Association between parenting practices and children's dietary intake, activity behavior and development of body mass index: the KOALA Birth Cohort Study

Associations between restrictive feeding practices and children's dietary intake: Systematic review and meta-analyses

BACKGROUND

Parents' attempt to limit or restrict children's intake of 'unhealthy' or discretionary foods has been widely considered as a counterproductive feeding practice associated with poorer dietary outcomes, but empirical evidence is varied.

AIM

The present systematic literature review aimed to investigate the association between parental restriction and children's dietary intake.

METHOD

Studies were identified through PsycInfo, MEDLINE, CINAHL, Web of Science, and Scopus databases on April 29th, 2022. Included were peer-reviewed, English-language articles published between 2001 and 2022, with an effect size between restriction and children's intake of foods that are 'healthy' (i.e., fruit, vegetables, other general healthy foods) or 'discretionary' (i.e., sweet or savoury energy-dense/nutrient poor foods, high-sugar foods, high-salt/fat foods, and high-energy/sugar-sweetened beverages), or overall diet quality. Risk of bias was assessed using a quality assessment checklist designed to evaluate survey studies.

RESULTS

Included studies (n = 44) were most often conducted in the USA, cross-sectional, and participants were mothers. Effect sizes (k = 59) from 21 studies were used in nine meta-analyses investigating various healthy and discretionary dietary intake variables. No meta-analytic effects were statistically significant. Qualitative synthesis of effect sizes ineligible for meta-analysis (k = 91) identified patterns of associations between restriction and increased intake of healthy foods, and decreased intake of discretionary foods.

CONCLUSIONS

Studies used a diverse selection of measures of restriction and dietary intake, limiting the ability of this review to make accurate cross-study comparisons. However, results suggest that instead of restriction being detrimental for children's dietary outcomes, it may be unrelated, or associated with more beneficial dietary outcomes. Research that utilises validated measures of restriction and dietary outcomes and a longitudinal design is needed to clarify this association.

The Role of Grandparents in Facilitating Children's Physical Activity

BACKGROUND

Research suggests there is considerable opportunity to improve children's movement behaviors while they are being cared for by their grandparents. An understanding of the extent to which grandparent practices facilitate children's engagement in physical activity is critical to the development of health interventions targeting grandparent caregivers. This study examined the activity-related beliefs and practices of grandparents and their association with grandchildren's engagement in various movement behaviors while in grandparental care.

METHODS

Australian grandparents (N = 1190; 60% women) who provided regular care to a grandchild aged 3-14 years were recruited via a web panel provider to complete an online survey. The survey assessed grandparents' physical activity-related beliefs (eg, perceived importance) and practices (eg, support and social control) and their grandchildren's engagement in physical activity (unstructured, structured, and outdoor play) and screen-based activities while in grandparental care.

RESULTS

The importance of grandchildren's physical activity was rated highly by grandparents. Grandparents' support for their grandchildren's physical activity was positively associated with their grandchildren's engagement in structured physical activity, unstructured physical activity, and outdoor play. Negative social control was associated with greater engagement in screen-based activities. Other correlates of grandchildren's physical activity and screen-based activities included grandparents' own engagement in these activities.

CONCLUSIONS

Findings highlight the importance of reinforcing the beliefs and practices that positively influence children's movement behaviors and addressing those that have unintended consequences. Encouraging grandparents to support their grandchildren's physical activity and discouraging forms of negative social control are likely to be important in efforts to promote physical activity in children.

Maternal depressive symptom trajectories and associations with child feeding

BACKGROUND

Responsive feeding, when caregivers attend to children's signals of hunger and satiation and respond in an emotionally supportive and developmentally appropriate way, is associated with the development of healthy eating behaviors, improved diet quality, and healthy weight status for children. However, gaps in the literature remain on how factors, such as maternal depressive symptoms and child temperament, influence feeding interactions.

METHODS

This longitudinal secondary data analysis explored the association between maternal depressive symptom trajectory and child temperament with maternal feeding practices in women with obesity who participated in a prenatal lifestyle intervention trial. Mothers self-reported depressive symptoms at baseline, 35 weeks gestation, and 6, 12, and 18 months postpartum. At 18- and 24-months postpartum, mothers completed self-reported assessments of feeding practices and child temperament and completed in-home video-recorded meals with their child, coded using the Responsiveness to Child Feeding Cues Scale. We used group-based trajectory modeling to identify distinct trajectories of depressive symptoms and generalized regressions to assess the association between symptom trajectory group and feeding. We also explored interactions between depressive symptoms and child temperament.

RESULTS

Three distinct trajectories of depressive symptoms were identified: No-Minimal and Decreasing, Mild-Moderate and Stable, and Moderate-Severe and Stable. At 18-months, when compared to the No-Minimal and Decreasing group, membership in the Moderate-Severe and Stable group was associated with higher observed responsiveness to child satiation cues ([Formula: see text] =2.3, 95%CI = 0.2, 4.4) and lower self-reported pressure to eat ([Formula: see text]=-0.4, 95%CI= -0.7, 0.0). When compared to the No-Minimal and Decreasing group, membership in the Mild-Moderate and Stable group was associated with higher self-reported restriction ([Formula: see text] =0.4, 95%CI = 0.0,0.7). The associations between trajectory group membership and feeding practices did not reach statistical significance at 24 months. Associations between depressive symptoms and restriction were moderated by child effortful control at 18 months [Formula: see text]) and surgency at 24 months [Formula: see text]).

CONCLUSION

A Moderate-Severe and Stable depressive symptom trajectory was associated with more responsive feeding practices and a Mild-Moderate and Stable trajectory was associated with higher restrictive feeding. Preliminary evidence suggests that depressive symptoms impact mothers' ability to match their use of restriction to the temperamental needs of their child.

Understanding health behaviors that modify the risk for obesity in ADHD

OBJECTIVE

Research provides support for the associated risk of inadequate sleep duration, limited physical activity, and excessive media use in attention-deficit/hyperactivity disorder (ADHD) and obesity. The present study aims to (1) examine the association between ADHD and overweight or obese status (OW/OB); (2) comprehensively examine sleep duration, physical activity, and media use as potential moderators of OW/OB; and (3) examine the moderating effects of these health behaviors cross-sectionally by comparing medicated youth with ADHD, unmedicated youth with ADHD, and youth without ADHD.

METHODS

Data were acquired from the 2018 and 2019 National Survey of Children's Health, a nationally representative survey of caregivers conducted across the United States. The current study used data for youth 11-17 years old with a final sample size of 26,644. Hours of sleep, physical activity, and media use per day were dichotomized based on national recommendation guidelines for each health behavior (i.e., either meeting or not meeting guidelines).

RESULTS

The OW/OB prevalence rate was 7% greater among unmedicated youth with ADHD than among medicated youth with ADHD. Medicated youth with ADHD and peers without ADHD had similar OW/OB rates. Among medicated youth with ADHD, physical activity, sleep duration, and media use did not contribute to OW/OB risk after controlling for family poverty level. However, among unmedicated youth with ADHD, meeting sleep duration guidelines was linked to a lower OW/OB risk.

CONCLUSION

Overall, findings suggest that clinical providers and parents may wish to prioritize improved sleep duration in the management of OW/OB risk in youth with ADHD.

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

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

The temporal stability of maternal parenting style and child feeding practices: A six-wave longitudinal study

Although parenting styles and child feeding practices are conceptualized as distal, static predictors of child eating and weight outcomes, few studies have examined the temporal stability (i.e., change over time) of these parenting measures. Also, parental characteristics, such as mental health or socio-demographics, may make it more or less difficult to sustain consistent parenting behavior. This study examined the temporal stability of parenting styles and child feeding practices and the association between temporal stability indices with maternal sociodemographic and mental health characteristics. The analytic sample included 161 ethnically diverse mothers enrolled in a six-wave bi-annual longitudinal study. During each wave, mothers reported on their parenting styles and child feeding practices using validated self-report questionnaires. Temporal stability indices for parenting styles were moderate for authoritative (ICC = 0.57) and authoritarian (ICC = 0.70) styles, yet high for permissive (ICC = 0.78) styles. Temporal stability scores for child feeding practices were low for discipline (ICC = 0.33), limit setting (ICC = 0.33), monitoring (ICC = 0.36), and pressure to eat (ICC = 0.34); however, restriction (ICC = 0.53) and role modeling of healthy eating were moderate (ICC = 0.73). Greater income and education status were positively associated with stability in authoritative, authoritarian, and permissive parenting styles, as well as with limit setting, monitoring, role modeling of healthy eating, and pressure to eat feeding practices. Higher anxiety and depressive symptoms and lower self-esteem were negatively associated with permissive parenting styles and role modeling of healthy eating. Findings show that maternal parenting styles and child feeding practices fluctuate over time, and sociodemographic and mental health characteristics are related to stability of some of these parenting styles and behaviors.

