Associations between whole-grain intake, psychosocial variables, and home availability among elementary school children

Facilitators and barriers to preparing and offering whole grains to children diagnosed with prediabetes: qualitative interviews with low-income caregivers

Background

The prevalence of U.S. youth with prediabetes and type 2 diabetes (T2D) is increasing, with those from racial/ethnic minority and low socioeconomic status (SES) backgrounds at greater risk. Dietary fiber (e.g., whole grains and vegetables) is shown to be inversely associated with T2D risk, yet dietary recommendations are not being met. Caregivers play an important role in home food availability, but low SES neighborhoods are shown to have limited access to fiber-rich foods such as whole grains. The overall aim of this qualitative study was to assess caregiver perceptions about facilitators and barriers to preparing and offering whole grains that they received as part of the 16-week Food Overcoming Our Diabetes Risk (FoodRx) pilot study.

Methods

A convenience sample of 60 youth (8–17 years) with obesity and prediabetes were recruited from an urban pediatric weight management clinic to participate in the FoodRx pilot study. Caregivers accompanied youth to a baseline clinic visit and completed a survey that asked about individual and household characteristics. Exit interviews were conducted at the follow-up clinic visit with caregivers of all youth who completed the study (n = 48) in order to assess facilitators and barriers experienced when preparing and offering whole grains. Interview transcripts were coded using the constant comparative method and grounded theory approaches.

Results

Caregivers (n = 48) had a mean age of 43 years and were primarily female (n = 46) and Hispanic (71%). Main facilitators to preparing and offering whole grains in the home were caregivers’ improved knowledge of whole grain health benefits and the development of strategies to encourage their children to consume whole grains (i.e., pairing whole grains with another liked food). A main barrier for caregivers was the lack of resources available to identify and prepare the novel whole grains that they received.

Conclusion

Findings suggest that caregivers are receptive to incorporating more whole grains into home-prepared meals, but they may need additional nutrition and cooking education to improve their self-efficacy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10915-5.

Solutions for whole grain food development

Owing to the health benefits associated with whole grains, there has been a sustained global effort to increase their consumption, with many countries developing guidelines for recommended amounts of whole grain intake. In China, the consumption of whole grains is low. This is due, in part, to technical obstacles in the development of whole grain foods. This review focuses on possible solutions in the whole value chain and the application of new food technologies to develop whole grain foods that taste better, have more appealing texture, are safe to consume, and better retain bioactive compounds.

Main Factors Influencing Whole Grain Consumption in Children and Adults-A Narrative Review

Despite their recognized health benefits, intakes of whole grains (WG) are below recommended levels in almost all countries worldwide. This observation highlights the need to increase WG consumption by understanding factors influencing this consumption and how they could be favorably impacted. This review focused on facilitators of and barriers to WG consumption and how to improve the effectiveness of programs aiming at increasing WG consumption. The main methods to facilitate WG intakes in both adults and children seem to be to (i) increase the availability and the variety of foods containing WG, (ii) improve their sensory appeal, (iii) reduce their purchase cost, (iv) use a familiarization period to introduce them to consumers (with a gradual increase in consumed amounts and repeated exposure), and (v) improve communication and labeling to enhance consumers’ ability to identify products with WG. These strategies may be used to improve the effectiveness of programs aiming at promoting WG consumption, with a further emphasis on the need to apply them over a long period of time, and potentially to include tasting sessions of new foods containing WG. Finally, these strategies should involve broad partnerships between multiple stakeholders at the regulatory, institutional and industrial levels.

Factors Associated with Identification and Consumption of Whole-Grain Foods in a Low-Income Population

BACKGROUND

US Dietary Guidelines include recommendations to increase whole-grain consumption, but most Americans, especially low-income adults, fail to consume adequate amounts.

OBJECTIVES

The aim of this study was to determine major factors that may affect whole-grain consumption among low-income adults.

METHODS

A mixed methods approach including a whole-grain food identification activity and in-depth interview was used to determine the factors that influence whole-grain consumption based on the constructs of the integrative behavioral model. Participants were recruited from food pantries in the northeastern United States. Descriptive statistics were conducted for demographic data and survey scores, and logistic regression was used to examine differences in whole-grain accuracy by demographic characteristics.

RESULTS

Low-income adults (n = 169) completed a quantitative survey, with a subset (n = 60) recruited for an in-depth qualitative interview. When completing the whole-grain identification activity, most low-income adults identified popcorn incorrectly as refined grain (71%), whereas the refined-grain food commonly identified as whole grain was white rice (42%). Less than half of low-income adults (46%) identified the majority of whole-grain foods correctly. Age, race, and education were not associated with the ability to identify whole-grain foods correctly. However, younger adults (aged 18-49 y) were less likely to identify popcorn as a whole-grain food (OR = 0.42, P = 0.02) compared with older adults (aged ≥50 y). According to the qualitative results, additional barriers, such as perceived cost, may also affect whole-grain food consumption among low-income adults.

CONCLUSIONS

Low-income adults' ability to correctly identify whole-grain foods and having a perception that whole-grain foods are higher in cost may be the overarching barriers to consuming adequate amounts. Future efforts should focus on strategies improving identification and seeking affordable whole-grain foods to increase whole-grain consumption in low-income adults.

