Associations between children's diet quality and watching television during meal or snack consumption: A systematic review

Evaluation of the Prime Diet Quality Score from Early Childhood Through Mid-Adolescence

BACKGROUND

Few diet quality indices have been developed and validated for use among children and adolescents. Additionally, many available indices require completion of burdensome dietary assessments.

OBJECTIVES

We aimed to calculate and evaluate the performance of a modified version of the food-based Prime Diet Quality Score (PDQS) derived from different diet assessment methods conducted at 4 time points in a single study population from childhood through adolescence.

METHODS

Among 1460 child participants in the Project Viva cohort, we calculated the PDQS in early and mid-childhood and early and mid-adolescence using dietary data obtained from food frequency questionnaire (early childhood: parent report), PrimeScreen (mid-childhood: parent report; early adolescence: self-report) and 24-h recall (mid-adolescence: self-report). We evaluated construct and relative validity and internal reliability of the score in each life stage.

RESULTS

The PDQS showed a range of scores at all life stages and higher scores were associated with intake of many health-promoting macronutrients and micronutrients (e.g., protein, fiber, and vitamins) in early childhood and mid-adolescence. The PDQS performed similarly to the Youth Healthy Eating Index/Healthy Eating Index (Spearman r = 0.63-0.85) in various assessments. Higher PDQS was associated with expected characteristics including more frequent breakfast eating, family dinners, and vigorous physical activity; with less frequent TV viewing and fast food intake; and with more sleep and higher maternal diet scores during pregnancy. Cross-sectional associations of the PDQS with various anthropometric measurements and biomarkers were inconsistent but generally in the expected directions (e.g., higher PDQS associated with lower triglycerides and insulin and higher HDL cholesterol). Internal reliability was consistent with what has been found for other diet quality indices.

CONCLUSIONS

The PDQS can be calculated from data collected using different and brief dietary assessment methods and appears to be a valid and useful measure of overall diet quality in children and adolescents. Project Viva was registered at clinicaltrials.gov as NCT02820402.

Television watching during meals is associated with higher ultra-processed food consumption and higher free sugar intake in childhood

BACKGROUND

The consumption of ultra-processed foods (UPFs) is associated with an increased risk of noncommunicable diseases and mortality in adults. The aim of this study was to analyse the association between mealtime television (TV) watching and UPF consumption in childhood.

MATERIALS AND METHODS

Participants in the SENDO project recruited in 2015-2023 were classified into three categories based on the frequency at which they watched TV during meals. Dietary information was collected with a validated 147-item semi-quantitative food frequency questionnaire. Generalized mixed models were used to compare mean UPF consumption between groups after accounting for the main confounders. The predictive margins of participants who had a free sugar intake >10% of their energy intake in each category were also calculated.

RESULTS

Totally 970 subjects (482 girls) with a mean age of 5.00 years (SD = 0.85) were studied. Children who watched TV during meals ≥4 times/week consumed a mean of 4.67% more energy from UPF than those who watch TV <3 times/month. The adjusted proportions of children who had a free sugar intake >10% of their energy intake in the categories of <3 times/month, 1-3 times/week and ≥4 times/week exposure to TV during meals were 44.9%, 45.9% and 58.7%, respectively.

CONCLUSION

TV watching during meals is associated with higher consumption of UPFs and a higher risk of exceeding 10% of TEI in free sugar intake in childhood.

Enhancing children's nutrition: the influence of rural household technology under China's home appliances going to the countryside policy

This study explores the influence of household technological advancements on children's nutritional intake, specifically within the context of the Chinese government's "Home Appliances Going to the Countryside" (HAGC) initiative. Utilizing data from the China Health and Nutrition Surveys of 2006, 2009, and 2011, we employed a Propensity Score Matching Difference-in-Differences (PSM-DID) framework to ascertain the repercussions of enhanced household technology on the dynamics of children's nutritional consumption patterns. Our analysis reveals that the HAGC-inspired integration of household appliances, including color televisions, washing machines, and refrigerators, has beneficially reshaped the nutritional consumption patterns of children, with a pronounced effect among female children. This finding remains consistent even when employing alternate methodological robustness tests. A deeper examination of the HAGC policy's mechanisms underscores the pivotal roles of parental time allocation, improved food storage capabilities, and augmented information accessibility as significant drivers bolstering children's nutritional intake. These insights bear considerable significance for strategizing interventions aimed at elevating the nutritional wellbeing of children in rural settings, offering valuable input for shaping public health policies tailored for such demographies.

Relations between the levels of moderate to vigorous physical activity, BMI, dietary habits, cognitive functions and attention problems in 8 to 9 years old pupils: network analysis (PACH Study)

BACKGROUND

Physical activity (PA) and dietary habits (DH) play a crucial role on quality of life and health outcomes from various aspects.

METHODS

This study aims to investigate the relations between recommended daily levels of moderate to vigorous physical activity (MVPA) in 8 to 9 year old pupils, and their body mass index (BMI), DH, cognitive functions and attention problem scores by network analysis. Study participants were split into two groups based on their MVPA levels on weekdays.

RESULTS

Our findings suggest that children who reach recommended MVPA levels consume more vegetables and fruits, eat breakfast more frequently, have better motor speed and lower impulsivity score.

CONCLUSIONS

The number of interlinkages between various parameters in network structure for children who do not reach recommended MVPA levels is greater and more intense, highlighting the differences between the groups and suggesting that different interventions and approaches to improve/change lifestyle habits might be used.

Mothers' experiences of reducing family mealtime screen use in Australian households with young children

OBJECTIVE

Screen use at mealtimes is associated with poor dietary and psychosocial outcomes in children and is disproportionately prevalent among families of low socio-economic position (SEP). This study aimed to explore experiences of reducing mealtime screen use in mothers of low SEP with young children.

DESIGN

Motivational interviews, conducted via Zoom or telephone, addressed barriers and facilitators to reducing mealtime screen use. Following motivational interviews, participants co-designed mealtime screen use reduction strategies and trialled these for 3-4 weeks. Follow-up semi-structured interviews then explored maternal experiences of implementing strategies, including successes and difficulties. Transcripts were analysed thematically.

SETTING

Australia.

PARTICIPANTS

Fourteen mothers who had no university education and a child between six months and six years old.

RESULTS

A range of strategies aimed to reduce mealtime screen use were co-designed. The most widely used strategies included changing mealtime location and parental modelling of expected behaviours. Experiences were influenced by mothers' levels of parenting self-efficacy and mealtime consistency, included changes to mealtime foods and an increased value of mealtimes. Experiences were reportedly easier, more beneficial and offered more opportunities for family communication, than anticipated. Change required considerable effort. However, effort decreased with consistency.

CONCLUSIONS

The diverse strategies co-designed by mothers highlight the importance of understanding why families engage in mealtime screen use and providing tailored advice for reduction. Although promising themes were identified, in this motivated sample, changing established mealtime screen use habits still required substantial effort. Embedding screen-free mealtime messaging into nutrition promotion from the inception of eating will be important.

Food for thought or food for emotions? An analysis of marketing strategies in television food advertising seen by children in Colombia

OBJECTIVE

To establish the relationship between the marketing strategies and nutritional quality of foods and beverages promoted in television food advertisements (TV ads) seen by Colombian child audiences overall and based on child gender and socio-economic strata (SES).

DESIGN

A quantitative content analysis of marketing appeals was combined with nutritional data of the food products advertised and matched with TV audience ratings data for each food and beverage ads for Colombian children between 4 and 11 years.

SETTING

All beverages and foods TV ads cable or over-the-air channels in Colombia in 2017.

PARTICIPANTS

N/A.

RESULTS

Compared with rational appeals (e.g. freshness, health or nutrition messages), emotional appeals (referencing or depicting human senses or emotions, e.g. using cartoons to suggest fun) were more frequently used in the TV ads most viewed by Colombian children. Female children and children in lower SES tended to be more exposed to emotional appeals in TV ads than their male or higher SES counterparts. Furthermore, TV ads using more emotional appeals tended to be for products high in problematic nutrients.

CONCLUSION

The findings of this study highlight the need to implement statutory measures to reduce the deleterious effect of food marketing on children.

Role of parenting practices and digital media on beverage intake in European schoolchildren of different weight status. Feel4Diabetes-study

OBJECTIVES

Halting the rise in childhood obesity is an ongoing challenge in Europe. Sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) consumption has become common practice at home and during family meals. The objective of this study was to investigate associations of parenting practices and home digital media availability with beverage intake in European schoolchildren of different weight groups.

METHODS

Cross-sectional data were derived from six countries taking part in the multicentered Feel4Diabetes-study. Anthropometric data were measured for 12 030 schoolchildren (n = 6097 girls; median age = 8.1 y). Details on sociodemographic characteristics, beverage intake, food parenting practices, and home availability of digital media were collated from questionnaires. The outcomes, daily SSB and ASB intakes, were included as dependent variables in multivariable regression models that provided odds ratios reflecting their association with parenting practices and digital media (exposures), after stratifying for children's weight status (underweight or normal versus overweight or obese).

RESULTS

After controlling for children's sex, region, maternal body mass index, and education, the multivariate model found that in both body mass index groups, permissive parenting practices, such as rewarding and allowing consumption of unhealthy foods "very often or often," as compared with "rarely or never," were associated with a high daily intake of SSBs and ASBs in children, while parents "watching television together with their child," rewarding with screen time, and availability of television in children's rooms increased the likelihood of both beverages in the underweight or normal-weight group.

