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Urkia-Susin I, Guenetxea-Gorostiza J, Rada-Fernandez de Jauregui D, Mazquiaran-Bergera L, Martinez O, Maiz E. Development and validation of the baby eating behaviour coding system (BEBECS) to assess eating behaviour during complementary feeding. Appetite 2024; 196:107257. [PMID: 38364972 DOI: 10.1016/j.appet.2024.107257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/29/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
Eating behaviour in children is a matter of study for which diverse tools have been designed. Coding systems for videotaped meals allow the extraction of detailed in vivo information; however, there is no tool available for infants following a Baby-Led Weaning (BLW) method. This study aimed to create and validate a new tool to assess eating behaviour in infants during weaning, applicable regardless of the complementary feeding method. The Baby Eating Behaviour Coding System (BEBECS) was developed comprising time variables, behaviours, feeder-led actions, and other meal-related variables. Sixty videos of infants aged 6-18 months following spoon-feeding (SF) or BLW methods were coded by two trained coders. These scores were analysed together with intake and maternal ratings of liking and calmness. Additionally, combined analysis and internal comparison assessed the possible differences in BEBECS variables between SF and BLW. Inter-rater and test-retest reliability had good to excellent agreement: Cohen's Kappa >0.75, Lin's CCC >0.70, and Intraclass Correlation Coefficient >0.75, for almost all variables. Infants' liking and intake of the offered food correlated positively with meal duration and total count of mouth approaches but negatively with having leftovers and time between mouth approaches. Infants' calmness and tiredness were negatively correlated. More food than initially offered was available during the meal in BLW but not in SF. There was a tendency towards more autonomous behaviour in BLW infants regarding changes observed in the time the food was in the mouth at each stage (6, 12, and 18 months). In conclusion, BEBECS has the potential to be a valid tool for application in the research of infant eating behaviour during weaning by trained coders.
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Affiliation(s)
- Iratxe Urkia-Susin
- Department of Pharmacy and Food Science (G3S Research Group), Faculty of Pharmacy, University of the Basque Country UPV/EHU, Unibertsitateko Ibilbidea 7, 01006, Vitoria-Gasteiz, Araba, Spain; Bioaraba Health Research Institute, Nutrition and Food Safety Group Araba University Hospital, Vitoria-Gasteiz, Spain.
| | - Jone Guenetxea-Gorostiza
- Department of Preventive Medicine and Public Health, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Unibertsitateko Ibilbidea 7, 01006, Vitoria-Gasteiz, Araba, Spain; Biogipuzkoa Health Research Institute, Mental Health Group, Donostia, Spain
| | - Diego Rada-Fernandez de Jauregui
- Bioaraba Health Research Institute, Nutrition and Food Safety Group Araba University Hospital, Vitoria-Gasteiz, Spain; Department of Preventive Medicine and Public Health, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Unibertsitateko Ibilbidea 7, 01006, Vitoria-Gasteiz, Araba, Spain
| | - Leire Mazquiaran-Bergera
- Department of Preventive Medicine and Public Health, Faculty of Pharmacy, University of the Basque Country UPV/EHU, Unibertsitateko Ibilbidea 7, 01006, Vitoria-Gasteiz, Araba, Spain; Biogipuzkoa Health Research Institute, Mental Health Group, Donostia, Spain
| | - Olaia Martinez
- Department of Pharmacy and Food Science (G3S Research Group), Faculty of Pharmacy, University of the Basque Country UPV/EHU, Unibertsitateko Ibilbidea 7, 01006, Vitoria-Gasteiz, Araba, Spain; Bioaraba Health Research Institute, Nutrition and Food Safety Group Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Edurne Maiz
- Biogipuzkoa Health Research Institute, Mental Health Group, Donostia, Spain; Department of Clinical and Health Psychology and Research Methodology, Faculty of Psychology, University of the Basque Country UPV/EHU, Tolosa Hiribidea 70, 20018, Donostia, Gipuzkoa, Spain
