Longitudinal changes in diet from childhood into adulthood with respect to risk of cardiovascular diseases: The Cardiovascular Risk in Young Finns Study

Retrospective reports of coercive control food parenting practices during childhood are related to eating behaviors in adulthood: A latent profile analysis

Food parenting practices are parents' actions that influence their child's eating habits and food intake. Coercive control food parenting practices are behaviors that seek to satisfy parental desires concerning their child's eating. These practices (including emotional regulation, pressure to eat, food as a reward, restriction for health, and restriction for weight) can have detrimental effects on children's eating behaviors and diet quality. Using a person-centered approach, the present study examined whether experiencing controlling food-related parenting practices as a child relates to eating behaviors, food liking, and food intake in adulthood. Participants were 441 French-Canadian adults (50.2 % female; mean age = 42.7 years). A latent profile analysis (LPA) empirically identified three subgroups of individuals based on patterns of controlling food-related practices used by their parents during childhood. The "high control" subgroup (n = 47) reported more emotional eating, cognitive restraint, and disinhibition than the "moderate control with restriction for health" subgroup (n = 200), which reported higher levels of these behaviors than the "low control" subgroup (n = 194). The "high control" subgroup also reported less intuitive eating and a higher intake frequency of both savory and sweet foods than participants of the two other profiles, which did not differ from each other on these outcomes. Interestingly, liking for savory and sweet foods did not significantly differ among the three groups. Overall, results indicate that exposure to less controlling food parenting practices during childhood is associated with more positive eating behaviors and healthier food intake in adulthood.

Each Indicator of Socioeconomic Status (Education, Occupation, Income, and Household Size) Is Differently Associated with Children's Diets: Results from a Cross-Sectional CroCOSI Study

Background: There has yet to be an agreement on which specific socioeconomic status (SES) indicator most effectively reflects disparities in children's diets. However, children from lower SES backgrounds are particularly vulnerable, as research in other countries indicates that their diets contain fewer fruits and vegetables and more sweetened beverages. This paper aims to evaluate the associations between dietary habits and various SES indicators (education, occupation, income, and household size) among a representative sample of children in Croatia aged 7-10. Methods: Parents of children were asked to complete a questionnaire that contained indicators of their children's dietary habits and socioeconomic status (n = 5608). Associations between SES and children's dietary habits were assessed using logistic regression models. Results: The mother and father's educational attainment were strongly positively associated with breakfast consumption. Children of parents with a lower educational level consumed sweetened beverages, sweet snacks, and fast food slightly more often than children in families with a higher educational background. The mother's education was inversely associated with vegetable and cereal consumption, while the father's education was inversely associated with fruit and bakery product consumption. Meanwhile, household income per unit had a significant influence on the consumption of soft drinks and bakery products. Household size had a significant influence solely on sweet snack consumption. Conclusions: Each SES indicator showed an independent association with at least one particular dietary habit, except for the parent's employment status.

Food rejection is associated with tactile sensitivity and tactile appreciation in three-year-old children

Food rejections are common in young children and often include healthy foods, hereby impairing the quality of their diet. Previous studies indicate that food texture may play a role in children's food preferences and intake. Building on these findings, as part of an ongoing longitudinal project, the present study investigated whether food rejection is related to tactile sensitivity and tactile appreciation in three-year-old children. A total of 259 children and 289 parents participated in the study. Child food rejection was measured using an ad libitum taste test, in which children were asked to try four different types of vegetables. Next to this, parents reported on their child's food rejection tendencies by completing the Child Food Rejection Scale (CFRS), and indicating their child's liking of 14 vegetables and 11 fruits (Liking of foods). Tactile appreciation was measured using a behavioural Affective Appreciation of Textures (AAT) task, in which children were asked to feel five different objects with their hands and were asked to indicate the pleasantness of the sensation on a three-point smiley-scale. The subscale Touch of the parental questionnaire Sensory Profile (SP-t) was further used to measure tactile sensitivity. Results show that stronger food rejection measured using an ad-libitum taste test is related to a dislike of textures measured using the AAT task. Similarly, parent-reported food rejection measured using CFRS and Liking of foods is positively related to parent-reported tactile sensitivity measured using SP-t. Together, these findings suggest that some children do not only reject food because of its taste, but also because of their dislike of textures. To increase healthy food intake in picky children, it may thus prove helpful to improve children's appreciation of textures.

The influence of early and current feeding practices, eating behaviors, and screen time on dietary patterns in Polish toddlers - A cross-sectional study

Early nutrition has an important influence on a child's proper health and development, and understanding factors that may be related to desirable dietary patterns is key to improving the diet of future generations. The aim of this study was to assess whether early and current feeding practices, eating behaviors, and screen time viewing are associated with toddlers' dietary patterns. A cross-sectional sample of 467 mothers of toddlers (aged 1 year to 3) was surveyed between 2020 and 2022. Food consumption was evaluated by the Food Frequency Questionnaire (FFQ). The k-means algorithm was used to define dietary patterns on the basis of data collected from the FFQ and mealtime environment patterns, based on the data about practices during meals consumption. The odds of following a prohealth dietary pattern among early feeding factors were lower when infants ate commercial complementary foods more often. Distracted mealtime environment pattern increased the odds of following a non-eaters pattern, and commercial complementary foods pattern increased the odds of following a processed pattern. Currently, the odds of following a processed dietary pattern were higher when children were not breastfed and had higher screen time. Toddlers who ate during distraction and were more fussy had lower odds of following a prohealth dietary pattern, whereas higher enjoyment of food and satiety responsiveness increased the odds. The results indicate the need to increase parents' awareness about the importance of early factors in establishing dietary patterns.

Gender differences in adolescent food preferences and their association with parent food preferences: data from the China Health and Nutrition Survey (CHNS)

PURPOSE

Food preference is an important factor that affects one's eating behavior and dietary intake. Parent food preferences and food choices may influence children food preferences. This study is aimed to describe gender differences and time trends of Chinese adolescent food preferences and to explore the association between adolescent and their parent food preferences.

METHODS

The data were drawn from four waves of the China Health and Nutrition Survey (CHNS) conducted between 2006 and 2015. Participants were asked to indicate their degree of preferences for five food categories (fast food, salty snack food, fruits, vegetables, and soft/sugary drinks) using a 5-point Likert scale (from "dislike very much" to "like very much"). Logistic regression was performed to determine the association of food preferences between adolescents and their parents.

RESULTS

Adolescent preferences for unhealthy foods were significantly higher than those of adults. Adolescent food preferences for fruits and vegetables decreased slightly over nine years, and there were gender differences in healthy food preferences (girls > boys, P < 0.05). Regardless of boys or girls, adolescent food preferences for healthy foods (fruits and vegetables) were significantly associated with both their fathers (OR: 3.64-4.58 for boys and 2.71-4.39 for girls) and mothers (OR: 2.13-4.11 for boys and 3.07-5.66 for girls) food preferences. For fast food and salty snack food preferences, boys appeared to be influenced greater by their fathers than girls, while girls appeared to be influenced greater by their mothers than boys.

CONCLUSIONS

The present study reveals a high degree of unhealthy food preferences among Chinese adolescents and a gender-specific association of fast food and salty snack preference between Chinese adolescents and their parents. Our results may be useful for interventions to reduce adolescent unhealthy food preferences and intakes.

Influence of eating while watching TV on food preference and overweight/obesity among adolescents in China: a longitudinal study

Background

Eating while watching TV was found associated with unhealthy food preferences and obesity in adolescents in foreign studies, which is not clear in China. The study aims to explore the influence of eating while watching TV on food preferences and overweight/obesity in Chinese adolescents.

Methods

Data from 1768 adolescents (aged 12-17 years) in the 2006, 2009, 2011, and 2015 China Health and Nutrition Survey (CHNS) was analyzed. The height and weight were measured. Mixed effect models were used to identify the associations between eating while watching TV and adolescents' food preferences and overweight/obesity.

Results

Adolescents eating while watching TV ≥1 time/week were more likely to prefer fast food, salty snacks and soft drinks than those eating while watching TV <1 time/week. Adolescents eating meals while watching TV ≥1 time/week were less likely to prefer vegetables than those eating meals while watching TV <1 time/week. In addition, adolescents eating snacks while watching TV ≥1 time/week were more likely to be overweight/obesity than those eating meals while watching TV <1 time/week (odds ratio [OR] = 7.16; 95% confidence interval [CI] 1.39-36.93).

Conclusion

Eating snacks while watching TV was positively associated with adolescents' unhealthy food preferences and overweight/obesity. Eating meals while watching TV was associated with adolescents' unhealthy food preferences. Implementing web-based Community-based participatory research (CBPR) about reducing eating while watching TV may be a practical strategy to develop healthy food preferences and prevent overweight/obesity in Chinese adolescents.

