Family dinner and diet quality among older children and adolescents

Family meals with young children: an online study of family mealtime characteristics, among Australian families with children aged six months to six years

BACKGROUND

Evidence suggests that family meals influence food intakes and behaviours, which in turn impact children's eating habits, diets and health. Mealtimes therefore offer potential as settings for health promotion. Given diet, health behaviours and health are often socioeconomically patterned, it is important to consider whether family meals differ by socioeconomic position (SEP).

METHODS

The Family Meals with Young Kids study was an online survey completed by parents in 2014. Mealtime characteristics measured included; frequency of shared meals across the day, duration and location of mealtimes, parental modelling, and parental perceived importance of the evening meal. Maternal education was used to assess SEP. The aims of this study were to describe family meal characteristics among Australian families with children aged six months to six years and to describe the socioeconomic patterning of these.

RESULTS

Participants (n = 992) were mostly mothers (97%) with a university degree (71%). The evening meal was the most frequently reported meal eaten together with the responding parent and child (77% ≥ five nights/week). Snacks were least commonly eaten together (39% ≥ five days/week). The frequency of having everyone present for the evening meal was inversely associated with SEP (OR 0.70, CI 0.54-0.92). Parent rated importance of family meals was generally high and positively associated with higher SEP (OR 1.32, CI 1.00-1.76). Most children consumed breakfast (73%), lunch (58%) and dinner (82%) sitting at a table or bench and this was positively associated with higher SEP for all meal types (OR 1.61-2.37, p < 0.05). Increased television (TV) viewing during meals was inversely associated with SEP (OR 0.63, CI 0.54-0.72). Less than half of children (36%) watched TV during meals more than once a day.

CONCLUSIONS

Australian families engage in many healthy mealtime behaviours. Evidence that parents share meals with children and place high value on mealtimes with children provides important opportunities for promoting healthy behaviours in families. The choice of eating location and the practice of viewing TV during mealtimes are examples of two such opportunities. Socioeconomic patterning of the location of mealtimes and TV viewing during meals may contribute to socioeconomic differences in dietary intakes and may be important targets for future health promotion.

Individual, behavioural and home environmental factors associated with eating behaviours in young adolescents

This study aimed to examine individual, behavioural and home environmental factors associated with frequency of consumption of fruit, vegetables and energy-dense snacks among adolescents. Adolescents aged 11-12 years (n = 521, 48% boys) completed a paper-based questionnaire during class-time which included a Food Frequency Questionnaire assessing their consumption of fruit, vegetables, and energy-dense (ED) snacks, and items assessing habits, self-efficacy, eating at the television (TV), eating with parents, parenting practices, and home availability and accessibility of foods. Multiple linear regression analyses showed that eating fruit and vegetables while watching TV and home availability and accessibility of fruit and vegetables were positively associated with frequency of fruit consumption and vegetable consumption, while home accessibility of ED snack foods was negatively associated with frequency of fruit consumption. Habit for eating ED snack foods in front the TV, eating ED snack foods while watching TV, and home availability of ED snacks were positively associated with frequency of ED snack consumption. This study has highlighted the importance of a healthy home environment for promoting fruit and vegetable intake in early adolescents and also suggests that, if snacking while TV viewing occurs, this could be a good opportunity for promoting fruit and vegetable intake. These findings are likely to be useful for supporting the development of multi-faceted interventions and aid us in knowing what advice to give to parents to help them to help their young adolescents to develop and maintain healthy eating habits.

Regular family breakfast was associated with children's overweight and parental education: Results from the ENERGY cross-sectional study

INTRODUCTION

This study aims to assess (i) the prevalence of having regular family breakfast, lunch, dinner (i.e. 5-7days/week together with their family) among 10-12year olds in Europe, (ii) the association between family meals and child weight status, and (iii) potential differences in having family meals according to country of residence, gender, ethnicity and parental levels of education.

METHODS

7716 children (mean age: 11.5±0.7years, 52% girls) in eight European countries (Belgium, Greece, Hungary, The Netherlands, Norway, Slovenia, Spain, Switzerland) participated in a cross-sectional school-based survey in 2010. Data on family meals were self-reported by the parents and children's height and weight were objectively measured to determine overweight status. Binary regression analyses assessed the associations of having regular family meals (adjusted for potential confounders) with children's overweight/obesity and to assess potential differences in having family meals according to gender, ethnicity and parental education, in the total sample and for each country respectively.

RESULTS

The prevalence of regular family meals was 35%, 37% and 76% for breakfast, lunch and dinner respectively. Having regular family breakfast, but not lunch or dinner, was inversely associated with overweight (OR=0.78 (95% CI 0.67-0.91)). Children of higher educated parents were more likely to have regular family breakfast (1.63 (95% CI 1.42-1.86)) and less likely to have regular family lunch (0.72 (95% CI 0.63-0.82)) compared to children of lower educated parents.

CONCLUSION

This study showed that having regular family breakfast - but not other family meals- was inversely associated with children's weight status.

Perspectives About Family Meals from Racially/Ethnically and Socioeconomically Diverse Households With and Without an Overweight/Obese Child

BACKGROUND

Several quantitative studies have found a protective association between family meal frequency and child and adolescent weight and weight-related behaviors (e.g., healthy dietary intake, less disordered eating behaviors). However, limited qualitative research has been conducted to understand more in depth about family meal-level characteristics (e.g., rules, responsibilities, and interpersonal dynamics) that may be risk or protective factors for child weight and weight-related behaviors. The current study aimed to identify family meal-level characteristics within racially/ethnically and socioeconomically diverse households that were similar and/or different between households with and without an overweight/obese child.

METHODS

The current study is a qualitative study including 118 parents of children ages 6-12 who participated in the Family Meals, LIVE!

STUDY

Parents (92% female) were from racially/ethnically (87% minority) and socioeconomically (73% <$35,000 per year) diverse households. Parents were individually interviewed during a home visit. Data were stratified by child weight status (i.e., normal weight vs. overweight/obese) and analyzed using deductive and inductive content analysis.

RESULTS

Qualitative results showed some similarities and some differences in family meal-level characteristics by child weight status that may provide insight into past research showing significant associations between family meal frequency and child weight and weight-related behaviors. Similar themes between families with and without an overweight/obese child included: family meals provide more healthful food; rules about manners; meal planning; and involving children in meal preparation. Themes that were different between families with and without an overweight/obese child included: connection and communication; "clean your plate rule"; electronic devices; and child behavior problems.

CONCLUSIONS

Findings from the current study may be useful for developing interventions for racially/ethnically and socioeconomically diverse households with and without an overweight/obese child to be delivered through family meals.

Dietary intake of working women with children does not appear to be influenced by hours of employment: A secondary analysis of the Australian Health Survey (2011-2013)

Women with children often fulfil multiple roles of running a household, raising a family and working outside the home. Good nutrition during this time is important to optimise their performance and prevent lifestyle diseases. Women also act as nutritional gatekeepers for their family. The dual burden of paid employment and unpaid family work may be associated with time scarcity in mothers which can impact food preparation and therefore nutritional adequacy. The aim of this study was to examine the diet of women who lived with children by comparison of hours worked.

