Influence of body composition on the accuracy of reported energy intake in children

Validity of dietary assessment methods compared with doubly labeled water in children: A systematic review and meta-analysis

OBJECTIVES

We aimed to validate dietary assessment methods against the gold standard, doubly labeled water (DLW), for estimating total energy intake (TEI).

METHODS

PubMed, Scopus, Web of Science, and Google Scholar databases were searched until May 2023. Inclusion criteria encompassed studies involving participants aged 1-18 years, employing dietary assessment methods like food records, dietary histories, food frequency questionnaire (FFQ), or 24-h recalls estimating TEI alongside DLW to measure total energy expenditure (TEE). Data were pooled using random-effects meta-analysis models.

RESULTS

Thirty-three studies were identified, with sample sizes ranging from 9 to 118 participants. Meta-analysis of 22 studies identified underestimation of TEI (mean difference [MD] = -262.9 kcal/day [95% CI: -380.0, -145.8]; I2 = 93.55%) for food records compared with TEE estimated by DLW. Other dietary assessment methods, including food recalls (n = 9) (MD = 54.2 kcal/day [95% CI: -19.8, 128.1]; I2 = 49.62%), FFQ (n = 7) (MD = 44.5 kcal/day [95% CI: -317.8, 406.8]; I2 = 94.94%), and diet history (n = 3) (MD = -130.8 kcal/day [95% CI: -455.8, 194.1]; I2 = 77.48%), showed no significant differences in TEI compared with DLW-estimated TEE. All studies were of high quality.

CONCLUSION

Food records may underestimate TEI, yet additional research is needed to identify the most accurate methods for assessing children's dietary intake.

Machine learning modeling practices to support the principles of AI and ethics in nutrition research

BACKGROUND

Nutrition research is relying more on artificial intelligence and machine learning models to understand, diagnose, predict, and explain data. While artificial intelligence and machine learning models provide powerful modeling tools, failure to use careful and well-thought-out modeling processes can lead to misleading conclusions and concerns surrounding ethics and bias.

METHODS

Based on our experience as reviewers and journal editors in nutrition and obesity, we identified the most frequently omitted best practices from statistical modeling and how these same practices extend to machine learning models. We next addressed areas required for implementation of machine learning that are not included in commercial software packages.

RESULTS

Here, we provide a tutorial on best artificial intelligence and machine learning modeling practices that can reduce potential ethical problems with a checklist and guiding principles to aid nutrition researchers in developing, evaluating, and implementing artificial intelligence and machine learning models in nutrition research.

CONCLUSION

The quality of AI/ML modeling in nutrition research requires iterative and tailored processes to mitigate against potential ethical problems or to predict conclusions that are free of bias.

Dietary glycemic index and glycemic load mediate the effect of CARTPT rs2239670 gene polymorphism on metabolic syndrome and metabolic risk factors among adults with obesity

INTRODUCTION

The importance of genetic and dietary factors in occurrence and progression of chronic diseases such as metabolic syndrome (MetS) has been established. However, complex interrelationships, including direct and indirect effects of these variables are yet to be clarified. So, our aim was to investigate the mediating role of glycemic indices in the relationship between CARTPT rs2239670 polymorphism, socio-demographic and psychological factors and metabolic risk factors and the presence of MetS in adults with obesity.

METHODS

In a cross-sectional study of 288 apparently healthy adults with obesity aged 20-50 years, dietary glycemic index (GI) and glycemic load (GL) were measured using a validated semi-quantitative food frequency questionnaire (FFQ). Biochemical parameters, blood pressure and anthropometric indicators were assayed by standard methods. Genotyping was carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Structural equation modeling (SEM) was used in the statistical analysis.

RESULTS

CARTPT rs2239670 had a positive direct effect on MetS (B = 0.037 ± 0.022; P = 0.043) and, on the other hand, this variant was found to be indirectly associated with MetS presence through mediation of GI (B = 0.039 ± 0.017; P = 0.009). CARTPT was a significant predictor of both dietary GI and GL (B = 1.647 ± 0.080 and B = 3.339 ± 0.242, respectively). Additionally, glycemic indicators appeared to mediate the association of age and gender with LDL-C (B = 0.917 ± 0.332; P = 0.006) and HDL (B = 1.047 ± 0.484; P = 0.031), respectively. GI showed a positive relationship with LDL-C (P = 0.024) in men and similar relationships were found between GL and LDL-C (P = 0.050) and cholesterol (P = 0.022) levels in women.

CONCLUSION

The SEM findings suggest a hypothesis of the mediating effect of glycemic indices in the relationship between genetic susceptibility to obesity and MetS presence. Our findings need to be confirmed with large prospective studies.

The Role of Dietary Glycemic Index and Glycemic Load in Mediating Genetic Susceptibility via MC4R s17782313 Genotypes to Affect Cardiometabolic Risk Factors among Apparently Healthy Obese Individuals

Background

The association of genetic and dietary factors with occurrence and progression of chronic diseases such as metabolic syndrome (MetS) has long been addressed but there is a lack of evidence for complex interrelationships, including direct and indirect effects of these variables. Hence, this study is aimed at evaluating the mediating role of glycemic indices in the association of melanocortin-4 receptor (MC4R) rs17782313 polymorphism, sociodemographic, and psychological factors with the risk of MetS in obese adults using structural equation modeling.

Methods

We performed a cross-sectional analysis of data from 287 apparently healthy adults. Dietary glycemic index (GI) and glycemic load (GL) were calculated from a validated 147-item food frequency questionnaire (FFQ). MC4R s17782313 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Structural equation modeling was used to explore direct and indirect effects of genetic and nongenetic factors on MetS.

Results

MC4R gene variant was directly associated with the risk of MetS (B = 0.010; P = 0.023). On the other hand, this variant was found to be indirectly and positively associated with LDL-C (B = 6.589; P = 0.042) through mediatory effects of GI and GL. Moreover, GI and GL also mediated indirect positive effects of sex and age on LDL-C (B = 3.970; P ≤ 0.01; B = 0.878; P ≤ 0.01, respectively) and HDL (B = 2.203; P ≤ 0.01; B = 0.129; P ≤ 0.01, respectively). MC4R rs17782313 polymorphism had positive effects on GI (B = 1.577; P ≤ 0.01) and GL (B = 1.235; P ≤ 0.01).

Conclusion

Our data may state a hypothesis of the mediating effect of quantity and quality of carbohydrates consumed in relationship between genetic susceptibility to obesity and cardiometabolic risk factors. Further analyses should be carried out in high-quality cohort studies in order to confirm the findings.

Association and interaction of the MC4R rs17782313 polymorphism with plasma ghrelin, GLP-1, cortisol, food intake and eating behaviors in overweight/obese Iranian adults

BACKGROUND

Recent studies have shown that obesity is largely influenced by heredity and created by the interactions between several genes and environmental and behavioral factors. This study aimed to examine association between variant rs17782313 near melanocortin-4 receptor (MC4R) gene and behavioral and hormonal factors then evaluated interactions between variant MC4R rs17782313 with behavioral and hormonal factors on obesity.

METHODS

This cross-sectional study included 403 subjects, overweight and/or obesity, aged 20-50 years from Iran. The MC4R rs17782313 data were measured by the PCR-RFLP method. Dietary intake, physical activity, stress, anxiety, depression, appetite and emotional eating were assessed by using validated questionnaires. Ghrelin, glucagon-like peptide-1 and cortisol were measured by radioimmunoassay in plasma samples. Participants were also divided into three groups based on rs17782313 genotype and BMI.

RESULTS

After adjustment for age, gender, energy intake and PA, significant associations were observed between food intake, appetite, emotional eating, stress and physical activity with MC4R rs17782313 (p ˂0.05). Also, significant interactions were observed between fat intake (p-interaction = 0.002), protein intake (p-interaction = 0.01), energy intake (p-interaction = 0.01), emotional eating (p-interaction = 0.02), appetite (p-interaction = 0.04), stress (p-interaction = 0.04), ghrelin (p-interaction = 0.03), cortisol (p-interaction = 0.04) and physical activity (p-interaction = 0.04) and MC4R rs17782313 in terms of BMI.

CONCLUSION

Interactions between the CC genotype and high intakes of fat and energy, emotional eating, high appetite, and too much stress with high levels of cortisol and ghrelin probably can have an effect on BMI in overweight/obese subjects.

Dietary total antioxidant capacity interacts with a variant of chromosome 5q13-14 locus to influence cardio-metabolic risk factors among obese adults

Background

The association between cocaine- and amphetamine-regulated transcript prepropeptide gene (CARTPT) and obesity-related outcomes has shown in the epidemiological studies. Nevertheless, there is lack of data regarding the CARTPT gene-diet interactions in terms of antioxidant potential of diet. So, this study aimed to test CARTPT gene-dietary non-enzymatic antioxidant capacity (NEAC) interactions on cardio-metabolic risk factors in obese individuals.

Methods and material

The present cross-sectional study was carried out among 288 apparently healthy obese adults within age range of 20-50 years. Antioxidant capacity of diet was estimated by calculating the oxygen radical absorbance capacity (ORAC), ferric reducing antioxidant power (FRAP), total radical-trapping antioxidant parameter (TRAP) and Trolox equivalent antioxidant capacity (TEAC) using a semiquantitative food frequency questionnaire (FFQ). Genotyping for CARTPT rs2239670 polymorphism was conducted by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.