Interactions of parental feeding characteristics and adolescent emotional eating in relation to unhealthful food and sugar-sweetened beverage intake among adolescents

The purpose of the current study was to examine main and interaction effects of parental feeding characteristics and adolescent emotional eating in relation to adolescents' unhealthful food and sugar-sweetened beverage intake. Data was used from the Family Life, Activity, Sun, Health, and Eating (FLASHE) study, which is an internet-administered cross-sectional study of adolescent-parent dyads. There were 1573 dyads who completed all study questionnaires. Adolescents completed measures of their emotional eating and dietary intake and parents completed items of parental feeding practices and legitimacy of parental authority. Adolescents with parents who reported higher instrumental feeding, higher limiting and legitimacy of authority, and lower role modeling and stimulus control had greater unhealthful eating and sugar-sweetened beverage intake. Elevated adolescent emotional eating strengthened the positive association between parental instrumental feeding and adolescent unhealthful food and sugar-sweetened beverage intake. Elevated adolescent emotional eating weakened the negative association between parental role modeling and stimulus control and adolescent sugar-sweetened beverage consumption. There was no interaction between parental role modeling and stimulus control and adolescent emotional eating for unhealthful food intake and no interaction between parental limiting and legitimacy of authority and adolescent emotional eating for unhealthful food or sugar-sweetened beverage intake. Given these findings, adolescent obesity and nutrition interventions and preventions should target both parental feeding characteristics and adolescent emotional eating.

Parental practices and children's lifestyle correlates of childhood overweight/obesity in Europe: The Feel4Diabetes study

BACKGROUND

Parental influences on children's eating and physical activity (PA) and consequently on their weight are fundamental. The present study aimed to identify the predominant correlates of childhood overweight/obesity among a variety of parental practices and children's lifestyle indices in a large sample of children in Europe.

METHODS

Families from low socio-economic status regions were recruited through schools, located in six European countries (Belgium, Finland, Greece, Spain, Bulgaria and Hungary). Seven thousand three hundred ninety-seven children 4-12 years old and their parents were selected using the FINDRISC-questionnaire. Parental practices assessed included parental role modelling, permissiveness and reward. Children's dietary intake and lifestyle behaviours were assessed through parent-reported questionnaires.

RESULTS

Regarding parental practices, it was revealed that being sometimes (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.10-1.43) or rarely (OR = 1.43; 95% CI = 1.21-1.69) physically active with the child was associated with greater overweight/obesity risk, whereas rare permission of computer/mobile/tablet (OR = 0.81; 95% CI = 0.67-0.98) and sometimes (OR = 0.77; 95% CI = 0.68-0.88) or rare (OR = 0.77; 95% CI = 0.66-0.91) reward with PA were associated with lower risk. Regarding children's lifestyle factors, consuming > 3 cups/week fresh fruit juices (OR = 1.28; 95% CI = 1.13-1.45), skipping breakfast (OR = 1.37; 95% CI = 1.17-1.61), absence of 1 h of daily PA (OR = 1.40; 95% CI = 1.24-1.58) and increased daily screen time (ST) (OR = 1.23; 95% CI = 1.09-1.39) were associated with greater overweight/obesity risk. All the variables were adjusted for maternal education, child's sex and age.

CONCLUSIONS

These findings emphasize the necessity of family-centered approaches in health promotion and obesity prevention programs for children. Such programs should focus on parents as the primary role models in exerting positive influence and encouraging healthy eating habits, PA, and ST behaviors in their children, which in turn, may have a substantial impact on children's overall weight status.

Psychometric properties of the Portuguese version of the physical activity parenting practices questionnaire

BACKGROUND

Adopting a healthy lifestyle, including regular physical activity, is often part of interventions targeting childhood overweight and obesity. However, to properly inform the objectives of the intervention, reliable psychometric measures are needed to better understand children's and their families necessities and characteristics.

OBJECTIVES

To evaluate the psychometric properties of the Physical Activity Parenting Practices questionnaire in a community sample of Portuguese parents of children aged 5-10, assess measurement invariance across children's weight status, and construct validity.

METHODS

Five hundred three parents completed the Portuguese version of the Physical Activity Parenting Practices (PAPP) questionnaire, a sociodemographic questionnaire, the Comprehensive Feeding Practices Questionnaire, and the Lifestyle Behavior Checklist. A subsample (n = 125) completed the PAPP questionnaire 1 month later. Data analyses were performed using R's lavaan (version 0.6-12) and psych (version 2.2.9) packages.

RESULTS

Confirmatory factor analyses revealed good psychometric properties for the PAPP's single-factor Encouragement scale and the three-factor Discouragement scale. Configural, metric, and scalar invariance were found across parents of children with different weight statuses for both scales' factor structures. Internal reliability ranged from α = .64 to α = .89, and test-retest reliability ranged from r = .57 to r = .74.

CONCLUSIONS

The constructs evaluated by PAPP questionnaire revealed adequate validity. The Portuguese version of the PAPP questionnaire is a reliable measure to assess relevant physical activity parenting practices, capable of differentiating the practices of parents with children of different weight statuses, and useful for both research and intervention purposes.

Are adolescent diet quality and emotional eating predicted by history of maternal caregiving quality and concurrent inhibitory control?

The risk for unhealthy eating behaviour, including poor diet quality and emotional eating, is heightened in adolescence and could result in profound and long-lasting psychological and physical implications. Caregiving quality and adolescents' regulatory skills, such as inhibitory control, may play an essential role in the development of adolescent eating behaviour. This preregistered study investigated whether maternal caregiving throughout the first 14 years of life predicts adolescent diet quality and emotional eating and whether potential associations are mediated by adolescents' inhibitory control. In this low-risk community cohort, maternal caregiving quality was observed at child ages five weeks, 12 months, 2.5, 10, and 14 years. At age 14, diet quality and emotional eating were assessed through self-report. Adolescent inhibitory control was assessed with three behavioural tasks and a maternal report. Mediation analyses were performed with structural equation modelling in R. No evidence was found for links between maternal caregiving quality and adolescent diet quality and emotional eating. Higher levels of adolescent inhibitory control predicted better adolescent diet quality. Longitudinal and experimental studies are needed to investigate directionality, and replication studies are needed in more representative samples (e.g. including high-risk families). Such studies will shed further light on potential links between the history of caregiving behaviour and adolescent regulatory and eating behaviour.

Cultural and neighborhood characteristics associated with activity-specific parenting practices in Hispanic/Latino youth: a secondary analysis of the Hispanic Community Children's health study/study of Latino youth

Hispanic/Latino youth are less physically active than non-Hispanic/Latino youth. We assessed whether activity-specific parenting practices relate to moderate-to-vigorous physical activity (MVPA) and sedentary behavior among Hispanic/Latino youth, and whether cultural (acculturation) and neighborhood characteristics (perceived barriers to activity) relate to the use of parenting practice patterns. Using the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth, n = 976 8-16-year-olds), we modeled linear regression associations between parenting practices and mean daily MVPA and sedentary behavior. Parenting practice patterns were then developed using k-means cluster analysis, and regressed on parental acculturation and neighborhood characteristics. Discipline predicted higher MVPA in females (β 1.89 [95% CI 0.11-3.67]), while Monitoring/Reinforcement predicted higher MVPA in males (β 4.71 [95% CI 0.68-8.74]). Three patterns were then identified: Negative Reinforcement (high Limit Setting and Discipline use), Positive Reinforcement (high Limit Setting and Monitoring/Reinforcement use), and Permissive Parenting (low parenting practice use). Higher acculturation predicted use of Positive Reinforcement. Activity-specific parenting practices are associated with activity in sex-specific ways among Hispanic/Latino youth, and cultural factors predict the use of parenting practices.

Comparing the use of food and physical activity parenting practices: Parents of children with overweight and obesity versus parents of children with a healthy weight

Background

Paediatric overweight and obesity are caused by a complex imbalance between energy intake and expenditure. Parents may influence this imbalance through energy balance-related parenting practices. This study aims to compare the use of energy balance-related parenting practices between parents of children with overweight and obesity and children with a healthy weight.

