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Ko A, O’Brien D, Rivera P, Mancl L, Hopkins S, Randall C, Nguyen DP, Chi DL. Identifying sources of variation in added sugar intake for Alaska Native children using a hair biomarker. Int J Circumpolar Health 2024; 83:2336286. [PMID: 38560896 PMCID: PMC10986438 DOI: 10.1080/22423982.2024.2336286] [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: 09/16/2023] [Accepted: 03/25/2024] [Indexed: 04/04/2024] Open
Abstract
Sugars from sugar-sweetened beverages (SSBs) are an important risk factor for tooth decay. The study goal was to determine if there was variation in added sugar intake across communities and between and within households. In this cross-sectional study, intakes of total sugar, added sugar, and sugar-sweetened beverages (SSBs) were estimated for 282 Alaska Native children ages 0-10 years from 131 households in three Yukon-Kuskokwim (YK) Delta communities using biomarker equations based on hair carbon and nitrogen isotope ratios previously developed for the Yup'ik population. ANOVA was used to assess associations between each predictor (community and household) and outcome (estimated total sugars, added sugars, and SSB intake). Between- and within-household variation was estimated using a linear mixed-effects model with a random intercept for households with three or more children. There was no significant difference in mean estimated total sugar (p = 0.29), added sugar (p = 0.24), or SSB intake (p = 0.40) across communities. Significant variations were observed between and within households, with within-household variation amounting to 59% of the between-household variation. Added sugar intake in Alaska Native children from the three study communities is higher than the recommended maximum, and the variation is greater within households than between households.
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Affiliation(s)
- Alice Ko
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Diane O’Brien
- Center for Alaska Native Health Research, Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska, Fairbanks, AK, USA
| | - Patricia Rivera
- Center for Alaska Native Health Research, Institute of Arctic Biology, Department of Biology and Wildlife, University of Alaska, Fairbanks, AK, USA
| | - Lloyd Mancl
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Scarlett Hopkins
- Departments of Medicine and Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Cameron Randall
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Daisy Patiño Nguyen
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
| | - Donald L. Chi
- Department of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA
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Ortega-Ramírez AD, Maneschy IR, Miguel-Berges ML, Pastor-Villaescusa B, Leis R, Babio N, Navas-Carretero S, Portoles O, Moreira A, Jurado-Castro JM, Flores-Rojas K, Vázquez-Cobela R, Mimbreros G, Flores-Barrantes P, Martínez JA, Castro-Collado C, Ferré-Pallás N, Gimenez-Legarre N, Gil-Campos M, Salas-Salvadó J, de Miguel-Etayo P, Moreno Aznar LA. Early feeding practices and eating behaviour in preschool children: The CORALS cohort. MATERNAL & CHILD NUTRITION 2024:e13672. [PMID: 38853145 DOI: 10.1111/mcn.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 06/11/2024]
Abstract
This study aimed to investigate if the duration of breastfeeding and the method at initiation of complementary feeding affect eating behaviour in children aged 3-6 years. This is a cross-sectional analysis from the Childhood Obesity Risk Assessment Longitudinal Study project, an ongoing longitudinal cohort study that aims to identify childhood obesity risk factors in Spanish children. A total of 1215 children aged 3-6 years were included. Breastfeeding duration and the method of initiation of complementary feeding [baby-led weaning (BLW), traditional/spoon or mixed method] were evaluated. Eating behaviour at 3-6 years was assessed with the Child Eating Behaviour Questionnaire. Generalized linear models were fitted to assess the association between the aforementioned exposures and eating behaviour. Children breastfed for ≥4 months were less likely to be fussy eaters at 3-6 years compared to those breastfed for <1 month (OR: 0.86 95% CI: 0.76-0.98; p = 0.031). Compared to those children using the traditional/spoon-feeding method, those initiating complementary feeding through BLW or through a mixed approach were more likely to have higher scores on the enjoyment of food (EF) (OR, 95% CI: 1.33, 1.13-1.57; p = 0.001 and 1.17, 1.05-1.30; p = 0.002, respectively) and lower scores on food fussiness (FF) at 3-6 years (0.76, 0.62-0.91; p = 0.004 and 0.87, 0.78-0.98; p = 0.033, respectively). Breastfeeding for ≥4 months and initiation of complementary feeding with the BLW and a mixed approach were associated with greater EF and lower FF, which should endure practice.
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Affiliation(s)
- Ana Daniela Ortega-Ramírez
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Faculty of Medicine, University of Colima, Colima, Mexico
| | - Ivie Reis Maneschy
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Consorcio CIBER, M. P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - María L Miguel-Berges
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Consorcio CIBER, M. P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Belen Pastor-Villaescusa
- Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin (RICORS), RD21/0012/0008, Instituto de Salud Carlos III, Madrid, Spain
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Rosaura Leis
- Consorcio CIBER, M. P. 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, 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, Santiago de Compostela, Spain
| | - Nancy Babio
- Consorcio CIBER, M. P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Universitat Rovira i Virgili Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup ANUT-DSM, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Santiago Navas-Carretero
- Consorcio CIBER, M. P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Center for Nutrition Research, University of Navarra, Pamplona, Spain
- Department of Nutrition, Food Sciences and Physiology, Faculty of Pharmacy & Nutrition, University of Navarra, Pamplona, Spain
- IdisNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Olga Portoles
- Consorcio CIBER, M. P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department of Preventive Medicine and Public Health, University of Valencia, Valencia, Spain
| | - Ana Moreira
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - José Manuel Jurado-Castro
- Consorcio CIBER, M. P. 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
| | - 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
- Consorcio CIBER, M. P. 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, 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, Santiago de Compostela, Spain
| | - Gisela Mimbreros
- Universitat Rovira i Virgili Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup ANUT-DSM, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Paloma Flores-Barrantes
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Consorcio CIBER, M. P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - José Alfredo Martínez
- Consorcio CIBER, M. P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Center for Nutrition Research, University of Navarra, Pamplona, Spain
- Department of Nutrition, Food Sciences and Physiology, Faculty of Pharmacy & Nutrition, University of Navarra, Pamplona, Spain
| | - Cristina Castro-Collado
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Natalia Ferré-Pallás
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
- Universitat Rovira i Virgili Departament de Medicina i Cirurgia, Unitat de Recerca en Pediatria, Nutrició i Desenvolupament Humà, Tarragona, Spain
| | - Natalia Gimenez-Legarre
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Consorcio CIBER, M. P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Mercedes Gil-Campos
- Consorcio CIBER, M. P. 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
| | - Jordi Salas-Salvadó
- Consorcio CIBER, M. P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Universitat Rovira i Virgili Departament de Bioquímica i Biotecnologia, Unitat de Nutrició Humana, Grup ANUT-DSM, Reus, Spain
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Reus, Spain
| | - Pilar de Miguel-Etayo
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Consorcio CIBER, M. P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Luis A Moreno Aznar
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, Zaragoza, Spain
- Instituto Agroalimentario de Aragón (IA2), Zaragoza, Spain
- Consorcio CIBER, M. P. Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Department Physiatry and Nursing, Universidad de Zaragoza, Zaragoza, Spain
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Sleiman R, Abdelkader W, AlTannir D. Assessing the Body Composition of "Picky Eaters" Using Body Impedance Analysis: An Experience From a Tertiary Care Center. Cureus 2024; 16:e60538. [PMID: 38887328 PMCID: PMC11181006 DOI: 10.7759/cureus.60538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Picky eating might be associated with a higher risk of being underweight and poor growth. This study aimed to investigate if picky eaters aged between three and 12 years showed differences in height, weight, and body composition compared to their non-picky peers using a body impedance analysis (BIA). METHODS This cross-sectional study was conducted between March 1, 2022, and July 31, 2022, on children aged three to 12 years who presented to the outpatient pediatric clinics at Al Habib Ar Rayyan in Riyadh, Saudi Arabia. Body composition was measured using BIA after manually inserting the height, gender, and age into the machine, where body mass index (BMI), fat mass, and skeletal muscle mass were recorded. Participants were classified as under/normal/over for each body composition measurement. RESULTS A total of 2234 children were entered into the final data analysis. Our analysis showed that 1917 (85.8%) were Saudis and 1117 (50%) were males. The mean age of participants was 6.08±2.01 years and 1151 (51.5%) were in the pre-school age. The reported prevalence of picky eaters was 1684 (75.4%), of whom, 606 (27.0%) were selective eaters, 365 (16.2%) were low appetite eaters, and 723 (32.2%) were both selective and low appetite eaters. Being underweight was significantly more common among the picky eaters 487 (28.9%) compared to those non-picky eaters 55 (10.0%) (p<0.001). Significantly, 1280 (76%) picky eaters had below-average skeletal muscle mass compared to 151 non-picky eaters (27.5%) (p<0.001). The low appetite picky eater group had more under skeletal muscle mass children 277 (75.9%) compared to the selective picky eater group 412 (68.0%) (p=0.009). Additionally, the low appetite group possessed lower muscle ratios (p=0.012) and were more underweight than the selective group (p<0.001). Furthermore, the low appetite group showed a higher percentage of children below the 3rd percentile in the height for age category (p=0.003) compared to the selective group. CONCLUSION This study is the first of its kind in Saudi and globally to evaluate body composition using BIA among children. The study showed that picky eating is more associated with underweight children and low muscular mass. Despite the normal BMI, height, and weight of a picky eater, their skeletal muscle mass might be less than average, which could be associated with an increased risk of morbidity.
