A comparative validation of a child food frequency questionnaire using red blood cell membrane fatty acids

Relationship between dietary intake and erythrocyte PUFA in adolescents from a Western Australian cohort

BACKGROUND

Population-based studies show that the intake of omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFA) are associated with a range of health conditions. Therefore, the reliability of food frequency questionnaires (FFQ) as rapid and easily accessible screening tools for PUFA intake deserve investigation.

OBJECTIVE

We aimed to assess the relationship between erythrocyte fatty acids and fatty acid intake collected using the Commonwealth Scientific and Industrial Research Organisation (CSIRO) food frequency questionnaire in an adolescent cohort.

DESIGN

A cross-sectional study using data from 1155 young adolescents participating in the 14-year follow-up of the Raine Study. Bland-Altman plots were used to determine the agreement between dietary intake and erythrocyte levels of each fatty acid.

RESULTS

The main dietary source of n-3 long-chain (LC) PUFA was 'fresh fish' (53% of total n-3 LC-PUFA). Docosahexaenoic acid (DHA) showed the strongest correlation between erythrocyte and diet assessment (r = 0.274; p < 0.001), whilst linoleic acid (LA) (r = 0.103; p < 0.001) and arachidonic acid (AA) (r = -0.06; p = 0.042) showed weaker correlations, with limits of agreement relatively narrow. Bland-Altman plots showed a dose-dependent bias between the FFQ fatty acid data and corresponding erythrocyte data.

CONCLUSIONS

For the major n-3 and n-6 PUFA, dietary intakes derived from the FFQ showed weaker correlations and poorer agreement with erythrocyte levels, and the deviation between the two increased with higher intake levels.

Effects of dietary omega-3 intake on vigilant attention and resting-state functional connectivity in neurotypical children and adolescents

BACKGROUND

Vigilant Attention (VA) is a critical cognitive function allowing to maintain our attention, particularly in redundant or intellectually unchallenging situations. Evidence has shown that, as the brain develops, VA abilities rapidly improve throughout childhood and adolescence. Dietary omega-3 polyunsaturated fats (PUFA), playing a critical role for proper brain development and maturation of cortical regions, may contribute to variations in VA abilities.

OBJECTIVE

The present study investigated the effect of dietary omega-3 PUFA intake (docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)) on resting-state functional connectivity (rsFC) of a meta-analytically defined VA network in 24 neurotypical children and adolescents (7.3-17.2 years) from the Healthy Brain Network databank.

METHODS

Functional MRI and phenotypical information were collected from the Healthy Brain Network databank. Intake of omega-3 DHA and EPA was assessed using a food frequency questionnaire and was adjusted for total calorie intake. Out of scanner VA-related performance was assessed using the VA condition of the Adaptive Cognitive Evaluation tool.

RESULTS

Overall, reported intake of omega-3 PUFA was not significantly associated with VA-related performance. Furthermore, energy-adjusted omega-3 intake was not significantly correlated with rsFC within the VA network. A complementary whole-brain analysis revealed that energy-adjusted omega-3 intake was correlated with decreased rsFC between parieto-occipital brain regions.

CONCLUSION

The present study was not able to detect a relationship between dietary omega-3 and rsFC or VA performance.

The relationship between dietary intakes and plasma concentrations of PUFA in school-age children from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort

An adequate intake of PUFA plays a vital role in human health. Therefore, it is important to assess PUFA intakes in different populations and validate them with biomarkers, but only a few small studies are in paediatric populations. We calculated the dietary intake of PUFA and their main food sources in children and assessed associations between PUFA intakes and plasma proportions. Dietary intakes of 7-year-old children (n 8242) enrolled in the Avon Longitudinal Study of Parents and Children were calculated from the parental-completed FFQ. Plasma PUFA were measured in 5571 children 8 months later, and 4380 children had complete dietary and plasma data. The association between dietary and plasma PUFA proportions was estimated using Spearman's correlation coefficients, quintile cross-classification and Cohen's κ coefficients. Mean total PUFA intake was 13·2 g/d (sd 4·2), contributing 6·5 % of total energy intake; n-6 PUFA contributed 5·2 % and n-3 PUFA 0·7 %. The n-6:n-3 ratio was 7·9:1. Mean intakes of EPA and DHA were 35·7 mg/d and 49·7 mg/d, respectively. Most n-3 and n-6 PUFA intakes were weakly correlated with their respective plasma lipids (0·07 ≤ r ≤ 0·16, P < 0·001). The correlation between dietary and plasma DHA was stronger though (r = 0·34, P < 0·001), supported by a modest level of agreement between quintiles (k = 0·32). The results indicate that the FFQ was able to reasonably rank the long-chain (LC) PUFA, DHA, in this paediatric population. Public health initiatives need to address the suboptimal ratio of n-6:n-3 PUFA and very low n-3 LC-PUFA intakes in school-age children in the UK.

Increased adiposity in children with obesity is associated with low red blood cell omega-3 fatty acid status and inadequate polyunsaturated fatty acid dietary intake

The association between total dietary fat intake and measures of body fatness in children with obesity remains inconsistent. This study aimed to determine whether dietary long-chain polyunsaturated fatty acids (LCPUFA) and LCPUFA status relate to body composition in children with obesity. Children (n = 63, 9.0 ± 0.2 year, BMI Z-score 3.1 ± 0.2) were divided into tertiles of percentage body fat assessed by dual-energy X-ray absorptiometry. Diet was assessed 3-days food diaries. Fatty acid proportions in red blood cells (RBC) were measured by gas chromatography. Data stratified by sex and Tanner stages were compared with a MIXED model ANOVA. Associations between RBC fatty acid status and dietary intakes were examined with Spearman correlation. Moderate correlations were observed between RBC eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) proportions, dietary EPA and DHA (r = 0.39, P < .05) as well as fish servings (r = 0.33, P < .05). Dietary LCPUFA did not differ among tertiles. Children in tertile 3 had lower RBC α-linolenic acid (-40%) and EPA + DHA (-15%) proportions adjusted for age, Tanner stages and race compared with tertile 1. The lower omega-3 LCPUFA status in children with greater adiposity is consistent with suboptimal intakes of omega-3 LCPUFA and fish in the diet.

