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Lawson Y, Mpasi P, Young M, Comerford K, Mitchell E. A review of dairy food intake for improving health among black infants, toddlers, and young children in the US. J Natl Med Assoc 2024; 116:228-240. [PMID: 38360504 DOI: 10.1016/j.jnma.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 02/17/2024]
Abstract
Adequate nutrition is paramount for proper growth and musculoskeletal, neurocognitive, and immunological development in infants, toddlers, and young children. Among breastfeeding mother-child dyads, this critical window of development, is impacted by both maternal and offspring dietary patterns. For mothers, their dietary patterns impact not only their own health and well-being, but also the nutrition of their breast milk - which is recommended as the sole source of food for the first 6 months of their infant's life, and as a complementary source of nutrition until at least 2 years of age. For infants and toddlers, the breast milk, formulas, and first foods they consume can have both short-term and long-term effects on their health and well-being - with important impacts on their taste perception, microbiome composition, and immune function. According to dietary intake data in the US, infants and young children meet a greater number of nutrient requirements than older children and adults, yet numerous disparities among socially disadvantaged racial/ethnic groups still provide significant challenges to achieving adequate nutrition during these early life stages. For example, Black children are at greater risk for disparities in breastfeeding, age-inappropriate complementary feeding patterns, nutrient inadequacies, food insecurity, and obesity relative to most other racial/ethnic groups in the US. For infants who do not receive adequate breast milk, which includes a disproportionate number of Black infants, dairy-based infant formulas are considered the next best option for meeting nutritional needs. Fermented dairy foods (e.g., yogurt, cheese) can serve as ideal first foods for complementary feeding, and cow's milk is recommended for introduction during the transitional feeding period to help meet the nutrient demands during this phase of rapid growth and development. Low dairy intake may put children at risk for multiple nutrient inadequacies and health disparities - some of which may have lifelong consequences on physical and mental health. A burgeoning body of research shows that in addition to breast milk, cow's milk and other dairy foods may play critical roles in supporting physical growth, neurodevelopment, immune function, and a healthy gut microbiome in early life. However, most of this research so far has been conducted in White populations and can only be extrapolated to Black infants, toddlers, and young children. Therefore, to better understand and support the health and development of this population, greater research and education efforts on the role of milk and dairy products are urgently needed. This review presents the current evidence on health disparities faced by Black children in the US from birth to four years of age, and the role that dairy foods can play in supporting the normal growth and development of this vulnerable population.
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Affiliation(s)
- Yolanda Lawson
- Associate Attending, Baylor University Medical Center, Dallas, TX, United States
| | - Priscilla Mpasi
- ChristianaCare Health System, Assistant Clinical Director Complex Care and Community Medicine, Wilmington, DE, United States
| | - Michal Young
- Emeritus, Howard University College of Medicine, Department of Pediatrics and Child Health, Washington D.C., United States
| | - Kevin Comerford
- OMNI Nutrition Science; California Dairy Research Foundation, Davis, CA, United States.
| | - Edith Mitchell
- Sidney Kimmel Cancer at Jefferson, Philadelphia, PA, United States
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Grap ME, Hamner HC, Dooyema C, Noiman A, Park S. Factors Associated with Sugar-Sweetened Beverage Intake Among Young Children - United States, 2021. Prev Chronic Dis 2024; 21:E17. [PMID: 38512779 PMCID: PMC10962274 DOI: 10.5888/pcd21.230354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Introduction Because limited data exist about factors related to sugar-sweetened beverage (SSB) intake among younger children, we investigated factors associated with SSB intake among US children aged 1 to 5 years. Methods We examined SSB intake (0, 1-3, or ≥4 times/week) by using data from the 2021 National Survey of Children's Health. We performed a multinomial logistic regression to calculate adjusted odds ratios (aORs) for select sociodemographic and household factors associated with moderate (1-3 times/week) and high (≥4 times/week) SSB intake. Results Overall, 36% of children consumed SSBs 1 to 3 times/week and 21% consumed 4 or more times/week. Both moderate and high SSB intake were associated with child's age, child's race and ethnicity, highest caregiver education level, household income, primary household language, and frequency of family meals. For example, children who lived in households with caregiver education level of high school graduate or less were significantly more likely to have moderate (aOR, 2.06) and high (aOR, 2.81) SSB intake than those who lived in households with caregiver education level of college degree or higher. High SSB intake was also associated with marginal household food sufficiency, nonmetropolitan statistical area status, and receipt of government food benefits. Conclusion Several sociodemographic and household factors were significantly associated with SSB intake among children aged 1 to 5 years. Public health initiatives designed to address SSB intake among young children in various settings including pediatric health care, early care and education, and the child's home could consider key associated factors.
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Affiliation(s)
- Mary Ellen Grap
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Nutrition, Physical Activity, and Obesity, CDC, 4770 Buford Highway NE, MS S107-5, Atlanta GA, 30341
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Heather C Hamner
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carrie Dooyema
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adi Noiman
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Schiestl ET, Gearhardt AN, Wolfson J. The qualitative evaluation of food addiction across the lifespan. Appetite 2024; 194:107170. [PMID: 38147964 DOI: 10.1016/j.appet.2023.107170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/14/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
Although it remains controversial, food addiction (FA) research has expanded substantially and empirical evidence for FA is growing. While quantitative studies have explored the prevalence and correlates of FA during childhood and adolescence, little is known about the perceived lived experience of FA across the lifespan, nor how experiences and perceptions of FA may change over time. For this study, 16 participants who met symptom threshold criteria for FA on the Yale Food Addiction Scale 2.0 completed in-depth, semi-structured qualitative interviews focused on their perceptions of the development of FA overtime, and perceived risk and protective factors. Thematic analysis was used to develop themes about the lived experience of FA in childhood, adolescence, and adulthood. Overall, highly palatable foods were viewed as the most problematic, while minimally processed foods were less associated with impairment and distress. Themes in childhood included a strong desire for highly processed foods and the perception that parental control over food choices could be either protective or risky for the later development of FA depending on which foods were available at home. In adolescence and young adulthood, increasing autonomy over food choices and the high availability of highly processed foods in the college environment were viewed as risk factors. Additionally, weight gain was a prominent theme. Finally, adulthood was characterized by more severe manifestations of FA, and the stress of adult responsibilities (e.g., work, parenting) contributed to this perception. This research sets the stage for future quantitative studies to explore these novel findings at the population level.
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Okoli CB, Arrington N, Hall J, Paulus T, Miles I, Shieh J, Sharpe K, Cotwright CJ. Black Parents' Perceptions and Barriers to Limiting Sugar-Sweetened Beverages Among Young Children: A Social Cognitive Theory Application. Child Obes 2024; 20:23-34. [PMID: 36576994 DOI: 10.1089/chi.2022.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Sugar-sweetened beverages (SSBs) are a major contributor to obesity among young children 0 to 5 years of age. In addition, parental beverage intake influences children's beverage intake. Objective: This study explores Black parents' perceptions about and barriers to limiting SSBs among young children. Methods: Twenty-seven Black parents participated in six focus groups conducted across the state of Georgia. Questions grounded in Social Cognitive Theory (SCT) assessed perceived health impacts of SSBs and water consumption, influences of beverage choices, barriers to limiting SSB intake, and resources needed to overcome barriers. Before the focus group sessions, participants completed a demographic survey. Quantitative data were analyzed using R statistical software. Focus group sessions were analyzed using NVivo. Results: Family and cultural norms, price, taste, flavor, water safety, tantrums, and product placement at grocery stores primarily influenced beverage choice and consumption. Restaurant refills, price, lack of confidence, advertisements, cravings, tantrums, and budget were perceived barriers to drinking more water and fewer SSBs daily. Resources Black parents noted would help in promoting and serving healthy beverages to their young children included education on beverage recommendations, training on how to read nutrition labels, healthy alternatives, and the presence of support systems. Conclusion: Findings from this study will inform interventions to reduce SSB intake among Black families with young children.
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Affiliation(s)
- Chisom B Okoli
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
| | | | - Jori Hall
- College of Education, University of Georgia, Athens, GA, USA
| | - Trena Paulus
- Division of Family Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Isa Miles
- Isa Miles Consulting, Atlanta, GA, USA
| | - Josephine Shieh
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
| | - Kassidy Sharpe
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
| | - Caree J Cotwright
- Department of Nutritional Sciences, College of Family and Consumer Sciences, University of Georgia, Athens, GA, USA
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Dontsop M, Nwankwo K, Walker R, Potter C, Chen CK, Bol R, Sherden L, Gangula PR, Farmer-Dixon C. Investigating the relationship between dental cavities and protective factors among children aged 0-5 years. J Clin Pediatr Dent 2024; 48:60-68. [PMID: 38239157 PMCID: PMC10962213 DOI: 10.22514/jocpd.2024.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 07/04/2023] [Indexed: 01/23/2024] Open
Abstract
The purpose of this study was to determine the protective factors that contribute to the prevention of children aged 0-5 years from developing dental cavities. The oral hygiene practices of 266 children aged 0-5 years were assessed through surveys administered from 2019 to 2022 to identify clinical, dietary, social and parental factors. The Partial Least Squares (PLS) Regression and Artificial Neuron Networks (ANN) Models were used to determine protective factors associated with the prevention of dental cavities in children. The race distribution of the children as identified by caregivers is as follows: (1) Black or African-American (53.4%); (2) Asian (25.9%); (3) White (18.4%); and (4) Native American (2.3%). We found behavioral protective factors to significantly affect the oral health outcome (cavities) among children aged 0-5 years (p < 0.05). We also found that children whose parents/caregivers flossed their teeth were less likely to develop cavities. In addition, children were least likely to have cavities if their parents/caregivers used toothpaste and mouthwash, avoided sharing chewed food, and refrained from drinking 100% juice. In contrast, children were more likely to obtain cavities if their parents/caregivers had a lower education level, rarely cleaned their teeth, and often consumed marijuana, cow or goat milk, juice drinks and sugary beverages. The education level of parents, and on the contrary, oral hygiene practices of the family, play a significant role in influencing the prevalence of cavities in children aged 0-5 years.
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Affiliation(s)
- Marlene Dontsop
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Kyle Nwankwo
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Riva Walker
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Christianna Potter
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Chau-Kuang Chen
- School of Graduate Studies, Meharry Medical College, Nashville, TN 37208, USA
| | - Ruth Bol
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Lisa Sherden
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Pandu R Gangula
- Department of Oral Diagnostic Sciences & Research, Meharry Medical College School of Dentistry, Nashville, TN 37208, USA
| | - Cherae Farmer-Dixon
- Department of Dental Public Health, School of Dentistry, Meharry Medical College, Nashville, TN 37208, USA
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Fleming-Milici F, Gershman H, Pomeranz J, Harris JL. Effects of a front-of-package disclosure on accuracy in assessing children's drink ingredients: two randomised controlled experiments with US caregivers of young children. Public Health Nutr 2023; 26:2790-2801. [PMID: 37908052 PMCID: PMC10755381 DOI: 10.1017/s1368980023001969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/17/2023] [Accepted: 08/11/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Test effects of a standardised front-of-package (FOP) disclosure statement (indicating added sugar, non-nutritive sweetener (NNS) and juice content) on accuracy in assessing ingredients and perceived healthfulness of children's drinks. DESIGN In two randomised controlled experiments, the same participants viewed drink packages and indicated if products contained added sugar or NNS and percent juice and rated drink healthfulness. Experiment 1 (E1) included novel (non-US) children's drinks with a) product claims only (control), b) claims and disclosure, or c) disclosure only. Experiment 2 (E2) included existing children's drinks (with claims) with a) no disclosure (control) or b) disclosure. Both experiments evaluated sweetened (fruit drink and flavoured water) and unsweetened (100 % juice and juice/water blend) drinks. Potential individual differences (education level and race/ethnicity) in effects were explored. SETTING Online survey. PARTICIPANTS Six hundred and forty-eight US caregivers of young children (1-5 years). RESULTS FOP disclosures significantly increased accuracy for most ingredients and drink types, including identifying presence or absence of NNS in sweetened drinks, no added sugar in juice/water blends, and actual percent juice in fruit drinks and juice/water blends in both experiments. Disclosures also increased recognition that the novel 100 % juice and juice/water blend did not contain NNS or added sugar (E1) and existing sweetened drinks contained added sugar (E2). Disclosures reduced perceived healthfulness of sweetened drinks but did not increase unsweetened drink healthfulness ratings. Some differences by participant socio-demographic characteristics require additional research. CONCLUSIONS FOP disclosures on children's drink packages can increase caregivers' understanding of product ingredients and aid in selecting healthier children's drinks.
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Affiliation(s)
- Frances Fleming-Milici
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT06103, USA
| | - Haley Gershman
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT06103, USA
| | - Jennifer Pomeranz
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, USA
| | - Jennifer L Harris
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT06103, USA
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7
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Brown KJ, Beck KL, von Hurst P, Heath AL, Taylor R, Haszard J, Daniels L, Te Morenga L, McArthur J, Paul R, Jones E, Katiforis I, Rowan M, Casale M, McLean N, Cox A, Fleming E, Bruckner B, Jupiterwala R, Wei A, Conlon C. Adherence to Infant Feeding Guidelines in the First Foods New Zealand Study. Nutrients 2023; 15:4650. [PMID: 37960303 PMCID: PMC10647304 DOI: 10.3390/nu15214650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
Infant feeding guidelines provide evidence-based recommendations to support optimal infant health, growth, and development, and exploring adherence to guidelines is a useful way of assessing diet quality. The aim of this study was to determine adherence to the recently updated Ministry of Health "Healthy Eating Guidelines for New Zealand Babies and Toddlers (0-2 years old)". Data were obtained from First Foods New Zealand, a multicentre observational study of 625 infants aged 7.0-10.0 months. Caregivers completed two 24-h diet recalls and a demographic and feeding questionnaire. Nearly all caregivers (97.9%) initiated breastfeeding, 37.8% exclusively breastfed to around six months of age, and 66.2% were currently breastfeeding (mean age 8.4 months). Most caregivers met recommendations for solid food introduction, including appropriate age (75.4%), iron-rich foods (88.3%), puréed textures (80.3%), and spoon-feeding (74.1%). Infants consumed vegetables (63.2%) and fruit (53.9%) more frequently than grain foods (49.5%), milk and milk products (38.6%), and meat and protein-rich foods (31.8%). Most caregivers avoided inappropriate beverages (93.9%) and adding salt (76.5%) and sugar (90.6%). Our findings indicated that while most infants met the recommendations for the introduction of appropriate solid foods, the prevalence of exclusive breastfeeding could be improved, indicating that New Zealand families may need more support.
