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Masento NA, Dulay KM, Roberts AP, Harvey K, Messer D, Houston-Price C. See and Eat! The impact of repeated exposure to vegetable ebooks on young children's vegetable acceptance. Appetite 2023; 182:106447. [PMID: 36623774 DOI: 10.1016/j.appet.2022.106447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/30/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
Vegetable consumption in young children in the UK is well below the recommended five child-sized portions per day. Effective and practical strategies are therefore needed to encourage vegetable consumption in young children. In this exploratory study, we examine the effects of visual familiarization to foods via See & Eat ebooks, which show vegetables on their journey from 'field to fork'. As part of a larger study, in which 242 British families completed a range of measures about their family's eating habits, child's food preferences and potential parent and child predictors of these (Masento et al., 2022), parents were invited to download a See & Eat ebook about a vegetable their child did not eat. Thirty-six families participated in the intervention, looking at the ebook with their child for two weeks and reporting on their child's willingness to taste, intake and liking of the vegetable targeted by the ebook and a matched control vegetable before and after the intervention period. Results showed significant increases in parental ratings of children's acceptance of the target vegetable. Willingness to taste and intake ratings improved for the target vegetable, but not the control vegetable, while liking was reported to increase for both vegetables. These results corroborate previous research demonstrating the benefits of familiarising children with vegetables before they are offered at mealtimes and suggest that ebooks can be added to the set of tools parents can use to support children's vegetable consumption.
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Affiliation(s)
- Natalie A Masento
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | | | - Alan P Roberts
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - Kate Harvey
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | - David Messer
- Open University, Faculty of Wellbeing, Education & Language Studies, Open University, UK
| | - Carmel Houston-Price
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK.
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Roberts AP, Cross L, Hale A, Houston-Price C. VeggieSense: A non-taste multisensory exposure technique for increasing vegetable acceptance in young children. Appetite 2021; 168:105784. [PMID: 34748876 DOI: 10.1016/j.appet.2021.105784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 10/24/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
Vegetable consumption falls well below recommended levels for children in the UK. Previous research has found that repeated non-taste sensory exposure over the course of several days increases young children's willingness to touch and taste vegetables. The current study examined the impact of a one-off multisensory non-taste exposure intervention that took place on a single day on children's willingness to taste and intake of the exposed vegetables. Children (N = 110) aged 3- to 4-years-old were assigned to one of three intervention groups or to a control group. Children in all groups participated individually in a single activity session delivered in their nursery. Children in the intervention conditions took part in fun activities that provided either (a) visual exposure, (b) smell and visual exposure, or (c) smell, touch and visual exposure to six raw and prepared vegetables. Children in the control group engaged in a visual exposure activity with non-food items. After the exposure activities, all children were offered the prepared vegetables to eat; their willingness to taste and intake of the vegetables were measured. Results confirmed previous findings of sensory exposure activities increasing children's willingness to taste and intake of vegetables and revealed linear trends in both measures of acceptance with the number of senses engaged; children who took part in smell, touch and visual activities showed the highest level of acceptance. Findings suggest that multisensory exposures are effective in increasing consumption of vegetables in young children and that the effect of sensory exposure to healthy foods may be cumulative, with the more senses engaged prior to offering a food, the better.
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Affiliation(s)
- Alan Parry Roberts
- School of Psychology and Clinical Language Sciences, University of Reading, Earley, Reading, RG6 6BZ, UK.
| | - Lara Cross
- School of Psychology and Clinical Language Sciences, University of Reading, Earley, Reading, RG6 6BZ, UK
| | - Amy Hale
- School of Psychology and Clinical Language Sciences, University of Reading, Earley, Reading, RG6 6BZ, UK
| | - Carmel Houston-Price
- School of Psychology and Clinical Language Sciences, University of Reading, Earley, Reading, RG6 6BZ, UK
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Ashton LM, Morgan PJ, Grounds JA, Young MD, Rayward AT, Barnes AT, Pollock ER, Kennedy SL, Saunders KL, Collins CE. Dietary Outcomes of the 'Healthy Youngsters, Healthy Dads' Randomised Controlled Trial. Nutrients 2021; 13:3306. [PMID: 34684307 PMCID: PMC8541030 DOI: 10.3390/nu13103306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022] Open
Abstract
(1) Background: The effect of fathers on dietary intake in preschool-aged children is under-explored. The aims were to: (i) evaluate the efficacy of a family-based lifestyle intervention, Healthy Youngsters, Healthy Dads, on change in dietary intake in fathers and their preschool-aged children post-intervention (10 weeks) and at 9 months follow-up compared to a waitlist control group and (ii) investigate associations in father-child dietary intakes. (2) Methods: Linear mixed models estimated group-by-time effects for all dietary outcomes, measured by food frequency questionnaires. Cohen's d determined effect sizes, while correlation tests determined associations in father-child dietary intakes. (3) Results: For children, medium group-by-time effects sizes were identified at 10 weeks for sodium intake (d = 0.38) and percentage energy from core foods (d = 0.43), energy-dense, nutrient-poor (EDNP) foods (d = 0.43) and prepacked snacks (d = 0.45). These findings were sustained at 9 months follow-up. For fathers, medium to large, group-by-time effect sizes were identified at 10 weeks for energy intake (d = 0.55), sodium intake (d = 0.64) and percentage energy from core foods (d = 0.49), EDNP foods (d = 0.49), and confectionary (d = 0.36). For all of these dietary variables, except sodium, effects were sustained at 9 months. Moderate to strong associations existed in father-child dietary intakes for some of the dietary variables. (4) Conclusions: Although further research is required, this study provides preliminary support for targeting fathers as agents of change to improve dietary intakes in their preschool-aged children.
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Affiliation(s)
- Lee M. Ashton
- School of Health Sciences, College of Health, Medicine and Wellbeing, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (L.M.A.); (C.E.C.)
