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Lovell AL, Gardiner B, Henry L, Bate JM, Brougham MFH, Iniesta RR. The evolution of nutritional care in children and young people with acute lymphoblastic leukaemia: a narrative review. J Hum Nutr Diet 2024. [PMID: 38185902 DOI: 10.1111/jhn.13273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy in the world. Advances in treatment protocols have resulted in survival rates of >80% in most high-income countries (HIC); however, children and young people (CYP) with ALL continue to face significant nutrition-related challenges during treatment. METHODS This narrative review outlines the changing landscape of treatment and survivorship for CYP with ALL and the advances in nutrition knowledge that call for changes to clinical nutrition practice. RESULTS The incidence of ALL has remained stable in HIC; however, there have been significant advances in survival over the past 30 years. Overweight and obesity are increasingly prevalent in CYP with ALL at diagnosis, during treatment and in survivorship. Coupled with poor diet quality, high-energy and saturated fat intakes, altered eating behaviours and inactivity, this necessitates the need for a shift in nutrition intervention. Undernutrition remains a concern for CYP with high-risk treatment protocols where oral or enteral nutrition support remains a cornerstone of maintaining nutrition status. CONCLUSIONS With improved treatment protocols and high survival rates, a shift to focusing on diet quality, prevention of excessive weight gain and obesity during treatment and survivorship is necessary.
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Affiliation(s)
- Amy L Lovell
- Department of Nutrition and Dietetics, The University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
- Starship Blood and Cancer Centre, Starship Child Health, Auckland, New Zealand
| | - Breeana Gardiner
- Department of Nutrition and Dietetics, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Louise Henry
- Department of Nutrition and Dietetics, Royal Marsden NHS Foundation Trust, Surrey, UK
| | - Jessica M Bate
- Department of Paediatric Oncology, Southampton Children's Hospital, Southampton, UK
| | - Mark F H Brougham
- Department of Haematology and Oncology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Raquel Revuelta Iniesta
- Children's Health and Exercise Research Centre (CHERC), Faculty of Health and Life Sciences, Public Health and Sport Sciences, Medical School, St Luke's Campus, University of Exeter, Exeter, UK
- Child Life and Health, University of Edinburgh, Edinburgh, UK
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Hojsak I, Benninga MA, Hauser B, Kansu A, Kelly VB, Stephen AM, Morais Lopez A, Slavin J, Tuohy K. Benefits of dietary fibre for children in health and disease. Arch Dis Child 2022; 107:973-979. [PMID: 35277379 PMCID: PMC9606532 DOI: 10.1136/archdischild-2021-323571] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/23/2022] [Indexed: 01/12/2023]
Abstract
Fibre is an essential nutrient in the human diet that is crucial for human health. It provides a range of functional benefits, including stool bulking, and physiological benefits through fermentation of diverse fibre types by the gut microbiome including cholesterol lowering, glycaemic control and weight control. The by-products of the fermentation of fibre in the gut confer health benefits that extend beyond the gut to the immune system and organs such as the liver, kidneys and the brain. A lack of fibre in the diet has been associated with several disorders in children including constipation, irritable bowel syndrome, allergies and immune-related disorders. In paediatric practice, concerns exist over tolerance of dietary fibre which may lead to unnecessary restrictions, especially for children receiving nutritional support. One reason for this may be the terminology which has historically been used. Fibre is often described in terms of its physico-chemical properties (solubility, viscosity), rather than its physiological effects/functionality (fermentability, bulking effects). To describe fibre in these latter terms represents more clearly the important role it plays. Most international guidelines recommend a daily quantity of fibre, failing to mention the quality aspect of the fibre required for health. Here we consider the evidence base for the current recommendations for daily fibre intakes for healthy children, those requiring nutritional support and those with functional gastrointestinal disorders. We also consider the importance of the gut microbiome and the role of fibre in maintaining gut microbial health and its role in health beyond the gut.
