Family food involvement is related to healthier dietary intake in preschool-aged children

Gap between the concerns of healthcare professionals and parents' perceptions regarding dietary habits for 18-month- and 3-year-old children in Japan

BACKGROUND

A gap has been reported between healthcare professionals' (hereafter "professionals") recognition of preschool children's diets and parents' perception of concern. This study investigated the gap between the concerns reported by professionals and parents' perceptions regarding health and dietary habits by age (18 months and 3 years) and gender in Japan.

METHODS

The study design consisted of a cross-sectional, multilevel survey. The request letters were sent to all households with target children with the cooperation of local governments. After obtaining written informed consent from parents, questionnaires were distributed to them. The survey included 30 items on children's concerns about health and dietary habits. At the health checkup, parents indicated whether they were concerned in response to each item, and responded child's height and weight and birth height and weight. Next, the professionals provided counseling to the parents at a health checkup. After that, the professionals noted their concerns in response to the same 30 items as those given to parents. The participation rates were 82.9% (18 months) and 82.8% (3 years). Data of 239 persons for 18 months and 223 persons for 3 years old were analyzed. In the statistical analysis, the items that were judged as concerning by professionals but not by parents were identified; likewise, the items that were of concern to parents but not to professionals were identified. Sensitivity, false negative rate, specificity, false positive rate, and Youden index were calculated to analyze the discordance rate for each item.

RESULTS

Many parents in this study were concerned about the issues that professionals did not consider to be concerning. Moreover, the parents worried about more issues for 3-year-olds than for 18-month-olds. The items for which ≥ 10 professionals indicated concerns and with higher discordance between the professionals and parents for both boys and girls were "picky eating" for 18-month-olds and "inconsistent amount of food" for 3-year-olds.

CONCLUSIONS

The concerns that professionals have with respect to children's diets and the things that parents worry about show gaps. It might be necessary to provide professional counseling for parents to develop a correct understanding of their children's dietary habits.

Parental influences on children's dairy products consumption: a narrative review

OBJECTIVE

To review research on the influence of parent-related factors on children's dairy products consumption.

DESIGN

A search of electronic databases and a narrative synthesis of the literature were conducted. English-language articles were included if they reported data relating to parental influences on children's consumption of dairy products and if statistical significance was reported.

SETTING

Studies were carried out in the USA (n 8) and in a range of countries across Europe (n 12) and Asia (n 5).

PARTICIPANTS

The subjects of this research were children aged between 2 and 12 years of age, from a range of geographical locations.

RESULTS

Twenty-five studies met the inclusion criteria. The studies examined children's dairy products consumption in relation to parental socio-economic status (education level and income) (n 12), home availability (n 2), home food environment (n 3), parental dairy products consumption (n 4), parent feeding practices (n 3), parents' beliefs and attitudes (n 3) and parental nutrition knowledge (n 3). Results on the association between socio-economic status and children's dairy products consumption varied; however, studies reporting a significant association generally observed a positive relationship. Fifteen studies reported children's total dairy products intake as an outcome measure, with the remaining studies reporting intake of milk or other dairy products as individual foods.

CONCLUSIONS

This review identified literature exploring a range of parental factors in relation to children's dairy products intake. However, there were limited numbers of studies published within each category of modifiable factors. Further research on the parent-related determinants of dairy products consumption in children is required in order to identify potential intervention targets in this age group.

