Dietary habits, physical activity, and sedentary behaviour of children of employed mothers: A systematic review

Assessing family influence on adolescent healthy eating: insights from knowledge, attitudes, and practices in a cross-sectional survey in Hong Kong

BACKGROUND

Poor dietary habits in adolescents contribute to the development of non-communicable diseases in adulthood. While family influence by parenting style, food parenting practice and household income on adolescent eating habits has been well-established, other family factors such as parental health conditions as well as the impact on dietary knowledge and attitudes in adolescents are underexplored. This study aimed to evaluate the relative importance of family factors on adolescent healthy eating using the knowledge, attitudes, and practices (KAP) model.

METHODS

A cross-sectional online survey was conducted among parent-adolescent dyads recruited from a previous cohort study and secondary schools in Hong Kong. Adolescent healthy eating was assessed by a locally developed and validated KAP of Healthy Eating Questionnaire (KAP-HEQ). It evaluated knowledge on dietary recommendations, health outcomes and food choice; attitudes on outcome expectation, food preference, and self-efficacy; and practices on meal pattern and healthy/unhealthy food consumption. Parents reported on family factors including their KAP of healthy eating (KAP-HEQ), parenting style (Parenting Style and Dimensions Questionnaire), attitudes towards adolescent eating habit, food parenting practices, and family demographic characteristics such as employment status and household income. Multivariable linear regression was used to estimate the family influence on adolescent healthy eating.

RESULTS

Two hundred seven dyads of parents (mean age = 46.14 years, 85.02% mothers, 80.19% married, 60.87% attained senior secondary education or above) and adolescents (mean age = 15.21 years, 48.31% female) completed the survey. Positive associations were found between dyad knowledge (β = 0.28, p < 0.001), dyad attitudes (β = 0.22, p < 0.001), and between adolescent practices and food parenting practices (β = 0.18, p < 0.001) and parental employment status (part-time vs unemployed: β = 4.08, p < 0.05). Negative associations were identified between adolescent attitudes and authoritative parenting style (β = -0.11, p < 0.05) and household size (β = -3.19, p < 0.05), and between adolescent practices and higher parental education levels (senior secondary or above vs primary or below: β = -2.86, p < 0.05).

DISCUSSION

The study found positive effects of parental dietary knowledge, attitudes, and food parenting practices on adolescent KAP of healthy eating. Interventions to enhance these three family facilitators should be included in strategies for promoting KAP of healthy eating among adolescents.

Infant and young child feeding practice status and its determinants in UAE: results from the MISC cohort

BACKGROUND

To evaluate breastfeeding and complementary feeding practices and their determinants among infants and young children in the United Arab Emirates using the 2021 WHO/UNICEF IYCF guidelines.

METHODS

The Mother and Infant Study Cohort (MISC), is a prospective study of mothers recruited in their third gestational trimester and followed with their infants up to 18 months of age (n = 167). Data were collected at 3rd trimester, delivery, 2, 6, 12, and 18 months postpartum via questionnaires, review of medical records, anthropometric measurements, and 24-hour dietary recalls of the child's intake at 6, 12, and 18 months. Descriptive statistics and multiple logistic regressions were used to report on feeding practices and their determinants.

RESULTS

Ever breastfeeding, Early initiation of breastfeeding, and exclusive breastfeeding under 6 months were reported by 84.3%, 99.4%, and 32.9% of participants, respectively. Of children, 96.4% consumed solid foods at 6-8 months; 68.7% and 44.7% continued to be breastfed at 12 and 18 months, respectively. Despite improvement with age; several complementary feeding indicators remained suboptimal at 18 months: Minimum Dietary Diversity: 40.4%, Minimum Meal Frequency: 56.7%, Minimum Acceptable Diet: 23.1%, Sugar-Sweetened Beverages, 26.9%, Zero Vegetables and Fruits: 28.8%, Unhealthy Food Consumption: 65.4%. After adjustment, multiparous mothers had higher odds of exclusive breastfeeding, whereas pregnancy complications were associated with lower odds of exclusive breastfeeding. Continued breastfeeding at 18 months was associated with older age among mothers and lower income. Among the factors associated with complementary feeding indicators were higher physical activity and Minimum Dietary Diversity. While Gestational Diabetes Mellitus, Sugar-Sweetened Beverages, and higher education were associated with lower odds of Zero Vegetables and Fruits, and a higher income was associated with lower Unhealthy Food Consumption.

CONCLUSIONS

This study reported good rates of Early initiation of breastfeeding and ever-breastfeeding, yet suboptimal exclusive breastfeeding and complementary feeding. The identified risk factors for inappropriate practices could be used to guide nutrition interventions and public health programs in the United Arab Emirates.

