Adolescents' non-core food intake: a description of what, where and with whom adolescents consume non-core foods

The effect of discretionary snack consumption on overall energy intake, weight status, and diet quality: A systematic review

The consumption frequency and portion size of discretionary snacks are thought to contribute to a greater food intake and risk of overweight or obesity in the developed world but evidence from epidemiological studies is inconclusive. To investigate this, we systematically evaluated evidence on the effects of discretionary snack consumption on weight status, energy intake, and diet quality. Articles involving discretionary snacks reported against the outcome measures of any primary, peer-reviewed study using human participants from free-living conditions for all age groups were included. A total of 14,780 titles were identified and 40 eligible publications were identified. Three key outcomes were reported: weight status (n = 35), energy intake (n = 11), and diet quality (n = 3). Increased discretionary snack consumption may contribute modestly to energy intake, however, there is a lack of consistent associations with increased weight/BMI. Although cross-sectional analyses offered conflicting findings, longitudinal studies in adults showed a consistent positive relationship between discretionary snack intake and increasing weight or body mass index. Given that experimental findings suggest reducing the size of discretionary snacks could lead to decreased consumption and subsequent energy intake, food policy makers and manufacturers may find it valuable to consider altering the portion and/or packaging size of discretionary snacks.

Dietary Greenhouse Gas Emissions and Diet Quality in a Cross-Sectional Study of Swedish Adolescents

BACKGROUND

Interventions to improve dietary intake and reduce dietary greenhouse gas emissions (dGHGE) are urgently needed. Adolescence presents a unique time in life to promote sustainable diets. Detailed dietary data are needed to inform public health strategies aiming at improving adolescents' diet quality and reducing dGHGE.

OBJECTIVE

This study aimed to describe dGHGE in Swedish adolescents' diets by socio-demographic characteristics, evaluate how food groups contribute to dGHGE, and examine dGHGE in relation to diet quality.

METHODS

Data come from the national, school-based, cross-sectional dietary survey Riksmaten Adolescents 2016-17 of 3099 females and males attending school grades 5 (11-12 y old), 8 (14-15 y old) and 11 (17-18 y old). Participants completed 2 web-based 24-h recalls and questionnaires on lifestyle factors. dGHGE was estimated based on life cycle assessment data. Diet quality was estimated using NRF11.3 (Nutrient Rich Food Index) and SHEIA15 (Swedish Healthy Eating Index for Adolescents 2015).

RESULTS

dGHGE were higher in males than females (medians 4.2 versus 3.8 kg CO2e/10 MJ, P < 0.001). In females, dGHGE were highest in grade 5 (4.0 kg CO2e/10MJ), whereas in males, emissions were highest in grade 11 (4.4 kg CO2e/10MJ), P < 0.001 for the sex/grade interaction. Overweight/obesity was positively associated with CO2e/10MJ, but parental education, birthplace, and degree of urbanization were not. In females, the proportion of dGHGE from animal-based foods was lowest in grade 11, whereas the proportions from plant-based foods and sweet foods/beverages were highest. In males, these proportions were similar across grades. NRF11.3 was not associated with CO2e/10MJ, whereas healthier eating, according to SHEIA15, was inversely associated with CO2e/10MJ.

CONCLUSIONS

Food choices and dGHGE per calorie differ by sex in adolescents. Thus, intervention strategies to improve dietary sustainability need to be tailored differently to females and males. Diet quality should also be considered when promoting reduced GHGE diets.

Protocol to evaluate the effectiveness and cost-effectiveness of an environmental nutrition and physical activity intervention in nurseries (Nutrition and Physical Activity Self Assessment for Child Care - NAP SACC UK): a multicentre cluster randomised controlled trial

BACKGROUND

One in seven UK children have obesity when starting school, with higher prevalence associated with deprivation. Most pre-school children do not meet UK recommendations for physical activity and nutrition. Formal childcare settings provide opportunities to deliver interventions to improve nutritional quality and physical activity to the majority of 3-4-year-olds. The nutrition and physical activity self-assessment for childcare (NAP SACC) intervention has demonstrated effectiveness in the USA with high acceptability in the UK. The study aims to evaluate the effectiveness and cost-effectiveness of the NAP SACC UK intervention to increase physical activity, reduce sedentary time and improve nutritional intake.

METHODS

Multi-centre cluster RCT with process and economic evaluation. Participants are children aged 2 years or over, attending UK early years settings (nurseries) for ≥ 12 h/week or ≥ 15 h/week during term time and their parents, and staff at participating nurseries. The 12-month intervention involves nursery managers working with a Partner (public health practitioner) to self-assess policies and practices relating to physical activity and nutrition; nursery staff attending one physical activity and one nutrition training workshop and setting goals to be achieved within 6 months. The Partner provides support and reviews progress. Nursery staff receive a further workshop and new goals are set, with Partner support for a further 6 months. The comparator is usual practice. Up to 56 nurseries will be stratified by area and randomly allocated to intervention or comparator arm with minimisation of differences in level of deprivation.

