Parental nutrition knowledge and nutrient intake in an atherosclerosis prevention project: the impact of child-targeted nutrition counselling

Health-enhancing foods: barriers to consumers' choice in Iran

Given the growing market for health-enhancing or functional foods in Iran, the consumption rate is low. Identifying and understanding the causes is key for future decisions and interventions in the market. So, the present study was designed to provide this knowledge in Iran. The study was conducted in Tehran, the capital of Iran, between May and September 2014. In total, 105 people participated in this qualitative research, including 40 production/supply/health authority stakeholders and 65 consumer stakeholders (44 housewives and 21 employed women). The sampling strategy was the purposive method with maximum diversity, and snowball sampling was used to identify key stakeholders. The social marketing framework was used for analyzing the participants' views and experiences. To collect data, semi-structured focus group discussions and in-depth interviews were conducted. Data collection and content analysis were performed simultaneously, using MAXQDA® software. Categorization of the findings based on social marketing mix showed that the most important barriers to the consumption of functional dairy products were undesirable sensory and non-sensory characteristics, lack of physical and economic access to the product, the existence of product competitors in the market and inappropriate promotion strategies. Furthermore, personal barriers identified as a new dimension and included lack of knowledge about the product and its benefits, a negative attitude toward the product and personal taste and preference. Understanding these barriers might contribute to design and implement effective and appropriate interventions to increase the consumption of these products among consumers.

Improving parenting knowledge through caregiver education in China

BACKGROUND

Caregivers' parenting knowledge is of importance to child development and to achieve positive child outcomes. Even though some caregiver education programs have demonstrated positive effects, most of them are carried out in developed countries and among western samples. As a developing country with the second-largest child population worldwide, China has initiated caregiver education programs to promote parenting knowledge among caregivers since 2016. This study examines the effect of an innovative caregiver education program on caregivers' perceived increase of parenting knowledge.

METHODS

A total of 310 caregivers with a child aged between 0 and 3 from Z city, China, were randomly selected to complete a survey. Caregivers' perceived increase of parenting knowledge was assessed by five specified knowledge dimensions, namely, child growth, feeding behaviours, daily care, disease prevention and safety. The independent variable was program participation, measured by respondents' use of program services. OLS regression was employed to assess the association between caregivers' program participation and their perceived increase of knowledge, controlling basic demographic and socio-economic factors.

RESULTS

In general, program participation had statistically significant associations with caregivers' perceived increase of parenting knowledge. The associations varied by service type. Particularly, online development evaluations and in-home sessions showed relatively consistent and positive effects on caregivers' perceived increase of parenting knowledge.

CONCLUSIONS

This caregiver education program had a positive effect on caregivers' perceived increase of parenting knowledge, particularly through the use of the online development evaluations and in-home sessions. As one of the earliest initiatives of this kind in China, the findings reveal the promise of an innovative program to advance caregivers and children.

Psychometric Validation of a Nutrition Knowledge Questionnaire among Parents of 3-6-Year-Old Asian Indian Children in East Barddhaman District, West Bengal, India

Background:

In India, virtually, no study was aimed to develop a psychometrically valid and reliable questionnaire to assess the nutrition knowledge and practice among parents of children aged between 3 and 6 years.

Objective:

The present study describes an evaluation of validity and reliability measures in a questionnaire designed for the assessment of nutrition knowledge among parents of children participating in a study finding relationship between physical growth and development and nonverbal intelligence quotient development being undertaken in a semi-urban area.

Design:

This was a cross-sectional school-based reliability and validity study.

Setting:

This study was conducted in seven primary schools within the limits of Purba (East) Barddhaman district legislation, West Bengal, India.

Participants:

One hundred and thirty-four parents of children aged 3–6 years were included in the study.

Results:

The final questionnaire consisted of 32 questions that were selected on the basis of content validity. Questions included closed-ended and multiple-choice items which could be answered correctly by 5%–95% of the target population with a difficulty index of 0.33–0.87, discrimination index of 0.12–0.44, and validity index of 0.10–0.86. Internal reliability of each item as measured by Cronbach's α of 0.87 was also significant.

Conclusions:

The test comprises basic psychometric criteria of a valid and reliable 32-item knowledge questionnaire which further forms an instrument for measuring current scenario and interpreting changes associated with intervention work aiming improvement of dietary and nutrition knowledge-practice in the middle-to-low socioeconomic community.