Indian fathers' perceptions of young childcare and feeding - A qualitative study

The role of parents in fostering children's healthy habits is a robust area of research. However, most of the existing literature predominantly focuses on mothers' parenting practices. Given the emergence of nuclear, dual earning families and the recent surge in maternal employment in urban India, fathers' engagement in child rearing and feeding warrants attention. The purpose of this research was to document the views of Indian fathers about paternal parenting practices, with an emphasis on children's diet among other health behaviors. Thirty-three fathers of children aged 6-59 months from Kolkata, India took part in semi-structured interviews conducted either face-to-face or over Zoom/telephone in Hindi, Bengali, and English. The interviews were audio recorded, transcribed verbatim, and translated to English. The transcribed data were subjected to thematic analysis informed by the Template Analysis technique. Themes were detected using the NVivo software program. Overall, these Indian fathers played an important role in early childhood care and feeding as reflected in the following seven themes: (i) Involvement of fathers in various childcare activities; (ii) Implementation of responsive and non-responsive feeding practices; (iii) Concerns regarding fussy and slow eating; (iv) Concerns regarding excessive screen time; (v) Paternal vs maternal parenting; (vi) Barriers to routine engagement of fathers in childcare; (vii) Desire for more nutrition and health knowledge. This enhanced understanding of paternal parenting behavior supports the inclusion of fathers in future family-focused lifestyle interventions aimed at improving children's health outcomes, including their dietary habits.

A 30-year trend of dairy consumption and its determinants among income groups in Iranian households

Introduction

Milk and dairy products provide essential nutrients and have the potential to prevent chronic diseases, thus reducing healthcare costs. However, there is a lack of consistent and updated data on dairy consumption trends in Iran. This study aims to analyze the trends in dairy consumption among Iranian households from 1991 to 2021, focusing on household-level determinants across different expense groups.

Methods

The study uses data from the Iranian Household Expenditure and Income Survey conducted annually from 1991 to 2021 to analyze households' dairy consumption. The data includes values and expenses of food and non-food items purchased in the previous month, as well as demographic characteristics of household members. The households were categorized into 10 deciles based on their gross expense. The econometric model used weighted mean per capita milk, yogurt, cheese, and total dairy consumption based on milk equivalent for each decile. The model takes into account changes in income, prices, household composition, education level, occupation, and residency area using panel data. Data preparation and model estimation were performed using RStudio and STATA17 software.

Results

Based on the findings, in 1991, per capita milk, yogurt, and cheese consumption were 26.77 kg, 16.63 kg, and 2.42 kg, respectively. By 2021, these figures changed to 22.68 kg, 11.06 kg, and 3.79 kg, reflecting a decrease in milk and yogurt consumption but an increase in cheese consumption. Family size was positively correlated with yogurt consumption and head of the household spouse's job score were positively correlated with milk, yogurt and cheese consumption. Also, the presence of under five-year-old children and older adults members (over the age of 60) in the household was inversely related with yogurt and cheese consumption. Female-headed households tended to purchase more cheese, while their milk purchase level was significantly lower. Residing in urban areas was negatively related to milk, while cheese and total dairy consumption was higher in urban areas.

Discussion

The findings highlight the importance of targeted dairy subsidy interventions and educational programs to improve dairy consumption in Iranian households, especially among vulnerable groups. This will require urging policymakers and food system stakeholders for effective strategies that address macro-level factors to promote dairy consumption.

Association of Body Mass Index between Adolescents and their Parents in Mumbai and Kolkata: A Population-based Study

Introduction

Adolescent overweight and obesity as measured by body mass index (BMI) seem to be increasing at an alarming rate in urban populations. Parental BMI plays an important role in their adolescent's BMI. Overweight and obesity coexisting with undernutrition in adolescents is an important public health challenge in low- and middle-income countries (LMICs). We present results from a population-based study on adolescents' prevalence of BMI and its association with their parents' BMI in Mumbai and Kolkata, India.

Methods and materials

Multistage random sampling of households was used to select adolescents aged 12-14 years and one of their parents in 2019-2020. In Mumbai, 843 adolescents, and in Kolkata, 913 adolescents and one of their parents were interviewed independently by trained field investigators. Height and weight were measured using standardized procedures. Adolescents' BMI categories were defined using Centers for Disease Control and Prevention (CDC) recommendations. For parents, the BMI was categorized using Asian cut-off categories into underweight (BMI < 18.5), normal weight (BMI: 18.5-22.9), overweight (BMI: 23.0-27.0), and obese (BMI > 27.0). Multivariate logistic regression was used to determine the relationship between parental BMI and adolescents' BMI.

Results

In Mumbai, 15.7% and in Kolkata, 21.1% of adolescents were overweight or obese. Nearly 80% of mothers and 70% of other parents were either overweight or obese. The mothers of adolescents who were overweight or obese showed a high risk of their adolescent being overweight [odds ratio (OR): 4.16 (1.36-12.73)] or obese [OR: 18.53 (2.02-170.44)] in Mumbai and [OR: 4.45 (1.25-15.80)] and [OR: 8.81 (1.40-55.33)] in Kolkata respectively after adjusting for adolescent's gender and head of the household's highest level of educational attainment.

Conclusion

Adolescents' overweight/obesity status is strongly associated with their mothers' BMI in urban India. This association may reflect both genetic and environmental effects. The present study highlights the high prevalence of adolescent overweight and obesity in these urban populations and underscores how important it is to identify effective public health strategies for the primary prevention of childhood obesity.

