51
|
Tovar A, Vaughn AE, Fallon M, Hennessy E, Burney R, Østbye T, Ward DS. Providers' response to child eating behaviors: A direct observation study. Appetite 2016; 105:534-41. [PMID: 27328098 PMCID: PMC5067159 DOI: 10.1016/j.appet.2016.06.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 04/22/2016] [Accepted: 06/15/2016] [Indexed: 11/18/2022]
Abstract
Child care providers play an important role in feeding young children, yet little is known about children's influence on providers' feeding practices. This qualitative study examines provider and child (18 months -4 years) feeding interactions. Trained data collectors observed 200 eating occasions in 48 family child care homes and recorded providers' responses to children's meal and snack time behaviors. Child behaviors initiating provider feeding practices were identified and practices were coded according to higher order constructs identified in a recent feeding practices content map. Analysis examined the most common feeding practices providers used to respond to each child behavior. Providers were predominately female (100%), African-American (75%), and obese (77%) and a third of children were overweight/obese (33%). Commonly observed child behaviors were: verbal and non-verbal refusals, verbal and non-verbal acceptance, being "all done", attempts for praise/attention, and asking for seconds. Children's acceptance of food elicited more autonomy supportive practices vs. coercive controlling. Requests for seconds was the most common behavior, resulting in coercive controlling practices (e.g., insisting child eat certain food or clean plate). Future interventions should train providers on responding to children's behaviors and helping children become more aware of internal satiety and hunger cues.
Collapse
Affiliation(s)
- Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881, 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 27599-7426, NC, USA.
| | - Megan Fallon
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI 02881, USA.
| | - Erin Hennessy
- ChildObesity180, Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111, USA.
| | - Regan 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 27599-7426, NC, USA.
| | - Truls Østbye
- Duke University Medical Center, 310 Trent Drive, Durham, NC 27710, USA.
| | - Dianne S Ward
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd, CB 7426, Chapel Hill 27599-7426, NC, USA.
| |
Collapse
|
52
|
Jalali MS, Sharafi-Avarzaman Z, Rahmandad H, Ammerman AS. Social influence in childhood obesity interventions: a systematic review. Obes Rev 2016; 17:820-32. [PMID: 27138986 DOI: 10.1111/obr.12420] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/23/2016] [Indexed: 01/08/2023]
Abstract
The objective of this study is to understand the pathways through which social influence at the family level moderates the impact of childhood obesity interventions. We conducted a systematic review of obesity interventions in which parents' behaviours are targeted to change children's obesity outcomes, because of the potential social and environmental influence of parents on the nutrition and physical activity behaviours of children. PubMed (1966-2013) and the Web of Science (1900-2013) were searched, and 32 studies satisfied our inclusion criteria. Results for existing mechanisms that moderate parents' influence on children's behaviour are discussed, and a causal pathway diagram is developed to map out social influence mechanisms that affect childhood obesity. We provide health professionals and researchers with recommendations for leveraging family-based social influence mechanisms to increase the efficacy of obesity intervention programmes. © 2016 World Obesity.
Collapse
Affiliation(s)
- M S Jalali
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Z Sharafi-Avarzaman
- Faculty of Economics and Business Administration, Goethe University Frankfurt, Frankfurt, Germany
| | - H Rahmandad
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - A S Ammerman
- Center for Health Promotion & Disease Prevention, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
53
|
LaRowe TL, Tomayko EJ, Meinen AM, Hoiting J, Saxler C, Cullen B. Active Early: one-year policy intervention to increase physical activity among early care and education programs in Wisconsin. BMC Public Health 2016; 16:607. [PMID: 27439770 PMCID: PMC4955211 DOI: 10.1186/s12889-016-3198-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 06/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Early childcare and education (ECE) is a prime setting for obesity prevention and the establishment of healthy behaviors. The objective of this quasi-experimental study was to examine the efficacy of the Active Early guide, which includes evidenced-based approaches, provider resources, and training, to improve physical activity opportunities through structured (i.e. teacher-led) activity and environmental changes thereby increasing physical activity among children, ages 2–5 years, in the ECE setting. Methods Twenty ECE programs in Wisconsin, 7 family and 13 group, were included. An 80-page guide, Active Early, was developed by experts and statewide partners in the fields of ECE, public health, and physical activity and was revised by ECE providers prior to implementation. Over 12 months, ECE programs received on-site training and technical assistance to implement the strategies and resources provided in the Active Early guide. Main outcome measures included observed minutes of teacher-led physical activity, physical activity environment measured by the Environment and Policy Assessment and Observation (EPAO) instrument, and child physical activity levels via accelerometry. All measures were collected at baseline, 6 months, and 12 months and were analyzed for changes over time. Results Observed teacher-led physical activity significantly increased from 30.9 ± 22.7 min at baseline to 82.3 ± 41.3 min at 12 months. The change in percent time children spent in sedentary activity decreased significantly after 12 months (−4.4 ± 14.2 % time, −29.2 ± 2.6 min, p < 0.02). Additionally, as teacher led-activity increased, percent time children were sedentary decreased (r = −0.37, p < 0.05) and percent time spent in light physical activity increased (r = 0.35, p < 0.05). Among all ECE programs, the physical activity environment improved significantly as indicated by multiple sub-scales of the EPAO; scores showing the greatest increases were the Training and Education (14.5 ± 6.5 at 12-months vs. 2.4 ± 3.8 at baseline, p < 0.01) and Physical Activity Policy (18.6 ± 4.6 at 12-months vs. 2.0 ± 4.1 at baseline, p < 0.01). Conclusions Active Early promoted improvements in providing structured (i.e. teacher-led) physical activity beyond the recommended 60 daily minutes using low- to no-cost strategies along with training and environmental changes. Furthermore, it was observed that Active Early positively impacted child physical activity levels by the end of the intervention. However, resources, training, and technical assistance may be necessary for ECE programs to be successful beyond the use of the Active Early guide. Implementing local-level physical activity policies combined with support from local and statewide partners has the potential to influence higher standards for regulated ECE programs.