PRIMARY OUTCOMES

accelerometer-assessed mean total activity time on nursery days and average total energy (kcal) intake per eating occasion of lunch and morning/afternoon snacks consumed within nurseries.

SECONDARY OUTCOMES

accelerometer-assessed mean daily minutes of moderate-to-vigorous physical activity and sedentary time per nursery day, total physical activity on nursery days compared to non-nursery days, average serving size of lunch and morning/afternoon snacks in nursery per day, average percentage of core and non-core food in lunch and morning/afternoon snacks, zBMI, proportion of children who are overweight/obese and child quality-of-life. A process evaluation will examine fidelity, acceptability, sustainability and context. An economic evaluation will compare costs and consequences from the perspective of the local government, nursery and parents.

TRIAL REGISTRATION

ISRCTN33134697, 31/10/2019.

Influences of the community and consumer nutrition environment on the food purchases and dietary behaviors of adolescents: A systematic review

Adolescence is a period of increased autonomy over decision-making, including food choices, and increased exposure to influences outside the home, including the food environment. This review aims to synthesize the evidence for the influence of community nutrition environments, spatial access to food outlets, and consumer nutrition environments, environments inside food outlets, on adolescent food purchasing and dietary behaviors in high-income countries. Six databases were searched for articles published before January 2023. Results were synthesized using a vote-counting technique and effect direction plots that record the direction of the effect in relation to the anticipated relationship with health. Thirty-four observational and two intervention studies met the inclusion criteria. In the 13 studies assessing adolescent exposure to healthy community nutrition environments, results did not show clear associations with dietary and purchasing outcomes. Thirty studies assessed adolescents' exposure to unhealthy community nutrition environments with the majority (n = 17/30, 57%) reporting results showing that greater exposure to food outlets classified as unhealthy was associated with less healthy food purchases and dietary intakes. Inconsistent results were observed across the seven studies investigating associations with the consumer environment. Further research in these areas, including more high-quality intervention studies, may help to develop policy strategies to improve adolescents' dietary behaviors.

Protocol to evaluate the effectiveness and cost-effectiveness of an environmental nutrition and physical activity intervention in nurseries (Nutrition and Physical Activity Self Assessment for Child Care - NAP SACC UK): a multicentre cluster randomised controlled trial

Background One in seven UK children have obesity when starting school, with higher prevalence associated with deprivation. Most pre-school children do not meet UK recommendations for physical activity and nutrition. Formal childcare settings provide opportunities to deliver interventions to improve nutritional quality and physical activity to the majority of 3-4-year-olds. The nutrition and physical activity self-assessment for childcare (NAP SACC) intervention has demonstrated effectiveness in the USA with high acceptability in the UK. The study aims to evaluate the effectiveness and cost-effectiveness of the NAP SACC UK intervention to increase physical activity, reduce sedentary time and improve nutritional intake. Methods Multi-centre cluster RCT with process and economic evaluation. Participants are children aged 2 years or over, attending UK early years settings (nurseries) for ≥ 12 hours/week or ≥ 15 hours/week during term time and their parents, and staff at participating nurseries. The 12-month intervention involves nursery managers working with a Partner (public health practitioner) to self-assess policies and practices relating to physical activity and nutrition; nursery staff attending one physical activity and one nutrition training workshop and setting goals to be achieved within six months. The Partner provides support and reviews progress. Nursery staff receive a further workshop and new goals are set, with Partner support for a further six months. The comparator is usual practice. Up to 56 nurseries will be stratified by area and randomly allocated to intervention or comparator arm with minimisation of differences in level of deprivation.

PRIMARY OUTCOMES

accelerometer-assessed mean total activity time on nursery days and average total energy (kcal) intake per eating occasion of lunch and morning/afternoon snacks consumed within nurseries.

SECONDARY OUTCOMES

accelerometer-assessed mean daily minutes of moderate-to-vigorous physical activity and sedentary time per nursery day, total physical activity on nursery days compared to non-nursery days, average serving size of lunch and morning/afternoon snacks in nursery per day, average percentage of core and non-core food in lunch and morning/afternoon snacks, zBMI, proportion of children who are overweight/obese and child quality-of-life. A process evaluation will examine fidelity, acceptability, sustainability and context. An economic evaluation will compare costs and consequences from the perspective of the local government, nursery and parents.

TRIAL REGISTRATION

ISRCTN33134697.

