The Influence of Parental Dietary Behaviors and Practices on Children's Eating Habits

Interventions on Fruit and Vegetable Intake in Low-, Middle-, and High-Income Countries: A Scoping Review of Evidence and Knowledge Gaps

BACKGROUND

Adequate fruit and vegetable (F&V) intake is important for health, yet populations globally are failing to meet recommendations.

OBJECTIVE

A scoping review to summarize available evidence of evaluations of interventions to increase F&V intake globally, focusing on target populations, intervention strategies, research methods, and summarizing their evaluated impacts.

METHODS

We searched PubMed and Web of Science in February 2023 for intervention studies in which dietary intake of fruit and/or vegetables were documented. Eligible studies included all age groups, excluding those targeting populations with specific disease-related conditions, such as cancer patients/survivors. Only articles published in English since 2012 were included in the review.

RESULTS

We identified 6338 articles, with 226 meeting inclusion criteria, comprising 223 unique studies and 284 intervention comparisons. Most comparisons occurred in high-income countries (n = 192) compared to low- and middle-income countries (n = 92). Randomized controlled trials (RCTs; 37.3%) and cluster RCTs (52.5%) were predominant. Interventions primarily targeted adults (31.7%), school-aged children (18.0%), children under-five (14.4%), and adolescents (13.7%), lasting an average of 24 weeks (range: 2 weeks to 20 years). Food-frequency questionnaires (59.2%) and 24-h recalls (26.8%) were the most used dietary assessment method. Health and nutrition education (75.9%) was the most common intervention, utilizing interpersonal communication, mass media, and information-communication technology, often in combinations. Positive impacts on fruit (43.9%), vegetable (40.2%), and combined F&V intake (53.0%) were observed in nearly half the intervention comparisons.

CONCLUSIONS

These findings highlight the predominance of health and nutrition education interventions, predominantly in high-income countries, showing mixed success in improving F&V intake, emphasizing the need for context-specific strategies and standardized methodologies to design sustainable, cost-effective interventions for better diet quality and health outcomes.

PLAIN LANGUAGE TITLE

A literature review assessing what we know and do not know about efforts to improve fruit and vegetable intake across the world.

A snapshot of country-specific dietary habits and obesity in European children: the Feel4Diabetes study

This study assessed the dietary intake of European children by country, gender, and obesity degree across six European countries participating in the Feel4Diabetes study. It also compared food group intakes with European food-based dietary guidelines. The Feel4Diabetes study included 9,847 children (50.4% girls) from six European countries. Families provided baseline data on energy balance-related behaviors and socioeconomic factors via questionnaires. Children's dietary intake and breakfast consumption were assessed using semi-quantitative food frequency questionnaires, and anthropometric measurements were taken. Intake from 11 food groups was analyzed by country, gender, and obesity degree. Chi-square analyses compared food intake with dietary guidelines. "Nutrient-dense " foods (e.g., fruits, vegetables, whole grains) and "energy-dense, low-nutrient" foods (e.g., high in added sugars, saturated fats) were categorized based on the European food-based guideline. Over 85% of children consumed breakfast 5-7 days a week, with no significant differences by Body Mass Index (BMI) or country. Mean intakes of nutrient-dense food groups fell below recommendations, while the intake of energy-dense, low-nutrient foods exceeded limits, particularly in children with overweight/obesity (p = 0.048). No significant gender differences were observed in most food groups.

CONCLUSIONS

 Dietary intake varied by country and obesity degree among European children. Across the six countries, children's diets did not align with food-based dietary guidelines. These findings underscore the need for interventions promoting healthier eating habits among European children.

TRIAL REGISTRATION

The Feel4Diabetes-study is registered with the clinical trials registry (NCT02393872),  http://clinicaltrials.gov What is Known: • Childhood obesity is a growing concern across Europe, with some variations in food consumption observed between European countries • Previous studies have highlighted the role of diet in childhood obesity, but few have examined cross-country comparisons while accounting for gender and BMI status.

WHAT IS NEW

• This study provides a comprehensive cross-country analysis of children's dietary intake, considering gender, BMI status, and adherence to European dietary guidelines. • New insights into gender differences in sweets consumption and the positive association between BMI and food intake (such as soft drinks and sweets) are presented, which can inform targeted dietary interventions.

Cariogenic Dietary Assessment Using a Mobile App in Children

PURPOSE

A direct association exists between caries and high-sugar diets. The aim of this study was to test whether the cariogenicity of diet assessed and analysed through a new mobile app is associated with caries risk among children.

MATERIALS AND METHODS

A total of 247 children, 2-15 years old, were recruited from university and hospital daycare centers and dental clinics. Diet was assessed via a 24-h recall, and caries (dmft/DMFT- ICDAS criteria) was documented through clinical examination. A mobile app was designed to analyse dietary data and calculate the diet's cariogenicity. Demographics, daily meals, meal duration and type, and toothbrushing were entered. A diagram presenting an estimate of the oral pH was produced, showing the time interval during which caries may develop, and a calculated cariogenic dietary risk was generated. Multivariate logistic regression derived odds ratios estimating associations between the cariogenic diet and caries across three age groups.

RESULTS

A cariogenic diet analysed by the app was positively associated with dfmt (r = 0.477, p 0.001) in 2- to 6-year-old children, with dmft (r = 0.376, p 0.05) and DMFT (r = 0.271, p 0.05) in 7- to 11-year-old children, and with DMFT (r = 0.383, p 0.001) in 12- to 15-year-old children. Parents' lower educational level was associated with a statistically significantly higher caries risk in younger children (p 0.05).

CONCLUSION

Cariogenic diet evaluated with the new app was associated with increased caries, providing evidence of an accurate assessment among children. This app could assist dentists in providing dietary assessment and advice related to caries risk at the dental office in a more structured, educational, and time-saving way.

Each Indicator of Socioeconomic Status (Education, Occupation, Income, and Household Size) Is Differently Associated with Children's Diets: Results from a Cross-Sectional CroCOSI Study

Background: There has yet to be an agreement on which specific socioeconomic status (SES) indicator most effectively reflects disparities in children's diets. However, children from lower SES backgrounds are particularly vulnerable, as research in other countries indicates that their diets contain fewer fruits and vegetables and more sweetened beverages. This paper aims to evaluate the associations between dietary habits and various SES indicators (education, occupation, income, and household size) among a representative sample of children in Croatia aged 7-10. Methods: Parents of children were asked to complete a questionnaire that contained indicators of their children's dietary habits and socioeconomic status (n = 5608). Associations between SES and children's dietary habits were assessed using logistic regression models. Results: The mother and father's educational attainment were strongly positively associated with breakfast consumption. Children of parents with a lower educational level consumed sweetened beverages, sweet snacks, and fast food slightly more often than children in families with a higher educational background. The mother's education was inversely associated with vegetable and cereal consumption, while the father's education was inversely associated with fruit and bakery product consumption. Meanwhile, household income per unit had a significant influence on the consumption of soft drinks and bakery products. Household size had a significant influence solely on sweet snack consumption. Conclusions: Each SES indicator showed an independent association with at least one particular dietary habit, except for the parent's employment status.

Associations between caregivers' health behaviours and overweight/obesity among children aged 2-6 years in Beijing, China: a cross-sectional study

OBJECTIVE

To investigate the correlation between caregivers' health-related behaviours and the prevalence of overweight/obesity among children aged 2-6 years in Beijing city in China.

DESIGN

Cross-sectional study.

SETTING

Two kindergartens and two community health service centres in Beijing city, China.

PARTICIPANTS

A total of 1967 children aged 2-6 years were included.

PRIMARY AND SECONDARY OUTCOME MEASURES

Children's height and weight were measured and body mass index was computed. The caregivers' exercise health behaviours and dietary health behaviours were assessed using a questionnaire, encompassing the frequency of exercise and the duration of each exercise session, as well as the frequency of consumption of desserts, late-night snacks, and fast food, regular eating habits, and the proportion of meat and vegetables consumed daily. Logistic regression analysis was performed to identify relationships between caregivers' health-related behaviours and overweight/obesity in children.

RESULTS

Having caregivers who exercised ≥3 times/week (OR 0.643, 95% CI 0.417 to 0.990) was a protective factor against childhood overweight/obesity compared with having caregivers who exercised <1 time/week; caregivers' frequent encouragement of children's participation in physical activity was also a protective factor (OR 0.513, 95% CI 0.352 to 0.749). Additionally, children whose caregivers consumed sweets 2-3 times/week (OR 1.535, 95% CI 1.133 to 2.081) or ≥4 times/week (OR 1.916, 95% CI 1.258 to 2.918), as well as children whose caregivers consumed fast food ≥4 times/week (OR 2.298, 95% CI 1.349 to 3.914), were more likely to be overweight and obesity than children whose caregivers consumed these foods ≤1 time/week. Furthermore, caregivers' irregular eating habits were positively associated with the occurrence of overweight and obesity in children (OR 1.485, 95% CI 1.056 to 2.089).

CONCLUSION

Caregivers' health-related behaviours were significantly associated with overweight/obesity among children in China. Substantial measures should be implemented to address caregivers' health-related behaviours to prevent and control childhood overweight/obesity.

Origins of food selectivity in human visual cortex

Several recent studies, enabled by advances in neuroimaging methods and large-scale datasets, have identified areas in human ventral visual cortex that respond more strongly to food images than to images of many other categories, adding to our knowledge about the broad network of regions that are responsive to food. This finding raises important questions about the evolutionary and developmental origins of a possible food-selective neural population, as well as larger questions about the origins of category-selective neural populations more generally. Here, we propose a framework for how visual properties of food (particularly color) and nonvisual signals associated with multimodal reward processing, social cognition, and physical interactions with food may, in combination, contribute to the emergence of food selectivity. We discuss recent research that sheds light on each of these factors, alongside a broader account of category selectivity that incorporates both visual feature statistics and behavioral relevance.