METHODS

This was a secondary analysis of the Australian National Nutrition and Physical Activity Survey 2011-12. Subjects were women aged 18-65 years who resided with ≥1 child (<18 years). Women were grouped according to hours of employment: not working; working <25 h a week; and working ≥25 hours a week. Data from two 24-h dietary recalls were used to compare differences between groups in nutrient intake and proportion of energy from discretionary foods. Covariates included were age, education, smoker status, Socio-Economic Indexes for Areas (SEIFA), number of persons in household, week or weekend day of the survey and the sequence of recalls.

RESULTS

Analyses included 1869 women. Dietary intakes varied minimally between groups with intakes of fibre, vitamin C, and calcium lowest in the group not working. Overall diet quality was poor with >30% of energy coming from discretionary foods in all groups.

CONCLUSIONS

Usual hours of employment per week have a minimal effect on diet quality in women with children. It is likely that different factors specific to each group contribute to the poor dietary intakes and should be further investigated.

What's Being Served for Dinner? An Exploratory Investigation of the Associations between the Healthfulness of Family Meals and Child Dietary Intake

BACKGROUND

Little is known about the healthfulness of foods offered at family meals or the relationship between the food's healthfulness and child overall dietary intake.

OBJECTIVE

This exploratory study uses a newly developed Healthfulness of Meal Index to examine the association between the healthfulness of foods served at family dinners and child dietary intake.

DESIGN

Direct observational, cross-sectional study.

PARTICIPANTS/SETTING

Primarily low-income, minority families (n=120) video recorded 8 days of family dinners and completed a corresponding meal screener. Dietary recalls were completed on the target child (6 to 12 years old). The Healthfulness of Meal Index was used to measure meal healthfulness and included component scores for whole fruit, 100% juice, vegetables, dark green vegetables, dairy, protein, added sugars, and high-sodium foods.

MAIN OUTCOME MEASURES

Child dietary intake measured by three 24-hour dietary recalls.

STATISTICAL ANALYSES PERFORMED

Linear regression models estimated the association between the healthfulness of foods served at dinner meals and overall child HEI.

RESULTS

The majority of coded meals included foods from protein and high-sodium components; more than half included foods from dairy and vegetable components. Nearly half of the meals had an added-sugar component food (eg, soda or dessert). Few meals served foods from fruit, 100% juice, or dark green vegetable components. Many components served at family dinner meals were significantly associated with child daily intake of those same foods (ie, dark green vegetable, non-dark green vegetables, dairy, and added sugars). The Healthfulness of Meal Index total score was significantly associated with child HEI score.

CONCLUSIONS

This study represents the first report of a new methodology to collect data of foods served at family dinners. Results indicated a significant association between the majority of components served at family dinner meals and child overall dietary intake. Validation of the Healthfulness of Meal Index and video-recorded family meal methodology is needed to strengthen these research methods for use in future studies.

Impact of school-based vegetable garden and physical activity coordinated health interventions on weight status and weight-related behaviors of ethnically diverse, low-income students: Study design and baseline data of the Texas, Grow! Eat! Go! (TGEG) cluster-randomized controlled trial

Background

Coordinated, multi-component school-based interventions can improve health behaviors in children, as well as parents, and impact the weight status of students. By leveraging a unique collaboration between Texas AgriLife Extension (a federal, state and county funded educational outreach organization) and the University of Texas School of Public Health, the Texas Grow! Eat! Go! Study (TGEG) modeled the effectiveness of utilizing existing programs and volunteer infrastructure to disseminate an enhanced Coordinated School Health program. The five-year TGEG study was developed to assess the independent and combined impact of gardening, nutrition and physical activity intervention(s) on the prevalence of healthy eating, physical activity and weight status among low-income elementary students. The purpose of this paper is to report on study design, baseline characteristics, intervention approaches, data collection and baseline data.

Methods

The study design for the TGEG study consisted of a factorial group randomized controlled trial (RCT) in which 28 schools were randomly assigned to one of 4 treatment groups: (1) Coordinated Approach to Child Health (CATCH) only (Comparison), (2) CATCH plus school garden intervention [Learn, Grow, Eat & Go! (LGEG)], (3) CATCH plus physical activity intervention [Walk Across Texas (WAT)], and (4) CATCH plus LGEG plus WAT (Combined). The outcome variables include student’s weight status, vegetable and sugar sweetened beverage consumption, physical activity, and sedentary behavior. Parents were assessed for home environmental variables including availability of certain foods, social support of student health behaviors, parent engagement and behavior modeling.

Results

Descriptive data are presented for students (n = 1369) and parents (n = 1206) at baseline. The sample consisted primarily of Hispanic and African American (53 % and 18 %, respectively) and low-income (i.e., 78 % eligible for Free and Reduced Price School Meals program and 43 % food insecure) students. On average, students did not meet national guidelines for vegetable consumption or physical activity. At baseline, no statistical differences for demographic or key outcome variables among the 4 treatment groups were observed.

Conclusions

The TGEG study targets a population of students and parents at high risk of obesity and related chronic conditions, utilizing a novel and collaborative approach to program formulation and delivery, and a rigorous, randomized study design.

Systematic Review of School-Based Interventions to Modify Dietary Behavior: Does Intervention Intensity Impact Effectiveness?

BACKGROUND

Owing to the associations between diet and health, it is important that effective health promotion strategies establish healthful eating behaviors from an early age. We reviewed the intensity of school-based interventions aimed to modify dietary behavior in preadolescent and adolescents and related intervention characteristics to effectiveness.

METHODS

Our systematic literature search of 8 databases sought to identify interventions measuring dietary intake in school settings to students aged 9 to 18. We evaluated these studies for effectiveness, intensity, intervention category, and follow-up measures.

RESULTS

Of the 105 interventions 81 were found to be effective immediately postintervention, irrespective of intensity. Studies that were 6 weeks to 5 months in duration, targeted students' environment or group (alone or in combination), and reached students only in schools were more effective. Only one-fifth of interventions conducted a follow-up measure, and a majority showed a loss of effectiveness from postintervention to follow-up.

CONCLUSIONS

We identified characteristics of effective interventions. These findings may inform the development of future interventions targeting dietary behavior in preadolescents and adolescents in the school-based setting.

Positive influences of home food environment on primary-school children’s diet and weight status: a structural equation model approach

Objectives

The mechanism by which the home food environment (HFE) influences childhood obesity is unclear. The present study aimed to investigate the relationship between HFE and childhood obesity as mediated by diet in primary-school children.

Design

Cross-sectional data collected from parents and primary-school children participating in the Obesity Prevention and Lifestyle Evaluation Project. Only children aged 9–11 years participated in the study. Matched parent/child data (n3323) were analysed. Exploratory factor analysis underlined components of twenty-one HFE items; these were linked to child diet (meeting guidelines for fruit, vegetable and non-core food intakes) and measured child BMI, in structural equation modelling, adjusting for confounders.