Longitudinal child-oriented dietary intervention: Association with parental diet and cardio-metabolic risk factors. The Special Turku Coronary Risk Factor Intervention Project

Background The child-oriented dietary intervention given in the prospective Special Turku Coronary Risk Factor Intervention Project (STRIP) has decreased the intake of saturated fat and lowered serum cholesterol concentration in children from infancy until early adulthood. In this study, we investigated whether the uniquely long-term child-oriented intervention has affected also secondarily parental diet and cardio-metabolic risk factors. Methods The STRIP study is a longitudinal, randomized infancy-onset atherosclerosis prevention trial continued from the child's age of 8 months to 20 years. The main aim was to modify the child's diet towards reduced intake of saturated fat. Parental dietary intake assessed by a one-day food record and cardio-metabolic risk factors were analysed between the child's ages of 9-19 years. Results Saturated fat intake of parents in the intervention group was lower [mothers: 12.0 versus 13.9 daily energy (E%), p < 0.0001; fathers: 12.5 versus 13.9 E%, p < 0.0001] and polyunsaturated fat intake was higher (mothers: 6.1 versus 5.4 E%, p < 0.0001; fathers: 6.3 versus 5.9 E%, p = 0.0003) compared with the control parents. Maternal total and low-density lipoprotein cholesterol concentrations were lower in the intervention compared with the control group (mean ± SE 5.02 ± 0.04 versus 5.14 ± 0.04 mmol/l, p = 0.04 and 3.19 ± 0.04 versus 3.30 ± 0.03 mmol/l, p = 0.03, respectively). Paternal cholesterol values did not differ between the intervention and control groups. Other cardio-metabolic risk factors were similar in the study groups. Conclusions Child-oriented dietary intervention shifted the dietary fat intakes of parents closer to the recommendations and tended to decrease total and low-density lipoprotein cholesterol in the intervention mothers. Dietary intervention directed to children benefits also parents.

Relationship between nutrition knowledge and dietary intake among primary school children in Japan: Combined effect of children's and their guardians' knowledge

Background

Improving the dietary habits of children is important to decrease the future burden of noncommunicable diseases. While various food education programs have been implemented worldwide, evaluation of nutrition knowledge is difficult, even at baseline. Further, the relationship between nutrition knowledge and dietary intake has not been clarified in non-western countries.

Methods

After developing nutrition knowledge questionnaires for Japanese primary school children and adults, we examined whether higher nutrition knowledge of children and their guardians was associated with better dietary intake in children. A total of 1210 children in four public primary schools and 319 guardians were included in this cross-sectional study.

Results

Nutrition knowledge questionnaires were developed for children in lower and higher grades and adults. Higher nutrition knowledge of the children was significantly associated with higher vegetable intake (p for trend = 0.024 for boys and <0.0001 for girls in lower grades, <0.0001 for boys and 0.020 for girls in higher grades). Higher nutrition knowledge of the guardians was also associated with higher vegetable intake, except for boys in higher grades. The relationship between guardians' nutrition knowledge and intake of staple foods and fruits in children differed by children's sex.

Conclusions

We developed nutrition knowledge questionnaires for Japanese children and adults and identified a relationship between higher nutrition knowledge and healthier dietary habits. The child's own nutrition knowledge of dietary intake might be as important as that of the guardian for some foods. Sex differences in the effect of nutrition knowledge should receive greater attention in food education.

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Nutrition knowledge questionnaires were developed for Japanese children and adults.

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Higher nutrition knowledge was associated with healthier dietary habits in children.

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Both children's and guardians' nutrition knowledge affected food intakes in children.

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Sex differences in the effect of nutrition knowledge were suggested.

Integrated agriculture programs to address malnutrition in northern Malawi

BACKGROUND

In countries where the majority of undernourished people are smallholder farmers, there has been interest in agricultural interventions to improve nutritional outcomes. Addressing gender inequality, however, is a key mechanism by which agriculture can improve nutrition, since women often play a crucial role in farming, food processing and child care, but have limited decision-making and control over agricultural resources. This study examines the approaches by which gender equity in agrarian, resource-poor settings can be improved using a case study in Malawi.

METHODS

A quasi-experimental design with qualitative methods was used to examine the effects of a participatory intervention on gender relations. Thirty married couple households in 19 villages with children under the age of 5 years were interviewed before and then after the intervention. An additional 7 interviews were conducted with key informants, and participant observation was carried out before, during the intervention and afterwards in the communities. The interviews were recorded and transcribed, and analysed qualitatively for key themes, concepts and contradictions.

