Home food environment factors associated with the presence of fruit and vegetables at dinner: A direct observational study

Cooking behavior among mothers of children aged 2-5 years old in Kendari, Southeast Sulawesi, Indonesia

BACKGROUND

Cooking at home was associated with parental feeding practices. This study aimed to explore the interplay of components in cooking behavior of mothers with young children aged 2-5 years old in Kendari city of Southeast Sulawesi, Indonesia.

METHODS

This qualitative study involved 33 mothers from Kendari city, which was represented by each two sub-districts in coastal and mainland areas that were randomlyselected. Six focus group discussions (FGDs) were carried out using 20-item guide questions. The guide questions were developed following the Model of Goal-Directed Behavior (MGDB) theory approach exploring the components of cooking behavior i.e., skill, intention, desire, confidence, and attitude in cooking. Data analysis was performed in the field to assist decision on data saturation, followed by data analysis at desk through multilevel coding from the verbatim transcripts using NVivo R1 software. The data was analyzed thematically using pre-determined themes according to the MGDB theory. Emerging topics on enabling factors and constraints were captured to enhance our understanding of the complexity of cooking behavior.

RESULTS

The mothers' mean age was about 30 years old with a comparable representation of younger and older mothers. Most mothers were housewives and accomplished secondary school level. The mothers' intention was shown as they frequently cooked at home and allocated time for cooking. The enabling factors included their knowledge about food and nutrition, food source availability, their confidence in cooking meals and following recipes, and their motivation to keep their children healthy representing some intrinsic factors. The main constraint was the lack of skill to make snacks. The other extrinsic barriers were dependence on mobile food sellers and the availability of food kiosks that facilitated children's snack preferences.

CONCLUSION

The study obtained some insights that mothers had favorable cooking intention and desire, were supported with a confidence in some basic cooking skills. However, the existing constraints that encouraged the development of unfavorable children's snacking habit were beyond the mothers' control. A cookbook specifically for snack recipes that utilizes local ingredients may assist mother in preparing more healthier options for the children.

Longitudinal changes in home food availability and concurrent associations with food and nutrient intake among children at 24-48 months

OBJECTIVES

To describe changes in home food availability during early childhood, including modified, developmentally sensitive obesogenic scores, and to determine whether home food availability is associated with food and nutrient intakes of children concurrently, over time.

DESIGN

Data were drawn from the STRONG Kids 2 longitudinal, birth cohort to achieve the study objectives. Home food availability was assessed with the Home Food Inventory (HFI) and included fifteen food groups (e.g. fruit and vegetables) and three obesogenic scores (one original and two modified). Food and nutrient intakes were measured using the Block FFQ and included twenty-seven food groups and eighteen nutrients (e.g. vitamins A and C, protein). HFI and FFQ were completed by trained researchers or mothers, respectively, at 24, 36 and 48 months. Repeated-measures ANOVA and Spearman's correlations were used to achieve the study objectives.

SETTING

Central Illinois, USA.

PARTICIPANTS

Participants were 468 children at 24, 36 and 48 months of age.

RESULTS

Availability of less nutritious foods and obesogenic foods and beverages increased as children aged, and availability of both nutritious and less nutritious foods were associated with child food and nutrient intake. The three obesogenic scores demonstrated similar, positive associations with the intake of energy, saturated fat, added sugars and kilocalories from sweets.

CONCLUSION

These findings offer novel insight into changes in home food availability and associations with food and nutrient intake during early childhood. Additional attention is needed examining antecedents (e.g. built environments, purchasing behaviours) and consequences (e.g. child diet quality and weight) of home food availability.

Meta-synthesis of qualitative studies to explore fathers' perspectives of their influence on children's obesity-related health behaviors

BACKGROUND

In nursing research and practice, there is a paucity of information about how fathers perceive their role in shaping their children's health behaviors. Most studies on the parental factors affecting children's health behaviors have focused on the role of mothers. However, recent studies showed that fathers' health behaviors can influence those of their children. Therefore, the aim of this study was to synthesize existing qualitative studies to explore fathers' perspectives regarding how they influence children's obesity-related health behaviors.

METHODS

We conducted a descriptive meta-synthesis. To retrieve relevant articles, we used databases including PubMed, CINAHL, and Web of Science. Only qualitative studies published in English-language peer-reviewed journals, targeting fathers of children aged 2-18 years, and focusing on fathers' perspectives were included. All the quotes collected from the studies were reviewed and coded, and thematic analysis was used to derive themes.

RESULTS

Article screening and review yielded a total of 13 qualitative studies, from which the following themes emerged: (1) fathers' parenting practices and role-modeling behaviors, (2) fathers' roles in their relationships with their family members, and (3) fathers' resource-seeking behaviors and contributions to their home food environment. Fathers were aware that their parenting practices and role-modeling behaviors could influence their children's health behaviors. Furthermore, fathers recognized the importance of their relationships with family members, which was reflected in their family roles; that is, whether they took responsibility for childcare and household work, whether their parenting practices were similar to those of their spouses, and whether they involved their children in their activities. Fathers also reported their resource-seeking behaviors as well as their contribution to the home food environment, which affected their children's health behaviors.

CONCLUSION

Fathers' perspectives on their influence on children's health behaviors reveal their unique paternal role in influencing children's health behaviors. Fathers' perspectives could be incorporated into future nursing research to examine the relationship between fathers' roles and children's health behaviors to develop better health intervention programs.

Race/Ethnicity Modifies the Relationship Between Diet Quality at the Home- and Individual-Levels and Weight Status Among African American and Hispanic/Latinx Households With Preschool-Age Children

Background: Higher obesity prevalence and poorer diet quality disproportionately impacting groups based on income and race/ethnicity may be partially attributed to the home food environment. This study examined home- and individual-level diet quality with weight status among racially/ethnically diverse households. Methods: This cross-sectional study included African American (AA) and Hispanic/Latinx (H/L) households with preschool-age children (n = 97). Home-level diet quality was based on comprehensive home food inventories and individual-level diet quality was based on 24-hour dietary recalls; scores were estimated with the Healthy Eating Index. Child and adult appropriate weight categories based on BMI were estimated with measured heights and weights. Multiple linear regression models (independent variable: weight status, outcome: diet quality scores) with an interaction term for weight status and race/ethnicity and adjusting for potential confounding factors were used to estimate adjusted mean diet quality scores. Postestimation pairwise comparisons of these scores were used to look for within and between group differences by weight status and race/ethnicity. Results: Home-level diet quality scores were significantly higher among H/L households compared to AA counterparts regardless of weight status. AA parents with BMI <30 and AA children with BMI <85th percentile had poorer individual-level diet quality scores compared to AA parents and children of lower weight status and all H/L parents and children. Conclusions: These findings offer evidence that race/ethnicity modifies the relationship between diet quality and weight among AA and H/L households. Future research needs to examine the distinctive ways race/ethnicity shapes the relationship between weight and diet quality in these households.

