Development of eating behavior: biology and context

Rule-based systems to automatically count bites from meal videos

Eating behavior is a key factor for nutritional intake and plays a significant role in the development of eating disorders and obesity. The standard methods to detect eating behavior events (i.e., bites and chews) from video recordings rely on manual annotation, which lacks objective assessment and standardization. Yet, video recordings of eating episodes provide a non-invasive and scalable source for automation. Here, we present a rule-based system to count bites automatically from video recordings with 468 3D facial key points. We tested the performance against manual annotation in 164 videos from 15 participants. The system can count bites with 79% accuracy when annotation is available, and 71.4% when annotation is unavailable. The system showed consistent performance across varying food textures. Eating behavior researchers can use this automated and objective system to replace manual bite count annotation, provided the system's error is acceptable for the purpose of their study. Utilizing our approach enables real-time bite counting, thereby promoting interventions for healthy eating behaviors. Future studies in this area should explore rule-based systems and machine learning methods with 3D facial key points to extend the automated analysis to other eating events while providing accuracy, interpretability, generalizability, and low computational requirements.

Psychometric properties of the Turkish version of the eating in the absence of hunger in children and adolescents (EAH-C)

BACKGROUND AND PURPOSE

Eating in the absence of hunger is a risk factor for excessive energy intake and predisposes children to overweight/obesity. The purpose of this study was to test the validity and reliability of the "Eating in the Absence of Hunger Questionnaire for Children and Adolescents (EAH-C)" in Türkiye.

METHODS

This study was conducted in a total of six schools, with children 8-18 years old between September and December 2022. Factor analysis, item-total score analysis and Cronbach's alpha coefficient were used for the validity and reliability.

RESULTS

The calculated KMO statistic was >0.60, and the Bartlett's test statistic was <0.05. The three subscales accounted for 65.22% of the total variance. Factor loads ranged from 0.41 to 0.84. The value obtained by dividing χ2 by the number of degrees of freedom was <5; the RMSEA was <0.10; the RMR was <0.08; and the TLI, GFI, AGFI, and CFI were >0.90. Cronbach's alpha coefficient was 0.91 for the total scale.

CONCLUSIONS

Our study has confirmed that the Turkish-language version of the EAH-C is a valid and reliable tool.

PRACTICE IMPLICATIONS

In the effort of prevention of childhood obesity, identifying eating behaviors in the absence of hunger in children and adolescents will benefit policymakers to develop intervention and prevention programs, in addition to providing guidance to pediatric nurses, all healthcare professionals, researchers, children, and parents.

Chronodisruption and Gut Microbiota: Triggering Glycemic Imbalance in People with Type 2 Diabetes

The desynchronization of physiological and behavioral mechanisms influences the gut microbiota and eating behavior in mammals, as shown in both rodents and humans, leading to the development of pathologies such as Type 2 diabetes (T2D), obesity, and metabolic syndrome. Recent studies propose resynchronization as a key input controlling metabolic cycles and contributing to reducing the risk of suffering some chronic diseases such as diabetes, obesity, or metabolic syndrome. In this analytical review, we present an overview of how desynchronization and its implications for the gut microbiome make people vulnerable to intestinal dysbiosis and consequent chronic diseases. In particular, we explore the eubiosis-dysbiosis phenomenon and, finally, propose some topics aimed at addressing chronotherapy as a key strategy in the prevention of chronic diseases.

Almli V. Basic taste sensitivity, eating behaviour, food propensity and BMI of preadolescent children: How are they related?

Background

Taste sensitivity has been reported to influence children's eating behaviour and contribute to their food preferences and intake. This study aimed to investigate the associations between taste sensitivity, eating behaviour, food frequency and BMI (Body Mass Index) in preadolescents.

Methods

Preadolescents' taste sensitivity was measured by detection threshold of sweetness (sucrose), sourness (citric acid), saltiness (sodium chloride), bitterness (caffeine, quinine), and umami (monosodium glutamate). In addition, the Child Eating Behaviour Questionnaire (CEBQ), the Food Propensity Questionnaire (FPQ) measuring food frequency, and the children's body weight and height were completed by the parents. A total of 69 child-parent dyads participated (preadolescents mean age =10.9 years).

Results

Taste sensitivity to caffeine bitterness was significantly associated with eating behaviour in food responsiveness, emotional overeating, and desire to drink. The preadolescents who were less sensitive to caffeine bitterness had higher food responsiveness scores. Those who were less sensitive to caffeine bitterness and to sweetness had higher emotional overeating scores. In addition, preadolescents who were less sensitive to sourness and bitterness of both caffeine and quinine demonstrated to have higher scores in desire to drink. There was no association between taste sensitivity and FPQ, but significant differences were observed across preadolescents' BMI for FPQ of dairy food items, indicating higher consumption of low-fat milk in the overweight/obese compared to the underweight/normal-weight subjects. There was no significant difference in taste sensitivity according to BMI. Preadolescents' eating behaviour differed across BMI, demonstrating a positive association between BMI and food approach, and a negative association between BMI and food avoidance.

Conclusions

This study contributes to the preliminary understanding of the relationships between taste sensitivity and eating behaviour in preadolescents. The results may be used to develop effective strategies to promote healthy eating practices by considering taste sensitivity in preadolescents.

Methyl Jasmonate Modulates Feeding Behaviors and Hypothalamic Expression of the Orexin 1 Receptor in Rats

Objectives

Active plant ingredients have been successfully used in modern medicine to control appetite and energy hemostasis. This study was designed to evaluate the efficacy of the phytohormone methyl jasmonate (MJ) on food-related behaviors in rats.

Materials and Methods

Adult male Wistar rats were randomly divided into different groups (7 rats) and infused intracerebroventricularly (i.c.v.) with MJ vehicle (DMSO) or MJ (2.5, 5 and 10 μg/rat). Then, the individual rats were placed in an automated open field-like apparatus to assess a 12-h food-related activity in light and dark times. After behavioral tests, immunofluorescence staining of the orexin 1 receptor (Orx1R) was studied in the hypothalamus of rats.

Results

MJ (2.5, 5, and 10 μg/rat) administration significantly decreased food intake in the light and dark phases compared with the control group. Moreover, all the MJ-treated groups exhibited a decrease in visits to food containers at the light and dark times (p < 0.001). In addition, rats infused with MJ at 5 μg and 10 μg spent less time in the ports of food containers in the light and dark phases in comparison with control rats. Time in zone-related to food and locomotor activity was significantly decreased in the MJ (5 μg) groups during the light time and in all MJ-injected groups in the dark time. Moreover, hypothalamic expression of Orx1R in rats treated with MJ (5 μg) was significantly lower as compared to the control group.

Conclusion

Overall, the results indicated the potential of MJ to modulate feeding-related behavior and Orx1R expression in the hypothalamus of rats.

The evolution of nutritional care in children and young people with acute lymphoblastic leukaemia: a narrative review

BACKGROUND

Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy in the world. Advances in treatment protocols have resulted in survival rates of >80% in most high-income countries (HIC); however, children and young people (CYP) with ALL continue to face significant nutrition-related challenges during treatment.

METHODS

This narrative review outlines the changing landscape of treatment and survivorship for CYP with ALL and the advances in nutrition knowledge that call for changes to clinical nutrition practice.

RESULTS

The incidence of ALL has remained stable in HIC; however, there have been significant advances in survival over the past 30 years. Overweight and obesity are increasingly prevalent in CYP with ALL at diagnosis, during treatment and in survivorship. Coupled with poor diet quality, high-energy and saturated fat intakes, altered eating behaviours and inactivity, this necessitates the need for a shift in nutrition intervention. Undernutrition remains a concern for CYP with high-risk treatment protocols where oral or enteral nutrition support remains a cornerstone of maintaining nutrition status.

