Meeting calcium recommendations during middle childhood reflects mother-daughter beverage choices and predicts bone mineral status

Impact of Soft Drink Intake on Bone Development and Risk of Fractures in a Danish Cohort of Schoolchildren

BACKGROUND AND AIMS

Soft drink consumption is suspected to negatively impact bone health in children, but longitudinal evidence is limited. This study assessed the association between soft drink intake and bone health outcomes in Danish schoolchildren aged 7.7-12 years, within a physical activity intervention framework.

METHODS

This study was nested in the CHAMPS-DK trial, a quasi-experimental study. Participants (n = 529) were recruited from intervention schools offering 270 min of physical education (PE) per week (active arm) and control schools with 90 min of standard PE. Soft drink intake was assessed via a food-frequency questionnaire at baseline. Dual-energy X-ray absorptiometry (DXA) was used to measure Bone Mineral Content (BMC), Bone Area (BA), and Bone Mineral Density (BMD) at baseline and two-year follow-up (primary outcomes). Fracture incidence over a five-year period was recorded using the SMS-Track parental reporting system (secondary outcome). Multilevel mixed-effects linear regression and Weibull survival models were used to analyze associations.

RESULTS

Soft drink intake of more than twice per month did not significantly affect BMC, BA, or BMD over two years (Total body BMD: β = 0.004; 95% CI: (-0.007; 0.016). Adjustment for confounders such as age, sex, BMI, pubertal status, socioeconomic status, and physical activity did not change the results. Additionally, no significant difference in fracture risk was observed (HR = 0.86; 95% CI: [0.43; 1.71]).

CONCLUSIONS

Soft drink intake had no measurable impact on bone health indices or fracture risk in children, irrespective of PE intervention. Future studies should investigate the effects of specific soft drink types (carbonated vs. non-carbonated) on bone development.

Association of Parent and Child Intuitive Eating: A Scoping Review

Children's eating behaviors are dependent on childhood food experiences, which involve their parental feeding practices, home food environments, and modeling of eating behavior. Intuitive eating (IE) promotes eating based on internal hunger and satiety cues. IE has been associated with improvements in mental and physical health. There has been increasing interest in exploring the association between parent and child IE. The aim of this scoping review was to synthesize current literature reporting on parent and child IE associations. Four databases (MEDLINE, EMBASE, Web of Science and CINAHL) were searched using keywords focusing on IE, parents, and children. Inclusion criteria were reporting on parental and/or child IE, and reporting on parent-child relationships. After screening, 15 studies were retained. From these, 3 main correlations were described. Parental IE was associated with child feeding, child weight concerns, and the home food environment. As well, environmental factors (i.e., family cohesion, food security) were associated with components of child IE. Moreover, IE was directly correlated between parents and children. Overall, this study highlights how child IE behaviors may be shaped by both parental IE and the broader environments that they are raised within. Additional high-quality studies are required to verify these findings.

A synthesis of early antecedents of eating behavior and weight status in girls: The legacy of girls' NEEDS project

Dr. Leann Birch, an innovator in the field of children's eating behavior, was the first scientist to synergize the fields of developmental psychology and nutrition science. One of Leann's groundbreaking projects was the Girls' NEEDS Project (GNP), an NIH-funded observational study of the longitudinal development of eating and weight-related behaviors of girls across middle childhood and adolescence. At the time of GNP, obesity prevalence during childhood had roughly doubled during the previous two decades, research interest in dieting had increased as societal expectations of the 'thin ideal' got even thinner, and little was known about how environmental factors such as parenting influenced the development of maladaptive eating and weight-related behaviors. GNP resulted in over 70 publications, covering a range of topics from girls' dietary intake and physical activity to parental influences on girls' eating behavior, thus laying the groundwork for many topics in the obesity, food parenting, and dieting literature today. Therefore, this narrative review aims to summarize and synthesize the literature that resulted from the GNP and provide implications for future work building from this foundation.

Increasing dietary calcium intake of children and their parents: a randomised controlled trial

OBJECTIVE

Approximately 25 % of Canadian children aged 4-8 years fail to meet the recommended dietary allowance (RDA) of calcium (Ca). Young children's food choices are primarily determined by their parents. No interventions have directly targeted parents as a medium through which to increase children's Ca consumption. This study compared the effectiveness of a Ca-specific intervention targeted towards parents, with generic dietary advice on the Ca consumption of children aged 4-10 years.

DESIGN

A parallel two-arm randomised controlled trial was conducted.

SETTING

The study was conducted across Canada. Both conditions received information on the RDA of Ca and an index of intake requirements. Material sent to the intervention condition included behavioural strategies to increase dietary Ca consumption, information on the benefits of dietary Ca intake and messages addressing perceived barriers to the consumption of Ca-rich foods.

PARTICIPANTS

A total of 239 parents (93 % mothers) of children aged 4-10 years who consumed less than the RDA of Ca were randomly assigned in a 1:1 allocation ratio.

RESULTS

There was a significant increase in total Ca intake and Ca from dairy for children at weeks 8, 34 and 52 (P ≤ 0·001) in both conditions. Parental Ca intake and amount spent on dairy products did not significantly increase following the intervention.

CONCLUSIONS

Provision of daily Ca requirements with regular reminders could impact parents' delivery of Ca-rich foods to their children. This finding is important for public health messaging as it suggests that parents are a potent medium through which to promote Ca intake in children.

Sugar-sweetened beverage consumption and bone health: a systematic review and meta-analysis

BACKGROUND

Current evidence demonstrate that sugar-sweetened beverages (SSBs) and bone health are related; however, there has been only a few reviews on the link between SSBs and bone health. A systematic review and meta-analysis was performed to investigate the association between SSBs consumption and bone health in chidren and adults.

METHODS

Relevant studies of SSBs and bone health published up to 15 March 2021 were searched using PubMed, the Web of Science, Cochrane Library, and a reference search. A random-effects meta-analysis was conducted to estimate the standardized mean difference (SMD). Subgroup analyses were performed to identify whether effects were modified by age, sex, measured skeletal sites, type of SSBs, and SSBs intake questionnaire.

RESULTS

Twenty-six publications including 124,691 participants were selected on the review. The results from this meta-analysis showed a significant inverse association between SSBs intake and bone mineral density (BMD) in adults (ES: -0.66, 95% CI: - 1.01, - 0.31, n = 4312). Eighteen of the 20 studies included in the qualitative-only review in children and adults supported the findings from the meta-analysis. When subgroup analysis was performed according to skeletal site, a large effect was found on whole body BMD (ES: -0.97, 95% CI: - 1.54, - 0.40). There was a moderate effect on BMD in females (ES: -0.50, 95% CI: - 0.87, - 0.13). There was a moderate or large effect on BMD in individuals aged under 50 years (under 30 years: ES: -0.57, 95% CI: - 0.97, - 0.17; 30 to 50 years: ES: -1.33, 95% CI: - 1.72, - 0.93). High consumption of carbonated beverages had a moderate effect on BMD (ES: -0.73, 95% CI: - 1.12, - 0.35).

CONCLUSION

The meta-analysis showed that SSBs consumption such as carbonated beverages were inversely related to BMD in adults. Qualitative review supported the results of meta-analysis.

TRIAL REGISTRATION

This review was registered in the PROSPERO database under identifier CRD42020164428 .

Analysis of Fruit and Vegetable Consumption by Children in School Canteens Depending on Selected Sociodemographic Factors

Background and Objectives: Eating habits acquired or changed during childhood are likely to track into adulthood. Due to the fact that nutritional behaviours are not so strongly formed among children, it is easier to change and develop them in children than in adults. The aim of this study was to assess the impact of selected sociodemographic factors affecting fruit and vegetable consumption (i.e., age, parents' body mass index, parents' level education, duration of breastfeeding, child's time spent in front of computer/television) among children in school canteens. Materials and Methods: The sample consisted of 106 participants (52 girls, 54 boys) aged 6-12. The frequency of consuming fruits and vegetables at a school canteen was assessed using bar code cards for two weeks. Body composition estimates were obtained using a foot-to-foot bioelectrical impedance analysis, body height was measured using a stadiometer Seca 213. The questionnaire contained questions about selected factors which can have an influence on fruit and vegetable consumption. In the study group, 13.2% of participants were overweight and 17.9% were obese. Results: Our results showed a statistically significant relationship between age and fruit and vegetable consumption, and it increased with age in both sexes. Conclusions: Bearing in mind the various conditions discussed when shaping the eating habits of pre-school- and early-school-aged children, the importance of proper nutritional education should be stressed both among children and parents.