Adequate Food and Nutrition in School: Acceptability and Consumption by Students of a Brazilian Municipality

OBJECTIVE

This study aimed to evaluate the acceptability of a specific menu preparation based on minimally processed foods and the factors associated with the consumption of school meals by students in Brazilian public schools.

METHODS

A hedonic scale was employed to assess the acceptability of a milk preparation with 100% cocoa and sugar. A structured questionnaire was used to evaluate school food consumption, addressing consumption frequency, dietary habits, environmental conditions, and consumption of competing foods. A binomial logistic regression model was conducted to verify the association between individual variables and conditions of meal supply and consumption. Data analyses were performed using the Jamovi 2022 software.

RESULTS

A total of 1080 students participated, with 630 taking part in the acceptability test, and 450 completing the consumption questionnaire. The study highlighted acceptance below the minimum PNAE standards (79.68%) for the tested preparation, indicating a need for further investigation into student preferences. Pleasant taste was the most frequently cited reason (53.2%) for consumption. Disliking the served lunch increased the likelihood of not consuming school meals by 2.73% (p = 0.03). Bringing snacks from home showed no significant impact on consumption (p = 0.677). Using inadequate cutlery increased the likelihood of not consuming school meals by 6.44% (p = 0.009).

CONCLUSIONS

The study underscored the low acceptance of milk prepared with 100% cocoa and sugar, along with irregular school meal consumption, emphasizing the need for strategies to align students' taste preferences with healthier menu options. While PNAE ensures nutrient-rich meals, improving flavor, variety, and dining conditions, alongside permanent food and nutrition education, is essential to enhance adherence and support students' health. Although snacks do not affect the consumption of school meals, controlling snack intake is important from a health perspective.

Understanding Caregivers' Influence on Preschoolers' Eating Behaviors: An Integrative Review Guided by the Theory of Planned Behavior

BACKGROUND/OBJECTIVES

Primary caregivers of children play a significant role in developing their dietary behaviors. Guided by the Theory of Planned Behavior (TPB), this integrative review aimed to synthesize studies examining how personal and household characteristics, caregivers' dietary beliefs, intentions, and feeding practices influence the eating behaviors of preschool-aged children (2-5 years).

METHODS

PubMed, CINAHL, and PsycINFO databases were searched for peer-reviewed articles published between January 2014 and September 2024. The expanded PRISMA 2020 checklist was used to guide the literature search and report the results. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) was also used to evaluate the quality of the selected articles.

RESULTS

A total of 10 studies were included in the final analysis. The studies revealed that preschoolers' eating behaviors were significantly influenced by personal characteristics (e.g., caregivers' BMI, and weight perceptions) and household factors (e.g., food availability). Additionally, caregivers' feeding practices, such as restriction, modeling, and permissiveness, played a pivotal role in shaping children's eating habits. Although caregivers expressed intentions to provide a healthy diet, they often faced barriers, including conflicting work schedules, financial constraints, and logistical challenges, which impeded their ability to consistently promote healthy eating behaviors.

CONCLUSIONS

Caregivers' beliefs, intentions, and feeding practices are pivotal in shaping preschoolers' eating behaviors. However, the limited available literature and the underexplored mechanisms linking these factors make it challenging to draw solid conclusions. Future research should address these gaps and consider integrating caregiver-focused factors into tailored interventions to promote healthier eating habits in preschool-aged children. This can aid healthcare professionals in designing culturally and contextually sensitive strategies for improving childhood nutrition.

Dietary Lipid Profile in Spanish Children with Overweight or Obesity: A Longitudinal Study on the Impact of Children's Eating Behavior and Sedentary Habits

BACKGROUND

Dietary lipids, sedentary habits, and eating behaviors influence childhood obesity, but their interrelations remain unclear.

AIM

To assess the relationships between young children's dietary lipid profile and children's eating behavior, as well as their sedentary habits, providing evidence-based insights that can help mitigate obesity risk in this vulnerable population.

DESIGN

A longitudinal randomized controlled trial conducted over 9 months, involving 90 children aged 2-6 years with overweight or obesity who were followed under a program that promoted healthy lifestyle habits for all participants and regularly monitored their parameters.

METHODS

The dietary lipid profile, eating behavior, and sedentary habits were assessed at baseline and after 9 months using validated tools, including 24 h recalls, the child eating behavior questionnaire (CEBQ), and screen time questionnaires.

RESULTS

Reductions in screen/sedentary time were significantly associated with decreased total fat (-11.1 g/day) and saturated fat (-4.3 g/day) intake, compared to smaller reductions in unchanged screen hours and increases with prolonged screen use. A positive correlation was observed between changes in dietary fat and the CEBQ domain "Desire to drink" (r = 0.528, p < 0.001), with regression analysis confirming a direct relationship.

CONCLUSIONS

Managing screen time and eating behavior is crucial for improving dietary lipid profile and reducing childhood obesity risk. Strategies should include reducing sedentary behaviors, limiting sugary drinks, and promoting water as the main beverage, alongside effective nutrition education for families.

Theoretically Based Factors Affecting Diet Quality of Preschool Children: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

Diet quality during early childhood significantly influences long-term health outcomes, including obesity and chronic disease risks. Parental feeding practices, dietary beliefs, and demographic factors have been shown to impact children's diet quality. This study aimed to determine the extent to which the demographic characteristics and the factors of primary caregivers (dietary beliefs, intention to provide a healthy diet, feeding practices) can explain the variance in the diet quality of preschoolers in the US Methods: This descriptive correlational cross-sectional study was guided by the Theory of Planned Behavior (TPB). A total of 146 primary caregivers of preschool children (aged 3-5) were recruited through convenience and snowball sampling. Data were collected using a self-reported questionnaire and a structured telephone interview. Diet quality was assessed using the Dietary Approaches to Stop Hypertension (DASH) score. Hierarchical multiple regression analyses were conducted to determine the factors associated with preschoolers' diet quality.

RESULTS

The mean DASH score was 40.5 (SD = 10.1), reflecting moderate to low diet quality. The results showed that 16% of the variance in diet quality was significantly explained by race (non-White) and three caregiver feeding practices (food as a reward, restriction food for health, and restriction for weight control). Of these, race (non-White) and restriction food for health were significant predictors and associated with lower diet quality in preschoolers.

CONCLUSIONS

These findings align with previous studies and suggest that the conceptual framework of this study might be further refined and tested in future studies.

Reasons Behind (Un)Healthy Eating Among School-Age Children in Southern Peru

In recent decades, rates of childhood overweight and obesity have increased worldwide, surpassing those of adults. Understanding the factors influencing children's food choices is essential to promote healthy eating habits. This study examined why school-aged children make healthy and unhealthy food choices and how parents' eating habits influence their children's choices. Children's ability to rank 25 food pictures according to their healthfulness was assessed using a free sorting task (FST), while parents made a free list of healthy and unhealthy foods, and the cognitive salience index (CSI) was calculated. Children were grouped into two groups based on their responses: one mainly from Moquegua and the other from Puno. In general, children from Moquegua demonstrated a greater ability to identify healthy foods than those from Puno. The CSI provided information on healthy and unhealthy foods in each region. These findings underline the potential of selecting palatable and healthy foods to improve children's diets in the short term and contribute to the development of healthier products in the food industry. In addition, studies in other regions of Peru are recommended to understand children's perceptions better.

The relationship between self-efficacy, motivation, and dietary behaviors within parent-adolescent dyads: Application of actor-partner interdependence models with mediation

The purpose of the study was to examine interdependent relationships between cognitive factors (self-efficacy and motivation) and dietary behaviors (fruit and vegetable (F/V) and junk food and sugar sweetened beverages (JF/SSB) intake) within parent-adolescent dyads. This secondary data analysis was conducted for parent-adolescent dyads using a cross-sectional Family Life, Activity, Sun, Health, and Eating (FLASHE) study. The sample consisted of 1645 parent-adolescent dyads. Parents and adolescents answered questions regarding self-efficacy, motivation, and dietary behaviors. Actor-partner interdependence models with mediation (APIMeM) were run within parent-adolescent dyads. Adolescent's F/V and JF/SSB intake were positively associated with that of their parents. The relationship between F/V self-efficacy or F/V motivation and F/V intake showed the actor-partner pattern within the parent-adolescent dyads. The actor-only pattern was mainly reported for the relationship between JF/SSB self-efficacy or JF/SSB motivation and JF/SSB intake. In the F/V intake APIMeM, motivation mostly plays a mediating role in the relationship between self-efficacy and F/V intake within the parent-adolescent dyads. In the JF/SSB intake APIMeM, all the actor-actor mediations and only one partner-actor mediation of motivation were significantly confirmed in the relationship between self-efficacy and JF/SSB intake. This study highlighted the importance of parental involvement in promoting healthy dietary behaviors in adolescents. Personalized nutrition programs targeting both adolescents and their parents as a single unit of intervention should be provided.

From preschool to policy: A scoping review of recommended interventions for a systems approach to improve dietary intake in early childhood

Early childhood is a key opportunity to establish healthy eating behaviors and prevent future non-communicable diseases associated with poor diets. How to effectively intervene in the system of the many determinants influencing children's dietary intake remains unclear. This scoping review aimed to map the determinants of nutrition and eating that have been addressed in early childhood nutrition interventions and identify which of these improve dietary intake. We searched six electronic databases to identify eligible studies published from January 2000 to January 2024. We included studies of any interventions reporting dietary intake among children aged between two and five years. A total of 193 eligible studies were identified and mapped to the Determinants of Nutrition and Eating (DONE) Framework. Parent (n = 97) and child (n = 76) food knowledge and skills were most frequently addressed. Most studies addressing parent (67%) and child (66%) food knowledge and skills reported improvements in dietary intake. Government regulations such as healthy food subsidies, and food advertising and labeling interventions showed promised, with 82% of studies reporting improvements in dietary intake. However, these interventions were predominantly implemented in the United States and Chile. This review provides a comprehensive and systematic map of a range of interventions that positively influence nutritional outcomes in preschool-aged children but recommends further policy-level action globally.