'I'm having jelly because you've been bad!': A grounded theory study of mealtimes with siblings in Australian families

Obesity prevention interventions have been designed to promote responsive feeding in early childhood. However, existing interventions primarily target first-time mothers without considering the complexities of feeding multiple children within a family unit. By applying principles of Constructivist Grounded Theory (CGT), this study aimed to explore how mealtimes are enacted in families with more than one child. A mixed-methods study was conducted with parent-sibling triads (n = 18 families) in South East Queensland, Australia. Data included direct mealtime observations, semistructured interviews, field notes, and memos. Data were analysed using open and focused coding, during which constant comparative analysis was applied. The sample comprised of two-parent families with children ranging in age from 12 to 70 months (median sibling age difference = 24 months). A conceptual model was developed to map sibling-related processes integral to the enactment of mealtimes in families. Notably, this model captured feeding practices used by siblings, such as pressure to eat and overt restriction, that previously had only been described in parents. It also documented feeding practices used by parents that may occur only in the presence of a sibling, such as leveraging sibling competitiveness and rewarding a child to vicariously condition their sibling's behaviour. The conceptual model demonstrates complexities in feeding that give shape to the overall family food environment. Findings from this study can inform the design of early feeding interventions that support parents to remain responsive, particularly when their perceptions and expectations of siblings differ.

Cultural Influences on Family Mealtime Routines in Mexico: Focus Group Study with Mexican Mothers

Mexico’s obesity rates are alarming, and experts project drastic increases in the next thirty years. There is growing interest in understanding how remote acculturation and globalization processes influence health behaviors. The present study used focus group data from a central state, San Luis Potosí, in Mexico to explore mothers’ perspectives on factors that influence family mealtime routines. Thematic analysis was used to identify barriers and facilitators to healthy mealtime routines and diet within families. Twenty-one mothers participated in the focus groups; 76% were full-time stay at home mothers, the majority were low-income (65%), and fewer than half reached a high school education. Three major themes emerged: (1) mothers do most of the visible work involving mealtime routines; (2) family meals are different today, and globalization is a contributing factor; and (3) family mealtimes are shifting to weekend events. Empowering mothers to negotiate diet with family members to build healthy routines, navigate challenges due to changing environments, and set family boundaries around technology use during mealtimes should be taken into consideration when promoting healthy behaviors with Mexican families.

Family Social Support and Weight-Related Behaviors of School-Age Children: An Exploratory Analysis

Families are a key provider of support that may encourage positive weight-related behaviors. Yet little is known about the relation of family support to children’s performance of weight-related behaviors. Mothers (N = 524) who completed an online survey were categorized as having low, moderate, or high family support for fruit/vegetable intake, breakfast intake, limiting sugar-sweetened beverage intake, physical activity, limiting sedentary screentime, and sleep. ANOVA revealed that children in families with high support for breakfast ate this meal significantly more often. Additionally, children in families with low support for limiting sugar-sweetened beverages had significantly greater intake. Surprisingly, families with moderate support for physical activity and sleep tended to have children with lower physical activity level, sleep duration, and sleep quality, and fewer days/week with set bedtimes than those with low and high support. Binomial logistic regression revealed that high family support for eating breakfast, limiting sugar-sweetened beverages, and getting sufficient sleep had greater odds of meeting recommendations for these behaviors. Findings suggest that greater family support for healthy weight-related behaviors tends to be associated with children’s performance of these behaviors. Future interventions should further examine the impact of different types of family support on weight-related behaviors to better understand this complex interplay.

The Impact of COVID-19 Restrictions on the Healthy Eating and Movement Behaviors of 0–12-Year-Old Children in Western Sydney, Australia

This study examined effects of COVID-19 restrictions in early 2020 on movement (physical activity, sedentary behavior and sleep) and healthy eating behaviors in families with 0–12-year-old children in western Sydney, Australia. A total of 1,371 parents completed an online survey about changes in children's and families' food intake and movement behaviors. There was an increase in sedentary screen use by children (4.18/5.00) and families (3.91/5.00) and a slight increase in reported physical activity (3.56/5.00), amount of food consumed (3.58/5.00) and meals and snacks eaten (3.69/5.00) during the height of the COVID-19 restrictions compared to before. There was little change in reported sleep (3.17/5.00). Lower socioeconomic families were disproportionately affected, with greater increases in unhealthy eating (t = 2.739, P = 0.06), lower levels of improvement in physical activity, such as walking and cycling (t = −7.521, P < 0.001) and outdoor activity (t = 5.415, p < 0.001), and higher increases in family sedentary behavior (t = 2.313, P = 0.021). Therefore, even short periods of restrictions can result in detrimental health behavior changes. Such changes could become entrenched leading to increased risk of lifestyle diseases. Programmatic and policy strategies should be geared toward promoting healthy movement behaviors, focusing on families of lower socioeconomic status to ensure the pandemic does not widen an existing gap.

