Validation of energy intake by 24-hour multiple pass recall: comparison with total energy expenditure in children aged 5-7 years

Recruitment feasibility and dietary and behavioral patterns in toddlers with ASD: Preliminary results from the Autism Eats program

BACKGROUND

Problematic mealtime behaviors and inadequate diet quality are pressing concerns for children with autism spectrum disorder (ASD). This study aimed to evaluate recruitment feasibility and baseline outcomes of the Autism Eats program for children under 3 years with ASD.

METHODS

Recruitment feasibility was assessed through reach and participation rates. The Healthy Eating Index (HEI-2015) scores were calculated from 3-day food records. Problematic mealtime behaviors were assessed with the Brief Autism Mealtime Behavior Inventory. Parental feeding practices were assessed using the Child Feeding Questionnaire. Anthropometric measurements of children and parents were taken. Weight-for-length percentiles were calculated based on the CDC growth charts. Descriptive statistics, one-sample t-tests, and Spearman's rho correlations were used for data analysis.

RESULTS

Of the contacted dyads, 74 % agreed to participate. All 51 enrolled dyads completed baseline survey (100 %), and 98 % completed 3-day food records and anthropometric measurements. Significantly higher problematic mealtime behaviors were observed, compared to the reference (e.g., Total score 55.7 vs. 32.5; p < .001). Children with ASD exhibited lower HEI-2015 scores than national data (e.g., Total score 59 vs. 62). A large proportion of the children (29 %) had a weight-for-length ≥ 95th percentile. Several significant associations were found among mealtime behaviors, diet quality, parental feeding practices, and weight status.

CONCLUSION

Recruitment was highly feasible, and the findings suggest that early nutrition intervention may hold promise in addressing problematic mealtime behaviors and promoting healthier dietary habits in young children with ASD.

CLINICAL TRIAL REGISTRATION

This trial has been registered at www.

CLINICALTRIALS

gov (NCT05194345).

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.

Social desirability bias is related to children's energy intake in a laboratory test meal paradigm

Dietary intake is notoriously difficult to measure in children. Laboratory test meals address some of the methodological concerns of self-report methods, but may also be susceptible to social desirability bias, referring to the tendency for individuals to adjust their behaviors in order to be perceived more positively. The aim of the current study was to evaluate whether social desirability bias was associated with children's energy intake during a laboratory test meal, and whether this association varied by food type (total caloric intake, snack food intake, fruit/vegetable intake) and sex. A total of 82 children (M age = 9.45 ± 0.85; 50 % girls; 84.1 % rural; 85.4 % White) completed several surveys, including the Children's Social Desirability Scale and had their body composition measured. At lunchtime, they were granted access to a multi-array test meal (>5000 kcal). After adjusting for lean mass, fat mass, depressive symptoms, and parental food restriction, children who reported higher social desirability bias consumed fewer calories from snack foods (B = -11.58, p = .009, semi-partial correlation = -0.28). Boys with higher social desirability bias consumed less calories from fruits and vegetables (B = -6.47, p = .010, semi-partial correlation = -0.411); this association was not significant in girls. The desire to be perceived in a positive manner may influence children's eating behaviors in experimental paradigms. Replication studies with larger, more diverse pediatric samples are needed, as are strategies to reduce the effects of social desirability bias on test meal intake in order to enhance the validity of this dietary assessment approach.

The Influence of Obesity in the Autonomic Nervous System Activity in School-Aged Children in Northern Portugal: A Cross-Sectional Study

INTRODUCTION

Obesity is one of the most prevalent chronic diseases in childhood, being an important public health issue. Excessive weight has been associated with autonomic dysfunction but the evidence in children is scarce. Therefore, the aim of this study was to assess the effect of overweight and obesity on the autonomic nervous system activity, in children.

MATERIAL AND METHODS

Data from a cross-sectional study of 1602 children, aged 7 to 12 years, was used and 858 children were included in the analysis. Body mass index was calculated and classified according to criteria of the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC) and the International Obesity Task Force (IOTF). Body composition was characterized by bioelectrical impedance. Linear regression models were used to determine the association between body mass index, body composition and the autonomic nervous system activity, assessed by pupillometry.

RESULTS

Average dilation velocity was higher among children with obesity, according to the CDC and percentage of body fat criteria (β = 0.053, 95% CI = 0.005 to 0.101 and β = 0.063, 95% CI = 0.016 to 0.109, respectively). The same trend was observed for WHO and IOTF criteria (β = 0.045, 95% CI = -0.001 to 0.091, and β = 0.055, 95% CI = -0.001 to 0.111, respectively). CDC and WHO body mass index z-scores were also positively associated with the values of average dilation velocity (rs = 0.030, p = 0.048; and rs = 0.027, p = 0.042, respectively).

CONCLUSION

Our findings suggest an association between body mass and changes in the autonomic activity, Moreover, this study provides proof of concept for interventions targeting the prevention/treatment of obesity in children that may offer some benefit in re-establishing the balance of the autonomic nervous system, and subsequently preventing the consequences associated with the autonomic nervous system dysfunction.

Determining total energy expenditure in 3–6-year-old Japanese pre-school children using the doubly labeled water method

The doubly labeled water (DLW, 2H218O) method for calculating the total production of CO2 over several days is currently considered to be the most accurate technique for the measurement of total energy expenditure (TEE), and the results obtained using this method have been used to review energy requirements. Presently, there is limited data available on TEE in Japanese children. The objective of this study was to assess the TEE in pre-school Japanese children using the DLW method. We used a cross-sectional population of 140 children (69 boys and 71 girls) aged 3–6 years. TEE was measured using the DLW method over 8 days under free-living conditions. The average weights (kg) of the boys and girls were 15.6 ± 2.5 and 15.0 ± 2.1 for the 3–4 years old and 19.8 ± 3.8 and 19.6 ± 2.7 for the 5–6 years old, respectively. The corresponding TEE (kcal/day) was 1260.9 ± 357.8 and 1265.2 ± 408.0, and 1682.3 ± 489.0 and 1693.1 ± 473.3, respectively, showing a significant difference with respect to age. Furthermore, TEE per body weight (kcal/kg/day) was 83.2 ± 29.2 and 84.9 ± 26.6, and 85.4 ± 23.2 and 86.7 ± 22.6, respectively. However, when TEE was adjusted for body weight or fat-free mass, there were no age or sex differences. We conclude that in Japanese children, TEE in those aged 3–4 years was similar to the current Ministry of Health recommendations. However, TEE in children aged 5–6 years was slightly higher than the recommendations. Based on these findings, the present results obtained from a large number of participants will provide valuable reference data for Japanese children.

