Socioeconomic variation in diet and activity-related behaviours of Australian children and adolescents aged 2-16 years

Effect of a Technology-Integrated Curriculum on Sugary Drink and Snack Intake of Elementary-Aged Youth Experiencing Low Income

OBJECTIVE

To describe the results of a technology-integrated intervention on sugar-sweetened beverage (SSB) and energy-dense snack intake with third graders experiencing low income.

DESIGN

A 2 × 2 quasi-randomized cluster-block, parallel-group experimental research design.

SETTING

Low-income schools in Rhode Island.

PARTICIPANTS

Two-hundred seventeen intervention and 242 control third-grade students in low-income (89.6% and 88.2% free/reduced meals, respectively), ethnically and racially diverse (63% Hispanic/20% Black and 62% Hispanic/18% Black, respectively) schools.

INTERVENTION(S)

A 13-week in-school program held once per week for 1 hour. The hands-on, technology-integrated program used a modified version of the Body Quest: Food of the Warrior curriculum.

MAIN OUTCOME MEASURE(S)

Intake of SSB and energy-dense snacks, both salty and sweet snacks, using baseline (week 1) and postassessment (week 13) previous day self-recall.

ANALYSIS

Generalized mixed modeling with nesting.

RESULTS

Intervention students significantly reduced their SSB intake by 38% (0.5 times/d; F[1, 540] = 4.26; P = 0.04) and salty snack intake by 58% (0.8 times/d; F[1, 534] = 6.58, P < 0.01) from baseline to postassessment as compared with the control students.

CONCLUSIONS AND IMPLICATIONS

Findings suggest a technology-integrated curriculum is effective in decreasing SSB and salty snacks in elementary-aged students of low-income, minoritized populations. Improved dietary habits can potentially influence other facets of students' lives.

Predictors of Free Sugars Intake Trajectories across Early Childhood-Results from the SMILE Birth Cohort Study

Foods and beverages high in free sugars can displace healthier choices and increase the risk of weight gain, dental caries, and noncommunicable diseases. Little is known about the intake of free sugars across early childhood. This study aimed to examine the longitudinal intake from 1 to 5 years of free sugars and identify the independent maternal and child-related predictors of intake in a cohort of Australian children participating in the Study of Mothers' and Infants' Life Events Affecting Oral Health (SMILE). Free sugars intake (FSI) was previously estimated at 1, 2, and 5 years of age, and three distinct FSI trajectories were determined using group-based trajectory modelling analysis. This study utilized multinomial logistic regression to identify the maternal and child-related predictors of the trajectories. The risk of following the 'high and increasing' trajectory of FSI compared to the 'low and fast increasing' trajectory was inversely associated with socio-economic disadvantage (aRRR 0.83; 95% CI 0.75-0.92; p < 0.001), lower for females (aRRR 0.56; 95% CI 0.32-0.98; p = 0.042), and higher in children with two or more older siblings at birth (aRRR 2.32; 95% CI 0.99-5.42; p = 0.052). Differences in trajectories of FSI were evident from an early age and a high trajectory of FSI was associated primarily with socio-economic disadvantage, providing another example of diet quality following a social gradient.

Family socioeconomic status and childhood adiposity in Europe - A scoping review

Childhood obesity is a considerable public health problem worldwide. In Europe, lower parental socioeconomic status (SES) relates to higher childhood adiposity. This scoping review strives to discover, which SES indicators are the most commonly used and meaningful determinants of childhood adiposity (greater level of continuous adiposity indicator, e.g. body mass index z-score, or overweight or obesity categorized by established definitions). The review focused on studies about European general populations from the 21st century (January 2000-April 2021) considering children and adolescents aged 0-17 years. PubMed and reference lists of articles were searched in February-April 2021. Total of 53 studies with 121 association analyses between different SES indicators and adiposity indicators, were identified and reviewed. Different SES indicators were grouped to 25 indicators and further to six indicator groups. The most used indicator was mother's education (n of association analyses = 24) and the most used indicator group was parental education (n of association analyses = 51). Of all association analyses, 55% were inverse, 36% were non-significant, and 8% were positive. Composite SES (80%), parental education (69%) and parental occupation (64%) indicators showed most frequently inverse associations with obesity measures (i.e. lower parental SES associating with higher adiposity), while parental income (50% inverse; 50% non-significant) and property and affluence (42% inverse; 50% nonsignificant) indicators showed approximately even number of inverse and non-significant associations. Instead, majority of parental employment (60%) indicators, showed non-significant associations and 33% showed positive associations (i.e. higher parental SES associating with higher adiposity). Despite some variation in percentages, majority of the associations were inverse in each age group and with different outcome categorizations. In girls and in boys, non-significant associations predominated. It seems that children with parents of higher SES have lower likelihood of adiposity in Europe. Parents' employment appears to differ from other SES indicators, so that having an employed parent(s) does not associate with lower likelihood of adiposity. Positive associations seem to occur more frequently in poorer countries. Criteria for uniform childhood SES and adiposity measures should be established and used in studies in order to be able to produce comparable results across countries.

Parenting style as a predictor of dietary score change in children from 4 to 14 years of age. Findings from the Longitudinal Study of Australian Children

OBJECTIVE

To examine associations between parenting style and changes in dietary quality score across childhood.

DESIGN

This longitudinal analysis included the child's frequency of consumption for twelve food and drink items reported by mothers of children (aged 4-8 years) and children (aged 10-14 years) during face-to-face interviews biennially. These items were combined into dietary scores based on the Australian Dietary Guidelines. Parenting styles were classified at baseline as authoritative, authoritarian, permissive and disengaged. Multilevel modelling was used to examine changes in diet quality score over time by maternal parenting styles.

SETTING

The Longitudinal Study of Australian Children.

PARTICIPANTS

A total of 4282 children aged 4 to 14 years.

RESULTS

Children's diet quality score declined over time between 4 and 14 years of age (β = -0·10, 95 % CI (-0·11, -0·08)). There was strong evidence to suggest that change in diet quality differed dependent on baseline maternal parenting style, although diet quality declined for all groups. Children with authoritative mothers had the greatest decline in diet quality score over time (β = -0·13; 95 % CI (-0·18, -0·08)), while children with disengaged mothers had the lowest decline (β = -0·03; 95 % CI (-0·07, 0·01)). However, it is important to note that children with authoritative mothers had a better dietary quality score than children of permissive or disengaged mothers for most of their childhood.

CONCLUSION

These findings question the previous assumptions that early exposure to an authoritative parenting style has lasting positive effects on the dietary intake of children.

The impact of a community-based intervention on weight, weight-related behaviours and health-related quality of life in primary school children in Victoria, Australia, according to socio-economic position

Background

Approximately a quarter of Australian children are classified as overweight or obese. In high-income countries, childhood obesity follows a socio-economic gradient, with greater prevalence amongst the most socio-economically disadvantaged children. Community-based interventions (CBI), particularly those using a systems approach, have been shown to be effective on weight and weight-related behaviours. They are also thought to have an equitable impacts, however there is limited evidence of their effectiveness in achieving this goal.

Methods

Secondary analysis was conducted on data collected from primary school children (aged 6–13 years) residing in ten communities (five intervention, five control) involved in the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS) cluster randomised trial in Victoria, Australia. Outcomes included Body Mass Index z-score (BMI-z) derived from measured height and weight, self-reported physical activity and dietary behaviours and health related quality of life (HRQoL). Repeat cross-sectional data from 2015 (n = 1790) and 2019 (n = 2137) were analysed, stratified by high or low socio-economic position (SEP). Multilevel linear models and generalised estimating equations were fitted to assess whether SEP modified the intervention effect on the outcomes.

Results

There were no overall changes in BMI-z for either SEP strata. For behavioural outcomes, the intervention resulted in a 22.5% (95% CI 5.1, 39.9) point greater improvement in high-SEP compared to low-SEP intervention schools for meeting physical activity guidelines. There were also positive dietary intervention effects for high SEP students, reducing takeaway and packaged snack consumption, although there was no significant difference in effect between high and low SEP students. There were positive intervention effects for HRQoL, whereby scores declined in control communities with no change in intervention communities, and this did not differ by SEP.

