Role of parents in the determination of the food preferences of children and the development of obesity

Validity and reliability of healthy food knowledge and healthy food preferences scale for preschool children

Introduction

Early childhood nutrition plays a critical role in shaping lifelong health outcomes, yet preschool children in low- and middle-income countries often have poor dietary habits and limited knowledge of healthy foods. This study aimed to validate and assess the reliability of the 9-item Healthy Food Knowledge (HFK_PS) and Healthy Food Preference (HFP_PS) scales, ensuring cultural relevance for measuring food knowledge and preferences among Ethiopian preschool children aged 3-7 years.

Methods

A cross-sectional design was employed, involving 319 preschoolers from five randomly selected 5 kindergarten schools. Data was collected through an interactive photo-based interview with the children. A panel of ten experts assessed content validity, while construct validity was assessed using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Reliability was assessed using Cronbach's alpha.

Results

The EFA identified a two-factor structure for both scales, explaining 50.91% and 50.18% of the variance for HFK_PS and HFP_PS, respectively. CFA confirmed the model fit, with all indices meeting the recommended thresholds. The HFK_PS and HFP_PS scales demonstrated good internal consistency, with Cronbach's alpha values of 0.80 and 0.78, respectively. Older children and those in higher grades had significantly greater food knowledge (p < 0.001), and food preferences also improved with grade level (p < 0.05). However, preferences remained stable across age groups (p = 0.928). However, no significant gender differences were found. A positive correlation (r = 0.43, p < 0.001) was found between healthy food knowledge and preferences, suggesting that increased knowledge is associated with healthier preferences.

Conclusions

The validated scales can be instrumental in evaluating preschoolers' dietary knowledge and preferences in Ethiopia. Future studies should focus on implementing these scales in nutrition education programs to assess their effectiveness in fostering long-term healthy eating habits among young children.

The association of picky eating among preschoolers in Kuwait with mothers' negative attitudes and weight concerns

AIMS

To investigate the phenomenon of picky eating among children and its association with early feeding practices, including feeding patterns during infancy, introduction of solid food, and weaning age. We also examined the association of picky eating with negative parental attitudes toward eating behaviors and the weight status of children.

METHODS

This cross-sectional study included 365 preschool children (ages 2-6)-mother dyads living in Kuwait. To identify picky eaters, trained dietitians administered a set of questionnaires to the mothers, including one that assessed parental attitudes toward their children's eating behaviors. The participating children's weights and heights were recorded, and their weight status was determined using the WHO growth charts.

RESULTS

Of the children, 35.6% were identified as picky eaters. Picky eating was significantly associated with the mother's negative attitudes toward her child's eating behavior, reduced Height-for-age z-scores (HAZ), and reduced BMI-for-age z-scores (BAZ). No association was found between the type of feeding and age at which solid food was introduced.

CONCLUSION

Our findings highlight a significant association between maternal attitudes and picky eating. Mothers-especially those displaying consistent worry regarding their children's eating habits -were more prone to having picky eating children and therefore harbored greater concerns regarding their growth deficits. However, the cross-sectional design precludes determining causality. Future research is needed to explore potential bi-directional influences. Our findings can inform the development of effective strategies and interventions to address picky eating behaviors and promote healthier eating habits among Kuwaiti children, thereby enhancing their nutritional status and overall well-being.

Parental education and neighbourhood socioeconomic status in the prediction of childhood overweight: A multilevel analysis

OBJECTIVE

This study examined cross-level interaction between parental education and neighbourhood SES in predicting overweight including obesity among school-aged children.

METHODS

This analysis used data from 19 984 children aged 5-6 years participating in the school-entry examination of the years 2015 to 2019 in the Aachen city region in Germany. We employed multilevel logistic regression models to predict overweight based on parental education and neighbourhood SES, along with their cross-level interaction, while controlling for several characteristics of the child.

RESULTS

Children from families with intermediate (OR: 1.99; 95% CI, 1.65-2.40) and low parental education (OR: 2.55; 95% CI, 1.92-3.39) and from neighbourhoods with intermediate (OR: 1.25; 95% CI, 1.02-1.53) and low SES (OR: 1.61; 95% CI, 1.29-2.02) were at significantly higher odds for overweight. There was an indication of a cross-level interaction effect (p-value <0.10) to the disadvantage of children with higher parental education, suggesting that inequalities in overweight decrease in more deprived neighbourhoods. The predicted probability of overweight for children with high parental education increased from 6.4% in high SES neighbourhoods to 7.8% in intermediate and 9.9% in low SES neighbourhoods. Sensitivity analyses for obesity and a higher context level of spatial SES confirmed the results.

CONCLUSIONS

The results highlight the crucial role of both individual and contextual socioeconomic conditions in predicting childhood overweight. They also suggest that the impact of neighbourhood socioeconomic status on childhood overweight varies by parental education, particularly disadvantaging children with higher parental education, indicating a social contagion of overweight through spatial disadvantage.

Beyond table manners: Children's gratitude for food and the role of parental socialization

This investigation explores children's food gratitude and parents' socialization of this gratitude within the United States. Study 1 examined children's spontaneous expressions of gratitude (N = 1441), focusing on the concepts of food environmental sustainability, properties, origins, scripts, and well-being. Study 2 surveyed parents (N = 110) regarding their engagement in socialization practices that promote children's food gratitude: conversations; modeling; niche selection; and, scaffolding. The results unveil nuances in younger and older children's gratitude for food concepts as well as parents' differential use of food gratitude socialization practices and emphasis on specific concepts. Furthermore, the results demonstrate that parents' food gratitude socialization practices predict parents' reports of their children's food gratitude. These studies elucidate variability in children's gratitude for food and parents' contribution to its development within this domain. These findings have implications for food gratitude socialization. (137 words).

Healthy Lifestyle in the First 1000 Days and Overweight and Obesity Throughout Childhood

OBJECTIVES

Investigate associations of different family healthy lifestyle scores (HLS) during the first 1000 days with childhood overweight and obesity (OWOB).

METHODS

Cohort-specific analyses were conducted on participants (n = 25 006) from 4 European birth cohorts (The study on the pre- and early postnatal determinants of child health and development [EDEN], Elfe, France; Generation R, the Netherlands; and Lifeways, Ireland). Three composite HLSs were calculated: a maternal pregnancy HLS based on prepregnancy body mass index (BMI) and diet quality, physical activity, smoking status, and alcohol consumption during pregnancy; a parental pregnancy HLS additionally considering paternal BMI and smoking status; and an infancy HLS based on breastfeeding duration, age of solid food introduction, and exposure to passive smoking. Associations with child BMI (primary outcome) and waist-to-height ratio (WHtR, available in 2 cohorts) in early (5-5.5 years), middle (7-8 years), and late childhood (9-12 years) were assessed using linear (BMI and WHtR z-scores) and robust Poisson (International Obesity Task Force [IOTF] categories) regression analyses adjusted for sociodemographic confounders.

RESULTS

Only a small proportion of families had favorable lifestyle factors during pregnancy and early infancy, with 3.4% to 10.0%, 1.9% to 3.7%, and 12.2% to 23.6% scoring maximum for maternal, parental, and infancy HLS, respectively. Associations between higher HLSs and a lower risk of OWOB when measured by BMI z-scores or IOTF categories were found for maternal HLS and early (3/4 cohorts with available data), middle (1/2), and late childhood (2/4); parental HLS and early (3/4), middle (2/2), and late childhood (4/4). Associations between infancy HLS and childhood OWOB were less consistent and did not remain significant after additional adjustment for parental HLS. Associations with WHtR were solely significant in EDEN at 5.5 years.

CONCLUSIONS

Greater maternal and parental adherence to healthy lifestyle behaviors during pregnancy was associated with a lower risk of offspring OWOB throughout childhood, illustrating the importance of promoting healthy lifestyle behaviors at the family level during pregnancy.

Altered hippocampal effective connectivity predicts BMI and food approach behavior in children with obesity

Objective

The vicious circle model of obesity proposes that the hippocampus plays a crucial role in food reward processing and obesity. However, few studies focused on whether and how pediatric obesity influences the potential direction of information exchange between the hippocampus and key regions, as well as whether these alterations in neural interaction could predict future BMI and eating behaviors.