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Affiliation(s)
- Iva Hojsak
- Referral Center for Paediatric Gastroenterology & Nutrition, Children's Hospital Zagreb, University of Zagreb Medical School, Zagreb, Croatia
| | - Marc A Benninga
- Department of Paediatric Gastroenterology & Nutrition, Emma Children's Hospital, Amsterdam University of Medical Centres, Amsterdam, The Netherlands
| | - Bruno Hauser
- Department of Paediatric Gastroenterology and Nutrition, KidZ Health Castle UZ Brussel, Brussels, Belgium
| | - Aydan Kansu
- Department of Pediatric Gastroenterology, Ankara University, School of Medicine, Ankara, Turkey
| | - Veronica B Kelly
- Pediatric Department, Children's Health Ireland, Dublin, Ireland
- Paediatric Neurosciences, Evelina Children's Hospital, London, UK
| | - Alison M Stephen
- Retired Professor of Public Health Nutrition, Department of Nutritional Sciences, University of Surrey, Surrey, UK
| | - Ana Morais Lopez
- Pediatric Nutrition, Hospital Universitario La Paz, Madrid, Spain
| | - Joanne Slavin
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, Minnesota, USA
| | - Kieran Tuohy
- Department of Food Quality and Nutrition, Fondazione Edmund Mach Istituto Agrario di San Michele all'Adige, San Michele all'Adige, Italy
- School of Food Science & Nutrition, University of Leeds, Leeds, UK
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3
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Melhuish E, Lindeback R, Lambert K. Scoping review of the dietary intake of children with chronic kidney disease. Pediatr Nephrol 2022; 37:1995-2012. [PMID: 35277755 DOI: 10.1007/s00467-021-05389-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/04/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Adequate nutrition is integral to optimal health outcomes for children with chronic kidney disease. However, no studies to date have summarised the existing knowledge base on the dietary intake of this patient group. OBJECTIVE Analyse and summarise evidence regarding the dietary intake of children with chronic kidney disease and identify areas that require further research or clarification. METHODS A scoping review of English language articles using four bibliographic databases and a predefined search term strategy. Weighted mean intake for each nutrient was calculated. RESULTS Eighteen studies were identified (1407 children and 118 healthy controls). Data on socioeconomic status, underreporting of intake and binder use was sparse. Most studies collected dietary information using food records or 24-h recalls. Nutrient data was missing for many subgroups especially transplant and dialysis patients. Protein intake was excessive in all groups where data was reported and varied from 125.7 ± 33% of the recommended dietary allowance in the severe disease group to 391.3 ± 383% in the group with mild kidney disease. Fibre, calcium, iron and vitamin C intake was inadequate for all groups. For children undertaking dialysis, none met the recommended dietary allowance for vitamins C, B1, B2, B3, B5 and B6. Sodium intake was excessive in all groups (> 220% of the recommended dietary allowance). Limited data suggests diet quality is poor, particularly fruit and vegetable intake. CONCLUSIONS This review has identified important subgroups of children with kidney disease where nutrient intake is suboptimal or not well described. Future studies should be conducted to describe intake in these groups. A higher-resolution version of the graphical abstract is available as Supplementary information.
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Affiliation(s)
- Erin Melhuish
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Building 41, Northfields Ave., Wollongong, NSW, 2526, Australia
| | - Rachel Lindeback
- Department of Nutrition and Dietetics, St. George Hospital, Kogarah, NSW, 2217, Australia
| | - Kelly Lambert
- School of Medical, Indigenous and Health Sciences, University of Wollongong, Building 41, Northfields Ave., Wollongong, NSW, 2526, Australia.
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Verdonschot A, Follong BM, Collins CE, de Vet E, Haveman-Nies A, Bucher T. Effectiveness of school-based nutrition intervention components on fruit and vegetable intake and nutrition knowledge in children aged 4-12 years old: an umbrella review. Nutr Rev 2022; 81:304-321. [PMID: 35947869 PMCID: PMC9912007 DOI: 10.1093/nutrit/nuac057] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
CONTEXT School-based nutrition interventions can support healthy eating in children. OBJECTIVE To identify components of school-based nutrition interventions and synthesize the impact on consumption of fruits and vegetables (FV) and nutrition knowledge (NK) in children aged 4-12 y. DATA SOURCES Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and PICOS inclusion criteria, relevant systematic reviews and/or meta-analyses, written in English, published between 2010 and August 2020, across 6 databases were identified. DATA EXTRACTION Two reviewers independently performed data extraction and assessed the study quality. DATA ANALYSIS The JBI Critical Appraisal Instrument for Systematic Reviews and Research Syntheses was used to assess review quality, and the Grading of Recommendations Assessment, Development, and Evaluation approach was used to rate strength of evidence. RESULTS From 8 included reviews, 7 intervention components were identified: FV provision, gaming/computer-delivered, curriculum, experiential learning, reward/incentives, nudging, and caregiver involvement. FV provision had the greatest effect on F intake, gaming/computer-delivered on V intake, and curriculum on NK. CONCLUSION FV provision and gaming/computer-delivered components showed, overall, some positive effect on FV intake, as did the curriculum component on NK. More evidence evaluating single-component effectiveness that considers the setting and context of nutrition interventions is required to strengthen the evidence base. SYSTEMATIC REVIEW REGISTRATION PROSPERO, registration no.: CRD42020152394.