Conclusion

The WHO STOPS intervention had differential effects on several weight-related behaviours according to SEP, including physical activity. Similar impacts on HRQoL outcomes were found between high and low SEP groups. Importantly, the trial evaluation was not powered to detect subgroup differences. Future evaluations of CBIs should be designed with an equity lens, to understand if and how these types of interventions can benefit all community members, regardless of their social and economic resources.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12150-4.

SOCIOECONOMIC STATUS AND PHYSICAL ACTIVITY DURING ELEMENTARY SCHOOL STUDENT RECESS

ABSTRACT Introduction The association between socioeconomic status (SES) and the level of physical activity (PA) at school has not been studied at length. Objective To describe the association between SES and the intensity of physical activity during recess in elementary school children as well as the space dedicated to physical activity. Methods A total of 212 children (110 boys and 102 girls) who were enrolled in the fourth, fifth and sixth grade of elementary school at the time participated in this study. The subjects were divided into 4 levels according to the marginalization index (MI). The geographical location of the schools and the available area were calculated using Google Maps Pro (GMP) software.1 Physical activity level was measured using accelerometry.2 Comparisons of different levels of PA with respect to marginalization indices and sex were investigated using one-way analysis of variance. The association between health variables and PA was determined through the Pearson correlation coefficient. Results Results indicated that the level and intensity of PA during recess are associated with socioeconomic status and the social marginalization index, as well as sex, age, and infrastructure. Conclusion The higher the level of social marginalization, the lower the level of PA and the smaller the space dedicated to PA. Level of Evidence III; Comparative retrospective study.

Mediators of socioeconomic inequalities in dietary behaviours among youth: A systematic review

Children and adolescents with a lower socioeconomic position have poorer dietary behaviours compared to their counterparts with a higher socioeconomic position. A better understanding of the mechanisms behind such socioeconomic inequalities is vital to identify targets for interventions aimed at tackling these inequalities. This systematic review aimed to summarize existing evidence regarding the mediators of socioeconomic differences in dietary behaviours among youth. A systematic literature search of MEDLINE, Embase, PsycINFO, and Web of Science databases yielded 20 eligible studies. The dietary behaviours included in the reviewed studies were the intake of fruit and vegetables, sugar-sweetened beverages, unhealthy snacks/fast food and breakfast. The consistent mediators of the effects of socioeconomic position on dietary behaviours among youth were: self-efficacy, food preferences and knowledge at the intrapersonal level; and availability and accessibility of food items at home, food rules and parental modelling at the interpersonal level. Few studies including mediators at the organisational, community or policy levels were found. Our review found several modifiable factors at the intrapersonal and interpersonal levels that could be targeted in interventions aimed at combating inequalities in dietary behaviours among youth. Rigorous studies exploring organisational, community and policy level mediators are warranted.

Variability in sociodemographic factors and obesity in Korean children: a cross-sectional analysis of Korea National Health and Nutrition Examination survey data (2007-2015)

PURPOSE

Sociodemographic factors are well-known risk factors for childhood obesity, even though the relationship between sociodemographic factors and obesity varies among countries. The objective of this study was to evaluate the relationship between sociodemographic factors and obesity in Korean children.

METHODS

This study is an analysis of cross-sectional data from the 2007-2009, 2010-2012, and 2013-2015 Korea National Health and Nutrition Examination Surveys. The sample included 14,482 children aged between 2 and 18 years (7652 boys and 6830 girls) and their parents. Sociodemographic factors were measured as a combination of demographic, economic, and sociological factors, including sex, age, residential area, family income, parent education level, and parent employment status.

RESULTS

In 2013-2015, obesity among Korean children was associated with current maternal smoking (P < .001). Obesity categorized according to age group was positively associated with paternal education level/high school graduation (P = .026 for ages 7-12 years), maternal smoking (P = .003 for ages 7-12 years), maternal body mass index (all age groups), paternal body mass index (all age groups), and low monthly family income (P = .017 for ages 2-6 years).

CONCLUSIONS

Current maternal smoking habits, paternal education, and low family income are potential risk factors for obesity in Korean children.

Home environment predictors of vegetable and fruit intakes among Australian children aged 18 months

Suboptimal vegetable and fruit consumption by young children is common. Identifying predictors of vegetable and fruit intakes is important for informing strategies to promote sufficient intakes of these foods from early life. The aim of the present study was to examine predictors of toddlers' vegetable and fruit intakes at age 18 months. This study involved secondary analysis of data from 361 child-mother dyads participating in the Melbourne Infant Feeding, Activity and Nutrition Trial in 2008-2010 at child ages four, nine and 18 months. Children's vegetable and fruit intakes were assessed at age 18 months using multiple 24-h dietary recalls. Data on potential predictor measures were collected via parent-completed questionnaires when children were four or nine months of age. Bivariate and multivariable linear regression models were used to test associations between children's average daily vegetable or fruit intake and potential predictors controlling for treatment arm and clustering by parent group. Multivariable models also controlled for covariates and potential confounders. Home availability of vegetables at age nine months was found to predict children's vegetable intake at age 18 months and remained significant (β = 20.19, 95% CI:7.23, 33.15, p = 0.003) in the multivariable model. Children's average daily fruit intake at age 18 months was predicted by maternal education at child age four months and the availability of fruits in their home at child age nine months. Maternal education remained significant (β = 30.83, 95% CI:12.17, 49.48, p = 0.002) in the multivariable model. Strategies to promote adequate vegetable and fruit intakes among young children should address known barriers to the availability of vegetables and fruits in the home from early in life. Additionally, messages encouraging fruit consumption may need to be tailored to mothers with lower levels of education.

Free Sugars Intake, Sources and Determinants of High Consumption among Australian 2-Year-Olds in the SMILE Cohort

In the first 2 years of life, it is important to limit exposure to foods high in free sugars, in order to lay foundations for lifelong eating patterns associated with a reduced risk of chronic disease. Intake data at this age is limited, so compliance with recommendations is not known. This analysis describes free sugars intakes, food sources and determinants of high consumption among Australian children at 2 years of age. Free sugars intakes were estimated using a customized Food Frequency Questionnaire, and median usual free sugars intake at 2 years was 22.5 (Interquartile Range (IQR) 12.8⁻37.7) g/day, contributing a median 8% of the estimated energy requirement (EER). Based on the EER, most children (71.1%) exceeded the World Health Organization recommendation that <5% of energy should come from free sugars, with 38% of participants exceeding the <10% recommendation. Children from households with the greatest socioeconomic disadvantage were more likely to exceed the 10% recommendation (Prevalence Ratio (PR) 1.44, 95% Confidence Interval (95% CI) 1.13⁻1.84), and be in the top tertile for free sugars intake (PR 1.58, 95% CI 1.19⁻2.10) than the least disadvantaged. Main sources of free sugars were non-core foods, such as fruit juice, biscuits, cakes, desserts and confectionery; with yogurt and non-dairy milk alternatives the two notable exceptions. Improved efforts to reduce free sugars are needed from the introduction of solid food, with a particular focus on fruit juice and non-core foods.

Intake, sources, and determinants of free sugars intake in Australian children aged 12-14 months

The consumption of free sugars is directly associated with adiposity and dental caries in early childhood; however, intake data in the first 2 years of life are limited. This cross-sectional analysis aims to identify major food sources of free sugars for Australian children aged 12-14 months and investigate factors associated with meeting the World Health Organisation (WHO) Guideline for sugars intake. Three days of nonconsecutive dietary data were collected via a 24-hr recall and 2-day food record for 828 participants. Usual intake of energy, total sugars, and free sugars were estimated, along with food group contributions to free sugars. Multiple logistic regression analysis was used to investigate factors associated with exceeding the WHO conservative recommendation that <5% of energy should come from free sugars. Mean free sugars intake was 8.8 (SD 7.7, IQR 3.7-11.6) g/day, contributing 3.6% (SD 2.8, IQR 1.6-4.8) of energy. Only 2.4% of participants exceeded the WHO recommendation that <10% of energy should come from free sugars, with 22.8% of participants exceeding the <5% recommendation. Children from households with greater socio-economic disadvantage (IRSAD <5, OR = 1.94) and in the lowest income bracket (OR = 2.10) were more likely to have intakes ≥5% of energy. Major food sources of free sugars were commercial infant foods (26.6%), cereal-based products (19.7%), namely, sweet biscuits (8.3%) and cakes (7.6%), followed by yoghurt (9.6%), and fruit and vegetable beverages (7.4%). These findings highlight the substantial contribution of infant foods to free sugars intakes and provide further evidence that dietary intakes are influenced by social determinants.

