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Bell L, Manson A, Zarnowiecki D, Tan SN, Byrne R, Taylor R, Zheng M, Wen LM, Golley R. Development and validation of a short dietary questionnaire for assessing obesity-related dietary behaviours in young children. MATERNAL & CHILD NUTRITION 2024; 20:e13613. [PMID: 38192050 PMCID: PMC10981485 DOI: 10.1111/mcn.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 11/07/2023] [Accepted: 11/29/2023] [Indexed: 01/10/2024]
Abstract
There are few short, validated tools to assess young children's obesity-related dietary behaviours, limiting the rapid screening of dietary behaviours in research and practice-based early obesity prevention. This study aimed to develop and assess the reliability and validity of a caregiver-reported short dietary questionnaire to rapidly assess obesity-related dietary behaviours in children aged 6 months to 5 years. The Early Prevention of Obesity in Childhood Dietary Questionnaire (EPOCH-DQ) was developed using a rigorous process to determine content and structural validity. Three age-appropriate versions were developed for (1) infants, aged 6-12 months, (2) toddlers, aged 1-2.9 years and (3) pre-schoolers, aged 3-5 years. The questionnaire (7-15 items) measures dietary behaviours, including diet risk from non-core food and beverage intake, diet quality from vegetable frequency, bread type and infant feeding practices. Test-retest reliability was assessed from repeated administrations 1 week apart (n = 126). Internal consistency, concurrent validity (against a comparison questionnaire, the InFANT Food Frequency Questionnaire), construct validity and interpretability were assessed (n = 209). Most scores were highly correlated and significantly associated (p < 0.05) for validity (rs: 0.45-0.89, percentage agreement 68%-100%) and reliability (intraclass correlation coefficient: 0.61-0.99) for diet risk, diet quality and feeding practice items. The EPOCH-DQ shows acceptable validity and reliability for screening of obesity-related behaviours of children under 5 years of age. The short length and, thus, low participant burden of the EPOCH-DQ allows for potential applications in various settings. Future testing of the EPOCH-DQ should evaluate culturally and socio-economically diverse populations and establish the predictive validity and sensitivity to detect change.
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Affiliation(s)
- Lucinda Bell
- Flinders University, College of Nursing and Health Sciences, Caring Futures InstituteAdelaideSouth AustraliaAustralia
| | - Alexandra Manson
- Flinders University, College of Nursing and Health Sciences, Caring Futures InstituteAdelaideSouth AustraliaAustralia
| | - Dorota Zarnowiecki
- Flinders University, College of Nursing and Health Sciences, Caring Futures InstituteAdelaideSouth AustraliaAustralia
| | - Shi Ning Tan
- Flinders University, College of Nursing and Health Sciences, Caring Futures InstituteAdelaideSouth AustraliaAustralia
| | - Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of HealthQueensland University of TechnologyKelvin GroveQueenslandAustralia
| | - Rachael Taylor
- Department of MedicineUniversity of OtagoDunedinNew Zealand
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition SciencesDeakin UniversityGeelongVictoriaAustralia
| | - Li Ming Wen
- Sydney School of Public Health, Faculty of Medicine and HealthSydneyNew South WalesAustralia
| | - Rebecca Golley
- Flinders University, College of Nursing and Health Sciences, Caring Futures InstituteAdelaideSouth AustraliaAustralia
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Babio N, de Las Heras-Delgado S, De Miguel-Etayo P, Pastor-Villaescusa B, Leis R, Garcidueñas-Fimbres TE, Larruy-García A, Navas-Carretero S, Portoles O, Flores-Rojas K, Vázquez-Cobela R, Shyam S, Miguel-Berges ML, Martínez JA, Codoñer-Franch P, Gil-Campos M, Moreno LA, Salas-Salvadó J. Reproducibility and relative validity of a semi-quantitative food and beverage frequency questionnaire for Spanish children aged 3 to 11 years: the COME-Kids F&B-FQ. Eur J Pediatr 2023; 182:5577-5589. [PMID: 37798446 PMCID: PMC10746573 DOI: 10.1007/s00431-023-05220-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/26/2023] [Accepted: 09/16/2023] [Indexed: 10/07/2023]
Abstract
A reliable food and beverage frequency questionnaire (F&B-FQ) to measure dietary intakes for children across Spain is currently unavailable. Thus, we designed and assessed the reproducibility and relative validity of a new F&B-FQ in 210 Spanish children aged 3-11 years. COME-Kids F&B-FQ contained 125 items to assess the usual diet intake in the past year among children. To explore the reproducibility, caregivers answered COME-Kids F&B-FQ twice over a 15-day period (± 1 week). To evaluate the relative validity, estimates from a third COME-Kids F&B-FQ administered at 1 year of follow-up were compared with the mean estimates from 3-day dietary records (3d-DR) collected at baseline, 6 months, and after 1 year of follow-up. Reproducibility and relative validity of the COME-Kids F&B-FQ in estimating food groups and nutrients were assessed using Pearson (r) and intra-class (ICC) correlation coefficients. We used the kappa index to evaluate the agreement in repeat administrations or with the 3d-DR. We used Bland-Altman plots to identify bias across levels of intake. A total of 195 children (105 boys, 90 girls) completed the study. The reproducibility of data estimated from COME-Kids F&B-FQ was substantial with mean r and ICC being 0.65 and 0.64 for food groups and 0.63 and 0.62 for nutrients, respectively. Validation assessments comparing the FFQ and 3d-DRs showed r = 0.36 and ICC = 0.30 for food groups and r = 0.29 and ICC = 0.24 for nutrients. The mean agreement for food group reproducibility and relative validity was 86% and 65%, respectively. These estimates were 85% for reproducibility and 64% for relative validity in the case of nutrients. For reproducibility and relative validity, the overall mean kappa index was 63% and 37% for all food groups and 52% and 27% for nutrients, respectively. Bland-Altman plots showed no specific bias relating to the level of intake of nutrients and several food groups. CONCLUSION COME-Kids F&B-FQ showed substantial reproducibility and acceptable relative validity to assess food and beverage intake in Spanish children aged 3 to 11 years. Most children were correctly classified in relation to the intake of food groups and nutrients, and misclassification was unlikely with reference to 3d-DR. WHAT IS KNOWN • The estimation of dietary intake in children is complex, especially in large cohorts. • The food frequency questionnaire is a well-recognized and the most frequently used method for assessing food consumption. WHAT IS NEW • A new food and beverage frequency questionnaire including a beverage section and novel plant-based food items has been validated in Spanish children aged 3-11 years.
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Affiliation(s)
- Nancy Babio
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
- Universitat Rovira i Virgili, Unitat de Nutrició Humana, Grup ANUT-DSM, Departament de Bioquimica i Biotecnologia, Reus, Spain.
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain.
| | - Sara de Las Heras-Delgado
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Universitat Rovira i Virgili, Unitat de Nutrició Humana, Grup ANUT-DSM, Departament de Bioquimica i Biotecnologia, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Pilar De Miguel-Etayo
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2). Faculty of Health Sciences. Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009, Zaragoza, Spain.
| | - Belén Pastor-Villaescusa
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Rosaura Leis
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Service, Hospital Clínico Universitario de Santiago, 15706, Santiago de Compostela, Spain
- Pediatric Nutrition Research Group, Health Research Institute of Santiago de Compostela (IDIS), Unit of Investigation in Nutrition, Growth and Human Development of Galicia-USC, 15706, Santiago de Compostela, Spain
| | - Tany E Garcidueñas-Fimbres
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Universitat Rovira i Virgili, Unitat de Nutrició Humana, Grup ANUT-DSM, Departament de Bioquimica i Biotecnologia, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Alicia Larruy-García
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2). Faculty of Health Sciences. Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009, Zaragoza, Spain
| | - Santiago Navas-Carretero
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Center for Nutrition Research, University of Navarra, 31008, Pamplona, Spain
- Dept Nutr Food Sci & Physiol, Fac Pharm & Nutr, University of Navarra, 31008, Pamplona, Spain
- IdisNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Olga Portoles
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Departament of Preventive Medicine and Public Health. Department of Pediatrics, Obstetrics and Gynecology., University of Valencia, Valencia, Spain
| | - Katherine Flores-Rojas
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Rocío Vázquez-Cobela
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Service, Hospital Clínico Universitario de Santiago, 15706, Santiago de Compostela, Spain
- Pediatric Nutrition Research Group, Health Research Institute of Santiago de Compostela (IDIS), Unit of Investigation in Nutrition, Growth and Human Development of Galicia-USC, 15706, Santiago de Compostela, Spain
| | - Sangeetha Shyam
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Universitat Rovira i Virgili, Unitat de Nutrició Humana, Grup ANUT-DSM, Departament de Bioquimica i Biotecnologia, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - María L Miguel-Berges
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2). Faculty of Health Sciences. Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009, Zaragoza, Spain
| | - J Alfredo Martínez
- Center for Nutrition Research, University of Navarra, 31008, Pamplona, Spain
- Dept Nutr Food Sci & Physiol, Fac Pharm & Nutr, University of Navarra, 31008, Pamplona, Spain
- IdisNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Pilar Codoñer-Franch
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Departament of Preventive Medicine and Public Health. Department of Pediatrics, Obstetrics and Gynecology., University of Valencia, Valencia, Spain
| | - Mercedes Gil-Campos
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Luis A Moreno
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2). Faculty of Health Sciences. Universidad de Zaragoza, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), 50009, Zaragoza, Spain
| | - Jordi Salas-Salvadó
- CIBER. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Universitat Rovira i Virgili, Unitat de Nutrició Humana, Grup ANUT-DSM, Departament de Bioquimica i Biotecnologia, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
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Yi J, Song G, Lin Z, Peng Y, Wu J. Validity and Reproducibility of Food Group-Based Food Frequency Questionnaires in Assessing Sugar-Sweetened Beverage Consumption Habits among Chinese Middle-School Students. Nutrients 2023; 15:3928. [PMID: 37764712 PMCID: PMC10537416 DOI: 10.3390/nu15183928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/05/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Assessing the intake of sugar-sweetened beverages (SSBs) is crucial for reducing obesity; however, a simple but relatively accurate method for determining added sugar consumption among school adolescents is lacking. The aim of this study was to evaluate the reproducibility and validity of a food group-based food frequency questionnaire (FG-FFQ) for SSBs in assessing SSB consumption and added sugar among middle-school students. A total of 242 school students completed the FG-FFQs twice and four discontinuous 24-h dietary records (24HDR) over a three-month period. A weighted average approach was used to obtain the average sugar content in the sugary drink food group (FG). Correlation coefficient, weighted kappa statistic, misclassification analysis, and Bland-Altman plot were used to evaluate the validity and reproducibility of the FG-FFQ. Linear regression was utilized to obtain the calibration formulas. The average content of added sugar in sugary drink FG was 8.1 g/100 mL. SSB consumption frequency, consumption amount, and added sugar had correlation coefficients of 0.81, 0.87, and 0.87, respectively, in the validity analysis (p < 0.05). The majority of scatter plots were covered by 95% confidence intervals in the Bland-Altman bias analysis. The intra-class correlation coefficient of SSB consumption frequency and Spearman correlation coefficient of SSB consumption amount and added sugar were 0.74, 0.81, and 0.90, respectively, in the reproducibility analysis (p < 0.05). Results produced by the FG-FFQ calibration formula were more comparable to 24HDR. The FG-FFQ for SSB consumption showed acceptable validity and reproducibility, making it a viable instrument for epidemiological studies on sugary drinks in adolescents.
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Affiliation(s)
- Junyao Yi
- School of Public Health, Nanjing Medical University, Nanjing 211166, China; (J.Y.); (G.S.)
| | - Guoye Song
- School of Public Health, Nanjing Medical University, Nanjing 211166, China; (J.Y.); (G.S.)
| | - Zhenghao Lin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; (Z.L.); (Y.P.)
| | - Yuting Peng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; (Z.L.); (Y.P.)
| | - Jieshu Wu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China; (Z.L.); (Y.P.)
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Vitamin D Supplementation, Characteristics of Mastication, and Parent-Supervised Toothbrushing as Crucial Factors in the Prevention of Caries in 12- to 36-Month-Old Children. Nutrients 2022; 14:nu14204358. [PMID: 36297042 PMCID: PMC9607142 DOI: 10.3390/nu14204358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Severe early childhood caries (S-ECC), defined as any sign of smooth-surface caries in a child younger than three years of age, remains a serious health issue. The aim of this study was to indicate oral health behaviours related to S-ECC. The study surveyed parents (socio-economic and medical factors, oral health behaviours) and clinically examined children including non-cavitated d1,2/cavitated d ≥ 3 lesions. %S-ECC, and caries indices (d1,2 d ≥ 3 mft and d1,2 d ≥ 3 mfs) were calculated. Spearman’s correlation and simple and multiple logistic regression were used to assess the relationships between various factors and S-ECC. A total of 496 children were examined. S-ECC occurred in 44.8%: d1,2 d ≥ 3 mft = 2.62 ± 3.88, d1,2 d ≥ 3 mfs = 4.46 ± 8.42. S-ECC was correlated with socio-economic factors, vitamin D supplementation, breastfeeding and using formula after the 18th month, and toothbrushing. Supplementation of vitamin D and toothbrushing tended to decrease the odds of S-ECC (OR = 0.49 (0.27−0.87); p = 0.016, OR = 0.46 (0.24−0.86) p = 0.015, respectively). Feeding exclusively with formula was observed to increase the odds of S-ECC (OR = 2.20 (1.29−3.76); p = 0.004). Consuming > three snacks daily (OR = 1.39 (0.97−1.98); p = 0.072) and the reluctance to eat resilient foods (OR = 1.63 (1.05−2.51); p = 0.028) were nullified by the confounding factors. Vitamin D supplementation, mastication of resilient food, breastfeeding in the first six months of a baby’s life, and parent-supervised toothbrushing are factors in the prevention of caries in toddlers. Breast- and bottle-feeding after the 18th month of life, the reluctance to eat solids, lack of vitamin D supplementation, hygienic neglect, and delay in introducing oral health behaviours may contribute to the development of caries in toddlers.