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Affiliation(s)
- Rola Sleiman
- Pediatrics, Dr. Sulaiman Al Habib Medical Group, Riyadh, SAU
| | | | - Dana AlTannir
- Pediatric Medicine, Alfaisal University College of Medicine, Riyadh, SAU
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Kojima A, Kameyama Y, Kajiura A, Murayama Y, Kato M. Association between the Combination of Speed-Eating and Eating until Full and Overweight/Obesity in Part-Time High School Students. ANNALS OF NUTRITION & METABOLISM 2024; 80:128-135. [PMID: 38574480 DOI: 10.1159/000537851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/19/2024] [Indexed: 04/06/2024]
Abstract
INTRODUCTION This cross-sectional study aimed to examine the association between overweight/obesity and the combined behavior of speed-eating and eating until full among part-time high school students. METHODS In 2015, 2,507 male and female part-time high school students from Hyogo Prefecture, Japan, who completed a self-reported questionnaire on lifestyle, were included in the analysis. Overweight/obesity was defined as a body mass index of 25 kg/m2 or more. Responses regarding speed-eating and eating until full were obtained by self-reporting. Logistic regression analysis was used to estimate the odds ratio (OR) for overweight/obesity. RESULTS Among the participants, 340 (13.6%) were overweight/obese and 468 (18.7%) reported both speed-eating and eating until full. Compared to neither speed-eating nor eating until full group, after adjustment for sex, age, work pattern, physical activity level, sleep duration, frequency of picky eating, frequency of snack intake, fast food intake frequency, frequency of adding salty condiments, frequency of eating less food to save money, and survey schools, the OR (95% CI) for overweight/obesity in speed-eating and not eating until full, eating until full and not speed-eating, and speed-eating and eating until full was 2.11 (1.38-3.22), 1.54 (1.12-2.10), and 2.94 (2.08-4.16), respectively. CONCLUSIONS The combination of speed-eating and eating until full was associated with overweight/obesity among part-time high school students independent of other lifestyle factors.
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Affiliation(s)
- Akane Kojima
- Department of Nutrition, Faculty of Health and Nutrition, Yamanashi Gakuin University, Yamanashi, Japan,
| | - Yoshiko Kameyama
- Department of Health and Nutrition, Faculty of Nursing and Nutrition, The University of Shimane, Shimane, Japan
| | - Akane Kajiura
- Department of Human Life and Sciences, Nagoya University of Economics, Aichi, Japan
| | - Yuuki Murayama
- Department of Nutrition, Social Welfare Corporation Doho Fukushikai Doho Gakuen, Hyogo, Japan
| | - Masahiko Kato
- Department of Human Nutrition, School of Life Studies, Sugiyama Jogakuen University, Aichi, Japan
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Tura DC, Belachew T, Tamiru D, Abate KH. Effects of blending ratio variation on macronutrient compositions and sensory acceptability of dabi teff-field pea-based novel composite complementary flours. Food Sci Nutr 2024; 12:2408-2425. [PMID: 38628205 PMCID: PMC11016380 DOI: 10.1002/fsn3.3925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 04/19/2024] Open
Abstract
The response of a mixed system is determined by the proportions of the various ingredients that add up to one, not by the combination's total amount. This research aimed at examining the effects of blending ratio variation on the macro-composition and sensory acceptability of dabi teff-field pea-based novel composite complementary flours. Standard methods (AOAC, 2016, Official Methods of Analysis of the Association of Official Analytical Chemists) were used to determine macronutrients. The sensory attributes were evaluated using a 5-point hedonic scale. The ingredients were constrained at 0%-30% for field pea, 20%-35% for dabi teff, and 5%-20% for maize, while the remaining were set constant at 5% linseed, 15% oats, and 25% barley. D-optimal was used to examine the effects of blending ratio variation on the responses. All the responses were significantly different (p < .05) among the blends except for fat content, ranging from 14.58% to 17.21% for protein, 4.22% to 5.59% fat, 2.01% to 2.60% ash, 2.68% to 3.96% fiber, 68.08% to 70.76% utilizable carbohydrate, and 378.82 to 386.9 kcal/100 g gross energy. The sensory acceptability score ranged from 3.4 to 4.4. The linear model was significant (p < .05) and adequate to describe variation in moisture, protein, and ash contents. An increase in the ratio of field pea significantly increased (p < .05) protein, ash, fiber, and energy. The interactive effect between dabi teff and field pea significantly increased the sensory acceptability of the blends. These findings showed that varied proportions of the ingredients had a significant effect on the responses, and were used to develop a wholesome product to combat protein-energy malnutrition among children.
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Affiliation(s)
- Diriba Chewaka Tura
- Department of Nutrition and DieteticsInstitute of Health, Jimma UniversityJimmaEthiopia
- Department of Human NutritionWollega UniversityNekemteEthiopia
| | - Tefera Belachew
- Department of Nutrition and DieteticsInstitute of Health, Jimma UniversityJimmaEthiopia
| | - Dessalegn Tamiru
- Department of Nutrition and DieteticsInstitute of Health, Jimma UniversityJimmaEthiopia
| | - Kalkidan Hassen Abate
- Department of Nutrition and DieteticsInstitute of Health, Jimma UniversityJimmaEthiopia
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Smolko NA, Valiev RI, Kabdesh IM, Fayzullina RA, Mukhamedshina YO. Eating disorder in children: Impact on quality of life, with a spotlight on autism spectrum disorder. Nutr Res 2024; 123:38-52. [PMID: 38241984 DOI: 10.1016/j.nutres.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
Eating behavior, which includes eating habits and preferences, frequency of eating, and other features related to diet, is a major characteristic not only of a person's nutritional status, but also of health in general. In recent years, the prevalence of eating disorders in children has tended to increase; they also require cross-system approaches in diagnosis by a variety of specialists and correction requires appropriate selection of optimal methods. Maladaptive eating attitudes formed at an early age can contribute to the formation of eating disorders, which can lead to or worsen various neuropsychiatric diseases, digestive diseases, and other related conditions. In children with autism spectrum disorder (ASD), eating disorders often appear earlier than other major symptoms of the condition. However, the clinical manifestations of eating disorders in children with ASD are varied and differ in severity and duration, whereas these disorders in neurotypical children might present as short-lived and may not lead to serious consequences. Nevertheless, cases of progressive eating disorders accompanied by a child presenting as under- or overweight and/or with macronutrient and micronutrient deficiencies cannot be excluded. Given the high prevalence of eating disorders in children, many researchers have highlighted the lack of a valid and universally accepted instruments to assess atypical eating behaviors in this population. Therefore, in this review, we wanted to highlight the problems and causes of eating disorders in children, and also to analyze the existing approaches to the validation of these problems, taking into account the existing behavioral features in children with ASD.
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Affiliation(s)
- Natalia A Smolko
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia; Department of Propaedeutics of Pediatric Diseases and Faculty Pediatrics, Kazan State Medical University, Kazan, Russia
| | - Rushan I Valiev
- Department of General Hygiene, Kazan State Medical University, Kazan, Russia
| | - Ilyas M Kabdesh
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia.
| | - Rezeda A Fayzullina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia; Department of Propaedeutics of Pediatric Diseases and Faculty Pediatrics, Kazan State Medical University, Kazan, Russia
| | - Yana O Mukhamedshina
- Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia; Department of Histology, Cytology and Embryology, Kazan State Medical University, Kazan, Russia
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Ferreira P, Warkentin S, Oliveira A. Appetitive traits and food groups consumption in school-aged children: prospective associations from the Generation XXI birth cohort. Eat Weight Disord 2023; 28:67. [PMID: 37542554 PMCID: PMC10404169 DOI: 10.1007/s40519-023-01586-9] [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: 09/15/2022] [Accepted: 11/25/2022] [Indexed: 08/07/2023] Open
Abstract
PURPOSE Appetite can influence children's dietary choices; however, this relationship in school-aged children is still unclear. We aimed to explore the prospective associations between child appetitive traits at age 7 and food consumption at 10 years of age. METHODS The study included 3860 children from the Generation XXI birth cohort, recruited in 2005/2006 in Porto, Portugal. The Children's Eating Behaviour Questionnaire was used to evaluate children's appetitive traits at 7 years. Food consumption was measured at 10 years through a validated Food Frequency Questionnaire. Logistic regression models were performed and adjusted for possible confounders. RESULTS Children with greater Enjoyment of Food at 7 years were 36% more likely to eat fruits ≥ 2 times/day and 54% more likely to eat vegetables > 2.5 times/day at 10 years compared to those with less frequent consumption. Children who ate more in response to negative emotions had higher odds of consuming energy-dense foods (OR = 1.33; 99% CI 1.13-1.58) and salty snacks (OR = 1.28; 99% CI 1.08-1.51) 3 years later. Those with less ability to adjust intake (higher Satiety Responsiveness) and more selective about foods (higher Food Fussiness) at 7 years were less likely to consume vegetables frequently, and were more likely to consume energy-dense foods and sugar-sweetened beverages. CONCLUSIONS Children's appetitive traits at 7 years were associated with the consumption of several food groups at 10 years of age. Eating more in response to negative emotions (Emotional Eating), with less ability to adjust intake (Satiety Responsiveness) and more food selectivity (Food Fussiness) were associated with worse dietary choices (in general, lower fruit and vegetables, and higher energy-dense foods and sugar-sweetened beverages consumption). LEVEL OF EVIDENCE Level III: Evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Pedro Ferreira
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto [Institute of Public Health, University of Porto], University of Porto, Rua das Taipas nº135, 4050-600, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health [ITR], University of Porto, Rua das Taipas nº135, 4050-600, Porto, Portugal
| | - Sarah Warkentin
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto [Institute of Public Health, University of Porto], University of Porto, Rua das Taipas nº135, 4050-600, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health [ITR], University of Porto, Rua das Taipas nº135, 4050-600, Porto, Portugal
| | - Andreia Oliveira
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto [Institute of Public Health, University of Porto], University of Porto, Rua das Taipas nº135, 4050-600, Porto, Portugal.