The contribution of dietary composition over 25 years to cardiovascular risk factors in childhood and adulthood: the Princeton Lipid Research Study

Diet is a contributing factor to CVD risk, but how diet quality changes over the long term and contributes to CVD risk is less well studied. Diet data were analysed from parents and offspring from the Princeton Lipid Research Study (24-h recall in the 1970s; Block FFQ in 1998). Diet quality was assessed using an 8-point Dietary Approaches to Stop Hypertension nutrient-based scoring index, including a new method for scoring in children, as well as examining twelve key macro/micronutrients. Outcomes included blood glucose, blood pressure, serum lipids and BMI. The analysis included 221 parents (39 % male, mean age 38·9 ± 6·5 at baseline and 66·6 ± 6·6 at follow-up) and 606 offspring (45 % male, 11·9 ± 3·2 at baseline and 38·5 ± 3·6 at follow-up). Parents' Dietary Approaches to Stop Hypertension score increased slightly from baseline to follow-up (1·4 ± 1·0 and 2·1 ± 1·3, respectively, P < 0·001), while offspring remained consistent (1·6 ± 0·9 and 1·6 ± 1·1, respectively, P = 0·58). Overall, the Dietary Approaches to Stop Hypertension score, adjusted for age, race, sex and BMI, was not significantly associated with any examined outcomes. Of the macro/micronutrients at follow-up, saturated and total fat were associated with increased diabetes and dyslipidaemia in parents, while the inverse was seen with niacin. Among offspring, niacin was associated with lower rates of hypertension and dyslipidaemia. In conclusion, no relationship was detected between Dietary Approaches to Stop Hypertension adherence and disease outcomes. However, both saturated fat and niacin were associated with components of CVD risk, highlighting the need for improved diet quality overall.

Multidisciplinary study of the health and nutritional status of persons living in households at risk of poverty with children in Germany (MEGA_kids): Study design and methods

Background: In Germany, the nutritional situation of adults and children living in households at risk of poverty has been insufficiently studied so far. Aim: The aim of the mixed-methods study MEGA_kids is to gain a deeper understanding of the nutritional situation including socioeconomic, behavioral, and attitudinal factors and health characteristics among persons living in families at risk of poverty. Method: MEGA_kids is a mixed-methods cross-sectional study consisting of four modules combining quantitative and qualitative methods. The first module (A) applies self-administered questionnaires to assess the individual's diet, household food insecurity, and several other factors among adults and children of 500 households. Cash receipts are used to assess household's food expenses. For the second module (B), a semistructured interview guide is used to identify factors influencing food security and nutritional quality from the perspective of a subsample of module A (n = 20). The third module (C) applies the participatory World Café technique to explore experiences and generate ideas for tailored support measures for a healthy diet from the perspective of 40 parents participating in module A. Finally, the fourth module (D) investigates the knowledge and usage of existing nutrition-related preventive measures among 200 parents at risk of poverty by using an online questionnaire. Conclusion: By providing a comprehensive picture of nutritional aspects of families living at risk of poverty, MEGA_kids will guide officials to target and prioritize public health nutrition measures, inform policy makers to implement and improve healthy policies and, finally, identify research gaps to be prioritized.

Mapping the existing evidence of the effects of school food policies on health, acceptance and affordability of secondary school children in Europe: a scoping review protocol

INTRODUCTION

Unhealthy diets pose a significant public health risk among European children, contributing to the increasing prevalence of overweight and non-communicable diseases. Children spend a substantial amount of time at school daily, including lunchtime, so the school setting becomes crucial for promoting healthy diets and lifestyle habits. While there is a large body of literature on the impact of school food policies on health and non-health outcomes, it is essential to identify which policies are effective and can be recommended for implementation to ensure the efficient use of resources. This article presents a protocol for a scoping review that aims to map the current published literature on the effects of school food policies on health outcomes, acceptance and affordability in secondary school children in Europe. Moreover, the scoping review will map the measurements used to assess health outcomes, acceptance and affordability.

METHODS AND ANALYSIS

The scoping review protocol and review follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. To identify eligible studies, we will search MEDLINE, PsycINFO, CINAHL and Web of Science. The reference lists of the included articles will be checked for additional studies. In addition, country-specific ministry reports from Member States of the European Union, the UK, Norway, Iceland and Switzerland will be identified. The WHO and European Commission websites will also be searched for relevant reports. The scoping review will include literature published until 20 September 2023. No restrictions to study design and language will be applied. Screening and data extraction will be carried out independently by three reviewers. Disagreements will be resolved by discussion. A pretested data charting table will be used to extract key information. Findings will be presented in tabular and visualised summaries and a narrative summary.

ETHICS AND DISSEMINATION

This scoping review does not require ethical approval. Our dissemination strategy comprises peer-reviewed publications, conference presentations and recommendations to policy-makers.

Changes in urinary metabolomic profile show the effectiveness of a nutritional intervention in children 6-12 years old: The ALINFA study

Diet plays an essential role in health and disease. Therefore, its determination is an important component of many investigations. The aim of the study was to evaluate the effect of a nutritional intervention on the urinary metabolome in children aged 6-12 years. Also, it was intended to identify biomarkers of diet quality and dietary intake. A 2-month, randomized, controlled, parallel trial was conducted in Spanish children. The analyses focused on the ALINFA group, which followed a full-fixed meal plan including healthy products, ready-to-eat meals, and healthy recipes. Diet quality was assessed by the KIDMED index and dietary intake by a food frequency questionnaire. Untargeted metabolomic analysis on urine samples was carried out, and multivariate analyses were performed for pattern recognition and characteristic metabolite identification. PLS-DA and Volcano plot analyses were performed to identify the discriminating metabolites of this group. 12 putative metabolites were found to be the most relevant to this intervention. Most of them were products derived from protein and amino acid metabolism (N-Ribosylhistidine, indolacrylic acid, and peptides) and lipid metabolism (3-oxo-2-pentylcyclopentane-1-hexanoic acid methyl, Suberoyl-L-carnitine, and 7-Dehydrodichapetalin E). All these metabolites decreased after the intervention, which was mainly associated with a decrease in the consumption of fatty meat and total fat, especially saturated fat. In turn, N-Ribosylhistidine and Suberoyl-L-carnitine were negatively associated with diet quality, as well as able to predict the change in KIDMED index. In conclusion, the changes observed in urinary metabolome demonstrate the effectiveness of the ALINFA nutritional intervention.

"How difficult it is to change dietary behaviour" experience of older people with sarcopenic obesity: a qualitative study

BACKGROUND

Dietary intervention is an important method to manage sarcopenic obesity, but the implementation in real world is difficult to achieve an ideal condition. This study aimed to the experiences of older people with sarcopenic obesity during the implementation of dietary behavioural change (DBC) intervention.

METHODS

This study is a semi-structured individual interview embedded within a pilot randomized controlled trial on community-dwelling older people with sarcopenic obesity. Purposive sampling was applied to invite 21 participants who had received a 15-week DBC intervention. The interviews were audio-recorded and transcribed verbatim. Content analysis was performed to analyze the data.

RESULTS

The themes for facilitators included: (a) Attach importance to self's health; (b) Family's support; (c) Concern self's body shape; (d) Instructor's support; (e) Regular food diary taken. The themes for barriers included: (a) Difficulties of taking food diary; (b) Difficulties of calculating the food amount; (c) Yield to offspring's appetite; (d) Misjudging self's or family's appetite.

CONCLUSION

Support from family members and instructor, caring about self's health and body image facilitated the intervention implementation. The complication of food amount estimation and diary record, personal sacrifice for next generations, and previous living experience were barriers for implementing the intervention. Overall, the older people with sarcopenic obesity can accept the design of DBC intervention program and have great willing to join.

"O meu coração bate saudável" - Results from a pilot project for health education in Portuguese children

INTRODUCTION AND OBJECTIVES

Childhood offers an excellent window of opportunity to start interventions to promote behavioral changes before unhealthy lifestyles become established, leading to cardiovascular diseases. The goal of this pilot educational project for children is the promotion of healthy lifestyles and cardiovascular health.

METHODS

This project was implemented in 4th grade children and included teacher-led classroom activities, a lesson given by a cardiologist and a practical lesson with dietitians. The teacher received a manual containing information on the topics to be discussed in class with the pupils and the children received a book that addresses cardiovascular risk factors and prevention. The components included were diet (D), physical activity (PA) and human body and heart awareness (BH). At the beginning and at the end of the schoolyear, a questionnaire was applied to the children to assess knowledge (K), attitudes (A) and habits (H) on these topics.

RESULTS

A total of 73 children from two schools from an urban district public school in Lisbon, in a low to medium income area, participated in the project. Following the intervention, there was a 9.5% increase in the overall KAH score, mainly driven by the PA component (14.5%) followed by the BH component (12.3%). No improvement was observed for component D. The benefits were also more significant in children from a lower income area, suggesting that socioeconomic status is a determinant in the response obtained.

CONCLUSIONS

An educational project for cardiovascular health can be implemented successfully in children aged 9 years, but longer and larger studies are necessary.

