Food intake and overweight in school-aged children in Germany: Results of the GINIplus and LISAplus studies

Internalizing symptoms modulate real-world affective response to sweet food and drinks in children

The purpose of the current study was to examine affective response to sweet foods and drinks as a function of children's internalizing symptoms using ecological momentary assessment (EMA). A sample of 192 8-12-year-old children completed a self-report measure of internalizing symptoms and EMA prompts of affect and food intake for eight days, excluding time at school. There was an interaction between sweet food intake and internalizing symptoms for positive affect and for sweet drink intake and internalizing symptoms for negative affect. Those low in internalizing symptoms had significantly lower positive affect after consumption of sweet foods compared to when they did not consume sweet foods whereas those higher in internalizing symptoms had slightly, but not significantly, higher positive affect after consumption of sweet foods. Those low in internalizing symptoms had significantly higher negtive affect after consumption of sweet drinks compared to when they did not consume sweet drinks whereas those higher in internalizing symptoms had slightly, but not significantly, lower negative affect after consumption of sweet drinks. Findings highlight the ways in which internalizing symptoms may modulate affective response to sweet foods and drinks.

Does Dietary Diversity Reduce the Risk of Obesity? Empirical Evidence from Rural School Children in China

Childhood and adolescence overweight and obesity have implications for both health consequences and economic burden. Although it has been an emerging public health problem for primary school children in rural China and the importance of the diet–health link has been stressed for many years, rigorous analysis of the dietary diversity and obesity among children is rare. To clarify this issue, this study provides a better understanding of the functional linkage between dietary diversity and obesity by analyzing data from nearly 8500 rural primary students (aged from 10 to 13 years old) covering three provinces in China. Our estimation results show that there is a significantly negative correlation between dietary diversity and the probability of being overweight among primary students. In particular, for subgroups with higher dietary diversity, the negative correlation between dietary diversity and the incidence of overweight or obesity is stronger, and the absolute value of the coefficient is greater. The results also suggest that the increase in the consumption frequency of all dietary categories can significantly lead to a lower proportion of overweight. Thus, we conclude that higher dietary diversity can help to lower the risk of overweight and obesity among primary school children, presumably through increasing the daily frequency of food intakes and developing a more diverse dietary pattern.

Parents' and Children's Categorization of Candy are Similar: A Card Sort Protocol

American children frequently consume candy and, in excess, this may contribute to poor diets with attendant effects on obesity risk. Despite the ubiquity of candy in children's diets, parental concern about children's candy intake, and the diversity of confectionery products available, very little is known about how children and their parents conceptualize candy. Card sorting tasks offer a novel and visual technique to explore and compare an individuals' perceptions of foods and are useful where literacy is limited (e.g. young children). This study aimed to understand and compare how young school-aged children and parents categorize various candy products using a photo card sorting task. In individual laboratory sessions, children (n = 42, 5 to 8 years old) and parents (n = 35) categorized 51 types of candy based on their similarity. A cluster analysis showed that parents created more categories of candies than children (11 versus 8). For example, parents distinguished between candied fruit and candied nuts, whereas children tended to collapse these categories. However, 7 clusters were virtually identical between parents and children (93% similarity). The findings from this study can inform the measurement of candy intake and the development of education materials targeted towards parent feeding around candy.

Association of Dietary Fatty Acids with Blood Lipids is Modified by Physical Activity in Adolescents: Results from the GINIplus and LISA Birth Cohort Studies

The role of consuming different types of fatty acids (FA) at the expense of carbohydrates (CHO), on the blood lipid profile of adolescents is largely unknown, as is the modulating effect of different levels of physical activity (PA). Children from the GINIplus and LISA birth cohorts, with complete data on dietary FA (assessed by food-frequency questionnaires), objectively-measured PA (assessed by accelerometers) and blood lipids (lipoprotein cholesterol and triglycerides) at age 15 years, were included (N = 837). Sex-stratified associations between dietary FA and blood lipids were assessed by linear regression in substitution models which represented isocaloric replacements of CHO with saturated FA (SFA), monounsaturated FA (MUFA), n-3 polyunsaturated FA (PUFA) or n-6 PUFA. To assess the interactions with PA, analyses were then performed stratified by tertiles of different PA levels (sedentary, lifestyle, moderate-to-vigorous (MVPA)). Both sexes presented a significant inverse association between MUFA and triglycerides, and females a direct association between n-3 PUFA and high-density lipoprotein. Stratifying by PA tertiles, associations were mainly restricted to participants with the lowest levels of lifestyle PA, or the highest time spent sedentary. The effects of dietary FA on the lipid profile vary in an activity-specific manner, emphasizing possible synergistic roles of diet and PA.

Dietary intake in the early years and its relationship to BMI in a bi-ethnic group: the Born in Bradford 1000 study

OBJECTIVE

To assess relationships between dietary intake at age 12, 18 and 36 months and BMI Z-scores at age 36 months in a bi-ethnic group.

