Child Ate Research Articles

A qualitative exploration of food portion size practices and awareness of food portion size guidance in first-time parents of one- to two-year-olds living in the UK

BackgroundFood portion size guidance resources aimed at parents of young children in the UK are freely available from a number of credible sources. However, little is known about whether parents are aware of, and use, any of these resources to guide their food portioning practices.ObjectivesWe aimed to explore the food portion size practices used by first-time parents living in the UK when feeding their one- to two-year-old child, and their awareness of and views on six food portion size guidance resources.MethodsParticipants were recruited via parent Facebook groups and online parent forums. Online 1–1 semi-structured interviews were conducted, during which parents were shown images of six food portion size guidance resources to facilitate discussion. Data was analysed in NVivo 11 using a Reflexive Thematic Analysis approach.ResultsOf the 27 participants, most were women (n = 25), white (n = 18), and educated to first degree level or higher (n = 24). First-time parents mostly relied on their own judgement and “instinct” to portion foods, based on their learned experience of how much their child ate on a day-to-day basis. This experience was used alongside physical indicators of food portion size, such as the size of children’s dishware and food packaging. Most participants were unaware of any of the six food portion size guidance resources we showed them; only four had read any of the resources. Parents suggested they had previously sought advice about weaning from a range of sources (e.g. online, friends, community groups) but would be unlikely to seek out specific food portion size guidance. Parents suggested recommendations on food portion size should acknowledge and highlight parents’ perception that “every child is different”.ConclusionsExisting food portion size guidance resources for parents of young children in the UK are ineffective as they have poor reach and impact. We suggest parents should be involved in developing novel strategies to promote age-appropriate consumption and healthy weight gain in young children.

Leveraging ecological momentary assessment to understand variability in food parenting practices within a low-income racially/ethnically diverse sample of parents of preschoolers

Children's eating behaviors are shaped significantly by their home food environment, including exposure to food parenting practices. The current study leveraged ecological momentary assessment (EMA) to describe how food parenting practices used to feed preschoolers (n = 116) differed across contextual factors around eating, including type of eating occasion (i.e., meals vs. snacks), day of the week (i.e., weekend vs. weekday), who initiated the meal (parent vs. child), emotional climate of the eating occasion. Parent perceptions of how well the eating occasion went, including how well the child ate and whether the food parenting practices worked as intended were also explored. Parent use of specific food parenting practices, situated within four higher-order domains (i.e., structure, autonomy support, coercive control, indulgent), was found to differ by type of eating occasion; parents engaged in a higher proportion of structure practices at meals than at snacks. Use of specific food parenting practices differed by mealtime emotional climate; parent use of structure and autonomy support was associated with eating occasions described as relaxed, enjoyable, neutral, and fun. Finally, parent perception of how well the child ate differed by use of specific food parenting practices; during eating occasions when parent's felt their child ate “not enough”, they used less autonomy support and more coercive control compared to eating occasions where the child ate “enough and a good balance.” Leveraging EMA allowed for increased understanding of the variability in food parenting practices and contextual factors. Findings may be utilized to inform the development of larger-scale studies seeking to understand why parents choose specific approaches to feeding their children, as well as the impact of various approaches to child feeding on child health outcomes.

Fatal Rapunzel Syndrome: Gastric and Intestinal Trichobezoars in a Child With Trichotillomania.

We report a rare case of a young child, younger than10 years, who died of complications related to trichophagia and multiple gastrointestinal trichobezoars. One year before death, the child's clinical history yielded a diagnosis of iron deficiency anemia, believed to be related to poor diet, and alopecia areata, the etiology of which was unknown. Two weeks before death, the child presented with complaints of intermittent "flu-like" symptoms and vomiting. The child reported abdominal pain, anorexia, and fatigue on the night before death. The next morning, the child ate breakfast and was subsequently discovered unresponsive.On external examination, there were areas of thinning head hair. Postmortem computed tomography, magnetic resonance imaging, and internal examination revealed 3 distinct trichobezoars, occupying the stomach, jejunum, and ileum. This was complicated by small bowel obstructions and perforations due to the trichobezoars. The cause of death was peritonitis secondary to small bowel perforations due to small bowel obstruction with multiple trichobezoars. This is the first case report to demonstrate the utility of postmortem computed tomography and magnetic resonance imaging in characterizing the nature and extent of trichobezoars in a fatal case of Rapunzel syndrome.