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Moura AF, Grønhøj A, Aschemann-Witzel J. Spicing up food interactions: Development of a healthy food education activity targeting fathers and their young children. J Hum Nutr Diet 2023; 36:1795-1810. [PMID: 37158136 DOI: 10.1111/jhn.13179] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/13/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Childhood obesity rates have been rapidly increasing worldwide. Several actions to reduce this trend have addressed maternal feeding practices. However, research reports an unwillingness to taste healthful foods expressed by children and fathers, which represents a major obstacle to a healthy diet in the family household. The present study aims to propose and qualitatively evaluate an intervention to increase fathers' involvement with their families' healthy eating through exposure to new/disliked healthy foods. METHODS Fifteen Danish families took part in a 4-week online intervention involving picture book reading, a sensory experience session and the cooking of four recipes with four targeted vegetables (celeriac, Brussels sprouts, spinach and kale) and two spices (turmeric and ginger). Interviews were conducted with the families and the content was analysed through a blended or abductive approach. RESULTS Participating in the activities motivated children and fathers to try new vegetables and spices, and increased fathers' sense of self-efficacy toward cooking, tasting new foods and healthy feeding. For the family, the intervention acted as a trigger to consume a higher variety of vegetables and spices and prompted feelings of "food joy". The outcomes observed are of importance considering the relatively low cost and the remote approach of the intervention. CONCLUSIONS The results highlight the fact that fathers play an important role in the home food environment. We conclude that fathers should be included to a higher extent in food and nutrition strategies aimed at promoting healthy weight development in their children.
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Affiliation(s)
- Andreia Ferreira Moura
- Department of Food, Nutrition and Dietetics, School of Biosciences, University of Nottingham, Nottingham, UK
- Department of Management, BSS, MAPP Centre for Research on Value Creation in the Food Sector, Aarhus University, Aarhus V, Denmark
| | - Alice Grønhøj
- Department of Management, BSS, MAPP Centre for Research on Value Creation in the Food Sector, Aarhus University, Aarhus V, Denmark
| | - Jessica Aschemann-Witzel
- Department of Management, BSS, MAPP Centre for Research on Value Creation in the Food Sector, Aarhus University, Aarhus V, Denmark
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Srivastava D, Zheng LR, Dev DA. Examining correlates of feeding practices among parents of preschoolers. Nutr Health 2021; 28:555-562. [PMID: 34424083 DOI: 10.1177/02601060211032886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Parent feeding practices play a critical role in children's eating behaviors. Limited research has explored child-level correlates of parent feeding practices. Aim: To identify correlates of feeding practices (responsive and controlling) among parents of preschoolers US. Methods: Participants included parents (n = 273) of preschoolers (3-5 years), recruited from Early Care and Education settings (n = 24) located in a metropolitan city in the US. Analysis included descriptives, correlations, and multiple regression. Results: For responsive feeding practices, positive associations included child's weight with unintentional modeling (β = .17, 95% CI [0.12, 0.53]), child vegetable consumption with behavioral role modeling (β = 0.22, 95% CI [0.17, 0.44]), and parent monitoring with verbal modeling (β = 0.21, 95% CI [0.12, 0.34]). For controlling feeding practices, parent restriction was positively associated with child weight concern (β = 0.22, 95% CI [0.13, 0.39]) and parent monitoring (β = 0.13, 95% CI [0.01, 0.19]), whereas child vegetable consumption was negatively associated (β = -0.16, 95% CI [-0.27, -0.05]). Pressure to eat was negatively associated with child weight concern (β = -0.18, 95% CI [-0.45, -0.09]), child fruit consumption (β = -0.12, 95% CI [-0.37, -0.01]), household income (β = -0.13, 95% CI [-0.30, -0.02]), and parent weight (β = -0.14, 95% CI [-0.60, -0.05]), Conclusions: Findings highlight the importance of child characteristics when examining correlates of parent feeding practices, demonstrating bidirectional interactions between parent feeding practices and children's eating behaviors. Considering child-level correlates may improve the implementation of responsive feeding practices and reduce controlling feeding practices.
