Tracking of toddler fruit and vegetable preferences to intake and adiposity later in childhood

Sex- and gender-based medicine in pediatric nutrition

Consistent evidence increasingly highlights the significance of integrating sex and gender medicine to ensure a precision approach according to individual patient needs. Gender discrepancies emerge across various areas, even from pediatric age. The importance of recognizing these differences in pediatric nutrition is critical for the development of targeted nutritional strategies and interventions, particularly in cases of associated pathologies, including obesity, metabolic-associated fatty liver disease, eating disorders, and inflammatory bowel disease. The review highlights the biological and sociocultural factors that contribute to different nutritional needs and health outcomes in male and female children. By examining current evidence, we underscore the necessity for precision medicine approaches in pediatric care that consider these sex- and gender-based differences. Moreover, differences in dietary requirements and dietary patterns between males and females are evident, underscoring the need for precise nutrition strategies for a more accurate management of children and adolescents. This approach is essential for improving clinical outcomes and promoting equitable healthcare practices. This review aims to provide an overview of nutrition-related medical conditions exhibiting sex- and gender-specific discrepancies, which might lead to distinct outcomes requiring unique management and prevention strategies. Future research and public health initiatives should address these differences in designing effective lifestyle education programs and nutrition interventions targeting both children and adolescents.

Concordance in dietary intake among caregivers and infants during the period of complementary feeding: A scoping review

Dietary intake during infancy shapes later food preferences and is important for short- and long-term health and wellbeing. Although caregivers are thought to influence the developing food preferences of infants, children less than two years have been notably absent in existing meta-analyses on the topic. This scoping review seeks to fill this gap by using a systematic process to identify and summarize the published literature on the resemblance of caregiver and infant diet during the period of complementary feeding (6-23 months). Articles were included if they assessed intake of foods or beverages other than human milk or commercial milk formula and reported a test of association between the intake of caregivers and infants. Four electronic databases (PubMed, EMBASE, Scopus, and Global Health) were systematically searched for articles published since 2000. Thirty-three articles, representing 32 studies, were identified. The majority of studies examined infant intake of food groups/items (n = 20), seven studies examined infant dietary patterns, and six studies examined dietary diversity. Studies predominantly reported associations between diets of mothers and infants (n = 31); three studies reported associations for fathers. Most studies assessed infant diet at one timepoint (n = 26), with 12 studies combining the intakes of younger (0-11 months) and older infants (12-23 months). Food groups examined, in order of frequency, included 'non-core' foods and beverages (n = 14), vegetables (n = 13), fruits (n = 12), protein foods (n = 6), grains (n = 5), and dairy foods (n = 4). Definitions of variables for food groups and dietary patterns were highly heterogeneous, but consistent for dietary diversity. Nearly all studies (n = 31) reported significant associations between dietary intakes of caregivers and infants. Findings suggest caregiver diet may be a promising focus for interventions aiming to shape the food preferences and dietary intakes of infants.

Role-model, reoffer, reward: A thematic analysis and TDF mapping of influences on families' use of evidence-based vegetable feeding practices

Children's vegetable intake is low, despite benefits for immediate and long-term health. Repeatedly reoffering vegetables, role-modelling consumption, and offering non-food rewards effectively increase children's vegetable acceptance and intake. However, a number of barriers prevent families from reoffering previously-rejected vegetables. This study used the Theoretical Domains Framework (TDF) and the COM-B model of behaviour to explore barriers and enablers to reoffering, role-modelling and offering non-food rewards among parents of 2-4-year-old children. Twenty-five semi-structured interviews were conducted, from which eleven core inductive themes were generated: 'Child factors', 'Eating beliefs', 'Effectiveness beliefs', 'Past experience', 'Current family behaviours', 'Harms', 'Knowledge', 'Need for change', 'Parent effort', 'Parent values' and 'Practical issues'. The codes underpinning these themes were inductively mapped to 11 of the 14 TDF domains, and five of the six COM-B components. Previously-reported influences on families' vegetable feeding practices were confirmed, including concerns about child rejection of foods/meals, cost of vegetables, and food waste. Novel findings included some parents' perceptions that these practices are pressurising, and that certain beliefs/knowledge about children's eating behaviour can provide a "protective mindset" that supports families' perseverance with reoffering over time. Future interventions should be tailored to better reflect the diversity of needs and previous experiences of feeding that families have, with some families likely to find that troubleshooting and further signposting is appropriate for their needs while others might benefit from more persuasive and educational approaches. The mapping of codes to the TDF and COM-B will facilitate the identification of appropriate intervention functions and behaviour change techniques when designing new interventions to support families with increasing their children's vegetable intake.

Food addiction and dietary restraint in postpartum women: The role of childhood trauma exposure and postpartum depression

The early postpartum period is a sensitive time for understanding women's high-risk eating (i.e., eating behavior associated with negative health outcomes) given potential long-term eating behavior implications for infants. Food addiction and dietary restraint are two high-risk eating phenotypes associated with long-term negative health outcomes that have been theoretically linked. Yet, no research has considered how much these constructs overlap during the early postpartum period. The present study sought to characterize these two high-risk eating phenotypes in postpartum women to examine whether these are distinct constructs with specific etiologies and to inform future targets of intervention. Women (N = 277) in the early postpartum period reported on high-risk eating, childhood trauma exposure, depression symptoms, and pre-pregnancy weight. Women's height was measured and pre-pregnancy BMI was calculated. We conducted bivariate correlations and path analysis to characterize the relationship between food addiction and dietary restraint, controlling for pre-pregnancy BMI. Results showed that food addiction and dietary restraint were not significantly associated and that women's childhood trauma exposure and postpartum depression were associated with food addiction but not dietary restraint. Sequential mediation revealed that higher levels of childhood trauma exposure were associated with worse postpartum depression and, in turn, greater food addiction during the early postpartum period. Findings suggest that food addiction and dietary restraint have distinct psychosocial predictors and etiological pathways, which suggests important construct validity differences between the two high-risk eating phenotypes. Interventions seeking to address food addiction in postpartum women and mitigate the impact of this high-risk eating phenotype on the next generation may benefit from treating postpartum depression, especially in women with histories of childhood trauma exposure.

