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

Nutrition and packaging characteristics of toddler foods and milks in Australia

OBJECTIVE

To analyse nutritional and packaging characteristics of toddler-specific foods and milks in the Australian retail food environment to identify how such products fit within the Australian Dietary Guidelines (ADG) and the NOVA classification.

DESIGN

Cross-sectional retail audit of toddler foods and milks. On-pack product attributes were recorded. Products were categorised as (1) food or milk; (2) snack food or meal and (3) snacks sub-categorised depending on main ingredients. Products were classified as a discretionary or core food as per the ADG and level of processing according to NOVA classification.

SETTING

Supermarkets and pharmacies in Australia.

RESULTS

A total of 154 foods and thirty-two milks were identified. Eighty percentage of foods were snacks, and 60 % of foods were classified as core foods, while 85 % were ultraprocessed (UP). Per 100 g, discretionary foods provided significantly more energy, protein, total and saturated fat, carbohydrate, total sugar and Na (P < 0·001) than core foods. Total sugars were significantly higher (P < 0·001) and Na significantly lower (P < 0·001) in minimally processed foods than in UP foods. All toddler milks (n 32) were found to have higher energy, carbohydrate and total sugar levels than full-fat cow's milk per 100 ml. Claims and messages were present on 99 % of foods and all milks.

CONCLUSIONS

The majority of toddler foods available in Australia are UP snack foods and do not align with the ADG. Toddler milks, despite being UP, do align with the ADG. A strengthened regulatory approach may address this issue.

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.

Motivational theater to increase consumption of vegetable dishes by preschool children

Background

By 3 years of age, many children have developed a dislike for certain foods, particularly vegetables. Seventy-five percent of young children consume less than the recommended levels for vegetables. The objective of this randomized feasibility intervention was to demonstrate the impact of an innovative approach to increase consumption of vegetable dishes by minority preschool children attending Head Start. The specific aims included the collection of data to assess feasibility and efficacy of the intervention.

Methods

Both qualitative and quantitative assessments were conducted. Qualitative data was used for development of the intervention and for program feedback at post assessments. Two hundred fifty-three preschool children (49% boys; 66% Hispanics and 34% African-Americans; mean age 4.4 years) were randomized either to the intervention (n = 128) or the control group (n = 125). The teacher/parent intervention group showed the children videotaped (DVD) puppet shows. Based on the theoretical framework “transportation into a narrative world”, three professionally developed characters, unique storylines and an engaging, repetitious song were incorporated in four 20-min DVD puppet shows. Prior to lunch each show was shown for five consecutive days in school and a minimum of once in the home. Digital photography was used in school to assess consumption of vegetable dishes at the lunch meal (quantitative assessment). At home parents were asked to complete the booklet questions corresponding to each DVD; questions could be answered correctly only if parents watched the DVD with their child. A multilevel mixed-effect model was used to analyze the data, adjusting for age, gender, and ethnicity.

Results

Children in the intervention group significantly (p < 0.0001) increased consumption of vegetable dishes from baseline to follow-up compared to no change in the control group. At follow-up, the intervention group continued to have significantly (p = 0.022) higher intake of vegetable dishes compared to the control group. Sixty percent of the mothers completed the booklet’s questions with 76 to 98% correct responses.

Conclusion

Using theory-based motivational theater with multiple exposures may be an effective behavioral intervention to increase consumption of vegetable dishes by preschool children that can be easily disseminated to a large sample.

Trial Registration

ClinicalTrials.gov; Identifier: NCT02216968

Developmental and Environmental Influences on Young Children's Vegetable Preferences and Consumption

Food intake patterns begin to be shaped at the earliest points in life. Early exposures and experiences are critical for the acceptance of some foods, particularly healthful foods such as vegetables, which often have a bitter component in their flavor profiles. In addition to repeated exposure to these foods, the quality and emotional tone of parent-child interactions are important in facilitating children's acceptance of vegetables. During early childhood, parents are challenged by children's developmental characteristics related to eating, such as the emergence of child neophobia, and by individual characteristics of the child that are more biologically based, including genetic predispositions to bitter taste and sensory sensitivities. Experimental studies consistently show that repeated exposure to novel and rejected familiar foods is the most powerful method to improve acceptance. However, the manner and persistence with which these exposures are performed are critical. Research investigating influences on children's vegetable acceptance and ingestion has focused on associations among availability, parent intakes, child neophobia, and the parental feeding response to children's reluctance to try and consume vegetables. Because young children's dietary intakes are low and below dietary recommendations, investigations have focused more on factors that impede children's vegetable acceptance, such as controlling feeding practices, than on positive influences. Research that addresses the multifaceted nature of these interactions among different levels of social-ecological environment, individual traits, parental feeding styles and practices, and socioeconomic influences and that uses longitudinal designs and complex statistical approaches is called for to ascertain more effective methods to improve children's vegetable acceptance.

Complementary and alternative medicine in pulmonology

PURPOSE OF REVIEW

To provide a comprehensive review of complementary and alternative medicine (CAM) therapies for the treatment of pulmonary disorders in children.

RECENT FINDINGS

The use of complementary medicine (CAM) is commonly used by both children and adults with breathing problems, and especially in chronic pulmonary disorders such as asthma and cystic fibrosis. Many clinics and hospitals now offer CAM, even though most of the conventionally trained health practitioners have little knowledge or education regarding CAM therapies. Research in CAM that demonstrates overall benefit is lacking, especially in children. Often parents do not report CAM use to their child's healthcare provider and this could compromise their overall quality of care. Although many research studies evaluating CAM therapies have methodological flaws, data exist to support CAM therapies in treating children with pulmonary disorders.