Collapse
Affiliation(s)
- Tara L LaRowe
- Department of Dietetics, School of Natural and Health Sciences, Mount Mary University, 2900 North Menomonee River Parkway, Milwaukee, WI, 53222, USA.
| | - Emily J Tomayko
- College of Public Health & Human Sciences, School of Biological & Population Health Sciences, Oregon State University, 118D Milam Hall, Corvallis, OR, 97331, USA
| | - Amy M Meinen
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI, 53726, USA
| | - Jill Hoiting
- Supporting Families Together Association, 700 Rayovac Drive, Suite 6, Madison, WI, 53711, USA
| | - Courtney Saxler
- School of Medicine and Public Health, Area Health Education Centers System, University of Wisconsin-Madison, 750 Highland Avenue, Madison, WI, 53705, USA
| | - Bridget Cullen
- State of Wisconsin, Department of Children and Families, 201 East Washington Avenue, Madison, WI, 53708, USA
| | | |
Collapse
|
54
|
Tao S, Yu L, Gao W, Xue W. Food preferences, personality and parental rearing styles: analysis of factors influencing health of left-behind children. Qual Life Res 2016; 25:2921-2929. [PMID: 27188890 DOI: 10.1007/s11136-016-1317-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To understand the health status and problems of left-behind children (LBC) in rural China, those whose parents have moved to urban areas without them, and to focus on ways to improve their physical and mental health. METHODS The study examined 827 children between 7 and 15 years old, selected using stratified cluster random sampling from five towns in Xiji County of the Ningxia Hui Autonomous Region. Each child was classified as either LBC or non-LBC. Measures included age- and sex-specific height and body mass index (kg/m2), a food preference questionnaire, the Revised Junior Eysenck Personality Questionnaire, and the Egna Minnen av Barndoms Uppfostran-My Memories of Upbringing (EMBU). RESULTS Malnutrition rates for LBC and non-LBC were 14.83 % (70/472) and 7.04 % (25/355) (χ 2 = 11.86, p < 0.01). More LBC reported hating vegetables and fruits. Eysenck Personality Questionnaire profiles of LBC revealed a significantly higher degree of neuroticism and psychoticism, and a significantly lower lie scale score (p < 0.01). LBC's EMBU profiles showed that the paternal approach lacked emotional warmth and understanding and the maternal approach was characterized by favoritism, over-interference and overprotection. There were a significant negative correlation between the personality characteristic of neuroticism and liking vegetables and fruits (p < 0.01), and a negative correlation between psychoticism and liking vegetables (p < 0.05). CONCLUSION The health status of LBC is problematic. Food preferences, personality type and parenting styles should be taken into account when measures are developed to improve the health of these children.
Collapse
Affiliation(s)
- Sha Tao
- College of Information and Electrical Engineering, China Agricultural University, No. 17 Qinghua East Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Lina Yu
- College of Information and Electrical Engineering, China Agricultural University, No. 17 Qinghua East Road, Haidian District, Beijing, 100083, People's Republic of China
| | - Wanlin Gao
- College of Information and Electrical Engineering, China Agricultural University, No. 17 Qinghua East Road, Haidian District, Beijing, 100083, People's Republic of China.
| | - Wentong Xue
- College of Food Science and Nutritional Engineering, China Agricultural University, No. 17 Qinghua East Road, Haidian District, Beijing, 100083, People's Republic of China
| |
Collapse
|
55
|
Kharofa RY, Kalkwarf HJ, Khoury JC, Copeland KA. Are Mealtime Best Practice Guidelines for Child Care Centers Associated with Energy, Vegetable, and Fruit Intake? Child Obes 2016; 12:52-8. [PMID: 26699096 PMCID: PMC4753622 DOI: 10.1089/chi.2015.0109] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Mealtime best practices for obesity prevention in child care have been developed from experimental studies and expert opinion. Our objective was to describe adherence to best practices in child care centers and to evaluate the association between mealtime practices and children's dietary intake. METHODS We conducted an observational study of 349 preschoolers, ages 36 to 72 months, from 30 child care centers in Cincinnati, Ohio (November 2009 to January 2011). Trained observers recorded providers' behaviors related to six mealtime best practice recommendations and documented children's intake (n = 60 group lunches). General linear mixed models were used to evaluate the association between practice use and children's total energy (caloric consumption) and fruit and vegetable consumption. RESULTS Adherence to individual mealtime best practices was variable (0%-77%). Staff sitting with children at lunch was associated with lower energy intake and higher vegetable intake. Staff eating some of the same foods was associated with higher energy intake and higher vegetable intake. Staff encouraging children to try new/less-favorite foods more than once was associated with lower fruit intake. Staff having general conversations with children (not addressed in recommendations) was associated with lower vegetable intake. Family-style meal service, staff talking about healthy foods, and staff helping children assess hunger before seconds were not significantly associated with intake. CONCLUSIONS Few mealtime best practices were associated with dietary intake. Given the number of meals children consume in child care and the prevalence of childhood obesity, efforts to identify mealtime practices that improve children's dietary intake are crucial for obesity prevention.
Collapse
Affiliation(s)
- Roohi Y. Kharofa
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Heidi J. Kalkwarf
- Division of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jane C. Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Kristen A. Copeland
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| |
Collapse
|
56
|
Vaughn AE, Ward DS, Fisher JO, Faith MS, Hughes SO, Kremers SPJ, Musher-Eizenman DR, O'Connor TM, Patrick H, Power TG. Fundamental constructs in food parenting practices: a content map to guide future research. Nutr Rev 2016; 74:98-117. [PMID: 26724487 DOI: 10.1093/nutrit/nuv061] [Citation(s) in RCA: 369] [Impact Index Per Article: 46.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Although research shows that "food parenting practices" can impact children's diet and eating habits, current understanding of the impact of specific practices has been limited by inconsistencies in terminology and definitions. This article represents a critical appraisal of food parenting practices, including clear terminology and definitions, by a working group of content experts. The result of this effort was the development of a content map for future research that presents 3 overarching, higher-order food parenting constructs--coercive control, structure, and autonomy support--as well as specific practice subconstructs. Coercive control includes restriction, pressure to eat, threats and bribes, and using food to control negative emotions. Structure includes rules and limits, limited/guided choices, monitoring, meal- and snacktime routines, modeling, food availability and accessibility, food preparation, and unstructured practices. Autonomy support includes nutrition education, child involvement, encouragement, praise, reasoning, and negotiation. Literature on each construct is reviewed, and directions for future research are offered. Clear terminology and definitions should facilitate cross-study comparisons and minimize conflicting findings resulting from previous discrepancies in construct operationalization.