Describing the longitudinal breakfast quality index trajectories in early childhood: results from Melbourne InFANT program

BACKGROUND

Breakfast quality in early childhood remains understudied. This study describes the changes in breakfast quality index (BQI) (i.e. trajectory) in early childhood and assesses its associations with obesity outcomes.

METHODS

Data from children who participated in the Melbourne InFANT Program were used (n = 328). The Melbourne InFANT Program was a 15-month early obesity prevention intervention conducted from 2008 to 2013. Dietary intakes at ages 1.5, 3.5 and 5.0 years were assessed using three parent-proxy reported 24 h recalls. A revised nine-item BQI tool developed based on Australian dietary recommendations for young children was used to calculate BQI scores. Group-based trajectory modelling identified BQI trajectory groups. Multivariable linear and logistic regression examined the associations between identified BQI trajectory groups and obesity outcomes at age 5 years.

RESULTS

Mean BQI at ages 1.5, 3.5 and 5.0 years was 4.8, 4.8, 2.7 points, respectively. Two BQI trajectory groups were identified, and both showed a decline in BQI. The mean BQI of most children (74%) decreased from 5.0 to 4.0 points from ages 1.5 to 5.0 years (referred as "High BQI" group). The remaining children (26%) had a mean BQI of 4.8 and 1.2 points at age 1.5 and 5.0 years, respectively (referred as "Low BQI" group). The "Low BQI" group appeared to show higher risk of overweight (OR:1.30, 95% CI: 0.60, 2.81, P = 0.66) at age 5 years than the "High BQI" group. No difference in body mass index (BMI) z-score was found between the two groups.

CONCLUSIONS

Two BQI trajectory groups were identified. Both groups showed a decline in breakfast quality from ages 1.5 to 5.0 years. Our study highlights the need for early health promotion interventions and strategies to improve and maintain breakfast quality across early childhood.

The Chinese version of the child food neophobia scale and its reliability and validity in preschool children

OBJECTIVE

To translate the English version Child Food Neophobia Scale (CFNS) into the Chinese version and test its reliability and validity in preschool children.

METHODS

To create the Chinese version of the CFNS, it was translated, back-translated, and cross-culturally adapted. The use of the Chinese version of CFNS by 575 parents of preschool children in two kindergartens in Yangzhou City was investigated using cluster sampling to assess the reliability and validity of the scale.

RESULTS

The Chinese version of CFNS has nine items in total. The scale-level average content validity index (S-CVI/Ave) is 0.983. Exploratory factor analysis (EFA) extracted 2 common factors, and the cumulative variance contribution rate was 49.437%. Confirmatory factor analysis (CFA) showed that the 2-factor model was well fitted. The Cronbach'α coefficient of the scale was 0.759, the Cronbach'α coefficients of the two factors were 0.735 and 0.713, the split-half reliability was 0.788, and the test-retest reliability was 0.756.

CONCLUSION

The Chinese version of the Child Food Neophobia Scale has good reliability and validity in preschool children and can be used as an assessment tool for food neophobia in preschool children in China.

PRACTICE IMPLICATIONS

This study has gone through a rigorous translation process, and the CFNS may support future exploration of food neophobia in preschool children. Food allergy factors in the results may be the next step in the research, and several studies are still needed to understand the relationship between food allergy and food neophobia.

Prevalence and correlates of overweight and obesity among under-five children in Egypt

Background

Evidence suggests that Egypt, a country in North Africa, has a significant number of children at serious risk of excess body weight. Yet, there is a dearth of studies on overweight and obesity among children under 5 years in the country. This study examined the prevalence and correlates of overweight and obesity among under-five children in Egypt.

Methods

Data were retrieved from the latest (2008 and 2014) Egypt Demographic and Health Surveys (EDHS). A total of 42,568 children under 5 years were included. The prevalence of overweight and obesity was described using proportions whereas the factors associated with the prevalence were examined using logistic regression.

Results

Of the 42,568 children under 5 years, about one in every six (17%) were overweight or obese. Children aged 19-37 months, those with birth weights >4 kg, those given large portions of protein foods (eggs and meat), and those whose mothers were in the rich wealth quintile had significant risks of overweight or obesity.

Conclusion

Overweight and obesity are highly prevalent among children under 5 years in Egypt. Interventions developed to address these two overnutrition indicators in Egypt need to consider variations in risk factors across age, birth weight, food types and portions, and maternal wealth status.

Association between dietary related factors and central obesity among married women: China Health and Nutrition Survey

Waist-to-height ratio (WHtR) with a cut-off value of 0.5 has been recognized as an anthropometric indicator of central obesity to predict the risk of the chronic disease. The aim of our study was to identify dietary related risk factors of central obesity based on WHtR. We used cross-sectional data from the China Health and Nutrition Survey (CHNS) in 2011 obtained from 2881 married women aged 19-55. The association of dietary related factors and central obesity was analyzed using binary logistic regression and back-propagation artificial neural network. Overall, central obesity prevalence was 48.4% (1394/2881). Compared to the population of women without central obesity, the population of women with central obesity had an older average age (41.84 ± 6.89 years vs 38.45 ± 7.91 years, P < 0.001), and meanwhile an average lower per capita annual income (13904 ± 15916 CNY vs 16753 ± 19163 CNY, P < 0.001). Our analysis indicated that the score of dietary knowledge (adjusted odds ratio (aOR), 0.956; 95% confidence interval (CI), 0.936-0.976) and the score of food preferences (aOR, 0.961; 95% CI, 0.926-0.997) were significantly associated with lower risk of central obesity; whereas fast food (aOR, 1.002; 95% CI, 1.000-1.003) was associated with higher risk of central obesity. The study showed the score of dietary knowledge (15.5%), fast foods (10.2%), and the score of food preferences (8.8%) were the most important modifiable factors for central obesity. In summary, aging, fast food intake, and lower per capita annual income were positively associated with higher prevalence of central obesity, while higher scores of dietary knowledge and food preferences were negatively correlated. More nutrition education programs should be implemented by the government to strengthen the pro-healthy dietary behaviors.