Setting

Twenty geographically bounded metropolitan and regional South Australian communities.

Subjects

School children and their parents from primary schools in selected communities.

Results

In the initial exploratory factor analysis, nineteen items remaining extracted eight factors with eigenvalues >1·0 (72·4 % of total variance). A five-factor structure incorporating ten items described HFE. After adjusting for age, gender, socio-economic status and physical activity all associations in the model were significant (P<0·05), explaining 9·3 % and 4·5 % of the variance in child diet and BMI, respectively. A more positive HFE was directly and indirectly associated with a lower BMI in children through child diet.

Conclusions

The robust statistical methodology used in the present study provides support for a model of direct and indirect dynamics between the HFE and childhood obesity. The model can be tested in future longitudinal and intervention studies to identify the most effective components of the HFE to target in childhood obesity prevention efforts.

Food-choice motives of adolescents in Jakarta, Indonesia: the roles of gender and family income

Objective

The aims of the present study were to assess the reliability and validity of the Food Choice Questionnaire (FCQ) and to determine the factors associated with food-choice motives in public junior-high-school students in Jakarta, Indonesia.

Design

Cross-sectional study with self-administered questionnaires. Trained research assistants measured height and weight of the participants on the day of the data collection.

Settings

Fourteen randomly selected public junior-high schools in East Jakarta, Indonesia.

Subjects

Public junior-high-school students (n681) in grades 7 and 8, aged 13–14 years (377 girls and 304 boys).

Results

Three food-choice motives (subscales) were obtained from factor analysis and reliability testing: (i) comfort; (ii) convenience and price; and (iii) health. The subscale with the greatest mean value was health. Family affluence was inversely associated with the convenience and price subscale (β=−0·05,P=0·01) and with the health subscale (β=−0·04;P=0·02). Females were less likely than males to consider health when choosing foods (β=−0·16;P=0·03).

Conclusions

While its factor structure differed from those found in previous studies of adults, the FCQ can provide reliable measures of food-choice motives among these adolescents. Students from less affluent families placed more importance on food’s convenience and price, but more affluent students did not necessarily make healthier choices. Compared with females, males were more likely to choose healthy foods. Future interventions should be tailored based on the socio-economic status of the target group.

Food selectivity, mealtime behavior problems, spousal stress, and family food choices in children with and without autism spectrum disorder

Mealtime behavior problems and family stress occur frequently among families of children with autism spectrum disorder (ASD). However, it is unknown whether food selectivity is an associated factor. The associations of high food selectivity with mealtime behavior problems, spousal stress, and influence on family members were assessed among 53 children with ASD and 58 typically developing (TD) children ages 3-11 years. Compared to TD children, children with ASD were more likely to have high food selectivity, and their parents reported more mealtime behavior problems, higher spousal stress, and influence on what other family members ate. High food selectivity was associated with mealtime behavior problems in both groups. Interventions to reduce food selectivity may lead to decreases in mealtime behavior problems.

A Balanced Approach to Physician Responsibilities: Oncologists' Duties toward Themselves

Although critical to the provision of best patient care, physician self-care is an underattended aspect of responsibility in the medical professions, including oncology. Neglecting self-care bears negative consequences for the individual oncologist, ranging from burnout and fatigue to interpersonal and relationship stress, addiction, and disruptive behavior. It may also contribute to medical errors, disinterest in or depersonalization of patient care, and lower quality of care. Because of its effect on physicians, patients, and the health care environment, physician self-care is increasingly recognized as an important professional responsibility. Nonetheless, professional obligations, competing demands on time, and personal priorities conspire to prevent a large proportion of oncologists from adequately attending to self-care in even simple ways, such as getting sufficient exercise and sleep. This chapter discusses the need for physician self-care and the repercussions of not meeting this fundamental responsibility. Self-care is described in the context of three life domains: professional, personal (physical, psychological, mental, and spiritual), and interpersonal (relationships, family, social, and community). Strategies are provided for caring for the self in each domain.

Eating breakfast together as a family: mealtime experiences and associations with dietary intake among adolescents in rural Minnesota, USA

OBJECTIVE

Although existing evidence links breakfast frequency to better dietary quality, little is known specifically in regard to the benefits associated with eating breakfast together with one's family. The present study describes the prevalence and experience of having family meals at breakfast among rural families and examines associations between meal frequency and adolescent diet quality.

DESIGN

Data were drawn from Project BreakFAST, a group-randomized trial aimed at increasing school breakfast participation in rural Minnesota high schools, USA. Linear mixed models were used to examine associations between student reports of family breakfast frequency and Healthy Eating Index 2010 (HEI-2010) scores while accounting for clustering within schools, demographics and household food security.

SETTING

Adolescent students from sixteen schools completed online surveys, height and weight measurements, and dietary recalls at baseline in 2012-2014.

SUBJECTS

The sample included 827 adolescents (55·1 % girls) in grades 9-10 who reported eating breakfast on at most three days per school week.

RESULTS

On average, adolescents reported eating breakfast with their family 1·3 (sd 1·9) times in the past week. Family breakfast meals occurred most frequently in the homes of adolescents who reported a race other than white (P=0·002) or Hispanic ethnicity (P=0·02). Family breakfast frequency was directly associated with adolescent involvement in preparing breakfast meals (P<0·001) and positive attitudes (P≤0·01) about mealtime importance, interactions and structure. Family breakfast frequency was unrelated to most diet quality markers.

CONCLUSIONS

Family meals may be one important context of opportunity for promoting healthy food patterns at breakfast. Additional research is needed to better inform and evaluate strategies.

Father Involvement in Feeding Interactions with Their Young Children

OBJECTIVE

To examine the associations of father-child feeding and physical interactions with dietary practices and weight status in children.

METHODS

A nationally representative sample of children, mothers, and fathers who participated in the Early Childhood Longitudinal Study Birth cohort study (N = 2441) was used to explore the relationship of father-child feeding and physical activity interactions with child dietary practices and weight status. Logistic multivariable regression analyses were adjusted for child, father, mother, and socio-demographic characteristics.

RESULTS

Approximately 40% of fathers reported having a great deal of influence on their preschool child's nutrition and about 50% reported daily involvement in preparing food for their child and assisting their child with eating. Children had over 2 times the odds of consuming fast food at least once a week if fathers reported eating out with their child a few times a week compared to fathers who reported rarely or never eating out with their child (OR, 2.89; 95% CI, 1.94-4.29), adjusting for all covariates. Whether fathers reported eating out with their children was also significantly associated with children's sweetened beverage intake.

CONCLUSIONS

Potentially modifiable behaviors that support healthy dietary practices in children may be supported by targeting fathers.

