Fruit and vegetable intake during infancy and early childhood

Fruit and vegetable consumption among children in Saudi Arabia: Predictors and associations with dietary intake

BACKGROUND

Data exploring factors related to the consumption of fruits and vegetables (F&V) among children in Saudi Arabia are lacking. The present study aimed to evaluate F&V consumption among Saudi children. Predictors of F&V intake and associations with dietary intake were also explored.

METHODS

Cross-sectional data of 424 Saudi children (6-12 years) were collected from their mothers using an online survey. Phone interviews were conducted with mothers and children to provide data on dietary intake of children.

RESULTS

Most children included in the study (92.2%, n = 391) consumed less than five servings of F&V per day. Region of residency (B = -0.14, SE = 0.06, 95% confidence interval [CI] = -0.25 to -0.02, p = 0.019), paternal education level (B = 0.52, SE = 0.14, 95% CI = 0.24-0.79, p < 0.001) and family monthly income (B = 0.15, SE = 0.07, 95% CI = 0.01-0.29, p = 0.034) predicted the intake of F&V. Food neophobia and food pickiness also predicted the intake of F&V (B = -0.16, SE = 0.06, 95% CI = -0.27 to -0.05, p = 0.005 and B = -0.24, SE = 0.06, 95% CI = -0.36 to -0.12, p < 0.001, respectively). Children's intake of F&V positively predicted the intake of fibre, potassium, phosphorus, magnesium, iodine and vitamin C.

CONCLUSIONS

Limited intake of F&V was observed among Saudi children. F&V consumption was found to be associated with a number of sociodemographic factors, including region of residency, paternal education level and family income, as well as children's food neophobia and pickiness. Children's intake of F&V predicted higher intake of fibre, potassium, phosphorus, magnesium, iodine and vitamin C, suggesting that F&V consumption may contribute to improved intake of key nutrients in children.

Characterisation of complementary feeding practice and locally available climate-resilient crops for complementary food among agro-pastoralists of Ethiopia: a qualitative study

The current study aims to characterise the complementary feeding practice and identify locally available climate-resilient crops that can be used for complementary feeding among agro-pastoralists in Ethiopia. A phenomenological study in Benna-Tsemay district, comprising focused group discussions, key informant interviews, and household observations, was conducted. A pretested guide was used to capture information regarding types of complementary food, lists of food items, and ingredients included in their complementary formulation. A thematic analysis for emerging points of discussion was carried out. Three major themes, including infant and young child feeding practices, food items included in complementary food, and their consumption frequencies, as well as the incorporation of climate-resilient crops into complementary foods as coping mechanisms, emerged. Breastfeeding was common and regarded as essential. Gruel and porridge from grains, roots, and tubers were regular parts of complementary foods in the study area. Moringa and sorghum were dominantly identified as climate-resilient crops regularly grown and used in complementary foods. Growing these crops was regarded as a coping strategy for drought and seasonal constraints. The district is one of the most drought-prone areas in Ethiopia, compromising the quality of complementary food. Unlike the World Health Organization recommendation, the grains, roots, and tubers-based diet formed the basis of complementary food lacking flesh foods, eggs, pulses, and other fruits and vegetables. Thus, it is recommended to improve complementary food quality through value-addition using locally accessible crops.

Cyclic Formula Feeding Among Infants Participating in the Special Supplemental Nutrition Program for Women, Infants, and Children

BACKGROUND

Low-income households often experience a cyclic pattern in food availability, with acute food shortages at month end. Variations in the monthly feeding of infant formula are understudied.

OBJECTIVES

This study aimed to compare the amount and frequency of formula consumed at the beginning and end of the monthly Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) assistance cycle and test associations with total energy intake and other feeding practices among infants aged 7-11 mo.

METHODS

This study was conducted between May 2020 and April 2021 in the southeastern United States and involved mothers of infants participating in WIC's fully formula package. Mothers were interviewed and 24-h feeding recalls were conducted at the beginning and end of the month. We defined month beginning as 5 d following the first WIC formula purchase and month end as 5 d before the next monthly cycle. Fifty mother-infant dyads participated in single or multiple monthly cycles, totaling 98 monthly cycles. Generalized linear mixed-effects modeling was used to test differences in formula feeding at month beginning and end.

RESULTS

Most participants (84%) were African American or Latino and >90% purchased all formula within 2-3 d of the WIC issuance. The energy intake from formula at month beginning was significantly higher than at month end (67.63% and 57.85%, respectively; P = 0.002), with no differences in total energy intake. The odds of infants being fed cow milk and fruit juices/drinks increased from month beginning to end (P < 0.05).

CONCLUSIONS

Infants in low-income households are at risk of experiencing a cyclic feeding pattern characterized by higher formula feeding at month beginning and an increase in feeding of nonrecommended drinks at month end. The WIC program policy could review educational and distribution options to reduce cyclic formula feeding and clarify caregivers' understanding of infants' formula needs. Household-level investigations into formula management and determinants of cyclic feeding are warranted.

Household- and community-level factors of zero vegetable or fruit consumption among children aged 6-23 months in East Africa

Introduction

The World Health Organization recommends that children aged 6-23 months should consume a diversified diet, including fruits and vegetables, during each meal. However, low consumption of fruits and vegetables contributes to 2.8% of child deaths globally. The literature review indicates limited research on factors that affect zero vegetable or fruit consumption among children aged 6-23 months in East Africa. Therefore, this study aimed to investigate the household- and community-level factors determining zero vegetable or fruit consumption among children aged 6-23 months in East Africa.

Method

The study analyzed cross-sectional secondary data from the recent rounds of demographic and health surveys conducted in East Africa from 2015 to 2023. The weighted sample comprised 113,279 children aged 6-23 months. A multilevel mixed-effect analysis was used, measuring the random variation between the clusters based on the intra-cluster correction coefficient, median odds ratio, and proportional change variance. Adjusted odds ratio with a 95% confidence interval was reported while considering variables having a p < 0.05 as statistically significant.

Results

The overall prevalence of zero vegetable or fruit consumption among children aged 6-23 months in East Africa was 52.3%, with Ethiopia showing the highest prevalence (85.9%). The factors associated with zero vegetable or fruit consumption were maternal educational level, number of household members, short birth interval, multiple births, sex of the household head, household wealth index, community-level maternal literacy, community-level wealth index, and countries.

Conclusion

Considering the high overall prevalence of zero vegetable or fruit consumption among children aged 6-23 months in East Africa, overlooking this nutritional gap among children is a serious oversight. Therefore, efforts should be geared toward improving individual- and community-level maternal literacy. In particular, nutrition and public health organizations should support low-income communities to achieve vegetable or fruit consumption for infants and young children.

Infant Feeding Outcomes From a Culturally-Adapted Early Obesity Prevention Program for Immigrant Chinese American Parents

OBJECTIVE

To examine whether a cultural adaptation of an early childhood obesity prevention program promotes healthy infant feeding practices.

METHODS

Prospective quasi-experimental study of a community-engaged multiphasic cultural adaptation of an obesity prevention program set at a federally qualified health center serving immigrant Chinese American parent-child dyads (N = 298). In a group of historical controls, we assessed early infant feeding practices (breastfeeding, sugar-sweetened beverage intake) in 6-month-olds and then the same practices alongside early solid food feeding practices (bottle weaning, fruit, vegetable, sugary or salty snack consumption) in 12-month-olds. After implementation, we assessed these practices in an intervention cohort group at 6 and 12 months. We used cross-sectional groupwise comparisons and adjusted regression analyses to evaluate group differences.

RESULTS

At 6 months, the intervention group had increased odds of no sugar-sweetened beverage intake (aOR: 5.69 [95% confidence interval (CI): 1.65, 19.63], P = .006). At 12 months, the intervention group also had increased odds of no sugar-sweetened beverage intake (aOR: 15.22 [95% CI: 6.33, 36.62], P < .001), increased odds of bottle weaning (aOR: 2.34 [95% CI: 1.05, 5.23], P = .03), and decreased odds of sugary snack consumption (aOR: 0.36 [0.18, 0.70], P = .003). We did not detect improvements in breastfeeding, fruit, vegetable, or salty snack consumption.

CONCLUSIONS

A cultural adaptation of a primary care-based educational obesity prevention program for immigrant Chinese American families with low income is associated with certain healthy infant feeding practices. Future studies should evaluate cultural adaptations of more intensive interventions that better address complex feeding practices, such as breastfeeding, and evaluate long-term weight outcomes.

Socioeconomic Characteristics and the Home Food Environment Are Associated With Feeding Healthful and Discretionary Foods During the First Year of Life in the Pregnancy Eating Attributes Study

BACKGROUND

Feeding of nutrient-poor foods begins in infancy and may adversely influence long-term food preferences.

OBJECTIVE

To examine associations of socioeconomic characteristics, childbearing parent eating behaviors, and home food environment with infant feeding characteristics.

DESIGN

Secondary analysis of a prospective cohort study from first trimester of pregnancy through 12 months postpartum.

PARTICIPANTS/SETTING

Participants with uncomplicated singleton pregnancies and no major chronic illness were enrolled from November 2014 through October 2016 from 2 university-based obstetrics clinics in Chapel Hill, NC. Of 458 enrolled, 321 were retained through 12 months postpartum.