Adolescents' dietary behaviour: The interplay between home and school food environments

In the UK, school food standards have looked to improve the nutritional profile of school food provision and the choices made; however, adolescents' choices tend to bias towards micronutrient poor and energy dense options. This study aimed to explore how adolescents make their school food choices, along with how they engage with their environments whilst selecting food. Seven focus group interviews took place with adolescents (n = 28; 13-14 years) in a secondary school in Northern England. Discussions with participants were audio-recorded, transcribed verbatim and then analysed using an inductive thematic approach. Six themes emerged from the data: (1) parents' and adolescents' roles in the home food environment, (2) burgeoning food autonomy, (3) school food choice factors, (4) social aspects of school food, (5) home versus school, (6) food knowledge & beliefs. Adolescents identified two distinct environments during the focus group discussions: the home and school environments. Adolescents juxtaposed the two, in terms of food provision, food choices, rules and customs surrounding food choice. This juxtaposition emerged as an indirect but important influence on adolescents' school food choices. The school and home environments both (in)directly influence adolescents' school food choices, which involve an integration of multiple, often conflicting influences. Adolescents may adopt a number of unhelpful dietary rationalisations as they try to manage and reconcile these influences. Consultation, together with consideration of relevant food choice models, is required to identify opportunities to influence adolescents' food choices at school.

Social Environment and Food and Beverage Intake in European Adolescents: The Helena Study

BACKGROUND

The family environment influences food consumption and behaviours, which impact adolescent's eating habits, diet and health. Young individuals who frequently eat family meals are less likely to develop risk- and behaviour-related outcomes as obesity.

AIM

To assess the relationship between the family meal environment and food and macronutrient consumption in European adolescents.

METHODS

1,703 adolescents aged 12.5-17.5 years (46.5% male) from the European HELENA cross-sectional study were selected. Sociodemographic variables and dietary intake using two non-consecutive self-reported 24-hour dietary recalls were collected from all the included participants. The relationship between family meals' environment and food and macronutrient consumption was analized using analysis of covariance.

RESULTS

Adolescents who used to take their main meals with their family were associated with high consumption of healthy foods and beverages (i.e. vegetables, fruit, milk, water) and low consumption of energy dense food and beverages as chocolate, savoury snacks, sugar or juices compared with those who used to eat alone, with friends or other people (p < 0.05).

CONCLUSION

The company/people with whom adolescents consume their meal have an important influence on the adolescent's consumption of different types of food (especially at lunch). Family's environment during meals has been associated with a high consumption of healthy foods.

Food for teens: how social media is associated with adolescent eating outcomes

OBJECTIVE

To assess the relationship between exposure to social media food messages and self-reported adolescent eating outcomes (including food intake, perceived norms and food literacy).

DESIGN

A cross-sectional survey was used to assess reported exposure to core and non-core food messages (including marketing messages) on social media, as well as reported food intake, perceived norms, food literacy, attitudes, self-regulation, among others.

SETTING

18 secondary schools across Flanders, Belgium.

PARTICIPANTS

1002 adolescents 11-19 years of age.

RESULTS

Self-reported exposure to food marketing and overall food messages on social media was positively associated with eating attitudes, behaviours, perceived norms and food literacy among adolescents. Interestingly, the relationship between food exposure and intake was shaped differently depending on food type; descriptive norms mediated the positive relationship between non-core food social media exposure and non-core food intake (e.g. indirect effect estimate on self-reported sweets consumption is 0·005, se 0·002, P < 0·01), while food literacy mediated the positive relationship between core food social media exposure and core food intake (e.g. indirect effect estimate on self-reported vegetable consumption is 0·01, se 0·003, P < 0·000).

CONCLUSIONS

This study highlights the significance of social media in relation to adolescent eating. There is an opportunity for health professionals to use social media in the promotion of core food among adolescents. We call for relevant policy actions to regulate the marketing of non-core food to adolescents on social media.

Ultraprocessed food consumption and dietary nutrient profiles associated with obesity: A multicountry study of children and adolescents

This study assessed associations between ultraprocessed food consumption and dietary nutrient profile linked to obesity in children and adolescents in Argentina, Australia, Brazil, Chile, Colombia, Mexico, the United Kingdom, and the United States using nationally representative data collected between 2004 and 2014. Linear regression models were used to evaluate associations between dietary share of ultraprocessed foods (country and age group-specific quintiles and a 10% share increase) and the energy density of diets and their content of free sugars and fiber. Ultraprocessed foods, defined by the NOVA system, ranged from 18% of total energy intake among preschool children in Colombia to 68% among adolescents in the United Kingdom. In almost all countries and age groups, increases in the dietary share of ultraprocessed foods were associated with increases in energy density and free sugars and decreases in fiber, suggesting that ultraprocessed food consumption is a potential determinant of obesity in children and adolescents. Effective global policy action to address growing ultraprocessed food consumption and childhood obesity is urgently needed.

