Individual and family environment correlates differ for consumption of core and non-core foods in children

Association between snack intake behaviors of children and neighboring women: A population-based cross-sectional analysis with spatial regionalization

Background

Accumulated evidence indicates that neighborhood environments affect children's health behaviors. However, measuring neighborhood environments remains challenging because there exist strengths and weaknesses both in objective and perceived environment measures. Drawing on a recent conceptual model of how environment, perception, and behavior interact, we hypothesized that neighbors' behavioral similarities indicate the combined influence of physical and social environmental opportunities on specific behaviors. We then examined how these similarities (i.e. the behavioral tendencies of children's adult neighbors) relate to children's obesogenic dietary behaviors.

Methods

We used data for 2275 women and 821 elementary schoolchildren from a 2012-2013 population-based survey in greater Tokyo, Japan. Snack intake was defined as the total consumption of various types of snacks, estimated using a validated self-administered diet history questionnaire. Spatial regionalization, a type of spatial clustering, was used to empirically identify segments that could effectively differentiate regional variation in women's snack intake behaviors. We conducted multiple regression analysis to assess the cross-sectional association between children's snack intake and the mean snack intake of neighborhood women, adjusting for mother's intake.

Results

A 1-g increase in the mean snack intake of neighborhood women was associated with a 0.23-g (95% confidence interval: 0.00-0.45) increase in children's intake, while a 1-g increase in mother's intake was associated with a 0.34-g (95% confidence interval: 0.26-0.41) increase in children's intake.

Discussion

The results suggest that the out-of-home physical and social neighborhood environments may have non-ignorable associations with children's dietary behaviors by offering behavioral opportunities in addition to maternal influence.

Food neophobia scores at 8 Years and associations with nutrition-related behaviors at home in early life: Findings from a New Zealand contemporary birth cohort

Food neophobia (FN) reduces nutritional adequacy and variety which poses a significant concern for children's health and well-being We described the FN scores among 8-year-olds and examined its associations with nutrition-related behaviors at 45 months within the Growing Up in New Zealand cohort (n = 4621). FN was estimated using the Food Neophobia Scale (FNS). Mean FNS scores between variable categories were compared using t-tests for independent samples and ANOVA. Associations between FNS scores at 8 years and nutrition-related behaviors at 45-months were examined using multivariate linear regression. The mean (standard deviation) FN score was 46.2 (15.2) with statistically significant differences by sex (boys = 47.6 (15.7), girls = 43.8 (14.2), p=<0.001). For all children, in models adjusted by breastfeeding duration and sociodemographic characteristics: children who sometimes and never/almost never ate the same foods as their parents, scored, on average, 5.8 and 11 points higher in the FNS (versus those who did always/almost always); children who occasionally/never found mealtimes enjoyable scored on average 3.6 points lower in the FNS (versus mostly/quite often); children who always/almost always had the television on during mealtimes scored on average 2.7 higher in the FNS (versus never/almost never). In comparison to children who mostly/quite often had time to talk to others during mealtimes, those who never/occasionally did it scored on average higher points in the FNS overall (1.46 points higher) and within girls (1.73 points higher). These findings support the eating behavior statements in the National Children's Food and Nutrition Guidelines, which emphasize early exposure to food variety, limiting mealtime distractions, and acknowledge that parental role modeling shapes children's nutrition-related behaviors. Early adoption of preventative interventions for reducing FN in early and middle childhood are needed.

Interpersonal determinants of diet quality and eating behaviors in people aged 13-30 years: A systematic scoping review

Adolescence is an important period of increasing independence, when adolescents experience changing influences of family and friends on their diets as they transition into adulthood. We conducted a scoping review to map the literature on interpersonal determinants of diet quality and eating behaviors among individuals aged 13-30 years. We searched seven literature databases, and following screening, 329 papers were included. Determinants were grouped according to sub-categories of the Determinants of Nutrition and Eating framework: family structure (n = 122), social influences (n = 121), parental behaviors (n = 90), family food culture (n = 83), social support (n = 69), parental feeding styles (n = 24), parental attitudes/beliefs (n = 8), and parental resources/risk factors (n = 6), and we added two new sub-categories: parenting style (n = 74) and partner behaviors (n = 6). Fruit/vegetable (n = 143) and sugar-sweetened beverage (n = 102) intake were the most commonly measured diet outcomes, and breakfast consumption (n = 41) and fast food/takeaway intake (n = 39) the most commonly examined eating behaviors. This review highlights the gaps in the literature, both across the determinant sub-categories and also the relative paucity of longitudinal evidence and lack of evidence in emerging adults, particularly outside of university settings. Future research should focus on these areas to provide stronger evidence to support better design of interventions for this age group.

Associations between restrictive feeding practices and children's dietary intake: Systematic review and meta-analyses

BACKGROUND

Parents' attempt to limit or restrict children's intake of 'unhealthy' or discretionary foods has been widely considered as a counterproductive feeding practice associated with poorer dietary outcomes, but empirical evidence is varied.

AIM

The present systematic literature review aimed to investigate the association between parental restriction and children's dietary intake.

METHOD

Studies were identified through PsycInfo, MEDLINE, CINAHL, Web of Science, and Scopus databases on April 29th, 2022. Included were peer-reviewed, English-language articles published between 2001 and 2022, with an effect size between restriction and children's intake of foods that are 'healthy' (i.e., fruit, vegetables, other general healthy foods) or 'discretionary' (i.e., sweet or savoury energy-dense/nutrient poor foods, high-sugar foods, high-salt/fat foods, and high-energy/sugar-sweetened beverages), or overall diet quality. Risk of bias was assessed using a quality assessment checklist designed to evaluate survey studies.

RESULTS

Included studies (n = 44) were most often conducted in the USA, cross-sectional, and participants were mothers. Effect sizes (k = 59) from 21 studies were used in nine meta-analyses investigating various healthy and discretionary dietary intake variables. No meta-analytic effects were statistically significant. Qualitative synthesis of effect sizes ineligible for meta-analysis (k = 91) identified patterns of associations between restriction and increased intake of healthy foods, and decreased intake of discretionary foods.

CONCLUSIONS

Studies used a diverse selection of measures of restriction and dietary intake, limiting the ability of this review to make accurate cross-study comparisons. However, results suggest that instead of restriction being detrimental for children's dietary outcomes, it may be unrelated, or associated with more beneficial dietary outcomes. Research that utilises validated measures of restriction and dietary outcomes and a longitudinal design is needed to clarify this association.

Losing sleep influences dietary intake in children: a longitudinal compositional analysis of a randomised crossover trial

BACKGROUND

Although inadequate sleep increases the risk of obesity in children, the mechanisms remain unclear. The aims of this study were to assess how sleep loss influenced dietary intake in children while accounting for corresponding changes in sedentary time and physical activity; and to investigate how changes in time use related to dietary intake.

METHODS

A randomized crossover trial in 105 healthy children (8-12 years) with normal sleep (~ 8-11 h/night) compared sleep extension (asked to turn lights off one hour earlier than usual for one week) and sleep restriction (turn lights off one hour later) conditions, separated by a washout week. 24-h time-use behaviors (sleep, wake after sleep onset, physical activity, sedentary time) were assessed using waist-worn actigraphy and dietary intake using two multiple-pass diet recalls during each intervention week. Longitudinal compositional analysis was undertaken with mixed effects regression models using isometric log ratios of time use variables as exposures and dietary variables as outcomes, and participant as a random effect.

RESULTS

Eighty three children (10.2 years, 53% female, 62% healthy weight) had 47.9 (SD 30.1) minutes less sleep during the restriction week but were also awake for 8.5 (21.4) minutes less at night. They spent this extra time awake in the day being more sedentary (+ 31 min) and more active (+ 21 min light physical activity, + 4 min MVPA). After adjusting for all changes in 24-h time use, losing 48 min of sleep was associated with consuming significantly more energy (262 kJ, 95% CI:55,470), all of which was from non-core foods (314 kJ; 43, 638). Increases in sedentary time were related to increased energy intake from non-core foods (177 kJ; 25, 329) whereas increases in MVPA were associated with higher intake from core foods (72 kJ; 7,136). Changes in diet were greater in female participants.

CONCLUSION

Loss of sleep was associated with increased energy intake, especially of non-core foods, independent of changes in sedentary time and physical activity. Interventions focusing on improving sleep may be beneficial for improving dietary intake and weight status in children.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ANZCTR ACTRN12618001671257, Registered 10th Oct 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367587&isReview=true.