A critical review of the role of milk and other dairy products in the development of obesity in children and adolescents

Existing reviews suggest that milk and other dairy products do not play a role in the development of obesity in childhood, but they do make an important contribution to children's nutrient intake. It is thus curious that public health advice on the consumption of dairy products for children is often perceived as unclear. The present review aimed to provide an overview of the totality of the evidence on the association between milk and other dairy products, and obesity and indicators of adiposity, in children. Our search identified forty-three cross-sectional studies, thirty-one longitudinal cohort studies and twenty randomised controlled trials. We found that milk and other dairy products are consistently found to be not associated, or inversely associated, with obesity and indicators of adiposity in children. Adjustment for energy intake tended to change inverse associations to neutral. Also, we found little evidence to suggest that the relationship varied by type of milk or dairy product, or age of the children, although there was a dearth of evidence for young children. Only nine of the ninety-four studies found a positive association between milk and other dairy products and body fatness. There may be some plausible mechanisms underlying the effect of milk and other dairy products on adiposity that influence energy and fat balance, possibly through fat absorption, appetite or metabolic activity of gut microbiota. In conclusion, there is little evidence to support a concern to limit the consumption of milk and other dairy products for children on the grounds that they may promote obesity.

Parent and household influences on calcium intake among early adolescents

BACKGROUND

Calcium intake during early adolescence falls short of requirements for maximum bone accretion. Parents and the home food environment potentially influence children's calcium intakes. This study aimed to quantify parental psychosocial factors (PSF) predicting calcium intakes of Asian, Hispanic, and non-Hispanic white (NHW) early adolescent children from a parental perspective.

METHODS

This was a cross-sectional study involving the administration of a validated calcium-specific food frequency questionnaire to a convenience sample of children aged 10-13 years and the primary individual responsible for food acquisition in the child's household. Based on Social Cognitive Theory, parental factors potentially associated with children's calcium intake were also assessed via parent questionnaires. The total study sample consisted of 633 parent-child pairs (Asian = 110, Hispanic = 239, NHW = 284). Questionnaires were completed at community-based centers/sites. Outcome measures were the association between parent-child calcium (mg), milk (cups/day), and soda (cans/day) intakes and the predictive value of significant parental PSF towards calcium intakes of their children. Sex-adjusted linear regression and multivariate analyses were performed.

RESULTS

Calcium intakes of parent-child pairs were positively associated among all ethnic groups (r = 0.296; P < 0.001). Soda intakes were positively associated among Hispanic parent-child pairs only (r = 0.343; P < 0.001). Home availability of calcium-rich foods (CRF), parental rules and expectations for their child's intake of beverages, and parents' calcium intake/role modeling were positively associated with children's calcium intake and overwhelmed all other PSF in multivariate analyses. Significant cultural differences were observed. Parental role modeling was a significant factor among Hispanic dyads only. Multivariate models explained 19-21% of the variance in children's calcium intakes.

CONCLUSIONS

Nutrition interventions to improve children's calcium intakes should focus on parents and provide guidance on improving home availability of CRF and increasing rules and expectations for the consumption of CRF. Among Hispanic families, interventions promoting parental modeling of desired dietary behaviors may be most successful.

Are consumption of dairy products and physical activity independently related to bone mineral density of 6-year-old children? Longitudinal and cross-sectional analyses in a birth cohort from Brazil

OBJECTIVE

To evaluate cross-sectional and longitudinal associations of consumption of dairy products and physical activity (PA) with bone mineral density (BMD).

DESIGN

Cohort study with children from the 2004 Pelotas (Brazil) Birth Cohort.

SETTING

Pelotas, a medium-sized Brazilian city.

SUBJECTS

The study started in 2004 and mothers/children were interviewed/measured periodically from birth to age 6 years. PA was measured by maternal proxy at 4 and 6 years and by accelerometry at 6 years. Consumption of dairy products was measured using 24 h food recall (at 4 years) and FFQ (at 6 years). Total-body and lumbar-spine BMD (g/cm2) were measured by dual-energy X-ray absorptiometry.

RESULTS

At 6 years, BMD was measured in 3444 children and 2636 children provided data on objectively measured PA by accelerometry. Consumption of dairy products at 4 years was associated with higher lumbar-spine BMD at 6 years in boys, while current consumption was positively associated with BMD in both sexes (P < 0·001). PA assessed by maternal report at 4 and 6 years of age was associated with higher BMD at 6 years in boys. PA assessed by accelerometry was positively related to total-body and lumbar-spine BMD in boys and lumbar-spine BMD in girls. We did not find evidence for an interaction between PA and consumption of dairy products on BMD.

CONCLUSIONS

We observed positive and independent longitudinal and cross-sectional associations between consumption of dairy products and PA with BMD in the total body and at the lumbar spine in young children.

Do Preschools Offer Healthy Beverages to Children? A Nationwide Study in Poland

Background: Children’s beverage consumption patterns have received increased attention in light of the obesity epidemic in this group. In day care centers (DCCs), children spend up to 10 h a day, and typically consume half to three quarters of their daily food intake. The purpose of the study was to investigate what beverages are typically served to children in preschools in Poland, and to evaluate the practices associated with adding sugar and other sweetening agents to beverages. Methods: Direct interviews with preschools staff were conducted with a questionnaire regarding offered beverages and adding sugar and other sweetening agents. The menu of 10 consecutive days and inventory reports were analyzed to verify information. Results: A total of 720 preschools were included in the study. Cocoa and milk coffee substitute were served in 95% of preschools, followed by compote (92%), tea (84%), fruit/herbal tea (73%) and water (69%). Water was the only beverage available between meals (93% DCCs). 86% of preschools added sugar to tea/cocoa/coffee substitute drinks, and 74% to compote. Conclusions: In the majority of preschools, beverages which are not recommended were offered. Such an assortment of beverages and common practice of sweetening can increase the amount of added sugar in a children diet. Nutrition education and legal regulations concerning the assortment of beverages served in preschools are urgently needed.

Strategies for public health initiatives targeting dairy consumption in young children: a qualitative formative investigation of parent perceptions

OBJECTIVE

Dairy products contain essential nutrients to ensure healthy growth and bone development in children. However, a significant proportion of children in developed countries fail to consume the daily recommended intake of dairy products. Parents are the gatekeepers of familial nutritional intake and represent a potential vehicle through which to increase dairy consumption in children. As such, formative research was conducted to gain insight into parents' perceived barriers to and benefits of purchasing and consuming dairy products and to develop innovative message content that could be utilized in future public health campaigns.

DESIGN

Seven in-depth group interviews were conducted in two phases between February and May 2015.

SETTING

Interviews were conducted in local recreational centres and libraries in British Columbia, Canada.

SUBJECTS

Mothers (n 21, mean age 38 (sd 5) years) and fathers (n 9, mean age 38 (sd 3) years) of children aged 4-10 years.

RESULTS

Parents perceived both positive and negative physical outcomes associated with consuming dairy. Lack of trustworthy information was a frequently discussed barrier theme to purchasing and consuming dairy products. Mothers were concerned about the cost of dairy products. Differences in purchasing and consumption strategies were reported between parents of children who consumed adequate dairy and those who did not. Parents believed the most appropriate communication channel was through print material.

CONCLUSIONS

Messages targeting parents, as a means of increasing dairy consumption in children, should address barriers identified by parents. In addition, practical tips should be provided to promote purchasing and consumption of dairy products.