- School of Education, College of Human and Social Futures, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.A.G.); (A.T.R.); (A.T.B.); (E.R.P.); (S.-L.K.); (K.L.S.)
- School of Psychology, College of Engineering, Science and Environment, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia;
| | - Philip J. Morgan
- School of Education, College of Human and Social Futures, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.A.G.); (A.T.R.); (A.T.B.); (E.R.P.); (S.-L.K.); (K.L.S.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Jacqueline A. Grounds
- School of Education, College of Human and Social Futures, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.A.G.); (A.T.R.); (A.T.B.); (E.R.P.); (S.-L.K.); (K.L.S.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Myles D. Young
- School of Psychology, College of Engineering, Science and Environment, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia;
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Anna T. Rayward
- School of Education, College of Human and Social Futures, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.A.G.); (A.T.R.); (A.T.B.); (E.R.P.); (S.-L.K.); (K.L.S.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Alyce T. Barnes
- School of Education, College of Human and Social Futures, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.A.G.); (A.T.R.); (A.T.B.); (E.R.P.); (S.-L.K.); (K.L.S.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Emma R. Pollock
- School of Education, College of Human and Social Futures, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.A.G.); (A.T.R.); (A.T.B.); (E.R.P.); (S.-L.K.); (K.L.S.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Stevie-Lee Kennedy
- School of Education, College of Human and Social Futures, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.A.G.); (A.T.R.); (A.T.B.); (E.R.P.); (S.-L.K.); (K.L.S.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Kristen L. Saunders
- School of Education, College of Human and Social Futures, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (J.A.G.); (A.T.R.); (A.T.B.); (E.R.P.); (S.-L.K.); (K.L.S.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Clare E. Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW 2308, Australia; (L.M.A.); (C.E.C.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
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Development of a stand-alone index for the assessment of diet quality in elementary school-aged children. Public Health Nutr 2021; 24:5629-5640. [PMID: 34420540 DOI: 10.1017/s1368980021003657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop and evaluate a stand-alone Elementary School-aged Children's Index of Diet Quality (ES-CIDQ). DESIGN In this cross-sectional study, children filled in a food frequency questionnaire (FFQ) with twenty-nine multiple-item questions on the consumption of foods, portion sizes and eating frequency and a 5-d food diary. Nutrient intakes were calculated with nutrient analysis software. FFQ questions best reflecting a health-promoting diet with reference to dietary recommendations were identified by correlations, logistic regression modelling and receiver-operating characteristics curve analysis. SETTING Southwest and Eastern Finland. PARTICIPANTS Healthy elementary school-aged volunteers [n 266, mean (sd) age 9·7 (1·7) years] were recruited between March 2017 and February 2018. RESULTS A set of questions was identified from the FFQ that best depicted the children's diet quality as defined in the dietary recommendations. These fifteen questions were scored and formulated into a stand-alone index as a continuous index score (range 0-16·5 points) and a two-category score: good and poor diet quality. The cut-off score of six points for a good diet quality had a sensitivity of 0·60 and a specificity of 0·78. Children with a good diet quality (49·8 % of the children) had higher intakes of protein, dietary fibre, and several vitamins and minerals, and lower intakes of sucrose, total fat, SFA and cholesterol compared to children with a poor diet quality. CONCLUSIONS The developed short stand-alone index depicted diet quality as defined in the dietary recommendations. Thus, ES-CIDQ may be used for assessing diet quality in Finnish elementary school-aged children in school health care and nutrition research.
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KARĞIN D, OMURTAG KORKMAZ B, MUNGAN NC, AKYÜZ S. EVALUATION OF HEALTHY NUTRITION INDEX-2015, DENTAL HEALTH AND ORAL FLORA RELATIONSHIP IN SCHOOL-AGE CHILDREN. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.938353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Røed M, Medin AC, Vik FN, Hillesund ER, Van Lippevelde W, Campbell K, Øverby NC. Effect of a Parent-Focused eHealth Intervention on Children's Fruit, Vegetable, and Discretionary Food Intake (Food4toddlers): Randomized Controlled Trial. J Med Internet Res 2021; 23:e18311. [PMID: 33591279 PMCID: PMC7925157 DOI: 10.2196/18311] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 12/08/2020] [Accepted: 01/17/2021] [Indexed: 01/16/2023] Open
Abstract
Background In Western countries, children’s diets are often low in fruits and vegetables and high in discretionary foods. Diet in early life tends to track through childhood and youth and even into adulthood. Interventions should, therefore, be delivered in periods when habitual traits are established, as in toddlerhood when children adapt to their family’s diet. Objective In this study, we assessed the effect of the Food4toddlers eHealth intervention, which aimed to enhance toddlers’ diets by shaping their food and eating environment. Methods The Food4toddlers randomized controlled trial was conducted in Norway in 2017-2018. Parent-child dyads were recruited through social media. In total, 298 parents completed an online questionnaire at baseline (mean child age 10.9 months, SD 1.2). Postintervention questionnaires were completed immediately after the intervention (ie, follow-up 1; mean child age 17.8 months, SD 1.3) and 6 months after the intervention (ie, follow-up 2; mean child age 24.2 months, SD 1.9). The intervention was guided by social cognitive theory, which targets the linked relationship between the person, the behavior, and the environment. The intervention group (148/298, 49.7%) got access to the Food4toddlers website for 6 months from baseline. The website included information on diet and on how to create a healthy food and eating environment as well as activities, recipes, and collaboration opportunities. To assess intervention effects on child diet from baseline to follow-up 1 and from baseline to follow-up 2, we used generalized estimating equations and a time × group interaction term. Between-group differences in changes over