Children's Dietary Intake Research Articles

Food Insecurity Is Associated with Higher Added Sugar and Sugar-Sweetened Beverage Intake Among Low-Income Elementary Aged Children (P04-059-19)

ObjectivesFood insecurity is adversely associated with physical and mental health and wellbeing in children. The mechanism that underlies this association is assumed to be dietary intake; however, evidence linking food insecurity to child dietary intake has been mixed. This study examined the relationship between self-reported food insecurity and dietary intake among low-income 7–12 year old children. MethodsCross-sectional data were used from TX Sprouts, a school-based cooking, gardening, and nutrition intervention in 16 central Texas schools. A sample of 680 children completed two 24-hour dietary recalls (24hDR) and a questionnaire that included an adapted version of the 5-item Child Food Security Assessment (CFSA). Four ordinal groups, High Food Security (HFS), Marginal Food Security (MFS), Low Food Security (LFS), and Very Low Food Security (VLFS), were generated based on summed scores from the CFSA. The Health Eating Index-2015 and dietary components (total energy, macronutrients, and servings of fruits, vegetables, whole grains, and sugar-sweetened beverages (SSBs)) were derived from 24hDR. Multivariate linear regression models were used to examine the associations between food security and dietary outcomes. A priori covariates included sex, age, ethnicity, and daily energy. ResultsChildren in the study were 45% male, 54% Hispanic, and had an average age of 9.3 years. Main effects of food security were significant for added sugar (P < 0.03) and SSBs (P < 0.04). Compared to children with HFS (referent), those who were LFS and VLFS consumed more added sugar (33.2 g vs. 39.9 g and 40.6 g, P < 0.03 and P < 0.003; respectively). Compared to the HFS referent group, those who were MFS and VLFS had higher mean intakes of SSBs (0.6 vs. 0.8 and 0.9 servings, P < 0.03 and P < 0.01; respectively). There were no significant associations between food security and other dietary outcomes. ConclusionsSelf-reported food insecurity among children (7–12 years of age) was associated with higher added sugar and SSB intake. Future research should assess if the positive association between food insecurity and added sugar and SSB intake contributes to adverse health outcomes. Funding SourcesThis study was supported by funding from the National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI).

The association of TV viewing during dinner meals with quality of dietary intake and BMI z-scores among low income, ethnic minority preschool children

BackgroundTV viewing has been associated with children's weight status and is thought to be mediated mostly through children's dietary intake. However, the mechanisms underlying this association are not understood. ObjectiveAssess the associations of having the TV on and the child watching TV during dinners with the dietary quality consumed at that meal and with the child's weight status. MethodsSecondary analysis of a directly-observed study of 144 preschool-aged African American and Hispanic, low-income children's dinner meals. Three home dinners were video recorded per child (428 meals observed) and what children were served and consumed measured. The Healthy Eating Index-2010 assessed dietary quality of dinners served and consumed. Child height and weight were measured and parents completed questionnaires. Videos were coded for whether the TV was on and the proportion of the dinner the child watched TV. Mixed models with meal observations nested within child assessed the associations. Results77% of children consumed at least one dinner with the TV on. The proportion of the meal the child watched TV was not associated with lower dietary quality consumed. TV on was associated with the dietary quality consumed only in the fully adjusted model (p < 0.05). The dietary quality of dinner served was most strongly associated with the dietary quality consumed (p < 0.0001). Neither having the TV on nor child watching the TV while eating were associated with the child's BMI z-score. ConclusionHaving the TV on during meals was common, but watching TV during the meal was not associated with the dietary quality of what the children consumed. Further controlled studies should evaluate if turning the TV off during dinner directly improves the dietary quality children consume at that meal.

Adaptation of a mental development assessment tool for the evaluation of the long-term effect of a successful nutrition intervention in Ghana.