Evaluation of a Farm-to-School Intervention to Improve Locally Grown Vegetable Choices of Low-Income, Primary School Students

BACKGROUND

The study objective was to determine impact of a Farm-to-School intervention on low-income, diverse elementary school students' nutrition-related attitudes, self-efficacy, behaviors, and locally grown vegetable choices.

METHODS

Six elementary schools within 1 US school district were equally assigned to 1 of 3 conditions: Local Message, Nutrition Message, or Control. Locally grown vegetables (kale, green beans, zucchini, butternut squash, and beets) were served twice during lunch over 16 weeks. "Local" and "Nutrition" groups also received biweekly nutrition education and a messaging campaign in the cafeteria. Knowledge, attitudes, self-efficacy, and related behaviors were assessed using a validated questionnaire. Vegetable selection was assessed using the food service daily production records. General linear model analysis, analysis of covariance, and t tests were performed.

RESULTS

Students in the "Local" group (N = 81) had significantly improved nutrition-related attitudes (p = .0001), preferences (p = .001), and overall vegetable behavior score (p = .002), compared to control (N = 79). There was no difference in overall locally grown vegetable choices, but local beet choices were higher in the "Local" (p = .005) and "Nutrition" (p = .02) groups compared to control.

CONCLUSIONS

Messages about local foods in school cafeterias may improve students' attitudes, preferences, and selection of certain locally grown vegetables.

Mothers' Perceptions and Attitudes towards Children's Vegetable Consumption-A Qualitative, Cross-cultural Study of Chilean, Chinese and American Mothers Living in Northern California

This exploratory research focused on the cultural variables involved in children’s vegetable consumption, through the analysis of mothers’ perceptions, attitudes, and feeding practices regarding their children’s intake, using qualitative consumer research methods. Twelve focus groups of mothers with children between 2–12 years old (Euro-Americans n = 20, Chinese n = 19, and Chilean n = 19) were conducted. All participants lived in Northern California, had higher education, and incomes that did not limit their vegetable purchase. Intercultural differences in vegetable preferences and consumption habits were found. Mothers across all groups agreed on the importance of children’s vegetable consumption, the influence that mothers have over their children’s vegetable intake, and how challenging it is to get children to eat a variety of vegetables. The ethnic groups differed regarding how they perceived the level of mothers’ responsibility over children’s vegetable intake, the way that mothers defined the amount of vegetables that children should eat, the constraints that mothers had on increasing their children’s vegetable intake and mothers’ recommendations to encourage vegetable consumption. Our study suggests that under similar socio-economic and parental education levels, culture-specific strategies should be considered to foster healthy dietary habits in children.

A narrative review of highly processed food addiction across the lifespan

Evidence is growing that highly processed (HP) foods (i.e., foods high in refined carbohydrates and fat) are highly effective in activating reward systems and may even be capable of triggering addictive processes. Unlike traditional drugs of abuse, exposure to HP foods is common very early in development. HP food addiction has been associated with negative outcomes, including higher body mass index (BMI), more frequent binge eating, greater failure in weight loss treatment trials, and poorer mental and physical health. Although most research on HP food addiction has been conducted using adult samples, research on this topic now spans across the life span beginning in utero and extending through older adulthood. HP food addiction and related reward-based changes are associated with negative outcomes at every life stage, which has important implications for developmentally tailored prevention and treatment efforts. Using a developmentally informed approach, the current study comprehensively reviews the existing research on HP food addiction across the lifespan and highlights important areas of future research.

Online Behavioral Screener with Tailored Obesity Prevention Messages: Application to a Pediatric Clinical Setting

Obesity prevention involves promoting healthy eating and physical activity across all children. Can we leverage technology to feasibly survey children's health behaviors and deliver theory-based and user-tailored messages for brief clinical encounters? We assessed the acceptability and utility of an online pediatric-adapted liking survey (PALS) and tailored messages among children receiving non-urgent care in a pediatric emergency department (PED). Two hundred and forty-five children (average age = 10 years, racially/ethnically diverse, 34% overweight/obese from measured indices, 25% of families reporting food insecurity) and their parents/caregivers participated. Each reported the child's activity and behaviors using the online PALS and received two to three messages tailored to the responses (aligned with elaboration likelihood and transtheoretical models) to motivate behavioral improvements or reinforce healthy behaviors. Most children and parents (>90%) agreed the PALS was easy to complete, encouraging thought about their own/child's behaviors. The child's PALS responses appeared reasonable (fair-to-good child-parent intraclass correlations). Most children and parents (≥75%) reported the tailored messages to be helpful and favorable for improving or maintaining the targeted behavior. Neither message type (motivating/reinforcing) nor favorability responses varied significantly by the child's weight or family's food security status. In summary, children and parents found the PALS with tailored messages acceptable and useful. The message types and responses could help focus brief clinical encounters.