Methods

This study compares energy balance-related parenting practices among a group of parents with children with overweight and obesity at the start of a lifestyle intervention (N = 107) and children with a healthy weight (N = 137). Specifically, it compares the feeding practices 'overt control' (open control over eating), 'encouragement', 'instrumental feeding', 'emotional feeding', and 'covert control' (hidden control over eating), as well as the physical activity parenting practice 'promoting physical activity'. Multiple regression analyses are used to calculate associations between child weight groups and parenting practices when corrected for children's characteristics.

Results

Parents of children with overweight and obesity reported significantly different scores on control over eating practices than parents of children with a healthy weight, namely a significantly higher score on covert control (B = 0.397, S.E. 0.123, p = 0.001) and a significantly lower score for overt control (B = -0.136, S.E. 0.068, p = 0.046).

Conclusion

Covert control is reported more, while overt control is reported less in parents of children with overweight and obesity compared to parents of children with a healthy weight, even after correction for the child's, family, and maternal characteristics. Future longitudinal research and intervention trials are recommended to determine whether and how the use of control over eating practices changes.

Parental child-feeding practices at 4 years of age are associated with dietary patterns of 7-year-olds

BACKGROUND

Parental child-feeding practices have been associated with child body mass index (BMI) and specific food group consumption; however, their role in the development of dietary patterns is less understood. We aim to study the association between parental child-feeding practices at 4 years old and dietary patterns at 7 years that explain BMI z-scores at age 10.

METHODS

Participants were children from the Generation XXI birth cohort (n = 3272). Three patterns of feeding practices at 4 years were previously identified: 'Perceived monitoring', 'Restriction' and 'Pressure to eat'. At 7 years, two dietary patterns were derived: 'Energy-dense foods', higher consumption of energy-dense foods and drinks and processed meats and lower consumption of vegetable soup (significantly associated with BMI z-scores at 10 years) and 'Fish-based', higher in fishery intake and lower in energy-dense food intake. Associations were estimated by linear regression models, adjusted for potential confounders (mother's age, education and pre-pregnancy BMI).

RESULTS

Girls whose parents used more Restriction, Perceived monitoring and Pressure to eat at 4 years were less likely to follow the 'Energy-dense foods' dietary pattern at 7 years (β̂ = -0.082; 95% confidence intervals [CI]: -0.134; -0.029; β̂ = -0.093; 95% CI: -0.146; -0.039; β̂ = -0.079; 95% CI: -0.135; -0.04, respectively). In both sexes, children whose parents used more Restriction and Perceived monitoring at 4 years were more likely to follow the 'Fish-based' dietary pattern at 7 years (girls: β̂ = 0.143; 95% CI: 0.077; 0.210; β̂ = 0.079; 95% CI: 0.011; 0.148; boys: β̂ = 0.157; 95% CI: 0.090; 0.224; β̂ = 0.104; 95% CI: 0.041; 0.168).

CONCLUSIONS

Children whose parents used more Restriction and Perceived monitoring at preschool age were more likely to follow healthier dietary patterns at age 7.

Breastfeeding Duration and Timing of Bottle Supplementation: Associations with Body Mass Index from Childhood to Young-Adulthood

Evidence for the association between breastfeeding (BF) duration and later body mass index (BMI) is inconsistent. We explored how BF duration and BF type (exclusive or partial) related to BMI from childhood to young adulthood in a Chilean cohort. Infants were recruited at 6 months between 1994 and 1996 in Santiago, Chile (n = 821). Mothers reported date of first bottle and last BF; anthropometry was measured at 1, 5, 10, 16, and 23 years. We tested whether: (1) type of BF at 6 months (none, partial, exclusive) and (2) duration of exclusive BF (<1 month, 1 to <3 months, 3 to <6 months, and ≥6 months) related to BMI. At 6 months, 35% received both breastmilk and formula ("partial BF") and 38% were exclusively breastfed. We found some evidence of an association between longer BF and lower BMI z-scores at young ages but observed null effects for later BMI. Specifically, BF for 3 to <6 months compared to <1 month related to lower BMI z-scores at 1 and 5 years (both p < 0.05). Our results are in partial accordance with others who have not found a protective effect of longer BF for lower BMI.

Maternal feeding styles in infancy predict child body mass index z-scores at 72 months: findings from a cohort of Jamaican children

Objective

To explore whether maternal feeding styles at 12 months predict child Body Mass Index (BMI) z-scores at 72 months and evaluate whether BMI z-scores at 18 months mediates the association.

Methods

Data from 239 mother-child pairs participating in a parenting intervention were analyzed. Feeding information was ascertained at 12 months by questionnaire with feeding styles identified using factor analysis. Children's weight and length/height were measured at 18 and 72 months and BMI z-scores computed. Maternal sociodemographic data, depressive symptoms and language skills were obtained by questionnaire. Multilevel linear regression analysis was used to examine whether feeding styles predicted 72 month BMI z-scores. Complete case analysis was conducted and multiple imputation used to treat missing values of explanatory and outcome variables at 18 and 72 months. Mediational analysis was performed to assess the indirect effects of feeding styles on 72 month BMI z-scores via 18 month BMI z-scores.

Results

Restrictive feeding at age 12 months predicted higher 72 month BMI z-scores in both complete case analysis [β (95%CI): 0.19 (0.02, 0.37)] and multiple imputation [β (95%CI): 0.20 (0.02, 0.39)]. Uninvolved, forceful, indulgent and responsive feeding styles were not significant predictors of 72 month BMI z-scores. A significant indirect effect was observed between restrictive feeding and child BMI z-scores at 72 months via 18 month BMI z-scores [β (95% CI) 0.12 (0.03, 0.22)].

Conclusion

Restrictive feeding at 12 months was associated with higher BMI z-scores at 72 months and appeared to be mediated by BMI z-scores at 18 months.

Child Weight Status: The Role of Feeding Styles and Highly Motivated Eating in Children

Although parental feeding plays an important role in child eating and weight status, high food motivation among children may also be a factor shaping how feeding impacts child weight. This study explored whether individual differences in preschool children’s food motivation interacted with mothers’ feeding styles in predicting subsequent child weight status. Participants included 129 Hispanic Head Start mother/child dyads. Data were collected at ages 4–5 years (Time 1) and 7–9 (Time 3). Staff measured heights/weights and observed children in an eating in the absence of hunger task. Mothers reported on feeding styles/practices and children’s eating behaviors. A principal components analysis derived a measure of highly motivated eating in children. Multiple regressions predicted Time 3 child BMI z-scores. Time 3 BMI z-scores were positively predicted by authoritative and indulgent feeding styles and negatively predicted by monitoring. Since feeding style interacted with highly motivated eating, separate regressions were run for high and low food motivation in children. Unexpectedly, results showed that authoritative feeding positively predicted Time 3 child BMI z-scores only for children showing low levels of food motivation. Characterizing differential parental feeding and child eating phenotypes may assist in tailoring childhood obesity prevention programs for the target populations.

Parental Influence on Child and Adolescent Physical Activity Level: A Meta-Analysis

Parents are often regarded as one of the significant social agents who are important to the participation of physical activity (PA) among children and adolescents. However, within the literature, the relationships between parental influences and child and adolescent PA have been inconclusive and discordant. The purpose of this meta-analysis was to quantify and synthesize the associations between parental social influences (positive parental influence, punishment, and discouragement) and the PA level of children and adolescents. Through a systematic literature search using PsycINFO, Web of Science, PubMed, ProQuest, and SPORTDiscus databases, we identified 112 eligible studies and subsequently extracted 741 effect sizes for our analysis. Multilevel meta-analysis showed that the corrected zero-order correlation of positive parental influence was positive and statistically significant, r = 0.202, SE = 0.014, t = 14.975, p < 0.001, 95% confidence interval (CI) = [0.176, 0.228]. Further moderation analysis also found that this was significantly moderated by parental gender (maternal vs. paternal), respondent of influence measure (parent-reported vs. child-reported), and type of PA measure (subjective vs. objective). The corrected zero-order correlations of negative parental influences (i.e., punishment and discouragement) were not statistically significant, and no significant moderation effects were observed. The findings of our meta-analysis showed that children and adolescents had higher PA levels when their parents supported PA participation by exerting positive social influence. Punishment and discouragement against PA by parents did not appear to be significantly associated with the PA level of children and adolescents. The findings of negative parental social influence were mixed and required further investigations.