Pica in childhood: Prevalence and developmental comorbidity

BackgroundPica is an eating disorder in which a person feels the urge to eat non-nutritious, non-food substances. It can occur at any age; however, a higher prevalence is observed among children with mental health issues and pregnant women. Recently, additional attention has been given to the role of sensory sensitivity in eating disorders.Aim of the studyTo examine the prevalence of pica in preschool children and explore the associations with increased sensory sensitivity traits and rates of internalizing and externalizing difficulties.MethodologyParents/guardians of children aged 3–6 years were asked to complete an anonymous online questionnaire containing demographic data, questions regarding the peculiarities of children's eating, sensory sensitivity. Furthermore, a Strengths and Difficulties Questionnaire was also completed. This study included 655 participants. Of those 655, 41 study participants who did not complete the questionnaire were excluded. The final sample consisted of 614 participants who had completed the questionnaire.ResultsApproximately, 3.7% of participants indicated that their child ate non-nutritious, non-food substances. Children with increased sensory sensitivity traits in response to sounds (p = 0.008), visual stimuli (p < 0.001), and skin contact (p = 0.006) ate significantly more non-nutritious non-food substances. Those who had higher scores on internalizing and externalizing difficulties had more difficulties associated with eating. Children who had increased sensory sensitivity to sounds, visual stimuli, or skin contact had significantly more internalizing difficulties (p < 0.05). There were no significant differences between higher externalizing difficulties and increased sensory sensitivity to sounds, visual stimuli, skin contact, or smells (p > 0.05).ConclusionsChildren with increased sensory sensitivity traits were more likely to eat inedible substances than those without. Furthermore, children who had increased sensory sensitivity traits were significantly more picky about food and had more internalizing difficulties. It is important for specialists to combine clinical data on the characteristics of a child's development, including sensory, eating, and emotional health aspects.

Garden Hunter

Garden Hunter

Development of Perception-Focused Nutrition Education Material for Mothers of Children in Early Childhood

Purpose: Mothers play a crucial role in shaping the eating behavior of their children. Several studies have shown that mothers misperceive the diet quality, total energy intake, and portion sizes of their children. This misperception leads to overestimation or even underestimation of their children’s dietary intake which can have a detrimental effect on their health. Mothers associate a chubby child with good health and have a lot of emotional investment related to the amount of food their child ate.
 Design/Methodology/Approach: Even though past research articles acknowledge the existence of these perceptions, nutrition education material that could target these misperceptions has not been developed. The first step was to conduct a needs assessment and the second was to develop perception-focused nutrition education material.
 Findings: Three themes were identified by conducting a needs assessment and six themes were identified by going through research articles from the past. These nine themes identified were then organized and developed into three lesson plans with specific objectives.
 Practice implications: The perception-focused nutrition education material, thus developed, can be delivered to mothers through oral and visual aids. Through our developed nutrition educational material, future researchers will be able to test the perceptions of mothers regarding their child’s diet.

The effects of school gardens on fruit and vegetable consumption at school: A randomized controlled trial with low-income elementary schools in four U.S. states

This randomized controlled trial examines the effects of a school garden intervention on children’s fruit and vegetable (FV) consumption at school over two years. We randomly assigned schools to the intervention group that received gardens and related curriculum (n = 24) or to the waitlist control group that received gardens and curriculum at the conclusion of the study (n = 22). Children in second, fourth, and fifth grade at baseline (n = 2767) in low-income schools (n = 46) in four U.S. States (Arkansas, Iowa, New York, and Washington) participated. The intervention comprised gardens for each classroom; a curriculum focused on nutrition, plant science, and horticulture, including activities and FV tasting sessions; resources for the school that addressed topics such as soil contamination and food safety; an implementation guide focused on issues related to planning, planting, and maintaining the garden through the year, engaging volunteers, summer gardening, building community capacity, and sustaining the gardening program. FV consumption was measured by photographing lunches before and after children ate, for 2–3 days, at baseline and at each of 3 subsequent periods of data collection during the intervention. FV consumption was calculated using Digital Food Image Analysis. Among children in the intervention, fruit consumption and low-fat vegetable consumption increased from pre-garden baseline to post-garden more than among control group children. Garden intervention fidelity (GIF) also predicted changes in dietary intake, with more robust interventions showing a stronger effect than weaker interventions. GIF-lessons was a particularly potent predictor of change in dietary intake. School gardens modestly increase children’s FV consumption at school.

