Influences of Parental Snacking-Related Attitudes, Behaviours and Nutritional Knowledge on Young Children's Healthy and Unhealthy Snacking: The ToyBox Study

Effect of Time-Varying Exposure to School-Based Health Promotion on Adiposity in Childhood

BACKGROUND

The results of most school-based health promotion initiatives are inconclusive.

OBJECTIVES

This trial assessed the effect of time-varying exposures to a multicomponent school-based health promotion intervention (SI! Program) on adiposity markers.

METHODS

A total of 48 schools in Madrid (Spain) were cluster randomized to receive the SI! Program through elementary education grades 1 to 6 (E1-6, 12 schools, 459 children), 1 to 3 (E1-3, 12 schools, 513 children), or 4 to 6 (E4-6, 12 schools, 419 children) or to receive the standard curriculum (control, 12 schools, 379 children). The primary endpoint was the between-group difference at 3- and 6-year follow-up in the change from baseline in adiposity markers and the overall knowledge-attitudes-habits (KAH) score.

RESULTS

At 3-year follow-up, children who had the intervention showed significantly lower increases than the control group in z-scores for body mass index (BMI), waist-to-height ratio (WHtR), and waist circumference (WC) (zBMI: -0.09; 95% CI: -0.16 to -0.03; P = 0.003; zWC and zWHtR: -0.19; 95% CI: -0.28 to -0.10; P < 0.001). At 6-year follow-up, the beneficial trend in zWC and zWHtR was maintained in the E1-6 and E1-3 groups: difference zWC control vs E1-6 (-0.19; 95% CI: -0.36 to -0.03; P = 0.020), control vs E1-3 (-0.22; 95% CI: -0.38 to -0.06; P = 0.009); difference zWHtR control vs E1-6 (-0.24; 95% CI: -0.41 to -0.06; P = 0.009), and control vs E1-3 (-0.29; 95% CI: -0.47 to -0.11; P = 0.001). No significant between-group differences were found in the change of overall KAH score.

CONCLUSIONS

Early elementary school interventions may be more effective than later interventions on abdominal adiposity. Further research should assess the sustainability effects of school-based health promotion programs.

Longitudinal associations between food parenting practices and dietary intake in preschool children: The ToyBox Study

INTRODUCTION

Food Parenting Practices (FPPs) include the practices parents use in the act of feeding their children, which may further influence their health.

OBJECTIVES

To assess associations between changes in FPPs (permissiveness, food availability, guided choices, water encouragement, rules and limits and the use of food as reward) over 1 year and dietary intake (water, energy-dense/nutrient-poor and nutrient-dense foods) at follow-up in 4- to 6-year-old preschool-aged children.

METHODS

Longitudinal data from the control group of the ToyBox study, a cluster-randomized controlled intervention study, was used (NCT02116296). Multilevel ordinal logistic regression analyses including FPP as the independent variables and dietary intake as outcome.

RESULTS

Nine hundred sixty-four parent-child dyads (50.5% boys and 95.0% mothers) were included. Limited changes on the use of FPPs were observed over time. Nevertheless, in boys, often having F&V at home was associated with higher F&V consumption (OR = 6.92 [1.58; 30.38]), and increasing home availability of F&V was directly associated with higher water consumption (OR = 7.62 [1.63; 35.62]). Also, not having sweets or salty snacks available at home was associated with lower consumption of desserts (OR = 4.34 [1.75; 10.75]). In girls, having F&V availability was associated with higher F&V consumption (OR = 6.72 [1.52; 29.70]) and lower salty snack consumption (OR = 3.26 [1.50; 7.10]) and never having soft drinks at home was associated with lower consumption of sweets (OR = 7.89 [6.32; 9.86]). Also, never being permissive about soft drink consumption was associated with lower soft drink consumption (OR = 4.09 [2.44; 6.85]).

CONCLUSION

Using favorable FPPs and avoiding the negative ones is prospectively associated with healthier dietary intake, especially of F&V, and less intake of soft drinks, desserts, and salty snacks.

Nutritional Quality of the Mid-Afternoon Snack of Schooled Children between the Ages of 3 and 12 Years in Three Areas in Spain

BACKGROUND

The aim of this study was to analyze the nutritional quality of mid-afternoon snacks for schooled children aged 3 to 12 years in three areas of Catalonia (Spain).