Results

A significant interaction was revealed between CARTPT rs2239670 and dietary ORAC on BMI (PInteraction = 0.048) and fat mass percent (FM%) (PInteraction = 0.008); in A allele carriers, higher adherence to the dietary ORAC was related to lower level of BMI and FM%. And, the significant interactions were observed between FRAP index and rs2239670 in relation to HOMA (PInteraction = 0.049) and QUICKI (PInteraction = 0.048). Moreover, there were significant interactions of rs2239670 with TRAP (PInteraction = 0.029) and TEAC (PInteraction = 0.034) on the serum glucose level; individuals with AG genotype were more respondent to higher intake of TRAP.

Conclusion

The present study indicated that the relationships between CARTPT rs2239670 and obesity and its-related metabolic parameters depend on adherence to the dietary NEAC. Large prospective studies are needed to confirm our findings.

Association between CLOCK 3111 T/C polymorphism with ghrelin, GLP-1, food timing, sleep and chronotype in overweight and obese Iranian adults

BACKGROUND

Circadian Locomotor Output Cycles Kaput (CLOCK), an essential element of the positive regulatory arm in the human biological clock, is involved in metabolic regulation. The aim was to investigate the behavioral (sleep duration, food timing, dietary intake, appetite and chronobiologic characteristics) and hormonal (plasma ghrelin and Glucagon-like peptide-1 concentrations) factors that could explain the previously reported association between the CLOCK 3111 T/C SNP and obesity.

METHODS

This cross-sectional study included 403 subjects, overweight and/or obesity, aged 20- 50 years from Iran. The CLOCK rs1801260 data were measured by the PCR-RFLP method. Dietary intake, food timing, sleep duration, appetite and Chrono-type were assessed using validated questionnaires. Ghrelin and GLP-1 were measured by ELIZA in plasma samples. Participants were also divided into three groups based on BMI. Logistic regression models and general linear regression models were used to assess the association between CLOCK genotype and study parameters. Univariate linear regression models were used to assess the interaction between CLOCK and VAS, Food timing, chronotype and sleep on food intakes.

RESULTS

After controlling for confounding factors, there was a significant difference between genotypes for physical activity (P = 0.001), waist circumference (P˂0.05), BMI (˂0.01), weight (P = 0.001), GLP-1 (P = 0.02), ghrelin (P = 0.04), appetite (P˂0.001), chronotype (P˂0.001), sleep (P˂0.001), food timing (P˂0.001), energy (P˂0.05), carbohydrate (P˂0.05) and fat intake (P˂0.001). Our findings also show that people with the minor allele C who ate lunch after 3 PM and breakfast after 9 AM are more prone to obesity (P˂0.05). furthermore, there was significant interactions between C allele carrier group and high appetite on fat intake (Pinteraction = 0.041), eat lunch after 3 PM on energy intake (Pinteraction = 0.039) and morning type on fat intake (Pinteraction = 0.021).

CONCLUSION

Sleep reduction, changes in ghrelin and GLP-1 levels, changes in eating behaviors and evening preference that characterized CLOCK 3111C can all contribute to obesity. Furthermore, the data demonstrate a clear relationship between the timing of food intake and obesity. Our results support the hypothesis that the influence of the CLOCK gene may extend to a wide range of variables related to human behaviors.

The Interaction Between Fatty Acid Desaturase-2 (FADS2) rs174583 Genetic Variant and Dietary Quality Indices (DASH and MDS) Constructs Different Metabolic Phenotypes Among Obese Individuals

Background and Aim: Genetic variation in fatty acid desaturases (FADS) has previously been linked to several diet-related diseases. We aimed to determine whether the FADS2 rs174583 variant interacts with the Dietary Approach to Stop Hypertension (DASH) score and Mediterranean dietary score (MDS) to influence cardio-metabolic risk factors among obese adults. Methods: This cross-sectional study was performed among 347 apparently healthy obese adults (aged 20-50 years). Dietary quality indicator scores (DASH and MDS) were generated using a validated 147-item Food Frequency Questionnaire (FFQ). The FADS2 rs174583 variant was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The gene-diet interaction was analyzed by the ANCOVA multivariate interaction model. Results: A significant interaction was observed between rs174583 and adherence to the DASH score in relation to serum triglyceride (TG) concentration among the female group (P Interaction = 0.046); CT-genotype carriers who were assigned to the second tertile of DASH compared with those in the first tertile had a lower TG level (P < 0.05). Another significant interaction was revealed between adherence to MDS score and rs174583 polymorphism on serum glucose levels (P Interaction = 0.044); the lowest mean of glucose level was observed in homozygous minor subjects (TT) in the third tertile of MDS, in comparison with other tertiles of this dietary index (P < 0.05). There was a similar significant interaction between DASH and rs174583 in relation to diastolic blood pressure (P Interaction = 0.038) among the male group. Additionally, a significant positive association was found between TT genotype and odds of having high TG both in the crude (OR, 3.21; 95% CI, 1.02-10.14) and adjusted (OR, 3.58; 95% CI, 1.07-11.97) models, taking into account different confounders. Conclusion: Adherence to the dietary quality indicators (DASH and MDS) modified the relationship between FADS2 rs174583 polymorphism and cardio-metabolic risk factors in obese subjects. Prospective cohort studies are needed to confirm the results of our study.

Supporting families of children with overweight and obesity to live healthy lifestyles: Design and rationale for the Fitline cluster randomized controlled pediatric practice-based trial

BACKGROUND

Over a third of preadolescent children with overweight or obesity. The American Academy of Pediatrics (AAP) recommends pediatric providers help families make changes in eating and activity to improve body mass index (BMI). However, implementation is challenging given limited time and referral sources, and family burden to access in-person weight management programs.

PURPOSE

To describe the design of a National Heart Blood and Lung Institute sponsored cluster randomized controlled pediatric-based trial evaluating the effectiveness of the Fitline pediatric practice-based referral program to reduce BMI and improve diet and physical activity in children with overweight or obesity. Comparison will be made between brief provider intervention plus referral to (1) eight weekly nutritionist-delivered coaching calls with workbook to help families make AAP-recommended lifestyle changes (Fitline-Coaching), vs. (2) the same workbook in eight mailings without coaching (Fitline-Workbook).

METHODS

Twenty practices are pair-matched and randomized to one of the two conditions; 494 parents and their children ages 8-12 with a BMI of ≥85th percentile are being recruited. The primary outcome is child BMI; secondary outcomes are child's diet and physical activity at baseline and 6- and 12-months post-baseline. Cost-effectiveness of the two interventions also will be examined.

CONCLUSION

This is the first randomized controlled trial to examine use of a centrally located telephonic coaching service to support families of children with overweight and obesity in making AAP-recommended lifestyle changes. If effective, the Fitline program will provide an innovative model for widespread dissemination, setting new standards for weight management care in pediatric practice.

TRIAL REGISTRATION

The ClinicalTrials.gov registration number is NCT03143660.

Melanocortin-4 receptor (MC4R) rs17782313 polymorphism interacts with Dietary Approach to Stop Hypertension (DASH) and Mediterranean Dietary Score (MDS) to affect hypothalamic hormones and cardio-metabolic risk factors among obese individuals

BACKGROUND AND AIM

The association with obesity of a common variant near the melanocortin-4 receptor (MC4R) gene (rs17782313) has been indicated in various studies. Adherence to dietary quality indices also have shown to have potential favorable effects on obesity-related health outcomes. However, no study has examined the interaction between rs17782313 and the Dietary Approach to Stop Hypertension (DASH) score and the Mediterranean Dietary Score (MDS) on cardio-metabolic risk factors and hypothalamic hormones. Therefore, the purpose of the current study was to examine whether adherence to these dietary quality indices modifies the association of the MC4R rs17782313 polymorphism with cardio-metabolic risk factors and hypothalamic hormones among obese adults.

METHOD

Two hundred eighty-eight healthy obese adults were recruited in this cross-sectional study. Diet quality indices, including DASH score and MDS, were calculated from a validated 147-item food frequency questionnaire (FFQ). MC4R s17782313 genotypes were determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). An ANCOVA multivariate interaction model was used to assess the gene-diet interaction.

RESULTS

Significant interactions were detected between DASH score and MC4R rs17782313 genotypes on systolic blood pressure (SBP), atherogenic index of plasma (AIP), and serum glucose and triglyceride (TG) among the female group (p_Interaction < 0.05). In the male group, there were gene-DASH and gene-MDS interactions in relation to serum glucose concentration and plasma α-melanocyte stimulating hormone (MSH) levels, but these were found only in multi-adjusted interaction models (p_Interaction < 0.05). In addition, there was a significant interaction between MC4R rs17782313 polymorphism and DASH score on plasma agouti-related peptide (AgRP) concentrations in the female group in a multivariate interaction model (p_Interaction < 0.05). An inverse association between DASH score and chance of having the CC genotype in a multivariate-adjusted model among women was also revealed.

CONCLUSION

MC4R rs17782313 interacts with healthy dietary pattern (DASH score and MDS) to influence cardio-metabolic risk factors and hypothalamic hormones in obese individuals. Prospective cohort studies are needed to further assess these findings.