The relationship between height and fruit/vegetable intakes in adults: A nationwide cross-sectional study

Background: Worldwide, fruit and vegetable intake is below recommendations. There is increasing evidence to suggest an association between height and diet. Aim: to analyse the associations of fruit and vegetable intake with attained height in Portuguese adults. Methods: A representative sample of 17 480 Portuguese adults (56.7% women) participated in this cross-sectional study. The survey comprised sociodemographic characteristics and self-reported height and weight. We performed regression models to assess the associations between height and fruit and vegetable consumption. Results: Compared with no intakes, those men with higher fruit and vegetables intake had 0.54 cm (95% CI 0.04; 1.04) greater height. Also, women with higher intakes of vegetables, fruit and vegetables combined were directly associated with a greater height of 0.29 cm (95% CI 0.03; 0.56 in vegetables) and 0.51 cm (95% CI 0.09; 0.93 in fruit and vegetables combined). Conclusion: Greater consumption of fruit and vegetables was directly associated with higher height in adults. From a health promotion perspective, intervention programmes aiming at improving fruit and vegetable intake should be highlighted so that full height potential is achieved.

Longitudinal tracking of diet quality from childhood to adolescence: The Interplay of individual and sociodemographic factors

This study aimed to examine diet tracking from childhood to adolescence, using 4 time-points, and the influence of socioeconomic and individual characteristics in this transition. The sample included 6893 children from the Portuguese birth cohort Generation XXI with complete information on Food Frequency Questionnaire in at least one of the considered follow-ups. A Healthy Eating Index (HEI), previously developed to assess adherence to WHO's dietary recommendations, was applied at all ages (4, 7, 10 and 13y). The intraclass correlation coefficient (ICC) was used to analyse the tracking of diet quality. Linear mixed-effect models were performed to estimate the association of the child's socioeconomic and individual characteristics with the HEI score and respective trajectories over time. The overall diet quality decreased from childhood (22.2 ± 3.6 at 4y) to adolescence (18.2 ± 3.9 at 13y), with moderate tracking (ICC = 0.53), showing that children who start a healthy diet earlier might have a better diet quality as time goes by. Children of older mothers (β = 0.079, 95%CI = 0.061-0.097) and with higher education (β = 0.203, 95%CI = 0.178-0.229) and a higher household monthly income (β = 0.024,95%CI = 0.007-0.041) had a higher diet quality over time. Besides family characteristics, the child's sedentary activities (β = -0.009, 95%CI = -0.014--0.003) negatively influence diet quality throughout life. In contrast, being a girl (β = -0.094, 95%CI = -0.132--0.056) and having higher sleep duration (β = 0.039, 95%CI = 0.015-0.064) are associated with a higher diet quality over time. The presence of dietary tracking from childhood to adolescence implies that promoting healthy eating habits during the first years of life is crucial for a healthier diet quality during late childhood and early adolescence, focusing on maternal and individual child characteristics.

Ultraprocessed Food Consumption and Cardiometabolic Risk Factors in Children

IMPORTANCE

High intake of ultraprocessed foods (UPFs) has been associated with higher cardiometabolic risk in adults; however, the evidence in children is limited.

OBJECTIVE

To investigate the association between UPF consumption and cardiometabolic risk factors in the Childhood Obesity Risk Assessment Longitudinal Study (CORALS).

DESIGN, SETTING, AND PARTICIPANTS

This baseline cross-sectional analysis was conducted using the data of CORALS participants recruited between March 22, 2019, and June 30, 2022. Preschool children (aged 3-6 years) were recruited from schools and centers in 7 cities in Spain. Inclusion criteria included informed consent signed by parents or caregivers and having a completed a set of questionnaires about the child's prenatal history at home. Exclusion criteria included low command of Spanish or unstable residence.

EXPOSURE

Energy-adjusted UPF consumption (in grams per day) from food frequency questionnaires and based on the NOVA food classification system.

MAIN OUTCOMES AND MEASURES

Age- and sex-specific z scores of adiposity parameters (body mass index [BMI], fat mass index, waist-to-height ratio, and waist circumference) and cardiometabolic parameters (diastolic and systolic blood pressure, fasting plasma glucose, homeostasis model assessment for insulin resistance, high-density and low-density lipoprotein cholesterol, and triglycerides) were estimated using linear regression models.

RESULTS

Of 1509 enrolled CORALS participants, 1426 (mean [SD] age, 5.8 [1.1] years; 698 boys [49.0%]) were included in this study. Mothers of children with high UPF consumption were younger, had a higher BMI, were more likely to have overweight or obesity, and had lower education levels and employment rates. Compared with participants in the lowest tertile of energy-adjusted UPF consumption, those in the highest tertile showed higher z scores of BMI (β coefficient, 0.20; 95% CI, 0.05-0.35), waist circumference (β coefficient, 0.20; 95% CI, 0.05-0.35), fat mass index (β coefficient, 0.17; 95% CI, 0.00-0.32), and fasting plasma glucose (β coefficient, 0.22; 95% CI, 0.06-0.37) and lower z scores for HDL cholesterol (β coefficient, -0.19; 95% CI, -0.36 to -0.02). One-SD increments in energy-adjusted UPF consumption were associated with higher z scores for BMI (β coefficient, 0.11; 95% CI, 0.05-0.17), waist circumference (β coefficient, 0.09; 95% CI, 0.02-0.15), fat mass index (β coefficient, 0.11; 95% CI, 0.04-1.18), and fasting plasma glucose (β coefficient, 0.10; 95% CI, 0.03-0.17) and lower HDL cholesterol (β coefficient, -0.07; 95% CI, -0.15 to -0.00). Substituting 100 g of UPFs with 100 g of unprocessed or minimally processed foods was associated with lower z scores of BMI (β coefficient, -0.03; 95% CI, -0.06 to -0.01), fat mass index (β coefficient, -0.03; 95% CI, -0.06 to 0.00), and fasting plasma glucose (β coefficient, -0.04; 95% CI, -0.07 to -0.01).

CONCLUSIONS AND RELEVANCE

These findings suggest that high UPF consumption in young children is associated with adiposity and other cardiometabolic risk factors, highlighting the need for public health initiatives to promote the replacement of UPFs with unprocessed or minimally processed foods.

Benefits and Difficulties of Implementing Family-Farming Food Purchases in the Brazilian National School Feeding Program

Objectives: To explore the opinions of Brazilian National School Feeding Program (NSFP) nutritionists concerning the benefits and difficulties of implementing family-farming food purchases for the school feeding program. Methods: Exploratory and descriptive qualitative study conducted through the analysis of inductive content of open interviews carried out with technically responsible nutritionists of the School Feeding Program of 21 municipalities in Southern Brazil. Results: The qualitative analysis of the interviews resulted in 17 codes grouped into four categories that show the opinion of nutritionists on the benefits and difficulties of purchasing family-farming food: 1. increasing the visibility of rural areas and 2. improving the quality of food provided in school meals; 3. low product availability and 4. limited infrastructure for production and delivery. Conclusion: According to nutritionists, purchasing family-farming food in NSFP can increase the supply of healthy food in schools and stimulate rural development. However, efforts are needed to adjust institutional food demands for local food production and improve infrastructure for food production and distribution.

Child-eating behaviour as predictor of anthropometric status of preschool children aged 2-4 years in Umuahia South LGA Abia State, Nigeria

INTRODUCTION AND OBJECTIVE

Eating behaviour at the childhood level plays a vital role in the outcome of the nutritional status and the overall health of an individual. The study was focused on the association between anthropometric status and child eating behaviour.

METHODOLOGY

A community-based cross-sectional survey purposively enrolled consenting participants from 256 households with preschool children aged 2-4 years. The parents/legal guardians were interviewed on the eating behaviour of their children using a validated semi-structured child-eating behaviour scale, and anthropometric measurement of the children were taken. WHO Anthro-software for child growth standards was used to categorize anthropometric status of the preschool children. Paired sample t-test was performed to compare child-eating behaviour by gender, while regression and correlation analysis was performed to determine the extent to which child-eating behaviour predicted anthropometric status at 5% level of significance.

RESULTS

Mean comparison of child eating behaviour by gender showed significant difference (P < 0.05) between male and female children in their eating behaviour with respect to enjoyment of food and satiety responsiveness. Some of the children were wasted (26.6%), stunted (20.7%) and underweight (16.4%). A significant association (P < 0.05) was observed between body mass index-for-age and food fussiness behaviour of the children. There was also a significant difference (P < 0.05) between weight-for-age and food fussiness behaviour of the children.

CONCLUSION

The study showed that child eating behaviour may have contributed to the anthropometric status of the children, however, differences in their eating behaviours by gender was observed.

Factors Associated with Daily Fruit and Vegetable Intakes among Children Aged 1-5 Years in the United States

To describe child, caregiver, and household characteristics associated with fruit and vegetable intakes among US children aged 1-5 years, we examined fruit and vegetable intakes (less than daily vs. daily) using data from the 2021 National Survey of Children's Health among children aged 1-5 years. Multiple logistic regression provided adjusted odds ratios for factors associated with (1) daily fruit and (2) daily vegetable intakes. Among children aged 1-5 years, 68% (n = 11,124) consumed fruit daily, and 51% (n = 8292) consumed vegetables daily. Both daily fruit and daily vegetable intake were associated with child age, child race and ethnicity, and frequency of family meals. For example, children who ate a family meal 4-6 days/week (aOR 0.69; 95% CI 0.57, 0.83) or 0-3 days/week (aOR 0.57; 95% CI 0.46, 0.72) were less likely to consume fruit daily compared to children who had a family meal every day. Participation in food assistance programs, food insufficiency, and household income were not significantly associated with odds of daily fruit or daily vegetable intake in the adjusted models. Several factors were associated with daily fruit and vegetable intake among children aged 1-5. Strategies aimed at increasing fruit and vegetable consumption in early childhood may consider these child, caregiver, and household characteristics. Pediatric healthcare providers, early childhood education centers, and families of young children may be important partners in this work.

