Recommendations for a trans-European dietary assessment method in children between 4 and 14 years

Background/Objectives: The main objective of European Food Consumption Validation (EFCOVAL)-child Project is to define and evaluate a trans-European methodology for undertaking national representative dietary surveys among children in the age group of 4–14 years. In the process of identifying the best dietary assessment methodologies, experts were brought together at a workshop. The paper presents the discussion of the best available method and the final recommendations for a trans-European dietary assessment method among 4- to 14-year-old children.
Subjects/Methods: The starting point was to investigate whether the method (two non-consecutive 24-h dietary recalls (24-HDRs)) suggested for the adults in European Food Consumption Survey Method (EFCOSUM) would be usable for children in
the age group between 4 and 14 years. However, all available dietary assessment methods were included in the discussion to ensure that the final recommendation would be based on the best evidence. Six criteria were defined and used as additional
guidance in the process.
Results: The literature does not give a clear recommendation on the dietary assessment methods that are most suitable for children in the age group of 4–14 years. Nevertheless, on the basis of the literature, the recommendations were separated for preschoolers (4–6 years) and schoolchildren (7–14 years).
Conclusion: For preschoolers, two non-consecutive days of a structured food record are recommended, using a (for children adapted) picture booklet and household measures for portion-size estimation. For schoolchildren, repeated 24-HDRs are recommended, using a picture booklet and household measures for portion-size estimation. In addition, the child should bring a booklet to register what is eaten out of home. One parent should assist the schoolchild at the 24-HDR interview, and therefore face-to-face interviews are required.

Accounting for the multidimensional nature of the relationship between adult obesity and socio-economic status : the French second National Individual Survey on Food Consumption (INCA 2) dietary survey (2006–07)

The objective was to study the multidimensional nature of the relationship between adult obesity (OB) and socio-economic status (SES),
using comprehensive indices of SES taken separately or synthesised in an overall index. A nationally representative sample of adults aged
18–79 years was taken from the French second National Individual Survey on Food Consumption (INCA 2) dietary survey (2006–07).
Weight and height were measured and OB defined as BMI $ 30 kg/m². SES variables were reported in questionnaires and included
occupation, education and characteristics of household wealth. Composite indices of SES (household wealth and overall SES indices)
were computed by correspondence analysis, and relationships with OB were investigated with logistic regression analysis. In total, 11·8
(95% CI 10·1, 13·4) % of French adults were obese, without significant difference by sex. While no significant relationship was observed
in men, all SES indicators were inversely correlated to OB in women. Both education and the household wealth index were retained in the
stepwise multivariate model, confirming that different socio-economic variables are not necessarily proxies of each other regarding the OB
issue. On the other hand, ‘controlling for SES’ while including several measures of SES in multivariate models may lead to collinearity, and
thus over-adjustment. A more integrative approach may be to derive a synthetic index by including the SES factors available in a given
study. Beyond this methodological perspective, understanding how OB is related to the different dimensions of SES should help to
target the more vulnerable groups and increase the effectiveness of prevention.

Feasibility of repeated 24-h dietary recalls combined with a food-recording booklet, using EPIC-Soft, among preschoolers

Background/Objectives: This study evaluates the feasibility among preschoolers of the 224-h dietary recalls (24-HDRs) method combined with a food-recording booklet (FRB), using EPIC-Soft pc-program for the 24-HDR (the software developed to conduct 24-HDRs in the European Prospective Investigation into Cancer and Nutrition (EPIC) Study).
Subjects/Methods: A total of 20 and 25 (4- to 5-year-old) children were recruited, as a convenience sample, through worksites or day or healthcare in Denmark and Spain, respectively. One parent (or both parents together) completed two face-to-face 24- HDR, combined with an optional use of a FRB. Feasibility was evaluated by evaluation questionnaires completed by parents and interviewers.
Results: The face-to-face interviews were primarily conducted with the mothers. The FRB was used by 90% of the participants, and proxy persons, other than the parent, were also involved; involvement of proxy persons seems necessary in a majority of the recalls in both the countries.
Conclusions: The results suggest that 224-HDR with one parent combined with a FRB is feasible for registering preschoolers’ diet. An FRB and/or information from proxy persons, other than the parent, is needed for a majority of the parents. In future studies, it may be beneficial to develop the FRB more like a structured food record (FR), which might, in principle, change the method to a one-day FR method from more than a 24-HDR method. It is recommended then to further investigate the use of EPIC-Soft as a data-entry tool.

A cluster randomized controlled trial of a telephone-based parent intervention to increase preschoolers’ fruit and vegetable consumption

Background: Inadequate fruit and vegetable consumption is associated with increased chronic disease risk and represents a considerable global health burden. Despite evidence that dietary habits track from early childhood, there are few published trials of interventions attempting to increase preschoolers’ fruit and vegetable consumption.