Valuing the Diversity of Research Methods to Advance Nutrition Science

The ASN Board of Directors appointed the Nutrition Research Task Force to develop a report on scientific methods used in nutrition science to advance discovery, interpretation, and application of knowledge in the field. The genesis of this report was growing concern about the tone of discourse among nutrition professionals and the implications of acrimony on the productive study and translation of nutrition science. Too often, honest differences of opinion are cast as conflicts instead of areas of needed collaboration. Recognition of the value (and limitations) of contributions from well-executed nutrition science derived from the various approaches used in the discipline, as well as appreciation of how their layering will yield the strongest evidence base, will provide a basis for greater productivity and impact. Greater collaborative efforts within the field of nutrition science will require an understanding that each method or approach has a place and function that should be valued and used together to create the nutrition evidence base. Precision nutrition was identified as an important emerging nutrition topic by the preponderance of task force members, and this theme was adopted for the report because it lent itself to integration of many approaches in nutrition science. Although the primary audience for this report is nutrition researchers and other nutrition professionals, a secondary aim is to develop a document useful for the various audiences that translate nutrition research, including journalists, clinicians, and policymakers. The intent is to promote accurate, transparent, verifiable evidence-based communication about nutrition science. This will facilitate reasoned interpretation and application of emerging findings and, thereby, improve understanding and trust in nutrition science and appropriate characterization, development, and adoption of recommendations.

The relationship between diet quality and the severity of household food insecurity in Canada

OBJECTIVE

To examine the relationship between the dietary quality of Canadian children and adults and household food insecurity status.

DESIGN

Dietary intake was assessed with one 24-h recall. Households were classified as food secure or marginally, moderately or severely food insecure based on their responses to the Household Food Security Survey Module. We applied multivariable analyses of variance to determine whether % energy from ultra-processed foods, fruit and vegetable intake, Healthy Eating Index (HEI) scores, macronutrient composition and micronutrient intakes per 1000 kcal differed by food insecurity status after accounting for income, education and region. Analyses were run separately for children 1-8 years and 9-18 years and men and women 19-64 years of age.

SETTING

Ten provinces in Canada.

PARTICIPANTS

Respondents to the 2015 Canadian Community Health Survey-Nutrition, aged 1-64 years, with complete food insecurity data and non-zero energy intakes, N 15 909.

RESULTS

Among adults and children, % energy from ultra-processed foods was strongly related to severity of food insecurity, but no significant trend was observed for fruit and vegetable intake or HEI score. Carbohydrate, total sugar, fat and saturated fat intake/1000 kcal did not differ by food insecurity status, but there was a significant negative trend in protein/1000 kcal among older children, a positive trend in Na/1000 kcal among younger children and inverse associations between food insecurity severity and several micronutrients/1000 kcal among adults and older children.

CONCLUSIONS

With more severe household food insecurity, ultra-processed food consumption was higher, and diet quality was generally lower among both adults and children.

Breastfeeding duration in infancy and dietary intake in childhood and adolescence

Although several studies have focused on associations between breastfeeding and child obesity, few have focused on associations with dietary intake. We examined associations between breastfeeding duration in infancy and dietary intake in childhood and explored whether associations are still observed in adolescence. The QUALITY (QUebec Adipose and Lifestyle InvesTigation in Youth) cohort includes 630 children aged 8-10 years at baseline (T1) who have at least one parent with obesity. A follow-up assessment was done 7 years later (T2) when participants were aged 15-17 years (n=377). Non-exclusive breastfeeding duration was evaluated at T1 using a parent questionnaire (never, < 3 months, 3-6 months, > 6 months). Dietary intake was assessed at T1 and T2 using three 24-h diet recalls, namely daily servings of vegetables (≥ 2 vs < 2), fruits (≥ 2 vs < 2), vegetables and fruits combined (≥ 5 vs < 5), sugar-sweetened beverages (SSB) (none vs any), and an overall diet quality index (DQI-I) (good vs poor). Multiple logistic regressions, adjusted for age, sex and total kilocalorie intake of the child, for age and body mass index of the mother, and for parental education and income were used. Compared to children breastfed > 6 months (reference group), those never breastfed or breastfed for 3-6 months were 42% (OR = 0.58, 95% CI: 0.34-0.96) and 38% (OR = 0.62, 95% CI: 0.39-1.00) less likely to consume ≥ 2 servings of vegetables per day at 8-10 years, respectively, while no association was found for those breastfed < 3 months. Compared to children breastfed > 6 months, those never breastfed were 1.8 times more likely to drink any SSB (OR = 1.82, 95% CI: 1.03-3.22). No associations were found for other diet indicators, and associations observed in childhood were no longer found by adolescence. In this cohort, breastfeeding was associated with greater vegetable intake and the avoidance of SSB in childhood, but not in adolescence, nor were associations found for fruit intake or overall diet quality.

Controlling and less controlling feeding practices are differentially associated with child food intake and appetitive behaviors assessed in a school environment

BACKGROUND

Child food intake and appetitive behaviors show an inconsistent pattern of associations with parental feeding practices. Relationships likely vary depending on parent feeding style, and on the method by which child eating behaviors are measured.

OBJECTIVES

We tested relationships of controlling and less controlling forms of parental promotion and limitation of eating with food intake and appetitive behaviors assessed in preschoolers' normal school environments.

