The Association between Parent Diet Quality and Child Dietary Patterns in Nine- to Eleven-Year-Old Children from Dunedin, New Zealand

Sex-Moderated Divergence between Adult Child and Parental Dietary Behavior Patterns in Relation to Body Mass Condition-Evaluating the Mediating Role of Physical Activity: A Cross-Sectional Study

The main objective of this study was to explore the dietary behaviors of parents and their adult children, focusing on patterns, potential intrinsic and extrinsic predictors of body mass, and determinants of becoming overweight. Non-probability, cross-sectional sampling was used to select participants from a university student population. Young adults (19-21 years of age, n = 144) and their parents were examined. The data of those family pairs with complete sets of results were used. Dietary patterns and physical activity were assessed with questionnaires (QEB and IPAQ), and body height, weight measurements, and body mass indexes were calculated. A cophylogenetic approach with tanglegrams and heatmaps was used to study patterns, while predictors of body mass index were identified using multiple linear regression, stepwise logistic regression, and mediation analysis procedures. Cophenetic statistics confirmed significant incongruence between fathers and sons, confirmed by Baker's Gamma correlation (rBG = 0.23, p = 0.021), and mothers and daughters (rBG = 0.26, p = 0.030). The relationships between the dietary patterns of the fathers and daughters, as well as mothers and sons, were of medium strength (rBG = 0.33, p = 0.032, rBG = 0.43, p = 0.031; respectively). Most of the patterns were mixed. Fast food, fried meals, alcoholic drinks, energy drinks, and sweetened beverages were associated significantly with being overweight. Significant intrinsic predictors of excessive weight in young adults were sex (b = 2.31, p < 0.001), PA (b = -0.02, p < 0.001), and eating fermented milk and curd cheese (b = -0.55, p = 0.024), while extrinsic (parental) predictors included eating fast food and fried meals (b = -0.44, p = 0.049). Both physical activity and dietary behaviors independently determined the sons' overweight status (b = -1.25, p = 0.008; b = -0.04, p < 0.001; respectively); while only PA did in daughters (b = -0.04, p < 0.001). No mediating effects of physical activity were observed. Adult children and parental dietary patterns were divergent, reflecting the influence of multiple factors on a child's dietary habits. However, this divergence is moderated by sex. Reciprocal interactions between dietary intake-particularly positive dyads such as fruits and vegetables, fermented milk, and curd cheese-and physical activity significantly impacted children's body mass index (BMI). The study of dietary patterns in conjunction with physical activity (both as independent determinants), particularly in relation to the link between overweight/obese children and overweight/obese parents, presents a separate challenge.

Utility of waist-to-height ratio, waist circumference and body mass index in predicting clustered cardiometabolic risk factors and subclinical vascular phenotypes in children and adolescents: A pooled analysis of individual data from 14 countries

AIMS

The clinical utility of waist-to-height ratio (WHtR) in predicting cardiometabolic risk factors (CMRFs) and subclinical markers of cardiovascular disease remains controversial. We aimed to compare the utility of WHtR with waist circumference (WC) and body mass index (BMI) in identifying children and adolescents (youths) at risk for cardiometabolic outcomes, including clustered CMRFs, high carotid intima-media thickness (cIMT), and arterial stiffness (assessed as high pulse wave velocity, PWV).

METHODS

We analyzed data from 34,224 youths (51.0 % boys, aged 6-18 years) with CMRFs, 5004 (49.5 % boys, aged 6-18 years) with cIMT measurement, and 3100 (56.4 % boys, aged 6-17 years) with PWV measurement from 20 pediatric samples across 14 countries.

RESULTS

WHtR, WC, and BMI z-scores had similar performance in discriminating youths with ≥3 CMRFs, with the area under the curve (AUC) (95 % confidence interval, CI)) ranging from 0.77 (0.75-0.78) to 0.78 (0.76-0.80) using the modified National Cholesterol Education Program (NCEP) definition, and from 0.77 (0.74-0.79) to 0.77 (0.74-0.80) using the International Diabetes Federation (IDF) definition. Similarly, all three measures showed similar performance in discriminating youths with subclinical vascular outcomes, with AUC (95 % CI) ranging from 0.67 (0.64-0.71) to 0.70 (0.66-0.73) for high cIMT (≥P95 values) and from 0.60 (0.58-0.66) to 0.62 (0.58-0.66) for high PWV (≥P95 values).

CONCLUSIONS

Our findings suggest that WHtR, WC, and BMI are equally effective in identifying at-risk youths across diverse pediatric populations worldwide. Given its simplicity and ease of use, WHtR could be a preferable option for quickly screening youths with increased cardiometabolic risk in clinical settings.

