Accuracy of maternal dietary recall for preschool children

Relation of social network support to child health behaviors among children in treatment for overweight/obesity

PURPOSE

Little is known about the influence of social network support on child health behaviors in the context of weight-loss interventions. This study examined the associations between a child's co-participation (i.e., network support) in weight-related health behaviors (i.e., physical and sedentary activity, eating behavior) and the child's own health behaviors during family-based behavioral treatment (FBT).

METHODS

Children (n = 241) with overweight/obesity (mean age = 9.4 ± 1.3y; 63% female) completed semi-structured interviews assessing network support for healthy/unhealthy eating and physical/sedentary activity, and a 3-day dietary recall. Physical activity was assessed with accelerometry, and sedentary activity was measured via parent-reported child screen time use. All assessments were taken at baseline and after 4 months of FBT. Hierarchical linear regressions examined changes in network support as they related to changes in health behaviors from baseline to the end of FBT.

RESULTS

Changes in network support for healthy eating were related to changes in vegetable, but not fruit, intake across FBT, while changes in network support for unhealthy eating were negatively related to changes in diet quality. Changes in network support for sedentary activity were negatively related to changes in minutes of physical activity and positively related to changes in screen time.

CONCLUSION

The present findings suggest that a child's network support for health behaviors may relate to behavior change among children during FBT and provide opportunities for targeted intervention.

LEVEL OF EVIDENCE

III. cohort study.

The cost of diets according to diet quality and sociodemographic characteristics in children and adolescents in Belgium

This study aims to estimate cost variations according to diet quality and sociodemographic characteristics in children. Data (n = 1,596; 5-17 y) from the Belgian National Food Consumption Survey were used. The "Kidmed index" and dietary patterns (DP) identified through principal component analysis were used to assess diet quality. Daily diet cost was estimated after linking the consumed foods with the GfK ConsumerScan panel food prices. The mean diet cost was 4.68€/day (SEM: 0.05). Adjusted for covariates and energy intake, the mean diet cost was 9.1% higher in the highest Kidmed adherence (vs. the lowest) and 6.2% higher in the tercile T3 (vs. T1) of the "Healthy" DP score. It was 4.8% lower in the T3 (vs. T1) for the "Junk food" DP score. Diet cost was higher in 12-17 year-olds (vs. 5-11 years) and in medium and high educated household (vs. the lowest). These findings support policies to make healthy diets more affordable.

The enriched home environment and dietary intake are related to percent overBMI in children

Longitudinal research suggests that living in a cognitively enriched home environment, in which access to activities including hobbies and books are plentiful, can prevent excess weight gain and obesity in children. In order for the enriched home environment to influence weight it should influence energy and macronutrient intake and/or energy expenditure. To test this hypothesis, we used a cross sectional design to study aspects of the child's enriched home environment along with energy and macronutrient intake. A sample of 158 6-9-year-old children measured between February 2017 - April 2019 in Buffalo, NY were selected from a larger study based on criteria for accurate reporting of energy intake using the Block Kid's Food Frequency Questionnaire. Results showed that the Home Observation for Measurement of the Environment (HOME) subscales enriched environment, parental warmth and an integrated family structure were negatively related to child percent overBMI. Hierarchical regression showed that each of these factors improved variance in child percent overBMI accounted for beyond dietary intake or macronutrients, specifically accounting for a total of 18.2% variance in models controlling for total energy intake. These results provide the first demonstration that characteristics of a child's home environment are associated with lower energy intake and independently associated with percent overBMI beyond knowledge of diet. Enriching a child's home environment by providing alternative activities to eating, improving parental warmth and providing opportunities for parents to interact positively with their children may be novel ways to reduce childhood obesity that should be experimentally tested in future research.

Validation and calibration of the Eating Assessment in Toddlers FFQ (EAT FFQ) for children, used in the Growing Up Milk - Lite (GUMLi) randomised controlled trial

The Eating Assessment in Toddlers FFQ (EAT FFQ) has been shown to have good reliability and comparative validity for ranking nutrient intakes in young children. With the addition of food items (n 4), we aimed to re-assess the validity of the EAT FFQ and estimate calibration factors in a sub-sample of children (n 97) participating in the Growing Up Milk - Lite (GUMLi) randomised control trial (2015-2017). Participants completed the ninety-nine-item GUMLi EAT FFQ and record-assisted 24-h recalls (24HR) on two occasions. Energy and nutrient intakes were assessed at months 9 and 12 post-randomisation and calibration factors calculated to determine predicted estimates from the GUMLi EAT FFQ. Validity was assessed using Pearson correlation coefficients, weighted kappa (κ) and exact quartile categorisation. Calibration was calculated using linear regression models on 24HR, adjusted for sex and treatment group. Nutrient intakes were significantly correlated between the GUMLi EAT FFQ and 24HR at both time points. Energy-adjusted, de-attenuated Pearson correlations ranged from 0·3 (fibre) to 0·8 (Fe) at 9 months and from 0·3 (Ca) to 0·7 (Fe) at 12 months. Weighted κ for the quartiles ranged from 0·2 (Zn) to 0·6 (Fe) at 9 months and from 0·1 (total fat) to 0·5 (Fe) at 12 months. Exact agreement ranged from 30 to 74 %. Calibration factors predicted up to 56 % of the variation in the 24HR at 9 months and 44 % at 12 months. The GUMLi EAT FFQ remained a useful tool for ranking nutrient intakes with similar estimated validity compared with other FFQ used in children under 2 years.

Dietary Habits of 2- to 9-Year-Old American Children Are Associated with Gut Microbiome Composition

BACKGROUND

The human gut microbiome is recognized as an important determinant of human health, yet little is known about how dietary habits are related to the microbiome in post-weaned, pre-pubescent children.

OBJECTIVE

The goal of this work was to link quantitative dietary intake with microbiome features in a diverse population of children consuming a predominantly Western diet.

DESIGN

This was a cross-sectional study.

PARTICIPANTS/SETTINGS

English- or Spanish-speaking families with healthy children between the ages of 2 and 9 years were recruited from a community-based, early childhood learning center in suburban Los Angeles, California between June and September 2014.

MAIN OUTCOME MEASURES

Children included in the analyses (n=75) contributed three fecal samples and three quantitative 24-hour dietary recalls using the multiple-pass method with an average of 5.7 days between samples. Microbial communities of each fecal sample were characterized using Illumina sequencing of the 16S ribosomal RNA gene. Dietary recalls were analyzed using the Automated Self-Administered 24-Hour Recall Dietary Assessment Tool.

STATISTICAL ANALYSIS PERFORMED

Associations between dietary factors and microbiome features were assessed using the Kruskal-Wallis test, Spearman rank correlations, or permutational multivariate analysis of variance. For demographic and health-related variables, χ2 analyses were used to test for differences between age groups for categorical variables.

RESULTS

Our results show that age is correlated with three metrics of microbiome diversity (P<0.05) and is associated with both community structure (P=0.0488) and membership (P=0.0002). Several dietary food groups and nutrients were likewise associated with microbiome features. For example, consumption of non-whole-grain foods was associated with community structure (P=0.0089) and membership (P=0.0057), but not diversity (P>0.05). Likewise, the relative abundance of several bacterial taxa were linked to consumption of particular food groups and/or nutrients, as illustrated by the positive associations between total fruit (Pfalsediscovery rate<0.05) and fiber (Pfalsediscovery rate<0.05) consumption with the relative abundance of the Lachnospira genera.

CONCLUSIONS

This hypothesis-generating study demonstrates that the composition of the child gut microbiome remains dynamic beyond the age of 3 years and responds to dietary differences across individuals. In particular, non-whole-grain foods fortified with vitamins and minerals appear to be associated with the composition of the microbiome. Future interventional or model organism-based studies will be needed to test these associations between diet and microbiome composition.

Access With Education Improves Fruit and Vegetable Intake in Preschool Children

OBJECTIVE

To compare effects of interventions aimed at increasing fruit and vegetable (FV) intake in children.

DESIGN

Pre-post comparison and intervention study with randomly grouped classrooms.

SETTING

Head Start classrooms.

PARTICIPANTS

Two hundred nine Head Start children.

INTERVENTIONS

Treatment A (n = 61) and treatment B (n = 82) children received high-carotenoid FVs for 8 weeks. Treatment B children also received weekly FV education, and their caregivers received FV information and recipes. The comparison group (n = 66) received neither FVs nor education.

MAIN OUTCOME MEASURE

Carotenoid values in Raman units.