Diet self-management: A qualitative study of college students' experiences and perspectives

Background

Overweight and obesity among college students have become an emergent public health concern, which may be effectively prevented by diet self-management (DSM). The purpose of this explorative study was to explore college students' experiences and perspectives on diet self-management (DSM), as well as its influencing factors.

Method

Thirty-three college students were recruited from different universities in China. A qualitative method was used to conduct semi-structured interviews with audio recording to explore their DSM experience and factors that influence DSM. Data were analyzed using thematic analysis to develop themes related to DSM.

Result

In the perception of what "good DSM" means, three themes and ten subthemes were identified: characteristics of good DSM (including 5 subthemes: regularity, balanced diet, no picky eating, good eating habits, and scientificity), method of good DSM (including three subthemes: self-control, adjusting, and making plans), and content of good DSM (including two subthemes: nutrition management and safety management). The influencing factors of DSM can be categorized into four levels of themes and 34 subthemes: individual, family, school, and social levels.

Conclusion

The results of this qualitative research highlighted the complexity and multi-dimension of DSM and its influencing factors. Our findings may help to inform diverse and needs-based intervention approaches to improve DSM and promote healthy diet among college students so as to prevent overweight and obesity.

The Relationships between Parenting Practices and Child Health-Related Behaviors in Children with Intellectual Disability: The Moderating Role of Child Body Weight Status

This study aimed to examine the associations between parenting practices and child health-related behaviors, and the moderating role of child body weight status in children with intellectual disability (ID). A cross-sectional study was conducted among a sample of children with ID in Hong Kong; 440 participants were included in this study. All the variables investigated were collected from questionnaires, except body weight status, which was objectively measured. Logistic regression analysis was used to examine the associations between parenting practices and children's unhealthy behaviors. Interaction items were added to investigate the moderation effect of child body weight status, adjusting for significant background characteristics. Results showed that the parenting practices of "restricting access to unhealthy food and sedentary behaviors (RA)" (OR range: 0.63-0.64) and "using food or sedentary behaviors as rewards (UR)" (OR range: 1.28-1.60) were significantly associated with some eating behaviors, but not with sedentary behaviors. Body weight status significantly moderated these associations. Only RA showed favorable effects on some eating behaviors in children with overweight and obesity (OR range: 0.17-0.28), whereas the effects of UR differed by body weight status. Future research should focus on developing educational interventions which encourage parents to use practices that are tailored towards children's individual characteristics.

Assessing parents’ self-efficacy to handle child obesity-related behaviors: validation of the Lifestyle Behavior Checklist in Iran

Background

The aim of the present study was to validate the Lifestyle Behavior Checklist (LBC) questionnaire, to measure Iranian parents' perceptions of their children's weight-related behaviors and their self-efficacy in dealing with those behaviors.

Methods

The LBC was translated into Farsi. Face and content validity of the questionnaire was evaluated by an expert panel. A total of 213 mothers of 3–12-year-old children responded to the questionnaire. Criterion validity of the questionnaire was evaluated through comparing its result with a parenting style questionnaire. Principal component analysis (PCA) and confirmatory factor analyses (CFA) were used to evaluate construct validity of the questionnaire. Reproducibility was measured by twice administration of LBC, one month apart and using Spearman's rho correlation test. The questionnaire's internal consistency was assessed by calculating Cronbach's α.

Results

LBC Problem scale was significantly correlated with authoritarian parenting style score, while the Confidence scale was significantly correlated with authoritative and negatively with permissive and authoritarian parenting styles. PCA suggested a six-factor construct, including, fussy eating, food-related problem behaviors, overeating behaviors, low interest in physical activity, poor self-image and sedentary behaviors. The results of CFA indicated acceptable fit indices for the proposed models. Both, Problem scale (Cronbach's α = 0.8) and Confidence scale (Cronbach's α = 0.95) had high internal consistency. Spearman correlation coefficients indicated acceptable reproducibility for both the Problem scale (r = 0.74) and the Confidence scale (r = 0.70).

Conclusions

The Farsi version of LBC questionnaire is reliable and reasonably valid to measure Iranian mothers' perception of their children's weight-related problem behavior.

Associations between Emotion Regulation, Feeding Practices, and Preschoolers' Food Consumption

Previous research identified emotion dysregulation, non-responsive feeding practices, and unhealthy food consumption as risk factors for childhood obesity. However, little is known about the relationships between these factors. This study examined associations between children’s emotion regulation, parental feeding practices, and children’s food consumption. The sample consisted of 163 mothers of children aged 3–5 years. Mothers completed the Emotion Regulation Checklist, the Child Feeding Questionnaire, and the Child Health Section from the Parent Interview of the Early Childhood Longitudinal Study-B to assess model variables. Results showed that healthy food consumption was associated with higher emotion regulation abilities, higher monitoring, and lower pressure to eat. For unhealthy food consumption, the associations were in opposite directions. Higher emotion regulation abilities were also associated with higher monitoring, lower pressure to eat, and lower restriction. For lability, the associations were in opposite directions. Regression analyses revealed that children’s lability, pressure to eat, and monitoring were significant predictors of children’s food consumption. These findings suggest that children’s emotion regulation and feeding practices are important determinants of children’s food consumption. Future longitudinal studies that examine bidirectional associations between children’s emotion regulation, parental feeding practices, children’s food consumption, and potential mechanisms accounting for these associations are needed.

Diet Quality and Changes in Food Intake during the University Studies in Polish Female Young Adults: Linkages with Food Experiences from Childhood and Perceived Nutrition Concerns

The transition from adolescence to young adulthood may be associated with unfavorable changes in food intake due to some substantial transformations in social life and environment. Factors that affect food choices and diet quality during early adulthood are still not well-recognized. This paper aims to explore the relationship between females’ childhood food experiences related to parents’ monitoring practices and healthy eating guidance, perceived nutrition concerns, changes in food intake during university studies, and diet quality. A cross-sectional study with the use of CAWI (Computer-Assisted Web Interview) was carried out on 657 female students aged 19–30 years. Beliefs and Eating Habits Questionnaire (KomPAN) was used to assess the frequency of eating various kinds of food and then to calculate the diet-quality index (DQI). Adults’ Memories of Feeding in Childhood (AMoFiC) questionnaire was used to assess food experiences from childhood, and Health Concern Scale (HCS) was used to assess nutrition concerns. Associations between changes in food intake, diet quality, and selected factors describing the study sample were verified using logistic regression analysis. The DQI of the majority of students indicated a low intensity of nonhealthy and pro-healthy dietary characteristics. The intensity was higher among nutrition and health students, those with low nutrition concerns, and those with childhood experiences of monitoring. The chances of a negative change in food intake were increased by a higher score for childhood food experiences associated with parents’ monitoring practices. The chances of a negative DQI were increased by bigger concerns about nutrition and by technical and agricultural majors; however, they were reduced by positive changes in food intake. Both childhood food experiences and perceived nutrition concerns should be factored into strategies aimed at improving youth diet and educating parents about effective parental feeding practices.

Exploration of Malaysian school-children's food preferences: what do we know?

BACKGROUND

Feeding practices exert a definite influence over children's experiences. This article aims to explore parental feeding practices and investigate the prediction domain of food preference from parent-child perspectives.

METHODS

Two individual studies were conducted on Malay families with children aged 7-12 years. In Study 1, mothers (n = 17) participated in semi-structured focus group interviews on their knowledge of foods and feeding practices. In Study 2, parent-child pairs (n = 14) answered a 36-item, 5-point Likert scale Food Preference Questionnaire followed by virtual structured qualitative interviews. The interviews were digitally recorded, transcribed verbatim, back-translated and analysed according to the framework analysis technique.

RESULTS

In Study 1, mothers perceived vegetables, chicken, fish and plain water as healthy foods and drinks while discretionary options were snacks, fast foods and carbonated drinks. The mothers defined healthy foods as foods handled safely with health benefits. They used 'healthy' cooking methods to prepare preferred foods and overtly controlled the child's access to discretionary food. In Study 2, the food groups reported by parent-child pair's report were consistent for the most preferred foods [snacks, median (interquartile range), parent: 4.5 (1.0) vs. child: 4.5 (0.0), p &gt; 0.05] and least preferred food [legumes, parent: 2.0 (1.0) vs. child: 2.0 (1.0), p &gt; 0.05]. Parents emphasized taste as the key determinant of food preference.

CONCLUSION

These studies were the first to qualitatively explore parents' perceptions of foods affecting their feeding practices among the Malaysian community to highlight the cultural contribution. Key insights into children's food intake and factors influencing their food preferences were identified.