How Can We Increase the Nutrition-Related Knowledge in Children Aged 7-12 Years: Results of Focus Groups Interviews with Parents-Junior-Edu-Żywienie (JEŻ) Project

Nutrition education is a long-term process that should cover various population groups. A special focus should be placed on children, adolescents and their parents. The aim of this research was to find out the opinions of parents of primary school pupils aged 7-12 on their expectations towards school education in the areas of food and nutrition, addressed to both pupils and their parents. The research was conducted among 101 parents of primary school pupils with the use of the Focus Group Interview (FGI) method. It demonstrated that what is most needed are hands-on activities relating to basic theoretical issues. While parents see the need for nutrition education for their children, educating pupils in this area is of interest to only some of the respondents for whom nutrition aspects are quite important. All parents would like formal nutrition education at school, but at the same time, they do not want classes to take up too much of their children's time, due to the already excessive number of school subjects. It seems appropriate to include everyone in regard to nutrition education, regardless of their declared interest in this issue. The need for consistent presentation of educational content addressed to teachers and parents is very important, so that they can, in a uniform way, shape the attitudes towards food and nutrition of children and adolescents.

Examining the New Zealand school food environment: what needs to change?

Habitual dietary intakes and nutrition behaviours developed during childhood and adolescence pave the way for similar behaviours to manifest in adulthood. Childhood obesity rates have now reached a point where one in six children globally are classified as overweight or obese. Schools have the unique ability to reach almost all children during key developmental stages, making them an ideal setting for influencing children's nutrition behaviours. Evidence suggests the school food environment is not always conducive to healthy food choices and may be obesogenic. The aim of this narrative review is to explore factors that influence the healthy food and drink environment in and around schools in New Zealand. The review focused on evidence from New Zealand and Australia given the close resemblance in education systems and school food guidance. Using the Analysis Grid for Environments Linked to Obesity (ANGELO) framework, the school food environment was categorised into the following domains: economic, political, physical and socio-cultural factors. Findings suggest that food policies are not utilised within schools, and guidelines to improve the school food environment are not well implemented. Canteen profit models, lack of staff support and resources, and higher availability of low-cost unhealthy foods are among barriers that hinder implementation. This review highlights recommendations from existing evidence, including canteen pricing strategies, restriction of unhealthy foods and using peer modelling in a time-scarce curriculum to improve the school food environment. Key areas for improvement, opportunities to enhance policy implementation and untapped avenues to improve the food and nutrition behaviours of children are highlighted.

Pediatric Overweight, Fatness and Risk for Dyslipidemia Are Related to Diet: A Cross-Sectional Study in 9-year-old Children

Pediatric overweight, dyslipidemia and insulin resistance can result from unhealthy lifestyle habits and increase morbidity and mortality in adulthood. Herein, we evaluated the relationship between diet and physical activity patterns with the metabolic health of 9-year-old school children. Measurements included anthropometry, adiposity, lipid, and glycemic profiles. Questionnaires evaluated diet and physical activity. Exploratory factor analysis (EFA) screened for diet patterns, and multilevel models evaluated diet and physical activity patterns against overweight, dyslipidemia, and insulin resistance markers across schools and children. EFA highlighted two diet patterns, Western and Traditional. Food rich in fat, salt, and sugar and fewer vegetables and fruits defined the Western pattern. The Traditional pattern, linked to healthier eating habits, had analogies to the Mediterranean diet. Overall, 39% of the children were overweight (including the obese), while 62% presented cardiovascular risk factors on their lipid profiles. Normal-weight children presented 60% high cholesterol incidence. Global insulin resistance incidence was 4.1%, but almost doubled among the overweight/obese. The Westernized diet consistently linked to worse cardiovascular risk markers, even independently of physical practice. Intensive or competitive physical activity was associated with decreased triglycerides (p = 0.003), regardless of diet. Future prospective studies are warranted to validate these results externally.

Adiposity in preadolescent children: Associations with cardiorespiratory fitness

Lifestyle factors contribute to childhood obesity risk, however it is unclear which lifestyle factors are most strongly associated with childhood obesity. The purpose of this cross-sectional study was to simultaneously investigate the associations among dietary patterns, activity behaviors, and physical fitness with adiposity (body fat %, fat mass, body mass index [BMI], and waist to hip ratio) in preadolescent children. Preadolescent children (N = 392, 50% female, age: 9.5 ± 1.1year, BMI: 17.9 ± 3.3 kg/m2) were recruited. Body fat (%) and fat mass (kg) were measured with bioelectrical impedance analysis. Cardiorespiratory fitness (VO2 max), muscular strength (hand-grip strength), activity, sleep, and dietary pattern was assessed. Multivariable analysis revealed that cardiorespiratory fitness associated most strongly with all four indicators of adiposity (body fat (%) (β = -0.2; p < .001), fat mass (β = -0.2; p < .001), BMI (β = -0.1; p < .001) and waist to hip ratio (β = -0.2; p < .001). Additionally, fruit and vegetable consumption patterns were associated with body fat percentage, but the association was negligible (β = 0.1; p = 0.015). Therefore, future interventions should aim to promote the use of cardiorespiratory fitness as a means of reducing the obesity epidemic in children.

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

OBJECTIVE

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

DESIGN

Cross-sectional study using Feel4diabetes FFQ.

