Energy-dense Snacks Research Articles

Cluster randomised controlled trial and economic and process evaluation to determine the effectiveness and cost-effectiveness of a novel intervention [Healthy Lifestyles Programme (HeLP)] to prevent obesity in school children

BackgroundApproximately one-third of children in England leave primary school overweight or obese. There is little evidence of effective obesity prevention programmes for children in this age group.ObjectiveTo determine the effectiveness and cost-effectiveness of a school-based healthy lifestyles programme in preventing obesity in children aged 9–10 years.DesignA cluster randomised controlled trial with an economic and process evaluation.SettingThirty-two primary schools in south-west England.ParticipantsChildren in Year 5 (aged 9–10 years) at recruitment and in Year 7 (aged 11–12 years) at 24 months’ post-baseline follow-up.InterventionThe Healthy Lifestyles Programme (HeLP) ran during the spring and summer terms of Year 5 into the autumn term of Year 6 and included four phases: (1) building a receptive environment, (2) a drama-based healthy lifestyles week, (3) one-to-one goal setting and (4) reinforcement activities.Main outcome measuresThe primary outcome measure was body mass index (BMI) standard deviation score (SDS) at 24 months post baseline measures (12 months post intervention). The secondary outcomes comprised waist circumference SDS, percentage body fat SDS, proportion of children overweight and obese at 18 and 24 months, accelerometer-assessed physical activity and food intake at 18 months, and cost-effectiveness.ResultsWe recruited 32 schools and 1324 children. We had a rate of 94% follow-up for the primary outcome. No difference in BMI SDS was found at 24 months [mean difference –0.02, 95% confidence interval (CI) –0.09 to 0.05] or at 18 months (mean difference –0.02, 95% CI –0.08 to 0.05) between children in the intervention schools and children in the control schools. No difference was found between the intervention and control groups in waist circumference SDS, percentage body fat SDS or physical activity levels. Self-reported dietary behaviours showed that, at 18 months, children in the intervention schools consumed fewer energy-dense snacks and had fewer negative food markers than children in the control schools. The intervention effect on negative food markers was fully mediated by ‘knowledge’ and three composite variables: ‘confidence and motivation’, ‘family approval/behaviours and child attitudes’ and ‘behaviours and strategies’. The intervention effect on energy-dense snacks was partially mediated by ‘knowledge’ and the same composite variables apart from ‘behaviours and strategies’. The cost of implementing the intervention was approximately £210 per child. The intervention was not cost-effective compared with control. The programme was delivered with high fidelity, and it engaged children, schools and families across the socioeconomic spectrum.LimitationsThe rate of response to the parent questionnaire in the process evaluation was low. Although the schools in the HeLP study included a range of levels of socioeconomic deprivation, class sizes and rural and urban settings, the number of children for whom English was an additional language was considerably lower than the national average.ConclusionsHeLP is not effective or cost-effective in preventing overweight or obesity in children aged 9–10 years.Future workOur very high levels of follow-up and fidelity of intervention delivery lead us to conclude that it is unlikely that school-based programmes targeting a single age group can ever be sufficiently intense to affect weight status. New approaches are needed that affect the school, the family and the wider environment to prevent childhood obesity.Trial registrationCurrent Controlled Trials ISRCTN15811706.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 1. See the NIHR Journals Library website for further project information.

Parental feeding practices to manage snack food intake: Associations with energy intake regulation in young children

BackgroundLittle attention has been directed to understanding the relationship between restriction and regulation of snack food intake in toddlers. ObjectiveThe aim of this study was to examine the effects of parental restriction of toddlers' eating of snacks in the absence of hunger (EAH) and to examine the impact of three contextual factors; snack food access, frequency of snack food consumption, and attraction to snack food. Design64 parents and toddlers (aged 22–36 months) took part in a protocol to measure EAH (defined as kJ of energy-dense snack foods consumed). Mean EAH was 199 kJ (SD = 299), with 43 children consuming at least some snacks. Restriction was measured with the Child Feeding Questionnaire Restriction subscale. Snack food access was measured with Allow Access from the Toddler Snack Food Feeding Questionnaire (TSFFQ), snack food consumption was measured with a short snack food frequency questionnaire, and attraction to snack foods was measured with Child's Attraction from the TSFFQ. Moderated regression analyses tested interactions between Restriction and contextual factors in predicting EAH. ResultsEAH was associated with Restriction (r = 0.25, p = .05, 95% CI 0.004 - 0.47). There was an interaction between Restriction and accessibility of snack foods (R2 change = 0.08, p = .025); restriction was associated with EAH only when access to snack foods in the home was, on average, higher. The effect of Restriction on EAH was not moderated by frequency of snack food consumption or Child's Attraction. ConclusionsThese finding have practical relevance and reinforce the importance of the home food environment for managing young children's snack food intake.