MAIN OUTCOME MEASURES

Participants completed infant food frequency questionnaires indicating age at introduction and frequency of consuming multiple food groups. Exposures included childbearing parent socioeconomic characteristics, hedonic hunger, addictive-like eating, Healthy Eating Index 2015 calculated from three 24-hour diet recalls, and home food environment fruit/vegetable and obesogenic scores.

STATISTICAL ANALYSES PERFORMED

Multiple imputation using Heckman selection model; linear and logistic regressions examining associations with infant feeding characteristics.

RESULTS

Lower education and income were associated with later infant age at introduction to, and lower frequency of consuming fruits and vegetables at age 12 months. Socioeconomic characteristics were not associated with age at introduction to discretionary solid foods; however, lower education and income were associated with greater infant frequency of intake of discretionary foods and greater odds of introducing fruit juice and sweetened beverages by age 12 months. Childbearing parent Healthy Eating Index 2015, hedonic hunger, and addictive-like eating were not consistently associated with infant feeding characteristics. A more obesogenic food environment was associated with greater frequency of intake of discretionary foods, lower frequency of intake of fruit, and greater odds of fruit juice introduction by age 12 months.

CONCLUSIONS

Infant feeding characteristics may be important intervention targets for addressing socioeconomic disparities in child diet quality. Efforts to reduce routine feeding of discretionary foods across socioeconomic groups are needed; modifying the home food environment may promote healthful infant feeding.

Factors Associated with Daily Fruit and Vegetable Intakes among Children Aged 1-5 Years in the United States

To describe child, caregiver, and household characteristics associated with fruit and vegetable intakes among US children aged 1-5 years, we examined fruit and vegetable intakes (less than daily vs. daily) using data from the 2021 National Survey of Children's Health among children aged 1-5 years. Multiple logistic regression provided adjusted odds ratios for factors associated with (1) daily fruit and (2) daily vegetable intakes. Among children aged 1-5 years, 68% (n = 11,124) consumed fruit daily, and 51% (n = 8292) consumed vegetables daily. Both daily fruit and daily vegetable intake were associated with child age, child race and ethnicity, and frequency of family meals. For example, children who ate a family meal 4-6 days/week (aOR 0.69; 95% CI 0.57, 0.83) or 0-3 days/week (aOR 0.57; 95% CI 0.46, 0.72) were less likely to consume fruit daily compared to children who had a family meal every day. Participation in food assistance programs, food insufficiency, and household income were not significantly associated with odds of daily fruit or daily vegetable intake in the adjusted models. Several factors were associated with daily fruit and vegetable intake among children aged 1-5. Strategies aimed at increasing fruit and vegetable consumption in early childhood may consider these child, caregiver, and household characteristics. Pediatric healthcare providers, early childhood education centers, and families of young children may be important partners in this work.

Household Food Insecurity and Maternal-Toddler Fruit and Vegetable Dietary Concordance

OBJECTIVE

To examine whether prenatal or concurrent household food insecurity influences associations between maternal and toddler fruit and vegetable (FV) intake.

DESIGN

Application of a life-course framework to an analysis of a longitudinal dataset.

SETTING

Early childhood obesity prevention program at a New York City public hospital.

PARTICIPANTS

One-hundred and fifty-six maternal-toddler dyads self-identifying as Hispanic or Latino.

VARIABLES MEASURED

Maternal and toddler FV intake was measured using Centers for Disease Control and Prevention dietary measures when toddlers were aged 19 months. Household food insecurity (measured prenatally and concurrently at 19 months) was measured using the US Department of Agriculture Food Security Module.

ANALYSIS

Regression analyses assessed associations between adequate maternal FV intake and toddler FV intake. Interaction terms tested whether prenatal or concurrent household food insecurity moderated this association.

RESULTS

Adequate maternal FV intake was associated with increased toddler FV intake (B = 6.2 times/wk, 95% confidence interval, 2.0-10.5, P = 0.004). Prenatal household food insecurity was associated with decreased toddler FV intake (B = -6.3 times/wk, 95% confidence interval, -11.67 to -0.9, P = 0.02). There was a significant interaction between the level of maternal-toddler FV association (concordance or similarity in FV intake between mothers and toddlers) and the presence of food insecurity such that maternal-toddler FV association was greater when prenatal household food insecurity was not present (B = -11.6, P = 0.04).

CONCLUSIONS AND IMPLICATIONS

Strategies to increase FV intake across the life course could examine how the timing of household food insecurity may affect intergenerational maternal-child transmission of dietary practices.

Maternal determinants of dietary patterns in infancy and early childhood in the Growing up in New Zealand cohort

Given the importance of diet in early life, assessing children's diet is crucial to guide interventions. Using data from a nationally generalizable New Zealand (NZ) birth cohort we examined children's dietary patterns at 9- (n = 6259), 24- (n = 6292), and 54-months (n = 6131), and their association with maternal sociodemographic and health behaviours. At each time-point, children's dietary patterns were identified using principal components analysis. We then used multivariate linear regression to examine associations between each pattern and maternal variables. At 9-, 24- and 54-months, two dietary patterns were identified, explaining 36.4%, 35.3% and 33.6% of children's intake variability, respectively. Refined high in sugar, salt and fat dietary pattern, at all time-points, was characterized by high positive loadings in white/refined breads and cereals, and items with high sugar, sodium, and fat content. At 24-months, Refined high in sugar, salt and fat also included a high positive loading with protein food groups. Fruit and vegetables dietary pattern, at all time-points, had high positive loadings for fruits and vegetables (with type varying across time-points). Fruit and vegetables also included high loading in whole grain options of breads and cereals at 24-months and the protein food group was part of this dietary pattern at 9- and 54-months. Children's scores on the Refined high in sugar, salt and fat pattern had strong associations with maternal smoking habits, education level, ethnicity, and maternal scores in the "Junk" and "Traditional/White bread" dietary patterns (constructed from an antenatal interview). Children's scores on the Fruit and vegetables pattern had strong associations with the maternal scores in the dietary pattern "Health Conscious". Interventions to improve diet in early life in NZ need to be responsive to ethnicity and suitable for people of all education levels. Interventions that improve maternal health behaviours may also improve children's diet.

Exploring Vegan Mothers' Experiences of Making Food Choices for Infants and Young Children

OBJECTIVE

Our study aimed to explore vegan mothers' experiences and decision-making processes when feeding their children (up to 3 years old).

METHODS

We conducted a qualitative photo-elicitation interview study in the United Kingdom. Eight vegan mothers provided 5 photographs of food choices they had made for their children and completed online photo-elicitation interviews to discuss these images. Data were transcribed verbatim and analyzed using reflexive thematic analysis.

RESULTS

Five themes were developed: role modeling eating behavior, shared decision-making, nutritional guidance for vegan parents, fear of judgment for being vegan, and desire for convenience.

CONCLUSIONS AND IMPLICATIONS

Findings illustrate the complexity of the decision-making process and highlight the need for targeted resources for vegan parents. There is a need for awareness raising and training for health care professionals and the development of vegan-specific child-feeding resources to facilitate the provision of evidence-based nutritional guidance for vegan parents.

Increased WIC Cash Value Benefit is Associated with Greater Amount and Diversity of Redeemed Fruits and Vegetables among Participating Households

Background

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages for children ages 1 to 4 y include a cash value benefit (CVB) redeemable for fruits and vegetables (FVs) with participating vendors. The CVB value was increased beginning in June 2021.

Objectives

This study evaluated associations of the augmented CVB with the amount and diversity of redeemed FVs.

Methods

Price look-up codes (PLUs) in redemption data determined outcomes including any redemption (any, none), amount redeemed (United States dollars [USD]/mo), and percent of total CVB redemption (percent) in 54 FV commodity groups among a cohort of 1770 WIC-participating children in Southern California. Outcomes across all commodity groups for fresh fruits, fresh vegetables, and all FVs were evaluated including dollar amount redeemed, percentage of redemption, and diversity of produce redeemed (variety and balance among items redeemed). Comparisons were made between augmented CVB periods (35 USD/mo in June-September 2021, 24 USD/mo October 2021-June 2022) and the preaugment period (9 USD/mo in June 2020-May 2021). Associations were tested in multivariable generalized estimating equation Poisson (any redemption) and linear (amount, percent, diversity) regression models.

Results

The augmented CVB was associated with higher any redemption prevalence and amount redeemed for 53 of 54 commodity groups at both 35 USD/mo and 24 USD/mo compared with 9 USD/mo. Redemption diversity increased for both fruits, vegetables, and all produce during both augment periods, and modestly greater increases in redeemed fruits relative to vegetables were observed at 35 USD/mo. The most commonly redeemed vegetables were tomatoes, onions, cucumbers, peppers, and avocados and the most commonly redeemed fruits were bananas, apples, grapes, limes, and melons.

Conclusions

The augmented CVB was associated with greater redeemed FV amount and greater redeemed FV diversity. Data on FV intake diversity among WIC-participating children are needed to understand dietary impacts of the CVB increase.

