Children's Diets Research Articles

Exploring Dietitians' Experience of Blended Tube Feed in Paediatric Inpatient Settings: National Cross-Sectional Survey, United Kingdom.

Enteral tube feeding is used for children who are unable to meet their nutritional requirements orally. Gastrointestinal symptoms are some complications that can occur in enteral tube-fed patients. Blended tube feeds (BTFs) for children who are gastrotomy tube-fed have significantly increased in the last decade. BTF refers to homemade food that has been liquidised for enteral tube feeds. An increasing amount of evidence suggests that children on BTF have improved feed tolerance. It is unknown whether children admitted to a hospital established on a BTF can continue a BTF due to the potential barriers such as catering processes, staffing hours (limited to syringe bolus feeding) and food safety concerns. This national cross-sectional survey aimed to explore the use of BTF in a paediatric hospital setting. This was a prospective, cross-sectional, practice-based survey of registered paediatric dietitians who work in an inpatient care setting to explore the use of BTF. The final survey consisted of 13 questions and took dietitians approximately 15 min to complete. The questions focused on the dietitian's experience, knowledge and confidence in children on a BTF. Across the United Kingdom, 51 hospitals completed the survey. Of these, 16 of 19 were specialist children's hospitals (79% response rate) and 35 of 89 were general paediatric hospitals (39% response rate). All responders were paediatric dietitians. 49 of 51 (96%) dietitians knew of the British Dietetic Association (BDA) Practice Toolkit for Blended diets. Dietitians were asked to estimate on average per month how many children were admitted on a BTF; 41% (21 of 51) of dietitians reported that on average there are one to five children admitted on a BTF. There was no significant difference in the number of children admitted on a BTF between a specialist and a general children's hospital (χ2 statistic = 4.96, p value < 0.08). The number of dietitians who had clinical guidelines to support children admitted on a BTF was 49% (25 of 51). Specialist children's hospitals were more likely to have a clinical guideline compared with a general hospital (χ2 statistic = 6.348, p value = 0.01). However, only 18 of 51 (35%) dietitians reported being confident or very confident to review a child on a BTF. The most common perceived benefit was that parents/carers could incorporate family foods into their child's diet. 26% reported that a varied diet was beneficial in relation to the gut microbiome. If a BTF was contraindicated for children admitted to a hospital (immunocompromised, post-pyloric feeding or intensive care), 49 of 51 (96%) dietitians reported they would use an enteral formula with food-derived ingredients (Compleat paediatric-Nestle Health Science) as an alternative to a BTF. BTF continues to grow in popularity. Our survey reported that children on BTF are frequently admitted to the hospital. There is growing evidence to support BTF in relation to family psychosocial health and feed tolerance. Dietitians must keep abreast of this fast-evolving area practice to ensure that they are the experts in BTF. When a BTF is contraindicated, an enteral formula with food-derived ingredients is a suitable alternative. Issues such as microbial contamination, nutritional composition, and adequacy of diluted BTF need further exploration.

Validation of a brief food parenting measure for fathers: A test of factorial validity, measurement invariance, internal reliability, and concurrent validity.

Fathers are underrepresented in food parenting research partly due to the lack of succinct, theory-informed, and father-mother equivalent food parenting measurement tools. To address this, we 1) tested the factorial validity of a brief food parenting measure utilizing a subset of items from the Comprehensive Feeding Practices Questionnaire (CFPQ) to represent coercive control, structure, and autonomy support, 2) assessed the extent to which the brief tool works similarly in fathers and mothers (i.e., measurement invariance), and 3) evaluated its internal reliability and concurrent validity. Participants included 1071 fathers of children aged 2-6 years and 487 of their co-parents (mothers) from the Fathers & Families study. Fathers and mothers responded to 16 CFPQ items, and fathers reported on children's diets. Confirmatory factor analysis (CFA) was used to test factorial validity. Multi-group CFA was used to examine measurement invariance across fathers and mothers. Internal reliability was examined using Cronbach's alpha and the Spearman-Brown coefficient. Concurrent validity was assessed utilizing multiple logistic regressions to examine associations between the three food parenting factors and children's intakes of fruit, vegetables, sugar-sweetened beverages (SSBs), and fast food. CFA confirmed a three-factor model with 11 items, including coercive control (four items), structure (five items), and autonomy support (two items). Multi-group CFA indicated measurement invariance across fathers and mothers. Internal reliability was established. Concurrent validity was strong for structure, but weaker for coercive control and autonomy support. Further refinements are encouraged to enhance items' utility in characterizing fathers' food parenting practices, including in different social and cultural contexts.