CONCLUSIONS

Modification of permissive parenting practices and removal of television from children's rooms could effectively reduce SSB intake and curb the ongoing threat of child obesity in Europe.

TV Time, Especially During Meals, is Associated with Less Healthy Dietary Practices in Toddlers

BACKGROUND

While several studies examine the relationship between screen time and dietary practices in children and teenagers, there is limited research in toddlers. This study evaluates the association between television (TV) exposure and dietary practices in two-year-old children.

METHODS

We conducted a cross-sectional, secondary data analysis from the Greenlight Intervention Study. Toddlers' daily TV watching time, mealtime TV, and dietary practices were assessed by caregiver report at the 24-month well child visit. Separate regression models were used and adjusted for sociodemographic/household characteristics and clinic site.

RESULTS

532 toddlers were included (51% Latino; 30% non-Latino Black; 59% ≤$20,000 annual household income). Median daily TV watching time was 42 minutes [IQR: 25, 60]; 25% reported the TV was "usually on" during mealtimes. After adjustment, toddlers who watched more TV daily had higher odds of consuming sugar-sweetened beverages (SSB), fast food, and more junk food; those watching less TV had higher odds of consuming more fruits/vegetables. Those with the TV "usually on" during mealtimes were more likely to consume SSB [aOR 3.72 (95%CI 2.16-6.43)], fast food [aOR 2.83 (95%CI 1.54-5.20)], and more junk food [aOR 4.25 (95%CI 2.71-6.65)].

CONCLUSIONS

Among toddlers from primarily minoritized populations and of lower socioeconomic status, those who watched more TV daily and usually had the TV on during meals had significantly less healthy dietary practices, even after adjusting for known covariates. This study supports the current American Academy of Pediatrics screen time guidelines and underscores the importance of early counseling on general and mealtime TV.

Gap between the concerns of healthcare professionals and parents' perceptions regarding dietary habits for 18-month- and 3-year-old children in Japan

BACKGROUND

A gap has been reported between healthcare professionals' (hereafter "professionals") recognition of preschool children's diets and parents' perception of concern. This study investigated the gap between the concerns reported by professionals and parents' perceptions regarding health and dietary habits by age (18 months and 3 years) and gender in Japan.

METHODS

The study design consisted of a cross-sectional, multilevel survey. The request letters were sent to all households with target children with the cooperation of local governments. After obtaining written informed consent from parents, questionnaires were distributed to them. The survey included 30 items on children's concerns about health and dietary habits. At the health checkup, parents indicated whether they were concerned in response to each item, and responded child's height and weight and birth height and weight. Next, the professionals provided counseling to the parents at a health checkup. After that, the professionals noted their concerns in response to the same 30 items as those given to parents. The participation rates were 82.9% (18 months) and 82.8% (3 years). Data of 239 persons for 18 months and 223 persons for 3 years old were analyzed. In the statistical analysis, the items that were judged as concerning by professionals but not by parents were identified; likewise, the items that were of concern to parents but not to professionals were identified. Sensitivity, false negative rate, specificity, false positive rate, and Youden index were calculated to analyze the discordance rate for each item.

RESULTS

Many parents in this study were concerned about the issues that professionals did not consider to be concerning. Moreover, the parents worried about more issues for 3-year-olds than for 18-month-olds. The items for which ≥ 10 professionals indicated concerns and with higher discordance between the professionals and parents for both boys and girls were "picky eating" for 18-month-olds and "inconsistent amount of food" for 3-year-olds.

CONCLUSIONS

The concerns that professionals have with respect to children's diets and the things that parents worry about show gaps. It might be necessary to provide professional counseling for parents to develop a correct understanding of their children's dietary habits.

Use of screens and intake of unhealthy food among children and adolescents: association with physical activity in a cross-sectional study

BACKGROUND

The intake of unhealthy food taken on very regular basis may bring even further negative impact on health if associated with excessive time using of screen-based electronic devices.

OBJECTIVE

To estimate the association between the use of different types of screen-based devices and the intake of unhealthy foods amongst children and adolescents and to determine whether daily physical activity (DPA) has a moderating effect on the association.

METHODS

Cross-sectional study carried out with a probabilistic sample of students from second to fifth grade of public elementary schools in Feira de Santana, Bahia (n = 2,477; girls: 53.2%; age: 9.1 ± 1.38 years; BMI z-score 0.37 ± 4.19 Kg/m²). Food intake, screen use, and physical activity were assessed using an online questionnaire based on previous day recall (Web-CAAFE). Prevalence Ratios (PR) and 95% Confidence Intervals (95%CI) were estimated via multiple zero-inflated negative binomial regression, with adjustments for sex, age, and weekly frequency of school meal intake. The moderating effect of DPA was verified by inserting interaction terms with each screen-based device individually and with the daily sum of screen-based device exposure (∑ Screens).

RESULTS

The majority of students (72.2%) reported using screens. The intake of unhealthy foods was positively associated with the use of cell phones (PR = 1.21; 95%CI = 1.13-1.30), computers (PR = 1.33; 95%CI = 1.22-1.46), and video games (PR = 1.36; 95%CI = 1.22-1.52). TV use was inversely associated with intake of unhealthy foods (PR = 0.92; 95%CI = 0.87-0.99). DPA moderated the effect of video game use on intake of unhealthy foods, that is, among students with DPA ≥ 4 who used video games, the intake of unhealthy foods was 21% lower (PR = 0.79; 95%CI = 0. 65-0.97). Overall, ∑ Screen-based devices were associated with a 20% increase in intake of unhealthy foods.

CONCLUSION

The intake of unhealthy foods was positively associated with the use of cell phones, computers, and video games. In addition, a frequency of four or more DPA attenuated the effect of video game exposure on intake of unhealthy foods. Upcoming investigations on the use of screen-based devices and the intake of unhealthy foods among schoolchildren should consider the exposure to different types of screen-based devices, as well as the influence of DPA.

Twelve-month effectiveness of telephone and SMS support to mothers with children aged 2 years in reducing children's BMI: a randomized controlled trial

BACKGROUND/OBJECTIVES

Few quality intervention studies have assessed whether a combined telephone and short message service (SMS) intervention to mothers is effective in reducing BMI and obesity risk behaviors of children at 3 years of age. This study aimed to assess effectiveness of telephone and SMS support in reducing children's body mass index (BMI) and obesity risk behaviors.

SUBJECTS/METHODS

A randomized controlled trial (RCT) with 662 women of 2-year-old children (with the proportion of overweight and obesity being similar to the general population) was conducted in Sydney, Australia, March 2019-October 2020. The mothers in the intervention group received three telephone support sessions plus SMS messages and mailed-intervention-booklets over a 12 months period i.e., 24-26, 28-30, and 32-34 months of the child's age. Mothers in the control group received usual care and two mailed booklets on information not related to the intervention. The primary outcome was child's BMI at 3 years of age. Secondary outcomes were children's dietary and activity behaviors. All outcome measures were based on mothers' self-report using standardized tools due to COVID-19 pandemic restrictions.

RESULTS

537 (81%) mothers completed the post-intervention assessment at 3 years with only 470 (71%) children having weight and height measures. Multiple imputation analysis showed no statistically significant difference in mean BMI between the groups. Children in the intervention group were more likely not to eat in front of the TV [AOR 1.79 (95% CI 1.17-2.73), P = 0.008], more likely to meet the dietary recommendations [AOR 1.73 (95% CI 0.99-3.02), P = 0.054] and meet the activity recommendations [AOR 1.72 (95% CI 1.11-2.67), P = 0.015] than those in the control group respectively. Among those with an annual household income (

CONCLUSIONS

A staged telephone and SMS support intervention to mothers with children aged 2 years was associated with improved dietary and activity behaviors. The intervention was also associated with reduced children's BMI at age 3 years only for those from lower income households.

TRIAL REGISTRATION

The trial is registered with the Australian Clinical Trial Registry (ACTRN12618001571268).

Collapse

Key Words

• epidemiology
• risk factors

Collapse

MESH Headings

• Female
• Humans
• Child, Preschool
• Mothers
• Body Mass Index
• Australia/epidemiology
• COVID-19
• Obesity/epidemiology
• Weight Loss
• Telephone

Collapse

Grants Collapse

Affiliation(s)

Li Ming Wen Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia. Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia. NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia. Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia.
Huilan Xu Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia
Philayrath Phongsavan Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
Chris Rissel Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia College of Medicine and Public Health, Rural and Remote Health, South Australia and Northern Territory, Flinders University, Bedford Park, SA, Australia
Alison Hayes Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia
Sarah Taki Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia
Limin Buchanan Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW, Australia
Lisa Simone Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
Renee Moreton Population Health, Sydney Local Health District, Sydney, NSW, Australia
Louise A Baur Sydney School of Public Health, Faculty of Medicine and Health, and Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood (EPOCH), Sydney, NSW, Australia Specialty of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

Collapse

Sedentary Activities and Food Intake among Children and Adolescents in the Zhejiang Province of China: A Cross-Sectional Study

BACKGROUND

Sedentary behavior may affect the types of food consumed in children and adolescents' daily diets. Previous published studies are limited to local surveys. This study aimed to explore the relationship between sedentary behavior and food intake among children and adolescents.