A Scoping Review of Household Factors Contributing to Dietary Quality and Food Security in Low-Income Households with School-Age Children in the United States

Low-income and food-insecure households are at risk of poor dietary quality and even more severe food insecurity. Especially in childhood, consuming a nutritionally adequate diet is an essential driver of health, growth, and development. Household-level factors can present challenges to support the nutritional needs of low-income and food-insecure household members. The aim of this scoping review is to identify the contributing household factors to dietary quality and food security in US households of school-aged children 5 to 19 years and synthesize the evidence around emergent themes for application to future interventions. The scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols Extension for Scoping Reviews using search terms addressing food insecurity, low income, and dietary behaviors in the database PubMed. Screening by 3 independent reviewers of the title, abstract, and full study phases identified 44 studies. The 5 themes around which the studies grouped were: parental behaviors, child/adolescent behaviors, food procurement behaviors, food preparation behaviors, and household environment factors. Most studies were cross-sectional (n = 41, 93%) and focused on parental behaviors (n = 31, 70%), followed by food preparation and procurement behaviors. The themes identified were interrelated and suggest that incorporating education on parent and child behaviors that influence food procurement and preparation, along with strengthening organization and planning in the household environment, may hold promise to improve dietary quality and food security among food-insecure and low-income households. The findings can be used to inform future nutrition education interventions aimed at improving dietary quality and food security in households with school-aged children.

Parental intentions to implement vegetable feeding strategies at home: A cross sectional study

In order to increase vegetable intake by children, parents are encouraged to implement strategies that promote trying and eating vegetables at mealtimes. Qualitative studies have previously highlighted barriers parents face in implementing healthy eating practices, such as time, monetary costs and child factors (e.g. fussy eaters). This study aimed to specify the relationships between child and parent factors and their effects on parental intentions to implement vegetable feeding strategies at mealtimes. Parental intentions to implement meal service (serving larger portions, offering variety, serving vegetables first) and experiential learning (repeated exposure, games, sensory play) strategies were examined. Parents (N = 302, 73 male, Mage = 33.5) also explained reasons why certain strategies may or may not work for their child (4-7y). For both types of strategy, higher food fussiness of the child predicted higher parental intentions to implement strategies at home. However, this was competitively mediated by low beliefs that the strategy would work for their child, resulting in weaker overall positive effects on intentions. In the meal service model, parental beliefs that healthy eating is important for their child had a positive, indirect effect on higher intentions, through involved parental feeding practices. However, this was not significant in the experiential learning strategies model. Written parental responses suggest that this may be due to meal service approaches being viewed as easier to implement, with little additional effort required. Increasing parental confidence to implement strategies successfully and managing expectations around successful outcomes of strategies (e.g. tasting, eating) may be important focuses of future interventions to support parents implementing vegetable feeding strategies at mealtimes.

Contribution of home availability, parental child-feeding practices and health beliefs on children's sweets and salty snacks consumption in Europe: Feel4Diabetes-Study

Adoption of healthy dietary and snacking habits could support optimum physical and mental development in children as they define health in adulthood. This study assessed parameters associated with children's snacking such as food home availability, parenting practices, and parents' health beliefs. In this cross-sectional study 12 039 children, 49·4% boys 5-12 years, participating in the European Feel4Diabetes-Study were included. Children's weekly consumption of sweets and salty snacks, home availability of snacks, food parenting practices, and health beliefs were assessed via questionnaires. Logistic regression was applied to explore associations of a) home availability of snacks, b) food parenting practices (permissiveness and rewarding with snacks) and c) parent's opinions on deterministic health beliefs with children's consumption of sweets and salty snacks. Results showed that home availability (sweets: OR_adj: 4·76, 95 % CI: 4·32, 5·23; salty snacks: OR_adj: 6·56, 95 % CI: 5·64, 7·61), allowing to consume (sweets: OR_adj: 3·29, 95 % CI: 2·95, 3·67; salty snacks: OR_adj: 3·41, 95 % CI: 2·98, 3·90) and rewarding with sweets/salty snacks (sweets: OR_adj: 2·69, 95 % CI: 2·23, 3·24; salty snacks: OR_adj: 4·34, 95 % CI: 3·57, 5·28) 'sometimes/or less frequently' compared to 'always/or often' were associated with lower weekly consumption of sweets and snacks. Parents' disagreement compared to agreement with deterministic health beliefs and inattentive eating were associated with lower consumption of salty snacks and sweets in children. Overall, the findings of this study indicate that attempts to promote healthy snacking habits in children should aim to improve parental dietary habits, food parenting practices, health beliefs, and reducing home availability of unhealthy foods and snacks.

Parental Perspectives of the Impact of COVID-19 Lockdown on Food-Related Behaviors: Systematic Review

Home confinement during the COVID-19 pandemic has been accompanied by dramatic changes in household food dynamics that can significantly influence health. This systematic literature review presents parental perspectives of the impact of COVID-19 lockdown (up to 30 June 2022) on food preparation and meal routines, as well as other food-related behaviors, capturing both favorable and unfavorable changes in the household food environment. Themes and trends are identified and associations with other lifestyle factors are assessed. Overall, families enjoyed more time together around food, including planning meals, cooking, and eating together. Eating more diverse foods and balanced home-cooked meals (e.g., fresh fruit and vegetables) was combined with overeating and increased snacking (e.g., high-calorie snacks, desserts, and sweets), as parents became more permissive towards food; however, food insecurity increased among families with the lowest income. Adoption of meal planning skills and online shopping behavior emerged alongside behaviors aimed at self-sufficiency, such as bulk purchasing and stockpiling of non-perishable processed foods. These results are an important first step in recognizing how this pandemic may be affecting the family food environment, including low-income families. Future obesity prevention and treatment initiatives, but also ongoing efforts to address food management, parental feeding practices, and food insecurity, can account for these changes moving forward.

