Which Diet-Related Behaviors in Childhood Influence a Healthier Dietary Pattern? From the Ewha Birth and Growth Cohort

Causal relationships between dietary habits and Barrett's esophagus risk: a univariable and multivariable Mendelian randomization study

Aims: Dietary habits are reported to be associated with Barrett's esophagus (BE) risk; however, whether there is a causal relationship remains controversial. Here, we systematically examined the causal effects of genetically predicted dietary habits on BE risk through a Mendelian randomization (MR) analysis approach. Methods: Data for exposures were obtained from the UK Biobank (UKB), while the summary-level data for outcomes were obtained from a large sample-size GWAS meta-analysis. Genetic variants associated with 17 ordinary dietary habits at the genome-wide significance level were regarded as instrumental variables (IVs). Univariable and multivariable MR analyses were conducted to explore the causal relationships between dietary habits and BE risk. Sensitivity analyses were implemented to evaluate robustness of the results and determine the potential pleiotropy bias. Results: Univariable MR (UVMR) analysis showed that genetic predisposition to alcohol intake frequency, cooked vegetable intake, beef intake, bread intake, fresh fruit intake, salad/raw vegetable intake, and dried fruit intake were associated with BE risk, with all P values <0.05. After adjusting confounders, the effects of four dietary habits on BE risk persisted; multivariable MR (MVMR) analysis revealed that alcohol intake frequency (adjusted odds ratio (OR) = 1.74 (1.34, 2.27); P = 3.42 × 10-5) was causally associated with higher BE risk, the cooked vegetable intake (adjusted OR = 2.64 (1.16, 5.97); P = 0.02) had suggestively increased BE risk, while higher consumption of bread (adjusted OR = 0.54 (0.32-0.91); P = 0.02) and fresh fruit (adjusted OR = 0.34 (0.15, 0.77); P = 0.01) were suggestively associated with lower BE risk. Conclusions: These MR analyses demonstrate evidence of causal relationships between dietary habits and BE risk. These findings provide new insights into targeted dietary intervention strategies for BE prevention.

Association of Maternal Feeding Style with Fruit and Vegetable Consumption in Saudi Preschoolers: A Nationwide Cross-Sectional Study

Parental feeding style (PFS) remarkably influences fruit and vegetable (F&V) consumption in preschoolers. This study aimed to determine the association between PFS and preschoolers' F&V consumption, as influenced by socioeconomic factors. A nationwide cross-sectional study was conducted among 1418 mothers of children aged 3-5 years in Saudi Arabia. Multinomial logistic regression model analysis was performed to assess the association between PFS and children's daily F&V intake using the Parental Feeding Style Questionnaire. The influence of socioeconomic factors on this association was also evaluated. For mothers with university degrees, encouragement, emotional, and instrumental feeding enhanced their children's intake of F&Vs, fruits, and vegetables, respectively. Children from families earning SAR >10,000 monthly had increased F&V intake with encouragement feeding and increased fruit intake with emotional feeding. However, F&V intake was reduced in children of working mothers with controlling feeding styles. Breastfeeding for <6 months was associated with increased F&V intake through emotional feeding. The most prevalent feeding style was encouragement, followed by emotional, with control and instrumental styles being less common. This study provides strong evidence on the association between PFS and daily F&V intake in Saudi preschoolers. Interventional and longitudinal studies on PFS are required to confirm these findings.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Factors Associated with Dietary Patterns of Schoolchildren: A Systematic Review