Evaluating the Alimentary and Respiratory Tracts in Health and disease (EARTH) research programme: a protocol for prospective, longitudinal, controlled, observational studies in children with chronic disease at an Australian tertiary paediatric hospital

INTRODUCTION

Chronic gastrointestinal and respiratory conditions of childhood can have long-lasting physical, psychosocial and economic effects on children and their families. Alterations in diet and intestinal and respiratory microbiomes may have important implications for physical and psychosocial health. Diet influences the intestinal microbiome and should be considered when exploring disease-specific alterations. The concepts of gut-brain and gut-lung axes provide novel perspectives for examining chronic childhood disease(s). We established the 'Evaluating the Alimentary and Respiratory Tracts in Health and disease' (EARTH) research programme to provide a structured, holistic evaluation of children with chronic gastrointestinal and/or respiratory conditions.

METHODS AND ANALYSIS

The EARTH programme provides a framework for a series of prospective, longitudinal, controlled, observational studies (comprised of individual substudies), conducted at an Australian tertiary paediatric hospital (the methodology is applicable to other settings). Children with a chronic gastrointestinal and/or respiratory condition will be compared with age and gender matched healthy controls (HC) across a 12-month period. The following will be collected at baseline, 6 and 12 months: (i) stool, (ii) oropharyngeal swab/sputum, (iii) semi-quantitative food frequency questionnaire, (iv) details of disease symptomatology, (v) health-related quality of life and (vi) psychosocial factors. Data on the intestinal and respiratory microbiomes and diet will be compared between children with a condition and HC. Correlations between dietary intake (energy, macro-nutrients and micro-nutrients), intestinal and respiratory microbiomes within each group will be explored. Data on disease symptomatology, quality of life and psychosocial factors will be compared between condition and HC cohorts.Results will be hypothesis-generating and direct future focussed studies. There is future potential for direct translation into clinical care, as diet is a highly modifiable factor.

ETHICS AND DISSEMINATION

Ethics approval: Sydney Children's Hospitals Network Human Research Ethics Committee (HREC/18/SCHN/26). Results will be presented at international conferences and published in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT04071314.

Fast track to health - Intermittent energy restriction in adolescents with obesity. A randomised controlled trial study protocol

BACKGROUND

Intermittent energy restriction (IER) has shown early success in adolescents with obesity, however efficacy trials are needed. This study aims to determine if IER results in lower body mass index (BMI) z-score after 52 weeks in metabolically unhealthy adolescents with obesity compared with continuous energy restriction (CER).

METHODS/DESIGN

This is a prospective, randomised, multi-centre trial conducted in tertiary care settings, with three phases: jumpstart (weeks 0-4); intensive intervention (weeks 5-16); continued intervention and/or maintenance (weeks 17-52). During the jumpstart phase, all participants follow a very low energy diet (∼800kcal/3350kJ/day), then transition to their allocated intervention: IER or CER. IER involves three energy-restricted days/week, consuming one-third of daily energy requirements (∼600-700kcal/2500-2950kJ/day), and four days/week of a healthy meal plan. The CER, which is current standard care, has individually tailored energy prescription based on age and sex (13-14years, 1430-1670kcal/6000-7000kJ/day; 15-17years, 1670-1900kcal/7000-8000kJ/day). The study will recruit 186 (93 per arm) treatment-seeking adolescents aged 13-17years with obesity and at least one metabolic co-morbidity. The primary outcome is change in BMI z-score at 52 weeks. Secondary outcomes are changes at 4, 16 and 52 weeks in: body composition; diet quality, food choices and food patterns; cardio-metabolic risk factors; physical activity and sedentary behaviour; sleep and psycho-behavioural measures.

DISCUSSION

This study challenges existing clinical paradigms that CER is the only method for weight management in metabolically unhealthy adolescents. If successful, IER may offer an alternate medical nutrition therapy approach for those seeking treatment in tertiary settings.

CLINICAL TRIAL REGISTRATION NUMBER

ACTRN12617001630303.

Feasibility and efficacy of a web-based family telehealth nutrition intervention to improve child weight status and dietary intake: A pilot randomised controlled trial

INTRODUCTION

Innovative eHealth solutions that improve access to child weight management interventions are crucial to address the rising prevalence of childhood obesity globally. The study aimed to evaluate the feasibility and preliminary efficacy of a 12-week online telehealth nutrition intervention to improve child weight and dietary outcomes, and the impact of additional text messages (SMS) targeted to mothers and fathers.

METHODS

Families with children aged 4 to 11 were randomised across three groups: Telehealth, Telehealth+SMS, or Waitlist control. Telehealth and Telehealth+SMS groups received two telehealth consultations delivered by a dietitian, 12 weeks access to a nutrition website and a private Facebook group. The Telehealth+SMS group received additional SMS. Feasibility was assessed through recruitment, retention, and intervention utilisation. Efficacy was assessed through changes in measured child body mass index (BMI), waist circumference and diet.

RESULTS

Forty-four (96%) and 36 (78%) families attended initial and second telehealth consultations, respectively. Thirty-six families (78%) completed week 12 assessments. Child BMI and waist circumference changes from baseline to week 12 were not statistically different within or between groups. Children in Telehealth+SMS had significantly reduced percentage energy from energy-dense nutrient-poor food (95% CI -21.99 to -0.03%E; p = .038) and increased percentage energy from healthy core food (95% CI -0.21 to 21.89%E; p = .045) compared to Waitlist control.

DISCUSSION

A family-focused online telehealth nutrition intervention is feasible. While the modest sample size reduced power to detect between-group changes in weight status, some improvements in child dietary intakes were identified in those receiving telehealth and SMS.

Dietary intake, food addiction and nutrition knowledge in young people with mental illness

AIM

The aim of this study was to comprehensively assess dietary intake, nutrition knowledge and food addiction in young people with mental illness.

METHODS

This was a three-arm cross-sectional study of 16-25-year-olds attending community mental health services who met criteria for: (i) first-episode psychosis (FEP), (ii) ultra-high risk for psychosis (UHR) or (iii) depression/anxiety. Participants self-completed three validated questionnaires: (i) Australian Eating Survey, (ii) General Nutrition Knowledge Questionnaire-Revised and (iii) Yale Food Addiction Score Questionnaire.

RESULTS

Thirty participants (mean age 19.7 ± 2.5 years) completed the study (10 per study arm); 43% of the energy intake was obtained from energy-dense, non-nutritious foods, higher than the recommended upper limit (<15%) and the levels reported in the general population (35%). Mean diet quality score was 33.5 ± 11.8 of 73. Mean food addiction symptom score was 3.3 ± 3.7. Prevalence of food addiction was 37%. Nutrition knowledge was lower in the FEP and UHR participants than the depression/anxiety group (48.2 ± 13.8 and 49.5 ± 8.2 of 88 respectively); however, this difference was not statistically significant.