CONCLUSIONS

With improved treatment protocols and high survival rates, a shift to focusing on diet quality, prevention of excessive weight gain and obesity during treatment and survivorship is necessary.

Maternal control and eating styles in children: The mediating role of emotion differentiation

Introduction: Theoretical accounts and empirical research suggest that mother-child interactions significantly influence the child's eating styles (emotional, external, and restrained eating). However, little or no research has explored the association between maternal psychological control and eating styles and whether other mechanisms may be involved in such association. To address this shortcoming, the present study aimed to investigate the mediating role of difficulties in differentiating emotions between maternal control and eating styles.Methods: Participants were 324 elementary school children (Girls = 172, 53.1%) aged between 8 and 11 years (Mage = 9.13, SD = .89) assessed through self-report measures. Parents provided information about weight and height.Results: Path analysis model showed an acceptable fit to the data (χ2 (3) = 3.966, p = .256; RMSEA = .032; CFI = .990; TLI = .911; SRMR = .018). Difficulties in differentiating emotions significantly mediated the relationship between maternal control and emotional eating (β = -.071, 95%CI [-.094, -.052]; p < .001). The model was invariant across genders.Conclusions: Our findings support the importance of dyadic interaction in enhancing the risk for dysfunctional eating style during infancy, showing that emotion differentiation deficits may be particularly salient in such relationship. Clinical and practical implications of these findings are discussed.

The role of dysregulated ghrelin/LEAP-2 balance in anorexia nervosa

LEAP-2 is a ghrelin antagonist with an anorexigenic drive. This study investigates the evolution of plasma ghrelin and LEAP-2 concentrations in 29 patients with anorexia nervosa (AN) before and after refeeding and compares it to physiological adaptations during fasting in healthy controls or to mouse model of chronic food restriction and refeeding. Acute and chronic food restriction decrease LEAP-2 and increase ghrelin concentrations in both humans and mice, while patients with AN displayed higher ghrelin and LEAP-2 concentrations before than after refeeding (p = 0.043). After 6 months follow-up, patients with unstable weight gain (n = 17) had significantly decreased LEAP-2 concentrations after refeeding (p = 0.044), in contrast to patients with stable weight gain (n = 12). We provide evidence that the ghrelin/LEAP-2 system is not regulated according to the nutritional status in AN, in contrast to what is physiologically expected when coping with food restriction.

NIH-supported implementation science and nutrition research: a portfolio review of the past decade

Objective

This portfolio analysis aims to describe the scope of NIH-funded extramural research grants at the intersection of nutrition research and implementation science (IS) from 2011 to 2022 and to offer insights into future research opportunities relevant to the Strategic Plan for NIH Nutrition Research 2020-2030.

Methods

A portfolio analysis of funded grants using NIH reporting systems was conducted to identify nutrition research and IS awarded between fiscal years 2011 and 2022. The authors screened the titles and abstracts for inclusion criteria: research and career development awards involved a nutrition and/or dietary intervention and measured a stated implementation outcome or used an IS theory, model, or framework.

Results

In total, 33 NIH-funded awards met the inclusion criteria. Almost half of the awards (48.5%) were investigator-initiated research projects compared to research career awards and cooperative agreements. While studies were predominantly conducted in the United States, 15.2% were conducted in low- and middle-income countries in Africa, Latin America, and Asia. Adults aged 19-64 years and children aged 2-11 years represented most of the study populations (45.5 and 15.2%, respectively). Studies provided nutrition/dietary guidelines and created culturally tailored interventions, which were then adapted in collaboration with community partners in schools, hospitals, and religious settings. The most cited IS outcomes were feasibility, costs, adoption, and acceptability. Sixteen awards (48.5%) used an IS theory, model, or framework to guide their work.

Discussion

The findings show the breadth of NIH-funded nutrition and implementation research and highlight potential research opportunities.

Police Bias and Low Relatability and Diet Quality: Examining the Importance of Psychosocial Factors in Predominantly Black Communities

How police bias and low relatability may contribute to poor dietary quality is poorly understood. In this cross-sectional study, we analyzed data from 2021 from a cohort of n = 724 adults living in predominantly Black communities in Pittsburgh, Pennsylvania; these adults were mostly Black (90.6%), low-income (median household income $17,500), and women (79.3%). We estimated direct and indirect paths between police mistrust and dietary quality (measured by Healthy Eating Index (HEI)-2015) through perceived stress, community connectedness, and subjective social status. Dietary quality was poor (mean HEI-2015 score was 50) and mistrust of police was high: 78% of participants either agreed or strongly agreed that something they say might be interpreted as criminal by the police due to their race/ethnicity. Police bias and low relatability was associated with lower perceived social status [Formula: see text]=  - 0.03 (95% confidence interval [CI]: - 0.05, - 0.01). Police bias and low relatability was marginally associated with low dietary quality β =  - 0.14 (95% CI: - 0.29, 0.02). Nineteen percent of the total association between police bias and low relatability and lower dietary quality β =  - 0.16 (- 0.01, - 0.31) was explained by an indirect association through lower community connectedness, or how close respondents felt with their community [Formula: see text] Police bias and low relatability may play a role in community connection, social status, and ultimately dietary disparities for Black Americans. Addressing police bias and low relatability is a continuing and pressing public health issue.

Avoidant restrictive food intake disorder and pediatric feeding disorder: the pediatric gastroenterology perspective

PURPOSE OF REVIEW

Avoidant/restrictive food intake disorder (ARFID) and pediatric feeding disorder (PFD) are the newest evolutions of frameworks for dysfunctional feeding and share overlapping features but maintain notable differences. This review will compare the two frameworks, highlighting some of the latest advances in diagnosis and management.

RECENT FINDINGS

Dysfunctional feeding, particularly withing the PFD definition, benefits from multidisciplinary care with equal attention to medical, nutritional, skill-based, and behavioral domains. Management requires medical attention, often with functional gastrointestinal disease and anxiety. Pharmacologic appetite stimulation may play a role. A single empirically proved behavioral approach has not been described and multiple options exist regarding type, location, and intensity of feeding therapy.

SUMMARY

ARFID and PFD not only share areas of overlap, but also differ, likely based on the origins of each framework. Ultimately, both frameworks describe dysfunctional feeding and require input from medical providers. The more effective approaches tend to be multidisciplinary, addressing medical, nutritional, skill-based, and/or behavioral aspects of the disorder (the PFD model). Future evolution of both ARFID and PFD frameworks is likely to generate refinement in their defining criteria, hopefully generating a structured link between the two.

Change in preference for vegetables and their perceptual attributes as a function of age and pickiness

Preference for vegetables is influenced by various factors, including demographic, psychological, socio-environmental, and genetic factors. This study confirmed that age, pickiness, and perceptual attributes were predictors of preference for vegetables and examined how preference for vegetables and their perceptual attributes varies with age and pickiness. Children (8-14 years, n = 420), youth (15-34 years, n = 569), middle-aged adults (35-64 years, n = 726), and older adults (65-85 years, n = 270) were asked which vegetables they liked (or disliked) and which perceptual attributes of each vegetable they liked (or disliked). On the basis of their responses, an overall preference score and a preference sub-score for each perceptual attribute were calculated. Participants in each age group were classified into four statuses (non-, mild, moderate, and severe) according to their pickiness scores. Multiple regression analysis revealed that age and preference sub-scores for eight perceptual attributes (sweetness, sourness, bitterness, umami, pungency, orthonasal aroma, texture, and appearance) were positive predictors of overall preference score and that pickiness score and four perceptual attributes (saltiness, astringency, retronasal aroma, and aftertaste) were negative predictors. In addition, overall preference score and preference sub-scores for perceptual attributes other than saltiness increased with increasing age group and decreasing picker status; however, preference sub-scores for at least one of the six perceptual attributes (bitterness, astringency, pungency, orthonasal aroma, retronasal aroma, and aftertaste) exhibited negative values in children, youth, and pickers (mild, moderate, and severe). The increase in preference for these perceptual attributes might be an indicator of the adultization of food perception and the expansion of food acceptance.