Concordance in dietary intake among caregivers and infants during the period of complementary feeding: A scoping review

Dietary intake during infancy shapes later food preferences and is important for short- and long-term health and wellbeing. Although caregivers are thought to influence the developing food preferences of infants, children less than two years have been notably absent in existing meta-analyses on the topic. This scoping review seeks to fill this gap by using a systematic process to identify and summarize the published literature on the resemblance of caregiver and infant diet during the period of complementary feeding (6-23 months). Articles were included if they assessed intake of foods or beverages other than human milk or commercial milk formula and reported a test of association between the intake of caregivers and infants. Four electronic databases (PubMed, EMBASE, Scopus, and Global Health) were systematically searched for articles published since 2000. Thirty-three articles, representing 32 studies, were identified. The majority of studies examined infant intake of food groups/items (n = 20), seven studies examined infant dietary patterns, and six studies examined dietary diversity. Studies predominantly reported associations between diets of mothers and infants (n = 31); three studies reported associations for fathers. Most studies assessed infant diet at one timepoint (n = 26), with 12 studies combining the intakes of younger (0-11 months) and older infants (12-23 months). Food groups examined, in order of frequency, included 'non-core' foods and beverages (n = 14), vegetables (n = 13), fruits (n = 12), protein foods (n = 6), grains (n = 5), and dairy foods (n = 4). Definitions of variables for food groups and dietary patterns were highly heterogeneous, but consistent for dietary diversity. Nearly all studies (n = 31) reported significant associations between dietary intakes of caregivers and infants. Findings suggest caregiver diet may be a promising focus for interventions aiming to shape the food preferences and dietary intakes of infants.

Tooth loss severity and core and non-core food consumption among older Brazilian adults

OBJECTIVE

To investigate the association between tooth loss severity and core and non-core food consumption in the older Brazilian population.

METHODS

We analysed data from 20 756 people aged 60 years or older who participated in the 2019 Brazilian National Health Survey. The average consumption days a week of core (8-item) and non-core (4-item) foods were the outcomes, measured using a Food Frequency Questionnaire. Tooth loss severity was the main exposure, using a four-category ordinal variable: mild (1-12 teeth missing), moderate (13-22), severe (23-31) and edentulous (all 32). Sociodemographic, tobacco smoking, use of dental prosthesis, difficulty in chewing and systemic conditions were among the covariates. Linear regression models estimated the association between tooth loss and food consumption.

RESULTS

Almost two-thirds of participants had moderate or worse levels of tooth loss. Older adults with more severe tooth loss reported an overall lower consumption of core and higher non-core foods than those with mild tooth loss. Worse tooth loss severity was associated with lower consumption of vegetables and/or legumes and fruits, and higher consumption of beans, artificial fruit juices and confectionery.

CONCLUSIONS

Older Brazilian adults with more severe tooth loss are consuming lower core and higher non-core foods. Our findings reinforce the importance of the common risk factor approach to tackle the adverse effects of tooth loss on diet.

The effect of modest changes in sleep on dietary intake and eating behavior in children: secondary outcomes of a randomized crossover trial

BACKGROUND

Insufficient sleep duration increases obesity risk in children, but the mechanisms remain unclear.

OBJECTIVES

This study seeks to determine how changes in sleep influence energy intake and eating behavior.

METHODS

Sleep was experimentally manipulated in a randomized, crossover study in 105 children (8-12 y) who met current sleep guidelines (8-11 h/night). Participants went to bed 1 h earlier (sleep extension condition) and 1 h later (sleep restriction condition) than their usual bedtime for 7 consecutive nights, separated by a 1-wk washout. Sleep was measured via waist-worn actigraphy. Dietary intake (2 24-h recalls/wk), eating behaviors (Child Eating Behavior Questionnaire), and the desire to eat different foods (questionnaire) were measured during or at the end of both sleep conditions. The type of food was classified by the level of processing (NOVA) and as core or noncore (typically energy-dense foods) foods. Data were analyzed according to 'intention to treat' and 'per protocol,' an a priori difference in sleep duration between intervention conditions of ≥30 min.

RESULTS

The intention to treat analysis (n = 100) showed a mean difference (95% CI) in daily energy intake of 233 kJ (-42, 509), with significantly more energy from noncore foods (416 kJ; 6.5, 826) during sleep restriction. Differences were magnified in the per-protocol analysis, with differences in daily energy of 361 kJ (20, 702), noncore foods of 504 kJ (25, 984), and ultraprocessed foods of 523 kJ (93, 952). Differences in eating behaviors were also observed, with greater emotional overeating (0.12; 0.01, 0.24) and undereating (0.15; 0.03, 0.27), but not satiety responsiveness (-0.06; -0.17, 0.04) with sleep restriction.

CONCLUSIONS

Mild sleep deprivation may play a role in pediatric obesity by increasing caloric intake, particularly from noncore and ultraprocessed foods. Eating in response to emotions rather than perceived hunger may partly explain why children engage in unhealthy dietary behaviors when tired. This trial was registered at Australian New Zealand Clinical Trials Registry; ANZCTR as CTRN12618001671257.

Contribution of home availability, parental child-feeding practices and health beliefs on children's sweets and salty snacks consumption in Europe: Feel4Diabetes-Study

Adoption of healthy dietary and snacking habits could support optimum physical and mental development in children as they define health in adulthood. This study assessed parameters associated with children's snacking such as food home availability, parenting practices, and parents' health beliefs. In this cross-sectional study 12 039 children, 49·4% boys 5-12 years, participating in the European Feel4Diabetes-Study were included. Children's weekly consumption of sweets and salty snacks, home availability of snacks, food parenting practices, and health beliefs were assessed via questionnaires. Logistic regression was applied to explore associations of a) home availability of snacks, b) food parenting practices (permissiveness and rewarding with snacks) and c) parent's opinions on deterministic health beliefs with children's consumption of sweets and salty snacks. Results showed that home availability (sweets: OR_adj: 4·76, 95 % CI: 4·32, 5·23; salty snacks: OR_adj: 6·56, 95 % CI: 5·64, 7·61), allowing to consume (sweets: OR_adj: 3·29, 95 % CI: 2·95, 3·67; salty snacks: OR_adj: 3·41, 95 % CI: 2·98, 3·90) and rewarding with sweets/salty snacks (sweets: OR_adj: 2·69, 95 % CI: 2·23, 3·24; salty snacks: OR_adj: 4·34, 95 % CI: 3·57, 5·28) 'sometimes/or less frequently' compared to 'always/or often' were associated with lower weekly consumption of sweets and snacks. Parents' disagreement compared to agreement with deterministic health beliefs and inattentive eating were associated with lower consumption of salty snacks and sweets in children. Overall, the findings of this study indicate that attempts to promote healthy snacking habits in children should aim to improve parental dietary habits, food parenting practices, health beliefs, and reducing home availability of unhealthy foods and snacks.

Evidence of Unhealthy Dietary Patterns in the School Lunch Sent from Home for Children in Mexico City

The identification and characterization of dietary patterns are tools that are used to assess associations between diet and health or disease conditions. In Mexico, studies have examined dietary patterns in children for breakfast or for the whole day, but not specifically for their school lunch. The aim was to describe dietary patterns identified in school lunch and their association with the nutritional status and metabolic parameters of schoolchildren. In this cross-sectional study on schoolchildren from four elementary schools of Mexico City, we recorded anthropometry measurements, a fasting blood sample was collected, and metabolic parameters were determined. We obtained information on the foods and beverages that children brought for their school lunch; estimated the caloric and nutritional content; and created food groups to obtain dietary patterns from the energy provided by those groups. Among the 350 schoolchildren (mean age, 7.9 ± 1.2 years) included, 24.9% and 21.7% presented having overweight and obesity, respectively. A total of 89.4% of schoolchildren brought the school lunch from home. Using the K-means method, the following four dietary patterns were identified: (1) sandwiches, tortas, and sweetened dairy products were consumed by 13.1% (n = 46) of the schoolchildren; (2) sweet snacks were consumed by 50.3% (n = 176); (3) sweetened dairy products were brought by 15.1% of the children (n = 53); and (4) sandwiches and tortas were brought by 21.4% (n = 75). These four patterns showed significant differences in terms of the caloric and nutritional contents (p < 0.001). Energy sources in the identified patterns were primarily sugars (15.8-40%). No association was found between the anthropometric and metabolic parameters of children and the dietary patterns. No dietary pattern obtained from the school lunch could be considered as healthy, since all of them had high energy content, and a high percentage of the energy was from sugars from ultra-processed foods and beverages.

