Association between Sociodemographic Factors and Dietary Patterns in Children Under 24 Months of Age: A Systematic Review

Exploring possibilities for the development of healthy eating habits in preschool settings: parent's and teacher's perspectives

Adoption of eating habits starts early in life, through interaction with family members and alongside preschool settings that offer context for developing healthy lifestyles among children. The aim of this study was to explore the perceptions and practices of teachers and parents related to the development of healthy eating habits among preschool children. Focus groups were conducted with a total sample of 48 parents and teachers (three focus groups among parents and three among teachers) from 15 kindergartens in the Republic of Srpska, Bosnia, and Herzegovina. All of the mentioned kindergartens are part of the "Nutrition friendly preschool/school initiative", a program aimed at creating and developing settings that support and improve children's health. Focus groups were audiotaped, transcribed verbatim, and analyzed according to the Framework Method. Teachers emphasized that good communication and support from parents are important factors for the development of healthy eating habits. During COVID-19, direct communication with parents was restricted, and mutual activities among teachers, children, and parents were reduced. Lack of knowledge, finance, and time are perceived by parents as main obstacles to the improvement of children's healthy eating habits. All participants in the focus groups agreed that more education and informative material are needed so their skills related to good nutrition can be improved and adopted in a culture-sensitive way. Mutual support, education, and dissemination of informative materials are imposed as particularly important needs by all actors involved in the upbringing of children in order to support the development of children's healthy eating habits.

Unhealthy food consumption and its determinants among children aged 6 to 23 months in sub-Saharan Africa: a multilevel analysis of the demographic and health survey

BACKGROUND

Unhealthy food consumption that begins early in life is associated with a higher risk of nutrient inadequacy and related chronic diseases later in life. Healthy eating and consumption of important nutrients help to maintain a healthy body weight and reduce the risk of developing chronic conditions. Research from sub-Saharan Africa regarding consumption of unhealthy foods remains limited, with no studies quantifying the pooled prevalence among young children. Therefore, this study is intended to assess the pooled prevalence and determinants of unhealthy food consumption among children aged 6 to 23 months.

METHODS

Data from the most recent demographic and health surveys of five countries in sub-Saharan Africa conducted between 2015 and 2022 were used. A total weighted sample of 16,226 children aged 6 to 23 months was included in the study. Data extracted from DHS data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with the dependent variable. Intra-class correlation coefficient, likelihood ratio test, median odds ratio, and deviance (-2LLR) values were used for model comparison and fitness. Finally, variables with a p-value < 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant.

RESULTS

The pooled prevalence of unhealthy food consumption among children aged 6 to 23 months was 13.41% (95% CI: 12.89-13.94%). Higher consumption of unhealthy foods was reported among mothers with low education [adjusted odds ratio (AOR) = 0.37; 95% confidence interval (CI) (0.30, 0.46)], unmarried women [AOR = 1.19; 95% CI (1.05, 1.34)], who had no media exposure [AOR = 0.64; 95% CI (0.56, 0.72)], delivered at home [AOR = 0.74; 95% CI (0.62, 0.87)], who hadn't had a PNC checkup [AOR = 0.66; 95% CI (0.60, 0.73)], wealthier households [AOR = 1.20; 95% CI (1.05, 1.37)], older children (aged ≥ 9 months) [AOR = 3.88; 95% CI (3.25, 4.63)], and low community level media exposure [AOR = 1.18; 95% CI (1.04, 1.34)].

CONCLUSION

Nearly one out of seven children aged 6 to 23 months consumed unhealthy foods. Maternal educational level, marital status of the mother, exposure to media, wealth index, place of delivery, PNC checkup, and the current age of the child were factors significantly associated with unhealthy food consumption. Therefore, improving women's education, disseminating nutrition-related information through the media, providing more attention to poor and unmarried women, and strengthening health facility delivery and postnatal care services are recommended.

Associations between socioeconomic status, home food availability, parental role-modeling, and children's fruit and vegetable consumption: a mediation analysis

BACKGROUND

Recent literature has suggested that associations and interactions between family socioeconomic status (SES) and home food environment influence children's diet, but little is known about the mediation roles of parental role-modeling and food availability in the socioeconomic inequalities of children's diet. This study aimed to determine the associations between family SES and children's fruit and vegetable (FV) consumption and to assess the mediation roles of parental role-modeling and food availability in the above associations.