SUMMARY

This review examines the latest evidence of CAM use and effectiveness in children with pulmonary disorders. Physicians should be aware of the many CAM therapy options and the research surrounding them in order to provide their patients with the most current and accurate information available.

Food neophobia and its association with diet quality and weight in children aged 24 months: a cross sectional study

BACKGROUND

Food neophobia, the rejection of unknown or novel foods, may result in poor dietary patterns. This study investigates the cross-sectional relationship between neophobia in children aged 24 months and variety of fruit and vegetable consumption, intake of discretionary foods and weight.

METHODS

Secondary analysis of data from 330 parents of children enrolled in the NOURISH RCT (control group only) and SAIDI studies was performed using data collected at child age 24 months. Neophobia was measured at 24 months using the Child Food Neophobia Scale (CFNS). The cross-sectional associations between total CFNS score and fruit and vegetable variety, discretionary food intake and BMI (Body Mass Index) Z-score were examined via multiple regression models; adjusting for significant covariates.

RESULTS

At 24 months, more neophobic children were found to have lower variety of fruits (β = -0.16, p = 0.003) and vegetables (β = -0.29, p < 0.001) but have a greater proportion of daily energy from discretionary foods (β = 0.11, p = 0.04). There was no significant association between BMI Z-score and CFNS score.

CONCLUSIONS

Neophobia is associated with poorer dietary quality. Results highlight the need for interventions to (1) begin early to expose children to a wide variety of nutritious foods before neophobia peaks and (2) enable health professionals to educate parents on strategies to overcome neophobia.

Tracking of dietary intakes in early childhood: the Melbourne InFANT Program

BACKGROUND/OBJECTIVES

The objectives of the present study were to describe food and nutrient intakes in children aged 9 and 18 months, and to assess tracking of intakes between these two ages.

SUBJECTS/METHODS

Participants were 177 children of first-time mothers from the control arm of the Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program. Dietary intake was collected at 9 and 18 months using three 24 h diet recalls. Tracking was assessed for food and nutrient intakes using logistic regression analysis and estimating partial correlation coefficients, respectively.

RESULTS

Although overall nutrient intakes estimated in this study did not indicate a particular risk of nutrient deficiency, our findings suggest that consumption of energy-dense, nutrient-poor foods occurred as early as 9 months of age, with some of these foods tracking highly over the weaning period. Intakes of healthier foods such as fruits, vegetables, dairy products, eggs, fish and water were also relatively stable over this transition from infancy to toddlerhood, along with moderate tracking for riboflavin, iodine, fibre, calcium and iron. Tracking was low but close to ρ=0.3 for zinc, magnesium and potassium intakes.

CONCLUSIONS

The tracking of energy-dense, nutrient-poor foods has important implications for public health, given the development of early eating behaviours is likely to be modifiable. At this stage of life, dietary intakes are largely influenced by the foods parents provide, parental feeding practices and modelling. This study supports the importance of promoting healthy dietary trajectories from infancy.

Maternal feeding practices and feeding behaviors of Australian children aged 12-36 months

To explore parents' perceptions of the eating behaviors and related feeding practices of their young children. Mothers (N=740) of children aged 12-36 months and born in South Australia were randomly selected by birth date in four 6-month age bands from a centralized statewide database and invited to complete a postal questionnaire. Valid completed questionnaires were returned for 374 children (51% response rate; 54% female). Although mothers generally reported being confident and happy in feeding their children, 23% often worried that they gave their child the right amount of food. Based on a checklist of 36 specified items, 15% of children consumed no vegetables in the previous 24 h, 11% no fruit and for a further 8% juice was the only fruit. Of 12 specified high fat/sugar foods and drinks, 11% of children consumed none, 20% one, 26% two, and 43% three or more. Six of eight child-feeding practices that promote healthy eating behaviors were undertaken by 75% parents 'often' or 'all of the time'. However, 8 of 11 practices that do not promote healthy eating were undertaken by a third of mothers at least 'sometimes'. In this representative sample, dietary quality issues emerge early and inappropriate feeding practices are prevalent thus identifying the need for very early interventions that promote healthy food preferences and positive feeding practices. Such programs should focus not just on the 'what', but also the 'how' of early feeding, including the feeding relationship and processes appropriate to developmental stage.

Improving nutrition in home child care: are food costs a barrier?

OBJECTIVE

Child-care providers have a key role to play in promoting child nutrition, but the higher cost of nutritious foods may pose a barrier. The present study tested the hypothesis that higher nutritional quality of foods served was associated with higher food expenditures in child care homes participating in the Child and Adult Care Food Program (CACFP).

DESIGN

In this cross-sectional study, nutritional quality of foods served to children and food expenditures were analysed based on 5 d menus and food shopping receipts. Nutritional quality was based on servings of whole grains, fresh whole fruits and vegetables, energy density (kJ/g) and mean nutrient adequacy (mean percentage of dietary reference intake) for seven nutrients of concern for child health. Food expenditures were calculated by linking receipt and menu data. Associations between food expenditures and menu quality were examined using bivariate statistics and multiple linear regression models.

SETTING

USA in 2008-2009.

SUBJECTS

Sixty child-care providers participating in CACFP in King County, Washington State.

RESULTS

In bivariate analyses, higher daily food expenditures were associated with higher total food energy and higher nutritional quality of menus. Controlling for energy and other covariates, higher food expenditures were strongly and positively associated with number of portions of whole grains and fresh produce served (P = 0·001 and 0·005, respectively), with lower energy density and with higher mean nutrient adequacy of menus overall (P = 0·003 and 0·032, respectively).

CONCLUSIONS

The results indicate that improving the nutritional quality of foods in child care may require higher food spending.

