Diet Quality of Atlantic Families Headed by Single Mothers

Food security and diet quality in a racially diverse cohort of postpartum women in the USA

Food insecurity has been associated with poor diet, but few studies focused on the postpartum period - an important time for women's health. We examined associations between food security and diet quality in postpartum women and assessed whether participation in federal food assistance programmes modified this potential relation. Using longitudinal data, we analysed the association between food security at 3 months postpartum and a modified Alternate Healthy Eating Index-2010 (AHEI) at 6 months postpartum (excluding alcohol). We conducted multivariable linear regressions examining associations between food security and AHEI. We assessed two food assistance programmes as potential effect modifiers. The sample included 363 postpartum women from the Nurture study, located in the Southeastern USA (2013-2017). Among women, 64·4 % were Black and 45·7 % had a high school diploma or less. We found no evidence of an interaction between food security and two federal food assistance programmes. In adjusted models, marginal, low and very low food security were not associated with AHEI. However, low (β: -0·64; 95 % CI -1·15, -0·13; P = 0·01) and very low (β: -0·57; 95 % CI -1·02, -0·13; P = 0·01) food security were associated with greater trans fat intake. Food security status was not associated with overall diet quality but was associated with higher trans fat (low and very low) and more moderate alcohol (marginal) intake. Future studies should assess the consistency and generalisability of these findings.

Study protocol for CELLAR (COVID-related Eating Limitations and Latent dietary effects in the Atlantic Region): population-based observational study to monitor dietary intakes and purchasing during COVID-19 in four Atlantic Canadian provinces

INTRODUCTION

Poor diet is a leading preventable risk for the global burden of non-communicable disease. Robust measurement is needed to determine the effect of COVID-19 on dietary intakes and consumer purchasing, given the widespread changes to consumer food environments and economic precarity. The research objectives are as follows: (1) describe dietary intakes of foods, beverages and nutrients of concern during the COVID-19 pandemic; (2) quantify change in diet during COVID-19 as compared with prepandemic, previously captured in the provincial samples of the population-representative 2015 Canadian Community Health Survey-Nutrition and (3) examine how household purchasing practices predict dietary intakes during COVID-19.

METHODS AND ANALYSES

Observational study of diet, using a population-based stratified probability sampling strategy allocated via dual-frame (landline and cellphone) calls to random-digit dialled numbers, followed by age-sex group quotas. The base population comprises the four provinces of the Atlantic region of Canada, jurisdictions with an excess burden of pre-existing dietary risk, compared with the rest of Canada. Our aim is n=1000 to obtain reliable estimates at a regional level to describe intakes and compare with prepandemic baseline. Data collection entails 12 weeks participation: (1) enrolment with sociodemographics (key dietary risk predictors such as age, sex, gender, pre-COVID-19 income, employment, household composition, receipt of economic relief, rural residence); (2) two 24hour diet recalls using the online ASA-24 Canada 2018 tool; and (3) online uploads of household food purchase receipts over the 12 weeks enrolled. Participation incentives will be offered.

ETHICS AND DISSEMINATION

This research protocol received funding from the Canadian Institutes of Health Research (FRN VR5 172691) and ethics review approval from the Dalhousie University Research Ethics Board. Study protocol and instruments and a de-identified dataset will be made publicly available. We will submit the findings to peer-reviewed journals, as well as conferences geared towards scientific and decision-maker audiences.

The relationship between diet quality and the severity of household food insecurity in Canada

OBJECTIVE

To examine the relationship between the dietary quality of Canadian children and adults and household food insecurity status.

DESIGN

Dietary intake was assessed with one 24-h recall. Households were classified as food secure or marginally, moderately or severely food insecure based on their responses to the Household Food Security Survey Module. We applied multivariable analyses of variance to determine whether % energy from ultra-processed foods, fruit and vegetable intake, Healthy Eating Index (HEI) scores, macronutrient composition and micronutrient intakes per 1000 kcal differed by food insecurity status after accounting for income, education and region. Analyses were run separately for children 1-8 years and 9-18 years and men and women 19-64 years of age.

SETTING

Ten provinces in Canada.

PARTICIPANTS

Respondents to the 2015 Canadian Community Health Survey-Nutrition, aged 1-64 years, with complete food insecurity data and non-zero energy intakes, N 15 909.

RESULTS

Among adults and children, % energy from ultra-processed foods was strongly related to severity of food insecurity, but no significant trend was observed for fruit and vegetable intake or HEI score. Carbohydrate, total sugar, fat and saturated fat intake/1000 kcal did not differ by food insecurity status, but there was a significant negative trend in protein/1000 kcal among older children, a positive trend in Na/1000 kcal among younger children and inverse associations between food insecurity severity and several micronutrients/1000 kcal among adults and older children.

CONCLUSIONS

With more severe household food insecurity, ultra-processed food consumption was higher, and diet quality was generally lower among both adults and children.

Methodological Aspects of Diet Quality Indicators in Childhood: A Mapping Review

Diet quality indicators (DQIns) are tools that aim to assess an individual's overall diet quality. Previous reviews focused mainly on health-related outcomes but did not provide detailed information about components, assessment variables, or important methodological issues for the development and application of DQIns in the pediatric age. The current mapping review aims to provide comprehensive guidance regarding DQIns developed through a priori methodology in children aged ≤14 y that have been applied worldwide. A mapping review was conducted, whereby 1665 original articles describing the development, modifications, and updates of DQIns, published up to June 26, 2020, in English and Spanish, were retrieved. A total of 139 articles were identified and classified into 13 subgroups. There were 10 overall DQIns: Healthy Eating Indexes (n = 25), Dietary Diversity Scores (n = 20), Diet Quality Indexes (n = 16), Food Variety Scores (n = 11), Healthy and Unhealthy Scores (n = 11), Feeding and Eating Indexes (n = 10), Diet Quality Scores (n = 5), Nutritional Adequacy and Micronutrients Indexes (n = 5), Dietary Guidelines Indexes (n = 5), and Other Healthy Diet Indexes (n = 13). Three additional subgroups of dietary and lifestyle indicators found were Mediterranean Diet Indexes (n = 10), Diet-Lifestyle Indexes (n = 5), and Breakfast Quality Indexes (n = 3). This compilation of DQIns will help researchers select the most appropriate tool for future epidemiological studies by considering a careful selection of information about the assessment components, scoring methods, and key methodological issues. The main limitations of this review are that, due to its nature, a risk-of-bias assessment was not performed and the article screening was completed in 2 databases (PubMed/MEDLINE and Scopus). More research is needed to identify health-related outcomes associated with DQIns in the pediatric population, using clearer and more standardized methodological criteria.