Zero fruits/vegetables consumption and associated factors among Children aged 6-23 months in Ethiopia: Mixed effect logistic regression analysis

BACKGROUND

The first two years of life is a vital period for promoting optimal growth, development and health. The lifelong nutritional habit and overall health of children is influenced by their early age feeding practice. Ethiopia is among the top five countries in Sub-Saharan Africa with the highest burden of zero fruits/vegetables consumption. This study aims to access factors associated with zero fruits/vegetables consumption among children aged 6-23 months in Ethiopia.

METHODS

The study analyzed Ethiopian Mini Demographic and Health Survey 2019 dataset with a total weighted sample of 1459 young children aged between 6-23 months and who were living with their mothers. Data cleaning, coding and labeling were done using STATA version 14 software. Multilevel mixed effect logistic regression model was employed to identify associated factors.

RESULTS

Exactly 69.3% of children aged 6-23 months in Ethiopia had zero fruits/vegetables consumption. In the multivariable multilevel binary logistic regression analysis a child from household with middle (AOR = 0.55, 95% CI: 0.35, 0.86) and rich (AOR = 0.37, 95% CI: 0.23, 0.60) wealth index, mothers who aged between 25-34 years old (AOR = 0.44; 95%CI = 0.29-0.69), mothers who were married/living with partner (AOR = 3.21; 95%CI: 1.58-6.52), children of mothers who follow Islamic religion (AOR = 0.34, 95% CI: 0.19, 0.61), mothers who had more than four ANC visits during their most recent pregnancy (AOR = 0.57; 95%CI: 0.39-0.83), children in age group of 12-18 month(AOR = 0.41, 95% CI: 0.28, 0.59), and 19-23 months (AOR = 0.26, 95% CI: 0.17, 0.40), health facility delivery (AOR = 1.52, 95% CI; 1.00-2.30), and small peripheral regions (AOR = 4.40, 95% CI; 1.39-13.97) were found to be significant factors associated with children's zero fruits /vegetables consumption. The Interclass correlation coefficient (ICC) value in the null model was 0.34, which indicates that 34% of the variation in children's zero fruits /vegetables consumption was attributed to the variation between clusters.

CONCLUSION

This study found that zero fruits/vegetables consumption among children aged 6-23 months in Ethiopia is high. Therefore, efforts should be made by stakeholders who are concerned about optimal diet and health of children to improve fruits/vegetables consumption of children particularly those from poor households, young mothers (15-24), and peripheral regions of Ethiopia. This could be done during ANC follow up visits and during nutrition counseling.

Estimates and trends of zero vegetable or fruit consumption among children aged 6-23 months in 64 countries

Children require a diverse diet, that includes vegetables and fruits, to support growth and development and prevent non-communicable diseases. The WHO-UNICEF established a new infant and young child feeding (IYCF) indicator: zero vegetable or fruit (ZVF) consumption among children aged 6-23 months. We estimated the prevalence, trends, and factors associated with ZVF consumption using nationally representative, cross-sectional data on child health and nutrition in low-and-middle-income countries. We examined 125 Demographic and Health Surveys in 64 countries conducted between 2006-2020 with data on whether a child ate vegetables or fruits the previous day. Prevalence of ZVF consumption was calculated by country, region, and globally. Country trends were estimated and tested for statistical significance (p<0.05). Logistic regression analysis was used to examine the relationship between ZVF and child, mother, household, and survey cluster characteristics by world region and globally. Using a pooled estimate of the most recent survey available in each country, we estimate the global prevalence of ZVF consumption as 45.7%, with the highest prevalence in West and Central Africa (56.1%) and the lowest in Latin America and the Caribbean (34.5%). Recent trends in ZVF consumption varied by country (16 decreasing, eight increasing, 14 no change). Country trends in ZVF consumption represented diverse patterns of food consumption over time and may be affected by the timing of surveys. Children from wealthier households and children of mothers who are employed, more educated, and have access to media were less likely to consume ZVF. We find the prevalence of children aged 6-23 months who do not consume any vegetables or fruits is high and is associated with wealth and characteristics of the mother. Areas for future research include generating evidence from low-and-middle-income countries on effective interventions and translating strategies from other contexts to improve vegetable and fruit consumption among young children.

Complementary feeding practices and their determinants among children aged 6-23 months in rural Bangladesh: evidence from Bangladesh Integrated Household Survey (BIHS) 2018-2019 evaluated against WHO/UNICEF guideline -2021

BACKGROUND

Appropriate Complementary feeding (CF) practices play a crucial role in determining child nutrition, growth, and development. This study seeks to examine CF practices and their predictors among children aged 6 to 23 months in rural Bangladesh according to the most recently updated WHO/UNICEF guidelines for CF.

METHODS

A total of 665 children aged 6 to 23 months from the Bangladesh Integrated Household Survey (BIHS) 2018-2019 dataset were analyzed. The WHO/UNICEF guidelines for CF were followed to evaluate each of the nine CF practice indicators. We also examined the effect of the child, maternal, household, and community-level factors on different CF components using multiple logistic regression analyses.

RESULTS

Approximately two-thirds of the children initiated complementary feeding on time (63.5%) but had zero vegetable or fruit consumption (63.2%). More than half (52.4%) and the majority (86.5%) of children had minimum meal frequency and minimum milk feeding frequency, respectively. On the other hand, the proportion of minimum dietary diversity was quite low (18.3%), as reflected in the alarming prevalence (16.3%) of minimum acceptable diet. Egg and/or flesh food, sweet beverage, and unhealthy food consumption were 23.3%, 2.5%, and 12.2%, respectively. Child age, mothers' education level, antenatal care visit, household food security, monthly household income, and place of residence were found to be associated with CF practices.

CONCLUSION

When compared to results obtained using the previous guideline, the new one has resulted in a lower prevalence of Introduction of solid, semi-solid, or soft foods (ISSF), Minimum dietary diversity (MDD), Minimum meal frequency (MMF), and Minimum acceptable diet (MAD). It is crucial to convey the new knowledge for better child feeding and nutrition as the country prepares to apply the new guideline.

Feeding characteristics in infancy affect fruit and vegetable consumption and dietary variety in early childhood

BACKGROUND/OBJECTIVES

Previous studies have shown an association between breastfeeding and higher fruit and vegetable consumption and the level of dietary variety in children. However, few studies have reported this association on the feeding characteristics. Therefore, this study examined the association of the feeding characteristics with the consumption of fruit and vegetable and dietary variety in children.

SUBJECTS/METHODS

This study recruited 802 participants from their parents with information on their feeding, and 24-h dietary recall. The associations of the feeding characteristics with fruit and vegetable consumption and dietary variety score (DVS) were analyzed using a multiple logistic regression model.

RESULTS

Compared to the feeding type of exclusive breastfed children, exclusive formula-fed children had a significant association with a lower DVS (odds ratio [OR], 0.42, 95% confidence interval [CI], 0.23-0.77). Fruit and vegetable consumption was classified into 6 groups: non-salted vegetables (NSV), salted vegetables (SV), fruit (F), total vegetables (TV), non-salted vegetables + fruit (NSVF), and total vegetables + fruit (TVF). According to the mean level of fruit and vegetable consumption, compared to the duration of total breastfeeding for 6 month or less, a greater duration of breastfeeding for 12 mon had a significant association with a higher intake of NSVF and TVF (OR, 1.85, 95% CI, 1.20-2.85 and OR, 1.89, 95% CI, 1.22-2.92). On the other hand, the early introduction of formula feeding for 4 mon had a significant association with a lower intake of F and NSVF (OR, 0.59, 95% CI, 0.38-0.91 and OR, 0.63, 95% CI, 0.40-0.99).

CONCLUSIONS

These results confirm that breastfeeding is associated with higher fruit and vegetable consumption and dietary variety, whereas formula feeding is associated with lower fruit and vegetable consumption and dietary variety. Therefore, the feeding characteristics in infants may affect fruit and vegetable consumption and dietary variety in children.

Integration of Food-based Learning With Science in the Preschool Classroom: Implementation Gaps and Opportunities

OBJECTIVE

To explore Head Start teachers' use and integration of food-based learning (FBL) with science learning in the Head Start classroom.

DESIGN

Phenomenological approach using in-depth semistructured telephone interviews.

SETTING

North Carolina Head Start preschools.

PARTICIPANTS

Thirty-five Head Start lead and assistant teachers.

PHENOMENON OF INTEREST

All interviews were transcribed verbatim. Authors coded interview data for emergent themes.

ANALYSIS

Eleven primary themes were identified during analysis and inductively organized using the Systems Thinking Iceberg Model.

RESULTS

Teachers described most frequently using FBL during mealtimes. Teachers stated they felt successful when children were engaged and willing to try a new food. However, they struggled to connect food to science concepts. Teachers reported several motivators (eg, improving health) and barriers (eg, food waste) to integrating FBL. Teachers prioritized preparing children for kindergarten, but most teachers did not see how FBL could help them achieve this goal.

CONCLUSIONS AND IMPLICATIONS

Head Start teacher professional development programs could impact all 4 levels of the Systems Thinking Model to improve teachers' perceptions, underlying structures, and mental models regarding integrative FBL. Additional research is warranted to investigate the adoption, implementation, and potential impact of FBL on academic outcomes.

