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Johnson SL, Moding KJ, Flesher A, Boenig R, Campain J. I'll Never Give Up: A Qualitative Study of Caregivers' Perceptions and Decisional Processes When Feeding Infants and Toddlers Novel and Disliked Foods. J Nutr Educ Behav 2024:S1499-4046(24)00008-3. [PMID: 38493374 DOI: 10.1016/j.jneb.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE To better understand caregivers' decisional processes related to offering novel and disliked foods to their infants and toddlers. DESIGN As part of a parent study on young children's food acceptance that took place in Denver, CO, this secondary analysis used a basic qualitative approach to explore caregivers' decisional processes related to repeated exposure and children's food rejection. PARTICIPANTS English-speaking caregivers of infants and toddlers (aged 6-24 months; n = 106) were recruited via flyers and social media and interviewed (from July, 2017 to January, 2018) during a laboratory visit focused on introducing a novel food. PHENOMENON OF INTEREST Factors influencing caregiver decisions to (dis)continue offering novel or disliked foods. ANALYSIS Using a combined deductive and inductive coding approach, trained researchers coded transcripts and codes, which were reviewed and discussed by all investigators to identify themes. RESULTS Three major themes (and 2 subthemes) were generated regarding caregivers' decisions about re-offering rejected foods: 1) Caregivers understand that multiple experiences with new foods are needed because children's reactions can be unpredictable and depend upon time, developmental stage, and child traits; 2) Caregivers vary in their persistence and decisions to keep offering foods depending on responsiveness to child cues (sub-theme) and adult-centered beliefs, needs, and decisions (sub-theme); 3) Child food acceptance will change with time, circumstances, and development if you keep trying. CONCLUSIONS AND IMPLICATIONS Although caregivers are aware of repeated exposure, additional implementation research focused on translating theory into effective home practices could assist caregivers to persist in offering novel or disliked foods.
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Affiliation(s)
- Susan L Johnson
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Kameron J Moding
- Department of Human Development and Family Science, Purdue University, West Lafayette, IN
| | - Abigail Flesher
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca Boenig
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Joseph Campain
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO
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Kielb EI, Moding KJ, Kimiecik C, Klenosky DB. Parents' food choice for their preschool-aged children: A means-end investigation. Child Care Health Dev 2024; 50:e13172. [PMID: 37699702 DOI: 10.1111/cch.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/26/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Despite the growing literature on the importance of parental feeding practices, the factors that influence how parents make decisions regarding the foods they offer to their young children are not fully understood. Means-end theory and its associated methodology known as laddering provide a useful framework for characterizing the relationships between the attributes of a choice option (e.g., a food item), the consequences (i.e., the benefits or costs/risks) associated with those attributes and the personal values (i.e., enduring beliefs) those consequences help reinforce. The present research uses this means-end perspective to enrich our understanding of how parents make food choices for their preschool-aged children. METHODS Interviews were conducted with parents (N = 33) of 3- to 5-year-old children to explore the factors underlying parents' decisions regarding the foods they recently offered, prefer to offer and avoid offering to their preschooler. The resulting data were transcribed, content analysed and summarized in a series of summary diagrams known as hierarchical value maps (HVMs). RESULTS Study results indicate that although most parents reported trying to make food decisions because they want their child to be healthy, factors such as avoiding fights/battles and low perceived likelihood their child would eat a food may be barriers to offering certain foods. CONCLUSIONS Taken together, these study findings enhance our understanding of the range of meanings underlying parents' food choice decisions and suggest opportunities for interventions to improve the quality of foods that parents offer to their children at home.
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Moding KJ, Kielb EI. Conceptual Considerations and Methodological Challenges to Measuring Food Acceptance During Infancy. Curr Nutr Rep 2023; 12:407-415. [PMID: 37460785 DOI: 10.1007/s13668-023-00480-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE OF REVIEW The purpose of this review is to (1) present a conceptual definition of infant food acceptance, (2) explore methodological challenges to measuring different components of food acceptance, and (3) provide recommendations for future research on food acceptance during infancy. RECENT FINDINGS Infant food acceptance includes separate but overlapping components: wanting, liking, and consumption. Recent evidence suggests that although these components are often correlated, there is variability in the sensitivity of these measures to detect differences in infants' responses to target foods. To date, consumption and caregiver perceptions of liking have been the primary outcome measures of interest in studies of infant food acceptance. More diverse and precise measures across the three components of infant food acceptance are needed to address a wider scope of research questions, which would in turn strengthen the interpretability and translational potential of research in this area.
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Affiliation(s)
- Kameron J Moding
- Department of Human Development & Family Science, Purdue University, 1200 Mitch Daniels Blvd, West Lafayette, IN, 47907, USA.
| | - Elizabeth I Kielb
- Department of Human Development & Family Science, Purdue University, 1200 Mitch Daniels Blvd, West Lafayette, IN, 47907, USA
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Barrett KJ, Moding KJ, Flesher A, Johnson SL. "The Kale Is Green" and Other Things Caregivers Say when Feeding Infants and Toddlers Are Associated with Child Rate of Acceptance. J Nutr 2023; 153:1297-1304. [PMID: 36803576 DOI: 10.1016/j.tjnut.2023.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Responsive feeding is important for helping children to develop healthy eating behaviors. Verbal feeding interactions between caregivers and children may reflect caregiver's responsiveness and contribute to children's developing lexical networks related to food and eating. OBJECTIVES This project aimed to: 1) characterize what caregivers say to infants and toddlers during a single feeding session and 2) test the associations between caregiver's verbal prompts and food acceptance by children. METHODS Filmed interactions of caregivers and their infants (N = 46 infants aged 6-11 mo) and toddlers (N = 60 toddlers aged 12-24 mo) were coded and analyzed to explore the following: 1) what caregivers said during a single feeding session and 2) whether caregiver's verbalizations were associated with child food acceptance. Caregiver verbal prompts were coded during each food offer and summed across the feeding session; prompts were categorized as supportive, engaging, and unsupportive. Outcomes included accepted tastes, rejected tastes, and rate of acceptance. Mann-Whitney's U tests and Spearman's correlations tested bivariate associations. Multilevel ordered logistic regression tested associations between verbal prompt categories and the rate of acceptance across offers. RESULTS Verbal prompts were largely supportive (41%) and engaging (46%), and caregivers of toddlers used significantly more verbal prompts than caregivers of infants (mean ± SD: 34.5 ± 16.9 compared with 25.2 ± 11.6; P = 0.006). Among toddlers, more engaging and unsupportive prompts were associated with a lower rate of acceptance (ρ = -0.30, P = 0.02; ρ = -0.37, P = 0.004). For all children, multilevel analyses revealed that more unsupportive verbal prompts were associated with a lower rate of acceptance (b = -1.52; SE = 0.62; P = 0.01) and individual caregiver use of more engaging and unsupportive prompts than usual was associated with a lower rate of acceptance (b = -0.33; SE = 0.08; P < 0.001: b = -0.58; SE = 0.11; P < 0.001). CONCLUSIONS These findings suggest that caregivers may strive for a supportive and engaging emotional setting during feeding, although verbalization category may change as children exhibit more rejection. Furthermore, what caregivers say may change as children develop more advanced language capabilities.