High dietary sodium intake among young children in Vancouver, British Columbia

OBJECTIVE

To determine the intake distribution and food sources of sodium among young children.

METHODS

Dietary intake was determined for 190 children, 16 months to 6 years of age, using a food frequency questionnaire completed by interviewing a parent. Dietary intake of all nutrients, including dietary sodium, was analyzed. The major food sources of sodium were assessed by grouping foods into categories based on Canada's Food Guide, with subsequent subdivision into food type categories.

RESULTS

Dietary sodium intakes were skewed, with a median intake of 2021 mg/d and 5th-95th percentile range of 888-3975 mg/d. The sodium intake of 91.6% of children was above the recommended 1000 or 1200 mg/d for children 1-3 or 3-6 years, respectively, and 85% and 54% had intakes above the tolerable upper limits of 1500 and 1900 mg/d, respectively. The 5 food sources providing the highest amount of sodium were soups, processed/fast foods, dairy products, breads, and processed meats.

CONCLUSION

Children are vulnerable to high sodium intake as a result of their food patterns and the high sodium content of these foods. This report demonstrates that Canadian children have high sodium intakes. Knowledge of feeding practices involving high-sodium foods can assist parents and caregivers in reducing the high sodium intake of young children.

How much is enough? Tablespoon per year of age approach meets nutrient needs for children

BACKGROUND

Adults often ask health professionals for guidance on offering the appropriate serving sizes for young children and little research is available on whether serving size approaches meet children's nutrient needs.

OBJECTIVE

Determine whether three serving size approaches for young children meet dietary standards for nutrient adequacy.

DESIGN

We examined nutrient contents of three serving size approaches for children ages 2-5 years of age: 1 tablespoon per year of age (T/y), MyPyramid, and Child and Adult Care Food Program. Nutrient content of the three approaches were compared to the Estimated Energy Requirements (EER), Estimated Average Requirement (EAR), or Adequate Intake (AI) for each year of age for males and females; Analysis of Variance identified differences in nutrient content among the three approaches.

RESULTS

Young children's nutrient requirements were met for most nutrients by all approaches. However, the recommendation for vitamin E, potassium, and fat were not met by any approach, for any year, for either girls or boys. Energy content of the T/y serving size approach was below the EER for each year of age and for both sexes but still met minimal vitamin and mineral needs.

CONCLUSION

Health professionals can feel comfortable using any of the three approaches. However, the T/y approach is a more graduated serving size approach, may be more consistently age appropriate for young children, and may be implemented more easily by adults.

Outcomes of nutrition knowledge and healthy food choices in 5- to 6-year-old children who received a nutrition intervention based on Piaget's theory

PURPOSE

To develop nutrition education for preschool children based on Piaget's theory and to examine the effects of this education on children's nutritional knowledge, nutritional behaviors, and anthropometric measurements.

DESIGN AND METHODS

Pre- and postexperimental design. In experimental schools nutrition education was given. Children's nutritional knowledge, food consumption frequencies, and anthropometric measurements were evaluated.

RESULTS

The experimental group's nutritional knowledge scores increased and the group's food preferences positively changed. No significant difference was observed between the experimental and control groups' anthropometric measurements.

PRACTICE IMPLICATIONS

The nutrition education program used in this study may guide nurses in preparing education for preschoolers. The participation of families is recommended in their children's nutrition program.

Dietary sources of animal and plant protein intake among Flemish preschool children and the association with socio-economic and lifestyle-related factors

Background

The aims of this study were to assess the intake of animal, plant and food group-specific protein, and to investigate their associations with socio-economic and lifestyle-related factors in Flemish preschoolers.

Methods

Three-day estimated dietary records were collected from 661 preschoolers aged 2.5-6.5 y (338 boys and 323 girls). Multiple linear regression analysis was used to investigate the association between animal, plant, and food group-specific protein intake and socio-economic and lifestyle factors.

Results

Animal proteins (mean 38 g/d) were the main source of total protein (mean 56 g/d), while mean plant protein intake amounted to 18 g/d. The group of meat, poultry, fish and eggs was the main contributor (51%) to animal protein intake, followed by milk and milk products (35%). Bread and cereals (41%) contributed most to the plant protein intake, followed by low-nutritious, energy-dense foods (21%). With higher educated fathers and mothers as reference, respectively, preschoolers with lower secondary and secondary paternal education had lower animal, dairy-, and meat-derived protein intakes, and those with lower secondary and secondary maternal education consumed less plant, and bread and cereal-derived proteins. Compared to children with high physical activity levels, preschoolers with low and moderate physical activity had lower animal and plant protein intakes. Significantly higher potatoes and grains-, and fish- derived proteins were reported for children of smoking mothers and fathers, respectively, compared to those of non-smoking mothers and fathers.

Conclusions

The total protein intake of Flemish preschoolers was sufficient according to the recommendations of the Belgian Superior Health Council. Parental level of education and smoking status might play a role in the sources of children's dietary proteins.

More nutritious food is served in child-care homes receiving higher federal food subsidies

The US Department of Agriculture's Child and Adult Care Food Program (CACFP) serves 2.3 million children by providing monetary subsidies for food to participating child-care providers. This cross-sectional study tested the hypothesis that higher reimbursement rates for food result in higher food expenditures and higher nutritional quality of foods served in family child-care homes participating in CACFP. Sixty family home child-care providers were recruited in 2008-2009 from King County, Washington. Half the sample received higher reimbursements and the other half received the lower rates. Participants provided a 5-day menu of meals/snacks served and food shopping receipts. The nutritional quality of foods served was assessed from portion-standardized menus. Nutritional quality was quantified as the mean adequacy (mean percent of dietary reference intake) for seven nutrients of concern for child health. Food expenditures were calculated by linking menus with receipts. Student's t tests for independent samples and general linear models were used to test for between-group differences. The two groups of providers were socioeconomically and demographically similar with comparable professional backgrounds. However, higher reimbursement providers had significantly greater menu expenditures than the lower reimbursement group ($2.36 vs $1.96/child/day; P=0.031). Reimbursement level was not associated with a difference in calories, but menus of higher reimbursement providers showed a significantly higher mean nutritional adequacy (64.5% vs 56.3%; P=0.033). The finding that reimbursement rates were positively associated with food expenditures and the nutritional quality of foods served suggests that raising CACFP reimbursements can improve child nutrition.