SETTING

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

PARTICIPANTS

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

RESULTS

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

CONCLUSION

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

Factors Affecting High-Risk for Diabetes among Korean Adolescents: An Analysis Using the Eighth Korea National Health and Nutrition Examination Survey (2020)

The purpose of this study was to identify significant factors affecting diabetes and pre-diabetes in South Korean adolescents, including adolescents’ and parental factors. We used data on 416 Korean adolescents aged 12–18 years and their parents (302 fathers and 375 mothers) from the eighth National Health and Nutrition Examination Survey gained in 2020. The data were analyzed by descriptive statistics, t-test, Rao–Scott χ² test, and univariate logistic regression using complex sample analysis. Among the participants, 101 adolescents (22.7%) were classified as the high-risk group for diabetes. Significant factors affecting the risk for adolescent diabetes in both sexes were higher BMI, fasting plasma glucose, hemoglobin A1c, and insulin. The father’s high degree of stress perception was only related to male adolescents, and the father’s poor subjective health status was related to females at risk for diabetes. In mothers, physician-diagnosed diabetes, fasting plasma glucose, and hemoglobin A1c were factors affecting both sexes. Results from this study can be used as preliminary data for the early detection of high-risk groups for diabetes in adolescents, and for the development of systematic health care guidelines to prevent diabetes in adolescents.

Determinants of Adherence to the Mediterranean Diet in Spanish Children and Adolescents: The PASOS Study

A progressive shift away from traditional healthy dietary patterns, such as the Mediterranean diet (MedDiet), has been observed in recent decades. The aim of this study was to assess determinants of optimal adherence to the MedDiet in Spanish children and adolescents. A cross-sectional analysis was included in the PASOS nationwide representative study in Spain. Participants were 3607 children and adolescents; 8-16 years old. Primary and secondary outcome measures of weight and height were measured. Adherence to the MedDiet, physical activity, and sedentary behavior in children and adolescents, as well as parental physical activity and dietary habits, were assessed. Optimal adherence to the MedDiet was observed in 45.5% of primary school students and 34.8% of secondary school students (OR: 0.65; 95%CI: 0.56-0.75). Optimal adherence to the MedDiet was higher in children/adolescents meeting daily recommended moderate and vigorous physical activity (OR: 2.39, 95%CI: 1.97-2.89) and in those meeting daily recommended screen time on weekdays (OR: 2.05, 95%CI: 1.77-2.38) and weekends (OR: 1.76, 95%CI: 1.48-2.10). Participants with optimal adherence to the MedDiet were more likely to have mothers with a high-level education and high-tercile of SDQS, mothers who never smoked or were former smokers, and mothers who met the recommended physical activity and screen time. It can be concluded that a low prevalence of optimal adherence to the MedDiet was found among current Spanish children and adolescents. Optimal adherence to the MedDiet was associated with reaching the recommendations on physical activity and screen time, with the highest maternal educational level, and healthier maternal lifestyles.

Combined Body Mass Index and Waist-to-Height Ratio and Its Association with Lifestyle and Health Factors among Spanish Children: The PASOS Study

Background and Aims: The World Health Organization recommended simultaneous measurement of body mass index (BMI) and waist circumference (WC) and suggested joint use to predict disease risks. The aim of this study was to assess the prevalence of BMI and waist-to-height ratio (WHtR) categories among Spanish children and adolescents, as well as their associations with several lifestyle factors. Methods: Cross-sectional analysis of 8–16-year-old children and adolescents (n = 3772) were included in the PASOS nationwide representative study. Children/adolescents and their mothers/female caregivers answered a questionnaire on lifestyle and health factors. Child/adolescent anthropometrics were measured. Four combined BMI-WHtR disease risk categories were built. Results: A third of participants showed combined BMI-WHtR categories with high disease risk (12.3% ‘increased risk’, 9.7% ‘high risk’, 14.3% ‘very high risk’). Participants in the ‘very high risk’ group were less likely to be females (odds ratio 0.63; 95% CI: 0.52–0.76) and adolescents (0.60; 95% CI: 0.49–0.72), to practice ≥60 min/day of moderate-vigorous physical activity (MVPA) (0.73; 95% CI: 0.57–0.93), and to watch <120 min/day of total screen time on weekdays (0.61; 95% CI: 0.49–0.76). Mothers of participants in the ‘very high risk’ group were less likely to have a high educational level, be in the overweight or normal range, have never smoked or were former smokers, and watch <120 min/day of total screen time on weekends. Participants in the ‘increased’ and ‘high risk’ categories had mothers with normal weight and ≥60 min/day of MVPA. Participants in the ’high risk’ group did not achieve ≥60 min/day of MVPA and showed lower adherence to the Mediterranean diet. Conclusions: Adherence to a healthy lifestyle in children and adolescents, but also in their mothers/female caregivers during offspring’s childhood and adolescence, is associated with low BMI-WHtR disease risk.