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Hoeylaerts S, Van Opstal A, Huybrechts I, Koppen G, Devlieger R, Godderis L, Pauwels S. Validation of a food-frequency questionnaire to assess methyl-group donor intake in preschoolers. Eur J Pediatr 2022; 181:1871-1881. [PMID: 35029741 DOI: 10.1007/s00431-021-04367-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/26/2022]
Abstract
A good assessment of dietary methyl-group donor intake (folate, choline, betaine, methionine) is needed to investigate the effect of methyl-group donor intake on children's health. The aim is to develop and validate a food-frequency questionnaire (FFQ) to estimate the daily intake of methyl-group donors in preschoolers. For the relative validity and reproducibility of the FFQ, a 7-day estimated dietary record (7d EDR) and repeated measurements 6 weeks apart (n = 77) were used respectively. For the validity (n = 75), a moderate ranking ability was obtained (de-attenuated Pearson correlation = 0.43-0.70; weighted ƙ 0.10-0.40), but the FFQ tends to overestimate the real intake. Cross-classification analysis showed that 38% (choline) and 28% (betaine) of the subjects were misclassified. The FFQ shows a moderate to good reproducibility, intra-class correlation coefficients range between 0.67 (betaine) and 0.76 (choline) with a maximal misclassification of 6.5% for betaine (weighted ƙ 0.37-0.69) (n = 77). CONCLUSION The FFQ is a tool with a moderate validity and reproducibility to estimate the consumption of dietary methyl-group donors in preschoolers. This tool might be used in future research epidemiological studies including preschoolers. WHAT IS KNOWN • Poor dietary habits during childhood have been associated with chronic disease in adulthood. • Methyl-group donors are important for DNA methylation, which is the underlying mechanism of disease development. WHAT IS NEW • For the first time, a food-frequency questionnaire that can assess the intake of methione, folate, choline, and betaine has been developed and validated for the use in preschoolers.
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Affiliation(s)
- Sarah Hoeylaerts
- Environment and Health, KU Leuven-University of Leuven, Kapucijnenvoer 35, Blok D, 3000, Leuven, Belgium
| | - Annelies Van Opstal
- Environment and Health, KU Leuven-University of Leuven, Kapucijnenvoer 35, Blok D, 3000, Leuven, Belgium
| | | | - Gudrun Koppen
- Flemish Institute of Technological Research (VITO), Mol, Belgium
| | - Roland Devlieger
- Environment and Health, KU Leuven-University of Leuven, Kapucijnenvoer 35, Blok D, 3000, Leuven, Belgium
- University Hospitals of Leuven, Leuven, Belgium
| | - Lode Godderis
- Environment and Health, KU Leuven-University of Leuven, Kapucijnenvoer 35, Blok D, 3000, Leuven, Belgium
- External Service for Prevention and Protection at Work, IDEWE, Heverlee, Belgium
| | - Sara Pauwels
- Environment and Health, KU Leuven-University of Leuven, Kapucijnenvoer 35, Blok D, 3000, Leuven, Belgium.
- Flemish Institute of Technological Research (VITO), Mol, Belgium.
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Cheng XJ, Li GB, Zhang SS, Liu Y, Dong YC, Xue-Ning-Li. Factors associated with blood lead levels in children in Shenyang, China: a cross-sectional study. BMC Pediatr 2022; 22:122. [PMID: 35272651 PMCID: PMC8908648 DOI: 10.1186/s12887-022-03182-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 03/01/2022] [Indexed: 12/02/2022] Open
Abstract
Background Although blood lead levels (BLLs) in children are gradually decreasing, low-concentration lead exposure can still exert adverse effects. We studied the factors that affect BLLs in children in Shenyang, China. Methods We conducted a cross-sectional study by administering structured questionnaires on family demographics and food intake. The concentrations of lead in venous blood were determined by graphite furnace atomic absorption spectrometry. Results A total of 273 children aged 1–6 years were enrolled. The geometric mean (geometric standard deviation) of BLLs was 24.94 (12.70) μg/L in boys and 23.75 (11.34) μg/L in girls. The prevalence of BLLs of ≥35 μg/L was 22.7% and was mainly observed in children aged under 3 years. Often hand washing before meals was protective against BLLs ≥20 μg/L (adjusted OR: 0.427, 95%CI: 0.238–0.767, p = 0.004). Consumption of puffed grains and eggs had an adjusted OR (95%CI) for BLLs ≥20 μg/L of 1.714 (1.012–2.901) (p = 0.045) and 1.787 (1.000–3.192) (p = 0.050), respectively. Conclusions BLLs of children in Shenyang are still higher than in developed countries. Consumption of puffed grains and eggs is associated with higher BLLs. Often hand washing before meals may be protective against high BLLs.
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Affiliation(s)
- Xiao-Jun Cheng
- Department of Pediatrics, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Guang-Bo Li
- Department of Child and Adolescent Health, School of Public Health, China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Shuang-Shuang Zhang
- Department of Pediatrics, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Ying Liu
- Department of Pediatrics, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Yi-Chen Dong
- Department of Pediatrics, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China
| | - Xue-Ning-Li
- Department of Pediatrics, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
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Validity and Reliability of Semiquantitative Food Frequency Questionnaires for Assessing Nutrient Intake among Preschool Children in Northwest China. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1677252. [PMID: 35070224 PMCID: PMC8769832 DOI: 10.1155/2022/1677252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
Abstract
Background Considering the lack of valid and reliable food frequency questionnaires (FFQs) for nutritional epidemiological studies in China, it is necessary to develop an effective one for assessing nutrient intake among preschool children. The aim of this study was to evaluate the validity and reliability of newly developed FFQs for assessing food and nutrient intakes among preschool children in Northwest China. Methods Semiquantitative 67-item FFQs were developed and validated. In total, 326 children (aged 2–6 years) were recruited from three different cities in Northwest China. All subjects were asked to complete the FFQs twice with a six-month interval period for test-retest reliability. Apart from the FFQs, a 3-day food record (3-DFR) was also carried out to evaluate the validity of the FFQs. Results There was no significant difference in the nutrient intakes of preschool children between the two FFQs (P > 0.05), and these two FFQs demonstrated a positive correlation (P < 0.05). Spearman's coefficient correlation values ranged from 0.222 (“Selenium”) to 0.832 (“Energy”). The intraclass correlation coefficient values ranged from 0.282 (“Selenium”) to 0.882 (“Energy”). With regards to the validity of FFQs, nutrient intakes from FFQs were greater than 3DR dietary recalls (P < 0.05). After adjusting for total energy and intraindividual variation, all nutrient intakes showed a positive correlation (P < 0.05), and these correlations became stronger. According to the quartiles of nutrient intakes, the exact agreement between the FFQs and 3DR dietary recalls ranged between 40% (“Selenium”) and 70% (“Energy”), and grossly misclassified was low (12.5%). Conclusions The findings of this study indicate that the designed FFQs exhibit good test-retest reliability and moderate relative validity. Hence, the FFQs can serve as an important tool for the large-scale assessment of food and nutrient intakes among preschool children (in the mentioned areas of China).
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Othman SI, Fertig A, Trofholz A, Berge JM. How time in the US and race/ethnicity shape food parenting practices and child diet quality. Appetite 2021; 171:105870. [PMID: 34973995 DOI: 10.1016/j.appet.2021.105870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 12/07/2021] [Accepted: 12/12/2021] [Indexed: 11/17/2022]
Abstract
Childhood obesity prevalence is high among children from immigrant/refugee households who live in high-income countries. Poor child dietary intake is a critical risk factor for elevated obesity prevalence and food parenting practices have been found to be associated with child dietary intake and eating behaviors. The main aim of this study was to examine the associations between migrants'/refugees' food parenting practices, the length of residence time in the US, race/ethnicity, and child diet quality. The current study included 577 families from three racial/ethnic groups that include mostly foreign-born parents (Latino, Hmong, and Somali/Ethiopian), and a comparison group of 239 non-Hispanic White families. Results showed that for Latino and Hmong parents, some food parenting practices varied by how long they had lived in the US. For example, more recently moved parents engaged in more non-directive (e.g., avoid buying sweets) practices compared with US-born parents. In contrast, Somali/Ethiopian parents engaged in different food parenting practices than White parents, regardless of time in the US. Results also showed that diet quality among Hmong children was lower if their parents were US-born compared to foreign-born. Future researchers may want to consider studying why some food parenting practices change when parents move to the US and explore whether there is a combination of food parenting practices that are most useful in promoting a healthful child's diet and weight among immigrant and refugee families.
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Affiliation(s)
- Sally I Othman
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St SE, Suite 425, Minneapolis, MN, 55414, USA.
| | - Angela Fertig
- University of Minnesota, Humphrey School of Public Affairs, USA
| | - Amanda Trofholz
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St SE, Suite 425, Minneapolis, MN, 55414, USA
| | - Jerica M Berge
- Department of Family Medicine and Community Health, University of Minnesota Medical School, 717 Delaware St SE, Suite 425, Minneapolis, MN, 55414, USA
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9
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Raspini B, Prosperi M, Guiducci L, Santocchi E, Tancredi R, Calderoni S, Morales MA, Morelli M, Simione M, Fiechtner L, Muratori F, Cena H. Dietary Patterns and Weight Status in Italian Preschoolers with Autism Spectrum Disorder and Typically Developing Children. Nutrients 2021; 13:4039. [PMID: 34836294 PMCID: PMC8617730 DOI: 10.3390/nu13114039] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 12/18/2022] Open
Abstract
Atypical eating habits are more common in children with autism spectrum disorders (ASD) than typically developing (TD) peers. Feeding problems may lead to the double burden of specific nutrient deficiencies and excessive weight gain, with a consequent increase in obesity prevalence. The dietary intake of Italian preschoolers with ASD compared to their TD peers and the impact of their dietary choices on their weight status and relationship to food selectivity (FS) were investigated. Dietary patterns and their associations with body mass index (BMI) were evaluated in 65 children with ASD and 82 peers with TD aged 1.3-6.4 years. Eating habits were assessed with a modified version of a parent-rated semi-quantitative Food Frequency Questionnaire. Moreover, the prevalence of FS and possible links with dietary patterns and BMI were investigated in the ASD group. Children with ASD consumed significantly higher amounts of simple sugars, processed and ultra-processed carbohydrates, both low- and high-fat animal proteins, and lower amounts of vegetables and fruits compared to peers with TD. The obesity rate was 1.5% in children with TD and more than fourfold (6.2%) in children with ASD, although the difference between groups was not statistically significant. FS was significantly more frequent in children with ASD than in peers with TD. Children with ASD and FS showed significantly lower annual intakes of vegetable proteins and fiber (considered essential nutrients for a healthy diet) than children with ASD without FS. Our results showed that children with ASD showed different dietary habits than those with TD, with the higher consumption of energy-dense foods and lower amounts of food-sourced fibers, which could place them at increased risk to develop overweight, obesity, and micronutrient deficiencies later in life.
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Affiliation(s)
- Benedetta Raspini
- Department of Public Health, Neurosciences, Experimental and Forensic Medicine, Section of Human Nutrition, University of Pavia, Via Agostino Bassi, 21, 27100 Pavia, Italy
| | - Margherita Prosperi
- Developmental Psychiatry Unit, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy
| | - Letizia Guiducci
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy
| | - Elisa Santocchi
- Developmental Psychiatry Unit, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Raffaella Tancredi
- Developmental Psychiatry Unit, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
| | - Sara Calderoni
- Developmental Psychiatry Unit, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy
| | - Maria Aurora Morales
- Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy
| | - Mariangela Morelli
- Department of Public Health, Neurosciences, Experimental and Forensic Medicine, Section of Human Nutrition, University of Pavia, Via Agostino Bassi, 21, 27100 Pavia, Italy
| | - Meg Simione
- Department of Pediatrics, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA 02114, USA
| | - Lauren Fiechtner
- Division of Gastroenterology and Nutrition, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA 02114, USA
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 55 Fruit Street, Boston, MA 02114, USA
| | - Filippo Muratori
- Developmental Psychiatry Unit, IRCCS Stella Maris Foundation, Viale del Tirreno 331, 56128 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi 10, 56126 Pisa, Italy
| | - Hellas Cena
- Department of Public Health, Neurosciences, Experimental and Forensic Medicine, Section of Human Nutrition, University of Pavia, Via Agostino Bassi, 21, 27100 Pavia, Italy
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, Via S. Maugeri 10, 27100 Pavia, Italy
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10
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Huybrechts I, Miglio R, Mistura L, Grioni S, Pozzebon I, Odorifero C, Borea R, Gitto A, Terrafino M, Scipioni M, Turrini A, Krogh V, Ricci S, Martucci G, Longhi A. Relative Validity of an Italian EPIC Food Frequency Questionnaire for Dietary Factors in Children and Adolescents. A Rizzoli Orthopedic Institute Study. Nutrients 2021; 13:1245. [PMID: 33918879 PMCID: PMC8069881 DOI: 10.3390/nu13041245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 11/17/2022] Open
Abstract
Dietary factors play a major role in the development of non-communicable diseases, however little is known regarding the impact of nutrition on rare diseases like sarcomas. This Rizzoli Orthopedic Institute study aimed to evaluate the relative validity of a Food Frequency Questionnaire (FFQ) to measure the consumption of foods in comparison with a 3-days diary diet in a healthy Italian student population aged between 12 and 17 years. An extended version (including food groups for children) of the semi-quantitative FFQ used in the European Prospective Investigation into Cancer and Nutrition (EPIC) was administered. The validity of the FFQ was assessed by comparing the intakes from the FFQ against the 3-day diary method. 254 Italian subjects were included in the analyses: 128 females; 126 males; 116 from High Secondary School (14-17 years); 138 from Low Secondary School (12-13 years). Mean and median intakes are overall higher in the FFQs than in the food diaries. Spearman correlations adjusted for within-person variability were highest for legumes, vegetables and coffee/tea (>0.5), followed by potatoes, meat, fruits, breakfast cereals, biscuits and candies, and milk/yoghurts (>0.4). Moderate correlations were found for alcoholic drinks, soft drinks, juices, and grains (>0.3). For some food groups, such as fish, potatoes, and bread, correlations tend to become higher when stratifying the analyses for age group. These results demonstrate that the adapted EPIC COS FFQ validated in Italian adults is also appropriate and well understood by Italian children and adolescents.