METHODS

A descriptive observational study collected information on habits and the mid-afternoon snack of 782 schooled children aged 3 to 12 years in three cities, Barcelona, Girona, and Lleida, located in Catalonia (Spain). The children's families voluntarily agreed to complete an online questionnaire that collected information about demographic data and snacking habits in the afternoon, as well as a record of mid-afternoon snack intake over three school days.

RESULTS

A total of 2163 mid-afternoon snacks were analyzed from a sample of 764 families with 3 to 12 year-old children. Sandwiches emerged as the most prevalent choice, accounting for 41.89%, followed by pastries at 23.86%, fruit at 14.38%, and a combination of fruit and pastries at 6.29%. Of the mid-afternoon snacks recorded, 22.19% were healthy, 20.90% were quite healthy, 12.85% were quite unhealthy, and 44.06% were unhealthy.

CONCLUSIONS

The nutritional quality of mid-afternoon snacks for a large majority of schooled children should be improved. It is essential to develop food education programs to improve the quality of this intake from early childhood and to consider it as an opportunity to adjust the daily dietary requirements of Spanish children.

Role of parenting practices and digital media on beverage intake in European schoolchildren of different weight status. Feel4Diabetes-study

OBJECTIVES

Halting the rise in childhood obesity is an ongoing challenge in Europe. Sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) consumption has become common practice at home and during family meals. The objective of this study was to investigate associations of parenting practices and home digital media availability with beverage intake in European schoolchildren of different weight groups.

METHODS

Cross-sectional data were derived from six countries taking part in the multicentered Feel4Diabetes-study. Anthropometric data were measured for 12 030 schoolchildren (n = 6097 girls; median age = 8.1 y). Details on sociodemographic characteristics, beverage intake, food parenting practices, and home availability of digital media were collated from questionnaires. The outcomes, daily SSB and ASB intakes, were included as dependent variables in multivariable regression models that provided odds ratios reflecting their association with parenting practices and digital media (exposures), after stratifying for children's weight status (underweight or normal versus overweight or obese).

RESULTS

After controlling for children's sex, region, maternal body mass index, and education, the multivariate model found that in both body mass index groups, permissive parenting practices, such as rewarding and allowing consumption of unhealthy foods "very often or often," as compared with "rarely or never," were associated with a high daily intake of SSBs and ASBs in children, while parents "watching television together with their child," rewarding with screen time, and availability of television in children's rooms increased the likelihood of both beverages in the underweight or normal-weight group.

CONCLUSIONS

Modification of permissive parenting practices and removal of television from children's rooms could effectively reduce SSB intake and curb the ongoing threat of child obesity in Europe.

How parents' feeding styles, attitudes, and multifactorial aspects are associated with feeding difficulties in children

BACKGROUND

Parental complaints about feeding difficulties (FD) during childhood are frequent in pediatrics. Behavioral factors about children's feeding and parental aspects are fundamental in solving these problems, but research in this area lacks information considering the joint presence of fathers and mothers. Thus, this study aimed to investigate the features of children, parents and mealtime practices related to FD reported by fathers and mothers and to identify parenting styles, mealtime actions, practices and factors associated with FD in children.

METHODS

323 parents (226 mothers and 97 fathers) of children aged 1 to 7 years were recruited in the emergency waiting room at Sabará Hospital Infantil, in São Paulo, Brazil, and self-completed electronic questionnaires on parenting style (Caregiver's Feeding Styles Questionnaire), parents' mealtime actions (Parent Mealtime Action Scale), socioeconomic information, personal and children's health data and routine meal practices.

RESULTS

The prevalence of FD in children was 26.6%. Indulgent parenting style was the most frequent (44.2%), followed by authoritarian (25.1%), authoritative (23.8%), and uninvolved (6.9%) styles. Most parents (75.8%) reported presence during meals, and 83.6% used distractions. Regression analyses after adjustments showed, as factors associated with FD, female children (OR: 2.06; 95%CI: 1.19-3.58), parents' FD history (OR: 3.16; 95%CI: 1.77-5.64), and greater frequency of parents' behavior of offering many food options (OR: 2.69; 95%CI: 1.18-6.14). Parents with indulgent styles had decreased chances of reporting FD in their children (OR: 0.13; 95%CI: 0.06-0.27). Furthermore, the practice of children sharing the family menu (OR: 0.43; 95%CI: 0.18-0.99) and higher frequency of parents' behavior of setting snack limits (OR: 0.44; 95%CI: 0.23-0.85) were inversely associated with FD.