- Laboratory for Integrative and Translational Research in Population Health [ITR], University of Porto, Rua das Taipas nº135, 4050-600, Porto, Portugal.
- Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
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Gotow N, Nagai Y, Taguchi T, Kino Y, Ogino H, Kobayakawa T. Change in preference for vegetables and their perceptual attributes as a function of age and pickiness. Food Res Int 2023; 170:112967. [PMID: 37316010 DOI: 10.1016/j.foodres.2023.112967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 06/16/2023]
Abstract
Preference for vegetables is influenced by various factors, including demographic, psychological, socio-environmental, and genetic factors. This study confirmed that age, pickiness, and perceptual attributes were predictors of preference for vegetables and examined how preference for vegetables and their perceptual attributes varies with age and pickiness. Children (8-14 years, n = 420), youth (15-34 years, n = 569), middle-aged adults (35-64 years, n = 726), and older adults (65-85 years, n = 270) were asked which vegetables they liked (or disliked) and which perceptual attributes of each vegetable they liked (or disliked). On the basis of their responses, an overall preference score and a preference sub-score for each perceptual attribute were calculated. Participants in each age group were classified into four statuses (non-, mild, moderate, and severe) according to their pickiness scores. Multiple regression analysis revealed that age and preference sub-scores for eight perceptual attributes (sweetness, sourness, bitterness, umami, pungency, orthonasal aroma, texture, and appearance) were positive predictors of overall preference score and that pickiness score and four perceptual attributes (saltiness, astringency, retronasal aroma, and aftertaste) were negative predictors. In addition, overall preference score and preference sub-scores for perceptual attributes other than saltiness increased with increasing age group and decreasing picker status; however, preference sub-scores for at least one of the six perceptual attributes (bitterness, astringency, pungency, orthonasal aroma, retronasal aroma, and aftertaste) exhibited negative values in children, youth, and pickers (mild, moderate, and severe). The increase in preference for these perceptual attributes might be an indicator of the adultization of food perception and the expansion of food acceptance.
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Affiliation(s)
- Naomi Gotow
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba Central 6, 1-1-1, Higashi, Tsukuba, Ibaraki 305-8566, Japan.
| | - Yuko Nagai
- Kagome Co., Ltd., 17, Nishitomiyama, Nasushiobara-shi, Tochigi 329-2762, Japan.
| | - Taro Taguchi
- Kagome Co., Ltd., 17, Nishitomiyama, Nasushiobara-shi, Tochigi 329-2762, Japan.
| | - Yuko Kino
- Kagome Co., Ltd., 17, Nishitomiyama, Nasushiobara-shi, Tochigi 329-2762, Japan.
| | - Hiroyuki Ogino
- Kagome Co., Ltd., 17, Nishitomiyama, Nasushiobara-shi, Tochigi 329-2762, Japan.
| | - Tatsu Kobayakawa
- Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba Central 6, 1-1-1, Higashi, Tsukuba, Ibaraki 305-8566, Japan.
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Saati AA, Adly HM. Assessing the Correlation between Blood Trace Element Concentrations, Picky Eating Habits, and Intelligence Quotient in School-Aged Children. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1249. [PMID: 37508746 PMCID: PMC10378148 DOI: 10.3390/children10071249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Inadequate levels of iron, zinc, and copper have been linked to growth impairment and cognitive and motor development deficits. The objective of this study is to examine the deficiencies of trace elements and their correlation with selective eating patterns and the intelligence quotient (IQ) of children. METHODS AND PATIENTS The cross-sectional analysis involved 430 children aged between 7 and 10 years. Blood samples were analyzed using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) to measure the trace elements levels. Children's IQs were assessed using Raven's Standard Progressive Matrices. RESULTS Among the sample group, 20.3% exhibited iron deficiency, 42.5% had zinc deficiency, and 14% had insufficient copper levels. Single trace element deficiency was observed in 56.9% of the children, while 66.7% showed coexisting deficiencies of iron and zinc. Children with lower development levels exhibited significantly lower serum zinc levels compared to those with higher development levels (76.78 ± 10.67 vs. 81.14 ± 10.19 μg/dL). The analysis reveals that picky eaters had lower serum iron levels (76.59 ± 10.42 μg/dL) and higher serum copper levels (123.74 ± 13.45 μg/dL). CONCLUSION A strong association was observed between zinc deficiency, picky eating habits, and lower developmental stages. The findings underscore the importance of monitoring nutritional status in children, given the significant implications for their cognitive development.
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Affiliation(s)
- Abdullah A Saati
- Community Medicine and Pilgrims Healthcare Department, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Heba M Adly
- Community Medicine and Pilgrims Healthcare Department, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
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Anwar F, Yalawar M, Suryawanshi P, Ghosh A, Jog P, Khadilkar AV, Kishore B, Paruchuri AK, Pote PD, Mandyam RD, Shinde S, Shah A. Effect of Oral Nutritional Supplementation on Adequacy of Nutrient Intake among Picky-Eating Children at Nutritional Risk in India: A Randomized Double Blind Clinical Trial. Nutrients 2023; 15:nu15112528. [PMID: 37299491 DOI: 10.3390/nu15112528] [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: 04/19/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Nutrient inadequacies among picky-eaters have adverse effects on growth and development. Oral nutritional supplements (ONS) along with dietary counseling (DC), rather than DC alone as reported in our earlier publication, promoted growth among picky-eating Indian children aged from >24 m to ≤48 m with weight-for-height percentiles lying between the 5th and 25th (based on WHO Growth Standards) over 90 days. This paper presents the contribution of ONS to nutrient adequacy, dietary diversity, and food consumption patterns in children (N = 321). Weight, height, and dietary intakes, using 24-h food recalls, were measured at baseline (Day 1) and at Days 7, 30, 60, and 90. Nutrient adequacy, dietary diversity score (DDS), and food intake adequacy were calculated in both the supplementation groups (ONS1 + DC and ONS2 + DC; n = 107 in each group) and the control group (DC-only; n = 107). Supplements increased nutrient adequacy in both of the ONS + DC groups relative to control (p < 0.05). The proportions of children with adequate nutrient intakes increased significantly at Day 90 in the supplemented groups as compared to in the control group (p < 0.05), especially for total fat, calcium, vitamin A, vitamin C, and thiamin. Although no significant differences were observed in DDS in any of the groups, the percentage of children consuming ≥4 food groups in a day had increased in all the groups. Consumption of fruit and vegetables and cereals had increased significantly from baseline to Day 90. ONS along with dietary counseling was found to have improved nutritional adequacy without interfering with the normal food consumption patterns of picky-eating children at nutritional risk.
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Affiliation(s)
- Fahmina Anwar
- Abbott Nutrition, Research & Development India, Mumbai 400051, India
| | - Menaka Yalawar
- Biostatistics and Statistical Programming, Life Sciences-Digital Business Operations, Cognizant Technology Solutions India Private Limited, Bengaluru 560045, India
| | - Pranali Suryawanshi
- Biostatistics and Statistical Programming, Life Sciences-Digital Business Operations, Cognizant Technology Solutions India Private Limited, Navi Mumbai 400708, India
| | - Apurba Ghosh
- Institute of Child Health, Kolkata 700017, India
| | | | | | - Bala Kishore
- Saint Theresa's Hospital, Hyderabad 500018, India
| | | | | | | | - Sandeep Shinde
- Pune Sterling Multispecialty Hospital, Pune 411044, India
| | - Atish Shah
- Sangini Hospital, Sangini Complex, Ahmedabad 380006, India
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11
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Garcia-Iborra M, Castanys-Munoz E, Oliveros E, Ramirez M. Optimal Protein Intake in Healthy Children and Adolescents: Evaluating Current Evidence. Nutrients 2023; 15:nu15071683. [PMID: 37049523 PMCID: PMC10097334 DOI: 10.3390/nu15071683] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
High protein intake might elicit beneficial or detrimental effects, depending on life stages and populations. While high protein intake in elder individuals can promote beneficial health effects, elevated protein intakes in infancy are discouraged, since they have been associated with obesity risks later in life. However, in children and adolescents (4–18 years), there is a scarcity of data assessing the effects of high protein intake later in life, despite protein intake being usually two- to three-fold higher than the recommendations in developed countries. This narrative review aimed to revise the available evidence on the long-term effects of protein intake in children and adolescents aged 4–18 years. Additionally, it discusses emerging techniques to assess protein metabolism in children, which suggest a need to reevaluate current recommendations. While the optimal range is yet to be firmly established, available evidence suggests a link between high protein intake and increased Body Mass Index (BMI), which might be driven by an increase in Fat-Free Mass Index (FFMI), as opposed to Fat Mass Index (FMI).