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Affiliation(s)
- Inge Huybrechts
- International Agency for Research on Cancer, World Health Organization, 69372 Lyon, France;
| | - Rossella Miglio
- Dipartimento Scienze Statistiche “Paolo Fortunati”, University of Bologna, 40126 Bologna, Italy;
| | - Lorenza Mistura
- Council for Agricultural Research and Economics, Research on Food Nutrition, 00178 Roma, Italy; (L.M.); (A.T.)
| | - Sara Grioni
- Fondazione IRCCS Istituto Nazionale dei Tumori, Epidemiology and Prevention Unit, 20133 Milano, Italy; (S.G.); (V.K.)
| | - Irene Pozzebon
- LILT, Lega Italiana Lotta Contro Tumori Association, 00178 Roma, Italy; (I.P.); (C.O.); (M.S.); (G.M.)
| | - Carmen Odorifero
- LILT, Lega Italiana Lotta Contro Tumori Association, 00178 Roma, Italy; (I.P.); (C.O.); (M.S.); (G.M.)
| | - Renato Borea
- Epidemiology and Prevention Unit (EPIC), University Federico II, 80135 Napoli, Italy;
| | - Angelo Gitto
- Istituto Ortopedico Rizzoli, IRCCS, Dietetic Service, 40136 Bologna, Italy; (A.G.); (M.T.); (S.R.)
| | - Mariela Terrafino
- Istituto Ortopedico Rizzoli, IRCCS, Dietetic Service, 40136 Bologna, Italy; (A.G.); (M.T.); (S.R.)
| | - Mattia Scipioni
- LILT, Lega Italiana Lotta Contro Tumori Association, 00178 Roma, Italy; (I.P.); (C.O.); (M.S.); (G.M.)
| | - Aida Turrini
- Council for Agricultural Research and Economics, Research on Food Nutrition, 00178 Roma, Italy; (L.M.); (A.T.)
| | - Vittorio Krogh
- Fondazione IRCCS Istituto Nazionale dei Tumori, Epidemiology and Prevention Unit, 20133 Milano, Italy; (S.G.); (V.K.)
| | - Susanna Ricci
- Istituto Ortopedico Rizzoli, IRCCS, Dietetic Service, 40136 Bologna, Italy; (A.G.); (M.T.); (S.R.)
| | - Gianfranco Martucci
- LILT, Lega Italiana Lotta Contro Tumori Association, 00178 Roma, Italy; (I.P.); (C.O.); (M.S.); (G.M.)
| | - Alessandra Longhi
- Istituto Ortopedico Rizzoli, IRCCS, Chemotherapy Unit, 40136 Bologna, Italy
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11
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Huffhines L, Gusler S, Jackson Y. Adversity exposure and obesogenic food consumption in young children: The transgenerational role of emotion dysregulation. Pediatr Obes 2020; 15:e12658. [PMID: 32437081 PMCID: PMC8087181 DOI: 10.1111/ijpo.12658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/21/2020] [Accepted: 04/27/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Childhood adversity is linked with unhealthy eating behaviours and obesity, but the mechanisms underlying this association are unclear, specifically the transgenerational behavioural precursors that develop in early childhood. OBJECTIVE To determine whether adversity predicts change in obesogenic food consumption through child emotion dysregulation, and whether caregiver emotion dysregulation modifies this association. METHODS Participants included 190 low-income caregiver-child dyads (mean child age = 4.31 years [SD = 0.85]). Cumulative lifetime adversity exposure was assessed via study-created measure. The Difficulties with Emotion Regulation Scale and Emotion Regulation Checklist assessed caregiver and child emotion dysregulation, respectively. Children's obesogenic food consumption was assessed at two time points 6 months apart using a caregiver-report measure: the Children's Eating Habits Questionnaire. Moderated mediation models were tested using autoregressive structural equation modelling. RESULTS Cumulative lifetime adversity was associated with child emotion dysregulation only when caregiver emotion dysregulation was high. Child emotion dysregulation in turn was associated with greater obesogenic food consumption 6 months later. CONCLUSIONS Among young children with caregivers high in emotion dysregulation, cumulative lifetime adversity was linked to an increase in obesogenic food consumption through child emotion dysregulation.
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Affiliation(s)
- Lindsay Huffhines
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island,Bradley/Hasbro Children's Research Center, E.P. Bradley Hospital, Providence, Rhode Island
| | - Stephanie Gusler
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas
| | - Yo Jackson
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas,Department of Psychology, Pennsylvania State University, University Park, Pennsylvania
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12
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Validity and reproducibility of a semi-quantitative food frequency questionnaire in Spanish preschoolers - The SENDO project. NUTR HOSP 2020; 37:672-684. [PMID: 32686450 DOI: 10.20960/nh.03003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction Introduction: currently, it is important to determine whether food frequency questionnaires (FFQ) are valid tools to collect information on usual diet in children. Objective: we evaluated the reproducibility and validity of the semi-quantitative FFQ used in a Spanish cohort of children aged 4-7 years. Methods: to explore its reproducibility, parents filled a 138-item FFQ at baseline (FFQ-0) and then one year later (FFQ-1). To explore its validity, the FFQ-1 was compared with four weighed 3-day dietary records (DRs) that were used as standard of reference. To estimate associations we calculated deattenuated Pearson's correlation coefficients to correct for season-to-season variability, and the Bland-Altman index. We also calculated the weighted kappa index and assessed participant's gross misclassification across quintiles. We analyzed data from 67 (for reproducibility) and 37 (for validity) children aged 4-7 years old, recruited by the pilot study of the SENDO project. Results: regarding reproducibility, we found mean Bland-Altman indexes of 0-10.45 % for nutrients and 1.49 %-10.45 % for foods. The adjusted r ranged between 0.29 and 0.71, and between 0.27 and 0.74 for nutrients and foods, respectively. Regarding validity, we found mean Bland-Altman indexes of 0 %-16.22 % and 0 %-10.81 % for nutrients and for food groups, respectively. The deattenuated r ranged between 0.38 and 0.81 for nutrients, and between 0.53 and 0.68 for foods. The weighted kappa index for agreement across quintiles ranged from 54.1 to 85.1 for nutrients, and from 55.4 to 78.4 for food groups. Conclusions: our results showed acceptable levels of both reproducibility and validity, and that the ad-hoc developed FFQ is a valid tool for assessing usual diet in Spanish preschoolers.
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Van De Maele K, De Geyter C, Vandenplas Y, Gies I, Devlieger R. Eating Habits of Children Born after Maternal Bariatric Surgery. Nutrients 2020; 12:E2577. [PMID: 32854290 PMCID: PMC7551775 DOI: 10.3390/nu12092577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 12/14/2022] Open
Abstract
Mothers who underwent bariatric surgery (BS) before pregnancy have worrisome eating habits, but little is known about the eating habits of their offspring. EFFECTOR is a cross-sectional, long-term follow-up study of 4-11-year-old children born from mothers that underwent bariatric surgery before pregnancy (n = 36), mothers with overweight/obesity (OW/OB) in a control group (n = 71), and mothers with a normal weight (NW) in a second control group (n = 35). Data on anthropometry and on eating habits obtained through a Food Frequency Questionnaire were collected prospectively. The children's body mass index (BMI) scores significantly correlated with maternal pre-pregnancy BMI. The prevalence of overweight and obesity was the highest in children of the BS group (38.9% vs. 15.5% for children of the OW/OB group and 5.7% for those of the NW group; p = 0.004). Meal-skipping behavior was comparable between the groups. There was no difference in fruit and vegetable consumption. The BS group consumed more low-calorie sweetened beverages compared to the NW group (p = 0.01) but less fruit juice compared to the NW and OW/OB groups (p = 0.01). Our results may indicate a sugar-avoiding behavior in children of the BS group, fitting dietary maternal habits in a strategy to prevent dumping syndrome. In conclusion, maternal pre-pregnancy bariatric surgery does not alter unhealthy eating behaviors and the risk of development of overweight during childhood in their children.
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Affiliation(s)
- Karolien Van De Maele
- Pediatric Endocrinology, KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (K.V.D.M.); (I.G.)
- Research Unit Organ Systems, Department of Development and Regeneration, Catholic University of Leuven, 3000 Leuven, Belgium
- Research Unit GRON, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Charlotte De Geyter
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Yvan Vandenplas
- Research Unit GRON, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
- KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Inge Gies
- Pediatric Endocrinology, KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, 1090 Brussels, Belgium; (K.V.D.M.); (I.G.)
- Research Unit GRON, Vrije Universiteit Brussel, 1090 Brussels, Belgium;
| | - Roland Devlieger
- Research Unit Organ Systems, Department of Development and Regeneration, Catholic University of Leuven, 3000 Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospital of Leuven, 3000 Leuven, Belgium
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14
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Relative validity of FFQ to assess food items, energy, macronutrient and micronutrient intake in children and adolescents: a systematic review with meta-analysis. Br J Nutr 2020; 125:792-818. [PMID: 32807247 DOI: 10.1017/s0007114520003220] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
FFQ are one of the most widely used tools of research into nutritional epidemiology, and many studies have been conducted in several countries using this dietary assessment method. The present study aimed to evaluate the relative validity of FFQ, in comparison with other methods, in assessing dietary intake of children and adolescents, through a systematic review. Four electronic databases (Embase, PubMed, Scopus and Web of Science) found sixty-seven articles, which met the inclusion criteria (healthy children and adolescents from 3 to 18 years of age; journal articles written in English, Spanish and Portuguese between 1988 and March 2019; results showing the comparison between the FFQ with other methods of assessment of dietary intake). The articles were analysed by two independent reviewers. A meta-analysis was conducted using correlation coefficients as estimate effects between the FFQ and the reference standard method. Subgroup analysis and meta-regression were performed to identify the probable source of heterogeneity. In fifty-five of the sixty-seven studies, a single dietary assessment method was used to evaluate the FFQ; nine combined the two methods and three used three reference methods. The most widely used reference method was the 24-h recall, followed by the food record. The overall relative validity of the FFQ to estimate energy, macronutrient, certain micronutrient and certain food item intakes in children and adolescents may be considered weak. The study protocol was registered in PROSPERO under number CRD42016038706.
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Zheng M, Campbell KJ, Scanlan E, McNaughton SA. Development and evaluation of a food frequency questionnaire for use among young children. PLoS One 2020; 15:e0230669. [PMID: 32210467 PMCID: PMC7094848 DOI: 10.1371/journal.pone.0230669] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 03/05/2020] [Indexed: 12/03/2022] Open
Abstract
Background/Objectives This study described the development of a parent food frequency questionnaire (FFQ) for measuring diets of young children over the past month and the validation of this FFQ against three non-consecutive 24 hour recalls. Subjects/Methods Food and nutrient intakes from a 68-item FFQ were compared with three non-consecutive 24 hour recalls in a follow-up cohort of children aged 1.5, 3.5 and 5.0 years old. Data from both methods were available for 231, 172 and 187 participants at ages 1.5, 3.5 and 5.0 years, respectively. Results Out of 11 nutrients, four (protein, fat, fibre, iron), two (Vitamin C, folate) and three (protein, vitamin C and folate) nutrients showed good-acceptable outcome for 2 out of 3 group-level validation tests at ages 1.5, 3.5 and 5.0 years, respectively. Of 26 food groups, good-acceptable outcome for 2 out of 3 group-level validation tests was revealed for two, four and six food groups at ages 1.5, 3.5 and 5.0 years, respectively. For individual-level validation tests, all nutrients showed good-acceptable outcome for 2 out of 3 individual level tests across three time points, except for folate at age 1.5 years and energy intake at age 3.5 years. Most food groups (22 out of 26) at age 1.5 years and all food groups at both ages 3.5 and 5.0 years showed good-acceptable outcome for 2 out of 3 individual-level validation tests. Conclusions At all three time points, the FFQ demonstrated good-acceptable validity for some nutrients and food groups at group-level, and good-acceptable validity for most nutrients and food groups at individual-level. This quantitative FFQ is a valid and robust tool for assessing total diet of young children and ranking individuals according to nutrient and food intakes.
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Affiliation(s)
- Miaobing Zheng
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
- * E-mail:
| | - Karen J. Campbell
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
| | - Emily Scanlan
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
| | - Sarah A. McNaughton
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition (IPAN), Deakin University, Burwood, Victoria, Australia
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Abstract
Introduction Introduction: validated food frequency questionnaires in children are scarce, mostly long, and only provide data about food consumption. Objectives: the aim of this study was to evaluate the reproducibility and validity of a short food frequency questionnaire that estimates energy, nutritional intake, and the frequency of food consumption in children aged between 3 and 6 years. Material and methods: in 49 children (57% boys), the reproducibility and validity of a frequency questionnaire with 41 items was assessed using Spearman's and intraclass correlations, both adjusted and not adjusted for energy. A 6-day record was used as a reference method. Results: reproducibility was high in food groups with correlations > 0.70 for most of them and between 0.5 and 0.7 for meat, fish, potatoes, sweets/soft drinks, and oil. For energy and nutrients correlations were > 0.9 and > 0.7, respectively. Validity was strong to moderate for foods with correlations > 0.7 (dairy and milk) and between 0.4 and 0.7 (sausages, eggs, yogur/cheese, vegetables and oil), and for nutrients with correlations > 0.5 (lipids, AGS, AGP, phosphorus, calcium, vitamin E and vitamin C) and between 0.3 and 0.5 (energy, starches, fiber, MUFA, cholesterol, sodium, magnesium, potassium, retinol, riboflavin, niacin, pantothenic acid, vitamin B6 and folates). All correlations were significant and increased after they had been adjusted for energy. Conclusions: the short food frequency questionnaire for children between 3 and 6 years old has high reproducibility and good validity with results that are as good as those of long food frequency questionnaires.
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Gibson EL, Androutsos O, Moreno L, Flores-Barrantes P, Socha P, Iotova V, Cardon G, De Bourdeaudhuij I, Koletzko B, Skripkauskaite S, Manios Y. Influences of Parental Snacking-Related Attitudes, Behaviours and Nutritional Knowledge on Young Children's Healthy and Unhealthy Snacking: The ToyBox Study. Nutrients 2020; 12:nu12020432. [PMID: 32046193 PMCID: PMC7071198 DOI: 10.3390/nu12020432] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 12/25/2022] Open
Abstract
This study investigated parental influences on preschool children's healthy and unhealthy snacking in relation to child obesity in a large cross-sectional multinational sample. Parents and 3-5 year-old child dyads (n = 5185) in a kindergarten-based study provided extensive sociodemographic, dietary practice and food intake data. Parental feeding practices that were derived from questionnaires were examined for associations with child healthy and unhealthy snacking in adjusted multilevel models, including child estimated energy expenditure, parental education, and nutritional knowledge. Parental healthy and unhealthy snacking was respectively associated with their children's snacking (both p < 0.0001). Making healthy snacks available to their children was specifically associated with greater child healthy snack intake (p < 0.0001). Conversely, practices that were related to unhealthy snacking, i.e., being permissive about unhealthy snacking and acceding to child demands for unhealthy snacks, were associated with greater consumption of unhealthy snacks by children, but also less intake of healthy snacks (all p < 0.0001). Parents having more education and greater nutritional knowledge of snack food recommendations had children who ate more healthy snacks (all p < 0.0001) and fewer unhealthy snacks (p = 0.002, p < 0.0001, respectively). In the adjusted models, child obesity was not related to healthy or unhealthy snack intake in these young children. The findings support interventions that address parental practices and distinguish between healthy and unhealthy snacking to influence young children's dietary patterns.