Familial aggregation and dietary patterns in the Brazilian population

The aim of the study was to identify dietary patterns in Brazil and verify aggregation among members of the same family based on the Brazilian National Dietary Survey, a nationwide dietary survey conducted in 2008-2009 in individuals over 10 years of age. Dietary intake was estimated with a food record. Dietary patterns were identified by factor analysis, and familial aggregation was verified by linear regression. Three major dietary patterns were identified: (1) a traditional snack featuring coffee, rolls, oils and fats, and cheese; (2) traditional main meal, based on rice, beans and other legumes, and meat; and (3) fast food type snacks, namely sandwiches, processed meats, soft drinks, snacks, and pizza. Pattern 2 showed the strongest association (β = 0.37-0.64). Patterns 1 and 3 showed positive associations for all pairs of family members, with β ranging from 0.27 to 0.44 and 0.32 to 0.42, respectively. The study showed familial aggregation of dietary patterns in the Brazilian population.

Associations among Nine Family Dinner Frequency Measures and Child Weight, Dietary, and Psychosocial Outcomes

BACKGROUND

Family meal frequency has been consistently and significantly associated with positive youth dietary and psychosocial outcomes, but less consistently associated with weight outcomes. Family meal frequency measurement has varied widely and it is unclear how this variation might impact relationships with youth weight, dietary, and psychosocial outcomes.

OBJECTIVE

This study assesses how five parent/caregiver-reported and four child-reported family dinner frequency measures correlate with each other and are associated with health-related outcomes.

DESIGN/PARTICIPANTS

This secondary, cross-sectional analysis uses baseline, parent/caregiver (n=160) and 8- to 12-year-old child (n=160) data from the Healthy Home Offerings via the Mealtime Environment (HOME) Plus trial (collected 2011 to 2012). Data were obtained from objective measurements, dietary recall interviews, and psychosocial surveys.

OUTCOME MEASURES

Outcomes included child body mass index z scores (BMIz); fruit, vegetable, and sugar-sweetened beverage intake; dietary quality (Healthy Eating Index-2010); family connectedness; and meal conversations.

STATISTICAL ANALYSES PERFORMED

Pearson correlations and general linear models were used to assess associations between family dinner frequency measures and outcomes.

RESULTS

All family dinner frequency measures had comparable means and were correlated within and across parent/caregiver and child reporters (r=0.17 to 0.94; P<0.01). In unadjusted analyses, 78% of family dinner frequency measures were significantly associated with BMIz and 100% were significantly associated with fruit and vegetable intake and Healthy Eating Index-2010. In adjusted models, most significant associations with dietary and psychosocial outcomes remained, but associations with child BMIz remained significant only for parent/caregiver- (β±standard error=-.07±.03; P<0.05) and child-reported (β±standard error=-.06±.02; P<0.01) family dinner frequency measures asking about "sitting and eating" dinner.

CONCLUSIONS

Despite phrasing variations in family dinner frequency measures (eg, which family members were present and how meals were occurring), few differences were found in associations with dietary and psychosocial outcomes, but differences were apparent for child BMIz, which suggests that phrasing of family dinner frequency measures can influence associations found with weight outcomes.

Secular trends in family dinner frequency among adolescents

Background

Eating meals, particularly dinner, with family members has been found to be associated with improved dietary intake, lower prevalence of disordered eating behaviors, lower levels of substance abuse, and improved academic outcomes among adolescents. Limited research has examined how the frequency of family meals has changed over time. The objective of this study was to examine secular trends in family dinner frequency over a 12-year period using a large, nation-wide sample of adolescents.

Methods

Using data from two cohorts of the Growing up Today study (GUTS; n = 18,075 observations for 14,79,714 and 15 year olds), we compared family dinner frequency among 14–15-year-olds in 1996 (GUTS1) through 2008 (GUTS2) and rate of change in family dinner frequency from 1996 to 1998 (GUTS1) and 2004–2008 (GUTS2). We fit logistic models using generalized estimating equations with independence working correlation and empirical variance to account for correlation within individual and between siblings.

Results

From 1996 to 2008, the number of family dinners per week among males decreased from 5.3 to 4.6 (p = 0.04) and among females from 5.0 to 4.4 (p = 0.03). We found that the rate of decline in frequency of family meals was consistent in GUTS1 (1996–1998) and GUTS2 (2004–2008) among both males and females.

Conclusions

From 1996 to 2008, frequency of family dinners decreased among adolescents. Future research should explore reasons for this decline as well as strategies to increase family meals among adolescents.

Fundamental constructs in food parenting practices: a content map to guide future research

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.

Should the IDEFICS outcomes have been expected?

The Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study evaluated with a large sample a comprehensive carefully planned obesity prevention intervention targeting multiple levels of influence that were culturally adapted to the situations in eight European countries. Despite the great effort and attention to detail, the IDEFICS study did not achieve its targeted adiposity or behaviour change objectives. Should we be surprised that the IDEFICS trial did not have its intended effects? We think not, and would have been surprised if it did. Recent research has revealed the lack of consistent meaningful relationships between several apparently obesogenic behaviours and adiposity, weak or no relationships among behavioural change procedures, mediating variables and targeted behaviours and inadequate attention to moderating effects. Future obesity prevention interventions would benefit from a more thorough understanding of the complex relationships that have been hypothesized and the interrelationships with biological factors. While systems modelling has been proposed as providing the solution, important less complex identification of new constructs, new relationships and community interventions are still needed, both to find innovative solutions and to provide input into the systems models. We should question results from cross-sectional studies and be satisfied only with longitudinal or experimental tests of relationships.

Quantifying parental preferences for interventions designed to improve home food preparation and home food environments during early childhood

Though preparing healthy food at home is a critical health promotion habit, few interventions have aimed to improve parental cooking skills and behaviors. We sought to understand parents' preferences and priorities regarding interventions to improve home food preparation practices and home food environments during early childhood. We administered a discrete choice experiment using maximum difference scaling. Eighty English-speaking parents of healthy 1-4 year-old children rated the relative importance of potential attributes of interventions to improve home food preparation practices and home food environments. We performed latent class analysis to identify subgroups of parents with similar preferences and tested for differences between the subgroups. Participants were mostly white or black 21-45 year-old women whose prevalence of overweight/obesity mirrored the general population. Latent class analysis revealed three distinct groups of parental preferences for intervention content: a healthy cooking group, focused on nutrition and cooking healthier food; a child persuasion group, focused on convincing toddlers to eat home-cooked food; and a creative cooking group, focused on cooking without recipes, meal planning, and time-saving strategies. Younger, lower income, 1-parent households comprised the healthy cooking group, while older, higher income, 2-parent households comprised the creative cooking group (p < 0.05). The child persuasion group was more varied with regard to age, income, and household structure but cooked dinner regularly, unlike the other two groups (p < 0.05). Discrete choice experiments using maximum difference scaling can be employed to design and tailor interventions to change health behaviors. Segmenting a diverse target population by needs and preferences enables the tailoring and optimization of future interventions to improve parental home food preparation practices. Such interventions are important for creating healthier home food environments and preventing obesity starting from early childhood.

