A Food Variety Index for Toddlers (VIT): development and application

Dietary Intake, Diet Diversity, and Weight Status of Children With Food Allergy

BACKGROUND

Adoption of allergen avoidance diets may increase the risk of nutritional deficiencies and affect growth in children with food allergy (FA). How these dietary restrictions have an impact on diet diversity, a health-promoting eating behavior, remains unclear.

OBJECTIVE

To evaluate diet diversity, dietary intake, and weight status of children with FA.

DESIGN

Observational study.

PARTICIPANTS/SETTING

One hundred children with immunoglobulin E (IgE)-mediated milk, egg, or nut FA or multiple FAs and 60 children with perennial respiratory allergies (RA) matched as controls, aged 3 to 18 years, were consecutively recruited into the study.

MAIN OUTCOME MEASURES

Dietary intake and diet diversity (number of different foods consumed/day) were assessed through 4 24-hour recalls. Weight status (underweight, healthy weight, overweight, or obesity) was also evaluated.

STATISTICAL ANALYSES PERFORMED

Chi-squared test and 2-sample independent t test were used to test differences between groups. Adjustment for sex, age, and energy intake was made using linear regression.

RESULTS

The percentage of underweight was higher in children with FA (19.6%) compared with children in the control group (5.1%). Children with FA compared with children in the control group consumed more servings of meat (1.7, 95% CI, 1.6, 1.9 vs. 1.5, 95% CI, 1.3, 1.7 servings/day [Padj = 0.031]). No difference was observed in the diet diversity between the 2 groups (11-12 different foods/day). Within the FA group, children with allergy to milk proteins had lower energy intake from protein, lower intake of calcium, lower consumption of commercially prepared sweets, and higher consumption of eggs, compared with children with nut or egg allergy, but no difference in diet diversity was observed.

CONCLUSIONS

Diet diversity did not differ between children with FA and children with no FA, despite some differences in the intake from specific food groups. However, the higher percentage of underweight in children with FA suggests the need for targeted nutrition intervention as early as possible after FA diagnosis.

Methodological Aspects of Diet Quality Indicators in Childhood: A Mapping Review

Diet quality indicators (DQIns) are tools that aim to assess an individual's overall diet quality. Previous reviews focused mainly on health-related outcomes but did not provide detailed information about components, assessment variables, or important methodological issues for the development and application of DQIns in the pediatric age. The current mapping review aims to provide comprehensive guidance regarding DQIns developed through a priori methodology in children aged ≤14 y that have been applied worldwide. A mapping review was conducted, whereby 1665 original articles describing the development, modifications, and updates of DQIns, published up to June 26, 2020, in English and Spanish, were retrieved. A total of 139 articles were identified and classified into 13 subgroups. There were 10 overall DQIns: Healthy Eating Indexes (n = 25), Dietary Diversity Scores (n = 20), Diet Quality Indexes (n = 16), Food Variety Scores (n = 11), Healthy and Unhealthy Scores (n = 11), Feeding and Eating Indexes (n = 10), Diet Quality Scores (n = 5), Nutritional Adequacy and Micronutrients Indexes (n = 5), Dietary Guidelines Indexes (n = 5), and Other Healthy Diet Indexes (n = 13). Three additional subgroups of dietary and lifestyle indicators found were Mediterranean Diet Indexes (n = 10), Diet-Lifestyle Indexes (n = 5), and Breakfast Quality Indexes (n = 3). This compilation of DQIns will help researchers select the most appropriate tool for future epidemiological studies by considering a careful selection of information about the assessment components, scoring methods, and key methodological issues. The main limitations of this review are that, due to its nature, a risk-of-bias assessment was not performed and the article screening was completed in 2 databases (PubMed/MEDLINE and Scopus). More research is needed to identify health-related outcomes associated with DQIns in the pediatric population, using clearer and more standardized methodological criteria.

Multiple indicators of household dietary diversity in rural China: Effects of income and dietary knowledge

OBJECTIVE

The aim of this study was to examine the association among family income, dietary knowledge, their interaction, and the multiple household dietary diversity indices (HDDIs), including dietary diversity score (DDS), entropy index (EI), Shannon equitability index (SEI), Herfindahl index (HI), and Simpson index (SI).

METHODS

Based on 24-h dietary recall data collected from 1076 rural households in three provinces of Central China, we calculated HDDIs and compared them according to different levels of income and dietary knowledge. A set of multivariate linear regression were further established and estimated to examine the association among family income, dietary knowledge, and household dietary diversity.

RESULTS

Although the calculation formulas are different, the distributions of the five diversity indices, namely, DDS, EI, SEI, HI, and SI are similar. Family income and dietary knowledge were significantly and positively correlated with various HDDIs (P < 0.01) in addition to HI. Specifically, with a 1-unit (10 000 yuan [US $1545]) income increase, the DDIs respectively changed by 1.70% (DDS), 1.23% (EI), 0.92% (SEI), -0.62% (HI, reverse), and 0.45% (SI). With a 1-point dietary knowledge score increase, the DDIs changed by 0.91% (DDS), 1.33% (EI), 1.29% (SEI), -1.19% (HI, reverse), and 0.81% (SI). The interaction effect of income and dietary knowledge on HDDIs were significantly and negatively correlated with various HDDIs (P < 0.05) in addition to HI.

CONCLUSIONS

The present findings indicated that with an increase in income and dietary knowledge, rural residents in China would consume more diversified foods. There was a substitution effect of family income and dietary knowledge on HDDIs; that is, with an increase in family income, the effect of dietary knowledge on HDDIs would decrease. The findings of this study contributed to a better understanding of issues related to the dietary diversity of rural residents in China in the context of rising income and residents' increasing dietary knowledge.

Diet quality indices and their associations with health-related outcomes in children and adolescents: an updated systematic review

BACKGROUND

To describe a-priori diet quality indices used in children and adolescents, appraise the validity and reliability of these indices, and synthesise evidence on the relationship between diet quality and physical and mental health, and growth-related outcomes.

METHODS

Five electronic databases were searched until January 2019. An a-priori diet quality index was included if it applied a scoring structure to rate child or adolescent (aged 0-18-years) dietary intakes relative to dietary or nutrient guidelines. Diagnostic accuracy studies and prospective cohort studies reporting health outcomes were appraised using the Academy of Nutrition and Dietetics Quality Criteria Checklist.

RESULTS

From 15,577 records screened, 128 unique paediatric diet quality indices were identified from 33 countries. Half of the indices' scores rated both food and nutrient intakes (n = 65 indices). Some indices were age specific: infant (< 24-months; n = 8 indices), child (2-12-years; n = 16), adolescent (13-18 years; n = 8), and child/adolescent (n = 14). Thirty-seven indices evaluated for validity and/or reliability. Eleven of the 15 indices which investigated associations with prospective health outcomes reported significant results, such as improved IQ, quality of life, blood pressure, body composition, and prevalence of metabolic syndrome.