Food consumption and nutrient intake of Finnish preschool children according to parental educational level

We examined the association between parental educational level (PEL) and children's food consumption and nutrient intake in a sample of Finnish 3- to 6-year-old preschoolers (n 811). The data were obtained from the cross-sectional DAGIS project, conducted in eight municipalities in Finland during 2015-2016. The food consumption and nutrient intake were assessed using food records. The highest educational level of the family was used as the indicator of socio-economic status. Differences in diet by PEL were analysed using a hierarchical linear model adjusted for energy intake. Compared with high PEL, low PEL was associated with a child's lower consumption of fresh vegetables and salads, vegetarian dishes, berries, white bread, blended spread, skimmed milk and ice cream but higher consumption of milk with 1-1·5 % fat content, dairy-based desserts and sugar-sweetened soft drinks. Food consumption was also examined after disaggregating dishes into their ingredients. Low PEL was associated with lower consumption of vegetables, nuts and seeds, berries and fish but higher consumption of red meat. Children in the low PEL, compared with the high PEL group, had a lower intake of protein, fibre, EPA, DHA, vitamin D, riboflavin, vitamin B6, folate, vitamin B12, vitamin C, potassium, phosphorous, Ca, Mg, Zn and iodine but a higher intake of fat and saturated, trans and MUFA. The observed diet-related disparities highlight the need for policy actions and interventions supporting healthy eating patterns such as high consumption of vegetables, nuts and berries in childhood, paying special attention to those with low PEL.

Child characteristic correlates of food rejection in preschool children: A narrative review

Dietary habits formed in early childhood are key for establishing a healthy diet later in life. Picky eating and food neophobia - the two main forms of food rejection in young children - form an important barricade to establishing such healthy habits. Understanding these types of food rejection is thus essential for promoting healthy eating behaviour in both children and adults. To this end, the present narrative review aims to provide an overview of food rejection research in preschool-aged children, focusing on recent advances in the cognitive literature. Specifically, we evaluate the link between children's cognitive development, chemosensory perception and affective evaluation of food, food knowledge, decision-making strategies, anxiety and disgust sensitivity, and food rejection behaviour. Longitudinal and experimental studies are necessary to establish how the relationships between food rejection and cognitive processes develop over time and to determine their causal directions.

Perspective: The Benefits of Including Flavored Milk in Healthy Dietary Patterns

The Dietary Guidelines for Americans recommend two-and-a-half cup equivalents of low-fat and fat-free dairy foods per day for children 4-8 y and 3 cup equivalents per day for adolescents aged 9-18 and adults. Currently, the Dietary Guidelines for Americans recognizes 4 nutrients as being of public concern because of suboptimal levels in the diet. These include calcium, dietary fiber, potassium, and vitamin D. In the American diet, dairy foods are leading contributors of calcium, vitamin D, and potassium. Milk, because of its unique nutrient package that provides shortfall nutrients to the diets of children and adolescents, remains an underpinning of dietary recommendations and is included with school meals. Despite this, milk consumption is declining, and >80% of Americans do not meet recommendations for dairy. Data indicate that children and adolescents who consume flavored milk are more likely to consume more dairy and adhere to healthier overall dietary patterns. Flavored milk, however, receives more scrutiny than plain milk because of its contribution of added sugar and calories to the diet and concerns over childhood obesity. Therefore, the purpose of this narrative review is to describe trends in beverage consumption in children and adolescents aged 5-18 y and highlight the science that has examined the impact of including flavored milk in overall healthy dietary patterns within this population.

Affect, Body, and Eating Habits in Children: A Systematic Review

The present review investigates the complex associations between children's affective states, body perceptions, and eating habits, thus providing crucial insights for potential health interventions. Following PRISMA guidelines, three databases were searched for peer-reviewed studies exploring the relationship between eating habits, emotional states, and body image perceptions in a population of children (5 to 11 years old). A total of seven articles were included. Our findings revealed a pattern of associations between negative emotional states, like anxiety and depressive feelings, and maladaptive eating behaviors. Additionally, explicit influences from parental feeding practices, peer pressure, socioeconomic factors, and children's body perceptions were observed to shape eating habits, with a pronounced tendency among older girls towards dieting and food preoccupation. Our results underline the intertwining nature of age, gender, and emotional states. Furthermore, our findings accentuate the urgency for comprehensive interventions that acknowledge and address the complex interplay of emotional, familial, and socioeconomic factors alongside children's body image perceptions. The criticality of continued research, particularly ones employing longitudinal designs and diverse demographic samples, is highlighted as we strive to understand and navigate such multifaceted relationships to enhance children's health and well-being.

Eating behaviour, quality of life and cardiovascular risk in obese and overweight children and adolescents: a cross-sectional study

BACKGROUND

Childhood obesity is a major cardiovascular risk factor because it predisposes individuals to comorbidities that are implicated in an increased risk of cardiovascular events. Its origin may be related to poor eating habits, such as the intake of foods of low nutritional value or inadequate eating behaviours related to emotional factors. This work aims to evaluate the relationship between the total body mass of children and adolescents and its association with eating habits, quality of life (QoL), and possible changes in early markers of cardiovascular risk.

METHODS

This was a cross-sectional observational study that evaluated anthropometric and cardiovascular parameters, QoL, and eating behaviour in 181 children and adolescents aged between 5 and 13 years. Participants were stratified according to BMI/age into three groups (Adequate Weight, Overweight, and Obesity). Anthropometry included weight, height, waist and hip circumferences, waist-hip ratio, and waist-height ratio. QoL was assessed using the Peds-QL 4.0 questionnaire, and eating behaviour was assessed using the Children's Eating Behaviour Questionnaire (CEBQ). Cardiovascular parameters were assessed using the Mobil-O-Graph® device, which measures the pulse wave velocity (PWV) and augmentation index (AIx@75) to estimate arterial stiffness (AS), which is considered an early marker of cardiovascular disease.

RESULTS

In addition to the increase in anthropometric measurements (p < 0.001), the Obesity group exhibited behaviour related to food intake (p < 0.05). When analysing QoL, a worsening in the social domain was also observed in the Obesity group (p < 0.05). However, PWV and AIx@75 did not differ between groups.

CONCLUSIONS

Eating behaviour is related to the development of childhood obesity. However, early markers of cardiovascular risk related to AS did not change as a function of total body mass in the children evaluated.

The ALINFA Intervention Improves Diet Quality and Nutritional Status in Children 6 to 12 Years Old

The study aimed to evaluate the efficacy of a new nutritional intervention, focused on improving the quality of the diet in children aged 6 to 12 years. A 2-month parallel, controlled randomized trial was conducted in the Spanish child population. The children were randomized to ALINFA nutritional intervention, which consisted of a normocaloric diet that incorporates products, ready-to-eat meals and healthy recipes specifically designed for the study, or a control group, which received the usual advice on healthy eating. The change in diet quality was assessed through the Kidmed index. The secondary outcomes were anthropometry, glucose and lipid profiles, inflammation markers, dietary intake and lifestyle. The participants in the intervention group showed an increase in the mean score of the Kidmed index (p < 0.001). Alongside that, these children decreased their intake of calories (p = 0.046), and total and saturated fat (p = 0.016//p = 0.011), and increased fiber intake (p < 0.001). Likewise, the children in the ALINFA group increased the intake of white fish (p = 0.001), pulses (p = 0.004), whole grains (p < 0.001) and nuts (p < 0.001), and decreased fatty meat (p = 0.014), refined grain (p = 0.008), pastry (p < 0.001), fast food (p < 0.001) and sugar (p = 0.001) intake. Moreover, these children had a significantly decreased BMI (p < 0.001), BMI z-score (p < 0.001), waist circumference (p = 0.016) and fat mass (p = 0.011), as well as leptin (p = 0.004). Participants in the control group did not report significant changes in diet quality. In conclusion, ALINFA nutritional intervention is possibly a useful strategy to increase the diet quality in children, which is associated to improvements in the nutritional status. These results highlight the importance of developing well-designed nutritional interventions.