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Affiliation(s)
- Deepa Srivastava
- Nutrition, Family & Consumer Sciences Advisor, Cooperative Extension, 115148University of California Agriculture & Natural Resources, Davis, CA, USA
| | - Lucy R Zheng
- Department of Psychology, 8789University of California, Davis, CA, USA
| | - Dipti A Dev
- Department of Child, Youth and Family Studies, 14719University of Nebraska-Lincoln, Lincoln, NE, USA
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Hudak KM, Benjamin-Neelon SE. Timing of WIC Enrollment and Responsive Feeding among Low-Income Women in the US. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147695. [PMID: 34300147 PMCID: PMC8305462 DOI: 10.3390/ijerph18147695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022]
Abstract
We examined associations between the timing of The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) enrollment and responsive feeding and assessed food security as a possible effect modifier. We used data from the nationally representative WIC Infant and Toddler Feeding Practices Study-2. Our sample includes women-infant dyads interviewed through the first 13 months of age (n = 1672). We dichotomized WIC enrollment as occurring prenatally or after childbirth. The responsive feeding outcome was feeding on demand versus feeding on schedule. We used covariate-adjusted logistic regressions. Of women, 61.8% had a high school education or less and 62.9% lived at 75% or less of the federal poverty guideline. The majority (84.5%) of women enrolled in WIC before childbirth. In unadjusted estimates, 34% of women who enrolled prenatally practiced responsive feeding, compared to 25% of women who enrolled after childbirth. We found no evidence of food security as an effect modifier. In adjusted estimates, women who enrolled in WIC prenatally had 78% higher odds of practicing responsive feeding (OR: 1.78, 95% CI: 1.16, 2.73), compared to women who enrolled after childbirth. Prenatal enrollment in WIC was associated with higher odds of responsive feeding. Future studies should examine how the timing of WIC enrollment relates to responsive feeding in older children and over time.
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Affiliation(s)
- Katelin M. Hudak
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Correspondence:
| | - Sara E. Benjamin-Neelon
- Lerner Center for Public Health Promotion, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
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Lutter CK, Grummer-Strawn L, Rogers L. Complementary feeding of infants and young children 6 to 23 months of age. Nutr Rev 2021; 79:825-846. [PMID: 33684940 DOI: 10.1093/nutrit/nuaa143] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Complementary feeding, when foods are introduced to complement a milk-based diet, generally occurs between 6 and 23 months of age. It is a critical period for both physical and cognitive development. During this period, the growth rate of the brain is one of the fastest during the life span and, consequently, the timing, dose, and duration of exposure to specific nutrients can result in both positive and negative effects. Complementary feeding is more than ensuring an adequate intake of nutrients; it also is about avoiding excess intakes of calories, salt, sugars, and unhealthy fats. Meals are cultural and social events where young children observe, imitate, learn about foods to like or dislike, and form lifelong eating habits and practices. Meals are also when a child learns to touch foods and connect food tastes to how foods look and feel. Ideally, complementary feeding is responsive and promotes child autonomy, but it can also be used to manage behavior problems or overly indulge a child, resulting in long-term consequences for nutrition and health. Therefore, in addition to what a child is fed, attention to how a child is fed is also important. In this review, 12 topics relevant for updating global guidance on complementary feeding were identified: age of introduction of complementary foods; continued breastfeeding; responsive feeding; safe preparation and storage of complementary foods; food textures, flavors, and acceptance; energy and meal and snack frequency; fats, protein, and carbohydrates; dietary diversity; milks other than breast milk; fluid needs; unhealthy foods and beverages; and use of vitamin and mineral supplements or supplementary foods.
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Affiliation(s)
- Chessa K Lutter
- Division of Food Security and Agriculture, RTI International, Washington, DC, USA
| | | | - Lisa Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
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A 3-year Longitudinal Study of Pocket Money, Eating Behavior, Weight Status: The Childhood Obesity Study in China Mega-Cities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239139. [PMID: 33297510 PMCID: PMC7729809 DOI: 10.3390/ijerph17239139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/18/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022]
Abstract
The associations between children’s pocket money and their eating behaviors and weight status have not been examined using longitudinal data in China. Examined child and parental factors associated with children’s pocket money, and longitudinal effects of pocket money on children’s eating behaviors and weight status. Data were collected in 2015, 2016, and 2017 from 3261 school-age children and their parents in mega-cities across China (Beijing, Shanghai, Nanjing, Xi’an, Chengdu). Children’s weight, height, and waist circumference were measured; pocket money and eating behaviors were self-reported. Mixed effect models were used. Older children received more pocket money than younger children (incident rate ratio (IRR) = 1.21, 95% confidence interval (CI): 1.15, 1.26). Fathers gave their children more pocket money than mothers did (IRR = 1.22, 95% CI: 1.16, 1.30). Children with fathers having ≥ college education received more pocket money than the others did (IRR = 1.20, 95% CI: 1.04, 1.40). Some nutrition-related parenting behaviors and attitude were also associated with children’s pocket money. Compared with children receiving no weekly pocket money, those having 1–10 or 10–30 or >30-yuan weekly pocket money were 12.0–136% more likely to consume unhealthy foods and were 66–132% more likely to be overweight or obese. Some child and parental factors were associated with children’s pocket money, which increased risks of having unhealthy eating behaviors and being overweight and obese.