Can Headache Be a Symptom of Celiac Disease?: A University Hospital Experience

Aim: The purpose of this study was to determine the prevalence of Celiac disease in pediatric patients presenting with headache. However, little is known about the co-morbidity of Celiac disease and headache. To our knowledge, this is the first prospective pediatric study that systematically reviews this topic. Method: Two hundred forty four patients referred to the Pediatric neurology clinic of Adıyaman University Training and Research Hospital between January 2021 and November 2022 were examined. Gender, age, type of headache, Celiac serology, and other laboratory parameters of the cases meeting the inclusion criteria were recorded. Upper gastrointestinal endoscopy was performed on patients with positive Celiac serology. Patients whose results were compatible with Celiac disease were placed on a gluten-free diet. Results: The study group consisted of 202 patients, 123 girls (60.9%). The patients’ mean age was 12.67±3.524 years. Tension-type headache was determined in 121 (59.9%) of the patient group, and migraine type in 81 (40.1%). Celiac disease was detected in 5.4%. Vitamin B12 were 211±79.1 pg/ml, ferritin 19.5±13.9 ng/mL, and vitamin D 17.6±9.86 ng/ml (n=193). Interestingly, all patients who were diagnosed with Celiac disease reported that headache complaints decreased with the diet, However, no statistically significant correlation was found between any laboratory finding and headache type. Conclusion: Although it is still controversial whether headache is common in children with celiac disease, the results of our study showed that neurological symptoms improved after gluten-free diet in children presenting with headache and diagnosed with celiac disease. Celiac disease should be investigated in persistent headache despite pharmacological treatment.

Short- and Long-Term Nutritional Status in Children and Adolescents with Celiac Disease Following a Gluten-Free Diet: A Systematic Review

Background/Objectives: Numerous studies have highlighted the nutritional imbalances that are commonly observed in children and adolescents diagnosed with celiac disease (CD) who follow a gluten-free diet (GFD). However, the development and timeline of these nutritional deficiencies remain unclear. The aim of the present study is to investigate the short-term (≥6 months to &lt;12 months) and long-term (≥12 months) association between adherence to a GFD and nutrient intake as well as micronutrient blood status in children and adolescents aged from 0 to 18 years with CD. Methods: A systematic review was conducted in PubMed and Scopus for observational studies published up to June 2024. Results: A total of 15 studies (case–control, cross-sectional, and prospective studies) with 2004 children and adolescents were included. Their quality was assessed using the ROBINS-E tool. Despite the lack of high-quality data and the heterogeneity of the methods used in the included studies, the results of the cross-sectional/case–control studies show that, in the short term, children and adolescents with CD consumed excessive amounts of protein and carbohydrates compared to controls. After long-term adherence to a GFD, significant changes in the diets of children and adolescents with CD persisted. Fat intake was higher, while protein intake remained excessive compared to controls. Based on prospective studies, vitamin C and iodine intake improved both in the short and long term after adherence to a GFD. However, most other nutrients either remain inadequate or continue to decline, indicating that it is difficult to meet nutrient requirements despite dietary adjustments. Conclusions: Gaps in adherence to dietary recommendations appear to be widespread in children and adolescents with CD, emphasizing the need for improved diet quality and regular monitoring.

A sustainable mixed diet for children without compromising nutritional needs: The vitamin B12 issue.