Psychometric properties of the item-reduced version of the comprehensive general parenting questionnaire for caregivers of preschoolers in a Finnish context

Introduction

Many instruments for assessing general parenting have been reported as burdensome and are thus seldom used in studies exploring children’s energy balance-related behaviors or weight. This study evaluates the factorial structure of the item-reduced version of the Comprehensive General Parenting Questionnaire (CGPQ), which assesses five constructs of general parenting.

Methods

The study uses data from two cross-sectional studies: Study 1 in 2014 (n = 173) and Study 2 in 2015–16 (n = 805). Parents of children aged three to six answered the CGPQ; in Study 1 the 69-item version, and in Study 2 the 29-item version. The reduction was based on the results of the confirmatory factor analyses (CFA) in Study 1. In both datasets, internal consistency, as Cronbach’s alphas and intraclass correlations between the items of each construct, was tested. A combined assessment of the CFA and items response theory evaluated the construct validity and the item importance for the 29-item version, and a further the reduced 22-item version.

Results

In Study 1, the highest Cronbach’s alphas were shown for the five constructs in the 69-item version. A higher intraclass correlation was found between the constructs in the 69- and 29-item versions, than between the 69- and the 22-item version. However, a high concordance was found between the constructs in the 29- and 22-item versions in both Study 1 and in Study 2 (0.76–1.00). Testing the goodness-of-fit of the CFA models revealed that the 22-item model fulfilled all the criteria, showing that it had a better factorial structure than the 29-item model. Standard estimations ranged from 0.20 to 0.76 in the 22-item version.

Conclusion

The reduced 22- and 29-item versions of the 69-item CGPQ showed good model fit, the 22-item version the better of the two. These short versions can be used to assess general parenting without overburdening the respondents.

A 3-Year Longitudinal Study of Effects of Parental Feeding Practices on Child Weight Status: The Childhood Obesity Study in China Mega-Cities

This study examined the longitudinal associations between parental feeding practices and child weight status, and their potential modification effects by child sex, age, and maternal and paternal educations among children. Data were collected from 2015 to 2017 of 2139 children aged 6−17 years and their parents in five Chinese mega-cities. Parental feeding practices were assessed using 11-items from Child Feeding Questionnaire. Waist-to-height ratio (WHtR), body mass index (BMI), and general and central obesity were measured and analyzed using a mixed-effects model. Three parental feeding patterns were identified by factor analysis including “concern”, “pressure to eat”, and “control”. Concern was associated with higher BMI z-score, WHtR (βs ranged from 0.01 to 0.16), and general obesity (ORs ranged from 1.29 to 6.41) among children aged ≤12 years and >12 years, regardless of child sex and parental educations. Pressure to eat was associated with lower BMI z-score (β = −0.08, p < 0.001), WHtR (β = −0.004, p < 0.01), and general (OR = 0.53, 95%CI = 0.42, 0.66) and central obesity (OR = 0.72, 95%CI = 0.58, 0.90) among children aged ≤12 years. Further analyses showed that significant associations were found for children with maternal or paternal education of college and above. Control was associated with increased risk of general and central obesity among children with maternal education of college and above, regardless of age. Our study indicates that higher concern and lower pressure to eat were associated with increased risk of obesity among children. Control was associated with increased risk of obesity among children with maternal education of college and above. Future childhood obesity preventions may optimize parental feeding practices.

Lack of an association between dietary patterns and adiposity among primary school children in Kilimanjaro Tanzania

Introduction

Healthy dietary habits prevent childhood overweight and obesity and the risk of non-communicable diseases (NCDs) later in life. We examined dietary patterns and their association with adiposity among primary school children in northern Tanzania.

Methods

Dietary data was collected by 24-h recall and food frequency questionnaire (FFQ) for 1170 primary school children aged 9 – 11 years from 20 primary schools in the Kilimanjaro region. Factor analysis and FFQ data were used to identify dietary patterns. Children were categorized into terciles of their adherence to each dietary pattern. Multilevel logistic regression was used to evaluate the association of dietary pattern terciles with adiposity indicators: body mass index z–scores (BMI z scores), body fat percentage by bioelectrical impedance, triceps, subscapular skinfold thicknesses, and waist circumference.

Results

Fifteen percent of children had BMI Z > 1.0, indicating overweight or obesity. Two dietary patterns were identified by factor analysis: a healthy pattern characterized by frequent consumption of fruits and vegetables; and a mixed dietary pattern characterized by intake of fatty snacks, sweets and sugar snacks, sugary beverages, meat and alternatives, milk, and milk products. After adjusting for potential confounders, for both models: model 1 (age and sex), and model 2 (age, sex, school type, time spent walking to school, district [urban/ rural], availability of television and electronic gadgets at home and neighbourhood playground); we found no significant associations between dietary patterns and adiposity measures.

Conclusion

Dietary patterns were not associated with adiposity in Tanzanian primary school children, possibly because of limitations of the FFQ, which did not record information on portion sizes. Future research should focus on understanding the key foods / snacks consumed by school children, portion sizes and their long-term effects on adiposity in children.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40795-022-00529-4.

Relationships between Physical Activity Parenting Practices and Children’s Activity Measured by Accelerometry with Children’s Activity Style as a Moderator—A Cross Sectional Study

The objective was to examine the associations between physical activity parenting practices (PAPP) and children’s levels of moderate-to-vigorous physical activity (MVPA), and time spent sedentary (SED) during non-school time in weekdays and weekends when children’s activity style was taken into account. Study participants were 88 children (mean age 6.3 (SD 0.3) years); 51.0% girls) and their parents who took part in A Healthy School Start Plus in Sweden. The independent variables included PAPPs Structure, Neglect/control, and Autonomy promotion and children’s activity style as moderator, assessed through validated parent questionnaires. Dependent variables were the MVPA and SED in minutes, measured by accelerometry. Structural equation modeling was used to examine the associations between PAPPs and children’s MVPA and SED with children’s activity style as a moderator. No significant associations between the PAPPs Structure, Neglect/control, and Autonomy promotion and measures of physical activity were found (p > 0.13). The moderating role of activity style improved the model fit and the final model had a reasonable fit to the data. Our results suggest that in future studies, with the aim to explore the relationship between PAPP and children’s physical activity, the activity style of the children should be included as a moderator.

Perceptions and knowledge of school management teams about non-communicable diseases and strategies to prevent them

Background

In 2016, non-communicable diseases (NCDs) were reported to be responsible for 41 million of the world’s 57 million deaths. These deaths were reported to be associated with modifiable lifestyle behaviours, such as tobacco smoking, poor physical activity and diets of poor nutritional value. There could be a knowledge gap on NCD risk factors amongst non-health professionals. Knowledge of NCDs is, therefore, important for the implementation of preventive measures to onset of NCDs.

Aim

This study aimed at describing perceptions and knowledge of school management teams about NCDs and strategies to prevent them.

Setting

This study was conducted in Mt Frere, South Africa.

Methods

This explorative qualitative study using a phenomenological data collection approach was conducted amongst purposively selected school authorities in 2016–2017 to understand their perceptions and knowledge about NCDs and what can be performed to prevent them. Two focus group discussions (FGDs) were conducted using open-ended and unstructured questions guided by interview schedule. Tesch’s eight phases of thematic analysis approach was used to analyse narrative data resulting in two main themes and nine subthemes.

Results

Two themes (understanding and prevention of NCDs, and control measures for NCDs) and nine sub-themes emerged from the data analysis. Inconsistent description of NCDs, its causes and controls were identified amongst school management teams in the FGD. Diet, poverty, societal factors, gaps between decision makers and communities, and poor policy implementation were identified by participants as major issues in the development of NCDs.

Conclusion

There was no adequate knowledge on NCDs amongst the school management team participants. Improved visibility of health promotion personnel is needed to ensure community empowerment on NCDs prevention.

Contribution

The findings in this study will help in closing the gaps in the implementation of preventive health services for NCDs within school health.