Objective: The Healthy Habits trial aimed to assess the efficacy of a telephone-based intervention for parents to increase the fruit and vegetable consumption in their 3–5-y-old children.

Design: A cluster randomized controlled trial was conducted involving 394 parents of children aged 3–5 y recruited through local preschools. Parents allocated to the intervention received printed resources plus four 30-min telephone calls targeting aspects of the home food environment associated with children's fruit and vegetable consumption. Parents allocated to the control group received generic printed nutrition information. Children's fruit and vegetable consumption was assessed by using the Fruit and Vegetable Subscale of the Children's Dietary Questionnaire, which was administered via telephone interview at baseline and 2 and 6 mo later.

Results: Analysis of all available data showed that children's fruit and vegetable scores were significantly higher in the intervention group than in the control group at 2 mo (P < 0.001) and at 6 mo (P = 0.021). Sensitivity analysis using baseline observation carried forward showed an intervention effect at 2 mo (P = 0.008) but not at 6 mo (P = 0.069).

Conclusions: Telephone-delivered parent interventions may be an effective way of increasing children's fruit and vegetable consumption in the short term. Further investigation to determine whether the intervention effect is maintained in the longer term is recommended.

Effects of Dietary Vitamin B6 Supplementation on Fillet Fatty Acid Composition and Fatty Acid Metabolism of Rainbow Trout Fed Vegetable Oil Based Diets

Fish oil replacement in aquaculture feeds results in major modifications to the fatty acid makeup of cultured fish. Therefore, in vivo fatty acid biosynthesis has been a topic of considerable research interest. Evidence suggests that pyridoxine (vitamin B₆) plays a role in fatty acid metabolism, and in particular, the biosynthesis of LC-PUFA has been demonstrated in mammals. However, there is little information on the effects of dietary pyridoxine availability in fish fed diets lacking LC-PUFA. This study demonstrates a relationship between dietary pyridoxine supplementation and fatty acid metabolism in rainbow trout. In particular, the dietary pyridoxine level was shown to modulate and positively stimulate the activity of the fatty acid elongase and Δ-6 and Δ-5 desaturase enzymes, deduced by the whole-body fatty acid balance method. This activity was insufficient to compensate for a diet lacking in LC-PUFA but does highlight potential strategies to maximize this activity in cultured fish, especially when fish oil is replaced with vegetable oils.

Short-term food deprivation before a fish oil finishing strategy improves the deposition of n-3 LC-PUFA, but not the washing-out of C18 PUFA in rainbow trout

This study aimed to test the hypothesis that the efficiency of a finishing period can be improved by reducing the initial fat content of fish fillets, by means of a period of food deprivation. Two groups of rainbow trout (Oncorhynchus mykiss) were fed for an 18-week grow-out period on a vegetable oil-based diet (VO) or a fish oil-based diet (FO). VO fed fish were then split into two sub groups: one (VO/FO) was shifted to the FO diet for 8 weeks, whilst the other (UF/FO) was deprived of food (unfed) for 2 weeks and then fed the FO diet for the remaining 6 weeks. The control treatment (FO/FO) was represented by fish continuously fed FO. The subsequent reduction of total fat in the UF/FO treatment was then responsible for a much faster recovery towards a FO-like fatty acid profile, validating the proposed hypothesis. However, the modification of the fatty acid composition of fish fillets during the feed withholding period, coupled with the postponement of the finishing diet, resulted in only minor beneficial effects of this strategy, and the loss of potential weight gain. However, the n-3 LC-PUFA content in UF/VO fish fillets was significantly higher than fish subjected to the VO/FO treatment.

Trophic cul-de-sac, Pyrazus ebeninus, limits trophic transfer through an estuarine detritus-based food web

The importance to food-webs of trophic cul-de-sacs, species that channel energy flow away from higher trophic levels, is seldom considered outside of the pelagic systems in which they were first identified. On intertidal mudflats, inputs of detritus from saltmarshes, macroalgae or microphytobenthos are generally regarded as a major structuring force underpinning food-webs and there has been no consideration of trophic cul-de-sacs to date. A fully orthogonal three-factor experiment manipulating the density of the abundant gastropod, Pyrazus ebeninus, detritus and macrobenthic predators on a Sydney mudflat revealed large deleterious effects of the gastropod, irrespective of detrital loading or the presence of predators. Two months after experimental manipulation, the standing-stock of microphytobenthos in plots with high (44 per m²) densities of P. ebeninus was 20% less than in plots with low (4 per m²) densities. Increasing densities of P. ebeninus from low to high halved the abundance of macroinvertebrates and the average number of species. In contrast, the addition of detritus had differing effects on microphytobenthos (positively affected) and macroinvertebrates (negatively affected). Over the two-months of our experiment, no predatory mortality of P. ebeninus was observed and high densities of P. ebeninus decreased impacts of predators on macroinvertebrate abundances. Given that the dynamics of southeast Australian mudflats are driven more by disturbance than seasonality in predators and their interactions with prey, it is likely that Pyrazus would be similarly resistant to predation and have negative effects on benthic assemblages at other times of the year, outside of our study period. Thus, in reducing microphytobenthos and the abundance and species richness of macrofauna, high abundances of the detritivore P. ebeninus may severely limit the flow of energy up the food chain to commercially-important species. This study therefore suggests that trophic cul-de-sacs are not limited to the eutrophied pelagic systems in which they were first identified, but may exist in other systems as well.

