Associations between parental concern for adolescent weight and the home food environment and dietary intake

Objective: Examine associations between parental concern about adolescent weight and adolescent perceptions of their dietary intake, home food availability, family mealtime environment, and parents' feeding practices.

Design: Cross-sectional study.

Setting: Adolescents, aged 12-15 years from 37 secondary schools in Victoria, Australia, and their parents completed surveys in 2004-2005.

Participants: 1,448 adolescent–parent pairs.

Main Outcome Measures: Parental concern about adolescent weight; adolescent perceptions of their food intake and home food environment.

Analysis: Chi-square tests, exploratory factor analysis, independent t tests (P < .01).

Results: Although 12% of parents perceived their adolescent as overweight, 27% were concerned about their adolescent's weight (under- or overweight). Adolescents of concerned parents reported lower intakes of energy-dense snacks and less home availability of these food items, and they perceived that their parents less often listened to and considered their food preferences when shopping and cooking, than did adolescents of unconcerned parents. Concerned parents were no more likely to provide fruits and vegetables in the home or a positive family mealtime environment than unconcerned parents, at least as reported by their adolescents.

Conclusions and Implications: Parental concern about adolescent weight was associated with lower intakes of energy-dense snacks among adolescents, less home availability of these food items, and less supportive parental feeding practices. Parents should be encouraged to listen to and consider their adolescents' food preferences, and provide supportive family mealtime environments and healthful food in the home.

Reducing the energy density of multiple meals decreases the energy intake of preschool-age children1,2,3

Background: The energy density (ED) of an entrée affects children's energy intake at a meal consumed ad libitum. However, the effects in children of changing the ED of meals over multiple days are unknown.

Objective: We aimed to test the effect of reducing the ED of multiple meals on the ad libitum energy intake of preschool-age children over 2 d.

Design: In this crossover study, 3- to 5-y-old children (n = 10 boys, 16 girls) were served manipulated breakfasts, lunches, and afternoon snacks 2 d/wk for 2 wk. Foods and beverages served at these meals during 1 wk were lower in ED than were those served during the other week. ED reductions were achieved by decreasing fat and sugar and by increasing fruit and vegetables. Dinner and an evening snack were sent home with children, but these meals did not vary in ED. The same 2-d menu was served in both conditions.

Results: Children consumed a consistent weight of foods and beverages over 2 d in both conditions, and therefore their energy consumption declined by 389 ± 72 kcal (14%) in the lower-ED condition, a significant decrease (P < 0.0001). Differences in energy intake were significant at breakfast on day 1, and they accumulated at manipulated meals over 2 d (P < 0.01). Intake of the nonmanipulated meals was similar between conditions.

Conclusions: Children's energy intake is influenced by the ED of foods and beverages served over multiple days. These results strengthen the evidence that reducing the ED of the diet is an effective strategy for moderating children's energy intake.

Mediators of longitudinal associations between television viewing and eating behaviours in adolescents

Background: Television viewing has been associated with poor eating behaviours in adolescents. Changing unhealthy eating behaviours is most likely to be achieved by identifying and targeting factors shown to mediate the association between these behaviours. However, little is known about the mediators of the associations between television viewing and eating behaviours. The aim of this study was to examine mediators of the longitudinal associations between television viewing (TV) and eating behaviours among Australian adolescents.
Method: Eating behaviours were assessed using a web-based survey completed by a community-based sample of 1729 adolescents from years 7 and 9 of secondary schools in Victoria, Australia, at baseline (2004-2005) and two years later. TV viewing and the potential mediators (snacking while watching TV and perceived value of TV viewing) were assessed via the web-based survey at baseline.
Results: Adolescents who watched more than two hours of TV/day had higher intakes of energy-dense snacks and beverages, and lower intakes of fruit two years later. Furthermore, the associations between TV viewing and consumption of energy-dense snacks, energy-dense drinks and fruit were mediated by snacking while watching TV. Perceived value of TV viewing mediated the association between TV viewing and consumption of energy-dense snacks, beverages and fruit.
Conclusion: Snacking while watching TV and perceived value of TV viewing mediated the longitudinal association between TV viewing and eating behaviours among adolescents. The efficacy of methods to reduce TV viewing, change snacking habits while watching TV, and address the values that adolescents place on TV viewing should be examined in an effort to promote healthy eating among adolescents.