METHODS

As part of a 5-day protocol, preschoolers consumed standardized lunches, and caloric compensation, eating rate and eating in the absence of hunger were assessed. Feeding practices were measured using the Child Feeding Questionnaire (CFQ) and Parent Feeding Styles Questionnaire (PFSQ). CFQ-Pressure to eat and CFQ-Restriction were controlling forms of promotion/limitation of child intake, and CFQ-Monitoring and PFSQ-Prompting to eat were less controlling forms.

RESULTS

Children (3-5y, n = 70) of parents with higher CFQ-Pressure to eat scores showed lower total intake, consuming significantly fewer calories from bread, snacks and fruits and vegetables. Higher PFSQ-Prompting to eat was associated with lower fruit and vegetable intake only. CFQ-Restriction and CFQ-Monitoring scores were unassociated with food intake. Higher CFQ-Pressure to eat was associated with slower eating rate, while higher CFQ-Monitoring was associated with lower intake in absence of hunger.

CONCLUSIONS

Parental promotion and limitation of intake were associated with preschoolers' eating behaviors assessed in an ecologically valid setting, without parents present. Controlling and less controlling forms showed differential patterns of associations. Results were consistent with child-to-parent and parent-to-child effects, but research using longitudinal designs is needed to test bidirectional relationships.

Trends in Beverage Consumption and Related Demographic Factors and Obesity among Korean Children and Adolescents

It is well known that reducing consumption of sugar is a global public health priority. Beverages were the primary source of total sugar intake from processed foods. However, there are few studies investigating the trend of beverage consumption among children and adolescents in Korea. We examined the overall trend in beverage consumption among 11,996 participants aged 10-18 years who were enrolled in the Korea National Health and Nutrition Examination Survey (KNHANES) (1998-2018). Further, we examined the effect of beverage types on beverage consumption-related demographic factors and obesity among 6121 participants using the recent 24 h dietary recall data (2010-2018) that captured the consumption of fruit and vegetable juices, soft drinks, milk and milk-based products and alcoholic beverages. Demographic characteristics, including sex, age, body mass index, household income level and residential area, were considered. Consumers' overall beverage intake and the percentage of energy derived from fruit and vegetable juices and soft drinks steadily increased from 1998 to 2016-2018 (p-trend < 0.0001); in contrast, dairy product consumption declined since 2010-2012. The main sources of beverage-based calories were fruit and vegetable juices (107.5 kcal/day), soft drinks (145.2 kcal/day), dairy products (181.8 kcal/day) and alcoholic beverages (103.5 kcal/day). Also, Korean adolescents aged 16-18 years consumed more soft drinks, fewer dairy products and higher alcoholic drinks than other age groups; particularly, boys consumed more energy from beverages (p < 0.0001). The odds ratios of obesity prevalence tended to be higher for soft drink consumption than for other beverages but this was not significant. The consumption of fruit and vegetable juices and milk and milk products showed a marginal association with a reduced risk of obesity prevalence. Since beverage consumption has increased steadily among Korean children and adolescents, appropriate interventions are needed. In the future, data from a larger sample of Korean children and adolescents are necessary to identify significant differences and longitudinal studies are necessary to examine the causalities.

Measuring energy, macro and micronutrient intake in UK children and adolescents: a comparison of validated dietary assessment tools

Background

Measuring dietary intake in children and adolescents can be challenging due to misreporting, difficulties in establishing portion size and reliance on recording dietary data via proxy reporters. The aim of this review was to present results from a recent systematic review of reviews reporting and comparing validated dietary assessment tools used in younger populations in the UK.

Methods

Validation data for dietary assessment tools used in younger populations (≤18 years) were extracted and summarised using results from a systematic review of reviews of validated dietary assessment tools. Mean differences and Bland-Altman limits of agreement (LOA) between the test and reference tool were extracted or calculated and compared for energy, macronutrients and micronutrients.

Results

Seventeen studies which reported validation of 14 dietary assessment tools (DATs) were identified with relevant nutrition information. The most commonly validated nutrients were energy, carbohydrate, protein, fat, calcium, iron, folate and vitamin C. There were no validated DATs reporting assessment of zinc, iodine or selenium intake. The most frequently used reference method was the weighed food diary, followed by doubly labelled water and 24 h recall. Summary plots were created to facilitate comparison between tools. On average, the test tools reported higher mean intakes than the reference methods with some studies consistently reporting wide LOA. Out of the 14 DATs, absolute values for LOA and mean difference were obtained for 11 DATs for EI. From the 24 validation results assessing EI, 16 (67%) reported higher mean intakes than the reference. Of the seven (29%) validation studies using doubly labelled water (DLW) as the reference, results for the test DATs were not substantially better or worse than those using other reference measures. Further information on the studies from this review is available on the www.nutritools.org website.

Conclusions

Validated dietary assessment tools for use with children and adolescents in the UK have been identified and compared. Whilst tools are generally validated for macronutrient intakes, micronutrients are poorly evaluated. Validation studies that include estimates of zinc, selenium, dietary fibre, sugars and sodium are needed.

Sleep duration and bedtime in preschool-age children with obesity: Relation to BMI and diet following a weight management intervention

BACKGROUND

Sleep duration is associated with obesity in preschoolers. Weight-management interventions may be an opportunity to incorporate sleep health recommendations.

OBJECTIVES

To examine changes in sleep in preschool-age children with obesity following a family-based weight-management intervention (Learning about Activity and Understanding Nutrition for Child Health [LAUNCH]) compared with motivational interviewing and standard care conditions. Additionally, we examined associations between sleep with body mass index (BMI) z score (BMIz) and diet.

METHODS

One hundred fifty-one children (4.6 ± 0.93 y) completed baseline (pretreatment) and posttreatment (week 24) assessments, including anthropometrics, 24-hour dietary recalls, and a 7-day sleep diary. Analysis of variance (ANOVA) and chi-squared tests compared sleep variables between groups; linear regression models examined effects of sleep on BMIz and dietary intake at posttreatment, controlling for baseline values.