Feasibility of a Home-Delivery Produce Prescription Program to Address Food Insecurity and Diet Quality in Adults and Children

Produce prescription programs aim to improve food insecurity (FI) and nutrition but their effectiveness is unclear. We conducted a pilot study to demonstrate the feasibility and explore the potential impact of a family-based, home-delivery produce prescription and nutrition education program. We measured enrollment, satisfaction, participation, and retention as measure of feasibility. Adult participants answered pre-post self-report questionnaires assessing FI, child and adult fruit and vegetable intake, and culinary literacy and self-efficacy. To understand participants' lived experiences, qualitative interviews were conducted at the 6-month time point. Twenty-five families were enrolled. Feasibility measures indicate participants were generally satisfied with the program but there were important barriers to participation. Qualitative data revealed themes around reduced food hardship, healthy eating, budget flexibility, and family bonding. Fruit and vegetable consumption increased in a small subgroup of children, but post-intervention intake remained below recommended levels, particularly for vegetables. FI scores were not significantly different post-intervention, but qualitative findings indicated improved access and reliability of food. This is the first intervention of its kind to be evaluated for feasibility and our results suggest the intervention is well-received and supportive. However, further study, with a larger sample size, is needed to understand factors influencing participation and assess effectiveness.

Parenting Practices and Adolescents' Eating Behaviors in African American Families

Parents play an important role in developing the eating behaviors of their children by adopting specific parenting practices. As the prevalence of obesity is high amongst African American adolescents, investigations into associations of specific parenting practices and adolescents’ eating behaviors are essential. In this exploratory study, 14 African American parent–adolescent dyads were interviewed to characterize the influence of eight different parenting practices on the consumption of three main food categories (dairy, fruits and vegetables, and unhealthy snacks). The results revealed that authoritarian parenting practices were correlated with a higher BMI percentile in adolescents, whereas modeling and monitoring are correlated with a higher parent BMI. In addition, reasoning, monitoring, modeling, and authoritative parenting practices were associated with less unhealthy snack consumption among adolescents. Reasoning and monitoring were the only parenting practices associated with higher fruit and vegetable consumption. Finally, a significant correlation was found between eating fruits and vegetables and unhealthy snacks and the location of eating. In conclusion, different parenting practices and environmental factors may impact BMI and food consumption of African American dyads. The results of this study can be used to guide improvement in, and/or development of, nutritional education interventions considering the cultural differences of racial minorities.

Child involvement in meal preparation and grocery shopping is associated with lower levels of food fussiness among young children

This study examined associations between child food involvement and food fussiness. Analyses used survey data from 62 children ages 1.5 to 5.9 years who participated in the Guelph Family Health Study Pilot. Overall involvement (β = -0.51, p = 0.02), involvement in meal preparation (β = -0.42, p = 0.009), and involvement in grocery shopping (β = -0.29, p = 0.04) were inversely associated with food fussiness. Experimental research including larger, more diverse samples is needed to test whether food involvement reduces food fussiness among young children. Novelty: Our study identified significant, inverse associations between child food involvement and food fussiness.

Relationship between parents' dietary care and food diversity among preschool children in Japan

Objective:

To identify the relationship between preschool children’s dietary diversity and parents’ care behaviours related to their diet including contents of foods and snacks, mealtime practice and parent–child communication.