RESULTS

Several barriers were identified that undermine the quality of child care practices, many linked to gender constructions and norms. The dominant concepts of masculinity created shame and embarrassment if men deviated from these norms, by cooking or caring for their children. The study provided evidence that participatory education supported new masculinities through public performances that encouraged men to take on these new roles. Invoking men's family responsibilities, encouraging new social norms alongside providing new information about different healthy recipes were all pathways by which men developed new 'emergent' masculinities in which they were more involved in cooking and child care. The transformational approach, intergenerational and intra-gendered events, a focus on agriculture and food security, alongside involving male leaders were some of the reasons that respondents named for changed gender norms.

CONCLUSIONS

Participatory education that explicitly addresses hegemonic masculinities related to child nutrition, such as women's roles in child care, can begin to change dominant gender norms. Involving male leaders, participatory methods and integrating agriculture and food security concerns with nutrition appear to be key components in the context of agrarian communities.

A holistic school-based nutrition program fails to improve teachers’ nutrition-related knowledge, attitudes and behaviour in rural China

Purpose

– The purpose of this paper is to examine the effectiveness of a holistic school-based nutrition programme using the health-promoting school (HPS) approach, on teachers’ knowledge, attitudes and behaviour in relation to nutrition in rural China.

Design/methodology/approach

– A cluster-randomised intervention trial design was employed. Two middle schools were randomly selected and assigned to either the intervention school using the HPS framework (HPS School), or to the Control School, in Miyun County, Beijing. From each school 20 teachers were randomly selected to complete the survey. Nutrition-related knowledge, attitudes and behaviour were measured at pre- and post-intervention surveys with the same instrument. The nutrition intervention last for six months.

Findings

– The holistic school-based nutrition programme using the HPS framework had no statistical impact on improving teacher’s knowledge, attitudes and behaviour in relation to nutrition (p> 0.05).

Practical implications

– Future holistic school-based nutrition programmes targeting adolescents should also design and implement longer and more intensive interventions for teachers focusing on how to equip them with the awareness and ability to disseminate their knowledge, positive attitudes and role model behaviours to students, rather than on how to teach them basic knowledge and skills.

Originality/value

– Although teachers play a critical role in the HPS framework, there is very limited published research investigating the change in teachers’ nutrition-related knowledge, attitudes and behaviour as a result of a nutrition promotion programme.

Is an ecological school-based nutrition intervention effective to improve adolescents' nutrition-related knowledge, attitudes and behaviour in rural areas of China?

PURPOSE

The purpose of this article is to examine the effect of a school-based nutrition intervention using an ecological approach to improve adolescents' nutrition-related knowledge, attitudes and behaviour in rural China.

METHODS

A cluster-randomised intervention trial design was employed. Two middle schools were randomly selected and assigned to the school that was conducting a holistic school-based intervention using health-promoting school (HPS) framework, 'HPS School', or to the 'Control School' in Mi Yun County, Beijing. From each school we randomly selected 65 seventh-grade students to participate in the study. Their nutrition-related knowledge, attitudes and behaviour were measured by pre- and post-intervention surveys with the same instrument. The nutrition intervention lasted for six months.

RESULTS

Adolescents in the intervention school were more likely to know the nutrition knowledge items, with an odds ratio (OR) ranging from 1.86 (95% confidence interval (CI): 1.11-3.09) to 6.34 (95% CI: 3.83-10.47); more likely to think nutrition is very important to health, developing healthy dietary habits is very important, and that expired foods should be thrown away, with ORs of 3.03 (95% CI: 1.60-5.76), 2.76 (95% CI: 1.66-4.59) and 2.35 (95% CI: 1.33-4.17) respectively, and more likely to consume no soft drinks, desserts or fried food, and to eat vegetables every day of the last week, with ORs of 1.99 (95% CI: 1.31-3.04), 3.96 (95% CI: 2.43-6.46), 3.63 (95% CI: 2.26-5.85), and 2.51 (95% CI: 1.41-4.48) respectively, as compared with those in the control school after interventions.

CONCLUSIONS

Our intervention using the HPS framework, an ecological approach, was an appropriate model to promote nutrition among adolescents in rural China and its use should be advocated in future school-based nutrition promotion programmes for adolescents.