METHODS

A stratified sampling technique was employed in the present cross-sectional study. Demographic characteristics, sedentary behavior, transportation modes, and food intake were investigated.

RESULTS

We found that children and adolescents who watched movies or TV programs online or on their smartphones on weekends and who chatted online on weekends, including on QQ (an instant messaging software service) and WeChat (an instant messaging software service), increased their intake of instant noodles and fried pasta (Spearman's rho = 0.468, 0.575, 0.465, and 0.323; p < 0.05). Children and adolescents who chatted online on weekends, including on QQ and WeChat, increased their intake of tofu skin (Spearman's rho = 0.461; p < 0.05), and those who browsed online on weekdays increased their intake of whole-fat liquid milk (Spearman's rho = 0.455; p < 0.05). Children and adolescents who browsed and chatted online on weekends, including on QQ and WeChat, and who played computer or smartphone games, increased their intake of fried potato chips (French fries or other fried snacks) (Spearman's rho = 0.568, 0.270, and 0.412; p < 0.05). With respect to modes of transportation used to travel to and from school, children and adolescents who took buses and subways increased their intake of rice, instant noodles, sweet potatoes, soybean milk, tofu skin, processed meat products (sausage, ham sausage, or lunch meat), fish, shrimp, vegetables, nuts, and sweet cookies (buns, cakes, Dim sum, and moon cakes) (Spearman's rho = 0.394, 0.536, 0.630, 0.408, 0.485, 0.441,0.410, 0.424, 0.444, 0.541, and 0.366; p < 0.05).

CONCLUSIONS

Sedentary behavior affects the types of food consumed in children and adolescents' daily diets. Children and adolescents who browsed online on weekdays increased their intake of whole-fat liquid milk, but also increased their intake of foods with high fat, high salt, and low nutrient density. Children and adolescents taking buses and subways increased their intake of low-nutrition quality products. Public awareness efforts should focus on reducing the consumption of low-nutrition quality products and nutritional education.

The effects of hypothetical behavioral interventions on the 13-year incidence of overweight/obesity in children and adolescents

BACKGROUND

In view of the high burden of childhood overweight/obesity (OW/OB), it is important to identify targets for interventions that may have the greatest effects on preventing OW/OB in early life. Using methods of causal inference, we studied the effects of sustained behavioral interventions on the long-term risk of developing OW/OB based on a large European cohort.

METHODS

Our sample comprised 10 877 children aged 2 to < 10 years at baseline who participated in the well-phenotyped IDEFICS/I.Family cohort. Children were followed from 2007/08 to 2020/21. Applying the parametric g-formula, the 13-year risk of developing OW/OB was estimated under various sustained hypothetical interventions on physical activity, screen time, dietary intake and sleep duration. Interventions imposing adherence to recommendations (e.g. maximum 2 h/day screen time) as well as interventions 'shifting' the behavior by a specified amount (e.g. decreasing screen time by 30 min/day) were compared to 'no intervention' (i.e. maintaining the usual or so-called natural behavior). Separately, the effectiveness of these interventions in vulnerable groups was assessed.

RESULTS

The 13-year risk of developing OW/OB was 30.7% under no intervention and 25.4% when multiple interventions were imposed jointly. Meeting screen time and moderate-to-vigorous physical activity (MVPA) recommendations were found to be most effective, reducing the incidence of OW/OB by -2.2 [-4.4;-0.7] and -2.1 [-3.7;-0.8] percentage points (risk difference [95% confidence interval]), respectively. Meeting sleep recommendations (-0.6 [-1.1;-0.3]) had a similar effect as increasing sleep duration by 30 min/day (-0.6 [-0.9;-0.3]). The most effective intervention in children of parents with low/medium educational level was being member in a sports club; for children of mothers with OW/OB, meeting screen time recommendations and membership in a sports club had the largest effects.

CONCLUSIONS

While the effects of single behavioral interventions sustained over 13 years were rather small, a joint intervention on multiple behaviors resulted in a relative reduction of the 13-year OW/OB risk by between 10 to 26%. Individually, meeting MVPA and screen time recommendations were most effective. Nevertheless, even under the joint intervention the absolute OW/OB risk remained at a high level of 25.4% suggesting that further strategies to better prevent OW/OB are required.

Mediating effect of eating pattern on the relationship between television exposure and caries in children

Behavioral characteristics may also take part in the etiology of dental caries. Sedentary behavior, especially watching television, is associated with increased intake of foods high in fat or free sugar, which could influence the occurrence of dental caries. The aim of this study was to assess the mediating effect of eating pattern on the relationship between television exposure time and the presence of dental caries in children. A cross-sectional study was conducted with a representative sample of 580 parent-child dyads with children aged 7 to 8 years in 20 public schools in Pelotas, Brazil. Parents or legal guardians were interviewed and provided information on demographic/socioeconomic data, children's daily television exposure time, and answered the Biological Rhythms Interview for Assessment in Neuropsychiatry for Kids (BRIAN-K-eating pattern domain). Caries was evaluated through clinical examination. The mediating effect of eating pattern on the relationship between television exposure and presence of dental caries was estimated using the parametric g-formula. Prevalence of dental caries was 63%, and 22% of children watched TV 4 or more hours per day. Television exposure had no direct effect on the dental caries experience [odds ratio (OR): 1.05 (95% confidence interval (95%CI): 0.92-1.19)]. Nevertheless, difficulty maintaining regular eating pattern mediated the natural indirect effect of television exposure time (≥ 4 hours/day) on dental caries experience [OR: 1.07 (95%CI): 1.01-1.14)]. The results of this study confirm the indirect pathway between television viewing and dental caries and the role of disordered eating patterns in this association.

Unhealthy Foods and Sugar-Sweetened Beverages Consumption Among Bangladeshi Adolescents and Their Sociodemographic Determinants: Findings From a Nationally Representative Cross-Sectional Study

BACKGROUND

Consumption of savory crispy or fried snacks (SCFS), sugary snacks (SS), and sugar-sweetened beverages (SSB) is associated with an increased prevalence of obesity and noncommunicable diseases. We aimed to estimate the consumption of SCFS, SS, and SSB among adolescent males and females in Bangladesh and to report the factors associated with their consumption using data from a nationwide cross-sectional survey.

METHODS

We interviewed 4,907 adolescent males and 4,865 females for the seven-day recall on intake of SCFS, SS, and SSB from 82 randomly selected clusters from rural, non-slum urban, and slum areas. Sociodemographic and anthropometry data were also collected.

RESULTS

Consumption of SCFS, SS, and SSB for ≥7 times per week was reported by 11.6%, 28.9%, and 25.6% of the males and 4.9%, 24.8%, and 20.7% of the females, respectively. The weekly mean frequency of SCFS, SS, and SSB intake increased after adjustment for potential confounders among females with higher maternal education and for SCFS and SSB among males with the highest level of father's education. Increased intake of SS and SSB for both males and females was associated with dwelling in a female-headed household. SCFS intake was higher among both males and females from the richest households. Nutritional status, both overweight and obesity, and underweight, was not associated with a more frequent intake of SCFS and SS among males and females; however, a lower frequency of intake of SSB was observed among overweight and obese males. Screen time (television viewing: none, up to 1 hour, and more than 1 hour) was not associated with consumption of SCFS and SSB among both males and females.

CONCLUSION

Consumption of unhealthy snacks and drinks is high among adolescents in Bangladesh and needs to be addressed through policy and program measures to abate the epidemic of obesity and associated NCD.

Obesogenic behavior clusters associated with weight status among Brazilian students: a latent class analysis

This study aimed to examine the association between clusters of physical activity (PA), diet, and television viewing (TV) with weight status among a representative sample of Brazilian students. Data from the National Health School-based Survey (PeNSE) 2015 were analyzed (n = 16,521; mean age 14.8, standard deviation 0.03 year). PA (minutes/week spent in leisure-time, and commuting to/from school), TV (hours/day), and weekly consumption of deep-fried empanadas, candies, sodas, ultra-processed foods, fast foods, green salads or vegetables, and fruits were self-reported on the validated PeNSE questionnaire. Latent class analysis defined behavior classes, and binary logistic regression assessed the association between clustering and weight status. Six classes' types with positive and negative behaviors were identified. Adolescents belonging to the "low TV time and high healthy diet" class had higher chances of being overweight (including obesity) compared to their peers in the "moderate PA and mixed diet" class. No associations were found in the other clusters. Mixed classes with healthy and unhealthy behaviors characterized adolescents' lifestyles and these profiles were related to weight status.

Family Mealtimes: A Systematic Umbrella Review of Characteristics, Correlates, Outcomes and Interventions

Systematic reviews have examined the multitude of studies investigating family mealtimes and their importance to child/adolescent health and psychosocial outcomes, but the focus of each is limited to specific aspects of family meals (e.g., frequency) and/or specific outcomes (e.g., nutrition). Their findings require synthesis and so a systematic umbrella review was undertaken. Databases were searched to identify systematic reviews (with or without meta-analysis/meta-synthesis) addressing at least one of the following questions: what are the characteristics and/or correlates of family mealtimes; what outcomes are associated with family mealtimes; are interventions aimed at promoting family mealtimes effective? Forty-one eligible reviews were retrieved. Their findings demonstrate that families with children/adolescents typically eat together at least a few days each week. More frequent family meals are predicted by a more positive mealtime environment, more positive attitudes towards family meals, the presence of younger children, and families having more time. Greater family meal frequency protects children/adolescents against a poorer diet, obesity, risk behaviours, poorer mental health and wellbeing, and poorer academic outcomes. Findings from interventions seeking to promote family mealtimes are mixed. This umbrella review provides a comprehensive and integrated understanding of research into family mealtimes, establishing where evidence is sound and where further research is needed.

