Family Meals Research Articles

Impact of COVID-19 on Lifestyle Habits and Emotional State of Childhood Cancer Survivors and Their Parents.

The COVID-19 pandemic and associated social distancing measures affected the physical and emotional state of children and parents worldwide. Survivors of childhood cancer may be particularly vulnerable to these effects. We aimed to evaluate the lifestyle habits and emotional states of childhood cancer survivors and their parents during the COVID-19 outbreak. Lifestyle habits and emotional distress were assessed in 43 childhood cancer survivors (aged 8-21 years) and their parents before and during the COVID-19 lockdown, using the PROMIS anxiety and depression modules and the "Mabat Youth" questionnaire. Most parents (80.5%) reported eating more family meals during home confinement compared to their usual routine. Patients' physical activity levels did not change significantly during confinement, leisure-related screen time nearly doubled (p < 0.001), and sleep duration increased (p = 0.006). Anxiety levels of children (p = 0.045) and parents (p = 0.02) increased during confinement compared to pre-pandemic levels, with no significant changes in depression levels. Contrary to concerns regarding lifestyle habits during the COVID-19 lockdown, eating behaviors of childhood cancer survivors improved, sleep duration increased, and physical activity remained unchanged. Still, screen time increased significantly. Parents of childhood cancer survivors reported higher anxiety levels for themselves and their children during home confinement. Our findings may assist medical and psycho-social teams in guiding parents of cancer survivors during similar circumstances in the future.

Complementary feeding approach and maternal responsiveness in 8- and 12-month-old Italian infants: A longitudinal study

In Western countries, infants are usually introduced to solids through spoon-fed puréed foods (parent-led weaning, PLW). However, an alternative approach known as “baby-led weaning” (BLW), in which infants usually participate in family meals and eat independently, is becoming increasingly popular. We investigated the relationship between the type of complementary feeding approach and maternal responsiveness to infant feeding cues in a longitudinal sample of 178 infants observed at 8 and 12 months. Mothers reported the complementary feeding method used and, from video-recorded meals, we coded the proportion of time infants self-fed and rated maternal responsiveness by means of the Responsiveness to Child Feeding Cues Scale (Hodges et al., 2013). Responsiveness to infant receptiveness and fullness cues were significantly correlated at 8 months, but not at 12 months, when unresponsiveness decreased for receptiveness but remained stable for fullness cues. Thus, as infants got older, mothers were increasingly tuned in to their receptiveness cues. However, we did not observe the same pattern for fullness cues, perhaps because mothers were concerned that their infants did not eat enough. Moreover, at both time points, mothers were more responsive to infants’ receptiveness than fullness cues, possibly due to an evolutionary drive to protect infants from starvation. Finally, responsiveness to fullness, but not responsiveness to receptiveness, was positively related to the proportion of infant self-feeding, but there were no significant differences in responsiveness depending on the self-reported complementary feeding approach. Thus, a weaning style that emphasizes independent feeding, regardless of whether this is labeled as BLW, may promote more infant-centered maternal responses at the end of the meal, with potential implications for promoting infant self-regulation not only at mealtimes, but also in other domains.

Food Parenting Practices and Child Eating Behaviors in Australian Families: A Cross-Sectional Sibling Design

BackgroundResearch on feeding in early childhood has focused primarily on parent–child dyadic interactions, despite parents enacting these practices within the complex dynamic of the family system. ObjectiveUsing a sibling design, this study aimed to assess how parents may adapt their food parenting practices for siblings in response to differences in their eating behaviors. DesignA cross-sectional online survey was conducted between October and December 2022. Participants/settingData were collected from parents (97.5% women) in Australia with 2 children aged 2 to 5 years (n = 336 parents and n = 672 children). Main outcome measuresSurvey items were completed for each sibling, and included four subscales of the Children's Eating Behaviour Questionnaire and seven subscales of the Feeding Practices and Structure Questionnaire-28. Statistical analyses performedMultiple linear regression models examined associations between within-sibling pair differences in child eating behaviors and food parenting practices, adjusting for differences in child body mass index z score, age, gender, and early feeding method. ResultsWithin-sibling pair differences in eating behaviors were associated with differences in some food parenting practices. For the fussier sibling, parents reported using more control-based practices, including persuasive feeding, reward for eating, and reward for behavior, and less of the structure-based practice, family meal settings (P values < 0.001). Similar directions of associations were found for persuasive feeding, reward for eating, and family meal settings with siblings who were slower eaters or more satiety responsive (P values < 0.007); however, no significant differences in reward for behavior were observed in relation to sibling differences in these eating behaviors. For the more food responsive sibling, parents reported using more control-based practices, including reward for behavior and overt restriction (P values < 0.002). ConclusionsWithin families, parents may adapt certain practices in response to differences in their children's eating behaviors. Interventions promoting responsive feeding should be designed to acknowledge the integral role of siblings in shaping parents' feeding decisions.