The evaluation of food consumption in childhood is essential to help understand the effect of food choices on health. The objective of this study was to conduct a systematic review of studies that identified the dietary patterns in schoolchildren (7-10 years old) and their associated factors. Observational studies published in the last ten years were searched in the databases BVS (Virtual Health Library), Embase, PubMed, Scopus, and Web of Science. The Newcastle Ottawa Scale was adopted to evaluate the articles' quality. The studies covered schoolchildren, children, and adolescents as part of the sample. We selected 16 studies, 75% of which were considered good/very good and seven mentioned three food patterns. A dietary pattern considered unhealthy was identified in 93.75% of the studies, having as associated factors to its consumption: higher screen time, low bone mass, gain of weight and fat in children, and meal skipping. The children who usually had breakfast showed greater adherence to the dietary pattern consisting of healthier foods. The children's dietary patterns were related to their behavior, nutritional status, and family environment habits. Food and nutrition education's effective actions, as well as the regularization of the marketing of ultra-processed foods, must be stimulated and inserted in public policies as a way to promote and protect children's health.

Is breakfast consumption among Brazilian schoolchildren associated with an ultra-processed food dietary pattern?

Omission of breakfast starts at school age and can be explained as a reflection of the independent behaviour acquired in this phase of life. Breakfast has been investigated for its association with healthier diet quality, but few studies have investigated this relationship in schoolchildren aged 7 to 13 years. The objective of this study was to assess breakfast consumption in schoolchildren aged 7 to 13 years and to examine associations with dietary patterns (DPs). It was a cross-sectional study carried out in 2017 with 1069 students in Florianopolis, southern Brazil. Previous-day food consumption, physical activity and screen activities were self-reported. Factor analysis was used to identify DPs. Associations between breakfast consumption and overall DPs were evaluated using multivariate linear regression. Breakfast consumption was reported by 85% of the children, with the highest proportion observed among students on the afternoon school shift. Five DPs were identified explaining 41% of the total variance in daily food consumption: Ultra-processed, Mixed, Traditional Brazilian Lunch, Healthy + Sweets and Traditional Brazilian Breakfast. Breakfast consumption was directly associated with a Traditional Brazilian Breakfast DP (β = 0.335; 95% CI = 0.227, 0.442), a Mixed DP (β = 0.241; 95% CI = 0.160, 0.323), and a Healthy + Sweets DP (β = 0.160; 95% CI = 0.061, 0.260), and inversely associated with an Ultra-processed DP (β = -0.116; 95% CI = -0.207, -0.026). Breakfast consumption was associated with overall DPs, suggesting the importance of eating this meal by schoolchildren. We emphasise the relevance of offering a healthy breakfast at public schools for students who do not take this meal at home, contributing to health promotion.

Association between patterns of eating habits and mental health problems in Chinese adolescents: A latent class analysis

Objective

We aimed to investigate the association between different eating habit patterns and mental health problems among Chinese middle and high school students, and further to estimate the interaction effect of different grouping variables on eating habits.

Methods

One thousand three hundred and forty-eight adolescents from Jilin Province in China were involved in this cross-sectional study. Mental health and eating habits were assessed using General Health Questionnaire and questions on Nutrition Knowledge, Attitude and Practice, respectively. Latent class analysis (LCA) was performed to identify eating habit patterns. Binary logistic regression and generalized linear models were used to explore the association between eating habit patterns, energy-adjusted nutrient intakes and mental health problems. Interaction analysis was performed to analyze the association between eating habits and mental health in different groups.

Results

Based on the LCA results, a 3-class parallel model was identified: 648 adolescents (48.1%) were classified in class-1 “Healthy Eating Behavior/Eating at Home,” 452 adolescents (33.5%) in class-2 “Healthy Eating Behavior/Eating at School” and 248 adolescents (18.4%) in class-3 “Unhealthy Eating Behavior/Random Place.” Compared with class-1, participants in class-2 and class-3 were at higher risk of mental health problems, especially for class-3 (p < 0.05). The energy and nutrient intakes by different latent classes showed that adolescents who ate unhealthy had lower daily intake of energy, protein, carbohydrate, fiber, Vitamins and minerals (p < 0.05). The interaction between age, sleep duration and different eating habits was statistically significant (p for interaction < 0.1).