Methods

In this longitudinal study, a total of 39 children with excess weight (overweight/obesity) and 51 children with normal weight, aged 8 to 12, underwent resting-state fMRI. One year later, we conducted follow-up assessments of eating behaviors and BMI. Resting-state functional connectivity and spectral dynamic casual modeling (spDCM) technique were used to examine altered functional and effective connectivity (EC) of the hippocampus in children with overweight/obesity. Linear support vector regression, a machine learning method, was employed to further investigate whether these sensitive hippocampal connections at baseline could predict future BMI and eating behaviors.

Results

Compared to controls, children with excess weight displayed abnormal bidirectional inhibitory effects between the right hippocampus and left postcentral gyrus (PoCG), that is, stronger inhibitory hippocampus→PoCG EC but weaker inhibitory PoCG→hippocampus EC, which further predicted BMI and food approach behavior one year later.

Conclusion

These findings point to a particularly important role of abnormal information exchange between the hippocampus and somatosensory cortex in pediatric obesity and future food approach behavior, which provide novel insights into the neural hierarchical mechanisms underlying childhood obesity and further expand the spDCM model of adult obesity by identifying the directionality of abnormal influences between crucial circuits associated with appetitive regulation.

Associations between a paternal healthy lifestyle score and its individual components with childhood overweight and obesity

BACKGROUND

Maternal healthy lifestyle behaviors during pregnancy have been associated with reduced risk of offspring overweight and obesity (OWOB). However, there has been little investigation, in the context of the Paternal Origins of Health and Disease (POHaD) paradigm, of the potential influence of the paternal lifestyle on offspring OWOB.

OBJECTIVES

To describe paternal healthy lifestyle factors around pregnancy and investigate their associations, individually and combined, with offspring risk of OWOB during childhood.

MATERIALS AND METHODS

Participants included 295 father-child pairs from the Lifeways Cross-Generation Cohort Study. A composite paternal healthy lifestyle score (HLS) based on having a high dietary quality (top 40% of the Healthy Eating Index-2015), meeting physical activity guidelines (≥450 MET-min/week of moderate-to-vigorous physical activity), having a healthy body mass index (BMI) (18.5-24.9 kg/m2), being a non-smoker, and having no/moderate alcohol intake, was calculated (range 0-5). Paternal HLS (and individual components) associations with child BMI and waist-to-height ratio (WHtR) at age 5 and 9 years were assessed using linear (BMI z-scores and WHtR) and logistic (IOTF categories) regression analyses, adjusted for sociodemographic characteristics.

RESULTS

At age 5 and 9 years, 23.5% and 16.9% of children were classified as living with OWOB, respectively. Of the 160 pairs with a complete HLS, 45.0% of the fathers had unfavorable lifestyle factors, determined by a low HLS between 0 and 2 points. Although a low paternal HLS was not significantly associated with a higher risk of childhood OWOB measured using either BMI z-scores and IOTF categories, it was associated with a greater child WHtR, an indicator of central adiposity, at 9 years of age (β [95% CI] = 0.04 [0.01,0.07]).

DISCUSSION AND CONCLUSION

Almost half of the fathers had unfavorable lifestyle factors around pregnancy. A low paternal HLS was associated with a greater child WHtR at 9 years but not with a higher risk of childhood OWOB when measured by BMI z-scores or IOTF categories.

New Zealand Early Learning Service Menus Do Not Meet Health New Zealand Guidelines for Providing Healthy Menus and Reducing Food-Related Choking in Children

OBJECTIVE

To assess alignment of food and drinks served to New Zealand (NZ) children in early learning services (ELS) with the Health NZ (formerly known as Ministry of Health) Healthy Food and Drink (HFD) and Reducing Food Related Choking (choking) guidance.

METHODS

Menus (271) collected remotely from 148 ELS from November 2020-March 2021 were analysed for their nutritional quality based on a 'traffic light' classification of 'green' (most nutritious), 'amber' (moderately nutritious) and 'red' (least nutritious) based on the guidance.

RESULTS

Overall, 2.6% of menus met the guidance, and alignment was greater for menus for over 2-year-olds (over-2s) than under 2-year-olds (under-2s; p < 0.01). One-fifth (18.5%) of menus met the choking guidance. Services with a Healthy Heart Award (HHA) from the Heart Foundation provided more 'green' items to over-2s (p = 0.039) and under-2s (p = 0.01), and less 'red' items to over-2s (p = 0.04). Providing more green menu items was inversely correlated with providing less high choking risk foods (p < 0.01). Menu scores did not vary by service location, neighbourhood socioeconomic deprivation or type (services operating independently versus those part of an education group chain).

CONCLUSIONS

Alignment with Health NZ nutritional guidance is low, particularly in ELS caring for very young children (under-2s). Service characteristics, except for HHA status, are a poor predictor of nutritional quality of menus at ELS.

SO WHAT

Greater uptake of the HHA scheme could assist ELS to provide healthier food and drinks. Early learning services need further support from the public health sector to implement national nutritional guidelines.

School Meal Nutrition Standards Reduce Disparities Across Income and Race/Ethnicity

INTRODUCTION

Children's diets in the U.S. typically fail to meet dietary recommendations, contributing to associated adverse health outcomes. The Healthy, Hunger-Free Kids Act (HHFKA) of 2010 required the U.S. government to update nutrition standards for school meals to align with the Dietary Guidelines for Americans (DGAs). This study estimates the evolving impact of substituting school-prepared food for home-prepared food on overall daily diet quality and by subcomponents of diet quality. Subgroup analyses are performed by race/ethnicity and income.

METHODS

Two, nonconsecutive days of dietary recall data from the National Health and Nutrition Examination Survey (2005-March 2020) are used to calculate schoolchildren's Healthy Eating Index (HEI)-2020 scores. The study includes children with complete two-day dietary intakes who attend kindergarten through twelfth grade in a school offering lunch. An individual-level fixed effects regression is employed to examine the relationship of school food consumption on HEI-2020 scores before and after HHFKA-mandated changes in nutrition standards. Analyses were conducted on September 23, 2023.

RESULTS

Prior to changes in standards (2005-2008), school food did not impact diet quality within the overall group of children. In 2009-2012, positive associations between school food and diet quality emerged for low-income students and for non-Hispanic Black students. By 2013-2020, improvements were seen across all groups. The association between school food and diet quality was most attributable to more favorable consumption of dairy, fruit, whole grains, refined grains, added sugars and saturated fats.

CONCLUSIONS

HHFKA-based nutrition standards were associated with beneficial dietary changes and reduced dietary disparities for children across diverse backgrounds.

Neophobia, sensory experience and child's schemata contribute to food choices

PURPOSE

The aim of the present review is to analyze dynamic interactions between nutrigenomics, environmental cues, and parental influence, which can all lead to children's neophobic reactions and its persistence in time.

METHODS

We reviewed studies available on electronic databases, conducted on children aged from birth to 18 years. We also considered official websites of Italian Institutions, providing advice on healthy eating during infancy.

RESULTS

Modern day societies are faced with an eating paradox, which has severe and ever-growing implications for health. In face of a wider availability of healthy foods, individuals instead often choose processed foods high in fat, salt and sugar content. Economic reasons surely influence consumers' access to foods. However, there is mounting evidence that food choices depend on the interplay between social learning and genetic predispositions (e.g., individual eating traits and food schemata). Neophobia, the behavioral avoidance of new foods, represents an interesting trait, which can significantly influence children's food refusal. Early sensory experiences and negative cognitive schemata, in the context of primary caregiver-child interactions, importantly contribute to the priming of children's food rejection.

CONCLUSIONS

As neophobia strongly affects consumption of healthy foods, it will be relevant to rule definitively out its role in the genesis of maladaptive food choices and weight status in longitudinal studies tracking to adulthood and, in meanwhile, implement early in life effective social learning strategies, to reduce long-term effects of neophobia on dietary patterns and weight status.

LEVEL OF EVIDENCE

Level II, controlled trials without randomization.

Lifestyle and sexual habits of students in a Southern Italian region

BACKGROUND

Incorrect or harmful lifestyle during youth may impact negatively gonadal function later in life. To reduce the development of risky behaviors a series of health prevention and intervention campaigns have been conducted in Italy. The present study is part of a Sicily Region (Italy) health surveillance program that was carried out on a sample of late adolescents.