ANALYSIS

Multilevel mixed models, ANCOVA, and post hoc analysis were used.

RESULTS

Multilevel mixed models with the group as fixed effect and classrooms within group as a random effect; ANCOVA showed that the only significant variable affecting the score was the group main effect. The intraclass correlation coefficient was 0.037; the Raman unit scores of treatment B were significantly higher than those of treatment A (P = .02) or comparison group (P < .001). However, there was no significant difference between treatment A and comparison (P = .10; Cohen D = .71).

CONCLUSIONS AND IMPLICATIONS

The results suggested that providing education where FVs are offered may help increase consumption. Measurement of carotenoids in family members who received FVs plus education, as well as replication of this model in different locations and ages of children should be investigated in future research.

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.

Effects of a cluster randomized controlled kindergarten-based intervention trial on vegetable consumption among Norwegian 3-5-year-olds: the BRA-study

Background

Early childhood represents a critical period for the establishment of long-lasting healthy dietary habits. Limited knowledge exists on how to successfully increase vegetable consumption among preschool children. The overall aim of the present study was to improve vegetable intake among preschool children in a kindergarten-based randomized controlled trial.

Methods

The target group was preschool children born in 2010 and 2011, attending public or private kindergartens in two counties in Norway. Data about child intake of vegetables were collected by three methods. First, parents filled in a web-based questionnaire of the child’s vegetable intake. Second, among a subsample, trained researchers observed children’s vegetable intake in the kindergarten. Thirdly, a parental web-based 24-h recall assessing the child’s vegetable intake was filled in. For allocation of kindergartens to intervention and control groups, a stratified block randomization was used. Multiple intervention components were implemented from September 2015 to February 2016 and components focused at influencing the four determinants availability, accessibility, encouragement and role modelling. The effect of the intervention from baseline (spring 2015) to follow-up 1 (spring 2016) was assessed by mixed-model analysis taking the clustering effect of kindergartens into account.

Results

Parental consent was obtained for 38.8% of the children (633 out of 1631 eligible children). Based on the observational data in the kindergarten setting (n 218 in the control group and n 217 in the intervention group), a tendency to a small positive effect was seen as a mean difference of 13.3 g vegetables/day (95% CI: − 0.2, 26.9) (P = 0.054) was observed.

No significant overall effects were found for the total daily vegetable intake or for the parental reported frequency or variety in vegetable intake.

Conclusions

Based on the observational data in the kindergarten setting, a tendency to a small positive effect was seen with a mean difference of about 13 g vegetables/day, while no other effects on child vegetable intake were found. Additionally, further research to understand the best strategies to involve parents in dietary interventions studies is warranted.

Trial registration

International Standard Randomised Controlled Trials ISRCTN51962956. Registered 21 June 2016 (retrospectively registered).

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7436-3) contains supplementary material, which is available to authorized users.

Snacking characteristics and patterns and their associations with diet quality and BMI in the Childhood Obesity Prevention and Treatment Research Consortium

OBJECTIVE

To describe snacking characteristics and patterns in children and examine associations with diet quality and BMI.

DESIGN

Children's weight and height were measured. Participants/adult proxies completed multiple 24 h dietary recalls. Snack occasions were self-identified. Snack patterns were derived for each sample using exploratory factor analysis. Associations of snacking characteristics and patterns with Healthy Eating Index-2010 (HEI-2010) score and BMI were examined using multivariable linear regression models.

SETTING

Childhood Obesity Prevention and Treatment Research (COPTR) Consortium, USA: NET-Works, GROW, GOALS and IMPACT studies.

PARTICIPANTS

Predominantly low-income, racial/ethnic minorities: NET-Works (n 534, 2-4-year-olds); GROW (n 610, 3-5-year-olds); GOALS (n 241, 7-11-year-olds); IMPACT (n 360, 10-13-year-olds).

RESULTS

Two snack patterns were derived for three studies: a meal-like pattern and a beverage pattern. The IMPACT study had a similar meal-like pattern and a dairy/grains pattern. A positive association was observed between meal-like pattern adherence and HEI-2010 score (P for trend < 0⋅01) and snack occasion frequency and HEI-2010 score (β coefficient (95 % CI): NET-Works, 0⋅14 (0⋅04, 0⋅23); GROW, 0⋅12 (0⋅02, 0⋅21)) among younger children. A preference for snacking while using a screen was inversely associated with HEI-2010 score in all studies except IMPACT (β coefficient (95 % CI): NET-Works, -3⋅15 (-5⋅37, -0⋅92); GROW, -2⋅44 (-4⋅27, -0⋅61); GOALS, -5⋅80 (-8⋅74, -2⋅86)). Associations with BMI were almost all null.

CONCLUSIONS

Meal-like and beverage patterns described most children's snack intake, although patterns for non-Hispanic Blacks or adolescents may differ. Diets of 2-5-year-olds may benefit from frequent meal-like pattern snack consumption and diets of all children may benefit from decreasing screen use during eating occasions.

Comparison of Parent and Child Ratings of Fruit and Vegetable Liking to Assess Parent Accuracy as Proxy Reporters

This study examined the accuracy of parent-report child fruit/vegetable (FV) liking. Child/parent dyads (n = 24) were recruited from six Head Start preschools in North Carolina. Liking for 10 FVs was assessed using a validated pictorial tool for children; a similar scale was used for parents. Negative relationships were observed between parent/child for one fruit (grapes) and one vegetable (broccoli). Positive relationships were observed among oranges, grapes, and overall fruit rankings. Parents tended to rank children's liking of fruits higher than their children, while children ranked liking vegetables higher. Findings suggest parents may not be accurate respondents for preschool children's FV liking.

Sugar-sweetened beverage behaviors of Tennessee school children: How do parent- and child-report compare on school days and nonschool days?

INTRODUCTION

This study describes sugar-sweetened beverage (SSB) behaviors of children and compares child-reported SSB behaviors to parent-reported SSB behaviors during school days and nonschool days.

METHOD

Six elementary schools from Tennessee participated with 444 students and 287 parents. Descriptive statistics included means, standard deviation (SD), ranges of values, and measures of central tendency. To explore the relationship between parent and child report, intraclass correlation coefficients (ICC) were analyzed. The mean ( SD) differences and limits of agreement were calculated using paired t tests with Bonferroni corrections for multiple outcomes of interest. A p < 0.05 was significant.

RESULTS

Reporting differed with SSB type of school day. Children reported higher quantities of sweet tea and "coke/soda." Both agreed on SSB abstention, except for juice. ICCs ranged from 0.383 to 0.513 ( p = 0.000). The lowest and highest ICCs were for sweet tea, based on school days or nonschool days.

DISCUSSION

To determine the best estimate of SSBs, information should be obtained from children and parents to improve accuracy and enhance education about health behaviors.

Food Sources of Energy and Nutrients of Public Health Concern and Nutrients to Limit with a Focus on Milk and other Dairy Foods in Children 2 to 18 Years of Age: National Health and Nutrition Examination Survey, 2011⁻2014

Many children are not meeting current nutrient recommendations. The objective of this study was to determine the food sources of energy, nutrients of public health concern, and nutrients to limit with a focus on dairy foods. Twenty-four-hour dietary recall data from children 2–5 (n = 1511), 6–11 (n = 2193), and 12–18 years (n = 2172) participating in NHANES 2011–2014 were analyzed. Energy, fiber, calcium, potassium, vitamin D, added sugars, saturated fatty acids (SFA), and sodium intakes were sample-weighted and ranked on percentage contribution to the diet using specific food group intake and disaggregated data for dairy foods. For children 2–5, 6–11, and 12–18 years, milk, sweet bakery products, and sweetened beverages, respectively were the top food sources of energy, respectively. For calcium, potassium, and vitamin D, milk was the top ranked food source in all age groups. For children 2–5, 6–11, and 12–18 years, milk, sweet bakery products, and pizza, respectively were the top three ranked food sources of SFA; and sugar sweetened beverages and sweet bakery products were to top two food group sources of added sugars. Cured meats/poultry, pizza, and pizza, respectively, were the top ranked food sources of sodium for the three age groups. Identification of food sources of these nutrients can help health professionals implement appropriate dietary recommendations and plan age-appropriate interventions.

