Unhealthy Food and Beverage Consumption in Children and Risk of Overweight and Obesity: A Systematic Review and Meta-Analysis

Junk food or healthy food? The relationship between odor identification performance and dietary patterns among children and adolescents

PURPOSE

Children and adolescents with an insecure dietary pattern are at risk of experiencing adverse health effects. In general, olfactory capacity is particularly important in shaping food-flavor perception, affecting nutritious food intake, and ultimately influencing eating behaviors such as food selection, appetite, and consumption. Therefore, the present study aimed to explore the relationship between odor identification ability and dietary patterns in this population.

METHODS

607 children and adolescents (275 boys and 332 girls) aged 6-17 years from China were recruited for this study. Odor identification performance was assessed using the Universal Sniff (U-Sniff) test, and dietary patterns were measured using the Food Frequency Questionnaire (FFQ).

RESULTS

Children and adolescents who poorly behaved in the U-Sniff test exhibited a greater tendency to choose processed foods, beverages and snacks, while this tendency was mainly observed in children aged 6-8 years.

CONCLUSIONS

Better odor identification ability has a positive impact on children and adolescents' choice for healthier foods in their daily dietary intake.

Outcome measurement instruments used to measure diet-related outcomes in infancy: A scoping review

INTRODUCTION

Supporting positive diet behaviours during infancy is essential to support child health and prevent childhood obesity. How infant diet-related outcomes are measured in trials is crucial to determining intervention effectiveness. This scoping review examined what and how outcome measurement instruments are currently used to measure 13 infant diet-related outcomes from a previously developed core outcome set.

METHODS

The databases EMBASE, MEDLINE, CINAHL and PsycINFO were searched from inception to September 2023. Eligible studies reported trials that included infants ≤1 year old and at least one diet-related outcome measurement instrument. Titles/abstracts and full texts were independently screened in duplicate. Data were narratively synthesised.

RESULTS

136 studies reporting 133 trials were included. Outcome measurement instruments used included 66 questionnaires (n = 70 studies), 65 individual questions (n = 45 studies), 24 food diaries/records (n = 21 studies), 11 24-hour dietary recall (n = 11 studies), and healthcare record data (n = 6 studies). Outcome measurement instruments were predominantly self-administered by researchers in participants homes. There was a lack of reporting for some outcome measurements used.

CONCLUSION

Review findings highlight the need to improve clarity and completeness of outcome reporting. The findings also provide an important first step to address heterogeneity in measurement of infant diet-related outcomes. Consistent measurement of diet-related outcomes is needed to improve synthesis and evaluation of obesity prevention interventions.

Comprehensive systematic review and meta-analysis of risk factors for childhood obesity in China and future intervention strategies

Background

Childhood obesity is a critical public health concern in China. This study identified the key determinants of childhood obesity in China and provided recommendations for future intervention strategies.

Methods

We conducted a comprehensive systematic review and meta-analysis to identify multiple-level determinants of childhood obesity in China and calculated the population-attributable risk percentage (PAR%) for each modifiable determinant. We also conducted expert consultations using the Socio-ecological Model to gain insights into the causes of obesity. Additionally, we reviewed current Chinese policies on childhood obesity intervention and compared them with the priorities identified in the meta-analysis and expert consultation to pinpoint policy gaps.

Findings

Our meta-analysis, incorporating 419 studies, identified 33 risk factors for childhood obesity. At the individual-level, we identified 11 key contributors including early-life risk factors such as maternal pre-pregnancy overweight/obesity (PAR%: 16.7%), breastfeeding duration of less than six months (14.1%), cesarean section delivery (11.1%), excessive gestational weight gain (10.5%), high birth weight (4.2%), and gestational diabetes mellitus (3.6%), and 13 behavioral factors during childhood such as sugar sweetened beverage consumption (16.4%), insufficient sleep (15.0%), rapid eating speed (14.7%), less than 2 h of physical activity per day (6.3%), and over 2 h of daily screen time (5.6%). We also identified six prominent family-level factors such as maternal overweight/obesity (24.3%) and paternal overweight/obesity (23.5%). Expert consultation highlighted genetic factors, and prioritized actionable risk factors, particularly dietary, expanding on the meta-analysis findings. Finally, policy review revealed that existing Chinese policies inadequately addressed these determinants, especially at the macro and structural levels.

Interpretation

This study highlights the importance of targeting high-risk populations and addressing detrimental behavioral factors, especially on early-life influences. However, real-world impacts require a comprehensive approach that goes beyond individual factors. More future effective intervention efforts are needed.

Funding

This study was funded by the National Natural Science Foundation of China (NSFC 82073567; NSFC 82273641) and the National Science and Technology Innovation 2030, Noncommunicable Chronic Diseases-National Science and Technology Major Project (Grant No. 2023ZD0508500, 2023ZD0508504).

What influences Indian primary school children's food behaviors? - Perceptions of children, mothers and teachers

BACKGROUND

Development of healthy food behaviors in childhood is significant for optimum growth and development of children as well as future health. However, many Indian children display unhealthy dietary habits including poor intakes of fruits and vegetables and excessive consumption of calorie-dense, nutrient-poor foods and sugar-sweetened beverages. Therefore, the factors that influence their daily diet need to be explored for developing future interventions and policies. In this light, the present inquiry was designed to examine the various influences on the food behaviors of Indian primary school children.

METHODS

Informed by the socio-ecological framework, this study used an exploratory qualitative research approach to conduct semi-structured interviews with 22 primary school children, 19 mothers, and 18 teachers residing in Varanasi, India. For children, the interviews were preceded by a drawing session where the interviewees were asked to draw their preferred and non-preferred food and beverage items. Interviews were carried out in English or Hindi and digitally recorded. Interviews were conducted until data saturation was achieved. Digital recordings were transcribed verbatim and translated to English (where necessary) for the purpose of thematic analysis. The transcripts were coded both deductively and inductively using the NVivo software program.

RESULTS

Individual level influences included taste and nutritional knowledge. At the interpersonal level, the family food environment and peers emerged as key determinants. The physical environment also played a pivotal role in determining food behaviors, with the school food environment and food availability in the marketplace being significant. Lastly, at the societal level, television and internet advertisements were frequently cited as important determinants of children's food behavior.

CONCLUSIONS

The collective insights from the three stakeholder groups have the potential to inform public health nutrition policies and interventions targeting the different socio-ecological factors to encourage healthy eating in Indian primary school children.

How to evaluate ultra-processed food intake in pediatrics? UPF score: an easy alternative

BACKGROUND

The rising intake of ultra-processed foods (UPFs) among the pediatric population poses challenges due to the lack of precise and easily accessible tools to quantify such intake. This complicates understanding its effects on dietary quality and hampers the design of interventions to prevent the negative impact of UPF consumption on health. Given these challenges, it is essential to establish reliable methods to assess UPF consumption and its effect on diet.

OBJECTIVE

This study aims to determine the relationship between the UPF score and dietary characteristics.

METHODS

This cross-sectional study involved 353 participants aged 3 to 17. The methods included (1) collection of a three-day food record; (2) an evaluation of intake across five food groups; (3) categorization of intake frequency (0, 1, 2, or up to 3 times weekly); and (4) scoring by cumulative intake. Principal component analysis and regression models were utilized to assess diet associations with UPF score.

RESULTS

Higher cumulative UPF score groups were associated with increased intake of energy, fats, and sodium (p < 0.01); decreased fiber intake (p = 0.03), vegetables, fruits, and cereals (p < 0.05); higher sugar intake (p < 0.01); and reduced intake of vitamins A and C (p < 0.05). Four principal components, representing over 65% of sample variability, identified two healthy and two less healthy dietary patterns. Linear regression indicated higher fiber intake at lower UPF scores, declining with higher UPF scores.

CONCLUSIONS

The UPF score represents a useful tool for assessing UPF intake and dietary characteristics in pediatric populations.

How Screen Time Affects Greek Schoolchildren's Eating Habits and Functional Food Consumption?-A Cross-Sectional Study

BACKGROUND

Television (TV), video games, PC and devices such as tablets and smart phones have become part of everyday life at an ever-younger age. Increased screen time correlates with unhealthy eating habits among children.

METHODS

374 children aged 9-12 years and their parents (n = 159), from 3 schools in Lemnos and 5 schools in Thessaloniki, Greece, took part in this cross-sectional study. The children completed the KIDMED score and a questionnaire about their physical activity, time spent watching TV, PC and playing electronic games, the frequency of cooking or shopping with their parents, the frequency of eating fast food, soft drinks and Functional Foods (FFs). Statistical analysis was performed with SPSS-29.0, using One Way ANOVA and Pearson chi-square.

RESULTS

As the hours of TV viewing increased, so did the percentage of children who consumed soft drinks (p = 0.03). A statistically significant association detected between television (p = 0.024), video games (p = 0.028), all screen categories (p = 0.011) and fast-food consumption. Increased screen time is associated with a higher weekly consumption of fast food (p = 0.011). The more hours children spent in front of screens, the less adherence they had to the Mediterranean Diet (p = 0.001) and less natural FFs consumption (p = 0.001).

CONCLUSIONS

The results suggest that screen time seems to affect children's eating behaviors. The study concluded that the longer the screen time, the unhealthier the dietary habits of schoolchildren become. Future research should focus on reducing screen time, as a means of improving dietary patterns and potentially reducing childhood obesity.

Childhood Obesity: A Narrative Review

Obesity among children has emerged as a worldwide health issue due to childhood obesity becoming a pandemic, and it is often linked to various illnesses, fatal outcomes, and disability in adulthood. Obesity has become an epidemic issue in both developed and developing countries, particularly among youngsters. The most common factors contributing to non-communicable diseases (NCDs) are unhealthy eating habits, desk-bound games, avoidance of physical activity-requiring activities, smoking, alcohol usage, and other added items. All these factors increase NCDs, including obesity, resulting in various morbidities and early death. Additionally, childhood obesity has psychological, emotional, cognitive, societal, and communicative effects. For example, it raises the possibility of issues related to physical appearance, self-esteem, confidence level, feelings of isolation, social disengagement, stigma, depression, and a sense of inequality. Children who consume more energy-dense, high-fat, low-fiber-containing food than they need usually store the excess as body fat. Standardizing indicators and terminology for obesity-related metrics is critical for better understanding the comparability of obesity prevalence and program effectiveness within and between countries. The underlying variables must be altered to reduce or avoid harm to the target organ in children. As a result, reducing childhood obesity is a considerable public health goal for the benefit of society and the long-term well-being of individuals.