time for frequency and variety of fruits and vegetables and frequency of discretionary foods were assessed. Results At follow-up 1, a significant time × group interaction was observed for the frequency of vegetable intake (P=.02). The difference between groups in the change from baseline to follow-up 1 was 0.46 vegetable items per day (95% CI 0.06-0.86) in favor of the intervention group. No other significant between-group differences in dietary changes from baseline to follow-up 1 or follow-up 2 were observed. However, there is a clear time trend showing that the intake of discretionary foods increases by time from less than 1 item per week at baseline to more than 4 items per week at 2 years of age (P<.001), regardless of group. Conclusions A positive intervention effect was observed for the frequency of vegetable intake at follow-up 1 but not at follow-up 2. No other between-group effects on diet were observed. eHealth interventions of longer duration, including reminders after the main content of the intervention has been delivered, may be needed to obtain long-terms effects, along with tailoring in a digital or a personal form. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 92980420; https://doi.org/10.1186/ISRCTN92980420
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Affiliation(s)
- Margrethe Røed
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Anine C Medin
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Frøydis N Vik
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Elisabet R Hillesund
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
| | - Wendy Van Lippevelde
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway.,Department of Marketing, Innovation and Organisation, Ghent University, Ghent, Belgium
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Nina C Øverby
- Department of Nutrition and Public Health, University of Agder, Kristiansand, Norway
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Ribas SA, de Rodrigues MCC, Mocellin MC, Marques ES, da Rosa GPC, Maganha CR. Quality of complementary feeding and its effect on nutritional status in preterm infants: a cross-sectional study. J Hum Nutr Diet 2020; 34:3-12. [PMID: 32337779 DOI: 10.1111/jhn.12762] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/13/2020] [Accepted: 03/24/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The first 2 years of life represent a critical phase for growth and development, with the quality of the diet at this stage having repercussions throughout adulthood. The present study aimed to develop an Index for Measuring the Quality of Complementary Feeding (IMQCF) for infants, as well as to evaluate diet quality and its effects on the nutritional status of preterm infants. METHODS This cross-sectional study was conducted at a Brazilian University Hospital. The data were extracted by care protocol of outpatient preterm infants at 2 years of corrected age (CA). Dietary data were collected from 24-h recalls. The diet quality was assessed by the IMQCF composed of nine items based on a Brazilian Food Guide for children aged <2 years. Response options were scored 0-100, with scores closer to 100 representing a better quality diet. Association with growth indicators (Z-scores for weight- and length-for-age (WAZ and LAZ) were evaluated via tests of mean difference and multiple linear regression. RESULTS The median complementary feeding (CF) score was 72.2 (61.1-77.8) A shorter breastfeeding duration or infant formula use and the early introduction of wheat-based foods, ultra-processed foods and cow's milk in the preterm's diet were the main factors interfering in the adequacy of diet. There was an association between the quality of the diet score and WAZ (0.44; 95% confidence interval = 0.03-0.85; P = 0.03). CONCLUSIONS The introduction of poor quality food in the first 2 years of life interfered with the CF quality of preterm infants and can affect nutritional status at 2 years of CA, possibly in the long term.
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Affiliation(s)
- S A Ribas
- Department of Nutrition in Public Health, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M C C de Rodrigues
- Department of Pediatrics, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - M C Mocellin
- Fundamental Nutrition Department, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - E S Marques
- Institute of Social Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - G P C da Rosa
- School of Nutrition, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - C R Maganha
- School of Nutrition, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Priyadarshini P, Gurunathan D. Role of diet in ECC affected South Indian children assessed by the HEI-2005: A pilot study. J Family Med Prim Care 2020; 9:985-991. [PMID: 32318455 PMCID: PMC7113943 DOI: 10.4103/jfmpc.jfmpc_851_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 12/18/2019] [Accepted: 12/26/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND "Early Childhood Caries"(ECC) is a serious global oral health problem affecting children of 71 months of age or younger. ECC has a multifactorial model of causation and diet imparts an intricately specific effect. AIM The study aims to determine the protective and harmful role of different dietary consumption in the causation of ECC in South Indian children, assessed by the Healthy Eating Index-2005 (HEI-2005). SETTINGS AND DESIGN A pilot study of cross-sectional analytical study design was conducted in a dental college and hospitals in India. MATERIALS AND METHODS Hundred healthy South Indian children of 3-6 years age were screened for dental caries by the ICDAS II criteria, dmf/dmfs and pufa index. Participants were divided into three groups according to their caries status such as [Group 1:caries-free, group 2:ECC, group 3:severe ECC (S-ECC)]. Questionnaires were collected with demographic details, 24 h previous dietary record, and a subsequent 3-day chart of dietary consumption. Accordingly, the HEI-2005 score was calculated for each participant. Descriptive statistics was used for analysis of sociodemographic data, Kruskal-Wallis test for multivariate analysis, and for interpreting the total effect of HEI on study groups, logistic regression analysis was used. RESULTS Caries experience in South Indian children demonstrated a significant association with age. Caries-free children showed significantly higher association with darkgreen/orange vegetables/legumes, milk, and calories from SoFAAS (solid fat, alcohol, and added sugars) than the other groups. CONCLUSIONS The study findings illustrated a prominent protective role played by specific components of the HEI-2005, as healthy dietary intake against dental caries in South Indian children.