Collapse
Affiliation(s)
- Amber E Vaughn
- A.E. Vaughn and D.S. Ward are with the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. D.S. Ward is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. J.O. Fisher is with the Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA. M.S. Faith is with the Department of Counseling, School, and Educational Psychology, Graduate School of Education, University of Buffalo, State University of New York, Buffalo, New York, USA. S.O. Hughes and T.M. O'Connor are with the US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. S.P.J. Kremers is with the Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. D.R. Musher-Eizenman is with the Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA. H. Patrick is with LiveHealthier, Inc., Bethesda, Maryland, USA. T.G. Power is with the Department of Human Development, Washington State University, Pullman, Washington, USA.
| | - Dianne S Ward
- A.E. Vaughn and D.S. Ward are with the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. D.S. Ward is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. J.O. Fisher is with the Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA. M.S. Faith is with the Department of Counseling, School, and Educational Psychology, Graduate School of Education, University of Buffalo, State University of New York, Buffalo, New York, USA. S.O. Hughes and T.M. O'Connor are with the US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. S.P.J. Kremers is with the Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. D.R. Musher-Eizenman is with the Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA. H. Patrick is with LiveHealthier, Inc., Bethesda, Maryland, USA. T.G. Power is with the Department of Human Development, Washington State University, Pullman, Washington, USA
| | - Jennifer O Fisher
- A.E. Vaughn and D.S. Ward are with the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. D.S. Ward is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. J.O. Fisher is with the Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA. M.S. Faith is with the Department of Counseling, School, and Educational Psychology, Graduate School of Education, University of Buffalo, State University of New York, Buffalo, New York, USA. S.O. Hughes and T.M. O'Connor are with the US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. S.P.J. Kremers is with the Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. D.R. Musher-Eizenman is with the Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA. H. Patrick is with LiveHealthier, Inc., Bethesda, Maryland, USA. T.G. Power is with the Department of Human Development, Washington State University, Pullman, Washington, USA
| | - Myles S Faith
- A.E. Vaughn and D.S. Ward are with the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. D.S. Ward is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. J.O. Fisher is with the Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA. M.S. Faith is with the Department of Counseling, School, and Educational Psychology, Graduate School of Education, University of Buffalo, State University of New York, Buffalo, New York, USA. S.O. Hughes and T.M. O'Connor are with the US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. S.P.J. Kremers is with the Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. D.R. Musher-Eizenman is with the Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA. H. Patrick is with LiveHealthier, Inc., Bethesda, Maryland, USA. T.G. Power is with the Department of Human Development, Washington State University, Pullman, Washington, USA
| | - Sheryl O Hughes
- A.E. Vaughn and D.S. Ward are with the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. D.S. Ward is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. J.O. Fisher is with the Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA. M.S. Faith is with the Department of Counseling, School, and Educational Psychology, Graduate School of Education, University of Buffalo, State University of New York, Buffalo, New York, USA. S.O. Hughes and T.M. O'Connor are with the US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. S.P.J. Kremers is with the Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. D.R. Musher-Eizenman is with the Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA. H. Patrick is with LiveHealthier, Inc., Bethesda, Maryland, USA. T.G. Power is with the Department of Human Development, Washington State University, Pullman, Washington, USA
| | - Stef P J Kremers
- A.E. Vaughn and D.S. Ward are with the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. D.S. Ward is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. J.O. Fisher is with the Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA. M.S. Faith is with the Department of Counseling, School, and Educational Psychology, Graduate School of Education, University of Buffalo, State University of New York, Buffalo, New York, USA. S.O. Hughes and T.M. O'Connor are with the US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. S.P.J. Kremers is with the Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. D.R. Musher-Eizenman is with the Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA. H. Patrick is with LiveHealthier, Inc., Bethesda, Maryland, USA. T.G. Power is with the Department of Human Development, Washington State University, Pullman, Washington, USA
| | - Dara R Musher-Eizenman
- A.E. Vaughn and D.S. Ward are with the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. D.S. Ward is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. J.O. Fisher is with the Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA. M.S. Faith is with the Department of Counseling, School, and Educational Psychology, Graduate School of Education, University of Buffalo, State University of New York, Buffalo, New York, USA. S.O. Hughes and T.M. O'Connor are with the US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. S.P.J. Kremers is with the Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. D.R. Musher-Eizenman is with the Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA. H. Patrick is with LiveHealthier, Inc., Bethesda, Maryland, USA. T.G. Power is with the Department of Human Development, Washington State University, Pullman, Washington, USA
| | - Teresia M O'Connor
- A.E. Vaughn and D.S. Ward are with the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. D.S. Ward is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. J.O. Fisher is with the Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA. M.S. Faith is with the Department of Counseling, School, and Educational Psychology, Graduate School of Education, University of Buffalo, State University of New York, Buffalo, New York, USA. S.O. Hughes and T.M. O'Connor are with the US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. S.P.J. Kremers is with the Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. D.R. Musher-Eizenman is with the Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA. H. Patrick is with LiveHealthier, Inc., Bethesda, Maryland, USA. T.G. Power is with the Department of Human Development, Washington State University, Pullman, Washington, USA
| | - Heather Patrick
- A.E. Vaughn and D.S. Ward are with the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. D.S. Ward is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. J.O. Fisher is with the Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA. M.S. Faith is with the Department of Counseling, School, and Educational Psychology, Graduate School of Education, University of Buffalo, State University of New York, Buffalo, New York, USA. S.O. Hughes and T.M. O'Connor are with the US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. S.P.J. Kremers is with the Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. D.R. Musher-Eizenman is with the Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA. H. Patrick is with LiveHealthier, Inc., Bethesda, Maryland, USA. T.G. Power is with the Department of Human Development, Washington State University, Pullman, Washington, USA
| | - Thomas G Power
- A.E. Vaughn and D.S. Ward are with the Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. D.S. Ward is with the Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. J.O. Fisher is with the Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania, USA. M.S. Faith is with the Department of Counseling, School, and Educational Psychology, Graduate School of Education, University of Buffalo, State University of New York, Buffalo, New York, USA. S.O. Hughes and T.M. O'Connor are with the US Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA. S.P.J. Kremers is with the Department of Health Promotion, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. D.R. Musher-Eizenman is with the Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA. H. Patrick is with LiveHealthier, Inc., Bethesda, Maryland, USA. T.G. Power is with the Department of Human Development, Washington State University, Pullman, Washington, USA
| |
Collapse
|
57
|
It doesn't matter what they say, it matters how they behave: Parental influences and changes in body mass among overweight and obese adolescents. Appetite 2016; 96:47-55. [DOI: 10.1016/j.appet.2015.08.040] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 08/15/2015] [Accepted: 08/29/2015] [Indexed: 11/19/2022]
|
58
|
Morales-Suárez-Varela M, Rubio-López N, Ruso C, Llopis-Gonzalez A, Ruiz-Rojo E, Redondo M, Pico Y. Anthropometric Status and Nutritional Intake in Children (6-9 Years) in Valencia (Spain): The ANIVA Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:16082-95. [PMID: 26694443 PMCID: PMC4690981 DOI: 10.3390/ijerph121215045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/03/2015] [Accepted: 12/16/2015] [Indexed: 01/21/2023]
Abstract
The aim of our study was to assess nutritional intake and anthropometric statuses in schoolchildren to subsequently determine nutritional adequacy with Spanish Dietary Reference Intake (DRIs). The ANIVA study, a descriptive cross-sectional study, was conducted in 710 schoolchildren (6–9 years) in 2013–2014 in Valencia (Spain). Children’s dietary intake was measured using 3-day food records, completed by parents. Anthropometric measures (weight and height) were measured according to international standards, and BMI-for-age was calculated and converted into z-scores by WHO-Anthro for age and sex. Nutrient adequacy was assessed using DRI based on estimated average requirement (EAR) or adequate intake (AI). Pearson’s chi-square and Student’s t-test were employed. Of our study group (47.61% boys, 52.39% girls), 53.1% were normoweight and the weight of 46.9% was inadequate; of these, 38.6% had excess body weight (19.6% overweight and 19.0% obesity). We found intakes were lower for biotin, fiber, fluoride, vitamin D (p < 0.016), zinc, iodine, vitamin E, folic acid, calcium and iron (p < 0.017), and higher for lipids, proteins and cholesterol. Our results identify better nutritional adequacy to Spanish recommendations in overweight children. Our findings suggest that nutritional intervention and educational strategies are needed to promote healthy eating in these children and nutritional adequacies.
