Nutrition knowledge and food intake of seven-year-old children in an atherosclerosis prevention project with onset in infancy: the impact of child-targeted nutrition counselling given to the parents

Influence of adolescents' and parental dietary knowledge on adolescents' body mass index (BMI), overweight/obesity in 2004-2015: a longitudinal study

OBJECTIVE

The global epidemic of overweight/obesity in children and adolescents poses a significant public health threat. This longitudinal study aims to investigate the relationship between adolescents' and their parents' dietary knowledge and overweight/obesity among adolescents in China.

METHODS

Data were collected from the China Health and Nutrition Survey (CHNS) in 2004, 2006, 2009, 2011 and 2015. Overweight/obesity was defined according to the International Obesity Task Force (IOTF) cut-off for body mass index (BMI). A set of questions were used to assess the dietary knowledge scores of both adolescents and their parents during face-to-face interviews. Mixed effect models were used to analyze the data.

RESULTS

A total of 2035 adolescents aged 12-17 years were included in the data analysis. The mean BMI increased from 19.2 in 2004 to 20.5 in 2015, with a significant increase in the prevalence of overweight and obesity from 6.8% and 0.5% in 2004 to 15.1% and 7.8% in 2015, respectively. Adolescents with medium-score dietary knowledge were less likely to be overweight/obese compared to those with low-score dietary knowledge (OR (95% CI): 0.20 (0.05-0.80), P < 0.05). However, there was no association between parental dietary knowledge and adolescents' BMI or overweight/obesity (P > 0.05). Additionally, a significant interaction between adolescents' dietary knowledge score and education in relation to adolescents' BMI (P for interaction < 0.05).

CONCLUSION

Adolescents with medium dietary knowledge were less likely to be overweight/obese than those with low knowledge, but no association was found with parental knowledge. Promoting nutritional education and healthy eating habits is vital to prevent overweight/obesity.

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.

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.

Randomized Controlled Trial of a Primary Care-Based Child Obesity Prevention Intervention on Infant Feeding Practices

OBJECTIVE

To determine the effects of a child obesity prevention intervention, beginning in pregnancy, on infant feeding practices in low-income Hispanic families.

STUDY DESIGN

The Starting Early randomized controlled trial enrolled pregnant women at a third trimester visit. Women (n = 533) were randomly allocated to a standard care control group or an intervention group participating in prenatal and postpartum individual nutrition/breastfeeding counseling and subsequent nutrition and parenting support groups coordinated with well-child visits. Outcome measures included infant feeding practices and maternal infant feeding knowledge at infant age 3 months, using questions adapted from the Infant Feeding Practices Study II and an infant 24-hour diet recall.

RESULTS

A total of 456 families completed 3-month assessments. The intervention group had higher prevalence of exclusive breastfeeding on the 24-hour diet recall (42.7% vs 33.0%, P = .04) compared with controls. The intervention group reported a higher percentage of breastfeeding vs formula feeding per day (mean [SD] 67.7 [39.3] vs 59.7 [39.7], P = .03) and was less likely to introduce complementary foods and liquids compared with controls (6.3% vs 16.7%, P = .001). The intervention group had higher maternal infant feeding knowledge scores (Cohen d, 0.29, 95% CI .10-.48). The effect of Starting Early on breastfeeding was mediated by maternal infant feeding knowledge (Sobel test 2.86, P = .004).

CONCLUSIONS

Starting Early led to increased exclusive breastfeeding and reduced complementary foods and liquids in 3-month-old infants. Findings document a feasible and effective infrastructure for promoting breastfeeding in families at high risk for obesity in the context of a comprehensive obesity prevention intervention.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT01541761.

Diet, physical activity, weight status, and culture in a sample of children from the developing world

Objective. Barbados, a small developing state at the end of the nutrition transition, faces an obesity epidemic. Although there is hope of stemming the epidemic in childhood, no descriptions of children's dietary and physical activity (PA) patterns are available for planning purposes. We describe the food and activity preferences and adult encouragement of active and sedentary behaviors for children 9–11 years in relation to weight status and the cultural context. Design. We used data from a pilot study preceding a large-scale ongoing study on the local drivers of the obesity epidemic among preadolescent children. PA, sedentary activity, and dietary intakes were assessed from recalls. Weight and height were measured. Setting. Barbados. Subjects. Sixty-two (62), 9–11-year-old school children. Results. Sugar-sweetened beverages provided 21% of energy consumed. Energy intake significantly explained BMI. Parents selected significantly more of children's sedentary activities and encouraged mostly homework and chores (59%). Children's self-selected school-based activity was significantly related to BMI. Conclusions. Childhood obesity prevention recommendations and research should focus on culture-specific practices that promote acquired taste for excess sugar and parent-child interactions regarding PA. Child influenced by school-based activity intervention may an important area for preventive intervention research.