METHODS

Cross-sectional data of 574 Finnish children (aged 3 to 6) were analyzed. Parents completed an FFQ assessing their children's FV consumption frequency and a questionnaire assessing SES and home food environment. Two exposure variables: parental educational level ("low", "middle", and "high") and the relative family income tertiles of the family were used. The frequencies of parental role-modeling of FV and sugary food and drink (SFD) consumption, and the availability of FV and SFD at home were calculated. Single- and multiple-mediator models were created using IBM SPSS 27.0.

RESULTS

The positive association between high parental educational level and children's FV consumption (direct effect coefficient: 2.76, 95% CI: 0.51-4.86) was partially mediated by more frequent parental role-modeling of FV consumption (indirect effect coefficient: 0.89, 95% CI: 0.10-1.76), higher availability of FV (indirect effect coefficient: 1.00, 95% CI: 0.35-1.77), and lower availability of SFD (indirect effect coefficient: -0.30, 95% CI: -0.72 - -0.01). The relative family income was not directly associated with the outcome. However, the higher relative family income level indirectly predicted the Children's FV consumption (full mediation) through more frequent parental role-modeling of FV consumption (indirect effect coefficient: 0.91, 95% CI: 0.06-1.83) and higher availability of FV (indirect effect coefficient: 0.98, 95% CI: 0.40-1.67). Parental role-modeling on SFD consumption did not mediate any of the above associations.

CONCLUSIONS

Parental educational level showed more associations with children's FV consumption than relative family income. Our findings suggest that reducing the availability of SFD is as important as increasing the availability of FV to enhance children's FV consumption. Future interventions to improve children's dietary behaviors should pay greater attention to the lower SES segments of society. Longitudinal studies and intervention studies supporting these findings are needed for making meaningful recommendations for health promotion.

Analyzing gender differentials in dietary diversity across urban and peri-urban areas of Hyderabad, India

BACKGROUND

India's recent increase in urbanization alongside with feminization of rural agriculture could increase the existing gender disparities in dietary diversity. With many rural men migrating to urban areas, women have increased domestic burdens as well as productive burdens such as making informed crop production decisions so household members consume a diverse diet. Given the rapid and recent onset of this phenomenon, there is a need to explore gender differentials in diet diversity across urban and rural areas to assess if certain populations are being disproportionately impacted by this trend. There are limited established quantitative studies discussing this gender disparity with respect to urbanization. Therefore, this paper compares dietary diversity among adult men, adult women, adolescent males, and adolescent females in urban and peri-urban locations. The authors also assess if various sociodemographic factors correlate with dietary diversity.

METHODS

Analyses were conducted on dietary diversity data collected by the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) from selected urban (1108 individuals) and peri-urban (808 individuals) locations of Hyderabad, India. The total sample size of the population is n = 1816: 660 adult males, 662 adult females, 205 adolescent males, and 289 adolescent females.

RESULTS

Adult women and adolescent females have a higher diet disparity between peri-urban and urban areas when compared to adult males and adolescent males. Multivariate analyses followed by post hoc multiple comparisons testing further support that peri-urban adult women consume a less diverse diet compared to their urban counterparts and less than other peri-urban adult men and adolescent women. It was also found that marital status, type of household card owned, and the highest degree of education are statistically significant correlators of an individual's dietary diversity.

CONCLUSIONS

Given that urbanization could negatively impact already vulnerable populations such as peri-urban adult women, who play a key role in children's nutrition, it is important to provide support to these populations. This paper suggests it is possible to do so through government subsidization of peri-urban farmers to grow more diverse crops, fortifying easily accessible foods with commonly lacking micronutrients, including Vitamin A, folic acid, and iron, market access, and affordable prices.

Investigating group-based classes ('weaning workshops') to support complementary infant feeding in Irish primary care settings: a cross-sectional survey

OBJECTIVE

This study aims to (1) investigate current practice regarding 'weaning workshops' to support complementary infant feeding delivered within Irish primary care, (2) explore the experiences and opinions of community dietitians regarding optimal content and modes of delivery of weaning workshops and (3) identify the key factors to be considered in the development and implementation of weaning workshops delivered within primary care.

DESIGN

Cross-sectional survey.

SETTING

Irish primary care.

PARTICIPANTS

Forty-seven community-based dietitians.

RESULTS

Sixteen dietitians reported that workshops were run in their area with variable frequency, with ten reporting that workshops were never run in their area. Participants reported that mostly mothers of medium socio-economic status (SES) attended weaning workshops when infants were aged between 4 and 7 months, and that feedback from workshop attendees was predominantly positive. Dietitians identified that key factors to be considered in future development and delivery of weaning workshops are (1) workshop characteristics such as content, timing and venue, (2) organisational characteristics such as availability of resources and multidisciplinary involvement and (3) attendee characteristics such as SES.

