Effects of fast-food consumption on energy intake and diet quality among children in a national household survey

Mothers' Awareness of Obesity and Its Complications Among Children in the Western Region of Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Awareness about obesity, its complications, and an age-appropriate, healthy, active lifestyle are essential to maintaining a healthy life. This study aimed to determine the level of awareness Saudi Arabian caregivers have regarding obesity and regular physical activity.

MATERIALS AND METHODS

In this cross-sectional study, a survey was conducted among parents in Saudi Arabia using a structured questionnaire. A convenience and snowball sampling method was employed to recruit participants from various regions of Saudi Arabia. The questionnaire assessed parents' knowledge about obesity, its complications, and healthy, active lifestyle practices. Data were analyzed using descriptive statistics, and associations between variables were examined using chi-squared tests.

RESULTS

In this study, responses from 256 moms in various Saudi Arabian locations were included in the analysis. Merely 35.5% of the participants demonstrated good knowledge about obesity and its complications. Regarding the promotion of a healthy, active lifestyle, only 11.3% of the participants were aware that kids should eat five types of vegetables and fruits daily, whereas 85% were aware that kids should have <2 hours a day of screen time, and 75.4% were aware that kids should be engaged in physical activity for at least one hour daily.

CONCLUSION

This study highlights a concerning gap in knowledge among caregivers in Saudi Arabia concerning obesity and its consequences, with merely 35.5% of participants demonstrating a good understanding of obesity and its complications. Alarmingly, only a fraction (11.3%) showed awareness of the importance of promoting a healthy, active lifestyle. These findings underscore the urgent need for enhanced awareness initiatives focused on obesity and its prevention to ensure optimal child health development, avert health issues, and strengthen positive dynamics between parents and children.

Association between weight-adjusted waist index and serum total testosterone in males aged 6-19 years in the United States: Data from NHANES 2013-2016

Objective

This study aimed to estimate the association between weight-adjusted waist index and serum total testosterone (sTT) in males aged 6-19 years in the United States.

Methods

A cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2016. sTT was considered as the response variable, and weight-adjusted waist circumference index (WWI) as the independent variable. Multiple linear regression was performed to estimate the association between the two variables, and subgroup analysis was performed to identify sensitive cohorts. Smoothing curve fitting and threshold effects analysis was carried out to assess possible nonlinear relationships between WWI and sTT.

Results

The study included 4207 participants. The mean value of sTT (117.93 ng/dl) was used as the grouping basis, with 1066 participants having serum total testosterone levels above the mean. A negative association was observed between WWI and sTT [beta coefficient (β) = -72.50, 95% confidence interval (CI): -79.45, -65.55], which decreased as WWI increased (P for trend<0.05). Subgroup analysis indicated a stronger negative correlation in late adolescent (16-19 years) males (β = -128.94, 95% CI: -146.75, -111.13). The smoothing curve fit analysis revealed a U-shaped curve relationship for the negative correlation between WWI and sTT. Threshold effect analysis suggested a significant change when WWI exceeded 10.09 (β = -15.82, 95% CI: -24.11, -7.54), and stepwise threshold effect analysis indicated that this negative correlation became less stable when WWI exceeded 11.45 (β = -0.80, 95% CI: -9.15, 7.56).

Conclusions

Participants with higher WWI exhibited lower total testosterone levels, and a negative association was found between WWI and total testosterone, particularly in late adolescent males aged 16-19 years. Among males aged 6-19 years, caution should be exercised regarding the risk of lower testosterone levels associated with elevated WWI, particularly when WWI is below 10.09.

The Nexus of Training Duration, Body Image, Nutritional Practices, and Mental Health: Insights from a Strength Training Cohort

This study investigated the intricate relationship between strength training and its effects on body image, psychological health, and nutritional habits. By examining 605 participants, divided into two groups based on training frequency, the research aimed to discern how varying intensities of training influenced different wellness facets. The investigation employed a comprehensive survey, gathering demographic data, training specifics, dietary patterns, and psychological characteristics, utilizing statistical tools for analysis. Results unveiled significant differences in dietary habits and psychological profiles between groups with higher and lower training frequencies. The group with more frequent training displayed less favourable health outcomes and suboptimal dietary habits, challenging the prevailing notion that increased training frequency leads to better health. The study emphasized the necessity of a balanced approach to physical training, highlighting the need for personalized strategies that encompass both physical and mental health considerations. The findings exposed the complexities of training regimens and their broader implications on individual health, suggesting that enhanced training frequency alone does not assure improved health outcomes. This research significantly contributed to the domain by providing insights into how the frequency of strength training could differentially affect health and well-being, offering valuable guidelines for fitness professionals and healthcare providers.

The Role of Racism in Childhood Obesity

PURPOSE OF REVIEW

Obesity rates continue to rise among children and have shown persistent racial disparities. Racism plays a potentially essential and actionable role in these disparities. This report reviews some mechanisms through which racism may shape childhood obesity.

RECENT FINDINGS

From the youngest ages, disparities in childhood obesity prevalence are already present. Racism may shape intergenerational and prenatal factors that affect obesity and various stressors and environments where children grow up. The relationships between clinicians and patients may also be shaped by everyday racism and legacies of past racism, which may affect obesity prevalence and treatment efficacy. Comprehensive data on the extent to which racism shapes childhood obesity is limited. However, compelling evidence suggests many ways through which racism ultimately does affect childhood obesity. Interventions to address racism at multiple points where it shapes childhood obesity, including intergenerational and prenatal mechanisms, may help to close disparities.

#4Corners4Health Social Media Cancer Prevention Campaign for Emerging Adults: Protocol for a Randomized Stepped-Wedge Trial

BACKGROUND

Many emerging adults (EAs) are prone to making unhealthy choices, which increase their risk of premature cancer morbidity and mortality. In the era of social media, rigorous research on interventions to promote health behaviors for cancer risk reduction among EAs delivered over social media is limited. Cancer prevention information and recommendations may reach EAs more effectively over social media than in settings such as health care, schools, and workplaces, particularly for EAs residing in rural areas.

OBJECTIVE

This pragmatic randomized trial aims to evaluate a multirisk factor intervention using a social media campaign designed with community advisers aimed at decreasing cancer risk factors among EAs. The trial will target EAs from diverse backgrounds living in rural counties in the Four Corners states of Arizona, Colorado, New Mexico, and Utah.

METHODS

We will recruit a sample of EAs (n=1000) aged 18 to 26 years residing in rural counties (Rural-Urban Continuum Codes 4 to 9) in the Four Corners states from the Qualtrics' research panel and enroll them in a randomized stepped-wedge, quasi-experimental design. The inclusion criteria include English proficiency and regular social media engagement. A social media intervention will promote guideline-related goals for increased physical activity, healthy eating, and human papillomavirus vaccination and reduced nicotine product use, alcohol intake, and solar UV radiation exposure. Campaign posts will cover digital and media literacy skills, responses to misinformation, communication with family and friends, and referral to community resources. The intervention will be delivered over 12 months in Facebook private groups and will be guided by advisory groups of community stakeholders and EAs and focus groups with EAs. The EAs will complete assessments at baseline and at 12, 26, 39, 52, and 104 weeks after randomization. Assessments will measure 6 cancer risk behaviors, theoretical mediators, and participants' engagement with the social media campaign.

RESULTS

The trial is in its start-up phase. It is being led by a steering committee. Team members are working in 3 subcommittees to optimize community engagement, the social media intervention, and the measures to be used. The Stakeholder Organization Advisory Board and Emerging Adult Advisory Board were formed and provided initial input on the priority of cancer risk factors to target, social media use by EAs, and community resources available. A framework for the social media campaign with topics, format, and theoretical mediators has been created, along with protocols for campaign management.

CONCLUSIONS

Social media can be used as a platform to counter misinformation and improve reliable health information to promote health behaviors that reduce cancer risks among EAs. Because of the popularity of web-based information sources among EAs, an innovative, multirisk factor intervention using a social media campaign has the potential to reduce their cancer risk behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05618158; https://classic.clinicaltrials.gov/ct2/show/NCT05618158.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/50392.

Food security and its association with socioeconomic status and dietary diversity in free living older people in Tehran, Iran

BACKGROUND

Food security is a function of food access and dietary diversity. Older age is a period when adequate and diverse dietary intake is a challenge. This study aimed to investigate the association between food security on the one hand and dietary diversity and socioeconomic factors on the other hand among the free-living older people in the city of Tehran.