Maternal Feeding Beliefs and Behaviors Relate to Infant Diet and Appetite

INTRODUCTION

Maternal feeding practices may be linked to infant obesogenic outcomes, but research to date has focused primarily on infant growth as an outcome of maternal feeding practices rather than exploring additional obesogenic outcomes like infant appetite and diet. Therefore, the current study examined the association between maternal feeding practices and beliefs and infant growth, diet, and appetite simultaneously at a critical timepoint for obesity risk development (i.e., 3-months-old).

METHODS

Thirty-two 3-month-old infants and their mothers participated in this cross-sectional study. Infant anthropometrics were collected by trained staff and mothers completed questionnaires regarding maternal feeding practices and beliefs and infant diet and appetite. The data were analyzed by Spearman correlations.

RESULTS

Statistically significant correlations were identified between maternal feeding practices (e.g., using food to calm, concern about infant weight) and infant satiety, appetite, food responsiveness, slow eating, and kilocalories consumed. Infant weight-for-length was related to maternal concern about infant underweight and mother-infant social interaction during feeding.

DISCUSSION

These findings highlight the importance of the mother-infant feeding relationship and how these associations may influence responsive feeding practices and infant weight-related outcomes.

Measurement is the foundation of research and theory on children's eating behaviours: Current issues and directions for progress

Eating behaviours affect food intakes and are involved in the aetiology of obesity. There has been impetus to translate findings about children's eating behaviour into intervention and policy programs. However, measurement limitations have hindered our capacity to understand and influence children's eating behaviours. In the present paper we provide an overview of some of the key methodological and measurement issues facing the field of children's eating behaviours and highlight implications for research and health promotion. Drawing on insight from parallel issues that occur in the measurement of early social and emotional development, we examine two overlapping themes in children's (aged 0-∼12 years) eating behaviours (Somaraki et al., 2021) measurement issues related to validity and reliability, and (Steinsbekk & Wichstrøm, 2015) associated methodological challenges, such as contextual influences and the importance of designing studies that use multiple informants and multiple methods. We then suggest insights and strategies aimed at advancing approaches to measurement of children's eating behaviours. To progress our understanding of children's eating behaviours, we conclude that a range of psychometrically sound, fit-for-purpose measurement instruments and procedures are needed for use in multi-trait, multi-method, multi-informant studies in a range of populations and contexts.

An iterative neural processing sequence orchestrates feeding

Feeding requires sophisticated orchestration of neural processes to satiate appetite in natural, capricious settings. However, the complementary roles of discrete neural populations in orchestrating distinct behaviors and motivations throughout the feeding process are largely unknown. Here, we delineate the behavioral repertoire of mice by developing a machine-learning-assisted behavior tracking system and show that feeding is fragmented and divergent motivations for food consumption or environment exploration compete throughout the feeding process. An iterative activation sequence of agouti-related peptide (AgRP)-expressing neurons in arcuate (ARC) nucleus, GABAergic neurons in the lateral hypothalamus (LH), and in dorsal raphe (DR) orchestrate the preparation, initiation, and maintenance of feeding segments, respectively, via the resolution of motivational conflicts. The iterative neural processing sequence underlying the competition of divergent motivations further suggests a general rule for optimizing goal-directed behaviors.

Psychometric properties of the Thai version of the Scale of Oral Health Outcomes for 5-year-old children

BACKGROUND

As caries prevalence in Thai preschool children is very high and its consequences have scarcely been evaluated, the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) is considered as an appropriate tool to measure the children's oral health-related quality of life (OHRQoL).

AIM

To translate the SOHO-5 into Thai (Th-SOHO-5) and assess its psychometric characteristics.

DESIGN

The cross-cultural adaptation of the SOHO-5 into Thai comprised forward-backward translation by experts and face validation by 20 child-parent dyads. To evaluate psychometric properties of the final version, a cross-sectional study was conducted on 306 child-parent pairs using an interview mode for children and a self-administered mode for parents. A trained investigator examined children's caries status.

RESULTS

The Th-SOHO-5 showed satisfactory psychometric characteristics. Cronbach's alpha values were above 0.8 for both child and proxy reports. Overall intraclass correlation coefficients were > 0.9. Factor analysis supported a single-factor structure model of the Th-SOHO-5 and showed an excellent fit. Th-SOHO-5 scores were correlated with all global rating scales of oral health and well-being. Children with higher caries experience or caries with pulpal involvement demonstrated significantly higher Th-SOHO-5 scores.

CONCLUSION

The Th-SOHO-5 possessed good reliability and validity. It can be used to evaluate the OHRQoL of preschool children in Thailand.

Children's eating behaviours and related constructs: conceptual and theoretical foundations and their implications

BACKGROUND

There is a substantial body of research on children's eating behaviours (e.g., food responsiveness and fussiness) and related constructs (e.g., eating in the absence of hunger, appetite self-regulation). This research provides a foundation for understanding children's dietary intakes and healthy eating behaviours, as well as efforts at intervention, whether in relation to food avoidance, overeating and/or trajectories to excess weight gain. The success of these efforts and their associated outcomes is dependent on the theoretical foundation and conceptual clarity of the behaviours and constructs. This, in turn contributes to the coherence and precision of the definitions and measurement of these behaviours and constructs. Limited clarity in these areas ultimately creates uncertainty around the interpretation of findings from research studies and intervention programs. At present there does not appear to be an overarching theoretical framework of children's eating behaviours and associated constructs, or for separate domains of children's eating behaviours/constructs. The main purpose of the present review was to examine the possible theoretical foundations of some of the main current questionnaire and behavioural measures of children's eating behaviours and related constructs.

METHODS

We reviewed the literature on the most prominent measures of children's eating behaviours for use with children aged ~ 0-12 years. We focused on the explanations and justifications for the original design of the measures and whether these included theoretical perspectives, as well as current theoretical interpretations (and difficulties) of the behaviours and constructs.

RESULTS

We found that the most commonly used measures had their foundations in relatively applied or practical concerns rather than theoretical perspectives.

CONCLUSIONS

We concluded, consistent with Lumeng & Fisher (1), that although existing measures have served the field well, to advance the field as a science, and better contribute to knowledge development, increased attention should be directed to the conceptual and theoretical foundations of children's eating behaviours and related constructs. Suggestions for future directions are outlined.

I Don't Want to Be Thin! Fear of Weight Change Is Not Just a Fear of Obesity: Research on the Body Mass Anxiety Scale

Anxiety is one of the psychological factors associated with body weight experienced by people attempting to live up to expectations of an ideal body shape. The stigma of excessive or too low body weight and the stigmatization of people because of it is becoming a widespread problem with negative psychological and social consequences. One effect of the strong social pressure of beauty standards dependent on low body weight is the development of eating disorders and negative societal attitudes toward overweight or obese people. Research conducted to date has mainly focused on one dimension of weight-related anxiety-the fear of getting fat. Ongoing research has also revealed the other side of weight-related anxiety-fear of weight loss. Therefore, the purpose of the present project was to develop a two-dimensional scale to diagnose the level of weight-related anxiety and to preliminarily test the psychometric properties of the emerging constructs. Results: the BMAS-20 weight-related anxiety scale in both Polish and English versions was developed and its psychometric properties were confirmed. The components of body weight-change anxiety that emerged were: anxiety about getting fat and anxiety about losing weight. It was found that both AGF and ALW may have a protective function related to awareness of the negative consequences of poor eating and the health risks associated with it. Above-normal levels of anxiety may be a predictor of psychopathology. Both AGF and ALW are associated with symptoms of depression.