Collapse
Affiliation(s)
- María Morales-Suárez-Varela
- Unit of Public Health, Hygiene and Environmental Health, Department of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, University of Valencia, Valencia 46100, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain.
- Center for Advanced Research in Public Health (CSISP-FISABIO), Valencia 46010, Spain.
| | - Nuria Rubio-López
- Unit of Public Health, Hygiene and Environmental Health, Department of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, University of Valencia, Valencia 46100, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain.
- Center for Advanced Research in Public Health (CSISP-FISABIO), Valencia 46010, Spain.
| | - Candelaria Ruso
- Unit of Public Health, Hygiene and Environmental Health, Department of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, University of Valencia, Valencia 46100, Spain.
| | - Agustín Llopis-Gonzalez
- Unit of Public Health, Hygiene and Environmental Health, Department of Preventive Medicine and Public Health, Food Science, Toxicology and Legal Medicine, University of Valencia, Valencia 46100, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain.
- Center for Advanced Research in Public Health (CSISP-FISABIO), Valencia 46010, Spain.
| | - Elías Ruiz-Rojo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain.
- Center for Advanced Research in Public Health (CSISP-FISABIO), Valencia 46010, Spain.
- Dirección General de Salud Pública, Conselleria de Sanidad, Valencia 46010, Spain.
| | - Maximino Redondo
- Biochemistry Departament, Agencia Sanitaria Costa del Sol, University of Malaga, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Marbella 29603, Spain.
| | - Yolanda Pico
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid 28029, Spain.
- Food and Environmental Safety Research Group, Faculty of Pharmacy, University of Valencia, Valencia 46100, Spain.
- Research Center on Desertification (CIDE, UV-CSIC-GV), Carretera Moncada-Náquera, Moncada 46113, Spain.
| |
Collapse
|
59
|
Ward DS, Mazzucca S, McWilliams C, Hales D. Use of the Environment and Policy Evaluation and Observation as a Self-Report Instrument (EPAO-SR) to measure nutrition and physical activity environments in child care settings: validity and reliability evidence. Int J Behav Nutr Phys Act 2015; 12:124. [PMID: 26410387 PMCID: PMC4583722 DOI: 10.1186/s12966-015-0287-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/17/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Early care and education (ECE) centers are important settings influencing young children's diet and physical activity (PA) behaviors. To better understand their impact on diet and PA behaviors as well as to evaluate public health programs aimed at ECE settings, we developed and tested the Environment and Policy Assessment and Observation - Self-Report (EPAO-SR), a self-administered version of the previously validated, researcher-administered EPAO. METHODS Development of the EPAO-SR instrument included modification of items from the EPAO, community advisory group and expert review, and cognitive interviews with center directors and classroom teachers. Reliability and validity data were collected across 4 days in 3-5 year old classrooms in 50 ECE centers in North Carolina. Center teachers and directors completed relevant portions of the EPAO-SR on multiple days according to a standardized protocol, and trained data collectors completed the EPAO for 4 days in the centers. Reliability and validity statistics calculated included percent agreement, kappa, correlation coefficients, coefficients of variation, deviations, mean differences, and intraclass correlation coefficients (ICC), depending on the response option of the item. RESULTS Data demonstrated a range of reliability and validity evidence for the EPAO-SR instrument. Reporting from directors and classroom teachers was consistent and similar to the observational data. Items that produced strongest reliability and validity estimates included beverages served, outside time, and physical activity equipment, while items such as whole grains served and amount of teacher-led PA had lower reliability (observation and self-report) and validity estimates. To overcome lower reliability and validity estimates, some items need administration on multiple days. CONCLUSIONS This study demonstrated appropriate reliability and validity evidence for use of the EPAO-SR in the field. The self-administered EPAO-SR is an advancement of the measurement of ECE settings and can be used by researchers and practitioners to assess the nutrition and physical activity environments of ECE settings.
Collapse
Affiliation(s)
- Dianne S Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2207 McGavran-Greenberg Hall, CB 7461, Chapel Hill, NC, 27599-7461, USA.
| | - Stephanie Mazzucca
- Department of Nutrition, Gillings School of Global Public Health, and 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.
| | - Christina McWilliams
- 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, and 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.
| |
Collapse
|
60
|
Hart LM, Damiano SR, Cornell C, Paxton SJ. What parents know and want to learn about healthy eating and body image in preschool children: a triangulated qualitative study with parents and Early Childhood Professionals. BMC Public Health 2015; 15:596. [PMID: 26135125 PMCID: PMC4487845 DOI: 10.1186/s12889-015-1865-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions for parents to encourage healthy eating in children often do not address parental feeding practices and body image development. METHODS The current study investigated what parents (of children aged 1-6 years) understand about child healthy eating and body image, and what they would like in future interventions, by using structured focus groups with parents, and individual interviews with Early Childhood Professionals. Forty three parents (M(age) = 36.95 years, 93% female, 79% university degree) participated across 9 focus groups. Eleven Early Childhood Professionals (M(age) = 51.04, 100% female, 64% university degree, 64% Maternal and Child Health Nurses, 36% Childcare Centre Directors) completed individual telephone interviews. RESULTS Parents described healthy eating as a variety, balance, and range of foods as well as limiting certain foods, such as the intake of sugar, salt, and processed foods. Most often parents defined child body image as a child's physical appearance and did not mention thoughts and feelings related to appearance or body experiences. Body image was most commonly considered a problem in early adolescence and often not an issue of relevance in early childhood. Parents appeared knowledgeable about nutrition and accessed information about healthy eating across a range of resources though rarely accessed information about child body image. They desired more practical information about how to avoid encouraging negative body image when promoting healthy eating. Professionals' responses confirmed these findings. CONCLUSIONS Results suggest future interventions need to stress the important role positive body image plays in encouraging healthy attitudes to food and weight management, and the benefits positive body image can have on the health and mental health of preschool children.