METHODS

In this cross-sectional study, 583 older people, aged 60-80 years living in Tehran city, were selected through the systematic cluster sampling method. Food security was determined by the United States Household Food Security Survey Module (US-HFSSM (.Socioeconomic status (SES) and two 24-h recalls were obtained. Dietary Diversity Score (DDS) was calculated using the FAO 2010 guideline. Multinomial logistic regression was applied.

RESULTS

The average age of participants was 67.87 ± 5.86 years. Based on US-HFSSM, 56.9% of older people were food secure; while 25.7%, 14.2% and 3.2% suffered from food insecurity (FI) without hunger, with moderate hunger, and with severe hunger, respectively. There was no association between FI and DDS, even after controlling for confounders. FI with mild hunger was associated with household income (OR = 2.744, 95% CI = 1.100-6.846), while FI with severe hunger was associated with Fars ethnicity (OR = 0.146, 95% CI = 0.051-0.424).

CONCLUSIONS

Overall, socio-economic status and demographic characteristics were the predictors of FI among older people. The findings can have implication in design and targeting of interventions directed at older people.

Effect of milk fat globules on growth and metabolism in rats fed an unbalanced diet

We assessed the effects of supplementing milk fat globules (MFG) on the growth and development of the skeleton in rats fed a Western unbalanced diet (UBD). The UBD is high in sugar and fat, low in protein, fiber, and micronutrients, and negatively impacts health. The MFG-a complex lipid-protein assembly secreted into milk-has a unique structure and composition, which differs significantly from isolated and processed dietary ingredients. Rats consuming the UBD exhibited growth retardation and disrupted bone structural and mechanical parameters; these were improved by supplementation with small MFG. The addition of small MFG increased the efficiency of protein utilization for growth, and improved trabecular and cortical bone parameters. Furthermore, consumption of UBD led to a decreased concentration of saturated fatty acids and increased levels of polyunsaturated fatty acids (PUFA), particularly omega-6 PUFA, in the serum, liver, and adipose tissue. The addition of small MFG restored PUFA concentration and the ratio of omega-6 to omega-3 PUFA in bone marrow and adipose tissue. Finally, large but not small MFG supplementation affected the cecal microbiome in rats. Overall, our results suggest that natural structure MFG supplementation can improve metabolism and bone development in rats fed an UBD, with the effects depending on MFG size. Moreover, the benefits of small MFG to bone development and metabolism were not mediated by the microbiome, as the detrimental effects of an UBD on the microbiome were not mitigated by MFG supplementation.

Childhood Obesity: An Updated Review

BACKGROUND

Childhood obesity is an important and serious public health problem worldwide.

OBJECTIVE

This article aims to familiarize physicians with the evaluation, management, and prevention of childhood.

METHODS

A PubMed search was conducted in May, 2021, in Clinical Queries using the key terms "obesity" OR "obese". The search included clinical trials, randomized controlled trials, case-control studies, cohort studies, meta-analyses, observational studies, clinical guidelines, case reports, case series, and reviews. The search was restricted to English literature and children. The information retrieved from the above search was used in the compilation of the present article.

RESULTS

Most obese children have exogenous obesity characterized by a growth rate for height above the 50th percentile, normal intelligence, normal genitalia, and lack of historical or physical evidence of an endocrine abnormality or a congenital syndrome. Obese children are at risk for dyslipidemia, hypertension, diabetes mellitus, non-alcoholic fatty liver disease, obstructive sleep apnea, psychosocial disturbances, impaired quality of life, and shorter life expectancy. The multitude of serious comorbidities necessitates effective treatment modalities. Dietary modification, therapeutic exercise, and behavioral modification are the fundamentals of treatment. Pharmacotherapy and/or bariatric surgery should be considered for obese individuals who do not respond to the above measures and suffer from a serious comorbid condition.

CONCLUSION

Childhood obesity, once established, is often refractory to treatment. Most treatment programs lead to a brief period of weight loss, followed by rapid re-accumulation of the lost weight after the termination of therapy. As such, preventive activity is the key to solving the problem of childhood obesity. Childhood obesity can be prevented by promoting a healthy diet, regular physical activity, and lifestyle modification. Parents should be encouraged to get involved in school and community programs that improve their children's nutritional status and physical activity.

What Are the Challenges of School Nurses in South Korea in Managing Obese Children From Low-Income Households?

Given that the obesity rate among school-age children is increasing, school nurses can play a vital role in managing obesity and encouraging healthy living in school settings. Obese children from low-income backgrounds are more vulnerable than other students and require more careful attention and intervention. This qualitative study aimed to explore and understand the barriers recognized by school nurses in managing obesity in low-income household children. A focus group interview was conducted with 17 school nurses working at an elementary school. Children, home, school, political and structural, and social areas were revealed as intricate factors in obesity management. This study can help understand school nurses' obstacles in managing obese children from low-income families and can help them prepare practical measures to overcome these obstacles.

Population mobility data provides meaningful indicators of fast food intake and diet-related diseases in diverse populations

The characteristics of food environments people are exposed to, such as the density of fast food (FF) outlets, can impact their diet and risk for diet-related chronic disease. Previous studies examining the relationship between food environments and nutritional health have produced mixed findings, potentially due to the predominant focus on static food environments around people's homes. As smartphone ownership increases, large-scale data on human mobility (i.e., smartphone geolocations) represents a promising resource for studying dynamic food environments that people have access to and visit as they move throughout their day. This study investigates whether mobility data provides meaningful indicators of diet, measured as FF intake, and diet-related disease, evaluating its usefulness for food environment research. Using a mobility dataset consisting of 14.5 million visits to geolocated food outlets in Los Angeles County (LAC) across a representative sample of 243,644 anonymous and opted-in adult smartphone users in LAC, we construct measures of visits to FF outlets aggregated over users living in neighborhood. We find that the aggregated measures strongly and significantly correspond to self-reported FF intake, obesity, and diabetes in a diverse, representative sample of 8,036 LAC adults included in a population health survey carried out by the LAC Department of Public Health. Visits to FF outlets were a better predictor of individuals' obesity and diabetes than their self-reported FF intake, controlling for other known risks. These findings suggest mobility data represents a valid tool to study people's use of dynamic food environments and links to diet and health.

The impact of fast food marketing on brand preferences and fast food intake of youth aged 10-17 across six countries

BACKGROUND

Consumption of fast food, which is associated with poor diet, weight gain and the development of noncommunicable diseases, is high amongst youth. Fast food marketing, a modifiable determinant of excess weight and obesity, affects youth's food-related behaviours. This study aimed to examine the relationship between exposure to fast food marketing and the fast food brand preferences and intake amongst youth aged 10-17 across six countries.

METHODS

Data from 9,695 youth respondents living in Australia, Canada, Chile, Mexico, the United Kingdom (UK) and the United States (US) were analyzed from the 2019 International Food Policy Study (IFPS) Youth Survey. Survey measures assessed exposure to fast food marketing and brand-specific marketing, and preference for these brands and fast food intake. Regression models adjusted for age, sex, income adequacy and ethnicity were used to examine the associations.

RESULTS

Exposure to fast food marketing was positively associated with brand preferences and intake consistently across most countries. Overall, preference for McDonald's (OR:1.97; 95% CI:1.52, 2.56), KFC (OR:1.61; 95% CI:1.24, 2.09) and Subway (OR:1.73; 95% CI:1.34, 2.24) were highest when exposed to general fast food marketing ≥ 2x/week compared to never. Preference for McDonald's (OR:2.32; 95% CI:1.92, 2.79), KFC (OR:2.28; 95% CI:1.95, 2.68) and Subway (OR:2.75; 95% CI:2.32, 3.27) were also higher when exposed to marketing for each brand compared to not. Fast food intake was highest in Chile (IRR:1.90; 95% CI:1.45, 2.48), the UK (IRR:1.40; 95% CI:1.20, 1.63), Canada (IRR:1.32; 95% CI:1.19, 1.48), Mexico (IRR:1.26; 95% CI:1.05, 1.53) and the US (IRR:1.21; 95% CI:1.05, 1.41) when exposed to general fast food marketing ≥ 2x/week compared to never and was higher across most countries when exposed to brand-specific marketing compared to not. Respondents classified as ethnic minorities were more likely to report consuming fast food than ethnic majorities, and females were less likely to report consuming fast food than males.