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Affiliation(s)
- Maria Garcia-Iborra
- Abbott Nutrition R & D, Granada University Science Park, 18016 Granada, Spain; (M.G.-I.); (E.C.-M.)
| | - Esther Castanys-Munoz
- Abbott Nutrition R & D, Granada University Science Park, 18016 Granada, Spain; (M.G.-I.); (E.C.-M.)
| | - Elena Oliveros
- Abbott Nutrition R & D, Abbott Laboratories, 18004 Granada, Spain;
| | - Maria Ramirez
- Abbott Nutrition R & D, Abbott Laboratories, 18004 Granada, Spain;
- Correspondence: ; Tel.: +34-669127998
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Kamarudin MS, Shahril MR, Haron H, Kadar M, Safii NS, Hamzaid NH. Interventions for Picky Eaters among Typically Developed Children-A Scoping Review. Nutrients 2023; 15:nu15010242. [PMID: 36615899 PMCID: PMC9824123 DOI: 10.3390/nu15010242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 01/05/2023] Open
Abstract
Picky eating in children is often a major source of concern for many parents and caregivers. Picky eaters (PEs) consume limited foods, demonstrate food aversion, and have a limited food repertoire, which hinders their growth and health. These behaviours are common in children with special health care needs despite the rise in typically developing children. This leads to less attention being given to intervention programmes for typically developing children. Therefore, this scoping review aims to investigate the key concept of an existing intervention programme for PE among typically developing children, primarily on the types and approaches selected. A thorough literature search was conducted on three primary databases (PubMed, Emerald In-sight, and Web of Science) using predefined keywords. The literature was then appraised using the Joanna Briggs Institute's guidelines and protocols, and the PRISMScR checklist. Inclusion and exclusion criteria were also specified in the screening procedure. Results showed that the majority of the interventions in these studies were single-component interventions, with the sensory approach being the type that was most frequently utilised, followed by the nutrition approach and parenting approach. Single and multiple intervention components improved the assessed outcome, with a note that other components may or may not show a similar outcome, as they were not assessed in the single-component intervention. Given the evidence that picky eating is influenced by various factors, a multi-component intervention can provide a substantial impact on future programmes. In addition, defining picky eaters using standardised tools is also essential for a more inclusive subject selection.
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Affiliation(s)
- Mohd Shah Kamarudin
- Center for Rehabilitation & Special Needs Studies (iCaRehab), Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur 56000, Malaysia
| | - Mohd Razif Shahril
- Center for Healthy Ageing & Wellness (H-CARE), Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur 56000, Malaysia
| | - Hasnah Haron
- Center for Healthy Ageing & Wellness (H-CARE), Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur 56000, Malaysia
| | - Masne Kadar
- Center for Rehabilitation & Special Needs Studies (iCaRehab), Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nik Shanita Safii
- Center for Community Health Studies (ReaCH), Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur 56000, Malaysia
| | - Nur Hana Hamzaid
- Center for Rehabilitation & Special Needs Studies (iCaRehab), Faculty of Health Sciences, National University of Malaysia, Kuala Lumpur 56000, Malaysia
- Correspondence:
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13
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Yalcin S, Oflu A, Akturfan M, Yalcin SS. Characteristics of picky eater children in Turkey: a cross-sectional study. BMC Pediatr 2022; 22:431. [PMID: 35854285 PMCID: PMC9297567 DOI: 10.1186/s12887-022-03458-0] [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: 03/17/2022] [Accepted: 06/28/2022] [Indexed: 11/21/2022] Open
Abstract
Objective The aim of this study is to investigate the relations of picky eating habit of children with their nutrition, physical activity, screen time and sleep habits in the context of parental picky eating habit. Methods In a cross-sectional study a questionnare was applied to the parents of children aged 6–13 years in two provincies. The cases were analyzed as the overall group and the two subgroups in which both parents are not picky eater, and in which at least one parent was picky eater. Child's risk of being picky eater was analyzed by logistic regression. Results A total of 913 children and parent pairs were included in the study. The risk of picky eating of the child increases 2.85 (AOR: 1.67–4.88) times when only the mother was picky eater, 5.99 (AOR: 3.32–7.52) times when only the father was picky eater, and 22.79 (AOR: 6.95–74.71) times when both of the parents were picky eaters. In the subgroup in which at least one parent was picky eater, it was determined that children with physical activity duration of ≥ 1 h/day and sleep time of ≥ 9 h /day were less likely to be picky eater and the children with screen time of ≥ 2 h/day were more likely to be picky eaters. Conclusion Picky eating habit in childhood is related to the picky eating habit of the parents. In the context of this relationship, the picky eating habit of children is related to sleep, physical activity, screen time and other eating habits.
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Affiliation(s)
- Suzan Yalcin
- Department of Food Hygiene and Technology, Faculty of Veterinary Medicine, Selcuk University, Konya, Turkey
| | - Ayse Oflu
- Department of Pediatrics, Afyonkarahisar Health Sciences University Faculty of Medicine, Afyonkarahisar, Turkey
| | - Mustafa Akturfan
- Department of Hotel, Restaurant and Catering, Karamanoğlu Mehmetbey University Vocational School of Social Sciences, Karaman, Turkey
| | - Siddika Songul Yalcin
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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Balakireva E, Zvereva N, Koval-Zaitsev A, Nikitina S, Blinova T, Kulikov A. Eating behavior in children with autism spectrum disorder. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:42-45. [DOI: 10.17116/jnevro202212209242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Junqueira P, Santos DLCD, Cesar MFCD, Aleanza RMM, Pereira MM, Alves TC. Maternal complaints about feeding problems and anthropometric parameters of children with a diagnosis of pediatric feeding disorder. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222411322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Špindler N, Cilar Budler L, Klanjšek P, Kegl B. Vpliv izbirčnosti v prehrani na prehranjenost otrok. OBZORNIK ZDRAVSTVENE NEGE 2021. [DOI: 10.14528/snr.2021.55.4.3070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Vse pogosteje zaznavamo različne težave z načinom prehranjevanja pri otrocih. Otroci med 10. in 14. letom intenzivno rastejo in se razvijajo. Namen raziskave je bil ugotoviti vpliv izbirčnosti v prehrani otrok na njihovo prehranjenost v omenjeni starosti.Metode: Uporabljena je bila presečna opisna raziskava. Zajet je bil priložnostni vzorec osnovnošolcev zadnjega triletja. V raziskavi je sodelovalo 62 (49,2 %) učencev moškega in 64 (50,8 %) učencev ženskega spola zadnjega triletja ene izmed osnovnih šol v Sloveniji. Za zbiranje podatkov smo uporabili anketni vprašalnik, pridobili pa smo tudi podatke o telesni masi in višini. Uporabili smo opisno in sklepno statistiko (dvostranski test ANOVA).Rezultati: 37 (53,6 %) deklet in 28 (44,4 %) fantov je trdilo, da so izbirčni. Z dvostranskim testom ANOVA smo ugotovili, da obstaja povezava med izbirčnostjo in prehranjenostjo (p = 0,014). Pri dekletih je vidno večje odstopanje od prehranjenosti kot pri fantih.Diskusija in zaključek: Izbirčno prehranjevanje je v današnjem času zelo pogost problem, saj se je v njem prepoznala skoraj polovica vključenih učencev. Izbirčnost ima lahko negativne posledice v odrasli dobi. V starosti 10–14 let se ustvarjajo prehranjevalne navade, ki so lahko prisotne celotno življenje, zato je bistveno, da delujemo preventivno in s tem preprečimo negativne posledice. V prihodnosti bi bilo treba raziskovanje usmeriti v preventivne dejavnosti in promocijo zdravega prehranjevanja.
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Rolle H, Vollrath J, Kiess W, Flemming G. 3/w mit Perzentilenknick und selektivem Essverhalten. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01360-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Feeding difficulties in children fed a cows' milk elimination diet. Br J Nutr 2021; 128:1190-1199. [PMID: 34657644 DOI: 10.1017/s0007114521004165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A cross-sectional study compared feeding difficulties in children aged 2-5 years fed a cows' milk elimination diet due to food allergy with a control group on an unrestricted diet. All data were obtained online. Specific questionnaires evaluated three types of feeding difficulties: avoidant eating, picky eating and feeding problems. The median scores of feeding difficulties in the elimination diet (n 146) and control (n 109) groups were, respectively: picky eating (31 v. 27; P = 0·148), avoidant eating (3 v. 3; P = 0·508) and feeding problems (38 v. 34, P = 0·032). Picky eating was more frequent in the elimination diet (35·4 %) than in the controls (23·3 %; P = 0·042), but no difference was observed for avoidant eating (23·9 % v. 20·4 %, P = 0·508) and feeding problems (32·1 % v. 28·4 %, P = 0·541). Picky eating was associated with lower values of weight-for-age z-scores in both groups. Multivariate analyses identified associations of the three feeding difficulties with previous food refusal and/or inappetence in the elimination diet group. Current constipation and anticipatory gagging were associated with feeding difficulties in both groups. In conclusion, children on an elimination diet presented higher frequency of picky eating and higher scores of feeding problems. Picky eating was associated with lower values of weight-for-age z-scores. Food refusal and/or inappetence as clinical manifestations of food allergy were associated with feeding difficulties at the moment of the survey. Current constipation and anticipatory gagging were associated with picky eating, avoidant eating and feeding problems.