Prevalence of and Trends in the Co-Existence of Obesogenic Behaviors in Adolescents From 15 Countries

Background: The global epidemic of pediatric obesity is well-known, but data on co-existence of obesogenic behaviors are limited. We aim to report the prevalence of and trends in the co-existence of obesogenic behaviors in adolescents from 15 countries. Methods: This study was based on the Global School-based Student Health Survey 2003-2017 and included 121,963 adolescents aged 12-15 years from 15 countries where at least 2 cross-sectional surveys were conducted. We used sampling weights and calculated the country-level prevalence of and trends in the co-existence of obesogenic behaviors (low fruit and vegetable intake, anxiety-induced insomnia, no physical activity, and sedentary behavior) during survey years. Pooled prevalence and trend estimates were calculated with random-effects models. Results: Pooled prevalence of exposure ≥ 1, ≥2, and ≥3 obesogenic behaviors was 88.2, 44.9, and 9.8% in the first survey and 88.4, 46.4, and 10.2% in the last survey, respectively. Plateauing, increasing, and decreasing trends in the co-existence of obesogenic behaviors were observed in different countries. Specifically, we identified a plateauing pooled trend in the exposure ≥ 1, ≥2, and ≥3 obesogenic behaviors [odds ratios (95% confidence intervals): 1.03 (0.93, 1.14), 1.05 (0.97, 1.13), and 1.06 (0.95, 1.18), respectively]. Conclusion: Trends in the prevalence of the co-existence of obesogenic behaviors varied significantly across different countries, but the prevalence remained high in most countries. These findings suggest the need for behavioral interventions to mitigate obesogenic behaviors in adolescents for overweight and obesity prevention.

Evaluating the pathways linking complementary feeding practices to obesity in early life

The complementary feeding period, when solids and liquids other than breast milk and formula are added to the infant diet, is an important development window shaping infant growth and weight gain, metabolic development, and lifelong eating practices. Yet, relatively little is known about how the timing and types of foods offered to infants at this stage may shape their growth and subsequent risk of developing obesity. This narrative review describes the existing literature on complementary feeding practices, discusses potential biological and behavioral pathways linking complementary feeding practices to the development of obesity, and offers potential avenues for intervention. While further research is needed to more fully understand optimal complementary feeding practices, existing evidence supports the importance of healthful early feeding practices in the physiological and behavioral regulation of growth and metabolism and the need for early intervention to prevent the development of obesity.

The relationship between maternal dietary patterns during pregnancy in women with gestational diabetes mellitus and infant appetitive feeding behaviour at 6 months

Early dietary exposure may influence infant appetitive feeding behaviour, and therefore their later health. Maternal diabetes in pregnancy is associated with an increased risk of obesity in the offspring. We, therefore, examined third-trimester dietary patterns of women with gestational diabetes, their offspring's appetitive feeding behaviour at 6 months of age, and relationships between these. We used data from a prospective cohort of women with gestational diabetes and assessed maternal dietary patterns at 36 weeks' gestation using principal component analysis; infant appetitive feeding behaviour at 6 months of age using the Baby Eating Behaviour Questionnaire; and relationships between these using general linear modelling and chi-square tests. In 325 mother-infant dyads, we identified three distinct maternal dietary patterns: 'Junk,' 'Mixed,' and 'Health-conscious.' The maternal 'Health-conscious' pattern was inversely associated with 'enjoyment of food' in their sons (β - 0.24, 95% CI - 0.36 to - 0.11, p = 0.0003), but not daughters (β - 0.02, 95% CI - 0.12 to 0.08, p = 0.70), and was positively associated with 'slowness in eating,' (β 0.13, 95% CI 0.02 to 0.24, p = 0.01). Third-trimester dietary patterns in women with gestational diabetes may have sex-specific effects on infant appetitive feeding behaviour at 6 months of age.

The taste of biodiversity: science and sensory education with different varieties of a vegetable to promote acceptance among primary school children

OBJECTIVE

To determine the impact of an educational programme for primary schools that explored the biodiversity of tomato, by promoting science and sensory education with three distinct varieties of it, in the acceptance of vegetables.

DESIGN

A randomised controlled study in which children were exposed to the educational programme (intervention group) or remained in the class, as usual (control group). The educational programme consisted of three sessions where children explained the observed differences between the three varieties of tomato and individual perceptions of their flavours based on sensory-based food education and by planning and implementing experiments to explain those differences. We tested the effects on both children's willingness to try and their liking for tomato, and for lettuce and cabbage to study the carry-over effect, compared with the control group (Mann-Whitney U test; P < 0·05).

SETTING

The study took place in public primary schools in Porto, Portugal.

PARTICIPANTS

Children in the third grade (8-13-year-old children) (n 136) were randomly assigned to intervention or control group.

RESULTS

Children in the intervention group reported significant increases in their willingness to try and liking for tomato compared to the control group (P < 0·05), but not for lettuce and cabbage (P > 0·05).

CONCLUSIONS

These results highlight the potential for fostering children's acceptance of a vegetable by exploring biodiversity through science education. Further work may clarify the effects of exploring biodiversity on the consumption of vegetables and establish whether the results are stable over time and replicable across contexts and populations.

Home-based intervention for non-Hispanic black families finds no significant difference in infant size or growth: results from the Mothers & Others randomized controlled trial

Background

Non-Hispanic black (NHB) infants are twice as likely as non-Hispanic white infants to experience rapid weight gain in the first 6 months, yet few trials have targeted this population. The current study tests the efficacy of “Mothers & Others,” a home-based intervention for NHB women and their study partners versus an attention-control, on infant size and growth between birth and 15 months.

Methods

Mothers & Others was a two-group randomized controlled trial conducted between November 2013 and December 2017 with enrollment at 28-weeks pregnancy and follow-up at 3-, 6-, 9-, 12-, and 15-months postpartum. Eligible women self-identified as NHB, English-speaking, and 18–39 years. The obesity prevention group (OPG) received anticipatory guidance (AG) on responsive feeding and care practices and identified a study partner, who was encouraged to attend home visits. The injury prevention group (IPG) received AG on child safety and IPG partners only completed study assessments. The primary delivery channel for both groups was six home visits by a peer educator (PE). The planned primary outcome was mean weight-for-length z-score. Given significant differences between groups in length-for-age z-scores, infant weight-for-age z-score (WAZ) was used in the current study. A linear mixed model, using an Intent-To-Treat (ITT) data set, tested differences in WAZ trajectories between the two treatment groups. A non-ITT mixed model tested for differences by dose received.