Indexes to assess feeding practices of children under 2 years old: a systematic review

OBJECTIVE

To systematically review studies that used indexes to assess feeding practices of children under 2 years.

DESIGN

Seven databases were searched with no limit on language or publication date.

SETTING

The reviewed studies included thirteen Asian, ten Latin American, four European, four North American, three Oceanian and three African.

PARTICIPANTS

Children under 2 years.

RESULTS

We analysed thirty-six studies: twenty-two presenting original indexes and fourteen using adapted indexes. Among the original indexes, thirteen assess breast-feeding, fourteen food consumption, ten food groups, and ten other feeding practices. Original indexes were mainly adapted to fit the data available in the study, to update for current nutritional recommendations or to add components not present in the original indexes. Seven studies evaluated the associations between the indexes and nutrient intake or nutritional status. The main limitations cited by the authors were: flaws in the definition of the index components, criteria for cut-off points and weighting of the evaluated index components.

CONCLUSIONS

The assessment of feeding practices for young children and its comparison across countries remains a challenge, especially due to the lack of consensus on the construction of indexes and regional differences in dietary recommendations and practices. Lack of validation for some indexes also makes it difficult to choose the most appropriate index for a given objective. Adapting existing indexes is a viable option. We point out relevant recommendations that may contribute to future research. Validation and longitudinal studies in diverse populations are favourable to qualify the assessment of feeding practices in this group.

Diet quality indices and their associations with health-related outcomes in children and adolescents: an updated systematic review

BACKGROUND

To describe a-priori diet quality indices used in children and adolescents, appraise the validity and reliability of these indices, and synthesise evidence on the relationship between diet quality and physical and mental health, and growth-related outcomes.

METHODS

Five electronic databases were searched until January 2019. An a-priori diet quality index was included if it applied a scoring structure to rate child or adolescent (aged 0-18-years) dietary intakes relative to dietary or nutrient guidelines. Diagnostic accuracy studies and prospective cohort studies reporting health outcomes were appraised using the Academy of Nutrition and Dietetics Quality Criteria Checklist.

RESULTS

From 15,577 records screened, 128 unique paediatric diet quality indices were identified from 33 countries. Half of the indices' scores rated both food and nutrient intakes (n = 65 indices). Some indices were age specific: infant (< 24-months; n = 8 indices), child (2-12-years; n = 16), adolescent (13-18 years; n = 8), and child/adolescent (n = 14). Thirty-seven indices evaluated for validity and/or reliability. Eleven of the 15 indices which investigated associations with prospective health outcomes reported significant results, such as improved IQ, quality of life, blood pressure, body composition, and prevalence of metabolic syndrome.

CONCLUSIONS

Research utilising diet quality indices in paediatric populations is rapidly expanding internationally. However, few indices have been evaluated for validity, reliability, or association with health outcomes. Further research is needed to determine the validity, reliability, and association with health of frequently utilised diet quality indices to ensure data generated by an index is useful, applicable, and relevant.

REGISTRATION

PROSPERO number: CRD42018107630 .

Relationship of food insecurity to women's dietary outcomes: a systematic review

Context

Food insecurity matters for women's nutrition and health.

Objective

This review sought to comprehensively evaluate how food insecurity relates to a full range of dietary outcomes (food groups, total energy, macronutrients, micronutrients, and overall dietary quality) among adult women living in Canada and the United States.

Data sources

Peer-reviewed databases (PubMed/MEDLINE, CINAHL, Scopus, Web of Science) and gray literature sources from 1995 to 2016 were searched.

Data extraction

Observational studies were used to calculate a percentage difference in dietary intake for food-insecure and food-secure groups.

Results

Of the 24 included studies, the majority found food-insecure women had lower food group frequencies (dairy, total fruits and vegetables, total grains, and meats/meat alternatives) and intakes of macro- and micronutrients relative to food-secure women. Methodological quality varied. Among high-quality studies, food insecurity was negatively associated with dairy, fruits and vegetables, grains, meats/meats alternatives, protein, total fat, calcium, iron, magnesium, vitamins A and C, and folate.

Conclusions

Results hold practical relevance for selecting nutritional targets in programs, particularly for nutrient-rich foods with iron and folate, which are more important for women's health.

Mother-Related Determinants of Children At-Home Fruit and Vegetable Dietary Patterns in a Polish National Sample

Fruit and vegetable intake is indicated among the features of sustainable diets, while children’s intake is strongly associated with the intake of their parents, as well as the availability of food products and their accessibility at home. The aim of the study was to analyze the mother-related determinants of children at-home fruit and vegetable dietary patterns in a Polish national sample of children aged 3–10 years. The random quota sampling (with quotas for age, education, and place of residence) was conducted to recruit the national representative sample of Polish mothers of children aged 3–10 years (n = 1200) who were interviewed using a Computer-Assisted Telephone Interviewing (CATI) method. They were asked about their children’s at-home fruit and vegetable dietary patterns, which were later compared in sub-groups that were stratified for age, educational background, marital status, place of residence, occupational status, and total net income in households. The indicated features, but not marital status, were indicated as determinants of children at-home fruit and vegetable dietary patterns. Children of younger mothers more often than others consumed fruits, whereas those of older mothers consumed vegetables. Children of mothers who had a lower level of education more commonly than others consumed fruits alone as a dish, and they had a higher preference for them, while those of mothers who had a higher level of education had a higher consumption of vegetables than others, although they had a medium preference for them. Children of mothers from villages had a lower consumption of vegetables and fruits than others, although they had a higher preference for fruits. Children of mothers with no professional job had a lower consumption of vegetables than others and more often consumed them processed, although they had a higher preference for fruits and vegetables. Children of mothers with low income had a lower consumption of vegetables than others and more often consumed fruits in a dish with other products, although they had a higher preference for fruits and vegetables. To summarize, an indication of a high preference for fruits and vegetables by mothers is not accompanied by the higher consumption and recommended dietary patterns for fruit and vegetable intake by their children. In particular, the sub-samples of mothers who had a low level of education, were from villages, did not have a professional job, and had low income may either overestimate the fruit and vegetable preference of their children or do not offer them sufficient amount of fruits and vegetables, although they indicate a higher preference. In order to encourage more sustainable diet following, in terms of the fruit and vegetable intake, it is essential to introduce actions toward the properly planned nutritional education for the indicated target groups.