Demographic and socio-economic factors related to food intake and adherence to nutritional recommendations in a cohort of pre-school children

Objective

To examine: (i) children's food intake and adherence to both Canada's Food Guide for Healthy Eating and Dietary Reference Intakes; and (ii) the social and demographic factors related to children's food intake.

Design

A cross-sectional study.

Setting

Data were obtained through the Quebec Longitudinal Study of Child Development 1998–2010, a representative sample (n 2103) of children born in 1998 in the province of Quebec, Canada. Information on energy, macronutrient and food consumption was derived from responses to a 24 h dietary recall interview addressed to children's mothers and day-care staff when the children were 4 years old.

Subjects

A total of 1549 children aged 4 years who participated in a nutritional sub-study.

Results

The mean daily total energy intake was 6360 kJ (1520 kcal) for girls and 6916 kJ (1653 kcal) for boys. For boys and girls alike, energy intake was comprised of approximately 54 % carbohydrates, 31 % fats and 15 % proteins. The mean number of servings consumed from each of the four essential food groups closely approached the dietary recommendations made by Canada's Food Guide for Healthy Eating; however, <2 % of the children in the present study actually met the full dietary guidelines. The dietary intake of pre-school children was associated with socio-economic and demographic factors, most notably mother's level of education, mother's immigrant status and sex of the child.

Conclusions

Diet-related disparities associated with socio-economic and demographic factors exist from as early as 4 years of age.

An experimental study on the effects of exposure to magazine advertising on children's food choices

Objective

The present study sought to determine the feasibility of an experimental research design to investigate the effects of exposure to magazine advertising on children's food choices.

Design

Children were randomized to read either a magazine with food advertisements or a magazine with no food advertisements. They then chose two food items from the intervention ‘store’ to eat after the session. Data were also collected on attitudes to advertising and snack food preferences. Finally, participants’ parents were provided with a self-completion survey on food choices and other variables (n24).

Setting

Three vacation care centres in regional New South Wales, Australia.

Subjects

Children aged 5–12 years (n47).

Results

Children in the experimental condition were more likely to choose advertised foods than those in the control group. Interestingly, the majority reported taste and healthiness as the most important factors in snack food choices; however, when faced with the actual food choice, they predominantly chose unhealthy foods (eighty-two unhealthy and only twelve healthy items were chosen).

Conclusions

This was the first study to assess the effects on children of exposure to food advertising within the context of reading a child-targeted magazine. Importantly, even with the small sample size and venue limitations, we found that exposure to magazine advertising influenced food choices. Children's magazines are an under-researched and poorly regulated medium, with considerable potential to influence children's food choices. The present study shows that the methodology is feasible, and future studies could replicate this with larger samples.

Uma revisão das ações de nutrição e do papel do nutricionista em creches

As creches são uma realidade na vida de grande parcela das crianças brasileiras em idade pré-escolar, sendo que nelas permanecem por um longo período. A demanda por esse serviço tende a aumentar com a participação cada vez mais ativa da mulher no mercado de trabalho. Assim o objetivo desse estudo foi revisar a literatura publicada a partir de 1998, disponível nas bases de dados MedLine, SciELO, Lilacs e Science Direct. Foram selecionados artigos de estudos experimentais, revisão bibliográfica, livros, teses e boletins de comitês de saúde, sobre as ações desenvolvidas em creches no contexto atual das crianças brasileiras e sobre a atuação do nutricionista nesta instituição. A pesquisa revelou a dualidade vivida pelos educadores entre o cuidar e o educar. Destaca a importância da instituição na formação de hábitos alimentares e discute a necessidade de aprofundamento nas questões ligadas à educação alimentar, no sentido de proporcionar à criança o conhecimento e a autonomia na escolha de alimentos. Entre as principais carências nutricionais apresentadas pelas crianças frequentadoras de creches públicas destaca-se a anemia ferropriva, sendo que a alimentação oferecida nas creches tem mostrado deficiências de cálcio, ferro, vitamina A, fibras e energia. Finalmente, apresenta os principais desafios do nutricionista neste segmento e a necessidade de sua constante atualização sobre o quadro epidemiológico da nutrição para as faixas etárias que atende, bem como as prioridades estabelecidas pela Política Nacional de Alimentação e Nutrição vigente e normas emitidas pelos órgãos de referência para esta área. Ao nutricionista cabe considerar, além das necessidades nutricionais da criança, o viés educativo e de formação de hábitos alimentares.

The NOURISH randomised control trial: positive feeding practices and food preferences in early childhood - a primary prevention program for childhood obesity

Background

Primary prevention of childhood overweight is an international priority. In Australia 20-25% of 2-8 year olds are already overweight. These children are at substantially increased the risk of becoming overweight adults, with attendant increased risk of morbidity and mortality. Early feeding practices determine infant exposure to food (type, amount, frequency) and include responses (eg coercion) to infant feeding behaviour (eg. food refusal). There is correlational evidence linking parenting style and early feeding practices to child eating behaviour and weight status. A focus on early feeding is consistent with the national focus on early childhood as the foundation for life-long health and well being. The NOURISH trial aims to implement and evaluate a community-based intervention to promote early feeding practices that will foster healthy food preferences and intake and preserve the innate capacity to self-regulate food intake in young children.