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Affiliation(s)
- Pragyna Priyadarshini
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, 162, Poonamallee High Road, Chennai, Tamil Nadu, India
| | - Deepa Gurunathan
- Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, 162, Poonamallee High Road, Chennai, Tamil Nadu, India
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Røed M, Hillesund ER, Vik FN, Van Lippevelde W, Øverby NC. The Food4toddlers study - study protocol for a web-based intervention to promote healthy diets for toddlers: a randomized controlled trial. BMC Public Health 2019; 19:563. [PMID: 31088438 PMCID: PMC6518752 DOI: 10.1186/s12889-019-6915-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating habits are established during childhood and track into adolescence and later in life. Given that these habits have a large public health impact and influence the increasing rates of childhood obesity worldwide, there is a need for effective, evidence-based prevention trials promoting healthy eating habits in the first 2 years of life. The aim of this study was to develop and evaluate the effect of an eHealth intervention called Food4toddlers, aiming to promote healthy dietary habits in toddlers by targeting parents' awareness of their child's food environment (i.e., how food is provided or presented) and eating environment (e.g., feeding practices and social interaction). This paper describes the rationale, development, and evaluation design of this project. METHODS/DESIGN We developed a 6-month eHealth intervention, with the extensive user involvement of health care nurses and parents of toddlers. This intervention is in line with the social cognitive theory, targeting the interwoven relationship between the person, behavior, and environment, with an emphasis on environmental factors. The intervention website includes recipes, information, activities, and collaboration opportunities. The Food4toddlers website can be used as a mobile application. To evaluate the intervention, a two-armed pre-post-follow-up randomized controlled trial is presently being conducted in Norway. Parents of toddlers (n = 404) were recruited via social media (Facebook) and 298 provided baseline data of their toddlers at age 12 months. After baseline measurements, participants were randomly allocated to an intervention group or control group. Primary outcomes are the child's diet quality and food variety. All participants will be followed up at age 18 months, 2 years, and 4 years. DISCUSSION The results of this trial will provide evidence to increase knowledge about the effectiveness of an eHealth intervention targeting parents and their toddler's dietary habits. TRIAL REGISTRATION ISRCTN92980420 . Registered 13 September 2017. Retrospectively registered.
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Affiliation(s)
- Margrethe Røed
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO box 422, 4604, Kristiansand, Norway.
| | - Elisabet R Hillesund
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO box 422, 4604, Kristiansand, Norway
| | - Frøydis N Vik
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO box 422, 4604, Kristiansand, Norway
| | - Wendy Van Lippevelde
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO box 422, 4604, Kristiansand, Norway.,Department of Marketing, Innovation and Organization, Ghent University, Tweekerkenstraat 2, 9000, Ghent, Belgium
| | - Nina Cecilie Øverby
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, PO box 422, 4604, Kristiansand, Norway
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Mehdizadeh A, Nematy M, Khadem-Rezaiyan M, Ghayour-Mobarhan M, Sardar MA, Leis A, Humbert L, Bélanger M, Vatanparast H. A Customized Intervention Program Aiming to Improve Healthy Eating and Physical Activity Among Preschool Children: Protocol for a Randomized Controlled Trial (Iran Healthy Start Study). JMIR Res Protoc 2018; 7:e11329. [PMID: 30578226 PMCID: PMC6324517 DOI: 10.2196/11329] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/14/2018] [Accepted: 09/04/2018] [Indexed: 01/13/2023] Open
Abstract
Background Prevention of childhood obesity is a key approach to the primary prevention of noncommunicable diseases. Several models, based on the population health approach and aligned with ecological models, are used to design childhood obesity prevention programs around the world. Objective This study aims to introduce the design and evaluation plan of “Iran Healthy Start (IHS)/Aghazi Salem, Koodake Irani”—the customized Iranian version of Canadian Healthy Start/Départ Santé health promotion program—which is now being developed in Mashhad University of Medical Sciences (Mashhad, Iran) and focuses on improving physical activity and healthy eating among preschool children. Methods We will evaluate the intervention using a pilot randomized controlled design. The components of intervention include customized Decoda Web-based resources for children, an implementation guide for educators and managers, training and monitoring, communication and knowledge exchange, building partnership, and parent engagement. Outcomes include changes in anthropometry, physical activity level, nutritional risk status and dietary intake, and quality of life. Results The project is funded by Mashhad University of Medical Sciences. The intervention was completed by the end of March 2018, and the analysis is currently under way. The first results of the IHS intervention program are expected to be submitted for publication in December 2018. Conclusions The double burden of malnutrition in early years children is a major health concern in developing countries. This justifies the need for health promotion programs that are specifically designed to target both overnutrition and undernutrition prevention. If the efficacy approved, the IHS could potentially be a comprehensive health promotion program for young children whose lifestyle behaviors can be improved toward a healthy future life in a nutrition transition setting. Trial Registration International Clinical Trials Registry Platform IRCT2016041927475N1; https://en.irct.ir/trial/22497 International Registered Report Identifier (IRRID) RR1-10.2196/11329
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Affiliation(s)
- Atieh Mehdizadeh
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
| | - Mohsen Nematy
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
| | - Majid Khadem-Rezaiyan
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
| | - Majid Ghayour-Mobarhan
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
| | - Mohammad Ali Sardar
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
| | - Anne Leis
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Louise Humbert
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mathieu Bélanger
- Department of Family Medicine, Université de Sherbrooke, Moncton, NB, Canada
| | - Hassan Vatanparast
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
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Systematic review and meta-analysis of strategies to increase vegetable consumption in preschool children aged 2-5 years. Appetite 2018; 127:138-154. [PMID: 29702128 DOI: 10.1016/j.appet.2018.04.019] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 04/18/2018] [Accepted: 04/23/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Most children do not meet daily recommendations for fruit and vegetable intake, and consumption of vegetables remains especially low. Eating habits track from childhood to adulthood hence establishing liking and intake of vegetables is important. OBJECTIVE To identify the most successful strategies to enhance vegetable intake in preschool children aged 2-5 years. DESIGN The research was a systematic review and a meta-analysis of published studies. A comprehensive search strategy was performed using key databases such as Medline, Embase, PsychINFO, EBSCO and CENTRAL. Articles published between 2005-January 2016, specifically with measured vegetable consumption were included. RESULTS 30 articles and 44 intervention arms were identified for inclusion (n = 4017). Nine dominant intervention strategies emerged to promote vegetable intake in preschool children. These included; choice, pairing (stealth), education, food service, modelling, reward, taste exposure, variety and visual presentation. The meta-analysis revealed that interventions implementing repeated taste exposure had better pooled effects than those which did not. Intake increased with number of taste exposures and intake was greater when vegetables offered were in their plain form rather than paired with a flavor, dip or added energy (e.g. oil). Moreover, intake of vegetables which were unfamiliar/disliked increased more than those which were familiar/liked. CONCLUSIONS Repeated taste exposure is a simple technique that could be implemented in childcare settings and at home by parents. Health policy could specifically target the use of novel and disliked vegetables in childcare settings with emphasis on a minimum 8-10 exposures. The systematic review protocol was registered on the PROSPERO (number: CRD42016033984).