CONCLUSIONS

This study highlights substantial variability regarding provision of weaning workshops in Ireland, and a lack of standardisation regarding the provider, content and frequency of workshops where workshops are being delivered. The study also provides unique insights into the experiences and opinions of primary care community dietitians regarding the development and delivery of weaning workshops in terms of optimal content and delivery options. These perspectives will make a valuable contribution given the dearth of evidence in this area internationally.

Desigualdades sociais e alimentação complementar na América Latina e no Caribe

Resumo Este artigo tem como objetivo avaliar o papel das desigualdades sociais nos padrões de alimentação complementar nos países da América Latina e do Caribe. Trata-se de um estudo ecológico que utilizou dados agregados de inquéritos de base populacional. A unidade de análise da pesquisa foram 16 países da América Latina e do Caribe com informações disponíveis. Foram selecionados como desfechos a prevalência dos seguintes indicadores de alimentação complementar: introdução alimentar de alimentos sólidos, semissólidos e pastosos” (IASSP), “diversidade alimentar mínima” (DAM), “frequência alimentar mínima” (FAM) e “alimentação mínima aceitável” (AMA). As diferenças da prevalência dos indicadores entre os quintis de riqueza mais ricos e mais pobres foram calculadas de forma absoluta e relativa. Comparando os quatro indicadores de alimentação complementar, o IASSP teve o melhor desempenho, com 10 países, entre os 11 avaliados, apresentando prevalência acima de 80%. O indicador com pior desempenho foi o AMA, com apenas um país, entre os oito avaliados, com prevalências acima de 60%. Na quase totalidade dos países, a população mais pobre possuía prevalências de indicadores de alimentação complementar menores que os mais ricos.

Consumption of food groups and associated factors among children aged 6 to 23 months

Objective:

To assess the consumption of food groups among children aged 6 to 23 months in day care centers and at home and its associated factors.

Methods:

This is a population-based cross-sectional study conducted with children from nursery schools in Guaratuba, Paraná. Parents answered a socioeconomic and demographic questionnaire. Food consumption was assessed by directly weighing the meals offered at the day care center. At home, parents filled an estimated food record. The reported foods were classified into seven food groups. Minimum dietary diversity was calculated by the proportion of children who consumed foods from four or more groups. Data were analyzed by simple and multiple logistic regression, presented as odds ratios.

Results:

A total of 213 children participated in this study. The average number of food groups consumed was 4.2±1.0 at home and 4.2±1.2 in day care centers. At the day care center, all children consumed grains, roots, and tubers, while at home, this rate was 99.1%. The egg group was the least consumed both at day care (6.6%) and at home (2.8%). At home, more than 60% of children consumed sweets and sugar-sweetened beverages. Children aged 12 to 23 months were more likely to consume milk and dairy products, as well as flesh foods. Higher income was associated with the consumption of legumes, and older maternal age with the consumption of fruits and vegetables.

Conclusions:

At home, children had a predominantly dairy-based diet and a high intake of ultra-processed foods. In day care centers, the consumption of healthy foods was higher, indicating the need for families to participate in the formation of healthy eating habits.

Global, regional, and national burden of age-related hearing loss from 1990 to 2019

The global distribution and temporal trend of age-related hearing loss (ARHL) are unknown, and we aimed to investigate magnitudes and temporal trends of ARHL burden and its influencing factors at the national, regional, and global levels. Based on the information of Global Burden of Disease Study 2019, we calculated the estimated annual percentage change to quantify the global, regional, and national temporal trends of age-standardized rates (ASRs) of ARHL by gender, age, and severity. The number of prevalent cases and disability-adjusted life years (DALYs) of ARHL increased from 751.50 million and 22.01 million in 1990 to 1456.66 million and 40.24 million in 2019, respectively. Except for a few countries such as Niger and Burkina Faso, the age-standardized prevalence rate and age-standardized DALYs rate showed a downward trend in most countries and regions. Mild ARHL accounted for the largest proportion in all ARHL, and only mild ARHL showed an upward trend in ASRs. In most regions, the proportion of ARHL disease burden attributable to occupational noise showed a downward trend in the past 30 years. In 2019, ARHL disease burden attributable to occupational noise declined with the increase of socio-demographic index in countries. Although the ASR of ARHL in most parts of the world is declining, the absolute disease burden of ARHL is still heavy. Understanding the real-time disease burden of ARHL and its temporal trend is of great significance for formulating more effective preventive measures and reducing the ARHL burden.