Development and test-retest reliability of a nutrition knowledge questionnaire for primary-school children

OBJECTIVE

To evaluate a web-based nutritional knowledge questionnaire for primary-school children.

DESIGN

Children's nutritional knowledge was assessed in five domains: healthy choices (twenty-seven items), estimated recommended portions/servings (eight items), nutrient content (five items), main food function (five items) and categorization of food items (eight items).

SETTING

The questionnaires were completed in school.

SUBJECTS

A convenience sample of 576 Belgian children (aged 7-12 years) from fourteen primary schools completed the questionnaire once, 386 completed the questionnaire twice.

RESULTS

Healthy choices could be answered correctly by 73 % of the children, nutrients by 59 %, food categorization by 49 %, main function by 38 % and portion estimation by 36 %. Children's test-retest intra-class correlations were 0·75 for healthy choices, 0·33 for nutrients, 0·61 for food categorization, 0·44 for main function, 0·47 for portion estimation and 0·76 for the total scale. The intra-class correlation was lower in the youngest age group (grade 2: 0·51, grade 4: 0·65, grade 6: 0·66). The total score was significantly lower in the retest. The instrument was in general positively evaluated by the children.

CONCLUSIONS

The instrument is a promising, practical, inexpensive tool with acceptable test-retest reliability in fourth and sixth graders.

Salt intakes around the world: implications for public health

BACKGROUND

High levels of dietary sodium (consumed as common salt, sodium chloride) are associated with raised blood pressure and adverse cardiovascular health. Despite this, public health efforts to reduce sodium consumption remain limited to a few countries. Comprehensive, contemporaneous sodium intake data from around the world are needed to inform national/international public health initiatives to reduce sodium consumption.

METHODS

Use of standardized 24-h sodium excretion estimates for adults from the international INTERSALT (1985-87) and INTERMAP (1996-99) studies, and recent dietary and urinary sodium data from observational or interventional studies--identified by a comprehensive search of peer-reviewed and 'grey' literature--presented separately for adults and children. Review of methods for the estimation of sodium intake/excretion. Main food sources of sodium are presented for several Asian, European and Northern American countries, including previously unpublished INTERMAP data.

RESULTS

Sodium intakes around the world are well in excess of physiological need (i.e. 10-20 mmol/day). Most adult populations have mean sodium intakes >100 mmol/day, and for many (particularly the Asian countries) mean intakes are >200 mmol/day. Possible exceptions include estimates from Cameroon, Ghana, Samoa, Spain, Taiwan, Tanzania, Uganda and Venezuela, though methodologies were sub-optimal and samples were not nationally representative. Sodium intakes were commonly >100 mmol/day in children over 5 years old, and increased with age. In European and Northern American countries, sodium intake is dominated by sodium added in manufactured foods ( approximately 75% of intake). Cereals and baked goods were the single largest contributor to dietary sodium intake in UK and US adults. In Japan and China, salt added at home (in cooking and at the table) and soy sauce were the largest sources.

CONCLUSIONS

Unfavourably high sodium intakes remain prevalent around the world. Sources of dietary sodium vary largely worldwide. If policies for salt reduction at the population level are to be effective, policy development and implementation needs to target the main source of dietary sodium in the various populations.

Lipid management in children

Atherosclerosis begins in childhood, and early initiation of prevention through behavioral means may lower the risk of future cardiovascular disease. The obesity epidemic threatens the cardiovascular health of today's children. Genetic dyslipidemias such as familial hypercholesterolemia and the presence of multiple risk factors in the same child or adolescent may require pharmacologic therapy.

Trait-specific tracking and determinants of body composition: a 7-year follow-up study of pubertal growth in girls

BACKGROUND

Understanding how bone (BM), lean (LM) and fat mass (FM) develop through childhood, puberty and adolescence is vital since it holds key information regarding current and future health. Our study aimed to determine how BM, LM and FM track from prepuberty to early adulthood in girls and what factors are associated with intra- and inter-individual variation in these three tissues.