Diet Quality of US Infants and Toddlers 7-24 Months Old in the WIC Infant and Toddler Feeding Practices Study-2

Background

Despite the important implications of childhood dietary intakes on lifelong eating habits and health, data are lacking on the diet quality of low-income infants and toddlers.

Objective

The objective of this study was to characterize diet quality in low-income US infants and toddlers.

Methods

A national observational study was conducted of 7- to 12-mo-old (n = 1261), 13-mo-old (n = 2515), and 24-mo-old (n = 2179) children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) prenatally/at birth from 2013 to 2016. The study used a 24-h dietary recall and survey questions. For 7- to 12-mo-olds, an adapted Complementary Feeding Utility Index (CFUI) was used, and for 13- and 24-mo-olds, the Healthy Eating Index-2015 (HEI-2015) was used. Descriptive statistics were calculated for CFUI and HEI-2015 scores.

Results

For 7- to 12-mo-olds, the CFUI score (mean ± SE) was 0.56 ± 0.003 (range: 0.34-0.90, maximum possible 1.0). Most children met CFUI standards for exposure to iron-rich cereal (86.7%), and low exposure to energy-dense nutrient-poor foods (72.2%) and teas/broths (67.5%). Conversely, at 7-12 mo of age, exposure was low for vegetables (7.0%), fruits (14.4%), any sugary drinks (14.0%), and 12-mo breastfeeding duration (23.8%). At 13 and 24 mo of age, the HEI-2015 total score (maximum possible 100), on average, was 64.0. At both 13 and 24 mo of age, participants achieved, on average, maximal HEI-2015 component scores for total and whole fruits and dairy; however, scores for total vegetables, greens and beans, whole grains, seafood and plant proteins, fatty acids, and saturated fats were relatively low. Scores for refined grains, sodium, and added sugar were lower at 24 than at 13 mo of age, representing higher consumption, on average, over time.

Conclusions

Although findings demonstrate that young children are doing well on some dietary components, there is room for improvement, especially as children age. Findings may be used to inform the Pregnancy and Birth to 24-mo (P/B-24) Project. This trial was registered at clinicaltrials.gov as NCT02031978.

The effect of child hunger on educational attainment and early childbearing outcomes in a longitudinal population sample of Canadian youth

Purpose

Early childhood experiences of poverty are associated with adverse developmental outcomes that have impli cations for individual and population health. Low educational attainment and early childbearing are two such important outcomes that can perpetuate childhood poverty into adulthood. Child hunger, or severe food insecurity, is an extreme manifestation of household food insecurity that is associated with the stressful experience of deep family poverty. Life-course theories suggest that childhood experiences of hunger could have adverse effects in the developmental pathway. The objective of this study was to examine the independent contribution of the child hunger experience to subsequent educational attainment and early childbearing in young adult men and women, in consideration of other latent, cumulative or shock effects associated with child poverty.

Methods

We analyzed National Longitudinal Survey of Children and Youth data using logistic regression based on 15,468 Canadian children followed over 16 years.

Results

The prevalence of the experience of child hunger was 5.0%. Child hunger was independently predictive of youth leaving high school, yet was not a factor in the achievement of higher educational attainment if youth were able to graduate from high school. Having always lived in rental accommodation and repeated reports of child hunger over time were predictive of early childbearing.

Conclusions

Interventions directed at children and youth who are at risk of poor developmental outcomes because of severe food insecurity should focus on steering families toward their income entitlements, and providing support for youth to complete high school and to avoid early fertility.

Addition of food group equivalents to the Canadian Diet History Questionnaire II for the estimation of the Canadian Healthy Eating Index-2005

INTRODUCTION

Poor diet quality has been shown to increase the risk of common chronic diseases that can negatively impact quality of life and burden the healthcare system. Canada's Food Guide evidence-based recommendations provide dietary guidance aimed at increasing diet quality. Compliance with Canada's Food Guide can be assessed with the Canadian Healthy Eating Index (C-HEI), a diet quality score. The recently designed Canadian Diet History Questionnaire II (C-DHQ II), a comprehensive food frequency questionnaire could be used to estimate the C-HEI in Canadian populations with the addition of food group equivalents (representing Canada's Food Guide servings) to the C-DHQ II nutrient database. We describe methods developed to augment the C-DHQ II nutrient database to estimate the C-HEI.

METHODS

Food group equivalents were created using food and nutrient data from existing published food and nutrient databases (e.g. the Canadian Community Health Survey - Cycle 2.2 Nutrition [2004]). The variables were then added to the C-DHQ II companion nutrient database. C-HEI scores were determined and descriptive analyses conducted for participants who completed the C-DHQ II in a cross-sectional Canadian study.

RESULTS

The mean (standard deviation) C-HEI score in this sample of 446 adults aged 20 to 83 was 64.4 (10.8). Women, non-smokers, and those with more than high school education had statistically significant higher C-HEI scores than men, smokers and those with high school diplomas or less.

CONCLUSION

The ability to assess C-HEI using the C-DHQ II facilitates the study of diet quality and health outcomes in Canada.

Preliminary validation and piloting of a comprehensive measure of household food security in Australia

OBJECTIVE

To investigate the psychometric properties, validity and reliability of a newly developed measure of food insecurity, the Household Food and Nutrition Security Survey (HFNSS), among an Australian population.

DESIGN

Cross-sectional study.

SETTING

Metropolitan areas of Melbourne, Australia, identified as very high, high or medium vulnerability in the 2008 Vulnerability Assessment for Mortgage, Petrol and Inflation Risks and Expenditure index.

SUBJECTS

A convenience sample of 134 adults (117 females and fifteen males, aged over 18 years).

RESULTS

Rasch modelling and factor analysis identified four items for exclusion. The remaining items yielded excellent reliability among the current sample and assessed three underlying components: the adult experience of food insecurity (component one), initial/periodic changes to children's food intakes (component two) and progressive/persistent decreases in children's food intakes (component three). Compared with the widely used US Department of Agriculture Food Security Survey Module, the HFNSS identified a significantly higher proportion of food insecurity; this is likely due to the HFNSS's identification of food insecurity due to reasons other than (and including) limited financial access.