This study adapted a cognitive assessment tool to be used in evaluating nutrition interventions in developing countries and assessed its reliability and validity in Ghana. The tool was used to evaluate the long-term effect of the Enhancing Child Nutrition through Animal Source Food Management (ENAM) project. The former ENAM participants' children were contacted (now 13 to 15years old). The items in the Wechsler Abbreviated Scale of Intelligence-II were adapted, pretested, refined, and pretested again. Cross-sectional data collection was conducted with former ENAM participants (60 interventions and 51 comparison families) in one of ENAM's three sites (the Guinea Savanna zone). Data on participants' socio-economic status and food insecurity were collected, along with their children's intellectual functioning, dietary intake, school attainment, anthropometry, and symptoms of depression. Alpha coefficient of the verbal subscale improved between the first and second pretest (from .34 to .80). After controlling for age, the intelligence scores of the children were associated with their grade (r=.35, p=.001) and academic performance (r=.26 to .33, p<.05). The verbal scale was associated with their anthropometry (r=.24 to .27, p<.05). The intervention children still recorded a better dietary diversity score than controls (6.8 vs 5.8, p=.0001); however, significance was lost after adjusting for confounders. There were no significant group differences in growth or intellectual functioning. The adapted Wechsler Abbreviated Scale of Intelligence-II tool performed well in evaluating adolescent intellectual functioning in rural Ghana, and there were no long-term effects of ENAM intervention on child growth and development.

Tracking of fathers’ self-efficacy for promotion of young children's healthy eating and associations with child dietary intakes

Tracking of fathers’ self-efficacy for promotion of young children's healthy eating and associations with child dietary intakes

Repeated Exposure to Low-Sodium Cereal Affects Acceptance but Does not Shift Taste Preferences or Detection Thresholds of Children in a Randomized Clinical Trial

Although salt taste preference is malleable in adults, no research to date has focused on children, whose dietary sodium intake exceeds recommended intake and whose salt taste preferences are elevated. This proof-of-principle trial determined whether 8-wk exposure to low-sodium cereal (LSC) increased children's acceptance of its taste and changed their salty and sweet taste preferences. Children (n=39; ages 6-14 y; 67% female) were randomly assigned to ingest LSC or regular-sodium cereal (RSC) 4 times/wk for 8 wk. The cereals, similar in sugar (3 g/cup compared with 2 g/cup) and energy content (100 kcal/cup) yet different in sodium content (200 mg sodium/cup compared with 64 mg sodium/cup), were chosen based on taste evaluation by a panel of children. Mothers completed daily logs on children's cereal intake. At baseline and after the exposure period, taste tests determined which cereal children preferred and measured children's most preferred amount of salt (primary outcomes), and most preferred amount of sucrose and salt taste detection thresholds (secondary outcomes). Repeated measures ANOVAs were conducted on primary and secondary outcomes, and generalized estimating equations were conducted on amount of cereal ingested at home over time. Both treatment groups accepted and ate the assigned cereal throughout the 8-wk exposure. There were no group×time interactions in salt detection thresholds (P=0.32) or amount of salt (P=0.30) and sucrose (P=0.77) most preferred, which were positively correlated (P=0.001). At baseline and after the exposure, the majority in both groups preferred the taste of the RSC relative to LSC (P>0.40). Children showed no change in salt preference but readily ate the LSC for 8 consecutive weeks. Findings highlight the potential for reducing children's dietary salt intake by incorporating low-sodium foods in the home environment without more preferred higher-salt versions of these foods. This trial was registered at clinicaltrials.gov as NCT02909764.

Featured Article: Behavior Interventions Addressing Obesity in Rural Settings: The E-FLIP for Kids Trial.

To assess the effectiveness of behavioral parent-only (PO) and family-based (FB) interventions on child weight, dietary intake, glycated hemoglobin, and quality of life in rural settings. This study was a three-armed, randomized controlled trial. Participants were children (age 8-12 years) with overweight or obesity and their parents. A FB (n = 88), a PO (n = 78) and a health education condition (HEC) (n = 83) each included 20 group contacts over 1 year. Assessment and treatment contacts occurred at Cooperative Extension Service offices. The main outcome was change in child body mass index z-score (BMIz) from baseline to year 2. Parents in all conditions reported high treatment satisfaction (mean of 3.5 or higher on a 4-point scale). A linear mixed model analysis of change in child BMIz from baseline to year 1 and year 2 found that there were no significant group by time differences in child BMIz (year 2 change in BMIz for FB = -0.03 [-0.1, 0.04], PO = -0.01 [-0.08, 0.06], and HEC = -0.09 [-0.15, -0.02]). While mean attendance across conditions was satisfactory during months 1-4 (69%), it dropped during the maintenance phase (42%). High attendance for the PO intervention was related to greater changes in child BMIz (p < .02). Numerous barriers to participation were reported. Many barriers exist that inhibit regular attendance at in-person contacts for many families. Innovative delivery strategies are needed that balance treatment intensity with feasibility and acceptability to families and providers to facilitate broad dissemination in underserved rural settings.ClinicalTrials.gov Identifier: NCT01820338.