Bodyweight and human capital development: Assessing the impact of obesity on socioemotional skills during childhood in Chile

This article analyzes the effect of bodyweight on socioemotional skills for children aged two to 12 years in Chile. Using an instrumental variable approach and a representative survey, we show that both BMI and obesity are causality related to children's socioemotional development, even after assuming that our instrument is imperfect. Although we did not find significant differences between boys and girls, we do identify heterogeneous effects by age: the weight penalty for girls starts earlier than for boys. Our findings suggest that early interventions for childhood obesity not only might generate positive impacts on children's health, but also a greater accumulation of non-cognitive human capital in the future.

Capturing Eating Behavior from Video Analysis: A Systematic Review

Current methods to detect eating behavior events (i.e., bites, chews, and swallows) lack objective measurements, standard procedures, and automation. The video recordings of eating episodes provide a non-invasive and scalable source for automation. Here, we reviewed the current methods to automatically detect eating behavior events from video recordings. According to PRISMA guidelines, publications from 2010-2021 in PubMed, Scopus, ScienceDirect, and Google Scholar were screened through title and abstract, leading to the identification of 277 publications. We screened the full text of 52 publications and included 13 for analysis. We classified the methods in five distinct categories based on their similarities and analyzed their accuracy. Facial landmarks can count bites, chews, and food liking automatically (accuracy: 90%, 60%, 25%). Deep neural networks can detect bites and gesture intake (accuracy: 91%, 86%). The active appearance model can detect chewing (accuracy: 93%), and optical flow can count chews (accuracy: 88%). Video fluoroscopy can track swallows but is currently not suitable beyond clinical settings. The optimal method for automated counts of bites and chews is facial landmarks, although further improvements are required. Future methods should accurately predict bites, chews, and swallows using inexpensive hardware and limited computational capacity. Automatic eating behavior analysis will allow the study of eating behavior and real-time interventions to promote healthy eating behaviors.

Preference for high-carbohydrate foods does not change for children and adolescents in insulin-induced hypoglycemia

INTRODUCTION

Hypoglycemia elicits coordinated counter-regulatory neuroendocrine responses. The extent to which this process involves an increased drive to eat, together with greater preference for foods high in carbohydrate content, is unclear. Our objective was to examine this effect in children and adolescents (age 5-19 years) without diabetes and no prior known experience of hypoglycemic episodes.

RESEARCH DESIGN AND METHODS

We administered a computerised task designed to examine preference for high-carbohydrate foods (sweet and savory) to pediatric patients (n=26) undergoing an insulin tolerance test as part of the routine clinical assessment of pituitary hormone secretory capacity. The task was completed at baseline and three time points after intravenous infusion of insulin (approximately 7, 20 and 90 min).

RESULTS

Although all patients reached insulin-induced hypoglycemia (mean venous glucose at nadir=1.9 mmol/L), there was moderate evidence of no effect on preference for high-carbohydrate foods (moderate evidence for the null hypothesis) compared with euglycemia. Patients also did not display an increase in selection of foods of high compared with low energy density. Sensitivity of the task was demonstrated by decreased preference for sweet, high-carbohydrate foods after consumption of sweet food and drink.

CONCLUSIONS

Results support the view that acute hypoglycemia does not automatically prompt the choice of high-carbohydrate foods for rapid glucose restoration, and further stresses the importance that people and families with children vulnerable to hypoglycemic episodes ensure that 'rapidly absorbed glucose rescue therapy' is always available.

Food approach and avoidance appetitive traits in university students: A latent profile analysis

Eating behaviors are influenced by many factors including appetitive traits. Few studies have utilized latent profile analysis (LPA) to examine food approach and food avoidance appetitive traits. This study utilized LPA to define cluster profile groups based on appetitive traits in undergraduate and graduate/professional students at a large University in the southwest United States. Students completed a cross-sectional online survey in fall 2020 assessing demographic information, appetitive traits via the Adult Eating Behavior Questionnaire (AEBQ), and anxiety via the Generalized Anxiety Disorder Scale (GAD-7; higher scores indicate more severe anxiety symptoms). Appetitive traits were combined into eight scales (four food approach and four food avoidance traits). Latent profile analyses were conducted to identify homogenous subgroups of participants based on AEBQ scale scores. The final sample included 1243 students (mean age = 26.5 years, 73% female, 59% White, 57% undergraduates). LPA revealed four cluster profile groups: Cluster 1 (moderate eaters: lower than mean scores for food approach and avoidance traits), Cluster 2 (food seekers and avoiders: higher than mean scores for food approach and avoidance traits), Cluster 3 (food seekers: higher than mean scores for food approach traits), and Cluster 4 (food avoiders: higher than mean scores for food avoidance traits). Distribution of age, gender, race/ethnicity, and student status differed significantly between clusters. GAD-7 score was highest in Cluster 2 (food seekers and avoiders) and lowest in Cluster 1 (moderate eaters). Among the four LPA-defined cluster profile groups, students who endorsed both food approach and avoidance traits reported more severe anxiety symptoms compared to moderate eaters, food seekers, and food avoiders. It is useful to consider clusters of appetitive traits instead of individual appetitive traits when examining associations with physical and mental health.

Barriers and enablers to caregivers' responsive feeding behaviour: A systematic review to inform childhood obesity prevention

Responsive infant feeding is a critical component of childhood obesity prevention. However, there is little guidance for caregivers on how to do this successfully. The first step to developing an intervention to promote responsive feeding is to systematically identify its barriers and enablers. Searches were conducted in CINAHL, Cochrane Library, Medline, Embase, PubMed, PsycINFO, Maternity, and Infant Care from inception to November 2020. All study designs were included if they reported a barrier or enabler to responsive feeding during the first 2 years of life. We used a "best fit" framework synthesis, with the Capacity, Opportunity, Motivation, and Behaviour (COM-B) model. The Mixed Method Appraisal Tool (MMAT) was used to assess study quality. Forty-three studies were included in the review. Barriers (n = 36) and enablers (n = 21) were identified across five COM-B domains: psychological capacity, physical and social opportunity, and reflective and automatic motivation. Enablers were recognition of infant feeding cues, feeding knowledge and family and friends. Caregiver attitude toward control of feeding was a barrier, together with health care professional advice about formula feeding and breastfeeding expectation. These barriers and enablers provide a comprehensive evidence base to guide intervention development to improve responsive feeding and prevent obesity across individual and population levels.

Perspectives of Black/African American and Hispanic Parents and Children Living in Under-Resourced Communities Regarding Factors That Influence Food Choices and Decisions: A Qualitative Investigation

Families living in under-resourced communities are at risk of obesity and obesity-related chronic diseases. To develop effective interventions, it is important to identify parent and child perspectives of factors that influence food-related choices and decisions. This paper reports qualitative findings from a larger mixed method study investigating this topic. Hybrid thematic analysis was used to code and analyze the interviews. Family-generated photographs of factors influencing food choices were discussed during the interviews. Qualitative findings were organized by the socio-ecological model. Verbatim quotes and photographs were used to support themes. Thirty-six interviews were conducted (18 parents, 18 children). Findings from parents revealed personal (e.g., culture, beliefs, time), family (e.g., mother, child, father, health, finances, cohesiveness), environmental (e.g., availability, convenience, cost), and other (e.g., school food) factors influenced food choices. Similarly, child-reported influences were personal (e.g., preferences, beliefs, taste), family (e.g., mother, family encouragement, father, family time), social (e.g., school, friends), environmental (e.g., availability), and other (e.g., media, sports). The socio-ecological model provided a useful framework for identifying factors that influence food choices and decisions of families living in under-resourced communities. A deeper understanding of these factors could enhance both responsiveness and effectiveness of interventions to enhance diet and reduce obesity risk in families living in under-resourced communities.