CONCLUSIONS

The HFNSS may be a valid and reliable tool for the assessment of food insecurity among the Australian population and provides a means of assessing multiple barriers to food security beyond poor financial access (which has been identified as a limitation of other existing tools). Future research should explore the validity and reliability of the tool among a more representative sample, as well as specifically among vulnerable population subgroups.

Examining school-day dietary intakes among Canadian children

Understanding how dietary intakes vary over the course of the school day can help inform targeted school-based interventions, but little is known about the distribution or determinants of school-day dietary intakes in Canada. This study examined differences between school-hour and non–school-hour dietary intakes and assessed demographic and socioeconomic correlates of school-hour diet quality among Canadian children. Nationally representative data from the Canadian Community Health Survey were analyzed using 24-h dietary recalls falling on school days in 2004 (n = 4827). Differences in nutrient and food-group densities during and outside of school hours and differences in School Heathy Eating Index (School-HEI) scores across sociodemographic characteristics were examined using survey-weighted, linear regression models. Children reported consuming, on average, 746 kcal during school hours (one-third of their daily energy intakes). Vitamins A, D, B12, calcium, and dairy products densities were at least 20% lower during school hours compared with non-school hours. Differences in School-HEI scores were poorly explained by sociodemographic factors, although age and province of residence emerged as significant correlates. The school context provides an important opportunity to promote healthy eating, particularly among adolescents who have the poorest school-hour dietary practices. The nutritional profile of foods consumed at school could be potentially improved with increased intake of dairy products, thereby increasing intakes of protein, vitamin A, vitamin D, calcium, and magnesium.

Adapting the Healthy Eating Index 2010 for the Canadian Population: Evidence from the Canadian National Nutrition Survey

The Healthy Eating Index (HEI) is a diet quality index shown to be associated with reduced chronic disease risk. Older versions of the HEI have been adapted for Canadian populations; however, no Canadian modification of the Healthy Eating Index-2010 (HEI-2010) has been made. The aims of this study were: (a) to develop a Canadian adaptation of the HEI-2010 (i.e., Healthy Eating Index-Canada 2010 (HEI-C 2010)) by adapting the recommendations of the HEI-2010 to Canada's Food Guide (CFG) 2007; (b) to evaluate the validity and reliability of the HEI-C 2010; and (c) to examine relationships between HEI-C 2010 scores with diet quality and the likelihood of being obese. Data from 12,805 participants (≥18 years) were obtained from the Canadian Community Health Survey Cycle 2.2. Weighted multivariate logistic regression was used to test the association between compliance to the HEI-C 2010 recommendations and the likelihood of being obese, adjusting for errors in self-reported dietary data. The total mean error-corrected HEI-C 2010 score was 50.85 ± 0.35 out of 100. Principal component analysis confirmed multidimensionality of the HEI-C 2010, while Cronbach's α = 0.78 demonstrated internal reliability. Participants in the fourth quartile of the HEI-C 2010 with the healthiest diets were less likely to consume refined grains and empty calories and more likely to consume beneficial nutrients and foods (p-trend < 0.0001). Lower adherence to the index recommendations was inversely associated with the likelihood of being obese; this association strengthened after correction for measurement error (Odds Ratio: 1.41; 95% Confidence Interval: 1.17-1.71). Closer adherence to Canada's Food Guide 2007 assessed through the HEI-C 2010 was associated with improved diet quality and reductions in the likelihood of obesity when energy intake and measurement errors were taken into account. Consideration of energy requirements and energy density in future updates of Canada's Food Guide are important and necessary to ensure broader application and usability of dietary quality indexes developed based on this national nutrition guideline.

Associations between added sugar (solid vs. liquid) intakes, diet quality, and adiposity indicators in Canadian children

Little is known about the influence of different forms of added sugar intake on diet quality or their association with obesity among youth. Dietary intake was assessed by three 24-h recalls in 613 Canadian children (aged 8-10 years). Added sugars (mean of 3-day intakes) were categorized according to source (solid or liquid). Dietary intake and the Canadian Healthy Eating Index (« HEI-C ») were compared across tertiles of solid and liquid added sugars separately as were adiposity indicators (body mass index (BMI), fat mass (dual-energy X-ray absorptiometry), and waist circumference). Cross-sectional associations were examined in linear regression models adjusting for age, sex, energy intake, and physical activity (7-day accelerometer). Added sugar contributed 12% of total energy intake (204 kcal) on average, of which 78% was from solid sources. Higher consumption of added sugars from either solid or liquid source was associated with higher total energy, lower intake of micronutrients, vegetables and fruit, and lower HEI-C score. Additionally liquid sources were associated with lower intake of dairy products. A 10-g higher consumption of added sugars from liquid sources was associated with 0.4 serving/day lower of vegetables and fruit, 0.4-kg/m(2) higher BMI, a 0.5-kg higher fat mass, and a 0.9-cm higher waist circumference whereas the associations of added sugars from solid sources and adiposity indicators tended to be negative. In conclusion, higher consumption of added sugar from either solid or liquid sources was associated with lower overall diet quality. Adiposity indicators were only positively associated with added sugars from liquid sources.

Development of a Dietary Index to Assess Overall Diet Quality for Chinese School-Aged Children: The Chinese Children Dietary Index

BACKGROUND

A composite measure of diet quality is preferable to an index of nutrients, food groups, or health-promoting behaviors in dietary assessment. However, to date, such a tool for Chinese children is lacking.

OBJECTIVE

Based on the current Chinese Dietary Guidelines and Dietary Reference Intakes, a dietary index for Chinese school-aged children, the Chinese Children Dietary Index was developed to assess overall diet quality among children in South China.

DESIGN

Dietary data were recorded using 24-hour recalls among 1,719 children aged 7 to 15 years between March and June 2013. Inactivity data and sociodemographic information were also collected. The Chinese Children Dietary Index included 16 components, which incorporated nutrients, foods/food groups, and health-promoting behaviors. The range of possible Chinese Children Dietary Index scores was 0 to 160, with a higher score indicating better diet quality.