Dietary quality indices modifies the effects of melanocortin-4 receptor (MC4R) rs17782313 polymorphism on cardio-metabolic risk factors and hypothalamic hormones in obese adults

BACKGROUND

Although the Melanocortin-4 Receptor (MC4R) gene rs17782313 C/T has been consistently related to obesity risk, the interaction between MC4R polymorphism and diet quality indices on cardio-metabolic risk factors has not yet investigated. Therefore we aimed to test this hypothesis.

METHODS

This cross-sectional study recruited 188 (96 males and 92 females) healthy obese adults aged 20-50 years. Diet quality indices including Healthy Eating Index-2015 (HEI-2015) and Diet Quality Index-International (DQI-I) were constructed using data from a validated food frequency questionnaire. MC4R s17782313 were genotyped by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP). The interaction between MC4R polymorphism and diet quality indices was tested by Analysis of covariance (ANCOVA) multivariate interaction model.

RESULTS

There were significant gene-diet interactions between rs17782313 and HEI-2015 (P Interaction < 0.05) in modulating low-density lipoprotein cholesterol (LDL-C) levels among female group; rare allele heterozygotes of rs17782313 had highest mean of LDL-C concentration when placed in second tertile of HEI (P < 0.05). Moreover, rs17782313 and both indices (HEI and DQI-I) had significant interaction on serum glucose concentrations, systolic and diastolic blood pressure (SBP, DBP) in males (P Interaction < 0.05); when adherence to these indices was low, the obesity risk allele was associated with serum glucose concentrations, SBP and DBP. These gene-diet interactions remained significant even after adjustment for potential confounders.

CONCLUSION

Our study showed that MC4R rs17782313 interacts with adherence to the dietary quality indices (HEI and DQI-I) to influence several cardio-metabolic risk factors in obese male and females. Further large prospective studies are warranted to confirm our findings.

Cocaine and amphetamine-regulated transcript prepropeptide gene (CARTPT) polymorphism interacts with Diet Quality Index-International (DQI-I) and Healthy Eating Index (HEI) to affect hypothalamic hormones and cardio-metabolic risk factors among obese individuals

BACKGROUND

Epidemiologic studies show that cocaine- and amphetamine-regulated transcript prepropeptide (CARTPT) gene polymorphism modifies diet-obesity relationships. However, the interaction between CARTPT gene polymorphism and diet quality indices have not been investigated yet. The current study was aimed to evaluate the interaction between major dietary indices including Diet Quality Index-International (DQI-I) and Healthy Eating Index (HEI)-2015 and CARTPT gene rs2239670 variants among apparently healthy obese Iranians.

METHODS

This cross-sectional study was carried out by employing 288 apparently healthy obese adults aged 20-50 years with a BMI of 30-40 kg/m2. Diet quality was evaluated by Diet Quality Index-International (DQI-I) and Healthy Eating Index-2015 (HEI-2015) using a 132-items semi-quantitative validated food frequency questionnaire. The CARTPT gene rs2239670 polymorphism was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. Blood concentrations of glycemic markers, lipid profile, α-melanocyte stimulating hormone (MSH) and agouti-related peptide (AgRP) were also measured. ANCOVA multivariate interaction model was used to analyze gene-diet interactions.

RESULTS

The significant interactions were identified between CARTPT gene polymorphism and HEI, affecting BMR (PInteraction = 0.003), serum glucose (PInteraction = 0.009) and high density lipoprotein cholesterol HDL concentrations (PInteraction = 0.03) after adjusting for the effects of sex and age. Also we found gene-diet interaction between CARTPT genotypes and DQI-I in terms of fat mass (FM; PInteraction = 0.02), waist circumference (WC; PInteraction < 0.001), body mass index (BMI; PInteraction < 0.001), basal metabolic rate (BMR, PInteraction < 0.001), serum fasting glucose (PInteraction < 0.01) and AgRP (PInteraction = 0.05) in individuals even after adjusting for potential confounders.

CONCLUSION

Current study showed the effects of interaction between CARTPT genotype with adherence to HEI and DQI-I scores on obesity-related anthropometric and metabolic risk-factors.

A structural equation modeling approach for the association of a healthy eating index with metabolic syndrome and cardio-metabolic risk factors among obese individuals

Background

Numerous studies have evaluated the association between dietary factors and cardiovascular risk among patients with chronic disease. It is worthwhile to assess these associations in a combination model rather than in an isolated form. In the current study, we aimed to use structural equation modeling (SEM) to assess the association of adherence to a healthy eating index (HEI)-2015 with socio-demographic factors, psychological characteristics, metabolic syndrome (MetS) and other cardio-metabolic risk factors among obese individuals.

Methods

This cross-sectional study was conducted among 188 healthy obese adults (96 males and 92 females) aged 20–50 years in Tabriz. A validated semi-quantitative food frequency questionnaire (FFQ) was used to record dietary intake and to estimate HEI-2015. Anthropometric parameters, blood pressure and biochemical measurements were evaluated according to standard protocols. Interrelationships among socio-demographic parameters and HEI with cardio-metabolic risk factors were analyzed using SEM.

Results

The results of SEM analysis revealed that HEI mediated the association between age and several cardio-metabolic risk factors including fat mass (FM), fat free mass (FFM), systolic blood pressure (SBP) and high-density lipoprotein (HDL) (p < 0.05). Moreover, adherence to Dietary Guidelines for Americans (DGA) appears to mediate association between gender and waist circumference (B = -9.78), SBP (B = -4.83), triglyceride (B = -13.01) and HDL (B = 4.31). HEI also mediated indirect negative effects of socioeconomic status on FM (B = -0.56), FFM (B = -0.25), SBP (B = -0.55) and diastolic blood pressure (DBP) (B = -0.3). Additionally, depression and age had indirect unfavorable effects on some insulin resistance indices such as homeostasis model assessment of insulin resistance (B = 0.07; p<0.05, for age) and quantitative insulin sensitivity check index (p<0.05, for age and depression) via HEI. High adherence to HEI was found to be inversely associated with MetS risk (p<0.05).

Conclusion

Adherence to HEI-2015 seems to mediate the effect of socio-demographic parameters and mental health on cardio-metabolic risk factors as well as MetS risk. Further studies are needed to confirm these findings.

School-Age Children Can Recall Some Foods and Beverages Consumed the Prior Day Using the Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) without Assistance

BACKGROUND

Technological innovations allow for collection of 24-h recalls (24HRs) in a broader range of studies than previously possible. The web-based Automated Self-Administered 24-Hour Dietary Assessment Tool (ASA24) has been shown to be feasible and to perform well in capturing true intake among adults. However, data to inform use with children are limited.

OBJECTIVE

This observational feeding study was conducted to evaluate children's ability to accurately report a lunchtime meal using ASA24 without assistance.

METHODS

The study was conducted among children (n = 100) aged 10-13 y within a school setting. Students were served an individual cheese pizza, baby carrots, ranch dip, yogurt, a cookie, and 1 choice of water, juice, or milk. Plate waste was collected and weighed. The next day, participants completed ASA24 and a sociodemographic questionnaire. Descriptive statistics were generated to determine match rates by food item and age, and linear regression analyses were conducted to examine associations between sociodemographic characteristics and accuracy of reported energy and nutrient intake. Associations between true and reported energy and nutrient intakes and portion sizes were assessed with use of t tests.

RESULTS

Just under half (49%) of children fully completed ASA24 (median time, 41 min). Children reported an exact, close, or far match for 58% of all foods and beverages consumed, ranging from 29% for dip to 76% for pizza, but also reported some items not consumed as part of the study meal. Older children completed the recall in a shorter time than younger children (mean 31 among 13 y compared with 52 min among 10 y). Intakes of energy (39%), protein (33%), and sodium (78%) were significantly overestimated, whereas portion sizes for cookies (53%) and juice (69%) were underestimated.

CONCLUSIONS

Children can report some foods and drinks consumed using ASA24, but our findings suggest challenges with independent completion, necessitating research to examine strategies, such as training and resources, to support data quality.

Reduced Eating Pace (RePace) Behavioral Intervention for Children Prone to or with Obesity: Does the Turtle Win the Race?

OBJECTIVE

Rapid eating is a risk factor for childhood obesity but has not been a focus of intervention with young children. The short-term effects of a novel family-based treatment, "Reduced Eating Pace" (RePace), were tested on child eating speed and secondary outcomes.

METHODS

Twenty-eight rapid eating children were randomized to RePace (n  = 14) or Delayed Usual Care Control (DUC) (n  = 14). RePace taught families a slower eating pace using psychoeducational and behavioral techniques, including silent vibrating devices that prompted 30-second "turtle bites." Outcomes included child "slowness in eating" assessed by parent-report questionnaire and observed eating in the laboratory (i.e., mouthfuls/minute and kilocalories/minute). Child BMI and other eating variables were secondary outcomes.

RESULTS

Children in RePace compared with DUC showed increased "slowness in eating" (P  <  0.001), increased food enjoyment (P  = 0.04), and less BMI gain (P  = 0.02) after 8 weeks. There was no treatment effect for observed eating speed, although typicality of the laboratory test meal was an effect modifier in exploratory analyses. Specifically, RePace versus DUC showed attenuated increases in mouthfuls per minute over time among youth for whom the laboratory food amount was more typical of amounts served at home.

