Children's Diet Quality Research Articles

Complementary feeding and food-group level inequality among Ethiopian children 6-23 months of age (2011-2019).

Ensuring diet quality in the first 2 years of life is critical to preventing malnutrition and instilling healthy food preferences. Children's diet quality has changed little over time and inequalities by socioeconomic status, rural-urban residence, but also by food group may exist. Using data from the 2011, 2016 and 2019 demographic and health surveys (DHS), we estimated the prevalence and inequalities in the minimum diet diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). We further assessed food group-level inequities. In 2019, only 13.5% of children 6-23 months of age met the MDD, 55% met the MMF and only 11% met the MAD indicator. Absolute and relative measures of inequality were calculated. Modest increases in MDD, MMF and MAD were observed over the past decade (2011-2019). These modest improvements were concentrated in limited geographical areas, among children in wealthier households, and urban residents. Unhealthy practices such as bottle-feeding and zero fruit and vegetables have been increasing; whereas, inequities in the consumption of nutrient-dense foods have widened. Nevertheless, children from the wealthiest quintile also failed to meet the MDD. Multisectoral efforts that span from diversifying the food supply, regulating the marketing of unhealthy foods, and promoting minimal processing of perishables (i.e., to extend shelf-life) are needed. Context-adapted behavioural change communication along with nutrition-sensitive social protection schemes are also needed to equitably improve the diet quality of children in Ethiopia.

Pathways linking maternal mental health and child health in a dual burden context: Evidence from Galapagos, Ecuador

Research in low-and-middle income countries links maternal depression to child undernutrition; conversely, maternal depression is a risk factor for child overweight in higher income settings. Less is known about impacts of maternal mental health in dual burden contexts or the environmental and behavioral pathways linking maternal mental health to child health outcomes. Consequently, we examine the association between maternal mental health and the dual burden of undernutrition/infectious disease and overweight/obesity in children and test whether pathogenic, dietary and caregiving exposures mediate this association. Data come from 113 mothers and their 204 children, aged 2 weeks to 15 years, participating in the Healthy Families Study in Galapagos, Ecuador from July 2018 to May 2019, with mental health, anthropometry, diet and household environmental measures. Path analyses were used to test for direct and indirect effects of maternal distress on the likelihood of children experiencing the dual burden. We found that maternal distress is directly associated with a greater risk of having a child in the household with the dual burden with significant indirect paths through the emotional climate of the household and child diet quality. Maternal distress also moderated the impact of exposure to pathogens and diet quality. Our results highlight the need to understand how maternal distress may shape care practices in environments that present challenges for mothers in acquiring adequate resources and support needed to promote healthy child growth.

Dairy Animal Ownership and Household Milk Production Associated with Better Child and Family Diet in Rural Nepal during the COVID-19 Pandemic.

The economic and health crises related to the COVID-19 pandemic raised considerable concern about child and family diet, especially among small-holder farming households in low- and middle-income countries (LMIC). In rural Nepal, 309 families (including 368 children aged 6–66 months) were enrolled pre-COVID-19 in a prospective study of a nutrition education intervention and family milk consumption. The intervention could not be implemented due to COVID-19; however, child and family diet was assessed in three household surveys (one before and two during the pandemic). Over time, after adjusting for child and household factors, child and family diet quality declined (reduced diet diversity, consumption of milk and animal-source-foods (ASF)). However, in dairy-animal-owning (vs. non-dairy-animal-owning) households, both children and family were more likely to consume milk (aOR respectively 2.88× (p < 0.05), 5.81× (p < 0.001)). Similarly, in households producing >3.5 L/d milk (vs. ≤3.5 L/d), children and family members were more likely to consume milk (respectively 7.45× and 11.88× (both p < 0.001)). Thus, the overall decline in child and family diet quality, especially related to milk consumption, was buffered independently by household ownership of ≥1 dairy animals (cow or buffalo) and by milk production >3.5 L/day. A better understanding of these protective factors might facilitate the development of interventions to promote resilience in future crises.