Pediatric obesity: Causes, symptoms, prevention and treatment

Pediatric or childhood obesity is the most prevalent nutritional disorder among children and adolescents worldwide. Approximately 43 million individuals are obese, 21–24% children and adolescents are overweight, and 16–18% of individuals have abdominal obesity. The prevalence of obesity is highest among specific ethnic groups. Obesity increases the risk of heart diseases in children and adults. Childhood obesity predisposes the individual to insulin resistance and type 2 diabetes, hypertension, hyperlipidemia, liver and kidney diseases and causes reproductive dysfunction in adults. Obesity in children is a major health concern of the developed world. The National Health and Nutrition Examination Survey has reported that the prevalence of obesity is on the increase in all the pediatric age groups, in males and females, and in various ethnic and racial groups. Factors, such as eating habits, genetics, environment, metabolism, and lifestyle play an important role in the development of obesity. Over 90% of obesity cases are idiopathic and less than 10% are associated with genetic and hormonal causes. Obesity occurs when the body consumes more calories than it burns, through overeating and underexercising. The symptoms of obesity include breathing disorders, sleep apnea, chronic obstructive pulmonary disease, certain types of cancer such as prostate, bowel, breast and uterine, coronary heart disease, diabetes (type 2 in children), depression, liver and gallbladder problems, gastro-esophageal reflux disease, high blood pressure, high cholesterol, stroke, and joint diseases such as osteoarthritis, pain in knees and lower back. Environmental, behavioral such as consumption of convenience foods, genetic, and family factors contribute to pediatric obesity. Obesity can be countered through lower calorie consumption, weight loss and diet programs, as well as increased physical activity. A number of endogenous molecules including leptin, hypothalamic melanocortin 4 receptor, and mitochondrial uncoupling proteins, are known to affect body weight. These molecules serve as potential targets for the pharmacological manipulation of obesity. Sibutramine and orlistat are primariliy used for the treatment of adult obesity, which produces modest weight loss, of 3–8% compared to placebo. For children and obese adolescents, metformin is used in the case of insulin resistance and hyperinsulinemia. Octreotide is used for hypothalamic obesity. Bariatric surgery is performed for the treatment of severe childhood obesity. The causes, symptoms, prevention and treatment of pediatric obesity are described in the present review.

Increased Snacking and Eating Occasions Are Associated with Higher Energy Intake among Mexican Children Aged 2-13 Years

BACKGROUND

Little is known about the dietary behaviors of Mexican children with regard to frequency, amount, and quality of foods consumed at eating occasions and their impact on total daily energy intake.

OBJECTIVES

The objectives were to 1) describe foods consumed across eating occasions and 2) examine whether the number or type of total eating occasions was associated with increased total daily energy intake and differed between 2- to 5-y-old and 6- to 13-y-old Mexican children.

METHODS

A nationally representative sample of 5031 children from the 2012 ENSANUT (Encuesta Nacional de Salud y Nutrición) was used to examine the percentage of meals and snacks consumed, mean energy intake from meals and snacks, and the top food groups contributing to meals and snacks. Multivariate linear regression was used to examine the association between meals, snacks, and total eating occasions with daily energy intake for 2- to 5-y-old and 6- to 13-y-old children.

RESULTS

Eating patterns were similar across age groups (per capita mean intake of 3 meals and 1.4-1.6 snacks/d). Each additional snack was associated with greater increases in mean daily energy for older children (+191-289 kcal/d; P < 0.01) relative to younger children (+102-130 kcal/d; P < 0.01). Likewise, each additional eating occasion was associated with greater increases in mean daily energy for older children (+323 kcal/d; P < 0.01) relative to younger children (+166-261 kcal/d; P < 0.01). In both younger and older children, snacking was prevalent (75% and 68%, respectively). Top food contributors to snacks included fruit, salty snacks, candy, sweetened breads, and cookies. Among older children, whole milk as a snack was partially replaced with soda and sweetened fruit drinks.

CONCLUSION

Snacks represent an area for potential improvement in the diets of Mexican children, especially among those aged 6 to 13 y, for whom each additional snack or eating occasion was linked to even greater increases in total daily energy intake.

Perceptions of Adolescents with Overweight and Obesity for the Development of User-Centered Design Self-Management Tools within the Context of the Chronic Care Model: A Qualitative Study

BACKGROUND

The Chronic Care Model (CCM) is helpful to illustrate multiple levels of influence in the management of chronic disease, such as overweight and obesity in adolescents. Unfortunately, various constraints create gaps in the management process activities performed within the CCM. Consumer health technologies (CHT) may serve as a linkage between adolescents with overweight or obesity, their parents, and their pediatricians.

OBJECTIVE

To conduct formative research to qualitatively identify views of adolescents with overweight and obesity on use of consumer health technologies to manage weight loss across chronic care management settings.

DESIGN

As part of a multi-perspective qualitative study, 10 focus groups were conducted with adolescents with overweight and obesity.

PARTICIPANTS/SETTING

Forty-eight adolescents (15 male, 33 female) aged 12 to 17 years who were current participants of an intensive lifestyle change camp in the summer of 2012 participated in focus groups. All adolescents were classified as overweight (21%) or obese (79%) according to body mass index (BMI) for age charts published by the Centers for Disease Control and Prevention.

ANALYSIS

All focus groups were recorded, transcribed verbatim, and checked for accuracy. Predefined and open coding were used to analyze transcripts for emerging themes.

RESULTS

Adolescents perceive CHT, with its functional requirements of assistance with restaurant food selection, teaching cooking skills, and providing encouragement and motivation, to be helpful with overweight and obesity self-management. Desired features to carry out these functional requirements included avatars, self-monitoring capabilities, social networking, and rewards.

CONCLUSION

Our findings largely agree with previously reported parental perceptions of the benefit of CHT for adolescent overweight and obesity self-management and strengthen support for the design and implementation of CHT within the CCM.

Culinary efficacy: an exploratory study of skills, confidence, and healthy cooking competencies among university students

Aims:

This study was conducted to determine whether a group of college-age students in New Jersey, USA, had the requisite culinary skills, knowledge, and confidence to take personal control of their meal planning and production. The long-term threat to the public health systems posed by high rates of obesity among young adults in higher education institutions has garnered widespread attention across the world. Studies have shown that assuming personal responsibility over preparing and consuming food can play a key role in addressing the problem of poor nutrient intakes.

Methods:

Focus groups were conducted with students ( N = 24) who fit the eligibility criteria of not having a university meal plan, and living independently at the time of the study (not with family members). The sessions were recorded, transcribed, and then coded into themes. Two trained research assistants tested the results and inter-rater reliability was confirmed.

Results:

Content analysis revealed three major themes: Health Perceptions, Life influences, and Barriers to Cooking and Eating Healthy. The students’ comments indicated that while they had a basic knowledge of the key principles of eating a balanced diet, it may not have necessarily translated into actual food choices and cooking practices. Several students reported an overreliance on processed and prepared foods, and they consumed few fruits and vegetables.

Conclusions:

Factors such as lack of culinary knowledge and skill, financial instability, inadequate access to healthy food options, and other time/lifestyle constraints may have played a significant role in limiting their ability to prepare and consume healthy meals. The findings of this study highlight the importance of designing programmes with effective strategies to motivate and encourage college students to improve their food behaviours and practices.