Annual consumption rate of fish types in Tanzania's Singida municipality during 2022

This study assessed the annual fish consumption among the households in Singida Municipality. This was due to the long-time of unsatisfactory pupil performance in joining secondary schools which may be linked to a lack of Long-chain omega-3 polyunsaturated fatty acids. The study used a questionnaire based on a random household consumer survey of 204 households. The questionnaires were analyzed using SPSS statistical software version 27 and the results were reported using descriptive statistics including means, standard deviations, percentages, and frequency distributions. The results showed that the highest mean annual consumption was 25.92 kg and 23.00 kg per person for Nile tilapia (Oreochromis niloticus) and African catfish (Clarias gariepinus) respectively. Manyara tilapia (Oreochromis amphimelus) had a consumption rate of 22.27 kg annually per person. Nile perch (Lates niloticus) had the lowest consumption of 18.98 kg annually per person. The trend of respondents' perceptions on occurrences of non-communicable diseases was blood pressure, diabetes, stomach ulcers, marasmus, and inflammation of the lungs, epilepsy and Cancer. It was concluded that fish consumption in this study area varies with the type of fish and is higher than the national average fish consumption rate of 8.5 kg in 2020. Although unsatisfactory school performance may be attributed to other factors, more research should be conducted on fish omega-3 quantities from this study area.

Long-term exposure to fine particulate matter components with obesity in children and adolescents in China: The age-sex disparities and key effect modifiers

Long-term fine particulate matter (PM2.5) exposure was associated with childhood obesity. However, the key PM2.5 components and whether PM2.5 effect may vary by obesity type, growth stage, sex, and individual/family characteristics have yet been examined. In this study, we investigated 213,907 Chinese children and adolescents aged 3-18 years in 2017-2019. Three-year average concentrations of PM2.5 and five major components were assigned to each participant's address. Multivariable mixed-effects model and weighted quantile sum regression were used to estimate the effect sizes of each component. Stratified analyses were performed by age and sex groups, with the interactive effects of a series of individual/family features evaluated. The odds ratio of childhood obesity was 1.28 (95 %CI: 1.15-1.43) for per interquartile range increase in PM2.5, with organic matter identified as the key contributor. General central obesity and mixed obesity were more sensitive to PM2.5 exposure than peripheral obesity. As children aged, the effect size of PM2.5 attenuated for general central obesity, remained unchanged for mixed obesity and increased for peripheral obesity. Females, children with obese parents, and those with lower levels of physical activity were more vulnerable than others. Other adverse effect modifiers for certain children included family with one child, low family income, and less sleep duration. Our findings emphasize that the influence of exposure to PM2.5 and its components on risk of obesity in children and adolescents should be considered comprehensively in developing adequate obesity prevention strategies.

A Multi-Stage Dyadic Qualitative Analysis to Disentangle How Dietary Behaviors of Asian American Young Adults are Influenced by Family

The dietary behaviors of Asian American (AA) young adults, who face a growing non-communicable disease burden, are impacted by complex socio-ecological forces. Family plays a crucial role in the lifestyle behaviors of AA young adults; however, little is known on the methods, contributors, and impact of familial dietary influence. This study aims to deconstruct the mechanisms of AA young adult familial dietary influence through a multi-perspective qualitative assessment. A five-phase method of dyadic analysis adapted from past research was employed to extract nuanced insights from dyadic interviews with AA young adults and family members, and ground findings in behavioral theory (the Social Cognitive Theory, SCT). 37 interviews were conducted: 18 young adults, comprising 10 different AA ethnic subgroups, and 19 family members (10 parents, 9 siblings). Participants described dietary influences that were both active (facilitating, shaping, and restricting) and passive (e.g., sharing foods or environment, mirroring food behaviors). Influences connected strongly with multiple SCT constructs (e.g., behavioral capacity, reinforcements for active influences, and expectations, observational learning for passive influences). Familial influence contributed to changes in the total amount, variety, and healthfulness of foods consumed. Intra-family dynamics were crucial; family members often leveraged each other's persuasiveness or food skills to collaboratively influence diet. AA family-based interventions should consider incorporating both passive and active forms of dietary influence within a family unit, involve multiple family members, and allow for individualization to the unique dynamics and dietary behaviors within each family unit.

Relationships Among Endorsement of the Superwoman Schema and Health Outcomes

OBJECTIVE

To examine associations among endorsement of elements of the superwoman schema (the obligation to manifest strength and the obligation to help others) and health outcomes and to test if stress mediates the association between the obligation to manifest strength and depression in adult Black women.

DESIGN

Cross-sectional design.

SETTING

Community space in the Chicago metropolitan area.

PARTICIPANTS

Ninety-one adult Black women.

METHODS

Participants completed questionnaires to assess endorsement of superwoman schema roles, physical activity, healthy eating, weight satisfaction, depression, and stress. Height and weight were collected by research assistants. We used descriptive statistics, bivariate correlations, multiple regression models, and linear mediation analysis to analyze data.

RESULTS

Higher levels of obligation to suppress emotions were associated with lower physical activity, r(88) = -0.25, p < .05. Obligation to manifest strength was associated with higher levels of stress, r(79) = 0.53, p < .01, and symptoms of depression, r(71) = 0.36, p < .01. Stress mediated the relationship between the obligation to manifest strength and depression with a significant indirect effect, β = 0.37, SE = 0.10, 95% confidence interval [0.20, 0.60].

CONCLUSION

Our findings offer insight into the psychological and social processes that affect Black women and may aid in the development of culturally responsive prevention and intervention programs at individual and community levels to reduce chronic diseases.

Early life factors that affect obesity and the need for complex solutions

The prevalence of obesity increases with age but is apparent even in early life. Early childhood is a critical period for development that is known to influence future health. Even so, the focus on obesity in this phase, and the factors that affect the development of obesity, has only emerged over the past two decades. Furthermore, there is a paucity of iterative work in this area that would move the field forward. Obesity is a complex condition involving the interplay of multiple influences at different levels: the individual and biological level, the sociocultural level, and the environmental and system levels. This Review provides a brief overview of the evidence for these factors with a focus on aspects specific to early life. By spotlighting the complex web of interactions between the broad range of influences, both causal and risk markers, we highlight the complex nature of the condition. Much work in the early life field remains observational and many of the intervention studies are limited by a focus on single influences and a disjointed approach to solutions. Yet the complexity of obesity necessitates coordinated multi-focused solutions and joined-up action across the first 2,000 days from conception, and beyond.

SNAP and/or WIC Participation and Diet Quality in Mother-Child Dyads living in Greater Boston after Pandemic: A Mixed-Method Study

INTRODUCTION/OBJECTIVES

Since the COVID-19 pandemic, few studies have examined how participation in Supplemental Nutrition Assistance Program (SNAP) and/or Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) impacts diet quality in families with young children. This study aims to explore the association between SNAP and/or WIC participation and diet quality in mother-child dyads in Greater Boston, MA.

METHODS

A mixed-method approach involving cross-sectional surveys and in-depth interviews were utilized. Participants included 69 mother-child dyads for quantitative and 18 mothers for qualitative data collection. Analysis of covariance using generalized linear models was employed to compare differences in Healthy Eating Index-2015 (HEI-2015) scores based on SNAP and/or WIC participation, and thematic analysis was used for coding themes.

RESULTS

Mothers who participated in SNAP and/or WIC were more from lower socioeconomic backgrounds. After adjusting for age, race/ethnicity, and education, no significant differences in diet quality were found for both mothers and their children. However, qualitative results showed that mothers prioritized their children's nutrition, used benefits to buy fruits and vegetables, and experienced stress that impacted their own diet quality.

CONCLUSIONS

Since the pandemic, SNAP and WIC appeared to support families experiencing socioeconomic disadvantage (e.g., lower income and educational attainment) to improve diet quality, particularly through increased access to fruits and vegetables. However, these programs have not fully eliminated persistent disparities in diet quality, which seems to continue even the pandemic's immediate effects have subsided.

Prevalence of Obesity and Dental Caries in Kindergarten Children During the First Decade of Saudi Vision 2030: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

Obesity and dental caries are significant health issues affecting children worldwide. This study aims to investigate the prevalence of obesity and dental caries among kindergarten children in Saudi Arabia during the early implementation years of the Vision 2030 initiative. Specifically, it examines the obesity rates between public and private kindergartens and assesses the correlation between obesity and caries risk.

METHODS

We conducted a cross-sectional study involving a stratified sample of 347 kindergarten children in Jeddah, Saudi Arabia, from September 2022 to March 2023, as part of a larger project assessing the obesity and dental caries prevalence in school-aged children. Their body mass index (BMI) was computed after their weight and height were measured. Following an oral examination, the decayed, missing, and filled teeth (dmft) scores were noted. The relationships between dmft and BMI, sex, and school type were studied using non-parametric tests, and its predictors were assessed as well.

RESULTS

Our findings indicate that 15.3% of the children were classified as obese based on the BMI measurements, while 9.8% were categorized as overweight. The prevalence of obesity did not show significant differences by school type when classified by BMI. The mean dmft score was 2.8 ± 3.6, with those children in public kindergartens demonstrating significantly higher dmft scores compared to their private counterparts (p < 0.001). Notably, there was no observed relationship between obesity and caries activity.

