Trends in fruit, vegetable and salad intakes in 9-10-year-old schoolchildren living in Liverpool, 2000-2005

A Biopsychosocial Model of Sex Differences in Children's Eating Behaviors

The prevalence of obesity and eating disorders varies by sex, but the extent to which sex influences eating behaviors, especially in childhood, has received less attention. The purpose of this paper is to critically discuss the literature on sex differences in eating behavior in children and present new findings supporting the role of sex in child appetitive traits and neural responses to food cues. In children, the literature shows sex differences in food acceptance, food intake, appetitive traits, eating-related compensation, and eating speed. New analyses demonstrate that sex interacts with child weight status to differentially influence appetitive traits. Further, results from neuroimaging suggest that obesity in female children is positively related to neural reactivity to higher-energy-dense food cues in regions involved with contextual processing and object recognition, while the opposite was found in males. In addition to differences in how the brain processes information about food, other factors that may contribute to sex differences include parental feeding practices, societal emphasis on dieting, and peer influences. Future studies are needed to confirm these findings, as they may have implications for the development of effective intervention programs to improve dietary behaviors and prevent obesity.

Time trends in adherence to UK dietary recommendations and associated sociodemographic inequalities, 1986-2012: a repeated cross-sectional analysis

Background/objectives

Little is known about time trends in diet quality and associated inequalities in the UK. This study aimed to examine trends in adherence to four UK dietary recommendations, overall and among sociodemographic subgroups, from 1986 to 2012.

Subjects/methods

We conducted a repeated cross-sectional analysis using data from three UK diet surveys: Dietary and Nutritional Survey of British Adults 1986–87 (n = 2018), National Diet and Nutrition Survey (NDNS) 2000–01 (n = 1683) and NDNS Rolling Programme 2008–12 (n = 1632). We measured adherence to dietary recommendations for fruit and vegetables, salt, oily fish, and red and processed meat, estimated using food diary record data. We compared adherence across surveys and by four sociodemographic characteristics: sex, age, socioeconomic position and ethnicity.

Results

Overall, population adherence to dietary recommendations was low to moderate, but improved over time. There were inequalities in adherence to all recommendations at all timepoints according to one or more sociodemographic characteristic. When inequalities were present, women, older adults, those with non-manual occupations and non-Whites were more likely to adhere to dietary recommendations. Although some dietary inequalities declined, most persisted across the three surveys.

Conclusions

The persistence of most inequalities highlights the need for further interventions to reduce dietary inequalities as well as improve overall population diet. The greatest simultaneous improvement in population adherence and reduction of inequalities was observed for salt, which may reflect the success of the UK Salt Reduction Programme. Similarly comprehensive programmes should be encouraged for other dietary components.

Worldwide burden of gastric cancer in 2012 that could have been prevented by increasing fruit and vegetable intake and predictions for 2025

The regional and temporal variation in patterns of fruit and vegetable intake contributes to differences in the impact on gastric cancer burden across regions and over the years. We aimed to estimate the proportion and absolute number of gastric cancer cases that could have been prevented in 2012 with an increase in fruit and vegetable intake up to the levels defined by the Global Burden of Disease as the theoretical minimum-risk exposure distribution (300 and 400 g/d, respectively), as well as the corresponding figures expected for 2025. Preventable fractions (PF) were computed for 161 countries, using data on fruit and vegetable availability in 1997 and 2010 and published estimates of the magnitude of the association between fruit and vegetable intake and gastric cancer, assuming a time lag of approximately 15 years. Countries classified as very high Human Development Index (HDI) presented median PF in 2012 much lower than low-HDI countries for both fruits (3·0v.10·2 %,P<0·001) and vegetables (6·0v.11·9 %,P<0·001). For vegetables only, PF significantly decreased until 2025 in most settings; however, this corresponded to a reduction in the absolute number of preventable gastric cancer cases in less than half of the countries. Increasing fruit and vegetable intake would allow preventing a relatively high proportion of gastric cancer cases, mostly in developing countries. Although declines in PF are predicted in the near future, changes in order to achieve healthier lifestyles may be insufficient to overcome the load of demographic variation to further reduce the gastric cancer burden.