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Hasnin S, Dev DA, Tovar A. Participation in the CACFP Ensures Availability but not Intake of Nutritious Foods at Lunch in Preschool Children in Child-Care Centers. J Acad Nutr Diet 2020; 120:1722-1729.e1. [PMID: 32586746 DOI: 10.1016/j.jand.2020.03.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 03/12/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The US Department of Agriculture Child and Adult Care Food program (CACFP) recently (October 2017) updated requirements for meal reimbursement and best practice recommendations for serving nutritious meals and beverages, and minimum age-specific serving sizes for five food groups. It is not known whether CACFP-funded child-care centers are meeting the updated meal pattern requirements and best practice recommendations, and whether children are meeting nutrition recommendations based on the current 2015-2020 Dietary Guidelines for Americans (DGA). OBJECTIVE This study assessed whether the recruited CACFP-funded child-care centers in this study were meeting the updated (2017) CACFP requirements regarding foods served for lunch and whether children attending these child-care centers were meeting age- and sex-specific DGA recommendations regarding foods consumed. DESIGN This was a cross-sectional study using the Dietary Observation for Child Care method. PARTICIPANTS AND SETTINGS: Children aged 3 to 5 years (n=108) from 10 classrooms in three CACFP-funded child-care centers in Lincoln, NE, were recruited by convenience sampling during spring 2018. MEASURABLE OUTCOMES Food served and consumed during observed lunches in comparison with updated CACFP requirements and DGA, respectively. STATISTICAL ANALYSIS Adjusted mean amounts of foods served from each food group were compared with age specific minimum CACFP serving size requirements. Adjusted mean amounts of foods consumed from each food group were then compared with age- and sex-specific DGA recommendations. RESULTS The recruited child-care centers were meeting the updated CACFP requirements regarding foods served but showed limited adherence to the best practice recommendations during the observed lunches. However, the overall mean intake for grains, fruits, and vegetables was significantly lower (P<0.01) than DGA recommendations. In addition, approximately 25% of the children did not consume any vegetables during their meal. CONCLUSIONS: Although child-care centers were meeting the updated CACFP requirements by serving the recommended amounts of foods, children were not meeting DGA-recommended intakes. Future studies are needed to explore ways to improve adherence to best practice recommendations to improve children's consumption of healthy foods in child-care centers.
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Ward DS, Vaughn AE, Burney RV, Hales D, Benjamin-Neelon SE, Tovar A, Østbye T. Keys to healthy family child care homes: Results from a cluster randomized trial. Prev Med 2020; 132:105974. [PMID: 31899253 PMCID: PMC8091030 DOI: 10.1016/j.ypmed.2019.105974] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/24/2019] [Accepted: 12/28/2019] [Indexed: 01/11/2023]
Abstract
Early care and education settings, such as family child care homes (FCCHs), are important venues for children's health promotion. Keys to Healthy Family Child Care Homes evaluated a FCCH-based intervention's impact on children's diet and physical activity. This study enrolled 496 children aged 1.5-4 years and 166 FCCH providers into a cluster-randomized control trial (intervention = 242 children/83 FCCHs, control = 254 children/83 FCCHs) conducted during 2013-2016. The 9-month intervention addressed provider health, health of the FCCH environment, and business practices, and was delivered through three workshops, three home visits, and nine phone calls. The attention control arm received a business-focused intervention. Primary outcomes were children's diet quality (2 days of observed intakes summarized into Healthy Eating Index scores) and moderate to vigorous physical activity (3 days of accelerometry) at the FCCH. Secondary outcomes were child body mass index (BMI), FCCH provider health behaviors, and FCCH nutrition and physical activity environments and business practices. Repeated measures analysis, using an intent-to-treat approach, accounting for clustering of children within FCCHs and adjusting for child age, sex, and BMI, was used to evaluate change (completed in 2018). Compared to controls, intervention children significantly improved their diet quality (5.39, p = .0002, CI = 2.53, 8.26) but not MVPA (0.31, p = .195, CI = -0.16, 0.79). Intervention FCCH providers significantly improved their diet quality and several components of their FCCH environment (i.e., time provided for physical activity, use of supportive physical activity practices, and engagement in nutrition and physical activity education/professional development). FCCHs are malleable settings for health promotion, especially diet quality. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.govNCT01814215.