Design:

Cross-sectional study. Data were extracted from the National Nutrition Survey on Preschool Children in 2015 by Japan’s Ministry of Health, Labour and Welfare.

Setting:

The distribution of food diversity score (FDS) (maximum of eight points) was confirmed. The participants were divided into higher (≥4 points) and lower (≤3 points) food diversity groups. A comparison between the two groups examined parents’ socio-economic status, children’s health and living conditions, and parental care concerning children’s diets (thirteen items). A multiple regression analysis was performed relating FDS to the factors of parental socio-economic status and child health, and a logistic regression analysis was conducted to identify factors of parental care related to the higher food diversity group.

Participants:

2143 persons from households with children aged 2–6 years.

Results:

Parental care concerning children’s diets was the factor most strongly associated with children’s FDS. Those factors most strongly associated with higher food diversity were nutritional balance of foods (OR: 1·76; 95 % CI 1·44, 2·16; P < 0 0001), snack contents (OR: 1·41; 95 % CI 1·07, 1·86; P = 0·014) and regular mealtimes (OR: 1·30; 95 % CI 1·08, 1·55; P = 0·005).

Conclusions:

The findings indicate the importance of parents paying attention to the contents of children’s foods and snacks, ensuring that children eat regularly, and increasing the diversity of their diets.

Corish C, M. Kearney J. Associations between the Home Environment, Feeding Practices and Children's Intakes of Fruit, Vegetables and Confectionary/Sugar-Sweetened Beverages

Within the home environment, parents influence their children’s dietary intakes through their parenting and dietary practices, and the foods they make available/accessible. The aim of this cross-sectional study was to examine the associations between home environmental characteristics and children’s dietary intakes. Three hundred and thirty-two children aged three–five years and their parents participated in the study. Home environmental characteristics, including parental control feeding practices, were explored using validated and standardized questionnaires such as the Child Feeding Questionnaire (CFQ), the Physical and Nutritional Home Environment Inventory (PNHEI) and the Healthy Home Survey (HHS). Parent and child food consumption was also measured. Pressure to eat from parents was associated with lower fruit intake in children (OR 0.67, 95% CI 0.47–0.96, p = 0.032). Greater variety of fruit available in the home increased the likelihood of fruit consumption in children (OR 1.35 95% CI 1.09–1.68, p = 0.005). Watching television for ≥1 h per day was associated with a decreased probability of children eating vegetables daily (OR 0.38, 95% CI 0.20–0.72, p = 0.003) and doubled their likelihood of consuming confectionary/sugar-sweetened beverages more than once weekly (OR 2.15, 95% CI 1.06–4.38, p = 0.034). Children whose parents had lower vegetable consumption were 59% less likely to eat vegetables daily. This study demonstrates that modifiable home environmental characteristics are significantly associated with children’s dietary intakes.

"Food" and "non-food" self-regulation in childhood: a review and reciprocal analysis

BACKGROUND

In developmental science, there is an extensive literature on non-food related self-regulation in childhood, where several domains relating to emotions, actions and cognitions have been identified. There is now growing attention to food related self-regulation in childhood, especially difficulties with ASR, and the consequences for weight gain and adiposity. The aim of this narrative review was to conduct a reciprocal analysis of self-regulation in the food and non-food domains in childhood (referred to as appetite self-regulation (ASR) and general self-regulation (GSR) respectively). The focus was on commonalities and differences in key concepts and underpinning processes.

METHODS

Databases and major journals were searched using terms such as self-regulation, appetite self-regulation, or self-regulation of energy intake, together with associated constructs (e.g., Executive Function, Effortful Control, delay-of-gratification). This was followed by backward and forward snowballing.