STATISTICAL ANALYSIS PERFORMED

Pearson/Spearman correlation was used to assess relative validity using correlations between total Chinese Children Dietary Index score and age, body mass index (BMI; calculated as kg/m(2)), inactivity, whole-grain intake, frequency of fried-foods intake, nutrient adequacy ratios for energy intake and 12 nutrients not included in the Chinese Children Dietary Index, and the mean adequacy ratio. Finally, a stepwise multiple regression analysis was performed to indicate the factors correlated with Chinese Children Dietary Index.

RESULTS

Mean Chinese Children Dietary Index score of this sample was 88.1 points (range=34.2 to 137.8), the Chinese Children Dietary Index score of girls was higher than that of boys and decreased with higher age. Children with higher Chinese Children Dietary Index had lower body mass index and spent less time being inactive. Positive associations were observed between Chinese Children Dietary Index and the majority of nutrient adequacy ratios and the mean adequacy ratio. Age, paternal educational level, and family size were correlated with Chinese Children Dietary Index.

CONCLUSIONS

The Chinese Children Dietary Index successfully differentiated diets and, therefore, it can be used to rank-order overall diet quality among Chinese children. As the results showed, diet quality among Chinese children needs to be improved, especially in adolescents.

Systematic review of diet quality indices and their associations with health-related outcomes in children and adolescents

BACKGROUND

Diet quality indices add an important dimension to dietary assessment. The aim of this systematic review was to: (i) identify and describe the attributes and applications of diet quality indices developed for use or used in paediatric populations; (ii) describe associations between these diet quality indices and health-related variables in paediatric populations; and (iii) identify factors that are associated with diet quality in paediatric populations worldwide.

METHODS

Studies were identified by searching electronic databases for relevant papers from 1980 to October 2013 using keywords. Inclusion criteria were original studies that utilised a quantitative measure of diet quality in children and adolescents aged 0-18 years.

RESULTS

One hundred and nineteen studies met the inclusion criteria, from which 80 different diet quality indices were identified. The majority of studies had >1000 participants and were of acceptable quality. Of the 56 studies that investigated health-related outcomes, weight status was the most researched. Europe produced the most number of diet quality indices (n = 27 indices). Of the 119 studies, seven intervention studies were identified. Paediatric diet quality indices were found to be associated with environmental, behavioural and maternal factors.

CONCLUSIONS

The use of diet quality indices in paediatric populations is a rapidly expanding area of research in diverse populations internationally. In economically disadvantaged countries, diet quality indices may be predictive of child growth. However, prospective cohort, intervention and validation studies are required to draw stronger conclusions concerning risk of future disease in paediatric populations in general.

Chronic physical and mental health conditions among adults may increase vulnerability to household food insecurity

Analyses of cross-sectional population survey data in Canada and the United States have indicated that household food insecurity is associated with poorer self-rated health and multiple chronic conditions. The causal inference has been that household food insecurity contributes to poorer health, but there has been little consideration of how adults' health status may relate to households' vulnerability to food insecurity. Our objectives were to examine how the presence of an adult with one or more chronic physical or mental health conditions affects the odds of a household being food insecure and how the chronic ill-health of an adult within a food-insecure household affects the severity of that household's food insecurity. Using household- and respondent-level data available for 77,053 adults aged 18-64 y from the 2007-2008 Canadian Community Health Survey, we applied logistic regression analyses, controlling for household sociodemographic characteristics, to examine the association between health and household food insecurity. Most chronic conditions increased the odds of household food insecurity independent of household sociodemographic characteristics. Compared with adults with no chronic condition, the odds of household food insecurity were 1.43 (95% CI: 1.28, 1.59), 1.86 (95% CI: 1.62, 2.14), and 3.44 (95% CI: 3.02, 3.93) for adults with 1, 2, and 3 or more chronic conditions, respectively. Among food-insecure households, adults with multiple chronic conditions had higher odds of severe household food insecurity than adults with no chronic condition. The chronic ill-health of adults may render their households more vulnerable to food insecurity. This has important practice implications for health professionals who can identify and assist those at risk, but it also suggests that appropriate chronic disease management may reduce the prevalence and severity of food insecurity.

Short tools to assess young children's dietary intake: a systematic review focusing on application to dietary index research

Dietary indices evaluate diet quality, usually based on current dietary guidelines. Indices can therefore contribute to our understanding of early-life obesity-risk dietary behaviours. Yet indices are commonly applied to dietary data collected by onerous methods (e.g., recalls or records). Short dietary assessment instruments are an attractive alternative to collect data from which to derive an index score. A systematic review of studies published before April 2013 was conducted to identify short (≤50 items) tools that measure whole-of-diet intake of young children (birth-five years) and are applicable to dietary indices, in particular screening obesogenic dietary behaviours. The search identified 3686 papers of which 16, reporting on 15 tools (n = 7, infants and toddlers birth-24 months; n = 8, preschoolers 2-5 years), met the inclusion criteria. Most tools were food frequency questionnaires (n = 14), with one innovative dietary questionnaire identified. Seven were tested for validity or reliability, and one was tested for both. Six tools (n = 2, infants and toddlers; n = 4, preschoolers) are applicable for use with current dietary indices, five of which screen obesogenic dietary behaviours. Given the limited number of brief, valid and reliable dietary assessment tools for young children to which an index can be applied, future short tool development is warranted, particularly for screening obesogenic dietary behaviours.

Depression and suicide ideation in late adolescence and early adulthood are an outcome of child hunger

BACKGROUND

Child hunger represents an adverse experience that could contribute to mental health problems in later life. The objectives of this study were to: (1) examine the long-term effects of the reported experience of child hunger on late adolescence and young adult mental health outcomes; and (2) model the independent contribution of the child hunger experience to these long-term mental health outcomes in consideration of other experiences of child disadvantage.

METHODS

Using logistic regression, we analyzed data from the Canadian National Longitudinal Survey of Children and Youth covering 1994 through 2008/2009, with data on hunger and other exposures drawn from NLSCY Cycle 1 (1994) through Cycle 7 (2006/2007) and mental health data drawn from Cycle 8 (2008/2009). Our main mental health outcome was a composite measure of depression and suicidal ideation.

RESULTS

The prevalence of child hunger was 5.7% (95% CI 5.0-6.4). Child hunger was a robust predictor of depression and suicidal ideation [crude OR=2.9 (95% CI 1.4-5.8)] even after adjustment for potential confounding variables, OR=2.3 (95% CI 1.2-4.3).