Global climate change requires a paradigm change in diets, especially in affluent countries, with a reduction of animal-based food, including children. This will have direct consequences for Vitamin B12 supply as animal-based foods are the only food source. We examined these potential consequences using the German food based dietary guidelines for infants, children, and adults in Germany as the basis for the model calculation. The guidelines for 4 representative age groups were examined, representing exclusive milk feeding (2 months), complementary feeding (8 months), and mixed family diet (children: 4-6 years, adolescents: 11-14 years). For each age group (except 2 months), the contribution of animal-based food groups (milk/dairy, meat, fish, eggs) to the total daily intake of vitamin B12 was calculated based on 7-day menus with recipes for all meals. This allowed us to assess the potential Vitamin B12 deficits due to food group exclusion. Even in the guidelines diets, including exclusive breastfeeding, the vitamin B12 intakes just reached the reference values in all age groups. In infants on complementary feeding and also later in children and adolescents, cow's milk was by far the most important source of vitamin B12. Among the other animal-based foods, meat (16.9%-23.0%) ranked first, followed by fish (11.0%-16.5%), and eggs (8.1%). In our analysis of the German food-based guidelines for infant, child, and adolescent diets, the increased planetary health due to reduction of milk intake turned out severely to compromise vitamin B12 intake. In children, a reduction in the consumption of animal foods to improve the health of the planet must be weighed against the risk of inadequate intake of individual nutrients.

Exploring the acceptance of mozzarella cheese in school lunches among school-aged children: a pilot study

IntroductionDairy products are an important source of high-quality protein, calcium, vitamin A, and other nutrients, and they are a crucial part of a balanced diet for children. However, the daily intake of dairy products among school-age children in China is significantly inadequate. Considering school lunches as a vital pathway for children to obtain nutrients, this study aims to develop school lunch dishes incorporating mozzarella cheese and to assess the acceptance of these dishes among school-age children.MethodsThis study was carried out in a primary school which has a self-run canteen in Nanjing. We innovatively integrated cheese with traditional Chinese food, and conducted a 3-month pilot study to develop dishes that meet the nutritional needs and sensory experience of students. 121 students with an average age of 9.8 years were invited to assess each dishes’ appearance, aroma, taste and overall liking, by using a 5-point Likert Scale. Focus group discussions were conducted after the project to further discover students’ attitude toward cheese dishes and canteen cooks’ experience in improving cheese dishes.ResultsDuring the program, 16 cheese dishes were made, including 3 steamed dishes, 2 ready-to-eat foods (only heating required), and 11 stir-fried dishes. The overall liking’ results showed that ready-to-eat foods were the most popular among students, and steamed dishes ranked higher than stir-fried dishes (P &amp;lt; 0.001). Among the stir-fried dishes, students’ liking scores differed for cheese dishes made from different raw materials, pure meat food was more popular than vegetable food (P = 0.003), meat and vegetable food (P = 0.012). Additionally, focus group discussions found that students gave more positive ratings to and ready-to-eat foods and steamed dishes.ConclusionCheese can be well combined with traditional Chinese ingredients and be accepted, especially steamed or combined with meat. Introducing cheese in school lunches not only helps cultivate a habit of consuming cheese among children and adolescents from a young age, but also aids in closing the gap between their dairy consumption and dietary guidelines.

Appetite Self-Regulation in Childhood: A Narrative Review and Conceptual Model of Processes and Mechanisms With Implications for Research and Practice.

The purpose of the present narrative review was to propose a unifying generalized conceptual model of mechanisms and processes in appetite self-regulation (ASR) in childhood. Appetite self-regulation, along with other domains of self-regulation, develops across childhood and contributes to energy intake and balance, diet quality, weight, and therefore long-term health outcomes. There have been efforts to conceptualize and measure components of ASR and associated processes/mechanisms, but, at present, there is no unifying conceptualization of ASR in childhood. A search of key databases supplemented by snowballing was undertaken for definitions/conceptions and theoretical models of ASR with a focus on children. An interpretive synthesis approach was used to identify themes from the definitions and models. The themes formed the basis of the proposed unifying generalized model of ASR in childhood, which is the main contribution of the article. At the center of the model is bottom-up reactivity to food, food cues and hunger, satiation and satiety signals, together with top-down regulatory control. An additional contribution is the proposed 5 interacting and overlapping domains (biological, hedonics, cognitive, behavioral, and traits) that function in and influence both bottom-up reactivity and top-down regulation. The domains also contribute to ASR outcomes of enactment and competence. External contextual and intrapersonal factors are conceived as impacting the domains and the bottom-up, top-down processes. The relevance of the model for explanations of ASR phenomena in childhood and children's food choice and diet quality, as well as its implications for research directions and approaches to preventive intervention, including food parenting practices, are discussed. The model provides a framework for researchers and practitioners to support and interpret children's problems and competence in self-directing food choices, energy intake, and nutrition.