Watching Television while Eating: Associations with Dietary Intake and Weight Status among a Diverse Sample of Young Children

BackgroundTelevision (TV) watching at family meals has been associated with poorer dietary quality and weight outcomes in children. Most research has been limited to family meals, overlooking the influence of TV at any meal. ObjectiveThis study assesses how often children are eating meals at home while watching TV, the association between child dietary intake while watching TV during meals eaten at home and whether the association depends on meal type (eg, breakfast) or child race/ethnicity, and whether the number of meals consumed while watching TV at home is associated with overall child dietary quality or weight status. DesignThe Family Matters study utilized a cross-sectional design and was conducted between 2015 and 2016. Participants/settingThree 24-hour dietary recalls were conducted on children aged 5 to 7 years (n=150; 25 each from non-Hispanic white, African American, Latino, Native American, Somali, and Hmong households). Main outcome measuresMain outcomes of this study were dietary intake at meals, overall dietary quality, and child weight status. Statistical analysis performedConditional fixed effects estimators were used to address correlated error terms to model within-person variation between TV and dietary intake and race/ethnicity differences in child dietary outcomes. ResultsTV was watched during 30% of meals eaten at home, which differed significantly by race/ethnicity (P<0.001). Although effect sizes were small, TV watching at meals was associated with unhealthier intake of some foods groups (eg, increased sugar-sweetened beverages and chips/crackers and decreased fruits), dependent on the meal occasion (eg, snacks). However, TV watching during meals at home was not significantly associated with dietary intake for other food groups. These associations did not depend on race/ethnicity. An association between number of meals consumed while watching TV with overall dietary quality or weight status was not found. ConclusionsAlthough more research is needed, results suggest TV watching while eating meals at home is relatively common, depends on race/ethnicity, and that TV watching at some meal occasions is associated with child intake of certain food groups, with a majority being unhealthy.

Parental support in promoting children\u2019s health behaviours and preventing overweight and obesity \u2013 a long-term follow-up of the cluster-randomised healthy school start study II trial

BackgroundEffects of obesity prevention interventions in early childhood are only meaningful if they are sustained over time, but long-term follow-up studies are rare. The school-based cluster-randomised Healthy School Start (HSS) trial aimed at child health promotion and obesity prevention through parental support was carried out in 31 pre-school classes (378 families) in disadvantaged areas in Sweden during 2012–2013. Post-intervention results showed intervention effects on intake of unhealthy foods and drinks, and lower BMI-sds in children with obesity at baseline. This study aimed to evaluate the long-term effectiveness 4 years post-intervention.MethodsData were collected from 215 children in March–June 2017. Child dietary intake, screen time, and physical activity were measured through parental-proxy questionnaires. Child height and weight were measured by the research group. Group effects were examined using Poisson, linear, logistic, and quantile regression for data on different levels. Analyses were done by intention to treat, per protocol, and sensitivity analyses using multiple imputation.ResultsNo between-group effects on dietary intake, screen time, physical activity, or BMI-sds were found for the entire group at the four-year follow-up. In girls, a significant subgroup-effect was found favouring intervention compared to controls with a lower intake of unhealthy foods, but this was not sustained in the sensitivity analysis. In boys, a significant sub-group effect was found where the boys in the intervention group beyond the 95th percentile had significantly higher BMI-sds compared to boys in the control group. This effect was sustained in the sensitivity analysis. Analyses per protocol showed significant intervention effects regarding a lower intake of unhealthy foods and drinks in the children with a high intervention dose compared to controls.ConclusionsFour years after the intervention, only sub-group effects were found, and it is unlikely that the HSS intervention had clinically meaningful effects on the children. These results suggest that school-based prevention programmes need to be extended for greater long-term effectiveness by e.g. integration into school routine practice. In addition, results showed that children with a high intervention dose had better long-term outcomes compared to controls, which emphasises the need for further work to increase family engagement in interventions.Trial registration ISRCTN, ISRCTN39690370, retrospectively registered March 1, 2013, http://www.isrctn.com/ISRCTN39690370.