Emotion-driven impulsiveness and snack food consumption of European adolescents: Results from the I.Family study

We aimed to investigate the association between emotion-driven impulsiveness and snack food consumption in 1039 European adolescents aged 12–18 years. During the cross-sectional examination in 2013/2014, complete information was collected on: emotion-driven impulsiveness (using the negative urgency subscale from the Urgency, Premeditation, Perseverance, Sensation seeking, and Positive urgency (UPPS-P) Impulsive Behaviour Scale) and snacking behaviour operationalised as 1) consumption frequency of daily snacks, 2) consumption frequency of energy-dense snacks (both measured using Food Frequency Questionnaire) and 3) usual energy intake of food consumed per snacking occasion in calories. The latter was measured using online self-administered 24-h dietary recalls and was estimated based on the National Cancer Institute (NCI) Method. Anthropometric variables were measured and BMI z-score (zBMI) calculated. Age, sex, highest education level of the family and country of residence were assessed using a questionnaire. Mixed-effect regression analyses were separately conducted for each snacking behaviour outcome with emotion-driven impulsiveness as the exposure. After controlling for zBMI, age, sex, country and socioeconomic status, emotion-driven impulsiveness was positively associated with daily consumption frequency of snacks (β = 0.07, 95% Confidence Interval (CI) [0.02, 0.12]) and consumption frequency of energy-dense snacks (β = 0.25, 95% CI [0.19, 0.31]), but not with usual energy intake of food per snacking (β = 2.52, 95% CI [-0.55, 5.59]). Adolescents with a stronger emotion-driven impulsiveness tendency reported a higher snacking frequency and specifically more energy-dense snacks, whereas the energy intake of snack food seemed less important. These findings have implications for obesity prevention and treatment as they indicate the importance of targeting emotion-driven impulsiveness as a strategy to avoid excessive snacking.

The longitudinal link between mothers' and adolescents' snacking: The moderating role of television viewing

A large proportion of adolescents eats too many energy-dense snacks, which is detrimental for their current and future health. To understand how to promote healthy dietary behaviors in adolescents, we need to identify factors that affect their snacking. While previous cross-sectional work has shown mother-child similarities in eating behavior, longitudinal studies are lacking. Hence, the first aim of this study was to examine whether maternal snacking predicted changes in adolescents' snacking over time. A second aim was to examine whether adolescents' television viewing magnified the strength of this longitudinal association. Television viewing may increase the motivation to eat the snacks consumed by mothers later on, for example through food advertisement exposure and mindless eating. To address both aims, 2051 adolescents (Mage baseline = 13.81; 51.5% boys) were asked to report on their snacking and television viewing three times, with intervals of one year. Moreover, a subsample of mothers of adolescents (N = 1080) reported on their snacking at baseline as well. The results indicate that maternal snacking indeed predicts adolescents' snacking over time and that this effect is more pronounced among adolescents who watch a great amount of television. These findings attest to the importance of mothers in forming adolescents' snacking, not only concurrently but also prospectively. Additionally, this study highlights the relevance of assessing other home environmental factors that may influence maternal effects on their children's snacking.

