adequacy score (based on the presence of foods that are recommended for a healthy diet) and the HMI Moderation score (based on the absence of foods recommended to be consumed in moderation). The scores are summed to obtain the HMI Total score.

STATISTICAL ANALYSES PERFORMED

Generalized estimating equations tested the associations of mealtime characteristics with HMI scores, controlling for child sex and age, and parent education and race/ethnicity.

RESULTS

In adjusted models, Family Meals were positively associated with HMI Adequacy (P=0.02) and Total (P=0.05) scores. Eating at a Table was positively associated with HMI Moderation (P=0.01) and HMI Total (P=0.01) scores. Served Family-Style was positively associated with HMI Adequacy scores (P=0.04). TV Off was associated with higher HMI Total scores (P=0.05). Parent Partakes was not associated with HMI scores.

CONCLUSIONS

Family Meals were associated with greater healthfulness of the foods served. Characteristics of mealtime that are commonly utilized to define Family Meal were differentially associated with meal healthfulness.

Trends in Mean Nutrient Intakes of US Infants, Toddlers, and Young Children from 3 Feeding Infants and Toddlers Studies (FITS)

BACKGROUND

Many updates to young child feeding recommendations have been published over the past decade, but concurrent intake trends have not been assessed.

OBJECTIVE

The aim of this study was to evaluate adequacy and trends in energy and nutrient intakes of US infants and children aged 0-47.9 mo through use of Feeding Infants and Toddlers Study (FITS) data from 2002, 2008, and 2016.

METHODS

FITS are cross-sectional surveys of parents/caregivers of infants and young children (FITS 2002, n = 2962; FITS 2008, n = 3276; FITS 2016, n = 3235). Dietary intakes were assessed by telephone with trained interviewers using the Nutrition Data System for Research. Mean ± SE nutrient intakes were calculated. Diet adequacy was assessed with the nutrient adequacy ratio (NAR) for 17 nutrients and the corresponding mean adequacy ratio.

RESULTS

Energy and macronutrient intakes were generally stable across surveys, but significant decreases for saturated fat and total sugars and an increase in fiber were observed among 6-11.9-mo-olds and 12-23.9-mo-olds (P-trend < 0.0001). Mean sodium intakes exceeded Adequate Intakes (AI) for all ages, whereas fiber intakes were universally below the AI. Nutrients with the lowest NAR values were vitamin D (range 0.41-0.67/1.00) and vitamin E (range 0.60-0.79/1.00 for 2008 and 2016). For iron, infants aged 6-11.9 mo had the lowest NAR values at 0.77-0.88/1.00, compared to 0.85-0.89/1.00 for 12-47.9-mo-olds. Potassium was low from 12 to 47.9 mo (NAR range 0.55-0.63/1.00 across survey years). The nutrients with the greatest decline in mean intakes were iron and vitamins D and E among 6-11.9-mo-olds, and vitamin D and potassium among 12-23.9-mo-olds in 2016 compared to 2002.

CONCLUSIONS

The diets of US infants and young children were generally adequate for most micronutrients and stable over time, but sodium intakes were too high, and nutrient gaps still existed, especially for vitamins D, E, and fiber across ages and for iron among infants.

Consuming school meals improves Brazilian children’s diets according to their social vulnerability risk

Objective:

To estimate usual diets among Brazilian children regarding the consumption of school meals and social vulnerability risks.

Design:

A cross-sectional study. School meal consumers were considered those children who reported consuming school meals ≥3 times/week. Social vulnerability risk was classified by an index. Dietary intake was evaluated by one 24 h dietary recall for the whole sample; a second 24 h dietary recall was administered in a sub-sample (38·6 %). The National Cancer Institute’s method was used to estimate children’s usual intake of nutrients and food groups.

Setting:

Municipal public schools from Belo Horizonte, Brazil.

Participants:

Children (n 1357) aged 8–12 years.

Results:

Half of the sample lived in low/medium social vulnerability risk areas and 27·9 % were school meal non-consumers. School meal consumers more frequently lived in high/very high social vulnerability risk areas (76·2 v. 68·7 %). Children with low/medium social vulnerability risk had a higher mean intake of thiamin (1·13 v. 1·04 mg) and a lower mean intake of candy (1·35 v. 1·42 g). Consumption of school meals among children under high/very high social vulnerability risk was associated with higher mean consumption of vitamin C (31·9 v. 24·1 mg), unprocessed/minimally processed foods (956·3 v. 851·9 g), fruits (128·5 v. 90·9 g) and vegetables (58·2 v. 47·1 g). Ultra-processed food product consumption was lower among school meal consumers (136·2 v. 187·7 g), especially ultra-processed beverages (252·5 v. 305·7 g).