Collapse
|
61
|
Nehring I, Kostka T, von Kries R, Rehfuess EA. Impacts of in utero and early infant taste experiences on later taste acceptance: a systematic review. J Nutr 2015; 145:1271-9. [PMID: 25878207 DOI: 10.3945/jn.114.203976] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 03/23/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Dietary behavior exerts a critical influence on health and is the outcome of a broad range of interacting factors, including food and taste acceptance. These may be programmed in utero and during early infancy. OBJECTIVE We examined the hypothesis that fetuses and infants exposed to sweet, salty, sour, bitter, umami, or specific tastes show greater acceptance of that same taste later in life. METHODS We conducted a systematic review of the literature, using comprehensive searches and following established procedures for screening, data extraction, and quality appraisal. We used harvest plots to synthesize the evidence graphically. RESULTS Twenty studies comprising 38 subgroups that differed by taste, age, medium, and duration of exposure were included. Exposure to bitter and specific tastes increased the acceptance of these tastes. Studies on sweet and salty tastes showed equivocal results. Studies on sour tastes were sparse. CONCLUSION Our systematic review clearly shows programming of the acceptance of bitter and specific tastes. For other tastes the results were either equivocal or confined to a few number of studies that precluded us from drawing conclusions. Further research should examine the association of salty and sour taste exposures on later preferences of these tastes. Long-term studies and randomized clinical trials on each type of taste are needed.
Collapse
Affiliation(s)
- Ina Nehring
- Institutes for Social Pediatrics and Adolescent Medicine and
| | - Tanja Kostka
- Institutes for Social Pediatrics and Adolescent Medicine and
| | | | - Eva A Rehfuess
- Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| |
Collapse
|
62
|
Antoniou EE, Roefs A, Kremers SPJ, Jansen A, Gubbels JS, Sleddens EFC, Thijs C. Picky eating and child weight status development: a longitudinal study. J Hum Nutr Diet 2015; 29:298-307. [PMID: 25988483 DOI: 10.1111/jhn.12322] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children's picky eating behaviour has been linked both to being overweight and underweight. However, the role of parenting practices in this relationship has rarely been investigated. The present study aimed to clarify the direction of the association between picky eating and weight status and to examine the moderating role of food parenting practices. METHODS The present study comprised a longitudinal study on the effects of picky eating on child weight status within the KOALA Birth Cohort Study, the Netherlands. Mothers and their children were included in the analyses. Children's picky eating behaviour and food parenting practices were assessed at baseline (child age 5 years). Their weight status was assessed repeatedly until age 9 years. Mixed effects linear and logistic regressions were used to compare picky eaters (n = 403) and non-picky eaters (n = 621) on changes in weight status over the years. RESULTS At baseline of age 5 years, picky eaters were slightly shorter, more often underweight and less often overweight than non-picky eaters, whereas energy intake in relation to body weight (kJ kg(-1)) was similar. Picky eaters with a normal weight at baseline had no increased risk of becoming underweight during follow-up until age 9 years, and were less likely to become overweight compared to non-picky eaters. There were no interactions with food parenting practices. The parents of picky eaters more often reported pressuring their child to eat and restrict unhealthy food intake compared to parents of non-picky eaters. CONCLUSIONS The association between picky eating and child weight status was not influenced by parenting practices.
Collapse
Affiliation(s)
- E E Antoniou
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - A Roefs
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - S P J Kremers
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - A Jansen
- Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - J S Gubbels
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - E F C Sleddens
- Department of Health Promotion, Faculty of Health, Medicine and Life Sciences, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - C Thijs
- Department of Epidemiology, Faculty of Health, Medicine and Life Sciences, School of Primary Care and Public Health, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
63
|
Norman Å, Berlin A, Sundblom E, Elinder LS, Nyberg G. Stuck in a vicious circle of stress. Parental concerns and barriers to changing children's dietary and physical activity habits. Appetite 2014; 87:137-42. [PMID: 25542774 DOI: 10.1016/j.appet.2014.12.208] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 12/05/2014] [Accepted: 12/17/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Dietary habits and physical activity are often the focus of obesity prevention programmes and involving parents in such programmes has proven to be effective. The aims of this study were to describe parents' concerns about their children's diet and physical activity habits and to describe barriers to change. RESULTS The study used archival data gathered unobtrusively in the form of memos taken after sessions of Motivational Interviewing as part of the parental support programme, A Healthy School Start. The 74 MI-sessions were conducted from October 2010 to April 2011 with either a mother or father or both, all with children in pre-school class. Thematic analysis was applied. Three themes were identified regarding children's dietary habits: amount of food consumed influenced by behaviour in the family, eating situations influenced by stressful everyday life and family interplay, and food choices influenced by stressful everyday life and family interplay. One theme appeared regarding physical activity: physical activity influenced by stressful everyday life and family interplay. CONCLUSION Family interplay appears to be an important link between the work-life stress perceived by parents and less healthy food and physical activity habits in the home. Both lack of parental cooperation and negative parent-child interactions may act as barriers to healthy eating and physical activity and should be addressed in future intervention studies on health-related behaviours of children.
Collapse
Affiliation(s)
- Åsa Norman
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden.
| | - Anita Berlin
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Box 23100, 141 83 Huddinge, Sweden
| | - Elinor Sundblom
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
| | | | - Gisela Nyberg
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Stockholm, Sweden
| |
Collapse
|
64
|
Mameli C, Galli E, Dilillo D, Alemanno A, Catalani L, Cau S, Fransos L, Lucidi F, Macrì A, Marconi P, Mostaccio A, Presti G, Rovera G, Rotilio G, Rubeo M, Tisiot C, Zuccotti G. Psychosocial, behavioural, pedagogical, and nutritional proposals about how to encourage eating a healthy breakfast. Ital J Pediatr 2014; 40:73. [PMID: 25125024 PMCID: PMC4237809 DOI: 10.1186/s13052-014-0073-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/04/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even if more and more evidences have highlighted the importance of breakfast in the growth and development of children, from 10 to 30% of US and European children and adolescents regularly skip breakfast. Thus, there is still a lot to be done before breakfast becomes a daily habit. The aim of this paper is to try and understand how it is possible to overcome the real or imaginary difficulties associated with skipping breakfast by psychosocial, behavioural, pedagogical and nutritional proposals. DISCUSSION Schools are the best context where perform healthy interventions because it is here that children learn about the importance of good health at an age when the school still plays a major role in their education. Some school interventions, based on solid theories as the Self Determination Theory and the Behaviour Analysis, have been implemented in the last years to promote health behaviour such as intake of fruit and vegetables and physical activities. Cognitive behaviour therapy is the most closely monitored type of treatment/cure for obesity in randomised controlled trials. Moreover some associations such as the National Association of Food Science Specialists have drawn an own method to encourage food education at school and promote the importance of prevention. These projects could be used as starting point to perform interventions focus on breakfast. SUMMARY Increase the consumption of breakfast between children is very important. Efforts should be done to drawn new school projects based on scientific-evidences.