An index measuring adherence to New Zealand Infant Feeding Guidelines has convergent validity with maternal socio-demographic and health behaviours and with children's body size

Using data from a nationally generalisable birth cohort, we aimed to: (i) describe the cohort’s adherence to national evidence-based dietary guidelines using an Infant Feeding Index (IFI) and (ii) assess the IFI’s convergent construct validity, by exploring associations with antenatal maternal socio-demographic and health behaviours and with child overweight/obesity and central adiposity at age 54 months. Data were from the Growing Up in New Zealand cohort (n 6343). The IFI scores ranged from zero to twelve points, with twelve representing full adherence to the guidelines. Overweight/obesity was defined by BMI-for-age (based on the WHO Growth Standards). Central adiposity was defined as waist-to-height ratio > 90th percentile. Associations were tested using multiple linear regression and Poisson regression with robust variance (risk ratios, 95 % CI). Mean IFI score was 8·2 (sd 2·1). Maternal characteristics explained 29·1 % of variation in the IFI score. Maternal age, education and smoking had the strongest independent relationships with IFI scores. Compared with children in the highest IFI tertile, girls in the lowest and middle tertiles were more likely to be overweight/obese (1·46, 1·03, 2·06 and 1·56, 1·09, 2·23, respectively) and boys in the lowest tertile were more likely to have central adiposity (1·53, 1·02, 2·30) at age 54 months. Most infants fell short of meeting national Infant Feeding Guidelines. The associations between IFI score and maternal characteristics, and children’s overweight/obesity/central adiposity, were in the expected directions and confirm the IFI’s convergent construct validity.

Social jetlag is associated with obesity-related outcomes in 9-11-year-old children, independent of other sleep characteristics

INTRODUCTION

Social jetlag has been reported to predict obesity-related indices, independent of sleep duration, with associations in female adolescents but not males. However, such sex-specific relationships have not been investigated in pre-adolescents.

OBJECTIVES

To examine: (i) the relationships between sleep characteristics, including social jetlag, and obesity-related outcomes during childhood, and (ii) whether these relationships are moderated by sex.

METHODS

This cross-sectional study included 381 children aged 9-11 years (49.6% female). Average sleep duration, social jetlag, and physical activity were assessed via wrist-worn accelerometry. Sleep disturbances were quantified from the Children's Sleep Habits Questionnaire. Obesity-related outcomes included age-specific body mass index Z-scores (zBMI) and waist-to-height ratio. Additionally % fat, total fat mass, and fat mass index were assessed via bioelectrical impedance analysis. Linear mixed models that nested children within schools were used to identify relationships among sleep characteristics and obesity-related outcomes.

RESULTS

Positive associations between social jetlag with zBMI, % fat, and fat mass index were seen in univariable and unadjusted multivariable analyses. Following adjustments for known confounders, social jetlag remained significantly associated with zBMI (β = 0.12, p = 0.013). Simple slopes suggested a positive association in girls (β = 0.19, p = 0.006) but not in boys (β = 0.03, p = 0.703).

CONCLUSIONS

Obesity prevention efforts, particularly in girls, may benefit from targeted approaches to improving the consistency of sleep timing in youth.

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

Poor dietary habits established during childhood might persist into adulthood, increasing the risk of developing obesity and obesity-related complications such as Type 2 Diabetes Mellitus. It has been found that early modifications in eating habits, especially during childhood, might promote health and decrease the risk of developing diseases during later life. Various studies found a great influence of parental dietary habits on dietary behaviors of their children regardless of demographic characteristics such as gender, age, socioeconomic status and country; however, the exact mechanism is still not clear. Therefore, in this review, we aimed to investigate both parents’ and children’s dietary behaviors, and to provide evidence for the potential influence of parents’ dietary behaviors and practices on certain children’s eating habits. Family meals were found to contribute the most in modeling children’s dietary habits as they represent an important moment of control and interaction between parents and their children. The parental practices that influenced their children most were role modeling and moderate restriction, suggesting that the increase of parental encouragement and decrease of excessive pressure could have a positive impact in their children’s dietary behaviors. This narrative review highlights that parental child-feeding behaviors should receive more attention in research studies as modifiable risk factors, which could help to design future dietary interventions and policies to prevent dietary-related diseases.

Association of dietary acid load with anthropometric indices in children and adolescents

PURPOSE

High dietary acid load (DAL) may have an influence on anthropometric indices. Given that there was no study on the association between DAL and anthropometric indices children and adolescents, the current study was aimed to examine the association between DAL and anthropometric indices in Iranian children and adolescents.

METHODS

Students aged 6-18 years were recruited using a multi-stage, cluster sampling method from 30 provinces of Iran. Dietary intake was assessed through a validated food frequency questionnaire. Height (Ht), weight (Wt), neck circumference (NC), waist circumference (WC), wrist circumference, and hip circumference (HC) were measured. WC-to-HC ratio (WHR), WC-to-Ht ratio (WHtR), body mass index (BMI) z-score, tri-ponderal mass index (TMI), and parental BMI were computed. Potential renal acid load (PRAL) and net endogenous acid production (NEAP) were used to estimate DAL. The association between DAL and anthropometric indices was evaluated using linear regression models.