Conclusions:

Consuming school meals was associated with a better usual diet quality, particularly among those with higher social vulnerability risk.

Child-Centered Nutrition Phrases Plus Repeated Exposure Increase Preschoolers' Consumption of Healthful Foods, but Not Liking or Willingness to Try

OBJECTIVE

To determine whether the use of child-centered nutrition phrases (CCNP) with repeated exposure (RE) improved willingness to try, liking, and consumption of healthful foods compared with RE alone.

DESIGN

The researchers used a 2 × 2 × 4 fractionated within-subjects experimental design in the study: phrase condition (RE vs CCNP + RE) by time of measurement (preintervention, postintervention, and 1-month follow-up), by type of food (tomatoes, bell peppers, lentils, and quinoa).

SETTING

Children were recruited from 2 early education centers; 89% participated.

PARTICIPANTS

Children aged 3-6 years old (n = 87) who were predominantly white (67%) and from middle-income homes and had parents with some higher education.

INTERVENTION

Adult delivery of CCNP + RE weekly for 6 weeks.

MAIN OUTCOME MEASURE(S)

Willingness to try, change in liking, and change in consumption.

ANALYSIS

Two-level random-effects models were used to account for repeated measurements of willingness to try, liking, and consumption nested within participants.

RESULTS

Children exhibited greater consumption of CCNP foods at follow-up assessment compared with RE foods (b = -16.28, SE = 5.41, t(528) = 3.01; P = .003).

CONCLUSIONS AND IMPLICATIONS

Use of CCNP combined with RE may encourage healthy eating, especially for novel foods that children may typically refuse.

The intergenerational transmission of family meal practices: a mixed-methods study of parents of young children

OBJECTIVE

The current mixed-methods study explored qualitative accounts of prior childhood experiences and current contextual factors around family meals across three quantitatively informed categories of family meal frequency patterns from adolescence to parenthood: (i) 'maintainers' of family meals across generations; (ii) 'starters' of family meals in the next generation; and (iii) 'inconsistent' family meal patterns across generations.

DESIGN

Quantitative survey data collected as part of the first (1998-1999) and fourth (2015-2016) waves of the longitudinal Project EAT (Eating and Activity in Adolescents and Young Adults) study and qualitative interviews conducted with a subset (n 40) of Project EAT parent participants in 2016-2017.

SETTING

Surveys were completed in school (Wave 1) and online (Wave 4); qualitative interviews were completed in-person or over the telephone.ParticipantsParents of children of pre-school age (n 40) who had also completed Project EAT surveys at Wave 1 and Wave 4.

RESULTS

Findings revealed salient variation within each overarching theme around family meal influences ('early childhood experiences', 'influence of partner', 'household skills' and 'family priorities') across the three intergenerational family meal patterns, in which 'maintainers' had numerous influences that supported the practice of family meals; 'starters' experienced some supports and some challenges; and 'inconsistents' experienced many barriers to making family meals a regular practice.

CONCLUSIONS

Family meal interventions should address differences in cooking and planning skills, aim to reach all adults in the home, and seek to help parents who did not eat family meals as a child develop an understanding of how and why they might start this tradition with their family.

"If my family is happy, then I am happy": Quality-of-life determinants of parents of school-age children

OBJECTIVE

Obesity is a public health concern for children and adults and effective obesity prevention programming is needed urgently. The effectiveness of health-related messaging and interventions is influenced by the way content is framed. HomeStyles is an obesity prevention program, which aims to promote health through the frame of improved quality of life.

METHODS

Thus, focus groups were conducted with English- and Spanish-speaking parents of school-aged children (ages 6-11) to identify key quality-of-life determinants as described by parents.

RESULTS

Parents (n = 158) reported that their quality of life was influenced by family happiness and parent and child health (e.g. adequate sleep, exercise, healthy diet). Many parents expressed that their busy schedules and lack of family time were detrimental to their quality of life. Work-life balance and financial stability were other factors commonly noted to impact quality of life. Spanish-speaking parents also reported being undocumented and feeling a lack of a sense of community negatively influenced their quality of life.

CONCLUSION

Considering parent-defined quality-of-life determinants when framing health-related messaging and developing interventions may increase participant interest and ultimately improve health-related behaviors. Next steps in the HomeStyles project include using parent-reported quality-of-life determinants to guide the development of intervention materials.

Body composition and body mass index in Duchenne muscular dystrophy: Role of dietary intake

INTRODUCTION

In Duchenne muscular dystrophy (DMD) muscle is replaced by adipose tissue. The role of dietary intake (DI) in DMD has not been evaluated. In this study we examined body composition, body mass index (BMI), and adequacy of DI in patients with DMD and evaluated the influence of DI on body composition.