Perceived barriers to vegetable intake among urban adolescents from socioeconomically disadvantaged backgrounds: A qualitative study from the perspective of youth workers and teachers

Eating habits established during adolescence have been shown to track into adulthood. Adolescents from lower socioeconomic status groups tend to have lower intakes of vegetables as compared with their more affluent peers. However, there is limited evidence about the determinants of vegetable intake in this population group. Therefore, this study aimed to explore the barriers to vegetable intake in adolescents living in socioeconomically disadvantaged areas through the perspective of school teachers and youth workers. A total of 20 semi-structured interviews were conducted with post-primary school teachers and youth workers from disadvantaged areas in Dublin, Ireland. Thematic analysis was applied to analyze the data. Eleven themes were identified and fitted within the Socioecological Model of Health: adolescent's food preferences, lack of early exposure and familiarity with vegetables, lack of interest, knowledge and skills at the individual and family level, parenting practices around nutrition, living difficulties, peers' influence and social norms around nutrition, dual role of social media, lack of resources and support to promote healthy eating, competition between unhealthy food vs. vegetables, lack of adequate approaches & initiatives at the community and at the public policy levels, and lack of State support to promote healthy eating. Although several actions could be taken at the personal and interpersonal levels, more efforts are needed at the organizational, community and public policy levels to improve dietary choices and vegetable intake among adolescents in socioeconomically deprived areas. These findings will inform the development of tailored intervention strategies and policies for these vulnerable youths.

Infant and Young Child Feeding Practices and Mycotoxin Contamination of Complementary Food Ingredients in Kongwa District, Tanzania

Background

Inadequate infant and young child feeding (IYCF) practices in low income countries contribute to poor child growth and development.

Objectives

To assess IYCF practices and mycotoxin contamination in complementary food ingredients across 2 seasons in Kongwa District, Tanzania.

Methods

Early feeding practices in 115 rural households from 25 villages in Kongwa District, Dodoma region, Tanzania, were assessed. The primary caregiver for the index child (6-18 mo of age) was interviewed using a structured dietary questionnaire at recruitment (October/November 2017), and revisited 6 mo later. The questionnaire included questions on typical food consumption in the past 24 h. This study reports 7 of the revised and new IYCF indicators, including minimum dietary diversity (MDD). Aflatoxins (AF) and fumonisins (FUM) were analyzed in complementary food ingredients for pooled household samples to broadly establish patterns of contamination at the village level.

Results

The MDD was not met for 80% of infants at recruitment (survey 1) as compared with 56% in survey 2 (P < 0.05). Changes in MDD between the 2 surveys were dependent on season but not age. Maize was consumed by >90% of households in both surveys, whereas groundnut was consumed by 44% and 64% of households in surveys 1 and 2, respectively. AF concentrations in maize and groundnuts were found to be higher in survey 1 than in survey 2. Overall, AF exceeded the legal limit in 18% of maize and 61% of groundnut pooled samples in both surveys. Maize was also contaminated with significant FUM concentrations.

Conclusions

Poor diets were common among children in Kongwa District. Reliance on maize and groundnuts exposes this vulnerable age group to AF (also to FUM in maize). Inadequate diet and exposure to AF and FUM have separately been linked to linear growth retardation. Low diet diversity and mycotoxins contamination are plausible causes for poor growth and development among infants in Central Tanzania. Curr Dev Nutr 20XX;x:xx.

Total Usual Nutrient Intakes and Nutritional Status of United Arab Emirates Children (4 Years-12.9 Years): Findings from the Kids Nutrition and Health Survey (KNHS) 2021

This study aims at investigating the anthropometric status and food consumption patterns of children in the United Arab Emirates (UAE) and assessing their adherence to nutrient and dietary recommendations. It is a population-based cross-sectional survey of 690 children (4-12.9 years), from 3 major Emirates. Socio-demographic and anthropometric characteristics were collected. Dietary intakes were assessed using the 24-hour recall approach. Of the total sample, 4% were stunted, 8% were wasted and 28% were overweight/obese. A third of participating children consumed above the Estimated Energy Requirement, while the majority's intakes carbohydrate, total fat, and protein were within the recommendations; whereas over 70% and 90% of participants consumed above the WHO daily limits of free sugars and saturated fats, respectively. Inadequate intakes of linoleic acid (36% of children), alpha-linolenic acid (91%) and dietary fiber (100%) were observed. All children failed to meet the recommendation for vitamin D and considerable proportions had inadequate intakes of vitamin A, calcium, zinc, folate, and magnesium. Compared with the American Heart Association/American Academy of Pediatrics recommendations, low dietary adherence was noted for fruits (9%), vegetables (4%), and milk/dairy (14%). These findings may be used in the development of nutritional policies aimed at improving the diets of children in the UAE.

What are the determinants of vegetable intake among adolescents from socioeconomically disadvantaged urban areas? A systematic review of qualitative studies

BACKGROUND

Evidence available on the determinants of vegetable intake in young populations is inconsistent. Vegetable intake is particularly low in adolescents from less-affluent backgrounds, yet no systematic review of qualitative studies investigating determinants for vegetable intake specifically has been conducted to date in this group. This systematic review aimed to identify determinants of vegetable intake in adolescents from socioeconomically disadvantaged urban areas located in very high-income countries reported in qualitative studies.

METHODS

Five electronic databases (PubMed, Web of Science, CINAHL, PsycINFO and ERIC) were searched until August 2022. The search strategy used combinations of synonyms for vegetable intake, adolescents, and qualitative methodologies. Main inclusion criteria were studies exploring views and experiences of motivators and barriers to vegetable intake in a sample of adolescents aged 12-18 years from socioeconomically disadvantaged urban areas in very high income countries. Study quality assessment was conducted using criteria established in a previous review.

RESULTS

Sixteen studies were included out of the 984 screened citations and 63 full texts. The synthesis of findings identified the following determinants of vegetable intake: sensory attributes of vegetables; psychosocial factors (nutrition knowledge, preferences/liking, self-efficacy, motivation); lifestyle factors (cost/price, time, convenience); fast food properties (taste, cost, satiety); home environment and parental influence; friends' influence; school food environment, nutrition education and teachers' support; and availability and accessibility of vegetables in the community and community nutrition practices. Studies attained between 18 and 49 out of 61 quality points, with eleven of 16 studies reaching ≥ 40 points. One main reason for lower scores was lack of data validation.

CONCLUSION

Multiple determinants of vegetable intake were identified complementing those investigated in quantitative studies. Future large scale quantitative studies should attempt to examine the relative importance of these determinants in order to guide the development of successful interventions in adolescents from socioeconomically disadvantaged backgrounds.

Hands-on childcare garden intervention: A randomized controlled trial to assess effects on fruit and vegetable identification, liking, and consumption among children aged 3–5 years in North Carolina

Gardening at childcare centers may have a potent influence on young children’s learning about fruits and vegetables and their development of healthy dietary behaviors. This randomized controlled trial examined the effect of a garden intervention on fruit and vegetable (FV) identification, FV liking, and FV consumption among 3–5-year-old children enrolled in childcare centers in Wake County, North Carolina, USA. Eligible childcare centers (serving primarily low-income families) were randomly selected and then randomly assigned to one of three groups: (1) intervention; (2) waitlist-control that served as a control in year 1 and received the intervention in year 2; or (3) no-intervention control. From the 15 participating childcare centers, 285 children aged 3–5  years were consented by their parents or guardians to participate. The intervention comprised six standardized, raised, mulched garden beds, planted with warm-season annual vegetables and fruits, and perennial fruits. A Gardening Activity Guide describing 12 age-appropriate, sequential gardening activities was distributed for teachers to lead hands-on gardening activities during the growing season. Data were gathered between Spring 2018 and Fall 2019. FV identification and liking were measured using an age-appropriate tablet-enabled protocol. FV consumption was measured by weighing each child’s fruit and vegetable snack tray before and after tasting sessions. Compared to children receiving no-intervention, children who received the garden intervention showed a greater increase in accurate identification of both fruits and vegetables as well as consumption of both fruit and vegetables during the tasting sessions. Consistent with prior research, the effects on fruit consumption were greater than on vegetable consumption. There was no significant effect of the garden intervention on children’s FV liking. Garden interventions implemented early in life foster learning about FV and promote healthy eating. Early exposure to gardening may yield a return on investment throughout the lifecourse, impacting healthy diet and associated health outcomes, which are particularly important within disadvantaged communities where children’s health is challenged by a host of risk factors. Clinical Trials Registration #NCT04864574 (clinicaltrials.gov).