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Affiliation(s)
- Angeliek Verdonschot
- A. Verdonschot, School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW 2308, Australia. E-mail:
| | - Berit M Follong
- are with the School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia,are with the Priority Research Centre for Physical Activity and Nutrition (PRCPAN), University of Newcastle, Callaghan, New South Wales, Australia
| | - Clare E Collins
- are with the School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, New South Wales, Australia,are with the Priority Research Centre for Physical Activity and Nutrition (PRCPAN), University of Newcastle, Callaghan, New South Wales, Australia
| | - Emely de Vet
- are with the Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, The Netherlands
| | - Annemien Haveman-Nies
- are with the Consumption and Healthy Lifestyles, Wageningen University and Research, Wageningen, The Netherlands
| | - Tamara Bucher
- are with the Priority Research Centre for Physical Activity and Nutrition (PRCPAN), University of Newcastle, Callaghan, New South Wales, Australia,with the School of Environmental and Life Sciences, College of Engineering, Science and Environment, University of Newcastle, Ourimbah, New South Wales, Australia
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5
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Liu A, Han A, Chai L. Assessing the Nutrient Adequacy in China's Food Supply from 1965 to 2018. Nutrients 2021; 13:nu13082734. [PMID: 34444894 PMCID: PMC8400167 DOI: 10.3390/nu13082734] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/06/2021] [Accepted: 08/07/2021] [Indexed: 12/31/2022] Open
Abstract
Nutritional intake has important impacts on human health. A sufficient supply of nutrients is required to ensure high-level nutrition in a population. Assessment of nutrient supply adequacy can help to develop evidence-based policies and thereby promote public health. This study estimates the supply adequacy of nutrients in China's food system from 1965 to 2018 at the national level, aiming to reveal whether the supply of nutrients meets the demand. The results show that the nutrient supply in China's food system has experienced a sharp increase in the past five decades, and the deficiency in nutrient supply has been greatly mitigated. Although most nutrients such as potassium are already sufficiently supplied in China's current food system, some nutrients, especially calcium and zinc, still need a further enlarged supply to improve the nutrition condition of the Chinese population. Besides encouraging a healthy diet, supply-side regulation, e.g., fortification and enrichment, is also needed to improve nutrient availability. This study helps people better understand the development and current situation of nutrient adequacy in China's food supply, thereby providing information and implications for policymakers.
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Affiliation(s)
- Ao Liu
- International College Beijing, China Agricultural University, Beijing 100083, China; (A.L.); (A.H.)
| | - Aixi Han
- International College Beijing, China Agricultural University, Beijing 100083, China; (A.L.); (A.H.)
| | - Li Chai
- International College Beijing, China Agricultural University, Beijing 100083, China; (A.L.); (A.H.)
- College of Economics and Management, China Agricultural University, Beijing 100083, China
- Correspondence:
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Sangsefidi ZS, Lorzadeh E, Hosseinzadeh M, Mirzaei M. Dietary habits and psychological disorders in a large sample of Iranian adults: a population-based study. Ann Gen Psychiatry 2020; 19:8. [PMID: 32123535 PMCID: PMC7041096 DOI: 10.1186/s12991-020-00263-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 02/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since an association has been found between diet and psychological problems, this study aimed to evaluate the relationship between dietary habits and psychological problems among Iranian adults. METHODS Data on dietary habits and psychological problems among 9965 adults were provided from the recruitment phase of Yazd Health Study, a population-based cohort research on Iranian adults. The association between dietary habits and psychological problems was assessed by multiple logistic regression analysis. RESULTS After the adjustment for confounders, fast food and fried food consumptions were associated with increased depressive [odds ratio (OR) = 1.61, 95% confidence interval (CI) 1.18-2.20] and stress symptoms (OR = 2.47, 95% CI 1.46-4.18), respectively. Eating breakfast had a protective role on stress features (OR = 0.60, 95% CI 0.39-0.92), while snack intake was related to higher odds of depressive (OR = 1.36, 95% CI 1.01-1.84), anxiety (OR = 1.99, 95% CI 1.55-2.56) and stress symptoms (OR = 1.73, 95% CI 1.23-2.54). There was also an inverse association between sweetened drink consumption and depressive (OR = 0.76, 95% CI 0.59-0.96), anxiety (OR = 0.76, 95% CI 0.62-0.93), and stress features (OR = 0.73, 95% CI 0.55-0.97; OR = 0.63, 95% CI 0.48-0.82). CONCLUSIONS Even though an inverse relationship was found between sweetened drinks intake and psychological problems, snack consumption was associated with higher chances of them. Eating breakfast had a protective effect on stress symptoms, while fast food and fried food intakes were related to increased depressive and stress features chances, respectively.