CONCLUSIONS

Research utilising diet quality indices in paediatric populations is rapidly expanding internationally. However, few indices have been evaluated for validity, reliability, or association with health outcomes. Further research is needed to determine the validity, reliability, and association with health of frequently utilised diet quality indices to ensure data generated by an index is useful, applicable, and relevant.

REGISTRATION

PROSPERO number: CRD42018107630 .

Environmental Forces that Shape Early Development: What We Know and Still Need to Know

Understanding health requires more than knowledge of the genome. Environmental factors regulate gene function through epigenetics. Collectively, environmental exposures have been called the "exposome." Caregivers are instrumental in shaping exposures in a child's initial years. Maternal dietary patterns, physical activity, degree of weight gain, and body composition while pregnant will influence not only fetal growth, but also the infant's metabolic response to nutrients and energy. Maternal over- or underweight, excess caloric intake, nutrient imbalances, glucose dysregulation, and presence of chronic inflammatory states have been shown to establish risk for many later chronic diseases. During the period from birth to age 3 y, when the infant's metabolic rate is high and synaptogenesis and myelination of the brain are occurring extremely rapidly, the infant is especially prone to damaging effects from nutrient imbalances. During this period, the infant changes from a purely milk-based diet to one including a wide variety of foods. The process, timing, quality, and ultimate dietary pattern acquired are a direct outcome of the caregiver-infant feeding relationship, with potentially lifelong consequences. More research on how meal time interactions shape food acceptance is needed to avoid eating patterns that augment existing disease risk. Traditional clinical trials in nutrition, meant to isolate single factors for study, are inadequate to study the highly interconnected realm of environment-gene interactions in early life. Novel technologies are being used to gather broad exposure data on disparate populations, employing pioneering statistical approaches and correlations applied specifically to the individual, based on their genetic make-up and unique environmental experiences.

Tracking diet variety in childhood and its association with eating behaviours related to appetite: The generation XXI birth cohort

Research on the influence of early eating habits on eating behaviours related to appetite using a prospective approach is scarce, especially in children. The aim of this study was to explore the relationship between changes in diet variety from 4 to 7 years of age and appetitive traits measured at 7 years of age. Participants are from the population-based birth cohort Generation XXI (2005-2006). The present analysis included 4537 children with complete data on a food frequency questionnaire (FFQ) at both ages, and on the Children's Eating Behaviour Questionnaire at 7y. A healthy diet variety index (HDVI) was calculated at both ages using data from the FFQ. To assess tracking of diet variety, tertiles of HDVI scores were calculated and then re-categorized as 'maintain: low', 'maintain: high', 'increase' and 'decrease'. Although the HDVI score decreased from 4 to 7y (p < .001), it showed a high stability, a positive predictive value, and a fair agreement. Increasing diet variety, compared to maintaining a low variety, was inversely associated with the 'Desire to Drink' (β = -0.090, 95%CI: 0.174; -0.006) and 'Satiety Responsiveness' (β = -0.119, 95%CI: 0.184; -0.054) subdimensions and positively with 'Enjoyment of Food' (β = 0.098, 95%CI: 0.023; 0.172) and 'Emotional Overeating' (β = 0.073, 95%CI: 0.006; 0.139). Those classified as either increase or maintain a high diet variety, in comparison with maintaining a low variety, had lower scores of 'Food Fussiness'. In conclusion, diet variety decreased from 4 to 7y with a fair tracking. Children with a higher diet variety were less fussy, had a lower desire to drink and a higher general interest in food.

The effect of early feeding practices on growth indices and obesity at preschool children from four European countries and UK schoolchildren and adolescents

Not only healthy growth but also childhood obesity partly originate from early life. The current work aimed to examine the association of feeding practices during infancy with growth and adiposity indices in preschool children from four European countries and in UK schoolchildren and adolescents. Existing data from four European birth cohorts (ALSPAC-UK, EDEN-France, EuroPrevall-Greece and Generation XXI-Portugal) were used. Anthropometrics and body composition indices were collected. Parallel multivariate regression analyses were performed to examine the research hypothesis. Overall, the analyses showed that breastfeeding and timing of complementary feeding were not consistently associated with height z-score, overweight/obesity, and body fat mass in children or adolescents. However, breastfeeding duration for less than 6 months was associated with lower height z-scores in 5-year-old French children (P < 0.001) but with higher height z-scores in 4-year-old UK children (P = 0.006). Furthermore, introduction of complementary foods earlier than 4 months of age was positively associated with fat mass levels in 5-year-old French children (P = 0.026).

CONCLUSION

Early feeding practices, i.e., any breastfeeding duration and age of introduction of complementary foods, do not appear to be consistently associated with height z-score, overweight/obesity, and body fat mass in preschool children from four European countries and in UK schoolchildren and adolescents. What is known? • Healthy growth and childhood obesity partly originate from early life. What is new? • Breastfeeding duration less than 6 months was associated with lower height z-scores in 5-year-old French children, while the opposite was observed in 4-year-old British children. • Introduction of complementary foods earlier than 4 months was positively associated with fat mass levels in 5-year-old French children, but not in the other three countries. • Early feeding practices did not appear to be consistently associated with growth and adiposity indices, and as such, no clear influence can be observed.

Nutritional aspects of commercially prepared infant foods in developed countries: a narrative review

Nutritional intake during infancy is a critical aspect of child development and health that is of significant public health concern. Although there is extensive research on breast-feeding and timing of solid food introduction, there is less evidence on types of solid foods fed to infants, specifically commercially prepared infant foods. The consumption of commercially prepared infant foods is very prevalent in many developed countries, exceeding the consumption of homemade foods in some situations. Although these food products may have practical advantages, there are concerns about their nutritional composition, sweet taste, bioavailability of micronutrients, diversity of ingredients and long-term health effects. The extent that the manufacturing, fortification and promotion of these products are regulated by legislation varies between countries and regions. The aim of the present narrative review is to investigate, appraise and summarise these aspects. Overall there are very few studies directly comparing homemade and commercial infant foods and a lack of longitudinal studies to draw firm conclusions on whether commercial infant foods are mostly beneficial or unfavourable to infant health.

Dietary variety and food group consumption in children consuming a cows' milk exclusion diet

BACKGROUND

Dietary variety is defined as the number of different foods or food groups consumed over a given reference period, the consensus being that dietary variety and dietary quality are positively correlated. Recently there has been considerable interest in the association between infant dietary variety and atopic disease.

METHODS

This was a cross-sectional study of 8- to 27-month-old children from the Isle of Wight, UK, including two groups: a group of children consuming a cows' milk exclusion (CME) diet and a control group of children consuming an unrestricted diet. Parents completed a validated food frequency questionnaire, from which dietary variety and consumption of food groups were calculated. Growth measurements were recorded.