Results

Approximately 1575 women were screened for eligibility and 430 were enrolled. Women were 25.7 ± 5.3 years, mostly single (72.3%), and receiving Medicaid (74.4%). OPG infants demonstrated lower WAZ than IPG infants at all time points, but differences were not statistically significant (WAZ_diff = − 0.07, 95% CI − 0.40 to 0.25, p = 0.659). In non-ITT models, infants in the upper end of the WAZ distribution at birth demonstrated incremental reductions in WAZ for each home visit completed, but the overall test of the interaction was not significant (F_2,170 = 1.41, p = 0.25).

Conclusions

Despite rich preliminary data and a strong conceptual model, Mothers & Others did not produce significant differences in infant growth. Results suggest a positive impact of peer support in both groups.

Trial registration

ClinicalTrials.gov, NCT01938118, 09/10/2013.

Gender, Age, Geographical Area, Food Neophobia and Their Relationships with the Adherence to the Mediterranean Diet: New Insights from a Large Population Cross-Sectional Study

The Mediterranean diet (MD) is associated with many health benefits. The association between the MD and food neophobia (FN) is still unexplored in adults. The present cross-sectional study was aimed to explore the relationships between adherence to the MD, FN, and sociodemographic variables in a large Italian cohort. Familiarity and frequency use (FFI) of prototypical and non-prototypical Mediterranean foods were used to calculate a new adherence index: the Italian Taste Mediterranean Index (ITMI). The FFI of all Mediterranean foods increased with age, while butter, soft drinks, red/cured meat, and sweets were more common in younger people. Accordingly, ITMI increased with age (F_2,2384 = 54.11; p < 0.0001). Women recorded a higher ITMI (6.70) than men (6.10). Individuals with high FN showed higher FFI for soft drinks and sweets and lower ones for most typical MD foods, than individuals with low FNs. A decrease of ITMI was recorded with the increase of the FN(F_2,2384 = 22.84; p < 0.0001). With ageing, ITMI increased even in individuals with a high FN. The results suggest that FN may negatively affect adherence to the MD, lowering its potential health benefits, in the adult population. Monitoring of food habits, dietary education, and anxiety management, may be valuable tools to control FN and support the adherence to the MD.

Donuts on our daughters: Gender differences in food categories on children's apparel

OBJECTIVE

Recent trends in children's fashion have featured food-graphics on children's apparel. Little attention has been paid to the food-graphic content of children's apparel. The objectives of this study were to describe and quantify food-graphics appearing on children's apparel, to examine characteristics of children's apparel items associated with the presence versus absence of food-graphics, and to examine gender differences in food-graphics.

METHODS

A content analysis of food-graphics on children's apparel from major apparel retailer websites was performed. Images of food-graphic apparel were reliably coded for food-graphic categories. Multivariable analyses examined the association of apparel item characteristics with food-graphic presence. Bivariate analyses tested the association of presence or absence of each food category with gender of apparel item.

RESULTS

Of the 3870 apparel items coded, 8.2% (318) had food-graphics. In multivariable analysis, food-graphics were more likely to be present on girls' (versus boys') apparel (RR = 1.73, 95% CI 1.34-2.12). Content analysis of food-graphic items revealed categories including "pastries", "frozen desserts", "pizza", "fast food", "fruit", and "love of food". Girls' (versus boys') food-graphic apparel was more likely to have categories of "pastries" (33% versus 12%), "frozen desserts" (20% versus 9%), and "fruit" (30% versus 11%) and less likely to have categories of "pizza" (9% versus 30%), and "fast food" (3% versus 23%). The "love of food" category did not differ by gender. All p-values ≤.01.

CONCLUSIONS

Food-graphics on children's apparel are fairly common, especially on apparel marketed for girls. Children's apparel may represent a novel cultural influence on children's eating and food perceptions.

Pediatric-Adapted Liking Survey (PALS): A Diet and Activity Screener in Pediatric Care

Clinical settings need rapid yet useful methods to screen for diet and activity behaviors for brief interventions and to guide obesity prevention efforts. In an urban pediatric emergency department, these behaviors were screened in children and parents with the 33-item Pediatric-Adapted Liking Survey (PALS) to assess the reliability and validity of a Healthy Behavior Index (HBI) generated from the PALS responses. The PALS was completed by 925 children (average age = 11 ± 4 years, 55% publicly insured, 37% overweight/obese by Body Mass Index Percentile, BMI-P) and 925 parents. Child–parent dyads differed most in liking of vegetables, sweets, sweet drinks, and screen time. Across the sample, child and parent HBIs were variable, normally distributed with adequate internal reliability and construct validity, revealing two dimensions (less healthy—sweet drinks, sweets, sedentary behaviors; healthy—vegetables, fruits, proteins). The HBI showed criterion validity, detecting healthier indexes in parents vs. children, females vs. males, privately- vs. publicly-health insured, and residence in higher- vs. lower-income communities. Parent’s HBI explained some variability in child BMI percentile. Greater liking of sweets/carbohydrates partially mediated the association between low family income and higher BMI percentile. These findings support the utility of PALS as a dietary behavior and activity screener for children and their parents in a clinical setting.

Using repeated visual exposure, rewards and modelling in a mobile application to increase vegetable acceptance in children

Children are not consuming the recommended amounts of fruit and vegetables. Repeated visual exposure, modelling, and rewards have been shown to be effective at increasing vegetable acceptance in young children. The aim of this study was to assess the effectiveness of an evidence-based mobile application (Vegetable Maths Masters) which builds on these principles to increase children's liking and acceptance of vegetables. Seventy-four children (37 male, 37 female) aged 3-6 years old were randomised to play with either the vegetable app or a similar control app that did not include any foods. Children played their allocated game for 10 min. Liking and acceptance of the vegetables used in Vegetable Maths Masters (carrot and sweetcorn) and other vegetables which were not used in the game (yellow pepper and tomato) were measured pre- and post-play in both groups. Parents provided data about their child's food fussiness and previous exposure to the foods being used. Children who played with the Vegetable Maths Masters app consumed significantly more vegetables after playing with the app and reported significant increases in their liking of vegetables, relative to the control group. The effect of the Vegetable Maths Masters app on the change in consumption of vegetables was mediated by the change in liking of vegetables. These findings suggest that evidence-based mobile apps can provide an effective tool for increasing children's liking and consumption of vegetables in the short-term. Further work is now required to establish whether these effects are maintained over time.