CONCLUSIONS

Unhealthy dietary intake was observed in the early stages of mental illness, likely seeding future poor physical health. Further research is needed on the role of food addiction in this population, including effective intervention techniques.

Omega-3 and Omega-6 Intake Modifies Asthma Severity and Response to Indoor Air Pollution in Children

Rationale: Higher indoor particulate matter (PM) concentrations are linked with increased asthma morbidity. Dietary intake of fatty acids, also linked with asthma outcomes, may influence this relationship. Objectives: To determine the relationship between omega-3 and omega-6 fatty acid intake and pediatric asthma morbidity, and the association between fatty acid intake and strength of indoor, PM-related asthma symptoms, albuterol use, and systemic inflammation. Methods: Analyses included 135 children with asthma enrolled in the AsthmaDIET Study. At baseline, 3 months, and 6 months, data included: week-long average home indoor concentration of PM ≤2.5 μm in aerodynamic diameter and PM ≤10 μm in aerodynamic diameter, dietary intake of omega-3 and omega-6 fatty acids, daily symptoms, and peripheral blood leukocytes. Asthma severity and lung function were assessed at baseline. Multivariable regression models, adjusted for known confounders, were used to determine associations between each fatty acid and outcomes of interest, with interaction terms (fatty acids × PM) in longitudinal analyses. Measurements and Main Results: Higher omega-6 intake associated with increased odds of increased asthma severity (P = 0.02), and lower FEV1/FVC ratio (P = 0.01). Higher omega-3 intake associated with reduced effect of indoor PM ≤2.5 μm in aerodynamic diameter on symptoms (P < 0.01), whereas higher omega-6 intake associated with amplified effect of indoor PM ≤2.5 μm in aerodynamic diameter on symptoms and circulating neutrophil percentage (P < 0.01). Conclusions: Omega-3 and omega-6 intake are associated with pediatric asthma morbidity and may modify the asthmatic response to indoor PM.

Evaluation of a Rapid Assessment Questionnaire Using a Biomarker for Dietary Intake of n-3 Fatty Acids

While there is considerable evidence supporting health benefits of consuming diets high in omega-3 (n-3) fatty acids, there is no quick and effective tool to measure n-3 intake. The objective of this study was to evaluate the accuracy of a rapid assessment questionnaire (the Omega-3 Checklist) used to quantify intake of n-3 fatty acids. This was done by comparing n-3 intakes to blood biomarkers of n-3 exposure in a population of healthy men and women. In addition, a separate analysis was run including covariates age, sex, and weight, which have been shown to affect n-3 biomarker levels. Reported intake of eicosapentaenoic acid (EPA), docoshexaenoic acid (DHA), and EPA + DHA was correlated with erythrocyte EPA (Spearman's rank correlation r_s  = 0.51, p < 0.001), DHA (r_s  = 0.54, p < 0.001), and the Omega-3 Index (r_s  = 0.57, p < 0.001). These associations remained significant when controlling for age, sex, and weight. Therefore, the Omega-3 Checklist can be a useful, rapid assessment tool to estimate individuals' EPA and DHA intake.

Is high oily fish intake achievable and how does it affect nutrient status in 8-9-year-old children?: the FiSK Junior trial

PURPOSE

Most children do not meet dietary guidelines for fish intake. Fish is the main source of EPA (20:5n-3), DHA (22:6n-3) and vitamin D, but may replace better iron sources such as meat. We investigated if intake of 300 g/week oily fish was achievable in children and how it affected their nutrient status. Additionally, we validated a fish food frequency questionnaire (FFQ) by correlations against EPA + DHA in red blood cells (RBC).

METHODS

In a randomised 12-week trial, 199 children (8-9 years) received oily fish or poultry (control) to be eaten five times/week. We measured dietary intake and analysed fasting RBC EPA + DHA, serum 25-hydroxyvitamin D (25(OH)D), blood haemoglobin and plasma ferritin.

RESULTS

197 (99%) children completed the study. The median (25th-75th percentile) intake was 375 (325-426) and 400 (359-452) g/week oily fish and poultry, respectively. The fish group increased their intake of EPA + DHA by 749 (593-891) mg/day and vitamin D by 3.1 (1.6-3.8) µg/day. Endpoint RBC EPA + DHA was 2.3 (95% CI 1.9; 2.6) fatty acid %-point higher than the poultry group (P < 0.001). The fish group avoided the expected 25(OH)D winter decline (P < 0.001) and had 23%-point less vitamin D insufficiency (winter subgroup, n = 82). Haemoglobin and ferritin decreased slightly in both groups (P < 0.05), but the number of children with low values did not change (P > 0.14). FFQ estimates moderately reflected habitual intake (r = 0.28-0.35) and sufficiently captured intervention-introduced changes in intake (r > 0.65).

CONCLUSION

Oily fish intake of 300 g/week was achievable and improved children's EPA + DHA and 25(OH)D status, without markedly compromising iron status. These results justify public health initiatives focusing on children's fish intake.

Dietary and Plasma Polyunsaturated Fatty Acids Are Inversely Associated with Asthma and Atopy in Early Childhood

BACKGROUND

Polyunsaturated fatty acids (PUFAs) influence immune function and risk of allergic disease. Prior evidence of the effect of PUFA intake on childhood asthma and allergy is inconclusive.

OBJECTIVES

To investigate associations of PUFA plasma levels and dietary intake with asthma and allergy at age 3 years in this ancillary study of the Vitamin D Antenatal Asthma Reduction Trial.

METHODS

Plasma PUFA levels were reported as relative abundances from mass spectrometry profiling, and dietary PUFA intake was derived from food frequency questionnaire responses. Associations between PUFA and outcomes, including asthma and/or recurrent wheeze, allergic sensitization, and total IgE at age 3 years, were evaluated in adjusted regression models. Additional regression models analyzed the combined effects of antenatal vitamin D and early childhood PUFA on outcomes.

RESULTS

Total, omega-3, and omega-6 plasma PUFA relative abundances were significantly (P < .05) inversely associated with both asthma and/or recurrent wheeze and allergic sensitization. Likewise, dietary PUFA intake was inversely associated with asthma and/or recurrent wheeze (P < .05 for omega-6 PUFA only). For both dietary and plasma measures of total, omega-3, and omega-6 PUFAs, inverse associations with outcomes were strongest among subjects with both high umbilical cord blood 25-hydroxyvitamin D and high PUFA at age 3 years.