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Affiliation(s)
- Kimberley J. Brown
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (K.J.B.); (K.L.B.); (P.v.H.); (R.P.); (E.J.); (M.C.); (R.J.); (A.W.)
| | - Kathryn L. Beck
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (K.J.B.); (K.L.B.); (P.v.H.); (R.P.); (E.J.); (M.C.); (R.J.); (A.W.)
| | - Pamela von Hurst
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (K.J.B.); (K.L.B.); (P.v.H.); (R.P.); (E.J.); (M.C.); (R.J.); (A.W.)
| | - Anne-Louise Heath
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (A.-L.H.); (J.M.); (I.K.); (M.R.); (N.M.); (E.F.); (B.B.)
| | - Rachael Taylor
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand; (R.T.); (L.D.); (A.C.)
| | - Jillian Haszard
- Biostatistics Centre, University of Otago, Dunedin 9016, New Zealand;
| | - Lisa Daniels
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand; (R.T.); (L.D.); (A.C.)
| | - Lisa Te Morenga
- Research Centre for Hauora and Health, Massey University, Wellington 6140, New Zealand;
| | - Jenny McArthur
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (A.-L.H.); (J.M.); (I.K.); (M.R.); (N.M.); (E.F.); (B.B.)
| | - Rebecca Paul
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (K.J.B.); (K.L.B.); (P.v.H.); (R.P.); (E.J.); (M.C.); (R.J.); (A.W.)
| | - Emily Jones
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (K.J.B.); (K.L.B.); (P.v.H.); (R.P.); (E.J.); (M.C.); (R.J.); (A.W.)
| | - Ioanna Katiforis
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (A.-L.H.); (J.M.); (I.K.); (M.R.); (N.M.); (E.F.); (B.B.)
| | - Madeleine Rowan
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (A.-L.H.); (J.M.); (I.K.); (M.R.); (N.M.); (E.F.); (B.B.)
| | - Maria Casale
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (K.J.B.); (K.L.B.); (P.v.H.); (R.P.); (E.J.); (M.C.); (R.J.); (A.W.)
| | - Neve McLean
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (A.-L.H.); (J.M.); (I.K.); (M.R.); (N.M.); (E.F.); (B.B.)
| | - Alice Cox
- Department of Medicine, University of Otago, Dunedin 9016, New Zealand; (R.T.); (L.D.); (A.C.)
| | - Elizabeth Fleming
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (A.-L.H.); (J.M.); (I.K.); (M.R.); (N.M.); (E.F.); (B.B.)
| | - Bailey Bruckner
- Department of Human Nutrition, University of Otago, Dunedin 9016, New Zealand; (A.-L.H.); (J.M.); (I.K.); (M.R.); (N.M.); (E.F.); (B.B.)
| | - Rosario Jupiterwala
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (K.J.B.); (K.L.B.); (P.v.H.); (R.P.); (E.J.); (M.C.); (R.J.); (A.W.)
| | - Andrea Wei
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (K.J.B.); (K.L.B.); (P.v.H.); (R.P.); (E.J.); (M.C.); (R.J.); (A.W.)
| | - Cathryn Conlon
- School of Sport, Exercise and Nutrition, Massey University, Auckland 0632, New Zealand; (K.J.B.); (K.L.B.); (P.v.H.); (R.P.); (E.J.); (M.C.); (R.J.); (A.W.)
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Hall MG, Richter APC, Ruggles PR, Lee CJY, Lazard AJ, Grummon AH, Higgins ICA, Duffy EW, Taillie LS. Natural Claims on Sugary Fruit Drinks: A Randomized Experiment With U.S. Parents. Am J Prev Med 2023; 65:876-885. [PMID: 37480920 PMCID: PMC10592329 DOI: 10.1016/j.amepre.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/24/2023]
Abstract
INTRODUCTION Natural claims on food are largely unregulated in the U.S. This study examined the effects of natural claims on a fruit-flavored drink with added sugar (i.e., fruit drink). METHODS In 2019, U.S. parents of children aged 2-12 years (N=1,078) recruited from an online survey panel were randomized to one of three arms: natural claim on a fruit drink, 100% all-natural claim, or a no-claim control. Parents reported their intentions and perceptions regarding fruit drinks using 1-5 response scales. Analysis occurred in 2022-2023. RESULTS Both natural claims led parents to have higher intentions to purchase a fruit drink for their child than the control (average differential effect=0.20-0.24, both p<0.05). The natural claim (but not the 100% all-natural claim) also led parents to think that the fruit drink was healthier for their children (average differential effect=0.22, p=0.024). Claims made parents less likely to think that the drink contained added sugar (average differential effect= -0.08 to -0.12, both p<0.05) and led to lower estimated amounts of added sugar in teaspoons (average differential effect= -1.77 to -2.09, both p<0.05). Mediation analyses revealed that the claims led to higher intentions to purchase the fruit drink by increasing perceived healthfulness of the fruit drink and by leading parents to believe that there was no added sugar in the fruit drink. CONCLUSIONS Natural claims could increase interest in and perceived healthfulness of fruit drinks. Misperceptions about the nutritional content caused by claims appear to be driving greater purchase intentions. These findings suggest a need for stronger regulation around natural claims to prevent consumer misunderstanding.
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Affiliation(s)
- Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Ana Paula C Richter
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Phoebe R Ruggles
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cristina J Y Lee
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Hussman School of Journalism and Media, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anna H Grummon
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Isabella C A Higgins
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily W Duffy
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lindsey Smith Taillie
- Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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9
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Kay MC, Pankiewicz AR, Schildcrout JS, Wallace S, Wood CT, Shonna Yin H, Rothman RL, Sanders LM, Orr C, Delamater AM, Flower KB, Perrin EM. Early Sweet Tooth: Juice Introduction During Early Infancy is Related to Toddler Juice Intake. Acad Pediatr 2023; 23:1343-1350. [PMID: 37150479 PMCID: PMC10592660 DOI: 10.1016/j.acap.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 04/18/2023] [Accepted: 04/24/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To assess if 100% fruit juice intake prior to 6 months is associated with juice and sugar-sweetened beverage (SSB) intake at 24 months and whether this differs by sociodemographic factors. METHODS We used longitudinal data from infants enrolled in the control (no obesity intervention) arm of Greenlight, a cluster randomized trial to prevent childhood obesity which included parent-reported child 100% fruit juice intake at all well child checks between 2 and 24 months. We studied the relationship between the age of juice introduction (before vs after 6 months) and juice and SSB intake at 24 months using negative binomial regression while controlling for baseline sociodemographic factors. RESULTS We report results for 187 participants (43% Hispanic, 39% non-Hispanic Black), more than half (54%) of whom had reported 100% fruit juice intake before 6 months. Average 100% fruit juice intake at 24 months was greater than the recommended amount (of 4 oz) and was 8.2 oz and 5.3 oz for those who had and had not, respectively, been introduced to juice before 6 months. In adjusted models, early introduction of juice was associated with a 43% (95% confidence interval: 5%-96%) increase in juice intake at 24 months. CONCLUSIONS 100% fruit juice intake exceeding recommended levels at 6 and 24 months in this diverse cohort was prevalent. Introducing 100% fruit juice prior to 6 months may put children at greater risk for more juice intake as they age. Further research is necessary to determine if early guidance can reduce juice intake.
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Affiliation(s)
- Melissa C Kay
- Department of Pediatrics (MC Kay, AR Pankiewicz, and CT Wood), Duke University, Durham, NC.
| | - Aaron R Pankiewicz
- Department of Pediatrics (MC Kay, AR Pankiewicz, and CT Wood), Duke University, Durham, NC.
| | - Jonathan S Schildcrout
- Department of Biostatistics (JS Schildcrout), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Shelby Wallace
- Division of General Pediatrics (S Wallace and RL Rothman), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Charles T Wood
- Department of Pediatrics (MC Kay, AR Pankiewicz, and CT Wood), Duke University, Durham, NC.
| | - H Shonna Yin
- Departments of Pediatrics and Population Health (H Shonna Yin), New York University Grossman School of Medicine.
| | - Russell L Rothman
- Division of General Pediatrics (S Wallace and RL Rothman), Vanderbilt University Medical Center, Nashville, Tenn.
| | - Lee M Sanders
- Department of Pediatrics (LM Sanders), Stanford University, Calif.
| | - Colin Orr
- General Pediatrics and Adolescent Medicine (C Orr and KB Flower), University of North Carolina, Chapel Hill.
| | - Alan M Delamater
- Department of Pediatrics (AM Delamater), University of Miami, Coral Gables, Fla.
| | - Kori B Flower
- General Pediatrics and Adolescent Medicine (C Orr and KB Flower), University of North Carolina, Chapel Hill.
| | - Eliana M Perrin
- Department of Pediatrics (EM Perrin), Johns Hopkins University Schools of Medicine and Nursing, Baltimore, Md.
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10
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Zaltz DA, Pate RR, Liu T, McIver KL, Neelon B, Benjamin-Neelon SE. Young Children's Dietary Quality in Family Child Care and in Their Own Home. J Acad Nutr Diet 2023; 123:1197-1206. [PMID: 37479379 PMCID: PMC10851279 DOI: 10.1016/j.jand.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 07/23/2023]
Abstract
BACKGROUND Some evidence suggests that children may have higher quality dietary intake in early care and education settings, compared with their respective homes, but no studies have explored these differences among children in less formal family child care. OBJECTIVE The purpose of this study was to compare dietary quality via the Healthy Eating Index 2015 among children in family child care and in their own home. DESIGN This was a cross-sectional analysis of baseline dietary intake data from the Childcare Home Eating and Exercise Research study, a natural experiment, using directly observed dietary data in child care and 24-hour recall data in homes among children in South Carolina. PARTICIPANTS/SETTING Participants were 123 children in 52 family child-care homes between 2018 and 2019. MAIN OUTCOME MEASURE The main outcome was total and component Healthy Eating Index 2015 scores. STATISTICAL ANALYSIS The analysis was a hierarchical linear regression of children nested within family child care homes adjusting for child, provider, facility, and parent characteristics, including sex, age, race, ethnicity, and income, with parameters and SEs estimated via bootstrap sampling. RESULTS Children had a mean ± SD Healthy Eating Index 2015 score of 60.3 ± 12.1 in family child-care homes and 54.3 ± 12.9 in their own home (P < 0.001). In adjusted analysis and after accounting for clustering of children in family child care homes, total HEI-2015 scores were lower at home than in care (β = -5.18 ± 1.47; 95% CI -8.05 to -2.30; P = 0.003). CONCLUSIONS Children had healthier dietary intake in family child-care homes vs their respective homes.
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Affiliation(s)
- Daniel A Zaltz
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Russell R Pate
- Department of Exercise Science, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
| | - Tiange Liu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kerry L McIver
- Department of Exercise Science, University of South Carolina Arnold School of Public Health, Columbia, South Carolina
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Sara E Benjamin-Neelon
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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11
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Duffy E, Ng SW, Hall MG, Bercholz M, Rebolledo N, Musicus A, Taillie LS. Sociodemographic disparities in purchases of fruit drinks with policy relevant front-of-package nutrition claims. Public Health Nutr 2023; 26:1585-1595. [PMID: 37211358 PMCID: PMC10410375 DOI: 10.1017/s1368980023000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 02/08/2023] [Accepted: 04/12/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Our objectives were to describe sociodemographic characteristics associated with the purchase of (1) any fruit drinks and (2) fruit drinks with specific front-of-package (FOP) nutrition claims. DESIGN Cross-sectional. SETTING USA. PARTICIPANTS We merged fruit drink purchasing data from 60 712 household-months from 5233 households with children 0-5 years participating in Nielsen Homescan in 2017 with nutrition claims data. We examined differences in predicted probabilities of purchasing any fruit drinks by race/ethnicity, income and education. We constructed inverse probability (IP) weights based on likelihood of purchasing any fruit drinks. We used IP-weighted multivariable logistic regression models to examine predicted probabilities of purchasing fruit drinks with specific FOP claims. RESULTS One-third of households with young children purchased any fruit drinks. Non-Hispanic (NH) Black (51·6 %), Hispanic (36·3 %), lower-income (39·3 %) and lower-educated households (40·9 %) were more likely to purchase any fruit drinks than NH White (31·3 %), higher-income (25·8 %) and higher-educated households (30·3 %) (all P < 0·001). In IP-weighted analyses, NH Black households were more likely to purchase fruit drinks with 'Natural' and fruit or fruit flavour claims (6·8 % and 3·7 %) than NH White households (4·5 % and 2·7 %) (both P < 0·01). Lower- and middle-income (15·0 % and 13·8 %) and lower- and middle-educated households (15·4 % and 14·5 %) were more likely to purchase fruit drinks with '100 % Vitamin C' claims than higher-income (10·8 %) and higher-educated households (12·9 %) (all P < 0·025). CONCLUSIONS We found a higher likelihood of fruit drink purchases in lower-income, lower-educated, NH Black and Hispanic households. Experimental studies should determine if nutrition claims may be contributing to disparities in fruit drink consumption.
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Affiliation(s)
- Emily Duffy
- Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health and Carolina Population Center, 123 W Franklin St, Chapel Hill, NC27516, USA
| | - Shu Wen Ng
- Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health and Carolina Population Center, 123 W Franklin St, Chapel Hill, NC27516, USA
| | - Marissa G Hall
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health and Carolina Population Center, and UNC Lineberger Comprehensive Cancer Center, School of Medicine, Chapel Hill, NC, USA
| | | | - Natalia Rebolledo
- Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health and Carolina Population Center, 123 W Franklin St, Chapel Hill, NC27516, USA
| | - Aviva Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lindsey Smith Taillie
- Department of Nutrition, University of North Carolina at Chapel Hill Gillings School of Global Public Health and Carolina Population Center, 123 W Franklin St, Chapel Hill, NC27516, USA
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12
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Suzan ÖK, Kaya O, Kolukısa T, Koyuncu O, Tecik S, Cinar N. Water consumption in 0-6-month-old healthy infants and effective factors: A systematic review. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:181-199. [PMID: 37433164 PMCID: PMC10506693 DOI: 10.7705/biomedica.6745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/16/2023] [Indexed: 07/13/2023]
Abstract
INTRODUCTION Early introduction of fluids and water affects the duration of breastfeeding, the infant immune system, and possibly causes infants to consume less breast milk, which may, in turn, affect their nutritional and immune status. OBJECTIVE This study was carried out to determine water consumption in 0-6-month-old infants and the factors affecting this consumption. MATERIALS AND METHODS A literature review was conducted in seven electronic databases (Medline, Web of Science, PubMed, ScienceDirect, Scopus, Cochrane Library, and TÜBITAK) for studies published until April 25, 2022, using the keywords: drinking water, infant, and breastfeeding. RESULTS The systematic review included 13 studies. Five studies were crosssectional, three were descriptive and quasi-experimental, and the others were case-control and cohort studies. It was reported in the examined studies that 86.2% of the infants were around 6 weeks old, 44 % of the infants were 1 month old, 77% were 3 months old, 2.5% were 4 months old, and 2.5 to 85% of the infants were around 6 months old when they first consumed water. The prominent reasons for making the infants drink water are the thought that they need it and cultural reasons. CONCLUSIONS The exclusive breastfeeding of 0-6-month-old infants is the recommendation of reliable health authorities. Nurses play a key role in implementing this practice. In this systematic review, it was seen that families gave their infants water at varying rates in the 0-6-month period, and the factors affecting this situation were revealed. If nurses determine which factors affect families in terms of the early introduction of fluids, they could be able to plan the necessary education and interventions.