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Affiliation(s)
- Edward Leigh Gibson
- Department of Psychology, University of Roehampton, London SW15 4JD, UK;
- Correspondence:
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Physical Education, Sport Science and Dietetics, University of Thessaly, 42132 Trikala, Greece
| | - Luis Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Edificio del SAI, C/Pedro Cerbuna s/n, 50009 Saragossa, Spain; (L.M.); (P.F.-B.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Saragossa, Spain
- Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Saragossa, Spain
| | - Paloma Flores-Barrantes
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Faculty of Health Sciences, University of Zaragoza, Edificio del SAI, C/Pedro Cerbuna s/n, 50009 Saragossa, Spain; (L.M.); (P.F.-B.)
- Instituto Agroalimentario de Aragón (IA2), 50013 Saragossa, Spain
- Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), 50009 Saragossa, Spain
| | - Piotr Socha
- The Children’s Memorial Health Institute, 04-730 Warsaw, Poland;
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, 9002 Varna, Bulgaria;
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium; (G.C.); (I.D.B.)
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium; (G.C.); (I.D.B.)
| | - Berthold Koletzko
- Dr von Hauner Children’s Hospital, LMU-Ludwig-Maximilians-University at Munich, D-80337 Munich, Germany;
| | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece;
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Noor Hafizah Y, Ang LC, Yap F, Nurul Najwa W, Cheah WL, Ruzita AT, Jumuddin FA, Koh D, Lee JAC, Essau CA, Reeves S, Summerbell C, Leigh Gibson E, Poh BK. Validity and Reliability of a Food Frequency Questionnaire (FFQ) to Assess Dietary Intake of Preschool Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234722. [PMID: 31783477 PMCID: PMC6926524 DOI: 10.3390/ijerph16234722] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/28/2019] [Accepted: 11/08/2019] [Indexed: 12/19/2022]
Abstract
As there are few food frequency questionnaires (FFQ) to assess the dietary intake of preschool children, this study examined the validity and reliability of an FFQ for this purpose. A total of 210 preschoolers aged 4 to 6 years participated in the validation study, while a subsample of 66 participants joined the reliability study. The FFQ is modified from the ToyBox-study and South East Asian Nutrition Surveys (SEANUTS), and comprised 108 food items from 13 food groups. A three-day estimated dietary record (3DR) was used as reference and reliability was assessed through a second administration of the FFQ (FFQ2), four weeks after the first administration (FFQ1). For the validation study, Spearman’s correlation coefficients showed moderate to high correlations (p < 0.001) between FFQ and 3DR. Cross-classification of quartile analysis showed moderate agreement between the two methods. As for reliability, Spearman’s correlation coefficients showed moderate to high correlations (p < 0.001) between FFQ1 and FFQ2. Cronbach’s alpha values (0.708 to 0.824) and intraclass correlation coefficients (0.710 to 0.826) showed good agreement between repeated FFQs. The results suggest that the FFQ has acceptable validity and good reliability. Hence, the FFQ can be used to assess preschool children’s food intake.
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Affiliation(s)
- Yatiman Noor Hafizah
- Nutritional Sciences Programme & Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (Y.N.H.); (L.C.A.); (F.Y.); (W.N.N.); (A.T.R.); (F.A.J.)
| | - Lee Choo Ang
- Nutritional Sciences Programme & Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (Y.N.H.); (L.C.A.); (F.Y.); (W.N.N.); (A.T.R.); (F.A.J.)
| | - Fendy Yap
- Nutritional Sciences Programme & Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (Y.N.H.); (L.C.A.); (F.Y.); (W.N.N.); (A.T.R.); (F.A.J.)
| | - Wan Nurul Najwa
- Nutritional Sciences Programme & Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (Y.N.H.); (L.C.A.); (F.Y.); (W.N.N.); (A.T.R.); (F.A.J.)
| | - Whye Lian Cheah
- Department of Community Medicine and Public Health, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan 94300, Sarawak, Malaysia;
| | - Abd Talib Ruzita
- Nutritional Sciences Programme & Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (Y.N.H.); (L.C.A.); (F.Y.); (W.N.N.); (A.T.R.); (F.A.J.)
| | - Farra Aidah Jumuddin
- Nutritional Sciences Programme & Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (Y.N.H.); (L.C.A.); (F.Y.); (W.N.N.); (A.T.R.); (F.A.J.)
| | - Denise Koh
- Sports and Recreation Programme & Centre for Education and Community Well-being, Faculty of Education, Universiti Kebangsaan Malaysia, Bangi 43600, Selangor, Malaysia;
| | - Julia Ai Cheng Lee
- Faculty of Cognitive Sciences and Human Development, Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan 94300, Sarawak, Malaysia;
| | - Cecilia A. Essau
- Department of Psychology, University of Roehampton, London SW15 4JD, UK; (C.A.E.); (E.L.G.)
| | - Sue Reeves
- Department of Life Sciences, University of Roehampton, London SW15 4JD, UK;
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham DH1 3HN, UK;
| | - Edward Leigh Gibson
- Department of Psychology, University of Roehampton, London SW15 4JD, UK; (C.A.E.); (E.L.G.)
| | - Bee Koon Poh
- Nutritional Sciences Programme & Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (Y.N.H.); (L.C.A.); (F.Y.); (W.N.N.); (A.T.R.); (F.A.J.)
- Correspondence: ; Tel.: +603-9289-7686 (ext. 7511); Fax: +603-2694-7621
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Mouratidou T, Mesana Graffe MI, Huybrechts I, De Decker E, De Craemer M, Androutsos O, Manios Y, Galcheva S, Lateva M, Gurzkowska B, Kułaga Z, Birnbaum J, Koletzko B, Moreno LA. Reproducibility and relative validity of a semiquantitative food frequency questionnaire in European preschoolers: The ToyBox study. Nutrition 2019; 65:60-67. [PMID: 31029924 DOI: 10.1016/j.nut.2019.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 02/09/2019] [Accepted: 03/13/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to examine the reproducibility and relative validity of a semiquantitative food frequency questionnaire (FFQ) in assessing food group estimates. METHODS Food group estimates were assessed via a 37-item FFQ and a 3-d food record (FR). Pearson's correlation coefficients for log-transformed values were calculated to assess the reproducibility and Spearman's rank correlation coefficients for log-transformed values were calculated to assess the validity. Kindergartens from six European countries participated in the preparatory substudies of the ToyBox intervention study; data from preschool children 4 to 6 y of age (n = 196, reproducibility study; n = 324, validation study) were obtained. RESULTS In the reproducibility study, positive Pearson's correlation coefficients for single and aggregated food groups ranged from 0.14 for pasta and rice to 0.90 for cooked vegetables. In the validation study, the FR gave higher estimates of 40 of the 50 food items (single and aggregated) examined compared with those obtained from the FFQ. Positive crude Spearman rank correlation coefficients ranged from 0.01 for total beverages (added sugar) and rice to 0.62 for tea. Corrections for the deattenuation effect did not improve observed correlations. Quartiles and tertiles were calculated for a small number of food groups (N = 14) owing to zero consumption in the rest of the groups. CONCLUSIONS Moderately good reproducibility and low-moderate relative validity of the FFQ used in preschool children was observed. Relative validity, however, varied by food and beverage group; for some of the "key" foods/drinks targeted in the ToyBox intervention (e.g., biscuits), the validity was good. The findings should be considered in future epidemiologic and intervention studies in preschool children.
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Affiliation(s)
- Theodora Mouratidou
- Instituto Agroalimentario de Aragón (IA2). University of Zaragoza, Zaragoza, Spain
| | - María Isabel Mesana Graffe
- Instituto Agroalimentario de Aragón (IA2). University of Zaragoza, Zaragoza, Spain; Instituto de Investigqación Sanitaria de Aragón, Centro de Investigación Biomédica de Aragón (CIBA) Avda. San Juan Bosco, 13. 50009. Zaragoza, Spain; Red de Salud Materno-infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, Madrid, Spain; Red de Salud Materno-infantil y del Desarrollo.
| | - Inge Huybrechts
- Department of Public Health, Ghent University, Ghent, Belgium; International Agency for Research on Cancer, Lyon, France
| | - Ellen De Decker
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Marieke De Craemer
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Yanis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | | | | | | | | | - Julia Birnbaum
- Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Berthold Koletzko
- Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Luis Alberto Moreno
- Instituto Agroalimentario de Aragón (IA2). University of Zaragoza, Zaragoza, Spain; Instituto de Investigqación Sanitaria de Aragón, Centro de Investigación Biomédica de Aragón (CIBA) Avda. San Juan Bosco, 13. 50009. Zaragoza, Spain; Red de Salud Materno-infantil y del Desarrollo (SAMID), Instituto de Salud Carlos III, Madrid, Spain; Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y Nutrición
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20
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Dietary changes and its psychosocial moderators during the university examination period. Eur J Nutr 2019; 59:273-286. [DOI: 10.1007/s00394-019-01906-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
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21
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Parents' Reports of Preschoolers' Diets: Relative Validity of a Food Frequency Questionnaire and Dietary Patterns. Nutrients 2019; 11:nu11010159. [PMID: 30642103 PMCID: PMC6356196 DOI: 10.3390/nu11010159] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/08/2019] [Accepted: 01/09/2019] [Indexed: 12/19/2022] Open
Abstract
The accurate assessment of food consumption is crucial in nutritional studies. Since modern nutrition science has become more interested in diet as a whole, studies validating food frequency questionnaires (FFQs) and exploratory dietary patterns are needed. We aimed at examining the relative validity of a 47-item FFQ against three-day food records among three- to six-year-old Finnish children, as well as investigating the consistency of the dietary patterns derived using the principal component analysis (PCA), with food record and FFQ data as inputs. We conducted the PCA without forcing the food record data to match the FFQ items. Altogether, 75% or more of the participants were classified into the same or adjacent quarter of vegetables and fruits as well as sugary food consumption. Furthermore, the intake of folate and vitamin C increased linearly in the quarters of vegetable and fruit consumption, as did the intake of sucrose in quarters of sugary food consumption. Three fairly similar dietary patterns were identified from food records and FFQ data. Concerning the patterns, more than 70% of the participants were classified into the same or adjacent quarter. However, the Spearman correlation coefficients between the respective pattern scores were low (0.25–0.33). The FFQ showed acceptable validity when ranking food group consumption compared to food records. Additionally, the FFQ-derived dietary patterns were consistent with those derived using food record data.
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Van De Maele K, Gies I, Devlieger R. Effect of bariatric surgery before pregnancy on the vascular function in the offspring: protocol of a cross-sectional follow-up study. BMJ Paediatr Open 2019; 3:e000405. [PMID: 30815589 PMCID: PMC6361362 DOI: 10.1136/bmjpo-2018-000405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/28/2018] [Accepted: 01/04/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The offspring of obese pregnant women are at risk for adverse metabolic, inflammatory and cardiovascular programming. Comprehensive long-term data are lacking on the contribution of changes in maternal weight after bariatric surgery before pregnancy compared with lifestyle interventions during pregnancy on the cardiovascular programming of the offspring. METHODS EFFECTOR is designed as a cross-sectional cohort follow-up study targeting the children of different groups of women who were previously studied during their pregnancy. Four subgroups of children are identified, based on maternal weight characteristics during pregnancy: normal weight women, obese women without any intervention and obese women who underwent a lifestyle intervention during or bariatric surgery before pregnancy. Data collection is performed as a single study visit at home. Data on the sociodemographic situation, food habits and psychomotor development are obtained through questionnaires. During the home visit, extensive anthropometric and vascular assessment is performed. Information on body composition is provided by assessment of body weight and height, bioelectrical impedance analysis, skinfold measurements and ultrasound. Endothelial function is measured by non-invasive peripheral arterial tonometry (EndoPAT 2000). Biomarkers performed in blood and urinalysis conclude the data collection process. TRIAL REGISTRATION NUMBER NCT02992106 (Pre-results).
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Affiliation(s)
- Karolien Van De Maele
- Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Research Unit Organ Systems, Department of Development and Regeneration, Katholieke Universiteit Leuven Groep Biomedische Wetenschappen, Leuven, Belgium
| | - Inge Gies
- Department of Pediatrics, Division of Pediatric Endocrinology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Roland Devlieger
- Research Unit Organ Systems, Department of Development and Regeneration, Katholieke Universiteit Leuven Groep Biomedische Wetenschappen, Leuven, Belgium.,Department of Obstetrics and Gynecology, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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Allan C, Abdul Kader UH, Ang JYY, Muhardi L, Nambiar S. Relative validity of a semi-quantitative food frequency questionnaire for Singaporean toddlers aged 15-36 months. BMC Nutr 2018; 4:42. [PMID: 32153903 PMCID: PMC7050816 DOI: 10.1186/s40795-018-0252-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 10/03/2018] [Indexed: 02/07/2023] Open
Abstract
Background There is presently no simple tool for use in large epidemiological studies to understand the food and nutrient intakes of Asian toddlers. This study aimed to assess the relative validity of a semi-quantitative food frequency questionnaire (sqFFQ) developed for multi-ethnic Singaporean toddlers aged 15–36 months. Methods Ninety-one parents completed the sqFFQ and a 2-day weighed food record as the reference method. Intake of energy and 25 nutrients were determined for each method and compared using Pearson correlations corrected for attenuation, Bland-Altman plots, and weighted kappa according to quartiles; sqFFQ calibration was performed using multivariable linear regression. Results Deattenuated correlations for energy and all nutrients were acceptable (r = ≥0.30, p < 0.001). The sqFFQ was highly reproducible, but significantly overestimated intake of energy and all nutrients except vitamin A. Bland-Altman plots showed wide limits of agreement for energy and all nutrients. Weighted kappa ranged from 0.12 (slight) to 0.53 (moderate). After calibration, deattenuated correlations improved for energy and 10/25 nutrients, with no change or a slight decline for the remainder, including one falling to r = 0.27. Limits of agreement narrowed for energy and all nutrients, and except for DHA, median intakes were not significantly different except for vitamin A, enabling population estimates of absolute intakes. Weighted kappa improved overall; energy and 16 nutrients now had moderate agreement (0.41–0.60), while 9 nutrients had fair agreement (0.21–0.40). Conclusions The Singaporean toddler semi-quantitative food frequency questionnaire is suitable for ranking nutrient intakes of Singaporean toddlers in larger epidemiological studies. However, for population estimates of absolute nutrient intakes, it is recommended that a subsample within a cohort complete weighed food records for calibration purposes. Trial registration This study was registered retrospectively on clinicaltrials.gov on 3rd May 2017 (identifier code: NCT03138330).