A PRECEDE-PROCEED model-based educational intervention to promote healthy eating habits in middle school girls

The present study was designed to develop Nutrition Education Program (NEP) based on PRECEDE-PROCEED model (PPM) to address healthy eating behavior among middle school girls aged between 4 and 12 years. For this, middle school girls from grade 1 to 8 (n = 900) were consulted for their eating behaviors, followed by the analysis of their health problems. From 15 different schools of three large cities (Faisalabad, Lahore, and Rawalpindi) of Pakistan, students were divided into two groups: control group (n = 30) and intervention group (n = 30) from each school. The data were collected through interview-based questionnaires according to the phases of PRECEDE Model and evaluated based on PROCEED model. Implementation of NEP was carried out through lectures. Lessons were prepared to enhance student's awareness about nutritious food and healthy lifestyle through educational pamphlets and influenced their attitude towards selection of food choices from My-Plate. Results showed that NEP was quite successful for long-term results. A significant increase in total caloric intake was observed after 8 weeks of NEP intervention (1694 ± 217 Kcal) as compared to before intervention (1329 ± 318 Kcal). Similarly, carbohydrate, protein, and fat content was also increased in daily diet. Conclusively, NEP based on PPM has great impact on healthy lifestyle of middle school girls. Significant difference was observed in score of health variables before and after NEP intervention.

Associations Between Parental Employment and Children's Screen Time: A Longitudinal Study of China Health and Nutrition Survey

Objectives: Parents are often torn between their parenting roles in the family and working roles at the workplace. This study focused on the associations of parental employment with children's screen time (ST) on weekdays, weekends, and during the entire week. Methods: Unbalanced panel data including 2,977 children (aged 0-17 years) from five waves of the China Health and Nutrition Survey data from 2004 to 2015 were utilized. Two-way fixed effects models were fitted to examine the associations of parental employment status, working hours, and overwork with children's ST. Results: Compared to unemployment status, maternal formal employment positively predicted children's ST on both weekdays and weekends, while maternal informal employment was associated with increased children's ST on weekends. The more hours they worked, the more time their children spent using screens. Neither employment status nor the overwork of fathers was significant. Conclusion: Parental employment, especially maternal employment, was linked with the ST of children. More childcare-friendly labor policies are needed to promote healthy lifestyles among the next generation.

Parental Traits Associated with Adherence to the Mediterranean Diet in Children and Adolescents in Croatia: A Cross-Sectional Study

The Mediterranean diet (MD) is known to be one of the healthiest dietary patterns. Despite the significance of a healthful diet during the early stage of life, data for young individuals indicate that nutrition problems are common. This cross-sectional study aimed to determine parental factors associated with MD adherence in children and adolescents living in the Mediterranean region in Croatia. In total, 2623 children aged 2 to 18 years and their parents participated in this study. Data were collected during the period from September 2021 to February 2022 by using an anonymous questionnaire. We used KIDMED and MEDAS questionnaires for assessing MD adherence in young individuals and their parents, respectively. To assess the association of children’s MD adherence categories with the parental predictors, we performed multivariate multinomial logistic regression. Results showed that the children of parents with a low MD adherence are much more likely to have poor MD adherence than good (OR = 47.54 (95% C.I 18.24, 123.87), p < 0.001) or average (OR = 5.64 (95% C.I 3.70, 8.6), p < 0.001) MD adherence. Further, children of fathers with higher BMI (OR = 1.035 (95% C.I 1.0, 1.071)) and those who do not live with both parents (OR = 1.703 (95% C.I 0.994, 2.916), p = 0.053) are more likely to have poor MD adherence than good MD adherence. These results indicate that interventions focusing on enhancing the quality of both parents’ diets could effectively improve their children’s eating habits.

Maternal long working hours and offspring's weight-related outcomes: A systematic review and meta-analysis

It is unclear whether maternal working time has an impact on offspring's weight-related outcomes especially obesity; the objective of this study is to conduct the first meta-analysis to focus on this topic. We searched PubMed, Ovid, and Web of Science databases through August 2021. A random-effect model was used to assess the pooled odds ratios (ORs) and regression coefficients (β) with their corresponding 95% confidence intervals (95% CIs). Subgroup analyses were conducted to explore sources of heterogeneity. Publication bias was evaluated by the Egger's tests. Twenty-two observational studies were included with a total of 191,420 participants. Compared with children whose mothers worked less than 35 h/week, we found that children whose mothers worked more than 35 to 40 h/week had a 2.24-fold increased risk of childhood overweight/obesity (OR = 2.24, 95% CI: 1.61-3.11). An increment of 10 h/week in maternal working was associated with an approximately 1.0 percentage points in the probability of childhood overweight/obesity (β = 0.008, 95% CI: 0.004-0.012). The pooled OR also indicated a similar result (OR = 1.09, 95% CI: 1.04-1.15). In addition, an increment of 10 h/week in maternal working was associated with 0.029 units increase in offspring's BMI z score (β = 0.029, 95% CI: 0.016-0.042). Maternal long working hours is a potential risk factor for offspring's weight-related outcomes. Measures should be taken to protect the work welfare of females, thus facilitating the positive interaction of individual-family-society.