Associations of parent dietary role modeling with children's diet quality in a rural setting: Baseline data from the NU-HOME study

These analyses examined associations of parent dietary role modeling with diet quality among school-age children in a rural community. Past research has found protective associations between parent role modeling and children's dietary intake; however, there is a gap in understanding these associations for families in rural communities. Baseline data (2017 -2018) were drawn from the New Ulm at Home (NU-HOME) randomized controlled trial, conducted in the United States. The trial recruited 114 children (7-10 years old) and parents. Parents self-reported dietary intake [fruit and vegetable (FV), sugar-sweetened beverage (SSB), fast food (FF)] and frequency of sitting and eating with their child. Children reported parent role modeling of healthful eating (FV and salad at the evening meal; FV as snacks). Two 24-h dietary recalls assessed child diet quality indicators [Healthy Eating Index-2015 (HEI-2015) total scores, FV intake, SSB intake]. General linear models (GLM) and logistic regression analyzed associations of child diet quality (HEI score, FV intake, SSB intake) with parent dietary intake, parent sitting and eating the evening meal with their child, and child perceptions of parent role modeling healthful eating, adjusted for highest level of education in the home. Higher child HEI-2015 scores were positively associated with more frequent parent role modeling of fruit intake at meals, and inversely associated with more frequent parent role modeling of fruit as a snack; no significant associations of child FV intake with parent role modeling were observed. Higher child SSB intake was positively associated with parent FF intake. In this rural community, parents play significant roles in shaping children's dietary quality and intake, though more work needs to be done to address optimal intervention strategies to promote parent role modeling of healthful eating.

Factors Associated with Home Food Environment in Low-Income Overweight or Obese Pregnant Women

Limited research has examined factors associated with home food availability. This study investigated the associations among demographics, body mass index category, stress, and home food availability among low-income overweight or obese pregnant women. This cross-sectional study enrolled 332 participants who were non-Hispanic black or white. We performed logistic regression modeling for unprocessed food, processed food, overall ultra-processed food, and three subcategories of ultra-processed food (salty snacks, sweet snacks and candies, and soda). Black women were less likely than white women to have large amounts of processed foods (OR = 0.56), salty snacks (OR = 0.61), and soda (OR = 0.49) available at home. Women with at least some college education or at least a college education were more likely to have large amounts of unprocessed food (OR = 2.58, OR = 4.38 respectively) but less likely to have large amounts of soda (OR = 0.44; OR = 0.22 respectively) available at home than their counterparts. Women with higher stress were less likely to have large amounts of unprocessed food available at home (OR = 0.58) than those with lower stress. Home food availability varied by race, education, and levels of stress in low-income overweight or obese pregnant women.

Garden Access, Race and Vegetable Acquisition among U.S. Adults: Findings from a National Survey

With the majority of U.S. adults not meeting recommended vegetable intakes and well-documented racial and ethnic disparities in fruit and vegetable consumption, various approaches to increase vegetable consumption have been implemented. Gardening is one approach that has been associated with increased vegetable consumption in various subpopulations; however, limited national data exist examining this relationship. Since vegetable acquisition is a necessary antecedent to increased vegetable consumption, this study examines if garden access is associated with vegetable acquisition among adults in a nationally representative sample of U.S. households. Data come from the National Food Acquisition and Purchasing Survey (FAPS), a survey of 4826 US households. Descriptive analysis and modified Poisson regressions were performed to examine associations between household garden access and vegetable acquisition amongst the total population and by race. Results indicate that for foods for at-home consumption, respondents with their own garden had a 30% greater prevalence (PR: 1.30, 95% CI: 1.01, 1.64) of acquiring enough vegetables to meet USDA recommendations compared to respondents in households without access to any gardens. Among Black respondents, those with access to their own garden had over two times increased prevalence (PR: 2.35, 95% CI: 1.10, 5.01) of acquiring enough vegetables to meet recommended consumption amounts, compared to Black respondents without any access to a garden. No relationships between garden access and vegetable acquisition were observed for White or Asian respondents. This information may contribute to the body of evidence on strategies for increasing vegetable consumption among U.S. adults.

Behavioural change box? Applying the COM-B model to understand behavioural triggers that support consumption of fruits and vegetable among subscribers of a fruit and vegetable box scheme

OBJECTIVE

To understand the key mechanisms that support healthy dietary habits promoted by fruit and vegetable (F&V) box schemes, testing relevant behaviour change triggers identified under the COM-B model in an evaluation research study of a Portuguese F&V box scheme (PROVE).

DESIGN

Correlation study with a post-test-only non-equivalent group design based on survey data. The mechanisms underpinning the differences between subscribers and non-subscribers are operationalised as mediation effects. Data availability, theoretical relevance and empirical validation supported the selection and testing of four potential mediators for the effects of subscribing to the box scheme on F&V consumption. These estimations derive from the coefficients of a structural equation model combined with the product coefficient approach and Sobel test.

SETTING

The study is part of a wider evaluation study on the impact of the PROVE box scheme on sustainability, health and equity.

PARTICIPANTS

A sample of PROVE box subscribers (n 294) was compared with a matched subsample of non-subscribers (n 571) in a nationally representative survey.

RESULTS

Subscribing to the PROVE box correlates with an increased probability of eating at least five portions of F&V, irrespective of differences in age, education and perceived economic difficulties. Diet quality perceptions, and more robustly, the strength of meal habits and household availability were identified as relevant mediators.

CONCLUSIONS

The subscription to an F&V box scheme is connected with proximal context that enables the consumption of F&V by ensuring more readily available F&V and better situational conditions associated with healthier meal habits.

Treatment of Dyslipidaemia in Children

Childhood dyslipidaemia is one of the main traditional cardiovascular risk factors that initiate and exacerbate the atherosclerotic process. Healthcare providers may play a key role in the management of children with lipid abnormalities; however, they have to properly evaluate the normal lipid values and know the available treatment options in children and adolescents. Current guidelines recommend healthy behaviours as the first-line treatment for childhood dyslipidaemia. The therapeutic lifestyle changes should focus on dietary modifications, daily physical activity, reduction in body weight and tobacco smoking cessation. Parents play a key role in promoting their children’s healthy habits. In children with more severe forms of lipid abnormalities and in those who do not benefit from healthy behaviours, pharmacological therapy should be considered. Safe and effective medications are already available for children and adolescents. Statins represent the first-line pharmacological option, while ezetimibe and bile acid sequestrants are usually used as second-line drugs. Despite their limited use in children, other lipid-lowering agents (already approved for adults) are currently available or under study for certain categories of paediatric patients (e.g., familial hypercholesterolemia). Further studies are needed to evaluate the long-term efficacy, safety and tolerability of novel lipid-lowering drugs, especially in children.

Food-Based Science, Technology, Engineering, Arts, and Mathematics (STEAM) Learning Activities May Reduce Decline in Preschoolers' Skin Carotenoid Status

OBJECTIVE

To assess the effectiveness of food-based science, technology, engineering, arts, and mathematics (STEAM) learning activities on preschoolers' liking of 9 target vegetables and objectively-assessed fruit and vegetable (FV) intake.

METHODS

Seven hands-on, food-based STEAM learning activities were implemented to expose children to 9 target vegetables in 3 Head Start preschools (11 classrooms) across North Carolina. Child-reported vegetable liking scores and skin carotenoid status (SCS) were dependent variables collected at baseline, midpoint, and posttest. Adjusted repeated-measures ANOVA was used to examine intervention impact.