An evaluation of the Kinect-Ed presentation, a motivating nutrition and cooking intervention for young adolescents in grades 6–8

Recently, public health messaging has included having more family meals and involving young adolescents (YAs) with meal preparation to improve healthful diets and family dinner frequency (FDF). Kinect-Ed, a motivational nutrition education presentation was created to encourage YAs (grades 6–8) to help with meal preparation and ultimately improve FDF. The purpose of this study was to evaluate the Kinect-Ed presentation, with the goals of the presentation being to improve self-efficacy for cooking (SE), food preparation techniques (TECH), food preparation frequency (PREP), family meal attitudes and behaviours, and ultimately increase FDF. A sample of YAs (n = 219) from Southern Ontario, Canada, completed pre- and postpresentation surveys, measuring FDF, PREP, SE, and TECH. Kinect-Ed successfully improved participants’ FDF (p < 0.01), PREP (p < 0.01), SE (p < 0.01), and TECH (<0.01). Overall, goals of the presentation were met. Encouraging YAs to help prepare meals and get involved in the kitchen may reduce the time needed from parents to prepare meals, and, in turn, allow more time for frequent family dinners.

Development of the Intervention Materials for the HomeStyles Obesity Prevention Program for Parents of Preschoolers

Home environment is key to the development of obesity-preventing behaviors during childhood, yet few resources help preschool parents address factors at home associated with obesity risk. This paper describes creation of materials for an in-home intervention (HomeStyles) with this population. An advisory group of stakeholders and target audience members determined salient factors affecting childhood obesity to address in-home and developed program materials. The Social Cognitive Theory, Faith's Core Behavior Change Strategies to Treat Childhood Obesity, Adult Learning Theory and motivational interviewing techniques guided development of 12 guides targeting strategies parents can use to shape the home environment. Interviews were conducted to determine effectiveness of the guides. Cognitive testing of guide design (n = 251) and content (n = 261) occurred in English and Spanish in New Jersey and Arizona with parents and home visitation staff who would present the guides. Interviews investigated perceptions of content usefulness and parent comprehension. Findings were also examined in light of theoretical underpinnings. Both home visitation staff and parents felt the guides were very readable and useful. Parents appreciated use of motivational interviewing techniques and Adult Learning Theory. Current research is testing these guides through an in-home, randomized control trial.

Neighborhood and family social capital and parent-reported oral health of children in Iowa

OBJECTIVES

A growing body of evidence supports the impact of social factors on oral health disparities in children in the United States. The goal of this study was to examine the relationship between two types of social capital-family and neighborhood-and the parent-reported oral health of Iowa's children.

METHODS

We analyzed results from a 2010 cross-sectional statewide health survey. The outcome was parent-reported child oral health status, and the five primary independent variables were neighborhood social capital and four separate indicators of family social capital. Data were analyzed using a mixed-effects linear regression with a random effect for zip code.

RESULTS

Significant positive associations were found between child oral health status and neighborhood social capital (P = 0.005) and one indicator of family social capital, family frequency of eating meals together (P = 0.02), after adjusting for covariates.

CONCLUSIONS

This study adds to the growing body of literature around the social determinants of oral health. Our findings indicate that the oral health of children may be influenced by broad social factors such as neighborhood and family social capital.

The role of grandparents in childhood obesity in China - evidence from a mixed methods study

BACKGROUND

The current literature on the influences of family environment on childhood obesity is predominantly based on western populations and has focused on the role of parents. This study examined the influence of grandparents on the development of obesity among Chinese primary school aged children.

METHODS

A mixed methods study was conducted in four socioeconomically distinct primary school communities in two cities of southern China. The qualitative study (17 focus groups and four personal interviews) involved parents, grandparents, school staff, and food retailers in the vicinity of the schools (n = 99) and explored perceived causes of childhood obesity. The cross-sectional study examined the association between children's objectively measured weight status and reported health behaviours, and the presence and role of grandparents in the household. It included children from three randomly selected third grade (8 to 10 years) classes from each school (n = 497).

RESULTS

Grandparents were commonly perceived to contribute to childhood obesity through inappropriate perception (e.g. fat children are healthy and well cared for), knowledge (e.g. obesity related diseases can only happen in adults; the higher the dietary energy/fat content, the more nutritious the food), and behaviour (e.g. overfeeding and indulging through excusing the children from household chores). Conflicting child care beliefs and practices between grandparents and parents, and between grandparents and school teachers, were felt to undermine efforts to promote healthy behaviours in children. In the cross-sectional study, children who were mainly cared for by their grandparents were more likely to be overweight/obese (adjusted OR = 2.03; 95 % CI = 1.19 to 3.47); and to consume more sugar-added drinks and unhealthy snacks (B = 2.13, 95 % CI = 0.87 to 3.40), than children who were mainly cared for by their parents or other adult. Children who lived with two or more grandparents in the household were more likely to be overweight/obese than children who did not live with any grandparent (adjusted OR = 1.72; 95 % CI = 1.00 to 2.94).

CONCLUSIONS

Involvement of grandparents in childcare is an important factor contributing to childhood obesity in China. Future preventive interventions should include strategies that target grandparents.

Prevalence of picky eating behaviour in Chinese school-age children and associations with anthropometric parameters and intelligence quotient. A cross-sectional study

Previous studies have demonstrated the importance of eating behaviour regarding dietary variety and nutrient intake of children. However, the association between picky eating and growth of children is still a topic of debate. This study sought to estimate the prevalence of picky eating and to identify possible associations with the growth of school-age children in China. In this survey, 793 healthy children aged 7-12 years were recruited from nine cities and rural areas in China using a multi-stage cluster sampling method. Data collected included socio-demographic information and parents' perceptions of picky eating using a structured questionnaire, nutrient intake using 24-hour dietary recall, weight and height using body measurements, and intelligence using the Wechsler Intelligence Scale for Children. Blood samples were collected and analysed for minerals. The prevalence of picky eating reported by parents was 59.3% in children. Compared with non-picky eaters, picky eaters had a lower dietary intake of energy, protein, carbohydrates, most vitamins and minerals, and lower levels of magnesium, iron, and copper in the blood (p < 0.05), and also had a 0.184 z-score lower in height for age (95% CI: -0.332, 0.036; p = 0.015), a 0.385 z-score lower in weight for age (95% CI: -0.533, -0.237; p < 0.001), a 0.383 z-score lower in BMI for age (95% CI: -0.563, -0.203; p < 0.001), and scored 2.726 points higher on the intelligence test (95% CI: 0.809, 4.643; p = 0.006) when adjusted for children's birth weight and food allergy, mothers' education, and family income. Picky eating behaviour towards meat, eggs and vegetables showed negative associations with growth. Picky eating behaviour is prevalent in school-age children in China and may have a negative effect on growth.

The role of women in food provision and food choice decision-making in Singapore: a case study

As countries develop economically and increasing numbers of women enter the workforce, children are partly being cared for by someone other than their mother. Little is known about the impact of this shift in child-care provider on children's nutrition. This study presents findings from a case study of Singapore, a small country that has experienced phenomenal economic growth. Focus groups were conducted with 130 women of varying educational levels and ethnicities to learn about food decisions in their families. The findings showed that Singaporean working women cook infrequently, families eat out frequently, and children exert considerable influence on food choices. Implications for work-family policies and child health are discussed.