A Biopsychosocial Model of Sex Differences in Children's Eating Behaviors

The prevalence of obesity and eating disorders varies by sex, but the extent to which sex influences eating behaviors, especially in childhood, has received less attention. The purpose of this paper is to critically discuss the literature on sex differences in eating behavior in children and present new findings supporting the role of sex in child appetitive traits and neural responses to food cues. In children, the literature shows sex differences in food acceptance, food intake, appetitive traits, eating-related compensation, and eating speed. New analyses demonstrate that sex interacts with child weight status to differentially influence appetitive traits. Further, results from neuroimaging suggest that obesity in female children is positively related to neural reactivity to higher-energy-dense food cues in regions involved with contextual processing and object recognition, while the opposite was found in males. In addition to differences in how the brain processes information about food, other factors that may contribute to sex differences include parental feeding practices, societal emphasis on dieting, and peer influences. Future studies are needed to confirm these findings, as they may have implications for the development of effective intervention programs to improve dietary behaviors and prevent obesity.

Eating Veggies Is Fun! An Implementation Pilot Study in Partnership With a YMCA in South Los Angeles

PURPOSE AND OBJECTIVES

Children eat less than recommended amounts of vegetables. Repeated taste exposure can increase children's acceptance of initially disliked vegetables. However, implementation of this strategy is lacking. We conducted a pilot study to assess the feasibility of implementing an evidence-based intervention to promote liking of initially disliked vegetables among children enrolled in a YMCA summer camp.

INTERVENTION APPROACH

We adapted a research-tested intervention to promote child liking of vegetables for implementation in small groups. In summer 2015, 50 children aged 7 to 12 years were invited to taste 5 initially disliked vegetables daily for 10 days.

EVALUATION METHODS

Children rated how much they liked vegetables on a 5-point emoji-like faces Likert scale at baseline and 2- and 4-week follow-up. The mean ratings for liked and initially disliked vegetables were estimated over time using mixed effects modeling.

RESULTS

We achieved excellent participation of parents and children; however, we experienced nonstudy-related attrition caused by disenrollment of some children from the weekly camp program. The average liking increased over time (linear trend, P = .003) for the 5 targeted vegetables but not for the other nontargeted vegetables, as predicted.

IMPLICATIONS FOR PUBLIC HEALTH

This pilot study suggests that repeated vegetable tasting opportunities offered by community programs may be a practical strategy for introducing low-income, young children to new or initially disliked vegetables. The study demonstrates the feasibility of implementing a health promotion strategy that has the potential to improve population health in a community setting in an underresourced neighborhood.

Study of the reasons for the consumption of each type of vegetable within a population of school-aged children

BACKGROUND

Several studies have evaluated the existence of factors that influence the consumption of vegetables in children, such as family environment, daily exposure to one or several vegetables, parents' consumption and consumption pattern and the way in which vegetables are prepared in the household, among others. The objective of this study was to investigate the reasons for consumption associated with each vegetable in school-aged children through a survey designed to be answered by the parents.

METHODS

A preliminary study with 162 parents was carried out on the consumption of vegetables in children aged 6 to 12 years. Based on the information obtained, a survey was designed with 14 phrases to investigate the reasons for the low consumption of each type of vegetable among school-aged children, which was answered online by 419 parents.

RESULTS

The results obtained allowed us to categorise the vegetables into 6 groups. Group A consisted of tomatoes, corn, pumpkin and carrots as the vegetables that children like to eat most. Group B contains the vegetables that are consumed mostly camouflaged in other preparations, such as onions and red peppers. Group C contains only cauliflower, which was negatively associated with senses, such as colour, smell and taste. This vegetable was never offered to children by a high percentage of parents. Group D consists of green vegetables: zucchini, spinach, chard and peas. Vegetables of this group are added to other foods and the child usually ingests them camouflaged or obliged. Group E consists of beetroot, lettuce and broccoli. Beetroot and lettuce were the vegetables parents reported were most often rejected by their children. This rejection, they stated, was due to sensory aspects, such as colour, texture and taste.

CONCLUSIONS

The reasons for consumption among school-aged children depend on each type of vegetable and cannot be generalized. The sensory characteristics of the vegetable (mainly colour and flavour) and the habits of consumption in the family environment play a major role in children's acceptance or rejection of vegetables.

Observations of Toddlers' sensory-based exploratory behaviors with a novel food

BACKGROUND

Food neophobia hinders the acceptance of healthy foods in young children, and may be overcome by repeated food exposure. Prevalent literature states that children exhibit five sensory-based exploratory behaviors (SBEBs): smelling, licking, spitting, manipulating and/or swallowing as they progress towards accepting a novel food, yet there is a paucity of research on these behaviors. This study aimed to use direct observations of SBEBs across first-time exposures to hummus to (1) determine the prevalence of five SBEBs (smelling, licking, spitting, manipulating and swallowing) in 12-35 month olds, (2) quantify the psychometric properties of the SBEB assessment; and (3) examine the association of SBEBs with parent-assessed food fussiness, and consumption of the novel food.

METHODS

Direct observations of SBEBs during a 15-20 min snack time were conducted by trained staff members for 55 hummus-naïve toddlers ages 12-35 months, across 16 exposures to a novel food (hummus). Parents completed the child eating behavior questionnaire. Hummus consumption was measured using digital plate waste method.