Binary components of food reinforcement: Amplitude and persistence

BackgroundDemand curves provide an index of how reinforcing a food is. Research examining the latent structure of alcohol and tobacco reinforcement identified two underlying components of reinforcement, amplitude and persistence. No research has assessed latent structure of food reinforcement and how these factors are related to BMI. Subjects and methodsParticipants were 297 adults from two studies that completed food purchasing tasks to assess the following measures of relative reinforcing efficacy (RRE) of food: intensity (Q0): purchases made when the food was free or of very minimal price, Omax: maximum expenditure (purchases*price), Pmax: price point where maximum expenditure was observed, breakpoint: first price where 0 purchases are made, and demand elasticity (α): quantitative non-linear relationship between purchasing and price. Principal components analysis was used to examine the factor structure of RRE for food across samples and types of food. ResultsBoth studies revealed two factor solutions, with Pmax, Omax, breakpoint and α loading on factor 1 (persistence) and intensity (Q0) loading on factor 2 (amplitude) across both high and low energy dense foods. Persistence reflects an aggregate measure of price sensitivity and amplitude reflects the preferred volume of consumption (how long vs. how much). The two factors accounted for between 91.7 and 95.4% of the variance in food reinforcement. Intensity for high energy dense foods predicted BMI for both studies (r = 0.18 and r = 0.22, p's < 0.05). ConclusionsThe latent factor structure was similar across two significantly different independent samples and across low and high energy dense snack foods. In addition, the amplitude of the demand curve, but not persistence, was related to BMI. These results suggest specific aspects of food reinforcement that can be targeted to alter food intake.

Food consumption patterns of adolescents aged 14\u201316\xa0years in Kolkata, India

BackgroundThe nutrition transition has brought about rapid changes in the structure of the Indian diet. The replacement of traditional home-cooked meals with ready-to-eat, processed foods has contributed to an increased risk of chronic diseases in urban Indians. Improving the nutrition of Indians by promoting healthy food consumption in early life and in adolescence would help to reduce these health risks. However, little is known about the quality and quantity of foods and beverages consumed by urban Indian adolescents. Therefore, the aim of this study was to describe the food consumption patterns in a sample of urban Indian adolescents.MethodsA self-administered, semi-quantitative, 59-item meal-based food frequency questionnaire (FFQ) was developed to assess the dietary intake of adolescents over the previous day. A total of 1026 students (aged 14–16 years) attending private, English-speaking schools in Kolkata, India completed the survey.ResultsOverall, the adolescents reported poor dietary intakes; over one quarter (30%) reported no consumption of vegetables and 70% reported eating three or more servings of energy-dense snacks, on the previous day. Nearly half of the respondents (45%) did not consume any servings of fruits and 47% reported drinking three or more servings of energy-dense beverages. The mean consumption of food groups in serves/day varied from 0.88 (SD = 1.36) for pulses and legumes to 6.25 (SD = 7.22) for energy-dense snacks. In general, girls had more nutritious dietary intakes than boys.ConclusionsThe Indian adolescents reported poor food consumption patterns, and these findings highlight the need to design effective nutrition promotion strategies to encourage healthy eating in adolescence and targeting food supply and availability.

Effectiveness of a homemade supplementary food in the management of severe acute malnutrition in 2-5 year old children in the Kopay MOH area

Introduction Reducing wasting in children under 5 years is a challenge in Sri Lanka. Management strategy of moderate acute malnutrition (MAM) is to have target food supplementation as energy dense snacks. Objectives To assess the feasibility, acceptability and effectiveness, of a homemade supplementary food (HMSF) in the management of moderate acute malnutrition in 2-5 year old children. Methods A community based quasi experimental study was carried out from October to December 2014. The test population (n=275) were 2-5 year old children with MAM from Kopay MOH area. The control group (n=285) were children of similar age with MAM from Uduvil, Nallur area. HMSF consisted of a pre-packed cereal mixture (50g), with sugar (20g) and scraped coconut (20g) added at home (calorie content =500 kcal/90g), as a daily snack to the intervention group. Baseline weight and monthly weight gain was measured using standard calibrated weighing scales. Compliance and any acute illnesses were monitored weekly by calling or visiting households. Average weight gain of both groups was analysed using independent sample t–test. The acceptability and feasibility of the HMSF was assessed by focus group discussions with the PHMs and the mothers. Results: Mean age of test group and control group was 42.6 months and 43.1 months respectively. There was no difference in the baseline weight of the two groups (95%CI -0.059-0.416: p=0.14). The mean weight gain in the test group and control group after 3 months was 688.5g (SD=437gm) and 583g (SD=461gm) respectively (p=0.006). The mean gain in length in the test group and control group after 3 months was 1.5cm (SD=0.93cm) and 1.66cm (SD 1.3 cm) (p=0.234) respectively. Conclusions and Recommendations: This HMSF was effective, feasible and acceptable in improving weight in MAM children under the age of five years.