CONCLUSIONS

Despite the implementation of Saudi Vision 2030, the high prevalence of obesity and dental caries among kindergarten children suggests that the current health initiatives may be insufficient. The lack of a relationship between obesity and caries activity highlights the complexity of these health issues and the need for targeted interventions. To improve the health outcomes, it is recommended to enhance the awareness campaigns regarding oral health and nutrition, increase access to preventive dental care, and integrate nutrition education into kindergarten curricula.

Nutritional management and autism spectrum disorder: A systematic review

BACKGROUND

Autism spectrum disorder (ASD) presents unique challenges related to feeding and nutritional management. Children with ASD often experience feeding difficulties, including food selectivity, refusal, and gastrointestinal issues. Various interventions have been explored to address these challenges, including dietary modifications, vitamin supplementation, feeding therapy, and behavioral interventions.

AIM

To provide a comprehensive overview of the current evidence on nutritional management in ASD. We examine the effectiveness of dietary interventions, vitamin supplements, feeding therapy, behavioral interventions, and mealtime practices in addressing the feeding challenges and nutritional needs of children with ASD.

METHODS

We systematically searched relevant literature up to June 2024, using databases such as PubMed, PsycINFO, and Scopus. Studies were included if they investigated dietary interventions, nutritional supplements, or behavioral strategies to improve feeding behaviors in children with ASD. We assessed the quality of the studies and synthesized findings on the impact of various interventions on feeding difficulties and nutritional outcomes. Data extraction focused on intervention types, study designs, participant characteristics, outcomes measured, and intervention effectiveness.

RESULTS

The review identified 316 studies that met the inclusion criteria. The evidence indicates that while dietary interventions and nutritional supplements may offer benefits in managing specific symptoms or deficiencies, the effectiveness of these approaches varies. Feeding therapy and behavioral interventions, including gradual exposure and positive reinforcement, promise to improve food acceptance and mealtime behaviors. The findings also highlight the importance of creating supportive mealtime environments tailored to the sensory and behavioral needs of children with ASD.

CONCLUSION

Nutritional management for children with ASD requires a multifaceted approach that includes dietary modifications, supplementation, feeding therapy, and behavioral strategies. The review underscores the need for personalized interventions and further research to refine treatment protocols and improve outcomes. Collaborative efforts among healthcare providers, educators, and families are essential to optimize this population's nutritional health and feeding practices. Enhancing our understanding of intervention sustainability and long-term outcomes is essential for optimizing care and improving the quality of life for children with ASD and their families.

Understanding the Interaction Between Family Dynamics and Childhood Obesity in the Middle Eastern Population: A Qualitative Study

OBJECTIVE(S)

We aim to understand the interaction between family dynamics and lifestyle behaviors of school-age children with overweight or obesity in Oman. The outcomes would clarify the mediating familial determinants that contribute to childhood obesity in the Middle East population.

DESIGN

A qualitative phenomenological approach.

SAMPLE

Mothers of school-age children with overweight or obesity.

MEASUREMENTS

Semi-structured interviews were conducted following an interview guide, and thematic analysis was used to identify key themes and subthemes.

RESULTS

The study identified three main themes based on data collected from 12 participants. The first theme, "Children's Lifestyle Behaviors," highlighted the need to address unhealthy food consumption, low physical activity, and inconsistent sleeping habits. The second theme, "Parenting Lifestyle behaviors," underscored the importance of regaining control over children's eating behaviors, fostering shared interest in outdoor activities, and establishing a consistent sleep routine. Lastly, the third theme, "Determinants of Parenting Lifestyle Behaviors," identified factors such as parental stress, the high cost of healthy options, cultural influence on healthy eating, limited outdoor activity options, and the availability of unhealthy snacks in schools.

CONCLUSION

Our study underscores the need for family-centered obesity programs that address several determinants of parenting lifestyle behaviors, including psychological, financial, social, and environmental challenges.

Using the Behaviour Change Wheel and Theoretical Domains Framework to identify factors related to increasing fruit and vegetable consumption in children to guide future intervention development

OBJECTIVE

This study used the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF) to identify parental factors that are associated with increasing their child's fruit and vegetable consumption. The information gathered enabled a behavioural diagnosis and the identification of intervention functions to increase fruit and vegetable consumption in children.

DESIGN

A qualitative design using open-ended online survey methodology was utilised.

SETTING

United Kingdom.

PARTICIPANTS

Twenty-eight parents of primary school-aged children (4-11 years) aged 29-51 years participated.

RESULTS

Thematic and summative analysis identified skills in preparation and cooking, awareness of and desire to increase fruit and vegetable intake, knowledge of the recommendations and better health for their child as the main facilitators. The main barriers were time and financial constraints, their child's food preferences and refusal to eat fruit and vegetables, negative role modelling from parents and grandparents and beliefs that fruit and vegetable intake will increase with age. For behaviour change to occur, 'knowledge', 'social influences', 'environmental context and resources', 'beliefs about consequences' and 'beliefs about capabilities' need to be altered.

CONCLUSIONS

Novel findings suggest that future intervention development should focus on parental beliefs and skills around how to increase fruit and vegetable consumption as their child ages and expanding parental knowledge on the benefits of fruit and vegetable consumption such as mental and future health. The use of the TDF and BCW identified appropriate intervention functions that will guide future behaviour change techniques, modes of delivery and policy categories that best target increasing children's fruit and vegetable consumption.

Association of parental eating styles and markers of food intake and nutritional status of Brazilian children

We analysed the relationships between maternal feeding styles and children's eating and nutritional factors. A cross-sectional study was developed with 416 mothers linked to 130 public higher education institutions in all Brazilian states and their children aged 18 months to six years. A semi-structured online questionnaire was applied using the Google Forms tool, with questions about sociodemographic conditions, food consumption and anthropometry of the children. The children's food consumption was assessed based on the Food Consumption Markers Form (SISVAN) for the age groups up to 24 months (n = 84) and over 24 months (n = 332), and the parental style in feeding, based on the Parental Feeding Styles Questionnaire (QEPA). The assessment of the child's nutritional status was based on the weight and height data reported by the mother. The body mass index/age (BMI/Age) was calculated and classified into age-specific WHO curves. Descriptive analysis and univariate analyses were performed, in the Statistical Package for the Social Sciences (SPSS, version 26.0) programs (SPSS Inc., Chicago, IL). To test the association between categorical variables, the Chi-square test or Fisher's exact test was used, and multiple logistic regression was used to estimate the independent association between the variables of interest, with an estimated odds ratio and 95% confidence interval. Statistical significance was adopted at 5%. Children under 24 months of age with authoritative mothers were 8.7 times more likely to consume ultra-processed foods and 5.3 times less likely to consume foods rich in vitamin A than those with indulgent mothers. Children over 24 months old with authoritative mothers were 2.5 times more likely to eat meals while watching television, 2.0 times more likely to consume sandwich cookies, candies and sweets, and 2.3 times less likely to have at least the three main meals of a day, compared to those with indulgent mothers. The chances of overweight children being born to authoritative mothers were two times greater compared to underweight children. Higher scores in the demandingness domain among responsive mothers increased the odds ratios of children eating unhealthy foods, using screens during meals, and proved to be a protective factor against low child weight.

Food consumption and mental health in children and adolescents: A systematic review protocol

Mental illnesses are prevalent among children and adolescents worldwide and may be associated with food consumption. This protocol aims to evaluate the association between food consumption and mental health in children and adolescents through a systematic review and meta-analysis. The electronic search will include keywords related to childhood, adolescence, mental health issues (e.g., anxiety, stress, depression), and food consumption (e.g., in natura or minimally processed foods and ultra-processed foods ultra-processed foods), verified using MeSH terms. The systematic review will follow the PRISMA-2020 guidelines, employing the PECOS strategy, and will include quantitative observational and mixed-methods studies. A search will be conducted in the following databases: Scopus, CINAHL, SPORTDiscus, LILACS, Web of Science, APA-PsycArticles, PubMed/Medline, and EMBASE. Identifying the association between mental health and food consumption will contribute to the development of preventive and intervention strategies aimed at improving the health and well-being of children and adolescents. The analysis of the data will provide results on how psychological factors are linked to the consumption of various food groups, implying the updating of public policies. These guidelines can assist managers and researchers in creating effective interventions to promote mental health and healthy eating behaviors, ultimately leading to long-term positive impacts on public health.

The Role of Gut Microbiota in the Onset and Progression of Obesity and Associated Comorbidities

Obesity, a global public health problem, is constantly increasing, so the concerns in preventing and combating it are increasingly focused on the intestinal microbiota. It was found that the microbiota is different in lean people compared to obese individuals, but the exact mechanisms by which energy homeostasis is influenced are still incompletely known. Numerous studies show the involvement of certain bacterial species in promoting obesity and associated diseases such as diabetes, hypertension, cancer, etc. Our aim is to summarize the main findings regarding the influence of several factors such as lifestyle changes, including diet and bariatric surgery, on the diversity of the gut microbiota in obese individuals. The second purpose of this paper is to investigate the potential effect of various microbiota modulation techniques on ameliorating obesity and its comorbidities. A literature search was conducted using the PubMed database, identifying articles published between 2019 and 2024. Most studies identified suggest that obesity is generally associated with alterations of the gut microbiome such as decreased microbial diversity, an increased Firmicutes-to-Bacteroidetes ratio, and increased SCFAs levels. Our findings also indicate that gut microbiota modulation techniques could represent a novel strategy in treating obesity and related metabolic diseases. Although some mechanisms (e.g., inflammation or hormonal regulation) are already considered a powerful connection between gut microbiota and obesity development, further research is needed to enhance the knowledge on this particular topic.