RESULTS

A total of 113 children (intervention = 49; comparison = 64) participated. Children were an average age of 3.7 ± 0.57 years at baseline. Mean target vegetable liking scores for the intervention and comparison groups, respectively, were 3.2 ± 0.19 and 3.2 ± 0.17 at baseline, 2.9 ± 0.17 and 3.1 ± 0.15 at midpoint, and 2.8 ± 0.15 and 3.1 ± 0.13 at posttest. A time × group interaction was not significant for target vegetable liking scores. Mean SCS were 268.6 ± 13.24 and 270.9 ± 12.13 at baseline, 271.3 ± 12.50 and 275.6 ± 11.46 at midpoint, and 267.8 ± 11.26 and 229.6 ± 10.32 at posttest for the intervention and comparison groups, respectively. A time × group interaction was significant for SCS (F_1,77 = 3.98; P = 0.02; r = 0.10). Both groups declined from baseline to posttest (intervention = 0.06%; comparison = 15.09%), which occurred after winter break, with a smaller decline observed in the intervention group (P = 0.02).

CONCLUSIONS AND IMPLICATIONS

Food-based STEAM learning activities may present a unique opportunity to affect FV intake while meeting academic standards. More research is needed to understand how liking for familiar FV changes over time and its relationship with consumption. In addition, more implementation research featuring larger sample sizes, teachers as the interventionist, and a longer study duration is needed to confirm the outcomes of food-based STEAM learning observed in the current study and the long-term impact this approach may have on children's' dietary quality.

Days Needed to Characterize the Healthfulness of a Typical Dinner Meal in Direct Observational Research: Mixed Methods Study

BACKGROUND

Prior research around the home meal environment has demonstrated that family meals are associated with positive health outcomes for children and adolescents. Researchers have begun using direct observational methods to understand key aspects of family meals such as meal healthfulness and family meal frequency to explain the protective nature of family meals. Direct observational research, however, can be resource intensive and also burdensome for participants. Information about the number of days needed to sufficiently characterize typical meal healthfulness using direct observational research methods is needed.

OBJECTIVE

The current study aimed to produce guidance about the number of meals necessary to approximate typical meal healthfulness at the family dinner meal occasion in a direct observational, mixed methods study of the home food environment.

METHODS

Families were recruited between 2012-2013 from primary care clinics in the Minneapolis-St Paul metropolitan area (N=120). A total of 800 meals were collected as part of the Family Meals LIVE! mixed methods study. The Healthfulness of Meal Index was used to evaluate meal dietary healthfulness of foods served at 8 family meal occasions. Participating families were provided an iPad (Apple Inc) and asked to video-record 8 consecutive days of family dinner meals with a minimum of two weekend meals. After the meal, families completed a meal screener, which is a self-reported, open-ended measure of the foods served at the meal.

RESULTS

Weekend and weekday meals differed in their measurement of meal healthfulness, indicating that at least one weekday and one weekend day are necessary to approximate meal healthfulness. Single-day measurement mischaracterized the strength of the relationship between the quality of what was served and intake by almost 50%, and 3 to 4 observation days were sufficient to characterize typical weekly meal healthfulness (r=0.94; P<.001).

CONCLUSIONS

Relatively few direct observational days of family meals data appear to be needed to approximate the healthfulness of meals across 1 week. Specifically, 1 weekday and 1 weekend observation are needed, including a total of 3 to 4 days of direct observational meal data. These findings may inform future direct observational study designs to reduce both research costs and participant burden in assessing features of the meal environment.

Associations Between Weight Loss Attempts, Food Planning, and the Home Food Environment

OBJECTIVE

To evaluate whether food planning behaviors mediate the relationship between a reported weight loss attempt and the home food environment (HFE).

DESIGN

Secondary data analysis of 4 home visits, included collecting an objective home food inventory of the HFE and self-reported food planning behaviors.

PARTICIPANTS

There were 196 participants (mean age, 44.4 years; 83.7% female).

MAIN OUTCOME MEASURES

The percentage of obesogenic foods and fruits and vegetables (FV).

ANALYSIS

Four regression analyses to test mediation.

RESULTS

Meal planning and grocery list use did not explain the relationship between a weight loss attempt and obesogenic foods or FV in the home (P > 0.05). Post hoc analyses that examined participants with a body mass index of >25, >28, and >30 found that a weight loss attempt was associated with fewer obesogenic foods. In contrast, mediation analyses with planning behaviors and associations with FV in the home were nonsignificant (P > 0.05).

CONCLUSIONS AND IMPLICATIONS

Obesity was more indicative of the HFE than making a weight loss attempt. A weight loss attempt was not associated with food planning behaviors, which may be used for multiple reasons, including organization and time management. Future studies should evaluate individual differences in strategies to create a healthy HFE in the context of a weight loss attempt.

Does eating in the absence of hunger extend to healthy snacks in children?

OBJECTIVES

To assess if eating in the absence of hunger (EAH) extends to healthier snacks and examine the relationship between the home food environment and EAH in children with normal weight (NW) or overweight/obesity (OB) who are at low risk (LR) or high risk (HR) for obesity based on maternal obesity.

METHODS

EAH was assessed after lunch and dinner when children received either low energy dense fruit snacks or high energy dense sweet/savoury snacks. The availability of obesogenic foods in the home was assessed by the Home Food Inventory.

RESULTS

Data showed significant main effects of risk group (P=.0003) and snack type (P < .001). EAH was significantly greater in HR-OB (284±8 kcal) than LR-NW (249±9 kcal) or HR-NW (251±8 kcal) children. Serving fruit rather than sweet/savoury snacks reduced energy intake, on average, by 60% (223 kcal) across risk groups. For each unit increase in the obesogenic home food environment, EAH of sweet/savoury snacks decreased by 1.83 calories.

CONCLUSIONS

Offering low energy dense snacks after a meal can moderate EAH and increase children's intake of healthy foods. Increased access to obesogenic foods in the home may reduce the salience of high energy dense snacks when they become available in other settings.

The Relationships Between Parental Stress, Home Food Environment, and Child Diet Patterns in Families of Preschool Children

PURPOSE

Home food environment, including home food availability and parental food preparation practices, plays a significant role in child diet patterns. Recent evidence suggests that parental psychological stress is related to parental food preparation practices; however, there is limited information about the relationship between parental psychological stress and home food availability. The purpose of the study is to examine the relationships between parental stress, home food availability, child diet patterns, and body mass index (BMI) in families with young children.

DESIGN

A secondary data analysis from a mixed-methods design study.

SETTING

The parent study was conducted in both local and online communities using a web-based survey.

PARTICIPANTS

Participants were 256 parents of children aged 2 to 5 years (53.4% white; 41.5% of overweight or obese children).

MEASURES

Parents completed well-validated self-report questionnaires.

ANALYSIS

We used latent structural equation modeling using Bayesian analysis.