LIMITATIONS

A single question was used to assess child hunger, which itself is a rare extreme manifestation of food insecurity; thus, the spectrum of child food insecurity was not examined, and the rarity of hunger constrained statistical power.

CONCLUSIONS

Child hunger appears to be a modifiable risk factor for depression and related suicide ideation in late adolescence and early adulthood, therefore prevention through the detection of such children and remedy of their circumstances may be an avenue to improve adult mental health.

Evaluation of methodologies for assessing the overall diet: dietary quality scores and dietary pattern analysis

This paper aims to describe different approaches for studying the overall diet with advantages and limitations. Studies of the overall diet have emerged because the relationship between dietary intake and health is very complex with all kinds of interactions. These cannot be captured well by studying single dietary components. Three main approaches to study the overall diet can be distinguished. The first method is researcher-defined scores or indices of diet quality. These are usually based on guidelines for a healthy diet or on diets known to be healthy. The second approach, using principal component or cluster analysis, is driven by the underlying dietary data. In principal component analysis, scales are derived based on the underlying relationships between food groups, whereas in cluster analysis, subgroups of the population are created with people that cluster together based on their dietary intake. A third approach includes methods that are driven by a combination of biological pathways and the underlying dietary data. Reduced rank regression defines linear combinations of food intakes that maximally explain nutrient intakes or intermediate markers of disease. Decision tree analysis identifies subgroups of a population whose members share dietary characteristics that influence (intermediate markers of) disease. It is concluded that all approaches have advantages and limitations and essentially answer different questions. The third approach is still more in an exploration phase, but seems to have great potential with complementary value. More insight into the utility of conducting studies on the overall diet can be gained if more attention is given to methodological issues.

Coping with child hunger in Canada: have household strategies changed over a decade?

OBJECTIVE

To determine if household coping strategies for child hunger in Canada have changed over a decade (1996-2007).

METHODS

We applied t-tests to data derived from Cycle 2 (1996-1997; n=8165) and Cycle 7 (2006-2007; n=15,961) of the National Longitudinal Survey of Children and Youth (NLSCY) to determine changes in household coping strategies for child hunger. Data were restricted to households with children aged 2-9 years, allowing for cross-sectional analysis of two independent samples. Logistic regression was employed to estimate the odds of reporting child hunger for socio-demographic characteristics and the odds of using different coping strategies.

RESULTS

The national prevalence of child hunger fell from 1.5% in 1997 to 0.7% in 2007 (p<0.001). The determinants of child hunger (increased child age and household size, lack of home ownership, low household income, lone-parent status, family dysfunction) and hunger frequency (regular versus occasional) were similar in both NLSCY cycles. Utilization of food banks and other community resources as a method of coping with child hunger remained static despite an increase in national food banks/affiliated agencies in Canada (2,141 in 1998 to 3,540 in 2007). In contrast, there was an increased reliance on reducing household food variety, an internal coping mechanism, to manage child hunger (17.6% Cycle 2 to 35.1% Cycle 7; p=0.03).

CONCLUSION

Community outreach programs between 1997 and 2007 had little impact on coping strategies utilized by households facing child hunger. Our results indicate that current initiatives fail to reach these families.

Food management behaviours in food-insecure, lone mother-led families

PURPOSE

Little is known about how food is managed in households where food resources are scarce. In this study, the household food management behaviours utilized by food-insecure, lone mother-led families from Atlantic Canada were characterized, and relationships among these behaviours and diet quality were examined.

METHODS

Thematic analysis of 24 in-depth interviews from a larger study of mother-led, low-income families was integrated with sociodemographic characteristics, food-insecurity status, and four weekly 24-hour dietary recalls for all household members to yield a family behaviour score (FBS) as a summative measure of food management behaviours, and a healthy plate score (HPS) as a measure of diet quality.

RESULTS

Five distinct food management behaviours were identified: authoritative, healthism, sharing, structured, and planning behaviours. An increase in the FBS was associated with a proportional increase in the HPS. Authoritative, healthism, and planning food management behaviours were the strongest predictors of the HPS for all household members (p<0.05). The structured management behaviour was related to the degree of food insecurity.

CONCLUSIONS

The FBS and HPS tools hold promise as a way to identify food-insecure families at risk of low diet quality. The next phase of this research will validate the use of these tools in the practice setting.

Characterizing whole diets of young children from developed countries and the association between diet and health: a systematic review

Early childhood is an important nutritional period that involves the transition from a milk-based diet to ordinary foods. A systematic review was conducted of studies that applied whole-of-diet analysis of children aged 1-5 years to examine associations between diet and nutrition, health, and development. Literature searches identified 40 articles using dietary indices, principal component analysis, or cluster analysis. Reports that applied indices (n = 23, 18 indices) were cross-sectional, and most measured diet quality or variety. Articles reporting principal component or cluster analyses (n =17) described between two and six dietary patterns, and most identified healthy, unhealthy, and traditional patterns. In cross-sectional analyses, mixed associations were found between index or pattern scores and nutrient intake (n = 10), nutritional biomarkers (n = 1), and anthropometry (n = 10). Five reports from two birth cohorts showed healthier dietary patterns were associated with better lean mass, cognition, and behavior, but not with bone mass or body mass index at later ages. Few studies have characterized the diets of children under 5 years of age and linked diet with health. Given the limited evidence, research establishing the predictive validity of whole-of-diet methods in childhood is needed.

Spilt milk: an inter-sectoral partnership that failed to advance milk security for low-income lone mothers in Nova Scotia, Canada

Canadian agricultural policy supports higher milk prices. Consequently, poor families lack sufficient funds to purchase adequate quantities of milk. Low-income lone mothers in the Canadian province of Nova Scotia suggested their preferred strategies for improved access to milk. We then built inter-sectoral support for a policy intervention to address their recommendations. Our research-to-action process led to a policy dialogue focusing on an electronic smart card that would permit the delivery of lower-priced milk to poor households. While all agreed that milk insecurity was an important issue, the project ultimately failed because of the entrenched positions of influential stakeholder groups.