CONCLUSIONS

Slower eating may be a novel target for family-based obesity prevention targeting high-risk children.

The Cardiometabolic Risk Profile of Underreporters of Energy Intake Differs from That of Adequate Reporters among Children at Risk of Obesity

Background

Misreporting of energy intake (EI) in nutritional epidemiology is a concern because of information bias, and tends to occur differentially in obese compared with nonobese subjects.

Objective

We examined characteristics of misreporters within a cohort of children with a parental history of obesity and the bias introduced by underreporting.

Methods

The QUebec Adipose and Lifestyle InvesTigation in Youth (QUALITY) cohort included 630 Caucasian children aged 8-10 y at recruitment with ≥1 obese parent [body mass index (BMI; in kg/m2) >30 or waist circumference >102 cm (men), >88 cm (women)] and free of diabetes or severe illness. Children on antihypertensive medications or following a restricted diet were excluded. Child and parent characteristics were measured directly or by questionnaire. Three 24-h dietary recalls were administered by phone by a dietitian. Goldberg's cutoff method identified underreporters (URs). Logistic regression identified correlates of URs. We compared coefficients from linear regressions of BMI after 2 y on total EI at baseline 1) in all participants; 2) in adequate reporters (ARs) (excluding URs); 3) in all participants statistically adjusted for underreporting; 4) excluding URs using individual physical activity level (PAL)-specific cutoffs; and 5) in all participants statistically adjusted for underreporting using PAL-specific cutoffs.

Results

We identified 175 URs based on a calculated cutoff of 1.11. URs were older, had a higher BMI z score, and had poorer cardiometabolic health indicators. Parents of URs had a lower family income and higher BMI. Child BMI z score (OR: 3.07; 95% CI: 2.38, 3.97) and age (OR: 1.46/y; 95% CI: 1.14, 1.87/y) were the strongest correlates of underreporting. The association between BMI and total EI was null in all participants but became significantly positive after excluding URs (ß = 0.62/1000 kcal; 95% CI: 0.33, 0.92/1000 kcal) and after adjustment for URs (ß = 0.85/1000 kcal; 95% CI: 0.55, 1.06/1000 kcal).

Conclusions

URs in 8- to 10-y-old children differed from ARs. Underreporting biases measurement of nutritional exposures and the assessment of exposure-outcome relations. Identifying URs and using an appropriate correction method is essential.

Daily Snacking Occasions and Weight Status Among US Children Aged 1 to 5 Years

OBJECTIVE

To characterize associations of snacking frequency with weight status among US children aged 1 to 5 years.

METHODS

Participants were children (n = 4,669) aged 1 to 5 years in the 2005 to 2014 National Health and Nutrition Examination Survey (NHANES). Snacking was assessed by two 24-hour dietary recalls using definitions that considered "snack" occasions as well as other foods/beverages consumed between meals. Overweight/obesity (OW/OB) was defined using percentile cutoffs: ≥ 97.7th weight-for-length (< 2 years) cutoff and the ≥ 85th BMI-for-age (≥ 2 years) cutoff. Linear/logistic regressions evaluated snacking based on daily occasions and relative to current recommendations (two to three snacks per day).

RESULTS

During 2005 to 2014, US children aged 1 to 5 years consumed, on average, two to three snacks daily. Children with normal weight in both age groups tended to snack less frequently than children with OW/OB when considering all foods/beverages eaten between meals (P < 0.01-0.12). Across most snacking definitions, children < 2 years who snacked more frequently than recommended had greater odds of having OW/OB (P < 0.01-0.12) and consumed greater daily snack energy than those who snacked within recommendations (all P < 0.01). Recommendations did not clearly delineate weight status among children aged 2 to 5 years.

CONCLUSIONS

Snacking frequency and weight are positively associated among US children 1 to 5 years old, with most consistent associations seen among children < 2 years old and when considering all foods/beverages consumed between meals.

Agreement between parent and child report of physical activity, sedentary and dietary behaviours in 9-12-year-old children and associations with children's weight status

BACKGROUND

To date, population based surveys aimed at gaining insight in health related behaviour of children have often used either child self-reports or parent proxy reports. It remains unclear however, if surveys using different sources of information from either parents or children are comparable. In addition, (over)weight status of children can lead to under- and over reporting by parents and children as a result of social desirability bias. We aimed at gaining insight in the level of agreement between parents and child reports regarding aspects of certain dietary, physical activity and sedentary behaviours, and whether there are differences in agreement between parents and child reports in healthy-weight and overweight children.

METHODS

Weighted kappa was used to determine the level of agreement between child and parent reports on health-related behaviour in 1998 parent-child dyads. We also stratified for weight status of the children. Information on children's health related behaviours was obtained by parental and children's questionnaires, and children's height and weight were measured. Associations between children's weight status and children reporting less, reporting more and reporting the same amount of health behaviour as their parents were investigated with multinomial logistic regression analysis.

RESULTS

The Cohen's kappa coefficients ranged from almost perfect agreement for the variable means of transportation, fair for the variables breakfast consumption and frequency of outside play to slight for the variables duration of outside play, frequency and duration of TV/DVD viewing and family dinner. Overweight children were significantly more likely to report less breakfast consumption (OR = 2.6 (95% CI: 1.3 - 5.1)) and lower frequency of outside play than their parents (OR = 1.8 (95% CI: 1.1 - 2.9)).

CONCLUSION

There can be considerable disagreement between the health related behaviours of children as reported by parents or the children themselves. Based on the present study, it cannot be concluded whether parents' or children's reports are more accurate. For future studies, social desirability and recall bias would be best demonstrated in a validation study comparing child and parent self-reports with more objective measures of physical activity and food intake.

Diet quality index as a predictor of treatment efficacy in overweight and obese adolescents: The EVASYON study

BACKGROUND & AIM

A diet quality index (DQI) is a tool that provides an overall score of an individual's dietary intake when assessing compliance with food-based dietary guidelines. A number of DQIs have emerged, albeit their associations with health-related outcomes are debated. The aim of the present study was to assess whether adherence to dietary intervention, and the overall quality of the diet, can predict body composition changes.

METHODS

To this purpose, overweight/obese adolescents (n = 117, aged: 13-16 years; 51 males, 66 females) were recruited into a multi-component (diet, physical activity and psychological support) family-based group treatment programme. We measured the adolescents' compliance and body composition at baseline and after 2 months (intensive phase) and 13 months (extensive phase) of follow-up. Also, at baseline, after 6 months, and at the end of follow-up we calculated the DQI.

RESULTS

Global compliance with the dietary intervention was 37.4% during the intensive phase, and 14.3% during the extensive phase. Physical activity compliance was 94.1% at 2-months and 34.7% at 13months and psychological support compliance were growing over the intervention period (10.3% intensive phase and 45.3% during extensive phase). Adolescents complying with the meal frequency criteria at the end of the extensive phase had greater reductions in FMI z-scores than those did not complying (Cohen's d = 0.53). A statistically significant association was observed with the diet quality index. DQI-A variation explained 98.1% of BMI z-score changes and 95.1% of FMI changes.

CONCLUSIONS

We conclude that assessment of changes in diet quality could be a useful tool in predicting body composition changes in obese adolescents involved in a diet and physical activity intervention programme backed-up by psychological and family support.

Interrelationships of child appetite, weight and snacking among Hispanic preschoolers

BACKGROUND

Snacking among US preschoolers has increased in recent decades, raising questions about whether snacking contributes to dietary excess.

OBJECTIVES

This research aimed to characterize snacking contributions to dietary excess and to evaluate associations with appetite and weight among preschool-aged children.

METHODS

This study is a cross-sectional, observational study of 187 Hispanic low-income preschoolers. Three 24-h dietary recalls were used to assess snacking frequency and parameters of dietary excess including energy, saturated fat, trans fats and added sugars. Parental reports of child satiety responsiveness, food responsiveness, and enjoyment of food were obtained. Child height and weight were measured.

RESULTS

Children consumed 28% (395 kcal) of daily energy from snacks eaten at 2.3 ± 1.0 occasions per day. Greater snacking frequency was associated with greater daily intakes of energy (p < 0.05) and added sugars (p < 0.001). Among overweight/obese children, higher enjoyment of food was associated with more frequent snacking and greater energy intake from snacks (p = 0.01). Inverse associations of enjoyment of food with snacking frequency and energy intake were seen among normal weight children (p < 0.05).

CONCLUSIONS

More frequent snacking among low-income Hispanic preschoolers may contribute to excessive intakes of energy and added sugars, particularly among overweight/obese children with greater motivation to eat.

Gender differences and typical nutrition concerns of the diets of preschool children - the results of the first stage of an intervention study

BACKGROUND

Nutrition in children has an important influence on health both in childhood and adulthood. Actions aimed at improving children's nutrition are essential, not only to the children and their families, but also to the whole society. The aim of the study was to present the results of nutrient intake before starting a nutrition and physical activity intervention programme, to investigate gender differences in nutrient intake and to discuss whether the preschoolers' nutrient intake is similar to the intake of their peers from other countries.

METHODS

Nutrient intake was estimated from seven-day weighed food records kept by parents and preschool staff individually for 122 4-6-year-old children who attended two preschools in Piła, north-western Poland. Nutrient intake was calculated using Dieta 4.0 computer programme including water intake and intake of nutrients from dietary supplements. Statistical analysis was performed using the IBM SPSS Statistics computer programme, version 21.0, according to gender. The study was approved by the Bioethics Committee of the Poznan University of Medical Sciences (reference number 886/08).

