Dietary Patterns among Adolescents Are Associated with Growth, Socioeconomic Features, and Health-Related Behaviors

Psychometric Properties of the Dimensional Yale Food Addiction Scale for Children 2.0 among Portuguese Adolescents

The dimensional Yale Food Addiction Scale for Children 2.0 (dYFAS-C 2.0) was developed to provide a reliable psychometric measure for assessing food addiction in adolescents, in accordance with the updated addiction criteria proposed in the fifth edition of the Diagnostic and Statistical Manual (DSM-5). The present study aimed to evaluate the psychometric properties of the dYFAS-C 2.0 among Portuguese adolescents and pre-adolescents and to explore the relationship between food addiction and other eating behaviors such as grazing and intuitive eating. The participants were 131 Portuguese adolescents and pre-adolescents (53.4% female and 46.6% male) aged between 10 and 15 years (Mage = 11.8) and with a BMI between 11.3 and 35.3 (MBMI z-score = 0.42). Confirmatory Factor Analysis demonstrated an adequate fit for the original one-factor model (χ2 (104) = 182; p < 0.001; CFI = 0.97; TLI = 0.97; NFI = 0.94; SRMR = 0.101; RMSEA = 0.074; 95% CI [0.056; 0.091]). Food addiction was positively correlated with higher grazing (r = 0.69, p < 0.001) and negatively correlated with lower reliance on hunger/satiety cues (r = -0.22, p = 0.015). No significant association was found between food addiction and BMI z-score, or between food addiction and age. The results support the use of dYFAS-C 2.0 as a valid and reliable measure for assessing food addiction in Portuguese adolescents and pre-adolescents. Furthermore, the findings highlight that food addiction may be part of a spectrum of disordered eating behaviors associated with control impairment. Future research with a larger sample size could further elucidate the associations between food addiction and other variables, such as psychological distress and multi-impulsive spectrum behaviors.

Adherence to plant-based dietary patterns and anthropometric indices among primary school girls in Kerman: A cross-sectional study

The objective of the study was to evaluate the association between adherence to plant-based dietary patterns and anthropometric indices among primary school girls in Kerman. This cross-sectional study included 330 girls aged 6-12. A reliable and validated dish-based food frequency questionnaire was used to collect dietary data. Weight, height, and mid-arm circumference were measured, and z-score charts from the World Health Organization for girls between the ages of 5 and 19 were utilized. We used Satija et al. method to calculate plant-based diet index scores. After adjusting for age and energy, participants in the higher tertile of the overall plant-based diet index (PDI) had a lower height-for-age z score (HAZ) (0.38±0.12 vs. 0.59±0.12 kg; P = 0.033). Higher unhealthful plant-based diet index (uPDI) scores were significantly associated with decreased HAZ in models 2 (p = 0.028) and 3 (p = 0.035). A higher PDI score was associated with lower odds of being underweight and overweight, respectively (Model 1: P trend = 0.007, <0.001; Model 2: P trend = 0.010, 0.001). A significant inverse association was found between healthful plant-based diet index (hPDI) scores and underweight risk in the crude and adjusted models. (Model 1: P trend = 0.021; model 2: P trend = 0.018; Model 3: P trend = 0.031). Higher uPDI scores were associated with increased odds of being overweight and obese in all three models (Model 1: p trend<0.001; Model 2: p trend<0.001; Model 3: p trend = 0.001). We concluded that children who followed a plant-based diet had lower odds of being overweight and obese. Higher scores on the hPDI were linked to a decreased risk of being underweight, while higher scores on the uPDI were associated with an increased risk of being overweight and obese. The study suggests healthy plant-based diet may benefit children's weight and growth.

Attention-deficit hyperactivity disorder is associated with disordered eating in adolescents

AIM

Attention-deficit hyperactivity disorder (ADHD) and disordered eating (DE) are both highly prevalent among adolescents, but their relationship is understudied. This study examines their possible association in a nationally representative sample of adolescents.

METHODS

Participants in the Israeli Youth Health and Nutrition Survey (2015-2016), a cross-sectional, school-based study, completed self-administered questionnaires, including the SCOFF questionnaire, and underwent anthropometric measurements. An affirmative reply to at least two SCOFF items was considered a DE case. Multivariable logistic regression evaluated the ADHD-DE association and the associations between ADHD and individual SCOFF items, controlling for age, sex, socioeconomic status, and body mass index.