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Affiliation(s)
- Katherine J Barrett
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Section of Nutrition, Aurora, CO, United States.
| | - Kameron J Moding
- Purdue University, Department of Human Development and Family Studies, West Lafayette, IN, United States
| | - Abigail Flesher
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Section of Nutrition, Aurora, CO, United States
| | - Susan L Johnson
- University of Colorado Anschutz Medical Campus, Department of Pediatrics, Section of Nutrition, Aurora, CO, United States
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Robertson OC, Marceau K, Moding KJ, Knopik VS. Developmental pathways linking obesity risk and early puberty: The thrifty phenotype and fetal overnutrition hypotheses. Developmental Review 2022. [DOI: 10.1016/j.dr.2022.101048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Augustine ME, Moding KJ, Stifter CA. Person-centered profiles of child temperament: A comparison of coder, mother, and experimenter ratings. Infant Behav Dev 2022; 68:101725. [DOI: 10.1016/j.infbeh.2022.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/16/2022]
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Moding KJ, Bonvecchio Arenas A, Rawlinson C, Okronipa H, Pacheco‐Miranda S, Boenig R, Flesher AE, Johnson SL. Development of a live coding method to assess infant/toddler food acceptance. Maternal & Child Nutrition 2022; 18:e13348. [PMID: 35615887 PMCID: PMC9218310 DOI: 10.1111/mcn.13348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/02/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
Validated measures predicting infant consumption of nutrient supplements or fortified foods are essential for the success of nutritional interventions to improve undernutrition. Behavioural coding of food acceptance is one promising approach, though the required time and resources are limiting. The overarching goal of the present study was to adapt a video coding (VC) protocol for use as a live coding (LC) method to assess infant food acceptance in naturalistic settings. Infants (n = 59; ages 7–24 months) were fed a small‐quantity lipid‐based nutrient supplement (SQ‐LNS) mixed with a familiar food by caregivers in the State of Morelos, Mexico. Trained coders used a VC scheme to rate infant acceptance of each spoon offer using a 4‐point scale. The VC scheme was subsequently adapted for use as an LC method to be used in participant homes and a video live coding (VLC) method to monitor reliability. Reliability and validity of the LC method were tested in a subsample of dyads (n = 20). Intraclass correlation coefficients (ICCs) indicated that the inter‐rater reliability between coders using the LC method was moderate or good when compared to VC methods (ICCs = 0.75 and 0.87). Live coded acceptance scores were also moderately associated with consumption of the SQ‐LNS (ρ = 0.50, p = 0.03). The LC scheme demonstrated initial reliability and validity as an assessment of infant food acceptance. Since VC is both resource and time‐intensive, the LC scheme may be useful for assessing infant food acceptance in resource‐limited settings. Current measures to assess infant food acceptance in nutritional interventions are limited. This study presents a live coding scheme and protocol that can be used to objectively rate infants’ food acceptance in naturalistic settings. The coding method demonstrated initial reliability with video coding methods and was associated with infants’ consumption of a target food. The live coding protocol may be particularly useful for assessing infant food acceptance in resource‐limited settings.
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Affiliation(s)
- Kameron J. Moding
- Department of Human Development and Family Studies Purdue University West Lafayette Indiana USA
- Department of Pediatrics, Section of Nutrition University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | | | - Cloe Rawlinson
- Center for Research in Nutrition and Health National Institute of Public Health Cuernavaca Mexico
- Center for Primary Care and Public Health Unisanté Lausanne Switzerland
| | - Harriet Okronipa
- Department of Nutrition, Institute of Global Nutrition University of California Davis California USA
- Department of Nutritional Sciences Oklahoma State University Stillwater Oklahoma USA
| | - Selene Pacheco‐Miranda
- Center for Research in Nutrition and Health National Institute of Public Health Cuernavaca Mexico
| | - Rebecca Boenig
- Department of Pediatrics, Section of Nutrition University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Abigail E. Flesher
- Department of Pediatrics, Section of Nutrition University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Susan L. Johnson
- Department of Pediatrics, Section of Nutrition University of Colorado Anschutz Medical Campus Aurora Colorado USA
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Anzman‐Frasca S, Moding KJ, Forestell CA, Francis LA. Applying developmental science concepts to improve the applicability of children’s food preference learning research. Child Dev Perspectives 2022. [DOI: 10.1111/cdep.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Stephanie Anzman‐Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences University at Buffalo Buffalo New York USA
- Center for Ingestive Behavior Research University at Buffalo Buffalo New York USA
| | - Kameron J. Moding
- Department of Human Development & Family Studies Purdue University West Lafayette Indiana USA
| | | | - Lori A. Francis
- Department of Biobehavioral Health The Pennsylvania State University University Park Pennsylvania USA
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Gartstein MA, Seamon DE, Mattera JA, Bosquet Enlow M, Wright RJ, Perez-Edgar K, Buss KA, LoBue V, Bell MA, Goodman SH, Spieker S, Bridgett DJ, Salisbury AL, Gunnar MR, Mliner SB, Muzik M, Stifter CA, Planalp EM, Mehr SA, Spelke ES, Lukowski AF, Groh AM, Lickenbrock DM, Santelli R, Du Rocher Schudlich T, Anzman-Frasca S, Thrasher C, Diaz A, Dayton C, Moding KJ, Jordan EM. Using machine learning to understand age and gender classification based on infant temperament. PLoS One 2022; 17:e0266026. [PMID: 35417495 PMCID: PMC9007342 DOI: 10.1371/journal.pone.0266026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/11/2022] [Indexed: 11/19/2022] Open
Abstract
Age and gender differences are prominent in the temperament literature, with the former particularly salient in infancy and the latter noted as early as the first year of life. This study represents a meta-analysis utilizing Infant Behavior Questionnaire-Revised (IBQ-R) data collected across multiple laboratories (N = 4438) to overcome limitations of smaller samples in elucidating links among temperament, age, and gender in early childhood. Algorithmic modeling techniques were leveraged to discern the extent to which the 14 IBQ-R subscale scores accurately classified participating children as boys (n = 2,298) and girls (n = 2,093), and into three age groups: youngest (< 24 weeks; n = 1,102), mid-range (24 to 48 weeks; n = 2,557), and oldest (> 48 weeks; n = 779). Additionally, simultaneous classification into age and gender categories was performed, providing an opportunity to consider the extent to which gender differences in temperament are informed by infant age. Results indicated that overall age group classification was more accurate than child gender models, suggesting that age-related changes are more salient than gender differences in early childhood with respect to temperament attributes. However, gender-based classification was superior in the oldest age group, suggesting temperament differences between boys and girls are accentuated with development. Fear emerged as the subscale contributing to accurate classifications most notably overall. This study leads infancy research and meta-analytic investigations more broadly in a new direction as a methodological demonstration, and also provides most optimal comparative data for the IBQ-R based on the largest and most representative dataset to date.