Beverage Intake among Children: Associations with Parent and Home-Related Factors

Beverage intake can influence child diet quality in a positive or negative manner depending on the beverage type and amounts consumed. Parenting practices such as role modeling and control of home beverage availability have been associated with child beverage intake, whereas examination of the influence of parental beverage nutrition knowledge has been more limited. The purpose of this study was to examine the relationships between sugar-sweetened and dairy beverage intake among children (9–12 years) and home and parental factors. A questionnaire was administered among a convenience sample of parents (n = 194) to assess beverage nutrition knowledge, beverage intake and home availability of beverages. Children completed a questionnaire to estimate usual beverage intake. Daily sugar-sweetened beverage intake by children ranged from 0.4 to 48 oz. Logistic regression analysis was used to examine relationships. Parents were mostly female, white, well educated, and employed. Home availability of sugar-sweetened and dairy beverages was positively associated with child sugar-sweetened (OR = 1.48, p = 0.03) and dairy beverage intake (OR = 1.34, p = 0.03), respectively. Parent dairy beverage intake was associated with child dairy beverage intake (OR = 1.06, p = 0.01). Parent knowledge about sugar in beverages was related to child dairy beverage intake (OR = 1.46, p = 0.02), whereas calcium/dairy knowledge and general beverage nutrition knowledge were not related to child beverage intake. Parenting practices and knowledge may play a role in determining child beverage intake.

Systematic Review of School-Based Interventions to Modify Dietary Behavior: Does Intervention Intensity Impact Effectiveness?

BACKGROUND

Owing to the associations between diet and health, it is important that effective health promotion strategies establish healthful eating behaviors from an early age. We reviewed the intensity of school-based interventions aimed to modify dietary behavior in preadolescent and adolescents and related intervention characteristics to effectiveness.

METHODS

Our systematic literature search of 8 databases sought to identify interventions measuring dietary intake in school settings to students aged 9 to 18. We evaluated these studies for effectiveness, intensity, intervention category, and follow-up measures.

RESULTS

Of the 105 interventions 81 were found to be effective immediately postintervention, irrespective of intensity. Studies that were 6 weeks to 5 months in duration, targeted students' environment or group (alone or in combination), and reached students only in schools were more effective. Only one-fifth of interventions conducted a follow-up measure, and a majority showed a loss of effectiveness from postintervention to follow-up.

CONCLUSIONS

We identified characteristics of effective interventions. These findings may inform the development of future interventions targeting dietary behavior in preadolescents and adolescents in the school-based setting.

Dairy products, dietary calcium and bone health: possibility of prevention of osteoporosis in women: the Polish experience

The objective of the study was to analyze the consumption of dairy products and dietary calcium by women in the context of bone mineral density and to assess opportunities to prevent osteoporosis in a dietary manner. The study was carried out with 712 Polish women. In 170 women aged 32 to 59 bone mineral density (BMD) was measured. The data on the consumption of dairy products and dietary calcium and some other osteoporosis risk factors was collected from 712 women. The average calcium intake from a diet was 507 mg/day. Only 2% of the women met Polish calcium intake recommendations. During adulthood, dairy product consumption or dietary calcium intake did not differ significantly between women with low BMD (below −1 SD) and women with regular BMD (≥−1 SD) (47.4 vs. 44.3 servings/week and 459 vs. 510 mg/day, respectively, p > 0.05). The odds ratios adjusted for age, menstruation and BMI in women with upper BMD tercile in comparison to the reference group (bottom tercile) was 2.73 (95% CI: 1.14, 6.55; p < 0.05) for the daily consumption of dairy products during the pre-school period and 2.40 (95% CI: 1.01, 5.70; p < 0.05) for the daily consumption of dairy products during the school period. Two clusters of women were established. In the S1 cluster, low BMD (below −1 SD) was associated with older age (≥50 years), lack of menstrual cycle. In the S2 cluster, regular BMD (≥−1 SD) was related to younger aged women (<50 years), presence of menstrual cycle, consumption of higher level of dairy products (≥28 servings/week) during adulthood and daily intake of dairy products during childhood and adolescence. The results indicate that good bone health to the large extent depended upon the combined impact of dietary factors and some non-modifiable risk factors of osteoporosis such as age and the presence of menstruation. Consumption of dairy products in childhood and adolescence may improve bone mineral density and reduce the risk of osteoporosis in adult women.

National trends in beverage consumption in children from birth to 5 years: analysis of NHANES across three decades

Background

Given the epidemic of childhood obesity, it is crucial to assess food and beverage intake trends. Beverages can provide a large number of calories and since consumption patterns seem to develop at a young age we examined beverage consumption trends over three decades. The objective of this study was to assess the beverage (milk, fruit juice, fruit drinks, tea, soy beverages, and soft drinks) consumption trends in children <1-5 years of age.

Methods

Data from individuals ages <1-5 years participating in the National Health and Nutrition Examination Survey (NHANES) from 1976–1980, 1988–1994 and 2001–2006 were used to assess beverage consumption and associated calorie and nutrient intakes.

Results

During the NHANES 1976–1980 and 1988–1994 periods, approximately 84–85% of children were consuming milk, whereas only 77% were consuming milk during NHANES 2001–2006. Flavored milk intake was relatively low, but increased to 14% during the last decade (p < 0.001). Fruit juice consumption increased dramatically during NHANES 2001–2006 to more than 50% of the population compared to about 30% in the older surveys (p < 0.001). No significant changes were observed in fruit drink intake across all three decades with 35-37% of this population consuming fruit drinks. At least 30% of children consumed soft drinks. Milk was the largest beverage calorie contributor in all three decades surveyed and was the primary contributor of calcium (52-62%), phosphorus (37-42%), magnesium (27-28%), and potassium (32-37%). Fruit juice and fruit drinks each provided 8-10% of calories with soft drinks providing 5-6% of calories. Fruit juice was an important provider of potassium (16-19%) and magnesium (11%). Fruit drinks provided less than 5% of nutrients examined and soft drinks provided very little of the nutrients evaluated.

Conclusions

Given concerns about childhood obesity and the need to meet nutrition requirements, it is prudent that parents, educators and child caretakers replace some of the nutrient poor beverages young children are currently consuming with more nutrient dense sources like low-fat and fat-free milk.

Beverage displacement between elementary and middle school, 2004-2007

BACKGROUND

Sweetened beverages of low nutritional quality might be displacing more nutritious beverages, such as 100% fruit juice and milk, from children's diets. However, previous research has not examined changes in beverage intake over time using nationally representative longitudinal data.

OBJECTIVE

Our objective was to examine changes in sweetened beverage, milk, and juice consumption between 5th and 8th grade.

DESIGN

We used a longitudinal analysis of self-reported beverage consumption.

PARTICIPANTS/SETTING

Data were from the Early Childhood Longitudinal Survey-Kindergarten Cohort 1998-1999 (ECLS-K), a nationally representative study of children followed from kindergarten through 8th grade. This analysis used data from Spring 2004 and 2007, when most children were in 5th and 8th grade, respectively (n=7,445).

MAIN OUTCOME MEASURES

Main outcome measures were changes in consumption of sweetened beverages, milk, and 100% fruit juice last week.

STATISTICAL ANALYSES PERFORMED

Survey-adjusted linear regression was used to estimate longitudinal relationships between servings of milk, sweetened beverages, and 100% fruit juice, controlling for child and family characteristics and food consumption.

RESULTS

Children's milk consumption decreased between 5th and 8th grade, and these decreases were larger among children who drank sweetened beverages daily. However, after controlling for demographic characteristics, changes in children's milk consumption were not significantly related to changes in their consumption of sweetened beverages over time (β=.005; P=0.81), while changes in milk consumption were positively related to changes in juice consumption (β=.087; P<0.01).

CONCLUSIONS

Observed decreases in average milk consumption from 5th to 8th grade were not related to changes in sweetened-beverage consumption. They were positively related to changes in fruit juice consumption, so not indicating displacement. Caloric beverages generally tended to increase or decrease in tandem, so focus must be placed on their role in children's entire diet and on balancing them with food and total beverage intake.