RESULTS

There was a negative relationship between parents' general stress and healthy food availability at home (β* = -.20, P < .001 for fruits; β* = -.23, P < .001 for vegetables; and β* = -.24, P < .001 for healthy beverage) and a positive relationship between parenting stress and healthy snack and healthy beverage availability (β = .13, P = .03; β = .14, P = .02, respectively). There was no relationship between parental stress and unhealthy food availability at home while unhealthy food availability was significantly associated with child's unhealthy eating pattern (β* = .86, P < .01 for unhealthy snack; β* = .51, P < .01 for unhealthy beverage). There was no moderating effect of children's health insurance on the relationships between parental stress and home food availability. Furthermore, child diet patterns were not associated with child BMI.

CONCLUSION

Parental psychological stress is a potentially important intervention target point for improving home food environment and child diet patterns.

[Spatial distribution of public outlets for fruit and vegetable sales in Curitiba in the state of Paraná, Brazil]

Greater availability of fruit and vegetables (FV) may enhance the consumption of these food products. This study sought to investigate demographic and household income inequalities in the spatial distribution of FV in the city of Curitiba, State of Paraná. A total of 106 FV outlets were listed in the 10 administrative regions on the City Hall Supply Department website. Data on population and household income of the administrative regions were obtained from the 2010 Demographic Census. The food sale outlets were identified, and subsequently analyzed for the correlation between the regions by the Moran index. A total of 407 food stands were evaluated in 103 public facilities that commercialized FV. A concentration of street food markets in the central areas of the city, with a global Moran index of 0.99, was observed. In the regions, only one did not have an outlet (Tatuquara). There was a higher concentration of outlets in the higher-income regions (9.82/10,000 inhabitants) compared to those with the lower income regions (2.60/10,000 inhabitants) (p <0.001). Inequities were observed in the supply and in the quality of FV available in public facilities in lower-income regions, which should be considered by administrators when planning distribution in these locations.

Parenting Advice School-Age Kids Offer to Parents to Promote Healthier Child Weight-Related Behaviors

OBJECTIVE

To explore parenting advice children would provide to help parents encourage positive health-related behaviors by children.

DESIGN

Focus group discussions were conducted, and children shared the advice they would provide parents to help them encourage healthy weight-related behaviors (ie, diet, physical activity, and sleep) for children.

SETTING

Focus groups (n = 65) were conducted in 3 states (Florida, New Jersey, and West Virginia).

PARTICIPANTS

School-age children (n = 194) between the ages of 6 and 11 years old.

PHENOMENON OF INTEREST

What parenting practices are recommended by children, and are they in line with best-practice guidelines?

ANALYSIS

Focus group data were analyzed to identify themes and trends.

RESULTS

Children's recommendations were congruent with authoritative parenting styles (ie, high levels of warmth and control). Most of the advice shared by children aligned with recommended parent practices (ie, responsive feeding, facilitation, environmental restructuring, parent modeling, and encouragement). However, not all of the children's advice aligned with best practices guidelines (ie, use of food rewards and deception).

CONCLUSIONS AND IMPLICATIONS

Future nutrition education programs may be strengthened by helping parents adopt best practices for promoting healthy child behaviors. Furthermore, teaching children about recommended child feeding parenting practices may help protect future generations by preparing children to care for younger siblings or raise their children using best parenting practices.

Assessing dinner meals offered at home among preschoolers from low-income families with the Remote Food Photography Method

BACKGROUND

The high prevalence of obesity among preschoolers may be partially explained by the type and quantity of foods offered by parents and left unconsumed by preschoolers.

OBJECTIVES

(a) To compare foods offered and consumed at dinner to the Dietary Guidelines for Americans (DGAs) and the Child and Adult Care Food Program (CACFP) standards and (b) to examine the types, quantities, and nutrient composition of foods offered to and consumed by preschoolers and their plate waste.

METHODS

Participants were recruited from six Head Start/preschool centres. The Remote Food Photography Method was used to document dinner meals over 1 week (n = 153 meals). Energy and nutrients for foods offered, consumed, and plate waste were calculated. Foods offered and consumed were compared with the DGAs and CACFP standards.

RESULTS

Foods and beverages offered at dinner equaled 506 kcal, which is 36% of the DGA-recommended total daily energy intake. Meals offered and consumed were high in fat and sodium and low in fibre. Adherence to CACFP standards was low for fruits (25%) and milk (2%) and moderate for vegetables (63%). Mean plate waste (29%) was similar across food types.

CONCLUSIONS

Opportunities exist to improve preschoolers' adherence to the DGAs and CACFP standards by enhancing the quality of dinner meals offered to them.

Clinical Practice Recommendations for Pediatric Dyslipidemia

The leading cause of mortality in the United States is atherosclerotic cardiovascular disease (ASCVD). Atherosclerotic lesions begin during childhood and can place individuals at greater risk for ASCVD. Providers play an active role in preventing the progression of risk factors and future ASCVD events through appropriate clinical management of genetic and acquired dyslipidemias in the pediatric population. Health care providers need to be aware of current recommendations related to screening for dyslipidemia, lifestyle modification strategies, pharmacologic treatment, and guidelines for ongoing monitoring. Most patients with mild to moderate dyslipidemia can be managed by a primary care provider. It is imperative that providers understand the pathophysiology, screening methods, and available treatment options to effectively manage the condition. Frequent reassessment of family history and adherence to lifestyle modifications and pharmacologic interventions is essential for effective treatment.

Parent Food and Eating Behavior Assessments Predict Targeted Healthy Eating Index Components

OBJECTIVE

To examine the ability of parent response to assessments of in-home availability of 20 fruits and vegetables (FV), self-efficacy/outcome expectancy to prepare FV that their child would eat, modeling of FV eating behavior, and eating competence to predict parents' targeted Healthy Eating Index-2010 (HEI) scores at baseline.

DESIGN

Cross-sectional survey.

SETTING

Sixty-one classrooms in 8 northern Colorado elementary schools over 4 years participating in Fuel for Fun (FFF), a school-based culinary and physical activity intervention.

PARTICIPANTS

Parents and guardians (n = 71) of fourth-grade youths from participating classrooms.

MAIN OUTCOME MEASURE(S)

Healthy Eating Index-2010 scores as derived from 24-hour recalls administered with the Automated Self-Administered 24-hour dietary assessment tool.

ANALYSIS

Generalized linear regression models tested the predictive validity of survey assessments for targeted HEI components. Results were considered statistically significant at P ≤ .05.

RESULTS

In-home FV availability predicted total fruit (P = .01), whole fruit (P = .001), and total vegetable (P = .01) HEI, and parent modeling of FV eating behavior predicted total fruit (P = .01) and whole fruit (P = .02) HEI. However, these survey measures were not associated with other HEI components, including total HEI. Parent self-efficacy/outcome expectancy to prepare FV that their child would eat or like was not associated with total HEI or HEI components. Eating competence did not predict total HEI but was associated with seafood and plant proteins in the anticipated direction (P = .04).