Validation of a new scoring approach of a child dietary questionnaire for use in early childhood among low-income, Latino populations

BackgroundMeasuring diet quality in early childhood requires time-intensive and costly measurements (e.g., 24-hour diet recall) that are especially burdensome for low-income, minority populations. This study aimed to validate a new method for calculating overall diet quality among low-income, Latino preschoolers.MethodsThis study was an observational study using data from a randomized controlled trial. Participants included parents of Latino preschoolers who reported child diet quality at baseline, 4-month, 7-month, 12-month, and 13-month follow-up. At each timepoint parents responded to a 28-item child dietary questionnaire (CDQ), based on the National Health and Nutrition Examination Survey (NHANES) dietary module, which generated the number of times/day that a child ate each of 28 foods in the past month. These 28 items were then used to create a total standardized child diet quality index (possible range 0-100), using a percent of maximum method. Parents were asked to complete three 24-hour diet recalls at the 13-month follow-up, from which the 2015 Healthy Eating Index (HEI) was derived. Construct validity was evaluated by Spearman’s rank correlations between the new child diet quality index and the 2015 HEI at the 13-month follow-up. Test-retest reliability was assessed by intraclass correlation coefficients (ICC) for sequential pairs of time points.ResultsAmong 71 eligible parent-child pairs, mean child age was 4.2 (SD = 0.8) years, 50.7% of children were female, and mean child body mass index (BMI) was 17.8 (SD = 2.0) kg/m2. Mean Child Diet Quality Index was 45.2 (SD = 3.2) and mean HEI was 68.4 (SD = 10.5). Child Diet Quality Index and HEI total scores were significantly correlated (r = 0.37; p = 0.001). Test-retest ICCs were statistically significant between all sequential pairs of time points.ConclusionThe new approach for calculating a measure of overall diet quality from the previously-validated 28-item dietary questionnaire demonstrated modest construct validity. When time and resources are limited, this new measure of overall diet quality may be an appropriate choice among low-income, Latino preschoolers.Trial RegistrationThis reports presents observational data collected as a part of a clinical trial, which was registered on clinicaltrials.gov prior to participant enrollment (NCT03141151).

Alternative caregivers` role in food choices for young children in semi-urban and urban Mexico

ABSTRACT Alternative caregivers (i.e., someone besides the primary caregiver who also takes care of children) make food choices for children. This study investigated what alternative caregivers consider when making food choices for children and their perspectives on their role in making food choices to feed children. In-depth interviews were conducted with 16 alternative caregivers of children aged 1–5 years old in semi-urban and urban areas of the State of Mexico in Mexico. Interviews were recorded, transcribed, coded, and analyzed using constant comparative method. Alternative caregivers described spaces and situations that exposed children to food while under their care. Alternative caregivers who spent longer periods of time with the child described more involvement in what the child ate. Healthy or nutritious food, cost of food and affection for children were important considerations for alternative caregivers when deciding what to feed the child. Alternative caregivers had a substantial role in child feeding, decisions about cooking, and advising mothers on how to feed their children. Efforts to promote healthy food choices for children should include targeting of alternative caregivers.

Nutritional Preferences of Preschool Children for Breakfast

Background: It is stated that children who are acquainted with healthy foods early on are more likely to make healthy food choices in their lives and that parents play important roles in the devel-opment of nutritional preferences. Aim: The main purpose of the present study was to identify children's breakfast habits and what they know about this topic, and see if they transfer all this into life. Method and Material: In this study, the case study design is used because the aim is to describe and interpret from a holistic perspective children's preferences for breakfast. The study was conducted with a total of 30 children from the morning group. For one week, the children were offered a breakfast buffet containing food from each food group and what the children ate was observed. The structured individual interviews planned with 30 children were carried out with only 28 children on the grounds that two children were of Syrian origin and could not speak Turkish at an adequate level. Results: It was observed that the majority of the children (93.3%) stated that they like to have breakfast. The proportion of children who stated that they did not like to have breakfast was 3.4% while the proportion of children who were undecided was 3.3%. According to the findings obtained from the observations, the children finished all the food they put on their plates. In other words, every child tends to take as much food as he/she can eat. Conclusions: As a study conclusion, those children that stated they choose their preferred food and beverages at breakfast according to what they like know the correct foods, which they called "healthy," but do not choose them. It is thought that the reason the children gave the desired answer stems as much from the role of the researcher as it does from the wish to give an adult the "correct" answer.