CONCLUSIONS

Exposure to fast food marketing is consistently and positively associated with brand preferences and fast food intake in all six countries. Our results highlight the need for strict government regulation to reduce exposure of unhealthy food marketing to youth in all six countries.

Nutritional quality of children's menus in restaurants: does cuisine type matter?

OBJECTIVE

It is unknown whether the nutritional quality of children's menus varies depending on the cuisine type. This study aimed to investigate differences in the nutritional quality of children's menus by cuisine type in restaurants located in Perth, Western Australia (WA).

DESIGN

Cross-sectional study.

SETTING

Perth, WA.

PARTICIPANTS

Children's menus (n 139) from the five most prevalent restaurant cuisine types in Perth (i.e. Chinese, Modern Australian, Italian, Indian and Japanese) were assessed using the Children's Menu Assessment Tool (CMAT; range -5-21 with lower scores denoting lower nutritional quality) and the Food Traffic Light system, evaluated against Healthy Options WA Food and Nutrition Policy recommendations. Non-parametric ANOVA was used to test for a significant difference in total CMAT scores among cuisine types.

RESULTS

Total CMAT scores were low for all cuisine types (range -2-5), with a significant difference between cuisine types (Kruskal-Wallis H = 58·8, P < 0·001). The highest total CMAT score by cuisine type was Modern Australian (mean = 2·27, sd = 1·41) followed by Italian (mean = 2·02, sd = 1·02), Japanese (mean = 1·80, sd = 2·39), Indian (mean = 0·30, sd = 0·97) and Chinese (mean = 0·07, sd = 0·83). When using the Food Traffic Light for assessment, Japanese cuisine had the highest percentage of green food items (44 %), followed by Italian (42 %), Modern Australian (38 %), Indian (17 %) and Chinese (14 %).

CONCLUSIONS

Overall, the nutritional quality of children's menus was poor regardless of cuisine type. However, children's menus from Japanese, Italian and Modern Australian restaurants scored better in terms of nutritional quality than children's menus from Chinese and Indian restaurants.

Neighborhood Food Environment and Birth Weight Outcomes in New York City

Importance

Infants born with unhealthy birth weight are at greater risk for long-term health complications, but little is known about how neighborhood characteristics (eg, walkability, food environment) may affect birth weight outcomes.

Objective

To assess whether neighborhood-level characteristics (poverty rate, food environment, and walkability) are associated with risk of unhealthy birth weight outcomes and to evaluate whether gestational weight gain mediated these associations.

Design, Setting, and Participants

The population-based cross-sectional study included births in the 2015 vital statistics records from the New York City Department of Health and Mental Hygiene. Only singleton births and observations with complete birth weight and covariate data were included. Analyses were performed from November 2021 to March 2022.

Exposures

Residential neighborhood-level characteristics, including poverty, food environment (healthy and unhealthy food retail establishments), and walkability (measured by both walkable destinations and a neighborhood walkability index combining walkability measures like street intersection and transit stop density). Neighborhood-level variables categorized into quartiles.

Main Outcomes and Measures

The main outcomes were birth certificate birth weight measures including small for gestational age (SGA), large for gestational age (LGA), and sex-specific birth weight for gestational age z-score. Generalized linear mixed-effects models and hierarchical linear models estimated risk ratios for associations between density of neighborhood-level characteristics within a 1-km buffer of residential census block centroid and birth weight outcomes.

Results

The study included 106 194 births in New York City. The mean (SD) age of pregnant individuals in the sample was 29.9 (6.1) years. Prevalence of SGA and LGA were 12.9% and 8.4%, respectively. Residence in the highest density quartile of healthy food retail establishments compared with the lowest quartile was associated with lower adjusted risk of SGA (with adjustment for individual covariates including gestational weight gain z-score: risk ratio [RR], 0.89; 95% CI 0.83-0.97). Higher neighborhood density of unhealthy food retail establishments was associated with higher adjusted risk of delivering an infant classified as SGA (fourth vs first quartile: RR, 1.12; 95% CI, 1.01-1.24). The RR for the association between density of unhealthy food retail establishments and risk of LGA was higher after adjustment for all covariates in each quartile compared with quartile 1 (second: RR, 1.12 [95% CI, 1.04-1.20]; third: RR, 1.18 [95% CI, 1.08-1.29]; fourth: RR, 1.16; [95% CI, 1.04-1.29]). There were no associations between neighborhood walkability and birth weight outcomes (SGA for fourth vs first quartile: RR, 1.01 [95% CI, 0.94-1.08]; LGA for fourth vs first quartile: RR, 1.06 [95% CI, 0.98-1.14]).

Conclusions and Relevance

In this population-based cross-sectional study, healthfulness of neighborhood food environments was associated with risk of SGA and LGA. The findings support use of urban design and planning guidelines to improve food environments to support healthy pregnancies and birth weight.

Trends in Quick-Service Restaurants near Public Schools in the United States: Differences by Community, School, and Student Characteristics

BACKGROUND

More than one-third of children and adolescents consume foods from quick-service restaurants (QSRs) daily, which is associated with an increased risk of diet-related adverse health conditions.

OBJECTIVE

To examine trends in the proximity of top-selling QSR chains to all public schools across the United States between 2006 and 2018 by community-, school-, and student-level characteristics.

DESIGN

This longitudinal study examined changes in the number QSRs between the 2006-2007 and 2017-2018 school years using data from National Center for Education Statistics, Infogroup US Historical Business Data, and the US Department of Agriculture's Economic Research Service.

STATISTICAL ANALYSIS

A mixed-model analysis of variance using census tract as a random effect and accounting for repeated measures by school was used to examine the proximity of QSRs near schools. Models adjusted for demographic characteristics and census tract population density. Data were analyzed in 2021.

RESULTS

During 2006, 9% of schools had QSRs within 400 m, and 25% of schools in the most populated areas had at least one QSR within 400 m. There were more QSRs near schools with a high percentage of poverty (12%), and near schools with high school students with the highest population of Black or African American (16%) and Hispanic or Latino (18%) students. By 2018, the percent of all public schools within 400 m of QSRs increased to 12%. The increase over time was greater near schools with a high percentage of poverty (16%) and near schools with high school students with the highest population of Black or African American students (22%) and Hispanic or Latino (23%) students.

CONCLUSIONS

This is the first nationwide study to examine trends in QSR proximity to all public schools. QSRs were most likely to be located near schools with high school students, near schools with a high percentage of poverty, and near schools with a higher proportion of racial and ethnic minority students. Over time, there were greater increases in QSRs near these schools which may have important implications for children's health and diet-related disparities.

Sugar-sweetened beverage consumption among pregnant women attending general and teaching hospitals in Ibadan, Nigeria : SSB consumption during pregnancy

BACKGROUND

Sugar-sweetened beverages (SSBs) have become a global health concern because of their adverse health effects and their association with the obesity pandemic. It has not received much attention in sub-Saharan Africa, including Nigeria, especially among pregnant women. The pattern, frequency and factors associated with SSBs among pregnant women in Ibadan, Nigeria, were investigated.

DESIGN

Data were from the Ibadan Pregnancy Cohort Study - a prospective cohort study investigating 1745 pregnant women from four comprehensive obstetric facilities in Ibadan. A qualitative food frequency questionnaire (FFQ) was used to assess the pregnant women's intake of food and drinks over the previous months. Sugar-sweetened beverage variable and scores were also generated using the principal component analysis with varimax rotation. Factors associated with high SSB scores were examined using multivariate logistics regression analyses at a 5% significance level.

RESULTS

The most commonly consumed SSBs were cocoa-sweetened beverages, soft drinks, malt drinks, and fruit juice. A quarter of the women (75th percentile) consumed SSB more than once weekly. The factors associated with high SSB on multivariate analysis were; being employed (AOR: 1.52, 95% CI 1.02-2.26), maternal obesity (AOR: 0.065, 95% CI 0.47-0.89), high fruit intake (AOR:3.62, 95% CI 2.62-4.99), high green vegetable consumption (AOR:1.99, 95% CI 1.06-3.74), high milk intake (AOR: 2.13, 95% CI 1.65- 2.74), frequent fast food outlet visit (AOR: 2.19, 95% CI 1.53-1.70), all of these remained significant after adjusting for confounding variables.