‘My lips are sealed’ - The impact of package resealability on the consumption of tempting foods

Resealable packages are nowadays omnipresent on store shelves. While the main advantage of the resealability feature is its ability to reclose the package in order to extend the shelf life of the food product inside, the present research's aim is to assess whether this advantage also has implications for palatable, energy-dense food consumption. Two studies provide intentional as well as behavioral evidence for the claim that consumers are better able to self-regulate their consumption and thus eat less in one occasion when a palatable, energy-dense food product is offered in a resealable (vs. unresealable) package. A third study investigates the effect of package resealability across multiple consumption occasions and reveals that the resealability feature limits the volume consumed on each occasion (conditional on consumption incidence) while it does not accelerate consumption frequency, resulting in a lower total consumed volume of palatable, energy-dense snacks over a six-day period. This research offers actionable insights for consumer welfare and public health care and aids manufacturers in delineating optimal food packaging strategies.

Clustering and correlates of screen-time and eating behaviours among young adolescents

BackgroundScreen-time and eating behaviours are associated in adolescents, but few studies have examined the clustering of these health behaviours in this age group. The identification of clustered health behaviours, and influences on adolescents’ clustered health behaviours, at the time when they are most likely to become habitual, is important for intervention design. The purpose of this study was to assess the prevalence and clustering of health behaviours in adolescents, and examine the sociodemographic, individual, behavioural, and home social and physical environmental correlates of clustered health behaviours.MethodsAdolescents aged 11–12 years (n = 527, 48% boys) completed a questionnaire during class-time which assessed screen-time (ST), fruit and vegetable (FV), and energy-dense (ED) snack consumption using a Food Frequency Questionnaire. Health behaviours were categorised into high and low frequencies based on recommendations for FV and ST and median splits for ED snacks. Adolescents reported on their habits, self-efficacy, eating at the television (TV), eating and watching TV together with parents, restrictive parenting practices, and the availability and accessibility of foods within the home. Behavioural clustering was assessed using an observed over expected ratio (O/E). Correlates of clustered behaviours were examined using multivariate multinomial logistic regression.ResultsApproximately 70% reported having two or three health risk behaviours. Overall, O/E ratios were close to 1, which indicates clustering. The three risk behaviour combination of low FV, high ED, and high ST occurred more frequently than expected (O/E ratio = 1.06 95% CI 1.01, 1.15. Individual, behavioural, and social and physical home environmental correlates were differentially associated with behavioural clusters. Correlates consistently associated with clusters included eating ED snacks while watching TV, eating at the TV with parents, and the availability and accessibility of ED snack foods within the home.ConclusionsThere is a high prevalence of screen time and unhealthy eating, and screen time is coupled with unhealthy dietary behaviours. Strategies and policies are required that simultaneously address reductions in screen time and changes to habitual dietary patterns, such as TV snacking and snack availability and accessibility. These may require a combination of individual, social and environmental changes alongside conscious and more automatic (nudging) strategies.

Determining Factors and Critical Periods in the Formation of Eating Habits: Results from the Habeat Project

Background: Eating habits form early during childhood and are likely to track until the beginning of adulthood. Thus, understanding the formation of eating habits is important. Consequently, the population targeted in the European project Habeat comprised infants and young children up to 6 years of age. Summary: Habeat mainly focused on the qualitative dimension of eating habits with a particular attention on vegetables and to a lesser extent on fruit. Food intake of young children was also studied in 2 challenging situations where overeating may occur and the relation between children's behaviour and feeding parental practices was examined. Key Messages: Habeat found evidence that breastfeeding may facilitate the consumption of vegetables and fruit and a greater variety of healthy foods in later childhood. Introduction of a variety of vegetables at the beginning of the complementary feeding period increases later acceptance of novel foods. Repeated exposure is a powerful mechanism to increase children's intake of a novel vegetable in infants and young children. Offering energy-dense snacks before or after meals should be avoided. Moreover, food should be offered to children in response to their feelings of hunger, and not used as reward for a good behaviour or for any other reason.