RESULTS

A total of 126 participants of mean age 13.0 months were recruited. In addition to the expected differences in dairy and soya consumption, the CME group consumed sweet foods 1.6 times less frequently, non-water drinks seven times less frequently (p < 0.05) and ready-made baby foods 15 times more frequently (p < 0.01) than the control group. Overall dietary variety was significantly lower in the CME group (p < 0.01) as was variety of meat and sweet foods consumed. There was a greater concern with healthy eating in the CME group (p < 0.05).

CONCLUSIONS

Children consuming an exclusion diet for cows' milk allergy have an overall less varied diet, including a less varied consumption of meat and sweet foods. Efforts should be made to ensure exclusion diets are as varied as possible to optimize nutritional intake.

Higher dietary diversity is related to better visual and auditory sustained attention

Attention is a complex cognitive function that is necessary for learning, for following social norms of behaviour and for effective performance of responsibilities and duties. It is especially important in sensitive occupations requiring sustained attention. Improvement of dietary diversity (DD) is recognised as an important factor in health promotion, but its association with sustained attention is unknown. The aim of this study was to determine the association between auditory and visual sustained attention and DD. A cross-sectional study was carried out on 400 women aged 20-50 years who attended sports clubs at Tehran Municipality. Sustained attention was evaluated on the basis of the Integrated Visual and Auditory Continuous Performance Test using Integrated Visual and Auditory software. A single 24-h dietary recall questionnaire was used for DD assessment. Dietary diversity scores (DDS) were determined using the FAO guidelines. The mean visual and auditory sustained attention scores were 40·2 (sd 35·2) and 42·5 (sd 38), respectively. The mean DDS was 4·7 (sd 1·5). After adjusting for age, education years, physical activity, energy intake and BMI, mean visual and auditory sustained attention showed a significant increase as the quartiles of DDS increased (P=0·001). In addition, the mean subscales of attention, including auditory consistency and vigilance, visual persistence, visual and auditory focus, speed, comprehension and full attention, increased significantly with increasing DDS (P<0·05). In conclusion, higher DDS is associated with better visual and auditory sustained attention.

Development of a Dietary Index to Assess Overall Diet Quality for Chinese School-Aged Children: The Chinese Children Dietary Index

BACKGROUND

A composite measure of diet quality is preferable to an index of nutrients, food groups, or health-promoting behaviors in dietary assessment. However, to date, such a tool for Chinese children is lacking.

OBJECTIVE

Based on the current Chinese Dietary Guidelines and Dietary Reference Intakes, a dietary index for Chinese school-aged children, the Chinese Children Dietary Index was developed to assess overall diet quality among children in South China.

DESIGN

Dietary data were recorded using 24-hour recalls among 1,719 children aged 7 to 15 years between March and June 2013. Inactivity data and sociodemographic information were also collected. The Chinese Children Dietary Index included 16 components, which incorporated nutrients, foods/food groups, and health-promoting behaviors. The range of possible Chinese Children Dietary Index scores was 0 to 160, with a higher score indicating better diet quality.

STATISTICAL ANALYSIS PERFORMED

Pearson/Spearman correlation was used to assess relative validity using correlations between total Chinese Children Dietary Index score and age, body mass index (BMI; calculated as kg/m(2)), inactivity, whole-grain intake, frequency of fried-foods intake, nutrient adequacy ratios for energy intake and 12 nutrients not included in the Chinese Children Dietary Index, and the mean adequacy ratio. Finally, a stepwise multiple regression analysis was performed to indicate the factors correlated with Chinese Children Dietary Index.

RESULTS

Mean Chinese Children Dietary Index score of this sample was 88.1 points (range=34.2 to 137.8), the Chinese Children Dietary Index score of girls was higher than that of boys and decreased with higher age. Children with higher Chinese Children Dietary Index had lower body mass index and spent less time being inactive. Positive associations were observed between Chinese Children Dietary Index and the majority of nutrient adequacy ratios and the mean adequacy ratio. Age, paternal educational level, and family size were correlated with Chinese Children Dietary Index.

CONCLUSIONS

The Chinese Children Dietary Index successfully differentiated diets and, therefore, it can be used to rank-order overall diet quality among Chinese children. As the results showed, diet quality among Chinese children needs to be improved, especially in adolescents.

Early problematic eating behaviours are associated with lower fruit and vegetable intake and less dietary variety at 4–5 years of age. A prospective analysis of three European birth cohorts

Problematic eating behaviours during early childhood could be mediators of poor dietary habits. This study aims to prospectively relate early eating behaviours with fruit and vegetable (F&V) intake and a healthy diet variety score of children aged between 4 and 5 years. Eating behaviours were assessed in three European birth cohorts (Generation XXI from Portugal, ALSPAC from the UK and EDEN from France) at 4–6, 12–15, 24 and 48–54 months of age, based on the child’s feeding difficulties, mother’s perception of child’s poor eating (eating small quantities at each meal, not eating enough or needing to be stimulated to eat), food refusal and difficulties in the establishment of daily food routines. Daily servings of F&V (>1 v. ≤1 serving/d, except in Generation XXI: >3 v. ≤3) and the Healthy Plate Variety Score (categorised by the median score of each sample) were calculated using FFQ. Associations were tested by logistic regressions adjusted for maternal age, education, smoking during pregnancy, any breast-feeding and the child’s z-score BMI at 4–5 years of age. Children with more feeding difficulties, poor eating, food refusal/neophobia and difficulties in establishing a daily routine at 12–15, 24 and 48–54 months of age had in general lower F&V intake at 4–5 years of age. The association with vegetables was slightly stronger than with fruits. These early feeding problems were also inversely associated with the variety score at 4–5 years of age, particularly when eating behaviours were reported after 12–15 months of age. A better understanding of these early feeding difficulties may help define strategies to increase the dietary quality in children.

[Diet quality of preschool children aged 2 to 5 years living in the urban area of Pelotas, Brazil]

OBJECTIVE

To assess the dietary quality of preschool children in the urban area of Pelotas, Rio Grande do Sul, southern Brazil.

METHODS

Dietary quality was measured according to the Healthy Eating Index (HEI), adapted to Brazil. Food consumption was obtained using the Food Frequency Questionnaire (FFQ). The index score was obtained by a score, ranging from 0 to 100, distributed in 13 food groups that characterize different components of a healthy diet. The better the quality of the diet, the closer the score is to 100.

RESULTS

Dietary was evaluated in 556 preschoolers. The mean HEI score value was 74.4 points, indicating that diets need improvement. The mean scores were significantly higher among girls and in children from families with income between one and less than three minimum wages.

CONCLUSIONS

The children showed vegetable consumption below the recommended level, while the food group of oils and fats, as well as the group of sugars, candies, chocolates and snacks were consumed in excess. It is important to reinforce guidelines to promote healthier eating habits, which may persist later in life.