CONCLUSION

SSBs were common among our study population. Factors associated with high SSBs intake are crucial for implementing locally relevant public health interventions.

Reliability and Validity of Digital Images to Assess Child Dietary Intake in a Quick-Service Restaurant Setting

BACKGROUND

Development of methods to accurately measure dietary intake in free-living situations-restaurants or otherwise-is critically needed to understand overall dietary patterns.

OBJECTIVE

This study aimed to develop and test reliability and validity of digital images (DI) for measuring children's dietary intake in quick-service restaurants (QSRs), validating against weighed plate waste (PW) and bomb calorimetry (BC).

DESIGN

In 2016, cross-sectional data were collected at two time points within a randomized controlled trial assessing children's leftovers in QSRs from parents of 4- to 12-year-old children.

PARTICIPANTS/SETTING

Parents (n = 640; mean age = 35.9 y; 70.8% female) consented and agreed to provide their child's PW for digital imaging, across 11 QSRs in Massachusetts in areas with low socioeconomic status and ethnically diverse populations.

OUTCOME MEASURES

Outcome measures were interrater reliability for DIs, correspondence between methods for energy consumed and left over, and correspondence between methods across varying quantities of PW.

ANALYSES PERFORMED

Intraclass correlations, percent agreement, Spearman correlations, Wilcoxon signed rank tests, and Bland-Altman plots were used.

RESULTS

Interrater reliability ratings for DIs had substantial intraclass correlations (ICC = 0.94) but not acceptable exact percent agreement (80.2%); DI and PW energy consumed were significantly correlated (r = 0.96, P < 0.001); DI slightly underestimated energy consumed compared with PW (Mdiff = -1.61 kcals, P < 0.001). Bland-Altman plots showed high DI-PW correspondence across various energy amounts and revealed few outliers. Energy left over by BC was highly correlated with DI (r = 0.87, P < 0.001) and PW (r = 0.90, P < 0.001); and mean differences were not significantly different from DI (Mdiff = 9.77 kcal, P = 0.06) or PW (Mdiff = -2.84 kcal, P = 0.20).

CONCLUSIONS

Correspondence was high between PW and DI assessments of energy consumed, and high with BC energy left over. Results demonstrate reliability and practical validity of digital images for assessing child meal consumption in QSR settings.

Would you like fries with that? Investigating fast-food outlet availability near schools in Perth, Western Australia

ISSUE ADDRESSED

Locating fast-food outlets near schools is a potential public health risk to schoolchildren, given the easy access and repeated exposure to energy-dense, nutrient-poor foods they provide. Fast-food outlet availability near schools has not been previously investigated in Perth, Western Australia. This study aimed to quantify fast-food outlet availability near Perth schools and determine whether differences in area-level disadvantage and school type exist.

METHODS

Fast-food outlet locations were sourced from Perth Local Governments in 2018/2019. All Perth Primary (n = 454), Secondary (n = 107) and K-12 (n = 94) schools were assigned an area-level disadvantage decile ranking based on the Australian Bureau of Statistics Socio-Economic Index for Areas (SEIFA). Regression models assessed whether fast-food outlet availability within 400 m, 800 m and 1 km of schools differed by school type (ie, Primary/Secondary/K-12) or SEIFA.

RESULTS

Secondary schools were significantly more likely than Primary and K-12 schools to have a higher presence and density of fast-food outlets and the "Top 4" fast-food outlet chains (McDonalds, Hungry Jacks, KFC and Red Rooster) nearby. Schools located in low socio-economic status (SES) areas had a significantly higher density of fast-food outlets within 400 m, and "Top 4" fast-food outlet chains within 400 m and 1 km, than schools located in high SES area.

CONCLUSIONS

Perth schools are surrounded by fast-food outlets with densities significantly higher around secondary schools and schools located in lower SES areas. SO WHAT?: Policies and regulations aimed at reducing fast-food outlets near schools is an essential strategy to improve dietary intakes and reduce obesity in schoolchildren.

Fast-Food Consumption, Dietary Quality, and Dietary Intake of Adolescents in Saudi Arabia

High fast-food consumption is a common public-health concern among adolescents, due to its link to a number of non-communicable diseases. Frequent consumption of fast food may also affect diets of individuals; however, research addressing this issue is lacking in Saudi Arabia. We aimed to investigate the association between fast-food consumption, dietary quality, and dietary intake of adolescents in Saudi Arabia. This is a cross-sectional study of 617 healthy adolescents aged 11-18 years, who were recruited randomly from 16 middle- and high-schools located in Jeddah and Madinah, Saudi Arabia. Sociodemographic data were collected from parents. Dietary data, including the frequency of fast-food consumption, dietary quality (assessed using the short-form food frequency questionnaire), and dietary intake (assessed using multiple 24 h diet recalls from a subsample), were collected from the adolescents. Approximately one-third of adolescents (28.5%) reported frequent fast-food consumption (>two times a week). Results showed that a higher proportion of male adolescents frequently consumed fast-food, compared with female adolescents (32.8% vs. 24.8%, p = 0.039). Adolescents with the highest monthly family-income (≥SAR 21,000 ) reported a significantly higher frequency of fast-food consumption compared with families with a lower monthly income (p = 0.009). Frequency of fast-food consumption predicted lower dietary-quality in adolescents (Beta (B) = -0.27 [95% confidence interval (CI): -0.35 to -0.18]) and higher carbohydrate and free-sugar intake (B = 6.93 [95% CI: 0.78 to 13.1], and B = 3.93 [95% CI: 1.48 to 6.38], respectively). In conclusion, nutrition-intervention programs aiming to limit fast-food consumption and enhance the dietary quality of adolescents in Saudi Arabia, are warranted.

Development and Effect of Child Obesity Management Program by Applied Nudge

BACKGROUND

Child obesity rates are increasing worldwide. In Korea, the proportion of overweight students has steadily increased from 21.8% in 2015 to 25.8% in 2019. Childhood obesity causes mental problems, such as depression and social phobia, due to mental stress, feelings of inferiority, and low self-esteem.

METHODS

This experimental study aimed to verify the effect of the child obesity management program on body changes (height, weight, obesity degree, body mass index [BMI], body fat percentage), eating habits, exercise habits, obesity knowledge, and social support. This child obesity management program applies the nudge technique based on an ecological model and induces autonomous weight management through environmental control.

RESULTS

As results of this study, the child obesity management program using the nudge technique developed in this study improved the height (t = -5.19, p < 0.001), obesity degree (z = -3.28, p = 0.001), BMI (z = -3.22, p = 0.001), exercise habits (t = -2.09, p = 0.040), and obesity knowledge of obese children (z = -2.99, p = 0.003).

CONCLUSIONS

This multidimensional intervention improved obesity by inducing and sustaining behavioral changes in obese children. Therefore, applying the nudge techniques and multidimensional intervention methods based on ecological model are proposed to increase the effectiveness of the health promotion programs.

State and Local Healthy Kids' Meal Laws in the United States: A Review and Content Analysis

BACKGROUND

To address unhealthy restaurant food intake among children, localities and states are passing healthy restaurant kids' meal laws. However, there is limited knowledge of what these policies require and how they compare with expert and industry nutrition standards.

OBJECTIVES

The aim of this study was to develop a research instrument to evaluate healthy kids' meal laws and assess their alignment with expert and industry nutrition standards.

DESIGN

The study team conducted a content analysis of healthy kids' meal laws passed between January 2010 and August 2020 in the United States. Using a structured codebook, two researchers abstracted policy elements and implementation language from laws, regulations, fiscal notes, and policy notes. Nutritional criteria for kids' beverages and meals were compared with existing expert and industry nutrition standards for meals and beverages.

MAIN OUTCOME MEASURES

Measures included law characteristics, implementation characteristics, enforcement characteristics, definitions of key terms, and nutritional requirements for meals and default beverage options and alignment with expert and industry nutrition standards.

STATISTICAL ANALYSES PERFORMED

Interrater reliability of the coding tool was estimated using the Cohen kappa statistic, and researchers calculated descriptive statistics of policy elements.

RESULTS

Twenty laws were identified. Eighteen were healthy default beverage policies, two were toy restriction policies, and one was a nutrition standards policy. The nutrition standards, default beverage offerings, and implementation characteristics varied by location. No law met the expert nutrition standards for kids' meals or beverages.