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Affiliation(s)
| | | | | | - Michelle Bosquet Enlow
- Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States of America
| | - Rosalind J. Wright
- Department of Pediatrics, Kravis Children’s Hospital, New York, NY, United States of America
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Koraly Perez-Edgar
- Pennsylvania State University, University Park, PA, United States of America
| | - Kristin A. Buss
- Pennsylvania State University, University Park, PA, United States of America
| | - Vanessa LoBue
- Rutgers University, New Brunswick, NJ, United States of America
| | | | | | - Susan Spieker
- University of Washington, Seattle, WA, United States of America
| | | | - Amy L. Salisbury
- Virginia Commonwealth University, Richmond, VA, United States of America
| | - Megan R. Gunnar
- University of Minnesota, Minneapolis, MN, United States of America
| | - Shanna B. Mliner
- University of Minnesota, Minneapolis, MN, United States of America
| | - Maria Muzik
- University of Michigan, Ann Arbor, MI, United States of America
| | - Cynthia A. Stifter
- Pennsylvania State University, University Park, PA, United States of America
| | | | - Samuel A. Mehr
- Harvard University, Boston, MA, United States of America
| | | | | | - Ashley M. Groh
- University of Missouri, Columbia, MO, United States of America
| | | | - Rebecca Santelli
- University of North Carolina, Chapel Hill, VA, United States of America
| | | | | | | | - Anjolii Diaz
- Ball State University, Muncie, IN, United States of America
| | - Carolyn Dayton
- Wayne State University, Detroit, MI, United States of America
| | | | - Evan M. Jordan
- Oklahoma State University, Stillwater, OK, United States of America
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Reigh NA, Rolls BJ, Francis LA, Buss KA, Hayes JE, Hetherington MM, Moding KJ, Kling SMR, Keller KL. Examining the Role of Food Form on Children's Self-Regulation of Energy Intake. Front Nutr 2022; 9:791718. [PMID: 35223945 PMCID: PMC8865049 DOI: 10.3389/fnut.2022.791718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/17/2022] [Indexed: 11/15/2022] Open
Abstract
Increasing childhood obesity rates in both the United States and worldwide demonstrate a need for better prevention and intervention strategies. However, little is understood about what factors influence children's ability to sense and respond to hunger and fullness cues, a critical component of self-regulation of energy intake and maintenance of a healthy body weight. Research in adults suggests that food form may influence self-regulation of energy intake. More specifically, beverages are not as satiating as solid foods when matched for factors such as energy content, energy density, and volume and therefore elicit poorer energy intake self-regulation. However, much less is known about the impact of food form on children's ability to regulate their energy intake. This report describes a study that will examine the relationship between biological, cognitive, and psychological factors and children's appetite self-regulation (ASR). In this registered report, we will examine the influence of food form on children's short-term energy compensation, a proxy indicator of energy intake self-regulation. The study will employ a within-subjects, crossover design in which children (n = 78) ages 4.5-6 years will attend five laboratory visits, each ~1 week apart. During each visit, children will be presented with one of five possible preload conditions: apple slices, apple sauce, apple juice, apple juice sweetened with non-nutritive sweetener (NNS), or no preload. The order of preload conditions will be pseudorandomized and counterbalanced across participants. Following consumption of the preload (or no preload), children will consume a standardized ad libitum test meal of common foods for this age group. We hypothesize that children will demonstrate poorer short-term energy compensation (greater meal intake) in response to the liquid and semi-solid preloads compared to the solid preload. Understanding how energy in various forms affects children's ability to self-regulate intake has implications for dietary recommendations and will help identify those who are most at-risk for poor intake regulation and the development of obesity.
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Affiliation(s)
- Nicole A. Reigh
- The Metabolic Kitchen and Children's Eating Behavior Laboratory, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Barbara J. Rolls
- The Laboratory for the Study of Human Ingestive Behavior, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Lori A. Francis
- Center for Family Research in Diverse Contexts, Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States
| | - Kristin A. Buss
- The Emotion Development Laboratory, Departments of Psychology and Human Development and Family Studies, The Pennsylvania State University, University Park, PA, United States
| | - John E. Hayes
- Department of Food Science, Sensory Evaluation Center, The Pennsylvania State University, University Park, PA, United States
| | - Marion M. Hetherington
- Human Appetite Research Unit, School of Psychology, Woodhouse, The University of Leeds, Leeds, United Kingdom
| | - Kameron J. Moding
- Child Temperament and Health Laboratory, Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, United States
| | - Samantha M. R. Kling
- Evaluation Sciences Unit, Division of Primary Care Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | - Kathleen L. Keller
- The Metabolic Kitchen and Children's Eating Behavior Laboratory, Departments of Nutritional Sciences and Food Science, The Pennsylvania State University, University Park, PA, United States
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Johnson SL, Moding KJ, Grimm KJ, Flesher AE, Bakke AJ, Hayes JE. Infant and Toddler Responses to Bitter-Tasting Novel Vegetables: Findings from the Good Tastes Study. J Nutr 2021; 151:3240-3252. [PMID: 34191021 PMCID: PMC8485907 DOI: 10.1093/jn/nxab198] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/29/2021] [Accepted: 05/25/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Infants are born with the biological predisposition to reject bitterness. Dark green vegetables contain essential nutrients but also bitter compounds, making them more difficult to like. OBJECTIVE The Good Tastes Study was designed to determine whether reducing bitterness by adding small amounts of sugar or salt would alter infant acceptance of kale purées. METHODS Caregivers (n = 106, 94% mothers, 82% Non-Hispanic White) and children (53% male, aged 6-24 mo) participated in a videorecorded laboratory visit during which infants were offered 4 versions of puréed kale: plain, 1.2% or 1.8% added sugar, or 0.2% added salt. Caregivers rated their children's liking for each kale version. Videos were coded for the number of tastes accepted and for children's behaviors and acceptance of each kale version. A multilevel ordered logistic model was fit for the number of accepted tastes and caregiver ratings of child liking of kale versions with age, breastfeeding history, order effects, and kale version as predictors. RESULTS Infants 6 to <12 mo accepted more tastes (b = 2.911, P < 0.001) and were rated by caregivers as liking the kale more than older toddlers (≥18 mo; b = 1.874, P = 0.014). The plain kale was more likely to be accepted (P < 0.001); also, the first version offered was more likely to be rejected (b = -0.586, P < 0.007). Older infants (≥18 mo) exhibited more avoidant behaviors (b = 1.279, P < 0.001), more playing (b = 2.918, P < 0.001), and more self-feeding (b = 1.786, P = 0.005) than younger infants (6 to <12 mo). Children who were reported to have been breastfed more in the last 7 d were more likely to self-feed (b = 0.246, P < 0.001) and play with food (b = 0.207, P < 0.005). CONCLUSIONS Our findings support that there may be a sensitive period, during the early phase of complementary feeding, to improve success of introducing a novel, bitter, more difficult-to-like food. When low levels of sugar or salt were added, no advantage of bitterness reduction was observed. This study has been registered with ClinicalTrials.gov as NCT04549233.