Parental Traits Associated with Adherence to the Mediterranean Diet in Children and Adolescents in Croatia: A Cross-Sectional Study

The Mediterranean diet (MD) is known to be one of the healthiest dietary patterns. Despite the significance of a healthful diet during the early stage of life, data for young individuals indicate that nutrition problems are common. This cross-sectional study aimed to determine parental factors associated with MD adherence in children and adolescents living in the Mediterranean region in Croatia. In total, 2623 children aged 2 to 18 years and their parents participated in this study. Data were collected during the period from September 2021 to February 2022 by using an anonymous questionnaire. We used KIDMED and MEDAS questionnaires for assessing MD adherence in young individuals and their parents, respectively. To assess the association of children’s MD adherence categories with the parental predictors, we performed multivariate multinomial logistic regression. Results showed that the children of parents with a low MD adherence are much more likely to have poor MD adherence than good (OR = 47.54 (95% C.I 18.24, 123.87), p < 0.001) or average (OR = 5.64 (95% C.I 3.70, 8.6), p < 0.001) MD adherence. Further, children of fathers with higher BMI (OR = 1.035 (95% C.I 1.0, 1.071)) and those who do not live with both parents (OR = 1.703 (95% C.I 0.994, 2.916), p = 0.053) are more likely to have poor MD adherence than good MD adherence. These results indicate that interventions focusing on enhancing the quality of both parents’ diets could effectively improve their children’s eating habits.

Intergenerational transmission of dietary habits among Italian children and adolescents

The aim of this paper is to investigate the relationship between parental dietary habits and child and adolescent diet quality in Italy by adopting a parent-child perspective. We apply quantile regression modelling to an original database developed within the DEDIPAC knowledge hub, integrating multiple sources of information on the aspects of Italian households' daily lives, food consumption frequency, and calorie intake. Given the relevance of maternal care in shaping children's eating patterns, we focus on mothers' lifestyles and time-use. Results show that the intergenerational transmission of diet quality is a gendered process, especially involving mothers and their daughters. Our findings also highlight the pivotal role schools play in the fight against child malnutrition and indicate that, contrary to what is found in the international research literature, maternal employment is not correlated with a deterioration in their children's diet quality.

Families' Health Behavior: Validity and Reliability of the Turkish Version of the Family Health Climate Scale

This study aims to adapting the Family Health Climate Scale (FHC Scale) into Turkish and to conduct its validity and reliability analyses. The FHC Scale consists of two subscales, the Physical Activity Scale (FHC-PA) and the Nutrition Scale (FHC-NU). The validity and reliability analyzes of the scales were done separately. The sample included 789 participants (263 students, 263 mothers, 263 fathers). The sample was randomly allocated to two groups. Explanatory Factor Analysis (EFA) was performed on Sample I (132 students, 132 mothers, 132 fathers); and Confirmatory Factor Analysis (CFA) on sample II (131 students, 131 mothers, 131 fathers). As a result of the EFA it was determined that three factors FHC-PA Scale; and four factors FHC-NU Scale were included. The CFA result it was determined that scale models had good fit values. The FHC-Scale could be used as a reliable and valid measurement tool in Turkey.

The Contribution of Foods and Beverages of Low Nutritional Value to the Diets of Swedish Adolescents, by Food Group, Time and Place. A Nationally Representative Study

Adolescence is a time in life when lifestyle behaviours are acquired. One indicator of poor diet quality is the intake of foods and beverages with a relatively low nutritional value. Using the Australian classification of such foods, termed "discretionary", we classified the intakes of Swedish adolescents who participated in the Riksmaten Adolescent 2016-17 national dietary survey. From selected schools, 3099 adolescents in age groups 11-12, 14-15 and 17-18 years provided two 24-h recalls. Intakes and healthy dietary scores were calculated. Plasma ferritin, folate and 25(OH)D were available for a third. Almost 40% of total energy came from discretionary foods/beverages. Adolescents with higher intakes were more likely to be female, older, from a low socioeconomic position-household and born in Sweden. Most discretionary foods/beverages were consumed on weekend days and during in-between meals, outside of the home and at school. Percent energy from discretionary intake was associated with healthy dietary scores but not nutritional status. A substantial amount of energy was obtained from discretionary foods/beverages, and we found that consumption is pervasive across sociodemographic factors, time and place. Addressing this pattern will require a comprehensive approach to food environments and behaviours to reach all adolescents in an equitable manner.

Longitudinal Associations between Food Parenting Practices and Dietary Intake in Children: The Feel4Diabetes Study

Food parenting practices (FPPs) have an important role in shaping children’s dietary behaviors. This study aimed to investigate cross-sectional and longitudinal associations over a two-year follow-up between FPP and dietary intake and compliance with current recommendations in 6- to 11-year-old European children. A total of 2967 parent-child dyads from the Feel4Diabetes study, a randomized controlled trial of a school and community-based intervention, (50.4% girls and 93.5% mothers) were included. FPPs assessed were: (1) home food availability; (2) parental role modeling of fruit intake; (3) permissiveness; (4) using food as a reward. Children’s dietary intake was assessed through a parent-reported food frequency questionnaire. In regression analyses, the strongest cross-sectional associations were observed between home availability of 100% fruit juice and corresponding intake (β = 0.492 in girls and β = 0.506 in boys, p < 0.001), and between parental role modeling of fruit intake and children’s fruit intake (β = 0.431 in girls and β = 0.448 in boys, p < 0.001). In multilevel logistic regression models, results indicated that improvements in positive FPPs over time were mainly associated with higher odds of compliance with healthy food recommendations, whereas a decrease in negative FPP over time was associated with higher odds of complying with energy-dense/nutrient-poor food recommendations. Improving FPPs could be an effective way to improve children’s dietary intake.

The Validity and Reliability of the Persian Version of the Family Health Climate Scale (FHC-Scale) in Female Students and Their Mothers in Iran 2019

OBJECTIVES

This study examined the validity and reliability of the Family Health Climate Scale (FHC-Scale) among Iranian families. Second, can it be attributed to other family members by measuring the health climate in one person?

METHOD

In total, 261 female students and 196 mothers completed the FHC-Scale. The study instrument was a Persian version of the FHC-Scale prepared through a translation and back-translation process.

RESULTS

The results showed that the Persian version of the FHC-Scale is acceptable. Cronbach's alpha coefficient for FHC-PA in female students and their mothers, respectively, was 0.88 and 0.86 for the whole scale. Cronbach's alpha coefficient for FHC-NU in female students and their mothers, respectively, was 0.83 and 0.92 for the whole scale. The CVI values for all the items were equal to or above 0.8, and the CVR value for the total scale was 0.90.

CONCLUSION

The Persian version of the FHC-Scale is therefore an effective tool for evaluating the different dimensions of family health climate in the Iranian population.

Holiday Club Programmes in Northern Ireland: The Voices of Children and Young People

In Northern Ireland, nearly 30% of children are thought to be at risk of going hungry in the summer holidays when they are unable to access free school meals. Community groups, voluntary groups, local authorities, and faith groups have responded to this concern by developing and delivering holiday programmes that enable children from low-income families to take part in activities and access food. The current study used purposive sampling to investigate children's and young people's views of holiday provision, from across three holiday clubs, in Northern Ireland. Both primary school children (n = 34; aged 4-11) and secondary school children (n = 31; aged 12-17) showed high levels of awareness of poverty and food insecurity and associated pressures and stresses on households. Importantly, children and young people did not feel stigmatised about attending holiday provision, suggesting a positive and inclusive culture towards holiday club attendance. Children reported that they enjoyed the range of activities provided at holiday clubs and reported that attendance improved their self-confidence, especially for some older children, who acted as peer mentors to younger attendees, helped them to develop new skills, and provided them with opportunities to socialise with peers in a safe environment, out with their normal social groupings in school. Older children showed a high level of shrewdness and knowledge of sectarian divides in communities but spoke positively about how different religious or cultural backgrounds did not matter in terms of meeting and making new friends in holiday club settings. In terms of food provision, the findings of this study suggest that further work needs to be done to support children to access and eat healthy, nutritious food.

Cartoon Characters in Children’s Series: Gender Disparities in Body Weight and Food Consumption

(1) Background: Media play a significant role in forming audience perceptions about physical external appearance and food consumption patterns. It has been reported that children’s cartoons project slimness, and concomitantly consumption of poor nutritional quality food. However, data on the role of gender in this respect are lacking; thus, this was the aim of the present study. (2) Methods: 100 episodes of the 10 most popular cartoon series were analyzed. Characters’ body weight status was classified into underweight, normal weight and overweight, and foods consumed as core (e.g., fruit, vegetables) and non-core (e.g., sweets, snacks). Messages about characters’ attractiveness were recorded and classified according to their body weight status and gender. (3) Results: Out of 37 protagonists, 12 were female figures (32%), while out of the 10 thin protagonists, 7 were females (70%) and only 3 males (30%). Thin heroines were the recipients of the majority of the messages connotative to physical attractiveness (36 out of 58 messages). However, consumption of core and non-core foods did not differ within genders (core: z = −1.526, p = 0.127, non-core: z = −0.417, p = 0.667). (4) Conclusions: Females seem to be underrepresented in cartoon series but receive the majority of the comments related to physical appearance, with most of them addressing the attractiveness of a thin figure.