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Affiliation(s)
- Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB # 7461, Chapel Hill, NC 27599-7461, USA; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC 27599-7426, USA.
| | - Amber E Vaughn
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC 27599-7426, USA
| | - Regan V Burney
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC 27599-7426, USA
| | - Derek Hales
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, CB # 7461, Chapel Hill, NC 27599-7461, USA; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC 27599-7426, USA
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, 41 Lower College Road, Kingston, RI 02881, USA
| | - Truls Østbye
- Duke University Department of Family Medicine and Community Health, Duke University Medical Center, W Main St 2200, Suite 622, Durham, NC 27710, USA
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Abstract
AbstractObjective:Extensive marketing of ‘toddler milks’ (sugar-sweetened milk-based drinks for toddlers) promotes unsubstantiated product benefits and raises concerns about consumption by young children. The present study documents trends in US toddler milk sales and assesses relationships with brand and category marketing.Design:We report annual US toddler milk and infant formula sales and marketing from 2006 to 2015. Sales response models estimate associations between marketing (television advertising spending, product price, number of retail displays) and volume sales of toddler milks by brand and category.Setting:US Nielsen retail scanner sales and advertising spending data from 2006 to 2015.Participants:Researchers analysed all Universal Product Codes (n 117·4 million) sold by seven infant formula and eight toddler milk brands from 2006 to 2015.Results:Advertising spending on toddler milks increased fourfold during this 10-year period and volume sales increased 2·6 times. In contrast, advertising spending and volume sales of infant formulas declined. Toddler milk volume sales were positively associated with television advertising and retail displays, and negatively associated with price, at both the brand and category levels.Conclusions:Aggressive marketing of toddler milks has likely contributed to rapid sales increases in the USA. However, these sugar-sweetened drinks are not recommended for toddler consumption. Health-care providers, professional organizations and public health campaigns should provide clear guidance and educate parents to reduce toddler milk consumption and address misperceptions about their benefits. These findings also support the need to regulate marketing of toddler milks in countries that prohibit infant formula marketing to consumers.
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Duffy EW, Kay MC, Jacquier EF, Catellier D, Hampton J, Anater AS, Story M. Trends in Food Consumption Patterns of US Infants and Toddlers from Feeding Infants and Toddlers Studies (FITS) in 2002, 2008, 2016. Nutrients 2019; 11:nu11112807. [PMID: 31744210 PMCID: PMC6893614 DOI: 10.3390/nu11112807] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/12/2019] [Accepted: 11/13/2019] [Indexed: 12/24/2022] Open
Abstract
The Feeding Infants and Toddlers Study (FITS) is the largest survey of dietary intake among infants and young children in the United States. Dietary patterns in early childhood are a key component of prevention of diet-related chronic diseases, yet little is known about how food consumption patterns of infants and young children have changed over time. The objective of this study is to examine trends in food and beverage consumption among children ages 6–23.9 months using data from the FITS conducted in 2002, 2008, and 2016. A total of 5963 infants and young children ages 6–23.9 months were included in these analyses. Food consumption data were collected using a multiple-pass 24-h recall by telephone using the Nutrition Data System for Research. Linear trends were assessed using the Wald’s test in a multivariable linear regression model. Positive significant findings include increases in breast milk consumption and decreases in the consumption of sweets, sugar-sweetened beverages, and 100% fruit juice. More troubling findings include decreasing infant cereal consumption, stagnant or decreasing whole grain consumption, and stagnant consumption of vegetables. Our findings suggest some promising improvements in dietary intake among infants and toddlers in the United States over the past 15 years, but further policy, programmatic, and industry efforts are still needed.