METHODS

Between March 2022 to December 2022, we enrolled 718 adolescents (15-26 years old) attending the last two years of high school (278 males and 440 females) in the districts of Syracuse, Ragusa, Catania, and Agrigento (Sicily, Italy). All adolescents were invited to complete a questionnaire that explored their lifestyles and the student's knowledge of sexually transmitted diseases (STDs) and the main andrological diseases.

RESULTS

Our analysis revealed that 43% of students smoke cigarettes, with a similar gender distribution; one-third of the students use illicit drugs, with a higher prevalence of males than females. More than two-thirds of youngsters reported drinking alcohol with a statistically significant difference between genders. 68.2% of students do not have sexual difficulties and males have a greater tendency to sexual promiscuity than females and only about half of them use condoms. 92% of students surf the Internet every day; boys tend to visit pornographic sites more often than girls.

CONCLUSIONS

This survey revealed statistically significant differences between the two genders in terms of lifestyle and sexual habits. In particular, the survey shows that the prevalence of risky behaviour is still extremely high among late adolescents and young adults and that much still needs to be done in terms of prevention and information. Adequate prevention campaigns, to be proposed in the early years of adolescence, should be initiated in order to provide youngsters with adequate preparation in terms of healthy lifestyle habits.

Longitudinal changes in home food availability and concurrent associations with food and nutrient intake among children at 24-48 months

OBJECTIVES

To describe changes in home food availability during early childhood, including modified, developmentally sensitive obesogenic scores, and to determine whether home food availability is associated with food and nutrient intakes of children concurrently, over time.

DESIGN

Data were drawn from the STRONG Kids 2 longitudinal, birth cohort to achieve the study objectives. Home food availability was assessed with the Home Food Inventory (HFI) and included fifteen food groups (e.g. fruit and vegetables) and three obesogenic scores (one original and two modified). Food and nutrient intakes were measured using the Block FFQ and included twenty-seven food groups and eighteen nutrients (e.g. vitamins A and C, protein). HFI and FFQ were completed by trained researchers or mothers, respectively, at 24, 36 and 48 months. Repeated-measures ANOVA and Spearman's correlations were used to achieve the study objectives.

SETTING

Central Illinois, USA.

PARTICIPANTS

Participants were 468 children at 24, 36 and 48 months of age.

RESULTS

Availability of less nutritious foods and obesogenic foods and beverages increased as children aged, and availability of both nutritious and less nutritious foods were associated with child food and nutrient intake. The three obesogenic scores demonstrated similar, positive associations with the intake of energy, saturated fat, added sugars and kilocalories from sweets.

CONCLUSION

These findings offer novel insight into changes in home food availability and associations with food and nutrient intake during early childhood. Additional attention is needed examining antecedents (e.g. built environments, purchasing behaviours) and consequences (e.g. child diet quality and weight) of home food availability.

Evolutionary psychology of entomophobia and its implications for insect conservation

Many people, especially those living in developed countries, exhibit irrational negative feelings (e.g. fear, disgust, and aversion) toward insects. This so-called 'entomophobia' has often been suggested as a key contributing factor to the ongoing global decline in insects. However, this topic has not been well-investigated. From this point of view, we discuss the formation processes of entomophobia and its consequences from an evolutionary psychological perspective. Adopting the concept of the behavioral immune system, we suggest that the negative responses toward insects exhibited by modern people are driven by a series of emotional, cognitive, and behavioral traits that evolved to avoid infectious diseases. We then provide several strategic recommendations for mitigating the prevalence of entomophobia and a roadmap for better understanding how individual-level entomophobia can influence insect conservation. Understanding the human psychological dimension behind the ongoing decline of insects will provide useful insight on how best to mitigate this decline.

Fussy Eating Rescue, a mobile-web app for responsive feeding practises among parents of toddlers: protocol for a pilot randomised controlled feasibility trial

BACKGROUND

Fussy eating is most often a developmentally typical behaviour, generally presenting during toddlerhood. However, up to half of parents of young children are concerned about fussy eating, and this concern may mediate the use of nonresponsive feeding practises, such as coercive or unstructured feeding and using food to reward eating. Despite the high prevalence of parental concern for fussy eating and the negative impacts nonresponsive feeding practises have on children's health and diets, no previous digital intervention to improve the feeding practises of parents of toddlers concerned about fussy eating has been evaluated.

AIM

This article describes the protocol of a randomised controlled feasibility pilot aiming to evaluate Fussy Eating Rescue, a purely web app based intervention for parents of toddlers. The primary aim is to investigate feasibility and acceptability; secondary aims are to explore indications of intervention effect on parents' feeding practises or children's eating behaviours.

METHODS

Fussy Eating Rescue features include: (1) a Tracker, that allows parents to track repeated offers of food, (2) Topics, providing information on fussy eating, effective feeding strategies, and general nutrition, (3) Rescues, containing quick references to material supporting Topics contents, (4) Recipes, and (5) SMS notifications. Parents of toddlers (12-36 months old, n = 50) who have concerns about fussy eating will be recruited via Facebook. Parents will be randomised to an intervention group, which receives access to the app for 6 weeks, or to wait-listed control. Outcomes will be assessed at baseline and 6 weeks after app use, using online questionnaires and app usage statistics. Primary outcomes include participant retention rate, intervention engagement, app usability, perceived ease in using the app, perceived usefulness of the app, and user satisfaction. Secondary outcome measures include parents' feeding practises and children's eating behaviours.

DISCUSSION

Results will inform whether Fussy Eating Rescue is a feasible way to engage parents concerned for their toddler's fussy eating behaviours. If feasible and acceptable to users, a larger trial will further examine the efficacy of the Fussy Eating app in improving parents' feeding practises and children's eating behaviours.

TRIAL REGISTRATION

Prospectively registered with the Australian New Zealand Clinical Trials Registry on 15 July, 2021 (ACTRN12621000925842).

Association between specific types of parent stressors and fast-food consumption among parents and children

INTRODUCTION

Although stress has been associated with eating behaviors, such as overeating and eating less healthy foods, the relationships between specific types of parent stressors and fast-food consumption in parents and young children have not been well studied. We hypothesized that parent perceived stress, parenting stress, and household chaos would be positively associated with fast-food consumption for parents and their young children.

METHODS

Parents of 2-5 year olds and with Body Mass Index >27 kg/m2 (N = 234, parent mean age: 34.3 (±5.7); child age: 44.9 (±13.8) months; 65.8 % from two parent households) completed surveys on parent perceived stress, parenting stress, household chaos, and their fast-food intake and that of their child.

RESULTS

In separate regression models, controlling for covariates, parent perceived stress (β = 0.21, p < 0.01; R2 = 0.10, p < 0.01), parenting stress (β = 0.26, p < 0.01; R2 = 0.13, p < 0.01), and household chaos (β = 0.25, p < 0.01; R2 = 0.12, p < 0.01) were each significantly associated with parent fast-food consumption, and separately with child fast-food consumption [Parent perceived stress (β = 0.05, p = 0.02; R2 = 0.14, p < 0.01); parenting stress (β = 0.14, p = 0.03; R2 = 0.14, p < 0.01); parent fast-food consumption (β = 0.40, p < 0.01; R2 = 0.27, p < 0.01)]. However, combined final models showed parenting stress (p < 0.01) as the only significant predictor of parent fast-food consumption, which in turn was the only significant predictor of child fast-food consumption (p < 0.01).

DISCUSSION

The findings support the inclusion of parenting stress interventions that target fast-food eating behaviors in parents, which may in turn, reduce fast-food intake in their young children.

Relationship Between Food Security Status in a Caregiver's Family of Origin and Current Feeding Practices Among Low-Income, Single, Female Primary Caregivers

A child's familial environment is paramount to the formation and maintenance of their health behaviors. Factors that influence a child's health behaviors include parental modeling, types of available food, timing of food availability, and characteristics of the home environment. Previous research has demonstrated an association between a caregiver's current food security status and feeding practices, but no studies have explored the association between food security in the caregiver's childhood and their current feeding practices. This study investigates the relationship between parental food insecurity (both current and childhood) and child feeding practices. The US Household Food Security Survey and the Child Feeding Questionnaire were completed by 103 low-income, single, female primary caregivers. Results indicated that caregivers who reported current food insecurity expressed greater tendency to pressure their children to eat. Caregivers who reported food insecurity during their childhood also expressed greater tendency to pressure their children to eat and a greater concern about their child's weight. These findings can serve in both research and clinical efforts as an early screening tool to indicate families most in need of accessible resources. Findings also help to highlight the transgenerational nature of food insecurity, including its residual effects on health behaviors.