Body Weight of Cartoon Characters in Children Series Is Associated to Food Consumption, Attractiveness, and Physical Activity Engagement

BACKGROUND

Research is lacking regarding the eating habits of cartoon characters in relation to their body weight. The present study explored the context of food consumption and the cartoon characters' traits, according to body weight. Studies show that slim cartoon characters are usually considered as attractive; however, little is known regarding the type of messages projected about their physical appearance.

METHOD

One hundred episodes of ten series with high TV audience rates were reviewed. Characters' body weight status was classified into underweight, normal weight, and overweight, and food consumed as processed and less processed. Characters' traits such as physical activity and attractiveness were classified as positive, negative, or neutral. Comments made by the characters themselves regarding their proper physical appearance or the appearance of partner characters were recorded and classified as positive or negative.

RESULTS

Results show that characters' body weight was related to both type and quantity of foods consumed, as 58% of the non-core and 48% of all foods were actually eaten by oversized characters. Positive characters' traits, as defined by attractiveness and physical activity engagement, referred consistently to slim characters, with nine out of ten shown as good-looking and physically active. In addition, the majority (51 out of 58) of the positive comments on physical appearance were recorded for slim and attractive characters, either expressed by fellow actors or the characters themselves.

CONCLUSION

Body weight of cartoon characters seems to follow stereotypic perceptions which value slimness and relate unhealthy food consumption with overweight.

Influences of Parental Snacking-Related Attitudes, Behaviours and Nutritional Knowledge on Young Children's Healthy and Unhealthy Snacking: The ToyBox Study

This study investigated parental influences on preschool children's healthy and unhealthy snacking in relation to child obesity in a large cross-sectional multinational sample. Parents and 3-5 year-old child dyads (n = 5185) in a kindergarten-based study provided extensive sociodemographic, dietary practice and food intake data. Parental feeding practices that were derived from questionnaires were examined for associations with child healthy and unhealthy snacking in adjusted multilevel models, including child estimated energy expenditure, parental education, and nutritional knowledge. Parental healthy and unhealthy snacking was respectively associated with their children's snacking (both p < 0.0001). Making healthy snacks available to their children was specifically associated with greater child healthy snack intake (p < 0.0001). Conversely, practices that were related to unhealthy snacking, i.e., being permissive about unhealthy snacking and acceding to child demands for unhealthy snacks, were associated with greater consumption of unhealthy snacks by children, but also less intake of healthy snacks (all p < 0.0001). Parents having more education and greater nutritional knowledge of snack food recommendations had children who ate more healthy snacks (all p < 0.0001) and fewer unhealthy snacks (p = 0.002, p < 0.0001, respectively). In the adjusted models, child obesity was not related to healthy or unhealthy snack intake in these young children. The findings support interventions that address parental practices and distinguish between healthy and unhealthy snacking to influence young children's dietary patterns.

Gender Difference in the Relationship Among Family Function, Health Behavior, and Stress in Midlife

This study investigated whether there are gender-based differences in the process wherein family functions influence stress through various health behaviors in midlife adults. A cross-sectional study was done using a convenience sample of 250 middle-aged Koreans. Data on the family APGAR index, four health behaviors (i.e., seeking health information, physical activity, healthy diet, and social interaction), and stress were collected by a self-administered survey and analyzed using hierarchical multiple linear regression analyses and a PROCESS macro for SPSS. The study results showed that an indirect effect of family function on stress through health behaviors was significant in women, whereas such a relationship was not shown in men. This study found that the process wherein family function is linked with stress through health behaviors differs by gender. Developing gender-specific interventions is essential to decrease stress in midlife adults.

Investigating the Maternal Factors Associated with Preschool Children's Food Preferences; A Cross-Sectional Study

BACKGROUND

Dietary patterns of children are determined by their food preferences, and mothers have important implications for these preferences. This study was aimed to investigate the maternal factors associated with children's food preferences.

MATERIALS AND METHODS

In this cross-sectional study, a total of 576 healthy children aged 3-6 years participated from nursery schools through simple cluster sampling method and maternal factors associated with children's food preferences were determined using a researcher designed, validated tool through face-to-face interview with mothers. Data were analyzed by SPSS software version 16 using General Linear Model to assess the correlations between different variables.

RESULTS

The children with diploma-educated mothers had fewer preferences in consuming nuts, vegetables, and fruits, and children with academic-educated mothers had fewer preferences in consuming nuts, beans, vegetables, fruits, drinks, condiments, and snacks (P<0.05). Children with employed mothers had fewer preferences for beans and drinks (P<0.02). Drinks preferences were lower among children whose mothers had good nutritional knowledge score (P<0.03). Proteins, beans, fruits, condiments, and snacks preferences were higher among children whose mothers had good nutritional attitude score (P<0.05). A positive correlation was found between the food preferences of children and mothers (0.377

CONCLUSION

The results of the study showed that mothers̓ educational level and their high nutritional knowledge and attitude could not guarantee the healthy dietary patterns of children. To promote children's dietary patterns, it is imperative to improve the food preferences of mothers through specialized training.

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Key Words

• Attitude
• Children
• Food Preferences
• Knowledge
• Mothers

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MESH Headings Collapse

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Affiliation(s)

Nayyereh Farajzadeh-Moghanjoughi Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
Sorayya Kheirouri Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
Mohammad Alizadeh Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
Alireza Farsad-Naeimi Department of Nutrition, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

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Stress and Eating Behavior: A Daily Diary Study in Youngsters

Background: Overweight and obesity are growing problems, with more attention recently, to the role of stress in the starting and maintaining process of these clinical problems. However, the mechanisms are not yet known and well-understood; and ecological momentary analyses like the daily variations between stress and eating are far less studied. Emotional eating is highly prevalent and is assumed to be an important mechanism, as a maladaptive emotion regulation (ER) strategy, in starting and maintaining the vicious cycle of (pediatric) obesity. Objectives: The present study aims to investigate in youngsters (10 - 17 years) the daily relationship between stress and the trajectories of self-reported eating behavior (desire to eat motives; hunger eating motives and snacking) throughout 1 week; as well as the moderating role of emotion regulation and emotional eating in an average weight population. Methods: Participants were 109 average weighted youngsters between the age of 10 and 17 years (M _age = 13.49; SD = 1.64). The youngsters filled in a trait-questionnaire on emotion regulation and emotional eating at home before starting the study, and answered an online diary after school time, during seven consecutive days. Desire to eat motives, hunger eating motives and snacking were assessed daily for seven consecutive days. Results: Using multilevel analyses results revealed that daily stress is significantly associated with trajectories of desire to eat motives and hunger eating motives. No evidence was found for the moderating role of maladaptive ER in these relationships; marginally significant evidence was found for the moderating role of emotional eating in the trajectories of desire to eat and snacking. Discussion: These results stress the importance of looking into the daily relationship between stress and eating behavior parameters, as both are related with change over and within days. More research is needed to draw firm conclusion on the moderating role of ER strategies and emotional eating.

Sources of Dietary Sodium in Food and Beverages Consumed by Spanish Schoolchildren between 7 and 11 Years Old by the Degree of Processing and the Nutritional Profile

Excessive salt intake has negative effects on health and persists as a dietary problem in Spanish children. However, the analysis of dietary sodium sources has not been extensively studied. A group of 321 children between 7 and 11 years old from five Spanish regional communities was studied. A three-day dietary record was used to determine the contribution of food and beverages to dietary sodium intake. The food consumed was classified based on the level of processing (NOVA classification) and the nutritional profile. Boys consumed more dietary sodium and sodium from ultra-processed food (UPF) than girls (p < 0.05). The main sources of dietary sodium from discretionary food were meat and meat products (25.1%), some ready-to-eat and pre-cooked dishes (7.4%) and sugars and sweets (6.3%). More than 4/5 of the total dietary sodium consumed came from processed foods (PF) and UPF. Ready-to-eat and pre-cooked dishes (14.4%), meat and meat products (10.6%), and cereals (10.2%) were the most relevant UPF. These results demonstrate that a key point for Spanish children is a reduction in the sodium content in PF and UPF, whether these foods are for basic or discretionary consumption. Furthermore, a decrease in the frequency and the quantity of discretionary food consumption should be encouraged.