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Affiliation(s)
- Emily W. Duffy
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
- Correspondence: ; Tel.: +1-336-341-9149
| | - Melissa C. Kay
- Duke Global Health Institute, Duke University, Durham, NC 27110, USA; (M.C.K.); (M.S.)
| | | | - Diane Catellier
- RTI International, Research Triangle Park, NC 27709, USA; (D.C.); (J.H.); (A.S.A.)
| | - Joel Hampton
- RTI International, Research Triangle Park, NC 27709, USA; (D.C.); (J.H.); (A.S.A.)
| | - Andrea S. Anater
- RTI International, Research Triangle Park, NC 27709, USA; (D.C.); (J.H.); (A.S.A.)
| | - Mary Story
- Duke Global Health Institute, Duke University, Durham, NC 27110, USA; (M.C.K.); (M.S.)
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Using Trials of Improved Practices to identify practices to address the double burden of malnutrition among Rwandan children. Public Health Nutr 2019; 22:3175-3186. [PMID: 31221234 DOI: 10.1017/s1368980019001551] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Low- and middle-income countries (LMIC) are increasingly experiencing the double burden of malnutrition. Studies to identify 'double-duty' actions that address both undernutrition and overweight in sub-Saharan Africa are needed. We aimed to identify acceptable behaviours to achieve more optimal feeding and physical activity practices among both under- and overweight children in Rwanda, a sub-Saharan LMIC with one of the largest recent increases in child overweight. DESIGN We used the Trials of Improved Practices (TIPs) method. During three household visits over 1·5 weeks, we used structured interviews and unstructured observations to collect data on infant and young child feeding practices and caregivers' experiences with testing recommended practices. SETTING An urban district and a rural district in Rwanda. PARTICIPANTS Caregivers with an under- or overweight child from 6 to 59 months of age (n 136). RESULTS We identified twenty-five specific recommended practices that caregivers of both under- and overweight children agreed to try. The most frequently recommended practices were related to dietary diversity, food quantity, and hygiene and food handling. The most commonly cited reason for trying a new practice was its benefits to the child's health and growth. Financial constraints and limited food availability were common barriers. Nearly all caregivers said they were willing to continue the practices and recommend them to others. CONCLUSIONS These practices show potential for addressing the double burden as part of a broader intervention. Still, further research is needed to determine whether caregivers can maintain the behaviours and their direct impact on both under- and overweight.
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12
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Dwyer JT. The Feeding Infants and Toddlers Study (FITS) 2016: Moving Forward. J Nutr 2018; 148:1575S-1580S. [PMID: 30247582 PMCID: PMC6126635 DOI: 10.1093/jn/nxy159] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 07/02/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- Johanna T Dwyer
- Tufts University School of Medicine and Frances Stern Nutrition Center, Tufts Medical Center, Boston, MA,Address correspondence to JTD (e-mail: )
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13
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Saxe-Custack A, Lofton HC, Hanna-Attisha M, Victor C, Reyes G, Ceja T, LaChance J. Caregiver perceptions of a fruit and vegetable prescription programme for low-income paediatric patients. Public Health Nutr 2018; 21:2497-2506. [PMID: 29667562 DOI: 10.1017/s1368980018000964] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The physical and social environments that surround children should support good health. However, challenges with food security and access prevent many children from consuming a healthy diet, which is critical to proper growth and development. The present study sought to gain a better understanding of primary care initiatives to address these issues in a low-income setting. DESIGN Following the relocation of a paediatric clinic to a farmers' market building and the implementation of a fruit and vegetable prescription programme, researchers conducted thirty-two semi-structured interviews with caregivers. Researchers elicited caregivers' perceptions of clinic co-location with the farmers' market; experiences with the prescription programme; opinions of the farmers' market; and perceived impact on child consumption of fresh produce. Interview recordings were transcribed for textual analysis. Using thematic analysis, researchers examined qualitative data to identify patterns across transcripts and formulate emerging themes. Researchers concluded when data saturation was reached. SETTING Flint, Michigan, USA. SUBJECTS The majority of participants were female (91 %) and African American (53 %). RESULTS Four recurrent themes emerged during interviews: (i) convenience of relocation; (ii) attitude towards prescription programme; (iii) challenges with implementation; and (iv) perceived impact of combined interventions. Caregivers indicated that the co-location and prescription programme increased family shopping at the farmers' market, improved access to high-quality produce and improved food security. CONCLUSIONS A fruit and vegetable prescription programme involving a partnership between a farmers' market and paediatric clinic was perceived as effective in improving food security, food access and child consumption of fresh fruits and vegetables.