Misreporting of Energy Intake From Food Records Completed by Adolescents: Associations With Sex, Body Image, Nutrient, and Food Group Intake

Background and Objectives: A healthy diet during adolescence is important for growth and pubertal development. Assessing the diet of adolescents may be challenging as the behavioural factors and food habits which impact on what they eat may also affect how they report dietary intake. This study assesses factors associated with the misreporting of dietary intake.

Methods: Adolescents (n = 4,844; average age 13.8 years) from the Avon Longitudinal Study of Parents and Children (ALSPAC) completed a 3-day diet record. Misreporting was estimated using an individualised method, and adolescents were categorised by reporting status. Foods were categorised as core and noncore foods to evaluate diet quality. Body composition measurements were recorded at a research clinic. Information on dieting, weight concern, family socioeconomic status, and parental BMI were collected via questionnaires. Binary logistic regression was performed, in boys and girls separately, to investigate factors associated with underreporting of dietary intake.

Results: Girls were much more likely than boys to be dissatisfied with their weight and to diet, but showed similar levels of underreporting (~67%). In adjusted regression analysis underreporters (UR) were more likely to be overweight or obese: OR in boys 2.8 (95% CI 1.7–4.8) and in girls 2.2 (95% CI 1.5–3.2). Dissatisfaction with weight and dieting were positively associated, and perception of being underweight negatively associated with underreporting in boys. Perception of being overweight, dieting, and exact age were positively associated with underreporting in girls. UR obtained a greater percentage of energy from protein and a smaller percentage of energy from fat; they reported greater intake of core foods and lower intakes of non-core foods than plausible reporters.

Conclusion: A large proportion of adolescents underreported their dietary energy intake. This was associated with their body weight status and body image and had a differential effect on their estimated food and macronutrient intakes. Assessment of misreporting status is essential when collecting and interpreting dietary information from adolescents.

Where and when are portion sizes larger in young children? An analysis of eating occasion size among 1·5-5-year-olds in the UK National Diet and Nutrition Survey (2008-2017)

OBJECTIVE

To identify eating occasion-level and individual-level factors associated with the consumption of larger portions in young children and estimate their relative importance.

DESIGN

Cross-sectional.

SETTING

Data from parent-reported 4-d food diaries in the UK National Diet and Nutrition Survey (2008-2017) were analysed. Multilevel models explored variation in eating occasion size (kJ) within (n 48 419 occasions) and between children (n 1962) for all eating occasions. Eating contexts: location, eating companion, watching TV, and sitting at a table and individual characteristics: age, gender, ethnicity and parental socio-economic status were explored as potential correlates of eating occasion size.

PARTICIPANTS

Children aged 1·5-5 years.

RESULTS

Median eating occasion size was 657 kJ (IQR 356, 1117). Eating occasion size variation was primarily attributed (90 %) to differences between eating occasions. Most (73 %) eating occasions were consumed at home. In adjusted models, eating occasions in eateries were 377 kJ larger than at home. Eating occasions sitting at a table, v. not, were 197 kJ larger. Eating in childcare, with additional family members and friends, and whilst watching TV were other eating contexts associated with slightly larger eating occasion sizes.

CONCLUSIONS

Eating contexts that vary from one eating occasion to another are more important than demographic characteristics that vary between children in explaining variation in consumed portion sizes in young children. Strategies to promote consumption of age-appropriate portion sizes in young children should be developed, especially in the home environment, in eating contexts such as sitting at the table, eating with others and watching TV.

The Contribution of Foods and Beverages of Low Nutritional Value to the Diets of Swedish Adolescents, by Food Group, Time and Place. A Nationally Representative Study

Adolescence is a time in life when lifestyle behaviours are acquired. One indicator of poor diet quality is the intake of foods and beverages with a relatively low nutritional value. Using the Australian classification of such foods, termed "discretionary", we classified the intakes of Swedish adolescents who participated in the Riksmaten Adolescent 2016-17 national dietary survey. From selected schools, 3099 adolescents in age groups 11-12, 14-15 and 17-18 years provided two 24-h recalls. Intakes and healthy dietary scores were calculated. Plasma ferritin, folate and 25(OH)D were available for a third. Almost 40% of total energy came from discretionary foods/beverages. Adolescents with higher intakes were more likely to be female, older, from a low socioeconomic position-household and born in Sweden. Most discretionary foods/beverages were consumed on weekend days and during in-between meals, outside of the home and at school. Percent energy from discretionary intake was associated with healthy dietary scores but not nutritional status. A substantial amount of energy was obtained from discretionary foods/beverages, and we found that consumption is pervasive across sociodemographic factors, time and place. Addressing this pattern will require a comprehensive approach to food environments and behaviours to reach all adolescents in an equitable manner.