School-based intervention for nutrition promotion in Mi Yun County, Beijing, China

Purpose

– The purpose of this paper is to assess whether the school-based nutrition programme using the health-promoting school (HPS) framework was effective to improve parents’ knowledge, attitudes and behaviour (KAB) in relation to nutrition in rural Mi Yun County, Beijing.

Design/methodology/approach

– A cluster-randomised intervention trial design was employed. Two middle schools were randomly selected and assigned to either the intervention school using the HPS framework (HPS School), or to the Control School, in Mi Yun County, Beijing. From each school 65 parents of seventh-grade students were randomly selected to participate in the study. Nutrition-related KAB were measured at pre- and post-intervention surveys with the same instrument. The nutrition intervention last for six months.

Findings

– The school-based nutrition intervention using the HPS framework was effective in increasing parents’ nutrition knowledge; however, it had no statistical significant impact on improving parents’ attitudes towards nutrition and their eating behaviours.

Research limitations/implications

– The intervention appeared to be inadequate from the point of view of its impact on parents in terms of content, form and frequency.

Practical implications

– Future school-based nutrition promotion programmes using the HPS framework should focus more on parents, providing them with a more informative, participative and interactive, and frequent intervention.

Originality/value

– There is very limited published research focusing on the effect of the school-based nutrition promotion programmes using an HPS framework on parents’ nutrition-related KAB. Although, the improved KAB in relation to nutrition among parents is essential to promote young people’s nutrition and healthy eating behaviours.

Mothers’ behaviour contributes to suboptimal iodine status of family members: findings from an iodine-sufficient area

Objective

Iodine deficiency still remains a major public health concern worldwide despite global progress in its elimination. The aims of the present study were to evaluate dietary iodine status in the mother and one adult member of each family and the association between mothers’ knowledge, attitude and behaviour and the dietary iodine status of adult family members in Tehran.

Design

In this cross-sectional study, 24 h urinary iodine and Na concentrations and the iodine content of household salt were measured. Mothers’ knowledge, attitude and behaviour were assessed using a questionnaire administered in face-to-face interviews.

Setting

Health-care centres from four distinct areas of Tehran.

Subjects

Mother–adult family member pairs aged ≥19 years (n 290), enrolled through randomized cluster sampling.

Results

In mothers and adult family members, median 24 h urinary iodine concentration was 73 (interquartile range (IQR) 36–141) µg/l and 70 (IQR 34–131) µg/l, dietary iodine intake was 143 (IQR 28–249) µg/d and 130 (IQR 26–250) µg/d and dietary salt intake was 8·0 (IQR 5·9–10·2) g/d and 7·5 (IQR 5·3–10·0) g/d, respectively. Significant correlations were observed between mothers’ attitude and behaviour and the 24 h urinary iodine concentration, dietary iodine intake and iodine content of salt of adult family members. In multiple analysis, lower quartiles of salt iodine content and salt intake and inappropriate behaviour scores in mothers increased the risk of urinary iodine concentration <100 µg/l in adult family members.

Conclusions

The present study showed that mothers’ behaviour, but not knowledge and attitude, was among major contributors to the suboptimal dietary iodine status observed in adult family members.

Nutrition knowledge of low-income parents of obese children

Minority and low-income children are overrepresented among obese US children. Lack of basic nutrition knowledge among parents may contribute to this disparity. The purpose of this study is to measure nutrition knowledge of parents of Medicaid-insured obese children using a simple low-literacy tool. Parents, recruited from pediatric clinics, demonstrated their nutrition knowledge by placing food stickers into cells on a printed grid with food groups displayed in columns and three nutrition categories displayed in rows. In general, parents (n = 135; 74.8 % black; 79.2 % income of ≤$25,000/year) correctly identified food groups (median = 90.5 % correct). Nutritional categories were more commonly misidentified (median = 67 % correct), with parents mostly believing foods were healthier than they were. Multivariable linear regression revealed black race (p = 0.02), no college education (p = 0.02) and income of <$15,000 (p = 0.03) independently predicted misidentification of nutritional categories. Parents' understanding of food's nutritional value is variable. Black race, less education, and very low income are associated with poorer nutrition knowledge.