Adaptation of the Food Literacy Questionnaire for school children to Turkish: validity and reliability study

Food literacy is the ability to understand the nature of food and its level of importance, to obtain, process, analyze, and use information about food. This study aims to translate and cross-culturally adapt the Food Literacy Questionnaire for school children (FLQ-sc) into Turkish and to study its psychometric properties of reliability and validity. The study was conducted with 303 students aged 12-14 in Kayseri, Turkey. A pilot study was conducted with 36 students, and a test-retest was conducted with 219 students, 2 weeks after the first study was performed. Data were collected with the sociodemographic data form and FLQ-sc. Linguistic, content, face, and construct validity were evaluated for validity. Cronbach's alpha and intraclass correlation coefficients (ICCs) were calculated for the reliability evaluation. Model validity was tested with confirmatory factor analysis. Root mean square error of approximation (RMSEA), χ2/SD, and goodness-of-fit index (GFI) statistics were in good agreement. Comparative fit index (CFI), Tucker-Lewis index (TLI), and standardized root mean square error of approximation (SRMR) statistics were at acceptable levels (RMSEA = 0.033, χ2/SD = 1.324, GFI = 0.958, CFI = 0.944, TLI = 0.939, SRMR = 0.063). The Cronbach's alpha coefficient for the total scale score was quite good (0.795). The ICC for test-retest reliability was good (0.874) for the total scale score.  Conclusion: The Turkish version of the Food Literacy Questionnaire for school children (FLQ-sc) is a valid and reliable measurement tool and can be used to evaluate food literacy levels in Turkish children aged 12-14. What is Known: • It is important to acquire knowledge and skills in food literacy from childhood because the behaviors learned during childhood and adolescence regarding food intake and preparation continue into adulthood. • In addition to the limited scales evaluating the food literacy levels of children, there is no scale evaluating the food literacy levels of Turkish children between the ages of 12 and 14. What is New: • The Turkish version of FLQ-sc is a valid and reliable scale for evaluating the food literacy levels of Turkish school children. • Scale is a suitable tool to ensure the comparison of food literacy levels in different student groups and measure abstract concepts such as education.

Diet quality of preparatory school students in Awi Zone, Ethiopia: a cross-sectional study

OBJECTIVE

The study aimed to assess diet quality and associated factors among preparatory school students in Awi Zone, Ethiopia.

DESIGN

A school-based cross-sectional study design was used in this study.

SETTING

The study was carried out in Awi Zone, Amhara Region, Ethiopia.

PARTICIPANTS

A total of 834 preparatory school students participated in the study.

OUTCOME MEASURES

Diet quality was the outcome variable, and it was computed using the dietary diversity score, food variety score and consumption of animal-source foods. Students with high dietary diversity scores, appropriate animal-source food consumption and adequate food variety scores were labelled as having good-quality diets. Data were collected using a pretested structured self-administered questionnaire. Bivariate and multivariable logistic regressions were employed to analyse the data. Variables with p≤0.2 in the bivariate logistic regression analysis were included in the multivariable logistic regression model. Multivariable logistic regression analysis was done to determine the strength of the association. Statistical significance was determined at p value less than 0.05.

RESULTS

Only 24.7% (95% CI: 21.7%, 27.7%) of preparatory school students had good-quality diets. Being female (adjusted OR (AOR)=2.88, 95% CI: 2.0, 4.1), residing in an urban setting (AOR=1.90, 95% CI: 1.1, 3.2), having an educated mother (AOR=1.78, 95% CI: 1.1, 2.7), having pocket money (AOR=1.83, 95% CI: 1.2, 2.6) and nutrition information (AOR=1.90, 95% CI: 1.2, 3.1), and family monthly income >8000 Ethiopian birrs (AOR=3.90, 95% CI: 2.2, 7.1) were factors significantly associated with having good-quality diet.

CONCLUSION

The majority of the preparatory school students had poor-quality diets. These findings highlight the necessity of nutrition education that considers the sociodemographic characteristics of the students and their families. Implementing income-generating interventions for low-income households was also recommended by the findings.

Children's and adolescents' rising animal-source food intakes in 1990-2018 were impacted by age, region, parental education and urbanicity

Animal-source foods (ASF) provide nutrition for children and adolescents' physical and cognitive development. Here, we use data from the Global Dietary Database and Bayesian hierarchical models to quantify global, regional and national ASF intakes between 1990 and 2018 by age group across 185 countries, representing 93% of the world's child population. Mean ASF intake was 1.9 servings per day, representing 16% of children consuming at least three daily servings. Intake was similar between boys and girls, but higher among urban children with educated parents. Consumption varied by age from 0.6 at <1 year to 2.5 servings per day at 15-19 years. Between 1990 and 2018, mean ASF intake increased by 0.5 servings per week, with increases in all regions except sub-Saharan Africa. In 2018, total ASF consumption was highest in Russia, Brazil, Mexico and Turkey, and lowest in Uganda, India, Kenya and Bangladesh. These findings can inform policy to address malnutrition through targeted ASF consumption programmes.

Peers' parental education and cardiovascular disease risk in adulthood: The mediating role of health-related behaviors

RATIONALE

Although there is a growing body of empirical evidence on the relationship between peers' parental education and adolescents' educational outcomes, little is known about whether exposure to highly educated peers' parents is associated with improved physical health in adulthood.

OBJECTIVE

This study investigated the relationship between the education level of peers' parents (Wave I) and the risk of developing cardiovascular disease (CVD) in adulthood (Wave IV). Moreover, we considered a set of health-related behaviors (Wave II) as the underlying mechanisms linking peers' parental education to later-life physical health such as substance use (smoking, binge drinking, and marijuana use) and other lifestyle behaviors (physical activity, sedentary behavior, and unhealthy dietary habits).

METHODS

Data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), spanning respondents' adolescence to adulthood, were used. To address the endogenous school selection problem and account for the unobserved school-level confounders, this study exploited quasi-experimental within-school/across-cohort variation in peer composition. To formally test for mediation, Sobel tests were conducted.

RESULTS

The results of this study revealed that independent of own parents' education levels, exposure to higher levels of peers' parental education is associated with a lower CVD risk score in adulthood. For a one-standard-deviation increase in peers' parental education-that is, about a 0.98-year increase in grademates' parental educational attainment, a CVD risk in adulthood increased by about 6.2%. Our mediation analyses showed that part of this association is explained by a decrease in substance use (27% for smoking, 10% for binge drinking, and 11% for marijuana use). In contrast, none of the other lifestyle behaviors evaluated significantly mediated the association.

CONCLUSION

The study's findings suggest that the role of peers' parents should not be overlooked when developing health-promoting interventions for adolescents. Policymakers and practitioners may wish to increase opportunities for students to benefit from health-related social learning from their peers' highly educated parents.

Effect of Mid-Adolescent Dietary Practices on Eating Behaviors and Attitudes in Adulthood

This paper aimed to clarify the association of mid-adolescent dietary practices and experiences with adult eating behavior and attitudes using individual data from the "Survey of Attitudes toward Shokuiku (food and nutrition education), 2019" put forth by the Ministry of Agriculture, Forestry and Fisheries of Japan. We applied conditional mixed-process models to estimate the parameters simultaneously, and used them to predict current eating consciousness, current eating behaviors in a balanced diet, dietary behavior, and attitudes toward preventing or improving lifestyle-related diseases as dependent variables. As a result, compared to those who did not have good dietary practices and experiences in mid-adolescence, participants who had good dietary practices and experiences in the same period displayed greater interest in practicing a healthier diet. These participants frequently consumed a combination of staple foods, main dishes, and side dishes, and were more concerned about preventing or improving lifestyle-related diseases. In conclusion, mid-adolescent dietary practices and experiences had a lasting influence on adult eating behaviors and attitudes in Japanese participants.

The efficacy of a multi-strategy choice architecture intervention on improving the nutritional quality of high school students’ lunch purchases from online canteens (Click & Crunch High Schools): a cluster randomized controlled trial

Background

High school canteens are an ideal setting for public health nutrition intervention, and choice architecture strategies that facilitate the purchase of healthier foods and beverages from school canteens are recommended by the World Health Organization. The rapid uptake of online lunch ordering within school canteens provides a unique opportunity to implement choice architecture strategies that support healthier food choices with high fidelity. Despite this, no trial has tested the efficacy of choice architecture strategies within an online lunch ordering system on improving the nutritional quality of high school student lunch purchases. The objective of this study was to assess the impact of embedding choice architecture strategies into an online lunch ordering system on the nutritional quality of the school canteen lunch purchases of high school students (aged 12–19 years).

Methods

A cluster randomized controlled trial was conducted with nine high schools in one Australian state. Schools were randomized to receive either a 2-month choice architecture intervention (involving menu labelling, prompts, item positioning, and feedback), or usual online ordering. Nutrient quality of online canteen lunch purchases was assessed using routine data collected by the online ordering system. Primary outcomes were the proportion of ‘Everyday’, ‘Occasional’, and ‘Should not be sold’ items purchased, categorized using the state healthy canteen policy. Secondary outcomes were the mean energy, saturated fat, sugar, and sodium content of purchases and the mean weekly revenue from online lunch orders. Linear mixed models were analyzed to assess outcomes.

Results

Analysis of the student cohort (Intervention: 4 schools, 656 students; Control: 5 schools, 675 students) showed significant between group differences over time for the intervention group for the mean percentage of online lunch items per student that were ‘Everyday’ (+ 5.5%; P < 0.001) and ‘Should not be sold’ (− 4.4%; P < 0.001). There were no between group differences over time in the mean percentage of online lunch items that were ‘Occasional’; the average energy, saturated fat, sugar, or sodium content of lunch orders. There was also no difference in mean weekly revenue from high school student online lunch orders (P = 0.23).