Collapse
Affiliation(s)
- Chiara Mameli
- Department of Paediatrics, University of Milan, “Luigi Sacco” Hospital, Milan, Italy
| | - Erica Galli
- Department of Paediatrics, University of Milan, “Luigi Sacco” Hospital, Milan, Italy
| | - Dario Dilillo
- Department of Paediatrics, University of Milan, “Luigi Sacco” Hospital, Milan, Italy
| | | | | | - Silvia Cau
- Istituto Universitario di Lingue Moderne - IULM University of Milan, Milan, Italy
| | - Lucia Fransos
- Italian Association of Food Science Specialists (ANSiSA), Milan, Italy
| | - Fabio Lucidi
- Department of Psychology of Developmental and Socialisation Processes, University “La Sapienza” of Rome, Rome, Italy
| | | | - Paolo Marconi
- Italian Association of Food Science Specialists (ANSiSA), Milan, Italy
| | | | | | - Giuseppe Rovera
- Italian Association of Food Science Specialists (ANSiSA), Milan, Italy
| | | | - Mariagrazia Rubeo
- Italian Eating and Weight Disorders Association (AIDAP), Rome, Italy
| | - Carla Tisiot
- Association of Italian Pedagogists (ANPE), Rome, Italy
| | - Gianvincenzo Zuccotti
- Department of Paediatrics, University of Milan, “Luigi Sacco” Hospital, Milan, Italy
| |
Collapse
|
65
|
Manios Y, Androutsos O, Katsarou C, Iotova V, Socha P, Geyer C, Moreno L, Koletzko B, De Bourdeaudhuij I. Designing and implementing a kindergarten-based, family-involved intervention to prevent obesity in early childhood: the ToyBox-study. Obes Rev 2014; 15 Suppl 3:5-13. [PMID: 25047374 DOI: 10.1111/obr.12175] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 04/08/2014] [Accepted: 04/08/2014] [Indexed: 11/28/2022]
Abstract
The development of the ToyBox-intervention was based on the outcomes of the preliminary phase of the ToyBox-study, aiming to identify young children's key behaviours and their determinants related to early childhood obesity. The ToyBox-intervention is a multi-component, kindergarten-based, family-involved intervention with a cluster-randomized design, focusing on the promotion of water consumption, healthy snacking, physical activity and the reduction/ breaking up of sedentary time in preschool children and their families. The intervention was implemented during the academic year 2012-2013 in six European countries: Belgium, Bulgaria, Germany, Greece, Poland and Spain. Standardized protocols, methods, tools and material were used in all countries for the implementation of the intervention, as well as for the process, impact, outcome evaluation and the assessment of its cost-effectiveness. A total sample of 7,056 preschool children and their parents/caregivers, stratified by socioeconomic level, provided data during baseline measurements and participated in the intervention. The results of the ToyBox-study are expected to provide a better insight on behaviours associated with early childhood obesity and their determinants and identify effective strategies for its prevention. The aim of the current paper is to describe the design of the ToyBox-intervention and present the characteristics of the study sample as assessed at baseline, prior to the implementation of the intervention.
Collapse
Affiliation(s)
- Y Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | | | | | | | | | | | | | | | | | | |
Collapse
|
66
|
Duvinage K, Ibrügger S, Kreichauf S, Wildgruber A, De Craemer M, De Decker E, Androutsos O, Lateva M, Iotova V, Socha P, Zych K, Mouratidou T, Mesana Graffe MI, Manios Y, Koletzko B. Developing the intervention material to increase physical activity levels of European preschool children: the ToyBox-study. Obes Rev 2014; 15 Suppl 3:27-39. [PMID: 25047376 DOI: 10.1111/obr.12176] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 04/09/2014] [Accepted: 04/09/2014] [Indexed: 01/11/2023]
Abstract
Early childhood is an important period for adopting positive health-related behaviours. More than 95% of European preschool children attend kindergartens, making these settings ideal for the implementation of health promotion interventions. The ToyBox-intervention addressed preschool children, their parents/caregivers and teachers. The aim of the intervention was to improve four energy balance-related behaviours (i.e. healthy snacking, water consumption, physical activity and sedentary behaviour) by implementing a kindergarten-based, family-involved intervention in six European countries (Belgium, Bulgaria, Germany, Greece, Poland and Spain). The intervention material was developed following the intervention mapping protocol, taking into account local and cultural differences among the intervention countries. The present paper focuses on the development of the physical activity component of the intervention. Parental involvement was addressed by providing parents/caregivers with two newsletters, two tip cards and a poster. Teachers received a handbook with guidance on environmental changes in the classroom, 26 physical education sessions and suggestions for fun, interactive classroom activities aiming at total class participation to increase preschoolers' physical activity levels. The ToyBox-intervention material was distributed according to a standard time frame. Teachers received their material prior to the start of the intervention and parents/caregivers received their material during the intervention when each energy balance-related behaviour was implemented.