Expanding children's food experiences : the impact of a school-based kitchen garden program

Objective: Evaluate achievement of the Stephanie Alexander Kitchen Garden Program in increasing child appreciation of diverse, healthy foods.

Design: Comparative 2-year study.

Setting: Six program and 6 comparison primary schools in rural and metropolitan Victoria, Australia, matched for socioeconomic status and size.

Participants: A total of 764 children in grades 3 to 6 (8–12 years of age) and 562 parents recruited. Retention rates at follow-up included 85% children and 75% parents.

Intervention: Each week of the school year, children spent 45 to 60 minutes in a garden class and 90 minutes in a kitchen class.

Phenomenon of interest: Program impact on children’s willingness to try new foods, capacity to describe foods, and healthy eating.

Analysis: Qualitative data analyzed using inductive thematic analysis. Quantitative data analyzed using random-effects linear regressions adjusted for school clustering.

Results: Child and parent qualitative and quantitative measures (if never tried before, odds ratio 2.0; confidence interval, 1.06–3.58) showed increases in children’s reported willingness to try new foods. No differences in articulation of food descriptions (program vs comparison groups). Qualitative evidence showed that the program extended its influence to healthy eating, but this was not reflected in the quantitative evidence.

Conclusions and Implications: Findings indicate program success in achieving its primary objective, meriting further program research.

ShopSmart 4 Health - protocol of a skills-based randomised controlled trial promoting fruit and vegetable consumption among socioeconomically disadvantaged women

Background
There is a need for evidence on the most effective and cost-effective approaches for promoting healthy eating among groups that do not meet dietary recommendations for good health, such as those with low incomes or experiencing socioeconomic disadvantage. This paper describes the ShopSmart 4 Health study, a randomised controlled trial conducted by Deakin University, Coles Supermarkets and the Heart Foundation, to investigate the effectiveness and cost-effectiveness of a skill-building intervention for promoting increased purchasing and consumption of fruits and vegetables amongst women of low socioeconomic position (SEP).

Methods/design
ShopSmart 4 Health employed a randomised controlled trial design. Women aged 18–60 years, holding a Coles store loyalty card, who shopped at Coles stores within socioeconomically disadvantaged neighbourhoods and met low-income eligibility criteria were invited to participate. Consenting women completed a baseline survey assessing food shopping and eating habits and food-related behaviours and attitudes. On receipt of their completed survey, women were randomised to either a skill-building intervention or a wait-list control condition. Intervention effects will be evaluated via self-completion surveys and using supermarket transaction sales data, collected at pre- and post-intervention and 6-month follow-up. An economic evaluation from a societal perspective using a cost-consequences approach will compare the costs and outcomes between intervention and control groups. Process evaluation will be undertaken to identify perceived value and effects of intervention components.

Discussion
This study will provide data to address the currently limited evidence base regarding the effectiveness and cost-effectiveness of skill-building intervention strategies aimed at increasing fruit and vegetable consumption among socioeconomically disadvantaged women, a target group at high risk of poor diets.

Towards healthy and sustainable food consumption: an Australian case study

Objective To articulate a healthy and sustainable (H&S) diet; outline key health and environmental sustainability principles that can be applied in the selection of foods for inclusion in such a diet; and describe a methodology with which to assess the availability and affordability of a H&S food basket.

Design We synthesized publically available evidence on the environmental impact of different foods from academic, government, industry and non-government sources and constructed a hypothetical H&S equivalent of the typical Australian diet. Based on this, we constructed a weekly H&S food basket for a household of two adults and two children.

Setting Australia.

Subjects Australian populations.

Results The H&S diet is based on three overarching principles: (i) any food that is consumed above a person's energy requirement represents an avoidable environmental burden in the form of greenhouse gas emissions, use of natural resources and pressure on biodiversity; (ii) reducing the consumption of discretionary food choices, which are energy-dense and highly processed and packaged, reduces both the risk of dietary imbalances and the use of environmental resources; and (iii) a diet comprising less animal- and more plant-derived foods delivers both health and ecological benefits.

Conclusions We have focused on the articulation of a H&S diet not to facilitate ‘policy drift’ to focus on individual dietary choice, but rather to provide evidence to extend dietary guideline recommendations so as to integrate environmental considerations within the scope of food and health policy advice in Australia and elsewhere.