Conclusions

These findings suggest that a low intensity, choice architecture intervention embedded within an online ordering system can increase the purchase of healthier food items for high school students in one Australian state without any adverse impact on canteen revenue.

Trial registration

This trial was prospectively registered on Open Science Framework on 23rd October 2020 as osf.io/h8zfr.

Global dietary quality in 185 countries from 1990 to 2018 show wide differences by nation, age, education, and urbanicity

Evidence on what people eat globally is limited in scope and rigour, especially as it relates to children and adolescents. This impairs target setting and investment in evidence-based actions to support healthy sustainable diets. Here we quantified global, regional and national dietary patterns among children and adults, by age group, sex, education and urbanicity, across 185 countries between 1990 and 2018, on the basis of data from the Global Dietary Database project. Our primary measure was the Alternative Healthy Eating Index, a validated score of diet quality; Dietary Approaches to Stop Hypertension and Mediterranean Diet Score patterns were secondarily assessed. Dietary quality is generally modest worldwide. In 2018, the mean global Alternative Healthy Eating Index score was 40.3, ranging from 0 (least healthy) to 100 (most healthy), with regional means ranging from 30.3 in Latin America and the Caribbean to 45.7 in South Asia. Scores among children versus adults were generally similar across regions, except in Central/Eastern Europe and Central Asia, high-income countries, and the Middle East and Northern Africa, where children had lower diet quality. Globally, diet quality scores were higher among women versus men, and more versus less educated individuals. Diet quality increased modestly between 1990 and 2018 globally and in all world regions except in South Asia and Sub-Saharan Africa, where it did not improve.

Development of a conceptual framework of food and nutrition literacy in children

BACKGROUND

This study aimed to develop a conceptual framework to better understand food and nutrition literacy and its dimensions and components among Iranian children.

METHODS

The study included three sub-studies. First, two qualitative studies were conducted to explore experts' and students' perspectives and experiences regarding the topic. A comprehensive qualitative literature review was then conducted to identify food/nutrition literacy definitions and its components in the relevant literature. The data of the above three sub-studies were compiled as text data and were analyzed utilizing MAXQDA₂₀₁₀ software.

RESULTS

Two main domains, including cognitive and skill domains, emerged from the data analysis. The cognitive domain consisted of food- and nutrition-related knowledge included four subcategories "nutrition knowledge", "lifestyle knowledge", "food safety knowledge", and "knowledge of food and its preparation") as well as "food and nutrition understanding". The skill domain consisted of three dimensions: "functional", "interactive", and "critical" food and nutrition literacy.

CONCLUSIONS

The developed framework highlights the importance of integrated application of all dimensions of food and nutrition literacy among this population group. It can assist policymakers and curriculum developers in assessing education curricula and developing effective strategies for teaching and learning to increase students' food and nutrition literacy.

School Fruit and Vegetables Scheme: Characteristics of Its Implementation in the European Union from 2009/10 to 2016/17

The “School Fruit and Vegetables Scheme” (SFVS) was proposed in 2009/10 as a strategy to support the consumption of Fruit and Vegetables (FV), decrease rates of obesity, improve agricultural income, stabilize markets, and ensure the current and future supply of these foods. However, there is little information about how it was carried out in the EU. Given the potential of the SFVS to support healthier, more sustainable food systems, the objective of this study was to identify the characteristics of SFVS implementation from 2009/10 to 2016/17 in the EU. A longitudinal, observational, and retrospective study was carried out based on secondary data. A total of 186 annual reports of the Member States (MS) participating in the SFVS from 2009/10 to 2016/17 were consulted: European and national budget, funds used from the EU, participating schools and students, duration of the SFVS, FV offered, and application of sustainability criteria, expenditure per student, days of the week, the quantity of FV offered per student and other indicators were calculated. The majority of MS participated in the SFVS during the study period with a heterogeneous implementation pattern in terms of funds used, coverage, duration, quantity (totals and by portion), and cost of FV distributed per student. The sustainability criteria for the FV distribution were also not applied uniformly in all the MS. Establishing minimum recommendations for SFVS implementation are recommended to maximize the benefits of the SFVS. The results may be useful for planning new strategies to help address and improve current health and environmental problems.

Relationships between proximity to grocery stores and Oklahoma Early Care and Education classroom nutrition practices

The study purpose was to determine associations between proximity to grocery stores and Early Care and Education programs' (i.e., ECEs) classroom nutrition practices and barriers, by ECE context (Head Start, community-based childcare [CBC], and family child care homes [FCCHs]). A statewide cross-sectional survey was implemented in Oklahoma ECEs. Directors reported classroom nutrition practices with the Nutrition and Physical Activity Self-Assessment tool, and barriers to implementation. Locations of 457 grocery stores statewide were determined by in-person audit. Geocoded ECEs were considered within a "low proximity" area if no grocery stores were available within a 0.25-mile radius for urban, or 10-mile radius for rural, ECEs. From November 2019 to February 2020, 54 Head Starts, 159 CBCs, and 160 FCCHs participated. 31.0 % were considered as low proximity. Head Starts demonstrated the highest classroom nutrition scores for mealtime practices, and nutrition education and policy. While proximity to grocery stores was not related to classroom nutrition practices for any ECE context (p > 0.05), FCCHs located within a low proximity area reported barriers to implementing those practices more often compared to FCCHs in an area within accessible proximity of grocery store. Thus, proximity to grocery stores was related to barriers in FCCHs only; those provider's experiences and perceptions may be most susceptible to influence of the community nutrition environment, compared to other ECE contexts. Contrary to studies in residential areas and schools, nutrition environments were not related to nutrition practices in ECEs. ECEs may serve as protective micro-environments supporting health for children residing in nearby low-access communities.

Associations between childhood to adulthood socio-economic mobility and adult diet quality

The impact of change in socio-economic status (SES) from childhood to adulthood (SES mobility) on adult diet is not well understood. This study examined associations between three SES mobility variables (area disadvantage, education, occupation) and adult diet quality. 1482 Australian participants reported childhood area-level SES in 1985 (aged 10-15 years) and retrospectively reported highest parental education and main occupation (until participant age 12) and own area-level SES, education, occupation and dietary intake in 2004-2006 (aged 26-36 years). A Dietary Guidelines Index (DGI) was calculated from food frequency and habit questionnaires. A higher score (range 0-100) indicated better diet quality. Sex-stratified linear regression models adjusted for confounders. Area-level SES mobility was not associated with diet quality. Compared with stable high (university) education, stable low (school only) was associated with lower DGI scores (males: β = -5·5, 95 % CI: -8·9, -2·1; females: β = -6·3, 95 % CI: -9·3, -3·4), as was downward educational mobility (participant's education lower than their parents) (males: β = -5·3, 95 % CI: -8·5, -2·0; females: β = -4·5, 95 % CI: -7·2, -1·7) and stable intermediate (vocational) education among males (β = -3·9, 95 % CI: -7·0, -0·7). Compared with stable high (professional/managerial) occupation, stable low (manual/out of workforce) males (β = -4·9, 95 % CI: -7·6, -2·2), and participants with downward occupation mobility (males: β = -3·2, 95 % CI: -5·3, -1·1; females: β = -2·8, 95 % CI: -4·8, -0·8) had lower DGI scores. In this cohort, intergenerational low education and occupation, and downward educational and occupational mobility, were associated with poor adult diet quality.

The association and mediation role of Food and Nutrition Literacy (FNLIT) with eating behaviors, academic achievement and overweight in 10-12 years old students: a structural equation modeling

BACKGROUND

Food and nutrition literacy is a key factor in shaping healthy dietary behaviors and may result in decreasing decrease the prevalence of overweight. Empirical research on food and nutrition literacy and its outcomes is limited, especially among children and adolescents. Thus, this study investigates the link between Food and Nutrition Literacy (FNLIT) with eating behaviors, academic performance, and overweight in 10-12 years old students in Tehran, Iran.

METHODS

This study was performed through two phases: 1) Proposing a conceptual model of the relationship between FNLIT and its determinants and outcomes, based on the existing evidence and previous models, and 2) Testing the proposed FNLIT model through a cross-sectional study on 803 primary school students (419 boys and 384 girls, from 34 public and 10 private primary schools), aged 10-12 years using structural equation modeling. Demographic, socio-economic, and household food security characteristics were collected by interviewing the students and their mothers/caregivers using a questionnaire. FNLIT was measured by a self-administered, locally designed, and validated questionnaire.

RESULTS

The fit indices suggested a reasonably adequate fit of the data to the hypothesized model (χ2/df = 2.03, p < 0.001, goodness of fit index (GFI) = 0.90, adjusted goodness of fit index (AGFI) = 0.88, comparative fit index (CFI) = 0.91, incremental fit index (IFI) = 0.91, root mean square error of approximation (RMSEA) = 0.04, standardized root mean residual (SRMR) = 0.06). SES was directly and positively related to FNLIT and its subscale in students. FNLIT score had a positive direct (non-mediated) relationship with healthy eating behavior and academic performance. This pattern was strongly reversed in unhealthy eating behavior. There was a full mediation relationship between FNLIT and overweight/obesity via healthy eating behaviors. SES predicted academic performance partially through the mediating effect of Food Label Literacy (FLL). The results indicated that despite the direct relationship between SES and academic performance, an indirect but negative relationship existed with food insecurity. The finding also revealed the fully mediating role of Food Choice Literacy (FCL) in the relationship between demographic factors and healthy eating behaviors. Our study also found that Interactive Food and Nutrition Literacy (IFNL) protected unhealthy eating behaviors, and FCL predicted healthy eating behaviors in children.