Conclusion

“Unhealthy eating behavior/random place pattern” was positively correlated with mental health problems of adolescents. The adolescents with health diet were accompanied by fewer mental health problems, especially for that eating at home. And there were interactions between eating habits and age, sleep duration on the mental health problems.

Practical School Nutrition Program May Reduce Food Neophobia

The study’s purpose was to evaluate an intervention to reduce fruit and vegetable food neophobia and influence attitudes and behaviors among children using a four-month, non-experimental, before-and-after intervention. Participants were children aged 5–11 years in an intervention school (IS) and a control school (CS). Children were offered fruit or vegetable samples weekly utilizing school-specific psychosocial and educational practices to encourage participation. The outcomes of interest included attitudes measured using a written survey-based food neophobia scale (FNS), behavioral observations, and an oral survey. The post-intervention IS FNS score was significantly lower compared to pre-intervention (p = 0.04). Repeated-measures ANOVA revealed a statistically significant overall effect of time (p = 0.006). School type-time interaction was not significant (p = 0.57). Pre-intervention observational data showed the proportions finishing and taking another fruit and vegetable sample were higher in the CS (p < 0.001 for both). Post-intervention, the proportions taking the vegetable (p = 0.007) and the fruit (p < 0.001) were higher in the IS. The percentage tasting the vegetable was higher in the CS (p = 0.009). Offering samples of produce in school lunchrooms may reduce food neophobia. This intervention is an inexpensive program that volunteers can quickly implement.

Plasma lipid biomarkers in relation to BMI, lung function, and airway inflammation in pediatric asthma

INTRODUCTION

There is limited understanding of how plasma fatty acid levels affect pulmonary function in pediatric years. It has been speculated that polyunsaturated fatty acids influence asthma via anti or pro-inflammatory mechanisms. Metabolomics presents a new and promising resource for identifying molecular processes involved in asthma pathology.

OBJECTIVES

We investigated the relationship of plasma fatty acid metabolites as biomarkers of the 'mild-asthma' phenotype and lung function including airway inflammation in children.

METHODS

This cross-sectional study involved 64 children (5-12 years, 33 male) with mild-asthma phenotype attending an outpatient pediatric clinic in Athens, Greece. Clinical examination included spirometry (FVC, FEV₁, FEV₁/FVC, PEF, FEF_25-75%) and Fractional exhaled Nitric Oxide (FeNO). Targeted metabolomic profiling was used to quantify plasma fatty acid composition. Associations between lipids and pulmonary function indices were investigated applying linear regression.

RESULTS

Targeted GC-MS identified 25 unique plasma fatty acids in mild-asthmatic children. Linear regression revealed significant associations between linoleic, oleic, erucic, cis-11-eicosenoic, arachidic acids and FEV₁, FVC, FEV₁/FVC, PEF, FEF_25-75% and FeNO in the overweight/obese group, adjusting for age and sex; and in the normo-weight between stearic and arachidic acids versus FEV₁ and FEV₁/FVC respectively. No associations were observed for arachidonic, α-linolenic, EPA and DHA.

CONCLUSION

Metabolomics is a novel science that is useful to discover metabolic signatures specific to disease. Evaluation of fatty acid status could assist clinicians in decision-making about a dietary modification that can be used for personalized nutrition therapies to achieve better asthma control, optimum lung function, and therapeutic response in children.

Ultra-Processed Food Consumption Among Chilean Preschoolers Is Associated With Diets Promoting Non-communicable Diseases

Introduction: In adults, intake of ultra-processed foods (UPF) has been linked with poor diets and adverse health outcomes. In young children, evidence is scarcer but suggests a higher dietary share of UPF.

Objective: To quantify the intake of UPF and its association with the nutrient composition of the diet in a sample of preschoolers in Santiago, Chile.