METHODS

The study was a 7-year longitudinal cohort study. BM, LM and FM measured using dual-energy X-ray absorptiometry, self-reported dietary information, leisure time physical activity (LTPA) and other factors were assessed one to eight times in 396 girls aged 10 to 13 years (baseline), and in 255 mothers once.

RESULTS

The location of a girl's BM, LM and FM in the lower, middle or upper part of the sample distribution was established before puberty and tracked in its percentile of origin over 7 years (r = 0.72 for BM, r = 0.61 for LM, and r = 0.65 for FM all p < 0.001 first vs. last measurements' ranking). Seventy-three percent of those in the lowest quartile for BM and 69% for LM, and 79% of those in the highest quartile for FM at baseline remained in their quartile at 7-year follow-up. Heritability was estimated to contribute 69% of the total variance of the BM, 50% of the LM, and 57% of the FM. Besides body size, diet index (explaining 9% of variance), breast feeding duration (6%) and mother's BM (9%) predicted high BM. Diet index and high LTPA predicted high LM (24% and 14%, respectively), and low FM (25% and 12%, respectively), and low level of parental education predicted high FM (4%).

CONCLUSION

Individual levels of BM, LM and FM are established before puberty and track in a trait-specific manner until early adulthood. Girls who are prone to develop low BM and LM and high FM in adulthood can be identified in prepuberty. The developments of three components of body composition are inter-related during growth. BM was the most heritable trait while LM the most environmentally modifiable. Diet and physical activity played an important role in increasing LM and preventing the accumulation of excessive FM.

Dietary patterns among a national sample of British children aged 1 1/2-4 1/2 years

OBJECTIVE

Using a nationally representative sample, to identify groups among British children aged 1 1/2-4 1/2 years who report similar patterns of diet.

DESIGN

Nationally representative dietary survey, using 4 d weighed dietary records, of girls and boys aged 1 1/2-4 1/2 years living in private households in Great Britain in 1992-1993. Cluster analysis was used to aggregate individuals into diet groups.

SETTING

Great Britain.

PARTICIPANTS

Eight hundred and forty-eight boys and 827 girls.

RESULTS

Three clusters were identified for girls and three for boys. Among boys the most prevalent cluster was 'Healthy Diet' (52.3%), the second was 'Convenience Diet' (38.3%) and the third was 'Traditional Diet' (9.3%). Among girls, the most prevalent dietary cluster was 'Healthy Diet' (58.7%), followed by a 'Convenience Diet' (36.6%) and 'Traditional Diet' (4.3%). There were important differences in nutrient profile, sociodemographic and behavioural characteristics between clusters.

CONCLUSIONS

Cluster analysis identified three groups among both girls and boys which differed not only in terms of reported dietary intake, but also with respect to nutrient intake, social and behavioural characteristics. The groups identified could provide a useful basis for the development, monitoring and targeting of public health nutrition policy for pre-school children in the UK. Further research is needed on the consequences for chronic disease in the future for these children.

Growth patterns and obesity development in overweight or normal-weight 13-year-old adolescents: the STRIP study

OBJECTIVE

Our goal was to study childhood growth patterns and development of overweight in children who were overweight or normal weight at 13 years of age.

PARTICIPANTS AND METHODS

This study is part of a prospective atherosclerosis-prevention trial Special Turku Coronary Risk Factor Intervention Project for Children). At 7 months of age, 1062 children were randomly assigned to an intervention group (n = 540) receiving biannual fat-oriented dietary counseling or to a control group (n = 522). Height and weight of the children and their parents were monitored annually. Our study group comprised those children who participated in the 13-year study visit (n = 541). At 13 years of age, the child was classified as overweight (n = 84) if his or her BMI exceeded the international age- and gender-specific overweight criteria.