Children with functional abdominal pain disorders successfully decrease FODMAP food intake on a low FODMAP diet with modest improvements in nutritional intake and diet quality.

We sought to determine how a low fermentable oligosaccharide, disaccharide, monosaccharide, and polyol (FODMAP) diet (LFD) affected high FODMAP food intake, nutrient intake, and diet quality in children with functional abdominal pain disorders (FAPD). Children (ages 7-13years) with Rome IV FAPD began a dietitian-guided LFD. Three-day food records were captured at baseline and 2-3weeks into the LFD. Intake of high FODMAP foods, energy, macronutrients, micronutrients, food groups, and ultra-processed foods were determined. Median age of participants was 11years, and 19/31 (61%) were female. Twenty-eight (90%) decreased high FODMAP food intake on the LFD: overall median (25-75%) high FODMAP foods/day decreased from 5.7 (3.6-7.3) to 2 (0.3-3.7) (p<0.001). A more adherent subset (n=22/71%) of participants consumed on average ≤3 high FODMAP foods per day during the LFD. Baseline nutritional intake and quality were generally poor with several micronutrient deficiencies identified. Diet quality improved on the LFD with increased servings of vegetables and protein and decreased consumption of ultra-processed foods, trans-fatty acids, and added sugars. On the LFD, there were significant decreases in total carbohydrates and thiamin (remained within recommended intake) and significant increases in vitamin B6 (p=0.029), vitamin C (p=0.019), and vitamin E (p=0.009). Children more adherent to the LFD further increased vitamin D, magnesium, potassium, and fat servings. The majority of children with FAPD on a dietitian-led LFD successfully decreased high FODMAP food intake. Children with FAPD on the LFD (vs. baseline) modestly improved micronutrient intake and diet quality.

Nutritional health status: association of stunted and wasted children and their mothers

BackgroundAcross the globe, 149 and 49 million children are stunted and wasted, respectively. Prevalence of stunting and wasting is 40.2 and 17.7% in children of Pakistan. Stunting and wasting are accompanied with genetics, dietary factor, lack of information, bottle feeding, illiterate parents, less birth interval, infection such as diarrhoea, low birth weight, mother suffering from malnutrition during pregnancy, breastfeeding, pharmaceutical, and hormonal, psychosocial, and low social-economic status.MethodsStunted and wasted children and their mothers were called on and detail discussions related to research plan were carried out. Informed consent was assured from mothers, for participation in the study. The demographics, anthropometrics, vital signs observations, body composition, clinical signs and symptoms, dietary intake and associated biomarkers (CBC, level of urea nitrogen in blood, serum albumin globulin and serum creatinine.) were tools for nutritional health status assessment. SPSS software was implied on data.ResultsThe study found that 27.2% mothers were belonged to stunted children, 17.3% belonged to wasted children, and 50.9% belonged to those children who were suffering from both stunting and wasting condition.57.9% mothers who were illiterate belong to stunted and wasted children. CBC and Hb test was prominent, stunted and wasted children had Hb 9.88 mg/dL, whereas, their mothers had 10.8 mg/dL as average Hb. The average height and weight of stunted and wasted children was 68.6 cm and 7.11 kg respectively. Dietary patterns and diet quality of both mothers and children were poor, due to lack of affordability; they were not able to eat healthy food.ConclusionStunting and wasting ultimately resulted in poor growth and development of children. Most of children were anemic, they height and weight less than WHO growth standards. They had less knowledge and poor intake of food diet pattern so children growth was poor.