RESULTS

Of 4616 participants (12-18 years, 50.2% male), 654 reported an ADHD diagnosis. DE prevalence among ADHD adolescents was significantly higher than the non-ADHD group (50.2% vs. 43.9%, p = 0.003). Controlling for potential covariates, the association between ADHD and DE remained significant (OR = 1.409; 95% CI: 1.170-1.697), as did associations between ADHD and three SCOFF items. No difference in DE prevalence was found between stimulant-treated (n = 287) and untreated (n = 326) adolescents with ADHD.

CONCLUSION

Adolescents with ADHD are more likely to experience DE. As DE can herald an imminent eating disorder, early identification is crucial. Further studies are needed to determine the ADHD-DE relationship's causality.

IMPACT

Disordered eating (DE) and attention-deficit hyperactivity disorder (ADHD) are common among adolescents, and significantly affect health and well-being. This study examined the association between ADHD and DE in adolescents using the SCOFF questionnaire. Following adjustment for sociodemographic variables and BMI z-score, ADHD was associated with a 41% increased odds for DE. This study established the association between ADHD and DE, using a well-known questionnaire, in a large, nationally representative sample of adolescents. Monitoring eating behaviors and attitudes among adolescents with ADHD should be a priority, to minimize the risk of developing an eating disorder and its harmful consequences.

Socioeconomic status and health behavior in children and adolescents: a systematic literature review

Socioeconomic status affects individuals' health behaviors and contributes to a complex relationship between health and development. Due to this complexity, the relationship between SES and health behaviors is not yet fully understood. This literature review, therefore, aims to assess the association between socioeconomic status and health behaviors in childhood and adolescence. Preferred Reporting for Systematic Review and Meta-Analysis protocol guidelines were used to conduct a systematic literature review. The electronic online databases EBSCO Host, PubMed, Web of Science, and Science Direct were utilized to systematically search published articles. The Joanna Briggs Institute's critical appeal tool was used to assess the quality of included studies. Eligibility criteria such as study context, study participants, study setting, outcome measures, and key findings were used to identify relevant literature that measured the association between socioeconomic status and health behaviors. Out of 2,391 studies, only 46 met the final eligibility criteria and were assessed in this study. Our review found that children and adolescents with low socioeconomic status face an elevated risk of unhealthy behaviors (e.g., early initiation of smoking, high-energy-dense food, low physical activity, and involvement in drug abuse), in contrast to their counterparts. Conversely, children and adolescents from higher socioeconomic backgrounds exhibit a higher prevalence of health-promoting behaviors, such as increased consumption of fruit and vegetables, dairy products, regular breakfast, adherence to a nutritious diet, and engagement in an active lifestyle. The findings of this study underscore the necessity of implementing specific intervention measures aimed at providing assistance to families from disadvantaged socioeconomic backgrounds to mitigate the substantial disparities in health behavior outcomes in children and adolescents.

Unhealthy Dietary Patterns and Their Associations with Sociodemographic Factors as Predictors among Underweight and Overweight Adolescents in Southern Thailand

(1) Background: Adolescence is a critical developmental phase; dietary intake and nutritional status significantly impact health outcomes. (2) Objective: This cross-sectional study investigated dietary patterns (DPs) and the association between sociodemographic factors and unhealthy DPs among adolescents in Thailand. (3) Methods: A multi-stage sampling selected 1480 participants from three public high schools in Nakhon Si Thammarat province. A food frequency questionnaire assessed dietary habits, and principal component analysis was used to identify DPs. Multinomial logistic regression examined the association between sociodemographic factors and DPs. (4) Results: The findings show that 25.9% of adolescents were underweight, 14.7% were overweight, and 5.8% were obese. Three DPs were identified: a healthy 'protein and vegetables' pattern and two unhealthy patterns: 'snacks' and 'processed foods', which explained 12.49%, 10.37%, and 7.07% of the dietary variance, respectively. Among underweight adolescents, higher snack consumption was associated with being younger (odds ratio (OR) = 3.24) and receiving a higher daily allowance (OR = 3.43). Additionally, female adolescents who engaged in frequent exercise had a 2.15 times higher intake of processed foods. Among overweight adolescents, higher snack intake was linked to being younger (OR = 8.65) and having larger families (OR = 6.37). Moreover, an increased daily allowance was associated with higher consumption of processed foods (OR = 11.47). (5) Conclusion: This study underscores the socio-demographic influence on unhealthy DPs. Insights can guide targeted interventions to foster healthier dietary habits during adolescence.

Attention-deficit hyperactivity disorder is associated with relatively short stature among adolescents

AIM

To estimate the association between attention-deficit hyperactivity disorder (ADHD) and relatively short stature (RSS) among adolescents.