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Peltner J, Thiele S. Association between the Healthy Eating Index-2010 and nutrient and energy densities of German households' food purchases. Eur J Public Health 2018; 27:547-552. [PMID: 28073813 DOI: 10.1093/eurpub/ckw247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The USDA Healthy Eating Index (HEI) is used widely to measure diet quality because it allows a number of different applications. Although several evaluations of the HEI-2010 have already been carried out, there is lack of those which focus on associations between the HEI and nutrient intakes. This study updates and expands upon previous findings on these associations. Using German consumption data, where ∼12 million purchases from 13 131 households are recorded, HEI-2010 total and individual scores, as well as several energy and nutrient densities were calculated. Correlations between the HEI and individual energy and nutrient densities were carried out to identify which nutrients are more or less well represented by the HEI. The HEI had the highest correlations with energy density and the densities of water-soluble vitamins (e.g. folic acid) and minerals (e.g. calcium). Weaker associations were identified for the densities of fat-soluble vitamins (e.g. vitamin D) as well as of the vitamins B1 and B12. Negligible correlations were detected for the densities of trace elements (e.g. fluoride and iodine), salt and fat composition. Given that energy intake and the intake of plant-based foods are relevant dietary issues, the HEI-2010 can be defined as a meaningful index to describe diet quality. However, because the intakes of salt, trace elements (e.g. fluoride and iodine) and fat-soluble vitamins, as well as the fat composition may be less reflected, they should be analyzed separately when using the HEI for measuring diet quality.
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Affiliation(s)
- Jonas Peltner
- 1 Department of Food Economics and Consumption Studies, University of Kiel, Kiel, Germany
| | - Silke Thiele
- 2 Institute of Food Economics, Kiel, Germany as an additional author affilation for S.Thiele
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Toffano RBD, Hillesheim E, Mathias MG, Coelho-Landell CA, Salomão RG, Almada MORV, Camarneiro JM, Barros TT, Camelo-Junior JS, Rezzi S, Goulet L, Giner MP, Silva LD, Martin FP, Montoliu I, Moco S, Collino S, Kaput J, Monteiro JP. Validation of the Brazilian Healthy Eating Index-Revised Using Biomarkers in Children and Adolescents. Nutrients 2018; 10:E154. [PMID: 29385742 PMCID: PMC5852730 DOI: 10.3390/nu10020154] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 12/26/2017] [Accepted: 01/08/2018] [Indexed: 12/22/2022] Open
Abstract
The Brazilian Healthy Eating Index-Revised (BHEI-R) can be used to determine overall dietary patterns. We assessed the BHEI-R scores in children and adolescents, aged from 9 to 13 years old, and associated its component scores with biomarkers of health and dietary exposure. Three 24-h recalls were used to generate BHEI-R. Biomarkers were analyzed in plasma and red blood cells. Correlation tests, agreement, and covariance analyses were used to associate BHEI-R components with biomarkers. Data from 167 subjects were used. The strongest correlations were between fruits, vegetables and legumes with omega-6 and omega-3 fatty acids, and β-carotene intakes. Milk and dairy correlated with plasma retinol and pyridoxine. All components rich in vegetable and animal protein sources correlated with plasma creatine. Total BHEI-R scores were positively associated with intakes of omega-6, omega-3, fiber and vitamin C, and inversely associated with energy and saturated fat intakes of individuals. Plasma β-carotene and riboflavin biomarkers were positively associated with total BHEI-R. An inadequate food consumption pattern was captured by both biomarkers of health and dietary exposure. BHEI-R was validated for the above dietary components and can be associated with metabolomics and nutritional epidemiological data in future pediatric studies.
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Affiliation(s)
- Roseli B D Toffano
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto 14049-900, Brazil.
| | - Elaine Hillesheim
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto 14049-900, Brazil.
| | - Mariana G Mathias
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto 14049-900, Brazil.
| | - Carolina A Coelho-Landell
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto 14049-900, Brazil.
| | - Roberta G Salomão
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto 14049-900, Brazil.
| | - Maria O R V Almada
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto 14049-900, Brazil.
| | - Joyce M Camarneiro
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto 14049-900, Brazil.
| | - Tamiris T Barros
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto 14049-900, Brazil.
| | - José S Camelo-Junior
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto 14049-900, Brazil.
| | - Serge Rezzi
- Nestlé Institute of Health Sciences, Innovation Square, École Polytechnique Fédérale de Lausanne, Campus, 1015 Lausanne, Switzerland.
| | - Laurence Goulet
- Nestlé Institute of Health Sciences, Innovation Square, École Polytechnique Fédérale de Lausanne, Campus, 1015 Lausanne, Switzerland.
| | - Maria P Giner
- Nestlé Institute of Health Sciences, Innovation Square, École Polytechnique Fédérale de Lausanne, Campus, 1015 Lausanne, Switzerland.
| | - Laeticia Da Silva
- Nestlé Institute of Health Sciences, Innovation Square, École Polytechnique Fédérale de Lausanne, Campus, 1015 Lausanne, Switzerland.