CONCLUSIONS

The variations in policy specifications may influence how restaurants implement the policies, and, consequently, the policies' influences on children's consumption. Future policies could use expert nutrition standards to inform the standards set for kids' meals and specify supports for implementation.

Could Alcohol Abuse and Dependence on Junk Foods Inducing Obesity and/or Illicit Drug Use Represent Danger to Liver in Young People with Altered Psychological/Relational Spheres or Emotional Problems?

Recent data show that young people, mainly due to the pressure of some risk factors or due to disrupted interpersonal relationships, utilise greater reward value and display greater sensitivity to the reinforcing properties of “pleasurable stimuli”, specifically in those situations in which an enhanced dopamine release is present. Alcoholic beverages, foods rich in sugar and fat, and illicit drug use are pleasurable feelings associated with rewards. Research shows that there is a link between substance abuse and obesity in brain functioning. Still, alcohol excess is central in leading to obesity and obesity-related morbidities, such as hepatic steatosis, mainly when associated with illicit drug dependence and negative eating behaviours in young people. It is ascertained that long-term drinking causes mental damage, similarly to drug abuse, but also affects liver function. Indeed, beyond the pharmacokinetic interactions of alcohol with drugs, occurring in the liver due to the same metabolic enzymes, there are also pharmacodynamic interactions of both substances in the CNS. To complicate matters, an important noxious effect of junk foods consists of inducing obesity and obesity-related NAFLD. In this review, we focus on some key mechanisms underlying the impact of these addictions on the liver, as well as those on the CNS.

Association of Household Type and Fast-Food Consumption in Korean Adolescents

Background: Due to changing household types and weakening of family functions, children have fewer opportunities to develop healthy lifestyle patterns from contact with family members compared to the past. In this paper, we evaluate the association between household type and adolescents’ fast-food consumption, focusing on whether they were living with their parents or not, and determine their reasons for not living with their parents. Methods: This cross-sectional study analyzed data from the Korea Youth Risk Behavior web-based survey between 2017 and 2020. The subjects were students in grades 7–12. The outcome variable was a frequency of fast-food intake of ≥5 times per week. The main independent variable was the type of household: (1) living with both parents; (2) living with a single parent (one of father, mother, stepfather, stepmother); (3) not living together, but having parents; and (4) having no parents. Results: Participants without parents were more likely to eat fast food frequently than those living with both parents. Among boys, not having parents and living in a dorm or boarding house or living with other family members or relatives were significantly associated with frequent fast-food intake; among girls, not having parents and living in a dorm or boarding house were significantly associated with frequent fast-food intake. Conclusion: Adolescents having no parents have a higher risk of frequent fast-food intake than those living with both parents. Further studies are needed to address household types in greater detail.

Evaluating 12 Years of Implementing a Multidisciplinary Specialist Child and Adolescent Obesity Treatment Service: Patient-Level Outcomes

Introduction

Childhood obesity is a chronic disease that requires multidisciplinary and specialist intervention to address its complex pathophysiology, though access to treatment is limited globally. Evaluating the impact of evidence-based interventions implemented in real-world clinical settings is essential, in order to increase the translation of research into practice and enhance child health outcomes. In Ireland, the National Model of Care for Obesity highlighted the need to develop and improve healthcare services for children and adolescents with obesity.

Aims

This study aims to evaluate the impact of a family-based, Tier 3 multi-disciplinary child and adolescent obesity outpatient service (www.w82go.ie) on standardized body mass index (BMI-SDS).

Methods

Following referral by pediatricians, patients were assessed by a pediatric multidisciplinary team (physiotherapist, dietician, and psychologist) and personalized obesity treatment plans were developed. Anthropometric and demographic information were recorded at baseline and final visit. Descriptive statistics were used to explore distribution, central tendency and variation in the demographic data, change in BMI-SDS over time was assessed using a t-test, and multiple linear regression analysis was used to investigate the association of demographic factors on the change in BMI-SDS.

Results

The overall mean BMI-SDS reduction across the whole cohort (n = 692) was −0.17 (95% CI = −0.20, −0.13; P &lt; 0.001). Younger age at admission and longer duration of treatment were associated with greater BMI-SDS reduction but there was no significant association between change in BMI-SDS and any of the other parameters (deprivation score, treatment type, sex, obesity category at admission or presence of comorbid condition).

Conclusion

Engagement in a specialist Tier 3 pediatric obesity service was associated with reductions in BMI-SDS in children and adolescents with obesity.

The impact of maternal influences on childhood obesity

There was a lack of detailed information about maternal influences on their children’s body mass index (BMI) in Taiwan. The aim of this study was to find the evidence to describe how mothers’ factors could affect their 2 to 9-year-old children’s BMI, with data collected from May 2021 to June 2021. Anonymous self-administered questionnaires were completed by 1035 participants from Taiwan’s six metropolitan cities and eight counties. After controlling for children’s factors, such as number of children in a family, children’s constitution, children’s age and gender, hierarchical regression models were used to analyze the effects of five maternal factors on their children’s BMI: maternal BMI, age, education level, monthly household income, and marital status (single parent or not). The results were found as follow: maternal BMI [β = .24], maternal educational level [β = −.141], and monthly household income [β = .071], significantly (p < 0.05) influenced their children’s BMI. Higher maternal BMI was associated with a higher children’s BMI. Mothers with lower levels of education background were more likely to have children with a higher BMI. Monthly household income was a positive factor influencing children’s BMI. In conclusion, this study is the first detailed description of maternal influences on their 2–9 years old children’s BMI in Taiwan. Although the study could not cover all of the factors influencing Taiwan’s childhood obesity, we have discovered maternal BMI, education level, and monthly household income were significant factors associated with children’s BMI.

The Association Between Adolescents' Food Literacy, Vegetable and Fruit Consumption, and Other Eating Behaviors

Adolescents’ intake of vegetables and fruits is generally low, and many demonstrate unhealthy eating behaviors. Food literacy may be key to improving adolescents’ nutrition. However, the relationship between food literacy, fruit and vegetable intake, and other healthy eating behaviors remains unclear, as well as how these relationships may differ among boys and girls. This study assessed the relationship between food literacy (including food skills and cooking skills), vegetable and fruit consumption, and other eating behaviors of adolescents. This cross-sectional study included 1,054 students, including 467 boys and 570 girls from five francophone high schools in New Brunswick, Canada. Quantitative data on students’ food and cooking skills, vegetable and fruit consumption, and other eating behaviors were collected with a self-reported questionnaire. Multilevel regressions were used to assess the relationship between food literacy, students’ consumption of vegetables and fruits, and other eating behaviors. Better cooking skills were associated with healthier eating behaviors and greater vegetable and fruit consumption for boys and girls. Better food skills were also associated with healthier eating behaviors and greater vegetable and fruit consumption among both genders. These findings highlight the importance of improving food literacy among adolescents. Public health interventions should focus on increasing cooking and food skills to improve adolescents’ nutrition.

Bittersweet: How prices of sugar-rich foods contribute to the diet-related disease epidemic in Mexico

I provide new evidence on how price changes of nutritionally similar foods, such as those rich in sugar or fats, change obesity and diet-related diseases in the context of Mexico between 1996-2010. I merge a bar-code level price dataset with product-specific nutritional composition to two datasets with health outcomes: state-level administrative and nationally representative individual-level panel data. Exploiting within-city variation in prices using fixed effects models, I show that decreased prices of sugar-rich foods increase obesity, type 2 diabetes, and hypertension prevalence; yet the prices of foods rich in other nutrients do not. Health responses to price changes are the largest for those abdominally obese or at the highest risk for chronic disease. The association between prices of sugary foods and chronic disease is meaningful: I estimate that in Mexico, price reductions of sugary foods explain roughly 15 percent of the rise in obesity and diabetes during the 15-year study period.

Spatial clustering patterns and regional variations for food and physical activity environments across the United States

This study examined spatial patterns of obesogenic environments for US counties. We mapped the geographic dispersion of food and physical activity (PA) environments, assessed spatial clustering, and identified food and PA environment differences across U.S. regions and rurality categories. Substantial low food score clusters were located in the South and high score clusters in the Midwest and West. Low PA score clusters were located in the South and high score clusters in the Northeast and Midwest (p < .0001). For region, the South had significantly lower food and PA environment scores. For rurality, rural counties had significantly higher food environment scores and metropolitan counties had significantly higher PA environment scores (p < .0001). This study highlights geographic clustering and disparities in food and PA access nationwide. State and region-wide environmental inequalities may be targeted using structural interventions and policy initiatives to improve food and PA access.