RESULTS AND DISCUSSION

The scholarship on GSR in childhood has had a focus on the role of the cognitively-oriented Executive Function (EF), the temperamentally-based Effortful Control (EC) and the recursive interplay between bottom-up (reactive, emotion driven, approach or avoidance) and top-down (cognitive, conscious decision-making) processes. "Hot" and "cool/cold" EF and self-regulation situations have been distinguished. There were some parallels between GSR and ASR in these areas, but uncertainty about the contribution of EF and EC to ASR in young children. Possible differences between the contribution to ASR-related outcomes of delay-of-gratification in food and non-food tasks were apparent. Unique elements of ASR were identified; associated with psychological, biological and neurological responses to food and bottom-up processes. A diverse number of situations or elements connected to ASR exist: for example, energy balance homeostasis, caloric compensation, hunger regulation, satiation, satiety, energy density of food, eating in the absence of hunger, emotional eating, etc. CONCLUSIONS: Self-regulation in food and non-food domains are amenable to a reciprocal analysis. We argue that self-regulation of appetite should be added as a domain under the umbrella of self-regulation in childhood along with the other non-food related domains. This could lead to a broader understanding of self-regulation in childhood, and generate novel lines of enquiry.

Sprouts Growing Healthy Habits: Curriculum Development and Pilot Study

High rates of childhood obesity and the impact this has on children's health make it important to establish a healthy lifestyle during the early school years. This pilot study explored the impact of a newly developed healthy habits curriculum. The Sprouts: Growing Healthy Habits curriculum presents topics such as energy balance, healthy sleep habits, and food groups through short activities and interactive book-reading. A nonrandomized controlled experimental study design was used to assess impact. Fifty-seven children between 5 and 6 years of age participated from two elementary schools (36 from the intervention school, 21 from the control school). Knowledge was assessed pre- and post-intervention in five content areas (farm to table, bedtime routines, portion size, energy expenditure, sugar content of beverages) using card sorting, ranking, and sequence activities. Within- and between-school comparisons were conducted using differences between groups and mixed modeling approaches. Within the intervention school, significant increases in knowledge were observed for farm to table, sugar content of beverages, and bedtime routines. For the control school, there was a significant increase in knowledge of portion sizes. Considering between-schools, only change in knowledge of bedtime routines remained significant, with greater increases in the intervention school. Results seem promising given the short dosage of curriculum. Increases in knowledge of healthy habits in early childhood may help in promoting healthy behaviors and combatting the effects of obesity.

Understanding Parental Ethnotheories and Practices About Healthy Eating: Exploring the Developmental Niche of Preschoolers

PURPOSE

To understand parental ethnotheories (ie, belief systems) and practices about preschoolers' healthy eating guided by the developmental niche framework.

DESIGN

Qualitative hermeneutic phenomenology.

SETTING

Home.

PARTICIPANTS

Participants were 20 parents of preschool-age children ages 3 to 5 years, recruited from a quantitative investigation. A majority of the participants were white, female, married, well educated, and working full time.

METHODS

Participants who completed the quantitative survey were asked to provide their contact information if they were willing to be interviewed. From the pool of participants who expressed their willingness to participate in the interviews, 20 participants were selected using a random number generator. In-person semistructured interviews were conducted until data saturation (n = 20). Thematic analysis was performed.

RESULTS

Three themes and 6 subthemes emerged: theme 1-parental ethnotheories about healthy eating included subthemes of knowledge about healthy eating, motivations to promote healthy child development through healthy eating, and sources of knowledge about healthy eating (eg, doctors, social media, government guidelines, positive family-of-origin experiences); theme 2-parental ethnotheories that supported organization of children's physical and social settings included structured mealtime routines and food socialization influences (eg, grandparents, siblings, and childcare programs); and theme 3-parental ethnotheories that supported children's learning about healthy eating included parent-child engagement, communication, and encouragement in food-related activities (eg, meal preparation, visiting farmer's market, grocery shopping, gardening, cooking, baking).