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Affiliation(s)
- Zohreh Sadat Sangsefidi
- 1Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,2Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Elnaz Lorzadeh
- 1Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,2Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahdieh Hosseinzadeh
- 1Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,2Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Mirzaei
- 3Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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7
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Thomson R, Adams L, Anderson J, Maftei O, Couper J, Giles L, Peña AS. Australian children with type 1 diabetes consume high sodium and high saturated fat diets: Comparison with national and international guidelines. J Paediatr Child Health 2019; 55:1188-1193. [PMID: 30614108 DOI: 10.1111/jpc.14373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/13/2018] [Accepted: 12/16/2018] [Indexed: 12/26/2022]
Abstract
AIM We aimed to evaluate the diets of children with type 1 diabetes (T1D) against recommended Australian dietary intakes and international T1D guidelines and compare them to children without T1D. METHODS A cross-sectional analysis in 143 children (103 children aged 8-18 years with T1D and 40 age- and gender-matched controls) and longitudinal analysis at 0, 3, 6 and 12 months in 90 T1D children were conducted. Diet was assessed using an Australian validated food frequency questionnaire. Diet quality was assessed against recommended servings and nutrient intakes from Australian Dietary Guidelines and International Society for Pediatric and Adolescent Diabetes (ISPAD) Nutritional Guidelines. RESULTS Diet was evaluated in 478 questionnaires. Diet composition did not differ between T1D and controls, and both groups did not meet the majority of the Australian Dietary Guidelines, except for fruit intake. The majority of T1D children and controls (80-83%) were overconsuming sodium (2837 ± 848 mg/day), discretionary foods (5.9 ± 2.5 serves/day) and saturated fat and trans fatty acids (13.1 ± 2.7% of total daily energy intake) in comparison with Australian and ISPAD guidelines. A total of 84% of T1D children and controls achieved the recommended intake of fibre (34.4 ± 11.0 g/day). Longitudinal analysis in children with T1D showed that total daily energy, macronutrient, micronutrient and food group servings intake did not change over the 12 months. Overconsumption of sodium, discretionary foods and saturated fat persisted over the 12-month study period. CONCLUSIONS The majority of Australian children, with and without T1D, is not meeting recommended dietary guidelines. Significant overconsumption of sodium, saturated fat and discretionary foods attracts the most concern.
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Affiliation(s)
- Rebecca Thomson
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, University of Adelaide, Adelaide, South Australia, Australia.,Endocrine and Diabetes Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Lucinda Adams
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, University of Adelaide, Adelaide, South Australia, Australia
| | - Jemma Anderson
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, University of Adelaide, Adelaide, South Australia, Australia.,Endocrine and Diabetes Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Oana Maftei
- Endocrine and Diabetes Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Jennifer Couper
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, University of Adelaide, Adelaide, South Australia, Australia.,Endocrine and Diabetes Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Lynne Giles
- School of Public Health, Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Alexia S Peña
- Discipline of Paediatrics, Robinson Research Institute, University of Adelaide, University of Adelaide, Adelaide, South Australia, Australia.,Endocrine and Diabetes Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
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8
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Velardo S, Drummond M. Australian children's discourses of health, nutrition and fatness. Appetite 2019; 138:17-22. [PMID: 30880084 DOI: 10.1016/j.appet.2019.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/17/2022]
Abstract
Talking to children about their health-related understandings and experiences can provide valuable information for public health practitioners who seek to improve children's dietary behaviours. To date, however, research on children's food consumption has generally prioritized the views of parents and caregivers, rather than children themselves. This paper reports results from a qualitative study that explored preadolescent children's attitudes and perceptions towards health and nutrition. 38 children aged 11-12 years, across three state government schools, took part in an individual interview or group interview. Interviews were recorded, transcribed verbatim and analysed using thematic analysis techniques. Our results indicate that children inextricably linked the concept of health to diet and physical activity. They pondered the connection between different types of foods and physical implications for the body, emphasising nutrition and physical activity as a resource for preventing the onset of chronic disease and specifically the state of 'fatness'. Children collectively overemphasised the correlation between body size and health, and expressed that people should take responsibility for healthy choices to prevent fatness. In their discussions, they referred to aesthetic elements of the body and negative consequences of obesity. Overall, we argue that children's discourses of health and nutrition are potentially problematic. Results suggest that it is important to reshape these ideas to encourage children to develop more positive relationships with food and physical activity.