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Affiliation(s)
- Özge Karakaya Suzan
- Department of Nursing, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey.
| | - Ozge Kaya
- Institute of Health Sciences, Nursing Doctorate Program, Sakarya University, Sakarya, Turkey.
| | - Tugce Kolukısa
- Institute of Health Sciences, Nursing Doctorate Program, Sakarya University, Sakarya, Turkey.
| | - Oguz Koyuncu
- Institute of Health Sciences, Nursing Doctorate Program, Sakarya University, Sakarya, Turkey.
| | - Seda Tecik
- Institute of Health Sciences, Nursing Doctorate Program, Sakarya University, Sakarya, Turkey.
| | - Nursan Cinar
- Department of Nursing, Faculty of Health Sciences, Sakarya University, Sakarya, Turkey.
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Lewis KH, Hsu FC, Block JP, Skelton JA, Schwartz MB, Krieger J, Hindel LR, Ospino Sanchez B, Zoellner J. A Technology-Driven, Healthcare-Based Intervention to Improve Family Beverage Choices: Results from a Pilot Randomized Trial in the United States. Nutrients 2023; 15:2141. [PMID: 37432293 DOI: 10.3390/nu15092141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 07/12/2023] Open
Abstract
Background: Healthcare-based interventions to address sugary beverage intake could achieve broad reach, but intensive in-person interventions are unsustainable in clinical settings. Technology-based interventions may provide an alternative, scalable approach. Methods: Within an academic health system in the United States that already performs electronic health record-based sugary drink screening, we conducted a pilot randomized trial of a technology-driven family beverage choice intervention. The goal of the intervention was to reduce sugar-sweetened beverage (SSB) and fruit juice (FJ) consumption in 60 parent-child dyads, in which children were 1-8 years old. The pediatrician-initiated intervention consisted of a water promotion toolkit, a video, a mobile phone application, and 14 interactive voice-response phone calls to parents over 6 months. The study was conducted between June 2021 and May 2022. The aim of the pilot study was to assess the potential feasibility and efficacy of the newly developed intervention. Results: Intervention fidelity was excellent, and acceptability was high for all intervention components. Children in both the intervention and the control groups substantially decreased their consumption of SSB and FJ over follow-up (mean combined baseline 2.5 servings/day vs. 1.4/day at 6 months) and increased water consumption, but constrained linear mixed-effects models showed no differences between groups on these measures. Compared to parents in the control group, intervention parents had larger decreases in SSB intake at 3 months (-0.80 (95% CI: -1.54, -0.06, p = 0.03) servings daily), but these differences were not sustained at 6 months. Conclusion: These findings suggest that, though practical to implement in a clinical care setting and acceptable to a diverse participant group, our multicomponent intervention may not be universally necessary to achieve meaningful behavior changes around family beverage choice. A lower-intensity intervention, such as EHR-based clinical screening alone, might be a less resource-intense way for health systems to achieve similar behavioral outcomes. Future studies might therefore explore whether, instead of applying a full intervention to all families whose children overconsume SSB or FJ, a stepped approach, starting with clinical screening and brief counseling, could be a better use of health system resources.
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Affiliation(s)
- Kristina H Lewis
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Jason P Block
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA 02215, USA
| | - Joseph A Skelton
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Marlene B Schwartz
- Rudd Center for Food Policy and Health, University of Connecticut, Hartford, CT 06103, USA
| | - James Krieger
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA
- Healthy Food America, Seattle, WA 98122, USA
| | - Leah Rose Hindel
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Beatriz Ospino Sanchez
- Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | - Jamie Zoellner
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA 22903, USA
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Adherence to Healthy Default Beverage Laws for Children's Meals in 3 U.S. Cities. Am J Prev Med 2023:S0749-3797(23)00033-8. [PMID: 36764834 DOI: 10.1016/j.amepre.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/12/2023] [Accepted: 01/13/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Healthy default beverage laws are relatively new interventions designed to improve the healthfulness of children's meals in restaurants. In this study, researchers assessed adherence to healthy default beverage laws among children's meals ordered online in Los Angeles (California statewide law effective from September 2018), Baltimore (effective from April 2018), and New York City (effective from April 2019) compared with that in Boston, where no law existed. METHODS Between November and December 2020, researchers ordered children's meals from online ordering platforms (e.g., GrubHub, Uber Eats) from the top-grossing restaurant chains in each location (n=337 meal orders from 106 restaurants), coded these meals using 4 successively stricter definitions of adherence to the default beverage laws in each respective jurisdiction, and then applied each law to data collected in Boston to simulate different policy scenarios in a city with no such law. The team analyzed these data in late 2021. RESULTS Differences in adherence existed across jurisdictions, with 15% adherent in Los Angeles, 30% in Baltimore, and 43% in New York City, compared with 7%-30% in Boston, using the most lenient definition of adherence. Fewer than 3% of all meals adhered to laws when applying the strictest definition of adherence. CONCLUSIONS Overall adherence was low and variable across jurisdictions. Adherence may be lower in jurisdictions with fewer allowable default beverages, although more research is needed to assess this potential causal relation. In addition to increased resources and support for restaurants, additional policy design considerations may be necessary to increase adherence to healthy default beverage laws.
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15
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JaBaay NR, Nel NH, Comstock SS. Dietary Intake by Toddlers and Preschool Children: Preliminary Results from a Michigan Cohort. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020190. [PMID: 36832319 PMCID: PMC9955406 DOI: 10.3390/children10020190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/22/2023]
Abstract
Identifying the consumption patterns of toddlers and preschool children is critical to evaluating their potential for healthy development and future heath trajectories. The purpose of this longitudinal cohort study was to describe breastfeeding, nutritional trends, and dietary diversity in 12-to-36-month-old children in a Michigan cohort. Mothers completed surveys when their children were 12 (n = 44), 24 (n = 46) and 36 months old (n = 32). Mothers reported their child's dietary intake in the past 24 h and intake of specific foods in the past year. About 95% of 12-to-24-month-old children in the study population were ever breastfed, with 70% consuming human milk at 6 months and just over 40% at 12 months. Over 90% of participants gave their child a bottle since birth, with 75% providing human milk and 69% giving formula. Consumption of juice significantly increased with age and ~55% of the 36-month-old children consumed juice. A larger proportion of children consumed soda, chocolate, and candy as they aged. Though dietary diversity numerically increased with child age, this did not reach significance. Gut microbiota composition and structure was not associated with diet diversity. This research lays the foundation for future work to determine which nutritional interventions may be most effective in this population.
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16
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Abstract
Optimal hydration is required for all physiologic functions and cognition. Children, especially younger ones, are particularly susceptible to dehydration, given their physiological specificities, in particular, their renal immaturity and relatively large skin surface in early life, but also their dependence on adults and their greater propensity to develop digestive diseases leading to fluid losses. Mild dehydration consequences are dominated by their impact on cognitive functions, whereas more severe dehydration may endanger the health outcome. Studies on this subject in children are scarce; in particular, the long-term consequence on renal function remains questionable. This review considers how children's water intake including fluid intake and water content of food, are worrying. The findings show that, worldwide, most children do not meet adequate water intake recommendations. The main problems likely to explain insufficient water intake are access to safe water, availability of drinking water at school, and healthy-hydration education, which are all points that need to be improved within health policy.
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Affiliation(s)
- Jean-Pierre Chouraqui
- Paediatric Nutrition and Gastroenterology, Division of Pediatrics, Woman, Mother and Child Department, Pediatric Nutrition and Gastroenterology Unit, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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17
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Musicus AA, Roberto CA, Moran AJ, Sorscher S, Greenthal E, Rimm EB. Effect of Front-of-Package Information, Fruit Imagery, and High-Added Sugar Warning Labels on Parent Beverage Choices for Children: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2236384. [PMID: 36227595 PMCID: PMC9561948 DOI: 10.1001/jamanetworkopen.2022.36384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Fruit drinks are widely consumed by young children, and many parents mistakenly believe that these drinks are healthy, potentially due to front-of-package claims and imagery. Research is needed on the influence of this marketing and how labeling regulations could change behavior. OBJECTIVE To assess the effects of a front-of-package 100% vitamin C claim, fruit imagery, percentage juice and teaspoons of added sugar disclosures, and high-added sugar warnings on parents' choices, knowledge, and perceptions of beverages. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted May to July 2021 as a single-exposure (no follow-up) online survey of primary caregivers of children ages 0 to 5 years throughout the US. INTERVENTIONS Participants were shown no-, low-, and high-added sugar beverages and asked to choose 1 for their child. Participants were randomized to see high-added sugar beverages with 1 of 7 front-of-package conditions: (1) claim and imagery (control); (2) no claim; (3) no imagery; (4) no claim or imagery; (5) claim, imagery, and percentage juice disclosure; (6) claim, imagery, and warning; or (7) claim, imagery, warning, and teaspoons of added sugar disclosure. MAIN OUTCOMES AND MEASURES Primary outcomes were type of beverage chosen (eg, high-added sugar beverage) and resulting calories and added sugar (in grams). Secondary outcomes were fruit drink knowledge (added sugar and percent juice) and perceptions. RESULTS There were 5005 participants included in the final analysis (mean [SD] age, 31.5 [8.3] years; 3587 female participants [71.7%]), including 714 participants in group 1, 717 participants in group 2, 710 participants in group 3, 717 participants in group 4, 708 participants in group 5, 729 participants in group 6, and 710 participants in group 7. Compared with participants in the control group, who had a mean (standard error [SE]) of 9.4 (0.5) g of added sugar and 81.9 (1.6) kcal in chosen beverages, only participants who saw warnings with teaspoons of added sugar disclosures had significantly reduced added sugar (-1.3 g; 95% CI, -2.6 to -0.1 g [-14.2%; 95% CI, -26.7% to -1.8%]; P = .04) and calories (-5.3 kcal; 95% CI, -9.8 to -0.9 kcal [-6.5%; 95% CI, -11.8% to -1.3%]; P = .02) in selected beverages. In warning conditions (ie, 6 and 7) compared with the control group (mean [SE] 41.0% [1.8%]), the proportion of participants choosing high-added sugar beverages was significantly reduced, by 5.5 percentage points (95% CI, 0.5 to 10.5 percentage points [13.4%; 95% CI, 1.2% to 25.6%]; P = .03) and 6.4 percentage points (95% CI, 1.4 to 11.4 percentage points [15.6%; 95% CI, 3.3% to 27.8%]; P = .01), respectively. The no claim or imagery condition (4) significantly reduced the proportion of parents choosing high-added sugar beverages (-7.6 percentage points; 95% CI, -12.6 to -2.6 percentage points [-18.4%; 95% CI, -30.6% to -6.3%]; P = .003). Percentage juice disclosures did not affect beverage choice. CONCLUSIONS AND RELEVANCE These findings suggest that added sugar warnings and prohibitions of front-of-package claims and imagery may reduce parents' purchases of high-added sugar beverages for their young children but that percentage juice disclosures may not change behavior. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04811690.
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Affiliation(s)
- Aviva A. Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christina A. Roberto
- Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alyssa J. Moran
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah Sorscher
- Center for Science in the Public Interest, Washington, District of Columbia
| | - Eva Greenthal
- Center for Science in the Public Interest, Washington, District of Columbia
| | - Eric B. Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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18
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Krieger J, Freudenberg N. To Protect Young Children's Health, Limit Marketing and Ubiquity of Unhealthy Foods and Beverages. Am J Public Health 2022; 112:S770-S772. [PMID: 36288527 PMCID: PMC9612193 DOI: 10.2105/ajph.2022.307061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/04/2022]
Affiliation(s)
- James Krieger
- James Krieger is with the School of Public Health, University of Washington, Seattle, and Healthy Food America, Seattle. Nicholas Freudenberg is with the School of Public Health, City University of New York, New York
| | - Nicholas Freudenberg
- James Krieger is with the School of Public Health, University of Washington, Seattle, and Healthy Food America, Seattle. Nicholas Freudenberg is with the School of Public Health, City University of New York, New York
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Harris JL, Phaneuf L, Fleming-Milici F. Effects of Sugary Drink Countermarketing Videos on Caregivers' Attitudes and Intentions to Serve Fruit Drinks and Toddler Milks to Young Children. Am J Public Health 2022; 112:S807-S816. [PMID: 36288519 PMCID: PMC9612202 DOI: 10.2105/ajph.2022.307024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To test the effects of countermarketing videos addressing common misperceptions about ingredients and claims on children's sugary drinks. Methods. We conducted an online randomized controlled experiment in January 2021 with US caregivers (n = 600) of young children (aged 8‒37 months) to assess the effects of watching countermarketing versus control videos on intentions to serve sugary and healthy drinks (6-point scales) and attitudes (10-point scales) about fruit drinks and toddler milks. Results. The countermarketing videos significantly reduced positive attitudes about fruit drinks (mean difference = 0.92) and toddler milks (mean difference = 2.10), reduced intentions to serve both (mean difference = 0.50 and 0.92, respectively), and increased intentions to serve plain milk (mean difference = 0.52) versus control videos (all Ps < .001). Intentions differed by individual characteristics, but the videos remained effective after we controlled for these characteristics. Moreover, the videos were more effective for toddler milks versus fruit drinks, and effects on fruit drink intentions were greater for Black versus White caregivers and caregivers of children aged 24 months or younger. Conclusions. A countermarketing campaign aimed at diverse caregivers of young children designed to correct misleading children's drink marketing presents a promising public health approach for reducing sugary drink consumption in the first 1000 days. (Am J Public Health. 2022;112(S8):S807-S816. https://doi.org/10.2105/AJPH.2022.307024).