Dietary patterns in Mexican preschool children are associated with stunting and overweight

OBJECTIVE

To evaluate the association between dietary patterns, stunting, and overweight among Mexican preschoolers.

METHODS

This study was conducted with anthropometric (weight, height/length), sociodemographic (age, gender, education level of household head, socioeconomic status, country region and area, ethnicity, and beneficiary of social programs), and dietary data (Semiquantitative-food frequency questionnaire) on children aged from 1 to 4 years collected from the Mexican National Health and Nutrition Survey-2012. Dietary patterns were derived by principal components analysis. The association between dietary patterns, stunting, and overweight was assessed by prevalence ratios (PR), estimated by Poisson regression.

RESULTS

In total, 1,112 preschoolers (mean age 3.06 years, SD = 1.08 years; 48.8% females) were included in the study; 11.9% of whom presented stunting, and 6.7% overweight. We identified four dietary patterns: Fruits and Vegetables [F&V], Western [W], Traditional [T], and Milk and Liquids [M&L]. Considering the lowest tertile of each dietary pattern as reference, the prevalence of stunting was 2.04 times higher [95%CI: 1.17–3.56] among children in the highest tertile of the “F&V” pattern. The prevalence of stunting was lower among children in the highest tertile of the “W” pattern [PR = 0.48; 95%CI: 0.27–0.85]. Overweight was negatively associated with the “F&V” dietary pattern [PR = 0.37; 95%CI: 0.16–0.85 for its highest tertile], and children whose consumption was mostly equivalent to the “T” pattern showed higher prevalence of stunting [PR = 1.74; 95%CI: 1.01–3.00].

CONCLUSIONS

The prevalence of stunting and overweight in a nationwide sample of Mexican preschoolers was associated with dietary patterns.

The socio-ecological model as a framework for understanding junk food consumption among schoolchildren in Nepal

BACKGROUND

The consumption of industrially processed food, popularly known as junk food, is a growing public health concern worldwide, including in Nepal. Schoolchildren are a vulnerable group and they consume junk food at school.

AIM

The aim of this study was to examine multi-level determinants of junk food consumption among basic schoolchildren using the socio-ecological model as a framework.

METHODS

A cross-sectional study was conducted among students (n = 404), and a self-reported questionnaire was used to collect the data. The chi-square test and logistic regression were applied to analyse the results using SPSS version 26.

RESULTS

Nearly half (47%) of the students reported that they consumed junk foods at snack time. Important variables for explaining junk food consumption were knowledge of food and nutrition-a micro-level determinant; sharing knowledge of food and nutrition with classmates at school-a meso-level determinant; grade of student-an exo-level determinant; and occupation of parents-a macro-level determinant. However, multivariate analysis found that knowledge of food and nutrition (p < 0.05), and sharing knowledge of food and nutrition with classmates at school (p < 0.05) were the significant predictors of junk food consumption.

CONCLUSIONS

Junk food consumption is common among basic-level students in the study schools. Multi-level determinants explain the factors associated with this behaviour, extending from micro to macro as the socio-ecological model asserts. This study points to the need for comprehensive school-based nutrition education that targets multiple levels of influence, focusing on active learning approaches to promote healthy dietary behaviour in students.

Women's empowerment and child nutrition in South-Central Asia; how important is socioeconomic status?

Women's empowerment has been identified as an important strategy for improving children's nutrition outcomes in many settings. Empowerment indexes that are built from cross-country routine surveys are increasingly being developed, and further disaggregated analyses of such indexes are needed to examine in-depth, the relationship between women's empowerment and outcomes including children's nutrition. The Demographic and Health Surveys across five countries in South-Central Asia was used to examine the relationship between women's empowerment and children's nutrition outcomes. Empowerment was measured using the three domains (attitude to violence, social independence, and decision-making) in the Survey-based Women's emPowERment (SWPER) index. Main and interaction effects between the SWPER domains and women's wealth index were examined to check if there is a differential positive impact of empowerment for poorer women on children's nutrition outcomes. Outcome measures were children's height-for-age, weight-for-age, and weight-for-height z-scores. Marginal effects of logistic regression and OLS were used to examine main effects and linear probability models and OLS for interaction effects. Analyses were cluster-adjusted, sample-weighted, and important control variables were included. Significance was established at 95% and 99% confidence intervals. In South-Central Asia, to reduce stunting wasting and underweight rates, empowering women through improving their social independence and decision-making power might be important. Furthermore, targeting poorer women for empowerment in social independence and decision-making appears to confer positive benefits towards the reduction of stunting, wasting, and underweight rates in children. However, the main and interaction effects of women's empowerment and wealth index on children's nutrition outcomes vary across the countries examined. These variations suggests that exogenous contextual factors might play a role in the empowerment-nutrition and empowerment-wealth-nutrition associations and interactions.