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Affiliation(s)
- Stefania Velardo
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; Sport, Health, Activity, Performance and Exercise Research Centre, Flinders University, Adelaide, Australia.
| | - Murray Drummond
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; Sport, Health, Activity, Performance and Exercise Research Centre, Flinders University, Adelaide, Australia
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9
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Johnson SL, Ryan SM, Kroehl M, Moding KJ, Boles RE, Bellows LL. A longitudinal intervention to improve young children's liking and consumption of new foods: findings from the Colorado LEAP study. Int J Behav Nutr Phys Act 2019; 16:49. [PMID: 31159810 PMCID: PMC6547533 DOI: 10.1186/s12966-019-0808-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/08/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Many interventions have been conducted to improve young children's liking and consumption of new foods however their impacts on children's consumption have been limited. Consistent evidence supports the use of repeated exposure to improve liking for new foods however longitudinal effects lasting greater than 6 months often have not been demonstrated. Here we report the eating-related findings of the Colorado Longitudinal Eating And Physical Activity (LEAP) Study, a multi-component intervention, delivered primarily in the school setting, which aimed to improve children's liking and consumption of a target food via repeated exposure and positive experiential learning. METHODS Four sites in rural Colorado, each housing Head Start preschool programs, matched on state vital statistics for childhood obesity rates, (2 intervention and 2 control sites) took part in a quasi-experimental study design which included 4 time points (baseline, post-intervention, one-year [Y1] and two- year [Y2] follow ups). A total of 250 children and families were enrolled (n = 143 intervention and n = 107 control; 41% Hispanic and 69% low-income). A 12-week intervention, Food Friends - Fun With New Foods®, delivered by trained preschool teachers and which focuses on positive and repeated experiences with new foods, and a 5-month (1 unit/month) social marketing "booster program" was delivered in kindergarten (one-year follow up) and 1st grade (two-year follow up). Main outcome measures included change in children's liking for new foods, analyzed by ordinal regression using generalized estimating equations, and change in weighed consumption of new foods over time, analyzed using a hierarchical mixed effects model. RESULTS The intervention was delivered with good fidelity (87%). Both intervention and control groups demonstrated an increase in liking for the target food over time (p = 0.0001). The pattern of consumption of the target food was different, over time, for intervention and control groups (p < 0.005). In particular the change in intake between baseline and post-intervention was significantly greater in the intervention compared to the control group (p < 0.0001) though this pattern of change did not hold between baseline and Y2 follow up (p = 0.1144). Children in the intervention group who liked the target food consumed nearly double their baseline consumption at post-intervention (p < 0.0001;) and maintained this increase at Y2 follow up (p < 0.0001). CONCLUSIONS The Food Friends intervention, which utilized positive, repeated experiences with new foods, and was delivered with good fidelity by trained preschool teachers, found that larger improvements were observed in children's eating behaviors than would be expected with developmentally-based changes in eating behaviors. TRIAL REGISTRATION NUMBER This trial is registered at ClinicalTrials.gov : NCT01937481. Date registered: 09/09/2013; Retrospectively registered. Date first participant registered: 09/15/2010.
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Affiliation(s)
- Susan L. Johnson
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO USA
| | - Sarah M. Ryan
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Aurora, CO USA
| | - Miranda Kroehl
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Aurora, CO USA
| | - Kameron J. Moding
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO USA
| | - Richard E. Boles
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO USA
| | - Laura L. Bellows
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO USA
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10
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Nathan N, Janssen L, Sutherland R, Hodder RK, Evans CEL, Booth D, Yoong SL, Reilly K, Finch M, Wolfenden L. The effectiveness of lunchbox interventions on improving the foods and beverages packed and consumed by children at centre-based care or school: a systematic review and meta-analysis. Int J Behav Nutr Phys Act 2019; 16:38. [PMID: 31036038 PMCID: PMC6489330 DOI: 10.1186/s12966-019-0798-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 04/10/2019] [Indexed: 01/04/2023] Open
Abstract
Objective To assess the effectiveness of lunchbox interventions aiming to improve the foods and beverages packed and consumed by children at centre-based care or school; and subsequent impact on children’s adiposity. Methods Systematic search of nine databases for controlled trials published in English between 1995-January 2017. Where appropriate, data were pooled in a random effects meta-analysis. Results Of the 1601 articles identified, ten studies (centre-based care n = 4, school n = 6) were included of which eight were RCTs. The impact of interventions on the packing of discretionary foods, sugar-sweetened drinks and other core foods was inconsistent. Meta-analysis of four RCTs trials found a moderate increase in provision of vegetables (SMD = 0.40 95% CI 0.16 to 0.64, p = 0.001, I2 = 82%; equivalent to a mean difference of 0.28 serves) but not fruit. Four studies reported impact on children’s dietary intake, one reported no significant effect on consumption of discretionary foods, one reported improvements in the consumption of sugar-sweetened drinks and water, and two reported improvements in consumption of vegetables and fruit. Two studies, that were broader obesity prevention interventions, reported no significant impact on adiposity. Conclusions There is some evidence that lunchbox interventions are effective in improving the packing of vegetables in children’s lunchboxes, however more robust research is required to determine the impact on children’s dietary intake and adiposity. Trial registration PROSPERO 2016: CRD42016035646. Electronic supplementary material The online version of this article (10.1186/s12966-019-0798-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicole Nathan
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia. .,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia. .,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, Australia. .,Hunter Medical Research Institute, Newcastle, Australia. .,Hunter New England Population Health, Locked Bag No. 10, Wallsend, NSW, 2287, Australia.