Clinical case of early debut of food allergy in a child up to 6 months

Introduction: It is believed that if the child ate only a cow’s milk formula (CMF), and сow's milk allergy is the only possible at the age of <6 months. This approach leads to erroneous treatment tactics.
 Presentation of the clinical case: a child aged 3 months with the debut of atopic dermatitis (AtD) of light degree (on the scale of the assessment of the researcher IGA 2). The patient was fed on artificial with a CMF from 1,5 months. Infant was examined at the place of residence. The CMF was changed to full hydrolysis CMF and without examination. Additionally, cosmetics were applied to the skin as needed. The child was examined by an allergologist after 3-4 weeks of diet. Negative dynamics were observed. Atopic dermatitis has become moderately severe with secondary infection complications (IGA 3, 50% affected skin). Prick-tests with allergens of milk, eggs, wheat, fish were carried out. High sensitization to egg and controversial to cow’s milk was found. The results were clarified during enzyme immunoassay: IgE ovomucoid – 0.78 IU/ml (norm <0.3 IU/ml); cow's milk 0.01 kUA/ l; casein – 0.01 kUA / l (norm <0.1 kUA/l). 
 Considering the infected AtD, "hydrocortisone + natamycin + neomycin" 2 times a day was used in the therapy. Cosmetics on infected foci was canceled, while maintaining the treatment of dry unaffected skin. It is recommended to limit household contacts with eggs. After 2 weeks, the rash is residual (IGA 0-1). The cow’s milk formula was returned to the diet without exacerbations of the skin process. 
 Conclusion: The case illustrates that sensitization in children can begin and be maintained without oral ingestion of the allergen. Sensitization at the age of up to 6 months is likely with a moderate – severe recurrent course of dermatitis. A specific allergological examination can be conduct with a developed disease at an early age. Skin tests and enzyme immunoassay are applicable in infants. The appointment of a diet without examination is unreasonable and should not be used.

Abnornal connection of the left partial pulmonary vein to the innominate vein: A clinical case and literature review

Background: The left partial abnormal pulmonary venous connection is a very rare and easily missed congenital anomaly. If not handled properly, this defect can cause many serious disorders in the development of the child. Surgery to return the pulmonary vein to the left atrium is the solution to this situation.
 Methods: We report a case of a left partial abnormal pulmonary vein draining into the left innominate vein with a perimembranous ventricular septal defect that was diagnosed and operated on at the Pediatric Cardiovascular Surgery Department, Heart center, E hospital. In this case, we discuss methods of diagnosis, treatment, and review the medical literature on this abnormal form of pulmonary veins.
 Results: Female, 15 months old, history: second child, normal delivery, full-term, birth weight 3000g, no asphyxia, no cyanosis after birth; detected congenital heart from 30 weeks gestation. After birth, the child can eat, suckle, and have normal mental-motor development. Recently, the child ate poorly, had slow weight gain, went to the provincial hospital for examination, was transferred to E hospital's cardiovascular center. Ultrasound and cardiac catheterization detected perimembranous ventricular septal defect and left partial pulmonary vein abnormality. We performed a total surgical repair including patching the ventricular septal defect and transferring the pulmonary vein to the left atrium through the incision between the sternum. Postoperative echocardiography gave good results. The patient was discharged from the hospital 9 days after surgery.
 Conclusion: Surgery to transfer the pulmonary vein to the left atrium for the abnormality of the left partial pulmonary vein connection has good results.