Stabilization and reversal of child obesity in Andalusia using objective anthropometric measures by socioeconomic status

BACKGROUND

Childhood obesity continues to be a significant public health issue worldwide. Recent national studies in Spain show a stable picture. However, prevalence and trends differ by socio-economic status, age, and region. We present the trend in childhood excess weight prevalence, aged 8-15 years, in Andalusia from 2011-2012 to 2015-2016 by socio-economic status.

METHODS

Using the cross-sectional Andalusian Health Surveys, objective anthropometric measures were taken for a representative sample of 8-15 year olds in Andalusia in 2011-2012 and 2015-2016. Prevalence and changes in prevalence of excess weight (overweight plus obesity) were calculated, using both the WHO and IOTF criteria, overall and for sex, age and three different indicators of SES.

RESULTS

Overall prevalence of excess weight decreased from 42.0% in 2011-2012 to 35.4% in 2015-2016. Overweight decreased from 28.2 to 24.2% and obesity from 13.8 to 11.2%. In 2011-2012 the prevalence of excess weight in boys was 46.0%and 37.9% in girls; in 2015-2016 the difference became significant with 41% of boys with excess weight compared with 30% in girls.

CONCLUSIONS

Childhood excess weight prevalence in Andalusia has decreased slightly between 2011-2012 and 2015-2016. Notably, a decrease in obesity prevalence in girls aged 8-15 years was recorded. In 2011-2012 a social gradient for excess weight prevalence across three SES indicators was observed: in 2015-2016 this gradient disappeared. Nonetheless, prevalence remains too high.

The effects of a school-based physical activity intervention programme on children's executive control: The Health Oriented Pedagogical Project (HOPP)

AIMS

To assess the effects of a large school-based physical activity intervention on children's ability to resist distractions and maintain focus, known as executive control.

METHODS

A quasi-experimental design with seven intervention and two control primary schools. The Health Oriented Pedagogical Project (HOPP) intervention consisted of 45 min of physical activity a day during school time for 6-8 months in addition to the regular weekly physical education lessons. A total of 1173 children, spanning from second grade (age 7 years) to sixth grade (age 12 years) were included in the analysis. Main outcome measures were executive control was measured at baseline and 1 year after using a modified Eriksen flanker task for the younger children (second and third grades) and a computerised Stroop task for the older children (fourth, fifth, and sixth grades).

RESULTS

Both the intervention and control group showed improvements in executive control after 1 year. However, the children in the intervention group did not improve their performance more than those in the control group.

CONCLUSIONS

No positive effect of the physical activity intervention programme on children's task performance was found, suggesting that the intervention did not affect children's executive control.

Contribution of discretionary food and drink consumption to socio-economic inequalities in children's weight: prospective study of Australian children

BACKGROUND

In high-income countries, children with a lower socio-economic position (SEP) are more likely to gain excess weight compared with children with a higher SEP. The extent to which children's consumption of discretionary food and drinks contributes to the development of these inequalities over childhood has not been examined.

METHODS

The study sample comprised 3190 children from the nationally representative Longitudinal Study of Australian Children. Linear and logistic regression models were fitted in accordance with the product of coefficients mediation method to determine the contribution of cumulative consumption of sweet drinks, discretionary hot foods, savoury snacks and sweet snacks from the first year of life, over a period of 10 years, on the relationship between SEP and children's body mass index (BMI) z-score at age 10-11 years.

RESULTS

At age 10-11, mean BMI z-score was 0.17 in the highest SEP tertile, 0.33 in the middle and 0.47 in the lowest tertile. Corresponding values for overweight and obesity prevalence were 16.6%, 25.7% and 32.7%, respectively. Eleven per cent [95% confidence interval (CI) 4.77%, 19.84%] of the observed difference in BMI z-score at age 10-11 years was mediated by socio-economic differences in consumption of sweet drinks and discretionary hot foods including pies and hot chips throughout childhood.

CONCLUSIONS

Findings indicate that consumption of sweet drinks and discretionary hot food, from the first year of life, is likely to contribute to the development of inequalities in excess weight among children. Poor dietary intake is a key risk factor for excess weight gain among children and a reduction in discretionary food and drinks is likely to contribute to the dual goal of improving overall weight and reducing socio-economic inequalities in weight gain across childhood. To maximally reduce inequalities in weight gain across childhood, additional determinants must also be identified and targeted.

Can the sociology of social problems help us to understand and manage 'lifestyle drift'?

Lifestyle drift is increasingly seen as a barrier to broad action on the social determinants of health. The term is currently used in the population health literature to describe how broad policy initiatives for tackling inequalities in health that start off with social determinants (upstream) approach drift downstream to largely individual lifestyle factors, as well as the general trend of investing a the individual level. Lifestyle drift occurs despite the on-going efforts of public health advocates, such as anti-obesity campaigners, to draw attention to the social factors which shape health behavior and outcomes. In this article, we explore whether the sociology of social problems can help understand lifestyle drift in the context of obesity. Specifically, we apply Jamrozik and Nocella's residualist conversion model to the problem of obesity in order to explore whether such an approach can provide greater insight into the processes that underpin lifestyle drift and inform our attempts to mitigate it.

Iodine Intakes of Victorian Schoolchildren Measured Using 24-h Urinary Iodine Excretion

Mandatory fortification of bread with iodized salt was introduced in Australia in 2009, and studies using spot urine collections conducted post fortification indicate that Australian schoolchildren are now replete. However an accurate estimate of daily iodine intake utilizing 24-h urinary iodine excretion (UIE μg/day) has not been reported and compared to the estimated average requirement (EAR). This study aimed to assess daily total iodine intake and status of a sample of primary schoolchildren using 24-h urine samples. Victorian primary school children provided 24-h urine samples between 2011 and 2013, from which urinary iodine concentration (UIC, μg/L) and total iodine excretion (UIE, μg/day) as an estimate of intake was determined. Valid 24-h urine samples were provided by 650 children, mean (SD) age 9.3 (1.8) years (n = 359 boys). The mean UIE of 4–8 and 9–13 year olds was 94 (48) and 111 (57) μg/24-h, respectively, with 29% and 26% having a UIE below the age-specific EAR. The median (IQR) UIC was 124 (83,172) μg/L, with 36% of participants having a UIC < 100 μg/L. This convenience sample of Victorian schoolchildren were found to be iodine replete, based on UIC and estimated iodine intakes derived from 24-h urine collections, confirming the findings of the Australian Health Survey.

Can targeted policies reduce obesity and improve obesity-related behaviours in socioeconomically disadvantaged populations? A systematic review

This review synthesized evidence from controlled studies pertaining to the impact of targeted policies on anthropometric, dietary and physical activity outcomes amongst socioeconomically disadvantaged children and adults. Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity guidelines were followed. Eligible studies were published from 2004 to August 2015 and examined the impact of targeted policies on anthropometric, dietary and physical activity outcomes amongst socioeconomically disadvantaged populations. Twenty articles (18 studies) were included. Eight studies examined organizational policies within multi-component interventions in schools. Common elements of successful policy-containing interventions included nutritional standards, enhancements to physical education, additional physical activity opportunities, school self-assessments, and nutrition and physical activity education. Of the 10 studies of government policies, policies providing information/education and fruit and vegetable subsidies had positive impacts amongst children, but no impact amongst adults. Policies involving changes to built environments yielded nearly uniformly null findings in children and adults. Overall, the largest quantity of high-quality evidence of effectiveness was for comprehensive interventions that included school policies, and government policies targeting disadvantaged children in schools. None of the government policies targeting disadvantaged adults proved effective. Interventions during childhood may ameliorate negative obesity-related manifestations of socioeconomic disadvantage. Gaps in knowledge remain surrounding effective policies in adults, adolescents and very young children.