CONCLUSIONS

This study reinforces the multifactorial aspects involved in the feeding difficulties context. It points out the importance of expanding knowledge of the individual role of fathers and mothers to compose a scenario that can guide future studies and interventions.

TRIAL REGISTRATION

CAAE #99221318.1.0000.5567 with registration number 2,961,598.

The patterns and position of snacking in children in aged 2-12 years: A scoping review

BACKGROUND

Childhood obesity is associated with serious comorbidities during childhood and into adulthood. One potential risk factor for childhood obesity is consumption of unhealthy, energy-dense foods. This scoping review examines evidence on snacking in children aged 2-12years of age and presents the patterns and position of snacking in children's diets.

METHODS

A search of electronic databases (MEDLINE, Web of Science, PubMed, Embase) for articles published from March 2011 to November 2022 was conducted. Articles providing insight into the position of snacking (e.g., energy contribution), or patterns (e.g., location, timing), in children aged 2-12years were included. A quality assessment was conducted and data was synthesised according to data source (nationally representative or other).

RESULTS

Twenty-one articles were included, most (n = 13) reporting nationally representative data. The average number of daily snacks was 3, with 92.9-100.0% of children consuming snacks. Most were consumed in the afternoon (75.2-84.0%) and at home (46.5-67.3%). Snacks frequently consumed were 'fruits and vegetables', 'baked desserts', 'sweets, candy and confectionery', and 'dairy products'. Snacks contributed 231-565 kcal daily, up to a third of daily carbohydrate intake, a quarter of fat intake, and a fifth of protein intake. Snacks provided up to one third of vitamin C intake, one quarter of vitamin E, potassium and magnesium intake, and a fifth of calcium, folic acid, vitamins D and B12, iron and sodium intake.

DISCUSSION

This scoping review provides insight into patterns and position of snacking within children's diets. Snacking plays a significant role in children's diets with multiple snacking occasions occurring throughout a child's day, the overconsumption of which has the potential to increase risk of childhood obesity. Further research is required into the role of snacking, particularly specific foods playing a role in micronutrient intake, and clear guidance for snacking intake in children.

Supporting early childhood routines to promote cardiovascular health across the life course

Optimal cardiovascular health is an essential component of human health and well-being across the life course. Heart healthy practices around diet, physical activity, and sleep early in childhood have the potential to greatly improve lifespan and quality (Mehta et al., 2020). Early childhood routines, defined as functional practices that are predictable and repeatable, predict positive growth and development across the lifecourse (Fiese et al., 2002; Ferretti and Bub, 2017; Spagnola and Fiese, 2007). The American Heart Association has identified key heart healthy routines, such as daily regular activities including diet, physical activity, and sleep that promote cardiovascular health (Lloyd-Jones et al., 2022). Integrating the strength-based relational aspects of routines with the acquisition of cardiovascular health development capabilities allows children to establish their own optimal cardiovascular health trajectory early on. A systematic life course approach to supporting heart healthy routines in early childhood would inform clinical, research, and policy strategies to promote long-term cardiovascular health, and contribute to reducing inequalities in cardiovascular outcomes.

Clusters of lifestyle behaviours and their associations with socio-demographic characteristics in Dutch toddlers

PURPOSE

This study aimed to identify clusters of lifestyle behaviours in toddlers and assess associations with socio-demographic characteristics.

METHODS

We used data from the Dutch National Food Consumption Survey 2012-2016 and included 646 children aged 1-3 years. Based on 24-h dietary recalls and a questionnaire, a two-step cluster analysis was conducted to identify clusters in the intake of fruit, vegetables, sugar-sweetened beverages and unhealthy snacks, physical activity and screen time. Logistic regression models assessed associations between socio-demographic characteristics and cluster allocation.

RESULTS

Three clusters emerged from the data. The 'relatively healthy cluster' demonstrated a high intake of fruit and vegetables, low sugar-sweetened beverage and unhealthy snack intake and low screen time. The 'active snacking cluster' was characterised by high unhealthy snack intake and high physical activity, and the 'sedentary sweet beverage cluster' by high intake of sugar-sweetened beverages and high screen time. Children aged 1 year were most likely to be allocated to the 'relatively healthy cluster'. Compared to children of parents with a high education level, children of parents with a low or middle education level were less likely to be in the 'relatively healthy cluster', but more likely to be in the 'sedentary sweet beverage cluster'.