Young women's and midwives' perspectives on improving nutritional support in pregnancy: The babies, eating, and LifestyLe in adolescence (BELLA) study

RATIONALE

Teenage pregnancy has a high risk of poor outcomes for both mother and baby. Teenage girls have the poorest diets of any population group in the UK, which compounds the risk of poor pregnancy outcomes. Pregnant teenagers trust advice from their midwives, but midwives feel they do not have time, confidence, or knowledge to discuss nutrition.

OBJECTIVE

This study examined how the relationship between pregnant teenagers and their midwives could be utilised to deliver support to improve diet quality.

METHOD

Qualitative interviews were conducted across three urban sites in the UK: Manchester, Doncaster, and Southampton with adolescent mothers and their midwives regarding diet and lifestyle, and what form of support would be helpful. In total, 106 young women and 20 midwives were interviewed. Most of the young mothers were 19 or younger (67%). Half had had their first child in the past year (52%) and 21% were pregnant during the study. Thematic analysis was used to identify ways to better support young mothers to eat well.

RESULTS

Young women found it difficult to prioritise healthy eating; they often felt isolated and not in control of their own lives and wanted support from their midwife. Midwives felt that it was their role to support young mothers with diet in pregnancy but were anxious about initiating conversations and felt they lacked clear guidance.

CONCLUSIONS

Pregnant teenagers and their midwives lack reliable resources and strategies for healthy eating support. An effective intervention to improve pregnant teenagers' diet quality must empower, inform, and motivate young mothers and their midwives, and enable connections between young mothers.

Parental perspectives on negotiations over diet and physical activity: how do we involve parents in adolescent health interventions?

OBJECTIVE

To identify the ways in which parental involvement can be incorporated into interventions to support adolescent health behaviour change.

DESIGN

Data from semi-structured interviews were analysed using inductive thematic analysis.

SETTING

Southampton, Hampshire, UK.

PARTICIPANTS

A convenience sample of twenty-four parents of adolescents.

RESULTS

Parents consider themselves to play an important role in supporting their adolescents to make healthy choices. Parents saw themselves as gatekeepers of the household and as role models to their adolescents but recognised this could be both positive and negative in terms of health behaviours. Parents described the changing dynamics of the relationships they have with their adolescents because of increased adolescent autonomy. Parents stated that these changes altered their level of influence over adolescents' health behaviours. Parents considered it important to promote independence in their adolescents; however, many described this as challenging because they believed their adolescents were likely to make unhealthy decisions if not given guidance. Parents reported difficulty in supporting adolescents in a way that was not viewed as forceful or pressuring.

CONCLUSIONS

When designing adolescent health interventions that include parental components, researchers need to be aware of the disconnect between public health recommendations and the everyday reality for adolescents and their parents. Parental involvement in adolescent interventions could be helpful but needs to be done in a manner that is acceptable to both adolescents and parents. The findings of this study may be useful to inform interventions which need to consider the transitions and negotiations which are common in homes containing adolescents.

Cartoon Characters in Children’s Series: Gender Disparities in Body Weight and Food Consumption

(1) Background: Media play a significant role in forming audience perceptions about physical external appearance and food consumption patterns. It has been reported that children’s cartoons project slimness, and concomitantly consumption of poor nutritional quality food. However, data on the role of gender in this respect are lacking; thus, this was the aim of the present study. (2) Methods: 100 episodes of the 10 most popular cartoon series were analyzed. Characters’ body weight status was classified into underweight, normal weight and overweight, and foods consumed as core (e.g., fruit, vegetables) and non-core (e.g., sweets, snacks). Messages about characters’ attractiveness were recorded and classified according to their body weight status and gender. (3) Results: Out of 37 protagonists, 12 were female figures (32%), while out of the 10 thin protagonists, 7 were females (70%) and only 3 males (30%). Thin heroines were the recipients of the majority of the messages connotative to physical attractiveness (36 out of 58 messages). However, consumption of core and non-core foods did not differ within genders (core: z = −1.526, p = 0.127, non-core: z = −0.417, p = 0.667). (4) Conclusions: Females seem to be underrepresented in cartoon series but receive the majority of the comments related to physical appearance, with most of them addressing the attractiveness of a thin figure.

Body Weight of Cartoon Characters in Children Series Is Associated to Food Consumption, Attractiveness, and Physical Activity Engagement

BACKGROUND

Research is lacking regarding the eating habits of cartoon characters in relation to their body weight. The present study explored the context of food consumption and the cartoon characters' traits, according to body weight. Studies show that slim cartoon characters are usually considered as attractive; however, little is known regarding the type of messages projected about their physical appearance.

METHOD

One hundred episodes of ten series with high TV audience rates were reviewed. Characters' body weight status was classified into underweight, normal weight, and overweight, and food consumed as processed and less processed. Characters' traits such as physical activity and attractiveness were classified as positive, negative, or neutral. Comments made by the characters themselves regarding their proper physical appearance or the appearance of partner characters were recorded and classified as positive or negative.