Assessing the knowledge and practice toward food safety: An investigation of food selection and processing among primary food caregivers in a town of Ha Tinh province, Vietnam

The food selection and processing stage are important stages to prevent food poisoning. A good level of knowledge and practice regarding food selection and processing among people who are responsible for the family meals are important. In this study, we aimed to investigate the knowledge and practice of primary food caregivers regarding food poisoning prevention in food selection and processing and identify the factors that influence these outcomes. The current study applied a cross-sectional study to investigate 422 primary food caregivers in urban areas in Vietnam. Data were collected using a structured questionnaire, and knowledge and practice were assessed based on pre-defined criteria. The data were analyzed using descriptive statistics, chi-square test, and logistic regression. Our study found that 78.9% of people had good knowledge regarding food poisoning prevention in food selection and processing. Furthermore, 84.4% of people had correct practice in this regard. Our study also revealed that household income level and educational level were associated with knowledge and practice, respectively. The proportion of correct practice was higher in the group with good knowledge (90.4%) compared to the remaining group (61.8%). The results indicated that the proportion of good knowledge and practice were high among food caregivers, but further efforts are needed to improve the knowledge and practice of food caregivers with lower household income and educational levels. The findings also emphasize the importance of communication campaigns to enhance knowledge related to food poisoning prevention.

Backgrounds and challenges of food education policy in Taiwan: risk or chance in the reflexive food modernity?

In 2022, Taiwan enacted the Food and Agricultural Education Act, thus officially launching its food education policy. The objective of this article is to elucidate the social background to this Act and current challenges to promoting food education. The data were obtained from the relevant literature and interviews with 11 key actors, who represented academia, the government, public education and civil society. Although having much in common with the Japanese equivalent policy, Taiwan's food education contains some notable features. Food education began as a reaction to recent food safety scandals, growing food anxiety, the prevalence of eating out, the globalisation of food systems and increasing instability, all of which characterise reflexive food modernity. The Taiwanese policy aims to avoid the nutrition-centered, gendered and nationalistic tendencies of food education in countries such as Japan by stressing the interconnection of food system actors, social responsibility for family meals and an openness to diverse food cultures. However, achieving such objectives requires consciousness of the reflexive food modernity facing Taiwan and addressing operational issues, notably the strengthening of inter-ministerial collaboration and the integration of dialogue with diverse food education actors in defining educational content and professional qualifications.

Clinical usefulness of phase angle as an indicator of muscle wasting and malnutrition in inpatients with cardiovascular diseases.

Background and Objectives: Extracellular water is increased in patients with edema, such as those with chronic heart failure, and it is difficult to assess skeletal muscle mass with the skeletal muscle mass index when extracellular water is high. We investigated the relationship between phase angle and physical function, nutritional indices, and sarcopenia in patients with cardiovascular diseases, including chronic heart failure. Methods and Study Design: In 590 patients with cardiovascular diseases (372 men), handgrip strength, gait speed, and anterior mid-thigh muscle thickness by ultrasound were measured, and the skeletal muscle mass index, phase angle, and the extracellular water: total body water ratio were measured with a bioelectrical impedance analyzer, and presence of sarcopenia was evaluated. Results: Phase angle, but not the skeletal muscle mass index, was correlated with serum albumin (r = 0.377, p < 0.001) and hemoglobin values in women. Multivariate regression analysis showed that at the extracellular water: total body water ratio below 0.4, both phase angle and skeletal muscle mass index were independent determinants of handgrip strength and log mid-thigh muscle thickness in men, after adjustment for age and presence of chronic heart failure. In contrast, for the ratio of 0.4 or greater, after adjustment for age and presence of chronic heart failure, phase angle was a stronger independent determinant of handgrip strength and log mid-thigh muscle thickness than the skeletal muscle mass index in men. Conclusions: Phase angle is a good marker of muscle wasting and malnutrition in patients with cardiovascular disease, including chronic heart failure.