Associations of obesogenic behaviors in mothers and obese children participating in a randomized trial

Relatively little research has assessed the association between obesogenic behaviors in parents and their children. The objective of the present analysis was to examine cross-sectional associations in television (TV)/video viewing, sugar-sweetened beverage intake, and fast food intake between mothers and their preschool aged children. We studied baseline data among 428 participants in High Five for Kids, a randomized controlled trial of behavior change among overweight and obese children of ages 2-6.9 years. The main exposures were whether mothers viewed TV/videos <1 h/day, drank <1 serving/day of sugar-sweetened beverages, and ate fast food <1 time/week. The main outcomes were whether children met these goals for the same behaviors. Using multivariate logistic regression adjusted for maternal and child characteristics, we estimated odds ratios of children meeting the behavioral goals. The majority of mothers ate fast food <1 time/week (73%) and drank <1 serving/day of sugar-sweetened beverages (73%), while few mothers viewed <1 h/day of TV/videos (31%). Most children met the fast food goal (68%), but not the goals for sugar-sweetened beverages (31%) or TV/video viewing (13%). In adjusted models, the odds ratios for a child meeting the goal were 3.2 (95% confidence interval (CI) 1.7, 6.2) for TV/video viewing, 5.8 (95% CI 2.8, 12.0) for sugar-sweetened beverage intake, and 17.5 (95% CI 9.8, 31.2) for fast food intake if their mothers met the goal for the same behavior. Obesogenic behaviors of mothers and preschool aged children were strongly associated. Our findings lend support to obesity prevention strategies that target parental behavior and the family environment.

Improving children's dairy food and calcium intake: can intervention work? A systematic review of the literature

OBJECTIVE

Strategies are needed to address the shortfall in children's dairy food and Ca intakes. The present review identified interventions targeting an increase in children's dairy food or Ca intakes, and determined characteristics associated with successful intervention.

DESIGN

A systematic literature search identified fourteen intervention studies, published in English, between 1990 and 2010. Studies were evaluated for study population, setting and mode of delivery, dietary targets and outcome measures, measures of intervention intensity, intervention description, the use of behaviour change techniques and intervention effectiveness.

SETTING

Interventions targeting an increase in dairy food or Ca intake.

SUBJECTS

Children aged 5-12 years.

RESULTS

Ten of the fourteen studies were considered to be effective. Studies focusing on encouraging intake of dairy foods or Ca alone were all effective, compared with 55 % of studies promoting dairy within the context of a healthy diet. Effective interventions tended to be higher in intensity, provide dairy foods and were delivered across a variety of settings to a range of primary targets. The number of behaviour change techniques used did not differentiate effective and ineffective interventions, but the use of taste exposure and prompting practice appeared to be important for effective intervention.

CONCLUSIONS

Interventions that target an increase in children's dairy food or Ca intake could potentially increase children's dairy food intake by about one serving daily. Research conducted outside the USA is needed. The review has identified some promising strategies likely to be part of effective interventions for improving dairy and Ca intakes in countries where children's intake is insufficient.

Parent calcium-rich-food practices/perceptions are associated with calcium intake among parents and their early adolescent children

Objective

The study aimed to (i) segment parents of early adolescents into subgroups according to their Ca-rich-food (CRF) practices and perceptions regarding early adolescent CRF intake and (ii) determine whether Ca intake of parents and early adolescents differed by subgroup.

Design

A cross-sectional convenience sample of 509 parents and their early adolescent children completed a questionnaire in 2006–2007 to assess parent CRF practices and perceptions and to estimate parent and child Ca intakes.

Setting

Self-administered questionnaires were completed in community settings or homes across nine US states.

Subjects

Parents self-reporting as Asian, Hispanic or non-Hispanic White with a child aged 10–13 years were recruited through youth or parent events.

Results

Three parent CRF practice/perception segments were identified, including ‘Dedicated-Milk Providers/Drinkers’ (49 %), ‘Water Regulars’ (30 %) and ‘Sweet-Drink-Permissive Parents’ (23 %). Dedicated-Milk Providers/Drinkers were somewhat older and more likely to be non-Hispanic White than other groups. Ca intakes from all food sources, milk/dairy foods and milk only, and milk intakes, were higher among early adolescent children of Dedicated-Milk Providers/Drinkers compared with early adolescents of parents in other segments. Soda pop intakes were highest for early adolescents with parents in the Water Regulars group than other groups. Dedicated-Milk Providers/Drinkers scored higher on culture/tradition, health benefits and ease of use/convenience subscales and lower on a dairy/milk intolerance subscale and were more likely to report eating family dinners daily than parents in the other groups.

Conclusions

Parent education programmes should address CRF practices/perceptions tailored to parent group to improve Ca intake of early adolescent children.

The prevalence of self-reported lactose intolerance and the consumption of dairy foods among African American adults are less than expected

OBJECTIVE

To determine the self-reported incidence of lactose intolerance and its influence on dairy choices among African American adults.

DESIGN, SETTING, AND PARTICIPANTS

An online survey closely matched to the 2000 US Census was administered to a nationally representative sample of African Americans (2016 adults) and a comparison sample of the general population (1084 adults). Statistical analyses performed included pairwise t tests for proportion conducted on percent responses at the 95% confidence level.

RESULTS

African Americans were more likely to eat fewer dairy foods, experience physical discomfort after consumption, and believe they were lactose intolerant. While 49% of African Americans had ever experienced "some type of physical discomfort" after eating dairy foods, 24% believed they were lactose intolerant. Within this group, 85% of African Americans would be willing to consume more dairy products if they could avoid lactose intolerance symptoms.

CONCLUSIONS AND IMPLICATIONS

Dairy food, calcium, and vitamin D intake in African Americans and the general population are below US recommendations. Deficiencies of these nutrients are associated with chronic diseases that disproportionately affect African Americans. In the United States, dairy foods are the primary source of calcium and vitamin D, and lactose intolerance can be a significant barrier to dairy food intake. However, self-described lactose intolerance is less than commonly reported in African American populations. Low dairy intake may reflect concerns about lactose intolerance, other factors such as learned food habits and cultural preferences. Nutrition recommendations for African Americans and the general population should focus on the health benefits of dairy foods, provide culturally sensitive dietary options, and strategies to increase tolerance.

The Role of Dairy Products in Healthy Weight and Body Composition in Children and Adolescents

Overweight and obesity are major public health concerns with approximately 32% and 17% of U.S. children aged 2 – 19 being classified as overweight or obese, respectively. While the cause of overweight and obesity is multi-factorial, changes in eating habits and physical activity patterns have been proposed as contributing factors to the obesity epidemic. For example, the displacement of nutrient rich foods and beverages with non-nutrient dense items may be influencing childhood obesity. Many children do not consume the recommended servings of the Food Groups to Encourage, i.e. low-fat and fat-free dairy foods, fruits, vegetables, and whole grains identified by the 2005 Dietary Guidelines for Americans which results in low intakes of calcium, potassium, fiber, magnesium, and vitamin E. While attention has focused primarily on reducing energy intake and/or increasing energy expenditure for weight maintenance, a promising beneficial role for dairy products in weight management has emerged. Most research has focused on adults, but there is evidence in children and adolescents indicating either a beneficial or neutral effect of dairy food consumption on body weight or body composition. The current review provides and assessment of the scientific evidence on the effects of dairy food consumption on body weight and body composition in children and adolescents.

Girls' early sweetened carbonated beverage intake predicts different patterns of beverage and nutrient intake across childhood and adolescence

BACKGROUND

Information is limited on persistence of early beverage patterns throughout childhood and adolescence and their influence on long-term dietary intake.

OBJECTIVE

To describe changes in beverage intake during childhood and assess beverage and nutrient intake from ages 5 to 15 years among girls who were consuming or not consuming sweetened carbonated beverages (soda) at age 5 years.