Grocery intervention and DNA-based assessment to improve diet quality in pediatric obesity: a pilot randomized controlled study.

We assessed the impact of a food-provisioning intervention on diet quality in children with obesity. Participants (n = 33, aged 6-11 years) were randomly assigned to either usual care (intensive health behavior and lifestyle treatment) or intervention (usual care + food provisioning; high-fiber, low-dairy diet) for 4 weeks. The primary outcome was a change in child diet quality at Week 4. Secondary outcomes were changes in weight, food insecurity, gut microbiome composition (16S ribosomal RNA), and dietary intake, measured via an objective DNA-based biomarker (i.e., FoodSeq). Genomic dietary data were analyzed against a larger pediatric adolescent obesity cohort (n = 195, aged 10-18 years) from similar households. Intervention demonstrated changes across all assessed diet components and was more effective than usual care in increasing whole grain (β = 0.20, 95% CI: 0.05 to 0.34; p = 0.013) and fiber (β = 2.52, 95% CI: 1.28 to 3.76; p < 0.001) and decreasing dairy (β = -1.31, 95% CI: -2.02 to -0.60; p = 0.001). FoodSeq results, highly concordant with grocery orders (adjusted R2 = 0.65; p < 0.001), indicated a dietary shift toward low-energy-density plant taxa in the intervention relative to a prior survey of diet in a related cohort (β = 8.64, 95% CI: 5.18 to 12.14; p < 0.001). No significant changes were observed in microbiome, weight, or food insecurity. Our study supports the potential of dietitian-guided food provisioning for improving diet quality in children with obesity and demonstrates an objective genomic approach for evaluating dietary shifts.

Family Food Availability Income and Consumption Patterns Cause Wasting in Toddlers in Martapura Timur District

Asting, a condition characterized by low body weight in toddlers, has a prevalence of 28.94% in Martapura Timur District. This study aimed to explore the relationship between income, food availability, and consumption patterns as factors contributing to wasting among toddlers aged 12-59 months. Using a Cross-Sectional design, data were collected from 45 purposively sampled toddlers through questionnaires, food availability forms, and food frequency forms. Spearman Rank correlation (α=0.05) was employed for data analysis. Findings revealed that most mothers were under 20 or over 35 years old, with junior high school education and predominantly unemployed. Male toddlers were slightly more prevalent, with 82.2% classified as wasting and 17.8% in severe wasting. Low family income (below the minimum wage) was common (71.1%), and food availability ranged from insufficient to barely sufficient. Consumption patterns were largely suboptimal (64.4%), with staple food intake (&lt;150 g/day) limited to rice and corn, animal protein (50 g/day) from eggs only, plant protein (&lt;40 g/day) primarily from tofu, and minimum vegetable consumption (30 g/week of pumpkin, 1-3 times weekly). Statistical analysis indicated significant relationships between family income (p=0.048, r=0.296), food availability (p=0.048, r=0.296), and consumption patterns (ρ=0.002, r=0.455) with wasting. The strongest relationship was found in food availability. Efforts are being made to increase awareness through health centers, encouraging mothers to utilize home yards for food production, enhancing food availability, and improving children's diets. Addressing these factors can help reduce the prevalence of wasting and promote better nutrition in toddlers.

Serum metabolome indicators of early childhood development in the Brazilian National Survey on Child Nutrition (ENANI-2019).