Parental child feeding practices and their relationship with children's dietary intake and weight status in Nepal.

Background: Small children have less control over their dietary intake and parents have a major role to play in it. The aim of our study was to determine parental child feeding practices and their association with the weight status and dietary intake of the child.Design and methods: A cross-sectional study was conducted among 138 parents and preschool children attending two private schools in Kathmandu Valley, Nepal using a structured questionnaire. Parents filled in a self-report questionnaire to assess child feeding practices, perceived activity level of the child, and dietary intake at home. Child’s height and weight was measured using a standard height scale and a digital weighing scale. A digital food scale was used for measuring dietary intake.Results: Eight percent of the children were overweight and another 8% were obese. On bivariate analysis, the BMI of parents had weak, positive, and significant correlation (r=0.206, p=0.016 for fathers; r=0.307, p≤0.001 for mothers) with child’s weight status. Similarly, concern about child’s overweight had a significant, positive correlation (r=0.232, p=0.006) with the weight status of the child. Furthermore, these three independent variables were found to be significant predictors of a child’s weight status on multivariate analysis. None of the studied independent variables was associated with dietary intake.Conclusion: The study concludes that parental BMI and parental concern about the child being overweight is significantly associated with the weight status of the child.

The use of wearable cameras in assessing children's dietary intake and behaviours in China

The use of lifelogging device in dietary assessments can reduce misreporting and underreporting, which are common in the previous studies conventional methods. We performed the first study in Chinese children (primary school Grade 4) that applied the wearable cameras in assisting dietary recall. Children (n = 52) wore the wearable cameras (Narrative Clip 2) for seven consecutive days, during which they completed a 3-day 24-h dietary recall at home. Then children modified their dietary recalls at school by reviewing the photos taken by the wearable camera at school, with the assistance of the investigator, and generated the camera-assisted 24-h dietary recalls. Compared with camera-assisted dietary recalls, 8% (n = 160) and 1% (n = 11) of food items were underreported (i.e. not reported at all) and misreported (i.e. reported in an incorrect amount) by dietary recalls without camera-assistance, respectively. Dietary recalls without camera assistance underestimated daily energy intake by 149 ± 182 kcal/d (8%) in comparison to the camera-assisted dietary recalls. Foods consumed on the snacking occasions (40%) were more likely to be underreported than those consumed at main meals (P < 0.001). Beverages (37%), fruits (30%), snacks and desserts (16%) were foods most likely to be inaccurately reported. Children were satisfied with the wearable cameras, with a median score 5.0 (IQR: 5.0–5.0) for most features. Wearable cameras hold promise for improving accuracy of dietary intake assessment in children, providing rich objective information on dietary behaviours, and received high level of satisfaction and compliance of the users. Our results suggest that the accuracy of dietary recall among Chinse school-aged children could be improved by wearable camera, especially avoiding underreporting in the snacking occasions.

Brazilian Children's Dietary Intake in Relation to Brazil's New Nutrition Guidelines: a Systematic Review.

This systematic review reports the latest scientific evidence, from cross-sectional and cohort studies, describing the dietary intake of children and adolescents from Brazil. The goal of the review was to describe intakes according to Brazil's new food classification system (NOVA) which classifies foods according to the degree of processing, i.e., unprocessed/minimally processed, processed culinary ingredients, processed food, and ultra-processed food. Due to a paucity of data using the NOVA classification system, studies with other intake descriptors were included. Results using the NOVA system showed a somewhat high intake of (ultra-)processed items, than of minimally processed items. Studies using other methods of dietary assessment showed not only high intake of sources rich in fat, sugar, and sodium, most of them processed items (e.g., savory snacks and sweets) but also intake of fruit, vegetables, and whole grains. Overall, the literature was marred by inconsistencies and variation in study definitions and methods making it hard to make firm conclusions regarding the dietary intake of Brazilian children. The development of tools to evaluate the complexities of dietary intake is much needed. Such a tool needs to be accepted and adopted by numerous study groups, to describe dietary status among Brazilian children and devise the most effective, and to evaluate the success of nutrition education programs.