Infant Feeding Varies Across Eating Behavior and Feeding Modalities in Mothers With Low Income

OBJECTIVE

To examine if eating behaviors in mothers with low income relate to attitudes toward infant feeding and whether associations differed between breastfeeding and formula-feeding mothers.

DESIGN

Cross-sectional study.

PARTICIPANTS

Forty postpartum women (aged ≥ 18 years, body mass index ≥ 25 and &lt; 40 kg/m²) in the Louisiana Women, Infants, and Children program participated in a telehealth postpartum intervention for health and weight loss.

MAIN OUTCOME MEASURE(S)

Maternal eating behaviors and infant feeding styles, assessed 6-8 weeks after birth (baseline) using validated questionnaires.

ANALYSIS

Significance was detected using independent t tests, chi-square tests for independence, or linear models (P &lt; 0.05).

RESULTS

Most mothers formula-fed (n = 27, 68%). In formula-feeding mothers, maternal disinhibition and perceived hunger were positively associated with restrictive infant feeding (β = 0.41, P &lt;0.001 and β = 0.41, P = 0.001, respectively). These relationships were significantly higher (Δ = -0.85, P = 0.006 and Δ = -0.59, P = 0.003, respectively) than among breastfeeding mothers. Comparatively, pressuring/overfeeding was lower in formula-feeding mothers than among breastfeeding mothers with dietary restraint (Δ slopes: 1.06, P = 0.02).

CONCLUSIONS AND IMPLICATIONS

In this cohort of mothers with low income, maternal eating behavior was associated with infant feeding styles only when feeding modality was considered. Mothers may benefit from education on how their eating behaviors can influence their infants and children.

Psychometric properties and measurement invariance across gender of the Italian version of the tempest self-regulation questionnaire for eating adapted for young adults

The prevalence of overweight and obesity in young adults has increased dramatically in recent decades. The unhealthy eating habits that develop at this time can often lead to negative health consequences in the future. It is therefore important to learn about self-regulation and self-control strategies and help young adults to have healthy eating behaviours. This study aims to present an Italian version of the Tempest Self-Regulation Questionnaire for Eating (TESQ-E) adapted for young adults. The instrument assesses self-regulation and self-control strategies to counteract the desire and temptation to eat unhealthy food and to choose healthy foods. A total of 645 students (271 males and 374 females with an average age of 24.82 and SD = 4.34) took part in the study. The results of the confirmatory factor analysis supported the six first-order factors model concerning specific self-regulation strategies and a higher-order structure of the TESQ-E [χ² (152) = 336.480, p < 0.001; CFI = 0.95; RMSEA = 0.04; SRMR = 0.04]: three correlated second-order factors (addressing the temptation directly, addressing the psychological meaning of temptation, and addressing the goal directly) and one-third-order factor (self-regulatory competence). The results also confirmed the strong measurement invariance of the TESQ-E across gender. To have reliable comparisons across males and females, the latent mean differences tests were performed on the six specific self-regulation strategies. The analysis showed that females appear to prefer strategies that directly address the goal by expressing explicit intentions or plans to eat in a healthy way. Convergence validity was tested through correlations with Eating-Self-Efficacy Brief Scale (ESEBS), Emotional Eating Scale (EES), Scale of Attitudes towards Healthy Eating (SAHE), and Body Mass Index (BMI). In conclusion, the TESQ-E appears to be a psychometrically sound questionnaire that can be effectively used with young adults to measure self-regulation strategies in eating in order to plan personalised interventions for the prevention and control of the metabolic syndrome, and to reduce a wide range of diet-related diseases.

Use of a brief, retrospective Comprehensive Feeding Practices Questionnaire in a bariatric-surgery seeking adult population

Parental feeding practices in childhood have been shown to contribute to childhood eating habits, behaviors, and weight status. Less understood is the longitudinal impact of parental feeding practices on these variables in adulthood. Therefore, the aim of the present work was to validate a modified, brief, Comprehensive Feeding Practices Questionnaire (CFPQ) reformatted to account for retrospective recollections of parental feeding practices experienced in childhood among a sample of adults with obesity. Adults (n = 719, mean age = 44.3 years, mean BMI = 47.1 kg/m²) completed a modified, brief, retrospective CFPQ containing seven pre-defined subscales of the original CFPQ. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) procedures were used to evaluate survey factor structure and associations with gender, BMI, and self-reported race. An EFA derived six-factor model demonstrated better model fit and reliability than the originally proposed seven-factor model. Gender and self-reported race were not correlated with subscales of the brief, retrospective, CFPQ, while BMI was positively correlated with the Food as Reward subscale. This six-factor, brief, retrospective, CFPQ can be used to provide insight into the potential origins of individual eating behaviors, and warrants use in future work attempting to clarify the relationships between parental feeding practices and eating behaviors in adulthood.

Home Delivery of Water for Caries Prevention in Latinx Children (“Sediento por una Sonrisa,” Thirsty for a Smile): Protocol for a Single-Arm Feasibility Study

Background

Dental caries has significant public health implications afflicting young children. In addition to low social economic status, the most prominent risk factor for early childhood caries is sugar in the diet, particularly sugar-sweetened beverages. Dental treatment for caries in young children is commonly performed under general anesthesia and a significant proportion of children require repeated treatment. Interventions to reduce sugar-sweetened beverage consumption could lead to reduced rates of retreatment for dental caries in young children.

Objective

This protocol describes the rationale, design, and methods of the “Thirsty for a Smile” feasibility study. The aim of the study is to assess the feasibility, acceptability, and appropriateness of a dietary intervention promoting water consumption in lieu of sugar-sweetened beverages among young patients, mostly from Latino heritage.

Methods

This protocol describes a single-arm feasibility study. Twenty-one dyads of children and their caregivers will be recruited. Children between 2 and 9 years old who recently had treatment under general anesthesia for early childhood dental caries will be eligible to participate. The intervention has two components: (1) environmental, in which bottled water is delivered to participants’ homes; and (2) behavioral, in which caregivers will receive patient-centered counseling to increase children’s water intake and reduce sugar-sweetened beverages consumption. Dental caries and anthropometric data will be collected at examination during baseline and final visits. The primary outcome is feasibility and secondary outcomes are acceptability and appropriateness of the intervention.

Results

Funding has been obtained from the National Institute of Dental and Craniofacial Research and the University of Washington approved the study. The feasibility study was conducted from March to November 2019.

Conclusions

This feasibility study will test the study processes prior to a two-arm randomized controlled trial to determine feasibility and acceptability of the intervention and study procedures. This study may provide useful information for other researchers attempting to test similar interventions.

International Registered Report Identifier (IRRID)

RR1-10.2196/37200

Neophobia—A Natural Developmental Stage or Feeding Difficulties for Children?

Food neophobia is the tendency to reject or be reluctant to try new and unfamiliar foods. Due to the period of its occurrence, which falls in the years of early childhood, it can significantly affect the child’s food choices, shape taste preferences, and significantly influence the quality of the child’s diet. The neophobic attitude has an important evolutionary significance because it protects the individual from ingesting potentially dangerous substances. On the other hand, it fosters avoidance behaviors that can also relate to the beneficial aspects of obtaining and consuming food. Currently, the strong emphasis placed on food safety means that neophobia may be less adaptive; nevertheless, a conservative attitude toward new foods still prevails. There is a strong association between food neophobia and the diversity of a person’s diet and previous exposure to different foods. This review describes behaviors associated with food neophobia and analyzes other feeding and eating difficulties in children that should be differentiated from food neophobia. Management approaches affecting the reduction in food neophobia in children through various dietary and psychological interventions are also proposed.