Background: The role of circulating metabolites on child development is understudied. We investigated associations between children's serum metabolome and early childhood development (ECD).Methods: Untargeted metabolomics was performed on serum samples of 5,004 children aged 6-59 months, a subset of participants from the Brazilian National Survey on Child Nutrition (ENANI-2019). ECD was assessed using the Survey of Well-being of Young Children's milestones questionnaire. The graded response model was used to estimate developmental age. Developmental quotient (DQ) was calculated as the developmental age divided by chronological age. Partial least square regression selected metabolites with a variable importance projection ≥ 1. The interaction between significant metabolites and the child's age was tested.Results: Twenty-eight top-ranked metabolites were included in linear regression models adjusted for the child's nutritional status, diet quality, and infant age. Cresol sulfate (β = -0.07; adjusted-p &lt; 0.001), hippuric acid (β = -0.06; adjusted-p &lt; 0.001), phenylacetylglutamine (β = -0.06; adjusted-p &lt; 0.001), and trimethylamine-N-oxide (β = -0.05; adjusted-p = 0.002) showed inverse associations with DQ. We observed opposite directions in the association of DQ for creatinine (for children aged -1 SD: β = -0.05; p =0.01; +1 SD: β = 0.05; p =0.02) and methylhistidine (-1 SD: β = - 0.04; p =0.04; +1 SD: β = 0.04; p =0.03).Conclusion: Serum biomarkers, including dietary and microbial-derived metabolites involved in the gut-brain axis, may potentially be used to track children at risk for developmental delays.Funding: Supported by the Brazilian Ministry of Health and the Brazilian National Research Council.

Kann das Bürgergeld die Lebensmittelkosten einer gesunden Ernährung von Kindern und Jugendlichen decken?

ZusammenfassungEinleitungVon Armut betroffene Familien in Deutschland erhalten im Rahmen der Sozialgesetzgebung (SGB) existenzsichernde Leistungen. Das Bürgergeld umfasst auch Regelsätze für Kinder und Jugendliche, gestaffelt in 3 Altersgruppen. Der Bedarf für Ernährung ist die größte Kategorie des Regelsatzes. Die Optimierte Mischkost (OMK) ist ein praxisnahes Konzept einer gesunden Ernährung für Kinder und Jugendliche im Alter von 1–18 Jahren. Herkömmliche Lebensmittel und selbsthergestellte Speisen werden bevorzugt. Ziel des Projektes war es, die Lebensmittelkosten der OMK anhand des zugrunde liegenden 7‑Tage-Speiseplans zu berechnen.MethodikEs wurden die niedrigsten Regalpreise der 87 Lebensmittel der OMK im Lebensmitteleinzelhandel (1 Supermarkt, 1 Discounter; November 2022, Bochum) erfasst. Der Ernährungsregelsatz wurde mit den Lebensmittelkosten pro Monat nach den SGB-Altersgruppen sowie nach den Altersgruppen der Deutschen Gesellschaft für Ernährung (DGE) verglichen. Weiterhin wurden die Beiträge der Lebensmittelgruppen zu den Gesamtkosten und der Gesamtenergiezufuhr der OMK aufgeschlüsselt.ErgebnisseDie Kosten der OMK wurden mit dem Ernährungsregelsatz des Bürgergeldes für die 3 SGB-Altersgruppen zu 101–109 % gedeckt, für die enger gefassten DGE-Altersgruppen war der Betrag mit wenigen Ausnahmen ebenfalls ausreichend. Hauptsächliche Kostenträger der OMK waren Gemüse/Rohkost, hauptsächliche Energielieferanten waren Brot/Getreideprodukte.DiskussionMit dem Bürgergeld kann der ernährungsphysiologische Bedarf von Kindern und Jugendlichen gedeckt werden, unter der Voraussetzung der Selbstherstellung der Speisen und der Verwendung preiswerter Lebensmittel. Es bleibt zu diskutieren, inwieweit auch mit der Ernährung verbundene Bedürfnisse der sozialen Teilhabe erfüllt werden können.