The motivational and informational basis of attitudes toward foods with health claims

This research explored the effects of food choice motives, nutritional knowledge, and the use of food labels, on attitude toward food with health claims. Food with health claims was chosen as a relatively novel category of products designed to be beneficial for health. We identified eight motives served by food in general, and tested if they serve as motivations to positively evaluate functional food. Questionnaire was administered on nationally representative samples of 3085 respondents from six Western Balkan countries. We proposed two structural models relating an extensive list of eight and, alternatively, restricted list of three food-choice motives (health, mood and sensory appeal) to attitude toward functional food. We also expected the indirect association between the health motive and attitude, through nutritional knowledge and use of food labels. The results revealed highly positive, although undifferentiated attitude toward functional food, with no significant differences between the countries. The restricted model provided a better fit then the exhaustive model; the health motive was proven to have indirect influence on attitude through knowledge and label use. The implications of these findings for functional approach to attitudes, understanding the demand for functional food and overcoming barriers to dietary change are discussed.

Influence of nutritional knowledge on the use and interpretation of Spanish nutritional food labels

The present study analyzed the nutritional knowledge of Spanish consumers and its relationship with the correct use of food labels. Consumers were asked about their nutritional knowledge and some functional foods and about their understanding of food labeling and their use of it to select healthy food. A 2-part questionnaire was employed. The 1st part concerned their knowledge of nutritional facts, including their knowledge about macronutrients and perception of certain functional foods, while the 2nd part addressed some questions regarding food labels. The results revealed no statistically significant differences in nutritional knowledge by either age or gender, but a direct relationship with educational level. The association between nutritional knowledge and the perception and understanding of food labeling showed that the nutritional label rarely influenced the food purchases of the group with low nutritional knowledge, who considered that this information was too technical. More than half of the consumers did not consider the calorie or sugar content important for selecting food. In addition, the group with low nutritional knowledge stated that they never or rarely looked at the food labels to check whether it was low-fat food that they were buying.

PRACTICAL APPLICATION

Knowing the status of the consumer's nutritional knowledge allows health campaigns to be designed; considering the influence of cultural factors and the perception of food labeling is very useful for promoting better nutritional information.

Effect of Mothers Nutritional Knowledge and Attitudes on Omani Children's Dietary Intake

OBJECTIVES

The study investigates the dietary intakes of Omani preschoolers and associations with both socio-demographic characteristics and the mother's nutritional knowledge and attitudes.

METHODS

A sample of 154 parents of preschoolers completed a questionnaire including socio-demographic characteristics, a food-frequency questionnaire to assess children's food intake, nutritional knowledge and attitudes towards healthy eating.

RESULTS

The results showed a lower dietary adequacy of children's food intake in mothers with low educational levels, high-ranked occupation, and lower levels of both nutritional knowledge and food related health attitudes. The highest food intake and healthy eating attitude scores were found in children of mothers with high education level and mother without a job. The association of the dietary adequacy with socio-demographic background can help the Omani healthcare decision makers to develop better-tailored nutrition interventions which are more suitable for the Omani community.

CONCLUSION

The results from this study of mothers' nutritional knowledge and attitudes support the inclusion of knowledge and attitudes in dietary interventions.

Parental eating attitudes and indicators of healthy eating in a longitudinal randomized dietary intervention trial (the STRIP study)

OBJECTIVE

To examine the effects of child-oriented dietary intervention on parental eating attitudes and dietary behaviour.

DESIGN

In the prospective, randomized Special Turku Coronary Risk Factor Intervention Project for Children (the STRIP study), a cohort of Finnish families took part in a nutritional intervention trial focused on the quality of their children's fat intake since the age of 8 months. Health-related and hedonic eating attitudes of the parents were measured after 10 years of dietary intervention using a validated Health and Taste Attitude Scales (HTAS) questionnaire (n 660). Parents' eating behaviour was studied using a 1 d food record (n 491).

SETTING

Finland.

SUBJECTS

Mothers and fathers (n 660) of the STRIP children.

RESULTS

The parents of the intervention families had a higher level of interest in healthy eating compared with control parents. The interest in natural products or hedonic eating attitudes did not differ between the groups. The parents' general health interest was associated with low saturated fat intake, fruit and vegetable consumption, fibre intake and seeking pleasure in eating, but it was not associated with BMI. The intervention also improved the quality of dietary fat among parents with the lowest level of interest in healthy eating.

CONCLUSIONS

Parents' general health interest was associated with regular dietary counselling as well as with healthier food choice behaviour. However, the dietary intervention that focused especially on the quality of the child's fat intake also enhanced specific changes in the family's fat consumption without a high level of interest in healthy eating.