School Gardening, Cooking and Sports Participation Intervention to Improve Fruits and Vegetables Intake and Moderate-to-Vigorous Physical Activity among Chinese Children: Study Protocol for a Cluster Randomized Controlled Trial

Inadequate intake of fruits and vegetables (FV) and moderate-to-vigorous physical activity (MVPA) in children has become a global public health problem. Therefore, school-based gardening and cooking (SGC) and sports participation (SP) interventions may be effective in improving children's FV intake and MVPA. The aim of this study is to develop and evaluate the effectiveness of SGC and SP interventions on FV intake and MVPA among Chinese children. In this cluster randomized controlled trial study, 237 children in grades 4-5 from six public primary schools from Changsha, Hunan Province, China will be randomly assigned to: (1) a SGC and SP combined intervention group; (2) a SP intervention group; (3) a regular practice group. The intervention clusters will be implemented for a period of 6 months and follow up will be carried out after 12 months. The outcome will be collected using a combination of self-reported and objective measures. Primary outcomes will include children's FV intake and duration of MVPA per day, and secondary outcomes will included frequency and attitudes of FV intake and SP, in addition to other measures. Finally, a process evaluation will be used to analyze the facilitators and barriers to intervention implementation. Trial Registration: (Registration Number: ChiCTR2200064141).

The Household Food Security and Feeding Pattern of Preschool Children in North-Central Nigeria

Children’s feeding patterns and health outcomes are important determinants of any country’s food and nutrition security status. This study assessed the household food security and feeding patterns of preschoolers in Niger State, Nigeria. A cross-sectional descriptive design and a multi-stage sampling technique were employed to analyze 450 preschool children from selected local government areas. Household food security was measured using the HFIAS nine-item questionnaire, and feeding patterns were evaluated using the qualitative food frequency questionnaire (FFQ). The mean age of the preschoolers was 3.71 ± 0.80 years. A majority (61.30%) of the children consumed cereal-based products, while fruits and vegetables were the least consumed (16.40%). More than half (59.80%) of the preschoolers met their minimum dietary diversity. Almost all (98.80%) of the children were from food-insecure households, with 40.3% being severely food insecure. Parity, religion, and having a breadwinner and source of potable water were significantly associated with the adequacy of minimum dietary diversity (MDD) among the preschoolers (F value = 5.528, p ≤ 0.05). The contribution of poor feeding patterns and household food insecurity to the overall health outcome of preschoolers cannot be overlooked. Hence, nations must prioritize improving the availability, accessibility, and utilization of food to better meet the nutritional needs of preschool children.

Improving Nutrition in the First 1000 Days in the United States: A Federal Perspective

The first 1000 days begins with pregnancy and ends at the child's second birthday. Nutrition throughout the life course, and especially during the first 1000 days, supports maternal health and optimal growth and development for children. We give a high-level summary of the state of nutrition in the first 1000 days in the United States. We provide examples where continued efforts are needed. We then discuss select opportunities to strengthen federal research and surveillance, programs, and communication and dissemination efforts aimed at improving nutrition and positively, and equitably, influencing the health and well-being of mothers and children. (Am J Public Health. 2022;112(S8):S817-S825. https://doi.org/10.2105/AJPH.2022.307028).

Mapping and determinants of consumption of egg and/or flesh foods and zero vegetables or fruits among young children in SSA

Zero vegetable or fruit and egg and/or flesh foods are the latest indicators for assessing infant and young child feeding practices. Understanding national and subnational heterogeneity and regional clustering in children with SSA is becoming increasingly essential for geographic targeting and policy prioritization. Geographical case identification, determinants, and impacts were all investigated. SSA children's consumption of vegetable or fruit, egg and/or flesh food, and both were low. In SSA, some portions of the Southern, South direction of the Western and Central regions have a lower weight of all bad conditions than others, although children continue to suffer in considerable numbers in all disadvantage circumstances. Children under the age of 1 year, from rural areas, uneducated families, and low income were all disadvantaged by both feeding techniques. To improve child nutrition status, multisectoral collaboration is essential. This framework allows for the tracking, planning, and implementation of nutritional treatments.

Food Sources of Fiber and Micronutrients of Concern in Infants and Children in the United Arab Emirates: Findings from the Feeding Infants and Toddlers Study (FITS) and the Kids Nutrition and Health Survey (KNHS) 2020

We estimated the usual intakes of fiber, iron, zinc, calcium, folate, vitamin D, and vitamin A and the top foods that contribute to them among children in the UAE. Dietary intake was assessed using 24 h recalls among 5 age groups of infants and children. Foods were clustered into 54 food groups and ranked by their percentage contribution to the nutrients of interest in this study. The percentage achieving the adequate intake (AI) of fiber was negligible among all children. The top source of fiber was vegetables among children under 4 years, and white breads among those over 4 years. Only 45% of infants achieved iron adequacy, but iron standards were met by most children beyond the age of 1. The main contributors to iron intake were infant/young child formula and baby cereal in children under 4 years, while children over 4 years obtained it primarily from grains (fortified) and meat/fish. Vitamin D was inadequate across all age groups, with the percentage achieving adequacy ranging from 0 to 19% among pre-adolescents and toddlers, respectively. The top sources of vitamin D were fortified milks. Overall, nutrient inadequacies in fiber, calcium, and vitamin D highlight the need for greater intakes of whole grains and fortified dairy products in the UAE.

Total Usual Nutrient Intakes and Nutritional Status of United Arab Emirates Children (<4 Years): Findings from the Feeding Infants and Toddlers Study (FITS) 2021

Background

The transition from a predominantly milk-based diet to a diverse family diet is a window of opportunity for optimal child growth and development.

Objectives

The study aims to examine the nutritional status and food-consumption patterns of children under 4 y of age in the United Arab Emirates (UAE) and their adherence to nutrient and dietary recommendations.

Methods

A population-based cross-sectional survey of 525 children aged 0-47.9 mo was conducted in 3 major emirates: Abu Dhabi, Dubai, and Sharjah. Anthropometric measurements were obtained, and dietary assessment was conducted using the 24-h dietary recall approach. Usual intakes of energy, macronutrient, and micronutrients, including from supplements, were assessed using PC-SIDE software. Adherence to food-group recommendations was evaluated based on the American Heart Association/American Academy of Pediatrics dietary guidelines.

Results

Among 0-4-y-old children, 10% were stunted, 6% were wasted, 17% were at risk of overweight, 5% were overweight, and 3% were obese. The contribution of sweets and sugar sweetened beverages to energy intake increased from 5% in 6-11.9-mo-old children to 17% in 36-47.9-mo-old children. Compared with dietary guidelines, the lowest adherence was for fruit (13-18%) and vegetables (7-12%), while protein was within the recommendations, and 92% and 89% of children (aged 24 to 35.9 mo and 36 to 47.9 mo, respectively) had high intakes of saturated fat. Almost all toddlers failed to meet the Adequate Intake for fiber. The proportions of children exceeding the free-sugar upper limit increased from 10.6% in infants (0-5.9 mo) to 56.7% in toddlers (12- 23.9 mo). Micronutrient inadequacies were observed, particularly for calcium, zinc, folate, and vitamins A and D.

Conclusions

This study suggests a triple burden of malnutrition among infants and young children in the UAE. Results call for national nutrition intervention strategies aimed at improving dietary quality in the pediatric population.

The Relationship between Breastfeeding and Initial Vegetable Introduction with Vegetable Consumption in a National Cohort of Children Ages 1–5 Years from Low-Income Households

Compared to other food groups, vegetable intakes are lowest relative to recommendations. Breastfeeding and initial introduction to vegetables may help infants establish long-lasting taste preferences. We examined the relationship between breastfeeding and initial vegetable introduction and vegetable intake in early childhood (ages 13–60 months). This repeated cross-sectional study used data from the national WIC Infant and Toddler Feeding Practices Study-2 collected from low-income mother/caregivers about infants from around birth through age 5 (60 months; n = 3773). Survey-weighted adjusted regression models assessed associations between breastfeeding and vegetable introduction measures with vegetable consumption at child ages 13, 24, 36, 48, and 60 months. Longer breastfeeding duration was associated with a slightly, but significantly, greater variety of vegetables consumed/day in early childhood. There was also a small but positive statistically significant association between the number of different types of vegetables consumed on a given day at 9 months and the amount and variety of vegetables consumed/day in early childhood. Age of initial vegetables introduction and whether vegetables were the first/second food introduced were not consistently related to the amount or variety of vegetables consumed later in childhood. Longer breastfeeding and introduction to a greater variety of vegetables at 9 months may be behaviors to target to increase consumption of a greater variety of vegetables by young children.

Weekday and Weekend Differences in Eating Habits, Physical Activity and Screen Time Behavior among a Sample of Primary School Children: The "Seven Days for My Health" Project

BACKGROUND

Healthy eating and active lifestyle habits are essential for a child's development, wellbeing, and health. School setting and family environment play a crucial role in shaping these habits and this could be reflected in different behavior patterns during weekdays and weekends.

METHODS

We investigated primary school children's lifestyle habits through a cross-sectional analysis of 428 Italian primary school children, with a mean age of 8.99 years (±1.43). Data were collected from May to June 2017 using a weekly diary to assess children's lifestyles.

RESULTS

Children who eat their morning snack and lunch at school three or more times during the weekdays were 5.47 times more likely (95% CI 3.02, 10.2) to consume adequate snacks and 7.79 times more likely (95% CI 4.43, 14.5) to have adequate meals than those who did not.