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Caldwell AR, Krause EK. Mealtime behaviours of young children with sensory food aversions: An observational study. Aust Occup Ther J 2021; 68:336-344. [PMID: 33955028 PMCID: PMC8363574 DOI: 10.1111/1440-1630.12732] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Children with sensory food aversions (SFAs) are at risk for nutritional problems and occupational dysfunction during daily meals. To facilitate optimal occupational performance for children with SFAs, it is critical that clinicians understand child behaviour and caregiver strategy use to manage child behaviour during meals. The purpose of this paper is to examine the reliability of a novel coding scheme, the Behavioural Mealtime Coding System (BMCS) and identify associations among child acceptance of preferred and targeted foods, child food exploration and caregiver use of strategies to manage child behaviour. METHODS Twenty-one children (aged 18-60 months) with SFAs and their caregivers were recruited using a convenience sample. An observational video coding system was developed to code mealtime behaviour in 63 typical mealtime videos recorded by caregivers in the home environment. Inter-rater reliability, descriptive statistics and bivariate correlations were calculated. RESULTS The BMCS demonstrated excellent inter-rater reliability (ICC = .95). Child bites of targeted foods were associated with mealtime duration (rs = .51, p = .02) and events of the child licking food (rs = .57, p = .007). Caregiver use of threats was positively associated with child age (rs = .48, p = .03) and negatively associated with caregiver education level (rs = -.49, p = .03). CONCLUSION For children with SFAs, increasing mealtime duration by embedding positive activities to encourage food exploration may improve acceptance of healthy targeted foods. Future research is needed to better understand the complex relationships among caregiver strategy use, mealtime duration and child mealtime behaviour.
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Affiliation(s)
- Angela R Caldwell
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elise K Krause
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, USA
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Baraskewich J, von Ranson KM, McCrimmon A, McMorris CA. Feeding and eating problems in children and adolescents with autism: A scoping review. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:1505-1519. [PMID: 33653157 PMCID: PMC8323334 DOI: 10.1177/1362361321995631] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
LAY ABSTRACT Feeding problems, such as picky eating and food avoidance, are common in youth with autism. Other, broader difficulties with feeding and eating (eating disorder symptoms such as restricting food intake or preoccupation with body shape or weight and insistence on specific food presentation) are also common in autistic individuals. Here, we describe the nature and extent of feeding and eating problems in youth with autism. We found no common characteristics (such as severity of autism symptoms) that best describe autistic youth who experience problems with feeding or eating. Almost all studies we reviewed focused on problems with feeding (selective or picky eating), and only a few studies focused on eating disorder symptoms (concern with weight, shape, and/or body image). However, some researchers reported that eating disorder symptoms may occur more often in autistic individuals compared to their peers without autism. Many studies used the terms "feeding" and "eating" problems interchangeably, but understanding the difference between these problems is important for researchers to be consistent, as well as for proper identification and treatment. We suggest future researchers use "eating problems" when behaviors involve preoccupation with food, eating, or body image, and "feeding problems" when this preoccupation is absent. We highlight the importance of understanding whether feeding or eating problems are separate from autism traits, and the role of caregivers and other adults in the child's treatment. Considerations for health-care providers to assist with diagnosis and treatment are also provided.
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Affiliation(s)
- Jessica Baraskewich
- University of Calgary, Canada
- Alberta Children's Hospital Research Institute, Canada
| | - Kristin M von Ranson
- University of Calgary, Canada
- Alberta Children's Hospital Research Institute, Canada
| | - Adam McCrimmon
- University of Calgary, Canada
- Alberta Children's Hospital Research Institute, Canada
| | - Carly A McMorris
- University of Calgary, Canada
- Alberta Children's Hospital Research Institute, Canada
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Junqueira P, dos Santos DLC, Lebl MCG, de Cesar MFC, dos Santos Amaral CA, Alves TC. Relationship between Anthropometric Parameters and Sensory Processing in Typically Developing Brazilian Children with a Pediatric Feeding Disorder. Nutrients 2021; 13:nu13072253. [PMID: 34208820 PMCID: PMC8308362 DOI: 10.3390/nu13072253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 12/01/2022] Open
Abstract
In this study, we aimed to relate anthropometric parameters and sensory processing in typically developing Brazilian children diagnosed with a pediatric feeding disorder (PFD). This was a retrospective study of typically developing children with a PFD. Anthropometric data were collected and indices of weight-for-age, length/height-for-age, and body mass index-for-age (BMI-for-age) were analyzed as z-scores. Sensory profile data were collected for auditory, visual, tactile, vestibular, and oral sensory processing. We included 79 medical records of children with a PFD. There were no statistically significant (p > 0.05) relationships between the anthropometric variables (weight-, length/height-, or BMI-for-age) and the sensory variables (auditory, visual, tactile, vestibular, or oral sensory processing). In conclusion, we found no relationship between anthropometric parameters and sensory processing in the sample of typically developing Brazilian children diagnosed with a PFD under study.
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Affiliation(s)
- Patrícia Junqueira
- Children Development Institute, São Paulo 04537-040, Brazil; (D.L.C.d.S.); (M.C.G.L.); (M.F.C.d.C.); (C.A.d.S.A.); (T.C.A.)
- Correspondence:
| | | | - Mariana Célia Guerra Lebl
- Children Development Institute, São Paulo 04537-040, Brazil; (D.L.C.d.S.); (M.C.G.L.); (M.F.C.d.C.); (C.A.d.S.A.); (T.C.A.)
| | | | | | - Thais Coelho Alves
- Children Development Institute, São Paulo 04537-040, Brazil; (D.L.C.d.S.); (M.C.G.L.); (M.F.C.d.C.); (C.A.d.S.A.); (T.C.A.)
- Graduate of Speech, Language and Hearing Sciences Department, São Paulo State University-UNESP, Marília 17525-900, Brazil
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Gan K, Tithecott C, Neilson L, Seabrook JA, Dworatzek P. Picky Eating Is Associated with Lower Nutrient Intakes from Children's Home-Packed School Lunches. Nutrients 2021; 13:nu13061759. [PMID: 34064118 PMCID: PMC8224271 DOI: 10.3390/nu13061759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022] Open
Abstract
The objective was to assess the relationship between children’s picky eating (PE) status and nutrient intake from home-packed school lunches. The lunches of 321 students, aged 7–10 years, were quantified via cross-sectional direct observation. Children were classified as having PE (n = 155) or not (non-PE; n = 166) based on food neophobia scores and parental perceptions of PE. The PE group consumed significantly less protein, folate, magnesium, potassium, zinc, and vitamins B1, B2, B3, B6, D, and E than the non-PE group; however, both groups consumed amounts exceeding Dietary Reference Intakes (DRIs) for protein, carbohydrates, sugar, sodium, iron, and vitamins B1, B2, B3, B6, B12, and C. Conversely, both groups consumed amounts significantly lower than DRIs for calcium, fibre, folate, magnesium, potassium, zinc, and vitamins A, D, E, and K. The PE group ate significantly less meat and alternatives, vegetables and fruit, and fruit than the non-PE group, and did not meet any of Canada’s Food Guide (2007) recommendations. The non-PE group met recommendations for meat and alternatives only. PE impacts the dietary intake of children’s home-packed lunches; however, many packed lunches were of low nutritional quality. Focus should be placed on provision of nutritionally complete school lunches for all children.
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Affiliation(s)
- Kellseigh Gan
- School of Food and Nutritional Sciences, Brescia University College at Western University, 1285 Western Road, London, ON N6G 1H2, Canada; (K.G.); (C.T.); (L.N.); (J.A.S.)
| | - Carly Tithecott
- School of Food and Nutritional Sciences, Brescia University College at Western University, 1285 Western Road, London, ON N6G 1H2, Canada; (K.G.); (C.T.); (L.N.); (J.A.S.)
| | - Lisa Neilson
- School of Food and Nutritional Sciences, Brescia University College at Western University, 1285 Western Road, London, ON N6G 1H2, Canada; (K.G.); (C.T.); (L.N.); (J.A.S.)
| | - Jamie A. Seabrook
- School of Food and Nutritional Sciences, Brescia University College at Western University, 1285 Western Road, London, ON N6G 1H2, Canada; (K.G.); (C.T.); (L.N.); (J.A.S.)
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada
- Department of Epidemiology & Biostatistics, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada
- Human Environments Analysis Laboratory, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada
- Children′s Health Research Institute, 800 Commissioners Road East, London, ON N6C 2V5, Canada
- Lawson Health Research Institute, 750 Base Line Road East, Suite 300, London, ON N6C 2R5, Canada
| | - Paula Dworatzek
- School of Food and Nutritional Sciences, Brescia University College at Western University, 1285 Western Road, London, ON N6G 1H2, Canada; (K.G.); (C.T.); (L.N.); (J.A.S.)
- Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, 1465 Richmond St., London, ON N6G 2M1, Canada
- Correspondence: ; Tel.: +1-519-432-8353
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The Combination of Food Approach and Food Avoidant Behaviors in Children with Autism Spectrum Disorder: "Selective Overeating". J Autism Dev Disord 2021; 52:987-994. [PMID: 33846897 DOI: 10.1007/s10803-021-04945-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2021] [Indexed: 01/29/2023]
Abstract
Based on parent questionnaires, we demonstrate the presence of an eating pattern among children with autism spectrum disorder (ASD) that is characterized by both food selectivity and eating in the absence of hunger. Children with ASD were categorized as engaging in eating patterns of selective overeating, selective eating only, overeating only, or typical eating. Group differences were found in the areas of diet composition, body mass index, and behavioral flexibility. Both the selective overeating group and selective eating only group were prone to favor calorie-dense, nutrient-deficient diets as compared to other groups. Eating groups also presented with differing profiles of everyday behavioral flexibility. These results suggest that selective overeating in ASD may present unique challenges and require tailored interventions.