DESIGN/SUBJECTS

Participants were part of a longitudinal study of non-Hispanic white girls and their parents (n=170) assessed biennially from age 5 to 15 years starting fall 1996.

STATISTICAL ANALYSES

At each assessment, intakes of beverages (milk, fruit juice, fruit drinks, soda, and tea/coffee), energy, macronutrients, and micronutrients were assessed using three 24-hour recalls. Analyses of longitudinal changes and the interaction between beverage type and age were conducted using a mixed modeling approach. Girls were categorized as either soda consumers or nonconsumers at age 5 years. A mixed modeling approach was used to assess longitudinal differences and patterns of change in beverage and nutrient intake between soda consumption groups.

RESULTS

Early differences in soda intake were predictive of later soda and milk intake and of differences in selected nutrients. Relative to girls who were not consuming soda beverages at age 5 years, soda consumers at age 5 years had higher subsequent soda intake, lower milk intake, higher intake of added sugars, lower protein, fiber, vitamin D, calcium, magnesium, phosphorous, and potassium from ages 5 to 15 years.

CONCLUSIONS

Soda consumption at age 5 years predicted patterns of nutrient intake that persisted during childhood and into adolescence. Diets of soda consumers were higher in added sugars and lower in protein, fiber, calcium, vitamin D, magnesium, phosphorous, and potassium. Findings provide a more complex picture regarding the emergence of early beverage patterns and their predictive effects on nutrient intake across childhood and adolescence.

Parental influence on children's early eating environments and obesity risk: implications for prevention

Most childhood obesity prevention efforts have focused on school-age children and adolescents and have had limited success. We argue that the first years of life, including the prenatal period, the postnatal suckling period and the transition to the modified adult diet, may provide opportunities for preventive interventions. These early periods are characterized by high plasticity and rapid transitions, and parents have a high degree of control over children's environments and experiences. Observational and experimental evidence reveal persistent effects of early environments on eating behavior and obesity risk, suggesting that interventions should be tested during these early periods. The central task parents have in early development points to their potential as key targets and agents of change in early preventive interventions. In this paper, we review evidence of early environmental effects on children's eating and obesity risk, highlighting ways that parental feeding practices and parents' own behaviors impact these outcomes and calling for further experimental research to elucidate whether these factors are indeed promising targets for childhood obesity preventive interventions.

Dieting, restraint, and disinhibition predict women's weight change over 6 y

BACKGROUND

Although disinhibited eating is positively associated with higher weight in women, it is not known whether restrained eating and dieting moderate the influence of disinhibited eating on weight change.

OBJECTIVE

The objective was to investigate over 6 y the interactive effects of restrained and disinhibited eating and self-reported dieting to lose weight as predictors of weight gain in women.

DESIGN

Data were collected from non-Hispanic white women (n = 163) every 2 y. Height and weight were measured in triplicate. Dietary restraint and disinhibition were assessed by using the Eating Inventory. Participants were also asked if they were "currently dieting to lose weight." Multilevel modeling was used to examine change in weight as a function of time-invariant and time-varying predictors, including dietary restraint, dietary disinhibition, and self-reported dieting.

RESULTS

After covariates were adjusted for, growth curve models showed that within-person increases in restraint over time were associated with concurrent decreases in weight and that higher levels of restraint moderated the positive association between dietary disinhibition and weight. Women who reported dieting at study entry were heavier at study entry and gained more weight over time than did nondieters. Finally, a significant interaction between restraint, disinhibition, and dieting showed that restraint moderated the effect of disinhibition on weight differently in nondieters than in dieters.

CONCLUSIONS

Increasing levels of dietary restraint may be beneficial in moderating weight by attenuating the positive association between disinhibition and weight in dieting women. An understanding of weight and weight change requires examination of the interactive effects of restraint, disinhibition, and dieting.

Increased sweetened beverage intake is associated with reduced milk and calcium intake in 3- to 7-year-old children at multi-item laboratory lunches

Dietary survey data show that intake of sugar-sweetened beverages is negatively associated with intake of milk, but these findings have yet to be confirmed by laboratory feeding studies. The objectives of the present study were to analyze children's intake across two laboratory-based ad libitum lunches to (a) investigate the relationships between intake of sweetened beverages, milk, and calcium, and (b) explore relationships between beverage consumption and child age and weight status. Data were extracted from a cohort of 126 3- to 7-year-old twins from diverse ethnic backgrounds who participated in a cross-sectional study (conducted from November 1999 to September 2002) designed to determine the genetic and environmental contributions to eating and body weight. At two visits, children ate ad libitum from lunches that offered a variety of sugar-sweetened and calcium-rich beverages. Total beverage and nutrient intakes were computed from the test meals. Weight, height, and waist circumference were assessed on the final visit. Regression analyses tested the associations among intake of sweetened beverages, calcium, and milk (primary aim), and whether these variables were associated with child age and weight status (secondary aim). Sweetened beverage intake was negatively correlated with both milk (P<0.01) and calcium (P<0.01) intakes, and these relationships remained after controlling for age, sex, and ethnicity (P<0.01). Child age was negatively associated with milk intake (r=-0.22, P<0.01) but positively associated with intake of sweetened beverages (r=0.27, P<0.01). Results support the notion that sugar-sweetened beverages displace milk in a single meal, and this phenomenon may vary with child age. Due to the cross-sectional nature of this study, future investigations are needed to determine the long-term implications of this consumption pattern. The possibility that limiting sweetened beverages may help optimize dietary calcium during childhood is a topic that merits further research.

Dairy intake and anthropometric measures of body fat among children and adolescents in NHANES

OBJECTIVE

To explore the relation between dairy intake and body fat among children and adolescents.

MATERIALS AND METHODS

Children (5-11 years) and adolescents (12-16 years) were included who had data on diet, anthropometry measures of body fat, and relevant potential confounders (children: n = 3,864 and 2,231; adolescents: n = 1,884 and 2,636 in NHANES III and NHANES 1999-2002, respectively). Each child's daily dairy intake from 24-hour recalls was classified as low, moderate or high. For girls and boys, respectively: low intake: <1 and <2 servings; moderate intake: 1-<3 and 2-<4 servings; and high intake: >or=3 and >or=4 servings per day.) Analysis of covariance was used to control for potential confounding by age, gender, socio-economic status, race/ethnicity, height and television watching.

RESULTS

Among children, there was no consistent association between dairy intake and anthropometric indices of body fat. Among adolescents, the lowest dairy intake group (< one serving per day for girls and < two per day for boys) had higher estimated levels of body fat than those in the highest dairy group. Compared with the lowest intake level, adolescent girls in NHANES III who consumed 1-<3 servings per day of dairy had about 2.5 mm less subcutaneous body fat (95% CI: -4.70 mm, -0.39 mm) while girls consuming three or more servings had about 5 mm less fat in their sum of two skinfolds. Adolescent boys consuming 4 or more servings of dairy per day had lower anthropometry levels than did those consuming less than two servings.

CONCLUSION

Among adolescents, suboptimal dairy intake was associated with higher anthropometric measures of body fat.

Factors associated with television viewing time in toddlers and preschoolers in Greece: the GENESIS study

BACKGROUND

The aim of this work was to describe the television (TV) viewing time of preschoolers and to examine factors that may be associated with it.

METHODS

A representative sample of 2374 Greek children aged 1-5 years was examined (GENESIS study). Several anthropometric, socio-demographic and lifestyle characteristics were recorded.

RESULTS

The mean value of children's TV viewing time was 1.32 h/day. Twenty six percent of participants spent > or =2 h/day in TV viewing. The percentage of children whose TV viewing time was longer than 2 h/day was higher in children aged 3-5 years (32.2%) than in those aged 1-2 years (11.1%). Multiple logistic regression revealed that the time parents spent viewing TV and the region of residence were significantly associated with child's TV viewing time among children aged 3-5 years. Among children aged 1-2 years, the maternal educational status, the region of residence and the maternal TV viewing time were found to be related to child's TV viewing time.