| | - Lisa Janssen
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Rebecca Kate Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Charlotte E L Evans
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Newcastle, UK
| | - Debbie Booth
- University Library, Academic Division, University of Newcastle Australia, Newcastle, Australia
| | - Sze Lin Yoong
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Kathryn Reilly
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Meghan Finch
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, The University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, Newcastle, Australia
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11
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de Vlieger N, Riley N, Miller A, Collins CE, Bucher T. Nutrition education in the Australian New South Wales primary school curriculum: An exploration of time allocation, translation and attitudes in a sample of teachers. Health Promot J Austr 2018; 30:94-101. [PMID: 30054958 DOI: 10.1002/hpja.188] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/24/2018] [Indexed: 02/04/2023] Open
Abstract
ISSUE ADDRESSED The dietary intakes of Australian children are not optimal, with few meeting recommended vegetable and fruit intake targets. Nutrition education in childhood is important for developing healthy eating patterns, with schools an ideal setting for a wide reach. The aims of this study were to examine nutrition education within the NSW primary school syllabus, explore how much time teachers spend teaching nutrition, what is taught, what materials are used, and to identify attitudes towards nutrition education. METHOD An online survey consisting of 29 closed questions (with options for comments) was specifically developed for the purpose of this study. Teachers currently teaching at a NSW primary school were eligible to participate. RESULTS A total of 33 NSW primary school teachers completed the survey. Results indicate that limited time is spent on teaching nutrition with some important nutrition education components currently missed, resources perceived to be inadequate and lack of time reported as the largest barrier to teaching nutrition. CONCLUSION In order to improve the quality of nutrition education in NSW primary schools, several important topics need to be integrated into the curriculum, and time constraints of teachers should be taken into account. SO WHAT?: Findings from the current survey will inform the development of future nutrition education programs and resources with the aim of integrating nutrition education within the primary school curriculum.
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Affiliation(s)
- Nienke de Vlieger
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
| | - Nicholas Riley
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia.,School of Education, Faculty of Education and Arts, The University of Newcastle, Newcastle, NSW, Australia
| | - Andrew Miller
- School of Education, Faculty of Education and Arts, The University of Newcastle, Newcastle, NSW, Australia
| | - Clare E Collins
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
| | - Tamara Bucher
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
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12
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Childhood dietary trajectories and adolescent cardiovascular phenotypes: Australian community-based longitudinal study. Public Health Nutr 2018; 21:2642-2653. [PMID: 29947308 DOI: 10.1017/s1368980018001398] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE With the intention to inform future public health initiatives, we aimed to determine the extent to which typical childhood dietary trajectories predict adolescent cardiovascular phenotypes. DESIGN Longitudinal study. Exposure was determined by a 4 d food diary repeated over eight waves (ages 4-15 years), coded by Australian Dietary Guidelines and summed into a continuous diet score (0-14). Outcomes were adolescent (Wave 8, age 15 years) blood pressure, resting heart rate, pulse wave velocity, carotid intima-media thickness, retinal arteriole-to-venule ratio. Latent class analysis identified 'typical' dietary trajectories from childhood to adolescence. Adjusted linear regression models assessed relationships between trajectories and cardiovascular outcomes, adjusted for a priori potential confounders. SETTING Community sample, Melbourne, Australia. SUBJECTS Children (n 188) followed from age 4 to 15 years. RESULTS Four dietary trajectories were identified: unhealthy (8 %); moderately unhealthy (25 %); moderately healthy (46 %); healthy (21 %). There was little evidence that vascular phenotypes associated with the trajectories. However, resting heart rate (beats/min) increased (β; 95 % CI) across the healthy (reference), moderately healthy (4·1; -0·6, 8·9; P=0·08), moderately unhealthy (4·5; -0·7, 9·7; P=0·09) and unhealthy (10·5; 2·9, 18·0; P=0·01) trajectories. CONCLUSIONS Decade-long dietary trajectories did not appear to influence macro- or microvascular structure or stiffness by mid-adolescence, but were associated with resting heart rate, suggesting an early-life window for prevention. Larger studies are needed to confirm these findings, the threshold of diet quality associated with these physiological changes and whether functional changes in heart rate are followed by phenotypic change.