Appetite self-regulation declines across childhood while general self-regulation improves: A narrative review of the origins and development of appetite self-regulation

This narrative review discusses the origins and development of appetite self-regulation (ASR) in childhood (from infancy to age 6 or 7 years). The origins, or foundations, are the biological infrastructure associated with appetite regulation and appetite self-regulation. Homeostatic regulation in infancy is examined and then evidence about developmental change in components of ASR. The main ASR-related components covered are: delay-of-gratification, caloric compensation, eating in the absence of hunger, food responsiveness/hedonics and fussy eating. The research included behavioral measures, parent-reports of appetitive traits and fMRI studies. There were two main trends in the evidence: a decline across childhood in the components of ASR associated with food approach (and therefore an increase in disinhibited eating), and wide individual differences. The decline in ASR contrasts with general self-regulation (GSR) where the evidence is of an improvement across childhood. For many children, bottom-up automatic reactive processes via food reward/hedonics or food avoidance as in fussy eating, appear not to be matched by improvements in top-down regulatory capacities. The prominence of bottom-up processes in ASR could be the main factor in possible differences in developmental paths for GSR and ASR. GSR research is situated in developmental science with its focus on developmental processes, theory and methodology. In contrast, the development of ASR at present does not have a strong developmental tradition to access and there is no unifying model of ASR and its development. We concluded (1) outside of mean-level or normative changes in the components of ASR, individual differences are prominent, and (2) there is a need to formulate models of developmental change in ASR together with appropriate measurement, research designs and data analysis strategies.

Appetitive Traits in a Population-Based Study of Polish Adolescents within the PLACE-19 Study: Validation of the Adult Eating Behavior Questionnaire

Appetitive traits of food approach or food avoidance are commonly measured using the Adult Eating Behavior Questionnaire (AEBQ). However, there is no Polish version of the AEBQ validated for adolescents, and to the best of our knowledge, no study completed with the Polish version of the AEBQ has been published thus far. The present study aimed to validate the AEBQ in a population-based sample of Polish secondary school students and to assess differences in appetitive traits between boys and girls within the Polish Adolescents' COVID-19 Experience (PLACE-19) Study. The PLACE-19 Study was conducted in a group of 2448 adolescents recruited in May 2020 through the random quota sampling of secondary schools. The AEBQ was used to assess food approach subscales (Food Responsiveness, Emotional Over-Eating, and Enjoyment of Food) and food avoidance subscales (Satiety Responsiveness, Emotional Under-Eating, Food Fussiness, and Slowness in Eating). To validate the questionnaire, the standardized factor loadings within confirmatory factor analysis (CFA) with weighted least squares (WLS) were analyzed, and invariance was verified. The CFA presented good model fit, with χ² = 4826.105 (degrees of freedom (df) = 384), root mean square error of approximation (RMSEA) = 0.069 (90% confidence interval (CI): 0.067, 0.070), comparative fit index (CFI) = 0.90, and standardized root mean square residual (SRMR) = 0.08. The results revealed that, compared to the configural invariance model, the metric invariance model did not result in significantly decreased model fit, with ΔCFI = -0.002 and ΔRMSEA = -0.001, which were lower than the recommended cutoffs of 0.010 and 0.015, respectively. The scalar invariance model also did not result in significantly decreased fit of the model over the metric invariance model, with ΔCFI = -0.005 and ΔRMSEA = 0.000. Girls reported higher levels of Food Responsiveness (p < 0.0001), Emotional Over-Eating (p < 0.0001), Satiety Responsiveness (p < 0.0001), Emotional Under-Eating (p < 0.0001), and Slowness in Eating than boys (p < 0.0001), and the total AEBQ scores of girls were also higher (p < 0.0001). Positive inter-correlations were observed between all food approach subscales, as well as between Emotional Under-Eating and all food approach subscales for girls, boys, and the total sample; positive inter-correlations were also observed between the majority of food avoidance subscales. The present study confirmed the validity of the AEBQ in the studied population, and supported the associations between appetitive traits assessed using the AEBQ; it also indicated higher scores of both food approach and food avoidance subscales in girls than in boys in a population-based sample of Polish secondary school students.

The impact of active or passive food preparation versus distraction on eating behaviour: An experimental study

Research indicates a role for attention in the perception of hunger and food intake. The present experimental study aimed to explore the impact of attention to food cues through either active or passive food preparation, versus attention away from food cues through a non-food distraction task on eating behaviour using a preload/taste test design. Female participants (n = 80) were randomly allocated to one of four conditions: active food preparation (making a wrap); passive video preparation (watching video of researcher making a wrap); distraction (a non-food colouring task); no time control. Measures of desire to eat (hunger, fullness, motivation) were taken before and after the interventions. Food intake was measured in terms of mass of wrap consumed and snacks consumed at a subsequent taste test. The results showed greater wrap consumption for active and passive food preparation and the control groups compared to the distraction intervention. Further, the results showed that active food preparation resulted in increased hunger and motivation to eat and that passive food preparation resulted in increased motivation to eat. No changes were found following distraction. To conclude, attention to food cues through both active and passive food preparation can increase both food intake and the desire to eat. The implications for promoting changes in eating behaviour are discussed.

Eating in the Absence of Hunger and Obesity Among Adolescents in Santiago, Chile

In reports among mostly, US, white, preschool and young school-age children eating in the absence of hunger (EAH) has been positively related to adiposity, with some support for a sex-specific relationship. There is considerable interest in EAH and obesity in populations at risk for obesity-like populations of countries that have undergone rapid development. We assessed adolescents (n = 679) after an overnight fast with anthropometry and an EAH paradigm beginning with an ad lib pre-load meal. Participants reported satisfaction and perceived ability to eat more food, and then proceeded to a room with freely available snacks where they were permitted to eat ad lib for 20 min. Adolescents were 16.8 years old, 52% male, and 14% with obesity. Median preload meal kcal consumption was 602 (IQR 474-746). Additional calories were consumed at the EAH snack by 47.6%. Among those who ate snack, 155 additional calories were consumed (IQR 78-283). Adolescents with obesity had 0.61 (95% CI 0.37-0.99) reduced odds of eating at the EAH snack adolescents without obesity. Adolescents with obesity were also less likely to eat above the median total calories compared to adolescents without obesity (OR = 0.59, 95% CI 0.36-0.96). A sex by obesity interaction term was not significant in any model. Obesity was related to eating behavior in our sample of Chilean adolescents, however not in the direction we hypothesized. Adolescents with obesity were less likely to eat additional calories in the EAH paradigm and ate fewer total calories compared to adolescents without obesity.

CD36 gene polymorphism -31118 G > A (rs1761667) is associated with overweight and obesity but not with fat preferences in Mexican children

CD36 glycoprotein is a candidate receptor involved in the gustatory detection of lipids and emerging evidence has suggested that genetic variations in CD36 may modulate the oral perception threshold to fatty acids. Here, we analyzed the association of -31118 G > A polymorphism in CD36 gene with nutritional status and preferences for fatty foods in Mexican children. Genotyping of SNP rs1761667 was performed in school-age children (n = 63) in addition to sensory tests evaluating the preference and satisfaction score assigned to oil-based sauces of different fatty acid composition. The G allele was associated with high BMI z-score in children (OR = 2.43, 95% (CI 1.02-5.99); p = 0.02) but CD36 genotypes (AA, GA, and GG) did not show significant association with the preference and satisfaction scores assigned to oil-based sauces. The BMI z-score showed no association with the preference to oil-based sauces; however, children with normal weight gave higher satisfaction scores to sauces with a high content of unsaturated fatty acids than to sauces rich in saturated fatty acids (0.56 ± 1.26 vs. 0.06 ± 1.22; p = 0.02). Therefore, the G allele of -31118 G > A SNP in CD36 gene is associated with overweight and obesity in Mexican children but do not appear to modulate the preferences and satisfaction scores to fat.