CONCLUSION

Clusters of lifestyle behaviours can be distinguished already in children aged 1-3 years. To promote healthy lifestyle behaviour, efforts may focus on maintaining healthy behaviour in 1-year-olds and more on switching towards healthy behaviour in 2- and 3-year-olds.

Do Peers Matter? Unhealthy Food and Beverages Preferences among Children in a Selected Rural Province in China

With the growing problem of childhood obesity, unhealthy dietary preferences among children have become an issue of worldwide concern. This article examines the class-peer effect of these preferences using random class assignment data from a field survey. The results show significant positive peer effects for both unhealthy food and beverages preference. These results remained robust after controlling for endogeneity issues using instrumental variables. Further analysis of the mechanism of peer effect shows that the better the relationship between classmates, the greater the influence peers have on unhealthy diet preferences among rural children. The same peer effect is found in situations where it is easy for children to obtain unhealthy food and beverages. The analysis of heterogeneity finds that the peer effects of unhealthy dietary preferences are stronger for girls, older students, and obese students. This paper also discusses the role of parents and schools in mitigating the peer effect. This paper proposes policy recommendations for rural areas in China to improve dietary preferences in children. These results may also provide useful guidelines for policy in other developing countries.

Children's food choices are highly dependent on patterns of parenting practices and food availability at home in families at high risk for type 2 diabetes in Europe: Cross-sectional results from the Feel4Diabetes study

BACKGROUND

Food parenting practices, behaviours and food availability at home are associated with children's food choices; however, these associations have been mainly studied for each parenting practice separately and focused mostly on healthy populations. The aim of the study was to identify patterns of parenting practices (including data regarding food availability at home, food and physical activity-related behaviours and rewards) and to investigate their cross-sectional associations with children's food choices in families at high risk for type 2 diabetes (T2D).

METHODS

Data of parents and children (n = 2278), from the Feel4Diabetes study conducted in six European countries, were collected using validated questionnaires. The data analysed included children's food choices, food availability at home and food and physical activity-related parenting practices. Four patterns of parenting practices were identified using principal component analysis, and associations between those components and children's food choices were assessed using adjusted, individual linear regressions.

RESULTS

Parenting patterns focusing on unhealthy habits, such as allowing unhealthy snacks and unlimited screen time, providing higher availability of unhealthy foods at home, rewarding with snacks and screen time, were positively associated with children's unhealthy food choices (consumption of savoury/sweet snacks, fizzy drinks, etc.). The parenting patterns providing fruit/vegetables at home, consuming fruit, and being physically active with the child were positively associated with children's healthier food choices (consumption of fruit, vegetables, whole grain cereals, etc.).

CONCLUSIONS

Public health initiatives should focus on high-risk families for T2D, assisting them to adopt appropriate parenting practices and behaviours to promote healthier food choices for children.

An internet-based educational intervention for mothers targeting preschoolers' weight management promotion (PWMP): a pilot study

BACKGROUND

The prevalence of overweight and obesity among children has raised public health concerns. This study aimed to design and evaluate a behaviour change intervention program to promote weight management among Tehranian preschoolers.

METHODS

The PRECEDE-PROCEED model is one of the most popular models in health education used to develop and evaluate most educational interventions. In this one-group pre and post-pilot study, 13 mothers of preschoolers were recruited from preschools in Tehran (the capital of Iran), in August 2020. Mothers received a six-week educational intervention, including text messages and educational videos via WhatsApp, to increase their self-efficacy to overcome barriers changing their children's lifestyle. Mothers reported preschoolers' height and weight to assess Body Mass Index and filled out the Food Frequency Questionnaire, the Persian version of the children's health-related quality of life questionnaire, and demographic features. The "Children's physical activity and sedentary behaviors checklist," newly designed by the researchers, was also filled out by mothers. These behaviors were measured according to the minutes that children were involved in these activities in a day, and the days they spent in a week for them. All variables were measured at baseline, immediately after the intervention and three months later. Data analysis was performed using SPSS IBM statistics version 22. Friedman test was used to evaluate changes over time.