Associations of screen use with cognitive development in early childhood: the ELFE birth cohort.

The associations of screen use with children's cognition are not well evidenced and recent, large, longitudinal studies are needed. We aimed to assess the associations between screen use and cognitive development in the French nationwide birth cohort. Time and context of screen use were reported by parents at ages 2, 3.5 and 5.5. Vocabulary, non-verbal reasoning and general cognitive development were assessed with the MacArthur-Bates Communicative Development Inventory (MB) at age 2, the Picture Similarities subtest from the British Ability Scales (PS) at age 3.5 and the Child Development Inventory (CDI) at ages 3.5 and 5.5. Outcome variables were age-adjusted and standardized (mean = 100, SD = 15). Multiple imputations were performed among children (N = 13,763) with ≥1 screen use information and ≥1 cognitive measures. Cross-sectional and longitudinal associations between screen use and cognitive development were assessed by linear regression models adjusted for sociodemographic and birth factors related to the family and children, and children's lifestyle factors competing with screen use. Baseline cognitive scores were further considered in longitudinal analysis. TV-on during family meals at age 2, not screen time, was associated with lower MB scores at age 2 (β [95% CI] = -1.67 [-2.21, -1.13]) and CDI scores at age 3.5 (-0.82 [-1.31, -0.33]). In cross-sectional analysis, screen time was negatively associated with CDI scores at ages 3.5 (-0.67 [-0.94, -0.40]) and 5.5 (-0.47 [-0.77, -0.16]), and, in contrast, was positively associated with PS scores (0.39 [0.07, 0.71]) at age 3.5. Screen time at age 3.5 years was not associated with CDI scores at age 5.5 years. Our study found weak associations of screen use with cognition after controlling for sociodemographic and children's birth factors and lifestyle confounders, and suggests that the context of screen use matters, not solely screen time, in children's cognitive development.

Maternal mental health is associated with children's frequency of family meals at 12 and 24 months of age.

Diet during the child's first years is important for growth and development. In toddlerhood, higher diet quality is reported among children eating meals together with family. Although previous literature has documented several associations between maternal mental health and early child feeding practices, less is known about the relationship between maternal mental health and child frequency of shared family meals. This study explores associations between maternal symptoms of anxiety and depression, measured by The Hopkins Symptoms Checklist (SCL-8), and toddler participation in family meals. We used cross-sectional data from the Norwegian study Early Food for Future Health, in which participants responded to questionnaires at child age 12 (n = 455) and 24 months (n = 295). Logistic regression was used to explore associations between maternal mental health and child having regular (≥5 per week) or irregular (<5 per week) family meals (breakfast and dinner), adjusting for relevant child and maternal confounding variables. Children of mothers with higher scores of anxiety and depression had higher odds of Irregular family meals at both timepoints; (OR: 2.067, p = 0.015) and (OR: 2.444, p = 0.023). This is one of few studies exploring associations between maternal mental health and child frequency of shared family meals in early childhood, a period where the foundation for life-long health is shaped. Given the high prevalence of mental ailments and disorders, these findings are important and may inform future public health interventions. Further exploration of this relation is needed, including longitudinal research to test predictive associations and qualitative studies to increase insight and understanding.

Comparing the prevalence of chronic pain in school-aged children in the United States from 2019 to 2020: a nationally representative study examining differences associated with the COVID-19 pandemic.