Parental Feeding Practices in Families Experiencing Food Insecurity: A Scoping Review

Parental feeding practices and styles influence child diet quality and growth. The extent to which these factors have been assessed in the context of disadvantage, particularly household food insecurity (HFI), is unknown. This is important, as interventions designed to increase responsive practices and styles may not consider the unique needs of families with HFI. To address this gap, a scoping review of studies published from 1990 to July 2021 in three electronic databases was conducted. A priori inclusion criteria were, population: families with children aged 0–5 years experiencing food insecurity and/or disadvantage; concept: parental feeding practices/behaviours/style; and context: high income countries. The search identified 12,950 unique papers, 504 full-text articles were screened and 131 met the inclusion criteria. Almost all the studies (91%) were conducted in the United States with recruitment via existing programs for families on low incomes. Only 27 papers assessed feeding practices or styles in the context of HFI. Of the eleven interventions identified, two assessed the proportion of participants who were food insecure. More research is required in families outside of the United States, with an emphasis on comprehensive and valid measures of HFI and feeding practices. Intervention design should be sensitive to factors associated with poverty, including food insecurity.

CORRELATION BETWEEN APPETITIVE TRAITS AND DIET QUALITY OF YOUNG CHILDREN IN NORTH JAKARTA

exist in the literature examining appetitive traits and diet quality among children. Therefore, this study aimed to assess the correlation between appetitive traits and diet quality among children aged 2-6 years in North Jakarta. This cross-sectional study was conducted in Pejagalan village, North Jakarta. A total of 263 subjects were included in this study. Data collection was performed from January to April 2020. Children’s appetitive trait was measured using a validated child eating behaviour questionnaire (CEBQ), and the Diet Quality Index-International (DQII) was used to calculate diet quality scores in children. Most subjects had a DQII score below 60, indicating that the diet quality in children was classified as poor. Based on the CEBQ score, desire to drink, emotional undereating and satiety responsiveness were the common traits in our subjects. Using the Spearman test, we found that emotional overeating was negatively correlated with children’s diet quality score (r = -0.13, p-value &lt; 0.05). Linear regression models showed that food responsiveness was a positive predictor of the ‘variety’ component (β = 0.16, p-value &lt; 0.05), and satiety responsiveness was found as a positive predictor of the moderation component of diet quality (β = 0.17 p-value &lt; 0.05). These findings suggest the potential use of tools, such as the children's emotional overeating assessment, food responsiveness and satiety responsiveness assessments, to identify the risk of poor diet quality and plan an integrated intervention for dietary improvement among children.

A multi-component tailored intervention in family childcare homes improves diet quality and sedentary behavior of preschool children compared to an attention control: results from the Healthy Start-Comienzos Sanos cluster randomized trial

BackgroundChildcare settings are important environments for influencing child eating and physical activity (PA). Family childcare homes (FCCH) care for many children of low-income and diverse racial/ethnic backgrounds who are at greater risk for poor diet quality, low PA, and obesity, but few interventions have targeted this setting. The aim of this study was to assess the efficacy of a multicomponent intervention conducted in FCCH on the diet quality and PA of 2–5 year old children in their care.Trial designCluster randomized trial.MethodsThe cluster-randomized trial, Healthy Start/Comienzos Sanos (2015–2019) evaluated an 8-month nutrition and PA intervention that included four components: (1) monthly telephone calls from a support coach using brief motivational interviewing, (2) tailored reports, newsletters and videos, (3) group support meetings, and (4) active play toys. After completing baseline measurement, FCCH were randomized into intervention or comparison groups in matched pairs. Both groups received the same intervention components but on different topics (intervention: nutrition/PA vs. comparison: reading readiness/literacy). Evaluation staff were blinded to group assignment. Child primary outcome measures collected at baseline and 8-months included: 1) Healthy Eating Index (HEI-2015) scores calculated from diet observation, and 2) accelerometer measurement of PA. Process measures were collected from field data and provider surveys. Generalized Estimating Equation Models assessed changes in HEI-2015 scores and PA over time by experimental condition.ResultsEthnically diverse FCCH providers (n = 119) and 2-to-5-year-old children in their care (n = 377) were included in the final analysis. Process evaluation showed high participation in all intervention components except for group meetings. Compared to children in comparison group FCCH, children in intervention FCCH increased total HEI-2015 scores by 7.2 points (p < .001) including improvement in component scores for vegetables (0.84 points, p = .025) and added sugar (0.94 points, p = .025). For PA, compared to children in the comparison group, children in intervention FCCH decreased sedentary time by 5.7% (p = .021).ConclusionsThe multicomponent Healthy Start intervention was effective in improving diet quality and sedentary behavior of children in FCCH, which demonstrates the promise of obesity prevention interventions in this setting. Future research could include enhancing the Healthy Start intervention to strengthen the PA component, considering virtual peer support, and determining how to best translate and disseminate the intervention into FCCH nationally.Trial registrationNational Institutes of Health, NCT02452645. Registered 5 May 2015.