Caregiver perceptions of snacks for young children: A thematic synthesis of qualitative research

Snacks are inconsistently defined in nutrition research and dietary guidelines for young children, challenging efforts to improve diet quality. Although some guidelines suggest that snacks include at least two food groups and fit into an overall health promoting dietary pattern, snacks high in added sugars and sodium are highly marketed and frequently consumed. Understanding how caregivers perceive "snacks" for young children may aid in development of effective nutrition communications and behaviourally-informed dietary interventions for obesity prevention. We aimed to synthesize caregivers' perceptions of snacks for young children across qualitative studies. Four databases were searched for peer-reviewed qualitative articles including caregiver perceptions of "snacks" for children ≤5 years. We conducted thematic synthesis of study findings, concluding with the development of analytical themes. Data synthesis of fifteen articles from ten studies, conducted in the U.S., Europe, and Australia, revealed six analytical themes that captured food type, hedonic value, purpose, location, portion size, and time. Caregivers perceived snacks as both "healthy" and "unhealthy" foods. Less healthy snacks were described as highly liked foods, which required restriction and were consumed outside the home. Caregivers used snacks to manage behavior and curb hunger. Snack portions were described as "small", although caregivers reported various methods to estimate child portion size. Caregivers' perceptions of snacks revealed opportunities for targeted nutrition messaging, especially supporting responsive feeding and nutrient-dense food choices. In high-income countries, expert recommendations should consider caregivers' perceptions of snacks, more clearly defining nutrient-dense snacks that are enjoyable, achieve dietary requirements, reduce hunger, and promote healthy weight.

The treatment of obesity in children and adolescents: consensus position statement of the Italian society of pediatric endocrinology and diabetology, Italian Society of Pediatrics and Italian Society of Pediatric Surgery

This Position Statement updates the different components of the therapy of obesity (lifestyle intervention, drugs, and surgery) in children and adolescents, previously reported in the consensus position statement on pediatric obesity of the Italian Society of Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Lifestyle intervention is the first step of treatment. In children older than 12 years, pharmacotherapy is the second step, and bariatric surgery is the third one, in selected cases. Novelties are available in the field of the medical treatment of obesity. In particular, new drugs demonstrated their efficacy and safety and have been approved in adolescents. Moreover, several randomized control trials with other drugs are in process and it is likely that some of them will become available in the future. The increase of the portfolio of treatment options for obesity in children and adolescents is promising for a more effective treatment of this disorder.

Desynchronized daily activity rhythms and gender related psychological well-being of Moroccan university students during the quarantine-isolation

BACKGROUND

The disturbance of students' biological and academic rhythms induced by the Coronavirus generated considerable challenges that had an influence on their psychological well-being. This study aims to highlight the daily rhythm desynchronization and examine the mental health of Moroccan students who were impacted, notably females, in the context of the COVID-19 pandemic.

METHODS AND MATERIAL

A cross-sectional online survey was conducted in May 2020 at ten Moroccan faculties including 312 students with an average age of 22 ± 1.70 years old, processed according to a random sampling. A Daily Activities Biorhythm Questionnaire was used to assess the students' daily activities time use and duration, while the PTSD Symptom Scale, Hamilton Scale, Worry Domains Questionnaire, and Visual Analog Mood State Scale were used to assess their mental health. A statistical analysis used both Chi-square and t test to evaluate the relationship between females and males as two independent groups to the studied variables.

RESULTS

Based on individual gender differences, a significant disruption emerged in the daily time use and duration of activities during home confinement. Besides, females were more likely to experience psychological issues notably anxiety (2.04 ± 0.49), physical tiredness (2.11 ± 0.39), sadness (p <.05), and posttraumatic stress disorder (p <.01). In contrast, there is a strong correlation between males' concern of declining employment (p <.05) and their worry of declining family budgets (2.10 ± 1.39).

CONCLUSIONS

As an emerging behavior for a new risk factor, the daily activities rhythm of Moroccan university students have been altered and mental health difficulties have appeared due to the quarantine isolation. This might influence their overall academic performance and psychological balance. In this instance, psychological assistance is highly recommended.

Snacking Consumption among Adults in the United States: A Scoping Review

Snacks are a staple of the American diet, contributing to approximately 20% of energy intake. Most U.S. adults consume one to three snacks/day, yet few reviews have focused on snacking among this population. This scoping review was conducted to characterize snacks and snacking occasions among U.S. adults to further inform healthy eating practices. The protocol was prepared following the PRISMA-Extension for Scoping Reviews. Three web databases were used to identify articles using snacking or eating occasions as primary or secondary outcomes among U.S. adults. A search strategy was developed using subject headings, truncation, and phrase searching in the title and abstract of articles published between 2010 and 2022. A two-stage, multi-step screening process identified 31 of 4795 publications as meeting the inclusion criteria. Findings included identification of snacking themes, e.g., cues and motivations; diet composition; and weight management. Food quality, time of consumption, and convenience emerged as characteristics of snacking; time of day was found to influence food choice. Snacks contribute to or detract from a healthy diet. Strategic selection of healthy snack options can improve diet quality. Applied to nutrition education, this information can help strengthen programs or policies, ultimately contributing to health and wellbeing.

Results from the Strong Families Start at Home/Familias Fuertes Comienzan en Casa: feasibility randomised control trial to improve the diet quality of low-income, predominantly Hispanic/Latinx children

OBJECTIVE

To describe the feasibility, acceptability and results of Strong Families Start at Home, a 6-month pilot trial of a home-based food parenting/nutrition intervention.

DESIGN

Pilot randomised controlled trial.

SETTING

Participants received six visits with a community health worker trained in motivational interviewing (three home visits, three phone calls); an in-home cooking or reading activity; personalised feedback on a recorded family meal or reading activity; text messages and tailored printed materials.

PARTICIPANTS

Parents and their 2-5-year-old child were randomised into intervention (responsive food parenting practices/nutrition) or control (reading readiness) groups.

RESULTS

Parents (n 63) were mostly mothers (90 %), Hispanic/Latinx (87 %), born outside the USA (62 %), with household incomes <$25 k (54 %). Despite delivery during COVID-19, 63 % of dyads were retained at 6 months. The intervention was delivered with high fidelity. All parents in the intervention group (n 24) expressed high levels of satisfaction with the intervention, which produced positive treatment effects for whole and total fruit component Healthy Eating Index-2015 scores (point estimate (PE) = 2·14, 95 % CI (0·17, 1·48); PE = 1·71, 95 % CI (0·16, 1·47), respectively) and negative treatment effects for sodium (PE = -2·09, 95 % CI (-1·35, -0·04)). Positive treatment effects also resulted for the following food parenting practices: regular timing of meals and snacks (PE = 1·08, 95 % CI (0·61, 2·00)), reducing distractions during mealtimes (PE = -0·79, 95 % CI (-1·52, -0·19)), using food as a reward (PE = -0·54, 95 % CI (-1·35, -0·04)) and providing a supportive meal environment (PE = 0·73, 95 % CI (0·18, 1·51)).

CONCLUSION

Given the continued disparities in diet quality among low-income and diverse families, continued efforts to improve child diet quality in fully powered intervention trials are needed.

Sedentary Behavior, Dietary Habits, and Cardiometabolic Risk in Physically Active Children and Adolescents

BACKGROUND

Sedentary behavior has been associated with several cardiometabolic risk factors during childhood. However, little is known about the impact of sedentary behavior on the health and eating habits of physically active children and adolescents.

OBJECTIVE

To evaluate the association between sedentary behavior and cardiometabolic risk factors and eating habits in physically active children and adolescents.

METHODS

This cross-sectional study was conducted, including 516 physically active children and adolescents (10 to 18 years old; both sexes) enrolled in the social project "Estação Conhecimento-Vale" were evaluated. Biochemical and lifestyle variables (questionnaire) were collected. Sedentary behavior was determined indirectly (questionnaire), by using sitting time ≥ 3 hours per day as a cutoff point. A p-value < 0.05 was considered statistically significant for all tests.

RESULTS

Sedentary behavior was not associated with overweight/obesity (odds ratio = 0.72 [95% confidence interval (CI): 0.325-1.389]), hypertriglyceridemia (odds ratio = 0.63 [95% CI: 0.306-1.297]), low HDL cholesterol (odds ratio = 0.57 [95% CI: 0.323-1.019]), or high non-HDL cholesterol (odds ratio = 0.63 [95% CI: 0.283-1.389]). However, children and adolescents with sedentary behavior were more likely to regularly consume food in front of the television (odds ratio = 1.96 [95% CI: 1.114-3.456]) and to consume at least one ultra-processed food per day (odds ratio = 2.42 [95% CI: 1.381-4.241]). In addition, they were less likely to consume fruit regularly (odds ratio = 0.52 [95% CI: 0.278-0.967]).

CONCLUSION

There was no association between sedentary behavior and cardiometabolic risk factors in physically active children and adolescents. However, sedentary behavior was associated with inadequate eating habits. Thus, we may suggest that the regular engagement in physical activity may attenuate the deleterious effects of sedentary behavior on the cardiometabolic parameters of children and adolescents.