Ten-year changes in positive and negative marker food, fruit, vegetables, and salad intake in 9-10 year olds: SportsLinx 2000-2001 to 2010-2011

BACKGROUND

To investigate changes in intakes of 'negative' and 'positive' foods, fruit, vegetables, and salad in serial cohorts of 9-10-year-old children from 2000-2001 to 2010-2011.

METHODS

For this serial, cross-sectional study, children in school year 5 (9-10 years of age) completed the SportsLinx Lifestyles Survey [n = 30,239 (15,336 boys and 14,903 girls)]. Changes in positive and negative food scores, and the proportion of boys and girls reportedly consuming fruit, vegetables and salad on the previous day to surveying, were investigated annually from 2000 to 2011.

RESULTS

The consumption of negative foods declined and positive foods increased significantly compared to baseline. Positive changes in fruit, vegetables and salad consumption were observed over time, with the most recent cohort more likely to consume fruit, vegetables and salad compared to the 2000-2001 baseline. Girls displayed more favourable positive and negative food scores and were more likely to consume fruit, salad and vegetables across several study years compared to boys.

CONCLUSIONS

The consumption of negative and positive foods, fruit, vegetables, and salad has improved over the last 10 years. In addition, girls appear to have better positive and negative food scores, and were more likely to consume fruit, vegetables and salad, across a number of study years or cohorts compared to boys. These encouraging findings suggest that children's food intake has improved since 2000. Furthermore, the data indicate that boys and girls may require separate or different healthy eating messages to further improve food intake.

Promoting healthy weight in primary school children through physical activity and nutrition education: a pragmatic evaluation of the CHANGE! randomised intervention study

BACKGROUND

This pragmatic evaluation investigated the effectiveness of the Children's Health, Activity and Nutrition: Get Educated! (CHANGE!) Project, a cluster randomised intervention to promote healthy weight using an educational focus on physical activity and healthy eating.

METHODS

Participants (n = 318, aged 10-11 years) from 6 Intervention and 6 Comparison schools took part in the 20 weeks intervention between November 2010 and March/April 2011. This consisted of a teacher-led curriculum, learning resources, and homework tasks. Primary outcome measures were waist circumference, body mass index (BMI), and BMI z-scores. Secondary outcomes were objectively-assessed physical activity and sedentary time, and food intake. Outcomes were assessed at baseline, at post-intervention (20 weeks), and at follow-up (30 weeks). Data were analysed using 2-level multi-level modelling (levels: school, student) and adjusted for baseline values of the outcomes and potential confounders. Differences in intervention effect by subgroup (sex, weight status, socio-economic status) were explored using statistical interaction.

RESULTS

Significant between-group effects were observed for waist circumference at post-intervention (β for intervention effect =-1.63 (95% CI = -2.20, -1.07) cm, p<0.001) and for BMI z-score at follow-up (β=-0.24 (95% CI = -0.48, -0.003), p=0.04). At follow-up there was also a significant intervention effect for light intensity physical activity (β=25.97 (95% CI = 8.04, 43.89) min, p=0.01). Interaction analyses revealed that the intervention was most effective for overweight/obese participants (waist circumference: β=-2.82 (95% CI = -4.06, -1.58) cm, p<0.001), girls (BMI: β=-0.39 (95% CI = -0.81, 0.03) kg/m2, p=0.07), and participants with higher family socioeconomic status (breakfast consumption: β=8.82 (95% CI = 6.47, 11.16), p=0.07).

CONCLUSIONS

The CHANGE! intervention positively influenced body size outcomes and light physical activity, and most effectively influenced body size outcomes among overweight and obese children and girls. The findings add support for the effectiveness of combined school-based physical activity and nutrition interventions. Additional work is required to test intervention fidelity and the sustained effectiveness of this intervention in the medium and long term.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN03863885.

Trend in eating habits among Lithuanian school-aged children in context of social inequality: three cross-sectional surveys 2002, 2006 and 2010

Background

Intermittent monitoring of food intake at the population level is essential for the planning and evaluation of national dietary intervention programs. Social-economic changes in Lithuania have likely affected dietary habits, but only a limited number of temporal studies on food intake trends among young population groups have been published. The aim of this study was to investigate changes in eating habits among Lithuanian school-aged children from 2002 to 2010, and to explore the association of these changes with the respondents' reported socio-economic status (SES).