CONCLUSIONS

The current findings suggest that almost one third of Greek preschoolers exceed the limit of 2 h/day TV viewing and that parental TV viewing time may be the most important determinant of children's TV viewing time.

Parental influences on dairy intake in children, and their role in child calcium-fortified food use

OBJECTIVE

To understand how parental influences on dairy food intake relate to early adolescent children's use of calcium-fortified food.

DESIGN

Content analysis of qualitative interviews to identify parental influences on dairy intake; calcium-fortified food survey to identify children as either calcium-fortified food users or nonusers.

SETTING AND PARTICIPANTS

A convenience sample of Asian (n = 56), Hispanic (n = 61), and white (n = 74) parents of children 10-13 years old, including boys (n = 86) and girls (n = 105). VARIABLES MEASURED AND ANALYSIS: Cluster analysis to identify groups with similar coded parental influences and chi-square analysis to determine associations between these groups and calcium-fortified food use.

RESULTS

Two dominant patterns of parental influences: Cluster 1 (n = 128), with positive parental influences related to availability of dairy, milk, and cheese; positive health beliefs for dairy, and child preferences for dairy and cheese, included parents whose children were more likely to use calcium-fortified food. Cluster 2 (n = 63), with positive influences for availability of dairy and milk, included parents whose children were equally likely to be either users or nonusers of calcium-fortified food (P < .05).

CONCLUSION

Strategies to improve parental influence on children's dairy intake might also encourage calcium-fortified food intake and improve calcium nutriture.

Like parent, like child: child food and beverage choices during role playing

OBJECTIVE

To examine food and beverage choices of preschool-aged children.

DESIGN

Semistructured observational study. While pretending to be adults during a role-play scenario, children selected food and beverage items from a miniature grocery store stocked with 73 different products, of which 47 foods and beverages were examined in this analysis. Parents self-reported how frequently they purchased specific grocery items.

SETTING

A behavioral laboratory.

PARTICIPANTS

One hundred twenty children, aged 2 to 6 years, and 1 parent for each child. Main Outcome Measure Children's total purchases were classified according to the number of healthier and less healthy products they selected as least healthy, somewhat healthy, and most healthy choices. The same categories were used to classify parents' self-reported purchases.

RESULTS

Most of the children (70.8%) purchased foods that were categorized as least healthy choices. Only 13 children (10.8%) had shopping baskets consisting of the healthiest choices. On average, children in the group with the least healthy choices purchased the same number of healthier and less healthy products, whereas children in the group with most healthy choices purchased 5 healthier products for each less healthy product selected. The healthfulness of children's total purchases were significantly (P = .02) predicted by their parents' purchasing categorization.

CONCLUSIONS

When presented with a wide array of food products, young children chose combinations of healthier and less healthy foods and beverages. The data suggest that children begin to assimilate and mimic their parents' food choices at a very young age, even before they are able to fully appreciate the implications of these choices.

Need states based on eating occasions experienced by midlife women

OBJECTIVE

To identify a comprehensive set of distinct "need states" based on the eating occasions experienced by midlife women.

DESIGN

Series of 7 focus group interviews.

SETTING

Meeting room on a university campus.

PARTICIPANTS

A convenience sample of 34 multi-ethnic women (mean age = 46 years).

PHENOMENON OF INTEREST

Descriptions of eating occasions by "need states," specific patterns of needs for the occasion.

ANALYSIS

Interviews were audiotaped, transcribed verbatim, and analyzed for common themes using qualitative data analysis procedures.

FINDINGS

Eight need states suggested a hypothetical framework reflecting a wide range in emotional gratification. Need states with a low level of emotional gratification were dominated by sets of functional needs, such as coping with stress, balancing intake across occasions, meeting external demands of time and effort, and maintaining a routine. Food was a means for reinforcing family identity, social expression, and celebration in need states with high levels of emotional gratification. Occurrence of need states varied by day and meal/snack occasion, with food type and amount dependent on need state.

CONCLUSIONS AND IMPLICATIONS

Eating occasions are driven by specific sets of needs ranging from physical/functional to more emotional/social needs. Addressing need states may improve weight intervention programs for midlife women.

Prevention of rickets and vitamin D deficiency in infants, children, and adolescents

Rickets in infants attributable to inadequate vitamin D intake and decreased exposure to sunlight continues to be reported in the United States. There are also concerns for vitamin D deficiency in older children and adolescents. Because there are limited natural dietary sources of vitamin D and adequate sunshine exposure for the cutaneous synthesis of vitamin D is not easily determined for a given individual and may increase the risk of skin cancer, the recommendations to ensure adequate vitamin D status have been revised to include all infants, including those who are exclusively breastfed and older children and adolescents. It is now recommended that all infants and children, including adolescents, have a minimum daily intake of 400 IU of vitamin D beginning soon after birth. The current recommendation replaces the previous recommendation of a minimum daily intake of 200 IU/day of vitamin D supplementation beginning in the first 2 months after birth and continuing through adolescence. These revised guidelines for vitamin D intake for healthy infants, children, and adolescents are based on evidence from new clinical trials and the historical precedence of safely giving 400 IU of vitamin D per day in the pediatric and adolescent population. New evidence supports a potential role for vitamin D in maintaining innate immunity and preventing diseases such as diabetes and cancer. The new data may eventually refine what constitutes vitamin D sufficiency or deficiency.

When adults with diabetes attempt to drink less soda: resulting adult-child interactions and household changes

OBJECTIVE

To examine adult-child interactions related to soda consumption in families where 1 inner-city African-American or Latino adult with diabetes is attempting lifestyle changes.

METHODS

The study used semistructured individual interviews of adults and a child (age 10-17) in their home. Interviews were audiotaped, transcribed, coded and analyzed for themes.

RESULTS

We completed 28 interviews (14 adult-child pairs). Most adults in this group reduced or stopped drinking nondiet soda. Some parents included their children in that change by removing nondiet soda from the household and by delivering messages regarding soda to their children. Some children obtained soda outside the home. Sweetened fruit drinks remained in some households even after nondiet soda was removed. Nonetheless, many children reported adjusting to the lack of soda in the household and a lower intake of nondiet soda and sweetened fruit drinks, in contrast to continued high consumption of sweets and fried food.

CONCLUSIONS

These in-depth family interviews suggest that interventions intended to change adult consumption of sugar-sweetened beverages may also benefit their children, and this hypothesis merits further investigation in larger studies. A new diabetes diagnosis may motivate adults toward dietary change and provide opportunities to improve overall family health. Healthcare providers should emphasize decreasing availability of soda for everyone in the home.

Beverage consumption patterns of children born at different risk of obesity

BACKGROUND

Increased intake of sugar-sweetened beverages and fruit juice has been associated with overweight in children.

OBJECTIVE

This study prospectively assessed beverage consumption patterns and their relationship with weight status in a cohort of children born at different risk for obesity.

METHODS AND PROCEDURES

Participants were children born at low risk (n = 27) or high risk (n = 22) for obesity based on maternal prepregnancy BMI (kg/m(2)). Daily beverage consumption was generated from 3-day food records from children aged 3-6 years and coded into seven beverage categories (milk, fruit juice, fruit drinks, caloric and non-caloric soda, soft drinks including and excluding fruit juice). Child anthropometric measures were assessed yearly.

RESULTS

High-risk children consumed a greater percentage of daily calories from beverages at age 3, more fruit juice at ages 3 and 4, more soft drinks (including fruit juice) at ages 3-5, and more soda at age 6 compared to low-risk children. Longitudinal analyses showed that a greater 3-year increase in soda intake was associated with an increased change in waist circumference, whereas a greater increase in milk intake was associated with a reduced change in waist circumference. There was no significant association between change in intake from any of the beverage categories and change in BMI z-score across analyses.

DISCUSSION

Children's familial predisposition to obesity may differentially affect their beverage consumption patterns. Future research should examine the extent to which dietary factors may play a role in pediatric body fat deposition over time.