The food and nutrient intake of 5- to 12-year-old Australian children during school hours: a secondary analysis of the 2011-2012 National Nutrition and Physical Activity Survey

OBJECTIVE

School food intake of Australian children is not comprehensively described in literature, with limited temporal, nationally representative data. Greater understanding of intake at school can inform school-based nutrition promotion. This study aimed to describe the dietary intake of primary-aged children during school hours and its contribution to daily intake.

DESIGN

This secondary analysis used nationally representative, cross-sectional data from the 2011 to 2012 National Nutrition and Physical Activity Survey. Dietary intake was assessed using validated 24-h dietary recalls on school days. Descriptive statistics were undertaken to determine energy, nutrients, food groups and food products consumed during school hours, as well as their contributions to total daily intake. Associations between school food intake and socio-demographic characteristics were explored.

SETTING

Australia.

PARTICIPANTS

Seven hundred and ninety-five children aged 5-12 years.

RESULTS

Children consumed 37 % of their daily energy and 31-43 % of select nutrient intake during school hours, with discretionary choices contributing 44 % of school energy intake. Most children consumed less than one serve of vegetables, meat and alternatives or milk and alternatives during school hours. Commonly consumed products were discretionary choices (34 %, including biscuits, processed meat), bread (17 %) and fruit (12 %). There were limited associations with socio-economic position variables, apart from child age.

CONCLUSIONS

Children's diets were not aligned with national recommendations, with school food characterised by high intake of discretionary choices. These findings are consistent with previous Australian evidence and support transformation of the Australian school food system to better align school food consumption with recommendations.

Dietary intake and nutritional status of Korean children and adolescents: a review of national survey data

In Korea, several national cross-sectional surveys monitor the diet, nutritional status, and health status of children. This continual dedicated national surveillance system contributes to the identification of nutritional and health issues, establishment of public health policies, and development of nutrition recommendations. This paper provides recent information about the Korea National Health and Nutrition Examination Survey and the Korean Youth Risk Behavior Web-based Survey and describes key nationwide survey findings published in the last 5 years on infant feeding practices and the dietary intake and nutritional status of Korean infants, children, and adolescents. There have been increasing trends in children, and teenagers who skip breakfast, eat fast food, consume sugary drinks, have vitamin D deficiency, and are obese. This review will inform pediatricians, nutritionists, and other health care practitioners who track children's growth and development. It may also help researchers and policymakers identify diet-related policies and strategies for chronic disease prevention in Korean infants, children, and adolescents.

Racial Disparities in Obesity Treatment Among Children and Adolescents

PURPOSE OF REVIEW

With the growing obesity epidemic among children and adolescents, the evaluation of disease origin to slow disease progression is necessary. Racial disparities which are evident amid prevalence and treatment must be studied to counteract disease propagation.

RECENT FINDINGS

Disparities are pronounced among Black and Hispanic pediatric patients prior to conception and birth due to genetic composition and fetal environment. Postnatal environment and psychosocial influences can further increase a child/adolescent's propensity to increased weight. Current treatment options including nutrition, physical activity, behavior modification, pharmacotherapy, and surgery are underutilized in communities of color due to limited access to care and cost. Data is limited to demonstrate disparities among treatment of obesity in children and adolescents. The reviewed studies show the role of race on disease treatment. Increased research efforts, especially in pharmacotherapy and metabolic and bariatric surgery (MBS), will help combat obesity in pediatric communities of color.

U.S. Adolescents' Diet Consumption Patterns Differ between Grocery and Convenience Stores: National Health and Nutrition Examination Survey 2011-2018

Among U.S. adolescents, foods/beverages that are store-bought (i.e., from grocery and convenience stores) are significant contributors of energy intake. However, it remains unclear (1) what foods/beverages are consumed by U.S. adolescents from grocery and convenience stores and (2) if there are differences in foods/beverages consumed by store type. Therefore, we analyzed 29,216 eating occasions from adolescents (12–19 years; n = 4065) in the National Health and Nutrition Examination Survey 2011–2018 to report food/beverage groups and nutrients consumed from grocery and convenience stores. Differences in food/beverage groups and nutrient densities by store type were calculated using multiple logistic and linear regressions. Adolescents were more likely to consume “Beverages” and “Snacks and Sweets” and less likely to consume “Grains”, “Protein”, “Milk and Dairy”, “Condiments and Sauces”, and “Fruits” from convenience compared to grocery stores (all p < 0.0025). Foods/beverages from convenience stores were higher in carbohydrates, total sugar, and added sugar and lower in protein, fat, saturated fat, sodium, and fiber than those from grocery stores (all p < 0.0025). In conclusion, while foods/beverages from convenience stores are more energy-dense and nutrient-poor, there is a critical need to increase the availability, accessibility, and affordability of healthier foods/beverages in both store types to encourage healthier dietary behaviors among U.S. adolescents.

Marketing to Children Inside Quick Service Restaurants: Differences by Community Demographics

INTRODUCTION

In the U.S., children regularly consume foods from quick-service restaurants, but little is known about the marketing strategies currently used inside quick-service restaurants. This study aims to validate a child-focused Environmental Assessment Tool for quick-service restaurants, evaluate marketing strategies inside and on the exterior of quick-service restaurants, and examine differences by community race/ethnicity or income.

METHODS

The inter-rater and test-retest reliability of the Environmental Assessment Tool were assessed across the top 5 national quick-service restaurant chains. Marketing techniques in 165 quick-service restaurants (33 per national chain) in socioeconomically and racially/ethnically diverse communities throughout New England were examined in 2018-2019. Mixed methods ANOVA examined the differences in marketing techniques in 2020.

RESULTS

The inter-rater and test-retest reliability of the Environmental Assessment Tool were high (Cohen's κ>0.80). Approximately 95% of quick-service restaurants marketed less healthy foods, whereas only 6.5% marketed healthy options. When examining the differences by community demographics, there were significantly more price promotion advertisements inside and on the exterior of quick-service restaurants in lower-income communities. In addition, there was a greater number of child-directed advertisements with cartoon or TV/movie characters as well as fewer healthy entrée options and more sugar-sweetened beverage and dessert options on the children's menu inside quick-service restaurants in communities with higher minority populations.

CONCLUSIONS

Environmental Assessment Tool is a valid tool to evaluate marketing inside quick-service restaurants. Results suggest that there is a substantial amount of unhealthy food and beverage marketing inside quick-service restaurants, with differences in the number and types of techniques used in lower-income and minority communities. Policies that limit quick-service restaurant marketing to children should be considered.

The Pediatric Obesity Encounter: Literature and Resources to Help with 4 Common Issues

PURPOSE OF REVIEW

We review here best practices and resources for pediatricians providing pediatric obesity management in 4 key areas: how to assess all of the relevant factors contributing to obesity, how to provide nutrition education, how to counsel families who eat out regularly, and what to do with patients who frequently make poor eating choices.

RECENT FINDINGS

While there are many resources indicating recommendations for the physical exam and laboratory tests, there are very few resources that give pragmatic advice on the counseling aspects of the pediatric obesity encounter. We note new nutrition research showing the importance of avoiding ultra-processed foods. Most importantly, we list several resources regarding useful questionnaires, nutrition guidance, and even further training for pediatricians. There is a need for more curation of resources in different aspects of obesity care. We hope that this review and list of resources are helpful for pediatricians and will empower families and can be expanded in the future.

Messages Promoting Healthy Kids' Meals: An Online RCT

INTRODUCTION

Calorie labeling is now required on all large U.S. chain restaurant menus, but its influence on consumer behavior is mixed. This study examines whether different parent-targeted messages encourage parents to order lower-calorie meals for their children in a hypothetical online setting.

METHODS

An online RCT was conducted with sociodemographically diverse primary caregivers of children aged 6-12 years (data collected and analyzed in 2017-2019). Participants (N=2,373) were randomized to see 1 of 4 messages: (1) nonfood control, (2) kids' meals are the right size for children, (3) doctors recommend a 600 kcal per meal limit for kids, or (4) 600 kcal per meal is a generally recommended limit for kids. Participants ordered hypothetical meals for their children and themselves and rated meal and message perceptions.