RESULTS

In total, 5326 students (46.92% girls), with mean (standard deviations (SD)) age of 12.50 (3.14) years participated in the study (response rate: 98.13%). After adjusting for confounders, there was a significant association between NEAP and NC (P < 0.05). Also, an inverse association was observed between PRAL and NEAP with parental BMI (P < 0.05).

CONCLUSION

Our findings showed a direct association between diet-induced acid load and NC and an inverse association between DAL indices and parental BMI. More well-designed clinical studies are warranted to confirm our results and the underlying mechanisms.

LEVEL OF EVIDENCE

Level V, cross-sectional descriptive study.

Diet Quality Indices Used in Australian and New Zealand Adults: A Systematic Review and Critical Appraisal

Distilling the complexity of overall diet into a simple measure or summative score by data reduction methods has become a common practice in nutritional epidemiology. Recent reviews on diet quality indices (DQI) have highlighted the importance of sound construction criteria and validation. The aim of this current review was to identify and critically appraise all DQI used within Australian and New Zealand adult populations. Twenty-five existing DQI were identified by electronic searching in Medline and hand searching of reference lists. DQI were constructed based on the respective national dietary guidelines and condition-specific recommendations. For preferable features of DQI, six captured the dimensions of adequacy, moderation and balance; five had a nested structure; 12 consisted of foods, food groups and nutrients; 11 used metric scoring systems and most of those with metric scales used normative cutoff points. Food frequency questionnaires, either alone or with other methods, were the most common dietary assessment method used in 20 DQI. For evaluation of DQI, construct validity and relative validity are reported. Based on our critical appraisal, Dietary Guideline Index (DGI), Dietary Guideline Index-2013 (DGI-2013), Total Diet Score (TDS), Healthy Eating Index for Australian Adults-2013 (HEIFA-2013), and Aussie-Diet Quality Index (Aussie-DQI) were the preferred DQI used in Australian adults according to dimension, indicator selection, scoring criteria and evaluation. Further work is needed to enhance the construction of all Australian and New Zealand DQI, especially in terms of dimension and structure, for alignment with recommended construction criteria.

Relationships between Dietary Patterns and Indices of Arterial Stiffness and Central Arterial Wave Reflection in 9-11-Year-Old Children

Arterial stiffness is an important marker of vascular damage and a strong predictor of cardiovascular diseases (CVD). Given that pathophysiological processes leading to an increased arterial stiffness begin during childhood, the aim of this clustered observational study was to determine the relationship between modifiable factors including dietary patterns and indices of aortic arterial stiffness and wave reflection in 9–11-year-old children. Data collection was conducted between April and December 2015 in 17 primary schools in Dunedin, New Zealand. Dietary data were collected using a previously validated food frequency questionnaire and identified using principal component analysis method. Arterial stiffness (carotid-femoral pulse wave velocity, PWV) and central arterial wave reflection (augmentation index, AIx) were measured using the SphygmoCor XCEL system (Atcor Medical, Sydney, Australia). Complete data for PWV and AIx analyses were available for 389 and 337 children, respectively. The mean age of children was 9.7 ± 0.7 years, 49.0% were girls and 76.0% were classified as “normal weight”. The two identified dietary patterns were “Snacks” and “Fruit and Vegetables”. Mean PWV and AIx were 5.8 ± 0.8 m/s and −2.1 ± 14.1%, respectively. There were no clinically meaningful relationships between the identified dietary pattern scores and either PWV or AIx in 9–11-year-old children.

Dietary Patterns and Childhood Obesity Risk: A Systematic Review

Background: Childhood overweight and obesity are recognized as predictors of the risk of obesity in adulthood. The aim of this systematic literature review was to determine the association between dietary pattern and obesity risk among children. Methods: Articles were selected from databases (Cochrane Library, Lilacs, Eric, Livivo, and PubMed/Medline), without limitations regarding language or date. Database-specific search terms included the key words "obesity," "diet," "dietary pattern," "childhood," "children," "adolescents," and relevant synonyms. The review included studies that reported the assessment of the dietary pattern in childhood and that correlated eating patterns with the obesity risk through cluster analysis (CA) and/or factor analysis and/or principal component analysis and presented odds ratios (ORs). The methodology of the selected studies was evaluated using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. Owing to the heterogeneity among the assessments of the association of dietary patterns and obesity, the results are described narratively. Results: Using a selection process in two phases, 16 articles were included. Fifteen studies used a cross-sectional design, and one case-control study. The included studies showed variation in sample size (range = 232 to 10,187 children/adolescents) and age (range = 1-19 years old). The studies reported between two and five dietary patterns each. The OR for the relationship between the dietary pattern and the risk of childhood obesity ranged from OR = 1.02; confidence interval (95% CI) (0.91-1.15) to OR = 3.55; 95% CI (1.80-7.03). In this study, the dietary patterns identified by the studies were given different names. The food intake patterns identified could, in most factor or CA studies, be categorized as (1) potentially obesogenic foods that increased risk of becoming overweight (including fatty cheeses, sugary drinks, processed foods, fast food, candies, snacks, cakes, animal products, whole milk, and refined grains) or (2) food classified as healthy with the weakest association with the risk of becoming overweight or obese (including low levels of sugar and fat and high levels of fruits, vegetables, whole grains, fish, nuts, legumes, and yogurt). Conclusion: Overall, the results indicated from most studies that a diet with a lower percentage of obesogenic foods should be effective in reducing the risk of developing obesity.