RESULTS

The findings demonstrated that the mean BMI z-score stayed steady between baseline, immediately after the intervention and after three months (P = 0.60). Besides, after three months, the intervention programme led to a decrease in soft drink consumption (P = 0.001), and an increase in parental perception of their child's general health (P = 0.05), the parental concern regarding their child's emotional and physical health (P = 0.002) and minutes of physical activity per day (P = 0.02). However, fruit intake decreased (P = 0.01), and simple sugar, such as cube, increased (P = 0.03).

CONCLUSION

Results from this study are promising but should be interpreted with caution and should be replicated on a larger scale and compared with a control group to evaluate whether effects are maintained in a larger sample.

Neighborhood Food Environment and Children's BMI: A New Framework with Structural Equation Modeling

The relationship between neighborhood food environment and childhood obesity is complex and not yet well defined by current research in China, especially when considering the integrated effects with other relative factors. The main purpose of this article is to introduce a framework of children's weight status, based on their neighborhood food environment, and to identify the impact of food environment on the children's BMI and potential pathways. The participants of this cross-sectional study were students aged 8-16.5 years old and their parents. Two conceptual frameworks were tested using the structural equation modeling method, and two models were extracted. Model B added the neighborhood food environment based on model A. By comparing the two models, the neighborhood environment was potentially correlated with the children's BMI directly and may have a positive impact on unhealthy-food eating behaviors, which were positively associated with the children's BMI. The results suggest that the focus should be placed on the integrated effects of the potential risk factors of childhood obesity, based on considering the neighborhood food environment, which may relate to children's unhealthy-food eating behaviors and weight status.

Contribution of home availability, parental child-feeding practices and health beliefs on children's sweets and salty snacks consumption in Europe: Feel4Diabetes-Study

Adoption of healthy dietary and snacking habits could support optimum physical and mental development in children as they define health in adulthood. This study assessed parameters associated with children's snacking such as food home availability, parenting practices, and parents' health beliefs. In this cross-sectional study 12 039 children, 49·4% boys 5-12 years, participating in the European Feel4Diabetes-Study were included. Children's weekly consumption of sweets and salty snacks, home availability of snacks, food parenting practices, and health beliefs were assessed via questionnaires. Logistic regression was applied to explore associations of a) home availability of snacks, b) food parenting practices (permissiveness and rewarding with snacks) and c) parent's opinions on deterministic health beliefs with children's consumption of sweets and salty snacks. Results showed that home availability (sweets: OR_adj: 4·76, 95 % CI: 4·32, 5·23; salty snacks: OR_adj: 6·56, 95 % CI: 5·64, 7·61), allowing to consume (sweets: OR_adj: 3·29, 95 % CI: 2·95, 3·67; salty snacks: OR_adj: 3·41, 95 % CI: 2·98, 3·90) and rewarding with sweets/salty snacks (sweets: OR_adj: 2·69, 95 % CI: 2·23, 3·24; salty snacks: OR_adj: 4·34, 95 % CI: 3·57, 5·28) 'sometimes/or less frequently' compared to 'always/or often' were associated with lower weekly consumption of sweets and snacks. Parents' disagreement compared to agreement with deterministic health beliefs and inattentive eating were associated with lower consumption of salty snacks and sweets in children. Overall, the findings of this study indicate that attempts to promote healthy snacking habits in children should aim to improve parental dietary habits, food parenting practices, health beliefs, and reducing home availability of unhealthy foods and snacks.

Parental food consumption and diet quality and its association with children's food consumption in families at high risk of type 2 diabetes: the Feel4Diabetes-study

OBJECTIVE

To examine the parental food consumption and diet quality and its associations with children's consumption in families at high risk for developing type 2 diabetes mellitus across Europe. Also, to compare food frequency consumption among parents and children from high-risk families to the European Dietary guidelines/recommendations.

DESIGN

Cross-sectional study using Feel4diabetes FFQ.

SETTING

Families completed FFQ and anthropometric measures were obtained. Linear regression analyses were applied to investigate the relations between parental food consumption and diet quality and their children's food consumption after consideration of potential confounders.