Supporting vulnerable families' meal practices: process evaluation of a nationwide intervention implemented by a retailer and social organizations

BACKGROUND

Lower socioeconomic status (SES) is associated with poorer dietary habits and fewer family meals. Therefore, initiatives to empower families with a lower SES to adopt healthier meal practices are employed. The objective of this study was to evaluate a nationwide intervention "Dinner is served at 1-2-3 euros", developed by a Belgian retailer in collaboration with social organizations. It targets families with a lower SES and aims to promote more balanced and freshly cooked meals by providing recipe booklets of affordable meals at a guaranteed price of 1, 2, or 3 euros per portion. The process evaluation aimed to gain insight into the implementation process (Reach, Recruitment, Dose-delivered, Context), the satisfaction with the intervention (Dose-received), and the perceived impact of intervention participation.

METHODS

A mixed-methods study combining qualitative (i.e., focus groups and individual interviews) and quantitative research (i.e., surveys) was conducted. An interview with the retailer (n = 1), three focus group interviews with the involved social organizations (n = 15), and interviews with participants of "Dinner is served at 1-2-3 euros" (n = 26) were carried out, as well as surveys among these social organizations and participants.

RESULTS

Social organizations were generally satisfied with the project and appreciated the collaboration with the retailer. The main barrier to implement the project was a lack of time to help participants subscribing. Participants appreciated the inspiration from the recipe booklets, and the recipes' ease of preparation, their healthiness, and the variety. However, the recipes were sometimes deemed too exotic for participants' children. Participants also appreciated the budget friendliness, although the price guarantee mechanism of 1, 2 or 3 euros per portion was not always clear. Positive effects were mentioned in areas such as perceived healthy cooking and eating, improved cooking skills and ideas, and reduced financial concerns.

CONCLUSIONS

In general, participants and social organizations were satisfied with the delivery and implementation of the intervention. Participants also noted some positive effects on their meal practices. Future research should provide insight into the intervention's effectiveness and impact on the healthiness of participants' dietary choices.

TRIAL REGISTRATION

The study protocol was pre‑registered prior to data collection at Clinicaltrials.gov (NCT05595551-27/10/2022).

Barriers to healthy eating practices among school-aged children in Armenia: A qualitative study

The aim of this study was to use diverse perspectives of stakeholders to explore barriers to healthy eating, and attitudes, norms, and practices contributing to unhealthy food choices among school-aged children in Armenia. A qualitative study was carried out through focus group discussions and in-depth interviews, using the Theory of Planned Behavior. The study was conducted in 21 public schools located in three provinces (marzes) of Armenia: Shirak, Lori, and Tavush, and the capital city Yerevan. These study areas were chosen purposefully to target more vulnerable regions and have a geographically diverse sample. Purposive sampling techniques were used to choose the study participants. Five groups were targeted: high school students, school principals, teachers, school cafeteria staff members, and mothers of school children. Overall, 10 focus group discussions, and 51 in-depth interviews were conducted with a total of 94 participants. The study explored two main themes underlying unhealthy eating behaviors among school-aged children in Armenia - suboptimal preferences and restricted opportunities. Three subthemes were identified within the theme of suboptimal preferences: preferences/tastes, attitudes, and role models/normative referent, and another three subthemes within the theme of restricted opportunities: choice restrictions, time constraints, and financial barriers. The study found that most of the constructs of theory of planned behavior, such as general attitudes, preferences, perceived norms and perceived behavioral control, impacted unhealthy eating behaviors of school-aged children in Armenia. The recommendations for practice included enhancing the appeal of healthy foods, highlighting the significance of breakfast and healthy eating in educational activities utilizing role models, expanding and empowering school canteens, including higher grade students in school feeding programs, and extending school breaks to provide sufficient time for healthy eating.

Addressing diabetes by elevating access to nutrition (ADELANTE) - A multi-level approach for improving household food insecurity and glycemic control among Latinos with diabetes: A randomized controlled trial

BACKGROUND

Latinx adults are disproportionately impacted by the interrelated challenges of food insecurity and nutrition sensitive chronic diseases. Food and nutrition insecurity can exacerbate the development and progression of chronic diseases, such as diabetes. Sustainable, effective interventions aimed at improving food insecurity and diabetes management for Latinx populations are needed.

METHODS

This hybrid type 1 trial evaluates the effectiveness of a multi-level intervention that includes a medically supportive food and behavioral lifestyle program on the primary outcome of Hemoglobin A1c (HbA1c) at 6 months. Latinx adults (n = 355) with type 2 diabetes (HbA1c of 6.0-12.0 %), overweight/obesity (BMI > 25 kg/m2), and self-reported risk of food insecurity will be randomized 1:1 to intervention (12 weekly deliveries of vegetables, fruits, and whole-grain foods + culturally-modified behavioral lifestyle program) versus control (food deliveries after a 6-month delay). Outcome asessments will occur at 0, 6 and 12 months, and include HbA1c, dietary intake, psychosocial health outcomes, and diabetes-related stressors. In addition, food insecurity and the impact of the intervention on up to two household members will be measured. Qualitative interviews with patients, healthcare providers, and community partners will be conducted in accordance with Reach, Effectivenes, Adoption, Implementation, and Maintenence (RE-AIM) framework to identify barriers and best practices for future dissemination.

CONCLUSIONS

The ADELANTE trial will provide novel insight to the effectiveness of a multi-level intervention on diabetes-related outcomes in Latinx adults. The mixed-method approach will also identity the reach of this 'Food is Medicine' intervention on additional household members to inform diabetes prevention efforts.

CLINICAL TRIAL REGISTRATION

NCT05228860.

Parenting Practices to Prevent Childhood Obesity Among Hispanic Families: A Systematic Literature Review

Background: Childhood obesity disproportionately affects Hispanic families and remains an unresolved public health concern. Interventions to enhance health-related parenting practices may be a promising strategy to lower the risk for childhood obesity. However, there are scarce data on which parenting practices would be culturally relevant and contribute to lower the risk for childhood obesity among Hispanic families in the United States. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. An electronic database search of records was carried out in PubMed, CINAHL, PsycINFO, and Scopus to synthesize studies assessing associations or intervention effects of parenting practices on child BMI or other anthropometric measure among Hispanic parent-child dyads aged ≥18 and 2-12 years, respectively. Results: Of 1055 unique records identified, 17 studies were included. Most of these studies used a cross-sectional design (n = 10) and child BMI z-scores or BMI-for-age-sex percentiles as the outcome variable. Parenting practices to lower the risk for child overweight/obesity among Hispanic families included setting limits and providing routines (e.g., limited screentime), supporting a healthy lifestyle and physical activity (e.g., providing transportation to places for children's physical activities), and parenting feeding or diet-related practices (e.g., control the foods that children eat). Conclusion: Parenting practices that support healthy behaviors may be components of interventions to lower the risk for childhood obesity among Hispanic families.

A Self-Administered Eating Behavior Scale for Patients With Heart Failure Living at Home: Protocol for a Mixed Methods Scale Development Study

BACKGROUND

The prevalence of heart failure (HF) is increasing worldwide, with the associated mortality rates rising consistently. Preventing HF progression requires adherence to restricted sodium intake alongside sufficient and balanced nutritional consumption. For patients at home, preparing nutritionally balanced meals is essential, either self-assisted or with the aid of close individuals. Patients with HF frequently experience decreased exercise tolerance, depression, anxiety, and social isolation, which interfere with eating behaviors, leading to inadequate dietary habits. However, measures focusing on the determinants of eating behavior among patients with HF are currently lacking.

OBJECTIVE

This study aims to develop a self-administered scale to assess the eating behaviors of patients with HF living at home (Self-Administered Eating Behaviors Scale for Heart Failure [SEBS-HF]).

METHODS

This study encompasses 3 phases. Phase 1 involves identifying factors influencing eating behaviors in patients with HF. First, a literature review will be conducted using PubMed and CINAHL databases. The specified literature will be analyzed qualitatively and inductively. Additionally, verbatim transcripts obtained from semistructured interviews of patients with HF and medical experts will be qualitatively analyzed. Based on the Phase 1 results, a preliminary scale will be constructed. In Phase 2, cognitive interviews will be conducted with patients with HF and experts; the preliminary scale will be used to qualitatively evaluate its content validity. After validation, the scale will be used in Phase 3 to conduct a cross-sectional study involving patients with HF. In Phase 3, data will be collected from clinical records and self-administered questionnaires or scales. After conducting a preliminary survey, the main survey will be conducted. The reliability and validity of the scale will be assessed using statistical methods.

RESULTS

The first phase of this study commenced in September 2023, and by May 2, 2024, a total of 7 patients with HF and 6 expert professionals were enrolled as study participants. The draft creation of the scale will be completed in 2024, and the content validity evaluation of the draft scale is expected to be finished by early 2025. The third phase will begin its investigation in mid-2025 and is expected to be completed by late 2025, after which the SEBS-HF will be published.

CONCLUSIONS

The development and use of this scale will enable a more comprehensive evaluation of the factors influencing eating behaviors in patients with HF. Thus, medical and welfare professionals should provide appropriate support tailored to the specific needs of patients with HF.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/60719.

A Theory of Food Exploration with Gender Differences: Childhood Eating Habits and Implicit Food Attitudes

BACKGROUND/OBJECTIVES

The growing interest in nutritional psychology has sparked explorations into how eating habits impact one's emotional, cognitive, and physical health. The Theory of Food (ToF) posits that childhood eating patterns shape food choices in adulthood, influenced by cognitive and associative representations formed early in life. This study explores the relationship between specific childhood eating habits-fruit and snack consumption-and implicit attitudes toward these food groups in adulthood. It also investigates whether this relationship differs by gender.