Efficacy of interventions to improve feeding difficulties in children with autism spectrum disorders: a systematic review and meta-analysis

BACKGROUND

Feeding difficulties are relatively common in children with autism spectrum disorders (ASD), but current evidence for their treatment is limited. This review systematically identifies, reviews and analyses the evidence for intervention in young children with ASD and feeding difficulties.

METHODS

A comprehensive search strategy was used to identify studies from January 2000 to October 2013. Studies were included if they described interventions where the goal was to increase desirable eating behaviours or decrease undesirable eating behaviours using an experimental design, including single-subject research methodology. Studies were reviewed for descriptive information, and research quality was appraised using a formal checklist. Individual study findings were compared using Improvement Rate Difference (IRD), a method for calculating effect size in single-subject research.

RESULTS

Overall, 23 papers were included. All studies reviewed had five or fewer participants, and reported on operant conditioning style intervention approaches, where the child is prompted to perform an action, and receives a contingent response. Where quality measures were not met, it was primarily due to lack of detail provided for the purposes of replication, or failure to meet social validity criteria. Meta-analysis indicated a medium-large effect size [mean = 0.69, 95% confidence interval (CI) 0.60 to 0.79] when the outcome measured was an increase in desirable behaviours (e.g. consuming food), but a small-negligible effect size (mean = 0.39, 95% CI 0.18 to 0.60) when the outcome measured was a decrease in undesirable mealtime behaviours (e.g. tantrums). Only a small proportion of studies reported outcomes in terms of increased dietary variety rather than volume of food consumed.

CONCLUSIONS

The reviewed literature consisted primarily of low-level evidence. Favourable intervention outcomes were observed in terms of increasing volume, but not necessarily variety of foods consumed in young children with ASD and feeding difficulties. Further research in the form of prospective randomized trials to further demonstrate experimental effect in this area is required.

The development of a diet quality score for preschool children and its validation and determinants in the Generation R Study

BACKGROUND

Although many studies have examined health effects of infant feeding, studies on diet quality shortly after the weaning and lactation period are scarce.

OBJECTIVES

Our aims were to develop and evaluate a diet score that measures overall diet quality in preschool children and to examine the sociodemographic and lifestyle determinants of this score.

METHODS

On the basis of national and international dietary guidelines for young children, we developed a diet score containing 10 components: intake of vegetables; fruit; bread and cereals; rice, pasta, potatoes, and legumes; dairy; meat and eggs; fish; oils and fats; candy and snacks; and sugar-sweetened beverages. The total score ranged from 0 to 10 on a continuous scale and was standardized to an energy intake of 1200 kcal/d with the residual method. The score was evaluated in 3629 children participating in the Generation R Study, a population-based prospective cohort study. Food consumption was assessed with a food-frequency questionnaire (FFQ) at a median age of 13 mo.

RESULTS

The mean ± SD diet score was 4.1 ± 1.3. The food-based diet score was positively associated with intakes of many nutrients, including n-3 (ω-3) fatty acids [FAs; 0.25 SD increase (95% CI: 0.22, 0.27) per 1 point increase in the diet score], dietary fiber [0.32 (95% CI: 0.30, 0.34)], and calcium [0.13 (95% CI: 0.11, 0.16)], and was inversely associated with intakes of sugars [-0.28 (95% CI: -0.31, -0.26)] and saturated fat [-0.03 (95% CI: -0.05, -0.01)]. A higher diet score was associated with several health-conscious behaviors, such as maternal folic acid supplement use during pregnancy, no smoking during pregnancy, and children watching less television.

CONCLUSION

We developed a novel food-based diet score for preschool children that could be applied in future studies to compare diet quality in early childhood and to investigate associations between diet in early childhood and growth, health, and development.

The influence of early feeding practices on healthy diet variety score among pre-school children in four European birth cohorts

OBJECTIVE

The present study examined whether maternal diet and early infant feeding experiences relating to being breast-fed and complementary feeding influence the range of healthy foods consumed in later childhood.

DESIGN

Data from four European birth cohorts were studied. Healthy Plate Variety Score (HPVS) was calculated using FFQ. HPVS assesses the variety of healthy foods consumed within and across the five main food groups. The weighted numbers of servings consumed of each food group were summed; the maximum score was 5. Associations between infant feeding experiences, maternal diet and the HPVS were tested using generalized linear models and adjusted for appropriate confounders.

SETTING

The British Avon Longitudinal Study of Parents and Children (ALSPAC), the French Etude des Déterminants pre et postnatals de la santé et du développement de L'Enfant study (EDEN), the Portuguese Generation XXI Birth Cohort and the Greek EuroPrevall cohort.

SUBJECTS

Pre-school children and their mothers.

RESULTS

The mean HPVS for each of the cohorts ranged from 2.3 to 3.8, indicating that the majority of children were not eating a full variety of healthy foods. Never being breast-fed or being breast-fed for a short duration was associated with lower HPVS at 2, 3 and 4 years of age in all cohorts. There was no consistent association between the timing of complementary feeding and HPVS. Mother's HPVS was strongly positively associated with child's HPVS but did not greatly attenuate the relationship with breast-feeding duration.

CONCLUSIONS

Results suggest that being breast-fed for a short duration is associated with pre-school children eating a lower variety of healthy foods.

Finnish Children Healthy Eating Index (FCHEI) and its associations with family and child characteristics in pre-school children

OBJECTIVE

The objective was to develop a Finnish Children Healthy Eating Index (FCHEI), to determine the relative validity of the index and to examine associations between the index and familial sociodemographic and lifestyle characteristics.

DESIGN

Cross-sectional samples of children participating in a population-based birth cohort study in Finland.

SETTING

Type I Diabetes Prediction and Prevention (DIPP) Study cohort.

SUBJECTS

Three-day food records from 1-year-old (n 455), 3-year-old (n 471) and 6-year-old (n 713) children were completed between 2003 and 2005.

RESULTS

Validity of the FCHEI was assessed by studying the associations between the FCHEI and nutrient intakes of the children. Among all age groups, intakes of SFA and sugars decreased across increasing quartiles of the FCHEI while intakes of PUFA, dietary fibre, vitamin D and vitamin E increased. Among 3- and 6-year-olds, being cared for at home was associated with the lowest FCHEI quartile (diet that deviates most from the recommendations). The lowest FCHEI quartile was also associated with residence in a semi-urban area among the 3-year-olds and low maternal education and smoking during pregnancy among the 6-year-olds.

CONCLUSIONS

The FCHEI serves as a valid indicator of the quality of Finnish children's diet. Public health programmes aimed at improving the dietary behaviours of pre-school aged children should aim to improve the quality of food served at home. Families with history of lower parental education, maternal smoking during pregnancy or non-urban place of residence may require special attention.