RESULTS

Bedtime and sleep duration were not significantly different between treatment groups from baseline to posttreatment. After adjusting for baseline sleep, earlier bedtime was associated with lower BMIz (95% CI, 0.00-0.04; .03), intake of added sugars (95% CI, 0.70-4.32; .007), and sweet/dessert food servings (95% CI, 0.00-0.19; .04) at posttreatment. Longer night-time sleep duration was associated with fewer added sugars at posttreatment, adjusting for baseline sleep (95% CI, -3.79 to -0.35; .02).

CONCLUSIONS

More comprehensive sleep intervention incorporated into weight-management intervention may be necessary to promote positive changes for preschoolers with obesity. A focus on earlier bedtime and longer sleep duration appears to be important given associations between sleep duration and bedtime with BMIz and dietary intake.

Water and Beverage Consumption among a Nationally Representative Sample of Children and Adolescents in the United Arab Emirates

There are limited studies examining water consumption among individuals in hot climates. We assessed the daily total water intake from plain water, other beverages, and food in a nationally representative sample of children and adolescents aged 6-18 years in the United Arab Emirates. Total water intake was compared against the recommendations of the Institute of Medicine and the European Food Safety Authority. Sociodemographic information, 24 h dietary recall, physical activity levels, and anthropometric data were collected from 527 participants. The mean ± SE of total water intake was 1778.4 ± 33.8 mL/day. Plain drinking water was the largest contributor to total water intake (51.6%), followed by food (27.3%). Sugar-sweetened beverages constituted 13.9% of water intake. The proportion of participants who met the Institute of Medicine recommendations ranged from 15% (males aged 14-18) to 25% (children aged 6-8). The proportion of participants who met the European Food Safety Authority recommendations ranged from 31% (females aged 14-18) to 36% (males aged 14-18). The water-to-energy ratio was 1.0-1.15 L/1000 kcal, meeting recommendations. The majority of participants failed to meet water intake recommendations, highlighting the need for targeted interventions to promote increased water consumption among children and adolescents.

A systematic review of reviews identifying UK validated dietary assessment tools for inclusion on an interactive guided website for researchers: www.nutritools.org

Background: Health researchers may struggle to choose suitable validated dietary assessment tools (DATs) for their target population. The aim of this review was to identify and collate information on validated UK DATs and validation studies for inclusion on a website to support researchers to choose appropriate DATs.Design: A systematic review of reviews of DATs was undertaken. DATs validated in UK populations were extracted from the studies identified. A searchable website was designed to display these data. Additionally, mean differences and limits of agreement between test and comparison methods were summarized by a method, weighting by sample size.Results: Over 900 validation results covering 5 life stages, 18 nutrients, 6 dietary assessment methods, and 9 validation method types were extracted from 63 validated DATs which were identified from 68 reviews. These were incorporated into www.nutritools.org. Limits of agreement were determined for about half of validations. Thirty four DATs were FFQs. Only 17 DATs were validated against biomarkers, and only 19 DATs were validated in infant/children/adolescents.Conclusions: The interactive www.nutritools.org website holds extensive validation data identified from this review and can be used to guide researchers to critically compare and choose a suitable DAT for their research question, leading to improvement of nutritional epidemiology research.

Measuring beverage consumption in US children and adolescents: a systematic review

Beverage consumption habits are associated with weight outcomes for children and adolescents. Many studies have examined youth's beverage consumption, but little is known about what methods are commonly used to assess youth beverage consumption and whether these strategies are valid and reliable. This study aimed to systematically review articles assessing beverage consumption among children and adolescents. We searched PubMed and Scopus for English-language articles published between February 2007 and February 2017 that measured and reported on American youth's (ages 2-18 years) beverage consumption. Searches yielded 17,165 articles, of which 589 articles describing 615 measures were extracted. We examined the types of assessment methods used, characteristics of these methods (e.g. validity, reliability, and literacy level), characteristics of study samples, and beverages assessed. The most common assessment methods were questionnaires/screeners (used by 65.4% of articles) and recalls (24.4%). About three-quarters of articles did not address validity (70.5%) or reliability (79.5%) of any measures used. Study populations were diverse: 54.7% of articles included low-income children, and 90.2% included non-White children. The most commonly assessed beverage category was sugar-sweetened beverages. Findings suggest that improved measurement techniques and reporting are both needed to track progress towards a goal of ensuring all youth have healthy beverage consumption.

Accuracy of Parental Reporting of Preschoolers' Dietary Intake Using an Online Self-Administered 24-h Recall

Parents are typically relied upon to report young children's dietary intake. However, there has been limited research assessing the accuracy of such reports captured using novel dietary assessment tools. The purpose of the current study was to assess the validity of the web-based Automated Self-Administered 24-h Dietary Assessment Tool (ASA24-Canada) for capturing dietary intake among children aged two-five years (n = 40), using parental proxy reporting. The study was conducted in a daycare setting, allowing for standardization of foods and drinks offered and direct observation of intake. Parental-reported intake was compared to true intake for lunch and dinner, as well as an afternoon snack, on a single day. Each eating occasion, including plate waste, was unobtrusively documented. Parents were not present for lunch or the afternoon snack, but joined their children at the daycare centre for the dinner meal. The following day, parents reported their children's intake from the previous 24-h period using ASA24-Canada. For the eating occasions assessed, parents reported exact or close matches for 79.2% (82.3% for lunch, 81.2% for the snack, and 77.4% for dinner) of the foods and beverages truly consumed by children. Estimates of intake for energy and macronutrients examined (carbohydrates, fat, and protein) based on parental reports were higher than those based on true (observed) intake. Our findings suggest that parents are able to report what their preschool children eat and drink relatively accurately. However, the accuracy of portion size estimates is low. Strategies to enhance portion size reporting are needed to improve parental proxy reporting.