| | - Francois-Pierre Martin
- Nestlé Institute of Health Sciences, Innovation Square, École Polytechnique Fédérale de Lausanne, Campus, 1015 Lausanne, Switzerland.
| | - Ivan Montoliu
- Nestlé Institute of Health Sciences, Innovation Square, École Polytechnique Fédérale de Lausanne, Campus, 1015 Lausanne, Switzerland.
| | - Sofia Moco
- Nestlé Institute of Health Sciences, Innovation Square, École Polytechnique Fédérale de Lausanne, Campus, 1015 Lausanne, Switzerland.
| | - Sebastiano Collino
- Nestlé Institute of Health Sciences, Innovation Square, École Polytechnique Fédérale de Lausanne, Campus, 1015 Lausanne, Switzerland.
| | - Jim Kaput
- Nestlé Institute of Health Sciences, Innovation Square, École Polytechnique Fédérale de Lausanne, Campus, 1015 Lausanne, Switzerland.
| | - Jacqueline P Monteiro
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Bandeirantes Avenue, 3900, Ribeirão Preto 14049-900, Brazil.
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Rodríguez LA, Mundo‐Rosas V, Méndez‐Gómez‐Humarán I, Pérez‐Escamilla R, Shamah‐Levy T. Dietary quality and household food insecurity among Mexican children and adolescents. MATERNAL & CHILD NUTRITION 2017; 13:e12372. [PMID: 27863001 PMCID: PMC6866226 DOI: 10.1111/mcn.12372] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
Abstract
Seventy percent of Mexican households experience some level of food insecurity (FI). Studies have shown positive associations between FI and poor dietary quality. As far as it is known, this is the first time the Healthy Eating Index (HEI-2010) has been used to assess dietary quality of children and adolescents in Mexico, and to examine if FI is related to it. The objective of this research is to assess dietary quality and its association with FI among Mexican children and adolescents from a nationally representative cross-sectional sample. We analyzed data from 4635 2-19-year-old Mexican children and adolescents participating in the Mexican National Health and Nutrition Survey (Ensanut 2012). FI was measured using the Latin American and Caribbean Household Food Security Scale (ELCSA) and dietary quality with the HEI-2010. We examined the association between FI and dietary quality using multivariate linear regressions. Dietary quality was worst as FI became more severe among children and adolescents compared with their counterparts living in households with food security. Specifically, FI had a negative association with fruits, vegetables, and protein foods, and a positive association with refined grains consumption. Dairy intake was negatively associated with FI among older children and adolescents. Added sugars were not associated with FI, but intake was excessive across the population at 15% of total daily energy intake. Decreasing FI may help improve dietary quality of Mexican children and adolescents.
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Affiliation(s)
- Luis A. Rodríguez
- Berkeley School of Public HealthUniversity of CaliforniaBerkeleyCaliforniaUSA
- San Francisco School of Medicine, Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Feeney EL, O'Brien SA, Scannell AG, Markey A, Gibney ER. Suprathreshold measures of taste perception in children - Association with dietary quality and body weight. Appetite 2017; 113:116-123. [DOI: 10.1016/j.appet.2017.02.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/18/2017] [Accepted: 02/18/2017] [Indexed: 11/16/2022]
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Development and evaluation of a stand-alone index for the assessment of small children’s diet quality. Public Health Nutr 2015; 18:1941-9. [DOI: 10.1017/s1368980014002535] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AbstractObjectiveTo construct and evaluate an independent Children’s Index of Diet Quality (CIDQ).DesignA food consumption questionnaire, which contained twenty-five multiple-item questions on eating and food intake, was formulated and evaluated against 7 d food records. Key questions that best reflected a healthy diet, defined in criteria set by the nutrient recommendations, were searched and validated by correlation and analyses of receiver-operating characteristic curves.SettingsA cohort of a young population of South-West Finland.SubjectsParticipants (n 400) were 2–6-year-old children.ResultsFifteen questions were identified to best depict the children’s diet quality in reference to the recommendations. These questions were scored, summarized and further constructed into a three-class index (good, moderate and poor dietary quality) where higher scores depicted better diet quality. The CIDQ cut-off score of 14 points for good dietary quality had a sensitivity of 0·59 and a specificity of 0·82 and the cut-off score of 10 points, for at least moderate dietary quality, had a sensitivity of 0·77 and a specificity of 0·69. Higher index scores were related to higher dietary intakes of several vitamins, lower dietary intakes of SFA and cholesterol, and further with lower serum cholesterol and higher serum vitamin C concentrations.ConclusionsThe three-class food index was found to represent diet quality as defined in recommendations and evaluated against nutrient intakes from food diaries and biochemical markers. This self-standing index could provide an effective and low-burden method to obtain information about diet quality and guide future recommendations.
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Social capital, tolerance of diversity and adherence to Mediterranean diet: the Rhea Mother-Child Cohort in Crete, Greece. Public Health Nutr 2014; 18:1300-7. [PMID: 25089536 DOI: 10.1017/s136898001400144x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To estimate the associations of individual maternal social capital and social capital dimensions (Participation in the Community, Feelings of Safety, Value of Life and Social Agency, Tolerance of Diversity) with adherence to the Mediterranean diet during pregnancy. DESIGN This is a cross-sectional analysis of data from a prospective mother-child cohort (Rhea Study). Participants completed a social capital questionnaire and an FFQ in mid-pregnancy. Mediterranean diet adherence was evaluated through an a priori score ranging from 0 to 8 (minimal-maximal adherence). Maternal social capital scores were categorized into three groups: the upper 10 % was the high social capital group, the middle 80 % was the medium and the lowest 10 % was the low social capital group. Multivariable log-binomial and linear regression models adjusted for confounders were performed. SETTING Heraklion, Crete, Greece. SUBJECTS A total of 377 women with singleton pregnancies. RESULTS High maternal Total Social Capital was associated with an increase of almost 1 point in Mediterranean diet score (highest v. lowest group: β coefficient=0·95, 95 % CI 0·23, 1·68), after adjustment for confounders. Similar dose-response effects were noted for the scale Tolerance of Diversity (highest v. lowest group: adjusted β coefficient=1·08, 95 % CI 0·39, 1·77). CONCLUSIONS Individual social capital and tolerance of diversity are associated with adherence to the Mediterranean diet in pregnancy. Women with higher social capital may exhibit a higher sense of obligation to themselves and to others that may lead to proactive nutrition-related activities. Less tolerant women may not provide the opportunity to new healthier, but unfamiliar, nutritional recommendations to become part of their regular diet.