Validity of the MED4CHILD tool for assessing adherence to the Mediterranean diet in preschool children

Most of the available tools to assess adherence to Mediterranean diet (MedDiet) were constructed for adults, having limited applicability to children and adolescents. The aim of this study is to validate a specific questionnaire to assess adherence to MedDiet in children aged 3 to 6 years (MED4CHILD questionnaire). The validation was performed in a baseline examination of a cohort of children who were recruited in schools in seven cities. Of the total sample of 1509 children, we included 858 children aged 3 to 6 years with complete information on adherence to the MedDiet, food consumption, anthropometry and cardiometabolic characteristics. Adherence to the MedDiet was assessed using an 18-item questionnaire, adapted from validated questionnaire for adults using the Delphi method. Food and beverage consumption was assessed using a validated COME-Kids Food and Beverage Frequency Questionnaire. Anthropometric measurements and cardiometabolic risk factors were assessed using standard methods. Statistical analyses included kappa agreement, ANOVA and linear regression models. Higher MED4CHILD scores were associated with higher intakes of food characteristic of the MedDiet. The MED4CHILD questionnaire showed moderate validity, especially for key items of the Mediterranean diet (kappa ranging from 0.333 to 0.665). Direct significant associations were found between MED4CHILD scores and cardiometabolic profile, including waist circumference (p), triglycerides and HOMA-IR (p < 0.05). Conclusion: The 18-item MED4CHILD questionnaire showed moderate validity for assessing adherence to the MedDiet in children aged 3 to 6 years, in terms of agreement with food and beverage consumption and favourable cardiometabolic profile.What is known:• The Mediterranean diet has been linked to a number of health benefits and the assessment of children's adherence to this diet is important for public health and research.• The tools available to assess MedDiet compliance are mainly for adults.What is new:• The MED4CHILD questionnaire is a simple, inexpensive and rapid tool for assessing MedDiet compliance in children.• This tool showed moderate relative validity and a high score was associated with a favourable cardiometabolic profile.

Plant-based dietary patterns, nutrient intake, growth, and body composition in childhood: Results from a prospective population-based study.

Transitioning to more plant-based diets promotes environmental sustainability and has health benefits for adults. However, associations with nutrient intake adequacy and growth in children remain unknown. This study aimed to examine associations of plant-based diets with nutrient intake levels among children, and with longitudinal growth and body composition up to adolescence. We included 3340 children in the Generation R Study, a population-based cohort. Food and nutrient intake were assessed at the age of 8 years, and anthropometrics and body composition (using dual-energy X-ray absorptiometry) were measured at the ages of 10 and 13 years. Plant-based diets were quantified using three plant-based diet indices (PDIs): overall plant-based diet index (PDI), healthful PDI (hPDI), and unhealthful PDI (uPDI). Modified Poisson regression and linear mixed models were used to estimate the associations of PDIs with nutrient intake levels, and with sex- and age-standardized measures of anthropometrics and body composition. Higher scores on each of the three PDIs were associated with lower intake of vitamin B2, B12, and calcium, while higher hPDI score was associated with higher intake levels of fiber, vitamin C, magnesium, and copper. Higher hPDI score was also associated with higher fat-free mass index (FFMI) z-score (0.05 per 10-hPDI score increment, 95% CI: 0.01, 0.10), and with lower body fat percentage z-score (-0.05, 95% CI:-0.09,-0.01), while higher uPDI score was associated with lower height, weight, and FFMI z-score (FFMI:-0.08, 95% CI:-0.12,-0.03) up to age of 13 years. In this cohort study, higher adherence to healthful plant-based diets, rather than unhealthful ones, was associated with better nutrient intakes, and subsequent healthy body composition throughout childhood to adolescence. Our findings suggest that consuming healthful plant-based foods may contribute to children's diets' nutrient quality and subsequent body composition. Still, attention should be given to ensuring balanced and adequate nutrient intake for optimal plant-based eating.

Social media on children's diets: A review.

Social media on children's diets: A review.

Cropland expansion links climate extremes and diets in Nigeria.

Climate change threatens smallholder agriculture and food security in the Global South. While cropland expansion is often used to counter adverse climate effects despite ecological trade-offs, the benefits for diets and nutrition remain unclear. This study quantitatively examines relationships between climate anomalies, forest loss from cropland expansion, and dietary outcomes in Nigeria, Africa's most populous country. Combining high-resolution data on forest cover and climate variables within random forest and panel regression models, we find that 25 to 31% of annual forest loss is linked to climate variability. Using georeferenced household survey data, we then find that changes in forest cover have a significant positive association with changes in child diet diversity-a key proxy of nutritional adequacy-while cropland expansion does not, suggesting that such forest conversions may be an ineffective climate adaptation strategy for improving nutrition. Our findings highlight the potential of nutrition-sensitive climate adaptation to enhance yields, promote nutritious cropping choices, and protect remaining forests.