METHODS

Participants in the Israeli Youth Health and Nutrition Survey (2015-2016), a cross-sectional school-based study, completed self-administered questionnaires and underwent anthropometric measurements. Height z-score < -0.7 (<25th percentile) was defined as RSS. Multivariable logistic regression analyses assessed the relation between ADHD and RSS, controlling for age, sex, body mass index (BMI) and socioeconomic status (Basic Model), and also for lifestyle factors such as physical activity, sleep duration, dietary patterns and intakes.

RESULTS

Of 4173 participants (11-18 years, 50.2% males), 654 self-reported ever being diagnosed with ADHD; 3519 participants were controls. Overweight (BMI z-score ≥1) and pubertal status were not different among groups. According to the Basic Model, ADHD was significantly associated with RSS (OR 1.25, 95% CI 1.03-1.50), and even after adjustments for lifestyle factors and dietary intake (OR 1.28, 95% CI 1.03-1.58). Stimulant-treated ADHD adolescents had similar height z-scores and lifestyles as those not treated with stimulants.

CONCLUSION

Attention-deficit hyperactivity disorder was associated with RSS. Height deficit may be intrinsic to ADHD or its pharmacotherapy, rather than a consequence of lifestyle alone. Further studies are needed to determine the causal relationship between ADHD and short stature.

Development and validation of a smartphone image-based app for dietary intake assessment among Palestinian undergraduates

Accurate dietary assessment is required in a variety of research fields and clinical settings. Image-based dietary assessment using smartphones applications offer the opportunity to reduce both researcher and participant burden compared to traditional dietary assessment methods. The current study, conducted in Palestine, aimed to design an image-based dietary assessment application, to assess the relative validity of the application as a dietary assessment tool for energy and macronutrient intake using the 3-Day Food Record (3-DFR) as a reference method, and to test its usability among a sample of Palestinian university students. The development of a smartphone application (Ghithaona) designed to assess energy and macronutrient intake is reported. The application validity was tested among a sample of Palestinian undergraduates from An-Najah National University. Participants recorded their dietary intake using the Ghithaona application over 2 consecutive days and 1 weekend day. Intake from the Ghithaona application were compared to intake collected from 3-DFR, taken on 2 consecutive weekdays and 1 weekend day, in the second week following the Ghithaona application. At the end of the study, participants completed an exit survey to test assess application usability and to identify barriers to its use. Mean differences in energy, and macronutrients intake were evaluated between the methods using paired t-tests or Wilcoxon signed-rank tests. Agreement between methods was ascertained using Pearson correlations and Bland–Altman plots. The Ghithaona application took 6 months to develop. The validation test was completed by 70 participants with a mean age of 21.0 ± 2.1 years. No significant differences were found between the two methods for mean intakes of energy or macronutrients (p > 0.05). Significant correlations between the two methods were observed for energy, and all macronutrients (r = 0.261–0.58, p ≤ 0.05). Bland–Altman plots confirmed wide limits of agreement between the methods with no systematic bias. According to the exit survey, it was found that majority of participants strongly agreed and agreed that the application saves time (94.2%), helps the participant to pay attention to their dietary habits (87.2%), and is easy to use (78.6%). The Ghithaona application showed relative validity for assessment of nutrient intake of Palestinian undergraduates.

Impacts of Self-Efficacy on Food and Dietary Choices during the First COVID-19 Lockdown in China

The COVID-19 pandemic has caused a global public health emergency, increasing the prevalence of emotional distress, and potentially leading to altered diet behavior. Self-efficacy measures various aspects of perceiving and understanding emotions. The present study was carried out with the objective of understanding the effect of emotional self-efficacy on dietary behavior and quality. It also shed light on which elements contributed to the link between food-related behavior and perceived dietary quality during the first lockdown of the COVID-19 pandemic. Based on the factor analysis of nineteen food groups, choices, consumption, and socioeconomic status were examined in a sample of 441 Chinese participants. Multiple linear regression examined the association between food consumption, dietary quality, and self-efficacy. Contrary to prior research, the intake of salty snacks and alcoholic beverages dropped by 3.3% and 2.8%, respectively, during the first lockdown. Emotional self-efficacy negatively mediated the relationship between socioeconomic status and dietary quality. In conclusion, emotional self-efficacy is a well-established tool for evaluating how Chinese people cope with negative emotions. As an individual's dietary quality was affected during the imposed lockdown, the present study offers valuable insight into psychosocial factors that may contribute to health disparities by advocating for organized nutritional support in future epidemic-related quarantines.