The Impact of a Childcare Food Service Intervention on Child Dietary Intake in Care: An Exploratory Cluster Randomized Controlled Trial.

To assess the efficacy of a food service implementation intervention designed to increase provision of foods consistent with nutrition guidelines on child consumption of fruit, vegetables, breads/cereals, meat/alternatives, dairy, and diet quality in care. Exploratory cluster randomized controlled trial. Twenty-five childcare centers in New South Wales, Australia. Three hundred ninety-five children aged 2 to 5 years. Centers were randomized to the intervention or control group. Intervention development was guided by the Theoretical Domains Framework and included securing executive support, provision of group training, resources, audit and feedback, and one-on-one support. The intervention was delivered across six months and the study was conducted between March and December 2016. Child diet was assessed by educators using a validated questionnaire modified for completion in childcare center. Data were analyzed in SAS using generalized linear mixed models adjusted for clustering. Children in the intervention group consumed significantly higher number of serves of vegetables (0.4 serves; P < .001), wholegrain cereals (0.7 serves; P = .02), and meat/alternatives (0.5 serves; P < .001), and had higher diet quality scores (10.3; P < .001). A food service intervention targeting the provision of food significantly improved child dietary intake in care. Such findings are relevant to health promotion practitioners responsible for supporting improvements in child diet.

Family environment, children's acculturation and mothers' dietary intake and behaviors among Latinas: An autoregressive cross-lagged study

BackgroundMany Latinos in the U.S. do not meet dietary recommendations for healthy eating. Family systems theory posits that the family environment affects family members' dietary behaviors. Moreover, research suggests that children's acculturation is associated with Latina mothers' dietary intake and behaviors. PurposeThis longitudinal study examined the effect of the family environment on Latina mothers’ dietary intake and behaviors. Further, we examined whether these effects differed between mothers of assimilated versus bicultural children. MethodsSecondary data were collected at three time points (baseline, and four and 10 months' post-baseline) from 162 culturally traditional and bicultural Latina mothers residing in Imperial County, California, U.S. Participants were enrolled in the delayed treatment group of a randomized controlled trial. Mothers' daily fruit, vegetable, and sugary beverages intake, percent of calories from fat, weekly away-from-home eating, and percent of weekly grocery dollars spent on fruits and vegetables were examined. The family environment was measured by family expressiveness and family interactions around food. Separate autoregressive cross-lagged models examined the effects of the family environment on dietary outcomes, adjusting for sociodemographic variables. Interactions between the family environment and children's acculturation were also tested. ResultsLess positive family interactions around food at baseline predicted more frequent away-from-home eating four months later among mothers of assimilated children. More family expressiveness at four months predicted more grocery dollars spent on fruits and vegetables at ten months among mothers of bicultural children. ConclusionsFindings suggest the importance of a positive family environment on socially-bound dietary behaviors (e.g., away-from-home eating) exhibited by the mother. Family interventions aimed at improving dietary intake and associated behaviors should promote a positive family environment around food and consider the moderating role of children's acculturation.

Influence of maternal diet on flavor transfer to amniotic fluid and breast milk and children's responses: a systematic review

Maternal diet during pregnancy and lactation may provide the earliest opportunity to positively influence child food acceptance. Systematic reviews were completed to examine the relation among maternal diet during pregnancy and lactation, amniotic fluid flavor, breast-milk flavor, and children's food acceptability and overall dietary intake. A literature search was conducted in 10 databases (e.g., PubMed, Embase, Cochrane, and CINAHL) to identify articles published from January 1980 to June 2017. Data from each included study were extracted, risk of bias assessed, evidence synthesized qualitatively, conclusion statements developed, and strength of the evidence graded. Eleven and 15 articles met a priori criteria for inclusion to answer questions related to maternal diet during pregnancy and lactation, respectively. Limited but consistent evidence indicates that flavors (alcohol, anise, carrot, garlic) originating from the maternal diet during pregnancy can transfer to and flavor amniotic fluid, and fetal flavor exposure increases acceptance of similarly flavored foods when re-exposed during infancy and potentially childhood. Moderate evidence indicates that flavors originating from the maternal diet during lactation (alcohol, anise/caraway, carrot, eucalyptus, garlic, mint) transmit to and flavor breast milk in a time-dependent manner. Moderate evidence indicates that infants can detect diet-transmitted flavors in breast milk within hours of a single maternal ingestion (alcohol, garlic, vanilla, carrot), within days after repeated maternal ingestion (garlic, carrot juice), and within 1-4 mo postpartum after repeated maternal ingestion (variety of vegetables including carrot) during lactation. Findings may not generalize to all foods and beverages. Conclusions cannot be drawn to describe the relationship between mothers' diet during either pregnancy or lactation and children's overall dietary intake.