RESULTS

In overweight girls, the annual weight gain increased from 2.8 kg during the third and fourth year of life to 7.5 kg during the 12th year of life, whereas the annual weight gain of the girls who were normal weight ranged from 2.1 to 4.8 kg during the same period. The annual weight gain was similar of overweight boys and in their normal-weight peers until the age of 5 years, but after that it increased from 3.5 to 7.9 kg in overweight and from 2.6 to 5.5 kg in normal-weight boys. The BMI of the girls and boys who were overweight at the age of 13 exceeded the international cutoff point for overweight from the age of 5 and 8 years onward, respectively. The mean BMIs of the mothers and fathers of the overweight children were higher than those of the parents of the normal-weight children. The STRIP intervention had no effect on the examined growth parameters or on parental BMI.

CONCLUSIONS

The children who were overweight at 13 years of age gained more weight than their normal-weight peers by the age of 2 or 3 years onward. The girls became overweight by the age of 5 years, whereas the boys only after 8 years of age. Parental BMI and steep weight gain in early childhood indicate markedly increased risk for becoming overweight.

High sucrose intake is associated with poor quality of diet and growth between 13 months and 9 years of age: the special Turku Coronary Risk Factor Intervention Project

BACKGROUND

Previous studies have suggested that interventions to lower dietary fat content and improved fat quality lead to a compensatory increase in sucrose content.

OBJECTIVE

The purpose of this work was to determine what associations exist between sucrose intake and intake of nutrients, intake of specific foods, and growth in children aged 13 months to 9 years of age in the prospective, randomized Special Turku Coronary Risk Factor Intervention Project.

SUBJECTS AND METHODS

Nutrient intake and food consumption were evaluated annually at ages 13 months through 9 years by using food records. Altogether, 543 children were divided into 3 groups according to mean sucrose intake: constantly high sucrose intake (highest 10%), constantly low sucrose intake (lowest 10%), and average sucrose intake (80%). Absolute and relative weights and heights were recorded at 7, 13, and 24 months of age and annually thereafter until 9 years old.

RESULTS

The high sucrose-intake group exceeded the recommended sucrose intake (<10% of energy intake, World Health Organization) already at the age of 2 years. Energy and total fat intake did not differ between the sucrose-intake groups. Children with low and average sucrose intake consumed more protein and had a better dietary fat quality than children with high sucrose intake. They also tended to receive more vitamin E, niacin, calcium, iron, zinc, and dietary fiber than children who consumed a high sucrose diet. Children in the low sucrose-intake group consumed more grains, vegetables, and dairy products than the other children. Sugar intake had no direct association with obesity, but weight, height, and BMI of children differed between the sucrose-intake groups between 7 months and 9 years of age.

CONCLUSIONS

In children aged 13 months to 9 years, long-term low sucrose intake is associated with better nutrient intake and growth than high sucrose intake.

School teachers can effectively manage primary prevention of adult cardiovascular disease. The Stradella Project

OBJECTIVE

To determine whether school teachers educated about Primary Prevention of Adult Cardiovascular Disease (PPCVD) could help their students improve their blood lipid profile.

METHOD

Five teachers voluntarily received training about PP-CVD. Thirteen classes of a single high school in Stradella (north Italy) were randomized to receive a 2-month course on PP-CVD (PP-classes; 150 pupils) by their teachers or to a control group (control classes; 130 pupils) during 2004. In all students body weight and fasting venous blood concentrations of total cholesterol (TC), HDL-CHOL, LDL-CHOL, and triglycerides were determined before and 6 months after the completion of the PP-CVD course.

RESULTS

Six months after the PP-CVD course, males had significant improvements of all baseline lipid parameters whereas females had improved HDL-CHOL and TC/HDL ratio. No improvements were observed in the control class students. Body weight was unchanged in both groups of students 6 months after the PP-CVD course or the control course.

CONCLUSION

This investigation shows that well-trained school teachers are able to manage PP-CVD education so that students can really improve their lipid profile as a consequence of autonomous changes in dietary habits.

Dietary behaviour of Tehranian adolescents does not accord with their nutritional knowledge

Objective

To determine the nutritional behaviour of Tehranian adolescents.

Subjects and methods

This study was undertaken on 7669 adolescents (4070 boys and 3599 girls) of 22 junior high schools and high schools as a representative sample of Tehranian adolescents. A validated knowledge, attitudes and practices (KAP) questionnaire and a food-frequency questionnaire (FFQ) were used. Factor analysis was used to determine the key questions.