Associations of Dietary Diversity and Socioeconomic Factors with Anthropometric Failure among Children (6 To 23 Months Old) in Sagnarigu Municipality

Background: The role of adequate nutrition in population health is widely acknowledged. The objective of the study was to determine associations of dietary diversity and socioeconomic factors with anthropometric failure among children (6 to 23 months old) in Sagnarigu Constituency. Methods: This was a cross-sectional study, which involved 231 children randomly selected from child welfare clinics within Sagnarigu Municipality. Dietary diversity of children was computed from 8 food groups based on mothers recall of foods child ate in the past 24-hour period (previous day and night) preceding the survey. Child anthropometric data were assessed based on World Health Organization’s (WHO) standard protocols. Results: From a multiple binary logistics regression analysis, children who failed to meet the minimum dietary diversity (MDDS) (1-4 food groups) compared with those who met the MDDS (5-8 food groups) had higher odds for underweight [3.54(1.18-10.60); P = 0.024), stunting [2.97(1.39-6.33); P = 0.005], and a coexistence of multiple growth faltering indicators [2.68(1.38-5.22); P = 0.004]. Also, the odds of stunting in children were higher among those whose mothers lacked formal education compared with those whose mothers had formal education [2.70(1.15-6.32); P = 0.022]. Conclusions: In the study, low MDDS was a significant predictor of stunting, underweight, and the coexistence of multiple indicators of anthropometric failure. The health management team in the Sagnarigu Constituency has to intensify education on the importance of children meeting the MDDS.

Listening to children voices in early stages of new product development through co-creation – Creative focus group and online platform

To tackle current nutritional issues like obesity, it could be valuable to involve children in the development of healthy food products that they will actively chose and enjoy. The aims of the present exploratory study were (i) to assess a methodology for early-stage idea generation through co-creation, for the development of healthy snacks with pre-adolescents, and (ii) to compare two settings, creative focus groups (CFG) and an online community (ONL). Three steps were defined to allow the gradual exploration of the topic and mutual learning throughout the process: (1) Show &Tell: photo taking and -elicitation to understand what children ate; (2) Reflect: a sorting task of the pictures to discuss and reflect on snacking practices (3) Create: an idea generation step, in which a newspaper article describing an idea for a new healthy snack was created. To increase engagement and creativity, gamification strategies were used. Our results demonstrated that children (preadolescents) can create new food product ideas with the proposed process, using enabling and creative techniques. In the CFG the trained moderator could steer the group to the co-creation goal. The setting facilitated teamwork and group learning, collaborative ideas considering preferences of peers and produced a few detailed and mostly actionable ideas. In the ONL less control over the process was possible. The setting produced many ideas varying in the degree of detail and actionability focusing on individual preferences. The feedback and observations from our study, particularly in the CFG setting, implied that the creative approach was highly engaging for participants. Further research is necessary to assess the potential of initial ideas developed by pre-adolescents.

Predictors of the amount of intake of Ready-To-Use-Therapeutic foods among children in outpatient therapeutic programs in Nairobi, Kenya.

Ready‐to‐use Therapeutic Food (RUTF) therapy is a standard protocol for treating children with severe acute malnutrition (SAM) admitted in Out‐Patient Therapeutic Programmes (OTP). The amount of RUTF to be consumed by a child is based on weight (200 kcal/kg body weight/day) as stipulated in the Kenya Integrated Management of Acute Malnutrition (IMAM) protocol for timely weight gain. There is limited information on the determinants of consumption of the correct amount of RUTF. This study sought to fill this gap by establishing the associations between the caregivers' and the child's characteristics and the amount of RUTF the child ate within a 24‐h recall period. We used a cross‐sectional study design and interviewed 200 caregivers of children 6–23 months of age admitted in four OTP centers in Nairobi Kenya. We used a researcher‐administered questionnaire to collect information from the caregivers. Seventy‐three percent of the children ate the recommended amount of RUTF. A smaller proportion (54.4%) of younger children (6–11 months of age) ate the recommended amount of RUTF compared to older children (12–17 months old and 18–23 months old at 89.1% and 82.8%, respectively). The predictors of consumption of the correct amount of RUTF were child's birth order—firstborn (AOR 29.92; 95% CI: 5.67–157.93) and children's age; 12–17 months old (AOR 5.19; 95% CI: 2.18–12.36) and 18–23 months (AOR 6.19 95% CI: 2.62), indicating that firstborn and older children were more likely to consume the correct amounts of RUTF. Caregivers' knowledge and correct practices in feeding a child with RUTF also predicted the consumption of the correct amount of RUTF. In conclusion, maternal and child characteristics are determinants of the consumption of the correct amount of RUTF by children in OTP.

Ecological Momentary Assessment of Weight-Related Behaviors in the Home Environment of Children From Low-Income and Racially and Ethnically Diverse Households: Development and Usability Study.