Factors associated with feeding practices of black immigrant mothers of African and Caribbean origin living in Ottawa, Canada

In Canada, Black immigrant women and their children are at higher risk of developing obesity. Factors that could influence children's weight status include parental feeding practices. Feeding practices such as monitoring, restriction and pressure to eat, are well studied among non-Hispanic White and Latinos groups, however, little is known about the feeding practices of Black immigrant parents of African and Caribbean origin. The aim of this study was to identify factors associated with feeding practices of Black immigrant mothers in Ottawa, Canada. The sample includes 188 Black mothers of African and Caribbean origin and their 6-12-year-old children. The Child Feeding Questionnaire was used to assess mothers' feeding practices. Demographic and socioeconomic data were collected using questionnaires. All participants' weight status was determined from measured weight and height. Pearson Chi-square tests and multivariate logistic regressions were performed. Results showed that mothers who felt responsible for feeding their children were more likely to monitor their children's food intake (p < 0.05). While mothers of children with underweight or normal weight were more like to use pressure to eat (p < 0.01), mothers of children with overweight or obesity were more like to use restriction (P < 0.05). Recent immigrant mothers were also more likely to use pressure to eat (P < 0.05). This study also provides evidence for associations between maternal feeding practices and mothers' weight status, household income and food security status. Findings build on previous research suggesting that parental feeding practices vary based on parents' and children's characteristics. Longitudinal studies are needed to assess the directionality of the association between mothers' feeding practices, and children's weight, diet quality and health in this population.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Children's Physical Activity and Screen Time during COVID-19 Pandemic: A Qualitative Exploration of Parent Perceptions

OBJECTIVE

In this study, we explore parent perception of children's physical activity and screen time during COVID-19 stay-at-home orders.

METHODS

We interviewed 16 parents of children ages 5-12 years in the St. Louis, Missouri region using snowball sampling. We sampled from rural, urban, and suburban areas. The interviews were recorded, transcribed, and analyzed using a priori and emergent codes.

RESULTS

The transition to virtual school and work transformed daily activities. Physical education requirements varied, generally perceived as not contributing to overall physical activity. Parents perceived the amount of physical activity as the same or increased but reported an increase in screen time. The physical environment of the home, yard, and neighborhood emerged as a theme as did the social environment for physical activity.

CONCLUSIONS

COVID-19 stay-at-home orders created challenges for children's physical activity. Results can be used to inform more generalizable studies and serve as a basis for creating better parent resources to support their children's physical activity outside of ordinary school, sport, and community activity opportunities.

Associations between Coparenting Quality and Food Parenting Practices among Mothers and Fathers in the Guelph Family Health Study

Coparenting quality and food parenting practices have been shown to have a strong influence on child outcomes. However, little is known about whether coparenting quality may influence food parenting practices. This study aimed to investigate how coparenting quality is associated with both mothers’ and fathers’ food parenting practices. A cross-sectional analysis was conducted of 58 mothers and 40 fathers enrolled in the Guelph Family Health Study. The Coparenting Relationship Scale and the Comprehensive Feeding Practices Questionnaire were used to measure coparenting and food parenting practices, respectively. Linear regressions using generalized estimating equations were used to examine associations between coparenting quality and food parenting practices in mothers and fathers. Among mothers, higher coparenting quality was associated with lower use of food for emotional regulation, restriction of food for health, and child control of food intake and with higher encouragement of a balanced and varied diet, provision of a healthy home environment, and modeling of healthy eating behaviors. Among fathers, higher coparenting quality was associated with lower pressure to eat and with higher encouragement of a balanced and varied diet and provision of a healthy home environment. Coparenting quality is associated with food parenting practices among both mothers and fathers. Interventions aiming to improve food parenting practices should include fathers and should consider targeting parents’ coparenting relationship.

A Family-Based Lifestyle Intervention Focusing on Fathers and Their Children Using Co-Creation: Study Protocol of the Run Daddy Run Intervention

Fathers play a unique and important role in shaping their children’s physical activity (PA), independent from the mother. Lifestyle interventions focusing simultaneously on PA of fathers and their children (“co-PA”) are therefore a novel and promising way to improve PA of both. A theory-based lifestyle intervention was co-created with fathers (i.e., the Run Daddy Run intervention), using the behavior change wheel as a theoretical framework. The aim of the present study is to describe the protocol of the Run Daddy Run intervention study, focusing on improving (co-)PA of fathers and children, and the prospected outcomes. The developed intervention consists of six (inter)active father-child sessions and an eHealth component, delivered over a 14-week intervention period. Baseline measurements will be conducted between November 2019–January 2020, post-test measurements in June 2020, and follow-up measurements in November 2020, with (co-)PA as the primary outcome variable. Outcomes will be measured using accelerometry and an online questionnaire. To evaluate the intervention, multilevel analyses will be conducted. This study will increase our understanding on whether a theory-based, co-created lifestyle intervention focusing exclusively on fathers and their children can improve their (co-)PA behavior and has important implications for future research and health policy, where targeting fathers might be a novel and effective approach to improve (co-)PA and associated health behaviors of both fathers and their children.

Do parenting practices moderate the association between the physical neighbourhood environment and changes in children's time spent at various physical activity levels? An exploratory longitudinal study

BACKGROUND

As many children do not meet the recommended daily physical activity (PA) levels, more research is needed towards environmental determinants of children's PA levels. The aims of this longitudinal study were to investigate whether the physical environment and parenting practices have an impact on changes in children's weekday time spent at various PA levels and whether associations between physical neighbourhood environment and changes in children's PA are moderated by parenting practices.

METHODS

We performed a secondary data analysis of longitudinal data collected at three timepoints (baseline, 6, and 18 months) from 10 control schools of the Active Living study, a quasi-experimental study, which took place in South Limburg, the Netherlands. In total, 240 children aged 8-12 years were included in the analyses. PA levels were measured using accelerometry (ActiGraph GT3X+). The physical environment was assessed at baseline through neighbourhood audits of the school environment, and PA parenting practices were measured at baseline via validated parental questionnaires. Multivariate multilevel regression analyses were conducted to determine the main effects of the physical environment and parenting practices on changes in children's time spent in sedentary behaviour (SB), light PA and moderate-to-vigorous PA (MVPA) over 18 months. Additionally, moderation of the association between the physical environment and children's PA levels by parenting practices was examined by adding interacting terms to the regression equations.

RESULTS

Walkability of the physical environmental was associated with a decrease in SB at 18 months (B = -5.45, p < .05). In addition, the parenting practice logistic support was associated with an increase in MVPA (at all time points, B = .68, B = .73 and B = 1.02, respectively, all p < .05) and a decrease in SB (at 18 months, B = -1.71, p < .05). Stratified analyses (based on significant interaction terms) showed that the effect of specific physical environmental features (e.g., sports facilities) on children's improvements in PA levels were strengthened by favourable parenting practices.

DISCUSSION

Besides the main effects of walkability and logistic support, there were indications that several parenting practices moderate the association between the physical environment and changes in children's time in various PA levels. The current findings are exploratory, and need to be confirmed in further research.

The relationship between the home environment and child adiposity: a systematic review

BACKGROUND

Extensive research has demonstrated the role of the Home Environment (HE) in shaping children's energy balance behaviours. Less is known about direct relationships with bodyweight. This review examines associations between the social and physical aspects of three pre-defined Home Environment domains (food, physical activity and media) and adiposity measures in children ≤12 years.

METHODS

Six electronic databases (PubMed, Medline, EBSCO CINAHL, EMBASE, Web of Science, PsycInfo) were systematically searched up to October 2020. Studies reporting at least one physical and/or social aspect of the food, physical activity and/or media domains of the Home Environment in relation to child adiposity outcomes were included (n = 62).

RESULTS

Most studies examined one (n = 41) or two domains (n = 16). Only five studies assessed all three domains of the Home Environment. Most consistent relationships were observed for physical aspects of the home media environment; with greater availability of electronic devices associated with higher child adiposity (21/29 studies). Findings were less consistent for the smaller number of studies examining physical aspects of the home food or physical activity environments. 8/15 studies examining physical food environments reported null associations with adiposity. Findings were similarly mixed for physical activity environments; with 4/7 reporting null associations, 2/7 reporting negative associations and 1/7 reporting positive associations between access to physical activity equipment/garden space and adiposity. Fewer studies assessed social aspects (e.g. caregiver modelling or limit setting) of the Home Environment in relation to child adiposity and findings were again mixed; 9/16 media environment, 7/11 food environment and 9/13 physical activity environment studies reported null associations with child adiposity outcomes.

CONCLUSIONS

The home media environment was most consistently associated with adiposity in childhood. Findings were less consistent for the home food and physical activity environments. Greater agreement on definitions and the measurement of the obesogenic home environment is required in order to clarify the strength and direction of relationships with child adiposity. Robust longitudinal research using comprehensive measures of the holistic home environment is needed to better identify which aspects contribute to excess weight gain in childhood.