PARTICIPANTS

2095 European families (74·6 % mothers, 50·9 % girls). The participants included parent and one child, aged 6-8 years.

RESULTS

Parental food consumption was significantly associated with children's intake from the same food groups among boys and girls. Most parents and children showed under-consumption of healthy foods according to the European Dietary Guidelines. Parental diet quality was positively associated with children's intake of 'fruit' (boys: β = 0·233, P < 0·001; girls: β = 0·134, P < 0·05) and 'vegetables' (boys: β = 0·177, P < 0·01; girls: β = 0·234, P < 0·001) and inversely associated with their 'snacks' consumption (boys: β = -0·143, P < 0·05; girls: β = -0·186, P < 0·01).

CONCLUSION

The present study suggests an association between parental food consumption and diet quality and children's food intake. More in-depth studies and lifestyle interventions that include both parents and children are therefore recommended for future research.

Understanding the perceptions of parents and preschool principals on the determinants of weight management among Iranian preschoolers: A directed qualitative content analysis

The current study aimed to understand the perceptions and experiences of Iranian parents and principals of preschool children on weight management based on the PRECEDE-PROCEED Model (PPM), a comprehensive structure for assessing health needs for designing, implementing, and evaluating health promotion, and other public health programs. PRECEDE provides a structure for planning a targeted and focused public health program, and PROCEED provides a structure for implementing and evaluating the program. Data were gathered from 17 preschoolers’ parents and two principals using semi-structured interviews in the preschool setting in Tehran, the capital of Iran, in 2019. Data were analyzed manually through directed content analysis based on constructs in phases two and three of the PPM, simultaneously with data collection. This study identified genetic, behavioral (e.g., food preferences, physical activity, sedentary behaviors, the effect of parents’, peers’, principals’ and teachers’ behavior and also influence of grandparents’ and neighbors’ behaviors) and environmental (e.g., home, grandparents’ home and preschool) factors from the epidemiological construct. Also, predisposing (e.g., child’s attitude, parent’s and principals’ attitude, as well as parents’ knowledge and parents’ and principals’ beliefs), enabling (e.g., parental skills and skills of the principals and teachers, rules and laws in the preschools, and availability), and reinforcing (e.g., family support and influences, teachers’ encouragement and influences, and peers’ influences) factors were identified from the educational and ecological construct. Additionally, “quality of child-parent relationship” was determined as a new factor affecting preschoolers’ weight management promotion; however, it was not in the PPM. In the study, parents’ and principals’ experiences regarding preschoolers’ weight management promotion confirmed the genetic, behavioral, environmental, predisposing, enabling and reinforcing factors of the PPM. “Quality of child-parent relationship” factor may be related to the culture and family relationship type of Iranian people, which is suggested to be investigated in future studies.

The Effect of the "Colorful Eating Is Healthy Eating" Long-Term Nutrition Education Program for 3- to 6-Year-Olds on Eating Habits in the Family and Parental Nutrition Knowledge

Background: Effective strategies for improving eating habits and dietary intake in preschoolers are essential for reducing the risk of chronic non-infectious diseases in later life. The aim of this study was to evaluate the effect of long-term nutrition education for 3- to 6-year-olds on parental nutrition knowledge. Methods: The study was conducted as part of the “Colorful Eating is Healthy Eating” nutrition education program that has been implemented in kindergartens in Lublin since 2016. A total of 11 kindergartens were involved in this stage of the program, and 733 parents consented to participate in the project. The study was divided into three stages. In the first stage all parents completed a questionnaire containing 54 items. In the next stage, 211 children from four randomly selected kindergartens participated in the “Colorful Eating Is Healthy Eating” educational program that lasted 7 months. In the third stage of the study, the parents of children who had completed the 7-month educational program and the parents of control group children once again completed the questionnaire. Results: A positive outcome of the educational program was that it contributed to a decrease in the consumption of sweetened hot beverages (p = 0.005) and an increase in water intake (p = 0.001). The nutrition education program was also successful in reducing the consumption of sweets. Children’s education improved the parents’ knowledge about dietary sources of fiber and the recommended fiber intake, and it contributed to the awareness that breakfast is the most important meal of the day. The program did not enhance the parents’ knowledge about snacking between meals or the role of sweetened beverages in dental caries, overweight and obesity. Conclusions: Long-term multi-stage nutrition education for children aged 3 to 6 years can be helpful in shaping families’ eating habits and improving parental nutrition knowledge. However, the program was less effective in eliminating the respondents’ preference for sweet-tasting foods.