Scores on the dietary guideline index for children and adolescents are associated with nutrient intake and socio-economic position but not adiposity

Diet quality indices reflect overall dietary patterns better than single nutrients or food groups. The study aims were to develop a measure of adherence with dietary guidelines applicable to child and adolescent populations in Australia and determine the association between index scores and food and nutrient intake, socio-demographic characteristics, and measures of adiposity. Data were analyzed from 4- to 16-y-old participants of the 2007 Australian Children's Nutrition and Physical Activity Survey (n = 3416). The Dietary Guideline Index for Children and Adolescents (DGI-CA) comprises 11 components: 5 core food groups, wholegrain bread, reduced-fat dairy foods, extra foods (nutrient poor and high in fat, salt, and added sugar), healthy fats/oils, water, and diet variety (possible score of 100). The index criteria were age specific. The mean DGI-CA score was low (53.6 ± 0.4), similar between boys and girls, and differed by age; the youngest children scored higher than the oldest children (P < 0.0001). Higher DGI-CA scores were associated with lower energy intake, energy density, total and saturated fat, and sugar intake; higher protein, carbohydrate, fiber, calcium, iron, vitamin C, vitamin A, folate, phosphorous, magnesium, zinc, and iodine intakes; and a higher polyunsaturated:saturated fat ratio (P < 0.0001). DGI-CA scores were associated with socio-economic characteristics and measures of family circumstance. Weak positive associations were observed between DGI-CA score and BMI or waist circumference Z-scores in the 4- to 10-y and 12- to 16-y age groups only. This index is the first validated index in Australia and one of the few international indices to describe the diet quality of children and adolescents.

Associations between diet quality and physical activity measures among a southern Ontario regional sample of grade 6 students

The purpose of this study was to determine diet quality and physical activity behaviours of grade 6 students by sex and body weight status, and to determine the associations between diet quality and physical activity behaviours. The Web-based Food Behaviour Questionnaire, which included a 24-h diet recall and the modified Physical Activity Questionnaire for Older Children (PAQ-C), was administered to a cross-section of schools (n = 405 students from 15 schools). Measured height and weight were used to calculate body mass index and weight status (Cole et al. 2000). A Canadian version of the Healthy Eating Index (HEI-C) was used to describe overall diet quality. The mean HEI-C was 69.6 (13.2) with the majority (72%) falling into the needs improvement category. The overall mean physical activity score was 3.7 out of a maximum of 5, with obese subjects being less active compared with normal weight and overweight (p < 0.001). Ordinal logistic regression analysis (of HEI-C vs. all measures of the PAQ-C, sex, and weight status) revealed that HEI-C ratings were likely to be higher in students that walked to and from school 5 days per week (vs. 0 days per week; odds ratio 3.18, p = 0.010); and were active 1 evening per week (vs. none; odds ratio 3.48, p = 0.039). The positive association between diet quality and some aspects of physical activity suggests possible clustering of health behaviours. Future research should test the potential benefits of promoting 1 health behaviour (e.g., healthy eating) with another (e.g., physical activity).

The influence of physical and social contexts of eating on lunch-time food intake among southern Ontario, Canada, middle school students

BACKGROUND

Among students, little is known about the physical and social context of eating lunch. The objective of this study was to determine if food intake (including the type of food and beverages and portion sizes) was associated with specific aspects of the physical and social lunch environment (location, with whom lunch was consumed, who prepared the food, and where the food was originally purchased).

METHODS

A total of 1236 participants (males = 659, females = 566) in grades 6 (n = 359), 7 (n = 409), and 8 (n = 463) from southern Ontario, Canada, completed the Food Behavior Questionnaire during the 2005-2006 academic year.

RESULTS

A total of 8159 foods and 2200 beverages were consumed during the lunch meal, which contributed to 552 kcal (SD = 429) or 30% (SD = 16) of total daily energy intake (kcal/day). Higher amounts of energy, meats and alternatives, other foods, fried foods, and pizza were consumed when participants ate in between places or at a restaurant/fast food outlet (compared with at home or school, p < 0.05) and/or when prepared by friends or others (compared with themselves or family members, p < 0.05). A large number of participants (46%) reported consuming sugar-sweetened beverages during lunch, despite a school board-level policy restricting the sales of "junk food," which appears to be brought from home.

CONCLUSIONS

Our findings support schools in policy efforts that restrict fast food access (by leaving school grounds, preventing fast food companies from coming onto school grounds, or restricting sugar-sweetened beverage sales in vending machines) and that eating in between places should be discouraged.

Nutrition inequities in Canada

In Canada, increased morbidity and shorter life expectancy have been found among those with lower incomes and lower levels of education, but there has been little examination of socioeconomic variation in food and nutrient intake. Using data from the 2004 Canadian Community Health Survey, we examined the relationship between household income and education level and adults’ and children’s intakes of energy, fibre, micronutrients, and number of servings consumed of food groups from Canada’s Food Guide. To explore the public health significance of observed associations, we estimated the prevalence of inadequacy for selected nutrients for adults, stratifying by household income, education level, and sex. We found that a higher household income adequacy and (or) higher levels of education were associated with increased consumption of milk and alternatives, and vegetables and fruit, and significantly higher vitamin, mineral, and fibre intakes among both adults and children. The prevalence of inadequate nutrient intakes among adults was higher among adults with the lowest level of income adequacy or educational attainment, compared with others. Our results suggest that the nutritional quality of Canadians’ food intakes is, in part, a function of their social position. The impact of policy and program interventions needs to be examined across socioeconomic strata to ensure that actions reduce rather than exacerbate nutrition inequities.

Healthy eating index-C is positively associated with family dinner frequency among students in grades 6-8 from Southern Ontario, Canada

BACKGROUND/OBJECTIVES

Unhealthy eating behaviours may contribute to the rising prevalence of childhood obesity in Canada. The purpose of this study was to describe family dinner frequency (FDF) and its associations with overall diet quality.

SUBJECTS/METHODS

The sample included grades six (n=372), seven (n=429) and eight (n=487) students from Southern Ontario. Data were collected with the Food Behaviour Questionnaire, including a single 24-h dietary recall and questions about individual meals. Diet quality was calculated using the Healthy Eating Index-C (HEI-C), which is a recently modified diet quality index.

RESULTS

The majority of participants (65%) reported frequent family dinner meals (6-7 days/week versus 20% on 3-5 days/week and 15% on 0-2 days/week). Diet quality scores were higher among participants reporting 6-7 dinners/week (HEI-C=66.2 versus 62.1 and 62.8 for 0-2 and 3-5 days/week, respectively, P<0.001). Adjusted models reported that diet quality scores were also associated with whom participants consumed breakfast (P<0.001), lunch (P<0.001) and dinner (P<0.001), yet they were most strongly associated (negatively) with participants who skipped the meal altogether.