RESULTS

Boys, in comparison to girls, were found to have statistically significantly higher intakes of total protein, total protein per kg of body weight, saturated fatty acids, total carbohydrates, available carbohydrates, lactose, sucrose, total water, vitamin A, beta-carotene, vitamin B2, vitamin B12, vitamin C, calcium, phosphorus, and magnesium. Statistically significantly higher percentage of girls than boys had intakes of vitamin E below AI.

CONCLUSIONS

Gender was a significant factor of nutrient intake in the studied preschool children. The main nutritional concerns in the studied preschoolers' diets, irrespective of gender, are typical of the diets of preschool children from various parts of Europe and indicate the need to work out common nutritional strategies to improve preschoolers' nutrition across Europe to reduce future burden of diet-related diseases to the European societies.

The National Health and Nutrition Examination Survey's Food Insecurity Questionnaire Completed by Children: Effects of Assessment Mode (Classroom versus Interview)

The National Health and Nutrition Examination Survey's food insecurity questionnaire was administered to 155 children (77 African American, 65 White, 13 "Other" [7 Hispanic; 6 mixed races]) in grade 4 twice, 28-32 days apart. Test-retest reliabilities were modest and somewhat similar for assessment mode (classroom, interview) and subgroup variables (gender, race, socioeconomic status, academic achievement, body mass index percentile, social desirability). As academic achievement increased, White and Other children reported less food insecurity, and African-American children reported slightly less. As social desirability increased, White and African-American children reported slightly more food insecurity, and Other children reported substantially more. Although the questionnaire may be acceptable for use with diverse groups of children in grade 4, validation is needed.

A simple method for identification of misreporting of energy intake from infancy to school age: Results from a longitudinal study

BACKGROUND & AIMS

Misreporting is a major source of reporting bias in nutritional surveys. It can affect the analysis of associations between diet and disease. Although various methods have been proposed to identify misreporting, their application to infants and young children is difficult. We identify misreporting of energy intake in infants and young children and propose a simplified approach.

METHODS

1199 children were enrolled in the Childhood Obesity Programme (CHOP) based in 5 European countries (Belgium, Germany, Italy, Poland and Spain) with repeated measurements of 3-day weighed food protocol and anthropometric indices at 10 time points between ages 1-96 months. Individual cut-offs for the ratio of reported energy intake and estimated energy requirement were calculated to identify misreporters. Misreporting was studied according to age, gender, BMI z-scores and country.

RESULTS

We identified a higher proportion of over-reporters (18.9%) as compared to under-reporters (10.6%). The proportion of over-reporting was higher among infants while under-reporting was more prevalent in school-aged children. Under-reporting was higher in boys (12.0%) and in obese/over-weight children (36.3%). Mean values for upper and lower cut-offs for the ratio of reported energy intake and estimated energy requirement in children ≤12 months were 0.80 and 1.20, and 0.75 and 1.25 for children >12 months, respectively. Using these fixed (mean) values, 90.4% (kappa statistic: 0.78) of all misreporters could be identified.

CONCLUSIONS

Despite intensive measures to obtain habitual intake of children, an essential proportion of nutritional reports were found to be implausible. Both over- and under-reporting should be carefully analysed, even in studies on infants. Fixed cut-offs can be applied to identify misreporting if no individual variation in energy intake can be calculated.

CLINICAL TRIAL REGISTRY

This trial was registered at https://clinicaltrials.gov/show/NCT00338689.

Testing an Integrated Model of Program Implementation: the Food, Health & Choices School-Based Childhood Obesity Prevention Intervention Process Evaluation

Childhood obesity is a complex, worldwide problem. Significant resources are invested in its prevention, and high-quality evaluations of these efforts are important. Conducting trials in school settings is complicated, making process evaluations useful for explaining results. Intervention fidelity has been demonstrated to influence outcomes, but others have suggested that other aspects of implementation, including participant responsiveness, should be examined more systematically. During Food, Health & Choices (FHC), a school-based childhood obesity prevention trial designed to test a curriculum and wellness policy taught by trained FHC instructors to fifth grade students in 20 schools during 2012-2013, we assessed relationships among facilitator behaviors (i.e., fidelity and teacher interest); participant behaviors (i.e., student satisfaction and recall); and program outcomes (i.e., energy balance-related behaviors) using hierarchical linear models, controlling for student, class, and school characteristics. We found positive relationships between student satisfaction and recall and program outcomes, but not fidelity and program outcomes. We also found relationships between teacher interest and fidelity when teachers participated in implementation. Finally, we found a significant interaction between fidelity and satisfaction on behavioral outcomes. These findings suggest that individual students in the same class responded differently to the same intervention. They also suggest the importance of teacher buy-in for successful intervention implementation. Future studies should examine how facilitator and participant behaviors together are related to both outcomes and implementation. Assessing multiple aspects of implementation using models that account for contextual influences on behavioral outcomes is an important step forward for prevention intervention process evaluations.

Diet quality and its relationship with central obesity among Mexican Americans: findings from National Health and Nutrition Examination Survey (NHANES) 1999-2012

OBJECTIVE

Using the Healthy Eating Index-2010 (HEI-2010), the present study aimed to examine diet quality and the impact of overall diet quality and its components on central obesity among Mexican-American men and women.

DESIGN

Cross-sectional data from NHANES 1999-2012 were used. The HEI-2010 data, including twelve components for a total score of 100, were collected with a 24 h recall interview. Central obesity was defined as a waist circumference of ≥88 cm for women and ≥102 cm for men. Weighted logistic regressions were performed to assess associations between HEI-2010 scores and central obesity.

SETTING

National Health and Nutrition Examination Survey (NHANES) 1999-2012.

SUBJECTS

A total of 6847 Mexican Americans aged ≥20 years with reliable dietary recall status and non-pregnancy status.

RESULTS

Higher HEI-2010 total score was associated with lower odds of central obesity in Mexican-American men (OR; 95 % CI=0·98; 0·98, 1·00). Among all Mexican Americans, one-unit higher score of total fruit and sodium (i.e. lower level of intake) was associated with 4 % (0·96; 0·93, 0·99) and 2 % (0·98; 0·96, 0·99) lower odds of central obesity, respectively. However, a higher total proteins score was associated with higher odds of central obesity (1·08; 1·00, 1·16). In gender-specific analyses, a higher whole fruit or sodium score was inversely associated with central obesity in men but not in women.

CONCLUSIONS

HEI-2010 scores of total fruit and sodium were inversely associated with central obesity among all Mexican Americans. However, total proteins score and central obesity was positively associated. In Mexican-American men, HEI-2010 total and whole fruit scores were inversely associated with central obesity.

Health Promotion Intervention to Improve Diet Quality in Children

OBJECTIVE

This study aims to evaluate the impact of an intervention program, taught by trained teachers, on foods and nutrients components of the Diet Quality Index-International among children in Grades 1 to 4.

METHOD

A total of 464 children (239 female, 6-12 years) from seven elementary Portuguese schools participated in this randomized trial. Three schools were allocated to the intervention, and four to the control group. The intervention program was based on the health promotion model and social cognitive theory. Teachers previously trained by researchers in nutrition, healthy eating, and healthy cooking implemented the intervention in the classroom from November 2008 to March 2009. Sociodemographic, anthropometric, physical activity, and dietary assessments were performed before (2007/2008) and at the end of the intervention (2009). Dietary intake was gathered by a 24-hour dietary recall and the components of Diet Quality Index-International were defined.

RESULTS

Children from the intervention schools reported a significantly higher adequacy in vegetable consumption (p = .018) and a significantly higher moderation in sodium consumption (p = .032) compared with the controllers.

CONCLUSION

Our study provides further support for the success of intervention programs that aim to enhance children's dietary intake. Implementing similar interventions can be promising to support vegetable consumption and moderate sodium intake.

Preschool diets in children from Piła, Poland, require urgent intervention as implied by high risk of nutrient inadequacies

BACKGROUND

Among the studies published after the year 2000 which focused on nutrition at preschool, only three aimed to assess children's intake of energy and selected nutrients at preschool. The purpose of this study was to assess dietary intake in children during their stay at preschool.

METHODS

The studied population comprised 128 4-6-year-old children who attended preschools in Piła, Poland. Intakes of energy and macronutrients were estimated from a 5-day weighed food record completed by the preschool staff. Weight and height were measured, and BMI was calculated. Statistical analysis was carried out using the IBM SPSS Statistics 21.0 computer programme. The data were analysed according to gender.

RESULTS

Energy intake was the lowest in children with underweight, 2004 kJ (478 kcal), and the highest in obese children, 3388 kJ (809 kcal). Energy intake from lactose was statistically significantly higher in boys than in girls, 3.0 vs 2.6 %. Statistically significantly higher percentage of boys in comparison to girls had intakes of vitamin C below 70 % of EAR, 56.9 vs 38.1 %. It is important to highlight the excessive intake of energy from saturated fatty acids and energy from sucrose, along with inadequate intake of energy from polyunsaturated fatty acids. We also found excessive intake of sodium and inadequate intakes of dietary fibre, water, vitamin D, vitamin E, folate, niacin, calcium and potassium.