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Affiliation(s)
- Susan L Johnson
- Department of Pediatrics University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kameron J Moding
- Department of Human Development & Family Studies, Purdue University, West Lafayette, IN, USA
| | - Kevin J Grimm
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Abigail E Flesher
- Department of Pediatrics University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Alyssa J Bakke
- Sensory Evaluation Center, The Pennsylvania State University, University Park, PA, USA
- Department of Food Science, The Pennsylvania State University, University Park, PA, USA
| | - John E Hayes
- Sensory Evaluation Center, The Pennsylvania State University, University Park, PA, USA
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Johnson SL, Shapiro ALB, Moding KJ, Flesher A, Davis K, Fisher JO. Infant and Toddler Consumption of Sweetened and Unsweetened Lipid Nutrient Supplements After 2-Week Home Repeated Exposures. J Nutr 2021; 151:2825-2834. [PMID: 34036363 PMCID: PMC8417920 DOI: 10.1093/jn/nxab148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/10/2021] [Accepted: 04/22/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Small-quantity lipid-based nutrient supplements (SQ-LNS) are designed to address undernutrition during the complementary feeding period. SQ-LNS contains added sugars, but limited research has assessed whether infants' acceptance varies between versions with and without sugars. OBJECTIVES Our objective was to examine the effects of repeated exposure on children's acceptance of sweetened and unsweetened SQ-LNS. We aimed to understand caregivers' perceptions of children's liking of the 2 SQ-LNS versions and their influences on infant acceptance of SQ-LNS. METHODS Caregivers (86% non-Hispanic White) and children (7-24 mo), participated in a randomized, 2-week home-exposure study and baseline and post-home exposure assessments. Children were randomized to receive sweetened or unsweetened SQ-LNS versions, mixed with infant oatmeal. At in-person visits, caregivers fed both SQ-LNS versions to children and rated their child's liking for each. Caregivers fed the SQ-LNS version to which their child was randomized until the child refused to eat more. Acceptance was measured as total grams consumed. Mixed-effects linear models tested the change in SQ-LNS consumed between baseline and postexposure by the SQ-LNS version and number of home exposures. Covariates included the amount of SQ-LNS consumed at baseline, child BMI z-score, child age, and breastfeeding experience. RESULTS Children's acceptance of both SQ-LNS versions increased from baseline to postexposure (β, 0.71 g; 95% CI: 0.54-0.89 g; P = 0.04), regardless of SQ-LNS version (P = 0.88) or number of home exposures (P = 0.55). Caregivers rated children's liking of unsweetened SQ-LNS higher at baseline (P = 0.02). Children with lower liking ratings at baseline showed the greatest increases in acceptance between baseline and postexposure (P = 0.01). CONCLUSIONS Children's acceptance of SQ-LNS increased with repeated exposure, whether offered the sweetened or unsweetened version, providing preliminary support that adding sugar to SQ-LNS may not improve acceptance in young children. Children who initially like the supplement less may need repeated experience to learn to accept SQ-LNS. This trial was registered at clinicaltrials.gov as NCT04544332.
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Affiliation(s)
- Susan L Johnson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Allison L B Shapiro
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kameron J Moding
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, USA
| | - Abigail Flesher
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kathryn Davis
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jennifer O Fisher
- Department of Social and Behavioral Sciences, Center for Obesity Research and Education, Temple University, Philadelphia, PA, USA
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Ferrante MJ, Moding KJ, Bellows LL, Bakke AJ, Hayes JE, Johnson SL. Examining Front-of-Package Product Names and Ingredient Lists of Infant and Toddler Food Containing Vegetables. J Nutr Educ Behav 2021; 53:96-102. [PMID: 33573771 DOI: 10.1016/j.jneb.2020.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To investigate the alignment between vegetables and fruits listed in the ingredients of commercially produced infant and toddler food (ITF) and inclusion in front-of-package product names. DESIGN A database of commercial ITF containing vegetables (n = 548) was created. Inclusion of each vegetable or fruit in the product name (yes/no), form (ie, whole/puree, juice/juice concentrate, etc), and ingredient list position (ie, first, second) were recorded. Vegetables were classified per US Department of Agriculture categories; fruits were classified into 2 categories. ANALYSIS Chi-square tests of association tested associations between product name inclusion and (1) vegetable and fruit category, (2) form, and (3) form by category. RESULTS Associations were observed between vegetable and fruit categories and inclusion in product names [χ2 (6, N = 1,462) = 70.3, P < 0.001]. Vegetables in the US Department of Agriculture dark green category were more likely to appear in product names (94%; standardized residual [SR] = 2.1), as were other vegetables (62%; SR = 4.9). Vegetable and fruit forms were associated with inclusion in product name [χ2 (4, N = 1,462) = 206.6, P < 0.001]. Juice/juice concentrates were less likely to be included in names (32.4%; SR = -5.4). CONCLUSIONS AND IMPLICATIONS Substantial discrepancies exist between ITF ingredient lists and front-of-package product names. When only front-of-package information informs purchases, caregivers may not be purchasing products that facilitate children's building of vegetable preferences.
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Affiliation(s)
- Mackenzie J Ferrante
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Kameron J Moding
- Department of Human Development & Family Studies, Purdue University, West Lafayette, IN
| | - Laura L Bellows
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Alyssa J Bakke
- Department of Food Science, Pennsylvania State University, University Park, PA
| | - John E Hayes
- Department of Food Science, Pennsylvania State University, University Park, PA
| | - Susan L Johnson
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO.
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Johnson SL, Moding KJ. Introducing Hard-to-Like Foods to Infants and Toddlers: Mothers' Perspectives and Children's Experiences about Learning to Accept Novel Foods. Nestle Nutr Inst Workshop Ser 2020; 95:88-99. [PMID: 33181514 DOI: 10.1159/000511515] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/03/2020] [Indexed: 01/20/2023]
Abstract
Children reportedly consume a variety of adequate vegetables during the introduction of complementary foods, and breastfeeding helps to facilitate child food acceptance. However, dietary intake of vegetables is reported to fall when children begin to eat foods of the family table. In laboratory settings, repeated exposure is effective in promoting children's acceptance and consumption of novel foods. We have recently explored mother and child early experiences (from infancy to toddlerhood) with offering hard-to-like foods. Our findings suggest a "sweet spot" for food introduction and acceptance during the early complementary feeding period (6-12 months) with increasing variability in acceptance and negative child behaviors occurring during toddlerhood. When queried, most mothers are familiar with repeated exposure concepts, but their persistence in continuing to offer disliked foods differs. Some report they will "never give up" - a stance linked to health beliefs and that children should "eat what we eat." Others seem more influenced by children's resistance and food dislikes, and the amounts their child eat. The majority believe that children's tastes change and that their child will accept rejected foods later. These mothers may reoffer a rejected food after "a break." Opportunities exist to translate repeated exposure paradigms to practical methods mothers can successfully adopt in the home.
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Affiliation(s)
- Susan L Johnson
- Children's Eating Laboratory, Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA,
| | - Kameron J Moding
- Department of Human Development and Family Studies, Purdue University, West Lafayette, Indiana, USA
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Hepworth AD, Moding KJ, Stifter CA. A laboratory-based assessment of mother-child snack food selections and child snack food consumption: Associations with observed and maternal self-report of child feeding practices. Food Qual Prefer 2020; 83. [PMID: 32483400 DOI: 10.1016/j.foodqual.2020.103898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study explored how mothers' observed and self-reported child feeding practices (child control over food choices, encouragement of balance and variety, and teaching about nutrition) were associated with mother-child snack food selections and child snack food consumption in a laboratory setting. Mothers (N = 107) and their 4.5-year-old children (52% female) selected up to 5 snack foods (out of 9 snack foods: 6 higher-energy-density [ED] and 3 lower-ED) for optional child consumption throughout a one-hour laboratory visit. Mothers' in-the-moment child feeding practices during the snack food selection task were coded using observational coding schemes, and mothers' global child feeding practices (i.e., across meals and snacking occasions) were self-reported using the Comprehensive Feeding Practices Questionnaire (Musher-Eizenman & Holub, 2007). Results of multiple linear regression analyses with covariates showed that higher-ED snack food selections were positively associated with observed child control over food choices (B = 0.35, SE = 0.12, p = .006) and self-reported teaching about nutrition (B = 0.49, SE = 0.19, p = .010), and negatively associated with self-reported encouragement of balance and variety (B = -0.66, SE = 0.24, p = .007). Lower-ED snack food selections were positively associated with self-reported encouragement of balance and variety (B = 0.53, SE = 0.20, p = .008). Child consumption of higher-ED or lower-ED snack foods were not significantly associated with mothers' child feeding practices (observed or self-reported). We discuss the implications of these findings for future research on children's snack food selection and consumption.