Conceptualizing Family Influences on Children's Energy Balance-Related Behaviors: Levels of Interacting Family Environmental Subsystems (The LIFES Framework)

Healthy or unhealthy behavioral patterns develop and are maintained in a family context. The importance of the family environment for children’s and adolescents’ energy balance-related behaviors (EBRBs) has been shown previously. However, the way different family environmental factors are interrelated and interact with personal factors (e.g., motivation) are not well understood. Furthermore, the majority of studies have focused on the parent-child subsystem. However, there are family-level socialization dynamics that affect the development of a healthy lifestyle beyond the impact of parenting behaviors. The current paper aims to synthesize theoretical and empirical literature on different types of family influences. The Levels of Interacting Family Environmental Subsystems (LIFES) framework incorporates family influences on three levels (immediate, proximal, distal) and of three subsystems (individual, parent-child, family), relates them to each other and postulates potential paths of influence on children’s EBRBs. Several studies examining specific sections of the framework provide empirical support for LIFES’ propositions. Future studies should place their research in the context of the interrelationship of different family environmental influences. A better understanding of the interrelated influences would enhance the understanding of the development and maintenance of overweight and obesity among children and is crucial for the development of effective interventions.

High-risk environments for eating foods surplus to requirements: a multilevel analysis of adolescents' non-core food intake in the National Diet and Nutrition Survey (NDNS)

OBJECTIVE

Interventions to reduce adolescents' non-core food intake (i.e. foods high in fat and sugar) could target specific people or specific environments, but the relative importance of environmental contexts v. individual characteristics is unknown.

DESIGN

Cross-sectional.

SETTING

Data from 4d food diaries in the UK National Diet and Nutrition Survey (NDNS) 2008-2012 were analysed. NDNS food items were classified as 'non-core' based on fat and sugar cut-off points per 100g of food. Linear multilevel models investigated associations between 'where' (home, school, etc.) and 'with whom' (parents, friends, etc.) eating contexts and non-core food energy (kcal) per eating occasion (EO), adjusting for variables at the EO (e.g. time of day) and adolescent level (e.g. gender).ParticipantsAdolescents (n 884) aged 11-18 years.

RESULTS

Only 11 % of variation in non-core energy intake was attributed to differences between adolescents. In adjusted models, non-core food intake was 151 % higher (ratio; 95 % CI) in EO at 'Eateries' (2·51; 2·14, 2·95) and 88 % higher at 'School' (1·88; 1·65, 2·13) compared with 'Home'. EO with 'Friends' (1·16; CI 1·03, 1·31) and 'Family &amp; friends' (1·21; 1·07, 1·37) contained 16-21 % more non-core food compared with eating 'Alone'. At the individual level, total energy intake and BMI, but not social class, gender or age, were weakly associated with more non-core energy intake.

CONCLUSIONS

Regardless of individual characteristics, adolescents' non-core food consumption was higher outside the home, especially at eateries. Targeting specific eating contexts, not individuals, may contribute to more effective public health interventions.

Describing Food Availability in Schools Using Different Healthy Eating Guidelines: Moving Forward with Simpler Nutrition Recommendations

PURPOSE

Internationally, there is debate on whether a nutrient or a food-based approach to policy is more effective. This study describes the food/beverage availability in schools in Nova Scotia through a comparison of a traditional nutrient classification ("Maximum/Moderate/Minimum"), currently used in the provincial school policy and a simplified food-based system ("Core/Extra").

METHODS

School food environment audits were conducted in schools (n = 25) to record the food and beverages available. Registered dietitians categorized information using both the nutrient-based and simplified food-based classification systems. Number and percent in each category were described for items.

RESULTS

Food and beverage items consisted of breakfast, lunch, snacks, beverages, and vending of which 81% were permissible by the policy, whereas only 54% were categorized as Core. Many snacks and vending items classified as Extra fell within either Moderate (45% and 35%, respectively) or Minimum (29% and 33%, respectively) categories.

CONCLUSIONS

Dietitians have a role to support interpretation of classification systems for school nutrition policies. The nutrient-based classification used in the policy permitted some items not essential to a healthy diet as defined by the Extra food-based classification. However, the food-based Core/Extra categorization had less detail to classify nutrients.

Eating at food outlets and leisure places and "on the go" is associated with less-healthy food choices than eating at home and in school in children: cross-sectional data from the UK National Diet and Nutrition Survey Rolling Program (2008-2014)

Background

Where children eat has been linked to variations in diet quality, including the consumption of low-nutrient, energy-dense food, a recognized risk factor for obesity.

Objective

The aim of this study was to provide a comprehensive analysis of consumption patterns and nutritional intake by eating location in British children with the use of a nationally representative survey.

Design

Cross-sectional data from 4636 children (80,075 eating occasions) aged 1.5-18 y from the UK National Diet and Nutrition Survey Rolling Program (2008-2014) were analyzed. Eating locations were categorized as home, school, work, leisure places, food outlets, and "on the go." Foods were classified into core (considered important or acceptable within a healthy diet) and noncore (all other foods). Other variables included the percentage of meals eaten at home, sex, ethnicity, body mass index, income, frequency of eating out, takeaway meal consumption, alcohol consumption, and smoking.

Results

The main eating location across all age groups was at home (69-79% of eating occasions), with the highest energy intakes. One-third of children from the least-affluent families consumed ≤25% of meals at home. Eating more at home was associated with less sugar and takeaway food consumption. Eating occasions in leisure places, food outlets, and "on the go" combined increased with age, from 5% (1.5-3 y) to 7% (11-18 y), with higher energy intakes from noncore foods in these locations. The school environment was associated with higher intakes of core foods and reduced intakes of noncore foods in children aged 4-10 y who ate school-sourced foods.

Conclusions

Home and school eating are associated with better food choices, whereas other locations are associated with poor food choices. Effective, sustained initiatives targeted at behaviors and improving access to healthy foods in leisure centers and food outlets, including food sold to eat "on the go," may improve food choices. Home remains an important target for intervention through family and nutrition education, outreach, and social marketing campaigns. This trial was registered with the ISRTCN registry (https://www.isrctn.com) as ISRCTN17261407.

The home food environment and associations with dietary intake among adolescents presenting for a lifestyle modification intervention

BACKGROUND

The home food environment may be an important target for addressing adolescent obesity. The aim of this study was to investigate associations between aspects of the home food environment and the diets of adolescents who present for obesity treatment.

METHODS

Cross-sectional baseline data were collected from 167 overweight/obese adolescent-parent pairs participating in an e-health lifestyle modification intervention. Adolescent intake of specific foods (fruit and vegetables, total fat, sugar-sweetened beverages, desserts/treats, and snacking occasions) was assessed by three 24-h dietary recalls, while household factors were collected from adolescent and parent questionnaires. Structural Equation Modeling, controlling for relevant covariates, was used to examine the relationship between adolescent diet and the following household factors: parent modeling, parenting style, family meal practices, and home food/beverage availability.

RESULTS

Findings reveal that few characteristics of the home food environment were associated with adolescent dietary intake. Greater home availability of high-fat foods was moderately associated with adolescent snack intake (β = 0.27, p < .001). Associations with fruit/vegetables and fat intake were small and some were in unexpected directions. Parent modeling of healthful food choices and healthier family meal practices were associated with lower availability of high-fat foods and treats in the home, but were not directly associated with adolescent diets.

CONCLUSIONS

Parent modeling of healthy foods and positive mealtime routines might contribute to the healthfulness of foods offered in the homes of adolescents who are overweight/obese. Additional research is needed to better characterize the complex aspects of the household environment that influence adolescent diet.

The Effects of a Nutrition Media Literacy Intervention on Parents' and Youths' Communication about Food

Interventions addressing links between media exposure and obesity risk for school-age youth have not explicitly addressed the role of family communication about media. Youths' influence attempts on parents to purchase advertised foods can create conflict and negatively affect parental food choices. This study tested whether a family-based media literacy curriculum improves parents' media management skills and decreases youths' susceptibility to appealing but unrealistic food marketing. A matched-group pretest/posttest field experiment of parent-youth dyads with control group (N = 100 dyads, youth M = 11 years of age) tested the six-session curriculum. Hypotheses were analyzed using a Bayesian structural equation model. The curriculum increased parents' active negative mediation to foster youths' critical thinking about food marketing, b* = 0.35, 95% CCI [0.17, 0.50], increased parent Efficacy for making healthy dietary changes for their families, b* = 0.59, 95% CCI [0.41, 0.75], and fostered family discussion about nutrition labels (total effect = 0.22). Additionally, cumulative influences of Perceived Desirability and Wishful Identification on youths' requests for marketed foods were reduced (total effect = 0.04). Media literacy education can empower parents and improve youths' critical thinking to reduce effects of food marketing on families and improve use of media to obtain nutrition information.

Parental feeding practices to manage snack food intake: Associations with energy intake regulation in young children

BACKGROUND

Little attention has been directed to understanding the relationship between restriction and regulation of snack food intake in toddlers.