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Affiliation(s)
- Cameron Allan
- 1School of Exercise & Nutrition Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059 Australia
| | - Ummi Hani Abdul Kader
- Early Life Nutrition, Danone Nutricia Research, 30 Biopolis St, Matrix Building #05-01B, Singapore, 138671 Singapore
| | - Jowynn Yu Ying Ang
- 1School of Exercise & Nutrition Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059 Australia
| | - Leilani Muhardi
- Early Life Nutrition, Danone Nutricia Research, 30 Biopolis St, Matrix Building #05-01B, Singapore, 138671 Singapore.,Healthcare Nutrition Science, Danone Nutricia Sari Husada, 15th Fl, Cyber 2 Building, Jl. HR Rasuna Said no. 13, Jakarta, Indonesia
| | - Smita Nambiar
- Early Life Nutrition, Danone Nutricia Research, 30 Biopolis St, Matrix Building #05-01B, Singapore, 138671 Singapore
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Lambrinou CP, van Stralen MM, Androutsos O, Moreno LA, Iotova V, Socha P, Koletzko B, De Bourdeaudhuij I, Manios Y. Mediators of the Effectiveness of an Intervention Promoting Water Consumption in Preschool Children: The ToyBox Study. THE JOURNAL OF SCHOOL HEALTH 2018; 88:877-885. [PMID: 30392186 DOI: 10.1111/josh.12696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 01/03/2018] [Accepted: 02/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND The ToyBox-intervention has increased preschool children's water consumption. This study aimed to examine if family-related determinants mediate the effects of the ToyBox-intervention on preschoolers' water consumption. METHODS Overall, 6290 preschoolers and their families from 6 European countries participated in the ToyBox-intervention and returned parental questionnaires in May/June 2012 and 2013. This study included the 3725 preschoolers/families who had complete data on water consumption, all mediators, and confounders. Mediation effects were assessed with bootstrapping procedure. RESULTS Regarding the intervention effects on family-related determinants, the ToyBox-intervention significantly increased water availability during meals, parental water consumption, parental encouragement to their children to drink water, and parental knowledge on water recommendations. In the multiple mediator model, all factors were independently associated with preschoolers' water consumption and mediated the intervention effect on preschoolers' water consumption (total mediation effect = 40%). After including all mediators into the model, the direct intervention effect remained significant. CONCLUSIONS The effect of the ToyBox-intervention on preschool children's water consumption was mediated by most family-related determinants examined in this study (ie, availability, parental modeling, parental encouragement, and parental knowledge). Interventions aiming to promote water in preschoolers should target these mediators to enhance their effectiveness.
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Affiliation(s)
| | | | | | - Luis A Moreno
- Universidad de Zaragoza, C/Domingo Miral s/n, 50009 Zaragoza, Spain
| | - Violeta Iotova
- Medicak University of Varna, Clinic of Paeditric Endocrinology - Head, UMHAT "St. Marina", 1 "Hr. Smirnenski" Boulevard, Varna 9010, Bulgaria
| | - Piotr Socha
- The Children's Memorial Health Institute, Warsaw, Poland, Al. Dzieci Polskich 20, 04-730, Warsaw, Poland
| | - Berthold Koletzko
- Ludwig-Maximilians-Universität München, Dr. von Hauner Children's Hospital, Univ. of Munich Medical Center, Campus Innenstadt, Lindwurmstr. 4, D-80337 Muenchen, Germany
| | | | - Yannis Manios
- Harokopio University, El. Venizelou 70, Kallithea, 17676, Athens, Greece
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Relative Validity and Reproducibility of a Food Frequency Questionnaire to Assess Nutrients and Food Groups of Relevance to the Gut Microbiota in Young Children. Nutrients 2018; 10:nu10111627. [PMID: 30400145 PMCID: PMC6266661 DOI: 10.3390/nu10111627] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 01/28/2023] Open
Abstract
Dietary fiber is an important nutrient for the gut microbiota, with different fiber fractions having different effects. The aim of this study was to determine the relative validity and reproducibility of a food frequency questionnaire (EAT5 FFQ) for measuring intake of fiber, and low and high fiber foods, in studies examining diet and gut microbiota in young children. One hundred parents of 5-year old children completed the 123-item EAT5 FFQ on two occasions four weeks apart. A 3-day weighed diet record (WDR) was completed on non-consecutive days between FFQ appointments. Mean correlations between the (randomly chosen) FFQ and WDR were acceptable for nutrient and food group intakes (r = 0.34 and r = 0.41 respectively). Gross misclassification was below chance (12.5%) for quartiles of nutrient (mean 5.7%) and food group (mean 5.1%) intake. ‘Absolute values for surrogate categories’ suggested the FFQ clearly differentiated between highest and lowest quartiles for all nutrients and food groups tested. Mean correlations between repeat administrations of the FFQ suggested very good reproducibility for nutrients (r = 0.83) and food groups (r = 0.80). The EAT5 FFQ appears to be an appropriate tool for investigating the intake of nutrients and food groups of relevance to the gut microbiota, and is the first FFQ validated to measure total, soluble and insoluble non-starch polysaccharide intakes in young children.
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Mediators of the effectiveness of a kindergarten-based, family-involved intervention on pre-schoolers’ snacking behaviour: the ToyBox-study. Public Health Nutr 2018; 22:157-163. [DOI: 10.1017/s1368980018002653] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectiveThe present study aimed to explore the mediating role of family-related determinants on the effects of the ToyBox-intervention on pre-school children’s consumption of healthy and unhealthy snacks.DesignThe ToyBox-intervention was a kindergarten-based, family-involved intervention with a cluster-randomized design, aiming to promote healthy lifestyle behaviours to prevent obesity at pre-school age.SettingKindergartens (n 309) in six European countries.SubjectsA total of 6290 pre-schoolers and their families participated in the ToyBox-intervention in 2012–2013 and data from 5212 pre-schoolers/families were included in the current analyses.ResultsEven though the total effect of the ToyBox-intervention on healthy and unhealthy snacking was not significant, the ToyBox-intervention significantly improved parental rule setting on children’s unhealthy snack consumption (i.e. restriction of snacking while watching television and permission only at certain occasions) and parental consumption of unhealthy snacks, while it increased parental knowledge on snacking recommendations. Regarding healthy snacking, the ToyBox-intervention improved children’s attitude towards fruit and vegetables (F&V). All previously mentioned family-related determinants mediated the intervention effects on pre-schoolers’ consumption of healthy and unhealthy snacks. Almost all family-related determinants examined in the study were independently associated with pre-schoolers’ consumption of healthy and unhealthy snacks.ConclusionsThe intervention was effective in improving relevant family-related determinants. Interventions aiming to promote F&V consumption and limit the consumption of unhealthy snacks in pre-schoolers should target on these mediators, but also identify new family-, school- or peer-related determinants, to enhance their effectiveness.
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The Maastricht FFQ: Development and validation of a comprehensive food frequency questionnaire for the Maastricht study. Nutrition 2018; 62:39-46. [PMID: 30826598 DOI: 10.1016/j.nut.2018.10.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 10/05/2018] [Accepted: 10/18/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to develop and validate a comprehensive food frequency questionnaire (FFQ) for The Maastricht Study, a population-based prospective cohort study in Maastricht, The Netherlands. METHODS Item selection for the FFQ was based on explained variation and contribution to intake of energy and 24 nutrients. For validation, the FFQ was completed by 135 participants (25-70 y of age) of the Nutrition Questionnaires plus study. Per person, on average 2.8 (range 1-5) telephone-based 24-h dietary recalls (24HRs), two 24-h urinary samples, and one blood sample were available. Validity of 54 nutrients and 22 food groups was assessed by ranking agreement, correlation coefficients, attenuation factors, and ultimately deattenuated correlation coefficients (validity coefficients). RESULTS Median correlation coefficients for energy and macronutrients, micronutrients, and food groups were 0.45, 0.36, and 0.38, respectively. Median deattenuated correlation coefficients were 0.53 for energy and macronutrients, 0.45 for micronutrients, and 0.64 for food groups, being >0.50 for 18 of 22 macronutrients, 16 of 30 micronutrients and >0.50 for 17 of 22 food groups. The FFQ underestimated protein and potassium intake compared with 24-h urinary nitrogen and potassium excretion by -18% and -2%, respectively. Correlation coefficients ranged from 0.50 and 0.55 for (fatty) fish intake and plasma eicosapentaenoic acid and docosahexaenoic acid, and from 0.26 to 0.42 between fruit and vegetable intake and plasma carotenoids. CONCLUSION Overall, the validity of the 253-item Maastricht FFQ was satisfactory. The comprehensiveness of this FFQ make it well suited for use in The Maastricht Study and similar populations.
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Määttä S, Vepsäläinen H, Lehto R, Erkkola M, Roos E, Ray C. Reproducibility of Preschool Personnel and Guardian Reports on Energy Balance-Related Behaviors and Their Correlates in Finnish Preschool Children. CHILDREN-BASEL 2018; 5:children5110144. [PMID: 30360523 PMCID: PMC6262525 DOI: 10.3390/children5110144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 01/07/2023]
Abstract
Valid and reliable non-objective assessments of guardian and preschool personnel reports are necessary when estimating young children’s health behaviors. This study examines the test-retest reproducibility of (a) guardian and preschool personnel questionnaires about correlates of preschool-aged children’s energy balance-related behaviors (EBRBs), (b) a screen time diary, and (c) a food frequency questionnaire (FFQ) reported by a guardian. A sample of guardians having preschool-aged children (N = 69) and preschool personnel (N = 61) completed questionnaires twice within a five-week time interval during April–May 2018 in Finland. Intra-class correlations (ICC), kappas, and percentage agreement were calculated to test the test-retest-reproducibility. The guardian questionnaire for correlates of the children’s EBRBs demonstrated mainly moderate to good reproducibility whereas the preschool personnel questionnaire of preschool correlates for children’s EBRBs was mostly good. The reproducibility of the screen time diary was good and FFQ food items showed mostly moderate reproducibility. The reproducibility of the FFQ foods items for vegetables, fruit, and berries was slightly better for the amount consumed than for the frequency of consumption. To conclude, all the instruments are acceptable for use in future studies.
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Affiliation(s)
- Suvi Määttä
- Samfundet Folkhälsan, Folkhälsan Research Center, 00250 Helsinki, Finland.
| | - Henna Vepsäläinen
- Department of Food and Nutrition, University of Helsinki, 00014 Helsinki, Finland.
| | - Reetta Lehto
- Samfundet Folkhälsan, Folkhälsan Research Center, 00250 Helsinki, Finland.
| | - Maijaliisa Erkkola
- Department of Food and Nutrition, University of Helsinki, 00014 Helsinki, Finland.
| | - Eva Roos
- Samfundet Folkhälsan, Folkhälsan Research Center, 00250 Helsinki, Finland.
- Department of Food and Nutrition, University of Helsinki, 00014 Helsinki, Finland.
- Department of Public Health, Clinicum, University of Helsinki, 00014 Helsinki, Finland.
| | - Carola Ray
- Samfundet Folkhälsan, Folkhälsan Research Center, 00250 Helsinki, Finland.
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The Relative Validity of the Menzies Remote Short-Item Dietary Assessment Tool (MRSDAT) in Aboriginal Australian Children Aged 6⁻36 Months. Nutrients 2018; 10:nu10050590. [PMID: 29748493 PMCID: PMC5986470 DOI: 10.3390/nu10050590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/07/2018] [Accepted: 05/08/2018] [Indexed: 01/21/2023] Open
Abstract
The Menzies Remote Short-item Dietary Assessment Tool (MRSDAT) can be used to derive a dietary index score, which measures the degree of compliance with the Australian Dietary Guidelines. This study aimed to determine the relative validity of a dietary index score for children aged 6–24 months, living in a Remote Aboriginal Community (RAC), derived using MRSDAT. This validation study compared dietary index scores derived using MRSDAT with those derived from the average of three 24-h recalls. Participants were aged 6–36 months at the first dietary assessment and were living in a RAC. The level of agreement between the two methods was explored using Lin’s concordance correlation coefficient (CCC), Bland-Altman plots, weighted Cohen’s kappa, and Fischer’s exact and paired t-tests. Forty participants were recruited. The CCC was poor between methods (R = 0.35, 95% CI 0.06, 0.58), with MRSDAT estimating higher dietary intake scores for all food groups except fruit, and higher dietary quality scores by an average of 4.78 points/100. Community-based Aboriginal researchers were central to this validation study. MRSDAT was within the performance range of other short-item dietary assessment tools developed for young children, and shows promise for use with very young children in RACs.