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Affiliation(s)
- Allison D Hepworth
- University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD 21201, USA
| | - Kameron J Moding
- Purdue University, Fowler Memorial House, 1200 West State Street, West Lafayette, IN, 47907, USA
| | - Cynthia A Stifter
- Pennsylvania State University, 236 Health and Human Development Building, University Park, PA 16802, USA
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Fries LR, van der Horst K, Moding KJ, Hughes SO, Johnson SL. Consistency Between Parent-Reported Feeding Practices and Behavioral Observation During Toddler Meals. J Nutr Educ Behav 2019; 51:1159-1167. [PMID: 31540865 DOI: 10.1016/j.jneb.2019.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess whether feeding questionnaire responses reflect observed mealtime behavior. DESIGN Cross-sectional associations between self-reported and observed behaviors. SETTING Participants' homes. PARTICIPANTS Parents (n = 75) of toddlers (mean age = 24.7 months) in the US. MAIN OUTCOME MEASURES Feeding behavior questionnaires and coded videos of children's dinner meals. ANALYSIS Parents' questionnaire responses of "never" (or "rarely") considered consistent with video observation if behavior was not observed; responses of "always" (or "most of the time") if behavior observed at least once. Proportion (%) of participants observed performing each behavior was calculated for the groups of parents reporting that they "never," "sometimes," or "always" used that feeding practice. These were compared across the 3 response groups. RESULTS Parents reported 6 behaviors consistently (≥70% agreement): allowing child to eat as much as wanted, helping child eat, prompting child to eat, television/screens on during meal, nonfood rewards, and hurrying child. The remaining 8 behaviors fell below the threshold. For many behaviors, all response groups (never, sometimes, always) had similar rates of participants demonstrating the behavior. Only 5 behaviors had observed rates falling in the expected direction (frequency of always > sometimes > never). For some behaviors, the "sometimes" group had a higher (eg, clean plate) or lower (praise) frequency than the other 2 groups. CONCLUSIONS AND IMPLICATIONS Self-reported questionnaire responses predicted whether some, but not all, behaviors were observed. Parents' use of "sometimes" remains difficult to interpret as parents may use "sometimes" inconsistently across behaviors and perhaps to mitigate socially undesirable responses. Self-reports of "sometimes" performing a behavior may have limited utility for prediction of behavior and likely requires additional exploration with the respondent.
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Affiliation(s)
- Lisa R Fries
- Nestlé Research, Vers-chez-les-Blanc, Lausanne, Switzerland.
| | - Klazine van der Horst
- Applied Research & Development in Nutrition and Dietetics, Bern University of Applied Sciences
| | - Kameron J Moding
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine
| | - Sheryl O Hughes
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine
| | - Susan L Johnson
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine
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Moding KJ, Ferrante MJ, Bellows LL, Bakke AJ, Hayes JE, Johnson SL. Nutritional Content and Ingredients of Commercial Infant and Toddler Food Pouches Compared With Other Packages Available in the United States. Nutr Today 2019; 54:305-312. [PMID: 32655191 PMCID: PMC7319259 DOI: 10.1097/nt.0000000000000385] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The ingredients and nutrients of infant and toddler foods (ITFs) sold in pouches were compared with products available in other packages, such as jars/packs and other containers. Company websites (n = 21) and in-store shelf inventory (n = 3) were used to create a database of commercial ITFs containing vegetables (n = 548) sold in the United States. Results indicated that ITFs containing vegetables were most commonly packaged in pouches (50%), followed by "other" packages (25%) and jars/packs (25%). Infant and toddler food pouches contained significantly more sugars per serving and per Reference Amount Customarily Consumed, as well as a greater percentage of calories from sugars, compared with both jars/packs and "other" packages. Pouches were also more likely to contain vegetable/fruit blends, whereas jars/packs were more likely to contain single-vegetable or multivegetable blends, and "other" packages were more likely to contain vegetable/other ingredient combinations (eg, grains and/or dairy). Pouches are popular, widely available, and convenient but may not represent the vegetable profiles and nutritional qualities that parents believe they are buying for their children.
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Affiliation(s)
- Kameron J Moding
- is an assistant professor in the Department of Human Development & Family Studies at Purdue University in West Lafayette, Indiana
- is a PhD candidate in the Department of Food Science & Human Nutrition at Colorado State University in Fort Collins, Colorado
- is an associate professor in the Department of Food Science and Human Nutrition at Colorado State University in Fort Collins, Colorado
- is a research scientist and an instructor at the Pennsylvania State University in State College, Pennsylvania
- is an associate professor of food science and the director of the Sensory Evaluation Center at the Pennsylvania State University in State College, Pennsylvania
- is a professor of pediatrics at the University of Colorado Anschutz Medical Campus and the director of the Children's Eating Laboratory in Aurora, Colorado
| | - Mackenzie J Ferrante
- is an assistant professor in the Department of Human Development & Family Studies at Purdue University in West Lafayette, Indiana
- is a PhD candidate in the Department of Food Science & Human Nutrition at Colorado State University in Fort Collins, Colorado
- is an associate professor in the Department of Food Science and Human Nutrition at Colorado State University in Fort Collins, Colorado
- is a research scientist and an instructor at the Pennsylvania State University in State College, Pennsylvania
- is an associate professor of food science and the director of the Sensory Evaluation Center at the Pennsylvania State University in State College, Pennsylvania
- is a professor of pediatrics at the University of Colorado Anschutz Medical Campus and the director of the Children's Eating Laboratory in Aurora, Colorado
| | - Laura L Bellows
- is an assistant professor in the Department of Human Development & Family Studies at Purdue University in West Lafayette, Indiana
- is a PhD candidate in the Department of Food Science & Human Nutrition at Colorado State University in Fort Collins, Colorado
- is an associate professor in the Department of Food Science and Human Nutrition at Colorado State University in Fort Collins, Colorado
- is a research scientist and an instructor at the Pennsylvania State University in State College, Pennsylvania
- is an associate professor of food science and the director of the Sensory Evaluation Center at the Pennsylvania State University in State College, Pennsylvania
- is a professor of pediatrics at the University of Colorado Anschutz Medical Campus and the director of the Children's Eating Laboratory in Aurora, Colorado
| | - Alyssa J Bakke
- is an assistant professor in the Department of Human Development & Family Studies at Purdue University in West Lafayette, Indiana
- is a PhD candidate in the Department of Food Science & Human Nutrition at Colorado State University in Fort Collins, Colorado
- is an associate professor in the Department of Food Science and Human Nutrition at Colorado State University in Fort Collins, Colorado
- is a research scientist and an instructor at the Pennsylvania State University in State College, Pennsylvania
- is an associate professor of food science and the director of the Sensory Evaluation Center at the Pennsylvania State University in State College, Pennsylvania
- is a professor of pediatrics at the University of Colorado Anschutz Medical Campus and the director of the Children's Eating Laboratory in Aurora, Colorado
| | - John E Hayes
- is an assistant professor in the Department of Human Development & Family Studies at Purdue University in West Lafayette, Indiana
- is a PhD candidate in the Department of Food Science & Human Nutrition at Colorado State University in Fort Collins, Colorado
- is an associate professor in the Department of Food Science and Human Nutrition at Colorado State University in Fort Collins, Colorado
- is a research scientist and an instructor at the Pennsylvania State University in State College, Pennsylvania
- is an associate professor of food science and the director of the Sensory Evaluation Center at the Pennsylvania State University in State College, Pennsylvania