FACILITY: feeding the family-the intergenerational approach to fight obesity, a cross-sectional study protocol

Introduction

Paediatric obesity has been described by the World Health Organization as one of the most serious health challenges of the 21st century. Over the past four decades, the number of children and adolescents with obesity has increased between 10 and 12-fold worldwide.

Methods

Childhood obesity is a complex and multifactorial outcome which can be attributed to factors such as socioeconomic status, ethnicity, lifestyle and eating habits. Beside personal-children-related factors, maternal (education, food knowledge, income) and environmental ones (food environment's features and accessibility) have been proven but their influences are still worth discussion. The cross-sectional study of the "FACILITY: feeding the family-the intergenerational approach to fight obesity" project aims at estimating children prevalence of overweight and obesity and assessing the impacts of lifestyle and of socio-economic-cultural and environmental factors on overweight and obesity.

Results

Due to the current importance of developing multidisciplinary mother-child centred prevention programs, FACILITY cross-sectional study will investigate maternal and child socio-cultural, economic, environmental, health and lifestyle-related risk factors for the development of obesity.

Discussion

The knowledge gained will provide the basis to develop a "primordial prevention program" to early tackle childhood obesity.

Clinical Trial Registration

ClinicalTrials.gov, identifier (NCT06179381).

Relationship Between Family Factors, Food Consumption Behaviors, and Nutritional Status Among Muslim School-Age Students in Rural Southern Thailand

Purpose

The double burden of malnutrition, with both undernutrition and overweight threatening school-age children's development, presents a critical global public health challenge. This research aimed to study the relationships between family factors, food consumption behaviors, and nutritional status among Muslim school-age children in rural southern Thailand.

Samples and Methods

This study was cross-sectional descriptive research. The samples included 228 children aged 9-12 years in Thasala District, Nakhon Si Thammarat. Data were collected using demographic data, Nutritional status assessment, and food consumption behaviors assessment. Data were analyzed using descriptive, chi-square, and binary logistic regression statistics.

Results

Overall, 15.8% of the samples were classified as overweight and obese, and 18% were classified as stunted (<-1.5 SD). The samples had a normal weight-for-height (72.3%). The overall food consumption behaviors of the participants were moderate (Mean = 2.17, SD = 0.60). The number of siblings and food consumption behaviors had a significant relationship with nutritional status (p < 0.05). Confirmation with binary logistic regression results also revealed that the likelihood of appropriate nutritional status was 2.74 times higher in children with 3-4 siblings than those with 1-2 siblings (OR = 2.74; 95% CI: 1.494-5.047). Additionally, children with appropriate food consumption behaviors were 2.04 times more likely to have a proper nutritional status than those with inappropriate food consumption behaviors (OR = 2.04; 95% CI: 1.044-3.996).

Conclusion

The study found that most participants had moderately appropriate food consumption behaviors, with 15.8% showing issues like overweight and obesity. The number of siblings and food consumption behaviors significantly influenced nutritional status. Interventions should leverage Islamic religious settings and engage religious leaders to foster healthier lifestyles. Culturally and religiously sensitive nutritional education, blending scientific evidence with Islamic teachings, should be integrated into school curricula to cultivate healthy eating habits and mitigate long-term health risks.

Association of sugar-sweetened beverage consumption and cardiorespiratory fitness with executive function: a cross-sectional survey based on Tajik adolescents at high altitude in China

Background

Executive function has a significant impact on adolescents' academic and future achievement and is strongly associated with multiple factors. However, few studies have examined the association between sugar-sweetened beverage (SSB) consumption, cardiorespiratory fitness, and executive function. Moreover, no research studies have been found on Tajik adolescents at high altitudes in China. The present study aimed to understand the associations between SSB consumption, cardiorespiratory fitness, and executive function among Tajik adolescents in high-altitude areas of China. To accumulate information on the physical and mental health development of Tajik adolescents in high-altitude areas of China.

Methods

In this study, a cross-sectional assessment of SSB consumption, cardiorespiratory fitness, and executive function was conducted on 1,121 Tajik adolescents aged 13-15 years at high altitude in China in 2023. One-way analysis of variance (ANOVA), binary logistic regression analysis, and ordered logistic regression analysis with a generalized linear model were used to analyze the associations that existed between SSB consumption and cardiorespiratory fitness and executive function.

Results

The proportions of Tajik adolescents aged 13-15 years with SSB consumption of ≤1 time/week, 2-5 times/week, and ≥ 6 times/week were 14.6, 51.6, and 33.8%, respectively, in high-altitude areas of China. The VO2max of Tajik adolescents was (37.17 ± 5.52) ml.kg.min-1. The inhibit control function response, refreshing memory function response, and switching flexibility function response of Chinese Tajik adolescents were (19.71 ± 5.86) ms, (1114.39 ± 356.85) ms, (382.2 ± 213.4) ms. Overall, using the SSB consumption ≤1 times/w and VO2max of the Q4 group as the reference group, ordered logistic regression analysis showed that Tajik adolescents with SSB consumption ≥5 times/w and VO2max of the Q1 group experienced inhibit control function dysfunction (OR = 28.80, 95%CI: 10.23 ~ 81.07), refreshing memory function dysfunction (OR = 6.79, 95%CI: 3.19 ~ 14.43), switching flexibility function dysfunction (OR = 13.10, 95%CI: 5.59 ~ 30.70) were at increased risk (p < 0.001).

Conclusion

SSB consumption and cardiorespiratory fitness were associated with executive function in Tajik adolescents at high altitudes in China. Increased frequency of SSB consumption and decreased cardiorespiratory fitness increased the risk of executive function disorders in Tajik adolescents. In the future, SSB consumption and cardiorespiratory fitness should be effectively controlled in Tajik adolescents to improve their executive function and promote the physical and mental health of Tajik adolescents in high-altitude areas.

The relationship between self-efficacy, motivation, and dietary behaviors within parent-adolescent dyads: Application of actor-partner interdependence models with mediation

The purpose of the study was to examine interdependent relationships between cognitive factors (self-efficacy and motivation) and dietary behaviors (fruit and vegetable (F/V) and junk food and sugar sweetened beverages (JF/SSB) intake) within parent-adolescent dyads. This secondary data analysis was conducted for parent-adolescent dyads using a cross-sectional Family Life, Activity, Sun, Health, and Eating (FLASHE) study. The sample consisted of 1645 parent-adolescent dyads. Parents and adolescents answered questions regarding self-efficacy, motivation, and dietary behaviors. Actor-partner interdependence models with mediation (APIMeM) were run within parent-adolescent dyads. Adolescent's F/V and JF/SSB intake were positively associated with that of their parents. The relationship between F/V self-efficacy or F/V motivation and F/V intake showed the actor-partner pattern within the parent-adolescent dyads. The actor-only pattern was mainly reported for the relationship between JF/SSB self-efficacy or JF/SSB motivation and JF/SSB intake. In the F/V intake APIMeM, motivation mostly plays a mediating role in the relationship between self-efficacy and F/V intake within the parent-adolescent dyads. In the JF/SSB intake APIMeM, all the actor-actor mediations and only one partner-actor mediation of motivation were significantly confirmed in the relationship between self-efficacy and JF/SSB intake. This study highlighted the importance of parental involvement in promoting healthy dietary behaviors in adolescents. Personalized nutrition programs targeting both adolescents and their parents as a single unit of intervention should be provided.

Investigation of Complementary Feeding Transition Behaviours in Mothers in the Process of Transition to Complementary Feeding: A Cross-Sectional Study

BACKGROUND

The transition to complementary feeding directly affects child health. In this period, economic and cultural factors affect the transition to complementary feeding. The aim of this study was to investigate the transition behaviours of mothers with 6-month-old babies who were in the process of transition to complementary feeding.

METHOD

The cross-sectional study was conducted between February and April 2024. The study sample consisted of 721 mothers with 6-month-old babies. The data were obtained through snowball sampling method on the online platform. The study focused on mothers' demographic and Transition to Complementary Feeding Behaviors Scale (TCFBS) results. Data were obtained on an online platform. Difference, correlation and regression analyses were performed.

RESULTS

The mean age of the mothers included in the study was 27.58 ± 3.87. The TCFBS total score of the mothers included in the study was 92.01 ± 15.18. There was a statistically significant difference between the education and income status of the mothers and the gender of the baby and TCFBS total score (p < 0.05). According to the regression analysis, it is possible to explain approximately 46.4% of the variable of transition behaviour to complementary feeding in dependent mothers with the gender of the baby and the educational status of the mother.

CONCLUSION

Complementary feeding transition behaviour of mothers in the process of transition to complementary feeding was found to be positive. It was found that the complementary feeding behaviour of the mothers was affected by the gender of the baby and education, and the transition to complementary feeding behaviours of mothers with female babies and university graduates were positive. It can be said that mothers need care and counselling from midwives and nurses in this period.

ILSI Europe Systematic Review: The Impact of Digestible and Nondigestible Carbohydrate Consumption for Toddlers (1-4 Years) in Relation to Health Outcomes

CONTEXT

Early dietary habits play a crucial role in shaping long-term health outcomes. Understanding the effects of different carbohydrate types on physiological markers is essential for developing evidence-based nutritional guidelines for toddlers.

OBJECTIVE

The aim was to systematically evaluate the impact of both digestible and nondigestible carbohydrate intake during early childhood (1-4 years of age) on various health outcomes, including growth patterns, metabolic parameters, and the development of risk of cardiovascular diseases.

DATA SOURCES

PubMed, Embase, and CENTRAL databases were searched up to April 2022 to identify studies investigating carbohydrate consumption in toddlers.

DATA EXTRACTION

The types of carbohydrates consumed, their sources, and their associations with growth parameters and metabolic markers were extracted. Thirty-one publications, including 18 cohort studies and 2 randomized controlled trials, were included.

DATA ANALYSIS

The risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis was performed, with a visual summary table of the direction of effects.