CONCLUSION

Our study draws attention to FNLIT, especially the skills domain, including IFNL, FCL, and FLL, as the most important determinant of healthy eating behavior, academic performance, and weight status in school-age children reduces social inequalities in children's development. To ensure an adequate level of FNLIT, educators should assess and plan to enhance food literacy skills in children and adolescents.

Mealtime TV Use Is Associated with Higher Discretionary Food Intakes in Young Australian Children: A Two-Year Prospective Study

Background: Mealtime television use has been cross-sectionally associated with suboptimal diets in children. This study aimed to assess the two-year prospective association between baseline mealtime television use and subsequent diets in young children, and identify socioeconomic differences. Methods: Parents reported their child’s television use at meals, and fruit, vegetable, and discretionary food intakes. Multivariable linear and logistic regression analyses assessed the association between baseline mealtime television use and follow-up diet outcomes. Differences were assessed by socioeconomic position. Results: Participants were 352 Australian parents of children aged six months to six years. Daily mealtime television use (average frequency/day) was associated with higher daily frequency of discretionary food intakes (β 0.2, 95% confidence interval (CI) 0.07–0.67) at the 2-year follow-up. Individually, television use during breakfast and dinner (1–2 days/week compared to never) predicted higher daily intake frequency of discretionary food, β 0.36 (95% CI 0.12–0.60) and β 0.19 (95% CI 0.00–0.39), respectively. Similarly, 3–7 days/week of television use during breakfast and lunch predicted higher frequency of discretionary food intake, β 0.18 (95% CI 0.02–0.37) and β 0.31 (95% CI 0.07–0.55), respectively. Associations were not socioeconomically patterned. Conclusions: Investigating mealtime television use motivators across the socioeconomic spectrum could inform interventions targeting the high consumption of discretionary foods in children.

Duration of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participation is Associated With Children's Diet Quality at Age 3 Years

INTRODUCTION

Adequate childhood nutrition contributes to prevention of chronic diseases. The supplemental foods and nutrition education provided by the Special Supplemental Nutrition Program for Women, Infants, and Children, a federal program serving women, infants, and children up to age 5 years in low-income families and at nutritional risk, intend to optimize dietary intakes. This study assesses associations between duration of the Special Supplemental Nutrition Program for Women, Infants, and Children participation, early feeding practices, and children's diet quality at age 3 years.

METHODS

Using data collected between 2013 and 2017 from the Special Supplemental Nutrition Program for Women, Infants, and Children Infant and Toddler Feeding Practices Study-2, investigators derived 4 mutually exclusive patterns of the Special Supplemental Nutrition Program for Women, Infants, and Children participation: participation in the child's first year only, participation into the second year, participation into the third year, and intermittent participation across 3 years. In 2021, multivariable regression assessed associations between these patterns, early feeding practices, and 2015 Health Eating Index total score at age 3 years.

RESULTS

When compared with children who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children into their third year, children who participated in their first year only (p<0.01) had 2015 Healthy Eating Index total scores that were 3.6 points lower on a given day. Children introduced to sugar-sweetened beverages in their first year had scores that were 2.4 points lower than children not introduced to them in their first 2 years (p=0.03), whereas those breastfed longer exhibited a small increase in scores (p<0.01).

CONCLUSIONS

Longer participation in the Special Supplemental Nutrition Program for Women, Infants, and Children improves children's diets, potentially mitigating chronic disease risk. Clinician efforts to refer at-risk families to the Special Supplemental Nutrition Program for Women, Infants, and Children during the early childhood years are supported.

Development and Reliability Testing of a Nutrition Knowledge Questionnaire for Australian Children (the CNK-AU)

OBJECTIVE

To adapt and test an existing questionnaire to assess Australian children's level of nutrition knowledge.

DESIGN

The child nutrition knowledge questionnaire for Australian children consists of 8 nutrition-related categories: healthy choices, portion and serving sizes, balanced meals, nutrition labels, nutrient functions, and food sources, safety, and categories. Participants completed the questionnaire at 2 time points, with 1 week in between.

SETTING

The questionnaire was completed online in a primary school classroom using an Android tablet.

PARTICIPANTS

Fifth- and sixth-year students (n = 94; aged 10.9 years; SD, 0.76) at a primary school in New South Wales, Australia.

VARIABLES MEASURED

Item difficulty, item discrimination, and reliability.

ANALYSIS

Item analysis, interrater reliability, and test-retests.

RESULTS

The intrarater reliability per item between the first visit and 1 week later was moderate to substantial for the majority of items (mean κ = 0.50; SD, 0.21). Test-retest found a significant correlation for total score (r = 0.756), with all categories except portion and serving sizes showing significant correlations above r = 0.502.

CONCLUSIONS AND IMPLICATIONS

The child nutrition knowledge questionnaire for Australian children has the potential to be a reliable and practical questionnaire for measuring Australian children's nutrition knowledge. The questionnaire may be useful for future work evaluating the effectiveness of nutrition education interventions and would potentially be adapted to other cultures.

Effect of the multicomponent healthy high school intervention on meal frequency and eating habits among high school students in Denmark: a cluster randomized controlled trial

BACKGROUND

Previous studies have shown that multicomponent interventions may improve meal frequency and eating habits in children, but evidence among young people is limited. This study evaluated the effect of the Healthy High School (HHS) intervention on daily intake of breakfast, lunch, water, fruit, and vegetables at 9-month follow-up.

METHODS

The study included first-year students (≈16 years) attending high school in Denmark. Participating schools were randomized into the HHS intervention (N = 15) or control group (operating as usual) (N = 15). The intervention was designed to promote well-being (primary outcome) by focusing on healthy habits including meals, stress prevention, and strong peer relations. It included a curriculum, structural and organisational initiatives, a workshop, and a smartphone application. Students completed self-administered online questionnaires at the beginning of the school year and nine months later. To account for clustering of data, we used multilevel logistic regression analyses to estimate odds ratios (OR). We applied an intention-to-treat approach with multiple imputations of missing data.

RESULTS

At baseline 4577 of 5201 students answered the questionnaire and 4512 at follow-up. In both groups the proportion of students eating breakfast decreased from approximately 50% to 40% from baseline to follow-up, and lunch frequency decreased from approximately 50% to 47%. Daily water intake, intake of fresh fruit and intake of vegetables remained unchanged from baseline to follow-up. There were no significant between group differences on any of the outcomes at first follow-up: breakfast: OR = 0.85 (95% CI: 0.65;1.10), lunch: OR = 0.96 (95% CI: 0.75;1.22), water intake: OR = 1.14 (95% CI: 0.92;1.40), intake of fresh fruit: (OR = 1.07, 95% CI: 0.84;1.37), vegetables: (OR = 1.01, 95% CI: 0.77;1.33).

CONCLUSION

No evidence of an effect of the HHS intervention was found for any of the outcomes. Future studies are warranted to explore how health promoting interventions can be integrated in further education to support educational goals. Moreover, how to fit interventions to the lives and wishes of young people, by also including systems outside of the school setting.

TRIAL REGISTRATION

ISRCTN, ISRCTN43284296 . Registered 28 April 2017 - retrospectively registered.

Associations between diet quality and DSM-IV mood disorders during young- to mid-adulthood among an Australian cohort

PURPOSE

Many studies have reported associations between diet and depression, but few have used formal diagnoses of mood disorder as the outcome measure. We examined if overall diet quality was associated cross-sectionally or longitudinally with DSM-IV mood disorders among an adult cohort.

METHODS

Participants from the Australian Childhood Determinants of Adult Health study were followed up during 2004-06 (n = 1974, age 26-36 years), 2009-11 (n = 1480, 31-41 years), and 2014-19 (n = 1191, 36-49 years). Dietary Guidelines Index (DGI) scores were calculated from food frequency questionnaires at each time-point (higher DGI reflects better diet quality). DSM-IV mood disorders (dysthymia or depression) during the periods between, and 12 months prior to each follow-up were determined using the Composite International Diagnostic Interview. Sex-stratified risk and prevalence ratios (PR) and 95% confidence intervals (CI) were estimated using log-binomial regression. Covariates included age, self-perceived social support index score, marital status, parenting status, education, occupation, physical activity, BMI, and usual sleep duration.

RESULTS

A 10-point higher DGI was cross-sectionally associated with lower prevalence of mood disorders at the third follow-up only (females PR = 0.73, 95% CI = 0.56, 0.95; males PR = 0.72, 95% CI = 0.53, 0.97), but was attenuated after covariate adjustment (females PR = 0.92, 95% CI = 0.73, 1.16; males PR = 0.92, 95% CI = 0.69, 1.22). Adjustment for social support in the final model had attenuated the association for both sexes from 18% reduced prevalence to 8%. DGI scores were not longitudinally associated with mood disorder risk.