RESULTS

Results show that characters' body weight was related to both type and quantity of foods consumed, as 58% of the non-core and 48% of all foods were actually eaten by oversized characters. Positive characters' traits, as defined by attractiveness and physical activity engagement, referred consistently to slim characters, with nine out of ten shown as good-looking and physically active. In addition, the majority (51 out of 58) of the positive comments on physical appearance were recorded for slim and attractive characters, either expressed by fellow actors or the characters themselves.

CONCLUSION

Body weight of cartoon characters seems to follow stereotypic perceptions which value slimness and relate unhealthy food consumption with overweight.

Are the Italian Children Exposed to Advertisements of Nutritionally Appropriate Foods?

Unhealthy eating habits are one of the main risk factors for overweight/obesity, and food marketing plays a major role in their development. The aim of this study was to monitor the amount and the characteristics of food marketing directed to Italian children broadcasted on television (TV). The WHO tool to assess food and beverage multimedia marketing aimed at children was used to analyze TV recordings. Type of product branded, viewing time, channel’s target, and broadcasting company were the exposure variables analyzed. The power of persuasive techniques was also assessed. Food products were categorized as either core or non-core products on the basis of their nutritional profile. A total of 320 h of TV broadcasting was analyzed, including 51.7 h of commercials. Food and beverages were the second most frequently advertised products, with an average of 6 food advertisements per hour during peak viewing time. A total of 23.8% of food advertisements were recorded during the time slot of 3:00 p.m. Considering food and beverage commercials, “humor” was the most frequently used primary persuasive technique, while the “image of the product/packaging” was the most commonly used secondary persuasive technique. Products specifically targeted to children were 94.3% non-core. Our findings indicate that core foods are highly underrepresented in TV commercials, especially during children TV programs and peak viewing time.

Food Sources of Shortfall Nutrients Among US Adolescents: National Health and Nutrition Examination Survey (NHANES) 2011-2014

To identify food sources of shortfall nutrients consumed by adolescents (n = 3156), data from the National Health and Nutrition Examination Survey (NHANES) (2011-2014) were used. Some of the food groups commonly consumed by adolescents made a significant contribution to shortfall nutrient intakes in the diet. Many food sources that provided significant amounts of shortfall nutrients were from foods that also provided nutrients to limit. Awareness of nutrient intakes and food sources is essential to establish dietary guidance in a practical context. Efforts to continue monitoring the food sources of nutrients consumed by adolescents will be important to improve the current knowledge on this topic of research.

Determinants of Portion Size in Children and Adolescents: Insights from the UK National Diet and Nutrition Survey Rolling Programme (2008-2016)

Large portion sizes have been identified as contributing to overweight and obesity, particularly in children and adolescents. This study examined predictors of portion sizes of high energy snack foods eaten by children aged 1.5–18 years. Specifically, we examined whether portion sizes were adjusted for age, and what external features of the environment might be linked to large portion sizes. Portion sizes were derived from four-day food diaries that form the UK National Diet and Nutrition Survey. Diaries from 5942 children were examined and multilevel models were used to discover whether age, gender, location, time of day, household income, and watching TV while eating predicted portion sizes of savoury snacks, chocolate, confectionery and biscuits. Portion sizes of all the target foods were predicted by age. Boys had larger portions, and portion sizes were larger when target foods were consumed later in the day. Portion sizes were larger outside the home, for example in leisure venues, but the target foods were eaten more frequently in the home. As dietary patterns change to include more snack intake outside the home, these locations could be an important space to target for interventions for portion control.

Sociocultural Influences on Dietary Practices and Physical Activity Behaviors of Rural Adolescents-A Qualitative Exploration

In the aftermath of nutrition transition and ever-increasing sedentarism, adolescents globally are exposed to negative health consequences. Diverse sociocultural influences play a critical role in their adoption of unhealthy dietary practices and suboptimal physical activity behaviors. Context-specific understandings of how these sociocultural influences shape adolescents’ dietary and physical activity patterns in a rural, resource-limited setting remained elusive. Aiming to address the gap, this qualitative study explored adolescents’ and mothers’ perception of broader sociocultural aspects that sculpt the food choices, eating habits and physical activity behaviors of adolescents in Matlab, Bangladesh. Six digitally-recorded focus group discussions were transcribed verbatim, translated into English and analyzed thematically. Marked taste-driven dietary preference of adolescents and its prioritization within family by the mothers, popularity of street foods, better understanding of the importance of food hygiene and safety contrasting with narrow perception of balance and diversity in diet, peer influence along with deficient school and community food environment, internalization and rigidity of gender norms were found to be exerting major influence. The findings highlighted key targets for community-based nutrition interventions and endorsed thorough consideration of socio-cultural factors in formulating strategies to promote healthful eating and physical activity behaviors among the adolescents.