Frequency of family meals and food consumption in families at high risk of type 2 diabetes: the Feel4Diabetes-study

A family meal is defined as a meal consumed together by the members of a family or by having ≥ 1 parent present during a meal. The frequency of family meals has been associated with healthier food intake patterns in both children and parents. This study aimed to investigate in families at high risk for developing type 2 diabetes across Europe the association (i) between family meals’ frequency and food consumption and diet quality among parents and (ii) between family meals’ frequency and children’s food consumption. Moreover, the study aimed to elucidate the mediating effect of parental diet quality on the association between family meals’ frequency and children’s food consumption. Food consumption frequency and anthropometric were collected cross-sectionally from a representative sample of 1964 families from the European Feel4Diabetes-study. Regression and mediation analyses were applied by gender of children. Positive and significant associations were found between the frequency of family meals and parental food consumption (β = 0.84; 95% CI 0.57, 1.45) and diet quality (β = 0.30; 95% CI 0.19, 0.42). For children, more frequent family meals were significantly associated with healthier food consumption (boys, β = 0.172, p < 0.05; girls, β = 0.114, p < 0.01). A partial mediation effect of the parental diet quality was shown on the association between the frequency of family meals and the consumption of some selected food items (i.e., milk products and salty snacks) among boys and girls. The strongest mediation effect of parental diet quality was found on the association between the frequency of family breakfast and the consumption of salty snacks and milk and milk products (62.5% and 37.5%, respectively) among girls.Conclusions: The frequency of family meals is positively associated with improved food consumption patterns (i.e., higher intake of fruits and vegetables and reduced consumption of sweets) in both parents and children. However, the association in children is partially mediated by parents’ diet quality. The promotion of consuming meals together in the family could be a potentially effective strategy for interventions aiming to establish and maintain healthy food consumption patterns among children.Trial registration: The Feel4Diabetes-study is registered with the clinical trials registry (NCT02393872), http://clinicaltrials.gov, March 20, 2015.What is Known:• Parents’ eating habits and diet quality play an important role in shaping dietary patterns in children• Family meals frequency is associated with improved diet quality of children in healthy populationWhat is New:• Frequency of family meals was significantly associated with healthier food consumption among parents and children in families at high risk of type 2 diabetes in six European countries.• Parental diet quality mediates the association between family meals frequency and the consumption of some selected food items among children.

Moderators of Food Insecurity and Diet Quality in Pairs of Mothers and Their Children.

Research has suggested that maternal diet and characteristics may influence the diet of offspring during childhood. The present cross-sectional study aimed to assess the influence of distinct maternal characteristics and the diet quality of mothers on the prevalence of household food insecurity (FI) and the diet quality of children. A total of 179 mother–child pairs were recruited from two primary schools in the metropolitan area of Thessaloniki. The children were aged between 10 and 12 years old. Diet quality was assessed as the level of adherence to the Mediterranean diet (MD), with the use of the KIDMED for the children and the MedDietScore for the mothers. The household FI and the social and demographic characteristics of the mothers were also recorded, and anthropometric measures of both the mothers and their children were collected. Approximately ¼ (26.3%) of the pairs reported some degree of FI, with a greater prevalence (64.7%) within single-mother families. Moreover, FI affected the level of maternal MD adherence (p = 0.011). On the other hand, FI was decreased in households with a greater maternal educational level (OR: 0.25; 95% CI: 0.10–0.63) and conjugal family status (OR: 0.15; 95% CI: 0.87–0.52). Maternal adherence to the MD was inversely related to the respective adherence of their offspring (OR: 0.93; 95% CI: 0.86–0.997), suggesting that during periods of financial constraints, maternal diet quality is compromised at the expense of affording a better diet for the minors in the family.