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Affiliation(s)
- Amy Saxe-Custack
- 1Department of Food Science and Human Nutrition,Michigan State University,Pediatric Public Health Initiative,200 E 1st Street,Flint,MI 48502,USA
| | - Heather Claire Lofton
- 2Human Development & Family Studies,Couple and Family Therapy,Michigan State University,East Lansing,MI,USA
| | - Mona Hanna-Attisha
- 3Department of Pediatrics & Human Development,Michigan State University College of Human Medicine,Flint,MI,USA
| | - Colleen Victor
- 5Pediatric Residency Program,Warren Alpert Medical School of Brown University,Providence,RI,USA
| | - Gwendolyn Reyes
- 3Department of Pediatrics & Human Development,Michigan State University College of Human Medicine,Flint,MI,USA
| | - Tiffany Ceja
- 7Hurley Research Center,Hurley Medical Center,Flint,MI,USA
| | - Jenny LaChance
- 7Hurley Research Center,Hurley Medical Center,Flint,MI,USA
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Welker EB, Jacquier EF, Catellier DJ, Anater AS, Story MT. Room for Improvement Remains in Food Consumption Patterns of Young Children Aged 2-4 Years. J Nutr 2018; 148:1536S-1546S. [PMID: 29878237 PMCID: PMC6126636 DOI: 10.1093/jn/nxx053] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/27/2017] [Indexed: 11/23/2022] Open
Abstract
Background Healthy food consumption patterns in early childhood support optimal growth and development and promote lifelong health. Objective The objective of the Feeding Infants and Toddlers Study (FITS) 2016 is to provide updated information on food consumption patterns of children aged 0 to <4 y. This article focuses on several key aspects of the food consumption patterns of 2- and 3-y-olds and how those patterns differ between racial/ethnic groups. Methods The FITS 2016 is a cross-sectional study in caregivers of children aged 0 to <4 y living in the United States. Dietary data were collected in a national random sample of children (n = 3235, of whom 600 were aged 24-47.9 mo) by using a 24-h dietary recall telephone survey with the primary caregiver of the child. Data from the recall were used to calculate the percentage of children consuming specific food groups on the day of the recall and energy from these foods (kilocalories per consumer). Differences in food patterns between racial/ethnic groups were analyzed by using ANOVA and t tests. Results On the day of the 24-h dietary recall, 27% of 2- and 3-y-olds did not consume a distinct portion of vegetables. Fried potatoes were the most commonly consumed vegetable. Approximately 75% consumed a distinct portion of fruit and 45% consumed 100% fruit juice. Eighty-one percent of children consumed cow milk. Almost all (95%) consumed a grain product, and 59% consumed a whole grain-rich product. The majority of children (88%) consumed meat or another protein food. Nearly all (90%) consumed a dessert, sugar-sweetened beverage (SSB), or sweet; and 45% consumed an SSB. Thirty-six percent of children consumed a savory snack. There were some differences in food consumption patterns between racial/ethnic groups. Conclusion Findings from the FITS 2016 indicate that individual-, community-, and policy-level strategies are needed to improve the diets of young children in the United States.
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Affiliation(s)
- Emily B Welker
- Duke University, Duke Global Health Institute, Durham, NC,Address correspondence to EBW (e-mail: )
| | | | | | | | - Mary T Story
- Duke University, Duke Global Health Institute, Durham, NC
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