CONCLUSIONS

PUFA dietary intake and plasma levels are inversely associated with asthma and/or recurrent wheeze and atopy at age 3 years. Antenatal vitamin D could modulate the effect of early childhood PUFA on risk of asthma and allergy.

Design and Rationale for a Parent-Led Intervention to Increase Fruit and Vegetable Intake in Young Childhood Cancer Survivors (Reboot): Protocol for a Pilot Study

BACKGROUND

Poor dietary habits are common among childhood cancer survivors, despite increasing their risk of cardio metabolic complications after cancer treatment. Here, we describe the design and rationale for a pilot telephone-based, parent-led intervention aimed at increasing fruit and vegetable intake in young cancer survivors (Reboot).

OBJECTIVE

This pilot study aims to assess the feasibility and acceptability of delivering evidence-based telephone support to parents of childhood cancer survivors. A secondary aim includes assessing the effect of Reboot on improving childhood cancer survivors' dietary quality by increasing child fruit and vegetable intake and variety and its contribution to overall nutrient intake.

METHODS

We aim to recruit parents of 15 young cancer survivors aged 2 to 12 years who have completed cancer treatment less than five years ago. The intervention comprises of 4 weekly 45-minute telephone sessions led by a health professional and one booster session 6 weeks later. Sessions address the effects of cancer treatment on children's diets, recommended fruit and vegetable intake for children, and evidence-based strategies to promote the consumption of fruit and vegetables as well as to manage fussy eating.

RESULTS

Reboot is based on an existing, evidence-based parent nutrition intervention and modified for childhood cancer survivors following extensive collaboration with experts in the field. Primary outcomes of feasibility and acceptability will be measured by the number of participants who complete all five sessions, average session length (minutes), length between sessions (days) and parent Likert ratings of the usefulness and impact of the intervention collected after the booster session. Of the 15 participants we aim to recruit, 3 have completed the intervention, 1 declined to participate, 11 are actively completing the intervention and 2 participants are providing written consent. The remaining 3 participants will be recruited via telephone follow-up calls. The intervention is due to be completed by July 2018.

CONCLUSIONS

Reboot aims to support healthy dietary behaviors in childhood cancer survivors who are at increased risk of developing serious cardiometabolic complications after their cancer treatment. Results will inform the development and implementation of future evidence-based dietary interventions delivered to childhood cancer survivors, particularly those living in rural and remote areas.

REGISTERED REPORT IDENTIFIER

RR1-10.2196/9252.

Dietary outcomes of overweight fathers and their children in the Healthy Dads, Healthy Kids community randomised controlled trial

BACKGROUND

Few studies have examined dietary intake changes following a weight loss intervention in fathers and the association between father-child dietary intakes. The present study aimed to: (i) evaluate the change in dietary intake in overweight fathers randomised to a family-based lifestyle intervention [Healthy Dads Healthy Kids (HDHK)] versus controls and (ii) investigate whether an association exists between father-child dietary intakes.

METHODS

A secondary analysis was conducted of father-child baseline and 3-month post-intervention data (n = 93) collected in the HDHK community randomised controlled trial. Intention-to-treat linear mixed models were used to assess dietary changes by group, time (baseline and 3-month) and the group-by-time interaction. Cohens d was used to determine effect sizes.

RESULTS

Significant group-by-time effects (all P < 0.05) favouring fathers in the intervention group were identified for total daily energy intake (-1956 kJ, d = 0.74), total sugars (-45 g, d = 0.63), sodium (-414 mg, d = 0.58) and % energy from nutrient-dense, core foods (+10.1%, d = 0.86), fruit (+2.4%, d = 0.71), vegetarian protein sources (+1.2%, d = 0.57), pre-packed snacks (+1.7%, d = 0.58) and sugar-sweetened beverages (-4.1%, d = 0.58). At baseline, positive correlations were observed between father-child intakes for a number of dietary variables, and significant correlations were observed between father-child change scores for % energy carbohydrate (r = 0.35, P = 0.023), % energy from fruit (r = 0.47, P = 0.002), vegetarian protein sources (r = 0.46, P = 0.002) and frequency of consuming meals with vegetables (r = 0.38, P = 0.012).

CONCLUSIONS

The HDHK intervention successfully improved some aspects of father's dietary intakes compared to controls. The fathers' eating patterns also correlated with those of their children for several dietary variables. These novel data suggest that fathers can be targeted as agents of dietary change within obesity prevention and treatment programmes.

Polyunsaturated fatty acids in plasma at 8 years and subsequent allergic disease

BACKGROUND

Polyunsaturated fatty acids (PUFAs) are hypothesized to modulate the risk of allergic disease. However, evidence from previous studies is inconclusive, and limited longitudinal data exist using circulating biomarkers of PUFA intake and metabolism.

OBJECTIVE

We aimed to investigate associations between n-3 and n-6 PUFAs at age 8 years and asthma, rhinitis, and aeroallergen sensitization at age 16 years.

METHODS

Proportions of n-3 PUFAs (very long-chain n-3 [VLC n-3; sum of eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid] and α-linolenic acid) and n-6 PUFAs (linoleic acid and arachidonic acid [AA]) in blood samples at age 8 years were measured for 940 children from the prospective Swedish birth cohort BAMSE (Children, Allergy, Milieu, Stockholm, Epidemiology). Allergic disease phenotypes were defined by using questionnaires and IgE measures at the ages of 8 and 16 years. Logistic regression was used to examine potential associations.

RESULTS

A higher proportion of total VLC n-3 PUFAs in plasma at age 8 years was associated with a reduced risk of prevalent asthma, rhinitis, and aeroallergen sensitization at age 16 years and with incidence of asthma between 8 and 16 years (adjusted odds ratio, 0.67; 95% CI, 0.47-0.94). AA was associated with a reduced risk of asthma, aeroallergen sensitization, and allergic rhinitis. The findings were most evident for allergic phenotypes of asthma and rhinitis. Additionally, AA was associated with an increased probability of asthma and rhinitis remission between 8 and 16 years of age.

CONCLUSION

Higher proportions of certain VLC n-3 and very long-chain n-6 PUFAs in plasma phospholipids at age 8 years were associated with a reduced risk of allergic disease at age 16 years.