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13
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Hardy LL, Baur LA, Wen LM, Garnett SP, Mihrshahi S. Descriptive epidemiology of changes in weight and weight-related behaviours of Australian children aged 5 years: two population-based cross-sectional studies in 2010 and 2015. BMJ Open 2018; 8:e019391. [PMID: 29627808 PMCID: PMC5892739 DOI: 10.1136/bmjopen-2017-019391] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Over the past 10-15 years there has been substantial investment in New South Wales (NSW), Australia, to reduce child obesity through interventions in children aged 0-5 years. We report changes in weight and weight-related behaviours of 5-year-old children. DESIGN Cross-sectional surveys conducted in 2010 and 2015. SETTING NSW schools (2010 n=44; 2015 n=41) PARTICIPANTS: Australian children in kindergarten (2010 n=1141 and 2015 n=1150). OUTCOME MEASURES Change in anthropometry and indicators of diet, screen time, school travel and awareness of health recommendations. Additionally, we examined 2015 differences in weight-related behaviours by sociodemographic characteristics. RESULTS Prevalence of overweight/obesity was 2.1% lower (adjusted OR (AOR) 0.83, 95% CI 0.67 to 1.04) and abdominal obesity 1.7% higher (AOR 1.35, 95% CI 0.93 to 1.98) in 2015 than 2010. Significant improvements in multiple weight-related behaviours were observed among children in the highest tertile of junk food consumption (AOR 0.63, 95% CI 0.50 to 0.80), rewarded for good behaviour with sweets (AOR 0.59, 95% CI 0.47 to 0.74) and had a TV in their bedroom (AOR 0.65, 95% CI 0.43 to 0.96). In 2015, children from low socioeconomic neighbourhoods and non-English-speaking backgrounds were generally less likely to engage in healthy weight-related behaviours than children from high socioeconomic status neighbourhoods and from English-speaking backgrounds. Children in these demographic groups were less likely to eat breakfast daily, have high junk food intake and eat fast food regularly. Children from rural areas tended to have healthier weight-related behaviours than children from urban areas. CONCLUSIONS There were significant positive changes in 5-year-old children's weight-related behaviours but children from low socioeconomic neighbourhoods and from non-English-speaking backgrounds were more likely to engage in unhealthy weight-related behaviours than children from high socioeconomic neighbourhoods and English-speaking backgrounds. The findings indicate that there is a need to enhance population-level efforts and ensure community programmes are targeted and tailored to meet different subpopulation needs.
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Affiliation(s)
- Louise L Hardy
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise A Baur
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre for Research Excellence in The Early Prevention of Obesity in Childhood, The University of Sydney, Sydney, New South Wales, Australia
| | - Li Ming Wen
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre for Research Excellence in The Early Prevention of Obesity in Childhood, The University of Sydney, Sydney, New South Wales, Australia
- Health Promotion Unit, Sydney Local Health District, Camperdown, NSW, Australia
| | - Sarah P Garnett
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, Kids Research Institute at the Children's Hospital, Westmead, New South Wales, Australia
| | - Seema Mihrshahi
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- NHMRC Centre for Research Excellence in The Early Prevention of Obesity in Childhood, The University of Sydney, Sydney, New South Wales, Australia
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14
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Reilly K, Nathan N, Wolfenden L, Wiggers J, Sutherland R, Wyse R, Yoong SL. Validity of four measures in assessing school canteen menu compliance with state-based healthy canteen policy. Health Promot J Austr 2018; 27:215-221. [PMID: 27651107 DOI: 10.1071/he16053] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 08/04/2016] [Indexed: 01/27/2023] Open
Abstract
Issue addressed In order to assess the impact of healthy school canteen policies on food availability for students, valid methods of measuring compliance are needed that can be applied at scale. The aim of this study is to assess the validity and direct cost of four methods to assess policy compliance: 1) principal and 2) canteen manager self-report via a computer-assisted telephone interview; and 3) comprehensive and 4) quick menu audits by dietitians, compared with observations. Methods A cross-sectional study took place in the Hunter region of NSW, Australia, in a sample of 38 primary schools that had previously participated in a randomised controlled trial to improve healthy canteen policy compliance. Policy compliance was assessed using the four methods specified above. Percentage agreement, kappa, sensitivity and specificity compared with observations was calculated together with the direct time taken and costs of each method. Indirect costs (including set-up costs) for all measures have not been included. Results Agreement with observations was substantial for the quick menu audit (kappa=0.68), and moderate for the comprehensive menu audit (kappa=0.42). Principal and canteen manager self-report resulted in poor agreement and low specificity with the gold standard. The self-reported measures had the lowest cost, followed by the quick menu audit and lastly the comprehensive menu audit. Conclusion The quick menu audit represents a valid and potentially low-cost method of supporting policy implementation at scale. So what? This study demonstrates that a quick menu audit represents a valid measure of undertaking assessment of school canteen policy compliance at a population level.