CONCLUSIONS AND IMPLICATIONS

The results demonstrated construct validation of some parent Fuel for Fun survey assessments with targeted HEI components. Additional assessment in larger and more diverse samples is warranted so that nutrition education and behavior researchers may use these valid and reliable, brief, low-cost, and easy-to-use survey instruments as a proxy for dietary intake.

Fruit and Vegetable Intake and Preferences Associated with the Northern Fruit and Vegetable Program (2014–2016)

Purpose: To examine overall usual fruit and vegetable (FV) intake and preferences among grade 5–8 students participating in the Northern Fruit and Vegetable Program (NFVP) over 3 years (2014–2016).

Methods: In each year, a survey was administered 4 months into the NFVP in Northern Ontario, Canada.

Results: A total of 4744 students participated (2014 = 1551; 2015 = 1617; 2016 = 1576). Overall usual FV intake did not change over the 3 years, yet preferences generally increased. FVs offered by the NFVP were rated higher on preference than those not offered (fruit P < 0.001; vegetables P < 0.005). In each year, participants were more likely to consume a higher overall usual fruit intake if they had higher preference for fruit as offered by the NFVP (all P < 0.05) as opposed to not offered by the NFVP (all P > 0.05). For vegetables, participants were more likely to consume higher overall usual vegetables if they had a higher preference for vegetables as offered (all P < 0.05) and not offered by the NFVP (all P < 0.05).

Conclusions: This study documented that higher preferences for fruit (as offered) and vegetables (as offered and not offered) were associated with higher overall usual FV intakes within each of the 3 years.

mHealth Improved Fruit and Vegetable Accessibility and Intake in Young Children

OBJECTIVE

To explore the potential of mHealth using smartphones to improve fruit and vegetable intake in children.

DESIGN

A 10-week randomized control and intervention pilot study.

SETTING

Story time sessions at local libraries.

PARTICIPANTS

A convenience sample of 30 parents and children (aged 3-8 years).

INTERVENTION

Delivery of nutrition intervention through the mobile Jump2Health website, Facebook posts, and text messages.

MAIN OUTCOME MEASURES

Electronic food photos of children's meals and snacks, 10-question survey related to fruit and vegetable consumption, reflectance spectroscopy via Veggie Meter to measure skin carotenoid levels, body mass index percentiles, and a mobile learning survey.

ANALYSIS

Descriptive statistics and Wilcoxon matched-pairs signed-rank test.

RESULTS

Veggie Meter values for children and parents showed significant week × treatment interactions in the intervention group compared with the control group for both children (P < .001 and parents (P < .001).

CONCLUSIONS AND IMPLICATIONS

This pilot study offers a potentially effective program including a mobile Web site, social media, and test message components to increase fruit and vegetable intake of young children.

Parental and family predictors of fruits and vegetables in elementary school children's home-packed lunches across a school week

Home-packed lunches have been found to be of lower nutritional quality than school-bought lunches, yet little is known about family-based factors associated with lunch packing. The current exploratory study examines parental and family predictors of fruits and vegetables packed in lunches, hypothesizing parents' nutrition knowledge and authoritative parenting as well as children's involvement in lunch decisions would relate to packing more fruits and vegetables, while financial difficulties would relate to packing fewer. Ninety parent-child dyads from 4th-6th grade participated for 5 consecutive school days. Lunch contents were recorded using a digital imaging procedure to capture the number of days a fruit or vegetable was packed, and servings of fruits and vegetables in lunches each day. Parents completed family and parenting questionnaires and daily reports of child involvement in lunch decisions. Count-based regression models and longitudinal analyses within a multilevel modeling framework were used to examine predictors of lunch contents. Higher nutrition knowledge was associated with packing more fruit across the week and more vegetables on Monday. Authoritative parenting was associated with packing fewer vegetables on Monday, but more servings across the week. Financial stress was related to higher rates of never packing vegetables and when vegetables were packed including fewer servings, while child involvement in lunch decisions was associated with packing more fruits across the week, packing vegetables on more days and more servings of vegetables on Monday. Findings suggest parental and family factors impact the foods in packed lunches, with implications for children's dietary intake at school. Outreach programs can help parents pack more fruits and vegetables by providing nutrition education and suggestions for affordable, healthy lunch options as well as encouraging child involvement in the lunch packing process.

Description of the home food environment in Black, White, Hmong, Latino, Native American and Somali homes with 5-7-year-old children

OBJECTIVE

To categorize the home food environment and dietary intake of young children (5-7 years old) from racially/ethnically diverse households using objectively collected data.

DESIGN

Cross-sectional study.

SETTING

In-home observations in Minneapolis/Saint Paul, Minnesota, USA.

SUBJECTS

Families with 5-7-year-old children who identified as Black, White, Hmong, Latino, Native American or Somali.

RESULTS

There were many significant differences by race/ethnicity for child dietary intake and for the home food environment, with specific patterns emerging by race/ethnicity. For example, Somali children had high Healthy Eating Index-2010 (HEI-2010) scores, but low daily intakes of fruits and vegetables. Black children had low HEI-2010 scores and a pattern of low intake of healthful foods and high intake of unhealthful foods. White and Latino families had high levels of both healthful and unhealthful home food availability and children with high HEI-2010 scores.

CONCLUSIONS

Results indicate that the home food environment of young children varies across racial/ethnic group. Study findings also provide new information regarding the home food environment of young children in previously understudied racial/ethnic groups and indicate that interventions working to improve the home food environment and dietary intake of children may want to consider race/ethnicity.

Assessing the consumption of berries and associated factors in the United States using the National Health and Nutrition Examination Survey (NHANES), 2007-2012

Intake of berries was assessed relative to other fruit and fruit juices and total fruit intake in the U.S. population age 2 years and older using the National Health and Nutrition Examination Survey, 2007-2012. Average daily intake of total fruit was about 1 cup, and berries comprised approximately 10% of total fruit consumption. Only 18% of the population met the recommendation of at least 2 cups of fruit per day. Children ages 2 to 5 years consumed the most total fruit of which about half was juice and 4% of which was berries. Among adults, the highest berry consumption was by those who were 65 years and older, non-Hispanic White, and had the highest education and income levels. Use of the Nutrition Facts panel and ingredient labeling was associated with greater total fruit and berry intake. Those who were aware of an amount of fruit that is associated with good health and of dietary guidance in general and those who had fruit available in the home consumed about twice as much berries as others. Fruit intake remains below recommendations in the U.S.; berry intake is particularly low. Behavioral indicators provided insight on how fruit and berry consumption might be increased.