TRIAL REGISTRATION

PROSPERO Systematic review registration number:  CRD42018115139 .

General Parenting and Hispanic Mothers' Feeding Practices and Styles

Previous research has shown that general parenting styles, general parenting dimensions, maternal feeding styles, and maternal feeding practices all show specific relationships with the weight status of young children. This study examined the relationships between general parenting and maternal feeding styles/practices in a sample of 187 Hispanic mothers with low incomes. As part of a larger study, mothers of preschool children were recruited through Head Start programs and completed validated questionnaires assessing their general parenting, feeding styles, and feeding practices. Results identified numerous associations between general parenting dimensions and specific feeding practices: i.e., maternal nurturance was positively associated with healthy eating guidance and feeding responsiveness; inconsistency was positively associated with restriction for weight and promotion of overconsumption; follow through on discipline was positively associated with monitoring, healthy eating guidance, and feeding responsiveness; and family organization was positively associated with monitoring and healthy eating guidance. General parenting styles were associated with feeding practices as well, with authoritative mothers showing the highest levels of healthy eating guidance and authoritarian mothers showing the lowest levels of monitoring. There were no significant associations between mothers' general parenting styles and mothers' feeding styles. Implications of these findings for the prevention of childhood obesity are considered.

Associations of family feeding and mealtime practices with children's overall diet quality: Results from a prospective population-based cohort

Food parenting practices are considered to have a key influence on children's dietary habits, with potential long term effects. In this study, we explored the associations of parental feeding practices and family mealtime practices in early childhood with children's overall diet quality at school age among 3626 parents and their children in a population-based cohort study in Rotterdam, the Netherlands. Parental feeding practices (monitoring, pressure to eat, and restriction) and family mealtime practices (meal skipping behaviors and family meal frequency) at age 4 years were assessed by parental questionnaires. Children's dietary intake was assessed at age 8 years using a food-frequency questionnaire, from which diet quality scores (range 0-10) were calculated, reflecting adherence to age-specific dietary guidelines. Using multivariable linear regression models, we found that monitoring was associated with higher diet quality of children (β = 0.12; 95%CI: 0.08, 0.16), whereas pressure to eat was associated with lower diet quality (β = -0.08; 95%CI: -0.12, -0.04)), both independent of child BMI. Restriction was associated with a higher child diet quality, but this association was explained by child BMI. As compared to children who did not skip meals, children who skipped meals had a lower diet quality (e.g. breakfast skipping: β = -0.32; 95%CI: -0.48, -0.17). Similarly, children who had less frequent family meals had a lower diet quality compared with those who had family meals every day (e.g. family dinner ≤2 days/week: β = -0.37; 95%CI: -0.60, -0.14). These associations were not driven by single food groups. In conclusion, parental monitoring and family mealtime routines in early childhood may provide a supportive food environment that promotes children's overall diet quality. Longitudinal studies with repeated measurements are needed to replicate our findings.

Food parenting practices and children's weight outcomes: A systematic review of prospective studies

This systematic review is the first to provide an overview of the prospective links between food parenting practices and children's weight outcomes. Three databases were searched. All titles, abstracts and full-texts were double screened by two independent reviewers. Peer-reviewed journal articles published after 1990 assessing the prospective association between food parenting practices and weight outcomes of children aged 2-18 years were eligible. A total of 38 eligible studies were identified, focusing on 12 separate food parenting practices. Restriction, pressure to eat, and monitoring were generally not associated with children's weight over time, but higher quality studies suggest that pressure to eat was associated with lower weight outcomes over time. Most studies on food availability and accessibility found null-findings as well. Instrumental-but not emotional-feeding was associated with higher weight over time, but higher quality studies are needed to confirm this link. Results involving the link between frequency of mealtime and child weight were mixed. Autonomy supporting and other structure-related food parenting practices were understudied. In conclusion, food parenting practices receiving the most attention within prospective studies (i.e., restriction, pressure to eat, monitoring) were generally not associated with children's weight outcomes over time. Future high quality studies should focus more on other food parenting practices, further unravel bidirectional links between food parenting and children's eating behaviors and weight outcomes, and examine the mediating role of dietary intake.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Maternal parenting styles and ecological momentary assessment of maternal feeding practices and child food intake across middle childhood to early adolescence

BACKGROUND

Maternal parenting styles are salient trait-based factors associated with pediatric obesity risk. The purpose of this study was to examine the longitudinal associations of maternal parenting styles and ecological momentary assessment (EMA) measures of maternal feeding practices and child food intake across middle childhood to early adolescence.

METHODS

Mother-child dyads (n = 186; M baseline child age = 10.03 ± 0.89) enrolled in a six-wave bi-annual longitudinal study. At baseline, mothers completed a self-report measure of parenting styles. At each of the six waves, mothers and children completed EMA prompts of parenting practices and food intake, respectively, for eight days.

RESULTS

Children of mothers who reported a more permissive style consumed more pastries/sweets. Children of mothers who reported a more authoritative style decreased likelihood of pastry/sweets consumption with age, and children of mothers who reported a less authoritative style increased likelihood of pastry/sweets consumption with age. The likelihood of fruit/vegetable consumption decreased with age among children of mothers who reported a more authoritarian style, and the likelihood increased among children of mothers with a less authoritarian style. Mothers who either reported a more authoritarian style or a less authoritative style were more likely to report using food as a reward.

DISCUSSION

Results highlight the importance of maternal parenting styles in relation to child food intake and instrumental feeding.

Mothers' feeding profiles among overweight, normal weight and underweight Chinese preschoolers

We adopted a person-centered approach to identify maternal feeding profiles among urban Chinese mothers of preschoolers, including two previously unexamined culturally-emphasized practices, and examine the associations between these feeding profiles and child and parent characteristics. Participants included 167 mothers and their preschoolers residing in Shanghai, China. Mothers reported on their feeding beliefs and practices, perceptions of child's body shapes, child dietary intake, and family demographic information. The hierarchical clustering method revealed 3 feeding clusters: uninvolved feeding (35.3%), concerned and restrictive feeding (21.6%), and high-pressure feeding (43.1%). Child BMI, weight status, maternal length of staying in Shanghai, maternal perceptions of child actual body shape and ideal body shape, and child unhealthy dietary intake were significantly different across the three clusters. The person-centered approach allowed for the examination of various feeding beliefs and practices simultaneously and revealed patterns of maternal feeding in Chinese families with preschoolers. Our oversampling of underweight and overweight groups of children in the present study allowed for the derivation of feeding profiles across children in all weight status groups. Moreover, the examination of whether demographic, maternal body shape perceptions, and child dietary intake differed across the clusters of mothers provided a more complete picture of family context and processes that may underlie and contribute to mothers' feeding practices, and ultimately their children's weight.

Associations between family and home-related factors and child's snack consumption in a multi-ethnic population

BACKGROUND

Energy-dense snacks are considered unhealthy due to their high concentrations of fat and sugar and low concentrations of micronutrients. The present study aimed to evaluate associations between family and home-related factors and children's snack consumption. We explored associations within subgroups based on ethnic background of the child.

METHODS

Cross-sectional data of 644 primary school children (mean age: 9.4 years, 53% girls) from the population-based 'Water Campaign' study conducted in the Netherlands were used. Logistic regression analyses were used to evaluate the associations between family and home-related factors and child's snack intake.

RESULTS

Of the children, 28.7% consumed more than one snack per day. Children of parents who expressed more restrictive parenting practices towards the child's snack consumption (odds ratio (OR) = 2.5, P < 0.001), and who modelled snack eating less often (OR = 2.2, P < 0.001) had lower snack intake. Restrictive parenting practices and parental modelling of healthy snacking were significant for children with a Dutch or Moroccan/Turkish ethnic background, but not for children with a Surinamese/Antillean ethnic background.

CONCLUSIONS

We observed that parenting practices and parental modelling were independently associated with the child's snack intake. Also, the relationships between these factors and the child's snack consumption differed for children with distinct ethnic backgrounds.