Effects of Early Weight Gain Velocity, Diet Quality, and Snack Food Access on Toddler Weight Status at 1.5 Years: Follow-Up of a Randomized Controlled Infant Formula Trial

This study followed children who participated in a feeding trial in which the type of randomized infant formula fed from 2 weeks significantly affected weight gain velocity during the first 4 months and weight-for-length Z (WLZ) scores up to 11.5 months. We focused on measures of anthropometry, dietary intakes, and parenting related to the provision of snack foods that were collected at the end of the trial (1 year) and the 1.5 years follow-up visit. We not only describe what toddlers are eating, but we also determined the independent and/or interactive effects of randomized formula group, early weight gain velocity, the nutrient content of the post-formula diet, and maternal snack food practices, on toddlers’ weight status. Diet quality underwent drastic changes during this 6-month period. As infant formula disappeared from the diet, fruit and 100% fruit juice intake increased slightly, while intake of “What We Eat in America” food categories sweetened beverages and snacks and sweets more than doubled. Added sugars accounted for 5% of energy needs at 1 year and 9% at 1.5 years. Generalized linear mixed models revealed that, independent of the randomized formula group, greater velocities of weight gain during early infancy and lower access to snacks as toddlers predicted higher WLZ and a greater proportion of toddlers with overweight at 1.5 years. Energy and added sugar intake had no significant effects. These findings add to the growing body of evidence that unhealthy dietary habits are formed even before formula weaning and that, along with improving early diet, transient rapid weight gain and parental feeding practices are modifiable determinants that may reduce risks for obesity.

Do children favor snacks and dislike vegetables? Exploring children's food preferences using drawing as a projective technique. A cross-cultural study

OBJECTIVE

To avoid the rising spread of childhood obesity and preserve resources within planetary boundaries, healthy and sustainable eating habits and the consumption of adequate amounts of fruits and vegetables should be encouraged. Children's food preference was found to be an important determinant for food choice and consumption. The aim of this study was to explore children's food preferences using drawing as a projective technique in terms of healthy and sustainable eating and compare food preference patterns in Denmark and Lithuania.

METHOD

In total 484 children, aged between 8 and 13 years old, participated in the study (147 in Denmark and 337 in Lithuania). Participants were asked to fill the food preference questionnaire and answer questions about their daily intake of fruits, vegetables, and snacks and draw their favorite meal afterward. Sociodemographic questions about children's age, gender, parents' employment, and family composition were also included in the questionnaire.

RESULTS

Fruits, vegetables, highly-processed and animal-based foods were not included in a large part of children's most preferred meal composition. Favorite meals' composition varied among children in both countries and included different products from separate food groups. Vegetables were more likely to be present in the children's favorite meals together with meat products. Girls in both countries had more expressed vegetable preferences than boys. Boys in Lithuania had a relatively more expressed preference for highly-processed foods, while Danish girls had a more expressed preference for animal-based products.

CONCLUSIONS

Children's preferences for foods such as meat and animal-based products expressed in children's drawings, might be considered as relatively positive in terms of sustainable eating. However, children's preferences and intake of fruits and vegetables should still be encouraged among young consumers. Cultural and gender differences in children's food preferences should be considered while creating interventions and marketing strategies for promoting healthy and sustainable eating among young consumers.

The Association between Post-Migration Nutrition and Lifestyle Transition and the Risk of Developing Chronic Diseases among Sub-Saharan African Migrants: A Mixed Method Systematic Review Protocol

Sub-Saharan African (SSA) migrants face nutrition and lifestyle changes upon arrival in a host country. The shift in diet and lifestyle reflects post-migration acculturation and could predispose migrants to nutrition- and lifestyle- related chronic diseases. A mixed-methods systematic review of published studies and the grey literature on post-migration nutrition and lifestyle transition among SSA migrants will be undertaken. Studies published in English and conducted from 2000 to 2020 using quantitative and/or qualitative methods will be included. Ten bibliographic databases will be searched: Scopus, Ovid MEDLINE, EMBASE, Global Health, CINAHL, PubMed, ProQuest, PsycINFO, Informit and Web of Science. Data extraction will be informed by the Cochrane PROGRESS-Plus framework and the Joanna Briggs Institute manual. The quality of the included studies will be appraised for risk of bias using validated tools. An integrated approach to quantitative and qualitative data synthesis through data transformation will be undertaken, and a narrative synthesis of the findings will be provided. This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines and provides insight into the scope and parameters of the systematic review to be conducted. The aim of the review is to evaluate the association between post-migration nutrition and lifestyle transition and the risk of developing chronic diseases among SSA migrants in Australia. This review will provide insight into possible areas for interventions to improve the health of migrants. Systematic Review Registration: The protocol was registered with the PROSPERO international prospective register of systematic reviews CRD42020206560.