METHODS

One hundred and nineteen participants completed a recall questionnaire about their childhood eating habits and an Implicit Association Test (IAT) to assess implicit attitudes toward food groups. The primary hypotheses were that greater fruit consumption in childhood would lead to more positive attitudes toward fruits, and higher snack consumption would result in more favourable attitudes toward snacks.

RESULTS

The results did not support the initial hypotheses, indicating no direct relationship between the consumption of fruits or snacks in childhood and implicit attitudes in adulthood. However, further analyses revealed a significant difference in implicit attitudes toward fruits below versus high childhood fruit consumption participation, particularly among women.

CONCLUSIONS

These findings highlight the complexity of the relationship between childhood eating habits and implicit food attitudes. While no direct associations were found for the overall sample, the significant differences in attitudes based on childhood fruit consumption in women suggest gender-specific patterns. These results emphasize the need for further research to unravel the intricate connections between early eating behaviours and later food attitudes.

Associations between parent and child latent eating profiles and the role of parental feeding practices

Previous research employing the person-centred approach of Latent Profile Analysis (LPA) with parent-reported data of their child's eating behaviour identified four distinct eating profiles in 3-6-year-old children: typical, avid, happy, and avoidant eating (Pickard et al., 2023). In this follow-up study, the same parents were asked to self-report their own eating behaviour (N = 785) and LPA was conducted to determine the latent eating profiles of the parents/caregivers. The LPA showed that a four-profile solution best represented the sample of parents, termed: typical eating (n = 325, 41.4%), avid eating (n = 293, 37.3%), emotional eating (n = 123, 15.7%) and avoidant eating (n = 44, 5.6%). Multiple mediation analysis was then conducted to examine both the direct associations between parents' eating profiles and the child's probability of eating profile membership, as well as the indirect associations through the mediatory role of specific parental feeding practices. The results suggested direct links between parent and child eating profiles, with the 'avid eating' and 'avoidant eating' profiles in parents predicting similar profiles in their children. Feeding practices, such as using food for emotional regulation, providing balanced and varied food, and promoting a healthy home food environment, mediated associations between parent and child eating profiles. This research provides novel evidence to reinforce the need for interventions to be specifically tailored to both the parent's and child's eating profiles. The work also provides an interesting avenue for future longitudinal examination of whether the parents' provision of a healthy home food environment could protect against intergenerational transmission of less favourable eating behaviours.

Nutritional and Culinary Habits to Empower Families (n-CHEF): a feasibility study to increase consumption and home cooking of plant-based foods

OBJECTIVE

To analyse the feasibility and acceptability of a culinary nutritional intervention aimed at increasing plant-based foods consumption in the context of the Mediterranean diet in parent-child dyads.

DESIGN

The Nutritional and Culinary Habits to Empower Families (n-CHEF) is a 9-month feasibility study that included four culinary nutritional workshops (two face to face, two online) led by a chef and a dietitian-nutritionist. These workshops combined cooking with plant-based foods, with nutritional advice and experimental activities. The main outcomes were retention, quality of the intervention (monitoring workshops, acceptability and perceived impact) and changes in dietary and cooking habits.

SETTING

Parent-child dyads, Spain.

PARTICIPANTS

Parent-child (aged 10-14 years) dyads.

RESULTS

Fifteen parent-child dyads were recruited, of which thirteen were retained during the 6-month follow-up. All but one parent-child dyads attended the four workshops. The overall assessment of the workshops was positive, although the online workshops were rated lower than the face to face. In general, parent-child dyads reported benefits in terms of nutrition and cooking aspects. Parents significantly increased their adherence to the Mediterranean diet, but non-significant changes were observed in children. However, children increased their consumption of vegetables and legumes and reduced snacks and ready meals. Parents also changed some of their culinary habits and increased their confidence in cooking at home.

CONCLUSIONS

The n-CHEF showed that the culinary nutritional intervention had good levels of recruitment, retention and acceptability among parent-child dyads. In addition, dietary and culinary knowledge and habits can be improved, although further studies are needed to know the long-term effects in larger populations.

Dietary practices of children and adolescents residing in an area of Chakdaha Block, Nadia district, West Bengal

Background

Childhood and adolescence are crucial developmental stages during the life course. They develop and establish lifelong dietary and lifestyle habits. Unhealthy food environments that influence the risk of obesity and other nutrition-related NCDs by affecting the dietary patterns. Assessment of dietary patterns and factors affecting them will help to provide targeted interventions to improve the same.

Methods

A community-based cross-sectional study was conducted among children aged more than 6 months and adolescents by interviewing their mothers regarding the dietary patterns. A two-stage sampling method was followed for selection of the participants.

Results

A total of 325 participants were interviewed. Dietary diversity (DD) was present in 55.4% of the participants. Children of mothers who were educated beyond middle school (aOR = 3.81 (1.87-7.73), P = 0.000) and children who stayed in a joint family (aOR = 1.73 (1.11-2.72) P < 0.05) had higher odds of having dietary diversity in their diet, after adjusting for age and sex. Fast food shop location (aOR = 0.14 (0.05-0.38), P value = 0.000) was found to have a significant association with fast food intake among participants.

Conclusion

Children and adolescents residing in the study area have a distinct dietary pattern compared to prevalent dietary practices in India. To improve dietary diversity of children and adolescents, maternal education, family dynamics, and community food environment, which include fast food and market locations, can be points of targeted interventions.

Associations between maternal diet, family eating habits and preschool children's dietary patterns: insights from the UPBEAT trial

BACKGROUND

Dietary behaviours in early life often track across the life course, influencing the development of adverse health outcomes such as obesity and cardiovascular disease. This study aimed to explore the between dietary patterns (DP) in preschool children and maternal DP and family eating habits.

METHODS

We conducted a secondary analysis of 488 mother-child pairs from the UK pregnancy Better Eating and Activity Trial (UPBEAT) at 3-year follow-up. Previously published DP from mothers and children (derived from food-frequency questionnaires and exploratory factor analysis) were used. Mothers' DP were "Fruits-Vegetables", "African-Caribbean", "Processed and Snacks", and children's DP were "Prudent", "Processed-Snacking", and "African-Caribbean". Family meal environments were evaluated using a 5-point Likert scale.

RESULTS

Linear regression models revealed that child's prudent pattern was positively associated with maternal Fruits-Vegetables (B = 0.18 (0.08, 0.27)), Snacks patterns (B = 0.10 (0.01, 0.18)), and eating the same foods during meals (B = 0.25 (0.07, 0.43)). Child's Processed-Snacking pattern was directly associated with maternal Processed (B = 0.22 (0.13, 0.30)) and Snacks (B = 0.27 (0.18, 0.36)) patterns, receiving food as reward (B = 0.22 (0.04, 0.39)) and watching TV during meals (B = 0.27 (0.09, 0.45)). Finally, the child African-Caribbean pattern was directly associated with that from the mother (B = 0.41 (0.33, 0.50)) and watching TV during meals (B = 0.15 (0.09, 0.30)), and inversely associated with maternal processed (B=-0.09 (-0.17, -0.02)) and snacking (B=-0.08 (-0.15, -0.04)) patterns.

CONCLUSIONS

Unhealthy dietary patterns in childhood are directly linked to similar maternal patterns and family meal behaviours, such as television viewing and food rewards. These findings highlight targetable behaviours for public health interventions.

Comparative Analysis of Dietary Habits and Obesity Prediction: Body Mass Index versus Body Fat Percentage Classification Using Bioelectrical Impedance Analysis

Background: Obesity remains a widely debated issue, often criticized for the limitations in its identification and classification. This study aims to compare two distinct systems for classifying obesity: body mass index (BMI) and body fat percentage (BFP) as assessed by bioelectrical impedance analysis (BIA). By examining these measures, the study seeks to clarify how different metrics of body composition influence the identification of obesity-related risk factors. Methods: The study enrolled 1255 adults, comprising 471 males and 784 females, with a mean age of 36 ± 12 years. Participants exhibited varying degrees of weight status, including optimal weight, overweight, and obesity. Body composition analysis was conducted using the TANITA Body Composition Analyzer BC-418 MA III device (T5896, Tokyo, Japan), evaluating the following parameters: current weight, basal metabolic rate (BMR), adipose tissue (%), muscle mass (%), and hydration status (%). Results: Age and psychological factors like cravings, fatigue, stress, and compulsive eating were significant predictors of obesity in the BMI model but not in the BFP model. Additionally, having a family history of diabetes was protective in the BMI model (OR: 0.33, 0.11-0.87) but increased risk in the BFP model (OR: 1.66, 1.01-2.76). The BMI model demonstrates exceptional predictive ability (AUC = 0.998). In contrast, the BFP model, while still performing well, exhibits a lower AUC (0.975), indicating slightly reduced discriminative power compared to the BMI model. Conclusions: BMI classification demonstrates superior predictive accuracy, specificity, and sensitivity. This suggests that BMI remains a more reliable measure for identifying obesity-related risk factors compared to the BFP model.

Associations among screen time, sleep, mental health and cognitive functioning in school-aged children during the COVID-19 pandemic, November 2020 through to August 2022

Objective

To examine children's screen time use and sleep patterns over 2 years of the pandemic and the downstream associations with children's executive functions and behavioural problems, as well as the moderating effects of parental factors.

Method

This longitudinal cohort study examined school-aged children's lifestyle and behavioural changes over 2 years of the pandemic across 6 timepoints (November 2020 to August 2022). Latent growth modeling (LGM) was used to identify changes in screen time and sleep duration and multivariate LGM was used to determine how parental stress, positive parenting, changes in children's screen time and sleep over time were associated with children's executive functions and mental health outcomes at the final time point.