Systematic review of diet quality indices and their associations with health-related outcomes in children and adolescents

BACKGROUND

Diet quality indices add an important dimension to dietary assessment. The aim of this systematic review was to: (i) identify and describe the attributes and applications of diet quality indices developed for use or used in paediatric populations; (ii) describe associations between these diet quality indices and health-related variables in paediatric populations; and (iii) identify factors that are associated with diet quality in paediatric populations worldwide.

METHODS

Studies were identified by searching electronic databases for relevant papers from 1980 to October 2013 using keywords. Inclusion criteria were original studies that utilised a quantitative measure of diet quality in children and adolescents aged 0-18 years.

RESULTS

One hundred and nineteen studies met the inclusion criteria, from which 80 different diet quality indices were identified. The majority of studies had >1000 participants and were of acceptable quality. Of the 56 studies that investigated health-related outcomes, weight status was the most researched. Europe produced the most number of diet quality indices (n = 27 indices). Of the 119 studies, seven intervention studies were identified. Paediatric diet quality indices were found to be associated with environmental, behavioural and maternal factors.

CONCLUSIONS

The use of diet quality indices in paediatric populations is a rapidly expanding area of research in diverse populations internationally. In economically disadvantaged countries, diet quality indices may be predictive of child growth. However, prospective cohort, intervention and validation studies are required to draw stronger conclusions concerning risk of future disease in paediatric populations in general.

Who's feeding baby? Non-maternal involvement in feeding and its association with dietary intakes among infants and toddlers

This study examined non-maternal involvement in feeding during the first 2 years of life and its association with breastfeeding duration, early introduction of complementary foods, and dietary intakes of selected foods and beverages. Data were from the Infant Care, Feeding and Risk of Obesity Study, a cohort of 217 low-income, African-American mother-infant dyads, followed from 3 to 18 months postpartum. Non-maternal caregivers (NMCs) were defined as persons involved in feeding an infant/toddler 50% or more of the total daily feedings. Use of any NMC and the type of NMC was tabulated for each study visit (3, 6, 9, 12, and 18 months). At each time point, more than half of all households reported a NMC. Fathers, grandmothers, and licensed childcare providers were the most common types of NMCs. In longitudinal models adjusted for confounding variables, NMC use was associated with a decreased likelihood of continued breastfeeding, and an increased likelihood of infants and toddlers consuming juice or whole fruit. Given the high prevalence of non-maternal involvement in feeding, interventions targeting multiple family members are warranted as they are likely to be more effective than those targeting the mother alone.

Short tools to assess young children's dietary intake: a systematic review focusing on application to dietary index research

Dietary indices evaluate diet quality, usually based on current dietary guidelines. Indices can therefore contribute to our understanding of early-life obesity-risk dietary behaviours. Yet indices are commonly applied to dietary data collected by onerous methods (e.g., recalls or records). Short dietary assessment instruments are an attractive alternative to collect data from which to derive an index score. A systematic review of studies published before April 2013 was conducted to identify short (≤50 items) tools that measure whole-of-diet intake of young children (birth-five years) and are applicable to dietary indices, in particular screening obesogenic dietary behaviours. The search identified 3686 papers of which 16, reporting on 15 tools (n = 7, infants and toddlers birth-24 months; n = 8, preschoolers 2-5 years), met the inclusion criteria. Most tools were food frequency questionnaires (n = 14), with one innovative dietary questionnaire identified. Seven were tested for validity or reliability, and one was tested for both. Six tools (n = 2, infants and toddlers; n = 4, preschoolers) are applicable for use with current dietary indices, five of which screen obesogenic dietary behaviours. Given the limited number of brief, valid and reliable dietary assessment tools for young children to which an index can be applied, future short tool development is warranted, particularly for screening obesogenic dietary behaviours.

High nutritional quality is not associated with low greenhouse gas emissions in self-selected diets of French adults

BACKGROUND

Healthy diets are supposed to be more environmentally friendly because they rely mainly on plant-based foods, which have lower greenhouse gas emissions (GHGEs) per unit weight than do animal-based foods.

OBJECTIVES

The objectives were to estimate the GHGEs associated with the consumption of self-selected diets in France and to analyze their relation with the nutritional quality of diets.

DESIGN

For each adult in the national dietary Individual and National Survey on Food Consumption (n = 1918), the GHGEs of his or her diet were estimated based on the GHGEs of 391 foods. Highest-nutritional-quality diets were defined as those having simultaneously 1) an energy density below the median, 2) a mean adequacy ratio (MAR) above the median, and 3) a mean excess ratio (MER, percentage of maximum recommended values for nutrients for which intake should be limited) below the median.

RESULTS

MAR was positively correlated and MER was negatively correlated with diet-related GHGEs. High-nutritional-quality diets contained more plant-based foods, notably fruit and vegetables, and fewer sweets and salted snacks than did low-quality diets. After adjustment for age, sex, and energy intake, the consumption of sweets and salted snacks was negatively correlated with diet-related GHGEs, whereas the consumption of animal products and of fruit and vegetables was positively associated with them. After adjustment for energy intake, high-nutritional-quality diets had significantly higher GHGEs (+9% and +22% for men and women, respectively) than did low-nutritional-quality diets.

CONCLUSION

Despite containing large amounts of plant-based foods, self-selected diets of the highest nutritional quality are currently not those with the lowest diet-related GHGEs.

Reliability of questionnaires to assess the healthy eating and activity environment of a child's home and school

Childhood overweight and obesity are a growing concern globally, and environments, including the home and school, can contribute to this epidemic. This paper assesses the reliability of two questionnaires (parent and teacher) used in the evaluation of a community-based childhood obesity prevention intervention, the eat well be active (ewba) Community Programs. Parents and teachers were recruited from two primary schools and they completed the same questionnaire twice in 2008 and 2009. Data from both questionnaires were classified into outcomes relevant to healthy eating and activity, and target outcomes, based on the goals of the ewba Community Programs, were identified. Fourteen and 12 outcomes were developed from the parent and teacher questionnaires, respectively. Sixty parents and 28 teachers participated in the reliability study. Intraclass correlation coefficients for outcomes ranged from 0.37 to 0.92 (parent) (P < 0.05) and from 0.42 to 0.86 (teacher) (P < 0.05). Internal consistency, measured by Cronbach's alpha, of teacher scores ranged from 0.11 to 0.91 and 0.13 to 0.78 for scores from the parent questionnaire. The parent and teacher questionnaires are moderately reliable tools for simultaneously assessing child intakes, environments, attitudes, and knowledge associated with healthy eating and physical activity in the home and school and may be useful for evaluation of similar programs.