Sociodemographic factors are associated with dietary patterns in Mexican schoolchildren

OBJECTIVE

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

DESIGN

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

SETTING

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

SUBJECTS

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

RESULTS

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

CONCLUSIONS

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

Association between Plain Water and Sugar-Sweetened Beverages and Total Energy Intake among Mexican School-Age Children

Water consumption promotes a decrease in total diet energy intake, and one explanation for this fact is the replacement of sugar-sweetened beverages (SSBs) by plain water (PW). The objective of this study was to analyze the association between SSB and PW consumption as a part of the total energy intake. Dietary information was obtained by one 24 h recall of 2536 school-age children who participated in the National Nutrition Survey in Mexico. PW and SSB consumption was measured in mL and servings (240 mL), and consumption was stratified into two levels (<2 and ≥2 servings/day). Linear regression models were used to evaluate the association between PW and SSB consumption in relation to total energy intake. Models were adjusted for age, sex, the proportion of energy obtained from non-beverage food, area of residence, and socioeconomic status (based on information regarding housing conditions and ownership of home appliances). PW consumption at the national level was two servings/day, and was not associated with total energy intake. However, the combination of the high consumption of PW and the low consumption of SSB was associated with less total energy intake (p < 0.05). Promoting higher PW and lower SSB consumption provides a useful public health strategy for reducing total energy intake and preventing overconsumption among Mexican school-age children.

Usual Intake of Added Sugars and Saturated Fats Is High while Dietary Fiber Is Low in the Mexican Population

BACKGROUND

The Mexican National Health and Nutrition Survey (ENSANUT) was carried out in 2012. Information from the survey is used to design and evaluate food and nutrition policies in Mexico.

OBJECTIVE

The objective of this study was to estimate the usual intake of energy and macronutrients in the Mexican population by using the ENSANUT 2012.

METHODS

Twenty-four-hour recall interviews were administered to a nationally representative subsample of 10,096 individuals aged ≥1 y from the ENSANUT 2012. Usual intake distributions and the prevalence of inadequate intakes were estimated by using the Iowa State University method. Student's t tests and tests on the equality of proportions were used to compare usual intakes and prevalence of inadequacy across socioeconomic status, area (rural or urban), and region of residence (North, Center, or South).

RESULTS

Energy and macronutrient intakes and indicators of dietary adequacy are presented for children (ages 1-4 y and 5-11 y), adolescents (12-19 y), and adults (≥20 y). At the national level, the estimated mean fiber intake was below the Adequate Intake for all population subgroups, suggesting inadequacies. The estimated proportion with a usual added sugars intake of >10% of total energy intake was >64% in all age groups. The proportion with a usual saturated fat intake of >10% of total energy intake was estimated to be >78% in children, >66% in adolescents, and >50% in adults. Overall, fiber intake was lower and intakes of saturated fat and added sugars were higher in urban compared with rural areas, in the North compared with South regions, and among those with high compared with low socioeconomic status (P < 0.05).

CONCLUSIONS

Fiber intake is lower and added sugar and saturated fat intakes are higher than recommended for >50% of the Mexican population aged ≥1 y. These results highlight the importance of improving the diets of the overall population to reduce the risk of noncommunicable chronic diseases.

Nutrition and the homeless: the underestimated challenge

Homelessness is present in most societies and represents a situation in which the basic needs for survival including food are often limited. It is logical to surmise that the homeless person's diet is likely to be nutritionally deficient and yet there is a relative paucity in research regarding this issue with studies varying in both their methodology and homeless population. Despite these differences, diets of the homeless are frequently characterised as high in saturated fat and deficient in fibre and certain micronutrients, all of which can have negative implications for the homeless individual's health and/or mental state. The conclusion from intervention studies is that there is no consensus as to the most effective method for assessing dietary intake. In order to address this, the present review aims to provide a greater understanding of the existing literature surrounding nutrition and the homeless and to act as a foundation from which further research can be conducted. An evaluation of the main findings and challenges surrounding the assessment of the nutritional status of the homeless will be provided followed by a review of the physical and mental consequences of the homeless diet. Current and potential interventions aimed at increasing the nutritional quality of food consumed by the homeless will be addressed with a focus on the role of the nutritional science community in assisting in this endeavour.

Lunch-time food choices in preschoolers: Relationships between absolute and relative intakes of different food categories, and appetitive characteristics and weight

Children's appetitive characteristics measured by parent-report questionnaires are reliably associated with body weight, as well as behavioral tests of appetite, but relatively little is known about relationships with food choice. As part of a larger preloading study, we served 4-5year olds from primary school classes five school lunches at which they were presented with the same standardized multi-item meal. Parents completed Child Eating Behavior Questionnaire (CEBQ) sub-scales assessing satiety responsiveness (CEBQ-SR), food responsiveness (CEBQ-FR) and enjoyment of food (CEBQ-EF), and children were weighed and measured. Despite differing preload conditions, children showed remarkable consistency of intake patterns across all five meals with day-to-day intra-class correlations in absolute and percentage intake of each food category ranging from 0.78 to 0.91. Higher CEBQ-SR was associated with lower mean intake of all food categories across all five meals, with the weakest association apparent for snack foods. Higher CEBQ-FR was associated with higher intake of white bread and fruits and vegetables, and higher CEBQ-EF was associated with greater intake of all categories, with the strongest association apparent for white bread. Analyses of intake of each food group as a percentage of total intake, treated here as an index of the child's choice to consume relatively more or relatively less of each different food category when composing their total lunch-time meal, further suggested that children who were higher in CEBQ-SR ate relatively more snack foods and relatively less fruits and vegetables, while children with higher CEBQ-EF ate relatively less snack foods and relatively more white bread. Higher absolute intakes of white bread and snack foods were associated with higher BMI z score. CEBQ sub-scale associations with food intake variables were largely unchanged by controlling for daily metabolic needs. However, descriptive comparisons of lunch intakes with expected amounts based on metabolic needs suggested that overweight/obese boys were at particularly high risk of overeating. Parents' reports of children's appetitive characteristics on the CEBQ are associated with differential patterns of food choice as indexed by absolute and relative intake of various food categories assessed on multiple occasions in a naturalistic, school-based setting, without parents present.