Methods/Design

This randomised controlled trial (RCT) aims to recruit 820 first-time mothers and their healthy term infants. A consecutive sample of eligible mothers will be approached postnatally at major maternity hospitals in Brisbane and Adelaide. Initial consent will be for re-contact for full enrolment when the infants are 4-7 months old. Individual mother- infant dyads will be randomised to usual care or the intervention. The intervention will provide anticipatory guidance via two modules of six fortnightly parent education and peer support group sessions, each followed by six months of regular maintenance contact. The modules will commence when the infants are aged 4-7 and 13-16 months to coincide with establishment of solid feeding, and autonomy and independence, respectively. Outcome measures will be assessed at baseline, with follow up at nine and 18 months. These will include infant intake (type and amount of foods), food preferences, feeding behaviour and growth and self-reported maternal feeding practices and parenting practices and efficacy. Covariates will include sociodemographics, infant feeding mode and temperament, maternal weight status and weight concern and child care exposure.

Discussion

Despite the strong rationale to focus on parents' early feeding practices as a key determinant of child food preferences, intake and self-regulatory capacity, prospective longitudinal and intervention studies are rare. This trial will be amongst to provide Level II evidence regarding the impact of an intervention (commencing prior to age 12 months) on children's eating patterns and behaviours.

Trial Registration

ACTRN12608000056392

Obesity and sugar-sweetened beverages in African-American preschool children: a longitudinal study

A representative sample of 365 low-income African-American preschool children aged 3-5 years was studied to determine the association between sugar-sweetened beverage consumption (soda, fruit drinks, and both combined) and overweight and obesity. Children were examined at a dental clinic in 2002-2003 and again after 2 years. Dietary information was collected using the Block Kids Food Frequency Questionnaire. A BMI score was computed from recorded height and weight. Overweight and obesity were defined by national reference age-sex specific BMI: those with an age-sex specific BMI>or=85th, but <95th percentile as overweight and those with BMI>or=95th age-sex specific percentile as obese. The prevalence of overweight was 12.9% in baseline, and increased to 18.7% after 2 years. The prevalence of obesity increased from 10.3 to 20.4% during the same period. Baseline intake of soda and all sugar-sweetened beverages were positively associated with baseline BMI z-scores. After adjusting for covariates, additional intake of fruit drinks and all sugar-sweetened beverages at baseline showed significantly higher odds of incidence of overweight over 2 years. Among a longitudinal cohort of African-American preschool children, high consumption of sugar-sweetened beverages was significantly associated with an increased risk for obesity.

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.

Gross for kids but good for parents: differing messages in advertisements for the same products

Objectives

There has been surprisingly little research into the effects of food advertising on parents’ perception of commonly consumed children’s food items, although the available research suggests that parents may find nutritional claims in these advertisements confusing. The purpose of the present study was to investigate parents’ perceptions of branded snack foods targeted at children, and the extent to which these perceptions are influenced by advertising messages.

Design

Using an intercept survey, participants were shown either adult-targeted or child-targeted advertisements for the same food products.

Setting

Central business district of a major Australian city.

Subjects

One hundred adults, mean age 40 years.

Results

The study results suggest that: (1) adults’ perceptions of advertised food products and, most importantly, purchase intentions for those products differ according to the version of the advertisement seen (for three of the products, 42–54% would buy the product after seeing the child version compared with 82–84% after seeing the adult version); and (2) adults clearly perceive distinctly different messages in advertisements for the same products which are targeting parents vs. those targeting children (e.g. for three of the products, 74–92% perceived that the adult version of the advertisement suggested the food was nutritionally beneficial compared with 2–14% perceiving this for the child version).

Conclusions

It is clear that the messages conveyed to children about specific foods are quite different to the messages conveyed to adults – and importantly parents – about the same foods.

Avaliação da ingestão de nutrientes de crianças de uma creche filantrópica: aplicação do Consumo Dietético de Referência

OBJETIVOS: comparar a adequação aparente da ingestão dos nutrientes utilizando os valores de referência "Consumo Dietético de Referência" (Dietary Reference Intake-DRIs) de 35 crianças de uma creche filantrópica, em dois momentos, no ato da matrícula (momento 1) e após seis meses de freqüência na creche (momento 2). MÉTODOS: A avaliação sócio-demográfica foi realizada através de questionário abordando renda, escolaridade, condições de moradia e saneamento básico. Para avaliação do consumo alimentar, no ato da matrícula, a história dietética foi determinada em entrevista com o responsável, com o propósito de obter informações sobre consumo habitual da criança na sua residência. Após o período de seis meses foi utilizado o método de pesagem direta de alimentos (na creche) complementando com o consumo alimentar da criança na residência. A análise dos nutrientes como proteínas, ferro, cálcio e vitamina C, além das fibras alimentares, foi realizada através um programa computacional. Para comparar a adequação dos nutrientes nos dois momentos do estudo utilizou-se o teste t de Student para dados pareados (p < 0,05). RESULTADOS: observou-se que ocorreu uma melhora significativa no consumo médio de nutrientes e de fibras alimentares das crianças, após seis meses de frequência na creche. Chama atenção que nenhuma criança atingiu o nível de adequação de fibras alimentares nos dois momentos do estudo, apesar da diferença significativa. CONCLUSÕES: os resultados sugerem que as creches podem ter um importante papel na melhora do estado nutricional de crianças de estratos sociais menos favorecidos.