- is a professor of pediatrics at the University of Colorado Anschutz Medical Campus and the director of the Children's Eating Laboratory in Aurora, Colorado
| | - Susan L Johnson
- is an assistant professor in the Department of Human Development & Family Studies at Purdue University in West Lafayette, Indiana
- is a PhD candidate in the Department of Food Science & Human Nutrition at Colorado State University in Fort Collins, Colorado
- is an associate professor in the Department of Food Science and Human Nutrition at Colorado State University in Fort Collins, Colorado
- is a research scientist and an instructor at the Pennsylvania State University in State College, Pennsylvania
- is an associate professor of food science and the director of the Sensory Evaluation Center at the Pennsylvania State University in State College, Pennsylvania
- is a professor of pediatrics at the University of Colorado Anschutz Medical Campus and the director of the Children's Eating Laboratory in Aurora, Colorado
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Johnson SL, Ryan SM, Kroehl M, Moding KJ, Boles RE, Bellows LL. A longitudinal intervention to improve young children's liking and consumption of new foods: findings from the Colorado LEAP study. Int J Behav Nutr Phys Act 2019; 16:49. [PMID: 31159810 PMCID: PMC6547533 DOI: 10.1186/s12966-019-0808-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 05/08/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Many interventions have been conducted to improve young children's liking and consumption of new foods however their impacts on children's consumption have been limited. Consistent evidence supports the use of repeated exposure to improve liking for new foods however longitudinal effects lasting greater than 6 months often have not been demonstrated. Here we report the eating-related findings of the Colorado Longitudinal Eating And Physical Activity (LEAP) Study, a multi-component intervention, delivered primarily in the school setting, which aimed to improve children's liking and consumption of a target food via repeated exposure and positive experiential learning. METHODS Four sites in rural Colorado, each housing Head Start preschool programs, matched on state vital statistics for childhood obesity rates, (2 intervention and 2 control sites) took part in a quasi-experimental study design which included 4 time points (baseline, post-intervention, one-year [Y1] and two- year [Y2] follow ups). A total of 250 children and families were enrolled (n = 143 intervention and n = 107 control; 41% Hispanic and 69% low-income). A 12-week intervention, Food Friends - Fun With New Foods®, delivered by trained preschool teachers and which focuses on positive and repeated experiences with new foods, and a 5-month (1 unit/month) social marketing "booster program" was delivered in kindergarten (one-year follow up) and 1st grade (two-year follow up). Main outcome measures included change in children's liking for new foods, analyzed by ordinal regression using generalized estimating equations, and change in weighed consumption of new foods over time, analyzed using a hierarchical mixed effects model. RESULTS The intervention was delivered with good fidelity (87%). Both intervention and control groups demonstrated an increase in liking for the target food over time (p = 0.0001). The pattern of consumption of the target food was different, over time, for intervention and control groups (p < 0.005). In particular the change in intake between baseline and post-intervention was significantly greater in the intervention compared to the control group (p < 0.0001) though this pattern of change did not hold between baseline and Y2 follow up (p = 0.1144). Children in the intervention group who liked the target food consumed nearly double their baseline consumption at post-intervention (p < 0.0001;) and maintained this increase at Y2 follow up (p < 0.0001). CONCLUSIONS The Food Friends intervention, which utilized positive, repeated experiences with new foods, and was delivered with good fidelity by trained preschool teachers, found that larger improvements were observed in children's eating behaviors than would be expected with developmentally-based changes in eating behaviors. TRIAL REGISTRATION NUMBER This trial is registered at ClinicalTrials.gov : NCT01937481. Date registered: 09/09/2013; Retrospectively registered. Date first participant registered: 09/15/2010.
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Affiliation(s)
- Susan L. Johnson
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO USA
| | - Sarah M. Ryan
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Aurora, CO USA
| | - Miranda Kroehl
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Colorado School of Public Health, Aurora, CO USA
| | - Kameron J. Moding
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO USA
| | - Richard E. Boles
- Department of Pediatrics, Section of Nutrition, University of Colorado Anschutz Medical Campus, School of Medicine, Aurora, CO USA
| | - Laura L. Bellows
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO USA
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Ferrante MJ, Johnson SL, Miller J, Moding KJ, Bellows LL. Does a vegetable-first, optimal default strategy improve children’s vegetable intake? A restaurant-based study. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2019.01.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stifter CA, Moding KJ. Temperament in obesity-related research: Concepts, challenges, and considerations for future research. Appetite 2019; 141:104308. [PMID: 31158396 DOI: 10.1016/j.appet.2019.05.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/29/2019] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
Temperament, defined as individual differences in reactivity and regulation, has important implications for the development of childhood obesity. Indeed, numerous studies have demonstrated associations between temperament and children's eating behavior, parent feeding practices, and children's weight outcomes. Together, these findings have significantly improved our understanding of the developmental pathways to obesity-related outcomes. However, to better our understanding of the role of temperament in children's health, greater attention to how temperament is conceptualized and measured is needed. The purpose of this paper is to review the concept and principles of temperament, describe challenges in the measurement of temperament, and provide considerations for future research aimed at understanding the relationship between temperament, food intake, and childhood obesity. Moving forward, a fuller appreciation of the complexity of the temperament concept and thoughtful selection of temperament measures may help improve predictions and identify targets for interventions aimed at decreasing the risk for obesity in childhood.
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Affiliation(s)
- Cynthia A Stifter
- The Pennsylvania State University, Department of Human Development and Family Studies, 119 Health and Human Development Building, University Park, PA, 16802, USA.
| | - Kameron J Moding
- University of Colorado Denver Anschutz Medical Campus, 12631 E. 17th Ave, Mail Stop F561, Room 2600, Aurora, CO, 80045, USA.
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Abstract
OBJECTIVE Infants higher on negative reactivity and lower on regulation, aspects of temperament, have increased obesity risk. Responsive parenting (RP) has been shown to impact the expression of temperament, including the developing ability to regulate negative emotions. The aim of this analysis was to test the effects of the INSIGHT study's RP intervention designed for the primary prevention of obesity on reported and observed infant negativity and regulation. METHODS The sample included 240 mother-infant dyads randomized 2 weeks after birth to the RP intervention or a safety control intervention. Both groups received 4 home visits during the infant's first year. In the RP group, nurses delivered RP guidance in domains of sleep, feeding, soothing, and interactive play. At 1 year, mother-reported temperament was measured by a survey, and a frustration task was used to observe temperament in the laboratory. Effects of the RP intervention were tested using general linear models. RESULTS The RP intervention reduced overall reported infant negativity, driven by lower distress to limitations (p < 0.05) and faster recovery from distress (p < 0.01) in the RP group versus controls. There were no intervention effects on reported regulation or observed negativity. The intervention did increase observed regulation, particularly the use of self-comforting strategies (p < 0.05) during the frustration task. DISCUSSION An RP intervention designed for early obesity prevention affected reported infant negativity and observed regulation, outcomes that have been linked with subsequent healthy development. Interventions grounded in an RP framework have the potential for widespread effects on child health and well-being.