Risk of Obesity Among Children Aged 2-6 Years Who Had Prolonged Screen Time in Taiwan: A Nationwide Cross-Sectional Study

Objective

To evaluate the risk of obesity in preschool children with prolonged screen time in Taiwan.

Methods

Using a nationwide survey with random sampling, we collected information on 8378 preschool children aged 2-6 years among 206 preschools in Taiwan from 2016 to 2019. Socioeconomic data, body mass index, and lifestyle of the preschool children and their caregivers were compared among the groups of preschool children who had moderate and prolonged daily screen time. We used multiple log-binomial regression models to calculate the adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) of obesity associated with prolonged screen time.

Results

The prevalence of obesity in the preschool children was 13.1%, and the average screen time was 104.6 minutes. Children's age, sleep hours, outdoor play time, sugar intake, snack eating before dinner, sleep disturbance, and obesity, as well as caregiver's sex, age, education, screen time, exercise time and parent obesity were factors related to high screen time for preschool children. Compared with children with moderate screen time, children with prolonged screen time had a higher risk of obesity (PR, 1.45; 95% CI, 1.18-1.79). With a 60-minute increase in screen time, the risk of obesity increased, with an PR of 1.10 (95% CI, 1.03-1.17).

Conclusion

Preschool children with prolonged screen time had an increased risk of obesity in Taiwan. Interventions may be needed for this very susceptible population.

"That's the routine": A qualitative exploration of mealtime screen use in lower educated Australian families with young children

BACKGROUND

Family meals are an opportune context for initiating healthy eating habits in young children. However, using screens at family mealtimes may negate some of the associated nutritional and social benefits. In High Income countries, frequent mealtime screen use is common, particularly in families of low socioeconomic position (SEP). This study aimed to explore experiences and acceptability of mealtime screen use in families of low SEP with young children.

METHODS

Qualitative interviews with 25 mothers of low SEP were conducted via telephone or Zoom™ using Photo Interviewing and a semi-structured interview script. Transcripts were analysed thematically using a Constructivist paradigm.

RESULTS

Many parents reported an eagerness for reducing family mealtime screen use. Three major themes were identified in explaining the reasons behind levels of engagement in family mealtime screen use. These included parental self-efficacy, such as parental confidence in saying no to screens at mealtimes, physical resources such as having enough space in the home for a functioning dining table without view of a television, and temporal priorities such as prioritising screen use for managing children's difficult behaviour at mealtimes over long-term health considerations.

CONCLUSIONS

This study highlights that although family mealtime screen use is likely linked with a range of child behaviours and parenting practices that may negatively influence children's dietary intake and social engagement, parents often considered screens acceptable at mealtimes. Nonetheless, parents' desire to reduce family mealtime screen use provides an important opportunity to determine how best to support parents to achieve this.

Validation of the illustrated questionnaire on eating and sedentary behaviors (QUICAS) for seven to ten-year-old children

The Illustrated Questionnaire on Eating and Sedentary Behaviors (QUICAS) was developed and validated for schoolchildren seven to ten years old. It used previous day recall and was illustrated with ten eating behaviors (referring to the act of eating without distractions, with company, on a regular basis, the type of food eaten, and participation in tasks involved in meal preparation) and five sedentary behaviors (related to the use of television, computer, tablet, cell phone, and video game). The instrument was validated in four stages: (1) Its content was developed based on literature review and expert evaluation; (2) Items were validated by comparing the responses of children and their parents, through a questionnaire on Google Forms. At this stage, a convenience sample was adopted, consisting of 145 parent-child dyads. High sensitivity (average of 90.7%); high specificity (mean of 87.9%); low number of false positives (mean of 12.1%); low number of false negatives (mean of 9.3%); almost perfect agreement between the child's and the parent's reports (k = 0.81); and low disagreement (≤22%) were found. In addition, the child's gender and age did not significantly influence the child's report. (3) The illustrations were validated in a focus group with 18 children, who satisfactorily described all the eating and sedentary behaviors of the illustrations. (4) In the pretest of the questionnaire on Google Forms, with the participation of 15 children, the majority (86.7%) judged the questionnaire as excellent or good. Therefore, the QUICAS is valid to assess eating and sedentary behaviors in schoolchildren seven to ten years old.

Sedentary time and the risk of metabolic syndrome: A systematic review and dose-response meta-analysis

The dose-response association between sedentary time and the risk of metabolic syndrome is unclear, which indicates an important knowledge gap in public health. The objective of this study was to determine the categorical and continuous dose-response associations between sedentary time and the risk of metabolic syndrome. A systematic literature search of English articles published in PubMed, CINHAL, Embase, and Web of Science Core Collection prior to June 2022 was conducted. All cohort and cross-sectional studies that examined the association between sedentary time and the risk of metabolic syndrome were considered, and duplicate and non-related studies were excluded. Data extraction using a standardized chart and quality assessment using two appraisal tools were also performed. Two independent reviewers were involved in these processes. In categorical meta-analyses, the pooled effect sizes for metabolic syndrome associated with different categories of sedentary time were calculated by comparing the highest and intermediate with the lowest categories. In continuous meta-analyses, the linear and nonlinear dose-response associations were estimated using generalized least squares and restricted cubic spline models, respectively. Data were collected and analyzed from March to June 2022. Four prospective cohort studies and 22 cross-sectional studies with 105,239 participants and 16,185 MetS cases were included in this study. In categorical analyses, both intermediate (median duration: 4.11 h/day; pooled OR: 1.17, 95% CI: 1.08-1.26, P &lt; 0.001) and high levels (median duration: 7.26 h/day; pooled OR: 1.71, 95% CI: 1.43-2.04, P &lt; 0.001) of total sedentary time were significantly associated with an increased risk of metabolic syndrome. Similarly, a significant association between screen time and the risk of metabolic syndrome was also found in intermediate (median duration: 2.22 h/day; pooled OR: 1.20, 95% CI: 1.10-1.32, P &lt; 0.001) and high levels (median duration: 3.40 h/day; pooled OR: 1.63, 95% CI: 1.44-1.86, P &lt; 0.001) of exposure. Of note, these associations were significantly stronger in women. Different patterns of the behavior-disease association were not observed in children, adolescents, and adults. The findings of continuous meta-analyses could not provide solid evidence for the linearity and nonlinearity of the behavior-disease association. This study demonstrated that long-time sedentary behavior was associated with a higher risk of MetS independent of physical activity and the patterns of association varied by gender instead of age. These findings have implications for future guideline recommendations on physical activity, sedentary behavior, and prevention of metabolic syndrome.

Free sugar intake and associated factors among Sri Lankan preschool children

BACKGROUND

Excessive free sugar intake tends to be associated with unpleasant health consequences, such as dental caries and unhealthy weight gain in children, as well as a number of noncommunicable diseases in adults. The WHO suggests that the best method for addressing these issues is to reduce free sugar consumption throughout life, in order to be successful, these measures should be implemented as early as possible. This makes the early formative years of preschool an important point for possible intervention. To confirm this, baseline information on current sugar intake levels is needed, as well as identification of factors associated with high levels of consumption.

METHODS

This cross-sectional study was conducted in the district of Colombo, Sri Lanka. The probability proportionate to size technique combined with cluster sampling was used to select a representative sample of 813 children aged 4-5-years from 82 preschools. We developed, and validated a quantitative food frequency questionnaire (FFQ) to assess free sugar consumption. Data on correlated factors were collected from caregivers using a pre-tested self-administered questionnaire.

RESULTS

Based on the data, the daily median (IQR) free sugar intake of preschool children was 57.9 (33.2-95.8) grams/day (approximately to 14.5 (8.3-23.9) teaspoons/day) or 21.1% (12.5-34.9%) of their daily energy requirements. The WHO recommends limiting sugar intake to less than 5% of total energy intake; however, the current level is fourfold, and 96% of children consume higher percentage of energy from free sugar than recommended. In terms of total daily sugar consumption, bakery products accounted for 27%, followed by biscuits (15%), and table sugar (15%). Increasing maternal education level significantly reduced sugar intake (p = 0.04). Children of other ethnicities ate more sugar than the Sinhala children (p = 0.01). There was higher sugar intake among those who ate while returning from preschool (p < 0.001), while watching television (p < 0.001), and those who had school-going siblings (p = 0.02).

CONCLUSION

Among preschool children, free sugar consumption levels were very high and most of the children consumed more sugar than is recommended; which warranted urgent actions to curb sugar intake among them.

Screen Time and Its Association with Vegetables, Fruits, Snacks and Sugary Sweetened Beverages Intake among Chinese Preschool Children in Changsha, Hunan Province: A Cross-Sectional Study

(1) Introduction: Screen time may influence preschoolers’ food consumption. However, there is limited evidence regarding preschoolers, especially in China. The aim of this cross-sectional study was to investigate the association between screen time and the consumption of vegetables, fruits, snacks, and sugar sweetened beverages (SSBs). (2) Methods: Participants (1567 caregivers) were recruited from six kindergartens in Hunan, China. Caregivers completed the questionnaire, which included the food frequency questionnaire (FFQ) and questions regarding their children’s daily screen time. (3) Results: The mean screen time of preschoolers was 1.36 ± 1.26 h, and the proportion of children who spent more than one hour on screens was 54.3% in the overall sample. Children with longer screen time consumed vegetables and fruits less frequently, while having a higher consumption of snacks and SSBs. After adjustment of sociodemographic confounders, children’s eating behaviors and parental feeding practices, the association of screen time with vegetables and SSBs still remained significant. (4) Conclusions: Screen time exposure needs to be monitored in preschool children, which was negatively associated with their consumption of vegetables and fruits, whereas it was positively associated with snacks and SSBs. Future research should focus more on the impact of screen time on children’s unhealthy behaviors and dietary patterns.