The coronavirus disease 19 (COVID-19) pandemic negatively affected children's health in the United States (US), with more severe disruption for marginalized groups. However, potential impact on pediatric chronic pain has not been assessed at the population level. This study aimed to (1) estimate differences in the US national prevalence of pediatric chronic pain during the first year of the COVID-19 pandemic (2020), relative to one year earlier (2019); (2) determine whether differences in prevalence varied across sociodemographic groups; and (3) explore changes in child, caregiver, and family factors associated with chronic pain prevalence. Using data of children 6 to 17 years from the National Survey of Children's Health 2019 and 2020 (n = 50,518), we compared weighted percentages of sample characteristics by year and conducted a series of directed-acyclic graph-informed survey-weighted Poisson regressions. The estimated national prevalence (95% CI) of pediatric chronic pain was 10.8% (9.9, 11.9%) in 2019, decreasing to 7.6% (6.9, 8.3%) in 2020. Contrary to hypotheses, the adjusted prevalence of chronic pain was 31% lower in 2020 than in 2019 (aPR = 0.69, 95% CI: 0.61, 0.79), adjusting for child age, sex, race or ethnicity, caregiver education, neighborhood park or playground, and census region. The 2019 to 2020 change in chronic pain prevalence was similar by age ( P = 0.34), sex ( P = 0.94), race or ethnicity ( P = 0.41), caregiver education ( P = 0.49), neighborhood park or playground ( P = 0.22), and census region ( P = 0.20). Exploratory analyses identified 3 potential contributors to the unexpected decrease in the national prevalence of pediatric chronic pain: lower prevalence of bullying, more frequent family meals, and higher family resilience.

Adapting family-based treatment for adolescent anorexia nervosa delivered in the home: A novel approach for improving access to care and generalizability of skill acquisition

BackgroundAnorexia nervosa (AN) is a serious mental illness associated with high rates of morbidity and mortality. Family-based treatment (FBT) is a well-established treatment for adolescent AN, yet it is underutilized in community settings and is unavailable to many families, particularly those from lower income and racial and ethnic minority backgrounds. Furthermore, some families do not respond optimally to FBT, possibly because of challenges translating skills acquired in office-based treatment settings to naturalistic settings. Home-based treatment could reduce barriers to access and enhance generalization of newly learned treatment skills. Home-based models demonstrate initial feasibility, acceptability, and efficacy for adolescent AN, however, FBT principles have yet to be applied as a stand-alone intervention in a home-based level of care. This paper describes the rationale for and process of adapting FBT principles/interventions to improve fit within a home-based model delivered in the context of community mental health, and discusses potential strengths and opportunities associated with this approach.ResultsAdaptations were made through consultation with collaborating community agencies and were guided by the complex interventions framework. The primary modifications included: (1) altered dose; (2) multiple family meals; (3) additional support for meal preparation and supervision; (4) clinician attendance at medical appointments; (5) cultural adaptation; and (6) introduction of distress tolerance and emotion regulation skills.ConclusionsImplementing FBT in the home may present one promising and novel approach to enhance engagement and treatment outcomes for adolescents with restrictive eating disorders, particularly those who are underserved, but evaluation of efficacy/effectiveness is needed.

Changes in Food Consumption and Eating Behaviours of Children and Their Families Living in Italy during the COVID-19 Pandemic: The EPaS-ISS Study.

The aim of the EPaS-ISS study was to describe the changes in food consumption and eating behaviours of children (mainly aged 8-9 years) and their families between the pre-COVID-19 period (before February/March 2020) and the COVID-19 period (from February/March 2020 to April 2022). A web questionnaire completed by parents was used to collect data. The sociodemographic characteristics of the children and their parents were also explored through the web questionnaire. Seventeen regions out of nineteen and the two autonomous provinces (PA) of Italy participated in the study. The survey was completed for 4863 children (47.9% females). The study showed that only small changes in children's food consumption happened between the pre-COVID-19 period and the COVID-19 period; in particular, about 25% of parents reported an increase in savoury snacks and sweet food. A decrease in fruit and vegetable (about 8%) and fish (14%) consumption was also found. However, the changes seem to have mainly affected children from most disadvantaged families. The results also indicate positive changes during the COVID-19 pandemic in some families' eating behaviours, such as eating more home-cooked meals (42%) and family meals (39%), as well as cooking more with children (42%).