CONCLUSION

Findings advance the literature on parental practices about healthy eating. Parental ethnotheories (eg, beliefs, motivations, knowledge, and skills) matter. Developmental niche of preschoolers (ie, physical and social settings, childrearing practices, and parental ethnotheories) constitutes an interactive system in which ethnotheories serve as guides to parental practices. Fostering nutrition education and parent-child engagement, communication, and encouragement in food-related activities are recommended to promote children's healthy eating in daily routines.

Reprint of "The relationship between culinary skills and eating behaviors: Challenges and opportunities for parents and families"

Unhealthy dietary intake among American children and adults is of great concern to public health practitioners, nutritional scientists, and child development experts. Cooking skills are related to healthier dietary intake among Americans of all ages, but remain a substantial barrier for many parents who want to serve healthy meals for their families at home. Culinary education interventions are effective solutions for many parents who do not know how to cook, but issues with participation bias mean that these programs are not effective solutions for all individuals. The food industry should develop solutions to help those parents for whom learning cooking skills is not an option - specifically through the development of healthier pre-assembled or prepared foods that do not require cooking skills to make. In the future, the research community should also strive to collect comprehensive population-based data on the state of cooking skills in the United States.

The relationship between culinary skills and eating behaviors: Challenges and opportunities for parents and families

Unhealthy dietary intake among American children and adults is of great concern to public health practitioners, nutritional scientists, and child development experts. Cooking skills are related to healthier dietary intake among Americans of all ages, but remain a substantial barrier for many parents who want to serve healthy meals for their families at home. Culinary education interventions are effective solutions for many parents who do not know how to cook, but issues with participation bias mean that these programs are not effective solutions for all individuals. The food industry should develop solutions to help those parents for whom learning cooking skills is not an option - specifically through the development of healthier pre-assembled or prepared foods that do not require cooking skills to make. In the future, the research community should also strive to collect comprehensive population-based data on the state of cooking skills in the United States.

Do Chinese Preschool Children Eat a Sufficiently Diverse Diet? A Cross-Sectional Study in China

BACKGROUND

This study aimed to comprehensively evaluate dietary diversity and its associated factors in Chinese preschoolers and explore whether the daily food consumption of children with different dietary diversity-associated characteristics met recommended dietary amounts.

METHODS

A cross-sectional study covering seven cities and two villages was conducted and included 697 preschool children aged 3⁻7 years old. Dietary diversity score (DDS) and DDS 10 were calculated based on 24-h dietary recall. The food-intake differences among children with different DDS 10 predictors were examined.

RESULTS

The mean DDS and DDS 10 in Chinese preschool children were 7.4 ± 1.5 (ranged from 3 to 9) and 7.0 ± 3 (ranged from 3 to 9) respectively. Positive predictors of dietary diversity included residing in an urban environment, a higher household expenditure on children’s food, and a higher frequency of eating outside. Food-intake differences existed among the predictors.

CONCLUSIONS

Education and intervention should be strengthened to improve the dietary diversity of preschool children, especially in rural areas. The overall dietary pattern of children requires attention, which means not only increasing dietary diversity but also avoiding an unbalanced diet.

Helping With Meal Preparation and Children’s Dietary Intake: A Literature Review

Most children and adolescents do not meet dietary recommendations that may result in poor diets contributing to obesity. This systematic literature review was conducted to examine associations between helping with meal preparation at home and dietary quality, intake of specific foods, and/or dietary-related perceptions among youth. A search of databases using key terms was conducted for studies meeting criteria. This literature review included 15 studies using a cross-sectional descriptive design, with two studies also including a longitudinal design. Data were self-reported (or parent-reported) using various surveys and/or interviews. Study findings supported positive associations between youth involvement in home meal preparation and improvement in overall dietary quality, increased consumption of fruits and vegetables, greater preference for vegetables, and higher self-efficacy for cooking and choosing healthy foods. Further research is needed to develop efficacious meal preparation interventions involving parents and their children to promote this mealtime behavior with many potential health benefits.