Associations of accelerometer-measured sedentary time, sedentary bouts, and physical activity with adiposity and fitness in children

Sedentary time (ST) has been inconsistently associated with adiposity and cardiorespiratory fitness in children in previous studies. We studied cross-sectional associations of ST, light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA) with fat mass index (FMI) and cardiorespiratory fitness (estimated VO₂max). Associations were evaluated with and without considering pattern of ST by bout length. We measured ST and activity by a wrist-worn accelerometer, FMI by bioelectrical impedance, and VO₂max by Pacer test in 443 children (51.2% girls, 10.2 ± 0.6 years). Isotemporal substitution regression models estimated the effects of substituting ST, LPA, and MVPA on FMI and VO₂max. Further models repeated analyses separating ST into short (<10 min) and long (≥10 min) bouts. Only replacing ST or LPA with MVPA was consistently associated with lower FMI and greater VO₂max. When separated by bout length, only one unique association was found where replacing long ST bouts with short ST bouts was associated with lower FMI in girls only. In conclusion, activity pattern is associated with adiposity in girls and fitness in boys and girls. Separating ST into long and short ST bouts may be of minimal importance when assessing associations with adiposity and fitness using wrist-worn accelerometry in children.

Food Consumption Patterns and Body Composition in Children: Moderating Effects of Prop Taster Status

This cross-sectional study determined whether 6-n-propylthiouracil (PROP) taster status moderates the relationship between food consumption patterns and body composition in children. Children were recruited (n = 342, 50% female, 8-10 y) from across New Zealand. Using a food frequency questionnaire, these food consumption patterns were derived: Processed Foods, Fruit and Vegetables, and Breakfast Foods. Body composition variables included: body fat (%), fat mass (kg), fat mass index (FMI, kg/m²), body mass index (kg/m²) and waist to height ratio (W:Ht). Following adjustment for confounders, Processed Foods were positively associated with %fat (p = 0.015), fat mass (p = 0.004) and FMI (p = 0.016). Taste test strips determined PROP status. For Breakfast Foods, there were small negative associations with all body composition variables (p ≤ 0.001 to 0.037). The population sample was also stratified by PROP taster status. For the non-tasters, there were small to moderate negative associations between Breakfast Foods and each body composition variable (p = 0.003-0.045) except W:Ht (p = 0.112), and these relationships were stronger for girls compared to boys. For the tasters, there were small to moderate positive associations between Processed Foods with %fat (p = 0.030), fat mass (p ≤ 0.001) and FMI (p = 0.014). In conclusion, sensitivity to bitterness may moderate the relationship between food consumption patterns and body composition in children.

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

BACKGROUND

Understanding early-life complementary feeding dietary patterns and their determining factors could lead to better ways of improving nutrition in early childhood. The purpose of this review was to evaluate evidence of the association between sociodemographic factors and dietary patterns (DPs) in children under 24 months.

METHODS

Medline (PubMed), Cochrane Central, NICE guidelines, and Trip database were searched for observational studies that evaluated sociodemographic factors and their associations with DP.

RESULTS

Seven studies were selected for the present review. High education level among mothers was inversely associated with unhealthy DPs and positively associated with healthy DPs. Higher household income was negatively associated with unhealthy DPs. Four studies showed a positive association between low household income and unhealthy DPs and three studies showed a positive association between higher household income and healthy DPs. Additionally, in younger mothers, body mass index (BMI ≥ 30.0 kg/m2) and number of children were positively associated with unhealthy DPs.

CONCLUSIONS

This review provides evidence of a positive association between mothers' higher education level, higher household income, higher maternal age, and healthy dietary patterns as well as a negative association between these factors and unhealthy dietary patterns. Further studies from low- and middle-income countries are needed for comparison with associations showed in this review.

Static cut-points of hypertension and increased arterial stiffness in children and adolescents: The International Childhood Vascular Function Evaluation Consortium