CONCLUSION

In toddlers, the negative impact on health risks later in life is more pronounced for digestible dietary carbohydrate intake in liquid forms, such as sugar-sweetened beverages and fruit juice, compared with solid forms. Higher nondigestible carbohydrate (dietary fiber) intake during early childhood showed a beneficial trend on later lipid profile. Further studies are required to comprehensively assess the effect of digestible and nondigestible carbohydrate intake in toddlers on cognitive and psychomotor development, infections, bowel function, and gut microbiota.

Plant-based dietary patterns, nutrient intake, growth, and body composition in childhood: Results from a prospective population-based study

BACKGROUND & AIMS

Transitioning to more plant-based diets promotes environmental sustainability and has health benefits for adults. However, associations with nutrient intake adequacy and growth in children remain unknown. This study aimed to examine associations of plant-based diets with nutrient intake levels among children, and with longitudinal growth and body composition up to adolescence.

METHOD

We included 3340 children in the Generation R Study, a population-based cohort. Food and nutrient intake were assessed at the age of 8 years, and anthropometrics and body composition (using dual-energy X-ray absorptiometry) were measured at the ages of 10 and 13 years. Plant-based diets were quantified using three plant-based diet indices (PDIs): overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI). Modified Poisson regression and linear mixed models were used to estimate the associations of PDIs with nutrient intake levels, and with sex- and age-standardized measures of anthropometrics and body composition.

RESULTS

Higher scores on each of the three PDIs were associated with lower intake of vitamin B2, B12, and calcium, while higher hPDI score was associated with higher intake levels of fiber, vitamin C, magnesium, and copper. Higher hPDI score was also associated with higher fat-free mass index (FFMI) z-score (0.05 per 10-hPDI score increment, 95 % CI: 0.01, 0.10), and with lower body fat percentage z-score (-0.05, 95 % CI: -0.09, -0.01), while higher uPDI score was associated with lower height, weight, and FFMI z-score (FFMI: -0.08, 95 % CI: -0.12, -0.03) up to age of 13 years.

CONCLUSIONS

In this cohort study, higher adherence to healthful plant-based diets, rather than unhealthful ones, was associated with better nutrient intakes, and subsequent healthy body composition throughout childhood to adolescence. Our findings suggest that consuming healthful plant-based foods may contribute to children's diets' nutrient quality and subsequent body composition. Still, attention should be given to ensuring balanced and adequate nutrient intake for optimal plant-based eating.

The Mediating Effect of Concurrent Changes in Dietary Behaviors on the Associations Between Intervention and Changes in Adiposity Outcomes: Evidence from a Cluster-Randomized Controlled Trial

Behavioral interventions have been shown to be effective in improving dietary behavior and reducing childhood obesity. There is limited evidence on how concurrent changes in dietary behavior from intervention studies affect childhood obesity. The present study aimed to evaluate the mediating effect of concurrent changes in dietary behaviors between the intervention and changes in adiposity indicators. This study included 1180 children from the DECIDE-Children study, which was conducted across three areas in China, aiming to promote children's healthy diet and physical activity, while also engaging schools and families to support children's behavioral changes. Dietary behaviors were collected by a revised version of the Food Frequency Questionnaire and a self-designed questionnaire. Adiposity outcomes were objectively measured by trained personnel. Generalized linear mixed models were used to estimate the association between scores of dietary behavioral changes and adiposity indicator changes. Mediation analyses were used to evaluate how scores of dietary behavioral changes mediated the effect of intervention on adiposity indicator changes. Six hundred children in the intervention group and five hundred and eight in the control group with both baseline and follow-up data were included. Each increase in dietary behavioral change score was associated with a 0.06 (p = 0.016) decrease in changes in BMI and other adiposity indicators. Scores of dietary behavioral changes mediated 13.87% (p < 0.001), 11.81% (p < 0.001), 17.60% (p = 0.024), and 16.78% (p = 0.032) of the association between intervention and changes in body mass index (BMI), BMI z-score, body fat percentage, and waist circumference, respectively. Scores of dietary behavioral changes mediated the intervention effect on adiposity indicator changes. Future interventions targeting childhood obesity should incorporate promoting multiple dietary behaviors simultaneously.

A meta-analysis of epigenome-wide association studies of ultra-processed food consumption with DNA methylation in European children

BACKGROUND/OBJECTIVE

There is limited knowledge on how diet affects the epigenome of children. Ultra-processed food (UPF) consumption is emerging as an important factor impacting health, but mechanisms need to be uncovered. We therefore aimed to assess the association between UPF consumption and DNA methylation in children.

METHODS

We conducted a meta-analysis of epigenome-wide association studies (EWAS) from a total of 3152 children aged 5-11 years from four European studies (HELIX, Generation XXI, ALSPAC, and Generation R). UPF consumption was defined applying the Nova food classification system (group 4), and DNA methylation was measured in blood with Illumina Infinium Methylation arrays. Associations were estimated within each cohort using robust linear regression models, adjusting for relevant covariates, followed by a meta-analysis of the resulting EWAS estimates.

RESULTS

Although no CpG was significant at FDR level, we found suggestive associations (p-value < 10-5) between UPF consumption and methylation at seven CpG sites. Three of them, cg00339913 (PHYHIP), cg03041696 (intergenic), and cg03999434 (intergenic), were negatively associated, whereas the other four, cg14665028 (NHEJ1), cg18968409 (intergenic), cg24730307 (intergenic), and cg09709951 (ATF7), were positively associated with UPF intake. These CpGs have been previously associated with health outcomes such as carcinomas, and the related genes are mainly involved in pathways related to thyroid hormones and liver function.

CONCLUSION

We only found suggestive changes in methylation at 7 CpGs associated with UPF intake in a large EWAS among children: although this shows a potential impact of UPF intake on DNAm, this might not be a key mechanism underlying the health effects of UPFs in children. There is a need for more detailed dietary assessment in children studies and of intervention studies to assess potential epigenetic changes linked to a reduction in UPF in the diet.

Decreased frequency of sugar-sweetened beverages intake among young children following the implementation of the health promotion levy in South Africa

OBJECTIVE

This study assessed the association between baseline sociodemographic variables, body composition and 4-year changes in the intake of food groups, including sugar-sweetened beverages (SSB) among children, after the implementation of the health promotion levy.

DESIGN

Prospective cohort study.

SETTING

Ten schools in North West Province, South Africa.

PARTICIPANTS

950 children aged 5-9 years at baseline and data of 672 children at follow-up. The frequency of intake from healthy and unhealthy food groups was assessed by questionnaire. Anthropometric and sociodemographic information were collected; BMI-for-age z-scores were calculated. The health promotion levy was implemented after baseline and follow-up measurements were done after 4 years. A random intercept generalised linear mixed model analysis was applied to investigate the time effect of the weekly intake of the foods adjusting for BMI-for-age z-scores and sociodemographic characteristics of the children.

RESULTS

The weekly frequency of intake from most food groups remained unchanged at follow-up. The frequency of SSB intake decreased significantly over 4 years. Decreased intake of SSB was not linked to increased intake of healthy foods. Changes in intakes from SSB were not associated with household income, parental education or BMI-for-age z-score categories. A decreased frequency of intake from SSB was observed following the implementation of the health promotion levy after baseline, in line with reports of national decreases in SSB sales in South Africa since 2017.

CONCLUSIONS

The decreased frequency of SSB intakes following the implementation of the health promotion levy in South Africa may indicate that health policies can promote healthier dietary habits.

War exposure and changes in eating behaviours in Ukrainian school-aged children: A cross-sectional online survey

The war in Ukraine has exposed children to extremely high levels of acute and chronic stressors, which can impact their eating behaviour (EB). We aimed to determine the prevalence of war-induced, stress-related disruptions in EB of Ukrainian children. We conducted a cross-sectional online survey among parents of 5- to 17-year-old children, who had experienced the war in Ukraine in February-May 2023. Guardians reported their child's various war exposure changes in EBs using a modified version of the Child Eating Behaviour Questionnaire. We assessed associations between total and medium-term EB changes and age, sex, and war exposure using bivariate correlations and χ2 tests. Logistic regression models were fitted to explore the associations between socio-demographic factors, war exposure and frequency of EB changes. Of the 4854 children, 63% had changes in EBs during the war. The most common EB changes included food cravings (38%), food fussiness (37%), and aversion to certain foods (29%). Of the reported EB changes, 40% were medium-term, lasting over a month, and related to altered attitudes towards food. Food insecurity (adjusted OR 2.35, 95% CI: 1.76-3.14), and displacement (internally 2.01, 1.19-3.42) emerged as the most influential determinants of medium-term EB changes. The findings underscore a significant and robust association between war-related exposures and an increased risk of frequent EB changes. As healthy EBs are learned during childhood and have been shown to track into adulthood, the identified disruptions in EB may have medium-term consequences for the physical and mental health of Ukrainian children.

An Overview of Reviews on the Association of Low Calorie Sweetener Consumption With Body Weight and Adiposity

BACKGROUND

Numerous systematic reviews (SR) and meta-analyses (MA) on low calorie sweeteners (LCS) have been published in recent years, concluding that LCS have beneficial, neutral, or detrimental effects on various health outcomes, depending on the review.

OBJECTIVES

The objective of this overview of reviews was to determine how the methodologies of SR investigating the association between LCS consumption and body weight (BW) influence their findings and whether MA results can provide a consistent estimated effect.

METHODS

Systematic searches of PubMed, Scopus, and Cochrane Library were conducted in November 2022 to identify SR of randomized controlled trials (RCT) or non-randomized studies (NRS) investigating the association between LCS consumption and BW. The methods, MA results, and conclusions were extracted from each eligible SR.

RESULTS

Of the 985 search results, 20 SR evaluated the association between LCS and BW, drawing from publications of 75 RCT, 42 prospective cohort studies, and 10 cross-sectional studies. There was a considerable lack of overlap of studies included within each SR attributed, in part, to the inclusion of studies based on design; thus, each SR synthesized results from distinctly different studies. Evidence synthesis methods were heterogeneous and often opaque, making it difficult to determine why results from certain studies were excluded or why disparate results were observed between SR.

CONCLUSIONS

SR investigating the effect of LCS on BW implement different methodologies to answer allegedly the same question, drawing from a different set of heterogeneous studies, ignoring the basic assumptions required for MA, resulting in disparate results and conclusions. Previous MA show the large effects of study design, which results in inconsistent estimates of the effect of LCS on BW between MA of RCT and NRS. Given the availability of long-term RCT, these studies should be the basis of determining causal relationships (or lack thereof) between LCS and BW. This trial was registered at PROSPERO as CRD42022351200.