Early educators' practices and opinions in relation to pre-schoolers' dietary intake at pre-school: case Finland.

We aimed to examine associations between early educators' feeding practices and opinions and children's dietary intake at pre-school, in a context where uniform meals are served and pre-schools are highly regulated. Cross-sectional study. Food consumption data of the children consisted of two-day food records from pre-school kept by early educators. Early educators also reported their feeding practices and opinions on pre-school food. Serving style was observed. Municipal pre-schools in Southern and Western Finland.ParticipantsPre-schoolers (n 586) aged 3-6 years and early educators (n 378). Early educators' positive opinion of the food served at pre-school and the opinion that sufficient vegetables were available for the children were positively associated with children's vegetable consumption. Early educators' role modelling and a positive opinion of the food were negatively associated with children's energy intake. Encouragement to eat fruit and vegetables was associated with higher fibre intake. Intake of added sugar was low (4·4 % of energy). Some of the feeding practices and opinions of early educators were related to healthier dietary intake (higher vegetable consumption and fibre intake) among the children. However, in some respects, the results contradicted previous findings. Overall, early educators' feeding practices and opinions contribute to children's dietary intake and should be taken into account when promoting healthy food intake among pre-school children.

Moderation of associations between maternal parenting styles and Australian pre-school children's dietary intake by family structure and mother's employment status.

To examine associations between maternal parenting style and pre-school children's dietary intake and to test whether perceived maternal time pressures, parenting arrangements and employment status influence these relationships. This cross-sectional study examined mothers' reports of their child's frequency of consumption of eight food and drink groups, including sugar-sweetened beverages (SSB), unhealthy snacks, takeaway foods, fruit and vegetables. Parenting styles were classified as authoritative, authoritarian, permissive or disengaged using two parenting dimensions (warmth and control). The moderating roles of parenting arrangements, indexed by number of parents in the home and maternal employment status, were assessed. Associations were examined using multinomial regression. Data were from the infant and child cohorts in the Longitudinal Study of Australian Children.ParticipantsChildren aged 4-5 years from both cohorts (infant: n 3607; child: n 4661) were included. Compared with children of disengaged mothers, children of authoritative mothers consumed most unhealthy foods less frequently, and fruit and vegetables more frequently. Results suggested parenting arrangements and mothers' working status may moderate associations between parenting styles and SSB, takeaway foods, takeaway snacks and fruit consumption. These findings suggest that authoritative parenting style is associated with a higher consumption of fruit and vegetables and a lower consumption of unhealthy foods among children. However, parenting arrangements and the mothers' working status may influence these relationships. Further research is required to examine the influence of other potential moderators of parenting style/food consumption relationships such as household time and resource limitations.

Growth Pattern, Resting Energy Expenditure, and Nutrient Intake of Children with Food Allergies.

Growth impairment has been reported in children with food allergies (FA). However, the available data on the dietary intake of FA children are controversial, and no data are available on their resting energy expenditure (REE). The aim of this study was to test whether REE differs between FA and healthy children. In this study, 30 FA children were matched by sex and age, with 31 healthy controls using coarsened exact matching (CEM). Their REE was measured by indirect calorimetry (IC). Energy and macronutrient intake were evaluated using a three-day dietary record. Between-group comparisons were performed by robust median regression using CEM-related weights. The association of REE with allergies was also evaluated using robust median regression models. Anthropometric measurements, REE, and nutrient intake were similar in FA children and matched controls. Taking into account the association of REE with gender and age, a statistically significant but biologically negligible association was detected between median REE and allergy status (+9% in FA children). In conclusion, we did not find any biologically relevant difference in REE, anthropometry, and dietary intake in children with FA compared to healthy children.