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Children's Eating Behavior Questionnaire Correlated with Body Compositions of Thai Children and Adolescents with Obesity: A Pilot Study. J Nutr Metab 2021; 2021:6496134. [PMID: 33510908 PMCID: PMC7822704 DOI: 10.1155/2021/6496134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/25/2020] [Accepted: 12/31/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Obesity is a major threat to public health. Eating behavior and dietary intake of especially high energy-dense food with low nutrients contribute to the current epidemic of childhood obesity. However, the relationship between eating behavior and body composition has yet to be examined in Thai children and adolescents with obesity. We assessed the association between children's eating behaviors and their body composition in prerandomized patients who participated in the randomized trial titled "Impact of Dietary Fiber as Prebiotics on Intestinal Microbiota in Obese Thai Children". Methods During the prerandomization process, a cross-sectional study was conducted. We recruited children and adolescents aged 7 to 15 years from Bangkok, Thailand. Eating behaviors were assessed by the Children's Eating Behavior Questionnaire (CEBQ), which is a parent or self-reported research instrument conducted by face-to-face interviews. Body mass index (BMI), BMI-for-age Z-score, waist and hip circumferences, and body compositions were assessed. Pearson's correlation coefficients were used to assess associations between the study variables. Results Ninety-seven Thai children and adolescents with obesity participated in the study; 59 (61%) were male. Median [IQR] of age and BMI z-score were 10.5 [9.0, 12.2] years and 3.0 [2.6, 3.7], respectively. Subscale for Enjoyment of Food had the highest score. There were no associations between eating behaviors and BMI z-score. However, Emotional Overeating was associated with fat-free mass index (correlation coefficient = 0.24, p=0.02) and girls with obesity had lower scores in "Slowness in Eating" compared to boys [mean 2.1 versus 1.8, 95% CI: (-0.06, -0.01), p=0.04]. Conclusion Among Thai children and adolescents with obesity, the difference in multidimensional eating behavior might be affected by fat-free mass. Additional study with a larger sample size needed to explore underlying mechanisms and findings can be used to develop future behavior modification program.
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Abstract
Eating behaviors may be expressions of genetic risk for obesity and are potential antecedents of later eating disorders. However, childhood eating behaviors are heterogeneous and transient. Here we show associations between polygenic scores for body mass index (BMI-PGS) and anorexia nervosa (AN-PGS) with eating behavior trajectories during the first ten years of life using data from the Avon Longitudinal Study of Parents and Children (ALSPAC), N=7,825. Results indicated that one standard deviation (SD) increase in the BMI-PGS was associated with a 30-37% increased risk for early- and mid-childhood overeating. In contrast, one SD increase in BMI-PGS was associated with a 20% decrease in risk of persistent high levels of undereating and a 15% decrease in risk of persistent fussy eating. There was no evidence for a significant association between AN-PGS and eating behavior trajectories. Our results support the notion that child eating behavior share common genetic variants associated with BMI.
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Ren Z, Lan H, Szeto IMY, Yang C, Zhang J, Li P, Li J, Wang P, Zhang Y, Zhao A. Feeding Difficulty Among Chinese Toddlers Aged 1-3 Years and Its Association With Health and Development. Front Pediatr 2021; 9:758176. [PMID: 34888269 PMCID: PMC8650057 DOI: 10.3389/fped.2021.758176] [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: 08/13/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Feeding problems are biopsychosocial in nature and have a great influence on children's growth. The aim of this study was to profile the status and possible influencing factors of feeding difficulty among normal Chinese toddlers, and to investigate its association with health and development. This study is a part of the Young Investigation (YI study) conducted in 10 cities in China. Data from 924 children aged 1-3 years were analyzed. Data on socio-demographic factors, feeding behaviors, self-reported diseases, and anthropometry parameters were collected. Blood samples were drawn to determine hemoglobin levels. Feeding difficulty was evaluated by the Montreal Children's Hospital Feeding Scale (MCH-FS). Ages and Stages Questionnaires, Third Edition (ASQ-3) were used to assess developmental progress. Multivariable analyses were performed to explore the potential associations. The mean total score of the MCH-FS was 35.21 ± 12.90 and the highest scored item was "acting up/making a big fuss during mealtimes." Feeding difficulty occurred more often among children with picky eating behavior or whose caregivers once used the strategy of pre-mastication. Children with feeding difficulty had lower intakes of cereals, vegetables, and fruits, and were more likely to suffer from diarrhea (OR, 2.04; 95%CI: 1.32, 3.11) or constipation (OR, 2.04; 95%CI: 1.27, 3.24), but not anemia. Feeding difficulty was also negatively associated with weight, height, head circumference and mid-upper-arm circumference-related Z-scores (P all < 0.05). In addition, it was related to poorer fine motor skills, personal and social skills, and total scores of ASQ-3 (β, -9.00; 95%CI: -15.11, -2.89). Feeding difficulty assessed by MCH-FS showed a negative association with children's health and development, supporting the need for early identification.
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Affiliation(s)
- Zhongxia Ren
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Hanglian Lan
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
| | - Ignatius Man-Yau Szeto
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group Co., Ltd., Hohhot, China
| | - Chenlu Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jian Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Pin Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Jingwen Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Peiyu Wang
- Department of Social Science and Health Education, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yumei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Utami AF, Wanda D, Hayati H, Fowler C. "Becoming an independent feeder": infant's transition in solid food introduction through baby-led weaning. BMC Proc 2020; 14:18. [PMID: 33292247 PMCID: PMC7722414 DOI: 10.1186/s12919-020-00198-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Baby-led weaning (BLW), a method for introducing complementary foods, has become popular because it is considered beneficial for infants. METHODS This study investigated the experiences of mothers when using BLW in Jakarta, Indonesia using a qualitative descriptive approach. Thirteen mothers participated who had introduced complementary feeding using BLW for a minimum of 6 months. Semi-structured interviews and thematic analysis was used to work with the data. RESULTS Three themes were identified: avoiding being a 'picky' eater; infants gagging and choking; and becoming independent feeders. CONCLUSION Further research related to the growth and development of baby-led weaning infants in Indonesia is recommended.
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Affiliation(s)
| | - Dessie Wanda
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia.
| | - Happy Hayati
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Cathrine Fowler
- Faculty of Health, University of Technology Sydney, Sydney, Australia
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Patel MD, Donovan SM, Lee SY. Considering Nature and Nurture in the Etiology and Prevention of Picky Eating: A Narrative Review. Nutrients 2020; 12:nu12113409. [PMID: 33171966 PMCID: PMC7694604 DOI: 10.3390/nu12113409] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 12/25/2022] Open
Abstract
Children are often categorized as picky eaters by parents and caregivers for their rejection of foods, such as vegetables, and for exhibiting other difficult mealtime behaviors. However, there are several factors that contribute to these mealtime behaviors, including early feeding practices (i.e., breastfeeding, introduction to solid food), repeated exposure to novel foods, and genetic taste sensitivity to certain compounds. Using the online database of PubMed, a review of the literature on the development of picky eating in children, its outcomes, and intervention strategies was conducted. This review groups the developmental contributors to picky eating into the categories of nature and nurture and explores the interaction between the two. This paper will also summarize the potential outcomes of picky eating and the various strategies that are currently recommended to mitigate picky eating in young children. However, there is a lack of longitudinal work targeting consistent picky eating behaviors that have the potential to impact long-term food preferences and dietary variety. Future intervention strategies should address the factors that influence the development of picky eating on an individual level.
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Affiliation(s)
- Meera D. Patel
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA;
| | - Sharon M. Donovan
- Department of Food Science and Human Nutrition and Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA;
| | - Soo-Yeun Lee
- Department of Food Science and Human Nutrition and Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA;
- Correspondence: ; Tel.: +1-217-244-9435
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Barton AW, Koester BD, Fujimoto EM, Fiese BH. The complexities of family mealtimes in the 21st century: A latent profile analysis. Appetite 2020; 157:105009. [PMID: 33080332 DOI: 10.1016/j.appet.2020.105009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 11/16/2022]
Abstract
The goal of the present study was to characterize more than 500 families regarding family mealtime organization patterns. Family profiles were developed based on patterns detected across a set of sociological and psychological variables. Latent profile analyses indicated three distinct subgroups of families: Food Secure and Organized (55% of the sample), Very Low Food Security and Disorganized (27%), and Low Food Security and Organized (18%). Examination of group membership correlates revealed significant differences related to family mealtime behaviors and food preparation strategies, but not food shopping location or areas of requested change around family mealtimes. Findings highlight homogenous subgroups of families on the basis of co-occurring psychological and sociological factors pertinent to family mealtimes, with those families possessing the highest levels of risk in multiple domains also reporting family mealtime organization patterns associated with less healthy eating. Findings provide a snapshot into the organization, and complexities, of family meals for the American family today, highlighting the need for researchers and practitioners interested in promoting healthy food intake within American families to consider both psychological and sociological factors that influence family mealtime organization.