Accuracy of Parental Reporting of Preschoolers' Dietary Intake Using an Online Self-Administered 24-h Recall

Parents are typically relied upon to report young children's dietary intake. However, there has been limited research assessing the accuracy of such reports captured using novel dietary assessment tools. The purpose of the current study was to assess the validity of the web-based Automated Self-Administered 24-h Dietary Assessment Tool (ASA24-Canada) for capturing dietary intake among children aged two-five years (n = 40), using parental proxy reporting. The study was conducted in a daycare setting, allowing for standardization of foods and drinks offered and direct observation of intake. Parental-reported intake was compared to true intake for lunch and dinner, as well as an afternoon snack, on a single day. Each eating occasion, including plate waste, was unobtrusively documented. Parents were not present for lunch or the afternoon snack, but joined their children at the daycare centre for the dinner meal. The following day, parents reported their children's intake from the previous 24-h period using ASA24-Canada. For the eating occasions assessed, parents reported exact or close matches for 79.2% (82.3% for lunch, 81.2% for the snack, and 77.4% for dinner) of the foods and beverages truly consumed by children. Estimates of intake for energy and macronutrients examined (carbohydrates, fat, and protein) based on parental reports were higher than those based on true (observed) intake. Our findings suggest that parents are able to report what their preschool children eat and drink relatively accurately. However, the accuracy of portion size estimates is low. Strategies to enhance portion size reporting are needed to improve parental proxy reporting.

Agreement between parent and child report of physical activity, sedentary and dietary behaviours in 9-12-year-old children and associations with children's weight status

BACKGROUND

To date, population based surveys aimed at gaining insight in health related behaviour of children have often used either child self-reports or parent proxy reports. It remains unclear however, if surveys using different sources of information from either parents or children are comparable. In addition, (over)weight status of children can lead to under- and over reporting by parents and children as a result of social desirability bias. We aimed at gaining insight in the level of agreement between parents and child reports regarding aspects of certain dietary, physical activity and sedentary behaviours, and whether there are differences in agreement between parents and child reports in healthy-weight and overweight children.

METHODS

Weighted kappa was used to determine the level of agreement between child and parent reports on health-related behaviour in 1998 parent-child dyads. We also stratified for weight status of the children. Information on children's health related behaviours was obtained by parental and children's questionnaires, and children's height and weight were measured. Associations between children's weight status and children reporting less, reporting more and reporting the same amount of health behaviour as their parents were investigated with multinomial logistic regression analysis.

RESULTS

The Cohen's kappa coefficients ranged from almost perfect agreement for the variable means of transportation, fair for the variables breakfast consumption and frequency of outside play to slight for the variables duration of outside play, frequency and duration of TV/DVD viewing and family dinner. Overweight children were significantly more likely to report less breakfast consumption (OR = 2.6 (95% CI: 1.3 - 5.1)) and lower frequency of outside play than their parents (OR = 1.8 (95% CI: 1.1 - 2.9)).

CONCLUSION

There can be considerable disagreement between the health related behaviours of children as reported by parents or the children themselves. Based on the present study, it cannot be concluded whether parents' or children's reports are more accurate. For future studies, social desirability and recall bias would be best demonstrated in a validation study comparing child and parent self-reports with more objective measures of physical activity and food intake.

The relationship between home- and individual-level diet quality among African American and Hispanic/Latino households with young children

Background

The quality of most Americans’ diets is far from optimal. Given that many Americans consume a significant portion of calories in the home, intervening in this setting could be beneficial. However, the relationship between the home food environment and diet quality is not well understood. This study examined the relationship between diet quality at the individual level with home-level diet quality using an index that measures compliance with federal dietary guidance.

Methods

This was a cross sectional study that enrolled 97 African American and Hispanic/Latino low-income parent-child dyads. Diet quality at the individual level was assessed through two 24-h dietary recalls collected for parents and children, respectively. Diet quality at the home level was assessed with two home food inventories conducted in participants’ homes. Diet quality scores at the home and individual levels were computed by applying the Healthy Eating Index-2010 (HEI-2010) to these data. Linear models adjusted for potential confounding factors were used to examine the relationship between diet quality at the home and individual levels.

Results

Total HEI-2010 scores from parents and children’s diets were positively associated with HEI-2010 scores based on home food inventories (parent diet: β: 0.36, 95% CI: 012–0.60; child diet: 0.38 95% CI: 013–0.62). Positive associations were also observed between individual level and home level subcomponent HEI-2010 scores for total fruit (parent: 0.55 95% CI: 0.16–0.94; child: 0.49 95% CI: 0.03–0.94), whole fruit (parent only: 0.41 95% CI: 0.07–0.74), greens and beans (parent only: 0.39 95% CI: 0.05–0.74), and whole grain (children only: 0.33 95% CI: 0.04–0.63).

Conclusion

This study demonstrated that individual level diet quality was positively associated with home-level diet quality. Findings from this study can help us to address modifiable targets of intervention in the home to improve diet quality.

Associations between sociocultural home environmental factors and vegetable consumption among Norwegian 3-5-year olds: BRA-study

The home environment is the first environment to shape childhood dietary habits and food preferences, hence greater understanding of home environmental factors associated with vegetable consumption among young children is needed. The objective has been to examine questionnaire items developed to measure the sociocultural home environment of children focusing on vegetables and to assess the psychometric properties of the resulting factors. Further, to explore associations between the environmental factors and vegetable consumption among Norwegian 3-5 year olds. Parents (n 633) were invited to participate and filled in a questionnaire assessing the child's vegetable intake and factors potentially influencing this, along with a 24-h recall of their child's fruit and vegetable intake. Children's fruit and vegetable intakes at two meals in one day in the kindergarten were observed by researchers. Principal components analysis was used to examine items assessing the sociocultural home environment. Encouragement items resulted in factors labelled "reactive encouragement", "child involvement" and "reward". Modelling items resulted in the factors labelled "active role model" and "practical role model". Items assessing negative parental attitudes resulted in the factor labelled "negative parental attitudes" and items assessing family pressure/demand resulted in the factor labelled "family demand". The psychometric properties of the factors were for most satisfactory. Linear regression of the associations between vegetable intake and the factors showed, as expected, generally positive associations with "child involvement", "practical role model" and "family demand", and negative associations with "negative parental attitudes" and "reward". Unexpectedly, "reactive encouragement" was negatively associated with vegetable consumption. In conclusion, associations between sociocultural home environmental factors and children's vegetable consumption showed both expected and unexpected associations some of which differed by maternal education - pointing to a need for further comparable studies.

A simple method for identification of misreporting of energy intake from infancy to school age: Results from a longitudinal study

BACKGROUND & AIMS

Misreporting is a major source of reporting bias in nutritional surveys. It can affect the analysis of associations between diet and disease. Although various methods have been proposed to identify misreporting, their application to infants and young children is difficult. We identify misreporting of energy intake in infants and young children and propose a simplified approach.

METHODS

1199 children were enrolled in the Childhood Obesity Programme (CHOP) based in 5 European countries (Belgium, Germany, Italy, Poland and Spain) with repeated measurements of 3-day weighed food protocol and anthropometric indices at 10 time points between ages 1-96 months. Individual cut-offs for the ratio of reported energy intake and estimated energy requirement were calculated to identify misreporters. Misreporting was studied according to age, gender, BMI z-scores and country.

RESULTS

We identified a higher proportion of over-reporters (18.9%) as compared to under-reporters (10.6%). The proportion of over-reporting was higher among infants while under-reporting was more prevalent in school-aged children. Under-reporting was higher in boys (12.0%) and in obese/over-weight children (36.3%). Mean values for upper and lower cut-offs for the ratio of reported energy intake and estimated energy requirement in children ≤12 months were 0.80 and 1.20, and 0.75 and 1.25 for children >12 months, respectively. Using these fixed (mean) values, 90.4% (kappa statistic: 0.78) of all misreporters could be identified.

CONCLUSIONS

Despite intensive measures to obtain habitual intake of children, an essential proportion of nutritional reports were found to be implausible. Both over- and under-reporting should be carefully analysed, even in studies on infants. Fixed cut-offs can be applied to identify misreporting if no individual variation in energy intake can be calculated.

CLINICAL TRIAL REGISTRY

This trial was registered at https://clinicaltrials.gov/show/NCT00338689.