CONCLUSIONS

Preschool diets need urgent improvement to prevent diet-related diseases in the studied preschoolers in the future. The inadequacies observed in these diets are in accordance with the previously reported inadequacies in menus planned for preschoolers. More research is needed to investigate dietary intake of children during their stay at preschool. Common regulations worked out for all preschools in the European Union would be a good way to provide adequate nutrition to preschool children.

Evaluation of a Web-Based Food Record for Children Using Direct Unobtrusive Lunch Observations: A Validation Study

Background

High-quality, Web-based dietary assessment tools for children are needed to reduce cost and improve user-friendliness when studying children’s dietary practices.

Objective

To evaluate the first Web-based dietary assessment tool for children in Norway, the Web-based Food Record (WebFR), by comparing children’s true school lunch intake with recordings in the WebFR, using direct unobtrusive observation as the reference method.

Methods

A total of 117 children, 8-9 years, from Bærum, Norway, were recruited from September to December 2013. Children completed 4 days of recordings in the WebFR, with parental assistance, and were observed during school lunch in the same period by 3 observers. Interobserver reliability assessments were satisfactory. Match, omission, and intrusion rates were calculated to assess the quality of the recordings in the WebFR for different food categories, and for all foods combined. Logistic regression analyses were used to investigate whether body mass index (BMI), parental educational level, parental ethnicity or family structure were associated with having a “low match rate” (≤70%).

Results

Bread and milk were recorded with less bias than spreads, fruits, and vegetables. Mean (SD) for match, omission, and intrusion rates for all foods combined were 73% (27%), 27% (27%), and 19% (26%), respectively. Match rates were statistically significantly associated with parental educational level (low education 52% [32%] versus high 77% [24%], P=.008) and parental ethnicity (non-Norwegian 57% [28%] versus others 75% [26%], P=.04). Only parental ethnicity remained statistically significant in the logistic regression model, showing an adjusted odds ratio of 6.9 and a 95% confidence interval between 1.3 and 36.4.

Conclusions

Compared with other similar studies, our results indicate that the WebFR is in line with, or better than most of other similar tools, yet enhancements could further improve the WebFR.

Assessment of Diet and Physical Activity in Paediatric Non-Alcoholic Fatty Liver Disease Patients: A United Kingdom Case Control Study

Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children, with prevalence rising alongside childhood obesity rates. This study aimed to characterise the habitual diet and activity behaviours of children with NAFLD compared to obese children without liver disease in the United Kingdom (UK). Twenty-four biopsy-proven paediatric NAFLD cases and eight obese controls without biochemical or radiological evidence of NAFLD completed a 24-h dietary recall, a Physical Activity Questionnaire (PAQ), a Dutch Eating Behavior Questionnaire (DEBQ) and a 7-day food and activity diary (FAD), in conjunction with wearing a pedometer. Groups were well matched for age and gender. Obese children had higher BMI z-scores (p = 0.006) and BMI centiles (p = 0.002) than participants with NAFLD. After adjusting for multiple hypotheses testing and controlling for differences in BMI, no differences in macro- or micronutrient intake were observed as assessed using either 24-h recall or 7-day FAD (p > 0.001). Under-reporting was prevalent (NAFLD 75%, Obese Control 87%: p = 0.15). Restrained eating behaviours were significantly higher in the NAFLD group (p = 0.005), who also recorded more steps per day than the obese controls (p = 0.01). In conclusion, this is the first study to assess dietary and activity patterns in a UK paediatric NAFLD population. Only a minority of cases and controls were meeting current dietary and physical activity recommendations. Our findings do not support development of specific dietary/ physical activity guidelines for children with NAFLD; promoting adherence with current general paediatric recommendations for health should remain the focus of clinical management.

Prevalence and characteristics of misreporting of energy intake in US children and adolescents: National Health and Nutrition Examination Survey (NHANES) 2003–2012

Using data from the National Health and Nutrition Examination Survey (NHANES) 2003–2012, we investigated the prevalence and characteristics of under- and over-reporting of energy intake (EI) among 14 044 US children and adolescents aged 2–19 years. For the assessment of EI, two 24-h dietary recalls were conducted with the use of the US Department of Agriculture Automated Multiple-Pass Method. Under-, plausible and over-reporters of EI were identified using two methods: based on the 95 % confidence limits (1) for agreement between the ratio of EI:BMR and a physical activity level for sedentary lifestyle (1·55) and (2) of the expected ratio of EI:estimated energy requirement (EER) of 1·0. BMR was calculated using Schofield’s equations. EER was calculated using equations from the US Dietary Reference Intakes, assuming ‘low active’ level of physical activity. The risk of being an under- or over-reporter compared with a plausible reporter was analysed using multiple logistic regression. Percentages of under-, plausible and over-reporters were 13·1, 81·5 and 5·4 %, respectively, based on EI:BMR and 18·8, 72·3 and 8·8 %, respectively, based on EI:EER. Under-reporting was associated with older age, non-Hispanic blacks (compared with non-Hispanic whites) and overweight and obesity (compared with normal weight). Over-reporting was associated with younger age, lower family poverty income ratio, normal weight and the first survey cycle. Similar findings were obtained when analysing only the first 24-h recall data from NHANES 1999–2012 (n 22 949). In conclusion, we found that EI misreporting remains prevalent and differential in US children and adolescents.

WHO European Childhood Obesity Surveillance Initiative: health-risk behaviours on nutrition and physical activity in 6-9-year-old schoolchildren

Objective

To assess to what extent eight behavioural health risks related to breakfast and food consumption and five behavioural health risks related to physical activity, screen time and sleep duration are present among schoolchildren, and to examine whether health-risk behaviours are associated with obesity.

Design

Cross-sectional design as part of the WHO European Childhood Obesity Surveillance Initiative (school year 2007/2008). Children’s behavioural data were reported by their parents and children’s weight and height measured by trained fieldworkers. Descriptive statistics and logistic regression analyses were performed.

Setting

Primary schools in Bulgaria, Lithuania, Portugal and Sweden; paediatric clinics in the Czech Republic.

Subjects

Nationally representative samples of 6–9-year-olds (n 15 643).

Results

All thirteen risk behaviours differed statistically significantly across countries. Highest prevalence estimates of risk behaviours were observed in Bulgaria and lowest in Sweden. Not having breakfast daily and spending screen time ≥2 h/d were clearly positively associated with obesity. The same was true for eating ‘foods like pizza, French fries, hamburgers, sausages or meat pies’ >3 d/week and playing outside <1 h/d. Surprisingly, other individual unhealthy eating or less favourable physical activity behaviours showed either no or significant negative associations with obesity. A combination of multiple less favourable physical activity behaviours showed positive associations with obesity, whereas multiple unhealthy eating behaviours combined did not lead to higher odds of obesity.

Conclusions

Despite a categorization based on international health recommendations, individual associations of the thirteen health-risk behaviours with obesity were not consistent, whereas presence of multiple physical activity-related risk behaviours was clearly associated with higher odds of obesity.

Does an Adolescent's Accuracy of Recall Improve with a Second 24-h Dietary Recall?

The multiple-pass 24-h dietary recall is used in most national dietary surveys. Our purpose was to assess if adolescents' accuracy of recall improved when a 5-step multiple-pass 24-h recall was repeated. Participants (n = 24), were Chinese-American youths aged between 11 and 15 years and lived in a supervised environment as part of a metabolic feeding study. The 24-h recalls were conducted on two occasions during the first five days of the study. The four steps (quick list; forgotten foods; time and eating occasion; detailed description of the food/beverage) of the 24-h recall were assessed for matches by category. Differences were observed in the matching for the time and occasion step (p < 0.01), detailed description (p < 0.05) and portion size matching (p < 0.05). Omission rates were higher for the second recall (p < 0.05 quick list; p < 0.01 forgotten foods). The adolescents over-estimated energy intake on the first (11.3% ± 22.5%; p < 0.05) and second recall (10.1% ± 20.8%) compared with the known food and beverage items. These results suggest that the adolescents' accuracy to recall food items declined with a second 24-h recall when repeated over two non-consecutive days.

The Automated Self-Administered 24-Hour Dietary Recall for Children, 2012 Version, for Youth Aged 9 to 11 Years: A Validation Study

BACKGROUND

Valid methods of diet assessment are important for nutrition research and practice, but can be difficult with children.

OBJECTIVE

To validate the 2012 version of the Automated Self-Administered 24-Hour Dietary Recall for Children (ASA24-Kids-2012), a self-administered web-based 24-hour dietary recall (24hDR) instrument, among children aged 9 to 11 years, in two sites.

DESIGN

Quasiexperimental.

PARTICIPANTS/SETTING

In one site, trained staff members observed and recorded foods and drinks consumed by children (n=38) during school lunch. The next day, the observed children completed both ASA24-Kids-2012 and an interviewer-administered 24hDR in a randomized order. Procedures in a second site (n=31) were similar, except observations occurred during dinner in a community location.

STATISTICAL ANALYSES

Foods were classified as matches (reported and consumed), intrusions (reported, but not consumed), or omissions (not reported, but consumed) for each participant. Rates of matches, intrusions, and omissions were calculated. Rates were compared between each recall method using repeated measures analysis of covariance. For matched foods, the authors determined correlation coefficients between observed and reported serving sizes.