Results

A total of 198 parents (children's mean age = 9.14 years) were recruited and followed up. Non-school screen time was elevated at the initial timepoint (3.6 ± 2.3 h). Positive parenting at the initial timepoint was associated with lower screen time use in children (β = -.19, p < .001; β = -.19, p < .001, in internalizing and externalizing models). Children whose screen time use was constant during the pandemic had shorter sleep durations (β = -.45, p < .05 in internalizing model). Executive function was predicted by sleep duration at the first timepoint (β = -.55, p < .001; β = .73, p < .001, in internalizing and externalizing models) and changes in screen time during the pandemic was associated with both internalizing and externalizing symptoms (β = .58, p < .05; β = .54, p < .05, in internalizing and externalizing models).

Conclusion

Children's screen time decreased slightly but remained significantly higher than Canadian and International guidelines during 2 years of the pandemic. Positive parenting styles can have a significant impact on children's screen time use. Reducing excessive screen time can help improve sleep patterns and, consequently, cognitive, and emotional well-being in children.

The Effect of Parents' Nutrition Literacy on Children's Oral-Health-Related Quality of Life

Parents can help children adopt good eating habits early in childhood by encouraging them to eat healthy. While parents' levels of nutritional literacy is known to play a role in children's healthy nutrition, healthy food is also essential in improving oral-health-related quality of life (OHRQoL). Since the effect of parents' nutritional literacy on children's OHRQoL is not yet known, this study aimed to examine the impact of parental nutritional literacy on children's OHRQoL. This study was conducted with 459 parents of children aged 3-6 living in the Central Anatolia Region of Türkiye. Data collection tools included a sociodemographic form, the Early Childhood Oral Health Impact Scale (ECOHIS) and the Evaluation Instrument of Nutrition Literacy on Adults (EINLA). Data were analyzed in SPSS, using Student's t-test, Chi-square test, and binary logistic regression models. Parents with higher nutritional literacy tend to have higher levels of education. An increase in total nutritional literacy score, especially in the general nutrition knowledge (GNK) and food label and numerical literacy (FLNL) subscales, was associated with higher child OHRQoL. Increasing parents' nutritional literacy levels can contribute to OHRQoL by enabling them to be good role models for their children. Therefore, increasing parents' nutritional literacy can improve OHRQoL by improving children's nutrition and can be considered a protective factor for oral health.

Associations between Meal Patterns and Risk of Overweight/Obesity in Children and Adolescents in Western Countries: A Systematic Review of Longitudinal Studies and Randomised Controlled Trials

Childhood overweight/obesity (OV/OB) is a major public health problem in Western countries, often accompanied with comorbidities (e.g., hypertension and insulin resistance) (i.e., metabolically unhealthy obesity-MUO). Among diet-related risk factors of OV/OB risk and MUO, meal patterns remain limitedly studied. The aim of this systematic review was to explore associations between meal patterns and the risk of childhood OV/OB and MUO in children/adolescents aged 2-19 years. Longitudinal studies and randomised controlled trials from PUBMED and Scopus published between January 2013 and April 2024 were retrieved. Twenty-eight studies were included, all of which reported on OV/OB risk, with none on MUO risk. Regular consumption of breakfast (n = 3) and family meals (n = 4) and avoiding dining while watching TV (n = 4) may be protective factors against childhood OV/OB, whereas meal skipping (primarily breakfast; n = 4) may be a detrimental factor. Mixed effects of meal frequency on OV/OB risk were observed; no effects of frequency of lunch or of fast-food consumption and of meals served at school were found. There was insufficient evidence to support the role of other patterns (meal timing, eating in other social contexts). Meals were mainly participant-identified, leading to increased heterogeneity. Research focusing on childhood MUO and the use of harmonised definitions regarding the assessment of meal patterns are highly warranted.

Understanding parents' perceptions of children's exposure to unhealthy food marketing in digital and retail environments

Unhealthy food and non-alcoholic beverage marketing (UFM) adversely impacts children's selection and intake of foods and beverages, undermining parents' efforts to promote healthy eating. Parents' support for restrictions on children's exposure to food marketing can catalyse government action, yet research describing parent concerns is limited for media other than television. We examined parents' perceptions of UFM and their views on potential policies to address UFM in supermarkets and on digital devices - two settings where children are highly exposed to UFM and where little recent research exists. We conducted in-depth interviews with sixteen parents of children aged 7-12 from Victoria, Australia, analysing the data thematically. Parents perceived UFM as ubiquitous and viewed exposure as having an immediate but temporary impact on children's food desires and pestering behaviours. Parents were concerned about UFM in supermarkets as they viewed it as leading their children to pester them to buy marketed products, undermining their efforts to instil healthy eating behaviours. Parents generally accepted UFM as an aspect of contemporary parenting. Concern for digital UFM was lower compared to supermarkets as it was not directly linked to pestering and parents had limited awareness of what their children saw online. Nevertheless, parents felt strongly that companies should not be allowed to target their children with UFM online and supported government intervention to protect their children. While parents supported government policy actions for healthier supermarket environments, their views towards restricting UFM in supermarkets varied as some parents felt it was their responsibility to mitigate supermarket marketing. These findings could be used to advocate for policy action in this area.

Diet Quality Among Mothers and Children in India: Roles of Social and Behavior Change Communication and Nutrition-Sensitive Social Protection Programs

BACKGROUND

Limited evidence exists on determinants of maternal and child diet quality.

OBJECTIVES

This study examined the role of social and behavior change communication (SBCC) and nutrition-sensitive social protection (NSSP) programs on maternal and child diet quality.

METHODS

Data were from cross-sectional phone survey on 6627 Indian mothers that took place in late 2021. The Diet Quality Questionnaire (DQQ) was used to measure maternal and child diet quality, including minimum dietary diversity (MDD), dietary diversity scores (DDSs), noncommunicable disease (NCD)-protect and NCD-risk scores, adherence to dietary guidelines (All-5 and India-All-6), and unhealthy child feeding. Multivariate regression models were used to explore the association between diet indicators and coverage of SBCC and NSSP programs.

RESULTS

Maternal and child diet quality was suboptimal, with more mothers (57%) achieving MDD than children (23%). SBCC was positively associated with healthy food consumption in children (odds ratio [OR]: 2.14 for MDD; β: 0.60 for DDS and 0.54 for NCD-protect) and mothers (β: 0.38 for DDS and 0.43 for NCD-protect). Cash transfers were associated with healthier diets in mothers (OR: 1.45 for MDD, 1.86 for All-5, and 2.14 for India-All-6; β: 0.43 for DDS and 0.26 for NCD-protect), but less associations noted for children (β: 0.14 for NCD-protect). Receiving food was associated not only with healthier diets in mothers (OR: 1.47 for MDD; β: 0.27 for DDS and 0.33 for NCD-protect) and children (β: 0.19 for DDS and 0.15 for NCD-protect) but also with unhealthy food in children (OR: 1.34). Exposure to multiple programs showed stronger associations with diet quality.

CONCLUSIONS

SBCC has greater positive impact on child feeding than food and cash transfers, while cash has a stronger association with improved maternal diets. Food and cash are also associated with unhealthy food consumption. Our study underscores the importance of interventions that combine education, resource provision, and targeted support to promote maternal and child diet quality.

Effect of dietary antioxidant quality score on tobacco smoke exposure and asthma in children and adolescents: a cross-sectional study from the NHANES database

BACKGROUND

Asthma is a common non-communicable disease in children, and airway inflammation is the main pathological change of asthma. Tobacco smoke exposure (TSE) can cause systematic inflammation and oxidative stress, which may further aggravate the progression of asthma. Dietary antioxidants can relieve the inflammation and oxidative stress in human body. This study aims to assess the effect of overall antioxidant capacity of dietary intake, evaluating by dietary antioxidant quality score (DAQS), in the association between TSE and childhood asthma.

METHODS

Data of this cross-sectional study were extracted from the National Health and Nutrition Examination Surveys (NHANES) 2007-2018. DAQS was calculated based on the daily dietary intake of selenium, zinc, magnesium, vitamin A, C and E. TSE was measured by serum cotinine concentration. The weighted univariate and multivariate logistic regression models were employed to evaluate the role of DAQS in the association between TSE and asthma among children and adolescents. Subgroup analysis was conducted to further evaluate the association based on gender.

RESULTS

Totally 11,026 children and adolescents were included, of whom 1,244 (11.28%) had asthma. After adjusted all covariates, TSE was associated with the high odds of childhood asthma (OR = 1.26, 95%CI = 1.05-1.52). Among children exposed to tobacco smoke, those with higher DAQS level (OR = 1.15, 95%CI: 0.88-1.50) had a reduced risk of asthma compared with those children with lower DAQS level (OR = 1.43, 1.08-1.89), especially among girls (OR = 1.42, 95%CI: 0.93-2.17).

CONCLUSION

High DAQS may have a moderating effect on asthma in children; that is, the higher DAQS, the lower the odds of asthma in children who exposed to tobacco smoke. Our study provides a reference for developing more targeted strategies for prevention and treatment of asthma in children.

A report card assessment of the prevalence of healthy eating among preschool-aged children: a cross-cultural study across Australia, Hong Kong, Singapore, and the US

Objective

This study aimed to initially adopt an International Healthy Eating Report Card for Preschool-Aged Children to assess the prevalence of healthy eating behaviours and favourable family home food environments (FHFEs) among preschool-aged children in Australia, Hong Kong, Singapore, and the US. We also examined which cultural contexts would exhibit significant differences in the report card scores among the four cultural contexts.