Methods: Cross-sectional analysis of dietary data (24-h recall survey) from 960 preschoolers. Foods were categorized according to the extent and purpose of processing (NOVA classification) and participants were classified in quintiles of UPF intake. We explored the associations between UPF intake (% of the total energy) and intake of nutrients of concern for non-communicable disease development (carbohydrates, total sugars, fats, and sodium), and nutrients for promotion (proteins, polyunsaturated fats, iron, calcium, zinc, vitamins A, D, C, and B₁₂, folate, and fiber) using multivariate regression after controlling for covariates.

Results: UPF constituted 49% of the total energy intake. Preschoolers with higher intake consumed more energy, saturated and monounsaturated fats, carbohydrates, total sugars, and vitamin D, compared to preschoolers in the lowest quintile of UPF intake. In contrast, UPF intake was negatively associated with the consumption of proteins, polyunsaturated fats, fiber, zinc, vitamin A, and sodium (p < 0.05).

Conclusion: In Chilean preschoolers, UPF was the primary source of energy intake. The dietary share of UPF was associated with the nutrient composition of the diet. Improving children's diet should consider not only promoting healthy food consumption but also limiting UPF consumption.

Cohort profile: the Ewha Birth and Growth Study

With the introduction of life-course epidemiology, researchers realized the importance of identifying risk factors in early life to prevent chronic diseases. This led to the establishment of the Ewha Birth and Growth Study in 2001; the study is a prospective birth cohort designed to provide evidence of early life risk factors for a child's growth and health. Participants were recruited from those who visited Ewha Womans University Mokdong Hospital (a tertiary hospital in southwest Seoul, Korea) for prenatal care at 24-28 weeks of gestation. In total, 891 mothers enrolled in this study between 2001 and 2006 and their offspring (n=940) were followed-up. Regular check-up examinations of offspring were conducted at 3 years, 5 years, and 7 years of age and every year thereafter. To consider age-related health issues, extensive data were collected using questionnaires and measurements. In 2021, the study subjects will reach 19 years of age, and we are planning a check-up examination for early adulthood. About 20 years have passed since the cohort data were collected, and we have published results on childhood health outcomes associated with prenatal and birth characteristics, genetic and epigenetic characteristics related to childhood metabolism, the effects of exposure to endocrine disruptors, and dietary patterns in childhood. Recently, we started reporting on topics related to adolescent health. The findings will facilitate identification of early life risk factors for chronic diseases and the development of interventions for diseases later in life.

The association between metabolic components and markers of inflammatory and endothelial dysfunction in adolescents, based on the Ewha Birth and Growth Cohort Study

We assessed the association between metabolic health and markers of inflammation and of endothelial dysfunction using data from the Ewha Birth and Growth Cohort Study. The data of 195 subjects aged 13–15 years were analyzed. To assess metabolic syndrome, continuous metabolic syndrome (cMets) scores were calculated. We measured the levels of high-sensitivity C-reactive protein (hs-CRP), intercellular adhesion molecule 1 (ICAM-1), and vascular cell adhesion molecule 1 (VCAM-1) as markers of inflammation and endothelial dysfunction. An increase of one SD in the cMets score resulted in a 1.25-fold (95% CI 1.10–1.42) increase in the risk of acute inflammatory status and a 1.26-fold (95% CI 1.11–1.43) increase in the risk of endothelial dysfunction as defined by ICAM-1, while VCAM-1 showed a meaningless trend. Of the metabolic components, body mass index (BMI) was positively associated with elevated hs-CRP levels and high-density lipoprotein cholesterol (HDL-c) levels were negatively associated with elevated ICAM-1 levels. Additionally, a mediation analysis showed that a high BMI was directly related to elevated hs-CRP levels and indirectly related to elevated ICAM-1 levels via HDL-c. Our findings show that poor metabolic health was related to an unfavorable inflammatory status and endothelial dysfunction in adolescents.