Comparing three summary indices to assess diet quality of Canadian children: a call for consensus.

The Healthy Eating Index-Canada 2015 (HEI-C 2015), Diet Quality Index-International (DQI-I), and Healthy Eating Food Index 2019 (HEFI-2019) are commonly used to summarize the quality of Canadian diets. This paper sought to compare these three diet quality indices with respect to their ability to capture diets of different quality in Canadian children and to discriminate between population subgroups. Data were collected in school-based surveys from grade 4-6 students (9-12 years old) in western Canada through 24-h dietary recall in 2016 (n = 336), 2018 (n = 454), and 2020/2021 (n = 909). Diet quality was assessed using HEI-C 2015, DQI-I and HEFI-2019. Agreement between the three indices was assessed using weighted Cohen's kappa. Univariate and multivariable linear regression models assessed diet quality according to student's sex, grade level, school material/social deprivation, and geographic region. HEFI-2019 scores had the widest range, while DQI-I had the smallest. Agreement was 0.55 between HEI-C 2015 and DQI-I, 0.38 between HEI-C 2015 and HEFI-2019, and 0.29 between DQI-I and HEFI-2019. Boys and students from materially deprived areas reported diets of lower quality, irrespective of the index. There were no differences in diet quality across grade levels and geographic region. Energy consumption was associated positively with DQI-I and negatively HEFI-2019 scores. The three indices demonstrated fair to moderate agreement and varying ability to discriminate diet quality between different population subgroups of Canadian children. This study shows that the choice of a diet quality index affects the interpretation of results and practical considerations, yielding different conclusions with respect to the determinants of children's diet quality. Seeking consensus on which diet quality index to use for research, policy and/or practice would help support dietary research and policy development, and promote dietary guidelines implementation.

Bayesian Sequential Pragmatic Cluster Randomized Clinical Trial Design for PrEventive Effect of MEditerranean Diet in Children: PEMED Trial Research Protocol.

Background: Childhood nutrition plays an important role in the promotion of long-term health. Introducing solid foods in alignment with the Mediterranean Diet during weaning fosters a preference for healthy foods early in life. However, access to nutritious diets remains a challenge in underserved communities. Scampia, a socioeconomically disadvantaged district in Naples, Italy, exemplifies a community where barriers to healthy eating persist. This research reports a trial protocol that plans for a study to evaluate the impact of the Mediterranean Diet on child health and to establish preventive strategies for chronic diseases. Methods: The PEMED (PrEventive effect of MEditerranean Diet in Children) trial is a Bayesian Sequential Pragmatic Cluster Randomized Clinical Trial. Family Pediatricians (FPs) are randomized to deliver either Mediterranean Diet-based dietary guidance starting at weaning or standard dietary practices using typical baby foods. Children will be followed up for six years, with regular assessments of growth, microbiome composition, and adherence to the Mediterranean Diet, using validated tools. Interim analyses will be conducted at three-year intervals to evaluate the efficacy and monitor adverse events. Saliva and stool samples will be collected for genetic and microbiome analyses, and adherence will be monitored through quarterly dietary recalls and biomarkers. Results: This trial will consider Italy's established FP network for implementing innovative dietary intervention in a real-world setting. Conclusions: This study will address nutritional disparities in the underserved Scampia community and provide a scalable model for early dietary interventions. The results will shed light on the role of the Mediterranean Diet in improving childhood health and informing public health strategies globally.

Lessons Learned From the Use of Human-Centered Design Approaches to Improve Nutrition in Nigeria.