A thematic cluster analysis of parents' online discussions about fussy eating

Food fussiness is associated with non‐responsive parent feeding practices, such as persuasive and instrumental feeding. Although most children described as ‘fussy eaters’ are likely exhibiting developmentally typical behaviours, up to half of the parents of children 2–5 years old express concerns. Concern for fussy eating may mediate the use of non‐responsive feeding practices and so must be addressed in parent feeding interventions. Therefore, it is critical to better understand parents' concerns and how they may relate to feeding practices. This study aimed to explore how parents' feeding practices and the social cognitive factors that may drive them clustered based on parents' concern for fussy eating. Data were collected from parent discussions of fussy eating on a Reddit forum (80,366 posts). Latent Dirichlet allocation was used to identify discussions of fussy eating. Relevant posts (1542) made by users who identified as a parent of a fussy eater (n = 630) underwent qualitative coding and thematic analysis. Five clusters of parents were identified, ranging in size from 53 to 189 users. These were primarily characterised by parents' degree of concern and feeding practices: (1) High concern, nonresponsive; (2) Concerned, nonresponsive; (3) Low concern, responsive; (4) Low concern, mixed strategies; (5) Low concern, indulgent. Parents who used responsive practices tended to be less concerned for fussy eating, have greater trust in their child's ability to self‐regulate hunger, have longer‐term feeding goals, and exhibit greater ability for personal self‐regulation. Future research should further examine how these constructs may be leveraged in parent feeding interventions.

Parents using nonresponsive practices to manage fussy eating may have more concerns about fussy eating, less trust in their child's ability to self‐regulate hunger, shorter‐term feeding goals, and less developed self‐regulation skills.

As most children described as “fussy eaters” are likely exhibiting developmentally typical behaviours, interventions addressing nutrition and feeding practices in early childhood should aim to alleviate parental concern for fussy eating, for example, by helping them recognise developmentally normal eating behaviours.

Early childhood feeding interventions may also be enhanced by helping parents to develop long‐term feeding goals and improved self‐regulation skills in the context of their feeding practices.

Frequency of family meals and food consumption in families at high risk of type 2 diabetes: the Feel4Diabetes-study

A family meal is defined as a meal consumed together by the members of a family or by having ≥ 1 parent present during a meal. The frequency of family meals has been associated with healthier food intake patterns in both children and parents. This study aimed to investigate in families at high risk for developing type 2 diabetes across Europe the association (i) between family meals' frequency and food consumption and diet quality among parents and (ii) between family meals' frequency and children's food consumption. Moreover, the study aimed to elucidate the mediating effect of parental diet quality on the association between family meals' frequency and children's food consumption. Food consumption frequency and anthropometric were collected cross-sectionally from a representative sample of 1964 families from the European Feel4Diabetes-study. Regression and mediation analyses were applied by gender of children. Positive and significant associations were found between the frequency of family meals and parental food consumption (β = 0.84; 95% CI 0.57, 1.45) and diet quality (β = 0.30; 95% CI 0.19, 0.42). For children, more frequent family meals were significantly associated with healthier food consumption (boys, β = 0.172, p < 0.05; girls, β = 0.114, p < 0.01). A partial mediation effect of the parental diet quality was shown on the association between the frequency of family meals and the consumption of some selected food items (i.e., milk products and salty snacks) among boys and girls. The strongest mediation effect of parental diet quality was found on the association between the frequency of family breakfast and the consumption of salty snacks and milk and milk products (62.5% and 37.5%, respectively) among girls.

CONCLUSIONS

The frequency of family meals is positively associated with improved food consumption patterns (i.e., higher intake of fruits and vegetables and reduced consumption of sweets) in both parents and children. However, the association in children is partially mediated by parents' diet quality. The promotion of consuming meals together in the family could be a potentially effective strategy for interventions aiming to establish and maintain healthy food consumption patterns among children.

TRIAL REGISTRATION

The Feel4Diabetes-study is registered with the clinical trials registry (NCT02393872), http://clinicaltrials.gov , March 20, 2015.

WHAT IS KNOWN

• Parents' eating habits and diet quality play an important role in shaping dietary patterns in children • Family meals frequency is associated with improved diet quality of children in healthy population What is New: • Frequency of family meals was significantly associated with healthier food consumption among parents and children in families at high risk of type 2 diabetes in six European countries. • Parental diet quality mediates the association between family meals frequency and the consumption of some selected food items among children.

Burden of Diabetes Mellitus in Nepal: An Analysis of Global Burden of Disease Study 2019

Globally, the number of people living with diabetes mellitus (DM) increased by 62% between 1990 and 2019, affecting 463 million people in 2019, and is projected to increase further by 51% by 2045. The increasing burden of DM that requires chronic care could have a considerable cost implication in the health system, particularly in resource constraint settings like Nepal. In this context, this study attempts to present the burden of DM in terms of prevalence, mortality, and disability adjusted life years (DALYs). The study is based on the Global Burden of Disease Study 2019, a multinational collaborative research, led by the Institute for Health Metrics and Evaluations. In the study, the overall prevalence of DM was estimated using DisMod MR-2.1, a Bayesian metaregression model. DALYs were estimated summing years of life lost due to premature death and years lived with disability. There were a total of 1,412,180 prevalent cases of DM, 3,474 deaths and 189,727 DALYs, due to DM in 2019. All-age prevalence rate and the age-standardized prevalence rate of DM stood at 4,642.83 (95% uncertainty interval (UI): 4,178.58-5,137.74) and 5,735.58 (95% UI: 5,168.74-6327.73) cases per 100,000 population, respectively, in 2019. In 2019, 1.8% (95% UI: 1.54, 2.07) of total deaths were from DM, which is a more than three-fold increase from the proportion of deaths attributed in 1990 (0.43%, 95% UI: 0.36, 0.5) with most of these deaths being from DM type 2. In 2019, a total of 189,727 disability adjusted life years (DALYs) were attributable to DM of which 105,950 DALYs were among males, and the remaining 83,777 DALYs were among females. Overall, between 1990 and 2019, the DALYs, attributable to Type 1 and 2 DM combined and for Type 2 DM only, have increased gradually across both sexes. However, the DALYs per 100,000 attributable to DM have slightly reduced across both sexes in that time. There is a high burden of DM in Nepal in 2019 with a steep increase in the proportion of deaths attributable to DM in Nepal which could pose a serious challenge to the health system. Primary prevention of DM requires collaborative efforts from multiple sectors. Meanwhile, the current federal structure could be an opportunity for integrated, locally tailored public health and clinical interventions for the prevention of the disease and its consequences.

Eating Behaviors of Children with Autism-Pilot Study, Part II

Autism spectrum disorder is characterized by social communication deficit and non-normative behavior. The people with autism often experience troubles with feeding. The purpose of this study was to conduct evaluation of the feeding and eating behaviors among children with autism. Patients and Methods: The study group included 41 high-functioning autistic children. The control group consisted of 34 children without the ASD. The questionnaire was used to assess the nutritional status. Results: The children with ASD fuss during mealtimes more frequently, they require entertaining and diverting their attention, they are fed by parents, and they consume their meals away from the table. The significant difference found in the use of utensils and food selectivity works to the disadvantage of the Study Group. Conclusions: The food selectivity occurs significantly more frequently among children with ASD. The feeding and eating problems should be considered on a wider scale. The cooperation of the multidisciplinary and the parents teams should be proposed in the ASD patients care.

Parent Gender Affects the Influence of Parent Emotional Eating and Feeding Practices on Child Emotional Eating

Extant research supports a direct association between parent's own emotional eating and their child's emotional eating, and demonstrates correlations among parent emotional eating, feeding practices, and child emotional eating. However, the majority of this work focuses on the separate influences of these factors. The current study aims to add to the literature by simultaneously examining the indirect effects of three major parental feeding practices (i.e., emotion regulation, instrumental, and restrictive feeding) in the association between parent emotional eating and child emotional eating, and exploring how these indirect effects vary based on parent gender. Parents (86 fathers, 324 mothers) of an elementary school-age child (M = 8.35, SD = 2.29, range = 5-13) completed an online survey through Qualtrics Panels. Results suggested that restrictive feeding partially accounted for the association between parent and child emotional eating in the combined sample of mothers and fathers. Exploratory analyses revealed that the indirect effects of parental feeding practices in the association between parent emotional eating and child emotional eating varied based on parent gender. Among mothers, restrictive feeding was the only feeding practice that partially accounted for the association between maternal and child emotional eating, whereas all three feeding practices fully accounted for the association between father and child emotional eating. As the bulk of the literature on parent emotional eating and feeding has solely focused on mothers, these findings offer insight into how feeding practices may differentially function in the relation between parent emotional eating and child emotional eating for mothers versus fathers.