Pediatric elevated blood pressure (BP) and hypertension are usually defined using traditional BP tables at the 90th and 95th percentiles, respectively, based on sex, age, and height, which are cumbersome to use in clinical practice. The authors aimed to assess the performance of the static cut-points (120/80 mm Hg and 130/80 mm Hg for defining elevated BP and hypertension for adolescents, respectively; and 110/70 mm Hg and 120/80 mm Hg for children, respectively) in predicting increased arterial stiffness. Using data from five population-based cross-sectional studies conducted in Brazil, China, Korea, and New Zealand, a total of 2546 children and adolescents aged 6-17 years were included. Increased arterial stiffness was defined as pulse wave velocity ≥sex-specific, age-specific, and study population-specific 90th percentile. Compared to youth with normal BP, those with hypertension defined using the 2017 American Academy of Pediatrics guideline (hereafter referred to as "percentile-based cut-points") and the static cut-points were at similar risk of increased arterial stiffness, with odds ratios and 95% confidence intervals of 2.35 (1.74-3.17) and 3.07 (2.20-4.28), respectively. Area under the receiver operating characteristic curve and net reclassification improvement methods confirmed the similar performance of static cut-points and percentile-based cut-points (P for difference > .05). In conclusion, the static cut-points performed similarly well when compared with the percentile-based cut-points in predicting childhood increased arterial stiffness. Use of static cut-points to define hypertension in childhood might simplify identification of children with abnormal BP in clinical practice.

Associations of maternal zinc and magnesium with offspring learning abilities and cognitive development at 4 years in GUSTO

Objectives: Minerals deficiencies during pregnancy have been shown to be associated with poorer cognitive outcomes in offspring. This study aimed to investigate associations of maternal plasma zinc and magnesium concentrations with cognitive development in 4-year old children from the Growing Up in Singapore Towards healthy Outcome cohort.Methods: Maternal plasma zinc and magnesium concentrations were measured at 26-28 weeks' gestation. The Lollipop test of school readiness, tests of working memory, number knowledge, receptive vocabulary, and phonological awareness were performed in children at 4 years. Associations were examined in 715 mother-offspring pairs using linear regressions adjusted for key confounders.Results: Maternal plasma zinc and magnesium concentrations were 812 ± 144 µg/L and 19.9 ± 1.8 mg/L (mean±SD); 19% and 71% of mothers were zinc deficient and magnesium insufficient, respectively. After adjustment for multiple testing, higher maternal zinc concentrations (per SD increment) were associated with 0.35 higher scores in Lollipop subtest 2 of picture description and spatial identification (95% CI: 0.13, 0.58); higher maternal magnesium concentrations (per SD increment) were associated with 0.65 higher scores in Lollipop subtest 4 of letters and writing identification (95% CI: 0.23, 1.07).Discussion: No significant associations were observed for other tests, suggesting little long term influences of maternal zinc and magnesium on child's cognitive development.

Maternal plasma vitamin B12 concentrations during pregnancy and infant cognitive outcomes at 2 years of age

Evidence on long-term influences of maternal vitamin B12 deficiency or concentrations on infant cognition is limited. We examined associations between maternal plasma vitamin B12 and cognitive development in 24-month-old infants. Maternal plasma vitamin B12 concentrations were measured at 26-28 weeks' gestation; infant cognitive development was assessed with the Bayley Scales of Infant and Toddler Development-III at 24 months, for 443 mother-infant pairs from the Growing Up in Singapore Towards Healthy Outcomes cohort. Linear regressions adjusted for key confounders examined associations of maternal vitamin B12 with cognitive, receptive and expressive language, fine and gross motor subscales. Co-occurrence of maternal vitamin B12 with folate or vitamin B6 insufficiencies on child's cognition was explored. Average maternal plasma vitamin B12 concentrations was 220·5 ± 80·5 pmol/l; 15 % and 41 % of mothers were vitamin B12 deficient (&lt;148 pmol/l) and insufficient (148-220·9 pmol/l), respectively. Infants of mothers with vitamin B12 deficiency had 0·42 (95 % CI -0·70, -0·14) sd lower cognitive scores, compared with infants of mothers with sufficient vitamin B12. Co-occurrence of maternal vitamins B12 and B6 insufficiencies was associated with 0·37 (95 % CI -0·69, -0·06) sd lower cognitive scores in infants compared with infants of mothers sufficient in both vitamins. No significant associations were observed with other subscales. Study findings suggest the possible need to ensure adequate vitamin B12 during pregnancy. The impact of co-occurrence of maternal B-vitamins insufficiencies on early cognitive development warrants further investigation.

Mother's Fruit Preferences and Consumption Support Similar Attitudes and Behaviors in Their Children

Insufficient fruit intake is observed worldwide despite the generally higher preference for consumption of fruits than vegetables. For children, the determinants of consumption, such as at-home accessibility and parental consumption patterns, may especially influence fruit intake. The aim of this study was to analyze the association between fruit consumption behaviors and the preferences of mothers and their declared behaviors and preferences of children. The study was conducted in national samples of Polish (n = 1200) and Romanian (n = 1157) mothers of children aged 3–10 years (random quota sampling; quotas: age, education and place of residence) by using Computer-Assisted Telephone Interviewing (CATI). Mothers were asked about their general frequency of fruit consumption and their and their children’s most preferred fruits. A 24-h dietary recall of fruit intake was conducted for mothers and children. Significant associations were observed for (1) fruit consumption behaviors of mothers and children, (2) fruit consumption preferences of mothers and their declared preferences of their children, and (3) fruit consumption preferences of mothers and behaviors of their children. The associations were very strong for all fruits, both for Polish and Romanian samples. In order to increase the fruit intake of children, it is necessary to influence the fruit consumption preferences and behaviors of mothers.