Association between food marketing exposure and adolescents' food choices and eating behaviors

The present study examined associations between food marketing exposure and adolescents’ food choices and reported consumption of energy-dense and nutrient-poor (EDNP) foods. A cross-sectional survey of 12,188 Australian secondary students aged 12–17 years was conducted, using a web-based self-report questionnaire. Measures included students’ level of exposure to commercial television and non-broadcast types of food marketing, whether they had tried a new product or requested a product they had seen advertised, and their reported consumption of fast food, sugary drinks and sweet and salty snacks. Results indicated greater exposure to commercial television, print/transport/school food marketing and digital food marketing were all independently associated with students’ food choices. High commercial television viewers (>2 h/day) were more likely to report higher consumption of EDNP foods (ORs ranged from 1.31 for fast food to 1.91 for sweet snacks). Some associations between digital food marketing exposure and students’ eating behaviors were found; however, print/transport/school food marketing was only related to sweet snack consumption. These study results suggest that cumulative exposure to television food advertising and other food marketing sources are positively linked to adolescents’ food choices and eating behaviors. Policy changes to restrict food marketing to young people should include both television and non-broadcast media.

Breastfeeding mothers consume more vegetables and a greater variety of fruits and vegetables than non-breastfeeding peers : the influence of socioeconomic position

Aim:  This study compared the diets of breastfeeding and non-breastfeeding mothers from socioeconomically diverse regions of Melbourne to determine whether breastfeeding is a marker for healthier maternal dietary intakes.

Methods:  This cross-sectional study obtained information via self-reported questionnaire from 529 first-time Melbourne mothers. Breastfeeding status was determined when the children were 3.9 months. Diet information was obtained using a validated Food Frequency Questionnaire. Maternal diet was assessed by seven indicators: average daily intake of fruit, vegetables, non-core drinks, non-core sweet snacks, non-core savoury snacks, variety of fruit and variety of vegetables eaten in the preceding 12 months. Associations between breastfeeding status and each dietary variable were assessed using linear regression analyses. Socioeconomic position, maternal body mass index and the cluster-based sampling design were controlled for.

Results:  Of the 529 subjects, 70% were breastfeeding their child. Compared with non-breastfeeding mothers, breastfeeding mothers were found to consume more serves of vegetables (P= 0.001), a greater variety of fruit and vegetables (P= 0.001 and P≤ 0.001 respectively), and sweet snacks were consumed more frequently (P= 0.006). Differences were observed between low and high socioeconomic position mothers for fruit serves (P= 0.003), vegetable serves (P= 0.010) and fruit variety (P= 0.006). These associations persisted after controlling for socioeconomic position and maternal body mass index.

Conclusions:  The association between infant feeding (breastfeeding) and some aspects of maternal diet provides further evidence suggesting a link between maternal and child diets from a younger age than previously examined.

Socioeconomic variation in diet and activity-related behaviours of Australian children and adolescents aged 2–16 years

Background

Evidence for age-related variation in the relationship between obesity-related behaviours and socioeconomic position may assist in the targeting of dietary and physical activity interventions among children.
Objective

To investigate the relationship between different indicators of socioeconomic position and obesity-related behaviours across childhood and adolescence.
Methods

Data were from 4487 children aged 2 to 16 years participating in the cross-sectional 2007 Australian National Children's Nutrition and Physical Activity Survey. Socioeconomic position was defined by the highest education of the primary or secondary carer and parental income. Activity was assessed using recall methods with physical activity also assessed using pedometers. Intake of energy-dense drinks and snack foods, fruits and vegetables was assessed using 2 × 24-h dietary recalls.
Results

A socioeconomic gradient was evident for each dietary measure (although in age-specific analyses, not for energy-dense snacks in older children), as well as television viewing, but not physical activity. Whether each behaviour was most strongly related to parental income or education of the primary or secondary carer was age and sex dependent. The socioeconomic gradient was strongest for television viewing time and consumption of fruit and energy-dense drinks.
Conclusions

A strong socioeconomic gradient in eating behaviours and television viewing time was observed. Relationships for particular behaviours differed by age, sex and how socioeconomic position was defined. Socioeconomic indicators define different population groups and represent different components of socioeconomic position. These findings may provide insights into who should be targeted in preventive health efforts at different life stages.