Acute sleep restriction increases dietary intake in preschool-age children

Epidemiological findings suggest short sleep duration is associated with overweight and obesity across the lifespan. In adults, experimental sleep loss increases caloric intake more than total daily energy needs, thus leading to weight gain. To date, little is known about the relationship between sleep restriction and dietary intake in preschool children. Healthy children (n = 10; 41.2 ± 5.4 months; 5 females) followed a strict sleep schedule for 5 days before each experimental condition: 1 day of baseline sleep (nap and scheduled bedtime/wake time) and 1 day of sleep restriction (no-nap and ~2.3 h bedtime delay). Standardized parent-report dietary intake measures were obtained on baseline, sleep restriction and sleep recovery (ad libitum sleep opportunity in the 24-h following sleep restriction) days. As designed, children slept ~3 h less on the sleep restriction than the baseline day (P < 0.001), with no significant differences in sleep between baseline and recovery days (verified with actigraphy). Repeated-measures anovas indicated differences across conditions in total kilocalories, sugar, carbohydrate and fat intake (all P < 0.05; no differences in protein). Post hoc tests revealed that compared with baseline, children consumed 21% more kilocalories, 25% more sugar and 26% more carbohydrates on the day of sleep restriction, as well as 14% more kilocalories and 23% more fat on the day of sleep recovery (all P < 0.05). Findings suggest that acute sleep loss increases dietary intake in preschoolers both on the day of and the day after sleep restriction. Increased kilocalorie intake may promote weight gain over time and be a mechanism through which short sleep contributes to childhood obesity risk.

Associations between physical home environmental factors and vegetable consumption among Norwegian 3–5-year-olds: the BRA-study

Objective

First, to explore item pools developed to measure the physical home environment of pre-school children and assess the psychometric properties of these item pools; second, to explore associations between this environment and vegetable consumption among Norwegian 3–5-year-olds.

Design

Data were collected in three steps: (i) a parental web-based questionnaire assessing the child’s vegetable intake and factors potentially influencing the child’s vegetable consumption; (ii) direct observation of the children’s fruit, berry and vegetable intakes at two meals in one day in the kindergarten; and (iii) a parental web-based 24 h recall.

Setting

The target group for this study was pre-school children born in 2010 and 2011, attending public or private kindergartens in the counties of Vestfold and Buskerud, Norway.

Subjects

A total of 633 children participated.

Results

Principal component analysis on the thirteen-item pool assessing availability/accessibility resulted in two factors labelled ‘availability at home’ and ‘accessibility at home’, while the eight-item pool assessing barriers resulted in two factors labelled ‘serving barriers’ and ‘purchase barriers’. The psychometric properties of these factors were satisfactory. Linear regression of the associations between vegetable intake and the factors showed generally positive associations with ‘availability at home’ and ‘accessibility at home’ and negative associations with ‘serving barriers’.

Conclusions

This age group has so far been understudied and there is a need for comparable studies. Our findings highlight the importance of targeting the physical home environment of pre-school children in future interventions as there are important modifiable factors that both promote and hinder vegetable consumption in this environment.

Nutrient and Food Group Intakes of Manitoba Children and Youth: A Population-Based Analysis by Pulse and Soy Consumption Status

Poor eating habits among children are associated with negative health outcomes. The objective of this study was to use pulse/soy consumption as an indicator to evaluate the eating profile of young Manitobans. Data from the Canadian Community Health Survey Cycle 2.2 were used for analysis and restricted to Manitoba residents aged 2 to 18 years (n = 1840). Consumers were identified as individuals who reported eating at least 1 pulse/soy product during their recall. On any given day, 8.2% of Manitobans reported consumption of pulses/soy. Intakes of fibre, protein, magnesium, and zinc were higher in consumers only when expressed relative to total caloric intake. Consumers also reported increased intakes of meat and alternatives. Total intakes of vitamin D, fibre, and fruit and vegetable consumption were low among all groups. Sodium intakes in both groups were high when compared with levels recommended by health professionals. These results indicate that there are many dietary issues affecting Manitoba children, suggesting the need for more research targeting dietary habits of children and youth, the quality of the food supply, and effective strategies in nutrition education.

Fruit and Vegetable Intakes of Preschool Children Are Associated With Feeding Practices Facilitating Internalization of Extrinsic Motivation

OBJECTIVE

To examine the association between feeding practices and both fruit and vegetable intakes of preschoolers.

DESIGN

Cross-sectional; data collected from 2009 to 2010.

SETTING

Child care centers enrolled in the cohort of the Synergistic Theory and Research on Obesity and Nutrition Group Kids program.

PARTICIPANTS

Three hundred and sixteen mother-child dyads were recruited in the baseline survey as primary caregivers of children aged 2-5 years.

MAIN OUTCOME MEASURES

Ten aspects of maternal feeding practices were measured using a Comprehensive Feeding Practices Questionnaire. The frequency of children's fruit and vegetable consumption was estimated by mothers.

ANALYSIS

Spearman's rank order correlation and linear regression analysis between parental feeding practices and both fruit and vegetable consumption were adjusted for potential confounders. Pearson's correlation coefficients among 10 parental feeding practices were calculated.

RESULTS

Children in the study consumed fruit 1.7 ± 0.9 times per day and vegetables 1.4 ± 0.8 times per day. Feeding practices of building a healthy home food environment and involvement were positively related and those of restriction for health were negatively related to children's vegetable consumption (P < .001); moreover, encouraging balance and variety and monitoring were positively related to children's fruit consumption (P < .001).

CONCLUSIONS AND IMPLICATIONS

The results of this study suggest that both fruit and vegetable intakes of preschool children are more likely to increase if parents employ feeding practices that encourage child autonomy, competence, and relatedness.

Do children report differently from their parents and from observed data? Cross-sectional data on fruit, water, sugar-sweetened beverages and break-time foods

Background

Reliable assessment of children’s dietary behaviour is needed for research purposes. The aim of this study was (1) to investigate the level of agreement between observed and child-reported break-time food items; and (2) to investigate the level of agreement between children’s reports and those of their parents regarding children’s overall consumption of fruit, water and sugar-sweetened beverages (SSB).

Methods

The children in this study were 9–13 years old, attending primary schools in Rotterdam, the Netherlands. Children were observed with respect to foods brought for break-time at school. At the same day, children completed a questionnaire in which they were asked to recall the food(s) they brought to school to consume during break-time. Only paired data (observed and child-reported) were included in the analyses (n = 407 pairs). To determine each child’s daily consumption and average amounts of fruit, water and SSB consumed, children and their parents completed parallel questionnaires. Only paired data (parent-reported and child-reported) were included in the analyses (n = 275 pairs). The main statistical measures were level of agreement between break-time foods, fruit, water and SSB; and Intra-class Correlation Coefficients (ICC).

Results

More children reported bringing sandwiches and snacks for break-time than was observed (73 % vs 51 % observed and 84 % vs 33 % observed). The overall agreement between observed and child-reported break-time foods was poor to fair, with ICC range 0.16–0.39 (p < 0.05). Children reported higher average amounts of SSB consumed than did their parents (1.3 vs 0.9 L SSB, p < 0.001). Child and parent estimations of the child’s water and fruit consumption were similar. ICC between parent and child reports was poor to good (range 0.22–0.62, p < 0.05).

Conclusion

Children report higher on amount of break-time foods as compared to observations and children’s reports of SSB consumption are higher than those of their parents. Since the level of agreement between the observed break-time foods and that reported by children and the agreement of child’s intake between parent and child reports are relatively weak, future studies should focus on improving methods of evaluating children’s consumption behaviour or on ways on how to best use and interpret multiple-source dietary intake data.

Trial registration

Current Controlled Trials NTR3400.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2963-7) contains supplementary material, which is available to authorized users.

Hip-Hop to Health Jr. Randomized Effectiveness Trial: 1-Year Follow-up Results

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.

Dietary intake and food sources of added sugar in the Australian population

Previous studies in Australian children/adolescents and adults examining added sugar (AS) intake were based on now out-of-date national surveys. We aimed to examine the AS and free sugar (FS) intakes and the main food sources of AS among Australians, using plausible dietary data collected by a multiple-pass, 24-h recall, from the 2011–12 Australian Health Survey respondents (n 8202). AS and FS intakes were estimated using a previously published method, and as defined by the WHO, respectively. Food groups contributing to the AS intake were described and compared by age group and sex by one-way ANOVA. Linear regression was used to test for trends across age groups. Usual intake of FS (as percentage energy (%EFS)) was computed using a published method and compared with the WHO cut-off of <10 %EFS. The mean AS intake of the participants was 60·3 (sd 52·6) g/d. Sugar-sweetened beverages accounted for the greatest proportion of the AS intake of the Australian population (21·4 (sd 30·1) %), followed by sugar and sweet spreads (16·3 (sd 24·5) %) and cakes, biscuits, pastries and batter-based products (15·7 (sd 24·4) %). More than half of the study population exceeded the WHO’s cut-off for FS, especially children and adolescents. Overall, 80–90 % of the daily AS intake came from high-sugar energy-dense and/or nutrient-poor foods. To conclude, the majority of Australian adults and children exceed the WHO recommendation for FS intake. Efforts to reduce AS intake should focus on energy-dense and/or nutrient-poor foods.