RESULTS

Match, intrusion, and omission rates between ASA24-Kids-2012 and observed intakes in Site 1 were 37%, 27%, and 35%, respectively. Comparable rates for interviewer-administered 24hDRs were 57%, 20%, and 23%, respectively. In Site 2, match, intrusion, and omission rates between ASA24-Kids-2012 and observed intakes were 53%, 12%, and 36%, respectively, vs 76% matches, 9% intrusions, and 15% omissions for interviewer-administered 24hDRs. The relationship strength between reported and observed serving sizes for matched foods was 0.18 in Site 1 and 0.09 in Site 2 for ASA24-Kids-2012, and 0.46 in Site 1 and 0.11 in Site 2 for interviewer-administered 24hDRs.

CONCLUSIONS

ASA24-Kids-2012 was less accurate than interviewer-administered 24hDRs when compared with observed intakes, but both performed poorly. Additional research should assess the age at which children can complete recalls without the help of a parent or guardian, as well as elucidate under which circumstances recalls can reasonably be used among children.

Intake of energy-dense snack foods and drinks among Dutch children aged 7–12 years: how many, how much, when, where and which?

Objective

To describe the energy-dense snack food (EDSF) and energy-dense drink (EDD) consumption of children in the Netherlands and investigate subgroup differences. The amounts consumed, eating occasions, places of consumption and consumed types are reported.

Design

Twenty-four hour dietary recall data were used to describe the EDSF and EDD consumption. Subgroup differences concerning these intakes were identified with ANCOVA.

Setting

Dutch National Food Consumption Survey 2007–2010.

Subjects

Children (n860) aged 7–12 years.

Results

The mean number of EDSF events was 3·3 (sd1·6) per day, yielding 1569·7 (sd928·7) kJ. Average EDD consumption was 594·2 (sd342·3) ml/d, yielding 737·2 (sd495·9) kJ. Over 90 % of the children consumed more energy from non-core foods per day than recommended. Differences in EDSF and EDD consumption were found between several subgroups. Most importantly, we found higher intakes among older children and children with low educated mothers. Almost half of the EDSF events took place in the afternoon and at home. Cookies and sweets were consumed during half of the EDSF events. Almost one-third of the EDD were consumed in the afternoon. The majority of these drinks were consumed at home and most were soft drinks.

Conclusions

The results demonstrate that snack food and drink consumption is highly prevalent among Dutch children. Health promotion efforts addressing these behaviours are warranted and the present study could accelerate these initiatives. Focusing on children with low educated parents and on snacking at home after school offers the greatest potential to reduce snack food and drink intakes.

Anthropometric, lifestyle and parental characteristics associated with the prevalence of energy intake misreporting in children: the GRECO (Greek Childhood Obesity) study

The objectives of the present study were to identify childhood energy misreporting, and evaluate characteristics that are associated with its prevalence in a nationwide cross-sectional sample of Greek schoolchildren. Under the context of the GRECO (Greek Childhood Obesity) study, data from a total of 4547 children aged 10-12 years and 2318 parents were included in the analysis. Anthropometric, lifestyle and parental characteristics plus psychological concerns were investigated in relation to the prevalence of energy misreporting. Of the included children, 36 % were classified as energy under-reporters and 16 % as over-reporters. Multinomial logistic regression analysis revealed that the most important predictors of energy under-reporting (URP) were children's BMI (OR 1·11, 95 % CI 1·09, 1·14) and weight satisfaction (OR 0·87, 95 % CI 0·78, 0·97). In the case of energy over-reporting (ORP), children's BMI (OR 0·87, 95 % CI 0·84, 0·90), meal and snack consumption frequency (OR 1·52, 95 % CI 1·32, 1·75), female sex (OR 0·65, 95 % CI 0·45, 0·90), and maternal education (OR 0·95, 95 % CI 0·91, 0·99) remained as significant predictors. Additionally, parental perception that the body weight of their children was normal reduced the odds of URP (OR 0·69, 95 % CI 0·48, 0·99) and ORP (OR 0·53, 95 % CI 0·31, 0·93). In conclusion, the present study confirms that the issue of URP and ORP in childhood populations is evident and quite serious. Although there are no definite guidelines on how to use data obtained from misreporters in an epidemiological dataset, validity of reported energy intake seems to be influenced by children's BMI and weight satisfaction, as well as by parental perceptions regarding their children's weight.

Eating in the absence of hunger but not loss of control behaviors are associated with 16p11.2 deletions

OBJECTIVE

The ∼600-kb BP4-BP5 16p11.2 deletion has been consistently associated with obesity. We studied two heritable disinhibited eating behaviors, eating in the absence of hunger (EAH) and loss of control (LOC), to better characterize the relationship between the deletion and obesity.

METHODS

Our study population included ninety-three 16p11.2 CNV carriers (64 with deletions and 29 with duplications) and their families. We performed analyses using linear mixed models and focused on deletion carriers.

RESULTS

We confirmed previous associations between the 16p11.2 deletion and obesity (P < 0.0001) and between all EAH subscales and obesity (P < 0.05), after adjusting for confounders. We found significant associations between the deletion and EAH due to external cues (P = 0.004) and EAH due to boredom (P = 0.003), but not EAH due to fatigue/anxiety or negative affect. Conditioning BMI on the 16p11.2 deletion and each EAH behavior did not abolish the association between the deletion and obesity. LOC was underrepresented and not associated with the deletion.

CONCLUSIONS

We report evidence that the 16p11.2 deletion may influence specific obesity-associated disinhibited eating behaviors: EAH due to external trigger and EAH due to boredom. Prospective studies are needed to confirm the temporal order of EAH behaviors and obesity related to the deletion.

Leptin is associated with exaggerated brain reward and emotion responses to food images in adolescent obesity

OBJECTIVE

In the U.S., an astonishing 12.5 million children and adolescents are now obese, predisposing 17% of our nation's youth to metabolic complications of obesity, such as type 2 diabetes (T2D). Adolescent obesity has tripled over the last three decades in the setting of food advertising directed at children. Obese adults exhibit increased brain responses to food images in motivation-reward pathways. These neural alterations may be attributed to obesity-related metabolic changes, which promote food craving and high-calorie food (HCF) consumption. It is not known whether these metabolic changes affect neural responses in the adolescent brain during a crucial period for establishing healthy eating behaviors.

RESEARCH DESIGN AND METHODS

Twenty-five obese (BMI 34.4 kg/m2, age 15.7 years) and fifteen lean (BMI 20.96 kg/m2, age 15.5 years) adolescents underwent functional MRI during exposure to HCF, low-calorie food (LCF), and nonfood (NF) visual stimuli 2 h after isocaloric meal consumption.

RESULTS

Brain responses to HCF relative to NF cues increased in obese versus lean adolescents in striatal-limbic regions (i.e., putamen/caudate, insula, amygdala) (P < 0.05, family-wise error [FWE]), involved in motivation-reward and emotion processing. Higher endogenous leptin levels correlated with increased neural activation to HCF images in all subjects (P < 0.05, FWE).

CONCLUSIONS

This significant association between higher circulating leptin and hyperresponsiveness of brain motivation-reward regions to HCF images suggests that dysfunctional leptin signaling may contribute to the risk of overconsumption of these foods, thus further predisposing adolescents to the development of obesity and T2D.

Dietary intake of schoolchildren and adolescents in developing countries

School age and adolescence is a dynamic period of growth and development forming a strong foundation for good health and productive adult life. Appropriate dietary intake is critical for forming good eating habits and provides the much needed nutrients for growth, long-term health, cognition and educational achievements. A large proportion of the population globally is in the school age or adolescence, with more than three quarters of these groups living in developing countries. An up-to-date review and discussion of the dietary intake of schoolchildren and adolescents in developing countries is suitable to provide recent data on patterns of dietary intake, adequacy of nutrient intake and their implications for public health and nutrition issues of concern. This review is based on literature published from 2000 to 2014 on dietary intake of schoolchildren and adolescents aged 6-19 years. A total of 50 studies from 42 countries reporting on dietary intake of schoolchildren and adolescents were included. The dietary intake of schoolchildren and adolescents in developing countries is limited in diversity, mainly comprising plant-based food sources, but with limited intake of fruits and vegetables. There is a low energy intake and insufficient micronutrient intake. At the same time, the available data indicate an emerging trend of consumption of high-energy snacks and beverages, particularly in urban areas. The existence of a negative and positive energy balance in the same population points to the dual burden of malnutrition and highlights the emerging nutrition transition in developing countries. This observation is important for planning public health nutrition approaches that address the concerns of the two ends of the nutrition divide.

Dietary intake in 6-year-old children from southern Poland: part 1--energy and macronutrient intakes

Background

The studies on dietary intake in Polish children are sparse and the information about dietary intake in 6-year-olds in Europe is limited. The published studies on dietary intake in children rarely provide information on the intake of animal protein, plant protein and water. The purpose of the study was to analyse energy and macronutrient intakes in 6-year-old children from southern Poland.

Methods

The studied population comprised 120 children, 64 girls and 56 boys. Energy and macronutrient intakes were estimated from a three-day food record. Weight and height were measured, and body mass index was calculated.