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Affiliation(s)
- Allen W Barton
- Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign, United States.
| | - Brenda D Koester
- Family Resiliency Center, Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign, United States
| | - Elinor M Fujimoto
- Family Resiliency Center, Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign, United States
| | - Barbara H Fiese
- Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign, United States; Family Resiliency Center, Department of Human Development and Family Studies, University of Illinois, Urbana-Champaign, United States
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Gebru NW, Gebreyesus SH, Yirgu R, Habtemariam E, Abebe DS. The relationship between caregivers' feeding practices and children's eating behaviours among preschool children in Ethiopia. Appetite 2020; 157:104992. [PMID: 33049339 DOI: 10.1016/j.appet.2020.104992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 08/31/2020] [Accepted: 09/30/2020] [Indexed: 12/17/2022]
Abstract
Preschool age is a time when distinct eating behaviours are formed. Eating behaviours have been associated with underweight and poor growth as well as with overweight. However, the relationship between caregivers' feeding practices and children's eating behaviours remains poorly understood in developing countries. This study aims to evaluate the association between caregivers' feeding practices and eating behaviours among preschool children in Ethiopia. We conducted a school-based cross-sectional study among 542 caregivers of children aged between three and six years old. We used the Children Eating Behaviour Questionnaire and the Child Feeding Questionnaire to measure eating behaviour and caregivers' feeding practices respectively. A multiple linear regression was fitted to determine the association between caregivers' feeding practices and the multiple scales of children's eating behaviour while adjusting for potential confounders. Children whose caregivers practice food restriction tended to be more food responsive (β = .23, p < .001), tend to emotionally overeat (β = .09, p < .01), enjoy food more (β = 0.23, p < .001) and have more desire to drink (β = .24, p < .001). Meanwhile, children whose caregivers practiced pressure to eat were fussier about food (β = .09, p < .001), were more satiety responsive (β = .13, p < .001) and tended to eat slower (β = .10, p < .01). In Ethiopia, where under- and over-nutrition coexist among pre-school children, the results from this study underscore the importance of investigating eating behaviours at an early age, as these eating styles may contribute to children's poor nutritional status. It is also essential to include appropriate child eating behaviour and specific feeding practices components, together with responsive feeding in national nutritional programmes to improve the nutritional status of children aged 24-59 months.
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Affiliation(s)
- Nardos Wondafrash Gebru
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, 9086, Addis Ababa, Ethiopia.
| | - Seifu Hagos Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, 9086, Addis Ababa, Ethiopia.
| | - Robel Yirgu
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, 9086, Addis Ababa, Ethiopia.
| | - Esete Habtemariam
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, 9086, Addis Ababa, Ethiopia.
| | - Dawit Shawel Abebe
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Postboks 4, St. Olavs Plass, 0130, Oslo, Norway.
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Lane-Loney SE, Zickgraf HF, Ornstein RM, Mahr F, Essayli JH. A Cognitive-Behavioral Family-Based Protocol for the Primary Presentations of Avoidant/Restrictive Food Intake Disorder (ARFID): Case Examples and Clinical Research Findings. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sun M, Hu X, Li F, Deng J, Shi J, Lin Q. Eating Habits and Their Association with Weight Status in Chinese School-Age Children: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3571. [PMID: 32443674 PMCID: PMC7277406 DOI: 10.3390/ijerph17103571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/07/2020] [Accepted: 05/15/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Poor eating habits increase children's risk of chronic diseases such as overweight and obesity, adult diabetes, and cardiovascular and cerebrovascular diseases. Therefore, this study aimed to examine the eating habits of school-age children and their impact on children's body mass index. METHODS Multistage cluster sampling was used to sample 2224 students in grades 4 to 6 from 16 primary schools in Changsha. A self-designed questionnaire was used to collect general demographic, eating habit, and snack consumption data from school-age children. Height and weight were measured so that the body mass index Z-score could be calculated and evaluated according to the 2007 World Health Organization's Body Mass Index (BMI) reference standard. RESULTS The prevalence rates of overweight and obesity in school-age children were 17.0% and 8.3%, respectively. Boys had higher rates of overweight and obesity than girls (19.9% vs. 13.6%, 12.9% vs. 3.0%, respectively, p < 0.05). Among the total population of children, 71.6% reported picky eating habits, and 55.1% had late-night snacks. Children who skipped breakfast (OR 1.507 and 95% CI 1.116~2.035) and ate puffed food (OR 1.571 and 95% CI 1.170~2.110) were more likely to be overweight/obese. CONCLUSIONS The eating habits of school-age children are closely related to their weight status. Poor eating habits can be risk factors for overweight and obesity. The dietary management of children should be strengthened so that they develop good eating habits and the incidence of overweight and obesity in school-age children decreases.
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Affiliation(s)
- Minghui Sun
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China; (M.S.); (X.H.)
| | - Xiangying Hu
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China; (M.S.); (X.H.)
| | - Fang Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China; (F.L.); (J.D.); (J.S.)
| | - Jing Deng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China; (F.L.); (J.D.); (J.S.)
| | - Jingcheng Shi
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China; (F.L.); (J.D.); (J.S.)
| | - Qian Lin
- Department of Nutrition Science and Food Hygiene, Xiangya School of Public Health, Central South University, 110 Xiangya Rd., Changsha 410078, China; (M.S.); (X.H.)
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Jani R, Agarwal CK, Golley P, Shanyar N, Mallan K, Chipchase L. Associations between appetitive traits, dietary patterns and weight status of children attending the School Kids Intervention Program. Nutr Health 2020; 26:103-113. [PMID: 32223370 DOI: 10.1177/0260106020910962] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The nexus between appetitive traits, dietary patterns and weight status has predominantly been studied in a mixed sample (healthy weight, overweight and obese sample). AIM This cross-sectional study examined associations between overweight/obese children's appetitive traits, dietary patterns and weight status. METHODS We studied children (N = 58, body mass index z-score: 2.25±0.46), 4-12 years attending the School Kids Intervention Program. Children's appetitive traits and dietary patterns were measured with the Child Eating Behaviour Questionnaire and Children's Dietary Questionnaire, respectively. Children's height and weight were used to compute body mass index z-score; waist circumference was also measured and waist-to-height ratio was calculated. RESULTS After controlling for children's age and gender, hierarchical linear regression analyses showed that lower scores for slowness in eating were associated with higher body mass index z-scores in children (β = -0.31, p = 0.01). Higher scores for emotional overeating were associated with higher waist-to-height ratio in children (β = 0.48, p = 0.01). Higher scores for fussiness were correlated with lower scores for fruits and vegetables (β = -0.59, p < 0.001) and higher scores for non-core foods (β = 0.26, p = 0.04). CONCLUSION Results observed in the current sample of overweight and obese children are consistent with previous studies examining healthy-weight children. Slowness in eating may foster an obesity 'protective' effect, whereas emotional overeating may promote susceptibility to weight gain. Fussy eating may impair diet quality by lower consumption of vegetables and fruits and higher intake of non-core foods. This evidence will support dietitians to consider children's appetitive traits when providing dietary consultation to support obesity management among overweight/obese children.
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Affiliation(s)
- Rati Jani
- School of Clinical Sciences, University of Canberra, Australia
| | - Cathy K Agarwal
- School of Clinical Sciences, University of Canberra, Australia
| | - Pip Golley
- ACT Health Division of Women, Youth and Children, Australia
| | - Nicola Shanyar
- ACT Health Division of Women, Youth and Children, Australia
| | - Kimberley Mallan
- School of Behavioural and Health Sciences, Australian Catholic University, Australia
| | - Lucy Chipchase
- School of Clinical Sciences, University of Canberra, Australia
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Patterns of Complementary Feeding Behaviors Predict Diet Quality in Early Childhood. Nutrients 2020; 12:nu12030810. [PMID: 32204442 PMCID: PMC7146403 DOI: 10.3390/nu12030810] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/23/2022] Open
Abstract
Infancy is a time of plasticity in development of taste preference. Complementary feeding (CF) may be a “sensitive period” for learning new taste preferences and establishing healthy dietary behaviors that may track later in life. Among 1162 children in the U.S. prospective cohort study Project Viva, we aimed to identify patterns of CF behaviors around 1 year and examine associations with diet quality in early childhood (median age 3.1y). We identified patterns of CF using latent class analysis (LCA) and examined later diet quality based on scores on the Youth Healthy Eating Index (YHEI). We identified four distinct CF patterns (latent classes). Later YHEI scores were highest in the class characterized by “breast milk and delayed sweets and fruit juice” and lowest in the “picky eaters” class. The classes defined as “late flavor introduction and delayed sweets” and “early flavor introduction and more fruit juice” had similar, moderate scores. Our results suggest that CF patterns that increase food acceptance and discourage the innate preference for sweetness may have persistent influences on diet quality.
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36
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The Environmental and Bitter Taste Endophenotype Determinants of Picky Eating in Australian School-Aged Children 7-12 years-A Cross-Sectional Pilot Study Protocol. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051573. [PMID: 32121357 PMCID: PMC7084323 DOI: 10.3390/ijerph17051573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 12/11/2022]
Abstract
Caregivers’ perceptions of children’s pickiness are relatively scarce in relation to the five core food groups and their importance in providing a nutritionally balanced diet. Furthermore, there is no validated questionnaire that examines child-reported food preferences in an age-appropriate manner, and the use of terms such as a “picky eater” can be attributed to environmental and genetic factors. Despite potential links between children’s food preferences and endophenotype bitter taste, associations between bitter taste sensitivity and picky eating is relatively unexplored. The proposed cross-sectional study aims to develop and validate a parent-reported core-food Picky Eating Questionnaire (PEQ) and child-reported Food Preference Questionnaire (C-FPQ) and simultaneously investigate environmental and phenotype determinants of picky eating. The study will be conducted in three stages: Phase 1, piloting PEQ and C-FPQ questionnaires (15–20 primary caregivers and their children aged 7–12 years); Phase 2 and 3, validating the revised questionnaires and evaluating the 6-n-propylthiouracil (PROP) bitter taste sensitivity to examine perception to bitter taste (369 primary caregivers and their children). Study findings will generate new validated tools (PEQ, C-FPQ) for use in evidence-based practice and research and explore picky eating as a behavioural issue via the potential genetic-phenotype basis of bitter taste sensitivity.