Prompts to eat novel and familiar fruits and vegetables in families with 1-3 year-old children: Relationships with food acceptance and intake

Toddlers often go through a picky eating phase, which can make it difficult to introduce new foods into the diet. A better understanding of how parents' prompts to eat fruits and vegetables are related to children's intake of these foods will help promote healthy eating habits. 60 families recorded all toddler meals over one day, plus a meal in which parents introduced a novel fruit/vegetable to the child. Videos were coded for parent and child behaviors. Parents completed a feeding style questionnaire and three 24-h dietary recalls about their children's intake. Parents made, on average, 48 prompts for their children to eat more during the main meals in a typical day, mostly of the neutral type. Authoritarian parents made the most prompts, and used pressure the most often. In the novel food situation, it took an average of 2.5 prompts before the child tasted the new food. The most immediately successful prompt for regular meals across food types was modeling. There was a trend for using another food as a reward to work less well than a neutral prompt for encouraging children to try a novel fruit or vegetable. More frequent prompts to eat fruits and vegetables during typical meals were associated with higher overall intake of these food groups. More prompts for children to try a novel vegetable was associated with higher overall vegetable intake, but this pattern was not seen for fruits, suggesting that vegetable variety may be more strongly associated with intake. Children who ate the most vegetables had parents who used more "reasoning" prompts, which may have become an internalized motivation to eat these foods, but this needs to be tested explicitly using longer-term longitudinal studies.

Intake of total and added sugars and nutrient dilution in Australian children and adolescents

This analysis aimed to examine the association between intake of sugars (total or added) and nutrient intake with data from a recent Australian national nutrition survey, the 2007 Australian National Children’s Nutrition and Physical Activity Survey (2007ANCNPAS). Data from participants (n 4140; 51 % male) who provided 2×plausible 24-h recalls were included in the analysis. The values on added sugars for foods were estimated using a previously published ten-step systematic methodology. Reported intakes of nutrients and foods defined in the 2007ANCNPAS were analysed by age- and sex-specific quintiles of %energy from added sugars (%EAS) or %energy from total sugars (%ETS) using ANCOVA. Linear trends across the quintiles were examined using multiple linear regression. Logistic regression analysis was used to calculate the OR of not meeting a specified nutrient reference values for Australia and New Zealand per unit in %EAS or %ETS. Analyses were adjusted for age, sex, BMI z-score and total energy intake. Small but significant negative associations were seen between %EAS and the intakes of most nutrient intakes (all P<0·001). For %ETS the associations with nutrient intakes were inconsistent; even then they were smaller than that for %EAS. In general, higher intakes of added sugars were associated with lower intakes of most nutrient-rich, ‘core’ food groups and higher intakes of energy-dense, nutrient-poor ‘extra’ foods. In conclusion, assessing intakes of added sugars may be a better approach for addressing issues of diet quality compared with intakes of total sugars.

Consumption of apples is associated with a better diet quality and reduced risk of obesity in children: National Health and Nutrition Examination Survey (NHANES) 2003-2010

Background

Most children do not meet the recommendation for fruit consumption. Apples are the second most commonly consumed fruit in the US; however, no studies have examined the association of total apple products, apples, apple sauce, and 100 % apple juice consumption on diet quality and weight/adiposity in children.

Methods

The purpose of this study was to examine the association between various apple consumption forms with diet quality and weight/adiposity in a nationally representative sample of children. Participants were children 2–18 years of age (N = 13,339) from the National Health and Nutrition Examination Survey 2003–2010. Intake was determined using a single interview administered 24-h diet recall. Apple product consumption was determined using the cycle-appropriate USDA Food and Nutrient Database for Dietary Studies food codes. Total diet quality and component scores were determined using the Healthy Eating Index-2010 (HEI). Anthropometrics were determined using standard methods. Covariate adjusted linear and logistic regressions were used to compare apple product consumers with non-consumers; sample weights were used. Probability was set at <0.01.

Results

Approximately 26 % of the population (n = 3,482) consumed some form of apple products. Consumers of apple products, whole apples, apple sauce, and 100 % apple juice had higher HEI scores than non-consumers: 50.4 ± 0.4 v 41.9 ± 0.3, 52.5 ± 0.5 v 42.7 ± 0.3, 52.1 ± 0.8 v 47.2 ± 0.4, and 51.4 ± 0.6 v 46.5 ± 0.4, respectively. Apple products and whole apple consumers had lower BMI z-scores than non-consumers: 0.4 ± 0.04 v 0.5 ± 0.03 and 0.3 ± 0.1 v 0.5 ± 0.02, respectively. Apple products and whole apple consumers were 25 % (0.59–0.95 99^th CI) and 30 % (0.52–0.95 99^th CI), respectively, were less likely to be obese than non-consumers.

Conclusions

Consumption of any form of apples contributed to the fruit recommendation of children and improved diet quality. Apples should be included in the diets of children as a component of an overall healthy diet.

Relative validity and reproducibility of a brief-type self-administered diet history questionnaire for Japanese children aged 3-6 years: application of a questionnaire established for adults in preschool children

Background

Dietary intake assessment and subsequent dietary education or intervention in young children is important in decreasing prevalence of various noncontagious diseases in adulthood. Validation of diet assessment questionnaires for preschool children has just started in Japan. In this study, we rearranged the brief-type self-administered diet history questionnaire (BDHQ), a convenient diet assessment questionnaire that is widely used in a range of situations for adults, for use in children aged 3–6 years (BDHQ3y) and then validated the BDHQ3y in Japanese children.

Methods

The guardians of 61 children aged 3–4 years completed the BDHQ3y twice at an interval of 1 month, along with a 3-nonconsecutive-day diet record (DR) between the two administrations of the BDHQ3y. Dietary intakes for energy and 42 selected nutrients were estimated using both the DR and the BDHQ3y. Mean intakes estimated by the two methods were compared, and correlation coefficients were calculated. Reproducibility of the BDHQ3y estimates was investigated using intra-class correlation coefficients (ICCs).

Results

No significant differences in mean intakes estimated by the DR and the BDHQ3y were observed for one- to two-thirds of energy and examined nutrients. The median of Pearson correlation coefficients between intakes energy-adjusted by the residual method was 0.31 (interquartile range, 0.24 to 0.38). The median ICC was 0.72 (interquartile range, 0.63 to 0.76) for the crude nutrient intakes.

Conclusions

Although the BDHQ3y might be a good candidate for dietary intake assessment in Japanese preschool children, its validity is currently moderate to low. Shortcomings should be overcome by obtaining and utilizing more information about children’s dietary habits.

Validity of the Australian Recommended Food Score as a diet quality index for Pre-schoolers

BACKGROUND

Diet quality tools provide researchers with brief methods to assess the nutrient adequacy of usual dietary intake. This study describes the development and validation of a pediatric diet quality index, the Australian Recommended Food Scores for Pre-schoolers (ARFS-P), for use with children aged two to five years.

METHODS

The ARFS-P was derived from a 120-item food frequency questionnaire, with eight sub-scales, and was scored from zero to 73. Linear regressions were used to estimate the relationship between diet quality score and nutrient intakes, in 142 children (mean age 4 years) in rural localities in New South Wales, Australia.

RESULTS

Total ARFS-P and component scores were highly related to dietary intake of the majority of macronutrients and micronutrients including protein, β-carotene, vitamin C, vitamin A. Total ARFS-P was also positively related to total consumption of nutrient dense foods, such as fruits and vegetables, and negatively related to total consumption of discretionary choices, such as sugar sweetened drinks and packaged snacks.

CONCLUSION

ARFS-P is a valid measure that can be used to characterise nutrient intakes for children aged two to five years. Further research could assess the utility of the ARFS-P for monitoring of usual dietary intake over time or as part of clinical management.

