What Constitutes Traditional and Modern Eating? The Case of Japan

Offering vegetables to children at breakfast time in nursery and kindergarten settings: the Veggie Brek feasibility and acceptability cluster randomised controlled trial

BACKGROUND

In many Westernised countries, children do not consume a sufficient amount of vegetables for optimal health and development. Child-feeding guidelines have been produced to address this, but often only promote offering vegetables at midday/evening meals and snack times. With guidance having limited success in increasing children's vegetable intake at a population level, novel approaches to address this must be developed. Offering vegetables to children at breakfast time in nursery/kindergarten settings has the potential to increase children's overall daily vegetable consumption as children typically attend nursery/kindergarten and many routinely eat breakfast there. However, the feasibility and acceptability of this intervention (Veggie Brek) to children and nursery staff has not been investigated.

METHODS

A feasibility and acceptability cluster randomised controlled trial (RCT) was undertaken in eight UK nurseries. All nurseries engaged in one-week baseline and follow-up phases before and after an intervention/control period. Staff in intervention nurseries offered three raw carrot batons and three cucumber sticks alongside children's main breakfast food each day for three weeks. Control nurseries offered children their usual breakfast. Feasibility was assessed by recruitment data and nursery staff's ability to follow the trial protocol. Acceptability was assessed by children's willingness to eat the vegetables at breakfast time. All primary outcomes were assessed against traffic-light progression criteria. Staff preference for collecting data via photographs versus using paper was also assessed. Further views about the intervention were obtained through semi-structured interviews with nursery staff.

RESULTS

The recruitment of parents/caregivers willing to provide consent for eligible children was acceptable at 67.8% (within the amber stop-go criterion) with 351 children taking part across eight nurseries. Both the feasibility and acceptability of the intervention to nursery staff and the willingness of children to consume the vegetables met the green stop-go criteria, with children eating some part of the vegetables in 62.4% (745/1194) of instances where vegetables were offered. Additionally, staff preferred reporting data using paper compared to taking photographs.

CONCLUSIONS

Offering vegetables to children at breakfast time in nursery/kindergarten settings is feasible and acceptable to children and nursery staff. A full intervention evaluation should be explored via a definitive RCT.

TRIAL REGISTRATION

NCT05217550.

Would offering vegetables to children for breakfast increase their total daily vegetable intake?

The consumption of vegetables is vitally important for children's health and development. However, in many Westernised countries, most children do not eat sufficient quantities of vegetables and consume many energy-dense and high-sugar foods; a health behaviour associated with the onset of non-communicable diseases. To address this important public health concern, it is necessary to think 'outside the box' and consider innovative and pragmatic ways to increase children's daily vegetable intake. In many countries, caregivers implementing best-practice child feeding methods typically offer children vegetables at lunch, dinner and for snacks. It is unusual for children to be routinely offered vegetables for breakfast, yet there is no nutritional, physiological or medical reason why vegetables should not be eaten at breakfast. Indeed, in some countries, children frequently consume vegetables for breakfast. Increasing children's exposure to vegetables at breakfast from an early age would allow for the development of a positive association between eating vegetables and breakfast, thus providing another opportunity in the day where vegetables might be regularly consumed by children. In this paper, we propose a rationale for why vegetables should be routinely offered to young children at breakfast time in countries where this may not be the norm. Future research assessing the feasibility and acceptability of such a public health intervention would provide health policy agencies with evidence about a potentially effective and easily implementable approach for increasing children's vegetable intake, thus improving their overall nutritional status, as well as their heath and development.

Association of eating motives with anthropometry, body composition, and dietary intake in healthy German adults

Effective policies to address poor food choices and dietary patterns need to consider the complex set of motives affecting eating behavior. This study examined how different eating motives are associated with anthropometry, body composition, and dietary intake. Our analysis is based on a cross-sectional sample with 429 healthy adults in three different age groups collected in Germany from 2016 to 2018. Dietary intake, Body Mass Index (BMI), waist circumference (WC), and fat-free mass (FFM) were measured by standardized methods. Eating motives were measured using The Eating Motivation Scale (TEMS). Regressing dietary intakes and anthropometric indicators on TEMS motives, we identify the main sources of variation in diet and nutritional status separately for men and women. Results indicated the Health motive to be positively associated with FFM (B±SE=1.72±0.44) and negatively with WC (B±SE=-3.23±0.81) for men. For women, the Need & Hunger motive was positively associated with FFM (B±SE=1.63±0.44) and negatively with WC (B±SE=-2.46±0.81). While Liking and Habits were the most frequently stated eating motives, we did not find them to be significantly related to the nutritional status. Other motives were associated with dietary intake but not anthropometry or body composition. The Price motive was positively and the Convenience motive was negatively associated with energy (B±SE=63.77±19.98;B±SE=-46.96±17.12) and carbohydrate intake (B±SE=7.15±2.65;B±SE=-5.98±2.27) for men. The results highlight the need for more differentiated analyses of eating motives, beyond comparing the relative importance of motives based on mean values, towards the association of motives with dietary intake and nutritional status.