DESIGN

A prospective cohort study comparing cross-sectional and longitudinal data. Exposures included dietary intake at 12, 18 and 36 months (FFQ) with an outcome of BMI Z-score at age 36 months.

SETTING

Born in Bradford 1000 study, Bradford, UK.

SUBJECTS

Infants at age 12 months (n 722; 44 % White British, 56 % Pakistani), 18 months (n 779; 44 % White British, 56 % Pakistani) and 36 months (n 845; 45 % White British, 55 % Pakistani).

RESULTS

Diet at age 12 months was not associated with BMI Z-score at age 36 months. Higher consumption of vegetables at 18 and 36 months was associated with a lower BMI Z-score at 36 months (model coefficient (95 % CI): -0·20 (-0·36, -0·03) and -0·16 (-0·31, -0·02), respectively). Higher consumption of high-fat chips at age 36 months was associated with a lower BMI Z-score at age 36 months (-0·16 (-0·32, 0·00)). Overall, White British children had higher 36-month BMI Z-scores than Pakistani children (adjusted mean difference (95 % CI): 0·21 (0·02, 0·41)).

CONCLUSIONS

Our findings indicate that dietary intake at 18 and 36 months was somewhat related to BMI Z-score at age 36 months and suggest the importance of early interventions aimed at establishing healthy eating behaviours.

Prospective associations of meat consumption during childhood with measures of body composition during adolescence: results from the GINIplus and LISAplus birth cohorts

BACKGROUND

Higher meat and protein intakes have been associated with increased body weight in adults, but studies evaluating body composition are scarce. Furthermore, our knowledge in adolescents is limited. This study aimed to investigate the prospective associations of intakes of different meat types, and their respective protein contents during childhood, with body composition during adolescence.

METHODS

Dietary (using food frequency questionnaires) and body composition (measured by bioelectrical impedance) data were collected from the 10- and 15-year follow-up assessments respectively, of the GINIplus and LISAplus birth cohort studies. Sex-stratified prospective associations of meat and meat protein intakes (total, processed, red meat and poultry) with fat mass index (FMI) and fat free mass index (FFMI), were assessed by linear regression models (N = 1610).

RESULTS

Among males, higher poultry intakes at age 10 years were associated with a higher FMI at age 15 years [β = 0.278 (SE = 0.139), p = 0.046]; while higher intakes of total and red meat were prospectively associated with higher FFMI [0.386 (0.143), p = 0.007, and 0.333 (0.145), p = 0.022, respectively]. Additionally in males, protein was associated with FFMI for total and red meat [0.285 (0.145) and 0.356 (0.144), respectively].

CONCLUSIONS

Prospective associations of meat consumption with subsequent body composition in adolescents may differ by sex and meat source.

Confectionery consumption and overweight, obesity, and related outcomes in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Many calorie-rich dietary components contribute to obesity. However, the contribution of confectionery to obesity in children and adolescents has not been well established.

OBJECTIVE

In this systematic review and meta-analysis, we hypothesized that higher total, chocolate, and nonchocolate confectionery consumption would be associated with higher odds of overweight, obesity, and other obesity-related outcomes [body mass index (BMI), BMI z score, body composition, waist circumference, and percentage body fat] in children and adolescents.

DESIGN

We searched Scopus, PubMed, and reference lists of pertinent reviews, supplemented by expert contact, for randomized controlled trials (RCTs) and observational studies published between 1990 and 31 March 2015, and we conducted separate meta-analyses for categorical and continuous ORs and for total, chocolate, and nonchocolate confectioneries with the use of a random-effects model.

RESULTS

A total of 19 studies were included in the systematic review, and the cross-sectional results of 11 studies (∼177,260 participants) were included in the meta-analysis. In the meta-analysis, which examined the combined outcome of overweight and obesity, the odds of overweight or obesity were 18% lower (OR: 0.82; 95% CI: 0.69, 0.97) for subjects in the highest category of consumption than for a reference category of consumption. Thus, a 1-time/wk or a 1-U increase in consumption was associated with a 13% (OR: 0.87; 95% CI: 0.85, 0.88) decrease in the odds of overweight or obesity. Associations were similarly inverse for chocolate and nonchocolate confectioneries. In the longitudinal studies and the RCT included in the review, no associations were observed between confectionery consumption and overweight, obesity, or obesity-related outcomes.

CONCLUSIONS

Instead of overweight and obese children and adolescents having higher confectionery intakes, this review shows the reverse effect. This result might reflect a true inverse association, reverse causality, or differential underreporting in heavier individuals. Interventions may need to focus on dietary elements other than confectionery to tackle obesity.

A new food frequency questionnaire to assess chocolate and cocoa consumption

OBJECTIVE

Cocoa has been highlighted as a food with potential benefits to human health because of its polyphenol content. However, few studies show the contribution of cocoa and chocolate products in polyphenol intake. The aim of this work was to develop a food frequency questionnaire (FFQ) for evaluating the intake of food products containing cocoa (C-FFQ).