OBJECTIVE

The aim of this study was to examine the effects of parental restriction of toddlers' eating of snacks in the absence of hunger (EAH) and to examine the impact of three contextual factors; snack food access, frequency of snack food consumption, and attraction to snack food.

DESIGN

64 parents and toddlers (aged 22-36 months) took part in a protocol to measure EAH (defined as kJ of energy-dense snack foods consumed). Mean EAH was 199 kJ (SD = 299), with 43 children consuming at least some snacks. Restriction was measured with the Child Feeding Questionnaire Restriction subscale. Snack food access was measured with Allow Access from the Toddler Snack Food Feeding Questionnaire (TSFFQ), snack food consumption was measured with a short snack food frequency questionnaire, and attraction to snack foods was measured with Child's Attraction from the TSFFQ. Moderated regression analyses tested interactions between Restriction and contextual factors in predicting EAH.

RESULTS

EAH was associated with Restriction (r = 0.25, p = .05, 95% CI 0.004 - 0.47). There was an interaction between Restriction and accessibility of snack foods (R² change = 0.08, p = .025); restriction was associated with EAH only when access to snack foods in the home was, on average, higher. The effect of Restriction on EAH was not moderated by frequency of snack food consumption or Child's Attraction.

CONCLUSIONS

These finding have practical relevance and reinforce the importance of the home food environment for managing young children's snack food intake.

Familial aggregation and socio-demographic correlates of taste preferences in European children

Background

Studies on aggregation of taste preferences among children and their siblings as well as their parents are scarce. We investigated the familial aggregation of taste preferences as well as the effect of sex, age, country of residence and education on variation in taste preferences in the pan- European I.Family cohort.

Method

Thirteen thousand one hundred sixty-five participants from 7 European countries, comprising 2,230 boys <12 years, 2,110 girls <12 years, 1,682 boys ≥12 years, 1,744 girls ≥12 years and 5,388 parents, completed a Food and Beverage Preference Questionnaire containing 63 food items representing the taste modalities sweet, bitter, salty and fatty. We identified food items that represent the different taste qualities using factor analysis. On the basis of preference ratings for these food and drink items, a preference score for each taste was calculated for children and parents individually. Sibling and parent-child correlations for taste preference scores were calculated. The proportion of variance in children's preference scores that could be explained by their parents' preference scores and potential correlates including sex, age and parental educational was explored.

Results

Mean taste preferences for sweet, salty and fatty decreased and for bitter increased with age. Taste preference scores correlated stronger between siblings than between children and parents. Children's salty preference scores could be better explained by country than by family members. Children's fatty preference scores could be better explained by family members than by country. Age explained 17% of the variance in sweet and 16% of the variance in fatty taste preference. Sex and education were not associated with taste preference scores.

Conclusion

Taste preferences are correlated between siblings. Country could explain part of the variance of salty preference scores in children which points to a cultural influence on salt preference. Further, age also explained a relevant proportion of variance in sweet and fatty preference scores.

Eating at Food Outlets and "On the Go" Is Associated with Less Healthy Food Choices in Adults: Cross-Sectional Data from the UK National Diet and Nutrition Survey Rolling Programme (2008-2014)

Eating location has been linked with variations in diet quality including the consumption of low-nutrient energy-dense food, which is a recognised risk factor for obesity. Cross-sectional data from 4736 adults aged 19 years and over from Years 1–6 of the UK National Diet and Nutrition Survey (NDNS) Rolling Programme (RP) (2008–2014) were used to explore food consumption patterns by eating location. Eating location was categorized as home, work, leisure places, food outlets and “on the go”. Foods were classified into two groups: core (included in the principal food groups and considered important/acceptable within a healthy diet) and non-core (all other foods). Out of 97,748 eating occasions reported, the most common was home (67–90% of eating occasions). Leisure places, food outlets and “on the go” combined contributed more energy from non-core (30%) than from core food (18%). Analyses of modulating factors revealed that sex, income, frequency of eating out and frequency of drinking were significant factors affecting consumption patterns (p < 0.01). Our study provides evidence that eating patterns, behaviours and resulting diet quality vary by location. Public health interventions should focus on availability and access to healthy foods, promotion of healthy food choices and behaviours across multiple locations, environments and contexts for food consumption.

Sociodemographic factors are associated with dietary patterns in Mexican schoolchildren

OBJECTIVE

Childhood obesity has increased rapidly in Mexico, along with changes in the food environment. However, little is known about the dietary patterns (DP) of Mexican children. We aimed to characterize the DP of schoolchildren and to analyse their associations with sociodemographic factors.

DESIGN

Cross-sectional analysis. Dietary and sociodemographic information was obtained, including a single 24 h recall, socio-economic status (SES), geographic region, area of residence and ethnicity. DP were defined with cluster analysis (using k-means). Multinomial logistic regression models, adjusted for the survey design, were used to assess associations between DP and sociodemographic variables.

SETTING

2012 Mexican National Health and Nutrition Survey (ENSANUT-2012).

SUBJECTS

Schoolchildren (n 2751) aged 5-11 years who participated in ENSANUT-2012.

RESULTS

Four DP were identified: 'Traditional', 'Industrialized', 'Varied' and 'Modern'. Reported energy intake (mean (sd)) was lowest in the 'Traditional' and highest in the 'Industrialized' DP (7037 (3707) kJ/d (1682 (886) kcal/d) v. 8427 (3753) kJ/d (2014 (897) kcal/d), respectively, P<0·05). Significant differences in fat and fibre intakes were seen across DP. Non-indigenous v. indigenous children were 22·0 times (95 % CI 5·1, 93·6) more likely to have a 'Modern' rather than 'Traditional' DP. Relative likelihood of having an 'Industrialized' rather than 'Traditional' DP was 6·2 (95 % CI 3·9, 9·9) among schoolchildren from high SES v. low SES.

CONCLUSIONS

Among Mexican schoolchildren, DP were associated with sociodemographic variables. Non-indigenous children were significantly more likely to consume a 'Modern' than a 'Traditional' DP. Children with higher SES were more likely to have an 'Industrialized' pattern. It is necessary to consider dietary characteristics in the different sociodemographic strata when dietary interventions are designed.

Differences in Mothers' and Children's Dietary Intake during Physical and Sedentary Activities: An Ecological Momentary Assessment Study

BACKGROUND

Physical activity and diet are major modifiable health behaviors contributing to obesity risk. Although patterns of these behaviors tend to cluster within individuals and within family units, it is unknown to what extent healthy and unhealthy dietary intake might differentially accompany sedentary and physical activities in mothers compared with their children.

OBJECTIVE

Our goal was to examine differences in co-occurrence of activities and dietary intake between mothers and children, as measured in real time using ecological momentary assessment.

PARTICIPANTS/SETTING

This study examined cross-sectional data from 175 mothers and their children aged 8 to 12 years.

MAIN OUTCOME MEASURES

Participants completed 8 days of ecological momentary assessment surveys, reporting on whether the following activities had occurred during the past 2 hours: sedentary screen activity, physical activity, and intake of healthy (ie, fruits and vegetables) and unhealthy (ie, fast food, chips/fries, pastries/sweets, and soda/energy drinks) foods.

STATISTICAL ANALYSES PERFORMED

Multilevel logistic regression models estimated the adjusted odds of consuming healthy and unhealthy dietary intake for mothers and children during time periods reporting physical activity (vs no physical activity) or sedentary screen activity (vs no sedentary screen activity). Post hoc tests compared estimates for mothers vs children.

RESULTS

Children were significantly more likely than their mothers to consume unhealthy foods during 2-hour windows that included physical activity (odds ratio [children] 1.85, 95% CI 1.47 to 2.31; odds ratio [mothers] 0.83, 95% CI 0.58 to 1.20; P_diff <0.05), but not sedentary screen activity (P_diff=0.067). In addition, children and their mothers did not differ in their likelihood of consuming healthy foods during 2-hour windows with sedentary screen activity (P_diff =0.497) or physical activity (P_diff =0.170).

CONCLUSIONS

Results indicate that the consumption of unhealthy foods may be more likely to co-occur within a 2-hour window including physical activity in children as compared to their mothers. Future research should examine reasons for this difference, and potential areas for intervention.