Prevalence of Oral Diseases and the Influence of the Presence of Overweight/Obesity in Schoolchildren Population in Mallorca

Background: The pediatric population is one of the social groups most affected by oral pathology, and overweight and/or obesity is increasingly frequently observed. This work presents a study of the prevalence of oral disease in the school population in Mallorca and its relationship with overweight/obesity. Methods: A cross-sectional study was carried out with a sample of 718 students aged 5-6 (n = 255), 12 (n = 230) and 15 years (n = 233). The WHO criteria for diagnosing and coding examined teeth and overweight/obesity prevalence values. To explore the differences in data, the mean was analyzed using the Student's t-test or a one-way analysis of variance followed by the Bonferroni post hoc analysis. Results: Results found that students aged 15 years have a caries prevalence rate of 45.49%, higher than those aged 12 (27.39%). The presence of dental calculus in 15-year-old students is 52.8%, even higher than in 12-year-olds (30%). Students aged 6 and 12 with lower weight percentiles have fewer healthy teeth than those with higher percentiles. Conclusions: The schoolchildren have experienced a decrease in caries and an increase in periodontitis, with weight percentile potentially influencing the number of healthy teeth.

The divergent association of diet intake, parental education, and nutrition policy with childhood overweight and obesity from low- to high-income countries: A meta-analysis

Background

It is unclear whether the effects of dietary intake, parental education, and nutrition policy on childhood overweight and obesity is consistent between high-income (HICs) and low- and middle-income (LMICs) countries. The objective of this meta-analysis was to investigate the association of diet, parental education and nutrition policy with childhood overweight and obesity when the economic levels were controlled.

Methods

PubMed, Web of Science, Embase and Scopus were searched for observational studies published from January 1980 to October 2023 that examined the association of diet, parental education and nutrition policy with childhood overweight and obesity. Meta random effects model stratified by gross national income per capita was used to assess whether the associations were varied by economic levels.

Results

From 18 191 identified studies, 154 met the inclusion criteria. Meta-analysis revealed that higher sugar-sweetened beverage intake was a risk factor for childhood overweight and obesity in both HICs and LMICs countries/regions, whereas higher intake of fruit and/or vegetable was a protective factor only in LMICs countries/regions (odds ratio (OR) = 0.77; 95% confidence interval (CI) = 0.69-0.85). Moreover, lower parental education level increased the risk (OR = 1.46; 95% CI = 1.32-1.61) and nutrition policy implementation decreased the risk (OR = 0.96; 95% CI = 0.91-0.99) of childhood overweight and obesity only in HICs.

Conclusions

Fruit and/or vegetable intake, parental education and nutritional policy exert different influences on childhood overweight and obesity in countries with varied economic levels. These findings will enhance the understanding of the complex interplay between these factors and their impact on childhood health.

Influence of Nutrition on Growth and Development of Metabolic Syndrome in Children

Obesity is currently an increasing public health burden due to its related metabolic and cardiovascular complications. In Western countries, a significant number of people are overweight or obese, and this trend is, unfortunately, becoming increasingly common even among the pediatric population. In this narrative review, we analyzed the role of nutrition during growth and its impact on the risk of developing metabolic syndrome and cardiovascular complications later in life. An impactful role in determining the phenotypic characteristics of the offspring is the parental diet carried out before conception. During intrauterine growth, the main risk factors are represented by an unbalanced maternal diet, excessive gestational weight gain, and impaired glycemic status. Breastfeeding, on the other hand, has many beneficial effects, but at the same time the quality of breast milk may be modified if maternal overweight or obesity subsists. Complementary feeding is likewise pivotal because an early introduction before 4 months of age and a high protein intake contribute to weight gain later. Knowledge of these mechanisms may allow early modification of risk factors by implementing targeted preventive strategies.

Impact of unhealthy food and beverage consumption on children's risk of dental caries: a systematic review

CONTEXT

The impact of unhealthy foods and beverages, namely those high in sugar, salt, and saturated or trans fats, has been studied extensively in relation to weight, body composition, and noncommunicable diseases, but less so in relation to the risk of dental caries. Few previous reviews have examined the evidence from all countries globally.

OBJECTIVE

A systematic review was conducted to assess the impact of unhealthy food and beverage consumption on the risk of dental caries in children aged ≤10 years, commissioned by the World Health Organization to inform updated complementary feeding recommendations.

DATA SOURCES

Systematic searches were conducted in the PubMed, Cochrane, and Embase databases for articles meeting the inclusion criteria dating from January 1971 to March 2022; supplementary searches were undertaken for articles from that period to June 2022.

DATA EXTRACTION

Unhealthy foods and beverages were identified using nutrient- and food-based approaches. Risk of bias was assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I).

DATA ANALYSIS

A total of 30 023 unique citations were screened, yielding 37 studies for inclusion. Studies were conducted in high-income (n = 23 [62.2%]) or middle-income countries (n = 14 [37.8%]). Evidence synthesis was performed narratively, stratified by age (0 years to <2 years, 2 years to <5 years, and 5 years to ≤10 years) and exposure (unhealthy foods and unhealthy beverages). The heterogeneity of the exposures and comparators across studies was high. Almost all studies (n = 34) reported positive associations between the consumption of sugar-sweetened beverages or foods high in free sugars and dental caries. However, 67.6% of studies were assessed as having serious risk of bias.

CONCLUSION

The evidence indicates that the consumption of unhealthy food and beverages in children ≤10 years appears to increase the risk of dental caries. Further longitudinal studies with high-quality dietary assessments, including studies in low-income countries and children aged >5 years at baseline, are recommended in order to build a more robust evidence base for use in the development of policy recommendations.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020218109.

Patterns of complementary feeding introduction and associated factors in a cohort of Brazilian infants

BACKGROUND

Understanding the timing of food introduction in infants is essential for promoting optimal complementary feeding practices. However, existing studies often rely on cross-sectional data, limiting the ability to capture age-specific patterns. We aimed to describe food introduction during the first year of life by identifying patterns related to age at food introduction and associated factors in a cohort of Brazilian infants.

METHODS

Data were collected through standardized questionnaires administered to mothers via face-to-face interviews during the infant's first month of life and at 3, 6, 9, and 12 months of age. Additionally, two telephone interviews were conducted at 2 and 4 months of age. Information regarding food intake was assessed using a list of 48 foods, with two key aspects recorded: whether the food was introduced (yes/no) and the age at introduction. To define food introduction patterns, we employed k-means cluster analysis. Hierarchical Poisson multiple regression was employed to examine the associations between sociodemographic, biological, and healthcare factors and patterns of food introduction.

RESULTS

Three distinct patterns were identified and named according to their main characteristics: Pattern 1 - "Low Infant Formula and Timely CF Introduction"; Pattern 2 - "High Infant Formula and Early CF Introduction"; and Pattern 3 - "High Infant Formula and Later Ultra-processed Food Introduction". Breastfeeding at six months showed a positive association with Pattern 1 (PR = 1.40; 95% CI = 1.10-1.80), while bottle use at four months was negatively associated with Pattern 1 (PR = 0.68; 95% CI = 0.53-0.87). No variables studied exhibited an association with Pattern 2. For Pattern 3, higher prevalences were observed among children whose mothers were aged < 20 years (PR = 1.54; 95% CI = 1.13-2.01) or > 34 years (PR = 1.42; 95% CI = 1.04-1.93). Not receiving guidance on the recommended duration of breastfeeding and complementary feeding during prenatal care was associated with a higher prevalence of children in this pattern (PR = 1.35; 95% CI = 1.01-1.80).

CONCLUSIONS

We identified three distinct patterns of age at food introduction in the study population, although none perfectly aligned with Brazilian or WHO dietary recommendations. These findings underscore the need for targeted interventions to promote timely and healthy complementary feeding practices in Brazilian infants.

Relationship between motivations and dietary behaviours within parent-adolescent dyads: Application of actor-partner interdependence models

BACKGROUND

Parents play a substantial role in improving adolescent dietary behaviours.

OBJECTIVES

To examine the interdependent relationships between motivations (autonomous and emotional motivation) and dietary behaviours (fruit and vegetable [F/V] and junk food and sugar-sweetened beverage [JF/SSB] intake) within parent-adolescent dyads.

METHODS

This secondary data analysis was conducted on 1522 parent-adolescent dyads using a cross-sectional Family Life, Activity, Sun, Health, and Eating (FLASHE) study. The ratio of boys to girls among the adolescents was approximately equal, and 74% of the parents were mothers. The adolescents were between 12 and 17 years old, and 85.5% of the parents were between 35 and 59 years old. Parents and adolescents completed an online survey on dietary motivations and behaviours. Actor-partner interdependence models were performed within parent-adolescent dyads.

RESULTS

F/V and JF/SSB intake was influenced by parents' or adolescents' autonomous motivation (actor-only pattern), except among adolescents with obesity. A dyadic pattern was found in the relationship between autonomous motivation and F/V and JF/SSB intake, but only among adolescents with normal weight. No relationship was found between F/V and JF/SSB controlled motivation and F/V or JF/SSB intake among adolescents with overweight or obesity.

CONCLUSIONS

Autonomous motivation had a significant relationship with F/V and JF/SSB intake for both parents and adolescents, but the association varied depending on the adolescents' weight. Personalized programmes that foster autonomous motivation to change dietary behaviours should be provided based on the adolescents' weight status.

Association of ultra-processed food consumption with muscle mass among young and middle-aged US adults

INTRODUCTION

Muscle mass is vital for physical activity and fundamental physiological processes supporting long-term health. While aging is inevitable, certain modifiable factors positively influence muscle preservation and overall well-being. However, the relationship between the consumption of ultra-processed foods (UPF) and muscle mass is not yet clear.

METHODS

This study included 7,173 men and nonpregnant women aged 20-59 years with valid 24-hour dietary recalls and accessible whole-body dual-energy x-ray absorptiometry (DXA) scans from NHANES 2011-2018. UPFs were identified through the NOVA classification system, and the percentage of energy derived from UPF consumption was evaluated in quintiles. Muscle mass measures were derived from DXA scans and quantified by the total and regional muscle mass index (MMI, kg/m²) and appendicular muscle mass index (AMMI, kg/m²). Multivariable-adjusted generalized linear regression models were applied to investigate the association between consumption of UPFs and muscle mass measures overall and by sociodemographic subgroups.