Trial baseline characteristics of a cluster randomised controlled trial of a school-located obesity prevention programme; the Healthy Lifestyles Programme (HeLP) trial

BackgroundWe have developed a healthy lifestyles programme (HeLP) for primary school aged children (9–10 years), currently being evaluated in a definitive cluster randomised controlled trial. This paper descriptively presents the baseline characteristics of trial children (BMI, waist circumference, % body fat, diet and physical activity) by gender, cluster level socio-economic status, school size and time of recruitment into the trial.MethodsSchools were recruited from across the South West of England and allocated 1:1 to either intervention (HeLP) or control (usual practice) stratified by the proportion of children eligible for free school meals (FSM, <19%, ≥19%) and school size (one Year 5 class, >1 Year 5 class). The primary outcome is change in body mass index standard deviation score (BMI sds) at 24 months post-randomisation. Secondary outcomes are BMI sds at 18 months, waist circumference and percentage body fat sds at 18 and 24 months, proportion of children classified as underweight, overweight and obese at 18 and 24 months, physical activity (for a sub-sample) and food intake at 18 months.ResultsAt baseline 11.4% and 13.6% of children were categorised as overweight or obese respectively. A higher percentage of girls than boys (25.3% vs 24.8%) and children from schools in FSM category 2 (28.2% vs 23.2%) were overweight or obese. Children were consuming a mean (range) of 4.15 (0–13) energy dense snacks (EDS) and 3.23 (0–9) healthy snacks (HS) per day with children from schools in FSM category 2 consuming more EDS and negative food markers and less HS and positive food markers. Children spent an average 53.6 min per day (11.9 to 124.8) in MVPA and thirteen hours (779.3 min) per day (11 h to 15 h) doing less than ‘light’ intensity activity. Less than 5% of children achieved the Departments of Health’s recommendation of 60 min of MVPA every day.ConclusionWe have excellent completeness of baseline data for all measures and have achieved compliance to accelerometry not seen before in other large scale studies. Our anthropometric baseline data is representative of local and national data for children this age and reflects the gender and socio-economic variations expected of children this age in relation to physical activity and weight status.Trial registrationISRCTN15811706 (1/05/2012).

Does a ‘protective’ message reduce the impact of an advergame promoting unhealthy foods to children? An experimental study in Spain and The Netherlands

The weight of evidence points to the advertising of food affecting food consumption, especially among children. Such advertising often promotes unhealthy foods. Current policy deliberations focus on developing effective ‘protective’ messages to increase advertising literacy and consequent scepticism about advertising targeting children. This study examined whether incorporating a ‘protective’ message in an advergame promoting energy-dense snacks would reduce children's snack intake. A randomized between-subject design was conducted in the Netherlands (N = 215) and Spain (N = 382) with an advergame promoting either energy-dense snacks or nonfood products. The results showed that playing an advergame promoting energy-dense snacks increased caloric intake in both countries, irrespective of whether the ‘protective’ message was present or not. These results point to the limitations of ‘protective’ messages and advertising literacy and provide policy makers with a rationale for extending the current prohibition of food advertising to young children in the terrestrial media to online environments.

Multicontextual correlates of energy-dense, nutrient-poor snack food consumption by adolescents

Frequent consumption of energy-dense, nutrient-poor snack foods is an eating behavior of public health concern. This study was designed to inform strategies for reducing adolescent intake of energy-dense snack foods by identifying individual and environmental influences. Surveys were completed in 2009–2010 by 2540 adolescents (54% females, mean age = 14.5 ± 2.0, 80% nonwhite) in Minneapolis-St. Paul, Minnesota schools. Daily servings of energy-dense snack food was assessed using a food frequency questionnaire that asked about consumption of 21 common snack food items, such as potato chips, cookies, and candy. Data representing characteristics of adolescents' environments were collected from parents/caregivers, friends, school personnel, Geographic Information System sources, and a content analysis of favorite television shows. Linear regression was used to examine relationships between each individual or environmental characteristic and snack food consumption in separate models and also to examine relationships in a model including all of the characteristics simultaneously. The factors found to be significantly associated with higher energy-dense snack food intake represented individual attitudes/behaviors (e.g., snacking while watching television) and characteristics of home/family (e.g., home unhealthy food availability), peer (friends' energy-dense snack food consumption), and school (e.g., student snack consumption norms) environments. In total, 25.5% of the variance in adolescents' energy-dense snack food consumption was explained when factors from within each context were examined together. The results suggest that the design of interventions targeting improvement in the dietary quality of adolescents' snack food choices should address relevant individual factors (e.g., eating while watching television) along with characteristics of their home/family (e.g., limiting the availability of unhealthy foods), peer (e.g., guiding the efforts of a peer leader in making healthy choices), and school environments (e.g., establishing student norms for selecting nutrient-dense snack foods).