A Systematic Review of Dietary Assessment Tools for Children Age 11 Years and Younger

Dietary assessment tools are useful in nutritional epidemiology for identifying dietary patterns in both children and adults. Most commonly, dietary assessment methods include 24-hour recalls, food frequency questionnaires (FFQs), and food records. Despite the general acceptability of these methods, their accuracy and appropriateness for children have largely been underexamined. The purpose of this review was to identify the most appropriate dietary assessment methods for children age 11 years and younger by evaluating the existing evidence in relation to the validity and reliability of dietary assessment tools used in this population. This review consists of a systematic search of 3 electronic databases. In total, 9 studies with a sum of 735 participants were included in the review: 3 studies assessed the validity of 24-hour recalls; 5 assessed the validity of FFQs; and 1 assessed the validity of food record. The findings suggest that a FFQ may be the best method for assessing dietary intake in children between 9 months and 11 years of age. Further research is needed on the validity and reliability of these conventional dietary assessment methods used in young children.

Influence of the PROP bitter taste phenotype and eating attitudes on energy intake and weight status in pre-adolescents: a 6-year follow-up study

The PROP bitter-taste phenotype is a marker for food preferences and eating behavior, and may associate with differences in body weight in children. Previous work has shown that PROP status in combination with eating attitudes are better predictors of weight status in preadolescents, than either factor alone. However, no studies have examined the role of PROP phenotypes in body weight change in children over time. The primary objective of this study was to investigate current weight status and change in weight status in children from preschool (baseline) to preadolescence as a function of eating attitudes and PROP phenotype. Other measures included self-reported food intakes and physical activity by activity monitor. Seventy-three lean (BMI percentile=57.7±3.2%) children with mean age=10.3±0.5yrs, participated in the follow up. There were no group differences in energy intake, current BMI-percentile or change in BMI percentile from baseline by PROP phenotype in either boys or girls. However, there was a trend for non-taster girls to show a downward shift in BMI-percentile at follow up. Hierarchical regression analysis revealed that baseline BMI percentile and physical activity energy expenditure were the strongest predictors of current weight (28.5% variance),followed by child restraint, the taster×gender interaction, and the maternal BMI×maternal emotional eating interaction, accounting for 7.1%, 6.0% and 4.8% of variance in the model, respectively. These findings suggest that PROP status and eating attitudes are modest predictors of weight status in preadolescent children.

Validity of 24-h recalls in (pre-)school aged children: comparison of proxy-reported energy intakes with measured energy expenditure

BACKGROUND & AIMS

Little is known about the validity of repeated 24-h dietary recalls (24-HDR) as a measure of total energy intake (EI) in young children. This study aimed to evaluate the validity of proxy-reported EI by comparison with total energy expenditure (TEE) measured by the doubly labeled water (DLW) technique.

METHODS

The agreement between EI and TEE was investigated in 36 (47.2% boys) children aged 4-10 years from Belgium and Spain using subgroup analyses and Bland-Altman plots. Low-energy-reporters (LER), adequate-energy-reporters (AER) and high-energy-reporters (HER) were defined from the ratio of EI over TEE by application of age- and sex-specific cut-off values.

RESULTS

There was good agreement between means of EI (1500 kcal/day) and TEE (1523 kcal/day) at group level though in single children, i.e. at the individual level, large differences were observed. Almost perfect agreement between EI and TEE was observed in thin/normal weight children (EI: 1511 kcal/day; TEE: 1513 kcal/day). Even in overweight/obese children the mean difference between EI and TEE was only -86 kcal/day. Among the participants, 28 (78%) were classified as AER, five (14%) as HER and three (8%) as LER.

CONCLUSION

Two proxy-reported 24-HDRs were found to be a valid instrument to assess EI on group level but not on the individual level.

Dietary intakes assessed by 24-h recalls in peri-urban African adolescents: validity of energy intake compared with estimated energy expenditure

BACKGROUND/OBJECTIVE

The objective of this study is to determine the relative validity of reported energy intake (EI) derived from multiple 24-h recalls against estimated energy expenditure (EE(est)). Basal metabolic rate (BMR) equations and physical activity factors were incorporated to calculate EE(est).

SUBJECTS/METHODS

This analysis was nested in the multidisciplinary PhysicaL Activity in the Young study with a prospective study design. Peri-urban black South African adolescents were investigated in a subsample of 131 learners (87 girls and 44 boys) from the parent study sample of 369 (211 girls and 158 boys) who had all measurements taken. Pearson correlation coefficients and Bland-Altman plots were calculated to identify the most accurate published equations to estimate BMR (P<0.05 statistically significant). EE(est) was estimated using BMR equations and estimated physical activity factors derived from Previous Day Physical Activity Recall questionnaires. After calculation of EE(est), the relative validity of reported energy intake (EI(rep)) derived from multiple 24-h recalls was tested for three data subsets using Pearson correlation coefficients. Goldberg's formula identified cut points (CPs) for under and over reporting of EI.

RESULTS

Pearson correlation coefficients between calculated BMRs ranged from 0.97 to 0.99. Bland-Altman analyses showed acceptable agreement (two equations for each gender). One equation for each gender was used to calculate EE(est). Pearson correlation coefficients between EI(rep) and EE(est) for three data sets were weak, indicating poor agreement. CPs for physical activity groups showed under reporting in 87% boys and 95% girls.

CONCLUSION

The 24-h recalls measured at five measurements over 2 years offered poor validity between EI(rep) and EE(est).

Aerobic fitness in prepubertal children according to level of body fat

AIM

The purpose of this study was to investigate the relationship between maximum oxygen uptake (VO(2PEAK) ) and body fat in young children on a population-based level.

METHODS

Participants were 586 children (311 boys and 275 girls) aged 6.8±0.4 years, recruited from a population-based cohort. VO(2PEAK) was measured by indirect calorimetry during a maximal exercise test. Percent body fat (BF%) was estimated from skinfold measurements.