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Affiliation(s)
- Jennifer L Harris
- Jennifer L. Harris, Lindsay Phaneuf, and Frances Fleming-Milici are with the Rudd Center for Food Policy and Health, University of Connecticut, Hartford
| | - Lindsay Phaneuf
- Jennifer L. Harris, Lindsay Phaneuf, and Frances Fleming-Milici are with the Rudd Center for Food Policy and Health, University of Connecticut, Hartford
| | - Frances Fleming-Milici
- Jennifer L. Harris, Lindsay Phaneuf, and Frances Fleming-Milici are with the Rudd Center for Food Policy and Health, University of Connecticut, Hartford
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20
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Golova N, Eskander J, Pho A, Chu TC, Murillo AL, Friedman JF, Musial S. Preventing the Early Introduction of Juice and Sugar-Sweetened Beverages in Infants' Diets: A Randomized Controlled Trial. Clin Pediatr (Phila) 2022; 62:276-287. [PMID: 36146909 DOI: 10.1177/00099228221119983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A randomized controlled trial was conducted to determine whether a simple educational intervention targeting parents of young infants could have an impact on the consumption of juice and sugar-sweetened beverages (SSBs) in early childhood and decrease overweight and obesity rates. Parents of 2- to 4-month-old infants were randomized into intervention (n = 67) and control (n = 77) groups. Parents completed questionnaires about juice and SSB consumption and knowledge at baseline and 1-year follow-up. Intervention parents received informational handouts and watched videos about the health effects of juice and SSBs. Knowledge about juice increased significantly in the intervention group compared with control (P < .01) and was significantly higher in black/African American parents (P < .05) and those with some college education (P < .05). The intervention had a significant impact on the knowledge gained by parents about the health effects of juice and SSBs but did not decrease the consumption of sugary drinks or change children's weight status.
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Affiliation(s)
- Natalia Golova
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Pediatrics, Rhode Island Hospital, Hasbro Children's Hospital, Providence, RI, USA
| | - Jessica Eskander
- T.H. Chan School of Medicine, UMass Chan Medical School, Worcester, MA, USA
| | | | - Tzu-Chun Chu
- Department of Pediatrics, Rhode Island Hospital, Hasbro Children's Hospital, Providence, RI, USA.,Center for Statistical Sciences, Brown University, Providence, RI, USA
| | - Anarina L Murillo
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Pediatrics, Rhode Island Hospital, Hasbro Children's Hospital, Providence, RI, USA
| | - Jennifer F Friedman
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Pediatrics, Rhode Island Hospital, Hasbro Children's Hospital, Providence, RI, USA
| | - Sandra Musial
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.,Department of Pediatrics, Rhode Island Hospital, Hasbro Children's Hospital, Providence, RI, USA
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Beverage behaviors and correlates among Head Start preschooler-parent dyads. Matern Child Health J 2022; 26:2271-2282. [PMID: 36125670 DOI: 10.1007/s10995-022-03493-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 05/03/2022] [Accepted: 07/19/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To describe beverage behaviors among preschooler-parent dyads and explore correlates with preschooler's beverage behaviors. METHODS This exploratory, cross-sectional study includes a convenience sample of 202 parents of preschoolers surveyed from four Head Start programs in Virginia and Ohio. Measurements included parent-child beverage behaviors, parent beverage perceptions, parent beverage rules, home beverage availability, and demographics. Analyses included descriptive statistics, correlations, Kruskal-Wallis test, and Quade's non-parametric ANCOVA tests. RESULTS Mean sugar-sweetened beverage (SSB; i.e., regular soda, sweetened fruit drinks, sports/energy drinks, and coffee/tea with sugar) intake was 1.3 (SD = 1.4) and 2.3 (SD = 2.0) times/day for preschoolers and parents, respectively. When considering all sugary drink sources [i.e., summing SSB with flavored milk and 100% fruit juice (FJ)], the mean frequency increased to 3.2 (SD = 2.1) and 3.6 (SD = 2.4) times/day, respectively, for preschoolers and parents. A significant positive correlation was observed between preschooler-parent dyads for SSB (r = 0.406, p < 0.001) and for all sugary drinks (r = 0.572, p < 0.001). Parents who were younger, single, less educated, and with lower income had preschoolers with significantly higher SSB and all sugary drink intake (all p < 0.05). Significant correlates with preschoolers' beverage behaviors also included parent perceived behavioral control (SSB: p = 0.003, 100% FJ: p = 0.008, water: p < 0.0001), parenting practices (SSB: p = 0.022), and home availability (SSB: p = 0.011, 100% FJ: p < 0.001, water: p < 0.001). CONCLUSIONS This study highlights excessive SSB and all sugary drink consumption among Head Start preschooler-parent dyads. Also, intervention targets to improve preschooler's beverage behaviors are identified, including efforts to improve parent's beverage behaviors, perceived behavioral control, parenting practices, and the home environment.
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22
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Hua SV, Musicus AA, Thorndike AN, Kenney EL, Rimm EB. Child-Directed Marketing, Health Claims, and Nutrients in Popular Beverages. Am J Prev Med 2022; 63:354-361. [PMID: 35393144 PMCID: PMC9398955 DOI: 10.1016/j.amepre.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 02/10/2022] [Accepted: 02/14/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Fruit drinks are a major source of added sugar in children's diets. This study describes the associations between front-of-package child-directed marketing (i.e., sports, fantasy, or child-directed imagery; child-directed text) and (1) health-related claims and (2) nutrient content of fruit drinks, 100% juices, and flavored waters. METHODS Beverage purchase data from a national sample of 1,048 households with children aged 0-5 years were linked with front-of-package label and nutrition data to conduct a content analysis on fruit drinks (n=510), 100% juices (n=337), and noncarbonated flavored waters (n=40) in 2019-2020. Unstratified and stratified regression models assessed the differences in the prevalence of claims (macronutrient, micronutrient, natural/healthy, and fruit and juice), non-nutritive sweeteners, and nutrient content (calories, total sugar, and percent daily value of vitamin C) between drinks with and those without child-directed marketing in 2021. RESULTS Fruit drinks with child-directed marketing were more likely to show front-of-package micronutrient claims (OR=2.1, 95% CI=1.5, 3.1) and contained more vitamin C (18.5% daily value, 95% CI=1.6, 35.5) than fruit drinks without child-directed marketing. 100% juices with child-directed marketing contained less vitamin C (-35.6% daily value, 95% CI= -57.5, -13.8) and 3.0 (95% CI= -5.5, -0.4) fewer grams of sugar than 100% juices without child-directed marketing. Flavored waters with child-directed marketing contained less vitamin C (-37.9% daily value, 95% CI= -68.1, -7.6) than flavored waters without child-directed marketing. CONCLUSIONS The combination of child-directed marketing with health-related claims may mislead parents into believing that fruit drinks are healthy and appealing to their children, highlighting the need for government regulation of sugary drink marketing.
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Affiliation(s)
- Sophia V Hua
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
| | - Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anne N Thorndike
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Erica L Kenney
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Eric B Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Validation of the Thumbs food classification system as a tool to accurately identify the healthiness of foods. Br J Nutr 2022; 129:2001-2010. [PMID: 36038139 PMCID: PMC10167659 DOI: 10.1017/s0007114522002756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
The Thumbs food classification system was developed to assist remote Australian communities to identify food healthiness. This study aimed to assess: (1) the Thumbs system’s alignment to two other food classification systems, the Health Star Rating (HSR) and the Northern Territory School Canteens Guidelines (NTSCG); (2) its accuracy in classifying ‘unhealthy’ (contributing to discretionary energy and added sugars) and ‘healthy’ products against HSR and NTSCG; (3) areas for optimisation. Food and beverage products sold between 05/2018 and 05/2019 in fifty-one remote stores were classified in each system. System alignment was assessed by cross-tabulating percentages of products, discretionary energy and added sugars sold assigned to the same healthiness levels across the systems. The system/s capturing the highest percentage of discretionary energy and added sugars sold in ‘unhealthy’ products and the lowest levels in ‘healthy’ products were considered the best performing. Cohen’s κ was used to assess agreement between the Thumbs system and the NTSCG for classifying products as healthy. The Thumbs system classified product healthiness in line with the HSR and NTSCG, with Cohen’s κ showing moderate agreement between the Thumbs system and the NTSCG (κ = 0·60). The Thumbs system captured the most discretionary energy sold (92·2 %) and added sugar sold (90·6 %) in unhealthy products and the least discretionary energy sold (0 %) in healthy products. Modifications to optimise the Thumbs system include aligning several food categories to the NTSCG criteria and addressing core/discretionary classification discrepancies of fruit juice/drinks. The Thumbs system offers a classification algorithm that could strengthen the HSR system.
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Abstract
Hydration is a particular concern for infants and young children due to their greater risk of dehydration. However, studies on their water intakes are scarce. The current survey aimed to analyse total water intake (TWI) in non-breastfed children aged 0·5-35 months compared with the adequate intake (AI) for the same age group set by the European Food Safety Authority and to examine the different contributors to TWI as well as beverage consumption patterns. Nationally representative data from the Nutri-Bébé cross-sectional survey were used to assess food, beverage and plain water consumption by age group over three non-consecutive days. With age, median TWI in 1035 children increased from 732 to 1010 ml/d, without differences between sexes, but with a great inter-individual variation, and the percentage of children who did not meet the AI increased from 10 to 88 %. Median weight-related TWI decreased from 136·6 to 69·0 ml/kg per d. Among infants, 90 % had a ratio of water:energy below the AI, similarly for about 75 % of toddlers. Milk and milk products were the main contributors to TWI, while the part of plain water increased gradually to be 25 % in the older toddlers, half of which was tap water. The beverage consumption pattern varied in types and timing, with little consumption of juices and sweetened beverages. Vegetables and fruits accounted for 20 % of TWI after the age of 6 months. These initial results, showing strong discrepancies between actual and recommended water intakes in young children, should help identify ways to increase children's water consumption.
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Reverri EJ, Arensberg MB, Murray RD, Kerr KW, Wulf KL. Young Child Nutrition: Knowledge and Surveillance Gaps across the Spectrum of Feeding. Nutrients 2022; 14:nu14153093. [PMID: 35956275 PMCID: PMC9370290 DOI: 10.3390/nu14153093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
The first 1000 days is a critical window to optimize nutrition. Young children, particularly 12–24 month-olds, are an understudied population. Young children have unique nutrient needs and reach important developmental milestones when those needs are met. Intriguingly, there are differences in the dietary patterns and recommendations for young children in the US vs. globally, notably for breastfeeding practices, nutrient and food guidelines, and young child formulas (YCFs)/toddler drinks. This perspective paper compares these differences in young child nutrition and identifies both knowledge gaps and surveillance gaps to be filled. Parental perceptions, feeding challenges, and nutrition challenges are also discussed. Ultimately, collaboration among academia and clinicians, the private sector, and the government will help close young child nutrition gaps in both the US and globally.
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Affiliation(s)
- Elizabeth J. Reverri
- Abbott Nutrition, Abbott Laboratories, Columbus, OH 43219, USA; (M.B.A.); (K.W.K.); (K.L.W.)
- Correspondence:
| | - Mary Beth Arensberg
- Abbott Nutrition, Abbott Laboratories, Columbus, OH 43219, USA; (M.B.A.); (K.W.K.); (K.L.W.)
| | - Robert D. Murray
- Department of Pediatrics, The Ohio State University, Columbus, OH 43219, USA;
| | - Kirk W. Kerr
- Abbott Nutrition, Abbott Laboratories, Columbus, OH 43219, USA; (M.B.A.); (K.W.K.); (K.L.W.)
| | - Karyn L. Wulf
- Abbott Nutrition, Abbott Laboratories, Columbus, OH 43219, USA; (M.B.A.); (K.W.K.); (K.L.W.)
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Sylvetsky AC, Hoang ST, Visek AJ, Halberg SE, Smith M, Salahmand Y, Blake EF, Jin Y, Colón-Ramos U, Lora KR. Beverage Characteristics Perceived as Healthy among Hispanic and African-American Parents of Young Children. J Acad Nutr Diet 2022; 122:1158-1167. [PMID: 35026465 PMCID: PMC9124677 DOI: 10.1016/j.jand.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/17/2021] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is recommended that children younger than 6 years of age avoid sugar-sweetened beverages (SSBs); yet, 25% of toddlers and 45% of preschool-aged children consume SSBs on a given day, with the highest intakes reported among Hispanic and African-American children. OBJECTIVE To investigate characteristics that predominantly low-income Hispanic and African-American parents perceive to reflect a healthy beverage, and to examine the influence of these characteristics on parents' perceptions of the beverages they provide to their young children. DESIGN This study consisted of two activities: a qualitative activity where parents (n = 102) were asked to report what characteristics they perceive to reflect a healthy beverage and a quantitative activity where parents (n = 96) indicated the extent to which each of the reported characteristics influence parents' perceptions of the beverages they provide to their young children. PARTICIPANTS AND SETTING Hispanic and African-American parents of young children (younger than 6 years of age) were recruited from the District of Columbia metropolitan area. MAIN OUTCOME MEASURES Beverage characteristics and influence scores. STATISICAL ANALYSES PERFORMED Characteristics were categorized by the research team based on their perceived meaning. Perceived influence scores for each characteristic and category were compared across Hispanic and African-American parents using nonparametric, Mann-Whitney U tests, and false discovery rate adjustment was used to correct for multiple testing. RESULTS The characteristics perceived to be most influential included those pertaining to perceived beverage sugar and sweetener content, being natural, and containing certain nutrients. Characteristics such as being homemade, made with fruit, and containing vitamins were reported to be more influential among Hispanic parents compared with African-American parents. CONCLUSIONS Findings emphasize the need to address misperceptions about the healthfulness of beverages among Hispanic and African-American parents. Differences in the perceived influence of specific beverage characteristics across Hispanic and African-American parents underscore the importance of developing culturally relevant interventions to improve parents' beverage selection for their children.