BackgroundEcological momentary assessment (EMA) is an innovative tool for capturing in-the-moment health behaviors as people go about their daily lives. EMA is an ideal tool to measure weight-related behaviors, such as parental feeding practices, stress, and dietary intake, as these occur on a daily basis and vary across time and context. A recent systematic review recommended standardized reporting of EMA design for studies that address weight-related behaviors.ObjectiveTo answer the call for reporting study designs using EMA, this paper describes in detail the EMA design of the Family Matters study and how it was adapted over time to improve functionality and meet the needs of a racially, ethnically, and socioeconomically diverse sample.MethodsFamily Matters is an incremental, 2-phased, mixed methods study, conducted with a racially and ethnically diverse, immigrant and refugee sample from largely low-income households, designed to examine risk and protective factors for child weight and weight-related behaviors in the home environment. The Family Matters study intentionally recruited White, Black, Hmong, Latino, Native American, and Somali parents with young children. Parents in phase 1 of the study completed 8 days of EMA on their smartphones, which included signal-contingent surveys (eg, asking about the parent’s stress at the time of the survey), event-contingent surveys (eg, descriptions of the meal the child ate), and end-of-day surveys (eg, overall assessment of the child’s day).ResultsA detailed description of EMA strategies, protocols, and methods used in phase 1 of the Family Matters study is provided. Compliance with EMA surveys and participants’ time spent completing EMA surveys are presented and stratified by race and ethnicity. In addition, lessons learned while conducting phase 1 EMA are shared to document how EMA methods were improved and expanded upon for phase 2 of the Family Matters study.ConclusionsThe results from this study provided an important next step in identifying best practices for EMA use in assessing weight-related behaviors in the home environment.International Registered Report Identifier (IRRID)DERR1-10.2196/30525

Examining the consumer restaurant environment and dietary intake in children.

Within the away-from-home food environment there is a need to account for individual exposure (e.g., frequency of visitation) to that environment. The present study examined the consumer environment in both proximal and visited restaurants and their association with childrens’ diet quality and anthropometrics. A cross-sectional analysis used baseline data from the Neighborhood Impact on Kids (NIK) study (2007–2009). Participants were 6–12-year-olds living in King County, WA and San Diego County, CA. This analysis (conducted 2019–2020) examined relationships between nearby restaurant count, Nutrition Environment Measures Survey in Restaurants (NEMS-R) within the child’s block group, and weighted NEMS-R scores based on the restaurant where the child ate most frequently in relation to child energy intake, Healthy Eating Index (HEI-2010) total score and anthropometrics. Children’s HEI-2010 scores were associated with NEMS-R scores within block groups, with children in the lowest NEMS-R tertile having significantly higher HEI scores than participants in the middle tertile. Weighted NEMS-R scores were significantly associated with waist circumference, with children in the highest NEMS-R tertile having a lower waist circumference than children in the lowest tertile. Nearby restaurant count was not associated with children’s diet quality or anthropometrics. Our findings suggest the relationship between nutrition environment and child diet and anthropometrics varied depending on how nutrition environment was defined. However, findings may be limited by the low frequency of eating out reported in this sample. Food environment measures that account for individual-level behavior are needed to better understand the influence of food environments on diet and anthropometrics

Children's Consumption Patterns and Their Parent's Perception of a Healthy Diet.

This study aims to examine children’s fruit, vegetable, and added sugar consumption relative to the Dietary Guidelines for Americans and the American Heart Association’s recommendations, as well as to compare children’s reported consumption with parental perception of the child’s overall diet quality. Data were drawn from 2 independent, cross sectional panels (2009–10 and 2014–15) of the New Jersey Child Health Study. The analytical sample included 2229 households located in five New Jersey cities. Daily consumption of fruit (cups), vegetables (cups), and added sugars (teaspoons) for all children (3–18 years old) were based on parent reports. Multivariate linear regression analyses estimated children’s adjusted fruit, vegetable, and added sugar consumption across parents’ perception categories (Disagree; Somewhat Agree; and Strongly Agree that their child eats healthy). Although only a small proportion of children meet recommendations, the majority of parents strongly agreed that their child ate healthy. Nonetheless, significant differences, in the expected direction, were observed in vegetable and fruit consumption (but not sugar) across parental perceptional categories for most age/sex groups. Dietary interventions tailored to parents should include specific quantity and serving-size information for fruit and vegetable recommendations, based on their child’s age/sex, and highlight sources of added sugar and their sugar content.