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Bell LK, Golley RK, Mauch CE, Mathew SM, Magarey AM. Validation testing of a short food‐group‐based questionnaire to assess dietary risk in preschoolers aged 3–5 years. Nutr Diet 2018; 76:642-645. [DOI: 10.1111/1747-0080.12412] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 12/01/2017] [Accepted: 01/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Lucinda K. Bell
- College of Nursing and Health SciencesFlinders University Adelaide South Australia Australia
- School of Pharmacy and Medical Sciences (Nutrition and Food Science), Sansom Institute for Health ResearchUniversity of South Australia Adelaide South Australia Australia
| | - Rebecca K. Golley
- School of Pharmacy and Medical Sciences (Nutrition and Food Science), Sansom Institute for Health ResearchUniversity of South Australia Adelaide South Australia Australia
| | - Chelsea E. Mauch
- College of Nursing and Health SciencesFlinders University Adelaide South Australia Australia
| | - Suja M. Mathew
- Vaccinology and Immunology Research Trials UnitWomen’s and Children’s Hospital Adelaide South Australia Australia
| | - Anthea M. Magarey
- College of Nursing and Health SciencesFlinders University Adelaide South Australia Australia
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Assessment of Validity and Reproducibility of the Zinc-Specific Dietary Intake Questionnaire Conducted for Young Polish Female Respondents. Nutrients 2018; 10:nu10010104. [PMID: 29351220 PMCID: PMC5793332 DOI: 10.3390/nu10010104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 01/24/2023] Open
Abstract
One of the brief methods enabling the assessment of the zinc intake and identification of individuals characterized by insufficient zinc intake, is zinc-specific food frequency questionnaire. The aim of the study was to assess the validity and reproducibility of the elaborated zinc-specific food frequency questionnaire ZINC-FFQ (Zinc INtake Calculation—Food Frequency Questionnaire) in a group of young Polish female respondents. The validity was assessed in comparison with 3-day dietary records, while reproducibility was assessed for the ZINC-FFQ filled in twice (FFQ1 and FFQ2—six weeks apart). Bland–Altman indexes in the assessment of validity were 5.5% (FFQ1) and 6.7% (FFQ2), while in assessment of reproducibility it was 3.3%. In the assessment of reproducibility, 83% of respondents were classified into the same category of zinc intake adequacy and 72% of respondents were classified into the same tertile, that contributed to weighted κ statistic of 0.65 (substantial agreement). It may be concluded, that ZINC-FFQ is characterized by a validity on a satisfactory and reproducibility on a very good level, in a group of young Polish female respondents, and may be applied to indicate individuals characterized by the risk of insufficient intake.
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Beaton E, Wright J, Devenish G, Do L, Scott J. Relative Validity of a 24-h Recall in Assessing Intake of Key Nutrients in a Cohort of Australian Toddlers. Nutrients 2018; 10:nu10010080. [PMID: 29329266 PMCID: PMC5793308 DOI: 10.3390/nu10010080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/09/2018] [Accepted: 01/11/2018] [Indexed: 11/16/2022] Open
Abstract
There is limited information concerning the dietary intake of toddlers in Australia. Consequently, there is a need for studies investigating toddler intake that use dietary assessment measures that are valid and place a low participant burden on caregivers. The aim of this study was to determine the relative validity of a single 24-h dietary recall (24HR) in measuring the intake of five nutrients in a cohort of Australian toddlers compared to a combined 24HR and 2-day estimated food record (2DFR). A single 24HR and a 2DFR were collected from a cohort of Australian toddlers (n = 699) at approximately 12 months of age as part of the Study of Mothers' and Infants' Life Events affecting oral health (SMILE) project. Relative validity of one day of dietary data (24HR) in assessing intake of energy, protein, calcium, iron, and added sugars was tested against three days of dietary data (24HR + 2DFR) using paired t-tests, Bland-Altman analysis, cross-classification, and weighted Kappa statistic. Classification analysis found good agreement between the 24HR and 24HR + 2DFR for all nutrients with the percentage classified in the same tertile at 57.9% and above. The weighted Kappa statistic found acceptable agreement for all nutrients. This study suggests that a 24HR is a valid assessment tool for estimating the relative intake of energy, protein, calcium, iron, and added sugars among Australian toddlers at the individual level.
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Affiliation(s)
- Elizabeth Beaton
- School of Public Health, Curtin University, Perth, WA 6102, Australia.
| | - Janine Wright
- School of Public Health, Curtin University, Perth, WA 6102, Australia.
| | - Gemma Devenish
- School of Public Health, Curtin University, Perth, WA 6102, Australia.
| | - Loc Do
- Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, SA 5000, Australia.
| | - Jane Scott
- School of Public Health, Curtin University, Perth, WA 6102, Australia.
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Głąbska D, Książek A, Guzek D. Development and Validation of the Brief Folate-Specific Food Frequency Questionnaire for Young Women's Diet Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E1574. [PMID: 29240683 PMCID: PMC5750992 DOI: 10.3390/ijerph14121574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 12/12/2022]
Abstract
The tools enabling brief assessment of folate intake may be of great value for public health purposes. The aim of the presented study was to design a brief folate-specific food frequency questionnaire for Central and Eastern European population of women, as well as to assess the validity and reproducibility of the designed Folate-Intake Calculation-Food Frequency Questionnaire (Fol-IC-FFQ) on a group of Polish women aged 20-30 years. Participants collected 3-day dietary records and completed the Fol-IC-FFQ twice (FFQ1: directly after the dietary record; and FFQ2: six weeks later). The analysis included an assessment of validity (comparison of the results of FFQ1 and 3-day dietary record) and of reproducibility (comparison of the results of FFQ1 and FFQ2). In assessment of validity, a Bland-Altman index of 5.3% was observed. In assessment of reproducibility, a Bland-Altman index of 2.7% was observed, the share of individuals classified into the same intake adequacy category was over 85%, the share of individuals classified into the same tertile was almost 75%, the weighted κ statistic indicated substantial agreement (0.67) and correlation was significant (p = 0.0000; R = 0.7995). Assessment of the Fol-IC-FFQ revealed a satisfactory level of validity and very good level of reproducibility in the population of young Polish women. The Fol-IC-FFQ may be considered a valid tool for the assessment of folate intake in young Polish women and a promising tool for the assessment of folate intake in young women in Central and Eastern Europe.
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Affiliation(s)
- Dominika Głąbska
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159c Nowoursynowska Street, 02-776 Warsaw, Poland.
| | - Aneta Książek
- Department of Dietetics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159c Nowoursynowska Street, 02-776 Warsaw, Poland.
| | - Dominika Guzek
- Department of Organization and Consumption Economics, Faculty of Human Nutrition and Consumer Sciences, Warsaw University of Life Sciences (WULS-SGGW), 159c Nowoursynowska Street, 02-776 Warsaw, Poland.
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Clustering of energy balance-related behaviours and parental education in European preschool children: the ToyBox study. Br J Nutr 2017; 118:1089-1096. [DOI: 10.1017/s0007114517003129] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractEnergy balance-related behaviours (EBRB) are established in childhood and seem to persist through to adulthood. A lower parental educational level was associated with unhealthy behavioural patterns. The aim of the study is to identify clusters of EBRB and examine their association with preschool children’s BMI and maternal, paternal and parental education. A subsample of the ToyBox study (n 5387) conducted in six European countries was used. Six behavioural clusters (‘healthy diet and low activity’, ‘active’, ‘healthy lifestyle’, ‘high water and screen time; low fruits and vegetables (F&V) and physical activity (PA)’, ‘unhealthy lifestyle’ and ‘high F&V consumers’) emerged. The healthiest group characterised by high water and F&V consumption and high PA z scores (‘healthy lifestyle’) was more prevalent among preschool children with at least one medium- or higher-educated parent and showed markedly healthier trends for all the included EBRB. In the opposite, the ‘unhealthy lifestyle’ cluster (characterised by high soft drinks and screen time z scores, and low water, F&V and PA z scores) was more prevalent among children with lower parental, paternal and maternal education levels. OR identified that children with lower maternal, paternal and parental education levels were less likely to be allocated in the ‘healthy lifestyle’ cluster and more likely to be allocated in the ‘unhealthy lifestyle’ cluster. The ‘unhealthy lifestyle’ cluster was more prevalent among children with parents in lower parental educational levels and children who were obese. Therefore, parental educational level is one of the key factors that should be considered when developing childhood obesity prevention interventions.
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Androutsos O, Moschonis G, Ierodiakonou D, Karatzi K, De Bourdeaudhuij I, Iotova V, Zych K, Moreno LA, Koletzko B, Manios Y. Perinatal and lifestyle factors mediate the association between maternal education and preschool children's weight status: the ToyBox study. Nutrition 2017; 48:6-12. [PMID: 29469021 DOI: 10.1016/j.nut.2017.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/29/2017] [Accepted: 11/01/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE This study aimed to explore the associations among perinatal, sociodemographic, and behavioral factors and preschool overweight/obesity. METHODS Data were collected from 7541 European preschoolers in May/June 2012. Children's anthropometrics were measured, and parents self-reported all other data via questionnaires. Level of statistical significance was set at P ≤ 0.05. RESULTS Certain perinatal factors (i.e., maternal prepregnancy overweight/obesity, maternal excess gestational weight gain, excess birth weight, and "rapid growth velocity"), children's energy balance-related behaviors (i.e., high sugar-sweetened beverage consumption, increased screen time, reduced active-play time), family sociodemographic characteristics (i.e., Eastern or Southern Europe, low maternal and paternal education), and parental overweight/obesity were identified as correlates of preschoolers' overweight/obesity. Furthermore, maternal prepregnancy overweight/obesity, children's "rapid growth velocity," and increased screen time mediated by 21.2%, 12.5%, and 5.7%, respectively, the association between maternal education and preschoolers' body mass index. CONCLUSION This study highlighted positive associations of preschooler's overweight/obesity with excess maternal prepregnancy and gestational weight gain, excess birth weight and "rapid growth velocity," Southern or Eastern European region, and parental overweight/obesity. Moreover, maternal prepregnancy overweight/obesity, children's "rapid growth velocity," and increased screen time partially mediated the association between maternal education and preschoolers' body mass index. The findings of the present study may support childhood obesity prevention initiatives, because vulnerable population groups and most specifically low-educated families should be prioritized. Among other fields, these intervention initiatives should also focus on the importance of normal prepregnancy maternal weight status, normal growth velocity during infancy, and retaining preschool children's screen time within recommendations.
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Affiliation(s)
- Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
| | - George Moschonis
- Department of Rehabilitation, Nutrition and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC 3086, Melbourne, Australia
| | - Despo Ierodiakonou
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Kalliopi Karatzi
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece
| | | | - Violeta Iotova
- Department of Pediatrics, Medical University Varna, Varna, Bulgaria
| | - Kamila Zych
- The Children's Memorial Health Institute, Warsaw, Poland
| | - Luis A Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain; School of Health Science (EUCS), University of Zaragoza, Zaragoza, Spain
| | - Berthold Koletzko
- Ludwig-Maximilians-Universität Munich, Dr von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science & Education, Harokopio University, Athens, Greece.
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Development and Relative Validity of a Food Frequency Questionnaire to Assess Intakes of Total and Free Sugars in Australian Toddlers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14111361. [PMID: 29117133 PMCID: PMC5708000 DOI: 10.3390/ijerph14111361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 11/03/2017] [Accepted: 11/05/2017] [Indexed: 11/16/2022]
Abstract
Background: Dental research into early childhood caries is hindered by a lack of suitable dietary assessment tools that have been developed and validated for the population and outcomes of interest. The aim of this study was to develop and investigate the relative validity and reproducibility of the Study of Mothers’ and Infants’ Life Events Food Frequency Questionnaire (SMILE-FFQ), to assess the total and free sugars intakes of Australian toddlers. Methods: The SMILE-FFQ was designed to capture the leading dietary contributors to dental caries risk in toddlers aged 18–30 months via a proxy report. Ninety-five parents of Australian toddlers completed the questionnaire online before and after providing three 24-h recalls (24HR), collected on non-consecutive days using the multipass method. Total and free sugars were compared between the two SMILE-FFQ administrations and between each SMILE-FFQ and the 24HR using multiple statistical tests and standardised validity criteria. Correlation (Pearson), mean difference (Wilcoxon rank test) and Bland Altman analyses were conducted to compare absolute values, with cross-classification (Chi-Square and Weighted Kappa) used to compare agreement across tertiles. Results: All reproducibility tests showed good agreement except weighted kappa, which showed acceptable agreement. Relative validity tests revealed a mix of good and acceptable agreement, with total sugars performing better at the individual level than free sugars. Compared to the 24HR, the SMILE-FFQ tended to underestimate absolute values at lower levels and overestimate them at higher levels. Conclusions: The combined findings of the various tests indicate that the SMILE-FFQ performs comparably to the 24HR for assessing both total and free sugars among individuals, is most effective for ranking participants rather than determining absolute intakes, and is therefore suitable for use in observational studies of Australian toddlers.
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Michels N, Susi K, Marques-Vidal PM, Nydegger A, Puder JJ. Psychosocial Quality-of-Life, Lifestyle and Adiposity: A Longitudinal Study in Pre-schoolers (Ballabeina Study). Int J Behav Med 2017; 23:383-392. [PMID: 26809517 DOI: 10.1007/s12529-016-9537-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE In obesity prevention, understanding psychosocial influences in early life is pivotal. Reviews reported contradictory results and a lack of longitudinal studies focusing on underlying lifestyle factors. This study tested whether psychosocial Quality-Of-Life (QOL) was associated with pre-schoolers' lifestyle and adiposity changes over one school year and whether lifestyle moderated the latter. It was hypothesised that QOL might not impact adiposity in everybody but that this might depend on preceding lifestyle. METHOD Longitudinal data from 291 Swiss pre-schoolers (initially 3.9-6.3 years) was available. The following measures were used in longitudinal regressions: psychosocial QOL by PedsQL, adiposity (BMI z-score, waist, fat%), diet (food frequency), sedentary time and accelerometer-based activity. RESULTS Concerning lifestyle, low psychosocial QOL was only related to unfavourable changes in diet (less fruit β = 0.21 and more fat intake β = -0.28) and lower physical activity (β = 0.21). Longitudinal QOL-adiposity relations appeared only after moderation by lifestyle factors (beta-range 0.13-0.67). Low psychosocial QOL was associated with increased adiposity in children with an unhealthy diet intake or high sedentary time. By contrast, low psychosocial QOL was associated with decreasing adiposity in high fruit consumers or more physically active pre-schoolers. CONCLUSION Results emphasise the need for testing moderation in the QOL-adiposity relation. An unhealthy diet can be a vulnerability factor and high physical activity a protective factor in QOL-related adiposity. Consequently, QOL and lifestyle should be targeted concurrently in multi-factorial obesity prevention. The environment should be an 'activity encouraging, healthy food zone' that minimises opportunities for stress-induced eating. In addition, appropriate stress coping skills should be acquired.