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Affiliation(s)
- Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC.
| | - Son T Hoang
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Amanda J Visek
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Sabrina E Halberg
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Marjanna Smith
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Yasaman Salahmand
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Emily F Blake
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Yichen Jin
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Uriyoán Colón-Ramos
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Karina R Lora
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, Washington, DC
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Hall MG, Lazard AJ, Higgins ICA, Blitstein JL, Duffy EW, Greenthal E, Sorscher S, Taillie LS. Nutrition-related claims lead parents to choose less healthy drinks for young children: a randomized trial in a virtual convenience store. Am J Clin Nutr 2022; 115:1144-1154. [PMID: 35040866 PMCID: PMC8971006 DOI: 10.1093/ajcn/nqac008] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 01/13/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Consumption of sugar-sweetened beverages, including fruit drinks (i.e., fruit-flavored drinks containing added sugar), contributes to childhood obesity. OBJECTIVES We aimed to examine whether nutrition-related claims on fruit drinks influence purchasing among parents and lead to misperceptions of healthfulness. METHODS We conducted an experiment in a virtual convenience store with 2219 parents of children ages 1-5 y. Parents were randomly assigned to view fruit drinks displaying 1 of 3 claims ("No artificial sweeteners," "100% Vitamin C," and "100% All Natural") or no claim (i.e., control group). Parents selected among each of 2 drinks for their young child: 1) a fruit drink or 100% juice (primary outcome), and 2) a fruit drink or water. RESULTS When choosing between a fruit drink and 100% juice, 45% of parents who viewed the fruit drink with the "No artificial sweeteners" claim, 51% who viewed the "100% Vitamin C" claim, and 54% who viewed the "100% All Natural" claim selected the fruit drink, compared with 32% in the no-claim control group (all P < 0.001). "No artificial sweeteners" (Cohen's d = 0.13, P < 0.05) and "100% All Natural" (d = 0.15, P < 0.05) claims increased the likelihood of parents choosing the fruit drink instead of water but "100% Vitamin C" did not (P = 0.06). All claims made parents more likely to incorrectly believe that the fruit drinks contained no added sugar and were 100% juice than the control (d ranged from 0.26 to 0.84, all P < 0.001), as assessed in a posttest survey. The impact of claims on selection of the fruit drink (compared with 100% juice) did not vary by any of the moderators examined (e.g., race/ethnicity, income; all moderation P > 0.05). CONCLUSIONS Nutrition-related claims led parents to choose less healthy beverages for their children and misled them about the healthfulness of fruit drinks. Labeling regulations could mitigate misleading marketing of fruit drinks.This trial was registered at clinicaltrials.gov as NCT04381481.
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Affiliation(s)
- Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, USA
| | - Isabella C A Higgins
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Emily W Duffy
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Eva Greenthal
- Center for Science in the Public Interest, Washington, DC, USA
| | - Sarah Sorscher
- Center for Science in the Public Interest, Washington, DC, USA
| | - Lindsey Smith Taillie
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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28
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Fleming-Milici F, Phaneuf L, Harris JL. Marketing of sugar-sweetened children's drinks and parents' misperceptions about benefits for young children. MATERNAL & CHILD NUTRITION 2022; 18:e13338. [PMID: 35199914 PMCID: PMC9218304 DOI: 10.1111/mcn.13338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/17/2021] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
Despite expert recommendations, US parents often serve sugar‐sweetened children's drinks, including sweetened fruit‐flavoured drinks and toddler milks, to young children. This qualitative research explored parents' understanding of common marketing tactics used to promote these drinks and whether they mislead parents to believe the drinks are healthy and/or necessary for children. We conducted nine focus groups in Washington, DC and Hartford, CT with parents of children (9–36 months) of diverse race/ethnicity and socioeconomic status (N = 50). Semistructured discussions elicited parents' responses to four concepts designed to correct common misperceptions about toddler milks and sweetened fruit‐flavoured drinks (fruit drinks and flavoured waters) by providing information about drink ingredients and potentially misleading marketing tactics. Participants expressed widespread misperceptions about sweetened fruit‐flavoured drinks and toddler milks, including perceived healthfulness and benefits for children and confusion between sweetened and unsweetened drink categories (sweetened fruit‐flavoured drinks vs. juice, toddler milk vs. infant formula). They confirmed that common marketing strategies contributed to misperceptions, including front‐of‐package claims and marketing messages that imply benefits for children and/or hide problematic ingredients; cross‐branding and product extensions from trusted brands; side‐by‐side shelf placement at retailers; lower price than healthier products; and targeted marketing to children and parents. Some parents expressed anger about deceptive marketing and supported increased regulation and consumer education campaigns. Findings support the need for policies to address potentially misleading marketing of sweetened fruit‐flavoured drinks and toddler milks and revealed opportunities to reduce parents' provision of these drinks through countermarketing campaigns communicated via trusted sources. Marketing messages for sweetened fruit‐flavoured drinks and toddler milks can mislead parents to believe these sugar‐sweetened products are healthful options for young children. Parents described front‐of‐package label claims, images, and other marketing messages on sugar‐sweetened children's drinks as confusing, deceptive, and misleading. They also raised issues about targeted marketing to children and parents and lower prices for less‐healthy products. Findings support opportunities for countermarketing campaigns to correct misleading marketing messages and the need for government policies, such as restricting front‐of‐package claims and requiring consistent ingredient reporting, to assist parents in making healthier drink selections for their children.
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Affiliation(s)
- Frances Fleming-Milici
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
| | | | - Jennifer L Harris
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, Connecticut, USA
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Grummon AH, Sokol RL, Goodman D, Hecht CA, Salvia M, Musicus AA, Patel AI. Storybooks About Healthy Beverage Consumption: Effects in an Online Randomized Experiment With Parents. Am J Prev Med 2022; 62:183-192. [PMID: 34688521 PMCID: PMC8748291 DOI: 10.1016/j.amepre.2021.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/29/2021] [Accepted: 07/28/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Parents spend substantial time reading to their children, making storybooks a promising but understudied avenue for motivating parents to serve their children healthier beverages. This study examines parents' reactions to messages promoting healthy beverage consumption embedded in a children's storybook. METHODS In 2020, a total of 2,164 demographically diverse parents of children aged 6 months to 5 years participated in an online survey. Participants were randomized to view control messages (school readiness) or 1 of 3 beverage message topics (sugary drink discouragement, water encouragement, or combined discouragement and encouragement) presented as pages from the storybook Potter the Otter. Survey items assessed parents' reactions to the messages and their perceptions, beliefs, and intentions regarding sugary drinks and water. Data were analyzed in 2021. RESULTS Compared with control messages, exposure to the beverage messages led to higher discouragement from serving children sugary drinks and higher encouragement to serve children more water (p<0.001). The beverage messages also elicited more thinking about beverages' health impacts and led to stronger perceptions that sugary drinks are unhealthy (p<0.001). Moreover, the beverage messages led to higher intentions to limit serving children sugary drinks and higher intentions to serve children more water (p≤0.02). Parents' reactions to the beverage messages did not differ by most demographic characteristics. Few differences in outcomes were observed among the 3 beverage message topics. CONCLUSIONS Embedding beverage messages in storybooks is a promising, scalable strategy for motivating parents from diverse backgrounds to serve children more water and fewer sugary drinks.
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Affiliation(s)
- Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Rebeccah L Sokol
- School of Social Work, Wayne State University, Detroit, Michigan
| | - Dina Goodman
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Christina A Hecht
- Nutrition Policy Institute, Division of Agriculture and Natural Resources, University of California, Oakland, California
| | - Meg Salvia
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Aviva A Musicus
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Anisha I Patel
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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30
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Jensen ML, Choi YY, Fleming-Milici F, Harris JL. Caregivers' Understanding of Ingredients in Drinks Served to Young Children: Opportunities for Nutrition Education and Improved Labeling. Curr Dev Nutr 2022; 6:nzab151. [PMID: 35047722 PMCID: PMC8760421 DOI: 10.1093/cdn/nzab151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Against expert recommendations, sugar-sweetened beverages, especially fruit drinks, are consumed by young children. Misperceptions about drink ingredients and healthfulness can contribute to caregivers' provision. OBJECTIVES To assess caregivers' reasons for serving sweetened fruit-flavored drinks and unsweetened juices to their young children (1-5 y) and perceptions of product healthfulness and drink ingredients. METHODS A cross-sectional online survey assessed participants' (n = 1614) perceptions of sweetened fruit-flavored drinks (fruit drinks and flavored water) and unsweetened juices (100% juice and water/juice blends) provided to their child in the past month, including product healthfulness, reasons for providing, and knowledge of product ingredients [added sugar, nonnutritive sweeteners (NNSs), percentage juice]. One-factor ANOVA compared perceived healthfulness of drink categories and types of sugar and NNSs, and differences between participants who could compared with those who could not accurately identify drink ingredients. RESULTS Participants' top reasons for providing sweetened drinks included child liking it, being inexpensive, child asking for it, and being a special treat. Participants perceived 100% juice as healthiest, followed by juice/water blends, flavored waters, and, lastly, fruit drinks (P < 0.05). Many participants inaccurately believed the fruit drink or flavored water they served their child most often did not contain NNSs (59.0% and 64.9%) and/or added sugars (20.1% and 42.2%), when in fact they did, and 81.3-91.1% overestimated the percentage juice in the drink. Perceived healthfulness of fruit drinks was associated with caregivers' belief that the drink contained added sugar (P < 0.05), but not with their belief that it contained NNS; increased accuracy was associated with decreased perceived healthfulness (P < 0.05). CONCLUSIONS Inaccurate understanding of added sugar, NNSs, and percentage juice in drinks served to young children was common and could contribute to sugary drink provision. Public health efforts should seek to improve labeling practices and revise nutrition education messages.
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Affiliation(s)
- Melissa L Jensen
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
- School of Nutrition, University of Costa Rica, San José, Costa Rica
| | - Yoon Y Choi
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Frances Fleming-Milici
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
| | - Jennifer L Harris
- UConn Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT, USA
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Krieger J, Kwon T, Ruiz R, Walkinshaw LP, Yan J, Roberto CA. Countermarketing About Fruit Drinks, Alone or With Water Promotion: A 2019 Randomized Controlled Trial in Latinx Parents. Am J Public Health 2021; 111:1997-2007. [PMID: 34709859 PMCID: PMC8630474 DOI: 10.2105/ajph.2021.306488] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To test whether fruit drink countermarketing messages alone or combined with water promotion messages reduce Latinx parents' purchases of fruit drinks for children aged 0 to 5 years. Methods. We performed a 3-arm randomized controlled online trial enrolling 1628 Latinx parents in the United States during October and November 2019. We assessed the effect of culturally tailored fruit drink countermarketing messages (fruit drink‒only group), countermarketing and water promotion messages combined (combination group), or car-seat safety messages (control) delivered via Facebook groups for 6 weeks on parental beverage choices from a simulated online store. Results. The proportion of parents choosing fruit drinks decreased by 13.7 percentage points in the fruit drink‒only group (95% confidence interval [CI] = -20.0, -7.4; P < .001) and by 19.2 percentage points in the combination group (95% CI = -25.0, -13.4; P < .001) relative to control. Water selection increased in both groups. Conclusions. Fruit drink countermarketing messages, alone or combined with water promotion messages, significantly decreased parental selection of fruit drinks and increased water selection for their children. Public Health Implications. Countermarketing social media messages may be an effective and low-cost intervention for reducing parents' fruit drink purchases for their children. (Am J Public Health. 2021;111(11):1997-2007. https://doi.org/10.2105/AJPH.2021.306488).
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Affiliation(s)
- James Krieger
- James Krieger and Lina Pinero Walkinshaw are with the Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA. Taehoon Kwon is with the Department of Economics, University of Washington. Rudy Ruiz is with Interlex, San Antonio, TX. Jiali Yan and Christina A. Roberto are with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Taehoon Kwon
- James Krieger and Lina Pinero Walkinshaw are with the Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA. Taehoon Kwon is with the Department of Economics, University of Washington. Rudy Ruiz is with Interlex, San Antonio, TX. Jiali Yan and Christina A. Roberto are with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Rudy Ruiz
- James Krieger and Lina Pinero Walkinshaw are with the Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA. Taehoon Kwon is with the Department of Economics, University of Washington. Rudy Ruiz is with Interlex, San Antonio, TX. Jiali Yan and Christina A. Roberto are with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Lina Pinero Walkinshaw
- James Krieger and Lina Pinero Walkinshaw are with the Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA. Taehoon Kwon is with the Department of Economics, University of Washington. Rudy Ruiz is with Interlex, San Antonio, TX. Jiali Yan and Christina A. Roberto are with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Jiali Yan
- James Krieger and Lina Pinero Walkinshaw are with the Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA. Taehoon Kwon is with the Department of Economics, University of Washington. Rudy Ruiz is with Interlex, San Antonio, TX. Jiali Yan and Christina A. Roberto are with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Christina A Roberto
- James Krieger and Lina Pinero Walkinshaw are with the Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA. Taehoon Kwon is with the Department of Economics, University of Washington. Rudy Ruiz is with Interlex, San Antonio, TX. Jiali Yan and Christina A. Roberto are with the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Is High Milk Intake Good for Children's Health? A National Population-Based Observational Cohort Study. Nutrients 2021; 13:nu13103494. [PMID: 34684495 PMCID: PMC8541527 DOI: 10.3390/nu13103494] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 11/24/2022] Open
Abstract
Milk is widely considered as a beneficial product for growing children. This study was designed to describe the milk consumption status of Korean children aged 30–36 months and to investigate its association with the risk of obesity and iron deficiency anemia (IDA). This nationwide administrative study used data from the Korean national health insurance system and child health screening examinations for children born in 2008 and 2009. In total, 425,583 children were included, and they were divided into three groups based on daily milk consumption: low milk group (do not drink or drink <200 mL milk per day, n = 139,659), reference group (drink 200–499 mL milk per day, n = 255,670), and high milk group (drink ≥500 mL milk per day, n = 30,254). After adjusting variable confounding factors, the consumption of a large amount of milk of ≥500 mL per day at the age of 30–36 months was associated with an increased risk of obesity at the age of 42–72 months and IDA after the age of 30 months. These results may provide partial evidence for dietary guidelines for milk consumption in children that are conducive to health.
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Robinson SL, Sundaram R, Putnick DL, Gleason JL, Ghassabian A, Lin TC, Bell EM, Yeung EH. Predictors of Age at Juice Introduction and Associations with Subsequent Beverage Intake in Early and Middle Childhood. J Nutr 2021; 151:3516-3523. [PMID: 34486676 PMCID: PMC8564695 DOI: 10.1093/jn/nxab260] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/18/2021] [Accepted: 07/14/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The American Academy of Pediatrics recommends that if parents choose to introduce juice, they wait until ≥12 months, citing concerns of obesity and dental caries. OBJECTIVES We sought to identify correlates of early juice introduction (<6 months) and determine whether early introduction establishes a pattern of sugary beverage intake in childhood. METHODS Upstate KIDS is a prospective birth cohort study with follow-up through 7 years (n = 4989). The age of juice introduction was assessed from responses on periodic questionnaires from 4-18 months and categorized as <6, 6 to <12, and ≥12 months. Sociodemographic information was reported using vital records or maternal questionnaires. At 24, 30, and 36 months and 7 years, mothers reported their child's regular juice, soda, water, and milk intakes. The analysis was restricted to singletons and 1 randomly selected twin from each pair with information on juice introduction (n = 4067). We assessed associations of sociodemographic correlates with juice introduction using Cox proportional hazard models. The relations of juice introduction with beverage intake were evaluated using Poisson or logistic regression for adjusted risk ratios (aRR) or ORs, adjusting for sociodemographic covariates and total beverage intake. RESULTS Of the mothers, 25% and 74% introduced juice prior to 6 and 12 months, respectively. Younger maternal age; black or Hispanic race/ethnicity; lower educational attainment; Special Supplemental Nutrition Program for Women, Infants, and Children participation (yes); smoking during pregnancy; a higher pre-pregnancy BMI; a lower household income; and living in a townhouse/condominium or mobile home were associated with earlier juice introduction. Earlier juice introduction was related to a higher childhood juice intake, any soda intake, and lower water intake, holding total beverage intake constant [aRR, 1.5 (95% CI: 1.3-1.7; P-trend < 0.0001); adjusted OR 1.6 (95% CI: 1.0-2.4; P-trend = 0.01); aRR 0.9 (95% CI: 0.8-0.9; P-trend < 0.0001), respectively]. CONCLUSIONS Markers of lower socioeconomic status are strongly associated with earlier juice introduction, which, in turn, relates to sugary beverage intake in childhood, potentially replacing water.