Relationships between energy balance knowledge and the home environment

Certain aspects of the home environment as well as individuals' knowledge of energy balance are believed to be important correlates of various dietary and physical activity behaviors, but no known studies have examined potential relationships between these correlates. This study evaluated cross-sectional associations between characteristics of the home environment and energy balance knowledge among 349 youth/parent pairs recruited from the Minneapolis/St Paul, MN, metropolitan area from September 2006 to June 2007. Linear regression models adjusted for student grade and highest level of parental education were used to compare data from home food, physical activity, and media inventories (parent-reported) with energy balance knowledge scores from youth and parent questionnaires. Paired energy balance knowledge (average of youth and parent knowledge scores) was associated with all home food availability variables. Paired knowledge was also significantly associated with a media equipment availability and accessibility summary score (β=-1.40, P=0.005), as well as an activity-to-media ratio score (β=0.72, P=0.003). Youth and/or parent knowledge alone was not significantly associated with most characteristics of the home environment, supporting the importance of developing intervention strategies that target the family as a whole.

Consuming cassava as a staple food places children 2-5 years old at risk for inadequate protein intake, an observational study in Kenya and Nigeria

BACKGROUND

Inadequate protein intake is known to be deleterious in animals. Using WHO consensus documents for human nutrient requirements, the protein:energy ratio (P:E) of an adequate diet is > 5%. Cassava has a very low protein content. This study tested the hypothesis that Nigerian and Kenyan children consuming cassava as their staple food are at greater risk for inadequate dietary protein intake than those children who consume less cassava.

METHODS

A 24 hour dietary recall was used to determine the food and nutrient intake of 656 Nigerian and 449 Kenyan children aged 2-5 years residing in areas where cassava is a staple food. Anthropometric measurements were conducted. Diets were scored for diversity using a 12 point score. Pearson's Correlation Coefficients were calculated to relate the fraction of dietary energy obtained from cassava with protein intake, P:E, and dietary diversity.

RESULTS

The fraction of dietary energy obtained from cassava was > 25% in 35% of Nigerian children and 89% of Kenyan children. The mean dietary diversity score was 4.0 in Nigerian children and 4.5 in Kenyan children, although the mean number of different foods consumed on the survey day in Nigeria was greater than Kenya, 7.0 compared to 4.6. 13% of Nigerian and 53% of Kenyan children surveyed had inadequate protein intake. The fraction of dietary energy derived from cassava was negatively correlated with protein intake, P:E, and dietary diversity. Height-for age z score was directly associated with protein intake and negatively associated with cassava consumption using regression modeling that controlled for energy and zinc intake.

CONCLUSIONS

Inadequate protein intake was found in the diets of Nigerian and Kenyan children consuming cassava as a staple food. Inadequate dietary protein intake is associated with stunting in this population. Interventions to increase protein intake in this vulnerable population should be the focus of future work.

Prevention of overweight and obesity in children under the age of 6 years

Although obesity was rarely observed among children 30 years ago, it is now evident among Canadian children of all ages. Currently, 15.2% of 2- to 5-year-old children are overweight, whereas 6.3% are obese. Limited data suggest that poor dietary and physical activity patterns are increasing obesity risk among these young children. Body weight and lifestyle behaviours are known to track from childhood to adulthood, thereby increasing the risk for obesity and other chronic diseases later in life. Intrauterine life, infancy, and the preschool years may all include critical periods that program the long-term regulation of energy balance, and therefore obesity-prevention strategies should be initiated in utero and continue throughout childhood and adolescence. Although single-strategy obesity-prevention initiatives have had limited success, programs that target multiple behaviours may help reduce body weight and body fat among young children. Parental involvement is key to the success of obesity-prevention programs at a young age, as parents have primary control over their children's food and activity environments. Accordingly, parental obesity is the best predictor of childhood obesity. Parents should be encouraged to teach and role model healthy lifestyle behaviours for their young children. Health professionals can also be involved in obesity prevention, as they are ideally placed to identify young children at risk for obesity. By calculating and plotting the body mass index for all children, and initiating obesity-prevention strategies in utero, health professionals can help curb the rise in overweight and obesity among young children.