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Affiliation(s)
- Nathalie Michels
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185, 4K3, Ghent, B-9000, Belgium.
| | - Kriemler Susi
- Institute for Social and Preventive Medicine, University of Zürich, Zürich, Switzerland
| | - Pedro M Marques-Vidal
- Department of Internal Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Andreas Nydegger
- Department of Pediatrics, Pediatric Gastroenterology Unit, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Jardena J Puder
- Diabetes and Metabolism & Division of Pediatric Endocrinology, Service of Endocrinology, Diabetes and Obesity, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
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Rodríguez LA, Mundo‐Rosas V, Méndez‐Gómez‐Humarán I, Pérez‐Escamilla R, Shamah‐Levy T. Dietary quality and household food insecurity among Mexican children and adolescents. MATERNAL & CHILD NUTRITION 2017; 13:e12372. [PMID: 27863001 PMCID: PMC6866226 DOI: 10.1111/mcn.12372] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
Abstract
Seventy percent of Mexican households experience some level of food insecurity (FI). Studies have shown positive associations between FI and poor dietary quality. As far as it is known, this is the first time the Healthy Eating Index (HEI-2010) has been used to assess dietary quality of children and adolescents in Mexico, and to examine if FI is related to it. The objective of this research is to assess dietary quality and its association with FI among Mexican children and adolescents from a nationally representative cross-sectional sample. We analyzed data from 4635 2-19-year-old Mexican children and adolescents participating in the Mexican National Health and Nutrition Survey (Ensanut 2012). FI was measured using the Latin American and Caribbean Household Food Security Scale (ELCSA) and dietary quality with the HEI-2010. We examined the association between FI and dietary quality using multivariate linear regressions. Dietary quality was worst as FI became more severe among children and adolescents compared with their counterparts living in households with food security. Specifically, FI had a negative association with fruits, vegetables, and protein foods, and a positive association with refined grains consumption. Dairy intake was negatively associated with FI among older children and adolescents. Added sugars were not associated with FI, but intake was excessive across the population at 15% of total daily energy intake. Decreasing FI may help improve dietary quality of Mexican children and adolescents.
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Affiliation(s)
- Luis A. Rodríguez
- Berkeley School of Public HealthUniversity of CaliforniaBerkeleyCaliforniaUSA
- San Francisco School of Medicine, Epidemiology & BiostatisticsUniversity of CaliforniaSan FranciscoCaliforniaUSA
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Pinket AS, De Craemer M, Huybrechts I, De Bourdeaudhuij I, Deforche B, Cardon G, Androutsos O, Koletzko B, Moreno LA, Socha P, Iotova V, Manios Y, Van Lippevelde W. Multibehavioural Interventions with a Focus on Specific Energy Balance-Related Behaviours Can Affect Diet Quality in Preschoolers from Six European Countries: The ToyBox-Study. Nutrients 2017; 9:E479. [PMID: 28489048 PMCID: PMC5452209 DOI: 10.3390/nu9050479] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/10/2017] [Accepted: 05/05/2017] [Indexed: 11/16/2022] Open
Abstract
The present study aimed to examine whether a multibehavioural intervention with a focus on specific energy balance-related behaviours can affect total diet quality and its four subcomponents in European preschoolers and to investigate if these intervention effects differed by socioeconomic status (SES). Parents/caregivers of 3.5 to 5.5 year-olds (n = 4968) recruited through kindergartens in six European countries within the ToyBox-study completed questionnaires on socio-demographics and a food frequency questionnaire on their preschoolers' diet. To assess intervention effects and differences by SES, multilevel repeated measures analyses were conducted. In contrast to no significant difference in total diet quality, in both the intervention and control group, the dietary quality and dietary equilibrium increased, with a larger increase in the intervention group (mean difference quality: +3.4%; mean difference equilibrium: +0.9%) compared to the control group (quality: +1.5%; equilibrium: +0.2%). SES was not a significant moderator for intervention effects on total diet quality, nor for the four subcomponents. This study indicates that multibehavioural interventions with a focus on specific energy balance-related behaviours in preschoolers not only affect those targeted behaviours, but can also have more generalized effects. The ToyBox-intervention effects were similar for both lower and high SES preschoolers.
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Affiliation(s)
- An-Sofie Pinket
- Department of Public Health, Ghent University, 9000 Ghent, Belgium.
| | - Marieke De Craemer
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium.
| | - Inge Huybrechts
- International Agency for Research on Cancer (IARC/WHO), 69000 Lyon, France.
| | | | - Benedicte Deforche
- Department of Public Health, Ghent University, 9000 Ghent, Belgium.
- Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, 1000 Brussels, Belgium.
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, 9000 Ghent, Belgium.
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
| | - Berthold Koletzko
- Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, 80337 München, Germany.
| | - Luis A Moreno
- GENUD Research Group, University of Zaragoza, 50009 Zaragoza, Spain.
| | - Piotr Socha
- The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, 9002 Varna, Bulgaria.
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
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De Lepeleere S, De Bourdeaudhuij I, Cardon G, Verloigne M. The effect of an online video intervention 'Movie Models' on specific parenting practices and parental self-efficacy related to children's physical activity, screen-time and healthy diet: a quasi experimental study. BMC Public Health 2017; 17:366. [PMID: 28449658 PMCID: PMC5408449 DOI: 10.1186/s12889-017-4264-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 04/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background In children, being sufficiently physically active, having low levels of screen-time and having a healthy diet are largely influenced by parenting practices. Children of parents applying positive parenting practices are at lower risk for overweight and obesity. Therefore, we investigated the effect of a health promoting online video intervention for parents (‘Movie Models’) on children’s physical activity (PA), screen-time and healthy diet, and on specific parenting practices and parental self-efficacy related to these parenting practices. The online videos are delivered to parents of primary schoolchildren, and were based on real-life scenarios. Methods A two-armed, quasi experimental design was used. Parents of primary schoolchildren were recruited between November and December 2013 by spreading an appeal in social media, and by contacting primary schools. Participating parents were predominantly of high socio-economic status (SES) (83.1%), and only 6.8% of children were overweight/obese. Intervention group participants were invited to watch online videos for 4 weeks. Specific parenting practices, parental self-efficacy, PA, screen-time and healthy diet of the child were assessed at baseline (T0), at one (T1) and at four (T2) months post baseline. Repeated Measures (Multivariate) ANOVAs were used to examine intervention effects. The potential moderating effect of age and gender of the child and parental SES was also examined. Results Between T0 and T2, no significant intervention effects were found on children’s PA, screen-time or healthy diet. Most significant intervention effects were found for more complex parenting practices (e.g., an increase in motivating the child to eat fruit). Subgroup analyses showed that the intervention had more effect on the actual parenting practices related to PA, screen-time and healthy diet in parents of older children (10–12 years old), whereas intervention effects on parental self-efficacy related to those behaviors were stronger in parents of younger children (6–9 years old). Conclusions ‘Movie Models’ was effective in increasing some important parenting practices and parental self-efficacy related to PA, screen-time and healthy diet in children. Therefore, the current study is an important first step in promoting effective parenting-related factors, and possibly increasing children’s healthy diet and PA, and decreasing screen-time. Trial registration NCT02278809 in ClinicalTrials.gov on October 28, 2014 (retrospectively registered). Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4264-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sara De Lepeleere
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium.
| | - Ilse De Bourdeaudhuij
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Maïté Verloigne
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
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Development and evaluation of a Nutrition Transition-FFQ for adolescents in South India. Public Health Nutr 2017; 20:1162-1172. [PMID: 28069093 DOI: 10.1017/s1368980016003335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To develop and evaluate a Nutrition Transition-FFQ (NT-FFQ) to measure nutrition transition among adolescents in South India. DESIGN We developed an interviewer-administered NT-FFQ comprising a 125-item semi-quantitative FFQ and a twenty-seven-item eating behaviour survey. The reproducibility and validity of the NT-FFQ were assessed using Spearman correlations, intra-class correlation coefficients (ICC), and levels of agreement using Bland-Altman and cross-classification over 2 months (NT-FFQ1 and NT-FFQ2). Validity of foods was evaluated against three 24-h dietary recalls (24-HR). Face validity of eating behaviours was evaluated through semi-structured cognitive interviews. The reproducibility of eating behaviours was assessed using weighted kappa (κ w) and cross-classification analyses. SETTING Vijayapura, India. SUBJECTS A representative sample of 198 adolescents aged 14-18 years. RESULTS Reproducibility of NT-FFQ: Spearman correlations ranged from 0·33 (pulses) to 0·80 (red meat) and ICC from 0·05 (fruits) to 1·00 (tea). On average, concordance (agreement) was 60 % and discordance was 7 % for food groups. For eating behaviours, κ w ranged from 0·24 (eating snacks while watching television) to 0·67 (eating lunch at home) with a mean of 0·40. Validity of NT-FFQ: Spearman correlations ranged from 0·11 (fried traditional foods) to 0·70 (tea) and ICC ranged from 0·02 (healthy global foods) to 1·00 (grains). The concordance and discordance were 48 % and 8 %, respectively. Bland-Altman plots showed acceptable agreement between NT-FFQ2 and 24-HR. The eating behaviours had acceptable face validity. CONCLUSIONS The NT-FFQ has good reproducibility and acceptable validity for food intake and eating behaviours. The NT-FFQ can quantify the nutrition transition among Indian adolescents.
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A systematic review of methods to assess intake of sugar-sweetened beverages among healthy European adults and children: a DEDIPAC (DEterminants of DIet and Physical Activity) study. Public Health Nutr 2016; 20:578-597. [PMID: 27766999 DOI: 10.1017/s1368980016002639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Research indicates that intake of sugar-sweetened beverages (SSB) may be associated with negative health consequences. However, differences between assessment methods can affect the comparability of intake data across studies. The current review aimed to identify methods used to assess SSB intake among children and adults in pan-European studies and to inform the development of the DEDIPAC (DEterminants of DIet and Physical Activity) toolbox of methods suitable for use in future European studies. DESIGN A literature search was conducted using three electronic databases and by hand-searching reference lists. English-language studies of any design which assessed SSB consumption were included in the review. SETTING Studies involving two or more European countries were included in the review. SUBJECTS Healthy, free-living children and adults. RESULTS The review identified twenty-three pan-European studies which assessed intake of SSB. The FFQ was the most commonly used (n 24), followed by the 24 h recall (n 6) and diet records (n 1). There were several differences between the identified FFQ, including the definition of SSB used. In total, seven instruments that were tested for validity were selected as potentially suitable to assess SSB intake among adults (n 1), adolescents (n 3) and children (n 3). CONCLUSIONS The current review highlights the need for instruments to use an agreed definition of SSB. Methods that were tested for validity and used in pan-European populations encompassing a range of countries were identified. These methods should be considered for use by future studies focused on evaluating consumption of SSB.
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Pinket AS, De Craemer M, De Bourdeaudhuij I, Deforche B, Cardon G, Androutsos O, Koletzko B, Moreno LA, Socha P, Iotova V, Manios Y, Van Lippevelde W. Can Parenting Practices Explain the Differences in Beverage Intake According to Socio-Economic Status: The Toybox-Study. Nutrients 2016; 8:nu8100591. [PMID: 27669290 PMCID: PMC5083979 DOI: 10.3390/nu8100591] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/25/2016] [Accepted: 09/19/2016] [Indexed: 11/18/2022] Open
Abstract
Previous research indicated that preschoolers of lower socioeconomic status (SES) consume less healthy beverages than high SES preschoolers. The purpose of this study is to investigate the mediating role of parenting practices in the relationship between SES and plain water, soft drink and prepacked fruit juice (FJ) consumption in European preschoolers. Parents/caregivers of 3.5 to 5.5 years old (n = 6776) recruited through kindergartens in six European countries within the ToyBox-study completed questionnaires on socio-demographics, parenting practices and a food frequency questionnaire. Availability of sugared beverages and plain water, permissiveness towards sugared beverages and lack of self-efficacy showed a mediating effect on SES-differences in all three beverages. Rewarding with sugared beverages significantly mediated SES-differences for both plain water and prepacked FJ. Encouragement to drink plain water and awareness significantly mediated SES-differences for, respectively, plain water and prepacked FJ consumption. Avoiding negative modelling did not mediate any associations. Overall, lower SES preschoolers were more likely to be confronted with lower levels of favourable and higher levels of unfavourable parenting practices, which may lead to higher sugared beverage and lower plain water consumption. The current study highlights the importance of parenting practices in explaining the relation between SES and both healthy and unhealthy beverage consumption.
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Affiliation(s)
- An-Sofie Pinket
- Department of Public Health, Ghent University, Ghent 9000, Belgium.
| | - Marieke De Craemer
- Department of Movement and Sports Sciences, Ghent University, Ghent 9000, Belgium.
| | | | - Benedicte Deforche
- Department of Public Health, Ghent University, Ghent 9000, Belgium.
- Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, Brussels 1000, Belgium.
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Ghent 9000, Belgium.
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens 17671, Greece.
| | - Berthold Koletzko
- Ludwig-Maximilians-University of Munich, Dr. von Hauner Children's Hospital, München 80337, Germany.
| | - Luis A Moreno
- GENUD Research Group, University of Zaragoza, Zaragoza 50009, Spain.
| | - Piotr Socha
- The Children's Memorial Health Institute, Warsaw 04-730, Poland.
| | - Violeta Iotova
- Department of Pediatrics, Medical University of Varna, Varna 9002, Bulgaria.
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens 17671, Greece.
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A systematic review of methods to assess intake of fruits and vegetables among healthy European adults and children: a DEDIPAC (DEterminants of DIet and Physical Activity) study. Public Health Nutr 2016; 20:417-448. [DOI: 10.1017/s1368980016002366] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjectiveEvidence suggests that health benefits are associated with consuming recommended amounts of fruits and vegetables (F&V), yet standardised assessment methods to measure F&V intake are lacking. The current review aims to identify methods to assess F&V intake among children and adults in pan-European studies and inform the development of the DEDIPAC (DEterminants of DIet and Physical Activity) toolbox of methods suitable for use in future European studies.DesignA literature search was conducted using three electronic databases and by hand-searching reference lists. English-language studies of any design which assessed F&V intake were included in the review.SettingStudies involving two or more European countries were included in the review.SubjectsHealthy, free-living children or adults.ResultsThe review identified fifty-one pan-European studies which assessed F&V intake. The FFQ was the most commonly used (n42), followed by 24 h recall (n11) and diet records/diet history (n7). Differences existed between the identified methods; for example, the number of F&V items on the FFQ and whether potatoes/legumes were classified as vegetables. In total, eight validated instruments were identified which assessed F&V intake among adults, adolescents or children.ConclusionsThe current review indicates that an agreed classification of F&V is needed in order to standardise intake data more effectively between European countries. Validated methods used in pan-European populations encompassing a range of European regions were identified. These methods should be considered for use by future studies focused on evaluating intake of F&V.