Results

The mean ( ± standard deviation) age and body mass index of the adolescents was 14 ± 1 years and 27.2 ± 11 kg m− 2. Although 82% of girls and 75% of boys had good nutritional knowledge, only 25% of boys and 15% of girls had good nutritional practice. Eighty-five per cent of adolescents knew that drinking too many soft beverages resulted in overweight or obesity, but only 4.5% of them did not drink soft beverages. Although 89% of adolescents knew that crisps and corn balls are not healthy snacks, 45% of them used such snacks during their break time. Thirty-seven per cent of adolescents preferred whole-grain biscuits to creamy wafer ones but only 10% of adolescents used whole-grain biscuits as a snack. The most frequently consumed snacks among Tehranian adolescents were sausage sandwiches, cocoa cola, crisps and corn balls, creamy wafers, cakes, chocolate and toffee.

Conclusion

A low percentage of Tehranian adolescents have good nutritional behaviour and in most of them their nutritional practice does not accord with their nutritional knowledge. These results indicate the necessity of nutritional intervention in Tehranian adolescents.

Impact of nutrition counselling on nutrition knowledge and nutrient intake of 7- to 9-y-old children in an atherosclerosis prevention project

OBJECTIVE

To assess the impact of nutrition counselling given to 7.5- to 9-y-old children and their parents on children's nutrition knowledge and nutrient intakes.

DESIGN AND SUBJECTS

The study children are participants in a prospective, randomised STRIP study (Special Turku Coronary Risk Factor Intervention Project for Children), whose aim was to decrease the intakes of saturated fat and cholesterol while increasing the intake of unsaturated fat in the intervention children from the age of 7 months onwards. Nutrition counselling was given only to the parents until the child's age of 7 y. Nutrition knowledge and nutrient intakes (total energy, total fat, saturated fat, unsaturated fat and sodium) were studied in a time-restricted cohort of 47, 7-y-old intervention and 51 control children. Thereafter, nutrition counselling was given both to the children and parents. Children's nutrition knowledge and nutrient intakes were measured again at the age of 9 y.

RESULTS

Biannual nutrition counselling given to the intervention children and the parents maintained the differences in saturated fatty acid intake attained during the intervention given to the parents alone (11.5 vs 13.3 E% (percent of energy intake), at the age of 7 y, P<0.01; 11.1 vs 13.4 E% at the age of 9 y, respectively; P<0.01). The intervention children used more polyunsaturated fatty acids at the age of 9 y than the control children (5.7 vs 5.1 E%, P=0.05). At 7 y, the intervention and control children had similar nutrition knowledge scores (total knowledge score 12.9 vs 12.0, respectively, P=0.13). After 1.5 y of nutrition intervention, at 9 y, the intervention children's nutrition knowledge was higher than that of the controls (total nutrition score 16.5 vs 13.2, respectively, P<0.001) and the ability to explain the reasons for their picture choices in the nutrition knowledge test had increased.

CONCLUSION

This study showed that only a relatively short period of counselling with low input is needed to increase in children's nutrition knowledge and ability to explain nutrition-related subjects if advice has first been given to the parents and if the parents have received reinforcement and concrete help with parent-child communication after their children have been involved in the counselling. The differences attained in nutrient intake could also be maintained.

Nutritional influences on lipids and future atherosclerosis beginning prenatally and during childhood

Autopsy findings of pre-atherosclerotic changes in the coronaries and other arteries of young soldiers killed in action in the Korean war stimulated studies on the mechanisms that regulate the development of atherosclerosis. The data confirmed that vascular changes obviously begin developing much earlier than the manifestation of clinical symptoms, and numerous risk factors for atherosclerosis have been firmly identified. The mechanisms consist of the effects of numerous poorly characterized genes and a complex mixture of environmental factors, dominated by factors associated with nutrition. Observational and epidemiological studies also showed that the pathogenesis is not restricted to the postnatal period. The nutrition of the fetus during the 40 weeks of pregnancy may also play an important role both directly and by determining metabolism in the individual more widely than was previously believed. At the same time, several studies suggested that biochemical predictors of atherosclerosis, e.g. a high concentration of serum LDL cholesterol, a low concentration of serum HDL cholesterol and other lipid and lipoprotein abnormalities, may already in early infancy and childhood predict values later in life quite well. We now review recent studies that deal with the effects of fetal and childhood nutrition on serum lipid values, and discuss the likelihood that clinically meaningful changes of atherosclerosis may appear earlier than expected.