RESULTS

There were no significant differences between conditions in calories ordered for children at either restaurant, although all 3 food message conditions ordered fewer calories for their children than the control (full service: 27-68 fewer kcal, fast food: 18-64 fewer kcal). The general 600 kcal/meal limit message consistently performed best across outcomes, encouraging parents to order the fewest calories for their children at both restaurants (5%-7% fewer) and significantly increasing their understanding of calorie recommendations for kids' meals. It also significantly reduced fast-food calories parents ordered for themselves compared with the control (-106 kcal, p=0.042).

CONCLUSIONS

Although no statistically significant differences were detected, messages with specific calorie recommendations for kids led parents to order lower-calorie restaurant meals for their children, suggesting that additional real-world studies with larger sample sizes are warranted.

Worldwide flavor enhancer monosodium glutamate combined with high lipid diet provokes metabolic alterations and systemic anomalies: An overview

•

Flavor enhancing high lipid diet acts as silent killer.

•

Monosodium glutamate mixed with high lipid diet alters redox-status.

•

Monosodium glutamate mixed with high lipid diet induces systemic anomalies.

In this fast-food era, people depend on ready-made foods and engage in minimal physical activities that ultimately change their food habits. Majorities of such foods have harmful effects on human health due to higher percentages of saturated fatty acids, trans-fatty acids, and hydrogenated fats in the form of high lipid diet (HLD). Moreover, food manufacturers add monosodium glutamate (MSG) to enhance the taste and palatability of the HLD. Both MSG and HLD induce the generation of reactive oxygen species (ROS) and thereby alter the redox-homeostasis to cause systemic damage. However, MSG mixed HLD (MH) consumption leads to dyslipidemia, silently develops non-alcoholic fatty liver disease followed by metabolic alterations and systemic anomalies, even malignancies, via modulating different signaling pathways. This comprehensive review formulates health care strategies to create global awareness about the harmful impact of MH on the human body and recommends the daily consumption of more natural foods rich in antioxidants instead of toxic ingredients to counterbalance the MH-induced systemic anomalies.

Optimising Repeated Exposure: Determining Optimal Exposure Frequency for Introducing a Novel Vegetable among Children

Fruit and vegetables are important components of a healthy diet, but unfortunately many children are not consuming enough to meet the recommendations. Therefore, it is crucial to develop strategies towards increasing the acceptance of this food group. This study aims to investigate the effect of different repeated exposure frequencies on fruit and vegetable acceptance using a novel vegetable, daikon, among 3–6-year-old children. One hundred and fifty-nine children participated in this study. Eight kindergarten teams were assigned to one of the following groups: Three different intervention groups with varying exposure frequencies, but all receiving seven exposures: Twice a week (n = 47), once a week (n = 32) and once every second week (n = 30), and a control group (n = 50). Liking and familiarity of daikon and other vegetables (cucumber, celery, celeriac, broccoli, cauliflower and beetroot) were assessed at baseline, post-intervention and two follow up sessions (3 and 6 months) to test for potential generalisation effects and observe the longevity of the obtained effects. Intake of daikon was measured at all exposures and test sessions. Results showed significant increases (p ≤ 0.05) in liking and intake of daikon for all three frequencies and the control group. Over the exposures, intake of daikon increased until the 4th exposure for all the groups, where a plateau was reached. No systematic generalisation effects were found. Repeated exposure was a successful approach to increase liking and intake of a novel vegetable with all exposure frequencies to be effective, and no particular exposure frequency can be recommended. Even the few exposures the control group received were found to be sufficient to improve intake and liking over 6 months (p ≤ 0.05), indicating that exposures to low quantities of an unfamiliar vegetable may be sufficient.

Children's perceptions of their parent's parenting strategies and child influence on purchases in a supermarket

This field study identified, through observation, child influence on food and beverage purchases within a supermarket, as well as the influence of the children's perceptions of their parents' parenting strategies related to eating behaviors on these purchases. Four supermarkets were recruited to participate and agreed to allow recruitment of parent-child dyads and implementation of data collection protocols within their stores. Parent-child (7-14 yo) dyads were recruited to wear eye-tracking glasses during the supermarket visit, complete separate individual interviews, and have their store receipts scanned. The receipt data provided evidence of what was purchased, including overall purchases, as well as purchases of energy-dense, nutrient-poor foods and beverages. The eye-tracking data, together with the receipt data, identified which items were requested by the child and purchased. The child interviews provided the child's perceptions of parenting strategies (i.e., parental monitoring, control). Seventy-six dyads agreed to participate and completed the study protocols. During most of the shopping trips, items were purchased as a result of child-initiated request interactions. Children's perceptions of their parent's use of monitoring was consistently associated with fewer purchases overall and of energy-dense, nutrient-poor items, and with reduced child influence on what was purchased.

Examining the consumer restaurant environment and dietary intake in children

Within the away-from-home food environment there is a need to account for individual exposure (e.g., frequency of visitation) to that environment. The present study examined the consumer environment in both proximal and visited restaurants and their association with childrens’ diet quality and anthropometrics. A cross-sectional analysis used baseline data from the Neighborhood Impact on Kids (NIK) study (2007–2009). Participants were 6–12-year-olds living in King County, WA and San Diego County, CA. This analysis (conducted 2019–2020) examined relationships between nearby restaurant count, Nutrition Environment Measures Survey in Restaurants (NEMS-R) within the child’s block group, and weighted NEMS-R scores based on the restaurant where the child ate most frequently in relation to child energy intake, Healthy Eating Index (HEI-2010) total score and anthropometrics. Children’s HEI-2010 scores were associated with NEMS-R scores within block groups, with children in the lowest NEMS-R tertile having significantly higher HEI scores than participants in the middle tertile. Weighted NEMS-R scores were significantly associated with waist circumference, with children in the highest NEMS-R tertile having a lower waist circumference than children in the lowest tertile. Nearby restaurant count was not associated with children’s diet quality or anthropometrics. Our findings suggest the relationship between nutrition environment and child diet and anthropometrics varied depending on how nutrition environment was defined. However, findings may be limited by the low frequency of eating out reported in this sample. Food environment measures that account for individual-level behavior are needed to better understand the influence of food environments on diet and anthropometrics

An online randomized trial of healthy default beverages and unhealthy beverage restrictions on children's menus

•

Healthy default beverage policies have been enacted in several U.S. municipalities.

•

Effects of such policies or beverage restrictions on children’s menus are unknown.

•

Parents viewed and ordered children’s meals from one of three menu conditions.

•

Defaults and restrictions did not reduce beverage calories ordered in our experiment.

•

More robust legislation may be needed, such as implementing healthy food defaults.

Several U.S. jurisdictions have adopted policies requiring healthy beverage defaults on children’s menus, but it is unknown whether such policies or restrictions leads to fewer calories ordered. We recruited 479 caregivers of children for an online choice experiment and instructed participants to order dinner for their youngest child (2–6 years) from two restaurant menus. Participants were randomly assigned to one type of menu: 1) standard beverages on children’s menus (Control; n = 155); 2) healthy beverages on children’s menus (water, milk, or 100% juice), with unhealthy beverages available as substitutions (Default; n = 162); or 3) healthy beverages on children’s menus, with no unhealthy beverage substitutions (Restriction; n = 162). We used linear regression with bootstrapping to examine differences between conditions in calories ordered from beverages. Secondary outcomes included percent of participants ordering unhealthy beverages (full-calorie soda, diet soda, and/or sugar-sweetened fruit drinks) and calories from unhealthy beverages. Calories ordered from beverages did not differ across conditions at Chili’s [Default: 97.6 (SD = 69.8); p = 0.82; Restriction: 102.7 (SD = 71.5); p = 0.99; Control: 99.4 (SD = 72.7)] or McDonald’s [Default: 90.2 (SD = 89.1); p = 0.55; Restriction: 89.0 (SD = 81.0); p = 0.94; Control: 96.5 (SD = 95.2)]. There were no differences in the percent of orders or calories ordered from unhealthy beverages. Though Restriction participants ordered fewer calories from full-calorie soda [(3.0 (SD = 21.6)] relative to Control participants [13.4 (SD = 52.1); p = 0.04)] at Chili’s, we observed no such difference between Default and Control participants, or across McDonald’s conditions. Overall, there was no effect of healthy default beverages or restrictions in reducing total calories ordered from unhealthy beverages for children in our experiment.