The protective role of family meals for youth obesity: 10-year longitudinal associations

OBJECTIVE

To examine whether having family meals as an adolescent protects against becoming overweight or obese 10 years later as a young adult.

STUDY DESIGN

Data from Project Eating and Activity in Teens -III, a longitudinal cohort study with emerging young adults, were used. At baseline (1998-1999), adolescents completed surveys in middle or high schools, and at 10-year follow-up (2008-2009) surveys were completed online or via mailed surveys. Young adult participants (n = 2117) were racially/ethnically and socioeconomically diverse (52% minority; 38% low income) between the ages of 19 and 31 years (mean age = 25.3; 55% female). Logistic regression was used to associate weight status at follow-up with family meal frequency 10 years earlier during adolescence, controlling and testing for interactions with demographic characteristics.

RESULTS

All levels of baseline family meal frequency (ie, 1-2, 3-4, ≥5 family meals/wk) during adolescence were significantly associated with reduced odds of overweight or obesity 10 years later in young adulthood compared with never having family meals as an adolescent. Interactions by race indicated that family meals had a stronger protective effect for obesity in black vs white young adults.

CONCLUSIONS

Family meals during adolescence were protective against the development of overweight and obesity in young adulthood. Professionals who work with adolescents and parents may want to strategize with them how to successfully carry out at least 1 to 2 family meals per week in order to protect adolescents from overweight or obesity in young adulthood.

Weighing the Evidence of Common Beliefs in Obesity Research

Obesity is a topic on which many views are strongly held in the absence of scientific evidence to support those views, and some views are strongly held despite evidence to contradict those views. We refer to the former as "presumptions" and the latter as "myths." Here, we present nine myths and 10 presumptions surrounding the effects of rapid weight loss; setting realistic goals in weight loss therapy; stage of change or readiness to lose weight; physical education classes; breastfeeding; daily self-weighing; genetic contribution to obesity; the "Freshman 15"; food deserts; regularly eating (versus skipping) breakfast; eating close to bedtime; eating more fruits and vegetables; weight cycling (i.e., yo-yo dieting); snacking; built environment; reducing screen time in childhood obesity; portion size; participation in family mealtime; and drinking water as a means of weight loss. For each of these, we describe the belief and present evidence that the belief is widely held or stated, reasons to support the conjecture that the belief might be true, evidence to directly support or refute the belief, and findings from randomized controlled trials, if available. We conclude with a discussion of the implications of these determinations, conjecture on why so many myths and presumptions exist, and suggestions for limiting the spread of these and other unsubstantiated beliefs about the obesity domain.

Jamie's Ministry of Food: quasi-experimental evaluation of immediate and sustained impacts of a cooking skills program in Australia

Objective

To evaluate the immediate and sustained effectiveness of the first Jamie's Ministry of Food Program in Australia on individuals' cooking confidence and positive cooking/eating behaviours.

Methods

A quasi- experimental repeated measures design was used incorporating a wait-list control group. A questionnaire was developed and administered at baseline (T1), immediately post program (T2) and 6 months post completion (T3) for participants allocated to the intervention group, while wait -list controls completed it 10 weeks prior to program commencement (T1) and just before program commencement (T2). The questionnaire measured: participants' confidence to cook, the frequency of cooking from basic ingredients, and consumption of vegetables, vegetables with the main meal, fruit, ready-made meals and takeaway. Analysis used a linear mixed model approach for repeated measures using all available data to determine mean differences within and between groups over time.

Subjects

All adult participants (≥18 years) who registered and subsequently participated in the program in Ipswich, Queensland, between late November 2011- December 2013, were invited to participate.

Results

In the intervention group: 694 completed T1, 383 completed T1 and T2 and 214 completed T1, T2 and T3 assessments. In the wait-list group: 237 completed T1 and 149 completed T1 and T2 assessments. Statistically significant increases within the intervention group (P<0.001) and significant group*time interaction effects (P<0.001) were found in all cooking confidence measures between T1 and T2 as well as cooking from basic ingredients, frequency of eating vegetables with the main meal and daily vegetable intake (0.52 serves/day increase). Statistically significant increases at T2 were sustained at 6 months post program in the intervention group.

Conclusions

Jamie's Ministry of Food Program, Australia improved individuals' cooking confidence and cooking/eating behaviours contributing to a healthier diet and is a promising community-based strategy to influence diet quality.

Eating habits and eating behaviors by family dinner frequency in the lower-grade elementary school students

BACKGROUND/OBJECTIVES

Recently, there has been an increased interest in the importance of family meals on children's health and nutrition. This study aims to examine if the eating habits and eating behaviors of children are different according to the frequency of family dinners.

SUBJECTS/METHODS

The subjects were third-grade students from 70 elementary schools in 17 cities nationwide. A two-stage stratified cluster sampling was employed. The survey questionnaire was composed of items that examined the general characteristics, family meals, eating habits, eating behaviors, and environmental influence on children's eating. The subjects responded to a self-reported questionnaire. Excluding the incomplete responses, the data (n = 3,435) were analyzed using χ²-test or t-test.

RESULTS

The group that had more frequent family dinners (≥ 5 days/week, 63.4%), compared to those that had less (≤ 4 days/week, 36.6%), showed better eating habits, such as eating meals regularly, performing desirable behaviors during meals, having breakfast frequently, having breakfast with family members (P < 0.001), and not eating only what he or she likes (P < 0.05). Those who had more frequent family dinners also consumed healthy foods with more frequency, including protein foods, dairy products, grains, vegetables, seaweeds (P < 0.001), and fruits (P < 0.01). However, unhealthy eating behaviors (e.g., eating fatty foods, salty foods, sweets, etc.) were not significantly different by the frequency of family dinners.

CONCLUSIONS

Having dinner frequently with family members was associated with more desirable eating habits and with healthy eating behaviors in young children. Thus nutrition education might be planned to promote family dinners, by emphasizing the benefits of having family meals on children's health and nutrition and making more opportunities for family meals.

Childhood obesity and interpersonal dynamics during family meals

BACKGROUND

Family meals have been found to be associated with a number of health benefits for children; however, associations with obesity have been less consistent, which raises questions about the specific characteristics of family meals that may be protective against childhood obesity. The current study examined associations between interpersonal and food-related family dynamics at family meals and childhood obesity status.

METHODS

The current mixed-methods, cross-sectional study included 120 children (47% girls; mean age: 9 years) and parents (92% women; mean age: 35 years) from low-income and minority communities. Families participated in an 8-day direct observational study in which family meals were video-recorded in their homes. Family meal characteristics (eg, length of the meal, types of foods served) were described and associations between dyadic (eg, parent-child, child-sibling) and family-level interpersonal and food-related dynamics (eg, communication, affect management, parental food control) during family meals and child weight status were examined.