Associations Between Maternal Depressive Symptoms and Nonresponsive Feeding Styles and Practices in Mothers of Young Children: A Systematic Review

BACKGROUND

Childhood obesity is a significant global public health problem due to increasing rates worldwide. Growing evidence suggests that nonresponsive parental feeding styles and practices are important influences on children's eating behaviors and weight status, especially during early childhood. Therefore, understanding parental factors that may influence nonresponsive parental feeding styles and practices is significant for the development of interventions to prevent childhood obesity.

OBJECTIVE

The objectives of this systematic review were to (1) identify and review existing research examining the associations between maternal depressive symptoms and use of nonresponsive feeding styles and practices among mothers of young children (2-8 years of age), (2) highlight the limitations of reviewed studies, and (3) generate suggestions for future research.

METHODS

Using the PRISMA (Preferred Reporting Items for Systematic review and Meta-Analysis Protocols) guidelines, six electronic academic databases were searched for peer-reviewed, full-text papers published in English between January 2000 and June 2016. Only studies with mothers 18+ years old of normally developing children between 2 and 8 years of age were included. Of the 297 citations identified, 35 full-text papers were retrieved and 8 were reviewed.

RESULTS

The reviewed studies provided mixed evidence for associations between maternal depressive symptoms and nonresponsive feeding styles and practices. Two out of three studies reported positive associations with nonresponsive feeding styles, in that mothers with elevated depressive symptoms were more likely than mothers without those symptoms to exhibit uninvolved and permissive or indulgent feeding styles. Furthermore, results of reviewed studies provide good evidence for association between maternal depressive symptoms and instrumental feeding (3 of 3 reviewed studies) and nonresponsive family mealtime practices (3/3), but mixed evidence for pressuring children to eat (3/6) and emotional feeding (1/3). In addition, evidence for the association between maternal depressive symptoms and restricting child food intake was mixed: one study (1/6) found a positive association; two studies (2/6) found a negative association; whereas one study (1/6) found no association.

CONCLUSIONS

This review indicates that the results of studies examining the associations between maternal depressive symptoms and parental feeding styles and practices are mixed. Limitations of studies included in this review should be noted: (1) the use of a diverse set of self-report questionnaires to assess parental feeding practices is problematic due to potential misclassification and makes it difficult to compare these outcomes across studies, thus caution must be taken in drawing conclusions; and (2) the majority of included studies (6/8) were cross-sectional. There is a need for additional longitudinal studies to disentangle the influence of depression on parental feeding styles and practices. Nevertheless, given that depressive symptoms and feeding styles and practices are potentially modifiable, it is important to understand their relationship to inform obesity prevention interventions and programs.

The impact of environmental, parental and child factors on health-related behaviors among low-income children

Multi-level factors act in concert to influence child weight-related behaviors. This study examined the simultaneous impact of variables obtained at the level of the home environment (e.g., mealtime ritualization), parent (e.g., modeling) and child (e.g., satiety responsiveness) with the outcomes of practicing healthy and limiting unhealthy child behaviors (PHCB and LUCB, respectively) in a low-income U.S.

SAMPLE

This was a cross sectional study of caregivers of preschool children (n = 432). Caregivers were interviewed using validated scales. Structural equation modeling was used to examine associations with the outcomes. Adjusting for study region, demographics and caregiver's body mass index, we found significant associations between PHCB and higher mealtime ritualizations (β: 0.21, 95% confidence interval [CI]: 0.11; 0.32, more parental modeling (β: 0.39, 95% CI: 0.27; 0.49) and less parental restrictive behavior (β: -0.19, 95% CI: -0.29; -0.10). More parental covert control (β: 0.44, 95% CI: 0.35; 0.54), more parental overt control (β: 0.14, 95% CI: 0.03; 0.25) and less parental permissive behavior (β: -0.25, 95% CI: -0.34; -0.09) were significantly associated with LUCB. Findings suggest the synergistic effects of mealtime ritualizations and covert control at the environmental-level and parental modeling, overt control, restrictive and permissive behavior at the parent-level on the outcomes. Most factors are modifiable and support multidisciplinary interventions that promote healthy child weight-related behaviors.

Dietary Patterns of European Children and Their Parents in Association with Family Food Environment: Results from the I.Family Study

The aim of this study was to determine whether an association exists between children's  and  parental  dietary  patterns  (DP),  and  whether  the  number  of  shared  meals  or  soft  drink  availability  during  meals  strengthens  this  association.  In  2013/2014  the  I.Family  study  cross-sectionally assessed the dietary intakes of families from eight European countries using 24-h  dietary recalls. Usual energy and food intakes from six- to 16-year-old children and their parents  were estimated based on the NCI Method. A total of 1662 child-mother and 789 child-father dyads  were included; DP were derived using cluster analysis. We investigated the association between  children's and parental DP and whether the number of shared meals or soft drink availability  moderated this association using mixed effects logistic regression models. Three DP comparable in  children and parents were obtained: Sweet &amp; Fat, Refined Cereals, and Animal Products. Children  were more likely to be allocated to the Sweet &amp; Fat DP when their fathers were allocated to the  Sweet &amp; Fat DP and when they shared at least one meal per day (OR 3.18; 95% CI 1.84; 5.47). Being  allocated to the Sweet &amp; Fat DP increased when the mother or the father was allocated to the Sweet  &amp; Fat DP and when soft drinks were available (OR 2.78; 95% CI 1.80; 4.28 or OR 4.26; 95% CI 2.16;  8.41, respectively). Availability of soft drinks and negative parental role modeling are important  predictors of children's dietary patterns.

Meal planning is associated with food variety, diet quality and body weight status in a large sample of French adults

BACKGROUND

Meal planning could be a potential tool to offset time scarcity and therefore encourage home meal preparation, which has been linked with an improved diet quality. However, to date, meal planning has received little attention in the scientific literature. The aim of our cross-sectional study was to investigate the association between meal planning and diet quality, including adherence to nutritional guidelines and food variety, as well as weight status.

METHODS

Meal planning, i.e. planning ahead the foods that will be eaten for the next few days, was assessed in 40,554 participants of the web-based observational NutriNet-Santé study. Dietary measurements included intakes of energy, nutrients, food groups, and adherence to the French nutritional guidelines (mPNNS-GS) estimated through repeated 24-h dietary records. A food variety score was also calculated using Food Frequency Questionnaire. Weight and height were self-reported. Association between meal planning and dietary intakes were assessed using ANCOVAs, while associations with quartiles of mPNNS-GS scores, quartiles of food variety score and weight status categories (overweight, obesity) were evaluated using logistic regression models.