The Mediating Effects of Food Content Watching Motivation on the between Watching Time and Nutrition Quotient of Adolescents in Seoul, Korea

Food-related content varies widely and is increasingly popular. Using various media, teenagers can easily access food content, which could affect they eating habits. This study was conducted to confirm the effects of watching motivation on the relationship between food content watching time and eating habits among adolescents in Seoul, Korea. Exactly 806 participants were surveyed about their food content watching status, including watching time and watching motivation. The Nutrition Quotient for adolescents (NQ-A) questionnaire was used to confirm eating habits. Exploratory factor analysis was conducted to classify watching motivation’s subfactors. A parallel multimedia model was used to analyze the effect of watching motivation on the relationship between food content watching time and eating habits. As a result of this study, following the factor analysis, watching motivation was classified into information acquisition, emotional satisfaction, and enjoyment. The influence of food content watching time on NQ-A scores through information acquisition motivation was positively significant, whereas that through emotional satisfaction motivation was negatively significant. Enjoyment motivation did not indirectly affect the relationship between food content watching time and NQ-A scores. Hence, attention should be paid to these mediating factors when analyzing the relationship between watching food-related content and eating habits. Developing and distributing content that meets viewing motivations should help improve adolescents’ eating habits.

Eating contexts and their associations with socio-demographic factors in Brazilian adolescents (EVA-JF Study)

OBJECTIVE

To describe the eating contexts and estimate their associations with socio-demographic factors in a sample of Brazilian adolescents.

DESIGN

Cross-sectional study. We used an exploratory questionnaire about eating contexts (encompassing regularity of meals, places where they occur and if they take place with attention and in company), which was submitted to cluster analysis. Subsequently, three clusters were identified: cluster 1, 'appropriate eating contexts at breakfast, lunch and dinner'; cluster 2, 'inappropriate eating context at breakfast' and cluster 3, 'inappropriate eating context at dinner'. Multinomial logistic regression models were performed, without and with adjustments, using cluster 1 as reference.

SETTING

Twenty-nine public schools of Juiz de Fora, MG, Southeast Brazil.

PARTICIPANTS

Adolescents, 14-19-year-olds (n 835).

RESULTS

We observed relevant prevalence of adolescents omitting breakfast (52·9 %) and dinner (39·3 %), and who had the habit of eating sitting/lying on the couch/bed or standing/walking, and in front of screens. Breakfast usually occurred unaccompanied (70·8 %); around half (47·5 %) and little over a third (36·1 %) of the sample also would usually have lunch and dinner unaccompanied, respectively. Furthermore, through multivariate analysis, we found associations of eating contexts clusters with female sex (more likely in clusters 2 and 3), age range 14-15-year-olds (less likely in cluster 2) and higher mother's schooling (more likely in cluster 3).

CONCLUSIONS

We verified an alarming prevalence of adolescents with eating contexts unaligned with healthy eating recommendations. Additionally, inappropriate eating contexts at breakfast and/or at dinner were associated with socio-demographic factors (sex, age range and mother's schooling).

Food Insecurity, Dietary Intakes, and Eating Behaviors in a Convenience Sample of Toronto Youth

BACKGROUND

Food insecurity has been shown to be associated with poor dietary quality and eating behaviors, which can have both short- and long-term adverse health outcomes in children. The objective was to investigate the food security status, dietary intakes, and eating behaviors in a convenience sample of youth participating in the Maple Leaf Sports Entertainment LaunchPad programming in downtown Toronto, Ontario.

METHODS

Youth aged 9-18 years were recruited to participate in the study. Food security status, dietary intakes, and eating behaviors were collected using parent- or self-reported questionnaires online.

RESULTS

Sixty-six youth (mean ± SD: 11.7 ± 1.9 years) participated in the study. The prevalence of household food insecurity was higher than the national average with at least one child under 18 years of age (27.7% vs. 16.2%). Dietary intake patterns were similar to the national trends with low intakes of fiber, inadequate intakes of calcium and vitamin D; and excess intakes of sodium, added sugar, and saturated fat. Despite a low prevalence of poor eating habits, distracted eating was the most frequently reported poor eating habit.

CONCLUSIONS

Although youth were at high risk for experiencing household food insecurity, inadequate dietary intake patterns were similar to the national trends. Our findings can be used to develop future programming to facilitate healthy dietary behaviors appropriate for the target community.

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

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

Relationship between Family Racial/Ethnic Backgrounds, Parenting Practices and Styles, and Adolescent Eating Behaviors

Obesity is more prevalent among racial minority children in the United States, as compared to White children. Parenting practices can impact the development of children's eating behaviors and habits. In this study, we investigated the relationships among racial/ethnic backgrounds, parenting practices and styles, and eating behaviors in adolescents. Fifty-one parent-adolescent dyads were interviewed to characterize parenting practices and styles, as well as the consumption of dairy, fruits and vegetables, and unhealthy snacks. Height and weight were measured to calculate parent BMI and adolescent BMI-for-age percentiles. Three parenting practice categories-modeling, authoritative, and authoritarian-were found to be related to race/ethnicity. A higher score in authoritarian parenting practices was related to higher BMI percentiles among African American adolescents, whereas a higher score in monitoring practices was related to lower BMI percentiles among non-Hispanic White adolescents. Modeling, reasoning, and monitoring led to higher consumption of fruits and vegetables among adolescents; however, the consumption of unhealthy snacks was higher with rule-setting and lower with reasoning and authoritative practices. Finally, an analysis of the relationships between environmental factors and snack intake showed that adolescents consumed significantly more unhealthy snacks when performing other activities while eating. In conclusion, the findings from this study suggest that families' racial heritages are related to their parenting practices, BMI percentiles, and their adolescents' food consumption and eating behaviors. The results of this study can be used to develop and improve adolescent nutrition education and interventions with consideration of their racial/ethnic backgrounds.

Sex-Based Differences in Factors Associated With Sugar-Sweetened Beverage Consumption Among Korean High School Students

This study aimed to identify sex-based differences in the individual and environmental factors associated with sugar-sweetened beverage (SSB) consumption among Korean high school students. Secondary data were obtained from the 15th (2019) Korea Youth Risk Behavior Web-based Survey. In this study, we analyzed data from 13,066 high school students (5,874 boys and 7,192 girls) who answered questions regarding SSB consumption and individual and environmental factors. Complex sampling analysis (descriptive statistics and logistic regression analysis) was conducted using the SPSS Statistics 26.0 software. Most adolescents (97% boys and 95.2% girls) reported having consumed SSBs in the last seven days. Individual factors, such as increased stress, sleep dissatisfaction, and fast-food intake (more than thrice a week) were positively associated with SSB consumption among adolescent boys and girls. Environmental factors like high education levels (above college) of mothers were negatively associated with SSB consumption among both boys and girls. Furthermore, current alcohol consumption, smoking, low vegetable intake (less than thrice a week) in boys, and more than 2 h a day of screen-based sedentary behavior in girls were positively associated with SSB consumption. According to the results, individual factors associated with SSB consumption varied according to the sex of adolescents. Thus, sex differences in factors associated with SSB consumption in adolescents should be considered as basic knowledge for developing strategies for reducing SSB consumption.

Joint associations of physical activity and sedentary time with adiposity during adolescence: ALSPAC

BACKGROUND

In developing evidence-based physical activity (PA) guidelines for youth, a knowledge gap exists regarding the health effects of sedentary time (SED). The aim of this study was to determine the joint associations of moderate- and vigorous-intensity PA (MVPA) and SED with adiposity during adolescence.

METHODS

The study sample was 2619 non-obese participants (56.7% female) from the UK Avon Longitudinal Study of Parents and Children. Accelerometer-measured MVPA and SED at age 11, 13, 15 years and self-reported TV viewing at age 13 and 16 years were used to create two exposure variables: six MVPA&SED combinations based on two MVPA patterns [≥60 (active) and <60 min/day (inactive)] and three SED patterns [≈25 (low), ≈30 (middle) and ≈35 min/h (high)] and six MVPA&TV combinations based on two MVPA patterns and three TV viewing patterns [<1-2 (low), 1-2 (middle) and >1-2 h/day (high)]. Adiposity was evaluated using fat mass index (FMI) at age 17 years.

RESULTS

SED was not significantly associated with FMI in either active or inactive adolescents. However, higher TV viewing was associated with higher FMI in both active [adjusted FMI = 4.53 vs. 5.09 (95% CI = 4.87, 5.33) for low TV vs. high TV] and inactive adolescents [adjusted FMI = 4.91 vs. 5.21 (95% CI = 5.02, 5.39) for low TV vs. high TV].

CONCLUSIONS

Higher TV viewing time, but not total SED, was prospectively associated with higher adiposity among both active and inactive adolescents, suggesting a specific sedentary behavior target for public health.