Fat Tissue Accretion in Children and Adolescents: Interplay between Food Responsiveness, Gender, and the Home Availability of Snacks.

The appetitive trait “food responsiveness” is assumed to be a risk factor for adiposity gain primarily in obesogenic environments. So far, the reported results are inconsistent in school-aged children, possibly because these studies did not take into account important moderators such as gender and the food-environment. In order to better inform caregivers, clinicians and the developers of targeted obesity-prevention interventions on the conditions in which food responsiveness precedes adiposity gain, the current study investigated if this relationship is stronger in girls and in children exposed to a higher home availability of energy-dense snacks. Age- and sex-independent Fat and Lean Mass Index z-scores were computed based on air-displacement plethysmography at baseline and after 2 years in a community sample of 129 children (48.8% boys) aged 7.5–14 years at baseline. Parents reported at baseline on children's food responsiveness and the home availability of energy-dense snacks. Food responsiveness was a significant predictor of increases in Fat Mass Index z-scores over 2 years in girls but not boys. The home availability of energy-dense snacks did not significantly moderate the relation of food responsiveness with Fat Mass Index z-score changes. The results suggest that food responsiveness precedes accelerated fat tissue accretion in girls, and may inform targeted obesity-prevention interventions. Further, future research should investigate to which food-environmental parameters children high in food responsiveness mainly respond.

Individual, behavioural and home environmental factors associated with eating behaviours in young adolescents

This study aimed to examine individual, behavioural and home environmental factors associated with frequency of consumption of fruit, vegetables and energy-dense snacks among adolescents. Adolescents aged 11–12 years (n = 521, 48% boys) completed a paper-based questionnaire during class-time which included a Food Frequency Questionnaire assessing their consumption of fruit, vegetables, and energy-dense (ED) snacks, and items assessing habits, self-efficacy, eating at the television (TV), eating with parents, parenting practices, and home availability and accessibility of foods. Multiple linear regression analyses showed that eating fruit and vegetables while watching TV and home availability and accessibility of fruit and vegetables were positively associated with frequency of fruit consumption and vegetable consumption, while home accessibility of ED snack foods was negatively associated with frequency of fruit consumption. Habit for eating ED snack foods in front the TV, eating ED snack foods while watching TV, and home availability of ED snacks were positively associated with frequency of ED snack consumption. This study has highlighted the importance of a healthy home environment for promoting fruit and vegetable intake in early adolescents and also suggests that, if snacking while TV viewing occurs, this could be a good opportunity for promoting fruit and vegetable intake. These findings are likely to be useful for supporting the development of multi-faceted interventions and aid us in knowing what advice to give to parents to help them to help their young adolescents to develop and maintain healthy eating habits.

Memorizing fruit: The effect of a fruit memory-game on children's fruit intake.

Food cues of palatable food are omnipresent, thereby simulating the intake of unhealthy snack food among children. As a consequence, this might lead to a higher intake of energy-dense snacks and less fruit and vegetables, a habit that increases the risk of developing chronic diseases. The aim of this experimental study is to examine whether playing a memory game with fruit affects fruit intake among young children. We used a randomized between-subject design with 127 children (age: 7–12 y) who played a memory-game, containing either fruit (n = 64) or non-food products (n = 63). While playing the memory-game in a separate room in school during school hours, free intake of fruit (mandarins, apples, bananas, and grapes) was measured. Afterwards, the children completed self-report measures, and length and weight were assessed. The main finding is that playing a memory-game containing fruit increases overall fruit intake (P = 0.016). Children who played the fruit version of the memory-game ate more bananas (P = 0.015) and mandarins (P = 0.036) than children who played the non-food memory-game; no effects were found for apples (P > 0.05) and grapes (P > 0.05). The findings suggest that playing a memory-game with fruit stimulates fruit intake among young children. This is an important finding because children eat insufficient fruit, according to international standards, and more traditional health interventions have limited success. Healthy eating habits of children maintain when they become adults, making it important to stimulate fruit intake among children in an enjoyable way.Trial registration: Nederlands Trial Register TC = 5687