A new tool to capture dimensions of family dinners in relation to adolescent health and risk-related outcomes: The ‘Family Dinner Index’

There is a strong association between family meals and child and adolescent health. To systematically understand the associations between family meals with a variety of health and risk outcomes, we developed and conducted a validation study of child- and parent-versions of the Family Dinner Index (FDI; FDI-C/FDI-P). We validated the measures with a national sample of 2,090 parent–child dyads. Using factor analysis, we reduced the initial FDIs each to eight items representing communication, enjoyment, and digital distractions; the FDI-C also included meal logistics and the FDI-P, family bonding. Using multivariable log-binomial regression models, we examined the relationships between FDI scores and substance use, violence, weight perception, weight control intention, and health indicators. Children who scored ≥21 on the FDI-C had a significantly lower average prevalence of a ‘negative outcome’ composite, as well as a lower prevalence of each of the individual behaviors. Children of parents who scored ≥24 on the FDI-P had a significantly lower average prevalence of the ‘negative outcome’ composite, as well as a lower prevalence of substance use indicators, negative weight perception and intentions to lose weight, less than daily fruit and vegetable consumption, and not meeting guidelines for physical activity. The FDI measures provide support for face and content validity, as well as concurrent criterion validity and construct validity. Further validation with these measures using a longitudinal design will allow for the establishment of predictive validity. Currently, the FDI measures may help researchers and practitioners identify points of emphasis for tailoring family-based prevention programs accordingly.

Health Behaviors during the Early COVID-19 Containment Phase and Their Impact on Psychological Health.

The COVID-19 lockdowns have brought significant changes to individuals' daily lives, including their health behaviors and psychological health. Longitudinal studies exploring changes in health behaviors during the course of the initial containment phase are relatively scarce. Our aim is to understand how health behaviors have evolved during different phases of the early COVID-19 lockdowns and assess the impact of these changes on psychological well-being. By doing so, we hope to provide valuable insights that can enhance the understanding of the relationship between health behaviors and psychological health, with relevance not only to everyday life but to times of crises. A longitudinal study among 313 adults in Israel (44.5 ± 13.4 years old, 80% women) at three timepoints, beginning with the first COVID-19 lockdown (April 2020) and extending through June 2020. In each wave, participants were asked to report about exercising, eating fruits and vegetables, sharing family meals, and screen time. The BSI (Brief Symptom Inventory) was used to assess psychological health. There was an initial increase in the frequency of exercising (3.06 + 2.3 times a week) and shared meals (breakfast, 3.97 + 2.3; lunch, 5.30 + 1.9; dinner, 5.75 + 1.7 times a day) followed by a subsequent significant decrease in these behaviors (exercising, 2.84 + 2.0; breakfast, 2.63 + 2.1; lunch, 3.48 + 2.3; dinner, 4.75 + 2.0). The health behaviors of more exercising (r = -0.145, p = 0.43) and less screen time (r = 0.183, p = 0.010) had a positive impact on psychological health. External events, such as the first COVID-19 lockdown, may influence health behaviors which may, in turn, influence psychological health. While prior studies have mainly highlighted the negative impact of the pandemic on health behaviors, our analyses suggest that the first containment phase may have had an initial beneficial impact on several health behaviors, including exercising and family meals. However, this change was not sustainable.

Family Meals and Cardiometabolic Risk Factors in Young Children.

Family meals represent a novel strategy for improving cardiovascular health in youth. The purpose of this paper is to describe the association between family meals, dietary patterns, and weight status in youth. According to the American Heart Association's Life's Essential 8, poor diet quality and overweight/obesity status are key contributors to suboptimal cardiovascular health. Current literature highlights a positive correlation between the number of family meals and healthier eating patterns, including greater consumption of fruits and vegetables, and a reduced risk of obesity in youth. However, to date, the role of family meals in improving cardiovascular health in youth has been largely observational and prospective studies are needed to assess causality. Family meals may be an effective strategy for improved dietary patterns and weight status in youth.

Frequent Family Meals Reduce Obesity Among African American Adolescents

Frequent Family Meals Reduce Obesity Among African American Adolescents

P18-042-23 Association of Family Meals With Daily Fruit and Vegetable Intakes Among Children Aged 1–5 years, National Survey of Children's Health — United States, 2021

P18-042-23 Association of Family Meals With Daily Fruit and Vegetable Intakes Among Children Aged 1–5 years, National Survey of Children's Health — United States, 2021

Table Settings

“If you don’t eat your vegetables, you can’t have dessert.” That’s just one of the many tactics parents have tried in the struggle to get kids to eat more fruits and vegetables. But what actually works? In a recent study, my colleagues and I found that simply increasing the duration of family meals by approximately 10 minutes can be effective.