CONCLUSIONS

Increased family dinner meals were positively associated with daily diet quality and negatively associated with breakfast and lunch skipping. Promoting family dinner meals in healthy living intervention strategies is advised.

Effect of meal environment on diet quality rating

PURPOSE

Family meals have been associated with improved dietary quality in children and adolescents, and yet very little is known about family meals beyond their frequency. Specific aspects of the breakfast, lunch, and dinner meal environments were described and compared, and the associations with overall diet quality were investigated.

METHODS

Data on food intake and meal environments were obtained in northern Ontario, southern Ontario, and Nova Scotia grades six, seven, and eight classrooms over the 2005 to 2006 school year. Specific aspects of the meal environments described were where the meal was consumed, with whom participants consumed each meal, who prepared the meal, and where the food was originally purchased. Diet quality was assessed using the Canadian version of the Healthy Eating Index. Cluster K-means procedures were used to classify into groups observations about the four meal environment variables.

RESULTS

Three, eight, and six clusters of meal environments were identified for breakfast, lunch, and dinner, respectively. Diet quality was negatively associated with consuming/ purchasing meals outside the home, and with skipping breakfast, lunch, and/or dinner.

CONCLUSIONS

Results have immediate relevance for family-based and/or school programs and policies aimed at educating and feeding children and adolescents.

Beverage Consumption in Low Income, “Milk-friendly’’ Families

Purpose: Beverage consumption by poor, lone mother-led, “milk-friendly” families living in Atlantic Canada was characterized over a one-month income cycle.

Methods: Beverage intake and food security status were assessed weekly, using a 24-hour dietary recall and the Cornell- Radimer food insecurity questionnaire. Families were classified as “milk friendly” if total consumption of milk was 720 mL on a single day during the month. Beverage intake was assessed using t-tests, analysis of variance (ANOVA), repeated measures ANOVA with post hoc comparisons, and chi-square analysis.

Results: Milk consumption by milk-friendly families (76; total sample, 129) was highest at the time of the month when they had the most money to spend. During all time intervals, mothers consumed the least amount of milk and children aged one to three years consumed the most. Mothers consumed carbonated beverages disproportionately, while children of all ages consumed more fruit juice/drink. Mothers’ coffee consumption was profoundly increased when either they or their children were hungry.

Conclusions: The quality of beverage intake by members of low-income households fluctuates in accordance with financial resources available to purchase foods. Mothers’ beverage intake is compromised by the degree of food insecurity the family experiences.

Perception of needs and responses in food security: divergence between households and stakeholders

Objectives

The aim of the study was (i) to describe the needs of food-insecure households and their assessment of community programmes, as expressed by households and perceived by stakeholders; and (ii) to examine the similarities and differences between households’ and stakeholders’ perceptions in Quebec City area.

Design/setting/subjects

A semi-structured interview and sociodemographic questionnaire with fifty-five households and fifty-nine stakeholders (community workers, managers, donor agencies). The transcriptions were subjected to content analysis and inter-coder reliability measurement.

Results

The respondents’ perceptions converge towards three main categories of needs: needs specific to food security, conditions necessary for achieving food security and related needs. There was agreement on the necessity of better financial resources, although the impact of financial resources alone may be uncertain in the opinion of some stakeholders. Different perceptions of needs and of their fulfilment by community programmes emerge between both groups. Despite households found positive aspects, they complained that quality of food and access were major needs neglected. Their account suggests overall a partial fit between the programmes and food security needs; even a combination of programmes (e.g. collective kitchens, purchasing groups, community gardens) was insufficient to adequately meet these needs. In contrast, most stakeholders perceived that the household’s primary need was a basic amount of food and that the households were satisfied with programmes.

Conclusions

It is urgent to evaluate the overall effect of community programmes on specific aspects of household food insecurity. The results emphasise that community programmes alone cannot bring about social change needed to prevent food insecurity.

Healthy Eating Index-C is compromised among adolescents with body weight concerns, weight loss dieting, and meal skipping

The objective was to describe weight concerns, dieting, and meal skipping of adolescents and to determine associations with the Healthy Eating Index-C (HEI-C). Data, that were collected using the Food Behaviour Questionnaire, revealed that participants (male=810, female=1016) in grades 9/10 reported weight concerns (n=518), dieting (n=364), and skipping breakfast (n=498), lunch (n=252), and/or dinner (n=129). Of those dieting or weight concerned (n=602), 61% were healthy weight and of those not dieting or weight concerned (n=1224), 13% were overweight/obese. The ordinal logistic regression analysis revealed that HEI-C was likely to be rated lower among those weight concerned and dieting (p<.001), and among those that skipped the breakfast meal (p<.001). The current study identified inappropriate weight concerns and dieting that compromised diet quality and has implications for future intervention and policy development.

Gender of respondent does not affect the psychometric properties of the Brazilian Household Food Security Scale

BACKGROUND

Food insecurity is a major public concern that occurs when nutritional needs are not met, incorporates psychological and physiological coping mechanisms, and can range from basic concern over obtaining food to severe malnutrition. This study was performed to explore differences in female and male respondent psychometric characteristics of a locally adapted Brazilian Household Food Security Scale (Escala Brasileira de Medida da Insegurança Alimentar--EBIA).

METHODS

The 16-item EBIA was incorporated into the 2004 Brazilian National Household Sample Survey 2004 (Pesquisa Nacional por Amostra de Domicílios--PNAD; n = 108 606). Rasch Modelling was used to evaluate survey one-dimensionality, construct and independence through analysis of infit and relative item severities of adult and children items by gender. Differences in estimated item severities between male and female respondents were assessed using Differential Item Functioning (DIF) models.

RESULTS

The scale presented good fitness and most item infit values were within adequate range (0.8-1.2), being practically identical when comparing female and male responses. Both female and male respondents presented similar relative item severities for adult and children items and followed the same pattern of increasing relative item severities with each item in the questionnaire. None of the items presented substantial DIF.

CONCLUSIONS

This research demonstrates that the psychometric properties of the EBIA are not affected by respondent gender in Brazil. The results of this study support the validity of the proposed scale, suggesting that the scale will provide accurate information regardless of respondent gender for governments, researchers and agencies concerned with reducing epidemic levels of food insecurity and the resulting health disparities.