Rheological, pasting and microstructural studies of dairy protein–starch interactions and their application in extrusion‐based products: A review

The two biopolymers protein and starch are used to enhance the textural properties of food and play a key role in the formulation of novel food structures. In this paper, the interactions between dairy proteins and starch are discussed with a focus on the recent development on the rheological, pasting, and microstructural properties of these systems. Fortification of extruded cereal based snacks with dairy proteins leads to nutritious and energy dense snack foods. Milk proteins and starch interactions, and their effects on physiochemical and functional properties of extruded products are also explored in this review. Processing parameters of the extrusion process and feed characteristics affect final product quality and act as an important contributor in the determination of overall product texture. Fortification with dairy proteins may result in an acceptable quality of extrusion based ready to eat (RTE) snack foods. This review article will help food technologists to design and predict a product's behaviour during processing and final texture of a starch–protein based food system.

Fresh Fruit and Vegetable Profitability: Insights From a Corner Store Intervention in New Orleans, Louisiana

ABSTRACTFood store environments can influence consumers’ choices, but little is known about the financial feasibility of carrying healthier products. This case study evaluated the profits of a small store and the effect of infrastructure changes on produce availability and customer response. Invoice and inventory data were collected and customer intercept surveys (n = 323) measured exposure to promotions and awareness of a new cooler. Produce accounted for a greater percentage of store profits than energy-dense snacks, although the main sources of profit were tobacco, beer, and soft-drinks. The number of produce items on display 1 year after the intervention increased by 16%, whereas energy-dense snacks decreased. Customers exposed to at least one promotion were more likely (χ2 = 12.4, p < 0.001) to notice the cooler than those who were not. These results could encourage store owners to stock and promote healthier items.

Targeting implicit approach reactions to snack food in children: Effects on intake.

Implicit approach reactions to energy-dense snack food can facilitate unhealthy eating in children. Therefore, an experiment was conducted to test whether modifying implicit reactions to snack food by means of a go/no-go task can reduce consumption of this food. The effectiveness of this intervention on actual snack intake after exposure to a food or a control advertisement was tested. Children (133; age range = 7-10 years) played an advergame promoting either energy-dense food or nonfood products. Subsequently, children conducted either a go/no-go food task in which the advertised food was consistently associated with no-go cues, or a go/no-go control task in which colored circles were consistently associated with no-go cues. Afterward, they could eat the advertised food and a new food. Candy intake was weighed and caloric intake was determined. Results show that children who performed the go/no-go food task consumed significantly and considerably fewer calories (34%) than the children who carried out the control task. No main effect of type of advertisement was found. Furthermore, the effect of the go/no-go food task was similar after each type of advertisement, similar for advertised and new foods, and was significant for both girls and boys. Targeting implicit reactions to high-energy snacks proved effective in decreasing intake of snacks in children. Furthermore, the previously reported stimulating effect of food promoting advergames on intake may disappear when a short cognitive task is presented directly after the game. Future work should evaluate the clinical implications of these findings. (PsycINFO Database Record

Pairing images of unhealthy and healthy foods with images of negative and positive health consequences: Impact on attitudes and food choice.

To examine the impact of presenting images of foods paired with images of positive and negative health consequences of their consumption on food choice and attitudes. Participants (N = 711) were randomly allocated in a 2 × 3 factorial design (Food Type × Affective Valence) to 1 of 6 conditioning procedures that paired images of either energy-dense snack foods or fruit, with (a) images of negative health outcomes, (b) images of positive health outcomes, or (c) a no image control. The primary outcome was food choice assessed postintervention with a behavioral choice task. Secondary outcomes were implicit attitudes (assessed pre- and postintervention) and explicit attitudes (assessed postintervention). Presenting images of negative health outcomes led to more healthy food choices relative to control and positive image conditions, irrespective of whether they were paired with images of energy-dense snack foods or fruit. This relationship was partially mediated by changes in implicit and explicit attitudes. Images of positive health outcomes did not alter food choices. This study replicates and extends previous research showing that presenting images of negative health consequences increases healthy food choices. Because effects were elicited by manipulating affective valence irrespective of paired food type, these results appear more consistent with an explanation based on priming than on evaluative conditioning. (PsycINFO Database Record