Associations between selected dietary behaviours and academic achievement: A study of Australian school aged children

BACKGROUND

Research investigating the effects of dietary behaviours on children's academic achievement has predominately focused on breakfast consumption. The aim of this study was to conduct secondary analysis to examine associations between a range of dietary behaviours and children's academic achievement.

METHODOLOGY

Data on five dietary variables (fruit intake; vegetable intake; consumption of takeaway; sugar sweetened beverages; and breakfast) and scores in the five domains of a standardised academic achievement test known as NAPLAN (reading, writing, grammar/punctuation, spelling and numeracy) were obtained for Australian children aged 8-15 years in school grades three (n = 1185), five (n = 1147), seven (n = 1053) and nine (n = 860). Mixed linear models adjusted for socioeconomic status and gender were used to examine associations between dietary behaviours and academic scores.

RESULTS

Greater consumption of vegetables with the evening meal (7 nights/week) was associated with higher test scores in the domains of spelling and writing (p=<0.01), with the greatest effect observed for spelling with a mean score difference of 86 ± 26.5 NAPLAN points between the highest and lowest levels of consumption (95% CI: 34.0-138.1; p=<0.01). Increased consumption of sugar sweetened beverages was associated with significantly lower test scores in reading, writing, grammar/punctuation and numeracy (<0.01).

PRINCIPLE CONCLUSIONS

The findings of this study demonstrate dietary behaviours are associated with higher academic achievement. Future research should further explore relationships between a wide range of dietary behaviours and children's academic achievement.

The Diet Quality of Competitive Adolescent Male Rugby Union Players with Energy Balance Estimated Using Different Physical Activity Coefficients

Objectives: The aims of the current study were to comprehensively assess the dietary intakes and diet quality of a sample of Australian competitive adolescent rugby union players and compare these intakes with National and Sports Dietitians Association (SDA) Recommendations for adolescent athletes. A secondary aim investigated applying different physical activity level (PAL) coefficients to determine total energy expenditure (TEE) in order to more effectively evaluate the adequacy of energy intakes. Design: Cross-sectional. Methods: Anthropometrics and dietary intakes were assessed in 25 competitive adolescent male rugby union players (14 to 18 years old). Diet was assessed using the validated Australian Eating Survey (AES) food frequency questionnaire and diet quality was assessed through the Australian Recommended Food Score. Results: The median dietary intakes of participants met national recommendations for percent energy (% E) from carbohydrate, protein and total fat, but not carbohydrate intake when evaluated as g/day as proposed in SDA guidelines. Median intakes of fibre and micronutrients including calcium and iron also met national recommendations. Overall diet quality was classified as ‘good’ with a median diet quality score of 34 (out of a possible 73); however, there was a lack of variety within key food groups including carbohydrates and proteins. Non-core food consumption exceeded recommended levels at 38% of the daily total energy intake, with substantial contributions from takeaway foods and sweetened beverages. A PAL coefficient of 1.2–1.4 was found to best balance the energy intakes of these players in their pre-season. Conclusions: Adolescent rugby players met the percent energy recommendations for macronutrients and attained an overall ‘good’ diet quality score. However, it was identified that when compared to specific recommendations for athletes, carbohydrate intakes were below recommendations and these players in their pre-season reported high consumption of non-core foods, particularly sugar sweetened drinks and low intakes of vegetables.

Utility of a brief index to measure diet quality of Australian preschoolers in the Feeding Healthy Food to Kids Randomised Controlled Trial

AIM

The aim was to evaluate the utility of a brief dietary intake assessment tool in measuring nutritional adequacy of preschoolers and differences in food and nutrient intake between quartiles stratified by overall diet quality.

METHODS

Dietary intakes of preschoolers (n = 146) from the Feeding Healthy Food to Kids trial were reported by parents/caregivers using a 120-item food frequency questionnaire (FFQ). Diet quality was assessed using the Australian Recommended Food Score for Preschoolers. Analyses were performed using Kruskal-Wallis one-way analysis of variance, adjusted for Type 1 error. Participants were grouped into quartiles by total food score for comparison of subscale scores, food groups and nutrient intakes from the FFQ.

RESULTS

Participants who scored less than the median total food score of 36 were more likely to have suboptimal micronutrient intakes. Median fruit (9 vs 5, P < 0.0001) and vegetable (14 vs 7, P < 0.0001) subscale scores for preschoolers in the highest quartile were significantly higher than the lowest quartile, indicating much greater fruit and vegetable variety. Statistically significant differences in diet quality score by quartiles (P < 0.05) were found for total energy and percentage energy from core foods, protein, fibre and 11 micronutrients.

CONCLUSIONS

The Australian Recommended Food Score for Preschoolers is a practical brief diet quality assessment tool to measure food variety and nutritional adequacy in Australian preschoolers. Stratifying children by baseline diet quality in future nutrition interventions is recommended in order to identify those who are likely to benefit or require more targeted approaches to address specific nutritional needs in order to optimise food and nutrient intakes.

Erythrocyte fatty acid status in a convenience sample of residents of the Guatemalan Pacific coastal plain

We report the fatty acid composition, and in particular, the n-3 and n-6 long-chain polyunsaturated fatty acids (LCPUFA), in erythrocytes from a convenience sample of 158 women and 135 schoolchildren residing in the southern Pacific Coast of Guatemala. Erythrocyte fatty acids were analyzed by gas-liquid chromatography with flame ionization detection and the profiles were expressed as a weight percent; the Omega-3 Index values were also determined. Schoolchildren had significantly higher mean ARA and total n-6 fatty acid levels than the women. Women had significantly higher EPA fatty acid levels than schoolchildren, but the reverse was true for DHA. For mean total n-3 fatty acid concentration, women and schoolchildren had similar values. The red cell weight percentages of selected fatty acids were also similar in women and schoolchildren. As compared with erythrocyte fatty acid data from developed countries, Guatemalan women and schoolchildren had consistently lower LCPUFA values. The traditional diet of Guatemalans living in the Pacific coastal region provided a worse erythrocyte fatty acid profile than that typically obtained from a Western diet. Additional fatty acid composition studies with associated dietary intake data in other inland locations may be useful for the interpretation of the nutritional status of Guatemalan children and adults.

Foods and dietary profiles associated with 'food addiction' in young adults

Background

It has been suggested that addictive behaviors related to consumption of specific foods could contribute to overeating and obesity. Although energy-dense, hyper-palatable foods are hypothesized to be associated with addictive-like eating behaviors, few studies have assessed this in humans.