Overcoming picky eating. Eating enjoyment as a central aspect of children's eating behaviors

Picky eating is a relatively common problem during childhood, and parents lack clear strategies with which to decrease picky eating. This study examined whether increasing eating enjoyment and cooking enjoyment might give opportunities to decrease picky eating. Parents (n=305), mainly mothers with children between 6 and 12 years of age (53.8% boys; 46.2% girls), completed a questionnaire on pressure and restriction, eating enjoyment, and picky eating, and cooking enjoyment. Path analyses were performed to examine the mediating role of eating enjoyment. The final model provided a good fit to the data and explained 33% variance in picky eating. A strong inverse association between eating enjoyment and picky eating was found (β=-.44). Significant direct effects were found between cooking enjoyment and picky eating (β=-.16) and restriction and picky eating (β=.18). Eating enjoyment partly mediated the association between cooking enjoyment and picky eating. Results showed pressure had only an indirect effect on picky eating through eating enjoyment. Eating enjoyment serves as an important and central factor in children's picky-eating behavior. High controlling practices might create a negative environment around food and healthy eating and so decrease eating enjoyment and increase picky eating.

Characterizing whole diets of young children from developed countries and the association between diet and health: a systematic review

Early childhood is an important nutritional period that involves the transition from a milk-based diet to ordinary foods. A systematic review was conducted of studies that applied whole-of-diet analysis of children aged 1-5 years to examine associations between diet and nutrition, health, and development. Literature searches identified 40 articles using dietary indices, principal component analysis, or cluster analysis. Reports that applied indices (n = 23, 18 indices) were cross-sectional, and most measured diet quality or variety. Articles reporting principal component or cluster analyses (n =17) described between two and six dietary patterns, and most identified healthy, unhealthy, and traditional patterns. In cross-sectional analyses, mixed associations were found between index or pattern scores and nutrient intake (n = 10), nutritional biomarkers (n = 1), and anthropometry (n = 10). Five reports from two birth cohorts showed healthier dietary patterns were associated with better lean mass, cognition, and behavior, but not with bone mass or body mass index at later ages. Few studies have characterized the diets of children under 5 years of age and linked diet with health. Given the limited evidence, research establishing the predictive validity of whole-of-diet methods in childhood is needed.

Use of dietary indexes among children in developed countries

In this article, we review studies that have used dietary indexes to assess different aspects of diet in relation to health outcomes and sociodemographic factors in childhood populations of developed countries. Eighty-four papers published from 1980 to mid-2010 including 90 unique dietary indexes were reviewed. Seventy-two indexes were developed (or have been adapted) specifically for childhood populations; 38 of these were used to assess diet-disease associations, mostly of diet and obesity. In the majority of these studies, small inverse associations between dietary indexes and obesity indexes were shown. Children who were younger, female, and from high-income families had better dietary quality scores. Forty-nine indexes (of 90) were compared with other aspects of dietary intakes or behaviors, with correlations ranging from very low to modest (∼r = 0.05-0.50). Only 2 validation studies compared an index with nutritional biomarkers, and correlations were quite weak for most plasma nutrients (P < 0.10). Overall, a large number of indexes have been created and used, but the majority of studies are descriptive. Fewer analytic studies on index-health associations have been performed, and most analyses insufficiently adjusted for confounders. Thus, prospective and intervention research in diverse populations is needed to further test these tools. In conclusion, indexes are potentially useful methods for dietary assessment, because they offer valuable information on overall dietary patterns in children. However, understanding the advantages and limitations when applying them in research and public health settings is important, and more research is needed to further develop their utility.

Simple food group diversity indicators predict micronutrient adequacy of women's diets in 5 diverse, resource-poor settings

Women of reproductive age living in resource-poor settings are at high risk of inadequate micronutrient intakes when diets lack diversity and are dominated by staple foods. Yet comparative information on diet quality is scarce and quantitative data on nutrient intakes is expensive and difficult to gather. We assessed the potential of simple indicators of dietary diversity, such as could be generated from large household surveys, to serve as proxy indicators of micronutrient adequacy for population-level assessment. We used 5 existing data sets (from Burkina Faso, Mali, Mozambique, Bangladesh, and the Philippines) with repeat 24-h recalls to construct 8 candidate food group diversity indicators (FGI) and to calculate the mean probability of adequacy (MPA) for 11 micronutrients. FGI varied in food group disaggregation and in minimum consumption required for a food group to count. There were large gaps between intakes and requirements across a range of micronutrients in each site. All 8 FGI were correlated with MPA in all sites; regression analysis confirmed that associations remained when controlling for energy intake. Assessment of dichotomous indicators through receiver-operating characteristic analysis showed moderate predictive strength for the best choice indicators, which varied by site. Simple FGI hold promise as proxy indicators of micronutrient adequacy.

Development of food variety in children

Eating a variety of foods is essential to achieve adequate coverage of macro- and micronutrient needs. We expose here how eating habits for a variety of foods develop in childhood, from early infancy on. Preferences for specific flavours might develop early, through milk-related flavour exposures. Breastfeeding favours the acquisition of a taste for a variety of foods. At introduction of solid foods, food preferences develop thanks to repeated exposures to a variety of foods. The persistence of these early influences is still unknown. During the third year of life, most children enter a neophobic phase during which previously liked foods are no longer accepted and introduction of new foods becomes difficult. However, habits of eating a variety of foods acquired before the neophobic phase track further on into childhood, adolescence and early adulthood. This underlines the importance of promoting the access to a variety of foods in early childhood. However, beyond the nutritional advantage of eating a varied diet, could this present any drawbacks? Providing a variety of foods generally stimulates food intake and thereby might favour obesity. More research is needed to understand the link between variety and obesity, which might be food-group dependant.

Measuring the effects of nutritional counseling on total infant diet in a randomized controlled intervention trial

OBJECTIVES

To examine the effects of nutritional counseling for the infant diet focused on complementary feeding and total diet by use of dietary scores.

PATIENTS AND METHODS

In a randomized controlled intervention trial, 183 mothers of full-term infants were allocated to 4 intervention groups (IG0-IG3). Intervention consisted of dietary counseling based on the food-based guidelines for infant nutrition in Germany. Counseling was done in 3 different forms: a telephone hotline (IG1), then written information (IG2), followed by additional personal telephone counseling (IG3). The IG0 group was not counseled at all. The actual diet of the infants was assessed by telephone interviews when the infants were 2, 4, 6, 9, and 12 months old and evaluated by food-based and meal-based dietary scores.

RESULTS

Plausible, although often not statistically significant, effects of counseling were found for several single scores at various age points. Total diet during the first year of life was significantly closer to the recommendations in the most intensively counseled group than in the non-counseled and lowest-counseled groups. Telephone counseling proved to be more effective than distribution of written material.

CONCLUSIONS

The measured effects of the innovative approach of personal telephone counseling point to the advantages of giving dietary advice to mothers of infants by means of personal contacts and suggest that positive effects on dietary habits may even be greater by face-to-face talks between mothers and experts.

Are dietary diversity scores related to the socio-economic and anthropometric status of women living in an urban area in Burkina Faso?

OBJECTIVES

To study dietary diversity and its relationship with socio-economic and nutritional characteristics of women in an urban Sahelian context.