Impact of dairy products and dietary calcium on bone-mineral content in children: results of a meta-analysis

OBJECTIVE

Although calcium is essential for maintaining bone health in children, the optimum dietary intake of calcium in this age group, particularly in the form of dairy foods, is not well defined. A meta-analysis was conducted to examine the impact of dietary calcium/dairy supplementation on bone mineral content in this age group.

METHODS

Data were pooled from randomized controlled intervention trials and observational studies using previously described methods. The outcome of interest was a summary mean difference bone mineral content. Sensitivity analyses were employed to evaluate any observed statistical heterogeneity and to examine the influence of specific study characteristics on the summary estimate of effect.

RESULTS

Initially combining data from twenty-one randomized controlled trials (RCTs) using total body bone mineral content (TB-BMC) as the outcome of interest, yielded a non-statistically significant increase in TB-BMC of 2 g (supplemented versus controls). These data demonstrated substantial statistical heterogeneity with sensitivity analyses revealing that among study subjects with normal or near normal baseline dietary calcium/dairy intakes, supplemental dairy/calcium showed little impact on bone mineral content. Sensitivity analyses suggested that baseline calcium intake could potentially account for the statistical heterogeneity. Pooling the three reports utilizing low intake subjects yielded a statistically significant summary mean BMC of 49 g (24.0-76-6). Pooling two RCTs using calcium/dairy supplement plus vitamin D was also associated with an increase in lumbar spine BMC of, on average, 35 g (-6.8-41.8). The lack of data using BMC measurements at other anatomic sites as well as sparse data from non-randomized studies, precluded further statistical pooling.

CONCLUSION

Increased dietary calcium/dairy products, with and without vitamin D, significantly increases total body and lumbar spine BMC in children with low base-line intakes.

What's love got to do with it? Family cohesion and healthy eating behaviors in adolescent girls

OBJECTIVE

To examine the association between family cohesion and behaviors linked to health or overweight in adolescents.

METHOD

Cross-sectional analyses of family cohesion and eating behaviors of 2,379 girls (followed from ages 9-19) who participated in the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS). Height and weight measurements were obtained on an annual basis. Family cohesion was measured by the Family Adaptability and Cohesion Evaluation Scale (FACES) III. Food diaries were used to assess frequency of breakfast consumption and intake of milk, soda, fruits, and vegetables.

RESULTS

Family cohesion was significantly associated with less soda intake and higher rates of breakfast consumption. Ingestion of milk, fruits, and vegetables was predicted by family cohesion at the trend level.

CONCLUSION

Understanding the role of familial factors in adolescent eating behaviors is an important research priority. Strengthening family cohesion may be a valuable goal toward promoting the health of adolescents, increasing breakfast eating and decreasing soda consumption.

Does parenting affect children's eating and weight status?

BACKGROUND

Worldwide, the prevalence of obesity among children has increased dramatically. Although the etiology of childhood obesity is multifactorial, to date, most preventive interventions have focused on school-aged children in school settings and have met with limited success. In this review, we focus on another set of influences that impact the development of children's eating and weight status: parenting and feeding styles and practices. Our review has two aims: (1) to assess the extent to which current evidence supports the hypothesis that parenting, via its effects on children's eating, is causally implicated in childhood obesity; and (2) to identify a set of promising strategies that target aspects of parenting, which can be further evaluated as possible components in childhood obesity prevention.

METHODS

A literature review was conducted between October 2006 and January 2007. Studies published before January 2007 that assessed the association between some combination of parenting, child eating and child weight variables were included.

RESULTS

A total of 66 articles met the inclusion criteria. The preponderance of these studies focused on the association between parenting and child eating. Although there was substantial experimental evidence for the influence of parenting practices, such as pressure, restriction, modeling and availability, on child eating, the majority of the evidence for the association between parenting and child weight, or the mediation of this association by child eating, was cross-sectional.

CONCLUSION

To date, there is substantial causal evidence that parenting affects child eating and there is much correlational evidence that child eating and weight influence parenting. There are few studies, however, that have used appropriate meditational designs to provide causal evidence for the indirect effect of parenting on weight status via effects on child eating. A new approach is suggested for evaluating the effectiveness of intervention components and creating optimized intervention programs using a multiphase research design. Adoption of approaches such as the Multiphase Optimization Strategy (MOST) is necessary to provide the mechanistic evidence-base needed for the design and implementation of effective childhood obesity prevention programs.

Plausible reports of energy intake may predict body mass index in pre-adolescent girls

Inaccurate reporting of energy intake makes it difficult to study the associations between diet and weight status. This study examined reported energy intake at age 9 years as a predictor of girls' body mass index (BMI) at age 11 years, before and after adjusting for parents' BMI and girls' pubertal status. This prospective, observational cohort study included 177 non-Hispanic white girls and their parents. When the subjects were 9 years of age, three 24-hour recalls were used to categorize girls as plausible or implausible over-reporters and under-reporters based on previously published methods. Height and weight was measured to calculate BMI. Linear and hierarchical regression analyses were used to predict girls' BMI. Results revealed that girls who under-reported had significantly higher BMIs than plausible and overreporters. Among the total sample and among implausible reporters, reported energy intake was not a significant predictor of BMI; however, among plausible reporters, reported energy intake explained 14% of the variance in BMI and remained a significant predictor after adjusting for parental BMI and girls' pubertal status. Systematic bias related to underreporting in dietary data can obscure relationships with weight status, even among young girls. A relatively simple analytical procedure can be used to identify the magnitude and nature of reporting bias in dietary data.

Recommendations for treatment of child and adolescent overweight and obesity

In this article, we review evidence about the treatment of obesity that may have applications in primary care, community, and tertiary care settings. We examine current information about eating behaviors, physical activity behaviors, and sedentary behaviors that may affect weight in children and adolescents. We also review studies of multidisciplinary behavior-based obesity treatment programs and information about more aggressive forms of treatment. The writing group has drawn from the available evidence to propose a comprehensive 4-step or staged-care approach for weight management that includes the following stages: (1) Prevention Plus; (2) structured weight management; (3) comprehensive multidisciplinary intervention; and (4) tertiary care intervention. We suggest that providers encourage healthy behaviors while using techniques to motivate patients and families, and interventions should be tailored to the individual child and family. Although more intense treatment stages will generally occur outside the typical office setting, offices can implement less intense intervention strategies. We not ony address specific patient behavior goals but also encourage practices to modify office systems to streamline office-based care and to prepare to coordinate with professionals and programs outside the office for more intensive interventions.

Recommendations for prevention of childhood obesity

The majority of US youth are of healthy weight, but the majority of US adults are overweight or obese. Therefore, a major health challenge for most American children and adolescents is obesity prevention-today, and as they age into adulthood. In this report, we review the most recent evidence regarding many behavioral and practice interventions related to childhood obesity, and we present recommendations to health care providers. Because of the importance, we also suggest approaches that clinicians can use to encourage obesity prevention among children, including specific counseling strategies and practice-based, systems-level interventions. In addition, we suggest how clinicians may interact with and promote local and state policy initiatives designed to prevent obesity in their communities.

Parental influences on youth television viewing

OBJECTIVE

To assess associations among youth television (TV) viewing and parental TV viewing, parental knowledge of the American Academy of Pediatrics (AAP) recommendations to limit children's TV viewing time to < or = 2 hours per day (knowledge), and parental limits on the frequency of children's TV viewing (rules).

STUDY DESIGN

Adult participants in the 2002 Styles surveys answered questions about their weekly TV viewing, knowledge, and rules. TV viewing time of children of the adult participants (520 boys and 525 girls) age 10 to 18 years was also collected. Associations between hours of child TV viewing and parental TV viewing, parental knowledge, and parental rules were quantified using linear regression techniques.

RESULTS

Variables included in multivariate regression models accounted for 8% to 18% of the variance in TV viewing among boys and girls. Parent TV viewing was significantly associated with TV viewing in 10- to 12-year-old and 16- to 18-year-old boys and girls. Knowledge was not associated with TV viewing in boys and girls in this sample. Rules were associated with TV viewing in boys and girls of all ages.