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Affiliation(s)
- Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY
| | - Ian M. Paul
- Pediatrics and Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Kameron J. Moding
- Department of Pediatrics/Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jennifer S. Savage
- Center for Childhood Obesity Research and Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA
| | - Emily E. Hohman
- Center for Childhood Obesity Research and Department of Nutritional Sciences, Penn State College of Health and Human Development, University Park, PA
| | - Leann L. Birch
- Department of Foods and Nutrition, University of Georgia, Athens, GA
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Stifter CA, Moding KJ. Infant temperament and parent use of food to soothe predict change in weight-for-length across infancy: early risk factors for childhood obesity. Int J Obes (Lond) 2018; 42:1631-1638. [PMID: 29463917 PMCID: PMC6066452 DOI: 10.1038/s41366-018-0006-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/18/2017] [Accepted: 11/27/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Greater weight gain in infancy is a risk factor for childhood obesity. The present study examined the interaction between infant temperament and parent use of food to soothe infant distress (FTS) as predictors of weight gain across the first 2 years of life. SUBJECTS/METHODS A total of 160 mother-infant dyads were recruited into a longitudinal study. Infant temperament was assessed by parents through a questionnaire (surgency, negativity) and by observer ratings (surgency, irritability) during a laboratory visit when infants were 6 months old. Parents also completed a 3-day infant cry diary when their children were 6 months of age to assess when they used food in response to infant cry/fuss bouts. Infant weight/length was measured in the lab at 6 and 18 months. Multiple regressions were run to test the moderating effect of FTS on weight gain. RESULTS Significant interactions were revealed for both measures of surgency and parent FTS in predicting weight gain. Surgent infants whose parents had a greater tendency to use FTS had greater weight-for-length gain in 1 year than if their parents tended to use less FTS. The interaction between observer ratings of irritability and parent FTS was also significant but in an unexpected direction. CONCLUSIONS The findings point to the role of temperament, specifically surgency, in weight gain during infancy, but only if their parents used FTS. Surgency may have evoked this feeding practice that increased their health risk.
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Affiliation(s)
- Cynthia A Stifter
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, State College, PA, USA.
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Bakke AJ, Stubbs CA, McDowell EH, Moding KJ, Johnson SL, Hayes JE. Mary Poppins was right: Adding small amounts of sugar or salt reduces the bitterness of vegetables. Appetite 2018; 126:90-101. [DOI: 10.1016/j.appet.2018.03.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 03/01/2018] [Accepted: 03/21/2018] [Indexed: 01/23/2023]
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Moding KJ, Ferrante MJ, Bellows LL, Bakke AJ, Hayes JE, Johnson SL. Variety and content of commercial infant and toddler vegetable products manufactured and sold in the United States. Am J Clin Nutr 2018; 107:576-583. [PMID: 29635494 PMCID: PMC6693381 DOI: 10.1093/ajcn/nqx079] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/18/2017] [Indexed: 12/23/2022] Open
Abstract
Background Exposure to vegetable flavors during infancy and toddlerhood is hypothesized to enhance vegetable acceptance when children transition to table foods. Objective We sought to examine the vegetable types, ingredients, and nutrient contents of vegetable-containing infant and toddler foods (ITFs) manufactured and sold in the United States. Design A database of ITFs that contain vegetables (n = 548) was compiled from websites of companies based in the United States (n = 24). Product information was recorded, including intended age or stage, ingredient lists, and selected nutrients from the Nutrition Facts label. Ingredient lists were used to categorize vegetables using the USDA vegetable categories: dark green (e.g., spinach), red and orange (e.g., carrots), starchy (e.g., green peas, corn), beans and peas (e.g., black beans), and other (e.g., green beans, beets). Furthermore, products were categorized as single-vegetable, multi-vegetable, vegetable and fruit, vegetable and meat, or vegetable and other combinations (e.g., grains and and or dairy). Nutrients were examined, including energy (kilocalories), carbohydrates, fiber, and total sugars [per serving, per 100 g, per reference amount customarily consumed (RACC), and percentage of kilocalories from sugars]. Results Of the 548 vegetable products, only 52 single-vegetable products (9.5%) were identified, none of which contained dark green vegetables or beans and peas. Red and orange vegetables most often appeared as the first ingredient (23.7%) compared to other vegetable types, such as dark green vegetables, which were rarely listed first (1.1%). Fruits were listed as the first ingredient more commonly than all vegetables (37.8%). One-way ANOVA revealed that vegetable and fruit products contained more sugars on average than did vegetable products with other ingredients, such as dairy and/or grains (all P values < 0.001). Conclusions Current available products do not provide caregivers with a sufficient variety of single-vegetable products or products containing dark green vegetables to facilitate children's subsequent acceptance of these vegetables. Guidance should include making caregivers aware of the limitations of commercial ITFs manufactured and sold in the US market.
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Affiliation(s)
- Kameron J Moding
- Department of Pediatrics/Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO,Address correspondence to KJM (e-mail: )
| | - Mackenzie J Ferrante
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Laura L Bellows
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO
| | - Alyssa J Bakke
- Department of Food Science, The Pennsylvania State University, University Park, PA
| | - John E Hayes
- Department of Food Science, The Pennsylvania State University, University Park, PA
| | - Susan L Johnson
- Department of Pediatrics/Section of Nutrition, University of Colorado Anschutz Medical Campus, Aurora, CO
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Moding KJ, Stifter CA. Does Temperament Underlie Infant Novel Food Responses?: Continuity of Approach-Withdrawal From 6 to 18 Months. Child Dev 2017; 89:e444-e458. [PMID: 28766867 DOI: 10.1111/cdev.12902] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study investigated whether temperamental approach-withdrawal underlies infants' responses to novel foods. Data were drawn from a longitudinal study of mother-infant dyads (n = 136). Approach-withdrawal responses to novel foods and novel toys were coded when infants were 6 and 12 months of age. When infants were 18 months of age, approach-withdrawal behaviors, positive affect, and negative affect were used in a latent profile analysis to identify groups of toddlers who exhibited similar responses to novelty. As predicted, novel food and novel toy responses were concurrently associated at 12 months and followed a similar developmental pattern across the 1st year. Furthermore, novel food acceptance at 12 months of age, but not 6 months, predicted greater toddler approach.
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26
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Augustine ME, Moding KJ, Stifter CA. Predicting toddler temperamental approach-withdrawal: Contributions of early approach tendencies, parenting behavior, and contextual novelty. J Res Pers 2017; 67:97-105. [PMID: 28416889 DOI: 10.1016/j.jrp.2016.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Research suggests that temperamental approach-withdrawal is subject to parenting influences, but few studies have explored how specific parenting behaviors and contextual novelty contribute to the observed pattern of effects. The present study examined associations between infant temperamental approach, mother behavior while introducing novel objects (12 months) and temperamental approach-withdrawal in toddlerhood (18 months) in a sample of 132 infants (68 males). Maternal positive affect predicted more toddler approach-withdrawal for high-approach infants and maternal stimulation predicted less toddler approach-withdrawal for low-approach infants; however, these patterns varied with intensity of novelty in both parenting and toddler outcome contexts. Thus, maternal behavior may lead to stronger associations between earlier and later measures of approach-withdrawal; however, these effects are tied to contexts of measurement.