Self-Reported Eating Speed Is Associated with Indicators of Obesity in Adults: A Systematic Review and Meta-Analysis

Eating speed (ES) as a dietary behaviour has become a widely discussed factor for weight management and obesity. This study analysed the relationship between ES and anthropometric indicators of obesity, including BMI and waist circumference (WC) in adults. A search conducted of PubMed, Web of Science, Science Direct and Scopus found six longitudinal studies and fifteen cross-sectional studies published for further analysis. A quality assessment was performed with the MINORS checklist. Eight studies were included in the meta-analysis and almost all reviewed studies showed that ES was associated with BMI, and non-fast eaters had significantly lower BMI than fast eaters. Therefore, it was assumed that slowing down the ES may be an effective strategy for weight management and lowering obesity risk. There was also an association between WC and ES. Assessment of eating speed can be included in nutrition surveys to analyse obesity risk. More broadly, research is also needed to establish a validated and standardised methodology to determine eating speed. Further research needs to examine the links between eating speed, obesity, ethnicity, sex, food culture and chronic diseases.

Understanding traditional and modern eating: the TEP10 framework

Across the world, there has been a movement from traditional to modern eating, including a movement of traditional eating patterns from their origin culture to new cultures, and the emergence of new foods and eating behaviors. This trend toward modern eating is of particular significance because traditional eating has been related to positive health outcomes and sustainability. Yet, there is no consensus on what constitutes traditional and modern eating. The present study provides a comprehensive compilation of the various facets that seem to make up traditional and modern eating. Specifically, 106 facets were mentioned in the previous literature and expert discussions, combining international and interdisciplinary perspectives. The present study provides a framework (the TEP10 framework) systematizing these 106 facets into two major dimensions, what and how people eat, and 12 subdimensions. Hence, focusing only on single facets of traditional and modern eating is an oversimplification of this complex phenomenon. Instead, the multidimensionality and interplay between different facets should be considered to gain a comprehensive understanding of the trends, consequences, and underlying factors of traditional and modern eating.

Consumption of ultra-processed foods decreases the quality of the overall diet of middle-aged Japanese adults

Objective:

To estimate the consumption of ultra-processed foods and determine its association with dietary quality among middle-aged Japanese adults.

Design:

Cross-sectional study using data from the Saitama Prefecture Health and Nutrition Survey 2011. Dietary intake was assessed using one- or two-day dietary records. Sociodemographic and lifestyle factors were obtained via self-administered questionnaire. Food items were classified according to the NOVA system into four groups: unprocessed or minimally processed foods; processed culinary ingredients; processed foods; and ultra-processed foods. The dietary share of each NOVA food group and their subgroups was calculated in relation to total energy intake, and the average dietary content of key nutrients was determined across tertiles of the dietary energy share of ultra-processed foods (low, middle and high intake).

Setting:

Saitama Prefecture in Japan.

Participants:

Community-dwelling adults aged 30–59 years (256 men, 361 women).

Results:

Consumption of unprocessed or minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods contributed 44·9 (se 0·8) %, 5·5 (se 0·2) %, 11·3 (se 0·4) % and 38·2 (se 0·9) % of total daily energy intake, respectively. A positive and statistically significant linear trend was found between the dietary share of ultra-processed foods (tertiles) and the dietary content of total and saturated fat, while an inverse relationship was observed for protein, vitamin K, vitamin B6, dietary fibre, magnesium, phosphorus and iron.

Conclusions:

Our findings show that higher consumption of ultra-processed foods was associated with decreased dietary quality among Japanese adults.

Comparison of Objective and Perceived Access to Food Stores Associated with Intake Frequencies of Vegetables/Fruits and Meat/Fish among Community-Dwelling Older Japanese

This cross-sectional study aimed to compare access to the nearest food stores with perceived access associated with intake frequencies of vegetables/fruits and meat/fish among older Japanese people. We used intake frequencies of vegetables/fruits and meat/fish from a self-administered questionnaire in the Japan Gerontological Evaluation Study among 83,384 adults aged over 65 years. We defined distance over 1 km as poor objective access in community level. We performed multilevel regression analysis to investigate the association of objective and perceived access with intake frequencies of vegetables/fruits and meat/fish, respectively. Participants who lived in poor objective access had a significantly higher intake frequency of vegetables/fruits than those who lived in good access. In contrast, residents with poor perceived access consumed lower frequent intake of vegetables/fruits (beta coefficient (standard error) 0.086 (0.021) for objective access; -0.093 (0.009) for perceived access). There was no significant association between objective access and intake frequency of meat/fish, but poor perceived access showed a significant association with lower intake frequency of meat/fish. There was inconsistency between objective and perceived measurement of access to food stores associated with dietary habits among older Japanese adults. Food access needs to be comprehensively assessed, while considering characteristics of measurements.

Dietary Culture: A Concept Analysis

The concept of dietary culture is undefined in the nursing literature. This is problematic due to the significant influence of culture on group eating patterns, which impact cardiovascular health. Cardiovascular disease is the leading cause of death, globally. The purpose of this concept analysis was to define the concept of dietary culture to increase the understanding of the relationship between diet, culture, and cardiovascular health. Walker and Avant's method was employed. This analysis of dietary culture provides insight into the internal structure of the concept for future theory development and promotes the application of the concept to nursing research and practice.