Children's consumption of energy dense nutrient poor foods, fruit and vegetables; are they related? An analysis of data from a cross sectional survey

Issue addressed: Many children consume excessive amounts of energy-dense, nutrient-poor (EDNP) or 'extra' foods and low intakes of fruit and vegetables. The aim of this study was to examine the associations between EDNP foods and ascertain whether certain EDNP foods and beverages are more likely to be eaten in association with other EDNP foods.

Methods: A cross-sectional representative population survey of children in preschool (n=764), and of school students in Years K, 2 and 4 (n=1,560) and in Years 6, 8 and 10 (n=1,685) residing in the Hunter New England region of New South Wales, Australia. Dietary data were collected using a short food frequency questionnaire. Multivariate logistic regression models examined the association between EDNP foods and fruit and vegetable intake. Data were stratified by sex and age cohort.

Results: More frequent consumption of some EDNP food types was significantly associated with more frequent consumption of other EDNP foods. Fast food and soft drinks consumption were associated with each other as well as with fried potato and salty snacks; and with lower intakes of fruit and vegetables in some but not all age groups.

Conclusion: The positive associations found between EDNP foods point towards the existence of a high-risk group of children who frequently consume a variety of EDNP foods and drinks.

What to do when you can’t (afford to) collect your own data? : a test case using the longitudinal study of Australian children to investigate the influence of parental context on media use and obesity

The dramatic rise in childhood obesity prevalence in the last two decades has prompted concern about the risk factors that may precipitate or maintain weight gain, or both, in early childhood. Media use has long been implicated in policy debates in Australia, particularly around limits to advertising. However the Australian research funding ecology and dominant paradigms in Australian communication and media studies have resulted in a lack of independent, nationally representative studies upon which to base advice. Australian researchers often can’t afford to collect the kind of data they would like in order to intervene productively as policy actors. As a test case for innovative ways round this dilemma, this paper mobilises secondary data analysis methodologies to explore potential influences of parenting on children’s media use and their weight status.

The research reported here uses data from the first three waves of the Longitudinal Study of Australian Children. Results from a path model suggest that children of mothers who were less consistent in the way in which they enforce their rules were more likely to adopt unhealthy lifestyle behaviours, such as sedentary behaviour and consuming unhealthy snacks. Of the lifestyle behaviours considered, time spent watching television or DVDs was the only predictor of child weight status in late childhood. These results suggest a clear pathway linking consistent parenting and other parental practices, children’s lifestyle behaviours and weight status.

Associations between usual school lunch attendance and eating habits and sedentary behaviour in French children and adolescents

Background/Objective: Our objective was to investigate whether school lunch attendance was associated with overall eating habits and sedentary behaviour in a French sample of children and adolescents.

Subjects/Methods: Data for the study were taken from the second French cross-sectional dietary survey (INCA2-2006-07). In total, 1413 school children aged 3–17 years old were classified according to their school type and their usual school lunch attendance. Eating habits included meal regularity, dietary diversity, purchase in vending machine, snacking habits and frequency of eating in fast-foods. Two composite indices of eating habits were derived from multiple correspondence analyses. Sedentary behaviour was assessed by the average daily screen times for TV and computer. The association between school lunch attendance and each variable was tested. Multivariate association between school lunch attendance and the composite indices of eating habits and sedentary behaviours was studied.

Results: In all, 69.0% (CI95%: 64.2–73.9) of secondary school children and 63.0% (CI95%: 58.5–67.5) of pre- and elementary school children usually attended school lunch at least once a week. Pre- and elementary school children attending school lunches showed a higher dietary diversity score (P=0.02) and ate morning snacks more frequently (P=0.02). In secondary school children, attending school canteen was related to a lower rate of skipping breakfast (P=0.04) and main meals (P=0.01). In all school children, school lunch attendance was simultaneously associated with healthier overall eating habits and less sedentary behaviour.

Conclusion: In France, children attending school canteens seem to have healthier eating habits and display less sedentary behaviour, independently of their socio-economic and demographic background.