Assessing junk food consumption among Australian children: trends and associated characteristics from a cross-sectional study

Background

The ubiquitous supply of junk foods in our food environment has been partly blamed for the increased rates in overweight and obesity. However, consumption of these foods has generally been examined individually perhaps obscuring the true extent of their combined consumption and impact on health. An overall measure of children’s junk food consumption may prove useful in the development of child obesity prevention strategies. We describe the development of a children’s Junk Food Intake Measure (JFIM) to summarise temporal change in junk food consumption and examine the association between the JFIM and health-related behaviours.

Methods

Cross-sectional population surveillance survey of Australian children age 5–16 years collected in 2010 and 2015. Data were collected by questionnaire with parent’s proxy reporting for children in years K, 2 and 4 and children in years 6, 8 and 10 by self-report. Information on diet, screen-time and physical activity was collected using validated questionnaires. The JFIM comprised consumption of fried potato products, potato crisps/salty snacks, sweet and savoury biscuits/cakes/doughnuts, confectionary and, ice cream/ice blocks.

Results

A total of 7565 (missing = 493, 6.1%) and 6944 (missing n = 611, 8.1%) children had complete data on consumption of junk foods, in 2010 and 2015, respectively. The 2015 survey data showed that among students from high socio-economic status neighbourhoods, there were fewer high junk food consumers than low junk food consumers. Children from Middle Eastern cultural backgrounds had higher junk food consumption. High junk food consumers were more likely to consume take-away ≥3/week, eat dinner in front of the television, receive sweet rewards, be allowed to consume snacks anytime, have soft drinks available at home and a TV in their bedroom. There was a lower proportion of high junk food consumers in 2015 compared to 2010.

Conclusion

This is the first study to provide and examine a summary measure of overall junk food consumption among Australian children. The results indicate that junk food consumption among Australian children is lower in 2015, compared with 2010. Still, the public health workforce must continue their efforts as levels of junk food consumption remain of concern among Australian children.

High-Protein and High-Dietary Fiber Breakfasts Result in Equal Feelings of Fullness and Better Diet Quality in Low-Income Preschoolers Compared with Their Usual Breakfast

Background: In the United States, 17% of children are currently obese. Increasing feelings of fullness may prevent excessive energy intake, lead to better diet quality, and promote long-term maintenance of healthy weight.Objective: The purpose of this study was to develop a fullness-rating tool (aim 1) and to determine whether a high-protein (HP), high-fiber (HF), and combined HP and HF (HPHF) breakfast increases preschoolers' feelings of fullness before (pre) and after (post) breakfast and pre-lunch, as well as their diet quality, as measured by using a composite diet quality assessment tool, the Revised Children's Diet Quality Index (aim 2).Methods: Children aged 4 and 5 y (n = 41; 22 girls and 19 boys) from local Head Start centers participated in this randomized intervention trial. Sixteen percent of boys and 32% of girls were overweight or obese. After the baseline week, children rotated through four 1-wk periods of consuming ad libitum HP (19-20 g protein), HF (10-11 g fiber), HPHF (19-21 g protein, 10-12 g fiber), or usual (control) breakfasts. Food intake at breakfast was estimated daily, and for breakfast, lunch, and snack on day 3 of each study week Student's t tests and ANOVA were used to determine statistical differences.Results: Children's post-breakfast and pre-lunch fullness ratings were ≥1 point higher than those of pre-breakfast (aim 1). Although children consumed, on average, 65 kcal less energy during the intervention breakfasts (P < 0.007) than during the control breakfast, fullness ratings did not differ (P = 0.76). Relative to the control breakfast, improved diet quality (12%) was calculated for the HP and HF breakfasts (P < 0.027) but not for the HPHF breakfast (aim 2).Conclusions: Post-breakfast fullness ratings were not affected by the intervention breakfasts relative to the control breakfast. HP and HF breakfasts resulted in higher diet quality. Serving HP or HF breakfasts may be valuable in improving diet quality without lowering feelings of satiation or satiety. This trial was registered at clinicaltrials.gov as NCT02122224.

Trends in Child Obesity and Underweight in Spain by Birth Year and Age, 1983 to 2011

INTRODUCTION AND OBJECTIVES

The prevalences of child obesity and overweight are increasing worldwide and are a significant public health issue, particularly in terms of long-term cardiovascular risk profiles, which continue into adulthood unless obesity is reversed. Accurately identifying trends and at-risk subgroups is crucial to correctly target public health initiatives. The objective of this study was to examine changes in the prevalences of child obesity and underweight in Spain from 1983 to 2011 taking into consideration both age and birth year.

METHODS

A series of cross-sectional studies representative of the pediatric population in Spain between 1987 and 2011 was used to calculate the prevalence and trends of excess weight and underweight in girls and boys aged 2 to 14 years per survey year and per birth year.

RESULTS

The overall prevalence of overweight and obesity remained relatively stable. The prevalence of overweight in boys aged 10 to 14 years increased from 13.9% to 22.2%. The prevalence of obesity in girls aged 2 to 5 years decreased from 30% to 19.8%, whereas the prevalence of underweight in this group increased from 13.7% to 22.6%.

CONCLUSIONS

Child obesity trends in Spain over the last 2 decades appear to be stable with some fluctuations, but the trends differ depending on age and sex, and have stabilized at too high a level. The prevalence of underweight also appears to have increased and should be considered alongside excess weight when designing and implementing child health and weight measures.

Family meals with young children: an online study of family mealtime characteristics, among Australian families with children aged six months to six years

BACKGROUND

Evidence suggests that family meals influence food intakes and behaviours, which in turn impact children's eating habits, diets and health. Mealtimes therefore offer potential as settings for health promotion. Given diet, health behaviours and health are often socioeconomically patterned, it is important to consider whether family meals differ by socioeconomic position (SEP).

METHODS

The Family Meals with Young Kids study was an online survey completed by parents in 2014. Mealtime characteristics measured included; frequency of shared meals across the day, duration and location of mealtimes, parental modelling, and parental perceived importance of the evening meal. Maternal education was used to assess SEP. The aims of this study were to describe family meal characteristics among Australian families with children aged six months to six years and to describe the socioeconomic patterning of these.

RESULTS

Participants (n = 992) were mostly mothers (97%) with a university degree (71%). The evening meal was the most frequently reported meal eaten together with the responding parent and child (77% ≥ five nights/week). Snacks were least commonly eaten together (39% ≥ five days/week). The frequency of having everyone present for the evening meal was inversely associated with SEP (OR 0.70, CI 0.54-0.92). Parent rated importance of family meals was generally high and positively associated with higher SEP (OR 1.32, CI 1.00-1.76). Most children consumed breakfast (73%), lunch (58%) and dinner (82%) sitting at a table or bench and this was positively associated with higher SEP for all meal types (OR 1.61-2.37, p < 0.05). Increased television (TV) viewing during meals was inversely associated with SEP (OR 0.63, CI 0.54-0.72). Less than half of children (36%) watched TV during meals more than once a day.

CONCLUSIONS

Australian families engage in many healthy mealtime behaviours. Evidence that parents share meals with children and place high value on mealtimes with children provides important opportunities for promoting healthy behaviours in families. The choice of eating location and the practice of viewing TV during mealtimes are examples of two such opportunities. Socioeconomic patterning of the location of mealtimes and TV viewing during meals may contribute to socioeconomic differences in dietary intakes and may be important targets for future health promotion.