Methods

We used Lithuanian data from the cross-national Health Behaviour in School-aged Children (HBSC) study collected in 2002, 2006 and 2010. Analyses were conducted on comparable questionnaire-based data from children aged 11, 13 and 15 (total n = 17,189) from a random sample of schools. A food frequency questionnaire was used to investigate frequencies of food consumption. Logistic regression was used to examine the affects of changing social variables on reported diet trends.

Results

In Lithuania, school-aged children have low intakes of fruits and vegetables. Only 21.1% of boys and 27.1% of girls reported daily fruit consumption. Similarly, 24.9% of boys and 29.6% of girls disclosed vegetable intake at least once daily. Comparing 2010 to 2002, the proportion of girls who consumed fruits daily increased from 24.2% to 31.0% (p < 0.001) but the proportion of boys who consumed vegetables daily decreased from 29.3% to 23.1% (p < 0.001). In 2006, for both sexes, there were observed increases in regular (at least five days a week) intake of sweets and chocolates, biscuits and pastries, and soft drinks; however, in the next survey (2010) these figures decreased. In addition, between 2006 and 2010, a substantial decrease in regular consumption of chips and fast food was also detected. Fruit and vegetable consumption as well as intake of sweets and chocolates, biscuits and pastries and soft drinks increased with family social-economic status and family material wealth. Trends in consumption of fruits, and other foods, and their association with changing social variables were demonstrated using the ORs estimated by three logistic models, using 2002 as the reference point. Changes in social variables from 2002 to 2010 affected the likelihood of daily consumption of fruits among boys by 22.5% (the corresponding OR decreased from 1.11 to 0.86) and among girls by 34.0% (the corresponding OR decreased from 1.41 to 1.12). Over the study period, changing social variables had little impact on the daily consumption of vegetables and other foods.

Conclusions

Based on the food consumption trends observed in Lithuania, increases in consumption of fruits and vegetables should be promoted, along with a reduction in the intake of less healthy choices, such as soft drinks and high-fat, high-sugar snack foods, by diminishing social inequalities in food consumption.

Differences in fruit and vegetable intake and their determinants among 11-year-old schoolchildren between 2003 and 2009

BACKGROUND

Fruit and vegetable (FV) intake in children in the Netherlands is much lower than recommended. Recurrent appraisal of intake levels is important for detecting changes in intake over time and to inform future interventions and policies. The aim of the present study was to investigate differences in fruit and vegetable intake, and whether these could be explained by differences in potential determinants of FV intake in 11-year-old Dutch schoolchildren, by comparing two school samples assessed in 2003 and 2009.

METHODS

For 1105 children of the Pro Children study in 2003 and 577 children of the Pro Greens study in 2009 complete data on intake and behavioural determinants were available. The self-administered questionnaire included questions on children's ethnicity, usual fruit and vegetable intake, mother's educational level, and important potential determinants of fruit and vegetable intake.Multiple regression analysis was applied to test for differences in intake and determinants between study samples. Mediation analyses were used to investigate whether the potential mediators explained the differences in intake between the two samples.

RESULTS

In 2009, more children complied with the World Health Organization recommendation of 400 g fruit and vegetables per day (17.0%) than in 2003 (11.8%, p = 0.004). Fruit consumption was significantly higher in the sample of 2009 than in the sample of 2003 (difference = 23.8 (95%CI: 8.1; 39.5) grams/day). This difference was mainly explained by a difference in the parental demand regarding their child's intake (23.6%), followed by the child's knowledge of the fruit recommendation (14.2%) and parental facilitation of consumption (18.5%). Vegetable intake was lower in the 2009 sample than in the 2003 sample (12.3 (95%CI -21.0; -3.6). This difference could not be explained by the assessed mediators.

CONCLUSIONS

The findings indicate that fruit intake among 11-year-olds improved somewhat between 2003 and 2009. Vegetable intake, however, appears to have declined somewhat between 2003 and 2009. Since a better knowledge of the recommendation, parental demand and facilitation explained most of the observed fruit consumption difference, future interventions may specifically address these potential mediators. Further, the provision of vegetables in the school setting should be considered in order to increase children's vegetable intake.