CONCLUSION

Consumption of vegetables, lunch, and snacks are significantly more adequate during the weekdays as compared to the weekends. Physical activity levels did not differ between weekdays and weekends. Moreover, children spent more time engaged in physical activities than in front of a screen during both the weekdays and the weekends. The present results are good indicators of the importance of the school canteen in defining correct eating habits. Family-based and school-based interventions could represent valuable integrative strategies for promoting a healthy lifestyle in children.

Frequency of sweet and salty snack food consumption is associated with higher intakes of overconsumed nutrients and weight-for-length z-scores during infancy and toddlerhood

BACKGROUND

Current dietary guidelines recommend avoiding foods and beverages with added sugars and higher sodium before age 2 years.

OBJECTIVE

The aim was to describe daily snack food intake (frequency and total energy) and the associations with overconsumed nutrients (added sugars, sodium, and saturated fats) and child weight-for-length z scores.

DESIGN

A cross-sectional, secondary analysis of baseline data from an ongoing longitudinal intervention was conducted.

PARTICIPANTS AND SETTING

A sample of 141 caregivers with infants (aged 9 to 11 months) and toddlers (aged 12 to 15 months) was recruited in Buffalo, NY, between 2017 and 2019.

MAIN OUTCOME MEASURES

Three 24-hour dietary recalls were used to categorize 'sweet and salty snack foods' or 'commercial baby snack foods' based on the US Department of Agriculture What We Eat in America food group classifications and estimate nutrient intakes. Child recumbent length and weight were measured by trained researchers.

STATISTICAL ANALYSIS

Daily frequency (times/day), energy (kcal/day), and overconsumed nutrients from snack food intake were calculated. Multivariable regression models examined associations between the frequency of and energy from snack food intake with overconsumed nutrients and child weight-for-length z scores.

RESULTS

Infants consumed snack foods on average 1.2 times/day contributing 5.6% of total daily energy, 19.6% of added sugars, and 6.8% of sodium. Toddlers consumed snack foods on average 1.4 times/day contributing 8.9% of total daily energy, 40.0% of added sugars, and 7.2% of sodium. In adjusted models including all children, greater frequency of sweet and salty snack food intake, but not commercial baby snack foods, was associated with higher weight-for-length z scores.

CONCLUSIONS

Snack foods are frequently consumed by infants and toddlers and contribute to the intake of overconsumed nutrients such as added sugars and sodium. Given the current guidelines to avoid added sugars and higher sodium before age 2 years, additional recommendations related to nutrient-dense snack intake may be beneficial.

Caregiver Perspectives on Underutilization of WIC: A Qualitative Study

OBJECTIVES

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal program that improves the health of low-income women (pregnant and postpartum) and children up to 5 years of age in the United States. However, participation is suboptimal. We explored reasons for incomplete redemption of benefits and early dropout from WIC.

METHODS

In 2020-2021, we conducted semistructured interviews to explore factors that influenced WIC program utilization among current WIC caregivers (n = 20) and caregivers choosing to leave while still eligible (n = 17) in Massachusetts. By using a deductive analytic approach, we developed a codebook grounded in the Consolidated Framework for Implementation Research.

RESULTS

Themes across both current and early-leaving participants included positive feelings about social support from the WIC clinic staff and savings offered through the food package. Participants described reduced satisfaction related to insufficient funds for fruits and vegetables, food benefits inflexibility, concerns about in-clinic health tests, and in-store item mislabeling. Participants described how electronic benefit transfer cards and smartphone apps eased the use of benefits and reduced stigma during shopping. Some participants attributed leaving early to a belief that they were taking benefits from others.

CONCLUSIONS

Current and early-leaving participants shared positive WIC experiences, but barriers to full participation exist. Food package modification may lead to improved redemption and retention, including increasing the cash value benefit for fruits and vegetables and diversifying food options. Research is needed regarding the misperception that participation means "taking" benefits away from someone else in need.

Grandparent Coresidence and Risk of Early Child Overweight and Obesity in Low-Income, Hispanic Families in New York City

OBJECTIVE

Children in low-income Hispanic families are at high risk of obesity and are more likely to live with grandparents than their non-Hispanic white counterparts. We aimed to determine if grandparent coresidence (prenatal through age 2 years) was associated with: 1) obesogenic feeding practices; and 2) child weight outcomes from birth to three years.

METHODS

We analyzed data from 267 low-income, Hispanic mother-infant pairs in the control group of an obesity prevention trial in New York City. Linear and logistic regression tested differences in obesogenic feeding practices and weight outcomes at 2 and 3 years, dependent upon grandparent coresidence. Multilevel modeling tested associations between grandparent coresidence and WFAz over time.

RESULTS

Persistent grandparent coresidence (vs none) was associated with putting cereal in the bottle (adjusted odds ratio [aOR] 3.46; 95% confidence interval [CI] 1.43, 8.40). Persistent grandparent coresidence (vs none) was associated with higher mean WFAz (2 years: B 0.83; 95% CI 0.41, 1.25; 3 years: B 0.79; 95% CI 0.32, 1.25) and higher odds of child overweight/obesity risk (2 years: aOR 4.38; 95% CI 1.64, 11.69; 3 years: aOR 3.15; 95% CI 1.19, 8.36). In multilevel models, more occasions of grandparent coresidence were associated with higher WFAz.

CONCLUSIONS

Grandparent coresidence may be associated with higher risk of child overweight/obesity in low-income, Hispanic families. Further research is needed to elucidate mechanisms of these associations and to inform obesity prevention strategies in the context of multigenerational families.

Food Preparation Practices for Infants Aged From 7 to 13 Months

OBJECTIVE

To examine infant food preparation practices at age 7, 9, 11, and 13 months overall and by sociodemographic characteristics.

DESIGN

Data from a longitudinal study from the US Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study-2 (ITFPS-2) were used.

PARTICIPANTS

A sample of 1,904 infants (970 males and 934 females) enrolled in WIC who had been introduced to solid foods and were consuming food prepared at home.

MAIN OUTCOME MEASURES

Food preparation practices included pureeing, mashing, chopping/dicing, and prechewing. Estimates were provided overall and by sociodemographics.

ANALYSIS

Prevalence estimates were calculated for each survey month overall and by sociodemographics. Chi-square tests for independence were used to test for differences.

RESULTS

Food preparation practices changed as infants aged. Pureeing and mashing were common in month 7 (57.8% and 59.6%, respectively), but chopping/dicing were the most prevalent by month 13 (85.4%). Food preparation practices did not vary by education status, but statistical differences were consistently observed by race and ethnicity and inconsistently observed by maternal age at birth.

CONCLUSIONS AND IMPLICATIONS

Exposing children to a range of food textures at an appropriate age is important for developmental progress. Continued culturally relevant efforts by WIC educators and health care providers can emphasize the importance of early experiences with food textures.

Selection and use of vegetable parenting practices did not vary by parent feeding styles: Mixed methods investigation

Parents influence their child's vegetable intake through their feeding style, i.e. the emotional tone established around feeding, and vegetable parenting practices (VPPs), i.e. the specific behaviors employed to influence their child's vegetable intake. A model of precision food parenting proposes that child healthy dietary intake could be optimized by the selection and implementation of effective food parenting practices. Parents use and learn from these complex interactions with their child, which are reflective of feeding style. Intervention research has targeted VPPs in general without a delineation of which practices were selected, which were used, or why they were selected. It is not clear how these users were influenced by feeding style, nor what the parent learned from the interaction. The current study used mixed methods wherein middle socioeconomic status parents of 3-5 year old children were categorized within feeding style groups (n = 122), asked to select two VPPs, implemented them for a week (n = 63), and qualitatively interviewed about their experience. Responsiveness VPPs were most commonly selected, primarily due to their perceived ease of implementation. Parents believed there would be long term positive outcomes, e.g. more vegetable intake from using the practices selected. Frequency of use depended in part on opportunity, e.g. food purchase parenting practices could only be employed during intermittent shopping events. Few differences were detected by parent feeding styles in the types of VPPs selected, frequency of use, or effectiveness. Food parenting interventions can encourage selection of specific VPPs to employ and do not appear to have to tailor the types of VPPs offered to parent feeding style. Research is needed with larger, socioeconomically diverse samples to assess optimal categorization into feeding styles and confirm the present results.

Okra (Abelmoschus esculentus) in a refugee context in East Africa: Kitchen gardening helps with mineral provision

Kitchen gardening is considered a way to reconnect with agriculture and complement the cereal-based relief food offered to refugees in East Africa. This work aimed at profiling mineral content of okra in four refugee camps and settlements located in Ethiopia and Uganda and its contribution to adequate intake (AIs) or recommended dietary allowances (RDAs) for young children and pregnant and lactating women (PLW). The study also evaluated the applicability of portable X-ray fluorescence (PXRF) as compared with inductively coupled plasma mass spectrometry (ICP-MS) for mineral profiling of okra powder samples. The contents of minerals (mg kg-1) from the ICP-MS readings were in the following ranges: K (14,385-33,294), Ca (2610-14,090), P (3178-13,248), Mg (3896-7986), Cu (3.81-19.3), Fe (75.7-1243), Zn (33-141) and Mn (23.1-261). Regardless of geographic origin, at low-end consumption probability (17 g day-1 for young children and 68 g day-1 for PLW), okra could contribute ˂ 15% (2.7-12.9%) AI for macro-minerals (K and Ca). In addition, the contributions to RDA values for Fe and Zn, elements of known public health interest, ranged from 4.5 to 34.7% for young children. Interestingly, regression lines revealed strong agreement between ICP-MS and PXRF readings for Mn and Zn, with R2 values > 0.91. This information is useful in support of nutrition-sensitive kitchen gardening programs through scaling culturally important crops in refugee settings.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s42452-021-04898-6.