RESULTS

Significant associations were found between positive family- and parent-level interpersonal dynamics (ie, warmth, group enjoyment, parental positive reinforcement) at family meals and reduced risk of childhood overweight. In addition, significant associations were found between positive family- and parent-level food-related dynamics (ie, food warmth, food communication, parental food positive reinforcement) and reduced risk of childhood obesity.

CONCLUSIONS

Results extend previous findings on family meals by providing a better understanding of interpersonal and food-related family dynamics at family meals by childhood weight status. Findings suggest the importance of working with families to improve the dyadic and family-level interpersonal and food-related dynamics at family meals.

Home food availability, parental dietary intake, and familial eating habits influence the diet quality of urban Hispanic children

BACKGROUND

The home food environment influences children's eating behaviors and potentially affects overall diet quality. The aim of the present study was to evaluate the relationship between the home food environment and Hispanic children's diet quality.

METHODS

Hispanic children, 10-14 years of age (n=187), and their parents participated in this cross-sectional study. The Healthy Eating Index (HEI) was used to determine diet quality based on reported dietary intake obtained through a food frequency questionnaire administered to the children. Parents self-reported home food availability, familial eating habits, and their own habitual diet through a home environment survey.

RESULTS

The children's HEI total score was 59.4±8.8. Reported diets did not adhere to the dietary recommendations for total vegetables, greens and beans, whole grains, seafood and plant proteins, fatty acids, refined grains, sodium, solid fats, and added sugars. None of the participants had "good" scores (HEI, >80), 86% had scores that "need improvement" (HEI, 51-80), and 14% had "poor" scores (HEI, <50). Children with lower HEI scores had sugar-sweetened beverages available at home and participated in family meals while watching television more frequently, when compared with children with higher HEI scores.

CONCLUSIONS

Home food availability, parental diet, and familial eating habits seem to play an important role in the diet quality of children. Interventions targeting family education on healthful dietary habits at home could have a positive impact on children's diet quality and overall health.

Combating child obesity: impact of HENRY on parenting and family lifestyle

BACKGROUND

One-quarter of children in England are overweight/obese at school entry. We investigated the impact of a programme designed to provide parents of infants and preschool children with the skills required for a healthier family lifestyle.

METHOD

A cohort of families was followed across the 8-week HENRY (Health Exercise Nutrition for the Really Young) parent course at nine locations in England. Seventy-seven parents enrolled on the course, of which 71 agreed to complete questionnaires addressing eating behaviours, dietary intake and parental self-efficacy. Pre- and post-course data was available from 60 (84.5%) parents (8-week follow-up data from 58 parents) and was analysed using repeated measures analyses.

RESULTS

Significant changes were observed, with most sustained at follow-up. Parents reported increased self-efficacy and ability to encourage good behaviour (P < 0.001). Increased consumption of fruits and vegetables was reported in both children and adults, together with reduced consumption of sweets, cakes and fizzy drinks in adults (all P < 0.01). There were also positive changes in eating behaviours (e.g., frequency of family mealtimes and eating while watching television or in response to negative emotion [P < 0.01] ) and reduced screen time in adults (P < 0.001).

DISCUSSION

The results build upon earlier evaluation, indicating that the HENRY intervention has a beneficial impact upon the families of infants and preschool children. Furthermore, the findings suggest that positive changes inspired by the programme can be maintained beyond its completion. Such changes may serve to protect against later obesity.

The epidemiology of family meals among Ohio’s adults

Objective

The epidemiology of family meals among adults at a population level is poorly characterized and whether living with children impacts this health behaviour is uncertain. We determined the prevalence of family meals among US adults in a mid-western state whose families did and did not include minor children and described how it varied by sociodemographic characteristics.

Design

The cross-sectional 2012 Ohio Medicaid Assessment Survey is representative of Ohio adults and included questions on their sociodemographic characteristics and the frequency with which they eat family meals at home.

Setting

Trained interviewers administered landline and cell phone surveys to adults sampled from Ohio’s non-institutionalized population.

Subjects

We analysed data from 5766 adults living with minor children and 8291 adults not living alone or with children.

Results

The prevalence of family meals was similar for adults who did and did not live with minor children: 47 % (95 % CI 46, 49 %) of adults living with and 51 % (95 % CI 50, 53 %) of adults living without children reported eating family meals on most (six or seven) days of the week. Family meal frequency varied by race/ethnicity, marital and employment status in both groups. Non-Hispanic African-American adults, those who were not married and those who were employed ate family meals less often.

Conclusions

Adults in Ohio frequently shared meals with their family and family meal frequency was not strongly related to living with children. Broadening the scope of future studies to include adults who are not parents could enhance our understanding of the potential health benefits of sharing meals.

Position of the Academy of Nutrition and Dietetics: nutrition guidance for healthy children ages 2 to 11 years

It is the position of the Academy of Nutrition and Dietetics that children ages 2 to 11 years should achieve optimal physical and cognitive development, maintain healthy weights, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity. Rapid increases in the prevalence of childhood obesity during the 1980s and 1990s focused attention on young children's overconsumption of energy-dense, nutrient-poor foods and beverages and lack of physical activity. While recent data suggest a stabilization of obesity rates, several public health concerns remain. These include the most effective ways to promote healthy weights, the number of children living in food insecurity, the under-consumption of key nutrients, and the early development of diet-related risks for chronic diseases, such as cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. This Position Paper reviews what children 2 to 11 years old in the United States are reportedly eating, explores trends in food and nutrient intakes, and examines the impact of federal nutrition programs on child nutrition. Current dietary recommendations and guidelines for physical activity are also discussed. The roles of parents and caregivers in influencing the development of life-long healthy eating behaviors are highlighted. The Academy of Nutrition and Dietetics works with other allied health and food industry professionals to translate dietary recommendations and guidelines into positive, practical health messages. Specific recommendations and sources of science-based nutrition messages to improve the nutritional well-being of children are provided for food and nutrition practitioners.

Family meals and diet quality among children and adolescents in North Carolina

OBJECTIVE

To examine the relationship between diet quality and frequency of family meals throughout childhood and adolescence.

METHODS

Cross-sectional study of children ages birth through 17 years (n = 1,992) using data from the 2010 North Carolina Child Health and Monitoring Program. Multiple logistic regression was used to estimate the associations between family meals and fruit intake, vegetable intake, and sugar-sweetened beverage intake among younger children, older children, and adolescents.

RESULTS

In adjusted analyses, participating in ≥ 5 family meals/wk was associated with less sugar-sweetened beverage intake among younger (OR 2.04; CI 1.06-3.93) and older children (OR 2.12; 95% CI 1.27-3.55), greater vegetable intake among older children (OR 1.87; 95% CI 1.08-3.24) and adolescents (OR 1.81; 95% CI 1.14-2.88), and greater fruit intake among adolescents (OR 2.11; 95% CI 1.40-3.19).

CONCLUSIONS AND IMPLICATIONS

Strategies to encourage families to establish regular family meals early in life and continue them throughout childhood and adolescence is warranted.