RESULTS

  Significant relationships existed between BF% and absolute values of VO(2PEAK) (mL/min), VO(2PEAK) scaled by body weight (mL/min/kg) and VO(2PEAK) by allometric scaling (mL/min/kg(0.71) ), whereas no relationships were detected for VO(2PEAK) scaled to fat-free mass (FFM) (mL/min/FFM). Person correlation coefficients for boys were 0.26, -0.38, -0.19 and -0.01 NS and for girls 0.33, -0.42, -0.21 and -0.03 NS, respectively. Significant differences in VO(2PEAK) existed between different quartiles of BF%, with the exception when VO(2PEAK) was scaled to FFM.

CONCLUSION

 Our findings document the coexistence of two known risk factors for disease at a young age on a population-base and confirms that VO(2PEAK) was scaled to FFM represents a body fat independent way of expressing fitness.

A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labeled water

Measuring dietary intake in children enables the assessment of nutritional adequacy of individuals and groups and can provide information about nutrients, including energy, food, and eating habits. The aim of this review was to determine which dietary assessment method(s) provide a valid and accurate estimate of energy intake by comparison with the gold standard measure, doubly labeled water (DLW). English-language articles published between 1973 and 2009 and available from common nutrition databases were retrieved. Studies were included if the subjects were children birth to age 18 years and used the DLW technique to validate reported energy intake by any other dietary assessment method. The review identified 15 cross-sectional studies, with a variety of comparative dietary assessment methods. These included a total of 664 children, with the majority having <30 participants. The majority of dietary assessment method validation studies indicated a degree of misreporting, with only eight studies identifying this to a significant level (P<0.05) compared to DLW estimated energy intake. Under-reporting by food records varied from 19% to 41% (n=5 studies) with over-reporting most often associated with 24-hour recalls (7% to 11%, n=4), diet history (9% to 14%, n=3), and food frequency questionnaires (2% to 59%, n=2). This review suggested that the 24-hour multiple pass recall conducted over at least a 3-day period that includes weekdays and weekend days and uses parents as proxy reporters is the most accurate method to estimate total energy intake in children aged 4 to 11 years, compared to total energy expenditure measured by DLW. Weighed food records provided the best estimate for younger children aged 0.5 to 4 years, whereas the diet history provided better estimates for adolescents aged≥16 years. Further research is needed in this area to substantiate findings and improve estimates of total energy expenditure in children and adolescents.

Validation of an FFQ and options for data processing using the doubly labelled water method in children

OBJECTIVE

To validate an FFQ designed to estimate energy intake in children against doubly labelled water (DLW). To investigate how quality control and standard beverage portion sizes affect the validity of the FFQ.

DESIGN

Thirty healthy children, aged 4-6 years, participated. Total energy expenditure (EE) was measured by the DLW method during an observation period of 15 d. At the end of this period parents filled out an FFQ designed to assess the child's habitual energy intake (EI) of the preceding four weeks.

SETTING

Validation study in The Netherlands.

SUBJECTS

Thirty healthy children (fifteen boys and fifteen girls), aged 4-6 years.

RESULTS

Mean EI (6117 (sd 1025) kJ/d) did not differ significantly from mean EE (6286 (sd 971) kJ/d; P = 0·15); the mean EI:EE ratio was 0·98. The Pearson correlation coefficient between EI and EE was 0·62. The Bland-Altman plot showed no systematic bias and a constant bias close to zero. Less intensive quality control of the FFQ maintained the mean EI:EE ratio and decreased the correlation slightly. Using standard instead of individually measured beverage portion sizes decreased the mean EI:EE ratio, but maintained the correlation.

CONCLUSIONS

It can be concluded that the developed FFQ is a valid instrument to estimate mean energy intake in a group of 4- to 6-year-old children and performs reasonably well to rank the subjects with respect to energy intake. It is therefore a useful instrument to estimate energy intake in children in surveys and epidemiological studies in The Netherlands.

Relationships between reported macronutrient intake and insulin dynamics in a multi-ethnic cohort of early pubertal children

BACKGROUND

Racial/ethnic differences in the pediatric population in insulin dynamics have been documented. Additionally, girls tend to be more insulin resistant than boys. Although the mechanism driving these differences is unclear, diet may be a contributor.

OBJECTIVE(S)

The objective of this study was to evaluate the contribution of reported macronutrient intake on insulin dynamics and determine if diet composition may account for racial/ethnic and sex differences in insulin response/action.

METHODS

Participants were 250 African- (n=84), European- (n=105), or Hispanic-American (n=61) children 7-12 years, pubertal stage < or =3. An intravenous glucose tolerance test was used to derive the insulin sensitivity index and acute insulin response to glucose (AIRg) diet by two 24 h recalls, and body composition by dual-energy x-ray absorptiometry (DXA).

RESULTS

Reported energy intake from fat was positively related to fasting insulin (P < 0.05) and AIRg (P=0.05). Reported energy from carbohydrate was inversely associated with fasting insulin (P < 0.05), and reported energy from protein was inversely associated with AIRg (P < 0.05). The interaction terms between ethnicity and diet, and sex and diet were not significant for any outcome variables.

CONCLUSION

Dietary intake influences insulin dynamics; however, the racial/ethnic and sex differences in insulin dynamics in this population are not accounted for by macronutrient intake. Pubertal status is likely to play a role in the interaction between diet, race/ethnicity, sex and insulin dynamics. Longitudinal studies are needed to determine if the contribution of diet to insulin dynamics strengthens with reproductive maturation.

Overestimation of infant and toddler energy intake by 24-h recall compared with weighed food records

BACKGROUND

Twenty-four-hour dietary recalls have been used in large surveys of infant and toddler energy intake, but the accuracy of the method for young children is not well documented.

OBJECTIVE

We aimed to determine the accuracy of infant and toddler energy intakes by a single, telephone-administered, multiple-pass 24-h recall as compared with 3-d weighed food records.

DESIGN

A within-subjects design was used in which a 24-h recall and 3-d weighed food records were completed within 2 wk by 157 mothers (56 non-Hispanic white, 51 non-Hispanic black, and 50 Hispanic) of 7-11-mo-old infants or 12-24-mo-old toddlers. Child and caregiver anthropometrics, child eating patterns, and caregiver demographics and social desirability were evaluated as correlates of reporting bias.