Corish C, M. Kearney J. Associations between the Home Environment, Feeding Practices and Children's Intakes of Fruit, Vegetables and Confectionary/Sugar-Sweetened Beverages

Within the home environment, parents influence their children’s dietary intakes through their parenting and dietary practices, and the foods they make available/accessible. The aim of this cross-sectional study was to examine the associations between home environmental characteristics and children’s dietary intakes. Three hundred and thirty-two children aged three–five years and their parents participated in the study. Home environmental characteristics, including parental control feeding practices, were explored using validated and standardized questionnaires such as the Child Feeding Questionnaire (CFQ), the Physical and Nutritional Home Environment Inventory (PNHEI) and the Healthy Home Survey (HHS). Parent and child food consumption was also measured. Pressure to eat from parents was associated with lower fruit intake in children (OR 0.67, 95% CI 0.47–0.96, p = 0.032). Greater variety of fruit available in the home increased the likelihood of fruit consumption in children (OR 1.35 95% CI 1.09–1.68, p = 0.005). Watching television for ≥1 h per day was associated with a decreased probability of children eating vegetables daily (OR 0.38, 95% CI 0.20–0.72, p = 0.003) and doubled their likelihood of consuming confectionary/sugar-sweetened beverages more than once weekly (OR 2.15, 95% CI 1.06–4.38, p = 0.034). Children whose parents had lower vegetable consumption were 59% less likely to eat vegetables daily. This study demonstrates that modifiable home environmental characteristics are significantly associated with children’s dietary intakes.

Identifying patterns of physical activity and screen time parenting practices and associations with preschool children's physical activity and adiposity

Although physical activity and screen time parenting practices influence children's behaviors, little work has examined how these practices work in combination. The purpose of this study was to identify patterns of physical activity and screen time parenting practices, and examine differences in preschool children's physical activity, sedentary behavior, and adiposity among the identified patterns. Data were collected in 2009-2012 from 319 parent-child dyads enrolled in a randomized trial testing a parent-focused obesity prevention intervention. At baseline, physical activity and screen time parenting practices were assessed using a validated self-report survey. Children's physical activity and sedentary behavior were measured using accelerometers and child anthropometrics were objectively measured. Latent profile analyses identified patterns of physical activity and screen time parenting practices. Differences in child outcomes were tested among the identified classes. Three parent classes were identified: Rewarders (n = 165), Activity Supportive (n = 98), and Screen Time Permissive (n = 56). Rewarder parents were characterized by the highest scores on using physical activity and screen time to reward or control children's behavior. Activity Supportive parents generally had the highest scores on practices to promote physical activity, while Screen Time Permissive parents had the highest scores on practices facilitating screen time. There were no differences in the mean child physical activity, sedentary behavior or BMI z-score among the three classes. Findings revealed distinct classes of parents that could provide modifiable targets for family-based physical activity promotion, but more work is needed examining the influence of these patterns longitudinally and in different populations.

The association of parenting practices with toddlers' dietary intake and BMI, and the moderating role of general parenting and child temperament

Objective:

The objective was to examine the association between parenting practices, toddler’s dietary intake and BMI. In addition, potential moderation of these associations by general parenting and child temperament was examined.

Design:

The current cross-sectional study assessed parenting practices using the Comprehensive Feeding Practices Questionnaire, general parenting using the Comprehensive General Parenting Questionnaire, child temperament using the Child Behavior Check List, and children’s dietary intake through parental questionnaires. Children’s weight and length were objectively measured to determine BMI z-scores. Associations were examined using multiple linear regression analyses. Moderation was examined using interaction terms.

Setting:

Home setting.

Participants:

393 Dutch toddlers (age 1–3 years) and their parents recruited through fifty childcare centres and preschools in the Netherlands.

Results:

Various practices were related to children’s diet and BMI. For instance, the availability of healthy foods is the most important predictor of healthy dietary intake (e.g. β = –0·35 for sweets; β = 0·18 for fruit). The association of availability with a healthier diet was strongest when parents scored low on the positive parenting style dimensions, including nurturance, structure and/or behavioural control. In addition, it seemed that a high availability of healthy foods and low availability of unhealthy foods is especially beneficial for children showing withdrawal/depressive, anxious or overactive behaviour, while encouraging balance and variety is not beneficial for these children. All other practices were related to children’s diet and/or BMI as well.

Conclusions:

The findings underline the importance of viewing the impact of parenting practices in the context of general parenting and child temperament.

Clusters of diet, physical activity, television exposure and sleep habits and their association with adiposity in preschool children: the EDEN mother-child cohort

Background

Despite the growing interest in the relation between adiposity in children and different lifestyle clusters, few studies used a longitudinal design to examine a large range of behaviors in various contexts, in particular eating- and sleep-related routines, and few studies have examined these factors in young children. The objectives of this study were to identify clusters of boys and girls based on diet, sleep and activity-related behaviors and their family environment at 2 and 5 years of age, and to assess whether the clusters identified varied across maternal education levels and were associated with body fat at age 5.

Methods

At 2 and 5 years, respectively, 1436 and 1195 parents from the EDEN mother-child cohort completed a questionnaire including behavioral data. A latent class analysis aimed to uncover gender-specific behavioral clusters. Body fat percentage was estimated by anthropometric and bioelectrical impedance measurements. Association between cluster membership and body fat was assessed with mutivariable linear regression models.

Results

At 2 years, two clusters emerged that were essentially characterized by opposite eating habits. At 5 years, TV exposure was the most distinguishing feature, but the numbers and types of clusters differed by gender. An association between cluster membership and body fat was found only in girls at 5 years of age, with girls in the cluster defined by very high TV exposure and unfavorable mealtime habits (despite high outdoor playing and walking time) having the highest body fat. Girls whose mother had low educational attainment were more likely to be in this high-risk cluster. Girls who were on a cluster evolution path corresponding to the highest TV viewing time and the least favorable mealtime habits from 2 to 5 years of age had higher body fat at 5 years.

Conclusions

Efforts to decrease TV time and improve mealtime routines may hold promise for preventing overweight in young children, especially girls growing up in disadvantaged families. These preventive efforts should start as early in life as possible, ideally before the age of two, and should be sustained over the preschool years.

Maternal practices and perceptions of child body mass status explain child energy expenditure behaviors and body mass

This study investigated whether maternal perceptions of child body mass status would predict child body mass index (BMI) z-score via two sets of sequential mediators: (1) four maternal practices promoting child energy expenditure and (2) children’s energy expenditure behaviors. The data of N = 729 mother–child dyads were collected at baseline [T1; n = 495 at 7- to 8-month follow-up (T2)]. Mothers reported perceptions of child body mass status and maternal practices (T1); children reported sedentary screen use and physical activity (T1, T2). Child body mass was assessed objectively (T1, T2). Higher stimulation to be active (T1) was related to a lower child BMI z-score (T2) via higher levels of child physical activity (T2). Higher levels of monitoring of screen use (T1) were associated with higher child BMI z-score (T2) via lower levels of child physical activity (T2). Encouraging parents to stimulate their children to be active may be beneficial for children’s weight maintenance.

Parents' underestimation of their child's weight status. Moderating factors and change over time: A cross-sectional study

BACKGROUND

Parents' underestimation of their child's weight status can hinder active participation in overweight prevention programs. We examined the level of agreement between the parents' perception of their child's weight status and the child's actual weight status, moderating factors, and change over time.

METHODS

This cross-sectional study used data collected in 2009 (n = 8105), 2013 (n = 8844) and 2017 (n = 11,022) from a community-based survey conducted among parents of children age 2-12 years in the Netherlands. Parents classified their perception of their child's weight status on a 5-point Likert scale. In 2009 and 2013, the child's BMI was calculated from self-reported data by parents. The level of agreement between the parent's perception of the weight status and the actual weight status was examined using Cohen's kappa. The role of demographic factors on parents' perception were examined using logistic regression.

RESULTS

In 2009, 2013 and 2017, 6%, 6% and 5% of the parents, respectively, classified their child as heavy/extremely heavy. In 2009 and 2013, 64.7% and 61.0% of parents, respectively, underestimated the weight status of their overweight child. This was even higher among parents of obese children. Overall, the agreement between the parents' perception and the actual weight status improved from 2009 (kappa = 0.38) to 2013 (kappa = 0.43) (p<0.05), but remained unsatisfactory. The parents' underestimation of their child's overweight/obesity status was associated with the child's age in 2009 and 2013 (2-7 years; OR: 0.18), the child's gender in 2009 (male; OR: 0.55), and the parents' education level in 2009 (middle and high education; OR: 0.56 and 0.44 respectively).

CONCLUSIONS

Parents' underestimation of their child's weight status remains alarmingly high, particularly among parents of young, obese children. This underestimation is a barrier to preventing childhood overweight/obesity. Healthcare professionals should take this underestimation into consideration and should actively encourage parents to take steps to prevent overweight/obesity in their children.