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Affiliation(s)
- Sonia L Robinson
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Rajeshwari Sundaram
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Diane L Putnick
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Jessica L Gleason
- Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Akhgar Ghassabian
- Department of Pediatrics, New York University Grossman School of Medicine, New York, NY, USA,Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY, USA,Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Erin M Bell
- Department of Environmental Health Sciences, University at Albany School of Public Health, Albany, NY, USA,Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Albany, NY, USA
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Kostecka M, Jackowska I, Kostecka J. A Comparison of the Effects of Young-Child Formulas and Cow's Milk on Nutrient Intakes in Polish Children Aged 13-24 Months. Nutrients 2021; 13:nu13082511. [PMID: 34444672 PMCID: PMC8398400 DOI: 10.3390/nu13082511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/12/2021] [Accepted: 07/22/2021] [Indexed: 11/16/2022] Open
Abstract
Adequately balanced daily food rations that provide the body with sufficient amounts of energy and nutrients, including minerals, are particularly important in early childhood when rapid physical, intellectual and motor development takes place. Cow’s milk (CM) and young-child formulas (YCFs) are introduced to a child’s diet past the first year of age. The main aim of the present study was to perform a qualitative and a quantitative analysis of daily food rations of young children based on the recommendations of the daily food ration model. An attempt was also made to determine whether the type of consumed milk (YCF or CM) adequately meets young children’s energy demands and contributes to the incorporation of different food groups into a balanced and healthy diet for children aged 13–24 months. A total of 714 parents between October 2019 and March 2020 filled out a food frequency questionnaire. In the second stage of the study, the parents participated in a dietary recall and were asked to keep diaries of all meals and foods consumed by children over a period of three days. The mean daily intake of CM/YCF and fermented milks was determined at 360 mL ± 128 mL, and it accounted for 55.4% of the guideline values. Flavored dairy products were consumed more frequently than fermented milks without added sugar or flavoring (94 ± 17 g vs. 56 ± 26 g, p < 0.05). Diets incorporating CM were significantly more abundant in protein than YCF diets (29.3 g vs. 21.9 g; p < 0.01). Liquid intake was somewhat higher in children fed YCFs (1280.8 mL vs. 1120.1; p < 0.05), mainly due to the higher consumption of fruit juice, nectars and sweetened hot beverages (246 ± 35 mL in the YCF group vs. 201 ± 56 mL in the CM group; p < 0.05). Children fed YCF consumed significantly larger amounts of sweetened beverages such as tea sweetened with sugar or honey, sweetened hot chocolate or instant teas (OR = 2.54; Cl: 1.32–3.26; p < 0.001), than children receiving CM. This group was also characterized by higher consumption of sweetened dairy products, mainly cream cheese desserts, fruit yogurt and yogurt with cereal (OR = 1.87; Cl: 1.36–2.54; p < 0.01), as well as a lower daily intake of plain fermented milks (OR = 0.56; Cl: 0.21–0.79; p < 0.001). The daily food intake and the quality of the diets administered to children aged 13–24 months were evaluated and compared with the model food ration. It was found that milk type influenced children’s eating habits and preference for sweet-tasting foods. The study also demonstrated that Polish parents and caregivers only have limited knowledge of nutritional guidelines for toddlers.
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Affiliation(s)
- Malgorzata Kostecka
- Faculty of Food Science and Biotechnology, University of Life Sciences in Lublin, Akademicka 15, 20-950 Lublin, Poland;
- Correspondence: ; Tel.: +48-814-456-846
| | - Izabella Jackowska
- Faculty of Food Science and Biotechnology, University of Life Sciences in Lublin, Akademicka 15, 20-950 Lublin, Poland;
| | - Julianna Kostecka
- Faculty of Medicine, Medical University of Lublin, Chodźki 19, 20-093 Lublin, Poland;
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Ooi JY, Wolfenden L, Sutherland R, Nathan N, Oldmeadow C, Mclaughlin M, Barnes C, Hall A, Vanderlee L, Yoong SL. A Systematic Review of the Recent Consumption Levels of Sugar-Sweetened Beverages in Children and Adolescents From the World Health Organization Regions With High Dietary-Related Burden of Disease. Asia Pac J Public Health 2021; 34:11-24. [PMID: 34013784 DOI: 10.1177/10105395211014642] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This review aimed to investigate national estimates of sugar-sweetened beverage (SSB) consumption in children and adolescents aged 2 to 18 years, from countries in regions particularly burdened by dietary-related chronic illnesses. The most recent studies or reports from included countries (n = 73) with national-level consumption data of SSBs in children and adolescents, collected between January 2010 and October 2019, were considered for inclusion. A random effects meta-analysis was used to calculate pooled estimates of the mean consumption of SSB in millimeters per day. Heterogeneity between national estimates was assessed using the I2 statistic and explored via subgroup analyses by the World Health Organization region, age groups, and country-level income. Forty-eight studies were included in the review reporting national estimates of consumption for 51 countries. The highest estimate of daily consumption was in China at 710.0 mL (95% confidence interval [CI] = 698.8-721.2), while the lowest was in Australia at 115.1 mL (95% CI = 111.2-119.1). Pooled synthesis of daily SSB consumption of the 51 countries was 326.0 mL (95% CI = 288.3-363.8), although heterogeneity was high, and was not explained by subgroup analyses. While there is considerable variability between countries, intake of SSB remains high among children and adolescents internationally underscoring the need for public health efforts to reduce SSBs consumption.
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Affiliation(s)
- Jia Ying Ooi
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Rachel Sutherland
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | | | - Matthew Mclaughlin
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Courtney Barnes
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Alix Hall
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Sze Lin Yoong
- Hunter New England Population Health, Wallsend, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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36
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Korn AR, Economos CD, Hammond RA, Hennessy E, Kalkwarf HJ, Must A, Woo JG. Associations of mothers' source of feeding information with longitudinal trajectories of sugar-sweetened beverage intake, 100% juice intake and adiposity in early childhood. Pediatr Obes 2021; 16:e12746. [PMID: 33141511 DOI: 10.1111/ijpo.12746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/17/2020] [Accepted: 10/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There remains a need to understand how information sources can promote young children's healthy beverage consumption and prevent obesity. OBJECTIVES To examine associations of mothers' primary feeding information source with children's sugar-sweetened beverage (SSB) intake, 100% juice intake and adiposity between ages 3 and 7 years. METHODS We analyzed data from a prospective cohort study (n = 371 children; 13 visits). Mothers reported their primary feeding information source at baseline and completed child 3-day dietary records each visit. Child adiposity indicators were calculated from repeated height/weight measurements and dual-energy X-ray absorptiometry. Longitudinal models examined beverage intakes and adiposity over time by source. RESULTS Primary feeding information sources included doctors (48.2%), mothers (17.5%), grandmothers (13.5%), other healthcare professionals (11.3%) and other family/friends (9.4%). Children's juice intake with age differed by source (P interaction = 0.03), with steepest and slightest intake decreases in the doctor (-19.7% each year; 95% CI: -23.7%, -15.5%) and grandmother (-5.0%; -14.5%, 5.5%) subgroups, respectively. Children's SSB intake did not differ by source, but increased annually by 7.1% (4.5%, 9.8%) overall. The grandmother subgroup had the greatest child adiposity over time. CONCLUSIONS Mothers' primary feeding information source may have important, yet heterogeneous, influences on young children's beverage intakes and adiposity over time. Consistent evidence-based messages are likely needed.
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Affiliation(s)
- Ariella R Korn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Ross A Hammond
- Center on Social Dynamics and Policy, Brookings Institution, Washington, District of Columbia, USA.,Brown School at Washington University, St. Louis, Missouri, USA
| | - Erin Hennessy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA
| | - Heidi J Kalkwarf
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Aviva Must
- Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jessica G Woo
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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37
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Davison K, Franckle R, Lo B, Ash T, Yu X, Haneuse S, Redline S, Taveras E. Infant sugar sweetened beverage and 100% juice consumption: Racial/ethnic differences and links with fathers' consumption in a longitudinal cohort. Prev Med Rep 2021; 22:101324. [PMID: 33665064 PMCID: PMC7900833 DOI: 10.1016/j.pmedr.2021.101324] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 01/07/2021] [Accepted: 01/20/2021] [Indexed: 11/19/2022] Open
Abstract
The consumption of sugar-sweetened beverages (SSB) and 100% juice before age 12 months is discouraged. We examine racial/ethnic differences in SSB and 100% juice consumption when infants were 6- and 12-months old and examine links between fathers’ and infants’ beverage consumption. Participants were from a longitudinal cohort of infants and their parents (recruited 2016–2018), followed from birth until the child was 24 months. In 2020, we analyzed data collected when infants were 6- (N = 352 infants and 168 fathers) and 12-months (N = 340 infants and 152 fathers) old. Based on maternal report, 13% of infants consumed 100% juice at 6 months and 31% at 12 months. Two percent of infants consumed SSB at 6 months and 7% at 12 months. In models adjusting for income and education, Black/African American (Black/AA) and Hispanic infants were 5–6 times as likely at 6 months and 3 times as likely at 12 months to consume 100% juice compared with non-Hispanic white and Asian infants. At 12 months, Black/AA and Hispanic infants were 6–7 times as likely to consume SSB than non-Hispanic white and Asian infants after adjusting for covariates. In unadjusted models, infants were more likely to consume 100% juice and SSB at 12 months when their fathers were high consumers (>12times/month) of the beverage; effects were no longer significant after adjusting for income, race/ethnicity, education and maternal beverage consumption. Results highlight the need to implement culturally responsive interventions promoting healthy beverage consumption in infants prior to birth and should concurrently target fathers, in addition to mothers.
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Affiliation(s)
- K.K. Davison
- School of Social Work, Boston College, Chestnut Hill, MA 02467, USA
- Corresponding author at: Boston College School of Social Work, 115 McGuinn Hall, 140 Commonwealth Ave, Chestnut Hill, MA 02467, USA.
| | - R.L. Franckle
- Department of Biology, Boston College, Chestnut Hill, MA 02467, USA
| | - B.K. Lo
- School of Social Work, Boston College, Chestnut Hill, MA 02467, USA
| | - T. Ash
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI 02912, USA
| | - X. Yu
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - S.J. Haneuse
- Department of Biostatistics, Harvard Chan School of Public Health, Boston, MA, USA
| | - S. Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham & Women's Hospital & Harvard Medical School, Boston, MA, USA
| | - E.M. Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, USA
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38
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Rosenstock S, Ingalls A, Foy Cuddy R, Neault N, Littlepage S, Cohoe L, Nelson L, Shephard-Yazzie K, Yazzie S, Alikhani A, Reid R, Kenney A, Barlow A. Effect of a Home-Visiting Intervention to Reduce Early Childhood Obesity Among Native American Children: A Randomized Clinical Trial. JAMA Pediatr 2021; 175:133-142. [PMID: 33165594 PMCID: PMC7653536 DOI: 10.1001/jamapediatrics.2020.3557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/30/2020] [Indexed: 12/12/2022]
Abstract
Importance Early childhood obesity disproportionately affects Native American communities. Home visiting is a promising strategy for promoting optimal infant growth in this population. Objective To assess the impact of a brief home-visiting approach, Family Spirit Nurture (FSN), on sugar-sweetened beverage (SSB) consumption, responsive parenting and infant feeding practices, and optimal growth through 12 months post partum. Design, Setting, and Participants This study was a 1:1 randomized clinical trial comparing FSN with an injury prevention education control condition in a reservation-based community. Participants were Navajo mothers 13 years or older with infants younger than 14 weeks recruited between March 22, 2017, and May 18, 2018, and followed up through 12 months post partum. Intent-to-treat analyses were conducted. Interventions The 6-lesson FSN curriculum, delivered 3 to 6 months post partum by Navajo paraprofessionals, targeted optimal responsive and complementary feeding practices and avoidance of SSBs. The control group received 3 injury prevention lessons. Main Outcomes and Measures Primary outcomes established a priori were infant SSB consumption and responsive parenting and complementary feeding practices (responsive feeding scale, age at complementary food introduction, and percentage of mothers who introduced complementary food to infants at 6 months of age or older). The secondary outcome was the effect of the intervention on infant body mass index z scores (zBMIs). Results A total of 134 Navajo mothers of infants younger than 14 weeks were enrolled in the randomized clinical trial, including 68 (mean [SD] maternal age at enrollment, 27.4 [6.4] years) in the intervention group and 66 (mean [SD] maternal age at enrollment, 27.5 [6.1] years) in the control group. Intervention participants reported statistically significantly lower infant SSB consumption through 12 months post partum (mean [SE], 0.56 [0.12] cups per week in the intervention group and 1.78 [0.18] cups per week in the control group; incidence rate ratio, 0.31; 95% CI, 0.19-0.50). Improvements in responsive feeding practices were observed through 9 months post partum (mean [SE], 3.48 [0.07] in the intervention group and 3.22 [0.08] in the control group) (difference, 0.26; 95% CI, 0.06-0.47); statistical significance was lost at 12 months post partum. Age at which the infant was given first food was younger in the intervention group (mean [SE] age, 4.61 [0.21] months in the intervention group and 5.28 [0.23] months in the control group) (difference, -0.67; 95% CI, -0.04 to -1.29). Infants in the intervention group had lower zBMI at 6 and 9 months compared with those in the control group (mean [SE] at 9 months, 0.27 [0.14] in the intervention group and 0.81 [0.14] in the control group; difference, -0.54; 95% CI, -0.94 to -0.14). The 12-month between-group difference was meaningful but not statistically significant (mean [SE], 0.61 [0.16] in the intervention group and 1.07 [0.20] in the control group; difference, -0.46; 95% CI, -0.92 to 0.01). Conclusions and Relevance Infants of Native American mothers who participated in a home-visiting intervention had substantially lower SSB consumption and improvements in responsive feeding practices and infant zBMI scores, suggesting the intervention is effective for promoting healthy infant feeding and growth. Trial Registration ClinicalTrials.gov Identifier: NCT03101943.