Evaluation of an eHealth intervention aiming to promote healthy food habits from infancy -the Norwegian randomized controlled trial Early Food for Future Health

BackgroundStrategies to optimize early-life nutrition provide an important opportunity for primary prevention of childhood obesity. Interventions that can be efficiently scaled-up to the magnitude needed for sustainable childhood obesity prevention are needed. The objective of this study was to evaluate the effects of an eHealth intervention on parental feeding practices and infant eating behaviors.MethodsThe Norwegian study Early Food for Future Health is a randomized controlled trial. Parents were recruited via social media and child health clinics during spring 2016 when their child was aged 3 to 5 months. In total 718 parents completed a web-based baseline questionnaire at child age 5.5 months. The intervention group had access to a webpage with monthly short video clips addressing specific infant feeding topics and age-appropriate baby food recipes from child age 6 to 12 months. The control group received routine care. The primary outcomes were child eating behaviors, dietary intake, mealtime routines and maternal feeding practices and feeding styles. The secondary outcomes were child anthropometry. This paper reports outcomes at child age 12 months.ResultsMore than 80% of the intervention group reported viewing all/most of the video clips addressing infant feeding topics and indicated that the films were well adapted to the child’s age and easy to understand. Children in the intervention group were served vegetables/fruits more frequently (p = 0.035) and had tasted a wider variety of vegetables (p = 0.015) compared to controls. They were also more likely to eat family breakfast (p = 0.035) and dinner (p = 0.011) and less likely to be playing or watching TV/tablet during meals (p = 0.009) compared to control-group children. We found no group differences for child anthropometry or maternal feeding practices.ConclusionsOur findings suggest that the eHealth intervention is an appropriate and feasible tool to propagate information on healthy infant feeding to Norwegian mothers. Our study also suggests that anticipatory guidance on early protective feeding practices by such a tool may increase young children’s daily vegetable/fruit intake and promote beneficial mealtime routines.Trial registrationISRCTN, ISRCTN13601567. Registered 29 February 2016, http://www.isrctn.com/ISRCTN13601567

Effect of Parental Feeding Practices (i.e., Responsive Feeding) on Children's Eating Behavior.

Child eating behaviors contribute to individual variability in weight status and are influenced by a combination of genetic and environmental factors. Feeding practices have been identified as a potentially modifiable factor that can influence children's dietary intake and eating behaviors. However, the majority of research in the field has been cross-sectional whereas more recently a bidirectional relationship between parent feeding and child eating has been proposed. The purpose of this review is to provide a summary of patterns of findings related to feeding practices that may support or undermine children's eating behaviors. The focus is specifically on eating behaviors related to appetite regulation and obesity risk. Evidence for the potential effect of nonresponsive feeding practices as well as structure-related practices is presented. In sum, there is evidence that parents' feeding practices do impact on children's eating behaviors, but children's eating behaviors also influence the feeding practices parents use. Suggestions for future research in terms of design, measures, and research questions are proposed. Future work in this area will serve to build the evidence base for targeted intervention strategies that can guide parents to feed their children in a way that optimizes child health.

Kids Nutrition and Health Study in China.

The Kids Nutrition and Health Study (KNHS) in China is part of a global research project focusing on the assessment of children's dietary intakes and eating behaviors. By analyzing data from the 2011 China Health and Nutrition Survey (CHNS), we found that most Chinese children did not consume enough nutrients, such as fiber, calcium, and vitamin D, whereas the intakes of saturated fat and sodium were excessive in 57 and 85% of children, respectively. Children from urban areas and from higher-income households were more likely to have higher micronutrient intakes and consume more animal source foods, especially dairy products, than those from rural areas and from lower-income households. The prevalence of overweight and obesity in children was higher in urban areas and higher-income families than in rural settings and those from lower-income households. We also reported that almost all children had 3 main meals (breakfast, lunch, and dinner), and 71% of them consumed snacks that contributed 10% of daily energy. Results suggested that a comprehensive approach that includes nutrition education, nutrition intervention programs targeting vulnerable populations, and promotion of physical activity is needed to improve the nutrition and health status in Chinese children.