Involvement of children in hands-on meal preparation and the associated nutrition outcomes: A scoping review

A New Mediterranean Lifestyle Pyramid for Children and Youth: A Critical Lifestyle Tool for Preventing Obesity and Associated Cardiometabolic Diseases in a Sustainable Context

Cardiovascular disease risk factors begin in childhood and track into adulthood, increasing the possibility of impaired cardiometabolic health. Adopting healthy dietary patterns can help curb childhood obesity, a worrisome epidemic problem at present. In the era of personalized nutrition, dietary recommendations should be adapted to different stages of life, including children (older than 3 y) and adolescents. In this study, we present an updated version of the Mediterranean Lifestyle Pyramid addressed to children and adolescents, which may be used as a prevention tool by health professionals, teachers, and stakeholders. This pyramid arises from a consensus position between participants in an International Congress on Mediterranean diet held in Barcelona. During this meeting, after reviewing all literature published, a consensus was reached on the new Mediterranean Lifestyle Pyramid for kids including details such as labels of the pyramid, position of foods, servings, type of foods, and healthy lifestyle habits. All components of the pyramid are supported by the most recent scientifically sound research and are based upon top-level evidence in nutritional sciences. Fruit, vegetables, legumes, nuts, wholegrains, and extra-virgin olive oil continue to be at the basis of the pyramid, but the importance of an adequate intake of fish, dairy products, and meat during these particular ages, when body and brain development occurs, is also considered. The promotion of physical activity, adequate sleep, and good emotional health are emphasized, as well as the consumption of seasonal and local products, and overall sustainability. Improving dietary habits in early stages of life should increase health in adulthood and reduce future incidence of noncommunicable chronic diseases. The Mediterranean diet and its graphic representation in the Lifestyle Pyramid should be a health-fostering tool not only for adults and children but also for the entire planet because it promotes the diversity of species, respect for the earth, and the local economy.

Associations of behavioral, motivational, and socioeconomic factors with BMI among children and adolescents

BACKGROUND

Higher weight represents a significant health concern in youth and may be influenced by socioeconomic and behavioral factors. We investigated the relationship between BMI and parental education, nutritional health, eating culture, organized and non-organized physical activity (PA), motives for PA (weight loss/maintenance, enjoyment), and screen-time in children and adolescents.

METHODS

677 2- to 11-year-olds (young-age-group) and 464 12- to 20-year-olds (old-age-group) from Leipzig, a city in Germany, participated. We applied multivariate linear regression analyses to assess associations.

RESULTS

BMI-SDS was negatively associated with parental education (young-age-group: b = -0.25, p < 0.001, old-age-group: b = -0.27, p = 0.02), non-organized PA (young-age-group: b = -0.23, p = 0.029), and PA enjoyment (young-age-group: b = -0.05, p = 0.01, old-age-group: b = -0.05, p = 0.038), but negatively with media use during dinner (old-age-group: b = 0.53, p < 0.001), PA for weight loss/maintenance (young-age-group: b = 0.15, p < 0.001, old-age-group: b = 0.12, p < 0.001), and screen-time (young-age-group: b = 0.11, p = 0.009, old-age-group: b = 0.09, p = 0.001). Significant interactions with age, sex and parental education were observed.

CONCLUSION

A lower BMI in children is associated with high parental education, screen-free eating, higher participation in non-organized PA and lower screen-time. While measures of motivation were limited and thus findings should be interpreted with caution, intrinsic motivation for PA is associated with lower BMI whereas extrinsic motivation for PA is associated with higher BMI.

IMPACT

In a German cohort of children and adolescents, lower BMI is associated with high parental education, less screen time, more participation in non-organized physical activity and less media use during dinner. Intrinsic and extrinsic motives for physical activity are directly linked to the weight status of children and adolescents. These associations are particularly strong in families with low/medium formal education.

Cooking at Home: Correlates of Frequency and Intention in Fifth Graders

Cooking at home is associated with health benefits, and 10- and 11-year-old children are capable of participating in meal preparation. However, opportunities for children to cook at home have declined. This study aimed to identify determinants of the frequency and the intention to cook at home in fifth graders using the Theory of Planned Behavior as a framework with quantitative methodology. A total of 241 participants across five elementary schools of the Chaudière-Appalaches region (Quebec, Canada) took part in this correlational study. Data were collected via a self-administered questionnaire based on the Theory of Planned Behavior. Regression analyses led to the identification of determinants of frequency and intention to cook at home. More than two-thirds of participants (69%) declared having cooked at home in the past 7 days. Intention was the only significant variable explaining 18% of the variance for frequency. Intention was determined by perceived behavioral control, attitude, descriptive norms, subjective norms, perceived barriers, being a girl, and normative beliefs, which explain 74% of the variance. Whereas other studies aiming at better understanding children's involvement in meal preparation at home focused on self-efficacy for cooking, this study highlights other behavioral determinants. For example, support from parents appears to be crucial to promote this behavior in this age group. Future research and interventions should be oriented toward determinants such as subjective norms and normative beliefs, and focus on children's autonomy.