Development of relative body mass (BMI) of students from Łódź, depending on the selected environmental, psychological and sociological factors

The human height-to-weight ratio is an important parameter of the body homeostasis. Currently, the most popular measurement determining the relationship between body mass and height is the Quetelet II indicator, called Body Mass Index (BMI). The aim of this study is an evaluation of the differences in the height-to-weight ratios, depending on selected environmental, psychological and sociological factors in people studying at higher education institutions in Łódź. The research was conducted among students of higher education institutions in Łódź, by electronic means or with the use of an anonymous survey. It consisted of 28 closed single or multiple choice questions. Statistical analysis was made of complete results of the research involving 135 people, both males and females, aged between 19-26. It was revealed that the factors related to higher BMI values in students are the following: the presence of a tendency in the students to gain weight themselves, and a tendency to gain weight present in their mothers, an evaluation of their own body mass as excessive, regularly smoking cigarettes and rarely undergoing medical check-ups. Among the factors connected with lower BMI values are: regular coffee consumption, perception of their own body mass as being too low, and also obtaining systolic pressure values below 110 mm Hg. Additionally, a positive correlation between taking up physical activity and higher values of systolic blood pressure (p<0.05) was shown. Among the subjects, it was found that 92% of the underweight women declared that their body mass and figure were normal. In the case of women with optimal BMI values, 40% stated that their body mass was excessive. In the case of men the problem was reverse: 50% of the subjects who were either overweight or obese claimed that their body mass was within the norm. The factors that significantly influence body proportion differences among students include the subject’s and the subject’s mother’s tendency to put on weight, self-evaluation of their own body mass, the values of systolic blood pressure, coffee consumption and cigarette smoking, as well as the frequency of medical check-ups.

Can policy ameliorate socioeconomic inequities in obesity and obesity-related behaviours? A systematic review of the impact of universal policies on adults and children

This systematic review examined the impact of universal policies on socioeconomic inequities in obesity, dietary and physical activity behaviours among adults and children. PRISMA-Equity guidelines were followed. Database searches spanned from 2004 to August 2015. Eligible studies assessed the impact of universal policies on anthropometric, dietary or physical activity-related outcomes in adults or children according to socioeconomic position. Thirty-six studies were included. Policies were classified as agentic, agento-structural or structural, and their impact on inequities was rated as positive, neutral, negative or mixed according to the dominant associations observed. Most policies had neutral impacts on obesity-related inequities regardless of whether they were agentic (60% neutral), agento-structural (68% neutral) or structural (67% neutral). The proportion of positive impacts was similar across policy types (10% agentic, 18% agento-structural and 11% structural), with some differences for negative impacts (30% agentic, 14% agento-structural and 22% structural). The majority of associations remained neutral when stratified by participant population, implementation level and socioeconomic position measures and by anthropometric and behavioural outcomes. Fiscal measures had consistently neutral or positive impacts on inequities. Findings suggest an important role for policy in addressing obesity in an equitable manner and strengthen the case for implementing a broad complement of policies spanning the agency-structure continuum.

Socio-economic disparities in the diet of French children and adolescents: a multidimensional issue

OBJECTIVE

The present research aimed to study the multidimensionality of the link between dietary intake and socio-economic position (SEP) in a representative sample of French children and adolescents, using a variety of SEP indicators.

DESIGN

Data from the second French national food consumption survey (INCA2) were used. Information on food consumption was collected using a 7d food record and SEP data (occupation, education, income, household wealth indices) using questionnaires. Multivariable linear regression analyses were performed separately in children and adolescents to assess the relationships between dietary components (food groups and macronutrients) and each dimension of SEP.

SETTING

The INCA2 survey, France.

SUBJECTS

A representative sample of French children (3-10 years of age; n 574) and adolescents (11-17 years of age; n 881).

RESULTS

Compared with children from a higher SEP, those from a lower SEP had lower intakes of fruit and vegetables, yoghurts and confectionery and higher intakes of starchy foods, meat, milk, sugar-sweetened beverages and pizzas/sandwiches. Similar results were observed in adolescents for fruit and vegetables, yoghurts and sugar-sweetened beverages. Adolescents also had lower intakes of cakes/pastries and higher intakes of processed meat and dairy desserts. Neither energy nor protein intake was associated with SEP. Adolescents from a lower SEP had higher carbohydrate and lower lipid intakes. Overall, these findings were consistent across the various dimensions of SEP, but the gradient was steeper depending on the caregiver's educational level.

CONCLUSIONS

This research highlights the need for specific messages to help poorly educated families adopt good eating habits.

Correlation of Body Mass Index and Physical Activity Among 7- to 11-Year Children at Zahedan, Iran

Background:

Childhood obesity is currently one of the major concerns in pediatric field. In recent literature, correlation of obesity with some behavioral factors such as physical activity (PA) received attention.

Objective:

The purpose of this study was to determine the relationship between body mass index (BMI) and PA.

Materials and Methods:

This cross-sectional study was carried out in 2012 on 548 randomly selected 7- to 11-year schoolchildren from Zahedan, Iran. The underweight, normal weight, overweight, and obesity status were all based on BMI percentiles for age and sex. Moderate to vigorous PA during the previous 7 days was assessed by a modified version of the Physical Activity Questionnaire for Children.

Results:

The prevalence of underweight, normal weight, overweight, and obesity among the participants was 18.3%, 47.9%, 11.8%, and 22.1%, respectively. Overweight and obesity were significantly higher among girls than boys. Mean PA score in participants was 2.4 ± 0.5. The results showed the PA score was significantly higher among boys than girls. The PA score had a significant association with BMI ( P = .018), and it was greater in normal participants than in obese participants.

Conclusion:

On the basis of observed data and due to the impact of PA on BMI as an indicator of nutritional status and health, teaching children to have better nutrition and lifestyle changes is very important. Therefore, more studies should focus on childhood obesity prevention programs to prevent nonoverweight children from becoming overweight or obese in the future.

Associations between food and beverage consumption and different types of sedentary behaviours in European preschoolers: the ToyBox-study

OBJECTIVE

To examine the association between food and beverage consumption and time spent in different sedentary behaviours such as watching TV and DVDs, playing computer/video games and quiet play/activities in preschoolers.

METHODS

A sample of 6431 (51.8 % males) European preschoolers aged 3.5-5.5 years from six survey centres was included in the data analyses. Data on dietary habits and sedentary behaviours [watching TV, playing computer and quiet play (both during weekdays and weekend days)] were collected via standardized proxy-administered questionnaires. One-way analysis of covariance and general linear model (adjusted for sex, maternal education, body mass index and centre) were conducted.

RESULTS

The results of the generalized linear model showed that the more strong associations in both males and females who were watching TV for > 1 h/day during weekdays were positively associated with increased consumption of fizzy drinks (β = 0.136 for males and β = 0.156 for females), fresh and packed juices (β = 0.069, β = 0.089), sweetened milk (β = 0.119, β = 0.078), cakes and biscuits (β = 0.116, β = 0.145), chocolate (β = 0.052, β = 0.090), sugar-based desserts and pastries (β = 0.234, β = 0.250), salty snacks (β = 0.067, β = 0.056), meat/poultry/processed meat (β = 0.067, β = 0.090) and potatoes (β = 0.071, β = 0.067), and negative associations were observed for the consumption of fruits (β = -0.057, β = -0.099), vegetables (β = -0.056, β = -0.082) and fish (β = -0.013, β = -0.013). During weekend days, results were comparable.

CONCLUSIONS

In European preschoolers, sedentary behaviours were associated with consumption of energy-dense foods and fizzy drinks. The present findings will contribute to improve the strategies to prevent overweight, obesity and nutrition-related chronic diseases from early childhood.

Early Predictors of Eating Problems in Preadolescence-A Prospective Birth Cohort Study

PURPOSE

The epidemiology of childhood eating problems is far from being fully described. The present study aims to explore early predictors of eating behavior problems in preadolescence.

METHODS

The study sample comprised 1,939 children from the birth cohort study, the Copenhagen Child Cohort (CCC2000). Logistic regression models were used to investigate associations among infancy health, developmental and relational factors, maternal mental health problems, socioeconomic factors, parental reported eating behavior patterns in preschool age and eating behavior problems in preadolescence.

RESULTS

A number of factors expressing socioeconomic disadvantage across childhood were associated with an increased risk of eating behavior problems at age 11-12 years. In addition, overeating patterns at age 5-7 years predicted restrained eating in preadolescence (odds ratio [OR] = 2.77; 95% confidence interval [CI] = 1.13-6.77; p = .03), with overweight at age 11-12 years and low annual household income as strong explanatory factors (OR = 4.79; 95% CI = 2.81-8.17; p < .0001 and OR = 2.06; 95% CI = 1.19-3.58; p = .02, respectively). No significant associations between perinatal, early child- and relational factors, or maternal mental disorder and eating behavior problems in preadolescence were found.