Palatable food consumption in children: interplay between (food) reward motivation and the home food environment

To understand the importance of the home food environment on unhealthy food consumption in children high in reward sensitivity, this study tested the hypothesis that the home availability of unhealthy food moderates the effect of reward sensitivity on children's fast-food consumption frequency, exerted via food cue responsiveness. Children between 7.5 and 14 years (n = 174, 50.6% boys) reported on reward sensitivity and food cue responsiveness (by means of the subscale 'external eating'). Their height and weight were measured. Parents reported on their children's fast-food consumption frequency, food cue responsiveness (by means of the subscale 'food responsiveness'), and on the home availability of unhealthy foods. Two moderated mediation models were conducted, one with the parent- and one with the child-reported food cue responsiveness as mediator. Findings suggested that with a high home availability of unhealthy foods, (a) a higher fast-food consumption frequency was found in children high in reward sensitivity and (b) the relation between reward sensitivity and the fast-food consumption frequency was mediated by external eating.

CONCLUSIONS

The findings point at the importance of the home food environment in children high in reward sensitivity. They suggest to limit the home availability of unhealthy foods. What is Known: • Reward sensitivity (RS) is positively associated with children's palatable food consumption • In adolescents, this effect is mediated by food cue responsiveness, which determines the strength of an individual's motivation to obtain food when perceiving food cues What is New: • Children high in RS may be more vulnerable to palatable food cues in their everyday food environment because of a higher food cue responsiveness • The home food environment may be an important determining factor of the palatable food consumption of these children.

Dietary Patterns of European Children and Their Parents in Association with Family Food Environment: Results from the I.Family Study

The aim of this study was to determine whether an association exists between children's  and  parental  dietary  patterns  (DP),  and  whether  the  number  of  shared  meals  or  soft  drink  availability  during  meals  strengthens  this  association.  In  2013/2014  the  I.Family  study  cross-sectionally assessed the dietary intakes of families from eight European countries using 24-h  dietary recalls. Usual energy and food intakes from six- to 16-year-old children and their parents  were estimated based on the NCI Method. A total of 1662 child-mother and 789 child-father dyads  were included; DP were derived using cluster analysis. We investigated the association between  children's and parental DP and whether the number of shared meals or soft drink availability  moderated this association using mixed effects logistic regression models. Three DP comparable in  children and parents were obtained: Sweet &amp; Fat, Refined Cereals, and Animal Products. Children  were more likely to be allocated to the Sweet &amp; Fat DP when their fathers were allocated to the  Sweet &amp; Fat DP and when they shared at least one meal per day (OR 3.18; 95% CI 1.84; 5.47). Being  allocated to the Sweet &amp; Fat DP increased when the mother or the father was allocated to the Sweet  &amp; Fat DP and when soft drinks were available (OR 2.78; 95% CI 1.80; 4.28 or OR 4.26; 95% CI 2.16;  8.41, respectively). Availability of soft drinks and negative parental role modeling are important  predictors of children's dietary patterns.

The Family Home Environment, Food Insecurity, and Body Mass Index in Rural Children

Background. Family homes are a key setting for developing lifelong eating and physical activity habits, yet little is known about how family home nutrition and physical activity (FNPA) environments influence food insecurity (FI) and childhood obesity, particularly in rural settings. Aims. This study examined associations among FNPA, FI, and body mass index (BMI) in rural children. Method. Parents of 186 elementary school–age children completed FNPA and FI surveys. Child anthropometrics were directly measured. Logistic and linear regressions were used to examine associations. Results. Approximately 37% of children were overweight/obese; 43% of families were at risk for FI. Children whose families limited watching TV while eating were less likely to be obese (odds ratio [OR] = 0.56, p = .03) as were children whose families monitored intake of chips, cookies, and candy (OR = 0.54, p = .01). FI was higher in obese than normal weight children (OR = 11.00, p = .003) but only among families not eligible to receive free/reduced-cost school meals. Among eligible families, lower odds of FI were found for those who ate meals together often (OR = 0.31, p = .04) and for those with children frequently enrolled in organized sports/activities (OR = 0.65, p = .04). Findings were not significant after adjusting for multiple comparisons. Discussion. Results suggest that favorable FNPA factors were associated with healthier BMI and lower odds of FI. Conclusion. Opportunities for healthy eating at home may support rural children’s weight health. Additional resources may be necessary to promote food security among low-income families. Future research is warranted to better understand FNPA in relationship to the disproportionate rates of obesity and FI in rural populations.

Fat Tissue Accretion in Children and Adolescents: Interplay between Food Responsiveness, Gender, and the Home Availability of Snacks

The appetitive trait “food responsiveness” is assumed to be a risk factor for adiposity gain primarily in obesogenic environments. So far, the reported results are inconsistent in school-aged children, possibly because these studies did not take into account important moderators such as gender and the food-environment. In order to better inform caregivers, clinicians and the developers of targeted obesity-prevention interventions on the conditions in which food responsiveness precedes adiposity gain, the current study investigated if this relationship is stronger in girls and in children exposed to a higher home availability of energy-dense snacks. Age- and sex-independent Fat and Lean Mass Index z-scores were computed based on air-displacement plethysmography at baseline and after 2 years in a community sample of 129 children (48.8% boys) aged 7.5–14 years at baseline. Parents reported at baseline on children's food responsiveness and the home availability of energy-dense snacks. Food responsiveness was a significant predictor of increases in Fat Mass Index z-scores over 2 years in girls but not boys. The home availability of energy-dense snacks did not significantly moderate the relation of food responsiveness with Fat Mass Index z-score changes. The results suggest that food responsiveness precedes accelerated fat tissue accretion in girls, and may inform targeted obesity-prevention interventions. Further, future research should investigate to which food-environmental parameters children high in food responsiveness mainly respond.

Diet qualities: healthy and unhealthy aspects of diet quality in preschool children

BACKGROUND

Diet quality indexes combine the healthy and unhealthy aspects of diet within a single construct, but few studies have evaluated their association. Emerging evidence suggests that predictors differ for the more and less healthy components of children's diets.

OBJECTIVES

Our objectives were to determine whether preschool-aged children's frequency of eating healthy foods was inversely related to their intake of unhealthy foods and to determine whether this differed by household income, maternal education, or child race-ethnicity.

DESIGN

We analyzed data from a representative sample of 8900 US children (mean age: 52.5 mo) who were born in 2001 and participated in the Early Childhood Longitudinal Study-Birth Cohort. Primary caregivers reported the frequency with which children consumed fruit, vegetables, milk, juice, sugar-sweetened beverages (SSBs), fast food, sweets, and salty snacks in the past week. Response options ranged from none to ≥4 times/d. We created healthy (fruit, vegetables, milk) and unhealthy (SSBs, fast food, sweets, salty snacks) diet scores. Healthy diet behaviors were defined as ≥2 daily servings of fruit, vegetables, and milk.

RESULTS

The prevalence of consuming fruit, vegetables, and milk ≥2 times/d (i.e., having 3 healthy diet behaviors) was 18.5%, and a similar proportion (17.6%) of children had none of these healthy behaviors. Contrary to our hypotheses, children with more healthy diet behaviors did not have lower unhealthy diet scores. The intake of healthy foods was not inversely associated with unhealthy foods overall or within any subgroup. Overall, the Spearman rank correlation between healthy and unhealthy diet scores was positive (r = 0.09). From the lowest to the highest strata of household income, these correlations were 0.12, 0.14, 0.14, 0.05, and 0.00, respectively.

CONCLUSIONS

No evidence was found in US preschool-aged children of an inverse association between eating healthy and unhealthy foods. The implications of combining healthy and unhealthy aspects of diet quality within an overall index should be considered by researchers.

Adolescents' non-core food intake: a description of what, where and with whom adolescents consume non-core foods

OBJECTIVE

Little is known about adolescents' non-core food intake in the UK and the eating context in which they consume non-core foods. The present study aimed to describe types of non-core foods consumed by British adolescents in total and across different eating contexts.

DESIGN

A descriptive analysis, using cross-sectional data from food diaries. Non-core foods were classified based on cut-off points of fat and sugar from the Australian Guide to Healthy Eating. Eating context was defined as 'where' and 'with whom' adolescents consumed each food. Percentages of non-core energy were calculated for each food group in total and across eating contexts. A combined ranking was then created to account for each food's contribution to non-core energy intake and its popularity of consumption (percentage of consumers).

SETTING

The UK National Diet and Nutrition Survey 2008-2011.

SUBJECTS

Adolescents across the UK aged 11-18 years (n 666).

RESULTS

Non-core food comprised 39·5 % of total energy intake and was mostly 'Regular soft drinks', 'Crisps & savoury snacks', 'Chips & potato products', 'Chocolate' and 'Biscuits'. Adolescents ate 57·0 % and 51·3 % of non-core food at 'Eateries' or with 'Friends', compared with 33·2 % and 32·1 % at 'Home' or with 'Parents'. Persistent foods consumed across eating contexts were 'Regular soft drinks' and 'Chips & potato products'.

CONCLUSIONS

Regular soft drinks contribute the most energy and are the most popular non-core food consumed by adolescents regardless of context, and represent a good target for interventions to reduce non-core food consumption.