Parental role modeling of fruits and vegetables at meals and snacks is associated with children's adequate consumption

Research has shown that parental role modeling of healthful eating behaviors is positively correlated to children's dietary intake and fruit and vegetable (F&V) preferences. The purpose of this study is to (1) examine associations between parent and child report of parental role modeling of F&V consumption at snacks and dinner and (2) determine whether parental role modeling is associated with children meeting daily F&V recommendations. Parent-child dyads (N = 160) participating in the HOME Plus study completed baseline surveys on parental role modeling of F&V at snacks and dinner. Children also completed 24-hour dietary recalls. Spearman correlations and chi-square/Fisher's exact tests were used to examine relationships between parent and child report of parental role modeling of F&V at snacks and dinner and whether children met daily recommendations. On average, children consumed less than three daily servings of F&V with only 23% consuming the recommended servings. Statistically significant correlations were seen between parent and child report of parental role modeling fruit at dinner and green salad at dinner. Children who reported parental role modeling of vegetables at snack and salad at dinner were significantly more likely, than those who did not, to meet daily F&V recommendations. Parents who reported role modeling fruit at snack were significantly more likely to have children who met daily F&V recommendations. Results indicate that children are aware of their parents' eating behaviors and on occasion report this behavior similarly to their parents. Parents should be encouraged to utilize the opportunity to role model healthful dietary intake, especially at snacks, where consumption of F&V appears low.

Intensively managed young children with type 1 diabetes consume high-fat, low-fiber diets similar to age-matched controls

Despite significant emphasis on nutrition, older children with diabetes demonstrate poor dietary quality. We tested the hypothesis that dietary quality in young children with type 1 diabetes (T1D) would be better than age-matched children in the US population. Dietary data from children with T1D (n = 67) aged 2 to 12 years attending a pediatric diabetes clinic were compared with a nationally representative, age-matched sample from the National Health and Nutrition Examination Survey (NHANES; n = 1691). Multiple 24-hour dietary recalls were used. Recommended intakes were based on national guidelines, and dietary quality was assessed using the Healthy Eating Index-2005. More children with T1D were overweight or obese compared with children participating in NHANES (42% vs 30%, P = .04). Greater proportions of children with T1D met daily recommendations for vegetables (22% vs 13%, P = .03), whole grains (12% vs 5%, P = .005), and dairy (55% vs 36%, P = .001) compared with NHANES children, whereas similar proportions met daily fruit recommendations (40% vs 33%, P = .2). Less than one-third of all children limited total fat to recommended levels; children with T1D consumed more saturated fat than did NHANES children (14% vs 12% total energy intake, P = .0009). Fiber intakes were very low in both groups. Compared with NHANES children, children with T1D had higher Healthy Eating Index-2005 scores (59.6 vs 49.7, P = .0006) primarily because of lower intakes of added sugars. The nutritional intake of young children with T1D remains suboptimal in the contemporary era of diabetes management. Despite focused nutrition management, young children with T1D consume high-fat, low-fiber diets comparable with youth in the general population.

Children's food intake: a comparison of children's and parents' reports

PURPOSE

In longitudinal studies, parents are the most accurate source of information on young children's dietary intake; for older children, questioning children themselves may be more appropriate. However, if parental reports for young children and self-reports of older children are to be used in the same analyses, the measures must be comparable.

METHODS

During school hours, fourth and sixth graders in 14 Flemish (Belgium) primary schools completed an online 15-item food frequency questionnaire with a retest questionnaire one to two weeks later; parents completed a paper-and-pencil or online questionnaire. Test-retest data were available for 286 children; children's tests could be matched to parents' reports for 275 children.

RESULTS

On average, test-retest correlations were 0.68 (grade 4: 0.63; grade 6: 0.71) and correlations between children's and parents' reports were 0.44 (grade 4: 0.39; grade 6: 0.49). No systematic differences were found between the test and retest. Comparison of children's and parents' reports resulted in significant differences for six of the 15 items.

CONCLUSIONS

Low consensus between parents' and children's reports for several items may impede comparisons at a group level. Additionally, the results indicate more optimal dietary assessment in sixth graders.

Let's look at leeks! Picture books increase toddlers' willingness to look at, taste and consume unfamiliar vegetables

Repeatedly looking at picture books about fruits and vegetables with parents enhances young children's visual preferences toward the foods in the book (Houston-Price et al., 2009a) and influences their willingness to taste these foods (Houston-Price et al., 2009b). This article explores whether the effects of picture book exposure are affected by infants' initial familiarity with and liking for the foods presented. In two experiments parents of 19- to 26-month-old toddlers were asked to read a picture book about a liked, disliked or unfamiliar fruit or vegetable with their child every day for 2 weeks. The impact of the intervention on both infants' visual preferences and their eating behavior was determined by the initial status of the target food, with the strongest effects for foods that were initially unfamiliar. Most strikingly, toddlers consumed more of the unfamiliar vegetable they had seen in their picture book than of a matched control vegetable. Results confirm the potential for picture books to play a positive role in encouraging healthy eating in young children.

Validity of self-reported lunch recalls in Swedish school children aged 6-8 years

Background

Previous studies have suggested that young children are inaccurate reporters of dietary intake. The purpose of this study was to validate a single recall of the previous day’s school lunch reported by 6–8 year old Swedish children and to assess teacher-recorded intake of the same meal in a standardized food journal. An additional research question was whether parents could report their child’s intake of the previous day’s lunch. Subjects constituted a convenience sample from the large, multi-country study Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS). Validations of both children’s recalls and teachers’ records were made by comparing results with the duplicate plate reference method.

Findings

Twenty-five children (12 boys/13 girls) aged 6–8 years participated in the validation study at one school in western Sweden. Children were accurate self-reporters of their dietary intake at lunch, with no significant difference between reported and weighed intake (Mean difference (SD): 7(50) kcals, p=0.49). Teachers significantly over-reported intake (Mean difference (SD): 65(79) kcals, p=0.01). For both methods, child-reported and teacher-recorded, correlations with weighed intake were strong (Pearson’s correlations r=0.92, p<0.001 and r=0.83, p<0.001 respectively). Bland-Altman plots showed strong agreement between child-reported and weighed intakes but confirmed systematic differences between teacher-records and weighed intakes. Foods were recalled by children with a food-match rate of 90%. In all cases parents themselves were unable to report on quantities consumed and only four of 25 children had parents with knowledge regarding food items consumed.

Conclusions

Children 6–8 years of age accurately recalled their school lunch intake for one occasion while teachers recorded with less accuracy. Our findings suggest that children as young as six years of age may be better able to report on their dietary intake than previously suggested, at least for one main meal at school. Teacher-recorded intake provides a satisfactory estimate but with greater systematic deviation from the weighed intake. Parents were not able to report on their children’s school lunches consumed on the previous day.

Associations between energy intake, daily food intake and energy density of foods and BMI z-score in 2-9-year-old European children

PURPOSE

The aim of this study was to investigate the associations between proxy-reported energy intake, daily food intake and energy density of foods and body mass index (BMI) z-score in 2-9-year-old European children.

METHODS

From 16,225 children who participated in the identification and prevention of dietary- and lifestyle-induced health effects in children and infants (IDEFICS) baseline examination, 9,782 children with 24-h proxy dietary information and complete covariate information were included in the analysis. Participating children were classified according to adapted Goldberg cutoffs: underreports, plausible energy reports and overreports. Energy intake, daily food intake and energy density of foods excluding noncaloric beverages were calculated for all eating occasions. Effect of energy intake, daily food intake and energy density of foods on BMI z-score was investigated using multilevel regression models in the full sample and subsample of plausible energy reports. Exposure variables were included separately; daily food intake and energy intake were addressed in a combined model to check for interactions.

RESULTS

In the group of plausible energy reports (N = 8,544), energy intake and daily food intake were significantly positively associated with BMI z-score. Energy density of foods was not associated with BMI z-score. In the model including energy intake, food intake and an interaction term, only energy intake showed a significantly positive effect on BMI z-score. In the full sample (N = 9,782), only energy intake was significantly but negatively associated with BMI z-score.

CONCLUSION

Proxy-reporters are subject to misreporting, especially for children in the higher BMI levels. Energy intake is a more important predictor of unhealthy weight development in children than daily food intake.

Formative evaluation of the dietary assessment component of Children's and Adolescents' Nutrition Assessment and Advice on the Web (CANAA-W)

BACKGROUND

The increased availability of computers and the efficiency and user-acceptability of computer-assisted questioning have increased the attractiveness of computer-administered querying for large-scale population nutrition research during the last decade. The Young Adolescents' Nutrition Assessment on Computer (YANA-C), a computer-based 24-h dietary recall, was originally developed to collect dietary data among Belgian-Flemish adolescents. A web-based version was created to collect parentally reported dietary data of preschoolers, called Young Children's Nutrition Assessment on the Web (YCNA-W), which has been improved and adapted for use in young adolescents: Children and Adolescents' Nutrition Assessment and Advice on the Web (CANAA-W). The present study describes recent developments and the formative evaluation of the dietary assessment component.