RESULTS

The multivariable-adjusted differences of total MMI from the lowest to highest quintile of UPF consumption were 0 (reference), -0.03 (95% CI, -0.13, 0.07), -0.13 (95%CI, -0.24, -0.04), -0.12 (95% CI, -0.23, -0.01), and - 0.17 (95% CI, -0.27, -0.08) (P for trend < 0.001). Subtotal MMI followed a similar magnitude of associational pattern as total MMI. For trunk MMI, corresponding values from the lowest to highest quintiles of UPF consumption were 0 (reference), -0.02 (95% CI, -0.07, 0.02), -0.05 (95%CI, -0.11, 0.00), -0.07 (95% CI, -0.13, -0.01), and - 0.07 (95% CI, -0.12, -0.01). For AMMI, corresponding values from the lowest to highest quintiles of UPF consumption were 0 (reference), -0.004 (95% CI, -0.07, 0.06), -0.08 (95%CI, -0.14, -0.02), -0.05 (95% CI, -0.11, 0.02), and - 0.10 (95% CI, -0.16, -0.04) (All P for trend < 0.001). While most subgroups maintained similar overall patterns, heterogeneous findings were also observed. For example, the multivariable-adjusted differences in total MMI between the lowest and highest quantile of UPF consumption were - 0.19 (95% CI, -0.32, -0.06) for non-Hispanic Whites, 0.18 (95% CI, 0.01, 0.36) for non-Hispanic Blacks, -0.25 (95%CI, -0.45, -0.04) for Hispanics, -0.25 (95% CI, -0.51, 0.05) for non-Hispanic Asians and - 0.32 (95% CI, -0.75, 0.12) for others (P for interaction < 0.001).

CONCLUSION

Higher consumption of UPFs was significantly associated with lower values of total and regional muscle mass. Specifically, comparing the highest quantile of UPF consumption to the lowest, total MMI decreased by 0.93%, trunk MMI decreased by 0.76%, and AMMI decreased by 1.25%. The differences in associational patterns between UPF consumption and muscle mass across sociodemographic subgroups require further investigation.

Exploring Sugary Drink Consumption and Perceptions among Primary-School-Aged Children and Parents in Australia

BACKGROUND

Sugar-sweetened beverages (SSBs) account for a significant proportion of sugar in the diet of children and are directly associated with obesity in this group. While there have been many studies on adolescent SSB consumption, few studies have examined the predictors of SSB consumption in primary-school-aged children. The aim of this study was to understand the degree to which a child's consumption across a range of beverages is influenced by their own attitudes and by their parents' attitudes and parents' consumption behaviours.

METHODS

A survey of 1611 Australian parent-child dyads asked children (aged 4-11) and their parents to rate a variety of drinks in terms of healthiness, taste, and cost and indicate the amount of these drinks consumed in a typical week. Zero-inflated regression analyses were conducted to identify the strength of association between children's weekly beverage consumption, their perceptions of each beverage, their parents' perceptions, and their parents' weekly beverage consumption.

RESULTS

Parental consumption of a specific beverage was the strongest predictor of child consumption of that beverage, more so than the children's perceptions of the beverage.

CONCLUSIONS

These findings provide insights for developing parent and child education programmes to reduce SSB consumption.

Associations of sugar-sweetened beverage consumption and screen time with physical fitness index: a multicentre cross-sectional study among Chinese adolescents

BACKGROUND

Past research has focused on the analysis of the association between sugar-sweetened beverages consumption and screen time, respectively, and an indicator of physical fitness in adolescents. However, no studies have analyzed the interaction between sugar-sweetened beverage consumption and screen time on physical fitness index.

METHODS

Demographic information, lifestyle, sugar-sweetened beverage consumption and screen time were investigated and physical fitness indicators were tested in 8136 adolescents aged 13-18 years from six geographic regions of China using stage-stratified whole population sampling. The chi-square test and one-way ANOVA were used to compare the covariates. The Kruskal-Wallis test was used to compare physical fitness index between different sugar-sweetened beverage consumption and screen time groups. Generalized linear model ordered logistic regression analysis was used to analyze the interaction between sugar-sweetened beverage consumption and ST on physical fitness index.

RESULTS

The differences in physical fitness index among different sugar-sweetened beverage consumers in child adolescents were all statistically significant in boys, girls, and in total (H-value of 72.415, 16.859, and 78.544, P < 0.001). The differences were also statistically significant when comparing the physical fitness index of Chinese adolescents of different screen time in boys, girls, and total (H-Value of 46.307, 21.552, and 65.287, P < 0.001). Overall, using sugar-sweetened beverage consumption ≤ 1time/week and screen time < 60 min/d as the reference group, after adjusting for relevant covariates, adolescents in the group with an sugar-sweetened beverage consumption of ≥ 5 time/week and screen time > 120 min/d (OR = 2.27, 95% CI:1.78, 2.89) had the the highest risk of reduced physical fitness index (P < 0.001 ).

CONCLUSION

Associations of sugar-sweetened beverage consumption and screen time with physical fitness indices among Chinese adolescents. Both increased sugar-sweetened beverage consumption and prolonged ST further increased the risk of lower physical fitness index in adolescents.

Associations of sugar-related food parenting practices and parental feeding styles with prospective dietary behavior of children and adolescents: a systematic review of the literature from 2017 to 2023

Introduction

High consumption of sugar-rich foods and beverages has been associated with increased overweight and obesity in children and adolescents. Dietary behavior is influenced by learned mechanisms that originate in childhood and is associated with food parenting practices (FPP) and parental feeding styles (PFS). This systematic review aimed to narratively synthesize FPP and PFS concerning sugar-rich foods and beverages and their associations with the prospective dietary behavior of children and adolescents to derive evidence-based recommendations for health professionals and parents to promote healthy behaviors.

Methods

A systematic literature search was conducted using PubMed and Web of Science databases covering the publication years 2017-2023. The results were narratively synthesized, and exposure-outcome matrices were used for visual representation. The review included 15 peer-reviewed studies from different geographical regions that investigated FPP or PFS regarding the handling of sugar-rich foods and beverages in children's diets and reported the associations with the prospective dietary behavior of children and adolescents.

Results

The findings indicate that highly controlling parental practices were associated with the development of unhealthy eating behaviors and preferences for sugar-rich foods and beverages over time. Conversely, parental practices that emphasized structure and balance in dietary choices yielded more positive long-term outcomes, associated with reduced preferences for sugar-rich foods and drinks.

Discussion

The results underscore the significance of fostering a healthy home environment and active parental role modeling in promoting healthier dietary behaviors among children and adolescents.

Association between intake of flavanones and the overweight/obesity and central obesity in children and adolescents: a cross-sectional study from the NHANES database

Aim

The prevalence of obesity (Ob), overweight (Ow) and central obesity (CO) in children and adolescents has increased dramatically over the past decades globally. Flavanones have been recently studied as adjuvants for the treatment of obesity. This study was aimed at evaluating the association between intake of flavanones and its subclasses and the Ow/Ob and CO in children and adolescents.

Methods

This cross-sectional study extracted the data of children and adolescents with Ow/Ob and CO from the National Health and Nutrition Examination Survey (NHANES) database for 2007-2010 and 2017-2018. Ow and Ob were defined as a body mass index (BMI) ≥ 85th percentile. CO was defined as a waist circumference (WC) ≥ 90th percentile. The association between intake of flavanones and its subclasses and the Ow/Ob and CO in children and adolescents was determined by weighted univariate and multivariate Logistic regression models adjusted for potential covariates, and odds ratios (ORs) with 95% confidence intervals (CIs) was calculated. To further explore association between intake of flavanones and its subclasses and the Ow/Ob and CO in children and adolescents, subgroup analyses stratified by age, and gender.

Results

Of the total 5,970 children and adolescents, 2,463 (41.2%) developed Ow/Ob and 1,294 (21.7%) patients developed CO. High intake of flavanones, eriodictyol, hesperetin, and naringenin were associated with lower odds of Ow/Ob in children and adolescents. (OR: 0.75, 95%CI: 0.62-0.92, OR: 0.69, 95%CI: 0.55-0.87, OR: 0.69, 95%CI: 0.55-0.87, and OR: 0.76, 95%CI: 0.63-0.92, respectively). In addition, high intake of flavanones, eriodictyol, and naringenin were associated with lower odds of CO in children and adolescents (OR: 0.71, 95%CI: 0.57-0.88, OR: 0.67, 95%CI: 0.51-0.86, and OR: 0.69, 95%CI: 0.55-0.86, respectively). Subgroup analyses showed that among all the different subgroups, high intake of flavanones was associated with lower odds of Ow/Ob and CO in children and adolescents.

Conclusion

A diet loaded with high flavanones were associated with lower odds of Ow/Ob and CO in children and adolescents, and children and adolescents should be encouraged to increase their intake of flavanones.

Infants' Dietary Pattern Characterized by Ultraprocessed Foods Is Associated With Rapid Weight Gain and Overweight/Obesity Risk: National Health and Nutrition Examination Survey 2009-2018

BACKGROUND

Global trends toward childhood obesity have been associated with several factors, including suboptimal infant feeding practices, the increasing availability of ultraprocessed foods in the world's food supply, and the corresponding changes in children's dietary patterns.

OBJECTIVE

To describe infants' dietary patterns and assess their associations with weight status outcomes in a nationally representative sample of US infants.

DESIGN

Cross-sectional analyses were performed on data collected from infants participating in the 2009-2018 National Health and Nutrition Examination Survey.

PARTICIPANTS/SETTING

Participants included 744 infants aged 6 to 12 months who had data from at least 1 day of valid 24-hour dietary recall data.

MAIN OUTCOME MEASURES

Rapid weight gain and overweight/obesity risk.

STATISTICAL ANALYSES PERFORMED

Principal component analysis was used to identify dietary patterns considering the energy intake of 39 Nova food subgroups (expressed in calories per day), including breast milk. Associations were evaluated using logistic regression adjusted for potential confounders.