Role of parenting practices and digital media on beverage intake in European schoolchildren of different weight status. Feel4Diabetes-study

ObjectivesHalting the rise in childhood obesity is an ongoing challenge in Europe. Sugar-sweetened beverage (SSB) and artificially sweetened beverage (ASB) consumption has become common practice at home and during family meals. The objective of this study was to investigate associations of parenting practices and home digital media availability with beverage intake in European schoolchildren of different weight groups. MethodsCross-sectional data were derived from six countries taking part in the multicentered Feel4Diabetes-study. Anthropometric data were measured for 12 030 schoolchildren (n = 6097 girls; median age = 8.1 y). Details on sociodemographic characteristics, beverage intake, food parenting practices, and home availability of digital media were collated from questionnaires. The outcomes, daily SSB and ASB intakes, were included as dependent variables in multivariable regression models that provided odds ratios reflecting their association with parenting practices and digital media (exposures), after stratifying for children's weight status (underweight or normal versus overweight or obese). ResultsAfter controlling for children's sex, region, maternal body mass index, and education, the multivariate model found that in both body mass index groups, permissive parenting practices, such as rewarding and allowing consumption of unhealthy foods “very often or often,” as compared with “rarely or never,” were associated with a high daily intake of SSBs and ASBs in children, while parents “watching television together with their child,” rewarding with screen time, and availability of television in children's rooms increased the likelihood of both beverages in the underweight or normal-weight group. ConclusionsModification of permissive parenting practices and removal of television from children's rooms could effectively reduce SSB intake and curb the ongoing threat of child obesity in Europe.

Family Mealtimes: A Systematic Umbrella Review of Characteristics, Correlates, Outcomes and Interventions.

Systematic reviews have examined the multitude of studies investigating family mealtimes and their importance to child/adolescent health and psychosocial outcomes, but the focus of each is limited to specific aspects of family meals (e.g., frequency) and/or specific outcomes (e.g., nutrition). Their findings require synthesis and so a systematic umbrella review was undertaken. Databases were searched to identify systematic reviews (with or without meta-analysis/meta-synthesis) addressing at least one of the following questions: what are the characteristics and/or correlates of family mealtimes; what outcomes are associated with family mealtimes; are interventions aimed at promoting family mealtimes effective? Forty-one eligible reviews were retrieved. Their findings demonstrate that families with children/adolescents typically eat together at least a few days each week. More frequent family meals are predicted by a more positive mealtime environment, more positive attitudes towards family meals, the presence of younger children, and families having more time. Greater family meal frequency protects children/adolescents against a poorer diet, obesity, risk behaviours, poorer mental health and wellbeing, and poorer academic outcomes. Findings from interventions seeking to promote family mealtimes are mixed. This umbrella review provides a comprehensive and integrated understanding of research into family mealtimes, establishing where evidence is sound and where further research is needed.

The relationship between children's food allergies and family mealtimes: A systematic review.

Food allergy prevalence is increasing among children; however, it is not clear how children's food allergy status impacts family mealtimes. This study's purpose was to systematically synthesize research regarding the relationship between children's food allergies, parental meal-centered stress, and family mealtime dynamics. Data sources for this study include peer-reviewed, English language sources from CINAHL, MEDLINE, APA PsycInfo, Web of Science, and Google Scholar. Five keyword categories (child, food allergies, meal preparation, stress, and family) were utilized to identify sources regarding how food allergies of children (from birth-12years) relate to family mealtime dynamics or parental meal-centered stress. All 13 identified studies determined that pediatric food allergies relate to either increased parental stress, meal preparation issues, mealtime problems, or changes to family meals. Studies also indicate that meal preparation takes longer, requires more vigilance, and is more stressful due to children's food allergies. Limitations include that most studies were cross-sectional and based on maternal self-report. Children's food allergies are associated with parental meal-centered stress and mealtime issues. However, there is a need for research to account for specific changes to family mealtime dynamics and parent feeding behaviors so that pediatric health care professionals can alleviate parental meal-centered stress and provide guidance towards optimal feeding behaviors.