CONCLUSIONS

Crude cross-sectional associations between diet quality and mood disorders at ages 36-49 years were explained by sociodemographic and lifestyle factors, particularly social support.

Effectiveness of Nutritional Strategies on Improving the Quality of Diet of Children from 6 to 12 Years Old: A Systematic Review

Dietary habits, that are formed during childhood and consolidated in adulthood, are known to influence the development of future chronic diseases such as metabolic syndrome or type 2 diabetes. The aim of this review was to evaluate the effectiveness of nutritional interventions carried out in recent years focused on improving the quality of the diet of the child population. A systematic search of the PubMed and Scopus databases was performed from January 2011 until September 2021. A total of 910 articles were identified and screened based on their title, abstract and full text. Finally, 12 articles were included in the current systematic review. Of those, in six studies the intervention was based on the provision of healthy meals and in the other six studies the intervention focused on modifying the school environment. Six of the studies selected included other components in their intervention such as nutritional education sessions, physical activity and/or families. A wide variety of methods were used for diet assessments, from direct method to questionnaires. The results suggest that interventions that modify the school environment or provide different meals or snacks may be effective in improving children’s dietary patterns, both in the short and long term. Further research is necessary to evaluate the real effectiveness of strategies with multidisciplinary approach (nutritional sessions, physical activity and family’s involvement).

A Cross-Sectional Study of the Nutritional Quality of New South Wales High School Student Food and Drink Purchases Made via an Online Canteen Ordering System

Unhealthy dietary patterns in adolescence are associated with an increased risk of future chronic disease. This study aimed to assess online canteen lunch purchases made by high school students to identify: (1) the nutrient composition of purchases (energy, saturated fat, sugar, sodium, percent energy from saturated fat and total sugar); (2) the proportion of items classified as healthier (‘Everyday’) and less healthy (‘Occasional’ or ‘Should not be sold’) according to the New South Wales Healthy Canteen Strategy; (3) the frequency of purchases by product type (e.g., salty snacks), their classification and nutrient composition; and (4) associations between student characteristics and the nutrient composition and classification of purchases. The average order contained 2075 kJ of energy, 6.4 g of saturated fat, 18.4 g of sugar and 795 mg of sodium. Less healthy (‘Occasional’ and ‘Should not be sold’) items combined accounted for 56% of purchases. The most frequently purchased products were burgers and crumbed/coated foods. Students in higher grades purchased a significantly higher mean percent of ‘Everyday’ items, compared to students in grades 7 or 8. The majority of high school student purchases were less healthy (‘Occasional’ or ‘Should not be sold’) items, warranting further investigation of factors influencing online canteen purchasing behaviour in this setting.

Enough time for lunch? The duration and governance of lunch eating times in Australian primary schools: A mixed-methods study

Developing healthy eating behaviours is important to assist children in maintaining good health and decrease the risk of chronic health conditions. Recent nutrition promotion efforts in Australian primary schools have mainly focused on canteen guideline compliance and obesity prevention interventions. The aim of this study was to investigate the primary school food environment, specifically, allocated lunch eating duration and the governance of children's lunch breaks. Parents (n = 402) and teachers (n = 123) were asked via an online survey, about school allocated lunch eating duration and its adequacy. Respondents were asked about the supervision, monitoring and feedback of children's lunches, as well as how they felt about these practices. Parents (n = 308) and teachers (n = 102) also responded to the open-ended question "What could be done to improve the school food environment at your school?". Ten minutes was the allocated lunch eating duration reported by most parents and teachers and 58% of those parents and 30% of those teachers rated this as inadequate. Increasing the allocated lunch eating duration was frequently cited as a way to improve the school food environment. A similar proportion of parents and teachers agreed with teachers monitoring food intake, not providing feedback on food brought to school, and that parents should decide what children eat. More parents (44%) than teachers (23%) believed that teachers should eat their own lunch with the children. These findings provide an insight into the primary school lunch environment and the views of two key stakeholder groups. School food policies should consider these findings in future revisions, particularly with regards to eating times.

Sex hormones drive changes in lipoprotein metabolism

Women have a reduced cardiovascular disease (CVD) risk compared with men, which could be partially driven by sex hormones influencing lipid levels post puberty. The interrelationship between sex hormones and lipids was explored in pre-pubertal children, young post-pubertal cis-men/women, and transgender individuals on cross-sex-hormone treatment (trans-men/women) using serum metabolomics assessing 149 lipids. High-density lipoproteins (HDL, typically atheroprotective) were significantly increased and very-low- and low-density lipoproteins (typically atherogenic) were significantly decreased in post-pubertal cis-women compared with cis-men. These differences were not observed pre-puberty and were induced appropriately by cross-sex-hormone treatment in transgender individuals, supporting that sex hormones regulate lipid metabolism in vivo. Only atheroprotective apolipoprotein (Apo)A1 expressing lipoproteins (HDL) were differentially expressed between all hormonally unique comparisons. Thus, estradiol drives a typically atheroprotective lipid profile through upregulation of HDL/ApoA1, which could contribute to the sexual dimorphism observed in CVD risk post puberty. Together, this could inform sex-specific therapeutic strategies for CVD management.

Did School Meal Programs and SNAP Participation Improve Diet Quality of US Children from Low-Income Households: Evidence from NHANES 2013-2014?

Nutrition assistance programs such as school meals and the Supplemental Nutrition Assistance Program (SNAP) are designed to provide a safety net for the dietary intake of children from low-income families. However, compared with eligible non-participants, the relationship of diet quality with school meals only and school meals + SNAP is not well understood. The objectives of the study include: (1) To explore whether and to what extent nutrition assistance program participation (school meals only and school meals + SNAP) is related to diet quality; and (2) to examine the differences of diet quality between participating in school meals only, school meals + SNAP, or non-participation among American children. Children aged 5 to 18 years old from income eligible households who participated in the 2013-2014 National Health and Nutrition Examination Survey (NHANES) were included in this cross-sectional study (n = 1425). Diet quality was measured using the Healthy Eating Index (HEI)-2015 and its 13 subcomponents. A Rao-Scott Chi-square test, propensity scores approach, and Analysis of Covariance were performed. Covariates included age, sex, race/ethnicity, weight status, and family monthly poverty index. SAS survey procedures were used to incorporate the appropriate sample design weights. Participation in school meals + SNAP was not associated with higher diet quality compared to eligible non-participants or school meals-only participants. Participation in school meals + SNAP improved the intake of total dairy, but not added sugars or total vegetables compared to school meals only. Overall, school meal + SNAP participation did not significantly improve the overall diet quality of children in low-income households relative to comparable non-participants.

Practical School Nutrition Program May Reduce Food Neophobia

The study’s purpose was to evaluate an intervention to reduce fruit and vegetable food neophobia and influence attitudes and behaviors among children using a four-month, non-experimental, before-and-after intervention. Participants were children aged 5–11 years in an intervention school (IS) and a control school (CS). Children were offered fruit or vegetable samples weekly utilizing school-specific psychosocial and educational practices to encourage participation. The outcomes of interest included attitudes measured using a written survey-based food neophobia scale (FNS), behavioral observations, and an oral survey. The post-intervention IS FNS score was significantly lower compared to pre-intervention (p = 0.04). Repeated-measures ANOVA revealed a statistically significant overall effect of time (p = 0.006). School type-time interaction was not significant (p = 0.57). Pre-intervention observational data showed the proportions finishing and taking another fruit and vegetable sample were higher in the CS (p < 0.001 for both). Post-intervention, the proportions taking the vegetable (p = 0.007) and the fruit (p < 0.001) were higher in the IS. The percentage tasting the vegetable was higher in the CS (p = 0.009). Offering samples of produce in school lunchrooms may reduce food neophobia. This intervention is an inexpensive program that volunteers can quickly implement.

Longitudinal Study on Relationships among Snack Energy Intake, Body Mass Index, and Nutrient Intake in Japanese Children Aged 6-7 Years

A longitudinal study was conducted to assess associations between snack energy intake and either body mass index (BMI) or nutrient intake in Japanese children. A baseline survey was conducted with 243 children aged 6-7 y, and follow-up was performed 4 y later. Finally, 189 subjects were selected for the analysis. Snack intakes were obtained from self-administered records by guardians. The daily habitual whole dietary intake and exercise/sleep hours were obtained by questionnaires during the follow-up. Subjects were grouped into three, as per snack energy intake tertiles at baseline. Differences and linear trends between the three groups were tested for the mean values of snack energy intake, BMI, and nutrient density, 4 y after the baseline survey. In follow-up, the snack energy intake (kcal) in females was significantly higher in the intermediate (335±35, p<0.01) and high (318±32, p<0.05) groups than in low group (196±25). There was no significant difference in follow-up BMI in the three groups. However, after adjustment of the baseline BMI, a significantly positive linear trend (p<0.05) was observed in the follow-up BMI in females. There was no significant difference in total energy intake per day. In contrast, a significantly negative linear trend (p<0.05) was observed among the three groups in dietary nutrient density of calcium and vitamin A in females. These results suggest that, in females, a higher intake of snacks may affect the daily dietary balance, resulting in a higher BMI and lower mineral and vitamin intakes.