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Affiliation(s)
- Kathryn Reilly
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Nicole Nathan
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Rachel Sutherland
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
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15
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Velardo S, Drummond M. Australian children's perceptions of discretionary foods. Appetite 2018; 120:43-48. [DOI: 10.1016/j.appet.2017.08.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 07/31/2017] [Accepted: 08/21/2017] [Indexed: 11/25/2022]
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16
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Barco Leme AC, Tucunduva Philippi S. Home food availability, parents’/caregivers’ support, and family meals influence on dietary servings of low-income urban adolescent girls from Brazil. ACTA ACUST UNITED AC 2017. [DOI: 10.1186/s41110-017-0053-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Purpose
This paper aims to evaluate the impact of the groups from the Brazilian Food Pyramid on macro and micronutrient content of food consumed by adolescent girls from a school-based study.
Design/methodology/approach
Baseline data from “Healthy Habits, Healthy Girls” school-based randomized control trial was used for this study. A sample of the girls aged 14 to 18 years old (n = 253) from ten schools in Brazil was evaluated. Participants completed validated food frequency questionnaire, from which, the total kilocalories and/or grams from each food groups were calculated. Descriptive statistics, t-student test and linear regression were used for the analysis with a significant level of p < 0.05.
Findings
Mean daily intake of the girls was 2,887.09 (standard error 91.50) kcal/day. There was a positive significant association between relative intake of the “Oil and Fats” group and protein (ranged from 24.95 to 96.12 kcal/d), fats (48.36 to 192.62 kcal/d), iron (56.93 to 162.85 kcal/d) and sodium (208.08 to 699.69 kcal/d) contents. In regards to the intake of “Sugars and Sweets” group, there was a positive significant association for carbohydrates (97.53 to 491.70 kcal/day), total fiber (0.56 to 2.64 kcal/d), iron (0.85 to 4.40 kcal/d) and sodium (175.59 to 838.48 kcal/d) content.
Originality/value
Findings demonstrate that girls over consumed the “Oils and Fats” and “Sugars and Sweets” groups reflecting on increased of important macro and micronutrients of their diet. Therefore, consuming up to 1 serving size of these groups is a good way to promote healthy eating among this population.
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Pettigrew S, Jongenelis M, Miller C, Chapman K. A path analysis model of factors influencing children's requests for unhealthy foods. Eat Behav 2017; 24:95-101. [PMID: 28081517 DOI: 10.1016/j.eatbeh.2016.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/08/2016] [Accepted: 12/19/2016] [Indexed: 11/30/2022]
Abstract
Little is known about the complex combination of factors influencing the extent to which children request unhealthy foods from their parents. The aim of this study was to develop a comprehensive model of influencing factors to provide insight into potential methods of reducing these requests. A web panel provider was used to administer a national online survey to a sample of 1302 Australian parent-child dyads (total sample n=2604). Initial univariate analyses identified potential predictors of children's requests for and consumption of unhealthy foods. The identified variables were subsequently incorporated into a path analysis model that included both parents' and children's reports of children's requests for unhealthy foods. The resulting model accounted for a substantial 31% of the variance in parent-reported food request frequency and 27% of the variance in child-reported request frequency. The variable demonstrating the strongest direct association with both parents' and children's reports of request frequency was the frequency of children's current intake of unhealthy foods. Parents' and children's exposure to food advertising and television viewing time were also positively associated with children's unhealthy food requests. The results highlight the need to break the habitual provision of unhealthy foods to avoid a vicious cycle of requests resulting in consumption.
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Affiliation(s)
- Simone Pettigrew
- School of Psychology and Speech Pathology, Curtin University, Kent St, Bentley, Perth 6102, Western Australia, Australia.
| | - Michelle Jongenelis
- School of Psychology and Speech Pathology, Curtin University, Kent St, Bentley, Perth 6102, Western Australia, Australia.
| | - Caroline Miller
- South Australian Health and Medical Research Institute, University of Adelaide, Australia.
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