A parent-focused intervention to reduce infant obesity risk behaviors: a randomized trial

OBJECTIVE: To assess the effectiveness of a parent-focused intervention on infants’ obesity-risk behaviors and BMI.
METHODS: This cluster randomized controlled trial recruited 542 parents and their infants (mean age 3.8 months at baseline) from 62 first-time parent groups. Parents were offered six 2-hour dietitian-delivered sessions over 15 months focusing on parental knowledge, skills, and social support around infant feeding, diet, physical activity, and television viewing. Control group parents received 6 newsletters on nonobesity-focused themes; all parents received usual care from child health nurses. The primary outcomes of interest were child diet (3 × 24-hour diet recalls), child physical activity (accelerometry), and child TV viewing (parent report). Secondary outcomes included BMI z-scores (measured). Data were collected when children were 4, 9, and 20 months of age.
RESULTS: Unadjusted analyses showed that, compared with controls, intervention group children consumed fewer grams of noncore drinks (mean difference = –4.45; 95% confidence interval [CI]: –7.92 to –0.99; P = .01) and were less likely to consume any noncore drinks (odds ratio = 0.48; 95% CI: 0.24 to 0.95; P = .034) midintervention (mean age 9 months). At intervention conclusion (mean age 19.8 months), intervention group children consumed fewer grams of sweet snacks (mean difference = –3.69; 95% CI: –6.41 to –0.96; P = .008) and viewed fewer daily minutes of television (mean difference = –15.97: 95% CI: –25.97 to –5.96; P = .002). There was little statistical evidence of differences in fruit, vegetable, savory snack, or water consumption or in BMI z-scores or physical activity.
CONCLUSIONS: This intervention resulted in reductions in sweet snack consumption and television viewing in 20-month-old children.

Is socioeconomic status associated with dietary sodium intake in Australian children? A cross-sectional study

Objective To assess the association between socioeconomic status (SES) and dietary sodium intake, and to identify if the major dietary sources of sodium differ by socioeconomic group in a nationally representative sample of Australian children.

Design Cross-sectional survey.

Setting 2007 Australian National Children's Nutrition and Physical Activity Survey.

Participants A total of 4487 children aged 2–16 years completed all components of the survey.

Primary and secondary outcome measures Sodium intake was determined via one 24 h dietary recall. The population proportion formula was used to identify the major sources of dietary salt. SES was defined by the level of education attained by the primary carer. In addition, parental income was used as a secondary indicator of SES.

Results Dietary sodium intake of children of low SES background was 2576 (SEM 42) mg/day (salt equivalent 6.6 (0.1) g/day), which was greater than that of children of high SES background 2370 (35) mg/day (salt 6.1 (0.1) g/day; p<0.001). After adjustment for age, gender, energy intake and body mass index, low SES children consumed 195 mg/day (salt 0.5 g/day) more sodium than high SES children (p<0.001). Low SES children had a greater intake of sodium from processed meat, gravies/sauces, pastries, breakfast cereals, potatoes and potato snacks (all p<0.05).

Conclusions Australian children from a low SES background have on average a 9% greater intake of sodium from food sources compared with those from a high SES background. Understanding the socioeconomic patterning of salt intake during childhood should be considered in interventions to reduce cardiovascular disease.

Understanding meal patterns: definitions, methodology and impact on nutrient intake and diet quality

Traditionally, nutrition research has focused on individual nutrients, and more recently dietary patterns. However, there has been relatively little focus on dietary intake at the level of a 'meal'. The purpose of the present paper was to review the literature on adults' meal patterns, including how meal patterns have previously been defined and their associations with nutrient intakes and diet quality. For this narrative literature review, a comprehensive search of electronic databases was undertaken to identify studies in adults aged ≥  19 years that have investigated meal patterns and their association with nutrient intakes and/or diet quality. To date, different approaches have been used to define meals with little investigation of how these definitions influence the characterisation of meal patterns. This review identified thirty-four and fourteen studies that have examined associations between adults' meals patterns, nutrient intakes and diet quality, respectively. Most studies defined meals using a participant-identified approach, but varied in the additional criteria used to determine individual meals, snacks and/or eating occasions. Studies also varied in the types of meal patterns, nutrients and diet quality indicators examined. The most consistent finding was an inverse association between skipping breakfast and diet quality. No consistent association was found for other meal patterns, and little research has examined how meal timing is associated with diet quality. In conclusion, an understanding of the influence of different meal definitions on the characterisation of meal patterns will facilitate the interpretation of the existing literature, and may provide guidance on the most appropriate definitions to use.