Shared Dynamics of Food Decision-Making in Mother-Child Dyads

This study explored risk parameters of obesity in food decision-making in mother-child dyads. We tested 45 children between 8–12 years and their biological mothers to measure the decision weights of food health attributes, the decision weights of food taste attributes, self-regulated food decisions, and self-reported self-control scores. Maternal body mass index (BMI), and children's BMI-percentiles-for-age were also measured. We found a positive correlation between children's and their mothers' decision weights of taste attributes in food decision-making. We also found a positive correlation between children's BMI %iles and their mothers' BMIs. Children with overweight/obesity demonstrated lower correlations between health and taste ratings and a lower percentage of self-regulated food decisions (i.e., resisting to eat tasty but unhealthy foods or choosing to eat not-tasty but healthy foods) than children with healthy weight. Our findings suggested that the decision weights of taste attributes and weight status shared similar patterns in mother-child dyads. Also, the findings suggested that establishing dynamics of unhealthy food-decision making may increase the risk of childhood obesity. Helping children to develop the dynamics of healthy food-decision making by increasing the importance of health while decreasing the importance of taste may promote resilience to susceptibility to unhealthy eating and weight gain.

Eating Behaviors of Children with Autism-Pilot Study

Autism Spectrum Disorder (ASD) is the most recognized neuropsychiatric disorder of childhood. Comorbid conditions (such as feeding disorders) are more common among people with autism than among the general population. The most frequent somatic disorders in autistic children include the gastrointestinal disorders observed in 46-91% of patients. The purpose of this study was the evaluation of the nutrition of children with autism, with particular emphasis placed on feeding in the first year of life, in comparison to the group of healthy peers. Participants included 75 Caucasian children (41 children diagnosed with pure autism, and the control group consisting of 34 children without autistic traits). The analysis was performed based on a questionnaire of own design with the first part devoted to the eating practices of the early infancy. Results: Autistic children, as compared to the healthy peers, presented a shortened time of breastfeeding (the children fell asleep at the breast) (p = 0.04), a delayed introduction of dairy products (p = 0.001), the need of more trials to introduce new foods (p = 0.006), a delayed introduction of foods with solid and lumpy structure (p = 0.004), a longer duration of bottle feeding (p = 0.005), delayed attempts to eating using own hands (p = 0.006) and needed a greater support of parents to divert their attention from food during eating (p = 0.05). Conclusions: 1. The dietary problems are more common among children with the autism spectrum disorder than among the population of healthy children, during the first year of life from the time of introducing the complementary foods. 2. The autistic children experience difficulties with eating and require their parents' additional involvement significantly more often than their healthy peers.

Meat Reduction in 5 to 8 Years Old Children-A Survey to Investigate the Role of Parental Meat Attachment

It is by now well established that a plant-based and meatless or reduced-meat diet is an important contribution to a sustainability and healthy diet. This work discusses important determinants for parents of implementing a meat reduced diet for their children. A questionnaire was conducted with 90 parents of children aged 5-8 years living in Germany, where they had to choose one out of three options of a dish, namely meaty, reduced meat and no meat, for their child. The results show that the parent's attachment to meat and the associated attitudes and habits play a crucial role in their meal choice and therefore eating behaviour, including consumed amounts of meat, of their child. Moreover, perceived tastiness, healthiness and balanced serving style, as well as the child's preferences influences the parent's decision. The findings of this work provide valuable insights to the food industry and food producers, health professionals and public health, as it highlights the background, as well as some drivers and barriers for parents choosing a dish with less meat for their children.

Efficacy of a smartphone application-based intervention for encouraging children's healthy eating in Denmark

The growing rates of childhood obesity constitute a public health challenge worldwide. Therefore it is important to identify effective and widely applicable interventions to prevent it. This study aims to explore children's experience of using a newly developed smartphone application (app) designed to promote healthy eating and evaluate its efficacy on encouraging healthy eating. First, two focus groups were conducted to explore children's experience of using the app. Then, a quasi-experimental design was used to evaluate the app's efficacy. The children were asked to use the app for three months. Afterwards, the effect of the intervention was evaluated. 118 children aged 9 to 13 years (M=10.9, Sd=1.1) participated in the study. The children's experience of using the app was relatively positive, and they found the app easy to use. A significant increase in fruit (η2=.10) and vegetable preferences (η2=.37) and fruit intake (η2=.06) was found in the experimental group. No effects were found for vegetable intake, selfefficacy for healthy eating, or peer norms for healthy and unhealthy eating (p>0.05). The smartphone app-based intervention could potentially serve as an attractive and low-cost intervention to reach a wide population of children for the promotion of healthy eating and prevention of childhood obesity.

Effectiveness of an Innovative Sensory Approach to Improve Children's Nutritional Choices

A case-control study was conducted to investigate the effectiveness of the Edueat^® Method, through experiential workshops focused on the use of all 5 senses. In two different primary schools in the same city, questionnaires were administered in two months with a follow-up one year later. Participants: 119 children (age 8.2–9.0) chosen randomly; control group 66 (55.5%). Seven lessons of 2 h each were held in the schools by experts of the Edueat^® method and seven extra lessons by the teachers. The main outcome measures were the children’s changes in their approach and attitude towards their eating habits. The answers were grouped with factor analysis and summarized through scores. Repeated-measures analysis of variance was conducted in order to identify the relationships between scores and treatment over time. At the end of treatment, the intervention group showed a significant appreciation towards healthy foods (+4.15 vs. −0.05, p = 0.02) and a greater capacity in identifying foods which are very good for the health (+15.6 vs. +14.4, p = 0.02). In conclusion, the Edueat^® method was found to be particularly promising in transmitting knowledge of those foods which are healthy. Greater involvement of teachers and parents is crucial.

Policy and Food Consumption: What Nutrition Guidelines Are Swiss Children Meeting and What Determines Adherence?

Objectives: To describe the adherence of the children to the Swiss Society for Nutrition (SSN) dietary guidelines, assess determinants of adherence, and compare these findings with a previous study in the same population.

Methods: Data from 312 children ages 5–12 were collected through a survey and a 2-day food record. The associations of children- and parent-related factors with adherence of the children to guidelines were assessed by logistic regression analyses.

Results: SSN guidelines were not met for any food category, although there were improvements: vegetables (4.5% in this study vs. 0% in the previous study), sweets, snacks, and soft drinks (SSD) (12.5 vs. 9.5%), and fruit (45.5 vs. 10.4%). Higher Body Mass Index (BMI) in children was associated with higher adherence to guidelines for protein intake. Higher parental BMI was associated with higher adherence to vegetables. Parental lower educational level was associated with higher adherence for cereal.

Conclusion: Despite improvements since the last eating behavior assessment in this population, children consume too little fruit, vegetables, cereal, and milk and dairy products, and too much SSD and proteins. Further efforts are needed to promote healthy eating to children and achieve adherence to guidelines.

Do children favor snacks and dislike vegetables? Exploring children's food preferences using drawing as a projective technique. A cross-cultural study

OBJECTIVE

To avoid the rising spread of childhood obesity and preserve resources within planetary boundaries, healthy and sustainable eating habits and the consumption of adequate amounts of fruits and vegetables should be encouraged. Children's food preference was found to be an important determinant for food choice and consumption. The aim of this study was to explore children's food preferences using drawing as a projective technique in terms of healthy and sustainable eating and compare food preference patterns in Denmark and Lithuania.

METHOD

In total 484 children, aged between 8 and 13 years old, participated in the study (147 in Denmark and 337 in Lithuania). Participants were asked to fill the food preference questionnaire and answer questions about their daily intake of fruits, vegetables, and snacks and draw their favorite meal afterward. Sociodemographic questions about children's age, gender, parents' employment, and family composition were also included in the questionnaire.

RESULTS

Fruits, vegetables, highly-processed and animal-based foods were not included in a large part of children's most preferred meal composition. Favorite meals' composition varied among children in both countries and included different products from separate food groups. Vegetables were more likely to be present in the children's favorite meals together with meat products. Girls in both countries had more expressed vegetable preferences than boys. Boys in Lithuania had a relatively more expressed preference for highly-processed foods, while Danish girls had a more expressed preference for animal-based products.