CONCLUSIONS

Our findings suggest that parental TV viewing and rules limiting their child's TV time may play an important role in children's weekly TV viewing time.

Longitudinal assessment of micronutrient intake among African-American and white girls: The National Heart, Lung, and Blood Institute Growth and Health Study

OBJECTIVE

Low intakes of micronutrients among adolescents may be linked to long-term health risks, especially in African-American girls. This report describes intake of key micronutrients relative to the Dietary Reference Intakes in a sample of African-American and white girls.

DESIGN

Longitudinal analyses used data from 3-day food records collected in the National Heart, Lung, and Blood Institute Growth and Health Study.

SUBJECTS/SETTING

Subjects included 1,166 white and 1,213 African-American girls (aged 9 to 18 years).

MAIN OUTCOME MEASURES

Estimated usual daily intakes of vitamins A, E, C, D, B-6, B-12, magnesium, folate, calcium, and zinc were compared to the Adequate Intake (for vitamin D and calcium) or the Estimated Average Requirement (EAR) (all other micronutrients).

STATISTICAL ANALYSES PERFORMED

Usual daily intake of each micronutrient was estimated. For nutrients with an EAR, the EAR cut-point method was used to assess the prevalence of low nutrient intakes. Mixed models were used to identify age and racial differences in usual daily intake of each nutrient.

RESULTS

African-American girls consumed less vitamin A and D, calcium, and magnesium compared to white girls. Regardless of race, a substantial percentage of girls had intakes below the EAR: vitamin E (81.2% to 99.0%), magnesium (24.0% to 94.5%), folate (46.0% to 87.3%). Intakes of vitamins A, D, and C; calcium; and magnesium decreased across years. As girls aged, there was an increasing proportion with intakes below the EAR for vitamins A, C, B-6, and B-12.

CONCLUSIONS

Food and nutrition professionals should continue to educate adolescent girls, especially those who are African American, about the importance of a nutrient-dense diet for optimum health.

Influence of bovine and caprine casein phosphopeptides differing in αs1-casein content in determining the absorption of calcium from bovine and caprine calcium-fortified milks in rats

Bovine and caprine milks have a similar overall gross composition, but vary considerably in the ratios of their casein components. These differences cause significant changes in the ability of caseins to bind and stabilize calcium (Ca). It might be expected that these in vitro variations, which are thought to be due to differences in casein phosphopeptides (CPP) content, could lead to in vivo differences in the digestion and absorption of Ca. To test this hypothesis three milks with different casein ratios [bovine (B), caprine high in αs1-casein (CH) and caprine low in αs1-casein (CL)] were compared with regard to Ca absorption and deposition in growing male rats. For comparison, each milk was Ca-fortified (BCa-milk, CHCa-milk, and CLCa-milk) and CPP, prepared by enzymatic hydrolysis from the respective caseins (extrinsic CPP), were added to both native and Ca-milks. The effects of added CPP (extrinsic) could then be compared with intrinsic CPP released from the gastrointestinal digestion of caseins. Total gastric Ca was sampled at 15, 30 and 60 min after ingestion. No differences were found among the native milks with or without CPP, but the Ca from all Ca-milks (regardless of casein type) appeared to clear the stomach more rapidly and this was enhanced by the extrinsic CPP. The total intestinal Ca was not different among the native milks±CPP, however, it rose more rapidly with Ca fortification, and was higher at 30 min for all CPP-Ca-milks. At 60 min the total intestinal Ca level fell for the CPP-Ca-milks while all others continued to rise. These observations suggest that the CPP in Ca-milks enhance gastric clearance and uptake from the intestine. Ca availability from BCa-milk, CHCa-milk, and CLCa-milk with and without CPP was estimated by both plasma and femur uptake of 45Ca. Ca availability was enhanced at 5 h in the plasma in each case by added CPP. In all cases CPP stimulated Ca availability in the femur, but the CL-CPP was higher (P<0·05) than that of either CH-CPP or B-CPP (extrinsic CPP). Based on the results of this study we can conclude that the addition of CPP will have beneficial effect on the absorption of Ca in growing rats from CaCO3 added to bovine and caprine milks.

How do women change osteoporosis-preventive behaviours in their children?

OBJECTIVE

We have reported that a lifestyle intervention with mothers improved calcium intake and physical activity in both mothers and their children. In this study, we aimed to describe the strategies and approaches used by these mothers to improve their children's calcium intake and physical activity.

DESIGN

A qualitative study using semistructured interviews.

SETTING

Population-based convenience sample.

SUBJECTS

A subsample of 39 mothers were taken from a population-based random sample of 354 mothers who had participated in the original osteoporosis-prevention trial.

RESULTS

Mothers described specific dietary changes they made to increase their children's calcium intake. They also described strategies for improving calcium intake and physical activity such as raising awareness of the importance of calcium; ensuring calcium-rich foods were accessible; assessing their children's likes and dislikes and working within these; role modelling; information provision; taking a balanced approach to attempting behaviour change; and encouraging activities that they could do with their children. Mothers emphasized the general importance of a balanced diet and lifestyle, rather than just focussing on lifestyle factors specific to osteoporosis prevention.

CONCLUSION

Even without specific guidance, mothers are adept at developing strategies to apply to changing lifestyle behaviours in their children and identifying barriers to change. These results provide information, which could be incorporated into future interventions for lifestyle change in children and also provide further support for considering parent-focused approaches to this problem.

Consumption of 'extra' foods (energy-dense, nutrient-poor) among children aged 16-24 months from western Sydney, Australia

OBJECTIVE

This study evaluates the contribution of energy-dense, nutrient-poor 'extra' foods to the diets of 16-24-month-old children from western Sydney, Australia.

DESIGN

An analysis of cross-sectional data collected on participants in the Childhood Asthma Prevention Study (CAPS), a randomised trial investigating the primary prevention of asthma from birth to 5 years. We collected 3-day weighed food records, calculated nutrient intakes, classified recorded foods into major food groups, and further classified foods as either 'core' or 'extras' according to the Australian Guide to Healthy Eating.

SETTING

Pregnant women, whose unborn child was at risk of developing asthma because of a family history, were recruited from all six hospitals in western Sydney, Australia. Data for this study were collected in clinic visits and at participants' homes at the 18-month assessment.

PARTICIPANTS

Four hundred and twenty-nine children participating in the CAPS study; 80% of the total cohort.

RESULTS

The mean consumption of 'extra' foods was approximately 150 g day(-1) and contributed 25-30% of the total energy, fat, carbohydrate and sodium to the diets of the study children. 'Extra' foods also contributed around 20% of fibre, 10% of protein and zinc, and about 5% of calcium. Children in the highest quintile of 'extra' foods intake had a slightly higher but not significantly different intake of energy from those in the lowest quintile. However, significant differences were evident for the percentage of energy provided by carbohydrate and sugars (higher) and protein and saturated fat (lower). The intake of most micronutrients was also significantly lower among children in the highest quintile of consumption. The intake of 'extra' foods was inversely associated with the intake of core foods.

CONCLUSIONS

The high percentage of energy contributed by 'extra' foods and their negative association with nutrient density emphasise the need for dietary guidance for parents of children aged 1-2 years. These preliminary data on commonly consumed 'extra' foods and portion sizes may inform age-specific dietary assessment methods.

Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis

In a meta-analysis of 88 studies, we examined the association between soft drink consumption and nutrition and health outcomes. We found clear associations of soft drink intake with increased energy intake and body weight. Soft drink intake also was associated with lower intakes of milk, calcium, and other nutrients and with an increased risk of several medical problems (e.g., diabetes). Study design significantly influenced results: larger effect sizes were observed in studies with stronger methods (longitudinal and experimental vs cross-sectional studies). Several other factors also moderated effect sizes (e.g., gender, age, beverage type). Finally, studies funded by the food industry reported significantly smaller effects than did non-industry-funded studies. Recommendations to reduce population soft drink consumption are strongly supported by the available science.