Direct and indirect association between environmental factors and fruit intake, mediation by psychosocial factors: the Pro Children study

OBJECTIVES

To explore direct associations between home and school availability of fruit and fruit intake, and the mediating role of attitude towards fruit, liking, perceived barriers and self-efficacy.

DESIGN

Cross-sectional study.

SETTING

Primary schools in nine European countries.

SUBJECTS

Within the Pro Children study, data were collected on perceived home and school availability of fruit, psychosocial factors related to fruit intake and its frequency among 13 305 11-year-old schoolchildren.

RESULTS

Significant overall associations were found between child-reported home availability of fruit and fruit intake in all countries and in the total sample. School availability of fruit was associated with fruit intake in the pooled sample and in country-specific analyses in Sweden and the Netherlands. Liking (13·2-49·4 %) and self-efficacy (14·0-25·1 %) were the strongest mediators in the home availability-fruit intake relationship, but there was also a direct association between home availability and fruit intake, except in Spain and the Netherlands. Mediating pathways of the school availability-fruit intake relationship could only be assessed for Norway, Sweden and the total sample. Attitude was a significant mediator in Norway (80·4 %) and in Sweden (25·3 %), while in the total sample also liking (38·7 %) and self-efficacy (23·0 %) were identified as significant mediators.

CONCLUSIONS

The association between home availability of fruit and fruit intake is at least partly mediated by personal factors such as liking and self-efficacy indicates that fruit intake is not a complete automatic or unconscious behaviour.

Vegetable intake in Korea: data from the Korean National Health and Nutrition Examination Survey 1998, 2001 and 2005

The purpose of the present study was to analyse vegetable intake by the Korean population based on different meal formats. Twenty-four-hour dietary recall data from the Korean National Health and Nutrition Examination Survey were used to assess daily vegetable intake and consumption ratio of vegetables for different meal types/dining locations. Analysis was stratified by sex and age group. Daily vegetable intake increased from 293.5 g in 1998 to 305.7 g in 2001 and to 335.9 g in 2005. Findings were similar in men and women, as well as in each age group. Analyses for each meal type revealed that vegetable intake during breakfast did not substantially change, but vegetable intake increased during lunch and dinner. While vegetable consumption ratio during breakfast decreased, it increased during lunch and snack time. Men and women showed similar change in the analysis for meal types and dining locations. There were some differences between the age groups in daily vegetable intake depending on the meal type. Another notable observation was the increasing change of vegetable intake during lunch and during meals eaten at cafeterias and restaurants in all the age groups. Analysis of vegetable consumption ratio showed an increased consumption in cafeterias, restaurants, and other places and decreased vegetable intake at home for those aged 16-64 years with time. Since this change may be related to improvements in socioeconomic status, it will be necessary to further investigate difference in vegetable intake based on socioeconomic levels within the population.

Greenlandic schoolchildren's compliance with national dietary guidelines

OBJECTIVE

The aim of the present study was to examine to what extent children and adolescents in Greenland comply with the national dietary guidelines, and to analyse the influence of habitation and family affluence on the compliance with dietary guidelines.

DESIGN

Data were from the Health Behaviour in School-aged Children (HBSC) survey in Greenland. The 2006 survey included 2462 students aged 11 to 17 years.

RESULTS

The proportion of students complying with the national dietary guidelines varied from 14 % to 87 % depending on the food item. Sweets and soft drinks had the lowest compliance. The oldest children had the following characteristics compared with the younger children: fewer ate traditional Greenlandic foods, fewer ate fruit, fewer ate breakfast daily on school days and more drank soft drinks frequently. More boys than girls ate traditional Greenlandic foods often, while more girls ate vegetables daily. The least favourable eating habits in general were found among children from low affluent families and children in villages.

CONCLUSIONS

Many Greenlandic schoolchildren did not comply with the national dietary guidelines. Despite a higher intake of traditional foods as a whole, children in villages and less affluent children were less likely to comply with guidelines. A strong relationship between diet, family affluence and availability was found. The study findings indicate that factors such as availability, cost and seasonal variation are important to the intake of both imported and traditional Greenlandic foods. The findings should be taken into consideration when promoting the national guidelines.