Collapse
Affiliation(s)
- K Duvinage
- Division of Metabolic and Nutritional Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, München, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
67
|
Manios Y. Methodological procedures followed in a kindergarten-based, family-involved intervention implemented in six European countries to prevent obesity in early childhood: the ToyBox-study. Obes Rev 2014; 15 Suppl 3:1-4. [PMID: 25047373 DOI: 10.1111/obr.12178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Y Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | | |
Collapse
|
68
|
Entin A, Kaufman-Shriqui V, Naggan L, Vardi H, Shahar DR. Parental Feeding Practices in Relation to Low Diet Quality and Obesity among LSES Children. J Am Coll Nutr 2014; 33:306-14. [DOI: 10.1080/07315724.2013.874936] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
69
|
A systematic review of types of healthy eating interventions in preschools. Nutr J 2014; 13:56. [PMID: 24906305 PMCID: PMC4074866 DOI: 10.1186/1475-2891-13-56] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 05/14/2014] [Indexed: 02/02/2023] Open
Abstract
Background With the worldwide levels of obesity new venues for promotion of healthy eating habits are necessary. Considering children’s eating habits are founded during their preschool years early educational establishments are a promising place for making health promoting interventions. Methods This systematic review evaluates different types of healthy eating interventions attempting to prevent obesity among 3 to 6 year-olds in preschools, kindergartens and day care facilities. Studies that included single interventions, educational interventions and/or multicomponent interventions were eligible for review. Included studies also had to have conducted both baseline and follow-up measurements. A systematic search of the databases Scopus, Web of Science, CINAHL and PubMed was conducted to identify articles that met the inclusion criteria. The bibliographies of identified articles were also searched for relevant articles. Results The review identified 4186 articles, of which 26 studies met the inclusion criteria. Fifteen of the interventions took place in preschools, 10 in kindergartens and 1 in another facility where children were cared for by individuals other than their parents. Seventeen of the 26 included studies were located in North America, 1 in South America, 5 in Asia, and 3 in a European context. Healthy eating interventions in day care facilities increased fruit and vegetable consumption and nutrition related knowledge among the target groups. Only 2 studies reported a significant decrease in body mass index. Conclusions This review highlights the scarcity of properly designed healthy eating interventions using clear indicators and verifiable outcomes. The potential of preschools as a potential setting for influencing children’s food choice at an early age should be more widely recognised and utilised.
Collapse
|
70
|
Tatlow-Golden M, Hennessy E, Dean M, Hollywood L. Young children's food brand knowledge. Early development and associations with television viewing and parent's diet. Appetite 2014; 80:197-203. [PMID: 24859112 DOI: 10.1016/j.appet.2014.05.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/12/2014] [Accepted: 05/15/2014] [Indexed: 10/25/2022]
Abstract
Brand knowledge is a prerequisite of children's requests and choices for branded foods. We explored the development of young children's brand knowledge of foods highly advertised on television - both healthy and less healthy. Participants were 172 children aged 3-5 years in diverse socio-economic settings, from two jurisdictions on the island of Ireland with different regulatory environments. Results indicated that food brand knowledge (i) did not differ across jurisdictions; (ii) increased significantly between 3 and 4 years; and (iii) children had significantly greater knowledge of unhealthy food brands, compared with similarly advertised healthy brands. In addition, (iv) children's healthy food brand knowledge was not related to their television viewing, their mother's education, or parent or child eating. However, (v) unhealthy brand knowledge was significantly related to all these factors, although only parent eating and children's age were independent predictors. Findings indicate that effects of food marketing for unhealthy foods take place through routes other than television advertising alone, and are present before pre-schoolers develop the concept of healthy eating. Implications are that marketing restrictions of unhealthy foods should extend beyond television advertising; and that family-focused obesity prevention programmes should begin before children are 3 years of age.
Collapse
Affiliation(s)
- Mimi Tatlow-Golden
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland
| | - Eilis Hennessy
- School of Psychology, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Moira Dean
- Institute for Global Food Security, Queen's University Belfast, David Keir Building, Stranmillis Road, Belfast BT9 5AG, Northern Ireland, UK
| | - Lynsey Hollywood
- Institute for Global Food Security, Queen's University Belfast, David Keir Building, Stranmillis Road, Belfast BT9 5AG, Northern Ireland, UK
| |
Collapse
|
71
|
Martínez-Andrade GO, Cespedes EM, Rifas-Shiman SL, Romero-Quechol G, González-Unzaga MA, Benítez-Trejo MA, Flores-Huerta S, Horan C, Haines J, Taveras EM, Pérez-Cuevas R, Gillman MW. Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City. BMC Pediatr 2014; 14:77. [PMID: 24649831 PMCID: PMC3999907 DOI: 10.1186/1471-2431-14-77] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 03/17/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics. METHODS We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children's height and weight and parents reported children's diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values. RESULTS 93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program. CONCLUSIONS Although satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI. TRIAL REGISTRATION ClinicalTrials.gov NCT01539070.Comisión Nacional de Investigación Científica del IMSS: 2009-785-120.
Collapse
Affiliation(s)
| | - Elizabeth M Cespedes
- Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 3rd Floor, Boston, MA 02215, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
72
|
Prevalence and risk factors of iron deficiency in healthy young children in the southwestern Netherlands. J Pediatr Gastroenterol Nutr 2014; 58:193-8. [PMID: 24145621 DOI: 10.1097/mpg.0000000000000216] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Iron deficiency (ID) and iron deficiency anemia (IDA), during the first years of life, are associated with delayed motor and neurological development. Many studies evaluated iron status without an assessment of an acute-phase protein to identify infection. Because most indicators of iron status are influenced by infection, these data may underestimate the ID prevalence. A food consumption survey in the Netherlands showed that the mean iron intake of children ages 2 to 3 years was below the advised adequate intake of 7 mg/day. The aim of the study was to investigate iron status in a well-defined, healthy population of young children in the southwestern region of the Netherlands and to identify risk factors for ID. METHODS We conducted a multicenter, observational study in healthy children ages 0.5 to 3 years. We defined ID as ferritin <12 μg/L and IDA when, in addition, hemoglobin was <110 g/L. Children with elevated C-reactive protein levels (>5 mg/L) or underlying causes for anemia were excluded. Parents filled in a questionnaire to identify risk factors for ID. RESULTS We included 400 children in the study. ID and IDA were detected in 18.8% and 8.5% of the children, respectively. The present use of formula and the visit of preschool/day care were associated with a lower prevalence of ID, and a high intake of cow's milk was associated with a higher prevalence of ID, after adjustment for age. CONCLUSIONS ID is present in 18.8% of healthy children ages 0.5 to 3 years and living in the southwestern region of the Netherlands. The present visit of preschool/day care and the use of formula are associated with a reduced risk of ID, whereas a high intake of cow's milk is associated with an increased risk of ID.