Adolescents' media usage and self-reported exposure to advertising across six countries: implications for less healthy food and beverage marketing

OBJECTIVES

The study objectives were to examine: (1) adolescents' media viewing habits, (2) associations with media viewing and self-reported exposure to unhealthy food and beverage advertising and (3) differences in trends among younger and older adolescents in six high and upper middle-income countries.

DESIGN

Repeat cross-sectional online survey.

SETTING

Australia, Canada, Chile, Mexico, the United Kingdom (UK) and the United States of America (USA).

PARTICIPANTS

Respondents to the International Food Policy Study who provided information on all variables of interest in November-December 2019 aged 10-17 years (n=9171).

OUTCOME MEASURES

Self-reported exposure to screen-based media (screen time by media channel), use of social media platforms and self-reported location and frequency of exposure to unhealthy food and beverage advertising.

RESULTS

The average amount of time spent in front of various screens ranged from 7.6 hours to 10.2 hours across countries per week day, which may include possible viewing of multiple media channels simultaneously. Overall, Instagram was the most popular social media platform (52%-68% by country), followed by Facebook (42%-79%) and Snapchat (28%-52%). The percentage of respondents who self-reported having seen unhealthy food advertisements in the past 30 days was highest on television (43%-69%), followed by digital media (27%-60%) and gaming applications (10%-17%). Self-reported daily exposure to advertising varied between countries for sugary drinks (10%-43%) and fast food (19%-44%) and was positively associated with self-reported screen time. Self-reported exposure to screen-based media and social media platforms differed by sociodemographic characteristics and was higher among older adolescents than younger adolescents.

CONCLUSIONS

The important amount of time spent on screen-based media reported by adolescents and large percentage of adolescents reporting social media usage, coupled with high rates of self-reported advertising exposure, support the need for policies to restrict marketing of unhealthy food and beverages appealing to adolescents on screen-based media.

COVID-19 – Impact of the lockdown on the weight variation among the Lebanese population

The aim of this study is to assess lifestyle changes along with weight fluctuations during the COVID-19 lockdown in Lebanon. This cross-sectional study was conducted using a web-survey disseminated through social media platforms to a large sample of the Lebanese population between May 25th and June 8th, 2020, during the lockdown in Lebanon. Behavioral changes and weight variation during the confinement were assessed. Two thousand one hundred sixty-one participants (64.9% female) aged 18 to 78 years old were included in this study. On average, no net weight variation was reported by the participants. 59.3% of the smokers changed their smoking habits, 40.7% of the drinkers reported a decrease in alcohol consumption, 43.5% of the participants exercised less than one time weekly and 35.8% changed their diet. Increased frequency of physical activity, following a diet during lockdown, decreased weight dissatisfaction (P < 0.0001 for the three variables) were retained as significant factors associated with weight loss. Planning to engage in physical activity post lockdown was associated with weight gain (P = 0.021). In the Lebanese population, no net weight variation was reported during the lockdown. Increasing physical activity and initiating diet were associated with weight loss. Healthcare authorities should be alerted about the importance of these factors during the follow-up of the confined population.

Nutrition Knowledge as a Driver of Adherence to the Mediterranean Diet in Italy

Background

An optimal Nutrition knowledge (NK) among the population could result in greater Adherence to the Mediterranean Diet (AMD), a recognized dietary pattern capable of preventing chronic food-related diseases. This study aimed to evaluate the association between NK and AMD in Italy.

Methods

A national representative sample of 2,869 adults took part in an assessment that was carried out through a self-administrated questionnaire including sections relating to NK and AMD. AMD was evaluated following the PREDIMED PLUS methodology. Descriptive statistics were provided, and ordinal measures of NK score and AMD were calculated based on quartiles of the quantitative scores. A contingency analysis was performed to check associations between variables.

Results

In Italy, the average NK score was 50 ± 13.3, equivalent to 56.8% of correct answers. The average value of AMD was 6.8, corresponding to 40% of the maximum score with 31.4% of the population demonstrating low AMD, 31.3% in the lower-middle range, 24% in the medium-high range, and only 13.3% reporting a high AMD. A significant association between NK and AMD was found; respondents who reported the lowest AMD corresponded to those with the lowest NK (36.7%; p < 0.05) and similarly, those with the highest level of adherence to MD also achieved the highest NK scores (41.7%; p < 0.05).

Conclusion

This study showed that AMD in Italy is generally low, and the strong association between NK and AMD demonstrated that there is a clear connection between a healthy dietary pattern and the nutrition literacy of the population. Those with the highest AMD corresponded to the highest NK and, conversely, those with the lowest AMD displayed the lowest NK. The study also highlighted that socioeconomic aspects were strong determinants of both AMD and NK.

Influence of eating with distractors on caloric intake of children and adolescents: a systematic review and meta-analysis of interventional controlled studies

Eating habits developed during childhood can be perpetuated along life and contribute to the emergence of disorders. We aimed to investigate the influence of distractors during experimental meals on the energy intake of children and adolescents. We followed the PRISMA guidelines and the study was registered in PROSPERO (CRD42021259946). The PICOS strategy consisted of children and adolescents (P), exposed to distractors during meals (I), compared with no distraction (C) and the outcome was energy intake (Kcal) (O) evaluated in crossover and parallel randomized clinical trials (RCTs) (S). Searches were conducted in PubMed, Scopus, Web of Science, Cochrane, Proquest, Embase, and LILACs databases. We employed RoB 2 tool and NutriGrade. Databases searches returned 9,576 references. Thirteen articles were selected (five crossover and eight parallel RCTs). Volunteers aged 3 to 17 years-old. All studies evaluated TV as distractor. Most studies presented high/moderate risk of bias. Meta-analysis of parallel RCT indicated no significant difference in energy intake while eating with TV (MD = 0.05; 95% CI -0.13 - 0.23, P = 0.57), with moderate certainty level. In conclusion, under laboratory conditions, eating with distractors seems to barely alter energy intake for children and adolescents.Supplemental data for this article is available online at https://doi.org/10.1080/10408398.2022.2055525 .

Mealtime media use and cardiometabolic risk in children

OBJECTIVES

To examine the association between mealtime media use and non-HDL-cholesterol as well as other markers of cardiometabolic risk (CMR) in children.

DESIGN

A repeated measures study design was used to examine the association between mealtime media use and CMR outcomes. Multivariable linear regression with generalised estimating equations was used to examine the association between mealtime media use and CMR outcomes. Analyses were stratified a priori by age groups (1-4 and 5-13 years).

SETTING

The TARGet Kids! Practice-based research network in Toronto, Canada.

PARTICIPANTS

2117 children aged 1-13 years were included in the analysis.

RESULTS

After adjusting for covariates, there was no evidence that total mealtime media use was associated with non-HDL-cholesterol in 1-4 year olds (P = 0·10) or 5-13 year olds (P = 0·29). Each additional meal with media per week was associated with decreased HDL-cholesterol in 5-13 year olds (-0·006 mmol/l; 95 % CI -0·009, -0·002; P = 0·003) and log-TAG in 1-4 year olds (β = -0·004; 95 % CI -0·008, -0·00009; P = 0·04). Media use during breakfast was associated with decreased HDL-cholesterol in 5-13 year olds (-0·012 mmol/l; 95 % CI -0·02, -0·004; P = 0·002), while media during lunch was associated with decreased log-TAG (-0·01 mmol/l; 95 % CI -0·03, -0·002; P = 0·03) in children aged 1-4 years. Total mealtime media use was not associated with total cholesterol, glucose or insulin in either age group.

CONCLUSIONS

Mealtime media use may be associated with unfavourable lipid profiles through effects on HDL-cholesterol in school-aged children but likely not in pre-schoolers.

Screen use and internet addiction among parents of young children: A nationwide Canadian cross-sectional survey

Objectives

To establish the factorial structure and internal consistency of the Internet Addiction Test (IAT) in parents, the level and correlates of problematic internet use, and patterns and types of screen use.

Study design

Data were collected through an online questionnaire about preconception health among Canadian women and men with ≥1 child. The questionnaire included the IAT and questions about time spent on screens by device type, use of screens during meals and in the bedroom, and perceptions of overuse. Factor analysis was completed to determine the factorial structure of the IAT, with multivariable linear regression used to determine correlates of the IAT.

Results

The sample included 1,156 respondents (mean age: 34.3 years; 83.1% female). The IAT had two factors: “impairment in time management” and “impairment in socio-emotional functioning” of which respondents had more impairment in time management than socio-emotional functioning. Based on the original IAT, 19.4% of respondents would be classified as having a mild internet use problem with 3.0% having a moderate or severe issue. In the multivariable model, perceived stress (b = .28, SE = .05, p < .001) and depressive symptoms (b = .24, SE = .10, p = .017) were associated with higher IAT scores. Handheld mobile devices were the most common type of screen used (mean = 3 hours/day) followed by watching television (mean = 2 hours/day).

Conclusion

Parents spent a significant portion of their time each day using screens, particularly handheld mobile devices. The disruption caused by mobile devices may hinder opportunities for positive parent-child interactions, demonstrating the need for resources to support parents ever-growing use of technologies.