Associations between dietary intakes of first-time fathers and their 20-month-old children are moderated by fathers' BMI, education and age

Children's learning about food is considerable during their formative years, with parental influence being pivotal. Research has focused predominantly on maternal influences, with little known about the relationships between fathers' and children's diets. Greater understanding of this relationship is necessary for the design of appropriate interventions. The aim of this study was to investigate the associations between the diets of fathers and their children and the moderating effects of fathers' BMI, education and age on these associations. The diets of fathers and their first-born children (n 317) in the Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program were assessed using an FFQ and 3×24-h recalls, respectively. The InFANT Program is a cluster-randomised controlled trial in the setting of first-time parents groups in Victoria, Australia. Associations between father and child fruit, vegetable, non-core food and non-core drink intakes were assessed using linear regression. The extent to which these associations were mediated by maternal intake was tested. Moderation of associations by paternal BMI, education and age was assessed. Positive associations were found between fathers' and children's intake of fruit, sweet snacks and take-away foods. Paternal BMI, education and age moderated the relationships found for the intakes of fruit (BMI), vegetables (age), savoury snacks (BMI and education) and take-away foods (BMI and education). Our findings suggest that associations exist at a young age and are moderated by paternal BMI, education and age. This study highlights the importance of fathers in modelling healthy diets for their children.

Food sources of total energy and nutrients among U.S. infants and toddlers: national health and nutrition examination survey 2005-2012

Understanding the dietary intakes of infants and toddlers is important because early life nutrition influences future health outcomes. The aim of this study was to determine the dietary sources of total energy and 16 nutrients in a nationally representative sample of U.S. infants and toddlers aged 0-24 months. Data from the 2005-2012 National Health and Nutrition Examination Survey were analyzed. Dietary intake was assessed in 2740 subjects using one 24-h dietary recall. The population proportion was used to determine the contribution of foods and beverages to nutrient intakes. Overall infant formulas and baby foods were the leading sources of total energy and nutrients in infants aged 0-11.9 months. In toddlers, the diversity of food groups contributing to nutrient intakes was much greater. Important sources of total energy included milk, 100% juice and grain based mixed dishes. A number of foods of low nutritional quality also contributed to energy intakes including sweet bakery products, sugar-sweetened beverages and savory snacks. Overall non-flavored milks and ready-to-eat cereals were the most important contributors to micronutrient intakes. In conclusion this information can be used to guide parents regarding appropriate food selection as well as inform targeted dietary strategies within public health initiatives to improve the diets of infants and toddlers.

Characterizing eating patterns: a comparison of eating occasion definitions

BACKGROUND: To date, many approaches have been used to define eating occasions (EOs). A standard definition for EOs is required to facilitate further research. OBJECTIVE: In this study, we examined the influence of differing definitions of EOs on the characterization of eating patterns. DESIGN: Cross-sectional dietary data from two 24-h recalls collected during the 2011-12 Australian National Nutrition and Physical Activity Survey (n = 5242 adults, aged ≥19 y) were analyzed. Eight definitions were applied: participant-identified, time-of-day, and 6 neutral definitions (individual EOs separated by different time intervals and/or an additional energy criterion of 210 kJ). Frequency of and total energy intake from meals, snacks, and all EOs were estimated, as appropriate. Differences were tested by using F tests, stratified by sex and age group. Agreement between different definitions of meal and snack frequencies was assessed by using intraclass correlation coefficients (ICCs). For each definition, linear regression was used to estimate the proportion of variance in total energy intake (kJ) and amount of food intake (g) predicted by frequency of EOs and meals and snacks. RESULTS: Among both sexes and across all age groups, mean frequencies of meals differed between the participant-identified and time-of-day definitions (mean difference range = 0.1-0.3; P < 0.001). There were statistically significant differences between mean frequencies of EOs across the 6 neutral definitions (P < 0.001). There was good agreement for snacks (men: ICC = 0.89; women: ICC = 0.87) but not meal frequencies (men: ICC = 0.38; women: ICC = 0.36) between the participant-identified and time-of-day definitions. The neutral definition (15-min time interval plus energy criterion) best predicted variance in total energy intake (R(2) range = 19.3-27.8). CONCLUSIONS: Different approaches to the definition of EOs affect how eating patterns are characterized, with the neutral definition best predicting variance in total energy intake. Further research that examines how different EO definitions affect associations with health outcomes is needed to develop consensus on a standard EO definition.