RESULTS

A total of 42% infants experienced rapid weight gain, and 33% were at risk of overweight/obesity. Most infants (65.5%) were started on solid foods early. Three main dietary patterns were derived. The first pattern, labeled Natural or Minimally Processed Foods, had positive loadings for a variety of natural or minimally processed foods, some processed culinary ingredients, and a few processed and ultraprocessed foods. The second pattern, labeled Infant Formula, had high negative loading for breast milk, and high positive loading for infant formula and breakfast cereal. The third pattern, labeled Ultraprocessed Foods, had negative loadings for natural or minimally processed foods and processed culinary ingredients, positive loadings for other processed foods and for a variety of ultraprocessed foods, and negative loading for infant formula. Infants who adhere to the Ultraprocessed Foods dietary pattern were more likely to present rapid weight gain (adjusted odds ratio 1.3, 95% CI 1.1 to 1.5) and overweight/obesity risk (adjusted odds ratio 1.2, 95% CI 1.0 to 1.4).

CONCLUSIONS

Higher adherence to a dietary pattern characterized by ultraprocessed foods was associated with a greater likelihood of both rapid weight gain and overweight/obesity risk early in life. Promoting breastfeeding and increasing consumption of unprocessed/minimally processed foods during early infancy while restricting ultraprocessed foods are key components to reducing the growing burden of childhood obesity.

Unfavorable food consumption in children up to school entry age: results from the nationwide German KiESEL study

Introduction

Evidence points toward the early life being crucial for preventing nutrition-related diseases. As promotion of healthier food preferences in toddlerhood and preschool age might still modulate the trajectories of disease risk, understanding diet in these age groups is necessary. The objective was to analyze food consumption and diet quality of 1-5-year-old children living in Germany in relation to age and sex.

Methods

Data from 890 children, a subsample of the representative, cross-sectional Children's Nutrition Survey to Record Food Consumption (KiESEL) conducted by the German Federal Institute for Risk Assessment in 2014-2017, were analyzed. Dietary data were collected using food records (3 consecutive plus 1 independent day). Diet quality was evaluated against the German food-based dietary guidelines (FBDG).

Results

Consumption of unfavorable foods (e.g., sweets, soft drinks) exceeded the recommended maximum of 10% of energy intake (E%) by a multiple in all age and sex groups (medians: 24.8-35.8 E%). Preschoolers consumed more unfavorable foods than toddlers and boys more than girls. More than half of the children exceeded the recommendation for meat intake (medians: 2.3-3.2% of the total food consumption (%TFC) vs. 2 %TFC), especially preschoolers. In nearly all children, vegetable consumption was too low (medians: 4.2-4.5 %TFC vs. 12 %TFC). Also, milk/milk product consumption was below recommendations, more so in preschoolers (median: 12.0 %TFC ♂, 11.9 %TFC ♀ vs. 18 %TFC) than in toddlers (median: 16.1 %TFC ♂, 19.6 %TFC ♀). In toddlers and preschoolers with overweight or obesity, adherence to dietary recommendations of these food groups was largely similar to that of the total sample. Overall, 5-year-olds showed an unhealthier dietary pattern than 1-year-olds, which already emerged at age 2 years and became more evident at age 3 years.

Discussion

An adverse dietary pattern arises and even deteriorates at a very young age, showing sex-specific aspects. High attention from public health and research needs to be given to toddlerhood and even earlier life phases, e.g., to develop more age-specific FBDGs, aiming at reducing unhealthy food consumption.

Smaller subcortical volume relates to greater weight gain in girls with initially healthy weight

OBJECTIVE

Among 3614 youth who were 9 to 12 years old and initially did not have overweight or obesity (12% [n = 385] developed overweight or obesity), we examined the natural progression of weight gain and brain structure development during a 2-year period with a high risk for obesity (e.g., pre- and early adolescence) to determine the following: 1) whether variation in maturational trajectories of the brain regions contributes to weight gain; and/or 2) whether weight gain contributes to altered brain development.

METHODS

Data were gathered from the Adolescent Brain Cognitive Development (ABCD) Study. Linear mixed-effects regression models controlled for puberty, caregiver education, handedness, and intracranial volume (random effects: magnetic resonance scanner [MRI] scanner and participant). Because pubertal development occurs earlier in girls, analyses were stratified by sex.

RESULTS

For girls, but not boys, independent of puberty, greater increases in BMI were driven by smaller volumes over time in the bilateral accumbens, amygdala, hippocampus, and thalamus, right caudate and ventral diencephalon, and left pallidum (all p < 0.05).

CONCLUSIONS

The results suggest a potential phenotype for identifying obesity risk because underlying differences among regions involved in food intake were related to greater weight gain in girls, but not in boys. Importantly, 2 years of weight gain may not be sufficient to alter brain development, highlighting early puberty as a critical time to prevent negative neurological outcomes.

Pediatric obesity in the United States: Age-period-cohort analysis

The rates of obesity among American children aged 2-5 years has reached a historic high. It is crucial to identify the putative sources of population-level increases in obesity prevalence among preschool-aged children because early childhood is a critical window for obesity prevention and thus reduction of future incidence. We used the National Health and Nutrition Examination Survey data and hierarchical age-period-cohort analysis to examine lifecycle (i.e., age), historical (i.e., period), and generational (i.e., cohort) distribution of age- and sex-specific body mass index z-scores (zBMI) among 2-5-year-olds in the U.S. from 1999 to 2018. Our current findings indicate that period effects, rather than differences in groups born at a specific time (i.e., cohort effects), account for almost all of the observed changes in zBMI. We need a broad socioeconomic, cultural, and environmental strategy to counteract the current obesogenic environment that influences children of all ages and generations in order to reach large segments of preschoolers and achieve population-wide improvement.

A Pilot Study on Dietary Choices at Universities: Vending Machines, Canteens, and Lunch from Home

Commercial environments and food acquisition methods significantly shape dietary practices and impact health. This study assesses dietary choices among Portuguese university students regarding vending machines, canteens, and lunches from home. It also evaluates their use of the university canteen and their tendency to bring lunch from home. This pilot cross-sectional study used a self-administered electronic questionnaire, made available in early 2023. Participants were recruited through snowball sampling. The study included 137 students from Portuguese higher education institutions, mainly women (74.5%), pursuing degrees or integrated Master's degrees (83.2%), primarily in health-related fields (55.5%). The median age was 21 years (20 to 23.5 years). About 70.0% regularly consumed food from vending machines, while approximately 60.0% brought lunch from home, avoiding the canteen. Factors such as convenience (48.5%), price (47.5%), product availability (40.6%), and taste (39.6%) mainly influenced vending machine choices. Monthly, chocolates, water, coffee, cookies, treats, and soft drinks were the most commonly acquired items, with coffee being the most frequent daily purchase. These findings provide insights for creating policies and initiatives to promote healthier and more accessible food options for students and strategies to encourage positive eating behaviors.

A lifestyle screening tool for young children in the community: needs and wishes of parents and youth healthcare professionals

BACKGROUND

Youth healthcare has an important role in promoting a healthy lifestyle in young children in order to prevent lifestyle-related health problems. To aid youth healthcare in this task, a new lifestyle screening tool will be developed. The aim of this study was to explore how youth healthcare professionals (YHCP) could best support parents in improving their children's lifestyle using a new lifestyle screening tool for young children.

METHODS

We conducted four and seven focus groups among parents (N = 25) and YHCP (N = 25), respectively. Two main topics were addressed: the experiences with current practice of youth healthcare regarding lifestyle in young children, and the requirements for the lifestyle screening tool to be developed. The focus groups were recorded, transcribed verbatim and analysed using an inductive approach.

RESULTS

Both parents and YHCP indicated that young children's lifestyles are often discussed during youth healthcare appointments. While parents felt that this discussion could be more in-depth, YHCP mainly needed clues to continue the discussion. According to parents and YHCP, a new lifestyle screening tool for young children should be easy to use, take little time and provide courses of action. Moreover, it should be attractive to complete and align with the family concerned.

CONCLUSIONS

According to parents and YHCP, a new lifestyle screening tool for young children could be useful to discuss specific lifestyle topics in more detail and to provide targeted advice.

Bean Consumption during Childhood Is Associated with Improved Nutritional Outcomes in the First Two Years of Life

Bean consumption during childhood may play a role in promoting early-life health given their high nutritional quality. To examine the associations of children's bean consumption with the socio-demographic characteristics of the child and mother and the child's nutrient intake, we analyzed data from the WIC-ITFPS-2, which followed children and their mothers at 1, 3, 5, 7, 9, 11, 13, 15, 18, and 24 months (m) following birth. Caregivers (mostly mothers) responded to an interview-administered 24 h recall on their child's dietary intake at each time point. The intake of dried beans, chili, yellow beans, and lima beans was quantified. Correlate measures included socio-demographic characteristics. Outcome measures of interest focused on the intake of macronutrients (grams and % kcals) and micronutrients at 11 (infancy) and 24 m (toddler) only. To ensure statistical power, we only examined the associations of dried beans and chili with socio-demographics (Chi-square tests) and nutritional outcomes (ANOVA) at 11 and 24 m. The proportion of children who consumed dried beans or chili was very low in the first 6 m of age, started to increase at 7 m (1.2% and 0.4%) and 11 m (4.9% and 2.3%), and reached a high level at 18 m (10.5%) and 24 m (5.9%), respectively. Consumption of yellow or lima beans was rare (<0.1%). At 11 and 24 m, dried bean consumption was higher in children who were White (vs. Black). Dried bean and chili consumption was higher in children who were of Hispanic or Latino ethnicity (vs. non-Hispanic or non-Latino ethnicity). Children who consumed dried beans and chili at 11 or 24 m had a higher intake of total energy, protein, total fiber, potassium, folate, and magnesium compared with non-consumers. The bean consumption was low amongst children, differed by race and ethnicity, and was associated with improved macro- and micronutrient intake in children at 11 and 24 m.