Prevalence of Overweight and Obesity and Associated Diet-Related Behaviours and Habits in a Representative Sample of Adolescents in Greece

Excessive body weight during adolescence represents a significant public health problem worldwide. Identifying factors associated with its development is crucial. We estimated the prevalence of overweight and obesity in a representative sample of 11, 13 and, 15-year-olds living in Greece and explored the association with diet-related behaviours and habits. Self-reported data on weight, height, diet-related behaviours and habits were used from 3816 students (1898 boys, 1918 girls) participants in the Greek arm of the international Health Behaviour in School-Aged Children (HBSC) study during 2018. Overweight and obesity were defined using the 2007 WHO growth charts classification. Prevalence of overweight was 19.4% in the total sample, 24.1% for boys and 14.7% for girls, and prevalence of obesity was 5.3% in the total sample, 7.3% for boys and 3.4% for girls, respectively. In the total sample, overweight (including obesity) was positively associated with male gender, low family affluence, skipping breakfast, and being on a diet, and inversely associated with age and being physically active. Eating rarely with the family was positively associated with overweight only among boys and eating snacks/meals in front of screens only among girls. No association was noted for eating in fast-food restaurants, consuming vegetables, fruits, sweets, and sugar-sweetened beverages.

The Analysis of the Nutritional Status and Dietary Habits among Children Aged 6-10 Years Old Attending Primary Schools in Poland

A high prevalence of obesity among children is influenced by serious implications. Obesity mainly results from behavioral factors, such as improper dietary habits. This study aims to evaluate the nutritional status and dietary habits of children aged 6-10 (n = 908) attending primary schools in Poland, Europe. The research tool was a questionnaire that was completed by one of the children's parents. A statistical analysis was made using statistical software. The value of p = 0.05 was considered to be statistically significant. A total of 74.7% of children surveyed have a normal body mass. As many as 91.7% and 76.6% of children, respectively, eat a first and second breakfast daily. Nearly half of parents (48.9%) state that their child consumes milk or other dairy products daily. A total of 74.3% of children drink water daily. A total of 27.6% eats fish less frequently than once a week. A total of 7.6% of children eat fish several times a week. As many as 20.6% of the respondents state that their child eats brown bread several times a week, whereas 19.9% state that their child never eats brown bread. A total of 55.1% of children eat fruits and/or vegetables daily. A total of 14.1% of children surveyed consume sweets daily. The study revealed a positive correlation between BMI and the frequency of mineral water consumption (p = 0.013) in 9 y.o. girls. It was also revealed that the number of consumed fruit/vegetables increases with the BMI value among 10 y.o. boys (p = 0.044). Conclusions: The dietary habits of the investigated children are still improper. There is a great need for education on this issue, but family involvement is also required.

Television viewing and using screens while eating: Associations with dietary intake in children and adolescents

Screen time has been associated with overweight and obesity, as well as with poorer dietary quality. However, the reasons explaining these associations are not well understood. The objectives of this cross-sectional study were [1] to determine the extent of overall TV viewing as well as using screens while eating (e.g., watching TV or using a tablet), [2] to compare food and nutrient consumption of on-versus off-screen eating occasions, and [3] to determine whether TV viewing and using screens while eating is associated with overall dietary intake. Participants were from the Food Environment Chilean Cohort (n = 938, 4-6 y) and the Growth and Obesity Cohort Study (n = 752, 12-14 y). Dietary data was collected via one 24-h food recall. For each eating occasion, activity performed during consumption (e.g., watching TV, playing sports) was reported. Weekly TV viewing time was collected via an additional survey instrument. Analyses included multivariable linear and logistic regression. Post-hoc pairwise comparisons examined differences in outcomes by tertiles. Our sample reported a median of 9-13.5 weekly hours of TV viewing and 87.5% reported consuming at least one meal or snack per day while using screens. The median kilocalories contributed by eating during screen use was 387 kcal/d in children and 848 kcal/day in adolescents, which represents 34.7% and 42.3% of daily energy intake, respectively. There were no consistent differences when comparing eating occasions consumed on-screen versus off-screen. Higher weekly TV viewing was associated with elements of a less healthy diet including more sweets and desserts in children, and more sugar sweetened beverages in adolescents. A large percentage of Chilean children and adolescents' daily energy is consumed while using screens. In depth, longitudinal work is needed to understand how screen time eating affects diet quality and nutritional status.

Eating contexts at breakfast, lunch, and dinner: Associations with ultra-processed foods consumption and overweight in Brazilian adolescents (EVA-JF Study)

This cross-sectional study estimated associations of eating contexts (including regularity of meals, places where they occur, and if they take place with attention and in company) with food consumption by degree of industrial processing and overweight indicators in a sample of Brazilian adolescents (14-19 years old) enrolled in 29 public schools in Juiz de Fora, MG (n = 805). We used an exploratory questionnaire, which was submitted to cluster analysis. Three clusters were identified: cluster 1 (n = 572), "appropriate eating contexts at breakfast, lunch, and dinner"; cluster 2 (n = 139), "inappropriate eating context at breakfast"; and cluster 3 (n = 94) "inappropriate eating context at dinner". The evaluation of food consumption involved two 24-h dietary recalls, whose items were analyzed according to the NOVA classification system. Linear regression models were performed, using cluster 1 as reference. Clusters 2 and 3 were associated with an increase in the energy fraction from ultra-processed foods [respectively, β = 2.55% (IC 95%: 0.50; 5.05) and β = 4.18% (IC 95%: 1.21; 7.14)]; and cluster 2 was associated with a reduction in the energy fraction from unprocessed or minimally processed foods and processed culinary ingredients [β = -3.61% (IC 95%: -6.40; -0.82)]. Additionally, clusters 2 and 3 were associated with an increase of body mass index for age [respectively, β = 0.23 z-score (IC 95%: 0.01; 0.46) and β = 0.27 z-score (IC 95%: 0.02; 0.54)]; and cluster 2 was associated with an increase of body fat [β = 1.21% (IC 95%: 0.23; 2.64)]. In conclusion, inappropriate eating contexts at breakfast and dinner were associated with higher ultra-processed food intake, higher body mass index and higher body fat percentage.

Early nutritional influences of cardiovascular health

INTRODUCTION

Increasing evidence shows that nutritional choices during children's formative years, including prenatally, impacts the development of adult onset cardiovascular diseases (CVDs), such as hypertension, myocardial infarction, or stroke.

AREAS COVERED

This literature review aims to synthesize the current body of evidence on nutritional factors, from conception through adolescence, which may influence a person's risk factors for future development of CVD.

EXPERT OPINION

Given the escalating healthcare costs associated with CVD, it is imperative that medical professionals and scientists remain steadfast in prioritizing and promoting early CVD prevention, even within the first few years of life. Though not the only contributing risk factor, diet is a modifiable risk factor and has been shown to have a profound impact on the reduction of cardiovascular morbidity and mortality in adult literature. Nutritional choices should be targeted on multiple levels: prenatally with the mother, individually with the patient, in conjunction with their family unit, and also within the broader community wherein they reside. Healthcare providers can play a key advocacy role for local and national food environment policy changes.

Exploring Psychosocial Determinants of Eating Behavior: Fruit and Vegetable Intake Among Brazilian Adolescents

In most Western countries, children and adolescents do not eat the recommended amount of fruits and vegetables (FVs). Theoretical frameworks on social psychology of eating, such as the Reason Action Approach, Social Cognitive Theory, and Theory of Normal Conduct have been applied to understand how psychosocial variables can explain FV intake. However, considering those predictors is still rare on the understanding of FV intake among adolescents (particularly in Brazil) despite its importance within eating behavior. Therefore, this study explored important psychosocial determinants of weekly frequency of FV intake among Brazilian adolescents in a model testing socioeconomic status (SES) and body mass index (BMI). A cross-sectional design was performed with 429 students (58% female), mean age 14.45 (SD 1.86). Key variables of theoretical framework on social psychology of food were investigated by structural equation modeling. The model included self-efficacy, attitudes, and social norms (with its subcomponents descriptive and injunctive) as psychosocial predictors of weekly frequency of FV intake along with SES and BMI. An instrument developed for Brazilian Portuguese was used to collect psychosocial variables as well as to verify FV reported intake. The total model explained 45.5% of weekly frequency of FV intake, and self-efficacy was the only significant psychosocial determinant (λ = 0.51, p = 0.001). SES also showed an important effect on the model (λ = 0.21, p = 0.001), while for BMI no significance was observed. In conclusion, the model was adequate to understand psychosocial determinants of weekly frequency of FV intake for Brazilian adolescents, with self-efficacy and SES as the major determinants of this eating behavior.

Mobile Health and Telehealth Interventions to Increase Physical Activity in Adolescents with Obesity: a Promising Approach to Engaging a Hard-to-Reach Population

PURPOSE OF REVIEW

Adolescence represents a critical time to set habits for long-term health, yet adequate rates of physical activity are uncommon in this age group. Mobile technology use, however, is ubiquitous. We review advantages and challenges posed by mobile health (mHealth) and telehealth-based physical activity interventions aimed at adolescents.

RECENT FINDINGS

Mobile Health (mHealth) and telehealth interventions to increase physical activity in adolescents include use of wearable activity trackers, text messages or apps, and video visits with exercise specialists. Definitions and goals for physical activity differ across interventions, and methods of activity measurement also vary. User engagement is often poor, if tracked at all. No identified studies included use of behavioral economics-informed engagement strategies. Intervention designers must plan for ways to maximize engagement and to reliably measure the intended outcome. Although mHealth and telehealth interventions have advantages such as scalability and acceptability, potential pitfalls must be addressed before widespread implementation.