Young children's dietary habits and associations with the mothers' nutritional knowledge and attitudes

The study investigates the dietary habits of Flemish preschoolers and associations of these habits with both sociodemographic characteristics and the mother's nutritional knowledge and attitudes. A sample of 862 parents of preschoolers from 56 schools completed a questionnaire including sociodemographic characteristics, a food-frequency questionnaire to assess children's dietary intake, and a nutritional knowledge-and-attitude questionnaire. Regression analysis showed a lower dietary adequacy in children of mothers with low and medium level of education, medium-ranked occupation, and lower levels of both nutritional knowledge and food-related health attitude. The highest excess score (representing items that should be avoided or moderated) was found in children of mothers with low education level, without a job, with three or more children, of age less than 30 years, and possessing lower levels of nutritional knowledge and attitude scores for health and taste. The associations of the dietary adequacy and excess scores with sociodemographic background can help practitioners to develop better-tailored nutrition interventions. The associations with the mothers' nutritional knowledge and attitudes support the inclusion of knowledge and attitudes in dietary interventions.

Influence of nutritional knowledge on perceived healthiness and willingness to try functional foods

In order to assess the influence of nutritional knowledge on perceived healthiness and willingness to try functional foods, 104 consumers filled out a Nutritional Knowledge Questionnaire and answered a conjoint task. Participants had to evaluate 16 concepts consisting of combinations of carrier products (yogurt, milk desserts, pan bread and mayonnaise) and nutritional modifications (regular product, low-fat, enriched with antioxidants, and enriched with fibre). Three groups of consumers were identified with different level of nutritional knowledge. Highly significant differences were found in the healthiness evaluations of the clusters, which mainly depended on nutritional knowledge related to the links of diet and diseases. Highly significant differences in willingness to try functional foods were also found between the clusters. Whereas consumers with the lowest nutritional knowledge were not interested in consuming functional foods, the addition of fibre or antioxidants to healthy products increased the willingness of consumers with the highest level of nutritional knowledge to try the evaluated functional foods. These results suggested that lack of nutritional knowledge might limit the acceptance of functional foods and thus the use of health claims might be necessary to assure that consumers are aware of their health benefits.

Tradução, adaptação e avaliação psicométrica da Escala de Conhecimento Nutricional do National Health Interview Survey Cancer Epidemiology

OBJETIVO: O estudo objetivou traduzir e adaptar, para a língua portuguesa, a escala de conhecimento nutricional aplicada no National Health Interview Survey Cancer Epidemiology e avaliar sua validade e precisão. MÉTODOS: Após sua tradução e retro-tradução, a escala foi adaptada, substituindo-se alimentos tipicamente americanos por outros típicos do Brasil. Ela foi aplicada em 39 mulheres com transtornos alimentares e 57 estudantes de Nutrição. Esperava-se uma maior pontuação destas últimas, atestando a validade discriminatória do questionário. O instrumento foi reaplicado em 50 estudantes e obteve-se o coeficiente de correlação entre as duas aplicações. RESULTADOS: As estudantes fizeram 10,5 pontos, com desvio-padrão de 1,7 pontos, enquanto as pacientes fizeram 7,4, com desvio-padrão de 2,6 pontos (p=0,0000001). Apenas 1,75% das estudantes apresentou baixo conhecimento, versus 34,21% das pacientes (p<0,005). Encontrou-se alto conhecimento em 57,90% das estudantes e em 13,16% das pacientes (p<0,005). O coeficiente de correlação de Spearman foi 0,52 (p=0,00009). CONCLUSÃO: O teste preencheu os critérios psicométricos para validade, mas sua precisão deve ser reavaliada. Sugere-se que o reteste seja feito em menor intervalo de tempo. Dado que as estudantes ainda estão no processo aprendizado, seria interessante aplicar a escala em nutricionistas, com conhecimento mais sedimentado.

Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with 'best practice' recommendations