Impact of a sodium-reduced bread intervention with and without dietary counseling on sodium intake-a cluster randomized controlled trial among Danish families

BACKGROUND/OBJECTIVES

Excessive intake of sodium is a dietary risk factor for morbidity and mortality. Currently, intake of sodium is much higher than the recommended level in most western countries, and effective strategies to reduce population sodium intake are lacking. The objective of the present study was to investigate the effect of two different sodium reduction strategies on the intake of sodium, potassium, and the sodium to potassium ratio among Danish families SUBJECTS/METHODS: The study was a 4-month, single-blinded, cluster randomized controlled trial with a parallel design. Eighty-nine healthy Danish families, with a minimum of one child and one parent (n = 309), were randomly assigned to receive sodium-reduced bread (Intervention A), sodium-reduced bread and dietary counseling (Intervention B) or regular sodium bread (Control). The primary outcome was change in daily sodium intake, measured by 24-h urinary sodium excretion. Secondary outcomes included changes in dietary potassium and the sodium to potassium ratio.

RESULTS

No significant differences in daily sodium intake were observed in the two intervention groups compared with the control. When analyzing the results separately for children and adults, a reduction in dietary sodium of 0.6 g/day (-1.0, -0.2), p = 0.005 occurred among adults in intervention B compared with control.

CONCLUSIONS

This study demonstrates that providing sodium-reduced bread in combination with dietary counseling is an effective strategy to reduce dietary sodium among adults, but the effect is lacking in children. The study was not able to show significant effects when providing sodium-reduced bread alone in neither adults nor children.

Repercussions of maternal exposure to high-fat diet on offspring feeding behavior and body composition: a systematic review

Maternal nutrition is an environmental determinant for offspring growth and development, especially in critical periods. Nutritional imbalances during these phases can promote dysregulations in food intake and feeding preference in offspring, affecting body composition. The aim of this review is to summarize and discuss the effects of maternal high-fat diet (HFD) on offspring feeding behavior and body composition. A search was performed in the PUBMED, SCOPUS, Web of Science, and LILACS databases. Inclusion criteria were studies in rodents whose mothers were submitted to HFD that assessed outcomes of food or caloric intake on offspring and food preference associated or not with body weight or body composition analysis. At the end of the search, 17 articles with the proposed characteristics were included. In these studies, 15 articles manipulated diet during pregnancy and lactation, 1 during pregnancy only, and 1 during lactation only. Maternal exposure to a HFD leads to increased food intake, increased preference for HFDs, and earlier food independence in offspring. The offspring from HFD mothers present low birthweight but become heavier into adulthood. In addition, these animals also exhibited greater fat deposition on white adipose tissue pads. In conclusion, maternal exposure to HFD may compromise parameters in feeding behavior and body composition of offspring, impairing the health from conception until adulthood.

Relationships Among Parental Psychological Distress, Parental Feeding Practices, Child Diet, and Child Body Mass Index

BACKGROUND

Parents often play a main role in establishing the dietary patterns of preschool children, but there is no clear understanding about the relationship between parental psychological distress and child diet and body mass index (BMI).

OBJECTIVE

The aim of this study was to examine the relationships among parental psychological distress, parental feeding practices, child diet, and child BMI in families with young children.

METHODS

We conducted a mixed-methods study with families (parent-child dyad) of children aged 2-5 years. Measures included demographic data, parental general stress, parenting stress, parental sleep quality, parental depressive symptoms, social support for parents, mealtime environment, child feeding practice, child diet, and child BMI, with well-validated questionnaires completed by parents. Using structural equation models, we examined the path relationships of these factors. We also interviewed a subsample of 13 parents.

RESULTS

A total of 256 families participated. Higher parental psychological distress was associated with higher parental unhealthy feeding practices (B = 0.31, p < .01). However, a parental unhealthy practice in feeding was not associated with child's unhealthy diet or BMI. There was no direct relationship between parental psychological distress and child BMI. Social support for parents was significantly inversely related to parental psychological distress (B = -11.59, p < .01), and the relationship between social support for parents and parental unhealthy feeding practices approached significance (B = 6.11, p = .05). A main theme from analysis of parent interview was that parent stress and fatigue influenced their feeding and food preparation.

DISCUSSION

Parental psychological distress is a critical influential factor in parental feeding practices. This finding highlights potential foci in intervention programs to address parental psychological distress.

Effects of a School Based Intervention on Children's Physical Activity and Healthy Eating: A Mixed-Methods Study

Combined diet and physical activity school-based interventions (rather than only diet or physical activity interventions) are more likely to help prevent children from becoming overweight in the long term. However, such interventions are less prevalent, and therefore, this pilot study aimed to assess the feasibility of a gardening intervention coupled with awareness about plant-based meals among 9−10 year old children in a London primary school. We recruited 60 children from two Year 5 classes, one class participated as an intervention group, and results were compared against another class who acted as the control group. Children’s physical activity (PA) was measured using GENEActiv wrist-worn accelerometers. Their fruit and vegetable intake and attitudes to and preferences in eating fruits and vegetables were measured using a self-report questionnaire. Furthermore, three focus groups were held with children in the intervention group to understand the reasons behind any change as a result of the intervention. Results are inconclusive; however, they indicate some impact on reduction of sedentary behaviour, increase of moderate to vigorous PA, knowledge of nutrition and some level of acceptance in trying new vegetables. School-based interventions involving gardening show some promise to increase children’s PA and improve their attitudes to eating fruits and vegetables.

Development and Validation of a New Questionnaire Assessing Feeding Styles in Toddlers: Toddler Feeding Style Questionnaire (TFSQ)

PURPOSE

To develop and validate a new questionnaire assessing feeding styles in toddlers, the Toddler Feeding Style Questionnaire (TFSQ).

DESIGN AND METHODS

An instrumental design was used in this study. A convenience sample of 546 Spanish mothers of a toddler (12-24 months-old) completed the TFSQ and a web-based survey to obtain data on feeding styles, sociodemographic and anthropometric characteristics, weaning and attachment style. Items were developed and classified into two content domains: responsiveness and demandingness. For the construct validity analysis, the sample was randomly divided into two halves used to the exploratory and confirmatory factor analysis, respectively. Validation hypotheses about the differences in the TFSQ scores were suggested.

RESULTS

The factorial analysis revealed a responsiveness scale and a demandingness scale. The McDonald's Omega and Cronbach's alpha values coincided in both scales, being 0.84 and 0.75, respectively. A high responsiveness and demandingness feeding styles degree of agreement showed a statistically significant association with the correspondent scale (p < .01). The 33.3% of children who are overweight or obese have mothers who classify themselves as neglectful. Both scales were related to the mothers' attachment styles, toddler's age and the time of weaning at 6 and 12 months.

CONCLUSIONS

The TFSQ provides a valid and reliable Responsiveness and Demandingness scale to evaluate feeding styles in toddlers.

PRACTICE IMPLICATIONS

Parental feeding styles influence future eating behavior and children's weight. There is a lack of validated instruments used to evaluate feeding styles in toddlerhood based on the two theoretical dimensions of responsiveness and demandingness.