Associations of parent dietary role modeling with children's diet quality in a rural setting: Baseline data from the NU-HOME study

These analyses examined associations of parent dietary role modeling with diet quality among school-age children in a rural community. Past research has found protective associations between parent role modeling and children's dietary intake; however, there is a gap in understanding these associations for families in rural communities. Baseline data (2017 -2018) were drawn from the New Ulm at Home (NU-HOME) randomized controlled trial, conducted in the United States. The trial recruited 114 children (7–10 years old) and parents. Parents self-reported dietary intake [fruit and vegetable (FV), sugar-sweetened beverage (SSB), fast food (FF)] and frequency of sitting and eating with their child. Children reported parent role modeling of healthful eating (FV and salad at the evening meal; FV as snacks). Two 24-h dietary recalls assessed child diet quality indicators [Healthy Eating Index-2015 (HEI-2015) total scores, FV intake, SSB intake]. General linear models (GLM) and logistic regression analyzed associations of child diet quality (HEI score, FV intake, SSB intake) with parent dietary intake, parent sitting and eating the evening meal with their child, and child perceptions of parent role modeling healthful eating, adjusted for highest level of education in the home. Higher child HEI-2015 scores were positively associated with more frequent parent role modeling of fruit intake at meals, and inversely associated with more frequent parent role modeling of fruit as a snack; no significant associations of child FV intake with parent role modeling were observed. Higher child SSB intake was positively associated with parent FF intake. In this rural community, parents play significant roles in shaping children's dietary quality and intake, though more work needs to be done to address optimal intervention strategies to promote parent role modeling of healthful eating.

Duration of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Participation is Associated With Children's Diet Quality at Age 3 Years

Adequate childhood nutrition contributes to prevention of chronic diseases. The supplemental foods and nutrition education provided by the Special Supplemental Nutrition Program for Women, Infants, and Children, a federal program serving women, infants, and children up to age 5 years in low-income families and at nutritional risk, intend to optimize dietary intakes. This study assesses associations between duration of the Special Supplemental Nutrition Program for Women, Infants, and Children participation, early feeding practices, and children's diet quality at age 3 years. Using data collected between 2013 and 2017 from the Special Supplemental Nutrition Program for Women, Infants, and Children Infant and Toddler Feeding Practices Study-2, investigators derived 4 mutually exclusive patterns of the Special Supplemental Nutrition Program for Women, Infants, and Children participation: participation in the child's first year only, participation into the second year, participation into the third year, and intermittent participation across 3 years. In 2021, multivariable regression assessed associations between these patterns, early feeding practices, and 2015 Health Eating Index total score at age 3 years. When compared with children who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children into their third year, children who participated in their first year only (p<0.01) had 2015 Healthy Eating Index total scores that were 3.6 points lower on a given day. Children introduced to sugar-sweetened beverages in their first year had scores that were 2.4 points lower than children not introduced to them in their first 2 years (p=0.03), whereas those breastfed longer exhibited a small increase in scores (p<0.01). Longer participation in the Special Supplemental Nutrition Program for Women, Infants, and Children improves children's diets, potentially mitigating chronic disease risk. Clinician efforts to refer at-risk families to the Special Supplemental Nutrition Program for Women, Infants, and Children during the early childhood years are supported.