RESULTS

A total of 57% of the participants declared to plan meals at least occasionally. Meal planners were more likely to have a higher mPNNS-GS (OR quartile 4 vs. 1 = 1.13, 95% CI: [1.07-1.20]), higher overall food variety (OR quartile 4 vs. 1 = 1.25, 95% CI: [1.18-1.32]). In women, meal planning was associated with lower odds of being overweight (OR = 0.92 [0.87-0.98]) and obese (OR = 0.79 [0.73-0.86]). In men, the association was significant for obesity only (OR = 0.81 [0.69-0.94]).

CONCLUSIONS

Meal planning was associated with a healthier diet and less obesity. Although no causality can be inferred from the reported associations, these data suggest that meal planning could potentially be relevant for obesity prevention.

Innovative Techniques for Evaluating Behavioral Nutrition Interventions

Assessing outcomes and the impact from behavioral nutrition interventions has remained challenging because of the lack of methods available beyond traditional nutrition assessment tools and techniques. With the current high global obesity and related chronic disease rates, novel methods to evaluate the impact of behavioral nutrition-based interventions are much needed. The objective of this narrative review is to describe and review the current status of knowledge as it relates to 4 different innovative methods or tools to assess behavioral nutrition interventions. Methods reviewed include 1) the assessment of stress and stress responsiveness to enhance the evaluation of nutrition interventions, 2) eye-tracking technology in nutritional interventions, 3) smartphone biosensors to assess nutrition and health-related outcomes, and 4) skin carotenoid measurements to assess fruit and vegetable intake. Specifically, the novel use of functional magnetic resonance imaging, by characterizing the brain's responsiveness to an intervention, can help researchers develop programs with greater efficacy. Similarly, if eye-tracking technology can enable researchers to get a better sense as to how participants view materials, the materials may be better tailored to create an optimal impact. The latter 2 techniques reviewed, smartphone biosensors and methods to detect skin carotenoids, can provide the research community with portable, effective, nonbiased ways to assess dietary intake and quality and more in the field. The information gained from using these types of methodologies can improve the efficacy and assessment of behavior-based nutrition interventions.

Aquisição domiciliar de refrigerantes e de biscoitos reduz o efeito de uma intervenção de promoção de frutas e hortaliças

Resumo: O presente estudo examina a influência do aumento da disponibilidade intradomiciliar de refrigerantes e biscoitos sobre os efeitos de uma intervenção de promoção do consumo de frutas e hortaliças. Foram analisados os dados de 70 famílias que viviam em comunidades de baixa renda na cidade do Rio de Janeiro, Brasil, que foram selecionadas por meio de uma amostra probabilística estratificada e completaram registro alimentar de 30 dias antes e depois da intervenção. A intervenção contribuiu para um aumento significativo na disponibilidade intradomiciliar de frutas e hortaliças (+2,7 p.p.; IC95%: 1,5; 4,0), superando a tendência de estagnação na população brasileira. Já a aquisição de refrigerantes e biscoitos, que não foi objeto da intervenção, acompanhou a tendência crescente de consumo destes produtos (+5,8 p.p.; IC95%: 3,3; 8,4). As famílias que aumentaram a aquisição de refrigerantes e biscoitos apresentaram menores aumentos, ou decréscimos, na aquisição de frutas e hortaliças (p < 0,05) e tiveram uma chance quase quatro vezes menor de experimentar algum aumento na disponibilidade intradomiciliar de frutas e hortaliças.

No Time for Family Meals? Parenting Practices Associated with Adolescent Fruit and Vegetable Intake When Family Meals Are Not an Option

BACKGROUND

Despite research linking family meals to healthier diets, some families are unable to have regular meals together. These families need guidance about other ways to promote healthy eating among adolescents.

OBJECTIVE

Our aim was to examine the association between various parenting practices and adolescent fruit and vegetable (F/V) intake at different levels of family meal frequency.

DESIGN

We conducted a cross-sectional, population-based survey of influences on adolescent weight-related behaviors using Project EAT (Eating and Activity in Teens) 2010.

PARTICIPANTS/SETTING

Participants were 2,491 adolescents recruited from middle/high schools in Minneapolis/St Paul, MN.

MEASURES

Adolescent F/V intake was ascertained with a food frequency questionnaire. Survey items assessed frequency of family meals and F/V parenting practices (availability, accessibility, parent modeling, parent encouragement, and family communication).

STATISTICAL ANALYSES

Linear regression models were used to examine associations with and interactions among family meals and parenting practices. Models were adjusted for age, sex, socioeconomic status, race/ethnicity, and energy intake (kilocalories per day).

RESULTS

Family meals, F/V availability, F/V accessibility, F/V modeling, and encouragement to eat healthy foods were independently associated with higher F/V intake. Of the 949 (34%) adolescents who reported infrequent family meals (≤2 days/wk), mean F/V intake was 3.6 servings/day for those with high home F/V availability vs 3.0 servings/day for those with low home F/V availability. Similar differences in mean F/V intake (0.3 to 0.6 servings/day) were found for high vs low F/V accessibility, parental modeling, and parent encouragement for healthy eating. Frequent family meals in addition to more favorable parenting practices were associated with the highest F/V intakes.

CONCLUSIONS

Food parenting practices and family meals are associated with greater adolescent F/V intake. Longitudinal and intervention studies are needed to determine which combination of parenting practices will lead to improvements in adolescent diets.

An Experiential Cooking and Nutrition Education Program Increases Cooking Self-Efficacy and Vegetable Consumption in Children in Grades 3-8

OBJECTIVE

Evaluate the effect of a community-based, experiential cooking and nutrition education program on consumption of fruits and vegetables and associated intermediate outcomes in students from low-income families.

DESIGN

Quasi-experimental program evaluation by pre-post survey of participating students and their parents.

SETTING

Underserved elementary and middle schools in Chicago.

PARTICIPANTS

Students (n = 271; 65% girls, 44% Hispanic, 32% African American; 94% eligible for free/reduced price lunch) in grades 3-8 selected by school staff to participate by variable inclusion criteria. 59% of students who applied returned both pre- and post-surveys.

INTERVENTION(S)

Ten-week (2 h/wk) chef-instructor-led program held in cafeteria kitchens after school.

MAIN OUTCOME MEASURE(S)

Changes in student nutrition knowledge, cooking self-efficacy, fruit and vegetable liking and consumption, and communication to family about healthy eating.

ANALYSIS

Changes from beginning to end of program were analyzed with paired t test. Results were considered significant at P < .05.

RESULTS

Increased nutrition knowledge score from 0.6 to 0.8, cooking self-efficacy score from 3.2 to 3.6, and vegetable consumption score from 2.2 to 2.4 (all P < .05). Increased score for communication about healthy eating (4.1 to 4.4; P < .05) 6 months after the end of the course.

CONCLUSIONS AND IMPLICATIONS

Experiential cooking and nutrition education programs led by chef-instructors may be effective ways to improve nutrition in low-income communities.

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.