Intake of vitamin D by Finnish children aged 3 months to 3 years in relation to sociodemographic factors

OBJECTIVE

To study the total daily intake of vitamin D from food and supplements among Finnish children aged 3 months to 3 years, the dietary sources of vitamin D and the association between vitamin D intake and sociodemographic factors.

SUBJECTS AND METHODS

The subjects are participants in the Finnish Type I Diabetes Prediction and Prevention Nutrition Study born between October 1997 and October 1998. At the age of 3 and 6 months, 1, 2 and 3 years, 342 (72% of the invited families), 298 (63%), 267 (56%), 233 (49%) and 209 (44%) families, respectively, participated in the present study. Food consumption was assessed by a 3-day food record. A structured questionnaire was used to record the parents' socioeconomic status.

RESULTS

The mean dietary vitamin D intake exceeded the recommendation (10 microg/day) at the age of 3 (11.0 microg) and 6 months (12.0 microg), but decreased thereafter being 9.8, 5.0 and 4.1 microg at 1, 2 and 3 years of age, respectively. Among the children 91, 91, 81, 42 and 26% used vitamin D supplements at the age of 3 and 6 months, and 1, 2 and 3 years, respectively. In children not using vitamin D supplements, vitamin D intake was less than 10 microg/day at all ages. Vitamin D intake from food did not differ in children who used and did not use vitamin D supplements. Vitamin D supplements were the main source of vitamin D intake in all age groups studied, followed by vitamin D-fortified infant formula in 3-month-olds and infant formula and baby foods in 6-month-olds. After the age of 1 year, the most important food sources of vitamin D were margarine, fish, baby foods, low-fat milk and eggs. Sociodemographic factors, especially the number of children in the family and maternal age, were associated with the total vitamin D intake and vitamin D supplement use.

CONCLUSION

Vitamin D supplements are not used according to the dietary recommendations in a substantial proportion of Finnish children.

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.

Food choices at lunch during the third year of life: high selection of animal and starchy foods but avoidance of vegetables

AIM

The objective was to show patterns of food selection by 2- to 3-y-old children for a wide variety of foods in a self-service cafeteria and to assess the effect of individual variables (gender, BMI, mode of feeding after birth and rank in sibship).

METHODS

In a nursery self-service canteen, food choices at lunch made by children (n=418, 24-36 mo; 109 observations per child on average) were recorded by trained assistants who monitored portion size. An offer of eight dishes (animal products, starchy foods, combination dishes, vegetables and dairy products), excluding dessert-type foods, was proposed. Choice level was calculated for each food. Analysis of variance was used to compare choices for the various foods and to assess the effect of the individual variables.

RESULTS

The choice of a food largely depended upon its nature: animal products, starchy foods and their combinations were widely chosen, whereas vegetables were not often selected; the choice for dairy products depended upon the type. The mode of preparation of the food influenced its choice. Segmenting products were identified; however, except for cheeses, a given child did not refuse an entire food category. Children's characteristics did not explain the choice variability.

CONCLUSION

At the age of 2 to 3 y, children preferentially choose animal products and starchy foods and avoid vegetables; the high individual variability of their food choices could be related to previous food experiences.

The relationship of dietary and lifestyle factors to bone mineral indexes in children

OBJECTIVE

To identify factors related to children's bone mineral indexes at age 8 years, and to assess bone mineral indexes in the same children at ages 6 and 8 years.

DESIGN

Bone mineral content (BMC [g]) and bone mineral density (BMD; calculated as g/cm 2 ) were measured by dual-energy x-ray absorptiometry (DEXA) in children and their mothers when the children were 8 years of age. A subset of children had an earlier DEXA assessment at age 6 years. Children's dietary intake, height, weight, and level of sedentary activity were assessed as part of a longitudinal study from ages 2 months to 8 years.

SUBJECTS/SETTING

Fifty-two healthy white children (25 male, 27 female) and their mothers. Main outcome measures Children's total BMC and BMD at age 8 years.

STATISTICAL ANALYSES PERFORMED

Correlations and stepwise multiple regression analyses.

RESULTS

Factors positively related to children's BMC at age 8 years included longitudinal intakes (ages 2 to 8 years) of protein, phosphorus, vitamin K, magnesium, zinc, energy, and iron; height; weight; and age ( P < or = .05). Factors positively related to children's BMD at age 8 years included longitudinal intakes of protein and magnesium ( P < or = .05). Female sex was negatively associated with BMC and BMD at age 8 years ( P < or = .05). Children's bone mineral indexes at ages 6 and 8 years were strongly correlated ( r =0.86, P < .0001 for BMC; r =0.92, P <.0001 for BMD).

CONCLUSIONS

Because many nutrients are related to bone health, children should consume a varied and nutrient-dense diet.

Predictors of children's body mass index: a longitudinal study of diet and growth in children aged 2–8 y

OBJECTIVE

To identify longitudinal variables related to children's body mass index (BMI) (kg/m(2)) at age 8 y.

DESIGN

A longitudinal design, with nine interviews per child from ages 2 to 8 y.

SUBJECTS

In all, 70 white children (37 males, 33 females) who were continuous participants since infancy in the longitudinal study. Families were primarily middle and upper socioeconomic status.

MEASUREMENTS

At each interview, children's height and weight were measured, and mothers provided 3 days of the child's intake data (a 24-h recall and 2 days of food records).

ANALYSES

Analyses used were means+/-s.d., correlations, repeated measures analysis of variance, and forward stepwise regression. BMI at each interview was calculated and age of adiposity rebound was determined.