Sustaining Healthy Habits: The Enduring Impact of Combined School-Family Interventions on Consuming Sugar-Sweetened Beverages among Pilot Chinese Schoolchildren

This study assesses the enduring impact of combined school- and family-based interventions on reducing the consumption of sugar-sweetened beverages (SSBs) among schoolchildren in China. Two primary schools were assigned at random to either the Intervention Group or the Control Group, in Nanjing, eastern China. All students were in grade three and received an invitation to participate. In the first year, students in the Intervention Group received one-year intervention measures, including monthly monitoring, aiming to decrease the consumption of SSBs. Students in the Control Group only received regular monitoring without interventions. In the second year, both groups received only regular monitoring, without active interventions. A generalized estimating equations model (GEE) was used to assess the intervention effects. After two years, relative to the Control Group, the Intervention Group had a significantly improved knowledge of SSBs and an improved family environment with parents. In the Intervention Group, 477 students (97.3%) had adequate knowledge about SSBs, compared to 302 students (83.2%) in the Control Group (X2 = 52.708, p < 0.001). Two years later, the number of students who stated 'my home always has SSBs' in the Intervention Group (7.8%) was fewer than that in the Control Group (12.4%), which was a statistically significant finding (p < 0.05). One year later, both the frequency and the quantity of SSB consumption in the Intervention Group were less than those in the Control Group; such differences between the groups remained statistically significant for the quantity but not for the frequency of SSB consumption two years later. In the Intervention Group, the frequency of SSB consumption was significantly reduced by 1.0 times per week, compared to a reduction of 0.1 times per week in the Control Group in the first year (p < 0.05). In the second year, the frequency of SSB consumption was reduced by 0.8 times per week in the Intervention Group, compared to 0.5 times per week in the Control Group (p > 0.05). In the first year, the volume of SSB consumption was significantly reduced by 233 mL per week in the Intervention Group, compared to an increase of 107 mL per week in the Control Group (p < 0.05). In the second year, the volume of SSB consumption was reduced by 122 mL per week in the Intervention Group compared to an increase of 31 mL per week in the Control Group (p > 0.05). The combined school-based and family-based interventions had a positive effect on the students' knowledge of SSBs and their family dynamics during the first and second year. Relative to the Control Group, the Intervention Group had a statistically significant reduction in SSB consumption after 1 year, but not after 2 years.

Factors Associated with Sugar-Sweetened Beverage Intake Among Young Children - United States, 2021

Introduction

Because limited data exist about factors related to sugar-sweetened beverage (SSB) intake among younger children, we investigated factors associated with SSB intake among US children aged 1 to 5 years.

Methods

We examined SSB intake (0, 1-3, or ≥4 times/week) by using data from the 2021 National Survey of Children's Health. We performed a multinomial logistic regression to calculate adjusted odds ratios (aORs) for select sociodemographic and household factors associated with moderate (1-3 times/week) and high (≥4 times/week) SSB intake.

Results

Overall, 36% of children consumed SSBs 1 to 3 times/week and 21% consumed 4 or more times/week. Both moderate and high SSB intake were associated with child's age, child's race and ethnicity, highest caregiver education level, household income, primary household language, and frequency of family meals. For example, children who lived in households with caregiver education level of high school graduate or less were significantly more likely to have moderate (aOR, 2.06) and high (aOR, 2.81) SSB intake than those who lived in households with caregiver education level of college degree or higher. High SSB intake was also associated with marginal household food sufficiency, nonmetropolitan statistical area status, and receipt of government food benefits.

Conclusion

Several sociodemographic and household factors were significantly associated with SSB intake among children aged 1 to 5 years. Public health initiatives designed to address SSB intake among young children in various settings including pediatric health care, early care and education, and the child's home could consider key associated factors.

Impact of obesity on the structures and functions of the stomatognathic system: A morphofunctional approach

OBJECTIVE

The prevalence of obesity is increasing significantly worldwide, raising great concern among health professionals. This observational study evaluated the electromyographic activity and thickness of the masseter and temporalis muscles, in addition to the maximum molar bite force, in obese and eutrophic subjects.

METHODS

Sixty subjects were divided into three groups: I (7-12 years), II (13-20 years), III (21-40 years) and sex: with 10 men and 10 women for each group. Electromyographic recordings of the masticatory muscles were obtained during mandibular tasks. The masticatory muscles thicknesses were obtained at rest and during dental clenching. The maximum molar bite forces were measured on the right and left sides. The difference in outcome measures between the groups and sex was analyzed using Mann-Whitney U test (p < 0.05) and analysis of covariance (ANCOVA).

RESULTS

Electromyographic activity in the masseter and temporal muscles consistently displayed lower levels in obese subjects of both sexes across all three age groups during mandibular tasks. Additionally, greater thickness of the masticatory muscles was observed in obese subjects of both sexes across all three age groups. Obese women in Group II displayed higher values of molar bite force, both on the right and left sides, compared to eutrophic women. On the other hand, women in Group III exhibited higher values of molar bite force on the right side in comparison to eutrophic women.

CONCLUSIONS

This study underscores the potential impact of obesity on the morphofunctional aspects of the stomatognathic system in subjects aged 7 to 40 years.

Comparison of Performance in the Six-Minute Walk Test (6MWT) between Overweight/Obese and Normal-Weight Children and Association with Haemodynamic Parameters: A Cross-Sectional Study in Four Primary Schools

Physical activity plays a pivotal role in preventing obesity and cardiovascular risks. The six-minute walk test (6MWT) is a tool to assess functional capacity and predict cardiovascular events. The aim of this cross-sectional study was to compare the performance and haemodynamic parameters before and after a 6MWT between obese/overweight vs. normal-weight children (average age 8.7 ± 0.7 years) participating in a project involving four primary schools in South Verona (Italy). Validated questionnaires for physical activity and diet, as well as blood drops, were collected. Overweight or obese children (OW&OB; n = 100) covered a shorter 6MWT distance compared to normal-weight children (NW, n = 194). At the test's conclusion, the OW&OB group exhibited a higher Rate Pulse Product (RPP = Systolic Blood Pressure × Heart Rate) as compared to the NW. Body Mass Index, waist-to-height ratio, fat mass by electrical impedance, and trans fatty acids showed direct correlations with pre and post-test haemodynamic parameters, such as RPP, and inverse correlations with oxygen saturation. OW&OB children demonstrated lower performance in this low-intensity exercise test, along with an elevated haemodynamic response. Excess fat in childhood can be considered a risk factor for haemodynamic stress, with potential deleterious consequences later in life. Efforts should be initiated early to break this cycle.

Governmental institutionalization of corporate influence on national nutrition policy and health: a case study of Ecuador

Corporate influence in policy and decision-making is an important public health concern. This Health Policy paper reviews Ecuador's child malnutrition strategy instruments, approved between 2020 and 2023, to identify how private interests are becoming legally integrated into the public sector. Evidence indicates that recent changes are enabling corporations to promote their brands, gain tax deductions, oversee public policy and set priorities, allocate resources, and decide on implementation of the country's child malnutrition strategy. Further, corporate representatives are active members of an advisory council, free from scrutiny or accountability, while being privy to undisclosed government information. Moreover, a UN agency (the World Food Program) engaged in corporate promotion of highly processed foods, illustrating the breadth of Ecuador's corporate influence scheme. Improved regulations should set clear limits to the influence of food and beverage industries in national nutrition policy, while following transparency laws in the composition and operation of Ecuador's child malnutrition strategy and related efforts.

Designing intervention prototypes to improve infant and young child nutrition in Peru: a participatory design study protocol

INTRODUCTION

Nutrition during the complementary feeding period (6-23 months) is critical to ensure optimal growth and reduce the risk of diet-related disease across the life course. Strategies to reduce multiple forms of malnutrition (stunting, overweight/obesity and anaemia) in infants and young children (IYC) are a key priority in low-income and middle-income countries, including Peru. This study aims to co-design and develop prototypes for interventions to address the multiple forms of malnutrition in IYC in urban Peru, using a participatory design approach.

METHODS AND ANALYSIS

The study will be based within peri-urban communities in two areas of Peru (Lima and Huánuco city). Following the identification of key nutritional challenges for IYC aged 6-23 months through formative research (phase I), we will conduct a series of workshops bringing together healthcare professionals from government health centres and caregivers of IYC aged 6-23 months. Workshops (on idea generation; creating future scenarios; storyboarding and early implementation and feedback) will take place in parallel in the two study areas. Through these workshops, we will engage with community participants to explore, experiment, co-design and iteratively validate new design ideas to address the challenges around IYC complementary feeding from phase I. Workshop outputs and transcripts will be analysed qualitatively using affinity diagramming and thematic analyses. The intervention prototypes will be evaluated qualitatively and piloted with the participating communities.

ETHICS AND DISSEMINATION

Ethical approval for this study was obtained from the Ethical Review Committee of the Instituto de Investigación Nutricional (IIN) Peru (388-2019/CIEI-IIN), Loughborough University (C19-87) and confirmed by Cardiff University. Findings of the participatory design process will be disseminated through a deliberative workshop in Lima, Peru with national and regional government stakeholders, as well as participants and researchers involved in the design process. Further dissemination will take place through policy briefs, conferences and academic publications.

Development and evaluation study of FLY-Kids: a new lifestyle screening tool for young children

Evaluating, discussing, and advising on young children's lifestyles may contribute to timely modification of unhealthy behaviour and prevention of adverse health consequences. We aimed to develop and evaluate a new lifestyle screening tool for children aged 1-3 years. The lifestyle screening tool "FLY-Kids" was developed using data from lifestyle behaviour patterns of Dutch toddlers, age-specific lifestyle recommendations, target group analyses, and a Delphi process. Through 10 items, FLY-Kids generates a dashboard with an overview of the child's lifestyle that can be used as conversation aid. FLY-Kids was completed by parents of children aged 1-3 years attending a regular youth healthcare appointment. Youth healthcare professionals (YHCP) then used the FLY-Kids dashboard to discuss lifestyle with the parents and provided tailored advice. Parents as well as YHCP evaluated the tool after use. Descriptive and correlation statistics were used to determine the usability, feasibility, and preliminary effect of FLY-Kids. Parents (N = 201) scored an average of 3.2 (out of 9, SD 1.6) unfavourable lifestyle behaviours in their children, while 3.0% complied with all recommendations. Most unfavourable behaviours were reported in unhealthy food intake and electronic screen time behaviour. Parents and YHCP regarded FLY-Kids as usable and feasible. The number of items identified by FLY-Kids as requiring attention was associated with the number of items discussed during the appointment (r = 0.47, p < 0.001).     Conclusion: FLY-Kids can be used to identify unhealthy lifestyle behaviour in young children and guide the conversation about lifestyle in preventive healthcare settings. End-users rated FLY-Kids as helpful and user-friendly. What is Known: • A healthy lifestyle is important for optimal growth, development and overall health of young children (1-3 years). • Evaluating, discussing and advising on young children's lifestyles may contribute to timely modification of unhealthy behaviour and prevention of adverse health consequences. What is New: • The new lifestyle screening tool FLY-Kids generates a dashboard with an overview of young children's lifestyle that can be used as conversation aid between parents and youth healthcare professionals. • As parents and youth healthcare professionals rated FLY-Kids as helpful and user-friendly, and the number of items identified by FLY-Kids as requiring attention was associated with the number of items discussed during the appointment, FLY-Kids can be considered guiding the lifestyle discussion in preventive healthcare settings.