METHODS

Patients (n = 101; age 3-18 years; BMI 11.8-29.5 kg/m² ) completed a dietary recall to determine DI and then underwent dual-energy X-ray absorptiometry to determine body composition.

RESULTS

Preschool-age and school-age boys with DMD had high total energy intake. Protein intake per kilogram exceeded recommendations. As age increased, the percentage of boys with abnormal BMI and fat mass increased, while lean mass decreased. Dietary intake did not predict body fat or lean mass.

DISCUSSION

Age-dependent changes in BD in boys with DMD may be due to endogenous metabolic factors related to the underlying disease process and to disease-related mobility impairments. Muscle Nerve 59:295-302, 2019.

About feeding children: factor structure and internal reliability of a survey to assess mealtime strategies and beliefs of early childhood education teachers

BACKGROUND

Children spend a substantial amount of time in early care and education (ECE) settings and may eat a majority of their diet in this setting. While there are several instruments focused on measuring factors of the ECE environment that may influence diet and weight outcomes, there are few comprehensive, valid, and reliable measures for collecting self-report of ECE providers' feeding practices. The purpose of this study was to establish the factor structure and internal reliability of a survey developed to measure practices and beliefs of ECE providers relative to feeding children.

METHODS

Licensed ECE centers from CA, CO, ID and NV were included in this cross-sectional survey study. The sample was stratified by states and census regions to yield equal numbers of centers from each category. The total sample distribution included 1600 randomly selected centers and up to 8000 staff members (who represented teachers, aides, assistants, or cooks); 1178 surveys were completed. We conducted an exploratory, unrestricted factor analysis as well as parallel analyses to inform the number of factors to be extracted.

RESULTS

Factors within Structural Mealtime Strategies included Adult Control of Foods Consumed (Kuder-Richardson [KR] = 0.67), Bribing with Sweet Foods (KR = 0.70), and Supportive Adult Roles at Mealtime (KR = 0.55). Factors in Verbal Mealtime Strategies included Supporting Children's Eating Self-regulation (KR =0.61), Pressure to Eat (KR = 0.58), and Social Comparisons (KR = 0.59). Beliefs about Mealtime factors were Autonomy Promoting (α = 0.64), Coercive Beliefs (α = 0.77), and Concern-Based Control (α = 0.60).

CONCLUSIONS

The AFC Strategies and Beliefs Survey provides a promising self-report instrument with a strong factor structure consistent with the extant literature to measure practices and beliefs related to feeding and mealtimes in the ECE setting. Feeding young children in group settings differs in many ways from feeding in a family setting; hence it is important that measures such as the AFC Strategies and Beliefs Survey capture unique aspects of the ECE feeding environment.

Room for Improvement Remains in Food Consumption Patterns of Young Children Aged 2-4 Years

Background

Healthy food consumption patterns in early childhood support optimal growth and development and promote lifelong health.

Objective

The objective of the Feeding Infants and Toddlers Study (FITS) 2016 is to provide updated information on food consumption patterns of children aged 0 to <4 y. This article focuses on several key aspects of the food consumption patterns of 2- and 3-y-olds and how those patterns differ between racial/ethnic groups.

Methods

The FITS 2016 is a cross-sectional study in caregivers of children aged 0 to <4 y living in the United States. Dietary data were collected in a national random sample of children (n = 3235, of whom 600 were aged 24-47.9 mo) by using a 24-h dietary recall telephone survey with the primary caregiver of the child. Data from the recall were used to calculate the percentage of children consuming specific food groups on the day of the recall and energy from these foods (kilocalories per consumer). Differences in food patterns between racial/ethnic groups were analyzed by using ANOVA and t tests.

Results

On the day of the 24-h dietary recall, 27% of 2- and 3-y-olds did not consume a distinct portion of vegetables. Fried potatoes were the most commonly consumed vegetable. Approximately 75% consumed a distinct portion of fruit and 45% consumed 100% fruit juice. Eighty-one percent of children consumed cow milk. Almost all (95%) consumed a grain product, and 59% consumed a whole grain-rich product. The majority of children (88%) consumed meat or another protein food. Nearly all (90%) consumed a dessert, sugar-sweetened beverage (SSB), or sweet; and 45% consumed an SSB. Thirty-six percent of children consumed a savory snack. There were some differences in food consumption patterns between racial/ethnic groups.

Conclusion

Findings from the FITS 2016 indicate that individual-, community-, and policy-level strategies are needed to improve the diets of young children in the United States.