Child Autistic Traits, Food Selectivity, and Diet Quality: A Population-Based Study

BackgroundChildren with Autism Spectrum Disorders (ASDs) tend to be selective in their food intake, which may compromise their diet quality. While ASD diagnoses capture severe levels of impairment, autistic traits vary on a continuum throughout the population. Yet, little is known about how autistic traits relate to diet quality at the population level. ObjectivesThis study examines the association between autistic traits in early childhood and diet quality in mid-childhood and explores the mediating role of food selectivity. MethodsParticipants were children (n = 4092) from the population-based Generation R Study. Parents reported their child's autistic traits at 1.5, 3, and 6 years; food selectivity at 4 years; and food intake at 8 years, from which a diet quality score was derived. Associations of autistic traits and the autistic trait trajectory (identified using Latent Class Growth Modelling) with diet quality were examined using multiple linear regression models. The indirect effect of food selectivity in the association between autistic traits at 1.5 years and diet quality was examined using mediation analysis. ResultsAutistic traits were associated with diet quality (e.g., 1.5 years: β = −0.09; 95% CI: −0.13 to −0.06). Two classes captured the autistic trait trajectories from 1.5 to 6 years: children with “low and stable” (95%) and “high and increasing” (5%) mean scores. Children in the high and increasing group had poorer diet quality than those in the low and stable group (β = −0.28; 95% CI: −0.44 to −0.11). Food selectivity mediated the association between autistic traits at 1.5 years and diet quality at 8 years (βindirect = −0.03; 95% CI: −0.03 to −0.02). ConclusionsAutistic traits in early childhood are associated with poorer diet quality in mid-childhood, and food selectivity appears to mediate this association. Interventions intended to optimize nutrition in children with elevated autistic traits may integrate behavioral strategies to support parents’ responding to their child's food selectivity.

Determinants of Healthy Diet Among Children Exposed and Unexposed to Gestational Diabetes

ObjectivesTo evaluate the association between individual and environmental determinants of diet quality with diet quality of children exposed to gestational diabetes mellitus (GDM+) and unexposed (GDM−); to study the association between mother and child vegetables and fruit (VF) intakes. DesignCross-sectional study. ParticipantsOne hundred forty-two children (104 GDM+; 38 GDM−) aged 6.2 ± 2.5 years. VariablesCanadian Healthy Eating Index 2007 (HEI-C) and VF were obtained with 2 24-hour dietary recall questionnaires in children. Maternal VF was obtained by a validated food frequency questionnaire, and weight and height were measured. Sociodemographic determinants were obtained by questionnaires. AnalysisLinear regression models were used to evaluate the association between individual and environmental determinants and the HEI-C score with interaction for GDM status. ResultsFamily meals were associated with HEI-C among GDM− but not GDM+ children (β = 9.97, P = 0.01 and β = −0.41, P = 0.84, respectively; P for interaction = 0.02). Children's age (β = −1.45; 95% confidence interval, −2.19 to −0.72; P < 0.001) was a determinant of HEI-C among all children. Maternal VF intakes were positively associated with children's VF intake (r = 0.30, P < 0.001, r2 = 0.09), with association of larger variance among GDM− children (r = 0.38, r2 = 0.14, P = 0.02) than GDM+ children (r = 0.23, r2 = 0.05, P = 0.02). ConclusionsThe food environment at home was associated differently with the diet quality of GDM+ and GDM− children. Whether targeting family meals and maternal diet quality is a good strategy to improve children's diet quality among GDM+ children needs to be further investigated.

Few Differences in Energy Intake and Diet Quality of Children and Adolescents across BMI Categories, with and without Accounting for Underreporters: NHANES 2005–2014

Previous studies of the relationship between energy intake and child weight have shown mixed results and have largely not described differences in diet quality or the impact of underreporting. The objective of this study was to investigate the relationship between dietary intake and childhood obesity by assessing energy intake and diet quality across BMI categories for 2–19-year-old children before and after excluding underreporters. Energy intake and the Healthy Eating Index 2010 (HEI) were studied for 2–19-year-old children using data from 2005–2014 NHANES. Underreporters were defined as children consuming &lt;100% of their predicted resting energy expenditure (REE) and were excluded from some analyses. There were no statistically significant differences in HEI scores across weight categories; mean HEI total score was 47.1 (SE 0.23) out of a possible 100. When considering all 12–19-year-old children, those in the overweight, obesity, and severe obesity categories had a lower mean energy intake than children in the healthy weight category (p &lt; 0.001). Excluding underreporters, 6–11-year-old children in the overweight, obesity, and severe obesity categories had a higher energy intake than healthy weight children (p &lt; 0.001). In both analyses, children in the overweight, obesity, and severe obesity categories reported consuming a lower % REE than healthy weight children. Diet quality in all children is low, and the relationship between reported energy intake and BMI remains complex. Healthy eating messages should target all children.