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Rauber F, da Costa Louzada ML, Vitolo MR. Healthy Eating Index Measures Diet Quality of Brazilian Children of Low Socioeconomic Status. J Am Coll Nutr 2014; 33:26-31. [DOI: 10.1080/07315724.2014.869979] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Diet quality from pre-school to school age in Brazilian children: a 4-year follow-up in a randomised control study. Br J Nutr 2013; 111:499-505. [DOI: 10.1017/s0007114513002857] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A previous study demonstrated that dietary counselling for mothers during the first year of life improved overall diet quality of children at pre-school age in a low-income population. Thus, the objective of the present study was to assess the long-term effect of this intervention on diet quality of children at school age and examine the tracking of dietary intake throughout childhood. The present study was a follow-up of a randomised controlled trial with children who were assessed at 3–4 years (n 345) and 7–8 years (n 307) of age. We collected two 24 h dietary recalls and assessed diet quality using the Healthy Eating Index (HEI). Analyses were performed by group using a paired t test and a Student's t test for independent samples. Diet quality did not differ between the intervention and control groups at 7–8 years of age (HEI score 65·2 (sd 9·5) v. 64·9 (sd 8·5)). Regarding changes in diet quality from pre-school to school age, we observed the tracking of diet quality in the control group and the loss of the intervention effect in the intervention group. In both groups, the score for fruit and milk intake decreased, while that for saturated fat and dietary variety intake increased. The score for the intakes of grains, meat and legumes, and total fat remained constant for all children. The present data provide evidence that diet quality tracks during childhood since the total HEI score did not differ over time in the control group. The decrease in score for some HEI components did not affect the overall diet quality due to the increase in score for other HEI components.
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Wong JE, Parnell WR, Howe AS, Black KE, Skidmore PML. Development and validation of a food-based diet quality index for New Zealand adolescents. BMC Public Health 2013; 13:562. [PMID: 23759064 PMCID: PMC3706237 DOI: 10.1186/1471-2458-13-562] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Accepted: 05/30/2013] [Indexed: 11/14/2022] Open
Abstract
Background As there is no population-specific, simple food-based diet index suitable for examination of diet quality in New Zealand (NZ) adolescents, there is a need to develop such a tool. Therefore, this study aimed to develop an adolescent-specific diet quality index based on dietary information sourced from a Food Questionnaire (FQ) and examine its validity relative to a four-day estimated food record (4DFR) obtained from a group of adolescents aged 14 to 18 years. Methods A diet quality index for NZ adolescents (NZDQI-A) was developed based on ‘Adequacy’ and ‘Variety’ of five food groups reflecting the New Zealand Food and Nutrition Guidelines for Healthy Adolescents. The NZDQI-A was scored from zero to 100, with a higher score reflecting a better diet quality. Forty-one adolescents (16 males, 25 females, aged 14–18 years) each completed the FQ and a 4DFR. The test-retest reliability of the FQ-derived NZDQI-A scores over a two-week period and the relative validity of the scores compared to the 4DFR were estimated using Pearson’s correlations. Construct validity was examined by comparing NZDQI-A scores against nutrient intakes obtained from the 4DFR. Results The NZDQI-A derived from the FQ showed good reliability (r = 0.65) and reasonable agreement with 4DFR in ranking participants by scores (r = 0.39). More than half of the participants were classified into the same thirds of scores while 10% were misclassified into the opposite thirds by the two methods. Higher NZDQI-A scores were also associated with lower total fat and saturated fat intakes and higher iron intakes. Conclusions Higher NZDQI-A scores were associated with more desirable fat and iron intakes. The scores derived from either FQ or 4DFR were comparable and reproducible when repeated within two weeks. The NZDQI-A is relatively valid and reliable in ranking diet quality in adolescents at a group level even in a small sample size. Further studies are required to test the predictive validity of this food-based diet index in larger samples.
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Affiliation(s)
- Jyh Eiin Wong
- Department of Human Nutrition, University of Otago, Dunedin 9054, New Zealand.