Dietary Patterns of Children and Adolescents from High, Medium and Low Human Development Countries and Associated Socioeconomic Factors: A Systematic Review

The purpose of this systematic review is to assess the associations among education, income and dietary pattern (DP) in children and adolescents from high, medium and low human development countries (HHDC, MHDC and LHDC, respectively). Observational studies that evaluated the association between family income or education with the DP are obtained through electronic database searches. Forty articles are selected for review. In HHDC, education is inversely associated with "unhealthy" DP and positively associated with "healthy" DP. In cross-sectional studies from HHDC, higher income is negatively associated with "unhealthy" DP. In MHDC, there is no association between the socioeconomic variables (SE) and the DPs, although, in some studies, the unhealthy diet is positively associated with SE. Only one study conducted in LHDC showed an inverse association between income/education with "unhealthy" DP and there is no association between the SE and "healthy" DP. In conclusion, children and adolescents living in HHDC with high parental education tend to have a healthier diet. In MHDC, although an unhealthy diet is found among the high-income and educated population, the associations are not clear. Additional research is needed to clarify the associations between income and education with "unhealthy" and "healthy" DPs in MHDC and LHDC.

Omega-6/omega-3 fatty acid intake of children and older adults in the U.S.: dietary intake in comparison to current dietary recommendations and the Healthy Eating Index

BACKGROUND

Omega-6 and omega-3 fatty acids (FAs) and their ratio have been shown to affect cognitive function in children and older adults. With these analyses, we aimed to describe omega-6 and omega-3 FA intake among children and older adults in light of FA intake recommendations and with consideration of overall diet.

METHODS

Data were merged from two cross-sectional studies with 219 children 7 to 12 years old and one longitudinal study with 133 adults 65 to 79 years old. Demographic data, anthropometric data, and Healthy Eating Index scores were used to study relations among the omega-6 to omega-3 FA ratio and age, education, body mass index, and diet quality. FA intake, demographic, and anthropometric data were examined using partial correlations, t-tests, and analysis of variance.

RESULTS

Most children and adults consumed at least the recommended amount of alpha-linolenic acid (LNA; omega-3) for their age and gender without consuming high amounts of linoleic acid (LA; omega-6), but did not consume sufficient eicosapentaenoic acid (EPA; omega-) and docosahexaenoic acid (DHA; omega-3). The average omega-6 to omega-3 ratios in both groups were lower than previously reported. Eating lower ratios was associated with healthier diets and consuming adequate amounts of several other nutrients. No demographic or anthropometric variables were related to FA intake in children. Adults with a college degree had significantly lower ratios than those without a college degree.

CONCLUSIONS

American children and older adults are able to consume more balanced omega-6 to omega-3 ratios than has been indicated by commodity data. However, very few American children met even the lowest recommendations for EPA and DHA intake. Research is needed to clarify recommendations for the optimal ratio across development, which may aid in increasing EPA and DHA intake and improving health outcomes in the United States.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02199808 13 July 2014, NCT01823419 (retrospectively registered) 20 March 2013, and NCT01515098 18 January 2012.

A Polish Study on the Influence of Food Neophobia in Children (10-12 Years Old) on the Intake of Vegetables and Fruits

Adhering to the recommended intake of fruits and vegetables is an important habit that should be inculcated in children, whereas food neophobia is indicated as one of the most important factors creating food preferences that may interfere. The aim of the presented study was to analyze the association between the food neophobia level and the intake of fruits and vegetables in children aged 10-12 years. The study was conducted among a group of 163 children (78 girls and 85 boys). The assessment of the food neophobia level was based on the Food Neophobia Scale (FNS) questionnaire and the assessment of the fruit and vegetable intake was based on the food frequency questionnaire. A negative correlation between the food neophobia level and the vegetable intake was observed both for girls (p = 0.032; R = -0.2432) and for boys (p = 0.004; R = -0.3071), whereas for girls differences in vegetable intake were observed also between various food neophobia categories (p = 0.0144). It may be concluded that children with higher food neophobia level are characterized by lower vegetable intake than children with lower food neophobia level. For fruits and juices of fruits and vegetables, associations with food neophobia level were not observed.