CONCLUSIONS

Our results suggest that overeating at age 5-7 years is prospectively associated with restrained eating in preadolescence, with contemporaneous socioeconomic disadvantages and overweight as strong explanatory factors. Our findings might reflect successful public health interventions toward childhood obesity or might reflect a developmental course of problematic eating fluctuating between over- and undereating. Future studies should focus on the possible pathways from overeating to restrained eating and more severe eating pathology, including possible negative side effects of otherwise successful interventions aimed at reducing childhood obesity.

Effects of parent and child behaviours on overweight and obesity in infants and young children from disadvantaged backgrounds: systematic review with narrative synthesis

Background

Despite the crucial need to develop targeted and effective approaches for obesity prevention in children most at risk, the pathways explaining socioeconomic disparity in children’s obesity prevalence remain poorly understood.

Methods

We conducted a systematic review of the literature that investigated causes of weight gain in children aged 0–5 years from socioeconomically disadvantaged or Indigenous backgrounds residing in OECD countries. Major electronic databases were searched from inception until December 2015. Key words identified studies addressing relationships between parenting, child eating, child physical activity or sedentary behaviour and child weight in disadvantaged samples.

Results

A total of 32 articles met the inclusion criteria. The Mixed Methods Appraisal Tool quality rating for the studies ranged from 25 % (weak) to 100 % (strong). Studies predominantly reported on relationships between parenting and child weight (n = 21), or parenting and child eating (n = 12), with fewer (n = 8) investigating child eating and weight. Most evidence was from socio-economically disadvantaged ethnic minority groups in the USA. Clustering of diet, weight and feeding behaviours by socioeconomic indicators and ethnicity precluded identification of independent effects of each of these risk factors.

Conclusions

This review has highlighted significant gaps in our mechanistic understanding of the relative importance of different aspects of parent and child behaviours in disadvantaged population groups.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2801-y) contains supplementary material, which is available to authorized users.

The association of socio-economic factors with physical fitness and activity behaviours, spinal posture and retinal vessel parameters in first graders in urban Switzerland

Socio-economic status during childhood has been shown to be a strong predictor of adult health outcome. Therefore, we examined associations of parental educational level, household income and migrant background with physical fitness, spinal flexibility, spinal posture as well as retinal vessel diameters in children of an urban Swiss region. A total of 358 first graders of the Swiss canton Basel-Stadt (age: 7.3, SD: 0.4) were examined. Physical fitness (20 m shuttle run test, 20 m sprint, jumping sidewards and balancing backwards), spinal flexibility and spinal posture (MediMouse®, Idiag, Fehraltdorf, Switzerland) and retinal microcirculation (Static Retinal Vessel Analyzer, Imedos Systems UG, Jena, Germany) were assessed. Parental education, household income, migrant background and activity behaviour were evaluated with a questionnaire. Parental education was associated with child aerobic fitness (P = 0.03) and screen time (P < 0.001). Household income was associated with jumping sidewards (P = 0.009), balancing backwards (P = 0.03) and sports club participation (P = 0.02). Migrant background was associated with BMI (P = 0.001), body fat (P = 0.03), aerobic fitness (P = 0.007), time spent playing outdoors (P < 0.001) and screen time (P < 0.001). For spinal flexibility and retinal vessel diameter, no associations were found (0.06 < P < 0.8). Low parental education, low household income and a migrant background are associated with poor physical fitness, higher BMI and body fat percentage and low-activity behaviour.

Prevalence of overweight/obesity in relation to dietary habits and lifestyle among 7-17 years old children and adolescents in Lithuania

BACKGROUND

Until recently increasing prevalence of overweight and obesity among pediatric population in Europe and worldwide contributes to major well-known risks for metabolic consequences in later life. The aim of this study was to determine the prevalence of overweight/obesity among children and adolescents in Lithuania and assess its association with energy balance related behaviors as well as familial demographic and socioeconomic factors.

METHODS

Cross-sectional study included 3990 7-17 years old schoolchildren from 40 schools of Kaunas region, Lithuania. Study participants underwent anthropometric measurements. Body mass index (BMI) was evaluated according to International Obesity Task Force (IOTF) criteria for children and adolescents. Children and adolescents and their parents filled in the questionnaires on parental sociodemographic characteristics, dietary habits, TV watching time, and family socioeconomic status.

RESULTS

The prevalence of underweight, overweight, and obesity among boys and girls was 6.9 and 11.7 % (P < 0.05), 12.6 and 12.6 % (P > 0.05), and 4.9 and 3.4 % (P < 0.05), respectively. Obesity was significantly more prevalent in the 7-9 years old group (6.7 and 4.8 % in boys and girls, respectively, P < 0.05). Lower meals frequency and breakfast skipping were directly associated with overweight/obesity (P < 0.05); however, physical inactivity was not associated with higher BMI. Children's overweight/obesity was directly associated with lower paternal education and unemployment (OR 1.30, P = 0.013 and OR 1.56, P = 0.003, respectively).

CONCLUSIONS

The prevalence of overweight and obesity among 7-17 years old Lithuanian children and adolescents was more prevalent in younger age, still being one of the lowest across the European countries. Meals frequency, breakfast skipping, paternal education and unemployment as well as a family history of arterial hypertension were found to be associated with children's and adolescents' overweight/obesity.

Multidimensionality of the relationship between social status and dietary patterns in early childhood: longitudinal results from the French EDEN mother-child cohort

Background

The association between socioeconomic position and diet in early childhood has mainly been addressed based on maternal education and household income. We aimed to assess the influence of a variety of social factors from different socio-ecological levels (parents, household and child-care) on multi-time point dietary patterns identified from 2 to 5 y.

Method

This study included 974 children from the French EDEN mother-child cohort. Two multi-time point dietary patterns were derived in a previous study: they correspond to consistent exposures to either core- or non-core foods across 2, 3 and 5 y and were labelled “Guidelines” and “Processed, fast-foods”. The associations of various social factors collected during pregnancy (age, education level) or at 2-y follow-up (mother’s single status, occupation, work commitments, household financial disadvantage, presence of older siblings and child-care arrangements) with each of the two dietary patterns, were assessed by multivariable linear regression analysis.

Results

The adherence to a diet close to “Guidelines” was positively and independently associated with both maternal and paternal education levels. The adherence to a diet consistently composed of processed and fast-foods was essentially linked with maternal variables (younger age and lower education level), household financial disadvantage, the presence of older sibling (s) and being cared for at home by someone other than the mother.

Conclusions

Multiple social factors operating at different levels (parents, household, and child-care) were found to be associated with the diet of young children. Different independent predictors were found for each of the two longitudinal dietary patterns, suggesting distinct pathways of influence. Our findings further suggest that interventions promoting healthier dietary choices for young children should involve both parents and take into account not only household financial disadvantage but also maternal age, family size and options for child-care.

Impact of an early-life intervention on the nutrition behaviors of 2-y-old children: a randomized controlled trial

BACKGROUND

Despite an extensive well-child health service, 30% of New Zealand's 2- to 4-y old children are overweight or obese. This suggests that additional intervention is necessary to establish healthy nutrition behaviors.

OBJECTIVE

The aim of this study was to assess the effect of intervention from 0 to 18 mo of age on food and nutrient intake, eating behaviors, and parental feeding practices in 18- to 24-mo-old children.

DESIGN

In total, 802 families with healthy infants were randomly allocated to 1 of 4 groups: Usual Care (UC); Food, Activity, and Breastfeeding (FAB); Sleep; or FAB and Sleep (Combination). All groups received standard "well-child" care. The FAB intervention comprised 7-8 additional contacts for education and support around breastfeeding, food, and activity. The Sleep intervention comprised 2 additional contacts for guidance about sleeping habits. Combination families received both interventions. A validated food-frequency questionnaire assessed food intake at 2 y. A questionnaire assessed eating behaviors and parental feeding practices at 18 and 24 mo.