Diet quality in preschool children and associations with individual eating behavior and neighborhood socioeconomic disadvantage. The STEPS Study

A good quality diet in childhood is important for optimal growth as well as for long-term health. It is not well established how eating behaviors affect overall diet quality in childhood. Moreover, very few studies have considered the association of diet quality and a neighborhood socioeconomic disadvantage in childhood. Our aim was to investigate how diet quality is associated with eating behaviors and neighborhood disadvantage and their interaction in preschool age children in Finland. The participants were from the Steps to Healthy Development Study at age 2 y (n = 780) and 5 y (n = 653). Diet quality was measured with a short questionnaire on habitual food consumption and eating behavior was assessed with the child eating behavior questionnaire to indicate the child's eating style regarding food approach and food avoidance dimensions. Information on neighborhood socioeconomic disadvantage were obtained from the statistics Finland grid database. We found that diet quality was higher at 5 years compared to 2 years of age (p < 0.001). Food approach subscale, enjoyment of food, was positively associated with the diet quality (p < 0.001 for 2 and 5 y) while subscale desire to drink was negatively associated with the diet quality (p = 0.001 for 2 and 5 y). Food avoidance was negatively associated with the diet quality both at 2 and at 5 years of age (p < 0.001). A higher neighborhood disadvantage was negatively associated with the diet quality at the age of 2 years (p = 0.02), but not at the age of 5 years. Eating behavior had similar associations with diet quality both in affluent and deprived neighborhoods. Our results suggest that both the eating behavior and neighborhood disadvantage are, already in the early age, important factors when considering children's diet quality.

Urinary metabolic biomarkers of diet quality in European children are associated with metabolic health.

Urinary metabolic profiling is a promising powerful tool to reflect dietary intake and can help understand metabolic alterations in response to diet quality. Here, we used 1H NMR spectroscopy in a multicountry study in European children (1147 children from 6 different cohorts) and identified a common panel of 4 urinary metabolites (hippurate, N-methylnicotinic acid, urea, and sucrose) that was predictive of Mediterranean diet adherence (KIDMED) and ultra-processed food consumption and also had higher capacity in discriminating children's diet quality than that of established sociodemographic determinants. Further, we showed that the identified metabolite panel also reflected the associations of these diet quality indicators with C-peptide, a stable and accurate marker of insulin resistance and future risk of metabolic disease. This methodology enables objective assessment of dietary patterns in European child populations, complementary to traditional questionary methods, and can be used in future studies to evaluate diet quality. Moreover, this knowledge can provide mechanistic evidence of common biological pathways that characterize healthy and unhealthy dietary patterns, and diet-related molecular alterations that could associate to metabolic disease.

Are patterns of family evening meal practices associated with child and parent diet quality and weight-related outcomes?