Associations Between Household Frequency of Cooking Dinner and Ultraprocessed Food Consumption and Dietary Quality Among US Children and Adolescents

Introduction: Dietary quality is poor and intake of ultraprocessed foods (UPFs) is high among children and adolescents in the United States. Low dietary quality and high UPF intake are associated with obesity and higher risk of diet-related chronic diseases. It is unknown whether household cooking behavior is related to improved dietary quality and lower consumption of UPFs among US children and adolescents. Methods: Nationally representative data from the 2007-2010 National Health and Nutrition Examination Survey (n = 6032 children and adolescents ≤19 years of age) were used to examine the relationships between household cooking frequency of evening meals and children's dietary quality and UPF intake using multivariate linear regression models adjusted for sociodemographics. Two 24-hour diet recalls were used to assess UPF intake and dietary quality [Healthy Eating Index-2015 (HEI-2015)]. Food items were categorized according to Nova classification to obtain the UPF percent of total energy intake. Results: A higher household frequency of cooking dinner was associated with lower UPF intake and higher overall dietary quality. Compared to children in households cooking dinner 0-2 times per week, children in households cooking dinner 7 times/week had lower intake of UPFs [β = -6.30, 95% confidence interval (CI) -8.81 to -3.78, p < 0.001] and marginally higher HEI-2015 scores (β = 1.92, 95% CI -0.04 to 3.87, p = 0.054). The trends toward lower UPF intake (p-trend <0.001) and higher HEI-2015 scores (p-trend = 0.001) with increasing cooking frequency were significant. Conclusions: In this nationally representative sample of children and adolescents, more frequent cooking at home was associated with lower intake of UPFs and higher HEI-2015 scores.

Home-based cooking intervention with a smartphone app to improve eating behaviors in children aged 7-9 years: a feasibility study

Objective

To develop and evaluate the feasibility of a mobile application in Swiss households and assess its impact on dietary behavior and food acceptability between children who cooked with limited parental support (intervention group) with children who were not involved in cooking (control group).

Methods

A ten-week randomized controlled trial was conducted online in 2020. Parents were given access to a mobile-app with ten recipes. Each recipe emphasized one of two generally disliked foods (Brussels sprouts or whole-meal pasta). Parents photographed and weighed the food components from the child's plate and reported whether their child liked the meal and target food. The main outcome measures were target food intake and acceptability analyzed through descriptive analysis for pre-post changes.

Results

Of 24 parents who completed the baseline questionnaires, 18 parents and their children (median age: 8 years) completed the evaluation phase. Mean child baseline Brussel sprouts and whole-meal pasta intakes were 19.0 ± 24.2 g and 86.0 ± 69.7 g per meal, respectively. No meaningful differences in intake were found post-intervention or between groups. More children reported a neutral or positive liking towards the whole-meal pasta in the intervention group compared to those in the control group. No change was found for liking of Brussel sprouts.

Conclusions for practice

The intervention was found to be feasible however more studies on larger samples are needed to validate feasibility. Integrating digital interventions in the home and promoting meal preparation may improve child reported acceptance of some healthy foods. Using such technology may save time for parents and engage families in consuming healthier meals.

A critical review of children's culinary nutrition interventions, the methodologies used and their impact on dietary, psychosocial and wellbeing outcomes

Diet quality has been associated with numerous health outcomes, resulting in nutrition education to improve children's diet quality. Culinary nutrition interventions have been emphasised as a promising approach for enhancing children's food preferences and behaviours. Recently, there has been an increase in such interventions, and it is essential to understand their effectiveness and the specific methods used. Therefore, this review aimed to critically investigate methodological approaches in a range of children's culinary nutrition interventions and experiments. A secondary aim was to investigate the impact of these interventions on dietary, psychosocial and wellbeing outcomes. A systematic and pragmatic search strategy was developed and implemented using two electronic databases. Data extraction of the relevant content of eligible studies and a narrative synthesis were conducted. A total of 12 312 articles were identified from the search and 38 studies on children's culinary nutrition interventions or experiments were included. Most studies (n = 25) were conducted in North America. Only two studies had an RCT design. Less than half the studies (n = 16) used an underpinning theory, model or framework. Only four studies conducted sample size calculations. Some validated measurement tools were used. Despite the methodological concerns, most studies found some positive changes in dietary and/or psychosocial outcomes, while only two studies assessed wellbeing. Therefore, the area warrants further in-depth research anchored in methodological rigor to strengthen the validity of the research. The strengthening of the evidence in children's culinary nutrition could have a significant beneficial impact on public health if it resulted in widespread interventions and, in the long-term, reduce the impact on health systems.

Experiential Learning Interventions and Healthy Eating Outcomes in Children: A Systematic Literature Review

Experiential learning is the process where learners create meaning from direct experience. This systematic review aimed to examine the effects of experiential learning activities on dietary outcomes (knowledge, attitudes, behaviors) in children. Four databases: Education Research Complete, Scopus, Web of Science and PsychINFO were searched from database inception to 2020. Eligible studies included children 0-12 years, assessed effect of experiential learning on outcomes of interest compared to non-experiential learning and were open to any setting. The quality of studies was assessed using the revised Cochrane risk of bias tool by two independent reviewers and effect size was calculated on each outcome. Nineteen studies were conducted in primary school, six in pre-school and one in an outside-of-school setting and used nine types of experiential learning strategies. Cooking, taste-testing, games, role-playing, and gardening were effective in improving nutrition outcomes in primary school children. Sensory evaluation, games, creative arts, and storybooks were effective for preschool children. Multiple strategies involving parents, and short/intense strategies are useful for intervention success. Experiential learning is a useful strategy to improve children's knowledge, attitudes, and behaviors towards healthy eating. Fewer studies in pre-school and outside of school settings and high risk of bias may limit the generalizability and strength of the findings.