DESIGN

A qualitative dietary recall was performed over a 24-h period. Dietary diversity scores (DDS = number of food groups consumed) were calculated from a list of nine food groups (DDS-9) or from a list of 22 food groups (DDS-22) which detailed both micronutrient- and energy-dense foods more extensively. Body mass index (BMI), mid upper-arm circumference and body fat percentage were used to assess the nutritional status of the women.

SETTING AND SUBJECTS

Five hundred and fifty-seven women randomly selected in two districts of Ouagadougou, the capital of Burkina Faso.

RESULTS

The mean DDS-9 and DDS-22 were 4.9 +/- 1.0 and 6.5 +/- 1.8 food groups, respectively. In the high tertile of DDS-22, more women consumed fatty and sweetened foods, fresh fish, non-fatty meat and vitamin-A-rich fruits and vegetables. The DDS-9 was not associated with the women's socio-economic characteristics whereas the DDS-22 was higher when the women were younger, richer and had received at least a minimum education. Mean BMI of the women was 24.2 +/- 4.9 kg m-2 and 37% of them were overweight or obese (BMI > or = 25 kg m-2). Neither the DDS-9 nor the DDS-22 was associated with the women's anthropometric status, even though there was a trend towards fewer overweight women in the lowest tertile of DDS-22.

CONCLUSION

In this urban area, the qualitative measurement of dietary diversity is not sufficient to identify women at risk of under- or overweight.

A new index to measure healthy food diversity better reflects a healthy diet than traditional measures

The recommendation to eat diverse types of foodstuffs is an internationally accepted recommendation for a healthy diet. The importance of dietary variety is based on several studies that have shown that diverse diets are accompanied by positive health outcomes. However, the definition and measurement of healthy food diversity are often criticized in the literature. Nutritional studies generally use count indices to quantify food diversity. As these measures have considerable disadvantages, several nutritionists have called for a precise definition and measurement of food diversity. This study aimed to develop a new healthy food diversity indicator. This index is based on a distribution measure mainly applied in economic and ecological studies. It considers 3 aspects important for healthy food diversity: number, distribution, and health value of consumed foods. We have validated the new index using energy-adjusted correlations with diet quality indicators. A comparison with selected traditional diversity indices revealed that the new indicator more appropriately reflected healthy food diversity.

Food choices at lunch during the third year of life: increase in energy intake but decrease in variety

AIM

Modelling the evolution between the ages of 2 and 3 y of the energy intake and the variety of free food choices at lunch time in relation to children's and context variables.

METHODS

One-year follow-up from 2 to 3 y old. In a nursery canteen, food choices at lunch were recorded by trained assistants who monitored portion size. Energy intake and food variety were estimated. Three hundred and ninety-five children were studied, for 112 meals and over 10 mo on average. Mixed models of analysis of variance were used to take into account the longitudinal character of the data.

RESULTS

From 2 to 3 y, energy intake increased. Variety decreased during the first 7 mo and then remained constant. The individual variability in mean values and in evolution was high for both variables. Energy was positively linked to BMI at 2 y. Variety was slightly higher for girls and increased with duration of breastfeeding. Energy was higher in September to November than in December-January. Variety was maximal in December-January and in June-July.

CONCLUSION

During the third year of life, while energy intake increases, the restriction of food variety appears to be a normal transition phase. Long duration of breastfeeding is associated with higher food variety.

A comparison of food group variety between toddlers with and without cystic fibrosis

OBJECTIVES

To compare the food group variety and nutritional adequacy of the diet between toddlers with cystic fibrosis (CF) and age-matched controls. Subjects A clinical sample of 22 toddlers with CF (mean age=21.3 +/- 7.2 months) matched to a community sample of 22 healthy peers.

MAIN OUTCOME MEASURES

The variety index for toddlers (VIT) and the mean adequacy ratio (MAR).

RESULTS

Fruit group scores were highest for children with CF (0.95 +/- 0.13; possible range 0.00-1.00), and dairy group scores were highest for controls (0.90 +/- 0.18). All children earned the lowest scores for vegetables (CF: 0.15 +/- 0.12; controls: 0.26 +/- 0.22). No significant differences were found when comparing VIT and MAR scores by sample (P >0.05). A moderate positive relationship was found between total VIT scores and MAR scores for all children (r=0.38, P <0.05). Toddlers with CF did not achieve the 120-150% of Recommended Dietary Allowance (RDA) for energy.

CONCLUSIONS

Toddlers with CF are consuming diets that are varied and nutritionally adequate for a healthy child. To optimize nutritional status and growth, current recommendations for toddlers with CF to eat a well-balanced diet and to exceed daily RDA for energy requirements remain key dietary issues.

Índices dietéticos na avaliação da qualidade global da dieta

A alimentação pode atuar tanto na prevenção de certas doenças como no tratamento de outras. A análise do consumo alimentar fornece subsídios para avaliação das necessidades nutricionais e para promoção de programas de educação nutricional. Poucos estudos têm sido realizados com o objetivo de se fazer a avaliação global da dieta. Os índices dietéticos estão sendo estudados como uma alternativa para realizar esta avaliação. Este trabalho tem por objetivo apresentar os seguintes índices dietéticos: Índice de Nutrientes, Escore de Variedade da Dieta, Escore de Diversidade da Dieta, Índice de Qualidade da Dieta, Índice de Alimentação Saudável e Índice de Qualidade da Dieta Revisado. Observou-se que os índices possuem fundamental importância ao refletir a situação de diversos componentes da dieta em uma única variável.

Do food-related experiences in the first 2 years of life predict dietary variety in school-aged children?

OBJECTIVE

To determine if food-related experiences in the first 2 years of life predict dietary variety in school-aged children.

DESIGN/SETTING

Child/mother pairs were interviewed 7 or 8 times when children were 2 to 24 months using a randomized incomplete block design to schedule interviews. Each child/mother pair was interviewed when the child was ages 6, 7, and 8 years.

PARTICIPANTS

Child/mother pairs (n = 70) were continuous participants in the longitudinal study.

MAIN OUTCOME MEASURES

Dependent variables were children's vegetable and fruit dietary variety, assessed from 3 days of dietary data at ages 6, 7, and 8 years. Independent variables from the first 2 years of life were selected from the longitudinal data set.

ANALYSES

General linear models. Adjustments for age that vegetables (or fruits) were introduced in the diet.

RESULTS

Vegetable variety in the school-aged child was predicted by mother's vegetable preferences, R2 =.084. Fruit variety in the school-aged child was predicted by breast-feeding duration and either early fruit variety (R2 =.254) or fruit exposure (R2 =.246).

CONCLUSIONS/IMPLICATIONS

Nutrition education messages for mothers should emphasize the importance of early food-related experiences to school-aged children's acceptance of a variety of vegetables and fruits.