Family meal practices such as family member presence, fast food consumption and media usage have been associated with health outcomes. However, little is known about combinations of family meal practices and their effects on diet and health. This secondary data analysis aimed to identify patterns of family evening meal practices and examine their associations with family characteristics (e.g., demographics and chaos) and child and parent diet quality and weight-related outcomes. We used baseline data from a community-based randomized controlled trial with 7- to 10-year-old children and their parents in rural Minnesota (n = 114). Parent-reported structural (e.g. media usage) and interpersonal (e.g. mealtime routines) aspects of family evening meal practices were included in latent profile analyses to identify patterns. Diet quality was assessed by child Healthy Eating Index-2015 and parent fruit and vegetable intake. Weight-related outcomes were determined using measured body mass index (z-scores) and percent body fat. A 3-class model was the model of best-fit. The Unplanned Infrequent Family Evening Meals with Mixed Healthfulness class (C1) featured the least frequent family evening meals and the lowest scores for mealtime routines and planning skills. The Family Evening Meals with Fast Food class (C2) characterized having family evening meals four times a week, but fast food was often served. The Planful, Healthful and Frequent Family Evening Meals class (C3) reported the highest meal routine and planning scores as well as frequent family evening meals. Parents in C3 had higher consumption of fruits and vegetables and children in C3 had lower percent body fat, compared to those in other classes. Distinctly different patterns of family evening meal practices suggest a need for considering heterogeneity of family evening meal practices in developing tailored family-meal interventions.

Parental and Child Factors Associated With 2- to 6-Year-Old Children's Diet Quality in Finland.

There is limited evidence about diet quality and associated factors in a representative population-based sample of preschool-aged children in Finland. The aims of this study were to investigate (1) the extent to which child diet quality and the consumption of health indicator foods (vegetables, fruits, berries, vegetable oil-based spread, nonfat milk) are in accordance with Finnish recommendations for preschool-aged children, (2) whether diet quality differs between children with underweight or normal weight compared with children with overweight or obesity, and (3) whether parental or child factors are related to children's diet quality. This was a cross-sectional study. Healthy children aged 2 to 6 years (n = 766) were recruited from child health clinics across Finland from February to June 2016. Diet quality and consumption of the health indicator foods were assessed by the Children's Index of Diet Quality (CIDQ, score 0-21, values < 10 indicate poor; 10-13.5, moderate; and ≥14, good diet quality). Parental information was collected with a self-administered questionnaire. Child weight and height were measured by child health clinic nurses. The overweight/obesity status and diet quality of the children were compared with 1-way analysis of variance. One-way analysis of variance was used as the preliminary analysis between child and parental factors and CIDQ scores, and linear mixed model analysis to further analyze the relationship between child and parental factors and CIDQ data. Only a small minority (13.7%) of the children had a good diet quality, 55.4% had a moderate diet quality, and 30.9% had a poor diet quality. Only 1% of the children consumed the key health indicator foods, namely vegetables, fruits, and berries, as recommended. Diet quality did not differ between children with underweight/normal weight and overweight/obesity. Instead, the child's younger age, parents' higher education, and parents' self-perceived healthy diet were related to good diet quality in the child. The diet quality was moderate or poor in the majority of the children. Parental characteristics were the main factors related to the child's diet quality. The results suggest that future efforts to improve preschool-aged children's diet quality are needed including efforts to counsel families in pediatric care. Whether the findings from the current study also apply to Finnish school-aged children should be investigated further.

How time in the US and race/ethnicity shape food parenting practices and child diet quality

Childhood obesity prevalence is high among children from immigrant/refugee households who live in high-income countries. Poor child dietary intake is a critical risk factor for elevated obesity prevalence and food parenting practices have been found to be associated with child dietary intake and eating behaviors. The main aim of this study was to examine the associations between migrants'/refugees' food parenting practices, the length of residence time in the US, race/ethnicity, and child diet quality. The current study included 577 families from three racial/ethnic groups that include mostly foreign-born parents (Latino, Hmong, and Somali/Ethiopian), and a comparison group of 239 non-Hispanic White families. Results showed that for Latino and Hmong parents, some food parenting practices varied by how long they had lived in the US. For example, more recently moved parents engaged in more non-directive (e.g., avoid buying sweets) practices compared with US-born parents. In contrast, Somali/Ethiopian parents engaged in different food parenting practices than White parents, regardless of time in the US. Results also showed that diet quality among Hmong children was lower if their parents were US-born compared to foreign-born. Future researchers may want to consider studying why some food parenting practices change when parents move to the US and explore whether there is a combination of food parenting practices that are most useful in promoting a healthful child's diet and weight among immigrant and refugee families.