Background. Improving children's diets from 6 to 24 months can support children's survival, growth, and development, but progress toward this goal has stalled globally. Human-centered design offers a new approach to resolving program challenges, especially when integrated with social and behavior change (SBC) theory and rigorous evaluation. Method. Two human-centered design processes were conducted. In Ebonyi state, Federal Capital Territory, and Sokoto state a combined high-fidelity prototype, drawn from three low-fidelity prototypes, focusing on improving dietary diversity was developed and tested. In Kebbi state eight low-fidelity prototypes focused on developing tools to improve community health worker (CHW) nutrition counseling were developed and tested. High-fidelity prototype testing combined design and behavior change indicators and qualitative and quantitative methods. Prototype Testing Results. Seven of the eight prototypes in Kebbi state tested well. Prototypes that integrated SBC theory and encouraged two-way conversations between CHWs and caregivers were most successful. The high-fidelity prototype tested in Sokoto demonstrated improved knowledge and efficacy regarding dietary diversity and increased self-reported dietary diversity. Three low-fidelity prototypes in Kebbi will be combined into a counseling package for CHWs. The implementation of the high-fidelity nutrition prototype will be expanded. Discussion. Human-centered design is a promising approach to address complex global health challenges and can be strengthened through the integration of SBC theory and traditional monitoring and evaluation approaches, but this is challenging. Implications for Practice. It is essential to establish a foundation of human-centered design and SBC knowledge among all implementers, incorporate both knowledge bases throughout the process, and center in-country expertise.

Nordic nutrition recommendations 2023 on diet for health and environment estimated for children

Nordic nutrition recommendations 2023 (NNR2023) advised for the first time certain amounts of foods from food-groups based on scientific data on healthy and environment-friendly diet. The food-based-dietary-guidelines are intended for adults and children above age two, but children's energy requirement and intake are lower than those of adults. In this review, reference amounts of food from different food-groups are calculated for children to align with the combination recommended for adults in NNR2023. The calculated reference consumption for children aged three to 9 years was 50%-76% of that for adults, which means at least 250-380 grams daily of vegetables, fruits and berries, with at least half being vegetables. A comparison with results from studies on diet of randomly selected children in Iceland, in the capital area or country-wide, 2003-2012 (N=943), indicates that children's diet needs to be improved. The data are 10-20 years old, and new data are necessary, but changes in consumption of the food groups compared in the current paper are not expected to be large. Below 5% of the children had lower consumption of vegetables than advised. The median of meat intake was higher than advised maximum intake of red meat for pre-schoolers and adolescents. Pre-schoolers had high fish intake, while older children, especially adolescent girls, had a lower intake. New studies on children's diet are needed in Iceland to analyse their diet today.

Impact of sleep hygiene education on sleep and nutrition in children aged 10-18 years.

Sleep quality has positive effects on children's sleep and eating habits. In turn, improvement in sleep quality is associated with sleep hygiene training. The aim of our study was to determine the impact of sleep hygiene education on sleep and nutrition management in children aged 10-18 years. In addition, we explored the association between sleep problems and eating behaviours in participants before and after the training programme. We conducted a quasi-experimental study between August 25 and December 27, 2023, in children aged 10-18 years who participated in the study on a voluntary basis with the consent of their parents. We collected data from a total of 80 children aged 12-18 years. The study investigated the relationship between sleep problems and eating behaviours. We randomly allocated participants to one of two groups, the training group or the waitlist group. We assessed the association between changes in sleep problems and changes in eating behaviours in the training group. The data were collected using a sociodemographic data form, the Children's Sleep Habits Questionnaire, and the Three-Factor Eating Questionnaire. In the study sample, the proportions of male and female participants (training group) were 60.0% and 40.0%, respectively. There was a statistically significant difference between the pretest and post-test scores in the Children's Sleep Habits Questionnaire and the Three-Factor Eating Questionnaire (P < .01) and significant differences in the changes in sleep and eating habit scores between groups between the pre- and post-sleep hygiene training timepoints (P < .01). Thus, we concluded that sleep hygiene training is associated with and has an impact on sleep and nutrition. We observed that in children aged 10-18 years, sleep problems were associated with their eating behaviours. Sleep hygiene education had a significant and favourable impact on sleep and nutrition outcomes. Thus, sleep hygiene training has an important effect on children's sleep and diet.