Results

Intakes of energy (kJ, kcal), plant protein (g), total fat (g), saturated fatty acids (g, % of energy, g/1000 kcal), monounsaturated fatty acids (g) and starch (g, % of energy, g/1000 kcal) were significantly higher in boys, while intakes of sucrose (% of energy, g/1000 kcal) and total water (g/1000 kcal) were significantly higher in girls. The children’s diets were characterised by excessive intake of total fat, saturated fatty acids, sucrose, and by inadequate intake of polyunsaturated fatty acids, available carbohydrates and starch.

Conclusions

The observed adverse characteristics of the children’s diets are similar to those observed in the diets of children in other European countries and show the need to work out a common educational programme to improve nutrition in young European children. It is also important to provide the lacking information about the intake of animal protein, plant protein and water in young children.

Shifts in the recent distribution of energy intake among U.S. children aged 2-18 years reflect potential abatement of earlier declining trends

Recent national surveys suggest that child obesity in the United States may have reached a plateau, but corresponding trends in energy intake have not been examined in depth. This article evaluates medium-term trends in children's reported energy intake by using 4 waves of national dietary surveillance from 2003-2004 to 2009-2010. The analysis uses up to 2 24-h dietary recalls, incorporating methods that address challenges in estimating usual intake, accounting for intraindividual variance and covariates such as the presence of atypical consumption days. Quantile regression was used to assess disparities in intake among sociodemographic subgroups at extremes of the distribution as well as at the median, and the potential influence of misreporting was evaluated. Results indicated that after an initial decline in intakes across all age groups through 2007-2008, there were significant increases of ∼90 kcal/d at the median among adolescents in 2009-2010, whereas intakes in younger children remained steady. Among adolescent boys, the recent increase was larger at the 90th percentile than at the median. Intake trends did not vary by race/ethnic group, among whom intakes were similar at the upper end of the distribution. Misreporting did not influence trends over time, but intakes were lower in younger children and higher in older children after excluding misreporters. Overall, findings suggest that declines in children's energy intake from 2003-2004 through 2007-2008 were consistent with the obesity plateau observed in most age and gender subgroups through 2009-2010. However, there is evidence of increased intakes among adolescents in 2009-2010, which may threaten the earlier abatement in overweight in this older age group.

Food intake and overweight in school-aged children in Germany: Results of the GINIplus and LISAplus studies

OBJECTIVE

To investigate the cross-sectional association between food intake and overweight in children.

METHODS

Height and weight were measured in 2,565 school-aged children. Intakes of 11 food groups were categorized (low, medium and high) using specific tertile cutoffs. Multivariate energy partition models were applied. Adjustment included energy intake from other food groups, city, family income, parental education and 'screen' time. Possible underreporters were identified and used in sensitivity analyses.

RESULTS

Compared to low intake, high intakes of meat, fish, beverages and bakery products were associated with greater BMI z-scores [β (95% CI) = 0.32 (0.21, 0.42), 0.13 (0.03, 0.24), 0.23 (0.11, 0.35) and 0.10 (-0.01, 0.20)] and increased risk of being overweight [odds ratio (OR) (95% CI) = 2.08 (1.58, 2.73), 1.39 (1.08, 1.80), 1.36 (1.01, 1.84) and 1.62 (1.24, 2.11)]. Conversely, medium and high intakes of confectionery were associated with smaller BMI z-scores [β = -0.18 (-0.28, -0.07) and -0.22 (-0.33, -0.12)] and decreased risk of being overweight [OR = 0.64 (0.50, 0.83) and 0.53 (0.40, 0.68)]. These associations were robust to sensitivity analyses.

CONCLUSIONS

Intakes of meat, fish, beverages and bakery products correlate with body weight status.

Depressive symptoms and observed eating in youth

Depressive symptoms in youth may be a risk factor for obesity, with altered eating behaviors as one possible mechanism. We tested whether depressive symptoms were associated with observed eating patterns expected to promote excessive weight gain in two separate samples. In Study 1, 228 non-treatment-seeking youth, ages 12-17y (15.3±1.4y; 54.7% female), self-reported depressive symptoms using the Beck Depression Inventory. Energy intake was measured as consumption from a 10,934-kcal buffet meal served at 11:00am after an overnight fast. In Study 2, 204 non-treatment-seeking youth, ages 8-17y (13.0±2.8y; 49.5% female), self-reported depressive symptoms using the Children's Depression Inventory. Energy intake was measured as consumption from a 9835-kcal buffet meal served at 2:30pm after a standard breakfast. In Study 1, controlling for body composition and other relevant covariates, depressive symptoms were positively related to total energy intake in girls and boys. In Study 2, adjusting for the same covariates, depressive symptoms among girls only were positively associated with total energy intake. Youth high in depressive symptoms and dietary restraint consumed the most energy from sweets. In both studies, the effects of depressive symptoms on intake were small. Nevertheless, depressive symptoms were associated with significantly greater consumption of total energy and energy from sweet snack foods, which, over time, could be anticipated to promote excess weight gain.

Comparison of estimated energy intake using Web-based Dietary Assessment Software with accelerometer-determined energy expenditure in children

BACKGROUND

The OPUS (Optimal well-being, development and health for Danish children through a healthy New Nordic Diet) project carried out a school meal study to assess the impact of a New Nordic Diet (NND). The random controlled trial involved 834 children aged 8-11 in nine local authority schools in Denmark. Dietary assessment was carried out using a program known as WebDASC (Web-based Dietary Assessment Software for Children) to collect data from the children.

OBJECTIVE

To compare the energy intake (EI) of schoolchildren aged 8-11 estimated using the WebDASC system against the total energy expenditure (TEE) as derived from accelerometers worn by the children during the same period. A second objective was to evaluate the WebDASC's usability.

DESIGN

Eighty-one schoolchildren took part in what was the pilot study for the OPUS project, and they recorded their total diet using WebDASC and wore an accelerometer for two periods of seven consecutive days: at baseline, when they ate their usual packed lunches and at intervention when they were served the NND. EI was estimated using WebDASC, and TEE was calculated from accelerometer-derived activity energy expenditure, basal metabolic rate, and diet-induced thermogenesis. WebDASC's usability was assessed using a questionnaire. Parents could help their children record their diet and answer the questionnaire.

RESULTS

Evaluated against TEE as derived from the accelerometers worn at the same time, the WebDASC performed just as well as other traditional methods of collecting dietary data and proved both effective and acceptable with children aged 8-11, even with perhaps less familiar foods of the NND.

CONCLUSIONS

WebDASC is a useful method that provided a reasonably accurate measure of EI at group level when compared to TEE derived from accelerometer-determined physical activity in children. WebDASC will benefit future research in this area.

Estimating trajectories of energy intake through childhood and adolescence using linear-spline multilevel models

BACKGROUND

Methods for the assessment of changes in dietary intake across the life course are underdeveloped.

METHODS

We demonstrate the use of linear-spline multilevel models to summarize energy-intake trajectories through childhood and adolescence and their application as exposures, outcomes, or mediators. The Avon Longitudinal Study of Parents and Children assessed children's dietary intake several times between ages 3 and 13 years, using both food frequency questionnaires (FFQs) and 3-day food diaries. We estimated energy-intake trajectories for 12,032 children using linear-spline multilevel models. We then assessed the associations of these trajectories with maternal body mass index (BMI), and later offspring BMI, and also their role in mediating the relation between maternal and offspring BMIs.

RESULTS

Models estimated average and individual energy intake at 3 years, and linear changes in energy intake from age 3 to 7 years and from age 7 to 13 years. By including the exposure (in this example, maternal BMI) in the multilevel model, we were able to estimate the average energy-intake trajectories across levels of the exposure. When energy-intake trajectories are the exposure for a later outcome (in this case offspring BMI) or a mediator (between maternal and offspring BMI), results were similar, whether using a two-step process (exporting individual-level intercepts and slopes from multilevel models and using these in linear regression/path analysis), or a single-step process (multivariate multilevel models). Trajectories were similar when FFQs and food diaries were assessed either separately, or when combined into one model.

CONCLUSIONS

Linear-spline multilevel models provide useful summaries of trajectories of dietary intake that can be used as an exposure, outcome, or mediator.

Links of adolescent- and parent-reported eating in the absence of hunger with observed eating in the absence of hunger

OBJECTIVE

Eating in the absence of hunger (EAH) typically was assessed by measuring snack intake after consumption of a meal. There were no validated self-report measures of EAH. The relationship of adolescent self-report and parent-reported EAH to adolescents' measured intake in the absence of hunger was examined.

DESIGN AND METHODS

Ninety adolescents completed the Eating in the Absence of Hunger Questionnaire for Children and Adolescents (EAH-C) to describe eating when not hungry. Parents described children's EAH on a parallel version designed for parents (EAH-P). In a randomized crossover study, adolescent EAH in response to external cues was measured as snack intake after a lunch meal standardized to provide 50% of daily energy requirements and after a large array (>10,000 kcal).

RESULTS

Parents' reports of children's EAH in response to external cues were associated with greater EAH after both meals, adjusting for body composition, sex, age, race, puberty, and meal intake. Adolescent-reported EAH was unrelated or showed an inverse association with observed EAH.

CONCLUSIONS

Parent-reported EAH showed a positive association with adolescents' observed EAH and may be a useful research and clinical tool for assessing EAH in response to external cues in conditions when laboratory assessments are not feasible.