Media food marketing and eating outcomes among pre-adolescents and adolescents: A systematic review and meta-analysis

The media marketing's effect on child and adult eating has been extensively researched, yet, little is known about its effect on adolescents. The aim of this review is to synthesize available research on the relation between media food marketing and eating-related cognitions, attitudes, and behaviors among pre-adolescents (8-11) and adolescents (12-19). We systematically screened and retrieved 9324 articles, of which 28 were included in the review-analysis and 19 in the meta-analysis. Robust variance estimation with random effect weights indicated a positive small standard effect size (d = 0.26, P < .001) of media food marketing on all unhealthy eating outcomes, and a subgroup analysis revealed a small effect size (d = 0.26, P < .001) on unhealthy eating behaviors specifically. Another subgroup analysis among adolescents revealed an effect of marketing (d = 0.22, P < .05) on unhealthy eating outcomes. This review demonstrates the significance of media marketing on eating in pre-adolescents and adolescents, and highlights limitations in the food marketing and adolescent eating literature specific to eating outcomes and marketing media studied and research designs utilized. We call for properly designed food marketing research exploring digital media's effect on eating attitudes and cognitions, especially among older adolescents.

What Do Adolescents See on Social Media? A Diary Study of Food Marketing Images on Social Media

Food marketing influences eating preferences and choices, especially among adolescents, contributing to the rise of overweight, obesity, and other chronic health disorders. Recent social media advancements have provided food marketers with platforms to reach out to many in more personal and authentic ways as compared to classical media advertising. Such personalized and borderless social media platforms allow marketers to easily use owned, paid, and earned (word-of –mouth) marketing strategies, including paid and non-paid influencers to reach younger target audiences. This study therefore aims to explore food messages adolescents (12–18 years old) encounter on social media, and assess these messages for their sources, the presence of core and non-core food, and the marketing strategies employed. To attain an in-depth understanding of the food messages that adolescents are continuously exposed to, we carried out a diary study with 21 Flemish adolescents who took screenshots of food images they encountered on their social media platforms for the duration of one week. A quantitative and qualitative content analysis of 611 images revealed that adolescents are mostly exposed to messages of non-core (67% of images) and branded (49% of images) food, often (49% of images) presented in association with a social context such as hanging around with friends, eating at restaurants and celebrating with food. Adolescents often encounter branded food images through peers and social media influencers, the majority of which are part of earned (49% of branded images) or paid (40% of branded images) media food marketing. This research provides an in-depth understanding of the social media messages that adolescents encounter on a daily basis and sheds light on food norms typically communicated on social media by marketers, peers, and influencers. Study findings highlight prominent social media food messages that should be tested for their persuasiveness, providing insights for future research that aims to assess the effects of social media food marketing on adolescents. Based on the study findings, we call for relevant policy actions that address current social media marketing strategies targeted at adolescents.

The effect of mild sleep deprivation on diet and eating behaviour in children: protocol for the Daily Rest, Eating, and Activity Monitoring (DREAM) randomized cross-over trial

BACKGROUND

Although insufficient sleep has emerged as a strong, independent risk factor for obesity in children, the mechanisms by which insufficient sleep leads to weight gain are uncertain. Observational research suggests that being tired influences what children eat more than how active they are, but only experimental research can determine causality. Few experimental studies have been undertaken to determine how reductions in sleep duration might affect indices of energy balance in children including food choice, appetite regulation, and sedentary time. The primary aim of this study is to objectively determine whether mild sleep deprivation increases energy intake in the absence of hunger.

METHODS

The Daily, Rest, Eating, and Activity Monitoring (DREAM) study is a randomized controlled trial investigating how mild sleep deprivation influences eating behaviour and activity patterns in children using a counterbalanced, cross-over design. One hundred and ten children aged 8-12 years, with normal reported sleep duration of 8-11 h per night will undergo 2 weeks of sleep manipulation; seven nights of sleep restriction by going to bed 1 hr later than usual, and seven nights of sleep extension going to bed 1 hr earlier than usual, separated by a washout week. During each experimental week, 24-h movement behaviours (sleep, physical activity, sedentary behaviour) will be measured via actigraphy; dietary intake and context of eating by multiple 24-h recalls and wearable camera images; and eating behaviours via objective and subjective methods. At the end of each experimental week a feeding experiment will determine energy intake from eating in the absence of hunger. Differences between sleep conditions will be determined to estimate the effects of reducing sleep duration by 1-2 h per night.

DISCUSSION

Determining how insufficient sleep predisposes children to weight gain should provide much-needed information for improving interventions for the effective prevention of obesity, thereby decreasing long-term morbidity and healthcare burden.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12618001671257 . Registered 10 October 2018.