Methods

In this cross-cultural study, 2059 parent-child dyads, with approximately 500 dyads in each cultural context, were recruited. The parents were asked to complete the validated International Healthy Eating Report Card Scale to assess the dimensions of the Report Card [i.e., Indicator of Children's Eating Behaviours: (1) Children's Dietary Patterns and (2) Children's Mealtime Behaviours, and Indicator of FHFEs: (3) Parental Food Choices and Preparation, (4) Home Healthier Food Availability and Accessibility and (5) Family Mealtime Environments]. Each indicator received a letter grade [i.e., A (≥80%) = excellent, B (60-79%) = good, C (40-59%) = fair, D (20-39%) = poor, F (<20%) = very poor and including the plus (+) and minus (-) signs] to represent the proportion of participants who could meet the predefined benchmarks. We also employed ANCOVA and Bonferroni's post-hoc test to examine the differences in the report card scores between the four cultural contexts. A significance level was set at p < 0.05.

Results

The average overall report card grade across the four cultural contexts was "B-" (Good), ranging from "C+" (Singapore and the US) to "B-" (Australia and Hong Kong). The average grade for Children's Eating Behaviours was classified as Fair ("C-"), while the average grade for FHFEs was classified as Good ("B+") for all cultural contexts. A comparison of the overall report card scores revealed that Australia exhibited a significantly higher report card score than Singapore and the US, while Hong Kong achieved a significantly higher score than Singapore.

Conclusion

The International Healthy Eating Report Card provided an overview of the prevalence of healthy eating in different cultural contexts. We believe that the International Healthy Eating Report Card may offer new perspectives on interventions for fostering healthy eating in young children.

Parent-child skin carotenoid level and vegetable intake relationships in users of children's cafeterias in Japan

Introduction

Studies on the relationship between parental and child dietary intakes are limited in Asian populations. Here, we examined parent-child relationships in skin carotenoid levels and vegetable intake in a Japanese community.

Methods

The study participants were 58 children aged 6-15 years and 39 of their guardians (parents) using children's cafeterias. Skin carotenoid levels were measured using the Veggie Meter®, and the number of vegetable dishes (equivalent to a serving of 70 g) was evaluated using a self-administered questionnaire.

Results

The mean (standard deviation; SD) skin carotenoid levels were 366.8 (74.0) in children and 315.0 (101.4) in parents. The partial correlation coefficient between parents' and children's skin carotenoid levels, adjusting for cafeteria, sex, parental dietary supplement use, and household financial status, was 0.38 (P = 0.02); after adjustment for smoking status and BMI, the positive correlation was attenuated (r = 0.25, P = 0.14). A positive correlation was observed between parents' and children's vegetable dish intake (r = 0.30, P = 0.02).

Conclusion

This cross-sectional study identified a positive correlation between parent-child intake of vegetable dishes, accounting for potential confounders. However, the positive correlation observed between parent-child skin carotenoid levels may have been attenuated by internal factors such as smoking and obesity.

What Determinants Are Related to Milk and Dairy Product Consumption Frequency among Children Aged 10-12 Years in Poland? Nationwide Cross-Sectional Study

Due to their high nutritional value, milk and dairy products should be a permanent element of a properly balanced diet for children and adolescents. The study aimed to identify (i) the frequency of milk and dairy product consumption by children aged 10-12 years in the opinion of children and their parents and (ii) the determinants related to the consumption of these products (including lifestyle, nutrition knowledge, and the nutritional status of children's as well as parents' nutrition knowledge). A cross-sectional study was conducted with 12,643 primary school students aged 10-12 and 7363 parents. Dietary data were collected using the Food Frequency Consumption and Nutritional Knowledge Questionnaire (SF-FFQ4PolishChildren® and KomPAN®). Anthropometric measurements were taken and body mass index (BMI) and waist/height ratios (WHtR) were calculated. A logistic regression model was used to assess the likelihood of the frequent consumption of dairy products in the opinion of both the children and their parents, and the quality of the obtained models was assessed using model fit statistics and the Hosmer and Lemeshow test. The frequency of consuming milk and milk products (every day and more) was low in the opinion of children aged 10-12 years (29.6%). According to their parents, the frequency of the consumption of dairy products was slightly higher (44.8%). Six factors associated with the frequency of milk and dairy product consumption were identified independently. These included schoolchildren and their parents' nutrition knowledge, physical activity, sleep, gender, and place of residence. More of these products were consumed by children with greater nutrition knowledge-both their own and their parents'-higher physical activity, longer sleep duration, males, and those living in the city. Family eating habits, particularly eating meals together, also played an important role in the consumption of milk and dairy products. According to the parents, the children in older grades were less likely to consume dairy products more frequently. The obtained results suggest an insufficient consumption of milk and dairy products. The identification of modifiable factors, such as nutrition knowledge, physical activity, sleep duration, and eating meals with the family, suggests the need to improve the existing strategies, including activities encouraging nutritional education for both schoolchildren and their parents.

Cross-Sectional Assessment of Nutritional Status, Dietary Intake, and Physical Activity Levels in Children (6-9 Years) in Valencia (Spain) Using Nutrimetry

The aims of this research were to evaluate the current nutritional status, dietary intake, and level of physical activity and assess the need for intervention. This was a cross-sectional study with 2724 participating children aged 6-9 years old. Nutritional status was assessed using nutrimetry, dietary intake with a 3-day food-recall questionnaire and physical activity with an ad hoc questionnaire. The nutricode with the highest prevalence was healthy weight/normal stature, with 51.3% of the sample. For the BMI for age Z-score, those in the overweight/obesity category represented 37.5% of the sample, while the thinness category included 7.6%. Intake of calories, proteins, sugar, lipids, SFA, MUFA, and cholesterol were significantly higher than recommended. The thinness groups consumed a significantly higher amount of excess calories while the overweight/obesity groups had the lowest mean excess calorie intake. Children in the thinness category presented the highest rates at both ends of the spectrum for sedentary activities. This study showed the high prevalence of malnutrition in schoolchildren. The results for the risk of thinness and overweight/obesity according to individual nutrient intake should be carefully interpreted. Lifestyle is a fundamental aspect to consider when combating malnutrition, especially at the level of dietary and physical activity habits, to combine various methods of intervention to improve nutritional status.

Shaping a moral body in family dinner talk: Children's socialization to good manners concerning bodily conduct

The family meal has been extensively investigated as a site for children's acquisition of eating-related behaviors and attitudes, as well as culture-specific rules and assumptions. However, little is known about children's socialization to a constitutive dimension of commensality and even social life: good manners concerning bodily conduct. Drawing on 20th century scholarship on body governmentality and good manners, and building on recent studies on family meal as a socialization site, the article sheds light on this overlooked dimension of family commensality. Based on a corpus of more than 20 h of videorecorded family dinner interactions collected in Italy, and using discourse analysis, the article shows that family mealtime constitutes a relevant arena where parents control their children's conduct through the micro-politics of good manners. By participating in mealtime interactions, children witness and have the chance to acquire the specific cultural principles governing bodily conduct at the table, such as "sitting properly", "eating with cutlery", and "chewing with mouth closed". Yet, they are also socialized to a foundational principle of human sociality: one's own behavior must be self-monitored according to the perspective of the generalized Other. Noticing that forms and contents of contemporary family mealtime talk about good manners are surprisingly similar to those described by Elias in his seminal work on the social history of good manners, the article documents that mealtime still constitutes a privileged cultural site where children are multimodally introduced to morality concerning not only specific table manners, but also more general and overarching assumptions, namely the conception of the body as an entity that should be (self)monitored and shaped according to moral standards.

Exploring the Nexus between Food Systems and the Global Syndemic among Children under Five Years of Age through the Complex Systems Approach

The intricate relationship between food systems and health outcomes, known as the food-nutrition-health nexus, intersects with environmental concerns. However, there's still a literature gap in evaluating food systems alongside the global syndemic using the complex systems theory, especially concerning vulnerable populations like children. This research aimed to design a system dynamics model to advance a theoretical understanding of the connections between food systems and the global syndemic, particularly focusing on their impacts on children under five years of age. The framework was developed through a literature review and authors' insights into the relationships between the food, health, and environmental components of the global syndemic among children. The conceptual model presented 17 factors, with 26 connections and 6 feedback loops, categorized into the following 5 groups: environmental, economic, school-related, family-related, and child-related. It delineated and elucidated mechanisms among the components of the global syndemic encompassing being overweight, suffering from undernutrition, and climate change. The findings unveiled potential interactions within food systems and health outcomes. Furthermore, the model integrated elements of the socio-ecological model by incorporating an external layer representing the environment and its natural resources. Consequently, the development of public policies and interventions should encompass environmental considerations to effectively tackle the complex challenges posed by the global syndemic.

Investigating the Sociodemographic and Health Characteristics of Non-Sugar Sweeteners Consumption in Greek School-Aged Children: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

The childhood consumption of non-sugar-sweetened (NSS) soft drinks is a growing concern due to its potential health implications. This study investigated demographic, anthropometric, and lifestyle factors influencing NSS soft drink consumption among children.

METHODS

A sample of 1304 children and their parents were surveyed.

RESULTS

Analysis revealed that nearly 60% reported consuming NSS soft drinks at least once a week. Also, positive associations were found between NSS soft drink consumption and lower socioeconomic status, increased total beverage consumption, higher maternal BMI, and parental soft drink habits. However, upon employing multivariable models, only the association between total and NSS soft drinks consumption remained statistically significant (OR = 18.925, p < 0.05 for children; OR = 3.801, p < 0.05 for parents), highlighting the pivotal role of parental behavior in shaping children's consumption patterns.

CONCLUSIONS

These findings emphasize the importance of tracking parental habits, revealing a strong correlation between parental behavior and children's soft drink consumption patterns. Understanding these factors is crucial for developing effective public health strategies for children, which should prioritize not only individual behaviors but also parental modeling and household dynamics.