RESULTS

Children's BMI at 8 y was negatively predicted by age of adiposity rebound and positively predicted by their BMI at 2 y. Additionally, each model included one longitudinal dietary variable; mean protein and fat intakes recorded between 2 and 8 y were positive predictors of BMI at 8 y; mean carbohydrate intake over the same time period was negatively related to BMI at 8 y. R(2) values indicated that these three-variable models predicted 41-43% of the variability in BMI among children. BMI of 23% of the children exceeded the 85th CDC percentile.

CONCLUSIONS

The results of this study show that factors in early life are associated with children's BMI at age 8 y.

Longitudinal calcium intake is negatively related to children's body fat indexes

OBJECTIVE

To determine if dietary calcium was negatively related to children's body fat (BF), if BF indexes and calcium intakes changed over time, and to identify variables related to BF and calcium intake.

DESIGN

Percent BF and kg BF were assessed by dual energy x-ray absorptiometry (DEXA) in 8-year-old children. In a prospective design, height, weight, dietary intakes, and related variables were monitored longitudinally from ages 2 months to 8 years during in-home interviews.

SUBJECTS

Fifty-two white children, (n=25 boys, 27 girls) participated in a longitudinal study with their mothers. At 8 years of age, mean BMI was 17.3+/-2.1 (standard deviation) for boys and 17.1+/-2.5 for girls.

ANALYSES

Regression analysis of all variables, followed by further regression analysis on selected models.

RESULTS

At 8 years, percent BF was 22.7+/-6.7 for boys and 26.2+/-7.9 for girls, as assessed by DEXA. Dietary calcium (mg) and polyunsaturated fat intake (g) were negatively related to percent BF (P=.02 to.04) in 3 statistical models, which predicted 28% to 34% of the variability in BF among children. Variables positively associated with percent BF were total dietary fat (g) or saturated fat (g), female gender, sedentary activity (hours/day), father's BMI, and mothers' percent BF. Calcium intakes were significantly correlated over time. Dietary variety was positively related to calcium intake, and intakes of carbonated beverages and other sweetened beverages were negatively related.

APPLICATIONS/CONCLUSIONS

Children should be strongly encouraged to regularly include calcium-rich foods and beverages in their diets.

A comparison of nutrient intake between infants and toddlers with and without cystic fibrosis

OBJECTIVE

To compare the micronutrient and energy intake of infants and toddlers with cystic fibrosis (CF) to the intake of matched control children and dietary reference index (DRI) levels.

DESIGN

A two-group comparison study. Nutrient and energy intakes were measured via 3-day diet diaries. Anthropometric data were collected within 1 week of study enrollment.

SUBJECTS/SETTING

A clinical sample of 35 infants and toddlers with CF (mean=18.6, SD=8.1 months) matched to a community sample of 34 healthy controls.

STATISTICAL ANALYSES PERFORMED

Children with CF and controls were compared on anthropometric and nutrient data using independent sample t tests. Mean nutrient and energy intake for children in each group were compared with the age-appropriate DRI for targeted nutrients using percentages.

RESULTS

Children with CF and controls were similar on measures of growth (height, weight, or weight-for-height percentile). Four children with CF were at or below the 10th percentile for weight-for-height, compared with one control child. Children with CF and controls did not differ on average daily protein, calcium, zinc, and energy intake. Overall, children met or exceeded DRI levels for nutrient intakes. A notable exception was iron, for which mean intakes were lower for control children. Toddlers with CF consumed only 89% of the RDA per day for energy.

APPLICATIONS/CONCLUSIONS

Infants and toddlers with CF are likely obtaining adequate micronutrient intakes from food. Interventions to increase total energy intake in infants and toddlers with CF are needed. Dietitians may want to focus more on calorie intake and percent calories from fat than on micronutrient intake in their nutrition counseling in young children with CF.

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.

Longitudinal study of energy and nutrient intakes for infants from low-income, urban families

OBJECTIVE

To assess the energy and nutrient intakes of healthy infants from low-income families and to compare intakes with current recommendations.

DESIGN

We interviewed mother-infant pairs longitudinally when the infants were 3, 6, 9, 12, 18 and 24 months old. Food intake data were obtained by 24-hour dietary recalls. Selected nutrient intakes were calculated and compared with the Recommended Dietary Allowances (RDAs).

SUBJECTS/SETTING

Infants were the offspring of low-income, pregnant women recruited at the Albany County Department of Health, New York for the Albany Pregnancy and Infancy Lead Study, a prospective investigation of factors related to blood lead levels, including nutrition. Interviews were conducted during paediatric clinic visits.

STATISTICAL ANALYSES PERFORMED

Means and standard deviations were used to describe energy and micronutrient intakes for age groups. The probability approach was utilised to examine the prevalence of inadequate intakes.

RESULTS

Mean energy and nutrient intakes generally met or exceeded the RDA. The exceptions were vitamin D and zinc for which observed means were below the RDA at several data points. Protein consumption was exceptionally high in this sample. The highest estimated prevalences of inadequate intakes were observed for iron, zinc and vitamin D at the older ages.

CONCLUSIONS

This study identified several potential concerns about the diets of infants during the transition from infant food and formula to table foods. Low intakes of vitamin D, zinc and iron, especially at 12 and 18 months, were observed. High protein intakes were noted at all ages.

Family and child-care provider influences on preschool children's fruit, juice, and vegetable consumption

Children's intakes of fruit, juice, and vegetables (FJV) do not meet the recommended minimum of five daily servings, placing them at increased risk for development of cancer and other diseases. Because children's food preferences and practices are initiated early in life (e.g., 2-5 years of age), early dietary intervention programs may have immediate nutritional benefit, as well as reduce chronic disease risk when learned healthful habits and preferences are carried into adulthood. Families and child-care settings are important social environments within which food-related behaviors among young children are developed. FJV preferences, the primary predictor of FJV consumption in children, are influenced by availability, variety, and repeated exposure. Caregivers (parents and child-care providers) can influence children's eating practices by controlling availability and accessibility of foods, meal structure, food modeling, food socialization practices, and food-related parenting style. Much remains to be learned about how these influences and practices affect the development of FJV preferences and consumption early in life.