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Moding KJ, Bellows LL, Palmer C, Johnson SL. Sustained Effects of an Intervention to Improve Willingness to Try New Foods on Preschoolers' Liking Ratings of a Target Vegetable. FASEB J 2017. [DOI: 10.1096/fasebj.31.1_supplement.432.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Claire Palmer
- University of Colorado Anschutz Medical CampusAuroraCO
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28
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Moding KJ, Stifter CA. Temperamental approach/withdrawal and food neophobia in early childhood: Concurrent and longitudinal associations. Appetite 2016; 107:654-662. [PMID: 27622985 DOI: 10.1016/j.appet.2016.09.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/06/2016] [Accepted: 09/09/2016] [Indexed: 11/19/2022]
Abstract
The purpose of the present study was to investigate whether temperamental approach/withdrawal processes were concurrently and longitudinally associated with parent ratings and behavioral observations of food neophobia at 4.5 years of age. Additionally, maternal feeding practices were examined as potential moderators of the association between toddler temperament and food neophobia. Data were drawn from a longitudinal study following individuals (n = 82) from infancy through early childhood. At 18 months of age, toddlers were observed in an unfamiliar laboratory setting with an experimenter and their reactions were coded. At 4.5 years of age, the children were again observed in an unfamiliar setting and were also offered three novel foods (lychee, nori, and haw jelly). The number of foods they refused to taste was used as a measure of behavioral neophobia. Finally, mothers reported on their child's food neophobia and temperament, as well as their own feeding practices. As expected, temperament was associated with concurrent measures of food neophobia at 4.5 years of age. Also, low approach children who exhibited high negative affect and low positive affect in response to novelty at 18 months of age had higher levels of food neophobia at 4.5 years of age compared to their peers. Furthermore, evidence emerged to show that these neophobic tendencies in low approach children were strengthened by a maternal pressuring feeding style. Collectively, the results of this study emphasize that children who have low levels of temperamental approach are at a heightened risk for developing food neophobia during childhood.
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Affiliation(s)
- Kameron J Moding
- Department of Human Development and Family Studies, 119 Health and Human Development Building, Pennsylvania State University, University Park, PA 16802, United States.
| | - Cynthia A Stifter
- Department of Human Development and Family Studies, 119 Health and Human Development Building, Pennsylvania State University, University Park, PA 16802, United States
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Doub AE, Moding KJ, Stifter CA. Infant and maternal predictors of early life feeding decisions. The timing of solid food introduction. Appetite 2015; 92:261-8. [PMID: 26025089 PMCID: PMC4499500 DOI: 10.1016/j.appet.2015.05.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 04/26/2015] [Accepted: 05/22/2015] [Indexed: 11/22/2022]
Abstract
There is limited research on the maternal and infant characteristics associated with the timing of solid food introduction. The current study examined how maternal feeding style and infant temperament independently and interactively predicted the age at which infants were introduced to solid food. Data from 115 predominately white, middle-class mothers were collected when infants were 4 and 6 months of age. The timing of solid food introduction was positively correlated with mothers' age, education, breastfeeding at 4 months, self-reported responsiveness to infants' hunger and satiety cues, and negatively correlated with mothers' pre-pregnancy body mass index (BMI), beliefs about feeding infants solid food prior to 6 months of age, and infants' temperamental motor reactivity. When controlling for maternal age, education, pre-pregnancy BMI, and milk feeding method at 4 months, the timing of solid food introduction was negatively predicted by mothers' beliefs about feeding solid food prior to 6 months of age. Exploratory interaction analyses suggested that infant temperament marginally moderated maternal feeding style in predicting the timing of solid food introduction.
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Affiliation(s)
- Allison E. Doub
- 315 Health and Human Development-East Building, The Pennsylvania State University, University Park, PA 16802, United States
| | - Kameron J. Moding
- 315 Health and Human Development-East Building, The Pennsylvania State University, University Park, PA 16802, United States
| | - Cynthia A. Stifter
- 308 Health & Human Development-East Building, The Pennsylvania State University, University Park PA 16802, United States
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30
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Stifter CA, Moding KJ. Understanding and measuring parent use of food to soothe infant and toddler distress: A longitudinal study from 6 to 18 months of age. Appetite 2015; 95:188-96. [PMID: 26164121 DOI: 10.1016/j.appet.2015.07.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 06/09/2015] [Accepted: 07/07/2015] [Indexed: 12/14/2022]
Abstract
The present study examined the development of parent use of food to soothe infant distress by examining this feeding practice longitudinally when infants were 6, 12 and 18 months of age. Two measures of feeding to soothe were obtained: parent self-report and observations of food to soothe during each laboratory visit. Demographic and maternal predictors of food to soothe were examined as well as the outcome, infant weight gain. The findings showed that the two measures of food to soothe were unrelated but did reveal similar and unique relations with predictor variables such as parent feeding style and maternal self-efficacy. Only observations of the use of food to soothe were related to infant weight gain. The findings indicate that the two measures of food to soothe may be complementary and that observations of this feeding practice may capture certain relations that are not obtained through the use of self-report.
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Affiliation(s)
- Cynthia A Stifter
- Department of Human Development and Family Studies, 119 Health and Human Development Building, The Pennsylvania State University, University Park, PA 16802, United States.
| | - Kameron J Moding
- Department of Human Development and Family Studies, 119 Health and Human Development Building, The Pennsylvania State University, University Park, PA 16802, United States
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Moding KJ, Birch LL, Stifter CA. Infant temperament and feeding history predict infants' responses to novel foods. Appetite 2014; 83:218-225. [PMID: 25173062 DOI: 10.1016/j.appet.2014.08.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/20/2014] [Accepted: 08/23/2014] [Indexed: 11/29/2022]
Abstract
The purpose of the present study was to investigate whether infant temperament and previous feeding history were associated with infants' acceptance and rejection of a novel food at 12 months of age. Mother-infant dyads (n = 89) were video-recorded during a novel food (hummus, cottage cheese) feeding task. Infants' reactions (acceptance and rejection behaviors) and maternal responsiveness and affect during the interaction were coded from the recordings by teams of coders. Mothers reported on their infants' temperamental approach via the Infant Behavior Questionnaire-Revised (IBQ-R) and their infants' feeding history (previous exposure to solid foods and exclusive breastfeeding). Regression analyses revealed that infants rated lower on approach showed less acceptance of the first offer of novel food than infants rated higher on approach. Additionally, low approach infants who were previously exposed to a greater number of solid foods showed fewer rejection behaviors in response to the later offers of food. Exclusive breastfeeding for 4 months did not appear to have an effect on acceptance or rejection. Finally, greater maternal responsiveness was related to the infants' acceptance of the new food whereas lower maternal responsiveness was associated with rejection of the novel food. These results suggest that the acceptance and rejection of new foods by infants is dependent upon their temperament and previous exposure to solid foods, as well as the manner in which mothers present the novel food.
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Affiliation(s)
- Kameron J Moding
- Department of Human Development and Family Studies, 315 Health and Human Development East Building, Pennsylvania State University, University Park, PA 16802, USA.
| | - Leann L Birch
- Department of Foods and Nutrition, 176 Dawson Hall, University of Georgia, Athens, GA 30602-3632, USA
| | - Cynthia A Stifter
- Department of Human Development and Family Studies, 315 Health and Human Development East Building, Pennsylvania State University, University Park, PA 16802, USA
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