RESULTS

Intakes based on 3-d weighed food records were within 5% of estimated energy requirements. Compared with the 3-d weighed food records, the 24-h recall overestimated energy intake by 13% among infants (740 +/- 154 and 833 +/- 255 kcal, respectively) and by 29% among toddlers (885 +/- 197 and 1140 +/- 299 kcal, respectively). Eating patterns (ie, frequency and location) did not differ appreciably between methods. Macronutrient and micronutrient intakes were higher by 24-h recall than by 3-d weighed food record. Dairy and grains contributed the most energy to the diet and accounted for 74% and 54% of the overestimation seen in infants and toddlers, respectively. Greater overestimation was associated with a greater number of food items reported by the caregiver and lower child weight-for-length z scores.

CONCLUSIONS

The use of a single, telephone-administered, multiple-pass 24-h recall may significantly overestimate infant or toddler energy and nutrient intakes because of portion size estimation errors.

A Review of the Relationship Between 100% Fruit Juice Consumption and Weight in Children and Adolescents

Studies assessing a relationship between consumption of 100% fruit juice by children and adolescents and weight are contradictory. The purpose of this review was to assess the 9 cross-sectional and 12 longitudinal studies that have looked at this association. Of the 9 cross-sectional studies reviewed, only 3 reported any association. Those studies used small, local convenience samples of preschool children; furthermore, selection criteria were not well defined. One found that preschool children consuming ≥ 12 fluid oz/day of 100% fruit juice had a higher prevalence of overweight than those who consumed less than 12 oz/day (32% vs 9%). Later, a separate study showed that this relationship held only for apple juice. Another study demonstrated an association of overweight and energy from juice. These 3 studies were not nationally representative. Only 3 of the longitudinal studies showed an association between 100% fruit juice consumption and weight; 1 found an association only in adolescent girls, and 2 reported an association in children who were already overweight. None of the longitudinal studies was nationally representative, but 5 had sample sizes of at least 1000, 2 were ethnically diverse, and 3 had geographically separate sites, suggesting that the findings could be applicable to wider populations. Based on the currently available evidence, it can be concluded that there is no systematic association between consumption of 100% fruit juice and overweight in children or adolescents. Data do support consumption of 100% fruit juice in moderate amounts and suggest that consumption of 100% fruit juice may be an important strategy to help children meet the current recommendations for fruit.

Assessment of physical activity and energy expenditure in epidemiological research of chronic diseases

Physical inactivity has emerged as an important risk factor for a number of diseases, but the typically crude exposure assessments in epidemiological studies, with entailing variation in measurement accuracy, may be a source of heterogeneity contributing to inconsistent results among studies. Consequently, the choice of method for the assessment of physical activity in epidemiological studies is important. Good methods increase our chances of avoiding misclassification and may enhance our understanding of the association between physical activity and health. Since physical activity is also a potential confounder of other lifestyle-health relationships, good methods may enhance our ability to control for confounding. But despite a steadily increasing selection of methods to choose from, no method is suitable for every situation and every population. Although the questionnaire is the most widely used method in epidemiological studies, and laboratory methods are mainly used for validation purposes, improved technology may change our ways of assessing physical activity in the future. This paper describes different methods to measure physical activity and energy expenditure from the epidemiological perspective, and attempts to address the concepts related to the measurement of physical activity.

Comparação de dois programas computacionais utilizados na estimativa do consumo alimentar de crianças

OBJETIVO: Avaliar a concordância entre dois programas computacionais de análise do consumo alimentar de crianças de 6 a 30 meses. MATERIAIS E MÉTODOS: Foram selecionadas 100 crianças de 6 a 30 meses de idade entre 407 crianças cujas mães responderam o recordatório de 24 horas em visitas domiciliares. Foram comparados: 1) as gramaturas das medidas caseiras dos 10 alimentos mais consumidos entre os dois programas e em relação a uma tabela de pesos e medidas nacional; 2) os valores médios do consumo de consumo de energia e nutrientes. A análise estatística foi feita através do coeficiente de correlação de Spearman e metodologia descrita por Bland & Altman. RESULTADOS: Foram observadas diferenças entre as gramaturas em relação à medida caseira correspondente para quase todos os alimentos selecionados. Comparando as médias de consumo entre os dois programas, observamos maior correlação entre o consumo de carboidratos (r=0,81) e menor correlação para o consumo de zinco (r=0,52). As médias de consumo de energia e de macronutrientes pelo programa Virtual Nutri foram superiores aos valores obtidos pelo NutWin, enquanto que para o consumo de micronutrientes observamos valores superiores na análise pelo program NutWin. O consumo de vitamina C e retinol revelou diferença reduzida entre os programas. CONCLUSÃO: Os programas selecionados para análise do consumo dietético infantil apresentam diferenças quanto às gramaturas utilizadas, que se refletem através das diferenças na estimava de energia e nutrientes consumidos.

Parental feeding style, energy intake and weight status in young Scottish children

Parental feeding style, as measured by the Child Feeding Questionnaire (CFQ), may be an important influence on child feeding behaviour and weight status in early to mid childhood, but more evidence on parental feeding style is required from samples outside the USA. We aimed to use the CFQ in a sample of 117 Scottish children (boys n 53, girls n 64 mean age 4.6 (SD 0.5) years) to: characterise gender differences and changes over time (in forty of the 117 children studied over 2 years); test associations between parental feeding style, free-living energy intake (measured over 3 days using the multiple pass 24-h recall), and weight status (BMI SD score). No dimensions of parental feeding style changed significantly over 2 years in the longitudinal study (P>0.05 in all cases). No aspects of parental feeding style as measured by the CFQ differed significantly between the sexes (P>0.05 in all cases). Parental perceptions of child weight status were generally significantly positively correlated with child weight status as measured by the BMI SD score. In this sample and setting, measures of parental control over child feeding were generally not associated with child energy intake or weight status.