Early determinants of food liking among 5y-old children: a longitudinal study from the EDEN mother-child cohort

Background

Identifying the determinants of child’s liking for different foods may help to prevent future choices of unhealthy food.

Objective

To study early-life food-related characteristics associated with child’s liking for different foods at 5y with a longitudinal study.

Design

1142 5y- old children completed a liking test for “fruit and vegetables”, “meat, fish and eggs”, desserts and cheese. Data related to maternal food intake before pregnancy, infant feeding during the first year of life, maternal feeding practices at 2y, child’s food intake at 3y, and child’s food neophobia from 1 to 4y were collected prospectively from the mother. The associations between these factors and child‘s liking for each category of foods were analyzed using structural equation modelling.

Results

High food neophobia at 4 y was related to lower child’s liking for all food groups. Maternal feeding practices at 2y were associated with liking for dessert: negatively for the practices allowing child to control his/her own food intake, positively for restriction of child’s food intake for weight reasons. Moreover, child’s food intake at 3y was positively associated with child’s liking for “fruit and vegetables” as well as for cheese. Finally, adherence to the infant feeding pattern “long breastfeeding, later introduction of main meal components and use of home-made products” was positively associated with child’s liking for meat/fish/eggs.

Conclusions

For all food groups, food neophobia was a common determinant of child’s liking for food at 5y, whereas other factors were associated with food liking for specific food groups.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0342-5) contains supplementary material, which is available to authorized users.

Fundamental constructs in food parenting practices: a content map to guide future research

Although research shows that "food parenting practices" can impact children's diet and eating habits, current understanding of the impact of specific practices has been limited by inconsistencies in terminology and definitions. This article represents a critical appraisal of food parenting practices, including clear terminology and definitions, by a working group of content experts. The result of this effort was the development of a content map for future research that presents 3 overarching, higher-order food parenting constructs--coercive control, structure, and autonomy support--as well as specific practice subconstructs. Coercive control includes restriction, pressure to eat, threats and bribes, and using food to control negative emotions. Structure includes rules and limits, limited/guided choices, monitoring, meal- and snacktime routines, modeling, food availability and accessibility, food preparation, and unstructured practices. Autonomy support includes nutrition education, child involvement, encouragement, praise, reasoning, and negotiation. Literature on each construct is reviewed, and directions for future research are offered. Clear terminology and definitions should facilitate cross-study comparisons and minimize conflicting findings resulting from previous discrepancies in construct operationalization.

Fat, sugar and water intakes among families from the IDEFICS intervention and control groups: first observations from I.Family

BACKGROUND

The objective of this paper is to investigate differences in diets of families in intervention versus control communities 5 years after the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants intervention ended.

METHODS

Altogether, 4,691 families from the I.Family study with at least one participating parent and one child are included in this analysis. Diet quality indicators, defined as propensities to consume fat, sugar, water and fruit and vegetables, are calculated from a 59-item food frequency questionnaire. Multilevel linear models with random intercepts for study centre are used to determine whether mean diet indicators, calculated at the family level, differed as a function of previous exposure to the intervention.

RESULTS

Families in the intervention communities reported a significantly lower sugar propensity (19.8% vs. 20.7% of total food items, p < 0.01) and a higher water propensity (47.3% vs. 46.0% of total beverages, p < 0.05) compared with families in the control communities, while fat and fruit and vegetables propensities were similar. No significant diet differences between intervention and control children were present at the Identification and Prevention of Dietary- and Lifestyle-Induced Health Effects in Children and Infants baseline.

DISCUSSION

This result indicates better diet quality in intervention families, which was not present in children when their diets were assessed before the intervention, and gives some cause for optimism regarding the sustainability of some aspects of the diet intervention.

Family Health Climate and Adolescents' Physical Activity and Healthy Eating: A Cross-Sectional Study with Mother-Father-Adolescent Triads

INTRODUCTION

The importance of the family environment for children's and adolescents' health behavior has been demonstrated, the underlying mechanisms of this influence remain unclear. Therefore, the aim of the study was to investigate the relationship between family environmental and individual determinants. It was hypothesized that the Family Health Climate (FHC) is associated with adolescents' physical activity and dietary behavior and that intrinsic motivation mediates this association.

METHODS

Cross-sectional data were collected from 198 families (mother, father, and child) using questionnaires. Perceptions of FHC of mothers, fathers, and their children were assessed using the FHC-scales for physical activity (FHC-PA) and nutrition (FHC-NU). The adolescents also rated their intrinsic motivation for exercise and healthy eating, their physical activity and consumption of healthful food. A structural equation model was analyzed and a bootstrapping procedure was used to test direct and indirect effects.

RESULTS

The FHC-PA was related to the amount of weekly physical activity and the FHC-NU to the consumption of fruit, vegetables and salad. These effects were mediated by adolescents' intrinsic motivation; the indirect effects were significant for both behaviors.

DISCUSSION

These results emphasize the importance of the FHC in shaping adolescents' physical activity and dietary behavior. Individual motivational factors are potential mediators of family and parental influences. Considering family-level variables and their interaction with individual factors contributes to the understanding of adolescents' health behavior.

Conceptual framework of a simplified multi-dimensional model presenting the environmental and personal determinants of cardiometabolic risk behaviors in childhood

Clinical manifestations of cardiometabolic risk (CMR) may be set early in childhood due to unfavorable behaviors or lifestyle patterns related to diet and physical activity. Several factors may determine the adoption of such lifestyle-related behaviors, which researchers have tried to cluster under certain frameworks or models. In this context, the framework developed and proposed by this review gathers all the present knowledge regarding these determining factors to date and groups them into three main categories related to personal characteristics and the social and physical environment. Based on the proposed framework, a large variety of personal, social and physical environmental factors can positively or negatively influence CMR-related behaviors (either directly or indirectly via their interrelations), thus leading to decreased or increased risk, respectively. This framework could be of great value to public health policy makers and legislators for designing and implementing interventional programs tailored to the needs of susceptible population groups who are most in need for such initiatives. Targeting the correlates as potential determinants of CMR-related behaviors, and not just on the behaviors themselves, has been shown previously to be the most effective approach for tackling health issues related to CMR starting from early life stages.

Socio-economic position as a moderator of 9–13-year-old children’s non-core food intake

Objective

There is limited understanding as to why children of low socio-economic position (SEP) consume poorer diets than children of high SEP. Evidence suggests that determinants of dietary intake may differ between SEP groups. The present study aimed to determine if SEP moderated associations of personal and environmental predictors with children’s non-core food and sweetened drink intakes and unhealthy dietary behaviours.

Design

Children completed online questionnaires and parents completed computer-assisted telephone interviews to assess intrapersonal and environmental dietary predictors. Dietary intake was measured using an FFQ. Parents reported demographic information for maternal education, occupation and employment, and household income.

Setting

Twenty-six primary schools in South Australia, Australia.

Subjects

Children aged 9–13 years and their parents (n 395).

Results

Multiple personal and home environment factors predicted non-core food and sweetened drink intakes, and these associations were moderated by SEP. Maternal education moderated associations of girls’ sweetened drink intake with self-efficacy, cooking skills and pressure to eat, and boys’ non-core food intake with monitoring, parent’s self-efficacy and home environment. Maternal occupation and employment moderated associations of sweetened drink intake with attitudes, self-efficacy, pressure to eat and food availability, and non-core food intake with parents’ self-efficacy and monitoring. Income moderated associations with pressure to eat and home environment.

Conclusions

Identifying differences in dietary predictors between socio-economic groups informs understanding of why socio-economic gradients in dietary intake may occur. Tailoring interventions and health promotion to the particular needs of socio-economically disadvantaged children may produce more successful outcomes and reduce socio-economic disparities in dietary intake.

The Role of Parents' Critical Thinking About Media in Shaping Expectancies, Efficacy and Nutrition Behaviors for Families

A convenience survey completed online by 137 4-H parents in Washington state explored their orientation toward critical thinking regarding media sources and content and its implications for family dietary behaviors. Parents' critical thinking toward media sources predicted their information efficacy about content. Critical thinking toward media content predicted information efficacy about sources, expectancies for parental mediation, and expectancies for family receptiveness to lower-fat dietary changes. Expectancies for receptiveness to dietary changes and expectancies for parental mediation predicted efficacy for implementing healthy dietary practices; this strongly predicted healthy dietary practices. Media-related critical thinking, therefore, indirectly but consistently affected self-reported family dietary behaviors through its effects on efficacy for managing media and expectancies for the family's receptiveness to healthy dietary changes. The results suggest parents' media literacy skills affect their family's dietary behavior. Health campaigns that help parents interpret and manage the media environment may benefit all family members.