Systematic review of randomised controlled trials to improve dietary intake for the prevention of obesity in infants aged 0-24 months

Improving dietary intake early in life is a common behavioural target in obesity prevention trials. We undertook a systematic review of randomised controlled trials aiming to improve dietary intake of complementary foods during infancy (0-24 months). PubMed, Cochrane Library, EMBASE, Medline, and PsycInfo were searched for trials focussed on obesity prevention conducted between January 2000 and August 2019 where dietary intake was an outcome. Two reviewers screened studies and extracted data from selected articles. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias 2 tools. The protocol was registered on Open Science Framework (https://osf.io/6srg7/). Seventeen articles from 12 trials were selected for data extraction. Statistically significant group differences in outcomes were observed in 36 of 165 (21.8%) of dietary variables examined. Measurement and analysis of outcomes varied between studies. Overall risk of bias was rated as high, primarily due to missing outcome data. Improving dietary intake at this age appears challenging based on a relatively limited number of studies. Future research could consider dietary pattern analyses, which may provide more meaningful outcomes for this age group. Opportunities exist for further exploration of maternal-focussed interventions, responsive feeding interventions, and interventions delivered outside of homes.

Variation in outcomes of the Melbourne Infant, Feeding, Activity and Nutrition Trial (INFANT) according to maternal education and age 2 and 3·5 years post-intervention

OBJECTIVE

This study aimed to assess whether the long-term effectiveness of the Melbourne Infant, Feeding, Activity and Nutrition Trial (INFANT) at 2 and 3·5 years post-intervention varied according to maternal education and age.

DESIGN

Two and 3·5 years post-intervention follow-up of the INFANT cluster-randomised controlled trial. Outcomes at both follow-ups included children's BMI z-scores, physical activity (ActiGraph), television viewing (parental report) and dietary intake (3 × 24-h dietary recalls). Dichotomous moderator variables included maternal education (university v. no university) and age (< 32 v. ≥ 32 years).

SETTING

Population based.

PARTICIPANTS

Families completing the 15-month programme (n 492) were invited to participate in the follow-ups when their child was 3·6 and 5 years old.

RESULTS

At the 2-year follow-up, the intervention effects on vegetable (positive) and sweet snack (negative) intake were greater in children with higher educated mothers, whereas water consumption (positive) was greater in children with lower educated mothers. At the 2-year follow-up, the intervention was more effective in increasing water consumption in children with younger mothers and decreasing sweet snack intake in children with older mothers (opposite result observed at the 3·5-year follow-up). At the 3·5-year follow-up, children with younger and older mothers increased and decreased their consumption of savoury snacks, respectively.

CONCLUSIONS

Moderation by maternal education and age were observed for some outcomes; however, clear patterns were not evident at both follow-ups, with little consistency across outcomes. This indicates that INFANT was more-or-less equally effective in children irrespective of their mother's education level or age, which is important in community-based interventions.

Characterization of Infant Feeding Practices and Related-Family Characteristics in the French Nationwide ELFE Birth Cohort

Family characteristics such as education level or income are related to infant feeding practices. This study aimed to characterize infant feeding practices and investigate their associations with family characteristics. Analyses were performed with data from a French nationwide cohort, Etude Longitudinale Française depuis l’Enfance (ELFE). Feeding practices were characterized by two methods, a principal component analysis and a hierarchical ascendant classification (n = 8922). This characterization was conducted in three steps: considering firstly only introduction of main food groups, then also food pieces and finally adding the type of complementary food. The associations between family characteristics and the infant feeding patterns or clusters were tested by linear or multinomial regressions (n = 7556). Besides breastfeeding duration and age of first introduction of complementary foods, it appeared also important to consider specific food groups such as sweetened beverages and cow’s milk, and the introduction of food pieces, to describe feeding practices. Recommended feeding practices (longer breastfeeding, complementary food in the right period) were related to higher maternal age and education level, so was migration status, the presence of older children, low income or the mothers’ attendance to pre-birth preparation classes. The interrelations between feeding practices and family characteristics must be considered when examining the influence of feeding practices on child’s health.