Assessment of eating attitudes and dieting behaviors in healthy children: Confirmatory factor analysis of the Children's Eating Attitudes Test

OBJECTIVE

The Children's Eating Attitudes Test (ChEAT) is a self-report questionnaire that is conventionally summarized with a single score to identify "problematic" eating attitudes, masking informative variability in different eating attitude domains. This study evaluated the empirical support for single- versus multifactor models of the ChEAT. For validation, we compared how well the single- versus multifactor-based scores predicted body mass index (BMI).

METHOD

Using data from 13,674 participants of the 11.5 year-follow-up of the Promotion of Breastfeeding Intervention Trial (PROBIT) in the Republic of Belarus, we conducted confirmatory factor analysis to evaluate the performance of 3- and 5-factor models, which were based on past studies, to a single-factor model representing the conventional summary of the ChEAT. We used cross-validated linear regression models and the reduction in mean squared error (MSE) to compare the prediction of BMI at 11.5 and 16 years by the conventional and confirmed factor-based ChEAT scores.

RESULTS

The 5-factor model, based on 14 of the original 26 ChEAT items, had good fit to the data whereas the 3- and single-factor models did not. The MSE for concurrent (11.5 years) BMI regressed on the 5-factor ChEAT summary was 35% lower than that of the single-score models, which reduced the MSE from the null model by only 1%-5%. The MSE for BMI at 16 years was 20% lower.

DISCUSSION

We found that a parsimonious 5-factor model of the ChEAT explained the data collected from healthy Belarusian children better than the conventional summary score and thus provides a more discriminating measure of eating attitudes.

The Impact of a Novel Gaming Reinforcement System on Oral Intake Outcomes in Pediatric Feeding Therapy: A Single Case Study

Purpose The aim of this study was to implement a novel reinforcement strategy into traditional dysphagia therapy with a school-age child diagnosed with a rare genetic syndrome, anxiety, and a hypersensitive gag reflex response. This clinical focus article evaluated the impact of a computer-based straw-drinking game on total liquid volume intake and the relationship between motivation and its role in feeding therapy. Method A longitudinal pilot study was used and required the development and implementation of a computer-based straw-drinking game as a novel reinforcement strategy. The gaming system was implemented to supplement ongoing dysphagia treatment in a single-subject case study design utilizing a client with pediatric dysphagia. Results The participant exhibited a trend of increased endurance during therapy sessions, allowing for increased volume per sip, increased trials per session, and decreased time between sequential trials. Average daily volume of oral intake remained less than 30 ml. Conclusions The gaming system maximized opportunities for orosensory desensitization of tactile input, resulting in increased comfort and endurance during therapy sessions, leading to more opportunities to practice the swallow. A novelty effect was observed as motivation and interest in the gaming system appeared greatest at the onset of the study. Generalized fatigue and anxiety continue to serve as barriers to more significant progress.

'The hunger trap hypothesis': New horizons in understanding the control of food intake

The global obesity epidemic continues to present significant challenges to individuals and healthcare providers. Public health initiatives to tackle the rise in overweight and obesity in developed and developing nations have largely failed to tackle the problem and research into the underlying causes is of increasing importance. Central to understanding overconsumption of calories is an appreciation of the mechanisms of hunger and satiety. Research to date has revealed considerable detail regarding meal size, macronutrient composition of the diet and control of energy balance via adipose store derived signalling. It is clear however that such control mechanisms are overwhelmed in a significant proportion of the population. We hypothesize the hitherto under-researched possibility that micronutrient status may have an important role in energy balance. Poor vitamin and mineral profiles in the diets of the obese may potentiate overconsumption of calories due to an insufficiency of micronutrient intake relative to macronutrient consumption, a situation aggravated by increased requirements in the obese state. Amongst the multiplicity of metabolic and biochemical processes dependent upon micronutrients and which are impacted by their relative insufficiency, there may be triggers for increased food consumption in an attempt to bridge the gap between high energy consumption and low co-factor availability. This 'hunger trap' will continue as long as low nutrient density foods represent the mainstay of the diet. The accepted paradigm of variety seeking leading to vitamin and mineral adequacy of diets may not apply in the context of highly processed foods which use technological means to mimic organoleptic properties of nutrient density without delivering the same at the level of metabolism.

A biopsychosocial approach to processes and pathways in the development of overweight and obesity in childhood: Insights from developmental theory and research

Childhood obesity has reached alarming proportions in many countries. There is consensus that both biological (especially genetic) and environmental (including psychosocial) factors contribute to weight gain and obesity in childhood. Research has identified extensive risk or predictive factors for childhood obesity from both of these domains. There is less consensus about the developmental processes or pathways showing how these risk factors lead to overweigh/obesity (OW/OB) in childhood. We outline a biopsychosocial process model of the development of OW/OB in childhood. The model and associated scholarship from developmental theory and research guide an analysis of research on OW/OB in childhood. The model incorporates biological factors such as genetic predispositions or susceptibility genes, temperament, and homeostatic and allostatic processes with the psychosocial and behavioral factors of parenting, parental feeding practices, child appetitive traits, food liking, food intakes, and energy expenditure. There is an emphasis on bidirectional and transactional processes linking child biology and behavior with psychosocial processes and environment. Insights from developmental theory and research include implications for conceptualization, measurement, research design, and possible multiple pathways to OW/OB. Understanding the developmental processes and pathways involved in childhood OW/OB should contribute to more targeted prevention and intervention strategies in childhood.

Effect and process evaluation of a real-world school garden program on vegetable consumption and its determinants in primary schoolchildren

OBJECTIVES

This study aimed to investigate the effectiveness of a school garden program on children's vegetable consumption and determinants and to gain insight into the process of the program.

METHODS

The "Taste Garden" is a real-world nine-week school garden program developed and implemented by a local organization. A total of 350 children (149 intervention group, 201 control group) filled out questionnaires on vegetable consumption, determinants and process of the program. Additionally, teachers filled out a process evaluation questionnaire. For effect evaluation, interaction effects (time x group) were considered, using multilevel repeated measures analyses in MLwiN 3.02. Interaction effects were repeated, taking into account quality of implementation (time x implementation group). Process evaluation was descriptively assessed with SPSS 24.0.

RESULTS

Overall, beside some practical concerns of teachers, the program was well perceived by teachers and children. However, an intervention effect of "The Taste Garden" was only found for knowledge (p = 0.02), with a very small effect size (0.55%). When taking into account implementation quality, only small effects were found for awareness (p between 0.005 and 0.007 and an effect size of 0.63%) and knowledge (p between 0.04 and 0.09 and an effect size of 0.65%).

CCONCLUSIONS

Evaluation of the real-world "Taste Garden" program, which was positively perceived by teachers, showed no effects on vegetable consumption and small effects on its determinants. Adaptations of the current format and longer follow-up periods are therefore recommended.

Factors Influencing Children's Eating Behaviours

Relevant factors involved in the creation of some children’s food preferences and eating behaviours have been examined in order to highlight the topic and give paediatricians practical instruments to understand the background behind eating behaviour and to manage children’s nutrition for preventive purposes. Electronic databases were searched to locate and appraise relevant studies. We carried out a search to identify papers published in English on factors that influence children’s feeding behaviours. The family system that surrounds a child’s domestic life will have an active role in establishing and promoting behaviours that will persist throughout his or her life. Early-life experiences with various tastes and flavours have a role in promoting healthy eating in future life. The nature of a narrative review makes it difficult to integrate complex interactions when large sets of studies are involved. In the current analysis, parental food habits and feeding strategies are the most dominant determinants of a child’s eating behaviour and food choices. Parents should expose their offspring to a range of good food choices while acting as positive role models. Prevention programmes should be addressed to them, taking into account socioeconomic aspects and education.