Childhood obesity is a global epidemic and rising trends in overweight and obesity are apparent in both developed and developing countries. Available estimates for the period between the 1980s and 1990s show the prevalence of overweight and obesity in children increased by a magnitude of two to five times in developed countries (e.g. from 11% to over 30% in boys in Canada), and up to almost four times in developing countries (e.g. from 4% to 14% in Brazil). The goal of this synthesis research study was to develop best practice recommendations based on a systematic approach to finding, selecting and critically appraising programmes addressing prevention and treatment of childhood obesity and related risk of chronic diseases. An international panel of experts in areas of relevance to obesity provided guidance for the study. This synthesis research encompassed a comprehensive search of medical/academic and grey literature and the Internet covering the years 1982-2003. The appraisal approach developed to identify best practice was unique, in that it considered not only methodological rigour, but also population health, immigrant health and programme development/evaluation perspectives in the assessment. Scores were generated based on pre-determined criteria with programmes scoring in the top tertile of the scoring range in any one of the four appraisal categories included for further examination. The synthesis process included identification of gaps and an analysis and summary of programme development and programme effectiveness to enable conclusions to be drawn and recommendations to be made. The results from the library database searches (13,158 hits), the Internet search and key informant surveys were reduced to a review of 982 reports of which 500 were selected for critical appraisal. In total 158 articles, representing 147 programmes, were included for further analysis. The majority of reports were included based on high appraisal scores in programme development and evaluation with limited numbers eligible based on scores in other categories of appraisal. While no single programme emerged as a model of best practice, synthesis of included programmes provided rich information on elements that represent innovative rather than best practice under particular circumstances that are dynamic (changing according to population subgroups, age, ethnicity, setting, leadership, etc.). Thus the findings of this synthesis review identifies areas for action, opportunities for programme development and research priorities to inform the development of best practice recommendations that will reduce obesity and chronic disease risk in children and youth. A lack of programming to address the particular needs of subgroups of children and youth emerged in this review. Although immigrants new to developed countries may be more vulnerable to the obesogenic environment, no programmes were identified that specifically targeted their potentially specialized needs (e.g. different food supply in a new country). Children 0-6 years of age and males represented other population subgroups where obesity prevention programmes and evidence of effectiveness were limited. These gaps are of concern because (i) the pre-school years may be a critical period for obesity prevention as indicated by the association of the adiposity rebound and obesity in later years; and (ii) although the growing prevalence of obesity affects males and females equally; males may be more vulnerable to associated health risks such as cardiovascular disease. Other gaps in knowledge identified during synthesis include a limited number of interventions in home and community settings and a lack of upstream population-based interventions. The shortage of programmes in community and home settings limits our understanding of the effectiveness of interventions in these environments, while the lack of upstream investment indicates an opportunity to develop more upstream and population-focused interventions to balance and extend the current emphasis on individual-based programmes. The evidence reviewed indicates that current programmes lead to short-term improvements in outcomes relating to obesity and chronic disease prevention with no adverse effects noted. This supports the continuation and further development of programmes currently directed at children and youth, as further evidence for best practice accumulates. In this synthesis, schools were found to be a critical setting for programming where health status indicators, such as body composition, chronic disease risk factors and fitness, can all be positively impacted. Engagement in physical activity emerged as a critical intervention in obesity prevention and reduction programmes. While many programmes in the review had the potential to integrate chronic disease prevention, few did; therefore efforts could be directed towards better integration of chronic disease prevention programmes to minimize duplication and optimize resources. Programmes require sustained long-term resources to facilitate comprehensive evaluation that will ascertain if long-term impact such as sustained normal weight is maintained. Furthermore, involving stakeholders in programme design, implementation and evaluation could be crucial to the success of interventions, helping to ensure that needs are met. A number of methodological issues related to the assessment of obesity intervention and prevention programmes were identified and offer insight into how research protocols can be enhanced to strengthen evidence for obesity interventions. Further research is required to understand the merits of the various forms in which interventions (singly and in combination) are delivered and in which circumstances they are effective. There is a critical need for the development of consistent indicators to ensure that comparisons of programme outcomes can be made to better inform best practice.

Impact of nutrition knowledge on food evaluations

OBJECTIVE

This study explored whether nutrition knowledge interacted with evaluations of a food's healthiness to influence food attitudes (ie, global evaluations). Since attitudes guide behavior, understanding factors that impact food attitudes is one way to understand food selection and why factors such as nutrition knowledge have only a modest impact on food selection. We hypothesized that the relation between health evaluations and food attitudes would be stronger for people high in nutrition knowledge. We also explored the macronutrient composition of foods, and how it related to attitudes and health evaluations.

DESIGN

Survey employing multilevel analyses to examine within- and between-subject influences on food attitudes.

SETTING

Student unions at two universities in the Southwestern US.

SUBJECTS

A total of 138 participants (mean age=19.8; 69 males, 67 females, two unreported).

INTERVENTIONS

Participants indicated their attitudes toward; experience with; and health, flavor, and affective evaluations of 24 foods before and after lunch and completed questionnaires assessing individual difference variables.

RESULTS

Experience and evaluations of healthiness, flavor, positive affect, and negative affect all predicted food attitudes. Health evaluations were more strongly associated with attitudes for people high in nutrition knowledge.

CONCLUSIONS

These findings suggest a mechanism through which individual differences impact food attitudes and thus likely influence food selection.