Collapse
|
73
|
Persaud N, Maguire JL, Lebovic G, Carsley S, Khovratovich M, Randall Simpson JA, McCrindle BW, Parkin PC, Birken C. Association between serum cholesterol and eating behaviours during early childhood: a cross-sectional study. CMAJ 2013; 185:E531-6. [PMID: 23775611 DOI: 10.1503/cmaj.121834] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Modifiable behaviours during early childhood may provide opportunities to prevent disease processes before adverse outcomes occur. Our objective was to determine whether young children's eating behaviours were associated with increased risk of cardiovascular disease in later life. METHODS In this cross-sectional study involving children aged 3-5 years recruited from 7 primary care practices in Toronto, Ontario, we assessed the relation between eating behaviours as assessed by the NutriSTEP (Nutritional Screening Tool for Every Preschooler) questionnaire (completed by parents) and serum levels of non-high-density lipoprotein (HDL) cholesterol, a surrogate marker of cardiovascular risk. We also assessed the relation between dietary intake and serum non-HDL cholesterol, and between eating behaviours and other laboratory indices of cardiovascular risk (low-density lipoprotein [LDL] cholesterol, apolipoprotein B, HDL cholesterol and apoliprotein A1). RESULTS A total of 1856 children were recruited from primary care practices in Toronto. Of these children, we included 1076 in our study for whom complete data and blood samples were available for analysis. The eating behaviours subscore of the NutriSTEP tool was significantly associated with serum non-HDL cholesterol (p = 0.03); for each unit increase in the eating behaviours subscore suggesting greater nutritional risk, we saw an increase of 0.02 mmol/L (95% confidence interval [CI] 0.002 to 0.05) in serum non-HDL cholesterol. The eating behaviours subscore was also associated with LDL cholesterol and apolipoprotein B, but not with HDL cholesterol or apolipoprotein A1. The dietary intake subscore was not associated with non-HDL cholesterol. INTERPRETATION Eating behaviours in preschool-aged children are important potentially modifiable determinants of cardiovascular risk and should be a focus for future studies of screening and behavioural interventions.
Collapse
Affiliation(s)
- Navindra Persaud
- Keenan Research Centre, Li Ka Shing Knowledge Institute, Toronto, Ont. nav.persaud @utoronto.ca
| | | | | | | | | | | | | | | | | | | |
Collapse
|
74
|
Lakshman R, Mazarello Paes V, Hesketh K, O'Malley C, Moore H, Ong K, Griffin S, van Sluijs E, Summerbell C. Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses. Syst Rev 2013; 2:28. [PMID: 23663239 PMCID: PMC3691606 DOI: 10.1186/2046-4053-2-28] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/22/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of these reviews is to inform the design and content of interventions to reduce obesity in young children. The behaviors that are associated with obesity/overweight have been studied extensively; however, the factors associated with these behaviors in young children (0 to 6 years) have not been systematically reviewed. Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood. In order to develop effective interventions and change behavior, it is important to understand the factors that are associated with those behaviors. For example, we need to understand whether it would be more important to target the family, childcare settings or the wider environment and identify the most effective way of changing these energy balance related behaviors. METHODS/DESIGN Quantitative (intervention and observational) and qualitative literature on determinants/correlates of fruit and vegetable intake, sugar sweetened beverage and other unhealthy diet intake, and physical activity and sedentary behaviors in young children will be systematically identified, mapped and reviewed. A common search strategy (no language or period restrictions) will be used to identify papers from eight electronic databases and this will be supplemented by hand-searching. Next, studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years (at baseline) will be screened and mapped descriptively followed by in-depth data extraction, quality assessment and synthesis. Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis, and qualitative studies using thematic analysis. Qualitative evidence will be integrated with the quantitative evidence, using a parallel synthesis approach, to provide a deeper understanding of effective strategies to influence these energy balance related behaviors. DISCUSSION In addition to updating and mapping current research, these reviews will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group (0 to 6 years) with the aim of informing future interventions. TRIAL REGISTRATION International Prospective Register for Systematic Reviews (PROSPERO) Registration number: CRD42012002881.
Collapse
|
75
|
Manios Y, Grammatikaki E, Androutsos O, Chinapaw MJM, Gibson EL, Buijs G, Iotova V, Socha P, Annemans L, Wildgruber A, Mouratidou T, Yngve A, Duvinage K, de Bourdeaudhuij I. A systematic approach for the development of a kindergarten-based intervention for the prevention of obesity in preschool age children: the ToyBox-study. Obes Rev 2012; 13 Suppl 1:3-12. [PMID: 22309061 DOI: 10.1111/j.1467-789x.2011.00974.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The increasing childhood obesity epidemic calls for appropriate measures and effective policies to be applied early in life. Large-scale socioecological frameworks providing a holistic multifactorial and cost-effective approach necessary to support obesity prevention initiatives in this age are however currently missing. To address this missing link, ToyBox-study aims to build and evaluate a cost-effective kindergarten-based, family-involved intervention scheme to prevent obesity in early childhood, which could potentially be expanded on a pan-European scale. A multidisciplinary team of researchers from 10 countries have joined forces and will work to realize this according to a systematic stepwise approach that combines the use of the PRECEDE-PROCEED model and intervention mapping protocol. ToyBox-study will conduct systematic and narrative reviews, secondary data analyses, focus group research and societal assessment to design, implement and evaluate outcome, impact, process and cost effectiveness of the intervention. This is the first time that such a holistic approach has been used on a pan-European scale to promote healthy weight and healthy energy balance-related behaviours for the prevention of early childhood obesity. The results of ToyBox-study will be disseminated among key stakeholders including researchers, policy makers, practitioners and the general population.
Collapse
Affiliation(s)
- Y Manios
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
76
|
Summerbell CD, Moore HJ, Vögele C, Kreichauf S, Wildgruber A, Manios Y, Douthwaite W, Nixon CA, Gibson EL. Evidence-based recommendations for the development of obesity prevention programs targeted at preschool children. Obes Rev 2012; 13 Suppl 1:129-32. [PMID: 22309071 DOI: 10.1111/j.1467-789x.2011.00940.x] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The ToyBox intervention was developed using an evidence-based approach, using the findings of four reviews. These reviews included three critical and narrative reviews of educational strategies and psychological approaches explaining young children's acquisition and formation of energy-balance related behaviours, and the management of these behaviours, and also a systematic review of behavioural models underpinning school-based interventions in preschool and school settings for the prevention of obesity in children aged 4-6 years. This paper summarises and translates the findings from these reviews into practical evidence based recommendations for researchers and policy-makers to consider when developing and implementing interventions for the prevention of overweight and obesity in young (aged 4-6 years) children. The recommendations focus on two behaviours, physical activity and sedentary behaviour, and healthy eating, and include general recommendations, intervention approaches, interventions content, and simple messages. The review also briefly examines the role that the commercial sector plays in hindering or facilitating attempts to create healthy food environments for children. This paper also recognises that childhood obesity is not an issue for the education sector alone; it needs to be tackled at a multi sectoral level, recognizing the particularly important role of local governments, nongovernment organizations and the media.
Collapse
Affiliation(s)
- C D Summerbell
- Obesity Related Behaviours Group, School of Medicine and Health, Wolfson Research Institute, Durham University Queen's Campus, Stockton-on-Tees, UK.
| | | | | | | | | | | | | | | | | | | |
Collapse
|