Objective

To evaluate in young adults whether intakes of specific foods are associated with ‘food addiction’, as assessed by the Yale Food Addiction Scale (YFAS), and to describe the associated nutrient intake profiles.

Design

Australian adults aged 18–35 years were invited to complete an online cross-sectional survey including demographics, the YFAS and usual dietary intake. Participants were classified as food addicted (FAD) or non-addicted (NFA) according to the YFAS predefined scoring criteria.

Results

A total 462 participants (86% female, 73% normal weight) completed the survey, with 14.7% (n = 68) classified as FAD. The FAD group had a higher proportion of females (p = .01) and higher body mass index (p < .001) compared to NFA. Higher YFAS symptom scores were associated with higher percentage energy intake (%E) from energy-dense, nutrient-poor foods including candy, take out and baked sweet products, as well as lower %E from nutrient-dense core foods including whole-grain products and breakfast cereals. These remained statistically significant when adjusted for age, sex and BMI category (p = .001).

Conclusions

Statistically significant associations were identified between YFAS assessed food addiction and dietary intake, specifically intakes of energy-dense, nutrient-poor foods. However, the effect sizes were small limiting clinical applications. Further examination of the relationship between addictive-like eating and intake of specific foods in a nationally representative sample is warranted.

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14.7% participants met the YFAS predefined criteria for food addiction.

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Those classified as food addicted had a significantly higher body mass index.

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Higher symptom scores related to higher intakes of energy-dense nutrient-poor foods

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Lower odds of YFAS assessed food addiction with higher intakes of whole-grains.

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Higher odds of YFAS assessed food addiction with higher intakes of dietary fat.

Impact Evaluation of an After-school Cooking Skills Program in a Disadvantaged Community: Back to Basics

PURPOSE

Few efficacious child obesity interventions have been converted into ongoing community programs in the after-school setting. The aim of this study was to evaluate the impact of phase 2 of the Back to Basics cooking club on dietary behaviours and fruit and vegetable variety in a population at risk of obesity at a low income school with > 10% indigenous population.

METHODS

Baseline and 3-month dietary intake and social cognitive theory (SCT) constructs were collected in 51 children, mean age 9 years, 61% female. McNemar tests were used for comparison of proportions between categorical variables. Cohen's d was used to compare effect sizes across different measures.

RESULTS

Consumption of one or more fruit servings per day significantly increased from 41% to 67% (P = 0.02, d = 0.13) and there was a trend for increasing the weekly variety of fruit and vegetables. The SCT constructs assessed within the current study improved significantly (P < 0.05), with moderate to large effect sizes (d = 0.33-0.78).

CONCLUSION

This study documents that a previous efficacious healthy lifestyle program can be adapted for use as an obesity prevention program addressing improvements in vegetable and fruit intakes in a low income community with a relatively high indigenous population.

The comparative validity and reproducibility of a diet quality index for adults: the Australian Recommended Food Score

Adult diet quality indices are shown to predict nutritional adequacy of dietary intake as well as all-cause morbidity and mortality. This study describes the reproducibility and validity of a food-based diet quality index, the Australian Recommended Food Score (ARFS). ARFS was developed to reflect alignment with the Australian Dietary Guidelines and is modelled on the US Recommended Food Score. Dietary intakes of 96 adult participants (31 male, 65 female) age 30 to 75 years were assessed in two rounds, five months apart. Diet was assessed using a 120-question semi-quantitative food frequency questionnaire (FFQ). The ARFS diet quality index was derived using a subset of 70 items from the full FFQ. Reproducibility of the ARFS between round one and round two was confirmed by the overall intraclass correlation coefficient of 0.87 (95% CI 0.83, 0.90), which compared favourably to that for the FFQ at 0.85 (95% CI 0.80, 0.89). ARFS was correlated with FFQ nutrient intakes, particularly fiber, vitamin A, beta-carotene and vitamin C (0.53, 95% CI 0.37-0.67), and with mineral intakes, particularly calcium, magnesium and potassium (0.32, 95% CI 0.23-0.40). ARFS is a suitable brief tool to evaluate diet quality in adults and reliably estimates a range of nutrient intakes.

Australasian nutrition research for prevention and management of child obesity: innovation and progress in the last decade

BACKGROUND/OBJECTIVE

The Food and Nutrition stream of Australasian Child and Adolescent Obesity Research Network (ACAORN) aims to improve the quality of dietary methodologies and the reporting of dietary intake within Australasian child obesity research (http://www.acaorn.org.au/streams/nutrition/).

METHODS/RESULTS

With 2012 marking ACAORN's 10th anniversary, this commentary profiles a selection of child obesity nutrition research published over the last decade by Food and Nutrition Stream members. In addition, stream activities have included the development of an online selection guide to assist researchers in their selection of appropriate dietary intake methodologies (http://www.acaorn.org.au/streams/nutrition/dietary-intake/index.php).

CONCLUSIONS

The quantity and quality of research to guide effective child obesity prevention and treatment has increased substantially over the last decade. ACAORN provides a successful case study of how research networks can provide a collegial atmosphere to foster and coordinate research efforts in an otherwise competitive environment.

Evaluation of the relative concentration of serum fatty acids C14:0, C15:0 and C17:0 as markers of children's dairy fat intake

BACKGROUND/AIMS

Biomarkers can provide objective measures of dietary exposure, but their relationship with dietary intake in different populations needs to be characterized. This study aimed to determine the association between C14:0, C15:0 and C17:0 and children's dairy fat intake, and to ascertain whether these fatty acids can be used as biomarkers for detecting change in dairy fat intake.

METHODS

Data from a randomized controlled trial (114 healthy children of 4-13 years of age) was used. The intervention was a replacement of regular-fat dairy foods with reduced-fat or low-fat items. Serum fatty acid composition was measured and dairy intake was assessed via 3 × 24-hour diet recalls at baseline and at 12 weeks (the end of the intervention). Correlation analysis was used to evaluate the relationship between dietary intake and fatty acids at baseline and at week 12, and for the change in biomarkers and diet between these time points.

RESULTS

Total dairy fat intake correlated with C14:0, C15:0 and C17:0 at baseline (n = 114; r = 0.24; r = 0.42; r = 0.25 respectively, all p < 0.05), but not at week 12. The change in the total amount of dairy fat (g/day) after 12 weeks was associated with a change in serum C15:0 (n = 59; r = 0.27; p = 0.04).

CONCLUSIONS

C15:0 is a useful biomarker of dairy fat intake in children and can detect short-term changes in the absolute intake of dairy fat.