Longitudinal Associations between Food Parenting Practices and Dietary Intake in Children: The Feel4Diabetes Study

Food parenting practices (FPPs) have an important role in shaping children’s dietary behaviors. This study aimed to investigate cross-sectional and longitudinal associations over a two-year follow-up between FPP and dietary intake and compliance with current recommendations in 6- to 11-year-old European children. A total of 2967 parent-child dyads from the Feel4Diabetes study, a randomized controlled trial of a school and community-based intervention, (50.4% girls and 93.5% mothers) were included. FPPs assessed were: (1) home food availability; (2) parental role modeling of fruit intake; (3) permissiveness; (4) using food as a reward. Children’s dietary intake was assessed through a parent-reported food frequency questionnaire. In regression analyses, the strongest cross-sectional associations were observed between home availability of 100% fruit juice and corresponding intake (β = 0.492 in girls and β = 0.506 in boys, p < 0.001), and between parental role modeling of fruit intake and children’s fruit intake (β = 0.431 in girls and β = 0.448 in boys, p < 0.001). In multilevel logistic regression models, results indicated that improvements in positive FPPs over time were mainly associated with higher odds of compliance with healthy food recommendations, whereas a decrease in negative FPP over time was associated with higher odds of complying with energy-dense/nutrient-poor food recommendations. Improving FPPs could be an effective way to improve children’s dietary intake.

Social Modeling and Eating Behavior-A Narrative Review

Social modeling of eating is the adjustment of the amount of food eaten to the intake of the accompanying person. In this paper we provide a narrative review of literature on social modeling of eating with a particular focus on recent studies. Firstly, we describe the structure of a typical modeling experiment. Secondly, we present a variety of research in this field: experiments with various types of confederates, experiments aimed at the evaluation of the influence of gender, partner’s body weight, type of food, hunger, personal characteristics, etc. Thirdly, we present practical implications of this knowledge. The common conclusion is that social modeling of eating occurs in different situations and consumption is adapted to the standards established by the eating partner, but is not their direct reflection. Social influence of eating is not restricted to "artificial" laboratory situations; social modeling and social norms manipulations may be used to change people’s dietary practices, especially in children and young adults. Within the home environment parental modeling has been shown to promote children’s snacking and fruit and vegetable consumption. Social modeling may be used in nutrition interventions aimed at the improvement of children’s diet and in obesity prevention programs.

Effects of the Preschool-Based Family-Involving DAGIS Intervention on Family Environment: A Cluster Randomised Trial

Interventions promoting young children’s healthy energy balance-related behaviours (EBRBs) should also examine changes in the family environment as this is an important determinant that may affect the effectiveness of the intervention. This study examines family environmental effects of the Increased Health and Wellbeing in Preschools (DAGIS) intervention study, and whether these effects differed when considering three parental educational level (PEL) groups. The DAGIS intervention was conducted in preschools and involving parents in Southern Finland from September 2017 to May 2018. It was designed as a randomised trial, clustered at preschool-level. Parents of 3–6-year-olds answered questionnaires recording PEL, parental role modelling for EBRBs, and the family environment measured as EBRBs availability and accessibility. Linear Mixed Models with Repeated Measures were used in order to detect intervention effects. Models included group by time interactions. When examining intervention effects separated by PEL groups, models with three-level interactions (group × time-points × PEL) were evaluated. There was an interaction effect for the availability of sugary everyday foods and drinks (p = 0.002). The analyses showed that the control group increased availability (p = 0.003), whereas in the intervention group no changes were detected (p = 0.150). In the analysis separated by PEL groups, changes were found only for the accessibility of sugary treats at home; the high PEL control group increased the accessibility of sugary treats (p = 0.022) (interaction effect: p = 0.027). Hence, results suggest that the DAGIS multicomponent intervention had a limited impact on determinants for children’s healthy EBRBs, and no impact was found in the low PEL group.