Whole Grain Muffin Acceptance by Young Adults

Adolescents and young adults in the United States do not consume recommended amounts of whole grains. University dining services have opportunities to inform students about whole grains and to offer foods containing blends of whole grains with refined flour to increase daily consumption of these healthful foods. An online survey of university students (n = 100) found that 70% of respondents did not know the proportion of servings of whole grains that should be eaten daily. Mini blueberry muffins containing 50, 75, and 100% white whole wheat flour were served to 50 undergraduate students who rated their liking of the muffins using a nine-point hedonic scale. Respondents liked all muffin formulations similarly for appearance, taste, texture and overall liking. After the whole grain content of each muffin was revealed, 66% of students increased their liking of the muffins containing 100% whole wheat flour. Only half of the students increased their liking for the 75% whole wheat flour muffins, and most students reported no change in liking for the muffins made with the lowest percentage of whole wheat flour. Labeling whole grain foods in university foodservice operations may increase consumption of this food group by some students. Further research with actual purchase behavior is needed.

Knowledge, attitudes and practices of schoolchildren toward whole grains and nutritional outcomes in Malaysia

Whole grains play an important role in regulating body weight. However, interventions aimed to increase whole grains consumption have had limited impact on body mass index for age z-score (BAZ) due to insufficient understanding of knowledge, attitudes and practices (KAP) toward whole grains. This survey aimed to evaluate whole grains KAP among schoolchildren, as well as to investigate the associations of whole grains KAP with BAZ among the schoolchildren in Negeri Sembilan, Malaysia. This cross-sectional survey was conducted among 380 schoolchildren aged 9-11 years, cluster sampled from six randomly selected schools. Data were collected through a validated self-administered guided questionnaire. Body weight and height were measured. A majority of the schoolchildren had normal body weight (56.6%), moderate whole grains knowledge (42.6%), as well as neutral attitudes (66.1%) and poor practices (58.9%) toward whole grains consumption. Significant positive associations were found between knowledge and attitudes (r = 0.337; p < .01), attitudes and practices (r = 0.150; p < .01) and knowledge and practices (r = 0.190; p < .01). Further, whole grains consumption's practices was associated with BAZ after adjusting for sex, gender, race and area where children lived in (p < .001). Outcome of this present study implies that positive change in whole grain knowledge would help to inculcate positive attitudes and cultivate better practices toward whole grain consumption, which may be useful in lower BAZ among schoolchildren in Negeri Sembilan, Malaysia. This study reveals the importance of KAP toward whole grains among children to assist in identification of specific preventive childhood obesity actions.

Nutrition knowledge, outcome expectations, self-efficacy, and eating behaviors by calcium intake level in Korean female college students

BACKGROUND/OBJECTIVES

Calcium is important but deficient in diets of young adult women. This study aimed to examine if cognitive factors and eating behaviors differ according to calcium intake based on the Social Cognitive Theory.

SUBJECTS/METHODS

Subjects were female college students in Seoul, Korea. Three hundred students completed the questionnaire regarding calcium intake, nutrition knowledge, outcome expectations, self-efficacy and eating behaviors. Data on 240 students were analyzed using t-test or χ(2)-test. Subjects were categorized into two groups, high calcium intake (HC, ≥ 650 mg/day) and low calcium intake (LC, < 650 mg/day), according to recommended intakes of calcium for women aged 19-29 years.

RESULTS

The LC group constituted 77.9% of total subjects. Nutrition knowledge was not different according to calcium intake. Three out of 12 outcome expectations items were significantly different between the HC and LC groups. Subjects in the HC group agreed more strongly with the practical benefits of consuming calcium-rich foods, including 'taste' (P < 0.01) and 'going well with other snacks' (P < 0.05), compared to those in the LC group. Negative expectations of 'indigestion' were stronger in the LC group than HC group (P < 0.001). Among self-efficacy items, perceived ability of 'eating dairy foods for snacks' (P < 0.001), 'eating dairy foods every day' (P < 0.01), and 'eating calcium-rich side dishes at meals' (P < 0.05) differed significantly between the HC and LC groups. Eating behaviors including more frequent consumption of dairy foods, fruits or fruit juice (P < 0.001), anchovy, seaweeds, green vegetables, protein-rich foods (P < 0.05), and less frequent consumption of sweets or soft drinks (P < 0.01) were significantly related to calcium intake.

CONCLUSIONS

This study found that outcome expectations, self-efficacy in consuming calcium-rich foods, and eating behaviors are important in explaining calcium intake. Nutrition education needs to address practical benefits, reduce negative expectations of calcium-rich foods, increase self-efficacy, and modify eating behaviors contributing to calcium intake.

Barriers and facilitators to following the Dietary Guidelines for Americans reported by rural, Northern Plains American-Indian children

OBJECTIVE

The Dietary Guidelines for Americans (DGA) promote healthy dietary choices for all Americans aged 2 years and older; however, the majority of Americans do not meet recommendations. The goal of the present study was to identify both barriers and facilitators to adherence to DGA recommendations for consumption of five recommended food groups: grains (specifically whole grains), vegetables, fruits, meat/beans and milk (specifically reduced-fat/non-fat), among American-Indian children.

DESIGN

Nominal group technique sessions were conducted to identify and prioritize children's perceived barriers and facilitators to following the DGA, as presented in the 'MyPyramid' consumer education icon. After response generation to a single question about each food group (e.g. 'What sorts of things make it harder (or easier) for kids to follow the MyPyramid recommendation for vegetables?'), children individually ranked their top five most salient responses. Ranked responses are presented verbatim.

SETTING

A rural Northern Plains American-Indian reservation, USA.

SUBJECTS

Sixty-one self-selected fifth-grade children.

RESULTS

Core barriers for all food groups studied included personal preference (i.e. 'don't like') and environmental (i.e. 'cost too much'; 'store is too far to get them'; 'grandma don't have'). Core facilitators included suggestions, i.e. 'make a garden and plant vegetables'; 'tell your friends to eat healthy'.

CONCLUSIONS

Barriers and facilitators are dissimilar for individual food groups, suggesting that dietary interventions should target reduction of barriers and promotion of facilitators specific to individual food groups recommended by the DGA.