Test-retest reliability and validity of a web-based food-frequency questionnaire for adolescents aged 13-14 to be used in the Norwegian Mother and Child Cohort Study (MoBa)

Background

The assessment of food intake is challenging and prone to errors; it is therefore important to consider the reliability and validity of the assessment methods.

Objective

The aim of this study was to analyze the reproducibility and validity of a developed food-frequency questionnaire (FFQ) for use among adolescents.

Design

In total, 58 students (aged 13–14) from four different schools in the southern part of Norway participated in the reproducibility study of filling out the FFQ 4 weeks apart. In addition, 93 students participated in the relative validity study where the FFQ was compared to 2×24-hour dietary recalls, while 92 students participated in the absolute validity study where the intakes of fatty acids and vitamin D from the FFQ were compared to fatty acids and 25-hydroxy-vitamin D₃ in whole blood.

Results

The median Spearman correlation coefficient for all nutrients in the test–retest reliability study was 0.57. The median Spearman correlation for all nutrients in the relative validity study was 0.26, while the correlations coefficients were low in the absolute validity study with n-3 fatty acid coefficients ranging from 0.05 to 0.25, and absent for vitamin D (r=0.000).

Conclusion

The test–retest reproducibility was considered good, the relative validity was considered poor to good, and the absolute validity was considered poor. However, the results are comparable to other studies among adolescents.

Relationships between dietary intakes of children and their parents: a cross-sectional, secondary analysis of families participating in the Family Diet Quality Study

BACKGROUND

Being overweight and obese in Australian children is common. Current evidence related to parental influence on child dietary intake is conflicting, and is particularly limited in terms of which parent exerts the stronger relationship. The present study aimed to assess mother-father and parent-child dietary relationships and to identify which parent-child relationship is stronger.

METHODS

A cross-sectional analysis was performed of dietary intake data from 66 families with one parent and one child aged 8-12 years who were participating in the Family Diet Quality Study, in the Hunter and Forster regions of New South Wales, Australia. Dietary intakes were assessed using adult and child specific, validated semi-quantitative 120-item food frequency questionnaires. Diet quality and variety subscores were assessed using the Australian Recommended Food Scores for adults and children/adolescents. Pearson's correlations were used to assess dietary relationships between mother-father, father-child and mother-child dyads.

RESULTS

Weak-to-moderate correlations were found between mother-child dyads for components of dietary intake (r = 0.27-0.47). Similarly, for father-child dyads, predominantly weak-to-moderate correlations were found (r = 0.01-0.52). Variety of fruit intake was the most strongly correlated in both parent-child dyads, with the weakest relationships found for fibre (g 1000 kJ(-1) ) in father-child and percentage energy from total fats for mother-child dyads. Mother-father dyads demonstrated mostly moderate-to-strong correlations (r = 0.13-0.73), with scores for condiments showing the weakest relationship and vegetables the strongest. For all dyads, strong correlations were observed for overall diet quality (r = 0.50-0.59).

CONCLUSIONS

Parent-child dietary intake is significantly related but differs for mother versus fathers. Further research is required to examine whether differing dietary components should be targeted for mothers versus fathers in interventions aiming to improve family dietary patterns.

Dietary Intake Is Related to Multifactor Cardiovascular Risk Score in Obese Boys

Cardiovascular disease (CVD) originates in childhood and early identification of risk factors provides an early intervention opportunity. The aim was to identify children at higher risk using a CVD risk score, developed from factors known to cluster in childhood. Risk was scored as very high (≥97.5th centile), high (≥95th), moderate (≥90th) or threshold (<90th) using normal pediatric reference ranges for 10 common biomedical risk factors. These were summed in a multifactor CVD risk score and applied to a sample of 285 observations from 136 overweight Australian children (41% male, aged 7-12 years). Strength of associations between CVD risk score and individual biomedical and dietary variables were assessed using univariate logistic regression. High waist circumference (Odds Ratio: 5.48 [95% CI: 2.60-11.55]), body mass index (OR: 3.22 [1.98-5.26]), serum insulin (OR: 3.37 [2.56-4.42]) and triglycerides (OR: 3.02 [2.22-4.12]) were all significantly related to CVD risk score. High intakes of total fat (OR: 4.44 [1.19-16.60]), sugar (OR: 2.82 [1.54-5.15]) and carbohydrate (OR 1.75 [1.11-2.77]) were significantly related to CVD risk score in boys only. This multifactor CVD risk score could be a useful tool for researchers to identify elevated risk in children. Further research is warranted to examine sex-specific dietary factors related to CVD risk in children.

Reproducibility and comparative validity of a food frequency questionnaire for Australian adults

BACKGROUND

Food frequency questionnaires (FFQ) are used in epidemiological studies to investigate the relationship between diet and disease. There is a need for a valid and reliable adult FFQ with a contemporary food list in Australia.

AIMS

To evaluate the reproducibility and comparative validity of the Australian Eating Survey (AES) FFQ in adults compared to weighed food records (WFRs).

METHODS

Two rounds of AES and three-day WFRs were conducted in 97 adults (31 males, median age and BMI for males of 44.9 years, 26.2 kg/m(2), females 41.3 years, 24.0 kg/m(2). Reproducibility was assessed over six months using Wilcoxon signed-rank tests and comparative validity was assessed by intraclass correlation coefficients (ICC) estimated by fitting a mixed effects model for each nutrient to account for age, sex and BMI to allow estimation of between and within person variance.

RESULTS

Reproducibility was found to be good for both WFR and FFQ since there were no significant differences between round 1 and 2 administrations. For comparative validity, FFQ ICCs were at least as large as those for WFR. The ICC of the WFR-FFQ difference for total energy intake was 0.6 (95% CI 0.43, 0.77) and the median ICC for all nutrients was 0.47, with all ICCs between 0.15 (%E from saturated fat) and 0.7 (g/day sugars).

CONCLUSIONS

Compared to WFR the AES FFQ is suitable for reliably estimating the dietary intakes of Australian adults across a wide range of nutrients.