A Structural Equation Modelling Approach to Examine the Relationship between Socioeconomic Status, Diet Quality and Dyslipidaemia in South African Children and Adolescents, 6-18 Years

This study utilised a structural equation model to examine the relationship between diet quality, socioeconomic status, and cardiovascular disease (CVD) risk in South African learners. Confirmatory factor analysis was used to test the indirect effects model for diet, socioeconomic status, diet quality and cardiovascular risk using pre-existing cross-sectional data. The structural equation model was fit using Lavaan version 0.6-5 in R version 3.6.1. Data were analysed from 178 children and adolescents, aged 6-18 years, from five rural schools in Cofimvaba, South Africa. Latent variables were created for dietary quality, dyslipidaemia and the socioeconomic status of participants. A negative association was observed between socioeconomic status and dyslipidaemia in school-aged children (p = 0.029).

The Perspective of Nectarine Fruit as a Sugar Substituent in Puddings Prepared with Corn and Rice Starch

It has been long recognized that fruits are healthy diet compounds as they are excellent sources of health-beneficial bioactive components (polyphenols, minerals, vitamins, organic acids, etc.). The diversification of the consumer’s taste calls for an expansion of food options and novel ingredients. Puddings are a well-known food choice introduced in the human diet at a very early age because of their easy and high digestion. Four formulations with two types of starch (corn and rice) were selected as object of analysis. Nectarines were incorporated as a purée, and lyophilized powder. The nectarine variety “Gergana”, used for the preparations, is a local variety with proven beneficial properties. The study aimed at analyzing the physical (moisture, ash, color, water-holding capacity, water activity, density and syneresis), textural (firmness, gumminess, cohesiveness, springiness, and chewiness), nutritional, and sensory characteristics of the nectarine-enriched puddings. The outcomes obtained from this study provided significant information about the possible application of the formulations in the children’s daily menus. All four formulations had distinct peachy aroma. The formulations prepared with nectarine purée resulted in a better sensory perception about their texture, and better water-holding capacity. At this point, the formulation prepared with lyophilized fruit and rice starch has the most promising results. Sufficient evidence leads to further exploration of the perspective of fruit-enriched puddings in order to improve their technological and health-promoting properties.

Maternal feeding practices and toddlers' fruit and vegetable consumption: results from the DIT-Coombe Hospital birth cohort in Ireland

Background

Health benefits of fruit and vegetable have been well recognized. However, insufficient consumption of fruit and vegetable is prevalent among toddlers, and has become a global public health issue. Maternal feeding practices are potential factors influencing toddlers’ dietary intake, including fruit and vegetable intake. This study was conducted to explore the influence of maternal feeding practices on toddlers’ fruit and vegetable consumption in Ireland.

Methods

A follow-up to the DIT-Coombe Hospital birth cohort was conducted. Mothers in the original cohort were invited to participate in the present follow-up study by phone. A questionnaire assessing maternal feeding behavior and the child’s 3-day food diary was sent to mothers who agreed to take part in the present study by post, together with a self-addressed stamped envelope.

Results

There were 193 mother-children pairs included in the analysis, and the mean age of children was 2.4 (SD 0.7) years old. Toddlers’ mean daily intakes of vegetable and fruit were 67.57 (SD 45.95) g and 213.35 (SD 170.78) g, respectively. Logistic regression analyses showed that maternal practice of breastfeeding for more than 4 weeks was positively associated with fruit (OR = 2.93, 95% CI: 1.29–6.64) and vegetable (OR = 1.95, 95% CI: 1.00–3.81) intake or the contribution of fruit (OR = 2.62, 95% CI: 1.19–5.80) and vegetable (OR = 2.02, 95% CI: 1.02–3.99) to the total diet. Letting the child eat with other family members was associated with high vegetable intake (OR = 5.45, 95%CI: 1.69–17.61) and high contribution of vegetable to total diet (OR = 3.78, 95% CI: 1.04–13.82). Not being too worried about the child’s refusal to eat was positively associated with toddlers’ vegetable intake (OR = 2.10, 95%CI: 1.09–4.05).

Conclusions

To increase children’s fruit and vegetable intake, and develop good eating habits, parents should eat with their toddlers, be patient and not put much pressure on their children in the context of meal feeding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-021-00743-z.

The impact of maternal post-partum depressive symptoms on child diet at 18 months

Post-partum depression (PPD) is a serious mental health problem, which can impair maternal behaviours and adversely affect the cognitive, emotional and behavioural development of children. This study aims to explore the impact of maternal depressive symptoms at 3 months post-partum (baseline) on child diet at 18 months of age (follow-up). This study used longitudinal data from 263 first-time mothers from the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT) Extend. Women self-reported depressive symptoms (10-item Center for Epidemiological Studies Depression Scale [CES-D]) and child diet (fruits, vegetables and discretionary foods). Multiple linear regression analyses were used to explore the relationship between maternal depressive symptoms at baseline and child fruit and vegetable intake and discretionary food intake (g day-1 ) at follow-up. Baseline maternal depressive symptoms were associated with higher childhood consumption of discretionary foods at 18 months of age (β = 0.45, 95% confidence interval [CI] 0.03 to 0.87, P = 0.034 [adjusted]). There was no evidence of association for maternal depressive symptoms and child intake of fruits and vegetables. Further longitudinal studies are warranted to confirm these findings, with the hope of translating this knowledge into optimal clinic care and improved physical and mental health for mother and child.

Methodological aspects of the assessment of dietary intake in the Brazilian National Survey on Child Nutrition (ENANI-2019): a population-based household survey

This manuscript aims to describe the methodological, operational, and quality control aspects of the assessment of dietary intake in children under five years of age participating in the Brazilian National Survey on Child Nutrition (ENANI-2019), a household survey in a probability sample of Brazilian households. Two instruments were developed to assess child feeding practices - a structured, current status-type questionnaire and a 24-hour dietary recall (24HR), both installed in a mobile data collection device used by previously trained interviewers. A Photographic Manual for Quantification of Children's Dietary Intake was specifically developed for and used in the survey as a support aid to identify and quantify foods reported in the 24HR. During the fieldwork, continuous quality control of the records was performed. Data errors or incomplete data in the system were corrected, and the fieldwork team was systematically contacted and informed on their performance, with reiterated orientation on data collection. All children in the sample were evaluated with the two instruments, but data were obtained from the structured questionnaire on all children in the sample (n = 14,558) and 24HR on 14,541 children. ENANI-2019 developed innovative methods and materials based on the Brazilian and international literature to address knowledge gaps on under-five children's dietary intake. Unprecedented results will be produced, which will allow updating food and nutrition guidelines for children under five years of age in Brazil.

Predictors of Age at Juice Introduction and Associations with Subsequent Beverage Intake in Early and Middle Childhood

BACKGROUND

The American Academy of Pediatrics recommends that if parents choose to introduce juice, they wait until ≥12 months, citing concerns of obesity and dental caries.

OBJECTIVES

We sought to identify correlates of early juice introduction (<6 months) and determine whether early introduction establishes a pattern of sugary beverage intake in childhood.

METHODS

Upstate KIDS is a prospective birth cohort study with follow-up through 7 years (n = 4989). The age of juice introduction was assessed from responses on periodic questionnaires from 4-18 months and categorized as <6,  6 to <12, and ≥12 months. Sociodemographic information was reported using vital records or maternal questionnaires. At 24, 30, and 36 months and 7 years, mothers reported their child's regular juice, soda, water, and milk intakes. The analysis was restricted to singletons and 1 randomly selected twin from each pair with information on juice introduction (n = 4067). We assessed associations of sociodemographic correlates with juice introduction using Cox proportional hazard models. The relations of juice introduction with beverage intake were evaluated using Poisson or logistic regression for adjusted risk ratios (aRR) or ORs, adjusting for sociodemographic covariates and total beverage intake.

RESULTS

Of the mothers, 25% and 74% introduced juice prior to 6 and 12 months, respectively. Younger maternal age; black or Hispanic race/ethnicity; lower educational attainment; Special Supplemental Nutrition Program for Women, Infants, and Children participation (yes); smoking during pregnancy; a higher pre-pregnancy BMI; a lower household income; and living in a townhouse/condominium or mobile home were associated with earlier juice introduction. Earlier juice introduction was related to a higher childhood juice intake, any soda intake, and lower water intake, holding total beverage intake constant [aRR, 1.5 (95% CI: 1.3-1.7; P-trend < 0.0001); adjusted OR 1.6 (95% CI: 1.0-2.4; P-trend = 0.01); aRR 0.9 (95% CI: 0.8-0.9; P-trend < 0.0001), respectively].