RESULTS

Very low base rates of spitting (0.06%), smelling (0.97%) and licking (1.95%) were observed but manipulation (26.36%) and swallowing (62.15%) were more prevalent. Observation data on two behaviors over 16 occasions gave rise to a reliability coefficient from our G study portion of our generalizability analyses of Eρ² = 0.65. SBEBs did not significantly associate with parent-assessed food fussiness, nor hummus consumption.

CONCLUSIONS

Although literature refers to the prevalence of SBEBs, we did not observe this for three proposed behaviors. We did observe manipulation, but more research is needed to determine if there are additional SBEBs not noted in the literature, and to better delineate the process that leads to acceptance/rejection of novel food.

A cluster randomized web-based intervention trial to reduce food neophobia and promote healthy diets among one-year-old children in kindergarten: study protocol

BACKGROUND

A child's first years of life are crucial for cognitive development and future health. Studies show that a varied diet with a high intake of vegetables is positive for both weight and cognitive development. The present low intake of vegetables in children's diets is therefore a concern. Food neophobia can be a barrier for vegetable intake in children. Our hypothesis is that interventions that can increase children's intake of vegetables should be introduced early in life to overcome children's neophobia. This study aims to develop, measure and compare the effect of two different interventions among one-year-old children in kindergartens to reduce food neophobia and promote healthy diets.

METHODS

The kindergartens are randomized to one of three groups: two different intervention groups and one control group. We aimed to include a total of 210 children in the study. The first intervention group will be served a warm lunch meal with a variety of vegetables, 3 days a week during the intervention period of 3 months. The second intervention group will be served the same meals and, in addition, kindergarten staff will be asked to implement pedagogical tools including sensory lessons, adapted from the Sapere method, and advices on meal practice and feeding practices. The control group continues their usual meal practices. Parents and kindergarten staff will complete questionnaires regarding food neophobia, food habits and cognitive development at baseline and post intervention. A similar intervention among 2-year-old children in kindergarten has been implemented and evaluated earlier. We will investigate whether a digital version of this intervention has an effect, because digital interventions can be easily implemented nationwide. We will also investigate whether there are benefits of conducting such interventions in younger children, before the onset of food neophobia. Questionnaires, information videos and recipes will be digitally distributed.

DISCUSSION

Results of this study will provide new knowledge about whether a sensory education and a healthy meal intervention targeting children, kindergarten staff and parents will reduce levels of food neophobia in children, improve parental and kindergarten feeding practices, improve children's dietary variety, improve children's cognitive development and reduce childhood overweight.

TRIAL REGISTRATION

ISRCTN98064772 .

Does the distribution frequency matter? A subgroup specific analysis of the effectiveness of the EU School Fruit and Vegetable Scheme in Germany comparing twice and thrice weekly deliveries

OBJECTIVE

The present study aimed to examine the effectiveness of two different implementation forms of the EU School Fruit and Vegetable Scheme (SFVS).

DESIGN

A quasi-experimental design was applied including a thrice as well as a twice weekly intervention group. Repeated 24 h dietary recalls were used to measure children's fruit and vegetable (F&V) intake. Effects were analysed on days with and without F&V deliveries using hierarchical linear regression models.

SETTING

Twelve primary schools in North Rhine-Westphalia, Germany.

SUBJECTS

Third and fourth graders (n 664).

RESULTS

Average daily F&V intake at pre-intervention was 0·84 frequencies in the thrice weekly intervention group, 0·90 frequencies in the twice weekly intervention group and 1·25 frequencies in the control group. Providing children thrice weekly with F&V increased children's F&V intake on average by 0·96 (P<0·001) frequencies/d. The effects were higher on days with (1·07; P<0·001) than on days without (0·75; P<0·001) F&V deliveries. Distributing F&V twice weekly resulted in an increase of 0·75 (P<0·001) frequencies/d on average, again with higher effects on days with (1·30; P<0·001) than without (0·48; P<0·003) F&V deliveries. Subgroup analysis revealed some indications for differential effectiveness only in the twice weekly intervention group.

CONCLUSIONS

The SFVS with thrice or twice weekly deliveries of F&V led to a significant increase in children's F&V intake on days with and without deliveries. The latter might provide an indication of positive long-term effects of the scheme. The scheme shows equal efficiency for almost all subgroups.

Evaluation of the Cancer Council NSW Eat It To Beat It Healthy Lunch Box Sessions: A short intervention to promote the intake of fruit and vegetables among families of primary school children in NSW Australia

ISSUE ADDRESSED

Children and adults in Australia are not eating the recommended amounts of fruits and vegetables. Our objective was to assess the effectiveness of a health promotion intervention to improve fruit and vegetable intake among primary school children and their families in NSW.

METHODS

The Cancer Council New South Wales Healthy Lunch Box sessions were a 25-minute session delivered to parents of primary school-aged children. The sessions provided information and resources about fruit and vegetables and healthy school lunch boxes. The evaluation is a quantitative uncontrolled pre-post design. Data were collected using three questionnaires, pre-intervention, 1 week post-intervention and 6 months post-intervention.

RESULTS

A total of 204 parents completed all three evaluation questionnaires to 6 months. Knowledge of recommended intakes and serving sizes of fruit and vegetables improved significantly after the intervention. There was an increase in parents reporting packing vegetables (often/always) in the child's lunch box at 1 week (47%) and 6 months post-intervention (40%) compared to pre-intervention (32%). The proportion of parents reporting that they were confident in packing a healthy lunch box increased from 45% pre-intervention to 62% after the intervention.

CONCLUSION

The Healthy Lunch Box sessions were effective in improving parental knowledge and practices related to fruit and vegetables and parental confidence with packing a healthy lunch box. SO WHAT?: This short intervention could be a useful component of a portfolio of interventions to support parents with knowledge and resources to pack a healthy lunch box for their children.