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Rauber F, da Costa Louzada ML, Feldens CA, Vitolo MR. Maternal and family characteristics associated with the Healthy Eating Index among low socioeconomic status Brazilian children. J Hum Nutr Diet 2012. [DOI: 10.1111/jhn.12005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- F. Rauber
- Federal University of Health Sciences of Porto Alegre (UFCSPA); Porto Alegre RS Brazil
| | | | - C. A. Feldens
- Lutheran University of Brazil (ULBRA); Bairro São José Canoas RS Brazil
| | - M. R. Vitolo
- Federal University of Health Sciences of Porto Alegre (UFCSPA); Porto Alegre RS Brazil
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Truthmann J, Richter A, Thiele S, Drescher L, Roosen J, Mensink GBM. Associations of dietary indices with biomarkers of dietary exposure and cardiovascular status among adolescents in Germany. Nutr Metab (Lond) 2012; 9:92. [PMID: 23095712 PMCID: PMC3545909 DOI: 10.1186/1743-7075-9-92] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Accepted: 10/22/2012] [Indexed: 01/20/2023] Open
Abstract
UNLABELLED BACKGROUND Adolescence is an important life stage for the development of dietary preferences and health behaviour. Longitudinal studies indicated that cardiovascular status in adolescence predicts cardiovascular risk marker values in adulthood. Several diet quality indices for adolescents have been developed in the past, but literature concerning associations between indices and biomarkers of dietary exposure and cardiovascular status is rather sparse. Hence, the aim of this study was to analyse associations of dietary indices with biomarkers of dietary exposure and cardiovascular status. METHODS For the present analysis, data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS 2003-2006) were used. The analysis included 5,198 adolescents, aged 12 to 17 years. The Healthy Food Diversity Index (HFD), the Healthy Nutrition Score for Kids and Youth (HuSKY), the Indicator Food Index (IFI) and a simple fruit/vegetable intake index were derived from food frequency questionnaire information to indicate a healthy diet. Adjusted mean values for homocysteine, uric acid, CRP, total cholesterol, HDL-C, ferritin, HbA1c, folate, vitamin B12 and BMI were calculated using complex-samples general linear models for quintiles of the different indices. Furthermore, the agreement in ranking between the different indices was calculated by weighted kappa. All statistical analyses were conducted for boys and girls separately, and were adjusted for potential confounders. RESULTS Folate was positively associated with the HFD, the HuSKY, and fruit/vegetable intake for both boys and girls and with IFI for boys. Among girls, positive associations were seen between vitamin B12 and the IFI and between diastolic blood pressure and the IFI as well as fruit/vegetable intake. A negative association was found between homocysteine and the HFD, the HuSKY, and the IFI for both boys and girls and with fruit/vegetable intake for boys. Among boys, uric acid and HbA1c were negatively and prevalence of obesity positively associated with the IFI. CONCLUSIONS Overall, the indices, even the simpler ones, seem to have a similar general capability in predicting biomarkers of dietary exposure. To predict risk of cardiovascular disease dietary indices may have to be more specific.
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Affiliation(s)
- Julia Truthmann
- Robert Koch Institute Berlin, Department of Epidemiology and Health Reporting, Postbox 65 02 61, D-13302, Berlin, Germany
| | - Almut Richter
- Robert Koch Institute Berlin, Department of Epidemiology and Health Reporting, Postbox 65 02 61, D-13302, Berlin, Germany
| | - Silke Thiele
- Christian-Albrechts-University of Kiel, Department of Food Economics and Consumption Studies, Olshausenstraße 40, D-24098, Kiel, Germany
| | - Larissa Drescher
- TU München, School of Management, Marketing and Consumer Research, Alte Akademie 16, D-85350, Freising, Germany
| | - Jutta Roosen
- TU München, School of Management, Marketing and Consumer Research, Alte Akademie 16, D-85350, Freising, Germany
| | - Gert BM Mensink
- Robert Koch Institute Berlin, Department of Epidemiology and Health Reporting, Postbox 65 02 61, D-13302, Berlin, Germany
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Abstract
In this article, we review studies that have used dietary indexes to assess different aspects of diet in relation to health outcomes and sociodemographic factors in childhood populations of developed countries. Eighty-four papers published from 1980 to mid-2010 including 90 unique dietary indexes were reviewed. Seventy-two indexes were developed (or have been adapted) specifically for childhood populations; 38 of these were used to assess diet-disease associations, mostly of diet and obesity. In the majority of these studies, small inverse associations between dietary indexes and obesity indexes were shown. Children who were younger, female, and from high-income families had better dietary quality scores. Forty-nine indexes (of 90) were compared with other aspects of dietary intakes or behaviors, with correlations ranging from very low to modest (∼r = 0.05-0.50). Only 2 validation studies compared an index with nutritional biomarkers, and correlations were quite weak for most plasma nutrients (P < 0.10). Overall, a large number of indexes have been created and used, but the majority of studies are descriptive. Fewer analytic studies on index-health associations have been performed, and most analyses insufficiently adjusted for confounders. Thus, prospective and intervention research in diverse populations is needed to further test these tools. In conclusion, indexes are potentially useful methods for dietary assessment, because they offer valuable information on overall dietary patterns in children. However, understanding the advantages and limitations when applying them in research and public health settings is important, and more research is needed to further develop their utility.
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Affiliation(s)
- Chrystalleni Lazarou
- Department of Nutrition Science-Dietetics, Harokopio University, Athens, Greece.
| | - P. K. Newby
- Department of Pediatrics, Boston University School of Medicine, and Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118
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Abstract
BACKGROUND/OBJECTIVES To test a socioeconomic hypothesis on three dietary patterns and to describe the relation between three commonly used methods to determine dietary patterns, namely Healthy Eating Index, Mediterranean Diet Score and principal component analysis. SUBJECTS/METHODS Cross-sectional design in 1852 military men. Using mailed questionnaires, the food consumption frequency was recorded. RESULTS The correlation coefficients between the three dietary patterns varied between 0.43 and 0.62. The highest correlation was found between Healthy Eating Index and Healthy Dietary Pattern (principal components analysis). Cohen's kappa coefficient of agreement varied between 0.10 and 0.20. After age-adjustment, education and income remained associated with the most healthy dietary pattern. Even when both socioeconomic indicators were used together in one model, higher income and education were associated with higher scores for Healthy Eating Index, Mediterranean Diet Score and Healthy Dietary Pattern. The least healthy quintiles of dietary pattern as measured by the three methods were associated with a clustering of unhealthy behaviors, that is, smoking, low physical activity, highest intake of total fat and saturated fatty acids, and low intakes of fruits and vegetables. CONCLUSIONS The three dietary patterns used indicated that the most healthy patterns were associated with a higher socioeconomic position, while lower patterns were associated with several unhealthy behaviors.
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