Dietary intake and food sources of EPA, DPA and DHA in Australian children

Secondary analysis of the 2007 Australian National Children's Nutrition and Physical Activity survey was undertaken to assess the intake and food sources of EPA, DPA and DHA (excluding supplements) in 4,487 children aged 2-16 years. An average of two 24-h dietary recalls was analysed for each child and food sources of EPA, DPA and DHA were assessed using the Australian nutrient composition database called AUSNUT 2007. Median (inter quartile range, IQR) for EPA, DPA and DHA intakes (mg/day) for 2-3, 4-8, 9-13, 14-16 year were: EPA 5.3 (1.5-14), 6.7 (1.8-18), 8.7 (2.6-23), 9.8 (2.7-28) respectively; DPA 6.2 (2.2-14), 8.2 (3.3-18), 10.8 (4.3-24), 12.2 (5-29) respectively; and DHA 3.9 (0.6-24), 5.1 (0.9-26), 6.8 (1.1-27), 7.8 (1.5-33) respectively. Energy-adjusted intakes of EPA, DPA and DHA in children who ate fish were 7.5, 2 and 16-fold higher, respectively (P < 0.001) compared to those who did not eat fish during the 2 days of the survey. Intake of total long chain n-3 PUFA was compared to the energy adjusted suggested dietary target (SDT) for Australian children and 20 % of children who ate fish during the 2 days of the survey met the SDT. Fish and seafood products were the largest contributors to DHA (76 %) and EPA (59 %) intake, while meat, poultry and game contributed to 56 % DPA. Meat consumption was 8.5 times greater than that for fish/seafood. Australian children do not consume the recommended amounts of long chain omega-3 fatty acids, especially DHA, which could be explained by low fish consumption.

Comparison of energy intake in toddlers assessed by food frequency questionnaire and total energy expenditure measured by the doubly labeled water method

The ability of parents to accurately report energy intake in toddlers has rarely been validated using the gold-standard doubly labeled water (DLW) method to assess total energy expenditure (TEE). The aim of the study was to evaluate the accuracy of toddler energy intake (EI), estimated using the Australian Child and Adolescent Eating Survey (ACAES) food frequency questionnaire (FFQ) by parent report compared with a weighed food record (WFR) and TEE measured by DLW. Twelve toddlers had TEE assessed over 10 days using DLW. Usual energy intake was estimated by the primary caregiver, using standard toddler portions in ACAES-FFQ and a 4-day WFR and daily EI (in kilocalories) derived using national nutrient databases. Accuracy of reporting was calculated from absolute (EI-TEE) and percentage (EI/TEE×100) differences between EI and TEE and Pearson correlations and limits of agreement from Bland-Altman plots. Toddlers (n=12, 7 boys) had a mean age of 3.2±0.5 years, body mass index 16.2±0.9 kg, body mass index z score 0.1±0.8, EI from ACAES-FFQ 1,183±281kcal/day, and WFR 1,179±278 kcal/day and DLW TEE 1,251±149 kcal/day. The mean difference and limits of agreement (±2 standard deviations) compared with DLW was -68 (-623, 488) kcal/day for the FFQ and for the WFR -72 (-499, 354) kcal/day. Although both a semiquantitative FFQ and WFR can adequately estimate toddler energy intake at the group level in this population, toddler-specific portion size estimates should be assigned to foods listed in the FFQ. Choice of method is likely to depend on practical issues, including cost and burden.

The development and evaluation of the Australian child and adolescent recommended food score: a cross-sectional study

Background

Diet quality tools have been developed to assess the adequacy of dietary patterns for predicting future morbidity and mortality. This study describes the development and evaluation of a brief food-based diet quality index for use with children at the individual or population level. The Australian Child and Adolescent Recommended Food Score (ACARFS) was developed to reflect adherence to the Dietary Guidelines for Children and Adolescents in Australia and modelled on the approach of the US Recommended Food Score.

Methods

The ACARFS has eight sub-scales and is scored from zero to 73. The diet quality score was evaluated by assessing correlation (Spearman’s correlations) and agreement (weighted κ statistics) between ACARFS scores and nutrient intakes, derived from a food frequency questionnaire in 691 children (mean age 11.0, SD 1.1) in New South Wales, Australia. Nutrient intakes for ACARFS quartiles were compared with the relevant Australian nutrient reference values.

Results

ACARFS showed slight to substantial agreement (κ 0.13-0.64) with nutrient intakes, with statistically significant moderate to strong positive correlations with all vitamins, minerals and energy intake (r = 0.42-0.70). ACARFS was not related to BMI.Participants who scored less than the median ACARFS were more likely to have sub-optimal intakes of fibre, folic acid and calcium.

Conclusion

ACARFS demonstrated sufficient accuracy for use in future studies evaluating diet quality. Future research on its utility in targeting improvements in the nutritional quality of usual eating habits of children and adolescents is warranted.

A comparison and validation of child versus parent reporting of children's energy intake using food frequency questionnaires versus food records: who's an accurate reporter?

BACKGROUND & AIMS

The aim of this study was to (i) to compare the accuracy of reporting for child's total energy intake from a food frequency questionnaire (FFQ) completed independently by the mother, father and child in comparison to total energy expenditure (TEE) measured using doubly labeled water (DLW) (ii) compare the accuracy of the weighed food record (WFR) and DLW.

METHODS

Healthy weight children (mean ± SD age 9.8 ± 1.3 years, n = 6 girls/3 boys) and their parents independently completed an FFQ about children's intake. A 4-day WFR of child intake was recorded simultaneously. The accuracy of energy intakes reports were determined by the absolute and percentage differences between estimated energy intake and TEE measured by DLW.

RESULTS

The mean difference (limits of agreement LOA, ± 2SD) when compared to DLW was; child 130 (-1518, 1258) kcal or (113 ± 35% of TEE); father 398 (0,796) kcal or (121 ± 13%); mother 807 (-213, 1824) kcal or (144 ± 26%) and for the WFR -153 (1089, -1395) kcal or 95 ± 32%.

CONCLUSIONS

Children were the most accurate reporters when compared to their parents, with fathers more accurate than mothers. The 4-day WFR was approximately equal to the child report FFQ in estimating EI in children 8-11 years.

Dietary outcomes of the healthy dads healthy kids randomised controlled trial

Fathers have not been exclusively targeted in family-based lifestyle programmes. The aim was to determine whether dietary intakes of fathers and children can be improved, following an intervention targeting fathers. Overweight and obese fathers (n=50, 21-65 years, body mass index [mean ± standard deviation] 33.3 ± 4.1) and their children (5-12 years) were recruited. Dietary intake was assessed at baseline and 6 months (n=35) by food frequency questionnaire. Linear mixed models determined differences by time. Fathers significantly reduced portion size (P=0.03) but not energy intakes, whereas children reduced energy intakes (kJ) (P=0.02). There is an opportunity to target fathers as to improve child intakes.