High-risk environments for eating foods surplus to requirements: a multilevel analysis of adolescents' non-core food intake in the National Diet and Nutrition Survey (NDNS)

OBJECTIVE

Interventions to reduce adolescents' non-core food intake (i.e. foods high in fat and sugar) could target specific people or specific environments, but the relative importance of environmental contexts v. individual characteristics is unknown.

DESIGN

Cross-sectional.

SETTING

Data from 4d food diaries in the UK National Diet and Nutrition Survey (NDNS) 2008-2012 were analysed. NDNS food items were classified as 'non-core' based on fat and sugar cut-off points per 100g of food. Linear multilevel models investigated associations between 'where' (home, school, etc.) and 'with whom' (parents, friends, etc.) eating contexts and non-core food energy (kcal) per eating occasion (EO), adjusting for variables at the EO (e.g. time of day) and adolescent level (e.g. gender).ParticipantsAdolescents (n 884) aged 11-18 years.

RESULTS

Only 11 % of variation in non-core energy intake was attributed to differences between adolescents. In adjusted models, non-core food intake was 151 % higher (ratio; 95 % CI) in EO at 'Eateries' (2·51; 2·14, 2·95) and 88 % higher at 'School' (1·88; 1·65, 2·13) compared with 'Home'. EO with 'Friends' (1·16; CI 1·03, 1·31) and 'Family &amp; friends' (1·21; 1·07, 1·37) contained 16-21 % more non-core food compared with eating 'Alone'. At the individual level, total energy intake and BMI, but not social class, gender or age, were weakly associated with more non-core energy intake.

CONCLUSIONS

Regardless of individual characteristics, adolescents' non-core food consumption was higher outside the home, especially at eateries. Targeting specific eating contexts, not individuals, may contribute to more effective public health interventions.

Diet Quality through Adolescence and Early Adulthood: Cross-Sectional Associations of the Dietary Approaches to Stop Hypertension Diet Index and Component Food Groups with Age

Late adolescence to early adulthood is the period of life when prevalence of overweight and obesity rises the fastest, and an important time to understand changes in dietary risk factors. In this study we assess the variation in diet quality through analysis of cross-sectional data from 2957 individuals aged 13 to 30 from the National Diet and Nutrition Study (2008–2016). Diet data were self-reported using four-day food diaries and coded to give diet quality using the dietary approaches to stop hypertension (DASH) index (range 0–80) and DASH component food groups (grams/day). The mean DASH index score was low at 34.8 (95% confidence interval (CI) = 34.3–35.4). The regression of diet quality score and food groups on age categories revealed no significant change in diet quality score with age category in males, but an improved diet quality score among females aged 19–21 (β = 2.04, 95% CI = 0.05–4.02), 25–27 (β = 3.77, 95% CI = 1.36–6.18) and 28–30 (β = 2.39, 95% CI = 0.53–4.26), compared to age 13–15. Both sexes showed increased vegetable intake with age. Dairy intake was lower in early adult ages among males, while in females there was an increase in the proportion of low-fat dairy consumed with age. Further research should address the determinants of changes in diet in early adulthood to provide evidence for the targeting of public health policy.

Changes in diet from age 10 to 14 years and prospective associations with school lunch choice

BACKGROUND

There is limited evidence on how diet changes over the transition from primary to secondary school. In this study we investigated changes in diet from age 10 (2007) to age 14 years (2011) and the contribution of school-time consumption and school lunch choice to such changes.

METHODS

The 351 participants with dietary data (4 day food record) available at baseline (age 10 years) and follow-up (age 14 years) were included. Multi-level regression models were fitted for absolute or change in food and nutrient intake, cross-classified by primary and secondary school attended as appropriate, with adjustment for covariates and mis-reporting.

RESULTS

From age 10 to age 14 years, children decreased energy intake from sugars (-2.6% energy (%E)) (standard error (SE) 0.44) and from saturated fats (-0.54%E (SE 0.18)), decreased fruit (-3.13 g/MJ (SE 1.04)) and vegetables (-1.55 g/MJ (SE 0.46)) consumption and increased sugar sweetened beverage (SSB) (4.66  g/MJ (SE 1.87)) and fries (1.31  g/MJ (SE 0.39)) consumption. Intake of snack foods, SSBs, and fries, but also fruits and vegetables was higher outside school hours. Prospective change from non-school lunch to school lunch, compared to maintaining non-school lunch consumption, was associated with decreased consumption of savoury snacks (-8.32 g/day (SE 2.03)), increased consumption of fries (12.8 g/day (SE 4.01)) and decreased consumption of fruit (-25.16 g/day (SE 11.02)) during school hours.

CONCLUSIONS

Changes in diet from age 10 to age 14 years differed within and outside of school hours. Consumption of a school lunch, compared to lunch obtained elsewhere, was associated with negative as well as positive changes in diet, suggesting that any efforts to encourage school lunch take-up need to be accompanied by further efforts to improve school lunch provision to meet nutritional guidelines.