Children's food preferences: a longitudinal analysis

OBJECTIVE

To compare children's food preferences longitudinally and identify factors related to food preferences.

DESIGN

Mothers completed the Food Preference Questionnaire for children at 2 to 3 years of age (T1), 4 years (T2), and 8 years (T3) and for themselves at T1 and T3. Both groups completed a Food Neophobia Scale at T3.

SUBJECTS

70 child/mother pairs who had participated continuously in the longitudinal study.

STATISTICAL ANALYSES PERFORMED

Changes in food preferences over time were tested with paired t tests and correlations. Consistency percentages were calculated by summing the consistent matches (like/like) for each food between two time periods. Similarly, concordance percentages were calculated for child/mother pairs by summing the concordant matches for each food. General linear models were developed to identify influences on children's food preferences.

RESULTS

Although children liked most foods, the number of liked foods did not change significantly during the 5 to 5.7 years of the study. The strongest predictors of the number of foods liked at age 8 years (R2=0.74) were the number liked at 4 years (P<.0001) and the food neophobia score (P=.0003). Newly tasted foods were more likely to be accepted between T1 and T2 than T2 and T3. Mothers' and children's food preferences were significantly but moderately related. Foods disliked by mothers tended not to be offered to children.

APPLICATIONS/CONCLUSIONS

The important role of children's early food preferences is confirmed by this study. Mothers influence children via their own preferences, which may limit foods offered to children.

Food security and nutritional outcomes of preschool-age Mexican-American children

OBJECTIVE

To examine the relationship of food insecurity to nutrition of Mexican-American preschoolers.

DESIGN

Cross-sectional survey of low-income Mexican-American families with children of preschool age (3 to 6 years). Data included food security using the Radimer/ Cornell scale; acculturation; parental education; monthly income; past experience of food insecurity; and child weight, height, and frequency of consuming 57 foods. Weight-for-height z scores (WHZ), height- for-age z (HAZ) scores, and the percentage of overweight (> or = 85th percentile WHZ) were calculated.

SUBJECTS/SETTING

A convenience sample of Mexican-American families (n=211) was recruited through Head Start, Healthy Start, Migrant Education, and the Special Supplemental Nutrition Program for Women, Infants, and Children in Tulare, Fresno, Monterey, and Kern counties in California. Statistical analyses Analysis of variance, t tests, Spearman's correlations, and Mantel Haenszel chi2.

RESULTS

Limited education, lack of English proficiency, and low income were negatively correlated with food security (r = -0.31 to -0.44, P<.0001). After controlling for acculturation, children in severely food-insecure households were less likely to meet Food Guide Pyramid guidelines than other children (median number of food groups > or = recommended levels [interquartile range]: 2.0 (2.0) vs 3.0 (2.0), P<.006). Although WHZ (mean +/- SD = 1.28 +/- 1.80) and percent overweight (48%, N=19) tended to peak among children from household level food insecure families, no significant differences were found in weight or height status of children by level of food insecurity.

APPLICATIONS/CONCLUSIONS

Dietetics professionals working with low-income Hispanic-American families should screen for different levels of food insecurity to determine needs for nutrition education and other services.

The Food Situations Questionnaire: a measure of children's willingness to try novel foods in stimulating and non-stimulating situations

This paper reports the development and validation of a self-report measure of food neophobia for children. Items described hypothetical situations in which novel foods might be encountered and asked children to report how they would feel about tasting or eating them. Ten items, representing two correlated subscales, were selected from among a larger number, using standard item selection measures with a total of 335 children, aged 7-12 years. The two subscales represent willingness to try novel foods in highly stimulating circumstances and willingness to try novel foods in non-stimulating circumstances. The test was shown to significantly predict actual willingness to taste novel foods in a laboratory situation. In addition, it was shown to predict such willingness better than parents' reports of the children's neophobia. Finally, the test was shown to have satisfactory internal and test-retest reliabilities.

Longitudinal study of nutrient and food intakes of white preschool children aged 24 to 60 months

OBJECTIVE

To determine nutrient and food intakes of 72 white preschool children primarily from families of middle and upper socioeconomic status and to compare children's nutrient intakes with current recommendations.

DESIGN

Six in-home interviews were conducted with mothers when children were 24 to 60 months old; at each time mothers provided 3 days of dietary information on the child. Children and mothers independently provided information on the child's favorite and least favorite foods at 42 and 54 months.

SUBJECTS

Preschool children (24 to 60 months old) participating in a longitudinal study.

STATISTICAL ANALYSES

Mean nutrient intakes were compared with the most recent Recommended Dietary Allowances/Adequate Intakes. Differences over time were tested with repeated-measures analysis of variance; gender differences were determined with t tests. Food frequencies (i.e., percentage of children consuming specific foods) were determined from dietary recalls and food records. Dietary variety was assessed with the Variety Index for Toddlers or the Variety Index for Children.

RESULTS

Means were consistently less than the RDA/AI for energy, zinc, folate, and vitamins D and E. Energy, carbohydrate, and fat intakes were highest (P < or = .01) at 60 months. Boys consumed more (P < or = .05) protein (10 g), calcium (197 mg), magnesium (35 mg), and pantothenic acid (0.8 mg) at 60 months than did girls. Foods most commonly eaten were fruit drink, carbonated beverages, 2% milk, and french fries. The vegetable group consistently had the lowest variety scores; vegetables also dominated least favorite foods lists.

APPLICATIONS

Parents need to be encouraged to include more sources of zinc, folate, vitamin E, and vitamin D in children's diets. Parents should also encourage their children to eat more vegetables, zinc- and folate-fortified cereals, lean red meats, seafood, vegetable oils, and low-fat milk.

The phenomenon of "picky eater": a behavioral marker in eating patterns of toddlers

OBJECTIVE

To determine if toddlers who were considered "picky eaters" had lower dietary scores than non-picky eaters, and if family environment and socioeconomic status were significantly related to picky eater status and dietary scores.

METHODS

An incomplete block design provided two interviews at randomly assigned times (24, 28, 32, or 36 months) of Caucasian mothers from upper socioeconomic (n=74) and lower socioeconomic status (n=44). Using trained interviewers, 6 days of food intake, two administrations of a questionnaire about toddler's eating behavior, and one administration of the Family Environment Scales were collected in the home. MANOVA, discriminant function analysis, and logistic regression procedures were used to determine significant differences between picky and non-picky eater groups.

RESULTS

Picky eaters had lower dietary variety (p=.03) and diversity scores (p=.009) than non-picky eaters. Mothers of picky eaters compared to those of non-picky eaters used persuasion (p=.0001) and ranked their child's eating behaviors as more problematic (p=.0001).

CONCLUSION

Toddlers perceived by their mothers as picky eaters had significantly lower dietary variety and diversity scores. Parents need information and strategies to increase the number of foods acceptable to their toddlers and to develop a sound feeding plan.