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Middelkoop A, van Marwijk MA, Kemp B, Bolhuis JE. Pigs Like It Varied; Feeding Behavior and Pre- and Post-weaning Performance of Piglets Exposed to Dietary Diversity and Feed Hidden in Substrate During Lactation. Front Vet Sci 2019; 6:408. [PMID: 31803769 PMCID: PMC6877737 DOI: 10.3389/fvets.2019.00408] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/01/2019] [Indexed: 12/04/2022] Open
Abstract
Timely intake of solid feed is essential to ease the nutritional change from sow's milk to solid feed at weaning and thereby to reduce weaning-related problems. A significant percentage of piglets, however, do not or hardly consume solid feed before weaning. We studied effects of dietary variety and presenting the feed in substrate during lactation on the feeding behavior and performance of piglets up to 2 weeks post-weaning. Feed was provided ad libitum from d4 in two feeders, with four bowls each. In a 2 × 2 arrangement, 40 litters received either creep feed as a monotonous diet (MO) or four feed items simultaneously, i.e., creep feed, celery, cereal honey loops and peanuts, as a diverse diet (DD) and the feed was either provided without (CON) or with substrate (SUB), i.e., sand, in one of the two feeders up to weaning. Dietary diversity highly stimulated feed exploration and eating (≥2.5 times), feed intake and the percentage of (good) eaters from early in lactation, and enhanced piglet growth toward weaning (by 29 g/d), although MO-piglets spent more time eating creep feed from d18. Within MO, SUB-litters consisted of more good eaters than CON-litters. At weaning (d28) four piglets from the same treatment were grouped (n = 40 pens). DD-CON had the highest post-weaning feed intake and gain between d5–15 and the lowest proportion of pigs with higher tail damage scores. However, effects regarding behavior remained inconclusive, as DD-piglets had a lower and higher number of body lesions at 4 h and d15 post-weaning, respectively, spent less time exploring the feed(er) and drinker and environment, and more time nosing pen mates than MO-piglets. SUB-piglets showed a reduction in total post-weaning feed intake, gain (particularly between d0–2) and inactivity, increased levels of manipulation and aggression at week 1 and a higher number of body lesions at 4 h and d15 post-weaning. In conclusion, dietary diversity seems a promising feeding strategy in getting piglets to eat during lactation. Provision of substrate in the feeder subtly stimulated foraging behavior, but negatively impacted post-weaning adaptation, probably because treatments were not reinforced after weaning and piglets thus experienced loss of enrichment.
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Affiliation(s)
- Anouschka Middelkoop
- Adaptation Physiology Group, Department of Animal Sciences, Wageningen University and Research, Wageningen, Netherlands
| | - Manon A van Marwijk
- Adaptation Physiology Group, Department of Animal Sciences, Wageningen University and Research, Wageningen, Netherlands
| | - Bas Kemp
- Adaptation Physiology Group, Department of Animal Sciences, Wageningen University and Research, Wageningen, Netherlands
| | - J Elizabeth Bolhuis
- Adaptation Physiology Group, Department of Animal Sciences, Wageningen University and Research, Wageningen, Netherlands
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Ishikawa M, Eto K, Miyoshi M, Yokoyama T, Haraikawa M, Yoshiike N. Parent-child cooking meal together may relate to parental concerns about the diets of their toddlers and preschoolers: a cross-sectional analysis in Japan. Nutr J 2019; 18:76. [PMID: 31739787 PMCID: PMC6862729 DOI: 10.1186/s12937-019-0480-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parents often have concerns about the food habits of their young children. Cooking is a frequent behavior related to dietary activities at home. We hypothesized that "a parent cooking meals together with young children might alleviate dietary concerns." The aim of this study was to identify the relationship between parental cooking practices (e.g., cooking meals together with the child) and diet-related concerns. METHODS Data were extracted from the "National nutrition survey on preschool children" conducted among nation-wide households with toddlers and preschoolers in 2015 by the Ministry of Health, Labour and Welfare of Japan. Parents were classified into two groups comprising those who cooked meals together with their children and those who did not. The following variables were compared: taking too much time to eat (slow eaters), "picky" eating (eating only certain foods), inconsistent food intake (eating too much or too little), playing with food/utensils while eating, preferring sweetened beverages and snacks over meals, eating too fast to chew well, not swallowing food, disinterested in eating, and spitting out food. The associations between parent-child cooking meals together and the concerns pertaining to the child's dietary habits and food intake were analyzed and compared between the two groups. RESULTS The concerns of "picky eating" and "playing with food/utensils while eating" were lower, while "eating too much" was higher in the parent-cooking together group. The intake frequency of fish, soybeans/soy products, vegetables, and milk among children were higher in the "cooking together" group than among those in the "not cooking together" group. Children in the "cooking together" group consumed a significantly greater variety of foods than those in the "not cooking together" group. CONCLUSIONS Cooking a meal together with a child may be related to the parent's lower concerns about the dietary habits of the child, including "picky eating" and "playing with food/utensils while eating," but may also be related to the higher concerns of "eating too much."
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Affiliation(s)
- Midori Ishikawa
- Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan.
| | - Kumi Eto
- Faculty of Nutrition, Kagawa Nutrition University, 3-9-21 Chiyoda, Sakado, Saitama, 350-0288, Japan
| | - Miki Miyoshi
- Department of Nutrition, Faculty of Health Sciences, Aomori University of Health and Welfare, 58-1 Mase, Hamadate, Aomori, 030-8505, Japan
| | - Tetsuji Yokoyama
- Department of Health Promotion, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, 351-0197, Japan
| | - Mayu Haraikawa
- Department of Child Studies, Faculty of Child Studies, Seitoku University, 550 Iwase, Matsudo, Chiba, 271-8555, Japan
| | - Nobuo Yoshiike
- Department of Nutrition, Faculty of Health Sciences, Aomori University of Health and Welfare, 58-1 Mase, Hamadate, Aomori, 030-8505, Japan
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LeCroy MN, Siega-Riz AM, Albrecht SS, Ward DS, Cai J, Perreira KM, Isasi CR, Mossavar-Rahmani Y, Gallo LC, Castañeda SF, Stevens J. Association of food parenting practice patterns with obesogenic dietary intake in Hispanic/Latino youth: Results from the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth). Appetite 2019; 140:277-287. [PMID: 31063792 DOI: 10.1016/j.appet.2019.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/10/2019] [Accepted: 05/03/2019] [Indexed: 12/26/2022]
Abstract
Some food parenting practices (FPPs) are associated with obesogenic dietary intake in non-Hispanic youth, but studies in Hispanics/Latinos are limited. We examined how FPPs relate to obesogenic dietary intake using cross-sectional data from 1214 Hispanic/Latino 8-16-year-olds and their parents/caregivers in the Hispanic Community Children's Health Study/Study of Latino Youth (SOL Youth). Diet was assessed with 2 24-h dietary recalls. Obesogenic items were snack foods, sweets, and high-sugar beverages. Three FPPs (Rules and Limits, Monitoring, and Pressure to Eat) derived from the Parenting strategies for Eating and Activity Scale (PEAS) were assessed. K-means cluster analysis identified 5 groups of parents with similar FPP scores. Survey-weighted multiple logistic regression examined associations of cluster membership with diet. Parents in the controlling (high scores for all FPPs) vs. indulgent (low scores for all FPPs) cluster had a 1.75 (95% CI: 1.02, 3.03) times higher odds of having children with high obesogenic dietary intake. Among parents of 12-16-year-olds, membership in the pressuring (high Pressure to Eat, low Rules and Limits and Monitoring scores) vs. indulgent cluster was associated with a 2.96 (95% CI: 1.51, 5.80) times greater odds of high obesogenic dietary intake. All other associations were null. Future longitudinal examinations of FPPs are needed to determine temporal associations with obesogenic dietary intake in Hispanic/Latino youth.
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Affiliation(s)
- Madison N LeCroy
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, CB #7461, Chapel Hill, NC, 27599, USA.
| | - Anna Maria Siega-Riz
- School of Nursing, University of Virginia, 202 Jeanette Lancaster Way, Charlottesville, VA, 22908-0782,, USA
| | - Sandra S Albrecht
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, CB #7461, Chapel Hill, NC, 27599, USA; Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, CB #8120, Chapel Hill, NC, 27599, USA
| | - Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, CB #7461, Chapel Hill, NC, 27599, USA
| | - Jianwen Cai
- Collaborative Studies Coordinating Center, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, CB #7420, Chapel Hill, NC, 27599, USA
| | - Krista M Perreira
- Carolina Population Center, University of North Carolina at Chapel Hill, 123 West Franklin Street, CB #8120, Chapel Hill, NC, 27599, USA
| | - Carmen R Isasi
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Building, Bronx, NY, 10461, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Belfer Building, Bronx, NY, 10461, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, 9245 Sky Park Court, Suite 110, San Diego, CA, 92123, USA
| | - Sheila F Castañeda
- South Bay Latino Research Center, School of Public Health, San Diego State University, 780 Bay Blvd, Suite 200, Chula Vista, CA, 92101, USA
| | - June Stevens
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, CB #7461, Chapel Hill, NC, 27599, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, CB #7435, Chapel Hill, NC, 27599, USA
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