METHODS

A feasibility questionnaire was completed by 131 children [mean (SD) age: 11.3 (0.7) years] and 53 parents. Eight focus groups were held with children (n = 65) and three with parents (n = 17).

RESULTS

Children (C) and parents (P) found the instrument clear (C: 97%; P: 94%), comprehensible (C: 92%; P: 100%), attractive (C: 84%; P: 85%), fun (C: 93%; P: 83%) and easy to complete (C: 91%; P: 83%). There was ample explanation (C: 95%; P: 94%); the pictures were clear (C: 97%; P: 96%); and most respondents found the food items easy to find (C: 71%, P: 85%). The results helped to refine the lay out and structure of the instrument and the list of food items included.

CONCLUSIONS

Children and parents were enthusiastic. The major challenge will be to convince parents who are less interested in dietary intake and less computer literate to participate in this type of study. Children in this age group (11-12 years) should complete the instrument with assistance from an adult.

Characterizing lunch meals served and consumed by pre-school children in Head Start

OBJECTIVE

To examine the variability of food portions served and consumed by African-American and Hispanic-American pre-school children attending Head Start.

DESIGN

Cross-sectional.

SETTING

Food consumption by pre-schoolers (n 796) enrolled in sixteen Head Start centres in Houston, Texas (51 % boys, 42 % African-American, mean age 4 years) were assessed during 3 d of lunch meals using digital photography. Descriptive statistics and multilevel regression models, adjusting for classroom and school clustering effects, were determined.

SUBJECTS

Head Start pre-schoolers aged 3–5 years.

RESULTS

Mean amount served was 2428 kJ (580 kcal) and 572 g. Mean intake was 1421 kJ (339 kcal) and 331 g: 20 % protein, 46 % carbohydrate and 34 % fat. Plate waste was 43 % (range: 38 % (fruit) to 61 % (vegetables)). Mean CV of food served was 29 %: 33 % for entrées, 44 % for vegetables, 60 % for fruit and 76 % for starches. Mean CV of food consumed was 46 %: 58 % for entrées, 86 % for fruit, 96 % for vegetables and 111 % for starches. Total gram amount of food served was positively correlated with consumption (r = 0·43, P < 0·001).

CONCLUSIONS

Plate waste and variation in amounts served and consumed were substantial; amounts served were associated with amounts consumed. Large portion sizes may contribute to paediatric obesity by promoting excessive intake at meals. Understanding factors influencing portion sizes provides insight about specific intervention strategies that can be used in obesity prevention programmes.

Assessing diets of 3-year-old children: evaluation of an FFQ

OBJECTIVE

To evaluate the use of an administered eighty-item FFQ to assess nutrient intake and diet quality in 3-year-old children.

DESIGN

Frequency of consumption and portion size of the foods listed on the FFQ during the 3 months preceding the interview were reported by the child's main caregiver; after the interview a 2 d prospective food diary (FD) was completed on behalf of the child. Nutrient intakes from the FFQ and FD were estimated using UK food composition data. Diet quality was assessed from the FFQ and FD according to the child's scores for a principal component analysis-defined dietary pattern ('prudent' pattern), characterised by high consumption of fruit, vegetables, water and wholemeal cereals.

SETTING

Southampton, UK.

SUBJECTS

Children (n 892) aged 3 years in the Southampton Women's Survey.

RESULTS

Intakes of all nutrients assessed by the FFQ were higher than FD estimates, but there was reasonable agreement in terms of ranking of children (range of Spearman rank correlations for energy-adjusted nutrient intakes, r s = 0·41 to 0·59). Prudent diet scores estimated from the FFQ and FD were highly correlated (r = 0·72). Some family and child characteristics appeared to influence the ability of the FFQ to rank children, most notably the number of child's meals eaten away from home.

CONCLUSIONS

The FFQ provides useful information to allow ranking of children at this age with respect to nutrient intake and quality of diet, but may overestimate absolute intakes. Dietary studies of young children need to consider family and child characteristics that may impact on reporting error associated with an FFQ.

The Healthy Children, Strong Families intervention: design and community participation

Healthy Children, Strong Families (HCSF) is a 2-year, community-driven, family-based randomized controlled trial of a healthy lifestyles intervention conducted in partnership with four Wisconsin American Indian tribes. HCSF is composed of 1 year of targeted home visits to deliver nutritional and physical activity curricula. During Year 1, trained community mentors work with 2-5-year-old American Indian children and their primary caregivers to promote goal-based behavior change. During Year 2, intervention families receive monthly newsletters and attend monthly group meetings to participate in activities designed to reinforce and sustain changes made in Year 1. Control families receive only curricula materials during Year 1 and monthly newsletters during Year 2. Each of the two arms of the study comprises 60 families. Primary outcomes are decreased child body mass index (BMI) z-score and decreased primary caregiver BMI. Secondary outcomes include: increased fruit/vegetable consumption, decreased TV viewing, increased physical activity, decreased soda/sweetened drink consumption, improved primary caregiver biochemical indices, and increased primary caregiver self-efficacy to adopt healthy behaviors. Using community-based participatory research and our history of university-tribal partnerships, the community and academic researchers jointly designed this randomized trial. This article describes the study design and data collection strategies, including outcome measures, with emphasis on the communities' input in all aspects of the research.

Food sources of energy and nutrients among children in the United States: National Health and Nutrition Examination Survey 2003–2006

BACKGROUND

Recent detailed analyses of data on dietary sources of energy and nutrients in US children are lacking. The objective of this study was to identify food sources of energy and 28 nutrients for children in the United States.

METHODS

Analyses of food sources were conducted using a single 24-h recall collected from children 2 to 18 years old (n = 7332) in the 2003-2006 National Health and Nutrition Examination Survey. Sources of nutrients contained in foods were determined using nutrient composition databases. Food grouping included ingredients from disaggregated mixtures. Mean energy and nutrient intakes from the total diet and from each food group were adjusted for the sample design using appropriate weights. Percentages of the total dietary intake that food sources contributed were tabulated by rank order.

RESULTS

The two top ranked food/food group sources of energy and nutrients were: energy - milk (7% of energy) and cake/cookies/quick bread/pastry/pie (7%); protein - milk (13.2%) and poultry (12.8%); total carbohydrate - soft drinks/soda (10.5%) and yeast bread/rolls (9.1%); total sugars - soft drinks/soda (19.2%) and yeast breads and rolls (12.7%); added sugars - soft drinks/soda (29.7%) and candy/sugar/sugary foods (18.6%); dietary fiber - fruit (10.4%) and yeast bread/rolls (10.3%); total fat - cheese (9.3%) and crackers/popcorn/pretzels/chips (8.4%); saturated fatty acids - cheese (16.3%) and milk (13.3%); cholesterol - eggs (24.2%) and poultry (13.2%); vitamin D - milk (60.4%) and milk drinks (8.3%); calcium - milk (33.2%) and cheese (19.4%); potassium - milk (18.8%) and fruit juice (8.0%); and sodium - salt (18.5%) and yeast bread and rolls (8.4%).

CONCLUSIONS

Results suggest that many foods/food groupings consumed by children were energy dense, nutrient poor. Awareness of dietary sources of energy and nutrients can help health professionals design effective strategies to reduce energy consumption and increase the nutrient density of children's diets.

Accuracy and reliability of direct observations of home-packed lunches in elementary schools by trained nutrition students

Increased attention has been directed toward the school food environment because children consume important contributions toward their daily food intake while at school. In Canada, most elementary school students bring a lunch to school and there are minimal data on the composition and consumption of these lunches. Dietary assessment of home-packed lunches is challenging compared with assessment of standardized school meals due to greater diversity of items, nonstandard portions, and opaque containers. We assessed accuracy and reliability of a food observation method whereby upper-year nutrition students (n=15) were trained to assess packed lunch contents and intake in elementary schools. Accuracy and reliability was assessed during 2010-2011 in three observational phases: sample lunches, volunteer-consumed lunches, and elementary school students' lunches (n=32). Observers accurately identified 96% and 95% of items in the sample and volunteer lunches, respectively. Similarly, they accurately reported portion sizes for 86% and 94% of the items in the sample and volunteer lunches, thus showing improvements in successive phases. Interobserver reliability for amount consumed, by portion size and macronutrient content, ranged from 0.79 to 0.88 in the volunteer-consumed lunches and 0.78 to 0.86 in the students' lunches, with a majority ≥0.80. It is noteworthy that the analyses for the amount consumed were conducted as absolute amounts with no allowances for discrepancies, which differs from other interobserver reliability assessments where as much as 25% discrepancy is considered agreement. Observers with prior nutrition knowledge assessed packed lunch contents and intake accurately and reliably by direct observation in an elementary school setting.