CONCLUSIONS

Markers of lower socioeconomic status are strongly associated with earlier juice introduction, which, in turn, relates to sugary beverage intake in childhood, potentially replacing water.

Perspectives on Fruit and Vegetable Consumption and Government Dietary Guidelines: Content Analysis of Comments on News Websites

BACKGROUND

News websites are an essential source of medical news for the public. Many websites offer users the opportunity to leave comments, which may provide rich insights into public perspectives on health issues. With an established role in public health, fruit and vegetable (FV) consumption is central to the government's dietary guidelines. However, FV intake continues to fall short of government recommendations.

OBJECTIVE

Using comments from news websites, this study aims to explore public perspectives on FV intake and related government dietary guidelines.

METHODS

Data comprised 2696 web user comments generated in response to substantial media coverage for a meta-analysis examining FV consumption and the risk of all-cause mortality, cardiovascular disease, and total cancer. Using an inductive thematic approach, the data were analyzed and coded in an iterative process.

RESULTS

Four overarching themes emerged: personal factors, rejection, lack of knowledge, and food landscape, each with component subthemes. The lack of clarity around government dietary health guidelines was apparent, and this, along with emergent personal factors, may hinder better consumption. Rejection was also evident, as was a quality versus quantity of life debate.

CONCLUSIONS

There are gaps in the public's understanding of government guidelines, which may act as a constraint to better compliance. Further work should examine this issue and rejection and the possibility of public fatigue related to dietary health information and news. Similarly, future work should also explore targeted interventions with a specific emphasis on health literacy.

Development and Application of a Total Diet Quality Index for Toddlers

For the first time, the 2020-2025 Dietary Guidelines for Americans include recommendations for infants and toddlers under 2 years old. We aimed to create a diet quality index based on a scoring system for ages 12 to 23.9 months, the Toddler Diet Quality Index (DQI), and evaluate its construct validity using 24 h dietary recall data collected from a national sample of children from the Feeding Infants and Toddlers Study (FITS) 2016. The mean (standard error) Toddler DQI was 49 (0.6) out of 100 possible points, indicating room for improvement. Toddlers under-consumed seafood, greens and beans, and plant proteins and over-consumed refined grains and added sugars. Toddler DQI scores were higher among children who were ever breastfed, lived in households with higher incomes, and who were Hispanic. The Toddler DQI performed as expected and offers a measurement tool to assess the dietary quality of young children in accordance with federal nutrition guidelines. This is important for providing guidance that can be used to inform public health nutrition policies, programs, and practices to improve diets of young children.

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.

Effect of a Parent-Focused eHealth Intervention on Children's Fruit, Vegetable, and Discretionary Food Intake (Food4toddlers): Randomized Controlled Trial

Background

In Western countries, children’s diets are often low in fruits and vegetables and high in discretionary foods. Diet in early life tends to track through childhood and youth and even into adulthood. Interventions should, therefore, be delivered in periods when habitual traits are established, as in toddlerhood when children adapt to their family’s diet.

Objective

In this study, we assessed the effect of the Food4toddlers eHealth intervention, which aimed to enhance toddlers’ diets by shaping their food and eating environment.

Methods

The Food4toddlers randomized controlled trial was conducted in Norway in 2017-2018. Parent-child dyads were recruited through social media. In total, 298 parents completed an online questionnaire at baseline (mean child age 10.9 months, SD 1.2). Postintervention questionnaires were completed immediately after the intervention (ie, follow-up 1; mean child age 17.8 months, SD 1.3) and 6 months after the intervention (ie, follow-up 2; mean child age 24.2 months, SD 1.9). The intervention was guided by social cognitive theory, which targets the linked relationship between the person, the behavior, and the environment. The intervention group (148/298, 49.7%) got access to the Food4toddlers website for 6 months from baseline. The website included information on diet and on how to create a healthy food and eating environment as well as activities, recipes, and collaboration opportunities. To assess intervention effects on child diet from baseline to follow-up 1 and from baseline to follow-up 2, we used generalized estimating equations and a time × group interaction term. Between-group differences in changes over time for frequency and variety of fruits and vegetables and frequency of discretionary foods were assessed.

Results

At follow-up 1, a significant time × group interaction was observed for the frequency of vegetable intake (P=.02). The difference between groups in the change from baseline to follow-up 1 was 0.46 vegetable items per day (95% CI 0.06-0.86) in favor of the intervention group. No other significant between-group differences in dietary changes from baseline to follow-up 1 or follow-up 2 were observed. However, there is a clear time trend showing that the intake of discretionary foods increases by time from less than 1 item per week at baseline to more than 4 items per week at 2 years of age (P<.001), regardless of group.

Conclusions

A positive intervention effect was observed for the frequency of vegetable intake at follow-up 1 but not at follow-up 2. No other between-group effects on diet were observed. eHealth interventions of longer duration, including reminders after the main content of the intervention has been delivered, may be needed to obtain long-terms effects, along with tailoring in a digital or a personal form.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN) 92980420; https://doi.org/10.1186/ISRCTN92980420

Assessing Diet Quality in a Racially and Ethnically Diverse Cohort of Low-income Toddlers

BACKGROUND

Low-income racially and ethnically diverse children are at higher risk for obesity compared with their counterparts; yet, few studies have assessed their diet quality.

OBJECTIVE

The aim of the study was to evaluate the diet quality of a racially and ethnically diverse cohort of 2-year-olds using the Healthy Eating Index (HEI)-2010.

METHODS

We used 24-hour dietary recall data from caregivers of toddlers (24-34 months) at 4 pediatric resident clinics that participated in the Greenlight Study to calculate compliance with the Dietary Guidelines for Americans (DGA) using total HEI score (range 0-100) and 12 component scores.

RESULTS

Participants (n = 231) were mostly Hispanic (57%) or non-Hispanic black (27%) and from low-income families. Mean HEI-2010 score was 62.8 (standard deviation [SD] 10.5). Though not significant, Hispanics had the highest HEI score. Toddlers of caregivers without obesity, older than 35 years and born outside the United States had higher HEI scores. Most had high HEI component scores for dairy, fruit, and protein foods, but few achieved maximum scores, particularly for whole grains (13%), vegetables (10%), and fatty acid ratio (7%).

CONCLUSIONS

Despite scores reflective of DGA recommendations for fruit, dairy and protein foods, toddlers in this diverse sample had low quality diets as measured by the HEI, driven largely by low component scores for whole grains, vegetables, and ratio of unsaturated to saturated fatty acids.

Associations between parental food choice motives, health-promoting feeding practices, and infants' fruit and vegetable intakes: the Food4toddlers study

Background

Parents influence their infants’ diets and are the providers of healthy foods such as fruit and vegetables. Parental motives can influence infant’s diets directly or through parental feeding practices.

Objective

This study aimed to assess the associations between parental food choice motives and infants’ fruit and vegetable intakes and to examine whether parental feeding practices mediated these associations.

Design

A total of 298 parents participated in the Norwegian Food4toddlers study. Before the child’s first birthday (mean age = 10.9 months), the parents completed an online baseline questionnaire. Five parental food choice motives were assessed: health, convenience, sensory appeal, price, and familiarity. Infants’ fruit and vegetable intakes and three health-promoting feeding practices were also assessed. For each food choice motive and its relation to fruit or vegetable intake, three single mediation models were conducted. Mediation effects were examined using MacKinnon’s product of coefficients procedure, and bootstrap confidence intervals (CIs) were used for inferential testing.

Results

Higher scores on the motive of health were positively associated with infants’ vegetable intake (τ = 0.394, P < 0.001). No other significant associations were found between food choice motives and fruit or vegetable intake. The feeding practice of shaping a healthy environment mediated the relationships between health motive and both fruit (αβ = 0.067, CI: 0.001–0.146) and vegetable (αβ = 0.105, CI: 0.042–0.186) intakes. The feeding practice of encouraging balance and variety mediated the relationships between health motive and vegetable (αβ = 0.085, CI: 0.030–0.150) intake and between sensory appeal motive and vegetable intake (αβ = 0.047, CI: 0.005–0.103).

Conclusion

High levels of parental health motive are associated with higher infant vegetable intake. Our study contributes to understand the structure of parental feeding behaviors that may have implication for nutrition interventions targeting parents.

Financial Incentives Increase Purchases Of Fruit And Vegetables Among Lower-Income Households With Children

The high cost of fruit and vegetables can be a barrier to healthy eating, particularly among lower-income households with children. We examined the effects of a financial incentive on purchases at a single supermarket by primary shoppers from low-income households who had at least one child. Participation in an in-store Cooking Matters event was requested for incentivized subjects but optional for their nonincentivized controls. The sample included but was not limited to Supplemental Nutrition Assistance Program participants. Compared to the controls, incentivized shoppers-who were given an immediate 50 percent discount on qualifying fruit and vegetables-increased weekly spending on those items by 27 percent; this change was for fresh produce. There was no change in purchases of frozen and canned produce or unhealthful foods. Estimated annual average daily consumption of fruit and vegetables by the incentivized shoppers and by one designated child per incentivized household did not change. Attendance at Cooking Matters events was low. These findings support financial incentive programs to increase fruit and vegetable purchasing but suggest that effective complementary approaches are needed to improve diet quality.