METHODS

A sample of 50 university students was recruited to complete the 90-item questionnaire, a validated questionnaire (called here European Food Safety Authority [EFSA]-Q) as well as a 24-hour dietary recall (24 HDR). Spearman correlation test, Bland-Altman plots, and quintile classification analysis were conducted together with the Wilcoxon test and descriptive statistics.

RESULTS

Significant correlations between the C-FFQ and the EFSA-Q for the most common cocoa/chocolate products were observed (P < 0.05), as well as between data from the C-FFQ and 24 HDR (P < 0.05). However, a number of cocoa/chocolate products frequently consumed by the participants were detected by the C-FFQ and 24 HDR which were not included in the EFSA-Q. According to the C-FFQ, chocolate bars were the main source of cocoa in university students, but dairy products also provided an important amount of cocoa.

CONCLUSION

The developed C-FFQ questionnaire can be considered as a valid option for assessing the consumption frequency of cocoa/chocolate-derived products, thereby allowing the evaluation of cocoa polyphenol intake in further studies.

Changes in dietary intake during puberty and their determinants: results from the GINIplus birth cohort study

BACKGROUND

Understanding changes in dietary intake during puberty could aid the mapping of dietary interventions for primary prevention. The present study describes dietary changes from childhood to adolescence, and their associations with parental education, family income, child education, body mass index (BMI), pubertal onset and screen-time sedentary behaviour.

METHODS

Dietary data (n = 1232) were obtained from food frequency questionnaires at the 10- and 15-year follow-ups of the GINIplus birth cohort study. Intakes of 17 food groups, macronutrients and antioxidant vitamins, were described by a) paired Wilcoxon rank sum tests, comparing average intakes at each time-point, and b) Cohen's kappa "tracking" coefficients, measuring stability of intakes (maintenance of relative tertile positions across time). Further, associations of changes (tertile position increase or decrease vs. tracking) with parental education, family income, child education, pubertal onset, BMI, and screen-time, were assessed by logistic regression and multinomial logistic regression models stratified by baseline intake tertile.

RESULTS

Both sexes increased average intakes of water and decreased starchy vegetables, margarine and dairy. Females decreased meat and retinol intakes and increased vegetables, grains, oils and tea. Males decreased fruit and carbohydrates and increased average intakes of meat, caloric drinks, water, protein, fat, polyunsaturated fatty acids (PUFAs), vitamin C and alpha-tocopherol. Both sexes presented mainly "fair" tracking levels [κw = 0.21-0.40]. Females with high (vs. low) parental education were more likely to increase their nut intake [OR = 3.8; 95 % CI = (1.7;8.8)], and less likely to decrease vitamin C intakes [0.2 (0.1;0.5)], while males were less likely to increase egg consumption [0.2 (0.1;0.5)] and n3 PUFAs [0.2 (0.1;0.5)]. Females with a higher (vs. low) family income were more likely to maintain medium wholegrain intakes [0.2 (0.1;0.7) for decrease vs. tracking, and 0.1 (0.0;0.5) for increase vs. tracking], and were less likely to decrease vitamin C intakes [0.2 (0.1;0.6)]. Males with high education were less likely to increase sugar-sweetened foods [0.1 (0.1;0.4)]. Finally, BMI in females was negatively associated with decreasing protein intakes [0.7 (0.6;0.9)]. In males BMI was positively associated with increasing margarine [1.4 (1.1;1.6)] and vitamin C intakes [1.4 (1.1;1.6)], and negatively associated with increasing n3 PUFA.

CONCLUSIONS

Average dietary intakes changed significantly, despite fair tracking levels, suggesting the presence of trends in dietary behaviour during puberty. Family income and parental education predominantly influenced intake changes. Our results support the rationale for dietary interventions targeting children, and suggest that sex-specific subpopulations, e.g. low socio-economic status, should be considered for added impact.

Candy consumption patterns, effects on health, and behavioral strategies to promote moderation: summary report of a roundtable discussion

Nearly all Americans (97%) report eating candy at least once per year; yet, on a given day, only approximately one-fourth of the US population aged ≥2 y consumes candy. Among all Americans, candy contributes a relatively small proportion of calories, added sugars, and saturated fat to the total diet, and recent research suggests that current levels of candy consumption are not associated with risk of weight gain and cardiovascular disease in children and adults. Providing guidance for the consumption of candy in moderation requires an understanding of various behavioral health-related factors that influence candy consumption. A roundtable of behavioral nutrition experts, researchers, and nutrition educators met to discuss recent data on intakes of candy, health outcomes associated with usual candy intake, and the impact of behavioral strategies, including restriction, education, and environmental awareness, on modifying eating behaviors to achieve moderate intakes of candy. Restricting access to palatable foods, whether self-imposed or by parental control, may have potentially negative consequences. Techniques and insight into how to adopt "moderation" in candy consumption, from effective parental practices to environmental strategies that facilitate behavior change without a high degree of effort, were identified as important next steps toward sustainable dietary guidance related to the role of candy and other treats in a healthy lifestyle.