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Affiliation(s)
- Summer Rosenstock
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allison Ingalls
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Reese Foy Cuddy
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicole Neault
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shea Littlepage
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa Cohoe
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Leonela Nelson
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kimberlyn Shephard-Yazzie
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Shaneyka Yazzie
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anna Alikhani
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Behavioral and Social Science, Brown School of Public Health, Providence, Rhode Island
| | - Raymond Reid
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Anne Kenney
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Allison Barlow
- Center for American Indian Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Musial S, Abioye A, Murillo AL, Eskander J, Sykes O, Rodriguez L, Friedman JF, Bancroft B, Golova N. Introducing Juice and Sugar-Sweetened Beverages in Early Infancy: Parental Knowledge and Intended Behaviors. Clin Pediatr (Phila) 2021; 60:109-118. [PMID: 32964722 DOI: 10.1177/0009922820961080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Assess caregivers' knowledge about juice and sugar-sweetened beverages (SSBs) and identify factors that contribute to their early introduction. METHODS One hundred forty-four parents of young infants completed a 45-item questionnaire focused on infant nutrition. RESULTS Seventy-two percent of parents plan to give juice to their babies starting in the first year of life; only 16% plan to introduce SSBs. Parents with some college education or more were significantly less likely to report an intention to introduce juice (P < .0001) and SSBs (P < .001) in their children's diets. Education level was significantly associated with knowledge about juice and SSBs (P < .001). Parents with higher knowledge were significantly less likely to plan on introducing juice (P < .001) and SSBs (P < .001). CONCLUSION Parents of young infants lack enough knowledge about the detrimental effects of juice and sugary drinks. These knowledge gaps give pediatric providers a unique opportunity to provide anticipatory guidance starting in early infancy on the adverse health effects of juice and SSBs.
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Affiliation(s)
- Sandra Musial
- Brown University, Providence, RI, USA.,Rhode Island and Hasbro Children's Hospitals, Providence, RI, USA
| | | | - Anarina L Murillo
- Brown University, Providence, RI, USA.,Rhode Island and Hasbro Children's Hospitals, Providence, RI, USA
| | | | - Olivia Sykes
- University of Pennsylvania, Philadelphia, PA, USA
| | | | - Jennifer F Friedman
- Brown University, Providence, RI, USA.,Rhode Island and Hasbro Children's Hospitals, Providence, RI, USA
| | - Barbara Bancroft
- Rhode Island and Hasbro Children's Hospitals, Providence, RI, USA
| | - Natalia Golova
- Brown University, Providence, RI, USA.,Rhode Island and Hasbro Children's Hospitals, Providence, RI, USA
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40
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Beckman M, Harris J. Understanding individual and socio-cultural factors associated with hispanic parents' provision of sugar-sweetened beverages to young children. Appetite 2021; 161:105139. [PMID: 33513416 DOI: 10.1016/j.appet.2021.105139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 11/17/2022]
Abstract
Sugar-sweetened beverages (SSBs) contribute to childhood obesity, long-term risks for diet-related diseases, and health disparities affecting communities of color. Hispanic children are disproportionately affected by obesity, but research is needed to better understand culturally specific reasons for providing SSBs to Hispanic children. This exploratory study utilized the Social Ecological Model framework to evaluate Hispanic parents' perceptions of SSBs and serving them to young children. A cross-sectional survey (in English and Spanish) used a national US online panel to recruit a convenience sample of Hispanic parents (N = 350) with young children (aged 1-5 years). Participants reported types of drinks and SSB brands that they served their child in the past month and rated drink healthfulness. Attitude questions assessed individual, community-level, and socio-cultural factors, including normative beliefs, about serving SSBs to young children. Nearly all parents (98%) reported serving their child SSBs in the past month, averaging 6.7 different SSB types. For all categories of SSBs except fruit-flavored drinks, parents who served that type of SSB rated it as significantly healthier than parents who did not serve them. A linear regression model examined associations between individual and socio-cultural factors and number of SSB types served to their child. In the model, higher average rating of SSB healthfulness, child's age, normative beliefs that others serve SSBs to children, being born in the US/Puerto Rico, and parent and child enjoyment of SSBs were positively associated with serving more SSB types, while concerns about SSBs for their own health was negatively related. Language-related acculturation and community-level factors assessed were not significant. Public health initiatives should focus on healthfulness misperceptions of some SSB categories and address normative beliefs to help reduce serving SSBs to Hispanic children.
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Affiliation(s)
- Madeline Beckman
- Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA.
| | - Jennifer Harris
- University of Connecticut Rudd Center for Food Policy & Obesity, One Constitution Plaza Suite 600 Hartford, CT, 06103, USA.
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Duffy EW, Taillie LS, Richter APC, Higgins ICA, Harris JL, Hall MG. Parental Perceptions and Exposure to Advertising of Toddler Milk: A Pilot Study with Latino Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E528. [PMID: 33435227 PMCID: PMC7827454 DOI: 10.3390/ijerph18020528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/27/2020] [Accepted: 01/05/2021] [Indexed: 12/31/2022]
Abstract
Marketing of toddler milk (i.e., typically sugar-sweetened nutrient-fortified milk-based drinks marketed for children 12-36 months) is an emerging public health problem in the US. The American Academy of Pediatrics recommends against the consumption of toddler milk because it often contains added sugar and can displace nutrient-dense foods. Studies have not examined toddler milk perceptions among Latinos, an important gap given Latino children in the US are at high risk of having poor diet quality, and toddler milk is extensively advertised on Spanish-language TV. This study used an online survey of a convenience sample of 58 Latino parents to examine parents' experiences with toddler milk, understand their perceptions of the healthfulness and the nutrition-related claims on toddler milk, and describe their exposure to toddler milk advertising. Nearly half (44%) of parents in the sample reported purchasing toddler milk. When asked to provide open-ended interpretations of claims on toddler milk, almost all parents gave positive answers, suggesting potential "health halo" effects of the claims. More than half (56%) of parents reported seeing toddler milk advertisements, most commonly on Spanish-language TV. The misperceptions about toddler milk identified should be explored in further research using larger, more representative samples.
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Affiliation(s)
- Emily W. Duffy
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (E.W.D.); (L.S.T.)
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.P.C.R.); (I.C.A.H.)
| | - Lindsey S. Taillie
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (E.W.D.); (L.S.T.)
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.P.C.R.); (I.C.A.H.)
| | - Ana Paula C. Richter
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.P.C.R.); (I.C.A.H.)
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC 27599, USA
| | - Isabella C. A. Higgins
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.P.C.R.); (I.C.A.H.)
| | - Jennifer L. Harris
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT 06103, USA;
| | - Marissa G. Hall
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (A.P.C.R.); (I.C.A.H.)
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC 27599, USA
- School of Medicine, UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA
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Duffy EW, Hall MG, Dillman Carpentier FR, Musicus AA, Meyer ML, Rimm E, Smith Taillie L. Nutrition Claims on Fruit Drinks Are Inconsistent Indicators of Nutritional Profile: A Content Analysis of Fruit Drinks Purchased by Households With Young Children. J Acad Nutr Diet 2021; 121:36-46.e4. [PMID: 32978105 PMCID: PMC7752796 DOI: 10.1016/j.jand.2020.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Fruit drinks are the most commonly consumed sugar-sweetened beverage among young children. Fruit drinks carry many nutrition-related claims on the front of package (FOP). Nutrition-related claims affect individuals' perceptions of the healthfulness of products and purchase intentions, often creating a "health halo" effect. OBJECTIVE The aims of this study were to describe the prevalence of FOP nutrition-related claims on fruit drinks purchased by households with young children and to examine the association between claims and the nutritional profile of fruit drinks. DESIGN The sample included 2059 fruit drinks purchased by households with children 0 to 5 years old participating in Nielsen Homescan in 2017. FOP labels were obtained from 2 databases that contain bar code-level information on all printed material on product labels. A codebook was used to code for presence of FOP nutrition-related claims. The coded claims data were linked by bar code with Nutrition Facts label data. Claim type prevalence was calculated, and the association between claim types and median calories and total grams of sugar per 100 mL was analyzed using Wilcoxon rank-sum tests. The percentages of products containing noncaloric sweeteners (NCSs) with and without each claim type were also calculated and compared. RESULTS Almost all (97%) fruit drinks sampled had at least 1 nutrition-related FOP claim. Implied natural claims such as "natural flavors" were the most common (55% of products), followed by claims about the presence of juice or nectar (49%). Claims about vitamin C (33%), sugar (29%), and calories (23%) were also common. Fruit drinks with vitamin C, juice or nectar, fruit or fruit flavor, and overt natural claims were higher in calories and sugar and less likely to contain NCSs compared with products without these claims. Fruit drinks with calorie, sugar, NCS, implied natural, and other claims were lower in calories and sugar and more likely to contain NCSs compared with products without these claims. CONCLUSIONS Claims are prevalent on fruit drinks purchased by households with young children. This is concerning given prior research demonstrating that claims can mislead consumers. Regulatory actions such as requiring a warning or disclosure on drinks that contain added sugars or NCSs should be considered.
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Affiliation(s)
- Emily W Duffy
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC
| | - Marissa G Hall
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC
| | | | - Aviva A Musicus
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Michele L Meyer
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Eric Rimm
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Lindsey Smith Taillie
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC.
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Mitchell EJ, Frisbie SH, Roudeau S, Carmona A, Ortega R. Estimating daily intakes of manganese due to breast milk, infant formulas, or young child nutritional beverages in the United States and France: Comparison to sufficiency and toxicity thresholds. J Trace Elem Med Biol 2020; 62:126607. [PMID: 32683229 DOI: 10.1016/j.jtemb.2020.126607] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/16/2020] [Accepted: 06/30/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although manganese (Mn) is an essential nutrient, recent research has revealed that excess Mn in early childhood may have adverse effects on neurodevelopment. METHODS We estimated daily total Mn intake due to breast milk at average body weights by reviewing reported concentrations of breast milk Mn and measurements of body weight and breast milk intake at 3 weeks, 4.25 months, 7 months, and 18 months. We compared these figures to the Mn content measured in 44 infant, follow-up, and toddler formulas purchased in the United States and France. We calculated Mn content of formula products made with ultra-trace elemental analysis grade water (0 μg Mn/L) and with water containing 250 μg Mn/L, a concentration which is relatively high but less than the World Health Organization Health-based value of 400 μg Mn/L or the United States Environmental Protection Agency Health Advisory of 350 μg Mn/L. RESULTS Estimated mean daily Mn intake from breast milk ranged from 1.2 μg Mn/kg/day (3 weeks) to 0.16 μg Mn/kg/day (18 months), with the highest intakes at the youngest age stage we considered, 3 weeks. Estimated daily Mn intake from formula products reconstituted with 0 μg Mn/L water ranged from 130 μg Mn/kg/day (3 weeks) to 4.8 μg Mn/kg/day (18 months) with the highest intakes at 3 weeks. Formula products provided 28-520 times greater than the mean daily intake of Mn from breast milk for the 4 age stages that we considered. Estimated daily Mn intake from formula products reconstituted with water containing 250 μg Mn/L ranged from 12 μg Mn/kg/day to 170 μg Mn/kg/day, which exceeds the United States Environmental Protection Agency Reference Dose of 140 μg Mn/kg/day for adults. CONCLUSIONS Mn deficiency is highly unlikely with exclusive breast milk or infant formula feeding, but established tolerable daily intake levels for Mn may be surpassed by some of these products when following labeled instructions.
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Affiliation(s)
- Erika J Mitchell
- Better Life Laboratories, Inc., 293 George Road, East Calais, VT, USA.
| | - Seth H Frisbie
- Department of Chemistry and Biochemistry, Norwich University, Northfield, VT, USA.
| | - Stéphane Roudeau
- University of Bordeaux, Centre d'Etudes Nucléaires de Bordeaux Gradignan (CENBG), UMR 5797, F-33170 Gradignan, France; Centre National de la Recherche Scientifique (CNRS), CENBG, UMR 5797, F-33170 Gradignan, France.
| | - Asuncion Carmona
- University of Bordeaux, Centre d'Etudes Nucléaires de Bordeaux Gradignan (CENBG), UMR 5797, F-33170 Gradignan, France; Centre National de la Recherche Scientifique (CNRS), CENBG, UMR 5797, F-33170 Gradignan, France.
| | - Richard Ortega
- University of Bordeaux, Centre d'Etudes Nucléaires de Bordeaux Gradignan (CENBG), UMR 5797, F-33170 Gradignan, France; Centre National de la Recherche Scientifique (CNRS), CENBG, UMR 5797, F-33170 Gradignan, France.
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Complementary feeding practices and their association with adiposity indicators at 12 months of age. J Dev Orig Health Dis 2020; 12:780-787. [PMID: 33222718 DOI: 10.1017/s2040174420001038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Nutrition during the first 1000 days of life represents a window of opportunity to reduce the risk of metabolic dysfunctions later in life. Exclusive breastfeeding (EBF) and adequate introduction of solid foods are essential to promote metabolic and nutritional benefits. We evaluated the association of infant feeding practices from birth to 6 months (M) with adiposity indicators at 12 M. We performed a secondary analysis of 106 healthy term infants born from a cohort of healthy pregnant women. Type of breastfeeding (exclusive or nonexclusive), the start of complementary feeding (CF) (before (<4 M) or after (≥4 M)), and adiposity (body mass index - BMI, body mass index-for-age - BMI/A, waist circumference - WC, and waist circumference-length ratio - WLR) were evaluated at 12 M using descriptive statistics, mean differences, X2, and linear regression models. During the first 6 M, 28.3% (n = 30) of the infants received EBF. Early CF (<4 M) was present in 26.4% (n = 28) of the infants. Children who started CF < 4 M were less breastfed, received added sugars as the most frequently introduced food category, and showed higher BMI, BMI/A, WC, and WLR; those who consumed added sugars early (<4 M) had a higher WC. Starting CF < 4 M was the main factor associated with a higher WC at 12 M. Unhealthy infant feeding practices, such as lack of EBF, early CF, and early introduction of sugars, may be associated with higher adiposity at 12 M.