RESULTS

At 2 y, there were no statistically significant differences in food and nutrient intake or eating behaviors in the groups receiving the FAB intervention (FAB, Combination; 325 children) compared with the groups who did not (Sleep, UC; 341 children). With the use of a 5-point scale, small but statistically significant differences in parental feeding practices were observed in the groups receiving the FAB intervention: greater child control over eating (difference: 0.14; 95% CI: 0.02, 0.26) and less pressure to eat (difference: 0.18; 95% CI: 0.04, 0.32) at 18 mo, as well as greater encouragement of nutrient-dense foods at 24 mo (difference: 0.16; 95% CI: 0.03, 0.30). No statistically significant differences were observed between the groups who received the Sleep intervention (Sleep, Combination; 313 children) and those who did not, except higher meat intake in the former (11 g/d).

CONCLUSION

Additional education and support for parents from birth did not improve nutrition behaviors in this population at 2 y of age. This trial was registered at clinicaltrials.gov as NCT00892983.

Associations between dietary intakes of first-time fathers and their 20-month-old children are moderated by fathers' BMI, education and age

Children's learning about food is considerable during their formative years, with parental influence being pivotal. Research has focused predominantly on maternal influences, with little known about the relationships between fathers' and children's diets. Greater understanding of this relationship is necessary for the design of appropriate interventions. The aim of this study was to investigate the associations between the diets of fathers and their children and the moderating effects of fathers' BMI, education and age on these associations. The diets of fathers and their first-born children (n 317) in the Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program were assessed using an FFQ and 3 × 24-h recalls, respectively. The InFANT Program is a cluster-randomised controlled trial in the setting of first-time parents groups in Victoria, Australia. Associations between father and child fruit, vegetable, non-core food and non-core drink intakes were assessed using linear regression. The extent to which these associations were mediated by maternal intake was tested. Moderation of associations by paternal BMI, education and age was assessed. Positive associations were found between fathers' and children's intake of fruit, sweet snacks and take-away foods. Paternal BMI, education and age moderated the relationships found for the intakes of fruit (BMI), vegetables (age), savoury snacks (BMI and education) and take-away foods (BMI and education). Our findings suggest that associations exist at a young age and are moderated by paternal BMI, education and age. This study highlights the importance of fathers in modelling healthy diets for their children.

Nutrition promotion approaches preferred by Australian adolescents attending schools in disadvantaged neighbourhoods: a qualitative study

Background

Links between socioeconomic disadvantage and unhealthy eating behaviours among adolescents are well established. Little is known about strategies that might support healthy eating among this target group. This study aimed to identify potential strategies and preferred dissemination methods that could be employed in nutrition promotion initiatives focussed on improving eating behaviours among socioeconomically disadvantaged adolescents.

Methods

Semi-structured interviews were conducted in 2011 among 22 adolescents (12–15 years) recruited from secondary schools in disadvantaged neighbourhoods in Victoria, Australia.

Results

Strategies suggested by adolescents to support healthy eating included increasing awareness about healthy eating; greater cooking involvement; greater parental and peer support; frequent family meal participation; greater parental and peer role-modelling of healthy eating; increased availability of healthy foods and decreased availability of unhealthy foods in homes and schools. Adolescents preferred electronic media, adolescent-specific recipe books, and school-based methods for distributing nutrition promotion messages and strategies.

Conclusions

A number of suggested strategies and methods identified in the present investigation have been employed with success in previous nutrition promotion interventions targeting socioeconomically disadvantaged adolescents. The present study also contributes novel insights into potential strategies and methods that could be employed in initiatives aiming to improve eating behaviours in this vulnerable group, and particularly highlights the importance of incorporating strategies involving parents and modifying the home food environment.

Dietary behaviour and parental socioeconomic position among adolescents: the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS)

Background

The positive association between parental socioeconomic position (PSEP) and health among adolescents may be partly explained by dietary behaviour. We investigated the associations between fruit intake, vegetable intake, energy-dense food intake, the Healthy Nutrition Score for Kids and Youth (HuSKY) and parental education in a nationwide, cluster-randomized sample of adolescents in Germany.

Methods

The German Health Interview and Examination Survey for Children and Adolescents 2003–2006 (KiGGS) included 17,641 individuals aged 0–17 years and their parents. Complete information on relevant variables was available for 6359 individuals in the 11–17 age group. The associations between nutrition indicators and parental education were analysed separately for boys and girls, using multivariate logistic regression analysis. Odds ratios (ORs) adjusted for age, region, income, occupation, physical activity and weight status related variables, were calculated for the associations between parental education and nutrition indicators.

Results

After full adjustment, higher parental education level was associated with lower energy-dense food intake – with an OR of 1.3 (95 % CI 1.0–1.7) for boys with secondary educated parents and 1.8 (1.4–2.3) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.2 (0.9–1.5) and 1.6 (1.2–2.2). Higher parental education was associated with higher fruit intake – with an OR of 1.3 (1.0–1.7) for boys with secondary educated parents and 2.0 (1.5–2.7) for boys with tertiary educated parents compared to boys with primary educated parents; the corresponding ORs for girls were 1.0 (0.8–1.4) and 1.5 (1.0–2.1). Among boys and girls with tertiary educated parents compared to those with primary educated parents an OR of 1.3 (CI boys: 1.0–1.7, CI girls: 1.0–1.6) was observed for high vegetable intake. Among boys with tertiary educated parents compared to boys with primary educated parents an OR of 1.6 (1.2–2.2) was observed for a high HuSKY; the corresponding OR for girls was 1.5 (1.1–1.9).

Conclusions

A high PSEP is associated with consumption of less energy-dense food, more fruits and vegetables and more favourable overall dietary behaviour. Preferably school-based interventions are needed to promote healthy dietary behaviour among German adolescents and a special effort is needed to reach adolescents from low-PSEP families.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1830-2) contains supplementary material, which is available to authorized users.

Socio-economic position as a moderator of 9–13-year-old children’s non-core food intake

Objective

There is limited understanding as to why children of low socio-economic position (SEP) consume poorer diets than children of high SEP. Evidence suggests that determinants of dietary intake may differ between SEP groups. The present study aimed to determine if SEP moderated associations of personal and environmental predictors with children’s non-core food and sweetened drink intakes and unhealthy dietary behaviours.

Design

Children completed online questionnaires and parents completed computer-assisted telephone interviews to assess intrapersonal and environmental dietary predictors. Dietary intake was measured using an FFQ. Parents reported demographic information for maternal education, occupation and employment, and household income.

Setting

Twenty-six primary schools in South Australia, Australia.

Subjects

Children aged 9–13 years and their parents (n 395).

Results

Multiple personal and home environment factors predicted non-core food and sweetened drink intakes, and these associations were moderated by SEP. Maternal education moderated associations of girls’ sweetened drink intake with self-efficacy, cooking skills and pressure to eat, and boys’ non-core food intake with monitoring, parent’s self-efficacy and home environment. Maternal occupation and employment moderated associations of sweetened drink intake with attitudes, self-efficacy, pressure to eat and food availability, and non-core food intake with parents’ self-efficacy and monitoring. Income moderated associations with pressure to eat and home environment.

Conclusions

Identifying differences in dietary predictors between socio-economic groups informs understanding of why socio-economic gradients in dietary intake may occur. Tailoring interventions and health promotion to the particular needs of socio-economically disadvantaged children may produce more successful outcomes and reduce socio-economic disparities in dietary intake.

Obesogenic dietary intake in families with 1-year-old infants at high and low obesity risk based on parental weight status: baseline data from a longitudinal intervention (Early STOPP)

Purpose

To compare dietary intake in 1-year-old infants and their parents between families with high and low obesity risk, and to explore associations between infant dietary intake and relative weight.

Methods

Baseline analyses of 1-year-old infants (n = 193) and their parents participating in a longitudinal obesity intervention (Early STOPP) were carried out. Dietary intake and diet quality indicators were compared between high- and low-risk families, where obesity risk was based on parental weight status. The odds for high diet quality in relation to parental diet quality were determined. Associations between measured infant relative weight and dietary intake were examined adjusting for obesity risk, socio-demographics, and infant feeding.