The New school food standards and nutrition of school children: Direct and Indirect Effect Analysis

The Healthy, Hunger-Free Kids Act (HHFKA) of 2010 made sweeping changes to school nutritional standards. We estimate the impacts of shifts in school nutritional standards on dietary quality as well as dietary quantity of children's food intakes from school and away-from-school food sources. We find the average effect of consuming school food, rather than away-from-school food, on children's overall dietary quality significantly increased from the pre- to post-HHFKA implementation period. This effect was solely driven by substantial improvements in the dietary quality of foods acquired at school, mainly among older and higher-income children. Our indirect effect analysis indicated that children shifted towards consuming lower-quality diets at home in the post-HHFKA period, thereby partially offsetting the positive effects of the HHFKA on their overall dietary quality. Indirect impacts were primarily driven by a subset of children consuming more than a third of their daily calories from school food. Additionally, we find suggestive evidence of a modest decrease in daily calorie intake, particularly among older and higher-income children. Together, our findings imply that the HHFKA, despite its unintended negative indirect effects, led children to consume more-nutritious, less-energy-dense diets.

A 24-week intervention based on nutrition care process improves diet quality, body mass index, and motivation in children and adolescents with obesity

Higher motivation could support to lead behavioral change for obese children and adolescents. This study aimed to evaluate the effects of a nutrition care process (NCP)-based intervention targeted on diet and weight status in moderate to severe obese children and adolescents in Korea. One hundred four subjects (mean age: 10.95 years, body mass index (BMI) ≥97th percentile of age-sex) participated in the present study. Subjects were divided into a usual care group (UG) and a nutrition group (NG). All participants underwent nutrition education 6 times. The NG received individual access and continuous monitoring and setting goals with respect to nutritional problems. Consumption of high-calorie, low-nutrient (HCLN) food was significantly decreased (P < .05) and the Diet Quality Index-International (DQI-I) score also increased with respect to sodium (P < .001). The total self-efficacy score was increased from 9.15 to 10.14 points (P < .01). After 24 weeks, the BMI-z-score decreased from 2.27 to 2.19 in the NG (P < .05); however, no group difference was found. BMI-z-score was negatively associated with self-efficacy (β = -0.03, P < .019). NCP-based intervention might be helpful to solve dietary problems by enhancing self-efficacy and lower BMI-z-score in moderately to severely obese children and adolescents.

Differences in the sugar content of fast-food products across three countries

OBJECTIVE

To compare the sugar content of items at four multinational fast-food chains, across three countries.

DESIGN

Total sugar (g)/per serving was extracted from online nutrition information, and sugar/100 g serving was calculated. Foods were categorised as: breakfast sandwiches, burgers, sandwiches, desserts and condiments. Beverages were categorised as fountain, frozen or pre-packaged. Sugar (g) was compared across countries using linear mixed-effects models. Pairwise comparisons were performed with Tukey-Kramer adjustments.

SETTING

USA, Germany and Australia.

PARTICIPANTS

Burger King™ (Hungry Jack's™), Kentucky Fried Chicken™, McDonald's™ and Subway™.

RESULTS

Differences in total sugar/100 g or ml were observed across countries for burgers (n 104), desserts (n 110), sandwiches (n 178), pre-packaged beverages (n 36) and frozen beverages (n 72). Comparing identical items across countries (e.g. BigMacTM from McDonalds in USA, Germany and Australia), burgers (n 10 available in all three countries) had lower sugar content in Australia (3·4 g/100 g) compared with the USA (4·7 g/100 g, P = 0·02) or Germany (4·6 g/100 g, P = 0·04), yet no differences were observed in other food categories. Comparing the same beverages across countries (e.g. chocolate shake from Burger King), frozen beverages (n 4 available in all three countries) had lower sugar content in Australia (14·2 g/100 ml), compared with the USA (20·3 g/100 ml, P = 0·0005) or Germany (17·8 g/100 ml, P = 0·0148), yet no differences were observed in other beverage categories.

CONCLUSIONS

Heterogeneity in fast-food sugar content across countries suggests that reductions are possible and should be implemented to reduce health risks associated with excess added sugar intake.

Convenience Store Use and the Health of Urban Adolescents in Seoul, South Korea

To improve urban adolescents' dietary behaviors and health, factors that influence them to buy meals in convenience stores with regard to urban food environments must be determined. This study investigated the factors which influence adolescents' substitution of meals with convenience store meals and its impact on their health in Seoul (South Korea). Multilevel analysis and logistic regression analysis were conducted using data from the Korea Youth Risk Behavior Survey, a national health survey with a representative sample of Korean adolescents. Among 17,624 teenagers who responded to surveys in 2017 and 2019, 30.5% of them substituted meals with convenience store meals more than three times a week. Girls and students with a lower family economic level were more likely to frequently consume food from convenience stores. Unhealthy lifestyles and poor mental health status also influenced their decisions to substitute meals with convenience store food. Those who frequently consumed meals from convenience stores were more likely to have unhealthy lifestyles, featuring bad diets, smoking, drinking, and sedentary behaviors. They also reported significantly poorer self-rated health and mental health. To promote healthy lifestyles among adolescents, efforts to raise awareness and develop supportive environments for healthy diets are strongly recommended.

Rationale, design and study protocol of the 'Strong Families Start at Home' feasibility trial to improve the diet quality of low-income, ethnically diverse children by helping parents improve their feeding and food preparation practices

There is an urgent need to create effective interventions that help parents establish a healthy diet among their children early in life, especially among low-income and ethnically and racially diverse families. U.S. children eat too few fruits, vegetables and whole grains, and too many energy dense foods, dietary behaviors associated with increased morbidity from chronic diseases. Parents play a key role in shaping children's diets. Best practices suggest that parents should involve children in food preparation, and offer, encourage and model eating a variety of healthy foods. In addition, while parents help to shape food preferences, not all children respond in the same way. Certain child appetitive traits, such as satiety responsiveness (sensitivity to internal satiety signals), food responsiveness (sensitivity to external food cues), and food fussiness may help explain some of these differences. Prior interventions to improve the diet of preschool children have not used a holistic approach that targets the home food environment, by focusing on food quality, food preparation, and positive feeding practices while also acknowledging a child's appetitive traits. This manuscript describes the rationale and design for a 6-month pilot randomized controlled trial, Strong Families Start at Home, that randomizes parents and their 2-to 5-year old children to either a home-based environmental dietary intervention or an attention-control group. The primary aim of the study is to explore the feasibility and acceptability of the intervention and evaluation and to determine the intervention's preliminary efficacy on child diet quality, feeding practices, and availability of healthy foods in the home.

Stable isotopes in hair reveal dietary protein sources with links to socioeconomic status and health

Carbon and nitrogen isotope ratios in hair sampled from 65 communities across the central and intermountain regions of the United States and more intensively throughout 29 ZIP codes in the Salt Lake Valley, Utah, revealed a dietary divergence related to socioeconomic status as measured by cost of living, household income, and adjusted gross income. Corn-fed, animal-derived proteins were more common in the diets of lower socioeconomic status populations than were plant-derived proteins, with individual estimates of animal-derived protein diets as high as 75%; United States towns and cities averaged 57%. Similar patterns were seen across the socioeconomic status spectrum in the Salt Lake Valley. It is likely that corn-fed animal proteins were associated with concentrated animal-feeding operations, a common practice for industrial animal production in the United States today. Given recent studies highlighting the negative impacts of animal-derived proteins in our diets, hair carbon isotope ratios could provide an approach for scaling assessments of animal-sourced foods and health risks in communities across the United States.

Sodium and potassium excretion predict increased depression in urban adolescents

This study examined the prospective role of urinary sodium and potassium excretion in depressive symptoms among urban, low-income adolescents, and whether these relationships vary by gender. A total of 84 urban adolescents (mean age 13.36 years; 50% male; 95% African American) self-reported on their depressive symptoms at baseline and 1.5 years later. At baseline, the youth also completed a 12-h (overnight) urine collection at home which was used to measure sodium and potassium excretion. After adjusting for baseline depressive symptoms, age, BMI percentile, and pubertal development, greater sodium excretion and lower potassium excretion predicted more severe depressive symptoms at follow-up, with no significant gender differences. The results suggest that consumption of foods high in sodium and low in potassium contributes to the development of depressive symptoms in early adolescence, and that diet is a modifiable risk factor for adolescent depression. Interventions focusing on diet may improve mental health in urban adolescents.