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Abstract
BACKGROUND Low-income racially and ethnically diverse children are at higher risk for obesity compared with their counterparts; yet, few studies have assessed their diet quality. OBJECTIVE The aim of the study was to evaluate the diet quality of a racially and ethnically diverse cohort of 2-year-olds using the Healthy Eating Index (HEI)-2010. METHODS We used 24-hour dietary recall data from caregivers of toddlers (24-34 months) at 4 pediatric resident clinics that participated in the Greenlight Study to calculate compliance with the Dietary Guidelines for Americans (DGA) using total HEI score (range 0-100) and 12 component scores. RESULTS Participants (n = 231) were mostly Hispanic (57%) or non-Hispanic black (27%) and from low-income families. Mean HEI-2010 score was 62.8 (standard deviation [SD] 10.5). Though not significant, Hispanics had the highest HEI score. Toddlers of caregivers without obesity, older than 35 years and born outside the United States had higher HEI scores. Most had high HEI component scores for dairy, fruit, and protein foods, but few achieved maximum scores, particularly for whole grains (13%), vegetables (10%), and fatty acid ratio (7%). CONCLUSIONS Despite scores reflective of DGA recommendations for fruit, dairy and protein foods, toddlers in this diverse sample had low quality diets as measured by the HEI, driven largely by low component scores for whole grains, vegetables, and ratio of unsaturated to saturated fatty acids.
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Sirasa F, Mitchell L, Harris N. Dietary diversity and food intake of urban preschool children in North-Western Sri Lanka. MATERNAL AND CHILD NUTRITION 2020; 16:e13006. [PMID: 32351007 PMCID: PMC7507074 DOI: 10.1111/mcn.13006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 02/22/2020] [Accepted: 03/27/2020] [Indexed: 12/21/2022]
Abstract
Childhood malnutrition, associated with poor diet, is a clear public health threat in Sri Lanka, with high rates of under‐nutrition and micronutrient deficiencies coupled with the growing risk of overweight/obesity in urban locations. This study explored the dietary diversity and food intake of urban living Sri Lankan preschool children. A cross‐sectional analysis of the baseline data from a cohort study was conducted with parents/caregivers of children aged 2–6 years, from 21 preschool centres in Kurunegala District, Sri Lanka. Demographic and socio‐economic factors, dietary diversity score (DDS) (n = 597) and food intake (n = 458) (using a food frequency questionnaire) were assessed. Children had a mean DDS of 4.56 ± 0·85 out of 9, with most (91.1%) in the medium DDS category (DDS of 3.1–6.0), consuming rice as most common food. Lentils were consumed more than any meat or alternative food groups at all DDS levels. Child DDS differs with parent/caregiver age and ethnicity. Mean daily intakes of fruit (1.02) and vegetables (0.84) servings align with approximately half of national recommendations, with less than 20% of children meeting daily recommendations. More than one‐third consumed sugary snacks and confectionaries daily and 1 in 10 had them twice a day. Around 40% reported watching television while eating the evening meal. Despite the majority having reasonable DDSs (medium category), findings highlighted inadequate intakes of fruits and vegetables, excessive intakes of sugary snacks and unhealthy dietary and social behaviours, suggests the need for population‐based interventions to promote healthier dietary habits.
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Affiliation(s)
- Fathima Sirasa
- Public Health, School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Department of Applied Nutrition, Wayamba University of Sri Lanka, Makandura, Sri Lanka
| | - Lana Mitchell
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia.,Menzies Health Institute Queensland, Australia
| | - Neil Harris
- Public Health, School of Medicine, Griffith University, Gold Coast, QLD, Australia
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Foo LH, Lee YH, Suhaida CY, Hills AP. Correlates of sugar-sweetened beverage consumption of Malaysian preschoolers aged 3 to 6 years. BMC Public Health 2020; 20:552. [PMID: 32334561 PMCID: PMC7183579 DOI: 10.1186/s12889-020-08461-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 03/05/2020] [Indexed: 12/02/2022] Open
Abstract
Background There is little information about the diet, lifestyle and parental characteristics associated with habitual sugar-sweetened beverage (SSB) consumption in Asian children. The aim of the present study was to assess cross-sectional associations between habitual SSB consumption and preschoolers’ diet, physical activity, sedentary behaviour as well as parental and child characteristics in Malaysian preschoolers aged 3 to 6 y. Methods A total of 590 preschoolers, comprising 317 boys and 273 girls were included. Pre-pilot parental questionnaires were used to assess diet, physical activity (PA) and sedentary behaviour practices and anthropometry was assessed in preschoolers and their parents. Results Multiple logistic regression analyses showed that preschoolers with more frequent weekly intake of snacks [OR 2.7; 95% CI, 1.6–4.4; p < 0.001] and monthly fast food consumption [OR 3.5; 95% CI, 1.9–6.3; p < 0.001], were associated with higher SSB intake (≥5 days in a week), after adjustments of potential confounders. Preschoolers with higher daily fruit and vegetable intake had lower SSB intake [OR 0.4; 95% CI, 0.2–0.8; p = 0.011]. A positive association of higher weekly vigorous PA [OR 2.0; 95% CI, 1.1–3.7; p = 0.030] and daily screen-based practices [OR 2.0; 95% CI, 1.2–3.6; p < 0.001] on habitual SSBs intake was also substantiated. Conclusion Multiple diet, physical activity and sedentary behaviour factors were significantly associated with SSB intake among Malaysian preschoolers. Continued effort is required to encourage healthier beverage choices, as well as healthy diet and active lifestyle practices among children during the critical early years of growth and development.
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Affiliation(s)
- Leng Huat Foo
- Programme of Nutrition and Dietetics, School of Health Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia.
| | - Ying Huoy Lee
- Programme of Nutrition and Dietetics, School of Health Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Che Yahya Suhaida
- Programme of Nutrition and Dietetics, School of Health Sciences, Universiti Sains Malaysia, Health Campus, 16150, Kubang Kerian, Kelantan, Malaysia
| | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Newnham, Launceston, TAS, 7250, Australia
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Nutritional problems in childhood and adolescence: a narrative review of identified disparities. Nutr Res Rev 2020; 34:17-47. [PMID: 32329426 DOI: 10.1017/s095442242000013x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
To inform programmes and policies that promote health equity, it is essential to monitor the distribution of nutritional problems among young individuals. Common nutritional problems include overall low diet quality, the underconsumption and overconsumption of certain dietary components, unhealthy meal and snack patterns, problematic feeding practices and disordered eating. The objective of the present narrative review was to summarise recent evidence of disparities among US children (2-19 years) according to age, sex, socio-economic status, ethnicity/race and rural-urban location. Searches in PubMed® and MEDLINE® were completed to identify peer-reviewed research studies published between January 2009 and January 2019. Findings from the ninety-nine reviewed studies indicate adolescent females, young individuals from lower socio-economic households and individuals who identify as non-Hispanic Black race are particularly vulnerable populations for whom targeted strategies should be developed to address evidence of increased risk with regards to multiple aspects of nutritional wellbeing. Limitations of the existing evidence relate to the accuracy of self-reported dietary data; the need for consistent definitions of disordered eating; the focus on individual dietary components v. patterns; the complexities of categorising socio-economic status, ethnicity/race, and rural and urban areas; and the cross-sectional, observational nature of most research designs. There is an urgent need for research to address these limitations and fill a large gap in evidence on rural-urban differences in nutritional problems. It will further be important for future studies to build greater understanding of how nutritional problems cluster among population groups.
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Madrigal C, Soto-Méndez MJ, Hernández-Ruiz Á, Valero T, Ávila JM, Ruiz E, Lara Villoslada F, Leis R, Martínez de Victoria E, Moreno JM, M. Ortega R, Ruiz-López MD, Varela-Moreiras G, Gil Á. Energy Intake, Macronutrient Profile and Food Sources of Spanish Children Aged One to <10 Years-Results from the EsNuPI Study. Nutrients 2020; 12:E893. [PMID: 32218330 PMCID: PMC7231217 DOI: 10.3390/nu12040893] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 03/17/2020] [Accepted: 03/22/2020] [Indexed: 12/13/2022] Open
Abstract
The present study aimed to assess energy intake, nutrient profile and food sources in Spanish children participating in the EsNuPI ("Estudio Nutricional en Población Infantil Española") study. Plausibility of energy intake and adequacy of nutrient intakes to international recommendations were analyzed in a final sample of 1448 subjects (728 boys and 720 girls) and one group representative of the 1 to <10 years old urban Spanish children (reference sample (n = 707)) who consumed milk and one of the same age who consumed adapted milk over the last year (adapted milk consumers sample (n = 741)) were compared. Both groups completed data of a face-to-face and a telephone 24-h dietary recalls. Both the reference and the adapted milk consumers samples reported an adequate daily energy intake (1503 kcal/day and 1404 kcal/day); and a high contribution to total energy from protein (16.5% and 15.6%) and fat (36.5% and 35.9%). Also, a high percentage of children from both samples were below the lower limit of the recommendations for carbohydrates (47.8% and 39.3%). As the percentage of plausible energy reporters was high for both groups (84.7% and 83.5%, respectively), data for the whole sample were analyzed. Milk and dairy, cereals, meat and derived products, fats and oils, bakery and pastry, fruits and vegetables contributed to about 80% of the total energy intake in both groups. However, the reference sample reported significantly more contribution to energy from cereals, meat and meat products, bakery and pastry and ready to cook/eat foods; meanwhile, the adapted milk consumers sample reported significantly more energy from milk and dairy products, fruits and eggs. Those results suggest that adapted milk consumers have better adherence to the food-based dietary guidelines. Further analyses are warranted to characterize food patterns and the quality of the diet in the EsNuPI study population.
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Affiliation(s)
- Casandra Madrigal
- Department of Nutrition and Bromatology, Faculty of Pharmacy, University of Granada, Campus de Cartuja, s.n, 18071 Granada, Spain;
- Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3 ª pta, Armilla, 18016 Granada, Spain; (M.J.S.-M.); (Á.H.-R.); (Á.G.)
| | - María José Soto-Méndez
- Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3 ª pta, Armilla, 18016 Granada, Spain; (M.J.S.-M.); (Á.H.-R.); (Á.G.)
| | - Ángela Hernández-Ruiz
- Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3 ª pta, Armilla, 18016 Granada, Spain; (M.J.S.-M.); (Á.H.-R.); (Á.G.)
| | - Teresa Valero
- Spanish Nutrition Foundation (FEN), c/General Álvarez de Castro 20, 1ªpta, 28010 Madrid, Spain; (T.V.); (J.M.Á.); (E.R.); (G.V.-M.)
| | - José Manuel Ávila
- Spanish Nutrition Foundation (FEN), c/General Álvarez de Castro 20, 1ªpta, 28010 Madrid, Spain; (T.V.); (J.M.Á.); (E.R.); (G.V.-M.)
| | - Emma Ruiz
- Spanish Nutrition Foundation (FEN), c/General Álvarez de Castro 20, 1ªpta, 28010 Madrid, Spain; (T.V.); (J.M.Á.); (E.R.); (G.V.-M.)
- CIBERESP, Consortium for Biomedical Research in Epidemiology and Public Health, Carlos III Health Institute, 28029 Madrid, Spain
- National Center for Epidemiology, Carlos III Health Institute, 28029 Madrid, Spain
| | | | - Rosaura Leis
- Unit of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University Clinical Hospital of Santiago, IDIS, ISCIII, University of Santiago de Compostela, 15700 Santiago de Compostela, Spain;
- CIBEROBN (Physiopathology of Obesity and Nutrition CB12/03/30038), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
| | - Emilio Martínez de Victoria
- Department of Physiology, Faculty of Pharmacy, University of Granada, Campus de Cartuja, s.n, 18071 Granada, Spain;
- Institute of Nutrition and Food Technology “José Mataix,” Biomedical Research Center, University of Granada, Parque Tecnológico de la Salud, Avenida del Conocimiento s/n, Armilla, 18100 Granada, Spain
| | - José Manuel Moreno
- Pediatric Department, University of Navarra Clinic, Calle Marquesado de Sta. Marta, 1, 28027 Madrid, Spain;
| | - Rosa M. Ortega
- Department of Nutrition and Food Science, Faculty of Pharmacy, Complutense University of Madrid, Plaza Ramón y Cajal s/n, 28040 Madrid, Spain;
| | - María Dolores Ruiz-López
- Department of Nutrition and Bromatology, Faculty of Pharmacy, University of Granada, Campus de Cartuja, s.n, 18071 Granada, Spain;
- Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3 ª pta, Armilla, 18016 Granada, Spain; (M.J.S.-M.); (Á.H.-R.); (Á.G.)
- Institute of Nutrition and Food Technology “José Mataix,” Biomedical Research Center, University of Granada, Parque Tecnológico de la Salud, Avenida del Conocimiento s/n, Armilla, 18100 Granada, Spain
| | - Gregorio Varela-Moreiras
- Spanish Nutrition Foundation (FEN), c/General Álvarez de Castro 20, 1ªpta, 28010 Madrid, Spain; (T.V.); (J.M.Á.); (E.R.); (G.V.-M.)
- Department of Pharmaceutical and Health Sciences, Faculty of Pharmacy, CEU San Pablo University, Urb. Montepríncipe, crta. Boadilla km. 5.3, Boadilla del Monte, 28668 Madrid, Spain
| | - Ángel Gil
- Iberoamerican Nutrition Foundation (FINUT), Av. Del Conocimiento 12, 3 ª pta, Armilla, 18016 Granada, Spain; (M.J.S.-M.); (Á.H.-R.); (Á.G.)
- CIBEROBN (Physiopathology of Obesity and Nutrition CB12/03/30038), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Institute of Nutrition and Food Technology “José Mataix,” Biomedical Research Center, University of Granada, Parque Tecnológico de la Salud, Avenida del Conocimiento s/n, Armilla, 18100 Granada, Spain
- Department of Biochemistry and Molecular Biology II University of Granada, University of Granada, Campus de Cartuja, s.n, 18071 Granada, Spain
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Patterns of Complementary Feeding Behaviors Predict Diet Quality in Early Childhood. Nutrients 2020; 12:nu12030810. [PMID: 32204442 PMCID: PMC7146403 DOI: 10.3390/nu12030810] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 12/23/2022] Open
Abstract
Infancy is a time of plasticity in development of taste preference. Complementary feeding (CF) may be a “sensitive period” for learning new taste preferences and establishing healthy dietary behaviors that may track later in life. Among 1162 children in the U.S. prospective cohort study Project Viva, we aimed to identify patterns of CF behaviors around 1 year and examine associations with diet quality in early childhood (median age 3.1y). We identified patterns of CF using latent class analysis (LCA) and examined later diet quality based on scores on the Youth Healthy Eating Index (YHEI). We identified four distinct CF patterns (latent classes). Later YHEI scores were highest in the class characterized by “breast milk and delayed sweets and fruit juice” and lowest in the “picky eaters” class. The classes defined as “late flavor introduction and delayed sweets” and “early flavor introduction and more fruit juice” had similar, moderate scores. Our results suggest that CF patterns that increase food acceptance and discourage the innate preference for sweetness may have persistent influences on diet quality.
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