CONCLUSIONS

Children's preferences for foods such as meat and animal-based products expressed in children's drawings, might be considered as relatively positive in terms of sustainable eating. However, children's preferences and intake of fruits and vegetables should still be encouraged among young consumers. Cultural and gender differences in children's food preferences should be considered while creating interventions and marketing strategies for promoting healthy and sustainable eating among young consumers.

Understanding Preschoolers' Anticipation of Trying A New Food and Past Food Experiences

OBJECTIVE

The primary objectives of the study were to explore (1) preschoolers' anticipation when trying a new food and (2) preschoolers' past experiences with the food they like and do not like.

METHODS

Two semistructured interviews were conducted 3-7 days apart with each participant. Through thematic analysis, themes and subthemes related to children's food-related perspectives were identified.

RESULTS

A total of 34 preschoolers (4-5 years old) from low-income families in North Carolina participated in the study. Three major themes were found: preschoolers' avoidance techniques, predictors behind preschoolers' food-related emotions, and preschoolers' description of their food preferences.

CONCLUSIONS AND IMPLICATIONS

Preschoolers were able to discuss both their positive and negative food-related emotions and perspectives. Thus, strategies allowing children to discuss their perspectives of food could provide new insights into children's food preferences and improve dietary quality.

The Effect of Schooling on Women's Overweight and Obesity: A Natural Experiment in Nigeria

An extensive social scientific literature has documented the importance of schooling in preventing overweight and obesity among women. However, prior quasi-experimental studies investigating the causal effect of schooling on women's overweight and obesity have focused almost exclusively on high-income countries (HICs). Schooling effects may differ in low- or middle-income countries (LMICs), where information about the harms of being overweight is often sparse and where larger body sizes can be socially valued. Here I evaluate the causal impact of schooling on women's probability of being overweight or obese in an LMIC, Nigeria, using data from the 2003, 2008, and 2013 Demographic Health Surveys. In 1976, the Nigerian government abolished primary school fees and increased funding for primary school construction, creating quasi-random variation in access to primary school according to an individual's age and the number of newly constructed schools in their state of residence. I exploit both sources of variation and use a two-stage instrumental variables approach to estimate the effect of increased schooling on the probability of being overweight or obese. Each additional year of schooling increased the probability of being overweight or obese by 6%, but this effect estimate was not statistically different from zero. This finding differs from the protective effect of schooling documented in several HICs, suggesting that contextual factors play an important role calibrating the influence of additional schooling on overweight or obesity. Furthermore, my findings contrast markedly with the positive correlation between schooling and overweight/obesity identified in previous studies in Nigeria, suggesting that studies failing to account for selection bias overestimate the causal effect of schooling. More robust causal research is needed to examine the effect of schooling on overweight and obesity in LMIC contexts.

Mothers' Perceptions and Attitudes towards Children's Vegetable Consumption-A Qualitative, Cross-cultural Study of Chilean, Chinese and American Mothers Living in Northern California

This exploratory research focused on the cultural variables involved in children’s vegetable consumption, through the analysis of mothers’ perceptions, attitudes, and feeding practices regarding their children’s intake, using qualitative consumer research methods. Twelve focus groups of mothers with children between 2–12 years old (Euro-Americans n = 20, Chinese n = 19, and Chilean n = 19) were conducted. All participants lived in Northern California, had higher education, and incomes that did not limit their vegetable purchase. Intercultural differences in vegetable preferences and consumption habits were found. Mothers across all groups agreed on the importance of children’s vegetable consumption, the influence that mothers have over their children’s vegetable intake, and how challenging it is to get children to eat a variety of vegetables. The ethnic groups differed regarding how they perceived the level of mothers’ responsibility over children’s vegetable intake, the way that mothers defined the amount of vegetables that children should eat, the constraints that mothers had on increasing their children’s vegetable intake and mothers’ recommendations to encourage vegetable consumption. Our study suggests that under similar socio-economic and parental education levels, culture-specific strategies should be considered to foster healthy dietary habits in children.

Cross-Sectional Associations Between Mothers and Children's Breakfast Routine-The Feel4Diabetes-Study

Positive influences of family members have been associated with a high probability of children’s daily breakfast consumption. Therefore, the aim of this study was to scrutinize the association of breakfast routines between mothers and their children. The baseline data of the Feel4Diabetes-study was obtained in 9760 children (49.05% boys)–mother pairs in six European countries. A parental self-reported questionnaire gauging the frequency of breakfast consumption and of breakfast´ foods and beverages consumption was used. Agreement in routines of mothers and their children’s breakfast consumption was analyzed in sex-specific crosstabs. The relationship of breakfast routine and food groups’ consumption between mothers and their children was assessed with analysis of covariance. The highest proportion of children who always consumed breakfast were those whose mothers always consumed it. Children consuming breakfast regularly had a higher intake of milk or unsweetened dairy products and all kind of cereal products (low fiber and whole-grain) than occasional breakfast consumers (p < 0.05). The strong similarity between mothers and children suggests a transfer of breakfast routine from mothers to their children, as a high proportion of children who usually consume breakfast were from mothers also consuming breakfast. All breakfast foods and beverages consumption frequencies were similar between children and their mothers.

Early childhood factors associated with obesity at age 8 in Vietnamese children: The Young Lives Cohort Study

Background

Over recent decades, Vietnam has experienced rapid economic growth, a nutrition transition from the traditional diet to highly-processed and calorie-dense foods and beverages, and an increasing prevalence of childhood overweight/obesity (ow/ob). The goal of this study is to describe the patterns of ow/ob in a longitudinal sample of Vietnamese children from ages 1 to 8, and the sociodemographic and behavioral factors associated with ow/ob at age 8.

Methods

This study is a secondary data analysis of a geographically-representative, longitudinal cohort of 1961 Vietnamese children from the Young Lives Cohort Study from 2002 to 2009. Thirty-one communities were selected with oversampling in rural communities, and children age 1 were recruited from each community using simple random sampling. Surveys of families and measurements of children were collected at child ages 1, 5, and 8. Our specified outcome measure was childhood ow/ob at age 8, defined by the World Health Organization’s thresholds for body-mass-index (BMI) for age Z-scores. Associations between early and concurrent socio-behavioral factors, childhood nutrition and physical activity variables were analyzed using STATA 15. Bivariate and multivariable analyses were completed utilizing logistic regression models.

Results

The prevalence of ow/ob increased from 1.1% in both sexes at age 1 to 7% in females and 13% in males at age 8. Bivariate analyses show greater likelihood of ow/ob at age 8 was significantly associated with early life sociodemographic factors (at age 1), male sex (OR = 2.2, 1.6–3.1), higher wealth (OR = 1.1–1.4), and urban residence (OR = 4.3, 3–6). In adjusted analyses, ow/ob at age 8 was associated with early nutrition practices at age 5, including frequent consumption of powdered milk (OR = 2.8, 1.6–4.6), honey/sugar (OR = 2.7, 1.8–4.1), prepared restaurant/fast foods (OR = 4.6, 2.6–8.2), and packaged sweets (OR = 3.4, 2.3–4.9). In addition, breastfeeding for 6 months or longer was protective against obesity at age 8 (OR = 0.3, 0.1–0.9).

Conclusions

We found that increased consumption of powdered milk, honey/sugar, packaged sweets, and prepared restaurants/fast foods are associated with childhood ow/ob. In contrast, breastfeeding for 6 months or longer was protective against childhood ow/ob. These findings suggest that public health programs and campaigns aimed to prevent childhood ow/ob in Vietnam should target early feeding practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10292-z.

Irradiation and Consumers Acceptance

Treatment of foods with irradiation is an effective means to prevent food-borne diseases which cause massive disruptions to the health and economic systems of societies. Although the safety of irradiation technology to process foods has been extensively proven and it is highly regulated, some consumers are still reluctant to accept irradiated foods. The lack of access to science-based knowledge coupled with actions from consumer groups and the need for labeling hamper the commercial success of irradiated foods that are safe and nutritious. This article provides an overview of how consumers perceive irradiated foods and the factors affecting their acceptance.