Time trends and social inequalities in infant and young child feeding practices: national estimates from Brazil's Food and Nutrition Surveillance System, 2008-2019

OBJECTIVE

To describe the time trends and socio-economic inequalities in infant and young child feeding practices in accordance with the Brazilian deprivation index (BDI).

DESIGN

This time-series study analysed the prevalence of multiple breast-feeding and complementary feeding indicators based on data from the Brazilian Food and Nutrition Surveillance System, 2008-2019. Prais-Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95 % CI were calculated.

SETTING

Primary health care services, Brazil.

PARTICIPANTS

Totally, 911 735 Brazilian children under 2 years old.

RESULTS

Breast-feeding and complementary feeding practices differed between the extreme BDI quintiles. Overall, the results were more favourable in the municipalities with less deprivation (Q1). Improvements in some complementary feeding indicators were observed over time and evidenced such disparities: minimum dietary diversity (Q1: Δ 47·8-52·2 %, APC + 1·44, P = 0·006), minimum acceptable diet (Q1: Δ 34·5-40·5 %, APC + 5·17, P = 0·004) and consumption of meat and/or eggs (Q1: Δ 59·7-80·3 %, APC + 6·26, P < 0·001; and Q5: Δ 65·7-70·7 %, APC + 2·20, P = 0·041). Stable trends in exclusive breast-feeding and decreasing trends in the consumption of sweetened drinks and ultra-processed foods were also observed regardless the level of the deprivation.

CONCLUSIONS

Improvements in some complementary food indicators were observed over time. However, the improvements were not equally distributed among the BDI quintiles, with children from the municipalities with less deprivation benefiting the most.

Associations between Knowledge of Health Risks and Sugar-Sweetened Beverage Intake among US Adolescents

BACKGROUND

Sugar-sweetened beverage (SSB) intake is associated with adverse health outcomes.

OBJECTIVE

We examined associations between the knowledge of health risks related to SSB and SSB intake among adolescents.

DESIGN

A cross-sectional study using 2021 YouthStyles survey data.

PARTICIPANTS/SETTINGS

831 US adolescents (12-17 years old).

MAIN OUTCOME MEASURES

The outcome variable was SSB intake (none, 1-6 times/week, and ≥1 time/day). Exposure variables were knowledge of seven SSB-related health risks.

STATISTICAL ANALYSES PERFORMED

Seven multinomial regressions were used to estimate adjusted odds ratios (AOR) for drinking SSB, according to knowledge of SSB-related health risks and after controlling for sociodemographics.

RESULTS

Overall, 29% of adolescents consumed SSB ≥1 time/day. Although most adolescents identified cavities (75.4%), weight gain (74.6%), and diabetes (69.7%) as being related to drinking SSB, fewer adolescents identified related conditions such as high blood pressure (31.7%), high cholesterol (25.8%), heart disease (24.6%), and some cancers (18.0%). Compared to non-SSB consumers, drinking SSB ≥1 time/day was significantly higher among adolescents who lacked knowledge of associations between SSB intake and weight gain (AOR = 2.0), heart disease (AOR = 1.9), or some cancers (AOR = 2.3) after controlling for covariates.

CONCLUSIONS

Among US adolescents, knowledge of SSB-related health risks varied by condition, ranging from 18% (some cancers) to 75% (cavities and weight gain). There were increased odds of drinking SSB among those unaware that weight gain, heart disease, and some cancers are associated with SSB intake. Intervention could evaluate whether increasing certain types of knowledge may influence youth SSB intake.

Ultra-Processed Food, Reward System and Childhood Obesity

Obesity and overweight are a major public health problem globally. Diet quality is critical for proper child development, and an unhealthy diet is a preventable risk factor for noncommunicable diseases (NCDs), such as obesity. Consumption of sugar-sweetened beverages and ultra-processed foods (UPFs) in childhood may increase the BMI/BMI z-score, body fat percentage, or likelihood of overweight. A strict feeding regulation system allows for sufficient food to be consumed to meet ongoing metabolic demands while avoiding overconsumption. This narrative review explores the issues of obesity and the regulation of food intake related to reward systems and UPF consumption. Nutrient composition alone cannot explain the influence of UPFs on the risk of obesity. Furthermore, the non-nutritional properties of UPFs may explain the mechanisms underlying the relationship with obesity and NCDs. UPFs are designed to be highly palatable, appealing, and energy dense with a unique combination of the main taste enhancer ingredients to generate a strong rewarding stimulus and influence the circuits related to feeding facilitation. How individual UPF ingredients influence eating behavior and reward processes remains not fully elucidated. To increase the knowledge on the relationship between UPFs and pediatric obesity, it may be useful to limit the rapid growth in the prevalence of obesity and subsequent related complications, and to develop new strategies for appropriate food and nutrition policies.

Fluid Intake and the Occurrence of Erosive Tooth Wear in a Group of Healthy and Disabled Children from the Małopolska Region (Poland)

Background: The aim of this study was to analyse the relationship between the type and amount of fluid intake and the incidence of erosive tooth wear in a group of healthy children and children with disabilities. Methods: This study was conducted among children aged 6-17 years, patients of the Dental Clinic in Kraków. The research included 86 children: 44 healthy children and 42 children with disabilities. The prevalence of erosive tooth wear using the Basic Erosive Wear Examination (BEWE) index was assessed by the dentist, who also determined the prevalence of dry mouth using a mirror test. A qualitative-quantitative questionnaire on the frequency of consumption of specific liquids and foods related to the occurrence of erosive tooth wear, completed by the children's parents, was used to assess dietary habits. Results: The occurrence of erosive tooth wear was determined for 26% of the total number of children studied, and these were mostly lesions of minor severity. The mean value of the sum of the BEWE index was significantly higher (p = 0.0003) in the group of children with disabilities. In contrast, the risk of erosive tooth wear was non-significantly higher in children with disabilities (31.0%) than in healthy children (20.5%). Dry mouth was significantly more frequently identified among children with disabilities (57.1%). Erosive tooth wear was also significantly more common (p = 0.02) in children whose parents declared the presence of eating disorders. Children with disabilities consumed flavoured water or water with added syrup/juice and fruit teas with significantly higher frequency, while there were no differences in quantitative fluid intake between groups. The frequency and quantity of drinking flavoured waters or water with added syrup/juice, sweetened carbonated, and non-carbonated drinks were associated with the occurrence of erosive tooth wear for all children studied. Conclusions: The group of studied children presents inappropriate drinking behaviours regarding the frequency and amount of beverages consumed, which, especially in a group of children with disabilities, may contribute to the formation of erosive cavities.

Impact of complementary feeding on obesity risk

PURPOSE OF REVIEW

To discuss recent evidence on the influence of complementary feeding (CF) timing, content and feeding methods on childhood obesity risk.

RECENT FINDINGS

The evidence-base is limited by heterogeneity, risk of bias and the predominance of observational studies. The content of the diet and feeding practices are more influential than timing for obesity risk. There is limited evidence that CF introduction before 4 months may be associated with increased risk. Intake of animal protein, particularly dairy protein, may contribute to rapid weight gain; protein from infant/follow-on formula shows the most robust association with later obesity risk. Evidence linking sugar intake to obesity risk is limited, but intake should be as low as possible given there is no nutritional requirement. Responsive feeding (RF) practices may promote appropriate infant growth and reduce risk. The effect of baby-led weaning (BLW) is inconclusive.

SUMMARY

Recent evidence supports current recommendations to avoid high protein intakes, especially from infant/follow-on formula, for infants in high income countries; and to promote RF practices for all infants. Studies in low- and middle-income countries are required to define optimal CF practices given increasing rates of child obesity alongside double-burden malnutrition.

Unhealthy Food and Beverage Consumption during Childhood and Risk of Cardiometabolic Disease: A Systematic Review of Prospective Cohort Studies

BACKGROUND

Global consumption of unhealthy foods, including ultra-processed foods (UPFs) and sugar-sweetened beverages (SSBs), has increased substantially among pediatric populations. Suboptimal diet during early life can track into adulthood, alongside risk factors for cardiometabolic disease.

OBJECTIVE

To inform the development of updated WHO guiding principles for complementary feeding of infants and young children, this systematic review sought to examine the association between unhealthy food consumption during childhood and cardiometabolic risk biomarkers.

METHODS

PubMed (Medline), EMBASE, and Cochrane CENTRAL were systematically searched, with no language restriction, up to 10 March 2022. Inclusion criteria were randomized controlled trials (RCTs), non-RCTs, and longitudinal cohort studies; children aged ≤10.9 y at exposure; studies reporting greater consumption of unhealthy foods and beverages (defined using nutrient- and food-based approaches) than no or low consumption; studies assessing critical nonanthropometric cardiometabolic disease risk outcomes (blood lipid profile, glycemic control, or blood pressure).

RESULTS

Of 30,021 identified citations, 11 articles from 8 longitudinal cohort studies were included. Six studies focused on exposure to unhealthy foods or UPF, and 4 focused on SSB only. Methodological heterogeneity was too high across studies to meta-analyze effect estimates. A narrative synthesis of quantitative data revealed that exposure to unhealthy foods and beverages, specifically NOVA-defined UPF, in children of preschool age may be associated with a worse blood lipid and blood pressure profile in later childhood (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]: low and very low certainty, respectively). No associations were evident between SSB consumption and blood lipids, glycemic control, or blood pressure (GRADE: all low certainty).

CONCLUSIONS

No definitive conclusion can be made because of quality of the data. More high-quality studies that purposefully assess the effects of unhealthy food and beverage exposure during childhood on cardiometabolic risk outcomes are needed. This protocol was registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42020218109.