Mothers' sources of information about feeding their children ages 2 months to 54 months

The purpose of this study was to determine sources and types of information about child feeding practices that were received by 62 mothers with children aged 2 to 54 months. Each mother participated in 10 or 11 in-home interviews. Data analyses included chi-square testing for differences in information sources over time and content analyses to develop information themes. As sources, citations for professionals and magazines decreased, with no significant changes for relatives over time. After 24 months, newspapers, television, and friends were reported more frequently than earlier. Mothers reported multiple and concurrent information sources over time. Thus, nutrition educators have concurrent and multiple opportunities to disseminate nutrition information.

A longitudinal study of children's juice intake and growth: the juice controversy revisited

OBJECTIVES

To determine associations between children's longitudinal juice intake and growth parameters at age 72 months and to determine children's beverage intake patterns over time.

SUBJECTS/SETTING

White children (n = 72) residing in the vicinity of a Southern US city participated in a longitudinal study.

METHODS

Seven in-home interviews were conducted per child when each child was between 24 and 72 months of age. The 7 sets of 3-day dietary data were analyzed for beverage intake, categorized as juice (100% juice only), milk, carbonated beverages, and other drinks (e.g., lemonade, tea, juice drinks). The following growth parameters were determined for each child at age 72 months: height, weight, body mass index (measured as kg/m2), and ponderal index (measured as kg/m3); the 3 latter are measures of overweight.

STATISTICAL ANALYSES

Associations between longitudinal juice intake and each growth parameter were tested with general linear models. Repeated measures analysis of variance tested changes in beverage intakes over time.

RESULTS

There were no statistically significant associations between juice and children's height, weight, or body mass index, as tested by general linear models. Children's longitudinal juice intake was negatively related to ponderal index (beta = 0.065, P = .050). Children's juice intake decreased significantly between ages 2 and 6 years, from 6.8 to 3.6 oz/day (P = .0001); intakes of carbonated beverages and other drinks increased from 1.7 to 3.8 oz/day (P = .0016) and from 2.7 to 6.2 oz/day (P = .0001), respectively.

APPLICATIONS/CONCLUSIONS

Children's longitudinal juice intake was not associated with either short stature or overweight. As juice consumption decreased, intakes of less nutritious beverages increased. Consumption of 100% juices should be encouraged by health professionals and parents/caregivers.

The role of dietary calcium and other nutrients in moderating body fat in preschool children

OBJECTIVE

To assess preschool children's food consumption (24-60 months) and relate these findings to body composition at 70+/-2 months.

DESIGN

A longitudinal study of children's dietary intakes for selected nutrients and servings of dairy products.

SUBJECTS

Fifty-three white children participating in a longitudinal study (2-96 months) of children's food practices and growth.

MEASUREMENTS

Using in-home interviews and trained interviewers, 18 days of dietary data and measured height and weight of each child at 6 month intervals were collected. Body composition was determined by dual energy X-ray absorptiometry.

RESULTS

Dietary fat was 30-33% of energy with saturated and monounsaturated fat intakes>10% and polyunsaturated<10%. Adjusting for body mass index (BMI), GLM models to predict percent body fat (%BF) or grams of total fat (gTF) with mean longitudinal calcium intake (%BF: R2=0.51, F=7.88, P<0.0001; gTF: R2=0.51, F=9.84, P=0.0001) or total servings of dairy products (%BF: R2=0.47, F=6.93, P<0.0001; gTF: R2=0.47, F=8.31, P<0.0001) as independent variables gave significant results. Higher mean longitudinal calcium (mg/day) intakes and more servings/day of dairy products were associated with lower body fat. Males had significantly less body fat (P=0.01) than females.

CONCLUSIONS

Higher longitudinal intakes of calcium, monounsaturated fat, and servings of dairy products were associated with lower body fat.

Revisiting the picky eater phenomenon: neophobic behaviors of young children

OBJECTIVES

To compare picky eater behaviors (food neophobia) of children as toddlers and at 42 to 84 months of age and to assess their mothers' neophobic behaviors.

METHODS

In a follow-up study of toddlers' picky eater behaviors, trained interviewers conducted four in-home interviews with mothers (n = 71) when their children were 42, 60, 72 and 84 months of age. Mothers reported children's diets (1 weekend day and 2 week days, 12 days total) and their behaviors; weight and height were measured. An additional interview at 48 months involved only mothers' behaviors. Nutritionist IV software, correlations, t tests and repeated measures ANOVA were used to determine nutrient intake, behavioral relationships and differences by picky eater status. Mothers' descriptions of the children's food neophobia and bothersome behaviors were analyzed by qualitative methods.

RESULTS

Mothers reported children's neophobic behaviors at all ages. Mothers' and children's behaviors were significantly and consistently correlated for number of attempts before deciding an unfamiliar food was disliked (p < 0.01) and trying unfamiliar foods away from home (p < 0.01). Other behavioral associations were significantly related for some ages but not for all the children's ages. There were no significant differences by picky eater status for nutrient intake or height and weight at any age. Mothers most frequently attempted unfamiliar entrees away from home because of social setting/relationships. About 20% of mothers attempted unfamiliar foods or new recipes just because they were different.

CONCLUSIONS

Findings suggest that some neophobic behaviors of children did not improve with maturity. Mothers' perceptions about their children's picky eater status were inconsistent over time.