Association of Dietary Inflammatory Index with anthropometric indices in children and adolescents: the weight disorder survey of the Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease (CASPIAN)-IV study

This study aimed to assess the relationship between the Dietary Inflammatory Index (DII®), a validated tool for evaluating diet-associated inflammation, and anthropometric indices in children and adolescents. This multicentre survey was conducted on 5427 school students selected via multistage cluster sampling from thirty provinces of Iran. This survey was conducted under the framework of the weight disorders survey, which is part of a national surveillance programme entitled Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Diseases-IV. For calculating the DII scores, twenty-five dietary factors were obtained from a validated 168-item FFQ. Height, weight, wrist circumference, neck circumference (NC), waist circumference (WC) and hip circumference (HC) were measured. BMI z-score, waist circumference:hip circumference ratio (WHR), waist circumference:height ratio (WHtR) and parental BMI were computed. Linear regression models were used to evaluate the association of DII and anthropometric indices. Significant trends were observed across quartiles of DII score for all anthropometric indices in all participants (P &lt;0·05), except for WHR and WHtR. After adjustment for potential confounders, the multiple linear regression analysis for each anthropometric index revealed that participants in the highest DII quartile had higher BMI z-score, WC, HC and parental BMI compared with those in the first (or lowest) quartile. In summary, we found that a pro-inflammatory diet was associated with higher BMI z-score, wrist circumference, NC, WC, HC and parental BMI. The large sample size of the present study may influence the statistical significance of observed associations. Hence, the findings should be clinically interpreted with caution.

The Association Between Maternal Factors and Preadolescent Breakfast Skipping: The Mediating Role of Preadolescent Attitudes Toward Breakfast

BACKGROUND

Although skipping breakfast is common among children and adolescents, daily breakfast consumption is a healthy habit that is particularly important in childhood. There is a link between children's attitudes toward breakfast, breakfast-skipping behaviors, and maternal factors. Evidence demonstrating a clear relationship between maternal factors and preadolescent attitudes and behaviors toward breakfast skipping is scarce.

AIMS

This study aims to examine the mediation effect of preadolescent attitudes toward breakfast on the associations between maternal involvement (encouragement and control of breakfast eating) and preadolescent breakfast skipping.

METHODS

A cross-sectional descriptive study was conducted across Jordan in public and private primary schools in 2015. A sample of 1,915 preadolescent students (10-11 years) and their mothers (N = 1,299) was generated through proportional cluster stratification sampling. The interrelationships were examined among the participants' demographics, the number of preadolescent skipped breakfasts during a given week, self-reported attitudes toward breakfast, and perceived maternal encouragement and control of breakfast-eating variables.

RESULTS

Analysis revealed that preadolescent attitudes toward breakfast and mothers' involvement in preadolescent breakfast were negatively correlated with preadolescent breakfast skipping. Linear regressions revealed that maternal involvement (i.e., encouragement and control of breakfast eating, and educational attainment levels) was predictive of preadolescent attitudes toward breakfast consumption. Multiple regressions using bootstrapping analysis showed that preadolescent attitudes partially mediated the effect of mothers' control and encouragement of breakfast consumption over preadolescent breakfast-skipping behavior.

LINKING EVIDENCE TO ACTION

Results suggest that preadolescent attitudes, maternal encouragement, and control of breakfast eating influenced preadolescent breakfast skipping. These findings emphasize the importance of carefully assessing preadolescent attitudes toward breakfast, maternal encouragement, and control of breakfast consumption when developing interventions aimed at reducing breakfast-skipping behavior.

Dietary Patterns, Cardiorespiratory and Muscular Fitness in 9⁻11-Year-Old Children from Dunedin, New Zealand

Research shows that cardiorespiratory (CRF) and muscular fitness in childhood are associated with a healthier cardiovascular profile in adulthood. Identifying factors associated with measures of fitness in childhood could allow for strategies to optimize cardiovascular health throughout the lifecourse. The aim of this study was to examine the association between dietary patterns and both CRF and muscular fitness in 9⁻11-year-olds. In this study of 398 children, CRF and muscular fitness were assessed using a 20-m shuttle run test and digital hand dynamometer, respectively. Dietary patterns were derived using principal component analysis. Mixed effects linear regression models were used to assess associations between dietary patterns and CRF and muscular fitness. Most children had healthy CRF (99%, FITNESSGRAM) and mean ± SD muscular fitness was 15.2 ± 3.3 kg. Two dietary patterns were identified; &ldquo;Snacks&rdquo; and &ldquo;Fruit and Vegetables&rdquo;. There were no significant associations between either of the dietary patterns and CRF. Statistically significant but not clinically meaningful associations were seen between dietary patterns and muscular fitness. In an almost exclusively fit cohort, food choice is not meaningfully related to measures of fitness. Further research to investigate diet-fitness relationships in children with lower fitness levels can identify key populations for potential investments in health-promoting behaviors.