Perceived Parental Barriers to and Strategies for Supporting Physical Activity and Healthy Eating among Head Start Children

Despite the need for parents to support their children's healthy behaviors, knowledge of factors preventing parents from doing so is still rudimentary. This study primarily aimed to explore perceived parental barriers to and strategies for supporting physical activity and healthy eating among Head Start children. A semi-structured interview format was used with four focus groups conducted at two urban Head Start centers in the Midwestern U.S. A qualitative content analysis of audio-recorded sessions was facilitated using ATLAS.ti7. A convenience sample of 32 parents (Mage = 34.97 years) participated. Over half were female (78.1 %), African Americans (65.6 %), and single (65.6 %). About 61.3 % reported an annual family income <$20,000, and 43.8 % were unemployed. Three themes reflected the barriers: (1) intrapersonal (child): short attention span and limited eating preferences; (2) interpersonal (parent): lack of time and cooking skills and a tight family budget; and (3) environmental: inaccessible programs, lack of age-appropriate education, electronic media use, and unsafe environment. Parents across all groups expressed high interest in enrolling in a program with their children. Recommendations included: parents' support team; family outings at parks; taking a walk or enrolling in a class with children; and planting a garden. Many parents showed their preference for face-to-face meetings and a support group, but repulsion of counseling. To promote parental support in future interventions with Head Start children, their perceived intrapersonal, interpersonal, and environmental barriers should be considered as intervention targets. Involving parents through a support group and face-to-face meetings is recommended.

Development and Relative Validity of a Food Frequency Questionnaire to Assess Intakes of Total and Free Sugars in Australian Toddlers

Background: Dental research into early childhood caries is hindered by a lack of suitable dietary assessment tools that have been developed and validated for the population and outcomes of interest. The aim of this study was to develop and investigate the relative validity and reproducibility of the Study of Mothers’ and Infants’ Life Events Food Frequency Questionnaire (SMILE-FFQ), to assess the total and free sugars intakes of Australian toddlers. Methods: The SMILE-FFQ was designed to capture the leading dietary contributors to dental caries risk in toddlers aged 18–30 months via a proxy report. Ninety-five parents of Australian toddlers completed the questionnaire online before and after providing three 24-h recalls (24HR), collected on non-consecutive days using the multipass method. Total and free sugars were compared between the two SMILE-FFQ administrations and between each SMILE-FFQ and the 24HR using multiple statistical tests and standardised validity criteria. Correlation (Pearson), mean difference (Wilcoxon rank test) and Bland Altman analyses were conducted to compare absolute values, with cross-classification (Chi-Square and Weighted Kappa) used to compare agreement across tertiles. Results: All reproducibility tests showed good agreement except weighted kappa, which showed acceptable agreement. Relative validity tests revealed a mix of good and acceptable agreement, with total sugars performing better at the individual level than free sugars. Compared to the 24HR, the SMILE-FFQ tended to underestimate absolute values at lower levels and overestimate them at higher levels. Conclusions: The combined findings of the various tests indicate that the SMILE-FFQ performs comparably to the 24HR for assessing both total and free sugars among individuals, is most effective for ranking participants rather than determining absolute intakes, and is therefore suitable for use in observational studies of Australian toddlers.

Parent packs, child eats: Surprising results of Lunch is in the Bag's efficacy trial

Early care and education (ECE) centers that require lunch brought from home provide an uncluttered view of parent-child dietary interactions in early childhood. Children's eating from parent-provided bag lunches was observed at 30 ECE centers in Texas, with 15 randomly assigned to the Lunch is in the Bag intervention to improve the lunch meal and 15 to a wait-list control condition. Study participants were parent and child aged 3-5 years (N = 633 dyads). Data were collected at baseline (pre-intervention) and follow-ups at weeks 6 (post-intervention), 22 (pre-booster), and 28 (post-booster). Changes effected in the children's lunch eating-e.g., increase of 14 percent in prevalence of children eating vegetables (SE = 5, P = 0.0063)-reciprocated changes in parent lunch-packing. Irrespective of intervention, however, the children consumed one-half to two-thirds of the amounts of whatever foods the parents packed, and the eat-to-pack ratio did not change across time. Thus, children's lunch eating at the ECE centers appeared to be regulated by perceptual cues of food availability rather than food preferences or internal cues of hunger and satiety.

Cross-species comparison of behavioral neurodevelopmental milestones in the common marmoset monkey and human child

The common marmoset (Callithrix jacchus) is an increasingly popular non-human primate species for developing transgenic and genomic edited models of neurological disorders. These models present an opportunity to assess from birth the impact of genetic mutations and to identify candidate predictive biomarkers of early disease onset. In order to apply findings from marmosets to humans, a cross-species comparison of typical development is essential. Aiming to identify similarities, differences, and gaps in knowledge of neurodevelopment, we evaluated peer-reviewed literature focused on the first 6 months of life of marmosets and compared to humans. Five major developmental constructs, including reflexes and reactions, motor, feeding, self-help, and social, were compared. Numerous similarities were identified in the developmental sequences with differences often influenced by the purpose of the behavior, specifically for marmoset survival. The lack of detailed knowledge of marmoset development was exposed as related to the vast resources for humans.

Communication Strategies to Improve Healthy Food Consumption among Schoolchildren: Focus on Milk

This work provides an updated picture of communication strategies developed to improve healthy dietary habits in schoolchildren, with a focus on the importance of milk consumption. The paper has investigated two main areas: the definition of the main orientations and key points of research approach relative to the communication methods, with special attention to multiple strategies and the identification of their peculiarities to increase daily milk consumption. The school environment is considered as a unique environment to help increase the adoption of a correct dietary habit and lifestyle; it increases physical activity by facilitating the flow of health-related information. In this regard, several studies have highlighted the importance and effectiveness of school-based interventions on a large-scale, also considering multiple contexts, early interventions as well as the involvement of teachers, students and families. The effective actions range from interventions on prices and the availability of desirable and undesirable foods to educational programmes that improve food knowledge and the choices of students and/or their parents. From the nutritional point of view, milk is an important component of a well-balanced diet—especially for children—because it contains essential nutrients. It is a substantial contributor to the daily energy intake; however, its consumption often declines with aging and becomes insufficient. Therefore, developing strategies to increase its consumption is an important objective to reach.

Feeding Behavioral Assessment in Children with Cleft Lip and/or Palate and Parental Responses to Behavior Problems

BACKGROUND

Children with cleft lip and/or palate frequently experience feeding difficulties that may place them at risk of malnutrition. Parents' negative response to these problems is associated with development of problematic behaviors in the child. This study aimed to investigate feeding behavior in children with cleft lip and/or palate and parental responses to these problems.

MATERIALS AND METHODS

A total of 120 parents of children (aged 6 months to 6 years) with cleft lip and/or palate were recruited from the Cleft Lip and Palate Clinic in Isfahan University of Medical Sciences, Isfahan, Iran, who gave consent and completed a two-part questionnaire through interviews. Part A of the questionnaire consisted of 25 items that evaluate children's feeding behavior during mealtimes and part B consists of 18 items that assess parental response (strategies, feelings, and anxiety) to these problems.

RESULTS

Independent t-test showed a significant difference in the mean score of feeding behavior in mothers (P = 0.020) and parental responses in fathers (P = 0.030). The Pearson correlation coefficient showed an inverse correlation between behavioral feeding score and children's interval (P = 0.008, r = -0.381) and direct correlation between parental response and feeding behavioral difficulties (P = 0.003, r = 0.428).

CONCLUSIONS

With regards to the results representing appropriate feeding behaviors in children with cleft lip and/or palate, it is suggested that feeding be avioral assessment is an essential nursing and nonmedical intervention for all children.