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Pinket AS, De Craemer M, Huybrechts I, De Bourdeaudhuij I, Deforche B, Cardon G, Androutsos O, Koletzko B, Moreno L, Socha P, Iotova V, Manios Y, Van Lippevelde W. Diet quality in European pre-schoolers: evaluation based on diet quality indices and association with gender, socio-economic status and overweight, the ToyBox-study. Public Health Nutr 2016; 19:2441-50. [PMID: 27087125 PMCID: PMC10270831 DOI: 10.1017/s1368980016000604] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/19/2016] [Accepted: 02/29/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study diet quality among pre-schoolers using the Diet Quality Index (DQI) and to investigate differences according to gender, socio-economic status (SES) and overweight/obesity status. DESIGN Kindergarten-based cross-sectional survey within the ToyBox-study. A standardized protocol was used and parents/caregivers self-reported sociodemographic data and a semi-quantitative FFQ. A total DQI and its four subcomponents (diversity, quality, equilibrium and meal index) were calculated based on this FFQ. High total DQI scores indicate better diet quality than low scores. Results of the total DQI and the subcomponents were reported as percentages of maximum scores (100 %). SETTING Kindergartens in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain). SUBJECTS European pre-schoolers (aged 3·5-5·5 years) and their parents/caregivers (n 7063). RESULTS The mean total DQI score was 68·3 %. Mean scores of the subcomponents were 61·7 % for diversity, 56·5 % for quality, 65·4 % for equilibrium and 89·7 % for the meal index. Pre-schoolers of lower-SES backgrounds had lower scores on the total DQI and all its subcomponents. No clear differences were found by gender and overweight status. Results differed slightly according to country. CONCLUSIONS Pre-schoolers scored low on the total DQI and especially on dietary quality, as energy-dense, low-nutritious food items were more often consumed than highly nutritious food items. Furthermore, already in pre-schoolers lower-SES mothers were less likely to provide a good diet quality and this was consistent for all four subcomponents of the total DQI. Food intake in pre-schoolers should be enhanced, especially in pre-schoolers of lower-SES backgrounds.
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Affiliation(s)
- An-Sofie Pinket
- Department of Public Health, Ghent University, Unit Health Promotion, De Pintelaan 185 – 4K3 lokaal 036, 9000 Gent, Belgium
| | - Marieke De Craemer
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Inge Huybrechts
- Dietary Exposure Assessment Group (DEX), International Agency for Research on Cancer (IARC/WHO), Lyon, France
| | | | - Benedicte Deforche
- Department of Public Health, Ghent University, Unit Health Promotion, De Pintelaan 185 – 4K3 lokaal 036, 9000 Gent, Belgium
- Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Berthold Koletzko
- Dr von Hauner Children’s Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Luis Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - Piotr Socha
- The Children’s Memorial Health Institute, Warsaw, Poland
| | - Violeta Iotova
- Department of Pediatrics and Medical Genetics, Medical University of Varna, Varna, Bulgaria
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Wendy Van Lippevelde
- Department of Public Health, Ghent University, Unit Health Promotion, De Pintelaan 185 – 4K3 lokaal 036, 9000 Gent, Belgium
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Golley RK, Bell LK, Hendrie GA, Rangan AM, Spence A, McNaughton SA, Carpenter L, Allman-Farinelli M, de Silva A, Gill T, Collins CE, Truby H, Flood VM, Burrows T. Validity of short food questionnaire items to measure intake in children and adolescents: a systematic review. J Hum Nutr Diet 2016; 30:36-50. [PMID: 27561947 DOI: 10.1111/jhn.12399] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Short food questions are appealing to measure dietary intakes. METHODS A review of studies published between 2004 and 2016 was undertaken and these were included in the present study if they reported on a question or short item questionnaire (≤50 items, data presented as ≤30 food groups) measuring food intake or food-related habits, in children (aged 6 months to 18 years), and reported question validity or reliability. Thirty studies met the inclusion criteria. RESULTS Most questions assessed foods or food groups (n = 29), with the most commonly assessed being fruit (n = 22) or vegetable intake (n = 23), dairy foods and discretionary foods (n = 20 studies each). Four studies assessed food habits, with the most common being breakfast and meal frequency (n = 4 studies). Twenty studies assessed reliability, and 25 studies determined accuracy and were most commonly compared against food records. Evaluation of question performance relied on statistical tests such as correlation. CONCLUSIONS The present study has identified valid and reliable questions for the range of key food groups of interest to public health nutrition. Questions were more likely to be reliable than accurate, and relatively few questions were both reliable and accurate. Gaps in repeatable and valid short food questions have been identified that will provide direction for future tool development.
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Affiliation(s)
- R K Golley
- University of South Australia, Adelaide, SA, Australia
| | - L K Bell
- Flinders University, Adelaide, SA, Australia
| | | | - A M Rangan
- University of Sydney, Sydney, NSW, Australia
| | - A Spence
- Deakin University, Melbourne, VIC, Australia
| | | | - L Carpenter
- University of Melbourne, Melbourne, VIC, Australia
| | | | - A de Silva
- University of Melbourne, Melbourne, VIC, Australia
| | - T Gill
- University of Sydney, Sydney, NSW, Australia
| | - C E Collins
- University of Newcastle, Newcastle, NSW, Australia
| | - H Truby
- Monash University, Melbourne, VIC, Australia
| | - V M Flood
- University of Sydney, Sydney, NSW, Australia
| | - T Burrows
- University of Newcastle, Newcastle, NSW, Australia
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Miguel-Berges ML, Santaliestra-Pasias AM, Mouratidou T, Androutsos O, de Craemer M, Pinket AS, Birnbaum J, Koletzko B, Iotova V, Usheva N, Kulaga Z, Gozdz M, Manios Y, Moreno LA. Associations between food and beverage consumption and different types of sedentary behaviours in European preschoolers: the ToyBox-study. Eur J Nutr 2016; 56:1939-1951. [PMID: 27312566 DOI: 10.1007/s00394-016-1236-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 05/25/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the association between food and beverage consumption and time spent in different sedentary behaviours such as watching TV and DVDs, playing computer/video games and quiet play/activities in preschoolers. METHODS A sample of 6431 (51.8 % males) European preschoolers aged 3.5-5.5 years from six survey centres was included in the data analyses. Data on dietary habits and sedentary behaviours [watching TV, playing computer and quiet play (both during weekdays and weekend days)] were collected via standardized proxy-administered questionnaires. One-way analysis of covariance and general linear model (adjusted for sex, maternal education, body mass index and centre) were conducted. RESULTS The results of the generalized linear model showed that the more strong associations in both males and females who were watching TV for > 1 h/day during weekdays were positively associated with increased consumption of fizzy drinks (β = 0.136 for males and β = 0.156 for females), fresh and packed juices (β = 0.069, β = 0.089), sweetened milk (β = 0.119, β = 0.078), cakes and biscuits (β = 0.116, β = 0.145), chocolate (β = 0.052, β = 0.090), sugar-based desserts and pastries (β = 0.234, β = 0.250), salty snacks (β = 0.067, β = 0.056), meat/poultry/processed meat (β = 0.067, β = 0.090) and potatoes (β = 0.071, β = 0.067), and negative associations were observed for the consumption of fruits (β = -0.057, β = -0.099), vegetables (β = -0.056, β = -0.082) and fish (β = -0.013, β = -0.013). During weekend days, results were comparable. CONCLUSIONS In European preschoolers, sedentary behaviours were associated with consumption of energy-dense foods and fizzy drinks. The present findings will contribute to improve the strategies to prevent overweight, obesity and nutrition-related chronic diseases from early childhood.
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Affiliation(s)
- María L Miguel-Berges
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009, Saragossa, Spain. .,GENUD (Growth, Exercise, Nutrition and Development) Research Group, School of Health Sciences (EUCS), University of Zaragoza, C/Domingo miral s/n, 50009, Saragossa, Spain.
| | - Alba M Santaliestra-Pasias
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009, Saragossa, Spain.,GENUD (Growth, Exercise, Nutrition and Development) Research Group, School of Health Sciences (EUCS), University of Zaragoza, C/Domingo miral s/n, 50009, Saragossa, Spain
| | - Theodora Mouratidou
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009, Saragossa, Spain.,GENUD (Growth, Exercise, Nutrition and Development) Research Group, School of Health Sciences (EUCS), University of Zaragoza, C/Domingo miral s/n, 50009, Saragossa, Spain
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Marieke de Craemer
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - An-Sofie Pinket
- Department of Public Health, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium
| | - Julia Birnbaum
- Dr von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Berthold Koletzko
- Dr von Hauner Children's Hospital, University of Munich Medical Centre, Munich, Germany
| | - Violeta Iotova
- Medical University Varna, 55 Marin Drinov Str., 9002, Varna, Bulgaria
| | - Natalia Usheva
- Medical University Varna, 55 Marin Drinov Str., 9002, Varna, Bulgaria
| | | | | | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Luis A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, C/Pedro Cerbuna 12, 50009, Saragossa, Spain.,School of Health Science (EUCS), University of Zaragoza, C/Domingo Miral s/n, 50009, Saragossa, Spain.,GENUD (Growth, Exercise, Nutrition and Development) Research Group, School of Health Sciences (EUCS), University of Zaragoza, C/Domingo miral s/n, 50009, Saragossa, Spain
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Koleilat M, Whaley SE. Reliability and Validity of Food Frequency Questions to Assess Beverage and Food Group Intakes among Low-Income 2- to 4-Year-Old Children. J Acad Nutr Diet 2016; 116:931-9. [DOI: 10.1016/j.jand.2016.02.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 02/11/2016] [Indexed: 12/19/2022]
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Pinket AS, Van Lippevelde W, De Bourdeaudhuij I, Deforche B, Cardon G, Androutsos O, Koletzko B, Moreno LA, Socha P, Iotova V, Manios Y, De Craemer M. Effect and Process Evaluation of a Cluster Randomized Control Trial on Water Intake and Beverage Consumption in Preschoolers from Six European Countries: The ToyBox-Study. PLoS One 2016; 11:e0152928. [PMID: 27064274 PMCID: PMC4827861 DOI: 10.1371/journal.pone.0152928] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/20/2016] [Indexed: 12/14/2022] Open
Abstract
Background Within the ToyBox-study, a kindergarten-based, family-involved intervention was developed to prevent overweight and obesity in European preschoolers, targeting four key behaviours related to early childhood obesity, including water consumption. The present study aimed to examine the effect of the ToyBox-intervention (cluster randomized controlled trial) on water intake and beverage consumption in European preschoolers and to investigate if the intervention effects differed by implementation score of kindergartens and parents/caregivers. Method A sample of 4964 preschoolers (4.7±0.4 years; 51.5% boys) from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, Spain) was included in the data analyses. A standardized protocol was used and parents/caregivers filled in socio-demographic data and a food-frequency questionnaire. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample and for the six country-specific samples. Based on the process evaluation questionnaire of teachers and parents/caregivers, an implementation score was constructed. To assess differences in water intake and beverage consumption by implementation score in the total sample, multilevel repeated measures analyses were performed. Results Limited intervention effects on water intake from beverages and overall beverage consumption were found. However, important results were found on prepacked fruit juice consumption, with a larger decrease in the intervention group compared to the control group. However, also a decline in plain milk consumption was found. Implementation scores were rather low in both kindergartens and parents/caregivers. Nevertheless, more favorable effects on beverage choices were found in preschoolers whose parents/caregivers and kindergarten teachers had higher implementation scores compared to those with lower implementation scores. Conclusion The ToyBox-intervention can provide the basis for the development of more tailor-made interventions. However, new strategies to improve implementation of interventions should be created.
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Affiliation(s)
- An-Sofie Pinket
- Department of Public Health, Ghent University, Ghent, Belgium
- * E-mail:
| | | | | | - Benedicte Deforche
- Department of Public Health, Ghent University, Ghent, Belgium
- Department of Human Biometry and Biomechanics, Vrije Universiteit Brussel, Brussels, Belgium
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Berthold Koletzko
- Ludwig-Maximilians-University of Munich, Dr. von Hauner Children’s Hospital, München, Germany
| | - Luis A. Moreno
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - Piotr Socha
- The Children’s Memorial Health Institute, Warsaw, Poland
| | - Violeta Iotova
- Dept. of pediatrics and medical Genetics, Medical University of Varna, Varna, Bulgaria
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Marieke De Craemer
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
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50
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Cardon G, De Bourdeaudhuij I, Iotova V, Latomme J, Socha P, Koletzko B, Moreno L, Manios Y, Androutsos O, De Craemer M. Health Related Behaviours in Normal Weight and Overweight Preschoolers of a Large Pan-European Sample: The ToyBox-Study. PLoS One 2016; 11:e0150580. [PMID: 26950063 PMCID: PMC4780703 DOI: 10.1371/journal.pone.0150580] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/15/2016] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to investigate the associations of health related behaviours (HRB) with Body Mass Index (BMI) in preschoolers, and to study the likelihood of being overweight/obese in relation to compliance with recommended HRB. The sample consisted of 3301 normal weight and overweight/obese preschoolers (mean age: 4.7 years; 52% boys, 85% normal weight) from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, Spain). Height and weight were measured, total daily step counts were registered during six days, and HRB were assessed with validated parental surveys in 2012. Multiple linear and logistic regression analyses were performed. Only few HRB were significantly associated with BMI. In boys, higher water intake and higher soft drink and higher fruit consumption were significantly associated with higher BMI. Boys drinking less water than recommended were less likely to be overweight/obese (OR = 0.60), while boys who consume soft drinks were more likely to be overweight/obese (OR = 1.52). In girls, higher water intake, higher vegetable consumption, and more TV time on weekend days were significantly associated with higher BMI. Girls eating less vegetables than recommended were less likely to be overweight/obese (OR = 0.62), and girls who engaged in quiet play for more than 90 minutes on weekend days were more likely to be overweight/obese (OR = 1.64). In general, the associations between HRB and BMI or being overweight/obese were limited and mainly related to dietary intake. Awareness campaigns for caregivers should stress that HRB of young children are important and independent of children’s weight status.
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Affiliation(s)
| | | | | | | | - Piotr Socha
- Children’s Memorial Health Institute, Warsaw, Poland
| | - Berthold Koletzko
- Ludwig-Maximilians-University of Munich, Dr. von Hauner Children’s Hospital, Munich, Germany
| | | | - Yannis Manios
- Harokopio University, School of Health Science & Education, Department of Nutrition-Dietetics, Athens, Greece
| | - Odysseas Androutsos
- Harokopio University, School of Health Science & Education, Department of Nutrition-Dietetics, Athens, Greece
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