How to find information on national food and nutrient consumption surveys across Europe: systematic literature review and questionnaires to selected country experts are both good strategies

The present research was conducted within the framework of the EURopean micronutrient RECommendations Aligned project. In order to identify the best practice in assessing nutrient intakes, a search strategy for collecting data from national food consumption surveys/studies in Europe was developed. Systematic literature searches were carried out on twenty-eight European and the four European Free Trade Association countries. A questionnaire was also sent to two to five experts in each country. Systematic reviews using PubMed yielded 12 703 abstracts that were reduced to 200 studies using inclusion and exclusion criteria. Similarly, a search of ministry web sites yielded 3033 hits, and subsequently reduced to nine surveys. Belgium, France, Germany, Ireland, Sweden, Spain and the United Kingdom were the countries with most data and Slovenia and Liechtenstein were those with the least. Seventy-eight expert questionnaires were obtained from all countries except for Liechtenstein, Luxembourg and Slovakia. Detailed results and references are given. A systematic search and questionnaires are equally good at identifying national surveys across countries. Literature searching provides globally accessible and objective information albeit limited, whereas the questionnaire provides information that, depending upon responders, can be more complete. A combination of both strategies is recommended.

Secular trends in fruit intake among Danish schoolchildren, 1988 to 2006: changing habits or methodological artefacts?

BACKGROUND

Intermittent monitoring of fruit and vegetable intake at the population level is essential for the evaluation and planning of national dietary interventions. Yet, only a limited number of studies on time trends in fruit and vegetable intake among children and adolescents have been published internationally. In Denmark, national comprehensive campaigns to enhance fruit and vegetable consumption were initiated in 2001. This paper describes secular trends in fruit intake among Danish adolescents by six comparable school surveys from 1988 to 2006. The paper demonstrates and discusses the consequences of measurement changes introduced in long-term trend analyses.

METHODS

We used Danish data from the international Health Behaviour in School-aged Children (HBSC) study collected in 1988, 1991, 1994, 1998, 2002 and 2006. Analyses were conducted on comparable questionnaire-based data from students aged 11, 13 and 15 total (n = 23,871) from a random sample of schools. Data on fruit intake were measured by a food frequency questionnaire. Due to changes in number of response categories beween surveys, different cut-points were analysed.

RESULTS

The prevalence of students eating fruit at least once daily ranged from 78.3% among 13-year-old girls in 1988 to 17.3% among 15-year-old boys in 2002. Based on the six data collections, analyses of trends showed a significant decrease in prevalence of students eating fruit at least once daily from 1988 to 2002 (all p-values < 0.0001). In all age and gender groups, a significant increase in intake occurred between 2002 and 2006 (all p-values < 0.0065). Analyses of alternative cut-points revealed similar results.

CONCLUSION

Fruit consumption among Danish schoolchildren decreased from 1988 to 2002 with an increase since 2002. We suggest that the increase may be attributable to a nation-wide initiative conducted in Denmark since 2001 to increase the intake of fruit and vegetables in the population. Still, the results imply that a substantial proportion of Danish schoolchildren do not meet the nationally recommended daily intake of fruit. Our analyses indicate that the observed trends are not solely caused by methodological biases related to changes in measurements.

Portion size selection of fruits and vegetables by 9- to 10-year-old children in Liverpool

BACKGROUND

It is important to promote the intake of fruit and vegetables but it is not clear how children interpret the term 'portion'. The aim of this study was to describe portion sizes of various fruits and vegetables selected by primary school children.

METHODS

A cross-sectional study collected data on children's self-selected portions of fruits and vegetables. Forty-three boys and 52 girls aged 9-10 years attending after school food clubs in Liverpool took part. Children placed a 'portion' of each fruit and vegetable into an empty bowl which was weighed using digital scales accurate to 1 g.

RESULTS

Mean portion sizes ranged from 126 g for satsumas to 61 g for peas but there were no significant differences between boys and girls. Portions of fruits were larger than portions of vegetables and although there were statistically significant correlations between the portion sizes selected by individual children they were not particularly strong.

CONCLUSIONS

These children had all taken part in activities promoting '5-a-day' but their perception of 'a portion' varied enormously. It is recommended that children receive targeted activities to help them improve their understanding of what constitutes a 'portion'.