Characterizing dinner meals served and consumed by low-income preschool children

BACKGROUND

A dinner meal is consumed by approximately 95% of preschool children, yet few studies have characterized the dinner meal within a broader environmental context. The primary goal of this study was to identify the average quantities of foods served and consumed at the dinner meal by preschool children. A secondary goal was to look at factors that influenced the total amounts of food and energy consumed among preschoolers at the dinner meal.

METHOD

Food intake at a family dinner meal was measured using digital photography in African-American and Hispanic-American preschool children (n = 231). Pictorial records were converted to gram and energy estimates of food served and consumed; grams were converted to kilocalories for each food using Nutrition Data System for Research (NDSR) nutritional software. Foods were categorized by groups/subgroups. Comparison of means and coefficient of variation was examined overall and by food groups for food grams (and energy) served, consumed, and wasted. The relationship of mother/child characteristics to amounts served and consumed were analyzed by regression and analysis of variance (ANOVA).

RESULTS

Plate waste was high; 30% of the foods served to the child at the dinner meal were not consumed. The amounts of food and beverage served and consumed varied within and among the food groups studied. The proportion of children served a major food group at the dinner meal varied considerably: 44% fruit/juice, 97% vegetables, 99% grains, 97% meats, 74% dairy, 66% sweetened beverages, 92% fat and oils, and 40% sweets and sugars. The amount of food served was positively associated with the amount consumed (p < 0.0001). Energy density of the dinner meal was positively associated with energy intake consumed (p < 0.0001).

CONCLUSIONS

Plate waste and variation in amounts served and consumed was substantial. The amount of food served was positively associated with the amount of food consumed by preschool children.

Influence of stress in parents on child obesity and related behaviors

OBJECTIVE

To assess associations of the number of parent stressors and parent-perceived stress with obesity and related behaviors in their children.

METHODS

This cross-sectional analysis used data from the 2006 Southeastern Pennsylvania Household Health Survey in which 2119 parents/caregivers answered questions about themselves and their children (ages 3-17 years). Survey data were used to assess the main exposure variables: the number of stressors (measured using a stressor index) and parent-perceived stress (the response to a general stress question); child covariates (age, race/ethnicity, health quality, and gender); adult covariates (education, BMI, gender, poor sleep quality) and study outcomes (child obesity, fast-food consumption, fruit and vegetable consumption, and physical activity). To account for developmental differences, analyses were also stratified by age group (3-5, 6-8, 9-12, and 13-17 years). Analyses used multiple logistic regression, with results expressed as odds ratios and 95% confidence intervals.

RESULTS

The number of parent stressors was related to child obesity in unadjusted (1.12, 1.03-1.22, P = .007) and adjusted models (1.12, 1.03-1.23, P = .010). Parent-perceived stress was related to fast-food consumption in unadjusted (1.07, 1.03-1.10, P < .001) and adjusted (1.06, 1.02-1.10, P < .001) models.

CONCLUSIONS

The number of parent stressors was directly related to child obesity. Parent-perceived stress was directly related to child fast-food consumption, an important behavioral indicator of obesity risk. Clinical care models and future research that address child obesity should explore the potential benefits of addressing parent stressors and parent-perceived stress.

Validity and feasibility of a digital diet estimation method for use with preschool children: a pilot study

OBJECTIVE

The goal of the study was to assess the validity and feasibility of a digital diet estimation method for use with preschool children in Head Start.

METHODS

Preschool children and their caregivers participated in validation (n = 22) and feasibility (n=24) pilot studies. Validity was determined in the metabolic research unit using actual gram weight measurements as the reference method. Feasibility of using the digital diet estimation method was determined in Head Start and in the home by assessing 3 separate lunch and dinner meals.

RESULTS

The average correlation between estimated weights and actual weights was 0.96 (P < .001), and the average mean difference was 10.6 g. The digital diet estimates were 5% lower than the actual weights.

CONCLUSIONS AND IMPLICATIONS

The digital diet estimation method may be a valid and feasible method for assessing food intake of preschool children.

Prevalence and determinants of misreporting among European children in proxy-reported 24 h dietary recalls

Dietary assessment is strongly affected by misreporting (both under- and over-reporting), which results in measurement error. Knowledge about misreporting is essential to correctly interpret potentially biased associations between diet and health outcomes. In young children, dietary data mainly rely on proxy respondents but little is known about determinants of misreporting here. The present analysis was conducted within the framework of the multi-centre IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study and is based on 6101 children aged 2-9 years with 24 h dietary recall (24-HDR) and complete covariate information. Adapted Goldberg cut-offs were applied to classify the 24-HDR as 'over-report', 'plausible report' or 'under-report'. Backward elimination in the course of multi-level logistic regression analyses was conducted to identify factors significantly related to under- and over-reporting. Next to characteristics of the children and parents, social factors and parental concerns/perceptions concerning their child's weight status were considered. Further selective misreporting was addressed, investigating food group intakes commonly perceived as more or less socially desirable. Proportions of under-, plausible and over-reports were 8.0, 88.6 and 3.4 %, respectively. The risk of under-reporting increased with age (OR 1.19, 95 % CI 1.05, 1.83), BMI z-score of the child (OR 1.23, 95 % CI 1.10, 1.37) and household size (OR 1.12, 95 % CI 1.01, 1.25), and was higher in low/medium income groups (OR 1.45, 95 % CI 1.13, 1.86). Over-reporting was negatively associated with BMI z-scores of the child (OR 0.78, 95 % CI 0.69, 0.88) and higher in girls (OR 1.70, 95 % CI 1.27, 2.28). Further social desirability and parental concerns/perceptions seemed to influence the reporting behaviour. Future studies should involve these determinants of misreporting when investigating diet-disease relationships in children to correct for the differential reporting bias.

Reliability and validity of child/adolescent food frequency questionnaires that assess foods and/or food groups

OBJECTIVE

Summarize the validity and reliability of child/adolescent food frequency questionnaires (FFQs) that assess food and/or food groups.

METHODS

We performed a systematic review of child/adolescent (6-18 years) FFQ studies published between January 2001 and December 2010 using MEDLINE, Cochrane Library, PsycINFO, and Google Scholar. Main inclusion criteria were peer reviewed, written in English, and reported reliability or validity of questionnaires that assessed intake of food/food groups. Studies were excluded that focused on diseased people or used a combined dietary assessment method. Two authors independently selected the articles and extracted questionnaire characteristics such as number of items, portion size information, time span, category intake frequencies, and method of administration. Validity and reliability coefficients were extracted and reported for food categories and averaged across food categories for each study.

RESULTS

Twenty-one studies were selected from 873, 18 included validity data, and 14 included test-retest reliability data. Publications were from the United States, Europe, Africa, Brazil, and the south Pacific. Validity correlations ranged from 0.01 to 0.80, and reliability correlations ranged from 0.05 to 0.88. The highest average validity correlations were obtained when the questionnaire did not assess portion size, measured a shorter time span (ie, previous day/week), was of medium length (ie, ≈ 20-60 items), and was not administered to the child's parents.

CONCLUSIONS

There are design and administration features of child/adolescent FFQs that should be considered to obtain reliable and valid estimates of dietary intake in this population.

[Physical activity and obesity]

One reason for the high prevalence of overweight and obesity might be the differences in lifestyle compared to earlier decades, called the "obesogenic environment." With this, the decline in physical activity (PA) in favor of a sedentary lifestyle is assumed to play an important role. Physical activity or inactivity has a major impact on the development of overweight and obesity as well as on certain metabolic disorders. This review summarizes current scientific knowledge regarding the association between PA and overweight/obesity. The term "physical activity" is defined and different methods of its assessment are introduced. In addition, certain methods for the evaluation/operationalization of collected PA data are described. Finally, some epidemiological studies dealing with the associations between PA and overweight/obesity in children/adolescents as well as in adults are presented.