Results

Infant dietary intake did not differ between high- and low-risk families. The parents in high-risk families consumed soft drinks, French fries, and low-fat spread more frequently, and fish and fruits less frequently (p < 0.05) compared to parents in low-risk families. Paternal intake of vegetables and fish increased the odds for children being consumers of vegetables (OR 1.7; 95 % CI 1.0–2.9) and fish, respectively (OR 2.5; 95 % CI 1.4–4.4). Infant relative weight was weakly associated with a high intake of milk cereal drink (r = 0.15; p < 0.05), but not with any other aspect of dietary intake, obesity risk, or early feeding patterns.

Conclusions

At the age of one, dietary intake in infants is not associated with family obesity risk, nor with parental obesogenic food intake. Milk cereal drink consumption but no other infant dietary marker reflects relative weight at this young age.

Home environmental determinants of children's fruit and vegetable consumption across different SES backgrounds

OBJECTIVE

To investigate the association between home environmental determinants of fruit and vegetable consumption with childhood overweight separately for low, medium and high social economic status (SES) families.

METHOD

A cross-sectional study was carried out in 2006 among 4072 children aged 4-13 years in the city of Zwolle, the Netherlands. Of these children, data were available on measured height and weight, and from a parental questionnaire, on sociodemographic characteristics and children's fruit and vegetables intake. Associations were studied using logistic regression analyses.

RESULTS

Not eating the recommended amounts of vegetables daily was associated with overweight for children with a low SES background (odds ratio [OR]: 1.17; 95% confidence interval [CI]: 0.66-2.07) and medium SES background (OR: 1.73; 95% CI: 1.20-2.49). Eating < 2 pieces of fruit daily was associated with a lower OR for overweight among children with a high SES background (OR: 0.66; 95% CI: 0.50-0.88). Determinants of eating vegetables < 7 d were: permission to take candy without asking, eating at the table < 7 d per week, eating a takeaway meal ≥ 1 d per week, eating a home cooked meal < 6 d per week and cooking together with caregiver less than 5 d per week.

CONCLUSION

Interventions regarding vegetable consumption should be tailored to families with low and medium SES background. The most promising avenues for intervention seem to be (i) to prevent eating takeaway meals on a weekly basis and, (ii) to promote eating a home cooked meal at the table and (iii) to involve children in the cooking process. Interventions should support parents in making these home environmental changes.

Adolescent diet and time use clusters and associations with overweight and obesity and socioeconomic position

Risk factors for adolescent overweight and obesity include low levels of physical activity, high levels of sedentary behavior, low fruit and vegetable intake, and low socioeconomic position (SEP). To date, the vast majority of research investigating associations between lifestyle behaviors and weight status analyze dietary and time use factors separately. Our research aimed to describe Australian youth time use and diet clusters and explore relationships with weight status and SEP (parental education and income). Cluster analysis of the National Children's Nutrition and Physical Activity Survey data from Australians aged 9 to 16 years (random sample n = 1,853) was conducted. Time use data (17 age-adjusted time use variables) and dietary data (7 age-adjusted diet variables) were collected via 24-hour recalls. Two clusters were associated with a reduced frequency of overweight and obesity (the boys' Active Sitter and girls' Healthy Academic clusters) and one with an increased frequency of overweight and obesity (the boys' Unhealthy cluster). Of these three clusters, two demonstrated associations with parental income and/or parental education level. The boys' Unhealthy cluster was associated with low SEP status (parental income and education), and the girls' Healthy Academic cluster was associated with high parental income. Not all unhealthy adolescent clusters were associated with overweight and obesity. The findings suggest sex-specific diet and activity clusters can be used to identify at-risk subgroups and inform multifaceted interventions to address overweight and obesity.

What factors are associated with frequent unhealthy snack-food consumption among Australian secondary-school students?

OBJECTIVE

To examine demographic and behavioural correlates of unhealthy snack-food consumption among Australian secondary-school students and the association between their perceptions of availability, convenience and intake with consumption.

DESIGN

Cross-sectional survey of students' eating, physical activity and sedentary behaviours using validated instruments administered via an online questionnaire.

SETTING

Australian secondary schools across all states/territories.

SUBJECTS

Secondary-school students aged 12-17 years participating in the 2009-10 National Secondary Students' Diet and Activity (NaSSDA) survey (n 12 188).

RESULTS

Approximately one in five students (21 %) reported consuming unhealthy snack foods ≥14 times/week ('frequent snackers'). After adjusting for all covariates, older students and those with a BMI of ≥25 kg/m² were less likely to be frequent snackers, while students who reported high fast-food and high sugar-sweetened beverage consumption and those who watched television for >2 h/d were more likely to snack frequently. Furthermore, after adjusting for all covariates and demographic factors, students who agreed that snack foods are usually available at home, convenient to buy and that they eat too many snack foods were more likely to be snacking frequently. Conversely, students who agreed that fruit is a convenient snack were less likely to be frequent snackers.

CONCLUSIONS

Frequent unhealthy snack-food consumption appears to cluster with other poor health behaviours. Perceptions of availability and convenience are factors most readily amenable to change, and findings suggest interventions should focus on decreasing the availability of unhealthy snack foods in the home and promoting healthier options such as fruit as convenient snacks.

Effect of changes to the school food environment on eating behaviours and/or body weight in children: a systematic review

Previous school obesity-prevention reviews have included multi-component interventions. Here, we aimed to review the evidence for the effect of isolated food environment interventions on both eating behaviours (including food purchasing) and/or body weight. Five electronic databases were searched (last updated 30 November 2013). Of the 1,002 unique papers identified, 55 reported on school food environment changes, based on a review of titles and abstracts. Thirty-seven further papers were excluded, for not meeting the inclusion criteria. The final selection consisted of 18 papers (14 United States, 4 United Kingdom). Two studies had a body mass index (BMI) outcome, 14 assessed purchasing or eating behaviours and two studies assessed both weight and behaviour. Seventeen of 18 papers reported a positive outcome on either BMI (or change in BMI) or the healthfulness of food sold or consumed. Two studies were rated as strong quality and 11 as weak. Only three studies included a control group. A school environment supportive of healthy eating is essential to combat heavy marketing of unhealthy food. Modification of the school food environment (including high-level policy changes at state or national level) can have a positive impact on eating behaviours. A need exists, however, for further high-quality studies.

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

BACKGROUND/OBJECTIVE

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

METHODS/RESULTS

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

CONCLUSIONS

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

The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review

BACKGROUND

Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families.

METHODS

Searches of major electronic databases identified articles published from 1993-2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity.

RESULTS

Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m(2) to -0.54 kg/m(2) for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3-5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery.

CONCLUSION

There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required.

TRIAL REGISTRATION

PROSPERO Registration no: CRD42013006536.

Three-year change in diet quality and associated changes in BMI among schoolchildren living in socio-economically disadvantaged neighbourhoods

Findings from research that has assessed the influence of dietary factors on child obesity have been equivocal. In the present study, we aimed to test the hypothesis that a positive change in diet quality is associated with favourable changes in BMI z-scores (zBMI) in schoolchildren from low socio-economic backgrounds and to examine whether this effect is modified by BMI category at baseline. The present study utilised data from a subsample (n 216) of the Resilience for Eating and Activity Despite Inequality study, a longitudinal cohort study with data collected in 2007-8 (T1) and 2010-11 (T2) in socio-economically disadvantaged women and children (5-12 years at T1). Dietary data were collected using a FFQ and diet quality index (DQI) scores derived at both time points. The objective measures of weight, height and physical activity (accelerometers) were included. The other variables were reported in the questionnaires. We examined the association between change in DQI and change in zBMI, using linear regression analyses adjusted for physical activity, screen sedentary behaviour and maternal education level both in the whole sample and in the sample stratified by overweight status at baseline. After accounting for potential covariates, change in diet quality was found to be inversely associated with change in zBMI only in children who were overweight at baseline (P= 0.035), thus supporting the hypothesis that improvement in diet quality is associated with a concurrent improvement in zBMI among already overweight children, but not among those with a normal BMI status. The identification of modifiable behaviours such as diet quality that affect zBMI longitudinally is valuable to inform future weight gain prevention interventions in vulnerable groups.