The New school food standards and nutrition of school children: Direct and Indirect Effect Analysis

The Healthy, Hunger-Free Kids Act (HHFKA) of 2010 made sweeping changes to school nutritional standards. We estimate the impacts of shifts in school nutritional standards on dietary quality as well as dietary quantity of children's food intakes from school and away-from-school food sources. We find the average effect of consuming school food, rather than away-from-school food, on children's overall dietary quality significantly increased from the pre- to post-HHFKA implementation period. This effect was solely driven by substantial improvements in the dietary quality of foods acquired at school, mainly among older and higher-income children. Our indirect effect analysis indicated that children shifted towards consuming lower-quality diets at home in the post-HHFKA period, thereby partially offsetting the positive effects of the HHFKA on their overall dietary quality. Indirect impacts were primarily driven by a subset of children consuming more than a third of their daily calories from school food. Additionally, we find suggestive evidence of a modest decrease in daily calorie intake, particularly among older and higher-income children. Together, our findings imply that the HHFKA, despite its unintended negative indirect effects, led children to consume more-nutritious, less-energy-dense diets.

The Relationships Between Parental Stress, Home Food Environment, and Child Diet Patterns in Families of Preschool Children

PURPOSE

Home food environment, including home food availability and parental food preparation practices, plays a significant role in child diet patterns. Recent evidence suggests that parental psychological stress is related to parental food preparation practices; however, there is limited information about the relationship between parental psychological stress and home food availability. The purpose of the study is to examine the relationships between parental stress, home food availability, child diet patterns, and body mass index (BMI) in families with young children.

DESIGN

A secondary data analysis from a mixed-methods design study.

SETTING

The parent study was conducted in both local and online communities using a web-based survey.

PARTICIPANTS

Participants were 256 parents of children aged 2 to 5 years (53.4% white; 41.5% of overweight or obese children).

MEASURES

Parents completed well-validated self-report questionnaires.

ANALYSIS

We used latent structural equation modeling using Bayesian analysis.

RESULTS

There was a negative relationship between parents' general stress and healthy food availability at home (β* = -.20, P < .001 for fruits; β* = -.23, P < .001 for vegetables; and β* = -.24, P < .001 for healthy beverage) and a positive relationship between parenting stress and healthy snack and healthy beverage availability (β = .13, P = .03; β = .14, P = .02, respectively). There was no relationship between parental stress and unhealthy food availability at home while unhealthy food availability was significantly associated with child's unhealthy eating pattern (β* = .86, P < .01 for unhealthy snack; β* = .51, P < .01 for unhealthy beverage). There was no moderating effect of children's health insurance on the relationships between parental stress and home food availability. Furthermore, child diet patterns were not associated with child BMI.

CONCLUSION

Parental psychological stress is a potentially important intervention target point for improving home food environment and child diet patterns.

Retrospective reports of childhood feeding in mother-daughter dyads

Significant research has linked parents' feeding practices to children's eating habits. However, much less is known about how childhood feeding relates to longer-term outcomes such as eating in adulthood. The current study uses retrospective reports from mother-daughter dyads (N = 217) to compare childhood feeding practices and to examine how recalled feeding is related to current eating (emotional eating, intuitive eating, unrestrained eating) and body mass index (BMI) in adult daughters. Mothers and daughters completed the Comprehensive Feeding Practices Questionnaire (CFPQ), subscales from the Three Factor Eating Questionnaire, and the Intuitive Eating Scale. Results of an exploratory factor analysis indicated that mothers and daughters largely had similar factor structures on retrospective reports, with factor loadings varying on four of twelve original CFPQ subscales: monitoring, restriction for health, child control, and modelling. Paired samples t-tests examined mean differences between mother and daughter reports on each subscale; there was no significant difference between mother and daughter reports on six of the 11 scales. Daughters reported significantly higher levels of pressure to eat; mothers reported significantly higher levels of healthy practices, child control, involvement, and unhealthy environment than their daughters recalled. Hierarchical regressions revealed that daughters' reports of specific childhood feeding practices accounted for significant change in unadjusted variance for uncontrolled eating (18.8%), emotional eating (13.1%), intuitive eating (14.7%), and BMI (16.1%). Similarly, regressions revealed that mothers' reports of childhood feeding practices accounted for significant change in unadjusted variance for emotional eating (11.5%) and BMI (11.2%), but not uncontrolled or intuitive eating. Collectively, results lend strong support to the use of retrospective reports on childhood feeding and provide evidence that recalled childhood feeding practices have lasting relations with adult eating behaviors.

Correlates of body mass index among primary school children in Ho Chi Minh City, Vietnam

OBJECTIVES

To document the prevalence of overweight and obesity and examine associated risk factors.

STUDY DESIGN

A cross-sectional survey was conducted in 16 primary public schools in eight districts of Ho Chi Minh City in 2016. A multistage clustering sampling method was used to collect a sample of 1806 pupils attending the first, second, and third grades (7-9 years).

METHODS

Age- and sex-adjusted body mass index (BMI) status was defined using International Obesity Taskforce cut-offs. Ordered probit regression models were used to assess the association between child BMI and its socio-economic and demographic risk factors. The model was estimated separately for boys and girls to assess the extent to which the socio-economic gradients in BMI vary by gender.

RESULTS

The prevalence of obesity among boys was twice the rate for girls (24.7 vs 12.3%). The prevalence of overweight and obesity were also higher among pupils attending schools located in urban districts than in semi-rural districts. Gender, household wealth, the frequency of having breakfast at home, parental body weight, and school location were strong predictors of child BMI status. The protective effect of having breakfast more frequently at home against the risk of overweight/obesity was more pronounced in girls than in boys. Father's body weight and child BMI were more strongly associated with boys from poorer households than boys from wealthier households, while the differences were not significant for girls.

CONCLUSIONS

The high prevalence of childhood overweight and obesity indicates an urgent need for more gender-specific, effective intervention, and prevention programs.

Study Protocol of the Parents in Child Nutrition Informing Community (PICNIC) Peer Education Cohort Study to Improve Child Feeding and Dietary Intake of Children Aged Six Months to Three Years Old

One in five Australian pre-schoolers are overweight or obese, meaning the first years of life are vital for obesity primary prevention. Parent child feeding practices impact on children’s dietary intake, which in turn impacts on their weight status. Parents’ child feeding beliefs are heavily influenced by parenting peers. The aim of this cohort study is to evaluate the impact of the Parents in Child Nutrition Informing Community (PICNIC) study on parents feeding practices and diet quality. The secondary outcomes are the perceptions of trained peer educators and education recipients based on their involvement in PICNIC. One hundred parents with a child aged 0–2 years at time of recruitment will participate in peer educator training, then disseminate nutrition and child feeding content to other parents over an intervention period of 12 months, supported by project-specific, evidence-based social media pages and website. An additional 100 new parents, recruited by peer educators, will participate in the study as nutrition education recipients. Both peer educators and education recipients will complete quantitative child feeding surveys before and during the 12 month intervention and a dietary intake survey at a time point 12 months post intervention. Following the intervention, 30 education recipients will be asked to participate in semi-structured phone interviews about their experiences with PICNIC. Peer educators will contribute as co-researchers and active participants in the evolution of the PICNIC model. This study will contribute to enhanced understanding of contemporary health literacy strategies for communicating nutrition and feeding messages to new parents and the impact of these strategies on parents feeding practices and children’s dietary intake in a community setting.

Home Cooking and Child Obesity in Japan: Results from the A-CHILD Study

This study aimed to investigate the association between the frequency of home cooking and obesity among children in Japan. We used cross-sectional data from the Adachi Child Health Impact of Living Difficulty study, a population-based sample targeting all fourth-grade students aged 9 to 10 in Adachi City, Tokyo, Japan. Frequency of home cooking was assessed by a questionnaire for 4258 caregivers and classified as high (almost every day), medium (4-5 days/week), or low (≤3 days/week). School health checkup data on height and weight were used to calculate body mass index z-scores. Overall, 2.4% and 10.8% of children were exposed to low and medium frequencies of home cooking, respectively. After adjusting for confounding factors, children with a low frequency of home cooking were 2.27 times (95% confidence interval: 1.16-4.45) more likely to be obese, compared with those with a high frequency of home cooking. After adjustment for children's obesity-related eating behaviors (frequency of vegetable and breakfast intake and snacking habits) as potential mediating factors, the relative risk ratio of obesity became statistically non-significant (1.90; 95% confidence interval: 0.95-3.82). A low frequency of home cooking is associated with obesity among children in Japan, and this link may be explained by unhealthy eating behaviors.