Prevalence of food neophobia in pre-school children from southern Poland and its association with eating habits, dietary intake and anthropometric parameters: a cross-sectional study

OBJECTIVES

The present study aimed to assess the prevalence of food neophobia in pre-school children and its association with eating habits, dietary intake and anthropometric parameters.

DESIGN

Cross-sectional survey performed in 2012-2013. The Child Food Neophobia Scale (CFNS) adapted by Wardle, Carnell and Cooke was used to assess the level of food neophobia. Dietary intake was measured using an FFQ and dietary records from three days. Anthropometric measurements were taken to determine children's nutritional status and BMI was computed based on Polish growth charts. Wilcoxon's rank test and Pearson's rank-correlation coefficient were applied to compare the level of food neophobia and frequency of consumption of food products and nutrient intakes.

SETTING

Kindergartens in southern Poland located in or near Cracow.

SUBJECTS

Three hundred and twenty-five pre-school children and their parents.

RESULTS

Low neophobia was observed in 12·3 % and high neophobia in 10·8 % of the children examined. Children with a high level of neophobia were significantly less likely (P<0·05) to eat eggs, raw or cooked vegetables and legumes, whereas they tended to eat sweets and snacks more frequently; these foodstuffs were also eaten more often between meals. Because the neophobic children ate vegetables very rarely, their intakes of vitamin C (36 % of RDA) and thiamin (84 % of RDA) were far below the norms. No differences in anthropometric parameters according to level of food neophobia were observed.

CONCLUSIONS

High levels of neophobia are associated with diet variation and may enhance the risk of nutritional deficiencies in children.

State-Mandated Nutrition, Physical Activity, and Screen Time Policies in Child Care Centers

BACKGROUND

The child care center (CCC) environment presents opportunities for healthy weight promotion in preschoolers. Our study examined the current state of CCC adherence to nutrition, physical activity, and screen time legislative regulations and the differences in their adherence by center socioeconomic position (SEP: low, middle, high) in Miami-Dade County.

METHOD

In 34 CCC, we used the Environment and Policy Assessment and Observation tool to evaluate nutrition, physical activity, and screen time practices during 1-school day.

RESULTS

Twenty-five of the centers (73.5%) were participants of the Child and Adult Care Food Program. Almost 80% of the centers adhered to serving low-fat/fat-free milk to children older than 2 years. Only 34.5% served vegetables and 75.9% served whole fruits during meals/snacks. Ninety-four percent of the centers had quiet and active play incorporated into their daily routines. All centers adhered to the 2-hour screen time limit for children older than 2 years. Low- and middle-SEP centers fared better in the serving of fruits, vegetables, and low-fat/fat-free milk. The centers averaged 1 hour in outdoor play regardless of SEP. High-SEP centers had no TV or screen time during day of observation.

CONCLUSION

CCC practices highlight opportunities for improvement in nutrition, physical activity, and screen time practices in the prevention of overweight in early childhood.

Family-based obesity prevention for infants: Design of the "Mothers & Others" randomized trial

OBJECTIVE

Our goal is to test the efficacy of a family-based, multi-component intervention focused on infants of African-American (AA) mothers and families, a minority population at elevated risk for pediatric obesity, versus a child safety attention-control group to promote healthy weight gain patterns during the first two years of life.

DESIGN, PARTICIPANTS, AND METHODS

The design is a two-group randomized controlled trial among 468 AA pregnant women in central North Carolina. Mothers and study partners in the intervention group receive anticipatory guidance on breastfeeding, responsive feeding, use of non-food soothing techniques for infant crying, appropriate timing and quality of complementary feeding, age-appropriate infant sleep, and minimization of TV/media. The primary delivery channel is 6 home visits by a peer educator, 4 interim newsletters and twice-weekly text messaging. Intervention families also receive 2 home visits from an International Board Certified Lactation Consultant. Assessments occur at 28 and 37weeks gestation and when infants are 1, 3, 6, 9, 12, and 15months of age.

RESULTS

The primary outcome is infant/toddler growth and likelihood of overweight at 15months. Differences between groups are expected to be achieved through uptake of the targeted infant feeding and care behaviors (secondary outcomes) and change in caregivers' modifiable risk factors (mediators) underpinning the intervention.

CONCLUSIONS

If successful in promoting healthy infant growth and enhancing caregiver behaviors, "Mothers and Others" will have high public health relevance for future obesity-prevention efforts aimed at children younger than 2years, including interventional research and federal, state, and community health programs.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01938118, August 9, 2013.

Tracking of toddler fruit and vegetable preferences to intake and adiposity later in childhood

This study examined whether toddlers' liking for fruit and vegetables (FV) predicts intake of FV later in childhood, how both relate to childhood adiposity and how these were moderated by factors in infancy. Children in the Gateshead Millennium Study were recruited at birth in 1999-2000. Feeding data collected in the first year were linked to data from a parental questionnaire completed for 456 children at age 2.5 years (30 m) and to anthropometry, skinfolds and bioelectrical impedance and 4-day food diary data collected for 293 of these children at age 7 years. Aged 30 months, 50% of children were reported to like eight different vegetables and three fruits, but at 7 years, children ate a median of only 1.3 (range 0-7) portions of vegetables and 1.0 portion of fruit (0-4). Early appetite, feeding problems and food neophobia showed significant univariate associations with liking for FV aged 30 m, but the number of vegetables toddlers liked was the only independent predictor of vegetable consumption at age 7 years (odds ratio (OR) 1.28 p < 0.001). Liking for fruit aged 30 m also independently predicted fruit intake (OR = 1.31, p = 0.016), but these were also related to deprivation (OR = 2.69, p = 0.001) maternal education (OR = 1.28, p = 0.039) and female gender (OR = 1.8, p = 0.024). Children eating more FV at age 7 years had slightly lower body mass index and skinfolds. An early liking for FV predicted increased later intake, so increasing early exposure to FV could have long term beneficial consequences.