Evidence of Declining Dietary Diversity Among Children Aged 1–5 Years Between 2005 and 2017 in Lower-Income Countries

Abstract Objectives We sought to estimate trends in dietary diversity in children aged 1–5 years living in lower-income countries. We hypothesized that dietary diversity is increasing over time in this population, independent of changes in wealth. Methods We utilized 89 Demographic and Health Surveys conducted in 59 countries to cross-sectionally measure two separate outcomes, 1) the number of different types of food the child ate in the previous 24 hours (dietary diversity) and 2) the proportion of children who only ate one type of food in the previous 24 hours. We then estimated change over time across the years 2005–2017 in both a child-level analysis using negative binomial regression and logistic regression models, respectively. We also conducted a country-level analysis using a meta-analysis approach. In the child-level analysis, we tested for two separate interactions, one of year and wealth to determine if dietary diversity is changing differently depending on wealth, and one of year and place of residence (urban/rural) to determine if dietary diversity is changing differently depending on the place of residence. Results Across 59 lower-income countries, these data suggest an overall trend of decreasing dietary diversity over time, and an increase in the proportion of children who only consumed one food type in the previous 24 hours. We observed an annual decline in dietary diversity of 4% (95% confidence interval = 3.7–5.2%) among children 1–5 years of age from 2005–2017. No significant differences relative to wealth or place of residence were observed in the decline. We also observed an annual increase in the odds of a child only eating one type of food in the previous 24 hours of 5.8% (95% confidence interval = -0.5 – 12.5%) from 2005–2017. Conclusions These results suggest an unexpected decline in dietary diversity in lower income countries. The decline in dietary diversity could have significant implications for inadequate micronutrient intake of children. Although diets are thought to improve as the world's wealth increases, diet quality appears to be declining in lower income countries in some cases, concurrent with increases in wealth over this same time period. Funding Sources This research was funded through Syracuse University's Office of Undergraduate Research and Creative Engagement (SOURCE).

\u201cEveryone can take photos.\u201d Feasibility and relative validity of phone photography-based assessment of children\u2019s diets \u2013 a mixed methods study

BackgroundDietary assessment methods that are user-friendly, simple, yet valid are of interest to both researchers and participants, particularly for use in disadvantaged settings, where language barriers and low levels of education are often present. We tested if parents taking photos of what children ate, using mobile phones, would be a feasible, acceptable method that could still provide information with adequate relative validity.MethodsWe used a mixed-methods design, with parents of 21 5- to 7-year-olds from disadvantaged areas in Sweden. Parents reported all dietary intake, during non-school hours, on three days (two weekdays) using a photo method (PM). The PM consisted of simple instructions and a fiduciary card, but no training, equipment or software. Text messages could be sent if necessary. As a reference method, parents completed three 24-h recalls (24HRs) with an interviewer each following day. The next week, parents completed a 9-item semi-FFQ regarding the preceding week. The outcomes were intakes (in dl) of 9 food groups, categorised as fruits and vegetables, energy-dense sweet/salty foods, and sweet drinks. Agreement with the reference 24HRs was assessed using correlations, median differences and Bland-Altman plots. Parents completed an open-ended questionnaire on barriers and facilitators. Data collectors provided complementary information. Qualitative data was analysed using qualitative manifest analysis.ResultsNineteen parents (90%) provided complete data. The majority (n = 13) spoke Swedish as a second language, few (n = 4) were proficient. Compared to 24HRs, intakes measured by PM correlated well for all categories (Spearman’s rho = 0.609–0.845). However, intakes were underreported, significantly so for fruits and vegetables; Bland-Altman plots indicated that the underestimation was fairly constant across intake levels. When the FFQ was compared to the 24HRs, parameters of agreement were generally inferior than for the PM. Parents found the PM a positive experience, primarily facilitated by its simplicity and familiarity. Barriers, mainly related to time and logistics, can inform further methodological refinements.ConclusionsThe PM was an acceptable and feasible way to measure children’s diet outside of school hours in this population of parents from disadvantaged areas. While the absolute validity should be evaluated further, this relatively simple method has potential for assessing intakes of well-defined foods at group level.